Hospital Study -Relationship Btwn Emp. Satisfaction and Pt. Experiences (1)

7/24/2019 Hospital Study -Relationship Btwn Emp. Satisfaction and Pt. Experiences (1)

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THERELATIONSHIP BETWEENEMPLOYEE SATISFACTION

AND HOSPITAL PATIENT EXPERIENCES

APRIL2009

JIMMYPELTIER ANDANDYDAHL

UNIVERSITY OFWISCONSIN- WHITEWATER

FRANKMULHERN

NORTHWESTERNUNIVERSITY


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Abstract

THERELATIONSHIP BETWEENEMPLOYEE SATISFACTION

AND HOSPITAL PATIENT EXPERIENCES

Health care is an extraordinarily people-centric industry. Aside from the obious fact that the

patient consumes serices to his or her physical body! nearly all treatments and procedures are

administered by people. "he mana#ement of health care personnel ta$es place in a complex

enironment inolin# a ariety of professionals! extensie use of materials and e%uipment! and

an array of serices that extend beyond health care to include food! hospitality and instruction.

"his challen#in# enironment places a #reat deal of stress on employees. In this study &e

explore the satisfaction of employees in a ma'or hospital to determine the extent to &hichemployee satisfaction relates to the %uality of the patient experience. (e proide an extensie

reie& of the literature of health care employee satisfaction and then proide an empirical

analysis that sho&s a direct and positie relationship bet&een the satisfaction of employees and

the %uality of the patient experience in a ma'or urban hospital.


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patient satisfaction at a ma'or hospital in 7e& =or$ >ity. )xplorin# the relationship bet&een

employee and patient experiences in a hospital presents seeral benefits?

1 People - includin# doctors! nurses! administrators! and staff - play a crucial role in the

serice deliery process. "hese indiiduals perform duties that directly and indirectly

influence the %uality of patient care and satisfaction. 7ursin# staff in particular are

inoled &ith patents on a daily! and sometimes hourly! basis.

2 Administratie procedures in place facilitate the collection of data on patient

experiences throu#h a chec$-out surey for all patients/ as &ell as annual employee

sureys.

3 Hospitals are lar#e! dierse or#ani,ations &ith numerous departments that often

dramatically differ from each other in si,e! function! and performance %uality. "his

study uses department leel data dra&n from throu#hout the hospital.

M%t&!"

As noted! this exploratory study explores the relationship bet&een employee satisfaction

and patient satisfaction in a ma'or 7e& =or$ >ity Hospital. ur approach inoles a reie& of

current literature on health care performance! primary data collection throu#h an online forum

and interie&s &ith $ey hospital staff! and an empirical analysis of employee and patient

satisfaction data. "he literature reie&! &hich focuses on employee en#a#ement! employee

satisfaction! and patient satisfaction in health care settin#s! proides a foundation for the $ey

people related issues in health care. )mpirically! our primary ob'ectie is to assess the

relationship bet&een employee satisfaction and patient satisfaction. (hile &e limit our analysis

to a health care settin# the concepts discussed here can be applied to other serice- or people-

based industries. In addition to our primary ob'ectie! this exploratory research &ill help?

1 Proide an assessment of the $inds of metrics useful for ealuatin# employee

en#a#ement and satisfaction

2 )stablish a startin# point for connectin# employee en#a#ement to employee

performance! as measured by a dashboard of behaioral and outcome metrics based

on patient experiences and satisfaction

3 ;a$e preliminary recommendations for practices that the hospital may underta$e to

improe employee performance and patient experiences


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1 Proide #uidance for a lon#-term! more extensie data collection and analysis

techni%ues to more deeply explore the extent to &hich employee en#a#ement affects

performance and the aspects of en#a#ement issues that hae the #reatest impact on

employee retention and serice %uality

Part '( L$t%rat#r% R%)$%*

"he first part of the study inoles a reie& of oer @0 studies on employee

en#a#ement!B employee satisfaction!B and patient satisfactionB specific to the health care

industry. "his reie& proides initial insi#hts into the possible relationship bet&een these

constructs at a health care or#ani,ation. er the years much research has loo$ed at the areas of

customer satisfaction and employee satisfaction. Recent research has put een more of an

emphasis on ho& human resource mana#ement practices such as employee en#a#ement!

reco#nition pro#rams! and internal mar$etin# efforts can increase employee satisfaction and

retention. :e&er studies loo$ at the direct impact employee satisfaction has on customer

satisfaction. Ho&eer! these studies demonstrate the need for health care administrators to ta$e a

closer loo$ at human resource mana#ement practices of their or#ani,ation and efforts to improe

the %uality of care by chan#in# employee en#a#ement! satisfaction! and loyalty.

(hile relatiely fe& academic studies in the health care industry appear to exist &hichloo$ at the connection bet&een employee satisfaction and patient satisfaction! those that do loo$

at this topic sho& a relationship exists. ;any health care administrators are increasin#ly sho&in#

concern for delierin# hi#h %uality care in &hich both the customer patients/ and proiders

employees/ are satisfied &hile maintainin# a stron# financial enironment Loe et al.! 2008/.

"his represents a shift in mana#ement theory from the 990s &hen cost cuttin# and the bottom

line dominated concerns in the health care industry Cro&n 2002/.

In this reie& of academic literature! &e focus on the impact of human resource

mana#ement practices such as employee en#a#ement and empo&erment on employee

satisfaction and retention! and ultimately ho& these mi#ht impact patient satisfaction. 7e&man et

al. 200/ outlined ho& these interrelated issues affect one another based on a reie& of literature

on nurse recruitment and retention! serice %uality! and human resource mana#ement.


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7e&man sho&s a chain of connectiity such that a/ internal conditions and enironment affect

b/ the serice capability of staff &hich influences c/ nurse satisfaction &hich! in turn! affects

d/ retention of nurses. All of those factors can reduce e/ %uality of patient care and ultimately

f/ the leel of patient satisfaction. In other &ords! health care or#ani,ations that proide a #ood

&or$in# enironment &hich enhances the serice capability of staff throu#h empo&ered decision

ma$in# &ill lead to more satisfied nurses &ho are more li$ely to remain loyal to the or#ani,ation

and proide a hi#her leel of care resultin# in hi#her patient satisfaction. r#ani,ations that

desire to improe patient satisfaction must therefore be concerned about internal issues related to

employee satisfaction and ie& their employees as customers too. A connection appears to exist

bet&een ho& en#a#ed an employee is &ith the employeeDs role in the patient care process and

the leel of patient satisfaction. "his interrelationship affects not only satisfaction leels but also

patient loyalty and financial performance.

Defining Employee Engagement

A ariety of definitions exist for employee en#a#ement.B 5ibbons 200/ reie&ed

research on employee en#a#ement and determined seeral different definitions. Additionally! the

reie& sho&ed that preious studies coered 20 $ey driers of employee en#a#ement. A blended

definition created by 5ibbons defines employee en#a#ement as?

A heightened emotional connection that an employee feels for his or her

organization, that influences him or her to exert greater discretionary effort to his

or her work.B


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Effects of Employee Engagement on Employees

E+,!.%% E/a/%+%t 0 E+,!*%r+%t

;ana#ers in all industries hae made employee en#a#ement a hot button issue because of

#ro&in# eidence that en#a#ement has a positie correlation &ith indiidual! #roup! and

or#ani,ational performance in areas such as productiity! retention! turnoer! customer serice!

and loyalty Eetter! 2008/. "he health care industry is no exception to this phenomenon in human

resource mana#ement theory and practice. 7ursin# shorta#es in particular hae helped ma$e

en#a#ement an important topic in this industry.

(ith re#ard to health care specifically! research has fre%uently uncoered a lac$ of

loyalty to the or#ani,ation and the nursin# profession Cro&n 2002/. Cro&n noted that nurse

administrators face the challen#e of repairin# bro$enB relationships &ith nurses because of

chan#es in mana#ement policies oer time. 6urin# the 990s! health care or#ani,ations tried to

adopt cost cuttin# strate#ies employed by many other industries! thereby ta$in# the focus a&ay

from the %uality of care to patients. "his conflict ultimately left nurses feelin# disen#a#ed and

unempo&ered in their roles in delierin# patient care and at odds &ith the financial performance

initiaties of health care administrators Cro&n 2002/. Research has sho&n! as expected! that

&hen employees are disen#a#ed in their 'obs they are more li$ely to leae because they feel

unappreciated :u$uyama 99urran! 200/. "hese

findin#s hi#hli#ht the importance of creatin# en#a#ed employees and the important role of

administrators and other leaders in this process.

"he increased interest from health care administrators also stems from the belief that hi#h

turnoer rates and the lac$ of commitment ne#atiely affect the proision of care and ultimately

the financial performance of or#ani,ations ;orrison! et al. 2003/. "his ie&point helps sho&

&hy hospitals are increasin#ly interested in determinin# effectie &ays to en#a#e employees


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better. +a$s 200/ &as one of the first to note the important distinction bet&een 'ob en#a#ement

and or#ani,ational en#a#ement. He determined that perceied or#ani,ational support predicts

both 'ob and or#ani,ation en#a#ement. "herefore! health care or#ani,ations need to find &ays to

address these internal mar$etin# issues at both the 'ob and or#ani,ational leels. (hile employee

en#a#ement and reco#nition pro#rams hae al&ays been important to administrators! it is only

recently that these practices hae seen an increased leel of interest in health care because the

employeeDs role in patient care is more eident &hen considerin# the scarce resources of

hospitals and the oerall shorta#e of nurses :reed! 999/.

+o ho& can health care or#ani,ations chan#e employee en#a#ement at these t&o leelsF

"homas 2003/ defines en#a#ement as a state of aroused! situation specific motiation that is

correlated &ith both attitudinal and behaioral outcomes.B ;ana#ement and or#ani,ational

culture! alon# &ith empo&erin# employees appear to be three of the bi##est factors in employee

en#a#ement leels. >athcart 200@/ sho&ed that span of control had some effect on employee

en#a#ement and that addin# mana#ement positions to reduce the span of control helped increase

employee en#a#ement scores. ther studies hae sho&n &or$place culture! or#ani,ational

communication and mana#erial styles! trust and respect! leadership! and company reputation all

influence employee en#a#ement Loc$&ood! 2003/. +pecifically! hi#h inolement &or$

practices may enhance the financial performance of health care or#ani,ations Huselid! 99< and

Harmon! et al! 200G/.

)lements that appear to account for differences in empo&erment and 'ob satisfaction

scores of nurses include? / #reater accessibility of nurse leaders! 2/ better support of clinical

nurse autonomous decision ma$in# by nurse leaders! and G/ #reater access to &or$

empo&erment structures such as opportunity! information! and resources *penie$s! 200G/.

"hese findin#s su##est that hospitals that hae hi#hly accessible leaders! proide support for

autonomous decision ma$in#! and proide access to empo&erment structures hae a #reater

li$elihood of increasin# employee satisfaction.

H!* HRM ,ract$c%s !1 E/a/%+%t2 E+,!*%r+%t2 a" Ot&%rs I+,act E+,!.%% L!.at.

0 Sat$s1act$!


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+eeral studies hae sho&n ho& employee empo&erment and en#a#ement impact

employee satisfaction and loyalty to the or#ani,ation. Health care or#ani,ations that routinely

achiee hi#h employee satisfaction scores tend to hae the follo&in# in common / accessible

leadership! 2/ fre%uent communication! and G/ employees are empo&ered to satisfy patients

:assel! 200G/. Internal mar$etin# efforts hae been sho&n to deelop better relationships

bet&een employees and their or#ani,ations &hile increasin# satisfaction and retention. Peltier et

al. 200G/ determined that structural bonds follo&ed by social and financial bonds hae the most

impact on nurse loyalty. A 200@ study by Peltier et al. determined these three types of bonds

influence not only loyalty to the or#ani,ation! but nurse satisfaction as &ell. A 2003 follo&-up

study by Peltier et al. determined that %uality of care most impacted nurse satisfaction follo&ed

by the three types of bonds from the 200G and 200@ study.

A study of nurses and mid&ies in London hospitals determined that the three main

factors influencin# their 'ob satisfaction &ere patients! the inherent characteristics of nursin#! and

the nursin# team 7e&man! et al. 2002/. Additionally! 7e&man! et al. found that improin#

&or$in# conditions &as more important than increased pay. "his seems to be in line &ith Peltier

et al.Ds findin#s that structural and social bonds &ere more important than financial bonds from

an internal mar$etin# perspectie. (hile pay for performance actiities may lead to increased

satisfaction and hi#her %uality of care! these types of re&ard systems tend to be short-lied in

comparison to other reco#nition or en#a#ement pro#rams. Additionally! by allo&in# employees

to proide hi#her %uality care to patients! the employees tend to ta$e #reater pride in their 'ob

and feel #ood about the or#ani,ation and its alues. :reed 999/ also notes the importance of

sustainin# en#a#ement! somethin# that &ill help hae a lon#-lastin# impact on employee

satisfaction and the deliery of hi#h %uality care.

ther &ays in &hich empo&erment and en#a#ement increase satisfaction and loyalty

include?

Reduced Job Stress & Turnoer

)mpirical research has sho&n a ne#atie relationship bet&een empo&erment and 'ob

stress! su##estin# that as employees are more empo&ered their 'ob stress decreases oiner and


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Cartram! 200@/. In addition to stress! increased employee satisfaction helps reduce employee

turnoer! leaes of absence! and lo&er &or$-related disability and iolence claims Harmon! et

al! 200G/. ;orrison! et al. 2003/ outlined seeral &ays in &hich the lac$ of en#a#ement and

hi#h turnoer rates impact health care or#ani,ations. +ome of these factors include turnoer

costs! &hich accordin# to (aldman Eelly 200@/ ran#e bet&een G.@4 and AH 200


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feelin#s of support and sense of accomplishment at &or$ &hich may play an inte#ral role in

middle mana#ement retention and attractin# nurses to mana#ement positions. >onersely! this

&ould su##est that or#ani,ations that do not foster employee empo&erment may experience

problems retainin# and attractin# middle leel mana#ers.

%etter Relationships with #anagement

(a#ner 200/ determined that a primary factor in employeeDs satisfaction and loyalty to

that employer is the employeeDs relationship &ith his or her immediate superisor. "his findin#

further demonstrates the need for health care administrators to be concerned &ith employee

satisfaction as hospitals face nursin# shorta#es. It also is in line &ith >urranDs 200/ findin#s

that nurses indicated mana#ement that is out of touch &ith the realities of patient care lead to

lo&er nurse satisfaction and loyalty. "he %uality of relationships includin# communication

bet&een mana#ement and employees not only impacts the employees themseles but also has an

impact on or#ani,ational effectieness by affectin# productiity and turnoer rates Crunetto and

:arr-(harton! 200/. (hen mana#ement helps an employee feel en#a#ed and offers them the

support and resources necessary to proide %uality patient care! employees are not only more

satisfied &ith their employer but also remain more loyal.

(hile many studies sho& that en#a#ement and empo&erment in health care settin#s can

lead to #reater 'ob and or#ani,ational satisfaction! not eeryone has found a connection bet&een

the t&o. +uominen! et al. 200/ determined that based on their study of a multidisciplinary team

at the Rheumatism :oundation Hospital in :inland! 'ob satisfaction is not related to any of the

fields of empo&erment. (hile this differs from preious studies! it does raise the %uestion of

&hen and ho& does empo&erment and en#a#ement impact employee satisfaction. ;ore releant

to the current research is ho& does employee satisfaction impact patient satisfactionF

E11%cts !1 E+,!.%% Sat$s1act$! ! Pat$%t Car% a" Pat$%t Sat$s1act$!

7urse and other health care employeesD satisfaction hae been found to hae seeral

impacts on the %uality of care deliered &hich ultimately influences the leel of patient


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satisfaction. 7e&man et al.Ds 200/ chain outlines a clear interrelationship bet&een employee

satisfaction! the %uality of care! and patient satisfaction. At$ins et al.! 99/ sho&ed that

employee dissatisfaction ne#atiely impacts the %uality of care and ultimately has an aderse

effect on patient loyalty and in turn hospital profitability. Juality improement initiaties &ere

sho&n to hae a positie correlation &ith employee satisfaction as &ell as client satisfaction in a

study of +&edish healthcare Eammerlind! et al! 200@/. Health care employee morale also

demonstrates a stron# correlation &ith patient satisfaction scores! sho&in# that the lac$ of

commitment and en#a#ement hae far-reachin# impacts on more than 'ust employee turnoer

>AH 200


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Accordin# to :ahad Al-;ailam 200


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Tab% '(

R%,!rt%" R%at$!s&$,s 0 O#tc!+%s 1r!+ L$t%rat#r% R%)$%*

E11%cts !1 H$/&%r E+,-!.%% E11%cts !1 H$/&%r E+,!.%% E11%cts !1 H$/&%r E+,-!.%%

E/a/%+%t L%)%s ! E+,!.%%s E/a/%+%t 0 Sat$s1act$! ! E/a/%+%t3Sat$s1act$! !Pat$%ts F$ac$a- P%r1!r+ac%

Improes employee productiity Improed care %uality

Improes relationships &ith Increased patient satisfaction

mana#ement Increased patient loyalty

1 Reduces 'ob stress

2 Increases employee satisfaction

3 Increases retention turnoer

1 Lo&er employee

recruitmentretention and

trainin# costs

2 Hi#her patient loyalty to

or#ani,ation

3 Possibly lo&er costs related to

the

deliery of

patient care

because of

shorter

patient

stays/

Tab% 4(

R%,!rt%" M%t&!"s t! I+,actE/a/%+%t 1r!+ L$t%rat#r%

R%)$%*

1 )mpo&erment in

decision ma$in#

2;ana#ementaccessibility

leadership styles

3 Reco

#nitio

n

pro#r

ams4 (or$

place

culture

5 r#ani,ational

communication

6 "rust respect

7 >ompany reputation

8 Access to resources! trainin#!

information! opportunity


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Part 4( E+,$r$ca R%s%arc&

"o understand ho& employee satisfaction and patient satisfaction are lin$ed! &e conducted an

empirical study at a ma'or public hospital in 7e& =or$ >ity. "he hospital is located in an urban!

residential enironment and features an extensie ethnic diersity amon# employees and

patients. "he empirical research consisted of t&o components. :irst! &e established an adisory

committee that participated in an online forum about their perceptions about the %uality of

serice and the motiation! satisfaction and performance of employees. +econdly! &e conducted

%uantitatie analysis that matched employee satisfaction surey data &ith patient satisfaction

surey data to assess the relationship bet&een employee satisfaction and patient experiences.

O$% F!r#+

"he online forum featured G members of an adisory committee that a#reed to

contribute perspecties about employees in the hospital. "hat committee &as formed specifically

for this research pro'ect and consisted of a ariety of administrators and mana#ers &ho &ere

selected because of their administratie positions and $no&led#e about hospital personnel and

operations. "he forum coered topics such as a/ definitions of employee en#a#ement! b/ &ays

in &hich the hospital has been stron# or &ea$ in motiatin# inolement! effort! loyalty! and

retention! c/ en#a#ement strate#ies used by the hospital! and d/ the perceied %uality of patient

care and its impact on patient satisfaction. Participants ans&ered open-ended %uestions about

these topics and &ere able to reie& and comment on responses posted by other participants.

Defining Employee Engagement at the Hospital

As noted preiously! past studies on employee en#a#ementB hae used aryin#

definitions and identified oer 20 different $ey driers of en#a#ement 5ibbons! 200/. "he

adisory committee proided a definition of employee en#a#ement at the hospital. Cased on

indiidual responses! the follo&in# blended definition &as created for employee en#a#ement at

the hospital?

An engaged employee at the hospital takes pride

and makes a personal commitment to their 'ob,

organization, and patient( An employee

feels more


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engaged when they )a* participate in meetings and the decision making process,

)b* beliee their input is used+considered by

management, )c* hae a good understanding

of the organizations alues, missions, and

operating procedures )d* understand how they

contribute to the success of the organization,

and )e* care about the success of the

organization(-

Increasing Employee Loyalty & Retention and

Motivating Involvement & Effort

"he hospitalDs en#a#ement adisory committee

identified &ays in &hich the or#ani,ation is stron# and

&ea$ in the areas of employee loyalty and retention as

&ell as motiatin# inolement and effort. (ays to

improe loyalty and retention as &ell as inolement

and effort &ere discussed for different #roups

includin# nurses! physicians! administratie staff! and

non-clinical and serice staff. "he responses indicate

that participants beliee a more inoled employee

&ho puts forth more effort is more li$ely to remain

loyal to the or#ani,ation. "able G hi#hli#hts self-

reported best practicesB at the hospital as &ell as self-

reported &ays to improe in these areas.

Tab% 5(

Icr%as$/ E+,!.%% L!.at. 0 R%t%t$! a" M!t$)at$/ I)!)%+%t 0 E11!rt

H!s,$ta6s 7B%st Pract$c%s8 Wa.s t! I+,r!)%

Reco#nition of employee Cetter communication of #oals! decisions! and

milestonesaccomplishments bet&een departments

.The hospital/ has many long termemployees(

These employees feel engaged in the unit they

work and feel proud to work for .the hospital/(-

#essages from the top of the organization

stress the importance of all employees in

proiding a alued high 0uality serice to the

patients sered(-

#any of our employees hae beenemployed by

the hospital for years because they en'oy their

work and the friends they hae made oer the

years(-

1etting people to interact with each other

deelops relationships and through them comes an

understanding of the work that others do, and its

importance, and your own connection with them(-

2 think this place has generally had afamily

feeling about it for a lot of people( A lot of people

like being here because of the warm feeling andhae gotten to know a lot of people( "espite being

a ma'or medical center it almost feels more like a

small community hospital(-

Committee Comments

Involvement & Effort Eamples of !dvisory

Increasing Loyalty & Retention and Motivating


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:amily-li$e atmosphere amon# lon#-term )mpo&ermentInolement in decision ma$in#

employees #ood co-&or$er relationships/ >ontinue to improe &or$ relationships! especially

:inancial bonds includin# salarypay and benefits bet&een superisors and their departments and

bet&een physicians and nurses

Role of "hysicians in the Level of Engagement of #on$"hysician %taff


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In #eneral! the adisory committee beliees physicians hae a ma'or impact on the leel

of en#a#ement on non-physician staff throu#h the &ay they

interact &ith hospital employees. Physicians &ho are

disrespectful to non-physician staff! ma$e ne#atie comments!

or treat the patient as if they are a non-human intan#ible

entitiesB lead to reduced en#a#ement in non-physician staff.

"hese perceied ne#atie interactions reflect the importance

of co-&or$er relationships in motiatin# employee

en#a#ement and performance. (hen an employee feels li$e a

aluable team member and! feels respected by others! hi#her

leels of en#a#ement and performance are li$ely.

Role of %pervisors on the Level of Employee Engagement

+imilarly! superisors or mana#ers also hae a #reat

impact on employee en#a#ement as exemplified by the

follo&in# t&o comments from adisory committee members?

!eaders play the biggest role in motiating inolement

and effort through deeloping relationships with those

under their direction( 2t is important that training for

leaders helps them gain a better understanding of how

important their relationship is( 2n my opinion, more staff leae because they are unhappy

with leadership(-

They .leaders+superisors/ are the most important piece because people hae to

interact with superisors eery day( 2f the superisor is someone they don3t like, it makes

them miserable and, less likely to en'oy their 'ob( 2f it is someone they respect, it makes

them like their 'ob better(-

2 think that the nursing staff

needs to feel supported in their

efforts to proide 0uality serice to

our patients( The nursing staff is

largely responsible for the patients

and their opinion needs to be

re0uested and respected(-

4hysicians play an importantrole

in the engagement( The way

physicians work with staff and

conduct themseles has a big

impact( #ost of the staff hae a

great deal of respect for the

physicians and recognize their

authority( 5oweer, bad behaior

impacts morale and attitude toward

work(-

!dvisory Committee Comments

Engagement Level Eamples of

"hysician 'Co$(or)er* Impact on


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"erception of Ho+ Employee Engagement !ffects Care ,ality and "atient %atisfaction

"he consensus from the adisory

committee at the hospital is that the leel

of employee en#a#ement has been hi#h

and has had a positie impact on the

%uality of care and patient satisfaction. "he

belief! shared by many on the committee! is

that employees &ho are en#a#ed tend to

&or$ harder for the patient and patients are

more satisfied &ith the %uality of care they

receie.

+eeral adisory committee

members %uestioned the efficacy of

en#a#ement initiaties that had been

implemented. >oncerns &ere raised that

en#a#ement actiities hae only a short-

term impact on raisin# en#a#ement leels

and the %uality of care. Additionally! some

&ere concerned that the use of multiple

actiities at the same time &ea$ened the

impact of the pro#rams. "hese concerns

reflect the need for continued efforts to

increase employee en#a#ement leels

throu#h a more systematic approach. An

important ta$ea&ay from the committee is

that complacency and oeruse of tactics are

t&o areas mana#ers at all or#ani,ations

must monitor closely to maximi,e the

effectieness of en#a#ement actiities.

-he "erceived Impact of

Employee Engagement

1 6ngagement leel has direct

impact on the 0uality of care(

2f not engaged, 0uality can

suffer(-

2 7hen your staff is unhappy,

patient care will suffer( 2 think

it3s important to continually

take the pulse of the staff in

terms of morale(-

3 A highly engaged employee

cares more for the success ofthe organization( A highly

engaged employee works

harder for patients(-

4 6ngagement actiities like

many other initiaties often

tend to be ery intense for a

period and then fade away( 7e

seem to try many different

things to improe care, 0uality,

or patient or employee

satisfaction( Some work, some

do not, and most of them add

to the workload of those who

hae to implement and monitor

and report on them( 7e seem

to try a little of eerything, and

not focus enough on a few core

things or ingredients(-


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! .rame+or) for Lin)ing Employee Engagement to "atient Eperiences

Cased on the literature reie& and the input from the adisory committee! &e constructed

a frame&or$ for conceptuali,in# the lin$ bet&een employee en#a#ement leels! employee

satisfaction! patient satisfaction! and or#ani,ational financial performance. As sho&n in :i#ure !

the leel of employee en#a#ement influences the %uality of the patient experience and patient

satisfaction! &hich! in turn! helps drie the performance of the or#ani,ation.

F$/#r% '

P%rc%$)%" R%at$!s&$, !1 E+,!.%% E/a/%+%t2 E+,!.%% Sat$s1act$!2

Pat$%t Sat$s1act$! a" F$ac$a P%r1!r+ac%

Hi#h )mployee )n#a#ement

LeelsLeadin# to Hi#her )mployee

+atisfaction)2ncreases when they feel they

make a difference*

Leadin# to better patientcare! hi#her patient

satisfaction loyalty to thehealth care proider

Leading to /etter .inancial "erformance


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Sat$s1act$! S#r)%. Aa.s$s

"he next phase of the empirical research featured the statistical analysis of employee

satisfaction and patient satisfaction for a set of selected departments in the hospital. "he #oal of

the analysis &as to determine &hether there is a lin$ bet&een the &ay that employees feel about

their 'obs and the %uality of the patient experience as indicated by patient satisfaction scores. A

set of G hospital departments &ere selected for inclusion in the study. "he departments &ere

carefully selected to represent a breadth of serices types and performance %uality leels.

Rou#hly one-third of the departments &ere considered to be aera#e performers! &ith one-third

each bein# perceied as belo& aera#e or aboe aera#e. All of the departments &ere medical

units e.#.! same-day sur#ery! maternity! cardiac care/. ther serice areas such as food serice

and hospitality &ere not included in the study.

Data S!#rc%s

"he analysis utili,ed data that is routinely collected by the hospital. "he hospital

re#ularly collects data on employee satisfaction and patient satisfaction. )mployee satisfaction

&as collected by the hospital as part of an annual employee surey conducted each sprin#.

Patient satisfaction data is collected on an on#oin# basis at the time of a patientDs dischar#e from

the hospital. Coth sets of data &ere then matched at the department leel to assess the

relationship bet&een employee satisfaction and patient satisfaction.

)mployee and patient satisfaction data &as a##re#ated at the departmental leel. "hat is!

&e had information on the aera#e satisfaction scores for each department. A finer leel of

analysis &ould be possible &ith indiidual employee and patient data. Ho&eer! that information

&as not aailable for a sufficient number of departments! and! een if the data &ere aailable!

there &ould be no suitable &ay to match indiidual patients to indiidual employees in a

department. As such! our analysis inoles a department by department comparison of the mean

satisfaction scores for employees and patients.

"he specific metrics used in the analysis are as follo&s?

6mployee Satisfaction &as measured &ith a -point a#reement scale stron#ly disa#ree to

stron#ly a#ree/ across four oerall satisfactionB dimensions?


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1 2 would Recommend 6mployment 5ereK A common measure of commitment to an

or#ani,ation and is used by many or#ani,ations

2 2 am 4roud to 7ork for This 8rganizationK An assessment of pride in bein# associated

&ith an or#ani,ation

3 8ften !eae 7ork with $eeling of SatisfactionKA measure of the feelin# associated &ith

daily &or$ duties.

4 2 5ae 9onsidered !eaing "uring 4ast Six #onthsK A retention measure! thou#h can

be confounded by external factors i.e.! retirement! moin#! etc./

5 Satisfaction Summed Score : A composite of the aboe four measures &ere summed to

determine an oerall employee satisfaction measures.

"atient %atisfaction Data:Patient satisfaction &as measured &ith a 00-point satisfaction scale

00 is hi#hest/ across a &ide ariety of dimensions representin# numerous aspects of patient

experience ran#in# from admission throu#h dischar#e. erall Patient +atisfactionB

%uestionsmeasures included?

1 Li$elihood Recommendin# the Hospital:ne-item referral li$elihood score

2erall Ratin# of >are 5ien:ne-item care %uality score

3 +ummed erall +core:An Aera#e satisfaction score across all %uestions

4atient Satisfaction "ata from 6mployee Surey : "he employee surey contained t&o %uestions

that as$ed them to assess ho& satisfied they belieed patients &ere in their department. "hose

t&o measures are?

1 Patient +atisfied (ith Patient >are in ;y *nit

2 +atisfaction (ith ther 6epartmentsD +erice Juality

Data Aa.s$s

A ariety of statistical methods &ere used to ealuate the relationship bet&een employee

satisfaction and patient satisfaction of the departments. "he stron#est relationships &ere found


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by comparin# the scores in a mean-split analysis &hereby departments &ere #rouped based on

&hether their aera#e patient satisfaction score &as aboe or belo& the oerall mean.

"able @ sho&s the number of departments that fell into the lo& satisfaction and hi#h

satisfaction #roupin#s for each of the employee satisfaction measures analy,ed.

Tab% 9(

S%/+%t$/ E+,!.%% Sat$s1act$! M%as#r%s(

L!*%st a" H$/&%st Sc!r% C!"$t$!s

L!*%st :r!#, N H$/&%st :r!#, N

I (ould Recommend )mployment Here G 9

I am Proud to (or$ for "his r#ani,ation 3 losely related is the concern about communications &ithin the or#ani,ation.

+eeral commenters stated the need for employees to be informedB and the alue of helpin#

employees understand the #oals of the or#ani,ation.B


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"hese comments reeal a real stren#th in the people of the or#ani,ation. Ho&eer there &as

some concern that efforts to motiate employees needed to be more strate#ic. ne participant

noted!

6ngagement actiities, like many other initiaties, often tend to be ery intense

for a period and then fade away( 7e seem to try many different things to improepatient or employee satisfaction( Some work, some do not, and most of them add

to the workload of those who hae to implement and monitor and report on them(

7e seem to try a little of eerything, and not focus enough on a few core things or

ingredients(-

"he upshot is clear K more satisfied employees lead to more satisfied patients. A $ey aspect of

this findin# is that health care administrators can add %uality of patient careB to the list of

benefits of hain# satisfied employees. ther $ey benefits include increased retention! lo&er

costs! etc./

Hospitals compete a##ressiely to attract patients! particularly for hi#h reenue serices such as

cardiac care. "here are a ariety of dimensions that factor into the competitie landscape

includin# hospital location! infrastructure! technolo#y and e%uipment! physician reputation! and

hospital ima#e. Cased on the findin#s in this study! &e can include in that list of competitie

dimensions the leel of satisfaction of hospital employees. Health care administrators may not

al&ays consider employee satisfaction as a competitie ariable. Ho&eer! as &e hae

demonstrated! &hen employees are more satisfied! patients hae better experiences. (hile this

research did not explore financial implications directly! &e can infer some li$ely financial

outcomes. ne can reason that since more satisfied employees lead to more satisfied patients! the

follo&in# behaioral and financial outcomes may ta$e place?

1 Repeat isits by patients can be expected

2 La&suits or other ne#atie behaiors of patients are less li$ely

3 Patients &ill spread more positie &ord of mouth &ord of mouth is a primary drier in

patient health care decisions/

4 :inancial performance of hi#h satisfaction units &ill be better

5 >osts of mana#in# hi#h satisfaction employees are lo&er less attrition! etc./


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Health care is an extremely people-based industry. ;uch of the emphasis on the people side of

health care is on procedures K the myriad of processes for handlin# patients includin# chec$in#-

in! preparin# for treatment! medical procedures! food serice! dischar#in#! etc. A $ey ta$e-a&ay

from this study is that! in addition to &hat health care &or$ers do! emphasis needs to be placed

on ho& the employees feel about &hat they do. Patient experiences &ill not be #ood if

employees are not happy. r#ani,ational initiaties desi#ned to increase employee en#a#ement

and satisfaction for example! attemptin# to achiee employee satisfaction scores in all

departments that are &ithin


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R%1%r%c%s

At$ins! P. ;ardeen! ;arshall! Crenda +teenson! and aal#i! Ra'she$har 5. 99/! Happy

employees lead to loyal patients!Journal of 5ealth 9are #arketing! @! @-2G.

Cerlo&it,! 6. R.! =oun#! 5. .! Hic$ey! ). >.! +aliba! 6. ;ittman! C. +.! >,arno&s$i! ).! +imon! C.!

Anderson! . .! Ash! A. +.! Rubenstein! L. M.! and ;os$o&it,! ;. A. 200G/! Juality

improement implementation in the nursin# home!5ealth Serices ResearchG8! Part ! athcart! 6eb. 200@/! +pan of control matters!Journal of ;ursing AdministrationG@! 9! G9urran! >onnie R. 200/! +tay! +ay! and +ere!;ursing 6conomic9! 2! @-@2.

:ahad Al-;ailam! :aten 200


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Hes$ett! .L.! ones! "..! Loeman! 5.(.! +asser! (.). and +chlesin#er! L.A. 993/! Puttin# the

serice profit chain to &or$! in Loeloc$! >. H.! Patterson! P. 5. and (al$er! R. H. eds/!

Serices #arketing! Prentice-Hall! )n#le&ood >liffs! 7.

Huselid! ;. A. 99

Laschin#er! Heather E +pence! :ine#an! oan ).! +hamian! udith! and (Il$! Piotr 200@/! A

lon#itudinal analysis of the impact of &or$place empo&erment on &or$ satisfaction.

Journalof 8rganizational %ehaior 2

Loc$&ood! 7ancy R. 2003/! Leera#in# employee en#a#ement for competitie adanta#e? HRDs

strate#ic role!5R#agazine.! 5reene! Lloyd 2003/! ;eanin# in ;otiation? 6oes your

or#ani,ation need an inner lifeFJournal of 5ealth & 5uman Serices AdministrationG0! !

98-hansar$ar! Cal. 200/! "he nurse retention! %uality of care

and patient satisfaction chain!2nternational Journal of 5ealth 9are


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D7eill! ;artin 200onnor 99ontinuous Juality Improement"otal Juality

;ana#ement? >oncept ersus Implementation!5ealth Serices ResearchG0! 2! G33K@0.

+uominen! "ar#a! +ai$$o! 7iina! Eu$$urainen! ;ar'aLeena! Euo$$anen! Liisa! and 6oran! 6iane

Irine 200/! (or$-related empo&erment of the multidisciplinary team at the Rheumatism

:oundation Hospital!2nternational Journal of ;ursing 4ractice2! 2! 9@-0@.

"esta! ;. R.! +$aruppa! >. and Pietr,a$! 6. 998/! Lin$in# 'ob satisfaction and customer satisfaction

in the cruise industry? implications for hospitality and trael or#ani,ations!Journal of

5ospitality and Tourism Research 22! ! @-@.

"homas! >hristopher H. 2003/! A ne& measurement scale for employee en#a#ement? +cale

deelopment! pilot test! and replication.Academy of #anagement 4roceedings! 2003! -.


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*penie$s! Malda M. 200G/! "he interrelationship of or#ani,ational characteristics of ma#net hospitals!

nursin# leadership! and nursin# 'ob satisfaction! The 5ealth 9are #anager22! 2! 8G-98.

(a#ner! +ue )llen. 200/! +taff retention? :rom satisfiedB to en#a#ed!B;ursing #anagementG3!

G! 2@-29.

(aldman! . 6.! Eelly! :.! Arora! +.! and +mith H. L. 200@/! "he shoc$in# cost of turnoer in health

care!5ealth 9are #anagement Reiew29! ! 2-3.

Hospital Study -Relationship Btwn Emp. Satisfaction and Pt. Experiences (1)

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