Employee Engagement: A Critical Tool in the Age of Healthcare Reform

Kevin Kruse

Kevin Kruse

Published April 12, 2013

This week on Perspectives, we're counting down our most popular posts of 2013. With all the changes hospitals faced this year, fostering teamwork and a positive culture became more important than ever. So it's no surprise that this piece by bestselling leadership author Kevin Kruse racked up over 5,500 clicks. Reposted for your enjoyment … Perspectives' #2 post of 2013.


While acute care hospitals are veterans in the fight to contain costs, healthcare reform is bringing greater focus to other aspects of care including patient satisfaction, provider preventable conditions and readmission rates. One highly effective yet underutilized tool for achieving these goals is employee engagement.

So, what is employee engagement anyway? Let's start with what it's not …

Employee engagement does not mean employee happiness. Someone might be happy at work, but that doesn’t necessarily mean they are working hard and productively on behalf of the hospital.

Employee engagement also doesn’t mean employee satisfaction — that's too low a bar. A satisfied nurse might show up for her shift without complaint, and do the minimum required of him, and be very satisfied. And that same nurse will be satisfied as he takes the job from the competing hospital in the next town over for a slightly better schedule.

Employee engagement is simply the emotional commitment an employee has to the organization and to the organization's goals.

Plainly speaking, when your employees are engaged, they care about your hospital, their team, and your patients. When they care, they give the magical thing called discretionary effort.

Employee engagement has long been studied as an important variable in nurse retention, but how can employee engagement lead to better patient outcomes? The linkages come from what I call the Engagement-Healthcare Chain:

Engaged healthcare providers lead to…

1) More responsiveness to patients' concerns and complaints, which leads to…

Better patient experiences and satisfaction scores, which leads to…

Bigger Medicare bonuses.

2) More caring for overall hospital goals and initiatives, which leads to…

Fewer pressure ulcers, infections, falls and readmissions, which leads to…

Fewer payment penalties.

Do you think these linkages are theoretical? Think again.

Every day, physicians and nurses take hundreds of actions that impact health and satisfaction — from greeting a patient warmly, to inserting a catheter, to prescribing medication. To reach the desired satisfaction, quality and safety scores hospitals need more than just training and more than just information. It takes engagement, it takes caring.

Jane is a nurse who knows about the problem of hospital-associated infections and knows the proper protocol for catheterization. But what choice will she make at the end of her long, exhausting shift as she checks in on one of her patients? Will she remember to wash her hands and to clean around the catheter and meatus with soap and water? Will she take the time to double check that the drainage bag is below the bladder? After all, while reducing infection rates might be a goal of the hospital, does it really matter to Jane? Will it change her hours or pay? But Jane is emotionally committed to your hospital, to her colleagues and to her patients. She truly cares. Despite the hour and her fatigue, Jane remembers the protocol and takes the time needed to care for her patient, and to reduce the chance of a healthcare-associated infection (HAI).

In research involving over 10 million people in 150 countries, the primary drivers of engagement are Communication, Growth, Recognition and Trust. How is your hospital doing in these areas?

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