Friday, September 28, 2012

What do our people think about our system as a place to work?

In order to get to our vision, we must have our people fully engaged. We added “more employee joy in their work” to the triple aim of better health, better care and lower cost because we knew that the other three are not possible unless our physicians, nurses, other clinicians and support staff feel valued by our organization.

So how can we tell if our people feel that our system is a good place to work? Every year we do an Employee Opinion Survey. The results of this year’s survey are in and they show that in some areas we are improving and in others we are not.

Every year we hope for 100% participation so that we can hear from everyone. This year 75 percent of employees participated in the survey, which is down from 80 percent last year.

Our Employee Relations Index, which is a roll-up score of how satisfied employees are, was 69, down one point from where we stood between 2009 & 2011 and two points below our goal of 71.  While this is higher than the national average (65) for healthcare organizations surveyed by the same company, the fact that we are not improving is a problem for us. The actions that we must take to improve next year, however, lie in the responses to the individual questions.

Where did we improve?  The questions with the greatest score improvement included: Is senior management responsive to employee concerns?, which increased by seven percent;  trust in senior management, which increased by five percent; Does senior management treat you with dignity and respect, which saw a three percent favorable increase; and pay increase satisfaction, which also rose three percent.  I am grateful for the work of my colleagues on the Senior Team and our work in narrowing the distance between what the “front line” knows and what the “front office” knows. Things like senior leader rounding where we are partnered with a manager and his/her unit/department and luncheons with our staff and managers have clearly helped us build trust.

But while our scores improved in questions around trust in senior management (they were the highest since we started with the survey in 2007), these improvements were unfortunately offset with people’s unhappiness about compensation and benefits. Scores decreased on questions about satisfaction with benefits (10 percent drop), competitive benefits (nine percent), job security (eight percent), and future advancement opportunities (three percent).

We made some significant changes in benefits this year in an effort to save both the organization and employees money and keep as much of our “healthcare spend” within the GBMC family.  We will be asking our people for their insight into what specifically they may not like about the new plan. I realize that we have had some billing issues with the new system and I ask for patience as we correct these defects. We understand there is some confusion both among employees and physician practices and we’re working on improving that, but the fact that employees can now save significant family dollars is a benefit. Now, if you use a GBMC doctor in a GBMC facility, you have no out of pocket expense.

We’ve already begun taking steps to increase satisfaction with the new medical benefits program.  Letters have been sent to physician offices clarifying the co-pay process, additional communication is being sent to plan participants within the next two weeks and employee information sessions are being planned for early October.

We certainly faced some challenges in Fiscal Year 2012, and unfortunately had to make some personnel changes.  It’s understandable that some people get nervous about their longevity and security with the organization.

In the areas of job security and pay practices, some changes are already underway that will hopefully improve employee satisfaction.  Human Resources will be redoubling its efforts in ensuring managers understand how compensation decisions are made. We will work to provide clear expectations and processes for promotions, and we will continue educating managers on promoting our philosophy of a “Just Culture.”

Even though the formal survey process is over, I encourage all employees to share ideas, concerns and suggestions with their managers.  Every manager will review his or her department’s scores with their staff and come up with ideas for improvement. For things that cannot be fixed locally, like benefits and compensation, our Human Resources Department will take the lead on improving things.

The input shared by our employees is invaluable as we continue striving to reach our vision.   I encourage all of our employees to fill out the survey next year.  Without your thoughts we cannot improve. Also, you can share your ideas, concerns and questions at one of the upcoming Town Hall meetings. You will also want to attend a Town Hall meeting because we will be rolling out our Employee Incentive Plan for this fiscal year.

Town Hall Meeting Schedule

Thursday, October 11:  12 p.m. – 1 p.m., Civiletti Conference Center (Lunch will be served)
Friday, October 12: 2 p.m. – 3 p.m.., South Chapman
Tuesday, October 16, 9 a.m. – 10 a.m., GBMC at Owings Mills
Friday, October 19, 7 a.m. – 8 a.m., rear of the GBMC Dining Room (for OR staff)
Friday, October 19, 8:30 a.m. – 9:30 a.m., Gilchrist Hospice Care Corporate Office in Hunt Valley
Friday, October 19, 12 p.m. – 1 p.m., Civiletti Conference Center (Lunch will be served)

*Additional meetings will be scheduled during evening and weekend hours

Legacy Chase at Shawan Downs

If you don’t have any plans for this Saturday, September 29th, bring the family to Shawan Downs, which will once again be the home of The Legacy Chase, hosted by and benefiting the GBMC HealthCare system. The Legacy Chase has become an annual social event; marrying the excitement of steeple chasing with the beauty of the countryside.  As Jenny Coldiron, president of the GBMC Foundation says, "You don't need to be an avid steeplechase fan to have fun. Pack a picnic basket and come enjoy a day in the country."  In addition to the great horse races, there’s something for everyone – from wine tasting and live music to antique car displays and tons of kids’ activities including a stick pony race.   For more information, go to Legacy Chase at Shawan Downs


  1. I started working at GBMC because the benefits were good. Nonetheless, not everyone can take advantage of the benefits. For instance, not all employees can take a vacation time. Some of us have lost 100's of hours on holiday/vacation time. Even when we request time off, we are dinied. Where are the benefits?
    I wish I took some time off to recharge my batteries, I could not because I was not allowed.
    25% of people did not participate in the employee survey. It is a big number. I did not participate in that survey because I lost trust.

    1. Anonymous, you need to speak with your supervisor or with someone in Human Resources. All employees can and must take time off.

      What ideas do you have to get the 25% of employees who didn't participate in the survey this year to participate next year. Why are you anonymously writing in reply to the blog if you won't complete the survey and work with your boss to make things better? Don't act like a victim, get in action to make things better.

  2. Help me understand how employee satisfaction at 69% is a positive nunber? Especially with only 75% of surveys being submitted? Back when I was in school 69 was a "D" and I had some explaining to do.
    Senior management? Never see him except at quarterly meetings. When day to day operations are impacted because of hasty decisions with no proper planning and foresight are made at the senior level, why am I asked to pick up the pieces and make things right?

    I wonder what the true score would be if all 100% of employees took the survey. Sorry, but this is not a joyful place to work any more.

    1. This comment has been removed by the author.

    2. I reread my blog and I don't see where I wrote that achieving a 69% on the survey was "positive". What I said was it is higher than the average in other hospitals and it is down a point from last year. The main reason seems to be people who completed the survey being less happy with their benefits than they were last year. I started the blog stating that unless our people are happy at GBMC then we will never reach our vision. We must make our healthcare system a better place to work each year.

      The references to Senior Management were for the whole team. When you say "Never seen him except at quarterly meetings" are you referring to me? Do you work offsite? I am happy to speak with you more frequently if you would like. Each senior leader is assigned to two departments and we meet with them at least twice per month.

      What hasty decisions are you talking about? Have you discussed these with your supervisor? Are you giving him or her your ideas for improvement? What pieces are you picking up? You, too, sound like you are in the victim box. You should speak with your supervisor about your issues. If you feel so poorly about GBMC and where we are headed, either help us make it better or you should look for a position in a company where you will be happier.

  3. Should we all follow the lead on that previous comment Dr. Chessare, and tell unsatisfied patients and visitors to simply go to another hospital if it will make them happy?

    1. No, we should read our vision and get in action on making things better so that people will see that we are the best and choose us.

  4. One reason that I believe the satisfication scores have gone down is that somehow the onus of management and executive accountability has suddenly become our responsibility. I cannot read a simple blog on here where I do not read how it is "my" responsibility to limit costs, make cost cutting decisions, and basically assume the role of management and finance in my daily actions. Gee, with all of us taking on these roles is there a need for a vp of finance or other positions responsible for costs and finance at gbmc?

  5. I found this blog and your comments to the responses to be interesting given my experience at GBMC. You are either in denial of what goes on within your organization or misinformed by your staff.
    The reason why you only have 75% participation in your annual survey is that some of your employees have given up on you and senior management. It has been my experience that nothing is done with the feedback your employees give you so why bother. I know for a fact that we met with our directors one year and gave candid feedback only to go over those same issues the following year. When we voiced our frustration as to why corrective action wasn’t done in the previous 12 months, we were told there was nothing they could do. It involved compensation and there was little our HR could do about it. However, those same directors received their annual KPI bonuses for that year.
    I have to agree with you that it is important to spend the majority of your waking hours in a joyful environment and given that they are usually spent in the workplace, it is imperative that you enjoy what you do and who you work for. Unfortunately, I was not able to achieve that in my final years at GBMC and find your response to the one blogger suggesting they talk to their supervisor laughable. I was one of those employees that faithfully answered my employee opinion survey, provided my director with feedback and voiced my concerns on the lack of compensation/ merit rewards for the average employee. When reductions in staff took place and colleagues were leaving the organization to find their own form of joy, I was forced to take on additional tasks and told I should be grateful to have a job. I was not compensated for the additional workload even though I was asked to do more and was given less resources to do it. While my director was attending conferences and golf outings, I was no longer able to attend continuing education sessions because that funding was eliminated from our budget. While my director still received his KPI bonus on all of my extra uncompensated hours of work and accomplishments, I was given the same annual increase that the “bump on the log” sitting next to me received. When I asked for a fair merit review/ compensation I was told that it was not possible, that is not how our HR works. It would require them to actually do something other than plan for the next orientation. The turnover percentage and how much money is spent on recruiting and not retaining staff is mind boggling to me.
    Eventually, I was one of those employees that could no longer find joy at GBMC and made the decision to leave and happy to share with you that there are many opportunities for anyone that is in the same situation I was. Upon tendering my resignation, I was told again by my director that there was nothing they could do about my compensation and Human Resources was never involved. So another long term employee with years of experience and relationships was allowed to leave. I was never offered an exit interview so I’m not sure what exactly the role Human Resources serves.
    Since leaving GBMC I have found happiness in my new employment and have experienced a better, healthier me. I am happy to report that I have even been able to lose some weight and eliminate taking blood pressure medicine I began taking while I was employed there.
    I hope this response to your blog is insightful and that you address some of the real issues being brought to you by the people actually doing the work at GBMC. You need to be aware of the fact that until you eliminate KPIs and find a way to fairly compensate those that are doing the real work, you will never achieve higher scores in your employee surveys. The people you address at leadership, mid level managers and directors, continue to maintain their kingdoms and bonuses. They do not really care for the employees that help them achieve their KPI goals and don’t necessarily have the best interest of the patients in mind and this will continue to be reflected in your bottom line.

    1. Anonymous,
      You have raised the issue of our pay system. I agree that you are not the first and that you are correct that we do not have a system that gives raises to people on the basis of their annual review. I have been here for two years and we have given raises across the board. We are going to roll out a new employee incentive system next week. For fiscal 2014, beginning July 1, 2013 we will begin a true merit raise system.

      I am glad that you are happier with your new job.

  6. I have to agree with the prior blogger's comments on many aspects. And, the very management you frequently recommend 'we' bring our issues to, have no ability to effect change. I blame the VP's for this dynamic.

    Your tenured and educated employees do fill out surveys, attend town hall meetings and communicate regularly to management with suggestions for improvements, but unless your Directors have the ability to actually DO something with these suggestions, nothing will change. The result - more talented and valuable people will give up and leave. That's clearly what I see happened with this prior blogger.

    Until people are actually heard and Directors are given the training and power to make these changes, nothing will improve and morale will only dip lower. Lower morale will surely impact the patient visit. How can it not?

    Regarding compensation, until the KPI's are fairly distributed to those that are actually doing the work rather than just to the Directors and Managers, more well respected and valuable employees will leave GBMC frustrated and angry and in search of peace. I frequently hear "there is life after GBMC" from those peers that have left. That's a sad comment and one you should take very seriously. The work environment has truly become toxic and unhealthy.

    I recommend focusing your HR activities on retention rather than on recruiting and orienting new employees. In Leadership actually train your Directors and Managers on how to motivate and respect their team -- and reward them for doing it! Give give these Directors the tools and resources and flexibility to actually do this for their team. Have them decide how wage increases should be distributed -- not to everyone but to those that have earned it. Morale will improve and so will the work that impacts your entire health care system.

    I would also recommend having HR conduct real exit interviews and listen to the suggestions that are presented. Your front line and professional employees know what is going on but until this blog, we have had no avenue to present meaningful feedback without fear of reprisal. Yes, Dr. Chessare, reprisal.. it happens and has happened for some time.

    Your employees have no power, no respect yet all the burden to achieve projects and line items for their Director's and VP's KPIs. This doesn't sound like a winning combination and clearly with all this feedback, the current strategy isn't working.

    As Albert Einstein so aptly wrote:

    "Insanity: doing the same thing over and over again and expecting different results."

    Dr. Chessare, with all due respect, what can you do to make things better? What can you do to put more power in your Director's control? What can you do to keep tenured and professional and valuable employees? Do you want frustrated and talented employees to leave and TELL others of their experience? This surely won't help recruiting activities.

    I also firmly believe that your VP's may not understand the true patient care and employee impact from some of the cost cutting decisions they have made. But soon, you will as our patient satisfaction scores will surely decline to match your employee morale.

    As a suggestion, invite VP's to actually do the work along side and see the impact of their decisions. Weekend activities are most challenging and this is where some cost cutting measures have truly had a negative impact.

    On a positive note, I want to thank you for this blog to provide a venue for open communicate from you to us and us to you. You are a very wise and experienced physician and you clearly understand healthcare and have a great vision for GBMC. I believe this vision will carry us forward in this new and changing and competitive environment. However, your management team (VP Level) needs to get with your vision, too.

    One more time.. "Insanity: doing the same thing over and over again and expecting different results."

    It's clearly time for a change.

    1. Thanks, Anonymous. I agree with the "insanity" quote. So, we are changing a lot of things and we are changing our pay system as you and the person who commented above have asked.

      If your director is feeling that he or she cannot implement the required changes, then that person must take it on directly with his or her VP. I trust and respect my colleagues on the Senior Team. I expect that they make decisions openly, honestly, and visibly. If you see a decision that was made and you don't agree with it, you should discuss it with your Director and then you should feel free to discuss it with your VP. Blanket statements about "directors", "managers", or "VP's" are not very helpful because they are human and they are all different. If you see a problem with an individual that you cannot get resolved, you should take it to HR.

      On the issue of reprisals, I stand by my statement that there will be no reprisals. If someone thinks that they have been treated unfairly, they should take it to their boss, HR, or the compliance hotline.

  7. I have taken some time to consider what I would like to say in response and in addition to the prior comments made by Dr. Chessare and my coworkers.

    I feel on some level this is a point the finger or place the blame situation. What we all fail to consider is that everyone in this organization plays a part in its future. Yes, there are all things we would like to have done differently or changes made to "the system" to make our lives easier but it is always not that simple…But could it be?

    As an employee of many years I feel as though in some ways I am misrepresented by a manager or director that is out of touch with reality. On a daily basis we all have many people to answer to directors, supervisors/managers, patients etc... Employees that are in management positions have no clue of what goes on in their departments on a daily basis. Sure they know what the job description says but do you ever see them out on the floor, working in their department in the trenches? Or do you see them in their office or running to their next meeting, just to have another meeting about the meeting before? Any easy solution to that would be to have FEWER meetings and have directors/managers out of their offices and in their departments helping their workers.

    Lastly I wanted to comment on compensation. Yes, we all know money is tight but why should everyone be given the same percentage increase? I would like to think I am a good employee, I arrive to work on time, I rarely call out sick and I am good at my job. It is very upsetting to me that I get the same 2% increase as the person who does not show up to work on time, calls out often and is an ok worker. Yes, I know this should be addressed with my supervisor trust me it has without resolution. I firmly believe increases should be based on merit and performance. As for the upper level managers/directors and nursing staff getting bonuses just think of this: why is any one person better that the other to receive bonus money? Without your support staff (Clerical staff, NST's, Housekeeping, Billing etc..)how high would your KPI data be? How good would your turn around times be? So why bonuses would be issued to a group such as directors or nurses rather that sharing the money throughout the entire work force, what makes them better than the worker bees?

    1. Thanks, anonymous. I see most managers out and about and getting a deep understanding of what their people are doing. I agree with you that a manager who has lost touch with the work of his or her people is not doing a good job. I will reenforce this with our managers.

      As I said above, we will be rolling out a new employee incentive system in this year and we are developing a true merit compensation system for fiscal 2014.

  8. I would like to say it is refreshing that some positive changes have been made since Ben Berres came on board. Employees are actually now being held accountable for their lack of work performance, consistent latenesses & lack of team work.

  9. I am a manager who wears my scrubs to work, gets out of my office as much as I can, and helps the staff at the bedside so I can keep up my skills. I DO have a clue about what happens in my department on a daily basis, thank you very much. I also have a calendar full of meetings and an email inbox full of requests that I read this, submit that, review the other, check someone else's work from another department (HR and employee health are good examples), answer this patient's complaint, follow up with that employee's failure to renew a license, and constantly "post and share with your staff" items that could have been emailed directly to them. I have to make sure I'm always on top of my staff who need corrective action and issue numerous "notes to file" before I can give points and hopefully avoid union grievances after doing so. Managers are pulled in so many different directions that it's really impossible to devote my time directly to my staff - just to have a 5 minute conversation about their families. Or their professional goals, objectives, and dreams. I have to rely on them to be self-sufficient and motivated because I have little to no help to get my other day-to-day tasks accomplished. I would love for someone to follow me around for a day. It would blow your socks off. I give my heart and soul to my career, only to get slammed in the employee opinion survey by people who feel free to stick the knife in for things that are out of my control.

  10. I just would like to say things have improved since you and Ben Berres have come into the picture. We , the, employees are finally being recognized for what we do and how we do it.Some managers still however don't know to roll up their steeves and help out when times get tough.
    Customer Service Appreciation is a fantastic ideas to build up our moral. Thank you.

  11. Nothing surprises me about this place anymore. We have an incentive plan that incentivises managers and supervisors to write up employees. The union saw this ruse and immediately opted out. Why wouldn't supervisiors and directors worried about their KPI bonuses give incentives for those that write up employees, disqualifying them from receiving a bonus. All that leftover money quietly goes into the KPI bonus. If gbmc cared about making the bonus, they would tie management KPI bonus and merit increases into our achieving of the bonus criteria. Instead, there is very little to be excited about concerning this ruse.

  12. Anonymous, you take a very cynical position and I am sorry for you. We will live by our Just Culture commitment. I look forward to paying an incentive check to the largest number of eligible employees possible.

  13. I worked at GBMC as an RN for 15 years. I now work at a hospital closer to my home. When I worked there I absolutely loved it there. It truly had a family atmosphere. I would walk down the hall and always stop and talk to a fellow coworker or a doctor. It just made me feel really good. I talk to people who work there now. They tell me it is totally different now. Basically they tell me it has to do with how management treats its employees. I feel this is really a shame because the GBMC that I remember was truly awesome. I often reflect on my days working there and I think they were the greatest years ever on my nursing career.

  14. Thank you anonymous. I am not sure when you left, but last year we had the highest employee satisfaction since we started the survey. This year, the score is down, less than a point and still above average for hospitals in the survey. We also have some very high score departments, and some lower scoring departments. I don't know what you mean when you say "how management treats its employees". Do you have some specific opportunities where we might improve?

  15. I believe the reference about management treating employees can be evidenced in telling employees there is no raise while other employees in management and other departments get bonuses. How is that a just culture as you wrote in another reply?


Thank you for taking time to read "A Healthy Dialogue" and for commenting on the blog. Comments are an important part of the public dialogue and help facilitate conversation. All comments are reviewed before posting to ensure posts are not off-topic, do not violate patient confidentiality, and are civil. Differing opinions are welcome as long as the tone is respectful.