Mitigating the many costs of turnover by investing in leadership

The tsunami of staff turnover in healthcare during the COVID-19 pandemic is still being felt despite the industry slowly adding jobs in 2022.

While U.S. Bureau of Labor Statistics (BLS) data show that ambulatory care had the biggest chunk of new jobs added in January (14,700 out of 18,000 across the entire health sector), the healthcare industry was still roughly 379,000 jobs below pre-pandemic levels in February 2020.1

A mix of rising compensation for workers, burnout and decisions to retire or leave the workforce are key drivers of healthcare worker turnover, along with workers continuing to seek remote jobs and relocate because of a spouse or partner’s job change amid the Great Resignation.2

A Feb. 1 MGMA Stat poll found that most medical practice leaders said that their organizations’ staff turnover rates worsened (41%) or stayed the same (33%) in the most recent quarter compared to past quarters, while only 26% said turnover was slowing.3

The ongoing exodus of workers — either for better pay and benefits elsewhere or other reasons — is a clear signal that healthcare leaders should look closely at how their organizations measure employee engagement, analyze those results and take action to improve the employee experience.

Organizational culture and job satisfaction

In a recent ACMPE Certificate Program on human resource management, two HR experts from Brittain-Kalish Group — Christine “Chris” Kalish, MBA, CMPE, president and chief executive officer, and Penny Crow, MS, SHRM-SCP, RHIA, principal and compliance officer — detailed how employee engagement has changed during the COVID-19 pandemic, as well as some employee engagement tactics that are still viable despite all the recent upheaval.

One of those core elements of organizational culture that impacts employees’ satisfaction with their jobs and level of engagement is the practice leader’s commitment to talking to them and establishing a rapport that encourages honest discussion of workplace issues.

“Have open communication with your staff, because they need to know that you care about them,” Crow noted.

“Happy” employees are not the goal

Crow’s background as an organizational psychologist makes her caution practice leaders who think they need “happy” employees. “As much as I like people to be happy, that’s not what I’m looking for in the work setting,” Crow said. “Do we have satisfied employees?”

In many cases, satisfied employees will be among the best referral sources for the organization, because their feelings about the work environment can influence them to want to recommend the practice to their friends and family members.

So how do you build that sense of satisfaction with your employees? Crow says it begins with the foundation of your organization’s mission, vision and values. Kalish said this is something that smaller practices sometimes don’t recognize, especially if there are only a handful of doctors in the practice and the staff tend to just follow whatever the providers want to do: The mission and vision aren’t necessarily spoken or written down, but rather modeled by physician leaders.

In a small practice in which only a few providers tend to not agree on many things, the lack of a common mission can create chaos for the entire staff and negatively influence the overall culture. “Remember, the culture is not the brick and mortar of the building,” Crow said. “The culture is your people” and how they work together.

The role of your leaders

In an instance in which different members of the team clash or have other internal roadblocks to working well together, Kalish suggests considering how your leadership is oriented and deciding how top-down or bottom-up leadership structures will help resolve those conflicts.

The bottom-up leadership model, which sometimes is referred to as servant leadership, focuses on empowering workers to do what they need to do rather than being directed on a regular basis. By training workers to do their jobs with minimal roadblocks, the servant leader focus can shift to open communication about decision-making and treating those employees as equals in achieving bigger organizational goals.

“Do they have a voice? Does everybody feel heard and listened to?” Crow says. “When people feel like they have been treated as equals in decision-making and communication, they will help move mountains for you, even if they don’t necessarily agree with the decision.”

Staff engagement tactics

• Morning huddles: Taking a few minutes each morning to check in with your team can make overall operations smoother and improve engagement.
• Lunch as a group: While you still should have meetings at regular intervals, make time throughout the year to come together outside the practice for a meal and some authentic conversation. These interactions can help employees bring up issues they would like to improve and initiate brainstorming among colleagues.
• Formally measure job satisfaction: Have a regularly scheduled online survey that employees can fill out, and take steps to share what you’ve learned with your staff and how you intend to address the results to improve the workplace.

Leaders workers don’t want to leave

It costs an organization about half to twice an employee’s annual salary every time that position turns over, according to Kristin Baird, MHA, BSN, RN, president and chief executive officer of the Baird Group, who co-presented with Jessica Bush, BSN, RN, patient experience consultant at Surgeons Choice Medical Center, Southfield, Mich., at the 2021 Medical Practice Excellence: Leaders Conference.

Those turnover-related costs have been felt directly as competition for workers has surged in recent years, Baird noted, making it vital for practice leaders to retain the staff they have now by investing in themselves as leaders who inspire workers to stay with the organization.

Bush and Baird acknowledged that the pandemic eroded the sense of team for many nurses and other care team members who were pushed harder than ever in the past two years, trying to do more as other workers quit or were out sick.

“Burnout was something that I didn’t really understand until COVID,” Bush said. “Your ability to connect and care with your patients was compromised. With a loss of team, I remember having a very difficult time trying to work with new people I had never worked with before.”

In Bush’s case, it forced her to “begin to look at what I wanted out of a workplace,” and she realized the importance of connection with her manager and coworkers, as well as the shared knowledge developed among team members. “Turnover affected more than just my practice,” Bush added. “It affected the practice of all of my peers.”

Why people leave their healthcare jobs

In research that Baird conducted before and during the pandemic, she found there were two primary reasons for people who left healthcare jobs: “It’s the leader and the culture,” Baird said. “And the truth is, those two things are inextricably linked.”

In many settings across healthcare, leaders are promoted after having a great skill set in a frontline job but then becoming a supervisor or manager without all the necessary skills for a leadership role. “It’s vital that the leaders understand what it takes to keep people engaged, energized and loyal to your organization,” Baird added.

Breaking bad habits and dispelling assumptions

Baird outlined strategies to overcome some common assumptions that keep practice leaders stuck in old habits that can make it harder to engage employees and retain them:

1. When it comes to retention strategies, one sizes does not fit all. “Each person is different,” Baird said. “As a leader, if you can only do one thing to help improve retention, it’s to have an unrelenting focus on people as individuals.” Ways that a practice leader can break that habit is understanding generational differences in workers; conducting stay interviews to understand what motivates employees and gives them purpose; and regularly measuring worker satisfaction. “It’s not enough to do a survey once every three years,” Baird cautioned.
2. You can’t just hire the next warm body to lighten the load. If you compromise your standards for bringing in a new employee simply to help alleviate the strain on existing employees, it may have the opposite effect. As Bush related, she once encountered a new nurse who didn’t get work done adequately and had poor attendance; despite thinking the extra help would help the unit run more smoothly, “it made staffing the unit really challenging” as other nurses picked up the slack, Bush said. “All of these extra stressors could have been avoided” had the organization focused on hiring for fit with the job and larger team, Bush added. “Hesitation to take action when somebody isn’t pulling their load,” Baird said, can be very detrimental to a leader. “Nothing will erode morale faster than tolerating bad behavior,” Baird said.
   As Bush said, it’s important for managers to ask open-ended questions when talking with employees, as it usually helps bring more information to light to assess performance and areas that need improvement.
3. People don’t always leave for money alone. “If you have a culture that has really engaged people and has really built loyalty,” Baird said, “it’s going to take quite a difference in salary to lure people away.” Most healthcare workers, when asked what inspires them to do good work, will say it’s about making a difference for patients and in service to the community, Baird said. Managers should keep in mind that money is not the only driver of behavior for staff, she added. “If you enter the relationship with your team thinking that money is the primary driver, you are going to miss many opportunities to engage with your people, to offer recognition, to give reinforcement and to give them new challenges,” Baird said.
   To that end, Bush said visibility and presence around staff is huge. Rounding through areas of the practice and not staying in your desk most of the day can allow a leader to create opportunities to engage. “People associate the lack of your presence with a notion that you don’t care about what they’re doing,” Bush said. “As hard as it is, you have to be intentional with your team, scheduling rounds into your daily routine.”
   Stay interviews can be one of the best tactics to improve retention. For employees who seek challenges and have career aspirations, stay interviews can help leaders learn about what skills they want and need to build to keep Millennial and Generation Z workers more engaged, Baird said.
   While it might seem uncomfortable, some managers can use those interviews to ask an employee about the last time he or she considered leaving, or if there are any aspects of the workplace that make them dread coming in. “There are so many things that can come up” in these interviews that can help managers address lingering concerns and demonstrate that issues will be addressed when raised.
   Gifts and prizes can be appreciated, but when it comes to long-term engagement, Baird said it’s important to offer recognition as opposed to or in addition to rewards. “When we do the interviews with staff, what they want is validation,” Baird said. “They want validation that their work matters. They want validation that they’re making a difference — when you give recognition, it’s really spotlighting that you appreciate them, that their actions are helping live out the mission, vision and values of the organization.”

Building the culture of the future

While understanding these tactics and strategies will go a long way toward engaging employees and mitigating turnover, the broader goal of building a better organizational culture should be considered by practice leaders who recognize a need to invest in improving the way things are.

“In 99% of the organizations I work with, they don’t have a clear vision of what they want that culture to be,” Baird said. To do so, it requires asking a lot of questions to guide the efforts:

• What do you want that culture to look like?
• Where is the culture now compared to where you want it to be?
• Where are the gaps that need addressing?

 
The most important question, Baird says, is who do the leaders need to be to make progress toward that new culture? This means having a clear understanding of what competencies are necessary to lead cultural changes, managers’ ability to coach their workers, the accountability to hold themselves and workers to standards being set, and articulating visions with excellent communication.

Part of that work is recognizing fully engaged employees and working to get them to model the standards that everyone needs to follow, Baird added. As Bush noted, not all employees will be fully or mostly engaged, and that should affect how managers work to coach them. “It’s important to coach each individual based on their engagement level,” Bush said.

While it’s important to address disengaged employees and those with poor performance, it’s similarly vital for practice leaders to invest the right amount of time in trying to get employees who might only be somewhat engaged to better connect with their work.

“We have to be good at coaching, and we have to give people a fair chance” at making improvement, Baird said. “But we also have to recognize that when we’re spending all of our time trying to pull the disengaged along, we’re not giving the attention to … our star performers.”

Ultimately, those investments can ensure you’re developing workers, providing meaningful work and connecting them to a purpose and giving them pride in what they do each day. “You want to be a brand [your workers] will be proud of,” Baird said.

“Don’t hesitate to spark passion and purpose,” Baird said. “People need to be comfortable showing the passion that they have for the work. … You, the leader, are the keeper of the culture. You have to define it, then design it and then own it with fanatical consistency.”

• Dig deeper: Key insights from this article come from the ACMPE Human Resources Management Certificate Program, a seven-hour, in-depth online learning experience that provides healthcare leaders with a mastery of human resources management concepts. Upon completion of the program and passing an exam, participants are issued an HRMC credential.

Notes:

1. BLS. “The Employment Situation — January 2022.” U.S. Department of Labor. Feb. 4, 2022. Available from: bit.ly/3JdUcNu.
2. MGMA. “As compensation competition continues, medical group leaders say staff turnover not easing up yet.” Feb. 3, 2022. Available from: mgma.com/stat-turnover22.
3. Ibid.