Winning the War to Attract and Retain Healthcare Workers
We are in the midst of a global war for healthcare talent.
Due to the looming retirement of millions of baby boomers and the relatively small size of Generation X, organizations across all industries are focusing their attention on the upcoming generation—Generation Y—to fill their employment needs.
Nowhere is this more critical than in healthcare. Most of us are aware of the many personnel shortages facing the healthcare industry in the coming decade: nurses, physicians, pharmacists, allied health, and more. At the same time, the demand for healthcare services is expected to explode due to the aging of these same baby boomers, an increase in chronic diseases, and the simple fact that people are living longer.
Patient-centered design has been at the forefront of healthcare design for years, and has proven to be an effective way to attract patients to a facility. Staff-centered design needs to be leveraged in the same way to attract and retain the best talent, specifically young talent. Other industries are learning how to use design to make their spaces attractive to Generation Y; the opportunity exists for healthcare to do the same.
With 75 million members, Gen Y is the largest generation since the baby boomers. The generally accepted birth dates for this group are from 1980 to 1999, though there are a few variations. Just as the work environment changed with the influx of boomers in the 1960s, so can we expect it to change when Gen Y dominates the workforce over the next 10 to 20 years.
In healthcare, one of the biggest complaints about Gen Y is its embrace of, almost an eagerness for, job-hopping. Healthcare is a profession where experience has traditionally been acquired over years of working in the same organization. Nursing is facing perhaps the biggest challenge in terms of retaining young employees. It’s estimated that more than 55% of RNs plan to retire between 2011 and 2020.1 A poll of healthcare recruiters in 2005 found that the average turnover rate for RNs was 13.9%, with the average cost to hire a new RN standing at $2,821,1 making retention a top goal for most organizations.
Physicians also are retiring in huge numbers; the oldest baby boomers began leaving the workplace in 2010. General practitioners and family doctors will account for 37% of those retiring in the next few years.2 In addition, more physicians, both older and younger, are choosing to work part-time, putting added pressure on hospitals and clinics. The high costs associated with owning a practice are causing medical students to avoid family practice in favor of specialties; already more than 56,000 Americans live in areas without the necessary number of primary care physicians.2
The gap creates opportunities for other roles, such as the nurse practitioner and physician assistant. The number of physician assistant jobs alone is expected to increase by 27% between 2006 and 2016.3 Nurse practitioners will be required to obtain a doctorate of nursing practice by 2015, which will allow them to take on many of the duties of primary care physicians. To cover the nursing gap, many hospitals are also recruiting foreign nurses, particularly those from Asia, thereby leading to shortages there.4
While these strategies will help meet the demand, healthcare is going to have to rely heavily on GenY to fill the remaining jobs. To date, this has been a challenge. Gen Y RNs don’t get hired easily because they don’t have the experience hospitals are looking for; according to a recruitment study by TMP Worldwide, hospitals look for experienced RNs because they don’t want to train new graduates. If young nurses do get hired, they often discover the work isn’t what they expected, causing many to quit their job before the end of their first year.5
What causes these young clinicians to become so disaffected? Young nurses resign most often due to dissatisfaction with scheduling, work relationships, personal recognition, and growth opportunities. Young physicians’ main reason for leaving isn’t compensation, but practice issues, such as work pressure and inability to maintain a desired quality of life due to long hours. Unlike their predecessors, Gen Yers aren’t prepared to give up their personal lives for work.6
It seems to be a simple clash of cultures; Gen Y is unprepared for the realities of hospital culture, and hospital administrators are unprepared for the new ways of working that Gen Y is looking for. Steelcase researchers have spent months seeking to understand this complex generation, in the United States and in Asia, and have come to the conclusion that the typical hospital environment is diametrically opposed to the needs of Gen Y. While the solution may appear to be about culture change, designers have a key role to play in helping organizations make that change.
Who are these people?
To understand how to design for Gen Y, we need to know more about them. The key to this (or any) generation’s character lies not in its birth dates, but in the shared memories of events that happened during their teens and early 20s. For this reason, the older segment of any generation will generally have a different character than the younger segment, and that will likely be true of Gen Y.
It is the first demographic to be connected on a truly global scale; their awareness of global economies, global technologies, and global relationships is far superior to that of previous generations at the same age. While previous generations were shaped by U.S.-centric events, such as Watergate, the Vietnam War, and the civil rights movement, Gen Y was impacted by global phenomena such as the war on Al Qaeda, global warming, and Facebook.
Their inclusive view of the world overlooks boundaries that older generations take for granted. Likewise, they view diversity as normal, and will be turned off by a workplace that is too homogenous.
With these and other characteristics in mind, our research uncovered several key aspects of Gen Y that are important for employers to remember. We can think of them as shifts in behavior from the previous generations to this one.
From conformity to identity. Identity is about understanding who you are and what you desire, from yourself and your employer. Unlike previous generations, Gen Yers don’t identify themselves by the title on their business cards or the name of the organization they work for. Instead, they identify themselves by the experiences they’ve acquired, by their personal interests, and their lifestyles.
For this reason, climbing the organizational ladder isn’t as interesting as building a career lattice. What may appear to be job-hopping is often a search for new experiences that combine to give them a perspective that someone who has always worked for the same health provider may not have.
From training to growth. Growth is everything to this generation, and learning is the path to growth. Gen Y isn’t interested in traditional classroom-style learning, however. They want to learn by doing, with strong mentorship and constant feedback on their pr
ogress. Transparency is a big factor here, as it allows them to see where their work fits into the overall vision and strategy of their employer.
From work to work-life. This group watched its parents give heart and soul to their jobs, only to be laid off during recessions; the lesson learned was that work isn’t everything. This doesn’t mean they’re lazy; they simply expect to be able to give as much attention to their personal lives as to their jobs. They expect to work long hours, so they expect their work environments to accommodate their personal needs. They will look for employers that offer benefits such as on-site gym facilities, alternate work settings, child care, and flexible work schedules.
From collaboration to connections. Gen Y grew up learning to work in teams; they know work often gets done faster and the outcomes are better if it’s performed collaboratively. Unlike previous generations, asking for help from colleagues isn’t considered a weakness, but a means of delivering a stronger result more efficiently. Simple face-to-face collaboration is old news for this generation; they regularly reach out to online connections as resources for bringing new ideas to a project.
For this reason, an employer that blocks Facebook access is essentially cutting off their young employees’ right arms. Gen Yers view their networks as a valuable asset they bring to an employer. In addition, their capacity for quickly building trust online facilitates their ability to work with remote teams.
From technology as a tool to technology as an extension of me. While many Gen Xers and boomers are tech-adaptive, they all remember life without computers, cell phones, and the Internet. Gen Y has no memory of anything else; they grew up learning on technology. Technology is like oxygen; while many Xers and boomers dream of the vacation when they can turn off their cell phones, Yers can’t imagine being disconnected.
This immersion in technology also has contributed to their comfort with multitasking, which can be both an asset and a challenge in the workplace. It also allows Gen Y to embrace the possibility of working anywhere. With “work” no longer being tied to “place,” Gen Y is proving that how they work and what they accomplish is more significant than where they work.
Four design guidelines for Gen Y
So what does this all mean for hospitals and other healthcare organizations seeking to hire and retain Generation Y? In many ways, healthcare is tailor-made for Gen Y. Team-based care is the norm in hospitals, as is mentoring. Both feed nicely into Gen Y’s need for feedback and collective effort. Relationship-based care takes that a step further by supporting the individual’s need to take care of her or himself. Telemedicine and the transition to EHRs offer a unique opportunity for a generation that grew up on technology. All of this can be summarized in four design guidelines:
Design for identity. While the trend toward Lean principles has improved efficiency in healthcare settings, an unintended consequence has been the elimination of personal expression. Whether it’s depersonalized lockers or standardized scrubs, it sends the message that individual identities aren’t important. Healthcare designers need to offer places where Gen Y can express personal identities in a way that doesn’t interfere with brand or communication strategies.
Inviting Gen Yers to join teams to work with others outside their normal work groups will keep them engaged, while offering rewards and recognition on a regular basis, such as a public display of the “RN of the Week” or “Resident of the Week” will give them the personal recognition they value. In addition, Gen Y’s desire for employers who are socially conscious provides an opportunity for sustainable design and community-centered relationships.
Design for growth. In order for Gen Yers to understand the impact of their work, an employer needs to make clear how their role fits into the overall goals of the hospital, as well as what other roles they might grow into. Impact often means leadership, and while Gen Yers don’t expect to be hired in as a CNO, they do expect to be offered opportunities to lead teams or projects.
With their tech-savviness, they are ideal candidates to join any hospital’s EHR implementation team. While they may not know exactly what to do, providing appropriate mentoring will allow them to succeed.
Designers and architects can leverage Gen Yers’ tech skills, as well as their desire for fun, by inviting them to participate in the development and testing of new spaces via charettes or even test prototypes in Second Life, allowing for inexpensive piloting while also giving young employees a chance to contribute to a hospital’s growth.
Design for work-life. With the understanding that happy staff equals happy patients, it’s important to offer flexible scheduling options to enable Gen Y to maintain a positive personal lifestyle. In addition, clinical areas within a hospital need to be designed with areas for socialization included.
While no one mourns the loss of the noise associated with centralized nurses’ stations, the move to distributed workstations has meant a certain amount of isolation for clinicians. The campus approach to planning being adopted by many large hospitals can be a huge attractor for young nurses and physicians, with their offerings of classes, gym facilities, and cafes.
Design for connections. Formal mentorship programs that pair older clinicians with younger workers serve to foster cross-generational understanding and respect. Designing distributed nurses’ stations large enough to accommodate two people will help facilitate this mentoring. Offering technology that allows employees to connect with peers outside the hospital during break times enables Gen Y to maintain connections that are vital to their wellbeing. Leverage their ability to quickly develop trust online, as well as their comfort with video, when staffing telehealth programs.
Involve them in hospital projects to allow them to connect to others within the facility, as well as to help break down silos. Their innate understanding of technology will also
enable them to easily interface with EHRs as they evolve. Gen Y is mobile, connected, and eager. These emerging behaviors are here to stay, so any hospital that desires to attract and engage this generation must work to support these behaviors.
Through a combination of adaptive culture and thoughtful design, facilities that take steps to fully embrace Generation Y will not only meet the needs of their next generation of employees, but will effectively prepare themselves for the future. HCD
Melanie Redman and Caroline Kelly are Senior Design Researchers for Nurture by Steelcase and Steelcase, Inc. Redman can be reached at firstname.lastname@example.org, and Kelly can be reached at email@example.com.
1. American Association of Colleges of Nursing. (2011). Nursing shortage fact sheet. Retrieved 5/1/11 from www.aacn.nche.edu/Media/shortageresource.htm
2. AARP. (2008). Retrieved 6/7/11 from http://www.bulletin.aarp.org/yourhealth/caregiving/articles/where_have_all_the_doctors_gone_.html
3. Hess, C. (2010). Can physician assistants fill the MD shortage? The Business Journal online. Retrieved 2-8-11 from http://www.bizjournals.com/milwaukee/blog/health_care/2010/06/can_physician_assistants_ fill_the_md_shortage.html
4. Matsuno, A. (2009). Nurse migration: The Asian perspective. ILO/EU Asian Programme on the Governance of Labour Migration. Retrieved 6/8/11 from http://pstalker.com/ilo/resources/Technical Note - Nurse Migration by A Matsuno.doc
5. Sherman, G. (2009). Combining magnet status and the Gen Y RN. TMP Worldwide Advertising & Communications, LLC. Retrieved 11/2/10 from http://www.tmp.com/articles/article_00213.html
6. Harris, G. (2010). More doctors giving up private practices. The New York Times. Retrieved 6/7/11 from http://www.nytimes.com/2010/03/26/health/policy/26docs.html