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

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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

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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

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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

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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

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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

10

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

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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

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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

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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.