Does employee engagement lead to better patient care?
We set out to explore whether or not there were any linkages between levels of employee engagement and business performance in Alliance Medical.
Alliance Medical is Europe’s leading independent provider of medical imaging services, providing care to more than 400,000 patients in the UK each year and employing around 1000 people through a UK network of 50 centres and 40 mobile scanners.
They have been a client with ours for 10 years now and gave permission to publish this case study.
In May 2018 we worked with Alliance Medical to design and deploy a tailored employee engagement survey.
902 UK-based staff were invited to complete the survey and 648 completed it representing a completion rate of 71.8% which is a strong response rate.
48% of staff completing the survey were in clinical roles and 52% were in non-clinical roles.
Staff were asked to rate their overall level of engagement using the question “I feel engaged, in other words I am satisfied at work AND prepared to contribute a lot to the company”.
This question was used to establish a baseline level of engagement for correlation with all other questions in the survey.
Overall, 82.96% of staff agreed with the statement, which is a positive baseline.
There was a slight difference between clinical and non-clinical staff where 79.34% of clinical staff agreed and 85.58% of non-clinical staff agreed with the statement.
Responses to the individual survey questions showed that clinical staff were also fairly consistent in providing lower average ratings than non-clinical staff so the biggest challenge around engagement appeared to be with the clinical staff group.
We then set out to explore whether or not there were any linkages between levels of employee engagement and business performance.
We compared the data from the employee survey with key performance indicators from the same period.
The KPIs used were patient satisfaction (as measured by a separate patient satisfaction survey), patient complaints and patient throughput (the number of patients seen per day).
We correlated these KPI metrics against engagement survey data for each part of the business to explore whether or not there were any statistical relationships in the data.
Where significant correlations were found further regression analysis was carried out to test the significance of those relationships.
1. Greater employee engagement results in a higher level of patient satisfaction.
Correlating the question “I feel engaged, in other words I am satisfied at work AND prepared to contribute a lot to the company” with patient satisfaction percentages (PSS) at the business unit level showed a strong correlation with a correlation co-efficient (r-value) of 0.76.
Further regression revealed that overall levels of engagement do predict patient satisfaction.
2. Overall levels of employee engagement do not impact patient throughput. Indeed, as patient throughput increases, staff satisfaction decreases.
This appears to be counter-intuitive at first glance as it might be expected that higher levels of employee engagement would lead to higher levels of productivity.
However, exploration of how clinical staff rate the individual survey questions suggests that clinical staff measure patient satisfaction based on the amount of time they are allowed to spend with the patient.
As such, where staff feel the company is driving them to see more patients per day, they feel they are providing a lower level of care, which results in a lower level of engagement.
3. As patient throughput goes down, the number of patient complaints increases and patient satisfaction decreases.
This finding appears to complicate the previous finding.
Whereas staff might feel that spending more time with patients means they are providing a better level of care, this finding suggests that patients actually value being seen quickly and not being kept waiting.
As such, staff need to realise that spending lots of time with patients can actually have a detrimental impact on patient satisfaction.
A balance needs to be struck between efficient care and compassionate care.
Alliance Medicals patients may be tending to view the service provided as a transactional service, which means that whilst they will value a compassionate experience, their main needs are to be seen efficiently and quickly.
4. As patient satisfaction increases, the number of complaints increases.
This is another counter-intuitive finding, but it was only when reviewing the data with Alliance Medical that we discovered that the company has actually been encouraging staff to invite complaints from patients.
The intention behind this is to find ways to continually improve patient care and service.
As such, this finding suggests that staff who are more engaged are more inclined to seek patient complaints.
Where staff feel the company is committed to finding ways to improve patient care they are likely to be more engaged in helping them do that.
Where staff are more engaged there are higher levels of patient satisfaction.
Therefore, focussing on the individual drivers of engagement we identified in the employee survey will ultimately drive patient satisfaction.
The specific survey questions that we found to be drivers of engagement suggest that managers can have an impact by demonstrating appreciation for staff and helping them feel they have future developmental opportunities with the company.
Where staff see the company reinforcing the value of excellence they feel more engaged.
Engaged staff are more comfortable asking patients how things can be improved.
Whilst this leads to a higher level of complaints it provides patients and staff with a sense that there is a positive desire to provide ever increasing levels of patient care.
Managers need to encourage staff to seek ideas for improvement from patients.
Managers also need to involve staff in finding ways to improve processes.
Where there is a primary focus on throughput this leads to lower levels of employee satisfaction.
It reduces the ability and inclination for staff to ask patients how things can be done better and less satisfied staff are less likely to provide a positive patient experience.
Managers need to help staff understand why throughput is important, but appreciate the effort it takes to maximise throughput and ensure the focus on throughput is balanced with the focus on patient care.
The focus perhaps needs to shift towards provision of efficient care in addition to empathetic care.