The Mission of Making Life Better for Children Drives Engagement at Children's Health

Children's Health, based in Dallas, is one of the largest and most prestigious pediatric health systems in the country, and it started thanks to Nurse May Smith's perseverance and dedication to a mission to make life better for children.

What started as four tents on the lawn of Dallas' old Parkland Hospital in 1913 has grown to become the leading pediatric hospital in North Texas, treating more than 860,000 patients annually. In addition to providing life-saving treatments, Children's Health provides groundbreaking research at the world-renowned Children's Medical Center Research Institute at UT Southwestern, where it researches pediatric issues such as regenerative medicine, cancer biology and metabolism.

"Our mission to make life better for children is our common denominator," says Ira Kirkley, a Senior Vice President of HR, Talent, and Workforce Planning. "It cuts across everyone."

Mission, engagement and culture

By "everyone," Kirkley means practically everyone. Gallup surveys, which began in 2019, show that a sense of mission is nearly universal at Children's Health.

That's substantially higher than average. Gallup's database of millions of employees shows that just one in three strongly agree that their company's mission or purpose makes them feel their job is important.

The belief that "the mission or purpose of my company makes me feel my job is important" is one of the 12 elemental needs of engagement -- according to Gallup's 12-question engagement survey, the Q¹² -- and managers can encourage this belief with ongoing coaching conversations. Those conversations are the foundation of engagement. And managers trained to coach create a much better employee experience.

Children's Health saw real value in that experience. "There was a lot of engagement around creating engagement," says David Campbell, Vice President and Chief Learning Officer. "The research and the data really spoke to our employee base. Our leaders knew that if we do this, if we share our results with our teams, and if we action plan around those results, we will see improvement and a better work environment for everyone."

In hospitals, an engaging work environment isn't just a better way to work -- it can have a profound effect on patients: Hospitals with a high percentage of engaged nurses pay $1.1 million less in malpractice claims every year than those with less engaged nurses. Bloodstream infections are 18% lower for patients in more engaged work units. One Gallup client that moved from the bottom quartile of Gallup's healthcare employee engagement database to the top decile reduced patient complications by 20% and acuity-adjusted mortality by 16%.

Clearly, healthcare organizations have plenty of reasons to bolster their mission and engagement, but mission and engagement can also affect culture. Culture is a guiding light that affects employee behavior in big and small ways, and Children's Health had particular reason to value that. "We're really trying to influence the infrastructure of pediatric healthcare throughout North Texas," says Campbell. "Everything from pediatric behavioral health to the academic experience of physicians who care for our patients. We want to figure out how to create a common culture that will serve children in North Texas."

The realities of hospital work

That common culture, as Campbell puts it, would give Children's Health impact on patients all over the region. So even before Gallup finished analyzing engagement at the organization, several leaders took the Engagement Champions Course, which promotes and facilitates the creation of highly engaging and productive teams by encouraging and supporting leaders, managers and teams.

Leaders found the learning a natural fit for Children's Health because the elements of engagement -- things like recognition, genuine care and mission -- align with their core values. "This was not some completely different framework," says Kathleen Monks Kyle, Program Director of Talent and Engagement. "This is part of our mission, in keeping with our philosophy of local solutions for local problems."

So even before they knew the level of engagement at Children's Health, leaders had a solid understanding of engagement philosophy, its relationship to employee experience and mission, and how they all work together to affect outcomes.

But enculturating engagement had to fit the realities of hospital work. Children's Health decided leaders and managers would do best with a mix of accountability, support -- and a lot of flexibility. "Part of the messaging [of employee engagement] is this isn't another thing on your full plates; it's a different way to do what you're already doing," Kirkley says.

Shortly after leaders completed the Engagement Champions Course, Gallup presented the engagement analysis for Children's Health. The engagement numbers were high overall, but inconsistent between teams. That's not unusual. And organizations can achieve uniform performance by focused, purposeful and frequent conversations between leaders, managers and employees.

Their biggest problem -- which is the same problem remote and shift managers have -- is that too many Children's Health managers had too little one-on-one time with their employees. And when they are together, they're often hyper-focused on the work, not the employee experience.

So, the organization's challenge was helping leaders and managers influence employees' feelings and decisions -- the kind that create culture -- in schedules that don't always align, during a pandemic, for patients who, as Kyle says, "have some of the greatest healthcare needs."

Weaving engagement into the day-to-day

The solution for Children's Health was to weave engagement, conversation and activity together in innovative ways. Managers, for instance, learned to incorporate engagement conversations with regular rounding, or by keeping a Q¹² question on virtual meeting agendas, or by dedicating a white board to engagement messages in common spaces. Interactive resources and leader guides came by email (with an 80% click rate, Kirkley says) full of best practices for developing new mindsets and skillsets on a variety of topics, like trust and diversity and inclusion. Children's Health even created a downloadable playlist about engagement.

"We did a number of things to help leaders take local action and cascade it through their teams," Campbell says. "And we put all the tools and resources in one place so they could easily access the engagement-everyday resources that are most relevant to them."

It was a bit of a departure from the norm, but weaving engagement into activity allowed managers to deprioritize documentation and focus on merging the patient experience with culture and engagement. "We want managers' attention there, not diligently creating structure, not rigidly action planning," Kirkley says. "Put your effort into local relationships and the needs of your team members. This is not a compliance activity. This is really about making life better for children."

Nonetheless, Children's Health is a science-driven organization -- great hospitals usually are -- and data matter. So, in 2020, Children's Health implemented an accountability index: a set of survey questions that measure how effectively each team makes and achieves plans for improving engagement. Analysis showed the teams with the highest accountability index scores had the best performance outcomes, such as improved productivity and patient safety and lower absenteeism and turnover.

The second engagement survey -- which employees completed at the peak of the pandemic -- included new questions about nursing, team inclusivity and patient experience. The survey also assessed employees' experiences with on-site, off-site and hybrid workstyles. And most importantly, leaders received even more educational tools and resources, such as discussion guides for important and difficult conversations with their teams.

When the survey results were complete, Children's Health found that engagement was rising along with net promoter (NPS) and other patient experience scores. "It really showed the impact of simple things, like active listening," Kirkley says. "We are seeing it as a meaningful action in a way we didn't before. Surfacing voices is a really powerful thing."

Indeed, surfacing voices, improving the employee experience and facilitating individual strengths was elevating engagement across the board. In fact, the results of its third engagement survey qualified Children's Health to apply for the Gallup Exceptional Workplace Award. Prior winners include the most successful organizations in the world -- the criteria are that extreme -- with extraordinary employee brands. And Children's Health met or exceeded all the criteria.

That achievement articulates a cultural attribute Children's Health has had since it was treating babies in tents: People work there because they feel invested in it, because the mission is meaningful and because they can grow their careers the way they want. "It comes back to human-centric design, not just patient- or employee-centric, but human-centric," Kirkley says. "It manifests differently in different experiences, but fundamentally people are people. And we have to care for them in certain ways."

The award isn't a capstone at Children's Health -- it's a launch pad. Even before its fourth iteration of Q¹² employee engagement results were in, the health system introduced a holistic wellbeing program, a more robust diversity and inclusion framework, richer remote-work resources, and other employee experience endeavors.

"Those employee experiences drive a lot of KPIs," Kyle says. "The interactions employees have with each other -- and more potently, their manager -- affect their performance and opinion of their employer."

It's only through continuous innovation and collaboration with Children's Health team members focused on improving engagement that the organization can continue to fulfill its mission to make life better for children.