How to engage employees to improve patient outcomes?

Shawn Achor

Founder and CEO of Goodthink Inc.

How to engage employees to improve patient outcomes?

4 July 2019 | 14min

Quick Takes

  • Employee happiness is positively correlated to employee engagement and is a key competitive advantage for healthcare organizations

  • Distributing responsibility to employees that deepens the meaning and connection to their work will lead to better engagement and ultimately, improved outcomes for patients

  • A simple change of mindset towards stress from debilitating to empowering can reduce the negative health impacts and subsequent organizational outcomes of stress

Leading positive psychology expert, Shawn Achor, shares his research-based insights on employee happiness, engagement and managing stress to reach your organizations highest potential.

This is part two of a three part interview series. Don’t forget to sign up to our newsletter to make sure you don’t miss the final segment highlighting his compelling work.

THE HAPPINESS FACTOR: A key competitive advantage – PART 2

Empower employees to be engaged

Remove silos 

HT: Part of your book the Big Potential is about expanding power out to others so the CEO, or senior leadership, doesn’t bare the whole burden of positive change. Could you explain the case study from Kaiser Permanente’s “I Saved a Life” program.

Shawn Achor: I got the opportunity to work with Kaiser Permanente and from them I learned about a project called, “I Saved A Life” program. One of the things I’m interested in is how do we expand power out to other people in the ecosystem of potential. How do we make it so that the burden of positive change inside an organization is not just born by the CEO or the senior leadership, but also by others so they can also feel invested in it as well?

Oftentimes inside of the health system we have very rigid hierarchies and silos that we put people into. We say, “Here’s our medical providers. Here’s our non-medical providers. Here’s the back office. Here’s the non-back office”. We create these patterns. At Kaiser Permanente, they decided to overcome some of those labels to get more people to feel like they were involved. We’ve seen this at hospitals like Orlando Health, for example. They charge everyone from the CEO to the janitorial services to immediately go up and walk anyone who seems lost inside the hospital to where they are supposed to be going. Helping people makes the staff feel like they are part of that patient satisfaction score.

Kaiser Permanente decided to take their receptionists that are on the phone and have no medical training, and turn them into medical providers. They expanded power out to them to actually help improve the health outcomes for the entire health system, which is worth obviously not only tens of millions of dollars to the organization but also improves the health of the people in their communities as well.

The receptionists were given the power to have access to a database. When somebody called in, for example about an earache, they were trained and given the technology and resources necessary to scan through the database and see if that person had also already been screened for cancer or another medical procedure. They initially started looking at breast cancer and importantly, they tracked and quantified the change that was occurring as a result.

A life saved is a receptionist identifying a screen that needed to be done when a patient called in for a non-screening purpose. They could then make an appointment with that person on the phone. So a patient calls in for an earache, but the receptionists were empowered to set up an appointment right then and there in the system for a mammogram. If that person then discovers that they have a life threatening cancer in time then that is considered, as they were quantifying it, a life saved in the program.

Since the start of the program, 1500 hundred people’s lives were saved. As the organization talks about it, you see the receptionist to the senior leadership light up because the receptionists now realize that they are also part of providing medical services. They changed the way that they were thinking about it. They saw more meaning in the work that they were doing. Their engagement scores rose. And because they quantified the outcome, the receptionists at the end of the day didn’t just answer phone calls, they actually saved people’s lives and they felt a part of that process as well. That is what we are trying to see more and more. Getting people to expand power out inside an organization.

Cultivate ambassadors  

On this note, I’ve worked with United Health Group with David Sparkman and one of the things that they decided to do was create culture ambassadors that would go through extra training, which they were not paid for, to talk about the values of the organization and about happiness and positive psychology. These culture ambassadors would then go out and teach and be champions of those values inside that organization.

This was a voluntary activity that took more work in addition to the high levels of stress and work that they were already going through. Now they have more than 10,000 culture ambassadors worldwide. 10,000 individuals who not only bought into this idea, but who are also now the drumbeat of positive change inside the organization. This way, it’s not David Sparkman or a senior leader trying to continually get people to make this change.

Social influence and social psychology are defined by three things:

  • Strength of the message
  • Immediacy of the message
  • Number of sources

You can try to increase the strength of the message, but that’s actually the weaker approach. You can have one leader that’s really trying hard to have a strong message. A much more powerful way of increasing social influences is to increase the number of sources that are saying it. If you get champions involved with it, then you’ve got something really powerful.

At Nationwide insurance for example, we had this great individual who would go up and down the elevators holding a stuffed orange frog. She was in HR and she’d go up and down the elevators at lunchtime when all the senior leaders would be getting onto the elevators to go for lunch. People would obviously turn and ask why in the world was she carrying around an orange frog in the midst of a very serious environment. It would then give her an opportunity  to say, “I went through the Orange Frog training program. Here’s what we learned in terms of psychology and here are the outcomes we’re seeing for our team” – planting the seed. Then maybe that leader would want to do it as well.

It turns out,  that individual going up and down the elevator was part of the reason why we saw such an incredible response inside the organization from senior leaders adopting it, because she literally was giving an elevator pitch. The same way that one of the anesthesiologists at Genesis Health System brings an orange frog into the room with the patient and the patient inevitably asks, “Why did you bring an orange frog into the room?”.

He then says that he went through training that helped him realize that when he’s a happier individual there are seen improvements in the medical outcomes and patient satisfaction for the person in the room. So he brought an orange frog into the room to tell the patient about how his optimism and happiness were going to help that patient have better outcomes. That’s the type of organic change we want inside organizations. Where it’s not just the senior leader doing it. You’re getting anesthesiologists and endocrinologists and janitors involved with this process of improving the health system for an organization.

Create a positive work environment

HT: You have said that happiness can be a competitive advantage for organizations. What do you mean by that exactly?

Shawn Achor: I know a lot of organizations think that if they can hit their targets for their key performance indicators then the satisfaction of the people working there, their happiness levels, their engagement levels, will rise dramatically. What we’re finding in the research is the exact opposite.

If you’re waiting for those key performance indicators to rise in the midst of high levels of negativity, stress, isolation, and disconnection inside the organization, you’re trying to achieve the highest levels of performance and competition with other organizations while being hamstrung by our brains not working at the highest possible level.

When we did this research what we were finding was not a correlation between happiness and success, we were finding causation. If success rates rise for the next five year period of time, it doesn’t matter what the success outcome is because the same pattern emerges. The happiness levels for that individual flat line, they don’t actually move.

The reason for that is every time you have a success, your brain changes the goalposts of what success looks like. If you hit that target that you set for your team or your organization, then you’re trying to hit it for the next quarter or you’re trying to raise that target. If success in the past could create happiness for the rest of our lives, then the first time we put legos together as a four-year-old we could have been done in terms of happiness that lasts, right? No, we just keep changing what success looks like, which is adaptive.

What we’re finding is that success doesn’t yield higher levels of happiness. Higher levels of happiness and social connection and optimism improve every single key performance indicator we know how to test for, such as medical outcomes, patient satisfaction, energy levels, productivity, burnout, and turnover rates. All those things we’re trying to improve, improve dramatically when we focus on these precursors of success. That indicates that it’s not just a correlation between happiness and success – it’s causation, but it only flows in one direction. It was never success leading to happiness. Happiness leads to greater levels of success.

So in the midst of a competitive environment – not only within the medical space but as people who are trying to create better and better microchips every two years, as people who are trying to win an NBA championship, or trying to get into a top school – what we’re finding is that you are at the highest end of your potential when your brain is in a positive category. So if we can get individuals there, that’s how we hit our targets even better for the future.

Employee happiness and engagement are strongly and positively correlated.

HT: It seems there’s a strong relationship between happiness and employee engagement. Does your research suggest that happiness precedes the engagement of an employee?

Shawn Achor: We see them move in tandem. When somebody’s happiness level rises, the employee engagement rises at the exact same time. We know that people are not very engaged when they’re extraordinarily unhappy. We know that for ourselves individually. So what happens is we see them move lockstep with one another. What gets them to move are focusing on three elements that lead to happiness, which are:

  • Changing somebody’s levels of optimism
  • Deepening their social connection
  • Changing the way that they perceive stress from a threat to an opportunity

When you get those three changes that happen you get optimism, a social connection, and meaning involved with the stress in the work that they’re doing. That’s when we see happiness scores rise, and in tandem the engagement scores rise dramatically. What’s cool is that it’s not just engagement scores that rise, you also immediately get patient satisfaction scores improving, medical errors dropping, productivity rising, profitability increasing, turnover rates dropping. So what we’re finding is happiness is one of the greatest competitive advantages in the modern economy.

Manage stress and burnout among employees

Change the perception of stress from debilitating to enhancing

HT: With the increasing pressure to do more with less, stress and burnout within healthcare organizations are such key issues. Could you please tell us about the interesting study you did on stress at UBS that made the top psychology journal?

Shawn Achor: This is one of my favorite studies. I did this with Peter Salovey, who is now the president of Yale, and Alia Crum from Stanford. We did this study in the middle of the banking crisis. We were working with UBS and this is when they couldn’t pay people the way that they wanted to. They were having to do more with less. They were working extraordinarily long hours, but their pay was decreased and they had no idea when the economy would recover. This was a perfect chance to battle test this research – when life is difficult. We went out to see what they were doing to respond to stress and to stop the burnout that people were feeling in the midst of this banking crisis.

Stress is inevitable, but we can change our mindset towards it.

One of the very first things that we learned was that the stress management programs the bank were using were backfiring because they would come into a room and they would give employees information like, “Did you know stress is related to the 10 leading causes of death and disease in the US? The World Health Organization found stress to be the number one killer. Stress is catabolic and tears down every organ in the human body, including your skin. And it’s related to 80 to 90% of doctor visits. So whatever you do at work in the middle of this banking crisis, don’t stress”.

You hear this information and what does it make you feel? It makes you feel stressed because we’ve created a fight or flight response to the fight or flight response. It exacerbates the problem. The problem is that there’s fantastic research proving this coming out of Stanford, Harvard and Yale. What’s fascinating is there is amazing research coming out of Stanford, Harvard and Yale that proves the exact opposite as well.  That chronic and actually high levels of stress in some types of professions actually cause people to not only perform higher, but it can also release growth hormones and rebuild their cells extraordinarily fast. We find those are the people who get sick, not when they have a lot of work to do. They get sick when they get time off.

We would go out to organizations that are so worried about how stress is going to cause burnout and how they’re going to lose their employees to other organizations, but then I work with the military and they onboard you at bootcamp. They do so in one of the most stressful situations possible because they know that if you go through stress with the right lens and with other people that you’re experience of that stress can actually cause meaningful narratives that deepens not only your social bonds, but also allows people to continue in their work for years in a very difficult profession.

Study reveals that a change in perception of stress can reduce its negative health impacts

Study among UBS managers reveals changing mindset towards stress can help reduce its negative health impacts

We decided to figure out why there was such a different response to stress and burnout among populations, so we split up the managers at UBS. Half of them were told that stress is bad for you and we gave them some tools to decrease and fight against stress in their life. The other group were told that stress is actually enhancing and that embedded within every stress is meaning. If I tell you that someone is failing English, you don’t feel stress. If I tell you your kid is failing English, you feel stress because there’s meaning involved with a relationship there.

Regardless of the cause of stress – whether it was an overflowing mailbox, leads that needed getting back to, or whether or not their kid was passing English –  we got the managers at UBS in the latter group to do a simple three step process:

  1. Acknowledge the stress they were experiencing
  2. Identify the meaning behind why they felt stressed
  3. Rechannel their emotional response towards that meaning

I thought honestly, that there would be a drop in stress when we measured it and then we would get published. That would be great. I was totally wrong. Professor Krum, and Professor Salovey were right. It turns out that six weeks later there was no drop in stress. We were using the Perceived Stress Scale and as it turns out, six weeks later, the stress levels for both groups were almost identical and at the highest end of the scale.

They were going through a banking crisis so it made sense that they were extraordinarily stressed. But the group that saw stress as enhancing had a 23% drop in the negative health impacts of stress when you looked at an aggregate of headaches, backaches, burnout, fatigue, and lower job productivity.  There were different percentages for each one of those elements, but we found a significant drop in all five of those categories when somebody saw the meaning involved with their stress and connected to it versus someone who was simply trying to decrease stress within their life.

What I think that says is that while stress is inevitable, it’s effects upon us are not. And, it is not mediated by how much stress we’re experiencing in the world, it is mediated by the meaning that we perceive within the stress. Oftentimes we experience stress, but we lose the meaning to why that stress is important and it has a detrimental effect upon the health of our system. What we find is that you can have high levels of stress with someone who is performing surgery, or someone who is calling for the ball at the end of the game. There are high levels of stress in those professions, but if those individuals saw meaning and embraced it than they do not experience the negative health impacts as seen in people with the same levels of stress who don’t find meaning or connect with their stress.

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Shawn Achor is the New York Times best-selling author of The Happiness Advantage and Big Potential. Shawn has traveled to more than 50 countries, speaking to farmers in Zimbabwe, CEOs in China, doctors in Dubai and schoolchildren in South Africa. His research on happiness made the cover of Harvard Business Review, his TED talk is one of the most popular of all time with over 19 million views, and his lecture airing on PBS has been seen by millions.