MedCity Influencers, Hospitals

Healthcare workforces need sustainable systems

Our people are not the problem, our unsustainable systems are, including our activation around workforce development.

You do not rise to the level of your goals. You fall to the level of your systems. – James Clear, Atomic Habits.

Our healthcare outcomes tell us we have fallen to the level of our systems.

With the intense focus on Covid and workforce pressures, in many cases routine matters of quality and safety were deprioritized or overwhelmed. As a result, the healthcare system has lost ground on years of progress to improve on quality and safety metrics, evidenced by recent safety data and countless reports on setbacks.

Even as we recover from the acute fatigue of Covid, all too often missed handoffs, cumbersome processes and administrative fatigue – to name a few – are commonplace. This pattern can leave the healthcare workforce demoralized, overwhelmed and, yes, feeling burned out. We acknowledge the cumulative impact experienced by a workforce who continues to see the same challenges, errors and inefficiencies play out over and over again.

Going back to ‘normal’ is not all that comforting to the workforce because ‘normal’ was not working before the pandemic, and it will not work now.

Immediate solutions

Organizations working towards improving patient safety and quality by strengthening the healthcare workforce include the American Hospital Association, which laid out the following priorities in its 2022 Advocacy Agenda:

  • Helping ensure hospitals and health systems have the necessary workforce to continue to care for patients and communities during Covid-19 surges.
  • Investigating reports of anticompetitive behavior from nurse-staffing agencies during the pandemic that is further exacerbating critical workforce shortages.
  • Addressing nursing shortages and burnout by reauthorizing nursing workforce development programs to support recruitment, retention and advanced education for nurses and other allied health professionals.

We applaud these efforts and acknowledge they may take months and years to have an impact.

The opportunity today is for healthcare executives to take immediate ownership of these issues and start to have an impact on strengthening the workforce by improving system sustainability.

Sustainable systems, processes and structures can help ensure continuity in the face of known and unknown challenges, such as workforce shortages. And critical to that are clearly defined roles and responsibilities for stakeholders built around validated competency standards. If we are to sustain the work, we need to have a reference point for what the work ‘is.’ We need executive sponsorship to ensure that workforce competencies for quality and safety move to and stay on top of the list of organizational priorities.


Addressing quality and safety roles and structures is the first step in achieving sustainability. With NAHQ’s Competency Framework, organizations can provide essential staff with structures and a previously absent shared vocabulary and toolkit — particularly important in a healthcare environment challenged to do more with less.

At Lifespan, frontline safety initiatives are increasing event reporting and leading to a more engaged workforce, according to Nidia Williams, VP of Quality and Safety. Additionally, Lifespan recovered $7 million in wasted costs in just one year with improved quality-first initiatives like ‘waste walks.’

NAHQ conducted a Fall 2021 study to understand how healthcare quality professionals utilized PPI tools, methods, and mindsets during Covid-19. Healthcare quality professionals clearly recognized the value of PPI (performance and process improvement) methods and the expertise needed to effectively implement them to manage rapid change: 71% said improvement methods increased in their organization’s work during the pandemic.

A focus on preparing the workforce with requisite skills and competencies needed to address both long-standing and new challenges in healthcare is the shortest route to improving safety and reducing burnout.

Not only that, but a focus on advanced training that also promotes scholarship in the field further advances the knowledge base from which the discipline of quality and safety is advanced. A focus on improving today can also create seeds of wisdom from which to build the future. In fact, a group of leading universities have created graduate degree programs in healthcare quality and safety. By working together, they are practicing what they preach to constantly review the curriculum and collaborate to improve, as we all should.

Bring back purpose

To bring back purpose for the workforce and re-activate the ‘calling’ which led to this career choice, we must put the healthcare workforce in situations where they have the best possibility for success. They must see their leaders supporting them, and they must feel the impact of that support personally as they serve patients every day.

Our people are not the problem, our unsustainable systems are, including our activation around workforce development.

Leaders should aspire to unleash the human potential within the healthcare workforce and achieve a level of system sustainability that better prepares their organizations to face challenges ahead. Executive engagement and sponsorship of workforce development in quality and safety is a critical imperative that leaders should activate now.

Photo: Juanmonino, Getty Images

Stephanie Mercado, CAE CPHQ, is the CEO and Executive Director of National Association for Healthcare Quality (NAHQ), an organization dedicated to healthcare quality professionals, defining the standard of excellence for the profession. She has led association leadership roles, supporting both practitioners and healthcare executives for 20 years, developing healthcare competencies and medical curriculum models.

David B. Nash, MD MBA, is a board certified internist who is internationally recognized for his work in public accountability for outcomes, physician leadership development, and quality-of-care improvement. He is the Founding Dean Emeritus of the Jefferson College of Population Health and now serves as the Dr. Raymond C. and Doris N. Grandon Professor of Health Policy. Dr. Nash is regularly on Modern Healthcare's list of Most Powerful Persons in Healthcare and is a principal faculty member for quality of care programming for the American Association of Physician Leaders. Dr. Nash has authored more than 100 peer-reviewed articles and edited 23 books, including Connecting with the New Healthcare Consumer, The Quality Solution, Demand Better, and most recently Population Health: Creating a Culture of Wellness (3rd edition).

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