Engagement matters: Meeting the unique challenges of the healthcare workforce

In most industries, the value of an engaged workforce is typically discussed in terms of operational outcomes: increased productivity, improved retention, reduced turnover, enhanced recruitment, workforce safety and better overall business performance. In healthcare, the impact is even more expansive, encompassing patient safety, care quality and the overall experience of care. And the stakes are higher: patients’ lives.

The factors that influence workforce engagement in healthcare are similarly differentiated. While some engagement drivers and detractors are universal—such as flexibility, autonomy, transparency, career development opportunities, diversity, inspiration, communication, recognition, resource availability, stress and workload—others are unique to healthcare. These include personal alignment between individuals’ work responsibilities and the caring mission of their chosen profession; their sense of connection with the health system’s mission and vision; and the degree to which they feel their work contributes to that mission and vision.

A deep understanding of these relationships—and of the uniqueness of the healthcare workforce—is critical to a successful and sustainable engagement strategy. Following are some of the health care-specific considerations that should inform the design and implementation of such a strategy.

• Healthcare employees experience unique occupationally induced stressors that are not present in most other industries. Grief, illness, violence and death can be part of their daily work experience. Also, institutional elements such as work policies, communication or decision making at the team or organizational level can also contribute to employee stress and affect employee resilience—all of which directly influences the health and well-being of others.[i] This fundamentally changes the relationship between employee (caregiver) and customer (patient). It is qualitatively different from the relationship in industries such as retail or hospitality.
• The “cost” of disengaged employees, as measured through turnover, is particularly steep in healthcare, especially among nurses, who are the primary front-line caregivers. According to a 2018 nurse staffing and retention report, the cost of nurse turnover ranges from $38,000 to $61,100, resulting in the average hospital losing $4.4M to $7.0M, and each percent increase in RN turnover will cost an additional $337,500.[ii] Further, increased nurse turnover decreases patient access, patient safety and quality of care; contributes to adverse patient outcomes; and affects the engagement of the remaining RNs by increasing their workload and job stress, which leads to burnout and, subsequently, to further turnover.[iii]
• The interrelationships between engagement and other aspects of healthcare are unique to the industry as well. With respect to patient safety, for example, providing care without safety-related mistakes has a clear relationship with measures of care quality and the monetary factors related to quality, including the direct costs associated with the care surrounding the mistakes and performance-based reimbursement calculations. In addition, the relationship between engagement and safety is bidirectional. Not only does engagement drive safety, but safety drives engagement. Nurses who perceive their work environment to be safe are more engaged than those who do not.[iv] Similar interrelationships exist between engagement and patient experience measures, and between patient experience measures and safety and quality.[v] In other words, the web of considerations is complex.
• Burnout, a consequence of prolonged disengagement and diminished resilience, is especially important in this setting considering all of the interrelationships noted above. More than half of U.S. physicians experience one or more symptoms of burnout, and a similarly high prevalence has been observed among other healthcare professionals, including nurses, nurse practitioners, physician assistants and medical assistants, reflecting a dangerous public health problem that threatens the well-being of the caregiving workforce and the delivery of safe, high-quality, patient-centered care.

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Taken together, these considerations highlight the need for comprehensive, healthcare-specific strategies for collecting, analyzing and interpreting workforce engagement data and implementing improvement efforts that target the needs of employees by function, role and department.

Measurement, as noted, provides essential feedback to guide a comprehensive engagement strategy. It is a diagnostic tool for assessing an organization’s cultural health overall and the engagement of all segments of its workforce. As with any diagnostic tool, the output of engagement surveys is information, and information directs action.

To fully understand the culture of the organization, the insights from the engagement survey must be coupled with a cultural assessment to gain a deeper understanding of the organization’s current talent strategy, leadership buy-in and change readiness. This assessment identifies barriers to achieving the desired business outcomes and allows for strategic improvement planning. Tying the collected engagement data with this boots-on-the-ground assessment ensures that organizations are able to target their improvement efforts to address the specific needs of each department and unit across the organization.

In this regard, the key to a successful engagement strategy lies in the ability to translate the collected data into a set of realistic, meaningful and sustainable actions and behaviors that specifically address the unique needs of the healthcare workforce. Doing so requires the right measurement tools and post-survey resources. It also requires an enterprise-wide understanding that engagement is not an isolated HR process or promotional exercise. It is a strategic imperative that cuts across the organization and drives high performance on all healthcare delivery measures.

[1] “Burnout and Resilience: A Framework for Data Analysis and a Positive Path Forward.” 2018 Performance Insights white paper. Press Ganey Associates, Inc.
[2] 2018 National Healthcare Retention & RN Staffing Report. Published by: NSI Nursing Solutions, Inc.
[3] “The Influence of Nurse Work Environment on Patient, Payment and Nurse Outcomes in Acute Care Settings.” 2015 Nursing Special Report. Press Ganey Associates, Inc.
[4] “The Role of Workplace Safety and Surveillance Capacity in Driving Nurse and Patient Outcomes.” 2016 Nursing Special Report. Press Ganey Associates, Inc.
[5] “Achieving Excellence: The Convergence of Safety, Quality, Experience and Caregiver Engagement.” 2017 Strategic Insights white paper. Press Ganey Associates, Inc.