20 more ways to build employee loyalty. (Building Employee Loyalty).

Nearly 200 physician executives across the country responded to an ACPE e-mail asking about their organizations' efforts to gain employee trust. Here are some of the insights they and their employees shared.

1 Building employee trust is like making a marriage work

As a 31-year employee of Dr. Louis Wright, I can speak from personal experience that the primary reason for longevity and loyalty is flexibility. The company has always given their employees-rank and file, middle management, and senior management-the opportunity to have a flexible work schedule, especially during the childbearing and child-raising years. This ranks #1 for me personally.

The #2 reason for loyalty and longevity is that Dr. Wright has always been a proponent of growing management teams 'within" the organization. He would always challenge and encourage each individual.

I started working for Dr. Wright's practice as an administrative assistant and transcriptionist. Today, I hold the position of chief operating officer for a national company with approximately 300 employees.

Working for someone like Dr. Wright and his partners could easily be compared to making a marriage work. It takes dedication, hard work, trust and commitment toward the people that you spend at least one-third of your life with,

Suzanne B. Galloway

Chief Operating Officer

Pathology Service Associates, LLG 

Florence, S.C.

Most employees want loyalty to be understood as a mutual, respectful and beneficial relationship.

2 Mentoring program makes a difference

Our mentorship program at Olympic Health Management Systems operates on two levels. Our parent company, Aon in Chicago, offers a program for carefully selected high-potential employees throughout the company who fly to Chicago regularly for meetings with their assigned mentors and take part in leadership development educational programs.

This program was so successful and appreciated by the two Olympic employees who participated, that we began a similar program locally. Six promising employees and six experienced mentors (I am one of them) are paired up for regular education programs as a group and also for individual get-togethers over the course of a year.

I meet with the person I mentor every two to four weeks for lunch and a chat. He is in Finance and I am in medical, so it is a good learning experience for both of us and has fostered an ever-improving relationship between our two departments.

3 Holiday charity also boosts employee morale

The company charity participation is common in corporate America, but I didn't realize its full impact until I worked here at Olympic where we are small enough to hear the positive feedback from employees.

The giving tree sat in our lobby during December and every single child's card on the tree was taken, every single wish fulfilled. The building landlord even brought the "leftovers" from giving trees in his four other buildings to hang on our tree to make sure that no child was left out.

I heard many remarks from our employees about how wonderful it was to have the opportunity to contribute to the community and how easy it was to do right here at work. Many employees chose gift cards for children the same age as their own and shopped as a family.

My own son remarked on Christmas morning that he was thinking of the four children for whom we shopped and how pleased they must be.

G. Kristin Crosby, MD

Vice President & Chief Medical Officer

Olympic Health Management Systems

Bellingham, Wash.

4 Pediatricians throw a party

Pediatric Associates of South Florida instituted a program last year called "Let's Get Connected" to unite staff and clinicians and improve company morale. With more than 350 employees, 70 providers and 17 locations, it was important to establish both office and company-wide programs that help staff feel that they were part of our family. The program consisted of monthly events, held at either the office or company level. To keep the excitement going throughout the year, calendars were hung in each office listing the monthly events.

On an office level, each staff was given a budget for the program. Doctors, nurses and staff went bowling, ate dinner together, held ice cream socials and baking contests and hosted family picnics.

One of the highlights of the program was "Employee Appreciation Week." The five-day celebration allowed doctors to thank employees for their hard work. Employees received daily surprise gifts preceded by mystery clues. One of the most popular surprises occurred when physicians dressed up as chefs and served lunch to the employees. Some offices added themes to their lunches with doctors dressing in luau and Italian garb to add a dash of authenticity.

In its first year, the program helped reduce turnover by 12 percent and employees were happier than ever.

Peter J. Sulman, MD, MBA 

Chief Medical Officer Pediatric Associates

Lauderdale Lakes, Fla.

5 Loyalty vs. obedience

Most managers want loyalty to be understood as obedience to the person(s) in charge or the board of directors.

Most employees want loyalty to be understood as a mutual, respectful and beneficial relationship between and leaders and the employees. They want their efforts to be appreciated, their inspiration fulfilled.

Mohamad Bakhotmah, MD

Associate Professor, Surgery

King Abdulaziz University Hospital

Jeddah, Saudi Arabia 

6 First thing Friday

Every Friday morning, nearly without fail, I write a one- or two-page e-mail that I send to the entire organization.

In this message, I discuss important company initiatives, the rationale for them, discuss bad news as well as good, and give praise to individual staff as appropriate. I always err on the side of full disclosure, running the risk that some "competitive/sensitive" information may leave the company. It's more important that all employees feel fully informed.

This e-mail met with rave reviews, as a longstanding concern in the past was that staff did not know what was going on. Managers and directors have also been comfortable that I am not going around them, as I do my best to include them in anything new and important first.

I also sometimes banter about sports, the weather, or put some personal touches in the e-mail that gives a nice feel to the report.

Allan Kornberg MD MBA

CEO 

Network Health

Cambridge, Mass.

7 Walk this way

It is all too easy to get trapped in an office by "urgent" demands. Getting out among the other members of the organization permits you to recognize employee efforts and contributions.

By walking around, I typically find out things that I would never learn from written reports. Obviously, if you have shift operations it is essential to visit those members as well.

The visits should be more than just general "How are you doing?" sessions. They should focus on something specific. I use information gained from these walks to underscore the contributions our staff and providers are making when I meet with other managers or senior executives.

In essence, people who believe senior management is genuinely interested in them and their work seem to repay that interest with dedication and loyalty.

Royce Moser MD, MPH

Professor & Director

Rocky Mountain Center for

Occupational/Environmental Health

University of Utah 

Salt Lake City, Utah 

8 Values + leadership = loyalty

Creating loyalty is a combination of values and leadership.

I believe that people associate with others who have similar value systems, even though the person may not always be cognizant of what their specific values are--they are ingrained in their personality and character.

So, loyalty begins with an organization, person, boss, or friend displaying values that are consistent with an employee's.

Unfortunately, over the past 10-15 years our value systems have become less driven by mission or purpose and more driven by financial success. Job hopping to the next raise or new opportunity for more money has diminished our sense of loyalty to an ideal, purpose or organizational mission, much less to a leader. We have become fickle.

Corporate America directly contributed this loss of loyalty. Growing too fast, becoming "global," then laying off, downsizing or re-engineering brought deep skepticism in the workforce. Jobs are tenuous at best and employees tend to feel like chattel or another resource to use in the company. This is where leadership enters the picture.

It is leadership that illustrates the values and ideals, as well as the importance of the product or service that is provided by the corporation. Leadership must garner true loyalty through ethical behavior, treating employees with respect and truly caring about their interests and concerns.

Anthony Alford, DO, MS, MBA, FAAFP 

Executive Director, Medical Affairs

Houston Healthcare

Warner Robins, Ga.

9 Keep an open door

I have an open-door policy encouraging employees to approach me for any reason/concern. Every employee is free to talk to me and anything said is kept completely confidential. Employee concerns are addressed appropriately and expeditiously. As a result, employees do approach me freely and often.

Raksha Joshi, MD, CPE 

Director Ambulatory Obstetrics and Gynecology Services

St. Barnabas Health Care System

Toms River, N.J.

10 Avoid layoffs

In my humble experience, if you let employees go in an effort to downsize, it'll take you at least 10 years to recapture the loyalty factor.

James Birge, MD CPE

Medical Director

Yakima Valley Farm Workers Clinic

Yakima, Wash.

11 Lead, follow and get out of the way

In medicine, the physician by design will be the final common pathway for clinical decisions and responsibility. But a great deal of what we do in medicine, in our offices and in the hospital can be discretionary -- but only if we are secure in ourselves and with the people that surround us. That's why it's important to:

Hire the right people--not yes-folks, but people who can think and have an opinion.

Divest yourself of those who can't think for themselves. Set the basic rules of conduct, make the decisions that only the physician must make and then get out of their way.

Empower your staff. Authorize them. Give them the tools they need (instruments, education, networks of people to explore). As necessary, guide their direction and assure that they are moving in the right direction.

Some examples:

* I recently opened up another ambulatory clinic. I hired the staff early and let them make most of the decisions on decorating, furniture, equipment, stocking, etc. They now "own" that clinic and express a high degree of loyalty and support.

* Twenty years ago, I took over an ER that had some problems. I told the staff my expectations, gave them the education necessary to meet those expectations, gave those not willing to go along a chance to transfer, and then moved forward.

What a team we created and what fantastic care and efficiency evolved.

John Johnson, MD

Regional Director

Unity Physician Group

Valparaiso, Ind.

Watch your staff grow

I asked a staff member who has worked for me for several years in several organizations about what inspired loyalty. I then said, "What do I do?" Her reply, "You are real and you care. I also think respect is very important. I respect you, but I think you also respect me."

So my first suggestions for inspiring employee loyalty are: Be yourself and care. Respect those who work with you and they will respect you in return.

Also, through regular staff meetings and ongoing interaction, I do believe the staff feel they are part of a team working together toward worthwhile goals. We do have a "reason to be," a mission if you will, and the staff understand that mission.

Working with staff is one of the highlights of my day. Watching staff develop is one of the most rewarding parts of my career. I believe my staff understands that.

Shirley Dearborn MD,

President

Dearborn, Powell and Associates, Inc.

Oklahoma City, Okla.

13 'All for one, one for all'

I am in a small single specialty group practice of radiation oncologists. There are only 13 of us. We serve a wide geographic area in Wisconsin.

I think employee loyalty starts with recruiting. We tell all our prospective employee-physicians that we have an all-for-one, one-for-all attitude. The good of the many outweighs the good of the few.

Hiring the right people goes a long way. It's important to hire people who are not overly selfish and want to become prima donnas. We have been doing peer review since 1992. All physicians, including the senior partners, are reviewed at least yearly by all the doctors and managers--including the most junior employees.

Our pay scale also reflects this. New hires are paid a percentage of the top salary. In terms of governance, the new employees have equal vote in our major decisions. As a result, most employees feel ownership of the corporation early in their employment.

William Pao. MD CPE

Medical Director, Radiation Oncology 

St. Luke's Medical Center

Milwaukee, Wis.

14 Loyalty + trust = commitment

Without loyalty and trust, there cannot be full commitment. An executive mentor of mine taught me that employees will, in general, complete the work that is assigned to them.

But a great leader will be able to evoke discretionary effort from a workforce. This discretionary effort can translate into 20 to 25 percent more productivity. The trick is to make each and every employee of a health care organization believe that their work can contribute to the well-being of the community their company serves.

Raymond Fabius, MD, CPE, FACPE 

Global Medical Director

General Electric

Fairfield Conn.

15 Atta boy, way to go!

This is kind of corny but it has worked. We used an "atta boy" button to reward each other anonymously for kind service to one another or to our patients.

It works like this, I help a handicapped patient find their way in the hospital and one of my co-workers sees me. She sends my name to the designated person--including the time, date and what I was doing to help.

I am sent an atta boy button. The group with the most buttons at the end of the month gets a pizza. It's cheap, corny but very effective.

Tina Mason, MD, MPH

Chairman OBGYN 

Brookdale University Hospital/Medical Center

Brooklyn, N.Y.

16 Show 'em the door

This is a paradox, but one of the best ways that I think you can demonstrate your loyalty is to help people to leave. Sometimes you don't have the room within your organization to move a good performer up, but you may be able to help them get a job they deserve and desire somewhere else.

Mark Nadean MD, CPE

Chief of Physician Education

Air Force Personnel Center

Universal City, Texas

17 Retraining by Blue

Blue Gross Blue Shield of Illinois, like many companies, conducts a number of "morale" and "loyalty-building" programs. However, I attribute our unusually high degree of employee loyalty to the fact that the company bends over backwards to retain its employees. Rather than lay off, we typically train our people to fill other areas of need. People can focus on their jobs, rather than the paralyzing fear of worrying about those jobs. The mission of our company, providing reliable health care coverage, is recognized and appreciated by our community.

Richard Gayes, MD, MBA

Medical Director

Blue Cross/Blue Shield of Illinois

Chicago, Ill.

18 Reaching goals

I try to understand what a job means to the employee. Is it what they dreamed of doing? Is it a stepping stone? Or did life just happen to them and they got stuck in the job?

Once I know this, I can communicate the goals of the organization in the context of the person's situation.

I once hired a Holiday Inn employee as a receptionist for a clinic. Holiday Inn has excellent customer relationship training classes for their employees that allowed this lady to do excellent job right from the start. Within six months she was as popular with the patients as the physicians.

I asked her what she saw herself doing in 10 years. She said she wanted to go to college and study computers.

That was seven years ago.

For three of those years, we had an excellent representative of our organization checking patients in. Today, she is the information technology manager for the county health department and completing her masters in IT administration.

I did not lose a great receptionist. I gained a great IT consultant, Because we supported her in her personal goals to this day she is loyal to the organization even though she doesn't work for us.

Robert Allen, MD

Allegan Medical Clinic

Allegan, Mich.

19 Winning battles

The best way to inspire loyalty is to be involved with your physician team hip deep, not just going through the motions. Their fights and struggles are also your fights and struggles.

One is reminded of the story of Spartacus and the Roman slave revolt in 79 A.D. Spartacus stood before the army of slaves he had assembled on the eve of their biggest battles against the Roman legions. As he stood before them he slew this beautiful white horse and told his following army "I do this because if we lose this battle, there is no reason to have this horse. And when we win we will have a thousand horses even more magnificent than this."

His army went on to beat the Roman legions in that battle. Many lessons

to be learned from true leadership such as this.

Anthony S. Leno, DO, MBA FACEP,

Assistant Director Emergency Services 

St. John Riverside Hospital

Yonkers, N.Y.

20 Gift certificates and bonuses for meeting goals

Annual productivity goals are established for our medical practice and posted for the entire staff each January. Quarterly meetings are held to review the practice performance during the year.

During these meetings, the practice performance is reviewed and compared to the current goals and the previous year. Also, awards are made during the meetings and a drawing is held for a random winner. The awards are: Patient Choice - $50 gift certificate, Outstanding Performance - $50 gift certificate, Employee Suggestion - $50 gift certificate, and Drawing Prize - $100 gift certificate.

If the practice meets the quarterly goals, all employees are awarded bonus time off (e.g. one extra day for full-time staff). This allows up to four extra days of paid leave per year in addition to normal benefits.

These incentives have been used for the past two years and every quarter has met goal. In 2002, the goals were met and exceeded by nine percent in spite of Medicare reductions and a competitive metropolitan marketplace.

Richard Beck MD, FACS 

Medical Director

Advanced Otolaryngology Services, PA

Jacksonville, Fla.