RecruitCounsel™ Report

Unplanned vacancies within an organization’s leadership team, team burnout and low morale, and unprecedented shortages in healthcare staffing are significant issues challenging today’s healthcare management teams. American Consultants’ addresses these critical concerns with proactive, actionable insights to aid in mitigating these crises.

Last Updated: July 23, 2019 

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Proactive management in healthcare focuses on controlling or managing known risks to increase the chances of success by decreasing the possibilities and repercussions of risks.

Acquire strategies from healthcare industry leaders to address staff shortages

Learn preparation strategies to manage unexpected vacancies of key executives

Understand the signs and symptoms of employee burnout

Consider new approaches to employee satisfaction and wellness



Each of a hospital’s departments is critical and must function uninterrupted, yet an unplanned vacancy in management can negatively impact processes, productivity, and profitability.



Burnout, Disengagement, and Low Morale

Burnout rates among health care leaders and physicians are nearly double that of workers in other professions. Reduced empathy and productivity can spiral into serious quality and financial issues for healthcare facilities if ignored.




Unprecedented shortages of qualified healthcare staff poses immediate and long-term concerns for health care organizations, affecting patient outcomes and the overall strength of the hospital.


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Crisis Scenario



The unplanned and unexpected loss of an executive or departmental leader can throw a healthcare organization into disarray. Each of a hospital’s departments is critical and must function uninterrupted, yet an unplanned vacancy in management can negatively impact processes, productivity, and profitability.

In addition to concerns about operational efficiencies, individual staff member opinions about the cause and effect of the situation leading to the vacancy, replacement strategies, and the change’s impact on their professional trajectory creates an additional layer of complexity for those responsible for relieving the issue.

Voluntary terminations accounted for 92.7% of all hospital separations.


1) Personal reasons (caring for a child/parent, marriage, disability, etc.)
2) career advancement
3) relocation
4) retirement
5) salary
6) education
7) scheduling
8) commute/location
9) immediate manager
10) workload/staffing ratios
(2019 National Healthcare Retention Report)



Like most high-stakes scenarios, pre-crisis planning is a business practice few healthcare organizations can afford to ignore, though it may be tempting to put off when things are going smoothly (and especially when the leadership in charge is doing a great job).

Human resources crisis management planning should begin long before issues arise to craft strategies that can be tested, formalized, and disseminated. Failure to prepare can lead to severe operational, quality, and legal consequences that can add to recovery time, and the hospital may be seen as inept for it’s lack of preparation.

Contingency plans for each managing leader should be in place to cover the first three days, the first week, and the first month. Accurate job descriptions should be on file with HR, organizational charts should be kept current, and the Human Resources Director and other top-level executives should each have go-to personal contacts with executive staffing firms that specialize in healthcare leadership.


Skilled interim leaders have comprehensive experience dealing with the challenges and dynamics that come into play during the initial stages of an unexpected vacancy. They understand they may be walking into a complicated and disjointed environment with potentially polarized staff and are trained to diffuse problems.


The stability that the interim provides can also help maintain a sense of importance and respect to the existing leaders within the organization. Without an external interim leader, hospitals often delegate the leadership vacancy to another executive who is likely already at their maximum capacity or may be unprepared for the role. Over-burdening current management with additional responsibilities can lead to burnout and may result in their decision to resign, thus compounding the issue.

Placing a provisional leader within days of the gap provides immediate stability to the department impacted and allows other areas of the organization to operate as usual, minimizing the total impact to operations.


An effective interim leader will pay consideration to the personal side of the department’s intricacies, understanding that each staff member has a history and connection with the vacancy that influences the team’s overall success.

While some staff members may regard a new vacancy as a dilemma, others may view it as an opportunity for advancement and friction often develops as a result of numerous internal candidates applying for the open role that requires moderation.

Understanding that their primary function is the stabilization of the department, interim leaders emphasis open and frequent communication about daily activities, share progress on the permanent replacement process and manage individual needs to diffuse stress and avoid additional turnover.


The roles and responsibilities of hospital executives continuously evolve. Organizations may not have updated job descriptions or performed market-based salary evaluations in many years. Interim leaders can function as an unbiased third party during the transition period to gather the voice and needs of the department with a fresh set of eyes as part of their engagement.

Interim management can also be a valuable resource during internal candidate evaluations in the absence of the previous leader without lingering issues of favoritism or bias. Having a stable short-term leader at the helm while the organization refines new, permanent requirements can help avoid the costly mistake of hiring the wrong candidate.


Hospitals often plan and implement large projects such as deploying a new or updated EHR or implementing austerity measures over extended periods. These projects are often mission-critical and require significant human and financial capital to complete, so losing an executive leader during implementation can have catastrophic consequences.

The interruption of strategic plans can set back timelines and potentially cost the organization significant financial resources. Interim executive leaders have been involved in many of these types of projects and can hit the ground running, allowing the facility to continue its project implementation with minimal disruption, saving the organization time and money.

With a pre-approved interim strategy, a quick action plan, a caring and open dialog, and coordination with top leadership, keeping control of the impact of an unplanned vacancy is possible to protect the balance of the organization.

For the fifth straight year, hospital CEO turnover held steady at 18 percent, according to a recent report by the American College of Healthcare Executives. While less than the record high of 20 percent in 2013, the last five years represent the longest period during which turnover has remained elevated to this level since the study began in the early 1980s.” (

Crisis Scenario

Burnout, Disengagement, and Low Morale


First described by the clinical psychologist Herbert Freudenberger in 1974, the phrase “burnout” has evolved to become the professional catchall for symptoms of exhaustion, malaise, frustration, and inefficiency resulting from long-term job stress. Alarmingly, burnout rates among health care leaders and physicians are nearly double that of workers in other professions after taking into account hours worked, age, sex, and other factors. 1

In addition to burnout, disengagement and low morale can have an equally negative impact on a healthcare organization creating a ripple effect of reduced empathy and productivity that can spiral into serious quality and financial issues for healthcare providers if ignored. Gallup revealed that actively disengaged employees, about three in ten American workers, cost the U.S. $450 billion to $550 billion in productivity annually. What’s more, seven in ten professionals polled admit to not being committed to delivering their best performance. 

The Wall Street Journal reported on a study by the Harvard Medical School faculty, stating that, “96% of senior leaders reported feeling burnt out to some degree, with one-third describing their burnout as extreme.”


Treat the Crisis as a C-Suite Priority

Healthcare leaders understand that promoting holistic health and well-being initiatives inevitably results in more satisfied employees and lower turnover, however, too often there is a lack of planning to properly execute the programs. Like any major organizational change there must be leadership support, the willingness to make a financial investment in improvements, and a skilled team capable of managing processes short, mid, and long term. The project champions addressing burnout, wellness, and morale should be trained in mental health strategies and have direct decision-making authority.

Lead by individual Example

Based on statistics, it’s as likely that the top leaders in a healthcare group are also some of the most affected by disengagement and burnout. To spark change, the company’s top leaders should begin by taking a hard look at themselves and their own state of wellness. 

Self-assessment of one’s own leadership style may help reveal areas for potential improvement. Top leaders take responsibility, acknowledge failure, and avoid blame to instill credibility. They roll up their sleeves as active participants and are courageous and persistent to create solutions that the team can rally behind. Most importantly, they are truthful, respectful, and fantastic listeners. Consider how your leadership team’s actions (or inactions) may be affecting team morale and invest in solutions to treat your own symptoms of burnout.

A leadership team that can demonstrate professional effectiveness while living balanced mental and physical lives instills confidence in subordinates and peers that a healthy scenario is possible within a healthcare leadership career.

Become An Involved Leader

Healthcare leaders can take an active role in their employee’s lives to ensure they’re watching for early signs of burnout. Knowing your employee’s concerns and addressing them early and often fosters trust and demonstrates mutual respect. Look for the following red-flag for opportunities to begin a proactive conversation if there is a potential concern:

  • A decline in the quality and reduced enthusiasm for the work
  • Withdrawal from conversations or being unusually silent
  • Canceling meetings, tardiness, or frequent absenteeism
  • Repetitive complaints about the same problem even after it has been addressed 
  • Lack of participation in problem-solving to resolve their direct concerns
  • Complaining, blaming, or “venting” to peers
  • Moodiness, tired, and excessively stressed

Activity Solicit Communication

Organizations that encourage employee communication create opportunities for engagement to address issues before they become crises. Open office hours, team luncheons, vision workshops, and town hall-style meetings serve to encourage conversation and open a window into the overall morale and wellness of your team. 

Create a wellness-focused culture

Stress is simply a part of working in the healthcare world and caring employers prioritize treatment over termination. Offering employees the opportunity to address individual behaviors through education, tools, motivation, and social support starts them on a pathway toward developing healthier behaviors to decrease stress and their risk of chronic disease to improve their overall quality of life.

In addition to having happier and healthier employees, healthcare organizations also benefit financially from developing a culture of wellness. Health Affairs published that for every dollar that was spent on a wellness program the company saved $3.27 because of reduced healthcare costs.

Make the Top-level Connection

Employees need to feel invested and that their work contributes to the organizations business goals. In short, people want to matter. Taking the time to help your team understand how their efforts and job enrich the bigger picture builds their self-respect and helps reduce the chance of them not feeling heard or valued.

Champion Professional Development

Jack Welch famously said, “Before you are a leader, success is all about growing yourself. When you become a leader, success is all about growing others.” Offering continued learning and professional development programs let employees know that their individual growth is a priority to the organization. When a teammate is continuing to engage and learn in areas of professional interest, they feel more invested and in control of their career and life. Personal development is an often overlooked area of health and wellness cultures and is an area where leaders can make a major impact on employee satisfaction.


1. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Shanafelt TD, Boone S, Tan L, et al. Arch Intern Med. 2012;172:1377–1385.

Signs and Symptoms of Employee Burnout and Disengagement


  • Exhaustion or chronic fatigue
  • Frequent headaches or muscle pain
  • Lowered immunity/getting sick often
  • Change in appetite or sleep habits



  • Low motivation
  • Sense of self-doubt and failure
  • Feeling helpless, defeated, and trapped
  • An increasingly cynical outlook
  • Decreased sense of satisfaction
  • Feeling detached from the workplace



  • Isolation and withdrawal from peers
  • Taking out frustrations on others
  • Evading responsibilities/procrastination
  • Decreased productivity
  • Excessive absenteeism or tardiness


Crisis Scenario



Unprecedented shortages of qualified healthcare staff poses immediate and long-term concerns for health care organizations, affecting patient outcomes and the overall strength of the business.

An important topic in the healthcare industry, today’s leaders are feeling pressure to fill openings for the vast number of the new job needed, resignations, a growing retirement population, and a host of other reasons contributing to the abundance of job vacancies. The U.S. Bureau of Labor Statistics’s (BLS) 2016–2026 employment survey projects an alarming 1.26 million total health care job openings per year, estimating that there will be 624,000 vacancies per year for all practitioners and technical occupations, including the need for 204,000 registered nurses (RNs).


  • The American Association of Medical Colleges estimates a possible shortage of more than 100,000 physicians by 2030 (Mann 2017).
  • Various research reports forecast significant nursing shortages, including a deficit of more than 150,000 RNs by 2020 and more than 500,000 by 2030 (Zhang et al. 2018). Another report predicts a shortfall of 193,000 nurses by 2020 (Carnevale, Smith and Gulish 2015).
  • Because of budget constraints and a lack of faculty, clinical sites, classroom space and clinical preceptors, U.S. nursing schools turned away 64,067 qualified applicants in 2016 and 2017 (Fang et al. 2017).
  • Supply-and-demand models predict a shortage of 26,560 physical therapists by 2025 (American Physical Therapy Association 2017).
  • By 2025, the nation will likely face a shortage of 29,400 nurse practitioners and 98,700 medical and lab technologists and technicians (Stevenson 2018).

In AHA Data & Insights’ Futurescan Report,CHRO Denise J. Mariotti from the Hospital of the University of Pennsylvania shares, “Solving workforce shortages is a top priority for executives in the rapidly changing health care environment. In fact, the vast majority of those responding to the latest Futurescan survey indicates it is or is very likely to be one of their three most significant challenges over the next five years.”

Today’s staffing shortage demands that leaders maximize existing approaches within their organizations that return predictable success and adopt new ways of retaining and acquiring top talent.



Healthcare executives report that many of their organization are allocating funds for higher salaries, staff engagement, and recruitment. In addition, many are investing in comprehensive studies to ensure they are offering competitive compensation beyond salaries for in-demand positions at all levels of the organization (not just management).


Investing in new-employee onboarding processes and rethinking work processes to increase efficiency and employee satisfaction are top retention strategies. Employers are also developing sophisticated programs to help staff members to find “joy in practice” and combat burnout and disengagement.


The next generation of healthcare professionals are digital natives, so recruiting efforts should leverage all of the media they use most from social media to digital job boards. Leveraging staffing firms and partners with a pulse on the digital behaviors of tech-savvy candidates can increase efficiency and volume while preserving the necessary elements of employer-employee matching.


Using new data/technology tools such as marketing automation, predictive analytics, search engines, and mobile platforms increase the likelihood that your message will be heard. Establish a national recruitment strategy by procuring advanced data analytics expertise for workforce sourcing from trusted partners.


To compete on the national level and attract top talent, commit resources toward sponsored professional development opportunities as well as fellowships, mentoring programs, paid internships, job shadowing, tuition assistance/reimbursement, and loan forgiveness as part of the non-salary benefits. Also, consider reinventing the organization’s clinical education and training programs to offer a unique (and attractive) solution like no other.


Partner with regional colleges and universities to build educational programs that can serve as hiring pipelines, leveraging the institution’s marketing team to educate younger students about potential careers in healthcare. On the other side of the age spectrum, establish programs for veterans and retirees to begin or continue employment.

There is no magic solution for health care organizations to solve the challenges of workforce shortages; however, there are positive indicators of success on the horizon. Healthcare systems demonstrating an aggressive enthusiasm for change, creative problem solving, and those that champion empowerment at every level of the organization with a focus on managing to a new generation of employees are having a positive impact on addressing the shortages.


American Physical Therapy Association. 2017. “A Model to Project the Supply and Demand of Physical Therapists: 2010–2025.” Updated April 17.

Carnevale, A., N. Smith and A. Gulish. 2015. “Nursing Supply and Demand Through 2020.” Georgetown University Center on Education and the Workforce. Accessed July 24, 2018. cew-reports/nursingprojections/.

Fang, D., Y. Li, K.A. Kennedy and D.E. Trautman. 2017. 2016–2017 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington, DC: American Association of Colleges of Nursing.

2. Future Scan: Healthcare Trends and Implications, 2019-2024. AHA Data & Insights. January 2019.

Mann, S. 2017. “Research Shows Shortage of More Than 100,000 Doctors by 2030.” AAMC News. Published March 14.

Stevenson, M. 2018. Demand for Healthcare Workers Will Outpace Supply by 2025: An Analysis of the US Healthcare Labor Market. Mercer LLC. Accessed November 15. private/gl-career-2018-demand-for-healthcare-workers-will-outpace-supply-by-2025-analyisis-healthcarelabor-market-mercer.pdf.

Zhang, X., D. Tai, H. Pforsich and V.W. Lin. 2018. “United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit.” American Journal of Medical Quality 33 (3): 229–36.


Most healthcare executives polled indicate workforce shortages either already are or are very likely to be one of the three most significant challenges facing their organization. 2


Nearly 9 in 10 respondents are at least somewhat likely to implement strategies such as increasing staff engagement, raising salaries or expanding their recruitment budget to compete with emerging health care providers in the race to acquire talent. 2


Two-thirds of hospital and health system leaders either already are partnering with outside staffing experts to optimize their workforce or are at least somewhat likely to do so. 2


Our clients range from large healthcare systems to rural hospitals, from clinics to laboratories, and from clinical research organizations to providers of information technology to the healthcare industry. 

At American Consultants, we truly understand the pulse of healthcare and are committed to providing a wide range of healthcare staff, executive search, interim leadership and consulting services with a personal touch.

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