Are you talking to yourself? You should be.

Aug. 23, 2019

Most rural hospital CEOs recognize the importance of external marketing. I wish I could say the same when it comes to internal communications (IC). It seems that sometimes internal communications is only deemed important when a “crisis” is brewing or some controversial decision needs to be announced. Maybe that’s why IC is often under-appreciated and undervalued.

I can tell you from decades of experience that an effective internal communication strategy is directly related to employee engagement. Why? Because engaged employees will not only advocate for your rural health organization, they’ll also provide better care. Unfortunately, sometimes as leaders, we don’t always see that connection. Let’s explore this idea a bit more.

Engagement Pays

A recent Advisory Board study found that every 1 percent increase in hospital employee engagement correlated with a 0.33-point increase in the facility's Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) overall hospital rating. (And we all know that HCAHPS scores can positively or negatively influence a rural hospital's Medicare reimbursement.)

The study also showed that a 1 percent increase in hospital employee engagement was tied to a 0.41-point increase in patient safety grades. Researchers found that engaged employees are three times as likely as disengaged employees to earn top performance marks.

I’m sure this makes sense, but I love it when data backs up our instincts. Effective internal communications, engaged staff, satisfied patients, and successful rural health organizations are all related. If your IC program fails, it can pull the others down with it. If that sounds like hyperbole, consider this: Gallup found that nurse engagement is the No. 1 predictor of mortality variation across hospitals.

Make it work for you

This revelation puts a huge check next to the ROI box when it comes to investing in an effective IC program. When I say “effective,” I mean a program that is the true voice of your organization: one that breaks down operational silos, allows for two-way communication, and is targeted and ongoing.

 I’ve found that the majority of employees are actually hungry for communication. The problem is, they often feel like the messages they receive are overly complicated, irrelevant or are shared only when something “bad” is about to happen. That said, I’d like to highlight some important takeaways from my work with rural health organizations that are reinventing their IC programs to help increase engagement.

What employees want

 Overall, employees of rural health organizations:

  • Want a big picture perspective of where the organization is headed and how they can contribute to that vision. (If you go too deep into the details, you’ll lose them.)
  • Are more concerned about patients and quality of care than operational updates. Tip: If you need to talk about operational changes, do it in the context of how the changes will help improve patient care.
  • Want a dialogue. Yes, there are times when top-down communication is necessary. But employees are on the frontlines. They have opinions they want to share and valuable insights you need to hear to help move your organization forward. Make sure there is a channel for dialogue between executives, management and all other staff.  
  • Generally trust their managers and yes, even you—the CEO. Messages that come directly from supervisors and trusted leaders tend to resonate with staff. But they can also spot insincerity a mile away, so credibility and transparency are key.
  • Feel like they rarely hear about the “good stuff” and what they’re doing right. This is a real miss because authentic, well-placed kudos can really drive engagement. Staff members are proud of the work they do and how the hospital is making a difference in people’s lives. Don’t miss an opportunity to share positive stories about the organization as well as individual staff members.


Just as in external marketing, one size does not fill all when it comes to communicating with a diverse staff, often in different locations. With the above in mind, I recommend taking a holistic approach to communicating to employees. This includes multi-channel content provided in a variety of formats, such as:

  • Video: While there’s a time and place for professionally produced videos, smartphones have opened the door to capturing footage that’s real, compelling and employee driven. Say good-bye to talking heads and start educating, engaging and entertaining all at the same time.
  • Blogs are a good way to help maintain transparency and develop a more personal connection between CEOs and management and other staff. They’re also versatile and can be targeted to specific messages.
  • Intranet: When your intranet is well-designed and easy to navigate, employees tend to engage with it more often. It’s an effective tool that can pull employees in vs. pushing them to their overloaded inboxes.  
  • Email: OK, so I just mentioned “overloaded inboxes,” but there’s still a need for email in your IC program. Email continues to rank high on the list of employees’ preferred means of communication. The caveat is that if they hear from you too often, they’ll start to ignore you, so make sure any message you send is relevant, timely and targeted.
  • Print has had its day, but it certainly hasn’t gone away. Some rural hospitals I’ve worked with tried cutting print out of their IC program only to find that many employees still want a good old-fashioned magazine or newsletter to pick up and read.
  • Employee forums. These are often done, but in my humble opinion, not very well. An effective employee forum promotes transparency, two-communication and an interactive environment.
  • Employee ambassador program. Before we launch any new external initiative, we need to gain buy-in and acceptance internally. Employee ambassador programs involve employees in reviewing the message and in ensuring we can “deliver” on the promises we’re making.

I’ll be honest. I’ve seen my share of failing internal communication programs over the years. It’s an issue that comes with very real consequences for employee engagement and ultimately, organizational performance. That makes it an issue not just for Marketing or Human Resources, but especially for rural hospital CEOs and senior executives.

So I ask, “When was the last time you took a good hard look at your internal communications program?” What you see may shock you into making a powerful and positive change. If you’d like to learn more details on the ideas discussed here, I’d welcome your call.

If you’re planning on attending this year’s NRHA Critical Access Hospital Conference, September 18-20 in Kansas City, we’ll be discussing employee engagement in more depth. Join us at 9:00 a.m. for: Innovative Strategies to Increase Employee Engagement and Drive Growth, co-presented by Michael Coyle, CEO Ely Bloomenson Hospital.

Mike Milligan, President, Legato Healthcare Marketing

Website by: Craig Erskine

Click to follow us below: