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Opinion: Engagement is the Healthcare Industry's Unspoken Challenge

With all the issues facing the medical profession, engagement may be one of the most overlooked solutions. It’s a blue ocean opportunity for those who can bring formal engagement practices successfully used in other professions to increase patient and employee satisfaction and organizational performance.
By Bruce Bolger, EEA President

Most ESM readers would agree that the field of engagement remains in its early stages; relatively few organizations have a formal enterprise-wide strategy to engage all the people critical to success. Based on several speaking and consulting engagements in the medical profession over the last year, I wonder whether the medical profession, facing so many day-to-day life and death issues, challenges with reimbursements, legal threats, compliance complexities and continual regulatory uncertainty, is even further behind other industry sectors in its understanding of the role played by engagement in organizational success. 
I have seen striking, first-hand examples of the state of engagement in the healthcare industry and what, in contrast, a formal engagement strategy looks like in the private sector that suggests the significant economic and societal benefits that could occur if the healthcare field embraced a formal approach to engagement. Because the information shared here comes from healthcare management personnel speaking candidly in association conferences or consulting engagements, and from a friend in the consulting field whose company was recently acquired by a large firm who could only speak off the record, I cannot name names. Yet I know that much of this should sound believable to anyone with experience in healthcare or the private sector. 

Healthcare Engagement Challenge Comes at a Huge Cost

What I have heard in candid discussions with management at about 80 healthcare institutions ranging in size from $1 million to $1 billion per year in revenues reveals a significant overlooked opportunity to improve healthcare efficiency that has nothing to do with government and everything to do with better people management. Every healthcare executive and manager encountered in these consulting jobs and speaking engagements admits that their organizations have significant room for improvement in terms of revenues and cost savings – i.e., more walk-in traffic and elective procedures, lower employee turnover and recruitment costs, greater innovation, more happiness, and almost all admit that silos significantly impede united action to achieve formal goals. Most confess to having no formal business or engagement strategy to guide decisions throughout the year and to having no idea that a formal approach to engagement even exists.  
The open dialog in a medical conference or consulting job provides raw insight into the truth. In sessions with healthcare institution management, every attendee admits that there’s a significant opportunity to increase the financial performance of their institutions by having more highly engaged patients and employees in terms of positive word of mouth, referrals, more walk-in appointments and elective procedures and retention, but not one organization in these various sessions has a formal process to engage patients, employees, or communities. In one speaking engagement at a hospital, the staff identified over $1 million in potential incremental high-margin revenue in walk-in traffic and elective procedures, but to my knowledge nothing has been done since, despite (or perhaps because of) major financial challenges at the parent organization. 

At Best, an Ad Hoc Approach

In every case, managers at those meetings say their organizations have training programs where they attempt to communicate with employees, offer benefits, or spontaneous rewards and recognition. Not one encountered in these sessions could say their organization has a clear mission and values or a formal plan to achieve goals through engagement, such as a leadership recruiting and coaching process to support employee engagement, a means of assessing engagement, a formal strategy for designing jobs, communicating to people, supporting values through learning, innovation, community, rewards and recognition, or measurement. Many admit that whatever efforts related to culture they do have often are sporadic in the form of some temporary initiative that is quickly forgotten, so much so that employees roll their eyes when the next initiative is announced. 
This is not a criticism. The medical profession is composed of many heroes who make huge sacrifices for people, work long hours, endure many indignities and unfair exposure to risk. Many work in a war-zone atmosphere in which strategic thinking or implementation is a luxury. This column merely intends to make the observation that this is a field that can benefit perhaps more than any from a formal approach to engagement across the organization. When asked how it is their organizations can overlook engagement to such an extent, the general answer is something like: “It’s not in our culture to think that way. We think in terms of patient care and outcomes, not about more ways we can create a climate that encourages more people to utilize our services. We go from one crisis to the next.” 

What an Engagement Strategy Looks Like   

In the business sector, the field of engagement also remains in its early stages, but for decades many organizations have done business with a formal approach to engagement without calling it that. ESM readers know about companies such as Southwest Airlines, Costco, Wegmans, Big Y, Market Basket, Chick Fil-A and Whole Foods, which base their business strategies on a focus on people, but there are many others we rarely hear about. Here’s a story told me recently by a friend who works at a consulting firm that stands in stark contrast to what I hear from people in the medical profession. 
My friend is a consultant in a firm recently bought by a privately owned company dating back over three generations. He had a high regard for the firm he worked for, so of course harbored some trepidations. While the old company was collegial and supportive of people, the new company, he says, has a formal strategy that clearly articulates a vision and values that he has since seen fulfilled in the daily actions and policies of the firm. The day the acquisition was announced, he tells me, the new company’s management came to the facility to explain the new company’s mission and values, which are based on “acquiring and retaining the best talent and creating a culture of continuous improvement to systematically anticipate customer needs and exceed their expectations.” 
As explained by my friend, since that day it has become clear that the mission and values are part of a formal, well-thought-out process. After the meeting, at which the executives lingered to meet with the staff for as long as they were interested, my friend received and discussed in a meeting with his colleagues and human resources a written code of conduct clearly spelling out the organization’s human-centered values and focus on empowerment, growth and diversity. Shortly after, he received from human resources a form to fill out about his education and experience that he was told is part of a compensation fairness program in place at the parent company to make sure all employees have competitive pay comparable to their experience and regional cost-of-living. He said that his old company, while well-intentioned, had no formal compensation strategy, so pay was all over the place. The new company explained to employees that it is using payroll analytics in each of its cities to attempt to gauge actual pay trends and has indicated, he says, that those found to be underpaid will see adjustments. And those found to be overpaid have been assured they will not experience pay cuts. 
In the months since the acquisition, the CEO has come back for another personal visit, and my friend says he recently sat in on the company’s quarterly meeting, at which every employee is welcome. In the one-hour web meeting, the CEO restated the organization’s values, highlighted recent accomplishments, articulated the company’s innovation and growth strategies, and shared the financial results, even though the company is privately held. The company, he says, is doing exceptionally well. 

The Benefits of a Clear Vision

The CEO made it clear that the company seeks to grow from within, and top management’s longevity reflects that, my friend says. The company has made multiple acquisitions, and he has already seen people move up by stepping into a management post at another subsidiary. 
What does my friend say of his own job? He loves it, and so do others, because he has seen little sign of turnover. He says he has clear goals, significant empowerment to achieve them, a collegial culture in which people gladly support one another to solve problems or accomplish tasks, almost no hint of internal competitive struggles, and a respect for work-life balance. He says he generally can get home for dinner with his significant other and has enough flexibility and vacation time to live an enriching life. He says his work involves high-stakes contracts and deadlines, and he’s in a field in which a mistake can cost tens of millions of dollars or inconvenience to potentially millions of people, but that the pressure is offset by a culture of support and understanding with no trace of fear tactics or “fire drills” over petty management pet peeves. 
How many organizations have a formal engagement strategy as articulated by my friend? Obviously, only a relatively small percentage – in most businesses the only people who pay for inefficiency are investors or employees or customers. With healthcare equaling a reported one sixth of our national economy, and one of the most critical aspects of our lives, the lack of focus on engagement would be shocking if the public even knew that such a solution exists. 

Attend Engagement in Action

To learn more about how formal engagement practices can be applied in any organization, register to attend “Engagement in Action,” the first annual conference of the International Center for Enterprise Engagement, Dec. 7-8 at the Healthcare Management Institute on the University of Texas Medical Branch campus in Galveston, TX.  Register at
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