Workforce burnout and the retention crisis have dominated healthcare for the past three years, but the data is (finally) showing some encouraging trends. Analyzes of survey responses from the past three years show that the decline in workforce “engagement” has slowed and “strength” is actually improving. The data also shows the spread of the pack – with greater disparity between organizations where morale and worker retention are improving versus others where the slide continues. This article will draw on some of the best practices that have the potential to become a virtuous cycle.
The following analyzes are based on approximately 1.6 million survey responses from employees of US health care organizations (including more than 121,500 physicians) during 2020, 2021, and 2022 produced by our company, Press Ganey. While it’s burnout is getting worse for all kinds of health care professionalsthree additional metrics provide a more complete picture of what is happening in health care:
During the past year, there has been a flattening of the downward trend for engagement, which measures the emotional bond of employees to the organization and their willingness to go beyond their job descriptions to meet the needs of patients. and colleagues. Using a five-point scale, engagement declined .10 in the year after the pandemic began (calendar year 2021) — the largest decline in engagement for caregivers that Press Ganey has observed, but the decline has slowed, with .02 decrease in 2022. .
There is a similar flattening of the rate of decline in alignment, which is assessed through measures that reflect providers’ perceptions of their relationship with organizational leadership. For example, if they do not feel respected or that their voices are heard in decisions that affect their practice, they will not feel aligned with the organization even if they are proud of it. This helps explain why many female doctors quit.
There will be real progress in 2022 in strength: the ability to find meaning in work (activation) and recharge when away from work (decompression). (See in this article for specific survey items used to measure both.) The good news is that activation has remained stable throughout the pandemic for almost everyone in healthcare. These are good people who are motivated to do good. But the better news is that decompression has increased in 2022 after two years of sharp decline. This data shows that caregivers are learning how to cope with the stresses of this time, their organizations are doing a better job of supporting them, or both.
These three inspiring trends don’t work for everyone. Our data shows a widening gap between the top 10% of organizations in workforce engagement and the bottom 10%. In short, employee engagement in many organizations is improving, while in others it is deteriorating. The data suggests that some organizations are stuck in a vicious cycle where stress leads to burnout which leads to worse performance which leads to more stress. But some organizations (or sub-units of organizations) exist in a virtuous cycle where caregiver pride leads to better engagement which leads to better performance which leads to more pride.
The picture that emerges from this data is that health care has dedicated and hardworking people who have been through a lot but, under the right circumstances, have much more to offer. What are those right conditions? Data from organizations in the top decile of worker engagement offer insights.
Top performers scored higher than others in five specific domains: support and trust of senior leadership, recognition of employees’ contributions, respect and participation in decision-making, stress management of work, and adequate staff.
How do we get from a vicious cycle to a virtuous one? By implementing these steps:
Listen to the truth.
The first thing organizations and their leaders should (and can) do immediately is to listen and understand the challenges faced by their individual employees and their leaders. What is meant by actually listen changed during the pandemic. This no longer means just going out for “leadership walk rounds,” surveys every one or two years, or occasional town halls for a shift that happens to be on duty at noon. It involves not only gathering more information but also simultaneously SHOWS employees you create.
now, actually Hearing requires a significant change in frequency, width, and depth of hearing, which is made possible by technology. For example, new tools can empower managers to create pulse surveys focused on specific issues or specific groups of employees and reveal opportunities to respond to their specific needs. need. Virtual focus groups and digital communities can “bring together” employees facing similar challenges and create connections and opportunities to collaborate and solve shared challenges.
Crowdsourcing technology allows managers and leaders to involve their front lines in identifying solutions to problems and prioritizing which solutions to initiate. By using artificial intelligence (AI) and natural language processing, employee comments can be organized and channeled to reveal challenges and successes, both of which create opportunities to fix problems. and measure existing successful solutions. Many leaders still shudder at the idea of surveying employees when they know the feedback will hurt, but actually listening is a sign of respect.
Make engagement and well-being a priority.
While every organization has different and unique results from its listening efforts, high-performing organizations have one thing in common: Senior leaders (often including their boards) come first on the importance of employee engagement and well-being. They recognize that an active and healthy workforce is essential for them to provide excellent patient care and reduce patient suffering.
These top performers hold themselves accountable to progress each year and make the investments to support this progress. While they rely heavily on their HR leaders, they engage leadership across the organization, including nursing, physicians, and quality and safety leaders to collectively address these issues.
Focus on three areas of improvement.
Next, almost all top-performing organizations focus on doing these things:
Tactics to support individuals should emphasize the importance of self-care – something that is poorly done in health care. Organizations should share positive feedback from colleagues, leaders, and patients (and most patient feedback is the positive) to show organizational gratitude and respect.
Organizations should invest in partner support programs so that partners can identify suffering in their ranks and design solutions that can help them. And they must continue their evolution from the traditional in-person workplace to one that includes hybrid or remote work where possible – an evolution that introduces complexity to managers but improves the resilience of their employees. .
Support leaders and groups.
After listening, the best organizations take their data even deeper. They recognize teams that face many obstacles and leaders who struggle. They support the managers of these units in developing improvement plans to address specific issues revealed through surveys, focus groups, and other listening methods.
Developing leaders and building teams is also a critical tactic for maintaining virtuous cycles. This requires investment in teaching and more structured training. Focusing on the skills that leaders need to create trust and confidence should be taught so that new leaders have the skills to support and build their teams. Ultimately the goal of leaders is to create a psychologically safe environment where those around them feel comfortable speaking up and coming out and actively contributing to development.
Fix broken systems and processes.
Finally, top-performing organizations demonstrate their commitment to fixing dysfunction in existing systems and processes. They fix broken processes, leverage technology, and build teams so they can all work smarter. And they know that to solve these problems, they need to include the voices of their front lines. They have developed reliable processes to ensure that those closest to the job are supported in solving problems. Many organizations have adopted the approach GROSS (“get rid of the stupid stuff”) and put processes in place to listen to their front lines and then implement solutions. Some use new crowdsourcing technology that enables employees to submit innovative solutions to challenges revealed through annual surveys; these organizations then use these submissions to advance a path.
This continuous reevaluation of systems and processes must be built into the organizational structures of health care providers. This type of approach is one that many organizations are already taking to build a culture of safety and improve quality outcomes for patients. It must now be applied to organizational efforts to improve engagement and resilience in order to retain the exceptional people who continue to work in health care.
Organizational leadership that includes a coordinated strategy of truly listening to its employees and patients, developing their leaders, and continuously improving workflows will drive the flywheel of pride and engagement needed to sustain the virtuous cycle.