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How Employee Engagement Matters for Hospital Performance

  • The Graham Lowe Group Inc.

Abstract and Figures

Managers increasingly understand that employee engagement is a prerequisite for high performance. This article examines how job, work environment, management and organizational factors influence levels of engagement among healthcare employees. Original data come from the Ontario Hospital Association-NRC Picker Employee Experience Survey, involving over 10,000 employees in 16 Ontario hospitals. The article provides a clear definition and measure of engagement relevant to healthcare. In addition to identifying the main drivers of engagement, findings shows that a high level of employee engagement is related to retention, patient-centred care, patient safety culture and employees' positive assessments of the quality of care or services provided by their team. Implications of these findings for healthcare leaders are briefly considered.
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Healthcare Quarterly Vol.15 No.2 2012 29
Managers increasingly understand that employee engage-
ment is a prerequisite for high performance. This article
examines how job, work environment, management and
organizational factors influence levels of engagement among
healthcare employees. Original data come from the Ontario
Hospital Association–NRC Picker Employee Experience
Survey, involving over 10,000 employees in 16 Ontario hospi-
tals. The article provides a clear definition and measure of
engagement relevant to healthcare. In addition to identifying
the main drivers of engagement, findings shows that a high
level of employee engagement is related to retention, patient-
centred care, patient safety culture and employees’ positive
assessments of the quality of care or services provided by
their team. Implications of these findings for healthcare
leaders are briefly considered.
Engaged employees are essential to the success of any
organization. Increasingly, healthcare employers are
taking steps to strengthen this people-performance
link. While many studies have looked at the job satis-
faction of healthcare employees, we know far less about how the
broader concept of engagement applies to healthcare settings.
Furthermore, a lack of good data on employee engagement in
Canadian healthcare organizations has made it difficult to use
the concept as a workplace improvement tool, which has been
the case in other industries.
This article fills these gaps. Using results from the first wave
of the Ontario Hospital Association (OHA)–NRC Picker
Employee Experience Survey (EES), involving over 10,000
employees in 16 Ontario hospitals, this article does three things:
(1) provides a clear definition and measure of engagement;
(2) examines the main work environment drivers of engage-
ment; and (3) documents the relationship between levels of
employee engagement and critical organizational outcomes.
The Quality Healthcare Workplace
High-performing organizations have healthy and engaged
employees. Their work environments are designed to enable the
development and utilization of the “people capacity” required
for success. Critically important in this regard is a culture that
values employees, leadership commitment to the organization’s
people-development goals and support systems that enable
people to excel in their jobs (Lowe 2010).
These ideas have taken root in healthcare and are evolving.
A decade ago, the focus was on creating healthier workplaces.
For example, the US Joint Commission on the Accreditation
of Healthcare Organizations linked high-quality care and
healthy workplaces in this way: “A healthy workplace is one
where workers will be able to deliver higher-quality care and
one in which worker health and patients’ care quality are
mutually supportive. That is, the physical and emotional health
of workers fosters quality care, and vice versa, being able to
deliver high-quality care fosters worker health” (Eisenberg et
How Employee Engagement Matters
for Hospital Performance
Graham Lowe
30 Healthcare Quarterly Vol.15 No.2 2012
al. 2001: 447). Now, experts and practitioners are calling for
a comprehensive, strategically focused approach to measuring
and reporting the quality of healthcare work environments. (See
Healthcare Papers 10[3], published in 2010; the issue focuses on
using common work environment metrics to improve perfor-
mance in healthcare organizations.) This is a big step beyond
workplace health promotion programs, integrating employee
well-being within a comprehensive framework for improving
the quality of healthcare.
We also are learning more about the positive relationship
between staff satisfaction and patient satisfaction, echoing private
sector research showing strong correlations between employee
engagement scores and customer experiences (Harmon and
Behson 2007; Heskett et al. 2008). Recent studies in health-
care indicate that managers can improve patient care experiences
by improving employee satisfaction and retention (Collins et
al. 2008; Michie and West 2004; Rondeau and Wagar 2006;
Sikorska-Simmons 2006). Research conducted in England’s
National Health Service documents how hospitals with higher
levels of staff engagement provide higher-quality services and
have better financial performance (West et al. 2011).
To support this new direction in evidence-based human
resource practices, OHA recently created the Quality Healthcare
Workplace Model (Figure 1). The model outlines how health
system performance depends on a capable workforce in healthy
and productive workplaces. The OHA’s model suggests that the
quality of the work environment for staff and physicians is a
key determinant of a high-performing healthcare organization.
By integrating healthy workplace, human resources, quality and
patient safety goals within a performance-focused framework,
the model offers a useful guide to research and practice. At the
centre of the model is employee engagement.
Study Background
The development of the EES was guided by the model in Figure
1. The 95-item questionnaire assesses the drivers, individual
outcomes and organizational outcomes specified in the model.
(For further information, see OHA’s OHA-NRC Picker Employee
and Physician Experience Surveys Backgrounder.) A companion
survey for physicians was also developed but is not our focus
in this article. NRC Picker Canada was
a partner in the development of both
surveys. Some of the work environment,
patient safety and patient care items were
adapted from earlier NRC Picker surveys.
I acted as the project consultant.
The first wave of OHA members to
use the EES did so in late 2010 and early
2011. The total sample analyzed here
consists of 10,702 employees from 16
facilities. Table 1 shows that response rates
vary across peer groups, ranging between
45 and 60%. The overall sample response
rate is 46%, which is acceptable for an
employee survey (Baruch and Holtom
2008). (In studies published in peer-
reviewed academic journals, the average
response rate for employee surveys within
organizations is 53%.) The sample
composition reflects a concentration of
employees in community hospitals (43%
of the total sample) and teaching hospi-
tals (30% of total). The nine facilities in
the two other peer groups account for
27% of all respondents.
Looking briefly at respondents’ charac-
teristics, most have been in their current
job and with their employer for six years or
longer. More than two thirds are full-time
employees; the same proportion are union
members. A small percentage (6%) is in
Ontario Hospital Association Quality Healthcare Workplace Model
Enabling context: strong values - compelling vision - clear mission - committed leadership
Engaged and
capable employees
and physicians
Quality and
patient safety
and employer
Employee and
physician health,
safety and quality
of work-life
and costs
Source: Reproduced with permission from the Ontario Hospital Association.
How Employee Engagement Matters for Hospital Performance Graham Lowe
Healthcare Quarterly Vol.15 No.2 2012 31
Graham Lowe How Employee Engagement Matters for Hospital Performance
temporary, per-diem or standby arrangements. About one in five
have management responsibilities. And two thirds have frequent
patient contact. Most (86%) respondents are female, and there
is a good representation of older and younger employees (9% are
under the age of 30 years, 18% are between the ages of 30 and 39,
31% are 40–49, 34% are 50–59 and 8% are 60 years and older).
How Employees Experience Their Work
The EES asks employees to assess 36 features of their job,
training and development opportunities, their team, their super-
visor, senior management and how the organization supports its
employees. These factors are on the left side of the OHA model
(see Figure 1). Logically, they can be considered upstream influ-
ences on – or “drivers” of – employee engagement.
Presented in Table 2 are the percentage of positive answers
to each of the evaluative items (combining responses of four
and five on five-point response scales). Items receiving positive
ratings of 60% or higher are called “strengths,” and items with
positive scores of 40% or less are labelled “improvement priori-
ties” (each is colour coded in Table 2). These cut points are
based on results for the entire sample; individual organizations
are encouraged to use this approach to interpret their own
employee survey results and plan follow-up actions.
A quick look at Table 2 reveals that the responses are most
positive regarding aspects of respondents’ team or work unit. It
is notable that 70% or more of respondents positively rate their
team as working well together, welcoming people from diverse
backgrounds and being respectful and supportive of each other.
Supervisors also receive a positive rating for fair treatment of
employees. And senior managers are widely seen to be committed
to high-quality care and to improving workplace safety.
The items with the lowest positive ratings identify opportuni-
ties for improvement. Beginning with teams, this general area
of strength received low positive ratings on two measures of
workload: the percentage of respondents disagreeing or strongly
disagreeing with the statement, “We work in ‘crisis mode’ trying
to do too much, too quickly,” and the percentage agreeing or
strongly agreeing with the statement, “We have enough staff to
handle the workload.” None of the supervisory ratings fall at or
below 40% positive. However, one senior management behaviour
– acting on staff feedback – receives only a 31% positive rating.
The lowest ratings are on two dimensions: training and devel-
opment, and job characteristics. Career development opportu-
nities receives the lowest positive rating (17%) of any of the 36
items being considered here. Furthermore, only one in three
respondents positively rate the opportunities they have to make
improvements in how their work is done, or to receive education
and training. In terms of job characteristics, there is consider-
able room for improvement in three areas: recognition, work-life
balance and flexibility in hours and schedules. Lack of time and
other resources to do one’s work also receive low positive ratings.
Employee Engagement
A high level of engagement is a strategic goal for a growing
number of organizations in many industries, including health-
care. Engaged employees are committed to their employer, satis-
fied with their work and willing to give extra effort to achieve
the organization’s goals. Evidence suggests that engagement
influences other major human resources goals, such as reten-
tion, job performance, absenteeism and (indirectly through the
employer’s reputation) recruitment (Gibbons and Schutt 2010;
Macey and Schneider 2008).
Human resources experts prefer a multi-dimensional
approach to measuring engagement. This combines a number
of questionnaire items into a scale, yielding a single engagement
score. The resulting composite engagement metric can be useful
to employers for tracking progress on actions taken to improve
employee engagement. Employee engagement scales typically
combine job satisfaction, organizational commitment and other
performance-related indicators of a motivated employee.
Sample characteristics by peer group
Peer Group Number of
Respondents Response Rate (%)
Percentage of
Total Sample
Community hospitals (n = 5) 4,613 45 43
Teaching hospitals (n = 2) 3,260 45 30
Non-acute facilities: complex continuing care, rehabilitation and
mental health, community health centres (n = 5)
1,986 49 19
Small hospitals (n = 4) 843 54 8
Total (n = 16) 10,702 46 100
32 Healthcare Quarterly Vol.15 No.2 2012
Respondents’ positive ratings of work environment dimensions
Dimension Questionnaire Item
Responses* (%)
Job characteristics Able to decide how to do work 55.3
Have clear job goals/objectives 51.2
Flexibility in schedule/work hours 38.4
Balance of family/personal life with work 35.2
Have adequate resources/equipment to do work 30.3
Have time to carry out all your work 22.8
Get recognition for good work 22.0
Training and development Opportunity to use skills 51.3
Opportunity to take initiative 45.4
Opportunity to make improvements in how your work is done 34.1
Opportunity to receive education/training 30.7
Opportunity to advance in career 17.0
Work team We work together and help each other out 76.1
People from diverse backgrounds feel welcome 74.6
We treat each other with respect 71.3
We support one another 70.1
Feel I belong to a team 69.0
Able to make suggestions to improve work of unit/team 63.7
We collaborate well with other teams/units 54.9
Communication is open/honest 49.2
Consulted about changes that effect unit/team 42.3
We have enough staff to handle workload 30.9
We work in crisis mode (disagree) 24.0
Immediate supervisor Supervisor treats you fairly 67.4
Supervisor can be counted on to help with difficult tasks 55.4
Supervisor helps access training/development 50.6
Supervisor provides feedback on job performance 46.6
How Employee Engagement Matters for Hospital Performance Graham Lowe
Healthcare Quarterly Vol.15 No.2 2012 33
Measuring Engagement
The use of a multi-item scale score can streamline survey follow-
up and support a more detailed statistical analysis of results,
especially testing predictive models that show the “net” impact
of specific drivers on engagement. Standard social science
practices were followed in constructing the EES engagement
scale. Scale items were selected based on frequency distribu-
tions, correlations, face and construct validity considerations
and factor analysis. (Factor loadings for the six items range
between .77 and .89 [i.e., these items measure the same under-
lying concept – engagement] and Cronbach’s reliability a is .92.
The engagement scale has a range of six to 29 [five items are
measured on five-point “disagree-agree” scales, and one item
is measured using a four-point scale], a mean of 20.4 and a
standard deviation of 5.2.) The resulting engagement scale has
high internal reliability (tested using Cronbach’s a, a statistic
with a range of zero to one, with closer to one being better).
The six items in the engagement scale measure the key
dimensions researchers have identified as being central to the
concept of employee engagement (Gibbons and Schutt 2010).
Specifically, the engagement scale developed for the EES
measures three dimensions of engagement:
• Emotional: I am proud to tell others I am part of the organi-
zation. I find that my values and the organization’s values
are similar.
• Rational: I am satisfied with (my) job overall. Overall rating
of the hospital as a place to work (from poor to excellent).
• Behavioural: I look forward to going to work. This organiza-
tion really inspires the best in me in the way of job perfor-
This scale provides a robust and comprehensive measure of
employee engagement, captured in a single metric.
Identifying High-, Medium- and Low-Engagement
To simplify further analysis and reporting, engagement scale
scores were grouped into low, medium and high categories, based
on the distribution of scale scores. The high-engagement group
consists of individuals who responded four or five on the five-
point items and three or four on the one four-point item (their
score was 23 or higher out of 29). The medium-engagement
group had scale scores between 19 and 22 (note that the overall
scale mean is 20.3 and the median is 21, both falling within this
group). The low-engagement group scored 18 or lower.
Consistent with the distribution of engagement scores,
which is skewed slightly toward the low end of the scale, 33%
(n = 3,323) of all respondents are in the low category, while 39%
(n = 3,958) are in the medium- and 29% (n = 2,925) are in the
high-engagement categories, respectively.
Dimension Questionnaire Item
Responses* (%)
Senior management Senior management is committed to high-quality care 62.3
Senior management is committed to improving workplace safety 62.0
Senior management communicates clearly with staff regarding goals 48.9
Senior management acts on staff feedback 30.7
Organization I understand the goals of this organization 67.3
Organization provides a clean work environment 60.4
Organization promotes staff health/wellness 52.3
Organization values my work 46.1
I feel that I can trust this organization 37.3
*Combines responses of 4 and 5 on a 5-point scale, where 1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree and 5 = strongly agree. Green shading indicates strengths
(60% positive or more); blue shading indicates improvement priorities (40% positive or less).
Numbers of respondents for items vary between 10,177 and 10,596 due to missing data.
Graham Lowe How Employee Engagement Matters for Hospital Performance
34 Healthcare Quarterly Vol.15 No.2 2012
Basic Variations in Engagement
A higher percentage of high-engagement employees work in
non-acute facilities (i.e., community health centres, continuing
care, rehabilitation and mental health facilities) compared with
other peer groups. Furthermore, small hospitals have a slightly
higher percentage of fully engaged employees, compared with
teaching hospitals and community hospitals. These differences
underline the need to develop peer group benchmarks for
tracking employee engagement and other key workplace metrics.
Variations in peer group engagement levels may, however,
reflect differences in staff composition, the populations being
served, organizational contexts or other factors. Thus, it is
important to compare the organizations within peer groups to
gain a fuller understanding of the range of factors influencing
engagement. For example, additional analysis revealed more
variation among the five organizations within the community
hospital peer group than among the peer groups as a whole.
The same is true for the four small hospitals in that peer group.
Furthermore, highly engaged employees are more likely to be
found in certain demographic or employee groups. While there
are no significant gender differences in engagement levels, there
are interesting differences among age groups. Survey respond-
ents under age 30 years and those 60 years and older are more
likely to be highly engaged than their coworkers between the
ages of 30 and 59 years.
There also is a “newness effect,” with new recruits to the
organization and continuing employees who recently moved
into another position experiencing an initially heightened
sense of engagement. However, this newness effect wears off by
the five-year mark. The biggest drop in engagement happens
between a new hire’s first and second year with the organization,
signalling a problem that orientation programs must address.
The same is true for ongoing employees settling into a new
position. Indeed, 42% of respondents who have been in their
job less than one year are in the high-engagement group. This
drops to 34% for those who have been in their job one to two
years and declines further, to 30%, in years three to five.
Also notable is that engagement levels are slightly higher
among part-time employees and those employed other than in
full-time positions. Temporary, per-diem and on-call workers
also report slightly higher engagement levels. Both these findings
raise some interesting questions about the role that employment
flexibility and length of work hours may play in engagement.
Finally, survey respondents who are not union members are
slightly more engaged than their unionized counterparts. And
employees with managerial responsibilities also are somewhat
more engaged, compared with non-managerial employees (these
are overlapping groups).
We cannot read too much into these findings. After all, we
are looking at the relationship between each demographic or
employment characteristic and engagement in isolation from
other possible influences. Many factors, particularly the work
experiences discussed in the previous section, may also be
important. To illustrate, new recruits (who also are likely to be
young) may initially receive adequate training and career devel-
opment and get regular recognition for their work – three work
environment features that generally receive low ratings. So these
initial job experiences, not seniority, would explain the higher
engagement levels of new recruits. The next section sheds light
on the factors that influence engagement.
Drivers of Engagement
The variations in engagement scores just discussed raise further
questions about what job, work environment, management and
other organizational factors influence engagement. The EES can
provide answers.
Top-10 Engagement Drivers
Regression analysis was used to identify “net impacts” on
engagement scale scores. (The multivariate statistical analysis
reported in this section uses linear regression models that do
not determine “causation” but, rather, can measure how much
of the variation in the engagement score is explained by each
factor [measured by a questionnaire item], after taking into
account all other factors included in the regression model. So
the term net impact is a non-technical way of describing the
explanatory power of a particular variable on an outcome, in
this case engagement, after having taken into account the influ-
ence of all other variables in the model on that outcome.) This
statistical modelling finds that most (over 70%) of the varia-
tion in engagement scores among all survey respondents can be
accounted for by 10 questionnaire items. Here are the top-10
work environment drivers of engagement, rank ordered by their
net influence on engagement scores:
1. I feel I can trust this organization.
2. I have an opportunity to make improvements in work.
3. The organization values my work.
4. Senior management is committed to high-quality care.
5. I have clear job goals/objectives.
6. I feel I belong to a team.
7. My organization promotes staff health/wellness.
8. I have a good balance of family/personal life with work.
9. My supervisor can be counted on to help with difficult tasks.
10. I have adequate resources/equipment to do my work.
Two points should be kept in mind when considering
the top-10 engagement drivers. First, the regression analysis
included 36 EES items assessing jobs, training and develop-
ment opportunities, work team, immediate supervisor, senior
management and organizational supports. Second, the analysis
also took into account the possible influences on engagement of
How Employee Engagement Matters for Hospital Performance Graham Lowe
Healthcare Quarterly Vol.15 No.2 2012 35
peer group, as well as
the demographic and
employment charac-
teristics shown, in
our earlier discus-
sion, to be related to
One could
argue that trust
is an outcome of
these other work
experiences and, as
such, should not
be included in the
multivariate analysis
as a potential driver
of engagement. Trust
is a complex property
of organizational life,
being both a cause
and effect of work
experiences and
performance. After
removing trust from the regression model, the list of top-10
drivers of engagement remains largely the same, with only two
minor changes. First, the rank ordering shifts slightly: the top
three factors are (1) the organization values my work, (2) senior
management is committed to high-quality care and (3) I have
clear job goals/objectives. And, second, while the role of super-
visors remains important, “My supervisor can be counted on to
help with difficult tasks” is replaced by “My supervisor treats
me fairly.”
Other Influences on Engagement
Beyond the top-10 engagement drivers, other work environment
factors influence engagement scores. Employees’ assessments
of the following work environment factors had a statistically
significant influence on engagement scores, albeit less so than
the top-10 factors:
• Ihavetheopportunitytousemyskills.
• Iunderstandthegoalsofthisorganization.
• Iamabletodecidehowtodowork.
• Wehaveenoughstafftohandleworkload.
• Mysupervisortreatsmefairly.
• Ihaveanopportunitytoreceiveeducation/training.
• Myunitorteamdoesnotworkincrisismode.
• Myunitorteammemberstreateachotherwithrespect.
• Ihavetheopportunityforcareeradvancement.
• Seniormanagementcommunicateswithstaffaboutwhat
they are trying to achieve.
The newness effect on engagement, discussed earlier, disap-
pears when a broad range of work environment factors is taken
into account. Facility type (being employed in a teaching
hospital) and employment status (part-time or “other” employ-
ment status, being temporary/per diem or standby and not
being a union member) have very small positive effects on
engagement. Each of these factors explains less than 1% of the
variation in engagement scores.
Engagement and Key Outcomes
The OHA Quality Healthcare Workplace Model suggests that
more-engaged employees are better able than their less-engaged
colleagues to achieve organizational goals. This section provides
empirical confirmation that this indeed is the case, focusing
on four outcomes: retention, quality of patient care or services
provided by the respondent’s team/unit, patient safety culture
and patient-centred care.
One of the major human resource goals of any healthcare organi-
zation is to retain competent staff. Turnover is costly. It is widely
assumed that more-engaged employees stay and contribute. As
Figure 2 shows, this is the case among EES respondents. While
close to half of disengaged employees will be job hunting in the
next 12 months, only one in 10 of those who are highly engaged
will be looking for a new job with a different employer. In other
words, 90% of highly engaged employees plan to stay with the
organization, at least for the near future.
Retention by level of engagement
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Level of Engagement
Unlikely to look for a new job in next 12 months Likely to look for a new job in next 12 months
n = 10,053. Group differences are statistically significant (p < .001).
Graham Lowe How Employee Engagement Matters for Hospital Performance
36 Healthcare Quarterly Vol.15 No.2 2012
Work Unit Service Quality
Increasingly, healthcare organizations are using a variety of
tools to assess the quality of patient care and of the non-clinical
services provided. These tools range from wait times and hospital
readmissions to patient satisfaction surveys, awards for service
quality and informal client feedback. The EES provides another
equally useful metric for assessing quality: employees’ percep-
tions of the quality of patient care and other services provided
by their work unit.
Figures 3 and 4 document a clear pattern in patient care
and service quality. These results suggest that achieving higher
levels of employee engagement is part of the solution to quality
improvement. In both clinical and non-clinical units (based on
whether or not EES respondents have direct patient contact),
two thirds of highly engaged employees report that their work
units “always” provide top-quality service. This stands in
contrast to the low-engagement group, where only about one
in five believe that excellent quality service is always provided.
Patient-Centred Care
Creating and maintaining a patient-centred care environ-
ment has become a strategic goal for many hospitals. The EES
captures the main dimensions of a patient-centred care environ-
ment. Using the same statistical techniques described above to
create the EES, we constructed a multi-item Patient-Centred
Work Environment Scale (PCWE). (This six-item scale has a
range of six to 30, a mean of 21.2, a standard deviation of 4.8
and a Cronbach reliability a of .88, and factor loadings were
between .63 and .81.) The scale combines the following six
questionnaire items:
1. I support and involve family members when requested by the
2. I involve patients in decisions about their care.
3. I have the time I need to talk with my patients to make
sure they get the information they want about their medical
condition, treatment or tests.
4. I get timely information about my patients’ condition/treat-
5. I have the time and information to prepare patients for
leaving the hospital/program.
6. I treat patients as individuals with unique needs and prefer-
The scores for the PCWE were divided into quartiles,
making it easier to examine the relationship to engagement.
Figure 5 shows the percentage of employees in the three engage-
ment groups who
are in each of the
PCWE quartiles.
Employees in the
highest quartile have
the most positive
assessment of the
six items measuring
patient-centred work
environment. We
find a strong and
consistent relation-
ship between engage-
ment and assessments
of such an environ-
ment. Specifically,
46% of highly
engaged employees
have PCWE scores
in the top quartile.
By contrast, only
21% of disengaged
employees are in the
top PCWE quartile. Equally important, while 6% of highly
engaged employees fall into the lowest PCWE quartile, this rises
to 38% among the least-engaged employees.
Safety Culture
The EES also measured patient safety culture. These measures
are designed to inform improvements in patient safety, which is
a priority for the Canadian healthcare system. Applying the same
methodology as above, a six-item Patient Safety Culture (PSC)
Work unit provides top-quality patient care by level of engagement*
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Level of Engagement
Never/sometimes Usually Always
* Includes only respondents with frequent or occasional direct patient contact (n = 6,988). Group differences are statistically significant (p < .001).
How Employee Engagement Matters for Hospital Performance Graham Lowe
Healthcare Quarterly Vol.15 No.2 2012 37
scale was created.
(This six-item scale
has a range of six to
30, a mean of 20.6, a
standard deviation of
3.5 and a Cronbach
reliability a of .78,
and factor loadings
were between .53 and
.76.) The following
questionnaire items
make up this scale:
 Errors, near
misses and
incidents have
led to positive
changes here.
• After we make
changes to
improve patient
safety, we evaluate
their effectiveness.
• Weareinformed
about errors,
near misses and
• Myorganization
encourages us
to report errors,
near misses and
• Our procedures
and systems
are good at
preventing errors,
near misses and
incidents from
• Staffin myunit
are actively doing
things to improve
patient safety.
Figure 6 reports the results of the relationship between
engagement and PSC scores, using quartiles for the latter.
These results mirror what we saw in Figure 5 regarding a
patient-centred work environment. If anything, the relationship
between engagement and safety culture is even stronger, given
that 58% of highly engaged employees are in the top quartile of
PSC scores, while only 3% are in the lowest quartile.
This survey of hospital employees provides a unique opportu-
nity to explore the dynamics of employee engagement in health-
care. The results show a consistently strong relationship between
employee engagement and organizational performance, as
suggested in the OHA’s Quality Healthcare Workplace Model.
However, we should be careful not to infer causation. Further
analysis of EES and other employee survey data is required to
Work unit provides top-quality services by level of engagement*
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Level of Engagement
Never/sometimes Usually Always
*Includes only respondents with no direct patient contact (n = 1,983). Group differences are statistically significant (p < .001).
Patient-centred work environment scale scores (in quartiles) by level of engagement*
26.2% 21.1%
29.4% 28.3%
20.2% 45.6%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Level of Engagement
Lowest quartile 2nd quartile 3rd quartile Highest quartile
*Includes respondents with frequent or occasional patient contact (n = 6,949). Group differences are statistically significant (p < .001).
Graham Lowe How Employee Engagement Matters for Hospital Performance
38 Healthcare Quarterly Vol.15 No.2 2012
test the direction of causation in these relationships and how
they change over time. It is possible, for example, that being
part of a high-performing team is among the “causes” of high
engagement. Still, the results show that engagement levels are
positively and consistently related to a range of mission-critical
organizational outcomes in the 16 hospitals being studied.
While the study may not be fully representative of all Ontario
hospitals, it does provide insights that will be useful to Ontario
healthcare employers. The province’s Excellent Care for All Act
requires hospitals to measure, report and improve the work
environment as part of their overall quality improvement plan.
This study illustrates the types of employee survey measures
that can contribute to overall quality improvement initiatives.
And as more Ontario hospitals use the EES, its benchmarking
potential will grow. Also useful would be national benchmarks
of key outcome measures. This could include an engagement
scale score, such as the one used in this study, or a single-item
component of the engagement scale, such as job satisfaction
(Lowe and Chan 2010).
We now have an evidence-based definition of employee
engagement relevant to healthcare. Engaged employees have
strong emotional, rational and behavioural attachments to their
job and their organization. They experience pride, values congru-
ence, and job and organizational satisfaction, and they feel enthu-
siastic and inspired in their work. In short, the engaged employee
is the ideal employee. As the EES documents, engaged employees
benefit patients and reduce the workforce costs associated with
turnover. For healthcare leaders and policy makers, the overall
conclusion is that higher levels of employee engagement must
become a strategic
goal for all healthcare
Closing the
engagement gap must
be a priority. Indeed,
the fact that one
third of employees
surveyed have low
levels of engage-
ment poses a signifi-
cant risk to patient
care, internal service
quality and staffing
budgets. Reducing
the engagement gap
must become part
of risk management
by hospital boards
and executive teams.
Results from surveys
such as the EES can
help managers and employees to identify actions that will close
the gap between the lowest- and highest-scoring groups by
raising the lowest scores. In this study, the gap is wide, with
a spread of between 45 and 73 percentage points in positive
response levels on key drivers between the low-engagement and
high-engagement groups. At the organizational level, focused
and persistent efforts will be required to narrow this gap.
The EES results also highlight the importance of trust.
Indeed, the key to unlocking higher levels of engagement
is for managers at all levels to build trust with employees.
Demonstrating basic respect, fairness and integrity in all
dealings with staff is the basis for trust (Burchell and Robin
2011). Trust building is an incremental and ongoing process
that happens in every interaction and becomes engrained in
an organization’s culture. A prerequisite in this regard is open
communication. As well, culture becomes the vital link between
positive staff experiences and performance. Other studies show
that high-performance hospitals have distinctive cultures that
empower middle managers, champion pro-performance values
and clearly communicate a corporate vision that guides their
actions (Mannion et al. 2005).
The profile of the engaged employee emerging from this
study reinforces the importance of effective people practices
(Michie and West 2004). Any manager can carry out a simple
self-assessment by reflecting on how closely the organizations
employees fit this profile. Highly engaged employees not only
trust their employer, they also are able to improve how they
work, feel valued and have clear job goals and a sense of team
membership. They are able to perform effectively in their
Patient safety culture scale scores (in quartiles) by level of engagement*
38.6% 10.7%
33.8% 28.7%
17.5% 57.5%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Level of Engagement
Lowest quartile 2nd quartile 3rd quartile Highest quartile
*Includes respondents with frequent or occasional patient contact (n = 6,862). Group differences are statistically significant (p < .001).
How Employee Engagement Matters for Hospital Performance Graham Lowe
Healthcare Quarterly Vol.15 No.2 2012 39
job because they have a supportive supervisor and adequate
resources and equipment. Their quality of work life is enhanced
because the organization takes steps to promote staff wellness
and work-life balance. And they understand that senior manage-
ment is committed to high-quality care. None of these engage-
ment drivers requires costly new programs. If anything, they call
for a back-to-basics approach to how healthcare organizations
manage and motivate their employees.
I would like to thank OHA and NRC Picker Canada for making
available the data analyzed in this article. Useful comments on
earlier drafts were provided by Kimberley Burrows and Dana
Ross at the Ontario Hospital Association, as well as Heather
Dawson and Melanie Jameson at NRC Picker Canada.
Baruch, Y. and B.C. Holtom. 2008. “Survey Response Rate Levels and
Trends in Organizational Research.” Human Relations 61(8): 1139–60.
Burchell, M. and J. Robin. 2011. The Great Workplace: How to Build It,
How to Keep It, and Why It Matters. San Francisco: Jossey-Bass.
Collins, K.S., S.K. Collins, R. McKinnies and S. Jensen. 2008.
“Employee Satisfaction and Employee Retention: Catalysts to Patient
Satisfaction.” Health Care Manager 27: 245–51.
Eisenberg, J.M., C.C. Bowman and N.E. Foster. 2001. “Does a
Healthy Health Care Workplace Produce Higher-Quality Care?”
Journal of Quality Improvement 27: 444–57.
Gibbons, J. and R. Schutt. 2010. A Global Barometer for Measuring
Employee Engagement. (Research Working Group Report No. 1460-09-
RR). New York: Conference Board.
Harmon, J. and S.J. Behson. 2007. “Links among High-Performance
Work Environment, Service Quality, and Customer Satisfaction: An
Extension to the Healthcare Sector.” Journal of Healthcare Management
52: 109–24.
Heskett, J.L., W.E. Sasser and J. Wheeler. 2008. The Ownership
Quotient: Putting the Service Profit Chain to Work for Unbeatable
Competitive Advantage. Boston, MA: Harvard Business Press.
Lowe, G. 2010. Creating Healthy Organizations. How Vibrant
Workplaces Inspire Employees to Achieve Sustainable Success. Toronto,
ON: Rotman/UTP Publishing.
Lowe, G. and B. Chan. 2010. “Using Common Work Environment
Metrics to Improve Performance in Healthcare Organizations.”
Healthcare Papers 10(3): 43–47.
Macey, W.H. and B. Schneider. 2008. “The Meaning of Employee
Engagement.” Industrial and Organizational Psychology 1: 3–30.
Mannion, R., T.O. Davies and M.N. Marshall. 2005. “Cultural
Characteristics of ‘High’ and ‘Low’ Performing Hospitals.” Journal of
Health Organization and Management 19: 431–39.
Michie, S. and M.A. West. 2004. “Managing People and Performance:
An Evidence-Based Framework Applied to Health Service
Organizations.” International Journal of Management Reviews 5/6:
Sikorska-Simmons, E. 2006. “Linking Resident Satisfaction to Staff
Perceptions of the Work Environment in Assisted Living: A Multilevel
Analysis.” The Gerontologist 46: 590–98.
Rondeau, K.V. and T. Wagar. 2006. “Nurse and Resident Satisfaction
in Magnet Long-Term Care Organizations: Do High Involvement
Approaches Matter?” Journal of Nursing Management 14: 244–50.
West, M., J. Dawson, L. Admasachew and A. Topakas. 2011.
NHS Staff Management and Health Service Quality: Results from
the NHS Staff Survey and Related Data. Birmingham, England:
Aston Business School. Retrieved February 2, 2012. <http://
About the Author
Graham Lowe, PhD, is president of the Graham Lowe
Group Inc. (, a workplace consulting
firm based in Kelowna, British Columbia, and the author of
Creating Healthy Organizations (Rotman/UTP Publishing,
2010). He can be reached at
Graham Lowe How Employee Engagement Matters for Hospital Performance
... Similar little evidence has existed in the healthcare industry. Lowe(2012) has found that staffs in the health care industry have low evaluation of the level of slack resources of time, individual, and space in their institutions, while only 20%-40% of staff have believed that the resources have been su cient, which may have resulted in lower outcome output [43]. Han, et al. (2018) has proposed that hospitals in China should create a good resources support system for clinicians to strengthen the sense of belonging of staff, so that doctors are willing to engage in behaviors bene cial to the hospital, thereby improving individual performance [44]. ...
... Similar little evidence has existed in the healthcare industry. Lowe(2012) has found that staffs in the health care industry have low evaluation of the level of slack resources of time, individual, and space in their institutions, while only 20%-40% of staff have believed that the resources have been su cient, which may have resulted in lower outcome output [43]. Han, et al. (2018) has proposed that hospitals in China should create a good resources support system for clinicians to strengthen the sense of belonging of staff, so that doctors are willing to engage in behaviors bene cial to the hospital, thereby improving individual performance [44]. ...
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Background: The individual performance of clinicians is key to improving the output of the healthcare industry. Clinicians in Chinese public hospitals have an important functional position and face a complex and severe clinical practice environment. This study aims to explore the mechanism of slack resources in improving individual performance of clinicians and the effect of job satisfaction in this process. Methods: Based on the study framework composed of slack resources, individual performance, and job satisfaction, hypotheses have been put forward, and questionnaires have been distributed to representative clinicians in tertiary public hospitals. Finally, 318 valid data collected from clinicians have been obtained. To verify the four conditions of the mediation hypothesis, multiple linear regression models have been established to explore the relationship between variables. Results: Clinicians' job satisfaction has played a mediating role in the impact of slack resources and its three dimensions on individual performance. Among them, there has been a complete mediating effect for staff slack, while time and space dimensions have played a partial mediating role in the impact of slack resources on individual performance. Conclusions: In public hospitals in environments where behavior is subject to significant government interference, it is necessary and feasible to retain appropriate slack resources to improve individual performance. From the perspective of resources management in hospitals, it is necessary for public hospitals to implement a strategy of reserving an appropriate portion of time, staff and space in order to have the conditions to improve clinicians' satisfaction. The existence of slack resources in public hospitals can improve the job satisfaction of clinicians, and then improve the individual performance through the process.
... Extant research has reported positive relationships between coworkers' safety and workplace belongingness [204][205][206], willingness to embrace organizational change [207][208][209], job satisfaction [210,211], and creativity [95,212,213]. The difference between previous research and the current findings may reflect the unique conditions created by the COVID-19 pandemic. ...
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Resilient agility is a novel concept that refers to the combined resilience-agility capability that allows an actor to successfully perform in rapidly changing contexts. Change dynamics, at all levels, increase uncertainties and responsibilities for employees augmenting the need to strengthen the self via resilient agility. This study examines employee resilient agility as anteceded by supervisors’ safety, coworkers’ safety, workplace belongingness, job satisfaction, willingness to embrace organizational change, and creativity. Respondents are from multiple organizations, industries, and regions of the United States. Analyses were carried out utilizing PLS-SEM software. Findings indicate that supervisors’ safety, workplace belongingness, willingness to embrace organizational change, and creativity have substantial effects on explaining and understanding employees’ resilient agility. In contrast, the effects of coworkers’ safety were insignificant. This study (a) contributes to the nomological network of resilient agility by examining a set of its key antecedents and (b) suggests that drastic organizational restructuring (e.g., significant changes in the relative proportion of remote working during the COVID-19 pandemic) may negatively impact both relational-based constructs in organizations and employees’ ability to rapidly and effectively respond to change. Theoretical and practical implications as well as limitations and future research are discussed.
... Mongolian private and public organization's quality management level was higher than 61.4% compared to that in a Indian hospital [29]. Moreover, according to the previous study of a district healthcare center's performance assessment, the nurse's assessment was 64.4% and the doctor's assessment was 76% [30][31][32]. In addition, several studies also demonstrated that implementing the International Organization for Standardization (ISO) standard could increase staff job satisfaction. ...
... Feeling a sense of meaning and community at work, having an opportunity to make a contribution to their organisation and sharing an alignment of values will increase employee engagement (Markos and Sridevi, 2010). There has been an increasing effort to improve levels of staff engagement in the NHS in recent years through a greater understanding by leaders of its importance (Lowe, 2012;Dromey, 2014). ...
The provision of quality health care and standards of leadership in the National Health Service in England have been of concern for many years. To address falling standards and institutional failures external regulation of the service was introduced. However, despite the scrutiny of regulators, concerns regarding organisational culture, quality and leadership in the NHS prevail. Research in organisations that have improved their performance as evidenced by the health care quality regulator, Care Quality Commission, has mainly focussed on the organisational changes that have occurred. However, little has been studied as to whether organisational objectives go beyond delivering quality improvement and there is a lack of examination of the strategic leadership behaviour that underpins organisational performance improvement and resilience. Furthermore, there is little research into how the focus of organisational change may alter following a second inspection that demonstrates quality improvement, as evidenced by the Care Quality Commission. Thus it is unclear whether improvement is the result of corporate strategy that intends to deliver long-term, sustainable improvement, short to mid-term improvement to satisfy the regulator, or a mixture of both. This research set out to explore these issues. A multiple-case study design of two non-typical NHS Foundation Trusts were researched to identify the strategic leadership behaviours that enabled organisational performance improvement and underpinned the development of sustained organisational resilience. The research questions were explored through the multiple methods of interviews, secondary documents, non-participant observations and NHS Staff Survey data. Thematic analysis of interview data and analysis of documents were complemented by analysis of summary aggregated percentages of staff survey data. The research offers new insights into leadership behaviour that goes beyond a focus on quality improvement and presents a new theoretical framework regarding the development of organisational resilience. Five strategic leadership behaviours underpinned the development of sustained organisational resilience: responsible leadership, a values-led culture, being people-focussed, applying rigorous governance and a commitment to organisational learning. A new paradigm of leadership in the NHS is proposed, that of responsible leadership. This will benefit the health and social care sectors as they move into a model of integrated care.<br/
... PHCC dentist recently started to participate in student's placement and orientation program as part of partnership between PHCC and Qatar based educational organizations [8], they are also requested to engage in professional development programs and complete 35 -40 hours of work per week. From research, we know that health care organizations that managed to foster a culture of enhanced work environment and support of staff succeeded in adopting more patient-centered care and prevailed with quality improvement [9]; this study intends to investigate work engagement as a reverberation, of health and well-being of dentists and dental assistants in PHCC. ...
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Background: Work engagement is a positive, signicant, work-related mental state that involves enthusiasm, dedication, and attention, and it has been shown to have a direct impact on care quality. Employees who are more involved in their work, usually experience less job stress and anxiety than those who are not; increased levels of work engagement can improve dental team performance, job satisfaction, emotional wellness, and minimize the likelihood of turnover. to evaluate work engagement of PHCC dentists and dental assista Objective: nts in Qatar. Method: An electronic questionnaire was emailed to the whole population of PHCC (217) dentists and (192) dental assistants distributed over 27 health centers and obtained from Dentistry Department data base after securing approval. Study design: quantitative, correlational, and cross - sectional study using instruments reecting sociodemographic variables and Utrecht Work Engagement Scale (UWES) that consists of three constructs: vigor, dedication, and absorption (Schaufeli et al (2002)). Results: 187 out of 409 dentists and dental assistant replied to the survey with response rate of 46%. 66.8% of respondents were males, 79.1% were married, 68.4% of participants were below 45 years, 51.9% had less than 5 years of work experience with PHCC. 80.2 % had general satisfaction with the profession, and 43.9% had thoughts of leaving the profession. Conclusion: PHCC general dentists and dental assistants demonstrated average and above of work engagement levels with total mean score of (3.99± 1.15 SD), Dental specialists (3.74±1.29 SD), GP dentists (4.22 ± 1.21 SD), dental assistants (3.95 ± 1.02 SD).
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Backgroud Globally, employee engagement in healthcare organisations is low, with career advancement one of its main determinants. It may be useful for healthcare organisations to determine the factors of career advancement, to guide them to more effectively engage their workforce. Leadership competency is factor that may be crucial in influencing career advancement for healthcare employees. To our knowledge, a comprehensive analysis on its impact on the perception of career advancement within the healthcare setting has not been conducted. Research Design An ecological, cross-sectional study was conducted, aimed at examining the association between leadership competency of healthcare professionals and perceptions of career advancement. Poisson generalized-estimating-equation models were fitted to estimate the adjusted rate ratios with bootstrap 95% confidence intervals for the associations of the AHEAD items with the number of favourable responses on the career advancement items. In each model, we accounted for clustering by departments and controlled for length of service as a confounder. Results Statistically significant predictors of perception of career advancement were found, and included skills - Interpersonal Skills (aRR 1.53 CI 1.12–2.96), Motivating (aRR 1.31 CI 1.10–2.16), and Mentoring (aRR 1.30 CI 1.08–1.13); and values - Compassion (aRR 1.37 CI 1.17–3.40), and Collegiality (aRR 1.31 CI 1.00–1.99). Conclusion Our findings show an association between some components of leadership competency and the perception of career advancement. These results provide initial evidence that apart from hard skills, soft skills may play an equally (or more important) role in influencing the perception of career advancement.
Healthcare innovation should include an improvement of customer value co-creation toward a more experiential and systemic understanding of value creation. In this view, multiple actors integrate resources to offer value to the entire population in terms of health services. Healthcare value co-creation supposes that patients act as resource integrators and active co-creators of value, in collaboration with healthcare professionals. The focus of innovation should move from products and services to experiences involving different actors in exchanging resources to satisfy patients’ needs and outcomes. Following the value co-creation approach, the healthcare context needs to rethink the offering with the lens of patient experience and patient centricity.Digitization is a lever for empowering patients by facilitating the exchange with healthcare professionals and minimizing barriers.This chapter provides theoretical insights into value co-creation in healthcare.KeywordsValue co-creationInnovationStakeholders’ engagementPatients’ involvementCollaboration
This comprehensive meta-analysis study presents a summary of domestic publications based on the relationship between job satisfaction and the organizational commitment of healthcare professionals. The data of the study were collected in January 2022. The population of the research consisted of master's and doctoral theses, which were scanned on the National Thesis Center, and articles indexed by DergiPark Academic and TR Index. As a result of the screenings and in accordance with the inclusion criteria, it was decided a total of 46 studies that were suitable for analysis. As a result of the analyses carried out using the comprehensive meta-analysis program, it was revealed that the general z and p test values of the randomized impact size between the job satisfaction and organizational commitment of the health sector workers were significant, positive, and moderate. It was concluded that the lower limits of the confidence intervals of the 2 studies examined within the scope of the research were lower than the other studies. Before deciding on the appropriate impact size model, necessary heterogeneity tests were performed, and it was determined that the research data were not homogeneously distributed as a result of the Chi-square test result of the Cochran's Q test and Higgins' I2 test statistics, considering the forest graph results. Publication bias tests performed within the scope of the study indicate that there is no publication bias in the study and the results obtained are reliable. It is considered that the findings obtained will guide future studies and will provide evidence-based information for health managers and policymakers.
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Penelitian ini bertujuan untuk mengetahui pengaruh organizational safety culture terhadap work engagement pada karyawan kembali ke kantor, serta pengaruh organizational safety culture terhadap work engagement yang dimoderasi oleh leader safety commitment. Penelitian ini merupakan penelitian dengan pendekatan kuantitatif menggunakan metode survei. Teknik analisis yang digunakan adalah regresi linear sederhana dan moderated regression analysis (MRA). Hasil penelitian menunjukkan bahwa organizational safety culture berpengaruh signifikan terhadap work engagement (p=0,000) dan tidak dimoderasi oleh leader safety commitment (p=0,107).
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Background Work engagement is crucial for quality care at the primary healthcare level. This is especially true during the Covid-19 pandemic, as it has effects on the community from both a health and economic point of view. For example, inadequate work engagement can lead to fewer referrals to the secondary healthcare level. This study aims to examine the work engagement level in a public healthcare organisation at the primary healthcare level to further explore the role of work environment characteristics. The study addresses a research gap in the field of primary healthcare and emphasises the importance of managing the factors promoting work engagement. The future of healthcare will be strongly shaped by population ageing and Covid-19 disruption, which have created unpredictable and unfavourable working situations. Method A descriptive, cross-sectional, correlational design was used including the Utrecht Work Engagement Scale with a non-probabilistic availability sample of 630 employees of the Community Health Centre Ljubljana, Slovenia, in 2018. The role of the work environment was observed by applying the job resources concept adapted to the context of the observed organisation. Results Work engagement in the observed organisation is higher compared to previous research. The research confirmed that job resources play an important role in employees’ work engagement. The high level of work engagement of the home care nursing employees coupled with the significant proportions of unengaged in the management of the organization also caught our attention. This difference highlights the importance of the leadership style, career choices and employment process that exist in an institution. Conclusion The study has important implications for healthcare management at the primary level for unlocking the work engagement by ‘managing’ the factors stimulating work engagement. The hidden potential is especially large in so called ‘soft areas’, such as leadership style, communication and organisational climate, which are also less expensive to manage than other aspects of the work environment.
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The meaning of employee engagement is ambiguous among both academic researchers and among practitioners who use it in conversations with clients. We show that the term is used at different times to refer to psychological states, traits, and behaviors as well as their antecedents and outcomes. Drawing on diverse relevant literatures, we offer a series of propositions about (a) psychological state engagement; (b) behavioral engagement; and (c) trait engagement. In addition, we offer propositions regarding the effects of job attributes and leadership as main effects on state and behavioral engagement and as moderators of the relationships among the 3 facets of engagement. We conclude with thoughts about the measurement of the 3 facets of engagement and potential antecedents, especially measurement via employee surveys.
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This study examines the response rates for surveys used in organizational research. We analyzed 1607 studies published in the years 2000 and 2005 in 17 refereed academic journals, and we identified 490 different studies that utilized surveys.We examined the response rates in these studies, which covered more than 100,000 organizations and 400,000 individual respondents. The average response rate for studies that utilized data collected from individuals was 52.7 percent with a standard deviation of 20.4, while the average response rate for studies that utilized data collected from organizations was 35.7 percent with a standard deviation of 18.8. Key insights from further analysis include relative stability in response rates in the past decade and higher response rates for journals published in the USA.The use of incentives was not found to be related to response rates and, for studies of organizations, the use of reminders was associated with lower response rates. Also, electronic data collection efforts (e.g. email, phone,web) resulted in response rates as high as or higher than traditional mail methodology. We discuss a number of implications and recommendations.
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This article proposes a comprehensive framework for assessing, reporting and improving the quality of work environments in healthcare organizations across Canada. Healthy work environments (HWEs) contribute to positive outcomes for healthcare employees and physicians. The same HWE ingredients also can reduce operating costs, improve human resources utilization and ultimately lead to higher-quality patient care. We show how health system employers, governments, quality agencies and other stakeholders can implement effective HWE metrics. The common reporting framework and metrics we propose enable managers and policy makers to use HWE ingredients as levers to improve organizational performance. Progress requires the active involvement of stakeholders in developing common metrics, the integration of these metrics into existing measurement and reporting systems, the building in of managerial accountability for work environment quality and support for ongoing improvements at the front lines of care and service delivery.
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To compare and contrast the cultural characteristics of "high" and "low" performing hospitals in the UK National Health Service (NHS). A multiple case study design incorporating a purposeful sample of "low" and "high" performing acute hospital Trusts, as assessed by the star performance rating system. These case studies suggest that "high" and "low" performing acute hospital organisations may be very different environments in which to work. Although each case possessed its own unique character, significant patternings were observed within cases grouped by performance to suggest considerable cultural divergence. The key points of divergence can be grouped under four main headings: leadership and management orientation; accountability and information systems; human resources policies; and relationships within the local health economy. As with any study, interpretation of findings should be tempered with a degree of caution because of methodological considerations. First, there are the limitations of case study which proceeds on the basis of theoretical rather than quantitative generalisation. Second, organisational culture was assessed by exploring the views of middle and senior managers. While one should in no way suggest that such an approach can capture all important cultural characteristics of organisations, it is believed that it may be at least partially justified, given the agenda-setting powers and influence of the senior management team. Finally "star" performance measures are far from a perfect measure of organisational performance. Despite such reservations, the findings indicate that organisational culture is associated in a variety of non-trivial ways with the measured performance of hospital organisations. Highlights considerable cultural divergence within UK NHS hospitals.
The current global economic environment is defined by unprecedented uncertainty, a premium placed on knowledge, and the threat of future talent scarcity. Key to an organization's success under these conditions is its ability to strengthen the links between people and performance. Creating Healthy Organizations provides executives, managers, human resource professionals, and employees an action-oriented approach to forging these connections by creating and sustaining vibrant and productive workplaces.A healthy organization operates in ways that benefits all stakeholders, including employees, customers, shareholders, and communities. Using a wide range of examples from a variety of internationally based industries, Graham Lowe integrates leading practices with research on workplace health and wellness, quality work environments, employee engagement, organizational performance, and corporate social responsibility to make a compelling business case for creating healthy, resilient, and sustainable organizations.Creating Healthy Organizations offers readers, whether CEOs or front-line workers, an innovative framework and practical tools for planning, implementing, and measuring healthy change in their workplaces.
People and their performance are key to an organization's effectiveness. This review describes an evidence-based framework of the links between some key organizational influences and staff performance, health and well-being. This preliminary framework integrates management and psychological approaches, with the aim of assisting future explanation, prediction and organizational change. Health care is taken as the focus of this review, as there are concerns internationally about health care effectiveness. The framework considers empirical evidence for links between the following organizational levels: 1. Context (organizational culture and inter-group relations; resources, including staffing; physical environment) 2. People management (HRM practices and strategies; job design, workload and teamwork; employee involvement and control over work; leadership and support) 3. Psychological consequences for employees (health and stress; satisfaction and commitment; knowledge, skills and motivation) 4. Employee behaviour (absenteeism and turnover; task and contextual performance; errors and near misses) 5. Organizational performance; patient care. This review contributes to an evidence base for policies and practices of people management and performance management. Its usefulness will depend on future empirical research, using appropriate research designs, sufficient study power and measures that are reliable and valid.
Over the last few years, most health care facilities have become intensely aware of the need to increase patient satisfaction. However, with today's more consumer-driven market, this can be a daunting task for even the most experienced health care manager. Recent studies indicate that focusing on employee satisfaction and subsequent employee retention may be strong catalysts to patient satisfaction. This study offers a review of how employee satisfaction and retention correlate with patient satisfaction and also examines the current ways health care organizations are focusing on employee satisfaction and retention.
Background: The multiagency Quality Interagency Coordination Task Force (QuIC) coordinates activities and plans for quality measurement and improvement across all the U.S. federal agencies involved in health care. One of its working groups focuses on the health care workforce and ways to improve the quality of care that it provides. In October 1999 four government agencies, under the aegis of the QuIC, convened a conference to examine how health care workplace quality influences the quality of care. A healthy workplace is one in which workers will be able to deliver higher-quality care and in which worker health and patients' high-quality care are mutually supportive. In October 2000 a follow-up conference was held to focus on a specific aspect of health care quality-patient safety. What we still need to know: Although enough is known to justify some initiatives to improve the quality of the health care workplace, participants in both meetings agreed that the evidence to prove these associations is weak and that there has been too little research to evaluate the impact of interventions intended to improve quality through improvements in the health care workplace. New evidence-based information is needed to test the theory of the nature of the relationship between working conditions and care quality. Conclusion: The tradition of evidence-based decision making needs to be applied to health care management as it has in medicine and nursing, to show how staffing, environment, organization, and culture can each can affect the quality of care.