Reliable, sustainable staffing strategies are pivotal to helping healthcare organizations fulfill their missions of delivering high-quality patient care. During an executive roundtable moderated by Angie Stewart, content strategist at Modern Healthcare Custom Media, healthcare leaders convened to explore innovative and collaborative approaches for workforce management optimization, with a focus on addressing persistent cost control, flexibility and operational efficiency concerns.
How can healthcare leaders and staffing solution providers ensure they’re speaking the same language when it comes to staffing strategies?
JOHN HIGGINS: Healthcare is under siege as it relates to reimbursement and our need to manage expenses efficiently. The agencies that are really leaning into helping with cost containment are few and far between. When you’re looking for a partner, that’s something you want to make sure you home in on. What we’re asking of agencies is materially different than what it was before. We’re now leaning into agencies and saying, ‘You’re leveraging some technologies that would probably help us with our internal staffing agency. Rather than us building out new solutions, have you thought about being a software vendor?’ Those are new priorities that organizations like ours are pushing into the marketplace and challenging the former models of old to think differently.
RICHEY BROWNFIELD: We need to be creative and innovative about how we partner with our clients. It’s important that we understand staffing from the perspective of not what necessarily is beneficial to us, but how we solve this very complex problem for them. At AMN, we know from decades of practice and workforce analytics that a blend of staff maximizes efficiency, decreases burnout and fatigue, and gets the right clinicians to the bedside at the right time. Ultimately, there isn’t one solution, but multiple. You may be a staffing agency, but it’s necessary to think outside the box in terms of what you can really deliver. AMN is a great example of that. Our biggest focus since the pandemic has been on helping our clients understand how they reduce their reliance on external agency resources. How can they staff up? How can they be more effective from a recruitment processing perspective and from a technology perspective when it comes to talent acquisition? We continually challenge ourselves to be better for our clients and ultimately our communities.
What are the top roadblocks to progress with healthcare staffing?
RB: One is not having a clear sense of what talent is needed when and where. Healthcare systems traditionally have managed talent acquisition in silos, looking at individual facilities or individual departments. As we think about solutions moving forward, a lot of healthcare systems are (looking) to adopt a more holistic, multidimensional workforce management approach that does include all facilities, departments and skills, as well as demand considerations—but also starts to consider all employment models, whether that’s your core staff, internal agency, per diem, float pools—really, every employment model you may have available to you. How do you include all that resource availability in your workforce plan at an enterprise level?
CHRISTINE PIRRI: Healthcare historically has been reactive. It’s difficult (to change that), especially now with the staffing shortages you see across the board. There’s a shortage of doctors and nurses, but quite frankly, I don’t know that there’s any position that’s really easy to fill in healthcare. The staffing challenge has exacerbated that reactivity and the inability for leaders of any department to take a step back and say, ‘What do we actually need right now?’ If leaders can do that—and it’s hard, again, because we’ve got to fill shifts and plug holes— but if we can focus on that, it does provide opportunity to get creative with solutions.
For example, we’ve explored promoting boomerang employees. Maybe they leave and come back multiple times, but it doesn’t mean they’re disengaged with the organization. It just means that what they need isn’t always what we can offer, but when we can offer it, they come back, and it works. It’s similar for retired employees. Are we offering shorter assignments? Maybe there’s a retired nurse who wants to work just four hours, two days a week. Maybe that’s a four-hour time block that you really need covered because you have a lot of discharges happening at that time. So really taking a step back (to ask) what are your staffing challenges and needs, and how can you fill them creatively.
JH: This concept of per diem shifts in healthcare, and the Ubers and DoorDashes of the world—these kinds of opportunities are the direction our world’s going. Those employment models give employees the flexibility to live their lives the way they want and work when they want to. Candidly, health systems don’t have the right tools, technologies, processes and workflows really well ironed out at this point to answer this new demand. That’s one of the key opportunities that the right strategic staffing partners are leaning into.
How do you balance the needs of your employees and HR teams with your overall needs as a health system?
CP: Wages and benefits are the cost of doing business now. You have to provide competitive wages and good benefits. Something we’ve done within the HR departments is automate some things that used to be very manual and paper-driven. One of those is the exit survey. We have automated the exit survey data, so for example, if a certain department is experiencing people constantly leaving, we can pull the survey data and we can very quickly (determine if someone is leaving because they can get a small pay increase elsewhere, or if) it might be something else. In my 20 years in HR, I’ve seen that usually, it’s something else. At the end of the day, people still want to feel valued. They want to learn new skills. They want to feel as though their organization is investing in them. I can’t underscore enough the importance of training and development for the staff that we have. When there are cost containment strategies at play, training can easily be overlooked or skipped, when really, training will pay dividends to those who are receiving it. That is important for leaders to understand.
JH: The fact is workflows, technologies and new processes that better answer the demands from employees will more than pay for themselves. A big part of how they pay for themselves is your ability to retain staff by providing an employment model that works for them. Providing the flexibility they’re looking for gives them less reason to take their career elsewhere. So, I see it as not just a recruitment mechanism, I see it as a massive retention mechanism. That flexibility is what we really need to push for in our industry. Now, most larger health systems are using massive ERP systems, and those platforms are not aligned to do this kind of nimble work.
What are the most promising areas of opportunity for AI and automation in healthcare staffing? How are your organizations operationalizing new technologies?
JH: We’re leveraging automation in our recruiting processes. We have chatbots that can interact with candidates, answer questions about culture and benefits around the clock, and be a virtual recruiter to help with the application process, identify the right opportunities, and outline next steps. We’re leveraging similar technology to assist with interview scheduling. No longer do we rely on recruiters or coordinators to pick up the phone and play telephone tag with someone. We turn the calendar external to them and say, ‘Pick a time to talk to us.’ If they can’t find time that way, we’ll make it possible to have a one-way video conversation where they can interview with a virtual assistant.
By no longer using humans to do those administrative tasks, we allow the people on our team to work at the top of their license—to work with leaders and candidates, consult appropriately, and move things forward in a more meaningful way. Finally, we’re announcing a lot of opportunities around robotics process automation, leveraging those tools to assist us with managing employee data and other tasks. This is ultimately making it easier for both employees and candidates to get what they need from HR in an efficient and timely fashion, in the way they want.
RB: One of the most beneficial areas we’re seeing is workforce planning using predictive analytics. AI technology advances are allowing us to predict staffing levels 60 days out, within one, 96% of the time—so, significant improvements in predictive workforce planning. That same technology allows 75% of open shift hours to be picked up more than two weeks ahead of the shift. Technology learns as it goes to understand which shifts need to be targeted and what resources might potentially pick those shifts up, building in a lot of different variables. We’re also seeing some advances in Vendor Management System (VMS) technology, for instance, being able to predict when agency resources are going to be utilized, which agency is most likely to fill that position, and in how much time, at exactly at what rate. It provides better planning for everyone involved; we’re going to get that position filled faster, with better resources and in the most cost-optimized way.
How do you measure the success of workforce improvements using traditional workforce metrics, but also in terms of patient outcomes and the costs of care delivery?
CP: We’ve created this huge HR dashboard, with everything from tenure, age and diversity metrics to the standard turnover data for the first 90 days, first year, and so on. We can really get a snapshot of where we are specific to HR, but then compare those metrics to the metrics that are important to financial leaders and clinical leaders and using them to launch initiatives and make improvements that are mutually beneficial. Some simple ones are implementing workplace safety programs or safe patient handling programs—to really drive down concerns on the clinical side but also impact HR performance and our workers’ compensation costs.
JH: Some of the unique measures we’re leveraging include cost of care. We’re reviewing the cost of staffing on a weekly basis from a workforce optimization perspective and providing insight in terms of how we are answering the demand. What does the supply look like? Where is the supply coming from? Having those dialogues with the senior-most leaders in our organization helps put together financial forecasts and ensure that we’re tracking toward positive financial contribution. Separately, for recruiting, you have the standard measures like time to hire, time to start, what are the averages for those types of things, but our focus lately has been a lot more on the quality of the experience for our candidates as they move through the process. We’re also surveying those that we do not hire, getting feedback from them in terms of what their experience was and how we can improve. That’s a way to keep the door open to hopefully be able to recruit them later. Lastly, we’re looking at insights and feedback coming from our leaders. What are we doing that’s adding value? What should we keep doing? What aren’t we doing that we need to start?
What are the pillars of successful staffing partnerships?
CP: Meeting your partners where they are is so fundamentally important. Where we are at Bassett may be different than where Essentia is at. Even within our respective organizations, partnering with filling nursing roles may be very different than filling some other specialty role. So, find a partner that listens, understands your culture, understands your circumstances and is willing to work with you to figure out a path forward. Partners have to listen to their HR partners, hear what their challenges are, and then educate them about what options are out there. Richey talks to a lot of healthcare clients on an everyday basis. If I can call him and present the challenges, he can listen and say, ‘Have you tried what this other organization is doing?’
JH: It’s important that they make our goals their goals. We have goals that we set as an organization, and we look for them to help reinforce it. We leverage our partner in a managed-service- provider mindset. For example, we were pouring a whole lot of time and energy into managing rates on a position-byposition basis, really going off gut with very little data. Now, we’ve moved to a model where we’re looking on a weekly basis at national rates. We pegged ourselves to a particular percentile that we want to be paying at from an organizational perspective. As the market moves up, we move up to make sure we stay within that percentile. When the market moves down, which it has been doing as of late, our rates go down. There is no going back to operations to say, ‘What do you think?’ It’s programmatic. Putting some of those efficiencies into place, I’m sure, is saving us hundreds of thousands of dollars annually. That’s just one example of how we look for a partner to help us better manage our business.
Are there any common misconceptions when it comes to external staffing partnerships?
RB: It’s a common misconception that all agencies are created equal, and all agencies are bad. We talk to clients all the time that make blanket statements like, ‘I want to reduce or eliminate all agency.’ It’s understandable, considering the extremely high labor cost environment the industry has experienced over the past few years. Some clients are starting to see the escalating total cost of hiring and employment costs associated with permanent staff and weighing that against continuing rate declines for agency staff. Across the country, the actual total gap we’re seeing in unit costs between these two labor types might not be as significant as some might anticipate. Christine and John are two clients that see the benefits to a flexible workforce – whether it be the benefits that you can provide to permanent staff or core staff in terms of their overall job satisfaction, or having a portion of your workforce that you can flex up and down very quickly. Having the right partner to work with in designing flexible and effective workforce strategies is critical, and that’s where AMN’s focus is every day.
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