10 minute read 29 Oct 2021

Health care staffing is strained and seeing unprecedent levels of turnover.

Successful Hospital Team

How health systems can navigate the Great Resignation

Authors
Leisa Maddoux

EY Global and US Health Transformation Practice Leader

Purpose-driven leader. Change consultant. Problem solver.

Blair Bellamy

Partner, Health Consulting, Ernst & Young LLP

Leads health transformation efforts. Helps clients realize financial improvement through operational change. Experienced in the health care provider sector.

Gail Babes

EY US Health Data & Analytics Leader

Dynamic and trusted leader. Passionate about accelerating data into actionable insights. Advocate for social equity where all people can thrive. Life-long learner. Joy-seeker. Proud parent.

Kenny O’Neill

Principal, Consulting, Digital Health, Ernst & Young LLP

Subject-matter advisor on health system transformation. Global strategist. Champion for the benefits of virtual care. Trusted advisor. Former officer and pilot for the Royal Air Force in the UK.

Abby Johnson

EY Americas Health Consulting Leader

Working mom mentor. Dot connector. “Future of health” optimist. Strong aversion to status quo. Rock Chalk Jayhawk.

Chris Cooper

Managing Director, Consulting — Health Transformation, Ernst & Young LLP

Clinical leader. Focusses on interrelationships of operations, strategy, technology and design. Manages transformative tools for health care delivery.

10 minute read 29 Oct 2021

Health care staffing is strained and seeing unprecedent levels of turnover.

In brief
  • Many factors have contributed to the current staffing crisis in health care, and the time to act is now.
  • In the near term, health system executives should focus on employee engagement and workplace culture.
  • Technology enablement and new care models will be key to attract and retain caregivers for the long term.

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After nearly two years of the COVID-19 pandemic and decades on the brink, health care staffing is now strained at unprecedented levels. The aging nursing population, pandemic-related attrition and other factors have led to significant turnover in health care — more than almost every other industry.1 And with an estimated one-third of today’s nurses expected to reach retirement age in the next 10 to 15 years,2 the profession is also facing a gap in knowledge and experience.

In addition, the federal government estimates that nearly 200,000 new registered nurses (RNs) will be needed each year between now and 2030 to accommodate for attrition, growth in the profession and the large-scale retirement of veteran nurses.3 Similar obstacles around attracting and retaining talent are also pervasive at every other staffing level, from medical assistants to physicians.

Understanding today’s health care staffing challenges

This concerning data comes at a time of declining enrollment in nursing programs due to challenges around everything from faculty hiring to classroom space and funding.4 Simultaneously, many younger nurses are seeking more flexibility and thus leaving frontline care delivery for more attractive, less stressful nursing positions (often affiliated with alternative care delivery models) amid fierce competition for experienced hires. For example, many health care employers are offering rather sizable signing bonuses for nurses.5 In addition, many tech-driven digital health startups have emerged recently, offering yet another potential career path for frustrated caregivers who are seeking to exit traditional health systems. All told, hospitals and other health care stakeholders are racing to both blunt current attrition rates and attract new talent. The caregivers we’ve heard from believe that six main factors have led to this staffing crisis in health care:

  • Benefits and incentives. Employees often judge their employers’ authenticity and goodwill by how much they invest in employee benefits and incentives. For example, it’s estimated that 54% of employees are likely to resign if they don’t have access to flexible ways of working.6 While enhanced benefits or incentives alone may not move the needle on staff retention, it’s important to consider that hospital systems and other recruiting players across the sector are pulling out all the stops to attract talent.
  • Inconsistent or insufficient onboarding. A high-quality onboarding experience is essential to set newly hired clinicians up for success, directly impacting the length of their tenure with the organization. In addition, research shows that it’s quite difficult for employees to overcome poor onboarding programs, which are often too brief and focus more on paperwork and policies than on workplace culture and engagement.7 Despite this, many of the caregivers with whom we’ve spoken agree that onboarding experiences can vary widely, even within the same hospital or organization.
  • Burnout. The understaffing and heightened stress associated with the ongoing COVID-19 public health crisis have led to decreasing job satisfaction among nurses, most of whom are considering leaving the profession.8 In addition, studies show that burnout is exacerbated when employees don’t have flexibility around how and when they work.9
  • Lack of support and communication. Health care employees often lack clear lines of communication with leadership to discuss workplace conditions and other grievances, likely deepening distrust and isolation during the pandemic.
  • Limited growth and learning opportunities. Many caregivers are frustrated with their organization’s lack of continuing education, training and upskilling, and personalized growth opportunities. At a time when purpose and self-actualization are increasingly valued in the workforce, this will continue to be a key recruiting driver.
  • Limited ability to effectively impact patient care and models of care delivery. COVID-19 and the health care staffing crisis have limited clinical care team members’ ability to engage in interdisciplinary teaming. For many clinicians, top-of-license practice and participation in clinical decision-making are directly tied to satisfaction. In addition, constraints on support staff resources have limited clinicians’ ability to function at the top of their scope, amplified existing frustrations with models of care delivery and decreased clinician satisfaction. Clinicians (especially nurses) are passionate and engaged members of the care team but feel limited in their ability to impact patient care. As a result, many have begun to question their future as caregivers. According to the AACN survey referenced above, 92% of respondents believe the nursing profession has been depleted by COVID-19 and that as a result their careers will be cut hort.10

Getting ahead of the staffing crisis

While the issues outlined above involve a great deal of nuance and complexity, health systems looking to get ahead of the current staffing crisis should begin by simply focusing on the areas that will impact caregiver experience the most, as research shows that experience-focused organizations tend to attract and retain better employees.11 Specifically, employees who find meaning in their work are 1.4 times more engaged and 1.7 times more satisfied than their peers.12 In addition, companies that lead on employee experience see greater profit,  revenue and market value — on top of 40% less turnover — when compared with peer organizations.13 

Immediate priorities

While truly stemming the rising tide of caregiver attrition will require a multiprong approach, there are several actions that health system leaders can take now to mitigate current conditions.

  • Leverage talent liquidity. Talent liquidity is an organization’s ability to utilize in-demand skills or capabilities wherever they’re needed within the enterprise at any given point in time. This approach provides enhanced resourcing agility by aligning talent faster, boosts employee productivity, and enhances their experience and engagement. In addition, it means that talent can be sourced from anywhere in real time and for shorter periods, thus reducing transaction costs. Talent liquidity strategies also promote employees’ visibility with resourcing functions and managers, ultimately enhancing their motivation and access to career development opportunities (which are less accessible in traditional role alignment scenarios).
  • Enhance the onboarding experience. By developing an onboarding experience that provides a robust virtual experience and a task management portal that hosts back-end onboarding activities, health systems enable joining caregivers to navigate the onboarding process with ease and lay the groundwork for sustained engagement among new employees.
  • Provide resiliency training. Virtual, instructor-led workshops are essential to help clinicians cope better with the stress and pressure that lead to burnout. These interactive sessions equip participants with scientifically proven strategies for bouncing back from major challenges, thriving amid adversity and helping others flourish through change.
  • Think beyond traditional employee benefits. Health care organizations are no longer able to rely on the standard compensation and traditional medical, vision and dental benefits alone. The future of work requires reimagining employee rewards packages by focusing on flexibility, well-being and specialized rewards such as reimbursement for expenses related to remote working, technology perks on the hospital floor, enhanced leave, bonuses, dependent care, increased education reimbursement, and concierge services to help the organization build trust and goodwill within the workforce. This translates to fewer sick days taken, better productivity and increased employee satisfaction.
  • Expand sourcing of key talent alongside the application of intelligent automation.  Health systems are increasing their dependence on historically non-traditional sourcing to diversify talent recruitment. Alongside the use US contract labor and leveraging international talent, leading institutions are re-evaluating job roles to identify activities can be performed virtually, using non-clinical resources, and by processes augmented thorough artificial intelligence (AI) and intelligent automation.

Near-term agenda

After implementing the immediate fixes listed above, health systems then should pivot fairly quickly to roll out several other leading strategies that will help them attract and retain high-quality talent.

  • Embrace virtual care and remote work where possible. While care delivery staff largely will still need to perform in-person work, remote work opportunities are still prevalent for many employees. Building out the organization’s tech infrastructure to support remote work, collaboration and knowledge sharing will help provide the flexibility needed to minimize burnout and keep employees engaged.
  • Invest in constant listening using emerging technology and advanced analytics. Omnichannel data collection of structured and unstructured employee feedback enables health systems to respond quickly to employee pain points. Advanced analytic techniques using natural language processing, emotion analysis and theme detection clarify pain points and support the development of tailored frontline interventions. Recruiting and retention aren’t a one-size-fits-all proposition, and these approaches help provide a clearer picture of experience, sentiment and level of engagement at the individual and group level. Real-time supply-and-demand analysis of the workforce is allowing organizations to better forecast risks as well as interest in employer rewards.
  • Rethinking staffing models. By updating models of clinical care delivery, rightsizing staffing models to enable greater focus on top-of-license practice, and optimizing ancillary and clinical support resources, health systems can maximize existing resources and increase employee satisfaction.
  • Establish a credentialing program. Leveraging innovative technology solutions that integrate advanced analytics, QR technology, automation and blockchain to build a seamless end-to-end credentialing experience for providers will help health systems streamline the upskilling and retraining process to drive better engagement and motivation.
  • Emphasize growth and culture. Building an inclusive workplace culture that helps caregivers feel connected to one another, their work and their patients is key. Health systems can achieve this by investing in remote facilitation, meeting capabilities and collaboration tools.

Long-term agenda

Just as the current staffing crisis in health didn’t develop overnight, lasting solutions to prevent similar crises in the future will take time. But it’s not too early to begin considering some or all of the following long-term strategies:

  • Create talent pipelines. With the health care profession projected to grow significantly over the next 10 years,14 it’s important for health systems to plan now for the next generation of caregivers. That will require working closely with high schools, instructional schools, community leaders and college administrators to develop candidate pipelines, enhance nursing education and attract new nurses to the profession.
  • Enable new ways of learning.  Developing a digital academy or learning platform to improve access to caregiver-oriented education, including virtual learning, is one of the most effective ways to drive employee engagement and retention.
  • Work smarter. By leveraging AI and machine learning to support all employees in their day-to-day work — whether they’re triaging chronic disease patients to determine the appropriate follow-up care or in need of better case management tools to minimize time spent on administrative tasks — health systems minimize burnout and function more efficiently.
  • References#Hide References

    [1] “Who Is Driving the Great Resignation?,” Harvard Business Review website, https://hbr.org/2021/09/who-is-driving-the-great-resignation, accessed 18 October 2021.

    [2] “Nursing Shortage,” National Institutes of Health website, https://www.ncbi.nlm.nih.gov/books/NBK493175/, accessed 18 October 2021.

    [3] “Registered Nurses,” U.S. Bureau of Labor Statistics website, https://www.bls.gov/ooh/healthcare/registered-nurses.htm, accessed 18 October 2021.

    [4] “When nurses are needed most, nursing programs aren’t keeping up with demand,” The Hechinger Report website, https://hechingerreport.org/when-nurses-are-needed-most-nursing-programs-arent-keeping-up-with-demand/, accessed 18 October 2021.

    [5] “South Dakota health system offers $40K signing bonus to nurses,” Becker’s Hospital Review, https://www.beckershospitalreview.com/compensation-issues/south-dakota-health-system-offers-40k-signing-bonus-to-nurses.html, accessed 18 October 2021.

    [6] “More than half of employees globally would quit their jobs if not provided post-pandemic flexibility, EY survey finds,” EY website, https://www.ey.com/en_us/news/2021/05/more-than-half-of-employees-globally-would-quit-their-jobs-if-not-provided-post-pandemic-flexibility-ey-survey-finds, 18 October 2021.

    [7] “Employers Risk Driving New Hires Away with Poor Onboarding,” SHRM website, https://www.shrm.org/resourcesandtools/hr-topics/talent-acquisition/pages/employers-new-hires-poor-onboarding.aspx, accessed 18 October 2021.

    [8] “Hear Us Out Campaign Reports Nurses' COVID-19 Reality,” American Association of Critical Care Nurses (AACN) website, https://www.aacn.org/newsroom/hear-us-out-campaign-reports-nurses-covid-19-reality, accessed 13 October 2021.

    [9] “7 Strategies to Improve Your Employees’ Health and Well-Being,” Harvard Business Review website, https://hbr.org/2021/10/7-strategies-to-improve-your-employees-health-and-well-being, accessed 15 October 2021.

    [10] “Hear Us Out Campaign Reports Nurses' COVID-19 Reality,” AACN website, https://www.aacn.org/newsroom/hear-us-out-campaign-reports-nurses-covid-19-reality, accessed 13 October 2021.

    [11] “Why Invest In Employee Experience? Six (Proven) Reasons,” Forbes website, https://www.forbes.com/sites/forbescoachescouncil/2020/03/31/why-invest-in-employee-experience-six-proven-reasons/?sh=15d525e27d42, accessed 18 October 2021.

    [12] “Why You Should Stop Trying to Be Happy at Work,” Harvard Business Review website, https://hbr.org/2019/07/why-you-should-stop-trying-to-be-happy-at-work, accessed 18 October 2021. 

    [13] “Why Invest In Employee Experience? Six (Proven) Reasons,” Forbes website, https://www.forbes.com/sites/forbescoachescouncil/2020/03/31/why-invest-in-employee-experience-six-proven-reasons/?sh=15d525e27d42, accessed 18 October 2021.

    [14] “Registered Nurses,” U.S. Bureau of Labor Statistics website, https://www.bls.gov/ooh/healthcare/registered-nurses.htm, accessed 18 October 2021.

Summary

Health systems must act now to shore up the unprecedented attrition we’re seeing across the sector. Focusing on employee engagement and workplace culture in the near term, while also looking ahead to technology enablement and new care models in the future, will go a long way toward enabling the resiliency caregivers need to thrive and succeed

About this article

Authors
Leisa Maddoux

EY Global and US Health Transformation Practice Leader

Purpose-driven leader. Change consultant. Problem solver.

Blair Bellamy

Partner, Health Consulting, Ernst & Young LLP

Leads health transformation efforts. Helps clients realize financial improvement through operational change. Experienced in the health care provider sector.

Gail Babes

EY US Health Data & Analytics Leader

Dynamic and trusted leader. Passionate about accelerating data into actionable insights. Advocate for social equity where all people can thrive. Life-long learner. Joy-seeker. Proud parent.

Kenny O’Neill

Principal, Consulting, Digital Health, Ernst & Young LLP

Subject-matter advisor on health system transformation. Global strategist. Champion for the benefits of virtual care. Trusted advisor. Former officer and pilot for the Royal Air Force in the UK.

Abby Johnson

EY Americas Health Consulting Leader

Working mom mentor. Dot connector. “Future of health” optimist. Strong aversion to status quo. Rock Chalk Jayhawk.

Chris Cooper

Managing Director, Consulting — Health Transformation, Ernst & Young LLP

Clinical leader. Focusses on interrelationships of operations, strategy, technology and design. Manages transformative tools for health care delivery.