Smiling Nurse

What is employee engagement in healthcare – and what is it not?

I have an aversion to buzzwords. 

The more people talk about something, the more I get suspicious that it may be – well, fluffy: all noise, not much substance. 

‘Employee engagement’ is one such word. I spend my working day talking to healthcare professionals, and I’m often struck by the misconceptions about what ‘engagement’ actually means.

I understand why. It’s one of those slippery phrases that’s hard to pin down. I’ve seen it used interchangeably with, well, almost every positive behavior an employee could display. 

For instance, the NHS Engagement Toolkit defines engaged employees as better organized, happier, more satisfied, more loyal, healthier, more motivated, more productive, better at communicating, more prepared to go the extra mile and bend over backward… 

And it’s true that some of these behaviors are a symptom of engagement. But are they the same thing? No

So let’s debunk the myths of employee engagement in healthcare – and explain the truth. 

Why using employee engagement as a ‘catch-all’ for positive behavior does it a disservice.

First, it makes ‘engagement’ effectively unattainable because who exhibits all these behaviors most of the time? 

Second, if we couch ‘engagement’ in vague aspirational terms, it’s easy to view it as a ‘nice to have’ rather than the must-have it is. When that happens, healthcare leaders are more likely to dismiss it as a performance indicator rather than a practical initiative. 

Finally, it’s impossible to quantify the sum of all these behaviors at once. And if you can’t measure something, it’s tricky to improve it

Little girl getting a vaccine in a healthcare clinic

The good news? The reality is far less complicated. Employee engagement in healthcare is achievable, specific, and measurable. 

To understand what it is, let’s first look at what it is not

Employee engagement in healthcare isn’t:

Satisfaction 

A satisfied nurse will work their shift without complaint. They will do the work required. And they will accept another hospital job that offers a slightly better schedule.

Happiness

A care worker may feel happy at work because they have a lot of free time to go on their phone – but that doesn’t make them engaged. 

Motivation 

A medic may feel motivated to work hard because they want to get promoted, but that won’t necessarily correlate with higher engagement levels. Motivation is forward-looking, while engagement happens in the present.

Empowerment 

An organization might empower its physios to make more autonomous decisions when working with clients. But the physio will only take that opportunity when they also feel engaged. Empowerment doesn’t always translate into action; engagement does.

An absence of stress

A brain surgeon may feel stressed when operating but still be highly engaged. Some degree of stress can increase engagement. Gallup found in early May 2020 – i.e., mid-pandemic – the percentage of “engaged” workers reached 38% – the highest since tracking began 20 years ago. 

Productivity 

A hospital porter may be highly productive – i.e., put in lots of working hours – without ever being engaged. The same porter may work two hours a week and stay with the same hospital for 20 years because he is engaged. 

A fixed state 

Engagement isn’t an intrinsic trait or something that is ‘achieved’ and then forgotten. It ebbs and flows. 

The same for everyone 

Engagement manifests differently in different people. Industry, role, type of organization – all these all affect how an engaged individual will behave. That’s another reason why blanket definitions don’t work; an effective engagement strategy is personalized.

HR’s job 

An employee engagement strategy needs to stretch across the whole organization, starting at the top. That means it’s the responsibility of C-suite execs to initiate procedures and up to line managers to make them happen..

So – what is it?

Engagement boils down to a sense of purpose

When this is in place, they can maintain an engaged state of mind – at least for a finite period.  

This explains why, during the height of the Covid-19 pandemic, staff engagement levels in healthcare went up. The urgency of saving lives in never-before-seen conditions gave created a heightened sense of purpose.

But a sense of purpose in itself won’t sustain engagement. We see that, nine months later, when exhaustion, worry, trauma, and burnout have reduced staff engagement in the NHS to Great Recession-era lows

Instead, it’s helpful to think of engagement as a double-sided coin. On the one side, behavior: the emotional commitment an employee feels towards their organization. 

On the other, attitude: how much effort they are willing to dedicate to their patients. For engagement to be successful, both sides of the coin need to be in play. 

That happens when other, more practical factors supplement a sense of purpose:

  • clarity about your role; 
  • receiving adequate support;
  • having the right equipment; 
  • working in a position that plays to your strengths; and
  • working alongside committed colleagues. 

These are the critical aspects of the culture managers must foster if they want to increase staff engagement

Engagement is a mindset, but it also manifests as (visible) action.

As I already said, engaged employees won’t necessarily be smiling, stress-free, or working longer hours. So how can you tell if staff are engaged?

Here are some signs of high engagement at play: 

  • making eye contact with and escorting lost family members to where they need to go
  • never forgetting to wash hands or check IV lines
  •  noticing the yellow “fall risk” bracelet on a patient in the lobby and helping them back to their room
  • unrushed listening when a patient asks about their medications or other concerns
  • being mindful of the need to be quiet at night
  • ensuring all meals are delivered while still hot
  • wheeling a bed-bound patient out of the care home to feel snow for the first time in years
  •  giving a resident with dementia a hand or foot massage in a quiet moment.

What employee engagement looks like in healthcare

Engaged employees are aware of what they should be doing at any given time, have the resources they need to complete that work, and feel like they have an essential part to play in fulfilling your facility’s goals.
They feel empowered to share their concerns and ideas with management and the sense that their contribution is valuable and valued. Employees who are engaged are less likely to look for outside opportunities or accept unsolicited options because they feel emotionally invested in their work.

It looks like better patient outcomes

And as you might expect, what’s good for employees is good for patients. A Gallup study of more than 200 hospitals found that nurses’ engagement level was the most significant predictor of patient mortality rates. Research by Harvard Business Review shows a direct correlation between patient experience measures and measures of employee engagement. 

Engaged employees are more likely to hold themselves to the highest patient care standards, whether that means double-checking a patient’s medication list or sanitizing their hands more frequently.

Young family smiling at new born.

It looks like better patient outcomes.

And as you might expect, what’s good for employees is good for patients. A Gallup study of more than 200 hospitals found that nurses’ engagement level was the most significant predictor of patient mortality rates. Research by Harvard Business Review shows a direct correlation between patient experience measures and measures of employee engagement. 

Engaged employees are more likely to hold themselves to the highest patient care standards, whether that means double-checking a patient’s medication list or sanitizing their hands more frequently.

It looks like money saved.

What may be more surprising is that what’s good for employees is also good for a facility’s bottom line. In healthcare, turnover is a huge problem — with an overall rate of over 20% — and that turnover takes a significant financial toll on organizations. 

Retaining good employees saves money, and increasing employee engagement is one of the simplest ways to reduce staff turnover. In one Gallup case study, a hospital that raised its engagement score simultaneously saw a 7% reduction in turnover — saving $1.7 million.

They also found companies with high engagement are at an increased advantage and more resilient throughout the pandemic.

Employee engagement in healthcare during Covid-19: an impossible task?

Is the highest possible level of employee engagement a lot to shoot for – especially during uncertain times such as these? Absolutely? But one of the most persistent myths in the healthcare industry is that there are specific barriers that make improving the employee experience genuinely impossible. 

According to Advisory Board research, healthcare industry workers are already twice as engaged as employees in other industries. That means healthcare facilities can set higher employee engagement goals across departments and, given the right tools, expect to meet those goals.

Not exactly. And research shows that improving employee engagement becomes even more essential and effective in times of crisis (like the 2008 recession) because those are the times when resilience matters more than ever. 

When health and care staff are engaged, it impacts all of us, directly or indirectly. So should health and care organizations invest in employee engagement during a pandemic?

No-brainer.