Hospitals look to pull every lever in response to staff shortages

In April 2023, more than 3,320 hospital and health system leaders gathered in Chicago for the Becker's Hospital Review 13th Annual Meeting. For four days, more than 430 speakers engaged their peers in panel discussions and presentations spanning 11 tracks.

Big themes emerged from the meeting's 170 sessions. Rare was the conversation that didn't touch on the status of the U.S. healthcare workforce, which leaders were quick to note has been a studied and well-monitored trendline for years before the COVID-19 pandemic accelerated worker exits and exacerbated shortages.

The U.S. faces a shortage of between 37,800 and 124,000 physicians by 2034, including deficits in primary and specialty care, according to the Association of American Medical Colleges. The country may see a shortage of anywhere from 200,000 to 450,000 nurses by 2025, according to McKinsey. These figures are staggering, and only compound other thin spots throughout the healthcare system where demand exceeds supply, including designated mental health professional shortage areas and the exodus of nursing home workers that is forcing facilities to limit new patient admissions.

The labor shortage will continue to test the healthcare industry and hospitals for years to come. In Chicago, leaders exchanged strategies as they look to modernize care delivery and workflows to deliver on the "do more with less" mantra they have long braced for. They also discussed the changes required of leadership in times when a single percent change to staff retention can be crippling, and what is needed to renew healthcare as a desirable workplace and career for bright, motivated and mission-driven people.

But first, leaders offered up some thoughts on the systemic solutions needed to solve what is a systemic problem. Janet Liang, executive vice president, group president and COO of national care delivery operations with Oakland, Calif.-based Kaiser Foundation Health Plan and Hospitals, pointed to licensing requirements, inadequate funding for graduate medical education, and outdated work models as limitations in need of change to solve for the labor market.

State-based occupational licensing is a "horribly slow" process, as Ms. Liang put it. State boards can take upwards of three months to process nursing licenses. Ms. Liang questioned not only the efficiency of state licensure regulations, but their value given how they can limit employment opportunities for qualified providers.

Hospitals and health systems also have a great amount of change to enact to offer new ways to work that emphasize flexibility, including options for remote work. For a variety of reasons, healthcare has been slow to take up the shift to remote work. Even for white-collar jobs, the industry had one of the lowest rates of remote workers at 35 percent, according to a September 2021 Gallup survey.

"The reality is we are competing with virtual companies and concierge locations for healthcare workers," Ms. Liang said. "Those of us in bricks-and-mortar hospitals and medical centers need to see people in person. We're going to have to make work more flexible, otherwise we're going to lose everyone."

At 17-hospital Centura Health, President and CEO Peter Banko is listening actively to the workforce and modifying compensation, benefits and educational assistance to improve employee recruitment, retention and satisfaction at the Centennial, Colo.-based system. The changes stemmed from feedback provided by employees.

The system increased its annual tuition reimbursement benefit from $3,000 to $5,000 for full-time associates and $1,500 to $2,500 for part-time associates. It also built in options for PTO cash-outs, housing stipends, market-based bonuses and adjustments, and changes to sign-on bonuses. After meeting with more than 2,000 nurses two years ago, Mr. Banko recognized the tension existing between nurses who had worked with the health system for years and newer hires who had joined the system with a sign-on bonus.

"So we gave every RN an opportunity to get a $15,000 two-year retention bonus," Mr. Banko said. "Now, a year and a half later, the attrition in that group is 4 percent."

Cliff Megerian, MD, CEO of University Hospitals in Cleveland, has set out to simultaneously improve retention while also embracing employment as an important social determinant of health. The health system is Northeast Ohio's second largest private sector employer with more than 30,000 associates.

"We worked in communities in marginalized areas to help people get jobs at the very entry point, and then help promote them to create a career in healthcare," Dr. Megerian said. "So we have a pipeline. Last year we hired 293 folks from our community hiring programs, and we have an 88 percent retention rate after one year, which is really incredible. Really the goal should be to affect healthcare outcomes and the workforce dynamics of your community."

Health systems need to be well-connected with their communities in a number of ways to not only strengthen their workforce in challenging times, but also to build a workforce that has deep and lasting ties to the people they serve.

Susan Burroughs, CEO of MUSC Health Columbia Medical Center Northeast in Columbia, S.C., invests a great amount of energy and thought far upstream by connecting with children and teenagers so they understand early on how many professional opportunities that can be found in healthcare.

"We're reaching out to our younger populations, getting into school districts and talking to students about healthcare careers, because we all know that there's nationwide shortages in all of the areas of staffing that we're searching for," Ms. Burroughs said. "I think it's important that we start younger."



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