For most healthcare organizations, building and sustaining a highly engaged workforce has become a foundational strategy of their human capital initiatives. During the last decade, the scientific case for creating a highly engaged workforce has continued to grow. In healthcare settings, employee engagement has been shown to powerfully predict and enhance an array of key outcomes including productivity and efficiency; innovation; revenue growth and profit margin; quality and safety; patient satisfaction; and clinical outcomes. In addition to its significant influence on business success and patient experiences, employee engagement also strongly predicts workforce stability—whether employees choose to stay with an organization or leave it to pursue other opportunities. The growing realization that engagement is indelibly linked to business excellence has led to a widespread focus on measurement. To determine how engaged employees are, healthcare organizations have increasingly turned to employee surveys as a method of quantifying and assessing the engagement levels of their workforces.
Defining and Measuring Engagement
The way in which employee engagement is defined has a profound impact on how accurately employee engagement is measured. Organizational scientists have achieved a consensus that employee engagement should be treated as a multi-faceted metric best measured by exploring numerous dimensions including positive views of work, feelings of enthusiasm and commitment, and a likelihood to exert extra effort. Considering these findings alongside our own extensive research, Integrated Healthcare Strategies (Gallagher Integrated), a division of Gallagher Benefit Services, Inc., defines employee engagement as: “A pronounced state of enthusiasm characterized by effort, pride, and passion which fosters a mutually committed relationship between employees and organizations resulting in the enduring pursuit of organizational and personal goals.” Although well-crafted surveys are designed to gather employee views on an array of key workplace experiences (i.e., teamwork; career growth; quality and safety; leadership; etc.) which promote employee engagement, organizations are often most eager to view their employee engagement score. This crucial score offers an immediate understanding of how engaged employees are within the organization, and perhaps more importantly, provides comparisons to the engagement levels of other healthcare organizations (national benchmarks). Often, the next step is to look for differences across groups which comprise the organization (i.e., work units and demographic categories) to explore how the engagement score shifts higher or lower. A great wealth of knowledge can be gained through these comparisons.
However, it must always be remembered that employee engagement is a complex metric composed of multiple survey items, all of which are used to calculate an overall employee engagement score—at Gallagher Integrated, we use seven survey items to measure overall engagement. Organizations that focus on an overall engagement score as an indicator of workforce health often fail to develop a deeper understanding of the factors that determined the overall engagement score. For example, if an organization shows an average level of overall engagement, their score may be the result of half of the engagement items performing well, and the other half poorly. Likewise, an average overall engagement score can result from all of the engagement items performing at an average level.
Identifying Types of Engagement
To deliver deeper insights into the nuances of engagement, Gallagher Integrated uses an advanced analysis technique designed to isolate the varying types (or profiles) of engagement that exist within an organization. Our approach, based on hierarchical cluster analytics, sorts employee respondents into mutually exclusive groups based on how they responded to our seven engagement items. To demonstrate how this analysis works we have drawn a sample of approximately one quarter million healthcare employee respondents from our 2012 survey database. The results show that, based on the ways healthcare employees responded to items that directly measure engagement, there are five uniquely distinct profiles of engagement currently present among the U.S. healthcare labor force.
Engaged - “Engaged” profile members feel significantly favorable across all measurement items, as indicated by the green boxes with upward pointing arrows. This means that members in this cluster group exert a high level of effort; exhibit great pride about working for the organization; feel compelled to promote the organization as a great workplace; are not interested in leaving for other opportunities; sense a great deal of satisfaction; believe they contribute richly; and are engrossed in the organization’s mission. This profile represents 37 percent of active healthcare workers in the nation.
On the opposite end of the engagement continuum is the “Separated” cluster group. The “Separated” group shows significantly unfavorable scores across all engagement items, indicating they no longer care to exert great effort; are not prideful; would not recommend the organization as a workplace; would very much like to leave; exhibit no job satisfaction; and are not enthused by the organization’s mission or by their contributions —they have mentally and often physically separated from their jobs. While this profile represents only 6 percent of the nation’s healthcare workforce, their ability to dampen the engagement of those they interact with can be noteworthy.
The cluster group referred to as “Detaching” represents 16 percent of the workforce. These individuals are still exerting a reasonable level of effort but are at heightened risk for moving into a fully “Separated” profile. Like the Separated group, they can have a negative impact on those around them.
Representing 19 percent of the healthcare workforce are “Campers.” This fascinating group is strongly unfavorable about all engagement items with the exception of “not leaving.” This means that they do not have any plans to leave—more specifically, this disengaged group actually expresses a heightened desire to stay with the organization. Similar to “Detaching” and “Separated” employees, when “Campers” interact with engaged employees, there is a heightened risk that their attitudes about the organization and their job experiences may negatively impact the opinions of others. Most people can recall colleagues throughout their working experiences who accurately fit one of the above profiles.
Predicting the “Stepping Stone” Risk Seekers
The final profile is the “Seekers.” Representing 22 percent of the national healthcare labor force, “Seekers” are arguably the most curious group circulating within healthcare today and probably the most disturbing group for an organization to learn they have within their employee populations. “Seekers” exert a very high level of effort and contribution; exude pride; actively recommend their workplace as a great choice for employment; are highly satisfied and sense a very strong connection to the organization’s mission; but, want to leave to pursue other career opportunities. The primary reason why leaders are often astonished that “Seekers” exist in their organizations is that these employees appear strongly engaged, exhibit positive attitudes and are typically very high-performing individuals—their overall level of engagement seems high. In fact, “Seekers” rate six of the seven engagement items excessively favorable leading to a significantly high level of overall engagement. Therefore, “Seekers” typically remain completely undetected by healthcare organizations that focus on overall engagement as their key indicator of workforce health. It should also be noted that “Seekers” can be located anywhere within an organization. The following diagram shows the mapping of engagement profiles by position for a 900-bed hospital. The uppermost horizontal bar shows the percent distribution of the engagement profiles within the facility. In this hospital example, 40 percent of employees are “Engaged” while nearly 1 out of 5 employees (19 percent) are “Seekers.” What was most challenging for this organization was the realization that a disproportionate number of senior leaders fit the “Seekers” profile. In fact, 30 percent of senior leaders are “Seekers” compared to only 19 percent in the larger overall population of the hospital. Likewise, one in three (33 percent) of registered nurses were determined to be “Seekers.” Following this analysis, Gallagher Integrated worked closely with the human resources and organizational development professionals at the organization exampled above to create action plans that would help convert “Seekers” into “Engaged” profiles. The name “Seekers” was elected to describe this engagement profile group as a result of the key drivers of engagement for this group—the workplace characteristics which will make them want to stay with the organization. On average, the key drivers of engagement for “Seekers” tend to be related to career development, skills acquisition, and training needs. Based on what we know about “Seekers,” including their level of engagement and the key drivers that shape their engagement, a simple but accurate statement is that “Seekers” like their jobs, care greatly about their work and their organizations - but simply feel that they may have a better opportunity to accomplish their personal career goals elsewhere. They consider their current organization as a mere “stepping stone” to an opportunity they believe will help them further their career growth and professional goals.
Summary and Conclusion
Imagine the power of understanding whether or not “Seekers” exists in your organization, and if so, how prolific they are, where they are located within your organization (i.e., departments and demographic categories), and what action planning strategies you could pursue to convert them to “Engaged” employees. By focusing narrowly on overall engagement scores, “Seekers” will remain masked by their high overall engagement ratings, and will always be a tremendous risk. Our research on the “Seekers” group confirms that this group tends to be more educated, highly skilled, and most importantly, high-performing employees. “Seekers” tend to occupy positions which are more expensive and time-consuming to replace if their turnover becomes a reality. Without a deep exploration of overall engagement where each individual element of engagement is separately evaluated, an organization has little chance to implement strategies that will engage and retain “Seekers” and prevent them from leaving the organization. Gallagher Integrated believes that every healthcare organization should be equipped with the insight to guide their human capital strategies in a more meaningful and effective manner. When organizations fully understand the complexities and nuances of engagement, and are equipped with a clear roadmap for action planning, they can intervene to prevent turnover before it occurs.