Healthcare Employee Engagement: Data-Driven Strategies That Work

Perceptyx research on the Healthcare Employee Experience provides data-based insights into how healthcare employee experiences are changing by studying perceptions measured nationally across more than 500 healthcare systems and 3.5 million healthcare employees.

One metric Perceptyx monitors using this database is employee engagement since engagement has a critical impact on healthcare business outcomes including safety metrics and patient advocacy. Specifically, we measure employee engagement through its four components — pride, motivation, intent to stay, and advocacy. This research provides evidence-based context to help healthcare leaders better understand the current employee experience landscape at a scale unavailable when looking only within their own organizations.

Healthcare leaders often describe their employees' experiences using positive terms such as "hope," "optimism," "pivoting," and "thriving," but does the data support this optimistic discourse? With our industry data, we sought to answer the question: does the empirical evidence show improving employee experiences and engagement within healthcare?

Why is healthcare engagement falling?

Our research has revealed concerning trends. While some healthcare systems initially saw engagement stabilize after the early pandemic period, with top-performing systems — those in the top decile — seeing engagement rise sharply and surpassing even early pandemic highs, this improvement proved short-lived.

More recent data shows that all deciles have seen steep declines in engagement, reaching some ofthe lowest levels recorded and marking significant drops since the pandemic began.

The "best of the best" healthcare organizations reversed course, with the top decile ending almost where its average started and those in the top quartile falling well below their pre-pandemic perceptions. For most healthcare systems, engagement has steeply declined. Across the board, these empirical data reveal that improvements were not sustained by most.

What drives the decline in healthcare employee engagement?

Many factors contribute to these declines. Perhaps most notably, many healthcare systems have experienced their worst financial performance in decades. Recent reports from KaufmanHallhave found that median hospital operating margins were cumulatively negative. By way of comparison, despite losses during the initial months of COVID-19, hospitals previously reported median operating margins of 2 percent — although these were in large part buoyed by federal aid.

The 'why' behind this historically poor financial performance can also help us understand the related decline in engagement. Labor shortages and supply chain disruptions have fueled a dramatic rise in expenses, which hospitals — limited by the annually fixed nature of payment rates — have thus far been unable to pass through to payers. At the same time, diminished patient volumes — especially in more profitable service lines — have constrained revenues.

The primary driver of rising hospital expenses is a shortage of labor — in particular, nursing labor — which could likely worsen in the future. Since the start of the pandemic, hospitals have lost more than 100,000 employees, and nursing vacancies have more than doubled. In response, hospitals have had to rely on expensive contract nurses and extended overtime hours, precipitating a perfect storm of surging wage costs and employee burnout. While these issues were worsened by the pandemic, the national nursing shortage is a decades-old problem that — with a substantial portion of the labor force approaching retirement and an insufficient supply of new nurses to replace them — is projected to continue worsening.

What are the 5 barriers to employee engagement in healthcare?

In our healthcare research, we identified five barriers — staffing, well-being, safety, culture of listening, and optimism — that could impede the improvement of employee engagement and the overall employee experience. As the preceding data made clear, these barriers are indeed impeding engagement and leading to unwelcome business outcomes.

All is not lost, however. Even as many healthcare systems continue to face challenges, we can draw on examples from industry leaders for ideas to help us remove these barriers. Below we review specific actions from leading healthcare systems that are reversing these negative trends, helping both their people and their organization thrive.

Barrier #1: staffing shortages

In a Perceptyx study of 1.5 million healthcare workers, staffing perceptions remain the least favorable with less than 2 of 5 believing there is enough staff to meet patient demands and 1 of 3 stating they work longer hours than is best for patient care. Staffing continues to be a top focus of healthcare executives. Hospital CEOs know they need to hire more skilled people and offer competitive pay but also understand that salaries must fit within their budgets. According to a survey from the American College of Healthcare Executives (ACHE), 90 percent of surveyed CEOs ranked shortages of registered nurses as the most pressing within the category of "workforce challenges," followed by shortages of technicians (83 percent).

To address issues related to staffing, organizations can:

• Redesign workflows. Staffing gaps persist, so health systems must "get rid of stupid stuff" (GROSS), as the American Medical Association puts it. Research from Duke Health's Chief Quality Officer Dr. Richard Shannon noted that nurses spend only about one-third of their time on direct patient care while up to 35 percent goes to documentation. Mapping current processes helps teams eliminate low-value tasks and frees nurses to focus on patients and families.

• Empower flexibility with "internal staffing agencies" and innovative scheduling. Although the reliance on travel nurses is subsiding for most, many leading health systems continue to find value in leveraging "internal" staffing agencies, providing greater flexibility to move their own employees around their own system to fill staffing needs. Not only is this approach more cost-effective than the use of external agencies, but this also provides opportunities to grow your own talent, providing new experiences to team members without them having to leave your health system. Improved scheduling technology is another trend that leading health systems are embracing in order to empower their staff with more choices in when and where they work. This flexible scheduling meets the demand of today's workforce, helping organizations retain and attract talent who desire greater empowerment over their work schedules. Flexible scheduling also helps the organization more efficiently serve the needs of patients by deploying the right talent to the right units. Overall, both internal staffing agencies and flexible scheduling help attract and retain staff desiring more flexibility while also allowing health systems to operate in a more agile, cost-effective manner that better adjusts resources to changing patient demands.

• Bring in higher-quality talent faster with panel interviews. Many healthcare organizations continue to heavily invest resources in hiring new staff to alleviate staffing pressures. Unfortunately, constant hiring can significantly divert leaders' time away from leading their current teams, negatively impacting team morale and patient outcomes. Some leading health systems leverage panel interviews to improve the speed and quality of new hires. These organizations entrust the hiring for an entire unit or even location to a panel of expert leaders who are trained and passionate about the selection process. By trusting the expert panel to hire for the entire unit or location, other leaders can focus on other mission-critical work including leading their teams effectively.

• Rethink onboarding programs to retain more new hires. Hiring new talent is only one part of relieving staffing pressures. It's equally important to ensure new staff are quickly developed and actively retained. Invest in onboarding programs that foster a sense of belonging, communicate that new employees are valued, and enable them to be effective. Employee listening is essential here; lifecycle listening solutions from Perceptyx will enable leaders to quickly determine if onboarding programs are having the desired effects. Additionally, these solutions provide data to focus resources and actions on the areas that will improve new hire experiences, productivity, and retention the most.

• Build an early talent pipeline. Leading health systems are not only thinking about staffing needs today but are also actively growing their pipeline for the future. CoxHealth of Springfield, Missouri partnered with Ozark Public Schools to create a Health Sciences Academy that gives high school students hands-on experience and training in healthcare. While providing these students with early exposure to an in-demand sector of the economy, it also affords the healthcare system a chance to identify future top talent and create excitement about their organization. When combined with other forms of tuition and training reimbursement, investments to build excitement in healthcare among the next generation of workers could deliver a windfall of talent to healthcare systems willing to shoulder some upfront costs.

Barrier #2: workforce well-being

As noted by the AMA, clinical well-being impacts the entire healthcare system. Improved clinician well-being leads to better patient care, patient outcomes, patient satisfaction, recruitment, and retention. Ongoing stress and work overload lead to increased burnout and increased intent to leave, with one study finding 37% of those burnt out indicated they will leave and a third of that acting on their intentions. To improve well-being — a barrier with a major impact on retention and patient outcomes — organizations can:

• Create a psychologically safe work environment to discuss well-being. Companies can foster a psychologically safe work environment by normalizing discussions on mental health and well-being and empowering employees to speak up and be heard when they need help. In order for this environment to truly exist, it must start at the top. For example, an executive at a large healthcare system shared his moving, personal story of mental health with the entire organization. This vulnerability from a senior leader led to other colleagues feeling safe to share their own challenges and experiences. By sharing his story, this executive created a safe space for open dialogue, reduced the stigma of mental health within that workforce, and modeled leaders' commitment to staff well-being.

• Listen at scale for ways to truly improve employee well-being. Burnout specifically is a response to continual workplace stressors, requiring improvement in the overall work environment; well-being resources alone will not address the root causes of systemic factors that negatively impact well-being. As a result, leading health systems leverage employee listening to identify causes of workplace stress and burnout as well as actions to help alleviate these root causes. Crowdsourcing is particularly powerful for creating a psychologically safe culture through its inclusive, engaging method, which invites all employees to co-create and prioritize solutions. When it comes to well-being, inviting employees to share and prioritize what actions can improve well-being is a powerful way to gather insights for action across all employees and foster a culture where open discussion of well-being is normalized. Listening at scale during major events that can increase stress or anxiety, such as recession-driven layoffs, global pandemics, or mergers and acquisitions, provides healthcare systems with data-driven insights on the most effective actions for improving well-being while also fostering a psychologically safe culture for continued conversations on this topic.

• Optimize the use of technology. One contributing factor to job stress is the amount of work, especially administrative work, required of clinical staff. For example, one study reported eight hours of scheduled patient time equals five additional hours completing documentation in the electronic medical record (EMR) system. Some of these tasks can be delegated — which falls under the "GROSS" reworking of an employee's scope — but the EMR itself must also be optimized. A best practice shared by a leading EMR provider is to involve frontline staff in EMR optimization or redesign. While it may seem expensive to temporarily redirect limited frontline talent away from direct patient care, leading EMR providers have found that the most successful implementations include bedside nurses in the design or redesign. By optimizing EMRs, caregivers can thereafter focus more time with their patients and alleviate stress previously caused by these administrative tasks.

• Develop more empathetic leaders. Research on nurse career satisfaction found that nearly half of the 7,540 practicing nurses surveyed had experienced emotional abuse. RNs who experienced abuse indicated a manager or administrator was responsible 50 percent of the time. Investment in leader development, especially empathetic leaders who support employee well-being, is essential. Given the budgetary constraints now faced by most healthcare systems, organizations are leveraging artificial intelligence to provide leadership coaching at scale.

Barrier #3: safety risks

Team member and patient safety remain top priorities; Perceptyx research shows that many of the most-declined perceptions involve safety. External studies have also tied stronger employee engagement to better safety outcomes, including lower patient mortality. To address safety issues, organizations can:

• Address rising incivility: Perceptyx research found that 92% of healthcare workers experienced or were in close proximity to violence from a patient or patient's caregiver in the past month. Nurses in hospitals are the most likely of all healthcare employees to be exposed to violence (physical or verbal) at work, with that same study reporting that 96% experienced an instance in the past month. The magnitude of incidents is also greater for this group: four in five hospital nurses have had to call a coworker or security because they feel unsafe — twice as many as workers in other roles.

• Use nudges to promote kindness and civility: Some organizations report success with visual cues like posters, banners, and sayings on facility walls that remind patients and visitors to be kind. These visual cues help reinforce acceptable behaviors and reduce incivility.

• Provide de-escalation and kindness training: Training staff to de-escalate tense situations and understand patient behaviors can improve safety. Sharing stories of kindness and recognizing positive behaviors publicly also reinforce a culture of respect and safety.

• Implement codes of conduct: For example, UMass Memorial Health introduced a patient and visitor code of conduct requiring signed agreements. This formalizes expectations and signals that safety is a priority, with only a few visitors asked to leave during initial implementation.

Barrier #4: weak listening culture

Perceptyx research finds organizations with more mature listening cultures tend to outperform peers in metrics like financial performance, patient satisfaction, and employee retention. Healthcare organizations tend to listen and act on employee feedback less frequently than other industries, trailing all but retail.

To improve listening culture and retention, organizations can:

• Involve employees in decision-making: Engaging staff in decisions that impact their work fosters trust and commitment. For example, a healthcare system used Perceptyx's Dialogue to involve nurses in selecting traits for a new Chief Nursing Officer, giving them a voice in leadership decisions.

• Follow up with clear actions: Leader rounding with a structured follow-up approach, such as Atrium Health's stoplight method, ensures employees see their feedback leads to tangible actions, enhancing transparency and trust.

• Ask relevant, meaningful questions: Employee surveys should focus on current, impactful topics to gather useful insights. Asking the right questions helps measure perceptions and identify areas for improvement effectively.

Barrier #5: low optimism

Employees want to see a successful future for their organization and themselves. Perceptyx research shows declining optimism in healthcare, with staff feeling less confident about the future and understanding of organizational changes. Since optimism strongly influences retention, organizations should:

• Reconnect with purpose and meaningful work: Leaders should articulate a compelling vision, explaining how employees' work contributes to the bigger picture, fostering higher engagement and retention.

• Provide clear career pathways: Visualizing career development options and supporting education or training helps employees see a future within the organization. Many systems invest in education support to help staff achieve these goals.

• Hire a retentionist: Dedicated HR professionals proactively connect employees with growth opportunities, helping them advance their careers and stay engaged.

How can Perceptyx help your healthcare system?

Perceptyx helps healthcare organizations create listening programs that will facilitate all these best practices in employee engagement and experience. From crowdsourcing insights to developing always-on listening models, we provide organizations with crucial resources to help your people and organization thrive. To learn more, schedule a demo today.