Healthcare systems today face intense financial pressure, rising operational costs, and increasing complexity in patient care. At the same time, workforce shortages continue to challenge organizations across the country. Early tenure turnover remains elevated, and nursing gaps are projected to worsen.
These challenges are pushing organizations to rapidly reorganize and seek innovative ways to improve system efficiency, but such efforts can unintentionally weaken the critical connections between executive teams and frontline leaders.
Executive interviews conducted for this report consistently underscored that frontline managers are the most powerful amplifiers of the organization’s people strategy. And executives clearly understand the critical connection between people strategy and overall organization performance. Leaders also agreed that the solution is not adding complexity or extra tasks to managers’ already full plates, but rather that it is time to get back to the basics of human connections, with a renewed focus on foundational relational leadership behaviors: strengthening trust, communication, authentic presence, and support in leaders’ daily work. Direct managers’ frequent, meaningful interactions with team members are the primary way culture, expectations, and organizational values are demonstrated in daily work.
HR teams have an essential role to play in partnering with frontline managers to help them prioritize these meaningful activities to support relationship leadership or streamline distracting practices. In this environment, advancing a people strategy means empowering managers, strengthening alignment, reducing complexity, eliminating non-valued tasks, and focusing on the critical behaviors that shape culture and performance every day.
To do this, HR leaders first need to partner with their executive colleagues to create organization wide alignment on the behaviors, tasks, responsibilities, and processes that are core to a frontline manager’s daily work. The Leader Standard Work framework provided in this report, which evolved from conversations with over a hundred healthcare leaders, can be a starting point for establishing that clarity.
The leaders interviewed for this report reflected that, despite the innovations emerging across HR functions to better support frontline tasks, sustainable workforce stability still depends on the strength of human connections. They emphasized that real progress has resulted from closer collaboration between HR, nursing, operations, and executive teams, all anchored in a shared understanding of frontline managers’ standard work. People strategies depend on leadership, culture, systems, and trust, all of which are built on human connection.
Frontline managers juggle complex responsibilities across teams, patients, and departments while balancing quality, safety, experience, and financial performance. Many also manage exceptionally large spans of control, often across 24/7 operations. Nationally, a quarter of support services managers oversee 44 or more direct reports, with some departments reaching 90+, levels far higher than those seen in most other industries.
The most important retention factor remains the relationship team members have with their direct supervisor. And in an environment where the typical operating model includes large spans of control, it is especially critical to enable managers to prioritize their relational leadership practices and activities.
As shown in the figure below, three meaningful manager-employee interactions per quarter (i.e., one per month) are associated with a seven-percentage point improvement in retention. Similar associations are also observed with non-clinical roles. In other words, freeing up manager time and redirecting that time to purposefully recognize and coach team members on an ongoing basis is highly impactful to employee experiences.
A manager catching a team member in the hallway and saying something such as: “I heard what you did with that family earlier and you did a wonderful job,” is an example of a timely, valuable interaction managers can have with their team members on a consistent basis. Managers may need to be coached in how to use thoughtful words to connect and communicate in a meaningful way, even when they only have a moment in the hallway. Team members’ days may be filled with stress and crisis; the data shows that simple moments of hope, help, and appreciation can go a long way.
This is more relevant now than ever as Gen Z employees (i.e., those born between 1997 and 2012) enter the workforce. More than ever, early-career team members expect that their managers will provide consistent coaching, meaningful interactions, and direct connections from their work to broader organizational goals.
As shown in the figure above, Gen Z Registered Nurses (RNs) require five meaningful interactions every three months to reach about a 5-percentage point improvement in retention; in contrast, millennials only need about two such interactions and older generations about one. In other words, this research shows that Gen Z team members need 2.5 times more meaningful interactions with their managers than older generations to reach similar levels of retention.
There are now more new leaders in healthcare than ever before. Nearly half of support services managers have no more than four years’ tenure leading a team. A similar distribution exists for nurse managers and other clinical roles. Those with limited leadership experience are actively learning how to keep their department’s day-to-day operations running smoothly. At the same time, they are forming or refining their own leadership identity and need support to authentically build relational leadership practices that have the potential to create strong individual and team relationships. At a time when health systems are rapidly growing through mergers and acquisitions, manager role complexity and spans of control increase while more inexperienced managers enter the role. There are also fewer experienced managers and onsite HR business partners (HRBPs) to coach and guide them in real time. The result is wide variations in leadership practices and behaviors. In an effort to align and create a positive, shared employee experience, organizations are moving with more intentionality in creating, communicating, and supporting standard work for these frontline managers.
In the interviews conducted for the report, HR leadership expressed the criticality of a strong relationship with C-suite operational leaders, particularly the Chief Nurse Executive (CNE). Although the people strategy pertains to all staff, nursing comprises the largest number of employees and has a significant impact on patient care, therefore, it influences overall organization performance at scale. Strong HR-clinical leader partnerships, both at a manager and an executive level, accelerate trust and execution. However, HRBP and clinical manager connection is strained given the increased ratio of HRBPs to the number of leaders they support, and by the reduction in co-location in the clinical setting for day-to-day support. This reality indicates that creative solutions are needed to help ensure HR teams have the capacity to align with, support, and invest in frontline leaders.
nurse nInnovative HR departments are responding to reduced HR resources by using technology-based automation to augment staffing in high-volume areas such as recruitment. By shifting manual or transactional tasks like sourcing, candidate scheduling, and onboarding tasks to automated systems, recruiters are regaining valuable time that they can reallocate to meaningful work like partnering with managers on creating long-term staffing forecasts.
In a resource constrained environment, CHROs must carefully evaluate the return on investment of HR initiatives. For example, while signing bonuses are often used to address staffing shortages, research shows a minor difference in nurse retention beyond early tenure compared to those without bonuses, despite the inflated costs.
Time-limited, one-off bonus programs may appear to be the popular, proven solution to hiring in complex, highly competitive regions. In contrast, the innovative HR leaders interviewed for this report emphasized that their biggest competitive advantage is supporting the work of the frontline by getting “back to the basics” of relationship-building. In other words, finding new ways to bring HR leaders and executives, frontline managers, and HRBPs closer together can help attract new hires while creating an ideal environment to care for staff and patients.
While one time bonus programs can be used to compete for talent, innovative HR leaders emphasize relationship building as their true competitive advantage. By strengthening connections among HR leaders, executives, frontline managers, and HRBPs, organizations can attract new hires while creating a stronger environment for supporting staff and delivering patient care.
Start your tour or request a demo to see how Laudio helps people and healthcare leaders drive engagement, efficiency, and better outcomes.