Chapter Tools




Advance Your Emergency Department

Introduction: The New Reality


Section 1: Operate Efficiently

Chapter 1: Driving Performance

Chapter 2: Aligning Goals and Metrics

Chapter 3: Driving Efficient Flow


Section 2: Communicate Effectively

Chapter 4: Advanced Communication Tools

Chapter 5: Skills Validation and Verification

Chapter 6: Coaching for Performance


Section 3: Collaborate Consistently

Chapter 7: Driving Collaboration within the ED

Chapter 8: Driving Collaboration within the Hospital

Chapter 9: Driving Collaborations within the Community





The CG CAHPS Handbook

Chapter 1

Figure 1.2: CG CAHPS Core Questions and Composites
Figure 1.3: CG CAHPS Survey Family Tree
Figure 1.5: CG CAHPS Survey Questions Mappped by Composite

Chapter 2

Figure 2.1: CG CAHPS Fundamentals Self Test
Figure 2.2: CG CAHPS Fundamentals Self Test Tactic Guide
Figure 2.3 & 2.5: Acronym for AIDET and Composites Impacted by AIDET
Figure 2.8: CARE Service Recovery Model

Section One:

Figure i.1: Access Self Test
Figure i.2: Access Self Test and Composite Question Guide
Figure i.3: Access Composite Questions and Tactics Guide

Chapter 3

Figure 3.1: Sample Provider Schedule
Figure 3.2: Practice Scheduling Template

Chapter 4

Figure 4.1: Call Tracking Log Sample

Chapter 5

Figure 5.1: Huddle Agenda Sample
Figure 5.2: Status Board Sample
Figure 5.3: Room and Round Key Word for Office Staff

Section Two:

Figure ii.1: Provider Communication Self Test
Figure ii.2: Provider Communication Self Test Question Guide
Figure ii.3: Provider Communication Questions and Tactics Guide

Chapter 6

Figure 6.3: Patient Visit Guide Sample
Figure 6.4: Share Care Plan Conversation Starter
Figure 6.5: AIDET for Effective Explanations

Chapter 7

Figure 7.1: Careful Listening Through AIDET
Figure 7.2: NonVerbal Communication Techniques

Chapter 8

Figure 8.1: AIDET for Easy to Understand Explanations

Chapter 9

Figure 9.1: Sample Patient What Poster
Figure 9.2: Individual Patient Care Card
Figure 9.3: Sample Patient Scouting Report

Chapter 10

Figure 10.2: CARE Service Recovery Model

Section Three:

Figure iii.1: Test Results and Follow Up Self Test
Figure iii.2: Test Results and Follow Up Self Test Question and Tactics Guide

Chapter 12

Figure 12.1: Menu Example
Figure 12.2: Sample Test Results Communication Card

Section Four:

Figure iv.2: Courtesy and Helpfulness of Office Staff Self Test
Figure iv.3: Courtesy and Helpfulness of Office Staff Self Test Questions and Tactics Guide

Chapter 13

Figure 13.1: AIDET Validation Tool
Figure 13.2: Patient Reception Card Sample
Figure 13.3: Sample AIDET When Rounding
Figure 13.4: Rounding in the Reception Area Rounding Log Sample

Section Five:

Figure v.1: Overall Provider Rating Self Test

Chapter 15

Figure 15.1: Evidence-Based Leadership Framework
Figure 15.2: The Healthcare Flywheel

Chapter 16

Figure 16.1: Objective Goals with SMART
Figure 16.2: Cascade of CG CAHPS Goals Through An Organization
Figure 16.3: Sample CG CAHPS Goals Overall Rating
Figure 16.4: Example CG CAHPS Goals by Pillar
Figure 16.5: Sample Provider Feedback System Performance Summary




Engaging Physicians

Engaging Physicians - Tools by Stage


Stage 2: Leadership Development and Accountability for Performance
Leader Evaluation Manager - CEO Sample
Comparison of Accountability for Performance
Leader Evaluation Manager - Inpatient Physician Leader Sample
Leader Evaluation Manager - Outpatient Physician Leader Sample
Leader Evaluation Manager - Individual Leader Report

Stage 3: Establishing Physician Confidence and Trust
Sample Physician Satisfaction Survey
Regular Structured Communication Sample: Stoplight Report
Physician Rounding Log Sample
Physician Preference Card Sample
Key Questions for Discharge Phone Calls

Stage 4: Building Physician Leadership
Sample Contract for Physician Champion

Stage 6: Physician Measurement and Balanced Score Card
Nurse Feedback on Physician Interactions Survey Sample
Physician Peer Review Survey Sample
Balanced Outpatient Physician Score Card Sample
Inpatient Physician Score Card Sample
ER Physician Score Card Sample

The Physician Engagement Leader Checklist
Physician Engagement Stages With Self-Test





Excellence in the Emergency Department

Section 1: Why Change?

Chapter 1 – The Resistance Reality
Why people don't do what we want them to
How to conduct high middle low performer conversations (mentioned on page 13)

Chapter 2 – Building the Case for Service
Evidence-based leadership in the ED (Figure 2.1)

Chapter 3 – Connecting the Dots
Health care flywheel (Figure 3.1)
Lower employee turnover means better patient care (Figure 3.2)
The five pillars deliver bottom-line results (Figure 3.3)


Section 2: Three Must Have Tactics to Move Your ED in 90 Days

Chapter 4 – Rounding for Outcomes
Sample leader rounding on staff log (Figure 4.1)
Stoplight report (Figure 4.2)
Stoplight report blank template (Figure 4.2)
Evidence-based tactics reduce employee turnover (Figure 4.3)
Sample ED leader rounding on patients log (Figure 4.4)
Leader rounding on patients increases patient satisfaction (Figure 4.5)
Rounding in the reception area reduces ED left without being seen (Figure 4.6)
Sample key words (mentioned on p. 69 of book)
Sample ED reception area log for hourly rounding (Figure 4.7)

Chapter 5 – Discharge Phone Calls
Sample ED discharge phone call question template (Figure 5.1)
Sample ED discharge phone call trend report (Figure 5.2)
Discharge phone calls improve likelihood to recommend (Figure 5.3)

Chapter 6 – Bedside Shift Report
Bedside shift report improves patient satisfaction (Figure 6.1)
Sample letter to patients about bedside shift report
How to use SBAR(T) in ED bedside shift report (Figure 6.2)
Staff bedside shift report and evaluator competency assessment (Page 101)
ED bedside weekly report (Figure 6.3)
ED bedside weekly report blank template (Figure 6.3)


Section 3: Advanced Tactics to Accelerate and Sustain Success

Chapter 7 – Key Words at Key Times
Top 10 key words and better key words (Figure 7.1)
AIDET: the five fundamentals of service (Figure 7.2)
Key words and rounding drive ED volumes (Figure 7.3)

Chapter 8 – Hourly Rounding With Individualized Patient Care in the ED
Studer Alliance for Health Care Research 2006 ED study (mentioned on page 128)
Individualized patient care (Figure 8.1)
ED hourly rounding log with individualized patient care in treatment area (Figure 8.2)
ED hourly rounds dashboard (Figure 8.3)
ED hourly rounds dashboard blank template (Figure 8.3)
Sample hourly rounding competency check list (Figure 8.4)
Sample hourly rounding competency check list blank template (Figure 8.4)

Chapter 9 – Interdepartmental Communication Tools
Sample internal customer rounding log (Figure 9.1)
Sample internal customer rounding log blank template (Figure 9.1)
Reminder card (Figure 9.2)




Excellence With an Edge

Chapter 1


Section 1 - The "Sharp" Edge—Language and Tools to Excel

Chapter 2

Chapter 3

Chapter 4


Section 2 - The "Smooth" edge—The Power of Targeted Marketing and Strategic Planning

Chapter 5





Hardwiring Excellence

Chapter 2: Healthcare Flywheel

Chapter 3: Principle 1: Commit to Excellence

Chapter 6: Principle 4: Create and Develop Leaders

Chapter 7: Principle 5: Focus on Employee Satisfaction

Chapter 8: Principle 6: Build Individual Accountability

Chapter 9: Principle 7: Align Behaviors with Goals and Values

Chapter 11: Principle 9: Recognize and Reward Success





Hardwiring Flow

Chapter 1 – Defining Flow: The Foundations of Flow
The benefit-to-burden ratio defining flow in health care (Figure 1.1)
Mechanisms to increase, decrease, or keep static variables of benefits and burdens and increase or decrease value (Figure 1.2)
The seven types of waste that must be eliminated (Figure 1.3)
The two kinds of hunts (Figure 1.4)

Chapter 2 – Hardwiring for Flow: Key Strategies for Improving Flow
Demand-capacity management strategies (Figure 2.1)
Patient flow in an emergency department (Figure 2.2)
MICU utilization and patient rejection (Figure 2.3)
A real-time dashboard to manage queuing (Figure 2.4)
Analyzing and managing bottlenecks in a hospital (Table 2.1)
Effect of variation of call length on number of callers on hold (Figure 2.5)
Navy flight mishap rates (Figure 2.6)

Chapter 3 – Flow’s Teammates: Customer Service, Patient Safety, Lean Management, Six Sigma, and High-Reliability Organizations
A-team members (Figure 3.1)
B-team members (Figure 3.2)
The patient custo-meter (Figure 3.3)
The patient/customer relationship (Figure 3.4)
The three A-team behaviors (Table 3.1)
The A-team toolkit: Ten highly effective tactics for improving patient satisfaction and perception of flow (Figure 3.5)
The two pathways of Six Sigma (Table 3.2)
Representative patient-safety programs (Figure 3.6)

Chapter 4 – Leading for Flow
Extrinsic vs. natural change (Figure 4.1)
Extrinsic vs. intrinsic change (Figure 4.2)
Differences between the skills of leadership and management (Figure 4.3)
The difference between level 5 and level 4 leaders (Figure 4.4)
Pillar management: Populating the pillars with defined goals (Figure 4.5)

Chapter 5 – Show Me the Money: Making the Business Case for Improving Flow
Reducing wage cost per admission from a flow perspective (Figure 5.1)
Increasing bed turns (Figure 5.2)
The benefits of using scribes (Table 5.1)

Chapter 6 – Engaging Physicians in Flow: The Rate-Limiting Step
Differences in the education and training of physicians and nurses (Table 6.1)
Three models for obtaining physician engagement (Table 6.2)
Rogers’ theory of change (Figure 6.1)
Pillar management with discrete goals in each of the five pillars (Figure 6.2)
Physician behavior standards – best practices – Inova Fairfax Hospital, department of emergency management (Figure 6.3)

Chapter 7 – Emergency Department Flow: The Hospital’s Front Door
Patient satisfaction by time spent in ED (Figure 7.1)
Critical ED patient flow concepts (Figure 7.2)
Emergency department arrivals and staffing by hour (Figure 7.3)
The front end flow cascade: A portfolio of programs to increase value and eliminate waste (Figure 7.4)
The ESI five-level triage system (Figure 7.5)
Segmenting ED patient flow (Figure 7.6)
Keep your vertical patients vertical and moving (Figure 7.7)
Identifying and communicating potential admissions from the emergency department (Figure 7.8)
Accelerating admissions from the ED and optimizing patient flow (Table 7.1)

Chapter 8 – Inpatient Flow: Rethinking the Hospital Experience
An administrative system for flow (Figure 8.1)
The inpatient flow dashboard (Figure 8.2)
The IHI approach to real-time demand-capacity management (RTDC) (Figure 8.3)
WellSpan Hospital’s patient-flow zone system (Figure 8.4)
WellSpan York Hospital’s bed capacity guidelines (Figure 8.5)
A systems approach to improving flow based on demand-capacity management (Figure 8.6)

Chapter 9 – Surgical Flow
Tactics for optimizing surgical flow (Figure 9.1)
A surgical process timeline (Figure 9.2)
Staggered start time (Figure 9.3)
Surgical admission case demand mapping (Figure 9.4)

Chapter 10 – Case Studies in Flow
Challenges to implementing a proposed new and off-site fast track (Figure 10.1)
Reducing waiting times in the ECC (Figure 10.2)
Key words used to deflect resistance (Table 10.1)
Results of Wenatchee Valley Medical Center’s triage-improvement trial (Figure 10.3)





The HCAHPS Handbook

Chapter 1: HCAHPS Counts: Why It’s Your Key to Pay-for-Performance Success

Chapter 2: The Fundamentals: What You Must Know to Improve Your HCAHPS Scores


Section 1: Nursing Communication

Chapter 3: Courtesy and Respect (A Goal for Nurses and All Staff Members)

Chapter 5: Understandable Explanations


Section 2: Doctor Communication

Chapter 8: Doctor Explanation of Care


Section 3: Responsiveness of Staff

Chapter 9: Pre- and Post-Visit Patient Calls

Chapter 10: Hourly Rounding on Patients


Section 4: Pain Management

Chapter 11: Control of Pain/Helpfulness of Staff


Section 5: Communication of Medications

Chapter 12: Explanation Regarding Medications and Side Effects


Section 6: Discharge Information

Chapter 14: Written Symptom/Health Problem Information


Section 7: Hospital Environment

Chapter 16: Service Recovery


Section 8: Overall Rating of Hospital & Willingness to Recommend

Chapter 17: Overall Rating/Willingness to Recommend

The HCAHPS Handbook Supporting Resources




Nurse Leader Handbook


Section 1: Tactics to Manage and Lead

Chapter 1: Effective Communication

Chapter 2: Rounding on Staff

Chapter 3: Performance Management

Chapter 5: highmiddlelow® Performers and Critical Conversations

Chapter 6: Selecting and Retaining Talent

Chapter 7: Developing the Healthcare Team


Section 2: Tactics to Implement for Better Patient Care

Chapter 8 Nurse Leader Rounding on Patients

Chapter 9: Pre- and Post-Visit Patient Calls

Chapter 10: Hourly Rounding on Patients

Chapter 11: The Bedside Shift Report

Chapter 12: Individualized Patient Care

Chapter 13: Key Words at Key Times (AIDET)

Chapter 14: Service Recovery


Section 3: Knowledge Fundamentals

Chapter 15: Goal Management

Chapter 16: Understanding Financial Impact (From ROI to Revenue Creation)

Chapter 18: Measurement

Chapter 19: A Culture of Safety

Chapter 20: Collaborating with Physicians


Section 4: Professional Development

Chapter 21: Effective Meetings

Chapter 22: Supervisory Meeting Model

Chapter 25: How to Manage Change (Nursing Evolution Required)

  • Page 338 – The “Tough Questions Exercise” provides a structure method to anticipating and answering possible tough questions.

Chapter 26: Walking Life’s Tightrope





Straight A Leadership

Straight A Leadership:
Alignment, Action, Accountability

Section 1: The Straight A Diagnosis

Chapter 1 - Alignment

Chapter 2 - Action

Chapter 3 - Accountability

Chapter 4 - Leader Consistency and Best Practices


Section 2: External Environment Communication Tools

Chapter 5 - Senior Leader Visibility

Chapter 6 - Tough Questions

Chapter 7 - The Financial Impact Grid

Chapter 8 - Supervisory Meeting Model

Chapter 9 - Rounding for External Environment Issues

Chapter 11 - Employee Forums

Chapter 12 - Communication Boards


Section 3: Senior Leader Toolkit

Chapter 14 - Senior Leader Toolkit


Section 4: The Basics

Chapter 15 - A Word About Consistency





The Value of Employee Retention

Author: Quint Studer
Publication Name: hfm
Published Date: 03/01/2004

Throughout my years in healthcare administration, I used to think, "Life will be good if we can just re-engineer to cut expenses."

Later, I was sure it was just a question of finding ways to reduce length of stay. But then came managing vertical integration, managed care, patient safety, malpractice insurance, and the uninsured. All are very important issues. Eventually, I realized that after so much crisis and so many flavor-of-the-month initiatives, health care had lost the hearts and souls of its nurses-not to mention physicians, administrators, and financial managers. Many good people have left health care because they feel the barriers to delivering high-quality care are too many, they are confused about the direction of their organizations, and they no longer feel that their work is worthwhile.

As a result, agency and registry expenses are driving our labor expenses up. Staff turnover is higher than we would like. Predictions are for even greater staff shortages ahead.

High employee retention is key to service excellence and operational excellence. By retaining more staff, organizations will reduce overtime and use of temporary staff. With lower employee turnover, transition costs for new employees (e.g., physicals, drug tests, and orientation costs) decrease. Length of stay will go down because seasoned employees will move a patient through the system more efficiently. Because a retained staff understands the organization's processes and procedures, fewer medical errors and better clinical outcomes will occur. Even patient volume rises as physicians appreciate the opportunity to work with the same well-trained individuals, and thus refer more patients to the hospital. With more efficient operations and better throughput, a retained staff also ensures fewer patients leave without treatment in the emergency department. And finally, greater employee satisfaction correlates to higher patient satisfaction resulting in fewer claims and lower malpractice insurance.

But how do we win back our workforce?

Five-Pillar Leadership

The best way to ensure a retained workforce is what we call "five-pillar leadership." Five-pillar leadership is a sustained focus on people, service, quality, finance, and growth. These five pillars support an organization's journey to enduring service and operational excellence, and a key part of that excellence is a loyal, productive staff. By setting metrics under goals for each of the pillars, and by measuring progress toward the goals, healthcare leaders get results. Results in the first three pillars-people, service, and quality-drive results in the last two pillars-finance and growth.

Following are key prescriptive practices that five-pillar leaders can use to drive employee retention, examples of the kinds of results these practices can achieve, and tools that leaders use to "hardwire" strategic direction, communication, and accountability across all five pillars. The result: a culture of service and operational excellence, and a great place for employees to work, physicians to practice, and patients to receive care.

Perhaps more importantly, the tools that follow will help leaders "re-recruit" their best employees every day. By using these tools, leaders can engage in authentic dialogue with workers to remove barriers to performance; in turn, employees will feel valued and know they are making a difference.

A Domino Effect

Finance professionals quickly grasp the relationship between the five pillars of leadership and employee retention because they know what the cost of turnover means to bottom-line results. However, when I was moving up the ranks of hospital leadership, it took me some time to understand the cause-and-effect relationship between cost cutting and employee retention. When a nurse manager quit, my first thought was not "How can we fill that position?" but rather "How can we consolidate that position to save $84,000 in salary and benefits?" So when Jane Smith left, we put nurse manager Tina Jones in charge of two units. But since Tina was managing 70 employees on two floors, the nurses she supervised didn't have the same personal relationship with her that they had enjoyed with Jane. They didn't even know when she was on the unit.

Employees typically cite an unsatisfying relationship with their boss as one of the top reasons they leave their job. It's no surprise then that turnover went up. Agency costs soon soared, and quality clinical outcomes began to decrease with greater reliance on temporary caregivers, who had a "renter" versus "owner" mentality. The result was more frequent readmissions of patients and unhappy physicians who began to refer their patients elsewhere. So my effort to reduce expenses actually cost our organization quite a bit of money.

Fortunately, this domino effect also works in reverse. As a focus on people encourages employees to become more engaged and satisfaction rises, retention then increases and drives substantial gains in each of the other pillars. As an example, consider St. Alexius Medical Center, a 321-bed community hospital in Hoffman Estates, Ill. By creating a culture of service and operational excellence, Christine Budzinsky, the hospital's CNO, reduced nurse turnover from 20 percent in 2000 to just 8.5 percent in September 2003 and nearly eliminated agency costs. The average savings that has resulted is nearly $200,000 per month. It's no coincidence that Gallup ranks St. Alexius in the 90th percentile for employee satisfaction among hospitals nationwide.

How exactly does an organization demonstrate commitment to its people and begin this positive domino effect? Although there are many ways to encourage staff satisfaction, the following three approaches typically lead to the greatest success. In order of their impact on employee retention, the tools are:

  • Effective leader rounding
  • 30 and 90-day new employee retention meetings
  • Peer-recommended employee selection

Effective Leader Rounding

If you can only implement one tool to engage your employees, this is the one to implement. Effective leader rounding involves creating an ongoing dialogue with employees in your own department and in other areas of the organization. The goals and desired outcomes of these conversations are very specific: to fix systems, remove barriers, model "ownership" behaviors, ensure goals are getting accomplished, and identify staff to be rewarded and recognized.

Leaders should approach rounding with key questions such as "What's going well?" "Do you have the tools and equipment to do your job today?" "Who has been helpful to you?" "Which systems can be improved?" When employees have these conversations with their supervisors, they know their boss cares about them as individuals, will listen to their concerns, and appreciates them. These are the key drivers of employee satisfaction.

30 and 90-Day Retention Meetings

It's particularly important to focus retention efforts on those newly hired. Our experience indicates that more than a quarter of employees who leave health care do so in the first 90 days of employment. To demonstrate a people-first commitment to employees, supervisors should meet with each new employee at the 30- and 90-day mark and ask the following questions:

How do we compare with what we said in your interviewing process? Employees frequently have concerns during the first month of employment that should be addressed. As an example, I remember someone newly hired in our business office who took the position because she would start at 8 a.m. and could get her children off to school. During our 30-day meeting, I learned that her start time had been moved to 7:30 a.m., and so she was already seeking a new position elsewhere. By addressing her frustration and changing her hours, the hospital was able to prevent her departure.

What's working well? In health care, we have a tendency to focus on what's wrong. This approach is good because it is how we save lives and diagnose illnesses. However, in a service-driven culture, we also must strive to promote satisfaction. By asking this question, healthcare leaders can encourage a positive mind set early in a new employee.

Which individuals have been helpful to you? When a new employee offers names of other employees who have been helpful to him or her, you should recognize these individuals directly. Doing so can improve how the new employee will be accepted within the established culture. For example, a leader might want to say, "Steve, Sue tells me how helpful you've been these first days in helping her prioritize collections. Thanks so much." Instead of feeling resentful about all of the attention Sue is receiving as a new employee, Steve now perceives her as an asset-a way to receive compliments. She will immediately be perceived as more likeable by Steve.

Based on your past experience, what systems or ideas do you feel could improve our operations? This question demonstrates that the leader is approachable and has an interest in employee input. It also provides an opportunity for the hospital to harvest intellectual capital from other organizations where the individual has been employed. In health care, when employees tell us how they did it at their last organization, we often tell them, "That's not how we do it here." Instead say, "There must be many things you did at Hospital A that we could learn from here. What are those things?"

Is there anything you are experiencing that would cause you to think about leaving? The questions discussed previously have demonstrated concern for the new employee's satisfaction, leadership's approachability, a desire to make systems work, and willingness to look for and recognize positives. This question seals your commitment to the employee.

Using Peer Review for Employee Selection

Because ensuring a good initial fit is so critical to employee retention, organizations should use a disciplined approach to employee selection. One way to encourage good hiring is to have staff members in the department interview pre-screened candidates. Not only does peer-interviewing ensure the best cultural fit between the candidate and the organization, but it also fosters a sense of investment among current staff when they make the recommendation to hire.

Here are several suggestions for successful peer interviewing:

  • Pilot the peer-interviewing process in a strong department before rolling it out to the rest of the organization.
  • Include the department manager and those who will be working most closely with the hire in the peer interview.
  • Ensure that interviewers select behavioral-based questions to ask that address not only job-related skills and accomplishments, but also communication, problem solving, and leadership skills. Good questions will also assess personality/temperament, teamwork, and integrity, as well as customer service, creativity, initiative, diligence, and ability to prioritize.
  • Interviewers should rate each candidate privately using a 1-to-5 rating scale where "1" is "not a good hire," and "5" is "what a find!"
  • The hiring manager should act as facilitator.

Hardwiring Five-Pillar Leadership

Strategic direction, communication, and accountability along the five pillars must be aligned throughout the organization and "hardwired" into leaders' activities to create a true culture of service and operational excellence, and to attract and retain employees. Here are some tools to help ensure consistency.

Meeting agendas by pillar. One reason employees tend to leave is that they don't understand where the organization is headed and there appears to be a new direction every few years. By aligning strategic direction with goals under the people, service, quality, finance, and growth pillars at every level of the organization, employees understand that although tactics may change, the organization's strategies remain the same.

One notable way to demonstrate the organization's commitment to five-pillar leadership is to structure all meeting agendas by pillar. Doing so provides a consistent message on strategic direction and lays an important foundation for aligning performance communications and evaluations with the organization's goals.

At Sierra-Providence Health Network, a three-hospital healthcare system in El Paso, Tex., CEO Tom Cassady uses the five-pillar agenda as part of the communication plan he implements at all levels of the organization. At leader meetings, he requires directors to take notes and share them with department staff. Cassady then reviews the minutes of department meetings to ensure key points are being communicated to all staff.

Communication boards. Since agendas and evaluations are across all five pillars, communications should be aligned in the same way. One useful technique is to post communication boards in each department that measure and track the department's progress. Doing so ensures all employees have access to the same current data, and it provides a means for documenting progress toward meeting the goals.

At Provena Mercy Center, each hospital department communication board includes current department-specific results by pillar, as well as a separate window with staff photos and thank-you notes from patients. Examples of results that could be posted under each pillar include:

  • People: Statistics on hospital or unit vacancy rates, turnover, and featured staff
  • Service: Unit-specific monthly or weekly patient-satisfaction scores
  • Quality: For an emergency department, a door-to-catheterization time of 60 minutes or less
  • Growth: For an operating room, the number of surgical cases
  • Finance: For a nursing unit, agency costs

Valley Hospital in Ridgewood, N.J., also has found this means of communication helpful. When "better communication and enhanced reward and recognition" were listed as top opportunities for improvement on a 2000 employee-satisfaction survey, President and CEO Audrey Meyers used communication boards in combination with other tools like hand-written thank-you notes and employee forums to respond. Not only did the number of employees who responded to the survey double to 66 percent after these tools were used, but also Valley Hospital moved from the 60th to 85th percentile in employee satisfaction (AHA region two) over three years.

The leader evaluation tool. Once an organization has set clear expectations, it must hold individuals accountable for the results they achieve. An evaluation tool based on the five pillars is useful for this process.

All goals should flow from organizational objectives that reflect the organization's commitment to people, service, quality, finance, and growth. Note: Some leaders may not have goals under all these pillars. Also, goals may be weighted differently. For example, service goals may be a greater percentage of a hospital CNO's evaluation than that of a system CFO. Organizations should then use a five-point scale to rate results within each pillar (poor to very good). As a result, leaders and staff will know ahead of time how their performance will affect scores. There will be no surprises.

Organizations that structure evaluations in this way earn employee trust because it is clear that everyone is being held accountable to the same standards. As Jack Barto, CEO of Provena Mercy Center, Aurora, Illinois, explains, "The number one change we need in health care is more accountability. This value fundamentally changes the relationship between senior leadership and the rest of the leadership team. The relationship becomes more adult because expectations are clear and evaluation is objective."

The Power of Worthwhile Work

I recently met a CFO while speaking to a large group of employees at a healthcare system. He was introduced to me as "the guy focused on money" and was teased good naturedly about his aggressive approach to accounts receivable. I was impressed to learn his A/R was just 44 days. When we chatted during a break, I asked him why he got into health care. He told me that when he was in high school, his best friend had been in a car accident. He explained how he had waited in the emergency department while his friend was in surgery and what it was like when the physician told him his friend had died. He said the experience had such a profound impact on him that he decided he wanted to work in health care. But since his strength was with numbers, he became an accountant first and then sought out a finance position in health care.

He told me that the reason he works so hard on A/R is because he knows that the faster he collects money, the more quickly it can be reinvested back into the bedside. When I shared this story with my audience of hospital employees after the break, I could tell by the look in the eyes of the many clinicians who were there that they would never look at that CFO the same way again. I believe that financial managers work in healthcare for the same reasons clinicians do: purpose, worthwhile work, and the opportunity to make a difference.

If we can help people reconnect to their sense of purpose and doing worthwhile work, our workforce will be engaged like never before. Five- pillar leadership is not for the meek, but the rewards are many.


A retained workforce is directly related to bottom-line results. But in health care, many of our best workers have left because the barriers to doing their jobs seem insurmountable and eventually take away their sense of doing purposeful, worthwhile work.

We can win back our workforce by creating and sustaining a culture of service and operational excellence.