Viewpoint
Communicating Hospital Distress Starts with Employees
By Steven Rivkin And Fraser Seitel
"This hospital is losing $2 million a year," laments Chairman Throckmorton. "And there's not a person in this room who doesn't realize that a good part of the problem is that we're not getting our story out. Clearly, we've got to spread the word, and we've simply got to start advertising."
Welcome to the most futile exercise in the life cycle of a hospital board--the attempt to resuscitate a distressed hospital's reputation through increased advertising. Not only do the hospital's attempts to advertise its way out of a declining image not work, doing so can exacerbate the problems as key stakeholders see precious dollars going into promotional efforts instead of operational solutions.
In counseling hospital management and boards on rebuilding reputations, we regularly advise that image revitalization begins with the very constituency that trustees and CEOs regularly overlook--employees. It's virtually impossible to change how people outside the hospital view the facility if the people inside the hospital don't believe the story management is trying to tell.
Generally speaking, both not-for-profit and for-profit companies of all types do a poor job of engendering trust among their employees. National data from management and human resources consulting firms show that only half of all U.S. employees believe that management tells them the truth. Almost one third don't believe in their employer's stated vision and values. And three out of every five employees believe management communicates more honestly with customers and shareholders than with them.
The situation is even worse in hospitals--particularly ones in distress--where many employees feel underpaid, overworked and undervalued.
How then, can a CEO and a board influence employees to endorse management's effort to turn around a hospital's performance and reputation?
The answer lies first in adopting a tough, substantive program of operational improvement--enhancing core services, shoring up key processes such as billing and cutting unnecessary expenses.
Second, the turnaround program must be embraced by those expected, through their sacrifice and hard work, to carry it out. In other words, rank and file employees must "buy in" to the program.
This is a difficult task and can be best achieved through a multipronged, focused employee communications program. We call our four underlying communication principles SHOC: Strategic, Honest, Open, Consistent.
Strategic Communication
Most employees want you to answer two basic questions:
- Where is this hospital going?
- What is my role in helping us get there?
Once you level with staff about the hospital's direction and goals and their role in the process, even the biggest complainers will acknowledge your attempts to "keep them in the loop."
The case of 240-bed Algonquin Memorial Hospital (not its real name) is typical. We counseled Algonquin's board and CEO to let the staff know early on what management's 2004 loss projections looked like, and how the turnaround firm they'd hired would likely call for some staff cuts.
A few board members questioned the wisdom of this approach. After two successive years in the red, hospital employee morale was already at rock bottom, they argued. Many employees feared Algonquin would close, and most were suspicious of management. So how could providing employees with budget projections accomplish anything?
The answer, of course, was that once the CEO announced that Algonquin's goal was to cut its annual loss in half, those who feared the hospital would go bankrupt or close were reassured. Although across-the-board layoffs could be avoided, by announcing that some terminations were inevitable, the CEO began to earn employees' trust.
Honest Communication
The sad fact is that many health care managers may pay lip service to candor and honesty, but few practice either when it comes to confronting the staff. More often than not, they dissemble and obfuscate. However, hospitals cannot hope to build credibility through prevaricating or sugar-coating.
In Algonquin's case, when the CEO acknowledged at employee forums that, "Yes, we are considering outsourcing the food services operation," and "No, we don't foresee any gainsharing possibility this year or next," he began to build internal trust.
Open Communication
This is just another way of saying that there must be an opportunity for employees to provide feedback. The best communication is two-way communication. In the case of a hospital, employee views must be solicited, taken seriously and, most importantly, become the basis for action.
One Algonquin trustee balked at the notion of suggestion boxes in the hospital cafeteria. "Nobody ever uses them at our bank," he said. "They're a waste."
But when the suggestions started to trickle in--and the CEO started responding to them in the biweekly hospital newsletter and then acting on them--the trickle turned into a torrent.
Over time, Algonquin's staff came to expect action on the supply needs they raised and the facilities improvements they suggested. By the end of the year, the number of suggestion boxes in the hospital had tripled, along with the quantity--and quality--of suggestions.
Consistent Communication
Once you begin to communicate, keep it up. Maintain a regular, predictable program of disseminating information through internal newsletters, employee forums, leadership meetings and reward celebrations.
On-again, off-again communications undercut leadership's efforts to show that they are committed to keeping the staff informed. So do programs that start with bold promises only to peter out.
Early on, Algonquin's CEO promised to update the staff on the hospital's turnaround progress through enclosures in their biweekly pay vouchers.
Thereafter, like clockwork, every other Friday, Algonquin's staff was apprised of the latest personnel decisions, changes in organizational structure, physicians recruited and financial results.
On Dec. 31, 2004, in the year's 26th newsletter, the CEO reported: "Preliminary results suggest that we have accomplished our goal for the year of cutting our annual loss in half. I am personally grateful to all of you for working so hard in support of our turnaround. Thanks to you, our reputation is on the way back."
Steve Rivkin and Fraser Seitel are partners in Rivkin & Associates Inc., Glen Rock, N.J., a communications and management consulting firm that specializes in serving health care institutions. They can be reached through their Web site, www.HospitalCrisis.net.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
To respond to this article, please click here.
