Employee satisfaction and engagement are intangibles every institution wants to possess, especially with the daily stresses of hospital work. But they're more than just buzzwords—the time will come when every organization has a choice between genuinely listening to their employees and merely giving lip service to terms like "inclusiveness" and "open door policy."

I was reminded of these hard choices during last week's ACHE 2011 Congress in Chicago. During her keynote address, Commonwealth Fund President Karen Davis discussed efforts to drive employee engagement at El Camino Hospital in Mountain View, Calif., which ultimately led to recognition by the Commonwealth Fund as a top-performing institution.

When I interviewed Davis later in the week, she pointed to a critical moment in the evolution of El Camino Hospital—when the hospital had to choose whether to retain a difficult physician that staff had repeatedly complained about.

The hospital chose to let the physician go—Davis said, a clear sign to staff that leadership was not only listening to employees but willing to act on their feedback. Davis, an economist by background, had expected to find that financial incentives and structures drove high performance at El Camino, but ultimately concluded that employee buy-in was the key factor in its results.

Erik Steele, CMO of Eastern Maine Health System, made a similar point to me in a interview we ran last Friday about his system's efforts to sustain its electronic medical records. Despite the difficulties of adjusting to new systems that don't always work intuitively the first time around, Steele noted that the hospital's leadership made genuine efforts over time to continually listen to doctors about their concerns and suggestions and integrate them into the platform.

"If we can find areas where it helps me as a physician achieve extraordinary outcomes in things I really want my patients to have, then I begin to feel like it's a partnership," Steele said. For Steele and the other doctors at Eastern Maine, the success of the EMR wasn't based on mastering the technical details—it was getting to feel like partners.

Getting staff to feel engaged, of course, is notoriously difficult, even for institutions that make real efforts at it. Ultimately, though, employees either feel like trusted partners in their hospital or they don't. And gaining that critical buy-in requires a bit of the courage to make the tough decisions when the moment demands it—as at El Camino—and the patience to listen to employees over time, as at Eastern Maine.

Has your hospital had to make tough choices that signal whether employee concerns are truly valued or not? E-mail your stories to hbush@healthforum.com.