From staff engagement to leadership, how hospitals are measuring and improving the hard-to-quantify aspects of quality.
By Jeff Elliott
All hospitals face tight labor markets, but for Sacred Heart Hospital in Eau Claire, Wis., a city of 65,000 people that straddles the Chippewa River, the market was tighter than most. The hospital competes for healthcare talent with some top-notch institutions including a Mayo Clinic-affiliated hospital. To continue attracting top talent, says COO Faye Deich, Sacred Heart knew it needed a new plan to improve employee satisfaction and maintain an operationally sound enterprise.
On the heels of its service excellence initiative to improve patient satisfaction scores, the hospital tried an innovative approach to organizational excellence, applying metrics similar to those it employed when gauging patient satisfaction and clinical outcomes to staff and physician satisfaction scores. And it didn't stop there. Sacred Heart has since implemented metrics-based quality improvements to other operational issues such as employee performance, customer service, and leadership development.
‘Operational metrics are becoming much more accepted and utilized today, with some pretty impressive results,” says Quint Studer, CEO of The Studer Group, a healthcare performance improvement firm. Based on his firm’s evidence–based leadership tools, one hospital was able to reduce nurse turnover by 2 percent at an estimated annual savings of $311,000, while a physician group figures it saved $300,000 in litigation by implementing metrics that would ensure its physicians see all patients in 30 minutes or less.
A Winning Culture
According to research cited by Deloitte & Touche, during the next five years there will be a 6-million-employee gap between the supply and demand for knowledge workers, or individuals who evaluate information and ideas as part of their jobs, such as a product manager or financial analyst.
‘Hospitals are competing with everyone else for the highly talented, highly trained workforce,” says John Bigalke, vice chairman, U.S. Health Sciences and government leader for Deloitte & Touche’s Life Sciences and Health Care practice. ‘The issue is compounded by the fact that we have a changing workforce with different values and a unique way of thinking about careers that may not fit within the single career path that is common in health care.”
Although most executives would agree that employee satisfaction and development are critical pillars of a winning culture, many don't have the tools in place to collect and act upon meaningful staff and physician input. Sacred Heart was determined to be the exception. By developing detailed employee opinion surveys, the hospital was able to nail down specific reasons that morale wasn't as high as it could be.
For one, executives realized it needed to spend more time in reward and recognition. The hospital implemented ‘Team of the Month” and ‘Breakthrough” awards programs that acknowledged quality achievements. ‘We now make a concerted effort to communicate with our employees and tell them how grateful we are for what they do,” Deich says. ‘This has made a difference in keeping people connected with our mission.”
Sacred Heart also learned through surveys that employees had little regard for the performance evaluation process because they were not receiving productive feedback from their managers. Armed with this information, the hospital began training managers on good employee–evaluation techniques. ‘As a result of these efforts, we’ve reduced turnover by more than 10 percent over the last five years,” Deich says.
Chicago’s Northwestern Memorial Hospital (NMH) takes a slightly different, but no less effective, approach to employee relations and culture, measuring ‘staff engagement” rather than satisfaction because the idea of engagement has been shown to correlate with business operation improvements, according to Julie Creamer, senior vice president of quality and planning at NMH.
With survey support provided by the Gallup Organization, NMH regularly measures staff engagement and then conducts extensive follow-up with managers and staff to identify ‘improvement areas” based on the engagement scores. By tracking these scores over time, NMH has found a positive correlation between staff engagement and the hospital’s ability to retain employees, Creamer says.
Improving Customer Service
It's well known in marketing circles that it costs at least five times as much to generate a new customer as it does to maintain an existing one. And studies have shown that although a satisfied customer will tell up to five people about a positive experience, an unsatisfied one will tell 20 or more about a negative one.
Customer service in health care does not end at patient satisfaction. Rather, it provides a great jumping-off point. ‘Consumers know great service when they experience it, and our challenge as leaders is to continually meet the rising expectations of patients and families,” says Audrey Meyers, president and CEO of Valley Health System and The Valley Hospital in Ridgewood, N.J. ‘This is accomplished through higher levels of clinical excellence and a focused attention to customer service at all levels of the organization.”
Valley uses operational data to measure quality improvements throughout the organization. For instance, reducing emergency room wait times is a top priority. ‘The hospital has isolated each step in the delivery of care and identified metrics to reduce wait times and enhance clinical excellence,” Meyers says. ‘All steps in a patient’s experience—from entering the doors of the emergency department through discharge or admission—are closely examined to ensure we are doing all we can to provide a superior patient experience.”
Evidence-Based Leadership
Perhaps the most critical operational metrics executives can heed relate to leadership. ‘More and more organizations are proving that by standardizing best practices in leadership, you will continually outperform other healthcare providers,” Studer says.
But can a leadership evaluation program truly be evidence–based? ‘When you measure a leader, you measure the desired outcomes for the organization,” he says. ‘Typically, a top priority for an organization is patient satisfaction. Leaders should be measured on how good they are at delivering high satisfaction rates.”
Another key evidence-based metric by which leaders can be evaluated is mortality. ‘If I’m a good leader, my mortality rates should be lower, and the people that are supposed to live should still be alive after a visit to my hospital,” Studer says. According to Studer, the two most important things healthcare executives can do to improve leadership in their organizations are developing a realistic leader evaluation system and implementing a solid leadership-training program.
Developing a realistic leader evaluation system can mean improving already effective leaders, he says. In the organizations he works with, Studer has found that 98 percent to 100 percent of managers receive favorable evaluations. ‘If I’m a CEO, I’ve just made my job a lot harder,” he says. ‘I’m trying to motivate them to do a better job when they already think they’re doing a great job.” In order to achieve the greatest organizational success, executives must make sure that leader evaluations are directly connected with the performance of the organization.
Implementing a leadership training program is important because more often than not, executives are trying to direct an unskilled leadership team, Studer says. ‘In health care, we put people into leadership positions, and then we may or may not train them. We must first make them accountable for organizational performance and then teach them how to be successful.”
Communicating Quality
Healthcare providers around the country are beginning to see that operational quality measures—reducing staff turnover and thus fielding a more qualified workforce, for instance—also are vital for achieving good clinical outcomes. However, such metrics will be lost on hospital staff if healthcare executives cannot adequately communicate what they represent in terms of clinical effectiveness.
‘When you go to a doctor, you get all your vitals checked—weight, blood pressure, heart rate. Is that because all they care about are numbers?” Studer asks. ‘No, those numbers represent your health. We need to use that same mindset when connecting metrics back to the workforce.”