THE GREAT RESIGNATION- TURNING LOSS INTO LEVERAGE

DINESH JOHN MD, MMM, FACP ׀ HUMAN RESOURCES ׀ JULY 5, 2022

“Take this job and shove it.”

Apart from being a catchy 70s song title, this is how LinkedIn’s economist Karin Kimbrough

recently summarized the sentiments of workers who quit, after painstakingly analyzing their posts.

Why are people choosing to leave their once secure, cushy jobs in record numbers to strike it out on their own or look for greener pastures elsewhere? Let’s explore the data and stories behind this phenomenon.

The Great Resignation (TGR)-What’s the Big Deal?

The Great Resignation. The Big Quit. The Great Reshuffle. Call it what you will; this byproduct of the pandemic has arguably become the defining issue in healthcare and is likely to remain the case for years to come. The financial impact of ‘quits,’ as the Bureau of Labor and Statistics likes to call voluntary resignations, is estimated to be 1.85 trillion dollars, equating to 8% of the gross domestic product. And TGR is not going away just yet, with 1 in 4 workers planning to leave their jobs in 2022.

Fig.1 Labor Turnover -source Bureau of Labor and Statistics (BLS)

Havoc in the Healthcare Sector

Healthcare has been particularly hard hit, ranking only behind the hospitality industry for monthly quits. Not surprisingly, personnel shortages are #1 on the list of what keeps healthcare CEOs up at night, recently overtaking financial challenges (which led the rankings since 2004).

How TGR Came to Be- The Perfect Storm

TGR’s genesis might predate COVID-19. From 2009-2019, the monthly quit rate increased by 0.1 % each year, a phenomenon explained by what Fuller et al refer to as the Five Rs:

1. Retirement: occurring in great numbers

2. Relocation: less of a factor but still significant

3. Reconsideration of work-life priorities

4. Reshuffling: moving among different jobs in the same sector, or different sectors

5. Reluctance to work in a formal office setting

If the Five Rs were spark and tinder, COVID-19 was fuel to the fire. The effects were most pronounced for frontline healthcare workers, who often encountered the worst working conditions that they ever faced- death on an unprecedented scale, shortages of critical protective equipment, long hours, wavering hospital policies, and a near-constant fear of contracting the illness. As a result, nearly one in five of these workers quit during the pandemic. What’s even more alarming is that two-thirds of acute care nurses have considered leaving their profession, and one in five doctors plan to exit medicine within two years.

Is there a solution to this mess?

That is the trillion-dollar question. There is no magic bullet, or one-size-fits-all. This much is clear- the status quo is unacceptable. And as the hospitality industry learned the hard way, throwing money at the problem will not cut it.

For organizations to thrive, they must undergo what some experts call a ‘great reimagination’ to regain competitive advantage. Exceptional workplace culture is a good start, one where leaders walk the talk. The much-maligned and ‘Dilbertized’ MVV (mission, vision, and values) may need to be looked at with fresh eyes to ensure that they are socially conscious and still relevant. Flexibility and work-life balance consistently rank high on employee wish lists, as do opportunities for growth and learning. Ultimately, every organization must go through the process of introspection, using a data-driven approach to determine the best course of action.

Turning Loss to Leverage

Where to begin with this outsized problem? As a process improvement specialist and healthcare consultant, I fall back on proven improvement methodology and the adage, “ In God we trust, all others bring data.” Organizations with a growth mindset must look for data that provides clues about what is driving workers to leave, and bright spots, if any.

Data repositories may include, but are not limited to:

1. Your human resources department (HR) is a treasure trove of information, and generally utilizes software known as Human Resources Information Systems (HRIS). This contains the majority of organizational data, including employee demographics, salaries and benchmarks, applicant tracking, talent tracking, and exit interview data.

2. Global and Healthcare-specific HR trends: To get a feel for trends and best practices, try the Bureau of Labor and Statistics, Harvard Business Review, Becker’s Hospital Review, Modern Healthcare, and high-quality healthcare blogs.

3. People Analytics (PA): organizations are increasingly turning to novel solutions such as Chart Hop and Pegged software to uncover insights on effective hiring and performance outcomes. PA software essentially uses sophisticated analytical models that are similar to those used by marketers to predict a customer’s interest in a product. It turns out that those same sets of tools can predict the likelihood of turnover, or whether a candidate will excel in their job. PA has already demonstrated the ability to decrease turnover by an average of 38% in healthcare organizations, and boost job satisfaction.

4. Generating Data- proceed cautiously here, as survey fatigue must be factored in. Cultural surveys are generally helpful in shedding light on employee sentiment and their views on leadership. If the necessary expenditure and effort are taken to conduct these surveys, senior leadership must be willing to follow through with transparency and credible action plans.

Improvement methodology

Now that you have data, it is essential to formulate an overarching strategy (see Fig. 2 below) with action plans that can be tracked with- you guessed it-more data. Standard improvement methodology must be factored into these plans, underpinned by the scientific method (hypothesis-experiment-evaluation). Popular improvement methodologies include:

1. Business Process Management (BPM): heavy on automation, and summarized by the steps-Analyze-Model-Implement-Monitor-Optimize

2. Lean or Toyota Production Systems: the goal is efficiency, i.e. to minimize waste in any process

3. System Reengineering- application of new technologies to achieve dramatic, breakthrough improvements, often with a very high initial investment

4. Six Sigma: Developed by Motorola, the goal of this methodology is to reduce variation in the end product, ideally to the level of fewer than 3.4 defects/million cycles

5. Total Quality Management: customer-focused and based on continuous improvement. Data-driven decision-making is key

6. Agile: used extensively in software development, it focuses on delivering small, workable increments of work product to the customer, who may accept or reject these increments. The team responds to change requests nimbly.

With these pillars of quality data and improvement methodology in mind, one suggested approach might be as follows:

• Conduct ‘stay interviews’ with long-term employees to get a feel for what they like about the job, and what is lacking at the workplace. You might want to ask about what a good day looks like, what causes anxiety, and their perception of growth and learning opportunities. This valuable information, along with existing data sources, can be used to inform strategy and tangible action plans.

• Projects that stem from data and insights that are generated might include developing well-defined onboarding processes or automating/outsourcing undesirable tasks.

• Do not forget to track leading and lagging indicators of success, along with return-on-investment metrics whenever possible.

• Engage frontline staff in change processes wherever possible, providing dedicated time for improvement work.

Fig.2 Conceptual Model for a Reimagined State for Recruitment and Retention

A Chief Wellness Officer’s (CWO) Perspective

Dr. Leslie Kohman, CWO and Distinguished Service Professor of Surgery at Upstate University Hospital (UUH) likens current personnel issues to a leaky boat, which takes water on faster than it can be bailed out. Increasingly, she is finding that nurses and physicians are not driven by the opportunity to earn more money, but by the ability to have a work-life balance and take time off. Frequently cited causes of burnout are staff shortages, chaotic work environments, working too hard, and not being in charge of one’s schedule

Dr. Kohman strives for opportunities for new physicians to feel like a part of a team. Events such as summer picnics and winter holiday parties have been off the table for the past several years, and there may be an opportunity to reinstate these shortly. In addition, she has launched "Community-Building at Upstate (CBU)." These groups are small gatherings of about 6-10 physicians who meet every other week for an hour to discuss issues central to the physician experience.

Other initiatives in the pipeline include:

1. Partnering with external vendors such as Headspace/Talk space to provide a spectrum of app-based services to combat burnout

2. Recharge Rooms, a concept pioneered by Mount Sinai Hospital. These are designated, nature-filled spaces for healthcare personnel to take 15-minute breaks

3. Stay interviews for new employees- every three months in their first year, then every six months for year two, and every year thereafter. The major goal is to solve problems- whatever is hampering the employee's ability to feel joy and to practice medicine to their maximum satisfaction and effectiveness.

4. A high-level executive dashboard to bring attention to and highlight the effectiveness of wellness initiatives.

Dr. Kohman feels that wellness is, in part, a function of good leadership. For example, a well-regarded department chair at UUH has 360-degree evaluations done on himself every year, and is sure to discuss the results and proposed action plans with his teams. These days, an even bigger factor that is missing is the human connection. “If healthcare providers spent 20% of their time connecting with patients and with their passion, they can put up with 80% of the nonsense that life throws at them,” she states.

Is Turnover All Bad?

“Why then, ‘Tis nothing to you, for there is nothing good or bad, but thinking makes it so.”

Hamlet, act 2 scene 2

Shakespeare’s proclamation is apropos. Taking the long view of TGR, here are some positives:

• Exit interviews should be viewed as opportunities to turn negatives into positives by learning how to make meaningful improvements as a manager and organization

• Turnover is a chance to hire new employees with fresh, innovative ideas who may be a better fit for your organization

• Some entry-level roles are meant to highlight top-tier talent, and turnover is preferable in situations where higher-level positions are filled internally

My TGR story

TGR is personal to me. After the second COVID wave peaked in 2021, I made one of the hardest decisions of my life- I quit a VP-level position at a large healthcare organization. I did not have a replacement job lined up, which some might say was irresponsible. But with my physical and mental well-being at stake, I knew I had to move on.

I’d be lying if I said that I have never looked back. But I am happier being in control of my destiny. I currently have a 50/50 split between hospital and home-based work, with the flexibility to turn the spigot on/off for either type of work. The home-based work has a few different guises- consultant, expert reviewer, and director of utilization management. The variety of tasks keeps me interested, affording financial security to grow a business from the ground up.

Conclusions

• TGR is arguably the biggest challenge that the healthcare industry is facing

• Although TGR has had a devastating impact on the healthcare industry, it has afforded healthcare leaders an opportunity to push the reset button.

• Local and global data are a potential goldmine that can be used to gain a leg up over the competition

Please share your thoughts in the chat. Let us know how you plan to navigate TGR personally and/or as a leader.

Need help navigating the great resignation? Feel free to reach out to me to set up an initial consultation- I would love to work with you and your organization!

Dinesh John is a physician and healthcare consultant.