In the intense, ever-evolving landscape of healthcare, a perfect storm is brewing. Retaining workers in hospitals and health systems has become a near-impossible task. The factors behind this crisis are complex, but one looming culprit stands out: generational clash. CEOs are not only struggling to keep people on board; they’re fighting against rapidly shifting priorities driven by a multi-generational workforce that seems to have conflicting demands.
Meeting those demands is getting harder, not easier, largely due to the youngest generation’s relationship with work. Gen Z is the workforce of tomorrow, but its fit in the grueling environment of healthcare, which can often feel like a square peg in a round hole, is something hospital decision-makers are attempting to solve for.
It’s a challenge that threatens to destabilize an industry already reeling from the aftershocks of the pandemic.
But what's the solution? While cutting out an entire generation of workforce isn't feasible–or necessary–the truth is, healthcare is fighting a multigenerational war within its own walls, and healthcare leaders need to strike back.
How did this happen?
TAKEAWAYS
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Retention rates at hospitals have somewhat recovered since the height of the pandemic but continue to be a challenge as organizations try to meet the needs of younger workers.
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Newer generations are placing greater value on areas like work-life balance, career development, and workplace culture, forcing leaders to relearn what makes their employees tick.
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The future of the workforce depends on hospitals and health systems recognizing the generational differences and being willing to offer more non-traditional solutions.
Few industries are built on the backs of their workers like healthcare is. Those workers, however, have become increasingly difficult to keep in one place or in the profession altogether, placing significant pressure on hospital and health system leaders to improve their ability to retain staff.
A combination of factors are making retention efforts challenging in a post-COVID world, spearheaded by younger generations making up a greater proportion of the workforce, forcing decision-makers to meet a different set of wants and needs than has traditionally been the case.
The drain of talent from the industry is expected to result in a shortage of over 100,000 critical workers nationwide by 2028, according to a report by Mercer.
“It's not an exaggeration to say we're in the greatest healthcare workforce shortage in the history of the world,” Crouse Health CEO Seth Kronenberg says.
Generational sea change
Today’s healthcare workforce spans five generations—from the Silent Generation to Gen Z—and the divergent expectations are stretching hospital management to a breaking point. CEOs are tasked with not only managing the immediate crisis but navigating this evolving landscape in real time.
The younger workers—Gen Z and Millennials—are pushing back on traditional expectations. They value work-life balance, career mobility, and workplace culture more than ever, challenging the long-held norms that older generations largely accepted.
This tug-of-war between the values of older and younger workers is reshaping the fabric of healthcare employment. Leaders must figure out how to cater to these generational divides or risk a continued mass exodus of talent.
Seth Kronenberg
CEO,
Crouse Health
Those divides are widening and the disconnect with Gen Z in particular is making life difficult for those in charge. A recent survey of 1,500 U.S. adults conducted by Redfield & Wilton for Newsweek found that 40% of respondents tabbed Gen Z as the toughest generation to work with, while 36% said Gen Z is also the hardest to manage.
As much as organizations may prefer hiring workers from generations that they’re more familiar with, leaders know that they have little choice but to take Gen Z’s characteristics head on.
Generations differ on what would make work better
SOURCE: Nintex workforce study 2021. https://compt.io/blog/5-management-strategies-for-a-multi-generational-workforce/
The most successful methods for improving retention will always begin with learning about the type of people you’re strategizing for.
“The best thing we ever did with this organization was pre-COVID when we brought in an expert who was a generational speaker who is known for studying all the generations and how to work with all the generations,” University Health CEO Ed Banos says. “He gave us a lot of eye-opening experiences.”
The takeaway for the San Antonio-based health system was that you’re not going to meet everyone’s needs with a singular approach. Instead, organizations must tailor their management style and relationships depending on the employee.
“It's not an exaggeration to say we're in the greatest healthcare workforce shortage in the history of the world.”
—Seth Kronenberg, CEO, Crouse Health
For example, one experience the generational expert highlighted for Banos and his team was the difference between Baby Boomers and Gen Z when it comes to praise and validation. Whereas Baby Boomers are more likely to go about their job without the expectation that they’ll receive a pat on the back from their bosses, newer generations often seek that out and need it for motivation.
“The organizations that are going to keep these generations as employees, you're going to fulfil those generational needs that they have versus having something that is one-size-fits-all,” Banos says.
University Health brought the expert back for another presentation with its management council in the past year, recognizing the value of staying up to date on how to lead the different groups in its workforce. The results have been encouraging, with the system’s retention rate sitting around 12%.
Organizations, however, aren’t just trying to figure out how to keep staff under their own roof. They’re also attempting to retain workers in the industry in general, which starts with imparting the value of being a healthcare worker as early as possible by having a presence in schools and universities.
Crouse Health has been aggressive with educating future employees, even deploying a workforce development initiative that starts in first grade of a school district.
“Everybody knows they can be a doctor or nurse, but it’s about making sure everybody understands all the other opportunities that are available and hardwiring pathways because that's what's going to allow us to innovate and adapt as we move forward,” Kronenberg notes.
Terry Shaw
CEO, AdventHealth
Prioritizing well-being
In healthcare, work is more than just a job—it’s a mission. But this passion for caregiving has collided with the harsh realities of a younger workforce that won’t sacrifice themselves on the altar of patient care.
Gen Z and Millennials want meaning in their work, but not at the cost of their mental and physical health. For too long, healthcare systems have expected their employees to endure, even thrive, in conditions that offer little control over their own lives. Gen Z often is unwilling to make those trade-offs in the workplace, which can create an uncomfortable balancing act in healthcare settings where stakes are higher. That’s creating some frustration among leaders who want to those workers to be engaged and happy, but not at the cost of straying from responsibilities.
To keep these employees engaged, hospital leaders need to rethink how they define and reward success. Flexibility, career development, and innovative use of technology are now non-negotiable.
“We'd love for you to come work at Crouse for life but knowing the linear ‘I stay as a bedside nurse for 40 years,’ that's really not where the younger generation is headed,” Kronenberg says. “People want to transfer to different disciplines and bounce around and work in person, work remote. We want to be able to have those opportunities so that whatever somebody is looking for from a workforce lifestyle, we can provide here.”
Increasing flexibility often comes with increased complexity for organizations, especially with a shortage of workers, which can in some ways create more stress for employees. Still, that optionality is usually attractive for staff and can be the difference in retaining a worker or seeing them walk out the door.
Employees, of course, will always care about how they’re compensated, but another way for CEOs to make their workers feel valued is through the benefits they provide.
20.7%
hospital turnover rate in 2023, compared to 17.8% in 2019.
Source: NSI Nursing Solutions.
Shaw points to asking 50 executives what they considered to be the most important employee benefits and comparing that to the answers from 1,000 workers. The lists didn’t match, so AdventHealth changed some of its benefits to better align with staff members’ values.
Engagement, Burnout and Stress, by Generation
One of those benefits is better mental health access, Banos notes. There’s less of a stigma around getting help for mental health among newer generations, compared to say the Baby Boomers, so organizations should be factoring that into the options they offer employees.
“We look at how do we keep each generation happy and fulfilled? We think that will lead to retention,” Banos says.
While it takes a people-first approach to strengthen employee well-being, the role of technology shouldn’t be overlooked.
Kronenberg believes that a multi-pronged approach that leverages technology inside and outside the four walls of the hospital, along with utilizing AI to fill the void of tasks that can be automated, is valuable for relieving clinical staff of administrative burden and allowing them to spend more time with patients.
“When you have limitations on the workforce, how do you make them work more efficiently? Everybody talks about working at the top of your license, so how do we free up the doc and the nurse from tasks that can be done by either other labor, less expensive, more available labor pools or technology,” Kronenberg says.
For Banos, appealing to workers’ missions, which is often the reason they joined healthcare in the first place, can also go a long way to renewing their desire to stay. Other professions in other industries may offer a better work-life balance, but healthcare workers are usually committed to improving the health of their community and their fellow people. The onus is on organizations to remind them of the intrinsic value that comes with that.
“Healthcare is a 24/7 job. We have to show and make it worthwhile for people to want to get into those healthcare professions that many times are going to require them to work different shifts at various times of their career,” Banos says.
CEOs who fail to invest in these innovations risk driving their workforce into the arms of industries offering better work-life balance through remote work, flexible schedules, and meaningful employee engagement.
Multigenerational Workforce
Multigenerational Workforce
Leveraging the Strengths of Every Age Group
Leveraging the Strengths of Every Age Group
SOURCE: Peter Boolkah https://boolkah.com/multigenerational-workforce/
The power of empowerment and middle management
While senior leaders set the strategy, it’s middle management that determines day-to-day reality for healthcare workers. These managers wield immense influence over whether employees stay or go, yet they are often neglected in retention strategies.
Keeping employees content in the short term will result in less turnover, but providing a path for career growth is what allows organizations to ingrain workers into their fabric.
Especially in today’s age when clinical staff are seeking out amplified voices and leadership roles, it’s incumbent on hospitals to afford them the opportunities for personal development.
Ed Banos
CEO, University Health
Sometimes, it’s as simple as giving physicians and nurses a greater say in the clinical decision-making process. In other cases, it’s about grooming those clinicians to one day be in the C-suite, where they can potentially make the most impact.
With ambitions varying from person to person, organizations must be prepared to give avenues to whatever it is that their workers are striving towards.
“There are clinicians that really don't want to lead other people, but they want to progress in their clinical knowledge,” Shaw says. “We have clinical ladders for that group of people. Not everybody wants to come and be the chief nursing officer, but there are nurses that would like to be the best nursing clinician in the institution. So we've developed clinical ladders across the organization.”
Another aspect of leadership’s effect on retention that can go under the radar is the influence middle management wields. When organizations are focusing their attention on the highest and lowest levels of the workforce pyramids, the people who bridge the two can sometimes be lost in the shuffle.
It’s those middle managers though that are the leaders most interacting with clinical and non-clinical staff and cultivating the workplace culture.
“If that frontline sergeant is not equipped to lead, then we're in big trouble, so we do spend an inordinate amount of time with our frontline managers,” Shaw says.
AdventHealth offers leadership classes, new leader orientation, and leadership toolkits that middle management can utilize to in their huddles and department meetings. The system also takes a survey twice per year that gives frontline managers an analysis of their leadership and places them in a quartile, which they can improve upon at the organization’s leadership institute.
“The ability to lift in, work with, and help people become better leaders, it's evident in the data that shows up and how people perceive their own leader,” Shaw says.
“Healthcare is a 24/7 job. We have to show and make it worthwhile for people to want to get into those healthcare professions that many times are going to require them to work different shifts at various times of their career.”
—Ed Banos, CEO, University Health
More Than A Third of the Workforce are Millennials
% of the U.S. labor force
NOTE: Labor force includes those ages 16 and older who are working or looking for work. Annual averages shown. SOURCE: Pew Research Center https://www.pewresearch.org/short-reads/2018/04/11/millennials-largest-generation-us-labor-force/
At University Health, Banos wants to build upon the system’s leadership academy for more continual education. That involves figuring out how to onboard and train the management team, including middle management and senior leadership, to better equip them to lead different types of employees.
“It’s what we need to do for engagement of the workforce, management of the overall hospital system, seeing the system as a whole, and helping develop and build programmatic development, but then working on that on a continual education because if we don't invest in our leaders and our staff then we're really never going to get to where we want to be,” Banos says.
Unlike recruitment, which ends with a particular employee once you bring them in, worker retention is a never-ending battle that forces organizations to remain vigilant, aware, and proactive.
Even in the face of a mass workforce exodus in recent years, healthcare and its organizations have the ability to maintain and even build upon their employee base, as long as they constantly seek to understand who their workers are and what they want.
Jay Asser, Editor, HealthLeaders
Seth Kronenberg (the CEO of Crouse Health) is a HealthLeaders Exchange member.
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