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Study validates relationship between staff and patient satisfaction
Many have experienced how a grumpy waitress can ruin a meal or how a surly retail clerk can make you want to take your business elsewhere. But in the health care industry, few seemed to recognize the relationship between happy staff and satisfied patients. That is one of the reasons why the South Bend, IN-based benchmarking company, Press, Ganey Associates, recently conducted a study looking at that topic.
According to Dennis Kaldenberg, PhD, director of research and development for the firm, it’s nice to have empirical evidence to support what Press, Ganey tells its clients. "We wanted to confirm that the relationship between employee and patient satisfaction had some empirical truth," he says.
Kaldenberg took on his study after reading an article in the March 1, 1994, issue of the Harvard Business Review by James Heskett. In "Putting the Service-Profit Chain to Work," Heskett wrote that profits stem directly from the positive relationships between organizational structure, employee satisfaction, and customer satisfaction. In his own study, Kaldenberg looked at employee satisfaction scores compared to patient satisfaction scores. The results were a nearly linear graph in which the health care organizations that scored low in one area scored low in the other.
The premise that happy staff make happy customers has been proved true in other industries, Kaldenberg adds. It has been the subject of many books and articles (see box on further reading, p. 62). However, in health care, there is a lingering debate about whether patients are customers. "There has been some reservation in our industry to accept without proof what others have learned," he says.
There are specific incidents that show just how powerful employee satisfaction can be. For instance, Baptist Hospital in Pensacola, FL, was facing a highly competitive market in 1996, but patient satisfaction scores were in the 17th percentile. Morale among employees was low and sinking.
As part of an effort to improve customer satisfaction, the administration at the hospital held employee discussion sessions that provided management with as many opportunities to improve employee contentment as patient satisfaction. The hospital instituted changes that included improved communication between management and staff; rewarding and recognizing jobs well done; and providing leadership development.
The results were astounding. Within two years, staff morale rose, so did patient satisfaction scores. By the first quarter of 1997, they had increased to the 98th percentile.
While there are ways you can ascertain whether your staff is happy without doing a survey — for instance, your turnover level is low, you might assume that employees are satisfied — Kaldenberg says it is best to take a formal measurement of employee views.
"If you just ask someone if they are happy during an annual evaluation, you don’t have any source of performance improvement," he explains. "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 like, Are you happy’ is insufficient. You have to have a broad base of indicators."
Although Press, Ganey sells employee satisfaction surveys for about $3,800 for the report — including benchmarking results against other organizations nationally — 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 will also do custom surveys that either you can administer, or they can, says Donald Payne, PhD, director of research.
Kaldenberg says it is also possible for you to do a survey yourself, if employees feel safe in being honest about their responses and if those answers will remain anonymous.
"External surveys get higher response rates and more honest answers," he says. "If you do it inhouse, you have a fear among staff that you are trying to identify trouble makers.
"Also, internal surveys are not as statistically sound," Kaldenberg continues, "and it’s easier to write a questionnaire than to write a good one," he says. In other words, anyone can write a list of questions, but making them relevant to your organization is a much more difficult prospect.
Danny Frankel, PhD, vice president of Martin/Frankel Associates in Winston-Salem, NC, says there are some standardized tools psychologists have that can help you come up with the right questions. (For a list of topics used by Press, Ganey, see box, p. 64.)
Knowing what to ask is as important as asking it. "If you ask the right question, you get the right answer," he says. "You want to ask questions that will determine whether your staff is motivated, whether they are doing their jobs at the level you want, and what their idea of a sound organization is. 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 that while some organizations may have staff who are afraid to answer without a guarantee of anonymity, there is never any guarantee that 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.
If you know from the start that your staff won’t answer questions honestly if a survey is done internally, Frankel says, that is an immediate sign of a problem that needs to be addressed. "You need to get someone from outside who can measure satisfaction — or the lack of it — so that you can take action."
Kaldenberg says measuring employee satisfaction annually is best. "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. Says Kaldenberg: "There is a danger in measuring satisfaction, doing nothing, and then measuring it again."
Frankel agrees. "Businesses often initiate change 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."
Once you have the results, pick the top items for improvement, form teams, and really delve into the issues surrounding these items, says Kaldenberg. 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 problem? Would weekly staff meetings or some sort of e-mailed newsletter do the job?
Any change you do initiate has to be from the top down, Frankel says. "It has to be clear that the upper management will take responsibility for this information." When you do choose areas to work on, he adds, don’t bite off too much. "If you take on too many issues, you won’t succeed. Choose one or two that will drive the next year or two. When one is done, pick another issue."
Payne says the link between employee and customer satisfaction is pretty 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."
• Danny Frankel, PhD, vice president, Martin/Frankel Associates, 3253 Valley Road, Winston-Salem, NC 27106. Telephone: (336) 768-5466.
• Dennis Kaldenberg, PhD, director of research and development, Press, Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Telephone: (800) 232-8032.
• Peggy Mika, community relations manager, Baptist Hospital, 1000 W. Moreno Street, Pensacola, FL. 32522. Telephone: (850) 434-4011.
• Donald Payne, PhD, director of research, Business Research Lab, 250 Oser Ave., Hauppauge, NY 11788. Telephone: (888) 776-6583.