California hospital losing staff 'left and right' to competitors that can pay more, COO says

Like most hospitals and health systems, staffing is the number one priority for Colton, Calif.-based Arrowhead Regional Medical Center, a 3,500-employee organization that faces stiff competition in the labor market from big-box stores that can afford to pay staff more. 

Andrew Goldfrach, COO of Arrowhead Regional Medical Center, joined the "Becker's Healthcare Podcast" to discuss how he is addressing staffing challenges, how the medical center is growing and offers advice for other healthcare leaders navigating a difficult labor environment. 

Note: Responses are lightly edited for length and clarity.

Question: What are you most focused on currently? 

Andrew Goldfrach: Similar to many other facilities, our biggest challenge is staffing. I read that the nursing shortage is expected to remain into either 2026 or even 2030, which is a major challenge for us. Additionally, we're seeing a large number of physicians getting ready to retire over the next few years. So, compiling both of those on top of each other creates a real challenge. Even with our support services and non-nursing positions, we're starting to face challenges and competition in the workforce environment like we've never seen before, whether it be with the food industry, hotel industry or other services. 

Q: What are the big competitors for Airhead Regional today?

AG: We're a little unique as with other public hospitals in that our populations are really the entire county of San Bernardino, which is about 20,000 square miles or 2.2 million people. When we look at competition — unlike a lot of the private facilities — I don't look at our other hospitals necessarily as competition unless, except for certain niche areas, whether it be neurocritical care, cardiac programs or other subspecialties. We compete with the area hospitals in the county; there's about 18 hospitals in the county. But we really do serve a great population, mostly the underserved populations, and really are that safety net for the greater county.

Q: What are you seeing in terms of competition from Amazon, CVS, Walmart and other companies moving into healthcare? 

AG: I think our biggest competition or threat from the Amazons or some of the big-box stores, or even fast food or hospitality, is around staffing. We're losing individuals left and right to some of these organizations that can afford to pay more. Recently, there was an article about a casino doing a job fair, looking for food service workers, security, housekeepers, etc., and that really is our engine that helps keep our hospital going — the port service areas. And that's really where we're starting to see a lot of competition, uh, for people for our number one asset, uh, in industries that we've never had to compete against before.

Q: Outside of staffing, what will you be most focused on or excited about next year? 

AG: We're really excited about our growth trajectory at the medical center. We are continuing to evaluate and increase our medical residency programs. We've got about 200 medical residents and looking to add some new residency programs. We're very excited about our cancer, behavioral health and orthopedic surgery programs; we're really looking to create more niche environments for those different specialties. 

One area we are closely looking at is our expenses as they continue to rise, particularly with our labor expenses. To help combat that, we're taking another look at all of our payer contracts and contracting strategies to see how we can maximize our revenues to help combat the increase in our costs or inflation. That way, we could reinvest back into the hospital and back into the community. Even though we are a county-owned hospital, we don't receive dollars from the taxpayers.So we are truly self-sufficient in that regard. Uh, so it's really important for us to be able to look at our finances very closely, to be able to afford new technologies, new services, robotics, or whatever it may be, to reinvest back into providing world class care to the most underserved populations in the county.

Q: What advice do you have for other leaders in this challenging staffing environment?

AG: Be more present than ever before. It's really important to show your teams that you care for them, you have their back and you're working side by side for them. We can't always provide additional compensation, but we can certainly provide support. We can certainly provide visibility. On Halloween, for example, our entire administrative team decided to get dressed up as Where's Waldo. It's a very stressful environment, especially with short staff, so what we can do is add some fun into the workplace? Additionally, it's listening and understanding what their needs are or their frustration points are, and what can we do that's within our control just to make our staff that much happier at the hospital.

It is really important [to be visible and engaged] even if you don't have all the answers, particularly if it's a rough time being out there. Being visible rounding on your staff, rounding all different hours, coming in at 2 a.m. or on weekends. Being present with our frontline staff is absolutely critical. Letting them get to know who you are and you getting to know who they are. You build those relationships and bonds that I think outlast an additional couple dollars when it comes to salary. 

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