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5-Step Guide to Engaging Nurses

By Jennifer Thew RN  
   April 01, 2018

After retooling its leadership team and committing to improving staff engagement, Appalachian Regional saw big improvements in its quality, safety, and patient satisfaction scores. 

This article first appeared in the March/April 2018 issue of HealthLeaders magazine.

About four years ago, leaders at Appalachian Regional Healthcare System in Boone, North Carolina, realized they had a serious problem with employee engagement. 

Staff engagement scores were in the basement—around the 19th percentile on the Bivarus employee engagement survey—and a nurse called The Joint Commission to complain that electronic medical records were affecting nursing workflows. 

"I think [the nurses] felt like their only option was to report that externally," says Amy Crabbe, MBA, CHHR, senior vice president of people services at Appalachian Regional. "That really got our attention that we had some significant issues around engagement."

Additionally, the health system with two hospitals and more than a dozen medical practices was struggling with other metrics, such as HCAHPS scores. 

"Our thought was that when we have engaged employees, everything else doesn't just automatically fall into place, but it obviously lays an infrastructure for the patient experience and for quality."

Kim Bianca, MSN, RN, senior vice president of hospitals and acute services and CNO, Appalachian Regional Healthcare System, Boone, North Carolina

"Some questions had hit rock bottom. Some of the questions were as low as the 5th percentile; some were in the 30th percentile," Crabbe says. "On average, we were well below the 50th percentile, and that is not where we wanted to be." 

A C rating by the Leapfrog Group added salt in the wound.

"We just went, ‘Holy cow! How can this be, that we're a C?' " says Kim Bianca, MSN, RN, senior vice president of hospitals and acute services and CNO at Appalachian Regional. "We don't consider ourselves C people or a C organization, but to have someone externally grade us that way … our CEO was quite concerned about it."  

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Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


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