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Rethinking Employee Surveys to Drive Key Health Care Outcomes

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Despite competing priorities, health care executives must use hard data to determine how to invest their limited resources for maximum financial results. Human resources (HR) professionals can make a more persuasive case if we bring solid evidence and sound analytics to the table. To drive critical business outcomes, such as HCAHPS scores and financial performance, our surveys must demonstrate how they impact our organizations’ bottom-line. Instead of focusing solely on engagement scores and benchmark comparisons, HR leaders can make a stronger case by demonstrating our impact on actual business results.

Surveys as a Strategic Business Partner

While other management disciplines have ever-evolving measurement tools, the employee survey process has not changed significantly since it was introduced decades ago. HR launches an employee survey, reviews engagement scores and benchmark results, and then implements the follow-up and action planning process. The resulting strategy often revolves around developing a plan to improve engagement scores. Demonstrating improvement in employee engagement is an important goal. However, what is more crucial to C-suite colleagues is identifying the specific people practices that impact the organization’s business results. Consider Figure 1, which illustrates data from a survey company. It highlights that employee engagement scores haven’t changed over 13 years regardless of whether our country has a strong or weak economy, or whether we are at war or in peacetime. In more than one decade, we haven’t made notable progress on employee engagement and we don’t know what a “good” engagement score is.

To rethink our survey process, we should build our strategy around two key questions:  “What specific aspects of our work environment will, when enhanced, result in improvement in our organization’s critical business outcomes?” and “How can we arm our leaders at all levels with the analytics and actions they need to drive this improvement in performance?”[1],[2]

An effective employee survey should address more than engagement scores, benchmark comparisons, manager reports and action plans.  Knowing that work groups with higher engagement scores tend to have better outcomes doesn’t tell us much – intuitively better performing teams have more engaged employees – but where do we invest to drive financial outcomes?

Keys to a better survey:

  • Creating the analysis to show the cause-effect relationship between your organization’s employee survey results and your organization’s critical business outcomes. Generic proclamations about what’s important across an entire industry are of little value.  An organization doesn’t gain a competitive advantage if everyone else is taking the same actions.  HR needs tools to help determine what drives results in your culture, using your data.
  • Showing all leaders, in their individual reports, exactly how their results drive key outcomes. A PowerPoint for the C-suite may be helpful in sharing results, but the data needs to reach the front lines where actions make a real difference.
  • Linking your leadership development investments, such as learning management systems, into your leaders’ reports and tools will help them use action plans based on what is driving results. Generic action planning tips, common with existing surveys, are rarely used and have little impact.
  • Implementing metrics linked to survey elements that truly drive health care outcomes (HCAHPS, patient safety and financials).  We have relied too heavily on benchmark percentile scores that don’t explain how to gain a competitive advantage or improve your outcomes. For instance, when reviewing the benchmark score, how much higher should a score be in order to achieve a true competitive advantage? In reality, it’s impossible to calculate.
  • Demonstrating a true return-on-investment (ROI) by demonstrating improvement on the key drivers of health care outcomes year-over-year against the actual health care outcomes. If your CEO asked, “What’s the actual ROI of our employee survey in real dollars?” many may not have an answer. But you should, and can.

Driving Quality Outcomes, Financial Performance and Turnover

A large health care organization with 30,000-plus employees was facing significant patient quality issues and financial challenges. The CEO decreed that leaders needed to demonstrate the impact of all investments or risk losing their funding. The HR department was spending a lot of money on an annual employee engagement survey and always referred to the survey as a “successful initiative.” When employee participation rates were high, scores generally improved, the organization achieved good benchmark percentile comparisons, and managers submitted action plans.

Nonetheless, this wasn’t enough to meet the CEO’s new mandate to justify the survey’s cost. HR saved the project by changing its approach. A new survey tool was designed to identify specific aspects of the work environment that were driving quality indicators, financial results, and turnover. These were all business outcomes used to show the survey’s ROI and align leaders to work on the survey’s elements that drove these outcomes. With this new approach, the CEO and other executives viewed the survey not as an expense to be cut, but a tool that provided valuable evidence of improved business outcomes.

The HR leaders leveraged facts, data, and analytical tools rather than assumptions and opinions, to demonstrate a real impact on financial performance. Consider the data in Figure 2 – a HeatMap. Rather than share long survey reports focused on engagement scores and benchmark comparisons, an easy four-box chart allowed leaders at all levels to quickly target what they needed to do to improve Quality Outcomes, Financial Performance, and Turnover.

Executives and middle managers often viewed employee surveys as “extra work.” However, showing how the results improved and drove business outcomes positively changed the leaders’ view of the survey. Based on the data depicted in Figure 2, the organization decided to invest heavily in Quality, Career Development, and perceptions of Senior Management. All of these issues were identified through analytics to be the key drivers of business outcomes. As a result, the executives were directed to work on these priorities and also given customized best practices to help improve the key drivers.

Figure 2. A graph that shows the impact of employees’ attitudes on key outcomes – this allows leaders to identify attitudes that are key drivers of results and prioritize improvement efforts.

HeatMap Information

  1. Focus: Low Performing AND Key Driver
  2. Monitor: LowPerforming, Not Key Driver
  3. Promote: HighPerforming, Key Driver
  4. Maintain: HighPerforming, Not Key Driver

The organization focused on three key business drivers that would bring them competitive advantage (Career Development, Senior Management, and Quality). The results in Figure 3 illustrate the specific impact these efforts had on the key business outcomes identified as priorities by the health system.

HR demonstrated the potential for return-on-investment, and more importantly, showed a direct impact on the key business outcomes the organization had targeted. This was a change from discussing engagement and benchmark scores with skeptical leaders. There was no question about continuing the use of employee surveys now that they were viewed as a valuable business tool. Furthermore, executives wanted to learn what other business outcomes could be improved using employee survey data.


In today’s health care environment with significant financial challenges, leaders must make evidence-based decisions to improve key business outcomes including patient safety, quality and experience. As HR professionals, we must decide where to most effectively invest our increasingly limited human, financial and technological resources. We will not be able to serve as strategic partners and leaders if we are equipped only with assumptions, opinions, beliefs, or engagement scores. It’s imperative that we utilize actionable data to determine the specific people practices that will drive improved performance and business outcomes.

[1] Mondore, S.P. & Douthitt, S.S. Investing in What Matters: Linking Employees to Business Outcomes. Society for Human Resources Management. 2009.

[2] Mondore, S.P., Douthitt, S.S. & Carson, M.A. Business-focused HR: 11 Process to Drive Results. Society for Human Resources Management. 2011.

IRI Consultants partnered with SMD, the leader in predictive analytics for employee assessments, to form IRI Analytics. IRI Analytics is the only provider of patented analytics technology for healthcare organizations
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