For HR leaders, it all signals fresh challenge—and opportunity—for sowing a rich, rewarding experience across a growing spectrum of roles, identities, and life stages. Ahead, find strategies for shaping a flexible experience that can help attract and retain early-career employees (and others).
Today’s workforce encompasses the Silent Generation (generally considered to include those born between 1928 and 1945), Baby Boomers (1946–1964), Generation X (1965–1980), Millennials (1981–1996), and Generation Z (1997–2012).
The ranks are growing on both ends of the spectrum: Nearly two-thirds of employed U.S. adults aged 65 or older worked full-time in 2023, while Gen Z is expected to make up 30% of the workforce by 2030.
“If we live longer and do it well, how do we support our employees and their pursuits, however those may look?” asks Nonnie Shivers, shareholder at labor and employment law firm Ogletree Deakins, where she partners with HR executives as part of the healthcare, employment law, and diversity and inclusion groups, among others.
While people leaders should tailor solutions to their employees’ distinctive needs, Callahan and Shivers cite a growing refrain: The desire for flexibility across myriad dimensions of experience, from ways of collaborating in the workplace to caring for loved ones outside of it.
Put your people at the helm
While generational groupings are unscientific and just one reference point in a person’s lived experience, they can be a helpful lens for viewing the macro forces that help shape people’s collective mindsets and desires at work.
Millennials, for example, are racially and ethnically diverse; are some of the earliest inventors and adopters of social media; and have felt the weight of the Great Recession, 9/11, and school violence. “We know that some of those things have impacted their interest in staying at employers,” Shivers says. “It’s also impacted their desire for work-life balance.”
As employees make more—and more variable—demands of their employers, leaders must balance solutions with business obligations that may sometimes be at odds, she says.
That means getting specific on where the organization can play a role, and where it can’t. “I'm not going to say I'm 100% paternalistic and believe that an organization is supposed to satisfy all your needs,” Callahan says.
At the same time, interrogate “institutional stereotypes and justifications,” on what it takes to succeed, Shivers says. “Optimizing flexibility is key, embracing change, and challenging some of the C-suite beliefs about what creates a strong workforce.”
How should a busy executive figure out where to home in? “Ask people what they want,” Callahan says. “The greatest gift that you can provide someone is your time, your attention, and willingness to listen to them.”
He empowers employees to voice their needs at scale through Lean Six Sigma Green Belt strategies like focus groups, interviews, and questionnaires.
Recently, his team took a pulse on employee experience by launching a pair of surveys: one for HR staff on time allocation and another for key leaders and collaborators on value and effectiveness. “You can do a conjunctive analysis of those different things and determine where you have commonality, where you have differences, where you can transition to, and where you need to transform,” Callahan explains.
On the transformation front, MUSC Health, together with its university counterpart, is planning the organization’s first-ever benefits summit to talk strategy on cultivating a thriving multi-generational workforce. They’re also partnering with a consulting firm to make the shift from standardized benefit offerings to more flexible ones based on external benchmarks for academic medical centers and community hospitals, Callahan says.
To prevent legal trouble when collecting data at scale, leaders should ensure employees know why their input and information is being collected and how it’s being used, Shivers says. The data itself should be “rock solid confidentially” and maintained separately from employment records.
Get flexible
Across industries, younger employees are calling for more flexible and, in some cases surprising, ways of working, from lighter schedules to hourly, non-exempt work, Shivers says.
Though healthcare comes with elevated staffing and scheduling needs compared to many other settings, don’t discount what’s possible with a little ingenuity.
Given widespread challenges in recruiting for key clinical roles, Shivers has seen organizations embrace flexibility in ways once “almost unheard of for the grind of most healthcare professionals.” Things like offering doctors a 32-hour or four-day work schedule or the option to rotate in a clinic rather than a hospital.
To help make it work, consider solutions like expanded telemedicine and temporary staffing agencies, Shivers says. Also look inward: One of her healthcare clients has created a pathway for administrative professionals like receptionists to transition to patient care roles. “They're offering those folks the ability to train up as x-ray technicians,” Shivers says. The organization is seeing multi-year commitments in exchange for bonuses and tuition reimbursement. “They're building their pipeline internally with talent who’s loyal but also exposed to their own system.”
If a full-fledged staffing transformation is beyond reach, consider gaining executive sponsorship for something more finite like a Recharge Week or Day, where parts of the organization take coordinated time off to “truly prioritize mental health as well as physical health and family reconnection,” Shivers says.
It can be a “huge recruiting tool” for workers who are “dubious” of whether flexible or unlimited PTO translates to more time off, she adds.
Beyond workstyles and hours, flexibility can also mean easing onboarding requirements. “We’re seeing a decrease in pre-employment drug testing nationally, even in healthcare,” Shivers says. It’s especially true in states where recreational marijuana use has been legalized. The rationale, she says, is, “We don't want to discount those individuals from becoming our employees as long as they're not impaired at work, which is always going to remain the standard.”
Build connection
Connecting colleagues to each other and the organization is key to keeping them around.
Though Callahan is “a big methodological person,” he also knows not to overthink it when it comes to creating organic opportunities for exchange and connection.
He remembers a specific project at another healthcare organization a while back. He was in an office, working with a junior colleague on design plans for some open space outside a building. He didn’t want to make any final decisions in a vacuum, so at the next shift change, he brought his (reluctant) collaborator to the floor, where the pair conducted an “unscientific survey” on their proposals.
After they’d sourced about 100 opinions, Callahan’s colleague had a revelation: Her design was the most popular. “She was transformed” and eager to share the good news, he recalls, as were the people surveyed. They’d managed to build culture on the fly. “Sometimes we make things too complicated,” Callahan says. Don’t forsake the power of “a simple interaction.”
To formalize connection points, many organizations are acknowledging and uplifting aspects of identity that employees have historically felt the need to keep under wraps in the workplace. For example, Shivers has seen an uptick in dedicated benefits, resources, and affinity groups for neurodiverse and LGBTQ+ colleagues.
Employers seeking to validate their commitments to equity and justice through standards like the Human Rights Campaign’s Corporate Equality Index are rolling out transgender-inclusive care for employees and their dependents, “taking out any potentially unlawful blanket exclusions, and broadening their definitions of medical necessity,” Shivers explains.
Also consider introducing employee groups that bridge, rather than split along, aspects of identity. For example, many organizations are finding success with multi-generational affinity groups and education, Shivers says.
In all cases, prioritize parity and consistent treatment across employee groups, and ensure educational information and documentation is “carefully curated” to challenge harmful stereotypes, rather than inadvertently exacerbating them (and the related legal risks), she says.
Show you care that they care
Increasingly, employees are calling for benefits that help them care for themselves, their loved ones, and their broader community. “There's just so many things that have come to the fore over the last several years, but now we really need to address,” Callahan says.
To respond, organizations are increasing caregiving offerings, and communication around how to use them. “A huge amount of this is about education. And it's about helping people understand what they have,” Callahan says. “How do we provide them with the benefits that would lead to a more satisfying work relationship that would help them also to satisfy their current and future financial needs?”
For earlier-career employees—and others who’d benefit—emerging offerings could look like:
Enhanced reproductive health benefits: These can range from egg freezing to perimenopause and menopause benefits. “That's very much something we see with certain members of our workforce generationally,” Shivers says. “They want to be able to have choice over when their reproductive time frame happens in their life and their careers.” Part 2 will delve deeper into menopause benefits and the ground they’re gaining under The Pregnant Workers Fairness Act, which took effect last June.
Expanded caregiving definitions and supports: Increasingly, these span relationship types and life stages, Shivers says. For employees who are planning or caring for children, modern benefits range from expanded leave to creative solutions like stork services for pumping breast milk on the go and sick-child care services, reimbursement, or time off. On the flip side, organizations are offering benefits to help employees care for aging loved ones, and expanding bereavement policies to cover people who aren’t immediate family. There’s also an uptick in interspecies support. “Decrease in children, more pets as children, totally get it,” Shivers says. She’s seen employers introduce pet insurance and bring your pet to work policies.
Volunteer time: In recognition of widespread interest in giving back, many organizations are setting aside paid time each year for employees to volunteer for the communities and causes they care about. “It's a big cost lay out potentially, but it could have huge return on investment for employees who are committed to the organization, aligned with the purpose, but also feel like the organization is serving the whole person,” Shivers explains.
Mentorship is another way to enshrine community care as company culture, and it can start with the youngest of employees. MUSC Health’s MHA students have created “this tremendous program of interns and fellows,” Callahan says. “So there's all kinds of alternative ways to contribute, and to have knowledge exchange, to mentor people, to go through some career development.”
With their deep understanding of the interpersonal work that fosters a thriving culture, people leaders are well-positioned to meet this pivotal moment in workforce history—even if they’re not always quick to take the credit. “I don't do a lot of these interviews,” Callahan says. “It's never about me. It's about everybody else and how we make them feel, how we make them understand that they’re valued, and that we couldn't do what we do without them.”
Part 2 of this article will run later this month, offering inspiration and emerging strategy for supporting talent approaching later career stages and retirement.
The theme pervades everything from the pineapple—a hallmark of hospitality—adorning their logo, "PineApp," and flagship hospital fountain, to some of the very first words Adriene McCoy, senior vice president and chief people officer, utters when asked how the system has amassed more than two dozen national awards for their culture over the past eight years.
"Every organization wants to be known for something," McCoy says. "Baptist Health wants to be known for being a warm and welcoming environment, and that comes through, and it really resonates with people."
It resonates so much that new joiners often cite it—"unscripted"—as the reason they've come aboard, McCoy says. "I'm always stunned by the consistency."
But how does a CHRO go about cultivating one across an entire organization, especially one that's as vast as Baptist Health? (The system is South Florida's largest, with over 27,000 employees and 4,000 affiliated physicians across 11 hospitals and hundreds of outpatient facilities.)
It takes time, intention, and many hands.
Why it's worth it
"Culture is not a one and done," McCoy says. Instead, it's a worthy—and ever more necessary—investment for CHROs.
"Years ago, HR departments evolving was the nice thing to do," she explains. Not so today, when rapid change in where and how people work demands constant innovation. "If you're not doing that now, you're way behind the eight ball."
She would know—culture is Baptist Health's superpower. This year, the organization earned #61 in Fortune and Great Place to Work's 100 Best Companies to Work For, and #2 in their Best Workplaces in Health Care (Large) category.
In fact, the system has made iterations of both lists every year since 2016, along with additional national rankings of best employers for diversity, women, and social responsibility.
Accolades aside, there are urgent, material reasons to build a strong culture. "If you don't have a highly engaged workforce, [if] you have high turnover, you may find it difficult to recruit people," McCoy explains.
Indeed, one's relationship to work—liking it, finding it meaningful, feeling it makes a difference—was the top reason healthcare employees said they would stay with an organization for three years, even if offered a job elsewhere, according to research that Press Ganey, a healthcare consultancy and survey solutions provider, shared with HealthLeaders.
Other drivers Press Ganey found include strong managerial and team relationships, as well as the organization's care quality; ethics; and follow-through on diversity, equity, and inclusion commitments for patients and employees.
In other words, it all comes down to culture. "And that's something that has to be cultivated over time," McCoy says.
Get everyone in the mix
One way Baptist Health has used time to their advantage: By tapping leaders with staying power. CEO Bo Boulenger had been with the system for nearly 40 years before stepping into the role last year, and his predecessor, Brian Keeley, spent more than 50 years there. McCoy herself has been with the organization nearly two decades.
All that dedication leads to consistency—of message, of expectations—around how to care for one another and the broader community, she explains.
Though such strong, consistent leadership is powerful, the best people strategies are far from top down, McCoy says. They're also not the mantle of any single department.
"HR is not an island that should ever independently try to move the needle on culture," she explains. "Getting people deeply engaged in conversation is how you get things to permeate a culture."
Baptist Health convenes business resource groups (BRG) and employee activity groups to involve people at all levels of the organization in strategic discussions. McCoy's team also pulses participants on key initiatives to ensure things like rollout and communication are landing.
For example, by partnering with Baptist Health's multi-generational workforce BRG, McCoy's team learned that younger employees often come into the organization "with an expectation of transparency."
Based on this finding, her team increased the frequency of their surveying from annually to quarterly and arranged for their vendor to meet with employee group representatives to ensure the survey design reflects their input.
Now, McCoy's team can share and act on timelier insights, and sees proactive outreach as "a way of doing business."
Actually value values
Values can be another powerful cultural touchstone—when they're treated like more than lip service.
"Most organizations have these values. They're listed somewhere. Maybe people talk about them. Maybe you hear about them more in orientation, and you don't necessarily hear about them again," McCoy says.
Instead, Baptist Health is going to great lengths to ensure their core values—People, Belief, Compassion, Excellence, and Integrity & Transparency—are "part of the everyday conversation."
To do it, her team launched an organization-wide initiative last year in partnership with patient experience, employee experience, and marketing and communications.
First, they developed inspirational programming on the role of values at Baptist Health: what they are, why they matter, and how they shape strategy and business operations. Then, to achieve reach and resonance, they tapped leaders across the organization to facilitate hundreds of sessions delivering the material.
Following the context-setting sessions, the organization has been deep diving into a new value every two months. Each focus kicks off with a video-based lunch and learn to help leaders understand how to talk about the given value in huddles with their team members, so it's relevant whether they're part of a clinical unit or the accounting department.
To ensure learnings stay top of mind year-round, McCoy's team also launched an awards program that allows colleagues to nominate each other for bringing values to life and earn perks like intranet badges, publicity in broad-based internal communications, and eligibility for higher-level quarterly and annual awards.
All told, these efforts have reached more than 22,000 people—employees, affiliated physicians, and board members—in a matter of months.
It's an achievement McCoy attributes to the initiative's emphasis on conversation and community building.
"It's all about conversations and alignment and making sure that people are inspired and engaged in the work that we do in a meaningful way," she says.
Make real impact
Of course, it's important to understand the impact of all this intensive work. "There are barometers all over the place that we use to say, ‘How are we doing?' " McCoy explains. "Because otherwise you don't know whether or not all these activities make a difference."
But making a difference they are.
Baptist Health's turnover has dropped by almost half within the last year, McCoy says, and it's largely thanks to "all of these efforts."
Her team also keeps a pulse on success through employee surveys—which show consistently high engagement and satisfaction with communication—and patient experience scores, which cover cultural dimensions like how well staff are collaborating with each other on the patient's behalf.
"We just constantly want to help people get better because we know that if we take care of our employees, they're going to take care of our patients," McCoy explains.
That's also why Baptist Health supports their people throughout "their entire career journey," whatever that means for them, she says. "If you've got people that just want to come in and do the job, that's fine. If you have others that want to grow and develop into roles of greater scope and responsibility, then we really want to support that."
They provide this support through "very strong" internal training programs, along with tuition reimbursement, scholarships, and residencies for purviews as diverse as pharmacology and pastoral care.
It all comes back to Baptist Health's award-winning people approach: to invest in innovating for and with an ever-evolving workforce.
"We have to keep going back to the drawing board—not as though anything is wrong, but to constantly advance our thinking about how talent feels about their work," McCoy says. "As we know, when teams come together, and there's a level of openness and innovation, very special things can happen."
Delaney Rebernik is a contributing writer for HealthLeaders.
Violence is on the rise, but so is technology that can turn the tide, as long as those on the frontlines lead the way.
It’s a sobering reality across healthcare: Workplace violence is on the rise.
And nurses, who are at the heart of care, are at especially high risk. In a 2022 National Nurses United survey, nearly half of hospital-based respondents reported an increase in workplace violence, a 57% increase from the rate reported in their previous survey in late 2021.
“The examples, what people describe—years ago, you would never have heard of these kinds of incidents,” says Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE, FAAN, founder and CEO of Innovation Advantage, a healthcare innovation consultancy specializing in virtual nursing care delivery models. She recalls being in a hospital earlier this month when a patient who had just given birth punched a nurse following a communication breakdown over discharge plans.
It's an alarming escalation of a longstanding issue.
“Healthcare in general is an emotionally intense kind of field,” says Sharon Pappas, PhD, RN, NEA-BC, FAAN, chief nurse executive at Emory Healthcare in Atlanta, who co-chaired the American Organization for Nursing Leadership committee on evidence-based approaches to combatting workplace violence in 2014. “So even prior to the pandemic, it was something that of course we were concerned about.”
The pandemic brought with it a host of new challenges, like visitation restrictions that ratcheted up stress during an already fraught time.
“It predisposed us to more emotional reactions by family members, and maybe even patients themselves, because they were among strangers,” Pappas explains.
Beyond rising violence, nurses’ workplace expectations are evolving. Younger nurses tend to be “less tolerant of bad behavior,” Clipper says.
“I don’t think they’re wrong," she says. "We have to figure out how to make it comfortable and safe for everyone. Being a healthcare professional doesn’t mean we have to tolerate violence.”
That figuring out needs to happen fast—and at scale—to avoid sweeping loss.
“If we don't protect healthcare professionals, our numbers, turnover, is only going to accelerate,” Clipper says.
Nursing-Focused Tech Can Help
Two-thirds of U.S. chief nursing officers are already interested in, researching, or deploying a virtual nursing care model, Clipper says. And the involved solutions provide strong bones for safety strategy. For example, patient rooms wired with cameras, speakers, microphones, and more offer extra eyes and ears attuned to threats.
“We're on the precipice, and we’re starting to use some of those things to help us,” Clipper says.
And yet, the current crisis calls for even swifter uptake.
“We really have to have more of a sense of urgency in adopting these technology solutions that are going to help us not only provide better patient care, but also protect our caregivers more,” she says.
Beyond just-in-time tools like wired rooms and badge alert buttons, technologies with emerging safety applications run the gamut in terms of size, complexity, and point of intervention. AI solutions, while still baking, show potential for predicting and preempting behavioral risks, while virtual reality can make de-escalation training more resonant. Seamless incident reporting, meanwhile, can incentivize uptake and produce more insights to shape prevention strategies.
But before beelining to the latest innovation, consider the broader strategic context to avoid doing more harm than good, nurse executives and experts advise.
Some considerations Clipper addresses with her virtual nursing clients include:
What’s the real, underlying problem that needs to be solved?
What’s the model going to look like in the organization?
What are the specific use cases?
How are nurses being brought in to help identify solutions?
Then, design with humans in mind. That means tapping diverse disciplines—security who respond to threats, AI and data experts who can explore predictive applications, and, of course, nurses who are at the fore, Clipper says.
“They're the ones that have to be involved to say, ‘Hey, here was the trigger of this event,’ or ‘there was no warning whatsoever, and here’s what happened,.’” she says. And on the other end of the spectrum, they can share ideas for “proactively identifying precipitating events to predict and thus avoid violence in the first place."
Pappas agrees with the importance of an interdisciplinary approach.
Emory convened a group to probe workplace safety performance and implement structures to facilitate daily discussion on incidents and improvement opportunities.
“That's how you learn, and that’s how you get better and get safer,” Pappas says.
The health system named two co-chairs, a chief nurse and an operations leader, who in turn recruited a behavioral health expert to help guide the effort.
The diverse representation was intentional.
“This isn’t something that you do top down,” Pappas says. “We wanted to get people as connected and oriented toward the first line of workers as we possibly could.”
It’s working. The two inaugural co-chairs are still at the helm today, and Emory’s foresight to form the group “prepared us very well for the increase in some of those workplace safety issues that occurred during and following the pandemic,” Pappas says.
Keep An Eye On AI
With sound safety strategies and decision-making frameworks in place, nurse executives can explore specific technology applications.
Using AI during the intake process, for example, could help identify factors like diseases, conditions, substance use disorder or withdrawl, traumatic events, and family dynamics that could make patients more prone to violence, Clipper says.
It could also preempt fallible decision-making in charged situations, she says, like when the person being violent is a patient who needs care, and their behavior is the result of an underlying condition.
“If we have ways to identify, predict, and prevent, that's way easier for us to deal with than the more subjective, moral, and value-based conversations that nurses struggle with such as 'Do you press charges?' or 'Do you issue a criminal trespass warrant?'” she adds.
Of course, there are risks in relying on hyped, fast-evolving technology for weighty predictions.
“We don't want to bake in bias into our algorithms or into our predictive systems that might inaccurately identify someone that may potentially be at higher risk to behave poorly,” Clipper says. “We have to make sure that we're building these systems in a way that’s equitable."
Make Training Safe (And Sticky)
Technology can also enhance training on how to recognize and respond to violence. VR, for example, can produce realistic, scalable simulations for high-stakes skills like de-escalation and crisis prevention, Clipper says.
Plus, she adds, “the beauty of VR is that’s a failure-safe environment.”
Earlier this year, UT Southwestern Medical Center and UT Dallas designed a VR training tool that places clinicians inside a virtual hospital exam room and presents a series of realistic patient encounters so they can practice proven de-escalation tactics in a real-feeling environment, complete with a headset, vest, and gloves that mimic the sensation of being touched (or hit).
Given this capability, VR is a useful—and increasingly popular—tool for improving problem solving and “muscle memory,” Clipper says.
“When you go through those scenarios, you get to test over and over again what you should do, what you should say, how that works,” she says.
Technology can also make training more accessible and consumable in the course of a busy day.
“It's important that we look at training and newer ways that are more bite-sized as opposed to a three-day class,” Pappas says. “Technology can help with that by [creating] little vignettes, something you can access on your cellphone.”
Meet the Moment
With virtual nursing on the rise, many CNOs already have tools in place or in the works that they can weave into their safety strategy.
Such solutions range from simple, Clipper explains, such as a tablet that allows a virtual nurse to admit, discharge, or educate a patient, to sweeping: a room wired with cameras, speakers, microphones, and even sensor-enabled ambient computer vision and sound.
In the high-tech setups, the devices can act as an occasional or ongoing “extra set of eyes and ears observing what's going on or listening for things that might trigger someone’s interest,” she says.
One organization on Clipper’s radar has developed a safe phrase, “something along the lines of ‘there’s birthday cake in the breakroom,’” that “perks up” the virtual nursing system and prompts “no questions asked” action like a security visit.
It can “expedite that time it typically takes to get someone into the room to further investigate and check it out,” she explains.
Create a Strong Reporting Culture
Emory has found great success, Pappas says, using tech to improve ease of incident reporting so “you have information that you can use to understand it better and actually start to devise strategies to make the workplace safer.”
They’ve integrated reporting with their EHR to automate as much of the process as possible.
“If you can make reporting really easy, people are more prone to do it,” she explains.
As a result, Emory has seen tremendous, across-the-board improvement in levels of reporting thanks to their targeted interventions.
“We were able to detect, by operating unit, that we were having increases at just about every site in the amount of reporting that they do,” Pappas says.
It’s additional information they use daily to make the workplace better, which in turn fuels more reporting, she explains.
“The positive feedback system has helped us to continue to increase reporting and to improve safety,” she says.
To synthesize and act on findings, Emory has implemented a five-tiered huddle system, which runs from the frontlines all the way to operating unit leadership. Every day, the top tier comes together to share what they’ve learned from their own tiered huddles.
“It’s made people say, ‘Wow, if we report it, that means that people are going to talk about it, and I get a chance to improve this,’” Pappas says.
Know That Tech Alone Can’t Save You
An “aha moment” in Emory’s stepped-up reporting came from an unexpected setting: ambulatory clinics.
“The stakes aren’t quite as high [because] the patients aren't quite as sick,” Pappas explains.
And yet, their reporting revealed that some patients experiencing long wait times “would exhibit behaviors that threaten the staff,” she says. “It just was a real surprise to us.”
So they tapped their strong professional governance network, clinical nurses and other caregivers who come together on a regular basis to review competencies and patient outcomes, to review the safety reporting and help devise a response. Following these time-tested decision-making and discussion frameworks produced “some of our best interventions.”
Those interventions included targeted de-escalation training for staff in areas where patients had been demonstrating aggressive behaviors and lots of “very good discussions” about applying low- and high-tech solutions strategically, especially in high-risk areas like the emergency department.
Based on group deliberation, Pappas says, Emory installed metal detectors at certain—but not all—key entrances. They also explored the idea of placing alert buttons on badges but decided to instead voice needs and check on each other rather than introducing and keeping track of another new gadget.
“The key there is just involving the people that it impacts and getting the best direction from them about how to use devices and systems to improve safety,” Pappas says.
It's a testament to technology’s ability to augment but not replace human ingenuity and camaraderie. Safety is “everyone's job,” Pappas says. That means success comes from a shared responsibility and commitment to “take care of each other.”
In the second of a two-part series, CNOs talk about their plans for collaboration in the coming year
Editor’s note: This is part 2 of a two-part series. Part 1 was published on Thursday, November 30.
2024 will be restorative, if CNOs have their say.
Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers.
“The current times have required a new level of operational rigor [and] a keen focus on the people providing the care and service,” says Kate FitzPatrick, DNP, RN, NEA-BC, FAAN, executive vice president and Connelly Foundation chief nurse executive officer at Jefferson Health, which has 17 hospitals throughout New Jersey and Pennsylvania.
To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.
And while buoying wellbeing for beleaguered teams may sometimes seem at odds with imperatives like driving quality care and efficiency, it's the right strategy, says Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN, chief nursing officer at Press Ganey, which provides experience survey solutions and consulting services to healthcare organizations, including nursing leaders and teams.
“What our data clearly shows is that if you are not taking an employee-first approach right now, you will never be able to meet the … patient promises that organizations are making to their communities,” he says.
Here are some more ways that CNOs are approaching teamwork in 2024:
Share power
Another key to cultivating a rich and rewarding professional environment: Giving nurses a say in the strategy.
“I've been really fortunate to be in an organization that’s supported shared governance my entire career,” says Meredith Foxx, MSN, MBA, APRN, NEA-BC, PCNS-BC, PPCNP-BC, CPON, executive chief nursing officer for Cleveland Clinic. That includes getting input from every nursing council on “policy changes, practice changes, even the conversations around virtual nursing.”
Just be sure to define a clear scope so nurses aren’t asked to solve problems outside their purview, Foxx advises.
“Keeping them within track of what they can focus on, what should be their priorities,” she says.
Cleveland Clinic also invites nurses to shape innovation through formal opportunities like its annual Shared Governance Day, which Foxx launched in 2006 to give team members the chance to present their research and ideas to colleagues. Many go on to present at national conferences, and some even see their work enshrined as best practice across the enterprise. This year, nurses submitted more than 100 poster presentations.
“That’s just a testament to their engagement around wanting to be involved and wanting to solve the problems,” Foxx says.
The health system also invests heavily in professional development for their nurse managers.
“They have one of the hardest, if not the hardest, jobs in health systems,” Foxx says. “And so how do we continue to support them, make those jobs meaningful, and also develop that level of leader and then encourage other folks to want to be those leaders?”
In part, it’s by enhancing nurse manager onboarding with residencies and fellowships that offer formal programs for learning, development, and progression, including a homespun portfolio process that allows nurse managers to showcase their work and impact.
Take a lifelong lens to recruiting
Designing the care team of tomorrow means filling holes both current and anticipated.
“Everyone is going to be competing for the same resources and staff so it will be important to capture the staff as early as possible and to provide them a look into what it can be like to work in an exceptional organization,” says Deana Sievert, DNP, MSN, RN, chief nursing officer at The Ohio State University Wexner Medical Center.
Organizations are struggling with turnover at the 1- to 3-year mark, Doucette says, and it's because they're not hiring the right people.
“We got used to doing Zoom interviews for 10 minutes during the pandemic,” he says. It's not the right format and not nearly enough time to get how someone might gel with the team or what they need to feel supported and included.
Instead, he recommends spending up to three hours on the interview process, and building in conversation with the hiring manager, a structured peer interview, and an immersive experience on the unit or team.
“All of those things drive high sense of belonging and put employees at a much higher engagement level and at lower risk of leaving the organization,” he says.
Jefferson has implemented some of these practices with creative flair. FitzPatrick's team partnered with the college of nursing to launch a capstone program that provides seniors a three-week immersive experience in a desired unit. It also allows nursing leaders to find and offer employment to promising new team members before they even graduate.
Cleveland Clinic starts cultivating their workforce young, offering high schoolers and even grade schoolers opportunities to explore nursing through activities like shadowing, school and career fair visits, and summer programming.
The Howley ASPIRE Nurse Scholars program is its crown jewel. About to enter its eighth year, the program provides local tenth graders a 12-week career intensive and ongoing support throughout their high school and college careers. Beyond drumming up early interest in what Foxx calls an “incredible career choice,” the program aims to increase diversity in the nursing profession and reduce health and opportunity disparities by accepting 50 students annually who are poised to be first-generation college students, have a financial need, and/or come from a community that nursing has historically marginalized.
It’s working. To date, Cleveland Clinic employs five ASPIRE graduates and has clinched funding to formalize its early grade recruitment efforts into the Center for Nurse Exploration in early 2024.
It’ll allow the system “to follow those students and possibly look at other ways to support them,” including through wraparound services and “rich data and analytics” to do more of what works, Foxx explains.
Nurse executives are just as interested in talent on the other side of the career spectrum.
“We have lost a segment of our healthcare workforce due to retirement,” FitzPatrick says. To help recoup some of that “experience and intellectual brain trust,” they've debuted the Jefferson Nurse Emeritus Program, which brings back retired nurses to provide mentoring, direct care, and patient support.
Keep patients at the heart
Patients also feature prominently in 2024 plans.
“Everyone expects high quality patient care,” Foxx says. “The patients and families expect that, and expect a holistic experience with that care.”
FitzPatrick shares this focus. In the year ahead she's continuing to prioritize health equity, including in the realms of screening and intervention.
“Be knowledgeable about the social determinants of health that are important to those you are serving and align strategies accordingly.”
Nursing teams can help drive success with large-scale initiatives.
“Position nurses to lead in population health work and service line work,” FitzPatrick says. “Their line of sight and connection to patients and families will enrich this work.”
Her team plans to engage both groups in the new year by introducing a care partner model that allows patients to identify the person who will support them in their hospital journey and make key decisions together to “authentically advance” care.
Other priorities include educating patients on evolving strains of COVID-19 and expanding access and efficiency through telehealth without sacrificing connection.
“Technology-enabled care will continue to be an important component of care delivery,” FitzPatrick says. “And we will need to assure we don't lose the humanity of the care experience with this.”
Delaney Rebernikis a contributing writer for HealthLeaders.
The future of care hinges on a healthy nursing team that's in it for the long haul.
Editor’s Note: This is part 1 of a two-part story. Read Part 2 here.
2024 will be restorative, if CNOs have their say.
Amid geopolitical conflict, financial headwinds, and ramped nursing shortages and unrest, there's a lot of healing that needs to happen. Starting with the healers.
“The current times have required a new level of operational rigor [and] a keen focus on the people providing the care and service,” says Kate FitzPatrick, DNP, RN, NEA-BC, FAAN, executive vice president and Connelly Foundation chief nurse executive officer at Jefferson Health, which has 17 hospitals throughout New Jersey and Pennsylvania.
To set the stage for success in 2024 and beyond, CNOs must build up their teams, both in number and resilience, nurse execs and experts tell HealthLeaders. That means making compensation compelling, fostering shared purpose, redesigning care models, and playing a very long game when it comes to recruiting.
And while buoying wellbeing for beleaguered teams may sometimes seem at odds with imperatives like driving quality care and efficiency, it's the right strategy, says Jeff Doucette, DNP, RN, NEA-BC, FACHE, FAAN, chief nursing officer at Press Ganey, which provides experience survey solutions and consulting services to healthcare organizations, including nursing leaders and teams.
“What our data clearly shows is that if you are not taking an employee-first approach right now, you will never be able to meet the … patient promises that organizations are making to their communities,” he says.
That’s especially true as trends like aging baby boomers, escalating mental and behavioral health conditions, and worsening physician shortages ratchet up the demand for—and pressure on—nurses.
But that doesn’t mean CNOs can’t start turning the tide.
Foxx attributes a lot of Cleveland Clinic’s turnover turnaround to its robust total rewards.
“We have a professional ladder,” she says. “We have tuition assistance. We have loan repayment. We have a tremendous amount of resources in our wellbeing space.”
Her team has also enhanced communication around these benefits, many of which are longstanding, so nurses know the possibilities from the beginning.
“When I get to say a few opening comments [at orientation] to all the nurses starting, I tell them every time, ‘You can spend your entire career here and work in different locations, different specialties, have different opportunities.’ ”
Radiate shared purpose
When it comes to building a strong, committed team, compensation must be competitive, Doucette says. But that's not enough.
In Press Ganey's latest research on workforce loyalty, one’s relationship to work—liking it, finding it meaningful, feeling it makes a difference—was the top reason healthcare employees said they would stay with an organization for three years, even if offered a job elsewhere.
Other drivers include strong managerial and team relationships, as well as the organization's care quality; ethics; and follow-through on diversity, equity, and inclusion commitments for patients and employees.
It's “interesting given the national political climate around these types of conversations,” Doucette says. “But it is definitely at the top of mind for healthcare employees, and especially clinicians across all job categories.”
Resilience is a key to satisfaction across domains, he says.
“People talk about resilience all the time, but many leaders don't fully understand what it is,” he says.
To build it, CNOs should focus on the two major aspects that are measurable:
Activation: “How connected to the work we are, how we feel about the work, as well as our connection to the organization's mission, vision, and values,” Doucette explains.
Decompression: “How we get away from the work and recharge our batteries,” he adds. It's a big issue right now at all levels of the organization and especially for clinicians.
“How do we take what was already a fragile professional practice environment prior to the pandemic—and of course, these cracks turned into canyons during the pandemic—and how do we repair and rebuild an engaged and highly resilient workforce?” Doucette asks.
Listening can help.
“We've got to stay connected, especially to folks on the sharp edge of care,” he says.
Healthcare organizations that boast the highest employee engagement scores in Press Ganey's database have robust continuous listening strategies, meaning they check in with their teams in a variety of ways throughout the year (e.g., through surveys, stay interviews, and coffee chats with CNOs and other executives), he explains.
And all that listening should lead to talking.
FitzPatrick and Sievert find the people in their purview—from nursing teams and leaders to the C-suite—expect more transparency and communication on the macro conditions affecting healthcare.
“We have seen these national trends really take on a life of their own through social media and other media outlets,” Sievert says. “Part of my role as a CNO is to keep our team aware of the changes, the implications, and the risks [and] benefits.”
Doucette agrees. To keep everyone focused on the big picture, even amid the “everyday fires” that are bound to flare, he says, CNOs need a “well thought-through strategy that is well-communicated to all levels of that organization and creating that alignment and accountability.”
Design the future of care
Creating a professional practice environment that reinforces purpose and loyalty—what Doucette calls “the new PPE”—is a must to fortify nursing ranks.
Projected shortages in key clinical roles over the next decade are “forcing needed innovation in the care delivery models,” FitzPatrick says. “We will have to move fast and agile and the new models will have to demonstrate a more financially sustainable model with the same or better quality outcomes.”
It's quite an undertaking, especially in acute care.
“The biggest challenges that I believe we are facing are around making this 24/7/365 environment appealing to the younger generations,” Sievert says.
In the past, new graduates coveted bedside positions. Today, they're calling for balance and more predictability.
“That simply isn't the hospital setting where holidays and weekends are required, night shifts are necessary, and often many positions require on call beyond the normal work week,” Sievert explains. The challenge is to “create flexibility for the staff but ensure adequate, safe staffing for the patients,” all while keeping costs low.
One solution that all the nurse executives highlighted to HealthLeaders: Virtual experiences on the floor and behind the scenes. FitzPatrick now uses virtual nursing to offload administrative tasks so bedside nurses can focus on top-of-license practice, while Sievert says that ambient listening can cut down on clinical documentation.
Another common refrain: Be brave, bold, and agile.
“Get comfortable with taking some risk,” Sievert says. “In this market and time we are in, the first one out of the gate will be ahead.”
That means ditching perfectionism.
“Don't be afraid … if it doesn't work out exactly as you planned it the first time,” Foxx says. “We spend a lot of time discussing the what-ifs.” As long as patients aren’t put in harm’s way, “just go for it and fix things along the way.”
Foxx adopted this mindset when launching a virtual patient companion program earlier this year. The initiative allows unlicensed nursing assistants to monitor patients from afar—specifically, from existing onsite bunkers to preempt additional real estate costs—so bedside caregivers can focus on providing hands-on service.
“I'm giving you permission to be agile,” she says of her teams’ approach to implementation. And they’re being just that, with work underway to roll the program out to all system hospitals to reduce overall sitter hours and expenses. “We've had a lot of success with that this year. And so we definitely want to scale and push it out further.”
Delaney Rebernik is a contributing writer for HealthLeaders.
When setting strategy, put people at the heart and tech on the table.
With 2024 in sight, healthcare CHROs are charting their strategic courses amid some fierce headwinds.
“Our context has changed,” says Vishal Bhalla, MBA, MS, CPXP, SPHR, senior vice president and enterprise chief experience officer at Advocate Health. “Each of us is a little more unsettled than we were before … with all the catalysts that are impacting our lives.”
Those catalysts range from geopolitical conflict and economic downturn to skill shortages, nonstop disruption, and the pendulumlike swing of power when it comes to talent acquisition and retention.
To keep up with the pace of change, CHROs must (re)design bold, human-centric experiences for the workforces of today and tomorrow, experts say. It’s a tall order, and one that means getting smart with technology and analytics to enable, scale, and measure impact.
What’s at the fore for 2024?
These stakes are high for anyone, let alone the leaders who decide how to care for an organization full of caregivers, many of whom are exhausted.
“Burnout is a very real issue,” says Paul Bohne, a Boston-based managing partner in executive search and advisory firm WittKieffer’s healthcare and nonprofit and social impact divisions. That goes for clinicians, yes, and also leaders, says Bohne, who’s recruited more than a hundred of them to C-suites.
To buoy their teams, patients, and broader communities, CEOs are looking for HR chiefs with airtight core skills: integrity, communication, and emotional intelligence, Bohne says. But those foundations alone won’t cut it.
After surveying more than 500 HR leaders (a third of whom are CHROs) across 40 countries and all major sectors, Gartner, a global technology research and consulting firm, identified these as the top HR areas for 2024:
1. Leader and manager effectiveness
2. Organizational culture
3. HR technology
4. Change management
5. Career management and internal mobility
Making headway on such rangy domains is no small feat when up against what Bohne calls “the tyranny of now,” but a dogged focus on talent—and a full toolbox—will set CHROs up for success in 2024 and beyond, experts say.
Get smart with technology and analytics
Tech is a potential enabler across focus areas—and it’s a moving target. Gartner’s research shows 60% of HR leaders are uncertain about the impact of evolving trends, such as generative AI, on their priorities, while 56% say their solutions and strategy don’t match up with current and future business needs.
Despite the ambiguity, healthcare CHROs should see where they can use tools to get efficient and drive innovation, Bohne says. “Organizations are really seeking leaders who are facile and proficient with how to work smarter leveraging analytics and technology.”
At Advocate Health, Bhalla’s team uses both to shape and scale the experiences of employees alongside those of patients and others who touch the organization. This holistic approach cultivates a strong, integrated “human experience” across the enterprise, Bhalla explains.
The goal is to inspire all community members to “put their social capital on the table to recommend us as a place to get care, a place to work, a place to teach, a place to learn, or volunteer.” And that calls for insight that can be put to work.
“Use data and technology to go to the independent variable, which is actionable,” Bhalla says. “So people understand, ‘Yes, you want me to achieve the strategy. What do I need to do to deliver it? How is that measured, and can I impact it?’ ”
For a nurse leader, that might look like distilling data across the domains of team and patient experience, diversity, and safety into one or two high-impact actions that can be embedded in the flow of work “so it’s not one more thing to do, it’s how I act upon it,” Bhalla explains.
When choosing tech and data enablers, focus on which parts of the enterprise would benefit from timelier, deeper insight, Bohne advises. And lean into the values that draw so many service-oriented leaders to healthcare in the first place, Bhalla says. “Simplify and enable that sense of purpose.”
Redesign with humans in mind
Thoughtful use of tech and data can help CHROs bring about big transformation—a growing expectation as CEOs seek out HR leaders with “a sense of urgency around results,” Bohne says.
“Change leadership has just never been more important for a chief people officer,” he explains. “There's a lot more focus on HR leaders who can get stuff done, who can partner effectively with their CFO and operational and clinical colleagues to really help to not just improve current workforce strategies, but to redesign how organizations are approaching these issues.”
One approach he’s seen work well: “novel partnerships.” For example, one health system in the mid-Atlantic has teamed up with a concierge-style company to offer counseling and other services to employees who are caring for aging parents. It’s a “really creative way” to support well-being beyond a traditional EAP, Bohne says.
Continuous listening is another way to create positive people change, Bhalla says. “We have built systems and processes whereby our teammates can, in a psychologically safe manner, provide feedback about their leader and about the organization. And we close that loop all the time. ‘You said, we did.’ That's the key.”
Throughout 2021 and 2022, Advocate Health, like many healthcare organizations, was struggling with pandemic-fueled nursing turnover in parts of the enterprise. When temporary staffing and increased pay and incentives didn’t do enough to move the numbers, Bhalla’s HR and experience teams dug deeper. “We spoke to a lot of nurses—hands on. We spent a lot of time on the floor.”
What they found? Shortages in other departments—like environmental services—left nurses filling the gaps and operating below the top of their licenses. “I am doing all that, and I'm getting burnt out, and so I'm leaving,” Bhalla explains.
So his team increased focus on recruiting for those roles, putting themselves in the applicants’ shoes to pinpoint where they could outperform top competitors—in this case, major retail and fast food chains—in the acquisition process: “What’s most important to me is, [time] from the day I did my application to my first paycheck,” Bhalla says.
It’s something his team didn’t measure at the time, so they got to work reenvisioning the closest metric they had: time to fill. “We broke that down and looked at: from time of application, to time of interview, to time of hire,” Bhalla explains. “That’s what’s in our control.”
Then, in a joint effort between leaders and team members, they deconstructed the recruiting process “to identify what's essential—what can be done by a human, what can be done by machine, and what can be done after.” Then, they rebuilt.
In the end, Advocate Health crushed their reimagined metrics for their environmental services staff: Time of application to time of offer went from nine days to half a day, and time to start dropped from 15 days to three. Position vacancies dipped to less than 5%, and nursing satisfaction improved.
The takeaway? Think about how to redesign traditional systems and processes to measure what matters to people, not departments. “Are your metrics at a human-centric level?” Bhalla asks. “What you can measure, you will incentivize. What you incentivize, you will most likely achieve.”
Empower the talent of tomorrow
To keep top HR talent in today’s “soft market,” where early and mid-career professionals “have options,” CHROs should map and develop their teams, Bohne says. “There hasn't been a time I can recall where there’s more of an imperative.”
This can look like finding new talent in creative places—such as veterans’ organizations—and helping current leaders accelerate their progression through stretch opportunities, learning focused on the long term, and “robust, rigorous succession plans.”
“The talent of the future is not necessarily entirely human,” Bhalla says. Solutions like chatbots can not only enable talent strategy but also extend the team. “Are we including our HR in how that bot is built? Are they reflecting our culture, our values? Or are they reflecting the third-party vendor’s cultures and values?”
To ensure it’s the former, take care when designing, implementing, and training people on emerging tech. “It is so important that we’re inclusive from a DEI perspective, from a socioeconomic, from a thought-process perspective, of building those models so that they have less bias,” Bhalla explains. Once the models are built with the help of subject matter experts, democratize their use with clear guidelines and training approaches.
“How we define talent is very, very important,” Bhalla says. So is “making sure that we have a voice and are part of the group influencing the group that builds the talent of the future.”
Delaney Rebernik is a contributing writer for HealthLeaders.
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