Clinician engagement is key to driving effective cost and tech change at health systems

Nearly 100% of health systems surveyed are actively pursuing improvements in cost, quality, and clinical operations

The findings from the 2025 Health System Leader Survey indicate that nearly all organizations are engaged in some form of improvement initiative. In fact, 97% of the surveyed leaders reported their organizations are actively pursuing cost-transformation efforts, such as implementing new technologies, redesigning care delivery, and making process changes.

When asked about their workforce priorities for this year, leaders cited an increased focus on quality, cost, and operational efficiency. This is likely becoming more important in today’s challenging health care landscape, where organizations are under margin pressures and are seeking cost optimization. The findings show:

• 60% of health system leaders are focused on effectively managing hospital throughput, bed utilization, and staffing levels.
•  53% are focused on enhancing the quality and safety of care delivery.
• 43% are working to improve clinical operations efficiency and reduce costs.

Successfully executing these initiatives involves health systems engaging the clinical workforce, building trust, and securing their buy-in (figure 1).  

Clinicians’ needs are likely not being prioritized in workforce efforts

The surveyed clinicians expressed concerns that cost and technology initiatives can sometimes overlook the realities faced by frontline staff. As one physician at a health system explained, organizational technology and cost initiatives often increase the demand on physicians to see more patients, which can result in lower quality care for patients. This perspective highlights how a misalignment between organizational priorities and workforce realities can contribute to physician burnout and impact overall workforce stability.

The frontline clinician survey found that only 31% of respondents trust their organization’s leadership to do what’s right for patients, and even fewer (15%) trust leadership to do what’s right for workers. These figures represent a notable decline from Deloitte’s 2022 clinical workforce research, when 45% of clinicians reported trust in leadership to do right by patients and 23% trusted them to do right by workers.

Trust in executive leadership to act in the best interests of workers is higher among clinicians working in free-standing hospitals (38%) compared to those in large health systems (13%) and academic medical centers (17%), according to the 2025 US Health Care Frontline Clinician and Health System Leader surveys. This suggests that as organizations grow in size and complexity, coupled with uncertain regulatory and market conditions,¹ it becomes more challenging to effectively engage the workforce. As a result, clinicians in large health systems may experience a greater sense of disconnect and lower levels of trust compared to those in smaller, free-standing hospitals.²

Three key disconnects undermining clinician engagement in health systems

A comparison of responses from the frontline clinician and health system leader surveys reveals gaps between how leaders perceive clinician engagement and what frontline clinicians actually experience. Three key disconnects emerged (figure 2):

• Trust disconnect: While leaders believe clinicians trust their health system leadership, frontline clinicians reported otherwise. More than half of leaders (53%) said that clinicians trust executive leadership to enable the best care for all patients, and 43% said clinicians trust leadership to support the workforce. In contrast, only a small fraction of clinicians expressed this level of trust, highlighting a substantial gap in perception.

• Workforce engagement disconnect: While 93% of leaders reported that their health systems are making efforts to improve clinician engagement, skills, and communication as part of broader improvement initiatives, only 47% of clinicians agreed that these efforts exist. This disconnect may be due to insufficient communication about these initiatives or a lack of focus on what matters most to frontline clinicians. For instance, leaders reported limited emphasis on workforce buy-in for transformation (7%), career development (7%), and employee well-being programs (20%)—all areas that clinicians value for building trust and engagement.
• Collaboration disconnect: The surveyed leaders believe that clinicians are highly involved in organizational initiatives, with 93% stating that clinicians lead, co-lead, or regularly contribute to transformation efforts. However, 50% of clinicians reported having rare or no involvement. This gap in perception may be due to involvement being limited to clinical leaders, rather than including frontline clinicians—an observation also pointed out by one physician respondent.

Bridging the gap between frontline clinicians and leadership

While leaders may already be taking steps to engage clinicians, organizations can further strengthen improvement initiatives by actively involving those delivering care to help manage change more effectively and maximize value. Here are three actions leaders can consider:

Ensure transparent communication to build trust

Research has demonstrated that 79% of employees who trust their employer are more motivated to work and less likely to leave the organization.³ Transparency is an important factor in building trust⁴ and is an important aspect for clinicians. Along these lines, the Frontline Clinician Survey found that:

• Eight out of 10 surveyed clinicians indicated that clear, consistent communication and transparency about how their feedback is being addressed are extremely or very important to them.
• More than 80% of respondents emphasized the need to understand the rationale behind organizational changes.
• Seventy percent of respondents stated that receiving information about technology and cost efforts—including the nature of these changes, their impact on clinician roles, and updates on progress and measurement—is important.

These sentiments are further emphasized by a registered nurse at a health system, who notes that, “Always the same feedback for any change in the organization: invite more staff participation and inform staff on the rationale for changes that are being made.”

Respondents in the Health System Leader Survey also recognized the importance of transparent communication. In fact, involving the clinical workforce (43%) and maintaining effective communication and transparency with the workforce (33%) were identified by leaders as the top two drivers for achieving greater value in transformation projects (figure 3).

Here are a couple of potential approaches to consider for improving communication with clinicians:

• Focus on effective modes of communication: Organizations can prioritize communication methods that are most likely to resonate with clinicians. While many engage staff across multiple forums, including shift huddles, all-hands meetings, monthly forums, and emails, the survey findings show that live, in-person communication is generally the most impactful, especially since clinicians may not always be digitally accessible. As one registered nurse notes “Help the clinicians be more involved with the transformation effort at the ground level: more live or in-person communication on a regular basis.” Leaders can focus on connecting directly with clinical teams in person during shift changes to help ensure consistent, clear messaging for all staff.
• Listen to clinician feedback and address it: Organizations should help ensure that clinicians feel heard and can see tangible changes resulting from their feedback, which can foster engagement and strengthen trust with leadership.⁵ This might involve using insights from employee engagement surveys and qualitative employee feedback (gathered during town halls or one-on-one conversations) to drive clinician and leadership alignment. Promptly acknowledging input, summarizing key themes, and translating feedback into visible action plans with assigned ownership are important steps. Activating leadership to communicate with transparency and to consistently share regular updates using data with tailored messaging for each workforce segment can also help establish the foundation for trust.

Activate clinicians throughout initiatives

Leaders should consider clinicians as co-architects of change and actively engage them at every stage of the improvement initiatives—from planning and design to implementation and post-implementation. As one physician from an academic medical center shares “Prioritize early engagement with frontline staff when introducing new technologies or cost-saving initiatives.” Furthermore, involvement should be structured as co-creation, with clinician input starting from the outset, which addresses another component of trust building: putting the human at the center.⁶ A recently published study aimed at identifying the factors that influence early, mid-term, and sustained acceptance and use of clinical decision support systems in health systems found that ongoing engagement is key, as fragmented or piecemeal approaches often fall short.⁷

Importantly, engagement should extend beyond clinical leaders or subject matter specialists. As one physician at a health system explains, “Please involve end users, not just the department leaders, in product evaluation.” Involving frontline clinicians—the end users—can provide valuable perspectives.

The positive impact of clinician feedback and co-creation is evident in areas such as ambient AI and related technologies.⁸ For example, some health systems that engaged multiple clinicians across specialties and settings in piloting, feedback, and co-design of ambient AI technologies were able to shape solutions that aligned more naturally with workflows, leading to decreased documentation burden and gains in efficiency, utilization, and provider well-being.⁹

In another example, a regional nonprofit integrated health system implemented a comprehensive nursing strategic plan that directly engaged nurses and integrated their input into organizational initiatives. The plan focused on aligning nursing goals with the organization’s broader mission, establishing a dedicated system to drive and support change, and developing leadership to implement change. As a result, the health system increased nurse engagement, improved patient care, and realized a US$64.1 million financial impact.¹⁰

However, as organizations broaden participation, they should carefully manage clinicians’ workloads and create appropriate conditions for engagement. This includes planning for appropriate incentives and workload capacity to help ensure that participation is sustainable rather than burdensome.

Here are a few potential approaches to consider in order to help actively involve clinicians:

• Drive sustained impact through clinician-centered innovation incubators or labs: While many organizations have innovation labs, making them impactful involves consistent focus on workforce engagement and meaningful measurement of outcomes, among other things.¹¹ Leaders should consider supporting clinicians who show interest by giving them time, resources, and clear pathways to advance their ideas. Help make participation rewarding through mentorship, recognition, and balance that respects their clinical responsibilities.

It’s also important to establish a clear framework with agreed-upon financial and non-financial workforce metrics—defining how they are calculated and ensuring they are tracked consistently over time. Budgeting is equally important to consider, as it signals organizational commitment and enables continuous clinician participation in designing meaningful, people-centered solutions. When thoughtfully designed, these labs can become powerful engines for clinician-led transformation.

• Increase access to user testing and feedback loops: When engaging clinicians, seek opportunities to involve them in the flow of work, rather than relying on lengthy email chains or excessive meetings. Offer trial periods for frontline staff before fully launching new technologies or processes. Provide protected time for them to test new workflows and submit feedback in real time, such as during staff meetings. Integrate collaboration tools into their daily routines to capture this input efficiently. Some survey respondents emphasized the importance of leaders seeking feedback from those using the technologies in their day-to-day work. As one registered nurse at a health system says, “Listen to the people who are using or expected to use the technology regularly to draft and implement technological changes and make improvements accordingly.”

To help these efforts be successful, organizations should consider closing the loop by responding to feedback, either by making changes or explaining why a suggestion may not be adopted and seeking further feedback. Additionally, organizations should consider establishing metrics to track engagement, such as employee engagement surveys, listening sessions, and workforce analytics, to support ongoing improvement.¹² Sustained participation may also involve proactive planning for backup staff or offering financial incentives. While that may seem counterintuitive in the case of cost containment efforts, the resulting benefits could greatly outweigh the expenses.¹³

•  Empower line managers: When line managers (those who supervise staff) are involved in organizational initiatives and given tools to help their teams achieve them, it can empower those closest to the work. This tends to build trust in the process and the outcomes. Because line managers often have clinician backgrounds or strong relationships with frontline clinical staff, they can potentially serve as central conduits for clinician activation. Their deep understanding of the day-to-day operations of their units, their people, and how work will be impacted can enable them to effectively identify and plan for clinician involvement in design, validation, and testing initiatives. 

Enhance clinicians’ capability through technology

When asked about the tools or resources they need to be more effective in their roles, clinicians often mentioned technology: 30% wanted modern, integrated technological tools, and 22% wanted AI to be implemented in clinical workflows. This suggests that clinicians are likely to be open to technology that supports their work.

To understand leader perspectives, we held a focus group with 15 chief medical informatics officers in collaboration with The College of Healthcare Information Management Executives. The executives we spoke with agreed that clinicians are receptive to new technologies that improve efficiency, deliver return on investment, and enhance patient care without causing delays. One chief medical informatics officer we interviewed explained that if the tool doesn’t slow users down, they are more likely to be willing to implement it. However, any tool that distracts them from patient care will be rejected.

As organizations adopt new tools and technologies, they could consider the following actions to place workforce needs at the forefront and ensure technology empowers (not hinders) clinicians:

• Establish strong governance: Recent research from the Deloitte Center for Health Solutions shows that involving end users, including clinicians, in designing tech initiatives is an important driver for success.¹⁴ Although health care organizations appear to be investing in initiatives to engage clinicians to adopt new tools and technologies, establishing strong governance processes around these is important for organizations. Health care organizations can create structures that involve clinicians as key decision-makers, embed mechanisms for bidirectional feedback, and align on data metrics to measure, monitor, and use as intelligence for regular improvement. Ensure frontline clinicians are effectively involved in the design, validation, and testing of new technologies and associated processes so that they can be integrated into the flow of work from their perspective.
• Develop change champions: Organizations can consider developing change champions among frontline clinician staff who can participate in change impact assessment sessions, advocate for new technologies, and share positive, real-world experiences with peers. This can help build additional trust and credibility in the solutions. For instance, a large pediatric hospital implemented a new electronic health record system by engaging staff representatives as change champions, gathering regular feedback, and conducting dress rehearsals.¹⁵ Units that embraced these practices experienced smoother transitions and higher engagement.¹⁶
• Invest in learning and development opportunities: Organizations should consider investing in learning and development opportunities (access to courses, trainers, and supporting resources) designed specifically for frontline clinicians in various formats (in person, virtual, or asynchronous) to build their awareness and knowledge about the new technology being implemented and help them be comfortable with its usage. Showing clinicians the benefits of these technologies with use cases and proof points will build confidence and encourage adoption.
• Communicate expectations and impact: To help successfully implement new technology, it’s important to communicate expectations and role changes clearly. Provide ongoing support and gather feedback to optimize the technology and help ensure a smooth transition. Establish processes to regularly assess and communicate the technology’s value by highlighting its impact on cost savings, workflow improvements, clinician well-being, and collaboration with leadership.

Leveraging workforce engagement for organizational value

Empathizing with frontline clinicians, understanding their needs, and prioritizing their well-being are important for building trust and driving engagement, productivity, and satisfaction. Without clinician buy-in, organizations may struggle to realize the full value of technology and cost-improvement initiatives. By prioritizing workforce engagement, organizations can unlock the true potential of these efforts, possibly leading to better care delivery, enhanced patient experience, and ultimately, stronger organizational performance and growth.