Re-Recruit High and Medium-Performing

"There isn't a nursing unit anywhere that wouldn't rather work 'short', than deal with a difficult, low performing team mate," says Sue Boland, CNO at All Saints Hospital, Racine, WI. "It's critical to breed a healthy team."

To move organizational performance, healthy organizations hardwire the ways they re-recruit high performers, coach and develop middle performers, and create performance pressure for low performers to move up or out of the organization. If not, progress slows and organizations do not achieve their full potential.

In fact, the main reason that most performance improvement initiatives fail in health care is because organizations hit a "wall" after experiencing initial success.⁵ Tenacious low performers aggressively work to recruit middle performers to their cause: resisting change. High performers tire and begin to pace themselves or move elsewhere if leaders don't hold low performers accountable.

The solution? Leaders first rank their employees against a set of objective criteria (see sidebar to download a worksheet on how to differentiate your staff ). Then they hold distinctly different conversations and follow-up with high, middle, and low performers. The goal is to re-recruit those who role model excellence; coach middle performers on areas of improvement; and outline next steps and consequences for low performers. This creates an uncomfortable gap organization wide as low performers become more isolated from high performing employees. Eventually, they improve performance or leave.

The result is improved operational performance across the board. All Saints credits the adoption of this management tool in large part to their success across several Pillars. Inpatient satisfaction has been at the 80th percentile for nine months in a row, up from the 17th percentile in 2002. Financial performance has also improved significantly since completion of these conversations in July 2004. Today, All Saints builds these conversations into every day culture. "There's no doubt about the impact these conversations have had on what we've accomplished," adds All Saints CEO Ken Buser. "It's a credit to our leadership team who evidence their level of commitment to excellence in their interactions with people every single day."

⁵ Hardwiring Excellence by Quint Studer, page 116.