Individual vs. Organizational Engagement

Recently we’ve been exploring the idea of engagement on the blog. Last time we defined and outlined the idea of flow, as made popular by Mihaly Csikszentmihalyi. We know that the ability to achieve a flow state regularly in one’s profession is a key indicator of a physician’s ability to engage in their work. It follows that achieving a flow state consistently should be (so often it’s not!) a priority of organizational management and leadership. 

Yet, engagement is more than just flow. Engagement is one of the most positive aspects of human experience and wellbeing. While scientific study of personal engagement is a relatively new field, workplace engagement has been studied and dissected for much longer from the leadership and management perspective. There is a clear divergence between research aimed at understanding individual engagement and other research pointed toward organizational engagement. While the outcome of a fully engaged organization and a fully engaged workforce may look similar, the pathway to arrive there is different indeed. Put succinctly by Tom Morin of Work Feels Good, “organizations need performance, individuals need support” (Morin, 2017). The outcome looks the same, but the motivations and pathways to arrive there are separate. 

Organizationally focused studies generally stress the needs of the organization and the leader’s performance. As Morin indicates, the focus is on performance rather than individual wellbeing. But physician leaders must also commit to uncovering how engagement, or lack thereof, affects physicians and what both organizations and they as individuals can do to enhance it. Engagement is a two-way street—it cannot exist effectively without both parties understanding the other’s experience.

Lack of physician engagement is not a new problem. Studies going back several decades note lack of physician engagement as a challenge common to hospitals and health organizations. From an organizational perspective, Gallup defines engaged employees as “those who are involved in, enthusiastic about, and committed to their work and workplace” (2020). Or, in more detail: Employee engagement is the emotional attachment employees feel towards their place of work, job role, position within the company, colleagues and culture, and the affect this attachment has on wellbeing and productivity. Employees who feel emotionally connected to their positions are more likely to go the extra mile, remain loyal, and perform to the best of their ability. This emotional connection is the anchor which keeps employees motivated during difficult economic and personal times.

Though engagement can be defined easily, lack of engagement is slippery, elusive, and difficult to identify. Few leaders wake up in the morning feeling the need to engage physicians. And fewer still stay up at night worrying about lack of engagement. Yet, the fallout from lack of engagement, shows up clearly in these three categories: employee turnover and satisfaction, leadership performance, and customer satisfaction. And a sizable amount of money is tied to the success or failure of these measures.

Long term studies show that in the U.S. employee engagement ranges from 30%, and Gallup studies show that engagement among US workers is on the rise, which is encouraging. But engagement exists on a spectrum. The 2018 results, highest in Gallup’s history, showed 34% of actively engaged employees and 13% of actively disengaged workers, still leaving 53% percent of disengaged workers (2020). Satisfied enough to show up for work, but only motivated to achieve the required minimum. Over half of polling respondents self-reported to be disconnected from their workplace and likely to leave for the next best opportunity, adding to the problem of turnover.

Here, studies by Maslach et al provide a bridge between organizational engagement and the individual. The Maslach Burnout Inventory (MBI) and its twin Areas of Work/Life Survey (AWS), measure engagement on a spectrum from engagement on one end and burnout on the other. In between are the employees who are ineffective, overextended, and disengaged. Just as the components of burnout are exhaustion, cynicism, and inefficacy, the opposite – energy, involvement, and efficacy – are the components of engagement. The burned-out people on one end of the spectrum succumb to their situation while engaged workers on the other end thrive. The leftover 53% in the middle are languishing, neither fully burned out nor thriving at work. This view focuses organizational understanding of engagement on the individual.

The Importance of Engagement to Individuals at Work

Personal Wellbeing.

In the last two decades, the concept of flow has been integrated into the five elements of wellbeing: positive emotions, engagement or flow, positive relationships, meaning, and achievement – PERMA (Seligman 2018). This is the state where human beings flourish. The construct of wellbeing is conceptualized two ways – subjective wellbeing (SWB) and psychological wellbeing (PWB). Both types are necessary for survival, strongly related to each other, and affect each other. SWB focuses on the hedonic aspect of wellbeing: the pursuit of happiness, pleasure, and fun. PWB, on the other hand, focuses on eudemonic wellbeing: the fulfillment of human potential and search for a meaningful life.

Engagement, the experience of flourishing and thriving, is an essential part of PWB. Engagement helps humans flourish by broadening experience and building the foundation for future experiences. To move from burnout to engagement, it is important to understand the human experience of engagement, and what it means to be engaged. At the individual level, flow best explains the experience of engagement and is absolutely necessary for PWB and engaged individuals in the workplace.

Personal Productivity.

Having flow makes life more meaningful, improves positive emotions, gives a sense of achievement, and improves overall well-being. Naturally, in such a positive environment, individuals are more productive, as they enjoy what they do.

Reduces the Chance of Burnout.

Long-term studies on burnout show that burnout does not have a cutoff, rather it exists on a spectrum. Maslach, Leiter et al recognize person-job mismatch to be the root cause of burnout and lack of engagement and outline six different types: workload (too much work, not enough resources), control (micromanagement, lack of influence, accountability without power), reward (not enough pay, acknowledgment, or satisfaction), community (isolation, conflict, disrespect), fairness (discrimination, favoritism), and values (ethical conflicts, meaningless tasks) (2014). The higher the mismatch, the greater the burnout. Accepting this as true, any burnout mitigating strategy cannot have lowering burnout as the only target, but must include engagement creation as an equal or even primary goal.

As a physician leader, you may feel frustrated with the lack of engagement you see from employees. You’re regularly anxious that your physicians will quit and leave you short-handed. Or, even worse, you’re disengaged yourself and this lack of enthusiasm is visible to your team. How can you support the physicians on your team so they become more engaged? How can you on an individual level become engaged in your work daily?

You need help. You need support. Returning to Morin’s quote from the beginning of this article “individuals need support” (Morin, 2017). Support can come in no better form than someone who has helped hundreds of physician leaders and organizations engage employees. Someone like Harjot Singh. 

If you’re ready to maximize your leadership potential and provide opportunities for your team to thrive in the workplace, I invite you to participate in my 5-Day Challenge: Coach Yourself! Becoming a leader is not an overnight process, but a slow and steady commitment to create and fortify a culture of learning and growth in the workplace -- starting with you. 

References and Resources:

Csikszentmihalyi, Mihaly.

1975. “Beyond Boredom and Anxiety.” San Francisco: Jossey-Bass Publishers. Retrieved 3 September 2020.

Csikszentmihalyi, Mihaly, and Isabella Selega Csikszentmihalyi.

1992. “Optimal Experience.” Cambridge: Cambridge University Press.

Csikszentmihalyi, Mihaly, and Isabella Selega. Csikszentmihalyi.

2000. “Optimal Experience: Psychological Studies of Flow in Consciousness.” Cambridge: Cambridge University Press.

Csikszentmihalyi, Mihaly.

2008. “Flow, the secret to happiness.” Filmed October 2008 in Long Beach, CA. TED video, 18:55, https://www.youtube.com/watch?time_continue=15&v=fXIeFJCqsPs& feature=emb_title.

Csikszentmihalyi, Mihaly.

2009. “Flow: the Psychology of Optimal Experience.” New York: Harper Row.

Geirland, John.

2017. “Go With The Flow.” Wired. Conde Nast, June 4, 2017. https://www.wired.com/ 1996/09/czik/.

Goleman, Daniel.

2013. “Focus: The Hidden Driver of Excellence.” New York: HarperCollins, 2013.

Jain, Saurabh.

2018. “Education Needs Flow.” Medium. Medium, January 13, 2018. https://medium. com/@skjsaurabh/education-needs-flow-bdc08c659baa. Used with permission from Saurabh Jain. fun2dolabs.org.

Liddel, Henry George, and Scott, Robert.

2007. “A Greek-English Lexicon.”  London: Simon Wallenberg Press. http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057% 3Aentry%3Dkairo%2Fs1. Retrieved 3 September 2020.

Maslach, Christina, and Michael P. Leiter.

2014. “The Truth about Burnout: How Organizations Cause Personal Stress and What to Do about It.” San Francisco: Jossey-Bass Publishers, A Wiley Imprint.

Scott, Susan.

2017. “Fierce Conversations: Achieving Success at Work and in Life, One Conversation at a Time.” London: Piatkus.

Seligman, Martin.

2018. “PERMA and the building blocks of well-being.” The Journal of Positive Psychology. DOI: 10.1080/17439760.2018.1437466

McCambridge, Jim, Witton, John, and Elbourne, Diana R.

2014. “Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects.” Journal of Clinical Epidemiology. March 2014.

Medical Group Management Association (MGMA).

2018. “Practices are slow to adopt staff engagement programs.” Post: February 20, 2018. Accessed August 3, 2020. https://www.mgma.com/data/data-stories/mgma-stat-poll-practices-are-slow-to-adopt-staff.

Tom Morin, Work Feels Good Blog, 2017. Accessed 12 February 2021. 

https://workfeelsgood.com/commitment-vs-engagement-why-we-stay-at-a-company-and-why-we-perform/