You Can’t Manage It If You Don’t Measure It:
How Cape Fear Valley started the process of measuring and improving Employee Engagement.
By: Michele Westphall, Marketing Project Manager, HR Solutions, Inc.

Cape Fear Valley Health System opened its doors in 1956 as a 200-bed, one-building hospital and has grown into a regional health system with 619 beds, four hospitals and primary care physician offices throughout Cumberland County and surrounding areas. Yet it was not until 45 years later, that Cape Fear Valley embarked on its first full-census Employee Survey.

“When I first started as CEO in 2001, it was surprising for me to learn that Cape Fear Valley was not doing surveys of any kind: employee, physicians, patients, none at all,” emphasized Richard Parks, former CEO of Cape Fear Valley Health System. “I got a group of employees together and we started evaluating all of the top companies out there who provide employee surveys,” Parks shared.

Parks takes a deep breath and pauses for a moment, remembering as if it was yesterday, “The first time survey results were quite surprising. No one really expects to have such low scores or participation rates. It was so surprising, I can to this day still remember the results: 51% participation and in the 35th percentile compared to the National norm.” Cape Fear Valley’s percentile ranking meant they scored at the same or better than only 35% of other healthcare organizations.

“The first thing we did was get all the VPs and select employees together and formed task forces. We took the Quick Wins provided by HR Solutions and created a task force for each of those items. A quick win is a suggestion from the employees that could be implemented in a relatively short amount of time and make an immediate impact on employee engagement levels. We did them all and kept pounding on that list until everything was addressed,” stressed Parks.

Brenda Hubbard, former Vice President of Human Resources, added, “The most important thing for us was redefining the Organizational Communication process. We set up the following:

• All Employee Email group
• Around the clock Employee Forums
• Weekly voicemail from Richard (the CEO) to all employees about the changes and what we were doing to address each item
• Posters that communicated each and every change we were making as a result of the survey.”

The strong commitment of the Executive Team to the survey process was abundantly clear to the employees who took part in the Employee Forums. The Employee Forums slowly built up from 300 employees a day to about 1000-1200 employees per time slot. Parks elaborates, “I was basically there for 24 hours straight, just talking and meeting with each shift. It was important to have everyone involved, no matter what their shift was. We kept inundating them with all of the information. We shared all the changes that were being followed up on and who were on the task forces that were in charge of each item. We fielded any and all questions that the employees had.”

Cape Fear Valley established accountability for each item and committee/taskforce created as a result of the survey. They assigned responsibility for implementing each component of the plan, and each employee was accountable for the success of the plan. Hubbard explained, “We made the survey results and action planning part of the organizational dashboard as well as the incentive plans for the department heads. Management provided updates on the changes they implemented in their semi-annual management outcomes report. By focusing on the Supervisory Dimension results with the management team we were able to make sure that the supervisors at the top of the list were praised for their accomplishments and saw a direct result of their contributions.”

The HR Department communicated each and every item and change that had been completed since the last Employee Forum through printed update pages. They also included a short follow-up survey to find out if employees felt that change was occurring. This clear communication channel was able to build accountability for the survey process and demonstrate that Cape Fear Valley Executives and its managers were accountable for, and looked forward to, measuring future improvements. Parks confided, “I felt that it was important to keep up the same level of intensity about the change process so that employees knew that we were serious about addressing each and every item. I believe that intensity does pay off in the long run.”

With the follow-up surveys, Cape Fear Valley made a strong effort to improve the employee participation rates, and it became a personal goal for Richard Parks, as well as an organizational goal to try and reach 85% eligible employee participation in the survey process. “We followed all of the suggestions on increasing participation rate that our HR Solutions’ Project Manager gave us,” Parks further offered, “We gave incentives for the departments with the highest participation rates, like pizza parties and free meals and lotteries for different gift certificates and other prizes.”

Polly Weese, Human Resources Manager, shared, “We started using Survey Captains in every department. These are fellow employees who wanted to help their departments achieve our participation goals. They could speak face-to-face with the employees to let them know we really wanted their input in the survey. The Survey Captain would also talk to the department heads to make sure the employees were given the time to complete the survey. “

With the second full-census survey results in hand, was this enough to have made an impact in such a short time?

“We placed in the 79th percentile (top quarter) of all organizations surveyed by HR Solutions and had 92% participation. I remember Kevin Sheridan (CEO of HR Solutions) telling me that was the highest increase in the percentile ranking in HR Solutions’ history at the time,“ Parks elatedly shared. Indeed, that year Cape Fear Valley won HR Solutions’ Most Improved Client Award.

A few of the employees admitted they were eager to participate in the second survey due to the changes which occurred as a result of the first survey. Many of the employees attributed the positive cultural change to Mr. Richard Parks’ open and goal-oriented leadership style. A few direct comments from the follow-up survey highlight this overall feeling:

• “In all fairness, I have seen numerous CEOs and Administrators, and Mr. Parks has made things happen that none of the others could do. They talked about it, but it never got done. Since the last survey, he has done it,” shared one employee.

• “The best thing that happened here is sitting in the CEO seat. Mr. Parks, he has made this place move,” stated another employee.

• “He [Mr. Parks] is making changes. We had the largest profit in the history of the hospital last year, and that was his first year here,” confirmed yet another employee.

Employees also disclosed that they were allowed to openly voice their opinions to Senior Management, and that their ideas, suggestions, opinions, and concerns were heard. They felt that the Employee Forum was an excellent communication vehicle for both top-down and bottom-up communication.

Cape Fear Valley finally had the metrics in place to document their path to achieving a motivated and Engaged Workforce. Clearly, the process is not a one-time event, yet a continual path of growth and learning. Each item was given the same amount of importance as the previous survey results and Cape Fear Valley continued to stress the changes that they were making as a result of the survey at the Employee Forums and through the continued improved communication channels.

“By the third survey, employee participation reached 99.8% of eligible employees, and we scored above the National Healthcare Norm on all of the 18 survey dimensions. We moved up to the 84th percentile of all organizations in the National Database,” Parks confided.

What effect was the increasing of Employee Engagement levels having on financial and patient care outcomes? “As a direct result of these constant improvements, we started to see patient satisfaction scores going up as well,” confirmed Parks. Weese added, “The changes implemented in the emergency room brought them from 12% to 80% patient satisfaction, which is phenomenal.” In fact, in April, 2007, HealthGrades® rated Cape Fear Valley in the top 5% for both clinical excellence and patient safety along with being named in 2005 to Solucient’s 100 Top Hospitals®: Performance Improvement Leaders for Cape Fear Valley’s consistent improvements in patient care, financial performance, and operational efficiency. As the general financial well being increased, Cape Fear Valley implemented an employee bonus program based on profitability to which they have successfully contributed towards in every year leading up to 2008.

Not only were the Overall Job Satisfaction levels steadily increasing at Cape Fear Valley as a result of the survey (see chart), but confidence that Administration was using the survey results to strive towards continuous improvement was soaring. Employees responded in record numbers to the follow-up surveys on the item, “this organization used feedback from the last survey to make improvements,” which showed every department scoring this item above the National Norm, and some departments having 100% of employees agreeing with the statement.

And yet, attendance numbers started to go down at the Employee Forums. Parks stated, “We sent out quizzes to the employees to find out why they were no longer coming, and the overall response was, ‘We feel like we know what is going on and if we need anything, we know where to get the answers.’”

Action is the real measure of survey effectiveness. Cape Fear Valley Health System is an outstanding example of how Senior Management’s dedication to the survey initiative can create drastic changes to a workplace culture in a very short time. When those survey results are communicated to employees and translated into positive change, the rewards are abundant.