Listen, educate, recognize: a winning formula for staff engagement

In its frequent communication with revenue cycle leaders across the country, there is one area of focus that continues to cause anxiety and uncertainty: staff engagement and retention. The reasons for this are well known – ranging from an inability to compete for qualified staff, to unaligned job descriptions, hours, and pay grades within the health system itself. Even a lack of understanding among human resources regarding the need for further assessment in this arena has been raised as a barrier.

At a recent HBI Member Retreat, three groups of revenue cycle leaders from various levels and revenue cycle departments shared their challenges and successes related to staff engagement and retention. Throughout all three of these separately held discussions, three themes rang loud and clear:

1. Leaders need to spend more time actively listening to and responding to staff input.
2. Education needs to be invested in and supported, and it needs to go beyond role-specific and systems-based training.
3. Individual staff members and team successes need to be recognized and celebrated (not necessarily with dollars, but with praise, added responsibility, and more autonomy).


Leaders have noticed that today’s workforce craves engagement, but when decisions are made without notice or discussion, it can lead to speculation and hostility. Staff often grow restless in a culture where all decisions and improvements are driven from the top down.

This is especially true when employee engagement surveys show that staff feels they have worthy input, but it is not valued.

Transparency is not just for patients. Staff needs to see that leaders can talk openly about vulnerabilities, provide honest communication about current issues, and recognize both wins and losses. Staff may be suspicious of “talking points” do not seem sincere, and their trust must be earned regardless of hierarchy or title. Staff also want to be involved and allowed to share their front-line findings. And when they say something is broken, they want to know they were heard and that something will be done in response.

To foster trust and transparency between leadership and staff, revenue cycle departments are discussing employee satisfaction survey results openly as a team. Besides, leaders are scheduling more one-on-one time with staff as a separate avenue of feedback and as a way to ask staff “what would you do?” or even “what would you fix?” Forums are also being developed in which staff can submit project improvement proposals or present their ideas to C-suite executives. In some cases, leaders are even spending a certain amount of hours each month on the front lines or designating a space to work amongst their staff as schedules allow.


Leaders also shared the feeling that internal education is not always supported at the highest level of the organization and often at risk when margins or budgets get tight. Yet, cutting educational offerings can have negative implications for productivity, quality, and the ability for staff to grow successfully into their roles. Additionally, there is still a reliance on promoting and rewarding knowledge, skill, or tenure, but not the capability to lead or motivate others. In many cases, someone who does not manage others well is given direct reports, causing morale to suffer, or they may have great potential to be wonderful leaders if only given some training and mentorship.

To provide a greater level of support and education, organizations are building programs that teach staff their value, their impact throughout the revenue cycle, and their influence on the patient experience. Training on how to communicate both with patients as well as other staff is also being emphasized, in addition to trainings on concepts like active listening, demonstrating empathy, and how to accommodate varying personality types. In addition to expanding the scope of training, many leaders are also diversifying training methods, opting for more videos, activities and games, and role-playing scenarios mixed with classroom learning or online modules.


Studies evaluating the impact of recognition on job satisfaction are not new but often tell a similar story. This type of motivation, including the ability to earn added responsibility, influences how an employee views their job and employer more than policies, management, working conditions, or even salary. These studies may define “recognition” somewhat differently, perhaps even counting employees gaining more autonomy over their work, having them take on more ownership of a task, giving authority over the growth of others, and even just the ability to view reports without their leaders as forms of recognition. In providing these tokens of acknowledgment, whether large or small, leaders are likely to have a longer-lasting effect on staff perception—and therefore, quality and productivity.

To better recognize staff, leaders are implementing staff-nominated awards that come with rewards such as celebrations, gift cards, or even a bonus. Often, such awards were based on a theme like teamwork, quality, or “joyful service.” Career ladders prove to be imperative to all three of the themes addressed above, as they blend staff education and development with increasing compensation, title advancement, and a structured way to take on more responsibility. Last, leaders reminded each other to keep themselves and other levels of management accountable for employee recognition and engagement efforts by tying employee engagement scores to their annual performance rating.