Fostering a Culture of Employee Engagement

The landscape of care delivery in American hospitals and health systems is changing rapidly every day due to an aging population enrolling in Medicare, rising costs due to inflation, epidemics/pandemics causing delays in care delivery, workforce pipeline shortages, changes in technology, and lack of adequate reimbursement for services provided.

The state and federal governments, payers, patients, and other key stakeholders are demanding more from healthcare practitioners, often impacting the day-to-day operations. This is happening while C-suite executives adhere to challenging regulations and work to remain financially sound.

These challenges create a need for new leadership structures that foster a culture of engagement and collaboration to promote organizational quality resulting in improved health outcomes and increased employee satisfaction.

Reports from the Institute of Medicine (IOM) have emphasized that leadership is essential to achieving goals related to quality care and patient safety.(1) In contrast to traditional, centralized leadership models, the demands of healthcare today necessitate that leadership is distributed and expected from individuals at all levels of an organization, from the executive suite to those working directly with patients.(2) Specifically, the roles and responsibilities of many healthcare C-suite executives have changed over the last 20 years, particularly the role of a chief medical officer.

THE ROLE OF CHIEF MEDICAL OFFICERS

The chief medical officer’s roles and responsibilities have evolved far beyond peer review, with the opportunity to oversee utilization review, strategic growth and development, care delivery services alignment, process improvement, regulatory compliance, and more.

The CMO must demonstrate the ability to engage staff members, serve as the liaison to physicians, understand how to align strategic organizational initiatives, improve performance metrics, improve the quality of care, and be an effective communicator, all while being mindful of the available resources and cost containment.

Today’s CMO must understand the importance of the balancing act, ensuring the satisfaction of physicians and patients, while adhering to the organization’s strategic goals, mission, and vision.

The responsibilities of the CMO should be illustrated in a departmental strategic plan interwoven into an overall organizational strategic plan. The role of a chief medical officer should be to help create innovation as part of a roadmap while improving organizational quality and ensuring that physicians and employees are engaged, recognized, and valued.

CMOs AS TRANSFORMATIONAL LEADERS

Because CMOs are considered core members of the hospital or health system leadership team, it is important that they understand collaborative and transformational leadership theories. Collaborative leaders, according to the theory, distinguish themselves from other leaders by involving colleagues, including physicians and service line directors, in processes or activities to ensure that quality services are delivered and to encourage favorable outcomes.

Collaborative healthcare leaders encourage individuals to work together toward the implementation of effective practices and processes.(3) Healthcare leaders are facing challenges not previously experienced. Therefore, chief medical officers must understand the importance of leading differently by being transformational and creating innovative solutions.

Transformational leaders raise the motivation and morality of both the follower and the leader.(4) Transformational leaders “engage in interactions with followers based on common values, beliefs, and goals,” improving performance and supporting goal attainment. Leaders using transformational models identify the need for change, gain the agreement and commitment of others, and create a vision that guides change and embeds the change.(5)

These types of leaders develop their subordinates’ professional awareness and skills by focusing on their significance. They produce a convincing and encouraging vision for the future. They are “visionary leaders who seek to appeal to their followers’ better nature and move them toward higher and more universal needs and purposes.”(5) Transformational leaders prioritize their relationships with followers and demonstrate individualized consideration in meeting subordinates’ needs for empowerment, achievement, enhanced self-efficacy, and personal growth.

Leadership styles within a healthcare system do not account for all the factors that influence innovation and improve patient safety. According to Cummings, Midodzi, Wong, and Estabrooks, “leadership style alone could not be linked to patient mortality.”(6) Instead, the researchers examined that when the organization had consistent organizational culture, patient mortality saw a downward trajectory. It is the chief medical officer’s responsibility to manage the organization’s practices and procedures to ensure safe and effective medical services are delivered to patients. Cummings and colleagues observed that “leaders who practiced relational and transformational styles had better quality outcomes than those who demonstrated autocracy.”(6)

CMOs INFLUENCING CULTURE AND STAFF ENGAGEMENT

According to William Kahn, professor of management and organizations, and Everett W. Lord, Distinguished Faculty Scholar at Boston University Questrom School of Business, employee engagement strategies can be classified into three categories: cognitive, physical, and emotional. With cognitive engagement, employees are primarily focused and committed to their job. Physical engagement is present when employees’ attitudes and activities show that they are invested in the work. And employees are emotionally engaged when they channel their feelings and emotions into their work.(7)

Within healthcare environments, leaders can maximize team engagement and effectiveness by clearly communicating and centering the employer’s vision and strategies. Employee awareness of and engagement with the organization’s strategic roadmap supports their ability to achieve the best possible return for patients and for the employer.

When leaders clearly share and reinforce goals and expectations with employees, outcomes and accountability improve. In this way, accountability empowers individuals and increases organization effectiveness, and employees are inspired in their personal and professional growth and development. Storytelling is one powerful strategy that leaders can use to communicate organizational goals. Stories allow individuals to feel connected and emotionally supported, and a sense of buy-in to existing and new initiatives.

People who are passionate about their jobs tend to make more confident decisions. This translates into physically engaged employees who devote their emotional and physical energy to their work. These employees are invested in the organization and, as a result, benefit from increased physical, social, and emotional health, which allows them to contribute more to the business.

The United States Army calls this “esprit de corps.” It is a traditional military expression denoting the Army’s common spirit, a collective ethos of camaraderie and cohesion within the team. Esprit de corps exists at all levels, influencing individual morale, team cohesion, and ethos within the corps.

STRATEGIC FRAMEWORKS TO FOSTER ENGAGEMENT

Leaders must know how to execute strategies to support the organization’s success and advancement. This work involves more than simply analyzing the market and creating goals and objectives in a beautiful document placed on the organization’s intranet for people within the organization to access. Leaders must have the discipline and knowledge to clearly demonstrate and illustrate the role and impact of each goal and objective.

Additionally, an organization’s strategic plan can help foster a culture of engagement with its staff members. Aligning talent to the outlined strategies of an organization plan is imperative to its implementation and ultimate success. Front-line workers are integral, and leaders can intentionally include employees at all levels of the organization in support of the strategic plan, and in doing so, foster a culture of engagement.

Employee engagement is key to the health, success, and productivity of any organization. Employee engagement with the strategic plan can lower barriers to the challenge of change as the organization works to meet the evolving demands of its clients (or patients) while aligning new initiatives to organizational goals. In healthcare spaces, this work needs to be supported by the active participation of physicians, including independents, employed, hospitalists, specialists, and ancillary staff members.

As the liaison between medical staff and the organization, the CMO must be able to spearhead necessary culture changes by engaging multiple stakeholders. Leading in these spaces requires considerable conceptual, interpersonal, and communication skills. The CMO must frequently champion new patterns of physician behavior and lead physicians through change. This is often not an easy task and is one that requires courage and confidence as well as patience, persuasion, and perseverance, along with a robust diplomatic skill set.

The chief medical officer provides an integrating force linking all aspects of hospital care: utilization, quality and safety, credentialing, and physician practice evaluation. This integral role is required regardless of the type of organizational model, be it a small community hospital or a large health system. The order of organizational complexity may change, but the requirement for a unifying and integrated strategic leadership does not.

The chief medical officer translates administrative imperatives to the medical staff and provides a clinical perspective to administrative vision and strategy while ensuring that all patients receive quality healthcare services.

As expectations and responsibilities for healthcare leaders change, CMOs must be cognizant of how to create strategic frameworks to meet the mission and vision of the hospital or health system. Today, CMOs must spearhead physician acceptance of transparent performance improvement metrics and of working in partnership with nurses and case managers. They must ensure that physicians take steps to decrease variation in practice while recognizing the importance of delivering culturally competent care. This can help adherence to new regulatory compliance mandates, support the best care for all patients (regardless of their ethnicity or cultural background), and decrease the overall length of stay in hospitals. In so doing, the CMO promotes coordination of patient care throughout the hospital experience and during the post-discharge phase.

Dr. Mario Wallace, the author of the ADEM Strategy Management Cyclical Model (ADEM model) and strategy consultant at Ohio State University has created a strategic management framework for busy leaders across any industry to communicate a clear path of application from the beginning to the end of the strategic management process.(8)

The ADEM approach is an example of how a CMO’s efforts could be incorporated into the daily operations of a hospital or healthcare system. The acronym stands for strategy management phases: Analyze, Develop, Execute, and Manage. This model offers a linear application and a straightforward cyclical solution that help leaders reestablish a commitment to strategic management.

Analyze: Analyze the organization to establish its goals and objectives. Create benchmarks, goals, and measurement tools to evaluate the impact of proposed changes within the established or allocated timeframe. While conducting the analysis, gather data to tell your story centering on the proposed changes and their impact across the organization.

Develop: After conducting your analysis, develop the strategic plan or strategies to serve as a roadmap to illustrate the goal as supported by the targets, metrics, and personnel responsible for executing the strategic objectives and goals. A strategic initiative is a comprehensive plan for illustrating how an organization can achieve its strategic goals or long-term vision for improvement.

Execute: How a strategic plan is introduced and executed within an organization is essential. Unfortunately, most strategic plans fail to deliver their intended results; instead, they simply find a landing space on an organization’s intranet. Effective execution requires aligning the strategic plan to resources, including key personnel across all departments and service lines, front-line staff members, physicians, and clinicians. Ensure clear and frequent communication to all stakeholders who will be involved in accomplishing goals, monitor and track performance, and make any necessary adjustments.

Manage: Managing plans requires a unique skill set often held by project managers. Yet, it is important for a chief medical officer to be able to align the strategic plan with the overall hospital’s plan as well as to their own leadership style. It is the responsibility of the CMO to communicate effectively, be transparent as they progress, and solicit feedback from others involved for accomplishing the objectives and goals while documenting wins and opportunities for improvements.

ESTABLISHING TRUST, MOTIVATING, AND INSPIRING EMPLOYEES

Many leaders are too focused on managing day-to-day operations and accomplishing specific targets. This limits their ability to intentionally build trust and motivate and inspire employees to produce quality work in an environment that embraces a culture of inclusion and quality.

Inspirational leaders are those with the ability to drive innovation while promoting organizational quality. It is not about key performance indicators, but about keeping employees interested, informed, involved, and inspired. This is achieved when leaders help manage goals and processes while also leading.

Dr. Mark Olszyk says:

“The most important thing a chief medical officer can do is gain people’s trust and support them. It is far more critical to sit in the physician’s lounge than in my office and have people come to me. The informal conversations yield the best results — just listening. I learn by listening to physicians and others who may have concerns or need my assistance with addressing problems. Listening gives me insight into being the problem person, the administrator, and the leader, and that folks are not afraid or hesitant to approach.

“Many times, people may have problems where they do not want to go to the administration because they think it is a sign of weakness. When you can effectively gain their trust and make them feel comfortable (even confident) in being able to approach you, you have created a win-win situation. In that case, whether it is safety, quality, pay, personal issues, or an observation of a colleague, you can get way out front of any potential problem. Furthermore, if you do that with multiple people, you can pick up on patterns. Moreover, that is how you drive engagement. It is essential to engage with staff when they first join the organization.”

On the other hand, leadership is prospective; it defines what the future should look like, aligns the organization with a shared vision, and provides inspiration to achieve transformational goals.(9) Yet despite their very different functions and attributes, leadership and management complement each other. Both skills are necessary for organizational success to be achieved and driven forward.

Often, the healthcare industry is resistant to change. However, change is necessary because it helps leaders reevaluate their professional and personal growth. Therefore, newly appointed chief medical officers must seek opportunities to use or not use information that aligns with the organization’s strategic plan, which improves patient outcomes and safety while fostering organizational growth.

Collaborative leadership is a distinctive leadership style designed as a transformation style and is only sometimes employed within a healthcare setting. By incorporating collaboration, chief medical officers can nurture and build upon ideas while being transformational.

Healthcare leaders are responsible for ensuring the organization is profitable, productive, and safe while being encouraged and embraced to yield a more productive and positive outcome for an organization; collaboration ensures everyone’s voice is heard and respected.

REFERENCES

1. Lavin JE, Dixon-Woods M. Leadership and Patient Safety: A Review of the Literature. The Health Care Manager. 2016;35(2):99–114. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.

2. Page, A. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC, National Academies Press; 2004.

3. Atchison TA, Bujak JS. Leading Transformational Change: The Physician-Executive Partnership. Chicago: Health Administration Press; 2001.

4. House RJ, Shamir B. Toward the Integration of Transformational, Charismatic, and Visionary Theories. In M.M. Chemers & R. Ayman (Eds), Leadership Theory and Research: Perspectives and Directions (pp. 81–107). San Diego, CA. Academic Press; 1993.

5. MacGregor JN, Burns DJ. The Effect of Transformational Leadership Behaviors on Followers Outcomes: A Diary Study. Journal of Occupational Health Psychology. 2019;24(2):165–178.

6. Cummings GG, Midodzi WK, Wong CA, Estabrooks CA. The Contribution of Hospital Nursing Leadership Styles to 30-Day Patient Mortality. Nursing Research. 2010;59(5):331–339.

7. Albrecht SL. (ed.) Handbook of Employee Engagement: Perspectives, Issues, Research and Practice. Edward Elgar Publishing; 2010. https://doi.org/10.4337/9781849806374 .

8. Wallace M. Strategy Is Spelled ADEM: Making Strategy a Desired Conversation. Mario Wallace; 2020.

9. Kotter JP. Leading Change. Boston: Harvard Business Press; 1996.

Excerpted from The Chief Medical Officer’s Essential Guidebook by Mark D. Olszyk, MD, MBA, CPE.