Wayne Balshin, Regional Director Employee & Union Relations wayne.balshin@vch 604.875.4563

1. Building Employee Engagement in the Health Sector:increasing staff performance through engagement Wayne Balshin, Regional Director Employee & Union Relations wayne.balshin@vch.ca 604.875.4563

2. Engagement

3. Engagement is … “A heightened emotional connection that an employee feels for his/her organization that influences him / her to exert greater discretionary effort to his/her work.” Conference Board 2006

4. Engaged Employees … • “I feel good about the organization.” • “I enjoy being part of the team.” • “The organization supports the team’s performance.”

5. Why Engagement? “Intuitively, it seems clear that employees that feel strong, positive commitment to their jobs and workplace are likely to outperform those who don’t. Gaining this discretionary effort from employees may be the last remaining source of productivity, now that so many companies have already captured the efficiencies of technology and streamlined processes.” -- Working Today: Exploring Employees’ Emotional Commitment to their Jobs, Towers Perrin/Gang & Gang Research 2003

6. Key Driver for Engagement “An employee may join Disney or GE or Time Warner because she is lured by their generous benefits package and their reputation for valuing employees. But it is her relationship with her immediate manager that will determine how long she stays and how productive she is while she is there… managers trump companies.” - First Break All the Rules – What the World’s Greatest Managers Do Differently, Marcus Buckingham & Curt Coffman

7. Communication = Engagement Gallop Study of 1000 US Health Care Workers (2005)

8. Level of Engagement • Employee engagement in the Health Sector is generally lower than engagement in other sectors, whether public or private, in the United States or Canada: • Gallup (U.S.) documented in 2002 that nurses’ level of engagement scored 18% vs. 30% for overall working population

9. Engaged Employees … • speak positively about the organization to coworkers, potential employees and customers (recruitment) • have a strong desire to be a member of the organization (retention) • exert extra effort to contribute to the organization's success (performance)

10. A VCH Engagement & Performance Strategy:Continuous Communication

11. Case for Continuous Communication • 2004 Accreditation identified Human Resources needed to address the lack of performance appraisals for VCH staff • Given the Managers large span of leadership, eg. between 75 – 200 staff, Managers were challenged to find the time to write annual performance evaluations • Performance evaluations are specific to the individual, not department performance, they are retrospective and do not capture the level of employee engagement or process improvement opportunities • Employees’ perception is that negative evaluation = disengagement and grievance

12. Case for Continuous Communication • 2006 Accreditation endorsed HR’s partnership with Royal Roads University to conduct Continuous Communication as an alternative to regular performance appraisals and as a component of VCH’s Staff Performance Management Framework.

14. Continuous Communication Step 1 Continuous Communication Meetings (semi-annual) Step 2 Ongoing staff communication and recognition Step 3 Considerprocess improvement ideas and challenges

15. Continuous CommunicationStep 1: Meeting • Semi-annual informal discussion (15 – 20 minutes) between a front line employee and union supervisor or manager about: • What’s working well • Performance achievements and recognition • Skill and career development • Ideas for process improvements and discussion about operational challenges

16. Continuous CommunicationStep 2: Recognition • Positive and constructive • Catch them doing something good • Say it when you think it • Say it often • Smile when you say it

17. Continuous CommunicationStep 3: Process Improvement • Supervisor/manager records brief summary of ideas/challenges • Manager brings forward ideas and challenges to Director for consideration as appropriate • Manager communicates outcomes to staff • Some ideas may be feasible; others may require further analysis; some ideas may not be feasible for a variety of reasons

18. Performance Assessment • Staff new to a unit / department or to VCH • informed of what is required to succeed • orientation provided to facilitate success in position • recognition, feedback, and coaching provided • Coaching includes identifying strengths, areas for development and actions required • Written performance assessment completed at the conclusion of qualifying period

19. Performance Recovery • Applies to staff whose job performance is unsatisfactory. • Interventions to remedy performance: • supervision and instruction to the staff member; • learning plan and timelines; • alternative employment within the competence of the staff member; and, • warning(s) job in jeopardy.

20. Performance Assessment (5% staff) Performance Recovery (5% staff) # of Staff Impacted by Continuous Communication Continuous Communication (90%+ staff)

21. Pilot Study: Continuous Communication

22. Preparing for Continuous Communication • June 2007 VCH: • Identified 6 units to pilot Continuous Communication • Ask staff in pilot units to complete VCH Engagement Survey • Trained supervisors and managers for the pilot units, plus Human Resource Advisors, on Continuous Communication • Implemented Continuous Communication September 2007 for the 6 pilot units

23. Preparing for Continuous Communication:Engagement Survey • Duties of my job are clear • I have the material and equipment needed • I receive frequent recognition for my work • There is someone who encourages me to take advantage of career growth • I feel free to make suggestions for improvement • I receive feedback about my work • I recommend my unit as a good place to work • Answered on the Likert Scale: • Strongly agree; Somewhat agree; Neutral; Somewhat disagree; Strongly disagree

24. Preparing for Continuous Communication: Manager / Supervisor Training • Communication Skills Model • Effective Communication • Recognition • Conducting the Continuous Communication Meeting

25. Manager / Supervisor Training:Communication Skills Model • Developed by Roger D’Aprix, ABC, an internationally-recognized communication consultant, lecturer and author in collaboration with International Association of Business Communicators • Model based on experience working with managers and employees in Fortune 500 companies • Model describes the questions employees need answered to reach engagement

26. 1 6 How can I help? What’s my job? 2 What are our vision, mission and values? How am I doing? 5 How are we doing? Does anyone care? 3 4 Manager / Supervisor Training:Communication Skills Model Engagement Job Responsibilities Vision, Mission and Strategy Performance Feedback Department Objectives, Results Individual Needs

27. Manager / Supervisor Training:Effective Communication What Is Effective Communication? It is two-way: sender ►receiver receiver ► sender It is balanced: listening & talking talking & listening There is feedback: discussion, questions, answers, analysis, exploration of alternatives

28. Manager / Supervisor Training:Effective Communication “The most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention…” Rachel Naomi Remen

29. Manager / Supervisor Training:Effective Communication • Active Listening Techniques • Paraphrase • Re-frame • Acknowledge both content and feeling • Use bridges • Use positive words • Wait to hear what the other person is saying • Empathize • Accept silence • Ask open-ended questions

30. Manager / Supervisor Training:Recognition - “Recognition has been shown to motivate staff, increase morale, productivity, and employee retention, and decrease stress and absenteeism.”  • “…individual recognition” was one of the top three factors for improving the levels of employee satisfaction and employee engagement in the BC public service.” 2002 report, Auditor General of BC on Building a Strong Work Environment in British Columbia’s Public Service: A Key to Delivering Quality Service

31. Manager / Supervisor Training:Recognition • Bi-annual Continuous Communication Dialogue • Supervisor asks employee, “What’s going well?” • Actively listens • Supervisor recognizes employee for his/her contribution and performance

32. Manager / Supervisor Training:Recognition • Ongoing Spontaneous Recognition & Feedback • Positive and constructive • Catch them doing something good • Say it when you think it • Say it often • Smile when you say it

33. Manager / Supervisor Training:Recognition “As a manager, you add value to overall performance when you motivate your staff to achieve performance levels not otherwise attainable. Employee motivation comes from working with a leader who is open to ideas, who is accessible and who recognizes performance.” - Roger D’Aprix, ABC

34. Manager / Supervisor Training:Conducting the Meeting • Bi-annual Continuous Communication Dialogue (15 – 20 minutes) • Supervisor asks employee, “What’s going well?” • The CC dialogue is informal and positive. • The manager’s role is to recognizeperformance and listen to ideas, opinions and suggestions and follow up where appropriate

35. Manager / Supervisor Training:Conducting the Meeting • Choose topics appropriately – don’t need to cover all every time. For instance: • Long-term employee • ►process improvements/barriers • 2-3 year employee • ►skill and learning development • Everyone • ►Recognition

36. Manager / Supervisor Training:Conducting the Meeting • No formal record-keeping: • Barriers and process improvement ideas • Employee describes ideas; pinpoints barriers • Manager records ideas & barriers for follow-up • Barriers & process improvements follow-up • Discussion at staff meeting • Forward to Director • Follow-up with employee on action or reasons for non-action • Acknowledge employee’s contribution to others for process improvement ideas

37. Results from Pilot Study: September 2007 – June 2008

38. Feedback from Pilot UnitsWhat’s Working Well with CC • Informality of CC process is positive • Gives structure to conversation • Sets the tone – not a performance appraisal; putting people at ease • Increases opportunity for manager and staff to meet • After meetings, staff feel more comfortable to approach managers • Staff now coming up with improvements by phone, e-mail or in person

39. Feedback from Pilot UnitsWhat’s Working Well with CC • All staff who participated in one unit said they appreciated the ability to talk to their manager one-on-one • Prefer this process to yearly, long drawn out, labour intensive reviews that don’t get done; this is a great compromise and covers the real purpose of these interviews • Improved engagement at local level

40. Feedback from Pilot UnitsCC Challenges • Some managers found their large span of control was a challenge for scheduling meetings • Staff need more communication around the CC process as units adopt this approach • Continued need for training program, especially for staff with limited experience in difficult conversations and coaching.

41. Feedback from Pilot UnitsProcess Improvement Ideas • Storage of linen items to where staff could access them more easily; streamline the environment • Unit layouts (2) – One of the old patient’s rooms changed to a store room and another changed to a patient room closer to the nursing station • Identified educational need around a number of patients with delirium from alcoholism was addressed; educational need around skin care

42. Feedback from Pilot UnitsProcess Improvement Ideas • Equipment requirements: ordered gowns more appropriate to nurses’ size • Converting a portion of a nursing vacancy into a care aide position • Recycling

43. Next Steps

44. Next Steps • VCH Steering Committee reviewing feedback from pilot units and distributing follow-up engagement survey in September 2008 (approximate) • VCH to assess CC roll-out across organization

45. Manager is fundamental to Engagement “No one is a more influential leader than our immediate boss. He or she sets the tone, provides the example, and either motivates or destroys our engagement.” Roger D’Aprix, ABC