Can we talk? (Will you listen?)

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Nancy Anderson, RN, MA, Senior Vice President of Engagement Solutions
Nancy Anderson, RN, MA, Senior Vice President of Engagement Solutions

In my last blog, I shared some thoughts about leaders systematically creating a clear line of sight to what's most important in the organization. This aspect of your leadership system ensures that your employees are “in the know” about what matters most. Consistent communication aligns everyone's efforts, and provides insight into how each person's work contributes to the goals and priorities of your organization. But engaging communication must include candid, two-way communication between managers and employees, which means creating a dialogue, not just a monologue.

Frontline employees are your first line of offense and defense

Paraprofessionals such as CNAs, housekeepers, and dietary staff are closest to the point of care and service and therefore are uniquely positioned to positively impact patient, resident and family experience. They are also able to observe potential issues, often well before leaders have an inkling of any concerns. It's in your best interest to encourage open, candid communication from employees, especially those at the front line.

Ideally, frontline employees are your first line of offense for ensuring happy customers, and the first line of defense to prevent things from going wrong. However, there is a potential underlying barrier that prevents a proactive response to looming issues. If employees raise a concern to a supervisor or manager who responds dismissively, or discounts the matter, the obvious outcome is that those concerns or complaints are not dealt with appropriately or in a timely fashion. This ultimately results in service failures and increases the probability that residents and their families will seek other remedies, e.g., voice a complaint, issue a grievance, or call an ombudsman!

Engaged employees are the cornerstone for delivering great care and service, and preventing service breakdowns. An engaged employee is deeply invested in the success of their facility – they are loyal, more productive, and positively impact outcomes. They will also identify and report issues and concerns quickly. Clearly, engaged employees are foundational to service excellence. And supervisors and managers are the gatekeepers of employee engagement.

The Align employee engagement database holds tens of thousands of engagement survey responses from employees who are asked about specific supervisor practices that promote engagement. Unfortunately, an all-too-common theme relates to supervisory practices that do just the opposite… reports of dismissive or uncaring behaviors, indifference to employee input, and this narrative comment from a CNA that represents a feeling of futility in communicating concerns:

“When I bring concerns to my supervisor about any of my residents, she ignores me. It's like she thinks I'm not important enough to listen to.”

These are practices that ultimately create an environment of apathy and disengagement, shutting down any hope of candid communication from employees. When this is the narrative, it results in erosion of the first line of defense in identifying and resolving resident and patient concerns in real time. It also undermines the ability to identify system and process failures that contributed to the concern in the first place.

Combat complacency by creating communication safety

QAPI guidelines speak to creating an atmosphere where staff feel comfortable identifying and reporting quality problems and opportunities for improvement. The leadership category of the Baldrige Performance Excellence Program asks the question, “How do senior leaders encourage frank, two-way communication?”

Leaders must create a psychologically safe environment, opening the door to healthy, transparent communications between employees, supervisors and facility leaders. Here are 3 enabling behaviors that are strongly correlated with candor:

  • Role model candid communication. Demonstrate that it's okay to question how things are done. Challenge standard procedures if you question their value. In staff meetings, practice transparency about what you see working well as well as areas of concern. Validate, with both your words and actions, that you truly want people to raise risky issues.

  • Proactively ask for input. Establish consistent venues for actively seeking opinions, ideas, and concerns from employees. Don't expect employees to come to your office with issues… that's your turf. Reach out to them in their workspace. That's why employee rounding can be a great way to seek input. Ask how things can be done in a better way… and then listen. Really listen.

  • Take employee input seriously. When people share concerns and offer ideas, avoid sending mixed messages. Without even realizing it, managers can sometimes come across as judging, dismissive or condescending. Listen without interrupting and seek to understand the message. Of course, not every comment or idea will be helpful. In fact some may just be unwise or impractical. But to garner ideas that are insightful, innovative, or even genius, you have to maintain openness.

In an environment of continuous improvement, a fundamental goal is to root out problems before they become full-blown crises. The key is to make it safe for employees to share their thoughts, issues or ideas. Let your employees know that it's okay to ask questions and communicate concerns. People feel safe, valued and respected when you speak to them straightforwardly, listen to them closely and respond to them personally. These kinds of honest conversations are the result of conscientiously and methodically building trust and taking deliberate steps to humanize the workplace. And that is the topic of my next blog!

Nancy Anderson, RN, MA, is the Senior Vice President of Engagement Solutions for Align. She provides strategic leadership and supports development of solutions to help providers successfully build and sustain a culture of engagement.

 

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