Florida Association of Community Health Centers 2009 Annual Conference

Florida Association of Community Health Centers2009 Annual Conference Performance Management, Employee Retention & Motivation Mark E. Robledo, The Crossroads Group, Inc.

Who We Are The Crossroads Group, Inc. • Speaker: Mark Robledo, M.B.A., President and Founder • Specialization: Organizational development, with particular emphasis on delivering measurable outcomes. • Mission: To help clients assess and achieve measurable client goals and objectives. • Founder serving FQHCs since 2000 ©2009. The Crossroads Group, Inc.

The Crossroads Group Core CompetenciesCommunity Health Centers Core Services: • Strategic Planning Facilitation/Preparation • Patient Satisfaction/Experience Measurement and Improvement • Employee/Provider Perception Surveys and Focus Groups • Process Improvement/Patient Flow Improvement • Training and Development For more information and references: www.CrossroadsGrp.com/chc.htm ©2009. The Crossroads Group, Inc.

What is Performance Management?A Primary Management Function for all Managers and Supervisors • Performance management is an ongoing communication process, undertaken in partnership, between an employee and his or her immediate supervisor that involves establishing clear expectations regarding job functions, organizational goals (and relationship to), performance feedback, performance measurement, barrier removal, and continuous improvement. Bacal, Robert. Performance Management. New York: McGraw-Hill. 1999. ©2009. The Crossroads Group, Inc.

Why Performance Management? Why so Important? • People are the most strategic asset and the greatest investment • Delivery of all organizational goals and mission depends on people • Most health center managers are poorly equipped to manage subordinate performance (technically but not managerially proficient) Performance Management Directly Impacts: • Employee Retention, Engagement, and Commitment • Employee Productivity and Efficiency (all levels) • Process Performance • Service Excellence, Patient Satisfaction, and Community Image • Financial and UDS Metrics ©2009. The Crossroads Group, Inc.

Performance Management QuotesWhat High-Profile Business Leaders Have Said • “My main job was developing talent. I was a gardener providing water and other nourishment to our top 750 people. Of course, I had to pull out some weeds, too.” (Jack Welch) • “The conventional definition of management is getting work done through people, but real management is developing people through work.” (Agha Sahab, Founder of Bank of Credit & Commerce Int’l BCCI) • “(A) myth of management is that success equals skill.” (Robert Heller) ©2009. The Crossroads Group, Inc.

Performance Management Quotes • “Executives owe it to the organization and to their fellow workers not to tolerate nonperforming individuals in important jobs.” (Peter Drucker) • “Endeavors succeed or fail because of the people involved.” (Colin Powell) • "Never try to teach a pig to sing; it wastes your time and it annoys the pig.“ (Paul Dickson) • "So much of what we call management consists in making it difficult for people to work.” (Peter Drucker) ©2009. The Crossroads Group, Inc.

Performance Management QuotesDealing With Poor Performance • “I feel that there is no greater disrespect that you can do to a person than to let them hang out in a job where they are not respected by their peers, not viewed as successful, and probably losing their self-esteem. To do that under the guise of respect for people, is to me, ridiculous.” (VP Strategy and Corporate Relations Hewlett Packard) • “It’s incredibly demoralizing for the rest of the team if you don’t move poor performers out – and the leader looks blind and out of touch.” (Senior Executive, Arrow Air) ©2009. The Crossroads Group, Inc.

Why Managers Don’t Manage“Management Must Manage” (Harold Geenen) • Ill Equipped – lacking tools and basic skills • Fear of being perceived as a “micro-manager” • Perceived Lack of Time • Not seen as a priority • Busy “Putting out fires” • Emotional barriers/fear of confrontation • Not able to delegate • Easier to “Just do it” than to delegate to someone else “It is not necessary to change. Survival is not mandatory.” (W. Edwards Deming) Leverage ©2009. The Crossroads Group, Inc.

Failure to Manage r • Results: “Lose the best, keep the rest…” • Costs of Turnover (direct and hidden) • Direct: Recruitment, replacement, on-boarding, training and development, • Indirect: • Additional burden on staff (coverage and training) • Adverse effect on morale, knowledge drain • Adverse impact on patients (image, relationships) • Suggestion: Create sense of urgency. Run a turnover cost calculator for your organization. ©2009. The Crossroads Group, Inc.

Eight Key Elements of Performance ManagementAdditional Emphasis • Goal-setting (for new or established employees) • Motivation • Monitoring Performance • Gap Closure and Improved Performance • Coaching • Performance Appraisals • Development • Addressing Intractable Performance Problems ©2009. The Crossroads Group, Inc.

Goal-Setting • Goals are not job description activities • Goal provide the reason for activities. All activities should be linked to a specific goal or goals. • While all are important, should be prioritized (e.g. service vs. efficiency) accurately measured • Goals must be…recognized as important (by owner), clear, specific, measurable, timely, aligned with strategy, achievable but challenging, supported by appropriate and meaningful rewards (must be a meaningful “stake” in the outcome for the employee). ©2009. The Crossroads Group, Inc.

Individual Goal-Setting (Cont.) How to set goals with employees • Discuss goals with employee. Obtain agreement (2-way) • Clarify importance (reason for) of goals • Dialogue How To Aspect • Adjust participation according to KSA and employee level • Record Goals (copy for manager and employee) • Develop action plan (best driven by employee) • Record date of meeting, the goals (and targets), the actions, resources (coaching, training, other), date of next assessment. ©2009. The Crossroads Group, Inc.

Individual Goal-Setting (Cont.) • A Note on “Soft” Goals: • Do not neglect to include. Tend to often be left out in favor of “hard measures” (volume or UDI measures), but equally critical and supportive of. • Often lead the harder lag indicators • Examples include customer perceptions, employee perceptions, public perception, internal service, manager behaviors. • Tools: Internal and external surveys, focus groups, mystery shop ©2009. The Crossroads Group, Inc.

Monitoring PerformanceBeyond the foundations • Observe and gather data • Avoid premature judgments or assumptions • Consider other sources of information (validate with peers) • Attempt to differentiate between skill and/or motivation issues • Examine yourself. Managers may hinder performance by micromanaging the how, providing insufficient resources, not being available, or setting unclear or unrealistic time frames. Poorly designed processes may also contribute. • Periodically “Step into their shoes” (spend time in their work area) ©2009. The Crossroads Group, Inc.

Gap Closure • Performance Discrepancy or Gap: A mismatch between what employees are actually doing and what they should be doing, based on established manager/supervisor expectations. • First assessment step: • Are expectations realistic? • Assess the cost (impact) of the discrepancy • Is there a fast fix? ©2009. The Crossroads Group, Inc.

Gap Closure • First Step: Differentiate whether the issue is a process issue (beyond employee), a skill issue, or a motivational issue. • Validate over time (pattern) and with peers. • Be aware of (and sensitive to) other factors, particularly when performance decline is sudden: • Personal problems • Relational conflicts at work • Work overload or burnout ©2009. The Crossroads Group, Inc.

Gap Closure • Addressing with the Employee: • State the observation • Use metrics where available • Discuss behaviors, never presume motives • State the implications: (Example) • Plan follow-up actions ©2009. The Crossroads Group, Inc.

Coaching Basics:Practical Suggestions • Most powerful and readily available (ideally) tool in performance management • May address either performance or skill gaps • Can be delegated to others ‘Coach the coach”, especially for skill training (leverage) • Best weighted towards employees with potential for growth or on verge of promotion to new role • Secondary Benefit: Causes the employee to be valued. Meets need for growth and challenge. ©2009. The Crossroads Group, Inc.

Coaching Basics (Cont.) Practical Suggestions • Let new hires know to expect coaching as a normal part of management process. • Recommend creating a custom “Coaching Opportunity List” of your subordinates. • Build agreement as to the need for coaching beforehand. • Performance Gap • “Next Level” knowledge • Follow-up action plans • With input from the employee ©2009. The Crossroads Group, Inc.

Coaching (Cont.) Important Considerations • Climate: Mutual trust, accountability, and growth • Keep focus of feedback on future • Provide timely feedback • Focus on specific behaviors or metrics, not character, attitudes, or personality • Be specific • E.g. Praise vs. Positive Feedback ©2009. The Crossroads Group, Inc.

Motivating Employees Extrinsic Rewards vs. Intrinsic Rewards • Extrinsic more commonly focused on by administrators (e.g. pay) • Most effective for recruiting • Intrinsic more powerful and readily available • Growth opportunities, meaningful work, teamwork, positive work environment. • Extrinsic dissatisfaction may be (but not always) rooted in lack of intrinsic reward. ©2009. The Crossroads Group, Inc.

Intrinsic and Extrinsic DriversKey Drivers of Overall Satisfaction • Benefits and Compensation • Job Security • Communication With Management • Work/Life Balance • Relationship With Supervisor • Career Development Opportunities Source: Society For Human Resource Management (SHRM), 2003 ©2009. The Crossroads Group, Inc.

10Practical Ways to Motivate and Retain Strong PerformersSource: Harvard Business Essentials. Performance Management, 2006. • Demonstrate trust • Make jobs more complete • Introduce challenge • Encourage some to become experts • Drive out fear • Preserve subordinate dignity • Address poor performance • Empower, don’t micromanage • Hire self-motivated people • Be a good boss ©2009. The Crossroads Group, Inc.

Intrinsic MotivationFour Building Blocks • Cultivate meaning awareness • Positive work environment, vision, purpose, relevance, wholeness of tasks • Develop a sense of choice • Delegated authority, trust, security, clarity, information • Develop a sense of competence • Knowledge, positive feedback, skill recognition, challenge, standards • Develop a sense of progress • Collaboration, milestones, celebrations, access to customers, improvement measures Source: Thomas, Kenneth W. Intrinsic Motivation at Work- Building Energy and Commitment. San Francisco: Berrett-Koehler Publishers Inc. 2000. ©2009. The Crossroads Group, Inc.

ExpectancyTheory of Motivation Motivating Employees to Meet Goals Expectancy Theory MF= Motivation Force (towards goal achievement) MF = Expectancy x Instrumentality x Valence Expectancy asks: “Can I achieve the goal” (targets and skill level) Instrumentality asks: “Is achievement (or non-achievement) of the goal linked to a reward (or consequence)?” Does it matter? Valence asks: Is the reward (or consequence) meaningful to me? ©2009. The Crossroads Group, Inc.

Generation Y: Unique Factors (Born 1978-1998) • Generational Factors: Entry-level Employees • Over 14 million in workforce and growing • Independent, tech smart, self-reliant, like flexibility • High expectations for rapid career growth • Greater demand for work/life balance • High need for clear and frequent performance feedback • Want to be “paid volunteers” • Independent, but with high socialization needs • Hardest group to retain ©2009. The Crossroads Group, Inc.

Performance Appraisals • A formal method of assessing how well an employee is doing with respect to assigned goals • A natural extension of the performance management continuum • Software applications may assist • Allow employee opportunity to self-evaluate • Suggested 4 point Rating Scale: Did not meet expectations, Developing, Proficient, Role Model ©2009. The Crossroads Group, Inc.

Performance Appraisals • Common Pitfalls • A formal annual exercise with little real meaning • Requires training for quality and consistency • Requires real and honest evaluation, consistent with pre-established goals, coaching discussion, and measures. • Delays due to time-consuming nature, fear of confrontation (by manager), and staggered load (all at the same time). • Delays a major dissatisfier for employees (do not care message) ©2009. The Crossroads Group, Inc.

Employee Development • A key to retention, particularly for high-potential employees • Convergence of: • Company/department goals and objectives • Employee aspirations and interests • Employee development needs • Assessment tools include communication, learning needs assessment surveys (manager and employee perspective), and KSA inventory databases. • Tip: To avoid burning out talented employees, scale up and down (job re-design) when delegating new responsibilities. ©2009. The Crossroads Group, Inc.

Intractable Performance ProblemsConfronting Poor Performance (when all else fails) • Confront poor performance • Based on a pattern of observation rather than an isolated event. • Directly (and privately) with the individual (not to a group) • Be specific about nature of the problem and the ramifications on the organization • Listen actively • Make specific suggestion or request. Keep a record of what was said and agreements made. ©2009. The Crossroads Group, Inc.

Intractable Performance ProblemsWhat About “C” Performers? The Toughest Challenge: • C Performers- do just enough to get by • Do not respond to performance management efforts • Manager Barriers: Psychological and Practical • Impact of Ignoring C Performers: • Discredits leadership • Block advancement of A and B Performers • Poor Role Models/Examples • Stifle enthusiasm of new hires and A and B performers • Cause good performers to settle or leave • C-performers multiply (hire other c-performers) ©2009. The Crossroads Group, Inc.

Intractable Performance ProblemsSteps to Address • Decide to do something (first step) • Use “Iron Hand, Velvet Glove” approach • Identify A, B, and C Performers directly reporting to you. (multi-rater system and scorecard) • Develop action plan with C performers through coaching or performance evaluation process. • Hold Managers/Supervisors accountable for improvement and/or removal of their C performers. • Look for “C” Clusters • Manager/Supervisor Issue • Process improvement opportunity ©2009. The Crossroads Group, Inc.

Intractable Performance ProblemsWhen to Dismiss Dismissal Almost Always Justifiable For: • Consistently performing poorly (using objective criteria) on the job • Refusing to following instructions • Have a persistently negative or destructive attitude • Insubordinate behavior/disrespect of authority • Abusing sick leave or other privileges • Being chronically late or absent • Must be brought to employee’s attention, be documented, and persist thereafter. • Consult your HR Department/legal department for specific HR policies and procedures and/or state laws. ©2009. The Crossroads Group, Inc.

Recommended Resources • Cole Miller, Brian. Keeping Employees Accountable for Results. New York: American Management Association, 2006. • Thomas, Kenneth W. Intrinsic Motivation at Work- Building Energy and Commitment. San Francisco: Berrett-Koehler Publishers Inc. 2000. • Harvard Business Review on Appraising Employee Performance. Boston: Harvard Business School Press, 2005. • Bacal, Robert. Performance Management. New York: McGraw-Hill. 1999. • Mager, Robert F., and Peter Pipe. Analyzing Performance Problems. Atlanta: Center for Effective Performance Press, 1997. • Coaching and Mentoring. Boston: Harvard Business School Press, 2004. ©2009. The Crossroads Group, Inc.

ConclusionFollow-up Q&A, Contact Information • Q&A • Shared Best Practices Mark E. Robledo President, The Crossroads Group, Inc. Tel. 888-412-0160, Direct 305-412-0160. merobledo@crossroadsgrp.com www.CrossroadsGrp.com/chc.htm ©2009. The Crossroads Group, Inc.

Florida Association of Community Health Centers 2009 Annual Conference