Getting employees involved is a good thing. The Employee Involvement Association, which has recognized companies such as General Motors and Lockheed for their outstanding employee involvement programs, describes it as “the keystone of organizational development, nurturing the empowerment of people.”¹ The National Bureau of Economic Research concludes that employee involvement is “a net benefit to the U.S. labor market.”² And it is a “minimum” requirement in developing a work stress prevention program.³

Employee involvement (EI) programs can boost morale and reduce cost. It makes sense. Most of us prefer some control over our work environment. Workers have a practical interest in creating leaner, less wasteful, and cheaper processes. They also seek job satisfaction. Done right, an EI program can have impact in all of these areas. According to one study, eight out of ten companies reported that EI results were positive or very positive. Only three percent reported a negative experience.⁴

Great as this sounds, your organization may lack a program or perhaps your EI program was a “flavor of the month” in the past and is now on the shelf. Revitalizing or starting your own program is a worthwhile undertaking but as a manager, there are some practical considerations and potential hurdles to overcome.

Organizational culture: Put simply, your top dogs need to walk the walk. Northwest Community Hospital, for example, listed in Fortune’s 100 Best Companies to Work For in 2006, emphasizes employee involvement by increased communication, decisionmaking forums, “view teams,” and recognition programs.⁵ Upper management must recognize that an investment in employees can result in greater customer satisfaction and cost reduction.

Employee attitudes: According to the Gallup Organization, only 29% of employees are engaged, or feel a profound connection to their company. While 54% are going through the motions, the rest are actively disengaged, working to undermine the organization.⁶ Chances are two thirds won’t be enthusiastic participants no matter how obvious the benefits.

You: While you might be doing your best to up that 29% by talking about empowerment, involvement, and team building, these buzzwords can become shopworn and make you sound like the wa-wa of Charlie Brown's teacher no matter how sincere your efforts.

Indeed, a game called “Buzzword Bingo” is played everywhere from board meetings to college commencement addresses. The squares contain management buzzwords instead of numbers. You mark off words when you hear them, shouting “Bingo!” when you get five in a row.⁷

Humor can be healthy. Not so funny is a possibility that employees perceive your “verbal tribute” to EI as manipulative, especially if their ideas are discounted, altered, or ignored.8 Asking people what they want comes with an inherent obligation to respond.

So, how do you get your employees involved? Focusing on outcomes may be your answer.

Outcome-based management (OBM) is exactly what it sounds like — managing the outcome of a business. It measures satisfaction over sales. Quality, not the bottom line, is the driver. It is contrasted with valuebased management (VBM) in Table 1. Whereas VBM looks at the impact on future cash flows,⁹ OBM looks at the impact your product has on your customers.¹⁰

Traditionally, nonprofit organizations accountable to taxpayers have used OBM. Quality ethics also drive hospitals. For example, a lab test to measure cardiac function may cost less if done by an off-site reference laboratory, but the outcome might be fatal for a patient who suffers a heart attack.

If you’re a hospital laboratory manager, patient welfare trumps cost. While medicine is clearly outcome based, the products of all laboratories have end users. And focusing on outcomes connects your employees to those users, your customers. It provides a rational motive for involvement in how products are created.

OBM also focuses on wants. As put by the Urban Institute, “Outcome management enables organizations to define and use specific indicators to continually measure how well services or programs are leading to the desired results.”11 Your customers’ needs are almost perfunctory; their wants are a wellspring of pride for your employees. “Desired results” are integral to those wants.

To integrate your existing quality program with outcomes, you'll need to measure them. Quality, productivity, and customer satisfaction are a few examples. In a hospital setting you might also consider length of stay and readmission rate.

Your employees need this information, too. It gets them interested, makes their input more relevant, and makes change easier to accept. This natural link between quality improvement and outcomes measurement has already been recognized by managed care companies.¹²

As an example, Figure 1 illustrates the Deming PDCA (Plan-Do- Check-Act) cycle13 alone and aligned with your organization's goals and outcomes. In this model, change happens while measuring outcomes, linking process improvement to desired results. Figure 2 expands the model to include multiple quality cycles all linked to the same outcomes.

Focusing on outcomes makes change less arbitrary. To apply these concepts in getting employees involved, I’ll use a hospital laboratory setting. Note how individual processes affect desired outcomes in Table 2. Proper calibration, shorter turnaround time, accurate results, and fewer errors separately affect the measured outcome of how a patient receives treatment.

Given hurdles of employee attitudes, complexity, and limited resources, where do you begin? Here are some guidelines:

• Choose group outcomes. If your perceptions differ from your employees, you'll want to create expectations in their minds that match your own.
• Choose measurable outcomes. “Higher customer satisfaction scores” suggests a way to measure performance.
• Choose outcomes across a range of service. For example, hospital laboratory testing affects Emergency Department and walk-in patients.
• Consider a customer forum. To meet customer expectations, you have to know what they are. Including them in your decision making is one approach.
• Plan to prioritize based on outcomes. At a strategic meeting, ask for staff input in how they believe changing a process will impact customers, and arrive at consensus on what change will have the greatest impact.
• Plan feedback sessions. Letting your employees know the impact of their work can be rewarding or it can be a wake-up call. Feedback ensures their continued input.
• Respect your staff’s decisions. You’ll have to lay sufficient ground rules (e.g., decisions cannot include new hires or budget increases) to frame their consensus, but it’s important not to undermine their work to suit your notions.

Pilot programs are effective beginnings, making a relatively easy win possible. It can add credibility to what your staff may perceive as a gimmick or just “more of the same.”

For example, as a hospital laboratory manager you might look at routine outpatient blood draws. In this common process, a patient arrives at hospital registration, sits in a waiting area until summoned by a phlebotomist, and then a blood sample is taken. Your staff may perceive this as a relatively narrow interaction. So narrow, in fact, that it may not involve your lab techs who may see value as test completion before reports are run.

But the patient’s laboratory experience begins when the doctor orders a lab test and ends with a treatment decision. It includes how well the laboratory communicates its services, how easy it is for the doctor to order a test, the convenience of the laboratory hours, and all the wait time. What the patient wants is more than simply getting in and out of a phlebotomy chair quickly, as shown in Table 3.

The range of impact suggests processes to improve. In Table 3, for example, a current and accurate test menu doesn’t only affect order accuracy. It affects what the patient is told. Patient preparation is a related process in which the doctor or the lab person instructs the patient in how to fast or collect a sample.

Therefore, the end point of an up-to-date test menu isn’t that the patient gets in and out of your phlebotomy chair quickly, but that it happens once with accuracy. It affects everything down the line. Telephone calls to clarify orders and patient recalls are two possible indicators to measure. These measurements can ensure that employee performance is evidence based.

Bottom line, if you involve all employees in your outcome based strategy, measurement reflects group performance. Empowerment and team building are buy-products of this strategy and not prerequisites. Your employees won't need to play Buzzword Bingo.

How well your employees understand outcomes can get them involved, making the leap from good to great performance. You as a manager can lead them in the right direction.

References

1. The Employee Involvement Association page. 2004, Employee Involvement Association. 13 October 2006 http://www.eianet.org/ 
2. Freeman R, & Kliener M. “Who benefits most from employee involvement: firms or workers?” December 2000, The National Bureau of Economic Research Page. 13 October 2006 http://www.nber.org/sloan/freeman.html
3. Sauter S., Murphy L., et al. “Stress at Work.” National Institute for Occupational Safety and Health. 7 September 2006 http://www.cdc.gov/niosh/stresswk.html
4. Lawker, E. “Employee involvement makes a difference.” The Journal for Quality and Participation. Sep/Oct 1999.
5. Weiss, J. “From great to best: culture as a competitive advantage in healthcare.” 21 June 2006, The Great Place to Work Institute. 14 October 2006 http://resources.greatplacetowork.com/article/pdf/culture_as_competitive_advantage_northwest_community_hospital_6.21.06.pdf
6. Crabtree S. “Getting personal in the workplace.” 2004. The GovLeaders.org page. 01 October 2006 http://www.govleaders.org/gallup_article_getting_personal.htm
7. Geiger, K. “Business Buzzword Bingo!” 01 March 2003. Business Buzzword Bingo! 12 October 2006 http://its.usc.edu/~karl/Bingo/
8. McConnell CR. Employee involvement: motivation or manipulation? Health Care Superv1998 Mar;16(3):69-85.
9. Koller, T. “What is value-based management?” The McKinsley Quarterly (1994:3) http://www.exinfm.com/pdffiles/whba94.pdf
10. McNamara C. Basic Guide to Outcomes-Based Evaluation for Nonprofit Organizations with very Limited Resources.” 2006, Free Management Library. 12 October 2006 http://www.managementhelp.org/evaluatn/outcomes.htm#anchor30249
11. “Key steps in outcome management”. 2003, The Urban Institute. 12 October 2006 http://www.urban.org/uploadedpdf/310776_keysteps.pdf
12. Brown G, Burlingame G, Lambert M, et al. “Pushing the quality envelope: a new outcomes management system”. Psychiatric Services 2001:52; 925.
13. “Project Planning and Implementing Tools.” 2006, The American Society for Quality. 14 October 2006 http://www.asq.org/learn-about-quality/project-planning-tools/library/overview.html