THE LEADERSHIP OF ENGAGEMENT: WHAT DOES IT TAKE?

Increasingly, the evidence is mounting that to achieve high levels of patient satisfaction, you need to ensure that your patients are engaged in their care. It's also emerging that to achieve high levels of staff satisfaction, the same engagement is necessary. And the linkages between high-quality care, lower costs, and a great patient experience are now intertwined with staff satisfaction and "job joy."1 For those of us who have led care delivery systems, this seems obvious-you need highly engaged and caring clinicians to deliver world-class care so that patients have a positive, trusting experience and achieve the best possible clinical outcomes. But what is engagement anyway? And how does a leader go about creating a climate of engagement for both patients and staff?

When we work to define engagement, the dictionary provides us with some insights. Engagement is "...being involved in an activity, occupied, busy" or "greatly interested" and "committed." In the vernacular, "being in gear."2 We all know what it feels like to be truly engaged in a process or organization. It involves being "all in" intellectually, spiritually, and emotionally. It's not easy to achieve. And it's even more difficult to ensure that engagement is consistent and dependable.

WHAT IS A LEADER TO DO?

Engagement-whether of patients or staff-has some common themes. It involves helping people be their best selves and helping them own their journey, whether it's an employment journey toward purpose and meaning or a patient's journey toward health and wellness. Being engaged or activated or motivated or empowered means exercising a choice to be the owner of your path forward. It means bringing your best self to the table every day.

For most patients, the concept of engagement is new and requires a radically different approach to their health and health care. Health care is the only area in which people voluntarily hand over choices and decisions to outsiders, usually without becoming educated and informed about those choices and where they might lead. Think about it-in life we have many choices. Buying a car, for example, or choosing a home to live in, or finding schools for our children, or even selecting a grocery store to shop in. These decisions often require doing research, examining options, and considering the pros and cons of one path over another. Yet, in health care delivery, we still see a patriarchal structure where a person enters the system, is stripped of control, and discouraged from asking questions and exploring options. As clinicians, we say it's because we're "too busy," but really it's because we have been educated and socialized to consider ourselves the experts with the knowledge and training to tell patients what is best for them.

For the vast majority of patients, this lack of control remains the reality. But, gradually, the voice of the patient is emerging and individuals are beginning to demand change. In this issue, Pat Mastors' heartfelt account of her family's care experiences brilliantly illustrates the changes that must be made in our practices and our systems. Organizations such as Patients' View Institute3 and other patient advocacy groups are using the powerful strategy of storytelling as a catalyst for changing the system.

Bodenheimer and Sinsky4 link the goals of the Triple Aim (lower cost, high quality, and excellent patient experience) to employee engagement and employee job joy. Several articles in this issue address these strategies to improve employee engagement. Read how the team at Anne Arundel Medical Center takes a wider view of employee engagement to include a sense of purpose, as well as social, financial, health, and community aspects. In this model, the workplace becomes a powerful influence in improving well-being as part of a programmatic approach to deliberately shape employee engagement. The team at Texas Health Resources shares how its determined focus on vision and mission has resulted in sustained positive employee engagement scores over several years. Leaders share insights about what it takes to make and maintain these improvements.

A LEADERSHIP CALL TO ACTION

John Quincy Adams said, "If your actions inspire others to dream more, learn more, do more and become more, you are a leader."5

To effectively engage patients and employees, leaders must do more to change the system. We must conjure new ways to deliver care that not only inspire employees but also truly revolve around patient needs. Nurse executives must step up to fill leadership gaps. Wholesale changes are necessary if there are to be lasting differences in care experiences both for employees and the patients we care for. For example, we must begin to treat the space where people receive care as theirs, not ours. We must address interruptions in care, lack of intentionality, lack of compassion, and failure to heed patient questions as critical areas for change. To move forward, patient voices must be heard. As leaders, we must consistently integrate patient-centric and patient-focused approaches into our strategic plans, our budgets, and our care processes. We must create space and time to listen, to exchange information about care choices, and to allow the patient and family in. Similarly, we must create an environment for employees where they can bring their whole person to the work. Caregivers cannot adequately care for others if they are not fulfilled and whole themselves, spiritually, emotionally, physically, and financially. The compassion we show to our patients must extend to the workplace as well. This means that leaders need to actively address workplace hostility, bullying, incivility, and lack of respect where it exists. It's hard work that requires deep-seated changes in engrained structures and processes.

Leadership is not for the faint of heart. It involves risk taking, creativity, and courage. It requires tolerance for some failures along the way. But the need to change our system is paramount, and nurse leaders are uniquely positioned to step into the space.

A good place to start is this special issue of Nursing Administration Quarterly, focused on best practices, strategies, and tactics that elevate employee, patient, and family engagement. Take a look at the leadership competencies and skills required to create a culture of engagement, consider case studies from organizations involved in transforming the care delivery process, and reflect on first-person accounts of agitating for big changes in our nation's health care system.

Let's get busy! Our patients and employees need us.

-Karen Drenkard, PhD, RN, NEA-BC, FAAN

-Joyce Batcheller, DNP, RN, NEA-BC, FAAN

Guest Editors

REFERENCES