Rewiring culture in care delivery organizations to reflect the needs and aspirations of the current healthcare workforce
Organizations can move at two speeds to address cultural priorities. First, they can mobilize quickly to execute a set of no-regrets moves. Second, and in tandem, they can embark on a slower-paced, more holistic and sustainable culture transformation journey. Although organizations in the care delivery sector have their own culture priorities, our findings suggest that there are several common pain points in management practices.
Establishing sustainable working models with results that are clearly visible to improve the work environment.
The COVID-19 pandemic called for unprecedented working norms and performance metrics, and we continue to see that employee mental health and well-being has suffered in the healthcare sector. A 2023 McKinsey and American Nurses Foundation survey of more than 7,000 nurses found that 56 percent reported experiencing symptoms of burnout, such as emotional exhaustion.13 Organizations in the care delivery sector have an opportunity to renormalize ways of working, including by making performance results visible to enable labor productivity. This transparency, coupled with establishing sustainable working models, can help address the worsening burnout of clinical staff that also puts patient care at risk.14
Many organizations in the care delivery sector are instituting new, flexible operating models to improve productivity and employee satisfaction. For example, Trinity Health recently announced plans to expand the staff of virtual nurses; care teams comprise a direct-care RN, an on-site nursing assistant or licensed practical nurse, and a virtual RN.15
An academic medical center introduced dynamic staffing in which small teams of four to six colleagues (pods) coordinate their schedules internally to meet the required staffing levels for each shift. This model emphasizes flexibility and individual preferences within the pod. Moving away from the rigid 12-hour-shift paradigm ensures adequate coverage while empowering staff to have more control over their work-life balance.
Taking a consumer-centric approach to improve external orientation.
Leaders of care delivery organizations are facing the need to mirror the increasingly personalized experiences consumers have with sectors such as retail and banking to build enduring relationships with their patients. In contrast, patients express frustration with the healthcare system. According to the 2022 McKinsey Consumer Health Insights Survey, 21 percent reported that their clinicians do not listen to them or understand their needs, 22 percent reported feeling treated with less respect than other patients, and 28 percent reported that clinicians have made assumptions about them that have influenced the way they were treated.16
Organizations in the care delivery sector could take steps to improve their external orientation by focusing on the management practices that drive this outcome. For example, customer orientation includes prioritizing patient needs and satisfaction, gathering feedback with clearly defined metrics, and using it to improve services offered (for example, with personalized communications).17 One regional care delivery organization launched a consumer-centric transformation that included embedding new ways of working focused on customer experience and understanding care journeys at moments that matter to patients (such as when scheduling appointments online). As a result, the organization was able to increase performance metrics, including a 20-point increase in customer satisfaction.
Given the rapid changes in healthcare, organizations in the care delivery sector could also prioritize continually monitoring industry trends and making decisions accordingly. Competitive insights are one of four foundational behaviors—along with role clarity, strategic clarity, and personal ownership—that have an outsize impact on organizational health.18 Adopting any of these practices that are not already in place is a no-regrets move to improve organizational health.
Boosting motivation through opportunities for recognition and advancement.
Broken motivation practices could compromise patient outcomes and exacerbate widening talent gaps. For example, the Association of American Medical Colleges (AAMC) estimates a shortage of up to 86,000 physicians by 2036.19 In the face of chronic labor shortages and worsening burnout—especially among physicians and nurses—organizations in the care delivery sector are challenged to improve their employee value propositions, including career opportunities, rewards, and recognition.
Many companies are partnering with higher education institutions and certificate programs to offer career opportunities to frontline clinicians.20 For example, a regional health system launched a self-service tool for employees to find internal career advancement opportunities, leading to a threefold increase in open roles being filled with internal talent. In addition, rewards and recognition, supported by a formal structure, are critical to drive motivation. Bon Secours Mercy Health leverages an annual recognition initiative to meaningfully recognize nurses and staff in real time, and it saw a 10 percent retention increase with this program in place.21
Getting started on a holistic and sustainable cultural transformation
Our research and experience points to a structured approach for making culture change stick.22
Aspire and assess.
Leaders can choose from various methods to assess employee sentiment and gather their feedback. They could deploy survey tools to diagnose organizational health, conduct focus groups and interviews, or use people analytics to assess the strength of informal employee networks. These efforts could identify which critical practices to prioritize—such as career opportunities or customer orientation—and the strengths worth preserving.
Once the diagnostic is complete and a deep understanding of the organization’s culture has been established, it is crucial to align on specific objectives, including the behavioral shifts needed to accomplish the aspiration, and to develop a consistent plan for achieving them. For example, to accomplish a goal such as all employees prioritizing creating the best experience for patients, priority practices might include ensuring customer orientation across the organization and encouraging a focus on harnessing competitive insights.
Architect.
When designing performance improvement initiatives, it is paramount to actively involve the workforce in shaping the future culture. Creating customized culture transformation journeys, complete with skills development and a targeted communications strategy, can effectively cater to groups across the organization such as nurses, physicians, and administrative personnel, thus fostering greater support and momentum for organizational initiatives. As part of this effort, organizations could also take steps to improve individual accountability for results by clarifying roles, responsibilities, and performance management guidelines.
Act and advance.
Prioritize, sequence, and deliver interventions in waves to institute the behavior shifts needed to achieve the aspiration. Check on progress against initiatives and health goals regularly. Keep a pulse on employees through continuous listening efforts to allow for rapid adjustment and refinement of efforts as needed, and proactively communicate updates along the journey.
Essential actions for transforming institutional norms include effectively engaging clinical and nonclinical staff throughout the organization to test and innovate, increase buy-in, and tailor cultural practices to stakeholder groups, as well as empowering leaders to model and prioritize proven cultural practices.
By deepening their understanding of current organizational dynamics, acknowledging what needs to change, and having the courage to transcend norms, organizations in the care delivery sector can elevate their own performance and contribute to a more stable and effective healthcare system overall.