Alignment — the extent to which an employee feels connected with leadership and shares a vision with the organization’s mission — is on the decline among healthcare workers, according to Press Ganey.
A survey of nearly 2 million healthcare workers conducted by the firm revealed drops in engagement and alignment between 2024 and 2025, particularly among physicians and advanced practice providers.
At Cleveland-based University Hospitals, ensuring that employees feel they belong and believe in their value is a top priority, according to Peter Pronovost, MD, PhD, the system’s chief quality and clinical transformation officer.
As part of this goal, employees were asked what they needed to stop believing and start believing to feel valued and part of the team.
“This was back in 2021, and what was so stunning is that every role — including residents, nurses, pharmacists, transport — all said something to the equivalent of, ‘I’m going to stop believing that I don’t matter or that my voice won’t be heard, and I need to start believing that I’m part of a team, and if I speak up, I can make a difference,'” Dr. Pronovost said.
While rounding earlier this year, Dr. Pronovost saw the initiative in action across three units:
1. During a conversation about infections and patient experience, an environmental service worker stood up and said, “I’m preventing infections in this unit. This unit had gone a year without a CLABSI [central line-associated bloodstream infection], and I’m contributing to that. And now my kids know what I do and why it matters.”
2. In another unit, a different environmental services employee showed Dr. Pronovost the HCAHPS cleanliness measure and says, “I’m helping to make the score better. People are feeling that it’s cleaner. I go home each week, and when I get the updated score, I put it on my refrigerator for my family to see.”
3. In a third unit, the team discussed a new technology for treating deep vein thrombosis. While sequential compression devices are often used, the pump hose frequently becomes disconnected — with no alarm or visual signal, Dr. Pronovost said.
A newer solution, which he called “wireless squeezy boots,” eliminates that problem but introduces another: The devices are battery-operated and require daily checks.
“Some of the work we do in safety and quality takes away work. But sometimes, like this, there’s new work added,” Dr. Pronovost said. “Like, whose role is it to charge the batteries? There’s often finger pointing — at least, in a less integrated culture.
“The team is telling me about this, and the unit secretary comes running up in front of me, stands in front of my face, and she says, ‘Dr. Pronovost, that’s my job. I prevent blood clots because every morning, when I come in, I go check these compressions, the batteries, and if they’re low, I replace them, and then we go charge them, and I make sure every day, every patient on them is getting what they need.'”
