Why an annual survey won't make healthcare employees engaged

“We know it’s important. And we’ve got it covered. We do a survey every year.”

We hear this depressingly often in our daily conversations about employee engagement. 

Most healthcare workers know staff engagement matters. There are plenty of studies that show how important it is.

That’s because the Annual Engagement Survey is the primary tool wielded by most healthcare organizations.

It asks employees to rank answers to statements like “I would recommend my trust as a place to work” on a five-point scale.

When everyone has labored through the questionnaire, frontline managers receive team results. Then, someone tallies the average score. First for hospitals, then for the organization as a whole. Most healthcare organizations repeat this exercise every year.

And unfortunately, when it comes to measuring employee engagement in healthcare, the Annual Employee Engagement Survey is ineffective. The best-case scenario: it isn’t enough on its own. Worst case scenario? It actually makes employees less engaged.

Why an employee engagement survey isn’t enough.

The format is too rigid Employees rank based on inflexible, pre-determined, multiple-choice answers. There’s no room for the more varied input or nuance needed to get a clear picture.

The questions don’t yield actionable answers. Standard engagement metrics on predictors outside most leaders’ control: e.g., How motivated do you feel?

The metrics are fluffy. The most commonly-used questionnaire uses “percent favorable” metrics. These inflate scores and creates blind spots by making an appearance of high engagement without the outcomes to back it up.

The answers aren’t necessarily honest. No matter how many times managers tell employees surveys are anonymous, there will still be a nagging sense that if they are frank, someone will link the questionnaire to their name – and it may have repercussions. It’s a human thing.

Once a year is not enough. Bank account. Weight. If something matters to you, you’ll check it regularly. You wouldn’t rely on a once-a-year snapshot to get a clear picture of what’s going on. An annual survey is a snapshot in time, and many random factors can influence results. How a healthcare worker feels on that particular day isn’t reflective of how they feel year-round.

An employee engagement survey in itself is not enough. If something matters, you act on it. But most organizations finish the study and then move on.

Year after year: employees toil through the same one-size-fits-all form. No real changes happen. The same questions appear on the survey. And by the middle of the second quarter, any hopes for change fade again.

But what else can you do?

Surveys can be useful as an annual check-up. But healthcare leaders need to supplement them with regular, focused check-ins. Some companies choose to do this with pulse surveys. However, we find this leads to questionnaire fatigue. In a sector as demanding as healthcare – especially in the current climate – there will be even less patience.

The alternative? Monitor the vital data that contribute to engagement in the first place.

The following factors reflect how engaged your workforce is. By adding up averages and totalling scores, you will get a birdseye view of engagement across the organization as a whole and specific departments.

The 10 engagement indicators all healthcare leaders should be tracking

  1. Employees on a leave of absence.
  2. Workers who have filed compensation claims.
  3. The number of employees who have quit in the last 12 months.
  4. The number of training hours employees voluntarily attend.
  5. Performance appraisal and evaluation ratings.
  6. The number of discrimination complaints and legal claims.
  7. The average commute time (the shorter, the better). 
  8. The average amount of relevant education employees undertake.
  9. The number of employees on zero-hour contracts.
  10. The number of employees progressing in their roles.

Keeping an eye on your workforce’s ‘health’ in this way isn’t complicated. Technology will do it for you. Specialized engagement platforms like Blink make engagement patterns in your organization visible and highlight where you need to invest more time and energy.

The format is flexible. You can adjust the set of factors depending on the way your organization operates.

The results are actionable. Because the metrics are so focused, it’s clear what the issues are and whether it’s in your control to improve them.

Data doesn’t lie. These results are black and white, unsusceptible to individual moods or concerns about anonymity.

It’s ongoing. You can monitor these results weekly, monthly, annually, and even daily.

And finally…

There’s no need to pester busy healthcare workers. You can save the questioning for when it really matters.

Keeping an eye on the ‘health’ of your workforce by tracking these things on a regular basis (eg monthly) isn’t complicated. Technology like Blink will do it for you, making engagement patterns in your organization visible, and highlighting where you need to invest more time and energy. 

So you’re tracking engagement indicators – then what?

Here’s another thing that I need to keep emphasizing in my conversations about staff engagement: engagement not something that ‘happens’ (or not) – it’s something you need to make happen. If an employee leaves within 12 months, that’s not just bad luck; it means something was missing, either in the onboarding process or in other ongoing processes in your organization. And it almost certainly means the employee was not engaged.

We know a fair amount about what underpins employee engagement. Five actionable points, in particular, play a key role. From the perspective of the employee, these are:

  1. being clear about your role; 
  2. receiving adequate support;
  3. having the right equipment; 
  4. being able to play to your strengths; and
  5. working alongside committed colleagues. 

Not surprising, then,  that 70% of the variance in employee engagement in healthcare can be attributed to managers. 

Managers are key to employee engagement.

And here are four key strategies that managers can implement to improve staff engagement:

Foster a culture of continuous development

Staff will be more engaged in a culture that gives them opportunities for development and growth. This means encouraging employees to participate in their personal and professional development activities and giving them access to learning opportunities that align with their long-term goals. 

It also means creating an atmosphere in which employees feel comfortable asking for guidance about prioritizing tasks to learning a new skill. 

And it means supporting team members in sharing best practices, recognizing one another’s accomplishments, and fostering a sense of shared accountability.

Make check-ins less formal and more regular 

By seizing small opportunities for meaningful conversation, healthcare managers can build work environments where developmental conversations happen naturally and often. 

Rather than reserving such discussions for one-on-one office meetings, managers can use morning huddles or impromptu hallway discussions to briefly “round” with employees — asking about barriers, clarifying expectations, and answering questions. Even brief conversations can promote ongoing dialogue and communicate to employees that their manager cares about them.

Appoint clinical coordinators

For managers with vast control spans, facilitating regular conversations with individuals may be logistically impossible. In such cases, appointing and equipping nurses as clinical coordinators can nurture essential individualized development. 

These coordinators will continue their frontline nursing duties but will also be responsible for facilitating ongoing developmental discussions with an assigned group of nurses, including regular (e.g. quarterly) goal-setting, accountability and strengths coaching. 

Clinical coordinators often become a rich source of ever-present support. They turn into trusted counselors who hear opinions, remove obstacles and provide immediate feedback.

And because they maintain frontline responsibilities, they will have credibility among their teammates, as they will understand the demands of the job.

Prioritize employee health and wellbeing

This issue is urgent. The pandemic has made clear that much rests on employee health and wellbeing, and that these should be primary goals. The healthcare industry’s current triple aim is to improve patient experience, reduce costs and improve population health. 

A fourth one should be added to that, and it should probably come first: protect and support staff health and wellbeing.

A new Occupational Medicine study led by King’s College London found that over the past year, nearly half of NHS intensive care staff reported mental health symptoms consistent with severe anxiety or depression. An alarming 40% had symptoms of Post-Traumatic Stress Syndrome (PTSD), including flashbacks and nightmares.

This affects individuals and their lives; but it also impacts on teams and organizations.

Summing up

Frontline staff, when given enough support, confidence and encouragement, are capable of incredible things – improving care, reducing costs and designing solutions to big challenges. 

In what has arguably been the hardest year of their career, healthcare professionals have run entire wards, created PPE solutions and developed care packages for Covid-19 patients. All these are manifestations of high levels of engagement.

But real staff engagement needs real investment. Not just a financial investment (although that too) but investment in genuinely facilitative leadership – the kind that is prepared to “walk the talk” and make engagement a truly two-way exercise.

That’s why health and care managers play such an important role in fostering staff engagement. But they shouldn’t have to find their way through this from scratch, investing time they don’t have. Giving them the technology/tools to more effectively drive engagement is essential. 

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