(November 2021) – The importance of workplace engagement and satisfaction has always been a critical element of success in hospitals and health systems. While essential to everyday care, the passion and commitment that emerges from engaged employees is further highlighted during times of crisis. After more than a year of hospitals and health systems across the country developing crisis management strategies to respond to the COVID-19 pandemic, the American Hospital Association summarized key lessons learned for boards. One of the primary takeaways was that boards learned they need to be attentive to how employees are coping during times of crisis. Whether in the midst of a crisis or not, boards must understand the challenges staff are facing and prioritize workforce needs—from frontline staff to c-suite leaders.

What Is Employee Engagement?
Employee engagement is a feeling of commitment and enthusiasm for one's work leading to a willingness to go above and beyond the minimum required effort. Research shows engagement happens when employees feel:

1. An active commitment or a plan to stay and recommend the organization to others.
2. Personal significance, where employees feel valued and are enthusiastic about their work.
3. Confidence in the future or a belief in the future of the organization.

While most organizations recognize the value of employee engagement, it is important to recognize that not all engagement is created equal. To be impactful on the mission, employee engagement must be aligned with the organization's strategic goals.

The Benefits of Engaged Employees
Employee engagement and workplace satisfaction are critical to the success of any organization, but the connection between satisfaction and success is stronger in the health care industry.

Quality and Safety. A study from the Advisory Board found that every one percent increase in hospital employee engagement correlated with a 0.33-point increase in the facility's overall hospital rating in their Hospital Consumer Assessment of Healthcare Providers and Systems, known as HCAHPS. The study also reported a one percent increase in hospital employee engagement was tied to a 0.41-point increase in patient safety grades. Another key finding from the Advisory Board study was hospitals should not compare themselves with other industries when analyzing employee engagement. That's because health care employees are already more than twice as engaged as employees in other industries. Given the strong connection between employee engagement and outcomes, organizations should focus on health care-specific benchmarks and measurements when tracking employee engagement and satisfaction.

Interconnectedness of Factors Influencing Organizational Success. Research has proven safety, quality, the patient experience, and caregiver engagement are all connected. In addition, all four of these factors impact a hospital or health system's financial performance. Because all of these factors are interconnected, high performance in any one area can positively impact another area. For example, one study reported that organizations in the top quartile for physician and employee engagement have lower rates for most hospital-acquired infections than those in the bottom quartiles, as well as shorter lengths of stay, fewer readmissions, better hospital-acquired condition scores, and lower Patient Safety and Adverse Events Composite scores. The same analysis also found a positive connection between financial performance and workforce engagement.

Conducting Employee Satisfaction and Engagement Surveys
An employee satisfaction and engagement survey measures commitment and enthusiasm for the work being done, as well as key drivers of engagement. The act of surveying employees sends a strong message that the board and senior leadership values employee opinions. At the same time, success is dependent upon the organization's commitment to take action based on the results.

Typical areas of measurement for employee satisfaction and enthusiasm for work include:

• Engagement: Are employees excited about their work, willing to recommend the organization to others as a place to work, and do they plan to stay?
• Supportive supervisor: Do supervisors lead with fairness, provide feedback and recognition, explain changes, and listen and respond to employee ideas?
• Trust and collaboration: Do team members trust one another and work toward a common goal? Is collaboration and communication across functions/departments effective?
• Visionary leadership: Does senior leadership communicate with openness and share a compelling vision for the future?
• Conditions to do the best work: Do employees have the tools, resources and clear priorities to do their best work?
• Growth and autonomy: Do employees have input and feel encouraged to share new ideas? Do they see opportunities to develop their skills and advance their careers?
• Burnout and resilience: Does the hospital support my well-being? Is the amount of stress I experience reasonable?
• Quality of care: Would I recommend the hospital as a good place to receive care? Do the actions of senior management show that patient safety is a top priority?

The Board's Role in Employee Satisfaction and Engagement
Human resources play a critical role in any organization's ability to fulfill its mission and vision, but in few industries is it more prominent than health care. Board oversight is essential because workforce strategies, recruitment and retention are critical to strategic success. But according to a recent study, there are varying viewpoints among boards about whether the organization's human capital falls within the board's oversight responsibility or should belong exclusively at the human resources and management level. Forward-looking boards see the shifts taking place in the health care workforce as an opportunity to build employer-employee relationships, strengthen the organization's culture, and leverage human resources strategies as a competitive differentiator.

According to the study, 80 percent of board members spend more time discussing talent strategy than they did just five years ago. But there's still much room for improvement. For example, approximately 30 percent of board members surveyed reported they are either unsure or unable to articulate their company's cultural strengths and weaknesses. Now, more than ever, boards must build employee satisfaction, engagement and organizational culture into their strategic discussions. The hospital or health system's mission, vision and strategies should be aligned with the organization's culture, understood by all employees, and supported by employee behaviors.

Employee Engagement: Questions for Board Discussion

• Does the board set the tone for the strategic importance of human capital by dedicating the appropriate level of time and attention to employee satisfaction and engagement?
• Does the board understand the connection between employee engagement and patient safety and satisfaction, and allocate resources and priorities appropriately as a result?
• Does the board have the necessary expertise, education, perspectives and experience to provide effective oversight and direction in the area of human resources?
• Does the board and senior leadership understand workforce trends occurring in health care, and have strategies and plans to address those trends? Is the leadership team driving the necessary shifts in culture, training and development to be prepared for the future?
• Is human capital and talent strategy included in discussions about strategy and risk?
• Does the board know the future skills needed to successfully achieve the hospital or health system's strategic objectives? Is there a plan for how to acquire and develop those skill sets?
• Have appropriate and meaningful human capital and talent-related metrics been identified? If so, how often does the board review those metrics? Does the board compare the organization's employee engagement and satisfaction metrics with other healthcare-specific benchmarks?

Special thanks to The Walker Company and governWell™ for use of Building a Strong Workforce: The Board's Role in Employee Satisfaction and Engagement. Additional trustee resources are available in Kansas governWell and in the Trustees' section of the KHA website.