There has been plenty of coverage in the media these days about employee engagement. Gallup's "State of The American Workplace" was released earlier this year, indicating that as astounding 52 percent of all full-time workers in the country are not involved in or enthusiastic about their work, and an additional 18 percent are "actively disengaged." That leaves us with about 30 percent of the workforce that actually enjoys the work that they're doing.
According to 2013 research by AonHewitt, while employee engagement levels are beginning to show some slight signs of improvement globally, only 4 out of 10 employees report that they are engaged — 40 percent are "passive or actively disengaged," a number that has been relatively consistent since 2011.
At many healthcare organizations., with all of the stress, angst and pressure associated with delivering healthcare today, there's a good chance that this number is even lower.
Why does it matter? Well, it always has — or should have. The mission of healthcare organizations is to serve patients, often at very vulnerable times in their lives. The ability to deliver care that is both high-quality and provided with compassion is extremely critical. It always has been. The emergency of HCAHPS —and, soon, CAHPS— brings the issue of patient satisfaction to the forefront, though. Even those hopefully few healthcare organizations that didn't view patient satisfaction as a high priority are doing so now.
So, what does that have to do with employee engagement? Plenty. Engaged employees drive the patient experience. Think about the experiences that you have outside of healthcare, perhaps at the grocery store, a convenience store or a restaurant. How does that experience differ based on the engagement level of the employees you interact with? A negative dining experience is one thing. A negative healthcare experience is quite another.
Who's responsible for employee engagement? Well, technically, each of us is responsible. But, for healthcare leaders, there is a heightened level of responsibility involved.They play a role in impacting — hopefully in a positive way — the engagement level of their staff members and, in fact, every staff memberthey encounter.
The viral nature of a poor patient experience
These days savvy consumers are not content with a "treat 'em and street 'em" approach to healthcare. With population health management, healthcare is even more personal,perhaps the most personal transaction that any of us engage in. Despite the fact that many healthcare experiences, by and large, are inherently negative ones, patients want to feel good about the experience. They want to feel respected, valued and heard. When they don't,they talk.
According to the White House Office of Consumer Affairs, based on research done by TARP, dissatisfied customers will tell nine to 15 people about their negative experience. About 13 percent of your dissatisfied patients will tell more than 20 people. Compare this with those happy patients who will only tell, on average, about four to six people. It's pretty easy to do the math.
If you consider your own consumer interactions, you can readily see that these numbers reflect reality. When we're dissatisfied with the service we receive we tend to tell a lot of people When we're satisfied, we often take the experience for granted.
What healthcare leaders need to do
Healthcare leaders have a critical role to play here. Despite the fact that, yes, engagement is a personal prerogative, leaders can influence the level of engagement among their staff members by:
• Understanding the current reality
• Owning engagement at the senior leadership level
• Mapping the course for improving engagement and, along with it, patient satisfaction
Understanding the current reality
Understanding the current reality can be challenging. It can be difficult to assess a situation that we're in because our perspective has been influenced by our own experiences and biases. They need to identify issues within the culture that can hinder engagement. These issues may include:
• Lack of recognition by managers who have the attitude that, "It's their job. I don't need to give employees kudos for just doing their job."
• An overt, or covert, acceptance of behaviors not in the best interest of patients. "She's a great nurse but can be a little terse at times."
• The feeling that "good is good enough."
• Blaming or finger-pointing between departments (silos): "If the nurses would just do their jobs, our scores would be better."
• Complacency or acceptance of the status quo and excusing away the patient satisfaction scores. "Our patients expect too much — period. And this community is different."
How can leaders move beyond these issues? Survey data can help. But leaders need to dig beneath the survey data to find meaning that will resonate with staff. There are a variety of methods that can be used to understand the link between culture and the patient experience:
• Mystery shopping with photo documentation records experiences from the patient perspective including feelings and reactions to processes, communication and specific employee encounters
• In-depth interviews with physicians, executives and other key stakeholders to gain insight into the cultural norms
• Focus groups with frontline staff, patients and managers to gain insight into beliefs and attitudes that are currently shaping the culture. (One common belief is that "no one has ever been fired here for delivering poor service.")
• Data: patient, employee and physician satisfaction survey data and current patient complaints.
These efforts need to be led from the top of the organization. The quality department, the HR department or the customer service department cannot effectively lead this charge without clear vision, direction and support from the top.
Owning engagement at the senior leadership level
Iftheir senior leaders are espousing sentiments like those above,hospitals and health systems are going to face significant challenges in turning the tide on employee engagement and, subsequently, patient satisfaction. It starts at the top. The CEO and CMO set the stage and the expectations. But, more importantly, they hold others accountable — and that is key.
At a presentation I gave recently, I was heartened by what one CEO told me. He said he holds managers accountable for hiring the best people and supporting and coaching them on a regular basis. Knowing that this is happening consistently, he's comfortable setting another clear expectation. During every new employee orientation he does, he talks about his organization's mission, vision and values. He talks about having a sense of purpose and passion for great patient care and he tells these new employees, "If, in six months you don't wake up and feel excited about coming to work every day — if you don't feel like you're in the right place and that you're truly excited to be part of this, please leave. Otherwise, we'll help you leave."
That is exactly the kind of philosophy and culture that healthcare leaders around the country need to be nurturing and modeling. I wish every CEO I worked with would have the guts to stand up and say: "If you're not engaged, move on or move out." This, of course, is only advisable when you've taken the steps to make sure your all leaders are aligned and accountable for hiring, coaching and developing the individuals.
But the question remains: how do you get there?
Mapping the Course for Improving Engagement and Patient Satisfaction
There are six important steps that healthcare leaders should take to turn their culture into one that's engaged and patient-centered. They are the following:
1. Create a common vision and burning platform for change. Answer the question, "Where is our culture now, and where do we want it to be?"
2. Set expectations across the organization for specific standards of behavior.
3. Align resources to support expectations and priorities. Don't just say the patient experience is important. Devote necessary resources.
4. Establish systems to hold people accountable.In addition to performance reviews, expect ongoing employee rounding, coaching and one-to-one discussions.
5. Build service targets and behaviors into an evaluation system.
6. Position organizational leadership as the "keepers of the vision."
No, it's not easy. But it's a mandate that is being heard loud and clear across the country. Healthcare leaders are faced with significant challenges in the 21st century. But there is no challenge greater than the challenge of providing exceptional care to every patient, every time. That process starts with an engaged workforce. It starts with you.
Kristin Baird, RN, BSN, MHA, is president/CEO of Baird Group, a consulting group specializing in customer service improvement and mystery shopping for healthcare organizations. With more than 30 years of experience in patient care, healthcare marketing, business development and administration, Kristin Baird is a talented author, speaker and consultant with a passion for service excellence. Follow her on Twitter: @KristinBaird.
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