An analysis of six years of data from more than 80 hospitals and more than 192,000 employees in Victoria, Australia, adds to the evidence that employee engagement in their jobs matters. It found that happier workers improved hospital performance in terms of hospital costs, treatment effectiveness, and hospital-acquired infections and conditions. In particular, the research identifies three key ways to boost engagement: prioritizing patient and staff safety, building a culture of accountability, and providing proof that new practices will be worthwhile.
Hospital leaders around the world are desperately trying to find remedies for the stress and burnout that their pandemic-weary caregivers are suffering. Our research has uncovered one promising approach that improves hospital performance: increase staff engagement in their jobs.
We analyzed data gathered from over 80 hospitals in Victoria, Australia’s most densely populated state, over a six-year period (2013-2018). It included information on more than 92,000 health care employees, including clinicians, managers, and support staff. We then explored the effects of worker engagement and found greater engagement had a positive impact on outcomes such as hospital costs (e.g., insurance claims against the hospital for injuries or complications due to negligence), treatment effectiveness (measured by patient readmission rates), and the level of hospital-acquired infections and conditions (e.g., pressure injuries and surgical complications). For example, our longitudinal analysis revealed that a small (1%) increase in employee engagement leads to a 3% reduction in hospital-acquired complications and a 7% reduction in hospital readmissions.
Based on these findings, our team’s previous research, our experience in training health care leaders, and conversations with multiple government agencies involved in health care, we have come up with three key ways that hospitals can improve worker engagement.
1. Prioritize Patient and Staff Safety
Genuine employee engagement is only possible when workers believe that their safety and their patients’ is a priority. To provide this foundation, hospitals can encourage employees to observe, report, and fix errors or problems that place patient or staff safety in jeopardy. One approach that can help achieve this is to select employees to serve as role models and give them occupational health and safety training to reduce workplace hazards (e.g., occupational violence, bullying, work-related fatigue) or operational and service process training to improve patient handling.
2. Build a Culture of Accountability
Our research shows that when health care workers are not held accountable for their poor behaviors or underperformance, there are adverse cascading effects that undermine patient and hospital outcomes. These effects include an unwillingness to speak up and fear in providing feedback.
Hospitals that proactively build and nurture a culture of accountability ensure that employees are held responsible for their actions and give employees room to learn from mistakes. They also encourage staff to be forthcoming about errors, identify the problematic behaviors of others, and speak up when they witness actions or behaviors that don’t comply with hospital policies.
A culture of accountability, however, must be coupled with sustainable workloads and the employee freedom to make judicious choices about how to provide the best possible care and exercise control over approaches necessary to do that. An example might include employees being able to reach out directly to other specialists in the hospital without cumbersome referral mechanisms that introduce a middleman into the process and delay care. We appreciate that granting such latitude can be jarring for administrators more accustomed to enforcing adherence to controls and protocols. Paradoxically, however, our research shows that such empowerment improves patient safety and reduces errors.
3. Provide Proof That New Practices Will Be Worthwhile
When hospital workers are asked to adopt new practices, they want to see the evidence that they are effective. Toward that end, the leaders of one hospital we studied laid the groundwork for introducing new safety, accountability, and feedback practices by circulating evidence of their value. They included the Vanderbilt Framework for promoting professionalism in health care, scientific articles from Australia and the United States, and data from the hospital’s own internal safety system (e.g., incident reports, investigative outcomes). They also developed and implemented an incident reporting tool to establish clear and transparent procedures for reporting and addressing incidents, behaviors, and actions that undermine quality of patient care and staff and patient safety. These measures helped develop a “culture of speaking up,” and their implementation earned the strong support of the hospital’s staff.
During the pandemic, the pressure on hospitals to deliver high quality care with limited resources has arguably never been greater. Even when the pandemic subsides, the effects on hospitals finances and their staffs will remain. In this tough environment, hospitals must strive even harder to engage their workers. They are certain to benefit if they do.