The healthcare labor shortage has not been solved. Remember George Clooney in The Perfect Storm? Distracted by business pressures, he mistook for everyday turbulence what turned out to be a devastating tempest. Hospitals are in a similarly hazardous position these days.

Pamela Paulk

Like sailors watching shifting winds and tides, we are challenged with discerning how an unpredictable economy and policy climate will affect us. One thing is clear: There is a disturbance on the horizon in the form of baby boomer retirements and the expansion of coverage under healthcare reform. Many institutions are operating as if the current service volumes and vacancy and turnover rates will endure indefinitely, but this is dangerous short-term thinking.

On the demand side, the sputtering economy means a smaller patient base, with uninsured and insured patients deferring care. On the supply side, hospital employees are staying put in the face of economic uncertainty.

As the economy improves, we will undoubtedly see these trends reverse. An inevitable surge in service demand will be prompted by aging baby boomers, the oldest of whom began to qualify for Medicare last year. And the Patient Protection and Affordable Care Act will bring tens of millions of new patients into the system.

We predict that within two years, the “people power” shortage that kept us up nights in the past will reappear with a vengeance.

The “people power” issue also is a key driver of hospitals' fiscal fitness. To deliver quality care in an increasingly competitive environment, everyone will be challenged to improve productivity and curb costs. That means finding new ways to support doctors and nurses. We cannot afford for them to spend time performing activities that are “below their license.” Therefore the demands on “middle-skill” workers such as nurse extenders, surgical technicians and pharmacy technicians, are certain to expand. Yet these are often the hardest positions to fill.

Now is the time for hospitals to develop and institutionalize innovative workforce approaches—and to do it together, as our two Baltimore hospitals have done. We are competitors, but when it comes to building and supporting the healthcare workforce, we are collaborators.

We have joined forces with the Baltimore Alliance for Careers in Healthcare on a career development model for frontline workers, supported by the Casey, Abell, Weinberg, Robert Wood Johnson and Hitachi foundations, among others. Built around skill building, coaching and career mapping, BACH seeks to fill future “middle-skill” vacancies by building up the talent pool of entry-level workers, and engaging supervisors to motivate and troubleshoot. It helps address childcare and transportation, two challenges that often lead to high turnover. Employee and coach create a clear track leading directly to credential, certification and/or competencies resulting in advancement and pay raises.

This collaboration is great for our people and helps bolster our bottom lines. Reducing turnover, recruitment expenses and use of temp agencies helps to make the case. But we also note effects on patient outcomes and satisfaction, and our nurses benefit as they, like all professional healthcare workers, are constantly working to stretch productivity.

Why have we embraced this collaboration? First, our labor market is regional, and large enough to support both institutions. Second, we are able to share the costs while increasing the scale. And third, it extends our reach into potential employee pools that have not previously been considered—immigrants, older workers, formerly homeless, ex-offenders and workers displaced from other industries.

Every hospital leader who scans the horizon will see the warning signs of significant labor shortages. Waiting until the conditions—recovering economy, aging boomers, healthcare reform, retirements and attrition—align is a mistake. The result would be a perfect storm.

Larry Beck is the former president of and now a consultant to Good Samaritan Hospital of Maryland, Baltimore. Pamela Paulk is vice president of human resources for Johns Hopkins Hospital and Johns Hopkins Health System, Baltimore.