“In the beginner’s mind there are many possibilities, but in the expert’s, there are few.”
This famous observation by Shunryu Suzuki, which posits the importance of intellectual humility in understanding a new situation, is especially apt for healthcare’s unprecedented workforce challenges. During the pandemic, almost 1 in 5 healthcare workers quit their jobs. One-third of nurses plan to leave their current roles by the end of 2022, with more than a quarter of those intending to become traveling nurses. At the same time, hospitals find themselves competing with non-hospital employers that are aggressively pursuing hourly staff—companies that can pass along wage increases to consumers in the form of higher prices in a way that healthcare organizations cannot.
Unprecedented problems require new solutions. Finding those new solutions starts with setting aside long-held preconceptions, listening intently to the wants and needs of the many diverse stakeholders that constitute the healthcare workforce, and addressing what is heard with actions that are more nuanced and more flexible than ever before.
Addressing the Foundational Issues
While the industry faces an exceptional crisis related to staffing, the issue is symptomatic of more foundational workforce problems. Even prior to the pandemic, workforce burnout was a growing problem, with nearly 1 in 3 nurses, and 42% of physicians experiencing the physical and emotional stress and exhaustion and sense of detachment characterized as burnout.
With serious margin declines occurring during Q1 2022, maintaining financial integrity remains an ever-present concern, with organizations appropriately initiating cost-reduction strategies to drive lean operations. These efforts taking place alongside staffing shortages may prompt concern across the workforce regarding availability of resources and a health system’s commitment to investing in its people. The technologies implemented over the last ten years often provide little time or work savings (and sometimes create even more complications), as many organizations have not updated their processes to create real efficiencies. Diversity, equity, and inclusion investments have been made, but many hospitals have not made transformative progress.
Health systems need to favor prompt, innovative, and tailored actions, understanding that difficult cultural and leadership changes are required. Organizations need to address their workforce challenges as a foundational and cultural opportunity, with strategic and operational interventions.
Different Segments with Subtly Different Needs
Each segment of the workforce has its own wants and needs, satisfiers and dissatisfiers, with the current crisis emphasizing subtle and changing differences among groups and individuals. Capturing these subtleties requires assessing workforce needs with multiple approaches to segmentation, including job category, job type, job level, demographics, and value orientation.
Job category is a traditional way to segment the health system workforce, in which the categories roughly correspond to departments or divisions, such as administration, nursing, diagnostic imaging, physical therapy, environmental services, and so forth. Within each job category are many subcategories, each with its own workplace experiences. For example, in a survey on the pandemic’s impact on physicians, employed physicians, primary care physicians, females, and those under age 45 reported experiencing more burnout than their respective counterparts.
Segmenting the workforce by job type, for example, knowledge workers, caregivers, administrative employees, and service workers, can help leaders see worker needs with more nuance.
Job level, including hourly/nonexempt, professional, managers and directors, and executives, is frequently a relevant classification.
Demographics cut across all other categories. Demographic factors include age, educational attainment, certifications/ licenses, disability, family and marital status, foreign-born workers, and race and ethnicity.
Value orientation is another approach to workforce segmentation that cuts across all job categories and levels. Some people place a high value on intrinsic rewards, including deriving a sense of identity and meaning from one’s job, and perfecting one’s work. Others are driven by extrinsic motivators, such as compensation and status. Someone who is future-focused values future accomplishments over today’s experiences and may seek to make a positive difference in society. A person who values the experience of work may have strong preferences about the variety of tasks they wish to perform, the degree of control they want to have over their own work, and the amount of teamwork in which they wish to engage.
Although workforce segments are motivated by many of the same factors, variations on these themes may reflect different causes, which in turn suggest different solutions.
For example, consider the issue of compensation, which has been identified by physicians, nurses, and hourly workers alike as a motivating factor. Dig a little deeper and you’ll discover that the nature of the concerns that surfaced during the pandemic years differs significantly among these groups.
In a survey conducted by a professional association, nearly 7 in 10 independent physicians (and 44% of those who are employed) described concerns about income stability, stemming from a reduction in income they experienced as a result of COVID. In contrast, another survey found that nurses’ primary concern about compensation during this period was that travel nurses received ultra-premium wages for doing the same work that they, the permanent staff, were doing. And hourly workers, who are often at the bottom of the hospital pay scale, simply wanted higher wages, cited by 69% of respondents as their most wanted change.
In some instances, the problems experienced by one segment of the workforce are not shared by all. The extreme circumstances of the pandemic have led to correspondingly extreme variations in workplace experience. For example, nurses have been targeted by an uptick in violence perpetrated by patients and family members against healthcare workers, triggered by anger about hospitals’ mask requirements and other COVID-related restrictions on visitors. In a survey conducted by the nursing union National Nurses United, 48% of hospital nurses reported experiencing an increase in workplace violence. Yet the issue of physical safety, critically important to direct-care nurses, is likely a non-issue for employees who work in roles with little direct public contact.
It’s important, too, to discern assumed versus actual differences about segments. For example, executives may voice concerns about a specific generational demographic—for example, that Millennials do not work as hard, or that Gen Zers’ workplace flexibility expectations are untenable. The research shows that these are meta-stereotypes, with evidence suggesting only very small differences in the wants across ages. In fact, between the first quarter of 2021 and 2022, the greatest growth in resignations across all industries was among people aged 40 to 60, and those with an average tenure of 10 years.
Most hospitals and health systems have well-established employee satisfaction and engagement surveys and metrics. In light of the changes that the pandemic has brought about, however, it’s time to take a fresh look at them.
To understand changing workforce attitudes and needs and produce actionable information, all aspects of your organization’s information-gathering process require reexamination, including the frequency, level of specificity, sample size, forums, and tools that are brought to bear.
Approaching this task with a beginner’s mind can lead toward questions that reveal deeper insights, such as, “What does flexibility mean to you?” as a follow-up to, “Is flexibility important to you?” Cultivating a beginner’s mind can also help you formulate questions that enable people to articulate ideas they may not have shared with their employers before, like responses to, “What is meaningful work for you?” and, “What would cause you to stay rather than leave for another job opportunity?” It is important to also include tough questions, such as queries about whether people have experienced workplace aggressions, and to frame those questions using everyday language.
Approaching the Workforce with Empathy
The messages that executives hear from this highly discerning approach to listening and assessment will in all likelihood reflect the dramatic social and economic changes taking place throughout the nation. The intensity of these changes, as well as the high stakes for patients and providers, call for innovative actions.
When we think about innovation in this context, the most important quality is empathy. With different segments and subsegments voicing different needs, organizations need to provide workers with pay, benefits, support, and environments that are tailored to an extent healthcare organizations have never done in the past.
This is decidedly not the traditional approach to human resources management, which for very good reasons has emphasized consistency, and expectations of rules and control. In most organizations, workers are expected to adapt to the rules developed for human resources management. But if workers are first approached from a position of empathy, it’s the rules that adapt to meet the needs of the workers. In this environment, everything is on the table: wage scales, bonuses, job classifications, access to health coverage, schedules, work setting, and opportunities for change and growth. And in this environment, every type of worker support needs to be considered: first-year mentoring, relief from administrative tasks, transportation, child-care, tuition assistance, and more.
The Necessity of Humility
The COVID-19 pandemic has led each member of the American workforce to question what they want from a job. And for many workers, the pandemic has provided the means to follow the answer to that question into new types, locations, and experiences of employment.
To be the employer of choice in this time of change requires an unprecedented level of humility. Employers need to assume that what will attract and keep an engaged workforce is very different than has been provided in the past. Employers must place themselves right alongside their employees in their quest to determine what is wanted and expected from work. The answers employers hear will be new ones. They will challenge the status quo. They may be discomfiting.
It is critical that hospital and health system leaders leave their preconceived notions at the door during these conversations. All of society is in a position of learning and exploring. And meaningful participation in that effort is only possible with eyes, ears, and mind wide open.