We Need To Fix The “Triple-demic” In The Healthcare Workforce Now

“The system is flawed. It’s grinding us. It’s grinding good docs and providers out of existence.”

Keith Corl, M.D, Assistant Professor of Medicine, Brown University
Image Credit: Shutterstock.com

Author’s note: This is not a post about technology. I’m deeply concerned about the current state of our healthcare workforce, and recent newsfeed articles only point out that the situation is getting worse. And it’s not just about burnout, which is covered extensively in the press, in research publications, and at conferences around the world. It’s broader than that. I’ve borrowed the term “triple-demic” to characterize the current situation to include moral injury and physical threats to healthcare workers as the key issues demanding immediate action.

Roughly 2.9% of healthcare workers quit their jobs in November 2022, equating to about 600,000 resignations, according to new data from the Bureau of Labor Statistics. That’s the second-highest quit rate in recent healthcare history, only behind the 3.1% rate in November 2021. Burnout from caring for Covid-19 patients, rigorous work schedules, and stagnant or low wages continue to push many hospital nurses, technicians, nursing home staff, and others to switch to other healthcare settings — or leave the profession entirely. Three major factors contribute to these resignations: burnout, moral injury, and physical threats. Burnout has received most of the attention throughout the pandemic. But the other two factors also need to be addressed to fix the problem. Some thoughts on each follow.


Burned-out healthcare professionals are more likely to leave practice, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor patient interactions and when burned-out caregivers suffer from impaired attention, memory, and executive function. A survey conducted by an AHRQ-funded project, the MEMO—Minimizing Error, Maximizing Outcome—Study (AHRQ grant HS11955), found that more than half of primary care physicians report feeling stressed because of time pressures and other work conditions. Some of those work conditions are shown in the graphic below:

Image Credit: AHRQ

“The nation’s health care delivery systems are overwhelmed, and nurses are tired and frustrated as this persistent pandemic rages on with no end in sight. Nurses alone cannot solve this longstanding issue and it is not our burden to carry.”

Ernest Grant, PhD, RN, FAAN, President of the ANA

Moral Injury (MI)

Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical, and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.” Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care. Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

That idea resonates with clinicians across the country. The response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, and endless clicking on electronic health records.

“We have come to believe that burnout is the end stage of moral injury, when clinicians are physically and emotionally exhausted with battling a broken system in their efforts to provide good care; when they feel ineffective because too often they have met with immovable barriers to good care; and when they depersonalize patients because emotional investment is intolerable when patient suffering is inevitable as a result of system dysfunction.”

The Moral Injury Institute

Healthcare workers suffer an injury at the hands of each other: the medication error ignored at the nurse’s station, the doctor who orders unnecessary procedures, and the technician who is forced to carry out morally questionable orders. This regular violation of ethics, winking at incompetence, and hypocritical prosecution of employees ‘outside the clique’ drags down an organization’s culture. Healthcare workers are so blind to the effects of moral injury that they call their cognitive dissonance ‘professional detachment’ and label the effects they suffer ‘burnout and fatigue’ rather than guilt and anger. The impact on the healthcare worker of human trauma should not be downplayed: the opportunities to address trauma and suffering bring providers into the system. It is when the system itself inflicts suffering that the healthcare worker experiences MI.

A less discussed aspect of moral injury is shaming in the healthcare profession. The best discussion of the issue is this recent video from Dr. Zubin Damania. He interviews Dr. Emily Silverman, a UCSF hospital physician and host of the popular podcast The Nocturnists. They dive into shame and emotional repression in doctors, healthcare professionals, and beyond. It is a lengthy discussion but well worth the investment of your time. (And read the comments thread too. Interesting observations from healthcare professionals worldwide on the shaming issues they’ve faced.)

YouTube Video Credit: ZDoggMD

If you want to learn more about the topic, here are some additional resources to explore:

  • The Nocturnist Shame Series
  • More on Dr. Silverman
  • The Shame Space – An international network of professionals who use creative storytelling and research to advance shame awareness, shame resilience, and shame-sensitive practice in healthcare, with the overarching goal of creating more connected, authentic, and safe healthcare systems for all. The Shame Space was formed in 2022 by scholars studying shame at the University of Exeter, Duke University, and Duke-NUS Medical School.

Physical Threats

The seriousness of this issue was reinforced last week in an article written by Michael Dowling, President & CEO, Northwell Health, in Beckers Healthcare titled: The unthinkable priority now facing hospitals.

In his opinion piece, Dowling highlights this “additional and disturbing priority — one that, I would argue, we never imagined. We now must protect our hospital patients and employees from the growing threat of intimidation and violence. There has been a dramatic spike in staff assaults, with many leading to serious injury and some leading to death.” (How have we gone from nightly 7 pm balcony applause and cheering for healthcare workers during the pandemic to physical assaults in their workplace?)

“People are proud of their bitterness now.”

Peggy Noonan, Wall Street Journal, 2019

The number of injuries from violent attacks against medical professionals was already on the rise pre-pandemic, increasing 86 percent from 2011 to 2018, according to the Bureau of Labor Statistics. In a spring 2022 survey by National Nurses United, nearly half of the hospital nurses (48 percent) reported rising workplace violence, more than double the 21.9 percent who responded as such a year prior.

Dowling has already taken action to address the problem. At Northwell, they call this new priority “The Safe Place Initiative.” It includes the following actions, investments, and measures:

  • An investment in educating visitors, patients, and team members on proper behavior and how to promote dignity, respect, and understanding. Thousands of pieces of informational signage and posters are prominently displayed, emphasizing that harassment and verbal or physical assault will not be tolerated. Signs are also on display that reminds all visitors that this healing place — the hospital and ambulatory facility are weapon-free zones.
  • A comprehensive investment in training employees on what to do in a potential active shooter situation, on how to de-escalate a potentially violent situation, and on how to “stop the bleed” in the case of such a circumstance. Over 50,000 of our employees have already received this training.
  • The enhancement of security in all locations by increasing the presence of security personnel, as well as increasing video surveillance and alarm systems.
  • The installation of weapon detection technology at the entrance of our facilities.
  • Education for staff on how to recognize signs of domestic and partner violence and enhanced support offerings to team members impacted by such violence.

“Now is the time to champion kindness, respect and compassion. Times like this call for even greater generosity of spirit, the “better angels” of our nature. Positive leadership unites, promotes mutual trust, builds confidence and is optimistic.”

Michael Dowling, President & CEO, Northwell Health

I have tremendous respect for the work that Mr. Dowling is doing at Northwell. Action, not just words. Leadership, not just platitudes. We need more of this.

I’m not sure that I have good answers to these critical issues. I suspect that there is not one solution that will fit every situation. But my hope in writing this post is to raise awareness of the seriousness of these issues, put a different frame around the various elements, and drive a deeper conversation around how we can solve these challenges before we lose more dedicated professionals because of frustration, exhaustion, and intimidation. These good people deserve nothing less.

Big Tech Layoffs Could Benefit Healthcare

“As big tech companies continue laying off their skilled workforce in droves, those workers can find opportunity, purpose and incredible skills-alignment in healthcare.”

Seth Jospeh, Forbes contributor
Image Credit: Shutterstock.com

Last week two articles hit my news feeds on the same topic, the layoffs in the tech sector. One by Forbes contributor Seth Joseph focused on the opportunities in health care. And the second in Fast Company magazine by Josh Hendler focused on opportunities in the nonprofit sector.

Facing rising costs and widespread economic uncertainty, big tech companies continue laying off their skilled workforce in droves. From Meta to Twitter, Amazon to Stripe, and AirBnB to Zillow, network effects-driven platforms across industries are trying to right-size their forces, facing the consequences of over-hiring in recent years while navigating 40-year inflation highs. I’d been following the layoffs since the start of the year. But I had no idea how many people had been affected by the cuts. The graphic below shows the cumulative numbers since the beginning of the year.

Image Credit: VisualCapitlist.com

The number of layoffs is staggering. But as the two articles point out, within every crisis is a silver lining. For both big-tech workers debating their next career move and healthcare organizations needing big-tech chops and network effects experience, the landslide of layoffs means there is an abundance of tech talent available and plenty of companies – and an entire industry – that stand to benefit.

Using the three reasons healthcare is a prime landing spot for these out-of-work tech professionals in Joseph’s article, I’ll add some comments on why I think techies should seriously consider a move into the healthcare industry and healthcare nonprofits.

“There are massive problems that exist in healthcare, with an infinite number of ways to use technology and data to help solve them — and increasingly, this includes platforms and network effects. Taking a page from big-tech platform companies like Amazon and Apple, healthcare companies are finding new and novel ways to leverage platforms to help fix longstanding, systemic industry issues.”

Seth Joseph, Forbes Contributor

My Take: If you like to solve big problems, healthcare is a good fit for your skills. We still function in multiple data silos, and sharing patient records across platforms is a nightmare. Platform companies are uniquely suited to address challenges endemic to healthcare – where issues stem from a lack of consistent data and massive fragmentation, impacting everything from care coordination and quality to cost and patient/consumer experience. And healthcare data companies like Truveta are hiring

YouTube Video Credit: Truveta

“Big-tech talent outside of healthcare can also serve to improve and help redesign the consumer health experience.”

Seth Joseph, Forbes Contributor

My Take: If you are skilled in user interface design, we desperately need you in healthcare. Take a look at most consumer-facing healthcare apps, and you’ll see they are challenging to navigate, confusing for the end user, and do not integrate well with the information infrastructure of most organizations.

“Research from McKinsey in 2022 similarly found that 70 percent of employees say their personal sense of purpose is defined by their work — and when that work feels meaningful, they perform better, are much more committed and about half as likely to search for a new job. And earlier research from McKinsey in 2020 found that 82 percent of workers want their company to have a purpose and contribute positively to society.”

Seth Joseph, Forbes Contributor

My Take: If you want to do work that dramatically impacts people’s lives, healthcare needs you. There is personal merit in working in healthcare technology, a mission, and a purpose in the space absent in other industries. Finding this purpose can be a welcome shift for technologists looking for more meaning in their work while helping improve their mental health and well-being. The work that you can do in healthcare benefits not only patients and their families but also the workers who provide care to those patients. Your work in making the healthcare system easier to navigate for patients and their families is crucial to eliminating friction and frustration in dealing with the system. And anything you can do to eradicate frustrating, non-value-adding work for healthcare workers would go a long way in reducing the burnout they are currently experiencing. The best part of this work is it is immediately visible to you. You can see that you are making an impact.

“Many across the philanthropic and nonprofit world have caught on, from the federal government to conservation organizations, seeking out tech workers to improve outdated systems—and compensating them competitively.”

Josh Hendler, Fast Company

My Take: If you are passionate about making an impact for organizations and causes that have a real social impact, consider looking at the nonprofit sector for meaningful work. As Hendler points out in his article, exploring resources such as All Tech Is Human, U.S. of Tech, U.S. Digital Response, Fast Forward, Tech Jobs for Good, and Design Gigs for Good are helpful starting points to explore full-time, part-time, and volunteering opportunities in the impact sector. These organizations have put together job boards, talent pools, guides, and virtual and in-person communities to unite technologists who aim to make their mark for the good of society.

Bottom line – Healthcare needs you. There is a huge opportunity to do good via tech and digital strategy in healthcare. And the timing is right, as the market will only be growing and is (relatively) recession-proof. While this is a challenging time, technologists have the power to create meaningful change, improving the lives of others, as well as their own, at an unprecedented scale. Join us.