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Survey Solutions

Employee Engagement

Data-Driven Insights for Your

2017 Employee Engagement

Strategy

Findings from the Advisory Board Survey Solutions’

National Engagement Database

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Survey Solutions Employee Engagement

Project Directors

Research Team Gayatri Iyengar

Angelina Theodorou

Program Leadership Paul Matsui, Executive Director

Sarah Rothenberger, Managing Director

Anne Terry, Managing Director

For Further Information

This report only scratches the surface of the Advisory Board’s

resources on workforce engagement. Please don’t hesitate to contact

us at [email protected] if you would like to see more on:

• Additional cuts of our benchmark

• Analysis of our key findings

• Best practices for driving workforce engagement

About Survey Solutions

Partnering with Providers to Build a High Performance Culture

Introducing Survey Solutions

Advisory Board Survey Solutions combines the resources of the full Advisory Board with a world-class

survey platform and a dedicated staff. We serve as an objective partner with industry expertise to help

ensure your survey investments advance organizational performance.

To learn why hundreds of leading health care providers have switched to Advisory Board Survey Solutions,

please contact us at [email protected] or visit www.advisory.com/abss.

› Right Question Set for the Right People

› Prescriptive Results

› Change Management Expertise

› Leader-Centric Action Plans

Ensuring a Return on Your

Survey Investment

Key Attributes of Our Solutions

Representative Offerings

EMPLOYEE ENGAGEMENT SURVEY PHYSICIAN ENGAGEMENT SURVEY

NURSE ENGAGEMENT SURVEY

Magnet-compliant assessment with

department- and unit-level drill-downs

360˚ support for advancing

provider staff commitment

Targeted survey questions for employed,

affiliated, and independent physicians

CULTURE OF SAFETY SURVEY

End-to-end administration and

analytics for the AHRQ survey suite

LEADER CENTRIC ACTION PLANNING

Best-in-class software for integrating

performance improvement efforts

Annual renewal rate

95%

Average annual improvement

in engagement

10% Survey respondents

1M+

Action plans created via

online action planning tool

20,000+

CULTURAL AUDIT

Defines an organizational culture that

will attract, retain, and inspire top talent

PHYSICIAN NEEDS ASSESSMENT

Solicits medical staff input to inform

future investments in provider network

PATIENT EXPERIENCE PLATFORM

Captures real-time patient feedback

and creates actionable insights

Ten Data-Driven Insights

1 You can improve

engagement with

concerted effort

Let our national benchmarks inspire your ambition. Not only has our cohort seen

tremendous improvements in raising the floor on engagement scores (the 1st percentile

has seen an increase of over 13 percentage points), but our partners at every level of

performance are making larger year-over-year gains than ever before. Those at the

75th percentile are engaging nearly half of their employees. Additionally, multi-year

partners experience faster improvements as well as higher overall levels of

engagement, indicating a dedicated long-term focus on engagement does show

meaningful results.

Unfortunately, as organizations becomes more engaged it gets harder to sustain or

improve upon that performance. Only 44% of organizations starting above the median

engagement score improved, compared to 68% of those starting below the median.

That said, organizations starting above the median who experienced gains in

engagement saw on average a six percentage point increase, indicating improvement

is possible from any starting point.

See Charts 1 and 2 for employee engagement trends across 2015 and 2016. See

Chart 3 for trends in engagement among multi-year versus first year members. See

Chart 4 for how starting engagement scores impact the pace of improvement over time.

2 A healthcare-specific

benchmark is critical in

setting aspirational –

yet attainable –

engagement goals

Hospitals and health systems have a substantial engagement advantage over

employers in other industries. Our cohort is more than twice as engaged as

employees in other industries. Additionally, the level of disengagement in other

industries is three times that of the level within healthcare.

For the vast majority of health systems, comparing to generic industry benchmarks

will yield lackluster goals. Organizations looking to create accurate, ambitious goals

should use healthcare-specific benchmarks down to the nursing unit level.

See Chart 5 for how employee engagement within healthcare compares to

engagement from other industries.

4 Despite significant

increases in

engagement, clinical

departments remain

the least engaged

Across the industry, the biggest opportunity to boost engagement lies in targeting

several of the largest clinical departments: laboratory, surgery/OR, and of course,

nursing. These three departments are perennially among the least engaged groups.

This need not be the case—other large, clinical departments such as imaging and

rehab tend to have higher engagement levels, and several nursing unit types are

outpacing the overall employee engagement national benchmark.

While a focus on clinical departments is warranted, be careful of overlooking the

non-clinical areas – employees in those areas experienced the lowest level of

improvement across department type (nursing, clinical non-nursing, and non-

clinical).

See Chart 8 for employee engagement trends by department type. See Chart 9 for

how employee engagement compares across departments. See Chart 10 for

employee engagement by nursing unit type. See Chart 11 for RN engagement by

nursing unit type.

5 Frontline staff

engagement is

increasing at a faster

pace than leadership

engagement

While 2016 saw a continued rise in leader engagement, particularly among managers

and directors, the pace of improvement is falling behind that of frontline staff. Given

the critical role leaders play in driving and maintaining employee engagement, it is

worthwhile to consider a renewed focus on leadership, in particular executives.

This can mean targeting different issues. While top drivers of engagement overlap

significantly between managers, directors, and frontline staff, they look quite different

at the executive level. Executives place greater importance on job security, clear

expectations, and technology selection and implementation.

See Chart 12 for engagement levels and trends by leadership level. See Chart 13 for

engagement by job title. See Chart 17 for the drivers with the greatest impact on

leader engagement.

3 Challenge assumptions

about what constitutes

an organizational

demographic barrier

to engagement

Our 2016 hospital and health system data set shows little need to downgrade your

organization’s engagement ambition based on your system’s size or unionization

status. In many cases, including in the presence of an employee union,

organizations with perceived demographic disadvantages are outperforming the

national average. Facility type, however, shows greater variation, with research and

cancer centers experiencing the lowest levels of engagement among our cohort.

See Chart 6 for how employee engagement levels compare across organization-

level demographics. See Chart 7 for how employee engagement levels compare

across facility types.

6 After accounting for

relative impact, focus on

the engagement drivers

your organization can

realistically improve

The top drivers of all staff engagement have been remarkably stable across the last

several years, providing hospitals and health systems with clear guidance on what

matters most to engaging your people. The range of organization-level performance,

however, varies substantially across these high-impact drivers. For example,

organizations at the 75th percentile for executive actions outscore organizations at

the 25th percentile by nearly 9 percentage points whereas only 5 percentage points

separate 75th and 25th percentile performance for belief in the organization’s

mission. Use your organization’s specific results to prioritize the top impact drivers

where you have the greatest room for improvement compared to benchmarks.

At a national level, four drivers show the greatest opportunity for improvement –

executive actions, interest in promotion, ideas and suggestions valued, and

executive respect for contributions.

See Chart 14 for the drivers with the greatest impact on employee engagement. See

Charts 15 and 16 for how organizations perform on these drivers, or the relative

room for improvement.

7 For the largest boost in

employee performance,

focus on driving

engagement among

content employees

Engaged employees are 1.5 times more likely to receive top performance ratings

than content employees, and three times more likely to receive top performance

ratings than disengaged employees. Moving content staff to engaged largely

involves the same set of drivers that impact the engagement spectrum more

generally, with some exceptions around stress and burnout and fair pay. The major

difference is in their perception of organizational performance—on average,

engaged employees are two to seven times more likely to ‘Strongly Agree’ with

these drivers than content employees.

See Chart 18 for employee performance by engagement level. See Chart 19 for the

drivers with the greatest impact on differentiating contentment and engagement.

See Chart 20 for how content and engaged employees perceive organizational

performance on the top impact drivers.

9 Integrate your staff

engagement efforts with

your Magnet journey

The most successful organizations don’t silo engagement from other performance

improvement efforts. We have helped many of our survey partners reduce survey

fatigue and nurse manager workloads by deploying our all-staff engagement survey

to demonstrate achievement of Magnet’s nursing engagement requirements. Our

validated nursing-specific question bundle includes benchmarks at the unit level and

has been approved by Magnet to meet their engagement reporting requirements

without administering a separate nursing survey.

Looking at the national data, Leadership Access and Responsiveness and

Adequacy of Resources and Staffing are the Magnet themes where we see the

greatest opportunity for improvement nation-wide. Conversely, Fundamentals of

Quality Nursing Care and Inter-professional Relationships show the strongest

performance nationally.

See Chart 22 for national performance on the Magnet-approved bundle of drivers

mapping to their key themes.

8 Balance overlapping

and dedicated initiatives

for patient satisfaction,

culture of safety, and

employee engagement

Higher employee engagement correlates with stronger performance on patient

satisfaction and culture of safety measures at the organization level. More

importantly, we have identified several engagement drivers in the national data that

have the potential to directly drive these outcomes, including care quality, service

excellence, and employee safety.

Nonetheless, beware of over construing the data in the name of streamlining your

efforts. For many organizations, there has been limited overlap in the opportunities

presented by their specific data or even in the relationship between engagement

and other outcomes, particularly patient satisfaction, at the unit or department level.

In these cases, it is generally best to pursue targeted initiatives against the top

opportunities for each outcome instead of initiatives for weaker opportunities that

span multiple outcomes.

See Chart 21 for correlations between the Advisory Board’s employee engagement

metrics, HCAHPS’ overall hospital rating and willingness to recommend measures,

and the AHRQ Hospital Survey on Patient Safety Culture’s Patient Safety Grade.

10 Supplement engagement

efforts with a retention

strategy for Millennials

The data reveals a clear link between engagement and retention at all levels, with

disengaged staff of all ages more than twice as likely as engaged staff to leave their

organization in the 12 months following the survey. But unlike other age cohorts,

Millennials are more engaged than they are loyal during their first three years of tenure

at an organization. If you can retain them past the three year mark, their level of loyalty

more closely matches their level of engagement.

Effective on the job training, technology selection and implementation, stress and

burnout, and benefits are the four drivers unique to Millennial loyalty. Those

organizations looking to implement a unique strategy focused on retaining younger,

less tenured staff should first look to these themes.

See Chart 23 for turnover rates by employee engagement level. See Chart 24 for the

gap between engagement and loyalty by age and organization tenure. See Chart 25

for Top Drivers of Millennial Loyalty Compared to Top Drivers for Overall Engagement.

Supporting Data and Analysis

Results from the Survey Solutions’ National Employee Engagement Database

Chart 1: Variation in Percentage of Staff Engaged by Organization

By Calendar Year of Survey Administration

99th percentile

1st percentile

75th percentile

25th percentile

Chart 1 compares the 2015 and 2016 performance distributions for employee engagement. While progress at the top

has plateaued, we are seeing tremendous improvement raising the “floor,” or 1st percentile. This trend is leading to

the increase in engagement from 2015, outlined in Chart 2 below.

5.5%

13.8%

39.6% 41.1%

5.7%

14.2%

40.0%

40.0%

5.0%

13.4%

40.5% 41.1%

4.7%

12.8%

39.3%

43.2%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Disengaged Ambivalent Content Engaged

2013 2014 2015 2016

Chart 2: Staff Engagement Distribution by Year

Percentage of Respondents by Engagement Category, 2013-2016

Chart 2 compares the 2013-2016 performance distribution across all four categories of the engagement distribution. We

are seeing positive movement in all categories, with increases in the content and engaged categories coupled with

decreases in the ambivalent and disengaged categories.

33.7% 38.8%

71.2% 68.0%

22.8%

48.5% 48.7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Surveyed in 2015 Surveyed in 2016

9.5%

Chart 4: Level of Improvement in Engagement Based on Starting Percentile Rank

Percentage points among

improving facilities that

began above the median

6.0

Percentage points among

improving facilities that

began below the median

9.8

Percentage of Facilities Improving

Comparing Initial Scores to Relevant

Database Median

68% Below

median

44% Above

median

Average Improvement in Engagement

Chart 4 examines the differences in the degree and prevalence of improvement between organizations starting with

engagement scores above and below the benchmark median. This analysis includes all pairs of trended surveys in our

database, regardless of whether the organization is on a 12, 18, or 24 month survey cycle. Both charts illustrate that

gains are greater for organizations with lower starting levels of engagement. The increased difficulty of improvement as

engagement increases is likely a contributing factor to the stagnating progress we see at the 99th percentile of our

benchmark.

Nonetheless, our cohort indicates that improvement is possible, no matter your organization’s starting point. Additionally,

we are seeing stronger levels of improvement for our cohort each year. Improving organizations who began above the

benchmark improved by 6.0 percentage points in 2016, compared to 5.5 percentage points in 2015.

Comparing Average Improvement of Organizations

Above and Below Database Median

Chart 3: Engagement Trends in Multi-Year Partners Versus First Year Members

Percentage by Calendar Year of Survey Administration, 2012-2016

Chart 3 shows the engagement trend from 2012-2016 for the entire national cohort, as well as a

comparison between first-year and multi-year members. Multi-year partners are seeing both higher levels of

engagement as well as faster improvements year over year, indicating that a dedicated year-over-year

focus on engagement does in fact lead to meaningful improvement.

40.8% 41.1%

41.3% 43.2% 40.1%

42.1%

44.8%

39.0% 39.8%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

2012 2013 2014 2015 2016

Overall Multi-Year Partners First Year Members

Chart 5: Staff Engagement in Health Care vs. Other Industries Percentage Respondents by Engagement Category, 2016

Chart 5 compares the performance distributions for healthcare employees in our cohort versus a representative

national panel sample of over 2,000 respondents in industries outside of health care.* Employee engagement among

hospitals and health systems is nearly double that of other industries. Additionally, disengagement among non-

healthcare employees is almost three times that of healthcare employees within our national database.

We strongly recommend that hospitals and health systems use a healthcare-specific benchmark for goal setting

purposes, as it reflects a more accurate and aspirational comparison.

4.7%

12.8%

39.3% 43.2%

14.1%

30.1%

35.4%

20.4%


Hospitals and Health Systems All Other Industries

Chart 6: Variation in Percentage of Engaged Staff by Organization Type

Percentage of Staff Engaged, 2016

41.2% 42.5% 41.7% 42.8% 40.2%

44.0% 42.3% 45.0%

43.0%

Single Facility 2-3 Facilities 4+ More Facilities Less than 2kEmployees

2k to 5k employees 5K to 10kemployees

10k or moreemployees

Unionized Non-Union

System Size Unionization

-0.6% +0.9% +0.7% +3.4% +0.8% +1.2% +1.5% +1.1% -2.1%

Number of Employees

Chart 6 compares the variation in the percentage of engaged staff across organization-level demographics for 2016

and provides the trend from the 2015 data for each. While trends from 2015 vary slightly among the demographics,

there is very little variation in the level of engagement by demographic. The largest increases in engagement came

from organizations with both the lowest and highest number of employees, indicating positive engagement trends

are possible for both small and large health systems. Unionized organizations not only increased engagement from

2015, but their level of engagement is now outpacing the overall benchmark.

Percentage Point Change from 2015

Overall

Average

43.2%

*Outside Industries reflects 2015 data

48.9% 46.2% 44.4% 44.4% 43.1% 43.0% 41.4% 40.3% 38.8%

29.7%

9.5%

CorporateServices

Children's Heart Institute Outpatient Short TermAcute

Critical Access PhysicianPractice/Clinic

Psych Post-AcuteCare (PAC)

Research Cancer Center

Chart 7: Variation in Percentage of Engaged Staff by Facility Type


Percentage Point Change from 2015

+5.1% +4.6% +2.7% +4.3% +2.5% +6.0% +5.1% +2.3% +0.7% -12.8% -34.6%

Chart 7 compares the variation in percentage of staff engaged across facility types as well as the trend from 2015.

As we have seen in previous years, engagement levels vary remarkably little across facility types, with the exception

of research and cancer centers, both of which experienced significant declines from 2015. In contrast, we see

stronger levels of engagement compared to 2015 among several of the specialized facility types, including critical

access, corporate services, children’s, and outpatient facilities.

Overall

Average

43.2%

Chart 8: Variation in Percentage of Engaged Staff by Department Type

Percentage of Staff Engaged, 2014-2016

36.8% 37.8% 40.3% 39.5%

40.2% 42.8% 44.6%

43.1% 44.5%

30%

35%

40%

45%

50%

2014 2015 2016

Nursing Clinical (Non-Nursing) Non-Clinical

Chart 8 compares the percentage of engaged staff across Nursing, Clinical (Non-Nursing) and Non-Clinical areas from

2014-2016. As in years past, we see the lowest levels of engagement among nursing staff, with non-clinical employees

experiencing the strongest levels of engagement. However, clinical areas (both nursing and non-nursing) are improving

faster, and therefore are beginning to close the gap when compared to their non-clinical peers.

55.8% 53.6% 53.1% 51.0% 49.6% 48.8% 47.2% 47.2% 47.0% 46.2% 46.1% 45.9% 45.5%

45.3% 44.9% 44.5% 44.3% 44.3% 44.3% 44.1% 43.6% 43.0% 42.9% 42.8% 42.5% 42.5% 42.4%

Chart 9: Variation in Percentage of Engaged Staff by Department


Overall Average 43.2%

Chart 9 compares employee engagement across health system departments. Similar to past years, 2016 shows

significant variation at the department level. Per Chart 8, non-clinical departments generally outperform clinical

departments, with some of the largest clinical departments (nursing, surgery/OR, and laboratory) trending toward

the bottom.

The differences in average engagement shown here underscore the importance of using healthcare-specific

benchmarks down to the department and nursing unit level when setting your engagement strategy. Given that

continued improvement is harder for higher performing groups, evaluating how much running room departments

have for improvement is an important step in setting principled goals. For example, a score of 45% engaged

should be considered high performing for the pharmacy department, yet low performing for HR. The Survey

Solutions’ goal setting calculator tales into account these benchmarks when setting department-level goals, and

ensures that department-level targets roll up to facility and system-wide goals.

Top 10 Largest Departments All Other Departments

42.1% 42.1% 41.8% 41.7% 41.6% 41.5% 40.9% 40.3% 40.2% 39.4% 39.2% 38.1% 37.3% 36.5%

55.7%

45.0% 44.6% 44.6% 43.7% 43.3% 43.0% 41.9% 41.8% 41.6% 40.6% 40.5% 39.8% 38.0% 37.7% 37.4% 37.1% 36.4% 35.2% 34.7%

Chart 10: Variation in Percentage of Engaged Staff by Nursing Unit Type

Percentage of Nursing Unit Staff Engaged, 2016

51.0%

43.1%

40.1% 39.7% 39.6% 38.6% 38.1% 37.9% 37.8% 37.6% 37.2% 37.1%

36.2% 35.6% 34.6% 34.3%

33.2% 32.1%

30.8% 30.8%

Chart 11: Variation in Percentage of Engaged RN Staff by Nursing Unit Type

Percentage of RNs Engaged, 2016

Chart 10 compares engagement at the nursing unit specialty level for 2016. As seen previously, nursing is one of

the least engaged departments at 40.3% compared to the overall benchmark of 43.2%. In general, levels of

engagement among nursing units decrease as patient acuity increases, with critical care, NICU, and ED showing

some of the lowest levels of nurse engagement.

Given the substantial variation in engagement levels at the nursing unit level, we strongly recommend using

nursing unit-level benchmarks when setting goals and prioritizing improvement opportunities. Unit-level

benchmarks are also important for organizations pursuing Magnet status.

Chart 11 compares RN engagement levels at the nursing unit-level. All non-RN job roles working on the unit have

been excluded from this analysis. While the general trend across unit types remains the same, the overall levels

of engagement are lower across the board, with RN engagement at 36.9% overall. This data further establishes

the need to focus on the nursing population and consider taking a unique approach to enhancing RN

engagement.

Top 5 Largest Unit Specialties All Other Unit Specialties

Top 5 Largest Unit Specialties All Other Unit Specialties

Nursing Average: 40.3%

RN Average 36.9%

Chart 12: Engagement Comparison by Leadership Level

Percentage of Engaged Respondents by Leadership Level, 2013 - 2016

73.4% 71.0%

73.5%

74.0%

63.1%

58.8% 60.4%

61.5%

39.5% 38.1%

39.6% 41.7%

25%

35%

45%

55%

65%

75%

85%

2013 2014 2015 2016

Executive

Manager/Director

Frontline Staff

Chart 12 compares engagement levels among executives, managers/directors, and frontline staff from 2013-2016. While

engagement is on the rise for all groups, the pace of improvement is fastest among frontline staff. Given this trend, we

recommend looking at the data by level for your organization to inform your strategy, and to consider a special focus on

leadership at all levels.

Chart 13: Engagement Comparison by Job Title

Percentage of Engaged Respondents by Job Title, 2016

74.0% 69.9% 65.9%

61.8% 59.1% 56.8% 55.2% 49.4%

45.5% 45.5% 45.2% 44.8% 43.0% 42.2% 41.7%

41.5% 41.5% 41.3% 40.9% 40.7% 40.2% 40.2% 39.9% 39.7% 39.0% 38.7% 37.3% 37.1% 36.9% 36.3%

Chart 13 compares engagement levels across different job titles. With the exception of RNs, the job titles with the greatest

number of employees fall towards the middle to high end of the performance spectrum. For leaders, engagement generally

increases with seniority.

Top 5 Largest Job Titles All Other Job Titles

Overall Average 43.2%

Chart 14: Top 10 Drivers by Impact on Engagement for All Employees

Rank Determined by Multivariate Regression Analysis of 42 Engagement Drivers1 for 2012, 2015 and

2016

My organization provides excellent customer service to patients.

1

3

4

2

9

6

5

13

15

12

2015

Rank

I am interested in promotion opportunities in my unit/department.

I believe in my organization’s mission.

My ideas and suggestions are valued by my organization.

My organization provides excellent care to patients

My current job is a good match for my skills.

The actions of executives in my organization reflect our mission and values.

I understand how my daily work contributes to the organization' mission.

My most recent performance review helped me to improve.

Executives at my organization respect the contributions of my unit/department.

Driver

1

2

3

4

5

6

7

8

9

10

2016

Rank

1

3

5

2

7

6

4

9

16

13

2012

Rank

The preceding charts highlight national levels of employee engagement across a number of demographic cuts. The next

logical question is why – what is driving these numbers, and how can we improve them? To answer this question, our

survey measures 42 key drivers of engagement. While each driver correlates individually with engagement, multivariate

regression analysis explains how much the drivers collectively drive variations in engagement. By accounting for all

drivers together, the resulting model also provides the relative impact of each driver on the desired outcome, which

cannot be obtained from individual correlations.

Chart 14 compares the results of this regression across 2012, 2015, and 2016. Overall, the top drivers of employee

engagement have remained remarkably consistent across the past several years. Employees are inspired by a strong

connection to their organization’s mission, and an executive team that animates that mission. Employees also value

recognition for hard work, an environment where their ideas are respected, and opportunities for promotion and

professional development. Three new drivers surfaced in 2016 when compared to 2015 – executive respect for

department contributions, customer service, and helpful performance reviews. Ensuring strong and consistent execution

on these drivers will have a significant impact on employee engagement.

1) Based on multivariate regression of 42 engagement drivers. The

2016 all staff model contains 25 drivers with an R2 value of 0.63.

Chart 15: Performance Variation on Top 10 Impact Drivers for All Employees

Percentage of Respondents Agreeing or Strongly Agreeing Per Organization

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

I believe in myorganization's

mission

My organizationprovides

excellent care topatients

My current job isa good matchfor my skills

The actions ofexecutives in my

organizationreflect our

mission andvalues

I understandhow my daily

work contributesto the

organization'mission.

I am interestedin promotion

opportunities inmy

unit/department

My ideas andsuggestions are

valued by myorganization

Executives atmy organization

respect thecontributions of

myunit/department

My organizationprovidesexcellentcustomerservice topatients

My most recentperformance

review helpedme to improve

Top 10 Drivers by Relative Impact on Engagement Median Inter-Quartile Range

2015 2016 2015 2016

I believe in my organization’s mission 88.3% 88.7% 8.1% 4.6%

My organization provides excellent care to patients 83.8% 83.0% 12.5% 9.4%

My current job is a good match for my skills 82.4% 83.6% 5.9% 4.1%

The actions of executives in my organization reflect our mission and values 67.0% 67.3% 18.2% 9.0%

I understand how my daily work contributes to the organization' mission. 87.1% 86.9% 7.7% 4.0%

I am interested in promotion opportunities in my unit/department 66.3% 65.9% 11.6% 6.9%

My ideas and suggestions are valued by my organization 58.1% 57.9% 14.5% 8.0%

Executives at my organization respect the contributions of my

unit/department 55.4% 58.6% 10.2% 7.3%

My organization provides excellent customer service to patients 76.3% 80.3% 8.1% 10.6%

My most recent performance review helped me to improve 63.3% 65.9% 7.4% 7.6%

Chart 16: Performance Variation on Top 10 Impact Drivers, 2015 to 2016

Percentage of Respondents Agreeing or Strongly Agreeing by Driver, All Staff

Chart 15 compares the spread in performance across organizations in 2016 for the ten highest impact drivers of

engagement. The shaded boxes highlight those drivers with the greatest running room nationally – in other words,

those with the lowest levels of agreement and the greatest variation in performance.

Based on this analysis, four of the top ten drivers have the greatest opportunity for improvement. These include

executive actions, both in modeling the mission and recognizing employees, interest in promotion opportunities,

and valuing employee ideas and suggestions.

Chart 16 compares the median score and inter-quartile range across the top ten impact drivers in 2015 and

2016. The inter-quartile range measures the performance gap between the 75th and 25th percentile scores for

each driver within our cohort. The middle 50% of organizations fall within the inter-quartile range, with 25% of the

cohort scoring above it and 25% of the cohort scoring below it. While median performance has increased for six

of the ten drivers, the inter-quartile range has decreased across all drivers, indicating less variation in

performance across organizations.

Chart 17: Top 10 Drivers by Impact on Engagement for Leaders1

Rank Determined by Multivariate Regression Analysis of 42 Engagement Drivers2

Manager

Rank Driver All Staff

Rank

1) Leadership included respondents in the following job roles: “Director (Clinical)”, “Director (Non-Clinical)”,

“Executive/VP”, ‘”Manager (Clinical)”, “Manager (Non-Clinical)”.

2) Based on multivariate regression of 42 engagement drivers. The 2016 all staff model contains 25 drivers with an R2

value of 0.63. The 2016 manager model contains 21 drivers with an R2 value of 0.59. The 2016 director model

contains 15 drivers with an R2 value of 0.56. The executive model contains 8 drivers with an R2 value of 0.51.

Chart 17 compares the top impact drivers of engagement for leadership (managers, directors, and executives) to the

top impact drivers for frontline staff. Bolded drivers indicate those that overlap with the top ten drivers of all staff

engagement. In general, top drivers of managers and directors are extremely similar and overlap quite a bit with those

of frontline staff engagement, including mission, executive actions, and patient care.

Drivers of engagement look significantly different for executives. Mission and executive actions remain important,

indicating even senior leaders recognize the importance of their role in driving engagement. Beyond that, executives

are looking for clear expectations of their role, support from their peers, and successful selection and implementation of

technology.

Director

Rank Executive

Rank

1 I believe in my organization’s mission. 1 1 1

2 My current job is a good match for my skills. 3 3 --

4 The actions of executives in my organization reflect our mission and values. 4 4 3

5 I understand how my daily work contributes to the organization' mission. 5 8 --

3 My ideas and suggestions are valued by my organization. 7 6 --

7 My organization gives back to the community. 20 5 --

6 My organization recognizes employees for excellent work. -- 10 --

9 I have job security. 13 -- 7

My organization provides excellent care to patients. 8 2 2 --

-- I know what is required to perform well in my job. 16 11 4

10 I am interested in promotion opportunities in my unit/department. 6 15 --

19 My manager stands up for the interests of my unit/department. 18 7 2

14 Executives at my organization respect the contributions of my

unit/department 8 9 --

-- Over the past year I have never been asked to do something that

compromises my values -- -- 8

11 I receive the necessary support from employees in other units/departments

to help me succeed in my work. 11 12 5

15 My organization does a good job of selecting and implementing new

technologies to support my work. 14 -- 6

Chart 18: Variation in Employee Review Score by Engagement Category

Percentage Receiving Top Employee Review Scores, 2015

4.8%

9.2% 10.3%

15.1%


N = 9,117

Chart 19: Top 10 Drivers Most Predictive of Engaged vs. Content Staff

Determined by Regression Analysis of 42 Engagement Drivers1

I am interested in promotion opportunities in my unit/department.

I believe in my organization’s mission.

My ideas and suggestions are valued by my organization


unit/department

My organization provides excellent care to patients.

My current job is a good match for my skills.

My organization helps me deal with stress and burnout

I understand how my daily work contributes to the organization’s mission.

Driver

1

5

2

3

4

6

7

8

12

14

All Staff

Multivariate

Rank

The actions of executives in my organization reflect our mission and values

Engaged vs.

Content

Logistic Rank1

1

3

2

4

5

6

8

9

7

10 My organization pays me fairly for my job

Mean Review Score 3.31 3.39 3.49 3.58

1) Our Engaged vs. Content model is a logistic regression, which predicts whether respondents will fall into one of two discrete

categories. Logistic regression models do not produce an R-squared statistic that is comparable to a linear regression.

As an industry, research shows that engagement is a leading indicator of performance on several other key business

outcomes, including individual performance, patient satisfaction, and patient safety. The next few charts explore

these relationships.

Chart 18 illustrates the relationship between the percentage of employees receiving the top review score and their

relative engagement category. Engaged employees are three times more likely to be high performers than their

disengaged counterparts, and 1.5 times more likely than content employees. Moving from content to engaged

corresponds to the greatest increase in top review scores, indicating organizations should consider focusing on

building engagement among their content staff to have the greatest impact on employee performance.

In order to make this move, we must understand the underlying drivers that differentiate engaged employees from

content employees. Chart 19 compares the top impact drivers most predictive of whether staff are content or

engaged. The majority of drivers on this list overlap with the top ten drivers of overall engagement, meaning that by

focusing on these drivers, we not only aim to drive engagement across the full spectrum, but also to inflect the move

from content to engaged.

For organizations looking to double-down on content to engaged efforts, we recommend considering a focus on two

additional drivers – stress and burnout, and fair pay. These two drivers are significantly more predictive of content

versus engaged employees.

Engaged respondents are 3x more likely to receive the

top review score than disengaged respondents and

1.5x more likely than content respondents.

Chart 20: Performance Variation on Strong Agreement with Top Drivers of Engagement, 2016

Percentage of Respondents Strongly Agreeing by Engagement Category

Top 10 Drivers of All Staff Engagement Content Engaged Gap

I believe in my organization's mission 25.7% 68.5% 42.8%

My organization provides excellent care to patients 24.1% 70.9% 46.7%

My current job is a good match for my skills 25.5% 67.6% 42.1%

The actions of executives in my organization reflect our mission and

values 15.3% 82.3% 67.0%

I understand how my daily work contributes to the organization' mission. 24.1% 70.0% 45.9%

I am interested in promotion opportunities in my unit/department 25.8% 66.4% 40.5%

My ideas and suggestions are valued by my organization 12.4% 86.1% 73.7%


unit/department 13.7% 84.5% 70.9%

My organization provides excellent customer service to patients 22.8% 72.5% 49.7%

My most recent performance review helped me to improve 16.5% 80.7% 64.3%

Chart 20 compares the percentage of engaged and content employees who strongly agree with the top 10 drivers

most predictive of overall staff engagement. While the difference in the percentage of employees who agree or

strongly agree with these questions is minimal, there are significant differences when looking at the top box score

(strongly agree). The bolded drivers are those with the greatest differences in level of strong agreement, including

executive actions and recognition, ideas and suggestions being valued, and useful performance reviews.

For this reason, many of our most progressive partners have started to focus on increasing their ‘Strongly Agree’

scores instead of their ‘Agree/Strongly Agree’ scores for key drivers. As shown above, getting employees to strongly

agree with your organization’s performance on these drivers is a critical step in engaging content employees.

Chart 21: Linkage Between Employee Engagement, Patient Satisfaction, and Culture of Safety

Top Correlations Between Employee

Engagement Drivers and Patient Satisfaction

Correlation between HCAHPS Overall Rating and

Driver Score

0.47 0.45 0.44 0.44 0.44

Supportsemployee

safety.

Conflictsresolved

fairly

Ideas andsuggestionsare valued

Excellentcare to

patients.

Excellentservice topatients

Top Correlations Between Employee

Engagement Drivers and Culture of Safety

Correlation between AHRQ Overall Hospital Patient

Safety Grade and Driver Score

0.33

0.25

0.41

HCAHPS OverallHospital Rating

HCAHPSWillingness toRecommend

AHRQ Culture ofSafety PatientSafety Grade

0.55 0.55

0.38 0.38 0.36

Excellentcare ofpatients

Excellentservice topatients

Supportsemployee

safety

Supplies andequipment

Selecting andimplementing

newtechnologies

Correlation Between Employee Engagement

and Key Indicators of Patient Satisfaction and

Culture of Safety

Increase in relevant measure corresponding to 1%

increase in engagement

Chart 21 explores the relationship between employee engagement and two key business outcomes: patient

satisfaction and patient safety. The top chart shows the overall correlation between these metrics, while the bottom

two charts show the engagement drivers that have the greatest impact on patient satisfaction and patient safety,

respectively.

Predictably, employee perceptions of the quality of care and service patients receive are highly correlated to both of

these outcomes. The extent to which the organization supports employee safety is also correlated to both

metrics. These drivers represent the most promising opportunities to simultaneously advance patient satisfaction and

patient safety outcomes through employee engagement efforts.

In addition, employee perceptions of supplies, technology, and equipment have an outsized impact on patient

satisfaction scores. Employees feeling as though their ideas and suggestions are valued and that conflicts are

resolved fairly have a significant impact on patient safety scores.

Chart 22: Mean Scores for Magnet Categories, 2016

Mean Scores by Magnet Category, RNs only

Magnet Category

Benchmark Mean on

6-point Agreement

Scale

Fundamentals of Quality Nursing Care 5.11

Inter-professional Relationships (includes all disciplines) 5.00

Autonomy 4.99

RN-to-RN Teamwork and Collaboration 4.98

Professional Development (education, resources, etc.) 4.65

Adequacy of Resources and Staffing 4.38

Leadership Access and Responsiveness (includes nursing administration/CNO) 4.36

Starting in 2016, Magnet began requiring applicants to report survey data on questions mapping to at least

four of their seven categories, in addition to overall nurse engagement scores. Advisory Board Survey

Solutions has developed a proprietary 15-question bundle that can be added to our core survey instrument,

making the engagement survey Magnet-compliant and providing organizations benchmark comparisons for

all seven Magnet categories. These questions have been approved by the ANCC to meet the 2016 Magnet

requirements.

Chart 22 shows average scores across all seven Magnet categories. Nurses are most satisfied with the

fundamentals of quality nursing care and inter-professional relationships, and least satisfied with leadership

access and responsiveness as well as resources and staffing.

21.5%

17.8%

13.4%

9.8%


Chart 23: Turnover Rate by Engagement Category

Percentage of Respondents No Longer with the Organization One Year Later

N = 14,766

Chart 23 compares the turnover rate across employee engagement categories one year following the employee

engagement survey. While higher turnover rates among disengaged staff can be desirable, it is interesting to note that

moving content staff to engaged has a much lower impact on their turnover rate than it does on their performance. It

may be worthwhile for organizations to consider a specific focus on retention for certain populations.

Chart 24: Gap Between Engagement Index and Likelihood to Stay Score

Engagement Index Minus Likelihood to Stay Mean by Age and Tenure Cohort, 2015

Age Tenure

Less than 1 year 1-3 years 4-6 years 7-15 years Greater than 15 years

Younger than 25 0.44 0.41 -- -- --

25-35 0.20 0.23 0.09 -0.03 --

36-45 0.09 0.10 0.01 -0.06 -0.17

46-55 0.06 0.05 -0.01 -0.09 -0.17

Older than 55 0.19 0.18 0.17 0.16 0.29

Chart 24 compares respondent engagement to respondent loyalty across different combinations of age and

organizational tenure. Loyalty scores are based on respondents’ answers to the question “I am likely to be working for

this organization three years from now.”

The gaps in the chart above are calculated by subtracting the mean loyalty score for each group from the mean

engagement score. Positive gaps indicate that a group is more engaged than it is loyal. Across most age cohorts,

there is little to no gap between engagement and loyalty. While older respondents close to retirement are predictably

more engaged than they are loyal, we see a similar pattern among Millennials aged 35 and under during their first

three years of tenure. This data suggests that organizations may need to supplement their engagement strategy with

targeted retention efforts for their Millennial population.

Driver Millennial

Loyalty Rank

Overall

Engagement

Rank

The actions of executives in my organization reflect our mission

and values 1 4

My current job is a good match for my skills 2 3

My most recent performance review helped me to improve 3 10

I am interested in promotion opportunities in my unit/department 4 7

I receive effective on the job training 5 --

My ideas and suggestions are valued by my organization 6 5

My organization does a good job of selecting and

implementing new technologies to support my work 7 15

The benefits provided by my organization (such as health

care, retirement savings, etc.) meet my needs 8 21

My organization provides excellent care to patients 9 2

My organization helps me deal with stress and burnout 10 12

Chart 25: Top Drivers of Millennial Loyalty Compared to Top Drivers of Overall Engagement

Chart 25 explores the top drivers of Millennial loyalty as compared to the top drivers of engagement. The

majority of drivers overlap, indicating a focus on employee engagement will also serve to drive Millennial

loyalty. However, there are a few drivers unique to Millennial loyalty indicated in bold. These include

effective on the job training, technology selection and implementation, benefits, and stress and burnout..

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