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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
LEGAL CAVEAT
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Company. Advisory Board has made efforts to verify
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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 BurbachJ@advisory.com 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 BurbachJ@advisory.com 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%
Disengaged Ambivalent Content Engaged
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 of Staff Engaged, 2016
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
Percentage of Staff Engaged, 2016
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%
Disengaged Ambivalent Content Engaged
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
Executives at my organization respect the contributions of my
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%
Executives at my organization respect the contributions of my
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%
Disengaged Ambivalent Content Engaged
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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