What are the top workforce constraints in healthcare and at your respective organizations?
JOLINE TREANOR: The challenge in healthcare, and specifically when you talk about specialty care like cancer care, is having accessible resources. There’s just such a demand for nursing and overall talent. That really puts us in competition for talent that’s coming in. When we look at the aging population of nursing and the gap that we’re seeing there, that is certainly a concern for us. For City of Hope, we’re really thinking about pipeline to talent, not just immediately filling these roles but starting early.
KETUL PATEL: Back in 2020, many people that were thinking about retirement felt compelled to stay on to help take care of patients during an international crisis. But you get through several different phases, and those folks decide to finally retire. We (also) have competitors now that we never thought we would. Amazon recruits our staff, Microsoft, Costco—you can go down the list. We have major corporations pulling people trained in healthcare to leave the profession because wage rates in different industries are such that they’ve been able to do that. My focus is to recultivate and redefine who we actually are. I think that will draw people back to our industry.
MARC MILLER: We know how to compete with other healthcare providers and put our best foot forward in that realm, but we’ve spent so much time over the years trying to entice people to work in the industry for what I think are the right reasons, and then it just became a dollar-and-cents thing. We’ve lost people to other industries over the last couple of years. It’s all based on wages. But the good news is a lot have come back. Now, with Amazon in particular, a number of people that left for the higher wages are starting to see that the grass isn’t greener and are coming back to healthcare.
We have such a mental health crisis in this country that the types of patients we’re seeing in all settings are more complex than maybe five years ago. So, folks are choosing this as a profession—for example, the techs on the behavioral health side—sometimes not knowing the depth of what they’re going to be dealing with. It’s incumbent upon us to do a lot more on the front end to educate so that they are well prepared and can handle what they’re going to see.
Because we’re in so many different geographic areas, one other thing we’re seeing now is the rural areas are really getting hit hard. This is yet another byproduct of COVID. With travelers, 50% went an hour away. They didn’t move across the country, they stayed in their geographic region. And we’ve seen some people come back to our hospitals. But in a lot of rural communities and a lot of the Midwest, that’s not true. They did move away, they made a lot more money, and then they said, ‘I really like this place.’ And they never came back. The problem in the rural areas is that you can’t replace those people because there are not people moving to those areas. It’s really affecting the way we think about development in rural areas and how much more we want to be doing.
How have employee expectations changed in recent years, and how is this affecting your workforce strategy?
JARED MUENZER: We’ve seen and talked to the next generation of employees. You don’t have that, ‘I’m going to stay at one place for 20 years’ mentality. As they come into our organizations, we have to learn and educate about what their plan is, how it’s going to work, and what is the value and the culture of where you’re working. And then we must learn how to partner with high schools. We do a lot with colleges. But we have to figure out how to adapt.
Also, the new thing for us is that I get a lot of applications asking, ‘Is this a work-from-home job?’ and ‘How much time can I work from home?’
PATEL: The best thing that happened for us in our region is when Andy Jassy told everybody at Amazon they’d have to come into the office three days a week. We started to see people come back in Seattle and Tacoma just because Amazon moved in that direction. We were losing so many people for that specific issue. If you’re a nurse, you could work from home doing something completely different at a wage rate that justifies it. I get more questions about (remote and hybrid work). I struggle with that—that’s not how I grew up. But the reality is that we’re dealing with every different generation of people, and we’ve got to adapt.
MILLER: (In a recent meeting), I had a couple of under-30 employees say they had hit their five-year mark, and they just couldn’t believe they’re at the company still. They had no intention of being there for five years. They don’t intend to leave, but it wasn’t something that had ever dawned on them. Changing jobs every two years is interesting, and it’s a problem in the hospitals where the distribution’s not normal anymore. You have too many people with too many options to go out of the hospital setting earlier. We’ve always had people from the hospital that went to the doctor’s offices or the surgery centers, but now, it just seems like there are more (alternatives such as) home health.
MUENZER: And it’s that five to 15 years of experience, or more, that’s lost. We get hundreds of new grads, but we don’t get that next layer, and that cost of training is quite significant.
MILLER: And you don’t want to have all new grads. We used to limit it, and we’ve had to change that. We probably adjust our approach every six months now.
MUENZER: We had a policy for a long time that if you were an employee and you decided to travel, we limited how quickly you could come back. Because they would want to travel for three months and then come back. You get to a point where that policy’s no longer valid; we need them. But how do you balance that? You have to make really tough decisions around what you’re going to allow and not allow in your workforce.
What trends are you seeing in labor costs, and how is your organization managing these constraints?
PATEL: The Pacific Northwest has been staggering in terms of wage rate inflation. When we were giving signing bonuses and retention bonuses for staff, it was the only way to get more staff in, and it made much more economical sense than getting travelers. But now, when you get into wage rates—and not just the unionized workforce, we have two of the only non-unionized hospitals in the state—our wage labor expenses have increased 30% in two years. Obviously, we’re not seeing the commercial rates go up to that number.
MILLER: There’s a (misconception) that cost of living is equal to the increases that you then have in wage rates. It used to be more aligned; a lot of that changed during COVID. All of a sudden, people were going to lower cost places with the same wage.
TREANOR: We’re fortunate in that, in addition to our compensation and benefits, our purpose is a strong draw for our employees. People feel connected to the mission. Because of that, our turnover is really low. People that get into cancer care, they want to do it for a reason. I would say 90% of the people that I talk to, the reason they’ve joined City of Hope is there is a connection to cancer. But the wage pressure, it’s convincing for anyone.
MUENZER: In pediatrics, we have the same benefit. People come to us because of the care that we deliver to kids. We used to also have the benefit of being in Phoenix because it was way cheaper than L.A. It still is cheaper, but not nearly what it used to be. We’ve got our employees coming to us, saying, ‘What used to be a $200,000 house is now $750,000. And I need (more).’ So, we have the same pressures.
Amid resource constraints, how do you keep diversity, equity and inclusion efforts at the forefront of your workforce strategy?
TREANOR: For City of Hope, it is core to our mission of delivering cancer care. Through advanced diagnostics and genomic testing, we know that cancer is not one disease but hundreds. It affects different populations in unique ways. There is no one-size-fits-all approach when it comes to preventing, treating and curing cancer. Developing tailored, precision medicine solutions requires knowledge. We’re committed to advancing the representation of diverse populations in oncology clinical trials to generate better, more accurate data that represents the diverse patient population of the U.S. and includes those who would benefit most from innovations in treatment.
Interestingly enough, we recently finished our engagement survey, and the two things that had the highest level of importance were development and DEI. It was even above compensation and hybrid (work). So, we’re focused on truly infusing DEI into the DNA of City of Hope. I’m happy to say DEI was where we scored the highest in terms of improvements. We have a very detailed and prescriptive plan that we’re looking at for DEI, not just in the recruitment and retention of our people, but everything. Cultivating a culture of DEI enables us to engage and build trust with underserved and historically excluded communities and expand access to specialty cancer care. Our strategy takes a holistic view and includes everyone from our staff to our patients to our community at large. From a recruitment perspective, we’re leaning into that work by recruiting at historically Black colleges and universities (HBCUs) and historically Latino universities.
MILLER: One other thing that’s important about recruitment is it’s not just about who we’ll interview. We certainly have made adjustments the last few years, and we want to interview more candidates that have more diverse panels, but everybody’s trying to do that. You can’t find the people. So, you go to a lot of high schools in areas where they have not traditionally gone into business or healthcare, and they don’t even know it’s an opportunity. We’re trying to go to some of those communities and say, ‘You don’t just have to be a tech.There’s a whole gamut, here are all the jobs.’ That’s how we’re going to really be able to change this.
TREANOR: The other piece, too, is those recruits are looking at the leadership in the organization. They’re going, ‘Well, what does your board of directors look like? Are the ones making the decisions diverse? What does your leadership look like? What does your trajectory look like for your mezzanine leadership (middle management)?’
PATEL: We added something into our leadership team meetings called an equity pause. Before you conclude the meeting, are people’s voices being heard? Are there issues that we’ve not talked about that are really important for our organization’s mission? Are we focusing on the right priorities for all the communities, not just a business deal? That has opened conversations that we weren’t having. As an example, we started an administrative fellowship program three years ago throughout CommonSpirit and have been very intentional about making sure we had minority representation. I always asked the administrative fellow to lead the equity pause, and one of the first things one of our fellows said when asked for observations was, ‘It doesn’t seem like everybody’s talking. Why don’t you just call on people?’ You start that, and you build that muscle, and then it becomes a non-event—people start contributing and bringing up issues.
How do you anticipate the future workforce needs of your organization, and what steps are you taking to prepare for those changes?
MUENZER: We’re being proactive. At Phoenix Children’s, we have a partnership with Arizona State University in the mental healthcare space and in nursing. For the nursing side, we have developed a designated educational unit, where we get about 120 nursing students a year who apply to our program. We take upwards of 80 nurses, and (the majority) spend their third year in nursing at Phoenix Children’s. On average, we hire 78% of them and have a one-year retention rate of 84%. It’s a program that has really helped us. We’re maybe not as big as the other organizations represented at this table, but 80 nurses to our hospital is huge.
At the entry level, they want to know what’s possible, and they want to know it quickly. We’re doing more to define (their career path) for them: ‘Your next step can be this and then this and this.’ I think that helps them see it and helps us find the next talent for that next job. Being a children’s hospital, wages can have a significant impact on us because we’re competing against adult hospitals around Phoenix as well as around the country when you talk about traveling. So, we have to define for them where they can go over time, not only salary-wise, but where they can go position-wise.
TREANOR: We’re doing a lot more advanced analytics in our engagement surveys, correlating items such as likelihood to stay with team dynamics or leadership dynamics. Using Press Ganey, we’ve really pushed to see where we may have leaders that have challenges and how can we provide them with support. We’re digging into those analytics to understand what they’re doing, how they’re doing it, what does it mean (for those leaders) and what does it mean to the people that are working in those departments.
Another area is around development. At City of Hope, we think about leadership development at all levels. We are trying to have consistent understanding of that approach to leadership because these developmental pathways are so incredibly important. From the day they start, people want to know, ‘What’s next for me?’ So, ensuring that our people have opportunities, and maybe not a promotional opportunity, but even a project opportunity or getting them in front of leadership, inviting them to conversations. It’s those kinds of nuanced opportunities that satiate that drive to feel like they’re contributing. People want to feel a part of something, and in our newer generations, that has become even more important. It’s really the responsibility of us as leaders to make that connection for them.
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City of Hope’s mission is to deliver the cures of tomorrow to the people who need them today. Founded in 1913, City of Hope has grown into one of the largest cancer research and treatment organizations in the U.S. and one of the leading research centers for diabetes and other life-threatening illnesses. City of Hope research has been the basis for numerous breakthrough cancer medicines, as well as human synthetic insulin and monoclonal antibodies.
With an independent, National Cancer Institute-designated comprehensive cancer center at its core, City of Hope brings a uniquely integrated model to patients spanning cancer care, research and development, academics and training, and innovation initiatives. City of Hope’s growing national system includes its Los Angeles campus, a network of clinical care locations across Southern California, a new cancer center in Orange County, California, and treatment facilities in Atlanta, Chicago and Phoenix. City of Hope’s affiliated group of organizations includes Translational Genomics Research Institute and AccessHopeTM.
