Doctors and nurses in the UK are not in a happy place. According to Bain’s latest UK Front Line of Healthcare Survey, 23% of doctors and 50% of nurses in the UK are considering switching careers, and 27% of UK doctors and 37% of UK nurses are contemplating switching employers. These medical professionals cite burnout, excessive workload, and lack of recognition as driving factors behind their desire for a workplace shift. Currently, more than 60% of UK clinicians say they feel worn out at the end of the workday, and only 41% report feeling as though their job meets their basic physical and mental needs.

The impact of clinicians switching careers and employers over the past few years has been mixed. In 2022, a record high of nearly 170,000 workers, including 41,000 nurses, left NHS hospitals and community health services. Despite these losses, the total number of full-time employees (FTEs) working in the NHS grew by more than 20% between 2019 and 2024. Nurse vacancy rates also dropped by almost three percentage points, from 11.1% to 8.4%, from December 2018 to December 2023. 

Even with this recent significant increase in the size of the NHS workforce, nearly 90% of hospital managers still report experiencing organisational challenges in recruiting and retaining doctors and nurses. Moreover, around 40% of doctors believe that their organisation’s challenges with recruiting and retention are due to clinician dissatisfaction.

In addition to recruiting and retention pressures, NHS Trust Boards face challenging questions surrounding how best to improve their overall workforce productivity. Over the past five years, the NHS has seen its FTE establishments grow by nearly 250,000 and its annual spending on agency staff pay climb by nearly 12% per year. This surge in budgetary pressures comes at a time when yearly volume of hospital patients treated for elective procedures has fallen by 3% and the average wait times for hospital procedures has increased from 8 to 15 weeks, adding 3 million patients to the waitlist for treatment.

As noted in NHS England’s own analysis, the challenge for hospital managers is reconciling the fact that productivity remains down despite an increased number of staff and reduced hospital vacancy rates. This vexing productivity challenge is further complicated by the fact that only 34% of our surveyed clinicians and 24% of doctors in the 2023 UK Staff Survey report feeling that their teams are adequately staffed to provide high-quality patient care.

Getting to the bottom of clinician dissatisfaction

There is no single cause for the reduction in NHS productivity, but clinician dissatisfaction certainly plays a key role. After nearly two years of unprecedented and protracted pay disputes and strike action, clinicians in the UK remain largely dissatisfied with workplace salaries, professional demands, and long-term career sustainability. Only about 40% of doctors report being satisfied with compensation, staffing/workload, and benefits. More specifically, nearly 70% do not believe they are compensated fairly for the work they do.

Our survey uncovers significant differences in how doctors and nurses value certain professional aspects of their jobs and in what areas of their work and to what degree they feel satisfied or dissatisfied. Doctors rank professional development and compensation as their two most important job considerations, followed by staffing/workload, teaming and inclusion, and recognition (see Figure 1). For nurses, however, professional development is by far the highest priority, followed somewhat distantly by staffing/workload, flexibility, teaming and inclusion, and compensation (see Figure 2).

Figure 1

Figure 2

Although overall reported workplace satisfaction is low for doctors and nurses, our survey uncovered observable differences in degrees of satisfaction across specific professional dimensions. These findings point to several areas primed for improvement: specifically, job components that matter most to clinicians and those they feel their employers perform particularly poorly.

Within our survey population, the areas of highest priority for improvement in order to increase doctors’ satisfaction are compensation, recognition, and flexibility. These are the dimensions that our Front Line of Healthcare Survey has found to have a disproportional likelihood to create promoters and detractors (i.e., those who might either recommend their employer to friends and colleagues or criticize them, depending on their degree of workplace happiness) and with which doctors are broadly dissatisfied with today.

In fact, approximately 60% of doctors who are currently employer detractors report that improvements in recognition would significantly increase their Net Promoter Score^SM. Further, around 65% of doctors considering switching employers report that improved workplace recognition would make them strongly consider staying in their current role.

For nurses, meanwhile, professional development stands out as a prime area for improvement—despite its high reported satisfaction rates—due to this category’s disproportionate likelihood to delight and disappoint. With this in mind, hospitals should prioritise ongoing investments that support continued professional development efforts for their nursing staff. Likewise, compensation and flexibility emerge as additional improvement areas meriting focus for nurses, given that both factors considerably impact nurses’ Net Promoter Score and have very low satisfaction rates.

While benefits stood out as a dimension with very low satisfaction across the board, doctors’ and nurses’ views on the topic again varied significantly. Doctors rank “study leave” and “comfortable breakrooms” as the two benefits most likely to increase their workplace satisfaction. On the other hand, nurses rank “childcare support” significantly ahead of any other desired workplace benefit—including sick leave, pension programs, parental leave, salary sacrifice schemes, and discount programs.

Clinicians also report that their access to information, tools, and resources during the typical workday is far below ideal. Less than half of doctors believe that the technology they use helps them do their job better, and only 41% believe they have access to effective processes and workflows.

All in all, our survey finds that most clinicians in the UK today do not believe they have the resources needed to operate at their full potential or deliver high-quality patient care. In such an environment, meeting expectations of high productivity is challenging, if not impossible.

The treatment plan

Amid pressures to curtail mounting cost demands, it could be easy to overlook or discount the urgency of improving clinician satisfaction. But past experiences have proved that trying to control costs and improve productivity without appropriately engaging frontline workers and supporting their satisfaction backfires on employers.

In fact, employee engagement in and of itself has been shown to reduce healthcare costs and increase productivity within healthcare settings. Longitudinal analysis has shown that a slight increase (1%) in staff engagement can lead to a 3% reduction in hospital-acquired complications and a 7% reduction in hospital readmissions.

In times of change, employee engagement is even more critical. When organisations engage employees appropriately in performance improvement initiatives, they are more likely to move organisational energy in their favour to capture long-lasting results. The recent successful transformation of Virgin Australia exemplifies the power of this type of transitional engagement approach. There, leadership assessed the impact that each proposed change would have on employees while consciously scheduling initiatives to avoid overburdening their staff.

With NHS budgets already stretched thin, it can be tempting to focus only on bottom-line financial impacts. However, if hospital managers are to address and solve the lingering productivity crisis, they must prioritise improving clinician experience as a vital part of their treatment plan.

We recognise that different NHS trusts are at different stages along their employee-experience journeys. No matter their stage, every NHS trust can find value in investing in a well-crafted, clinician-centric engagement strategy. The following section outlines actionable steps trusts can take as they evaluate their in-year priorities.

Establishing effective systems to assess and act on clinician feedback

Listening to clinicians and implementing initiatives to address their feedback can go a long way in improving their satisfaction. Yet, only half of surveyed clinicians say their organisation routinely assesses employee experience.

To audit and act on clinician feedback effectively, hospital managers must first recognise that there are significant differences in how clinicians perceive value. Perceptions vary between doctors and nurses and at the individual worker level. Thus, there is little to no value in looking for one-size-fits-all solutions to improving clinician experience, especially if these so-called fixes are designed and mandated far from the front line.

Similarly, overinvesting in improving areas that clinicians rank as having low value is sure to deliver low or marginal returns. Instead, hospital leadership must work to understand what truly drives local clinicians—including how they perceive value—if they are to appropriately identify and calibrate investments that will effectively boost their clinician value proposition.

To effectively leverage clinician input, organisations must also move beyond collecting baseline feedback and simply tracking Net Promotor Score or other satisfaction metrics. Rather, they should implement systems that can more accurately identify drivers of satisfaction at the individual level and work to establish closed-loop feedback systems, such as the employee Net Promoter System^®.

Closed-loop feedback systems promote continuous improvement of clinician (and patient) experience by routing issues to the right teams, prioritising initiatives by their degree of potential impact on  satisfaction, and tracking progress against prioritised initiatives. In one successful test case, a cancer-focused healthcare provider in the UK that had been struggling with over-burdened staff and an unresponsive feedback system recently enacted efforts to improve both metrics. After implementing a closed-loop feedback system for patients and employees, the organisation achieved an 85% staff survey completion rate and full attendance in weekly huddles. It also successfully identified two to five prioritised actions per month and pinpointed more than 30 insights to improve staff and patient experience per pathway, during its feedback system’s pilot phase.  

Build a culture of support and recognition

Feeling supported and recognised by their employers are two foundational building blocks of clinician satisfaction. A supportive culture where clinicians feel appreciated enhances morale, reduces employee turnover, and improves patient outcomes. Yet, our recent study shows that most clinicians do not feel that their managers and leadership teams adequately support them to do their jobs effectively. Most clinicians also feel that their organisations fail to effectively recognise employees for their efforts or to celebrate their successes.

Internationally, a few leading health systems have provided examples of how to better support clinicians, including listening to their needs and finding more proactive ways to recognise their efforts and successes. Cleveland Clinic, for example, has implemented a formal employee recognition program in hopes of reducing clinician turnover and improving patient experience. Called Caregiver Celebrations, this recognition platform empowers clinicians to acknowledge one another for outstanding behaviour and performance through awards such as the Appreciation Award and Teaching Recognition Award. These awards are then shared publicly via corporate communications channels such as emails or videos.

Establishing a culture of support—through mentorship, professional development, and access to resources—is another critical step in showing clinician appreciation. One of the largest not-for-profit health systems in the US has developed support programs to improve nurse satisfaction and reduce turnover by focusing on coaching and career sponsorship and investing in nurse leadership development. These programs provide nurses with an opportunity to share their passions, goals, and ambitions one-on-one with mentors or career coaches. To date, the programs have yielded tangible results, including a retention rate of nearly 95% for participating nurses.

Unlock the potential of automation and generative AI

Day-to-day operational inefficiencies in the healthcare system are undeniably high. Currently, 63% of doctors report that they are required to fill out excessive forms and paperwork, while 52% feel they perform low-value and repetitive tasks that could otherwise be automated or simplified. In addition, doctors and nurses lose productivity and time each day while waiting for others to complete care-adjacent tasks. 

Generative AI has the potential to address and remove these operational inefficiencies, as shown by organisations at the forefront of generative AI adoption. For example, Klarna, a global payment solutions provider, reduced the average completion time for its customer service inquiries to less than a third and saw a 25% drop in repeat inquiries, after having AI handle two-thirds of its customer service chats globally. Similarly, one UK hospital expects to unlock over £2 million in net recurrent cost savings annually through the planned automation of its human resources processes, financial management, and patient administration. AI-driven automation processes are also projected to increase its back-office efficiency by about 15% to 20%, bringing the hospital to the top quartile in their industry for efficiency in functional spend.

However, technology can, at times, inadvertently create new, unintended workplace hurdles for clinicians rather than reducing their administrative demands. This risk is particularly great when organisations attempt to integrate new AI-driven systems without first investing in proper staff training or operational infrastructure. Case in point, the NHS is set to receive a £3.4 billion capital investment for digital transformation, automation, and other productivity boosters—a windfall it hopes will unlock £35 billion in productivity savings. However, most administrators report that their provider organisations are not yet ready to successfully incorporate generative AI at scale, citing a lack of discrete use cases, clear vision, leadership commitment, or required technology architecture or processes.

To succeed in implementing deeper and broader automation, including the incorporation of generative AI, health systems must first have a clear understanding of their operational starting point. For example, in most hospitals, mapping of processes across departments, including human resources, finance, clinician decision support, or patient administration, is being conducted manually rather than through automated means. In these cases, before generative AI can be utilised to boost efficiency, hospitals will need to take critical steps to automate their data collection processes.

Next, organisations should build on existing infrastructure and capabilities by adopting a standardised assessment framework to estimate measurable benefits (e.g., productivity improvement), evaluate associated costs, and analyse opportunities for future improvement.

In cases where the benefits of automation are uncertain, organisations should consider developing proof-of-concept projects to test potential advantages and gather user feedback. With this information, hospitals can create a multiyear roadmap that outlines steps required for successful implementation of broader generative AI—from use-case deployment strategy to talent, operating models, and risk management and governance mechanisms.

During this transition process, targeting the automation efforts of high-priority or high-potential tasks will be critical. Healthcare managers and their information technology teams can design, build, and deploy agile generative AI solutions by focusing first on “low-hanging fruit” functions to test and learn before attempting more complex tasks. In this way, hospitals can ensure that their operational systems are forward-looking, responsive to change, and embedded with the capacity for continuous improvement.

Industry

Healthcare Providers and Services

As healthcare systems embark on their journey to improve productivity, they will need to engage their clinicians and learn about what truly matters to them, beyond what was captured in the NHS Staff Survey. We support our NHS and other healthcare provider clients in delivering these transformative changes and results by offering Bain’s expertise and experience in performance and productivity improvement, implementing closed-loop feedback systems, redesigning clinician value proposition models, and unlocking the potential of automation and generative AI across global health systems.

About IncQuery

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