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People are the heart of the healthcare industry, and people bear the brunt of its turbulence.
Increasingly, healthcare employees are being asked to do more with less. Cuts to funding and significant decreases in Medicare reimbursement loom large over hospitals while operating costs rise. All the while doctors, nurses, technicians, and all other manner of healthcare employee are expected to deliver quality care experiences that keep patient satisfaction scores high. And as a focal point of the national conversation, disruption is a constant for the industry. New rules, regulations, and legislation make delivering on the finer details of patient’s experience taxing for professionals. Even a simple mistake can manifest as an unexpected infection or greater complication for a patient.
These factors compound to take a significant toll on employees in the industry. In healthcare, stress runs high and burnout comes quickly. A recent study from the American Medical Association (AMA) and the Mayo Clinic found 54.4% of healthcare providers demonstrated signs of burnout. The highest burnout rates were found in the emergency medicine, urology, physical medicine and rehabilitation, family medicine, and radiology specialities. Notably, a separate study found 45% of primary care physicians say that if they could afford to quit, they would.
Amidst this turbulence, employee engagement in healthcare has emerged as a key strategic tool for righting the ship. A focus on employees’ commitment and emotional investment in their work is, as Healthcare Finance News describes, a “must-have” core competency for leaders. And as the industry once again faces potentially widespread disruption under the current presidential administration, experts view employee engagement in healthcare as the stabilizing force that will help change adjustment. To quote Gallup, “Whether more changes will come about because of the ACA or its possible repeal, or other initiatives, employee engagement must be a top priority.”
But what exactly does employee engagement in healthcare look like? In the past, we’ve discussed the signs of engagement on Gather Around in generalized terms. This is because the signifiers of engagement are consistent across industries–higher productivity, job satisfaction, retention, profit margins, and more. However, within a given industry, engagement is expressed in idiosyncratic ways. Although the broad strokes may be similar, the fine details of employee engagement in healthcare are different from those of retail, which are different from those in the energy and utilities industries and so on and so forth.
As you might have surmised, today we’re putting the employee engagement in healthcare under the microscope and examining five conditions unique to the industry.
1. Employee engagement in healthcare is higher than global norms
A 2012 study from Towers Watson found that 44% of U.S. hospital employees are highly engaged. In other words, just under half of the people responsible for caring for the nation’s ill, injured, and ailing feel supported and emotionally committed in their roles. While this isn’t exactly a number to boast about, within the broader context of the report, this statistic is actually better than international norms. Only about 35% of the global population of more than 32,000 full time workers surveyed reported feeling highly engaged.
A separate report from Advisory Board, however, digs deeper. Its study observes that because employee engagement in healthcare trends higher than global norms, any goals or benchmarks set to raise these scores must reflect this data. Additionally, its research shows engagement is fragmented in the industry, with non-clinical departments exhibiting higher levels while clinical and nursing departments trend lower. Thus, engagement scores that reflect positive performance in one department may not do the same for another. When measuring employee engagement in healthcare, it’s critical that realistic, data-informed criteria directs your goals.
2. Nurse engagement can be the difference between life and death
Nurses have some of, if not the closest and most frequent contact with patients during their hospital stays. It should come as no surprise then, that when nurses are highly engaged, it’s reflected in the patients’ experiences. Gallup, studying more than 200 hospitals, found that the engagement level of nurses was the number one predictor of patient mortality rates.
Factors like the ratio nurses to total patient days as well as the percentage of overtime hours per year are the second and third most important factors, respectively. But, significantly, the firm concluded that nurses’ commitment and emotional involvement is what enables them to function as the “key quality control checkpoint” that prevents patient deaths.
3. Employee engagement in healthcare leads to lower operating costs
In the healthcare industry, turnover hits hard. A 2017 Compensation Data survey of more than 11,000 healthcare employers across the nation estimates the overall turnover rate at 20.6%. In other words, a little over one-fifth of employees in the healthcare workforce voluntarily or involuntarily left their positions in 2017. Each loss adds up to a massive financial toll. Per Healthcare Finance News, at this turnover rate if just one organization with a workforce of 3,000 strong loses 20% of its employees, each paid an average salary of $45,000, the turnover costs would total a whopping $27 million.
One of the most common signifiers of employee engagement is reflected in retention. This is no different for the healthcare industry. In an engagement study conducted by the Advisory Board, engaged employees had a turnover rate of 9.8%. Even employees who reported being “content” (read: satisfied in their roles but not quite engaged) had rates down to 13.4%. Disengaged employees, on the other hand, beat the industry average with 21.5% turnover.
Precedent shows that when healthcare organizations are able to spread engagement throughout the workforce, good things happen. One Gallup case study observed the engagement strategy of a hospital from 2010-2013. In that time, the hospital was able to raise its overall engagement score to the 70th percentile in Gallup’s hospital-level database. Overall turnover simultaneously began to decline as well, dropping seven percentage points to reach a low of 15% in 2013. As a result, the hospital was able to save $1.7 million from reduced turnover costs and increase its operating margin.
4. Patient care from engaged employees is safer and more thorough
Healthcare employees work tirelessly to create safe environments for patients. However, risks of Hospital Acquired Conditions (HACs), no matter how low they may be, are present within every facility. Some complications that arise during a patient’s stay even go unreported. A 2012 study showed that hospitals reported only 14% of patient harm events experienced by Medicare recipients.
When healthcare employees demonstrate high engagement levels, however the story’s different. As Forbes contributor Kevin Kruse writes, “they care about [the] hospital, their team and their patients.” Kruse says you can see this engagement in the way employees use discretionary effort to uphold core tenets of patient care. These employees always sanitize their hands, never forget to check IV lines, make few mistakes while administering medications, and more.
The data back Kruse up. According to Gallup, nurse engagement levels are the most significant factor explaining the variance of complication rates in hospitals. When nurses are more engaged, patients are less likely to develop complications or infections during their stay. Additionally, a study of the National Health Service in England showed that raising engagement levels could lead to a decline MRSA cases. Perhaps that’s one of the reasons why 82% of engaged healthcare employees say they would want to use their facility for their medical needs.
5. Engagement and patient satisfaction scores are closely linked
Patient satisfaction is critical for the healthcare industry for multiple reasons. Foremost, positive patient experiences help ensure success in ongoing treatment and lead to greater patient recovery. Beyond that, patient satisfaction is reported via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Required by the Centers for Medicare and Medicaid Services (CMS) for all hospitals in the U.S., the standardized survey gauges patient experiences across several areas, from communication with doctors and nurses to hospital cleanliness and quietness to overall hospital rating.
The survey results are important because they affect Medicare reimbursements for medical facilities. Hospitals with high scores see higher reimbursements, while those with lower scores see reimbursements reduced. When this was first implemented in 2012, hospitals could stand to gain or lose one percent of their Medicare reimbursements–an annual amount of about $850 million. In 2017, CMS raised the threshold of reimbursements wagered to 2%. That’s no small chunk of change.
Notably, hospitals with large populations of engaged employees have a competitive advantage. Because engaged employees are typically thorough and responsive in their care, they have a habit of producing higher overall HCAHPS scores. Hospitals that rank in the top 25% for employee engagement levels also score within the top 19% of highest ranking hospitals on the HCAHPS. In other words, it literally pays to have high employee engagement in healthcare.
Building your employee engagement strategy
If you’re a healthcare leader compelled by the data above but unsure where to begin with your engagement strategy, we have some resources for you, broken down by how nitty-gritty it gets.
Beginner
Know the Difference Between Productivity and Engagement in 5 Questions
It’s easier to confuse productivity and employee engagement than you might think. This article gives leaders helpful criteria for knowing if a strategy is targeting engagement.
Are You Really Working to Engage Employees?
Sometimes the most basic tenets of engagement can go undetected by leaders. Lay the foundation for engagement with a strategy guided by the principles listed in this article.
Intermediate
5 Emotional Constructs That Impact Workplace Engagement
Employee engagement is contingent on the presence of five core emotions: trust, belongingness, altruism, happiness, and achievement. Learn more about engagement frameworks that support each one.
Embrace the Truth About Measuring Employee Engagement
Everyone struggles with building and measuring engagement, even the organizations that are “doing it right.” You can minimize your frustration with thoughtful goal-setting and a holistic, team-oriented approach to feedback.
Advanced
How Relationships Shape Engagement and Culture
This white paper explores how human relationships are fundamental to highly engaged employees. Don’t miss out on this must-read deep dive into the nuances of engagement.
Finally, if you’ve already crafted your engagement approach and are looking for ways to expand it, we’ve got you covered too. You can sign up for the Gather Around newsletter to receive monthly updates on emerging employee engagement trends to keep your strategy current. 
