More is better when it comes to hospital staff satisfaction surveys

Staff satisfaction surveys are a vital tool when trying to improve employee engagement.  The connection between workplace health and quality patient outcomes is well documented. Yet, according to National Research Corporation Canada (NRCC), only two Ontario hospitals using their tool survey more frequently than once every year or two. Can an organization effectively focus on workplace health if measurements through surveys are only taken every second year?

Under the Excellent Care for All Act (ECFAA) Ontario hospitals are legislated to measure staff satisfaction at least every two years. Healthy Debate recently highlighted the value of measuring staff satisfaction in a standardized and transparent way, publicizing results. There are known links between staff satisfaction and patient safety. Empowered staff are more responsive to organizational initiatives to improve patient care. But when it comes time to act on staff satisfaction surveys administered so infrequently, many hospitals may find their data outdated and their mechanisms are insufficient for measuring real change.

What happens when hospitals measure staff satisfaction only every two years? Hospital leaders see a snapshot in time and immediately look for methodological or environmental reasons to explain the data. Were surveys collected around the holidays when staff were overworked? ‘We made major changes just before the last survey, so of course staff were unhappy.’ Perhaps more detrimental, when results are positive we may rest on our laurels and fail to hardwire improvement. The trouble is how will leaders ever parse the signal from the noise when samples are taken so infrequently? Moreover, they’re unlikely to detect trends early and course correct – or encourage positive changes – while they have the chance.

Such infrequent measurement would never stand in clinical areas: in Ontario we report C. difficile infections monthly and ventilator-associated pneumonia quarterly.  In an industry striving for continuous improvement we should measure outcomes on timescales that enable rapid testing of new ideas and detect changes as they happen. Timely data allow leaders to make evidence-informed decisions.

So why not do the same when it comes to staff satisfaction?

Toronto East General Hospital (TEGH) switched to measuring staff satisfaction quarterly about ten years ago. One of the advantages we’ve found with this practice is that it has helped us ensure that important new programs- for example the Workplace Violence Prevention Program – are effective and truly embedded into the hospital’s culture. Quarterly surveying allowed the hospital to measure staff perceptions of the workplace wellness and violence interventions allowing progress to be tracked. Consistent improvement has been demonstrated with positive scores increasing from 69.3% to 75.1% on the questions about staff security, 14% above the average for hospitals, and positive responses on wellness almost 20% above the provincial average.

One of the added benefits of quarterly measurement is an increased response rate from staff. More frequent announcements and email blasts keep the survey top-of-mind and greater response means more representational data. Simply put, conducting surveys quarterly boosts culture: asking staff their opinion promotes an open and transparent environment. Moreover, acting on the results shows that staff- and their opinions- are valued. It’s no secret: an engaged staff will support other initiatives across the organization. At TEGH, 78.5% of staff say they have an opportunity to improve the care they deliver compared to the average of 70.9% for other community hospitals using the NRCC survey tool.

But does it cost more? No. Quarterly measurement costs no more than the traditional yearly approach with each staff member being surveyed only once in both cases. Our approach has been to create cohorts of units from across the hospital’s divisions, striking a balance between representative stratification and the practicalities of administering the surveys at the unit level. With readily available surveying software, each cohort is surveyed at staggered, quarterly intervals throughout the year.

We agree that staff satisfaction surveys should include both standardized and hospital-specific questions. But we also need to update our legislation so the two year minimum described in ECFAA does not become an organization’s default frequency to measure its staff’s views. Management should receive quarterly reports broken down by unit, allowing directed feedback, planning, and implementation of initiatives to keep improving. Leaders must remember that happy, more satisfied and engaged staff deliver better care. For those who have not made this connection, maybe it’s time to update your approach.