Effect of Mission Articulation and Vision Presentation in a Medical Institution on Employee Job Satisfaction and Patient Numbers

An organization’s mission and vision are important elements that indicate the raison d’être and future direction of that organization.(1) The mission not only clarifies the purpose of the organization, but also elucidates its values, supports the formulation of management strategy and goal setting, and serves as a criterion for decision-making in daily organizational behavior. An organization’s vision clarifies its medium- to long-term direction, promotes an environment that allows the organization to demonstrate its creativity, and helps build employee trust.(2) Clearly presenting the mission and vision to employees not only motivates them internally, but also contributes to the formation of organizational culture.(3) Employees’ understanding of the organization’s direction and their recognition of how their work contributes to the achievement of the organization’s overall goals improve organizational engagement; in addition, improved job satisfaction increases work efficiency and service quality.(4,5)

The nature of medical institutions means that missions and visions are rarely clearly presented, and there are few studies on this topic.(6) The main purpose of medical institutions is to provide medical care to patients, a service that is motivated by social responsibility rather than economics. Therefore, in a busy environment where medical care and emergency responses are prioritized on a daily basis, the perspective of long-term organizational management tends to be overlooked.(7) If the importance of organizational mission and vision is not fully recognized, employees may overlook the importance of their roles and work, which may lead to a reduction in work motivation and a decline in work efficiency. There is evidence that the formulation of a mission and vision for a medical institution improves employee motivation and directly leads to the provision of high-quality medical services.(8)

Clearly presenting an organizational mission and vision to medical institution employees may have a positive effect on the provision of high-quality medical services9 and quantitative indicators such as number of patient visits. However, to the best of our knowledge, no studies have examined the effect of medical institution mission and vision presentation on employees or quantitative indicators. The purpose of this study was to examine the effect of clearly articulating a mission and vision at a medical institution on employee job satisfaction and the number of patients, which is a quantitative indicator.

Materials and Methods

Study Design

This was a retrospective study. Participants were individuals employed at our hospital from September 2021 to October 2023 and all patients who visited the hospital for medical treatment during that time. This study complied with the Declaration of Helsinki, and care was taken to manage personal information. Employees were given written and oral explanations when the questionnaire survey was distributed, and informed consent was obtained. This study was approved by the Ethics Committee of the Kanazawa Orthopedic Sports Medicine Clinic (Kanazawa-OSMC-2024-005). The survey procedure is shown in Figure 1. In September 2021, employees were surveyed about their work satisfaction and sympathy with the hospital’s mission. After the survey, we began the process of articulating our hospital’s mission, and completed this in April 2022. We used the articulated mission to create an organizational vision, which was finalized in September 2022 and presented to the entire organization. The newly articulated mission and vision were communicated to staff at staff meetings and via posters displayed throughout the hospital. In October 2023, we once again surveyed employees on their job satisfaction, engagement with the mission, and agreement with the vision. The number of patient visits was recorded from October 2021 to September 2023, one year before and one year after the completion of the mission articulation and vision presentation in September 2022.

Figure 1. Research protocol. Based on the September 2021 questionnaire survey, mission articulation was clarified in April 2022 and vision presentation in September 2022. The same survey was conducted again in October 2023 to assess the impact of mission articulation clarification and vision presentation on employees and patient visits.

Questionnaire Survey

A questionnaire was developed for the study, and all employees were surveyed to measure their job satisfaction and sympathy with the mission and vision. Job satisfaction was defined as “attitudes and feelings toward work.” Responses to job satisfaction were scored using a five-point rating scale:

• 1 = Very dissatisfied;

• 2 = Dissatisfied;

• 3 = Neutral;

• 4 = Satisfied; and

• 5 = Very satisfied.

High scores were considered to indicate satisfaction, and low scores to indicate dissatisfaction.(10) Sympathy with the mission and vision also were measured on a five-point rating scale:

• 1 = Not at all sympathetic,

• 2 = Not sympathetic;

• 3 = Don’t understand;

• 4 = Sympathetic; and

• 5 = Very sympathetic.

Overall job satisfaction and sympathy with the mission/vision were evaluated by calculating the change in responses from the first survey to the second survey.

Measurement of the Number of Patient Visits

The total number of patient visits was calculated by recording the number of visits per day and the number of visits in each department recorded by the cloud-based EMR service ippo (Medical-i, Inc., Tokyo, Japan). The number of visits by age group was calculated by recording the total number of visits per month using the ORCA system (ORCA Management Organization Co., LTD, Tokyo, Japan). In addition, the average number of patient visits was calculated by dividing the population into broad age groups: young (0–29 years); middle-aged (30–59 years); and elderly (≥ 60 years).

Statistical Analysis

Statistical analysis was performed using Microsoft Office Excel 2019 ver2306. A chi-square test was performed to examine changes in employee composition. To analyze the number of patient visits, after checking the basic statistics, a paired t-test was performed for normally distributed data, and a Wilcoxon signed rank sum test was performed for non-normally distributed data. The period before the mission and vision were presented (October 2021 to September 2022) was defined as pre-mission/vision, and the period after the mission and vision were presented (October 2022 to September 2023) was defined as post-mission/vision. The average number of visits per day (total number of visits and number of visits by department) and the average number of visits per month by age group were compared for these two periods. The significance level was set at < 5%.

Results

Questionnaire Survey

Table 1 shows the number and composition of employees at the time of the first and second questionnaire surveys. The total number of employees increased by five, but there was no significant change in the composition ratio by department (p = .983). The survey response rate was 100% for the first survey and 93.8% for the second survey (30 of 32 people responded).

Table 2 shows the change in employee job satisfaction. In September 2021, 66.7% of employees were satisfied overall with their work: 11.1% of employees reported being very satisfied and 55.6% reported being satisfied. A total of 7.4% were dissatisfied.

In October 2023, after the mission articulation and vision presentation were finalized, 6.7% of employees reported being very satisfied with their work, and 70.0% were satisfied. The percentage of employees who responded that they were very satisfied decreased, but overall, 76.7% were satisfied with their work, and job satisfaction improved in the second survey compared with the first survey. The percentage of respondents who felt dissatisfied dropped to 0%.

Table 3 shows the changes in employees’ sympathy with the mission and vision. In September 2021, 48.1% of employees sympathized with the mission, 48.1% answered that they did not understand the mission and 3.8% answered that they did not sympathize. In September 2023, after the mission was articulated and the vision was presented, 70.0% overall sympathized with the mission; 16.7% strongly sympathized; and 53.3% sympathized. The percentage of respondents who did not understand the mission dropped to 30.0%, and none reported that they did not agree with the mission. After the mission was articulated, 73.3% overall reported sympathizing with the vision presented; 6.6% strongly sympathized and 66.7% sympathized.

Number of Patient Visits

Table 4 presents the changes in number of patient visits before and after mission articulation and vision presentation, as well as an analysis of the number of patient visits by age group. The overall average number of patients visiting the hospital per day increased significantly, from 205.8 ± 18.6 patients before the vision presentation to 237.3 ± 16.3 patients after the presentation (p < .001). By department, the number of patients visiting the rehabilitation department was 127.2 ± 11.3 before the presentation, and 142.9 ± 16.3 patients after. The number of patients visiting for anti-inflammatory and analgesic treatment significantly increased, from 46.5 ± 12.8 patients to 65.4 ± 6.4 patients after (p < .001). There was a significant reduction in the number of consultations, but the average overall number of patients visiting the hospital increased. A comparison of the average number of patients visiting the hospital per month before and after mission articulation and vision presentation showed a significant increase in the number of patients in their 20s and those in their 50s to 80s. The number of patients in their 50s increased, from 634.5 ± 109.1 to 743.8 ± 44.2 (p < .01); those in their 60s increased from 663.7 ± 49.4 to 776.8 ± 45.6 (p < .001); those in their 70s increased from 1015.3 ± 98.8 to 1263.5 ± 86.4 (p < .001); and those in their 80s increased from 608.1 ± 46.4 to 723.8 ± 57.2. By age group, the number of elderly patients (> 60 years) increased significantly, from 2921.5 ± 252.2 to 3507.9 ± 180.9 (p < .001).

Discussion

This study examined the effect of mission articulation and vision presentation on employee job satisfaction and the number of patient visits to a medical institution. The results showed that increasing engagement with the mission and vision can improve job satisfaction among employees and increase the number of patient visits. Analysis of the number of patient visits by age showed a significant increase in the number of visits from patients aged 50 to 90 years, suggesting that improving employee job satisfaction may have a positive effect on middle-aged and older patients.

Jabri and Ghazzawi reported that when employees strongly identify with an organization’s mission and vision, the organization can provide psychological safety to employees and increase their engagement with the organization.(11) Increasing sympathy with the mission and vision also improves organizational performance by allowing the organization to adapt to the environment, improve work efficiency to achieve goals, and improve human relationships.(12) Dobrinic´ and Fabac reported that greater engagement with the organizational mission and vision is associated with higher job satisfaction.(13) Therefore, it is likely that increasing the sympathy of employees with the organization’s mission and vision can lead to greater engagement with the organization and improved organizational performance, which improves job satisfaction. Our findings show the results of an intervention to increase awareness of the organization’s mission and vision in a medical institution. The number of patient visits was compared between one year before and one year after mission articulation and vision presentation, and was found to have increased significantly after mission articulation and vision presentation. Although the number of consultations in each department dropped slightly, the number of patients visiting the hospital for rehabilitation and anti-inflammatory and analgesic treatment increased.

Macede et al., reported that when employees strongly identify with the mission and vision, organizational performance improves, as does as the company’s total revenue and sales growth rate.(14) Al-refaei et al., state that employees with high organizational commitment tend to expend more effort in achieving organizational goals, which results in improved financial performance.(15) Dharmadasa et al., showed that in terms of the shareholder equity ratio, which is an indicator of a company’s medium- to long-term financial stability, companies without a mission statement have an average shareholder equity ratio of 9.7%, whereas companies with a mission statement have an average shareholder equity ratio of 16.1%; this suggests that companies with a mission statement also have higher financial stability.(16)

The evidence indicates that in medical institutions, improving employee job satisfaction leads to improvement in both overall organizational efficiency and the quality of medical services.(17) Improving the job satisfaction of medical workers can improve patients’ current health status and satisfaction by improving high-quality care and empathetic responses to patients, and ensuring that patients receive safer and more effective treatment.(18,19) Our findings suggest that the mission articulation and vision presentation ensured that the hospital’s values and aims were disseminated throughout the organization, and that this led to an increase in staff agreement with the vision and an increase in job satisfaction. In addition, it was confirmed that this increase in sympathy and satisfaction contributed to the improvement of quantitative indicators that represent the performance of the entire organization. In this study, that was demonstrated in terms of the concrete indicator of an increase in the number of patient visits.

Evaluation by age group showed that the number of hospital visits increased significantly for patients aged 50 to 90 years after the vision presentation and mission articulation. The improvement in employee satisfaction resulting from increased engagement with the mission and vision may have had a positive effect on elderly patients. In a survey of elderly people’s satisfaction with medical care, Sharkiya reported that in order for elderly people to feel satisfied with medical care, it is essential that medical professionals provide high-quality medical services and communicate effectively with each patient, and that the work environment and job satisfaction of medical professionals are important factors in achieving this.(20) It also has been reported that the kindness and courtesy of medical staff is influenced by the work environment.(21) Our findings suggest that greater engagement with the mission and vision and increased job satisfaction led to positive changes in medical services for elderly patients.

Because the study participants included employees and patients of only one medical institution, the study population was limited, and the results are difficult to generalize. Additional research at multiple facilities is needed to further explore these issues. Furthermore, because data from only a two-year period was used, it was not possible to fully examine whether articulation of the organizational mission and vision leads to long-term changes. In addition, as the evaluation of employees’ job satisfaction and sympathy with the mission and vision may be subject to self-report bias, additional studies are needed using evidence-based question indicators to cross-check the questionnaire responses and confirm reliability. Another limitation that should be considered is the possible influence of external factors during the study period, such as changes in the economic situation and the effects of the COVID-19 pandemic, which may have affected the number of patient visits and job satisfaction. Finally, because we were unable to analyze in detail the specific factors that affected the change in the number of patient visits in each department, it is unclear to what extent factors other than the mission and vision affected such visits.

Conclusions

We examined the effect of mission articulation and vision presentation in one medical institution on employee job satisfaction and the number of patient visits. More sympathy with the organizational mission and vision was associated with an increase in employee job satisfaction. The overall number of patient visits also significantly increased after mission articulation and vision presentation, particularly for patients aged 50 to 90 years.

There were several study limitations, and additional research on this topic is needed. However, the findings suggest the need to examine the effect of organizational mission and vision on the number of patient visits by considering the influence of external environmental factors, such as the domestic economic situation, fluctuations in the local population, and the decline in services or closure of competing medical institutions. In addition, there is a need to investigate the effects of internal environmental factors, such as the introduction of new medical equipment, the results of implementing marketing strategies, and improvements in patient satisfaction.

Our study suggests that sharing mission articulation and vision presentation with employees in a medical institution may improve employee job satisfaction and increase patient numbers. Mission articulation and vision presentation in the medical institution also may contribute to improved measurement of quantitative indicators in management and also may provide higher-quality care to patients by providing increased motivation to employees. Higher-quality patient care may have a positive impact, especially for middle-aged and elderly patients, and also may lead to increased credibility in the community.

In conclusion, when management of a medical institution shares the mission articulation and vision presentation with employees, that has a positive impact on quantitative indicators of management. Such a management strategy supports the long-term development of the organization by enabling employees to provide high-quality medical services.

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