Defining culture within a medical group and sustaining it to attract and retain skilled professionals can be as challenging as providing outstanding patient care. In the recent member-exclusive MGMA webinar, “Playing for Keeps: Building Culture to Boost Retention in Healthcare,” MGMA consultants Adrienne Lloyd, MHA, FACHE; Amy Lafko, MSPT, MBA; and Owen Dahl, MB, LFACHE, CHBC, LSSMBB, shared insightful observations about the impact of workplace culture on staff retention and satisfaction, along with strategies and examples that foster loyalty and efficiency.
The critical nexus of culture and retention
Recent MGMA Stat polling has shown a sharp rise in recruitment efforts this year, with a staggering 78% of medical group leaders allocating more time to hiring in 2023 versus 2022.1
Lloyd stressed the fundamental importance of culture in retention — that regardless of generational differences, there’s a universal desire among employees to feel connected to their work and to believe in what they’re doing.
Echoing this sentiment, Lafko defined culture in its simplest form as everyday experiences employees encounter at work. “They want to have an experience at work that makes them want to choose to stay,” she said.
Lafko further underscored the necessity of a culture that fosters a culture conducive to growth and development. She believes this environment is achievable by considering two elements: “It’s what the leadership is creating, as well as what the staff is creating,” she said. When leadership and staff build the culture together, she explained, leadership practices will authentically reflect the desired culture and structural strategies that make the organization a place where people want to work.
Dahl introduced a provocative question leaders can ask themselves: “Do you manage your culture, or does your culture manage you?” The answer should challenge leaders to actively engage in culture shaping, thereby ensuring alignment with broader organizational goals such as enhancing patient care. “Whether you’re in the revenue cycle, in the back office or directly working with the patient, you have an impact on what goes on with that patient experience,” said Dahl, “and on establishing a culture that relates to improv[ed] patient experience.”
Fostering transparency and trust
Moving beyond the foundational elements of shaping culture, the speakers turned to transparency and trust within healthcare organizations.
Lafko addressed the significance of transparent communication, with a focus on the challenge of financials. She emphasized that while having a completely “open book” management style about this topic may be a stretch, some “transparency in financials and compensation helps build trust and aligns everyone toward profit goals,” she said. “When your team is coming to you for raises and promotions, [you can] actually have a conversation about how [you] derive [and spend] the profit in the company.”
Lafko went on to explain how one of her client’s goals was to demystify compensation and benefits for their employees. During the annual review process, each employee is presented with a breakdown that explicitly outlines their compensation, the monetary value of their benefits and the costs associated with each benefit option. Subsequently, the practice was able to engage in direct discussions with staff to determine the most valuable benefits to them.
“We get afraid to talk about compensation, finances and profit,” Lafko acknowledged, but it’s “a layer of transparency we can build into our culture that helps everyone feel like we are all in the same boat [and] … what our margin is supposed to be.”
Dahl said clear and consistent organizational values underpin the trust you want to build with staff. “When I say be consistent,” Dahl noted, “That means that not only do you say, ‘these are our values, this is our mission,’ but you live it” — with leaders’ actions aligning with their words on a daily basis.
Lloyd added that vulnerability can be powerful for leaders. Early in her career, she grappled with the belief that leadership equated to “having all the answers.” Over time, however, she recognized the importance of openness and vulnerability in building trust and encouraging a supportive culture. “I think it’s so freeing when we can [be vulnerable] as leaders,” she explained, and acknowledge what’s not working and how the market is changing.
By admitting to not having all the answers and openly acknowledging the organization’s challenges, leaders can forge a stronger, more genuine connection with their teams.
Enhancing job satisfaction beyond the paycheck
Competitive compensation, informed by MGMA benchmarking data or other sources, always helps staff retention, but Lloyd suggested a more holistic approach, highlighting the importance of valuing employees for their unique ideas and belief systems, as well.
“Some people are altruistic, they want to help everybody for the sake of helping,” Lloyd observed. “So, maybe it’s adding a charity day where they can go do a charity event.” Other strategies include offering a mental health day or financial credits for food delivery or housekeeping services. This approach aims to make employees feel valued not just for their professional contributions but as individuals with their own needs and challenges outside of work.
Drawing on personal experience, Dahl shared a pivotal moment during his time at Duke: he realized his intense workload was not only contributing to his own burnout, but also that of his team. “And sure enough,” he recalled, “One key team member was doing an amazing job — whom I had given more and more [workload] to because they were doing an amazing job — but had already started looking for other opportunities.”
This awakening prompted a candid dialogue about reorganizing workloads and expectations to prevent a star employee from leaving. “When you have that sense that people are stressed, and you’re asking questions, but nobody’s speaking up,” said Dahl, “I think [creating] an environment where you get some of those issues on the table and people start to feel heard” is critical for inspiring staff to stay beyond the financial benefits.
Engaging minds, enhancing retention
Lafko discussed the importance of understanding individual career aspirations and aligning them with organizational goals. “Create a culture where everyone truly feels valued outside of compensation,” she noted. “Valued for their ideas, valued in ways that actually motivate them...that’s why culture and retention are so closely tied,” she noted.
“They’re actually more closely tied than compensation,” she added.
Dahl offered a strategic perspective, emphasizing the necessity of aligning professional development efforts with organizational objectives. “One of the biggest wastes that we have in any organization is the fact that we don’t engage the brains of our employees,” he observed. By encouraging participation and continuous learning, Dahl argues that organizations can tap into the untapped potential of their workforce, thereby enhancing both individual and organizational performance.
Leadership strategies to mitigate and prevent burnout
Despite passion for your work, Lloyd cautioned to balance it with mindful leadership and strategic task management. “I think it’s good to [talk to your] team about what not to do,” she said. “What are you doing that you can automate, delegate or eliminate, [and] bring people in to help you as the leader?”
Lafko emphasized the complex nature of burnout in the workplace, advocating for a nuanced approach to well-being and employee engagement. “There’s not one thing that drives people to burnout, it’s often a combination,” she said. “What we need to understand as leaders and as business owners is: what are the causes for my specific team?”
Lafko shared a story of one practice that discovered the team’s perceived level of stress was much lower than anticipated. After discussions with employees, leaders discovered that the staff’s concerns about burnout largely stemmed from a collective response to widespread discussions on the subject, leading to a shared sentiment of solidarity rather than individual experiences.
Piggybacking Lafko’s insights, Dahl warned, “what can happen is you have one employee burned out, and that employee becomes [an] informal leader — they can impact a lot of other employees as well,” highlighting how narrowly held sentiment can proliferate across a team. He stressed the importance of recognizing early signs of employee burnout and proactively addressing it.
The continual courtship of talent — and when to let go
Recruitment is an ongoing need within organizations, Lloyd noted, likening it to continuously courting one’s own team to maintain loyalty and commitment. “Rather than focusing on this idea that we need to retain at all costs the people that we have,” she said, “focus on who is our actual talent and on building up their strengths.”
Dahl said that making room for top talent sometimes requires dismissing underperformers, even in a tight labor market. “There’s a tendency to be fearful of letting those lower performers go,” but it can be a tough decision that benefits the greater good of the team and the organization. “Because allowing those who are truly not able to get there, and not trying to get there — or worse yet undermining what you’re trying to create,” Dahl said. “You’ve got to address those; otherwise, it’s kind of futile for some of the other [strategies] we’re talking about.”
Actionable strategies from employee feedback
Lloyd emphasized the importance of customizing employee engagement surveys to align with an organization’s specific needs and objectives. “The thing that I see most often when people are frustrated, which ultimately leads to the high performers leaving,” she noted, “is when they feel like people aren’t held equally and fairly accountable for the work, and they don’t have any input into decisions that affect their work.”
Lafko argued that the focus of employee surveys should “be around behaviors, not just feeling — because feelings are not something that we can directly impact.” Because they are modifiable, behaviors might ultimately influence overall employee sentiment about their work.
After the survey, it is important for leaders to take meaningful action based on the insights gained from the results. Lafko proposed a strategic approach to deployment, suggesting an annual survey complemented by periodic pulse checks to gauge the effectiveness of implemented initiatives. She believes this strategy promotes ongoing improvement and guarantees that actions are relevant and effective, thus cultivating a culture of engagement and retention.
Dahl suggested Gallup’s employee engagement survey2 as a model worth considering, suggesting that its focused approach could serve as a blueprint for organizations aiming to tailor their engagement strategies to their specific needs. “And it would be well worthwhile in terms of looking at a list of questions to ask … that would be relevant to you today [and] in terms of potential questions you could add in a survey down the road,” he said.
Leadership strategies for championing employee appreciation
Making investments in employee appreciation programs might face opposition or reluctance from some leaders, but Dahl noted that it is crucial to demonstrate the financial and operational benefits of employee retention strategies. “I think you’ve got to be able to show some data that identifies the fact that [while] turnover is expensive, retention can be cheaper,” Dahl stated. “Then couple that with patient satisfaction surveys.” Positive patient feedback often serves as compelling evidence for investing in employee appreciation.
Lloyd echoed Dahl in stressing the importance of persistently advocating for employee support mechanisms. To be successful, she suggested a proactive approach in creating engagement “around how we’re going to support our team, how we’re going to keep people wanting to work with us,” Lloyd remarked, and the value of those investments.
Conclusion
These insights from Lloyd, Lafko and Dahl point to the indispensable link between a nurturing workplace culture and employee loyalty — that engaging staff in decision-making, fostering professional growth and maintaining transparency can help combat high turnover rates.
“Communicating more isn’t actually the solution; [it’s] communicating out,” Lafko concluded. “It’s the opportunity for us to listen more, get more feedback and [access] whatever means we need to do that.”
Notes:
- MGMA. “More job openings, fewer candidates means more time spent by medical group leaders on recruitment.” Oct. 18, 2023. Available from: https://www.mgma.com/stat-101723.
- Gallup. “Gallup’s Employee Engagement Survey.” Available from: https://www.gallup.com/q12.
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