A focus on value, changes the workforce

It has been five years since the Affordable Care Act of 2010 was signed into law.

Today the legislation, known more informally as ACA, is a standard part of the lexicon in the healthcare industry. Considering that the industry and the general public have had five years to acquaint themselves with the requirements, restrictions, rewards, and penalties associated with the changes it brings to healthcare delivery, little attention has been given to the ultimate impact to the healthcare workforce. Granted there has been some discussion about the anticipated increase in demand for care that the newly insured will create and the subsequent shortages of available physicians and nurses to supply the services. However, there needs to be a deeper assessment of the ACA's impact on how work is done and what the workforce of the future will look like.

There are three changes affecting the workforce that the ACA has set in motion: a renewed focus on prevention; delivery of services by multiple providers in an interconnected fashion requiring team-based delivery models; and an incentive to innovate and leverage technology in care delivery. When what the workforce does change, it also alters who -and- how the work is done. Therefore, the changes that the healthcare workforce is beginning to experience today will mold the workforce of tomorrow.

A focus on prevention. Attention to health promotion, prevention of disease rather than treatment of disease, and general management of communities or populations is becoming an important role for the healthcare professional. According to the American College of Preventative Medicine (ACPM), this work requires unique skills and competencies that include knowledge of biostatistics, epidemiology, environmental, and occupational medicine. There is also a social component to prevention. The workforce must be attuned to cultural and social value systems, as well as, how to influence them when behavior changes are required to optimize health. This requires superior communication skills.

Just as important as the workforce's ability to adjust to change to meet the goal of healthcare service from treatment to prevention, the place where the work will be provided may not be the traditional hospital or office setting. The patient may not come to the worker. The work may be done in the community or the patient's home. It may be a group activity or individual care and education. Vaccination programs are a good example. The Centers for Disease Control aggressively advocates annually for provision of influenza vaccines as a preventive healthcare program. These vaccines are increasingly available in the community and are delivered by non-traditional caregivers. The local pharmacy may now be a source of the vaccine and the caregiver delivering the service may be the pharmacist.

The healthcare worker of tomorrow will be as much a health coach promoting healthy behaviors as they are an administrator of medications and treatments. The ability to smoothly transition from one role to the other will be an essential skill. These skills will be required of tomorrow's workforce by organization's that have to operate under the ACA's inherent reward and penalty financial incentives. When value matters then high levels of workforce productivity alone is no longer enough to meet the job requirements but how well the work gets done becomes a primary concern and that requires a highly skilled and adaptable worker.

Team-based healthcare delivery. The Institute for Healthcare Improvement (IHI) describes team-based care as the result of two or more care providers working in collaboration with one another, the patient, the patient's family and others for the benefit of the patient. This may seem like common sense, but our evolution as an industry into professional specialty driven categories has lead to poor coordination in service delivery and planning. This fractured delivery system results in reduced efficiency and effectiveness both during an isolated episode of care delivery and across the continuum of care over a lifetime. The integration of services and improved communication amongst providers will enhance the value of the care. This is resulting in the development of new workforce roles. The emergence of Care Coordinators or Navigators to facilitate communication and patient navigation of the complex healthcare system is directly related to the team-based care concept. These roles cross traditional role boundaries and bring multi-disciplinary teams together with each member serving a specific purpose in the overall provision of care. In team-based care the whole is able to provide greater value to the patient than any individual part or person.

A particular challenge that the workforce presents when team-based care is the intended goal is presenting itself today. According to Schwabel (2015) reporting on the 2015 Millennial Majority Workforce Study finds that this is the year millennials transition to represent the majority generation in the active workforce. Being adaptable and innovative would seem to be good news; however, the millennial generation is also seen as significantly less team oriented than its predecessor generation X. This will present challenges for organizations heading in the direction of team-based care.

Innovation and Technology. With the ACA goal of increasing value and decreasing overall costs of healthcare, it is only natural to look to technology for opportunities. There are many examples of technology improving care or reducing costs, but the impact on the workforce must also be considered. When a technology provides a worker with a warning of an impeding problem or adverse event, risks are diminished and harm to the patient may be avoided. This is a good thing. When dozens of pieces of technology sound alarms simultaneously and frequently on an inpatient nursing unit, it becomes white noise and may be disregarded by the worker. Alarm fatigue is a real concern for the workforce. It is important to carefully assess the technology and how it impacts the overall environment.

Technology not only plays a role in the care delivery itself, but can enable care delivery in new settings. Mobile technology is becoming the norm in healthcare today. It can support care delivery in remote locations by connecting providers at far distances from each other together to share specialized knowledge or diagnosis and develop treatment plans. It can also keep older, experienced or physically limited workers from leaving the healthcare workforce by providing new ways for them to work.

Sentara and Indiana University's Methodist Hospital are two examples where technology has enabled the development of an eICU concept. Where critical care workforce resources work remotely and use video and audio technology to provide support to the bedside nurse or physician in the distant Intensive Care Unit. This concept allows for a new work setting, which accommodates unique worker needs or limitations while simultaneously retaining the experience, knowledge, and skills of a valuable resource.

As the work changes, the workforce will also change. The future holds challenges that will create new opportunities to address the work more efficiently and effectively with both existing roles, as well as, encourage the evolution and creation of new roles for the workforce. Preparing for the future requires the development of a keen eye for opportunities and a willingness to let go of the rigid workforce roles and traditions of the past to embrace a new an exciting time in healthcare delivery where value is the ultimate goal.


American College of Preventative Medicine. (n.d.). What is preventative medicine?
Institute for Healthcare Improvement. (2015).Team based care: Optimizing primary care for patients and providers.
Schwabel, D. (2015). Hiring managers say millennials surpass prior generations in several key business skills, new study reveals.

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