Judith Warner wrote in her March 12, 2012 Time Magazine article, “High Status Stress” that the “mental and physical health benefits associated with greater affluence due to increasing wages with promotions fade away the higher you go in an organization. Research indicates that as you near the top, life stress increases so dramatically that its toxic effects essentially cancel out any positive aspects of succeeding. Having authority over others binds people to all sorts of interpersonal conflicts and management turmoil leading to “off-the-charts” stress.”
Retention Vs Turnover
There are many reasons why good employees quit a job and the unfortunate truth is that most are preventable. The issue of turnover has been studied by Human Resource (HR) executives since the early 1950’s when researchers like Dr. Gallup and Frederick Herzberg examined human needs and job satisfaction. Decades of research support the original findings of those studies; 35% of all employees who quit a job cite their immediate boss as the driving motivation. In a January 2012 article published by Forbes magazine the author distilled the top 10 reasons top talent leave an organization down to one:
…when they are badly managed and the organization is confusing and uninspiring. The solution is to create an organization where those who manage others are hired for their ability to manage well, supported to get even better at managing, and held accountable and rewarded for doing so.
All of the components of the solution represent exactly what a coach brings to the table.
The factors that contribute to nurse leader longevity and excellent job performance were studied by Barbara Mackoff,Ed D. and Pam Triolo, RN PhD
Those factors are:
1.) Engagement;
2.) Culture of regard;
3.) Support for their Decisions;
4.) Educational Mobility.
Engagement has been found to be a key factor in reducing mortality and preventing errors. The author of, “Coaching the Big Game” from NURSE.com April, 2012, states,
Formal coaching programs are gaining ground as researchers and leaders find the practice of providing coaching boosts a nurse’s job satisfaction and confidence.
Executives who focus their efforts on creating a culture that supports a healthy work environment will improve staff satisfaction. The results of a healthy work environment are enhanced retention; improved patient outcomes and dramatic performance improvement. The methods to accomplish having an engaged staff are: support, recognition, teamwork and good physician/nurse relations.
The Business Care For Investing In Nurse Leaders
Nursing research has proven the link between patient outcomes and nurses who are engaged and empowered. The Agency for Healthcare Research and Quality (AHRQ) studied and reported on the cost of medication errors alone to be approximately $17.1billion per year. Medical errors represent the 6th leading cause of death in the United States and the cost of the deaths is calculated by the Institute of Medicine as $29 billion per year.
Any improvement in the average length of stay (ALOS) will reap monetary rewards in reduced expenses. If one were to consider just the costs associated with turnover the business case to invest in the mid-line nurse manager is clear. The cost associated with replacing one staff nurse is estimated to be 1.2-1.3 times the annual salary and for a nurse leader the cost is even higher. Studies support that retaining nurses increases morale, decreases errors and improves continuity of care, according to a recent journal article.
The Role Of Coaching
If training and education together were enough to change behavior and improve performance it is unlikely anyone would voluntarily smoke a cigarette. In two separate studies (Oliver,et al,1997 and Strayer&Rosset, 1994) it was observed that
following up training events with a coaching relationship had dramatic results.
The first demonstrated that following training for executives with coaching increased performance 4 ½ times as much as training alone. Coaching provides exercises around key competencies such as goal setting; taking action in consideration of system-wide impact; problem-solving; taking responsibility; evaluating outcomes and being held accountable.
Organizational leaders are in the best position to create interest and momentum around job satisfaction. Dr. Donald Clifton, in the late 1960’s, focused his research on the study of what makes people flourish. His team discovered
that change happens most efficiently at a local level, at the level of the front-line-manager.
Daniel R. Tobin wrote in his 1998 article, “The Fallacy of ROI Calculations” that
learning and coaching should be thought of as the wheels and tires of any organizational change. Any new model car must have wheels and tires but you would never ask the leader of that department to do an ROI to justify having wheels and tires on the new car.
A leadership development firm in Manchester, England observed,
40% of newly promoted managers and executives fail within 18 months of assuming a new role.
The leadership position, at any level of an organization, is a lonely position. A fact that supports why 60% of CEO’s from Fortune500 companies, when surveyed, stated that they had their own personal coach. A Fortune Magazine, 2/19/01, article shared the results of a poll of Executives and Managers who had had 6-12 months of coaching. Each participant was asked to give a conservative estimate of the monetary payoff from coaching. The average response placed the value at six (6) times the cost and fully 61% reported a marked increase in job satisfaction.
Calculating Return On Investment
Despite all the qualitative evidence that coaching is an extremely worthwhile investment the coaching industry must establish an effective evaluation system that takes into account that
no two coaching assignments are the same and no two coaches have the same approach.
For leaders in healthcare the argument to include coaching in any plan to reform the delivery of care and improve performance must include solid return-on-investment evidence.
If care is taken both in terms of assumptions and process before the engagement begins, the return on investment predictions from coaching will be at least as good as any other return on investment measurement. The coach should ask the intended client how they will know if the coaching engagement provides the desired outcome? What are the exact metrics expected to improve and what is the current metric being measured? Where no tools exist the coach should create one based on the behaviors the client expects to see modified in the coaching engagement.
Establish current baseline metrics from which to measure progress. Set a realistic timeline, behavior change is slow and for an engagement to be able to demonstrate substantive and sustainable improvement it could take a year or more. Ask the client to describe their current culture. If a supportive culture and a healthy work environment are not in place the possibility that any effort to change behavior will be successful is quite small. Peter Drucker, Strategy and Management expert, is quoted, “Culture eats strategy for breakfast.” An executive team may have the best strategy in the world but if the culture does not support the required changes success is unlikely.