Health care is a people-intensive business, and the industry's ability to navigate through today's crises hinges upon the abilities and engagement of its workforce. Today, that workforce is burned out, stressed, and exhausted. On Thursday, we hosted Advisory Board Vice President Steven Berkow to analyze the nature of the challenge, its strategic consequences for hospitals and health systems, and mitigation steps to take today.
Lessons learned from adverse outcomes on clinician resilience
1. The bank of staff engagement that health care executives had built up is now drawn down
Steven Berkow, vice president for Advisory Board research over the clinical and workforce programs, said , pre-Covid-19, the engagement of the health care workforce was in an overall fairly strong place. Challenges certainly existed, especially among certain segments, such as nurses and employed physicians. But overall levels of engagement were high compared to out-of-industry sectors, active disengagement was very low, and the overall trend was positive.
That "bank" of engagement and goodwill is now significantly drawn down, with the emotional exhaustion caused by multiple major public crises making workforce burnout far more prevalent and serious.
2. Remember that disengagement and burnout are not the same
To begin tackling the burnout problem that the industry faces, it's important to understand that levels of disengagement can be low, but burnout high. "It's not a 1:1 relationship. Basically, when someone is disengaged they are saying 'I don't want to do this,' whereas when someone is burned out, they are saying 'I can't do this—at least not in a way that keeps patients safe.'"
Overall burnout levels have risen sharply as the workforce has become emotionally exhausted by multiple major stressors.
3. Address burnout as experienced in both segments of your workforce
To understand conditions on the front line of care and address rising burnout, executives must account for two different workforce experiences created by the pandemic:
4. To bolster trust, be open about the difficulty of upcoming requests
The challenges faced by the workforce are not over; health care organizations will be forced to repeatedly make major requests of their workforces to survive the ongoing public health and financial crises.
To accomplish this, "We need to do a better job in appreciating and being straightforward about what we're asking of our workforce," Berkow said. "As we are saying, 'We need to reopen our health system,' we also are also saying, 'We need you to trust that the workplace we are reopening will be safe.'" And we need to recognize that, "When we make needed cuts, we are also asking our people to be more productive or make do with less and change their practice patterns."
In addition, "[i]f we are going to be straight with our workforce, we have to be comfortable saying, in answer to their questions, 'I don't know', Berkow said.
This can be challenging for health care leaders, who have built a clinical workforce that tends to value security and predictability.
5. Focus on a small set of immediate-term actions
Right now health care leaders should focus burnout mitigation efforts on a small set of concrete actions. Specifically:
6. Covid-19 will have a ripple effect on workforce planning for many different clinical job types
As organizations shift from the short-term crisis of averting workforce loss to longer-term workforce planning, they will see in coming months different segments of the clinical workforce impacted in different ways. Many of these effects are too early to predict in full yet—but for example:
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7. The overall clinical labor market will eventually tighten again
While Covid-19 may have a transformative impact on how and where we provide care, the macro supply and demand trends that made for a tight clinical labor market pre-Covid will continue.
"Yes, we will need more mental health professionals," Berkow said, "but we already knew that. Yes, we have a problem of over-specialization and we need more cross-credentialing—that too was a trend before, that has just been highlighted by Covid-19."
8. Focus on the challenge of navigating disruptive innovation with a workforce accustomed to incremental improvement
Prior to Covid-19, the biggest overall strategic issue for health care leaders was determining how to dramatically overhaul care to provide consumer value. This mandate for disruptive innovation has posed a major workforce challenge, particularly for clinicians. Clinicians are not only accountable for safeguarding their patients' wellbeing, but also have "accomplished remarkable things" through incremental improvement.
"But now, incremental change is not fast enough," Berkow said. "So, we see lots of leaders falling in between these two lines—the market saying you need fast transformation, and the clinical workforce being a brake on the needed pace of change."
9. The crises has sparked a spirit of innovation among staff—which will benefit the organization if leaders act now
One positive effect of the pandemic has been opening the window for transformation among clinicians, who have dramatically changed in response to a public health crisis. Clinicians—and front-line clinicians in particular—have leaned into evolving their role, reactivating privileges, moving into other specialties, altering their sites of practice, and more.
"Clinicians stepped up and said, 'here is where I can add value,'" Berkow said. "Changes that health systems had been trying for years to get them to embrace, they were suddenly running past those goals and saying, 'Here is a different way I can practice.'"
This is where the workforce opportunity is in health care. "We can't stop our population from aging, nor baby boomers from retiring," Berkow said. "But we can capitalize on this changed spirit we see in clinicians in terms of how to respond to Covid-19 … But the opportunity is time limited. You can already see some Covid-19 response softening. Financial stability of clinicians will return. We will go back to the tight labor market. This window of opportunity will eventually close."
10. Identify opportunities, codify positive changes, and find the potential in this challenging time
Many forward-looking executives are already trying to capitalize on the changed spirit among clinicians. Research interviews with these organizations point to a subset of actions that seem to be working well:
In closing, Berkow asked leaders to remember the fundamentals of employee recognition—essentially, "When you go to recognize people, really try to recognize specific great things they have done. Not just my workforce is great. Call out when a unit hits a certain survival rate or, think back across the last week and the most impactful changes a unit made, and recount specific stories—that helps your workforce know that you are truly aware of and value what they are doing. Acknowledge them as professionals—not just for being wonderful people."
Frontline caregivers have been bearing much of the responsibility for caring for patients with Covid-19. How can health systems, payers, and other players in the health care sector meet the financial, emotional needs of these essential members of our workforce while acknowledging the continuing business challenges that most of the industry still faces during the ongoing pandemic?
Last Thursday, we hosted Advisory Board Vice President Steven Berkow to analyze the nature of the challenge, its strategic consequences for hospitals and health systems, and mitigation steps to take today.
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