Hand in Hand
By Sherree Geyer
Patient and Employee Satisfaction
Debbie Cardello, chief operating officer at Robert Wood Johnson (RWJ) University Hospital Hamilton (N.J.), describes how a change in her facility's food service operation increased satisfaction levels among both employees and patients.
"We know that food service can be dissatisfying to patients. So, we went to a room service format where patients could order from a menu at anytime. Employees were delighted because they could see how happy patients were," she explains.
Cardello's experience exemplifies her belief that, "patient and employee satisfaction go hand-in-glove," a point echoed in What Goes Around, Comes Around, a 1999 report published by Press Ganey, a provider of satisfaction measurement and improvement services, based in South Bend, Ind. The report states that: "In health care, as in other service industries, customer satisfaction largely depends on the employees who deliver service to patients. Successful organizations understand the importance of front-line workers in their effort to satisfy the needs of customers."
As hospitals evolve toward a consumer-driven care model and vie for patients and employees in an increasingly competitive market, the need to satisfy both parties becomes crucial to successful operations. Trustees, who recognize--probably more than most--the intrinsic relationship between employee and customer satisfaction from their own business experience, stand to improve patient outcomes, lower labor costs and increase patient referrals through their support of such satisfaction initiatives.
Patient-Employee Satisfaction Go Hand-in-Hand
A Press Ganey 2005 Health Care Satisfaction Report states that "increases in employee satisfaction are associated with increases in patient satisfaction." The report's data, gathered from 100 organizations, show a direct relationship between the two.
Robert Wolosin, research product manager at Press Ganey, says, "tens of thousands of surveys" leave no doubt in his mind about the connection between patients and employees. He says that "empirical evidence leads to this conclusion" and that "hard numbers tend to drive out opinion."
He reaffirms, "We have data that show that employee and patient satisfaction go hand-in-hand. Studies from hospitals that use inpatient and employee satisfaction surveys find over and over again in questions and scores that hospitals that do well in patient satisfaction also do well in employee satisfaction."
Monica Locker, director of Press Ganey's employee perspectives division, sees an increased interest in employee satisfaction scores among top hospital executives, noting that, "In the past, they were concerned about employee data because they felt they had to improve the organization. Now, more and more, they're concerned with data that will reduce turnover and increase retention."
She also says that employees, who previously watched supervisors struggle with work-related issues, now expect hospital leaders to know "what's going on in hospital units and learn what's working and not working."
She explains: "One thing that's most remarkable is a 2004 to 2005 push on senior leadership to understand what's important to employees, prepare for the future and develop a strategic plan. Employees now look for leadership to take responsibility in strategic planning and address problems--and for CEOs, COOs and vice presidents to communicate with them."
Wolosin believes that service excellence drives employee satisfaction, which, in turn, drives patient satisfaction. Senior leaders, who make service excellence a priority, set a high standard of care that trickles down the chain of command to the rank-and-file employee.
"If we think of a hospital as having a culture, then some of them value service excellence, and some couldn't care less. This is the situation at the top levels among CEOs and boards, the higher echelons of management. We think the value an organization places on people in general permeates the culture of a hospital," Wolosin says.
Cardello agrees, noting that, "People are in the center of all that we do. We consider employees and patients to be our customers. They all play an intrinsic role."
RWJ Hamilton Wins Customer Service Award
In 2004, RWJ Hamilton received the Malcolm Baldrige National Quality Award in health care. As the first hospital to receive the award in the state of New Jersey and the only health care recipient for 2004, RWJ joins a group of only three other health care organizations that have received the Baldrige award.
Christy Stephenson, president and CEO of RWJ Hamilton, attributes the honor to successful implementation of the Baldrige framework criteria. Named after former U.S. Commerce Secretary Malcolm Baldrige, the framework's criteria emphasizes enhanced competitiveness by improving customer value and overall organizational performance, according to the National Institute of Standards and Technology, Gaithersburg, Md.
Stephenson says, "We put the framework in place on a state level in 2001" and credits it with moving RWJ Hamilton from fourth place in a market of five health care providers to a dominant market share position.
"We're a completely different organization today. People say, 'there's a palpable difference between the culture at Robert Wood Johnson and other hospitals,"' she says.
Cardello says that using the Baldrige framework raised employee satisfaction levels from 50 percent to 98 percent and patient satisfaction from 67 percent to 90 percent. She adds that, "Leadership drove that change ... [and] the Baldrige criteria provided the framework for it."
Griffin Hospital Ranks High as Employer of Choice
FORTUNE magazine ranked Griffin Hospital, Derby, Conn., eighth on its "100 Best Companies to Work For" in 2005. Griffin, which has been included on the list for six years running, also received this year's Pride Award from the Great Place to Work Institute, a research and management consultancy firm in San Francisco.
Patrick A. Charmel, Griffin's president and CEO, attributes the honors to his hospital's 1992 adoption of the Planetree care model saying, "We didn't set out to position ourselves as the employer of choice. That was an unintended consequence of redesigning the care model."
Griffin's Web site states: "The Planetree model was founded on the belief that if patients have access to information regarding their illness and hospitalization, they can become active participants in their own health." The patient-centered approach to care also "enables employees to practice their profession the way they envisioned it--with the focus on patient care and satisfaction."
Charmel has additionally observed that the Planetree model strikes a chord with visiting hospital trustees. Griffin, which hosts a tour of its facility nearly every week, has hosted 530 U.S. and 16 foreign hospital groups to date.
"When we talk about our patient-centered approach to care, the first people in the room to get it are hospital trustees," Charmel says. "The reason they serve on the board is to make the hospital environment a better place for friends, family and the community. Very quickly, you have trustees challenging hospital staff and thinking about things from the patient perspective. They'll ask, 'Why haven't we done that before?'"
William C. Powanda, Griffin's vice president of support services, credits the Planetree care model with improving hospital discharge rates by 26 percent between 1999 and 2004 and increasing outpatient visits by 72 percent between 1998 and 2004. Griffin, which enjoyed a 2004 patient satisfaction score of 97 percent, provides routine customer service training to employees to maintain its position as "the hospital of choice for the community it serves," Powanda says.
More Than Money
Press Ganey's What Goes Around, Comes Around report states specifically that: "The organization that attempts to improve satisfaction through extrinsic rewards such as increasing wages and benefits may be discouraged when these actions don't have the desired effect. Incentives, raises or bonuses should not be first on the priority list of building an effective performance management system in health care."
Tom Atchison, president of Atchison Consulting Inc., a health care management firm in Oak Park, Ill., adds, "If employee satisfaction is based on superficial aspects, such as pay and benefits, it won't be sustainable over time. Rather, hospital leaders need to focus on professional development. You need a boss who understands the need to be challenged; to feel connected to work."
Health care experts agree that it takes more than money to recruit and retain qualified employees. "From where I sit, money and material rewards are baseline," says Wolosin. "As long as people are adequately compensated, they're satisfied. What are really important are intrinsic rewards. Belief in hospital leadership and recognition make a huge difference."
Locker agrees that "money is a base need. The big motivator is participation--involving [employees] in the process--followed by recognition--patting them on the back." She adds, "When you think about the fact that health care workers save lives, retention is less and less about money and more about experience--learning to grow with an organization [and having] employee involvement in the decision-making process. If those things are in place, then money becomes less important."
Stephenson says the objectives outlined in RWJ Hamilton's strategic plan do just that, giving employees a voice in decision-making. For instance, "nurses choose equipment, review purchases, participate in shared governance (as an interdisciplinary team), and are involved in every aspect of practice," she says.
Wolosin says, "Successful hospitals have hardwired programs for rewarding employees right on the spot. If a nurse does something that's above and beyond the call, [he or she] gets a reward immediately. That shows that somebody cares."
Griffin employees receive a $250 after-tax check for extraordinary service to patients and family members, Powanda says. Employees receive the check during a monthly meeting in the hospital's cafeteria where Griffin's CEO "tells everyone why the employee of the month was chosen," Charmel explains.
Living the Mission
According to Press Ganey's What Goes Around, Comes Around: "Health care employees are as aware of the institution's mission statement as is the management. They believe in it. It's why they're in health care."
Senior leaders must "understand the mission and be able to articulate that to employees," Locker explains. "If employees don't see their behavior modeled by senior leadership, they feel disconnected from hospital operations. That leads to low morale, which has a significant impact on productivity."
She gives examples of what this means. "I've heard that some CEOs pick up litter when they see it in hallways or escort patients to a department. That's the type of CEO who lives the values of the health care organization."
Stephenson agrees that hospital executives should live an institution's mission and says, "Our senior leaders sign a commitment to be role models for the hospital." She believes that "when you write something on a page, that's pretty dry; but when you live it, that's something different."
Charmel also believes that senior executives who live the values of an organization instill a sense of pride and ownership in their employees. Atchison, who calls pride "the deeper dimension" of employee satisfaction, thinks, "There's a qualitative difference in the way that people with pride behave," adding that "loyalty is a manifestation of pride."
"Only the most satisfied customer will be a loyal customer," notes Wolosin. For hospitals, that means that the willingness of employees and patients to refer others to a hospital "is one aspect of loyalty," he says. Press Ganey's satisfaction report confirms that, "The willingness of employees to recommend a facility to their friends and family is an excellent signal of their loyalty."
Recruitment and Retention Benefits
The benefits of employee loyalty extend beyond such recommendations, however. According to the Press Ganey report, employee satisfaction translates into employee retention, and "the cost of attracting new employees far outweighs the cost of retaining the staff." From her experience, Locker has observed that, "typically, it costs two times the salary to recruit and train an employee"--funds that could be used to treat patients. Maintaining employee satisfaction preserves the bottom line and minimizes unanticipated costs.
"The last thing hospitals want is to recruit employees when more and more patients are coming in the door," Locker says. "If you've got satisfied employees, they'll give 110 percent and are less likely to [resign], which comes at a significant cost to hospitals. If [hospitals] are spending 3.4 to 4 percent of their operating budget on recruitment, those are direct dollars not going into patient care."
Satisfied employees also ease recruiting pressure, Cardello notes. "Up to 50 percent of our new employees come from employee recruitment efforts, and that's key for us to get an employee that fits our culture.... We have very low agency costs and recruitment fees," he says. Griffin pays 5 percent to 7 percent below the going rate for health care workers but enjoys vacancy rates of only 3.6 percent for nurses and 4.5 percent for staff overall, says Powanda, who notes, "The last time we ran an ad, we got 5,200 applications for 190 openings across the board. We have [needed] no agency nurses for over two years and currently have only three traveler nurses in specialty areas."
Advice to Trustees
According to Press Ganey's 2005 satisfaction report, "Efforts to improve customer satisfaction must take employee satisfaction into account. Measuring customer satisfaction without simultaneously measuring employee satisfaction may be shortsighted."
Wolosin agrees, explaining, "You can't manage what you can't measure. Unless you have a good idea of how employees feel on a day-to-day basis, there's no way to get a handle on it except through routine surveys. If you want to drive to a level of service excellence, you have to know where you are now."
Locker advises hospital trustees to "measure employee satisfaction regularly." She recommends conducting employee surveys once every 12 to 18 months and advises that, "No more than two years should pass before you measure the culture."
Cardello says RWJ Hamilton conducts employee and patient surveys every two years, and Charmel says Griffin measures employee satisfaction through surveys every year. He cautions hospital trustees and senior executives "to be prepared to respond to any concern on the survey because, by [giving] the survey, you create the expectation that you're going to do something about problems."
Trustees should initiate strategic plan objectives encouraging "management to develop a workplace that creates a high-level of employee satisfaction," say Charmel. "Encourage management to set the bar high ... because the return on investment is profound."
Sherree Geyer is a writer based in Orland Park, Ill.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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