Introduction: The impetus for employee engagement
9144001143000THE INFLUENCE OF EMPLOYEE ENGAGEMENT ON ORGANIZATIONAL OUTCOMES: A CASE STUDY AT MAGEE-WOMENS HOSPITAL OF UPMCbyEvangeline A. HarpstBA, Hendrix College, 2014Submitted to the Graduate Faculty ofDepartment of Health Policy and ManagementGraduate School of Public Health in partial fulfillment of the requirements for the degree ofMaster of Health AdministrationUniversity of Pittsburgh201600THE INFLUENCE OF EMPLOYEE ENGAGEMENT ON ORGANIZATIONAL OUTCOMES: A CASE STUDY AT MAGEE-WOMENS HOSPITAL OF UPMCbyEvangeline A. HarpstBA, Hendrix College, 2014Submitted to the Graduate Faculty ofDepartment of Health Policy and ManagementGraduate School of Public Health in partial fulfillment of the requirements for the degree ofMaster of Health AdministrationUniversity of Pittsburgh20169144000UNIVERSITY OF PITTSBURGHGRADUATE SCHOOL OF PUBLIC HEALTHThis essay is submittedbyEvangeline A. HarpstonMarch 21, 2016and approved byEssay Advisor:Wesley M. Rohrer, PhD, MBA ______________________________________Vice Chair of Education and Director of the MHA Program Department of Health Policy and Management Graduate School of Public Health University of PittsburghEssay Readers:Carrie Leana, PhD, BA______________________________________George H. Love Professor of Organizations and ManagementProfessor of Business Administration, of Medicine, and of Public and International AffairsUniversity of PittsburghPatty Genday, MSN, MBA, RN______________________________________Executive Director, Women’s ServicesMagee-Womens Hospital of UPMC 00UNIVERSITY OF PITTSBURGHGRADUATE SCHOOL OF PUBLIC HEALTHThis essay is submittedbyEvangeline A. HarpstonMarch 21, 2016and approved byEssay Advisor:Wesley M. Rohrer, PhD, MBA ______________________________________Vice Chair of Education and Director of the MHA Program Department of Health Policy and Management Graduate School of Public Health University of PittsburghEssay Readers:Carrie Leana, PhD, BA______________________________________George H. Love Professor of Organizations and ManagementProfessor of Business Administration, of Medicine, and of Public and International AffairsUniversity of PittsburghPatty Genday, MSN, MBA, RN______________________________________Executive Director, Women’s ServicesMagee-Womens Hospital of UPMC center4648200Copyright ? by Evangeline A. Harpst201600Copyright ? by Evangeline A. Harpst2016ABSTRACTcenter-222250Wesley M. Rohrer, PhD, MBATHE INFLUENCE OF EMPLOYEE ENGAGEMENT ON ORGANIZATIONAL OUTCOMES: A CASE STUDY AT MAGEE-WOMENS HOSPITAL OF UPMCEvangeline A. Harpst, MHAUniversity of Pittsburgh, 201600Wesley M. Rohrer, PhD, MBATHE INFLUENCE OF EMPLOYEE ENGAGEMENT ON ORGANIZATIONAL OUTCOMES: A CASE STUDY AT MAGEE-WOMENS HOSPITAL OF UPMCEvangeline A. Harpst, MHAUniversity of Pittsburgh, 2016Under the Affordable Care Act, hospitals are now reimbursed based on the patient experience and clinical outcomes. Recognizing the critical role of employees in shaping key elements of the patient experience, many organizations are turning to employee engagement as a way to maximize value-based reimbursement and thrive in a value and consumer driven environment. This paper provides an overview of the organizational benefits of employee engagement, including patient satisfaction, higher quality of care, and better financial results, and focuses on the key drivers of engagement in health care. A case study on employee engagement at Magee-Womens Hospital of UPMC studies the link between engagement and organizational outcomes on two inpatient units. The case study found certain organizational outcomes such as patient satisfaction and perceived quality of care to be correlated with engagement, and also highlighted the role of the direct manager in driving changes in unit level engagement. The public health relevance of this paper is through understanding the benefits and drivers of engagement, organizations can improve patient outcomes and the health of the community, while positioning the organization for a viable future.TABLE OF CONTENTS TOC \o "2-4" \h \z \t "Heading 1,1,Appendix,1,Heading,1" 1.0Introduction: The impetus for employee engagement PAGEREF _Toc449530439 \h 11.1The State of Engagement PAGEREF _Toc449530440 \h 21.2Implications of Health Care Reform PAGEREF _Toc449530441 \h 41.3Organizational Benefits of Employee Engagement PAGEREF _Toc449530442 \h 51.4The Drivers of Employee Engagement PAGEREF _Toc449530443 \h 101.4.1Ability and Desire to Contribute PAGEREF _Toc449530444 \h 101.4.2Quality of Work Environment PAGEREF _Toc449530445 \h 111.4.3Feeling Valued PAGEREF _Toc449530446 \h 121.4.4Growth Opportunities PAGEREF _Toc449530447 \h 131.4.5Perception of Leadership and Supervisor PAGEREF _Toc449530448 \h 141.4.6Pride in Service and Mission PAGEREF _Toc449530449 \h 161.5Measuring Employee Engagement PAGEREF _Toc449530450 \h 162.0Case Study at Magee-Womens Hospital of UPMC PAGEREF _Toc449530451 \h 192.1Introduction to Magee-Womens Hospital PAGEREF _Toc449530452 \h 202.2Measuring employee engagement at Magee-womens hospital PAGEREF _Toc449530453 \h 202.3Analysis of Engagement PAGEREF _Toc449530454 \h 232.3.1Highest Scoring Unit: Unit A PAGEREF _Toc449530455 \h 232.3.2Lowest Scoring Unit: Unit B PAGEREF _Toc449530456 \h 262.4Discussion PAGEREF _Toc449530457 \h 292.5recommendations PAGEREF _Toc449530458 \h 332.6Public Health Relevance PAGEREF _Toc449530459 \h 362.7Conclusion PAGEREF _Toc449530460 \h 36Appendix A : EMPLOYEE ENGAGEMENT INITIATIVES AT MAGEE-WOMENS PAGEREF _Toc449530461 \h 38Appendix B : UPMC ENGAGEMENT SPECTRUM CATEGORIES PAGEREF _Toc449530462 \h 41Appendix C : 2015 NDNQI RN PRACTICE ENVIRONMENT SCALE PAGEREF _Toc449530463 \h 42bibliography PAGEREF _Toc449530464 \h 44List of tables TOC \h \z \c "Table" Table 1. Example Statements of Ability and Desire to Contribute PAGEREF _Toc449530465 \h 11Table 2. Example Statements of Quality of Work Environment PAGEREF _Toc449530466 \h 12Table 3. Example Statements of Feeling Value PAGEREF _Toc449530467 \h 13Table 4. Example Statements of Growth Opportunities PAGEREF _Toc449530468 \h 14Table 5. Example Statements of Perception of Leadership and Supervisor PAGEREF _Toc449530469 \h 15Table 6. Example Statements of Pride in Service and Mission PAGEREF _Toc449530470 \h 16Table 7. Magee-Womens Overall MyVoice Engagement PAGEREF _Toc449530471 \h 21Table 8. Unit A’s MyVoice Engagement PAGEREF _Toc449530472 \h 26Table 9. Unit B’s MyVoice Engagement PAGEREF _Toc449530473 \h 29Table 10. Organizational Outcome Trends from 2013 to 2015 PAGEREF _Toc449530474 \h 32List of figures TOC \h \z \c "Figure" Figure 1. The Effect of Employee Engagement on Patient Experience Measures PAGEREF _Toc449530475 \h 6Figure 2. The Impact of Employee Engagement on Value Based Purchasing Points PAGEREF _Toc449530476 \h 9Figure 3. Unit A NDNQI Survey Data PAGEREF _Toc449530477 \h 24Figure 4. Unit B NDNQI Survey Data PAGEREF _Toc449530478 \h 27Figure 5. Change in HCAHPS Scores: 2013-2015 PAGEREF _Toc449530479 \h 31Introduction: The impetus for employee engagementThere are many ways to promote employee engagement in health care organizations, ranging from employee recognition and career development, to the quality of leadership and the work environment they experience. Many of these drivers of engagement can be under the organization’s control, yet can be difficult to achieve in a field as complex and demanding as health care. Employee engagement is just one of the challenges facing health care executives and managers, along with increasing competition, a changing regulatory environment, inadequate reimbursement, and shifting community anizations will always face difficulties retaining health care providers and support staff because of the relative ease with which they can obtain another job. However, retaining top talent will be critical for health care organizations as they enter a new era post-health care reform. The Affordable Care Act (ACA) shifts health care to a value-based purchasing context, where providers of care are now accountable to payors for patient outcomes. Health care providers will no longer receive the same level of reimbursement if the care they provide does not meet defined standards of quality and patient satisfaction. Pay-for-performance reimbursement and a concurrent rise in consumerism brings patient outcomes into sharper focus. Health care is a high-touch industry – meaning that employees have frequent contact with patients. To make a true difference in the patient’s experience and outcomes health care organizations will have to focus on the people driving this experience: all their employees who affect patient care directly or indirectly. This paper will make the case that health care leaders must put the time, energy, and resources needed into employee engagement to make a significant and lasting impact with their end user – the patients. Employee engagement has been shown in the literature to lead to more satisfying patient experiences and improved patient outcomes. It is also correlated with important organizational goals such as reduced turnover, improved patient safety, higher quality, and increased profitability (Harter, Schmidt, Agrawal, & Plowman, 2014; Lowe, 2012; Press Ganey, 2015a). For organizations looking to thrive in a value-based purchasing environment, where employees and health care leaders must achieve more with less, employee engagement is a crucial part of the solution. This essay will provide an overview of the literature focused on the organizational benefits of employee engagement, the drivers of engagement, and measurement best practices. Then, the author will present a case study of employee engagement at Magee-Womens Hospital of UPMC, with an analysis of engagement, and make recommendations. The State of EngagementPatients can easily discern whether an employee is engaged or not. Engaged employees are energetic and enthusiastic about their work (Lowe, 2012; Press Ganey, 2015a). These employees are invested in the success of the organization, proactive in sharing ideas and, as many studies have found, willing to expend discretionary effort (Caldwell & Watson, 2011; Engagement Strategies Media, 2016; Krause, 2015; Lowe, 2012). It is common for engaged employees to experience values congruence with the organization and to want to play a role in fulfilling the mission (Blizzard, 2003; Lowe, 2012). Engaged employees also have “strong emotional, rational, and behavioral attachments to their job and their organization,” often displayed through pride and loyalty to the organization (Lowe, 2012). Not surprisingly, engaged employees are more likely to recommend the organization as a place to work and to receive care (Lowe, 2012; Press Ganey, 2016; Press Ganey, 2015a; The Advisory Board Company, 2014). Engaged employees go above and beyond job expectations, and have been described as the ideal employee (Lowe, 2012). Individuals who enter health care are often highly motivated to provide compassionate care (Press Ganey, 2016). If the culture of an organization does not allow them to do so, they can become disengaged, affecting everything from retention, to productivity, to patient outcomes (Press Ganey, 2016; Scotti, Harmon, & Behson, n.d.). Two separate surveys on employee engagement in health care indicate significant room for improvement. The Global Workforce Study done by Towers Watson in 2011 found that only 44% of health care employees are actively engaged in their work (Caldwell & Watson, 2011). Based on these results, over half of health care employees are somewhat or actively disengaged with their work experience. Compared to 2007, the number of respondents who said they were willing to put in a great deal of effort to help the organization succeed decreased from 72% in 2007 to 66% in 2010 (Caldwell & Watson, 2011; Healthcare Source Blog, 2014). A more recent survey administered by The Advisory Board Company found that overall engagement in the health care industry leveled off in 2014 after gains since 2010. In 2014, 40.5% of the workforce was engaged, while 5.8% were disengaged. This plateauing effect was expected, because continual gains become more difficult to achieve the more an organization improves (The Advisory Board Company, 2014). Additionally, the 2015 Employee Engagement National Database found that direct caregivers are less engaged and more likely to leave an organization compared to other employees (Press Ganey, 2016). Nurses in particular have the lowest engagement and, given the critical role of nursing staff in providing direct patient care, this is especially troubling (The Advisory Board Company, 2014). These statistics are alarming health care leaders who understand the impact their employees have on patient outcomes. Post health care reform, negative patient outcomes are now tied to real financial consequences.Implications of Health Care Reform To encourage improved performance and slow the rising cost of health care, the ACA created several hospital payment reform programs. Under these pay-for-performance programs, the Centers for Medicare and Medicaid Services (CMS) rewards hospitals for providing higher quality and higher value services to patients (Press Ganey, 2015b). One of the most influential of these programs is the Hospital Value-Based Purchasing (VBP) program, where a portion of payment is set aside to fund an incentive pool for hospitals based on the quality of services they provide (Press Ganey, 2015a). Value-based incentive payments are based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores (commonly known as patient satisfaction scores) and certain clinical process measures (Krause, 2015; Press Ganey, 2015a). Hospitals face a two percent potential loss under the VBP program, in the range of tens of thousands of dollars up to millions of dollars at risk for hospitals that receive over half of their reimbursement from the federal government (Sherwood, 2013). The VBP program and others will shift the health care industry from a volume-based to a value-based orientation, and reinforce the links between employee actions, patient outcomes, and financial results (Press Ganey, 2015a; Sherwood, 2013). Organizational Benefits of Employee EngagementThe literature demonstrates a strong correlation between employee engagement and patient satisfaction – a link that has caught the attention of health care executives looking for evidence-based strategies to increase their HCAHPS scores (Blizzard, 2003; Harter et al., 2014; Press Ganey, 2016; Press Ganey, 2015a). Gallup created a health care consulting model which proposes that engaged employees are key to improving patient satisfaction and loyalty. To create this model, Gallup analyzed three years of inpatient satisfaction data and found a significant correlation between overall employee engagement and overall patient satisfaction (Blizzard, 2003). Other studies have demonstrated the positive relationship between employee engagement and HCAHPS performance (Press Ganey, 2016; Press Ganey, 2015a). For example, a study of over 2,200 health care facilities found that hospitals ranking in the top 20% of employee engagement score better in every HCAHPS dimension: communication with nurses, responsiveness of staff, physician care, pain management, medication explanations, discharge instructions, and overall hospital rating (see figure 1) (Press Ganey, 2016).Adapted from Press Ganey, 2016Figure 1. The Effect of Employee Engagement on Patient Experience MeasuresAnother study found that 85% of engaged employees displayed a genuinely caring attitude towards patients, compared to only 38% of disengaged employees (Healthcare Source Blog, 2014). Intuitively, a caring attitude translates into a better experience for patients. Engagement allows employees to be at their best with patients, and do what they entered health care to do – provide high-quality and compassionate care. Clearly, patients take notice and respond accordingly. Employee engagement goes beyond patient satisfaction, however. It is positively correlated to better outcomes for patients in the form of higher quality of care and patient safety (Harter et al., 2014; Press Ganey, 2015a; Sherwood, 2013). A Gallup study of 200 hospitals found that the engagement level of nurses showed the highest correlation to mortality, even above the number of nurses per patient day (Krause, 2015). Another review of engagement and clinical outcomes at the NHS in England shows that for every 10% increase in engagement there was a reduction in MRSA by .057 cases per 10,000 bed days (Krause, 2015). Another quality metric affected by engagement is avoidable readmission rates. Under the Hospital Readmission Program established by the ACA, health care facilities with higher than expected readmission rates for conditions such as heart attack, heart failure, and pneumonia will face reduced payments. Hospitals with high employee engagement have fewer readmissions and consequently experience considerably lower readmission penalties than hospitals with disengaged employees (Press Ganey, 2015a). Levels of engagement also affect how employees perceive the quality of care they deliver, which is closely related to the patients’ perception of quality of care (Press Ganey, 2015b; Scotti et al., n.d.). One study found that highly engaged employees were two-thirds more likely to report that their work unit “always” provided top quality service. Only one in five in the low engagement group believed excellent quality service was always provided (Lowe, 2012). Major human resource goals, from recruitment to improved retention to reduced absenteeism also seem to be positively influenced by engagement (Caldwell & Watson, 2011; Engagement Strategies Media, 2016; Lowe, 2012; Sherwood, 2013). Retaining top talent will be critical for organizations as they enter a value and consumer-driven environment. Now, not only do providers need to be excellent clinically, but they must also have strong interpersonal skills. This challenge of retaining top talent, compounded by an increasing shortage of providers, can be mitigated with employee engagement (Caldwell & Watson, 2011; Press Ganey, 2016). The Towers Watson study mentioned earlier found that engagement and likelihood of staying with the employer are closely correlated (Sherwood, 2013). Another study found that 90% of highly engaged employees plan to stay with their organization, at least for the near future (Lowe, 2012). Conversely, studies show that close to half of disengaged employees will be job hunting in the next 12 months (Lowe, 2012). Organizations know that turnover is costly. Jones, in the Journal of Nursing Administration (as cited in Press Ganey, 2015b, p. 19), found that the cost of replacing a nurse is $82,000 and as much as $125,000 for a specialty nurse. By improving engagement, organizations can reduce this cost and retain their best employees. Finally, financial performance is greatly impacted by employee engagement. Research has shown that revenue, operational budget and even stock performance are positively correlated with engagement (Berrett & Spiegelman, 2013; Engagement Strategies Media, 2016; Fuller, 2014; Harter et al., 2014). One study found that facilities “with engaged workers had eight percent higher net revenue per patient than facilities with lower engagement” (Healthcare Source Blog, 2014). Gallup polls also show a boost in productivity and profitability by 20% or more in companies with high engagement (Fuller, 2014). Hospitals with engaged employees recover value-based incentive payments in higher amounts than hospitals with a less engaged workforce. In 2013, hospitals with high employee engagement received $1.17 for every dollar at risk in VBP payments, whereas hospitals with low employee engagement received $0.91 for every dollar at risk (Press Ganey, 2015a). When looking at VBP program points, top performers in employee engagement score “on average 38 VBP points higher on HCAHPS, 12 points higher on core measures, and 16 points higher in total performance” (see figure 2) (Press Ganey, 2015a). Adapted from Press Ganey, 2015aFigure 2. The Impact of Employee Engagement on Value Based Purchasing PointsClearly, these results validate the considerable impact employees have on the patient experience and resulting financial outcomes. Organizations that fail to engage employees will lose revenue under current payment reforms (Press Ganey, 2016; Press Ganey, 2015a). Not only will failing to engage employees negatively influence financial performance, but these organizations will also be less likely to be selected as an Accountable Care Organization (ACO) and to be included in narrow networks and preferred provider delivery models (Press Ganey, 2016). The investment in employee engagement is well worth the cost in a value-based purchasing environment. Despite these indisputable benefits, engaging employees in the shifting health care environment remains a challenge. Many organizations try multiple efforts to improve engagement, with little to no success. Disengaged employees often do not have the tools or supervisory support to improve. Further, leaders who want to improve the engagement of their workforce do not necessarily know how to drive this change (Press Ganey, 2015a). The next section will review the main drivers of employee engagement. The Drivers of Employee EngagementAn in-depth understanding of the drivers of engagement is critical for health care organizations and leaders striving to improve engagement. After reviewing the literature, the author has established six categories which cover the major drivers of engagement: ability and desire to contribute, quality of the work environment, feeling valued, growth opportunities, perception of leadership and supervisor, and pride in service and mission. These categories are by no means mutually exclusive, but rather are overlapping and interdependent. Some categories, such as “feeling valued,” can be dependent on the direct supervisor and leadership of the organization. The essential elements of employee engagement in health care follow. Ability and Desire to ContributeThis fundamental driver has to do with the ability as well as the volition to perform daily job functions and tasks. To be able to fully contribute, employees must have clear goals and objectives and understand what is expected of them at work (Sherwood, 2013). Defining and clarifying outcomes to be achieved is a basic employee need and manager responsibility, and is a first step to employees feeling able and confident in their roles (Harter et al., 2014). Ability to contribute can also depend on whether employees feel their job utilizes their skills and abilities and is a good match for their talents (Harter et al., 2014; Press Ganey, 2016; The Advisory Board Company, 2014). Willingness to contribute depends in part on whether employees like the work they do and at least enjoy some aspects of their job. It is also important for employees to understand how their actions contribute to the organization’s mission and connect to the bigger picture (Engagement Strategies Media, 2016; The Advisory Board Company, 2014).Engagement survey questions reflective of “ability and desire to contribute” driver:Table 1. Example Statements of Ability and Desire to ContributeI know what is expected of me at work (Harter et al., 2014)I have clear job goals and objectives (Lowe, 2012)My job makes good use of my abilities/skills (Press Ganey, 2016)My current job is a good match for my skills (The Advisory Board Company, 2014)I like the work I do (Press Ganey, 2016)I understand how my daily work contributes to the organization’s mission (The Advisory Board Company, 2014)Quality of Work EnvironmentThe quality of the work environment is essential for not only employee satisfaction, but also for performance (Harter et al., 2013; Lowe, 2012). It is the responsibility of management to create environments that allow employees to consistently perform at their peak (Caldwell & Watson, 2011; Scotti et al., n.d.). To facilitate high-performing environments, adequate staff and resources to get the job done are required (Lowe, 2012). It also means removing process barriers and ensuring optimal work conditions, such as proper safety, lighting, equipment, scheduling, and clear direction from the supervisor when needed (Lowe, 2012). Optimal work conditions are also referred to as performance support, which enables employees to do their best work and achieve results for patients and customers (Scotti, Harmon, & Behson, n.d.). Having the needed supplies and resources is critical for employees to feel that their organization supports them and values what they and their department do (Harter et al., 2014). In addition to having the basic resources to perform their job well, there are also two other important variables critical for employee engagement: 1) the tools and support to deal with stress and burnout, and 2) a supportive team and good relationships with coworkers (Lowe, 2012; Sherwood, 2013; The Advisory Board Company, 2014).Engagement survey questions reflective of “quality of work environment” driver: Table 2. Example Statements of Quality of Work EnvironmentI have the tools and resources I need to provide the best care/service for our clients/patients (Press Ganey, 2016)I have the materials and equipment I need to do my work right (Harter et al., 2014)I have adequate resources to do my job (Lowe, 2012)My organization helps me deal with stress and burnout (The Advisory Board Company, 2014)I feel I belong to a team (Lowe, 2012)Feeling ValuedAt the heart of feeling valued is recognition for good work and employees feeling like their opinions count (Harter et al., 2014; Krause, 2015; The Advisory Board Company, 2014). Employee recognition most often comes from managers; however, it can also come from fellow employees, patients and their families. Recognition is increasingly important as the demographics of the workforce change. Numerous studies have shown that millennials like to be recognized frequently, even up to multiple times per day (Engagement Strategies Media, 2016). While this may seem excessive to older managers, organizational culture and management styles must change with the expectations of the workforce.Employees also want to feel like the organization listens to them and values their suggestions (Engagement Strategies Media, 2004; Harter et al., 2014; Krause, 2015). In a work setting that does not consider employee feedback, employees will stop offering suggestions and disengage with the organization, resulting in higher turnover and lower work quality (Healthcare Source Blog, 2014). Engagement survey questions reflective of “feeling valued” driver:Table 3. Example Statements of Feeling ValueMy organization recognizes employees for excellent work (The Advisory Board Company, 2014)In the last 7 days, I have received recognition or praise for doing good work (Harter et al., 2014)Organization treats employees with respect (Press Ganey, 2015a)The organization values my work (Lowe, 2012)My ideas and suggestions are valued by the organization (The Advisory Board Company, 2014)At work, my opinions seem to count (Harter et al., 2014)Growth OpportunitiesProviding growth opportunities, which include career development, is proven to be a vital part of engaging a workforce (Blizzard, 2003; Caldwell & Watson, 2011; Harter et al., 2014; Krause, 2015; Sherwood, 2013; The Advisory Board Company, 2014). If a person’s desire to advance in his or her career is not fulfilled, he or she will search for work elsewhere (Engagement Strategies Media, 2004; Krause, 2015). Employees, now more so than ever, look for opportunities for personal development and advancement in their job. Towers Watson explored the factors that attract individuals to seek employment in organizations, and found that advancement opportunities rose in its ability to attract from the 6th place in 2007 to the 3rd place in 2010 (just below competitive pay, and vacation and other paid time off) (Caldwell & Watson, 2011). Consequently, providing career planning tools, resources, and opportunities is a potent form of attracting employees, in addition to engaging the current workforce (Caldwell & Watson, 2011; Sherwood, 2013). Career development goes beyond promotion within the traditional hierarchy, however. It also entails providing opportunities for employees to expand their skills and knowledge sets, to keep current on the latest technology and techniques, and to benefit from a diversity of experiences (Blizzard, 2003; Caldwell & Watson, 2011). It is critical for employees to have a mentor or trusted peer to discuss their goals and development options. As indicated from the example statements below, this is not necessarily the direct manager’s responsibility, although he/she may play this role (Harter et al., 2014; Sherwood, 2013).Engagement survey questions reflective of “growth opportunities” driver: Table 4. Example Statements of Growth OpportunitiesThis organization provides career development opportunities (Press Ganey, 2016)I am interested in promotion opportunities in my unit/department (The Advisory Board Company, 2014)This last year, I have had opportunities at work to learn and grow (Harter et al., 2014)In the last six months, someone at work has talked to me about my progress (Harter et al., 2014)There is someone at work who encourages my development (Harter et al., 2014)Perception of Leadership and SupervisorEmployee perceptions of both senior leadership and their frontline managers are perhaps the most influential drivers of engagement. The Towers Watson Global Workforce Study found the quality of an organization’s senior leadership to be the number one driver of engagement in health care (Sherwood, 2013). One of the most critical aspects of leadership that drives engagement is whether decision-making is perceived to be in line with the organization’s values and mission (Sherwood, 2013; The Advisory Board Company, 2014). Other ways senior leadership can influence engagement is through a clear commitment to high-quality care and encouraging employees to give their best efforts at work (Caldwell & Watson, 2011; Lowe, 2012).The importance of the frontline manager also cannot be overstated. These supervisors and managers translate “strategy into action, enable individuals and teams to work productively, and coach people on their job performance and development” (Caldwell & Watson, 2011). The role of the manager is critical because often the other drivers of engagement are dependent on the actions and support of the manager (Engagement Strategies Media, 2016; Sherwood, 2013). Accordingly, studies completed by Gallup found that 70% of the variance in engagement is tied to the employee’s direct manager, highlighting the impact of their role (Krause, 2015). It is important for employees to be confident in their manager’s abilities, feel supported and respected, and to be treated fairly by their manager (Sherwood, 2013). Engagement survey questions reflective of “perception of leadership and supervisor” driver:Table 5. Example Statements of Perception of Leadership and SupervisorThe actions of executives in my organization reflect our mission and values (The Advisory Board Company, 2014)Senior management is committed to high quality care (Lowe, 2012)Employees have confidence in senior management’s leadership (Press Ganey, 2015a)I respect the abilities of the person I report to (Press Ganey, 2016)My supervisor can be counted on to help with difficult tasks (Lowe, 2012)Pride in Service and MissionThe final driver is pride in the services produced by the organization. In health care, this is high-quality care and services. Employees want to feel that their organization provides high-quality care and service to patients and are invested in the organization’s mission (Press Ganey, 2015a; The Advisory Board Company, 2014). If this is not the case, it is difficult for them to be proud of the organization and engaged in their work. A measure of this driver is whether employees see upper level management and their work team as committed to high-quality care (Caldwell & Watson, 2011; Harter et al., 2014; The Advisory Board Company, 2014).Engagement survey questions reflective of “pride in service and mission” driver: Table 6. Example Statements of Pride in Service and MissionMy organization provides excellent care to patients (The Advisory Board Company, 2014)I believe in my organization’s mission (The Advisory Board Company, 2014)Organization provides high quality care and service (Press Ganey, 2015a)My associates or fellow employees are committed to doing quality work (Blizzard, 2003; Harter et al., 2014)Senior management is committed to high quality care (Lowe, 2012)Measuring Employee Engagement Once health care organizations are convinced of the benefits of employee engagement and understand the drivers, the next logical step is measurement. Measuring employee engagement leads to many benefits: leaders can hear the employee voice, identify opportunities for improvement and areas of strength, retain high performers, and benchmark results with other organizations (Engagement Strategies Media, 2016; Fuller, 2014). The typical approach to measuring employee engagement is an annual engagement survey where employees rate their own level of engagement (Fuller, 2014; Krause, 2015). With literally thousands of questions available to measure employee engagement, the challenge is creating a succinct survey that still captures reliable and meaningful data leaders can use to confidently make decisions (Engagement Strategies Media, 2016). Some articles suggest using a third party vendor, so that results are unbiased and can be compared to national benchmarks (Engagement Strategies Media, 2016).Press Ganey stresses the importance of gathering detailed data on a work unit level (2016). This allows organizations to tailor work improvement plans to the unit’s engagement level and unique drivers. To create a highly engaged workforce, measurement alone is not sufficient; it must be complemented with accurate results and improvement efforts (Press Ganey, 2016). Human resource experts prefer a multidimensional approach to measuring employee engagement, and typically look at job satisfaction, organizational commitment, and other performance related indicators (Lowe, 2012). Below are a few examples of how various organizations measure engagement via surveys: Gallup uses the Q12, which is their standard employee satisfaction survey based on 30 years of accumulated qualitative and quantitative research. This survey consists of 13 questions in total, and includes statements that measure factors found to be highly indicative of employee engagement (Harter et al., 2014).In their Global Workforce Study, Towers Watson used “nine separate items that measure the strength of [employees] connections to the organization using three dimensions: rational (how well they understand their roles), emotional (how much passion and energy they bring to their work), and motivational (how well they perform)” (Caldwell & Watson, 2011). Ontario Health used a 95 item questionnaire assessing drivers of engagement, individual outcomes, and organizational outcomes. Employees were asked to assess 36 features of their job, including “training and development opportunities, their team, their supervisor, senior management, and how the organization supports its employees” (Lowe, 2012).A main challenge of measuring employee engagement lies in valid and reliable measurement, especially since the measures used in the base year will be the foundation for employee engagement measures in the future (Engagement Strategies Media, 2016). The downside of the survey approach is that it becomes dated quickly and there is the potential for employees responding how they think their employers want them to respond (Fuller, 2014). Additionally, the survey method looks at self-perceived engagement, which is important but might not actually reflect the employee’s actual engagement level. To combat the subjective nature of this kind of survey, it is important to balance these perceptions with more objective measures such as amount of work that occurs outside of normal working hours and level of participation in ad-hoc meetings (Fuller, 2014). Complementing attitudinal data with objective measures should provide a more accurate picture of engagement (Blizzard, 2004; Fuller, 2014). Case Study at Magee-Womens Hospital of UPMCThe purpose of this case study is to apply the concepts learned in the literature review in a real world scenario at Magee-Womens Hospital of UPMC. The author analyzed data from the two inpatient units scoring highest and lowest in nursing engagement to determine if organizational outcomes such as patient satisfaction and nursing turnover are correlated with engagement. The comparison of high and low scoring units will address why different units may score higher in engagement than others, what drives changes in engagement, and will identify areas for improvement. In this case study, employee engagement is addressed using two different surveys: the National Database of Nursing Quality Indicators (NDNQI) nursing satisfaction survey and the UPMC MyVoice employee engagement survey. These surveys are comprehensive as each captures the drivers of engagement previously identified in this paper by the questions used to measure engagement. Patient satisfaction was measured using Press Ganey HCAHPS scores and turnover metrics were gathered from Magee-Womens Human Resource department. In the NDNQI survey, quality of care was estimated through the “perceived quality of care” question. Additionally, job enjoyment, while not strictly an organizational outcome, was also compared across units to reveal differences in this measure. Introduction to Magee-Womens HospitalMagee-Womens Hospital of UPMC is a large, nationally-ranked teaching and research hospital which offers care to both men and women in all major specialties.?It is ranked ninth in the nation in gynecological services by U.S. News and?World report in 2015, and nationally recognized in cancer and orthopedics.?Its historical focus on women's and gender-specific care continues in its quality women’s care, and has allowed it to expand to offering a full spectrum of clinical and surgical services. Magee-Womens’ stated goal is to give individually-tailored health care to each patient and to quickly bring research advances to the bedside. It functions as a trauma center, has 360 beds, a large well-trained staff and four floors of ambulatory facilities.?Magee-Womens has been a major resource and health care provider in the Pittsburgh community since its inception in 1911 (UPMC, 2016a; U.S. News & World Report, 2016).Numerous employee engagement efforts are underway at Magee-Womens, ranging from leadership visibility and communication to human resource initiatives such as values-based hiring, recognition programs, and engagement initiatives unique to each unit and position category. Some of these initiatives were created in response to the MyVoice survey results in 2011 and 2014. For a partial list of hospital-wide engagement efforts, see Appendix A. Measuring employee engagement at Magee-womens hospitalMagee-Womens measures employee engagement in several ways to determine if these efforts are successful. The first is the MyVoice survey, which is an engagement survey and also described as a “commitment from leadership to give UPMC staff a channel to voice feedback and make sure it becomes action” (UPMC, 2016b). The MyVoice survey is a system-wide initiative, and was first administered in 2011 and most recently administered in 2014. UPMC uses the third-party vendor Decision Wise to administer the survey and analyze the results. The MyVoice survey has six domains: My Work, My Coworkers, My Department, My Supervisor, My Business Unit, and UPMC. There are 42 questions that compose these overarching domains, and the results are categorized into favorable, neutral, and unfavorable responses.Based on the survey results, employees were categorized by engagement level based on their responses to six engagement anchor questions. The four different categories are Fully Engaged, Key Contributor, Opportunity Group, and Fully Disengaged. Refer to Appendix B for a description of how employees in each category are characterized. At Magee-Womens in 2014, 26% of employees were Fully Engaged, 51% were Key Contributors, 18% were in the Opportunity Group, and 5% were Fully Disengaged.Table 7. Magee-Womens Overall MyVoice EngagementFully Engaged26%Key Contributors 51%Opportunity Group 18%Fully Disengaged 5%Each hospital unit also has a breakdown of how their employees responded to gauge overall engagement on the unit. These unit level responses are only available for 2014, which prevents trending of this data. Due to the inability to trend engagement results on the unit level with the MyVoice survey, the NDNQI nursing satisfaction data was used to correlate engagement with business outcomes. Nursing engagement specifically has been linked with higher quality of care and overall performance (Press Ganey, 2015b). The NDNQI survey is completed by nurses only. To be eligible for the survey, nurses must spend at least 50% of their time at the bedside with patients and be employed on the unit for a minimum of three months. The survey is composed of the Practice Environment Scale (PES) and other survey questions that measure job enjoyment, nurse-nurse interactions, intent to stay, and nurse characteristics. The full length PES survey can be found in Appendix C.The PES was described by Lake as the “organizational characteristics of a work setting that facilitate or constrain professional nursing practice” (2002). The PES looks at the following five categories: 1) Nurse Participation in Hospital Affairs 2) Nursing Foundations for Quality of Care 3) Nurse Manager Ability, Leadership, and Support of Nurses 4) Staffing and Adequate Resources, and 5) Collegial Nurse-Physician Relationships. These categories are measured by specific questions which nurses respond to using a 4-point Likert scale and the following response options: strongly agree, agree, disagree, strongly disagree.The NDNQI survey was administered in October of 2013 and 2015, and responses were measured on a unit level and compared to the mean of similar units at other teaching hospitals across the country. The author selected the NDNQI mean PES score as the measure of nurse engagement, because almost all of the questions asked in the NDNQI survey fall within the engagement drivers enumerated above. Although the domains may be categorized differently, the survey captures the elements of engagement and thus serves as a useful indicator of nursing engagement. Based on the results from the PES survey, the lowest negatively scoring and highest positively scoring inpatient units (that also receive HCAHPS scores) were selected to further analyze and identify trends in organizational outcomes and areas for improvement. The specific units have been de-identified for this analysis. The unit scoring highest in the PES will be referred to as Unit A, while the lowest scoring will be referred to as Unit B. Analysis of EngagementHighest Scoring Unit: Unit A NDNQI: From 2013 to 2015, the overall mean PES score (the metric of engagement used) on Unit A improved. Increases were seen in every domain over the two-year period, with the highest increase seen in “Nurse Manager Ability, Leadership, and Support of Nurses.” Unit A did have a change in their unit director over the two-year time frame. Interestingly, the new unit director previously worked in Unit B until October of 2014, left Magee-Womens Hospital, and came back to be the unit director of Unit A in August of 2015, two months prior to the NDNQI survey. Figure 3. Unit A NDNQI Survey DataUnit A performed above the mean in every domain with the exception of Collegial-Nurse Physician Relationships (although below the mean by only .01 percentage point). To find opportunities for improvement, the author examined the survey answers comprising the lowest scoring domain, Collegial-Nurse Physician Relationships. Out of the three questions, the two which scored farthest below the mean were “A lot of team work between nurses and physicians,” and “Collaboration (joint practice) between nurses and physicians.” Thus, a leadership driven focus on teamwork between nurses and physicians should result in improvement in these scores.Based on responses from the NDNQI “Unit Perceived Quality of Care” section, nurses’ perception of quality of care increased from 2013 to 2015. In 2015, Unit A’s Job Enjoyment scale was well above the mean (4.37 compared to 3.79), placing them in the 85th percentile compared to similar units at other teaching hospitals. Press Ganey HCAHPS: The nurse communication HCAHPS domain increased by three percentage points over the two-year time frame, which is below the overall hospital’s 4.5 percent increase in this domain. The largest increase was seen in “Nurses explain in a way you understand,” which increased by almost five percentage points. Unit A’s other HCAHPS domains (including care transitions, responsiveness of hospital staff, communication with doctors, hospital environment, communication about medicines, and discharge information), increased from 2013 to 2015, with the exception of pain management, which slightly decreased. Unit A’s HCAHPS trend paralleled the hospital’s scores, which increased over the two-year period; however, compared to the hospital overall, Unit A’s gains were typically greater. MyVoice: Based on the MyVoice 2014 survey responses, the highest scoring domain for Unit A was My Coworkers, which obtained a 91% favorable response rate. The lowest scoring domain was My Business Unit, with only a 57% favorable response. The majority of lowest scoring questions fell into the My Business Unit category, and revolved around hospital leadership trust, visibility, and communication, for example, “The leaders of my hospital are visible on a daily basis.” Highest scoring questions focused on the work relationships in Unit A, including questions such as “My coworkers treat me with respect” and “My coworkers care about me as a person.” The highest scoring question in this unit was “I clearly understand what my supervisor expects of me,” indicating clear manager communication and expectations. In 2014, the overall staff engagement in the Unit A was as follows: 29% were Fully Engaged with their job, 50% were Key Contributors, 14% were in the Opportunity Group, and 7% were Fully Disengaged. Table 8. Unit A’s MyVoice EngagementFully Engaged29%Key Contributors50%Opportunity Group14%Fully Disengaged7%The engagement index, composed of employees in the Fully Engaged and Key Contributor categories, was 79%. This was two percentage points higher than Magee-Womens engagement index overall. HR Metrics: Nursing turnover rate in this unit decreased from 18.3% in fiscal year 2013 to 16.0% in fiscal year 2015. Turnover was at a low point in fiscal year 2014 at 15.2%. Overall this shows a downward trend in turnover over the two years, and an expected inverse relationship with engagement scores.Lowest Scoring Unit: Unit BNDNQI: From 2013 to 2015, Unit B’s overall engagement score decreased. Scores dropped in all five NDNQI domains except for Collegial Nurse-Physician Relationships. The domain that had the largest decrease was Staffing and Resource Adequacy; however, this is also the only domain where this unit outperformed the NDNQI mean of similar units in other teaching hospitals. Figure 4. Unit B NDNQI Survey DataTo identify areas for improvement in Unit B, the author explored the domain where this unit scored farthest below the mean in 2015: Nurse Manager Ability, Leadership, and Support of Nurses. The individual questions in this category where the unit scored farthest below the mean are “Supervisors use mistakes as learning opportunities, not criticism,” and “A supervisory staff that is supportive of the nurses.” Nurses in this unit do not necessarily perceive their nursing manager as supportive when they make mistakes. This domain saw a fairly large drop from 2013 to 2015. As mentioned above, Unit B had a change in leadership over this period; the unit director left in October of 2014. The NDNQI scores suggest that nurses view their new manager as less supportive. Outside of the PES questions, from 2013 to 2015 the perceived quality of care decreased slightly. Unit B scored well below the mean in the Job Enjoyment scale, scoring around the 36th percentile.Press Ganey HCAHPS: In contrast with a decrease in nurse engagement, the HCAHPS nurse communication scores increased over the two years. The question with the greatest gains was “Nurses treat with courtesy and respect,” which increased by one percentage point. Although scoring below the mean in all NDNQI domains, Unit B has higher overall HCAHPS scores in the “Communication with Nurses” domain than Unit A. Although the nurse communication scores increased, Unit B decreased in five out of the eight HCAHPS domains from 2013 to 2015, contrasted with the pattern of increases in overall hospital scores. Additionally, the overall experience metrics (“likelihood to recommend” and “overall rating”) decreased over the two-year time frame; again, in contrast with the hospital and with Unit A. This noticeable difference suggests a relationship between decreased engagement and lower patient satisfaction scores.MyVoice: In 2014, Unit B’s highest scoring domain was My Coworkers, which received a 93% favorable score. The lowest scoring domain was My Business Unit, which had a 57% favorable score. Compared to Unit A, the percentage of favorable responses in all domains was not substantially different and in some cases higher, and fell within five percentage points of the other unit. Unit B’s lowest scoring questions were similar to Unit A’s, with a focus on questions in the My Business Unit category. The same trend of leadership visibility, trust, and communication was seen in the lowest scoring questions, but in a slightly different order. The highest scoring questions focused on enjoying the work team and a unit commitment to high-quality, patient centered care. “I know what my supervisor expects of me” also made the top five highest scoring questions. Looking at the distribution of engagement on Unit B, 21% of all employees were categorized as Fully Engaged in 2014, which is five percentage points lower than Magee-Womens overall and eight points lower than Unit A. However, the Key Contributor group was larger than Magee-Womens overall, and Unit B also had fewer employees rank in the lowest scoring groups (Opportunity Group and Fully Disengaged) compared to the overall hospital and Unit A. Table 9. Unit B’s MyVoice EngagementFully Engaged21%Key Contributor64%Opportunity Group11%Fully Disengaged4%Unit B’s engagement index was 85%, which was higher than both the hospital overall and Unit A. HR Metrics: The turnover rate trended steadily downward from 19.4% in fiscal year 2013 to 14.6% in fiscal year 2015, which did not support the trend between engagement and turnover found in the literature. Here, turnover decreased despite a dip in engagement.Discussion Major themes in the data emerged after the author completed her analysis. First, the impact of the direct manager seems to be a significant contributing factor to changes in engagement on each of the units. Second, though their impact on engagement, frontline managers can also affect metrics tied to engagement, such as patient satisfaction. Third, in this case study, engagement appears to have a relationship with certain organizational outcomes, such as patient satisfaction, perceived quality of care, and job enjoyment, while not with others, such as turnover. Each of these will be explored further in the discussion.Over the two-year time frame, engagement declined on Unit B, while the opposite occurred in Unit A. At the same time, each unit experienced a change in the unit director, involving the same leader (unbeknownst to the author upon initial review and trending of the data). It appears that in this case the direct manager is a major contributing factor to changes in engagement on each of the units, and this pattern was noticed prior to knowledge of the leadership change.Prior to the leadership change, in 2013 Unit B’s highest scoring NDNQI domain was nurse manager ability, indicating strong leadership on the unit. Their scores in 2015, however, reflected the loss of this leader—nurse-manager ability was now their lowest scoring domain, falling below the NDNQI mean. Over this period, the unit director transferred to Unit A, and as a result Unit A saw the greatest increase in scores in the nurse-manager ability domain. During the same period, Unit A went from scoring below the mean to well above in this domain. This case study presented the unique opportunity to observe the direct effect of a particular unit director’s leadership style. From this data we can infer a positive relationship between leadership style and engagement scores, while recognizing the limits of a sample size of one. As previously discussed, many of the other drivers such as growth opportunities, feeling valued, and the work environment are dependent upon or at the very minimum influenced by the frontline manager. Although unable to prove strength of association, the data suggests a link between the frontline manager and engagement, one that was also found to be true in the literature. In addition to driving improvement or decline in engagement, a frontline manager’s influence can ultimately be seen in the metrics tied to engagement, such as patient satisfaction. Again, during the same measurement period (2013 to 2015), the hospital saw increases in all patient satisfaction HCAHPS domains including the global experience ratings of “likelihood to recommend” and “overall rating.” Unit A followed this pattern and experienced even greater gains than the hospital overall. In contrast, Unit B experienced decreases in five out of eight domains in addition to declines in their overall experience ratings (see figure 5). This suggests a relationship between engagement and patient satisfaction, and that a frontline manager can influence organizational outcomes through his/her impact on engagement. Figure 5. Change in HCAHPS Scores: 2013-2015In this case study, engagement appears to be related to perceived quality of care. As engagement declined in Unit B, so did nurses perceptions of care quality on the unit. Unit A, however, experienced positive gains in both measures. Perceived quality of care should not be overlooked, as studies have found that nurse and patient perception of quality of care typically follow similar patterns (Press Ganey, 2015b; Scotti et al., n.d.). For this reason, any decreases in the perception of care quality should be taken seriously (Press Ganey, 2015b). Turnover, the last organizational outcome, decreased in both units over the studied time frame. In this particular measure, we would have expected to see turnover increase on Unit B to reflect a decrease in engagement, so in this case study engagement and turnover did not follow the pattern found in the literature.The Job Enjoyment Scale, while not strictly an organizational outcome but reflective of the work setting, highlighted one of the most substantial differences between the two units. Unit B ranked around the 36th percentile in job enjoyment, while Unit A ranked around the 85th percentile. Press Ganey found that job enjoyment differs based on unit type, with pediatric units scoring highest and adult units scoring lowest (Ganey, 2015b). However, by looking at percentile scores we can compare the standing of the two units in job enjoyment. Staffing is an influential factor contributing to both job enjoyment and intent to stay (Press Ganey, 2015b). The unit directors can look at the effectiveness of staffing in order to improve the job enjoyment of nurses on their respective units. Table 10. Organizational Outcome Trends from 2013 to 2015Organizational OutcomeUnit AUnit BEngagement (PES)↑↓Perceived Quality of Care↑↓Job Enjoyment↑↓HCAHPS Overall Experience↑↓Turnover↓↓With regards to the MyVoice survey, the two units scored highest in the same domain, My Coworkers, and lowest in the same domain, My Business Unit, and had similar high and low scoring questions. The need to improve hospital leadership visibility and communication and the strength in coworker relationships were trends highlighted in two otherwise diverse units. The MyVoice survey data that were available did not indicate a substantial difference in domain scores between the units. However, these data includes all staff and not just nurses, and was administered in 2014. Since this was prior to the change in unit director on the units, there is reason to believe it cannot reliably be compared to engagement of nurses in the 2015 NDNQI survey. Although interesting patterns were found in this case study, it is important to note the limitations of the data. First, the PES is not specifically a measure of nursing engagement, although its questions are reflective of the drivers of engagement. Second, only two years of the NDNQI data were available, which made it difficult to draw any definitive conclusions. The limited number of data points could explain why in some circumstances the organizational outcomes did not relate with engagement as expected. The author also compared two diverse units, whose different patient populations have dissimilar acuity of illness and average lengths of stay. Additionally, the engagement data used to describe trends was focused on nurses, where in reality the engagement of all employees (physicians, housekeepers, PCTs, etc.) influences patient outcomes and experience. recommendationsTo provide context for the author’s recommendations it should be noted that Magee-Womens has taken actions to enhance employee engagement. Magee-Womens measures engagement using comprehensive engagement surveys (MyVoice and NDNQI), demonstrating a commitment by hospital leadership to measure and improve the engagement of staff. Engagement was measured on a work unit level, which allows each unit to tailor their engagement plan to local circumstances (Press Ganey, 2016). Hospital leadership also responded quickly to the MyVoice survey results and created many new engagement initiatives to target low scoring areas, hospital-wide, many of which focused on leadership visibility, communication, and trust. Magee-Womens and the Human Resources department were also notably transparent with hospital MyVoice survey results, posted them online, and indicated how the hospital would address low scoring areas. Similar actions were done with the NDNQI nursing satisfaction survey. Nursing leadership followed up with the nurse manager of every unit to discuss results, and each manager was expected to create a work improvement plan. A further strength of Magee-Womens is hiring motivated and team-oriented individuals, indicated through high scores in the “My Coworkers” section of the MyVoice survey. Magee-Womens also recently began using a values-based hiring technique, which is another way to intentionally select employees that will positively contribute to the culture. Recommendations based on the author’s findings for both units and Magee-Womens Hospital are as follows: Recognize the role of the manager in engagement and provide manager training in this area. This case study demonstrated the impact that managers can have on engagement, both positively and negatively. A good manager can improve engagement and consequently other metrics tied to engagement, like quality of care and patient satisfaction. Managers at Magee-Womens need to understand their important role in driving engagement and have adequate training, knowledge, and tools to succeed. In order to keep managers accountable, engagement metrics should be tied to their goals and tracked and measured to show progress (The Advisory Board Company, 2014).Each unit must determine the most critical drivers of engagement and target lowest scoring areas for improvement. The lowest scores in Unit A were Collegial Nurse-Physician Relationships, and in Unit B it was Nurse Manger Ability, Leadership, and Support of Nurses. These indicate problem areas which can help focus action for improvement. More frequent measurement of engagement is desirable. The results from the NDNQI survey prove much can change over a two-year period. Taking a pulse on engagement more frequently would be beneficial so that corrective action can be taken. Gather input from employees. Not only does this make employees feel valued, one of the key drivers of engagement, but employees also are reliable sources of insight into the needs and expectations of the customer. Managers “must acknowledge this truth and survey the opinions of frontline providers” (Scotti et al., n.d.). Engage employees in developing their own engagement. Engagement cannot be solely the responsibility of management; it is a two-way street. Employees must be encouraged to take an active role in their engagement. Stay focused on the drivers of engagement. Managers must balance many competing priorities, which makes this recommendation easier said than done. However, by focusing on actions that are proven to engage employees, it will ultimately lead to better organizational outcomes on the unit and health outcomes for the patient—and it can be argued that nothing should have higher priority. Public Health RelevanceIt is important to look at the public health significance of employee engagement. By creating highly engaged employees, we know from the literature and from this case study that there will be a positive impact on the patient experience. Even more significant than that, it should lead to better clinical outcomes for patients in the form of reduced mortality, fewer adverse safety events, and higher quality of care. Thus, not only is employee engagement a strategically sound choice for organizations, it is in the best interest of the community as well. Employee engagement and its effects on patient care will help health care organizations achieve their goal to improve health while striving towards the national triple aim: improve the patients experience of care, reduce costs of care, and improve the health of populations. ConclusionThis paper has reviewed the major benefits of employee engagement, which range from improved financial performance to the improved health of the community served. Some of the more direct organizational outcomes are seen more clearly when analyzed in the case study at Magee-Womens Hospital of UPMC. In particular, this case study highlighted the role of the frontline manager, which cannot be underestimated when organizations make employee engagement a strategic goal. Frontline managers must be held accountable for the engagement of their direct reports and also be supported in their endeavors to improve engagement. Although engagement is not something that can or will change overnight, it is well worth the effort. Engaged employees will put forth the discretionary effort that helps an organization achieve its most vital goals. Finally, as health care reform brings value to the forefront, organizations will turn their focus on their employees, the people who must create that value for patients. Engagement will lead to an energetic and passionate workforce, healthy patients, and an organization well positioned for a viable future. : EMPLOYEE ENGAGEMENT INITIATIVES AT MAGEE-WOMENSLeadership Visibility & Communication Leadership Rounding and the eRound app: UPMC’s Leadership Rounding program promotes staff engagement and the sharing of ideas. The introduction of UPMC’s eRound app provides a web-based, real-time tool to help guide leaders on patient and staff rounding. Executive Leadership Q&A Sessions: Held annually at every business unit, these question-and-answer sessions with executive leadership give staff the opportunity to hear about essential issues facing UPMC and ask questions about current topics. Chats: Many leaders are now offering online chat sessions with staff in their business units or divisions. The online chats offer an opportunity for staff to ask questions on any topic of importance to them.You Asked We Answered: Many business unit leadership teams now have an online forum to ask questions. Staff can email a questions, the team researches the answer, and then it is posted on Infonet for all staff to read. 52 for You: The online tool consists of 52 weeks of effective leadership tips that help managers foster a culture based upon the UPMC core values. Breakfast with Magee Leadership: During the one-year employment anniversary month, employees are invited to join Magee Leadership for breakfast to discuss community, system-wide and Magee updates, ask questions, offer feedback, and meet other employees. Daily Extra: To help eliminate email overload and information coming from multiple sources, local and system wide news and information is now consolidated into one daily news email for staff. Employee Recognition Above and Beyond: Above and beyond recipients can be nominated by patients and their families, staff members, physicians, and visitors. Nominees should reflect UPMC’s core values. ACES: Award for Commitment and Excellence in Service (ACES) honors staff who exemplify UPMC’s five core values and exceed a high level of service. Each year, fewer than 1 percent of UPMC staff from across the health system receive this honor. Daisy award: The DAISY award is a nationwide program that rewards and celebrates the extraordinary clinical skills and compassionate care given by nurses. Patients, visitors, nurses, physicians, employees may nominate a nurse by filling out a Daisy nomination form and submitting it to the Professional Practice Counsel. Good Catch Award Program: A good catch occurs anytime a potential safety-related incident or event is avoided. Unit managers, individual employees, or A Just Culture committee representatives notify our patient safety officer, and the managers then presents the employee with a handwritten card of gratitude and a Garden View Café money gift card. The employees name is also listed and shared publicly on hospital screensavers, as well as the Nursing Caring Times publication and the “Safety at Magee” website. Employee Participation and TrainingCulture of Service Excellence education: The Culture of Service Excellence is a system-wide service standards initiative. Education sessions focus on skills and resources for living out the UPMC values, including the CARE+ standards of service and service recovery model. Employee Engagement Committee: The employee engagement committee was formed to be the main focus group for conveying the ideas, thoughts and suggestions of employees at Magee-Womens Hospital. Each department is allowed to have a representative attend each session to be the voice for that specific department. Human Resource representatives and selective leaders of the committee also attend. Human Resource InitiativesHiring for Values: During the application process, all candidates now complete an assessment specific to UPMC’s values. Values Added to Performance Reviews: Values are now 50 percent of every employee’s evaluation. : UPMC ENGAGEMENT SPECTRUM CATEGORIES: 2015 NDNQI RN PRACTICE ENVIRONMENT SCALEPractice Environment Scale For each item, please indicate the extent to which you agree that the item is PRESENT IN YOUR CURRENT JOB. Response options: strongly agree, agree, disagree, strongly disagree. Nurse Participation in Hospital Affairs 1. Career development/clinical ladder opportunity.?2. Opportunity for staff nurses to participate in policy decisions.?3. A chief nursing officer which is highly visible and accessible to staff.?4. A chief nursing officer equal in power and authority to other top-level hospital executives. 5. Opportunities for advancement.?6. Administration that listens and responds to employee concerns.?7. Staff nurses are involved in the internal governance of the hospital (e.g., practice and policy committees).?8. Staff nurses have the opportunity to serve on hospital and nursing committees. 9. Nursing administrators consult with staff on daily problems and procedures. Nursing Foundations for Quality of Care 1. Active staff development or continuing education programs for nurses.?2. High standards of nursing care are expected by the administration.?3. A clear philosophy of nursing that pervades the patient care environment.?4. Working with nurses who are clinically competent.?5. An active quality assurance program.?6. A preceptor program for newly hired RNs.?7. Nursing care is based on a nursing, rather than a medical, model.?8. Written, up-to-date nursing care plans for all patients.?9. Patient care assignments that foster continuity of care, i.e., the same nurse cares for the patient from one day to the next. 10. Use of nursing diagnoses. Nurse Manager Ability, Leadership, and Support of Nurses 1. A supervisory staff that is supportive of the nurses.?2. Supervisors use mistakes as learning opportunities, not criticism.?3. A nurse manager who is a good manager and leader.?4. Praise and recognition for a job well done.?5. A nurse manager who backs up the nursing staff in decision-making, even if the conflict is with a physician. Staffing and Resource Adequacy 1. Adequate support services allow me to spend time with my patients.?2. Enough time and opportunity to discuss patient care problems with other nurses. 3. Enough registered nurses to provide quality patient care.?4. Enough staff to get the work done. Collegial Nurse-Physician Relations 1. Physicians and nurses have good working relationships.?2. A lot of team work between nurses and physicians.?3. Collaboration (joint practice) between nurses and physicians. bibliographyBerrett, B., & Spiegelman, P. (2013). Patients come second: Leading change by changing the way you lead. New York: Inc. Blizzard, R. (2004, March 9). Engagement vs. Satisfaction Among Hospital Teams. Retrieved from , Rick (2003, June 17) Engagement Unlocks Patient Satisfaction Potential. Gallup. , M., & Watson, T. (2011). Perspectives: Employee Engagement and the Transformation of the Health Care Industry. Retrieved February 27, 2016, Retrieved from Strategies Media/Avatar HR Solutions. (2016) Best Practices in Assessing Employee Engagement. Retrieved from , Ryan. (2014, Nov 17) A Primer on Measuring Employee Engagement. Harvard Business Review. , J. K., Schmidt, F. L., Agrawal, S., & Plowman, S. K. (2014, September 22). The Relationship Between Engagement at Work and Organizational Outcomes. Retrieved from Source Blog, editorial staff. (2014, Jan. 19) Employee Engagement Drives Quality Patient Care. Retrieved from , J. L., Jones, T. O., Loveman, G. W., Sasse, W. E., Jr., & Schlesinger, L. A. (July-August 2008). Putting The Service Profit Chain to Work. Harvard Business Review. Retrieved from , CB. (2008) Revisiting nurse turnover costs: adjusting for inflation. Journal of Nursing Administration, 38 (1), 11-8. Krause, Kevin. (2015, Feb 26) The ROI of Employee Engagement in Hospitals. Retrieved from , E. (2002). Development of the Practice Environment Scale of the Nursing Work Index. Research in Nursing and Health, 25 (3), 176-188. Looking Ahead: 2015 Workforce Engagement. (n.d.). Retrieved February 26, 2016. Retrieved from , G. (2012). How Employee Engagement Matters for Hospital Performance. Healthcare Quarterly, 15(2), 29-39.Press Ganey (2015, Jul 15) Every Voice Matters: The Bottom Line on Employee and Physician Engagement. Retrieved from Ganey (2016, Jan 16). Building A High-Performing Workforce. Retrieved from Scotti, D. J., Harmon, J., & Behson, S. J. (n.d.). Links Among High Performance Work Environment, Service Quality, and Customer Satisfaction: An Extension to the Health Care Sector. Journal of Healthcare Management, 52(2), 109.Sherwood, Rick. (2013, Oct 30). Employee Engagement Drives Health Care Quality and Financial Returns. Harvard Business Review. Retrieved from Advisory Board Company. (2014). Looking Ahead: 2015 Hospital Workforce Engagement [PowerPoint Slides]. Retrieved from . (2016). Magee-Womens Hospital of UPMC. Retrieved from . (2016). MyVoice in Action: Listening. Retrieved from UPMC Infonet. U.S. News & World Report LP. (2016). Magee-Womens Hospital of UPMC. Retrieved from ................
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