Undoubtedly, the goal of your senior care organization is to achieve excellence in the care and satisfaction of your residents. Attaining that goal depends in no small way on the satisfaction and commitment of your employees. Research conducted by My InnerView in 2008 clearly shows a direct correlation between a committed workforce and organizational performance. The survey solicited the opinions of more than 200,000 long term care residents and their family members and more than 220,000 employees in 5,200 facilities.

Figure 1 demonstrates the relationship between employee commitment and customer satisfaction. Facilities are arranged according to the level of employee commitment. The highest levels of commitment are found in the facilities in the fourth quartile, while the lowest levels are found in the first quartile.
For families and residents, the levels of satisfaction are significantly higher where employee commitment is higher. In the fourth quartile, family satisfaction scores an average of 76 points (where Excellent=100, Good=67, Fair=33 and Poor=0). At the other end of the scale, the first quartile group had satisfaction rates averaging just 68 points. Residents rated the facilities similarly in each group.

In another, more focused, study in 2008, My InnerView researchers gathered a comprehensive group of measures consisting of employee and family satisfaction surveys, clinical and workforce measures, and Medicaid cost reports for 350 facilities in one state. Positive relationships were found between employee commitment and staff retention rates, financial performance, and occupancy.
Facilities with the highest levels of employee commitment were found to have significantly higher levels of nurse and nursing assistant retention. See Figure 2, below. In the highest group, it was found that 71% of nurses and 66% of nursing assistants had been employed by the facility for one year or more. At the other end of the commitment spectrum, facilities demonstrated a retention rate of only 61% and 58%, respectively.

Employee commitment is strongly correlated to financial performance as well. See Figure 3, page 3. Facilities with the highest levels of commitment had significantly stronger financial results. In the highest group, occupancy was found to be 90% overall, compared with just 86% in the lowest group. In terms of gross margin, the highest-scoring facilities earned 12%, compared with only 9% per bed for the lowest group. 

Job Satisfaction Not Enough

Creating a culture of excellence dictates that providers understand both satisfaction and commitment and the interrelationships between the two concepts.
In most common terms, “satisfaction” refers to the extent to which an employee “likes” his or her job and feels good about the employment experience.
Evidence of satisfaction is often measured in terms of retention, based on the assumption that satisfied employees tend to stay with an organization. Considering the cost of turnover in economic terms, its impact on effectiveness, and the impact on residents when a trusted employee leaves, reduction in turnover is a laudable goal.
“Commitment” (by other terms, “loyalty” or “engagement”) is a measure of the alignment of the employee’s motivations with the mission of the organization; in other words, to what degree does the employee feel that he or she is making a positive contribution to the ultimate outcome?
A successful health care provider needs to understand these relationships within its workforce. Leaders want their employees to be happy and satisfied with their work. They also want them to be effective in their roles.
To be truly effective, leaders have to consider whether their approaches are in line with achieving both satisfaction and commitment. Furthermore, leaders need to understand each within the context of their overall organizational goals. It is possible to have loyalty in the absence of satisfaction or satisfaction in the absence of loyalty, but it is unlikely that the end result will be what you expect it to be. You might say that the satisfied employee is more likely to stay, while the committed employee is more likely to be effective.
Organizational excellence is achieved by creating a culture where facilities have both.
In the most recent data available from My InnerView, 85% of employees in skilled nursing facilities were satisfied that their work allows them to make a difference in people’s lives. This is the material that the senior care profession is working with — a workforce that wants to make a difference in people’s lives.

Establishing Commitment

It is incumbent on employers to do everything they can to foster and nurture the extent to which the employee is committed and aligned with the goals of the organization. My Inner-View research suggests that employee commitment matures over time. To more fully understand the commitment levels of staff, it is valuable to consider the chronology, or the life cycle, of the employee/employer relationship.
The employee relationship begins with recruitment and hiring. Organizations need to understand their own needs and have effective means of identifying potential employees who are aligned with those needs. Finding the right people who will fit the culture of an organization, become committed to their jobs, and routinely “go the extra mile” is crucial to developing a committed workforce.
Once hired, the employee typically goes through formal orientation, which familiarizes him or her with the facility and the requirements of the job. The formal orientation is an opportunity for the facility to set the tone for the rest of the relationship. During formal orientation, the new employee is seeking confirmation that joining the organization was the “right decision.” Providing a solid welcome is essential for getting employees off to a good start in becoming a committed member of the workforce.
The early phase of employment, often referred to as onboarding, is considered to include the first three months of employment; however, it generally continues through the first year. This period is critical in building employee commitment and creating a foundation for sustained employee productivity. It is a time to educate the employee about the organization, its culture, and key expectations. It is a time when close relationships need to be built.
Aligning Commitment
As the employee progresses through his or her tenure, the relationship between the employee and the employer needs to mature. After successful orientation and onboarding, employers need to create an environment in which employees can feel as if the goals of the organization are aligned with their own personal goals. At this stage, employees should be able to see the importance of their roles and to sense the employer’s commitment to quality.
Employers must work to encourage employees’ growth, development, and commitment and to recognize each individual contribution.
To align commitment, providers should focus on training and support, encouragement and reward, as well as teamwork and communication. Training includes all of the traditional resources provided to employees to help them understand the organization’s systems, their roles, and how to be effective in their jobs. The effectiveness of those training programs contributes greatly to how employees see the organization and their place in it.
Support includes the employee’s relationship with his or her supervisor and with facility management. An effective leadership culture will demonstrate that both the supervisors and facility management listen to, care about, and are responsive to the employee’s needs and input.
Encouragement and reward are important considerations in understanding an employee’s view of his or her employment relationship. Employers must demonstrate that each individual’s contributions to the organization’s goals are not only recognized, but appreciated. In this way, the employee gets direct feedback that his or her contributions are making a difference.
An effective workforce is necessarily one in which co-workers are able to work together as a team. Effective communication is one of the most important ways in which providers can foster a culture of commitment in the workplace.  

Integrating Commitment

The fully integrated employee has reached the highest level of commitment. At the integration level, employees are supportive of the organization’s mission and are given the opportunities to enhance their skills. They are driven not only by their own performance but the performance of the entire workforce. In supporting the integrated employee, the employer must provide him or her with the resources and tools necessary to be effective and work to break down any barriers that prevent the employee from contributing even more.  

A Culture Of Effectiveness

Once the right people are on board, leaders need to build a culture of effectiveness — one that aligns with both satisfaction and commitment. My InnerView has designed a Workforce Commitment Assessment that focuses on those organizational practices that engage the employee and help providers understand satisfaction and commitment levels within their organization.
When providers understand both, they can begin to see where they stand in providing a workplace that is satisfying, fosters success, and ultimately impacts the quality of care and service being delivered within their organization.

This article was written by My InnerView’s Brad Shiverick, CPHQ, Vice President of Research, and Peter Janelle, MPP, Research Analyst. For more information, visit www.myinnerview.com or call (715) 848-2713. My InnerView is an applied research company that promotes evidence-based management practices in U.S. senior care organizations.
Research conducted in 2008 by My InnerView.