This editorial was originally published in the Summer 2022 issue of Frontiers of Health Services Management, one of ACHE’s leading journals. Members receive access to the digital edition of Frontiers as part of their benefits. Not a member? Join today.
Professional athletes not only train physically at their sport, they also endlessly analyze video of their performances and spend hours in restorative practices like cryotherapy, cupping, acupuncture, and ice baths. Their job isn't just physical. They need to keep their heads in the game and find the right mental space to achieve the high standards that their fans (and we armchair coaches) expect every single time.
When athletes are unable to perform optimally or fit in with team play, they are benched or sent back to training. After the most punishing period in the modern history of healthcare delivery, maybe mandatory restorative practices could help frontline heroes who are “sitting out a season” get back into the game. It is time to think differently if we are to get out of this workforce crisis.
We in healthcare know the value of dedicated people, but the Great Resignation has been a smothering overlay with a patchwork of fixes. We lurched into the COVID-19 pandemic with several human capital questions already in play. Are we facing a true shortage of physicians or nurses? Or is it that, absent coordinated resource deployment, the challenge is really maldistribution? Have we moved quickly enough on task shifting or the adoption of advanced practice practitioner models? Have we tried for too long to get by with too little? Did our workforce planning models not consider the possibilities that people would quit en masse or accelerate their retirement planning? The pandemic was the crumpling point (sorry, Malcolm, tipping point does not give us the proper description for what we are experiencing).
In the spring issue of Frontiers of Health Services Management, healthcare leaders shared their digital strategies, many of which responded to the pandemic's challenges. However, technology is not a panacea for workforce shortages and challenges. Technology is spurring new healthcare roles and occupations and stoking the demand for new skills and competencies.
Recognizing that digital innovation can exacerbate our talent concerns, this issue of Frontiers explores those concerns in the context of the Great Resignation. No matter how digital strategies are deployed in healthcare, people will be the key. Even a perfunctory survey of statements of operating revenue and expenditure clarifies the importance of workforce issues—the largest percentage of total expense is labor. So much of what matters and what healthcare carefully measures, from quality to patient and employee outcomes, depends on people. And smart healthcare leaders are acting accordingly.
In her feature article, Darlene Stromstad, FACHE, president and CEO of Mohawk Valley Health System in New York, outlines strategies to invest in the workforce, create a supportive work environment, and aggressively recruit. She notes that the employer of choice will be the one “that supports employees at the workplace while offering relief from the stresses of daily life.” This protection must also include stresses of work such as abuse and incivility from patients and families.
Talent maldistribution is intensely problematic for rural healthcare providers. Jo Anne Preston of the Rural Wisconsin Health Cooperative provides that perspective. Preston shares short- and long-term strategies for recruitment, retention, and innovative partnerships inside the 45-member co-op and with other stakeholders. Interestingly, Preston encourages some disruption of the status quo when she states, “During the pandemic in Wisconsin, the National Guard was trained in 72 hours to work as certified nursing assistants (CNAs). Students training as CNAs typically must complete 120 hours over several weeks. Rule changes clearly are overdue.” Perhaps this is one new lesson that healthcare leaders could advocate for now and apply in the future. What other innovations can be adopted and continued from the ongoing health emergency response?
One response to the shortage, triggered by the pandemic, was a relaxation of the oversight of advanced practice practitioners. In my state of New York, legislators made this temporary change permanent and granted nurse practitioners full practice authority in April 2022 (at least 24 other states and the District of Columbia have done the same). In his feature article, Paul E. Neagle, FACHE, senior vice president of operations at FastMed Urgent Care in Raleigh, North Carolina, presents the ambulatory response to the growing primary care physician shortage: deploy physician assistants/physician associates and nurse practitioners. Neagle points out that attracting frontline staff is about more than focusing on base pay and benefits. Employees “want to feel supported by the organization and valued as part of the team that puts patient care first,” he writes. He shares some strategies that support retention by cultivating a strong organizational culture.
Tresha D. Moreland, FACHE, a consultant and founder of HR C-Suite in Rapid City, South Dakota, picks up this clarion call for a stronger organizational culture. She asserts that “organizations whose leadership takes shaping organizational culture seriously and engages in deliberate discussions and planning to achieve it will see the light at the end of the workforce shortage tunnel.” Other strategies that she suggests include a new approach to job design and attention to the perception of pay fairness. More importantly, Moreland reminds us that “old ways cannot always be successfully applied to a new crisis.”
Undoubtedly, there must be an urgent and expanded appetite for change. To this end, Todd A. Zigrang, FACHE, president of Health Capital Consultants in St. Louis, shares novel approaches to physician compensation. He quotes Winston Churchill's admonition to never let a good crisis go to waste, then shares two important lessons he has learned from novel compensation approaches: First, provider buy-in is essential, else we risk unintended outcomes. Second, the model we select in our current and unfolding milieu must be flexible and transparent. Zigrang shares what I dub the “whole-person approach” to compensation, which includes important enhancements and noncompensation considerations, namely growth opportunities.
The pandemic also has highlighted the reality that staffing decisions are essentially ethical matters. Jason Lesandrini, FACHE, assistant vice president of ethics, advance care planning, and spiritual health, and David Reis, ethics research team lead at Wellstar Health System in Atlanta, Georgia, suggest that our workforce challenge is a complex resource allocation dilemma, and one for which leaders must rehearse. “They must be able to ethically distribute insufficient resources … and consider a variety of strategies, principles, and approaches to ensure that resources are distributed fairly,” they advise. This competency requires much practice in weighing competing values at the individual, group, and system levels to arrive at a defensible position.
As the various perspectives in this issue of Frontiers suggest, we can draw from lessons learned during the past two years to solve problems that have been building for many years. When faced with the healthcare emergency, our innovative healthcare organizations made about a decade of advancements in just a few weeks. To maintain this momentum, we must surmount roadblocks to political feasibility and establish national healthcare workforce planning as the infrastructure necessary for human development. Rather than wait and allow the travel nurse tsunami to drive wage costs further out of control, we must find opportunities for “coopetition” within regions and give nurses the flexibility they want. National licensure for professions, simplified credentialing and privileging, and mobility across the country could help address the maldistribution of healthcare providers. We might shift or even remove the boundaries between professions and create new roles that allow better patient outcomes with fewer handoffs.
What other creative approaches are working to address workforce challenges and support the welfare of staff, patients, providers, and communities? Feel free to continue the conversation with me at carla.sampson@nyu.edu.