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Safety: The critical starting point for engaging and retaining staff in healthcare

Coauthored by Milissa Eagle, MA, Director of Workforce Analytics.

Patients have the completely reasonable expectation that they will receive safe, error-free care, delivered with compassion and empathy, when visiting a healthcare facility. How safe they feel has a direct impact on the patient experience.

But for patients to feel safe, organizations need to develop a culture and environment where their employees feel equipped and empowered to deliver on that promise. Press Ganey data consistently demonstrates that high employee engagement leads to better patient experience and improved clinical outcomes. Furthermore, our data demonstrates that employee perceptions of safety culture are essential in driving engagement and retention. If your organization isn’t measuring and improving safety culture, you're missing a critical piece that impacts both your employee and patient experience.

Employee engagement in healthcare and safety culture enable each other

Engagement and safety drive performance in other key areas, like quality and patient experience. Drilling even further into safety and engagement, we see a strong correlation between the two: When employees’ perceptions of safety culture are higher, employee engagement is also higher. This relationship fuels a positive cycle of overall improvement. A strong safety culture drives engagement and retention; on the flip side, when people are more engaged, they’re better able to maintain a culture of safety and deliver safe care to patients. 

The virtuous cycle of quality, experience, efficiency, and safety/engagement in healthcare.The data speaks volumes about this tight-knit correlation. We analyzed feedback related to safety culture and engagement from 652,820+ employees (data timeframe: July 1, 2022, to June 30, 2023) and found that, when an individual’s perception of safety culture is high (4.00 or above on a 5-point scale), their engagement ranks, on average, in the 98th percentile of our national database. When perceptions of safety culture are low (less than 4.0 on a 5-point scale), they rank, on average, in the 3rd percentile of our national database—a 95 percentile drop. Importantly, about half of employees fall into this lower perception of culture group. These massive differences demonstrate just how important it is to make each individual feel positive about their organization’s safety culture.

Perception of safety culture is strongly related to engagement.

Focusing on safety culture as a critical element in your engagement and retention strategy

Our data underscores the close relationship between employee engagement and safety culture. Looking at our healthcare employee database, which brings together over 1.6 million unique voices, safety culture emerges as a clear theme for engagement and retention. Essentially, healthcare employees want to see that their organization is actively improving patient safety, senior management is committed to the organization’s mission and values, and the organization is delivering high-quality care and 5-star service.

Safety is one place where top performers on engagement excel. These organizations also perform at a notably higher level in these areas:

  • Respect
  • Meeting basic employee needs (staffing, tools/resources, pay, work/life balance)
  • Committed and involved senior leaders

Top-decile performers score notably better on these areas, compared to bottom-decile performers.

Of course, it’s all intertwined. Respect is a cornerstone of safety culture. Involved senior leadership is foundational to high reliability and safety culture. And staffing and resources have clear implications for safety. Joining the elite group of top performers requires superior execution on high reliability practices, and a demonstrated commitment to safety culture.

Safety culture is also a top driver of leader engagement. Directly involving leaders in safety efforts will not only help engage them individually, but it also helps leaders drive engagement efforts with their team(s).

Improving employee engagement: A path forward

Improvement always starts with data. What are you collecting? What questions are you asking? How does this data inform your learnings? If your organization isn’t asking about safety culture on your engagement survey, you could be missing out on critical insights and interdependencies that fuel employee engagement and patient experience.

Once you have your data, it’s important to segment it by workgroup and key demographic cohorts (position, gender identity, race, ethnicity) to get a holistic view of the unique experiences across your organization.

Also underscoring the importance of diversity, equity, and inclusion (DEI), our data shows:

So, where do you begin?

  1. Break down silos to understand the critical connection between safety and engagement. Engagement, safety, DEI, and patient experience must be integrated, and data can be leveraged to identify shared drivers of these areas. Press Ganey’s groundbreaking Human Experience platform collects information across multiple data sources and connects the dots to show you precisely where to focus.
  2. Start simple. Use engagement and safety culture data along with safety event reporting data as a starting point to determine improvement efforts at the department level. Linking your patient experience data will also return a clearer picture of what’s happening on the ground at your organization.
  3. Invest in, and sharpen execution on, high reliability practices—especially leader skills. Leaders have a direct impact on front-line teams. Equipping them with the skills to lead for safety, and to develop their talent, can help you improve faster. 
  4. Hardwire HRO practices into daily work. Leverage tools to ensure robust safety event analysis, improvement, and communication back to the front lines so staff know there’s a focus on safety. 

Press Ganey HRP dashboard example.

Above: Press Ganey High Reliability Platform example.

Receiving safe care is a patient’s expectation. And feeling safe at work, and equipped to provide safe care, is the expectation of every healthcare employee. Setting safety as a core value helps you meet these expectations, as well as create a culture where people feel engaged—and they want to stay.

Press Ganey’s suite of workforce and safety solutions, along with our expert team of strategic consultants, help the world’s leading healthcare organizations drive measurable, meaningful improvements in employee engagement and experience, safety and high reliability, and so much more. To discuss your organization’s safety culture, employee engagement, safety event reporting and learning systems, or anything else, reach out to a member of our team, and we’ll be in touch.  

About the author

As Chief Safety and Transformation Officer, Dr. Gandhi, MPH, CPPS is responsible for improving patient and workforce safety, and developing innovative healthcare transformation strategies. She leads the Zero Harm movement and helps healthcare organizations recognize inequity as a type of harm for both patients and the workforce. Dr. Gandhi also leads the Press Ganey Equity Partnership, a collaborative initiative dedicated to addressing healthcare disparities and the impact of racial inequities on patients and caregivers. Before joining Press Ganey, Dr. Gandhi served as Chief Clinical and Safety Officer at the Institute for Healthcare Improvement (IHI), where she led IHI programs focused on improving patient and workforce safety.

Profile Photo of Dr. Tejal Gandhi, MPH, CPPS