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MODULE 8: CULTURE, ENGAGEMENT & WELL-BEING
Section 8.2: Measuring and Improving Employee Engagement
Moving beyond guesswork to learn the science of diagnosing and treating the root causes of disengagement.
SECTION 8.2
Measuring and Improving Employee Engagement
Treating Engagement as a Critical Vital Sign for Departmental Health.
8.2.1 The “Why”: Engagement as a Leading Indicator of Operational Health
As a pharmacy professional, you are intimately familiar with the concept of vital signs and laboratory values. You know that a rising white blood cell count is a leading indicator of infection, often appearing before a fever spikes. You understand that a declining eGFR signals kidney damage long before the patient becomes symptomatic. These metrics are critical because they allow you to intervene before a crisis occurs. Employee engagement is the organizational equivalent of these leading indicators. It is the most critical “vital sign” for the health of your department.
Disengagement is the “subclinical infection” that, if left untreated, will inevitably manifest as severe, lagging symptoms: increased dispensing errors, higher staff turnover, plummeting patient satisfaction scores, absenteeism, and a toxic work environment. By the time you are dealing with these lagging indicators, the damage is already severe and difficult to reverse. Learning to accurately measure and proactively improve employee engagement is the practice of organizational preventive medicine. It is the single most effective strategy for ensuring the long-term health, safety, and productivity of your pharmacy operations.
But what, precisely, is “engagement”? It is not employee happiness or satisfaction, though those are related. The most effective definition comes from the extensive research by Gallup:
Defining Employee Engagement
Engaged employees are those who are involved in, enthusiastic about, and committed to their work and workplace.
- Involved & Enthusiastic (The Heart): They have a passion for their work, a sense of energy, and feel a deep connection to their company. They don’t just work for a paycheck; they work with a sense of purpose.
- Committed (The Mind): They understand their role and how it contributes to the organization’s success. They see a future for themselves at the company. This commitment leads them to give discretionary effort—they willingly go the extra mile.
This section provides you with the diagnostic tools and evidence-based treatment plans to move from a reactive manager of problems to a proactive leader of people. You will learn to stop asking “Why is my turnover so high?” and start asking “What are the root causes of disengagement on my team, and what specific interventions can I prescribe to improve the health of our work environment?”
Retail Pharmacist Analogy: The Non-Adherent Patient with Hypertension
Imagine you have a patient, Mr. Smith, with uncontrolled hypertension. His blood pressure readings (a lagging indicator) are consistently high. You could simply tell him, “You need to take your lisinopril.” This is the managerial equivalent of saying, “Our error rates are too high, you all need to be more careful.” It’s a directive that addresses the symptom without understanding the cause, and it’s rarely effective.
A great pharmacist, however, becomes a clinical investigator. You don’t assume the patient is willfully non-compliant. You start diagnosing the root cause of the non-adherence (the “disengagement” from their care plan). You ask questions and investigate:
- Is it a Knowledge Deficit? “Mr. Smith, can you tell me how you’ve been taking this medication?” (Maybe he doesn’t understand the instructions). This is the employee who doesn’t know what is expected of them at work.
- Is it a Resource Issue? “Are you having any trouble affording the copay for this prescription?” (Maybe he can’t get the tools he needs). This is the employee who doesn’t have the right equipment or software to do their job effectively.
- Is it a Side Effect Problem? “I know this medication can sometimes cause a bothersome cough. Have you noticed anything like that?” (Maybe the work environment itself is causing a negative reaction). This is the employee who feels their workplace is toxic or unsupportive.
- Is it a Belief System Conflict? “What are your thoughts on how well this medication is working for you?” (Maybe he doesn’t believe it’s important or that it’s helping). This is the employee who doesn’t feel their work has a purpose or that their contribution matters.
- Is it a Relationship Issue? “How are things going with Dr. Allen? Do you feel like you’re on the same page with your treatment plan?” (Maybe there’s a lack of trust in the provider). This is the employee who doesn’t trust their manager or feel their manager cares about them.
Only after you have diagnosed the true barrier to adherence can you prescribe the right intervention. A copay issue requires a patient assistance program, not a lecture. A side effect requires a call to the doctor to change therapy. A knowledge deficit requires better counseling. Measuring and improving employee engagement follows the exact same clinical logic. You must first diagnose the specific drivers of disengagement on your team before you can implement an effective plan to improve it. This section is your guide to that diagnostic and therapeutic process.
8.2.2 From Gut Feeling to Hard Data: The Engagement Measurement Toolkit
For too long, managers have relied on “gut feelings” or anecdotal evidence to gauge team morale. A high-performing leader recognizes that engagement is a quantifiable metric. Just as you rely on objective lab data, you must learn to use a combination of quantitative and qualitative tools to get an accurate picture of your team’s health. Relying on just one method is like trying to manage hypertension with only a single blood pressure reading—you’ll miss the full picture.
Masterclass Table: The Four Quadrants of Engagement Measurement
| Measurement Tool | What It Is | Pros | Cons & Pitfalls |
|---|---|---|---|
| 1. Annual Engagement Survey (Quantitative, Lagging) |
A comprehensive, standardized questionnaire (e.g., Gallup’s Q12, AON Hewitt) administered once a year by the organization. It provides benchmark data against other departments or companies. |
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| 2. Pulse Surveys (Quantitative, Real-Time) |
Short, frequent (weekly or bi-weekly) surveys, often with just 1-5 questions, focusing on specific, immediate topics like workload, communication, or well-being. |
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| 3. One-on-One Meetings & “Stay Interviews” (Qualitative, Proactive) |
Regular, scheduled check-ins with individual employees focused on their growth, challenges, and what keeps them at the company. A “Stay Interview” proactively asks questions like, “What do you look forward to when you come to work each day?” and “What would make your job more satisfying?” |
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| 4. Behavioral & Operational Metrics (Observational, Lagging) |
Analyzing objective data that serves as a proxy for engagement. This includes tracking voluntary turnover rates, absenteeism, medication error rates (near miss and actual), and productivity metrics. |
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8.2.3 The Diagnostic Gold Standard: Deconstructing the 12 Drivers of Engagement
After decades of research involving millions of employees, the Gallup organization identified 12 core elements—the Q12—that most effectively measure and predict employee and workgroup performance. These are not just survey questions; they are a hierarchical framework of fundamental human needs at work. Think of this as the “definitive lab panel” for diagnosing the health of a team. A deficiency in the foundational elements (like knowing what’s expected of you) will make it impossible to achieve the higher-level elements (like feeling your job has purpose). As a leader, your job is to ensure you are creating an environment where the answer to each of these 12 questions is a resounding “Yes.”
Masterclass Deep Dive: The Q12 Engagement Hierarchy in Pharmacy Operations
We will examine each of the 12 drivers, translating them from abstract concepts into the concrete reality of a busy pharmacy. For each, we’ll explore the ‘why’, how to diagnose deficiencies, and specific ‘therapeutic interventions’ you can apply.
The Hierarchy of Needs at Work
The Q12 drivers are not a random list; they form a pyramid of needs, much like Maslow’s hierarchy. You can’t focus on an employee’s growth (the top of the pyramid) if they don’t even have the basic tools to do their job (the bottom of the pyramid).
- Level 1 (Base Camp – Basic Needs): Q1 & Q2. “What do I get?”
- Level 2 (My Contribution – Individual Needs): Q3 – Q6. “What do I give?”
- Level 3 (My Belonging – Team Needs): Q7 – Q10. “Do I belong here?”
- Level 4 (My Growth – Personal Growth): Q11 & Q12. “How can we all grow?”
Q1: I know what is expected of me at work.
Level: Basic Needs. Why it’s the foundation: All performance begins with clarity. If an employee doesn’t know what “winning” looks like, they have zero chance of success. This is the most fundamental need and, shockingly, where many managers fail.
Signs of Deficiency: Team members working on the wrong priorities; duplication of effort; frustration over performance reviews (“I didn’t know that was part of my job!”); constant questions about basic procedures.
Therapeutic Interventions:
- Create a “Definition of Done” for key tasks: What does a “perfectly filled” prescription look like? (e.g., correct drug, patient, sig, bag, leaflets included). What does a “complete” inventory cycle count entail?
- Role-Specific Scorecards: Develop a simple scorecard for each role (Staff RPh, IV Tech, Adjudication Tech) with 3-5 key, measurable responsibilities. Review it in every one-on-one.
- The “Five Questions” Check-in: In your one-on-ones, ask: 1) What are your top priorities this week? 2) What does success look like for those priorities? 3) What resources do you need? 4) What obstacles are in your way? 5) How can I best support you?
Q2: I have the materials and equipment I need to do my work right.
Level: Basic Needs. Why it matters: Nothing is more disengaging than being asked to do a job without the proper tools. It signals to the employee that the organization doesn’t truly value their work or their time. It creates constant, unnecessary friction.
Signs of Deficiency: Constant complaints about slow computers, broken printers, or low stock of vials/lids/bags; technicians creating their own inefficient “workarounds” for faulty equipment; time wasted searching for supplies.
Therapeutic Interventions:
- Conduct a “Friction Audit”: Dedicate one team meeting to this question: “What are the top 3 most frustrating, time-wasting, or resource-related problems you face every single day?” Write them down and attack the list.
- Proactive Maintenance Schedules: Don’t wait for the label printer to die mid-rush. Have a schedule for cleaning, maintenance, and a clear process for reporting issues before they become critical.
- Empower the Experts: Put your lead technician in charge of the supply ordering and equipment maintenance log. They are closest to the work and know what’s needed. Give them a budget and the autonomy to manage it.
Q3: At work, I have the opportunity to do what I do best every day.
Level: Individual Needs. Why it matters: This is about aligning individual talent with daily tasks. When people get to use their strengths, they are more productive, more innovative, and more energized. Forcing a highly empathetic, people-oriented technician to spend all day in the inventory room is a waste of their greatest talent.
Signs of Deficiency: High performers seem bored or lethargic; employees are stuck in roles that don’t match their skills (e.g., the detail-oriented person forced to do chaotic intake); low creativity and problem-solving.
Therapeutic Interventions:
- The “Strengths-Based” One-on-One: Dedicate a one-on-one to discussing strengths. Ask: “What was the best part of your work week? Why?” “When do you feel most energized and effective at work?” “What’s one talent you have that you think we’re underutilizing?”
- Job Crafting: Look for small ways to tweak roles to better align with strengths. Can the tech who loves solving puzzles take the lead on complex insurance rejections? Can the pharmacist who is a great teacher be in charge of precepting students?
- Create “Specialist” Roles: Instead of having every technician be a generalist, create informal specialist roles: “Lead Compounding Tech,” “Inventory Champion,” “Training Lead.” This gives people ownership and allows them to deepen their skills in an area of strength.
Q4: In the last seven days, I have received recognition or praise for doing good work.
Level: Individual Needs. Why it matters: Recognition is emotional oxygen. A lack of it makes employees feel invisible and unvalued. Frequent, specific praise is the most powerful and cost-effective way to boost engagement and reinforce desired behaviors.
Signs of Deficiency: A culture where the only feedback is negative; employees have no idea if they’re meeting expectations; good work is simply taken for granted; you hear “no one ever says thank you.”
Therapeutic Interventions:
- The 5-to-1 Ratio: High-performing teams have a ratio of at least five positive interactions for every one negative interaction. Track your own ratio for a day.
- Make it Specific: Vague praise like “good job today” is nice but ineffective. Specific praise is a teaching tool. “Sarah, the way you handled that angry patient with such empathy and found a solution was a masterclass in patient care. Thank you.”
- Peer-to-Peer Recognition: Create a simple system for employees to recognize each other. A “kudos” channel on a messaging app, a whiteboard in the breakroom, or starting every team meeting by going around and having each person recognize a colleague for something specific they did that week.
Q5: My supervisor, or someone at work, seems to care about me as a person.
Level: Individual Needs. Why it matters: Employees are human beings first, workers second. A workplace where they feel they are just a cog in a machine will never earn their commitment. Building trust and showing genuine care are foundational to psychological safety and retention.
Signs of Deficiency: Conversations are 100% transactional and task-focused; manager doesn’t know basic personal details about their staff (kids’ names, hobbies); employees are afraid to mention personal struggles affecting their work.
Therapeutic Interventions:
- The First Five Minutes: Dedicate the first five minutes of every one-on-one to non-work conversation. Ask about their weekend, their family, their hobbies. And actually listen to the answers.
- Remember and Recall: Keep a simple, private note of important things you learn (“Son’s name is Michael, plays baseball”). The next time you talk, asking “How’s Michael’s baseball season going?” shows you listen and care.
- Acknowledge Life Events: Acknowledge birthdays, work anniversaries, and express condolences for losses. These small human gestures have an outsized impact.
Q6: There is someone at work who encourages my development.
Level: Individual Needs. Why it matters: The best employees are driven to learn and grow. If they don’t see a path for development in their current role, they will find one somewhere else. This is about showing them you are invested in their future, not just their current output.
Signs of Deficiency: High turnover among ambitious employees; no one ever gets promoted from within; performance conversations are only about past performance, not future potential.
Therapeutic Interventions:
- Individual Development Plans (IDPs): Co-create a simple IDP with every employee. Ask them: “What skills do you want to learn in the next year? What career goals do you have?” Then, identify one or two concrete actions they can take (e.g., take an online course on sterile compounding, shadow the inventory manager).
- “Stretch” Assignments: Give employees projects that are just outside their current comfort zone. Have a technician lead the implementation of a new workflow. Ask a pharmacist to prepare a presentation for the team meeting on a new clinical guideline.
- Be a Connector: You don’t have to be the sole source of development. Introduce a new tech to a senior tech who can act as a mentor. Point a pharmacist interested in leadership to resources and other leaders in the organization.
Q7: At work, my opinions seem to count.
Level: Team Needs. Why it matters: Engagement requires a two-way street. If communication and decision-making are purely top-down, employees feel like powerless order-takers. Asking for input signals respect and makes employees feel like owners of the process, not just renters.
Signs of Deficiency: Changes are announced by memo with no discussion; in meetings, the manager does all the talking; employees have stopped offering suggestions because they feel it’s pointless.
Therapeutic Interventions:
- Ask, Don’t Tell: Before you solve a problem, bring it to the team. “We’ve had three look-alike/sound-alike errors this month. What are your ideas on how we can mistake-proof this process?”
- Close the Loop: The fastest way to get people to stop giving opinions is to ignore them. If an employee makes a suggestion, you must close the loop. Either implement it and give them credit, or explain specifically and respectfully why you can’t. (“That’s a great idea to rearrange the fast-mover shelf. We can’t do it this month due to the corporate audit, but let’s put it on the agenda for our first meeting next month.”)
- Round-Robin in Meetings: In team meetings, go around the room and explicitly ask each person for their thoughts on the topic. This prevents the loudest voices from dominating the conversation.
Q8: The mission or purpose of my company makes me feel my job is important.
Level: Team Needs. Why it matters: People are starved for meaning. They want to know that their daily, often repetitive tasks, contribute to something larger and more important. The “why” is more powerful than the “what.”
Signs of Deficiency: Employees refer to their work as “just counting pills”; there is a cynical or detached attitude; no connection is ever made between daily tasks and patient outcomes.
Therapeutic Interventions:
- Connect to the Patient Story: Regularly share positive patient feedback. “I wanted everyone to hear about the thank you card we got from Mrs. Davis. The MTM you did, Jennifer, caught a major interaction, and she’s feeling so much better. That’s why we do what we do.”
- Translate Corporate Goals: Take the high-level hospital or corporate mission (e.g., “To provide compassionate, high-quality care”) and translate it into daily pharmacy behaviors. “One of our hospital’s goals is ‘patient safety.’ For us, that means we double-check every high-alert medication and keep our error rate below 0.1%.”
- Celebrate “Saves”: Create a ritual for celebrating clinical interventions or “good catches” that prevent patient harm. This directly links the team’s meticulous work to the ultimate purpose of the profession.
Q9: My associates or fellow employees are committed to doing quality work.
Level: Team Needs. Why it matters: High performers want to work with other high performers. Nothing kills the motivation of an “A” player faster than seeing a “C” player get away with mediocrity. It creates a sense of unfairness and drags down the standards of the entire team.
Signs of Deficiency: Constant complaints about certain coworkers not pulling their weight; good employees are forced to constantly fix the mistakes of others; you see cliques of high performers and low performers.
Therapeutic Interventions:
- Address Poor Performance: This is non-negotiable. You must have timely, direct, and respectful conversations with underperformers. Use the performance improvement plan (PIP) process when necessary. Tolerating poor performance is a choice that tells your best employees you don’t value their commitment.
- Set and Enforce Team Standards: As a team, create a “charter” of agreed-upon behaviors. What does quality mean to us? How do we handle mistakes? How do we support each other during a rush? This creates peer-to-peer accountability.
- Calibrate as a Team: Use a de-identified medication error or a workflow problem as a case study in a team meeting. Discuss as a group what went wrong and how “we” can collectively prevent it from happening again. This builds a shared commitment to quality.
Q10: I have a best friend at work.
Level: Team Needs. Why it matters: This question isn’t about literally having a “best friend.” It’s a proxy for trust, connection, and psychological safety. It measures whether an employee has a genuine, supportive social bond with at least one person on the team. People with a friend at work are safer, more innovative, and far less likely to leave.
Signs of Deficiency: The pharmacy is silent and transactional; no non-work conversations ever occur; employees “clock in and clock out” without interacting; high levels of gossip or back-channeling.
Therapeutic Interventions:
- Engineer Positive Collisions: Create opportunities for people to connect as humans, not just coworkers. Organize team lunches or potlucks. Start a meeting with a simple, non-work icebreaker (“What’s the best thing you watched this week?”).
- Create a “Buddy System”: Pair new employees with a seasoned “buddy” for their first month. This isn’t just for training; it’s for social integration.
- Model Vulnerability: As the leader, be the first to share a bit of your personal life or admit a mistake. This gives others permission to do the same and builds a foundation of trust.
Q11: In the last six months, someone at work has talked to me about my progress.
Level: Personal Growth. Why it matters: People need feedback to grow. An absence of feedback is destabilizing; it leaves people wondering where they stand. Regular, future-focused conversations about progress are essential for development.
Signs of Deficiency: The only feedback conversation is the annual performance review; employees are blindsided by constructive criticism; they have no idea what their long-term career path looks like.
Therapeutic Interventions:
- Implement Quarterly “Progress Reviews”: Ditch the annual review as your only feedback point. Have a formal check-in every quarter focused on progress against goals, challenges, and future development.
- Separate “Evaluation” from “Development”: Have two different types of conversations. Evaluation conversations look backward (the annual review). Development conversations (your monthly one-on-ones) look forward, focusing on coaching and growth.
- Ask About Progress: In your one-on-ones, ask: “What are you most proud of accomplishing since we last spoke?” and “Where do you feel you’ve grown the most?”
Q12: This last year, I have had opportunities at work to learn and grow.
Level: Personal Growth. Why it matters: This is the pinnacle of engagement. It’s the feeling of forward momentum. Stagnation is a primary driver of turnover. Growth doesn’t always mean promotion; it can mean learning new skills, taking on new challenges, or becoming a deeper expert in one’s current role.
Signs of Deficiency: Employees feel they are in a “dead-end job”; people describe their work as “the same thing every day”; your most ambitious people are the first ones to leave.
Therapeutic Interventions:
- The 70-20-10 Model: Frame development around this model: 70% of learning happens through on-the-job experience (stretch assignments), 20% through mentoring and feedback (coaching), and 10% through formal training (courses, CEs).
- Create a “Skill Matrix”: For your technician team, create a matrix of key skills (e.g., IV compounding, inventory management, MTM data entry). Track each tech’s current skill level and work with them to identify which skill they want to develop next.
- Fund Learning: Fight for a small budget for professional development. Send a technician to become a certified compounder. Pay for a pharmacist to attend a leadership seminar. This investment sends a powerful message that you are invested in their growth.
8.2.4 The Engagement Action Plan: From Diagnosis to Treatment
After using surveys, one-on-ones, and the Q12 framework to diagnose the state of your team’s engagement, the final step is to create and execute a targeted action plan. This is where many managers fail. They admire the data but fail to act on it, which is worse than not measuring at all. An effective action plan is focused, collaborative, and accountable.
Warning: Do Not Try to Boil the Ocean
Your survey results might show deficiencies in eight of the twelve areas. The temptation is to create a massive, 15-point action plan. This is a recipe for failure. An effective plan focuses on doing a few things well. Pick the one or two most foundational drivers (start at the bottom of the hierarchy: Q1/Q2) that are weakest for your team. Make significant, visible progress on those one or two things. Success here will build trust and momentum, making it easier to tackle the other drivers later.
Playbook: The 4-Step Engagement Action Planning Process
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Step 1: Communicate Results with Transparency.
Schedule a team meeting dedicated solely to discussing the engagement survey results. Be vulnerable. Present the data—the good, the bad, and the ugly—without being defensive. Say, “Here are the results. In some areas, like our commitment to quality work, we’re doing great. In other areas, like feeling recognized for good work, I am clearly failing as your leader. My commitment to you is that we are going to fix this, together.”
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Step 2: Collaborative Brainstorming.
Do not come to the meeting with a pre-baked plan. Your team is far more likely to commit to a solution they helped create. Focus the discussion on your chosen 1-2 priority areas. For example, if recognition (Q4) is the issue, ask the team: “The data shows we are not doing a good job of recognizing each other’s hard work. What would meaningful recognition look like for you all? What are some ideas we could implement?” Facilitate the discussion and capture every idea.
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Step 3: Commit to Specific, Visible Actions.
From the brainstormed list, choose 1-3 specific, actionable, and visible initiatives. Assign an owner and a timeline to each. This creates accountability.
Example: “Based on your feedback, we’re going to do three things to improve recognition. First, starting today, I will personally make it a point to give at least one piece of specific praise every shift. Second, Sarah has volunteered to create a ‘Kudos Corner’ on the whiteboard. Third, we will start every team meeting with a ‘recognition round-robin.’ We will try these for the next quarter and see how they work.” -
Step 4: Follow Up and Follow Through.
This is the most critical step. Action plans die from a lack of follow-up. Put a recurring 10-minute item on every team meeting agenda called “Engagement Action Plan Check-in.” Report on progress. Ask if the new initiatives are making a difference. This shows the team you are serious and that their feedback wasn’t an empty exercise. It builds a virtuous cycle of trust and continuous improvement, transforming your pharmacy’s culture one deliberate action at a time.
