In the ever-evolving landscape of American healthcare, organizations are grappling with an increasingly complex set of people-focused stressors. Ranging from a debilitating shortage of qualified talent to an alarming uptick in workplace violence and incivility, these issues are compounded by expanding workloads and a burgeoning crisis of mental health among healthcare workers.
Against this backdrop, Perceptyx recently hosted a webinar that assessed the state of the healthcare employee experience in the United States. The discussion leveraged a robust data set culled from more than 3.65 million healthcare workers across more than 500 healthcare systems, as well as supplementary market data sourced from 1,600 U.S. physicians and nurses.
The live event featured a panel of experts from our Research and Consulting teams:
- Emily Killham, Senior Director of Research & Insights at Perceptyx;
- Ellen Lovell, Ph.D., Senior Consultant;
- and Stephanie Schloemer, Ph.D., Senior Consultant.
The panel took the audience through the key findings of the freshly minted report, which addressed healthcare employee engagement trends, physician experience, nursing excellence, and institutional safety.
Culture Change Since the Pandemic
Early in the webinar, an attendee posed a probing question that addresses the crux of current challenges: "What have you been seeing in terms of how healthcare culture has changed since the pandemic?"
Ellen Lovell offered a nuanced response that sheds light on the seismic shifts in healthcare organizational culture since the onset of the COVID-19 pandemic. According to Lovell, healthcare organizations appear to have pivoted away from a mission and vision-centered ethos that was predominant before the pandemic.
"Pre-pandemic, there was a palpable sense of purpose that motivated healthcare professionals to show up to work every day. That sense of alignment within the organization around a greater goal was quite strong," Lovell said. "However, what we're observing now is a fundamental change at the macro-philosophical level. Healthcare systems are grappling more aggressively with operational questions — how to run the business, secure profits, and negotiate with insurance and pharmaceutical companies."
Lovell argued that the stress and strain experienced by healthcare workers are a direct consequence of these larger operational decisions now being made by senior leadership. The shifts in focus beg another question: What will healthcare look like in the future?
"As we look ahead," Lovell continued, "we must confront macro-level decisions that need to be made. These could range from legislative reforms to a reinvigoration of mission-purpose-focused work. Any course of action taken will invariably impact the perceptions of healthcare workers, who are already experiencing declines or lower scores in various aspects of job satisfaction and engagement."
Stress, Burnout, and Teamwork
Stephanie Schloemer then moved the discussion towards stress management, employee burnout, and the intricacies of teamwork within healthcare settings. Addressing the weight of stress on healthcare employees, Schloemer noted, "Unsurprisingly, healthcare workers are increasingly finding it difficult to manage stress at work, owing to heavier workloads, staffing deficits, and rapid procedural changes." Based on a specialized panel study focusing on RNs, she highlighted that perceptions of being understaffed and difficulties in finding qualified professionals were significant predictors of increased burnout rates.
"But it's not an entirely bleak picture," Schloemer added. "Our data shows that the pandemic has actually strengthened relationships between managers and their teams. However, this positive outcome is tempered by reduced trust and confidence in leadership, primarily due to rapid changes and insufficient clarity on how these changes affect frontline healthcare workers."
In terms of internal teamwork, Schloemer painted a complex picture. "While we've seen strong internal teamwork, likely a residual effect of the pandemic, cooperation falters when looking beyond the immediate team," she said. The study indicated that cooperation between different departments is the most important predictor of patient safety, followed by mutual respect among team members. "Cross-disciplinary cooperation — among nurses, physicians, and other healthcare providers — is critical to the healthcare ecosystem," Schloemer emphasized.
She also emphasized the increased susceptibility of professionals in acute care settings to toxic work environments due to high-risk and high-stress conditions. "Leadership and management must prioritize a clear vision for teamwork and adhere to it," Schloemer advised. "It's imperative to solidify policies and actions that encourage desired teamwork dynamics within the organization."
Schloemer went on to discuss the silver linings: "We're observing a steady increase in efforts around career development and opportunities for upskilling within organizations.” She outlined how some healthcare organizations are curating videos outlining career paths for different roles, providing a clear framework for advancement. "It's essential to give healthcare workers who are contemplating career changes a concrete plan for advancement within their current organization. This not only improves perceptions of organizational support but also encourages long-term association with the organization."
Ellen Lovell concurred and provided valuable context. "Healthcare systems are increasingly focusing on career development as a means to retain talent," she explained. "However, it's not as simple as just providing additional training or opportunities. It's about creating a user-friendly ecosystem where employees can easily access the information and resources they need for career growth." Lovell also underscored the importance of internal talent pools and dedicated staff for internal mobility as part of a holistic approach to career development.
The Rebound in Employee Engagement
According to Lovell, employee engagement continues to be a significant focal point for organizations, more so within healthcare. High-performing organizations are witnessing engagement levels rebounding to above pre-pandemic levels. However, for median-level organizations, the rate of growth is slightly less.
Lovell elaborated: "We measure engagement through multiple parameters such as intent to stay, pride in the company, intrinsic motivation, and willingness to recommend. Interestingly, intent to stay is stable if not higher, but the willingness to recommend one's organization as a place to work has declined."
Emily Killham added that such a trend was uncommon pre-pandemic. "Previously, there was rarely a divergence in engagement parameters across industries. The intent to recommend an organization but not willing to stay reveals intriguing patterns. For instance, an employee may enjoy a fruitful relationship with their immediate manager but hesitates to recommend the organization due to an unhealthy overall work climate."
Burnout: The Underlying Elephant in the Room
Burnout is a common factor when discussing why healthcare professionals might consider leaving their profession. Killham presented disconcerting statistics: "More than half of the nurses and nearly half of the physicians we surveyed have considered leaving the healthcare profession since the pandemic began. The primary reasons being burnout or adverse work schedules."
Ellen Lovell emphasized the labor shortage contributing to the increased workload, a known precursor to burnout. "As the demographic ages and healthcare needs grow more complex, the demand for healthcare professionals increases,” she said. “However, quality candidates are hard to find, and increased documentation demands add to the workload."
Killham further discussed the impact of labor shortages: "Labor shortage is going to continue to be a reality as a large portion of the workforce hits retirement age. Specifically, in healthcare, lack of quality candidates and high documentation demands are causing employees to spend less time on mission-driven activities and more on bureaucratic tasks, which can fuel burnout."
The Role of Leadership: Providers vs. Nurses
Leadership perceptions also play a critical role in engagement levels."Six in ten providers have confidence in senior leadership, but they also desire responsiveness to their concerns. For nurses, the level of confidence in leadership being responsive is comparatively lower,” said Lovell.
"For providers, the connection with top-tier leaders is essential for engagement,” added. “They seek a role in defining medical practices within a facility. Nurses, however, look for more direct communication, particularly from their Chief Nursing Officers, to feel engaged."
Lovell also explored the nuances of how physicians and nurses perceive their senior leadership. "Perceptions are likely exacerbated by the unprecedented stress and burnout levels we're seeing. Physicians and nurses don't have the resources to automatically give the benefit of the doubt to senior leadership.” She went on to highlight the disparity in responses to organizational action plans designed to improve engagement. "Physician leadership wants to have a voice and to be involved in change, whereas we didn't see the same positive trends for nurses and team members."
Lovell cited specific examples to illustrate her point. "I've got a highly successful health system that invested wisely during the pandemic. Despite improvements in overall engagement, there were opportunity areas focusing on senior leadership," she noted. Interestingly, the response differed between physicians and nurses. "Physicians were more positively responsive in the follow-up survey than nurses, underscoring the need for a more targeted approach."
According to Stephanie Schloemer, the issues highlighted by Lovell are far from isolated. "One of my customers, a top healthcare system, also had senior leadership as their lowest-scoring category despite otherwise positive metrics," she said. Both experts emphasize the need for visibility and ongoing communication. "This might come in the form of needing to dive deep to figure out which pockets are underperforming. Are there other ways we can get visibility of senior leaders? Opportunities to conduct focus groups could be valuable," Lovell suggested.
Addressing Attrition and Burnout
Emily Killham weighed in on the issue of attrition, especially among nurses. "Even though attrition is down, it's not going away. We're seeing a fair number of nurses who are retiring," she noted. According to Killham, the answer lies in building a collaborative environment. "We're really seeing that autonomy, mutual respect, and teamwork are key. These elements can significantly mitigate burnout."
In light of these insights, the question of how healthcare organizations listen to their employees becomes even more crucial. "You can't rely on a single survey approach in healthcare; you need to differentiate your listening process," Killham argued.
Schloemer highlighted the need for specialized survey tools. "For nurses, we designed a streamlined survey experience that measures seven core areas. It is Magnet-approved and only uses 24 items to preserve time for patient care," she explained. “Similarly, surveys targeting physicians should be distinct and relevant to their unique roles and challenges.”
The Tip of the Iceberg
For those interested in diving deeper into the complexities surrounding employee experience in healthcare, the ideas shared here constitute the tip of the iceberg. To gain a more comprehensive understanding, we invite you to view our on-demand webinar. You can also download our detailed State of the Healthcare Employee Experience 2023 report filled with data-driven insights and actionable strategies for improvement.