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  • Writer's pictureBruce Cummings

A Comprehensive, Sustainable Approach to Resolving Hospitals’ and Group Practices’ Workforce Challenges

For the third year in a row, “workforce challenges” — the combination of recruitment and retention worries, personnel shortages, and staff burnout  — tops the list of healthcare executives’ concerns as reported in the 2023 annual survey conducted by the American College of Healthcare Executives (ACHE).  As with the prior surveys in 2021 and 2022, financial issues is the second most significant concern cited.  The survey was sent to 1,285 hospital CEO’s.

As former healthcare executives — Paul DeChant, MD as a medical group practice CEO, Bruce Cummings as a hospital CEO for 27 years — we appreciate that ACHE places staffing shortages, recruitment, retention, and burnout in the same phenomenological bucket.  Here’s why:  these issues are best addressed by and effectively respond to the same or substantially similar solutions.  Hospitals which earn a reputation for being a preferred employer are more likely to be adequately staffed, to more readily attract and retain clinical and support staff, have lower turnover rates, and lesser levels of clinician burnout than other hospitals. Leadership practices and culture are key.  Later in this blog I’ll profile a health system that seems to be successfully pursuing an employer of choice strategy.  But before getting to what works, consider these findings from the the American Hospital Association’s 2024 Environmental Scan:

  • The average hospital staff turnover rate was 26% in 2021 and 23% in 2022 

  • The average RN vacancy rate was 17% in 2022 and 16% in 2023.  Indeed,  the majority of hospitals (51%) had a RN vacancy rate greater than 15%.  

  • There has been a 3.3% decline in the US nursing workforce over the past 2 years.

  • One-fifth of all RN’s are projected to leave the healthcare workforce by 2027.

The Reasons for Healthcare Worker Turnover

And the reasons for the turnover?  The same AHA report, drawing upon a May 5, 2023 McKinsey study, “Nursing in 2023:  How hospitals are confronting the shortages” cites these factors as the top 5 reasons for RN’s leaving a hospital job in the past 18 months:

  • Not valued by organization - 52%

  • Inadequate compensation - 52%

  • No work-life balance - 51%

  • Unmanageable workload - 46%

Now, compare and contrast the preceding list with the top factors influencing RN’s to stay in their current positions:

  • Doing meaningful work - 82%

  • Positive interactions - 69%

  • Having caring and trusting teammates - 69%

  • Good health - 65%

  • Safe environment - 64%

Northwell Health - Culture and Leadership Practices

Northwell Health, the Hyde Park, New York-based multi-hospital system employs some 86,000 staff.  In an interview with Becker’s Kelly Gooch published on February 2, Maxine Carrington, Northwell’s Chief People Officer described what sure sounded to me like a “people first” approach.   Prior to the pandemic, Northwell had turnover rates between 9.5% and 10%.  While those percentages did climb during the pandemic, she acknowledged, they have been substantially less than the industry averages before, during, and after the pandemic — and continues trending down.  Ms. Carrington “attributes this to the leadership of CEO Michael Dowling and the health system’s emphasis on culture and investments in people and the day-to-day workplace experience” (emphasis added).  Flexibility — in job descriptions and scheduling practices — seems to be a watchword there, too.

Higher Clinician Retention and Lower Burnout

Go back and re-read the reasons RN’s stay with an employer.  From our vantage point as experienced leaders, coaches, and consultants, here are the kinds of practices which result in higher clinician retention and lower burnout:

  • expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized)

  • create and require leader standard work (LSW)

  • develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors

  • consistently apply one or more of the improvement sciences (Lean, six sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches

  • invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add

  • regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays

  • get rid of superfluous or outdated policies, procedures, redundant approvals and other stupid stuff (GROSS)

Ready to transform your hospital or workplace?

Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.


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