The Engaged Workforce... Proven Strategies to Build a Positive Health Care Workplace, by Jo Manion (with contributors Sharon Cox and Mary G. Jenkins). Chicago, Illinois: Health Forum, Inc; 2009. Softcover, 450 pages, $69 for AHA members, $86 for nonmembers.

If you are serious about engaging your workforce, then this is a serious book on how to do so. Creating a positive work environment is at or near the top of agenda of most healthcare leaders. Actually doing it requires both an understanding of the multiple complexities of workforce issues, organizational culture, and the never-ending cycles of supply and demand of healthcare experiences and the discipline and commitment to do it. The author, with the help of 2 contributors, takes an evidence-based approach to address such questions as why an engaged workforce is important and which strategies are proven to work. Key for me was the author upfront, in the Preface, removes the onus of responsibility for work environment solely on the manager to a shared responsibility of the manager and the employee, both supported by the organization. The author states:

In fact, a primary working premise of this book is that the possibility of a positive work environment exists only when there is an active and dynamic state of interdependence among the organization, its leaders and managers, and its employees. (p xiv)

This in no way means that we do not need to develop our managers, but quite the contrary. Teaching managers tools such as appreciative inquiry, developing support networks, polarity mapping, and shared decision making or developing healthy relationships is still important to achieving the goal. All this must be done while coaching them in successful leadership behaviors. An entire chapter is devoted to a manager's or an organization's greatest challenges, which is influencing and managing performance. Here the author goes directly to one of the most frequent questions I am asked by young managers: How do I manage problem behaviors? Students of leadership accept the positive concepts, but they always make sure you address the difficult questions as well. The author does this throughout the book. Toward the end of the book, the author even devotes a chapter to hospital leaders, who say, "We are unique." So whether you have a manager or leader for whom "but" is the operative word, this will be a good book for them.

The book is divided into 3 parts:

1. Foundations for Understanding Engagement in the Workplace

2. Strategies and Interventions for Creating a Positive Workplace

3. Special Challenges

There are 12 chapters, 51 figures and tables, and nearly 20 pages of single-spaced references. Figures include surveys you can use to help gather data about your organization. At the end of each chapter, there are a conclusion and a list of questions for discussion and learning. At a first glance, the book has appeal for the student of leadership and/or organizational development because it is written from the perspective of a leader and so heavily referenced, drawn from credentialed sources within and outside healthcare. For the student of organizational learning, it is a handbook of questions, stories, and illustrations laid out in an objective thought-provoking style for teams to try and learn. In fact, there is a whole section devoted to teams and, in particularly, leadership teams. For the operations leader, it is a reference book for reflection on critical components of a complex equation needed to achieve the engaged workforce. Commitment is a 3-dimensional map: the organization, the manager, and the employee.

For example, a nursing director of a clinical division could have 8 to 10 managers, who, in turn, each have an equal number of assistants and charge nurses. Skipping over the discussion about how many titles, what these titles mean, and how many titles each director has under them, let us go to a question in the book. Take the first question in chapter 2: "Understanding why people work." With this book, the nursing director has the discussion laid out with references and easily understood yet complex answers to the question. So in that sense, the book becomes a tool you can reach for before you start the discussion or someone pops up: "people work for the money." If we were to accept the first assumption without evidence to the contrary, this small group could easily proceed to the wrong solution for recruitment and retention.

This was a simple example. Let us take a more complex suggestion in the book. Let us assume this same director would like the managers to share more of the responsibility for the performance of their units and for the whole division. We hear the need for this at many conferences and then we come back to work and say how. Chapter 7 of part II is "Creating Community at Work." In this chapter, there is an intervention idea called Collective Leadership Through the Development of Leadership Teams (p 207). Imagine having a small team that works with the director to collectively perform the leadership function of that division. The same thinking can be applied to the managers and their assistants or, in fact, to any department. The theory behind teams for the chapter is actually a favorite book of mine, The Wisdom of Teams by Katzenbach and Smith (McKinsey & Co, 1993). To achieve the learning behind this one chapter, you will have to read it. But because the author has chosen to make every chapter evidence-based, you have access to sound academic thinking without having to own all the books and articles behind it.

There are obviously other approaches to an engaged workforce. Magnet for nursing seems successful. Balanced scorecards and strategy maps are working for many organizations. Jo Manion's book is capable of doing the same. Have you calculated your turnover costs? Have you examined your patient safety data for an "engaged" staff? Does your workplace support the 5 intrinsic motivators for why people work? Have you seen new programs fail and were not certain why? Do you see a gap between the generations? Are your boomers about to retire? Most important, do you want to be the hospital or organization with the best and the brightest in an industry where knowledge is power and caring is the competitive edge? If that is your vision, you will need to choose how you get there. At the very least, this book will get you thinking. And chances are that you will not only read the whole book but also find yourself highlighting things in every chapter, just as I did.

Elizabeth (Betty) Falter, MS, RN, CNAA, BC

President Falter and Associates, Inc, Tucson, Arizona

Endnote: Following is a press release from the International Council of Nurses and the Society of Nursing, Sigma Theta Tau International. For free, they are offering both a reading guide and a continuing education test to all nurses worldwide. The guide is intended to help with retention. Coaching can be a very powerful retention tool.

Geneva, Switzerland, May 25, 2009-The International Council of Nurses (ICN) and the Honor Society of Nursing, Sigma Theta Tau International (STTI) have released a free resource titled Coaching in Nursing Workbook available to nurses around the world. This tool is a hands-on guide that can be used to teach nurses coaching principles and skills in order to develop individual professional competencies and improve nurse-staffing retention. Six International Continuing Nursing Education Credits and/or STTI's American Nurses Credentialing Center accreditation are available online and free of charge from the ICN and the STTI. You can access the workbook and the test on the ICN Web site at http://www.icn.ch/coachingworkbook.htm. The workbook is also accessible on the STTI Web site at http://www.nursingsociety.org/Ceworkbook and the test at http://www.nursingknowledge.org/stti_ce/MOC062b/moc062b_index.html.