The No. 1 universal correlating factor in high-performing agencies may surprise most health-care-at-home leaders. It isn’t a productivity metric; nor is it a specific clinical care model. Instead, it’s the ability of agency leadership to lead, engage and retain. We as health care organizations are truly only as strong as our weakest leader.
BerryDunn’s National Healthcare at Home Best Practices study showed that 30% of five-star home health agencies reported less than 10% turnover. For one- to two-star agencies, the average turnover was 20-30%. Additionally, agencies with five stars are more likely to have fewer positions unfilled, are more likely to have engaged staff and are more likely to have less frequent leadership turnover (every eight to 10 years). This data underscores agency leadership’s role not only in supporting the health of the organization but also in supporting the health of the patients and caregivers we serve. But what is staff engagement, and how can it be achieved?
Employee Engagement Defined
Many managers incorrectly perceive engagement as related to mood or the appearance of happiness. But it is more than that.
For a true definition, we look to William Kahn, who is widely acknowledged as being the first academic to research and write about engagement. In his analysis, Kahn said personal engagement or disengagement arises when “people bring in or leave out their personal selves during work-role performances.” Thus, personally engaged workers are those who express themselves authentically at work in three ways: cognitively, emotionally and physically. This authentic expression of self-in-role is contrasted with disengagement, whereby the individual “uncouples” his or her true self from his or her work role and suppresses his or her involvement.
Essentially, employees are engaged when they feel personally connected with their work. When employees understand their role in the business, approximately 90% will work toward that success, but the number plummets to 23% if they don’t.
And they don’t want to just feel connected, they want to feel good about that connection. In home health and hospice specifically, we see engagement levels increasing when employees state they would be willing to recommend their agency to families and friends. If they like and value the care the organization is providing, they are more likely to be engaged in their role in providing that care.
Leadership Strategies for Higher Engagement
Now that we know what engagement is, how do we supervise to optimize that engagement? Research shows certain management styles tend to lead to higher engagement levels beyond just sharing the mission of the organization
In a scientific study, neuroscientists analyzed oxytocin (sometimes called the love hormone because of its role in social bonding) levels in response to various work situations. Higher oxytocin levels indicate higher levels of engagement, trust and satisfaction. The 10-year research process measured human responses in a controlled environment and in uncontrolled environments. They found eight key supervisory behaviors that stimulate oxytocin production, and thus, higher employee trust and engagement.
Based on the eight behaviors the researchers found, supervisors who do the following can expect higher engagement and trust from their employees:
- Recognize excellence by consistently acknowledging employees who are doing great work.
- Induce “challenge stress” or good stress by setting achievable stretch goals.
- Give people discretion in how they do their work, allowing trained employees to complete work their own way, when possible.
- Enable job crafting by setting clear expectations and allowing teams to divide work based on skill sets.
- Share information broadly, giving employees details about the goals of the organization, plans for the future, etc.
- Intentionally build relationships, providing personal and professional support in their jobs.
- Facilitate whole-person growth.
- Show vulnerability by being open about things they don’t know as a manager and asking for help.
In addition, these management behaviors also resulted in 75% less stress, 106% more energy at work, 50% higher productivity, 13% fewer sick days, 29% more satisfaction with their lives and 40% less burnout. Employees with these higher oxytocin levels also displayed more empathy in their day-to-day work, which, as we all know, is a critical component of delivering true patient-centered care.
Supervising for Optimal Performance
In supporting agencies as they implement these engagement strategies, the most difficult barrier is balancing staff engagement with the work and responsibilities of caring for patients and caregivers. I have yet to meet a manager whose only job is to motivate their teams. In addition, not all employees can work with no direction or work-specific support. This is where we can look to the theories and applications of situational leadership to help us implement these strategies.
Developed by Paul Hersey and Ken Blanchard in the 1960s, situational leadership is not just a beneficial skill. In today's complicated work environments, it's imperative for effective supervision.
Situational leadership revolves around the core principle of adjusting one’s leadership actions to the development stage of the employee. As a leader, you are essentially adjusting your mindset from “who am I as a leader” to “what does this person in front of me need as a leader.” Leadership approaches can vary from highly directive to highly supportive, depending on the circumstances. The essence of situational leadership lies in aligning the leader's approach with the follower's capabilities and individual needs to promote optimal performance and personal growth.
The influence of situational leadership on both team productivity (or accuracy) and morale is profound. When leaders adjust their style to meet the evolving needs of their team, they demonstrate empathy and acknowledge individual growth journeys. This flexibility fosters a sense of support and appreciation among team members, leading to improved morale. Enhanced morale often drives greater productivity, as individuals feel more motivated and committed to achieving their goals.
Moving Forward
Health care at home is at a transformative crossroads. We're evolving with innovative care models, harnessing the power of artificial intelligence to streamline operations, expanding partnerships across the continuum and so much more. Yet, we must remain grounded in the core principles that drive our success. Your supervisors are pivotal to your agency’s performance. Prioritizing a strong leadership team will be instrumental in empowering your organization to navigate these changes effectively.