A Hospital Takes Action on Employee Survey

For 15 years as a human resources professional, I managed to stay clear of employee opinion surveys. I’d been warned against them early on by my first boss: “Never conduct an employee survey,” she said. “They raise expectations. Stay away from them.”

Having been properly admonished about the inherent dangers of employee opinion surveys, I managed to avoid them throughout my career. When I joined Doctors Hospital of Manteca, however, my luck ran out. My first assignment as HR director was to participate in the analysis and communication of a recently completed employee opinion survey.

Doctors Hospital of Manteca, California (DHM), is a 73-bed acute-care hospital with 375 full- and part-time employees. For most of its 32-year history, the majority of employees were represented by a collective bargaining unit. In 1991, the employees voted to decertify the union.

Despite the decertification vote, the hospital’s administration was aware that the union’s absence left a number of employees feeling unsettled. The open-door policy and employee forums regularly held by Rich Robinson, the CEO/Administrator, helped maintain open communication between the hospital’s administration and employees. However, Robinson and Barbara Mathis, then director of HR, concluded that an employee opinion survey would be the best way to comprehensively measure employee satisfaction with the hospital while guaranteeing the confidentiality of the participants.

DHM has a hand in developing the survey.
To ensure an accurate measurement of employee opinion, an outside firm was needed to conduct the survey. Before beginning its search, the hospital established specific criteria that the survey firm must meet. Knowledge, experience and understanding of health-care organizations was a primary consideration. In addition, the ideal firm would have a survey questionnaire that was comprehensive yet offered the flexibility of adding facility-defined questions; it would also boast a fast turnaround time and the ability to present a thorough explanation of the data. After an intense search, DHM identified Atlanta-based Avatar International Inc. as meeting these standards, and signed the company to conduct the study.

Avatar’s survey was a particularly good fit with DHM’s needs. The questionnaire consisted of 115 “statements” designed specifically for health-care organizations.

For each statement, employees expressed their opinion using a five-point scale which ranged from strongly agree to strongly disagree. The survey’s statements addressed a variety of issues, such as:

• The people in my work area encourage each other to give their best effort
• Considering the skill and effort I put into my work, I am satisfied with my pay
• There are significant problems of communication between my department and others.

The survey also allowed for 10 facility-defined statements and two open-ended questions soliciting direct employee comment. The hospital had only to decide which 10 issues it wanted to address. To ensure hospital-wide representation, HR established an Employee Opinion Survey Committee. Eleven employees from departments as diverse as data processing, radiology, surgery, staff development, food service, critical care and HR were tapped to form the committee.

The group met three times over a one-month period to develop the facility-defined questions. In the end, the 10 questions queried employees on such topics as:

• Whether their department maintained an adequate amount of supplies
• The perceived level of in-house educational opportunities
• The quality and cost of employee meals
• The way in which confidential matters and concerns were handled—in regards to both hospital employees and patients
• The level of comfort employees had in pursuing solutions to problems they feel are not being adequately addressed by supervisors.

The questionnaire also included an area for written comments to allow employees to give feedback on any issues unaddressed by the survey and to comment on ways in which the hospital’s work environment had improved over the year.

Upon completion, the survey was distributed to all employees. To encourage participation and further guarantee confidentiality and anonymity, employees mailed their completed survey questionnaires to the survey firm utilizing the preaddressed, postage-paid envelope included with the form.

For most mail-in surveys, a 40% response rate is considered very good. DHM achieved a 50% response rate—even more impressive considering that about 170 of DHM’s 370 employees work on a part-time basis.

DHM didn’t have to wait long to find out the survey’s results. About a month after the questionnaires were returned, the Employee Opinion Survey Committee and the hospital’s top management, known as the administrative group, each met with Avatar representatives to review the data.

To make the review process quickly understandable, survey statements were designed in such a way that groups of related statements made up an overall survey factor. For instance, survey statements such as “How hard I work makes a big difference in the success of the hospital” or “I have a clear understanding of what is expected of me” all address the issue of Performance Expectations. The results of these statements can be measured individually, and also were grouped together to communicate a composite result for the Performance Expectations factor.

To ease the communication of the survey’s results, the hospital identified the five most positive factors and the five factors representing areas needing the most improvement. DHM now knew where it stood.

The hospital sets its plan for improvement into motion.
Michael Everett, Avatar CEO, said that a 35% or higher rating of “unfavorable” response to any survey question indicated an area of concern. The Survey Committee and Administrative Group reviewed the survey to identify these problem spots. They were:

• Communication
• Career development
• Identifying staffing needs
• Performance evaluations
• Compensation and benefits
• Cafeteria.

The Employee Opinion Survey Committee and the Administrative Group set out to create action plans to correct the problems. Department directors whose areas of responsibility were identified as needing improvement were included in the action plan discussions and participated actively in developing the final draft.

The action plans varied depending on the problem spots identified. For instance, 46% of the survey respondents indicated that “there are significant problems of communication between my department and others.”

The action plan to correct the situation included such steps as:

• Presenting a management training program highlighting communication within and between departments
• Implementing a “walk a mile in my shoes” program to encourage understanding between departments.

After all the action plans had been decided, they were communicated, along with the survey results, to all hospital employees in a special edition of the hospital newspaper. The eight-page issue also included a review of the survey’s purpose and methodology. While the positive factors were clearly communicated, special attention was given to those factors identified as needing improvement. Each factor identified as a weak area was accompanied by a corresponding action plan, which was printed in a shaded box. By highlighting the action plans, employees could see the importance being placed on the plans and the seriousness with which the hospital’s administration viewed the survey process.

To further drive home this final point, the special edition also included letters from the CEO/Administrator, the assistant administrator and the human resources department. Each letter emphasized the writer’s support for the survey and for the action plans which had been developed as a direct result of employee participation. Management also committed to future newsletter updates designed to keep employees informed concerning the implementation of each action plan.

The special edition of the newsletter was published in July 1992, six months after our CEO/Administrator announced the hospital would be conducting an employee opinion survey. Since then, hospital-wide memos have announced implementation of each action plan, and two newsletter updates have been published since.

Currently, 13 of the 17 action plans developed have been completed. The remaining action plans, most of which deal with the hospital’s cafeteria service, should be complete by the end of the summer.

Through the employee opinion survey, and the action plans which resulted from it, the administration of Doctors Hospital of Manteca demonstrated the seriousness with which it views issues that are important to its employees. The survey also provided the impetus for creating new programs that have resulted in greater efficiencies while improving the quality of the care the hospital provides.

The Partners in Education was one such program. The initiative was created to address what employees felt was a lack of opportunity to pursue continuing education. The Partners in Education program identified and addressed barriers that lower-income employees face while trying to complete their education. For instance, the hospital’s Education Funds committee realized that although the hospital reimburses 100% of tuition, it does so at the end of the semester. This prohibited many employees from using it. Now, tuition is provided up front. To address employees’ flexibility and mobility problems, the hospital introduced a loan program to assist employees with costs not covered by the tuition assistance program, such as child-care expenses.

In addition, a Student/Employee program permits a select few to attend class and work part-time while maintaining their full-time benefits and salary. The program is open to two employees a semester. Partners in Education had such an impact at Doctors Hospital of Manteca that the program was awarded the Society of Human Resources 1994 Creative Application Award.

My first boss was right. Employee opinion surveys do raise expectations and, as such, can be dangerous. But if conducted with the sincere desire to find out what employees are thinking, the intent to act upon that information and, most importantly, with the commitment of the organization’s top management to the survey process, they can also be a powerful employee relations tool.