Staffing: In Need of a Culture Change?

The workplace environment at our surgery center is healthy and morale is high. We have regular pot luck dinners and wear T-shirts designed by the daughter of one of our employees whenever we volunteer in the community. We like each other. A lot.

That wasn't always the case. About 18 months ago, staff members complained about on-the-job issues to anyone who would listen. Longtime employees formed negative cliques. They arranged work schedules to benefit themselves, felt entitled and made it hard on new staff members with whom they didn't connect, sometimes driving away the newly hired workers. Things needed to change, so we took steps to end toxic relationships and develop a team full of togetherness.

1 Set clear expectations
Staff were feeling bullied, not supported by management and poorly treated by colleagues, surgeons and anesthesiologists. We had to learn to respect each other and become a tighter group. That meant everyone — including physicians — had to sign a newly created code of conduct. Anyone who violated the code was brought in for a counseling session and told that leadership would try to help them improve their behavior. We weren't looking to fire anyone; we were trying to help employees grow, but with the clear understanding that they needed to make changes in how they treated others. The code of conduct is very specific and makes it clear that everybody deserves respect. The signed code is kept in every employee's file. If we have an issue, we meet with the staff member, discuss the problematic behavior, show them the code and say, "This is what you signed. We're concerned, and we need to redirect your behavior."

Having that signed document on hand helped when we had the tough conversations with staff, telling them they're bullying others or playing one person against another. The conversations weren't easy and at times very uncomfortable, but ultimately productive. Troublesome employees realized they had to align themselves with the facility's values — or leave.

2Respect the chain of command
Some staff members who considered themselves victims were actually the most toxic. They would complain to surgeons about workplace dynamics. They'd walk into leadership's offices to tattle or complain about colleagues instead of discussing issues with direct supervisors.

We no longer permit those kinds of impromptu meetings and instructed surgeons to immediately shut down such conversations. We gave it to employees straight, saying, "Look, this is what your role is. These are our expectations. Don't bypass the chain of command. Don't go to surgeons with your issues." Everyone understood that we meant business, and realized that if they didn't change their ways, they were going to have to find somewhere else to work.

3Assign ownership
We formed teams of staff members to plan activities, community service opportunities and quality improvement projects. This has been a popular change, as staff now have more direct input into everything from volunteering opportunities to holiday parties to how to improve the way we work. Working in teams to organize staff activities has also been an eye-opening experience for some employees, who now understand how difficult it can be and how much work it takes to create change. It helps them realize why things are done a certain way, why some initiatives are deemed more important than others and that you can't please everyone.

4Keep staff informed
Some employees felt they were being kept in the dark, so we improved our communication efforts. But we also put part of the responsibility back on them. Employees are now required to read and sign a new book that contains minutes from staff meetings and company announcements. We hold regular staff meetings that begin with team-building games, and block off surgeries for the 2-hour gatherings so everyone can attend. These meetings are good forums for employees to share their concerns in a constructive and supportive environment.

Explaining the reasons for change goes a long way toward getting employees on board with what's new instead of having them dig in their heels and fight it. We always tell employees when they will receive responses to their questions or concerns. If we're not going to have answers by the promised deadline, we tell them we're still working on it. It's important for employees to know we're not blowing off the issues that are important to them.

Our leadership team meets weekly to discuss all pressing issues at the center. Before the meeting adjourns, everyone agrees that staff members will get the same answer to a question, no matter who they ask. We don't always agree on decisions that are made, but we're committed to sharing a consistent message.

5Show appreciation
Employees are encouraged to deliver written kudos to their colleagues, and those who receive several of them receive $5 gift cards or other small giveaways. We've also established a new employee recognition week. Employees know that although we call them into our offices often, it's not always to call them out. We're now making more of a concerted effort to let every staff member know they're doing a good job. That simple gesture goes a long way to increasing their overall satisfaction.

One employee was particularly difficult to manage. We met weekly for about 20 conversations in all. It was awful at first. There was anger, tears, denials and a lack of awareness. But we worked together on how they could improve. The employee eventually told me she realized how her behavior negatively affected her teammates and thanked me for helping her grow as a person and as a professional. Hearing that type of feedback from a staff member was extremely rewarding, and inspired us to ensure we continue to work in a supportive and positive environment. OSM