Employee Engagement is more than a buzzword. Health care organizations that place a high value on actively cultivating a Culture of Engagement will stand apart from their peers – and enjoy better business outcomes. The numbers don’t lie: According to HR Solutions, Inc.'s National Employee Engagement Research, 75 percent of American workers are not currently Engaged. This is a wake-up call for organizations, regardless of vertical or size, to develop ongoing strategies to create Engaged workplaces and continually seek employee feedback to measure levels of Engagement and affect positive change. In fact, the health care field is facing major challenges in the area of retention. T Walter Jenkins, Sr. Vice President with Michael C. Fina, has identified three underlying issues tied to employee retention, including:

1. Competition among hospitals/practices to attract the most talented employees
2. A very demanding and irregular work schedule e.g., night shifts, on cast, weekend/holiday coverage
3. Health care industry expansion requires more Human Capital to manage and care for patients

Improved retention requires an investment in Engagement/retention strategies to create and sustain a Culture of Engagement as well as to make sense of why employees leave. But, the question remains: Is it worth the investment?

Engagement and Patient Care

The solution to the staffing needs in health care isn’t simply more bodies – it is more quality employees (i.e., higher Engagement levels). Survey research has uncovered staggering differences in the responses of Engaged and Disengaged Employees on patient-care related items. Engaged Employees were two or three times more likely to respond favorably to key items assessing the quality of patient care. Engaged Employees were two-and-a-half times more likely to feel comfortable speaking up if they witnessed something that may negatively impact patient care. Similarly, Engaged Employees were two to three times more likely to report a medical error that they had either discovered (70 percent for Engaged; 24 percent for Disengaged) or caused (85 percent for Engaged; 46 percent for Disengaged) without fear of reprisal. Therefore, it is not surprising that patient safety was perceived very differently by Engaged Employees (88 percent believed patients were safe at their organization) versus the Disengaged (46 percent).

The Journey to the Top

To further illustrate the interconnected nature of Employee Engagement, employee turnover, and patient care, consider the case of Columbus Community Hospital (CCH), located in Columbus, Wisconsin. In 2004, the organization conducted its first Employee Opinion/Engagement Survey and had only 46 percent of employees participate. After compiling the results, CCH ranked in the 12th percentile (or, bottom quartile) of HR Solutions’ database, according to HR Solutions’ National Employee Engagement Research.

CEO Ed Harding recalls that his goal upon being hired in 2004 was to use the survey as a vehicle for identifying what was “broken” and discover how to fix it. “We anticipated that the scores might be low as it was the first time we were asking employees for their feedback,” he says. Harding and his management team committed to using the survey instrument as a voice for the staff.

Focus group meetings with employees in the organization found the employee morale was definitely coloring the patient experience. In 2004, employees commented that, “Patients complain that nobody is happy here, that no one smiles.” Another employee recounted how, “A patient was glad to see me because I had a smile on my face. The patient asked if I could be her nurse all day. People are not happy campers and are taking it out on the patients.” Obviously, the morale at the organization was not optimal and improvement was needed. Harding recounted, "My number one goal was to not have anyone say that nothing ever changes. The only way to not hear that is if you truly affect change based on the survey.”

Through the hard work of staff and management, by 2007, the organization increased their percentage of Engaged Employees by 43 percent , and the overall survey results resulted in a database ranking in the 97th percentile! Employee pride continues to grow as employees in feedback now say, “I get constant positive feedback regarding the dedication, caring, and friendly nature of this hospital; it is not impersonal like the larger hospitals.”

Effect on Patient Outcomes

Research indicates that the level of Engagement significantly impacts patient safety and safety-related loss. Furthermore, in accordance with the aforementioned linkage between Engagement and Patient Care, health care facilities that maintain an engaging work environment experience improved patient outcomes. As CCH’s Employee Engagement scores increased over the years, the number of patient falls decreased by 81 percent and medical errors decreased 32 percent.

Linkage between Employee Engagement and Retention

In the year immediately after their first survey through 2007, CCH decreased its turnover rate by nearly three full percentage points (from 13.1 percent to 10.2 percent) through its comprehensive retention strategy. The Employee Opinion/Satisfaction Survey has been reflective of the turnover rate as the number of employees that had recently considered resigning decreased 25 percent from the first survey to the most recent. By administering Exit Surveys in conjunction with the Employee Engagement Survey CCH was able to link the Engagement Survey with Exit Data to develop a true value driver. “There have been little things that have re-enforced what has been found in Employee Survey results. They have coincided a lot on the issues,” explains Ann Roundy, vice president of Employee Services.

Roundy shares the turnover rate with CCH’s board so they are in alignment with the rest of the management team. At board of directors meetings, she takes the time to periodically spend 30 minutes covering the organization's updated figures on turnover, and recruitment costs, which serve to re-enforce why it is important to keep the benefits and pay competitive. As a best practice, she shares the turnover information in conjunction with the scores for the Employee Engagement Survey.

How did CCH turn things around?

The Role of CCH’s Staff

An undeniable factor in the turnaround at CCH’s scores was the strong commitment of the staff. “The staff really stepped up; they are so responsible and engaged,” stated Roundy. “The staff is very hard working, dedicated, and really cares about CCH. They were not satisfied with scores any more than we were. I have to give a lot of credit to the staff.”

Employees also realized that the executive management team was sincere and committed to asking employees’ opinions to make positive change. CCH had success in the measurable plans because they involved the employees in creation and implementation of action plans.

“The action plans have to be measurable, and we get sign-off from the employees in the department,” explains Harding. "Communication throughout the survey process was instrumental in our success. In fact, communication is one of CCH’s core values developed by employees through a customer service task force. The survey has given us the ability to do a better job at listening to our most valuable resources: the employees.”

Flexibility is Key

It is no secret that our lives are becoming increasingly busy with activities both in and out of the workplace. As we add to our responsibilities with work, family, and personal commitments, making time for it all can seem like a daunting task. CCH is among many employers that have implemented some version of flexible scheduling or flextime for their employees, allowing them to remain active in all aspects of life. The job satisfaction outcomes are astounding, and these flexible arrangements also can be great benefits for employers with respect to recruitment, Engagement, and retention.

“Work schedules at CCH are very flexible,” Roundy says. “Some people work 8 hours, some 12 hours, some work every third weekend, some work every other weekend. It is a bit challenging to manage, but we try to respect work/life balance and flextime.” In addition to flextime, CCH offers employees other time-saving perks such as on-site oil changes, dry cleaning, workout facilities, stamp sales, and UPS parcel post. “They don’t have to worry about running those errands,” she explains.

Ensuring the Best Fit

CCH has not taken the hiring process lightly. In addition to hiring a recruiter, the organization seeks to really understand how a potential hire will fit with the organizational culture during the interview process.

“Every position we hire includes staff interviews with co-workers, peers, and the hiring manager. These interviews are not just Q- and A- sessions; candidates might be asked to participate in scenario teambuilding activities to validate skills or (assess team dynamics),” says Roundy.

The results of the team interviewing process are taken seriously as proven by one team’s decision to restart the hiring process after the team-building event revealed that the group interaction style of two finalists for a “key position” was a poor fit.

A second way CCH ensures a good organizational fit is by “growing their own.” By partnering with schools in the area, hosting clinical practice, and fortifying its tuition reimbursement program, CCH has been able to develop students and staff for the future of the organization.

“Students that come here for clinicals have a chance to feel us out,” says Roundy. During focus group meetings, employees have appreciated the support commenting, “They do promote your education from my experience. If you want to further your education, it has been promoted. I have seen it personally and within my department.”

Conclusion

So do the benefits of Employee Engagement outweigh the costs? “Better morale and teamwork, increased efficiencies. The atmosphere is so different today than it was in 2004," Roundy says. "You can feel it walking through the floors. I don’t know how you put a number on that. I know it feels good when I’m going home at the end of the day. I feel good about what is going on at the hospital when I’m not there.”

Being able to market to prospective employees using the Engagement scores and organizational rank is a significant competitive advantage. The organization has tangible evidence that it achieved a "Best in Class" status and that employees like working there.

“Having a tool like the Employee Opinion Survey helps to differentiate yourself in the market. These days you have to prove that you are seeking to be a good employer. If you’re a health care employee, it is a buyer’s market,” says Harding.

CCH is still in the process of completing its departmental action plans for the year. It has an estimated 50 action plans, down from 170 in 2004, and to ensure action planning success, it assesses action planning progress quarterly.

Harding says, “I have a hard time picturing anyone that is against the employee survey process. How could you not value your employees’ opinions which are often correlated with Employee Engagement and organizational performance?”