The Connection Between Employee Satisfaction and Patient Satisfaction

Want to boost your patient satisfaction scores? Try investing more resources and attention in your clinical staff.

Today, every healthcare organization is invested in achieving and maintaining the best possible patient satisfaction scores. Among other benefits, patients are more likely to return if they had a positive experience. And there is definitely a financial impetus in achieving high patient satisfaction rates.

The first public reporting of HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) began in March 2008. But the importance of this data has only increased since then. Starting this October, HCAHPS scores will be included in the measures used to calculate value-based incentive payments in the Hospital Value-Based Purchasing program.

Hospitals therefore must be proactive to ensure that patients are having a positive experience. And research shows that one of the best ways to improve your patients’ experience at your facility is to make sure your employees are engaged and satisfied with their work experience.

Barbara Balik, RN, Ed.D., said, "The more ineffective and unreliable the systems are for staff, the more they get in the way of a good patient experience."

As Barbara Balik, RN, Ed.D, a senior faculty member of the Institute for Healthcare Improvement (IHI), puts it, “We can only treat patients as well as we treat one another.”

Patients notice employee dissatisfaction

Matthew McHugh, Ph.D., RN, an assistant professor of nursing at the University of Pennsylvania, noted that a quality work environment usually leads to a number of quality patient outcomes, such as lower mortality rates and lower levels of failure-to-rescue. And a less-than-quality work environment can lead to lower patient satisfaction levels.

McHugh and a team of researchers published a study last year in Health Affairs that found that the percentage of patients who reported they would “definitely recommend” a hospital to their loved ones decreased by 2 percent for every 10 percent of the nurses who expressed dissatisfaction with their jobs.

Matthew McHugh, Ph.D., RN, said that environments that support nurses allow them to do their jobs well and provide the best possible care.

“It wasn’t surprising to us that places that are good environments for nurses to work would also then translate into nurses being able to do their jobs well and being able to provide good quality care to their patients,” McHugh said.

And patients really do pick up on problems, Balik said. They may not always understand the technical details of what’s happening during their hospitalization, but they notice the environment around them, including any sense of dissatisfaction or disrespect among the staff.

“It eventually permeates, and patients are very attuned,” said Balik, who co-authored an IHI white paper titled Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care in 2011.

That’s why employee engagement is so crucial, she continued. Employees want to feel that their opinions matter, that their input is valued and that leadership is listening to them.

“When you fully engage with staff and providers, you get that commitment to the organization at a deep and powerful level, and that’s where you get results,” she said.

Leadership is crucial

A 2009 Forum Group report titled “The Relationship Between Employee Satisfaction and Hospital Patient Experiences,” by Jimmy Peltier, Andy Dahl and Frank Mulhern, found in a literature review that efforts to create higher employee satisfaction have a very desirable outcome on patients, including increased patient satisfaction, improved care quality and increased patient loyalty. The report suggested that one effective way of meeting the needs of employees, with the goal of ultimately satisfying patients, is “by viewing employees as internal customers.”

The report also noted that quality leadership is often the driver for providing “empowering work environments” that are more likely to result in engaged employees, which leads to better patient care.

“Management plays an integral role in the level of care provided even when they are not directly involved,” they wrote.

According to the report, a primary determining factor of an employee’s satisfaction and loyalty is the relationship with his or her direct supervisor. “When management helps an employee feel engaged and offers them the support and resources necessary to provide quality patient care, employees are not only more satisfied with their employer but also remain more loyal,” the authors wrote.  And that, in turn, can reduce costly turnover and enhance retention.

Managers and leaders can do that by making sure that employees have all the resources and training necessary to do their jobs well, said John Griffith, M.B.A., a professor at the University of Michigan’s School of Public Health.

In 2009, Griffith published a report that examined 34 community hospitals that had won the Malcolm Baldridge National Quality Award in the healthcare sector. He found that hospital employee morale was the biggest factor in patient satisfaction--and achieving that started with leadership at the very top.

Those leaders were unafraid to try new, unusual things in the name of improvement. They changed their processes, including their clinical processes. They worked to eliminate the things that led to more expenses, such as errors and duplications. And they invested in training their people.

“The first thing it takes is commitment,” said Griffith.

The Magnet hospital model is a good model to emulate, he noted. The Magnet Recognition Program, which was developed by the American Nurses Credentialing Center (ANCC), recognizes quality patient care and nursing excellence and innovation; among the specific characteristics of a hospital that has received Magnet status are the qualities of transformational leadership and structural empowerment.

The bottom line, again

Will a strategic emphasis on improving employee engagement and satisfaction really help your hospital improve its bottom line? Peltier, Dahl, and Mulhern’s report suggests that it can. With more satisfied employees and more satisfied patients, an organization can most likely look forward to repeat visits by patients, fewer lawsuits of negative patient behaviors and lower costs in managing employees due to less attrition. They can also anticipate the power of positive, word-of-mouth reviews.

“Patients who have a better quality of care, they’re happy with their care, they’re more likely to recommend the hospital to their friends and family,” McHugh said. “It’s a win–win for everybody, really.”