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A hospital system improves both patient care and employee satisfaction

New quality and efficiency standards made measurable differences in patient outcomes and nursing-staff morale across a national military hospital network.


A large military hospital system, encompassing more than 70 hospitals, was struggling to motivate and retain its nursing staff; 40 percent of nurses were dissatisfied with their work environment, and more than 70 percent saw no clear path to career advancement. A dearth of mentoring and professional-development opportunities for junior nurses resulted in poor retention rates. The nursing staff’s low morale—combined with the fact that nursing roles and procedures were inconsistent and varied widely across hospitals—was negatively affecting the quality and efficiency of care provided.

The hospital system sought McKinsey’s help in developing a strategy to increase nurse satisfaction and retention and to improve the quality of patient care.


The McKinsey team took a multiphased approach to the project, starting with building a fact-based understanding of the organization’s performance and health.

Diagnostic phase

We first assessed the baseline levels of clinical performance and staff engagement among nurses, identifying major gaps. We conducted an extensive review of internal and external best practices—visiting hospitals across the country, engaging key stakeholders (including patients, doctors, nurses, and ward clerks), and studying the relevant clinical evidence. Based on the results of the assessment, we developed a novel system of care tailored for the military environment.

Pilot phase

We conducted a pilot to test and refine the new care system and to ensure that it would drive impact against key metrics, including patient outcomes, patient satisfaction, and staff engagement. Specific activities during this phase included instituting a systematic approach and metrics for measuring and tracking nursing-team performance, as well as standardizing communication processes among nurses and other medical staff. The pilot phase began within the medical and surgical units and eventually expanded to other units and outpatient clinics.

Full-scale transformation planning and implementation

We developed a phased, system-wide rollout plan that included all major care facilities in the system. We helped train leaders and change agents and supported the implementation of a performance-management system that collects and tracks ten priority metrics at all levels of the organization and identifies areas for performance improvement and best practices across the system.

The client’s internal change-leadership team then took responsibility for governance of the transformation program and national rollout of the initiatives. To help the transformation “stick” and become deeply embedded in the client’s institutional culture, we focused on ensuring consistent use of performance-management systems, clinical standards, training, and strategic communication.


The transformation program yielded positive results across a variety of metrics, including increased patient communication, enhanced professionalism within the nursing team, and improvements in quality-of-care indicators. Specific examples of impact include the following:

  • reduced absentee rates among nurses
  • higher levels of employee engagement
  • increased quality of care at pilot sites (for instance, nurses’ medication-administration errors decreased by 1.2 per full-time employee per 100 patient days)
  • greater compliance with quality-of-care initiatives (for example, the percentage of pain reassessments completed rose from 90 percent to 99 percent)
  • financial savings from reduced total overtime and contract hours (for instance, one pilot site reduced costs by $140,000 over three 1-week pay periods)

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