Lots of research has been done on the relationship between doctors and nurses who are more engaged with their jobs and higher patient satisfaction scores. These scores are vital to the economics of hospitals, as funding is decided through the numbers.
But what about the front-line foodservice workers in hospitals? Barely any data had been compiled on the correlation between their levels of engagement and how satisfied patients are. That’s what Thomas “Dusty” Deringer, Ph.D., vice president, patient experience for Compass One Healthcare, found as he began his dissertation, A Correlational Study of Hospital Food-Service Employee Engagement and Quality Outcomes in U.S. Acute Care Hospitals, about three years ago.
As focused as his work is on patient satisfaction, Deringer was looking to find hard numbers on hospital foodservice employees’ level of engagement and how that relates to more satisfied patients, lower absenteeism and better employee retention. He figured that what’s true for doctors and nurses must also be true for foodservice staff…right? That’s what conventional wisdom—not to mention common sense and anecdotal evidence—pointed to.
“In my role, we’re always trying to figure out how to improve patient satisfaction,” Deringer says. “For the last 20 years, I’ve always thought if you have high employee engagement, you’ll have increased satisfaction and decreased absenteeism, etc. But for my doctorate, I wanted to do something useful. Is there really a relationship there?”
‘Blown away’ by the results
Working with statistical analysis of two years of written surveys to hundreds of employees at several hospitals, Deringer quickly had a sinking feeling: His hypothesis was way off.
“It was actually disproven,” he says. “Employee engagement doesn’t have a significant impact on patient satisfaction or turnover. I was shocked. It flies in the face of everything we thought.”
Deringer was careful not to lead his research anywhere or mine for correlations where there were none, known as p-hacking in the scientific community—a big no-no. “In a true research sense, you’re not supposed to try and lead it anywhere,” he says. “I had an assumption that there would be a relationship of some type with employee engagement and patient satisfaction. I was thinking, ‘There’s something there.’ I’ve observed it at our accounts, but I wanted to prove it empirically, and I couldn’t. I ran the numbers seven times and I was just really blown away by it.”
The implications of the data are significant.
“It’s important because hospitals are in this competitive landscape. To be able to survive, they’ve got to be financially solvent, maintain quality reputations and a huge factor is having patients who are satisfied,” Deringer says. “We’ve put a lot of eggs in one basket for the last 10 years or so, focusing on patient experience, but there are gaps in the analysis.”
Wages, scheduling, transportation and culture make the difference
While employee engagement should never be discounted out of hand, Deringer thinks there are other factors that foodservice should focus their resources on when it comes to employees.
One gap in the comparison between nurses/doctors and foodservice workers is wages, Deringer found.
“From a wage standpoint, the research suggest that the average foodservice employee makes $19,000 per year. A nurse makes about $70,000 and a physician makes between $120 and 150,000 and that’s not a specialist,” he says. “When you take the engagement of an employee making $70,000 or $100,000, it’ll be much different than an employee who may be happy with what they’re doing, but will need to jump to a different job if there’s a dollar-an-hour increase somewhere else so they can feed their family.”
“We think wages and scheduling have a lot to do with this,” he says, especially within urban healthcare systems, where “it has a lot to do with bus routes. If your schedule doesn’t coincide with bus routes, you’ll have more turnover. A lot of people are working multiple jobs and have limited transportation.”
In addition, Deringer’s research found that company culture plays into better outcomes with patients, but a management company like Morrison Healthcare cannot control the larger hospital communities that make up the atmosphere for their employees at each account.
“As an organization, we manage our employees to think of themselves as caregivers,” he says. “But if I don’t feel valued by the people I work beside—the clinical caregivers—I’m less likely to be engaged and not focus on patient satisfaction.”
In a way, a management company has “two distinct cultures,” Deringer says. “Corporate culture, and then the culture at each of our client hospitals. We do a lot with our corporate culture with celebrations, awards and recognition. However, we can’t always control the type of atmosphere at a hospital so it’s very difficult.”
Training that specifically deals with the hospital environment could be one way to focus on this issue.
“A hospital is a lot different than a hotel,” Deringer says. “If I come upon a sick patient, am I being trained to feel like I’m part of something greater than myself?”
So what direction should hospital foodservice admins take in light of this new information?
“It’s a quest for prioritization,” Deringer says. “Where do I focus my resources and attention? At the end of the day I want people to use their limited resources for something that’s more effective. We deal with foodservice directors who are very frustrated, so our theory is, focus on the right things vs. what you’ve been told.”