Actionable Tips for Improving the Employee Experience, Turnover & Patient Satisfaction

We recently conducted a study that focused on uncovering the key factors that impact two healthcare metrics – employee turnover and patient satisfaction (HCAHPS). Why? Because these factors are critical to healthcare organizations functioning effectively. Spoiler alert – the approach we outline in this blog works. Two recent examples of clients following this strategy resulted in significant return on investment. In one instance, the client reduced their Registered Nurse (RN) turnover from 19.8% to 11.8%, 8 full percentage points. In another example, the client reduced their turnover rate from 28% to 24% across the organization, resulting in a savings of more than $8 million.

If you still need an impetus to pay attention, take a look at the scary stats below that underscore the importance of healthcare facilities taking strategic aim at reduc­ing employee turnover, as well as providing an employee experience that links to improving the patient experience and HCAHPS scores.

  • Reimbursement Rates: HCAHPS scores are a factor in the reimbursement rates from the Centers for Medicare and Medicaid. Thus, poor performance on a hospital’s HCAHPS is tied directly to the bottom line.
  • Money, Money, & More Money: Turnover for patient-facing employees can have direct impact on the costs to the organization, increases in patient care ratios, increases to workload for remaining clinical staff, as well as negative impacts to patient care outcomes. Specifically, it has been found that RNs have an average turnover rate of 14.2%. Loss of one RN costs a hospital between $44,000 and $64,000, equating to an estimated loss of $4M to $6M a year1. Finally, because of the increased patient load on the remaining staff, it has been found that there is a 7% increased likelihood for failure to rescue or patient death for each additional patient2.

So, you now know why you must act; how do you take action? By the way, get all the details on the study in our recent white paper.

  • Focus on Senior Leadership, Job Fit, & Management: These are the strongest and most consistent drivers of both voluntary turnover and HCAHPS scores, based on the study. Get descriptions on these drivers here. Caveat: while these areas consistently relate to outcomes for SMD’s clients, it is still important to validate drivers of outcomes in your own organization. While these areas may come up as drivers, other nuanced drivers may be found in other organizations depending on the survey focus, organizational culture, and employ­ee makeup.
  • Directly assess the connections between the employee experience and subsequent turnover: You can pull a page from our book and do this – we revisit client survey data a few months after the survey administration. Using a file of employees who have since voluntarily exited the organization, we can flag employees in the survey data as turned over or still employed. This allows for an analysis of the direct drivers from the employee experience that are related to turnover. From here, you would know exactly what to focus on improving to reduce the likelihood that employees will exit. You also can review survey scores of those employees who remain with the organization by supervisor or department and know exactly where in the organization there is the most near-term risk of high turnover, based on the key drivers that are identified. Organizations are then equipped to make targeted, strategic steps to intervene and get in front of turnover.



1. Nursing Solutions, Inc. (2014). 2014 National Healthcare and RN Retention Report.

2. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288(16): 1987–93. doi:10.1001/jama.288.16.1987

What’s Trending in Healthcare HR Analytics?

You’re probably hearing “data” and “analytics” tossed around frequently but not sure which trends are meaningful or beneficial. We’ve cut through the clutter for you and boiled the trends down to the top five, along with the risk/challenge and benefit of each.

1. More Data & More Measurement: Many survey vendors and so-called “thought leaders” out there are touting the concept of “continuous listening” when it comes to surveys – meaning that organizations should be surveying their people all the time – or at least very often. However, we DO NOT recommend simply increasing the frequency for the sake of more measurement. There must be a measurement strategy with specific benefits and outcomes.

Risk or Challenge: Over surveying, lack of action, survey fatigue, low response rates

Benefit: When strategic, understand employee lifecycle, better information, pinpointed diagnosis of issues, better decisions

2. Integration of Data: HR needs to think beyond data sources that specifically relate to the employee and consider integrating traditional data sources with business metrics (e.g. HCAHPS, patient satisfaction). Although many questions can be answered using one data source, more strategic questions often require data from two or more sources.

Risk or Challenge: Working across silos and resistance to data sharing; data in different systems requires expertise in pulling data to one location and format

Benefit: Effective utilization of data sources to enable advanced analytic approaches; uncover connections between people data and business data; able to tell the whole story

3. Linking HR Data to Business Metrics: HR is in a state of transition, moving from a concentration on meeting internal metrics to identifying the links between metrics. Accumulation of data itself is not that interesting. The real utility of big data comes when it is used in predictive analytics. The outcome? Better talent decisions.

Risk or Challenge: HR becomes accountable for demonstrating ROI and change

Benefits: HR is able to become a strategic business partner for the organization; help make strategic business decisions; show value in HR initiatives

4. Analytics to Front Line Managers: Too often HR analytics projects stop with a PowerPoint presentation to senior leaders. This results in a series of HR initiatives to drive systemic (organizational) changes – e.g., a new series of courses for managers. You will see the most impact when the analytics are cascaded throughout the organization (all the way to the front line).

Risk or Challenge: Keeping it simple and actionable for managers; communicate what it means and how to use it; comfort of managers in receiving this information if this is new for them

Benefits: Managers are informed and empowered with an understanding of their workgroups and where they need to focus to drive the business; alignment and focus on action across all levels

5. Clinical vs. Non-Clinical: You’ve probably already been treating these two employee populations differently – perhaps with targeted measures on employee surveys. But, are you using analytics to uncover unique aspects of the employee experience for clinical vs. non-clinical (e.g., differences in drivers of turnover, unique competency models, different developmental needs)?

Risk or Challenge: Potentially adding a layer of complexity to the analysis and providing results

Benefits: Clear understanding of the differences among the two employee populations. This should be part of your measurement strategy in the healthcare setting


It’s Time to Operate (on your Talent Strategy): How HR Can Improve HCAHPS Scores & Readmissions

Are you exhausted from not having the answers to the following questions? Do HCAHPS scores drive readmissions? Or do readmissions drive HCAHPS scores? Wonder no longer – we have uncovered the answers. And, with the results from the research we conducted, you will be able to identify and address barriers to good performance and significantly improve HCAHPS scores, clinical process compliance, and readmission rates.

We performed an analysis of four years of Centers for Medicare and Medicaid Services (CMS) data at more than 3,000 healthcare facilities, which brought together multiple data points including HCAHPS scores, clinical care processes, and readmissions, as well as controls for hospital demographics (location and size). This study represents the most comprehensive analysis of CMS data us­ing advanced, cause-effect analytic techniques and conclusively determines which factors most affect patient care and satisfaction.

The study revealed that the five key drivers found to directly impact outcomes critical to hospi­tal performance and reimbursements, in order, are as follows. It’s important for you to note that, counter to some prevailing wisdom, physician communication with patients is not a key driver of overall HCAHPS.

  1. Communication between nurses and patients
  2. Pain management
  3. Medication and discharge instructions
  4. How quiet the patient care area is
  5. How clean the patient care area is

Now, it’s time for you to roll up your sleeves and start operating. No scalpel or forceps needed. Based on the evidence presented in this research, you can enhance and refine your talent strategies to create an effective hiring process that accurately assesses the skills that will drive HCAHPS.

Hiring: There is a clear business case to be made for developing a comprehensive hiring process for all patient-facing employees and leaders.

Employee Surveys: Leaders have a unique opportunity to establish a competitive advantage by using the same cause-effect approach in linking employee engagement survey results directly to their HCAHPS scores.

Competency Models: This analytics tool also provides leaders a platform to build compe­tency models for managers and staff to improve HCAHPS scores.

360 Assessments: Similar to employee surveys, 360 assessments that rate competencies and behaviors are an effective way to uncover the specific, local behaviors that directly affect HCAHPS rankings, with key behavior ratings directly linked to HCAHPS scores and the ability to gauge which actions will have the greatest impact.

Leadership Development: Programs that focus directly on interpersonal skills allow healthcare leaders to leverage evidence demonstrating the business case for commu­nications as a cause-effect driver of HCAHPS, Clinical Care Processes compliance, and readmission rates.