Involvement and EngagementValuing Those We Lead

I & E + Appreciation = RespectInvolvement and engagement (I & E) is respectfully valuing the skills, knowledge, ideas, opinions, and perspective of those we lead. In action, it is like a conductor’s baton calling on us all to play our part in improving the health of our patients, our members, and our community.

Involvement and engagement not only ensures that we do a better job of achieving results, it is crucial in influencing how people feel about the organization. In focus groups conducted in the last two years with over 800 employees, we learned that involvement and engagement combined with appreciation is what enabled employees to feel respected at work.

PrefaceThis monograph is intended as a Leadership Briefing regarding a matter of importance to our organization. It is provided to help prepare you to put involvement and engagement concepts into practice in your daily work life.

It will help you: •DefineI&E •Listanddescribethethreephasesofinvolvement(engagement,explanation,expectation) •Identifycurrentopportunitiestoinvolveandengagethatarenotcurrentlybeingutilized •ReflectonthosedeeplyheldviewsandbeliefscentraltoI&E

I & E Overture*Inmostorganizationsleadersmakemanydecisions.Agooddecision, however,isbestmadebyinvolvingandengagingthoseaffectedbythat decision.Thisshouldnotbeconfusedwithdecisionmakingbyconsensus, peacethroughcompromise,orwithacorporateexpressionofdemocracy (51%infavor,49%opposed).Involvementandengagementmeansthat we practice a culture that respects and values the wisdom and work of everyone,andthatweseektotakeadvantageofwhatweeachknowbest. Itisexpressedinthisfundamentalcommitment:Whenever possible, we will involve and engage HealthPartners employees in those decisions that significantly impact their work or that touch strongly held views and feelings. Consistentlyactingonsuchacommitmentwillresultinbetterdecisionsandinamoresatisfyingworkexperience.

Inthisregard,wearelikeanorchestramadeupofmanyinstruments.Weeachareassignedapartandoccupyachair. Weplaywiththeconductor’sdirectionandallcontributetotheperformance.

*Anovertureistheintroductorymovementofalargermusicaldramaticwork...abeginningpoint.

...likeaconductor’sbatoncallingonusalltoplayourpartinimprovingthehealthofourpatients,ourmembers,andourcommunity.

Effective involvement consists of three elements: engagement, explanation, and clear expectation.1Engagementrequiresthatleadersprovideinformationandcontextregardinganissueandaskforinput.Contextsettingincludesthe“why”ofthematter,decisiondrivers,externalfactorsand,ingeneral,thosebigpictureconcernsthatframethedecision.Suchinputencouragesdebate–thevigorousandevenheatedexaminationandrefutingofideasandassumptions.Leadersneedtobeconsistentlyopentoquestionsandtorespectfulinquiry,listeningactivelywithacuriousandempatheticear.Engagementassumesgoodintentiononthepartofbothpartiesandprovidesforhonestconsiderationof the issues.

Oncethedecisionismade,everyoneaffectedreceivesanexplanation of what the decision is and the rational for it. This accountabilitydemonstratesthatmanyviewswereconsideredandthatthefinaldecisionwasmadeimpartiallywiththebestinterestoftheorganizationinmind.

Oncethisexplanationhasbeenoffered,signalsaregiventhattheinputphasehas concludedandthattheorganizationismovingtoimplementation.Whenthedecision involves new expectations,youmustexplainwhattheseare;e.g.,newresponsibilities, goalsorstandardsforevaluation.Asaleader,youneedtocommunicatewhatyour expectationsareandthatitistimetomoveforwardandimplementthedecision.

Insomecases,theinvolvementandengagementofotherswillbelimitedtoonlyaportionofaparticulardecision.Leadersmustclearlydefinetheseboundaries.Whenengagementinaparticulardecisionisnotpossible,leadersmustclearlystatethatfact,explainwhy,andseekinputonhowtoimplementthedecision.And,ifyouareunsurewhethertoinvolveorengage,askyourleader.Notalldecisionsrequirethesamelevelofengagement.Intensityoftheefforttoinvolveothersgoesupasimpactondailyworkandthelevelofemotionassociatedwithanygivendecisionincreases.Lowimpactandlowemotionalattachmentrequirerelativelylowlevelsofengagement;e.g.,decisionsrelatedtosnowremovalataparticularclinic.Whenadecisionislikelytohavehighimpactand/orhighemotionalattachment,moreengagementofthoseaffectediscalledfor;e.g.,advancedaccess.(See Figure 1.)

Not all decisions are open for input. Some decisions leaders must make alone. These include decisions involving confidential matters (for example, decisions related to individual performance or details of contract negotiations) or where time does not allow involvement of others.

1FairProcess:ManagingintheKnowledgeEconomy,W.ChanKimandRenéeMauborgne,HarvardBusinessReview,January2003

Factors Impacting the Extensiveness of the Involvement & Engagement Process: Strategies for Responding

Examples

• Corporate policy that does not affect a work group,

but evokes strong feelings.

Example: Use of religious symbols during holidays

Strategy: Open forums, widely participative, limited

redundancy. Keep people informed as plans develop

and collect reactions along the way.

Example

• Snow Removal

Strategy: Informational, meeting announcements,

postings, email.

Examples

• EHR

• Breast Lump Management

• Healthy Workplace

• Improving Patient Satisfaction

Strategy: Focused on the affected unit, multiple venues with redundant opportunities.

Significant face-to-face and one-on-one, walking about with increased accessibility.

Interaction up and down the organization, across multiple levels.

Examples

• Minor Workflow Changes

Strategy: More focused consultation with those most knowledgeable or those

most affected.

LOW IMPACT on Daily Work HIGH IMPACT on Daily Work

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Figure 1.

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Case StudyRead the following and identify where there was a failure of involvement and perhaps with engagement.

Dr.RoseMariethoughtshewasgoingtoloseit.AsaprimarycarephysicianatRedspireforthepasttwoyears,shehadbecomeveryfrustratedwiththelackofimprovementinthepatientsatisfactionscoresatherclinic.Everymonththescoreswerepostedonthebulletinboardinthestaffloungewheretheycouldbeseenbyalltheclinicalstaff.

Rosehadalwaysseenherselfascompetitive,sohavingmediocredatapostedonthebulletinboardreallybotheredher.Today,thedatalookedasmiddlingasever,notshowinganyrealimprovementordecline.Lookingattheflatline,shegrewincreasinglyirritatedthatthescoreshadn’timproved in months.

Roseknewthepatientsatisfactionsurveydatawasbasedontwoquestions:Would you recommend this clinic to others? Were your medical concerns addressed to your satisfaction at this visit?Thesurveysweremailedtopatientsaboutaweekaftertheyleftthefacility,andthedatawascollected

byanationalsurveyorganization.Rosecouldn’tchangetheprocessofthesurveyorthequestions.Toimprovethescores,something would have to change.

Inthepastyear,attemptshadbeenmadebyclinicalleadershiptoengageotherstoimprovethescores.Dr.MartinAce,ClinicChief,hadraisedtheissueatamonthlystaffmeetingsixmonthsagoandhadformedasmallteamoffourdoctorsandafewstafftoaddresstheissue.Thisgrouphadsetupaprocesswherethefeedbackwouldberegularlyposted,butthescores certainly had not changed.

To collect input within a single setting (department, clinic,etc.)youcanmakeuseofexistingchannels:departmentsite,committeemeetings,informal face-to-facetransactions.Wheremultipleunitsareaffected,ataskforcethatdrawscarefullyfromtheaffectedgroupsmaybeuseful.Takecaretoconsistentlyutilizeallvehiclesavailabletoyouinengagingthoseyou work with. Involvement and engagement is not a newtune.Rather,itreflectsachangefromtheminortothemajorkey.Theintentionbehindthefocusonengagement,explanation,andclearexpectationsistoincorporate the knowledge of others into the decisions wemake.Changeisnevereasy,butwhendoctorsandstaffappreciatethattheirinputwassolicited,heard,andtakenintoaccount,commitmenttochangeincreases.

Questions to consider:In what ways do you see I & E being important to improving the performance of the medical group?

u Whataretheimplicationsofactingontheideas described?Ofnotacting?

u WheredoesHealthPartnersMedicalGroup&Clinics faceitsgreatestchallengerelatedtothistopic?

u What,ifanything,concernsyouaboutI&E?

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Would you RECOMMEND this clinic to others?

2014 GoalScore

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402Q06 4Q06 2Q07 4Q07 2Q08 4Q08 2Q09 4Q09 2Q10 4Q10 2Q113Q06 1Q07 3Q07 1Q08 3Q08 1Q09 3Q09 1Q10 3Q10 1Q11 3Q11

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Dr.Aceconsideredhimselftobeacarefulleaderandseenasanexcellentclinician.Hewasawarethatthescoreshadnotimproved,butsincecommissioningtheteam,hewasreluctanttopushtheissueanyfurther.Hewasinagreementwiththeteamonpostingthescores,buthadn’theardabouttheirotherplansandwasscheduled to follow up with them soon.

Rose’sfrustrationboiledoveratlunchwhenoneoftheotherdoctorswastalkingabouthowaportionoftheircompensationwasbasedonthepatientsatisfactionsurveydata.“Thenwhydon’twedosomethingaboutit?!”sheinquired.

Atthestaffmeetingthatweek,themostrecentsurveydatawaspostedandshowedslightmovementinthedata,butreallynosubstantialchange.Dr.Aceaskedforanupdatefromtheimprovementteam.Unfortunately,theteam leader was on vacation and two of the other doctors werestillseeingpatients.Discussionwasdeferredtothenextmonth.

Rosecouldn’tcontainherself.Sheraisedherhand,andafteracknowledgement,shechallengedthephysiciansandstafftodobetter.“Weshouldnotbesatisfiedwiththesenumbers.Whatcanwedotoimprovethesescores?”Twophysiciansalsochimedin,“Weneedtodosomething!”

In small groups, take a few minutes to discuss the following:u Giventhenumberofpeopleandthebuy-inrequiredtocreateimprovement,whatcouldhavebeen donetogarnergreatersupportforandcommitment?

u Howwouldyouhavedesignedandrolledoutaprocessthatwouldhavehelpedphysiciansandstaff buy-intotheneededchangeandbecomeactiveparticipantsintheprocess?

u Howcouldtheprocessofengagementbeimproved?

Dr.Acewascaughtoffguard.Hehadraisedtheissuemonthsagoandhadcreatedanimprovementteam.Heknew the team was meeting and was looking forward to theirrecommendations.Hewantedtosupporttheirwork.Hisgoalhadbeentoinvolveothersincreatingasolution.Nowhefeltothersperceivedthatnothingwasbeingdoneandwereangryandfrustrated.Heknewitwascrucialto engage others to improve the care of patients and the patient satisfaction scores.

Dr.Acedecidedtotakeaction.Helookedatthedataquicklyanddecideda10%improvementwasrequiredtomeetthegoals.Heneededtogeteveryone’sattentionsoheannouncedthatanyphysicianwhodidn’tmeetthegoal will not receive any of the pool dollars. After the meeting,hesatdownandpunchedoutanemailtothesameeffect.Immediately,hisphonestartedtoring...

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Quick Guide to Decision MakingTheQuickGuideisatooltobeusedincollectingandusingtheinputofothersinmakingdecisions.Itincludesbothastructured thought-flow process,aswellasaworksheetthatguidesyouthroughspecificactionsteps.Itisintendedforanyonewhosedecisionscanbeimprovedthroughthebenefitofanother’sinsight.Suggestion: Select an issue you are facing and use this process for addressing it.

n Name the Pending Decision or Issuen Prepare for Engagementn Engage!n Make your Decisionn Explain your Decision

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Instructions and TipsName the Pending Decision or Issue–Makeitclearandsuccinctandframedasaquestion.

Prepare for Engagement–Asixstepplanningprocess(Pages7and8,2a.-2f.)willassistyouininvolvingandengaging those you lead in the decision under consideration.

• Define limits to and opportunities for participation. Challengeyourselftoincorporateasmuchengagementaspossible;thismayrequireyoumovingbeyondwhat youfind“comfortable,”atleastinitially.Becarefultonamethelimitstoparticipationandexplainthereasons for those limits.

• Analyze issue for impact and emotional attachment. Askthequestion,“Whoseworkwillbeaffectedbythisdecision?”and“Towhatextentarepeople emotionallyattachedtoit?”Thinkalongverticalandhorizontalaxes.Createalistofallthoseaffected.

• Describe context and/or big picture. Toproductivelyengagesomeoneindecisions,theymustbegivenfacts,perspectives,assumptions,trends, andanythingrelevanttothedecisionthattheydon’tcurrentlyhaveaccessto.

• Write questions. Withregardtoanygivendecision,collectinputusingthesefourquestions. –Howwillthisaffectyourwork? –Howdoyoufeelaboutthisdecision? –Whatelsedoyouknowthatwouldhelpusmakethebestdecision? –Whatspecificsuggestionsdoyouhaveregardingthisdecision?

• Anticipate triggers. Anticipating reaction ahead of time and having a plan for how you will channel that reaction to a productive endisanimportantpartofyourplanning.Vigorousdebateisnecessaryandvaluableandshouldnotbeavoided. Youmaywishtosetgroundrulesforrespectfuldiscourse,learnwhentoredirectorbringsuchdiscussionsto aclosewhentheybecomenonproductive,orconsiderwhentohaveindividualdiscussionswhereinitial responsescanbecontained.

• Determine needed support. Seek support in advance from key constituency groups. You may also want support during the process of involvingothers.Asecondpersoninattendancewithaspecificrole:takingnotes,fieldingquestions,offering ahigh-levelperspective,providingdata,etc.,mayprovehelpful.

Engage!–Executeyourplanandcollecttheneededinput.

Make your Decision–Usetheinputprovided.

Explain your Decision–Gobacknowandexplainthedecisionyoumadetothoseyouinvolved.Thegoal istobeastransparentaspossible.Includewhatthedecisionwas,whyyoumadethedecisionyoudid,how youusedtheirinput,andwhetherornotthereareanynewexpectationsofthemasaresult.Thismayinclude thingslikenewstandards,targets,workflowsortimelines.Besuretoidentifytheconsequencesofmeetingor failingtomeetthenewexpectations.

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Quick Guide to Decision MakingName the Pending Decision or Issue

Prepare for Engagement2a. Set limits–Doesthisdecisioninvolveconfidentialmattersthatwillpreventothersfromengagingwith youinaddressingit?

oYES–Ifyes,stopandframeanexplanationtobecommunicated.

oNO–Ifno,proceedtothenextstep.

•Whatarethegivensrelatedtothisdecision?(Thatis,whathasalreadybeendecidedandisnotnegotiable?)

• Iftheissuerequiresprivacyorconfidentialityoriftimeorotherfactorsprohibitparticipation,isthere opportunitytogiveinputtoimplementation?

oYES–Ifyes,describetheneededinput.

oNO–Ifno,proceedto#5andcraftanexplanation.

2b. Use the matrix on Page 2 (Figure 1.) to analyze the decision regarding degree of impact and associated emotion; build your I & E strategy.

• Whowillyouengage?Identifyyourconstituency:groupsandindividualsbasedondegreeofimpactand emotional investment.

• Howwillyouengagethemandwhen?Whatexistingvenuescanbeused?Whowillreceivea1:1? Whereisthereaneedtoengagebutwherenovenueexists?Whatapproachwillmeetthatneed? Thinkverticallyaswellashorizontally,aboveyouandbelow.

2c. What contextual or big picture information will participants need to understand to make a meaningful contribution?

• Internal:

• External:

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82d. Frame your important questions in four categories.

• Howwillitaffectyourdailywork?

• Howwillitmakeyoufeel?

• Whatelsedoyouknowthatwouldhelpus/memakethebestdecisionintermsofwhatismostimportantto ourpatientsandcustomers?

• Whatspecificsuggestionsdoyouhaveregardingthisdecision?

2e. Triggers

• Whatdoyouthinkwilltriggeranger,heateddebateorcriticism?

• Howwillyoucreateanenvironmentthatsupportsdialogueunderthesecircumstances?

2f. What support do you need in addressing these issues?

Engage!Executeyourplan.

Make your Decision

Explain your Decision

5a. Identify who is to receive this explanation.

5b. When and how will this be communicated?

5c. What decision did you make?

5d. Why this decision?

5e. What input were you able to use in making your decision and how did it help you?

5f. What notable input did you consider but did not incorporate into your decision? Why were you not able to use it?

5g. Are there any new expectations?

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Going Deeper: Embedding the Spirit of I & ESofar,thisbriefinghasfocusedonthemechanicsof I&E,the“how”and“why.”Butbehindthetechniques,behaviorsandattitudeswe’recallingI&E,issomethingdeeper–thebeliefthatourorganizationisstrongerandbetterabletodeliverresultsif:

•Weseekoutandlistentotheknowledgeofallstaff.

•Leadersareopentoallideasandmakedecisions basedonmerit.

•Thereistransparencyindecisionmaking–everyone knows why a particular decision is made.

•Informationissharedwiththoseaffectedbychange.

•Oncetherehasbeenfairprocessandadecisionis enacted,thereisaccountabilitytogetonboardwith the change.

Theoverarchinggoalistomakegreater,authentic,appropriateinputapartofdailylifeatHealthPartners.I&EdoesnotstopwithfillingouttheQuick Guide to Decision Making. The Quick Guide is simply a set of training wheels to help you get started involving staff in those decisions that will have impact on them.

TheI&Einitiativewillnotbeconsideredsuccessfulif all it amounts to is another checklist leaders and supervisors have to tick off as a routine part of their responsibilities.TheaimistoenrichHealthPartnersasaplacetoworkandpracticemedicine–thatmeansthatthespiritofI&Eisexpressedinvariouswaysbyallleaders.

“…if people are treated consistently in terms of certain assumptions, they come eventually to behave according to those assumptions in order to make their world stable and predictable.” E. H. Schein, Organizational Culture and Leadership

If we were living the values, beliefs, and assumptions that are the bedrock of I & E, how would our leadership behaviors be different and, as a consequence, how would daily work life be changed?

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Going DeeperAnswerthesetwoquestionsforeachcategoryofleadershipbehavioridentifiedinthecolumnontheleft.

What will I & E mean for me?Take a moment to reflect on the following. How will executing I & E be a stretch for me personally?

uWhatnewbehaviorswillbecalledforonmypart?

uWhichofthenewbehaviorsarelikelytobemostchallengingtomasteroremployonaregularbasis?

uWhatcanIdotoensurethatIrolemodelwhatisexpectedofme?

uFromwhomcanIgetfeedbackregardingtheextentIambeingarolemodelforI&E?

uFromwhomcanIgetsupportormentoring?

uWhatotherresourcescanIdrawon?

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If we live the values, beliefs, and assumptions behind I & E, what would we be doing in this category?

What impact would these leadership behaviors have on those I lead at HealthPartners?

LeadershipBehaviors

©2012HealthPartners

817033rdAvenueSouthP.O.Box1309Minneapolis,MN55440-1309healthpartners.com

AlearningresourcefromHealthPartnersInstituteforMedicalEducation.

ProducedincollaborationwiththeHealthPartnersInvolvement&EngagementSteeringGroup, Co-chairs,CherylMagnuson-GieseandMichaelTrangle.

LearningDesign:DanJohnson,CarlPatow,MD

GraphicDesign:MargueriteBrunner

Consultantstotheproject:JackSilversin,DMD,DrPHandMaryJaneKornacki,MS

For questions or more information contact: CherylMagnuson-Giese,SeniorDirectorPhysicianServices,952-883-5381 email:Cheryl.A.MagnusonGiese@HealthPartners.com