A Strategy for Employee Engagement and Performance Improvement

Kaiser Permanente increased engagement and performance by focusing on unit-based teams. The strategy transforms workplace relationships while setting concrete goals and completing projects that advance the organization's operational strategy.

This article accompanies What's Keeping You Up Now?

Friday, September 2, 2011
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It's a challenge every large organization faces: how to engage employees in a shared purpose -- and how to align their interests and efforts with the strategic goals of the organization.

Any company that relies on its front-line staff to provide caring, consistent service needs an engaged and committed workforce. That is especially true if providing high-quality customer service is a strategic goal of the organization and is central to its brand identity.

Ensuring that the people in the field meet customers' expectations becomes almost a matter of life and death for the organization.

At Kaiser Permanente, we know it can be done: employees with divergent roles and interests -- including 25,000 front-line managers, 92,000 union-represented workers, and 15,000 physicians -- can coalesce around a strategic goal.

Through our Labor Management Partnership, Kaiser Permanente and the Coalition of Kaiser Permanente Unions have put in place a workplace process in which front-line managers, union-represented workers and physicians work together to not only ensure that each patient has the best possible experience, but also make full use of each individual employee's expertise.

Key to our strategy is the unit-based team. It includes all the members of a natural work group and focuses on transforming workplace relationships and improving performance. This happens by setting concrete goals and completing projects that advance Kaiser Permanente's operational strategy.

While teams' project selection is self-directed, internal data show that 50 percent of the projects are focused on improving clinical quality and customer service, two of Kaiser Permanente's key strategic priorities. Each unit-based team is co-led by a manager and a union worker.

Some aspects of our partnership are unique to Kaiser Permanente. But the principles and benefits of employee engagement are universal, and three practices we've learned in our work can help others engage their workforce:

* Empower the workforce to make a difference.

* Identify and support the essential attributes of successful teams.

* Disseminate effective team practices throughout the organization and integrate them into day-to-day operations.

Empower the Workforce to Make a Difference

Most people come to work to succeed, and they want their teams to succeed. They also want a voice and a measure of control over their work lives. At the same time, organizations need the strength and flexibility to achieve long-term results and respond to changing conditions.

We have found a way to combine these often-competing interests to further larger organizational goals, which in our case are patient service, social purpose and professional pride. Consider the opening language of our 2010 National Agreement:

The essence of the Labor Management Partnership is involvement and influence, pursuit of excellence, and accountability by all. ... Employees throughout the organization must have the opportunity to make decisions and take actions to improve performance and better address patient needs. This means that employees must have the skills, knowledge, information, opportunity, and authority to make sound decisions and perform effectively. 

The agreement commits all parties to be guided by a set of shared values called the Kaiser Permanente Value Compass.

The Value Compass has become an effective tool for our unit-based teams in setting goals, solving problems and improving performance in four key areas at the heart of the patient and member experience: quality, service, affordability and workplace experience. UBTs use the Value Compass to set meaningful, specific goals at the local level, as shown in the "Getting Results" section below.

Others have taken note of our collaborative approach. In a July-August 2011 Harvard Business Review article, entitled "Building a Collaborative Enterprise," authors Paul Adler, Charles Heckscher and Laurence Prusak praised Kaiser Permanente's Value Compass, noting that it "succinctly defines the organization's shared purpose" by providing "a description of what everyone in the organization is trying to do."

The authors further noted that the Value Compass provides "recognition of the challenges that every member of the group has the responsibility to meet every day."

Identify and Support the Essential Attributes of Successful Teams

There are nearly 3,500 unit-based teams operating across Kaiser Permanente. These are not project teams or committees; they are the front-line teams that serve members and patients every day, while continuously learning and improving.

What makes successful teams click? In a 2010 study, researchers from Rutgers University, Johns Hopkins University and Kaiser Permanente identified five elements of high-performing unit-based teams. We invest considerable time, effort and resources into developing each element, as laid out below:

1. Leadership: Develop joint leadership capacity, provide coaching and share information, including financial data.

2. Line of sight: Make ongoing use of meaningful metrics, encourage systems thinking and show how the work of the team connects to regional goals.

3. Team cohesion: Make time for face-to-face communication, create a safe learning environment and focus on the work -- with the member and patient at the center of our efforts.

4. Processes and methods: Be proficient in the performance-improvement methodologies and use daily huddles to discuss problems and build solutions.

5. Infrastructure and support: Develop and recognize strong sponsors, and provide ongoing training.

Disseminate and Integrate Effective Team Practices

To get results on a large scale, teams need data, metrics and a consistent approach to problem-solving. In 2009, we developed a database to track the progress of every UBT in the organization. It allows leaders to see how their team is doing, compare results and share effective practices.

In addition, we have developed further ways for front-line teams to learn from one another. These include:

* A website, newsletters and other communications that share best practices and give voice to front-line teams' direct experience (see

* Unit-based Team Fairs where several teams present their practices and results to other workers, managers and physicians in the region or facility.

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* The annual Union Delegates Conference, at which as many as 700 or more front-line workers, union stewards and leaders learn from one another and from other leaders in health care, social change and innovation.

Getting Results at the Front Lines

In our 2010 survey by Towers Watson of more than 130,000 employees, 86 percent of employees reported favorable responses on an "engagement index" of employee commitment and organizational alignment.

That's 15 points higher than for the industry overall, and on a par with "best in class" healthcare organizations such as Johns Hopkins, Mayo Clinic and the Cleveland Clinic.

The survey found that engagement is even higher among members of unit-based teams. Workers who are part of a UBT had more favorable scores in 42 of 57 measures of empowerment, alignment and learning than did those not yet in UBTs.

In no areas were UBT members' scores less favorable.

This table shows 10 indicators with the greatest differences between UBT members and non?UBT members overall.

Such results matter, because as Towers Watson showed in Driving Business Results through Continuous Engagement, a 2008/2009 WorkUSA Survey Report, consultants have found that:

* Highly engaged employees are twice as likely to be top performers.

* Three-quarters of them exceed performance expectations.

* They miss fewer days of work due to illness.

* They more readily identify with the organization and its customers.

* High employee engagement is correlated with high patient satisfaction.

Our experience bears this out: high-performing UBTs have higher levels of patient satisfaction scores, higher attendance and fewer injuries. They take on more goals in more points of the Value Compass.

Here are examples from four teams that address, respectively, service, quality, affordability and best place to work:

* Increasing patient satisfaction: An inpatient pediatric unit in Los Angeles tackled a classic complaint -- hospital food -- by allowing patients to choose their meals from a kid-friendly nutritional menu. The percentage of parents satisfied with their children's meals increased to 97.5 percent from 52 percent.

* Higher immunization rates: A pediatrics team in San Francisco streamlined its vaccination processes and increased the percentage of young children who are current on their immunizations to 92 percent from 84 percent in nine months.

* Eliminating unnecessary costs or waste: After updating its system for tracking operating room supplies, a team in Hawaii saved nearly $10,000 a month by reducing duplicate and overstocked supplies. 

* Reducing workplace injuries: By engaging housekeeping staff in new training, process and equipment design, and conversations about safety, the Northwest region reduced injuries among housekeepers by 77 percent between 2009 and 2010.

Across the country, UBTs produce similar results every day in our 35 hospitals and more than 450 medical offices.

By building the leadership, skills and engagement of front-line teams, our partnership is advancing the strategic goals of Kaiser Permanente and its unions -- and is better serving our patients and members.

We believe it is a model that can strengthen any organization looking for a sustainable performance advantage in a time of change.

Barbara Grimm is senior vice president of the Office of Labor Management Partnership for Kaiser Permanente. John August is executive director of the Coalition of Kaiser Permanente Unions.

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