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The Three Biggest Contributors To Employee Disengagement And What to Do About It

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Employees are more disengaged than ever. There are ways to help

By Jenna Gourlay, PT, DPT, and Phil Plisky, PT, DSc

You’ve stayed positive. You’ve been encouraging. You’ve taken an interest in your team. Yet your staff still doesn’t seem engaged, and the lack of energy is palpable. You’ve heard rumblings of complaints, and the team is unsatisfied no matter what you do. You’ve tried team-building events, catered lunches, and a bunch of other sincere gestures. Despite your effort, your team is disgruntled and anxious to leave at the end of the day.

This dissatisfaction is not an uncommon problem, with nearly 50% of physical therapists stating that they feel more burned out in 2020 than ever before and only 19% reporting that they do not feel burned out. In addition to burnout, many physical therapists feel less optimistic about the profession’s future.1 The presence of burnout and fear of the future is enough to undermine the cohesiveness and positive culture we try so hard to foster in our clinics. With this many therapists reporting these feelings, it is no longer a question of if you will face a struggle with culture, but the question of when.

These statistics should not discourage or worry, but rather identify a problem and allow us to discuss a solution. Besides making for an unpleasant workday, disgruntled teams cause lower productivity levels and increased turnover of employees. Just because your team is no longer what it once was, or you’ve hit a difficult period in your company’s culture, does not mean that you are doomed. Instead, it is an opportunity to reevaluate and create a more desirable work environment that cultivates loyalty and productivity.

There are three main contributors to employee disengagement and corresponding solutions for each. Each solution only works if there are no deep-rooted culture problems. Working environments go through ebbs and flows, and you can address these changes. However, none of these solutions can repair toxic problems within a culture. Larger problems such as an understaffed and chronically overworked team, personal or professional mistreatment, and unrealistic expectations will require a systemic fix versus these solutions. For the better, most physical therapy companies are dealing with a disgruntled team and not a toxic environment.

Let’s look at the three most significant contributors that often lead even the best teams astray.


Autonomy sounds like a broken record at this point. The word is thrown around from the early days of physical therapy school. While the power of the word autonomy may have weakened with its redundancy, the need for it has not. Now more than ever, new graduates report flexibility and work-life balance as two of the most important aspects of a job.1 Yet, they often experience rigid ways of doing things. When there is a lack of control within an organization, the organization itself becomes the enemy.

Loyalty Solution: Outcomes Over Operations

Managing multiple people is complex, and operational systems often make the company more efficient and smoothly run. This is a good thing, but it can be taken to extreme lengths and isolate employees in the process. Operational procedures become inflexible and decrease the autonomy of your team. That is not to say that we should do away with systems, but we can create more flexibility by taking an outcomes approach when possible. Instead of telling employees how things need to be done, tell them what needs to be accomplished and let them figure out how to meet the desired outcome.2

Clinical Application: Outcomes Over Operations

To help employees perform at their best during working hours, we often need to consider their responsibilities and desires outside of work. Do they need to go to the doctor? Is their child playing in a sporting event? Do they love going to a certain yoga class? Having the ability to do any of these things outside of work can positively affect mood and mindset during work. Instead of requiring the employee to use time off or vacation for these things, can they arrange their schedule to maintain the desired level of productivity? If the answer is yes, giving them this freedom will allow them to perform well at work without sacrificing important values.


Lack of opportunity for growth/advancement remains a prominent reason for leaving a job.3 It is also an underlying cause of burnout and disengagement among employees, especially those who have been with the company for a long time. The path to becoming a physical therapist requires the characteristics of a high-achieving individual. The desire for achievement does not disappear after physical therapy school even though the path to advancement becomes unclear. Many physical therapists find themselves unsure of what comes next, and this lack of progression can result in apathy or dissatisfaction.

Loyalty Solution: Individualize Growth Opportunities

Knowing how to effectively help employees grow is a complex task. What is right for one person may not be right for another. Many organizations have managerial paths, but these will not satisfy all employees. Companies fail to support employees who do not seek these roles. Rarely do our ideas as managers or owners fit the physical therapist’s concept of a growth opportunity. We need to ask what growth looks like for them. If they don’t know, we certainly need to give suggestions, but then let them choose. Team members who do not want to lead still play an immediate role in the company culture and need guidance.

Clinical Application: Individualize Growth Opportunities

While many employees do not wish to run a clinic, many have an ideal clientele. Physical therapists that are able to treat the patients they want to treat are more likely to be engaged and enjoy work. This is something that you can facilitate for your employees. Finding opportunities to improve their reach in the community, courses/materials to advance their expertise, and support along the way will help clinicians grow.


Lack of appreciation and recognition is one of the driving forces behind a disgruntled employee. Working hard with little-to-no acknowledgment quickly becomes tiresome. When employees aren’t recognized, hard days become harder, and hard weeks become unbearable. This can be difficult for clinicians in management positions because you are often doing the same clinical work as others, with other roles added on. So, it may feel burdensome to have to show appreciation for the hard work of others when you are doing the same, but appreciated employees will do more and feel better about the work they are doing.4

Loyalty Solution: Frequent and Personal Appreciation

Pizza parties are great, but even the sincerest gesture can come off disingenuous in the absence of personal connection. Personal and specific appreciation builds relationships between you and your employees. The more frequent, specific, and consistent the appreciation the better.

Clinical Application: Appreciation

Your employees have been hitting their expectations, and you want to demonstrate your appreciation. You may be tempted to state the numbers when doing so, but finding something personal in addition is even better. Was your team working well together? Did they help each other out? Did they demonstrate a great attitude even in the most difficult times? These are important distinctions and foster behavior that creates a positive culture. The numbers are great, but good productivity does not create harmonious teams.

Having a great culture is worth fighting for and is essential for your company’s long-term sustainability. The best teams constantly reassess and adjust to the current environment.5 You do so much for your team and at times it can feel never-ending, but the strongest leaders recognize that each team and each individual is forever changing. While each solution requires work, it allows leaders to address cultural problems before they become a more systemic problem. An engaged, appreciated, and autonomous team will do more for the organization and will create the productivity and outcomes we need for success. 

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1WebPT. The State of Rehab Therapy. https://www.webpt.com/downloads/state-of-rehab-therapy-2021/. Published June 1, 2021.

2Wagner JI, Warren S, Cummings G, Smith DL, Olson JK. Workplace model for physical therapists and occupational therapists. J Health Organ Manag. 2014;28(3):290-314. doi:10.1108/JHOM-04-2012-0070

3Lee BK, Seo DK, Lee JT, Lee AR, Jeon HN, Han DU. Impact of work environment and work-related stress on turnover intention in physical therapists. J Phys Ther Sci. 2016;28(8):2358-2361. doi:10.1589/jpts.28.2358

4Pingo JC, Dixon MR, Paliliunas D. Intervention enhancing effects of acceptance and commitment training on performance feedback for direct support professional work performance, stress, and job satisfaction. Behav Anal Pract. 2019;13(1):1-10. doi:10.1007/s40617-019-00333-w

5Farrington SM, Lillah R. Servant leadership and job satisfaction within private healthcare practices. Leadersh Health Serv (Bradf Engl). 2019;32(1):148-168. doi:10.1108/LHS-09-2017-0056

Jenna Gourlay, PT, DPT, and Phil Plisky, PT, DSc

Jenna Gourlay, PT, DPT, and Phil Plisky, PT, DSc, are the co-founders of the Professional Rebellion, a company dedicated to guiding and mentoring professionals on the path to their ideal careers. Reach Jenna at jennagourlay@gmail.com and Phil at philplisky@gmail.com.

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