For the first time since Perceptyx began tracking the National Healthcare Engagement Benchmark, the typical healthcare organization is losing ground on engagement. The median score dropped 2.9 points year over year, from 71.5% to 68.6%. Intent to stay fell 3.0 points to 72.3%. These are not catastrophic numbers in isolation, but they are the first meaningful declines after three years of stability through pandemic disruption, post-pandemic recovery, and persistent labor pressure.
The leading indicators arrived in last year's data. Confidence in the organization's future fell 7.6 points in 2025. Support through change fell 7.2 points. Optimism fell 4.7 points. Those driver-level shifts have now caught up to the outcomes leaders track most closely, with engagement and retention moving in the directions the underlying perception data predicted twelve months earlier.
Where Is the Decline Concentrated?
The slide is not distributed evenly. At the 75th percentile, engagement fell 2.4 points and intent to stay fell 2.7. At the median, the drops were 2.9 and 3.0 respectively. At the 90th percentile, both measures fell only 0.3 points.
Above-average organizations are losing ground despite their stronger starting position, which means the pressure runs industry-wide rather than concentrated among underperformers. The top-tier gap with the middle is also widening for a different reason than in prior years. Previously, the highest-performing organizations widened the gap by improving. In 2026, they widened it by staying still while everyone else moved backward. In a labor-constrained industry, holding steady has become a competitive position rather than a baseline expectation.
Why Aren't Operational Gains Producing Better Experience?
The 2026 data also shows real progress on long-running operational complaints. Several of the largest year-over-year gains in the entire dataset land on items healthcare employees have raised for years.
Influence over physician practice rose 21.7 points, from 41.2% to 62.9%. Satisfaction with the balance between administrative tasks and patient care rose 17.2 points, from 44.4% to 61.6%. The ability to finish notes and EMR tasks before leaving the hospital or clinic rose 11.9 points. Authority to make decisions rose 14.9 points, senior management visibility rose 21.4 points, and understanding of strategic direction rose 11.3 points. These gains reflect sustained investment in administrative burden reduction, EMR optimization, AI-assisted documentation, and clearer change communication.
Workflow mechanics improved without producing a comparable improvement in how the work feels to do day to day. Employees have more authority on paper and clearer information about where the organization is headed, while the questions of whether they feel heard, supported, and recognized are moving in the wrong direction at the same time.
What's Happening to Psychological Safety in Healthcare?
The largest negative movements in the dataset cluster around speaking up. Difficulty voicing disagreement worsened by 18 points. Fear of asking questions when something does not seem right rose 15 points. Open discussion of office problems fell 5 points, and the sense that it is safe to speak up without negative consequence fell 4.6 points.
In healthcare settings, these items carry consequences beyond engagement. Incident reporting depends on staff willingness to raise concerns. When clinicians hesitate to ask whether something looks wrong, the path from a near-miss to an adverse event shortens. The same workforce that now reports more authority to act also reports less willingness to use that authority when patient safety could be at stake. Structural empowerment increased in 2026 while psychological empowerment moved the other direction in the same year.
Why Don't Employees Believe Their Feedback Leads to Action?
The companion finding to the psychological safety decline is a sharp drop in belief that feedback produces change. The item measuring whether improvements were made as a result of the last survey fell 12.4 points after a 1-point decline the year before. Confidence that ideas are valued by managers fell 11.2 points. Respect across job levels fell 5.3 points. Recognition for outstanding performance fell 5.1 points.
The data-to-action gap shows up directly in the barriers healthcare leaders cite. Among the most mature listening programs in the study, the data-to-action gap is now the most frequently cited obstacle to progress, with 23% naming it as the primary barrier alongside another 23% citing lack of leadership buy-in. The mechanism is straightforward. When employees stop seeing visible follow-through on what they share, they share less. Response rates decline. Survey fatigue sets in. The informal feedback loops between frontline staff and managers, where real-time improvement actually happens, erode without anyone noticing until response rates start telling the story.
What Should Healthcare Leaders Do in 2026?
Healthcare leaders should focus on three priorities for the remainder of 2026 and into 2027. The first is protecting operational gains, since the 21.7-point increase in physician influence and the 17.2-point gain in administrative balance reflect years of focused work that should continue and extend to non-provider roles where the same level of progress has not yet arrived. The second is addressing psychological safety before it affects patient safety, since the 15-point rise in fear of asking questions has direct implications for incident reporting and adverse event prevention. The third is closing the feedback-to-action loop visibly, since the 12.4-point drop in belief that surveys produce improvements is a perception crisis even when action is happening behind the scenes.
The top-tier organizations in the benchmark show this slide is not inevitable. They held engagement and intent to stay essentially flat while the middle of the industry lost ground. The differentiator in the data is consistency. Strong organizations deliver a similar employee experience at the team, manager, and senior leadership levels, while declining organizations show stronger team and manager experiences combined with weaker confidence in senior leadership and organizational alignment. Closing those internal gaps appears to be the most reliable path through the current pressure.
For the full benchmark, percentile breakdowns, and item-level movement covering 250 survey items across 4 million respondents, read the 2026 State of Healthcare Employee Experience report. To discuss applying these findings to your organization, schedule time with the Perceptyx team.
