10 Key Considerations for Medical Staffing in a Changing Healthcare Workforce

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Hospital leaders will need to change medical staffing as the landscape of the healthcare industry, including the healthcare workforce, continues to change due to a variety of ongoing or impending forces. For example, hospitals are struggling to balance budgets in light of declining reimbursements and a tough economy. Additionally, hospitals will need to acclimate to recent changes brought on by healthcare reform and the American Recovery and Reinvestment Act. Consequently, hospital CEOs and physician leadership must be wary of how to be prepared and execute staffing practices accordingly. Here are 10 key considerations to have when changing your medical staff.

Changing medical staff in light of a struggling economy

1. Layoffs may not be the best option to save money. Eric Chen, MBA, JD, assistant professor of business administration at Saint Joseph College in West Hartford, Conn., says although employee layoffs may seem like the most obvious answer to balance hospital budgets, it may not always be the best solution due to loss of talent.

"If you have a conversation with most hospitals, the first thing out of their mouths usually is that there is no funding and, as a result, there needs to be layoffs. Well, layoffs result in knowledge loss because you're losing the skills needed to provide medical care," Mr. Chen says. "Hospital leaders have to remember that their top performers can get jobs in any economy, and actually they're usually the first ones to flee the ship because they can."

Mr. Chen adds that releasing employees with higher salaries and replacing them with employees with lower salaries may not necessarily imply added profits in the future. "The financial implications of layoffs don't always follow through in the long-term every time. Hospitals may think they're cutting costs because they don't have to pay those employees anymore, but between severances and costs for re-training, you might end up losing more money."

Changing medical staff in light of healthcare workforce shortages

2. Consider hiring from the National Healthcare Career Network. The healthcare workforce is experiencing major shortages in primary care physicians, specialty physicians and nurses. Tony Burke, president and CEO of AHA Solutions, says the American Hospital Association has a career center website that hosts the National Healthcare Career Network where hospital CEOs can go to hire specific talent for their organizations. The initiative was carried out to help healthcare providers avoid costs tied to hiring recruiters or staffing agencies.

"The National Healthcare Career Network includes 230 professional or trade organizations, such as the American Nurses Association, so if a hospital needs to fill an open position, they can post that opening and it's directly forwarded to an association that best represents that title," Mr. Burke says. "Ideally, hospitals will have greater and more efficient access to a talent pool that's qualified rather than dealing with stacks of resumes from recruiting organizations."

3. Find a balance between business and clinical experience. Although some hospitals employ individuals without clinical experience to fill administrative roles, it could benefit the organization to employ business administrators who have expertise in practicing medicine, Mr. Chen says. In that same vein of thought, he adds if you are going to put a physician to task on administrative matters, it is equally as critical for them to have some background in business administration as well.

"About a decade ago, Pfizer decided to move their researchers and doctors to management positions, and what happened was that very few actually knew how to run the business and it was a disaster," he says. "I see some of this happening in hospitals, but they need a special kind of business administrator. There needs to be a balance between the business and medicine."

Changing medical staff in light of an evolving healthcare workforce

4. Plan for employee succession and career development. Employment habits have changed significantly from previous generations. Older employees are used to staying with their employers for a majority of their careers, seeking upward movement in the employment chain within that company. Now, employees tend to move in a horizontal fashion, seeking shorter terms of employment with numerous companies. "Employees from a younger generation are highly motivated and highly skilled, and there is no longer a permanent relationship between the employer and employee like there used to be in the past. With this kind of dynamic, hospitals need to strategize and plan promotion opportunities despite the lack of top positions at hospitals," Mr. Chen says. To prevent employee turnover and achieve higher rates of staff retention, hospital leaders must look for ways to promote and retain their employees.

"There is a CFO at a hospital who is trying to develop a path for younger employees to get rotated around the hospital to learn various functions and be exposed to all facets of the organizations," Mr. Chen says. "It's going to give them that kind of training in hopes that they will be in a position to run a hospital with a holistic perspective somewhere down the line."

5. Look for ways to accommodate a more diverse workforce. Mr. Burke says hospitals may face the possibility of having a staff with employees across several generations — all with differing backgrounds, experiences and skill sets — as healthcare professionals come out of retirement and re-enter the workforce. To meet the diverse range of needs from employees, hospital CEOs will need to look for more creative ways to satisfy and retain all employees. "You can't look at any hospital as a homogenous culture like you used to," Mr. Burke says. "No one is trained the same way, and everyone adapts to changes at different paces."

One of AHA Solutions' services includes working with hospital leaders to ensure they have the appropriate benefit programs, such as 401k programs, and workplace excellence assessment tools to attract, engage and retain a diverse workforce. "We also have an employee engagement tool and compensation programs that can really help a hospital engage their employees across a generational continuum by offering a suite of different programs," he says. "The hospital can then decide which programs or services they want to adopt. These programs aren't built by AHA Solutions, but we've endorsed them and introduce them to hospital executives as approved programs."

Changing medical staff in light of healthcare reform

6. Consider how ACOs will impact your staff. Accountable care organizations are another result emerging from the healthcare reform law. Hospital CEOs looking to develop ACOs must be mindful of how their organizations will be impacted by this change. "A hospital's workforce has to be trained and aligned with the organization's move toward ACOs," Mr. Burke says. "It's essential that the entire organization understand and be able to manage the processes around ACOs by focusing on the design and workflows that will drive greater patient volume and efficiency in each department."

7. Implement processes for more efficient coordination of care. The healthcare community will be held more accountable for the quality of care provided. In the near future, healthcare providers will be reimbursed based on various performance measures, such as readmissions rates, mortality rates and other health indicators. Consequently, hospitals need to find a way to efficiently coordinate care among their physicians and employees. John Heydt, MD, chief ambulatory officer for the University of California-Irvine, says hospitals should consider installing comprehensive care teams to improve clinical performance.

"At UCI, we have something called patient navigation systems, which is for patients whose conditions are especially complex and are in need of special care," Dr. Heydt says. "For example, if we have a cancer patient, we'll recommend to him or her that they be placed in the program because they have so many visits to physicians, need testing and so on. The patient will be provided with one number to call, and we coordinate their care so that they don't have to call seven specialists."

Changing medical staff in light of ARRA

8. Make technological competency a standard across all employees. Starting next year, healthcare providers demonstrating meaningful use of electronic health records can qualify to receive incentive payments if they are able to demonstrate meaningful use and meet criteria set by the government. Hospitals looking to cash in on those incentive payments should make sure their current staff are trained and aligned with the hospital's health IT efforts.

"Many hospitals just don't have the right work force," Mr. Chen says. "Recently, I was talking to an employee who had been with their hospital for 20 years, barely knew how to use a computer and didn't want to learn how to use one."

9. Add health IT experts to the staff. Because the healthcare industry is facing shortages in health IT experts, hospital CEOs must pay more attention to how to bring in IT expertise and support if they are looking to implement EHRs. Dr. Heydt says that as the market comes out with more technology aimed to do data analysis, it's important that hospitals work with health IT experts who are knowledgeable in both the clinical aspect and technological aspect of these systems.

Additionally, hospital CEOs must be wary of other staff support members that are essential to successful implementation of other technologies aside from EHRs, such as biomedical engineers, case managers, quality assurance officers and coders who will all likely be using technology geared toward carrying out their responsibilities in an electronic fashion.

10. Develop a high tolerance to uncertainty. As these factors begin to impact the healthcare industry, hospital CEOs must adopt the ability to produce good results in an uncertain environment. Mr. Chen says it is incumbent upon hospital leaders now more than ever to be business savvy and proactive about strategically planning around a changing healthcare workforce.

"CEOs are going to have to get their hands dirty because it's one thing to have an idea and another thing to implement a process toward achieving that idea," he says. "Events just happen so quickly. When you wake up in the morning, the first thing you should do is turn on the TV and see what's changed since last night and see what needs to be done to acclimate to those changes. It has to be engrained."

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