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Called to Coach
How Engaging Employees Benefits Patients at Infirmary Health System
Called to Coach

How Engaging Employees Benefits Patients at Infirmary Health System

Webcast Details

  • What current challenges do healthcare organizations face today?
  • How is Infirmary Health System addressing these challenges through engaging its employees?
  • How can accountability empower healthcare organizations to carry out their mission through greater engagement and more effective help for their patients?

Called to Coach Webcast Series -- Season 11, Episode 23

Below are audio and video plus a transcript of the conversation, including time stamps.


Staffing is one of the biggest challenges healthcare organizations face today, making employee retention vital. For leaders at Infirmary Health System in southwestern Alabama, keeping their employees engaged has become Job 1. What is Infirmary doing to grow employee engagement? What role do accountability and clear communication play in ensuring that these efforts are successful? And how is a focus on engagement, along with patient safety and satisfaction, helping Infirmary carry out its mission? Join Infirmary's Jay Martindale and Chuy Ramirez to learn more.


There are a lot of challenges we face in healthcare. And having engaged team members really is the way to success.

Jay Martindale, 5:06

The Gallup survey ... gives us alignment. We're speaking the same language throughout the system, [from] our clinics to the hospitals. And so that's another plus that we get from the survey.

Chuy Ramirez, 44:17

You want to do good. You want to get good scores. ... But that means ... that you're doing good by the patients. And at the end of the day, that's what really matters.

Chuy Ramirez, 48:25

Jim Collison 0:00
I am Jim Collison, and this is Gallup's Called to Coach, recorded on August 11, 2023.

Jim Collison 0:20
Called to Coach is a resource for those who want to help others discover and use their strengths. We have Gallup experts and independent strengths coaches share tactics, insights and strategies to help coaches maximize the talent of individuals, teams and organizations around the world. Today, we're going to particularly focus on engagement. If you're, if you are listening live, and you don't see the chat room, there's a link to it right above me up there. Click on that. It'll take you to YouTube. There's a chat room; we'd love to take your questions live during the program. If you're listening to the podcast or on YouTube after the fact -- the recorded version -- and you have questions, you can always send us an email: Don't forget to subscribe on your favorite podcast app here to Called to Coach, or right there on YouTube, so you never miss an episode. Lauren Hunter is our host today. Lauren is a Key Account Leader with Gallup and works with me out of the Omaha office. And Lauren, always great to have you on Called to Coach. Welcome!

Lauren Hunter 1:11
Thanks, Jim! I am so excited to be here this morning!

Meet Our Guests on This Episode

Jim Collison 1:15
We are glad to have you. We've got some great guests. Why don't you take a second and get them introduced?

Lauren Hunter 1:20
Yeah, that would be wonderful. Thank you everyone for joining us live, or for those who may be streaming in at a later date. But I am thrilled to introduce you to Jay Martindale and Chuy Ramirez, who are both on the organizational development team at Infirmary Health down in Alabama. So as you can imagine, there may be some football talk as we have our partnership together here in the past. But I've been so thrilled to partner with Jay and Chuy over the last 3 years. In just a second, I'm gonna have them explain a little bit more about their roles. But something that's really interesting with Jay and Chuy is in their Top 5 strengths. They both have Belief®, Developer® and Responsibility®. And just think about how powerful of a partnership that is. The two of them are creating such a fantastic organizational development strategy at Infirmary that's really leaning into their employee and patient experience. So I'm thrilled for them to share a little bit more about that today. Jay, Chuy, I'd love if you could just share with the crowd a little bit more about your role at Infirmary and what your day-to-day looks like.

Jay Martindale 2:26
All right, I'll -- go ahead, Chuy.

Chuy Ramirez 2:28
OK, I was going to say, "Go ahead, Jay." No, it's, actually, it's a privilege for me to be able to do this. It, I'm very passionate about our employees and their engagement and just the interaction that we have. I just, every opportunity that I get to get with, with our teammates, just take advantage of it, you know, because it's such a special thing that we do in healthcare -- we impact people's lives on a daily basis. So pretty much everybody that, that's on our team has that. And my role on it really is, I guess, it, to start it off, really is more logistical, you know, putting all our, everything together for, for our tech, tech rep Brady, and communicating it out and just getting everybody ready. And then after the, and like, during it, we, letting everybody know how we're doing, what's our response rate. And then afterwards, just putting calendars together for results, rollout, state-of-the-team meetings, action planning -- all those things.

Chuy Ramirez 3:35
So it's, it's really logistical, but it's also support, you know, just supporting our leaders and our teams with anything they need around employee engagement, you know, maybe need assistance with the state-of-the-team meeting, maybe need assistance with action planning -- anything like that. So it's really, I guess, I don't want to take thunder from Jay. But it's like we come together for a little while, put it all together, send it out. It's live. Then we get it back. So gosh, that's a long way of saying logistical and support -- cause my main role.

Lauren Hunter 4:17
You are much more than logistical on support, Chuy. It's, it takes everyone to make this happen. Thank you so much. Jay, what about you?

Jay Martindale 4:25
Well, good morning. Thank you, Jim. Thank you, Lauren. It's just a pleasure to be with you. And just as the director of, of organizational development, one of the things that we get to do is, is really just every day try to make engagement, employee engagement, part of our culture at Infirmary Health. And working with Gallup over the last 3 years has been a fantastic experience for us. And we've been thrilled with the progress that we're making. We'll talk about that some, some of that today. And Chuy is an integral part of everything we do around engagement. So it's just been exciting for us. We are always looking to do this better every day, for those of, those watching, if you're in healthcare, there are a lot of challenges we face in healthcare. And having engaged team members really is, is the way to success; you have to have it for all the things you're trying to do to provide care for patients and their families in your community. So it's just a pleasure to be with you and talk about what we're doing at Infirmary Health. So thank you.

Current Healthcare Industry Challenges

Lauren Hunter 5:25
Yeah, that is wonderful. And it's just so great to hear how the two of you partner closely together to ensure that it's part of Infirmary's strategy that's affecting your patients and your employees. And, Jay, you mentioned this a little bit -- there are so many challenges right now in healthcare that you are seeing, and so many other of our healthcare clients are seeing around the world. I know, we're just recently coming off of a global pandemic. But I'd love if you both could share a little bit more about some of those specific challenges that you're seeing in the healthcare industry right now.

Jay Martindale 5:59
Well, certainly probably the biggest one for all of us, and it's not unique to healthcare, is, is really having enough team members -- staffing, as we like to say a lot. And so with the shortage, the national shortage of nurses in particular, it just presents some challenges when you're trying to really take care of so many patients every day, whether they're in one of our hospitals or in our clinic network. And so that's just something that we, we're, we've worked really hard around recruiting and retention, but also trying to help our leaders do the things they need to do every day to create the right environment for engagement. And, you know, when employees come to us today, new team members, they have a lot of expectations. And so we've got to respond to that. We've got to create the right, not just work environment, but the right working conditions and the right, if you will, everything from compensation and pay to flexible schedules. And doing all of that, at the same time trying to help them kind of understand what their role is in helping us achieve our mission every day.

Jay Martindale 7:01
So that's probably the, one of the biggest challenges that we face. And obvious, obviously, the things that come every day for safety and quality and the patient experience, which we work towards every single day, how to live that out, and provide the kind of care we need to provide. So those are the things that come to top of my mind, and that we talk about, really, every day. And Chuy can have some thoughts around that as well, so --

Chuy Ramirez 7:30
Yeah, and I totally agree that that's probably the biggest challenge. I mean, everywhere you go, it's staffing, staffing, staffing. And when you have that, you know, you have, on the, what, the result of that, when people are working overtime, and so there's a lot of burnout, you know, it's frustration, of course. And, and it's a challenge when you're trying to get people motivated and engaged, but you're also asking them to do a lot more than, than they're used to doing. Luckily for us, though, and I would guess that any other healthcare organization, the people that are dedicated, that truly feel the value that they get out of providing care for other human beings, you know, that it's, that's, I think, what keeps them going. You know, it's just to be able to say that, yeah, I am tired, I'm burnt out, I'm frustrated. But these people need me. You know, they come to us for, for help, you know. They, you know, we take people probably at their most vulnerable time in their life, and we provide the care for them.

Chuy Ramirez 8:40
You know, our, our vision is to be the No. 1 choice for healthcare in our region. And I think we're doing that, you know. It's one of those things that's really hard to measure, if you think about it, but I think we're doing that, because we have a lot of very, very dedicated people. And they are, you can just see it, you know, nursing, specialty physicians, that they just, it's, they're compelled to provide quality care. And our techs, you know, all our lab techs, radiology techs, every, everybody coming together to make it happen. You know, and I think that's what really keeps them, keeps us going is because, you know, frustration, burnout, all of those things that are, that impact every healthcare organization, I think what keeps us going is that, is the passion to do what you are compelled to do.

Infirmary Health and Gallup

Lauren Hunter 9:34
I love that. That is so true. And Infirmary, you know, you are meeting with people at their most vulnerable state. And it is a matter of, How can we ensure our team is dedicated to help our patients through this time? And I love what you said too of, we are living our purpose out. We're living our mission out. And I want to explore that more with you today around how you're doing that. And I think a really good place to start around that is I'd love for us to just focus in a little bit on how, our history together as partners over the last 3 years, which is crazy. But really, you know, how you came to know us. I think the three of us and the other team members here at Gallup that partner closely together, we talk, I feel like most weeks, around, you know, what's going on. So I'd love for you both to share just a little bit more about your history with Gallup, and, you know, how you came to know us and work with us.

Jay Martindale 10:27
Well, we had been doing engagement surveys for years. And, and we, we realized about 4 years ago that we really needed, we wanted more from that experience. And so it wasn't just about a survey, and it really isn't with Gallup either; it's about engagement and living out everything we're trying to do around engagement every day. But we, we needed a partner -- not, not a vendor, but a partner that we could work with who not only would help us with the survey process, but also help us with resources. And that's one of the things that we were thrilled with, with Gallup Access, and the many, many resources we have, but also the work that we have with, working with Lauren and Lisa and others at Gallup that really help us learn how to put engagement into the culture of the organization, to the point now where we have it on our scorecard. And we have scorecards for our hospitals and our system, our clinic network, and engagement is on that scorecard now under the leadership principle.

Jay Martindale 11:28
So it's something that we make part of our meetings and obviously make part of our conversations with, not only leaders every day, but with our teams. And so we had, we wanted that. We needed that. We reached out to several national organizations, companies. And at the end of the day, the decision was made to partner with Gallup, and we've been thrilled and pleased with certainly that, since we started this journey 3 years ago. And, and, and looking forward to continuing that. So --

Chuy Ramirez 12:01
Yeah, absolutely. And, you know, one of the things that, if you remember, Lauren, when we all started, you know, one of our biggest things was really that our leaders have a mechanism to get their information at their fingertips. That was one of the, at least for me, it was one of the most important things. And that's what we have now. And, and kudos to you guys for everything that you do around it. One of the challenges we had after our first survey, if you remember, was the action-planning process. We, you know, on our end, because we use it so much, you know, we, we tend to think that it's very intuitive. But if you only use it, you know, maybe once or twice every couple of months, it's not as intuitive.

Chuy Ramirez 12:52
So we reached out to you all's reps, tech reps and stuff. And lo and behold, they fixed it. And now our, our leaders are all about putting in action plans, because it's very, it's, I don't want to call it easy. It's easy, the system, to put in an action plan; it's very hard to execute on it. But that's one of the things for me that, where we've come from. And Jay mentioned that, you know, we surveyed previously. And I think we generally went with what was out there at the time. And, you know, there was a lot of focus on leadership, on management, you know, so we had a lot of questions strictly about your manager this, your supervisor this. But if you look at the Q12® and the, and the hierarchy pyramid for engagement for Gallup, you can see that, even though you, you see leadership and management in there, it's really about the self. It's really about what, what's in it for me? What do I give? You know, teamwork. And I just think it makes all kinds of sense.

Chuy Ramirez 13:59
And then of course, there was, you know, our big ask at the beginning was, can we include our Patient Safety Survey? Because that's something that we do, you know, we have a couple of agencies that we're accredited with that require us to do that Patient Safety Survey. So again, you guys stepped up to the plate and put that together for us. And then we had our cultural questions that we added. So I think we went to a place where we're now, it's part of our, part of our being, you know. It's, when I'm working with a leader, you know, they say, Hey, you know, what do I need to do to check my action plans? Or what have you. It's like, it's right there at your fingertips, boom, boom, boom, and get a lot of, a lot of really good feedback about where we're at now.

Meeting Healthcare Challenges With Engagement Resources

Lauren Hunter 14:47
That's amazing. And it's incredible, too, Jay and Chuy, to just hear how you both articulate the Q12 survey, and how it's really, I mean, integrated into your culture and your scorecards, Jay, like you mentioned. And it's just part of your culture, as well as, Chuy, like you mentioned, the patient safety focus, which we'll explore more as well. But you both articulated that, you know, 4 years ago, you were looking for a new partner, right? And you were really focusing on, How can we have more than just a survey? Are there any particular challenges? If we go way back in time, 4 years ago -- I know that's a big ask -- but are there any particular challenges that you had 4 years ago, where you feel like the Q12 and the engagement process with Gallup has really helped and has really relieved some of those challenges that you had as a healthcare system 4 years ago?

Jay Martindale 15:44
You know, I think the Q12 benchmark is, benchmarking is very important to us as well, too. And I think Gallup has been able to offer that with the Q12. And those questions that, you know, we, that, that Gallup has built, and that we now have adopted and, as part of certainly our survey, our survey has many more questions than the Q12. But that is really at the core of what we're, what we do talk about the most, and two of those questions are on our scorecard. But I think that, you know, we've helped by using the resources that we have around those questions, they're helping our leaders really understand, you know, what does the question really mean? And how can you go back and talk about that with your teams and get them to buy in, right? We need that investment, that, that psychological investment we talk about, about being totally in, all in, being engaged.

Jay Martindale 16:40
But, you know, the benefit that we have with those Q12s is we've got the resources. And I'll tell you, the tip sheets that are in Gallup Access, I think, are one of the best resources that we have. And so we make sure that our managers have those at their fingertips, and that they can speak to it. So it's, it's not just the OD team coming in and talking about engagement, in every maybe a monthly meeting, but the managers have the resources at their fingertips. They can talk about every one of those Q12, Q12 questions. And then they can sort of drill down too, not only to the questions that we have, the focus that's on the scorecard, but also the things they need to be thinking about for their teams, right? How do they tailor an action plan or talk to their teams in the standup meetings about, about what's most important to them, and then how they're going to live that out every day and getting the team's buy-in. What do we want to work on? What's important to you? How can we help you be more engaged in what we do every day? So that's just a few thoughts around kind of where we were then and what we think, certainly my thoughts on the Q12 and how it's impacted us to this point that, as Chuy said, you know, having our leaders be able to get in and have it at their fingertips. So that's been a huge benefit to us, certainly, in the last 3 years.

Chuy Ramirez 18:01
Yeah, I think the, the questions are, are, they make sense. You know, they make sense. They start, you know, like I said earlier, with the first couple of questions about, you know, what, what are my needs, you know? Equipment, support, and then just how they, how they go through, I think it's important. One of the things that I look at, and it's important, like, like Jay said, to be able to look at where you sit in regards to the Gallup database, with our percentile rankings. But one of the things that I like to do from, from the get-go, when we get our results, is trend against ourselves. You know, how did we do on the last survey on any particular question? Because I think that's where our leaders and our staff will have the most impact. And if you kind of go with how it, I think it cascades, is if you do improve at the local level by question, then most likely, you're going to improve your percentile rank too. So we try to help our leaders understand that, you know, it starts here with you.

Chuy Ramirez 19:13
But, and we're seeing a lot of really, really great results. We had a, we had one department that, you know, if, they were, they were very low on pretty much all their, their scores on all the questions -- Q12, cultural, and patient safety. And we went in there and did a lot of work with them. You know, we used your resources and went in there and, and helped them out as a team. And I mean, it was night and day on the next survey. They had full percentage-point increases, which is, which is kind of rare; usually, you don't see that. But they just had the full -- and, and as far as leadership engagement for them, they were, the leaders were fully engaged; even the, even the physicians, they all, they were bought in, and they said, Let's do this. So we did a couple of pulse surveys, and they continually increased.

Chuy Ramirez 20:07
And so, and, you know, I think, it's kind of weird how human nature, sometimes, it depends on when you're taking that survey, you know, what kind of mood you're in that day, you know, what are the things that are happening around at that time? And we try to talk to our staff about that. We try to help them, you know, it's a point in time, for sure, when you're sitting down and actually taking it, but, you know, think outside the box a little bit. Think about in the last 6 months, in the last year, some of the things that we've done. So that's another communication piece that we send out, you know, since our last survey, these are some of the things that we've implemented, or we've done, just reminding our staff that, you know, we're always, we're always looking to do better. So --

The Q12 as Organizational Tool

Jim Collison 20:51
Chuy, I want to ask you a question. And oftentimes, when we think about the Q12, the questions themselves get embedded in the culture. We, it is an example at Gallup, we call ourselves, This is my Q10. Right? My best friend at work. We don't say, "They're my best friend"; we say, "Oh, you're my Q10." Right? Do you see examples where, have you guys seen any examples in there where those questions themselves become kind of the bedrock of the culture of, of, of engagement, and those terms start showing up, either in whole or in part, as people are talking, just in normal conversation?

Chuy Ramirez 21:29
Yeah, you actually hit the nail right on the head. That's one of the things, when we open up presentations, says, "Hey, I'm glad to be with my best friends!" But that was a really interesting, that, that was, we got a lot, as I'm sure you guys get a lot of feedback from different people, we got a lot of feedback on that question. It's like, because people were taking it literally, you know, literally your best friend. And so we just helped them understand, and we used part of our Patient Safety questions to, to help us with that. We have, one of our protocols in patient safety is, I've got your back. And that essentially means that you have your coworkers backs. And then we kind of took a little bit of a step further to say that, you know, you have someone at work who you can depend on, who you can rely on always, and they feel the same way about you. Maybe not necessarily the best friend, but that you have someone at work that you can confide in, and so on. And so we're making progress on that. And I think we've increased our score every survey on that. So that's really cool.

Chuy Ramirez 22:30
And we had a, we had a department-head meeting one time where we actually broke out the Queen song, "You're My Best Friend," and got a little bit of a laugh out of it, just to help them, you know, see, see where it's at. The, the other one is the recognition. In the last 7 days, you know, helping our leaders, you know, they have 50 or 70 or 80 people that report to them. You know, how are you gonna have a every-7-day recognition? So we just help them get creative. You know, it's, it's, they're, they're starting to understand, maybe it's not the 7 days, but maybe it's that I need to recognize my people for doing good work, you know, and it, but it's a prompt, and I think it works.

Jim Collison 23:23
Jay, would you add anything to that?

Jay Martindale 23:25
No, I think that Q04 question, praise and recognition, is probably the question that we, that really is embedded in the culture the most. And people laugh a lot, because we'll say, pay a compliment or share some appreciation for a teammate, and somebody will say, "OK, you're good for another 7 days," you know, so we kind of have some fun around that. But we're helping our leaders to understand that it's not just, it's not just the manager, right. That we can, we can give praise and recognition to one another as peers and on the team. And so, and so that's huge, because, you know, the work that a lot of our people are in every day is stressful, and it's demanding. And we, we want them to find opportunities that they can appreciate one another. And, and so that's something that we really have worked hard with, and that question has been on our scorecard the longest. So praise and recognition and, and helping our managers to keep that in front of themselves. And when they're, when they're, when they start a meeting, when they start any kind of a team meeting, that it, that they talk about opportunities to have praise and recognition in that meeting.

Jay Martindale 24:39
And so there's so many things to talk about in healthcare when you, when there's a department meeting, and operationally, that, that we just can't forget. We've got to talk about the team in the room. Right. So that one, and we're spending a lot of time right now on Q11, talking about performance, right. We want our managers engaging with their teams and talking about their performance. One of the things we've learned, and certainly, as new, new team members come in, they want to know how they're doing. They want to be, they want the opportunity to know their progress, and then how they can learn and grow. So we, we're working on that now. That's probably one of the areas we've focused on more in the last, last year. We're praise and recognition; then we're having a lot of fun around Q10, Best friend at work, and I think that, that question really demanded from us a lot of education. We really spent a lot of time around really helping leaders and our, all of our team members understand, you know, what that question is, is about in our culture. And it's not, it's not, as Chuy said, you know, the person you grew up with who was in your wedding, or whatever; it was, it was that teammate you can trust, rely on, depend on, confide in, has your back. And so that's helped us tremendously. And we do have a lot of fun around that question too, just like y'all have spoken about. So I would say Chuy's one of my best friends at work.

Jim Collison 26:07
Lauren, I want to throw it back to you here in just a second. But I love -- what I hear is the Q12 is a management framework that goes beyond a score twice a year, once a year, how, however people implement it. But it becomes a management framework to think through those things, hey, for managers, a tool. These are 12 things that are really, really important to my teams. And some, it gives me some priorities on which to work with them. If my team members don't know what's expected of them, I'm gonna have some really, some real problems, no matter whether I have best friends at work or not, right, in a lot of ways, because of the expectations. So Lauren, let me, let me throw that back to you.

Lauren Hunter 26:44
I just loved hearing that, and hearing, too, Jay, like you said, you and Chuy are best friends at work. And I, I can attest to that. I just have to share a really quick story. Chuy, Chuy called me once -- I think it was about last year at this time, actually. And I'm like, "What's going on?" You know, he emailed me; he needs me to call him this morning. I pick up the phone. "Hey, Lauren, are you free to join a Zoom call this afternoon to sing Jay 'Happy Birthday'?" I was like, "Yes, I will definitely hop on; we'll sing Jay 'Happy Birthday.'" But that is the perfect example of the Q10, Best friend at work, relationship and the two of you, and how everything that you're mentioning together is possible at Infirmary, really because of the work that you're doing, and the work your leadership team is doing, and your local level leaders are doing, to Jim's point, to ensure that the Q12 is not just a survey but a framework, and that recognition piece and that progress piece. So it's so exciting to hear that. I think something that a lot of healthcare organizations constantly wonder about is the idea of survey fatigue. And how often do we actually ask questions, to be sure we're having those right conversations? So I think people would be really interested in hearing about just your overall process, in terms of how often are you sending out the Q12 survey? Are you sending out any pulse surveys? From your perspective, I'd love to hear that.

Chuy Ramirez 28:06
Yeah, we do the annual in January. And then we do a pulse; we're actually going to do a pulse next month. We use the Accountability Index. And then we also add the Q04 and Q11. And what's really good for us -- and I agree with the survey fatigue, because we do other, we survey other, Corporate Compliance Survey, we do other surveys. And I agree with that. But I think a lot of it has to do with the communication prior to the survey, and why we're doing it. For us, the way I explain it, I explained it to a team last night, you know, We want to know from you how we are doing. You know, we, we want you to tell us how we're doing, with regard to your work life. And we want, and we really spend a lot of time helping our teammates understand that we care about their life, you know, that it's not, it's not just about work. We've got the tools and everything we need to help them with the work. But what about their life? You know, and we want them to understand that it's important to us, because, you know, we believe that if a person, to be engaged, they have to have that stability that they've got, they know that their organization is looking out for them and cares about them. And that's one thing we get out of that surveying. And so anyways, just kind of short answer to your question is, we do it, we do the annual survey, and then we do the pulse, like again, we're gonna do it next month.

Lauren Hunter 29:38
Yeah. I really like, too, Chuy -- and Jay, I want to hear your perspective as well -- but that emphasis on that presurvey communication, and emphasizing the purpose of this. You know, especially with it being on your scorecard, it's not about the survey, but about what are we going to do together after this? So, Jay, I'd love to hear your perspective too around if there's anything particular you're doing to really emphasize the communication around why this is so important to our culture.

Jay Martindale 30:07
Well, I think the leaders have to be bought in and engaged, right. And so we've seen that really kind of increase every year, to the point now where all of our hospital presidents certainly are, are, you know, are not only setting the expectations, but there's accountabilities around that, around what, why this is important. We've talked a lot about it now, so they know why we're doing it. And they know why it matters, right? You can't do anything, you can't achieve any goals on that scorecard without, without having engaged employees, engaged team members. So it's just important that we continue to, from the top, right, that in this organization, they know why we're doing this, right.

Jay Martindale 30:47
But the communication side is so important. There are so many competing priorities, right? There's so many demands on the time and attention of all of our team members, right, at every level. And so we're competing a lot with that. And we're trying to make sure that, OK, and all the things that you've got to talk about today, you've got to talk about engagement. But also, now we're going to, we're, we're having the survey -- whether it's the annual survey, or whether it's the pulse survey, we gotta get ready. So we start weeks in advance. We have flyers, QR codes, business cards, email communications, Constant Contact, just a lot of different things. And we're doing it in all the meetings.

Jay Martindale 31:33
We start talking about it in leadership meetings and saying, It's coming. Get ready. Get your teams ready. Do a follow-up from your last meeting, from your state-of-the-team meeting or talk about your action plans. Make sure you put this back on their minds, right? The teams need to remember, OK, we're getting ready to do a survey again, whether it's the polls or whether it's the census survey, and let's talk about those questions, get them out, let's start talking about them. And so we realize we've got to help the leaders, you know, help their teams keep it fresh, right? You know, because there's so many other things that will come the next day and the next day, the next day. And so this is just something we've got to, you know, you have to embed it in the culture. And when you do that, it gets easier. And it gets, it's getting easier for us every year. But there's still a lot of things that we have to, a lot of demands on, on the time and attention of our team. So we, we just put a lot of effort around that. And we're always looking for ways to improve that as well. So, but good question.

Managers and Action Plans

Lauren Hunter 32:38
Yeah. And Infirmary has had such great improvement, you know, and process with your Q12 survey, even just thinking back to where we were 3 years ago and understanding the dynamics of the Q12 question. And it's, or sorry, the Q10 question of the Q12 survey. And it's so fun to just hear how you already are articulating some of these examples of how it's in your culture. Chuy, I'd love for you, because I know that you're really focused on the implementation piece of action planning you referenced at the beginning. And it sounds like so many of your managers and leaders are completing action plans. It's part of your scorecard. Tell us a little bit about what that process looks like, and how the action-planning process has really become embedded into Infirmary's culture, compared to where, where you were 3 years ago.

Chuy Ramirez 33:23
Sure, like Jay said, our presidents probably have made the most impact. They are reaching out to us a lot more. They're, they're getting, getting us to help them with, with the postsurvey communication, getting the results out and all. And what we do, and this is really our executive leaders, with our assistance, put together the plan. So, for example, for this, the survey we had in January, the first thing we do is the executive, executive leader meeting with you all. And then we put, like, a little road map together for them -- in this case, by April 30, they had to have had a state-of-the-team meeting, where they roll the results out and discuss action plans and things. And they have to have an action plan implemented by May 31.

Chuy Ramirez 34:20
And so the presidents reached out to me and said, Can you give me a, a weekly report on where we're at? And so that right there tells me there's some accountability happening. And so giving them those, those reports on, you know, where their leaders stand on action plans, right. And I'll tell you, when that came out, I can't tell you how many phone calls or emails I got on a daily basis -- Chuy, Chuy, check, check my, can you check, make sure I got it in there? And, and it was awesome. I'll tell you, it was awesome to get to that point. And, and the biggest thing, I think, from the original 2020 to where we're at now was the structure of how you can go in there and put an action plan. Because it was a little bit difficult. And, you know, you guys invited us to be on the Advisory Board. And that's one of the things that we brought up was that it, it may seem intuitive, but it's really not. I mean, you have to go here, here, here, here. And we kind of said, you know, it'd be great if we could change that.

Chuy Ramirez 35:24
And sure enough, now, it's like, boom, boom, I think it's three clicks, maybe, boom! And the leaders will say, That's it! I got an action plan. I say, Yeah, you got your action plan; it's right there. You know, there's a lot more to it, too. But it's, and it's very intuitive, when you start thinking about tasks, you know, assigning tasks to people and all those things. But as our leaders are watching this and seeing this, they're thinking, Wow! This is, this is cool. You know, I can actually, you know, put somebody's name down there and give them this task and, and all that kind of stuff. And it's just the ease of it now. But I credit it, really, to our senior leaders, especially our presidents. We have one President, Mobile Infirmary, she is very, she, she just makes sure that all her leaders are on board with that. And, and our President Thomas, President at NBI, as well, they asked us to come and help them better understand the process and how they can get, get their leaders engaged. And so we've seen a lot, a lot of very good results from that, compared to where we were in 2020.

Accountability, Expectations Matter

Lauren Hunter 36:31
Yeah, definitely. And so the audience watching live too, Chuy referenced the Advisory Board. So just to kind of bring that to light a bit, a little bit, Jay and Chuy are from, you know, infirmary. They're on our Advisory Board. So we have a handful of clients here at Gallup who really help us as a team at Gallup understand what's working really well for you? What are some challenges that you're having? And Chuy mentioned, you know, Hey, here's something that we'd like to see implemented on the action planning tool. And it's something that our team has actually came back and really fully implemented. And, to your point, Chuy, I do think the action-planning tool looks really night-and-day difference from back in 2020. So that's a really good example of how Jay and Chuy are really a key client in helping us ideate to really meet that fast-paced healthcare environment that you all are working in. Jay, is there anything that you'd add, in terms of that action planning and holding people accountable, and how fast paced healthcare is? It's something that a lot of people run into challenges with.

Jay Martindale 37:33
You know, I think Chuy, Chuy, really did a good job, you know, speaking to that. You know, I just think the, you know, it's, it's, the accountability matters, right. And this, and accountability is not a bad word; it's, you know, it's just, it's just, we, you know, we have to be there for one another to say, OK, we gotta get this done. And for all the right reasons. And so, as I said earlier, too, from the executive team all the way down, I mean, it's the expectations are there. And you have to have the expectation that we, not only are we going to have the survey, but we're going to, we want a, we want participation. We want to, you know, we want everyone to have the, not only the opportunity; we want them to participate.

Jay Martindale 38:15
And you know, some employees, sometimes, as you, as you know, and I'm sure everybody watching knows, are reluctant to do surveys, you know, they, particularly when you're asking them very personal questions. And so, you know, we're helping the teams, the teams understand that, you know, this is a good thing. It's a positive thing. And one of the things that we've had to do -- and this is important -- is that you come back after the survey, the postsurvey. Chuy spoke about the postsurvey results. But then you communicate back to teams, not just at the department level, but the facility level, and say, We heard you. We're getting this information. We will take the verbatim comments that come back, and we'll summarize those, we'll theme them out. And, and then we'll, we'll get in front of the teams and the, maybe in some, in some town hall meetings that will follow the survey and talk about, We heard you. These are the things you told us that you need -- equipment, resources, whatever it might be, you know, security, safety, we need more lighting in the parking lots. I mean, that's one of the things that, that we came from January we're working on now.

Jay Martindale 39:18
So it was just, we, you've got to go back to your employees and tell them, you know, you know, we heard you. This is what we heard. And we're taking some steps and action on that -- not just at the, the unit level, but really at the facility level and at the system level. And so I think that's important, and that's a critical piece, we, you know, that, that has helped us. So there's an accountability now on the leadership to come back to, you know, everybody else in the organization, the team members, and say, We're doing our part. Thank you for participating. Now we owe you this back. So yeah, thank you.

Lauren Hunter 39:59
Yeah, I love how you said that too, Jay -- accountability really does go two ways. You know, it's something as an organization where we want our managers to action-plan and have conversations, but as a leadership team, Infirmary is doing such a great job at ensuring, Hey, we heard you, here's how we're going to, you know, security lights, or here's how we're going to focus more on recognition in our environment, or even expectations. That's something in healthcare right now that can be really difficult, with lower staff and more of the workload. I'd be curious, before we kind of transition into patient safety, How are you reinforcing expectations with a lower staff? I know it's one of the main challenges right now in healthcare. Is that a challenge, focusing on expectations right now?

Jay Martindale 40:43
Well, I think, you know, for us, we have some things in the organization, the culture at Infirmary Health, that, that are constant. And, and we start with those, right. We have core values, and our core values are leadership, integrity, family and excellent service. So from the day you arrive at orientation, we have to set those expectations. And we talk to them about, Here they are, and here's how we define them. But then how do you live them out? How do you really take action on living out these core values every single day. And then we have a customer service program, we call it DUO -- D-U-O, Do Unto Others. That's how we brand the program. And it has four attributes to that program: It's Attitude, Empathy, Communication and Accountability. And then we have our entire safety program that's got safety tools and safety behaviors.

Jay Martindale 41:31
So we really have, those are embedded in the culture of the organization. But, you know, they're expectations, right? These are expectations that we all have. And, and there's an accountability piece to this. And so when you're talking, now, when we're talking about engagement, whether it's with individuals and with small groups or with, with, in our large meetings or in our, just in our email communication, you know, we talk about, we have to sort of talk about it all together, right. And so the expectations never stop, right, on the things that we think make us the market leader, and we are in southwest Alabama, in our area of the world. We're excited about that.

Jay Martindale 42:11
You know, when you have half the market, that's, it's, you have to earn it every day. And the things that we have to practice every day around our core values and around DUO and around our safety program, everybody has to understand those, and they have to -- as best we can help them -- live those out every single day. And if we do that, and they're bought in, the engagement piece happens. And so I guess it's connected in that way. So expectations are important. And, and our questions over the last several years have shown that we do a pretty good job at that. That's probably our highest-ranked question, if I'm not mistaken. But we, we can do better. We always are looking for ways to improve. So some additional thoughts on expectations.

Chuy Ramirez 42:55
Absolutely. And, and just to add to what Jay just said, there are other things that we do. For example, right now, we're really putting a lot of focus on workplace violence. And it comes from different areas. So we've got, that's a huge program for us, because our employees said, Hey, what are you doing about it? So we're doing, doing a lot around there. And then again, you know, at the end of the day, the majority, if, I'm sure all, feel that it's a calling. You know, it's something that they feel it's, it's a value to them to help others. And I think that definitely helps with, with all of the other challenges.

Lauren Hunter 43:39
Yeah, yeah the values, tying that right in to the expectations, especially with Infirmary and having more than one just stand-alone hospital, right, you can run into microcultures really easily. So it's, right, so it's really, really good to hear, you know, here's how we're living out our mission, our vision, our purpose and our values every single day, across, you know, our healthcare system in its entirety.

Chuy Ramirez 44:03
That's, that's huge. That's huge, because it brings alignment. You know, it Mobile, Baldwin counties, they differ, just like, I'm sure in Nebraska, different counties, different demographics and things like that. And we're no different. But what the Gallup survey does is, gives us alignment. You know, we're speaking the same language throughout the system, you know, through our clinics to the hospitals. And so that's another plus that we get from the survey.

The AHRQ Survey and Patient Safety

Lauren Hunter 44:31
Yeah, that's, that is great. And it's really, you know, it's common language. And, like Jim and we were all talking about probably 20 minutes ago is, it's the survey, but it's also the elements that your managers can use across all your healthcare systems, when it comes to having a meaningful conversation, as well. So it's great that it's been implemented in that way as a framework. Switching gears just a little bit because we've really emphasized engagement, but at the beginning, I know we were talking a little bit about safety, and how that is always a priority, no matter what, in healthcare. For the crowd, just so they're aware, Infirmary uses both the Q12 survey and then Gallup's, what we call our AHRQ Patient Safety Survey. Jay and Chuy, I'd love for you to just talk a little bit more about how you're using the AHRQ survey to focus on safety within your organization.

Jay Martindale 45:25
Well, I'll start, and then I'll hand it over to Chuy. But, you know, it, we've been on a safety journey now that we're on, the kind of journey we're on now, since 2013. And for those of, that are watching that maybe are not in healthcare, that so many, many patients across the country every day get, are harmed or hurt or injured. And, and so just good people making simple mistakes. And so it's something that we vowed that we were going to do, work really, really hard. And, gosh, since, since 2013, we have reduced our serious safety event rate by 80%. So, but, you know, it takes time to do that and embed that in the culture of the organization.

Jay Martindale 46:08
So we knew that not only a focus on the safety culture, but understanding, you know, when you're, when we're doing safety surveys, asking those questions, and then, and making sure we, we're acting on the information we're getting back -- not only has the question rated, but what is the, what is the team telling us? How do we need to get better at this every single day? And I mentioned the safety behaviors and safety tools. And so, but we, we're thrilled now that we, we're able to combine the safety survey with the engagement survey. So we have taken advantage of Gallup's 9 safety questions that, that obviously meet our standards for Leapfrog and some other, other organizations that we're affiliated with. But now we can do this one survey, and it's all together. And so back to the survey fatigue, it takes some of that away. And it helps us, we have an Employee Engagement and Culture of Safety Survey -- that's what we call it. So with that, I'll, Chuy, I know has worked very closely with our safety questions. And so, Chuy, I'll let you comment on that as well.

Chuy Ramirez 47:18
Yeah, and I really want to do a shout-out to you guys again for the work that you did for us when we started. If, I don't, I don't remember exactly how it worked, but it wasn't part of the survey or site. But your team did a lot of work for us to get that put in there. Because that's, like Jay said, it's a requirement for, for organizations like Leapfrog, they require that we that we do the AHRQ survey. And you all did the work with the AHRQ, to make sure that we, that the questions were according to how they want them, because, you know, they're very, very specific -- especially the ones that are reverse coded. And we do a lot of work with our, our staff as well, to communicate the ones that are reverse coded; that, you know, you do want to get a bad score on that -- bad score is better,

Jay Martindale 48:08
Lower score is better.

Chuy Ramirez 48:09
Lower score, excuse me. But, and I think one of the things that has really been embedded now, because we've been in this journey for so long, is that you want to do good. You want to get good scores. You want to be Leapfrog-accredited. All of those things are good. But that means that if you're doing good in those areas, that you're doing good by the patients. And at the end of the day, that's what really matters. You know, so we have these things in place. We want to do great, and we want to be recognized. But at the end of the day, we're getting good scores, it means our patients are doing well. And we're doing right by our patients. And to us, that, you know, I think, I would say that's probably the most important thing.

Jay Martindale 48:56
Absolutely, yeah.

Other Areas of Focus at Infirmary

Lauren Hunter 48:57
Definitely. It really is. And that's where it's so critical, you know, that -- I love how Infirmary views this "engagement survey" -- I'm kind of putting air quotes up -- as more of a cultural, how are we really, not only affecting our employees, but our patients. And you're doing such a great job at that, because they're the core of every single thing, you know, that you're doing as a healthcare system. So it's been incredible to see how you've used the AHRQ survey, you know, in combination with the engagement survey. Are there any other particular questions that you're asking? You know, I know you're asking some questions around wellbeing and respect in the workplace. Are there any particular areas that you're really focusing on right now at Infirmary, outside of that engagement and patient safety piece that we've talked about today?

Chuy Ramirez 49:45
I think it's the work-life questions that we ask -- the, basically, you know, How are we doing around diversity? How are we doing around, you know, our culture? You know, do, do we educate our people? Do, how do they feel about, do, are we concerned with their work life? So we have the 6 questions -- we had 5 before, but we added the 6th question on the last survey. And I think people appreciate that. You know, it's just, it's really focused on work life and the work experience. That, you know, Infirmary Health is an organization that cares about you. That it's, we want to do great as a system, we have a mission, we have a vision, but we care about you. And we want you to enjoy working here, you know, that, that it's a good work experience. And, and obviously, one, one of the best ways to do that is, How are we doing? We ask our team, our staff, How are we doing? Where can we improve? And we act on their feedback, that we put action behind their feedback.

Lauren Hunter 50:59
Yeah, I can hear, Chuy, when you just mentioned that I can hear the leadership, the excellent service and the family, all those values, I can just hear it coming out around how you're ensuring that we're acting on everything. Jay, is there anything that you'd add there around different areas that you're really focusing on besides that work-life balance, and the diversity, equity and inclusion aspect?

Jay Martindale 51:21
You know, those are, those really are important to us, in addition to, we're talking about engagement and, and safety. I think we did take Gallup's recommendation and added that third diversity question, and I'm so glad we did. You know, you want to, you want to, you know, in this day and time, you know, people need to feel like that they're, you know, no matter who they are, where they're from, what they're like, that they're welcome in the organization, they're part of the team, part of the family. And so we want to make sure that people feel like they're respected, they're treated right, and in no way in any way that they're treated any differently than the person next to them. And so we work hard at that as well.

Jay Martindale 52:03
And so we have, we have those 3, 3 questions that we focus on that that, that Gallup has provided for us. And so that's been helpful. And I think just, to Chuy's comments, I mean, we're just continually wanting to create the right place, right, that people want to come, and they want to be a part of this. And, you know, that's just, you know, people, I don't know, you just, you know, in the market today, in the labor market today, there are places, other places you can go work, right. So we want people to want to come, be here, want to be a part of this organization, share in this journey with us, and, and, you know, we've got to create the right place, provide the right leadership and the tools and the resources. And certainly, all that makes up the culture, you know, what, what, you know, that people want to come and hopefully be a part of, you know. We're, the job's never done; we got to keep working at it every day, as just part of something that we strive, we have to get up and continue to make a difference. And, and so that's, that's what our goal is.

Chuy Ramirez 53:09
Yeah. And just kind of to add to that, Jay mentioned, the, the market share and all, and we have the technology that any other facility has. We have, you know, staffing levels, everything else, but our differentiator for us is our people. And that's why I think we have the market share is because of, of our people. You know, we have a reputation in Mobile and Baldwin counties and, and even other outlying areas, we have a reputation of being that organization that has the people that make the difference. You know, it's the, it's the patient experience that, what, what they get from Infirmary Health, and I think it's driven by the people.

Lauren Hunter 53:53
Absolutely. Yeah, the, Jay and I had, we owe each other a jinx there. But it is. You know, it's the people that drive everything in your organization and, and for your patients. It's just so critical. I know we only have a few minutes left here, so I just have, I have a couple more questions in our, in our last couple minutes. But you all have just provided so many great examples today of what you're doing to build such incredible momentum on your engagement results. I just feel so lucky to work with you each day and see the progress that you're making and the impact that you're making on your patients. But I'd be curious from both of you: What, what are you most proud of, when you think about the momentum that you're making on your engagement results and your patient experience?

Chuy Ramirez 54:37
Well, for me, it's the opportunity to engage with our staff. I mean, it would be great if we could just go and meet with everyone every day, but we got 6, over 6,000 employees. But every opportunity that I get to go out, and if it's driven because I got to go out and talk about the engagement survey, then that's, that's great, you know. It's just being able to go out and talk to our staff, the people that are out there doing the work, you know, that are face to face with our patients and face to face with our clients and our customers. You know, just to see them in action, that, to me, it's awesome that I get to be in part of this and putting it together logistically and framework and all of those things. But to be able to go out and meet with staff, because I'm gonna go talk to you about engagement, you know, that's, that's, for me, where really, where I get my momentum and my passion. And that doesn't mean at the end of the day that I kind of like slump down and think, OK, what a day! But tomorrow will be a new day. And hopefully, I'll get those opportunities again.

Jay Martindale 55:53
Chuy said it so well. I mean, you know, it, what are you, what are you proud, what are you most proud of? And I think he and I get a lot of energy and, and, and satisfaction by going and having these meetings and conversations. And I think when you see the light come on, I think that's probably something that gets exciting for us, when we, when we, when they begin to kind of speak it back to you. Right? The, the leaders and the teams begin to talk about, they, they say the words, they use the language, and that you have, you have talked about, and we've tried to communicate for several years, and it begins to come back to you, right. They're not, they're talking to you about the Q12 questions; you're not always doing the talking. And so, that's exciting, and to see it, to see that the learning is happening and that they are multiplying that and sharing that information with, sharing all that knowledge and with the people that they are entrusted to lead every day.

Jay Martindale 56:50
And so I like it to see it when the light comes on in, in so many ways, because it takes time for some people to really kind of get, get bought in and understand it and what we're trying to do. But that, that really engagement has just been part of our culture now, like so many other things, right? There was a time we didn't talk about engagement like we talk about it today. We talked about patient satisfaction. We talked about safety. Now we're talking about engagement too, just as much, and that has been a huge accomplishment for us. So one of, that's certainly something we're very proud of. And thank you to Gallup for being our partner.

Looking Ahead

Lauren Hunter 57:28
Yeah, of course, no, that is, that is huge. And it's really, you know, you that are in there day-to-day that are having those conversations that are making it possible. So that's just, it's just been amazing to hear all the examples. My last question for you both, just in our last few minutes here: What's next for Infirmary? So what are your next top priorities? What are your next goals? What are you both most excited about that's coming up here for you?

Chuy Ramirez 57:54
Now, for me, it's our growth. I mean, golly, just next Tuesday, I'm gonna go meet with a physical therapy clinic in northern Mobile, Saraland. You know, and when we meet with our executive leaders, and they have town halls, and they talk about all the things that we're doing, it's like, golly, it's, it's, it's really just exciting to be part of that. You know, I go around town and drive around, and I always wonder, I see, I see a little kid running around and wondering, did you, were you born in our hospital? And more than likely, they were. You know, we've got tons of employees who are employees now that were born in our hospitals. That's, it's just, and then, and then, of course, it's just being a part of an organization that gets help, get, gets to help people live a better, more quality life. That's, that's pretty exciting, to be able to say I work at an organization that does that. Yeah.

Lauren Hunter 58:52
Yeah. Mission critical. Absolutely.

Jay Martindale 58:54
Yeah, our growth and development, I mean, it's, it's, you know, it, the health system is expanding. And, you know, we're adding service lines in our Neuro and Vascular Institute and our orthopedics and our cancer care program. It's just exciting to see what's happening, our physical presence and our footprint. Baldwin County has really become a destination. We're located right here on the Gulf of Mexico and beautiful Mobile Bay. And so we're getting a lot of people from across the country who are retiring to this area. And some of us that grew up here, you know, it's getting a little crowded, but it's a beautiful, beautiful part of the country. And we're excited about that. The challenge for us is taking care of this community. We are a community-based health system -- not-for-profit, community-based health system. And so our job is to take care of our friends, our family and our neighbors. And so, you know, we have to do that every day. And, you know, we just got to meet the demand, you know, and we're working really, really hard to do that and look into the future. Where will this, our healthcare system need to be in, in 3, 5, 10 years from now? So it's exciting to think about it. It's a little, you know, there are challenges here. But we, we're up for the challenge. We're excited about the future, and, and engagement will be part of that. There's no question -- it has to be.

Lauren Hunter 1:00:01
Well, I'm excited about the future too. And I just want to thank you both so much, Jay and Chuy, for spending an hour with us this morning to celebrate all the incredible accomplishments that you have at Infirmary. And I am thrilled to partner with you day in, day out to keep reaching these goals.

Chuy Ramirez 1:00:39
Thank you.

Jay Martindale 1:00:40
Thank you a lot.

Chuy Ramirez 1:00:41
Thank you very much for the invite.

Jay Martindale 1:00:42
Thank you, Jim.

Jim Collison 1:00:42
And I'll thank both of you as well. Thanks for coming on here and being a part of it. Always great. I'm always get excited, I always get inspired when I hear what our customers are doing, you know, both in the United States and around the world. And so thank you guys both for taking the time to do that. You guys hang tight for me one second. With that, I'll remind everyone listening, take advantage of all the resources we have available -- you guys mentioned it several times -- in Gallup Access head out to You can log in there. Or there's information around Gallup Access, if you want to see it there and check that out as well. Follow us on any social platform by searching "Gallup" or "CliftonStrengths." Love to have you do that; a lot of resources out there as well. And want to thank you for joining us today. If you found this helpful or if you got questions, you still have questions, you can always send us an email: Thanks for coming out today. With that, we'll say, Goodbye, everybody.

Lauren Hunter's Top 5 CliftonStrengths are Developer, Positivity, Arranger, Responsibility and Individualization.

Chuy Ramirez's Top 5 CliftonStrengths are Developer, Positivity, Belief, Responsibility and Achiever.

Jay Martindale's Top 5 CliftonStrengths are Belief, Arranger, Developer, Responsibility and Connectedness.

Learn more about using CliftonStrengths to help yourself and others succeed:

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