Reach for a higher level
Once the organization’s direction is set, it’s important to let
your employees know how their day-to-day responsibilities tie
into the big picture. At St. Joseph, this is primarily done
through manager-to-employee performance reviews.
At the annual evaluation, the employee and manager sit
down and set goals for the next year. Then, the manager indicates how the employee’s work can contribute to the hospital’s overarching goals.
“In some instances, an individual employee can’t affect our
‘healthiest communities’ goals,” Ainsworth says. “But most of
the time, they can do something, at least tangentially, to contribute to perfect care or sacred encounters.”
Once that discussion occurs and the goals are set, metrics are
set at the same time. Managers will check in periodically
throughout the year to determine how their employees are
doing, then at the end of the year, they’re evaluated on their
performance. Ainsworth rewards the employees who hit their
targets — their incentive compensation is determined based
on progress toward their individual goals.
Performance evaluation isn’t difficult when you track as
many different variables as St. Joseph does. The hospital
meticulously collects data on everything that goes on within its
doors. If Ainsworth wants to know how many bloodstream
infections were acquired at the hospital last year, that information is readily available.
The depth of information at his fingertips helps the leaders
of each department set benchmarks for progress toward the
goal of perfect care. Each department has several areas on
which it focuses, and each employee’s performance is measured against these benchmarks.
There are three levels of achievement for each area: threshold, target and exceptional. Ainsworth says the levels are
determined by the likelihood that an employee will be able to
meet them. For example, employees have an 80 percent likelihood of achieving the threshold level, 50 percent likelihood of
achieving the target level and only a 20 percent chance of
reaching the exceptional performance level.
“As you’re progressing up the chain of difficulty, there is a
decreasing likelihood that we’ll actually be able to achieve that
goal,” he says. “Obviously, exceptional is going to be much
tougher to achieve than threshold. That’s the way the metrics
are set.”
Ainsworth also ties financial incentives in each employee’s
compensation plan to his or her overall performance level.
This system gives employees a compelling reason to strive for
the higher levels of performance, while making sure the hospital is held accountable for meeting national standards.
For instance, Ainsworth’s executive management team has
several performance goals devoted to improving five
Medicare-chosen focus areas. The hospital is held accountable
for improvements in those areas, which include the hospital’s
emergency department response to heart attacks and the
staff’s treatment of patients with congestive heart failure,
among other things.
Because of the data, Ainsworth knows where his hospital
stands. His management team sets its performance-level goals
based on how St. Joseph ranks in national databases.
It’s easy to collect easily quantified and measured facts, like
the number of patients with a particular disease or the average
number of days of their hospital stay. However, it’s a bit more
difficult to develop metrics that measure how close an interaction was to being a sacred encounter.
Ainsworth measures the hospital’s particular brand of service
by making sure his staff asks each patient several questions
about their experience. The staff has a list of seven or eight questions like “Were you looked after in a compassionate fashion?” and “Did people seek to understand your needs before
they cared for you?”
By asking questions like those, Ainsworth is able to determine if employees have been exhibiting the types of behavior
that will keep the patients comfortable.
