Hospitals are suffering from worker shortages. Can technology fill the gaps?

The great resignation in healthcare has been years in the making — COVID-19 just sped up the problem.

Many healthcare workers left the industry during the pandemic to escape harsh conditions and growing responsibilities. Each worker that left meant another worker that had to pick up the slack. Burnout became synonymous with the job title "hospital worker," whether that worker was a nurse, paramedic or custodian.

A job vacancy rate of roughly 17 percent persists at Michigan hospitals, leading to about 1,300 fewer patient beds available for the sick across the state compared to last year.

"The reality is we knew even before the pandemic that we would have many people leaving the field," said Brian Peters, CEO of the Michigan Health & Hospital Association. "Demographics aren't on our side, and we're simply not training enough nurses, doctors, pharmacists, whatever to replace all those retiring in the coming years."

Roughly one in five healthcare workers left or retired from the field between the start of the pandemic in 2020 and November 2021, according to a survey from research company Morning Consult. The U.S. faces a projected shortage of between 37,800 and 124,000 physicians within 12 years, according to a report released in June 2021 by the Association of American Medical Colleges. A similar story plays out for nurses, medical assistants and so on.

In an attempt to bolster the workforce without a pipeline for backfilling the jobs, local hospitals are turning inward and finding innovative — and sometimes obvious — ways to implement technology and create a pool of available workers seeking alternatives to full-time shifts.

Henry Ford Health is finding job models that allow it to retain some of those leaving the grind of the long work weeks on the hospital floor but may be willing to entertain a part-time job ... from the comfort of their home.

The Detroit-based health system is going to launch a job called "virtual sitting" in the fall at two of its hospitals. Often in the hospital, patients suffering from dementia or another mental episode will require a nurse or medical assistant to watch the patient for their own safety. That chews up an expensive resource that could be assisting other patients as well as reducing the number of available caregivers, said Eric Wallis, chief nursing officer for HFH.

"If I am a nurse close to retirement, maybe working a 12-hour shift isn't attractive anymore," Wallis said. "But if we can use cameras, we can employ staff from anywhere who can visualize and watch those patients and speak to them via a speaker and interact with a team that's on site if they do something that isn't safe. That will help reduce the bedside stress on our nurses."

Wallis said the "telesitting" program is the first of many to come for HFH as it embraces the use of cameras and technology to nurse virtually.

John Jones, managing director of advisory firm Willis Towers Watson's employee experience unit for North America, said managing patient loads with appropriate work schedules is the industry's greatest focus — and technology is the ultimate leveler.

"Being able to use technology to make it easier on a nurse to cover a larger patient load and, in some cases, improve care even with staffing shortages is paramount," Jones said. "Necessity is the mother of invention, so healthcare is looking at things very differently right now."

The HFH system is looking to move the time-consuming task of completing admittance and discharge paperwork, which takes between 20 and 45 minutes, Wallis said, to a virtual setting through a camera and speaker system.

"We're not deploying this to our high-end resources," Wallis said. "The hardest part of any patient is when they are admitted and when they are discharged. Those transitions in care are burdensome and time consuming for staff."

Peters said HFH moving some workflow to the virtual space follows in accordance with the industry's long-standing initiative to move workers to operate at the highest of their credentials.

"We have had, unfortunately, highly trained and highly skilled nurses and even doctors doing things on a daily basis that could be done by a less trained person," Peters said. "They should spend more time doing things they are trained for. Maximizing that will go a long way to addressing this workforce challenge."

Replacing outgoing healthcare workers remains the industry's great long-term threat. Earlier this month, higher education institutions and the industry in the state released a collaborative plan to produce those skilled workers.

Michigan's public universities will work with the state's community colleges to make four-year nursing degree education available away from the ivory tower of their universities.

Prospective nurses would be able to earn a bachelor's in nursing at 28 community college campuses with cooperation from local employers and workforce development agencies.

However, funding remains the hurdle. The organizers of the plan — the Michigan Community College Association, Michigan Association of State Universities, Michigan Independent Colleges and Universities and the Michigan Health and Hospital Association — are seeking $56 million from the state to supply grants to students that completed an associate in nursing degree. Under that plan, each community college would be eligible for $2 million in grant funding for students in hopes of boosting bachelor's degrees among nurses.

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"The plan ensures that Michigan nursing students have every option possible to get high-quality education and training on nearly every college, university or community college campus in this state," Robert LeFevre, president of the Michigan Independent Colleges and Universities, said in a press release.

Trinity Health, the national health system of 88 hospitals based in Livonia, isn't waiting for the structural fixes needed to boost healthcare workers.

Trinity is expanding an apprenticeship program launched in 2016 in West Michigan to more hospitals.

"At that time, we had a demand issue with medical assistants that led to us have to reduce some of our practice hours," said Shana Lewis, vice president of talent acquisition and workforce development programs for Trinity. "When we saw our turnover data and forecasting, we thought we should try an apprenticeship program like manufacturing and construction do."

The program, developed with Grand Rapids Community College and Michigan Works!, is 12 months long and has boosted Trinity Michigan's medical assistant retention rate to 76 percent one year after graduating from the program. The health system has trained 129 medical assistants since launch six years ago.

Most certification programs, like a medical assistant or nursing assistant, are external six-week programs that charge students fees. In Trinity's program, students are paid to participate in the classroom three days a week and in the hospitals two days a week.

Trinity has since launched four more apprenticeship programs in clinical documentation, coding, surgical technology and image processing.

Trinity is also taking its medical assistant apprenticeship program it launched in Michigan to its hospitals nationally starting in July.

"We're exploring other ways of introducing the apprenticeship program in any space we have workforce gaps which is pretty much every sector," Lewis said. "This is 100 percent pipeline building and designed to start individuals down a career path in healthcare."

The loss of nurses has been particularly difficult for many hospitals.

In an effort to fill open shifts, the BHSH System came up with the Beaumont Flex Nursing team, a program that offers competitive nursing pay rates, various shift options and staffing contract choices. The nursing team can create its own schedule using a scheduling app, the system said.

Adding to that is more effort in recruiting for nurses and medical technologists from Canada and overseas. Beaumont works with a vendor to bring these employees in full time as contract workers and they are then hired permanently once they complete their required hours.

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"There's no one thing that you do to turn the faucet on when it comes to recruitment," Gianna Ferrarotti, vice president of talent management and organizational effectiveness for Beaumont Health, said in an emailed statement. "Everyone is competing for talent right now, and we believe there are many compelling reasons to choose to be a part of BHSH Beaumont Health."

For its part, Henry Ford Health is also offering more choices to its workforce.

Its Best Choice program, which it launched eight years ago, is a pool of healthcare workers at the company that operates like an agency. The program identifies its daily needs for workers and taps the existing pool of workers who are not attached to a regular full-time gig at its hospitals and deploys them to fill the gaps.

"Instead of relying on external agencies to supply us labor at a high cost, we wanted to create a team internally with a slightly higher pay rate that could be flexible enough for us to address our daily needs," Wallis said.

These workers notify the health system of their weekly availability and are tapped when a hospital or clinic has a need. They are considered contingent workers and are not provided benefits.

Currently, the program includes roughly 470 nurses, 92 medical assistants and 25 technical staff that can be deployed to HFH's five hospitals and 126 ambulatory sites.

The group averaged 430,000 hours worked in 2021, or about 14 hours per week per employee, Wallace said. Some of those in the Best Choice program are employed at other health systems and use the program for extra pay, he said.

"We've sized the pool to cover about 80 percent of the staffing we need," Wallis said. "We still have overtime for our regular staff, but this helps alleviate most of our issues during normal operations."

Jones said beyond innovative approaches to workflow and scheduling, hospitals are also grappling with creating a better work environment for staff, which is a large part of the outflow problem.

"Workers have seen a difficult two-to-three years now," Jones said. "Creating a healthy work environment is critical. Organizations are getting creative but unless the technology and shift scheduling can improve employee satisfaction, it's not solving the problem."

This story first appeared in our sister publication, Crain's Detroit Business.