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From Low Engagement to Great Workplace Award Winner — A Hospital’s Journey

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In 2010, Mary Lanning Healthcare, a Nebraska hospital with 1,200 employees, had low levels of employee engagement, which translated into high turnover and other unhealthy business metrics. In response, it launched an initiative to increase employee engagement. By 2014, the results were astounding, which resulted in it being one of 40 worldwide recipients of the 2015 Gallup Great Workplace Award. Bruce Cutright, Vice President of HR & Administration, describes the process.

JATHAN JANOVE: What created the momentum for your employee engagement initiative?

BRUCE CUTRIGHT: We were experiencing high turnover, especially in the first year of work. Healthcare organizations can no longer afford to take high turnover and low engagement for granted. Changes brought by the Affordable Care Act, HCAHPS, patient choice and other developments have changed the game. Patient outcomes and satisfaction spell the difference between success and failure. And the evidence demonstrates the link between patient outcomes, satisfaction and employee engagement.

JANOVE: What did you do?

CUTRIGHT: First, we commissioned Gallup to do an employee engagement survey. The results were dismal. We were in the 22nd percentile compared to other hospitals. Our 3:1 ratio of engaged to actively disengaged employees was far below what Gallup considers healthy.

JANOVE: And yet in 2015, Gallup recognized you as one of the most engaged organizations in the world. How had things changed?

CUTRIGHT: Our mean engagement score rose to the 88th percentile; and our engaged-to-disengaged employee ratio went from 3:1 to over 11:1, well above what Gallup considers highly engaged.

JANOVE: Did the rise in employee engagement scores correlate with other metrics?

CUTRIGHT: Yes. We cut overall turnover from 22% to 13% and first year turnover from 48% to 14%. With our nurses, we cut turnover from 25% to 10%, and we cut first-year nurse turnover to zero. The reduction in nurse turnover alone saves us nearly $1 million/year. Also, over this time period, the hospital’s operating margin went from -2% to +6%. In 2010, we had a net operating loss of $1.3 million. In 2014, we had a $6.9 million net operating gain.

JANOVE: What were the critical factors that caused the turnaround?

CUTRIGHT: There were several:

  1. We got the active support and participation of our CEO and board. It wasn’t “Hey HR - Go handle it!” Top leadership remained an integral part of the process.
  2. We focused closely on the relationship between immediate boss and direct report. We believed that improving these relationships are critical to improving employee engagement.
  3. We researched and then employed a tool to help us make better long-term employee selection decisions. In the past, our hiring process had been more informal, which led to some poor choices.
  4. We developed a wellbeing program. Every employee has the opportunity to work with a personal coach to improve their work life and their personal life.
  5. We committed ourselves to avoid the survey-without-action mistake. Each engagement survey has been shared with everyone from board members to the CEO to all employees, with a commitment to acting on the results. Among other steps, we have used data from the surveys to create management core competencies.
  6. We sit down with every director at least twice a year to discuss survey results, which are broken down by division, department and benchmarking references. We discuss their action plan for improving scores. With the backing of our CEO, our directors know we’re serious about results. Accountability is built in.
  7. We revised our onboarding program to focus more on supervisors spending time with their new employees including having lunch together on the first day.
  8. Under the leadership of our Director of Organizational Development Services Sharon Hayek, we created a nurse residency program for new nurses. It involves mentoring, professional development, and has become a fixture.
  9. We replaced our existing performance appraisal system with an approach that focuses on goals and future growth, and doesn’t focus on money.

JANOVE: Now that you’ve created this momentum, how will you maintain it?

CUTRIGHT: This question keeps me up at night. Maintaining momentum is perhaps harder than improving low engagement to high engagement. We have four strategies for 2016:

(1) Employee wellbeing - Gallup has furnished us with questions we will use to assess the aggregate state of employee wellbeing in our organization. This data can be drilled down to department level, giving us an opportunity to design action plans to improve individual wellbeing.

(2) Becoming a strengths-based management organization - Performance management processes and daily interactions between manager and employee will focus on employee strengths, rather than fixing weaknesses.

(3) Enhanced management training — We are adding additional proven concepts in employee engagement to our existing training program.

(4) Intensified focus and analysis of our hiring processes — Insofar as humanly possible, we want to ensure that we hire the right person for the right job every time.

For readers desiring more information about Mary Lanning Healthcare's experience, Bruce Cutright shares additional thoughts and observations here.

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