Cost of Friction in Care

Looking beyond turnover to understand how structure, environment, and execution shape retention.

In healthcare, turnover has become so normalized that one in five people leaving each year

barely raises concern—numbers that would feel destabilizing in most other fields.

Behavior is communication, and the complex nature of healthcare environments poses significant challenges to optimizing space and experience, especially since the primary purpose of these facilities is to provide medical care. While designing spaces to enhance wellbeing is valuable, certain circumstances don’t always allow for it.

Most healthcare workers don’t leave because they stopped caring. They leave because caring without the necessary environment is unsustainable. The common way that systems are measured is in the form of metrics that reveal statistical type data. Let’s take it one step deeper, numbers reflect what is happening. What would we discover if we also explored why it is happening?

When we focus only on what is happening—like turnover numbers or productivity

metrics—without asking why, we often miss the most powerful factor for meaningful change. An individual’s behavior is deeply shaped by their environment and how it makes them feel. That environment also includes the people sharing the space, whose behaviors ripple through daily experience. Taking a closer look at common reasons that are reported for individuals transitioning out of a healthcare job, it's rarely that the work itself was causing the strain; more often, it’s how the work is structured—workflow inefficiencies, unclear communication, and broken operational systems.

If we parallel this idea to a physical therapy evaluation, the focus shifts to identifying the

physiological structures causing imbalance and taking a targeted approach with interventions to restore balance. Through this process, muscles become stronger or more flexible, balance is practiced and refined, and modifications are made to activities or environments. Ultimately, this promotes a higher-quality movement pattern that helps prevent dysfunction from recurring.

Over nearly a decade practicing as a physical therapist, I’ve observed firsthand how our

healthcare system continually shifts and adapts. Working as a traveling physical therapist gave me the unique opportunity to broaden my perspective on environments—not just through diverse clinical settings but also by experiencing the variations across different regions of the country. I’ve had the opportunity to witness how different environments shape both care and the people who provide it. This broad exposure has given me a nuanced understanding of how operational systems, culture, and human experience intertwine. It has become clear to me that meaningful change requires more than surface-level fixes; it demands a deep, intentional examination of the spaces we create—both physical and organizational—and a commitment to fostering environments where people feel supported, valued, and empowered to thrive.