In 2020, at the height of the pandemic, University of Missouri Healthcare decided to move its Women and Children’s hospital from its location on the East side of town to single centralized campus.  Within weeks a dozen project teams went to work.  In daily huddles, they mapped out the entire project.  From large scale concerns like security, safety and clinical service, to granular decisions such as which way cabinets should open, no detail was overlooked.  Care was made to include the nurses and physicians in decisions.  Internal communications were beefed up to ensure daily talking points were on hand.  The learning center offered classes on change management and agility.  The CEO and other leaders rounded frequently with employees to share progress.

And yet throughout the organization there was a growing sense of uncertainty.  Despite all the best efforts of talented and capable leaders, a slow exodus of talent began.  Within 5 months of the decision to relocate, the CHRO, COO, Executive Director of Talent, Director of Employee Relations and many fifteen year veteran nurses and staff quietly exited the organization.  Why?  What was happening?  Well, the short answer was that it was the year of COVID-19.  The less obvious answer was more complicated.

High-performing employees battered by a year of political, racial, social, economic and public health uncertainty and months punctuated by mandatory furloughs, budget cuts, vaccine roll-outs, the opioid crisis and compassion fatigue finally caught up.  The workforce, in a word, was exhausted. 

Students of Lewin, Kotter and other change masters are familiar with change management theories and best practices such as Hiatt’s ADKAR model and the Kubler-Ross grief cycle.  These and other models of human response to change all proved insightful… to a point.  

The most effective model turned out to be a practical application of the SCARF model of social threat from the Neuroleadership Institute.  SCARF helped explain what was going on beneath the surface.  After a year of daily having their status, certainty, autonomy, relatedness and sense of fairness challenged, the majority of healthcare workers needed help.

That help came in the form of intentional dialogues.  First, frontline leaders were trained in NLI’s SCARF principles and learned how to manage their own social threats.  Next those leaders were deployed to engage staff in personal conversations about their immediate needs.  The net effect was the perception that “management” really did care.  And the proof soon followed.  A daycare was created so Nurses had a place to bring their kids.  Wellness programs and resources were brought in and staff who had previously been cynical, began to seek out information.  

The key to success was equipping frontline leaders to create these one-on-one authentic dialogues.  At mid levels in the organizational hierarchy, all the leaders were in project planning meetings 6 days a week and willing but incapable of quality face-to-face interactions.  At higher levels, top leaders were unable to feel the disconnect because their immediate SCARF needs of status and certainty were being met. 

Where these dialogues occurred, staff hung tight.  In some cases, even staff who had previously left but heard about these efforts returned to the workforce out of a desire to work for leaders who took their needs seriously.  Where a top down only messaging strategy was used, turnover stayed high.  In another year that top down internal messaging might have been sufficient, but 2020 required a different kind of communication and MU Healthcare found a way to provide it.