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Front Line Workers and Patient Satisfaction: Don't Forget About Their Managers!

April 14, 2011
Healthcare organizations are realizing patient satisfaction scores don’t just reflect the care provided by nurses and physicians.  Front line workers – direct care givers like Nursing Assistants, and service workers in dietary, environmental services, and transport have a significant impact on the patient experience.   These often forgotten groups can make or break patient satisfaction.  Senior leaders see this and preach it.  So much so that they often want to start selection projects by focusing on just these job categories.

Even if they select better front line workers, there is often a barrier that prevents facilities from empowering and keeping quality employees that will improve the patient experience.

Mid-level managers and professional level coworkers sometimes do not appreciate the important role of these positions, and even value something different than what the senior leaders are preaching!   To put it bluntly, these people are often treated with rampant disrespect, which strips them of meaningful psychological status, and discourages even the most highly motivated individuals.  Oftentimes their direct supervisors, in spite of the vision of senior leadership, merely want “good soldiers” who will follow rules without thinking.  They are encouraged to stay within their prescribed tasks and not to engage patients unnecessarily.  To some, a good service worker is simply someone who shows up on time, follows direction, and completes predetermined tasks diligently.  The contextual performance and organizational citizenship behaviors that drive patient satisfaction and are prized by the senior leaders, are oftentimes discouraged at the direct management level.

Ted Kinney, Ph.D, who leads our Healthcare Solutions consulting team, notes, “This [disconnect] creates an important selection problem.  How do you hire people?  Do you hire them for how they are going to be managed (bring in low growth need strength individuals) or do you hire for the senior leaders’ aspirational state (bring in high growth need strength individuals)?  If you decide to hire for the senior leader’s vision, it is critical that there are concurrent cultural interventions put in place so that high growth need strength associates will receive the cultural support that they need.”

In a report on shortages in the direct care workforce, nursing home CAN focus groups reported that their direct supervisor was the single most influential variable in whether they decided to stay in a position.  Not pay, not benefits.  They value their role in providing care for patients.  They feel respected and satisfied when their knowledge of patients is appreciated and put to good use.  They like to be engaged in developing the care plan.  Charge nurse focus groups, however, were completely ignorant of this need and didn’t feel like it was their role to manage the CNAs or include them in decisions that affect patients.  This is a perfect example of the disconnect between senior leadership’s vision and the approach taken by first line managers.

What does this mean?

  1. Selection efforts targeting only front line workers will have limited impact on the patient experience.  Hiring better employees only goes so far if they don’t stay.
  2. Engage front line workers in process improvement and customer service initiatives.  These people have much to offer, for instance, a unit team looking at improving the patient experience.
  3. Cultural change is critical.  The vision of the senior leaders must be adopted by the direct supervisors.
  4. Moreover – selection of the first level managers is possibly more important than improving selection of the front line workers, themselves.

In your organization, has the senior leader message that front line workers play a critical role in patient satisfaction, been adopted by the front line supervisors? What is your experience at your workplace?

Note:  Kevin Klinvex, EVP of Select International, and Bryan Warren, Manager, Healthcare Solutions, will be speaking on Long Term Care Recruitment, Selection and Retention Strategies at:

CPERI 2011 Long Term & Health Care Conference

Monday, May 2nd through Wednesday, May 4th

Ramada Inn & Convention Center, State College, PA

Bryan Warren Bryan Warren was the former Director of Healthcare Solutions at PSI. He was responsible for developing and promoting tools and services designed specifically for the unique challenges faced by healthcare organizations.