Horizon Health Network Cuts Voluntary Turnover from 9.6% to 7.6% by Co-Creating a Culture Commitment with 15,000+ Employees

What Was the Opportunity?

Horizon faced a challenge common to large, multi-site healthcare systems: a growing culture gap. Employees across diverse roles, disciplines, and geographies did not always feel aligned around shared expectations or consistent ways of working. While individual commitment to patient care was strong, the organization lacked a unifying cultural identity that could connect people across sites.

The healthcare environment was compounding the problem. Retention, engagement, and trust were all under pressure. By August 2023, voluntary employee turnover had reached 9.6%. Participation in listening efforts existed but did not yet reflect the level of psychological safety Horizon aspired to build.

In 2024, leadership made a deliberate decision to treat culture as a strategic lever for organizational performance, employee experience, and patient care. Through an initiative called Our Promise, the organization invited employees and physicians across all roles and facilities to co-define the culture they had and the one they wanted to build.

From these guided discussions, Horizon identified three culture aspirations chosen directly by employees: Accountability, Collaboration, and Respect. These became the foundation of Horizon’s Culture Commitment, which reinforced that every voice is heard, every role is valued, and all employees are accountable for creating a healthy culture.

What Was the Solution?

Horizon’s approach combined a comprehensive Perceptyx listening strategy with the operational rollout of its Culture Commitment.

Embedded a listening strategy guided by Perceptyx best practices. The organization ensured employee feedback was not only collected but used to drive action at every level: company-wide, function-specific, location-based, leadership-driven, and within individual teams.

Enhanced the survey experience with open-ended feedback. In 2025, Horizon gave employees the opportunity to provide feedback in their own words, creating space for richer input and clearer direction for improvement.

Operationalized the Culture Commitment across the organization. Leaders and employees were asked to actively model Accountability, Collaboration, and Respect as shared anchors for day-to-day decisions and interactions. This aligned staff across sites, roles, and disciplines around common behavioral expectations.

Closed the loop consistently. By demonstrating how feedback translated into organizational priorities and initiatives under Our Promise, Horizon strengthened trust in the listening process and reinforced the message that employee voice drives real change.

What Was the Impact?

Voluntary turnover dropped from 9.6% to 7.6%. Between August 2023 and January 2026, Horizon reduced voluntary turnover by 2 full percentage points, placing the organization 4.3 points below the national benchmark of 11.9% (Mercer Survey, 2024).

Survey participation surged 64%. Monthly survey participation averaged 1,467 in 2025, up from 894 in 2024. Participation peaked at 1,711 in January 2025, and even the lowest month in 2025 (1,317) outperformed most months the prior year.

Annual pulse completion rate jumped from 27% to 38%. The number of employees completing the annual pulse grew from 3,980 to 5,779, a net gain of 1,799 respondents that reflected growing willingness to participate in organizational listening.

Engagement scores improved across the board. Overall engagement rose from 68% to 70%. Pride in working at Horizon increased from 60.4% to 62.2%. Intent to stay climbed from 81.6% to 84.3%.

Employer brand strengthened externally. Horizon was named Atlantic Canada’s Top Employer for two consecutive years (2024 and 2025). Among new hires, 13% cited Horizon’s reputation as a good place to work as their primary reason for applying.

Employees felt the shift. As one frontline nursing staff member put it during the Culture Commitment work:

“It reminds frontline nursing staff that you have a voice and that your contributions matter and drive positive change in organizations.”

For a healthcare organization with more than 15,000 employees across multiple hospitals and 100+ facilities, this combination of reduced turnover, increased participation, improved engagement, and external recognition represents a measurable cultural shift driven by listening, acting, and following through.