American Association of Healthcare Executives

Ethical Issues Related to Workforce Shortages

Approved by the Board of Governors Dec. 5, 2022.

Statement of the Issue

Alleviating workforce shortages or adapting to them is a complex problem for which there are few easy solutions. Nevertheless, healthcare executives have an ethical responsibility to address any shortages that exist within their organizations in such a way that patient care is not compromised, existing staff are not unduly burdened and financial costs do not become excessive.

Policy Position

The American College of Healthcare Executives recommends that healthcare executives develop responsible action plans for delivering patient care in the face of workforce shortages. To this end, ACHE recommends that such plans address the following:

Attracting and retaining a qualified workforce by addressing issues important to today’s workforce, including strengthening the patient/clinician/executive partnership, treating each other with respect, promoting continuous quality improvement, and providing fair compensation, flexible scheduling and professional development.
Maintaining workloads, expectations and support that strive to alleviate and prevent burnout.
Examining workflow processes to ensure staff is being deployed in an effective manner to meet patient needs.
Creating systems for job assignments and backup coverage that ensure responsibilities are appropriately matched with qualifications.
Being sensitive to the financial and nonfinancial consequences of using temporary personnel to fill vacancies.
Responding to a rapid and significant demand for increased services that may require activation of the organization’s disaster plan, which could significantly impact staff availability over sustained periods, requiring multilevel backup capacity.
Conducting employee opinion surveys and exit interviews, using results to identify steps to improve job satisfaction.
Engaging employees to help define and address issues adversely affecting recruitment and retention objectives.
Advancing a diverse and culturally competent workforce, and embracing diversity, equity and inclusion.
Analyzing departments or units with high turnover rates to determine whether management shortcomings, working conditions and/or other factors may be contributing to morale problems.
Exploring, evaluating and implementing best practices from similar organizations that could be helpful in avoiding workforce shortages.
Closing units or diverting patients if workforce shortages become severe to ensure that patient care is not compromised and high-quality care is maintained.

Healthcare executives may find it beneficial to join forces with others in their service areas to address the problem of workforce shortages. Collaboration to recruit qualified employees will prove to be a more effective long-term strategy than competition for the same resources. ACHE encourages healthcare executives to collaborate on the development of creative, sustainable strategies that will benefit their respective organizations as well as help ensure that high-quality, affordable healthcare remains available in their communities.

In addition, ACHE encourages healthcare executives to work to ensure the future supply and diversity of healthcare workers. Healthcare executives should collaborate with others to expose students to and train them in clinical and managerial careers in healthcare.

Policy created: March 2002
Last revised: December 2022