Reimagining the Workforce: Strategies from the 2024 AHA Health Care Workforce Scan

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Tom Haederle
Health care is about taking care of people, and that's difficult to achieve without a strong and healthy workforce.

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Tom Haederle
Welcome to Advancing Health, a podcast brought to you by the American Hospital Association. I'm Tom Haederle, with AHA communications. Delivering high quality, compassionate care to the communities we serve remains the top priority of the AHA and our members, and our ability to provide that care depends on a strong, well-supported workforce. To that end, we must address the root causes of emerging and continuing workforce issues,

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Tom Haederle
then implement thoughtful and sustainable solutions for improvement. Join us to hear valuable insights and real world approaches outlined in the 2024 AHA Health Care Workforce Scan to help organizations re-imagine, redesign and transform workforce strategies to support, retain and recruit staff.

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Elisa Arespacochaga
Thanks, Tom. I’m Elisa Arespacochaga, vice president of Clinical Affairs and Workforce with the American Hospital Association. Joining me again this year to share their insights on workforce trends are Ron Werft, president and chief executive officer of Cottage Health, who chaired the AHA's Board Task Force on Workforce. And Felicia Sadler, vice president of Quality with Relias. Welcome to you both.

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Elisa Arespacochaga
And thank you again for joining me.

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Ron Werft
Happy to be here. Thank you.

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Felicia Sadler
Thank you.

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Elisa Arespacochaga
So we're here to talk about workforce and in particular the AHA's 2024 Health Care Workforce Scan, which focuses on three critical workforce challenges confronting hospitals and health system. First, providing high quality care with a changing clinical workforce  - sort of shifting faster and further than we ever have before. Second, building a sustainable and adaptable talent pipeline. And three, what I often refer to as the table stakes work, which is supporting the well-being, satisfaction and safety of the team that comes to work every day.

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Elisa Arespacochaga
So, Ron, I'm going to start with you. How are you seeing your colleagues and how are you tackling some of these challenges and maintaining the effort in the dedication to continue to do these this work and these address these foundational challenges?

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Ron Werft
You know, I think that we've certainly seen some improvement across the industry, really. Employment's back to levels pre-pandemic and of course, the demand for patient care is back where it was before as well. Contract labor is down. The amount that we're paying for contract labor is down. We're seeing some reductions in turnover in various regions of the country as well.

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Ron Werft
So there are some reasons to be hopeful. I would just say that it's really important that we keep our eye on this one. Because as we know, it is top of the list for CEO concerns across the country. And I think it's the sort of thing that if you see some incremental improvement, you might think that you can move on to other things.

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Ron Werft
But that isn't the case. And certainly the colleagues that I have the good fortune to interact with, they're continuing to take it very, very seriously in both not so much a crisis anymore, but seeing it as a mid-and-a-long term challenge that is really important for us to address.

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Elisa Arespacochaga
Absolutely. And I know throughout the task force work, we spent a lot of time thinking about both the upcoming challenge of increased patient care, smaller numbers of providers and how we sort of manage for that. So I think we sort of define this as a math problem going forward. So Felicia, would love to hear your thoughts on what you're seeing around the field as well.

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Felicia Sadler
I couldn't agree with Ron more. We think about the crisis that we just went through, the pandemic, unprecedented times. It certainly disrupted so many so many things. As we think about what organizations really need to do and what we've seen them doing around reimagining, redesigning and really leading transformation within their systems. It becomes critical. And as we think about high reliability focused organizations, you know, sustainability is also a big factor and something that's vital.

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Felicia Sadler
We get to that, that moment. We think, okay, we're past the crisis. The numbers are looking better, what can we move on to next? And workforce has always been something that has been a challenge as we think about health care, but even more so now when we think about the shortage that we've just encountered and certainly in certain parts of the region that are still encountering.

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Felicia Sadler
So commitment to sustainability, high reliability, understanding what's working, lessons learned, what hasn't worked well and moving forward with the strategic plan focused long term.

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Ron Werft
You know, I'll add, if I may, I think that the workforce or HR section of our strategic plans, if it even was in there, was not front and center. I know we've just gone through the next iteration of our formal strategic planning process. Our board approved a workforce development plan that's five years long, and it's actually patterned after the work that the American Hospital Association did.

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Ron Werft
But it's no longer just a way to get our mission accomplished and to get the daily needs met. It's really part of our strategic thinking now. Just important that we see it in that context.

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Elisa Arespacochaga
And I think that really feeds into my next question, which is that I think we're no longer looking at pretty much anything since the pandemic in the same way that we did before. So we're thinking about redesigning care delivery, thinking about different staffing models. We're trying to build the plane as we're flying it. And while it's already trying to do a couple of loop-de-loops on the way, we're really trying to think through with maybe in some cases a smaller staff how do we do this differently and how do we bring technology into that?

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Elisa Arespacochaga
So Ron, I'd love to hear sort of your thoughts about how you're keeping your eye on all sort of three of those: the idea of the workforce, what technology you might bring in, and then how you manage all of this in the current financial environment.

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Ron Werft
Just before talking about some of the things that we're seeing here and in our region, I'll just speak to the fact that nationally organizations are in very different places depending on their size, their scope, their balance sheet as to what extent they can actually invest in technology and take some risks in new care delivery models. And so I just want to make that point that going to some national meetings, you might be sitting next to somebody who has an innovation center and is able to invest a lot into new models.

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Ron Werft
You might also be sitting next to somebody on the other side who is still really struggling to make sure that their ER is staffed today. I think it's important and this is one of the things that AHA is so very good at is creating resources that meet each of us where we are. And just really express my appreciation to AHA for offering something for small rural hospitals, for large urban centers, for multi-hospital systems and small systems like ours.

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Ron Werft
What we're seeing, I think, is well known to really all those who might be tuning into this. We're seeing a change in how we view technology, period. The technology is not certainly not there any longer is technology sake. We're really seeing it not only as a way to improve the quality of care along the lines, points that you made, Felicia, but also embracing technology as a way to provide support for our caregivers in ways that allow them to maximize the time they're spending doing meaningful work.

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Ron Werft
So we had a chance last year to meet with some of the leading EHR vendors, and it's very clear that we have their attention now on focusing some of their energy into creating ways to minimize documentation time. To implement methods for ambient notes. Examples like that. And you know, we're seeing virtual nursing or as some prefer to call it - nursing virtually, and the expanded use of telemedicine, particularly into behavioral health.

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Ron Werft
So those would just be some of the examples that come to mind.

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Elisa Arespacochaga
Felicia, from your perspective, I'd love to hear how you're seeing some of the the changes in how we're taking care of our our teams.

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Felicia Sadler
So as great as technology is, is become even more important today and become more embraced, if you will, in health care in so many ways. I think that's a place for innovation to really thrive. We are seeing and the report, the 2024 health care work force scan noted this. The prevalence of using it in staffing models, projective analysis around acuity and being able to align the staff, the work force, to the acuity of the patients.

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Felicia Sadler
I'm really looking at those resource hours so they can be more lean, focused, if you will, but also effective. And the patient experience is there. We're all about providing high quality care and ensuring that we have the highest quality patient experience and certainly that does positively impact outcomes. So ensuring our workforce is aligned and ready is a key component.

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Felicia Sadler
Understanding the virtual nursing, thinking about expanded uses around virtual preceptors, potentially with your more seasoned nurses on those night shifts where you may have less experienced nurses is another thought. We have several organizations mentioned in the workforce scan around some of the innovation that they're able to do and have done with great outcomes, all the way from your smaller facilities to your larger health systems, who have more resources and an expanded applicant pool, if you will.

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Felicia Sadler
So a lot going on out there in the world around recruitment and in innovation.

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Elisa Arespacochaga
Really appreciate that. Let me dig in on that a little bit. And Ron, you said this in your opening, that health care employment has rebounded to pre-pandemic levels, although I think we may might have pointed out that pre-pandemic we weren't doing great. We were already seeing some shortages. So continuing to look for ways to bring more people in or how to do things in different ways.

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Elisa Arespacochaga
But I want you to talk a little bit about some of the work you've done and what you're seeing others do to not only think about, okay, we're going to put up a job opening and see who comes, but really working with your community to grow and recruit and really retain your team and build that pipeline for the long term.

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Ron Werft
Again, I'll refer back to the the workforce scan as a great document for this section as well with a lot of really good ideas in there. Just here locally in our situation: In looking for what might be non-traditional sources of employees who may become future licensed caregivers. One example would be kind of marrying our work with getting at health inequities and outreach into our community and the use of community health workers in that regard.

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Ron Werft
And now equipping them with the resources, the understanding of how they can grow their careers into the future. So it taps into a part of our community that we may not have tapped into effectively before and gives them the tools to  grow their career in a different way. The recent announcement of these Bloomberg grants was very interesting in terms of supporting health systems, partnering with high schools for high school career academies.

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Ron Werft
And we've had a health care academy at one of the local high schools here for about 20 years. But I think that it's an amazing opportunity to inform - and really you need to start before high school - but to inform seventh and eighth graders about health careers and then reinforce that for those who want to enter into a health careers academy.

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Ron Werft
Ours has been primarily nursing focused here, but we're thinking very differently now about educating them on and helping them fast-track into other post-graduate work that will result in them being clinical scientists or on a different level, maybe an EMT route as well. We're seeing also with our local colleges and universities, we're fortunate to have quite a few of them here on the central coast of California,

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Ron Werft
we're partnering with them to expand enrollment in the programs they already have and also working with them to expand the program offerings that they have. We're working with an organization now to expand their their PA program, for example, which is not something we had thought of before. So we're seeing growth in the enrollment and growth in the number of programs.

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Ron Werft
And for us, that's serving as a very important pipeline for their graduates into our system.

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Elisa Arespacochaga
I love that you have so many different ways into the community and different connections. Felicia, you mentioned specifically the idea of looking for ways to take some of those more experienced nurses to help support the newer nurses who may be struggling to find their footing. Can you talk a little bit about what you're seeing in terms of building that pipeline really as robustly as possible.

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Felicia Sadler
During the pandemic we lost over a hundred, I believe, was 100,000 registered nurses, and we saw some of the emergence of bringing seasoned nurses back into the workforce as virtual preceptors. Many of them had burned out during the pandemic and being able to bring them out in a new and different way was almost refreshing to them. They could still be part of without feeling guilty of kind of missing out, if you will, on patient care, but be part of something bigger, if you will, and really supporting those new nurses who also had some gaps in their programs.

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Felicia Sadler
Many of them graduated early. Many of them did not have their clinical experience that they would typically get in their senior practicum, if you will. And so those were opportunities for the preceptors to really partner with, with newer nurses while supporting them on those shifts, the night shifts where there are less resources. I think, too, bringing them back in the telehealth mode as well.

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Felicia Sadler
We have a lot of nurses. There's more seasoned, experienced nurses can come back in that way, as well, as they are entering back into the workforce. I want to touch a little bit too on the interprofessional component, because that's critically important as we think about Team Steps, as we think about interprofessional communication, interprofessional teamwork as it relates to the patient care experience.

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Felicia Sadler
That's something we're seeing. And really there's a need to be fostered through a program like Team Steps that can be very helpful to kind of bring teams together as we think about focusing on high quality care.

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Elisa Arespacochaga
We not only look for opportunities to educate these teams together, but help them function as an expert team. Speaking of the expert team, our goal really has always been to not only build a health care system where we can take care of our communities, but to ensure - and more than ever now - that our team that comes to that through our doors every day, whether virtually or physically, is well, that they are engaged, that they are safe, that they feel like they are doing, as Ron, you said, meaningful work.

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Elisa Arespacochaga
And I know this is a major priority for nearly everyone I speak to. And I know there is work going on, but I'd love to hear from your perspective sort of what some of the opportunities are. They range from technology to things as simple as...Ron, I'm going to call you out here writing amazingly sweet notes to your team to thank them for things.

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Elisa Arespacochaga
That personal touch makes a huge difference to the team that you're working with. So, Ron, you want to share a little bit about what you're doing and what you're seeing in the field.

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Ron Werft
This is so critically important to our success going forward. We can find all the best technology that these companies are able to produce and they're wonderful ideas. You said at the top of the hour here, Elisa, we have a math problem. And that means that we're going to have to do significant care redesign.

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Ron Werft
So we're not going to be successful at redesigning care if it isn't our frontline staff who are actually redesigning care. And so that means really creating a culture where staff are motivated to be engaged, enjoy being engaged and share the rewards of being engaged in an organization that is helping to solve their problems and most importantly, helping them take care of their patients.

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Ron Werft
So in our organization, we many years ago made a serious commitment to shared governance. It's a fundamental part of our culture, and it started with conversations and nursing. But to nursing's credit, they very quickly pointed out that it was going to be so much more successful if it engaged the entire organization. So we have a shared governance. According to counsel,

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Ron Werft
it has representation from throughout the organization. There's very little that goes on here that frontline staff haven't either asked for, recommended or made better. Ideas that we might have in my office are always made better by engaging the staff. So it's very complex. We have a broad age range. We have different demographics in terms of race and ethnicity.

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Ron Werft
We have people who have no children to small children, to parents who need their help at the other end of life. And so I think some of the approaches would be implementing employee resource groups and listening to staff. So just creating mechanisms where you actually listen to what their needs are and what their ideas are. You wind up creating a culture of innovation that really makes this journey toward care redesign much faster and helps with also enormously with retention.

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Ron Werft
People want to be a part of an organization where they can make a meaningful difference. You learn a lot, and it's very important that when you hear these ideas, acting on them quickly speaks volumes to the staff. So whether it's housing or child care or it might be various elements of the compensation structure for premium pay for things that that they think important that you might not have thought are important to addressing issues.

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Ron Werft
Again, important to listen to them and important to act very quickly. And that word gets spread out through the organization very quickly. It makes people more inclined to give their ideas the next time.

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Elisa Arespacochaga
I think letting people know you heard them makes a huge difference. Felicia, your experience.

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Felicia Sadler
I love exactly what Ron just said because building the foundational trust is so critical to any kind of change, leading any kind of innovation. You build that trust by listening and by acting. There may be some things that will take a little bit longer to act upon, but by sharing those quick wins and meeting some immediate needs with urgency is absolutely key to really building trust and really sharing some transparency in that.

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Felicia Sadler
So that is fantastic. It also can help some of the initiatives that you're bringing in around physical safety is so important to a health care workforce. Creating that cycle, not only physical safety but psychological safety. And in this day and age, when there's already increased burnout, there are statistics in this report that talk about the levels of burnout and the levels of concern, the increased incivility and bullying.

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Felicia Sadler
It's becoming even more so much more than it was when I was starting out in my career, more than 30 years ago. I think it's taken a toll on the workforce in helping them to feel not only physically safe, but providing that psychological safety within a health system can be certainly important through trust and transparency.

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Ron Werft
Yeah, that's so true. I'm just thinking of some of the ideas around addressing workplace violence that have come into fruition here that come directly from frontline staff. I mentioned the weapons detection system that we now have that, as it turns out discovered there were a lot more weapons coming into the organization than we realized. So that was a great recommendation by staff.

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Ron Werft
We also have a K-9 program for security and have for many, many years. And all these years of having a K-9 program that has been very effective in just bringing what could be a very volatile situation, making it quiet very quickly, our security officers have only issued the command twice in 20 years with that program. Again, an idea from staff that has been very effective here.

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Ron Werft
And then just reminding our patients and visitors that our staff are real people. One of the great ideas that emerged was we have some posters and banners throughout the hospital now that show, with their permission, a staff member. It might be, let's say, a staff nurse in the emergency department and scrubs and right next to that picture is a picture of her as a soccer mom.

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Ron Werft
And it says, you know, I'm a UC Santa Barbara graduate soccer mom. I'm also your nurse today. And so it just sort of helps make people real in front of their patients and family members. And that was important to staff, too, to tell that story.

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Elisa Arespacochaga
I love that example. And such one that's from the staff and back to our very early discussion, one that doesn't require a huge financial commitment from the organization but does help us get back to humans caring for humans. Ron and Felicia, thank you again so much for joining me today. You covered and touched on just a few of the topics and a couple of the statistics that are available in the AHA health care workforce scan, which is based on a review of many reports and studies and data sources from across the country.

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Elisa Arespacochaga
And it provides valuable insights and practical recommendations to help organizations think innovatively and act boldly to support, retain and recruit their staff. I encourage folks if they want to learn more about the AHA Workforce Scan, you can find it online at www.aha.org/aha-workforce-scan. And I want to point out that the workforce scan is made possible by and sponsored by Relias.

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Elisa Arespacochaga
To learn more about Relias. please visit www.relias.com. Thanks so much for joining us.

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Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and read us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.