The employee satisfaction survey is right around the corner. It's time again to make your mark.

When employees on the East Baltimore campus complained about limited mealtime choices, Hopkins opened two new eateries-Asian Café and Subway. Next up: a "wings-to-go" program and two-week hot food menu rotation in the main cafeteria.

While planners and architects are busy sketching out the physical characteristics of Hopkins' medical campuses of the future, others are attending to what human resources specialists call its "most valuable resource"-its employees.
In June 2001, leaders at every component of Johns Hopkins Medicine asked their staffs to weigh in on a host of common workplace concerns. The confidential, 120-question survey asked for opinions on pay and benefits, advancement opportunities, the qualifications of supervisors, and employees' views on parking and food services.

Over the past 18 months, the questionnaires (some 6,500 at Hopkins Hospital and School of Medicine alone) have been analyzed and acted upon, not only by Hopkins leaders but also by department directors who've compiled their own "action plans."
What's happened since then? Not an insignificant amount of progress, considering that making changes in an organization as complex as Hopkins can sometimes feel like steering the Titanic.

At Hopkins Hospital and Health System Corporation, where only 46 percent of employees reported satisfaction with benefits, a slew of new perks was introduced, including tuition for dependents, long-term care coverage, a college savings program, domestic partner benefits and PTO improvements. Retirement benefits, one of the biggest dissatisfiers among Hospital and Health System Corporation employees, were beefed up by improving the employee pension formula and by adding a matching contribution by Hopkins to non-union employees' 403(b) plans.

Although the School of Medicine is a separate organization with its own policies and procedures, many of its responses to the survey overlapped with Hopkins Hospital's under the umbrella of Johns Hopkins Medicine. Those include everything from more funding for patient safety initiatives to new eateries like Subway. Perhaps most significant is the School's new in-grade salary adjustment policy, an alternative way for employees to move up the pay scale.

Now, from Feb. 3 to 14*, Hopkins is checking in with its employees again. Much as it would like to, the organization cannot grant every wish. "We must prioritize how we spend our limited budget to provide the maximum benefit for the most employees," says Ronald Peterson, president of The Johns Hopkins Hospital and Health System.

Hopkins hopes to improve its scores this month, even if it doesn't get skyrocketing bar graphs. It does, however, expect better participation. In 2001, 40 percent of School of Medicine and 50 percent of Hospital/Health System Corporation employees took the hour to complete the survey.

Pamela Paulk, vice president of human resources for Hopkins Hospital and Health System, stresses how important participation is. "The more representation you have, the more relevant your survey results will be."

Here are a few ways Hopkins has been working on employees' concerns expressed in the last survey.

Surveying the Surveyors

Gloria Bryan feels like the cobbler whose children have no shoes. She's been so focused on responding to hot-button issues expressed by the 10,000 employees of the School of Medicine, for which she is senior director of human resources, that she's had scant time to sit down with her own crew of 21 to delve into issues troubling them.
Luckily, they are a happy group, judging from how they rated their division. Eighty-five percent report overall job satisfaction; 83 percent like their co-workers; and 86 percent approve of their supervisory support. "Every score is comparable to or higher than the School of Medicine," says Bryan proudly. "We have this incredible spirit and interact well."

So it's all the more perplexing that half of School of Medicine employees said they were dissatisfied with human resources' policies and service. "It hurt us," says Bryan. "We've got this little group who's absolutely grinding themselves to the knob delivering the best service they know how."

Staffing is certainly part of the problem. When the School of Medicine formed its own "personnel" division in 1983, it began with half the staff it has today and was charged with filling 80 vacancies. Now, they're dealing with more than 550.
Bryan's group saw a way to improve customer service, however, when they tore apart the hundreds of pages of narrative comments written by survey participants. Employees had lots of questions, and no easy place to go for answers. To solve the problem, a new Web site (www.jhu.edu/~hr1/hrdivis/
somdiv/somhome.htm) was created in direct response to the survey, complete with a meaty FAQs section and easy access to the JHU personnel policy manual.

From a broader perspective, the School's overall scores were good enough to "shock" the consulting firm who administered the survey, according to Bryan. The organization excelled in areas like satisfaction with work and co-workers. It also scored well in benefits satisfaction, a confirmation that the money the University invests in benefits ($208 million in FY'03) is worth it, says Bryan.

The School received its lowest score in pay satisfaction, but this was no surprise to Bryan "I've not seen a survey here or anywhere where pay satisfaction isn't universally low," she says. Still, it's an area that begs for improvement, "not necessarily because people need to be paid better across the board, but because we don't adequately explain the procedures that lead to a salary determination."

There is a bright spot here. A new "in-grade salary adjustment" allows employees to move through pay ranges quicker than waiting for an annual review. The policy can be used if an employee has taken on extra duties (but not enough to result in a job reclassification); if there are internal equity issues (such as a new hire making as much as someone with many years of service); or market changes (such as in nursing or information technology).

Of course, an increase hinges on two factors-the employee's performance and the health of the department's budget. "An academic medical center is not an easy environment to implement consistent compensation plans," says Bryan. "There are such limited resources and so many demands on them. And yet, I believe that even our biggest skeptics have seen that in the last 18 months things have changed."

Polishing Pathology

Shabby may be chic in some circles, but not among Hopkins employees working in antiquated quarters. One of their strongest complaints on the last survey was the state of their physical plant. Not surprisingly, people working in a depressing environment expressed dissatisfaction in categories such as productivity and concern for employees.
In the Department of Pathology-where some 650 Hopkins Hospital and 330 School of Medicine employees work in two of the East Baltimore campus's oldest buildings, overall survey scores came in 12 points below those of the hospital. This was no fluke. Whereas 50 percent of hospital employees took the survey, in Pathology it was an emphatic 68 percent.

"Where we scored best," says Rosemary Hines, Pathology's assistant administrator for finance, "was in enjoying the people we work with. But, by and large, people were especially unhappy in the areas of communications, the work environment, HR and benefits, and patient care. We've always had staff meetings. Now, we talk employee satisfaction at every meeting."

In fact, they scheduled more than 50 small-group meetings to convey the survey results, get feedback and solicit ideas. Then, everyone got to work. Formerly drab walls now sport lighter colors and artwork. New racks, cabinets and lockers help organize work and gear. Live and artificial plants soften hard edges. And even though it's unlikely they can change the black tile in some bathrooms, everything looks much cleaner.

To beef up communication, says Hines, "we're using more elaborate bulletin boards. We reinstated the departmental newsletter. We're working on making our educational things more fun. We're emphasizing teamwork. Anything to blow away the little silos where people don't talk to each other."

Furthermore, employees' concerns about overtime have resulted in a re-design of the weekend rotation and what Hines calls "creative shifts." And because employees are determined to provide the best patient care possible, departmental leaders have updated computers and improved automation to ensure both timeliness and accuracy where specimens are concerned.

"You can't always move as quickly as you'd like, or change everything," says Hines. "But I firmly believe improving employee satisfaction will improve patient satisfaction."

Please Say Thank You

Throughout Johns Hopkins Medicine, there's been a new push to recognize employees who make going above and beyond a way of life. Everyone-co-workers, supervisors, patients and family members-can "Catch a Shining Star." The reward and recognition program (at Johns Hopkins HealthCare it's called "Say Thanks"; at Howard County General Hospital, "Recognition Matters") shines a well-deserved spotlight on those who exemplify Service Excellence. Nominees get on-the-spot certificates, and qualify for quarterly and annual awards.

At the Johns Hopkins Home Care Group-where employee satisfaction is a standing agenda item on management committee meetings-the idea has taken a unique twist. Here, you can receive the "Almost Anything Can Happen Award."

Over the last three years, faced with decreasing reimbursement and increasing government regulations, Home Care employees have had no choice but to get creative. "'Do More with Less' is kind of our first name," says Linda Scott, senior director of home health services. And that's meant asking people not only to stretch beyond roles they're used to, but take on jobs they had no idea they could do.

Last November, at Home Care's annual employee recognition ceremony, Nancy Pasternak was stunned to learn she'd been named the "Almost Anything" award winner. The special projects coordinator (she calls it "the other-duties-as-assigned job") says she thinks one reason is her willingness "to try pretty much anything."
Scott says one reason is that, when they asked Pasternak to tackle nurse recruitment-in the midst of a nationwide shortage-she ended up getting a nearly one-third vacancy rate down to almost zero.

A pediatric nurse practitioner by training, Pasternak streamlined hiring guidelines. Two years ago, she says, hiring went from human resources to the nurse managers, who were so busy running operations that they couldn't make timely decisions about job candidates. Now, Pasternak does the interviewing, and if she senses a good fit, makes the job offer within 24 hours (pending a background check).

"I'm a cheerleader for the organization," she says. "I tell the nurses that you get quality time to teach and have the potential to make a huge impact on people. But I have to figure out quickly whether they have the organizational skills, the ability to know what you don't know, the understanding that you're a guest in someone's home. Am I 100 percent on the money? Nooooo. But I think the managers trust my decisions."
"In this environment, you have to act while the iron is hot," says Scott. "The fact that Nancy is making offers on the spot is something we consider a major accomplishment. Now the managers can focus on operations."

Still, says Pasternak, "I'm a little embarrassed by the recognition. I do the job they ask me to. But it was very kind, the thank you."

Footnote p1:
*Includes employees of The Johns Hopkins Hospital/Health System Corporation, School of Medicine, Home Care Group and Community Physicians. In late spring 2003, Johns Hopkins Bayview Medical Center, Howard County General Hospital and Johns Hopkins HealthCare will conduct the employee survey.

-Mary Ann Ayd & Mary Ellen Miller

Skills to Pay the Bills Deborah Knight-Kerr always worries when she hears an employee say, as many did on the 2001 Satisfaction Survey, that Hopkins doesn't offer enough opportunities for promotion. As director of community and education projects in Hopkins Hospital's human resources department, Knight-Kerr has made a career out of helping people not only get hired, but find ways to get ahead. Lately she's been tackling a particularly thorny problem: When you've got an entry-level job and a family to support, how can you afford the training you need to move up? For some new clinical associates, medical coders, and surgical and pharmacy techs, the answer has been a program called STEP. Short for Skills-Based Training for Employment Promotion, the program helps qualified employees at Hopkins Hospital and Bayview Medical Center learn a skilled health occupation. During the training, which can take up to nine months, employees work 24 hours per week in their current jobs and spend two days a week in the classroom. Training costs are covered by a state-funded grant administered through the Baltimore Mayor's Office of Employment Development. The hospitals, meanwhile, pay the employees their full-time wage and keep their health and pension benefits intact. Knight-Kerr says the STEP program is one of many paths (including on-site GED classes and help with tuition) available to employees who are eager to overcome promotion obstacles. She also oversees a similar program called LINC (Ladders in Nursing Careers) that helps employees become nurses. "We don't want people to be buried in one job," she says. "We have such good and loyal employees here." April Brown is one of a dozen Hopkins Hospital employees who, in December, became the first graduates of the STEP clinical associate training program. The nearly five-month course teaches students how to take vital signs, change central line dressings, and insert Foley catheters. Brown, 22, had been a clerical associate on Jefferson 3. "It's like a family," she says. "You can do anything from a floor tech to a doctor and love working there." Yet with two young children to raise, Brown knew her high school diploma wasn't enough. Further, she discovered a new ambition. "Everywhere I go," she says, "people tell me I should be a nurse." Describing herself as a "one-step-at-a-time person," Brown opted to become a clinical associate first. This would give her a quick pay upgrade and still allow the time she needs with her children. She landed a position on her favorite floor, Jefferson 3. But she's not finished. "My nurse manager brought me a Johns Hopkins book bag," says Brown, "for when I go to nursing school."