January 10, 2024 | 11 minute

How Can Health Systems Enhance Nurse Safety, Reduce Burnout, and Boost Retention

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How can healthcare leadership continue to navigate the uncertainty of the frontline workforce in 2024? What is the best business case for solving the ongoing challenges of nurse duress and burnout? How can organizations quickly and effectively deploy digital transformation tactics and measure success?

To answer these questions and more,’s CEO Philipp Von Gilsa sat down with Dr. David J. Shulkin, Ninth Secretary of the U.S. Department of Veterans Affairs and new Healthcare Advisory Board Member at Read this recap of their in-depth conversation to gain high-level insights into the future of healthcare and new opportunities to leverage technology to improve staff experiences and increase the quality of care for patients.

Philipp Von Gilsa (PVG): Let’s dive right into it. What keeps you going, what’s been your journey?

Dr. David J. Shulkin: I think most people know me as the former secretary of the Department of Veteran Affairs. I served in both the Obama Administration and the Trump Administration. And still, to this day, I think I’m the last member of the President’s Cabinet to get a 100-0 confirmation vote in the Senate. That’s just to say, that I completely looked at this as public service, and not as being on anybody’s political team or having political loyalty. My loyalty is to help the veterans who sacrificed and served our country.

I define myself much more as a physician, than as a government leader. I’m an internist and that’s the way I look at things. I’m there to try to figure out how to help people who are suffering, or how to keep them healthy.

Before going into government, I was the CEO of several different health systems and I served as the Chief Medical Officer of many academic centers, so I have been very privileged just to be in a position where I’ve seen great healthcare delivered in teams always trying to get better.

PVG: What are the key themes and topics you discuss when you meet healthcare executives? What’s currently on the top of your mind and what are the themes that you’ve distilled down from there?

Dr. David J. Shulkin: I get to see healthcare from many different perspectives. Not only as a provider, but I’ve worked in payer environments and government environments. I worked in technology and across a whole variety of different aspects of the healthcare ecosystem including pharma.

Many people who work in healthcare systems see only a narrow view. Since I look at things horizontally across the ecosystem, I often make connections between the impact of regulations on business models, the impact of technology on healthcare environments, and how payers and providers can be better aligned.

PVG: Let’s move for a second to the people who are part of the providers and part of the health system. What are their concerns? What are the worries that they bring up to you in conversation?

Dr. David J. Shulkin: I think almost everybody uniquely worries about uncertainty. It’s hard enough to run a healthcare operation, but when it’s constantly changing and you don’t know what’s next on the landscape, I think that becomes a bigger challenge for leadership.

You have a changing regulatory environment, a changing economic environment, and a changing competitive environment. You may not even understand who your competitors are next year. And yet, you still have all these fixed costs and the responsibility to your employees and the people that you serve in your community, your patients. It’s a challenge to try to make decisions now when the future is increasingly uncertain.

PVG: I think where we sort of want to dive a little bit is uncertainty in the workforce and the changes that healthcare systems have gone through in the last five or 10 years. When you think about the people who are actually on the front lines providing care to patients, what are the workplace dynamics you see changing?

Dr. David J. Shulkin: I’m going to put the pandemic front and center at what has fundamentally changed with a large part of the workforce’s perspective on what their relationship is to the organization that employs them. Many workers have re-evaluated their careers and how hard they work and decided to go into retirement or semi-retirement. It’s more significant in the younger workforce who don’t want the same things that past generations have. Their relationship with their employer is more focused on meeting their needs than on meeting their employer’s needs.

This is not necessarily a value judgment on whether that’s good or bad, it just shows that more people want to work in a hybrid environment where they have flexibility, both geographically and with the hours that they work. That shift, along with the demographics of the country getting older and requiring more healthcare resources has translated into workforce shortage situations. Unless something gives, unless people create more attractive environments to work in, there’s just no way to increase the supply of the workforce in the way we’re projected to need.

What I think has not changed, Philipp, is what employees want. People want to believe in leadership, particularly people in healthcare. They want to understand what their organization stands for, what the values are, and the belief systems. They want predictability. They don’t want leadership saying one thing and then policies and actions demonstrating something different. They want active, vocal leaders who talk about the values they share. They want to feel financially secure and be part of a winning organization that’s going to be there for them in the future. They also want to have physical security in an environment where people are coming into buildings attacking healthcare workers and there’s employee-on-employee violence. Employees want to understand that their organization is trying to create an environment that uses and values their skills. I think everybody wants to feel that their organization is moving in the right direction.

PVG: This resonates with what I’m seeing and what we’re exposed to on a day-to-day basis working with health systems and trying to address some of these issues.

There are statistics that one in three nurses wants to quit the profession. I don’t know if that’s a number that’s always been around, or if that’s a reaction to some of these changes. The research says nurses feel undervalued and that’s more stressful to them than work. What’s your take?

Dr. David J. Shulkin: When you ask the general population of Americans how many are happy at work, 80% are not happy. I think we’re seeing healthcare catching up with the rest of the workforce. It’s become much harder to be a nurse, particularly in an acute care environment.

The fact that there’s understaffing puts an additional burden on those who do come to work every day. There’s more and more work being piled onto the people that are there. Also, the patients we’re seeing in the hospitals are sicker and demand more care.

I think the institutions that invested in education, in training, have support systems that offer gratitude, and address the non-salary needs of their workforce by supplying them with support programs and other ways to address the work-life issues they’re facing have done better at attracting and retaining staff. This is really where leadership matters. We’re seeing proactive organizations outperforming those who are just sitting there watching this happen.

PVG: You’ve mentioned some of the categories of what we can do to change this. If you were to become CEO of a health system today, what would you do? What are the things that you think should be implemented?

Dr. David J. Shulkin: I’ve been doing this long enough that I have a playbook. Mine goes back to seeing myself as a provider. In every organization I’ve worked in, I’ve first put on a white coat and gone in to take care of patients. I believe it helps me become a better leader to understand what my colleagues are going through, whether the systems are working or not, and how the patients are reacting to the systems.

Leaders need to get close to the place where care is delivered. To be seen as a colleague and not as the executive who stays up in the office. You have to understand the culture of the environment and to do that you have to listen and incorporate others’ thinking into your management plans, especially with the levels of stress people are feeling.

PVG: One in four nurses gets assaulted at work every year in the U.S. One of our product lines is a workplace violence prevention program that uses staff badges as safety devices. They have a duress button to alert security to the location of the sender to send help. From your perspective on implementing technology and innovation at scale, what are the recipes for success to drive innovations fast so the people who need them can benefit?

Dr. David J. Shulkin: People who go to work need to feel secure. People want to see that their leaders care about their employees and the patients that they serve. When a leader rolls out a system, the community that is impacted observes that. Is this a system that is focused primarily on financial improvements, on making my workplace better, on improving the quality of care, or on improving the patient experience? Every decision that a CEO makes is going to be evaluated in the context of one of those criteria. When a CEO makes a decision to put a system in place that ensures their employees feel safe, people notice. It makes a statement of how important the employees are.

In terms of how to roll systems out in a successful way, it’s about the clarity of the message, making sure there are people accountable to make sure the projects are implemented, having a timeline, and making sure the appropriate resources are allocated to ensure the timeline can be followed.

Also, you do need clinical buy-in where people are transparent and explain why they are doing something and that’s going to entail, whether that’s more work on the part of the clinicians, some time to get used to the new systems, or something seamlessly integrated into their workflow. It all starts with clarity about why you’re doing things, how it’s going to be accomplished, and clarity about how it’s going through feedback of whether we’re on target and what to do to get back on target if needed.

PVG: We have a lot of people listening that are responsible for coming up with these new initiatives and ideas and winning stakeholders over. How do I build a very compelling business case? What have other health systems done? What would be your advice?

Dr. David J. Shulkin: The projects that are done for financial return on investment are the easy ones to build a business case for because you can show calculations. It gets challenging in areas that improve the quality of care, safety, or patient experience, but I don’t think leaders should be putting financial return on investments on these. There are times that you do things because it is the right thing to do, and because you know they are the intangibles that make good organizations great organizations. And that always has a good return on your investment.

It’s clear to me that you can track patient and employee satisfaction directly along with the financial results of the organization. In other words, if you have satisfied patients, you have satisfied employees, and your organization is going to do well. That’s not to say you don’t need to have your eye on the budget. We all know that. But there are times you need to do the things that are the right thing to do.

PVG: I love that. I think that summarizes it amazingly.

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