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4/20/2015
1
Making the Connection Between Employee
Engagement and Patient Satisfaction
Presented by:
Debbie Costello, MSM,RN
“The delivery of compassionate care leads to safer
care but this will only occur with an engaged workforce under effective leadership.”
Day, 2014, British Journal of Nursing
Session Overview
Patient Satisfaction as a Quality Measure
Value Based Purchasing
Characteristics of Engaged Employees
Psychological Engagement
Management Guidelines to Promote Employee Engagement
The Link Between Employee Engagement and Patient Satisfaction
The Business Case
4/20/2015
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Quality Measure Spotlight: Patient Satisfaction
Three Composite Measures
Care of Patients
Communication
Specific Care Issues
Global Ratings
Overall Rating
Willing to Recommend
Roadmap for VBP
2015 PPS rule
Demo project 2016 in 5-8 states
Current Pay-for-Reporting provides foundation
Will align with National Quality Strategy
Align with existing VBP programs
Coordinate with existing components
“A critical tool to identify link between patient experience and perceived quality of care”
US DHHS Report to Congress: Plan to Implement a Medicare HHA VBP Program, 2012
Work with passion
Feel connected to the organization
Are more productive
Are more customer focused
Are less likely to leave their job
Go above and beyond the call of duty
Attract people who have the same level of commitment
Help move the organization forward
Engaged Employees…
Spreitzer, 2015, Harvard Business Review
4/20/2015
3
Defining Engagement
• Recognize and agree with the mission of the organization Rational
• Incorporates high energy and discretionary effort Behavioral
• Attitudinal attachment
• Enthusiasm Emotional
Gray, 2012, Nursing Forum
Psychological Engagement Presence
Feeling that job tasks are worthwhile
Trust and support
Physical, emotional, and
psychological means
Rakovec-Felser, 2011
Management Impact Meaningful
Worthwhile Useful Valuable Making a difference Appreciated
Safety No fear of negative
consequence Trust Openness Supportiveness
Availability Sense of having
physical, emotional, psychological means
Rakovec-Felser, 2011
4/20/2015
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Psychological Engagement
and Relationships
Linked to the level of satisfaction with
patient care delivery
Low satisfaction with care delivery
associated with related to:
High level work pressures
Inadequate materials
Inadequate staffing
Social support can help to buffer
Carter and Tourangeau, 2012
Common Factors of Highly Engaged Employees
Organization values me
Organization practices what it preaches
I would recommend this
organization
Employees are included
in decision making
Organization encourages and
supports innovation
Safe and effective ways to communicate a complaint
Upper management is trustworthy
Upper management listens to employee ideas and opinions
Supervisors understand key issues in their departments
Overall, my supervisor is an effective leader
Wagner, 2006
Rules of Engagement In order to be engaged, employees need to:
Know what is expected them
Have the necessary materials and equipment
Receive recognition for doing a good job
Trust their leader and co-workers
Know their opinions matter
Feel their job is important
Believe their fellow employees also are committed to doing quality work
Have open dialogue with managers about goals and progress
Have opportunities to learn and grow
4/20/2015
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"The way you create great service is by creating a great place to work. The key is creating great supervisors."
Quint Studor
Engagement Starts with the Leader
Do you have the right leader?
Hiring practices
Aligned values and beliefs
Cultural values
Mission of the organization
Influential
Expertise
Conflict management
Accountability
Referent power
People matter
7 Step Action Plan:
Ensuring Employee Engagement
1. Provide a positive work environment
2. Reward and recognition
3. Shared values and guiding principles
4. Involve and engage the workforce
5. Develop employees skills and abilities
6. Promote positive relationships with coworkers
7. Evaluate and measure job satisfaction
Heathfield, 2015
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Action Plan #1: Provide a Positive Work Environment
Demonstrate trust and respect Understand what motivates people
Employee discounts Ensure safety of staff Work environment
Lateral violence
Fair and manageable workloads
Equal opportunity and treatment Competitive pay and benefits
Open communication and transparency
Action Plan #2: Reward and Recognize
Acknowledgement from the manager Verbal/ written
Physical
Timing: don't delay praise Sincere
Specific - Give details of the achievement
Personal - Do it in person or through a handwritten note
Positive - Don't mix in criticism
Proactive - Don't wait for perfect performance
Effective feedback ongoing
Build morale through fun recognition events
http://hrcouncil.ca/hr-toolkit/keeping-people-employee-recognition.cfm
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Action Plan #3 Shared Values and Guiding Principles
Set the culture tone Common purpose
Value alignment Accountability Focusing on detail
Delivering quality
Honesty Positive
Helping others.
Being a great team member Respecting company policies and respecting
others
Showing tolerance.
http://www.mindtools.com/pages/article/understanding-workplace-values.htm
Action Plan #4 Involve and Engage the Workforce
Employee suggestions
Forum to promote exchange of ideas
Spotlight on specialties
Cross functional teams, committees
Special projects
Invite input into decisions
Transparency
Open door policy
Keep promises
Action Plan #5 Develop Employees Skills and Abilities
Understand individual goals
Look internally to fill positions
Transfers, lateral mobility
Promotions
Development and training
Orientation
Certifications
Seminars
In house education
Invitees
Subscriptions
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Action Plan #6 Promote Positive Relationships
People matter
Focus on strengths
Empathy
Humor
Minimize incivility
Action Plan #7 Evaluate and Measure Satisfaction
Satisfaction surveys annually
Attitudes
Morale
Motivation
Periodic check in
Employee forums
Quick informal surveys
Personal dialogue
“The level of employee engagement
significantly impacts retention, absenteeism, patient satisfaction, patient
outcomes, and ultimately, patient safety.”
Wagner, 2006
4/20/2015
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Employee
Engagement Patient
Satisfaction
Is there a Relationship Between Employee
Engagement and Patient Satisfaction?
Gallup Analysis
Gallup’s five core items show a consistent strong relationship to patient satisfaction
1. I have the materials and equipment to do my job right.
2. At work, I have the opportunity to do what I do best every day.
3. The mission or purpose of my organization makes me feel my job is important.
4. My associates are committed to doing quality work.
5. This last year, I have had opportunities at work to learn and grow.
Blizzard, 2015
AHRQ Research Portfolio
Model describing relationship of
organizational climate and patient outcomes
Positive organizational climates were generally found to improve patient safety.
Consistent research findings: patient and employee outcomes were affected by organizational climate
Stone, Hughes, and Dailey, 2008
4/20/2015
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Study: Home Health Client Satisfaction and Nursing
Perception
Relationship with patients cited as reasons
to stay in home care
Nonprofessionalism of colleagues as a
reason to consider leaving
High value on colleagues that serve as a
resource and can be trusted
Correlation between nurse/ supervisor relationship and client satisfaction
Study: Home Health Client Satisfaction and Nursing
Perception (cont.)
Correlation between client satisfaction
scores and a structured framework
Managers provide opportunities for their
nurses to maintain currency with home health nursing practice
Kropowski & Alexander, 2006.
Study: Relationship Based Care
Increased workloads
High stress level
Unprofessional behavior
Patient perceives lack of caring
Weakens patient engagement
Increase in poor outcomes
Guglielmi, et al. , 2014
4/20/2015
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Study: Compassionate Care
Delivery
Byproduct when compassion is lacking:
Increase in avoidable harm to patients
Pressure ulcers
Falls
UTI (catheter related)
Day, 2014
Research: Vital Link
Employee Satisfaction and
Satisfaction and Quality of Patient Care
Department comparison
High employee sat/
high patient sat
Patients more likely to
recommend
Individual employee
recognition key
contributor
More respect and
visibility
Being listened to /
decision making
Key conclusion
Emphasis on how
employees feel about what they do
Blizzard, 2014
How Anna Jacques
Improved Patient Sat. Scores
Developed a philosophical change
Changed the culture
Adopted a more cohesive team
approach
Raised level of accountability
Implemented a patient first customer focused approach
Changed community perception
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Report: Malcolm Baldridge
National Quality Award
Necessary resources and training for staff
“Employee morale was the biggest factor in patient satisfaction.”
Achieving this started with leadership at the top.
Larson, 2015
The Commonwealth Fund
In order to become patient centered:
Workforce most important aspect
Nurture an environment of valued
Workforce/ Patients : Same dignity and respect
Leaders model positive behavior
Encourages similar behavior in others
Responsive, service-oriented care to patients and their families
Shaller, 2007
“Evidence of significant associations between positive
leadership practices and increased patient satisfaction,
reduced adverse patient events and reduced patient complications” Wong, 2010
“A team of interdisciplinary scholars developed a
model depicting aspects of organizational climate
and their relationship to worker and patient outcomes” Stone, 2008
“Relationship was found between positive patient-reported
inpatient experiences and lower-than-expected pre-
admissions, hospitalization, and 30-day post-discharge costs” CMS, 2015
4/20/2015
13
Culture of
Engagement
Two Way Feedback
Trust in Leadership
Employee Role in
Success
Career Dev.
Shared Decision
Making
Employee
Engagement
Enhanced Org.
Performance
Increased Productivity
Retention
Greater Financial Success
Financial/Operational Results
http://www.frontlinelearning.com/Article_Employee_Engagement_Creating_a_Culture.html
70%
75%
80%
85%
90%
95%
Agency
SHP Database
Agency HHCAHPS Mar 13 – Feb 14
Agency Engagement
Indicator
“In the end, we must not forget that patients do
not care how much we know until they know how much we care.”
Gerald Healy MD, 2014
4/20/2015
14
Questions?
Blizzard, R. Engagement Unlocks Patient Satisfaction Potential. Retrieved 1/4/15 at
http://www.gallup.com/poll/8650/Engagement-Unlocks-Patient-Satisfaction-Potential.aspx
Carter, M. & Tournangeau, A. (2012). Staying in nursing: what factors determine whether nurses intend to remain
employed? Journal of Advanced Nursing 68, (7), 1589-1600.
Day, H. (2014). Engaging staff to deliver compassionate care and reduce harm. British Journal of Nursing,23, (18),
pp. 974-980.
Gray, L. (2012). Nurse manager engagement. Nursing Forum, 47, (3), pp.193-199.
Guglielmi, C. The growing role of patient engagement: relationship-based care in a changing health care system.
AORN Journal, 99, (4), pp. 517-528.
Heathfield, S. Create a Work Environment That Encourages Employee Engagement. Retrieved 1/4/15 at
http://humanresources.about.com/od/Employee-Engagement/qt/Employee-Engagement.htm
Kropowski, B. & Alexander, J. (2006). Correlation among client satisfaction and nursing perception of outcomes,
and organizational variables. Home Healthcare Nurse, 24, (2).
Press Ganey. (2011). Anna Jaques recognition. Nursing News.
Rakovec – Felser, Z. (2011). Professional burnout: what to do? Collegium Antropologicum, 35, (2), pp. 577-585.
Shaller, D. (2007). Patient centered care: what does it take? The Commonwealth Fund
http://www.commonwealthfund.org/usr_doc/Shaller_patient-centeredcarewhatdoesittake_1067.pdf?section=4039
Stone, P., Hughes, R., & Dailey, M. (2008). Patient Safety and Quality: An Evidence Based Handbook for Nurses.
http://www.ncbi.nlm.nih.gov/books/NBK2634/
Wagner, S. (2006). Staff retention: from “satisfied” to “engaged.” Nursing Management, 37, (3), pp. 24-30.
Wong, C., Laschinger, H., & Cummings, G. (2010). Authentic Leadership and Nurses' Voice Behaviour and
Perceptions of Care Quality. Journal of Nursing Management, 18, pp. 889–900.
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