How to Help Senior Leaders Appreciate Their Staff

Dear David,

We’re tasked with continuing to build our hospital system into a national brand, but our CEO doesn’t see our nurses as a part of the brand equation. Our senior leaders see them as entirely replaceable, and accept high turnover as part of our culture. I’ve heard that the answer is better training, but training alone does not create retained, engaged employees. We train them and they leave. I don’t believe training is a magic bullet; the culture has to value its skilled staff. How do you convince the president of a company that employees matter?

Searching for the Solution

Dear Searching,

Thank you for asking a challenging question that is relevant to every employee and senior leader—not just those in healthcare. How do improvements in employee engagement, commitment, and retention fit into an organization’s brand equation? And how do you convince a harried and skeptical team of senior leaders? Your challenge will be to show that a) these improvements are possible, given your current situation and the turnover in the profession, and b) these improvements are worth the investment, given the strategic goals that keep senior leaders up at night.

Begin with Their Existing Goals and Strategies. You suggest that your senior leaders have a clear objective: to build your hospital system into a national brand. Make it very clear that you support this goal. Your desire to improve engagement, commitment, and retention needs to be positioned as an essential strategy for achieving this strategic objective. But how do you convince skeptics that it really is essential? How do you change their hearts and minds?

Create Personal Experiences. The mistake we make is to try to change hearts and minds with our mouths. We think that if we find the right words, the right data, and the right tone of voice, we can somehow bring the skeptics over to our side. The sad result is a mix of lectures, sermons, data dumps, and rants. Verbal persuasion is the least effective way to convince others.

Personal experience is the gold standard for changing hearts and minds. Find ways to put senior leaders into situations where they will experience for themselves the importance of engagement, commitment, and retention. But how can you do that?

Partner with them on their current strategies for building your brand. We’ve worked with several hospital systems that were engaged in similar initiatives, so I can share some common strategies. Your team will need to build at least one world-class heart center, cancer center, and children’s hospital. You will need to either purchase or partner with at least twenty community hospitals in your area to expand your reach to where patients live. And you will need to build research facilities and partner with a medical school in order to raise your profile to a national level.

You and I know that these building projects will remain hollow monuments unless they are filled with passionate, committed nurses. The best way to convince senior leaders of this truth is to have them visit other hospital systems that have succeeded or failed at these same strategies. I recall one CEO who returned from visiting a new children’s hospital and said, “They thought they could move their people into a new building without moving their old culture. It was a colossal failure. We won’t be making that mistake here!”

Educate Their Eyes. As Yogi Berra once quipped, “You can observe a lot by just watching.” But sometimes we fail to recognize what we’re seeing. You can help senior leaders recognize what they’re seeing by providing them with questions and cue sheets.

There is a wonderful and popular HBR piece titled, How to Read a Plant, Fast. The author, R. Eugene Goodson, describes how to make the most of a plant tour. He and his team can tell the cost of sales, sales per employee, overhead, and time to assembly after a half-hour plant tour. I have a neighbor, a retired COO of a major restaurant company, who can answer similar questions within twenty minutes of having been seated at a restaurant. You have similar talents within your senior team. Work with them to create a checklist and list of questions to ask as they visit other hospitals. This preparation will ensure they see the cultural and interpersonal dimensions—as well as the spiffy new buildings.

Begin with a Specific Project. Remember that structure drives behavior. This is one of the reasons that new buildings get more attention than engagement, commitment, and retention. Building a building is a clearly defined project, while improving engagement is not.

The solution is to begin with a specific project that will improve engagement. Achieving Magnet Status is an example of this kind of project. In the case of Magnet Status, it’s a large, demanding project that would have a huge payoff in terms of branding.

If Magnet Status is too difficult a place to start, then select a smaller, more feasible project that will build engagement. For example, work with a member of the senior team to select one or more of the Institute for Healthcare bundles—small, straightforward set of evidence-based practices for improving patient outcomes—and build mastery across your hospital system. This kind of project demonstrates that engagement is possible, and that it pays off.

Make Respect Visible. I was once at a meeting when a hospital VP made a joke that compared nursing turnover to prostitution. The CEO of the hospital laughed, and added to it. The division manager was also at the meeting, and he didn’t laugh. In fact, within the week he had removed both the CEO and the person who had told the joke. There needs to be a commitment to respect your own workforce. Of course most senior leaders have an enormous respect for their people. But how do the people see this respect? Senior leaders need to make it visible. For a wonderful example, take a look at this brief video. It seeks to honor the men and women like yourself, who seek to save lives every day. I hope this helps.


David Maxfield


David Maxfield is a New York Times bestselling author, keynote speaker, and leading social scientist for organizational change. For thirty years, David has delivered engaging keynotes at prestigious venues including Stanford and Georgetown Universities. David’s work has been translated into twenty-eight languages, is available in thirty-six countries, and has generated results for three hundred of the Fortune 500.