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Continuous listening 101: A healthcare leader’s guide to employee feedback

Coauthored by Alexis Wegman, Manager, Workforce Solutions, Press Ganey.

As we consider the Human Experience in healthcare, our workforce is foundational to everything we do. Optimal patient experiences, better clinical outcomes, and fewer safety events all start with an engaged, resilient workforce—as well as an environment that supports and empowers them.

But the healthcare workforce has been struggling. And the events of recent years poured gasoline on an already-lit flame. The daily pressures of the job—compounded by a global pandemic, a rise in violence against caregivers, and even bullying among colleagues—have seen engagement plunge to an all-time low. This is further exacerbated by the widespread erosion of employee and physician/APP engagement and physician/APP alignment (i.e., how providers perceive their relationship with organizational leadership). As a result, burnout and turnover have reached alarming levels among clinical and nonclinical workers alike. Healthcare has crossed the threshold, and entered into an unsettling reality that has organization- and industry-wide implications. Because, when the workforce suffers, safety culture declines, and our patients suffer, too.

Between 2020 and 2022, workforce engagement declined at 3x the average rate compared to previous years.

Level set: The state of healthcare employee engagement today

Before the pandemic, downward trends in employee, nurse, and physician/APP engagement issued a cautionary tale about the “health” of our healthcare workforce. And COVID-19 just made a bad situation worse.

Between 2020 and 2022, employee engagement declined at 3x the average rate of previous years—and it’s yet to recover. Across all roles, levels, tenures, and locations, engagement has reached a historic low, and healthcare organizations face a serious staffing crisis. Competition for talent is fierce. High performers are seeking out more lucrative opportunities. And many healthcare employees—fed up with long hours, unsafe conditions, hostile patients, and extreme daily pressures—have left the industry altogether.

After everything our workforce has been through, the question is: How do we bounce back?

As healthcare leaders, we must understand and accept the current state to be able to quickly move to meaningful action in supporting our ailing workforce. Data is a great place to start. Press Ganey analyzed feedback from 1.72M+ employees, nurses, and physicians—across hundreds of organizations and thousands of facilities—to gauge the state of the healthcare workforce and see how top performers keep key metrics, like employee engagement, high. 

Healthcare organizations that have managed to buck negative workforce trends lean on consistent employee listening strategies to both collect feedback about what’s happening on the ground and collaborate with employees on developing new solutions and tactics.

Beyond the annual employee survey: What is continuous listening?

Continuous listening is the mission-critical practice of regularly gathering, analyzing, visualizing, and, most importantly, acting on employee feedback. This can be accomplished by synthesizing input across various channels to gain deep insight into employees’ needs—and then using this information to drive intentional change and improvement. Continuous listening fuels critical action to drive engagement and overall experience, as well as other important healthcare outcomes like safety and patient experience.

Continuous listening must be just that: continuous. It's not a suggestion box in the break room, or a one-and-done annual survey. It’s a concerted effort to regularly hear employee voices and show them, through direct actions, that their feedback is valuable to the healthcare organization.

Continuous employee listening must also be purposeful. This means taking direct action as a result of your learnings—and communicating those actions across the organization, so everyone knows their feedback led to real change. When employees see their input is valued, they feel respected, they become more engaged, and they’re more likely to offer feedback in the future.

Lastly, we know the HR department can't do all this alone. Leaders across the organization must support and be involved in the strategy. It's imperative that leaders understand the employee data coming in, and are empowered to take the appropriate actions to support their teams.

How does continuous listening drive employee engagement?

One tenet of Human Experience in healthcare is that all individuals—from patients and their families, to the clinical and nonclinical workforce—want to feel heard, respected, and cared for. When done well, continuous listening helps actualize this tenet and impacts employee engagement in several important ways. By understanding employee’s firsthand experiences, thoughts, ideas, and feelings, healthcare leaders can make the most informed decisions about immediate interventions as well as long-term strategies to improve the day-to-day lives of their workforce. Using multiple feedback channels unlocks a comprehensive, 360° view of where an organization is succeeding, and where there’s opportunity for change.

Employees who report a strong relationship with their manager have turnover rates 18% lower than those who report a poor relationship with their manager.

Continuous listening also invites employees into improvement efforts at every level. When employees see that their ideas and suggestions lead to real-time change, it creates a positive feedback loop, where employees feel respected and cared for too. They know their voices matter to leadership and feel like they're part of the bigger picture. This positive feedback loop creates a sense of belonging and unity.

Lastly, this approach to listening supports and empowers middle managers to be more effective leaders. Ensuring managers also have a voice in decision-making and get what they need to be successful with their teams helps drive top-down organizational alignment. When employees feel heard and supported by their immediate leader, they are more connected to their work—and less likely to leave. In fact, our data shows that the turnover rate for employees who report a strong relationship with their manager is 18% lower than those who report a poor relationship.

All our research affirms that actively engaging employees—listening intentionally, maintaining open lines of communication, and closing feedback loops—benefits individual healthcare workers, their organizations, and patients. At Press Ganey, we’ve identified four keys to successful continuous listening:  

  1. Make your efforts known. Explain to employees how you're listening and why you’re collecting feedback. Set the expectation that you will regularly be asking for their input, so it becomes built into employees’ routines.
  2. Simplify the “ask.” Healthcare workers are often on their feet—and on the go. Deploy easy-to-use tools (like quick, on-demand pulse surveys) that make responding no-fuss and hassle-free.
  3. Tune in, at scale. Train every leader—from individual unit managers to the C-suite, across all departments and teams—on the technology and tools that collect feedback. Pull the right people together to spot and discuss universal trends, and collaborate on improvement strategies.
  4. Close the feedback loop. Show your work, and ensure employees know what changes have been made based on their feedback. When employees believe their organization is committed to positive transformation, and they see the tangible results of their input, they’re more committed to providing feedback. They feel they're making a true difference—a difference that impacts their colleagues, patients, and the organization. And that is a powerful thing.

We all know the healthcare workforce is hurting. And getting back on track will take hard work. But technology can relieve much of the effort when it comes to listening to, understanding, and helping employees—and uncovering the best next steps to drive meaningful improvement.

To learn more about implementing a continuous listening strategy, check out our e-book: “From awareness to action: Transform your workforce through continuous listening.”

To discuss our findings, and their implications for your organization, reach out to a workforce expert here.

About the author

As Chief Clinical Officer, Jessica leads efforts to support organizations in increasing clinician engagement and improving patient care outcomes, particularly among physicians. Her areas of expertise include leadership development, clinical care redesign through outstanding teamwork, addressing clinician burnout, and advancing professional fulfillment. Jessica also leads Press Ganey’s Workforce Well-Being Collaborative, an initiative designed to help healthcare organizations identify the varied and disparate needs of their workforce and enable them to respond to their physical, emotional, financial, and operational needs in both the near term and beyond.

Profile Photo of Jessica C. Dudley, MD