Listen Up Healthcare Execs! The Top 3 Reasons Healthcare Employees Quit

Updated: Feb 14

The healthcare workplace is chock full of expertise.

I don’t think I can count high enough to quantify the years of education and experience walking the halls of my local hospital, or even my doctor’s office.

Healthcare employees are dedicated, caring people who can find tiny veins in moving arms, hold strong when people are fainting around them, and remember thousands of medical facts. With each patient they serve, they get better at their jobs. Frontline healthcare professionals deal with things everyday that healthcare executives could not stomach (unless they’ve been there too). Emphasis on the word professionals.

Meanwhile, healthcare executives sit in the ivory tower (so it seems from the perspective of the exam room) and review spreadsheets about budgets, employee turnover, patient satisfaction, and profit (ew) and loss statements. Those executives face their own seemingly impossible tasks and pull their hair out trying to figure out how to make it all work.

Then you’ve got the middle managers, which may be the hardest job in the whole world, no matter which industry you’re in. The managers and supervisors make the schedules, console the frontline workers, and respond to patient/family complaints. The privilege of a higher salary will probably never balance out the added stresses. Frontline work plus managing people? What do they think you're a miracle worker? You probably are.

Some workplaces are better than others, but there’s no question that the business of healthcare is stressful no matter what. For crying out loud, people’s lives are at stake!

Now that we’ve established that fact, how can we deal with the other fact that nurse turnover alone costs an average hospital $4-6 million per year? Are nurses and other healthcare professionals just being whiny because they don’t have all the bells and whistles of a silicon valley company? I'm gonna go with "no" on this one. I mean, I’d love to have beer on tap, free meals, and bring-your-dog-to-work days. (I’ll have to talk to my boss.) But what’s really going on in hospitals?

It turns out, the problem of turnover may be a result of not instituting the cheapest possible solution: LISTENING.

According to a study conducted by SMD, which included data from over 500,000 healthcare employees working in various settings,

The top three drivers of employee turnover were (drumroll please):

(1) Senior Leadership, (2) Job Fit, and (3) Management.

None of this has anything to do with doggies or beer, so lay off the millennials for a minute. Let’s break this down.

Nerd Alert! Here’s a link to SMD’s report.

Senior Leadership

The number one factor in turnover is whether healthcare employees perceive that the executives have their back. SMD says that employees want to know that senior leadership members “are visible and convey the organization’s goals, mission, and vision; that employees feel confident in their leadership; and that employees feel senior leaders care about and value their contributions.” You might actually have your employee's back, but if you're a bad listener, they won't know it. If you don't have their back, you may be able to fool them by listening (I don't recommend this course of action). But the bottom line is (and it does affect the bottom line, make no mistake about that), if you want to retain employees and save millions of dollars: JUST LISTEN! And maybe act with some integrity for good measure.


We are going to skip down to the third biggest factor in turnover, because it goes hand-in-hand with number one. Once again, employees need to feel heard by their direct supervisors and management team. Remember all that expertise we talked about at the top of the page? How would you feel if you had spent decades honing your craft only to have your concerns and ideas dismissed, ignored, or minimized by the leadership team? Obviously, that would not feel good. And let’s not forget the young professionals. Guess what: they are the future leaders. They bring a new perspective that is not clouded by years of compassion fatigue. They may be able to see new solutions that you hadn’t thought of. The time may be ripe to try something that didn’t work in 1985. You won’t know unless you listen.

SMD counsels healthcare managers to “start by understanding their employee needs. They should ensure they provide performance recognition and feedback on a regular basis, not only during annual performance evaluations. Managers should also check in with staff consistently to know they value employee feedback and have genuine concern for their employees.” In my broad-based scholarly and google search on the topic of millennials in healthcare, they often get accused of being big babies that need medals for showing up to work on time. But here’s the deal: all people want to know they are valued. Millennials are helping us evolve. The secret is that the baby boomers and Gen-Xers would also like to know if they are doing a good job. They would also like to know that if they have an idea or concern, there is a place to communicate that. Your kindergarten teacher implores you: put on your listening ears.

Job Fit

Job fit is a bit different, but can probably also be solved through listening. There will be workplaces where employees cannot be moved to a different position. In small organizations, it will be imperative to do extensive research into employee fit at the hiring stage. For the rest of the organizations out there, invest in helping your employees match their skills, personality, and interests to their job. Everyone will benefit, and, most importantly, your patients (i.e., paying customers) will benefit. Have you ever had a rude food server? Yeah…time to move that person to the back of house. The former server will be spared from the stupidity of hangry customers AND the hangry customers will leave a good review on Yelp.

Before I set you loose to go plan out your listening agenda for the year, I’m going to leave you with a sports analogy.

Those who know me might find this funny because I’m more of a yoga person, but here goes:

My best friend is a college waterpolo coach (we will call her “Coach”). That would make her the middle manager. She makes schedules, recruits players, listens to life problems, and blows the whistle really loud when the players piss her off. Yes, even 20-year-olds get hangovers and drag their asses to work, only to show up with their best 50%. Sometimes those players need the loud whistle. They need to get their shit together, show up on time, work hard, and leave their personal dramas in the dorm room. Other times, they have very real problems that will affect their performance in the pool.

Imagine if Player A stopped swimming during a game after a run-in with that hyper-aggressive a$$hole on the other team. Player A limps her way over to the side of the pool (is it possible to limp in the water?). Coach has two options, she can ask what’s wrong or she can blow the whistle and tell Player A to get back to work. The trouble is, Player A has dislocated her shoulder while simultaneously trying to whirl the ball around her head and keep the jerky opponent from ripping off her suit. If Coach chooses to ignore Player A’s pleas and makes her go back into the game, Coach jeopardizes the entire team and her player’s well-being. If an injury goes unaddressed, it can affect the player’s future performance. It can also cause Player A to find a more reasonable coach, at a rival university, who knows when to blow the whistle and when to listen. And you can bet that the Athletic Director (that’s you healthcare executive!) will be getting a nasty call from a parent, if Coach makes Player A push through an injury.

To summarize: bad things happen when healthcare managers and executives fail to hear their employees.

Your employees cannot just keep pushing through their work with "injuries" like a dislocated shoulder or a ridiculous patient load. Sometimes healthcare professionals make mountains out of mole hills. (Newsflash: that’s usually caused by compassion fatigue and repeated failure to listen when it counts.) But sometimes they have very real concerns. There may be faulty equipment that doesn’t alert them properly when a patient is in distress. There may be an aggressive patient that requires the attention of more than one nurse. They may be worked to exhaustion because all their co-workers have already quit. And they may be making medical errors because their brain no longer functions properly because of this exhaustion. The list of real problems is endless and this can cause managers and executives to experience their own kind of compassion fatigue. But as mentioned in previous blog posts, the stakes are very high. Patients lives are at stake. Your employees lives are at stake. And (quick, tell your shareholders!) your profits are at stake.

How much does it cost you to listen? I’m not sure, but I’m guessing it’s a lot less than $4-6 million per year.

And who knows...that employee you decide to listen to may just have a brilliant money saving idea that makes you look even better to those shareholders.

To my readers:

You're probably not a healthcare executive. I hope some of you are, but I'm guessing most of you are on the front lines. That's actually who I want to reach. I want to know what gets you out of bed and into those scrubs in the morning. I want to know what makes you feel dread about it. I want to know what's working in your personal life and at work. The other readers want to know.

Also, if this blog post resonates with you, feel free to secretly slip a copy of it under the office doors of your senior leadership team.

And don't forget:

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  • Tell Jamie what compassion fatigue issues are nagging at you so she can write about them.

#turnover #healthcareturnover #healthcare #leadership #burnout #compassionfatigue #research

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