Revamp Organizational Structure to Focus on People, Not Performance, Expert Advises
With clinical research professionals exiting the industry in droves, it’s high time for research institutions to step back and assess themselves internally, evaluating how their own paradigms, cultures and priorities affect employees.
In the view of Chad Adams, assistant vice president and chief operational officer for HonorHealth Research and Innovation Institute in Scottsdale, Ariz., the trend is less about the employee and more about the employer.
“We should seriously question whether the recent exodus in healthcare jobs is truly about a failure of staff who are deficient in some manner versus systematic issues and inconsistent priorities that have compounded into a negative risk-benefit ratio for the employee,” Adams said during a presentation at the MAGI West conference in Las Vegas, Nevada.
HonorHealth hasn’t been spared from the effects of the staffing crisis; on the contrary, it’s seen massive hits to its employee numbers, losing 44 percent of its staff to resignations in 2021 and seeing great difficulty in filling positions, Adams said. But “an overhaul and complete restructure” within the institute that saw it face some harsh truths has helped cut staff turnover down to 15 percent this year.
“We work within a system that hired 500 new nurses [in 2020], and we can’t even get someone to apply to a position. Why is that? Asking ourselves these tough questions is really important,” said Adams, who joined HonorHealth Research in October 2021. This scrutiny, he said, ultimately pointed to the fact that “our training and onboarding was almost nonexistent, we didn’t have any formalized structure, roles had no growth and systems were not aligned.”
“We absolutely knew we had to invest in a sincere and sustained commitment to valuing people. Do we see our employees as people first, or do we see them as a resource to get work done?” Adams said.
Embarking on its journey to revamp itself, the first thing HonorHealth did was aim its sights at encouraging open, civil communication and accountability within the organization at an environmental level by developing nonnegotiable, employment-dependent standards, or “trust accelerators,” that everyone must agree to abide by and use in their interactions with each other.
These trust accelerators — posted across the three-story facility from executive, director and management offices to conference rooms and public spaces — hold real weight, Adams explained, with disciplinary action ensuing for any employee that fails to follow them. Staff are also encouraged to speak up if they feel a coworker is not adhering to the standards.
HonorHealth’s Universal Trust Accelerators are:
- Follow through on commitments (do what you say you’re going to do).
- Be impeccable in your communication, but be direct, be kind, be respectful.
- Move forward with sensitivity (acknowledge and address the impact of past HonorHealth culture).
- No domination and no silence. Everyone has a voice and a seat at the table.
- No meetings after the meeting. Keep intentions on the table.
- Truthfulness without fear of retribution (avoid broad sweeping statements and seek to understand, not underhand).
- Actively seek peer advisement and clarity.
- No defensiveness (tone, body language).
- Seek clarity (listen to, understand and stay engaged in dialogue).
- No under-the-table issues. Keep them on the table. We cannot fix a problem we cannot see.
In addition, Adams realized that the organizational alignment of the company needed serious adjustment so that staff were afforded career development opportunities and upward mobility within the institution. With support from its human resources department, the institute created entry-level positions that gave people who were interested but inexperienced in research the chance to explore such a career, with a one-year time limit to qualify for promotion to the next level and keep the job.
HonorHealth also came up with a class of job descriptions that allow employees to work toward the next promotion level within their current job area and reevaluated employee compensation ranges to ensure all staff were receiving payment proportional to market value, he said. Similarly, they implemented equity adjustments to ensure that staff members with the same levels of experience and education were all paid fairly.
To address the lack of employee onboarding and training, HonorHealth developed a 90-day documented program across every position at the organization that lays out expectations for all new hires and what success looks like for their positions. “This was a lot of work and it took a lot of time to put in place, but now that it’s in place, there is a clear pathway for success for every employee,” Adams said.
HonorHealth also sought to arm its supervisors with team-building skills — “teaching leaders how to lead,” he said — by putting them through a leadership training program that taught “how to invest in relationships that were constructive and positive.”
In a similar fashion, the institute created a mentorship training program that gives experienced employees the opportunity to impart their knowledge and skills to newer staff. The organization’s clinical research nurses are required to complete the course, Adams said, but as of this year, 26 other employees have completed the program voluntarily. To complement this program, HonorHealth also developed competency sheets and tasked mentors with evaluating new staff members’ progress in their first 90 days.
Employers that want to follow HonorHealth’s model should compare their own internal characteristics, Adams advised, with a set of 10 traits identified by organizational development experts and doctors Rosie Ward and Jon Robison, authors of How to Build a Thriving Culture at Work:
- Leadership and workgroups are truly cohesive;
- An organization’s mission, vision and values statement is clearly articulated and accepted/implemented by employees;
- Employees are empowered;
- The organization has strong communication practices throughout;
- Employees are given timely, clear and meaningful feedback designed to help them grow (not just improve their performance);
- The organization’s work environment encourages innovation, meaningful work and creativity;
- Leadership values employees and employees feel valued;
- Employees are encouraged to be authentic;
- Employees care for other employees as genuine people, not just as coworkers; and
- Accountability is embraced across the company, with everyone answering to the same rules.