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Good medicine Featured

7:00pm EDT January 26, 2009

David Ross does not like the idea that employees would be afraid to see him walk into a room at Barnes-Jewish St. Peters Hospital.

“The worst thing that can happen is we have a relationship or a culture here where every time the president comes around, something must be wrong,” says the president of the $260 million hospital. “‘Uh-oh, here come Dave Ross; that’s not good.’ I want them to think the exact opposite. I want them to think, ‘Dave is here; I have a question or a comment for him.’ The only way you can do that is through consistent, ongoing devotion to making rounds and trying to interact with your staff. I’m trying to make them feel like I’m just another staff member who happens to have the title of president.”

With just under 1,000 employees at the hospital, it would be nearly impossible for Ross to develop relationships with each and every one of his people. But the opportunity to interact with at least some of the people who work for you can pay great dividends.

“I went down to ICU, and I spent about a half-hour there, and I found out the nurses were very frustrated because the computer system, the electronic medical record system, was not working as well as it should or as quickly as it should,” Ross says.

“They were very frustrated by that. It’s just much more compelling when you witness it face to face as opposed to getting an e-mail or hearing it from a third party. If you can see something firsthand, it’s going to resonate more strongly.”

Ross got the message that there was a problem, called his IT department, and the problem was resolved.

“Hopefully, the nurses in ICU have the belief that I do care and I try to follow through and help them out whenever possible,” Ross says.

By making regular visits to other parts of the hospital, Ross is able to stay in touch with what is happening at a more personal level. He is also able to work more closely with his employees to build a stronger team that can follow through on fulfilling the hospital’s mission, vision and values.

Get out there

Getting out of your office is the first step to building a more open culture.

“It’s helpful to be transparent,” Ross says. “You need to come across as human, someone who is comfortable exposing your warts to other people and someone who is approachable. Too often, leaders isolate themselves, or through their actions, they are not perceived to be approachable. If that’s the situation, people don’t feel comfortable bringing up concerns. If that is the situation, you’re not as aware of what is bothering your employees or, for that matter, what’s going well.”

At least once a month, Ross heads down to either the inpatient or outpatient surgery center, gets on his scrubs and observes whatever procedure is being done.

“I’ll see how they work together, and if you spend a little time, they’ll appreciate it,” Ross says. “Other times, I’ll just go down to the emergency department and sit down and talk to them or listen to them for 15 or 20 minutes.”

Your encounters with employees don’t have to be long, drawn-out sessions to have an impact.

“If I have lunch with someone and we spend 20 minutes together, that person will know me better than they did before,” Ross says.

On a slightly more formal level, Ross and his managers meet with new employees for lunch after 60 days to see what their experience with the company has been like.

“I’ll specifically ask them, ‘How do you like working here? How’s the culture here? Are the employees friendly and helpful?’” Ross says.

The idea is to show that you are aware of what your people are doing in the company each day and that they are not just a number on the payroll. Your effort to take time out of your schedule to meet with them in person can have a lot more value than an e-mail or a newsletter update.

“People are judged by their actions, whether you’re the housekeeper or president or a nurse,” Ross says. “The more people you can interact with, the more people you can develop a relationship with that is positive and caring, the more likely they will try to pass on those traits and let people know what I’m like. They can communicate to their friends, ‘Yeah, I had lunch with Dave. He’s pretty normal. He does care.’”

In the absence of being able to meet with every person individually, word-of-mouth is the next best thing.

“Hopefully, most every employee has heard through people that I am approachable, I am caring and I do get out in the hospital,” Ross says.

The benefit for your visibility is an increased awareness of what is happening in your company and a level of comfort that when something does occur that you’re not directly aware of, your employees will tell you about it.

“If leadership asks them how things are going, they’ll be honest and straightforward,” Ross says. “If things are going well, they will tell you that. If there are some concerns, they will tell you that also. The best way to pursue employee satisfaction is just to talk with the employee.”

Take action

At the same time, you shouldn’t rely completely on in-person meetings to determine employee satisfaction and the level that they are buying in to your mission, vision and values.

Surveys can also be an effective feedback mechanism. But it takes effort to get beyond the, ‘Yes, I like my job’ response that doesn’t tell you anything.

“When you establish a survey, you have to hold the people who fill out the survey accountable,” Ross says. “If people just put down 3 all the time, you have to sit down and say, ‘You know what, we need more information from you. We want to hear from you. We want you to feel like you can take ownership in this and let us know what’s going well and what isn’t going well.’ Leadership has to be disciplined enough to assure thorough accountability that employees are taking the time to fill this out.”

You need to show employees that there is value to filling out the survey and that it is not a waste of their time.

“It’s not just an annoying, time-consuming process,” Ross says. “The more we can hear about departments throughout the hospital, the better the culture will be and the more likely you will enjoy your job here. Impress upon the employees how they personally will benefit. If they feel they will benefit, they will take much more ownership and be engaged.”

In a recent survey, Ross received several comments from night staffers who felt underappreciated by the organization as a whole.

“So we got together with the night staff and said, ‘What can we do for you to make you feel more appreciated?’” Ross says.

One of the complaints was that the cafeteria was not open during the night shift, which limited what employees had to eat on their breaks.

“So every month now, at least once a month, we’ll have leadership come in in the middle of the night and cook dinner for them,” Ross says. “What you need to do is listen to the concerns, sit down with the people involved in giving you those thoughts and come up with specific action plans to address those concerns. Then communicate what you are doing.”

It’s through a consistency in responding to concerns and taking action that you will build trust with your employees.

“I think it’s difficult, if not dangerous, to pound it over someone’s head, ‘This is a great place to work, don’t you understand that?’” Ross says. “It’s just hard to have that resonate unless the person you’re talking to feels the same way. I don’t know if you can show them or tell them or hammer home to them what the benefit is. They need to perceive that themselves.”

Hold people accountable

As you get to know your employees and see how they respond when asked for feedback, you will gain a sense of how they fit in at your company and how they measure up to your standards and expectations.

The employees who are meeting or exceeding those standards know about those who aren’t, and they expect you to do something about it.

“It’s very frustrating for employees when they see other individuals where they work not working hard, having terrible attitudes and terrible behavioral skills and being allowed each year to continue getting the same raises they do,” Ross says. “No one does anything about it. We’ve heard from enough employee engagement surveys that it is critically important to identify what expectations are and then hold employees accountable.

“Attitudes are very infectious. Positive attitudes infect the organization with positive thoughts and ideas. Negative attitudes conversely infect the organization with negative behaviors and negative cultures.”

Every year, managers complete evaluation surveys for each employee rating each person either low, middle or high in various areas, along with a narrative as to why the employee was rated that way.

It’s through the constant communication and feedback that you learn about your people. And it’s through your response in the evaluations that you can track their progress and take steps to either keep them on target or move them back toward that path.

“Someone should not be low more than two times in a row,” Ross says. “If someone is evaluated low, there needs to be specific action plans, an identification of specific concerns that are causing the low evaluation and what the employee needs to do to raise himself or herself to middle or hopefully high. If they are not able to do that, we have to take appropriate disciplinary action. Employees want that.”

They want it because they want to know the work they are doing means something and that if they do their jobs, they will be rewarded.

The best way to reward your employees who are doing their jobs is through positive feedback, which, like your information-seeking missions, has a personal touch.

“Every month, I send out about 30 personalized thank-you notes to employees,” Ross says. “We ask our managers to identify one or two members of their department or an employee who did something special. I’ll read it over and handwrite a thank-you note that tries to incorporate the specific act. Hundreds of times, people have come to me and said, ‘I got your thank you-note. I appreciate it.’”

The more you can do to show appreciation to your employees who deserve it, the better off you’ll be.

“People like to be told, ‘You did a great job,’” Ross says. “If you can do that, it makes it easier to develop relationships. It also makes it easier to hold people accountable, which at times you have to do. But if you keep telling them what they did wrong, it knocks them down. Without balancing that with the things they did well, it can get discouraging.”

Everyone has a busy schedule and often struggles to get it all done to keep the company going. But the time you spend getting to know your people will always be time well spent.

“You become more comfortable and more understanding, and you become more of a strong team that is committed to the common goal,” Ross says.

HOW TO REACH: Barnes-Jewish St. Peters Hospital, (636) 916-9000 or www.bjsph.org