The proof is in the pudding

The proof is in the pudding

A lot of ink has been spilled over the relationship between worker engagement and customer satisfaction.  In some of the WorkersCount and NursesCount blogs we have touched on this (“the secret to driving service as a business differentiator” and “which comes first, customers or employees?”).  In healthcare it is a widely accepted linkage, as it is also in retail and most personal-service industries.  Yet it has been limited to “truisms, common sense, wisdom from experience and anecdotes.”  It has indeed been an elusive connection to document.  Until now.

WorkersCount and NursesCount (and PatientCount) simultaneously monitor both worker engagement and workplace satisfaction directly against customer (patient in healthcare) service satisfaction and outcomes.  This is an industry-first in healthcare and all of general industry in terms of data modeling and actionable insights.  And unlike any data service, this data is gathered is in real-time, on a daily basis.

A Case In Point

Warning signs and risk areas

In a healthcare client of WorkersCount, the challenges were several.  The first challenge:  Move the general customer engagement index from 4.6 (out of 5) upwards towards 5.  Even a small increase in this index is very difficult, yet executive management felt strongly that this was a mediocre score, and signaled problems. 

The next challenge:  Address a recently exposed problem of engagement in a particular cohort (in this case, workers with over 5 years of tenure).  There was a plateau and even a slide in job satisfaction.  Executive management felt that this was a particularly high-risk item, as these workers represented key experience, expertise and were in leadership roles working on business-critical projects and programs.  Turnover in this area would be particularly painful and potentially disasterous to the organization.

The WorkersCount (and NursesCount and PatientCount) process

The exec team implemented WorkersCount’s daily check-in service, which was done without the need to dig-into the HRIS system or any proprietary or sensitive system in the healthcare organization, including HIPAA or HCAHPS areas.  It runs independently in the cloud and uses social sign-on to make daily check-ins (a hallmark of WorkersCount’s services) fast, fun and easy.  It’s a daily reminder with a link, and a 30-second check-in process that’s anonymous.  It asks workers only two questions:  a baseline “how is your life at work today” question, and a second “question of the day” that rotates among a broad list.  Only two questions are asked per daily check-in, so it’s fast and fresh every day.

A bit of fun on the way to 30-50% daily participation

Workers were encouraged to participate (voluntary), with the pledge from management that this was a safe, anonymous way to make their voices heard, and to help drive a better workplace for all (workers and “customers”).  Using simple gamification to inject a bit of fun, and keep things interesting, individuals were rewarded with lunch, or cinema tickets, or dinner at random, or from groups that had high participation.   The system does not link any particular user “votes” or input with a user identity.  It is completely anonymous.

With a daily pulse on employee engagement, managers could actively manage employee engagement and make adjustments in days, not weeks or months. They could see where they were strong and where they were weak. They could see where they had engagement gaps, take actions, and actually see whether their actions resulted in real improvement.  The system became a daily and weekly insight or “pulse” of the organization that could be used as a true management tool.

Startling results

By the end of the measurement period some startling discoveries were made, both from the raw data and more importantly from the interpretation and insights of the reports and data by the management team, working groups and nursing staff.

Here are some highlights:

Eliminating “hell days”

Wednesdays and Thursdays were particularly low days.  Upon review of the data week-over-week and in context with benchmarks, the nurses council and the exec team hit upon an obvious, but hidden issue.  Surgeons were scheduling elective procedures on Monday and Tuesday. Backlogged procedures were stuffed into Wednesdays and Thursdays because many surgeons had a habit of taking time off on Fridays.

Quick and effective adjustments

These are the simple and inexpensive fixes that were able to be made immediately (not months after complex analysis):  Manage overall scheduling more carefully to spot “stuffing” trends like this, and manage doctors more closely to prevent mass exodus on Friday (or any day)  -- for whatever reason. 

Cost- nil.  Impact:  Great.  Timing:  Immediate.

Diagnosing the “happiness plateau”

A completely hidden set of issues emerged with respect to the more experienced managers.  These were the ones with over 5 years of tenure, and had the lowest scores around overall job satisfaction. In fact only 29% of this group reported being happy about work.  This was a huge risk area.  What the service quickly exposed were several gaps that executive management did not see coming:

·      40% had to work long hours to get things done

·      53% were not satisfied with the recognition they received

·      50% did not feel they had a positive work environment

and the most alarming bit of information that workers willingly shared:

·      43% were regularly taking calls from recruiters 

These were the most experienced and seasoned managers in the organization.  They had apparently been “suffering in silence” for some time—perhaps years.  Yet the exec team had not been able to surface these straightforward management gaps until now.  And it was done in weeks, not months.

Swift, simple and inexpensive solutions

Solutions were swift and obvious.  Re-evaluate project timelines and expectations.  Get more frequent feedback on staffing levels for projects and departments.  Make it a formal priority to give recognition and credit for projects that may have been “invisible” to all but a few.  Go deeper about ways of creating a more “positive” work environment.  Track workers into career paths that were exciting and meaningful within the overall organization.

Cost:  nil.  Impact:  Tremendous.  Timing: immediate.

Update—this group posted an immediate 17 point gain in satisfaction, dropped their “willingness to take a recruiter’s call by over 50% and contributed greatly to the overall organization's 13 point overall general engagement improvement.

This was in just 120 days.  The process is still accelerating and improving at this organization. 

When the “standard” customer survey was tabulated, management was able to post the increase they were looking for and more.  In just 120 days the 4.6 score jumped to 4.75, which was a very big single-period swing, and it continues to edge upwards.

What about customer satisfaction?  Did the elimination of “hell days” (Wednesdays and Thursdays) impact “customer” satisfaction as well?  It did.  The external customer satisfaction index climbed substantially during this period, after a pattern of decline.  Here’s what it looked like when compared together: 


We have mounting empirical evidence that links worker engagement to customer satisfaction.  More importantly, using the WorkersCount methodology, reporting and check-in data, management has shown that hidden issues emerge quickly, causes are identified more rapidly and fixes or changes can be implemented (immediately in some cases) that are inexpensive and have high impact across the organization and customer base. 

It doesn’t have to be hard, and the adjustments and "course corrections" need only be small, as long as they are part of a continuous improvement drive from good to great.  All organizations need to do is decide, then make a commitment and then listen to workers and customers.  It's astounding what your customers and workers will tell you ---if you only listen and give them a voice.   The rest will quickly emerge from the talented and committed teams across the organization

In the journey from good to great, this is one of the lasting lessons: listening works.

What's your view?

Systems of Employee Engagement - Are we acting like fossils?

Is it possible that living in the most highly connected, wired and always-on world, we persist with processes and business customs that were “current” at the turn of the last century?  (no, we mean 1900 not 2000)

Geoffrey Moore used the term “Systems of engagement” to describe how employees communicate with one another, which he believes is driven by technology in new ways.    Gary Hamel suggested that the industrial age has reached its limits of improvement.

What does this mean for today’s worker engagement and quality organizations?

Just listen to a recent real-life discussion at a major healthcare organization in the context of driving real improvement in engagement and quality:

Manager 1

“I don’t get to spend enough time with top leaders.  The organization has grown so large that I no longer have the access I had, and I feel I can’t share my big ideas about ways to improve.”

Manager 2

“We have employee engagement surveys, but they’re too infrequent, the information is dated and the working groups change by the time we can see the results.  We want to work on “continual improvement” but our information won’t support this.  We’re stuck. “

Individual contributor 1

“Why do we have to have infrequent surveys that have stale questions?  Why can’t we collaborate on the questions, conduct shorter surveys more often, and use technology more effectively?”

What are some of the take-aways from this discussion?

a)     Workers, managers and customers have a common interest in driving better quality, better employee engagement and better methods of feedback.

b)     All parties recognize the value of more current, (optimally something closer to real-time) information to drive continual improvement efforts

c)     It is widely recognized that the current feedback “systems” are broken, outdated and provide stale and relatively non-actionable data.

It’s not all bad news.

Survey 2.0 and WorkersCount is inside these meetings with daily feedback from workers and customers, using mobile technology and friendly, simple check-in style behavior.

Look out Geoffrey Moore, we’re about to leverage small technology (phones and tablets) to drive big changes in the “systems of engagement” across groups of workers, managers and customers in real-time.  It’s about time we started acting like it’s 2013 and not 1913.  Fossils?  No more.

And for Gary Hamel and having reached the limits of the industrial age’s improvements?  We think he is spot-on.  We’re moving on to what’s possible with the tools and behavioral customs in our new digital and mobile age.  Lots of room here.  

More like a wide open road.

What do you think?

The secret to driving service as a business differentiator

Remember when Service was the “only” differentiator?  That was when most all business was local business, and most of it happened on Main Street in your town.  It wasn’t the packaged goods at the grocery, or even the produce. It was your friendly and knowledgeable grocer.   Was the whisky at the bar or the coffee at the café or the ice cream at the diner the differentiating factor?  Nope.  It was the barista or the soda jerk or the bartender that knew your name, your favorite beverage or treat, and knew your dog’s name too.  Great companies know this.  Great brands leverage and exploit it.

Large and small service organizations are challenged on many fronts today. They need to improve service, control delivery costs, maximize business revenue and reimbursements, and attract and retain customers to grow.

But as the leader in an organization where service is the most significant differentiator, where should you put your emphasis?  Is there a business case or example where tangible return was driven from the people and dollars invested?  It has been difficult for many organizations to “connect the dots” between service quality and specific bottom-line results. 

Introducing the Service-Profit Chain

This very academic/scientific diagram is based upon the work of Service Profit Chain Institute. Does it make common sense, or do thoughtful people really even question the relationship of corporate financial success to company processes (policies) and worker satisfaction and engagement?  What is your experience in business on this matter?  Do most executives “get” this connection?

Healthcare is an interesting case in point.  Lots of money, lots of risk, and many high-value customer “events” or “interactions.”  Recently we met with a healthcare executive who asserts that everyone in their hospital needed to be focused on the quality of the experience of those being cared for.  This executive understands that employee engagement and satisfaction is the gating item for the quality of each and every customer interaction.  In this industry, worker engagement and satisfaction is widely accepted as the primary drivers of performance across each and every customer transaction and interaction. The message is clear for healthcare and every industry: put your attention on employee engagement.   Bottom-line will follow.

Back to our diagram: What are the “inputs” to service employee satisfaction? Is there a formula or rule-book?  Is it really just good common sense for experienced and inspired managers?  We believe it is good common sense that every organization can access.  It’s basic blocking-and-tackling fundamentals. Yet they often get lost in the hectic day-to-day and Quarter-to-Quarter chaos.  These include the following:

-Workplace design

-Employee job design

-Employee selection and development (and training)

-Employee rewards and recognition

-Employee tools for serving the customer

-Frequent feedback mechanisms for consistent “listening” by management

We recently asked users at WorkersCount whether they felt that they were getting the training and help they needed to succeed. Only 21% said this was frequently the case; and 58% said it was only occasionally the case. Great organizations put strong emphasis here.  Yet why was this receiving such a mediocre result from workers across over 300 enterprises?

To be clear, it is important to improve the quality of “business processes” for employees and the customers that they interact with.  What are these “business processes?”  They are the way leadership has designed the day-to-day “standard operating procedures” (both formal and informal customs and ways of doing things and handling customer interactions and policy). 

Put simply:  Are leaders making it more efficient and effective for employees to work with customers in front and back office environments, or are they making it harder to deliver positive interactions and outcomes?  What would employees say about their level of empowerment to do the right thing for the customer?

Combining all this determines employee satisfaction, engagement, empowerment and ultimately, employee retention.  One great organization can’t even say in a few words “what exactly” makes them excellent, because their sense of customer interaction spans over 100 individual “touches” over the course of a transaction.  It is holistic for them.  Customer retention, satisfaction and referrals are their metrics, and the organization only feels those impacts after-the fact or indirectly over time.  Not at the end of each transaction.  The small insight that keeps this company at the top in earnings, brand value and customer loyalty—they understand that their business results are driven by employee engagement, empowerment and job satisfaction.

A case study that proves the point: Quality of service becomes a business differentiator

Several years ago, Sue Nokes moved T-Mobile from the bottom to the top of the JD Power survey.  Sue did this by implementing a simply philosophy: “Making the customer happy is a lot easier to do when employees actually like their jobs and feel that what they do matters.”  With consistent focus on her employees, customer service became a key business differentiator for T-Mobile.

So how bad was it at T-Mobile? Before committing to accepting the job, Nokes visited a few call centers and was horrified. Absenteeism averaged 12% daily; turnover was a staggering 100%-plus annually. The company used "neighborhood seating," a common technique at call centers in which employees didn’t even have regular desks but instead dragged their stuff from cubicle to cubicle.

In her first meetings with her direct staff, Sue asked her managers, 'Are you losing any good people?' They said, 'yeah’.  She retorted, 'anybody feeling bad about that?” She then asked them two questions: “What's going well, and what's broken?" Nokes also, launched a listening campaign, asking what customers were complaining about and what employees needed improved in their workplace. In one focus group, everybody came out crying. The people said they had never felt so inspired in their lives, and that they had never met with any leader at that level who cared.

Nokes then gave employees their own seats and got $17 million to bring salaries up to the 50th percentile. She also overhauled the training process (reps receive 132 hours of training and team meetings each year) and began hiring based more on spirit and attitude than experience. She created a standard set of metrics to measure reps on tracking call quality, attendance, and schedule reliability along with the speed of the call resolution. Nokes told her team that she would never hold them accountable for “things that don't matter to your customer or to fellow employees.”

Finally, to motivate employees in what has long been considered the service desk a dead-end job, Nokes promised that 80% of promotions would eventually go to existing employees. She even put in a "rewards and recognition” system in which high performers were rewarded with fun trips to Las Vegas or Hawaii and prizes. Today absenteeism is at 3% and attrition is at 42%, a very low number in call centers.  And most importantly, employee satisfaction moved to 80% - the highest it's ever been.

One of the big techniques Sue and other great brands leverage is the often-forgotten one of listening.  It’s easy, and it’s one of the least expensive ways of discovering what’s working in an organization and what’s not working.  Both discoveries are like gold.  Yet companies stumble over the process, often making it a burden, or a chore, or a scary process filled with threats or “remediation.”

The best leaders are always the best listeners.  Do you have a mentor that listens to you?  Are you committed to engendering a workplace that values listening and authentic, frequent feedback?  Do you have an organizational value system that holds your workers in trusted positions as “experts” in their respective roles?  If you do, you’re among the vanguard of top leaders.

At WorkersCount we’re all about enabling and empowering workers to have voice, and companies to hone their listening skills.  By creating daily, real-time feedback channels that are safe, simple and easy to implement, companies that use WorkersCount become ninjas at listening and acting on the advice and feedback of their best experts--- their workers and customers.   And that always hits the bottom line in a positive way. 


Being connected

 "I feel connected to my organization"

How do you feel about this?

Many of us feel that our work-life balance is a bit of a challenge.  This can impact how "connected" or grounded we feel - at work and at home.  Sound familiar?  

Many of us feel rushed-around and pulled in many different directions. It's natural to feel like we're always "running" at full speed non-stop.  But it's not healthy.  We can't "connect" and get perspective when we can't see context and stop to take a breath.

It's very important to feel "grounded" and connected at work and at home. Today's question asks about our "connectedness" at work.   Ever feel like you don't know what's coming aound the corner at work?  Are you feeling like you're frequently "surprised" at events and task / project requests and organizational changes?

You're not alone.  You're probably being hit with "tunnel vision."  It's common with hard workers.

Great leaders are good at spotting this and help their super-workers avoid this. It's simpler to alleviate than you might think.  The easiest way to do this is to "over-communicate."  If you're a worker that feels disconnected or out of sync, hang in there!

If you're a leader here's what you can focus on, when you conduct all-hands "info-sessions" and communications

  • recap of our company's status, direction and even overall mission
  • discuss our group's role and how it contributes to overall company progress
  • be specific about daily/weekly/current projects and relate our tasks to company progress
  • showcase and celebrate recent wins and achievements, give group and personal credit when possible
  • invite group leaders and managers to discuss their projects to the rest of us
  • keep people out of their cubes and offices at lunch and get people talking 
  • recap this in a weekly all-hands communication to keep everyone connected to the group's contributions and successes

If you're a leader, try to do this at least once a month if not weekly.  If you're a co-worker, encourage your team leaders and company leaders to over-communicate in this way.  In fact, insist on it!

There's no doubt, It's a lot of work to keep a working group or office team in-touch and connected.  But it's the only way you can ensure everyone is engaged, closely coordinated and highly motivated.  

We've broken it down to some simple ways to "over-communicate." That's one important step.  

Group activities, anonymous and frequent group feedback (direct to leadership) and self-direction are steps that great companies and great leaders embrace and encourage.  

More on those in another post.


Active Listening

Active Listening

"My manager listens to and values my ideas"

Are you a great listener?  

Everyone wants their manager to value their ideas, and to be a good listener.  It’s a two-way street.  Think about your listening skills and habits. 

One of the best ways to get others to value your opinions is by listening to theirs. 

If you are in a situation that makes you question whether or not your ideas are valued, consider ways to acknowledge others’ ideas and recognize their contributions.  This is a great exercise and it may also help you discover new insights about the way you communicate and are perceived by others.

One exercise that was recently suggested in our office is called mindful listening.  Its very simple to understand but very difficult to do consistently.  All you have to is wait.  Three... Little...Seconds.  

The exercise is as follows:
Whenever you are with someone, simply wait three long beats (one Mississippi, two Mississippi, three Mississippi) before you speak.  No exceptions.  It forces you to focus and pay closer attention to what your colleague is saying. And here's the kicker-- if you are angry or upset, you have to count to six. 

Try it and let us know how it goes for you.

It’s easy to change lives. Just check-in daily and spread the word.

What's amazing about WorkersCount is the power each of us has to help drive a better work environment.

Yet we don't realize how simple it is for us to make that influence and power felt.

The workplace is an important part of our lives.  If we're happy at work, we carry that home.  We make more money.  We get promoted and advance.  We're happy people.  Better parents.  Better spouses.  Better human beings.  

If we are not happy at work, we bring that back home as well.  It's impossible to make separations.

Our leaders in industry know this, and want us to be happy, motivated, engaged and psyched to be at work at their companies.  For all the right "human being" reasons.  And also to help them drive better company financial performance.  This makes a lot of common sense.

Yet the tools, systems, and even measurement processes fail them.  It's not that they don't try.  It's that the measurements are flawed.  For example-- would you check your bank accounts just once or twice a year?  Would you check the gas in your tank every 3 months?  Would you look to re-stock your refrigerator once a year?

This sounds absurd and comical.  Yet that's exactly what most of our leaders are doing when it comes to checking-in on their workforce.  Once per year, and in a perfect world, once per Quarter is as good as it gets.  We appreciate and applaud their efforts, but it's too little and too far in-between.

You can change this.  And many of you are already changing this.  Checking-in daily at WorkersCount is as simple as looking at your smartphone or laptop for 30 seconds.  Getting the word to your friends at your company and at other companies is as simple as making a comment using the built-in Facebook, LinkedIn or Twitter post inside the WorkersCount app.

Getting "critical mass" at more companies each week, WorkersCount is rapidly becoming the daily standard for workers at all levels to make their voices heard, and for leaders to listen and respond.

WorkersCount is now being used by hundreds of companies, including major healthcare organizations to help drive better workplaces, better business and medical outcomes and more engaged, happy people, customers, patients and workers.  

Corporate Amercia, medium-sized businesses and even small companies are using WorkersCount to compare their experiences with others in similar industries, roles and backgrounds.  This information is being used by company leaders, group supervisors and business owners to help them understand how to create great workplaces and get their companies from "good to great" places to work.

There's a war for talent happening these days, as we slowly climb out of tough economic times. The great people will migrate to the best companies and best working groups.  Smart companies want to listen.  Smart workers want to be heard, and drive better workplaces.  It all makes sense.

WorkersCount is the simple yet powerful way to provide daily and consistent feedback to ensure that this happens for all of us.

Please continue to tell your co-workers and everyone in your life about WorkersCount.  It helps everyone.

Remember to go to  and check-in every day.  It's free, secure and safe.  All data is anonymized.   It's a way for workers at all levels to provide daily feedback and help drive a better workplace.

That's it! 

Keep up the great work, and thanks for being a WorkersCount member.  You are helping all of us make history, and change lives.

 What do you think?

Spotlight Blog: Healthcare and the “healthcare profit chain” – what it is and why it’s important

Today’s blog entry is one in our “spotlight” series where we focus on a particular leading-edge thought leadership topic.   It's a bit longer than usual, and dives a bit more deeply into an important and current topic.

Healthcare delivery is in a state of dramatic change, driven by forces inside and outside of the industry.  “ObamaCare” or the “affordable Healthcare Act” is but one of the many new forces driving rapid and sweeping change. 

One thing is certain – the changes are inevitable and will result in winners and losers in the coming years.  What will define the winners?  One factor we can be confident about is “quality” and the many measures that define it, both from the patient satisfaction standpoint and from the new types of objective “outcomes” and “cost of service” measures.

This post discusses some of the concepts around quality, accountability and some of the areas that healthcare delivery organizations at all levels can take to measure and manage to this new quality imperative. 

If you’re in a business relating to healthcare this is familiar territory to you, although some of the new measures, metrics and dynamics may be new.  If you’re in another industry or another type of business, this post can be helpful to you as both a cautionary tale (quality and accountability will always win, and those that ignore it will pay dearly), and also as an inspirational or visionary touch-point- in that quality and the driving values around it will always win… 

Let’s dig-in.

Like any business or process, healthcare has it’s components of value and elements in the path to “deliver” these services to customers.  We call this the “Healthcare Profit Chain” or value chain.  

It’s not surprising that this involves the sequence of experiences and person-to-person interactions around the holistic or comprehensive experience patients have in receiving their care, treatment and follow-up.  What’s new and quite interesting is the “value-based-pricing” that the Affordable HealthCare Act has set up around reimbursements.  

The “bad apple” is only part of the problem

We see this in any other product or service-based business.  The quality of the apples leads us to examine the source and handling of the apples on their way to the grocery store… Equally so, the demeanor and response of the Produce Man at the grocery store (when confronted with “bad apples”) really defines whether or not we forgive him and the store for our bad experience (and whether it’s an opportunity to build loyalty and trust, or to spread the word and “punish” the brand for their poor process and bad outcomes).

For the first time the “patient experience” (and related to that, the caregiver experience) is a measurable and measured component of care ---and now payment.  This is what one industry expert calls a watershed moment for healthcare – a moment that demands huge cultural change.  Healthcare organizations can no longer measure themselves on outcomes alone. 

Today, the holistic patient experience matters as much as outcomes (to the healthcare organizations).  Perceptions matter more than ever.  Brand value and revenue now depend on it.   And now these perceptions have a direct and material impact on the money side of this business. 

But there is good news here:  much of this “healthcare profit chain” is well-understood (if not well-managed) and as a result it’s going to be much simpler to succeed in the new world than was perhaps once thought. 

In this new reality, managers at every level must manage all components of this profit or value chain in order to, as the Kaiser Permanente ad campaign says, “thrive.”  In your business or industry you might consider how this is parallel to your way of driving quality and accountability. 

Introducing the Healthcare Profit Chain

The flow above is loosely inspired by the work of the Service Profit Chain Institute, except that in this view of the value or profit chain, we exchange the role of “employee” with “caregiver” (reflecting healthcare). 

In a recent discussion with a “Chief Patient Experience Officer” at a leading healthcare organization, he asserted that

“…Everyone in the hospital is now officially in the “field” of nursing because everyone must be focused on the “experience” of those being cared-for...“ 

Given this, the most important component of “quality” of each and every patient interaction is the overall satisfaction relative to the caregiver.  This is a groundbreaking recognition and one that turns the traditional “respect” and “recognition” of nursing and caregiver on its head, from a “rank” and “influence” standpoint in the industry. 

We’re all “customers” and we’ve all been patients.

As patients ourselves we have long known this and been aware of it.  However if we’re honest with ourselves, we also know that nurses and other caregivers are also historically some of the most underpaid, under-recognized and overworked professionals we know. This has unfortunately been a driving force behind the perceived necessity of nurses and caregivers to seek unionization and collective bargaining protection. 

Collective bargaining as the symptom, not the solution

Bank Tellers, Fast Food workers and even theme park works have experienced this reality.  Obviously whenever a group of workers is forced to consider or implement unionization it’s a clear sign of a catastrophic break between perceived value of their work and its impact on quality and profitability of the organization.  In healthcare it’s a bit more frightening.  Do you want the caregiver of your premature infant to be brooding over an unfair shift change and a freeze on overtime?  Would you be happy about your surgical nurse worrying about longer hours and shortened lunch breaks during your procedure? 

This upside-down paradox is finally in the open, as a new financial (reimbursement) connection is made at just this point of “interaction and satisfaction.”  As patients (“customers”) we should celebrate it.

Translating to the workers and the workplace

So how does this largely academic diagram relate to the way we manage our organizations?  In healthcare it’s not particularly complicated.  However it’s just as clear that these basic management touch-points are being ignored or allowed to wither.  Consider these factors (and translate them to your industry if you’re outside of healthcare by substituting “caregiver” for “employee” and “patient” for “customer”):

-Caregiver workplace

-Caregiver job design

-Caregiver selection and development

-Caregiver rewards and recognition

-Caregiver tools for serving the patient 

We asked the workers

We recently asked users at WorkersCount whether they felt that they were getting the training and help needed to succeed. Only 21% said this was frequently the case; and 58% said it was only occasionally the case.

Great (healthcare) organizations assign a huge value to this point of training and help.  As an industry and as an individual organization, it’s important to ask:  “are we making it easier or more difficult for our front-line patient (customer) care teams to deliver great quality?” 

A break in the value chain results in a cascading break in the profit chain and introduces high risks

This leads to measurement (and now much more effective understanding) of the drivers of caregiver (worker) satisfaction and for that matter, caregiver retention.  Notwithstanding the obvious primary expense of experienced, skilled caregiver turnover, we now have direct correlation to patient satisfaction, team cohesion and outcomes.  This cascades into a huge set of risks for healthcare delivery organizations and now directly throws financial projections into question at all levels.

It’s also about brand risk and brand reputation

One aspect that is not lost on savvy healthcare marketers is the concept of quality of care, patient-to-caregiver interaction and satisfaction and loyalty or “preference” in a brand sense.  In this case it’s the brand of the hospital, healthcare organization or even a specific “rock-star” anchor in a practice.

Yet the components of person-to-person “quality” and loyalty are subtle and hard to pinpoint.  It may be the sum of 100 or 1000 special touches and empathy at each interaction.  A few words, or a lack of being rushed or harried.  A simple smile and a gentle act of reassurance.  Taken together, these drive patient retention and loyalty, CMS evaluations (ratings at hospitals that determine reimbursements) and of course brand value by way of referrals and reputation.  Connecting the dots, this means revenue growth and increased profitability in the new world order of satisfaction and quality-based reimbursements. 

Leaders no longer able to just talk the talk….New imperatives to walk the walk.

The tipping point has been reached.  What was once considered “nice to have” and “thought leadership” but still “soft benefit” and marketing-speak has now become hardcore financial stewardship and risk management. 

Top executives in these companies are not only espousing, but are now expected to put solid policies and “mission-vision” prescriptions into place to act on the age-old lesson from other service industries:  Your business results are directly determined by caregiver (worker) satisfaction, as this is the most direct and manageable factor relating to patient (customer) satisfaction and good outcomes.

How do you manage this so you can improve?

Clearly there is a lot already happening in the effort to improve hospital and healthcare delivery processes.  It’s a red-ocean in many ways.  Crowded with “experts” and fancy consultants (with pretty graphs like the one above) and lots of measurement and process.  Yet the most important piece of this puzzle seems to be lost in the furious effort to “control” the process.  The missing piece is a simple one, yet an elusive one for outsiders to “control” with rules and requirements—Caregiver satisfaction. 

It has been long said that you cannot “fake a smile.”  And what a difference it makes to every patient (and customer) interaction!  If we accept the equation that the sum of patient interactions determines patient satisfaction, there are two simple and easy-to-implement ways to get started. 

Real-Time VS Stale data.  Which would you rather use?

The first is to start to measure caregiver satisfaction regularly.  Just as the weatherman and economic advisors forecast “early and often” so must healthcare workers’ satisfaction be measured.  This is the front-end of the value-chain or profit-chain we saw at the beginning of this post.  

Big Fix Projects VS Continual Improvement philosophy

The second is to move from periodic measurement and “remediation” and drastic break-fix cycles to an approach of continual improvement, feedback and small, frequent adjustments.  If you are a sailor you know this well.  Small, frequent adjustments in the tiller and the sail will always be better than once-a-day measurement and wide swings in direction and remediation.  People work that way too. 


Annual, Quarterly or even Monthly surveys don’t cut it.  The data is stale and the working groups are scattered or re-arranged by the time the “remediation” or “analyses” get to the right place.  It’s not a bad idea to do deep self-evaluations periodically.  It’s just impractical to try to manage something as subtle and ever-shifting as caregiver and patient satisfaction that way.  And now it’s clear that it’s also financially reckless (if not derelict) to do so, as these measures form the foundation of multi-billion dollar financial projections and swings of millions of dollars in top-line reimbursement revenue at any given facility.  We need something that keeps satisfaction results in front of the managers all time, because transparency makes improvement happen.


Actionable data in a digestible format

Finally, we need a way to manage against quality discrepancies as they happen. Depending on paper surveys that are weeks or months old does not allow managers to find gaps and improve.

Caregiver satisfaction and patient quality of care is not an exercise in history.  It’s real-time.  As real-time as and EKG.  History is nice, but in an “event” it’s irrelevant.  Real time is what matters to the patient.

We need to be able see daily how well are doing and find gaps in performance and then be able drill into where the quality of patient experience is succeeding or failing.

Correlating the two sets of data with ease

At same time, we need to have what we call “temporal concurrence” between patient and caregiver data so leaders can cross-reference between patient and caregiver data. This is the best way to reveal the root causes and gaps that are doing damage in near real-time.  And by the same token, reveal the bright spots in the value chain where everything is working brilliantly (and presumably what we want to replicate). 

WorkersCount is leading the industry in this practice of correlating these two sets of fresh data for the benefit of organizations (including healthcare), workers (including healthcare caregivers of all types) and the patients (customers) they serve.


To learn more about how to do this in your organization, write to us at and start following us at @workerscount on twitter

Which comes first, customers or employees?

Recently we encountered an article with the very same idea in Inc. Magazine, written by Steve Tobak. What fascinated us was the question as to whether there was a clear relationship between customer and employee engagement.  Did companies that we think of as providing great customer service necessarily treat their employees (or in the case of healthcare—caregivers) better?  Is there clear evidence that employee engagement the secret sauce for great customer engagement and satisfaction?

To explore this a bit more, we asked a series of experts what they thought about the topic.  But before doing so, we wanted to take a quick poll to find out how many people in the WorkersCount community actually felt empowered in their jobs to deliver extraordinary customer service.  One of our co-founders tells an amazing (and true) story about this engagement and empowerment and a major credit-reporting bureau. So we asked our daily users at WorkersCount what they thought about their experience.  Interestingly only 58% felt regularly so empowered.   

Like most of you, we would love to get a list of the organizations which provide this secret sauce (or not) to their employees.  As WorkersCount community members already know, we can’t disclose the exact responses.  But we’ll report them in aggregate in the “Grass is Greener” section of the app.

Armed with these aggregated survey results, we reached out to the experts. We were surprised by what we heard.

The Customer Comes Second

Our first expert referred us to a book by Hal Rosenbluth. The book’s title says it all. “The Customer Comes Second.”  It’s this sort of “hard-boiled” reality about how brands have to behave that gives us pause.  Pragmatic voices in this area point out that customers can’t get world-class service and products when the very people that provide front-line service and care are in agony.  Makes sense, but it’s eye-opening that big brands are also aware of the need to bump the priorities of end-users in favor of focusing on worker priorities.  This gives us pause, yet also hope.

Companies shouldn't have to choose

Our second expert disagreed with the first by saying companies don't have to choose between putting employees or customers first.  

“But if you don't have highly engaged employees, you won't have customer engagement or loyalty. So I would argue that if the company doesn't put employees first, the employees won't put the customer first”.

We loved this comment from this expert. How many organizations really have this perspective?  He concluded with:

“so many still don't get it, that employee engagement is not about making your employees happy by giving them expensive perks but more about treating them like adults and evolving them in decisions that affect them”. 

Well-said and words to live-by for both companies and families, as all of us with children already know.

Employees come first in sequence, not importance

Our next expert said that he agreed 100%. Both are important, and they are, but employees come first because they then deliver the desired customer experience. That's when differentiation starts to happen.   So employees are the first place to focus effort because the customer is “down-stream” and thus second mainly in sequence and impact, not in priority.  This starts to make sense.

Getting Culture Right Makes everything else fall in place

Our next expert, however, didn’t flinch in his position that it starts with workers.  Citing how great customer-focused brands includiing Starbucks, Zappos, Southwest Airlines, USAA, Amazon have a set of values that put both on equal footing.  That said, it’s the workers at these great companies that have the role and primary mission of delivering this service.  So that’s the first place to focus a company’s training, resources and overall attention.   It’s “first” in sequence, not pure importantce per-se.

So while workers come out “first” in this in terms of sequence, it’s not suggesting winner and a loser and in fact the evidence shows that they both “win.”  As Tony Hsieh said

"If you get the culture right, most of the other stuff, including building a great brand, will fall into place on its own."

Employee Engagement is not the same thing as Employee Happiness

Our next expert agreed by saying great employees are a prerequisite to great customer service/loyalty. The big difference in perspective however is that employee engagement is not the same thing as employee happiness. “Meaning” is the key component of employee engagement.

A question every employer should ask themselves about “Meaning”

“Do you know why your employees are doing what they do for a living?”  Too many companies never bother to connect with the “motivations” of their front-line workers.  Thus they never really know where to focus their engagement efforts.  It’s hard work to get to this truth.  And the truth can sometimes be scary to employers.  It’s easier to create catchy slogans about “customers come first” than it is to take the time to figure out what motivates, excites and really drives the very workers charged with delivering this great service.  Sounds odd, doesn’t it.  But it’s the reality at most companies.  Marketing slogans don’t drive worker engagement efforts.  They are too often in different silos.

Coming back to our question -- companies don't have to choose between putting employees or customers first. " Our experts agree that If you lose one, you 'll lose both.  What’s often lost is the “meaning” part of the discussion.  Workers must be addressed and engaged as individuals that “want” to provide great service and have pride about their contribution to a great brand.  Within that, it’s important to connect with the “why” of worker engagement—why are they working for your brand?  What is driving them to do their particular role/job?  For those that directly (personally) impact the customer experience, what emotional drivers are at work? 

When brands connect with these emotional drivers, and marry worker engagement efforts with accountability and ownership of customer satisfaction metrics, they win.


The question of who comes “first” is an interesting debate with many nuances, our experts agree as a group that it can’t be “either-or.”  Great organizations- from industrial equipment makers, to retail organizations to healthcare delivery giants – all have one thing in common in this global marketplace—the most powerful and effective way to create durable competitive advantage is to deliver world-class customer care.  And the obvious (but often lost) correlative to that is the “who” of this service delivery is their great employee base.  Giving lip-service to “customers come first” is a great branding and “internal company meme” but it misses the mark if its not accompanied by real and meaningful attention to worker engagement and the “meaning” of their jobs, roles, and personal experience vis-à-vis “their” customers.

And of course we conclude with the coda of “WorkersCount.”  A brand can’t deliver world-class customer service without a group of highly motivated, empowered and “happy” workers.  Customer loyalty comes from interactions with actual workers.  And because this means real human beings connecting with others, we can’t ignore the impact of happy people on others.   We’re all customers.  Which kind of worker would you rather encounter?

That’s what we thought.

Searching for meaning in one’s work: the truth about employee engagement

The existential crisis of this millennium is around work.  Does it have meaning, value or purpose?  Why do we do what we do, and what contribution or difference will it all make when we’re gone?

Heavy stuff.    Especially as we reflect on the year as it comes to a close this Winter.  What does “belonging” have to do with “meaning” and connectedness?  And how does that relate to worker engagement?

Carolyn Jolly says, “Employee motivation isn’t really a mystery, but many managers seem to be mystified about it. Employees perform best when they are appreciated, comfortable and feel like they belong.” So we asked our users at WorkersCount whether they feel that they “belong” in their organization.  We found that only 54% feel that “magic” regularly.  And 16% even say it is a rare phenomenon.  

Given this, we are left with lots of questions. In particular, how should leaders and managers drive a greater sense of belonging and thereby improve engagement within their organizations?   So we kept asking. This time we asked a few experts, and they shared some interesting insights…

Belonging drives engagement; Small things count. 

One expert said “I would agree that workers need to feel they belong in order to be fully engaged. How do any of us feel when we know we belong?  We feel valued just for being who we are.  Managers can do many small things like smiling when someone comes into the room, saying Good Morning and Good Night, asking staff what they need from them as their boss to get their tasks done that day or being sure to spend time with employees when things are also going well instead of only when there is a problem!” 

Belonging makes us part of something bigger

“In very simplistic terms, whenever an employee has a sense of belonging to a team or work group and feel that their work provides value or has meaning I believe that engagement is possible. Part of the human condition wants to be part of something bigger than the individual.” 

Managers need to articulate value to employees

Pulling from research from Harvard Business School, another expert said this “shows clearly that possessing a sense of meaning in one's work is key to engagement. The best course of action for managers is to look for opportunities to articulate the value of their employees' work to their employees. While the meaning and values of some jobs is obvious, e.g. ER nurse, this is not the case with most jobs.  Managers should not assume employees fully understand the value and impact of their jobs. To remedy this, managers can regularly reinforce how valuable their employees are to any number of entities: the team, the organization, the customer, the community.  It doesn't matter, as long as employees understand their work matters and that message is consistently communicated.”

 Issue facing organizations is not apathy but rather futility

Another expert weighed-in on the Existential Crisis this way: “the terms "meaning", "belonging", "connectivity", etc. are focusing on attitudes, habits of thought, are they not? What is the role of accountability in engagement?  That it seems to me is a foundational component.  In his book "Team Covenant" Randy Hopkins makes the interesting point that apathy, as some writers may suggest, is not the core issue in engagement. Apathy suggests people don't care. People generally do care. The issue facing organizations is not apathy but rather futility. Futility occurs when people are not kept informed, they are not allowed to think and make decisions on their own about what they are doing, their creative problem solving is discouraged, and they have no voice. Employees who are told to be compliant rather than accountable see their role as futile and futility stands as a barrier to engagement.

Research looking into how we stay connected

Our final expert added on by saying “there is a growing interest and research into "how we stay connected" (I.e. belong) it concerns understanding how and the quality of the "relationships" that individuals form and maintain in the workplace. There are several studies that looked at hospitals and nurses in particular! My own research shows that "secure" relationships have significantly higher levels of engagement than those that are "insecure”. It's called Attachment Theory and is highly predictable in determining the strategies people use to stay connected (belong) at work and then, based on those strategies, you can determine their level of engagement. “


In these five different perspectives we see the heart of the problem is “belonging” in the context of many small, but very important things that any manager can start to do overnight.  And in that sense it is encouraging and exciting.  Engagement simply means recognition, empowerment and meaning.  If this is really the case, there is hope, and lots of it, for our millennial workers and our society at large.

And with 46% of those responding at WorkersCount not feeling the magic, it is a place for enlightened managers to start.   Low-hanging fruit for those who can open their eyes and see it.

What do you think?

When less of a good thing is better


The use case for more frequent measurement of employee sentiment

Most medium and large organizations do some form of employee survey on a yearly basis. Some even up the ante by doing a few spot surveys throughout the year. But for some organizations, their whole world can change over 3 or 4 months.  Customer service is one of these sensitive areas.  Healthcare is another.  Large organizations with shift-work and high turnover costs are common hot spots.  The immediacy of the relationship between workers and the bottom-line (quality, costs, outcomes, customer loyalty, operating risk) is well-accepted.  And there are many other examples where this close relationship is both obvious and well-understood by executives. 

Yet we see again and again how these same organizations and great leaders continue to “measure” these drivers of enterprise health and risk using outdated and “stale-dated” data and methods.  Why is this?  And what connections can we make for these otherwise-great leaders and organizations to encourage and enable them to measure these key drivers of organizational health more frequently?

Everybody loves taking tests, surveys and trips to the dentist

For decades the gold standard in employee measurement has been the dreaded survey.  Whether administered by management, consultants or unions, these have traditionally been “bad medicine” – yet the only option most business leaders feel they have.  Billions of dollars are spent each year trying to upgrade, re-brand, or sugar coat these customs.  Making them shorter, coming up with catchy names “360” or putting them online, are among the “upgrades.”  As good as it gets, it’s too often a perfunctory “check-box” that top executives have to live with .  They must go through the process, yet they admit freely that the results are “stale dated” and “DOA” most of the time, even after spending millions on “employee engagement” professional services experts that sift, sort, interpret and “implement” the results. 

Blow-up the old process and join the digital age, along with your millennial workers

A root canal is still a root canal

One thing is clear about today’s workers:  more and more they are calling-out their employers and flatly refusing to take and re-take the tired old employee surveys.  Today’s worker and customer survey industry is in turmoil, as today’s workers and customers “just say no.”  The industry is flopping around with “incentives” and gamification and even paying survey-takers.  The truth is that in its current format, it’s still a one-way transaction and often a sink-hole for one’s time as well.  Busy workers can’t be bothered. 

Back to trust, and lipstick on a pig

According to Stephen Covey, distrust of management doubles the cost of doing business and triples the time it takes to get things done.

Trust is a huge driver here.  The industry’s big improvement was “automation.”  This meant that the surveys now came in online form, with complex authentication, and a whole stream of “reminders” for tardy response.  Same long, drawn-out survey.  The technical term for this is “lipstick on a pig.”  It’s still a pig.   This “automation” of the survey backfired, and the “reminders” to complete the surveys call anonymity into question.  The ridiculously late and mostly irrelevant “results and insights” that come back 6 or 8 months later (or sometimes not at all) make a farce out of the whole exercise, as line workers often see their mid-level supervisors scrambling to “create a plan” based on completely irrelevant and outdated data… and wasting valuable time in the process.

The crisis has reached a point at which the industry leaders are forced to admit that it’s almost like the old communist lament:  “we pretend to work, and they pretend to pay us.”  In this case, the workers pretend to report honestly on their surveys and the executives pretend to accept the results and the related “process and plans to improve” as effective and accurate.  In fact all parties know that this is flawed. 

To be fair, nobody wants it to remain this way.  And there are many great leaders at great companies trying to fix the process.  In fact, innovation is happening around the issue, but it’s uneven and it disrupts the overall system, so it’s slow going.

“Survey 2.0”  - One new approach:  frequency, simplicity, real-time insight, and mobility

It's no longer a survey  It's a real-time management tool.  It augments the pre-existing survey.  What if traditional surveys wouldn’t go away, but instead would be updated…. Daily.  And cut down to one question.  Quite a challenge, yet there is a model for this.   Today, in 2012, billions of people check-in (in a way) each day using some social network, or check their email… and most people are now doing this via their mobile device (phone or tablet) on the go.  We take this for granted, and it’s almost “native” behavior.  Just look at the number of people on the street walking - but staring at a tiny screen.

Why not take this simple, known behavior and create a daily check-in and simple worker sentiment service that works on a phone, laptop or tablet… from anywhere.  That’s what WorkersCount is all about.

If you take the concept of worker surveys (“sentiment” measurement), strip-out the annoying “survey” format and reduce the number of questions to 1…. And use a radio button and a fun mobile app (with rewards and total anonymity)… it’s possible to augment the dreaded annual survey with a simple daily check-in.  And voila! You have a daily pulse of the workforce.  Add-in simple worker-facing insights and comparisons and it’s no longer a one-way street.  All parties get value, insight and transparency.

Who wins?

Workers win, because everyone sees the external trends and can help drive accountability for the companies.  Workers can instantly compare their company to another, and drill all the way down to a job or role.

Companies win when they use the Enterprise service, which is a “private” instance of the WorkersCount service.  In this situation, workers participate in a “private” check-in service (same level of anonymity) and the company can work out it’s most serious issues (and find its most wonderful internal successes) in private.  The powerful adjunct is that the company can also compare some of its private results to selected public results and benchmarks established anonymously via the overall service.

What might this look like?

As readers of this blog already know, the service is in public release today.  Workers from over 450 companies are checking-in daily to report their sentiment, and answer a single “question of the day” on their mobile device or laptop.

So go to today and experiment with the service.  Think about what this might look like in your organization.  And think about the valuable (and fun) insights you and your colleagues will have as you compare your experience to benchmark information and other companies as well.

Whether you’re a business leader or a new employee, knowledge is power.  The best thing you can do for yourself or for your employees is create trust, authenticity and transparency.

And it’s much more like enjoying a hot fudge sundae than taking a survey.

We promise.    With a cherry on top.