Accountability Begins With Me: Healthcare Employee Satisfaction
By Hayden McKaskle, Consultant (HCAHPS and Other Surveys), HealthStream
I have had the pleasure of providing HealthStream Employee Insights (employee satisfaction survey) report reviews to many client hospitals in my consulting role. These deep dives help senior leadership teams better understand their results so more effective action planning can take place.
Accountability Affects Healthcare Employee Satisfaction
Although most of the survey questions are core and common to all of our Employee Insights survey clients, one particular HealthStream client asks a very interesting custom question. The question asks how committed employees felt their leadership was to a culture that includes effective rounding, better communication with patients, HCAHPS scores improvement, and other important areas. Some interesting observations developed out of this question and the report review process. More often than not, when the score for this question was good and possibly increasing, overall employee satisfaction was generally better than most and usually increasing. An analysis confirmed this observation in that for every hospital that asked that question, it had a correlation relative to Overall Satisfaction of greater than .50 and some were higher than .70. In other words, this question was highly correlated to overall employee satisfaction. Additional analysis of verbatim comments from employees suggests that the score for this question was something of an indicator of the culture of accountability within that hospital. This topic deserves additional investigation but it did start me thinking about accountability in strategic terms.
Developing a Culture of Accountability in Healthcare
Baptist Leadership Group has a terrific accountability program called Vital Conversations. The Studer Group has an excellent “High Middle Low” employee program as well. These are great beginnings for any hospital starting their journey toward a healthy culture of accountability. This journey must have goals and a way to monitor progress toward achieving them. HealthStream’s Competency Center provides such a platform because it formalizes competency and performance for all levels in an organization. The final piece that makes all of this work and become “hardwired” in any culture is consequence.
The Effects of Non-Compliance on Employee Satisfaction
The percentages may vary from facility to facility, but let us say for the purposes of discussion there are about 20% top performers in a typical hospital. These are the nurses, for example, who understood rounding from the first time it was presented and immediately proceeded to perform it correctly. They got it. The bottom 20% or so of nurses never get it the first time (perhaps ever), and managers continually struggle to get effective rounding performed by this group every single shift. The rest (60% or so) may need additional coaching and training but should eventually get it. The problem occurs when the bottom 20% are allowed to get away with non-compliant behavior. Not only do patient satisfaction scores suffer, but satisfaction of the top performing employees may decline. Retention of this key group may be at risk as well. What are the implications for the 60% in the middle? What will be their view of this lack of accountability and the possible impact on their own performance, satisfaction, and retention?
Healthcare Leaders’ Role in Accountability
Reading and analyzing verbatim comments from those being surveyed is particularly interesting to me. One recent employee comment speaks to the heart of this discussion. “I joined several years ago. Our previous director had favorites, and some of us had to pick up the slack caused by those who just showed up for a paycheck. Since our new director started, a few of these are now gone, and the others are being held accountable. What a difference she has made. I have worked at several hospitals and this is best by far!” Here is an employee, arguably a top performer, who likely gave the same high level of performance before and after a new director arrived. Satisfaction and possibly engagement rose after the arrival of a new director. These may have risen to top box or Very Satisfied, based on the way others were being managed and held accountable – not necessarily in the way he or she was being directly managed. This type of comment shows up in various forms on many surveys.
Hospital Leadership Must Lead By Example
Organizations spend tremendous amounts of time and resources on improving patient satisfaction scores and rightly so. Often, that emphasis tends to be more focused on the staff that touches the patient each day. Many organizations have implemented audit mechanisms, and some of these have real consequences in place for those failing to meet performance standards. This works to a point, but a healthy culture of accountability always starts at the top and not at the bottom of an organization. Hospital leadership must lead by example and hold each other accountable by the same standards they set for staff. For example, if they expect care givers to effectively communicate with patients they must do so as well, not just when they encounter patients but with their own employees. Top management should take the time to use employee names when speaking with them, refrain from texting and phone use during meetings, and make the effort to listen intently whenever speaking with employees. Leadership also expects caregivers to round with frequency and validity. Do nurse managers, directors, and the CNO round to patients regularly? The CEO and perhaps other C levels also have an opportunity and potentially a responsibility to round to patients where appropriate.
Turn Middle Level Healthcare Staff into Top Performers
Imagine the encouragement and reinforcement top performers will receive when they witness a leadership team that actually leads by example. Although the effect on bottom tier performers may be limited, the combination of consequence and accountability leadership can be a powerful way to move up a few of these. The best impact of all, however, may be on the middle tier of employees. These “fence-sitters” now see leadership that “practices what it preaches.” That along with real consequences is how we turn some of the 60 percenters into top performing employees.
Accountability is not a panacea for all problems, but it touches very many things. A healthy culture of accountability can help a hospital achieve higher patient satisfaction as well as higher employee satisfaction and engagement scores. When Value Based Purchasing dollars and the cost of employee turnover are considered, the strategic value of accountability in management as well as for employees is significant. Accountability is not just for someone else, staff, or only the clinical departments. A true culture of accountability starts at the top and takes root with every single employee. It can be said that “accountability begins with me.”
Learn More About the HealthStream Employee Insights survey.