Turnover has become alarmingly high in the healthcare industry, posing a serious threat to each facility’s ability to deliver patient care. This surge in turnover is also causing a major spike in spending by inflating the cost of staying fully staffed. Amid these challenges, leaders are discovering that the question of how to increase employee retention in healthcare depends largely upon their strategy and style of leadership.
“A high employee turnover rate can be equated with the style of leadership implemented in an organization,” write the authors of a 2022 study published in Frontiers in Psychology. And an analysis of leadership styles from Advent Health University argues that leadership is key to “shaping the culture of a healthcare organization and ensuring its ability to tackle complex issues related to healthcare delivery.”
At a time when labor is scarcer and costlier than ever, ensuring optimal staffing for a facility can be considered chief among those complex issues. With that in mind, here’s a closer look at the role healthcare leadership strategies play when tackling how to increase employee retention in healthcare, and the leadership styles that may be best suited to the job.
The Challenge Facing Healthcare Employers
“Significant labor costs and the ongoing clinical labor shortage are the main contributors to the projected $370 billion increase in healthcare expenditures by 2027,” notes Victoria Bailey in a report on healthcare spending at RevCycleIntelligence. Citing a 2022 McKinsey report, she adds that the industry is looking at a shortage of “200,000 to 450,000 registered nurses” by 2025.
“In addition, clinical labor costs are expected to grow by 6 to 10 percent over the next two years, which is 3 to 7 percentage points higher than the prevailing inflation rate,” she adds. “Workforce shortages will likely get worse due to increasing demand and decreasing supply … The annual demand for registered nurses may increase by 7 to 10 percent between 2021 and 2025.”
Even in instances where nurses and clinical workers can be readily replaced, it’s usually expensive to do so. Calculating the cost of “lost revenue caused by clinician vacancies and the expense of recruiting new personnel,” the authors of a 2019 cohort study on clinical burnout and turnover published in the Annals of Family Medicine estimated the specific cost of turnover “at upward of $500,000 per clinician.”
Research shows that burnout, exhaustion and compassion fatigue are key drivers for this employee turnover, especially since Covid-19 struck. This isn’t new. Among nurses and other clinical workers, burnout has been an area of intense concern for decades. But it’s only gotten worse since the spring of 2020, as a record number of workers have retired early or just left the profession altogether.
> In Case You Missed It: 7 Tips to Help Prevent Nurse Burnout & Compassion Fatigue from CareerStaff
While there may be no silver-bullet solution to the challenge of burnout and exhaustion, there are ways to alleviate it. This is where a healthcare leader’s specific style can have a tremendous impact — by tackling not only the immediate problem of how to increase employee retention in healthcare, but also addressing the deeper structural and cultural issues driving burnout in the first place.
How to Increase Employee Retention in Healthcare by Updating Your Leadership Style
“Although reducing clinician burnout may help to decrease rates of turnover, health care organizations and policymakers concerned about employee turnover in primary care need to understand the multifactorial causes of turnover to develop effective retention strategies for clinicians and staff,” the Annals of Family Medicine study authors point out.
These causes are often well understood, with some basic principles to follow to help offset them. Working to build a positive, non-toxic culture. Emphasizing safety and support for staff. Ensuring plenty of personal leave time. Offering availability of mental health interventions like counseling for any worker who should request it, as well as the time to do so. Allocated space for self-care sessions.
These are all important action items, but they should be done in the context of a larger plan. There are a number of specific leadership models for doing so. The most predominant include transactional/reward leadership, democratic leadership, innovative leadership, situational leadership and transformational leadership. Let’s take a closer look at each.
#1: Transactional Leadership
Transactional leadership encourages workers to meet specific goals by offering them special distinctions or awards for doing so. Emphasizing respect for rules and procedures, clearly defined tasks and close supervision, this leadership model is designed to monitor performance and motivate workers to achieve continuous improvement. It usually includes penalties for underperformance, as well.
Also known as reward leadership, transactional leadership may not “encourage creativity or inspire problem-solving,” the AHU notes, but can “prove very beneficial when addressing straightforward problems. In situations that require focus on achieving specific tasks, as may be the case in crises, a transactional leadership approach can effectively get things done and keep everything afloat.”
#2: Democratic Leadership
Democratic leadership is a model that emphasizes team-oriented decision making. This gives staff members more input over what’s actually being done on a day-to-day basis, as well as during a given crisis or other situation. As with any democracy, it also requires keeping staff fully informed and engaged. This model may also include mentoring programs, which can further promote job satisfaction.
#3: Innovative Leadership
As the AHU authors define it, innovative leadership “focuses on how to succeed in unpredictable circumstances and how to foster an environment conducive to innovation in a healthcare organization.” That means creating a culture where people are expected to use innovative thinking to face challenges — and are supported when they do so.
“Because this style of leadership invites staff members to explore their own ideas, people tend to feel more intrinsically motivated under innovative leaders. Intrinsic motivation often produces people’s best work,” the AHU notes. “It can also result in high job satisfaction and reduced turnover.”
#4: Situational Leadership
The situational leadership model involves embracing the idea that different situations call for different approaches. In this system, leaders examine each task that comes before them and come up with the leadership style that best tackles each. Sometimes, the solution may lie in delegating; other times, a hands-on, direct approach may be more appropriate.
#5: Transformational Leadership
Transformational leadership is by far the most often cited style and strategy when discussing how to increase employee retention in healthcare. Combining the concepts of inspirational motivation, idealized influence, and individualized consideration, this system emphasizes unselfishness. The idea is to transform and channel the leader’s natural influence in a way that nurtures trust and respect.
Under this model, leaders “care about their subordinates’ personal development and help their subordinates by having an open communication style and offering support,” write the Frontiers in Psychology authors. Workers are motivated to feel “optimistic about the future, their work, and work progress rather than pessimistic which can lead to feelings of demotivation.”
“Transformational leaders motivate and inspire staff members to work toward the betterment of a healthcare organization,” the AHU authors note. “While transformational leaders care about achieving goals, they also focus on the individuals they lead — committed to their growth, development, and success as well.”
When it comes to figuring out how to increase employee retention in healthcare, the transformational model seems to best fit the bill with its emphasis on culture and the wellbeing of workers. The Frontiers in Psychology study authors come to a similar conclusion, writing that, “transformational and democratic leadership should be implemented … to have the most effective working relationships.”
Of course, each leader should use the style that works best for them, weighing each against the specific needs of the facilities under their watch. As with any aspect of leadership, that means making the best choices with the resources available. Even so, an informed rethinking of healthcare leadership strategies could help put some important goals within reach — like how to increase employee retention in healthcare, for starters.
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