The State of Workforce Engagement: Leveraging Interdependencies for Improvement

Added on Mar 18, 2020

By Lauren Keeley

Research reported in Press Ganey’s Health Care Workforce Special Report: The State of Engagement reveals that hospitals with high engagement scores and top performance on Overall Rating maintained their high overall ratings one year after their engagement surveys, while those with low engagement saw their overall ratings decline. Similarly, among hospitals in the bottom quartile for Overall Rating at the time of their engagement surveys, those with high engagement saw their overall ratings rise one year later, while those with low engagement did not. This fourth installment in the State of Workforce Engagement blog series explores ways to leverage these interdependencies to drive sustained improvement.

nurse taking blood pressureWith the growing prevalence of burnout and unpredictable changes in the health care landscape, even the most resilient sectors of the health care workforce face new challenges. Studies show that workforce engagement is connected to multiple performance outcomes and has major impacts on the safety, quality, and experience of care. Organizations can use these interdependencies to their advantage when driving improvement.

Looking closely at one of these relationships, patient experience and workforce engagement, the white paper shows that high workforce engagement is associated with improved or sustained patient experience scores from one year to the next, while no such improvement or sustainment is seen in the presence of low workforce engagement.

“When we think about engagement, what we’re really talking about are those employees who lean in, exert more discretionary effort, and are co-owning engagement and the culture,” said Martin Wright, partner, Press Ganey Strategic Consulting. “They’re not waiting for their leader to make the organization a great place to work, they’re participating in making it a great place to work.”

For this type of participation to occur, organizations must consistently call on mutual respect, open communication, a commitment to zero harm, elimination of bullying, and empowerment within their workforce, among other things, said Wright. These culture-shaping factors not only generate an engaged workforce, they structure a work environment that always puts the patient first.

According to Ingrid Summers, senior associate at Press Ganey, one of the most important steps in creating and sustaining a highly engaged workforce is ensuring that there is a shared connection to the organization’s purpose. This guiding purpose—undoubtedly centered on the patient—is the bridge between workforce engagement and patient experience and therefore is crucial to uniting the two for optimal improvement work.  

“Engagement means doubling down on a hard day to get the work done because you’re connected to the meaning,” Wright added.

To foster this integration, organizations can implement improvement tools that prioritize alignment and facilitate crossover between patient experience and workforce engagement. In their own consulting work, Summers and Wright collaborated with leaders at University of Tennessee Medical Center (UTMC) to develop a patient experience narrative to guide their workforce improvement interventions. They began by developing a mantra to anchor this narrative, “Together Safe. Together Effective. Always for Our Patients,” making sure it encompassed the interlocking elements of safety, patient experience, and workforce engagement. From there, they created universal behaviors, which they call Always Behaviors, to ensure that all employees are on the same page with the expected behaviors to support the patient experience narrative. These Always Behaviors orient all staff toward the same shared vision for driving the patient experience. They also apply to how staff treat each other as team members, which encourages teamwork, an engagement variable that has a particularly strong impact on patient experience outcomes.

For organizations that already have a high Overall Rating, sustaining the workforce engagement advances is crucial to maintaining high patient experience outcomes. To avoid flavor-of-the-month improvements, organizations must make sure employees constantly connect back to the mission, embedding best practices along the way, Wright and Summers explained. They emphasized tailoring focused strategies rather than using solely tactical approaches to drive improvement.

“Before our partnership with UTMC, their organization leveraged a more traditional approach to improvement where best practices were interchangeable, depending on whether or not they were having an immediate impact,” Wright explained. Although this approach is common, it does not consider the time needed to integrate initiatives fully and secure buy-in across an organization, he said.

To keep transformation on track, Summers and Wright suggested appreciative coaching, tracking the engagement metrics (both compliance and outcome), communicating expectations to staff, and incorporating accountability standards into everyday work.

According to Summers and Wright, while approaches to improving workforce engagement will differ from one organization to the next, all should share one key element: consistency. “There needs to be an ongoing commitment to a few improvement initiatives until they are fully embedded,” said Wright. “Staying the course is the best means to real culture change.”