Workforce Strategies
Today’s blog post is by Robert Frediani with assistance from Jennifer Boese. Rob is completing his PhD in Health Care Administration and works across health care segments to assist with key operational and workforce services.
We’ve written about the ongoing health care labor crunch for years. In our January 2023 article, we posited: “Whether due to burnout, low morale, insufficient wages, the need for life balance, or even early retirement, health care organizations across the industry are still facing labor headwinds.” We suggested some actions health care organizations – physicians, hospitals, and post-acute – could consider. One action was to pay very close attention to employe morale, engagement, and loyalty. Today’s blog will dive into this topic and provide next steps your organization can take.
How did we get here?
New workers are not entering the health care workforce as quickly as needed and existing health care workers are leaving the industry. Demographic trends in the United States have been driving worker shortages and the pandemic accelerated the trend. The pandemic drove significant amounts of workforce churn in the industry, which resulted in a reduced workforce. In the nursing home segment, for example, the result also included a reduction in workers holding jobs in multiple facilities.
According to the Bureau of Labor Statistics and the Centers for Medicare and Medicaid Services, the trend in demand for health care services is outpacing the supply of health care workers (direct care and administrative). This is forecasted to continue through 2038.
There are direct and indirect costs for health care organizations that need to replace a worker. Those include significant financial costs (anywhere from six months of the lost employee salary to over 200% for specialized workers) along with indirect costs such as reduced employee morale. Exactly why retaining your workforce should not only be a human resource priority, but also an organizational leadership and financial priority.
Why hasn’t measuring employee satisfaction and engagement improved retention rates?
Poor satisfaction and engagement are two symptoms of a larger issue – low employee commitment. While researchers have been measuring employee satisfaction since the 1930s, employee engagement has only been measured since 1990. In other words, the role of commitment as a root cause of engagement is a relatively recent discovery. We have learned that engaged employees generally report higher satisfaction with their jobs, but satisfied employees may not be engaged in their jobs. Many temporary and/or contracted employees are an example of this situation.
What are health care workers thinking?
More recent research is showing us that every employee has some amount of commitment to their job, and that every employee has thought about or is thinking about making a job change. Effects of the pandemic on work environments increased the frequency health care workers thought or think about changing jobs. Perhaps due to the nature of their work, health care workers are more actively considering job change than workers in other industries. Some employees are closer to changing jobs than others and commitment levels and type are variable. The most important “take-aways” from recent research is that you can determine and measure an employee’s stage of decision-making along with their commitment levels and types. Remember, if we can measure something, we can monitor, influence, and improve it over time.
What is commitment and what influences it?
In the Meyers and Allen model there are three components that make up general commitment.1 The three types/components are affective, continuance, and normative commitment. All employees have at least a little bit of each, and each type is measurable and influenced, or moderated, by experiences in the workplace. For example, continuance commitment is influenced by economic benefit, personal recognition, organizational reputation, and feelings of isolation. Other things moderate affective and normative commitment as well. Leaders that know the level and type of commitment their employees possess can improve their employee’s working experience in ways that will reduce their likelihood of quitting.
Quit or stay?
All employees are in a constant state of decision making about quitting their job or staying in their job. A decision not to quit or a decision to do it takes to avoid quitting represent different stages in the decision-making process. There are six stages of decision-making. For example, a firm decision NOT to change jobs represents the “Termination” stage, while people in the “Action” stage are actively pursuing a different job. Leaders that know where their employees are in their stage of decision-making can better prioritize when and where to spend resources on retention initiatives.
What can you do to understand commitment levels and retain workforce?
Here are a few steps to take immediately.
- Add employee commitment measurement to existing efforts.
- Assess the cost effectiveness of employee recruitment, retention, engagement, and satisfaction practices already in place.
- Understand generational differences of your workforce for better retention rates.
- Find which groups of employees are actively considering quitting.
- Develop effective retention strategies, specifically including measurement and monitoring of commitment over time.
- Reassess your pay structures compared to your market.
- Reassess your benefit package.
- Review your organizational culture.
- Increase remote work and/other scheduling flexibilities where feasible.
- Think innovatively about how to deliver care.
- Develop new or reinforce existing talent pipelines.
- Reach out to CLA for assistance.
How CLA can help
The United States’ health care industry has a worker shortage, and that shortage is expected to persist through 2038. Retention of health industry employees is better for your patients and organization. Employee commitment and their desire to quit change in response to moderating factors in the work environment. Leaders who are actively measuring and working on improving these factors can help retain workers by improving commitment levels.
CLA is already assisting clients and associations across the country with understanding their workforce situation, improving processes and work environments in ways that positively impact employee retention and recruitment. After taking the step of analyzing employee commitment using a fully developed survey and statistical model (CLA can help), we can then work with you on improving your return on that investment through additional services:
- Operational Assessments – Uses internal and external benchmark analysis to identify operational opportunities that improve organizational health and performance.
- Assurance Services – Helps organizations ensure the accuracy and reliability of their internal controls and financial statements.
- Strategic Services – Provides strategic guidance and operational support through assessments, strategic planning, operational implementation, and performance monitoring.
- BizOps Services – Provides back-office staff and/or organizational supports.
- Digital Services – Creates customized data and analytic tools and processes that leverage technology/data to improve organizational performance and customer experience, including accounting systems, data warehouses, dashboards, service line profitability and more.
Reach out today.
1. (Meyers, J. P., & Allen, N. J. (1991). A three-component conceptualization of organizational commitment. Human resource management review, 1(1), 61-89).
Jennifer Boese is the Director of Health Care Policy at CLA. She is a highly successful public policy, legislative, advocacy and political affairs leader, including working in both the state and federal government as well as the private sector. She brings over 20 years of government relations and public policy knowledge with her to CLA. Well over half of her career has been spent dedicated to health care policy and the health care industry, affording her a deep understanding of the health care market and environment, health care organizations and health care stakeholders. Her role at CLA is to provide thought leadership, policy analysis and strategic insights to health care providers across the continuum related to the industry's ongoing transformation towards value. A key focus of that work is on market innovations and emerging payment models. Her goal is to help CLA clients navigate and thrive in an increasingly dynamic health care environment.
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