Open Up and Say ‘Aha’: Encouraging Health Workers to Share Good Ideas
Hospital staffers don’t always go to managers with their ideas for improving patient care. Research prescribes methods for getting them to speak up.
By Steve Brooks
If knowledge is power, emergency room staffers should be some of the most powerful workers around. In life-or-death situations, they know what’s working and what’s not, and many are full of ideas on how hospital systems could work better.
“It’s always surprising to go into a health care setting and see people on the frontlines screaming at the top of their lungs, ‘We have to change X, Y and Z,’” says Ethan Burris, associate management professor at the McCombs School of Business.
Too often, though, those ideas never get to the hospital managers who could implement them, says Burris. He researches the factors that encourage or discourage employees from speaking up.
His interest isn’t just academic. His wife, a social worker, once had a boss who forbade her to speak with anyone outside their department. She eventually left for a job that paid less but made her happier.
But Burris also sees things from a hospital manager’s point of view. “When you’re thrust into an administrative position,” he says, “you’re suddenly responsible for a couple of hundred people in the ER. Each of those people has ideas for improving operations, and there’s no way you can implement the majority of ideas.”
The challenge is to bridge the information divide by helping both sides understand each other. In his newest study, Burris finds that different groups of health care workers can have very different kinds of ideas, as well as attitudes on how well management will listen. In the ER at a large southern hospital, he interviewed seven doctors, 17 nurses, and 11 technicians, asking what kinds of topics they chose to speak up about.
Those topics varied, he discovered, with how the staffers defined themselves at work. Did they identify more strongly with their professions or with their workplace?
Those who identified more with their professions would speak up with ideas for helping patients. Those who identified more with the hospital tended to offer ideas for making operations more efficient.
Not only were their issues different, but so were the levels of receptiveness their ideas received from management. Says Burris, “Some types of content in employee voice seem to align better than others with what managers are looking for.”
Workplace-oriented employees felt they got more positive responses — perhaps, Burris suggests, because they raised issues their managers wanted to hear about, like saving or making money. In contrast, those who identified with their professions often felt discouraged or penalized when speaking up about shortfalls in patient care.
“They pick their battles,” says Burris. “They’re choosy about which topics they want to hang their hats on and bear the risk.”
Blocking the flow of ideas can put a drag on business operations, he adds. In a non-health care study of 93 branches of credit unions, Burris found a correlation between better unit performance and a higher flow of ideas upward from employees to bosses. Units showed poorer performance when ideas flowed sideways, e.g., workers griping to other workers.
“It depends on where voice flows in an organization,” says Burris. “If it flows upward, to someone who can do something about it, then voice leads to better performance. If you’re going to encourage that upward flow, you stand a better chance of having important issues addressed.”
How can health care managers encourage that flow? Burris suggests both symbolic and substantive actions.
Symbolic actions include getting out and talking to employees. “You can’t just sit in your office and expect people to come your way,” he says. “Feelings of risk prevent people from doing so. You have to be proactive, knock on doors, and interact on a regular basis with your employees to draw out some of those ideas.”
Even subtle gestures can help put subordinates and patients at ease. Burris cites one local hospital administrator who suggested to a doctor that he try sitting on the same level as a patient. “Patients were more comfortable with him speaking at eye level,” Burris says. “All of a sudden, his patient satisfaction scores started going through the roof.”
The substantive part, he adds, is that managers can’t just solicit ideas. They need to act on some. “If you implement none of them,” says Burris, “chances are, you will not hear more ideas.”
Originally published at www.texasenterprise.utexas.edu.
