While often overlooked, employee engagement is a key element in determining whether a hospital, health system, or pharmacy service can effectively meet its patient access, patient quality, and organizational financial demands.
The pace of change in business overall is faster than has ever been experienced before, and healthcare is no exception. The healthcare organizations that recognize and adapt to these changes will ultimately be winners, while those who cling to the status quo will be left by the wayside.
Essentially, hospitals and health systems are service providers, with a skilled workforce as the cornerstone of that service delivery. Employees are a constant across all hospitals and health systems, and their ability to adapt and succeed during times of change will be a key factor in determining whether a hospital or health system can effectively meet its demands in patient access, patient quality, and organizational finances. Employee engagement is critical to organizational success. This is particularly true in how we practice the business of pharmacy in hospitals and health systems.
The dictionary offers several definitions of “engagement”: an arrangement to meet at a specified time and place (eg, dinner engagement); a job or period of employment (eg, a performer’s engagement); a betrothal; a hostile battle between military forces; and finally, an emotional involvement or commitment. This last one is the context that interests us, and what we seek in our pharmacy employees.1
The Gallup organization has identified several characteristics that distinguish engaged employees from those who are less so. Engagement affects employee performance and efficiency, often significantly impacting the organization’s overall success.2 In general, engaged employees are less prone to absenteeism, more loyal to the organization, willing to expend discretionary effort for the organization, willing to trust and cooperate with others in the organization, willing to work through significant challenges, and willing to speak up and offer constructive suggestions for improvement.
Ideally, we should seek a level of engagement that goes even beyond this baseline. What we really want is engagement so strongly felt that employees feel they have “ownership” in the organization. We should work to ensure that our people feel they have been an integral part of the actions, decisions, and plans for the organization, and we should want them to understand that they have participated in the development of the programs and services we offer, and additionally that they have chosen freely to endorse and believe in what we are doing. Too often, however, this scenario is lacking in the businesses of pharmacy as practiced in hospitals and health systems.
If we look at some of the more successful business entities outside of pharmacy (eg, technology, finance and insurance industries) the topic of employee engagement is eagerly embraced. US companies currently spend an estimated $720 million annually on engagement, and that is projected to increase quickly eventually to over $1.5 billion.3 These companies realize that being able to attract and retain talent and keep employees “well engaged” contributes significantly to the business’ overall success. Disengaged employees are generally less productive than those more highly engaged, contributing to reductions in the business’ overall productivity and quality; they tend toward higher rates of absenteeism an extra expenditure of real money, for benefits and have higher rates of turnover, which is often a hidden cost for healthcare organizations. Successful businesses realize that turnover significantly contributes to costs, and they keep a very close eye on retention.
When we consider the business of pharmacy, we have a variety of tools available to calculate the cost of losing a pharmacist based on local salary and benefit costs, training time, and job functions. In general, we can safely assume that it costs at least $85,000 each time we lose a pharmacist and have to replace one “off the street,” so a high turnover rate clearly creates very real costs for the business.4
Pharmacy Employee Engagement
In a recent assessment of healthcare careers by Forbes, pharmacy was identified as the most attractive healthcare career5; however, this does not, unfortunately, correlate with pharmacist engagement and satisfaction, a result consistent across a variety of survey types. In a recent analysis by The Advisory Board of 36 different healthcare services, for instance, pharmacy ranked 34th out of 36 for employee engagement.6 This is puzzling, because on the surface, considering pharmacist work broadly, it supports the Forbes assessment. Pharmacists are very well compensated compared with practitioners of other healthcare professions; they also have many opportunities to advance their skills and to do interesting, worthwhile work, and to make a difference in the care of patients. They are a respected element of the healthcare delivery system, and for the most part, pharmacists have good working conditions. Yet, with all of these positives, pharmacists typically rank near the bottom in satisfaction and engagement when compared with other healthcare providers. Why?
There are no quick and easy answers. What we do know for certain, though, is that traditional thinking concerning employee engagement in pharmacy needs to be challenged, because what healthcare leaders have been doing is clearly not working. As leaders, we obviously would like to see this trend reversed, but to accomplish that, we need to understand what factors drive employee engagement and we need to rethink what we can do to positively influence these factors.
One of the most important elements to support a program to improve engagement is an effective way to measure and manage engagement. Engagement is not a “one-and-done” kind of activity it must be constantly reviewed and managed. Nevertheless, one of the most popular traditional systems to measure engagement consists of a large, hospitalwide survey that includes hundreds of questions and is administered annually or biannually. Employees typically do not like these long, time-consuming surveys, and their dislike affects participation, which in turn makes the results difficult to translate into meaningful and sustainable actions.
Recognition of this dynamic has led to the popularity of “pulsing” employee surveys across a growing number of industries, to get frequent reads on employee engagement. In contrast to large surveys taken infrequently, leaders ask employees to answer quick surveys on a weekly or biweekly basis. They get valuable feedback on what is energizing their teams and what is driving them down.
Pulsing surveys differ from annual surveys in a number of ways: a) each is limited to 1 or 2 questions, versus 50 for the average annual survey, which increases response rates, thereby affording leaders with more robust and accurate feedback; b) pulsing surveys fielded weekly or biweekly, versus once a year, bring a real-time approach to employee feedback; c) pulsing survey questions are simple, with responses limited to yes/no, scale, or open-ended prompts, and there are no complex conditional structures. This, too, helps to increase response rates.
The advantages to pharmacy leaders using pulsing survey tools are many:
Timely data. Employee morale and sentiment tend to ebb and flow quickly. Rather than waiting a full year between employee surveys, pulsing surveys give pharmacy leaders a real-time read on sentiment, well before an employee considers looking for a new job.
Actionable data. Because data are timely and specific to a particular workplace issue, leaders are afforded the information they need to make material changes that will positively impact engagement in both the short and long term.
Manageable data. Pulsing surveys yield relatively limited amounts of targeted feedback. When faced with such a small amount of data to review, pharmacy leaders can review it completely and tackle known issues quickly.
In summary, pulsing employee surveys empower pharmacy leaders with the data they need when they need it, to make material workplace improvements that can impact engagement, productivity, and even their bottom lines.
Consider the demonstration study (unpublished) fielded between the Pharmacy Leadership Academy and TINYpulse, a leading pulsing employee survey tool. Using TINYpulse, pharmacy leaders attending the Academy’s learning sessions were offered the opportunity to pulse their teams, and compare their scores with those of all organizations using the tool. In just the first week of surveying employees, pharmacy leaders discovered that their teams were far less happy in their workplace than the general working population. As shown in the
, pharmacy employees averaged 6.8 on a 10-point happiness scale, while nonpharmacy employees averaged 7.6. Without pulsing surveys, pharmacy leaders would normally wait 12 months for these results.
Pulsing surveys often ask employees who express unhappiness to explain what factors led to this feeling. This can uncover challenges such as limited opportunities for professional growth, difficulties with manager-employee interpersonal dynamics, and concerns about peer competence, among others. Armed with this level of detail, pharmacy leaders can know precisely where (eg, specific departments or situations) to focus their attention. The end result could well be more satisfied, engaged workers who are far more likely to stay with their current employer.
The question remains for many leaders: What workplace factors most commonly drive engagement down, and need to be tackled most quickly? Additionally, what makes a person feel engaged? What creates that sense of purpose and commitment that translates into a willingness to go to extra lengths to commit, invest, and “make things happen”? Why does one person head off to work with excitement and anticipation, while another drags in to mark the time required?
Employee engagement is ultimately about social connections within the organization as well as the alignment of the work itself with the employee’s personal value system that sense of being connected to a larger purpose. While specifics on what works to increase engagement vary across industries, all highly engaged workplaces have factors in common.7
Understand what employees are thinking. To understand and improve anything, you need to measure it and measure it often enough to not only grasp the “big picture,” but to also pick up on nuances of changing attitudes. Beyond the use of surveys, there are hosts of ways to engage employees in giving them opportunities a true voice to share their thoughts and to participate in dialogue around the work we do.
Create an intentional organizational culture. Culture plays a key role. While we know it is complex and does not move easily, a leader can influence those factors of culture that contribute to engagement. Factors that can build cultural identity among employees include creating a sense of connectedness in the job that a person does every day as a contribution to the work of the organization and to overall enterprise strategy; building a sense of personal ownership in the larger strategy and goals of the organization; nurturing collaboration, commitment, and relationships; creating clear expectations and clarity of purpose; and fostering confidence and a sense of personal achievement through regular and sincere recognition of contributions. As a leader, building this sense of cultural identity may be one of your most vital contributions to the overall achievement of the organization.
Appreciation. Consider expanding expressions of personal appreciation for contributions large and small, noticing and thanking people for going an extra step or picking up the slack, or for intervening to save a life, fix a system failure, or avoid a catastrophic error. Thanking them personally and acknowledging their contributions publicly in appropriate ways can be particularly meaningful to employees.
Communication. Communication is a core element in an engagement culture. Ensuring that employees not only know what to do and how to do it, but also have the larger context of why they are doing it within the logic of the larger organizational purpose, makes their work more meaningful. Leaders must realize that in an engaged culture, communication is critical and multi-channeled. Keeping employees “in the loop” about what is going on and fostering the sense that leaders want to hear their perspectives as well may take time, but it creates a culture in which leaders will get much more of a sense of what is going right and what needs improvement. It creates the opportunity for employees to provide input, and it advances their sense that their opinions are valued. Engagement happens as a result of positive, trust-building relationships, in which open conversation and dialogue are critical.
Support career development and growth potential. Workers, particularly millennials, often express a need for personal growth and development. Offering formal mentoring to demonstrate the organization’s commitment to employees’ personal growth gives incontrovertible evidence of a willingness to invest in their skills and personal portfolio of experiences. It shows that a future for them exists within the organization that transcends the work they do today.
Social engagement beyond work. Engaged workplaces don’t just happen. Frequently, a very important factor is the strengthening of relationships and connectivity that stems from broader social interaction, often beyond the workplace. Shared social events and experiences, having fun together or working together on community service projects, builds a sense of shared purpose. Typically, greater workplace engagement and improved results follow. In addition, don’t forget to celebrate achievements large and small. Establish milestones, and celebrate triumphs to give a sense of accomplishment and to mark progress. This can be particularly important in the case of major long-term initiatives in which incremental achievements might be otherwise hard to see.
It is clearly incumbent on leaders to proactively measure engagement and seek out those areas that will drive higher levels of productivity and satisfaction among employees. The measures listed above can play a significant role in engagement, but most likely, other addressable issues lurk beneath the surface, issues that only regular employee feedback can uncover.