University Health System

How one public hospital is using recognition to treat what ails

Take one public hospital, thousands of geographically dispersed employees, a high pressure environment, limited budget, and what many in the healthcare field are calling a crisis in care and what do you get? For Andrea Casas, Director of Human Resources for University Health System in South Texas, it's a recipe for success.

For the last 18 months Casas and her team at University Health System, one of the most prestigious health care systems in South Texas, have been working on a strategy to maximize employee potential, improve patient care and create a culture that engages today's best health professionals. Her focus? Appreciating great work.

Routinely named a best hospital by U.S. News and World Report, University Hospital, owned by the taxpayers of Bexar County, is a 604-bed acute care hospital and the primary teaching facility for The UT Health Science Center at San Antonio. In addition to its role as a teaching hospital, a regional level I trauma center, and a leader in organ transplantation, University Health System operates 16 community clinics. All of which make uniting its many thousands of employees a challenging goal.

"Everyone responds to appreciation," says Casas. "No matter how busy our jobs may be, we need others to notice when we've given our best. And as an organization we've discovered that when we do that well, our people truly engage and commit to giving their best again and again."

Like many healthcare organizations today, University Health System works hard to improve turnover, customer service and maintain its reputation as a world-class service provider. And while the hospital espouses noble values, Casas discovered the lengthy recognition process to acknowledge those who best achieve those values and the link to what those values meant to the organization was not always clear to recipients.

"Don't get me wrong, our people do amazing things," says Casas. "The trouble was when it came time to nominate an employee of the quarter or employee of the year, I was having to solicit those nominations. Something was clearly broken."

One of the keys to the success of the new recognition program at University Health System was to avoid assuming that every manager in the organization understood recognition, its importance and relevance to achieving organizational goals.

"I felt strongly that in addition to making the recognition process easier by taking it from a nomination form that took several hours to complete to a quick six-question click and answer online process, I had to make training a major and ongoing component of its success," says Casas.

Casas invited trainers from O.C. Tanner's Carrot Culture group to educate, train and enthuse University Health System managers. "A lot of light bulbs went off during the training," says Casas. "Managers realized that recognition is a priority for employees and has a substantial impact on important measures like turnover, retention and productivity. And it made a difference that I wasn't the one telling them about it. To have an outside expert come in and share other organization's success stories was extremely powerful and inspiring."

Following the training, University Health System managers put the new, simplified approach to recognition to the test. The result? In just 18 months University Health System has seen over half a percent decrease in turnover that equals approximately $580,000 for the organization, greater employee satisfaction scores and a general increase in morale.

"That drop in turnover represents a significant change in trend for us and it's something we hope to repeat again and again," says Casas. And judging by the impressive increases in participation levels—up 56 percent in the first half of 2008 for the hospital's on-the-spot program and an 88 percent increase in above and beyond performance recognition program participation levels—it's a trend that's likely to continue.

Dr. Gary McWilliams, Chief Ambulatory Services Officer and Executive Vice President for University Health System says the success of the new program comes from implementing a more visible, easy to use platform for recognition in the organization.

"If there's anything the Carrot Culture training taught us it's that you actually have to be verbal about your appreciation. You have to be visible. You have to make a big deal of it," says McWilliams. "It really adds another level when you recognize people for specific things in front of their peers."

Anthony Herron, Clinic Manager for University Health System could not agree more. When he read of University Health System's leadership in so many fields he decided to come work for the System.

"I wanted to be a part of the greatness that was happening here," says Herron. "But when I got here and started to tell people where I was working, they would frown. It was hard for me to learn that an organization that is tops in so many medical innovations did not have the great customer service reputation it desired. I knew it was my job to change that. Now, nine years later, I think we've done that and I'm proud to tell everyone where I work."

Herron attributes a large part of that change to the organization's increased focus on appreciating people and connecting recognition with University Health System's core values.

"When people understand that employees are recognized for certain actions that contribute to University Health System being better at serving patients and each other, a light bulb goes off and they understand, 'Oh, that's what that value means,'" says Herron. "Sometimes we assume that having the values is enough. And that's just not true. Recognition teaches people what those values look like in action and the organization becomes better for it one employee, one patient at a time.

"Those healthcare managers who blame high turnover on the industry are missing the boat," says Herron. "Yes it's a challenging field. But by and large the people who choose to work in healthcare are not here for the money. They are here to make a difference. They are here to be a part of something larger than themselves."

That certainly rings true for Lynn Lindemann, a Learning Resources Performance Development Manager and recipient of several of University Health System's performance recognition awards.

"Even though I am not at the bedside, I impact care," says Lynn Lindemann who says receiving her Commitment to Excellence award was one of the best experiences of her life. "I feel so directly connected to the mission of the Health System and it is recognition like this that keeps me motivated day after day."

Such inspirational tools are what managers like Susan Gerhardt need to encourage employees to continue to give. As Administrative Nursing Director for the Surgical Trauma ICU and Transplant ICU, Gerhardt says it's not difficult to get eager doctors and nurses in the door, but helping them feel appreciated in the hustle and bustle of everyday life saving can be a challenge.

"I give out more on-the-spot cards than you can imagine," says Gerhardt speaking of the instant thank yous the hospital offers to managers to recognize great work when and where it happens. "They love it and they value it. I get quarterly evaluations with on-the-spot cards attached, even internal applications. They collect them and are very proud of them. I now see other nurses and doctors recognizing each other. It's one thing to be acknowledged by your boss, but it's really important when your peers say that you do a great job."

That accessibility to recognition and the culture change it's brought to University Health System is something the organization's leadership hopes to push forward.

"Appreciating great work is really about offering employees something that gets them to a point where they truly enjoy their jobs," says Theresa Scepanski, Vice President of Organizational Development. "Recognition works to move people to a place where they are engaged in the organization. It's the message that the organization values you as an individual, your skills and your dedication."

And with the right training, communication and continued reinforcement of recognition as a good management practice, University Health System hopes to move the organization closer to its goals.

"We invest in training, create smart programs that simplify recognition and deliver improvements in bottom line results like reduced turnover," says Scepanski. "We're counting on staying creative with the money we have and continuing to make appreciation part of our culture as a way of creating a measurable difference to our employees and our patients."