Health worker commitment declines slightly in 2003

Drop mostly due to lower scores among leadership

The results of the latest Healthcare@Work survey by AON Consulting and the American Society for Healthcare Human Resources Administration (ASHRA), both located in Chicago, finds U.S. health care employees slightly less committed to their organizations in 2003 than they were in 2002. Most of the drop in the survey’s Workforce Commitment Index (WCI), which fell from 91.5 to 91.0, was due to a drop in the score for executive leadership and manager/department head groups.

"We’ve been tracking this industry for the last four years," notes Erin Wilkins, AON assistant vice president. "And what we’ve found is that we’ve not seen a lot of change, but a slight drop in commitment in 2003. When we dug a little deeper, we attributed it to the executive leadership and manager/department head group."

She goes on to note that it was striking to see people at that leadership level have a lapse in commitment. "Mostly, I’d tie that to pressure to perform," Wilkins says. "We’ve heard lots about physicians and nurses, but with all that’s going on in the industry, leadership is actually feeling the pain, too."

Even more striking, perhaps, is the difference between the health care WCI and that of American industry in general. "Health care falls about nine points below the national average," says Wilkins. "That’s shocking, but when we presented the results and discussed them with our partners at ASHRA, we determined that while that’s a hard number to swallow, it’s not all that surprising given what’s going on in the field." This was compounded, she notes, by extensive media coverage of worker shortages in health care.

Gathering the information

The survey results are based on responses from 3,784 U.S. health care employees from all areas of the health care field. "It’s based on a pretty simple model," says Wilkins. "AON defines work force commitment by five behaviors — productivity, pride, retention, responsibility, and trust. For each of these behaviors, the survey has two questions."

To each of these, the participants would respond: disagree, agree, somewhat disagree, somewhat agree, or neither agree nor disagree. The statements are as follows:

  1. The people I work with make personal efforts to improve their skills so that they can make a better contribution to their jobs.
  2. The people I work with make personal sacrifices when required to help our work group succeed.
  3. I would recommend my organization’s services as the best that a customer could buy.
  4. I would recommend my organization as one of the best places to work in my community.
  5. I intend to stay with my organization for the next several years.
  6. I would stay with the organization even if offered a similar job with slightly higher pay.
  7. I feel responsible to help my organization be successful.
  8. I feel responsible to help my supervisor be successful.
  9. I trust the leadership of my organization to do the right thing.
  10. I share the same values as my organization.

Getting more commitment

In its study, AON also outlines the factors that create a committed work force. "All workplace practices may have an impact on commitment, but we illustrate what’s impacting commitment across the health care field," notes Wilkins.

These factors are illustrated in what AON calls the Performance Pyramid. The factors, from the bottom of the pyramid to the top, are as follows:

  • Safety/Security: A physical sense of well-being and a psychological belief that the environment is safe from fear, intimidation or threatening interpersonal treatment.
  • Rewards: Compensation and benefits are a fundamental foundation that must be in place before higher-level needs become commitment drivers.
  • Affiliation: A sense of belonging, being "part of the team" and "in the know" is key at this level.
  • Growth: Employees want opportunities to change, learn and have new experiences on the job.
  • Work/Life Harmony: The work force wants to reach its potential both on the job and in other facets of life.

"What should you work on if you want to improve your organization’s WCI?" poses Wilkins. "Make sure you have the work force needs met at the lower level of the pyramid before climbing to higher needs."

Some organizations, she notes, have a long way to go. "With our client data, we have seen overall organizational WCI’s ranging from the 70s to the upper 110s," she observes. "When get down into work groups, we see them range from the 40s to above 120."

Based on these latest survey results, the norm or average is 91 in most health care organizations. "However, if you want be best-in-class, you should shoot for above that," Wilkins advises. "You also need to see how you stack up both against competitors as well as companies outside the industry, because your workers can leave to go to those organizations as well."

As with most change in health care organizations, senior leadership is key in this area. "You often need a culture change, a restructuring of the work environment," says Wilkins. "Senior leaders send out the mission/vision, and it filters down."

In addition, she says, it is critical that you give midlevel supervisors and managers the tools they need to be successful. "You must equip frontline supervisors with the skills they need to motivate and retain their teams," she concludes.

The full Healthcare@Work report can be found at

[For more information, contact:

  • AON Consulting Chicago, 200 E. Randolph St., Suite 900, Chicago, Il 60601. Telephone: (312) 381-4800.]