Combating the staffing crisis: Technology and disruption to the rescue
Healthcare chief executives explore innovative solutions to address staffing shortages and clinician burnout.
Healthcare organization executives are wrestling with many challenges, but finding the human resources to treat patients is weighing heavily on them, and they’re looking to technology and improved processes to counteract shortage concerns.
Health system executives and technology developers are looking to shift the paradigm for how technology has affected this trend. The use of electronic health data systems has been cited as a major contributing factor for clinician burnout, with usability, and data input and information overload as burdens related to digital technology.
The industry is looking for emerging technology to relieve burdens for clinicians and make their jobs easier. In addition to process changes, providers are becoming creative in promoting healthcare professions and widening the recruitment net.
But all agree that it’s a deep-seated problem that is crucial to solve.
“At the end of the day, we’re hurt more by lack of workforce than we are by paying or helping somebody get trained,” says David Cole, MD, president of the Medical University of South Carolina. “These are common problems (across all organizations) – the common challenges that we’re facing makes me think that workforce is going to probably be a generational challenge.”
The extent of the problem
Clinician burnout, rising rates of retirement of aging staff and retention concerns that administrators have struggled with for years. One of the most recent barometers of clinicians’ professional despair came early in 2023 with the release by Medscape of its U.S. Physician Burnout and Depression Report, entitled, “I Cry but No One Cares.” It found that both continue to worsen and have increased substantially in the past five years. Predictions from The Association of American Medical Colleges suggest a shortage of 54,100 to 139,000 physicians by 2033.
Gaps in staffing also continue to emerge among the ranks of nurses, the front-line caregivers at most organizations. Current data suggest that the U.S. healthcare industry may have 200,000 to 450,000 nursing vacancies by 2025; trauma related to the COVID-19 pandemic resulted in 100,000 nurses leaving the workforce in 2021, and annual turnover in 2022 stood at 27 percent, industry data suggest.
Even with COVID-19 – for now – in the rear-view mirror, shortages are significant, says Jeff Surges, CEO of RLDatix. “In order to cover everything, we need 400,000 nurses,” he says. “We're not going to make 400,000 nurses. But what we are going to do is innovate and make (the work force) efficient.”
But innovation doesn’t take place in a vacuum, and staffing solutions must be accomplished even as organizations face unprecedented pressures, says Steve Brewer, CEO of Galen Healthcare.
“When you start with the financial pressures and the staffing pressures, those are the things that are making everything so much more challenging,” Brewer notes. “If you don't have people today, and the financial pressures are closing hospitals, making providers leave the market, those are real challenges that need to be tackled.”
External factors definitely are exacerbating staffing shortages, notes Tom Kleinhanzl, CEO of Frederick (Md.) Health, an integrated delivery system.
“Things have been piling up – this shortage of staff and people really started before COVID, and COVID exacerbated it,” he explains. “The economic issues that healthcare systems are having, a lot of those are due to the inflationary issues and the cost of staffing … You're hearing a lot about staff burnout or staff resilience, or the lack thereof, and that affects everybody in an organization and even the person at the top.”
Past economic pressures traditionally have prompted healthcare organizations to compete for patients. Now, facing a staffing crisis, these providers are competing for employees, contends Tom Mee, CEO at North Country Health, a system based in Bethlehem, N.H.
“If you're a healthcare executive in 2023 and issues surrounding workforce aren't keeping you awake at night, then you're just not paying attention,” Mee says. “The competitive landscape for healthcare has really been turned upside down. The most successful healthcare organizations of the future are going to be those that are able to staff their organization so they don't have to shut down services due to staffing constraints.
“When you look at workforce, it's not just hiring people, it's retaining people, it's engaging them and having them be involved,” he explains. “It's one thing to get them into the door, and we've done some innovative things as it relates to compensation and benefits and allowing people … to choose from a menu of benefits. But once we have them, then it's a matter of retaining them and keeping them engaged.”
Part of North County’s engagement process involves its goal of training all employees in Lean Six Sigma, with the goal of re-engineering all roles in the organization. As of this summer, about 75 percent of employees have been trained in the methodology over the previous 18 months in its journey to achieve high reliability.
How technology fits in
Executives from healthcare organizations and technology vendors admit that emerging technology isn’t a complete solution for staffing shortages, but appropriate applications can reduce staff burden, offload menial work, and enable clinicians to improve efficiency and the quality of their care.
Clinical staff “are stressed, they're tired, they're really burning out,” says Michelle O’Connor, president and CEO of MEDITECH. “Technology is going to be something that assists them.” For example, MEDITECH has been incorporating Google search and summarization with Google “for just about a year now. And I think that's the first step that we're going to take and help with AI, enabling clinicians to find information in the record much quicker, much smoother and show it (longitudinally).”
Technology providers are focusing increasingly on how to better support clinicians and reverse the burnout trend, says Adam Gale, CEO of KLAS, recalling the optimism that tech companies and health organizations exuded at a recent meeting at KLAS’s Arch Collaborative, an event that highlights best practices in the use of information technology. “They're optimistic that they can make real improvements,” he said. “And I think it's not just hope and pixie dust – it’s real improvements that I think clinicians are finding with technology.”
B.J. Schaknowski, CEO of technology provider symplr, reaffirms Gale’s perception. “What you want humans doing is high-value work and what software can do is take away all the various routine tasks can remove a lot of the risk,” he says. “Healthcare is so full of opportunities to make meaningful improvements (and) make some logical improvements – get nurses back to actually providing care, get doctors back to providing care.”
Casting a wider net
While many believe technology can make a difference in reversing staff burnout and the resulting shortages, there’s wide understanding that many factors need to be addressed to reverse the trend and ensure adequate staffing for provider organizations. A crucial piece is taking a closer look at ways to enable staff efficiency.
“At the end of the day, it still becomes incumbent upon hospital administration, to ensure that, at any given point in time, I've got the right person in the right place at the right time – it’s providing the right employee that has the appropriate skill set,” says Mee. “We're having conversations that we haven't had for 20 years, about staffing of inpatient services and how we – rather than just sitting back and lamenting the fact that there are going to be less registered nurses over the short term – how do we work more effectively with what we do have? And more importantly, how do we engage them in that own redesign?”
Other efforts include better promotion of healthcare as an exciting, humanitarian and high-demand career.
“Every one of our divisions, as an example, are partnering with technical colleges,” says Cole of MUSC. “And we’ve tried to increase awareness, even to the elementary and middle school level, that, ‘Hey, there's a career path for you,’ in terms of all the different dimensions of healthcare delivery, especially at the tech level. We're actively partnering with our technical colleges … trying to figure out creative ways to partner with them to either prioritize a program, provide greater awareness to help with enrollment, provide the clinical experience that's required in our place and even guarantee employment.”
In part, reversing staffing declines requires a fresh look at the potential pool of workers, says Mee.
“We're now dealing with a generation of providers. If you're a new physician coming out of your residency, you have never trained on anything but electronic health records – you don't even know what a paper record looks like,” he explains. Compare that with the other end of the spectrum – “With large healthcare organizations, the average age of our providers is upper 50s and lower 60s. You've got to develop a mix so that the young person can feel comfortable, where the people that haven't had the same encounters can also feel comfortable. But eventually, that's going to have to shift, and as we recognize that there's a younger generation coming in, we're going to have to embrace the digital age more than we ever have in the past.”
Outreach to younger students and the community also is a hallmark of the effort at AnMed Health, a health system based in upstate South Carolina and northeast Georgia, says William Kenley, its CEO.
“We're working very aggressively with schools, all of the schools from the middle school up through the colleges,” he says. “But we also work with Clemson, we work with South Carolina and others to build our team.” Part of its efforts include sharing its instance of its Epic EHR with schools, training nurses and allied health staff so they become familiar with it. “I think that's something that's great for the school, it's great for the student, it's great for us and, frankly, it's great for Epic as well.”
As healthcare organizations morph and evolve, they’ll need new types of healthcare workers who can operate in new settings, such as providing hospital care at home, and through virtual means, Kenley concludes. This expanded use of technology can perhaps enable clinicians to practice in new ways or even potentially return to provide care in acute-care settings.
“We are looking at a few different options to go to virtual nursing that will be augmenting our hands-on caregivers,” he says. “I think it's great … to bring a level of expertise, particularly when you've got younger, inexperienced nursing and caregivers who are working, you can have more experienced folks that are that are working virtually – that are in their headset, so to speak – who can help them. It also can extend the careers of some folks.”