Overlake Hospital Using a Web-Based Software Tool to Measure Workplace Climate Overlake Hospital Medical Center is a 337-bed, not-for-profit regional institution offering a full range of advanced medical services to the Puget Sound region. To local residents, Overlake is more than a hospital: it is the only Level III Trauma Center in eastern Puget Sound and it stands at the forefront of cardiovascular care and treatment. It has been ranked as a top 100 heart program in the country, a top performer in the state of Washington, and has received many regional and national awards. The task of maintaining current care quality and reaching to still higher levels is a challenge to Overlake's 700 doctors, and 2,300 full and part-time employees Healthcare is a talent-intensive industry, and medical institutions around the United States face a highly competitive labor market in which the demand for many skilled positions-nurses and medical technicians, in particular-outstrips supply. Consequently, retention and recruiting at Overlake and other institutions across the country is a matter of strategic importance. No one at Overlake understood this better than Lisa Brock, who joined the hospital in 2002 as Vice President of Human Resources. As the new head of HR, she needed up-to-date information on the hospital's workplace climate, as perceived by employees and managers. An accurate assessment would serve as both a base line and as a jumping off point for future improvements. Unfortunately, the hospital had not conducted an employee survey for five year prior to Brock's arrival. Thus, the data she had was not timely. "I needed a current assessment of morale and how people felt about different aspect of our working environment," she recalled later. That assessment would be essential in pinpointing specific areas of strength and weakness, and guide improvement initiatives from her office. "How are we doing? What are our issues? What do we have to work on? Those were questions I hoped to answer." But the HR department had no systematic way of measuring employee attitudes. Overlake's CEO at the time, Ken Graham, suggested a solution. Graham was acquainted with InfoTool, a Web-based organizational assessment methodology developed by Stan Labovitz. InfoTool's workplace climate survey appealed to Graham's new VP of Human Resources for a number of reasons:
Finally, InfoTool was easy to use. As Brock observed later, "One of its strengths over other tools is its technology, which is extremely user-friendly with wonderful, easy-to-use graphics. And once you have the data, you can cut it any way you want without additional charges. Comparable tools add a charge every time you re-cut the data." Administering the Survey Overlake's first experience with InfoTool took place in April 2004,
when a work climate survey was offered to all employees on a voluntary
basis. That survey contained over seventy statements designed to assess
how people feel about their working environment. Exhibit 1 shows a portion
of those questions and scoring choices offered to respondents, who anonymously
indicated their agreement with those statements on a 1-to-10 scale.
They did this either online (at home or at work) or via a paper form.
Professional atmosphere. Caring co-workers. Quality care for patients. Senior management has responded to my concerns with positive results. I find my job challenging and fun. My manager is a good person to work with. My co-workers. Proximity to home. Pay. The hours I work. Benefits package. The people I work with.
Analyzing the Data Thanks to its graphic analysis, InfoTool made it possible for Lisa
Brock and hospital managers to quickly see how employees rated the work
climate at that point in time. Exhibit 2 contains one of the graphic
displays produced by the InfoTool software engine; it reflects the combined
views of 1,778 employee respondents to the 2005 survey. In terms of
"overall climate" they gave the hospital a score of 65, as
shown in the center circle. That's a mediocre grade in the InfoTool
system, where green represents good performance, yellow represents average
performance, and red represents sub-standard. Each of the drivers of
employee satisfaction-culture, employee development, leadership, and
so forth-is also scored by number and by color. InfoTool even drills
down to the contributing components of those drivers. For example, the
components of "Employee Development" at Overlake are training,
recognition, and rewards. Each of those is scored based on survey responses.
A quick look at this graph reveals that performance was overwhelmingly
average, with only one of the contributing components-commitment-receiving
a high mark.
Clearly, this level of mediocrity was not acceptable to Overlake management, nor did it reflect the organizational performance goals of Lisa Brock and her team. Improvements had to be made. But where? Aggregated data like that shown in Exhibit 2 generally conceal substantial variation. In a complex organization such as Overlake, which has many departments, many employee groups (nurses, clerical, executives, etc.), and many levels, it was likely that some stakeholders were highly satisfied with their work climate, while others were not. InfoTool allowed managers to drill down and take the temperature of smaller and smaller segments of the employee population: by job group (e.g., nurses), position level, shift, department, length of service, full-time and part-time. By viewing the responses of theses different demographic groups, management was able to pinpoint areas where intervention was most needed. For example, the Overlake executive group judged its work climate to be highly satisfactory. To the 12 members of that group, almost every driver and component of overall climate received a green rating! These executives scored their overall climate at 81-27 percent higher than the employee population as a whole. The ability to quickly segment responses on line proved immensely useful
in analyzing the Nursing Division, whose 966 employees worked in over
two dozen operating units, including breast health, cardiac care, intensive
care, radiation oncology, and senior care to name just a few. In the
wake of the 2005 InfoTool survey, the manager of nursing division discovered
huge variability between departments. The seven employees in the Senior
Care unit, for example, were almost overwhelmingly favorable to their
work climate, whereas, members of the 89-person Intensive Care (IC)
unit gave their work climate very low scores (Exhibit 3). Something
was clearly amiss in Intensive Care. Before remedial steps could be
taken, however, managers had to understand the reason for its low scores. Exhibit 3 
From Analysis to Action Why was the IC unit's work climate viewed so negatively by employees? InfoTool provided a number of mechanisms for drilling down to the details of what was bothering employees in that important activity. Exhibit 4 displays the ten most important Strength/Weaknesses screen for the IC unit in the 2005 survey. Notice in the "weaknesses" section the low scores (red) accorded to Trust/Fairness, Management Involvement, and Confidence in Management. By viewing employee responses to statements about these areas, hospital managers were able to get closer to the sources of employee discontent. Notice, for instance, the extremely low agreement (26 out of 100) given to the statement, "I have confidence in the fairness of management."
Once they understood their problems and, thanks to InfoTool's segmenting capabilities, exactly where those problems were located, Overlake developed initiatives to overcome them. HR department "facilitators" met with division and department leaders to discuss survey results and develop improvement action plans. The hospital also developed a policy mandating that all leaders and managers whose units rated below average on the workplace climate survey would be required to include workplace climate improvement among their personal goals for the coming year. Those goals, in turn, were aligned with the organization's rewards system. In addition, a number of Overlake managers participated in Web-based conferences with InfoTool CEO Stan Labovitz; those sessions helped them use survey results to diagnosis problems and develop plans to overcome them. The HR department also began a four-pronged initiative to increase employee satisfaction in all departments. That initiative stressed employee appreciation, more effective training, and made sure that people had the equipment and supplies they needed to do the jobs they were trained to do. It also asked people directly, "What do we have to do to get a '10' on each survey response. Between 2005 and 2007, those actions produced measurable improvement in how employees viewed their work climate. Exhibit 6 combines 2005 and 2007 "overall climate" scores for the problematic Intensive Care unit at Overlake, as assessed by unit employees. As the exhibit indicates, this unit still has a long way to go before it hits the green area, but progress is significant. Alerted to problems by the 2005 survey, management intervened, and its actions clearly made a difference. In this InfoTool screen shot, 2005 results are shown in blue and 2007 results in black. The six dimensions measured are: 1. Overall satisfaction The dots on each of those dimensions represent the mean scores given by unit personnel in each of those two surveys. As shown, substantial improvement was made along each dimension, leadership in particular, which improved by 44 percent! Other units and employee groups demonstrated similar improvements over the two-year period, demonstrating an important truth of organizational life: if managers can pinpoint problems, they can usually identify their causes and develop effective remedies. The result is organizational improvement and higher performance. Exhibit 6 
Lasting success in climate improvement and other initiatives, according
to Brock, depends on alignment between organizational goals and rewards.
As a "balanced scorecard" organization, Overlake ties its
managers' evaluations to how well their units perform relative to the
four scorecard metrics: customer satisfaction, employee satisfaction,
financial results, and internal processes. The annual InfoTool climate
survey has helped the organization measure performance in one of those
metrics: employee satisfaction. Says Brock, "Measurement and tying
rewards to progress toward goals is how you get the attention of managers
and convince them that this isn't just a fad or just another thing they
need to pay attention to. It's a way of impressing them with the importance
of these things to the organization."
Exhibit 7 
Overlake Hospital Medical Center has come a long way since its initial "baseline" work climate survey. Its leadership group now understands both the big picture and where each division and department stands on the work climate issue. And thanks to four annual surveys, it can see the general trajectory of change and where progress is and is not being made. Individual managers can also see how well their units are doing and, thanks to InfoTool data, identify issues where their attention is most needed. According the Lisa Brock, the hospital will continue to measure and monitor the workplace climate to better understand employee satisfaction. However, since retention is now the overriding concern of the people of the business, future surveys will focus more directly on that important issue.
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