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Healthcare employee engagement: 3 ways to shift from a ‘vicious cycle’ to a ‘virtuous cycle’

Coauthored by Milissa Eagle, MA, Director of Workforce Analytics.

Healthcare performance of all types is suffering in many organizations. The impacts of rising labor costs and inflation, an aging population, competition from alternative healthcare providers, a widespread staffing shortage, and a global pandemic have impacted physician and employee engagement in healthcare, in addition to financials, patient experience, and employee and patient safety.

In the face of these challenges, Press Ganey data shows that, while some organizations have declined, others are continuing to sustain or improve—widening the gap between our top and bottom performers. In this landscape, many lower-performing healthcare organizations find themselves caught in a “vicious cycle”: When one aspect of their performance—like employee engagement in healthcare—is in trouble, other areas (like patient experience or safety outcomes) will suffer as a result. On the other hand, higher-performing healthcare organizations have transitioned into a “virtuous cycle,” where improvements in specific areas lead to improved performance in others.

We analyzed feedback from more than 1.72 million employees, nurses, and physicians, across 509 organizations and more than 4,500 facilities. And through this data, we’ve pinpointed patterns and employee engagement trends that can help organizations move from a vicious cycle into a virtuous cycle. Which is good news for those caught in the vicious cycle, because it means there is a way out.

Employee engagement in healthcare starts with a paradigm shift

Moving from a vicious cycle to a virtuous cycle starts with a paradigm shift. Organizations must make strategic decisions in how they think about experience and employee engagement in healthcare, taking an approach that’s inherently more connected and human-centric.

How to increase employee engagement in healthcare

Organizations should work to move:

  • From being siloed, to integrated. All experiences—from employees, to physicians, to staff, to patients—are intertwined. Internal teams across all areas of experience must communicate and work together to solve problems.
  • From hiring, to optimizing. Hiring your way out of a staffing shortage, or asking your already exhausted workers to work harder, won’t make your organization successful in the long run. Find ways to optimize the teams you have by building trust, community, and supporting your people to practice top of license. Optimize your hiring process by focusing on tactics for attracting, recruiting, and interviewing talent. Organizations should also focus on how to optimize the talent they currently have by ensuring people can practice top of license by removing barriers to their work.
  • From the individual, to teams. You can’t just ask people to work harder. Invest in team building and leadership development to empower individuals to work smarter.
  • From employee surveys, to continuous listening. A once-a-year employee engagement survey is still necessary to provide your organization with a baseline as well as the ability to do targeted follow-up, but just listening once a year is insufficient in the fast-paced healthcare landscape. Checking in regularly—through crowdsourcing, digital focus groups, and other tools that prevent survey or inaction fatigue—gives you a fuller picture of the employee experience, and helps you identify any fluctuations (and what might be causing them). You need to leverage technology to continuously listen to team members—through formal survey channels, interactive brainstorming, predictive analytics and alerts, and individual-focused employee feedback. Leaders and teams must then be held accountable for actions that can drive experience.
  • From creating a brand for patients, to creating a brand for employees too. Many health systems focus on growing a strong brand to attract patients, but it’s also important to create a brand that will attract talent. Focus on attracting talent by promoting the positive aspects of your culture—especially ones you identify during your surveys—this might be promoting a strong sense of teamwork, growth opportunities, or strong leadership. It’s also important to highlight any competitive benefits your company may offer.

3 steps to stop the vicious cycle of employee burnout

Before an organization can move to and nurture a virtuous cycle, it must put an end to the vicious cycle in healthcare employee engagement. These three steps will help leaders get back on the right track. Consider implementing the following employee engagement strategies in healthcare:

  1. Build trust. Trust is the bedrock for both engaging your workforce and creating a positive patient experience. Think of trust as a triangle with three key vertices: authenticity, logic, and empathy. When people perceive you as authentic (i.e., genuine and true to yourself), logical (exhibiting good judgment and competence), and empathetic (showing care and concern for them), they are more likely to trust you. In turn, they feel more comfortable being their authentic selves. They’re also more likely to be empathetic toward you and/or the organization. And it’s impossible to build trust without listening and being transparent.
  2. Listen. To make well-informed decisions, organizations must prioritize listening to everybody. When listening to employees, organizations need to consider factors like role, race and ethnicity, age, and gender, which means segmenting your data to drill down into feedback by demographic. Of course, that doesn’t mean every suggestion will be implemented. But employees feel included, heard, and valued when they see their feedback put into action, and it needs to be clear that everyone’s voice has been considered. Technology like crowdsourcing and pulse surveys can help organizations better listen to their employees.
  3. Be transparent. Transparency begins with the board and C-suite setting the tone, and making transparency a top priority within the organization. Organizations must measure employee engagement and experience, then share the findings, whether positive or negative. Genuine transparency occurs when leaders close the loop by communicating what they are able to fix, what they need help fixing, and what challenges can’t be resolved immediately.

Together, building trust, listening, and communicating transparently create an environment of respect and psychological safety—an environment where employees at all levels feel comfortable speaking up and speaking out, without fear of retribution.  By improving employee engagement in healthcare, an organization can begin to nurture the virtuous cycle.

3 ways to cultivate the virtuous cycle of employee engagement in healthcare

Once an organization has put an end to the vicious cycle, it can turn its attention to the virtuous cycle of healthcare employee engagement by focusing on three priorities. 

  1. Take care of yourself first. Employees must tend to their own needs in order to provide high-quality care to patients and best serve their communities. Clinicians must also be able to accept support from their colleagues without any stigma attached. Setting aside time during work hours for peer-to-peer support and promoting a culture of self-care helps leaders and employees feel connected and thrive—even in a high-pressure, high-stakes environment. Similarly, leaders can’t give what they don’t have—so taking care of their own physical and mental well-being is paramount to effectively leading and empowering their teams.
  2. Build the teams and train the leaders. To create a welcoming and inclusive environment, team members must feel respected. They should be able to trust their leaders and teammates and feel empowered to contribute their unique talents, opinions, and efforts. Leaders must foster a culture of gratitude, recognition, respect, and psychological safety in the workforce. Healthcare organizations should prioritize coaching and developing leaders, ensuring they have the necessary technical and interpersonal skills to succeed in their roles.
  3. Fix the systems. Broken systems and processes abound in healthcare. Addressing these issues requires the involvement and perspectives of front-line employees, so those most impacted have a say in how these problems are fixed. Leaders must actively seek input from the front lines, listening intently to their suggestions, and making clear-cut changes. Leaders also must communicate these changes to ensure everyone is aware of the improvements being made. When front-line employees feel heard and understood, it fosters the virtuous cycle of open communication and continuous improvement.

Challenges will always arise in healthcare. Building trust through listening and transparency can stop the vicious cycle. Supporting individuals, building teams, and fixing processes will enable organizations to drive the virtuous cycle of healthcare employee engagement that leads to better outcomes and better Human Experience—for employees and patients).

Reach out to one of our workforce experts to see how Press Ganey employee experience tools can help your organization improve your healthcare employee engagement and workforce well-being, and, in turn, your patient experience.

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