White Paper

The Influence of Employee Satisfaction

on Patient Satisfaction and Safety
The Case for Automated Talent Management in Healthcare
 The Georgia Quality Initiative,
which began in 2003, has
identified that Long Term Care
(LTC) facilities with happy
employees have fewer patient
falls, and fewer residents with
acquired pressure ulcers and
acquired catheters.
2 The Influence of Employee Satisfaction on Patient Satisfaction and Safety.
©2008 Halogen Software. All rights reserved.
Introduction
Intuitively, it is easy to link patient safety and patient satisfaction to employee
satisfaction. A happy employee is focused on their professional tasks,
without being distracted by a negative environment, which leads to better
performance. Statistically valid research is turning this intuition into fact. For
example, The Georgia Quality Initiative, which began in 2003, has identified
that Long Term Care (LTC) facilities with happy employees have fewer patient
falls, and fewer residents with acquired pressure ulcers and acquired catheters.1
There is also statistically valid evidence that shows a strong relationship
between patient satisfaction and employee satisfaction.2
The Centers for Medicare & Medicaid Services (CMS) already have initiatives
underway that use performance-based financial incentives and public
reporting of quality information to encourage improvements in all aspects of
quality, including patient safety.3 In fact, CMS’s Innovators’ Guide to Navigating
CMS (August 25th 2008) states “CMS intends to develop a hospital VBP
(value-based purchasing) measure set that comprehensively addresses
clinical quality, patient safety, patient experience, and resource use.”
Since patient safety and patient experience are heavily influenced by employee
attitudes and satisfaction, an unhappy workforce can have significant financial
consequences on payments from Medicare and Medicaid, the two largest
payment systems.
1
The Critical Link Between Workforce & Organizational Excellence (My InnerView Inc. 2007); Dr. Leslie Grant,
Associate Professor of Healthcare Management in the Division of Health Policy Management and
Director of the Center for Aging Services Management at the University of Minnesota.
2
2007 National Survey of Consumer and Workforce Satisfaction in Nursing Homes. Members of My
InnerView’s Research Team– Leslie Grant, Ph.D., Michael Davern, Ph.D., Brad Shiverick, C.P.H.Q., V.
Tellis-Nayak, PH.D., Amy Hu, M.S., and Eric Lewerenz, M.S
Hospital Check-up Report 2007 Nurse and Employee Perspectives on American Healthcare; Press Ganey
Associates, Inc. Faculty.
3
Innovators’ Guide to Navigating CMS; Version 1.0, August 25, 2008 p.52; Centers for Medicare &
Medicaid Services
Research on healthcare employees indicates that there are five key drivers of
employee satisfaction, especially among nurses (Notes 1 & 2): Corporate HR Policies create
1. Management shows they care about their employees the foundation of fairness
2. Management listens to employees
that support employee
satisfaction and retention.
3. Employees receive help with job stress

4. Employees perceive evaluations to be fair

5. Employees feel their work makes a difference to patients and the

organization

This white paper explores how a good talent management system that
addresses the unique needs of healthcare organizations can enhance
employee satisfaction by addressing each of the above core challenges.

Talent Management Defined

Talent Management is generally defined to include all the HR and manage-
ment activities that encompass attracting, deploying, developing, motivating
and managing employees. According to Bersin and Associates, it incorporates:
workforce planning, sourcing and recruitment, employee performance
management, career management, succession management, learning manage-
ment, and compensation and rewards management.

Addressing the Key Drivers of

Healthcare Employee Satisfaction
Management Shows They Care
Employees need to tangibly see that they and their work are valued by man-
agement and by the organization overall. The old adage of “actions speak
louder than words” applies well here. While support from co-workers and
immediate supervisors is important, it is insufficient. Healthcare organizations
need to have HR policies and tools in place that institutionalize and demon-
strate their commitment to employees, and establish a foundation of fairness.
Employees rely on these policies to ensure the organization’s HR practices (such
as promoting from within, stress management, pay increases, career training
etc.) are applied reasonably, and consistently.

The Influence of Employee Satisfaction on Patient Satisfaction and Safety. 3

©2008 Halogen Software. All rights reserved.
 The bottom layer of Figure 1 “Corporate HR Policies” represents the policies
that create the foundation of fairness that support employee satisfaction and
retention. The top layer represents the HR programs that instantiate these
s policies in the employees’ daily work life. The middle layer is comprised of the
d Talent Management systems and solutions that automate the individual HR
e programs and, ideally, share data between them, so that corporate HR policies
s can be managed and enforced consistently. For example multi-rater feedback
. data needs to be easily incorporated into performance appraisals, which might
in turn feed succession planning and compensation adjustments, etc. Without
integrating these individual programs, they remain siloed, which can pose a risk
to the integrity of your corporate HR policies and to
employee satisfaction.

Figure 1

Workforce Sourcing and Performance 360 Multi-Rater Professional Succession Learning Compensation

Planning Recruiting Management Feedback and Career Management Management and Rewards

Development Management

Automated Talent Management Solutions

Corporate HR Policies
accountability, pay for performance, fairness, stress management,
e
promote from within, etc.
t
o
r
” Talent Management systems and solutions that automate the individual HR programs and, ideally, share data between them, so that corporate HR
policies can be managed and enforced consistently.

An automated talent management system assumes the role of HR programs

integrator, captures corporate HR policies, and provides comprehensive reports
and tools to support HR and employee management best practices that help
employees improve, succeed, and feel valued. Let’s look at some of those best
practices in more detail.

4 The Influence of Employee Satisfaction on Patient Satisfaction and Safety.

©2008 Halogen Software. All rights reserved.
Training and Development Plans: Helping employees achieve their profes-
sional and career aspirations makes a very powerful statement. For example, Helping employees
a nurse with great technical skills but a weaker bedside manner is still a great achieve their
asset to any healthcare organization. However, that nurse’s poor bedside professional and career
manner might be holding him/her back from a desired promotion, leading to aspirations makes a very
frustration and increasing the risk of poor patient care. A good Talent Manage- powerful statement.
ment system:

• facilitates a fair performance appraisal for the nurse

• gives him/her feedback from multiple sources

• identifies areas for development

• captures concrete examples to highlight any weaknesses

• empowers his/her manager to create a development plan that helps improve

and expand skills

All of which ensure the employee understands their employer wants to help
them improve, not just judge them.

Help Managers with Easy Record Retrieval: A Talent Management system that
is easy to use and saves manager time goes a long way to encouraging man-
ager adoption of the system. There are significant time savings generated by
centralizing employee information for managers so they have quick access to
competency check lists, performance journals, self appraisals, etc. CentraState
Healthcare Systems in New Jersey estimates such features saved managers
nearly 575 hours with every appraisal cycle.

If appraisals are quick and easy to complete, managers will embrace the system
because it gives them more time to focus on patient care.
For example:

• St. Mary’s Medical Center managers have the flexibility to complete reviews
regardless of where they are – home,
office, etc.

• Howard Regional Health System (HRHS) had 95% of managers declare the
automated process a “must keep” because of the time savings and the ability
to forward multi rater assessments to others.

The Influence of Employee Satisfaction on Patient Satisfaction and Safety. 5

©2008 Halogen Software. All rights reserved.
 On Time Merit Pay Increases: It seems trite, but no one likes to a have well
Completing deserved pay increase held back by “paperwork”. Completing performance
performance appraisals appraisals on time is not just good for Joint Commission reporting, it’s also
on time is not just good good for ensuring employee merit increases happen on time. Ensuring on time
for Joint Commission completion requires tools to speed up the writing process for managers, and
reporting, it’s also good to track and manage performance appraisal status – driving accountability for
for ensuring employee incomplete or late appraisals. Those tools include:
merit increases happen • Real time appraisal status reporting so everyone can see what’s outstanding
on time. • Automatic email reminders, with management escalations, to keep everyone
on task and on time

• Performance journals to keep track of each employee’s individual accom-

plishments and incidents, comment helpers and coaching tips that suggest
appropriate feedback for ratings on competencies, and medical spelling and
phrase checkers, all of which help to speed up the appraisal writing process
for managers

• Built in multi-rater (peer) feedback to ensure ratings are accurate and fair

• Goal management tools to ensure goals are aligned and being worked on

• Built in development planning so employees get the training they need

to succeed

Fayette County Memorial Hospital’s past employee performance and talent

management process was ineffective and time consuming. HR had no way to
hold managers accountable for completing their appraisals. Fayette automated
their process and gave HR and managers the reporting and record keeping
tools they needed to promote a culture of accountability.

Continuous Feedback: Many new healthcare employees are from Generation

X and Y – they grew up getting constant feedback from parents, teachers,
friends... Now that they’re working, they want the feedback to keep coming.
They’re determined to know how they’re performing, what’s expected of them,
and how they can advance their careers. And employees of all ages benefit
from frequent and specific feedback and guidance on their performance.
Talent Management systems put strong processes and accountability in place
to ensure that managers meet their employees’ needs for feedback
and development.

Lutheran Life Communities for example, automated their performance

management process to make sure that every employee had an appraisal
and was getting more feedback on a consistent basis. Managers find they
have more time for relationship-building conversations about performance
6 The Influence of Employee Satisfaction on Patient Satisfaction and Safety.

©2008 Halogen Software. All rights reserved.
with employees, which supports their organizational focus on the “human
side of things”. Gen Y is determined
Keeping track of employee accomplishments and incidents, and remembering to know how
them at appraisal time is challenging for managers and employees in a busy they’re performing,
healthcare environment. Automated Talent Management systems provide what’s expected of
performance journals so both managers and employees can jot down them, and how
performance notes as they happen, rather than try to remember things months they can advance
later, at review time. These notes can be easily referenced by both employees their careers.
and managers.

Management Listens to Employees

There are several ways that management can use their talent management
processes to demonstrate to employees that they are listening.

Often, during an employee evaluation meeting, employees will make reason-

able, negative comments about a specific department or the organization
overall. If captured, these comments can provide healthcare facilities with
invaluable employee satisfaction and performance improvement data.
However, compiling the negative comments from performance appraisals
can be a time consuming task for any organization; and it’s even harder to track
the resolutions.

West Virginia’s St. Mary’s Medical Center’s HR team uses their Talent
Management solution to run a report of all negative comments and then
ensure those comments are addressed. Employees know their management
is listening, because their comments are being acted upon.

Many automated performance management applications also allow

organizations to include self-appraisals as part of their performance
management process, and provide performance journals where employees
can make notes on their performance and share them with managers. Both of
these tools help to give employees a “voice”. Including comments from their
performance journal or self-assessment in their performance appraisal, or at
the very least, discussing them during the appraisal meeting, help the
employee to know that management is listening to them and cares about
what they have to say.

Employees Get Help With Job Stress and Burnout

This issue of job stress and burnout can be rampant in all healthcare roles, but
is particularly acute in the nursing profession. There are many complex reasons
for the high degree of job stress and therefore no single solution, but your
talent management programs can help in several ways:

The Influence of Employee Satisfaction on Patient Satisfaction and Safety. 7

©2008 Halogen Software. All rights reserved.
 • Performance management processes provide a forum for communicating and
Employees know managing expectations. Uncommunicated, divergent expectations can be a
their management is source of friction and stress.
listening, because their • Setting clear goals that are linked to organizational goals can help by giving
comments are being employees a context for their work and efforts, so they know they are working
acted upon. on the right things, and what they are doing matters.

• Formalized goal setting can help identify unrealistic expectations and

encourage managers and employees to better balance workloads.

• Creating a consistent and uniform process helps ensure all employees

are getting the feedback and direction they need to perform, and
establishes fairness.

• Multi-rater feedback takes the “subjectivity” out of performance reviews for

both managers and employees.

• Regular performance evaluations help identify knowledge/skill gaps so they

can be addressed with training.

• Succession planning helps identify career paths and gives employees a sense
that they have a future with the organization.

• Compensation programs that automate and enforce policies and budget

restrictions help to keep things fair.

Automated talent management process have the added benefit of saving

employees and managers significant time in performing all of these vital tasks,
increasing the likelihood that they will be done, and done well, and freeing up
everyone’s time to focus on patient care.

All of these talent management functions help to support performance,

ensure employees have the skills they need to do their jobs effectively, ensure
objectivity and fairness, and communicate to the employee that they are
valued by the organization. They are known contributors to employee satisfac-
tion. And employee satisfaction has been shown to have an impact on job
stress and burnout.

8 The Influence of Employee Satisfaction on Patient Satisfaction and Safety.

©2008 Halogen Software. All rights reserved.
Employees Perceive Evaluations to be Fair
Employees want evidence that their organization has policies in place to ensure Employee satisfaction
performance evaluations are done fairly, and present objective and construc- has been shown to have
tive feedback. That sense of fairness makes it much easier for employees to an impact on job stress
accept any negative feedback, and challenge themselves to improve. An and burnout.
automated Talent Management system gives HR the flexibility to implement
and change policies and work standards quickly and fairly. Consider these
examples:

• Standardized Forms and Competencies: Fayette County Memorial Hospital

was struggling with keeping an unwieldy number of paper-based forms up
to date, and ensuring managers were using the latest version. Employees in
the same role, regardless of their department or location should be evaluated
using the same standard form. Common leadership or clinical competencies
should be assessed using the same standards of performance. Any changes
to those standards need to be rolled out uniformly. A Talent Management
system can help by automating your forms and processes, giving you control
over the forms and competencies being used, so everyone is being evaluated
fairly, using the same standards.

• Multi-Rater Feedback: Nurse Managers at Rockford Health System insisted

that multi rater evaluations be part of their Talent Management system.
Because healthcare workers engage with numerous colleagues during each
shift, it can be difficult for managers to see their staff perform on a regular
basis. A Talent Management system that supports multi-rater evaluations as-
sures employees that their manager is getting broad feedback from multiple
perspectives.

• Employee Self-Evaluations: It can be important to give employees a chance

to express their views on their performance and working environment. Rock-
ford Health System’s Talent Management system allows employees to com-
plete self appraisals that include the same questions as those on their man-
ager’s appraisal form, creating a forum for them to discuss score differences.

The Influence of Employee Satisfaction on Patient Satisfaction and Safety. 9

©2008 Halogen Software. All rights reserved.
 Form and competency consistency, self-evaluations, and multi-rater evalu-
ations can add a lot of paper handling and labor to the already complex
employee appraisal process, making it hard to enforce HR policies fairly and
consistently. An automated Talent Management system simplifies the entire
An automated Talent process with automatic event triggers, driven by your organization’s policies.
Management system For example, do you want to allow managers to write employee appraisals even
simplifies the entire if the employee has not completed their self-evaluation, or if the multi-rater
process with automatic evaluations are incomplete? Your Talent Management system needs to support
event triggers, driven your policies on these and many other things.
by your organization’s Employees Feel Their Work Makes a Difference
policies.
Knowing that their work matters is one of the primary contributors to
employee satisfaction. One of the key ways to achieve this is by aligning
employee goals with organizational goals. An automated Talent Management
system makes it easy for managers and employees to view higher level organi-
zational goals, and link individual employee goals to them as appropriate. For
example, a facility may have a goal to increase patient satisfaction by reducing
wait times. Each department’s application of this might be slightly different: the
Emergency department might give its managers goals to improve patient flow,
while Food Services could re-examine its suppliers to offer more menu variety.

In addition, a Talent Management System can let everyone see progress on

linked goals. This linking, and clear line of sight give employees the context
they need for their work and give them a stronger sense of belonging and
contribution. It also fosters greater accountability throughout the organization.
At West Virginia’s Cabell Hunting Hospital, managers love running their own
reports and keeping track of the status of their employees’ goals; it empowers
them to be more proactive when issues arise.

Making Employee Satisfaction an

Organizational Priority
Dissatisfied employees are costly. They either leave, or do just enough work
to keep their job, putting patient safety and satisfaction at risk. Both of these
situations pose concerns for those who pay for healthcare services – Medicare,
Medicaid, HMOs and insurance companies.

However, CFOs and CEOs would refer to most financial costs and savings
discussed in this paper as soft costs – costs without a specific, identifiable
value. So how do you quantify and justify these for a CFO or CEO who is consid-
ering other high profile projects with hard cost savings or revenue generation,
like a new high powered X-ray machine, or operating room improvements?

10 The Influence of Employee Satisfaction on Patient Satisfaction and Safety.

©2008 Halogen Software. All rights reserved.
Medical facilities can have the most modern, leading-edge equipment, but if
those operating the equipment are (even inadvertently) projecting their dis-
satisfaction to patients, both safety and patient satisfaction are compromised.

Employee turnover increases recruiting requirements. For most hospitals

recruiting costs represent between 3.4% and 4% of their annual operating Employee dissatisfaction
budgets.4 Reducing that by 1% would represent substantial savings to any concerns Medicare,
facility and clearly offset the cost of an automated talent management Medicaid, HMOs and
system. HR policies, backed by a comprehensive talent management insurance companies.
solution, engage employees and increase employee satisfaction; engaged
employees are less likely to be romanced by other facilities with aggressive
compensation packages.

Summary Reducing employee

turnover by 1% would
Statistically valid research is proving that patient satisfaction and patient safety represent substantial
are both heavily influenced by employee satisfaction. savings to any facility.
Medicare and Medicaid have made patient satisfaction and patient safety
criteria for payments to healthcare facilities, further driving the importance of
employee satisfaction.

To support HR’s critical role in this, automated Talent Management systems

provide a foundation for long term sustainable employee performance man-
agement policies that support employee satisfaction. Medical professionals
need integrated and consistent HR programs and practices (such as fair apprais-
als, training, development, rewards and recognition, etc) to reinforce the HR
policies that engage and motivate employees. With so many related programs,
it is impossible to manually administer and integrate them all effectively and
maintain the integrity of HR policies – the policies driving employee satisfac-
tion, patient safety and patient satisfaction. An automated Talent Management
System automates the processes, saving time and money for all users, and
integrates the programs so employees have definitive and demonstrable proof
that management is listening and really cares.

This white paper mentions the experiences of only a few of the hundreds of
healthcare facilities across North America who have automated their tal-
ent management process using a Halogen Software – a system exclusively
endorsed by the American Hospital Association. All have seen impressive
results, including increased employee satisfaction and retention.

To take a self-guided product tour of Halogen’s award-winning eAppraisal™

Healthcare solution please visit:
http://www.halogensoftware.com/products/tours/

4
Kevin S Collins, RT(R)(T), CMD, MsEd; Sandra K. Collins, MBA; Richard McKinnies, RT(R)(T), MsEd; Steven
Jensen, PhD; “Employee Satisfaction and Employee Retention Catalyst to Patient Satisfaction”; The
Healthcare Manager; Volume 27, number 3, pp. 245 - 251

The Influence of Employee Satisfaction on Patient Satisfaction and Safety. 11

©2008 Halogen Software. All rights reserved.
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12 The Influence of Employee Satisfaction on Patient Satisfaction and Safety.

©2008 Halogen Software. All rights reserved.