March 22, 2021
The COVID-19 pandemic has eroded trust between clinicians and their employers while accelerating pre-pandemic challenges of burnout and staff shortages, among others. Healthcare workers were hailed as heroes early in the pandemic, but the celebrations have since died down. Clinicians are exhausted. Morale is declining. Distrust in leadership may be a bigger concern than ever.
HRI spoke with PwC principal Igor Belokrinitsky, managing director Reid Carpenter and director Inshita Wij about how to move through the COVID-19 pandemic to restore trust and rebuild an even more robust, inspired and inclusive front-line workforce for the long term.
How would you describe the current state of the healthcare workforce?
While the critical work of saving lives continues, the hero celebration seen early in the pandemic definitely has waned. Higher levels of stress and burnout, with the accompanying erosion of trust between clinicians and employers, were created in part by the inability to ensure employee safety via adequate personal protective equipment (PPE) and testing.
In the recent COVID wave, even with vaccinations, everyone realized that the pandemic is going to take a while to subside. All these factors have a cumulative effect. In some cases, this could mean people leaving the profession, saying I just can’t do this anymore.
We have to realize when we see hospitalization numbers and death tolls rise that the people who are watching patients die are healthcare workers. While healthcare workers aren’t strangers to death in normal times, the numbers they’re witnessing now are very high over an incredibly short time. Some of them are experiencing real trauma.
And it goes without saying that among the caregiver population, women and minorities get the worst of it because of the extra labor they have to perform at home and the bias they’re experiencing, for example, against caregivers who may look Chinese, with China being the origin of COVID-19. Unfortunately, hospital walls do not keep out racial, gender, economic and other disparities that plague our society and add complexity to already complex issues.
HRI: What have healthcare organizations done during the pandemic to show commitment to the workforce and help employees through it?
Inshita Wij: What I’m seeing are commitments to fair compensation, safety and well-being. One health system raised the base pay for employees across the board to $15 an hour. Others are making behavioral health much more accessible to employees, including one organization that developed an app that employees can use to easily receive virtual behavioral health consults.
Some leaders are on the front lines with staff, not working from home. Other leaders have been asked to work from home, making it even harder for them to collaborate with clinicians. In both cases, many leaders are celebrating wins—like the number of patients who’ve left the ICU and the number of patients who’ve recovered.
Reid Carpenter: Yes, good point. Those celebrations are so important and mean so much—to patients and workers alike. It is a much-needed acknowledgment and release of the emotion.
Igor Belokrinitsky: Some clients who’ve been building social determinants of health programs—like nutrition, housing and social services—for underserved populations are redirecting those to their workforce. For example, a hospital providing meals for employees.
Also, as administrators cut costs in response to declining revenue brought by the pandemic, they’re using more humane measures—voluntary early retirements, delayed bonuses or raises, furloughs—instead of moving directly to reduce headcount.
HRI: Have you seen anything other industries are doing that healthcare could use to help rebuild trust?
Reid Carpenter: In a recent survey of chief human resource officers (CHROs) across industries, CHROs told PwC that employees feel that employers aren’t doing enough for them, particularly around well-being. So these other industries are looking to ramp up a number of well-being efforts, including mental health benefits, hazard pay, childcare, private transportation, even upskilling.
It’s also illuminating to see the fairly stark differences between what CHROs think is needed versus what CFOs think. We have a bit of a disconnect in the healthcare industry where cost really matters. Trying to find that balance is going to be tough.
Igor Belokrinitsky: An example of CHROs and CFOs actually having incentives that align is in grocers and delivery services, which are paying their employees to get vaccinated. That’s just beautiful.
HRI: If you were a health systems leader, what would you do to rebuild employee trust?
Inshita Wij: Consider Maslow’s “hierarchy of needs” to understand employees’ needs. You start with serving the basic needs of safety and well-being, then move to the psychological aspects of belongingness and having pride in the work. Then you earn the right to improve trust. But you can’t go directly to trust.
For example, maybe you start with making sure that employees feel safe by providing PPE and a safe environment—perhaps have a rotational program where people cannot work 12-hour shifts in the ICU on consecutive days. Then you can move to belongingness and pride by communicating how important their work is to patients and society, reinforcing the “why” of their work—the core beliefs behind choosing this career. Emphasizing team cohesion could be another part of this. Once you’ve firmly established those tenets, you can move on to trust.
Reid Carpenter: It’s all about our emotional commitment to the purpose and to one another—how you feel about walking in every day. The patients receive healthcare workers’ emotional commitment, but if a healthcare worker is not feeling connected to that organization, their peers and co-workers, you’re not going to be able to stop that worker from going somewhere else. Sometimes it comes down to really little things, like caring acts by leaders who are willing to be authentic and vulnerable. Those can go a long way.
I also was thinking about how healthcare, particularly in a hospital setting, is such an interesting microcosm of our entire society, with broad socioeconomic, ethnic, race and other diversities all thrown together. So the dynamics of leadership and respect make building trust tricky in healthcare. Look at what we’ve seen at other companies: leadership taking huge pay cuts and imposing other measures instead of filing for Chapter 11 protection or firing a bunch of people. But in a hospital setting, who takes the pay cuts? The executive team? The physicians? Orchestrating that give and get is more complicated for providers.
Igor Belokrinitsky: Four things that I think are really relevant about trust: First, if you can’t measure it, you can’t manage it. You need to track trust and engagement levels in the organization closely and frequently.
Second, building on what Inshita said, you need to introduce this point about pride. You need to remind people of the shared purpose and why we are here, and focus on the patients and community—remind people that we’re continuing to honor our commitment to the patients, to the community and to each other. Building that esprit de corps around that shared purpose. “We’re proud to work here.”
Third is the notion “nothing about me without me.” How do you increase staff representation when you make decisions that impact them? It doesn’t have to become a democracy, but you could have more ombudspeople. Many health organizations with unions already have that representation. What are ways to have more representation?
Related to that is Reid’s earlier point about inclusion. If you have a hospital where the C-suite is all white males and all the nurses are Puerto Rican, how can you realistically expect to build trust if you’re that demographically different? So, for us to move forward, we need greater inclusion in the C-suite and on boards.
Fourth, keep celebrating desirable behaviors among staff. Whether it’s the janitor, medical assistant or parking attendant, advertise it and keep celebrating it. That way, you’re giving out carrots, not just sticks.
HRI: Looking beyond COVID-19, what are some of the challenges the healthcare workforce may face and how can health systems start preparing for the next challenge? Do they even have the capacity?
Igor Belokrinitsky: I’m not sure they have a choice. The healthcare industry is changing inexorably because we as health consumers and as a society want it to change. Employers want their workforces to be healthy. The marketplace expects more equitable, higher value, higher quality, better health.
We have the preconditions to have better health, but we need to renew the vows. We need a new deal between leaders of health organizations and the workforce. Remember, that’s the product you’re selling: access to clinicians who provide great care. That new deal promises foundational safety, respect, trust, pride, career development and better tools to take on greater responsibility.
We’ve got robots coming to take the more menial tasks. We’ve got potentially greater separation between caregiver and patient as more and more care is delivered remotely, which makes it more important to continue emphasizing the pride. We have to upskill and prepare for the next stage while providing some of the basic safety measures.
More consolidation and merging will occur, and that always makes the workforce nervous. More pressure will be exerted to squeeze reimbursement. More technology. More interoperability. All of those things are in motion and can’t be stopped.
But it’s also more exciting because we’ll be able to do more for our patients, our communities and each other as caregivers, as long as we can provide safety and emphasize shared purpose—that we’re all in this together, that our destinies are linked.
Inshita Wij: Agreed. Health systems are thinking a lot about the consumer value proposition, but they need to take a step back and think about, after all of this, what is the employee value proposition and what have we learned from the pandemic? What are we going to take forward?
Health systems used to be the top employer in their communities. During the pandemic, they are one of the most dangerous places to work. How do they navigate that?
It comes down to a lot of the points Igor emphasized: prioritizing safety, focusing on well-being, investing in employee upskilling, being creative with talent sourcing—thinking about gig workers—and reinforcing the purpose and pride. All of this will help define and execute that value proposition.