CONDUCTING HOSPITALEMPLOYEE SATISFACTIONSURVEYSPractical Step-by-Step Information forAssessing Employee PerceptionsLinda Powell, MSMountain States Group, Inc.1

CONDUCTING HOSPITAL EMPLOYEE SATISFACTION SURVEYSWritten by: Linda Powell, MSIPTCopyright 2001For questions, concerns, clarification, ortechnical assistance, contact:Linda PowellMountain States Group, Inc.1607 West Jefferson StreetBoise, Idaho 82702(208) 336-5533 extension 235(800) 382-4234 extension [email protected] initiative of the National Rural HealthResource Center with partial funding from theFederal Office of Rural Health Policy, HealthResources and Services Administration.2

ContentsPage No.Section I – Why Evaluate Employee Satisfaction?1What is Job Satisfaction?4Section II – Survey Methods5Interviews6Questionnaires7Section III – Conducting an Employee Satisfaction Survey8Steps in Process9Survey Design/Construction11Packaging and Layout of Survey14Section IV – Employee Satisfaction Survey Template15Section V – Employee Satisfaction Survey Report Template21Processing Survey Responses22Survey Report Content24Example 125Example 233Section VI – Survey Report Presentation Template45Appendix A – Sample Group Interview Template3

1Why Evaluate Employee SatisfactionSECTION I

Why Should You EvaluateEmployee Satisfaction?There is a definite link between employee attitudes and patient satisfaction.1Ifemployees are unhappy or dissatisfied, despite their best efforts, it is difficult for them toconceal this factor when interacting with patients and other staff members. One of theprimary reasons for evaluating employee satisfaction is to identify problems and try toresolve them before they impact on patient care and treatment.Improving the quality of patient care in American hospitals is a vital and necessaryactivity. Patients report they receive less individual attention than ever before. Theycomplain that doctors and nurses are too busy tending to the technical aspects of careto provide the much needed attention to patients’ personal needs.2Not only is it important in terms of quality of patient care, assessing employeesatisfaction is a critical component in retaining qualified health professionals. Manyhealth care providers feel frustrated and disillusioned in jobs they expected to findfulfilling. They have less time to do a quality job of caring for patients; they arecontinually expected to cut corners, but see waste and feel unable to change thesituation; they feel unappreciated and they feel their skills are underused. This leads tolow morale, staff turnover, and overall disenchantment with job opportunities in healthcare.2In a recent article in Trustee3, a publication of the American Hospital Association, it wasnoted that nursing ranks are thinning just as the need for nurses is poised to soar duedo to baby boomers’ heading into retirement. Nursing school enrollment declined 4.6%in the Fall of 2000 for the fifth straight year. Radiation technologists and technicallyinclined students are increasingly choosing software related jobs. Pharmacists are alsoin short supply at about half of all U.S. hospitals. The causes are lower pay combinedwith a frustrating work environment. With increased job pressures, an increase in theacuity of patients, declining nurse to patient ratios, less autonomy, and moreadministrative duties, it’s no wonder health care professionals are re-evaluating theircareer decisions. Non-hospital jobs offer more flexible hours, more advancementopportunities, equal or better pay, and a lot less stress.It appears imminent, if not already realized, the demand for health care professionalswill soon exceed the supply. Retaining qualified health care professionals will becomeeven more important given these realities. If you know what your employees thinkabout their workplace environment, you’ll be more able to design an environment that istoo attractive to leave.A book based on the Worker Representation and Participation study4 identifiedconclusively the vast majority of employees want more say, influence, representation,2

participation, or voice in their workplace. If they had more participation, 87% indicatedthey would enjoy their jobs more, 75% thought their company would be morecompetitive, 79% felt the overall quality of services or products would improve, andmost felt more effective problem-solving would occur (58% of managers agreed withthis last statement). Increased participation would improve the quality of workers’ lives,increase production and overall company success.The study also found that employees liked open door policies, suggestion boxes, andaccess to management. Employees want cooperative relations with management, butwant some measure of independence and protection of that independence. Most feltthat management resistance to sharing power is the primary reason for their lack ofinfluence.Greater empowerment (job identification and ownership) of health care employees canlead to better patient care, greater job satisfaction, and lower health care costs.Empowerment energizes the people who are closest to the patients and the technologyto continuously look for ways to provide high quality patient care and improveprocesses. The accumulation of ideas-both large and small-from many people willresult in better patient care and operational efficiencies.2Employee satisfaction surveys can provide managers with good information about theorganization’s health. In addition to improved patient satisfaction, other benefits ofmeasuring and improving employee satisfaction include: Reduced turnoverAssociated reductions in training costsIdentifying cost-saving opportunitiesCurbing absenteeismStrengthening supervisionEvaluating patient-service issuesAssessing training needsStreamlining communicationBenchmarking the facility’s progress in relation to the industryGauging employee’s understanding of, and agreement with, the facility’smission5Most importantly, an improved reputation of your facility as a place to work may make iteasier to attract quality employees.3

What is Job Satisfaction?Before attempting to evaluate employee satisfaction, we need to know what it is. Howwe define job satisfaction will help us structure an evaluation process that providesadequate measurements of the variables that contribute to an employees performanceand attitude.Employee job satisfaction is the fulfillment, gratification, and enjoyment that comes fromwork. It’s not just the money or the fringe benefits, but the feelings employees receivefrom the work itself.Employment should be a mutually rewarding experience. The facility has certainexpectations for productivity, dependability, and cooperation and the employees havecertain expectations for good pay, benefits, quality supervision, and good workingenvironments.There are two basic sources of job satisfaction: 1) the employees’ pride in their craftand 2) the work environment both physical and interpersonal. The ability to produce,the quality of the work, the opportunity to learn and express creativity, the sense of pridein their profession, the recognition for a job well done, the ability to work well in a team,the social satisfaction derived from relationships at work, the opportunity to experiencepersonal growth, and the rewards from a physically supportive work environment are allfactors that impact on job satisfaction. Individuals may vary to the degree in which eachof these factors contribute more or less to their own job satisfaction. But the end resultis that high job satisfaction typically leads to career success.6 Caring for others andmaking the organization work better are two sides of the same coin.The value to an organization that incorporates regular employee satisfaction surveys ismulti-faceted. First, it stimulates employee thinking and awareness about themselvesand others. Secondly, a quantitative survey can objectively and impersonally providefeedback about behavior or attitudes. Finally, it can serve as the basis for discussionand learning as well as for personal and organizational development.4

SECTION IISurvey Methods5

Survey MethodsThere are two broad categories of surveys: the questionnaire and the interview.Questionnaires are typically paper-and-pencil instruments that the employeecompletes. Interviews are completed by the interviewer based on what theemployee says.7 The following discusses the various types of surveys and theadvantages or capabilities and the disadvantages or limitations of each type.InterviewsInterviews are a more personal form of surveys than questionnaires. Interviewscan occur on an individual basis or within groups and either over the telephone orin person. Properly conducted interviews can provide managers and decisionmakers with a deeper understanding of employee perceptions about theirworkplace environment.Unlike structured survey methods which require strict adherence to a setprocedure to ensure the scientific accuracy of the results, interviewing techniquesare less rigid and concentrate more on revealing issues and underlyingreasoning rather than on quantifying employee attitudes and behavior. The moreface-to-face nature of group meetings enable you to not only ask employees“what” are their issues, opinions, and needs, but also to probe “why” they feelsuch issues, opinions and needs exist. 7The interpersonal nature of interviews allows for much give and take ofinformation. Often during the course of an interview, issues raised will needclarification from either management or employees. Interviews provide anoutstanding opportunity to answer questions and clarify issues.Conducting these interviews can serve a public relation’s role for yourorganization. By providing employees with a formal opportunity to express theirviews, your facility is making a strong statement of its interest in the attitudes ofemployees. Still, the manner in which you respond to the issues raised willultimately demonstrate your respect for, and commitment to employeeinvolvement in the health care system.For the sake of brevity, detailed information on the process of conductingindividual and/or group interviews is not repeated here. Please refer to thepublication “Conducting Key Informant and Focus Group Interviews”8 for morespecific information on the process of interviewing. These same techniques canbe applied to individual employees and groups of employees. A sample templateof potential questions a trained interviewer could use is attached as Appendix A.The advantages of interviews is their personal form. Unlike questionnaires, theinterviewer has the opportunity to probe or ask follow-up questions. Interviews6

are generally easier for the respondent, especially if what is sought is opinions orimpressions. However, they can be very time consuming and they are resourceintensive. The interviewer is considered a part of the measurement instrumentand interviewers have to be well trained in how to respond to any contingency.In addition, if the interviewer is on the staff of the facility, there may be somereticence by employees to share their perceptions openly and honestly. Even anoutside interviewer might encounter problems because the employee’s identity isknown. Interviews should not be conducted by those with authority over theemployees being interviewed. Interviews conducted by people external to theorganization are preferable.QuestionnairesWhen most people think of questionnaires, they think of written surveys. Writtensurveys consist of the same exact instrument sent (usually mailed) to a widenumber of people. In this instance, an employee satisfaction survey could bedistributed directly to employees either in their paychecks or by mailing them totheir homes.A second type of questionnaire is the group administered questionnaire. Thedifference between a group administered questionnaire and a group interview isthat each respondent is handed an identical survey to complete while in the roomfor a group administered questionnaire and for a group interview, respondentsdon’t complete a survey individually but listen and answer questions as part of agroup.There are many advantages to a written survey. They are relatively inexpensiveto administer and you can send the exact same survey to a wide number ofpeople. They allow the respondent to fill it out at their own convenience. Theycan be completely anonymous and confidential, removing the fear of respondinghonestly. However, the disadvantages are that response rates from writtensurveys are often very low and they are not the best vehicles for asking fordetailed written responses. In addition, poorly designed questions can bemisinterpreted by respondents and incorrectly designed surveys may produceinvalid and misleading results. 7Group administered questionnaires are also inexpensive to administer and couldincrease the response rate. However, there may be reluctance on the part of theemployees to respond honestly for fear of being identified. Measures would benecessary to insure confidentiality.The remaining sections of this publication, discuss the specific steps to design,distribute, and analyze an employee satisfaction survey.7

8Conducting an Employee Satisfaction SurveySECTION III

Steps in ProcessThere are seven basic steps in any survey project.9 An eighth step was added toaddress how the data will be used and who is privy to the analysis. goals of project - what you want to learnDetermine your sample - who will you askChoose interviewing methodology - how you will askCreate questionnaire - what you will askPre-test the questionnaire, if practical - test the questionsDistribute questionnaire - ask the questionsEnter and analyze data - produce the reportsDistribution/sharing of reports.1.What do you want to learn?Write down what information you need or what you want to know from youremployees. Typically, in employee satisfaction surveys you want to learn theiroverall job satisfaction, their satisfaction with the work, their satisfaction with payand benefits, their perceptions on coworker/supervisor performance orcooperation, their understanding of the mission and goals of the facility, theirperceived need for additional training and development, their perceptions abouttheir physical working conditions, and any suggestions for improving theworkplace.2.Who will you ask?In this instance, the target population (who you will ask) will be employees ofyour facility.3.How will you ask?There are a variety of methods including personal or group interviews andquestionnaires (written, telephone, or on-line for individuals or groups). For ourpurposes, this guide is focused on constructing and conducting writtenquestionnaires. There are other options you also might want to consider. Thereare several Internet companies that specialize in on-line employee satisfactionsurveys. Just search for “employee satisfaction surveys” and you can check outtheir websites and request information on costs.4.What will you ask?Write questions you think will elicit the information you need. Survey questionsmay be open-ended – questions requiring the respondents to provide answers intheir own words, or closed-ended – questions requiring the respondents to selectfrom responses or answers you provide. Most surveys use closed-endedquestions typically in the form of multiple choice, True-False, Yes-No, AgreeDisagree or rating and agreement scales , Excellent to Poor or Strongly Agree toStrongly Disagree. While open-ended questions can potentially provide you with9

greater insights into employees’ attitudes or knowledge, interpreting responses toopen-ended questions is time consuming and can be misleading, unless youdevelop a carefully created coding system. Closed-ended questions are mucheasier for you to use and score because of the uniformity of the responses. Foryour greatest benefit, if you are considering an open-ended question, firstdetermine if you can create a closed-ended question that can provide you withthe same information. You should also consider how the order of questions orthe order of answer choices can affect the results. Mentioning something in onequestion can make people think of it while they answer a later question. Tips toconstructing questions follow later in this section.5.Pre-test questionsIf you are designing a set of questions from scratch, you should test them with asmall number of individuals prior to distributing to the entire sample. Ideally, youshould test the survey on the same kinds of people you will include in the mainstudy. This kind of test run can reveal unanticipated problems with questionwording, instructions to skip questions, etc. It can help determine if yourquestions are clear and concise and obtain useful answers.6.Distribute surveyOne key to a successful employee satisfaction survey process is the manner inwhich the surveys are distributed and collected. Employees must be certain thattheir anonymity will be maintained. The survey must be anonymous. Thedistribution of a survey to employees can be accomplished by including a copy ofthe survey in their paycheck or mailing it directly to their home or distributing thesurvey in a group meeting. However it is distributed, make sure that the surveydoesn’t identify individual employees. If you can afford to have an outsideagency collect and analyze the data, include a postage paid return envelopedirectly to this agency. If you have to complete this process with internalresources, have a central location where employees can drop of their surveyswhich protects their identities. Additionally, you will want to publicize thedistribution of the survey in advance through staff meetings or by posting flyers.A cover letter from the administrator should also accompany the survey toexplain the reasons for completing a survey. The letter should stress the needfor employees to express their honest opinions and state clearly that the hospitaladministration nor anyone else will know the identify of the employee filling outthe survey.7.Produce reportA good total response rate for an employee satisfaction survey is in the 40% to60% range. If the response rate lags, about two weeks after the initialdistribution of the survey send a reminder to all employees. All data from thesurveys should be entered into a database or spreadsheet program for analysis.It would be too time consuming to try to manually tally responses to individualquestions, although it is possible to do so. Analyze all the responses (avoidpartial analysis). Do not extend results that are valid for the given sample to the10

entire population without taking the necessary precautions. Typically a reportincludes a description of survey's purpose, who received the survey, how it wasdistributed, how many responded, a brief summary of the highlights, and theactual responses to each question. An employee satisfaction survey reportshould include the frequencies (numbers) or distribution (percentages) ofresponses for each question. Sometimes it is useful to compare responses totwo or more questions (cross tabulations). Avoid biases and "politically correct"conclusions. Where ever possible, the use of charts and graphs should beincluded to visually depict the data. Most word processing programs have thecapability to insert a chart or graph.8. Distribution/dissemination of reportOnce a report has been prepared using the data from the survey process, adecision needs to be made on who has access to this data. Employees whoparticipated in the survey process deserve feedback regarding the results.Hospital board members would also benefit from reviewing the results of anemployee satisfaction survey. A good mechanism for sharing the results of thesurvey would be the preparation of a presentation using either MicrosoftPowerpoint or transparencies. Separate presentations could be made to keydepartment managers and to hospital board members. You could also post asummary of the findings on bulletin boards throughout the facility whereemployees could publicly view the information.Employee satisfaction surveys can be used to identify areas for improvement.They can be useful tools to assess employee knowledge about the facility, howwell internal communication processes are functioning, whether employees feelthey are supported by their direct supervisors and administration, and even whatkinds of changes employees feel are needed.Survey Design/ConstructionBasic Tips on Writing Closed-ended Questions1. Questions should be clearly related to what you are trying to accomplish with thesurvey – as outlined in your cover letter to the employee or in an introductoryparagraph at the beginning of the survey. Employees need to see theconnection between each question and the overall purpose of the survey.2. Keep your questions brief and concise, using Standard English and propergrammar. Avoid jargon, acronyms, and scientific terms – all of which arecommon pitfalls when trying to communicate.11

3. Avoid writing biased questions and responses, which lead the employee toprovide responses that reflect your opinions or attitudes. The best way to checkthis is to ask someone with contrary views to review your survey for biases.4. Do not introduce more than one concept, issue or thought per question. Forexample, organizational questions followed by benefit package questions mayrequire a transitional statement in between to help the employee in answeringquestions.5. When asking background or demographic information, avoid being too personal,for you may offend or inhibit the respondent, thus discouraging them fromcompleting the survey. For example, if trying to determine their annualhousehold income provide income range choices rather than requiring them toprovide their specific income. This example holds true for age and educationbackground as well. Do not include demographic questions when the followingapply: a) the sample size is so small (less than 50 responses) that including thequestions provides no added value; b) there have been issues aboutmanagement trust in an organization; or c) when the survey is too long.6. Always include instructions on how to answer the question, no matter howobvious it may seem to you. Such as “check all that applies”, “circle the one bestanswer”, and so forth.7. If you are coding your answers, check to see if your coding is consistent.(Coding is the assignment of a number that represents a response when using acomputer to assist in handling the data). For example, all questions that areyes/no should use the same #1 to represent “yes” and #2 to represent “no”. Notethe response categories to the various questions in the sample survey includedin this kit and the consistency of numbers that represent similar responses. Ifyou are planning to input your survey responses into a computer or contract withan agency or university to compile your data, double check your final survey draftto make sure all coded responses are consistent.8. Once you have drafted your questions, you need to group them in logical order orsequence. In the sample survey included in the next section, you’ll note that thesurvey questions are grouped with questions related to the organization first,followed by how they feel about their role, then questions about managementand their direct supervisors. Benefit questions are in an entirely different section.12

Decision time You can draft your own survey questions from scratchor create a survey using a combination of your ownquestions and the questions contained in the samplesurvey provided in the next section. This surveyinstrument was designed by Marsha Irvin, MountainStates Group, Inc. staff in 1999 and has been used inseveral rural hospitals in Idaho. The sample EmployeeSatisfaction Survey includes questions for measuringperceptions, attitudes, and satisfaction levels and is ona disk in three formats (Microsoft Word file (doc), MSDOS text with layout (asc) and an ASCII file (txt)). Thedisk is can be found in Section IV.To customize the survey to your facility, simply insertyour facility’s name where appropriate. Your surveyshould be as brief as possible without compromising itsability to provide you the information you want. If yoursurvey is too long, the response rate will suffer, thedata gathered will become more difficult to manage,and the time you will need to process the data willincrease. Once you have completed a draft of yoursurvey, test it on a few employees or colleagues. Askthem to critique it for clarity, simplicity and the time ittakes to complete it. In other words, test its “userfriendliness!”13

Packaging and Laying Out Your SurveyThe Appearance of ThingsThe appearance of the survey can have a major impact on the responserate. The more attractive and easy to read, the more likely therespondent is to complete it and return it promptly. The appearance ofthe survey also affects respondents’ perceptions of the credibility andimportance of the survey. Follow these basic rules of print design andlayout when formatting the appearance of your survey:1. Never use a type (font) size smaller than 10 point (pt). Preferable, use 12 pt.Remember, the smaller the type, the more difficult to read.2. Don’t crowd a page with type. Allow for space (known as “white space”)between questions and provide adequate margins on the sides, top andbottom of the page. White space enhances the readability and eye appeal ofthe survey.3. Use boldface, underlining, and italics to set off key words, phrases orinstructions.4. Use arrows and boxes to guide respondents to questions that must be askedin sequence. For example: “If you answered YES to Question 16, go toQuestion 18”. An arrow from YES could be drawn to a box-containingQuestion 18.5. Make two-sided copies. Single-sided pages will make the survey feel andlook longer than it actually is, discouraging some respondents fromcompleting it. In addition, a survey printed using both sides of a page willweigh less, saving you money on postage costs.6. Avoid page breaks within a question.7. When possible, arrange responses to each question so they create a verticalpresentation on the page. This vertical presentation of responses on thepage helps prevent respondents from inadvertently missing an answer, whichcan happen if the responses require respondents to visually move all aroundthe page rather than in a straight, vertical line.8. Give the survey an attractive cover page, which should include the name ofthe survey, a brief statement of why you’re conducting the survey, and thename of the organization sponsoring the survey. An attractive illustration thatrelates to the topic of the survey is also a good idea.14

15Employee Satisfaction Survey TemplateSECTION IV

EMPLOYEE SATISFACTION SURVEYHospitalWe need your help! Your answers to the following questions will be an important part ofthe an organizational review being completed for Hospital. Please takea few minutes to complete this survey, and return it in the enclosed postage paidenvelope today. The information you provide will be completely anonymous.1. How would you describe the level of your overall job satisfaction with yourwork at Hospital? Circle one answer.Very Satisfied123Very Dissatisfied54Describe your level of agreement/disagreement with each statement by circling onenumber for each statement.AgreeStronglyDisagreeStrongly2. I understand the long-termplan of Hospital123453. I have confidence in thehospital leadership toimplement the plan123454. There is adequate planningof hospital objectives123455. I contribute to the planningprocess at Hospital123456. I am proud to work forHospital123457. I feel I contribute to thefacility’s plan and mission123458. I am given enough authorityto make decisions I need tomake.123459. My physical workingconditions are good1234516

(circle one number for eachstatement)AgreeStronglyDisagreeStrongly10. If I do good work I cancount on making moremoney1234511. If I do good work I cancount on being promoted1234512. I believe my job is secure1234513. I feel part of a team workingtoward shared goals1234514. I like the type of work that Ido1234515. I feel valued atHospital1234516. I like the people I work withat Hospital1234517. I experience a spirit ofcooperation atHospital1234518. At Hospital I amtreated like a person, not anumber1234519. I am given enoughrecognition by managementfor work that’s well done1234520. Communications frommanagement are frequentenough1234521. Communications frommanagement keep me up todate on the hospital1234517

(circle one number for eachstatement)AgreeStronglyDisagreeStrongly22. I feel I can trust what I amtold by the managementstaff1234523. Quality is a top priority atHospital1234524. My supervisor asks me forinput to help makedecisions1234525. I feel that my supervisorgives me adequate support1234526. My supervisor treats mewith respect1234527. I feel that my supervisortreats me fairly1234528. My supervisor tells mewhen my work needs to beimproved1234529. My supervisor tells mewhen I do my work well1234530. I am provided enoughinformation by the Hospitalto do my job well1234531. My initial training providedby the Hospital was asmuch as I needed1234532. As much ongoing trainingas I need is provided by theHospital1234533. I believe my salary is fair formy responsibilities1234518

(circle one number for eachstatement)34. I would recommendemployment atHospital to my friendAgreeStrongly1DisagreeStrongly2345I am satisfied with the: (circle one number for each statement)AgreeStronglyDisagreeStrongly35. Overall benefits package1234536. Amount of vacation1234537. Sick leave policy1234538. Amount of health care paidfor by health insurance39. Retirement plan benefits123451234540. Life insurance1234541. Disability benefits1234542. Are there any benefits you would like to see added to Hospital’s benefitspackage? (check

Section III - Conducting an Employee Satisfaction Survey 8 Steps in Process 9 Survey Design/Construction 11 Packaging and Layout of Survey 14 Section IV - Employee Satisfaction Survey Template 15 Section V - Employee Satisfaction Survey Report Template 21 Processing Survey Responses 22 Survey Report Content 24 Example 1 25