Employee burnout and turnover was a problem in health care before COVID-19, and the pandemic has only accelerated it. To stem the tide, clinics should look to improve their workplace culture. Work culture in clinics includes shared goals for patient care, the community, and the health of employees. Culture determines how well the medical team works together.¹ Positive culture leads to engaged clinicians and staff who feel valued and supported by colleagues and leadership. This improves care quality and patient satisfaction and reduces burnout.^2,3

Negative work culture, on the other hand, increases work-related stress and burnout. Work stress, in turn, leads to illness, higher job turnover, and an estimated 550 million days of work lost each year.⁴ This exacerbates staffing shortages and decreases patient safety.⁵

It is clear that clinics and health care systems need to develop positive work cultures to retain staff and improve employee and patient health. But how do we do that? First, get everyone on the same page. In a 2018 FPM article, “How to Create a Culture of Well-being in Your Practice,” Mark Greenawald, MD, FAAFP, presented a process for joint agenda-setting to align everyone in a practice around shared goals.⁶ The process, called the “STARRS method,” evaluates six aspects of workplace culture: service (focus on the meaning of the work), teamwork (working together with mutual respect), attitude (positive attitudes at work), reflection (thinking about how we relate to one another and why we do what we do), renewal (spending time recognizing others' work and providing uplifting messages), and self-care (maintaining the health of the care team to allow for high levels of dedication to the work). A tool for implementing the STARRS method is available on the FPM website.

Once you have everyone working toward a shared vision, it will be easier to implement more granular changes that sustain a positive work culture. One study identified several attributes that correlate to higher organizational effectiveness in health care: caring, compassionate support of coworkers, forgiveness, inspiration, meaning, respect, integrity, and gratitude.³ Fostering these attributes in your clinic depends on three things:

1. The behavior of leadership. Leaders set the tone by modeling positive behaviors. Kindness and empathy from those in authority engender worker loyalty, and employees often behave as they have seen their leaders behave.⁷

2. Clear communication. In a clinic setting, communication between colleagues, team members, leadership, and employees correlates to excellent patient care. Poor communication, on the other hand, leads to burnout and adverse patient outcomes.⁵ Clear communication can take the form of daily care team huddles, e-mails from leadership, or clinic newsletters. Think about how your team members communicate with each other and whether there are ways to make it more productive.

3. Workforce empowerment and connection. An empowered and connected workforce is a strong and positive workforce.^4,7 Ways to create a sense of empowerment and connection include robust onboarding of new employees, teambuilding exercises and experiences, social events outside the clinic, and regular recognition of employees.^4,7

As burnout and staff shortages accelerate, health care leaders need to renew their commitment to improving work culture in order to optimize staff and patient outcomes. Focusing on these three themes can help.