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Press Ganey Associates has come out with its 2008 survey of job satisfaction among 200,000 healthcare professionals at 423 healthcare organizations nationwide—including 45,000 nurses—and the news is neither good nor surprising.

According to the 2008 Employee and Nurse Check-Up Report: Employee and Nurse Perspectives on American Health Care Organizations, there is a simmering discontent out there at hospitals big and small, urban, suburban, and rural, and registered nurses are the most dissatisfied with their jobs.

Take heart, however. As Press Ganey points out, there are simple, practical, affordable solutions out there to improve employee morale and patients outcomes—solutions that can be implemented by any hospital that is willing to honestly assess its own shortcomings.

The expected irritants are in the mix, namely, compensation and staffing. But there is also considerable discontent with senior management. "The most important issue to employees is how well senior leadership, including senior management and administration, listens to them," Press Ganey concludes in its 21-page report. "Organizations that take steps to partner with their employees can see not only increased employee retention, but also increased patient volumes and satisfaction and a healthier bottom line."

Included in the Press Ganey report is a National Nurse Loyalty and Retention Opportunity Index, which shows nurses' priorities. At the top of the list, nurses say they want senior leadership that: listens to employees; responds promptly to most problems; and can be trusted.

The nurses also want sufficient staff to ensure quality of care, and some level of involvement in decision-making. "Listen to the RNs," one nurse told Press Ganey. "Not listening to us leads to frustration, and frustration leads to vacancies."

Press Ganey recommends that hospitals implement regular communication between employees and leadership, and that leadership solicit suggestions for improving patient care and employee needs. Listening to employees' concerns and suggestions to improve your hospitals shouldn't be that difficult or time consuming, and it appears to pay dividends.

One facility that got the memo was Lowell General Hospital in Massachusetts, which was singled out by Press Ganey for a turn-around strategy that centered on employee satisfaction. In 1999, the 200-bed, nonprofit community hospital found employee satisfaction in the 14th percentile, and annual turnover of 30%. In 2007, employee satisfaction increased to the 58th percentile and turnover dropped to 13%.

What happened in the intervening years? For starters, LGH knew it couldn't improve patient care and outcomes without the support of a motivated and experienced staff. So, they made employee satisfaction and retention a priority. The hospital created a weekly internal newsletter that provides a forum for news and events, project updates, and employee recognition. LGH installed an Intranet communication program where employees can access senior leadership in a virtual town hall meeting format. The hospital also created improvement initiatives that reward and recognize staff, including personalized thank-you notes from senior leadership to exemplary employees, peer-to-peer recognition for outstanding work, and an annual in-house award for the hospital's five top managers.

If feedback from employees is any indication, the LGH strategy is working. "The best things about working here are the respect, collaboration and supportive teamwork among the nurses, doctors and ancillary staff; that I am continually learning and the fact that we put the patients first," one LGH employee told Press Ganey. "I love my role and responsibilities, feel valued, have fun, and I am very proud that I work here."

Under new state rules, California hospitals and physicians are barred from billing patients for the balance of emergency care not covered by insurers. But hospitals and physicians are protesting the rules in court. The disputes typically occur when an insured patient ends up in an emergency room that is not in his or her carrier's network, and hospitals and physicians may send insurers bills that are higher than what the insurance firms usually pay providers in their network. And insurers often balk, sending back less than the full payment.