Changing the Conversation: Three Considerations to Strengthen Hospital Clinician Engagement and Retention

by Robert Dean, DO, MBA, Vizient Senior Vice President, Performance Management

Katie Davis, MS-HSM, BSN, RN, Vizient Clinical Workforce Intelligence Director

Back in March 2020 when the COVID-19 pandemic began, the needs of our nation’s clinical care teams looked much different than they do today. At that time, clinical team members needed hotels to quarantine from family members, access to food and other essentials that were in limited supply and personal protective equipment (PPE) that was also in short supply. 

Almost 18 months later, COVID continues to wage war on individuals’ health, and hospitals remain the battleground. Many of the needs of clinical team members remain priorities, such as adequate PPE, while other needs have changed over time and will continue to do so as we battle a fourth COVID surge, navigate new variants and manage vaccination rates in different communities. 

Engagement and retention of clinicians have been a priority for health care organizations globally, but amidst a pandemic, the conversation will expectedly change. Three prominent considerations are leadership support, onboarding and role clarity. As part of an organization’s broader workforce strategy, these considerations can help shed light on how to retain and ensure a long and positive professional relationship with your clinical staff.

Impact of clinical leadership on retention 

The impact of leadership in any clinical discipline cannot be underestimated. And to meet the needs of, support and engage the clinical care team in our ever-changing environment, a multi-disciplinary clinical leadership team is needed.

Leadership qualities of physician supervisors impact the well-being and satisfaction of individual physicians working in health care organizations. A study by the Mayo Clinic found that for every one-point increase in a composite leadership score there was an associated 3.3% decrease in likelihood for burnout.

Data from Vizient’s Clinical Team Insights highlights a general lack of APP leadership that exists. APP leaders support almost six times as many clinicians as physician leaders do. When APPs report to leaders of the same discipline, there is better engagement and more accessible professional development opportunities.

Continuous learning is a critical aspect of any clinician’s career and an area that requires leadership support. As clinicians, we have the responsibility to not only learn about the best clinical practice but also upskilling in personal, professional and team competencies. A 2019 report found that the health care industry spends less on training than other industries ($602 vs. $1,296), shining a light on the opportunity to spend more time and resources on the education of clinicians in these areas. Communication, resilience and navigation of ethical dilemmas and stress management are examples of continuous learning content available in Vizient’s Clinical Workforce Solutions. 

Onboarding impacts retention 

First impressions have a lasting impact. Ensuring the that onboarding process is optimal and standardized for all clinicians at your organization is critical to laying the foundation for a lasting relationship with each employee. 

• Hiring managers and leadership should put themselves in the shoes of individuals hired in different disciplines across the health care organization. 
• Team members should be aware of when new colleagues are joining the team. New hires should be aware of day-to-day logistics (i.e., badge access, EHR access, cafeteria, parking, etc.) and a clear onboarding plan should be laid out for each employee. 
• National and local perspectives, and the processes that surround them, should be part of every onboarding experience (examples include accreditation, quality and evidence-based practice). 
• Expectations and scheduling of preceptors are critical, as well as providing a mentorship program.

Programs such as the Vizient/AACN Nurse Residency Program and the Vizient Physician and APP Onboarding Program support clinicians in transitioning into their professional role at the organization successfully by providing curriculum content, benchmarking data to the organization and protected time for professional development and networking with peers. The Vizient/AACN NRP has reported retention rates for members consistently higher than the national average since its inception in 2002.

Impact of role clarity on retention 

Ensuring that clinicians find meaning in their work is a critical component of retention, and much of this can be addressed when looking at how clinicians spend their time. Clinical Team Insights participants reported that over 50% of ambulatory clinics have APPs and physicians devoting time to care management activities and form completion ². 

“… contributing factors to clinician burnout points to the role of repetitive, meaningless, low-value work that does not fit with the abilities and motivations of clinicians” (NAM)

Spending time on these administrative tasks instead of patient care activities results in significant financial losses for the organization. For every full-time physician employee (FTE), .24 FTE is spent on administrative activities translating to $68,880 (2020).

Next steps for health care leaders

There are no easy solutions to improving clinician engagement and retention, and they're likely will never be. The last year has revealed how complex the clinician role is, and what kind of well-rounded support is required for clinicians to bring their best selves to work and in turn, provide the best possible care for their patients. 

Ensuring that structures are in place to enable balanced and representative leadership, visibility and facilitation of professional growth and development with leadership support are crucial. Role clarity ensures that clinical team members can practice at their highest ability and find the most meaning in their work. Finally, a successful onboarding experience for all employees is one of the first steps in establishing a long, lasting relationship with employees.

References

1. National Academies of Sciences, Engineering, and Medicine. (2019). Taking action against clinician burnout: a systems approach to professional well-being.

2. CTI 2020 data trend report