Wendy Horton of UVA Medical Center: ‘How do we inspire the next generation?’

It’s no secret that the COVID-19 pandemic exacerbated staffing shortages throughout the healthcare industry. Long hours and the strain of caring for patients with COVID-19 has led to burnout and mental health issues among providers. Can you describe what workforce challenges the pandemic created for your health system?

For the University of Virginia, and across the nation, healthcare was impacted substantially [during] the pandemic. Hundreds and hundreds of individuals left healthcare altogether, and many organizations were really left [at] critical staffing levels. So this has been an amazing challenge for industry leaders.

Did workforce issues already exist for your system prior to the pandemic?

Absolutely. We knew there was [a] shortage in many specialties, including nursing, going into the pandemic—that we didn’t have the workforce that we needed, that there were shortages, and people were retiring. And we weren’t replacing those, or training as many people as we needed.

What has been your strategy to address this?

Being in Charlottesville, Virginia, it’s not a city environment. So we had to think creatively [about] what we would do. I would say it’s a work in progress. I don’t know that anyone has exactly all of the answers. But one day we came to the realization as a leadership team that even if we are the best recruiters, even if we are paying really top dollar for our team members, it probably still won’t be enough. This was a hard realization.

How do we inspire the next generation? How do we really think about training and diversifying our workforce? We spent a long time soul-searching on what that might look like.

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I know that you’ve taken some innovative approaches to expanding the workforce. Can you tell me about the Earn While You Learn training program?

The Earn While You Learn program is really meant to meet people where they are. We had this realization that individuals, when they think about healthcare, often they think of physicians, or nurses, or maybe pharmacists, but they don’t think of all the vast roles that are available in healthcare. And a lot of these roles do not require formal university education.

We know that people have jobs and families and a really complex life. How can we create a program where individuals have [access to] more of an apprenticeship model, where they could come in, have full-time employment in fully benefited positions and really have the support to earn on the job? Half a day is spent on job training, and the other half of the day is in a more didactic, traditional way. We’ve had great success with the program. We are continuing the journey in many areas such as pharmacy technician, EMT, CMA, CNA—a variety of roles.

How do you measure success?

We’re measuring success, first and foremost, by the satisfaction of people. How are people liking it? How are they doing in the programs? Are they able to complete the certification at the end? For me, as a leader, that’s really the amazing thing: when you can talk to an individual, give them four or five choices, sit down and talk about the difference between a phlebotomist and a pharmacy technician, and the pros and cons of each, and really help them get a career. They can really see a career ladder from there.

“As healthcare leaders, we need to inspire and hold ourselves
accountable to how we will redesign the care delivery model.”

How have you been trying to use people in some roles to fill in shortages in other areas?

Even if we have more individuals, we know that we will probably never have enough, for example, nurses. In the height of the pandemic, in our emergency departments, we were really in short supply on our nursing teams. As healthcare leaders, we need to inspire and hold ourselves accountable to how we will redesign the care delivery model. In our emergency department, we’re trying a couple of different models. What we’re trying right now is: What roles do we need to help support the team to do the work?

In the height of COVID, we said, ‘If we don’t have enough RNs for our emergency department, where do we go next?’ We talked about the patient types that are coming into our emergency department. We have a lot of mental health [needs]. So now we have psych nurses. We have paramedics helping with airway work. We have EMTs, technicians, sitters, scribes. There’s a variety of roles that are now in our emergency department that even six or nine months ago were not there. We believe that this is the future.

Do you think other health systems could use this as a model?

At health systems across the nation, what I love is that we share our ideas. I think others are really thinking hard about how to do this. Another role that we’ve been trying in our inpatient [departments] the last couple of weeks is using kinesiology students to make our patients more mobile. We believe this will help take some of the pressure off of patient care [staff]: our CNAs and RNs.

It sounds like you’re willing to try a lot of new things. I know that can be a scary thing for some leaders. What’s been your approach in trying to be innovative and nimble?

When you don’t have what you need, then that’s where the creativity really comes about. What’s most important for leaders is how to do that safely and how to maintain quality. Every time that we talk about doing something, we talk about the guardrails and precautions and what we need to be doing to maintain quality and safety, and also adhere to any legal requirements. You want to be in compliance [from a regulatory perspective], as well.

What happens when you decide something isn’t working?

We’ve tried things for a day, and we’ve failed miserably. That’s OK, too. We have a lot to learn in healthcare: trying technology, implementing new roles and new ways of doing things. Sometimes it’s figuring out different ways to document. Right now is a perfect inflection point in healthcare to really try it and to do it differently. It could be a model for the future. I’m really hoping some of the things that we’re doing here at UVA can help nationwide.

How have you seen the initiatives that you’ve taken so far pay off?

It inspires hope when people can see that we’re trying, we’re innovating, we’re doing things, we’re pushing forward, we’re modernizing. All of those things really inspire a lot of hope and excitement. That’s why we go into healthcare: to really care for patients and to do things that will propel the industry forward.

Does that help with burnout?

I think they are interrelated. A large part of burnout can be system issues. If we can make systems work more efficiently or take some of the barriers out of clinical care design, that really positively impacts burnout and the exhaustion of working really hard. Always, my goal is, ‘Can we make it easier? Can we make it more efficient? And can we do it better to take care of the patients and the families?’ I don’t know that we have the perfect recipe, but we are trying to innovate and improve each and every day.