I originally presented this talk when health system leadership asked me to speak about ways we recognized our employees in the ED. Recognition in the form of awards is nice, but it’s not what people need. It’s not what makes them stay. And it’s not what makes them the most proud.
“It cycles like this every so often. It’ll be fine eventually.”
I accepted this as a fact of life when I came here, because everyone said it. Every year or two in the emergency department, there would be an exodus of nurses. Despite our amazing group, despite our beautiful site, someone would leave. And others would follow. That was just the way it was and would always be.
A little over a year ago, however, the unthinkable happened. We lost our nursing director, manager, and nearly 50% of our nursing staff. The morale was lower than I’d ever seen it since joining the group.
I believe that oftentimes, especially in healthcare, when change is needed, we ask our employees to change. To be happier, to do better, to put their heads down and grind it out. We might even cheer them on and give them high fives for encouragement. This is how our department handled things in the past. And then we’d wait for the storm to pass and we’d get “normal” again, only waiting for the next cycle of departures to happen.
They say the definition of insanity is doing something the same way over and over again expecting different results.
This time we had to change. And we did. We saw this chance as an opportunity, as a new start, to create something incredible. As department leadership, we changed our mindset. We learned from our mistakes and continued to improve. We created a department that functions and feels as incredible as the people who work within it. I’d like to share the rules that drove our changes today while I share our journey with you, a journey of how we took one of the worst things to happen to our young department and turn it into our advantage.
Rule 1. Create a vision.
While we had just suffered some major losses, we were grateful for the many employees who were still around. There was a great deal of worry in our department, but there was even more loyalty. We wanted to know the reasons for that loyalty, the source of people’s strength, so we could foster it, nurture it, and promote that strength.
We sent out a survey to every employee of our ED (docs, nurses, techs) and asked them what they loved about our emergency department. We received an incredible number of responses, and read every one closely. We identified themes and using those responses, created our department’s mission statement. “Working and learning together to provide outstanding care to our community in their time of need; treating ourselves and others with respect and love to heal the hurting and fix the broken.”
That mission statement hangs at the entrance to our department, so that everyone can see it every day. To remind themselves of the why and the how of what we do. The most incredible part is that this statement comes from everybody’s voice. We’re not telling them how to be. They told us how they love to be. And instead of enforcing a culture on the people “below,” we built our culture from the ground up by giving everyone a voice.
Rule 2. Make everyone matter.
We know, however, that just being happy and promoting love won’t fix everything. We recognized there were serious problems that caused people to leave. While our CAO and CNO scrambled tirelessly to find solutions for the staffing problem at hand, a small group in our emergency department went to work with a question.
Not “Why us?” Not “why does this always happen?” Instead, we wanted to know “What matters to everybody?”
Erin Ward, a nighttime charge nurse, created a survey for the nursing and medic staff called “You Matter.” Within it, she asked about career goals, she asked what makes people proud about the department, she asked what makes people happy. Not at work. But in general. And she asked what could be improved about their workplace.
Answers flooded in. Communication from leadership was lacking. They wanted education. They felt teamwork wasn’t encouraged. Staffing was poor, especially at night.
We’ve all filled out surveys. In fact, many of us are “surveyed out.” I, personally, hate filling out surveys unless there’s some sort of monetary incentive. Because otherwise, I feel like they’re not worth my time.
But Erin, with the help of Chelsea Brucker, another nighttime charge nurse, made them worth people’s time. They literally sat down with every single person who submitted a survey. And they listened. They didn’t have the answers. But they had their attention. And they had the ear of the department and hospital leadership.
This showed that every single person matters, their responses mattered, and their lives mattered, which brings us to:
Rule 3. Communication is everything.
When people think of communication, they oftentimes think about the best way to deliver a message. But the most important part of effective communication is active and attentive listening, which Erin and Chelsea displayed.
Not only did they listen, but by this action, they communicated to everyone that we were serious about change. And we were serious about listening to people to make those changes.
Rule 4. Be open to change by being vulnerable.
We were grateful for the answers we received. We chose not to defend ourselves against the responses, but open ourselves up to change. In fact, Erin and Chelsea asked everyone for their ideas on how things could be better. We realize that the majority of the talent in our department doesn’t sit in the managerial hallway – we took ideas from anyone and everyone and considered them, and came up with some ideas of our own. Recognizing that we didn’t have all the answers allowed us to be open to anything and everything.
Thanks to hospital leadership for believing in us and realizing that change was needed, we were given resources. And we made changes.
- Erin Ward and Lisa Vogele became nurse educators. Two exceptionally passionate nurses who care about quality of care, but also about individuals. Two people who remain dedicated, working tirelessly, to create new simulations (Erin) and continually have an ear out for things that are not being fully addressed
- Staffing was immediately addressed. We needed nurses and we need techs. We needed sitters. These were addressed immediately and creatively and our staffing is markedly improved, but still not perfect.
- Set an example – Rebecca has no formal ER training. Yet she appeared almost nightly in the ED for a while. Helping however she could, in any way. Getting out there and being a part of the team, especially when you’re needed or when guidance is required. The effect of getting our hands dirty cannot be underestimated.
- We became cheerleaders.
Rule 5. Celebrate the victories.
We created the CAPE committee, which stands for celebrating and advancing the patient experience. Our focus would be twofold – celebrating our victories with patient experience, and addressing systems issues that seemed to be negatively impacting experiences. We wanted to create an environment where everyone could be at their best.
- The Rock award was created by Lisa Vogele. People don’t like when awards are chosen by leaders. There’s a lot of mystery. So we got rid of the mystery. We encourage every person in our department, if they see someone doing something extraordinary, to submit a “You Rock” Award for their colleagues. In turn, their colleague gets not only a piece of paper that goes in their files, a rock with their achievement on it, but they get that peer recognition that they deserve, and makes them feel good.
- Brian Reining, our clinical manager, combs through our Press Ganey surveys and emails those individuals that have been recognized by their patients. It takes a lot of time. It probably cuts into time where he can be doing other things. But more than meetings, more than phone calls, more than anything in a department, it’s the individuals that matter most. And that’s what matters to Brian.
- Katie Schuler, now an assistant clinical manager partially due to her efforts with CAPE created a recognition board for our committee. Katie Schuler drew on her strengths as an incredible artist to create our CAPE board, to celebrate people publicly. We select deserving PG comments and post them above people’s pictures to highlight the difference we can make by exemplifying PRIIDE values.
Rule 6. Take the hard way. Listen and respond, don’t react.
Along with the quotes , we created a position of the quarter. This came with a gift card award for the nurse, doctor, and APP of the quarter, based on their positive comments received. We wanted to highlight those people that made the biggest difference. Almost immediately, we heard grumblings.
The natural response when we hear negative feedback towards something we’ve done is to be defensive. To tell people why you chose to do something a different way, or in this case, why someone was deserving of the award. We chose to listen and learn. Leadership books actually could have predicted this response. When you single out people for praise, it doesn’t always make everyone else work harder. So,
Rule 7 and 8. Learn from your mistakes; make everything about the team.
We scrapped the awards of the quarter, and instead, made the team shoot for a goal and be rewarded together. With hospital leadership support, we now award an ice cream party to the department when we meet or exceed our patient experience score goals quarterly. In this way, people hold themselves, and their teammates, accountable. And it fosters the teamwork and camaraderie that was lacking previously, per the survey.
Rule 9. Fix the system, not the individual.
In the
CAPE committee, We remove the individual from the scenario when there are
complaints. Chances are, if someone makes a mistake, someone else will make
that same mistake in the future. So
educating the individual only goes so far, as compared to changing our system.
We address problem areas and brainstorm – that’s what our meetings are. We don’t review metrics. We think. We have an incredible team of nurses and even Jeff Perkins. Everyone in that committee has a voice and ideas are created
There are a lot of other projects that we’ve completed. There are a lot of answers to “what” have you done. But what I feel what is most important is the “how” have you done it. And that’s by focusing on change.
We continue to grow, we continue to learn, we continue to better our department. But we’re incredibly proud of our staff for holding on and for growing with us. We’ve changed as a leadership group and changed our mindset and approach.
In summary, I think we can boil everything down to 4 main rules
- Make everyone matter.
- Be grateful for everyone and give heartfelt praise whenever you can.
- Fix the system, not the individual.
- Be vulnerable, open to change, and take the hard way every time. By being vulnerable, I mean being okay with the fact that we don’t know everything and that we make mistakes. We are surrounded by tremendous talent, and if we do not make use of everybody’s ideas, we are letting amazing potential go to waste.
It’s easy to keep things the way they are, and accept them as fate, even when they’re suboptimal. Fix the system instead of people through change. It’s easy to reflexively blame people and just say we didn’t teach them well or they didn’t learn well. It’s also easy to try to make a quick fix. Social media is filled with thousands of quick fixes. “Be happier with this one simple trick!” These fixes tend to be easy, but ineffective. If we’re looking for true, recognizable change, it cannot be via a quick fix. It must be an organic change within ourselves, with our thinking, and that takes hard work and time.
People will perform well when they know that they’re an influential part of something bigger. And that’s what has happened. PRIIDE is important as an acronym, but with the right support structure for our colleagues, PRIIDE characteristics blossom naturally, because it allows our beautiful employees to be their best selves.
Involve and invest in your colleagues, empower and inspire them, and everything else will follow.
Thank you for reading our story.
