Employee and physician engagement: Insights and trends from COVID-19

Coauthored by Jessica Dudley, MD.

The pandemic impacted all industries, but healthcare has been especially hard-hit. As the stressors and pressures of COVID-19 amplified over time and continued into 2022, caregiver engagement fell—and drove unprecedented levels of burnout and turnover with it.

Press Ganey analyzed its Employee and Physician databases to learn just how COVID-19 has impacted the healthcare industry, particularly in terms of engagement, resilience, safety, and more. Through feedback from more than 1.5 million employees and 120,000+ physicians, we've uncovered the following insights and trends.

Employee and physician engagement continues to trend downward—and is lower than it’s ever been

Employee engagement—which assesses job satisfaction, pride in the organization, and willingness to recommend and stay with an employer—had been slightly yet steadily dropping since 2018, but it really took a nosedive as we entered 2022. Overall employee and physician satisfaction and intent to stay saw some of the greatest declines. But this comes as no surprise, as more front-line caregivers than ever are now leaving organizations or exiting the industry entirely.

Following an uptick in the 2021 database (CY2019 and 2020), physician engagement fell to 4.03 in the 2022 database (CY2020 and 2021)—its lowest level in the last decade. The three engagement items that declined the most among physicians were overall satisfaction, intent to stay (if offered a position elsewhere), and willingness to recommend the organization.

Employee and Physician Engagement

The largest declines are seen in staffing, job stress, and decompression

Every day, it seems there’s a new article on nurse turnover, healthcare staffing shortages, increased job stress, or employee burnout, and Press Ganey data continues to support this troubling reality. In fact, we've never seen perceptions of staffing this low.

Adequate unit staffing is the core item with the greatest decline among employees (-0.19) and one of the greatest for physicians (-0.25). This is closely coupled with increased job stress, which is highly correlated with perceptions of staffing, and a sharp decline in employees’ and physicians’ abilities to decompress from the job.

The pandemic is dynamic by nature. New hotspots and variants, for example, keep changing the rules of the game. And this has made it difficult for healthcare systems to recover and reestablish a healthy working environment for all caregivers. In Press Ganey’s 2022 database, employee decompression (i.e., the ability to disconnect and recharge) decreased by 0.08 overall, and physician decompression declined by 0.13.

But there's good news: Many healthcare organizations have developed unique and creative strategies to combat turnover and staffing shortages. Learn more about the steps Press Ganey clients are taking to overcome these challenges in our on-demand webinar: Caregiver Staffing Crisis: Real Solutions for Today's Biggest Challenges.

Zero harm must remain at the forefront of health systems’ goals

The pandemic exposed significant and ongoing safety gaps within healthcare organizations. While staffing saw the greatest decline, the other safety items that fell focused on resources needed to provide care and team communication to provide coordinated care.

>> Related read: Caregiver crisis: How to confront challenges to coordinated care

With perceptions of high-quality care continuing to drive engagement across health systems, it further emphasizes the need to focus on elements that impact the safety of caregivers and patients. Many organizations have mitigated staffing shortages with early-career caregivers—many of whom are working under new, unfamiliar conditions, where they have little to no familiarity for certain tasks. This increases the likelihood that mistakes will be made and, subsequently, increases the risk of patient safety events.

Despite significant challenges, an overall sense of unity, trust, and respect has brought caregivers together

The pandemic, undoubtedly, challenged caregivers in new ways. But throughout it all, a strong sense of community has kept teams together. Trust, a connection to coworkers, and feeling respected have helped boost caregiver morale. More caregivers have reported that they feel their ideas and suggestions are taken seriously and that the person they report to treats them with respect. At the same time, their perceptions that management supports diversity (i.e., “the person I report to treats all employees equally, regardless of their background”) have improved.

Physicians have better leveraged technologies and clinical processes in providing care

Compared to the 2021 database (CY2020 and 2019), recent investments in digital tools that support communication and collaboration—like telehealth—are behind improvements in physician survey items focused on technology and clinical processes. Physicians’ perceptions around EMR’s ease and efficiency have improved slightly, along with their perceptions of hospitalists and communication with the emergency department. Slight upticks were also seen in physician satisfaction with continuity of care and time spent with patients—potentially driven by massive telehealth adoption. All of these items are scoring at an all-time high in Press Ganey’s database, which covers 10+ years of physician perception and sentiment.

Teamwork, support, respect, and staffing differentiate top-decile facilities

Top-decile facilities that remained stable or improved their engagement scores between 2020 and 2021 saw nearly across-the-board increases—or at least kept declines in check. Compared to non-top-decile organizations, top-decile facilities saw the greatest differences in the following areas.

• Providing a supportive environment
• Having good teamwork and collaboration
• Fostering a culture of respect and involvement
• Making efforts to mitigate staffing issues and job stress.

So what does all this mean for you?

Despite recent dips in employee and physician engagement, the data outlines a plan to bounce back stronger and more resilient than ever.

Caregiver feedback is a valuable tool for improving culture, advancing caregiver and patient safety, developing leaders, and retaining top talent. Capturing this feedback via census or pulse surveying during difficult times can provide insights into both immediate and long-term interventions.

1. Segment the data. Looking at the data by job level, unit or practice level, or team level helps identify subgroups that are outperforming and those with room for improvement.
2. Track and benchmark staffing rates. Using the National Database of Nursing Quality Indicators (NDNQI) can be an integral part of addressing challenges around staffing, engagement, and job stress, as we have seen staffing and the work environment linked to clinical outcomes. Leveraging NDNQI to gain insights from interconnected data enables organizations to reset their focus on quality.
3. Show support. Support leaders in building team members’ psychological safety and have them be present with the team by conducting huddles and practicing high reliability rounding techniques to listen and respond to feedback. Optimize each interaction by practicing the “4C” framework (Connect, Check, Concern, Commit). These optimization tactics can help team members feel connected, open the door to feedback, and help each individual commit to future action.
4. Lean on high reliability. Commit to pursuing Zero Harm for patients and caregivers. Embrace a fair and just culture, and strive to improve your ability to detect, learn from, and prevent errors. Reduce job stress, inefficiencies, and error by addressing the challenges of technology and operational processes through high reliability principles. From electronic medical record systems to scheduling, evaluate your processes and optimize them to serve your patients and your teams.

To learn more about the trends and strategies discussed, reach out to a Press Ganey expert here.