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Employee Engagement: Where Do Hospitals Begin?

by Rick Blizzard, D.B.A.
Health and Healthcare Editor

The first article in a multipart series on healthcare jobs

A hospital is like a small community. Each employee -- nurse, physician, administrator, or clerk -- fills a niche within that community and contributes his or her talents, skills, and knowledge to its success. This high degree of role specificity benefits the hospital, but it also creates a challenge for healthcare organizations seeking to improve employees' levels of engagement with their jobs. Knowing where -- and with whom -- to start is often tough.

Why is employee engagement worth so much forethought? Gallup research has continually demonstrated that engagement -- that is, the degree to which employees are fully involved in and satisfied with their work -- drives financial performance, patient loyalty, turnover, and safety outcomes. Healthcare organizations cannot improve on these measures unless they improve engagement.

Hospital administrators looking to improve employee engagement should first determine which job categories are most and least engaged with their jobs. The healthcare employees in Gallup's 2003 Employee Engagement database can be divided into five basic categories:

  • Administrative/Clerical
  • Licensed Technical (licensed practical nurses [LPNs], radiology)
  • Professional (pharmacists, physical therapists)
  • Registered Nurses (RNs)
  • Support (housekeeping, dietary)

Analyzing job satisfaction and engagement numbers within each job category can provide some insight about what administrators need to do to improve the productivity of their larger workforce.

Job Satisfaction by Job Category

As part of its employee engagement questionnaire, Gallup asks each survey participant to rate his or her overall satisfaction with the hospital as a place to work, on a scale of 1 to 5 (1 means "extremely dissatisfied" and 5 means "extremely satisfied"). Results show that support personnel make up the most satisfied category on average (their rating is .20 higher than the 50th percentile in the database), followed by professionals, administrative/clerical employees, RNs, and licensed technical personnel. Both RNs and licensed technical personnel give scores below the 50th percentile on average.

The relatively high levels of satisfaction among support and administrative/clerical workers could possibly be influenced by the competitive salary and benefits packages that healthcare organizations tend to offer, especially for lower-level positions. Among the RN and licensed technical groups, low satisfaction levels could be largely a function of staffing shortages in these areas. When looking at the percentage of position vacancies in most hospitals, radiology technologists, RNs, and LPNs are almost always at the top of the list. For these employees, competitive salaries and benefits are no match for the problems that staffing shortages cause.

Employee Engagement by Job Category

Competitive salaries and benefits may be more relevant to newer employees than to veterans. When employees join a company, they may often base their decision to do so on those factors. However, Gallup research has shown that the engagement of existing employees in an organization tends to be based on factors such as the relationship they have with their managers and the overall dynamic of their workgroups. Gallup's Q12 survey measures these factors.

Overall employee engagement can be measured using the combined average scores -- or grand mean -- of the 12 core items on the Q12 survey. Looking at the grand mean scores by job category, the pattern is consistent to that for the overall job satisfaction question.

While support staff, professional staff, and administrative/clerical staff show less variation from the 50th percentile on the grand mean, there is greater variation for RNs and licensed technical staff. Given the shortage of workers in these categories and the inevitable stress that job vacancies must cause in existing workgroups, these relatively low levels of engagement are not surprising.

The second part of this series will focus on key workplace issues for RNs and licensed technical staff.


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