Want to boost patient satisfaction? Try boosting staff job satisfaction
Want to boost patient satisfaction? Try boosting staff job satisfaction
Study links happy staff and satisfied patients
It may seem self-evident, but a recent study by South Bend, IN-based health care consultants Press, Ganey Associates found that the happier your employees are, the more satisfied your patients will be. Even though it sounds obvious, Dennis Kaldenberg, PhD, director of research and development for the firm, says it’s nice to have empirical evidence to support what Press, Ganey tells its clients. "We wanted to confirm that this relationship had some empirical truth."
The premise that happy staff make happy customers has been proven true in other industries, Kaldenberg adds. It has been the subject of many books and articles (for references, see box, p. 72). But in health care, there is a lingering debate about whether patients are customers. "There has been some reservation in our industry to accept what others have learned without proof."
In his study, Kaldenberg compared employee satisfaction scores with patient satisfaction scores. The results were a linear graph in which health care organizations that scored low on one scored low on the other.
Neil Baum, MD, a New Orleans urologist, knows firsthand the impact an unhappy staff can have on patients. "When I started my practice, it was my way or no way," he recalls. "We had unrest, turnover, dissension, and patient complaints."
When Baum turned his efforts toward making staff happy and improving morale, that dissension decreased. "Unhappy staff reflects on patient care. If you take care of your staff, you will ensure that your patients have a positive health care experience."
The results were astounding: Before he changed his focus, turnover was high; today his staff are all long-timers who have served in his practice for as long as 18 years.
Danny Frankel, PhD, vice president of the health care consulting firm Martin/Frankel Associates in Winston-Salem, NC, has another example. One clinic he worked with revamped its staffing so nurses who long had dealt one-on-one with patients ended up as highly paid ushers who escorted patients into examination rooms. "That led to ill-feeling," he says. "And patients complained because they felt cheated out of that personal time with nurses."
Once the problem was discovered, the clinic looked again at the nurses’ role. Another change was made, this time to ensure that patients always deal with the same nurses and that the nurses taking the most recent patient history develop and maintain a personal relationship with the patients. That satisfied both patients and staff.
What to ask and when to ask it
While low turnover and seemingly high morale are good indications that things are going well, Kaldenberg says it is best to take a formal measurement of employee views. "If you just ask someone if they are happy, you don’t have any source of performance improvement. They may be happy with their salary, but unhappy with their training or the amount of freedom they have to make decisions. Unless you know that, a yes-or-no question is insufficient. You have to have a broad base of indicators."
Press, Ganey sells employee satisfaction surveys for about $3,800 for one report — including benchmarking results against other organizations nationally — but there are cheaper alternatives. Business Research Lab of Hauppauge, NY, offers an off-the-shelf computer program for $400. It includes a variety of proven topics. The company also offers custom surveys that either they or you can administer, says Donald Payne, PhD, director of research.
Kaldenberg says it is possible to do a survey yourself, but only if employees feel safe in being honest about their responses and are assured that their comments will remain anonymous. "External surveys get higher response rates and more honest answers," he says. "If you do it in-house, you have a fear of identifying troublemakers.’ Also, internal surveys are not as statistically sound, and it’s easier to write a bad questionnaire than to write a good one."
Frankel says psychologists have standardized tools that can help you come up with the right questions. You want to ask questions that will determine whether your staff are motivated, whether they are doing their jobs at the level you want, and what their idea of a sound organization is, he says. (For more information on the topics, see box, p. 72.) "You want to include questions about opportunities for personal growth, about how they feel about the work environment, if they think you value their contribution, and if they understand their role in carrying out the mission of the company."
You can avoid the fear issues by having some external source, such as your outside accountant, legal counsel, or a consultant accept the results and compile the reports, Frankel says. "But you have to create a venue where staff know that their feedback is confidential and where there is no risk of adverse consequences for answering the questions."
Payne says while some staff may be afraid to answer an in-house survey without a guarantee of anonymity, there is no guarantee an outside company will keep identities secret, either. "This has to be an act of faith either way," he says. "I’ve seen it done both ways, and it rarely makes a difference."
Generally speaking, the larger the organization, the harder it is to do a survey internally, Payne adds, if only because you might not have the clerical staff to do the data entry in a timely manner.
Once you have the results, you need to pick the top items for improvement, form teams, and delve into the issues surrounding those items. For instance, if you find that employees feel there is a lack of communication between management and staff, you need to ask them to be more specific. What kinds of problems exist? What could solve the problems? Would weekly staff meetings or an e-mailed newsletter do the job?
Kaldenberg says its best to measure employee satisfaction annually. "If you find areas for improvement, you want time to change processes and implement programs. You want time to see the results of those changes before you do the next survey."
Which brings up another caveat of looking at employee satisfaction: If you have no plan to act on the data, it’s better not to ask again. "There is a danger in measuring satisfaction, doing nothing, and then measuring it again."
Frankel agrees. "Businesses often initiate processes that go nowhere," he says. "You can continue to ask questions in these cases and even get feedback from staff. But if you continue to do nothing, that has a demoralizing impact on staff."
"At the very least, you have to feed back the results to staff," says Payne. "There is no human resources policy that can address all idiosyncratic complaints that arise. But you can look at themes that come up and do something about common problems. And if you can’t do something about them, then you should be prepared to explain why."
Team approach
Baum says many physicians may balk at asking staff, in effect, to critique them as bosses. "But if you have an autocratic practice, you will have staff turnover. You won’t have a team approach. And if you want to exceed patient expectations, then you must have that team approach. That is not a radical idea."
Payne says the link between employee and customer satisfaction is clear. "If you have a real concern with the health of your business, and your business relies on its employees, you have to be concerned about whether they are happy. But remember, too, that employee satisfaction isn’t the be-all and end-all. Without the proper tools, training, and supervision, you have nothing but happy employees. This is only one element in effective performance by your staff."
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