Knowledge of Employee Satisfaction Measurement and Improvement Techniques

Recently, I wrote a series of articles for the ACHE, American College of Healthcare Executives. If you have not been involved with this organization, they are someone to get involved with. As a Technology Profesional you have many choices, CHIME, HIMSS, etc. I have found this organization to be among the absolute best in examining practices and trends in healthcare delivery and all it's component organizations. ACHE membership provides excellent guidance and education to executive leadership. I hope you enjoy these feature articles submitted to the ACHE through Quantum Leadership.

Healthcare providers are faced with cutting costs while maintaining high quality services. Patients, employers, business groups, health plans, and insurers are scrutinizing the delivery of care from the perspective of quality and cost. Determining what matters most to employees and aligning expenditures with priorities are strategic challenges for HR. “For organizations to be successful at competing for new talent and retaining employees, they have to know what workers want, what keeps them happy, and what makes them stay,” said Susan R Meisinger, president and CEO of Society for Human Resource Management (SHRM).

Addressing the essentials, including fair compensation, valuable benefits, and the ability to balance work and life are crucial components of an organization’s overall retention strategy. Organizations must not only create a mix of benefits that retain and motivate what are often very diverse workforces, but they must also continually fine-tune that mix. Hospitals that know how to create an organizational culture that accommodate the needs of their targeted workforce will have the advantage in the competition for talent.

Research has proven that wholly engaged employees tend to be more self-motivated, reliable, and have higher levels of organizational loyalty. Additionally, studies have revealed that an engaged personnel tends to retain employment and is less absent Besides, these engaged employees have higher levels of customer approval and service quality and they regularly achieve, and often surpass, goals.

Some factors of job satisfaction are universal and consistent. Both employees and HR professionals note compensation and benefits are important to employee job satisfaction. However, research has shown that there are more important factors that contribute to job satisfaction, such as relationships with immediate supervisors, management recognition of employee job performance, and communication between employees and senior management. These factors have more to do with the organizational culture and working conditions in the company.

Determining the need
• The need for such surveys is greater when one or more of the following factors is present:
• Rapidly growing organization: It is critical to find out how employees feel about their jobs, the hospital and their fit and future within it.
• Highly competitive industry: In an industry like health care, turn over minimization and productivity and creativity maximization are keys to success. Staying in touch with employees is necessary to facilitate continued competitiveness.
• Contemplated changes in pay & benefits: To know what needs to be “fixed” and how much “fixing” it needs to maximize return on invested money and people resources.
• Planned or recent organizational changes, including change of leadership: Change can be difficult for many people. If not handled properly, productivity and profits can decline.


Determining what and how to ask
• Organizations usually develop a base questionnaire that contains core questions necessary for substantially all employers. There are three broad types of questions: Factual ones, those dealing with opinion i.e. opinion questions and those dealing with motivation i.e. motivation questions. Classification questions such as date of birth and age, which are a special group of factual questions, are asked at the end of the questionnaire. The majority of questions on a employee satisfaction survey should be answered using a scale.
• Examples include 10-point scales, Likert scales (e.g., five points ranging from “strongly agree” to “strongly disagree”), four-point scales (which force a sided response) and many other variations. Including an open-ended question allows the respondents to give their suggestions and recommendations in writing. While verbatim comments are not easy to tabulate, they will bring meaning to some of your scores. The verbatim responses will help you understand what is behind that score,” “It’s pretty powerful to see exactly what some of your employees are saying about you.” This is then customized to fit it to the particular needs of the department being studied, adding and deleting items as appropriate.
• The area of focus in the current study being front office, the researcher studied and reviewed all the recent projects and trainings organized for this team in order to select the broad dimensions for study. Existing instruments were reviewed and studied. All types of questions were included covering nearly every facet of employee satisfaction.
• All items were to be rated on a four point Likert scale. Each item in the survey was combined with other related survey items to produce dimensions. A dimension is a broad-based subject category which measures an important aspect of satisfaction. Dimensions greatly simplify the reporting and feedback of survey results by providing specific findings for each subject category measured.

Proofing & testing
• This includes checking misspelled words, proper skip patterns, question numbering, grammar and format.
Inviting the employees & obtaining a high response rate
• Certain information is communicated to the employees to invite them for the survey and obtain a high response rate. It may be regarding what and why is happening, assuring the anonymity, how will the results be used in their favor, duration and deadline for completing the questionnaire to thanking the employees for their time and co-operation.
Interpreting the results
• It is astounding how much “data” can be created by a survey. Each scale question has multiple possible answers, each of which is reported along with each item’s average score; there are results for various dimensions, and there is statistical analysis.
• The different approaches for analysis may include:
• Analysis of strengths & weaknesses: In this, the emphasis is laid on the intra-survey strengths and weaknesses, i.e. how the items in the survey compare to each other. This may be done at the attribute (individual question) level as well as on a section/dimension (groups of question) level.
• Leverage analysis: It provides a way of selecting areas to focus on, by calculating each area’s level on a “bottom line” measure – overall satisfaction.
• Comment Analysis: Recommendations/suggestions written by employees as well as patients/attendants generated qualitative data. Simply reading comments can give one a flavor for the types of issues on employees’ minds. However, proper interpretation becomes difficult, if not impossible, for two reasons:
• The reader may tend to give more weight to comments that mirror his/her point of view. The number of comments can be overwhelming. The solution is to “code” the comments, which is done by reading all or a large sample of comments, and creating categories. This yields a table of results showing the prevalence of comments of various types.

• In one study at Rocfkord Hospital, more than 80 per cent of the employees were satisfied with the nature of their job. They acknowledged that their job is challenging and used their skills effectively. However, 35 per cent felt that the facilities in terms of resources provided need to be improved.
• The results also showed a positive relationship between the employees and their immediate supervisor which was a motivating factor for many of them. Nanty per cent of the team members unanimously felt that their head is knowledgeable, cooperative, and he recognizes their contribution. They highlighted that his leadership traits and openness to suggestions play an important role in their job satisfaction.
• The front office department also displayed team spirit and synergy as more than 85 per cent team members expressed that the team is efficient and manpower is sufficient. The organization also reflected a positive work ambience as most of the employees praised the management for giving fair and equal treatment, recognizing their achievements and providing development opportunities. Regular training session, workshops and team building exercises emerged as a key factor in enhancing their team spirit.
• The only dimension on which majority of employees expressed their dissatisfaction was compensation and benefits. Seventy five per cent of them were unhappy with their salary. Sixty per cent said that increments and appraisals are almost absent. Thirty five per cent felt that the HR policies need to be revised and improved in favor of the employees.
• The analysis of the open ended verbatim section revealed that the only demotivating factor or the dimension that might hamper the employee loyalty in this organization is compensation and benefits, absence of promotions, perks and performance based appraisals and lack of information regarding HR policies.

Sharing the results
• It is critical to share results for two reasons’ everyone must know where the hospital and their individual areas stand. Employees need to know that the time spent in completing the survey was worthwhile.

• The basic principles of sharing employee satisfaction survey results:

 Being honest: An organization/hospital should be willing to share both its strengths and its areas in need of improvement.
 Being timely: The sooner the results are released, the earlier can the hospital move towards positive changes.
 Sharing appropriate information at each level: Senior management needs encapsulated results and access to detailed results for the organization as a whole and differences between departments. Department heads need to know how their department compares to the organization as a whole and how different departments compare with each other.
 Discussion: After presenting the results, discussion on future plan of action is needed for improvement.
 Respect of confidentiality: Confidentiality of employee’s responses is maintained.

Acting on the results
• Mostly hospitals fail to communicate the findings of the survey and the plans created to improve weak areas. Distribution of the complete survey doesn’t mean reporting to everyone, but an open and honest discourse of both organizational strengths and areas for improvement at the department level if possible. Admittedly, the method of hospital’s communication and the content of those messages are again, influenced by the hospitals culture. Failing to reveal the results of the survey and to take action to correct shortcomings can prove detrimental.

Examples of improvements offered:

• Empower employees via the Service Recovery program to make a difference
• Tie together employee satisfaction and patient satisfaction initiatives
• Encourage employee feedback by surveys for corporate benefits, ideas for use of funds, and home mailings of all marketing information
• Celebrate successes with food carts and box lunches
• Validation of hard work given through peer-to-peer access to meal vouchers and gift shop certificates
• Customer Service Representatives for each department (Super User/Role Model)
• Provide monthly Open Forums with administrator
• Provide walking rounds by administrative team
• Honor each department with their week
• Encourage informal problem resolution directly with union representatives
• Recognize outstanding staff with the annual STARS program
• Support an Employee Activities Committee:
 Vendor sales
 Annual holiday dinner dance
 Annual holiday dinner in cafeteria served by leadership
• Provide monthly New Employee Orientation with top leadership
• Expanded tuition program
• Quarterly union meetings with administrative team and various union representatives

References:

Bidhan, Das, Dr., Jyoti Gupta, Express Healthcare Management, 30 September, 2005.

Joan Jeffords, RN, MPA, IHI.org, Excellence in employee satisfaction, December 2004

Debbie Cardello, Urgent Matters, Studer Group, 2007

Governance - Verse 1

Governance is defined as a shared process of top-level organizational leadership, policy making and decision making. Although the governing board has the ultimate authority and accountability, the CEO, senior management and clinical leaders are also involved in top-level functions. Thus, governance is not a “board only” activity, but rather an interdependent partnership of leaders.

It is the function that holds management and the organization accountable for its actions and that helps provide management with overall strategic direction, and at an informal level it keeps things "glued together."

Reports to the board need to present measures of the processes and performance areas that are most critical to the organization’s mission, vision and strategic and operational goals. These measurements are frequently reported indicators of the organization’s key strategic initiatives and critical processes. Reports generally include the following major topics: financial position, revenues and costs, clinical quality and appropriateness review, service volumes and environmental changes and progress reports on ad hoc committees and ongoing projects.
Increasingly, boards are also informed of quality outcome measurements, ratings and comparisons that may be reported through the media. Many, but not all, of these measurements are provided to the board prior to communitywide dissemination.

Reports should also include evidence of how well the organization performed in meeting its own expectations. Reported measures should include established expectations, tolerance limits of variation and highlighting of variance that exceeds those limits. This is not necessarily the same information as presented to management (e.g., it may be simplified), and it does not have to be the same as similar organizations (that may have different missions and financial constraints). Reports on these measures are generally made in aggregate since board members have limited time to review information .



Of course there is much more to the substance and the form for each organization. Let InterOPERANT have a look. We specialize in this subject as well as strategic and tactical planning for your systems - Financial, Clinical and the key integration points between them.

I'll follow this verse with some very specific examples of organizations I have worked with in developing their governance processes. Governance won't work miracles, but it can be a very effective tool for all healthcare organizations particulairly as it relates to InformationTechnology, capital management and spending, priorities, and project management.


Bader, B.S. “CQI progress reports: The dashboard approach provides a better way to keep boards informed about quality.” Healthcare Executive, September/October 1993, 8-11.

Shortell, S.M. and Kaluzny, A.D. Health care management: Organization design and behavior (5th Ed.), Clifton Park, NY: Thompson-Delmar Learning. 2006

Griffith, J.R. and White, K.R. The Well-Managed Healthcare Organization (6th Ed.), Chicago: Health Administration Press. 2007.

For more information try this excellent podcast, and link. I feel you will find them very useful:

"Peter Weill, director of the Center for Information Systems Research at MIT's Sloan School of Management and co-author of IT Governance, discusses lessons he learned while researching his book":

http://www.cio.com/podcast/102564/What_Makes_for_Good_IT_Governance

also try,

http://www.cio.com/article/355413/IT_Governance_Tips_Help_to_Improve_Executive_Buy_In

Best,

Don Lyons

CEO and Managing Partner