Employee engagement is a crucial driver of patient experience. The higher the level of engagement, the more willing employees are to deliver an outstanding patient experience.
Susan Milligan, CHAM, CRCR
Healthcare organizations seek various methods to develop and improve patient experience, but one aspect that can be easily overlooked is employee engagement. Unfortunately, overlooking this relationship can sacrifice a match made in heaven. “Recent studies indicate that focusing on employee satisfaction and subsequent employee retention may be strong catalysts to patient satisfaction.”1 It is not surprising, then, that employees — and their level of engagement — are the foundation for strong patient experience performance.
Admittedly, engagement can be tricky, and it can be difficult to understand what initiatives will have a direct impact. Worse is the fact that many engagement measurements end with the process, stopping short of delivering meaningful outcomes for employees and organizations. Engagement surveys are an easy way to check the pulse of a team’s engagement, but simply conducting the survey is not enough. Surveys are meant to evoke discussion, invite improvements and foster collaboration. Without proper follow through, an engagement survey will not result in a love connection.
So, let’s play matchmaker. Coupling patient experience and employee engagement starts with a focus on executing a successful engagement survey. Next, we’ll build the relationship by discussing some practical measures to improve patient experience through employee engagement.
A successful engagement survey starts with realistic expectations for outcomes. First and foremost, leadership must be committed to acting on results. Transparent communication of results and prioritized action plans also are central to successful survey outcomes, but without real commitment to action plans, a survey can actually damage engagement. Assuming the necessary commitment is in place, leaders will experience more success if they review results empathetically (by viewing responses from the employees’ perspective), develop a structured plan for prioritization and limit action plan initiatives. After all, connection is a marathon, not a sprint.
Ultimately, leaders can begin to spot engaged employees by using a memorable three-part characterization of what it means to be engaged — Aon Hewitt’s model of engagement, where employees demonstrate the following:2
- Say: Employees speak positively about the organization to coworkers, potential employees and customers.
- Stay: Employees have a sense of belonging, a desire to be part of the organization.
- Strive: Employees are motivated toward success for themselves and the company.
In addition, leaders must understand the importance of spending time with and learning what is important to their team members. “Effective communication is essential to improving employee engagement and patient experience.”3 One of the best things a leader can do is ask questions. Leaders who exhibit strong command of this concept ask open-ended questions and make questions a habit during daily rounding, huddles and staff meetings. By doing so, these leaders maintain a clear understanding of their teams’ needs, the effectiveness of interventions and identify additional methods to improve engagement.
Finally, while asking questions regularly is crucial, it is important to recognize the potential for survey fatigue. Sending surveys too often — with insufficient time devoted to responding to results — gives the impression that the survey is perfunctory; just a process box to be checked with no observable changes or results. Consider the use of short pulse surveys twice per year, surveying every two years or a combination of pulse surveys alternated with a biannual survey. Either way, bridge the results by taking noticeable action, such as those described in the following sections.
Engagement Advisory Groups (EAGs)
Employee voice and contributing to organizational decision-making is a proven method of driving employee engagement. Additionally, having an opportunity to make improvements to the work environment is one of the top three drivers of engagement.4 Engagement Advisory Groups (EAGs) are a simple, but highly effective, way to provide a platform for employees to contribute insight on issues that affect their jobs, increase morale and improve job satisfaction. In fact, 84% of employees say they love tasks that challenge them and allow them to widen their skillset.5
Employees want a say in running things, and EAGs allow space for employees to express themselves, exchange viewpoints and discuss decisions made about their department.6
To be most effective, an advisory group needs a sense of purpose, doable tasks, a timeline, praise and recognition and a belief that its input is valued. An advisory group needs regular guidance from its leadership sponsor to be sure they are staying on task. It makes sense for leaders to invest time here, because “feeling the organization values my work” is another of the top three work environment drivers of engagement.4 Perhaps the best part of EAGs is they have a low bar of entry and require little to no financial resources. Here are some proven best practices to follow:
- Discuss the formation of the group during huddles, staff meetings and via email, including the purpose and who should volunteer.
- Be sure to include people of influence: high-potential employees and nay-sayers.
- Choose representatives from all departments. Consider forming a night shift sub-group or schedule meetings at shift overlap to engage them in the process.
- Select a leadership sponsor who can immediately legitimize the group and its mission.
- Leadership should attend but not lead, as their role is to participate and endorse decisions or explain the “why” behind what cannot be done.
- EAGs also are a great opportunity to provide regular coaching and development for the team: ask questions, allowing employees to arrive at the appropriate determination instead of routinely being given the answer.
- Develop the team structure to include a chair, co-chair, notetaker and timekeeper responsibilities.
- Keep the group small enough to ensure agile decision-making; a maximum of 15 individuals is suggested.
- Create a name so they can connect with the cause; something fun but professional, as the group will be asked to report on progress.
- Create a mission statement, a short statement defining the group’s purpose or goal.
- Be specific and inspiring!
- Create guiding principles: rules of engagement, such as requiring all members to participate and attend regularly, demonstrating respect for all members, reflecting the diversity of the organization, etc.
- Identify goals.
- Review the results of the employee engagement survey and establish no more than four focused priorities for action.
- Focus on conquering two challenges: morale and operational processes, for example:
- How can the work environment be improved, making it fun and enjoyable?
- How can workflows be improved to make day-to-day functions more efficient/effective?
- How can peers and patients best be supported?
- What tools or resources are needed?
12. Ask members to consult widely with colleagues to understand root causes and solicit ideas for solutions.
13. Put the members in charge of implementing action plans.
14. Establish a chain of command for decision-making.
15. Clarify extent or limits of authority, keeping in mind the group must have some decision-making authority.
16. Make as many decisions as possible in the room, in real time.
Even the singular step of creating and effectively overseeing an EAG is likely to have a significant positive impact on engagement. To further deepen the relationship between engagement and patient experience, consider investing in professional development. The more that is invested in the employee, the more they will invest in their patients.
Investing in Development
“Career development options lead to lower rates of employee turnover, which can be very beneficial to healthcare organizations.”1 Formal and informal programs, from training courses to mentoring, are instrumental in building a culture of development. For career development options to be effective, consider the following:1
- Leaders must encourage professional and personal development by directing employees to be involved with crucial training opportunities and follow through by allowing time to attend.
- Identify core competencies employees need to be successful, communicate those competencies and be sure they are consistently modeled by leaders.
- A culture of development means it is an ongoing and dynamic process; this cannot be a one-time event or a flavor of the month.
- Be diverse and creative by offering training for schedules that are not 9 to 5; offer variety through e-learning, facilitator-led, hands-on and other venues.
- Programs should promote an environment of trust and welcome employee feedback (which will have an added benefit in forming EAGs).
- Employees should be empowered to self-manage their careers and initiate learning opportunities in collaboration with their leaders.
“Programs that focus on employee participation and involvement in decision-making processes are the ones most likely to experience long-term success.”1
“Every role impacts patient experience and, therefore, healthcare leaders are responsible for equipping clinical and non-clinical professionals with the tools and resources needed to be successful.”3 Chances are most organizations already have a fairly robust training program or can easily partner with organizations that provide webinars and self-directed learning. Making the effort to tie development into the organization’s engagement strategy allows employees to become more confident and proficient in their responsibilities, which certainly translates to improved patient experience.
Strong relationships include mutual interests. As the adage goes, the couple that plays together stays together. The employment relationship is similar. The most engaged employees tend to have values that align with those of the organization, and the No. 1 work environment driver of engagement is “I feel I can trust this organization.”4 Organizations build trust by engaging employees in the work, investing in their development and encouraging participation in opportunities that align with their core values. Organizations that build more satisfied teams tend to promote volunteerism, invest in employee disaster and hardship relief funds, promote and match employee’s charitable donations and encourage community involvement. Satisfied teams promote higher patient experiences because they live and work in environments that foster empathy, engagement and empowerment.
According to a study from Deloitte, creating a culture of volunteerism within a company does not just help others; it also improves the organization.7 Everyone knows volunteering gives back to the volunteer and those they are assisting, but the organization’s employment brand also is viewed more favorably within its own community. Employee volunteer events can improve and develop brand perception. Patients and their families tend to associate organizations with the good work they do8 — how they give back and invest in their community — setting up a positive patient experience perception before they ever step foot through the door.
Back to the question, does employee engagement feed experience? “Investing in Patient Access services communication education and development is critical to our organization’s success because they often are the first and lasting impressions for patients and families. They have the ability to positively or negatively impact the overall experience.”3 Building employee engagement gives frontline employees a voice in the organization’s goals and processes, develops employees personally and professionally and aligns their values with the values of the organization and the community. Engaged employees are more likely to deliver an outstanding patient experience more consistently.
Is employee engagement a key to patient experience living happily ever after? Yes!
Susan Milligan, CHAM, CRCR, is the patient experience director for Ensemble Health Partners. Informed by her experiences in healthcare and as the mother of a child with Down syndrome, she is passionate about helping healthcare organizations improve their patient experience through empathy, empowerment and engagement. Listen to episode 1 of the NAHAM Connections Podcast for more from Susan on the patient experience.
1 Collins KS, Collins SK, McKinnies R, & Jensen S. (2008). Employee satisfaction and employee retention: catalysts to patient satisfaction. Health Care Manager, 27(3), 245-251.
2 AON. “2018 Trends in Global Employee Engagement.”
3 Barden A, Giammarinaro N. (2018). Patient experience grant program series research report: Effectiveness of the communication model, C.O.N.N.E.C.T., on patient experience and employee engagement: A prospective study. The Beryl Institute.
4 Lowe, G (2012). How employee engagement matters for hospital performance. Health Human Resources, 15(2), 29-39.
5 Towers Perrin. “Working Today: Understanding What Drives Employee Engagement.”
7 Deloitte. “2017 Deloitte Volunteerism Survey.” https://www2.deloitte.com/us/en/pages/about- deloitte/articles/citizenship-deloitte-volunteer-impact-research.html?nc=1
8 Operation Warm. “5 Reasons Why Employee Volunteering is a Smart Investment.”
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