Golden rule and R-E-S-P-E-C-T encourage employee loyalty - Building Employee Loyalty

Physician Executive, July-August, 2003 by David Ollier Weber

Over the past six years, not a single doctor among the 32 who staff the emergency rooms of Pennsylvania's Lehigh Valley Hospital & Health Network has left for another job.

"In emergency medicine that's very unusual, to have zero attrition," says department head and interim chief medical officer Michael Weinstock, MD.

There are no job openings for registered nurses at Austin Medical Center, a 99-bed Mayo Health System hospital in Austin, Minn.

At a time when the nationwide hospital nursing vacancy rate tops 16 percent, Mayo's director of human resources, Rod Nordeng, has a waiting list in case any of the 125 RNs on his facility's payroll decide to leave. He politely declines the services of expensive agency nurses and recruiters.

Nordeng negotiates contracts with unionized staff without a lawyer in the room. No reason to be adversarial toward people he works with every day, he reasons. It took him all of four sessions to forge an agreement during the latest round of bargaining. And in a recent survey of the hospital's 750 non-executive and non-physician employees, 96.5 percent said they would recommend AMC to a friend as a place to work.

Among Fortune magazine's 100 Best Companies To Work For, Baptist Health Care, in Pensacola, Fla., ranks 15th. The organization's "no-secrets" policy means housekeepers are privy to the same financial information as the CFO, the magazine reports, adding that every employee received a $100 check as thanks for the hospital's scoring in the top percentile for patient satisfaction.

Indeed, when you click on Baptist's Web site (www.ebaptisthealthcare.org) the first thing that pops up on the screen is not a picture of a building or a list of services but a boldface proclamation: "You'll Like the Way Baptist Cares for Our Employees.

Seething and churning

Why is it that a few organizations stand out as tranquil islands in a roiling sea of wage-earner disillusionment, disgruntlement and rampant turnover?

* According to the American Organization of Nurse Executives, one in five hospital-based nurses will submit a resignation this year. (1)

* Nearly half of all health care workers, according to a recent study, said they'd "begun to think about or make plans to leave their current organization." (2)

* Data from a 1999 study of primary care physicians under the age of 45 indicate that 55 percent will switch practices in the next four years--and 20 percent will quit twice during that period. (3)

The costs of this seething and churning--both in dollars and diminished quality of care--are beyond reliable calculation.

Earlier this year, The Physician Executive queried some of its members by e-mail in search of advice and insights on how to encourage employee loyalty. The response was an eager spate of nearly 200 suggestions.

A few who answered wanted to unload about what does not promote workforce loyalty.

"After 15 years as a physician executive," wrote David Epstein, MD, in Marietta, Ga,, "I am profoundly disappointed at the treatment afforded medical directors, nursing executives and other clinical professionals by non-clinical management executives.... It's about honesty and respect--two qualities in very short supply,"

David Olsen, MD, was "loyal to the bitter end," he says. Olsen is the former chief medical officer at the Ceres Group, a life and health insurer headquartered in Cleveland, Ohio. "It's supposed to be bad form to speak ill-ly of your former employer," he acknowledges. "But a lot of promises weren't kept."

However, he adds, he continues to enjoy close relationships with many of the people he himself used to supervise. "They're incredibly loyal to me. This happens to be one of my greatest strengths as a manager."

And amid all the suggestions involving acts of positive reinforcement--courtesy, openness, appreciation, tribute--there were also some nods to the unpleasant task of eliminating the negative.

"If one of my physicians acts out with a nurse," says Ben Knecht, MD, medical director of Wenatchee Valley Hospital, a 16-bed physician- owned medical/surgical unit attached to a large outpatient clinic in Wenatchee, Wash., "I speak to the physician the next day or soon after the event. I ask that they apologize to the person and mend their interpersonal conduct as it relates to our nurses.

"The word is out that this is what happens. There has not been a problem for close to twelve months, [but] it has taken nearly four years to get to the point where the physician stuffs the frustration or anger and takes it to me or others higher on the food chain.... They know we do act."

Basic questions

Just what are the hot buttons that turn employee allegiance on or off?

Extrapolating from some 80,000 workplace interviews, the Gallup Organization concluded that "the core elements needed to attract, focus and keep the most talented employees" can be measured by 12 simple questions.

Detailed in the book First, Break All the Rules: What the World's Greatest Managers Do Differently (Buckingham, M. and Coffman C., Simon & Schuster, 1999), they are: