Very interesting question. I would be very interested in hearing others perspective on the topic.

I too am struck by this reflective question. Turnover is down in my practice environment and in part it is due to the economy. While the younger workforce still maintain some mobility, even these young workers are staying on in these times. I wonder if your question can be better answered outside of the "turnover statistic". Engagement can be measured when turnover is high or low. One can measure staff engagement by how willing staff take necessary risks to make the organization better; do staff seek opportunities to become involved in committee, volunteer and other initiatives desired to be done by the organization; and staff engagement can be measured by the degree that staff meet or exceed their own personal, workgroup or organizational goals set (joinly) in the organization. Is there evidence to support that there is teamwork; good communication; andadvancement of strategic and short term goals? Or is there increasing incidences of conflict; staff grievances; or an increase use of sick time or work related injuries? To what extent do managers report staff coming in late; leaving early; failing to check details or a drop in the quality of their work? And visa versa for all of the above. To what extent are all of these things going in the right direction?

Employee engagement is one of our top priorities at our organization and in fact we believe that we can improve patient satisfaction through employee engagement and thus, have put the strategies together. Our organization had staff take an engagement survey about a year ago and the data was very insightful and provided us some focused attention on top issues. Each department used their data to develop a plan and we have been working on improving engagement through 1) voice in decision that impact practice 2) Staff well being 3) communication and trust in leadership.

We have many tactics that focus on improving these areas such as initiation of wellness team and many activities to promote employee wellness. We are also in the midst of restructuring our shared governance model and have added a "your voice" icon to the nursing website to offer opportunities for staff to get involved and have a voice in decisions.

We also have worked hard to increase visibility of senior leadership through scheduled town hall meetings on all shifts, routine rounding, "day in the life" shadowing of clinical staff, Presidents line for weekly updates and messages to staff etc.

The follow up survey will take place in Sept of 09 and we will be able to use this data to determine whether tactics have been successful in improving engagement. I must say with the economy dip, many staff are verbalizing they are glad to have a job.

part of my job is recruiting and retaining primary care providers for ambulatory practice .
i find that there is a growing shortage of primary care providers and most of them are electing to work as hospitalists or as locums to give them more freedom .
I agree that staff engagement and retention is best brought about by participative decision making and trust in leadership

Our HCO has experienced an ongoing low turnover rate which we have in the past attributed to our culture and employee engagement practices. One tool that we have just recently hard wired is monthly staff rounding focusing on what has worked well in their workplace, what processes they feel need to be improved and what tools or additional resources do they need to get their work done in a quality and efficient manner. Our hope is that during this uncertain time this will help our employees to remain engaged and feel valued.

Having recently had the opportunity to open a brand new facility from the ground up, we have spent and still do spend a considerable amount of time framing our environment and culture. While we are part of a system we were charged with starting from "scratch" a new dynamic where the expectation was set that employees are engaged from employment. Our work began with an organizational behaviorist to help develop the initial team with team building and collaborative skills. Communication was the foundation and any department/party was included in the decision making as the building was "activated". This mindset carried through and is engaged throughout the entire facility whereby even the staff level is included and feedback requested. Of course our Administrative Team operates under an open door policy and is very accessible and visible.

After the course of being open for almost a year it has become very easy to identify those employees who are not engaged and are the "weakest link" to improvement and collaboration. In fact, those who are engaged "push" them out. Those non-engaged employees have been removed. Because of the teamwork that does exist, other departmental managers step in to support those without direct leaders/managers.

Our next step is to define what collaboration means for the organization. We will conduct a brief interview of the CEO and COO and then allow staff to attend focus groups to answer the same questions. The three catagories of information will then be shared with the employees so that we can continue to develop the collaborative infrastructure and further allow the employees to engage themselves.

We also use systemwide surveys for feedback every six months and develop action plans against the results. It is very robust and does not permit those directors, managers or staff to become complacent.

We have had a "hold" on travel spending for the past year and we just recently announced that there will be no annual increase this fall. Of course a few are not pleased, but the majority support the goals as they were a part of that decision.

I appreciate the comments by Gabriella Mitchell. Her organization sounds like the right steps have been implemented and it is a healthy organization. Coming into an organization three years ago that was not as healthy, we have implemeted many steps to improve the engagement, the accountability, the employee satisfaction and subsequently improve turnover and vacany. The organization did not have very high turnover 3 years ago. The accountability of the administration and the managers to the staff was very low. Turnover under these circumstances was necessary to create an environment of postive change, growth and to facilitate the agressive strategic plan on emplowering the employees, creating a transparent organization in operational excellance and implementing new services to improve the growth and image of the hospital. We began by using the Studor principles of 30 and 90 day evaluations where new employees evaluate the hosptial. We began comfort care rounding on the floors hourly. We implemented senior thankyou notes written and sent to employees homes with specific remarks on what the employee did to go above and beyond and manage up their manager. We taught the concept of managing up to managers, other departments and physicans. We implemented AIDET training. Specially focusing on acknowledgement, introduction, duration, explanation and thankyou. This is emphasized at new employee orientation, at safety fairs and on evaluations. We have quarterly employee update meetings, all managers meetings are posted on the intranet for employees to view and every senior manager has an open door policy. We began a collaborative operations council consisting of floor nursing to staff to accept committee commitments and make decisions on policy changes, strategy implementation and quality assessments. They were empowered to follow through with education to their floors. They made mistakes but learned through process improvement of why changes needed to occur and they were part of this change. We have a clinical ladder program that paid out $25,000 last fiscal year to those that went above and beyond which included community volunterism and involvement in the hospitals committees. We also paid out a 1.35% bonus to all employees based on achievement of quality outcomes, satisfaction percentages and financial goals. We started catch me if you can cards that employees can "right up" other employees for doing something great. They are entered into a monthly drawing for a specific parking space, and other gifts. Turnover is what helped precepitate this progress. We have excellent managers that hold their staff accountable and work to build the engagement of the staff. Without the senior leadership support and facilitating this process, these steps would not have occured. Our employee satisfaction surveys have greatly improved over the last 3 years. We are proud of our efforts but even more proud of the changes that we have seen in the organzational pride.

I apologize for not posting my contact information for the above comments.

I apologize for not posting my contact information for the above comments.