The Georgia Dialogue

S p r i n g 2 0 0 2

”

Promoting

Health Care

Workplace

Excellence

“

A Summary of the Process and Findings of the Regional Invitational Forums on Workplace Excellence

Sponsored by the

Health Care Workforce Policy Advisory Committee Georgia Department of Community Health

and the

Georgia Hospital AssociationGeorgia Nurses Association

Georgia Nursing Home AssociationGeorgia Pharmacy Association

Georgia Society of Allied Health Professionals

P r o m o t i n g H e a l t h C a r e Wo r k p l a c e E x c e l l e n c e —T h e G e o r g i a D i a l o g u e

Tom Cronemeyer, RNAdministratorMagnolia Manor Nursing Centers

C. Richard Dwozan, RPhPresidentHabersham County Medical Center

Amy FincherVice President, Governmental AffairsGeorgia Chamber of Commerce

Samuel Gulley, DDS

Valerie Hamilton, RN

Debbie Hatmaker, PhD, RNPresident, Georgia Nurses Association

J. Rhodes Haverty, MDGeorgia Health Foundation

Hunter HurstSt. Joseph’s/Candler Health System

William P. KisselDirector of Health ServicesGeorgia Department of Corrections

Reverend Jeffery D. Lawrence, MSWVice President for Program ServicesMethodist Home for Children & Youth

Marcia Pearl, PhDProfessor and President, Georgia Society of Allied Health Professionals

Pamela Reynolds, MEd, MSNExecutive Director, SOWEGA-AHEC

Lucy Rogers, RNVice President of Operations, Care-More

Health Care Workforce Policy Advisory CommitteeGeorgia Department of Community Health

W. Douglas Skelton, MD, Committee ChairSr. Vice President for Health Affairs and Research, Mercer University

Marla E. Salmon, ScD, RN, FAANDean, Nell Hodgson Woodruff School of Nursing, Emory University

Ninfa M. Saunders, RN

Hal M. Smith, Jr.Executive Director, Three Rivers HomeHealth Services

Patricia Sodomka, FACHE, COOMCG Hospitals and Clinics

Flynn W. Warren, Jr., RPhFirst Vice PresidentGeorgia Pharmacy Association

Ex-Officio Members or DesigneesGary B. Redding, Commissioner, Georgia Department of Community HealthGlenn Newsome, Executive Director, Georgia Student Finance Commission

Secretary of State—Mollie Fleeman, Director, Professional Licensing DivisionGeorgia Department of Labor—Andrea Harper, Assistant Commissioner, Job Training

Board of Regents—Margaret Taylor, Deputy to the Senior Vice ChancellorsHuman Resources—Rosa Waymon, Director, Office of Human Resource Management

Technical and Adult Education—Patt Stonehouse, Director, Education InitiativesHealth Strategies Council—Charlene Hanson, EdD, FNP, CS, FAAN

Regional Invitational Forums on Workplace Excellence

Planning Committee

Julie Buffalo, RN, Athens Regional Medical CenterLisa Burk, Winthrop Manor Nursing Center

Mindy Hartley, RN, St. Joseph’s/Candler Health SystemPatricia Horton, RN, Dekalb Regional Healthcare SystemStephen R. Mayfield, Dekalb Regional Healthcare System

Janice McKenzie, RN, Habersham County Medical CenterVickie Moore, RN, Saint Joseph’s Hospital of AtlantaKim Starkey, RN, Saint Joseph’s Hospital of Atlanta

Association Representatives

Georgia Association of Nurse LeadersSandra Morton, RN, Piedmont Hospital, President

Georgia Hospital AssociationKaren Waters, Vice President of Professional Services

Barbara Lewis, RN, Nurse Consultant

Georgia Nurses AssociationDebbie Hatmaker, PhD, RN, President

Georgia Nursing Home AssociationJoanne Grubbs, RN, Regulatory Director

Project Consultant and Staff

Ninfa M. Saunders, RNProject Consultant

Department of Community HealthBenjamin Robinson

Manager, Workforce Initiatives

Valerie A. HepburnDirector, Division of Health Planning

Health Care Workforce Policy Advisory Committee Subcommittee on Work Environment and Enhanced Productivity

C. Richard Dwozan, RPh, Co-ChairLucy Rogers, RN, Co-Chair

Valerie Hamilton, RNDebbie Hatmaker, PhD, RN

Hunter HurstHal M. Smith, Jr.

Rosa Waymon

Contents

Executive SummaryPage 3

IntroductionPage 4

The Search for Workplace Excellence

Page 5

Lessons Learned and Other Recommendations

Page 9

ConclusionPage 11

Appendices

Regional Invitational Forum on

Workplace Excellence

Appendix AAssessment Tool

Page 12

Appendix BCase Studies

Page 15

Appendix CReference Materials

Provided to ParticipantsPage 17

Appendix DSummary Evaluation

Page 18

In recognition of the impact that workplace dynamics are reported to have on thegrowing problems with recruitment and retention of health care workers, the

Health Care Workforce Policy Advisory Committee decided to implement a seriesof forums to discuss and document strategies for workplace excellence. The forumswere developed and implemented with the support of five partner associationsrepresenting health care professionals and organizations. The sessions were designedto provide representatives of the Georgia health care workforce with an avenue todeliberate on factors affecting the workplace environment and a means to design asustainable set of solutions and interventions to address recognized challenges.

Forum participation was by invitation only and representation consisted of healthcare executives, nursing staff and managers, pharmacists, and other allied healthprofessionals from both hospitals and long-term care communities. More than 100individuals participated. Forum content focused on an assessment tool and casestudy analysis to portray the operational challenges facing health care organizations.Group problem-solving discussions and presentations were structured to allowparticipants to equitably participate in the case review and to develop recommend-ed solutions using both traditional and innovative practices.

The forum discussions provided many insightful thoughts and measures. The groupsidentified a common set of themes to identify and resolve challenges in the healthcare workplace:

• Participants identified communication as the number one factor affecting theworkplace. Most believed that their organizations lack the mechanisms needed for clear and effective communication. The groups suggested thoughtful adjustments and accommodations that any organization could easily make toimprove organizational communications—including information delivery andactive listening strategies.

• Organizational goals must be well defined and sensitive to the many differentvalues held by different stakeholder groups. In addition, ample opportunity mustbe given to staff at all levels to re-define and re-direct these goals in accordancewith the changing needs of the organization and the community it serves.

• Employee participation and involvement are at the heart of many identified issuesand solutions. Employees want and expect to be involved—and managementshould have this expectation of employees as well. They wish to be regarded asthe group that helps craft the solutions to the problems, as oppose to beingconsidered the problem. The extent of this involvement must run the gamut fromgoal setting and service delivery, to include crafting broad-based future visions forentire institutions as well as day-to-day bedside clinical planning.

• The performance of the organization determines its ability to hold a successfulposition in the market place and speaks to its ability to serve its community effec-tively. Great care should be taken to balance these two values. Although timesmay require that organizations take calculated steps toward innovation andgrowth, organizations should weigh rapid progress and change against the need toensure that clinical professionals are able to retain their ability to provide thequality of care for which they strive.

• Organizations must aggressively pursue reward and recognition strategies thathighlight individual and group success. Participants spoke with a perceptible senseof urgency about the need to develop and implement such programs, many of

which are simple and inexpensive innature. These emotive tools are seenas potential immediate remedies tothe workplace strain created by theexponential increase in workload andwork intensity.

• Health care facilities and staff mustfind ways to build partnerships witheach other and the communities theyserve. Forum participants believedthat health care organizationsfrequently overlook the need to workcooperatively with other providersand the community, an excellentpartner and resource, in developingsolutions to workforce problems.

The forum process and participants’assessments are presented in greaterdetail in this report. The lessons learnedand the implications for future actionsare also outlined. While the dialogueestablished at the forums was impor-tant, the more critical intent of thesesessions was to facilitate real change inorganizational behavior. Towards thisend, forum participants were encouraged to consider and act onrecommended strategies they saw to beof particular merit for their individualorganizations. A cadre of professionalsthroughout the state, in every type ofhealth care organization, committed to mutual respect and workplace excellence will be the only mechanismto promote a gradual, but real,improvement in these organizations’performance and the ability to attractand retain high quality health careprofessionals.

3

E x e c u t i v e S u m m a r y

”“

Forum participation was

by invitation only and

representation consisted

of health care executives,

nursing staff and managers,

pharmacists, and other

allied health professionals

from both hospitals and

long-term care communities.

States and health care organizations across the nation are increasingly besieged bya workforce shortage much different and more complex than other any shortages

experienced in the past. Georgia’s current situation is no different and, if anything,it is worse than other places due to the state’s incredible growth and uniquedemographics. In recent years, Georgia has become aware that short and long-termworkforce shortages gravely threaten the system’s ability to deliver health care.

To address the growing workforce shortages, Governor Roy Barnes and the GeneralAssembly approved the formation of the Health Care Workforce Policy AdvisoryCommittee during the 2001 legislative session. The Committee’s primary responsi-bilities are to monitor and address issues related to the ongoing supply, demand,distribution, mix and quality of non-physician, health care professions licensed orregulated by the state and issues of recruitment, retention, and utilization of theworkforce. To address its mission, the Committee has divided into four work groups:

• Educational Programming and Student Finance;• Marketing and Recruitment;• Data and Forecasting; and• Workplace Environment and Enhanced Productivity.

The Workplace Environment and Enhanced Productivity subcommittee is chargedwith considering workplace conditions that impact the attractiveness of work in health care, promoting increased productivity of health care workers and recom-mending strategies that will positively affect the workplace environment and resultin improved quality of care and stability and effectiveness of the workforce.

In considering the workplace environment, this subcommittee recognized challengesin the current health care climate and within the workplace that render the environment less than hospitable to long term retention and recruitment. The groupacknowledged that many excellent ideas and quality programs already were beingimplemented by organizations throughout the state. The concept of holding a numberof invitational forums across the state was conceived as a systematic means to beginpublicly identifying and sharing these strategies of excellence to address work environ-ment shortcomings. With the goal of facilitating the emergence of a welcoming andsupportive work environment, four major goals were established for the forums:

• To serve as an avenue for sharing best practices and innovative ideas;• To educate others on challenges and dynamics impacting staff and executive

decision-making;• To identify positive actions which improve workplace dynamics and environment;

and• To create an environment of shared learning and understanding.

Five state-level health care associations agreed to provide leadership in this effort,thus ensuring that the forums were properly constituted and that all possible issueswere identified and addressed in the early planning stage. The sponsoring organiza-tions were the Georgia Hospital Association; the Georgia Nurses Association; the Georgia Nursing Home Association; the Georgia Pharmacy Association; and theGeorgia Society of Allied Health Professionals.

Through a series of planning meetingswith representatives from these associa-tions, specific forum guidelines andprinciples were established. Theseguidelines included:

• The forums would be held in a numberof locations throughout Georgia, withregions established to center aroundmajor focal areas of the state.

• Forums would be by invitation only,with the invitees to be identified bythe partner associations.

• Case study analysis would be used for discussion and learning.

• Participants should include individu-als from the nursing home sector andthe hospital sector.

• The invitee list should consist of amatrix of administrative staff andclinical staff. Those to be invited will come from one of the followingpositions: administrative (chief execu-tive, operating or financial officers,human resource professionals), nursingstaff and managers, pharmacists,physical therapists, and other alliedhealth professionals.

• The forum should last no more than two and one half hours with aworking luncheon.

• No more than 48 individuals wouldbe invited to each forum, to be situated at tables combining variouspositions in health care withoutallowing more than one person froman organization to be at a table.

• The forum would provide the follow-ing program schedule:

• Introduction• Overview of Workplace Issues• Completion of the Assessment Tool• Lunch and Case Study Analysis• Group Presentation: Strategies for

Workplace Excellence• Shared Learning and Identification

of Next Steps

• The final report, to be submitted tothe Health Care Workforce PolicyAdvisory Committee at its July 2002meeting, should document theprocesses and findings of the forumeffort and participants with the goalof encouraging replication of both thedialogue and the identified solution-oriented strategies. The report shouldbe made publicly available for use byall partner organizations.

4

I n t r o d u c t i o n

”“

The overall tone and dialogue of the forums held around the state spoke to this as a realistic, achievable endeavor. While some new and complex concepts were

expressed at the forums, generally the ideas and strategies identified by participantswere familiar and uncomplicated in design and implementation. If anything, theyrecall concepts, ideas and thoughts that everyone traditionally reads, hears andintuitively knows. In short, many suggestions focused on the use of good, simple,common organizational sense.

Conceptual FrameworkHigh performing organizations have created environments that allow them torecruit and retain motivated and high performing employees. Generally, these kindsof organizations share a common set of characteristics. Typically, they demonstratestrong customer satisfaction, creating customers that tell others of their positiveexperiences. Employees in these types of organizations are satisfied, and ratethemselves as fulfilled, enjoying their work, and helping to recruit new employees.As a result of these efforts, these organizations deliver services with fewer steps,often at lower costs, while showing superior quality based on outcomes.

Although there are various beliefs regarding core competencies that are intrinsic toorganizational success, five dimensions were presented as the core values, which besttypify the characteristics of a high performing organization.

• Customer satisfaction • Organizational performance• Employee satisfaction • Reward, recognition and reinforcement• Organizational goals

Forum participants, using an assessment tool developed by the forum planning team (Appendix A), were asked to confidentially rate their organization’s degree ofcongruence to these five core values. Participants were asked to be mindful of theirresponses on the assessment tool as they conducted their dialogue. At the end of theforum, each participant was also asked to chose one core value and to commit towork on that particular value upon return to the their organization.

Case StudiesThe medium utilized for analysis and discussion were two case studies. (Appendix B).Each case study portrayed operationally challenged organizations, typical of currenthealth care systems. The case studies recognized that staff frustration with the work

environment problems is frequently asymptom of overarching financing,service delivery and workflow problems.However, the case studies called uponthe teams to identify strategies toaddress systems issues, human resourcesdevelopment and participatory manage-ment. Each group of individuals wasasked to analyze a case study and toprovide their assessment and recom-mended solutions to the problemshighlighted in their case study. The participants were encouraged to thinkof traditional solutions as well as innova-tive, best practice solutions.

FindingsThe workplace is where strategies andinnovation are developed and executed.It is also where problems and difficultiesemerge which can paralyze the vision,mission, values, goals and objectives ofan organization. Using the case studies,participants identified the followingfindings and recommendations:

CommunicationLack of quality communications was byfar the number one concern expressedby the participants. They believed communication to be the most criticalof all issues. From this issue stems lowmorale, lack of employee ownershipand participation, lack of leadershipstability, staff and managementturnover, and loss of focus. Staff oftenexpressed a sense of feeling “out of theloop”, thereby hampering their abilityto see their work and contributionswithin the bigger picture. This concernplays a critical role in lowering moraleand in preventing buy-in to organiza-tional operations. Not surprisingly,participants articulated that thepresence of strong communicationamong the employees of an organiza-tion at all levels is the most pivotalcatalyst for an organization’s success.Open, two-way communications isdeemed to herald the best of circum-stances, to promote the advent and

5

T h e S e a r c h f o r Wo r k p l a c e E x c e l l e n c e

”“

Imagine my surprise, nay, my conster-

nation, when without moving from his

privacy, Bartleby in a singularly mild,

firm voice, replied, “I would prefer

not to.”

Herman Melville, Bartleby

The split between what is nourishing at work and what is agonizing is the verychasm from which our personal destiny emerges. Accepting the presence of thischasm we can begin to deal, one step at a time, with the continually hiddenunderground forces that shape our lives, often against our will. Institutions mustnow balance the need to make a living with a natural ability to change. They musthonor the soul of the individuals who work for them and the great soul of thenatural world from which they take their resources.

Whyte, D. The Heart Aroused: Poetry and the Preservation

of the Soul in Corporate America. New York

presence of entrepreneurial talents,and to nurture the development ofsustainable solutions for many of theorganizations strategic concerns.

Well Defined and RefinedOrganizational GoalsAlthough some conformity exists ingenerally held principles regardingorganizational goals, tensions areinevitable between various stakeholdergroups within an organization, as goalsare clarified and implemented. Much ofthese tensions reflect legitimate differ-ences between staff at varying levelsthat are reflective of the training, dutiesand position of individuals. For thisreason, participants stressed the needfor organization management to ensurethat the process for setting goals isaccessible to a broad range of stake-holder groups and is receptive of thevarious, and sometimes competing,values within an organization. Clearly,it is important to set goals and priori-tize them, however, everyone mustremember that organizations cannot be“all things to all people”. New goals canand must be developed that reflect andbalance a broad set of values, skills andcapacity within an organization.

Employee Participation and InvolvementThe disparity in thoughts betweenadministration and staff, created in partby mismatched communications and aconsequent lack of ownership, sits atthe apex of this particular concern.Administration representativesacknowledged the need to be moreinclusive with staff throughout theirorganizations. Yet, information receivedduring the forums indicated that thiswas not occurring effectively. Failure toeffectively include broad organizationalparticipation prevents effective designof and buy-in to proposed solutions.Clearly, some consensus exists regarding

efforts from administrators to establishmethods to seek broad participation.However, whether real or perceived,participants acknowledged that someparticipation methods are hollow gestures. In short, when an organizationasks, it is incumbent on that organiza-tion to also act. Surveys, dialoguesessions, quality circles, etc. must be realfor participants to ensure real resultsfor the organization. Organizationsmust develop more effective means ofenabling true participation and involve-ment. Indeed, administrators and staffalike recognized the substantive valuethat employees at every level provideto identifying cost-effective and quality-driven patient care solutions.

Organizational PerformanceThere was an incredible desire amongthe participants to see their respectiveorganizations become the best in what they do. This was true for all participants, regardless of their positionwithin the organization. A criticalcomponent in achieving this goal is thestability of the workplace environmentand the ability of that workplace tosupport the workers responsible foradministering care. Increasingly, thisstability is challenged as demand forhealth care services increases inresponse to the growing and aging population in Georgia. Organizationsrespond to this growing demand byadapting services and structures withintheir facilities.

Yet, a sense was often expressed thatorganizational efforts to grapple withthis growing demand are compoundingthe problem, as many organizationsoften move too fast and expand tooaggressively, thereby placing greaterburdens on staff while preventing them from getting involved in otherimportant areas of professional andorganizational development. This factposes risk regarding the quality of careand potentially serves as a distractionthat will lead to unacceptable sacrificein the overall quality of care and organizational performance.

Reward and RecognitionEffective rewards and recognition ofstaff for exceptional performance,achievement of outcomes beyond thenorm, and performance above andbeyond the normal range of their

professional duties were perceived tobe an effective means to build moralewithin individual staff. However, mostparticipants expressed a common beliefthat such programs were rare and were often mediocre when available.Compensation at a level that recognizesthe value and professionalism of nursing and clinical staff is certainlyimportant. However, money is rarelycited as the sole or even primary motivator for improving staff morale.Generally, recognition programs thatrely solely on monetary rewards arecostly and ultimately ineffective inimproving satisfaction and retention.

According to many participants, one of the most important values for staff is “to be respected and valued.” A fewsimple, well conceived methods thatdemonstrate how organizations valuestaff can do much to turn the currentenvironmental malaise to a more supportive and rewarding workplace.Workers who feel welcomed and valuedare more committed to the organiza-tion and its goals.

Partnership with the CommunityAlthough the context of the forumswas the internal workings of health caresystems, considerable attention wasgiven to relationships with otherproviders and the external communityin which organizations function. Manyparticipants expressed a belief thathealth care organizations have failed toadequately involve each other and thecommunity-at-large in addressing theworkforce shortages, workload andsystems issues in ways to help alleviatethe impact of these shortages. Theyexpressed a perceived lack of will andsubsequent initiatives to mobilizeproviders and community outside theirorganizational walls.

At minimum, mechanisms to commu-nicate with an organization’s customersmust be in place. Though they areultimately the end users of the servicesof the organization, communities arecomprised of consumers, educators,

6

Our deepest fear is not that we areinadequate. Our deepest fear is thatwe are powerful beyond measure. It is our light, not our darkness thatfrightens us. Your playing small doesn’t serve the world...

Nelson Mandela

Choose a job you love, and you willnever have to work a day in you life.

Confucius

payers, policy makers, regulators, andancillary service providers who are in aposition to exert influence, positive ornegative, on matters that may greatlyimpact an organization. Given thepotential impact, more needs to bedone within the health care sector to aggressively interface with partnerproviders and the community at large.

RecommendationsThe forum process called upon partici-pants to develop suggestions to addressthe identified findings in a manner thatwould promote workplace excellence.Participants identified numerous recommendations. A number of ideasreflect efforts currently employed bysome organizations with great success,while others represent newer, moreinnovative solutions not implementedin Georgia. All were positive andshould be able to find use in any of anumber of facilities across the state.The recommendations were as follows:

Communication• Design an avenue for communication

among all stakeholders at all levels ofthe organization. This may be in theform of a town hall meeting, smallgroup discussions or regular employeesurveys with consistent follow up.Other recommended measuresinclude breakfast or lunch with theboss, going on a fact finding mission,and developing a “story line” that isrealistic and credible for the staff.

• Consistent and frequent communica-tion among stakeholders to discussorganizational goals and performance,as well as accomplishments, concernsand action plans.

• Opportunity for administration andstaff to listen and react without constraint.

• Over communicate! One can nevercommunicate enough—in reality,most managers only really begin toscratch the surface for open dialogueand discourse.

• Though communication of all formsis highly encouraged, the visibility ofmanagement is an equally importantstrategy. Staff’s ability to recognizeand relate to the organization’s leaderallows for a greater sense of belongingand inclusion.

• Listen, talk and take action!

• Organizations should provide ananonymous and less threateningvenue for the staff to express theirthoughts and concerns.

• Leadership training should be provided with strong emphasis onlistening skills.

Well Defined and RefinedOrganizational Goals• Organizations should strive towards

the achievement of a corporate culture focused both on mutualrespect and shared accountability.

• Organizations should find ways todeal with the inherent conflictsbetween the goal of continued serviceexpansion and the reality of limitedresources.

• Planning of the organization’s growthstrategy, while meeting the needs ofthe community, must be considerateof the workforce shortage and thefinancial and professional burden itcreates.

• Leaders and staff should revisit theorganization’s strategic plan and makeadjustments and modifications so asto make it realistic.

• Organizations should focus equallyon the ability to positively impactcare as to increase revenues andreduce expenses.

• All parties must commit to creating awork environment that is appealingand comfortable at every level.

• By encouraging meaningful participa-tion of all organizational members inthe goal setting process, organizationswill greatly improve processes andoutcomes.

Participation and Employee Involvement• Each department should have input

into any decisions that affect thatdepartment. Moreover, organizations

should consider cross-departmentalreviews and staff cross-training efforts–both to promote systems improvementand to address workforce shortages.

• A momentary delay in the develop-ment and implementation ofprograms and projects is a fair priceto pay, so long as the staff and allstakeholders can feel rightful owner-ship of the process.

• Consider the talents and best practices in your organization andutilize them as a benchmark for theother units to emulate.

• Employees should feel a sense of control for their work, accomplish-ments and contributions. They mustfeel that their contribution is valuableto the success of the organization.

• Staff should recognize that along with heightened authority and participation comes accountability.As management involves staff in decision-making, it then becomesimportant for the staff to approachwork and the organization with anenhanced sense of ownership andresponsibility.

• Problem-solve with the staff and consider them as part of the solution.

7

Today, working in organizations

must be a partnership between the

employees and the employer. While

the employing organization has

legitimate needs, including fulfilling

its mission and maintaining economic

viability, equally important is having

a workforce committed to these same

goals. That commitment will only

occur if the organization follows

contemporary human resource

practices that include active dialogue

with employees, an understanding of

their needs and desires, and a diligent

effort to respond to those needs.In Our Hands,

AHA Commission on Workforce for Hospitals and Health Systems

April 2002

Perfection of means and confusion of goals seem—in my opinion—to characterize our age.

Albert Einstein

Organizational Performance• There should be a systematic

approach to measuring and under-standing what is being done in theorganization. Process improvementmeasures must be readily accessiblefor use by everyone in addressing andresolving issues of consequence.

• A set of performance criteria andmeasurements should be used toinsure strong organizational qualityperformance. Staff should understandthe criteria and actively participate inthe measurement process.

• Organize the workload for maximumefficiency. This can be accomplishedthrough the development of hybridprograms where staff is cross-trainedto perform a variety of different butrelated roles.

• Understand that the danger of inaction in any organization can bethe primary cause for breakdown ofstaff and unit functioning.

• Ensure a balance between competinginterests within an organization—onethat equally values fiscal demands andquality of service

• Consider untried, innovativeapproaches as well as provensolutions to traditional and commonproblems.

Reward and Recognition• Provide a comfortable environment in

which to work, with ample space anda work area pleasing in appearance.

• Ensure the availability of a rewardand recognition program thatprovides incentives through employeerecognition for performance andexcellence. Likewise, consider thedevelopment of a “spot incentive program” providing reward and incen-tives to staff working in areas wherethere is unexpected increase inworkload and work intensity.

• Ensure that the rewards provided to selected individuals are of value to them.

• Give the staff the opportunity to provide leadership in recruitment andretention projects with support fromadministration.

• Provide for flexibility in the develop-ment and implementation ofrecruitment and retention strategies.Efforts should include the hiringprocess, job transitions (e.g., offeringdeparting staff “on call status”) andongoing staffing plans that includeinnovative and seasonal scheduling.

• Utilize the happiest and most contentemployees to promote the organiza-tions programs.

• Ensure that any recognition programprovides staff interaction with theorganization’s leadership. Participantsexpressed the desire for all venues ofcommunication, be it a regularlystructured meeting, a quarterlyawards ceremony or simply a casualconversation.

• Ensure availability of training and mentorship programs for staff.Accommodate the changing demandsof their role through continuousimprovement in the educationalofferings of the organization. The programs must be flexible and shouldprovide for refinement of existingskills and acquisition of new ones.Any mentoring program should provide easy access to leadership andclinical mentors

• Value the service that people provideand they will feel constantly includedin the organization’s plans. As oneforum participant noted, “Money isnice to have but what really matters is the recognition of the staff andletting them know they are valued.”

• Health care facilities should ensurephysician involvement in the respectfor and recognition of the staff and inthe development of solutions to theworkforce shortage.

Partnership with the Community• Organizations should reach out to the

community to get it actively involvedin the development and support ofprograms. Share the challenges confronting the organization andallow the community to participate in the development of the solutions.

• Collaborate with other health careproviders, acute and non-acute, incrafting a seamless care deliveryprocess for the patients from admission, transfer and discharge.

• Team up employees with the community to identify specific needsand opportunities.

• Work with colleges, universities,technical schools and other educa-tional and training programs, as wellas public and private agencies, toincrease the workforce supply and tomake available to recruits easy accessto their programs.

• Develop a program that promotes thehealth care organization as part of the community’s growth strategy.

• Take advantage of other health related resources that may serveorganizations by decreasing overalldemand for their services.

• Partner with businesses and employers to develop a collaborativeprogram that can help grow the economy.

• Enhance financial support forprograms and product offerings byexploring the availability of additionalresources from the private and public sector.

8

Training is everything. The peach wasonce a bitter almond; cauliflower isnothing but cabbage with a collegeeducation.

Mark Twain

We belong to the community. It is notthe tailor alone who is the ninth partof a man; it is as much the preacher,and the merchant, and the farmer.Where is this division of labor to end?and what object does it finally serve?No doubt another may also think forme; but it is not therefore desirablethat he should do so to the exclusionof my thinking for myself.

Henry David Thoreau

T he regional invitational forums proved to be an excellent linkage of talents,organizations, professionals, and architects of change. Participants expressed

appreciation for the opportunity to share in the dialogue. Ninety-nine percent(99%) of participants indicated a desire to replicate this kind of forum on a regularbasis. (See Appendix D for a summary of the participant evaluations.) The members ofthe Health Care Workforce Policy Advisory Committee recognize and support theneed for consistent and frequent approaches to maintain the open dialogue neces-sary to promote improvements in the workplace. Yet, neither the Committee northe state should serve as the principle convening body for future forums. The bestapproach to achieving true change requires that individual health care organizationsand the professional associations assume an increasing level of responsibility towardsconvening structured dialogues for their respective constituencies. The successes ofthis forum process should serve as a model to enlighten any interested association inimplementing these forums in a workable fashion

To facilitate such replication, it is important to understand the challenges andsuccesses involved with the implementation of the forums. As with any new endeavor, difficulties did surface in the implementation of these forums that shouldbe considered in any future efforts.

While conventional wisdom would suggest that the critical workforce shortagewould command an ardent call to action, reality proved otherwise. Despite the factthat most participants expressed strong positive opinions, the principle challengethroughout the forums involved getting invitees to commit and show up for theforums. The partner associations should play a strong role in this effort. While theywere all responsive in providing lists of invitees, the greatest successes in responserates from invitees happened when association staff became directly involved inencouraging invitees to attend. Typically, the staff involved in this role were wellestablished and known throughout the constituency served by their association.

The case study proved to be a useful method of stimulating dialogue. However, inthe planning stages, identifying suitable, pre-developed case studies proved to be asurprisingly difficult task. Additionally, locating scenarios that could be assembled toproduce an applicable case study was laborious and often those located were notwell suited to the purposes of the forum. In the end, forum sponsors had to createhypothetical case studies using limited written material and case studies that wereadapted to better reflect and simulate the work environment of today. Ultimately,this creation proved to be successful, as demonstrated by evaluation responses,however additional case studies may be required in future forums—to reflect thechanges in the workplace or to provide greater diversity in forum discussions.

The apparent lack of quality case studies focusing on management practices andorganizational development speaks volumes to the underlying problems of the workenvironment. In future dialogue efforts, care should be taken to find or develop newcase studies that are reasonably accurate and believable renderings of the dynamicworkplace that comprises the world of health care.

9

L e s s o n s L e a r n e d a n d O t h e r R e c o m m e n d a t i o n s

”“

The best approach to achiev-

ing true change requires that

individual health care organ-

izations and the professional

associations assume an

increasing level of responsi-

bility towards convening

structured dialogues for their

respective constituencies.

The successes of this forum

process should serve as a

model to enlighten any

interested association in

implementing these forums

in a workable fashion.

"Leadership should be born out of theunderstanding of the needs of thosewho would be affected by it."

Marian Anderson

Certain other issues will also continueto demand attention and, althoughthese forums successfully overcamethese challenges, will require great care.Perhaps the most important of theseissues is providing a comfortable environment in which all present willactively participate. Great care wastaken to promote an egalitarian environment in the forums andsponsors received overwhelminglypositive comments for this effort.Participants clearly valued the approachof organizing participants by variedprofessions and organizations at eachtable. The process allowed participantsto identify themselves by name andorganization; the use of professionaltitles was strongly discouraged. Inaddition, the forums used an “ice-break-er” exercise to have participantsidentify their favorite hobby or avoca-tion. The exercise allowed participantsto value the non-work related interestsand skills of others. This process wasalso used to provide an unbiasedvehicle for selecting the presenter forthe group.

All of these strategies served to create agroup environment that was conduciveto easy conversation without the disadvantage of introducing power relationships inherent in knowing thetitle and position each participant heldwithin their organization. Staff nurses,pharmacists and other allied health professionals sensed a “level playingfield” and believed that their ideas,thoughts and suggestions carried equalvalue and weight. Further, administra-tors welcomed the candid nature of thedeliberations and understood the valuesof the ideas and the suggested strategies.

Though there were challenges involvedwith creating the case studies used inthe forums, the case study analysis andpresentation did prove to be well suitedas a medium for group discussion aboutthe workplace environment. This element should be replicated in anyfuture forums. However, care had to betaken to ensure that a small group ofindividuals did not dominate the conversation at the group tables thatdeveloped through these case studies.To facilitate this, association partnersprovided staff at each forum to serve asfacilitators/moderators of the conversa-tion. Generally, these individuals wouldnot directly participate in the conversa-tion beyond answering questions andhelping it get started. Their role,however, would become critical if theyperceived an imbalance in the dialogue,in which case they would work toidentify other, less involved groupmembers and encourage their input and move the conversation to othermembers throughout the table.

Care with logistical issues alsocontributed to the overall success of the forums:

• The participants appreciated theforum sessions stayed on schedulewhile acknowledging the optimumlearning that transpired over the designated period.

• The assessment tool and tool kit wereconsidered valuable resources.(See Appendix C for the list of referencematerials provided in the tool kit.)

• The participants found the report onthe problem-solving strategies andidentification of the target areas workexceptionally helpful and beneficial.

• Although much of the group discus-sion centered on the case study, theparticipants welcomed the fact thatthe ideas and thoughts shared anddiscussed were not constrained by orlimited to the case study.

• The timing, location and setting ofthe forums were well received.

Perhaps the greatest benefit from theseforums was the opportunity it providedto allow health care colleagues to sharetime and talk with each other. It wasthe consensus of the participants thatthe time they had invested in theforum was time well spent and that theinformation they gained, especiallyregarding the opinions and thoughts ofthose located elsewhere in the world ofhealth care, would serve them wellwhen they returned to their organiza-tion. Every effort should be made tomaintain this aspect of any futureforums, as it is this dialogue, ifmaintained over an extended period oftime, that will lead to successfulchanges in the workplace environment.

10

Perhaps the greatest benefitfrom these forums was theopportunity it provided toallow health care colleaguesto share time and talk with each other. It was theconsensus of the participantsthat the time they had invest-ed in the forum was timewell spent and that the information they gained,especially regarding theopinions and thoughts ofthose located elsewhere inthe world of health care,would serve them well whenthey returned to their organization.

The regional invitational forum process proved to be an excellent avenue toassemble key stakeholders in pursuit of strategies to make the workplace

environment more conducive to effective, enjoyable work and long term retention.Collectively, administrators, clinical managers and front line staff can find thecommon threads to weave together their ideas and thoughts so as to build a sharedvision for an organization. The chance to network was greatly appreciated by eachorganization and across professional groups. Through the dialogues that developedaround the case studies, groups were able to assess a situation, discuss and arguepossibilities, and agree on a common and optimal path for resolution.

While many of the assessments and recommendations outlined in this report arefamiliar and simple, they all reflect careful thought and were presented in a mannerthat is practical and feasible. More importantly, the materials presented were bornout of an open, deliberate and respectful discussion by groups of individuals whooften do not engage in this type of dialogue. During the forums, they worked handin hand to craft and present unified thoughts on the best avenues to correct currentwork environment problems.

It is not clear, at this point, how the information gleaned will be regarded, managedand implemented. Successful implementation of change is more demanding thandeveloping the concepts. However, it is obvious that needed change in theworkplace environment cannot occur until the required dialogue ensues and acommon vision is developed. This important first step did begin to take shapethrough the forums. And, the process has provided the participants and many stakeholders with a positive sense that health care systems and staff at every levelcan identify and embrace the principles necessary to cultivate and maintainworkplace excellence.

The performing, learning, and transforming organization must find leaders of alltypes. They are not only to be found within the top levels of management. Rather,a leader may represent a combination of members throughout the organization andinclude those who merely desire change and improved processes and outcomes.Employees and, in some respects, the community at large have been longoverlooked as the source of solutions, innovative strategies and, indeed, leadership.The health care workplace environment is where all the key players, administrationand front line staff alike, perform to achieve competitive advantage and success inpatient care and quality. Conversely, it is also in the workplace environment whereadversity and potentially destructive incidents can occur. Leaders from every level inthe organization must play critical roles and serve as catalysts of transformation andchange. Health care must seize the moment and provide the infrastructure and themechanisms for creating a harmonious and progressive work environment cementedin the traditional values of caring and concern.

11

C o n c l u s i o n

”“

Do not think purely of today’s difficulties, but of the success that may cometomorrow. You have set yourselves a difficult task, but you will succeed if youpersevere, and you will find joy in overcoming the obstacles. Remember, no effortthat we make to attain something beautiful is ever lost.

Helen Keller

All of the great leaders have had onecharacteristic in common: it was thewillingness to confront unequivocallythe major anxiety of their people intheir time. This, and not much else, isthe essence of leadership.

John Kenneth Galbraith

The work environment will continue tobe a pivotal force in making or break-ing the human dynamics of any healthcare organization. In the years ahead,familiar benchmarks and guidepostswill change as rapidly as the times, butthe one constant will be the leader.

HesselbeinThe How-To-Be a Leader

Successful implementation

of change is more demand-

ing than developing the

concepts. However, it is

obvious that needed

change in the workplace

environment cannot occur

until the required dialogue

ensues and a common

vision is developed.

This important first step

did begin to take shape

through the forums.

Special Note: This Assessment Tool was developed by Stephen R. Mayfield, of Dekalb Regional Healthcare System, and the staff of theGeorgia Department of Community Health, Division of Health Planning. Any party may use it with appropriate reference provided.

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Assessment ToolA

Regional Invitational Forums on Workplace Excellence 12

High performing organizations havecreated environments that allow them to recruit and retain motivatedand high-performing employees.Generally, these kinds of organizationsshare a common set of characteristics.Typically, they demonstrate strongcustomer satisfaction, creating customers that tell others of their positive experiences. Employees inthese types of organizations are satis-fied, rate themselves as fulfilled,enjoy their work, and help to recruitnew employees. These organizationsdo a good job of communicating whatis important—both internally andexternally. As a result of these efforts,these organizations deliver services

with fewer steps, often at lower costs,while showing superior quality basedon outcome measures.

This assessment has been designedspecifically for use at the RegionalInvitational Forum on WorkplaceExcellence and it is solely for yourpersonal use. It will not be sharedunless you decide to do so. You willtake this tool with you when theforum ends—hopefully, you will beable to use the ideas from the forumand the observations from this assess-ment to strengthen your organizationand enhance your workplace.

The assessment tool is designed to beused by staff at any level in an organi-

zation—from front line staff to thechief executive. For each statement inthe sections below, please indicate towhat extent you agree that yourorganization reflects the stated valuesor engages in the specified activities.Your responses should reflect yourpersonal knowledge of the organiza-tion and its activities. Please do notrespond from the perspective of whatyou think should be occurring in theorganization—and you should feelfree to check “don’t know” if you arenot sure about the applicability of any of the statements to your organization. (Note: Please leave the“My Priority” Column blank at the timeyou initially complete the Assessment.)

Section 1: Customer SatisfactionThe best-performing organizations know how their customers feel about the quality of services they provide and the manner in which they are delivered, and they communicate that information with their staff.

Our organization surveys our customers on a frequent basis or at the time they receive service, before they leave the facility.

Our organization uses a number of different strategies to encourage customerfeedback, to collect customer comments and suggestions, and to quickly resolve customer complaints.

Our organization quickly and frequently shares customer satisfaction scoresand feedback with staff at all levels in the organization.

Our organization shares positive customer feedback as well as customer concerns, recognizing staff for good performance as well as helping staff make improvement when necessary.

Our organization helps staff understand the important role they play in contributing to customer satisfaction.

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nowStatements About Customer Satisfaction

Section 2: Employee SatisfactionThe best-performing organizations know how their employees feel about the workplace. They understand and value employees’ percep-tions—about the availability of adequate resources to get the job done, about having the support needed to handle issues, and about theability to resolve obstacles.

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Assessment Tool A

Regional Invitational Forums on Workplace Excellence13

Our organization obtains frequent feedback from employees through surveys,meetings, suggestion boxes, and other mechanisms.

Our organization shares the results of employee feedback with employees.

Our organization uses employee feedback to identify concerns and resolve problems.

Our organization makes it clear to employees that their feedback and satisfaction isimportant and valued.

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nowStatements About Employee Satisfaction

Our organization has a set of clearly defined and understandable goals and performance measures that monitor progress on these goals.

Our organization presents progress reports on performance measures and goal attain-ment to all staff and helps staff understand what these measures mean.

Our organization helps staff understand the importance of good internal customerservice (department to department) in goal attainment and performance.

Our organization has methods in place to measure internal customer service and toensure that all staff understand how their internal customers viewtheir department or program.

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nowStatements About Organizational Goals

Section 3. Organizational GoalsIn top performing organizations, staff members at every level are able to articulate clearly the goals of the organization and staffmembers review the progress toward these organizational goals by routinely reviewing a few simple measures of success.

Section 4. Organizational PerformanceThe best performing organizations regularly measure their processes and clinical outcomes to ensure that the processes are efficient and effective, result in lower-than-average costs per episode of care, and produce better-than-average clinical outcomes (length of stay,re-admissions, mortality, infection, etc.).

Section 5. Recognition, Reward and ReinforcementThe best performing organizations have methods to regularly acknowledge the success and contributions of staff members.

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Regional Invitational Forums on Workplace Excellence 14

Our organization regularly compares (or benchmarks) our processes to those in similarorganizations as a measure of performance.

Our organization identifies areas where it is not performing at the level of similar organizations and then identifies ways to improve clinical efficiency by reducing duplication and streamlining service processes.

Our organization regularly compares our costs for clinical services with those of similarorganizations and shares that information with staff.

When our costs appear out of line with those of similar organizations, our organizationengages staff at every level to identify ways to reduce costs without negatively impactingservices.

Our organization regularly compares our clinical outcomes with those of similar organi-zations and shares that information with staff.

Our organization encourages participation from staff at every level to plan strategies toimprove and/or maintain good clinical outcomes.

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nowStatements About Organizational Performance

Our organization has ways to measure the success and contributions of staff membersand everyone is familiar with these methods.

Our organization gives public acknowledgement to employees for their successes andaccomplishments.

Our organization has a system or systems in place for rewarding successful employeeperformance.

Our organization reinforces positive performance, promotes a sense of family for staff atevery level, and makes staff feel good about their work and contributions.

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nowStatements About Reward, Recognition and Reinforcement

Section 6. Next Steps—This Section Should Not Be Completed Until the End of the ForumFrom this assessment and our work today in the forum, I have determined that my organization could improve employee satisfaction andthe organization’s overall performance by doing the following:

______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________

I am going to work with my organization in hopes that we move forward with these next steps.

My Signature _______________________________________________________________Date_______________________________________

Case Study #1For the past 2-year period, the largeemergency center had experiencedhigh turnover in nursing management.The nurses who left were clinicalmanagers/charge nurses, responsiblefor the day-to-day operations of thecenter. Each of three clinical managerswas responsible for one of three 8-hour shifts. In the last 24 months, fivemanagers resigned from the threepositions. One position still remainsvacant after four (4) months ofrecruitment.

In the past, applicants for the positionswere plentiful. The attractive salaryhad served as the primary motivatorfor those pursuing advancement.As staff members observed the fastturnover of managers, other prospec-tive applicants from within the ranksbecame skeptical about applying forthese positions. Money was no longer amotivator. The general responseamong the staff nurses was “There’s no amount of money to pay me totake that job!” Additional incentives,including specialty certification reimbursement, opportunity to attendmanagement seminars, and flexiblework hours, were also marketed toattract nurses to apply for this salariedposition.

Soon, difficult behaviors wereobserved among the rotating chargenurses who ran the shifts in theabsence of clinical managers—theseindividuals were the most likely to bepromoted to the vacant supervisorypositions. One rotating charge nursestood out from the rest in that shewas in charge of this shift each timeshe worked. She demonstrated behav-iors that indicated her distaste for therole she was filling by default. Herbehaviors showed lack of teamwork,verbalization of negative feelingsabout coming to work, and inabilityto make any decision without consulting the Unit Manager. It wassuspected that these behaviors developed in this nurse and withinthe group of other charge nursesbecause each feared he or she wouldbe promoted into the open position.

Concerning the events surroundingspecific turnover issues of the five

managers who left the positions, aclose look at the demographics of thisdepartment is revealing. The medianage of the clinical managers was 30.In this center, nurses over 30 whoremained in staff positions werebelieved not to be interested in management positions. Internal hiringwas another issue. Promoting fromwithin had traditionally served as apositive motivator. Further, in thiscenter, experience from hiring outsideinto management roles had proven hazardous because of increased orien-tation time, the lack of comparablecenters within the area from which itrecruits, and potential internalfriction. Traditionally, higher successrates had occurred with internalpromotions. When internal hiring waspracticed, nurses in the early stages ofprofessional development tended tobe the applicants. In reviewing theprofessional age of the nurses whohad most recently occupied theseclinical leadership positions, it wasfound that four of the five hadpracticed nursing less than 3 years andsenior management was concernedthat limited seniority and maturitymay have contributed to highturnover. Lack of good, stable clinicalmanagement also led to poor moraleand increased turnover among front-line emergency staff nurses.

This particular emergency center hadalways been very clear on departmen-tal goals and purposes. Missionstatements include concepts such asacute management of life-threateningconditions, interim stabilization priorto transfer to inpatient care areas, andproviding effective triage of patientconditions so as to meet the needs ofeach category of patients in a timelymanner. Yet, in the most recent 2-yearperiod the mission of the departmentwas in conflict with the reality. Thehospital was frequently on diversion,sometimes nearly 10 days per month.The situation was particularlyproblematic during flu season whenmany elderly patients presented forservice through the emergency room.Nursing homes in the area relied onthe emergency room to serve a largenumber of elderly patients with acutecare needs. Staffing shortages in long-

term care programs make it moredifficult then normal to care for thevery frail and sick.

Recent data indicated that more than50% of the admissions to the hospitalfor inpatient care had come throughthe emergency center. There was lackof available staffed acute care beds,particularly critical care beds. The lackof staffed acute care beds was due inpart to a limited number of nursesavailable to staff those units. Areassuch as the post-anesthesia care unitand the emergency center sometimeswere forced to hold transfer patientsfor up to 48 hours because of thisdilemma. Nurses could not effectivelyprovide access to care to potentialemergency room patients because ofthe transfer delays.

Hospital management and the ERphysicians are frustrated about thecost, quality and liability of inappro-priate and burdensome emergencycare. Front-line clinical staff feelsoverwhelmed and view the clinicalmanagement as crisis-driven and disorganized. Clinical managementspend the majority of their day begging for inpatient beds and callingin additional staff and agency nursesto care for the intensive patients, withlittle time to actually plan for ormanage anything.

• What are the most pressing organi-zational and staffing issues to beaddressed? How might the hospitalgo about identify the root causeproblems in this situation?

• Are there environmental pressuresthat may be driving or at least contributing to the emergency centers staffing problems? Is it possible to address external forcesthat may generate serious workplaceproblems?

• What steps could be taken toimprove morale and staff relations?What are the dangers of inaction?

• Have you had a similar experiencein an organization? What factorsmight lead to a successfulturnaround? What measures mightbe used to determine “success” orimprovement?

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Case Studies B

Regional Invitational Forums on Workplace Excellence15

Special Note: These case studies were developed by the staff of the Georgia Department of Community Health, Division ofHealth Planning, with assistance from Ninfa Saunders, RN. Any party may use them with appropriate reference provided.

Case Study #2Area Hospital is a 300-bed hospitalwith a 100-bed nursing home locatedin a regional urban area. The commu-nity has a four-year college and severallarge manufacturing industries—yield-ing a patient population that hasvarying levels of insurance coverageand health care sophistication. Thehospital is a private, not-for-profitinstitution that offers a wide range ofservices and specialties to the commu-nity and surrounding areas. Outsidethe urban core, the area is primarilyrural and agricultural. The AreaHospital is the primary provider ofspecialized care to the regionalpopulation. However, within closeproximity across the state border aretwo significant medical centers—oneoperated by a state medical schooland one operated by a national for-profit chain. Area hospital isassociated with a PPO/HMO programand operates several primary careand/or rural health clinics that supplyalmost half of the patient population.The hospital has historically beenfinancially sound, benefiting from thecapable direction of a future-mindedchief executive officer, and communi-ty and public support. It also hasenjoyed the role of being one of thelargest employers in the region.

In recent years, the region has beenhit with the loss of several largeemployers and a drought that hasseverely impacted agribusiness. Thenumber of unemployed anduninsured has skyrocketed. In themeantime, public and private insur-ance reimbursement has been cappedor reduced. Two smaller communityhospitals within 30 miles of AreaHospital have been forced to closedue to long term financial loses. AreaHospital has attempted to respond tothe many needs of its immediatecustomers and the surroundingcommunities by developing newoutreach/prevention programs andsatellite services models.

Area Hospital is viewed as a fast-paced, responsive organization thatoffers continual activity, growthopportunities, and professionalchallenges. In the past several years,the hospital has initiated new clinicalprograms such as open-heart surgery,trauma services, and inpatient rehabil-itation. Other programs are in thedevelopmental or formal planningstages. Although this process hasresulted in growth and additionalmarket opportunities, it has also beencostly. The hospital has made exces-sive capital expenditures whilepatient revenues were declining. Lastyear, deductions from gross patientrevenue were nearly 50%. This year,the hospital projects that it mayactually have a negative margin—and be forced to rely on reserves tobalance.

The dramatic changes have beendraining for front line staff. Theaggressive expansion—deemed ascritical from a market share and long-term viability standpoint—has invitednegative perspective or impact amonglong time employees, for activity isoccurring at a constant, rapid pacethat allows little time for processingand adjustment. The young and theelderly increasingly dominate thepopulations in communities served byArea Hospital. While the four yearcollege provides a good education,advanced employment opportunitiesare not as readily available as theyonce were—so many young peopleare leaving to pursue career opportu-nities. The region has only twonursing schools and one PT program;most allied health, behavioral healthand pharmacy professionals have tobe recruited from schools that aremore than 150 miles away. Nursingvacancy rates have topped 16% in thepast year, and it has been virtuallyimpossible to maintain sufficientpharmacy and allied health coveragefor all of the new programs initiatedby the hospital.

Staff at the nursing home, which has had trouble keeping sufficientregister nurses to meet state staffing mandates, have a hard timeunderstanding how the hospital couldopen a new inpatient rehabilitationprogram that is draining the staff evenmore. Physicians and nurses recognizethe community benefit of traumacenter designation but are unwillingor unable to shoulder the additionalworkload and emotional burden. Aspharmacy, nursing and allied healthvacancies persist, the hospital hasspent a considerable sum to designand secure surgical expertise for thenew open-heart program. The CEOand the Board of Trustees are strug-gling to understand why front linestaff are not supportive of the organi-zation’s growth and efforts to securetheir role in the market. The recentspike in the cost of malpractice insurance has forced the hospitalmanagement re-think whether fundsare available to award staff any payincreases or bonuses.

• What organizational challenges arefacing the hospital? What stabilityand morale problems are facing the staff?

• How should management and staffexpress their concerns to eachother? Is there common ground?

• How does the hospital balance itsneed to be competitive and innova-tive with the financial and staffingchallenges presented by such rapidchange?

• What, if any, interventions shouldbe undertaken immediately? Doesthe hospital incur increased risk bynot responding to the financial andstaffing problems?

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Regional Invitational Forums on Workplace Excellence 16

Special Note: These case studies were developed by the staff of the Georgia Department of Community Health, Division ofHealth Planning, with assistance from Ninfa Saunders, RN. Any party may use them with appropriate reference provided.

Promoting Workplace Excellence–An Introductory Tool Kit

Listing of Reference Materials

1. An Introduction to Process Improvement, developed by Stephen R. Mayfield, April 2002.

2. Excerpts from the American Hospital Association, In Our Hands: How Hospitals Can Build a Thriving Workforce,April 2002. (www.aha.org/workforce/index.asp)

3. Excerpts from Nursing’s Agenda for the Future, A Call to Action, April 2002. (www.nursingworld.org/naf/)

4. Overview of the Malcolm Baldridge National Quality Program 2002, Health Care Criteria for Performance Excellence.

5. Improving the Workplace: Using the Malcom Baldridge Award Criteria for Hospitals and Healthcare Systems,prepared by Janice McKenzie, Habersham County Medical Center.

6. Summary of the American Health Care Association Quality Award Program. (www.ahca.org/quality/)

7. Overview of JCAHO Requirements for Measuring Staffing Effectiveness. Preliminary Indices for Behavioral Health Care and Ambulatory Health Care, March 2002.

8. The Magnet Nursing Services Recognition Program, provided by Kim Sharkey, RN, MBA, CNAA, Saint Joseph’s Hospitalof Atlanta and Mindy Hartley, MSN, RN, St. Joseph’s/Candler Health System (Georgia’s two magnet hospitals).(nursingworld.org/ancc/magnet.htm )

9. The Georgia Nurses Association/Georgia Nurses Foundation Awards Program. (www.georgianurses.org )

10. Excerpts from the Georgia Hospital Association, Health Care Workforce Resource Manual. (www.gha.org)

11. Overview of Workplace Strategies from Baptist Health Care, Florida, one of the four health care companies named toFortune Magazine’s 2002 List of “100 Best Companies to Work For.”

12. Excerpts from H*Works: Hardwiring Retention Excellence, 1999.

13. Case studies by H*Works: UPMC-St. Margaret; Clarian Health System.A

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Regional Invitational Forums on Workplace Excellence17

3. I particularly enjoyed and/or benefited from:

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Summary EvaluationD

Regional Invitational Forums on Workplace Excellence 18

Includes summary statistics and all written comments.

1. Please let us know if the tools and topics were helpful to you (check one column per session):

Very Helpful

GenerallyHelpful

SomewhatHelpful

Not Helpful At All

Not ApplicableSession/Topic

Session Introduction and Assessment Tool

Case Study and Group Problem-Solving

Report on Problem-Solving Strategies and Identification of Target Areas for Work

Tool kit and Materials to Promote Workplace Excellence

n = 115

48% 46% 5%

56% 36% 7% 1%

53% 37% 10%

58% 36% 5% 1%

Very Helpful

GenerallyHelpful

SomewhatHelpful

Not Helpful At All

Not Applicable

58% 36% 10%

2. Overall, I found the forum to be:

� Meeting a variety of people fromdifferent levels within Health Careand the tea was really good!

� Working in groups and discussingworkplaces issues amongst ourselves(small tables, good number)

� The different perspectives offeredfrom the different settings; “titles”

� Case Study; Group Discussion� Sharing in small group� Small group discussions� Case Study Analysis� Suggestions for improving perform-

ance and organizations� Case Study Interaction� The group experience; Leadership

by Ninfa Saunders� The round table discussion; The

presentation by Ninfa Saunders� Group Discussion� Assessment tool; Was very well

done� Relaxed atmosphere; Easy to

understand� Group discussion

� Group participation; Meetingpeople from all different HealthCare walks

� Group summaries of Case studies� Participants Interaction� Networking at table; “Sharing”� Teamwork and group problem-

solving handouts� Sharing ideas with people from

different Health Care fields� Different perspectives of the same

problem. The need for balance andrecognition of everyone’s need forbalance.

� Self assessment; Case Study� Interaction with others� Ideas to take back� Hearing different view points and

perspectives on the same casestudies

� The tool kit/resources; Also meetingnew people

� Creative job solving� The group discussions that allowed

and provided perceptions from avariety of staff; The differentpositions and years of experience

� Listening to others in the HealthCare field

� Discussions with others in otherfields about strategies

� Meeting with all members of differ-ent facets (disciplines) of industry

� Varied perspectives; I especiallylook forward to examining the tool kit

� Case Studies� Networking� Discussions regarding hospitals

strategies for addressing currentproblems

� Interaction with other participantsfrom other professions and organi-zations; very good ideas!

� Meeting the folks at my table� Broad spectrum of people involved;

Good input� Group discussion� Case Studies and camaraderie� The diversity of the group� Interaction with others� Case Study� Group work on problem-solving

strategies with Case Studies

� Discussion with participants� Networking and table group regard-

ing interventions/solutions� Opportunity for dialogue with

people from various organizationswho face common problems

� Day of week and time were good� Group problem solving and

facilitation� Hearing other solutions and similar

problems� Interesting; almost reassuring that

we are all experiencing the sameissues; Sharing common goals byusing Case-Studies

� Working on the Case Study� All the different opinions and ideas� Group comments and discussions� Case presentations; table discus-

sions with group� Brainstorming with group related to

communication (?) Health Careissues

� The assessment tool� Other disciplines-same problems,

but somewhat different perspective� Meeting new people from different

backgrounds and hearing we allhave some of the same problems

� Information in handout� To interact with other colleagues, to

see their perspective on some of thecommon issues we all deal witheveryday. To see how they attemptto solve problems. To focus onproblems and solutions to make this.

� Interaction with my group� The networking; discussions; ideas� Case Studies; Sharing of ides within

our group and in presentations. Veryhelpful and informative. Thoughtprovoking

� Group discussion� Group presentations� Interactions with others� The small group dialogue and

sharing of ideas. The members ofmy group were varied and I learneda lot from them.

� The presentations of Case Studiesreports

� Interaction from many disciplines� The discussion of various issues with

the Case Study was great.Representatives with differentbackgrounds discussed commonproblems, but the different solutionsused in hospitals, nursing homes, etc.

� Dialogue with other Health Careworkers.

� The group activity� Being paired with other fields

within healthcare� Group reporting of team results;

Having different level or knowledgeperspective

� Sharing of ideas, especially things toimprove upon

� Group� Case Study and group problem-

solving� Group discussions

� Interaction with other Health CareMembers

� Chance for Open Communicationwith other tables and disciplines

� Listening to group presentations onperspectives and ideas

� Listening� The reports on problem-solving

strategies� Group discussion� Case study; Discussing different

ideas with other Health care profes-sionals

� The group participants and summa-ry of the case studies

� Small dialogues; Reports� Sharing of best practices� Small group discussions� Shared Learning� Table discussion; Case study

discussions� Report of the case study strategies� Hearing from others� Open discussion and dialogue� The presentations� Exchange of ideas; Interaction� Group presentations� Listening� Case-Study discussion at tables;

Many ways of reviewing a problem;Amazing how upper managementlooks at a problem-staffing was theone of the last issues addressed!

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Summary Evaluation D

Regional Invitational Forums on Workplace Excellence19

4. I thought we could have done without:

� It was all good; It would have beenhelpful if we all could have readboth case studies

� More variety of Case Studies wouldhave been helpful

� All of it was beneficial� I thought this forum was very

positive� Well planned; Topic of value

presented in a timely manner� All that was necessary to make this

forum such a success; has been done

� Completion of assessment tool� All was appropriate� Would like to have talked with

more individuals, not at tables;longer time for more interaction

� I felt all sessions were beneficial� Everything seemed appropriate� Nothing noted� Too much focus on the negatives� Room was too cold� Lunch was difficult to eat while

working

� The brownies; too tempting.� The introduction could have been

more concise� Nothing; Format was excellent.

Time well spent. Thanks for endingon time.

� It could have been better to have acase mix study about a setting otherthan a hospital

� Dessert-just kidding!

5. I enjoyed and benefited from the opportunity to interact with people from other organizations and from differentbackgrounds.

(check one): ❒ yes (100%) ❒ no (0%)

6. It would be helpful to convene a forum or some type of gathering on workplace excellence on an annual basis.

(check one): ❒ yes (99%) ❒ no (1%)

7. Other comments and recommendations:

� Having individuals at table fromdifferent areas helped withopenness; Not competing with eachother

� Need staff members from govern-ment regulations (Surveyors)/PolicyMembers

� Focus on obtaining multiple disci-plines from same organizations

� Very Informative� The participants were selected with

a variety of backgrounds. Thisprocess helped bring different viewsof the work environment.

� Well Organized� Include physicians in the forum� Communicate back to the partici-

pants, organizations, associations;the results of this and other forums

� Would like to discuss in moredetail; retention strategies

� It would be good to pick an actualproblem (with their permission) of afacility and brainstorm with themto help solve this problem

� Thoroughly enjoyed this!� Enjoyed!� Would like to hear something new.

We seem to all be doing the samethings. Maybe some consultantcould present new ideas, etc…

� Participant list distributed the endof the meeting

� Organized with facilitation� I would like to have had more time

to discuss ideas with others� Tight use of time appreciated� Thanks for the invitation. It was

enjoyable and time well spent.� Maybe more time

� I like the regional routine (?) of this� Keep/Continue to gather informa-

tion to help the Health Care workerto have a more conducive environ-ment

� Excellent coordination; Programmoved! No dead time. Respectful ofparticipant’s time! Good CaseStudies, we all could relate to.

� Excellent idea but I hope one astate level, some of the strategieswill be reviewed

� I enjoyed it, thanks.� You ended right on time! That is

great!� Send reading materials and agenda

before meeting� Provide an opportunity for ideas

generated by the group; that werenot necessarily in response to(directly) to the case scenario.

� (Less Broad) Future Forums–Focusless on what problems are–butmore specific practical solutions for BOTH short term and longthem “industry solutions; RE:“Communication”–Who, What,When Where, How (DevelopSystem) and learn effects of excel-lent communication now; Start asystem of compiling statistics for 5-10 years out.

� Wish we had more time; Wish I’d had the tool kit prior to theforum; Visuals higher than speaker(blocked), Microphone for eachpresenter (reporter)

� Diet Sprite!� Discussions on what works at your

facility� “Certificate of Attendance” at such

volunteer forums� Forum was very innovative and the

interaction with other healthcarepersonnel really makes a difference

� Perhaps your synopsis could includethe central concept of active listen-ing, rather than the upper level ofmanagements conception that midlevel’s to front lines require talking“to”

� Workforce issues of nurses in thetrenches and solutions; multigenera-tional workforce

� As the facilitators stated, theprimary issue is how to go aboutimplementing the ideas. Where tobegin. Is it reasonable to have ideassubmitted to CEO’s and boardmembers of these forums withsuggestions mode?

� I enjoyed it.� Well organized; informative; good

networking opportunity� Well organized and on time!� This is the beginning of making

change. I love having administra-tion, staff and ancillary stafftogether to make change comeabout. Each piece makes the puzzleclearer.

� Have an instructor discussion onsome of the ideas of best practice sowe can hear from real stories. It feltas if we didn’t quite finish. T/U (?)with stats RE: Our Region

� Time well spent. Beneficial� Very well done. Thank you.

Ap

pe

nd

ix

Summary EvaluationD

Regional Invitational Forums on Workplace Excellence 20

produced for the Health Care Workforce Policy Advisory Committee

by the Division of Health Planning

2 Peachtree Street, NWAtlanta, Georgia 30303-3159

www.communityhealth.state.ga.us