Seeds of Dissatisfaction

In our 2012 Industry Survey, one in five (19%) healthcare leaders report that they are not satisfied in their job, a figure that has steadily increased since 2009, when it was 13%. What is behind this trend and what are effective ways to address this lack of satisfaction? Organizationally, how do you track this?

Jeff Thompson, MD
CEO
Gundersen Health System, La Crosse, Wis.

On what's driving the dissatisfaction: Although there may be a trend of people less satisfied with their jobs I am not sure that is the same thing as engagement. I think people are still engaged. They're still working hard. But there are several issues at play. One is the complexity of the healthcare business, which it is only getting more complex. And the pace of change is accelerating. Then you have external factors that we struggle to control: the lingering effects of the economic downturn and the proliferation of insurance company and government regulations. I believe it is not too surprising that more leaders are feeling stressed than they were before.

On the new measures for success: There is increasing demand and an expectation for measurable performance. So whether it is quality, service, financial performance, or community connection, those organizations that have not been measuring for a long time may feel under a great deal of pressure as there is a move toward more transparency and clarity. It isn't reputation and billboards that win the day anymore. It's outcomes.

On reversing the trend: It can be reversed but it is going to take a behavior on the part of boards to not only select people but to assist people in being successful in this new world of greater complexity, fast change, and more transparency. It starts with the board and who they select and how they evaluate them, but senior leadership has to be clear about where the organizations need to go.

Alan J. Burgess
CEO
Tehachapi (Calif.) Valley Healthcare District

There is more pressure on public hospitals with CEO compensation. I am seeing some ratcheting down and restricting benefits. Some bad actors have caused significant problems for others of us in the public sector.

There is also more dependence on others. Hospitals are much more complex organizations than they were even five years ago, and I have been in the business now for 46 years. There is some frustration because there is less that the CEO level can do to guarantee that things are happening because you are relying on so many other people to do their part. In the old days it was much more of a one-man show.

One of the advantages and reasons that I am in small and rural hospitals is because I still know all of my employees, I know most of my patients, and I can work with them one on one. Another reason for the dissatisfaction is the quick turnover. In some states CEO tenure is down to two and three years.

I don't know if this trend can be reversed. Some of it is just the changing marketplace. There is a different culture moving into the C-suite these days than used to be. Some CEOs aren't willing to put in the hours or the effort and so they are going to have the frustration. I am hearing CEOs for the first time encouraging people not to enter the field. They just feel like the compensation no longer matches the level of responsibility and trust and accountability that they are held to.

Pam Harmon
Chief Nursing Officer
Rooks County Health Center, Plainville, Kan.

I'm surprised and in some ways I am not. A lot of time when people are new to leadership they are not taught how to be leaders. So, basically they are not prepared to deal with all of the turmoil and the fires that they are supposed to put out,. A lot of times they just give up. If somebody with the experience would just have a job of going to hospitals to teach people how to be leaders, if only for a few weeks, it would make a tremendous difference in satisfaction.

There is not the commitment to find good leaders. It's kind of like "Oh my! We need someone to fill this position. Let's put an ad out there." A lot of times, especially in rural America, they take whoever applies because it's better than leaving the position open. 

Someone told me one time "You're not the CNO, you're the mother of 50." That's about how it really is. If you put it in that perspective—like how you would deal with your children—it makes things a little easier.

Terrence Deis
President and CEO
Parma (Ohio) Community General Hospital

Part of it is the general uncertainty. No one likes that. There is a certain lack of control and autonomy as more hospitals have become systematized.
 

If tomorrow we were purchased by an outside organization I am guessing you would still call me a "health leader" but now I've gone from running an organization to becoming a cog in a wheel. I have the same title but now I report to another healthcare guy, probably a COO or lower. I don't report to a board. I don't have the autonomy I once had.

These jobs are difficult, pressure-packed positions. These pressures as far as I can tell are going to continue to trend upwards. I don't think the landscape is going to change. To some degree the people will have to change and the attitude with have to change. Maybe it will attract people who are happier in that environment.