Survey Solutions

Employee Engagement

Data-Driven Insights for

Your 2016 Employee
Engagement Strategy
Findings from the Advisory Board Survey Solutions’ National Engagement Database

©2016 The Advisory Board Company • advisory.com


Survey Solutions Employee Engagement
Project Director
Anne Terry, Senior Director
Research Team
Charlie Carbery
Abby Martin
Program Leadership
Sarah Strumwasser, Senior Director
Steven Berkow, Executive 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 abssinfo@advisory.com if you would like to see more on:
• Additional cuts of our benchmark
• Analysis of our key findings
• Best practices.
©2016 The Advisory Board Company
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2 advisory.com
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
in the last 24 months, please contact us at ABSSinfo@advisory.com or visit advisory.com/abss.

Ensuring a Return on Your

1M+
Survey respondents
20,000+
Action plans created via
online action planning tool
10% Survey Investment
Average annual improvement Key Attributes of Our Solutions
in engagement
› Right Question Set for the Right People
90%+ › Prescriptive Results
Annual renewal rate
› Change Management Expertise

› Leader-Centric Action Plans

Representative Offerings

EMPLOYEE ENGAGEMENT SURVEY PHYSICIAN ENGAGEMENT SURVEY

360˚ support for advancing Targeted survey questions for employed,
provider staff commitment affiliated, and independent physicians

NURSE ENGAGEMENT SURVEY PHYSICIAN NEEDS ASSESSMENT

Magnet-compliant assessment with Solicits medical staff input to inform
department- and unit-level drill-downs future investments in provider network

CULTURE OF SAFETY SURVEY PATIENT EXPERIENCE PLATFORM

End-to-end administration and Captures real-time patient feedback
analytics for the AHRQ survey suite and creates actionable insights

CULTURAL AUDIT LEADER CENTRIC ACTION PLANNING

Defines an organizational culture that Best-in-class software for integrating
will attract, retain, and inspire top talent performance improvement efforts

©2016 The Advisory Board Company 3 advisory.com

Ten Data-Driven Insights

You can improve

engagement with
1
concerted effort
Let our national benchmarks inspire your ambition, as we have yet to find the ceiling on
hospital and health system employee engagement. Not only does our cohort set a new
“high score” every year, our partners at every level of performance are making larger
year-over-year gains than ever before and those at the 75th percentile are now
engaging nearly half of their employees.

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

improve upon that performance. Only 42% of organizations starting above our mean
engagement score improved, compared to 65% of those starting below the mean. But
that improvement was significant, 5.5 percentage points on average for those starting
above the mean.

See Charts 1 and 2 for employee engagement trends across 2014 and 2015. See
Chart 3 for how starting engagement scores impact the pace of improvement over time.

Challenge assumptions
about what constitutes
a demographic barrier
2 Our 2015 hospital and health system data set shows little need to downgrade your
to engagement
organization’s engagement ambition based on your system’s size or teaching status.
In many cases, including in the presence of an employee union, organizations with
perceived demographic disadvantages are outperforming the national average.
Furthermore, hospitals and health systems have a substantial engagement advantage
over employers in other industries. For the vast majority of health systems, comparing
to generic industry benchmarks will yield lackluster goals: our cohort is more than
twice as engaged as employees in other industries.

See Chart 4 for how employee engagement levels compare across industries. See
Chart 5 for how employee engagement levels compare across organization-level
demographics.

engagement in the
3
It is time to tackle

biggest clinical
Across the industry, the biggest opportunity to boost engagement lies in targeting
several of the largest clinical departments: pharmacy, surgery/OR, laboratory, and
of course, nursing. These four departments make up approximately 40% of the
typical hospital workforce and are perennially among the least engaged groups.
departments This need not be the case—other large, clinical departments such as imaging and
rehab tend to have higher engagement levels, and for 15% of our cohort, nursing is
more engaged than the organization as a whole.

See Chart 7 for employee engagement trends by department type. See Chart 8 for
how employee engagement compares across departments.

©2016 The Advisory Board Company 4 advisory.com

 Look beyond staffing
richness to offset the
engagement-sapping
4 Patient acuity is the common thread across the five unit types with the lowest
engagement within the nursing department: OR, critical care, ED, PICU, and NICU,
even though these units offer richer staffing ratios and often higher pay differentials.
Adequate staffing and competitive compensation are necessary but not sufficient for
effects of job intensity driving engagement—nationally, executive recognition of these nurses’ contributions
on high acuity units and an emphasis on employee safety are often the difference between contentment
and engagement. As with the large clinical departments, dedicated focus on these
units has the potential to drive significant improvement in organization-wide
engagement levels given their size.

See Charts 9 and 10 for nursing unit staff engagement across unit specialties. See
Chart 17 for the top impact engagement drivers for RNs in high-acuity units.

Our partners are

seeing early impact of
our leadership
5 2014 saw a sizable drop in leader engagement, particularly among directors and
executives. The Advisory Board’s HR Advancement Center partnered with Advisory
Board Survey Solutions on a data-driven approach to identify the solvable challenges
in engaging hospital and health system leaders and corresponding best practices in
engagement work response. Not surprisingly, you need an increasingly differentiated approach from
your overall engagement strategy when you focus on more senior leaders.

This can mean targeting different issues—for example, benefits become more
important than pay at senior levels, and career pathing conversations, technology
selection, and collaboration with other departments are all much more important to
VPs and CXOs than to frontline staff or more junior leaders. It can also mean taking a
different approach to addressing the same engagement driver—for example,
addressing communication with leaders is as much about equipping them to
communicate with their staff as it is about making sure they have the information
themselves.

While leader engagement in our cohort has not yet returned to 2012 levels, it is back
on the rise at every level of management.

See Chart 11 for engagement levels and trends by leadership level. See Chart 16 for
the drivers with the greatest impact on leader engagement.

Click here to read the HR Advancement Center’s ‘Data-Driven Prescription for Leader
Engagement’.

©2016 The Advisory Board Company 5 advisory.com

 After accounting for
relative impact, focus on
the engagement drivers
6 The top drivers of all staff engagement have been remarkably stable across the last
your organization can
realistically improve
Aim for ‘Strong
Agreement’ to drive
engagement—and
7 Engaged employees are 1.5 times more likely to receive top performance ratings
employee performance
Integrate your staff
engagement efforts with
your Magnet journey
8 The most successful organizations don’t silo engagement from other performance
©2016 The Advisory Board Company
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 recognition outscore organizations at the 25th
percentile by nearly 18 percentage points whereas only 8 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.
Our cohort pushes the ceiling higher on these drivers each year. At the same time,
we are seeing more performance variation on these drivers over time, meaning that
a subset of health systems are losing ground.
See Chart 13 for the drivers with the greatest impact on employee engagement. See
Charts 14 and 15 for how organizations perform on these drivers, or the relative
room for improvement.
than content employees, and 3 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 service excellence and setting clear expectations. The
major difference is in their perception of organizational performance—on average,
engaged employees are 2-5 times more likely to ‘Strongly Agree’ with these drivers
than content ones.
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 these drivers.
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.
See Chart 24 for national performance on the Magnet-approved bundles of drivers
mapping to their key themes.
6 advisory.com
 Balance overlapping
and dedicated initiatives
for patient satisfaction,
9 Our data is clear: 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.
culture of safety, and Accordingly, we work with our partners to target best practices with the highest
employee engagement potential to simultaneously inflect performance across multiple goals.

Nonetheless, beware of over construing the data in the name of streamlining your
efforts. For many organizations we’ve worked with, there has been limited overlap in
the opportunities presented by their specific data or even in the relationship between
engagement and other outcomes 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 23 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
In light of the looming staffing shortage, hospitals and health systems are encouraged
to supplement their engagement efforts with a retention strategy specifically targeting
employees aged 35 and younger. There is 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 after 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.

Advisory Board Survey Solutions is partnering with the HR Advancement Center to

identify best practices for retaining new hires across their first three years with your
organization for their upcoming 2016 national meeting series.

See Chart 21 for turnover rates by employee engagement level. See Chart 22 for the
gap between engagement and loyalty by age and organization tenure.

Click here to register for the HR Advancement Center’s 2016 national meeting.

©2016 The Advisory Board Company 7 advisory.com

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

80%

70% 70.3% 71.2% 99th percentile

60%

50% 48.5% 75th percentile

46.8%
40%
33.7% 33.7% 25th percentile
30%

20%
16.8%
10% 9.5% 1st percentile

0%
Surveyed in 2014 Surveyed in 2015

Chart 1 compares the 2014 and 2015 performance distributions for employee engagement. As an industry, we are
seeing slight improvement at the 50th and 75th percentile. Of particular note is the decline in engagement at the
bottom of the distribution, indicating that a lack of focus on engagement can lead to significant declines, no matter
your starting point.

Chart 2: Staff Engagement Distribution by Year

Percentage of Respondents by Engagement Category, 2013-2015

39.6% 40.0% 40.5% 41.1% 40.0% 41.1%

In 2015, multi-year partners

had an average percent
13.8% 14.2% 13.4% engaged of 42.1%,
compared 39.0% for first
5.5% 5.7% 5.0% year partners

Disengaged Ambivalent Content Engaged

2013 2014 2015

Chart 2 compares the 2013-2015 performance distribution across all four categories. We are seeing movement in all the
right directions, with increases in the content and engaged categories coupled with decreases in the ambivalent and
disengaged categories. Additionally, the percentage of engaged staff is higher among multi-year partners than first year
partners, indicating that a dedicated, year-over-year focus on engagement does in fact lead to meaningful improvement.

©2016 The Advisory Board Company 8 advisory.com

 Chart 3: Influence of 2014 Engagement Scores for Improvement in 2015

Average Improvement of Engagement Percentage of Facilities Improving

Comparing Average Improvement of Organizations Comparing Initial Scores to Relevant
Above and Below Database Median Database Median

Percentage points among

5.5 improving facilities that
began above the median

Percentage points among

65% 42%
8.7 improving facilities that
Below
median
Above
median
began below the median

Chart 3 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 incremental 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 3.1 percentage points in 2014, compared to 5.5 percentage points in 2015.

Chart 4: Staff Engagement in Health Care vs. Outside Industries

Percentage Respondents by Engagement Category, 2015

40.5% 41.1%
35.4%
30.1%

20.4%
14.1% 13.4%

5.0%

Disengaged Ambivalent Content Engaged

Hospitals and Health Systems All Other Industries

Chart 4 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. And it is not because employees in other
industries are highly satisfied but not engaged—disengagement among non-healthcare employees is almost three
times that of staff within our cohort. These findings corroborate cross-industry results we have seen using other
surveys’ engagement measures as well.

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.

©2016 The Advisory Board Company 9 advisory.com

 Chart 5: Variation in Percentage of Engaged Staff by Organization Type
Percentage of Staff Engaged, 2015

System Size Number of Employees Unionization Teaching Status

42.8% 43.9%
41.7% 41.5% 41.0% 40.8% 40.9% 41.7% 40.1% Overall
39.4% 39.4% 39.0%
Average
41.1%

Single Facility 2-3 Facilities 4+ More Less than 2k 2k to 5k 5K to 10k 10k or more Unionized Non-Union AMC Non-Teaching Teaching
Facilities Employees employees employees employees

Percentage Point Change from 2014

-1.0% -1.8% +1.5% -2.4% +0.4% +3.3% +0.2% +4.0% +1.1% +1.0% +0.6% +0.1%

Chart 5 compares the variation in the percentage of engaged staff across organization-level demographics for 2015
and provides the trend from the 2014 data for each type. The most noteworthy trends are based on organization
size. Smaller organizations – those with less than three facilities or less than 2,000 employees – saw decreases in
engagement from 2014. In contrast, larger organizations – those with four or more facilities and greater than 2,000
employees – experienced increases in engagement. Contrary to widespread concerns, consolidation across the
industry may actually be contributing positively to engagement. Additionally, unionized organizations experienced a
four percentage point increase in engagement, with engagement among unionized organizations now outpacing the
overall benchmark as a result.

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

Percentage of Staff Engaged, 2015

44.1% 43.8% 42.5% 41.7% 41.6% 40.6% 40.1% Overall

38.1% 38.0% 37.0% 36.3% Average
41.1%

Cancer Center Corporate Research Heart Institute Children's Short Term Outpatient Post-Acute Psych Critical Access Physician
Services Acute Care (PAC) Practice/Clinic

Percentage Point Change from 2014

+17.4% +0.1% +9.0% +6.0% +1.6% +0.9% +1.9% -3.5% +0.4% +0.7% +3.4%

Chart 6 compares the variation in percentage of staff engaged across facility types and from 2014 to 2015. As we
have seen in previous years, engagement levels vary remarkably little across facility types. In contrast to 2014, we
see stronger levels of engagement among several of the specialized facility types, including cancer centers,
research entities, and heart institutes. All facility types saw an increase in engagement from 2014 with the exception
of post-acute care (PAC) facilities.

©2016 The Advisory Board Company 10 advisory.com

 Chart 7: Variation in Percentage of Engaged Staff: Nursing, Other Clinical, and Non-Clinical
Percentage of Staff Engaged, 2013-2015
50% In 2015, only 15.1% of
43.1% organizations had higher
45% 44.6% 44.4% engagement for nursing
40.7% 39.5% department staff than overall.
40% 40.2%
Nursing department staff
37.7% 36.8% 37.8%
made up 28.1% of all
35%
respondents in 2015.
30%
2013 2014 2015

Nursing Clinical (Non-Nursing) Non-Clinical

Chart 9 compares the trend in the percentage of engaged staff across Nursing, Clinical (Non-Nursing) and Non-Clinical
areas from 2013-2015. As in years past, we see the lowest levels of engagement among nursing staff, with non-clinical
employees experiencing the strongest engagement.

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

Percentage of Staff Engaged, 2015
Top 10 Largest Departments All Other Departments
53.5%
50.7% 48.4% 48.1%
47.9% 46.7% 46.4% 45.8%
44.8% 44.0% 43.9% 43.8% 43.7%

Overall Average 41.1%

43.4% 43.3% 43.2% 43.2% 42.3% 41.9% 41.9% 41.8% 41.7% 41.7% 41.0%
40.7% 40.7%

40.3% 40.1% 39.6% 39.5% 39.1% 39.0% 38.9% 38.5%

37.8% 37.7% 37.2% 37.1% 36.2%

Chart 8 compares employee engagement across health system departments. Similar to past years, 2015 shows
significant variation at the department level. Per Chart 7, non-clinical departments generally outperform clinical
departments, and nursing remains toward the bottom of the spectrum.

The differences in average engagement shown here should inform your goal setting strategy, particularly if you tie
engagement to financial incentives at the manager level. Given that continued improvement is harder for higher
performing groups, you need to set a principled bar to evaluate how much running room different departments
have. For example, a score of 40% engaged should be considered high performing for the pharmacy department,
but low performing for HR. The Survey Solutions’ goal setting calculators reflect these benchmarks and also
ensure that targets roll up to the facility and system-wide goals.
©2016 The Advisory Board Company 11 advisory.com
 Chart 9: Variation in Percentage of Engaged Staff by Nursing Unit Type
Percentage of Nursing Unit Staff Engaged, 2015
Nursing Average 37.8%
43.1% 42.0%
41.8%
40.1% 40.0% 39.7% 39.5%
39.0% 38.9% 38.7% 38.4%
37.1% 36.8%
34.9%
33.5% 33.1%
31.4%
30.2%

Top 5 Largest Unit Specialties All Other Unit Specialties

Chart 9 compares engagement at the nursing unit specialty level for 2015. As seen previously, nursing is one of
the least engaged departments at 37.8% compared to the overall benchmark of 41.1%. In general, levels of
engagement among nursing units seem track inversely to the level of patient acuity. For example, NICU,
emergency, and critical care among the least engaged unit types.

Given the substantial variation in engagement levels at the nursing unit level, we strongly recommend using unit-
level benchmarks when setting goals and prioritizing improvement opportunities. Unit-level benchmark are also
essential for organizations pursuing Magnet status.

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

Percentage of RNs Engaged, 2015

45.8%

41.2%
RN Average 34.5%
38.8%
37.9%
36.3% 36.3% 36.1% 35.9% 35.5%
35.3% 35.0% 34.8%
33.5% 33.1%
31.7%
29.6% 29.5% 29.5%
27.1%

Top 5 Largest Unit Specialties All Other Unit Specialties

Chart 10 compares RN engagement levels at the nursing unit specialty level with all non-RN job roles working on
the unit excluded from the data. While the general trend across unit types remains the same, the overall levels of
engagement generally tend to be lower, with RN engagement at 34.5% overall. This data further establishes the
need to focus on the nursing population and consider taking a unique approach to enhancing RN engagement.

©2016 The Advisory Board Company 12 advisory.com

 Chart 11: Engagement Comparison by Leadership Level
Percentage of Engaged Respondents by Leadership Level, 2012 - 2015
85%

75% 75.8%
73.4% 73.5%
71.0%
65%
62.9% 63.1%
58.8% 60.4%
55% Executive
Manager/Director
45% 39.5% 38.1% Frontline Staff
38.8% 39.6%
35%

25%
2012 2013 2014 2015

Chart 11 compares engagement levels among executives, managers/directors, and frontline staff form 2012-2015. While
engagement is on the rise for all groups, managers and directors are still lagging behind 2013 levels. We recommend
putting special emphasis on mid-level leaders to ensure their engagement continues to move in the right direction.

Chart 12: Engagement Comparison by Job Title

Percentage of Engaged Respondents by Job Title, 2015

73.5% 68.7% Overall Average 41.1%

62.8% 61.4%
55.8% 55.5% 55.1%
46.2% 44.0% 43.9% 42.5% 41.3% 40.7% 40.1% 39.9%

39.8% 39.0% 38.8% 38.2% 38.1% 37.7% 37.4% 37.3% 37.1% 36.9% 36.2% 35.5% 34.5% 34.5% 34.2%

Top 5 Largest Job Titles All Other Job Titles

Chart 12 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.

©2016 The Advisory Board Company 13 advisory.com

 Chart 13: Top 10 Drivers by Impact on Engagement for All Employees
Rank Determined by Multivariate Regression Analysis of 42 Engagement Drivers1 for 2012, 2014 and
2015

2012 2014 2015

Driver Rank Rank Rank

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

The actions of executives in my organization reflect our mission and values. 2 2 2
My organization provides excellent care to patients. 3 3 3
My current job is a good match for my skills. 5 4 4
My ideas and suggestions are valued by my organization. 4 6 5
I am interested in promotion opportunities in my unit/department. 6 5 6
My organization helps me deal with stress and burnout. 8 8 7
My organization recognizes employees for excellent work. 10 11 8
I understand how my daily work contributes to the organization’s mission. 7 7 9
My organization pays me fairly for my job. 12 9 10

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 also 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 models also provide the relative impact of each driver on the desired
outcome, which cannot be obtained from individual correlations.

Chart 13 compares the results of this regression across 2012, 2014, and 2015. 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. 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

2015 all staff model contains 21 drivers with an R2 value of 0.66.

©2016 The Advisory Board Company 14 advisory.com

 Chart 14: Performance Variation on Top 10 Impact Drivers for All Employees
Percentage of Respondents Agreeing or Strongly Agreeing Per Organization

100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Believe in Executive Organization Current job is Ideas and Interested in Support for Organization Daily work Competitive
organization's actions reflect provides good match for suggestions are promotion stress and recognizes contributes to compensation
mission mission excellent care skills valued burnout employees mission

Chart 14 compares the spread in performance across organizations in 2015 for the 10 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, 6 of the top 10 drivers have the greatest opportunity for improvement. General themes
across these 6 include executive actions, respect for ideas and suggestions, interest in promotion, support for
stress and burnout, recognition for hard work, and competitive compensation.

Chart 15: Performance Variation on Top 10 Impact Drivers – 2012 to 2015

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

Median Inter-Quartile Range

Top 10 Drivers by Relative Impact on Engagement
2012 2015 2012 2015

I believe in my organization’s mission 87.1% 88.3% 4.4% 8.1%

The actions of executives in my organization reflect or mission and values. 66.3% 67.0% 10.4% 18.2%

My organization provides excellent care to patients 81.6% 83.8% 8.2% 12.5%

My current job is a good match for my skills 81.4% 82.4% 3.5% 5.9%

My ideas and suggestions are valued by my organization 57.9% 58.1% 7.5% 14.5%

I am interested in promotion opportunities in my unit/department 65.6% 66.3% 7.0% 11.6%

My organization helps me deal with stress and burnout 41.6% 42.1% 8.3% 13.8%

My organization recognizes employees for excellent work 55.6% 56.7% 11.3% 17.7%

I understand how my daily work contributes to the organization’s mission 86.1% 87.1% 4.6% 7.7%

My organization pays me fairly for my job 50.7% 49.5% 11.0% 17.2%

Chart 15 compares the median score and inter-quartile range across the top 10 impact drivers in 2012 and 2015.
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. Not only has median performance increased for 9
out of 10 drivers, but the inter-quartile range has also increased across all drivers, indicating more variation in
performance across organizations.
©2016 The Advisory Board Company 15 advisory.com
 Chart 16: Top 10 Drivers by Impact on Engagement for Leaders1
Rank Determined by Multivariate Regression Analysis of 42 Engagement Drivers2

All Staff Manager Director Executive

Driver Rank Rank Rank Rank
I believe in my organization’s mission. 1 1 1 1
My current job is a good match for my skills. 3 2 2 3
I understand how my daily work contributes to the organization' mission. 5 3 6 5
The actions of executives in my organization reflect our mission and values. 4 4 4 4
My ideas and suggestions are valued by my organization. 7 5 5 2
My organization provides excellent customer service to patients. 15 6 -- --
My organization provides excellent care to patients. 2 7 3 6
Training and development opportunities offered by my organization have
helped me to improve. 9 8 16 --
I have job security. 14 9 13 11
I am interested in promotion opportunities in my unit/department. 6 10 -- --
My organization gives back to the community. -- 16 7 --
My organization recognizes employees for excellent work 8 15 8 --
I have the right amount of independence in my work. 16 11 9 --
I receive the necessary support from employees in other units/departments
to help me succeed in my work. -- -- -- 7
My organization does a good job of selecting and implementing new
technologies to support my work. 18 15 8 8
Over the past year I have never been asked to do something that
compromises my values -- 23 20 9
I have helpful discussions with my manager about my career -- -- -- 10

Chart 16 compares the top impact drivers of engagement for leadership (managers, directors, and executives) to the
top impact drivers for frontline staff. In general, leaders are inspired by the same top drivers as frontline staff, including
mission, executive actions, and patient care.

Beyond the top 5 drivers, engagement priorities start to diverge across seniority levels. It makes sense that frontline
leaders’ top engagement drivers most closely resemble those for frontline staff, though providing excellent service is a
stronger driver of engagement for them than for any other group. For managers and directors, autonomy is
substantially more important than it is at the frontline, though it’s interesting to note that at the executive level, having
the necessary support from others becomes the bigger priority. For your executive team, meaningful career pathing
conversations are more engaging than other forms of investment such as recognition or training and development.

1) Leadership included respondents 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 2015 all staff model contains 21 drivers with an R2
value of 0.66. The 2015 manager model contains 23 drivers with an R2 value of 0.57. The 2015 director model
contains 20 drivers with an R2 value of 0.58. The executive model contains 12 drivers with an R2 value of 0.43.

©2016 The Advisory Board Company 16 advisory.com

 Chart 17: Top 10 Drivers by Impact on Engagement for RNs in High-Acuity Care Settings1
Rank determined by Multivariate Regression Analysis of 42 Engagement Drivers2

All Staff High Acuity

Driver Rank RN Rank

My organization provides excellent care to patients. 3 1

I believe in my organization’s mission. 1 2
My ideas and suggestions are valued by my organization. 5 3
My current job is a good match for my skills. 4 4
The actions of executives in my organization reflect our mission and values. 2 5
I am interested in promotion opportunities in my unit/department. 6 6
I understand how my daily work contributes to the organization’s mission. 9 7
Executives at my organization respect the contributions of my unit/department. 13 8
Training and development opportunities offered by my organization have 11 9
helped me to improve.
My organization supports employee safety. 17 10

Chart 17 compares the top impact drivers of engagement for RNs in high-acuity patient care settings: OR, ED, NICU,
PICU, and critical care units.

While there is significant overlap with the highest impact drivers of engagement for all staff, providing excellent care is
by far and away the most critical driver for these RNs, trumping even the organization’s mission. Additional drivers that
contribute to engagement for these nurses more than for other types of staff include executive recognition for their
contributions and support for employee safety. Interesting to note that support for stress and burnout is not a top 10
impact driver for this cohort—it falls from #8 overall to #16 for nurses in intense care settings.

1) High-acuity care settings include the following unit types: OR, Emergency, PICU, NICU, and Critical Care.

2) Based on multivariate regression of 42 engagement drivers. The 2015 high-acuity RN model contains 24 drivers with
an R2 value of 0.63.

©2016 The Advisory Board Company 17 advisory.com

 Chart 18: Variation in Review Score by Engagement Category
Percentage Receiving Top Employee Review Scores, 2015
N = 9,117
15.1%
Engaged respondents are 3x more likely to receive the
9.2% 10.3% top review score than disengaged respondents and
1.5x more likely than content respondents.
4.8%

Disengaged Ambivalent Content Engaged

Mean Review Score 3.31 3.39 3.49 3.58

As an industry, we know 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. In addition, this data makes a strong case for focusing on moving content employees to
engaged. Moving from content to engaged corresponds to the greatest increase in top review scores.

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

Determined by Regression Analysis of 42 Engagement Drivers1
All Staff Engaged vs.
Multivariate Content
Driver Rank Logistic Rank1

I believe in my organization’s mission. 1 1

My organization provides excellent care to patients. 3 2
I understand how my daily work contributes to the organization’s mission. 9 3
My current job is a good match for my skills. 4 4
I know what is required to perform well in my job 20 5
I am interested in promotion opportunities in my unit/department. 5 6
The actions of executives in my organization reflect our mission and values 2 7
My organization gives back to the community -- 8
My organization provides excellent customer service to patients 15 9
My organization pays me fairly for my job 10 10
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 engagement drivers that are most predictive of whether staff
are content or engaged. The majority of drivers on this list overlap with the top 10 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
three additional drivers – understanding what is required to perform well in their role, giving back to the community,
and providing excellent customer service. These three drivers are significantly more predictive of content versus
engaged employees.
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.
©2016 The Advisory Board Company 18 advisory.com
 Chart 20: Performance Variation on Strong Agreement with Top Drivers of Engaged vs. Content, 2015

Percentage of Respondents Strongly Agreeing by Engagement Category

Top 10 Drivers Content Engaged Gap

I believe in my organization’s mission 28.6% 68.6% 40.0%

My organization provides excellent care to patients 26.6% 66.2% 39.6%

I understand how my daily work contributes to the organization’s mission 24.8% 64.9% 40.1%

My current job is a good match for my skills 24.7% 59.5% 34.8%

I know what is required to perform well in my job 32.1% 66.9% 34.8%

I am interested in promotion opportunities in my unit/department 21.2% 47.2% 26.0%

The actions of executives in my organization reflect or mission and values 9.7% 45.0% 35.3%

My organization gives back to the community 23.9% 60.6% 36.7%

My organization provides excellent service to patients 22.0% 59.0% 37.0%

My organization pays me fairly for my job 6.2% 28.3% 22.1%

Chart 20 compares the percentage of engaged and content employees who strongly agree with the top 10 drivers
most predictive of engaged versus content staff. 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 (strongly
agree).

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. As shown above, getting employees to strongly agree with your
organization’s performance on these drivers is critical to securing their engagement.

©2016 The Advisory Board Company 19 advisory.com

 Chart 21: Turnover Rate by Engagement Category
Percentage of Respondents No Longer with the Organization One Year Later
N = 14,423

22.4%

14.3%
11.7%
10.4%

Disengaged Ambivalent Content Engaged

Chart 21 compares the turnover rate across employee engagement categories one year following the employee
engagement survey. This preliminary analysis includes respondents for two large organizations in our cohort. While
higher turnover rates among disengaged staff are desirable to most organizations, it is interesting to note that moving
content staff to engaged has much lower impact on their turnover rate than it does on their performance.

Chart 22: 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 22 compares respondent engagement to respondent loyalty across different combinations of age and
organization tenure. Engagement is calculated as a mean of a respondent’s answers to the following four questions,
whereas loyalty is calculated as a mean only the fourth question:
• I would recommend this organization to family and friends as a great place to work
• I am inspired to perform my best
• I am willing to go above and beyond to help my organization succeed
• I am likely to be working for my organization three years from now

The gaps in the chart above were 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 are predictably more engaged than
they are loyal, we see a similar pattern among Millennials aged 35 and under during the first three years of tenure.
This data suggests that organizations may need to supplement their engagement strategy with targeted retention
efforts for their youngest, newest employees.

©2016 The Advisory Board Company 20 advisory.com

Chart 23: Linkage Between Employee Engagement, Patient Satisfaction, and Culture of Safety

Correlations Between Employee Engagement

and Key Indicators of Patient Experience and
Culture of Safety
Correlation between Measure and Engagement Index

0.41
0.33
0.25

HCAHPS Overall HCAHPS AHRQ Culture of

Hospital Rating Willingness to Safety Patient
Recommend Safety Grade

Top Correlations Between Employee Top Correlations Between Employee

Engagement Drivers and Patient Satisfaction Engagement Drivers and Culture of Safety
Correlation between HCAHPS Overall Rating and Correlation between AHRQ Overall Hospital Patient
Driver Score Safety Grade and Driver Score

0.55 0.55
0.47 0.45 0.44 0.44 0.44
0.38 0.38 0.36

Excellent Excellent Supports Supplies and Selecting and

care of service to employee equipment implementing Supports Conflicts Ideas and Excellent Excellent
patients patients safety new employee resolved suggestions care to service to
technologies safety. fairly are valued patients. patients

Chart 23 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,
though more so to patient safety than patient satisfaction. These drivers represent the most promising opportunities to
simultaneously advance patient satisfaction and patient safety outcomes through employee engagement initiatives.

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.

©2016 The Advisory Board Company 21 advisory.com

 Chart 24: Mean Scores for Magnet Category Bundles, 2015
Mean Scores by Magnet Category, RNs only

Benchmark Mean on
Magnet Bundle Theme 6-point Agreement
Scale

Autonomy 4.88

Professional Development (education, resources, etc.) 4.66

Leadership Access and Responsiveness (includes nursing administration/CNO) 4.24

Inter-professional Relationships (includes all disciplines) 4.90

Adequacy of resources and staffing 4.37

RN-to-RN teamwork and collaboration 4.91

Fundamentals of Quality Nursing Care1 Coming Soon

Starting in 2016, Magnet will require 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 proprietary question bundles that can be added to our core survey instrument to give
organizations working toward Magnet certification benchmark comparisons for all seven Magnet themes, all
of which have been approved by Magnet.

Chart 24 shows average scores across six of the seven Magnet themes we captured on our survey across
2015.1 Within our current benchmark, nurses are most satisfied with inter-professional relationships and
least satisfied with leadership access and responsiveness, echoing our earlier finding that one of the best
asks you can make of your executive team is to clearly communicate the connection between their actions
and the organization’s mission and values.

1) Magnet has approved our question set for the seventh dimension, Fundamentals of Quality Nursing Care,
which we began administering in H2 of 2015. We will begin reporting benchmarks for this dimension in 2016.

©2016 The Advisory Board Company 22 advisory.com

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