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What happened to continuity?

Updated: Mar 23, 2023

Change in our world is accelerating so fast it is impossible to process. The pandemic, climate catastrophes, international conflicts, social isolation and upheaval in employment are just some of the factors in play as we navigate uncharted waters.

Healthcare, by far the largest industry in the U.S., has experienced many of these changes, marked by staff and leadership turmoil, as well as high costs from increasing patient acuity and low to non-existent margins. One result was annual staff turnover averaging 26% in 2021, according to the NSI National Healthcare Retention & RN Staffing Report. Data for 2022 is not yet available, but it seems inevitable that the trend will worsen. Morning Consult research finds that since 2020, one in five healthcare workers have quit their jobs. Various surveys suggest that as much as 40% of healthcare staff plan to leave their positions in the next two years. A third of all physicians are thinking seriously about new careers.


While all of this has received plenty of attention, less discussed is the impact it is having on our industry and the teams left behind. Upheaval caused by staff turnover isn’t limited to the many difficulties in finding new talent. When an IT manager jumps ship, the projects he was leading are stopped in their tracks while the hiring process gets under way and the new hire gets up to speed. When an accountant leaves, some integrity in the balance sheets is inevitably lost. When a revenue cycle VP suddenly says adios and takes most of the staff with her, an ecosystem of processes is thrown into chaos, with profound implications for organizational finance and sustainability.


What is being lost is continuity – staying the course to get things done. Continuity goes well beyond personnel. There are times when change is important, even central, such as fixing broken systems or partnering with a vendor or competitor to improve services. Too often, though, change is done just because someone wants to make his or her mark. We see this every day in new technology systems that are purchased without enough regard to how they will interact with existing systems in the organization or what it will mean for staff or patients. We see this in mergers done for market control, without regard for service.


One of the big challenges any leader must confront today is deciding when it is better to change and when continuity is more important. Today it seems like what we have is paralysis in the face of uncertainty. Mass layoffs in healthcare are often carried out reactively, without a strategy for what happens next.



My company has no need for such a strategy because we don’t have problems with recruitment and retention. Senior leaders have been there all the way since we started more than a decade ago. A big part of our success has been in how we interact with and treat our staff. They feel cared for and have meaningful work. An amazing 98% of our staff say that they are satisfied with their jobs.


It is part of a culture we have developed through hard work over the years. One reason for the upheaval in healthcare is that in many places there is no established culture through which staff can grow and find meaning. When the leadership is turning over so often, this is no surprise.


A lot of what I do as a CEO is take care of my team. If I do that, and give them all the tools they need, they take good care of our clients and success follows.



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