OUR HEALTH CARE workforce requires the immediate and sustained attention of health system governing boards. The current conditions within the health care workplace have led to a significant destabilization in the caregiving workforce and are having an undeniable impact on patient outcomes and the ability to serve the community. We have also seen overwhelming evidence of the negative financial consequences to our health care organizations if workforce challenges are not effectively resolved.

Over several decades, health care governing boards have appropriately broadened their financially focused agenda to include quality, patient experience, and other strategic concerns.1 In a prescient prepandemic article published in 2018 by the American Hospital Association (AHA) Trustee Services, health care governing boards were encouraged to "elevate the discussion about workforce planning and development to ensure it becomes a standing, rather than crisis driven, component of ... strategic planning."2^(p1)

However, according to the AHA 2022 National Health Care Governance Survey, only 3% of health system boards have a standing committee focused on workforce compared with finance (99%) and quality (91%). The current metrics included in board reports to monitor organizational performance related to workforce are most commonly limited to physician (72%) and employee engagement (96%).2,3

Executive nurse and physician leaders and their human resources colleagues play a critical role in educating governing boards regarding the current state of the health care workforce, both within their organization and across the country. Senior leaders need to encourage governing boards to fully embrace their accountability in this vital area of organizational performance. Board oversight should begin with ensuring the design and implementation of a comprehensive strategic workforce development plan that includes appropriate metrics, ensures a healthy work environment, and can realistically provide a sufficient and qualified workforce that can support and sustain quality patient care now and into the future. This includes providing the needed infrastructure (reasonable span of control), technology, and resources to support the efficient use of the clinical workforce and other care assets. While organizational cultures and local employment landscapes can vary greatly, a thoughtful and comprehensive workforce development plan should be the cornerstone of every health care organization's strategic plan. There is no mission or margin without caregivers.

To fulfill their oversight function, governing boards need visibility of key workforce metrics that reflect the status of the current workforce as well as the investments being made to ensure availability of future caregivers. Understanding and quantifying the effectiveness of current recruitment, onboarding, retention, and workforce development strategies are key to educating the board and helping maintain focus on this important topic. It is also important for boards to support critical investments in local clinician pipelines, career development activities, and clinical leader and provider succession plans as these are all necessary and an essential part of an effective workforce plan.4

Collaboration among key leaders across operations, clinical, and human resources is key to presenting a unified and balanced workforce strategy to the governing board. It is important for boards to understand that multiyear investments and sustained commitment are required for many workforce development strategies to be successful. Progress toward workforce-related goals can be a routine board report and a performance goal for senior leaders. An essential competency of senior leaders is the ability to build and sustain an organizational culture that ensures an engaged and loyal workforce.

While the pandemic heightened our workforce challenges, it did not create them. The sustained focus of governing boards and their senior leaders is urgently required to ensure that health care's workforce challenges are identified, addressed, and conquered. Otherwise, we may find ourselves with no one left to care for us.

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