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The Anarchy Index: Looking at Hospital Employee Engagement

April 1st, 2021
April 1st, 2021

There are four questions asked in our Employee Insights surveys that determine the level of engagement in a hospital.  Responses represent a four point scale and these are Strongly Agree, Agree, Disagree, and Strongly Disagree (about their level of engagement).  These organizational engagement questions are:

  • You feel that being a member of this organization is very rewarding
  • You are proud to be part of this organization
  • You are highly motivated to contribute to the success of this organization
  • You are highly engaged in this organization

There is a humorous analogy I have heard that is useful in describing engagement of employees and it goes something like this:

Another Way to look at Employee Engagement

If a “Strongly Agree” employee is walking down a hospital corridor and sees trash in the hallway, he or she will proactively pick it up, dispose of it, and likely not make a big deal out of it.  That action is just part of who they are.  An “Agree” employee might also see the trash and dispose of it or at least find someone in Housekeeping and ask them to take care of it. In contrast, the “Disagree” (non-engaged) employee may well walk right by the mess and feel no obligation or responsibility to see that it’s picked up.  Some might not even notice it is there.  And then, to stretch the example even a bit further, the “Strongly Disagree” employee may well be the person who put the trash there to begin with.

The Percent Negative Group = Anarchy Index

A traditional description of those two bottom categories combined is the “percent negative” group.  That is certainly descriptive but I have come to think of those two categories of engagement as a kind of “anarchy index”.  For example, the HealthStream national database indicates that there is an 11% negative score for Organizational Engagement.  On average, the typical hospital in our database has about 11% of employees that are disengaged and some portion strongly so.  These employees have not bought in to the vision of the administrative team, and many go about their daily work with little or no passion or even lacking a sense of belonging.  Others within this group actually pull against the vision and can create turmoil within their respective units.  This disengaged group often makes up a large percentage of the low performers within a hospital.  The effect of this group on high performers as well as the larger group in the middle was discussed in my earlier blog.  Overtime, this group can actually erode employee satisfaction of the high and middle performers and eventually negatively impact employee turnover of these key groups.

What the Anarchy Index Can Mean for Overall Employee Satisfaction

It is interesting to note the anarchy index when preparing to deliver an Employee Insights report review for a client hospital.  Whenever this index is above 11% and rising, employee satisfaction overall is generally lower than average and usually declining.  However, when the anarchy index is single digit, stable or perhaps even declining over time, overall satisfaction is usually higher than average.  In this more positive environment, employee verbatim comments will often reflect this as well. There will generally be more positive employee comments than negative.  On the other end of the scale, when the anarchy index is approaching 20% negative, an alarm bell of sorts is sounding for management.  The effect of this negativity on engagement is broad based and will show up in lower satisfaction scores, verbatim comments – and left unchecked, will ultimately result in eroding Outcomes such as Intent to Stay.

A poor anarchy index score is usually a symptom of a number of factors.  These can include instability or frequent turnover in the C suite and/or lack of leadership continuity.  On the other hand, stability in leadership is not an absolute guarantee of engagement, especially when senior executives regularly fail to follow through on commitments or practice what they preach.  These can erode trust in administration over time – a key component in organizational engagement.

Much like a healthy culture of accountability, reducing “anarchy” index scores is the result of an engaged C suite – one that is consistent in delivering on commitments, communicating with employees, and holding themselves as well as all employees to a high standard.  If a CEO sees that employee engagement scores are not where he or she wants them to be, the best place to start the evaluative process may very well be at the top.

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