Intuitively, a hospital’s safety culture ought to be related to its service quality. Practices such as open communication among staff members and providing patient- centered care have an impact on both patient safety and patient satisfaction. This instinctively links patient safety and patient satisfaction to employee satisfaction. For example, nurses who are satisfied and engaged and can spend sufficient time at the bedside will presumably know their patients and their vulnerabilities better and will be more prepared to identify and ward off potential harms.
In today’s healthcare environment, however, rarely are a hospital’s safety culture and poor patient satisfaction caused by apathetic staff and unwilling managers, but rather by a system that fails to support them. Leaders who create a work environment and culture that are engaging and where people are proud to work, create engaged employees and in turn, satisfied patients.
Empirical connections between patient safety, patient satisfaction and employee engagement appear in greater frequency in today’s literature. A recent study examined inpatients’ reports of service “incidents” — deficiencies in service quality such as waits/delays, poor communication, poor care coordination, lack of respect for personal preferences, or environmental issues. Approximately 40 percent of patients reported at least one incident, and reporting incidents was associated with diminished patient satisfaction. In its Health Care Satisfaction Report, Press Ganey, Inc. stated “empirical evidence leads to the conclusion that increases of employee satisfaction are associated with increases in patient satisfaction”. The Centers for Medicare & Medicaid Services (CMS) is aware of this empirical research and has developed a value-based purchasing ( VBP) measure set with performance-based financial incentives and public reporting of quality information to comprehensively evaluate all aspects of quality, including patient satisfaction and safety. With these changes to Medicare and Medicaid, the two largest payment systems, employee attitudes and engagement can have a significant financial impact on a hospital’s bottom line.
With this in mind, Oakwood Annapolis Hospital’s surgical services department recently created a staff-driven, manage- mentsupported team composed of informal employee leaders within the department to address the challenge of improving the culture and increasing the employee engagement within the department. The team created three guiding principles for the group:
- Clear scope of practice: This principle is geared toward establishing responsibilities, accountability and education. It is intended to help the group articulate what the staff can do against the perception of what they should be doing.
- Culture of mutual respect and recognition: This principle is geared toward bridging the gaps and barriers caused by existing culture and generational differences. It focused the group on cultivating sincere, authentic relationships grounded in trust and respect with a shared appreciation of the nursing and support service jobs. It ’s also a mechanism for rewarding and recognizing all members of the team for their impact on the patient experience.
- Continuous open communication: The group established a communication plan that disseminates key messages and decisions throughout the department, implementing mechanisms to measure and act on departmental staff satisfaction and feedback.
After creating the three guiding principles, the team moved forward in addressing the barriers within the department. This portion of work led to the development of a baseline survey instrument to measure the existing employee satisfaction and the staff members’ perception of the existing culture. Feedback from the survey identified several gaps between nursing and support staff, nursing and support staff to physicians, and all staff to administration. Themes among the gaps were:
- Freeing up staff time so they can do their job
- Taking personal accountability when tasks were not completed
- Communicating to others when and if there will be a delay in the process
- Providing increased visibility and support to the staff by administration
The team then began applying the guiding principles to address the gaps identified in the survey and then communicated the solutions back to the surgical services team. To address the area of freeing up staff time and taking personal account- ability when tasks were not completed, the team recommended that the administration create opportunities for staff members to “job shadow” others within the department in order to gain a better understanding of the staff members’ day-to-day responsibilities and how their actions affect the rest of the team.
When communicating to others about a delay in the process, supervisors and staff from the different units within the surgical services department were invited to attend other units’ daily pre-shift “huddles” and listen to their concerns or provide proactive feedback regarding equipment, staffing ratios or other areas where delays could be created.
Finally, to provide increased visibility and support to the staff, administration implemented the following items:
- A monthly “Employee of the Quarter” program to recog- nize and reward staff members who demonstrate patient safety and satisfaction behaviors in their day-to-day work; employees received a nominal award
- A semi-annual employee appreciation event with massages and relaxing food and drinks during their shift
- An employee question box and “sounding board” where employees could submit anonymous questions pertaining to department needs, and management would post their response on the board for all staff to see
While the team’s progress is still ongoing, early results are encouraging. Through the team’s use of the guiding principles to address the gaps from the survey, the surgical services department has seen an increase in employee satisfaction and improvement in the culture. As the team’s action plan becomes further hardwired into the culture of the department, the intrinsic rewards of the plan (increased staff recognition, increased staff pride in the department and a greater belief in hospital leadership) give the staff a greater voice in the decision-making process and ultimately lead to increased patient safety and satisfaction.
Aaron Bontrager, MBA, MHA, is the director of surgical ser- vices and outpatient services for Oakwood Annapolis Hospital in Wayne, Mich. Bontrager can be reached at 734-467-2536 or via e-mail at firstname.lastname@example.org.