How hospitals and health systems are overcoming clinical staffing challenges and improving culture in a transformative era

It is a tumultuous period in healthcare and particularly in perioperative care and anesthesiology. Demand for care is increasing while the supply of labor is decreasing.

Labor issues are top of mind for hospital CEOs, who cite staffing as their number one concern. Because of the importance of these challenges, hospital and health system leaders are urgently looking for solutions. 

During a roundtable discussion at Becker's Hospital Review's 12th Annual Meeting, sponsored by NAPA, company CEO John F. Di Capua, MD, and Executive Vice President Peter Doerner discussed challenges in the marketplace and offered their perspectives on solutions. 

Key takeaways shared by Dr. Di Capua included:  

1. The demand for perioperative care and anesthesiology is mismatched with the supply of labor. Demand has increased due to population growth and increases in procedures and care sites. This is attributable to patients living longer — with older patients needing more procedures — along with medical innovation and the migration of procedures from hospitals to outpatient surgery sites, where costs are typically lower. 

However, while demand is increasing, the labor shortages that exist throughout healthcare are especially acute in anesthesiology. Many clinicians are retiring, some due to frustration with declining reimbursement, while new clinicians are being trained in insufficient numbers. Citing data from GasWork.com, Dr. Di Capua noted that job openings in the last year are up 70 percent for nurse anesthetists and have increased 57 percent for anesthesiologists. "What are we [as an industry] going to do about it is the real question," Dr. Di Capua said. 

"I don't see any end to this," said Dr. Di Capua. "We are going to see continued expansion of procedural areas. We are going to see continued early retirements . . . It's a cliff, it's not a subtle thing, it's a big cliff." He continued, "We have to find solutions."

2. A best practice in retaining talented clinicians is being a destination of choice. One way we do this is by continually measuring market compensation in every community in the 20 states where we serve to stay competitive, while recognizing that being a destination of choice is about more than just compensation. Early in the pandemic, some health systems made the short-term decision to cut pay for anesthesia providers. This hurt the organizations' competitiveness and sent the wrong message to valued clinicians. 

3. Being a destination of choice ultimately results from an organization's culture. Culture comes from inspiring a sense of teamwork among all of the clinicians in the perioperative space and with the C-suite. Culture is created by focusing on key performance indicators, like quality data and patient satisfaction scores. Culture is established by investing in ongoing education and in digital tools to provide staff and partners with meaningful information.

Critical in creating culture is an organization's on-site leadership. "[On-site leaders] are the most important people in creating a healthy work environment at any facility," Dr. Di Capua said. Effective on-site leaders develop talent and create opportunities for clinicians. NAPA invests in training and programs that help local leadership focus on team-building teams, developing emotional intelligence, and understanding the basics of leadership. “We teach our people the skills they don’t learn in medical school,” said Dr. Di Capua.

Part of a healthy culture is listening to clinicians to understand exactly what they want. Dr. Di Capua advises organizations to recognize that people are their greatest asset. By listening to people and investing in what matters to them, it is possible to create an environment that attracts and keeps people. This is what it means to be a destination of choice.

4. Scale is essential to advance anesthesiology. Scale is essential to advance anesthesiology. Market forces such as staffing, retention, payors, CMS, collections, and new technologies are challenging everyone in the anesthesia community, particularly small groups who must now spend more time grappling with administrative issues vs. practicing medicine. More small practices are turning to larger anesthesia partners, who can help them thrive in the current environment. 

From his personal experience, Dr. Di Capua’s view of the market is that success requires scale. With greater scale, an anesthesia organization can take on issues that smaller provider groups typically don’t have the resources to confront. This can include negotiating with payors and advocating for policies that benefit anesthesia providers across the industry. Scale enables investments in infrastructure, recruitment and retention, and leadership development. Organizations with scale also have greater resources to partner with academic institutions, to train the next generation of anesthesiologists and CRNAs.

5. Factors often overlooked are the importance of efficiency, enabling anesthesia staff members to practice at the top of their license, and investing in training. A chief officer of hospital operations at a health system with 15,000 employees stressed the idea of leveraging certified registered nurse anesthetists (CRNAs) and certified anesthesia assistants. Dr. Di Capua said that multiple strategies must be used to cope with the staffing shortage. One strategy is creating a more efficient environment and another is enabling everyone to practice at the top of their license. For this to occur, surgeons must be comfortable with the model, which takes extensive experience and training of all employees. It also takes years to do it right. 

One California hospital executive said a strategy his health system is taking is increasing its orientation and training programs. Dr. Di Capua added that training is essential to staff retention and bringing more people into the industry. The expenditure to train people is a better long-term economic value proposition as compared to filling vacancies. 

6. Front-line workers are hurting and need their communities to lift them up. An Oregon CMO believes that as a result of the pandemic, many clinicians are dispirited. Retaining these critical employees requires empathy and effective communication. Dr. Di Capua agreed, noting that after the past two years, knowing how staff members truly feel is a challenge. The inability to protect healthcare employees early in the pandemic was damaging. Amid today's divisions, talk of heroes does not resonate. Front-line staff members need to be lifted up and need to know that their community has their backs. Support for workers comes from leaders who listen, inspire great cultures, and care for their people.

It is important to recognize that the world has changed, with the pandemic accelerating this change. In this new era, scale, culture, and leadership matter immensely. Success won't come from acting alone; it requires collaboration and partners. "We want to work with institutions that understand the value of people and who will be strong partners in driving cultures that attract and retain talented clinicians, " Dr. Di Capua said.