Innovative Workforce Strategies to Lead Your Organization Forward

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Tom Haederle
America's health care workers are the backbone of hospitals and health systems and our most precious resource. Without a strong and resilient workforce, our system of patient care collapses. It's as simple as that. Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle with AHA Communications. The numbers aren't pretty. More than 100,000 nurses left the profession in 2021, and the nation faces a projected shortage of up to 124,000 physicians by 2034.

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Tom Haederle
Bold and innovative approaches are needed to support current staff, attract the workers to meet the health care demands of today, and design the care delivery models of tomorrow. Join us to hear valuable insights on the practical recommendations outlined in the AHA's 2023 Health Care Workforce Scan, designed to help organizations think and act innovatively to support, retain and recruit staff.

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Elisa Arespacochaga
Hello, I'm Elisa Arespacochaga, vice president of Clinical Affairs and workforce for the American Hospital Association. With me today are Ron Werft, president and CEO with Cottage Health and chair of AHA’s board level Task Force on Workforce. And Felicia Sadler, vice president of Quality with Relias. Welcome to both of you. And thank you so much for joining me.

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Ron Werft
Thank you. Happy to be here.

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Felicia Sadler
Yes.

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Elisa Arespacochaga
All right. We're here to talk about the health care workforce scan, which really focuses on three critical workforce challenges we are seeing confronting our members. And I know you're experiencing in the field and really how we can think about some of the strategies to address these challenges. Now, I know you are both working very deeply on these, both through the aging task force and in your own organizations.

00;02;02;19 - 00;02;24;05
Elisa Arespacochaga
But let me just quickly recap the three areas that we're focused on. The first is reconnecting clinicians to purpose. We know very much the value that that brings and the fact that in most cases, those who are in health care are there because they really believe in the work. The second is to think about how we can provide support, training and the technology that we all need

00;02;24;05 - 00;02;47;18
Elisa Arespacochaga
to thrive in the different care delivery environments and some of the changes and challenges we've all been seeing. And the last is really how to recruit innovatively and really invest in retention and building that pipeline for the future. So let me start out with you, Ron, to tell me a little bit about what you're seeing and how you're seeing these challenges really affect the field.

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Elisa Arespacochaga
As you know, you're on the front lines of providing care.

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Ron Werft
Thanks, Elisa. You know, we're talking about reconnecting to purpose here. And I would just make the observation that our staff, our health care clinicians and support staff, they are still connected to purpose. It's just become very, very hard. You know, our staff has been through ... more has been asked of them by society and by our organizations than really should be expected for anyone.

00;03;17;21 - 00;03;49;24
Ron Werft
We all know the story. They've gone from PPE to isolation units to visitor restrictions. And I think all of that has had the effect of a loss of human connection. And so as we think about how to reconnect, it's not so much finding their passion because they all share this core value of compassion and all they want to do is to have the resources and the environment in which to provide the very best possible care that they can.

00;03;50;16 - 00;04;14;06
Ron Werft
So we need to support that and find ways to support and strengthen that connection back to purpose. So what you know, what we're seeing around the country and in our own organization are a number of approaches that I think the first and foremost, it will vary by generation and by institution. And so the most important thing is to ask our staff what is important to them.

00;04;14;24 - 00;04;45;27
Ron Werft
And for us, we hear that recognition and celebration and hearing the stories is very, very important. And so we ask how how can we best do that? And we follow their lead on that. Secondly, there's the sense of finding ways to do meaningful work. And as the National Academy of Medicine says, get rid of stupid stuff. So how do you how how can we maximize their time doing what they do best and what they love the most?

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Ron Werft
And then lastly, really addressing issues of burnout, providing mental health support beyond EAP for our staff and making sure we provide a safe environment with the rise that we've seen in workplace violence. So those are just some of the things that I know our organizations are all focused on and working on. And again, it's really about culture and listening to our people.

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Elisa Arespacochaga
Couldn't agree more. I think you're right. They certainly were the ones who ran into the fire from the beginning of the pandemic and continue to do so in ways that we can support them in being able to do that work. Felicia, I know you trained as a nurse and this is something you feel passionate about. How are you seeing this affect the field?

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Felicia Sadler
Absolutely. And thank you, Elisa. This is it's really interesting because we're in unprecedented times coming through. We're coming out of the pandemic and we're seeing some of the fallout and the consequences of that during the pandemic and during times of crisis. It was really, you know, as Ron alluded to, you know, there is connecting that passion. It's really reconnecting.

00;05;53;09 - 00;06;14;04
Felicia Sadler
Absolutely, that passion to purpose. Sometimes that gets lost in amidst the crisis and amidst the fires that, you know, that that folks were dealing with, if you will. So rediscovering and helping them to rediscover and getting back to that one on one, the reason they chose the profession. I know I was committed very early on at a very early age.

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Felicia Sadler
I wanted to help people and that I didn't know really how to do that. I just knew I wanted to go into health care, to be able to accomplish that. And it was through the training and education that I was able to see that that path very clearly. So I think it's just reconnecting them back to the foundational principles that we all started from.

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Felicia Sadler
And then also reconnecting them to their their the patient experience. You know, we have technology. We have other components that come into play. But certainly making sure that there is that, you know, as Ron alluded to, the human connection, which we know can impact patient safety and quality. Recognition as a huge driver, but also providing the meaningful recognition.

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Felicia Sadler
I know I as as a frontline nurse, always appreciated when they were specific in that recognition and acknowledgment and expression of that gratitude. And that the difference I made that day on that shift with that patient in that same place, I think as specific as we can get with the recognition certainly helps not only for individuals but for teens, and it can be very empowering.

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Ron Werft
Now, I had a an opportunity just last night to participate in the awarding of a Daisy Award to one of our emergency department nurses at one of our hospitals. And what is clear in these honoring ceremonies is there's a there's a important story, an inspiring story that's told. There is somebody who is honored for really for their their passion and sometimes often going above and beyond.

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Ron Werft
But what was clear is that when we honor, in this case a nurse, when we honor a nurse, we honor all nurses. And I think there was as much joy and all of the other staff members who were there for that event as there was for the recipient. And so those are really important events to to formalize and and do on a frequent basis.

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Elisa Arespacochaga
And I think they really support that connection not only to the leadership, but then between and among coworkers. So I think that's a really good point, and let me use that as a good way to transition into my next question, which is really about some of the things that both the pandemic and we have put in the way of some of those human connections.  As an industry, not had a great relationship with technology.

00;08;34;20 - 00;09;02;09
Elisa Arespacochaga
There are studies that show we actually lost productivity when we brought in various technologies along the years. So understanding how to best use technology, not only just for technology's sake, but to help support our teams in the midst of the changes that are happening, the needs to move to different solutions to take care of our patients because we don't have the same numbers and complements of caregivers.

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Elisa Arespacochaga
How are you seeing and Ron, again, I'll start with you seeing technology and other resources in your organization helping to support your care teams in doing what they need to do.

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Ron Werft
Yeah, I would say we're really at the very beginning stages of using technology in the context of supporting our workforce. You know, there's been incredible technology in medicine and in our health care organizations. But the focus, the objective has been very different from supporting our staff. Obviously, the focus has been on medical advances. It's been on timely access to health information and data, interoperability.

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Ron Werf
And then, you know, EHRs hours and ERPs. When you think about the purpose of all of the above, incredible medical advances in device technology, minimally invasive access safety has been a focus. You know, pop ups that prevent and help us avoid the medical errors. I would say that none of these are focused on helping people maximize what they would define as meaningful work.

00;10;16;21 - 00;10;43;21
Ron Werft
Dr. Tait Shanafelt at Stanford. This is really important work that he does on burnout and he has found that if you can just increase the percent of time that someone spends on what they would define as meaningful work from 20 to 30%, you make a dramatic reduction in burnout for that individual. So I think we just need to partner with technology with a different objective in mind.

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Ron Werft
Now we need to part with technology to find ways to not move people away from the bedside or away from the patient. The health information is very, very important, but we have to have as a focus and work with our tech partners on ways to get back to the first conversation about meaningful work and connecting to purpose.

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Ron Werft
And I don't think we've really scratched the surface on that yet. I'll just say that the pandemic has really been very important. It has been the acceleration of virtual care and the use of and the acceptance of virtual care. So when we think about our workforce who may have left the bedside, many of them, to the extent that we can partner with technology, which is moving rapidly in response to a consumer movement, to make sure that our staff have more flexibility and the opportunity, if not working at the bedside, to continue to fulfill their passion in doing patient care virtually or in other ways.

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Ron Werft
So I think we have a real opportunity there.

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Elisa Arespacochaga
Yeah, I think there's been a very big shift in where we all feel comfortable with technology and even, you know, comfort with video calls and all of these other things that felt like they should be on The Jetsons and nowhere else. But I think there's a lot of opportunity, but there's also a lot of need to focus. As you mentioned, on focus on what we're trying to do with this technology most effectively.

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Elisa Arespacochaga
So, Felicia, let me ask you, what are you seeing in terms of the best uses and best ways to bring that technology into your organization and into your work?

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Felicia Sadler
That is a great question, and I totally agree. We've brought you know, the pandemic has brought about the embracing and expansion of technology like never before in health care and in new ways, innovative ways of utilizing technology to improve access to care, improve care, quality, streamline processes, make it more efficient. And that's really where I see that organizations have have included this as part of their strategic growth and priority is looking at how can we standardize, how can we streamline workflows to make it easier to do business and easier to work all the way to the front lines for our our staff.

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Felicia Sadler
We've seen benefits that were realized very early on with the expand quick expansion and the use of technology when we went to virtual ICU use or virtual preceptors. One key realization and one thing that I witnessed personally was really helping assisting organizations in transitioning across specialties in times of crisis. And we're still still seeing some of that where there's an opportunity, especially to address workforce shortages around cross-training, upskilling, ensuring that they have everything they need to be able to be competent and safe, and they're using technology to do that.

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Felicia Sadler
And it's become is being hardwired in the organization to really meet the staffing demands. So I think that there's opportunities to continue to expand that. And as we think about these increased competencies around virtual, you know, telehealth, telemedicine, if you will, a hospital at home and so forth, increasing the ability to measure those competencies, ensuring they have the education and training that they need via technology.

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Elisa Arespacochaga
Absolutely. We need to be able to deliver some of that education, as you know, in the moment. And I think technology has helped us to be able to do that effectively. So let me pivot just a little bit to some of the work that has been done. And I know it's been every organization has had to get creative in understanding how they best could support their teams from some of the things we discussed around well-being, supporting their mental health, addressing some of the increases in violence.

00;14;38;14 - 00;15;01;17
Elisa Arespacochaga
But we've also had to think differently about how we both recruit and retain both the next generation but also the current generation of those who current generations who are in our workforce. Understanding what are the benefits structures that make sense? What are the things that people actually would like back from their organization? What does that relationship look like?

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Elisa Arespacochaga
And I know, Ron, you touched on a couple and Felicia, that focus on additional training, additional education, what else can you know, my organization helped me be able to do? I think there are a lot of opportunities now, and given some of the challenges that we've had with the workforce shortages, I think we all need to think about how can we bring people in and make sure that we are building that robust pipeline.

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Elisa Arespacochaga
So Felicia, let me start with you. In terms of those opportunities to educate, to train. How are you seeing not only keeping the workforce we have, bringing in new folks, but then helping those who are maybe in high school or grade schools think about a career in health care that isn't just a doctor or a nurse.

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Felicia Sadler
I love that question because that's actually a trend that we're seeing organizations go across the country and it really is in line with with really reaching out in their communities, diving deep into the the community where you're actually exposing them to health care in general at the high school level. I know in my own experience I had a vocational industrial, you know, Club of America.

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Felicia Sadler
I was part of a health occupations education program within our high school. It was through that program I was first exposed to health care and what the opportunities were that that afforded. In addition, I had a recruiter come from a nursing school to visit us as part of that program where you have different folks from the community come forward.

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Felicia Sadler
And I really it really engaged me. And there was a tremendous interest in how can I be part of this community. This is this seems like a great way that I can help people. And that's really what pulled me into the pipeline early on. And I think we do have that opportunity to really revisit. In addition, I think health systems are for forming academic partnerships with local communities alike across the world of academia to really help build a community or a workforce community.

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Felicia Sadler
If you will. And because health care is one of the largest contributors to the economy locally as well as nationally. So I think there are opportunities there as well.

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Elisa Arespacochaga
Ron, your thoughts on how we grow both keep the folks we have and then really make sure we have the folks we need in the future.

00;17;19;26 - 00;17;54;03
Ron Werft
Yeah, I think that's really the kind of the near, now, and far of our challenge here is focusing right now on making sure that we retain our staff and give them the support that they need to continue to thrive in this health care environment. And as Felicia said, that we think really strategically about the the academic pipeline and start early and make sure that we're messaging to youth really the benefits of committing your your your professional lives to a health care career.

00;17;54;12 - 00;18;14;14
Ron Werft
And there are many just, you know, locally. And what I've heard from other task force members and elsewhere around the country: clearly start with compensation and benefits. It's a tough market. We know that labor costs are increasing at a very challenging financial time for hospitals and health systems and yet we have to get that part right.

00;18;14;14 - 00;18;37;02
Ron Werft
It's sort of the bottom rung on an Maslow's need. And so we just have to get that part right and we have to think a little bit differently about that because as you said, Elisa, we have four or five different generational cohorts within our organizations and where one population is going to feel that child care access is critically important.

00;18;37;21 - 00;19;03;17
Ron Werft
Let's say the baby boomer generation who are still actively contributing, they need more flexibility, maybe need to go part time, maybe need to move to a virtual option. So we need to be much more flexible in terms of our benefit and support structures. I think that one of the advantages that we have in health care is that there are tremendous growth opportunities within health care.

00;19;03;17 - 00;19;29;01
Ron Werft
And so I know that right now we're mapping career paths that start with community health workers and go all the way to RN. We're mapping 20 different career paths this year. And we're starting with our local health health academy at one of the local high schools here, which is becoming, as Felicia said, much more common practice around the country. As we look at the different generations, again, we need to understand the different needs that they have.

00;19;29;08 - 00;19;55;16
Ron Werft
I know that for some in our organizations, just the focus on diversity and equity and inclusion as is very, very important to some. So the advent of employee resource groups that can help people thrive and feel included as part of the health care team is very, very important.

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Ron Werft
For us, shared governance is a critical foundation for our work here, and we have systems to make sure that every voice has an opportunity to contribute. And frankly, the ideas that come from our frontline staff are far better when it comes to workflow and workforce, I'll say, than the ones made in my office, certainly. And so, so important to listen to that.

00;20;20;17 - 00;20;50;06
Ron Werft
Lastly on that, I'll just say that workplace violence has escalated dramatically for a number of reasons. And so our staff have dealt with push back on mask mandates and visitor restrictions and all that they've had to deal with. And we've seen a significant increase in workplace violence. So providing a safe, secure facility ... that's on the agenda of many of our networking meetings, our state association meetings, our national meetings.

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Ron Werft
And there are some important solutions there that can be as simple as safe escorts to parking lots and better lighting. So, again, it really important to hear: what do your staff say is important for them to feel that they're in a safe environment? And our ability to respond quickly to that and make those changes sends a very powerful message that they are supported and safe in our environment.

00;21;18;15 - 00;21;40;23
Ron Werft
So that's a long answer, Elisa, to your question about how we retain people, and I think we just have to do all of those things and we shall cover the the academic pipeline very, very, very well. I know for us, these are going to be local and regional solutions by and large, and there's tremendous variability across the country and supply and demand coming out of our professional schools.

00;21;41;12 - 00;22;02;23
Ron Werft
And so just our local experience has been that we are partnering with ten local colleges and ten local health systems. And just through that work, we found out that there was a 3 to 1 ratio on the number of new grads we all hire each year. These are nursing grads, and the number that are graduating from these local schools.

00;22;02;23 - 00;22;32;00
Ron Werft
And so it just elevates the argument for and the opportunities for local partnerships that expand classroom space and perhaps have partnerships with our staff and their faculty and importantly, increase clinical rotations so we can increase that enrollment. Lot of people still interested in health care. 92,000 qualified applicants to nursing school last year didn't get in, not because they weren't interested or weren't qualified.

00;22;32;00 - 00;22;42;27
Ron Werft
We didn't have space for them. So high level of interest. That's the good news. We got to figure out how to get them in these schools and and taking care of our communities.

00;22;43;25 - 00;23;10;03
Felicia Sadler
Elisa, I'd like to add to the retention component that you had mentioned you now in addressing the needs of the workforce regarding the training education, how can we better retain our workforce? I also wanted to add to this around taking a proactive approach. We think about acclimating to the culture, the environment. Having an effective onboarding process is absolutely critical because we know that leads to improved retention and decreased turnover.

00;23;10;14 - 00;23;47;17
Felicia Sadler
Part of that is really emphasized. We think about the importance of providing robust and personal, personalized experience, if you will, beginning with this effective onboarding process and then providing solutions and resources around that. We know that we can improve in our satisfaction, communication, increase critical thinking through content, personalized learning, as well as improved performance and knowledge. We were able to demonstrate that in the work we did with Virginia Mason Franciscan Health, which is part of CommonSpirit, for example, is a great example of using competency assessments as well as personalized solutions to demonstrate those outcomes.

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Felicia Sadler
One other note I wanted to mention around effective onboarding was the work at Memorial Hermann around effectively transitioning to practice, which is so critical for new grads today and being able to personalize that experience through data driven, personalized coaching for new hires. Personalization, especially when we think about across generations, is absolutely critical because you're actually speaking to the unique needs of that learner and then being able to provide include well-being, patient safety, career growth opportunities as Ron alluded to.

00;24;14;00 - 00;24;24;03
Felicia Sadler
In addition, I've seen fellowships, mentorships, programs being developed to support them even beyond year one to support and grow the workforce.

00;24;24;18 - 00;24;41;01
Elisa Arespacochaga
I think that's key. We no longer can have just one way for everyone to learn. We have to have opportunities for them to learn that work for them. Well, as we wrap up, can I just see if there's anything else that we haven't covered that you want to touch on before we wrap up? Ron, let's start with you.

00;24;41;16 - 00;25;09;11
Ron Werft
I would just add to two comments, really. One is following on Felicia's last comments, and it is the need to provide scholarship support for our staff to give them those growth opportunities. And certainly what we've seen is a significant increase in the interest of philanthropists to support those activities. So I think there's a real opportunity to get our community involved.

00;25;10;02 - 00;25;39;11
Ron Werft
They have you know, we've gone from banging pots and pans in New York to posters at our hospitals and health care heroes. And now I think there are real ways we can engage our communities in supporting our staff. And they really want to do that. So that's an important linkage. And the other thing I would just mention that we haven't touched on yet is that the retention of our staff is often times heavily driven by their support for and appreciation of their manager.

00;25;39;29 - 00;26;05;00
Ron Werft
And so the importance of supporting our our management team, elevating the role of preceptors, maybe moving from preceptor to mentor. So there's an ongoing relationship there. I've seen good examples of that. I think those are really important - I'll say tools to use - but just smart things to do that will keep our staff really engaged and supported in our organizations.

00;26;05;18 - 00;26;33;22
Ron Werft
I would really encourage everybody to make sure that they take advantage to the resources that are available at AHA. I've been so impressed and being involved with this workforce task force with the contributions of the staff are enormous. And by accessing this information on the AHA website, you're you're provided access not only to work done by the AHA, but work that's done by many other organizations for which the AHA serves as a clearinghouse.

00;26;34;00 - 00;26;38;27
Ron Werft
It's really important and valuable information for all of us. I'd encourage you to take a look.

00;26;39;18 - 00;26;43;12
Elisa Arespacochaga
Wonderful. Felicia, anything else to add now?

00;26;43;12 - 00;27;16;07
Felicia Sadler
I completely agree. Just a few things. And we think about building a culture of retention. I think all these key components certainly play into that. The Workforce Scan provides several key strategies to really improve retention, proven impact retention. And I think health care is really a journey. We are headed in the right direction. Of course, we have arisen from an unprecedented pandemic better, more agile, taking those lessons learned forward and then the meaningful strategies really needed to address our workforce.

00;27;16;07 - 00;27;29;15
Felicia Sadler
I think the organizations can definitely find those in the workforce scan. We are improving patient safety. Certainly that's a key focus while developing stronger collaborative partnerships and expansions in our communities, in the communities we serve.

00;27;30;12 - 00;27;58;09
Elisa Arespacochaga
Well, thank you both so much for joining me today and sharing your insights. If you'd like to learn more about the latest health care workforce trends, be sure to check out the AHA’s 2023 Health Care Workforce Scan on aha.org/aha-workforce-scan. The 2023 AHA Health Care Workforce Scan is sponsored by Relias. To learn more about Relias, please visit www.relias.org