Episode Overview

Healthcare industry leaders across the country are all facing the same challenges with their workforce. We are seeing record high turnover rates and record low job satisfaction. Now is the time to prioritize proactively listening to employees and making changes that will stabilize the workforce after a tumultuous couple of years.

On this episode of Value-Based Care Insights, host Daniel J. Marino discusses how to create positive change while facing the current healthcare workforce challenges with Lumina Principal, John Malone and national expert and industry leader in workforce management, Kristi Roe.

Key points include:

  • COVID was an accelerant to an already existing problem with employee experience in our healthcare workforce. The idea of organizational listening at scale, and really deeply understanding the experience of caregivers, has been amiss. COVID lifted this issue up and we're all talking about it. 

  • Healthcare providers have gone through a lot of change in the past two years. When going through significant changes, thoughtful communication and listening are necessary components to successfully managing change. Stakeholders must be engaged, and everyone needs to understand their role in implementing good quality change management.

  • Organizational leaders need to organize around improving the employee experience in a more deliberate way. A “retention” goal should be on strategic scorecards and a priority for leaders.


Daniel J. Marino
Daniel J. Marino

Managing Partner, Lumina Health Partners


Kristi Roe

National Expert and Industry Leader in Workforce Management

John Malone

Principal, Lumina Health Partners



Daniel J. Marino: Welcome to Value-Based Care Insights. I'm your host, Daniel Marino. We're very excited to kick off our inaugural radio show here at Value-Based Care Insights. We've been doing a podcast for the last three years or so, and now we're shifting to our radio program and particularly want to thank HealthcareNOW Radio for the opportunity to launch our radio programs. Very excited about today's episode. We have a great program in store. Many organizations around the country, as we all know, in healthcare have struggled with a lot of the workforce challenges in a recent survey. In many of the discussions that I've had with industry leaders across the country, challenges with their workforce are the number one issue facing organizations. It's impacting their financials, it's impacting their recruitment, and it is certainly impacting their care delivery to patients. And not only is it challenging with the nonclinical staff, but the clinical staff, the nurses, and the physicians are really struggling with their role and comfort level within the overall care model. While I am joined today by two great individuals, my colleague John Malone, Managing Partner at Lumina Health Partners. John has a lot of experience in operational change management. And my special guest today is Kristi Roe. Kristi is the national expert in helping organizations understand workforce challenges, especially with physicians and nurses. She's also incorporated many programs to help healthcare organizations improve the employee experience. John and Kristi, welcome to the program.


John Malone: Thanks, Dan.


Kristi Roe: Great to be here. Thank you.


Daniel J. Marino: So John, maybe we can start with you. I know you've worked with numerous organizations around the country. What are you seeing as kind of the number one driver of some of these workforce challenges that hospitals or positioning groups are struggling with?


John Malone: Oh, Dan, that's a great question. I'll just start off by saying, oh my goodness, the challenges have never been more intense for healthcare organizations regarding managing their workforce. There are record high turnover rates, record low job satisfaction, and burnout is at an all-time high. We’re seeing this across the board from one end of the country to the other and across all kinds of different provider settings. You know, I'll just make note that generation Y, or millennials, are now the largest group out there in the employment world. And they have a different culture and a different attitude towards work. I think one of the things we're seeing is that the culture and focus on family first, as opposed to job first, has resulted in a lot more willingness of that employee group, that age category, roughly 25 to 40 being willing to jump.

They use LinkedIn and they move from organization to organization at the drop of a hat. So that's one of the factors we're experiencing. And I'll just end by saying, AHA came out earlier this year, talking about the scope of the problem and they stopped addressing it as a workforce challenge and started thinking about it as a financial challenge because what they're seeing is that the median margin for hospitals has moved from about 4% to negative 1%. And they're attributing that negative shift to not only COVID and the situation we all face there, but also to these workforce challenges. So it's a huge challenge. I think it's a great topic to dig into today with you and Kristi.


Daniel J. Marino: So I can't help but think as I'm hearing you kind of talk through that, John, clearly employee satisfaction is at an all-time low. Well, frustration fatigue with the physicians, nurses, and clinical staff has to be a driving reason for low satisfaction. And frankly, this turnover, Kristi, what are you hearing? Is this kind of aligned with what you're hearing from organizations?


Kristi Roe: Yeah, it absolutely is. I think John's framing of it is spot on. You know, I would offer that COVID was the greatest accelerant to an already existing problem. What it did was it gave a platform to the already existing problem. Those of us working in this space for years have seen this coming. So, you know, there was some research done last year stating 62% of physicians attribute their burnout to their employer and only 25% attribute their burnout to COVID. So I think it's just so easy to blame COVID for so many reasons. I think what COVID did was it lifted it up so that we're all talking about it, and fundamentally, the miss for healthcare organizations. There are so many reasons why we're here. There are so many different things that we can blame it on. If you talk to physicians, they all have different stories. At the end of the day, I think this idea of organizational listening at scale, and really deeply understanding the experience of their caregivers, has been amiss. And it's part of why we are here when you're doing an annual survey to listen to your employees, that's just not enough. My hope is that, you know, yes, there's a lot of things that need to be done, a lot of culprits here that need to be looked at from administrative issues to perhaps leadership issues, etc., but at the core of it, if we're not listening, understanding, and acting on it we're just gonna keep in this cycle.


Daniel J. Marino: That's such a good point, too. There are many organizations that go through their employee satisfaction service, for instance, every year and from there they typically put together a team that will address a couple of these issues with the goal of putting some type of improved process or satisfaction program together, but in my mind, it never really seems to go far enough, right. You're not really addressing the core root of the problem. I have a lot of physician friends who've often said to me, that the reason why I got into medicine in the first place seems to be lost. It's not that they don't want to do it anymore, it's just that the structure, the environment, and the way they practice medicine, for instance, are not the same. It's been totally changed. So, you know, when you think about listening, how does that impact your ability to kind of connect the dots between the group problem and I guess some type of solution going forward?


Kristi Roe: Yeah, healthcare has changed. The way that clinicians work has changed. The miss, and John can probably speak about this also, is that when you're going through significant changes really thoughtful communication and listening is a necessary component to the success of the change, right? Because it's being done to them, not with them. So yes, healthcare needed to change and it will continue to need to change. We know enough about moving through change that we have to make sure our stakeholders are engaged. They understand why they're engaged in the change, perhaps helping to implement it. There are best practices around this that I think from the systems I've seen struggle, is really foundational aspect of really good quality change management.


Daniel J. Marino: Yeah. I agree. So John kind of building on what Kristi’s saying, if you're gonna achieve real change management, you have to engage the stakeholders and it has to be influencers. That is really gonna drive that change.


John Malone: Oh, that's absolutely right, Dan. You know, one of the challenges many health systems, hospitals, and physician groups are experiencing is that they have not traditionally been very good at managing change. They have what we like to call a poor change history and that creates difficulty in their culture. People in the organization will see a change coming and they'll wanna duck and cover and say this too shall pass and try to avoid being a part of the change process. So it's not like we have to start doing it right, we have to overcome some of the challenges we've created by doing it poorly in the past. This really signifies the importance of communication, involvement, and structuring whatever the change may be.


John Malone: In this case, it's typically talking about the workforce. It has to do with better processes, better information flow, and getting the right piece of information to the right individuals at the right time. Making sure there's collaboration end to end and a care process that creates a sense of satisfaction for the employees and clinicians, as well as, the sense of being taken care of well by the patients. Working on all those things means the clinicians have to be involved. They have to design it, be a part of designing it, and be a part of defining what success is and making sure they're able to see that success at the end of the process.


Daniel J. Marino: Yeah, you're absolutely right. For our audience, If you're just tuning in, I’m Daniel Marino, and you're listening to Value-Based Care Insights. I'm talking today with John Malone and Kristi Rowe regarding the challenges to our workforce that many hospitals and medical groups are experiencing. So Kristi let's dive a little deeper here. When you look at some of the specific areas of frustrations that are impacting physicians and impacting particularly nurses, what are a couple of those that are really top of mind for you?


Kristi Roe: That's a great question. I was involved in some research last year of physicians and nurses where we were asking questions just like that. Specifically around the intent to stay and their overall experience. I think what really caught my attention for physicians when we asked about their intent to stay, and we specifically asked, how long do you intend to stay at this organization? One of the really incredible findings for physicians was how ethics really drove their intent to stay. So the organization showing a commitment to ethical care delivery and professional conduct to psychological safety and the ability to take social risks. I found that fascinating. That's a shift from what you typically see. Although I would also offer, we don't often ask positions enough about their intent to stay and look for the primary correlates of it. So it could perhaps be that I just never saw that data point before, but what that tells me for physicians is perhaps during COVID, the way we were having to shift care so quickly didn't land well with them. They were concerned about the way we were delivering care. I think that's a real opportunity for organizations. Psychological safety. I've chewed on this one with people, and there are different views of that, where we would go, wow, we wouldn't think a physician would struggle with psychological safety, but yet we’ve heard other opinions about that like no, when you think of perhaps a physician and the pecking order, if you will, of physician leaders and those who've been there for a while that perhaps some new physicians might be struggling to kind of speak up if there's something of concern to them. I think those really stood out. Then for nurses, when asked specifically about the intent to stay, managing change was the number one driver of where they indicated their intention to stay. So very, very relevant to our conversation. I mean, those nurses are at the frontline every day, they're getting something new where they have to do a new process, implement it a different way, and again, it's being done to them, not with them. That is really, really powerful to see, and that by the way, managing change, showed up all over our study for physicians and nurses. So, very, very relevant to our conversation. The final thing I would offer is the other driver around an overall experience for nurses and physicians that really stood out in our study was the desire to grow. The desire to grow and develop. I think when you think of COVID, you know, there's lots of PTSD that caregivers experience and there's this concept of post-traumatic growth. So my background is in psychology. This is a way we heal from trauma. I think organizations should focus on how can you have a whole campaign around growth. Growing professionally, career ladders, personal, just a grow campaign because that really showed up dominantly in our study.


Daniel J. Marino: I agree with all of those, and I think that's sort of the root of that needs to be addressed in order to keep folks at their organization. But it seems like we're in this spiral world right now and particularly for nurses. There's high nursing turnover, and organizations are having trouble recruiting nurses, but they need nurses. Right. So what they're doing is they're actually paying for travel nurses. So they're getting travel nurses in, and in some cases, travel nurses are 20 to 30% above what the cost would be if you were to employ the nurses. Well, travel nurses are seeing that. So nurses that would normally be taking jobs within their community are saying, well, for a little extra premium of a dollar, I'm gonna join the travel nursing crew and incorporate some of that and it is helping some of the experience. So it seems like we're on this cycle. That is really building on itself, moving from less ability to recruit and having to contract with travel nurses, which, you know, again is feeding itself. How much is the financial piece coming into play there when you're thinking about the nursing experience, so to speak?


John Malone: Dan, I'll jump in and then let Kristi round it out. I attended ASHHRA earlier this year, which is a national HR organization for healthcare, and I was a panelist and spoke on some topics related to this. One of the things that became really, really clear talking to all these HR leaders is there's a recognition that they need to get off the hamster wheel of recruiting, and really what they need to focus on is retention. One of the buzzwords floating around was retention is the new recruiting. Now that's not to diminish the importance of recruiting of course because there are always ways to continue to improve and tighten up our recruiting processes, that's always critically important, but we have to move beyond that to solve these challenges. 


Daniel J. Marino: We absolutely do because if you don't focus on putting some dollars or resources to retain, then not only is it costing you a lot more money for recruitments, but it clearly impacts the way we're delivering care. There's no continuity with our patients.


Kristi Roe: I totally agree with that. We're just what I like to call, MacGyvering a solution here. This cannot stay where it is. It's causing even more attention because nurses who belong to the organization who wear the badge, they're working right alongside someone who's making three, four times as much as them. I think when you see this mass exodus and people going to travel, they're basically saying healthcare, we're fed up with you. You're not allowing me to have a healthy life with meaningful work. I say to healthcare systems all the time, find out what you're paying your contracted nurses and take that spend and invest it in the culture of your employees.


Kristi Roe: Some organizations are really starting to be aggressive in that saying, we're gonna stop this and we're gonna invest in better benefits, more programs for our employees. Call the people back to healthcare. That's where they wanna be. We messed up, but now we've course corrected and we've created a space where you can work, you can have that high meaning and you can have a healthy life. That is the only way we're gonna get out of this. I think it’s HR leaders in partnership with a lot of other leaders in the organization CMOs, CMOs, I was just involved in the chief nursing round table that was held nationally, and this was the topic. So I really wanna see those teams coming together to talk about the problem. Yes, HR is an incredible part and leader, but this is, to John's point, this has risen to one of the main issues around finances for healthcare organizations. Everyone needs to be leaning in on this. I often challenge folks. We need to be leaning in on this the same way we leaned in on the early days of reorganized care


Daniel J. Marino: We need to do something now. As you said, and you are spot on, this is one, if not the leading causes of financial instability for organizations and the cost of high turnover with having to pay travel nurses, having to pay position locum, I can't help but think that if they invest that in their teams, that would certainly pay dividends. So Kristi, when you think about these organizations, what are a couple of key recommendations or strategies you would give them so maybe they can start getting on a different path?


Kristi Roe: So one thing we have got to reimagine is the healthcare employee experience. You need to think about it just as we think about patient journeys, we need to think about employee journeys, nurse journeys, physician journeys, and listen across the moments that matter. So again, it's not just this annual exercise, but rather, listening at the moments, from everything from onboarding to perhaps, when they're getting into leadership, all along the entire life cycle. I think that's really critical. I think organizational leadership needs to organize themselves around this problem in a more deliberate way than I'm seeing it discussed. I wanna see retention goals on strategic scorecards. Like that kind of, I love


Daniel J. Marino: Retention goals. I love that! Absolutely right.


Kristi Roe: That’s the kind of energy we need to be seeing. Then after that it's really gonna start to get leadership really organized and really focused on this, people in healthcare can do anything. We just proved that during COVID. So I think it's really just an opportunity to have a deeper organizational focus on this issue instead of it just being like it's always gonna be this way. No, it doesn't always have to be this way. 


Daniel J. Marino: They have to make the change. They have to be proactive and make the change. I love your suggestions about listening and boy, the retention goals and setting some key performance indicators around that. That's what's gonna measure your success. John, lemme turn it back over to you. Any final thoughts, any piece of advice to give some of our listeners around the change management?


John Malone: Oh, well, absolutely. Just building off Kristi's excellent points. Reimagining the employment experience is critical and we have to look forward, not backward. The way healthcare is going to be delivered 10 years from now is completely different than the way it is today with the introduction of big data, artificial intelligence, remote monitoring, and genome sequencing. I mean, Stanford University already allows their employees the opportunity to have their DNA sequence, to identify health problems proactively. That future is now. Reinstating that we need to be looking forward, not backward.


Daniel J. Marino: Yeah, I absolutely agree. Well, guys, this has been fantastic. I appreciate you coming on the show and sharing some insights. As we said, in my opinion, this is probably the number one issue that is really facing our healthcare industry. Particularly when we're thinking about delivering care to patients. Patients rely on their clinical support team. They rely on the nurses, they rely on their physicians, and they rely on the registration person. If there's a lot of turnover, if folks move around, you lose that continuity. You lose that focus and not to mention it's extremely expensive and really impacting the stability of our healthcare organizations. So really wanna thank you for your time today. We'd love to have you both back at some point down the road. Thanks.


Kristi Roe: Thank you so much.


Daniel J. Marino: So thanks again to our listeners. We really appreciate it. Appreciate your time for listening. And until the next insight, I’m Daniel Marino bringing you 30 minutes of value to your day.












About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners

Daniel J. Marino

Podcast episode by Daniel J. Marino

Daniel specializes in shaping strategic initiatives for health care organizations and senior health care leaders in key areas that include population health management, clinical integration, physician alignment, and health information technology.