Health system CEOs are navigating a variety of issues as they respond to market consolidations, industry disruption and financial concerns.
In this second installment of a two-part roundtable series, Ketul Patel, CEO of Tacoma, Washington-based Virginia Mason Franciscan Health and president of Chicago-based CommonSpirit Health’s northwest division; Dr. David Herman, CEO of Duluth, Minnesota-based Essentia Health; and Airica Steed, president and CEO of Cleveland-based MetroHealth System, discuss how their organizations are shifting away from contract labor and expanding their capacity for patient care, among other ongoing challenges.
The interviews have been edited for length and clarity. For part one of the roundtable, in which the CEOs discuss their current partnership and revenue cycle strategies, click here.
What efforts do you have in place to develop a more permanent workforce, as opposed to relying on travel nurses and contract labor?
Patel: Our pipeline is our biggest opportunity. We have been very focused in the last year-and-a-half on building relationships with community colleges and nursing programs. We're doing more around our CommonSpirit national family to create nurse residency programs that allow us to connect new staff to our organization. If you look at the pandemic journey, there were times that many of our units were deeply reliant on traveling and premium pay, and almost 50% of our staff were travelers. Now, we're weaning ourselves off of that because we're doing a better job of recruiting.
Steed: Contract labor is less of a challenge for us because we have been able to maintain a balance using our own internal staff. However, we've had to increase our premium compensation incentives. We're partnering with local colleges and universities to build a robust pipeline. We've instituted a variety of programs, including having nurse residency programs in concert with various colleges and universities.
We've also adjusted our skill mix. We've adopted a team-based care delivery model, using licensed practical nurses as opposed to only registered nurses in our workforce delivery pools. We’ve instituted a virtual option. We're trying every single lever that we can.
Herman: We're becoming less reliant on contract labor. We are seeing that our turnover is way down. We also have a nurse residency program that connects you for the first 12 months of your tenure here at Essentia Health with people within the organization that can help that transition.
We appreciate when people can come and help us when we have gaps, but we know that we're a better organization from a quality, safety and stability standpoint, as well as a financial standpoint, when our employees are the ones that help us care for the people we're privileged to serve.
How are you handling capacity strain in high-demand areas?
Patel: Where we're challenged the most is the outpatient side of business. There's just not enough of a workforce to help us to continue to scale the needs of outpatient behavioral health. We are moving more toward making sure that we've got the right level of care closer to home. We've also launched a hospital-at-home partnership with Contessa, what we call our home recovery program.
How are you addressing health equity?
Steed: The emergency department is often the front door to many healthcare organizations, but it should not be the only front door. We are working to ensure we get the patient to the provider more seamlessly. We're also addressing barriers by [offering] free non-emergent transportation to our communities in need. Access is key.
What are some specific challenges in reaching and treating patients in rural areas?
Herman: Rural areas are different than other areas. We know that they have higher rates of poverty and higher rates of behavioral health disorders. The distances to be covered are much greater.
Telehealth is important. We try to have rural clinics where we can. What we try not to do is have what I would call the “feed the beast” model, where if you need a higher level of care, you need to come to some of our larger hospitals. We try to push those services out into the community.
We know when we do that, that our patients are much more likely to avail themselves of those services. We can keep closer track of them, and they have better health outcomes.
There’s a lot to reckon with in the industry right now. What keeps you up at night?
Patel: You worry about your workforce and the folks coming into our profession. You worry about the fact that there's so much fatigue and about the wellness capacity for a workforce.
Reimbursement in this country is very difficult when you look at our government programs. If you look at Medicare and Medicaid, it's not keeping up with our wage inflation and the cost of providing the resources that we need in our healthcare industry.
Herman: The burden of illness in the United States is so high, and the healthcare organizations, whether it's in the clinic or the emergency rooms or community-based programs, are the last backstop. What I would like to see in the United States is more of a focus on health as policy. If we want to get better outcomes, if we want to reduce the cost of healthcare, if we want to continue to retain people in this healthcare space who do a great job serving people, we really need to have health as policy to say, “How do we keep our population more healthy?”