How to Design and Administer Effective Staff Satisfaction and Engagement Surveys

Many medical practice managers believe that their practice’s greatest asset is its workforce, and rightly so. The quality of the employees has everything to do with the quality of the medical services provided to patients, and, overall, with how well the medical practice performs. At the core of all of that is how employees feel about their work. But how can you know if your employees are satisfied with their jobs and with your practice? How can you know that they are actively engaged in their work? Of course, the practice manager can observe employees and interact with them to check the pulse of the staff. But that alone may not tell the whole story. As Knowles(1) explains, “Not all employers fully understand the attitudes and perceptions of their staff.”

Fortunately, there is a tool that can help. Conducting regular employee surveys can help medical practice managers understand employee attitudes and perceptions. In fact, as Knowles explains, surveys are critical if performance is to be maximized. Employee surveys offer many benefits. They can improve attendance, enhance patient relations, improve collaboration and teamwork, and help you identify opportunities and eliminate problems. They also can increase profitability, employee satisfaction, and employee engagement. According to Knowles, “Staff surveys that provide a thorough understanding of staff attitudes and perceptions are the first essential step in developing strategies that really can improve staff motivation, reduce staff turnover, increase innovation, and lead to better customer retention—all of which will increase productivity, reduce costs, and improve profitability.”

Poorly designed surveys can be confusing and provide inaccurate data.

This all sounds great, right? But there is a dark side to surveys. Poorly designed surveys can be confusing and provide inaccurate data. They can stir up negative feelings and questions without offering solutions. And it is not always easy to trust the reliability of a survey. After all, an employee may answer a question one way on one day and have a completely different answer on another, depending upon what is going on at the time. And asking questions about what an employee may do or not do in the future is speculation; the practice manager won’t know for sure what employees will do until they actually do it.

So is it possible to design and administer an effective survey? The short answer is yes. But in truth, it can be harder than it looks. Fortunately, with thought, care, and a little bit of elbow grease, medical practice managers can design and execute effective employee surveys. As with most things, there are established procedures that work well, as well as common mistakes to avoid.

Employee Satisfaction versus Employee Engagement

A good first step in designing a survey for your employees is to decide whether you will be gathering data about employee satisfaction or employee engagement. There’s an overlap between the two, but they are different. Employee satisfaction surveys address how satisfied employees are with their work, working conditions, salary and benefits, supervisor, colleagues, and the medical practice that employs them. Employee engagement surveys, on the other hand, address the extent to which employees feel valued and involved in their everyday work.

Employee engagement is far more important than employee satisfaction.

According to SurveyMonkey,(2) employee engagement is far more important than employee satisfaction because it relates to whether employees feel invested in their employer’s mission and success. Engagement is an indicator of the overall health of your medical practice, and it is an excellent way to spot areas for improvement. Engaged employees are more fulfilled, motivated, and productive, and they are more likely to remain loyal to the practice that employs them. As SurveyMonkey succinctly puts it, medical practices not only should measure employee engagement, “they can’t afford not to.”

SurveyMonkey suggests that there are more dimensions that define employee engagement than employee satisfaction alone. That’s because conducting an employee engagement survey doesn’t measure only how happy employees are; it measures how dedicated they are to the mission and outcome of your medical practice, which is far more complex. Good employee engagement surveys will measure several factors, SurveyMonkey says, including:

• Leadership behavior: Effective leadership can make or break employee engagement. A good employee engagement survey will help you gauge whether your leadership is perceived as fair, ethical, responsive, inspiring, and appropriate.

• Nature of work: Contrary to popular belief, most employees don’t actually want a job that is too easy. Use your employee engagement survey to ask your employees how challenging and motivating their work is.

• Career development: Are your employees getting support from educational and mentoring opportunities? Do they see a clear path forward and feel that they have the support they need to get where they want to go? An employee engagement survey can help you find out if your employees feel that they do or will have opportunities to advance their careers.

• Pride: When employees are proud of where they work and of their place of employment, it shows. They believe in your mission and they want to see your medical practice succeed as much as you do. That attitude translates to their performance. Your employee engagement survey can help you assess the level of pride your employees feel about their work individually and about your practice overall.

• Colleagues: How employees feel about their colleagues can have a huge impact on their morale and their faith in meeting their goals. Therefore, employee survey questions about relationships with colleagues should be a part of any employee engagement strategies you implement.

Designing and Administering Employee Surveys: Twenty-Five Do’s and Don’ts

A well-crafted, well-executed survey will yield helpful data. Fortunately, there are a number of best practices anyone can follow to improve the quality of a survey. Here are 25 recommended do’s and don’ts for you to follow when you are designing and administering your own employee survey.

1. First, do no harm. Do not conduct an employee survey unless your practice’s leadership is committed to listening to and acting on the feedback. If you ask your employees what they think and then do nothing with the results, you will foster cynicism and skepticism with your employees. In fact, as SoGoSurvey(3) suggests, “You’ll be worse off than if you didn’t conduct a survey at all.” Don’t ask your employees about things you know that you cannot change. That’s a surefire recipe for making your employees feel that you don’t listen to them.

2. Determine the purpose of your survey. It is tempting to jump head first into a survey initiative before determining the purpose of the survey. However, this leads to ineffective surveys. Spend time figuring out what you want to know and why. Then begin to design your survey.

3. Involve your staff in the survey design process. According to Hoeck,(4) involving employees in the survey design improves the survey response rate. That’s because employees feel more invested in the survey. Employee participation also can help you improve the quality of your survey instrument, Hoeck says.

4. Keep it short. Shorter surveys are more likely to be completed than longer ones. As Smith(5) suggests, three things happen when a survey is too long: respondents drop out; people stop paying attention; and respondents can become angry. Long surveys can lead to survey fatigue, a well-documented phenomenon that occurs when survey participants become tired of the survey task and the quality of the data they provide begins to deteriorate. Fifteen minutes can seem like a long time to a person taking a survey. Keep yours no longer than that if you can. Try to make your survey relevant, interesting, and easy to complete. Remember, you don’t have to ask every question you can imagine in a single survey.

5. Guarantee employees’ confidentiality. You want your employees to be as honest as possible when they take your survey. To do that, your employees will need the reassurance that their views will be confidential. Make the survey anonymous to increase their sense of security. Then, when reviewing employee survey results, don’t let the conversation turn to who said what. This diminishes the credibility and integrity of a confidential survey process.

6. Offer incentives. A little incentive such as an entry in a drawing can help to ensure that your employees complete their surveys.

7. Don’t survey everyone just because they are there. In larger medical practices, a practice-wide survey that tries to be all things of all people and that asks the same questions every year may not yield the most accurate insights. Targeted one-time surveys of specific units, processes, or roles will produce deeper insights into the critical, current issues for those groups, SoGoSurvey suggests.

8. Be comprehensive at first. You may be interested in measuring and improving only a few of the factors of employee engagement or satisfaction. However, SurveyMonkey warns that when you focus a survey on a specific topic from the beginning, you may miss out on other areas for improvement. When trying to develop an overarching employee engagement strategy, it’s best to be comprehensive first and then focus on specific parts second. Let the survey data you gather in the first go-round help you refine your questions for follow-up surveys.

9. Survey employees when they will have time to provide thoughtful input. While the end of the calendar year may seem like a good time to ask your staff about the prior 12 months, it usually isn’t. That can be a hectic time for everyone. And in far too many cases, Gibbs(6) suggests, “Valuable employee feedback is gathered at the wrong time, typically during exit interviews,” when it is far too late to turn things around. Instead, choose a calmer, more stable time when your employees can focus and when there is time for you to take action on what they tell you. Give your employees several chances to respond. Most importantly, ask your staff to complete the survey during the workday. As Gibbs suggests, surveys are part of your employees’ work. Do not ask them to complete them on their own time.

10. Use simple, direct language. Avoid using big words, complicated words, and words that could have multiple meanings. Your question should be short, simple, and clear. Remember that some concepts may mean different things to different people, so be as specific as possible. Quantify responses when you can. For example, instead of asking “Do you feel stressed regularly at work?” you could ask “How many hours per week, on average, do you feel stressed while at work?” This gives you a more precise, objective answer.

11. Avoid absolutes. In particular, avoid questions that ask if something always or never happens in your medical practice. For example, don’t ask, “Does your practice manager always listen to you?” Instead, you might ask, “How often does your practice manager listen to you?” and give the employee choices on a scale from always to never.

12. Don’t use double negatives. For example, don’t ask employees to respond to the statement, “I am not unhappy with my salary.” Better: “I am happy with my salary.”

13. Break down big ideas into multiple questions. Come at broad concepts several different ways. For example, when gauging employee satisfaction, you might ask them to agree or disagree with several statements such as:

    1. I enjoy my job.

    2. My job meets my needs.

    3. I would recommend this practice to a friend who is looking for a job.

14. Don’t ask difficult recall questions. People’s memories are increasingly unreliable as you ask them to recall events further and further back in time. You will get far more accurate information from your employees if you ask, “About how many times in the last month have you fallen behind schedule?” rather than, “About how many times last year have you fallen behind schedule?”

15. Explain unexpected questions. For instance, if it’s important for you to ask your employees to tell you their preferred take-out food item, you might want to explain why that is relevant.

16. Justify requests for sensitive information. For example, explain why you want to know your employees’ opinions of their colleagues or whether they have ever thought about looking for a job elsewhere. Remind them that they are answering anonymously and that survey responses are confidential.

17. Allow room for open feedback. When given the opportunity, people like to provide honest feedback to tell you what they really think. They will need free text fields for that. Add one to three text boxes. However, do not create a survey of too many free text fields. You will want to give employees a chance to speak freely, but at the same time, you will want to make your survey fast to take and easy to analyze.

18. Offer an out for questions that don’t apply. Some employees can’t answer certain questions because they lack needed experience or don’t know the answer. For example, an employee who is very new to your practice may not have any knowledge of your team building activities because he or she may not have experienced them yet. For these questions, offer an option for them to select “Does Not Apply” or “Don’t Know.”

19. Don’t focus only on the bad things. Ask questions that allow for a range of positive and negative responses about working in your medical practice. The goal of an employee survey is both to build on successes and to identify and address your shortcomings or failures.

20. Pretest your survey. Pretesting will help identify unclear questions, badly worded choices, and more before you administer your survey to your employees. It will give you a chance to improve your survey and its chances of generating actionable feedback. To pretest, Beadall(7) suggests that you send your completed survey to a few different people you can trust. Ask them to tell you about any questions that seemed unclear or any problems they found. If you can, sit down with at least one or two people while they take the survey and listen to their reactions and feedback as they go. You’ll often hear things like “I’m not sure how to answer this” or “Wow, this is really long,” which are clues that you will need to do some revisions, Beadall says.

21. Notify employees in advance that you’ll be launching a survey and asking for their feedback. Think of this step as “marketing” the survey. When employees understand the process, they are more likely to participate and provide candid feedback. Communicate your purpose. Employees should know why you are going to ask them your survey questions.

22. Provide helpful information with the survey. Reiterate the purpose of the survey. Then include information about the security of responses and confidentiality, survey open and close dates, how long the survey will take to complete, when and where during the day to complete the survey, what will happen after the survey, and any incentives you are offering. If you are using a third party to administer the survey or if you have engaged an external survey group (more on this later in this article), explain who that is and why you have engaged that particular person or firm.

23. Send reminders to your staff. At first you’ll receive a burst of survey responses. However, that will quickly die down. When that happens, give your survey a boost by sending reminders to your staff. Mention the importance of the survey, how little time it takes to complete it, and the incentive you’ve provided.

24. Don’t be a one-and-done surveyor. A common mistake is to conduct one survey and to stop. As TalentKeepers(8) suggests, “Building momentum is a key ‘do’ for survey initiatives to create sustained positive change.” How often should you conduct employee engagement surveys? Trudel(9) suggests once a year. Trudel explains, “If an engagement survey is formatted properly, offers a clear degree of engagement, and offers actionable items for increasing engagement, then it just makes sense that management has timely versions to refer to.” Additionally, some employers find it beneficial to conduct very short engagement surveys semi-annually to gather timely data and to gauge the effects of engagement initiatives, Trudel says. And of course, short follow-up surveys can stem from larger ones and be administered anytime, as needed.

25. Don’t tinker with words. SurveyMonkey suggests that you keep the wording of your questions consistent between surveys and from year to year. That way you can be sure of measuring the same aspects of your medical practice’s culture each time.

Analyzing, Sharing, and Using Survey Data: Ten Strategies

There is no point in conducting an employee survey if you do not analyze and use the data you collect. Of course, precisely what you do will rely on what you learn from your survey. However, the following 10 tips will help no matter what you find out:

1. Review and analyze survey data quickly. Then share the results of your survey with your staff promptly. The longer the gap between the survey and feedback, the greater the risk of inactivity.

2. Prepare to be surprised. Many medical practice managers believe that they can predict what their employees will say. Some will be correct. However, Gibbs suggests that others will find that their survey results blindside them. That’s why it’s worth conducting a survey, Gibbs(6) says. If you were already aware of every problem and attitude in your medical practice, there would be no point in conducting a survey. As you review and analyze survey data, remain as impartial as you can and go wherever the data take you.

3. Identify ambiguous questions. Take a look at any question that elicited results that seem inconsistent or that otherwise stand out to you. Could it be that the question was ambiguous? If you determine that it is, note this in your analysis. Then, rewrite the question so it is clearer in future surveys. For tips on writing clearer questions, see the sidebar, “Avoid These Seven Common Survey Mistakes” that accompanies this article.

4. Share the good, the bad, and the ugly. Prepare a succinct executive summary for your staff that summarizes and simplifies the survey data, highlighting key findings. Include both the positive outcomes and the more challenging ones. As SoGoSurvey suggests, “Present all the facts, warts and all.” Be honest, open, and objective. Don’t attempt to position the results as better or worse than they are. Do your best to play the role of an impartial observer. Communicate the findings without intermingling your personal opinions.

5. Don’t try to change opinions. Communicating survey results is what SoGoSurvey describes as “a time for humility.” Don’t argue with the results or try to persuade your employees to change their opinions. As Wright(10) suggests, you must be careful not to “guilt trip” your employees. Says Wright, “Employees should never feel like they have to retract their survey responses. If you make them feel guilty about your organization’s survey results, they are less likely to trust the survey process, and you.”

6. Don’t debate who’s right and who’s wrong. Employee survey follow-up conversations aren’t about debating which opinions are right and which are wrong. According to Wright, “Employee surveys reveal employee perceptions, and right or wrong, perception is reality.” Debating right versus wrong sends the message that not all employees’ feelings and experiences are considered valid. “That disengages,” Wright warns.

7. Invite discussion. Invite employees to comment as you discuss survey results. Make them feel as though you’re talking with them instead of at them. This will help foster a productive conversation.

8. Ask for questions. If employees seem quiet, let them know you’ll be asking direct questions during the discussion. Then follow through. Just be sure to do so in an open, non-threatening way. Be neutral and nonjudgmental in your words, tone, and body language. Create and foster an environment of trust.

9. Create a post-survey action plan. Identify follow-up actions that will generate positive outcomes for your medical practice. Demonstrate through action that you are listening to your employees and that you believe that their feedback is valuable.

10. Don’t stop what you’re already doing to gather employee feedback. Employee surveys can help you identify successes and challenges within your medical practice. However, other avenues where employees can provide input daily remain crucial. As Gibbs suggests, “A survey cannot replace the need for day-to-day informal feedback at all levels of the organization.”

Hiring a Third Party or External Survey Group

An in-house employee survey is likely to be your least expensive choice. You can design your own survey from scratch or use one of the many templates that are available. Keep in mind, however, that employees may be most likely to provide truthful responses when they feel that their answers are confidential and won’t be used against them. Therefore, consider having employees send their completed surveys to a third party, such as a consultant, not to you. Even though your employees will know that the results will ultimately come to you, they may perceive that their anonymity is better safeguarded and feel more comfortable when they submit their responses to a third party. There is an added benefit of working with a third party; internally administered anonymous surveys pose a problem for tracking participation. As TalentKeepers(8) suggests, an external partner is able to track participation and to contact those who have not yet responded for follow up, without breaking confidentiality.

Hiring an external survey group to design and administer a survey is generally a more expensive option. But it is a good one if you believe that you lack the expertise to design the survey. One of the advantages of hiring an external survey group is that, as with a third party, employees may feel that they can speak more confidentially. Another is that external survey providers are able to tie an individual’s survey results to his or her operational performance metrics and then report these relationships through the use of group reports. According to TalentKeepers, “This maintains the confidentiality of the individual’s responses but still leverages the ability to see survey results for certain groups of respondents such as high performers.” Internally administered surveys cannot provide this vital information without violating confidentiality, TalentKeepers says. In addition, Gibbs suggests that external surveyors have the expertise to develop questions that will elicit valuable responses that employers can act upon. Medical practice managers are encouraged to search online and through word of mouth for employee survey templates, consultants, and external survey groups that can help them.

References

1. Knowles P. Staff surveys: following good practice. Team Technology. www.teamtechnology.co.uk/surveys.html . Accessed January 2, 2018.

2. Build a better, more productive workplace with an employee engagement survey: go beyond employee satisfaction and measure what matters most. SurveyMonkey. www.surveymonkey.com/mp/employee-engagement-survey/ . Accessed January 2, 2018.

3. Employee surveys do work: the do’s and don’ts for getting it right. SoGoSurvey Blog, December 20, 2016. www.sogosurvey.com/blog/employee-surveys-do-work-the-dos-and-donts-for-getting-it-right/ . Accessed January 2, 2018.

4. Hoeck J. The do’s and don’ts of employee surveys. Effectory. September 12, 2013. www.effectory.com/knowledge/blog/the-dos-and-donts-of-employee-surveys/ . Accessed January 2, 2018.

5. Smith S. 4 common sense tips for creating surveys that work. Qualtrics Blog. December 31, 2012. www.qualtrics.com/blog/creating-surveys/ . Accessed January 3, 2018.

6. Gibbs R. The do’s and don’ts of employee engagement surveys. Money Inc. August 2017. http://moneyinc.com/the-dos-and-donts-of-employee-engagement-surveys/ . Accessed January 2, 2018.

7. Beadall S. Surveys 101: a simple guide to asking effective questions. Zapier. https://zapier.com/learn/forms-surveys/writing-effective-survey/ . Accessed January 3, 2018.

8. TalentKeepers. The risky business of employee surveys: do’s and don’ts for getting it right. TalentKeepers White Paper. www.talentkeepers.com/wp-content/uploads/2015/03/TalentKeepers-The-Risky-Business-of-Employee-Surveys-The-Dos-and-Donts-for-getting-it-Right-Whitepaper.pdf . Accessed January 2, 2018.

9. Trudel N. The do’s and don’ts of executing engagement surveys: Part 1—do. CRG emPerform. http://employee-performance.com/blog/the-dos-and-donts-of-executing-engagement-surveys-part-1-do/ . Accessed January 2, 2018.

10. Wright H. Communicating employee survey results: 10 do’s and don’ts. The QWork Future. January 13, 2015. www.quantumworkplace.com/future-of-work/communicating-employee-survey-results-10-dos-donts/ . Accessed January 3, 2018.

Avoid These Seven Common Survey Mistakes

No doubt you’ve taken a survey or two that had questions that were ambiguous or that did not provide you with appropriate choices for your answers. We’ve all encountered mistakes that keep survey questions from being effective. Smith(1) describes seven of the most common mistakes:

1. Leading words and questions: Be especially mindful of words and questions that suggest bias. For example, a survey can ask: “How would you rate the career of legendary outfielder Joe DiMaggio?” The word legendary in this example can bias participants to rate DiMaggio more favorably. Better: “How would you rate the career of baseball outfielder Joe DiMaggio?” Another example: a survey can ask participants to agree or disagree with the statement, “The government should force you to pay higher taxes.” Forced is a biased word. No one likes to be forced to do anything. Better: “The government should increase taxes.”

2. Failing to give mutually exclusive choices: Multiple choice response options should be mutually exclusive so that respondents can make clear choices. Don’t create ambiguity. Review your survey and identify ways respondents could find themselves with more than one answer. For example, do not present choices like these when asking, “What is your age?”

   1. 0-10

   2. 10-20

   3. 20-30

   4. 30-40

   5. 40+

   The respondent would not know what to select if he or she is 10, 20, 30, or 40.

3. Vague questions without intent: Make sure your participants know what you’re asking for. Here is an example of a vague question: “What suggestions do you have for improving our medical practice?” This question may be intended to obtain suggestions about improving the daily schedule, but respondents may offer suggestions about marketing, referral building, interior décor, supplies, equipment, staff, policies, uniforms, etc.

4. Forgetting to add Prefer Not to Answer as an option: Privacy is an important issue to most people. Different cultural groups may respond differently when they feel that their privacy is at stake. For example, according to Smith, U.S. respondents may skip sensitive questions, while Asian respondents often discontinue the survey entirely. Include “Prefer not to Answer” as a choice for your most sensitive questions. That way, you will know whether a respondent simply missed a question or preferred not to answer it. This is a potentially important distinction.

5. Failure to include all possible answer choices. For example, when asking, “What type of vehicle do you own?,” you would not want to offer only three choices:

   1. Van

   2. SUV

   3. Sedan

   The respondent would have no choice to select if he or she owned a truck, hybrid, crossover, motorcycle, moped, scooter, or no vehicle at all. Offer as possible responses these and other choices that occur to you, as well as “Other (please specify).”

6. Offering unbalanced scales: When designing a scale for responses to survey questions, make sure that there are two extremes and that there are equidistant points on the scale. For example, here is an example of an unbalanced scale: “What is your opinion of our staff meetings?”

   1. Pretty good

   2. Great

   3. Fantastic

   4. Incredible

   5. The best ever

   This question offers only positive responses and will not elicit truthful opinions of respondents. As well, one employee’s “incredible” may be higher than another’s “fantastic.”
   Tip: Respondents will find surveys most pleasant when they use the same scale from question to question. Think about using the very popular Likert scale, a scale created by University of Michigan sociologist Rensis Likert in 1932 that has stood the test of time. The Likert scale asks respondents to rate the level to which they agree with a statement, usually offering five potential choices (strongly agree, agree, neutral, disagree, strongly disagree). The Likert scale has the added benefit that it is familiar to many survey respondents, and therefore, comfortable.

7. Asking more than one question at a time: Do not ask compound questions. For example, do not ask, “What is the fastest and most economical Internet service for you?” This should be two questions: “What is the fastest Internet service for you?” and, “What is the most economical Internet service for you?” Another example: Avoid a question that combines two activities such as, “How likely are you to go out for dinner and a movie this weekend?” This, too, should be broken into two questions: “How likely are you to go out to dinner this weekend?” and, “How likely are you to go out to a movie this weekend?” If you want to know if respondents would go to dinner and movie on the same night or at different times over the weekend, that would require further probing.
   Tip: Check your survey for compound questions by looking for the words “and” or “or.”

Reference

1. Smith S. Make any of these 7 question writing mistakes? Qualtrics Blog. January 14, 2013. www.qualtrics.com/blog/writing-survey-questions/ . Accessed January 2, 2018.

The Top Nine Employee Engagement Survey Topics

Employee engagement is a worthwhile goal, but it is not the end goal. According to Hadjistoyanova,(1) the ultimate goal is a better outcome for the medical practice. For this reason, Hadjistoyanova suggests that managers keep three things in mind when designing employee engagement surveys: gauging the employee’s connection to your practice’s goals; determining whether employees view themselves as part of a collaborative team; and determining whether employees have the right capabilities.

To that end, Hadjistoyanova offers the top nine survey topics that will help you look for the meaningful kind of engagement that can improve employee performance and outcomes. You may need to ask several specific questions to tease out employee responses to each of these topics:

1. Do you understand the strategic goals of our medical practice?

2. Do you know what you should do to help our practice meet its goals and objectives?

3. Can you see a clear link between your work and the practice’s goals and objectives?

4. Are you proud to be a member of our team?

5. Does our team inspire you to do your best work?

6. Does our team help you complete your work?

7. Do you have the appropriate amount of information to make correct decisions about your work?

8. Do you have a good understanding of informal structures and processes in our practice?

9. When something unexpected comes up at work, do you know who to ask for help?

Reference

1. Hadjistoyanova I. The 9 questions that should be in every employee engagement survey. CEB Blogs. May 4, 2016. www.cebglobal.com/blogs/the-9-questions-that-should-be-in-every-employee-engagement-survey/ . Accessed January 2, 2018.