Developing a Health Care Workforce to Meet Current and Future Needs
As hospitals and health systems adjust to value-based population health and other transformative changes, they need to invest time, energy and resources in workforce planning and development.
When Banner Health hires for open positions, both clinical and nonclinical, the 28-hospital system not only assesses the applicant's job-specific knowledge and expertise, but "we also consider how patient-centric they are and how resilient they are," said Carol Cheney, vice president, staffing and workforce planning, during an American Hospital Association (AHA) webinar.
Using a talent-assessment tool, Banner Health evaluates potential new hires on 10 so-called soft skills. While it varies somewhat by position, all applicants are assessed for their commitment to doing the right thing correctly, their ability to build relationships, their motivation to serve patients and their tendency to meet obstacles head on and bounce back from difficult situations.
This tool is just one of many strategies the Phoenix-based health system uses to build a workforce capable of delivering value-based care — not just in the hospital but across the health continuum — at the same time the field is absorbing technological advances, moving toward population health and addressing regulatory demands. "You can't achieve quality, safety, etc., without a solid workforce," said Rhonda Anderson, R.N., DNSc, consultant and former CEO of Cardon Children's Medical Center at Banner Health Hospital.
The cost of inadequately addressing workforce issues can be high, said Chuck Alsdurf, director of health care finance policy, Healthcare Financial Management Association. The cost of turnover for one bedside registered nurse is $40,300 to $64,000, according to a 2019 survey. Associated expenses include recruitment costs and the use of travel nurses until a replacement can be hired. "If you think about a base of 1,000 employees, a 1% reduction [in turnover] can amount to half a million dollars," Alsdurf said.
But the cost is not just financial. "If you are not fully staffed appropriately on a specific unit or in a department, staff morale can really [fall]," Alsdurf said. "Also, think about all the process-improvement and cost-reduction initiatives going on. If the key folks leading [these initiatives leave], it's very difficult to keep the momentum going."
A Strategic Approach to Workforce Planning
During the webinar, Anderson underscored the need for senior leaders and trustees to align strategic, operational and workforce planning. This is a key point made in a 2017 AHA workforce report, "The Imperative for Strategic Workforce Planning and Development: Challenges and Opportunities."
This report provides 12 workforce recommendations for integrating strategic, operational and workforce planning [see sidebar]. Health system leaders begin by identifying their transformation strategy for meeting patient needs in their communities, as well as the model(s) of care they are adopting to support that strategy. Then they need to develop a workforce plan that supports this cross-continuum strategy. To do this successfully, hospitals ought to acquaint themselves with their respective state's health care workforce data so that they can model future workforce needs and gaps.
"This is not only about what types of clinicians you need where, based on the model of care, but what the timeline is for implementing," Anderson said. "You have to have the transition plan mapped out and then you can communicate it with the workforce."
Banner Health's 4-Step Approach
Banner Health has developed a workforce planning approach that emphasizes four priorities: strategically focused staffing, continuous education of employees (i.e., workforce fluidity), work-life balance and retention.
The health system focuses on right-sizing staffing, or determining the right number of staff required for various roles across the health continuum. Part of this involves assessing how many core staff are needed so as to limit costly premium labor, Cheney said. The health system has its own internal staffing agency that deploys clinical and nonclinical employees to fill temporary vacancies. But Banner hospitals still use contract staff to some degree.
Banner Health also is building an internal pipeline of talent to meet future needs by strategically placing students and new graduates in nursing, information technology and other positions to learn from more experienced staff. "We really focused on our selection when we were bringing in these interns and fellows, questioning what they hope to achieve and whether they want to stay in the state," Cheney said. "That helped us ... bring in the people who were not only interested, but were going to stick and create a ... better pipeline."
The talent-assessment tool that Banner Health uses to evaluate soft skills is another staffing strategy. The average assessment score of new hires who started between August 2016 and 2017, after the tool was implemented, was higher than the sample group of existing employees deemed as top performers. In addition, hospital units with a high number of employees with above threshold scores on this talent tool are reporting improved employee satisfaction scores.
Time will tell if the hiring evaluations reduce turnover. "Hiring evaluations can help you with retention if you've brought in the right people whose behaviors and values align to the culture, behaviors and values of your organization," Cheney said.
"Don't discard the workforce that knows your organization and is aligned with your culture," Anderson said. "Transition them ... to other opportunities to make sure that you keep a good core staff in the various new roles."
Banner Health leverages onboarding pathways, preceptorships and classroom training to help new graduates as well as more experienced staff obtain the skills they need to transition to new roles (e.g., medical-surgical unit to critical care) or to assume management positions. The health system also has a large medical simulation hospital in Mesa, Ariz., where staff can practice new clinical skills on high-tech mannequins to mimic real-life medical situations.
Banner Health is deploying a number of strategies to reduce employee burnout and improve work-life balance, including flexible and seasonal scheduling. "In Arizona ... we get a lot of winter visitors and ... we intentionally hire people to work during the winter," Cheney explained. These seasonal workers take three months off per year, typically during the summer, when volumes are lower.
Another key contributor to workload balancing is leader engagement with staff. Banner Health uses techniques like skip-level rounding, which is when a higher up manager meets with the employees that are one step down the chain of command to help stay in tune with what's happening at the front lines. For instance, Cheney asks her team: "If you were me, and you could change one thing, what would it be?"
This simple question "gives me really great insights into some of the things that are affecting my staff," Cheney said.
While compensation is important in retaining staff, it's often not the sole reason why people leave an organization. "I haven't seen many individuals who leave roles because they love their boss, they love what they do, they love their work-life balance, they love their coworkers ... [but] they just need to get paid a little bit more," Cheney said. "It's usually because 'I don't like my leader,' 'I don't like the culture,' 'I work too much' and 'They don't pay me enough.'"
Cheney recommends various approaches (e.g., one-on-one interviews, employee satisfaction surveys) to determine if employees are at risk of leaving their jobs. But it's important to follow through and make changes after identifying problems. "If you use employee-satisfaction surveys, [you need to] actually take action ... and communicate back to your teams about what you are doing."
A Process-Improvement Mindset
As hospitals and health systems roll out strategies to build a workforce that will meet current and future needs of patients and their communities, they likely will find that some tactics don't work as well as desired. This is to be expected, stressed the webinar presenters.
"This should be treated like a process improvement in terms of how you monitor and [adjust] the improvements," Anderson said. "If it's not working, go back to your team, the literature or network with colleagues across the country to see if you should make changes to the approach that you were using."
Alsdurf added, "If the program isn't yielding results, maybe look at some other industries and see if there is a model that could be adjusted to work in health care."
Additional workforce resources.
Hiring High-quality Employees Using Lean Recruiting Practices
Recruiters at Our Lady of the Lake Regional Medical Center, a Franciscan Missionaries hospital in Baton Rouge, La., used to struggle with hiring demands. Part of the problem was that many of the recruiters had not been formally trained.
To improve the situation, Farrar Anderson, senior director of human resources, arranged for training in recruitment best practices through The Recruiter Academy from Lean Human Capital by HealthcareSource. The online program focuses on Lean, scalable processes used by elite recruiters.
"One of the biggest things that has changed is the quality of conversations among recruiters," Anderson said. The team now brainstorms and shares sourcing strategies. The Recruiter Academy also taught recruiters how to use data to inform hiring practices and build stronger relationships with hiring managers. Learn more.
"When I learned about Lean Human Capital's Recruiter Academy, it seemed like the ideal situation." — Farrar Anderson, senior director of human resources, Our Lady of the Lake Regional Medical Center
Keys to Successful Nurse-Physician Dyad Leadership Teams
Reflecting on what makes a dyad clinical partnership successful, Kathleen Sanford, DBA, R.N., senior vice president and chief nursing officer at Catholic Health Initiatives (CHI), points to three characteristics: "... that you both are willing to look for and seek out the truth, that you both deal with people with respect and that you communicate effectively what you learn and what you know."
Sanford's dyad partner at CHI, Robert Weil, M.D., chief medical officer, said coaching can help. "But coaching can be coaching one another," he said, "... either preparing for a meeting or when a meeting or situation is over, going back over it with one another ... ."
Listen to the full podcast of the AHA's interview with Sanford and Weil.
Acuity-based Staffing System Uses Predictive Analytics to Align Patient Needs and Nursing Schedules
Midland (Texas) Memorial Hospital saw catheter-associated bloodstream infections decrease by 64% after rolling out an acuity-based staffing system that uses predictive analytics to identify future nurse scheduling needs. The facility has seen decreases in other hospital-acquired conditions as well, including falls and pressure ulcers. Nursing turnover has also decreased by 32%.
Patient acuity data, evidence-based nursing staffing guidelines, and historical patient volume data are aligned to help unit nursing managers determine how many nurses with which skill sets will be needed in the coming days and weeks. Clinician huddles also have been helpful. "Including direct care nurses in some of those conversations is important in having them understand where the information comes from and how it's used," said Brandi McDonald, director of clinical operations. Read the full AHA case study.