Strategies to Augment Staff, Improve Workflows During Labor Crisis

Alex Bacchetti, executive lead of the Center of Operational Transformation, AVIA, shares staffing ideas and technological solutions for health systems to improve recruiting and alleviate burnout now that the pandemic has exacerbated the labor crisis.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

In this episode, Alex Bacchetti offers advice for providers and health systems to optimize their staff and workflows.

My name is Alex Bacchetti. I am the executive lead for the Center for Operational Transformation with AVIA. AVIA is a health care firm that works with over 50 member hospitals and health systems across the country, to assist them in their digital transformation and enablement journeys.

Thank you, Alex. How has COVID-19 impacted staffing in hospitals?

COVID-19 has not been the cause of this, which is to say that staffing shortages have been on the minds of health care systems and hospitals for a long time, so this has been pretty significant even before COVID-19. Now, having said that, COVID-19 was definitely an accelerator, an exacerbator, if you will. A real jolt to an already declining workforce. In fact, labor participation rates in the United States have been declining since the year 2000, which is about the time the baby boomers entered retirement.

The other thing is burnout. We hear this a lot. Burnout drove early retirements. When you already have a workforce that is tending toward retirement, and you have something like COVID-19 hit and drive burnout, it drove a lot of folks into early retirement. “We're going to retire in a couple years anyway, let's just get out now. It's just too stressful.”

There have been career changes, folks who said this is just too much, and shifts to other health care roles. As other disruptors come into the market, there are lots of different options for health care workers to work outside of the traditional health systems and hospital environments.

Then, finally, work from home. That whole paradigm shifted to more of a gig economy and further changed the way people want to balance their work and their life.

What challenges do providers face due to staffing shortages?

Certainly a lot. I've thought about it in 4 ways.

One is providers are going to continue to face greater competition for talent. That's competition not just from other hospitals, health systems, and similar types of organizations within their communities, but competition from alternatives—alternative health care companies, alternative non-health care. We even see IT folks, for example, leaving the health care world and taking IT jobs in other industries. So, greater competition.

Second is the ability to deal with the ebbs and flows and surges that a continued pandemic could bring. Hopefully we're seeing our way through the end of it, but who knows?

Burnout is also going to continue to be a challenge in an environment of worker shortages.

Then, finally, the supply and demand mismatch, which is to say the demand for labor in health care is not changing. In fact, unfortunately, the double whammy for health care is as baby boomers are retiring and leaving the workforce, and therefore more people are leaving health care jobs, they're also the ones that demand greater care. So, demands on health care will increase.

In the short term, those are the 4 biggest challenges.

In the long term, the biggest challenge will be how to build and scale automation to augment your staff and do the types of things that the staff doesn't need to be spending their time on when automation can do it just as well.

This includes increasing the ability to integrate and analyze data. We have so many disparate systems in use through individual hospitals and health systems. Getting all that data, analyzing it, and synthesizing it in a way that's meaningful will be a long-term challenge for health care systems, especially as labor continues to be in shortage.

What are some examples of technology that can be used during the staffing crisis, and how does it impact providers and patients?

Let's think about those 4 categories. When talked about, for example, the increase in competition, where can technology support that? When you have a highly-competitive market, one of the things you need to think about doing is accelerating the recruiting and onboarding process. I've had health care systems say that it can take up to 3 months from the time a nurse candidate submits an application to when they've been offered the position and can start on the floor. That timeline has to go from months to days if you're going to compete in this marketplace.

There are technologies to help do that, including predictive staffing tools that give you an idea in advance what staff you're going to need. Also, automation tools help in the HR function to accelerate recruitment processes and review resumes using artificial intelligence and machine learning and so on.

In terms of the ebbs and surges in staffing, health care systems need to create greater resiliency and agility. That includes identifying new sources of talent. Not the traditional agency necessarily, where we know health systems are paying often double or triple or even more what they're paying their full-time nurses, but tapping into the gig economy. There are technologies, applications, and solutions that help organizations to do that, to tap into resources in the marketplace that health systems otherwise would struggle to recruit because of traditional ways of staffing.

For burnout, there are digital tools to not only help individual employees with mental health challenges they're dealing with, but also to help managers do a better, more consistent, and more efficient job in interacting, communicating, and supporting their workforces.

Finally, in terms of the supply and demand mismatch, it's about utilizing technology to allow people to work at the top of their license and ability, and to do the things that technology can't do, which is to care for patients.

I talk about the swivel chair work—the work where you're just swiveling from computer screen to computer screen, passing paper or documentation, and using technology for voice-activated and other forms of assisted documentation. Clinical documentation integrity programs automate that so the nurses can spend more time with patients.

Thank you, Alex. As the pandemic and technology continue to change, where do you see the future headed?

Terrific question, and I wish I had the crystal ball to know exactly where things are going, but here are some things we see on the cutting edge.

One is that even as the direct effects of the pandemic wane, health systems will absolutely need to embrace digital solutions to support their workforce because the reality is the staff is not coming back. It might come back in dribs and drabs, but we've been on this decline for 20 years. It's going to continue, and so we're going to see more and more automation, digitization, and technology being used in health care systems.

The second is, we're going to see, as part of that, much more sophisticated artificial intelligence solutions to better analyze the data and to provide prescriptive courses of action. We're already seeing this in staffing, for example, where tools and solutions can not only predict staffing needs 90 days or 120 days out, but also provide a prescriptive sort of work plan or staffing model for the managers to follow.

Finally, using automation, again, to further reduce the swivel chair and other non-value-added tasks so staff can truly focus on those things that technology can't do. The technology's not going to replace that patient-to-caregiver contact, but it can substitute for a lot of the labor-intensive administrative tasks. In fact, I heard a statistic the other day that upwards of 75% of a nurse's time is spent on administrative tasks. How do we flip that, so that 75% is spent on patient care and only 25% on admin? The way you do that is through technology.

Is there anything else that you wanted to add today that we haven't mentioned yet?

You asked earlier about the impact on patients. I would say this: a more consistent workforce leads to higher quality and patient satisfaction. The more agency you're bringing in, and folks who aren't necessarily used to that particular culture, used to working with the people in that organization, you're probably better off having a stable workforce. The more you can do to stabilize that workforce, the higher patient satisfaction will be.

Virtual care offers so many more options for patients, but it also potentially alleviates staffing challenges. At the same time you're thinking about virtual care through the patient's lens, how do you also think about how virtual care can impact your staffing levels? Because it's something you can do while still providing a great benefit to patients.

A more efficient health care system is better for everyone. Even things like patient self-service can alleviate a lot of stress on operations and workforces, while offering a valuable service that patients actually want.

Thanks for tuning in to another episode of PopHealth Perspectives. For similar content or to join our mailing list, visit populationhealthnet.com.

This transcript has been edited for clarity.