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Change Management

DEI & Health Equity: More than Good Intentions

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Earlier this year, we at Jarrard published a special report on health equity and diversity, equity and inclusion work within healthcare providers. Separately, but roughly in parallel, a team at our parent firm, The Chartis Group, in partnership with the National Association of Health Services Executives, developed Leading While Black, a research piece on similar issues that includes a health equity maturity model for healthcare organizations.

Together, those pieces cover a huge amount of ground in some of the underlying issues, challenges, and also possible solutions for both delivering more equitable care to patients and also developing a more diverse and inclusive workforce. Now, with a bit of time having passed since publication, we wanted to revisit the topic and bring together the teams that produced them for some combined insight.

In this conversation, we spoke with LaTonya O’Neal and Mark Wenneker, MD, lead authors of the Chartis report, and James Cervantes, who helps lead our Kaleidoscope DE&I work here at Jarrard. You can listen to the podcast or read the transcript below.

(Be sure to get in touch and sign up for all of our thinking here.)

Read the Transcript

David Shifrin: Let’s jump in. And Mark, tell us just about some of the high-level structural challenges that healthcare organizations are dealing with today in terms of DE&I and structural racism.

Mark Wenneker: The first answer I would give around this is that healthcare organizations, and the healthcare industry, has been aware of ethnic and racial disparities in healthcare for decades. This isn’t a new problem. In the early part of my career, I published an article demonstrating that Black patients were less likely to receive important cardiovascular procedures than white patients. That was in the 1980s. That wasn’t the first piece of research that showed that. Just last week, the Journal of the American Medical Association published an entire issue on the challenges of disparities in healthcare access for ethnic and racial minorities. So this is not a new problem. To answer your question more directly, I think there’s a greater awareness now that healthcare organizations have around the importance of addressing inequity. Most healthcare organizations have a mission to serve their communities. And if they’re not addressing the reality that there are portions of their communities that are not receiving the same kinds of care, then they’re not fulfilling their mission.

LaTonya O’Neal: When we talk about the challenges that healthcare organizations really need to overcome to move the needle on health equity, there are five things to think about. One, it takes more than just good intentions and a stated purpose.

Two, moving the needle toward health equity has to start at the top with the organization’s leadership.

Three, intentional cultural change is essential. Organizations need to expect and empower every employee to take an active role in addressing health disparities.

Four, promoting health equity needs to take place both within the healthcare organization and in the community.

And five, organizations need meaningful data to inform, measure and facilitate change.

David Shifrin: LaTonya, talk about the importance of going beyond just good intentions, right? You know I think, I hope, that everyone would agree that good intentions aren’t enough. But what does that actually mean? What qualifies as good intentions and what qualifies as the work that needs to be done?

LaTonya O’Neal: When you talk about good intentions, you can’t just take steps only because it’s the right thing to do. Just because your heart’s in the right place doesn’t mean you get credit. I think the distinction is that the actual work that has to be done should be at the foundation of the organization’s mission.

And that has to be done… the work that has to be done there is really challenging, and it’s also broad. So implementing a single, specific program to address a certain issue is great, but you can’t stop there and declare that the work is done. It’s really an ongoing, continuous process. And some of the clients I’ve worked with have struggled because they do want to do the right thing, but there’s a vast gap between wanting to do the right thing, trying to do the right thing and actually doing the right thing.

So I think having good intentions is certainly a great place to start, but you have to put the steps in place to ensure that, one, the actions are going to be meaningful; two, that they’re going to be measurable; and then three, that they’re going to be sustainable.

James Cervantes: I think too what you’re referring to, LaTonya, is really cultural change, right? So it’s not just change that happens in one department or with one program or with one person who’s leading one initiative. I think what we’re seeing, and it sounds like you are as well, is that to really move the needle on health equity and become a more diverse, inclusive organization, for many of these systems, it requires a level of cultural change that, honestly, many to this point haven’t been willing to take.

So it certainly starts at the top, but it’s also finding a way to engage every employee, every leader, to have an active role in that cultural change and that journey in becoming better—for each other and for their community.

Mark Wenneker: I would follow up what James just said. LaTonya and I recently wrote an article that was published in The Governance Institute magazine that emphasized the criticality of leadership commitment and intentionality. So, good intentions have to translate to a commitment from the top, from the board, and a set of plans that are actionable and have resources behind them. And if I’m talking to an organizational leader who’s asking me about what they do or what they should do around addressing inequities and disparities, that would be the first question: do you have your board on board and do you have a plan?

David Shifrin: Let’s talk a little bit about what you’re talking about, Mark, with the specific plans and how you build… It’s the, what is it? The SMART framework? The… Of course now I can’t think what the acronym stands for. Measurable…something: Measurable, Actionable, Timely.

What does the S… anyway… Specific! So there have to be specific goals and plans, and then also the overarching communications and mindset, and really change management that has to take place at almost a human level. And so between our organizations, I think we’ve got a lot of those bases covered in how we operate in the work that we do with clients.

But talk back and forth a little bit about how you merge those two things together, specifically as it relates to DE&I work.

LaTonya O’Neal: Change management is tremendous. It is the thing that I think, no matter the initiative in an organization, that’s required. If you don’t have a good change management process in place, you’re probably not going to be as successful as quickly in whatever that initiative is—but certainly when you’re talking about diversity, equity and inclusion, because everyone’s coming in with their own thoughts, ideas, sentiments on diversity, equity and inclusion.

You’re asking folks to align to a common idea, a common culture that speaks around the idea that you’re not going to allow inequities to occur within your organization as employees, but also that you’re going to try to resolve those inequities within direct patient care. And so I think it’s a bit of a challenge in at least some of the organizations that I’ve spoken with, it’s… even if you set up that structure, without the change management component of it, you run the risk of that idea or that initiative being abandoned because there aren’t any steps in place to make sure that you have that sustainability.

If your three highest admitters are not on board, what’s the consequence to the organization if they decide they don’t want to practice in your organization anymore. I mean, that’s an extreme example, but those are the kinds of things that I think minimize the effectiveness of some of the programs that might be out there even with well-intentioned folks, is that if these folks are not on board with it, then we must abandon it because we can’t survive without them.

James Cervantes: I think that’s a really important point; it’s having that initial buy-in, and that may take time for some organizations to build. And then beyond that, it’s really creating the awareness about what we’re doing and why, and making sure that everyone understands what our intentions are.

That we have buy-in from the board, we have buy-in from our leaders and here’s why we’re doing it. I think what makes this so challenging as well is that race and inequity is personal for many, right? We’re not talking about rolling out a new electronic medical record. We’re talking about deeply rooted issues that are very personal, very complex, very sensitive.

And so where we’ve seen some organizations struggle is just the way that we talk about it in identifying the problem. And so, one thing that we’ve done for a health system is just develop a language word bank so that we have a common definition set around how we talk about diversity, equity and inclusion across our health system and with each other so that we can all agree on something. And that, we’ve found, really built some momentum and created a more safe place for those conversations to happen.

Mark Wenneker: One area that I think healthcare organizations… after there’s been a verbal commitment made at all levels, that they really can quickly start working on is measurement. You can’t change what you haven’t measured, and healthcare organizations can readily look to see whether there’s diversity in their workforce, to have that data.

They can begin if they’re not already looking at whether there’s differences in how they treat patients. The kinds of care that they received. Their access to services. Whether there are differences by racial and ethnic background. Those are things that can be looked at. And that’s where you can start and identify those areas where there might be the greatest opportunity.

LaTonya O’Neal: You’ve got to start by defining what “it” is, right? Before you even talk about putting in measurement you’ve got to know what it is you’re measuring. And I think that that’s a challenging thing to do. And I think if you don’t start with defining what it is you’re trying to solve for, and then establishing those metrics that you’re going to measure yourself up against, it’s just a lot of busy work.

David Shifrin: One more question before we get into some of the specific examples. In thinking about both the internal and external work… so, advancing this work inside the organization and developing a more diverse workforce and getting people rallied around change in diversity equity and inclusion, and then also doing things that are going to improve patient care and the relationship between the provider organization and the community that it serves.

I hope nobody would see those as two separate initiatives. But I think it can be difficult to really know how to bring them all together. So how do you all think about that as sort of a continuum under the same umbrella?

Mark Wenneker: David, while they all really fall under the umbrella of addressing disparities in care and access, they really are separate strategic initiatives in my mind. So, the activities and focus and resources that need to address social determinants of health are very different than what needs to get done to address access to a healthcare organization. And I think both are important. So, healthcare organizations need to spend time thinking about who their community partners are and what their role is in supporting the community’s efforts to address social determinants of health.

It may be purely resources. Money. Or it may be something more direct like providing staffing or support. But it’s a very different type of work.

James Cervantes: I would agree with that. I do see them as separate, but I do think they are interrelated. Especially for healthcare organizations in more small and rural communities, where oftentimes your workforce is an extension of the community. So, how you’re talking about equity, where it sits on your strategic priority plan, how it’s mentioned in your vision and values, I think speaks volumes to your workforce.

And what you’re doing proactively, externally, I think, also needs to mirror how you talk about it and how you treat your workforce internally. So I agree a hundred percent, I think they’re separate, but there are connection points because they all sort of ladder up to the same overall vision and values.

LaTonya O’Neal: Yeah, they’re separate but not mutually exclusive.

Mark Wenneker: Yeah, I think that’s a great point, James. Most healthcare organizations are the biggest employers in the communities that they serve. So you really can’t think about that completely separately. You’re absolutely right.

David Shifrin: Well, let’s talk through some specific examples. You are doing this work, you’re researching this. So let’s just kind of go around the room and talk about some of the folks that you see doing a really good job. Some of the unique things that are happening across the healthcare industry and ways that colleagues and peers can kind of take some of those lessons about the things that we’ve talked about.

LaTonya O’Neal: We did a panel. Mark referenced the paper that we wrote some months ago where we were talking about leading while black, addressing disparities in our healthcare communities. We did a panel with some esteemed senior executives from some of the largest healthcare organizations around the country.

And three things that struck me in their talking that I think is a good blueprint for how others might want to try to get at addressing the disparities and also some of the issues around, you know, just racism in general. One individual said, “The best way to know what’s happening in your community is to get out in your community and actually see for yourself what’s going on.”

Part of that could be through board representation, but the other part about that is leveraging the people that work in your organization to help you understand what’s really happening. One example that they gave was they invited one of the nurses to join a board meeting one day, just to talk about what was going on in the community.

And it really made a difference in helping the board understand what the real problems were. The other thing that they mentioned was the measurement, which we’ve spoken about already. That is putting together performance metrics that truly you can measure yourself against in order to know whether or not you’re succeeding or not.

And the third thing that really struck me, it kind of dovetails on the first one around knowing what’s going on in your community. But we had one leader talk about how they’d started creating traveling grocery stores in areas where there were food deserts, right?

So, a lot of the issues that were going on in their particular community had a simple problem of… and I say simple not in that it’s a simple problem but as straightforward a problem of… our folks are not getting the food that they need to stay healthy and to be able to thrive.

And so, they took it upon themselves to create these traveling grocery stores so that those individuals who couldn’t get out and get the food that they needed, they provided that service to the folks within that community. Other stories like that, of being creative about how do we serve our community in the way that our community needs to be served, it’s just very important in order to make sure that we’re actually addressing the root causes of the problems that we’re experiencing.

David Shifrin: LaTonya, keep going on that a little bit, if you would. Leadership recognizes the need to go out and understand what’s happening and what needs to be done. They make the commitment to go out. They go out—whether to the community or inside the organization.

What does it look like practically for a leader to step into that conversation and listen and extract the information that they can then take back and use?

LaTonya O’Neal: You know, it’s a great question. I know that at least with a couple of folks that we spoke with, they talked about how being a trusted leader in the community was one of the ways that they were able to actually even get people to share with them the needs that they were experiencing. And so, I think part of it is being present, being available, and not just coming in to be a speaking head, if you will, is the first way you do that.

And I think that listening to the teams that you have in your organization could be another way of doing that. It’s one thing to think that you’re going to be able to walk around the neighborhoods and knock door to door and have people to just share with you what’s going on. You’ve got to be creative in how you get that information, whether it be surveys, whether it be information you’re collecting when the patient is admitted into your service.

No panels… you’re really getting that real-world feedback. I guess the key point is not to assume that you know what the problem is.

Mark Wenneker: You know, it’s striking to me that a very close corollary of this importance of listening is, who is actually representing your organization to listen? And while I think we need all leaders, regardless of their background to be present—as LaTonya is saying—in the community, it is very important that organizations have leaders that reflect the backgrounds of their representative communities. And that’s not happening enough. Because I think the communities, when they see those leaders that have similar backgrounds, are going to feel more engaged. They’ll have more trust. And I also think the other piece of this around workforce diversity is if you have those opinions and experience brought into your organization, it’s important to also listen to your community and go out.

But having that representative thinking and experience within also helps you understand what needs to be done.

LaTonya O’Neal: And too, Mark, creating that safe space which we’ve talked a lot about in the past, you’ve got to create that safe space where your teams are comfortable enough to even bring those types of ideas forward.

James Cervantes: Along those lines of listening, one thing we did at Jarrard to help facilitate conversations like that—and this was for a large health system out West—is they knew that they wanted to leverage their clinicians and physicians who for the most part their workforce and even members of their communities trusted.

But some of the folks just weren’t sure how to have those conversations, what questions to be asking, how to dispel some of the myths. They have the clinical information, but it’s how you frame it. And so we created a couple of toolkits. One was really for internal ambassadors and clinicians to use within the organization, as they’re in meetings to just address some of the top topics head on and to dispel some of those myths. But more importantly, to your point, Mark and LaTonya, to just be available to answer questions. And to really hear what the concern is from some of these groups that were very reluctant to get the vaccine. And then the other toolkit was really more for community partners. So, how were they able to leverage their community partners to engage in thoughtful conversations outside of the walls of the medical center?

And I think from both of those efforts, sort of in parallel, they saw tremendous uptick in the number of folks that were coming to get the vaccine. And I think they just have a deeper sense of who their community is now in a way that a data point wasn’t able to provide before those conversations.

LaTonya O’Neal: Just to add onto that, we created a maturity model as part of the work that we did earlier in the year as a way to help hospitals take a hard look at themselves. To look in the mirror and say, “Where are we along this continuum of where we want to be to address these disparities and make sure that we are really serving our communities holistically?”

And there are lots of other tools out there that we’ve seen. Actually, through the work that we did with the National Association of Health Services Executives, they’ve got other resources as well. But, I think that’s really important. You’ve got to take a look in the mirror and understand where you are, ask yourself those questions, and be honest about where you really are. And then put a program in place to drive toward where it is you’re really trying to head. I think without that, it again is well-intentioned, but it’s certainly not going to move the needle in a way that’s going to be measurable and impactful.

David Shifrin: Okay. LaTonya, Mark, James, what did we miss? What do you want to chat about?

Mark Wenneker: You know, there’s… the only other thing I was thinking about in terms of topics, was this issue around, is there a business case to be made?

So, in our report, that we did in collaboration with NAHSE, we talked about one of the challenges that healthcare organizations are facing, which is the question about, “How do we invest in these important areas, given the challenges we’re facing financially—most acutely with the pandemic, but certainly in the long term?” And yes, those are real. Those are real issues. However, it’s important to understand that the societal impact of healthcare disparities from a financial standpoint is significant. A Kaiser Family Foundation report estimated that disparities contribute almost $100 billion dollars in excess medical costs to our society and $42 billion in lost productivity.

Now that’s not to say that healthcare organizations can always capture those savings by making investments, but I think it’s important that they in their planning think through how can they benefit financially in addition to morally, their moral commitments, as they proceed with this planning work.

LaTonya O’Neal: You know, Mark, that’s a great point demonstrating the return on the investment. So, even in our consulting work, there are a lot of things that are the right thing to do that are good for the organization but might not have a return on investment. When you think about health disparities, the readmission rates that happen with patients who are not able to care for themselves at home, or when you think about extra admissions just because patients are not able to make their regular physician visits and things like that.

I mean, there is not enough data yet. I think that this is again back to where we need to really create some good measurement vehicles. But the return on the investment of making these programs part of your organization’s internal fabric and culture is significant. And in my mind, at least in working in the revenue cycle space like I do, you think about admissions, hospital care and then the billing that happens on the back end. I’m sure that there could be a direct correlation between these programs and patients do in your organizations on a regular basis.

James Cervantes: I would add, too, going back to our point earlier about your workforce, the labor market is as tight as it ever has been. And so, how are you honoring your commitment to health equity and retaining the talent and bringing in top talent? And I think more people, especially younger generations, are driven by and inspired by organizations that do what they’re going to say that they do and fulfill those commitments to their community and to solving for health equity. So, I think there’s sort of the workforce element as well, from a business imperative.

A Win for Patients…and Rural Providers

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: New study finds consolidation lowered mortality in rural hospitals

“Rural hospitals that merged with or were acquired into larger health systems are associated with greater reductions in mortality for conditions like heart failure, stroke and pneumonia compared to facilities that remained independent, according to a new study.

What it Means for Your Health System

(2-minute read, 13-minute podcast)

Some good news for those trying to make the case in favor of rural hospital M&A. For too long, insurance companies, policymakers and some parts of the media have been filling the “cons” column with negative consequences – real, alleged and everything in-between – of rural providers joining up with former competitors and larger systems alike. Now, this study, published in one of the reputable journals within the JAMA constellation, offers a solid datapoint for the “pro” column.

We’ve been encouraging providers pursuing partnerships to tell their story by explaining the value that partnership will create. We’ve also advocated for finding data that can undergird those arguments. And so for many reasons it was encouraging to see lives saved – mortality from heart attacks was cut nearly in half following an acquisition, mortality due to stroke decreased by about a third.

Whether your organization is looking to acquire, be acquired or simply help change the narrative around consolidation, add this study to your stack of materials. Here are some considerations as you do.

Be motivated. Nothing in the data guarantees an outcome, but rather shows what’s possible. That possibility can serve as a goal for everyone involved. “They cut mortality by half? It can be done – and let’s take it further!” It’s a way to connect back to your mission and give your people hope through the promise of making healthcare better.

Learn from the results. Use the overall data as the impetus to look at how other providers have succeeded. It’s the action to follow the motivation. That means spending time to reverse engineer the improved outcomes following an acquisition, then working to apply and explain those lessons for your specific situation. Who knows? Even hospitals who aren’t in the middle of a deal might find some valuable ideas.

Go on offense. A risk with positive data such is that it can become fetishized, something that advocates for a deal instinctively point to every time criticism comes their way. Don’t give in to the temptation. For one thing, you run the risk of muddying the waters by getting into a tit-for-tat argument. “They showed that costs went up? Well, we showed that mortality went down!” Technically accurate, maybe, but not helpful. In addition, if you use data defensively you are, by definition, reacting to the opposition. Instead, be positive and proactive by using the numbers to explain why you’re moving towards a deal and what you plan to accomplish.

Don’t expect a magic bullet. First, what does it tell us? That done well, a merger or acquisition can lead to meaningful improvements. What does it not tell us? That a partnership will lead to meaningful improvement. Be very careful to not overstate results. Getting to better outcomes will take a lot more than just partnering up and letting things run their course. It’s years of careful, mission-driven work to get the desired outcome.

Be patient. The Modern Healthcare article about the paper noted that many of the improvements “were not seen until after three to five years post-merger.” That’s a tough pill to swallow in an instant-gratification society, especially for something as acute and personal as medical care. As you proceed through a deal, it’s critical to set expectations about what is and isn’t possible, including when people can reasonably expect to see the results. But at the same time, explain to people the meaningful benchmarks along the way so they can track your progress towards the goal.

Rural hospitals are struggling and need a path forward. Recognizing those difficulties and mapping the way is the impetus for groups like Rural Healthcare Initiative. Here we have a bit of light, showing that there is a way to improve care for these communities through strong relationships. It takes time and energy to find that right partner, but here we have strong, reliable data that it can be done.

Want to learn more about the study and what it means for rural M&A? Check out the 13-minute conversation with Jarrard Inc. Partner Isaac Squyres.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

Operations and Emotions: A Case Study from Penn Medicine’s Employee Engagement for the COVID-19 Vaccines

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When people do it right, it’s our duty to share.

The “doers,” in this case, were leaders at Penn Medicine. Their challenge was getting their workforce quickly vaccinated against COVID-19.

“Our flu vaccination each year isn’t an issue,” said PJ Brennan, MD, chief medical officer and senior vice president of the University of Pennsylvania Health System. “But for this, we had to be more persuasive. We needed an organized approach.”

In that statement, he spoke for virtually every healthcare leader across the country as they prepared for the COVID-19 vaccine rollout last fall and as studies starting last year revealed concerns about the vaccines among healthcare workers.

Penn Medicine’s approach to driving vaccine acceptance is worthy of a close look – especially for the way it connected with employees of color and groups with high levels of vaccine skepticism. And it offers lessons for other projects requiring employee buy-in that providers will always have to undertake.

How’d Penn Medicine do it? The short answer: It took a careful blend of operational nous and emotional intelligence. By May 2021, all of the health system’s employees and clinical staff had been offered the vaccine, and nearly 70 percent—more than 33,000 people—were fully vaccinated. That month, the health system was among the first, and the nation’s largest to date, to mandate COVID-19 vaccination for all its employees by Sept. 1 and for new hires effective July 1.

Taking Responsibility

Florencia Greer Polite, MD, felt the emotional weight of the pandemic from the beginning. An obstetrician, she was just settling into her role as chief of Penn Medicine’s Division of General Obstetrics and Gynecology when a close colleague got very sick from COVID-19. He was intubated for over 40 days, had a stroke and is now unable to operate on patients.

With that experience setting the tone for “the most stressful of my 20 years in medicine,” Polite considered the fall vaccine rollout. “I wasn’t sure when I was going to get the vaccine, although I knew I would eventually,” she said. “I’m not an early adopter by nature.”

But then she noted she was “a leader – and a Black leader – in this department and this institution. I considered what being at the beginning of the curve could mean for other people.” After hearing that vaccine would be arriving in mid-December, Polite ultimately leaned into her role over her natural tendency. “I said, ‘I’m getting it. I’m going to stand on the side of science and not fear.”

Not everyone in her personal circle supported her decision. Nonetheless, Polite joined a group of other Penn Medicine leaders who received the vaccine on December 16, the first day it was available.

Operating with Intention

While Polite was wrestling with her decision to get vaccinated, CMO Brennan was studying the dynamics within the Penn Medicine staff and considering the operational implications of a mass vaccination push.

What led to success was the one-two punch of an efficient operation that came to life mindful of issues of trust and emotion. So the rollout, for instance, ensured from day one that Penn Medicine staffers could see someone from their community who had opted to receive the shot.

The team recognized that no operational work could succeed without first addressing the concerns of the people involved. That concept is going to prove vital in future non-pandemic, non-crisis change management efforts. Whether getting employees vaccinated or getting them comfortable with a new strategic initiative, addressing the emotional weight of the situation must come early on. This is especially true for skeptical groups – in this case, people of color wary of vaccinations.

Here’s how it looked from Polite’s vantage point: “We’re asking you to not just trust science; we’re asking you to trust us. We did it. We’re not asking you to be blindly faithful. We’re letting you know that you can see us in action.” This idea of trust and honesty demonstrated through personal example was at the root of Polite’s ability to move the needle. She didn’t need to “convince” anyone so much as show them.

Backed by Numbers

Looking at the other side of the coin, no amount of emotional support can make up for a poorly executed plan. Weak operations can damage the most carefully cultivated trust. Feel-good stories open the door, but they don’t finish the job.

Brennan and his team turned to the numbers. They wanted to understand the nuances of vaccine acceptance across the Penn Medicine constellation with a particular eye toward job position and race. “In this context, occupation is a surrogate for zip code,” said Brennan, referencing the public health method of using residential zip code as an effective way to categorize peoples’ demographics like socioeconomic status and race/ethnicity.

“White employees had a higher vaccine acceptance rate from the get-go,” he said. Only about one in five Black employees scheduled a vaccine appointment in the first week, compared to more than half of white employees. Other groups fell somewhere in between.

Brennan and his team worked to close the gap. Polite saw her mission clearly. “I have the opportunity as the chief to make sure that we are an institution that practices what it preaches and takes care of our vulnerable neighbors in Philadelphia,” she said.

Launching the Program

Here, the emotional and operational stories of Polite and Brennan merge.

Their solution was Operation CAVEAT, a multimodal educational outreach approach about COVID-19 and the vaccine that Polite fully describes in a Los Angeles Times column she co-authored with Penn Medicine colleague Eugenia C. South, MD, MSPH.

“CAVEAT allowed us to say, ‘Here’s the organizational structure around which we can be in direct contact with the folks who need to see us,’” Polite recalled. She also connected with the CMO of the Hospital of the University of Pennsylvania (HUP) about the lower vaccine uptake in people of color.

That conversation led to an introduction to Aron Berman, who leads environmental services, food services, patient transport and materials management at HUP. “We talked very frankly about the racial dynamics of his team,” said Polite.

Berman said, “There was a very clear problem with high-stakes consequences. I was fortunate to be in a position to have this conversation” and to use his position of leadership to, “do the right thing for our Black and brown colleagues.”

Through that understanding of his team, Berman, like Polite, recognized and acknowledged that race was a significant factor in vaccine acceptance and confirmed that his team wanted to hear from Black physicians.

Matching Tactics to Needs

Having determined who employees wanted to hear from, the next step was how.

Many of the employees on the teams Berman led had limited access to Penn Medicine email. So, the system’s vaccine-related information wasn’t reaching them while false or negative information from external sources was.

The health system responded quickly with several primary tactics:

  • Individual paper “vaccine invitations” that hourly employees could take to the vaccine center and walk in – no appointment, no waiting, no worries about trying to stretch a lunch break long enough to get through the process.
  • A series of posters and one-pagers featuring Polite and other physicians with quotes about why they got vaccinated and facts from the CDC.
  • A set of vaccine-related screensavers featuring Black physicians initially located in break rooms and clock-in/out rooms but later deployed throughout the health system.
  • Inviting physicians – at least one of whom was Black – to join the daily group huddles environmental services, food services and similar teams were already having to listen and answer questions.
  • A town hall meeting, open to anyone in the University of Pennsylvania Health System, featuring a highly diverse group of speakers.

The result was a notable – though not immediate – increase in vaccine uptake among Black employees. While the 30 percent gap they initially had actually briefly widened to 40 percent as uptake among all groups grew, it then declined as the efforts among Black employees gained momentum. Moreover, it’s likely that the effort put forth by the leaders involved will have positive long-term ramifications thanks to trust gained during Operation CAVEAT and related initiatives.

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Psychology, Communications and Vaccine Hesitancy

Woman lifting her shirt sleeve while a man inserts a medical shot into her arm

We fear things that can help us. Why? And, maybe more importantly, how do we overcome that fear?

A couple of weeks ago, we ran a conversation between Molly Cate, founding partner and chief innovation officer at Jarrard, Dr. Mark Wenneker, a partner at The Chartis Group and primary care internist who leads Chartis’ behavioral health practice, and Dr. Danny Mendoza, a psychiatrist with the Beth Israel Lahey Health System and an expert in behavioral health integration. In that conversation, we looked at some clinical principles healthcare leaders can apply to their teams, patients, and the public to allay fear in this bizarre pandemic world we’ve been living in.

It was all rooted in a white paper that we published along the same lines. You can find that white paper at jarrardinc.com. But as we went through that first conversation, and as things continued moving forward in the vaccine rollout, it became clear that the principles applied to vaccine hesitancy as well. There’s a whole second discussion to be had with Wenneker and Mendoza about some of the psychology behind hesitancy and how healthcare providers can sort of guide people rather than push them. This is that conversation.

Vaccine Case Study: Understanding and Encouraging the Reluctant

Aerial view of a city

The pandemic has rocked California. And Cedars-Sinai provides care for over a million people annually across 40 locations in the incredibly diverse Los Angeles area.

Today, as vaccine distribution is underway, Cedars-Sinai is faced with a common challenge: how to encourage vaccination among Black and Latino communities.

We asked Dorian Harriston, associate director of brand strategy, to explain how Cedars-Sinai is tackling this challenge. The answer lies in the organization’s longstanding commitment to community partnerships.

photo courtesy of Cedars-Sinai

Jarrard Inc: The issue of vaccine hesitancy among the Black community is well-documented and something many providers are struggling with right now. What does it look like in Los Angeles?

Dorian Harriston: Vaccine hesitancy appears to be as prevalent here as anywhere else – especially in Black and brown communities.

From my experience, the level of education, income or job doesn’t factor into whether an individual is hesitant to get the vaccine. It’s a deeply rooted effect of historical medical mistreatment that has caused distrust. I hear the same things from family and friends as I do on social media and even colleagues in healthcare: People are afraid, and the conspiracy theories and misconstrued testimonies posted online are not helping. This is a serious issue.

How is Cedars-Sinai addressing the hesitancy?

We’ve prepared an overall strategy to strengthen our relationship with these communities. It starts by partnering with organizations that cater to the needs of Black and brown communities. We hope to be a true partner, amplifying their messages and providing support – and not just monetary support – to increase and sustain resources while conducting outreach to show commitment to our community.

What does that strategy look like in practice?

Initially, we’re doing a series of virtual talks and engaging faith, community and healthcare partners to discuss the issue in various formats. We’re enabling our clinicians and researchers to answer FAQs and attempt to ease fears by responding with facts.

We have to be honest about barriers that cause hesitancy to address them and help determine culturally relevant and satisfactory solutions. Transparency, honesty and commitment are paramount to changing longstanding thoughts and behaviors. We need to regain the Black community’s trust, and we must prepare for a long-term commitment.

Talk more about the role of your team members.

It’s essential that we take as much care internally as we do externally. We’re creating internal conversations around vaccine hesitancy and trust, taking the time to tackle this initiative collectively because it affects all aspects of the programs and services we provide as an institution. Employees must be ambassadors that carry factual and positive messages to their circles of influence. It will take a village to make headway.

How is it going?

We’re just getting started. The first step is to find out what Black and brown communities want and need. We’re doing this through our partners and stakeholders. Partnership is the key to expanding outreach and ensuring the message is reaching every audience within these communities. We need to communicate with influencers – whether that’s the internal family circle (caretakers responsible for multi-generational households, children that bring new information and technology, etc.) or external relationships (faith leaders, clinicians, community and civic leaders and friends). Organizations have provided what they believe this demographic needs for far too long without doing the research to back it up. We want to be sure we are addressing needs in a way that helps build trust and establish a consistent path to preventive care.

Healthcare is local. How do you, as a large system with a significant geographic footprint and diverse patient population, present messages that will resonate with each community while remaining consistent across the system?

The pandemic has forced our team to review our current practices for efficiency and align messages across channels. I see us working together more as a team due to COVID-19 than before the pandemic. Although we have a lot more meetings, being able to divide and conquer and form special project teams has allowed us to refine our messaging and reach a larger audience while promoting significant but often overlooked areas – in particular, research, education, and community engagement. These areas create a trifecta with clinical care vital to defining needs, breaking down barriers to vaccine acceptance, and promoting health equity. We also want to ensure that Black faculty and staff are included and visible so that these communities know there are people who look like them working on their behalf.

What advice do you have for other providers? Are there best practices that that apply across the board?

  1. It’s important to align strategy around your organization’s health equity and diversity and inclusion goals. Creating tactics is easy, but it’s essential to have a definitive strategy that speaks to who the organization is and provides a roadmap to inclusively provide for your community’s health.
  2. Ensure that your communication is honest and transparent. There’s no shame in admitting you don’t have a piece of information or don’t know something. Also, remember that one message may not be sufficient. There are varied audiences within each targeted demographic, and having a single message isn’t enough. Having multiple messages and communications vehicles could be the difference between being heard or ignored.
  3. Before beginning any outreach, know that there are no quick fixes. If your organization isn’t willing to invest budget, time and resources, don’t proceed. To battle the distrust and inequity that Black and brown communities have experienced, you must consistently engage and work to understand unique needs, health disparities and cultural norms. Have BIPOC (Black, Indigenous and people of color) on your team or as advisors to vet advertising and messaging and provide communication vehicles such as unique media outlets and preferred ways in which the target demographic seeks and digests information. One wrong message or misstep could injure an already fragile relationship with communities of color.
  4. When crafting a call to action, ensure you have the capacity and resources to engage and execute in a manner that will make it easier on your audience. Right now, individuals are afraid, anxious, angry and burned out. Anything that appears to be unclear or complicated will cause frustration, dismissal and possibly a negative perception of your organization. Ensure that your strategy allows for flexibility and resources that will help everyone within the community – even if you cannot provide those services.

First in Line? No, Thank You

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Why Your Vaccination Communications Must Attune to Justified Reluctance of Black Populations

Nine months into the pandemic, it’s clear that Black people are suffering disproportionately from COVID-19. Now, on the verge of emergency use authorization for Pfizer’s vaccine, providers and government agencies are working urgently to determine who will receive it first. As plans are laid to prioritize and execute vaccine distribution, healthcare providers are well-served to step back and consider how they will address the reluctance of their own staff and their patients of color to get the vaccine.

Assuming Black healthcare workers and patients will want to be first in line for the vaccine is a flawed approach, according to Rick Smith, president and CEO of United Way of Ross County in Ohio, vice president of Advancement and Engagement at the Northern Pennsylvania Regional College, Warren, PA, and a seasoned communications strategist who’s served in senior roles at several prominent health systems.

Smith maintains that when it comes to being first in line for a vaccine, some African-Americans hear this: “You’re going to be the first because, once again, we want to experiment and see how it works. Once we’ve seen the results and tweaked it, then the rest of the population will get their vaccine.”

To that, their reaction is “No, thank you,” Smith said.

“That’s what society has engrained in that segment: We’re your guinea pig,” he added.

As healthcare provider organizations begin to develop their vaccination communication strategies, they need targeted and particular outreach – internally and externally – to reach and better serve Black populations who have been harmed by health researchers and providers in the past.

Jarrard Inc.’s national consumer survey revealed striking disparities in who is likely to get a COVID-19 vaccine, once available.  The results showed that 36 percent of Black respondents reported being extremely or very likely to get a vaccine compared to 57 percent of white respondents. Black respondents also reported lower levels of trust in hospitals, nurses and doctors.

Those results didn’t surprise Smith or Dr. Pam Oliver, Novant Health’s executive vice president and physician network president in Winston-Salem, N.C. and a practicing OB-GYN.

“Our African-American and Latinx communities are extremely vulnerable to disinformation campaigns because they don’t trust who we would say they should go to,” Oliver said. “They may not trust physicians. They may not even trust us, as African-American physicians, because now we’re part of ‘the system.’”

Smith said these disparities are driven by “a history of mistrust,” – alluding to decades of appalling mistreatment and atrocities the medical community has inflicted upon Black people in the U.S., particularly with experimental treatments.

Henrietta Lacks. The Tuskegee Syphilis Study. Cincinnati radiation experiments. These outrages are contemporary, modern tragedies, Smith said.

“A lot of people want to put their heads in the sand, saying that was so long ago and it doesn’t mean anything now. But these are real issues, and we’ve got to start to combat them head-on,” he said.

Further, these infamous examples don’t even account for everyday experiences Black men and women encounter within our health care system. For example, studies have demonstrated that Black women are often not listened to when reporting signs of complications and one-quarter of Black women reported disrespect and abuse from medical professionals in the hospital.

As healthcare provider organizations enjoy overwhelming trust among the public and a politicized battle over the COVID-19 vaccine looms, there’s work to do to overcome barriers to trust among minority groups. To do so, healthcare organizations should bear in mind:

Educate yourselves first to repair trust

Smith and Oliver agree that deeply educating leaders and internal teams is a crucial first step. “A public, open acknowledgement of where the opportunities are and the history is important,” Oliver said. Smith agreed: “There has to be a coming together to first be educated on the history of mistrust and abuse that one body of people have had most often at the hands of others. There is a mistrust, and here’s why.”

Communicate internally first

Doctors aren’t the only ones who interact with patients. Front desk staff, nurse aides and lab techs also need to be consistently prepared with your organization’s message on COVID-19 safety and vaccines – as they also interact with patients. To gain the trust of all patients related to vaccines, “a thought-out, thorough internal communications process needs to happen with these folks first,” Smith said. Oliver added that people should feel empowered to openly ask questions.

Don’t go it alone

While doctors do enjoy the highest level of trust among the general population (53 percent) and among the Black population (45 percent), provider organizations need to push beyond their own spokespeople – meeting people where they are through partnerships with community organizations and groups like historically black fraternities and sororities, Smith said. For instance, one of Jarrard Inc.’s large health system clients works with a network of 80 churches to reach underserved populations. People who are already trusted in the community should be visible and vocal, Smith said. As we say at our firm, “The messenger is just as important as the message.”

Start communicating early and transparently

While it’s true that no one knows when a vaccine will be safely and widely available, health systems need to start building trust and credibility on this issue now. For Oliver, that means being open and candid with internal teams about how vaccines were evaluated and identified and about any potential risks. Even if you don’t have all the answers – no one does! –transparency and openness are key. “If we wait to start communicating when we have a vaccine, it’s too late,” Smith said, adding that systems must proactively devote extra effort to reaching underrepresented communities.

Make a real commitment to meaningful action

To foster trust, Smith said, “People need to see themselves reflected in the organization.” “When African-American patients come into the room and see no one who looks like them telling them the benefits of the vaccine – there’s going to be a hesitancy,” Smith said. All organizations will benefit from a concentrated effort to diversify their workforces at all levels of the system. When it comes to regaining the trust of marginalized communities, “We can’t just tell people they should trust us because we have their best interests at heart,” Oliver said. “We have to find ways to show it.

About the national consumer survey

In partnership with Public Opinion Strategies, we conducted a national consumer online poll of 1,101 adults between July 31 through August 3. The demographics of the respondents included a representative sample of our nation in terms of gender, region, urban/suburban/rural. This was the second survey conducted in response to COVID-19 with the first occurring in April of this year. Both surveys were designed to assess the lay of the land for providers by measuring public sentiment on topics including telemedicine, federal funding, mask wearing, vaccines and provider trust.

About Kaleidoscope

At Jarrard Phillips, Cate & Hancock, we recognize the power of diversity in shaping perspective, generating awareness and leading to long-term sustainable change. This pertains to our own culture, as well as the work we do on behalf of our clients, most of whom serve diverse communities. Through Kaleidoscope, we hope to use our gifts to do good to drive toward action, broaden perspectives and be more inclusive. We acknowledge that as communicators we are better and our work is stronger when we consider all backgrounds and perspectives. We deeply value diverse viewpoints reflective of our communities and believe that only by seeking out and learning from these diverse voices are we able to perceive the world through the eyes of others. We will use our words, wisdom and resources to help our clients build a better healthcare community for the populations they serve and the teams delivering care, all while striving to eliminate racial disparities and being inclusive of all.

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Part 2 – The New Healthcare Marketing: Precision-Based Execution

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In an earlier post, nationally recognized healthcare marketer Reed Smith teased the need for healthcare marketers to drive engagement through precise targeting. Smith is a 20-year veteran of healthcare marketing and digital innovation who serves as Jarrard Inc.’s vice president of digital strategy. We asked him to get deeper into what precision-based execution means and some specific tactics for giving it a go.

Jarrard Inc.: Explain what you mean by precision-based execution

Reed Smith: It’s about avoiding broad digital marketing campaigns. Of course, sometimes you do need to go broad with, say a general brand awareness campaign. But for the most part, when you’re thinking about service line marketing, service line growth or patient acquisition, you need to be going after very specific people. And some of the typical approaches – like running radio ads – may not make sense.

JI: Has the need for or anything about this rifle approach changed over the past few months?

RS: The last eight months have created some interesting nuances. Think about the flu shot. We’re focusing on everyone getting a flu shot going into the winter, so that’s tens, hundreds of millions of people who need it. But providers can still be very specific about the messaging they’re using. It’s not, “Hey, everyone needs to get the flu shot.” It’s differentiating between and speaking directly to moms with kids at homes or empty-nesters or teens.

All of that is going to weigh into where you get the shot, the message that you hear convincing you to get it, the medium used to deliver that message – is it a video or a photo an ad on the local public radio station?

JI: We also know the messenger is critical. How do you combine the right precision-based message with the right messenger?

RS: With digital tools, we have a true opportunity to bring that message to the right people via the right messenger in fairly straightforward ways.

People want to hear from physicians, nurses, therapists, APPs and other caregivers. Once provider organizations have identified those people, digital channels lend themselves to expertise and thought leadership. Think about all the live content we see on Instagram or Facebook or YouTube. People are already accustomed to these types of environments because they’re already doing webinars and taking to other leaders through Zoom.

JI: But are people going to see that content?

RS: Historically, we’ve seen mediocre organic performance on social channels. Healthcare marketing has had to push pay-for-performance if we wanted anyone to see our content. But a side effect of COVID-19 is that we’ve gotten a lot more traffic to our sites because people are looking for medical information they can trust, and providers have been sharing it. We’re seeing a wave of organic traffic. Now we need to leverage that opportunity.

JI: Whether a provider feels behind or keeping pace with digital, how do they grab the opportunity you just mentioned? For example, do they just start doing Facebook live or take a more measured approach?

RS: Historically I’ve been a heavy proponent of “proceed until apprehended.” But it’s important to put some nuance on that. When it comes to digital marketing there’s value in trying things out, beta testing new approaches to figure out how useful they’ll be. You mentioned Facebook live. It’s hard to understand the ins and outs and how useful it’ll be without just using it.

But ultimately, you need to think through a strategy and a plan before you get too far down the road. Healthcare marketers need to answer the question about what a new tactic means for the organization – both strategically and tactically. The other issue to keep in mind is the politics. “If I do something with one physician, does that affect another physician?” Overall, though, if you have an understand of what’s going on across the organization and have built enough credibility to get permission to test and tinker, it’s great to get into the lab and figure out what works.

JI: What else have providers learned over the past few months?

RS: What I’ve found interesting is the expectations around virtual care and other alternative delivery methods. We’ve talked a lot about telehealth and how people have experienced it and loved it. But think, too, about drive-through testing for COVID-19. That’s all in place so drive-through flu shots wouldn’t be a stretch, right? So, organizations have an opportunity because the baseline has been reset.

If you want figure out how your organization stacks up when it comes to digital maturity, check out our 28-question, 15-minute Digital Maturity Survey. You’ll get a complimentary scorecard and benchmark against industry averages.

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The New Healthcare Marketing: Measure Twice. Improve Once.

Measuring tape displaying 7 inches on a granite countertop

We’ve long said that measurement is one of the consistent deficiencies we observe when it comes to healthcare marketing. We’re typically referring to marketing analytics – reach, engagement, reputation, etc. when we say that. But what really needs to happen is that we measure, well, everything.

Providers today must have a baseline understanding of where they are today so they can either consolidate recent gains or make adjustments based on existing deficiencies (or both). A recent McKinsey study suggests that adoption of digital tools by consumers and businesses has vaulted forward five years in just a few months. It’s happened in healthcare, largely with telehealth. But we have to go deeper. It’s not just spooling up new platforms. It’s ingraining digital thinking into the organization’s psyche, getting buy-in from leadership, making targeted investments in tools and people, and yes, measuring the crap out of everything.

It’s also about setting expectations for what digital thinking can do for healthcare providers. This is where providers are lagging. In our conversations with clients and friends from a variety of healthcare provider organizations, we’re repeatedly hearing that people simply don’t have a great understanding of what the expectations for digital are or should be.

To set those expectations, you have to be able to show what digital can do for your organization. But it’s hard to show what digital can do without having the infrastructure in place to do it.

The fix? Instead of going for the homer, swing for singles and doubles with things like:

  • Listing management
  • Scheduling tools
  • Patient portals
  • Chatbots for frequently asked questions

These are all easy to identify. Not always simple to execute, but manageable. For example, since you want people to find the right information when they search for you online, start with that foundational piece. And if you want people to schedule care at their (and your) convenience, look at online tools.

Let’s be clear: This isn’t optional anymore. Since March, the pandemic has forced providers to get those foundational pieces in place. So much care moved online during the pandemic, and we’re still waiting to see what the new equilibrium looks like. As patient expectations have shifted even more towards digital options, providers desperately need to invest in getting the basics right – even though doing so will take some work.

Aside from being the right thing for patients, it’s important for marketers to think big but act small. You need to know what marketing can do for your organization and what digital tools can do for your marketing. That’s the big thinking. But none of that can happen without the day-to-day execution. Ultimately, it’s about people. It’s too easy to get lost in some of the bigger ideas, which just leads to frustrated consumers, distracted marketing teams and dead ends for everyone. Realistically, we have to focus on connecting with narrow groups of people, driving engagement and helping them find solutions to specific needs.

That’s where precision-based execution comes in. More on that soon.

In the meantime, if you want figure out how your organization stacks up when it comes to digital maturity, check out our new 28-question, 15-minute Digital Maturity Survey. You’ll get a complimentary scorecard and benchmark against industry averages.

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You Are What You Eat!

A paper towel with measuring cups and spoons sitting on top

Four Ways to Feed the Health of Your Employees and Your Health System

I love whole foods and can eat veggies nonstop. My body returns the favor with loads of energy and the endurance I need to focus and get through the day. But like so many people, when I’m busy and overwhelmed, the first thing I neglect is my health. Whether it’s eating junk food, ignoring the treadmill, or feeding my soul useless thoughts and doubting self-talk, I begin to suffer from a lack of self-care and concern. I get sluggish. I become lazy, unproductive and feel empty and uptight.

Oh, the irony.

The same is true for the health of your health system. Regardless of today’s stressors – the immense pace of change, technology, your race to improve HCAHPS scores and reduce hospital-acquired infections – at the end of the day, healthcare is still a people business. What you feed your employees is reflected in your patient experience scores, reputation, revenue and even the state of your bricks and mortar.

These four ingredients provide the immediate nourishment your employees and organization need to stay healthy and productive:

  1. A cup of curiosity – Research shows that curiosity is vital to performance. Fostering an environment of curiosity in the workplace, while showing genuine interest in your people, is essential. As humans, we crave attention and long to know that someone cares. The simple act of asking questions to learn more about your employees meets this basic need and leads to better engagement and higher levels of productivity.

But take it one step further. Look for opportunities to create time and space for curiosity each day. A great way to begin is by asking leading questions before interjecting your ideas or the outcome. Be willing to pause, listen and acknowledge when you don’t know the answer. This vulnerability establishes trust and connection.

The bottom line: Curiosity helps us think more deeply and sensibly about decisions. It also improves collaboration, fuels innovation and creative solutions to complex challenges, while strengthening our ability to adapt to change and pressure more quickly.

  1. A tablespoon of collaboration – Employees need to have a voice; it’s critical to their health. When you create an environment that honors and supports two-way dialogue and communication, employees are happier, more collaborative and productive.

Fostering collaboration lines up closely with fostering creativity. Do a pulse check during your next meeting. Ask questions and call on people to share their thoughts and ideas. Consider calling on people by name, or saying, ‘We’ve covered our agenda, what else is on your mind?’ to draw input from those who may not have spoken. Rotate who leads your daily meetings. Ask everyone to share a win from the week. Also, from time to time provide an outlet for anonymous opinions through a dedicated phone line or online pulse poll.

The bottom line: Outlets for expression foster an environment of innovative thinking, improve teamwork and promote a healthy balance between new ideas and the tried-and-true.

  1. A dash of recognition – The majority of employees aren’t solely motivated by their paycheck. A study in Harvard Business Review revealed that 87 percent of employed Americans don’t feel they’re recognized enough, and 40 percent admit they’d work harder if they were recognized more.

Do you recognize your people? Not the “great job” recognition, but the “I see you and know who you are” recognition. Do you know their names, where they work, what they do and how they like to spend free time? I worked for a CEO who insisted on access to photos, names and job titles of everyone working in the hospital. He cared so much that he could call every person in the building by name when walking the halls. He even studied the surgical services’ roster before walking into the unit. This paid huge dividends when nurses on the unit were recognized and called on by name by the CEO.

How are you recognizing your people?  Healthcare workers were some of the most celebrated heroes in the early months of the COVID-19 pandemic. As time has passed, the fanfare has quieted, and for many, it’s now business as usual (or as much as it can be at this moment). With burnout and PTSD at all-time highs for healthcare workers and leaders, it’s more important than ever to keep recognizing your people. The best appreciation is honest and authentic. Take time to write a thank-you note and mail it to an employee’s home. Strategically place sticky notes on employee’s cars. Give public thanks in a group setting when it makes sense, or buy coffee for the nurse in line needing it to get through his shift. And don’t forget your leaders. They carry a heavy burden to ensure employees are engaged. They need to know they’re doing a great job as well. Consider delivering a meal to their home or create a leader award to recognize leaders at all levels of the organization.

The bottom line: Only one-third of U.S. workers strongly agrees they’ve received recognition for doing good work in the past week, and employees who don’t feel adequately recognized are twice as likely to say they’ll quit in the next year, according to Gallup. That’s a high price for something that doesn’t cost much.

  1. A pinch of possibility – Employee development and growth opportunities are critical to the health and viability of your health system. We know it’s less expensive to retain quality employees than to find new ones. Demonstrating there’s a future with your organization keeps employees engaged. Tuition reimbursement, leadership development training, online classes and access to webinars goes a long way in developing your team. It helps you remain competitive, reduces turnover, increases productivity and equips your people for the future.

The bottom line: There’s a correlation between engaged employees and development opportunities. A Quantum Workplace study found that 72 percent of hostile employees feel they receive too little training, compared to 43 percent of engaged employees. Competition for healthcare talent is only going to become more fierce, a pinch of possibility sweetens the pot.

It sounds so simple: “Feed your insides well and you’ll shine on the outside.” The reality is, it takes time, energy, effort and intense focus to deliver a five-star experience that will set you apart from those who are starving for great health.

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Hope Is Not a Strategy

A group of masked surgeons huddling and hugging in their medical uniform

While times of challenge and change are not new, none of us can confidently or reliably predict when the hurricane we’ve been living through for more than six months will end or the exact toll it will take on our personal and professional lives. Without that crystal ball, we plan as well as we can and then hope for the best.

A few years back, I had to laugh when a colleague declared that “Hope is not a strategy” after a thoughtful, proactive crisis plan we put together was killed by a “Let’s just hope, wait and see” leader.

As healthcare providers, we understand the power of hope even as we practice the science of medicine. When hope takes root, our strategies take flight as they are no longer just words on a page, but deep-seated ideas that are lived out in the minds, hearts and actions of our people and organizations. It’s that emotional connection that makes strategies and tactics effective. Facing today’s uncertainty, hope should be a catalyzing element of the strategies we create to keep people positive, resilient and moving forward together.

Consider these seven ways you may be inadvertently signaling that your organization’s strategy and future are hopeless—plus some smart countermeasures to combat the perception.

  1. You stop listening and start assuming. Your patients and employees desire for you to genuinely listen to them. Open the door to dialogue through pulse surveys, virtual town halls and focus groups. Reinvigorate your Patient and Family Advisory Council virtually and encourage managers to conduct one-on-ones with employees using a defined set of questions. Ensure the plans you’ve made align with the needs of your stakeholders.
  2. You lay aside your mission and undermine your values. While hope is necessary, it alone is not a strategy. Before announcing change, ensure your leadership team can articulate how the change will help fulfill your mission long-term. If a decision seems to conflict with your values, lean into the tension and discuss why it’s the right course. Proactively addressing tension helps people respect your reasoning and willingness to make tough decisions, even if they disagree with it.
  3. You underestimate the impact of change. This is a common mistake that can have severe consequences as people in our organizations concurrently face unprecedented (yes, I said it) challenges at home and at work. It’s more important than ever that leaders emphasize partnership over power and demonstrate they genuinely care about employee well-being. By listening, collaborating, making change more manageable and tying it to your mission, you will strengthen resilience and ensure your team has the bandwidth to make change happen. Be upfront about challenges you are facing, ask departments to come up with solutions and remain supportive by following up with a check in on how things are going.
  4. You create a steady drip of negative news. We all know the only thing worse than ripping off a bandage is removing it slowly. Organizations often get too clever in an effort to minimize negative perception and mitigate the impact of tough news. “We’ll announce layoffs next week, benefits changes in two weeks, service-line closures in October, cancellation of our expansion by Halloween…” Drip, drip, drip… Before long, employees come to believe that every communication from leadership will contain negative news. They’ll dread coming to work. When possible, consolidate tough changes into one announcement tied to a compelling strategy and vision – despite the unpleasant process. You don’t have to have all the details to do this. In fact, this type of announcement is the perfect moment to say, “We will partner with our employees, providers and leaders over the coming weeks to implement these changes in a thoughtful way.”
  5. You fuel speculation. Vague or infrequent communication leaves room for anxiety and rumor to grow. If employees or the community sense a scurry of activity among top leadership, chances are they will invent a reason that is likely worse than reality. Instead of pretending that all is well or avoiding communication, be responsibly transparent. It’s usually better to say what you do and don’t know than to let rumors and fear take over. If you can’t answer or don’t know, share what you can answer and do know, as well as what won’t change.
  6. You emphasize money and ignore the recognition gap. Money is usually not the primary reason people want to work in healthcare. The majority want to make a difference and also care for their families. Change challenges morale, so one of the best ways to protect it and foster resilience, trust and pride is by focusing on the recognition gap. Research shows that leaders believe they give recognition far more than employees perceive receiving it. Recognition has to start at the top, and it has to be a priority. Focusing on wins and encouraging those you lead won’t eliminate the sting of no bonus or annual pay raise, but it will help.
  7. You take the community’s support and trust for granted. Beyond your employees, your community is your best asset in solving challenges. And trust is the key to your relationship with the community. If you blindside people with tough news, make decisions that seem in conflict with your values or have a workforce that is actively speaking out in a negative tone, you very well may lose trust and find yourself worse off. Maintain community support by sharing regular updates, talking openly about the implications of external factors like COVID-19 and change in the industry. And, ensure your employees have the information they need to be ambassadors in the community.

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