The State of the Healthcare Workforce
In many parts of the country the existing nursing shortage has been exacerbated by continuing COVID-19 waves. The challenge faced by many organizations is churn of its workforce; 86% of Baby Boomer nurses are considering retirement in the next five years, 42% of nurses are experiencing burn out, and hiring rates are not keeping pace with the rate of turnover. In fact, AMN Healthcare saw the ratio of nurse demand versus supply reach a level of more than four orders for every application in the second quarter of 2021. Travelers are tired and exiting the pool of contingent labor. The number of travelers who were on assignment previously and who were retained in the first half of 2021 decreased by 9%, according to AMN data. The ongoing pandemic has challenged our systems and abilities, but in its wake, new perspectives and a refined set of practices have emerged based on flexibility and precision.
A Flexible Talent Model
Before the pandemic, providers had extended their locations to include medical group practices and clinic networks in grocery stores, schools, and corporate settings to meet more patients where they are. With the pandemic, this has extended to testing and vaccination sites as well as a retooling of spaces to care for patients with the virus. This degree of diversification and breadth of services requires a highly coordinated network of care providers to effectively meet demand. The onset and continuation of the pandemic has forced a further fine tuning of strategies and the adoption of creative methods. Organizations are seeking contingent staff to fill immediate needs, yet the supply is not there. The key is taking a combination or mix of approaches, thinking of talent in a broad sense and in terms of the enterprise. This enterprise perspective encompasses a lot more roles in a healthcare system than might first come to mind. In addition to core and contingent talent, there’s Statement of Work (SOW) contractors, freelancers, remote workers, even volunteers.
Nurses are Key
The foundation of any organization’s ability to provide care and services is their permanent nursing staff. These employees drive organizational culture and recruiting them is critical to retaining a workforce that delivers quality care. The number of staff needed by department or service area should correlate to the most frequent census/volume point. This strategy reduces over and understaffing as well as minimizes the need to float staff to or from other departments, which is a known dissatisfier. There are a number of strategies to drive engagement and keep permanent staff feeling and performing their best, including:
- Team-based staffing models have been shown to increase nurse satisfaction and improve communication. There are many variations to suit an organization’s needs and culture.
- Identify staff who are excited about and willing to receive training to increase cross-specialization and their scope of practice.
- Reduced shift lengths for nurses is another option, although one that may or may not work with every organization’s culture. A study by the National Institute of Nursing Research reported that shorter shifts have been shown to decrease clinician burnout and increase patient satisfaction.
While recruitment has been a challenge for many organizations, internal talent acquisition teams can be aided by external recruitment solutions. External Recruitment Process Outsourcing optimizes permanent recruitment by augmenting a system’s internal recruiters so that staff can be planned for and acquired quickly and efficiently. This results in lowered costs, a good cultural fit and a better care experience. The right partner can streamline the permanent workforce planning and recruitment process through an efficient, agile solution.
Contingent Talent Strategies
After permanent staff, the next layer of caregivers are contingent staff, including float pools, travelers on assignment, and per diem agency caregivers. Float pools – qualified healthcare professionals willing and able to work in multiple units and locations – can either be internally or externally managed. Traditionally, these have been managed internally by organizations, but the benefits of externally managed pools are prompting many to utilize this solution. Externally managed float pools handle all the employment and administrative work and provide organizations with the assurance of staff dedicated to their organization. Again, finding the right number and types of qualified contingent workers is a challenge for many organizations who rely on local agencies. The rise of bid-driven marketplaces is the latest development in the effort to leverage external talent. A bid-driven marketplace provides an end-to-end portal enabling healthcare facilities to quickly staff and manage their entire range of contingent talent. These are agency agnostic systems that allow organizations to have access to hundreds of suppliers that submit qualified and available candidates for both clinical and non-clinical talent needs, matched to each organization’s specific criteria. Because of the nature of the bidding system, rates are competitive and fair. Hiring Managers can review, select, offer and on-board desired credentialed talent in one interface.
Technology to Manage Talent and Provide Care
Technology tools are a crucial component of an effective workforce management model and an organization’s ability to provide care. Effective scheduling of the workforce across the enterprise has always been important, and the use of predictive analytics now increases the accuracy of scheduling. Additionally, the pandemic has seen telemedicine and artificial intelligence experiencing an accelerated pace of adoption.
Scheduling with Predictive Analytics
Scheduling approaches vary from organization to organization. Within a facility, departments can have completely different needs, strategies and goals. Because of this, many organizations are forced to use several different platforms, sometimes spreadsheets or even pencil and paper. An effective, holistic approach to staffing requires alignment from all areas of a health system. Organizations need a single, flexible solution to manage staffing across the entire enterprise, from traditional nursing units to specialty areas and outpatient environments. Scheduling solutions exist that forecast staffing needs, help build more accurate schedules, and clearly identify areas that could be understaffed. These solutions also provide the ability to view resources at the enterprise level for a more objective and strategic approach to placing staff that benefits the entire system.
Telemedicine
Telemedicine is a technological advancement that had begun to surface prior to the onset of the coronavirus and whose usage has increased greatly. Telemedicine appointments help reduce the spread of the virus and other infectious diseases. It also provides convenience and time savings for patients and healthcare professionals, allowing them to see more patients and have less downtime between appointments. According to a McKinsey & Co. report, physicians can see between 50 to 175 times more patients through telemedicine as compared to in-clinic visits.
Artificial Intelligence
In the past, clinician burnout has been addressed through work-life balance training, mindfulness activities, limitations on work hours, and other means of preventative action. Because of the pandemic, not all of these methods are feasible, as physicians and nurses do not have the liberty of time. Artificial intelligence (AI) can be inserted into daily workflows to help prevent burnout and eliminate some of the burdens that frontline workers face. One way that AI can aid healthcare professionals is through the concept of a keyboard-free environment. By taking over the keyboard process in the physician workflow, AI gives physicians and nurses the ability to have more time with their patients and less time in front of a computer. AI can also create efficiencies with triage. Regional Cancer Care Associates, a cancer center based in New Jersey, uses machine learning technology (a form of AI) to improve the way they prioritize patients. They created a program that filtered the highest risk patients into a single list, allowing staff to allocate resources according to urgency.
How to Get Started
Like any journey, the path to a cohesive and effective talent strategy is accomplished in steps. By evaluating the current state and understanding what success looks like, organizations can tackle this in stages at the pace that works for them. With each part of the process organizations can achieve near-term margin recovery and cost containment through the alignment of workforce needs to various patient volume scenarios. While working on short-range goals, a strategic plan should be developed for long-term benefit, such as physician/clinician engagement and retention strategies, workforce capacity planning, and improved enterprise transparency to allow for more flexible use of staffing resources.
Staffing Plan Assessment
Examining current staffing grids can identify the right types and sizing of all sources of staff to create an optimal and flexible model that supports demand. This exercise is not about increasing patient load. It is an opportunity to better align resources with demand in a way that meets productivity targets, minimizes costs, and maximizes the ability to cover patient demands at every census point.
Talent Roadmap Development
By analyzing volume trends organizations can consider various hiring scenarios that are balanced between clinical needs, staff satisfaction and financial stability. A financial and operational analysis will provide a detailed plan for staffing based upon current and forecasted volume scenarios. Prioritization should focus on opportunities to maximize the existing staff capacity while developing plans for expansion and contraction flexibility.
Scheduling Optimization
Once the initial discovery and planning is complete, organizations can dive into scheduling practices and processes to identify inefficiencies that lead to staffing issues, including employee satisfaction and turnover, as well as develop a playbook that provides direction to maximize staffing outcomes.
Conclusion
The ongoing pandemic has presented challenges unlike any before, but it has also presented opportunities to rethink our approach to managing our workforce that should reap long-term benefits. Providers have never had a greater need for talent strategies and tools to provide more efficient care. Healthcare professionals are committed to delivering the highest quality of care, but they need their well-being prioritized. By exploring the best practices discussed here, organizations can take a more strategic approach to creating dynamic and successful workplaces that help foster health and well-being for both patients and caregivers.
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