We’re making progress in employee engagement. Now comes the hard part.

By Jessica Dudley, MD, Chief Clinical Officer, Press Ganey

Employee engagement across healthcare is finally moving in the right direction. But beneath the national gains, the data tells a more complicated story—one healthcare leaders can’t afford to ignore.

Press Ganey’s “State of Healthcare Employee Experience 2026” report draws on feedback from more than 2.6 million healthcare workers to better understand the workforce trends reshaping healthcare organizations nationwide. There is progress, but it is segmented: Healthcare employee engagement is seeing the strongest year-over-year improvement in nearly a decade, yet recovery remains uneven across roles, generations, tenure groups, and organizations.

Generational gaps are becoming retention gaps

That unevenness is shaping workforce stability in real time. While national engagement scores rose from 3.97 to 4.03 between 2025 and 2026, and physician engagement from 3.96 to 4.01, persistent gaps in trust, safety, workload, and leadership alignment continue to influence retention risk and day-to-day performance.

Nowhere is that more evident than among early-career employees. Turnover among Gen Z workers remains the highest of any generation at 35%, compared to 22% for millennials and 14% for Gen X. At the same time, a wave of baby boomers retiring is creating strain at both ends of the workforce.

The first years of employment have become especially consequential. Employees with less than two years’ tenure are at the highest risk of turning over, with a third of those in their first six months leaving within a year. These findings point to a critical reality for healthcare leaders: Retention challenges often begin long before disengagement becomes visible. Early experiences shape long-term outcomes. Organizations seeing stronger retention are investing intentionally in onboarding, career development, leadership visibility, and team connection. Rather than treating these as isolated or standalone programs, they are embedding them into a broader, data-informed approach to employee engagement, well-being, and experience.

Social capital is running the show

At the same time, we’re seeing a broader shift in what drives engagement today. Seven of the top 10 engagement drivers are tied to safety culture, reflecting growing expectations that employee safety and patient safety be treated with equal importance. But a persistent disconnect remains between leadership perceptions of safety and the realities on the front lines, particularly around whether caregivers feel protected, supported, and heard in their daily work.

That gap ultimately comes down to trust—what we call social capital: the respect, teamwork, and shared accountability that allow organizations to perform consistently under pressure. When social capital is strong, communication improves, silos disintegrate, and engagement improves in a sustainable fashion. Patients notice the difference, too. Units with strong climates of trust are 2.4x more likely to achieve top performance on the PX measure “rate hospital 0–10.”

The missing link? Leadership visibility, communication, and support.

Leadership alignment remains one of the clearest opportunities for improvement. More than a third of employees and providers still report low confidence in senior leadership, particularly among patient-facing caregiver roles.

The organizations making progress are taking a more strategic and individualized approach to strengthening alignment. While a visible leadership presence, two-way communication, and leader development are important components, they are most effective when guided by continuous listening and front-line insight. But there’s no single formula for strengthening alignment. Organizations making the greatest progress in this area use workforce feedback to uncover the unique drivers of trust, engagement, and connection within their own teams—and shape their strategies accordingly.

The healthcare workforce has shown extraordinary resilience over the past several years. While those gains are well worth celebrating, longer-term workforce challenges persist, even as they continue to evolve. The organizations best positioned to accelerate improvements shift to targeted, human-centered strategies that strengthen trust, reduce operational friction, and support teams grappling with the realities of their day-to-day work.

To explore the complete findings and recommendations from the report, download “State of Healthcare Employee Experience 2026.” If you’d like to discuss your organization’s unique workforce challenges and opportunities one on one, reach out to an employee experience expert.