Caught between the aftereffects of the COVID-19 pandemic and care delivery models that have outlived their usefulness, healthcare is undergoing large-scale transformation — in terms of both staffing and models of care.
During Becker's Hospital Review's 12th Annual Meeting, in a session sponsored by Ernst & Young LLP (EY US), two of the firm’s managing directors — Jason Rife and Matt Weiss, MD, from EY-Parthenon — along with Andy Anderson, MD, chief executive officer of RWJBarnabas–Rutgers Medical Group in New Jersey, led a roundtable discussion about the snowballing problem of staffing shortages, meaningful ways of addressing those shortages and using workforce issues as a segue into innovating care delivery models.
Three key takeaways were:
- The dynamics of the healthcare marketplace are causing a great deal of stress. Due in part to the consequences of the COVID-19 pandemic and in part to long-simmering workforce issues, staff shortages have become endemic. Establishing a good organizational culture and effective teamwork in such an unstable environment is difficult; meanwhile, the costs of labor keep rising. "If you just look at the macroeconomics of it, it's not sustainable without higher reimbursement from payers," Dr. Anderson said.
While staffing and retention challenges are most acute around nursing, specialties are also affected. One participant shared that her organization hires locum physicians to fill gaps in the medical team, but because "our locum can charge us 5 to 10 times more than we would pay [staff physicians], it started to disengage our local providers."
- To address staffing tensions, organizations are redefining roles. Several attendees said their organizations are attempting to stem the tide of clinician churn by breathing new life into established roles. For some, that means putting providers on a path to decision-making or leadership roles and supporting their development through continuing education programs. For others, it involves emphasizing the autonomy and expanded practice scope of staff members, compared to the limited roles of "transient" locum physicians.
Yet others are empowering staff to contribute ideas to clinical program development or to work remotely if their role permits it. And then there are retention bonuses. "It's all those pieces coming together," the vice president of a pediatric health system in the Mid-Atlantic region said.
- Beyond transforming roles, leaders must overhaul care delivery processes and paradigms. The chief strategy officer of a multi-state hospital system said one approach her organization has taken to disrupting established care models is having physicians document the support they receive from mid-level staff and justify the cost of that level of support. "That incentivizes them not to use the staff as scribes, but to actually have them do helpful work," she said.
An attendee representing a health system in the Midwest pointed out that hospitals may decrease the volume of physicians they are using while increasing the use of other bedside clinicians, nurses and paramedics. "I need a couple of physicians and telehealth . . . but I don´t necessarily need the volume of hospitalists or intensivists we have," she noted.
Being transparent with data at the individual physician, practice and hospital level is another way to bring clarity to performance, expenditures and even hiring conversations. "[Candidates] want and deserve clarity in terms of the organization they're joining. If they join and it's not what they thought [because of an untransparent hiring process], they're going to leave. So being clear and transparent up front pays dividends down the road," one panelist said.
Ultimately, this transformation and disruption will be worth it if it benefits patients, who are currently caught in the middle. One attendee captured this sentiment: "Patients are feeling that tug of war that is going on internally with all of our hospitals and our physicians and our physician groups, and they're not comfortable with it. You have to figure out a way to bring them into the loop."