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How Hospitals Can Impact Employee Behavior to Drive Better Care Outcomes
This Perspectives focuses on the hospital industry. It examines the relationship between employee attitudes and aspects of patient care, highlighting actions that hospital leaders can take to inuence the employee behaviors that help drive better results for the organization. Amid the complex business challenges facing hospitals today from intensifying financial pressures, to new competitors, to a changing care delivery model workforce issues can all too easily drop in importance on managements agenda. Yet Towers Watson research and practical experience indicate this is precisely the wrong time to take your eye off creating the right employee experience. The fact is, employees attitudes and behavior have a direct and material impact on key patient and clinical results, and can be an essential element in effectively adapting to change. As our research shows, the right environment leads to behaviors that make an appreciable difference in hospital performance, particularly in terms of patient satisfaction, clinical unit performance and better patient health outcomes all of which can ultimately lead to better financial results and a stronger competitive position.
The fact is, employees attitudes and behavior have a direct and material impact on key patient and clinical results, and can be an essential element in effectively adapting to change.
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On-the-Job Support
I have the equipment and supplies I need to perform my job 95 88 I have the opportunity to enhance my skills and abilities 96 87 Communication here is a priority, and I have access to the information I need 97 86
Commitment to Quality
My facility always demonstrates a commitment to patient safety 97 86 My organization is committed to deliver quality in every aspect of the work 97 86 The organization sets high standards for integrity and compliance 97 86
Top quartile
Bottom quartile
In all cases, our data show that when employees have more favorable attitudes about their place of work, patients are more satised.
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As part of our work at this organization, we also tracked both patient satisfaction levels and employee opinion at each location over two years to gauge change. At those facilities where employees believed the culture was improving, patient satisfaction increased as well, at a faster rate than was the case at those facilities where employees did not feel the culture was improving (Figure 3). Finally, for the organization with 23 in-home medical care provider units, we found that support in the form of greater ability to balance work and personal life correlated with greater patient satisfaction (Figure 4). In units where work/life balance was perceived more favorably (i.e., above the median score for the organization), patients were more satisfied with providers friendliness and technical skills, and were more likely to recommend the organizations in-home care to others.
66%
63 63%
Time 2
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Understanding Linkage
Towers Watsons linkage model (shown below) is a powerful analytic tool for understanding how employeerelated measures impact other measures of organizational performance. By identifying correlations across data sets in the four categories shown below, it helps identify the specific variables that affect customer behavior (patients, in the case of the hospital industry) and determines what employees need to do, or focus on, to help achieve those desired outcomes. The illustration indicates the types of metrics typically used in each category. The hospital industry has the opportunity to gain important insights from this tool, specifically in terms of analyzing staff survey results, risk management data, safety incident rates, employee turnover and absenteeism, and comparing these metrics against time-tested measures of patient satisfaction, quality-of-care outcomes and financial performance. The resulting correlations can point the way toward changes in internal processes and practices that can lead to a more engaged and productive workforce, and ultimately better patient and financial outcomes.
People Systems and Programs Rewards Retention programs Leadership Communication Change management Talent management Cultural integration Onboarding
Employee Behavior Engagement Safety Customer service Turnover Absenteeism Industry-specific productivity/ operational measures
Financial Performance Revenue growth Net earnings EBITDA ROA Stock performance
At the large system in our study, we examined correlations among employee attitudes, safety and absenteeism. We found that on-the-job support affected safety, just as it did patient satisfaction. Across the systems 536 facilities, units where employees said they had good on-the-job support had far better safety records than other units. But support in this context took a slightly different turn than it did for patient satisfaction, involving regular performance feedback and recognition from supervisors for good work. Locations scoring in the top percentile for positive employee scores in these areas had a 48% lower rate of workplace safety incidents than did hospitals with bottom-quartile scores on employee support.
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The top-quartile facilities also had lower absence rates. Across the systems five major regions, facilities that scored in the top 25% for local support had consistently lower rates of sick leave than those scoring in the bottom quartile giving the top-quartile group an advantage, on average, of 20% fewer sick days overall relative to the bottom-quartile group (Figure 5).
0%
Region A
Region B
Region C
Region D
Region E
All regions
Across the systems ve major regions, facilities that scored in the top 25% for local support had consistently lower rates of sick leave than those scoring in the bottom quartile.
Insights into this broad employee base can be a key element in creating an environment that not only supports organizational objectives, but actually shapes behavior to deliver on those objectives. Figure 6 summarizes the essence of our research results at the three health care systems weve looked at. It underscores the impact of two aspects of the work experience. One is support giving employees adequate resources, skill-building opportunities, effective and helpful supervisors, and programs that enable work/life balance. The second is the tone set by leaders and their ability to put quality of care first, make long-range goals and strategies understandable,
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and earn employees trust and confidence. When a hospital makes a commitment to these things in tandem, patients are more likely to be satisfied; quality of care is enhanced, and employees take less sick time and work more carefully. The illustration also highlights the indirect link to financial performance. While our research confirms that employee opinion and behavior do not, in themselves, affect financial performance, they do form the beginning of the linkage chain (see Understanding Linkage, page 5) that leads to better patient outcomes. And better patient outcomes do correlate strongly with financial results. For example, findings from the study of the 21 acute care facilities showed that the HCAHPS overall hospital rating of satisfaction predicts financial success. In particular, those with above-median scores on patient satisfaction reported a 35% higher operating margin and a 37% higher operating income than those facilities with belowmedian scores.
These linkages are consistent with a body of research on the more general service-profit-chain model, popularized by a seminal article in the late 1990s that connected employee influence on customer opinion and behavior to bottom-line business performance.* Given the close contact that health care workers have with patients, its not surprising to see this same model emerging from our research. Employees with direct patient contact help shape not only patients opinions but also their decisions on future care. And where patients decide to spend their health care dollars has a direct impact on the bottomline performance of health care organizations. Put another way, investments in resourcing and employee development, as well as compelling communication and leadership visibility, will pay off over time in better business performance.
Figure 6. Linkage analysis Summary of our study of three health care systems
People Systems and Programs On-the-Job Support Investments in resourcing and employee development Helpful supervisors and programs that enable work/ life balance Organization Values and Culture Tone set by leaders Leaders ability to put quality of care first Leaders ability to make long-range goals and strategies understandable Leaders ability to earn employee trust Employee Behavior Increased employee safety and reduced absenteeism Enhanced delivery of quality of care Patient Behavior Increased HCAHPS overall hospital rating of satisfaction Financial Performance Higher operating margin Higher operating income
*The Service Prot Chain How Leading Companies Link Prot and Growth to Loyalty, Satisfaction and Value, by James L. Heskett, W. Earl Sasser, and Leonard A. Schlesinger
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