Let’s Flip the Question of the Healthcare Workforce Shortage

As the ACHE’s 2024 Congress on Healthcare Leadership wrapped up, I reflected on what I heard at last year’s meeting compared to this year. In 2023, multiple presentations discussed the workforce shortage, and hospital CEOs and human resources executives were grappling with this question: How can we attract more workers to our noble profession of healthcare?

As a former clinician and researcher who changed career paths to focus more directly on the organizational challenges in healthcare, this question landed oddly with me. The healthcare worker shortage is not new, but headlines and social media posts drew attention to it during the pandemic and post-pandemic timelines as if it was. Overall employment has returned to pre-pandemic levels and turnover rates at some health systems have stabilized, but the gap has widened between the number and location of healthcare workers and the increased demand for services.

As the most pressing issue reported by CEOs for three years running, hospitals and health systems have attempted to draw more individuals into the workforce with large bonuses, upskill training programs, and reimbursement of educational costs. While these approaches have shown early promise, evidence of long-term effectiveness is not robust. Why? Because these expensive, band-aid solutions fail to address the deeper cultural challenges driving workforce shortages.

I began to wonder if we have been asking the wrong question—and at this year’s Congress, I noticed that some executives were wondering the same thing. So, what if we flipped the question, asking instead: What changes can we make to the system and work environment to make it more attractive to workers? Are there opportunities to transition from fighting every workforce “fire” with incentives and instead examine the sources of the original fire? Could this flipped question lead to different and more sustainable solutions to the ongoing workforce crisis?

I believe that solutions will require a mindset shift from getting bodies in the door to creating an environment where people want to work. While shortages invoke a sense of urgency, like putting out a fire, data suggest that this fire has been burning for a decade or more and will not be conquered with simple incentives.

To prevent a scorched earth situation from taking hold, the firefighting mindset needs to evolve toward leaders exploring and implementing initiatives that hold greater promise in the eyes of frontline workers. Healthcare employees want to feel more respected, valued and heard by leaders. The ideas below explore interrelated areas for systemic and cultural improvements to create environments in which workers can thrive while delivering excellent patient care.

Empathy and listening: A 2023 American Nursing Foundation survey found that the top factor influencing nurses’ decision to leave their position was feeling that their organization did not value them. What workers mean by feeling valued goes beyond financial compensation. In work environments, empathy can be thought of as having an awareness of what other responsibilities, pressures and concerns a colleague has. For people to know that another worker has an appreciation of their situation, colleagues and leaders must express that understanding via verbal and nonverbal communications. Today’s leaders especially need to demonstrate that they are listening to their employees, actively soliciting feedback from multiple channels and closing the loop on what actions are or are not taken based on that feedback.

Interpersonal interactions: Healthcare is interpersonal work, including caregiver-patient, caregiver-colleague or caregiver-administrator interactions. Examples of interpersonal dysfunctions in today’s healthcare workplaces include violence and threats from patients or families toward providers, loss of psychological safety within care teams and distrust in organizational leadership. Data are scarce among workers who leave healthcare, but my personal experience and conversations with talented individuals who entered the field before pursuing other career interests indicate that dysfunction in these interactions can result in dissatisfaction, disengagement and attrition among healthcare workers.

Interprofessional communication practices: Effective interprofessional communication is critical for delivering high-quality, safe, patient-centered care. Respectful and timely communication among professional disciplines also promotes well-being by improving psychological safety and supporting the experience of purpose in one’s work. When communication patterns enable people to feel safe to speak up, ask questions, learn and develop a shared understanding of the patient care situation, a rewarding professional environment that workers want to be in emerges.

The growing importance of life in work-life considerations: The existence of this field of research into work-life balance, work-life integration and work-family conflict indicates the growing importance of an individual’s time away from work in addressing burnout and attrition. Research shows that positive work-life cultures are associated with lower burnout rates and better teamwork and safety ratings.

None of these connected elements of cultural dysfunction can be addressed effectively in isolation. Leaders must step back and observe the full picture of human dynamics in their organization and develop a holistic strategy to address systemic workforce challenges.

Leaders can crack the code on the healthcare workforce crisis in several ways:

• With frontline employee input, establish or re-establish organizational values with corresponding behaviors that are tailored locally.
• Allow ideas from the frontline to determine what solutions to implement for quality-related initiatives.
• Consider the effects on interpersonal interactions and organizational culture when implementing new technology, such as an artificial intelligence strategy.
• Foster connections and cultivate empathy for each other’s roles and responsibilities across professional disciplines.
• Develop shared behavioral expectations and the appropriate accountability mechanisms to uphold those standards.
• Include a talent strategy with human resources leaders as part of any strategic planning process.
• Align incentive structures to reward interprofessional teamwork and communication practices.
• Accept that differences exist in work-life preferences across generations and develop a strategy that can adapt to the range of workers in the organization.

By focusing on systemic and cultural elements, organizations can create environments in which professionals are not only drawn to the work but are also motivated to stay. This shift in perspective is essential for building a robust, reliable workforce that can meet the growing demands for healthcare services in our country.

Several executives showed signs of this shifting perspective at the 2024 Congress. Our patients need more leaders to flip the question on the workforce shortage and make bold, meaningful cultural changes for our healthcare workers.

Jason Pradarelli, MD, is manager and healthcare practice leader, CFAR, Inc.

The American College of Healthcare Executives (ACHE) is a network of leaders committed to excellence in healthcare and achieving their personal best.

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