Ask the leaders of health care organizations about their top three challenges for the coming year, and many will answer, “Workforce, workforce, and workforce.” These leaders continue to say that they are struggling to recruit and retain caregivers of all types, that costs are breaking their budgets, and that morale is at historic lows. As a direct result, every type of performance suffers: financial, safety, and overall quality, including the patient experience.
With an air of desperation, organizations are trying a number of tactics, including offering bonuses for signing, retaining, and referring new recruits. They are implementing programs to reduce burnout such as mindfulness training and investing in AI and other technologies that reduce administrative burden. All of these tactics to improve compensation and reduce the life-threatening aspects of work have merit, but organizations should not rely on them to create the loyalty and resilience needed for health care excellence.
Our data on hundreds of thousands of doctors, nurses, and other caregivers in the United States shows that pride in their work and loyalty to their colleagues are the strongest correlates of their willingness to stay. in their organization and continue to show up for work. Competitive salary and other support options are essential Persuasion caregivers, of course, but the culture of the organization, including a commitment to excellence, is what makes them STAY.
Improving organizational culture is a leadership challenge that is more complex than finding money to increase compensation or correcting problems that cause grief. After all, in life in general, happiness is something more than the absence of sadness. The same is true in health care. For example, “Service recovery” programs. that responding quickly to patients’ complaints can reduce their anger, but lack of anger does not equate to loyalty. Similarly, organizational responses to caregivers’ pain may prove that leaders care, but this does not mean that caregivers will continue to show up and do everything to meet the needs of their patients.
What drives loyalty and resilience among caregivers? As is true in other industries during these difficult times, getting back to basics is important – and in healthcare that means focusing on organizational culture. the noble cause of reducing the suffering of patients and then support carers in that work. Our data shows that this is not wishful thinking; it is an operational imperative.
For example, we examined the drivers of loyalty for 410,000 healthcare employees during the pandemic. In these analyses, we examined the factors associated with the expression of employees who strongly agree with these two statements: “I would stay in this organization if offered the same position elsewhere ” and “I want to work in this organization three years from now.” For both metrics, there is a marked decrease across the country from 2020 to 2022 (on a 1-5 scale, from 4.15 to 4.00 for the first statement and from 3.93 to 3.78 for the latter).
But the patterns of change are not the same in every organization and in every type of work. There is a “spread of the pack,” with greater differences than in the past in measures of employee engagement between organizations that perform well and those that perform poorly. The data suggests that leadership matters like never before – not only at the C-suite level but also on the front lines where managers really determine what the organizational culture feels like for employees. For example, there may be significant differences in how nurse morale works on two patient care units that are physically adjacent to each other but have different nurse managers.
Whatever differences exist among managers, there seems to be a remarkable consistency in what is important to the people who work for them. In our analyses, for all type of health care personnel, their organizations’ commitment to quality and patient-centered care is one of the main drivers of their likelihood of retention. When employees give their organization low ratings on these issues, they are more than six times more likely to say they are preparing to leave. These issues are important to security guards, maintenance, and clerical personnel as well as clinicians.
That finding may seem strange at first glance, but as one hospital executive told us, “It makes perfect sense. When patients feel mistreated, they don’t yell at the doctor often; they take it to the clerks and security guards. But if the patients have a good experience, the clerks and security guards enjoy the light – and that’s what they want to stay.
For doctors, the main factors related to their stated likelihood of staying are whether they like their job, feel that the organization uses their skills, and organizational culture. For example, if doctors feel that the organization does not have an inclusive culture, that increases their risk of considering leaving by 5.5 times. Compensatory compensation packages are likely critical to recruiting physicians, but culture is critical to sustaining them.
Press Ganey’s data is completely consistent with the findings of a study of 20,627 physicians and advanced practice clinicians in 120 large US health care organizations by Mark Linzer and his colleagues published in November in JAMA Health Forum. It is known that the intention to leave has increased from 24% in 2019 to more than 40% in 2021 but many factors have been identified that mitigate the risk of burnout. In the multivariate regression analysis, positive factors include feeling valued, good teamwork, and having values that align with leaders.
Our data for doctors, nurses, and all types of personnel show a mix of positive effects that accompany these sources of caregiver pride. For example, these measures of overall organizational “involvement” are also strongly associated with measures of safety culture, such as their reliance on the organization’s commitment to preventing and reporting adverse events – and those safety culture measures were associated with lower rates of safety events. . In short, the data confirms that excellence in all the performance areas that drive business success are linked: patient experience, quality and safety, and workforce engagement.
The implications of these findings for health care leaders are that they, of course, must listen carefully to understand what issues cause pain and fear in employees and try to solve it. But leaders must also listen to understand their employees’ hopes for what their work means to them and reinforce the aspirations that brought their employees to health care in the first place.
To do that, leaders must be clear about their values, their commitment to safety, reducing suffering, and a culture of respect and inclusion. They need to prove their authenticity by committing to measuring how things are going on these issues, sharing the findings, and using them to improve. The result is greater loyalty and stability in the workforce, which translates into better performance in all respects.
