Deputy Physiotherapy Manager at Epworth Rehabilitation, Amy Bach, outlines some key features of a Staff Engagement Action Plan that enabled her department to shift from a culture of ‘blame’ to one of ‘success’ in less than 18 months.

Employee engagement is the emotional commitment a person has to an organisation or position and is based on the psychological ‘social exchange’ theory where people make social decisions based on perceived benefit and cost. It is a reciprocal relationship between the supports that organisations provide to their employees, and an employee’s willingness to make the most of their individual performance.

Engagement levels in a workplace have an effect on a number of different occupational outcomes, including:

• performance—communication, interpersonal cohesion, and work quality and safety
• productivity—work output, innovation and absenteeism
• retention—staff morale, attrition rate, recruitment costs
• consumer (patient) satisfaction—ultimately impacting on organisational reputation.

An anonymous, organisation-wide employee engagement survey is conducted every two years at Epworth HealthCare by an external company (Best Practice Australia [BPA]). Featuring interim surveys for targeted departments, the process measures the proportion of staff currently experiencing their working life in an ‘engagement cycle’ versus swinging voters and those in a ‘disengagement cycle’.

Staff members in an engagement cycle are described by BPA as being openly positive, ready for change, and trusting of management. The benchmarked average for the health workforce is 42 per cent.

Those in a disengagement cycle are openly pessimistic, reluctant to change, and distrustful of management. This cohort has a benchmarked average of 17 per cent (one in every six employees).

Swinging voters are those that sit on the fence, and are neither openly positive nor negative. They are inclined to come to work to do their job and not engage with organisational purposes. This group makes up an average of 41 per cent of employees (BPA 2016).

The survey encompasses:

• 56 sections of questions covering BPA’s 7 Research Programs into Organisation Culture
• A combination of specific and general questions
• Extensive narrative ‘free text’ feedback questions.

Based on the results, it is imperative that department-specific action plans are developed to target strength and improvement areas for each team. The October 2013 survey conducted on the Physiotherapy Department at Epworth Camberwell indicated that the department was in a culture of blame—defined as 20–30 per cent of employees being engaged with the organisation (BPA 2015).  The action plan that was developed for the department centred primarily on three pillars of cultural change highlighted in the survey results as the main improvement areas requiring attention. These included Engagement, Leadership, and Values.

Engagement
The need for enhanced communication up and down reporting lines was identified as a focus area based on improving the sense that employees ‘have a say in how the organisation is run’. To enhance individual and team involvement, the existing supervision structure was reviewed to create increased mentoring opportunities, including the consistent use of a template for monthly catch-ups with sections on:

• what we are doing well
• what we can do better
• team dynamics
• staff wellbeing
• professional development plan goals
• resources
• peer/colleague recognition.

To encourage a shift from a reactive to proactive culture for change management, staff members were encouraged to actively submit ideas via an intranet link, as well as raise ideas during staff meetings and supervision sessions. A further action was the initiation of representation by senior inpatient physiotherapists at the daily bed meetings, for involvement with admission planning.

In the initial survey, there was only a nine per cent agreement level with the statement: ‘There is a strong sense of success and achievement within the department’. This result highlighted the need for increased strategies for reward and recognition. Initiatives that were implemented including a peer-nominated staff meeting ‘Oscar’ award; the addition of a ‘What are we doing well?’ item to all staff meeting agendas; inclusion of a staff recognition section in the end of month manager’s report; and formal public recognition for exceptional performance through CEO dinner nominations and staff forum awards. The result was an increase to an 89 per cent agreement level.



Leadership
There is evidence to suggest that a transformational, rather than instructional, leadership approach can maximise an employee’s sense of involvement, engagement, and readiness for change. This approach is based on providing a supportive environment with openness to new ideas in order to promote psychological safety. The action plan included a concerted effort to increase transparency around the department’s key performance indicators as well as the development of goals for individual performance plans that were aligned with the overall strategic plan for the organisation.

To empower senior staff and allow for robust lines of communication, a review of the reporting lines was completed to allow stream leader roles in each clinical area. Senior staff leadership training included both formal one-day courses on core management principles (eg, conflict resolution, performance development plans, building positive attendance) and informal training, including leadership skills sessions in senior staff meetings.

To encourage reinforcement of positive performance, an increased culture of feedback was promoted through the delivery of balanced, timely and specific feedback, with the use of discussion planners during mentoring sessions. For recruitment of new staff, behavioural-based recruitment is utilised with an emphasis on organisational fit, and centres on the theory that past behaviour predicts future behaviour. This is undertaken through a questioning of actual, rather than hypothetical, interview scenarios.

An important part of the action plan was developing a plan for appropriate resourcing. Business cases, subsequently successful, were developed for additional senior clinician positions to allow for equitable governance in each clinical stream. A review of inpatient versus outpatient EFT was also completed, with changes implemented aimed at aligning the department structure with organisational goals and optimal patient ratios.

Values and behaviours
The development of a ‘values charter’ was an integral component of the action plan, in order to establish a set of peer-driven ‘ground rules’ for the team. Brainstorming sessions were held at senior staff level, grade level and within each clinical stream. Then, based on the outcomes of the brainstorming sessions, workshops were held over a series of weeks to establish key components of the charter. The workshops were split into groups focused on each of Epworth’s organisational values (respect, excellence, community, compassion, integrity, accountability) with the team opting for a poster competition for visual display of behaviours relating to each value. After completion of the workshops, a follow-up session was held to establish individual actions to ensure consistent involvement and accountability across the department.

Following the action plan intervention, overall employee engagement for the department tripled, shifting from 24 to 76 per cent. This indicates a culture of success, defined as more than 60 per cent of employees being engaged with the organisation (BPA 2016). This culture is described as having large numbers of employees that are optimistic about the organisation‘s future.  There is a sense that ‘things are getting better all the time’. This type of culture is very close-knit, cohesive, and focused (BPA 2016).



Employee engagement is a crucial precursor to the provision of high-performing physiotherapy teams. This example has demonstrated that a targeted Action Plan can transform a workplace culture, and a strongly positive culture within a workplace can be embedded through the development of a values charter. 

There is evidence for two significant drivers of employee engagement:

• communication—people need to feel empowered and informed, rather than having change ‘imposed’ on them
• Involvement—having opportunities to have their voice heard.

Combine these two factors with a shared vision and strong leadership and you have a team to be reckoned with!

This article was based on Amy’s recent presentation at the Australian Physiotherapy Association “Connect” conference, Joint ACHSM/ACHS Asia-Pacific Congress and National Allied Health conference.

The Blame to Success Model of Organisational Culture is a proprietary model owned by, and copyrighted to, Best Practice Australia Pty Ltd.