The workforce pressure on our increasingly strained health-care system is not a Human Resources (HR) problem; it’s a human problem that affects every single person in the chain of care, from physicians and Personal Support Workers to the administrative teams who hold it all together.
If we are serious about sustainability, we need to be honest about what is broken at a system level – and equally clear about what HR departments can and must do within those constraints. While we continue the essential, slow work of advocating for major policy reform, we have a parallel responsibility to challenge our own assumptions about how work is designed and experienced within our organizations. We can’t wait for the system to be fixed to start fixing the experience of working within it.
Many of the most pressing workforce challenges in health care today are structural, not organizational. Across the system, fragmented funding approaches, siloed services and technologies that do not integrate create inefficiencies that affect both frontline and non-frontline staff. Time that should be spent on care, coordination or quality improvement is often redirected toward navigating gaps between systems.
This has real consequences for the workforce. When roles are shaped by inefficiency rather than purpose, frustration increases, burnout accelerates and retention becomes more difficult.
These pressures are especially pronounced in home and community care, with funding for home care still lagging institutional care and wage disparities between home care and hospitals contributing to ongoing recruitment and retention challenges. In The Cost of Turnover in Home Healthcare: A Conceptual Model, researchers highlight the costs to our health-care sector. Homecare providers have some of the lowest retention rates in health care, with high turnover disrupting care continuity and pushing patients into more expensive settings, such as hospitals. In this context, turnover becomes a major health system cost problem.
What is clearly needed is sustained advocacy for major policy reforms and investments to address these system-level pressures. At the same time, this work is complex and often slow to yield results.
The question then becomes: what can organizations do now, within these constraints, to improve workforce sustainability? The simple reality is that acknowledging structural limits does not absolve organizations of responsibility for how work is designed and experienced. Even within an imperfect system, HR continues to play a significant role in shaping whether jobs feel doable and whether people choose to stay.
One area that needs to evolve is how we define commitment and, more broadly, how we fundamentally structure work without losing stability, predictability and a sense of belonging. For too long, commitment has been equated with full-time hours and maximum availability. In a sector facing workforce shortages and growing demand, that definition is increasingly unworkable.
A more sustainable approach recognizes that commitment can take many forms, including part-time roles that are treated as real, stable employment, not stopgaps. Modular Work Design roles should be intentionally designed to vary in hours, schedules and responsibilities so people can contribute meaningfully without being stretched beyond what they can sustain. Clear expectations, predictable patterns where possible and manageable workloads anchor these roles as flexibility allows for a range of working arrangements.
Sustainability depends on this balance: enabling different ways of working while maintaining the stability, predictability and sense of belonging that allow employees to thrive.
Retention depends less on abstract promises and more on concrete experiences, particularly during the first months of employment. Recognizing this, Circle of Care has intentionally invested focus, time and resources to support new employees during this critical period.
Our PSW Preceptorship Program is one of many examples: new hires are paired with experienced staff during early client visits and supported by a buddy system.
This approach extends across our workforce. Every new employee is connected to a network of colleagues who help them navigate the organization, introduced to multiple departments to understand how the system operates and supported through Learning & Development resources. Through Cross Functional Immersion, our new hires are encouraged to spend the day at our Adult Day Program and do a Meals on Wheels delivery, providing insight into other parts of the organization and fostering cross-team understanding.
These deliberate investments in early tenure create a strong sense of support, belonging and confidence. The results are clear: structured onboarding and mentorship reduce early attrition, help experienced staff grow into leadership roles and reinforce that meaningful career growth does not require leaving the organization – or the sector.
Workforce sustainability is not limited to frontline roles. It depends on strong leadership and clear pathways for growth across all functions.
At a time of intense workforce pressure, organizations must invest in leadership capacity. First, by hiring the right leaders: people who are comfortable engaging with their teams and valuing input, but who also can take that input and provide clarity amid complexity. Second, by developing leaders from within through sustained education and mentoring, equipping them to continually refine their skills and adapt to evolving workforce needs.
Central to effective leadership is transparency. Leaders must clearly communicate what roles involve, the trade-offs required and the opportunities available. Employees need to feel supported in their current roles while also understanding how strong performance can lead to growth.
Growth opportunities should be both vertical and lateral, allowing employees to deepen expertise, expand responsibilities or explore new roles within the organization. When growth is absent and roles feel static, even highly committed staff can disengage, contributing to burnout and turnover across all levels of the workforce.
HR is often framed as a compliance function, but it shapes the conditions of everyday work. At a time when retention is critical and system pressures are intensifying, workforce sustainability cannot be left to chance.
Broader system reform is essential and must continue to be advocated for. In parallel, organizations must take responsibility for designing work that people can realistically sustain. There is still meaningful work to be done to improve how roles are structured, how people are supported and how organizations create conditions where staff can stay and thrive.
