How can companies measure employees' satisfaction with the short-term disability (STD) benefits that are intended to help them recover and return to productive work, and what is an acceptable level of satisfaction in a system that includes claim denials as individuals deal with health and work disruptions?
Historically, the only “measurement” of satisfaction has been anecdotal feedback collected from labor union grievances or through homegrown survey tools. Although these do yield some limited insights, none provides a standardized approach to measurement or a valid basis for benchmarking and comparison.
To address this issue, the Employer Measures of Productivity, Absence and Quality (EMPAQ) initiative, which is part of the National Business Group on Health, developed a standardized survey in 2003 to gauge the satisfaction of employees who were returning to work following a STD absence. Employers can use the survey regardless of who their STD administrators are or whether they have a self-administered plan.
The purpose of the tool is not solely to measure the performance of a particular strategic partner. Rather, it pinpoints areas where improvements can be made to increase the satisfaction and the effectiveness of disability claims processes and return-to-work (RTW) efforts. The survey allows companies to establish a validated baseline to measure the impact of program changes and determine if their scores are in line with peer organizations.
Using the EMPAQ Employee Satisfaction Survey
The EMPAQ Employee Satisfaction Survey tool is available to all employers and strategic suppliers on the EMPAQ web site.
The National Business Group on Health charges nonmembers a minimal fee to have company results benchmarked through its partnership with the University of Michigan. By submitting validated data to EMPAQ for comparison, employers get the additional benefit of national benchmarking, and they help to further industry research.
However, companies can gain tremendous insight by simply using the survey and having comparisons available internally by department, or during industry roundtables if others are encouraged to adopt the survey.
The Certification of Disability Management Specialists Commission provided an educational grant to develop The Art and Science of the EMPAQ Employee Satisfaction Survey: An Employer Toolkit, which can be downloaded from the EMPAQ web site. The toolkit provides practical applications for using the survey to evaluate and improve disability management processes, from scoring and interpreting results to customizing the survey and cover letter.
One of the benefits of measuring and benchmarking results is the ability to learn from the experience of others. Below, early adopters of the survey share some of their insights gained from the survey, as well as tips for other employers to improve the experience of their employees.
Employee Satisfaction Can Affect Productivity Outcomes
The University of Pittsburgh Medical Center (UPMC), with more than 48,000 employees in 20 hospitals and 400 outpatient sites worldwide, uses the survey to benchmark its results against other employers and to compare scores internally by business unit.
“We needed to look at employees’ overall experience. Did they get the information they needed and were their claims processed on a timely basis? The answers we get back from the survey help us find workflow and throughput issues, which may have an effect on RTW,” explained John Galley, UPMC's vice president for compensation, benefits and HR information systems.
UPMC employs best practice disability and absence management strategies to help employees return to productive work as soon as medically feasible, using a RTW program and transitional duty to help ease employees back to the workplace and to mitigate delays in processing claims or negative customer service experiences that can make an employee less willing to return to the job.
“Our goal is getting employees back to work when they’re able—not before that, and certainly not after,” Galley commented. “We want to make sure there are no delays with short-term disability claims that could lead to late payments and then to late returns.”
Drill Down To Identify Root Causes
When properly implemented, the survey allows users to drill down into the data for root cause analysis. This includes assessing sub-processes within the overall continuum of the disability experience. Employers can analyze responses by respondent age, gender, demographic region and wage class. Looking at the responses across various profiles, companies can then determine whether they need better targeted interventions for certain populations.
Looking at responses across various profiles,
companies can see if they need better targeted
interventions for certain populations.
For another employer, Ascension Health—the nation’s largest not-for-profit health system, with more than 100,000 employees—the survey provided insights into individuals’ experiences, from how they perceived the process to whether they felt taken care of and believed they received benefits checks on time.
Suzann Bylund, director of workers’ compensation and disability management for Ascension Health, had received some complaints from senior people regarding the STD claims process; specifically, that they felt it was too complex. “We wanted to decipher whether the senior staff was getting complaints from associates [employees], which they were then reporting, or whether they themselves perceived the process to be complicated.”
Through the survey, Ascension Health asked its employees who had been out on STD about their own, personal experiences. This provided Ascension Health with input and responses across the spectrum of their employee population to see, for example, if targeted education or communication was needed with a particular group.
Ascension Health was able to uncover misunderstandings among some employees regarding the period before short-term disability benefits begin; when checks would be received; and that benefits are taxable income. “We thought we were doing well, although we had received a couple of phone calls from people about not getting their checks right away,” Bylund commented. “What the survey showed us was that education for associates on these issues needed to be improved.”
According to the University of Pittsburgh Medical Center's Galley, similar issues around the benefit elimination period were discovered at UPMC, such as confusion regarding that the first seven days of an employee’s STD absence are covered by paid time off before benefits begin. “We had a communication issue that we could jump on right away to make sure employees know how the benefit programs work together,” he noted.
Not Just for Employers
Strategic suppliers of disability management services such as third-party claim administrators are also embracing the standardized survey tool. Typically, these providers have used their own internally developed surveys to gauge their performance. However, these tools limited the ability of third-party administrators (TPAs) and other providers to benchmark outside their own business. Another impetus for TPAs and others to use a standardized tool is that many employers are specifically requesting the survey be used during the request-for-proposal process to allow an “apples to apples” comparison.
“Employee satisfaction plays a key role in [evaluating] program effectiveness. There is a correlation between satisfaction and how fast employees heal and get back to work,” said Bryon E. Bass, vice president and absence management practice leader at Sedgwick Claims Management Services, one of the largest TPAs in the United States. Sedgwick CMS goes the extra mile to have survey results sent to an objective third party for scoring to reinforce the integrity and validity of the results before presenting it to customers.
Comments Are Golden
Another plus from the survey is the ability to obtain written comments from employees, which provide additional insight and detail. When employees take the time to comment about a concern or experience it is usually reflective of an issue about which they feel strongly. The survey provides access to employee responses in their own words, which may lead directly to focused interventions that can address a problem or communications issue.
Surveys may produce hundreds of written comments from respondents. It is helpful to organize this feedback by a discrete process component, such as benefit levels and payments, the courtesy of the disability management staff, the overall RTW experience, and so forth. By categorizing the comments, data can be mined more effectively.
“From what we’ve seen, the majority of comments and responses from employees are in line and very reflective of the organization,” Sedgwick CMS's Bass added. “The responses correlate almost exactly to problem areas, as well.”
Measuring Improvements over Time
Over the two-and-a-half years that Ascension Health has been using the survey, Bylund said, the organization has seen improvements not only in the overall response rate (from a 26 percent return rate to 45 percent) but also in specific areas related to employee satisfaction. The organization has the assurance that it is maintaining areas that have been perceived as strengths.
“One area that has always been positive for us is when associates were contacted by the claims examiners they felt respected and were dealt with compassionately. That area has always scored very high,” Bylund said.
Maintaining that positive aspect of the employees’ experience is critical to the Ascension Health culture. “We’re a faith-based organization. Our associates deserve to be treated with compassion,” she added.
The ability to re-measure results over time helps employers determine the impact of specific changes, whether it's an education effort that helped to clear up misunderstandings, or a new initiative that improved the RTW process for employees.
“Things don’t happen in a vacuum,” Bass added. “It’s just like in an ecosystem in which everything relates to the health of something else—in this case, the relationships and patterns around program changes and employee perception.”
Maria S. Henderson, MS, CRC, CDMS, CCM, is chair-elect of the Certification of Disability Management Specialists Commission (CDMSC), the only nationally accredited organization that certifies disability management specialists (www.cdms.org). She is also founder and principal of HDM-Solutions Inc., a consulting firm based in Denver.
Integrating Health and Productivity Management, SHRM Online Benefits Discipline, May 2008
Return-to-Work/Stay-at-Work Programs: Reduce Lost Time, Boost Productivity, SHRM Online Benefits Discipline, March 2008
Absenteeism: Measure Costs, Adjust Incentives, Change Behaviors, SHRM Online Benefits Discipline, December 2007
Disability Cost Management via Wellness, Prevention & Data Integration, SHRM Online Benefits Discipline, June 2007
Short-Term Disability Plan Design: Effects on Employee Behavior and Outcomes, SHRM Online Benefits Discipline, April 2007