University of Virginia Health System School of Medicine (SOM)

University of Virginia Health System School of Medicine (SOM) 2015 Engagement Survey Executive Presentation July 2015

Burning Platform for Engagement 2

Engagement Helps Produce Better Outcomes for the Organization Helps People Work More Effectively Increases Retention Among Top Performers Gallup sees the connection between engagement and performance across its database and specifically at UVA. 3

Across Gallup s Database, Top Quartile Teams Outperform Bottom Quartile Teams Top quartile teams have 37% Lower Absenteeism 25% Lower Turnover (in High Turnover Organizations) 65% Lower Turnover (in Low Turnover Organizations) 28% Less Shrinkage 48% Fewer Safety Incidents 41% Fewer Patient Safety Incidents 41% Fewer Quality Incidents (Defects) 10% Higher Customer Metrics 21% Higher Productivity 22% Higher Profitability when compared to bottom quartile teams. 4

In a Recent Analysis at Another Healthcare System, Engagement Tied Closely to HCAHPS Results On average, the 13 facilities that were below the Gallup Healthcare 50 th percentile in employee engagement were below the CMS 50 th percentile on all HCAHPS domains. Percentile Within CMS Public Release Database Below Gallup 50th (n=13) At/Above Gallup 50th (n=8) 82.5 69.0 76.6 71.1 73.9 77.1 72.3 58.8 58.9 60.0 46.2 22.8 41.3 34.8 31.0 40.8 30.2 43.5 48.2 45.2 Nurse Communication Doctor Communication Clean Quiet Bathroom Help Pain Mgmt. Medicine Info Overall Rating Discharge Instructions Recommend 5

Safety Incidents per 100 Team Members At the Medical Center, Engaged Workgroups Had Far Fewer Safety Incidents The focus on Be Safe likely added to the number of incidents reported this past year. However, there was still a noticeable difference in incidents reported by top quartile vs. other workgroups. MEDICAL CENTER TEAM MEMBER SAFETY INCIDENT RATE (per 100 team members) 12.00 2014 2015 10.00 10.42 8.77 8.89 9.61 9.58 10.12 8.00 6.66 6.00 4.00 3.72 2.00 Top Quarter Upper Middle Quarter Lower Middle Quarter Bottom Quarter n= Ave Dept Size= 41 42 41 41 26 74 50 35 Note: Departments selected for analysis when survey n >= 5, and when safety incidents were tracked for the department. The top 25% of 2015 engaged departments tends to be much smaller than the size of other departments. 6

Turnover Percentage Engagement at the Medical Center Also Showed a Strong Correlation to Turnover Voluntary turnover rates were higher among less engaged team members. While it s true that all turnover is not necessarily bad turnover, there are likely some top performers in the Not Engaged and Actively Disengaged groups that the Medical Center would want to retain. 15% Involuntary Term Voluntary Term 12% 11.8% 9% 8.4% 6% 3% 5.5% 4.3% 4.0% 5.1% 0% Engaged Not Engaged Actively Disengaged n= 3,563 3,991 1,095 Note: Turnover rates have been corrected for response rate differences. The overall 2014 response rate was 77%, while rates for voluntary and involuntary terms were 58% and 41%, respectively. Over the past 12 months, 1,347 of 11,322 team members have left the organization with 869 classified as voluntary and 478 as involuntary. 2014 survey data exists for 504 of the voluntary and 194 of the involuntary terms. 7

Success Rate Every Bit of Engagement Movement Increases the Probability of Strong Performance* At the 30 th percentile, a workgroup has only a 42% probably of achieving above average performance. By moving to the 50 th percentile, that probability increases to 50%. 100% 90% 80% 70% 60% 50% 40% 30% 20% 20% Probability of Above Average Performance 62% 58% 54% 50% 46% 42% 38% 28% 32% 68% 72% 80% 10% 0% 1 st 5 th 10 th 20 th 30 th 40 th 50 th 60 th 70 th 80 th 90 th 95 th 99 th Engagement Percentile Analysis of Business Units Across Organizations in Gallup s Database *Composite of absenteeism, turnover, shrinkage, safety, quality, customer metrics, productivity and profitability 8

Engagement Overview 9

GrandMean Engagement at SOM Continued to Improve in 2015 The 0.07 increase in GrandMean in 2015 followed a 0.16 increase in 2014 (from 3.70 in 2013 to 3.86 in 2014). Percentile: 5.00 4.75 4.50 34 th 39 th 31 st 35 th 50 th 4.25 4.00 3.90 3.98 3.86 3.93 4.13 3.75 3.50 3.25 3.00 2014 2015 2014 2015 Gallup UVA Health System SOM Healthcare Workgroup Note: Percentiles based on Gallup s Q 12 Healthcare Workgroup Level Database from the survey year 10

Performance Improved Across All Engagement Items There were meaningful increases (0.10 or more) on three items: Best Friend, Opinions, and Do Best. Growth Teamwork Individual Basic Needs 2015 Mean (n=1,500) 2014 2015 Mean Change 2015 Percentile 2014 Mean (n=1,781) GrandMean: 3.93 +0.07 35 th 3.86 Learn & Grow 4.09 +0.08 41 st 4.01 Progress 3.77 +0.05 29 th 3.72 Best Friend 3.49 +0.11 26 th 3.38 Quality 4.22 +0.08 47 th 4.14 Mission 3.99 +0.08 30 th 3.91 Opinions 3.84 +0.10 50 th 3.74 Development 3.86 +0.07 35 th 3.79 Cares 4.14 +0.02 37 th 4.12 Recognition 3.45 +0.07 32 nd 3.38 Do Best 3.96 +0.10 26 th 3.86 Materials 4.02 +0.09 40th Expectations 4.34 +0.07 27 th 4.27 3.93 Note: Percentiles based on Gallup s 2015 Q 12 Healthcare Workgroup Level Database 11

GrandMean Engagement Improved for Both Faculty and Staff Percentile: 21 st 5.00 4.75 4.50 4.25 4.00 3.75 3.50 3.25 3.00 n Size: 30 th 32 nd 3.84 3.89 3.90 3.72 3.72 SOM Staff 2013 2014 2015 21 st 34 th 41 st 15 th 29 th 30 th 4.01 SOM Clinical Faculty 3.61 3.83 3.86 3.83 3.87 3.87 SOM Research Faculty 28 th 32 nd 31 st SOM Professional Research Staff 1,023 1,021 780 399 453 396 319 278 206 135 121 73 Note: Percentiles based on Gallup s Q 12 Healthcare Workgroup Level Database from the survey year 12

GrandMean Tenure Track/Tenured Exhibited Greater Increases Percentile: 21 st 35 th 35 th 5.00 4.75 4.50 4.25 4.00 3.75 3.50 3.25 3.00 n Size: 4.11 3.72 3.91 3.93 3.73 3.81 3.63 3.61 3.81 Tenure Ineligible SOM Clinical 2013 2014 2015 22 nd 33 rd 49 th 16 th 31 st 27 th Tenure Track/ Tenured Tenure Ineligible SOM Research 15 th 28 th 32 nd 3.89 Tenure Track/ Tenured 210 247 224 189 205 172 106 97 74 213 181 132 Note: Percentiles based on Gallup s Q 12 Healthcare Workgroup Level Database from the survey year 13

As a Result of Increased Engagement, There Are Now Nearly Four Engaged Team Members for Every One Actively Disengaged Team Member Engaged Not Engaged Actively Disengaged 2.8:1 3.7:1 9.1:1 14% 12% 7% 39% 44% 29% 47% 44% 64% 2014 2015 Top Quartile of Gallup s Healthcare Database SOM 14

The Goal Is to Continue to Accelerate SOM Along the Engagement Curve Gallup s average healthcare client exhibits a +0.26 increase in GrandMean after four administrations. 0.30 0.25 0.20 0.15 Average Increase in GrandMean +0.14 SOM +0.16 +0.21 SOM's Increase in GrandMean SOM +0.23 +0.26 0.10 0.05 0.00 Admin 1-2 Admin 1-3 Admin 1-4 Note: Admin 1 2 includes 113 client orgs., Admin 2 3 includes 85 client orgs., Admin 3 4 includes 58 client orgs. 15

It Is Important That Engagement Is Not Put on Hold as Other Changes Are Implemented New Strategic Plan at SOM Implementation of Be Safe Initiative Upcoming Changes in Leadership These changes can be opportunities to drive engagement. However, they are more likely to detract from engagement if no further actions are taken. 16

Of Concern, Fewer People Participated in the Process in 2015 Response Rate 70% 60% 81% 83% 2014 2015 HC HC 3 rd + Admin SOM Gallup Avg. 17

Scores for Those Who Took the Survey in Both 2014 and 2015 Were Relatively Flat The GrandMean for team members who took the survey in both 2014 and 2015 increased by 0.01 (from 3.92 to 3.93). Team members who dropped out of the process in 2015 had an average GrandMean of 3.74. Their failure to participate this year was a meaningful driver of this year s total increase in GrandMean across SOM. Growth Teamwork Individual Basic Needs 2014 Mean (n=1,186) 2014 2015 Mean Change 2015 Mean (n=1,186) GrandMean: 3.92 0.01 3.93 Learn & Grow 4.09 0.00 4.09 Progress 3.78-0.03 3.75 Best Friend 3.46 0.11 3.57 Quality 4.19 0.02 4.21 Mission 3.98 0.01 3.99 Opinions 3.83 0.00 3.83 Development 3.86-0.01 3.85 Cares 4.18-0.06 4.12 Recognition 3.42 0.01 3.43 Do Best 3.91 0.06 3.97 Materials 3.97 0.05 4.02 Expectations 4.31 0.04 4.35 18

Some Key Areas of Opportunity Remain There are a number of areas where SOM continues to trail Gallup s Academic Medical Center Database. SOM is below the 25 th percentile on two key foundational items: Expectations and Do Best. Below 25 th Percentile At/Above 25 th Percentile At/Above 50 th Percentile Growth Teamwork Individual Basic Needs SOM 2015 Mean Gallup Academic Medical Center Database 25 th Percentile 50 th Percentile GrandMean: 3.93 3.88 4.02 Learn & Grow 4.09 3.89 4.06 Progress 3.77 3.77 3.95 Best Friend 3.49 3.63 3.85 Quality 4.22 4.01 4.10 Mission 3.99 3.99 4.10 Opinions 3.84 3.53 3.63 Development 3.86 3.78 3.92 Cares 4.14 4.01 4.11 Recognition 3.45 3.46 3.64 Do Best 3.96 4.02 4.17 Materials 4.02 3.94 4.04 Expectations 4.34 4.38 4.49 19

Local Action 20

While Accountability Improved, a Significant Percentage of Teams Still Aren t Making Meaningful Progress on Action Plans Accountability Index 2015 2014 3.68 (28 th ) 3.62 (29 th ) %1 %2 %3 %4 %5 Mean Percentile Received Feedback on Previous Survey 2015 6% 6% 13% 26% 49% 4.05 34 th 2014 6% 6% 13% 26% 48% 4.04 38 th Team Participated in Effective Action Planning 2015 13% 11% 19% 24% 33% 3.52 25 th 2014 14% 11% 18% 26% 31% 3.48 26 th Team Has Made Progress on Action Planning Goals 2015 12% 11% 23% 26% 28% 3.48 26 th 2014 13% 12% 25% 28% 23% 3.36 25 th Note: Percentiles based on Gallup s Q 12 Additional Items Accountability Index Overall Workgroup Level Database from the survey year; Due to rounding, percentages may sum to 100% +/-1% 21

For the Best Results, Local Teams Need to Focus on Issues, Not Items Action at the Local Level Use scores to inform discussions. Link to a survey item, if necessary, for tracking purposes. Define success beyond engagement scores. Look to involve other parties/ departments. 22

Additional Steps Leaders Can Take to Drive Accountability at the Local Level Recurrent Leader-to-Leader Conversations Brief Action Plan Updates Mentoring Engagement Review Panel Highlighting of Effective Action Plans 23

Managers Can Learn From Best Practice Examples at SOM At SOM, 40% of workgroups are above the 50 th percentile of Gallup s Q 12 Healthcare Workgroup-Level Database. SOM BEST PRACTICE MANAGERS Name Department GrandMean n Size Bobby Chhabra Orthopaedic Surgery 4.63 16 Sandra Burks Surgery 4.61 9 Joy Hilton Internal Medicine 4.57 8 Paul Levine Otolaryngology 4.57 5 James Ferguson II OB/GYN 4.52 7 Mitchell Rosner Internal Medicine 4.51 7 James Carnes Radiology 4.49 6 Deborah Carver Pediatrics 4.47 6 Lori Elder Dean s Office 4.35 5 Veronica Harris Surgery 4.35 5 24

Communicating to Leaders About Engagement 25

With All of the Recent Changes, Senior Leadership Needs to Continue to Lay the Groundwork for Engagement Mean %1 %2 %3 %4 %5 Feel Empowered to Speak Up and Address Problems During Workday 3.92 18% 29% 41% If Suggestions/Concerns Raised, Confident Supervisor/Chair Will Act 1 3.76 10% 18% 30% 35% Supervisor/Chair Involves Team in Decisions Affecting Jobs and Work Environment 2 3.72 10% 18% 30% 34% Understand How My Role Contributes to Success of the Six UVA Goals 3.53 11% 10% 21% 33% 26% Know the Six UVA Goals 3.33 14% 13% 21% 27% 24% Have Clear Sense of Direction SOM Is Heading 3.19 10% 16% 33% 27% 14% 1.00 5.00 0% 100% Note: Due to rounding, percentages may sum to 100%, +/-1%; Numerical values shown when 10% or higher; 1 Item mean increased by +0.03 from 3.73 in 2014; 2 Item mean increased by +0.04 from 3.68 in 2014 26

There Are Some Basic Activities for Senior Leaders to Engage in to Help Drive Engagement Be transparent and explain the why of decisions Dedicate sufficient face time to team members Acknowledge efforts and accomplishments (say thank you ) Are you doing these things on a consistent basis? Could you be spending more on these activities? What, if anything, is getting in the way? 27

CULTURE COMMUNICATION Senior Leaders Can Also Speak Directly to Areas of Opportunity at SOM* Expectations Do Best Establish clear guidelines for conduct and performance during the transition. Be very clear and consistent on communications once the new leadership is in place. Prepare talking points for local managers to reinforce messaging Recognition Best Friend Reiterate the importance of trust in the workplace. Find additional opportunities for team members to provide input on changes/initiatives. Recognize/reward contributions from all team members around successes. Areas Below the 35 th Percentile based on Gallup s 2015 Q 12 Academic Healthcare Database 28

Appendix 29

Gallup s 2015 Q 12 Databases Updated Annually; Contains Three Years of Rolling Data Healthcare Workgroup Level Healthcare 3 rd and Greater Administration Workgroup Level Academic Medical Center Hospital Level 1,137,356 Respondents 96,412 Workgroups 63 Organizations 938,546 Respondents 76,601 Workgroups 52 Organizations 267,530 Respondents 53 Hospitals 21 Clients 25 th Percentile GrandMean: 3.78 50 th Percentile GrandMean: 4.13 75 th Percentile GrandMean: 4.46 90 th Percentile GrandMean: 4.72 25 th Percentile GrandMean: 3.86 50 th Percentile GrandMean: 4.20 75 th Percentile GrandMean: 4.52 90 th Percentile GrandMean: 4.75 25 th Percentile GrandMean: 3.88 50 th Percentile GrandMean: 4.02 75 th Percentile GrandMean: 4.11 90 th Percentile GrandMean: n/a 30

Understanding Q 12 Results (page 1 of 2) Survey Items Scored on a 5- Point Scale A 5 has been shown to link most strongly to positive outcome measures. A 5 has been shown to correlate to a psychological yes and indicates consistency in a workgroup. A 4 indicates a yes, but it is a yes response, but with some reservation. A 1, 2 or 3 response is a form of no, varying in degrees. GrandMean Average of the 12 Q 12 items The 75 th percentile GrandMean is the high performance target. The 50 th percentile is mean, or average, performance. 31

Understanding Q 12 Results (page 2 of 2) Engagement Index and Ratio Index: Engaged data is suppressed when n<30; Not Engaged and Actively Disengaged data are not provided when n<100. Ratio: Compares the percent of Engaged team members to the percent of Actively Disengaged team members in a ratio, e.g., 5:1. Top Box (%5) The percent of respondents who answer 5 on a particular item. Workgroup A group of team members who report directly to a specific leader. 32

SOM Engagement Dashboard Response Rate GrandMean 70% 60% 81% 83% 2014 2015 HC HC 3 rd + Admin SOM Gallup Avg. 3.90 (34 th ) 3.98 (39 th ) 3.86 (31 st ) 3.93 (35 th ) 4.13 (50 th ) 2014 2015 2014 2015 Gallup HC UVA Health System SOM Workgroup Database Ratio: Engagement Index Engaged Not Engaged Actively Disengaged 2.8:1 3.7:1 4.6:1 14% 39% 47% 12% 44% 44% 11% 38% 51% 2014 2015 Gallup Healthcare SOM Database Teams Above 50 th Percentile 5% 32% 40% 2013 2014 2015 SOM Note: Percentiles and quartile designation based on Gallup s Q 12 Healthcare Workgroup Level Database from the survey year 33

Steps That Leaders Can Take to Foster Dedication, Trust and Ownership Dedication Questions Do team members have a clear sense of what s going on at the School of Medicine? Do they know how the changes/initiatives affect them personally? Do they see how recent changes/initiatives are helping to further the mission (i.e., as leaders, are we taking time to explain the why )? Do team members feel that this is an organization that continues to command their loyalty? Initial Action Steps Audit your most recent communications to team members. Assess the clarity and effectiveness of that messaging. Consider the steps taken to follow up on those communications. Develop/refine your elevator speech for team members. Briefly define the purpose, brand and culture of the organization ( organizational identity ). Highlight what is special or unique about working for UVA or the School of Medicine. Think about how that value proposition may have changed over the last few years (on its own and relative to competitors). Test your hypotheses in upcoming rounding sessions. Identify one near-term opportunity to reinforce the mission with team members. 34

Steps That Leaders Can Take to Foster Dedication, Trust and Ownership Trust Questions Are team members made a priority? Are you, as leaders, sending consistent messages to team members (through your words or actions)? Are you consistently acknowledging team members and thanking them for their for their contributions? Are you modeling the behaviors you want the team members to follow? Are you enabling/promoting cooperation across roles and functions? Initial Action Steps Dedicate a sufficient amount of face time with team members. Walk the halls. Set up breakfasts, lunches or other mechanisms to meet with team members on an informal basis. Continue to call out best practices in department meetings, team member meetings and huddles. Highlight the actions being taken to make SOM safer for team members and patients. Suggest other opportunities for teams to personalize the Be Safe initiative. Set at least one collaborative session with another unit or function. Use this session to review protocols and timelines, clear up any misinformation/disconnects or identify opportunities for improvement. 35

Steps That Leaders Can Take to Foster Dedication, Trust and Ownership Ownership Questions Do team members feel supported in their actions? Do they have sufficient and meaningful outlets to voice their questions and concerns? Are you, as leaders, consistently acknowledging and responding to those comments? Do team members feel vested in the overall success of the School of Medicine (or the success of recent initiatives)? Initial Action Steps Initiate team member rounding in your group/make optimal use of the existing rounding process. Be consistent in your approach. Listen, don t judge. Acknowledge comments; follow up on progress. Take findings to the broader leadership team and seek out systemic issues and challenges. Highlight one or two recent rounding wins for the group. Set goals for team members based on key initiatives. Define success for the group in their roles. Establish some sort of reward/recognition system for achieving the goals. [Note: This does not have to be financial.] 36

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