Among the many impacts brought on by the COVID-19 pandemic, a surprise has been what analysts call The Great Resignation. According to the article, Who is Driving the Great Resignation? by Ian Cook, Harvard Business Review, the US Bureau of Labor Statistics estimates that around 4 million Americans left their jobs in July 2021. That record was shattered in November 2021 when another 4.5 million Americans left their workplaces, highlighting several months in a row when 3% of the workforce quit. Furthermore, individuals between the ages of 30 and 45 represent the demographic with the highest increase in resignations in 2021. 

According to the Job Openings and Labor Turnover Survey (JOLTS), these industries were most affected by this phenomenon: 

  • Accommodations
  • Food services
  • Transportation
  • Warehousing 

The healthcare industry was not far behind. So as leaders, how do we keep our healthcare workers and design a workplace with a great culture? Let’s consider some data first.

New Evidence Suggests There’s Been a Great Reshuffling, Not a Great Resignation

Many factors contributed to the resignations. But surprisingly, there is evidence they may not be all resignations, but instead a reshuffling of individuals to different industries. This would allow workers to reinvent the shape and trajectory of their careers. In any event, to improve employee retention organizational leaders will do well to think seriously about causes for employee attrition, and think creatively about ways to lessen some of these resignations. 

During the COVID-19 shutdown, employees had time at home to reflect on their values, priorities, and current opportunities for work-life integration. They also had time to think about potential career advancement opportunities, and time to consider how they were being treated at their current jobs. Together with balancing more work hours, attending remote meetings while working at home, homeschooling children or caring for young children, and other caregiving responsibilities, you have a set-up ripe for The Great Resignation.

Is There Evidence Workplace Culture is the Main Reason People Left Their Jobs?

Better pay and better work hours are often reasons people give for changing jobs. But in this case, workplace culture seems to be a leading cause why people left the workforce. The Great Resignation is more likely a “great reshuffling,” says the article, The Great Resignation: How Employers Drove Workers to Quit, by Kate Morgan. She states retail and service workers left their jobs for other entry-level positions (i.e. in warehouses or offices). These new jobs “actually [paid] less, but offer(ed) more benefits, upward mobility, and compassion.”

Ross Seychell, chief people officer at HR company Personio, says the pandemic resulted in higher expectations of employers by employees. It also served as a tipping point for individuals who considered leaving their jobs due to company culture prior to the pandemic. Workers were worried about their own personal safety with exposure to SARS-CoV-2 at work. They did not believe companies had their health or well-being as a priority, nor was there much acknowledgment of rising burnout. This caused disgruntled workers who wanted to quit.

Seychell also stated that “when there’s a lot of people moving, that costs companies in terms of turnover and lost productivity,” Organizations that lose many in their workforce will have difficulty over the next 12 to 16 months since it “takes six to nine months to onboard someone to be fully effective.” Ultimately, “companies that don’t invest in their people will fall behind,” says Seychell.

An Alarming Trend With Healthcare Workers

This trend raises alarms, as during a pandemic our healthcare system faces the same fate as other industries. According to survey research firm Morning Consult, 18% of healthcare workers in the US have quit their jobs (vs.12% who lost jobs) since February 2020. Of the 70% who kept their jobs, 31% considered leaving their jobs during the pandemic. A staggering 19% considered leaving healthcare altogether. The survey outlines the causes for this attrition to include “insufficient pay or opportunities and burnout.” 

Other causes include ill-conceived and performative wellness initiatives that failed to support proven wellness efforts, such as reduced hours. Actions designed to promote health, like adequate personal protective equipment (PPE), or mental health resources for burnout and PTSD, failed to be consistently implemented due to the volume and acuity of patients seen. In some cases, healthcare workers complained that employers “downplayed the severity of their experiences.”

How Can Leaders Build a Work Culture that Keeps their Healthcare Employees from Leaving?

Many organizations have recognized the need for diversity, equity, and inclusion initiatives in their workspaces, particularly after widely publicized social injustices over the last several years. Few have realized how these initiatives will benefit the culture of a workplace and promote employee retention. 

So in response, here are 5 simple strategies leaders can use rooted in diversity, equity, and inclusion to improve the culture of their organization and retain their healthcare workforce.

Expand Your Skillset: 

1. Be Inclusive

Diversity is often the first word presented when referring to diversity, equity, and inclusion initiatives. Many people do not hear past the word diversity. Equity and inclusion are at least equally (if not more) important than diversity.

Being inclusive means “the practice of ensuring people feel a sense of belonging in the workplace, or that employees feel comfortable and supported by the organization when it comes to being their authentic selves.”  

The power of an inclusive organizational culture is strong, and important for individuals who are part of your organization. Admittedly, psychological safety must be present in the organization for all parties to feel they are able to bring their true selves to work. This is particularly true for members of communities who have been oppressed, underrepresented, or historically marginalized. 

Psychological safety, although countercultural to traditional medical culture, is a term coined by Harvard Business School Professor of Leadership and Management Amy Edmondson. She defines it as the belief one can speak up without risk of punishment or humiliation. Moreover, psychological safety relates to “giving candid feedback, openly admitting mistakes, and learning from each other.” Cultures with high degrees of inclusivity and psychological safety promote increased employee engagement, which facilitates more productivity and loyalty to the organization, producing greater financial gains.

How does one create an inclusive culture? Providing a sense of belonging starts with being curious about your workers. Since people have a basic need to feel seen and heard for who they are, one way is getting to know your employee, showing an interest in their lives and who they are. Being intentional about getting to know your employees and their needs is a critical step to finding out ways to be supportive as a leader. In basic terms, it requires emotional intelligence. An easy way to accomplish this is through the use of regular ‘check-ins.’

According to Primary Care Progress, a national organization that seeks to improve healthcare by leveraging the power of human connection through relational leadership, “check-ins are ways to gather feedback from your team while building trust and psychological safety.” Check-ins allow for reflection, and can be built into meetings. The process of taking these steps may uncover previously unknown ties among team members. Things like common hometowns, parenting status, etc. facilitate teamwork, collaboration, and other intra-group interactions. Once camaraderie is built among team members, facilitate ongoing team-building activities. 

Along with fostering an inclusive culture, it is incredibly important for leaders to disavow acts of exclusion of individuals and those who commit them.

2. Provide Mentorship, Coaching, and Sponsorship

As mentioned earlier, a perceived lack of career development and opportunities for advancement were main reasons employees left their workplaces. In addition to knowing who your employees are, be intentional in asking about their goals and what sustains their interest in their jobs. Workers who find passion and meaning in their work are more satisfied at work. 

Once their goals and passions are known, leaders can provide them with and/or facilitate opportunities for achieving them. Strong leaders have keen understanding and skills in mentorship, sponsorship, and coaching. According to Chantel Brine in the article, Mentorship & Sponsorship: Why You Need Both, mentorship typically involves an experienced person providing support, guidance, or advice to a less experienced person. Mentoring also focuses on the development and career path of an individual over time. 

Sponsorship involves an individual who has the ability to create opportunities for people who would not be able to attain them on their own. Furthermore, sponsors help to advance careers by making introductions to key individuals, facilitating networking, and encouraging stretch goals. 

Coaching can enhance one’s job performance by helping an individual focus on a current issue. Coaches can employ ‘how’ or ‘why’ questions to encourage introspection and reflection for the individual who is being coached.

Check Your Biases at the Door:

3. Acknowledge Current Talent

Recognize the talents and skills your employees already bring to the table. Help them to get recognition in a broader context. According to an employee engagement survey conducted by Achievers in 2017, 36% of employees considered lack of recognition the “number one reason they’re considering switching jobs.” Further, if achievements are being recognized, whose are? Implicit Biases of leaders towards (or against) certain groups could influence that. For employees, however, the toll can be great and have longstanding implications. A lack of recognition undermines confidence and instills a belief that individuals are not valued. This fuels imposter syndrome, a belief one is not as competent as they are perceived and they do not deserve their accomplishments. This can stifle growth in the long term.

As a leader, if it is your practice to provide widespread notification of an individual’s achievements, make sure the achievements of all individuals are acknowledged equally with the same caliber of audience.

4. Avoid the Trap of ‘Culture Fit’

One of the best ways to improve culture is to proactively create one. This can be accomplished by being mindful of hiring for “culture fit”. Although “culture fit” is a term readily utilized in organizations, it is not often defined. This can lead to affinity bias, or the tendency to select those who are similar to us. 

At first glance, affinity bias seems like a great solution. Who wouldn’t want to work with people who are like us? Unfortunately, homogeneity can lead to ‘group think,’ which is disadvantageous to the culture of an organization. In a meta-analysis of 13 studies (2258 participants on 567 teams), Clint Bowers and Associates discovered groups with more homogeneity had lower performance on ‘high-difficulty’ tasks. Homogenous workplace cultures also cause those who are ‘outside of the mold’ to have a decreased sense of belonging and a decreased sense of loyalty to the organization. Instead, when people of differing backgrounds and interests are hired, “the more diverse the participants, the broader the viewpoints and perspectives. The more creative the problem-solving. The more thinking out of the box. The more innovation.” 

Similarly, leaders themselves need dissenting opinions to improve. This can bring awareness to blind spots and help make arguments supporting their own agendas stronger. The key, however, is NOT having enough diverse voices at the table, but having every person have an understanding and appreciation for the contribution of others.

Remember the Human in Humanism:

5. Be Intentional about Messaging Appreciation

As previously mentioned, the shift to remote work in some industries resulted in employees working longer hours and attending more meetings, while simultaneously taking care of matters at home such as virtual school or other caregiving tasks. This put a strain on their time commitments. The truth however, is that many employees don’t actually mind working harder. According to an employee engagement survey by Glassdoor evaluating 2,044 full and part-time adult workers 81% of employees say they’re motivated to work harder when their boss shows appreciation for their work, compared to 38% who were motivated by a demanding boss, and 37% who were motivated by a fear of job loss. What employees do not like is when their extra efforts are not acknowledged at all.

At the end of the day, it’s important to remember employees are not machines, but real people with lives away from their workplaces.

This is an Exciting Time to Become a Great Leader

In short, this is a difficult time to be a leader in an organization, much less one in a healthcare setting. The Great Resignation resulted in the loss of 3% of the workforce each month of the last few months, with 19% of the healthcare workforce considering leaving the healthcare field. By the same token, this is an exciting time to be a leader.

The pandemic has demonstrated the need for leaders to create and foster a positive work environment. With some intentionality, these positive environments can be created by strong leaders curious about their employees and co-workers. They will be open to diverse ideas, provide career development opportunities, recognize current employees’ skillsets, disrupt their own biases, promote employee wellbeing, and proactively give appreciation for employees’ efforts. 

Now is the time to get serious about retaining our employees. We don’t have time to waste.

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Dr. Kim Nichols MD, FASA, is a co-author of The Chronicles of Women in White Coats 4. She is also a native of North Carolina. Prior to earning her Doctorate of Medicine, Dr. Nichols earned an undergraduate degree in Psychology. She then completed a residency in Anesthesiology and a fellowship in Pain Management. Since graduation from fellowship, Dr. Nichols held leadership and educational positions in both academic and private practice, and strongly believes in the importance of building relationships in all of her work. Dr. Nichols is also passionate about mentorship and sponsorship of more junior members of the medical community. Dr. Nichols’ other areas of interest include evaluating learners, providing feedback, and facilitating equitable and inclusive environments in organizations.

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