"We're going to center our attention on the one thing that I know is top of mind for you," said Julie Cerese, PhD, RN, MSN, Vizient group senior vice president, performance management and national networks, who led the Vizient Connections Summit session alongside David Levine, MD, FACEP, Vizient group senior vice president, advanced analytics and product management.
"And that's workforce."
In the nearly two decades that Cerese and Levine have studied top-performing healthcare organizations, they've discovered five characteristics that support an organization's ability to sustain top performance and quality: processes, decision making, board support, consistent goals and reliable markers, and people. It was the people portion that took center stage at Summit, where workforce was directly linked to care delivery and patient outcomes.
"When I say people, I mean all people," Cerese said. "All the people in your organization and how they connect and relate to one another. I throw this challenge out to you — how do you get everyone to think critically about their role and responsibility in quality patient care?"
It was a quandary that arose again and again in presentations, education sessions and workshops. If major healthcare challenges can only be addressed by a robust, engaged workforce, what happens when that enthusiasm lags — and employees exit?
"Workforce has been absolutely battered over the past few years and engagement has been super challenging," said Paul Casey, chief medical officer for Rush University Medical Center, who spoke at the leadership, workforce, quality and care delivery peer-to-peer meeting. "The right question, from my perspective, is how do we take care of the team to take care of the patients?"
As industry experts shared their insights across multiple sessions, answers began to emerge, including increased feedback and collaboration at every level of the organization; strategies that allow staff to operate at the top of their license; and creating workplace cultures that emphasize wellness, flexibility, incentivization and purpose.
"Healthcare is a calling," said Marc L. Boom, president and CEO of Houston Methodist who delivered the Vizient Connections Summit opening keynote. "We have a profound responsibility as healthcare employers to connect all of our people to that purpose and passion that makes healthcare so special."
FEEDBACK AND COLLABORATION
When employees at Houston Methodist The Woodlands Hospital first began to feel the strain during the COVID-19 pandemic, every level of leadership jumped into action. It wasn't about devising top-down policy announcements or analyzing patient experience points — it was about rolling up their sleeves and supporting the entire organization to fulfill their most basic, and important, mission.
"Our leaders lead from the front," said Jason Knight, the hospital's chief medical officer, who spoke at the leadership, workforce, quality and care delivery peer-to-peer meeting. "We were like every other hospital — we had turnover, we had agency nurses, we were short on different units. Our CNO put on scrubs and went down and worked like everyone else did. We culled nurses from our quality department and put them all over our hospital — in the Emergency Department, the ICU, and on the floors. Even if they weren't doing nursing-specific tasks, they were helping out as a team. When you have that engagement, that drive, that frontline example from leadership, it really sets the culture in your organization and helps motivate staff. We all own the patient experience together."
Another major aspect of improved collaboration is widespread communication with staff, typically involving a combination of online and face-to-face interactions. The more you know your staff, the more easily you can pinpoint their needs — and intervene before they're on the precipice of leaving.
"I can tell you I've had email lists of every single nurse who worked for my organization," said Jackie Herd, MSN, DNP, RN, NEA-BC, FACHE, Vizient principal, shared her insights as part of the Strategic Solutions for Reimagining Your Workforce power huddle. "I would receive feedback via the listserv and then follow up when I was rounding on the units to revalidate that feedback. Your employees are always looking for something different, and the only way you're going to know what that is will be to have those conversations and create an environment where they can share — and whatever it is that they're sharing, it's your responsibility to make sure you follow up."
But collaboration doesn't just have to happen among health system employees. One way to alleviate some of the more rote tasks placed on providers is to partner with former clinicians or teachers to serve as "coaches" for patients.
"Many times, these coaches look like our patients, they speak their language, and they can help them understand the process," said Tom Villanueva, DO, MBA, FACPE, SFHM, Vizient senior principal, who spoke on a panel about evolving care models. "To bring the passion back to clinicians, we have to try to eliminate some of the clerical burdens. As an example, my colleague was given a five-page listing of all the patients who had not received an A1C check, and the expectation was that she would call all of them. That's not what a doctor should be doing. In fact, it would be far more impactful for a coach to call those patients and explain to them why they need that A1C check."
OPERATING AT TOP OF LICENSE TO IMPROVE CARE ACCESS
One of the more pervasive issues related to workforce challenges is patient access to care providers. Currently, clinicians are so overwhelmed with caseloads that the average wait time to see a specialist is 45 to 60 days, with some diabetic patients waiting months to see an endocrinologist.
That's why specialists need to be operating at the top of their license, Villanueva said, meaning there must be more emphasis on making sure that the right patient is treated by the right person. That requires changing who does the work by integrating advanced practice providers, social workers and pharmacists into team-based care; leveraging technology like Scribes and AI-optimized scheduling, patient monitoring and review of diagnostics; and redesigning work to target waste such as unavoidable visits, unnecessary tests and enabling patient access through virtual health where appropriate.
"The truth is, we cannot possibly treat all patients who need help at this moment unless we develop a methodology for top-of-license treatment. It's a journey that we've only just begun," Villanueva said.
Additionally, when it comes to increased access for patients and top-of-license work for clinicians, the continued development of health systems' virtual platforms is critical, Villanueva said. Sg2's recent Impact of Change® forecast predicts that by 2032, telehealth will account for 27% of all evaluation and management visits — freeing up time for patients and doctors.
"Truth is, 50% of the patients I see for chronic conditions could be seen virtually," Villanueva said. "Patients enjoy the convenience, and telehealth improves access to care as well. Continuing to modify virtual platforms will be key."
WELLNESS, FLEXIBILITY, INCENTIVIZATION AND PURPOSE
If you want every employee on the same page — and pursuing the same purpose — it's essential to ensure they're all internalizing your organization's mission from day one.
"When we went to the University of Kansas, the CEO, COO and CNO told us, `We do an orientation for everyone — it doesn't matter what level they're at,'" Cerese said. "They could be a doctor, a nurse, a housekeeper. But they're all in the same room together and hearing the same message from senior leaders about the goals and objectives of the organization."
And, she noted, many top-performing organizations also had a common mantra: "We're proud of the work we do, but we're not satisfied. We're going to make things better for the patient." Those same sustainers also are laser-focused on making things better for their employees. Some of the ways they pursue that objective is by providing spaces to decompress, access to psychologists, and ensuring leadership is visible to employees across the organization and is intentional in making them feel important.
"Retention bonuses can be based on years of experience and recommitment," said Herd (pictured, left). "Even if it's not a whole lot of money, it's about being intentional and aware of what staff want and making it happen."
Retaining staff also relies on flexibility, said Evy Olson, MSN, MBA, RN, Vizient VP, nursing (pictured, right), who spoke on the "Reimagining Your Workforce" panel. A term that's recently gained traction is "preferment" — meaning retired nurses work the days, hours and shifts that are most appealing to them.
"Can you keep these nurses who have been working 10, 20, 30 years in your organization?" Olson said. "Can they come in for a couple of hours during the night? Think about that flexibility — otherwise, that's a whole lot of knowledge walking out of your buildings."
At the end of the day, most experts agreed that keeping employees at your organization requires healthcare's most essential characteristic: empathy.
"We hardwire empathy into everything that we do in quality, safety and patient experience," said Mike Woodruff, chief patient experience officer at Intermountain Healthcare. "No one comes to work not wanting to do a great job. What we've hardwired is to start with the caring part, which is `How's your team? How's the patient? What do you all need?' And we don't get to the learning part until we ask those questions and get the answers. And that has engendered a lot of trust. But it has to be authentic — you have to mean it, and you have to be willing to deliver on it."