Struggling with shortages

If the shortage of nurses and physicians is projected to grow by several hundred thousand vacant jobs 15 years from now, should it really be called a “shortage” at all?

A new report from the American Hospital Association suggests that healthcare executives start to accept the difficult workforce staffing reality ahead and start adapting today. But it’s not clear whether the workforce-shortage report’s timing—coming at the end of two years in which the U.S. economy lost 7.6 million jobs—will affect the urgency with which readers embrace its advice.

“Obviously, at one level, it’s kind of a weird message to be coming out at the bottom of the job cycle,” said Ian Morrison, a California-based author and healthcare consultant focusing on long-term strategy. But “it’s a very important message: Don’t whine, get active. And do things to make the place attractive to the new workers and keep the older workers around.”

Despite what’s happened in the job market during the recession, experts say many of the demographic and systemic factors that are causing healthcare worker shortages have not changed. On one hand, the conversion of baby boomers from providers to consumers of healthcare will increase demand for workers.

At the same time, the U.S. educational system is simply incapable of producing the healthcare workers that would be demanded in the future under today’s models of staffing and patient care, particularly in light of the acute shortage of workers projected for all sectors of the U.S. economy and the lengthy educational process for nurses and doctors, the report says.

“Clearly, we’re never going to be able to produce 260,000 new individuals for the field in the next decade,” said Geraldine Bednash, CEO and executive director of the American Association of Colleges of Nursing, referring to a widely accepted projected shortfall of nurses by the year 2025. “We will have to find ways to use nurses so that we use them as knowledge workers. … Right now we are using them as multipurpose workers.”

The report’s summary of recommendations runs over two pages, and includes a 10-point list and several sublists, as prepared by the AHA’s 20-member Long-Range Policy Committee. In general, the committee is urging hospital executives to recognize that they’re about to enter an extremely tight labor market, and take steps to address the problems today, including: redesigning work for maximum efficiency and staff satisfaction; retaining existing workers who are nearing retirement; promoting executives who can lead change; and attracting the “millennial” generation of workers born after 1978.

Thomas Royer, president and CEO of Irving, Texas-based Christus Health, said systems that truly embrace the kinds of changes and employee-satisfaction practices outlined in the report aren’t likely to experience staff shortages in their acute-care settings. That’s partly because many more services will be migrating into outpatient or home-care settings, relying on patient family members and even other patients to assist in care delivery.

Interestingly, Royer said many of the efficiencies involving nonprovider participation in care delivery could be adapted from practices already widely accepted in Mexico, Royer said. Christus Health owns or contract-manages 21 hospitals in the U.S. and seven acute-care hospitals in Mexico. “In Mexico, it would be unusual for someone who is sick not to have one or more family members staying overnight” in the hospital, Royer said. Family members in the hospital and during home-based recovery often ask to be taught how to perform basic tasks, like watching a monitor and alerting hospital staff of certain events.

Labor leaders, however, took a dim view of the AHA’s report, saying that many of its predictions and recommendations seemed to echo false ideas from the past without considering the more radical transformation that front-line workers say is needed. “This is not a revelation. This is: Here they go again,” said Jean Ross, a co-president with the union National Nurses United. “It’s all profit-driven. We try to get them to look further out. Other businesses do a five-year plan; we’re trying to get them to look past 12 noon. … Every two hours, they look at your staffing and see who they can send home.”

Mary Kay Henry, an executive vice president with the Service Employees International Union in Washington, said the recommendations seemed not to recognize the effects of reform efforts. The SEIU estimates that expanding insurance coverage to more than 30 million Americans would create demand for 700,000 new healthcare workers, even though the industry is already short-handed. “There’s a workforce crisis; there’s a cost crisis. For us, it’s all connected. And this report seems to suggest that if you can just redesign work inside the current system, that’s going to relieve the current shortage, which seems ludicrous,” she said.

The AHA report authors acknowledged that many front-line workers have good reason to be skeptical when administrators talk about work redesign, because past efforts largely focused on increasing efficiency by having more work done by fewer workers.

However, Debra Stock, vice president of member relations at the AHA, said the association’s workforce strategies—including recommendations on soliciting front-line worker input and maintaining staff satisfaction—are indeed taken to heart by hospital administrators. She noted that an AHA workforce Web site contains more than 1,000 case studies showing real-world examples of hospitals finding success after implementing AHA workforce strategies like those in the latest report.

What do you think?