Recognition a Key Driver for Healthcare Worker Engagement, HCAHPS Scores

March 20, 2018 John Rossheim

Hospitals and medical centers have recognized that rewards and penalties for their patients’ satisfaction ratings are having an ever-increasing impact on the bottom line. And savvy institutions can see that HCAHPS scores – derived from the patient satisfaction survey mandated by the Centers for Medicare and Medicaid Services – are dependent on the satisfaction and engagement of another key constituency: these healthcare providers’ own employees.

What makes hospital employees – especially clinicians – happy at work and engaged in their jobs? The root causes of employee satisfaction, or its absence, are diverse. But, independent of each institution’s specific problems, sound organizational processes to self-evaluate the work environment and effect change can improve employee satisfaction, and therefore patient satisfaction and fiscal health.

It’s not merely an article of faith that satisfied hospital employees make for a better patient experience. “There are a couple of decades of evidence that happier hospital employees raise HCAHPS scores and improve patient safety and outcome quality,” says Barbara Balik, RN, EdD, senior faculty at the Institute for Healthcare Improvement.

One key component to positive change for clinicians and their patients is employee recognition, which can in turn help to boost to HCAHPS scores.

“Recognition is a huge need,” says Balik, a former hospital CEO and CNO. “Most meaningful recognitions are specific, close in time to a particular action, and tied to the mission of the organization.”

But all employee recognition programs are not created equal. “Many hospitals go about recognition the wrong ways,” says Kevin Kruse, author of Employee Engagement 2.0. “If they do an employee of the month program, the winner’s circle is too small, and you may disengage as many people as you award. The best recognition programs are systematic and often driven by peers.”

Of course, none of this can happen if a hospital’s top leadership isn’t convinced of the value of employee engagement and its potential to improve patient satisfaction scores. ROI is the metric of choice here.

“Metrics can work to convince executives, especially with turnover,” says Diane Shannon, MD, MPH, a consultant and co-author of Preventing Physician Burnout.  The total costs of replacing a physician and getting them up to speed is $500,000 to $1 million, she adds. Not to mention the cost of having hundreds of patients interact with physicians who are dissatisfied with the current conditions of the demanding career that they’ve chosen.

When hospital leaders set out to improve their HCAHPS scores, they first must identify the issues and their scope. Physician burnout, which is very costly to providers, can be a good starting point. “Hospitals need to acknowledge the problem of burnout and get a handle on the scope of it, including some measurement and understanding of the drivers of it,” says Shannon.

But the extreme case of burnout is not the only form of employee distress that concerns hospitals. The broader problem is a shortfall in clinician engagement, and the attendant job dissatisfaction. Healthcare systems that provide a better employee experience see improved engagement metrics.

Take nurses in acute-care institutions, for example. Hospitals with better work environments for nurses have higher HCAHPS scores, according to a survey of more than 20,000 nurses reported in Health Affairs. Contributing factors to these clinicians’ satisfaction included effective leadership, nurse-physician collaboration, and quality of care provided, the study concluded.

But lack of engagement continues to be a widespread problem. Only 44 percent of U.S. hospital workers are highly engaged, according to a Harvard Business Review analysis of a Willis Towers Watson study.  And engagement can make a big difference with loyalty – and retention. Whereas 43 percent of disengaged employees in the study were interested in changing employers, only 17 percent of highly engaged employees were contemplating greener pastures.

As with so many business challenges, to address employee engagement, you have to measure it. “The only way a hospital will improve employee engagement is if they conduct an employee engagement survey, give each manager their own results, and hold managers accountable for creating an action plan with their team to improve on the worst items,” says Kruse.

Once areas of dissatisfaction are identified, managers need to find ways to address the problems without simply adding to-dos to a clinical staff that may already be feeling overburdened. Eliminating redundant patient-care and administrative processes is a productive way to free up staff bandwidth.

“We have very wasteful systems in healthcare that waste time, energy and good will,” says Balik. “So we need to have conversations with clinicians about what matters to them, and work with them to identify what gets in the way. This gives staff some space to find the energy to improve care.”

Then it's time to address individual issues that affect employee and patient satisfaction. “Some organizations engage the clinical team in understanding what the pain points are,” whether it’s too much time spent on the electronic health record system or inefficient flow of patents through the medical office, says Shannon. “Just the fact that they’re getting resources and attention to the things that drive them crazy gives them a sense of hope and bandwidth to address issues.”

Employees will be happier, from the outset of the change process, if their perspectives are integral to creating solutions to the problems that disengage them. “We need to address how we work together as team members to develop respect and a sense of community,” says Balik. “Psychological safety means that we can trust, and are trusted.

And recognition, thoughtfully given by managers and peers, can make a difference in building that trust through positivity and connectivity.

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