The Exec: How Memorial Healthcare System's CEO Slashed Workforce Turnover

Scott Wester details his first year as president and CEO of the south Florida system and looks toward future strategies, including slashing the system's turnover rates.

The first 365 days on the job are a vital time for a health system CEO. In this time, the CEO can make or break their organization's success. While a year can go by fast without major change, that wasn't the case for Scott Wester, who joined Memorial Healthcare System as president and CEO in July 2022.

During Wester's first year of leading the South Florida-based nonprofit system, the team has already made headway in staff turnover and lowering agency utilization.

In a recent interview with HealthLeaders, Wester details those successes and his future strategies for the system.

HealthLeaders: What short-term goals did you accomplish during your first year as president and CEO?

Scott Wester: Listening, learning, and leading: that was my framework of what I wanted to get accomplished when I started back in July 2022.

COVID changed the landscape of how we dealt with the workforce, predominantly the reliance on agency nurse travelers, outside contractors, and not having enough personnel to meet the demand that was out there, mostly on the clinical side. Workforce development was that first leading charge to really move things forward. I've been more than impressed with how we've really changed the narrative on our workforce over the last 12 months.

We were almost $280 million a year of utilizing outside contract or incentive pay and heavy reliance predominantly on nurse travelers.We recogniz[ed] we needed to get back people wearing our Memorial badge. Over the course of 12 months, we've dropped about 80% of use of outside contract labor. We're now about a $200 million savings just on that perspective.

We did it with the intention of understanding we had to make sure that we had a better talent acquisition team,  making sure that we played more offense than defense, and by reaching out to the work community to try to figure out what are things that are maybe are limiting the people to come join our organization.

We work very closely getting information, understanding we needed to do some market adjustments on individual pay raises for certain job classifications, and working closely with our university and educational facilities. Over the course of the last year, we've had a record year of hires within the organization. We hired 3,700 individuals, and of that we had 1,250 RNs. Our turnover went from around 21% and now we're below our historical average of under 14% over the course of the year.

The team has done a great job. Our chief nurse executive, Monica Puga, said we have to create the best experience possible for our students. We have embraced our students, and in turn, we did over 1,700 nursing rotations this past year. Nurse externs can have other job categories such as phlebotomy and EKG techs, so they understand the pace of play as it is for nursing, and [we're] able to then try to get them to join our organization.

We have over 500 nurse residents and I think we have 23 fellowship tracks of about 250 fellows. We now have 23 different types of fellowship programs that can accelerate an individual nurse who wants to go to a higher level of clinical care.

HL: What are you currently working on and how will these help with your long-term strategic goals?

Wester: We now have a very structured short-term incentive program for our leadership team that is focused on key areas such as improving clinical quality and patient safety as it relates to throughput and access, down to how we deal with the experience of the consumer.

Our two-year retention plan is vital for really changing our turnover rate. Our goal is to even drive that further knowing that the first 24 months of an individual beginning of working relationship with us is very important.

We put new communication activities, from new employee orientation to following up after a couple of weeks, after 6 months, and after 180 days, so that people feel that they're part of the Memorial family from day one and to make sure we understand what's working well and what's not working well.

HL: How would you describe Memorial Healthcare System's overall culture?

Wester: Our overall culture [is] very family oriented as it relates to the engagement of our workforce. This sense of belonging and community resonates throughout the organization, which then resonates into the community. We are community-centered, working hand in glove with community influencers, leaders, and stakeholders to improve overall health and well-being of a community, and we do it exceptionally well.

HL: Looking to the future, what is your overall vision for Memorial Healthcare System?

Wester: Overall we've been focused on what we call patient-centered care, and [want] it moving from patient-centered care to person-centered care. We want to pivot more into people's top of mind and awareness.

We've been fortunate; we're one of the best trusted health systems by Monigle  in the country. It's because the interconnection between the community at large with Memorial is tight. When people are thinking healthcare, we want to be first of mind and awareness. This person-centered care is going to be very critical for us to really move into that next level of interrelationship with individuals across South Florida.

HL: What are some of your long-term goals for the system?

Wester: It's multifactorial. We have a lot of demand for clinical services. We've done an exceptional job of building infrastructure for the depth and types of clinical care we provide, whether it's on the acute care side, the ambulatory side, and the clinic side.

We have a provider-sponsored network, a health plan called Community Care Plan that predominantly serves employers but also those with Medicaid. We're making sure we're efficient with the premium dollar. We're one of the best value-based ACO's in the country producing that value equation back to employers, back to key stakeholders, whether it's the state government or federal government.

But we also have to be a good financial steward. We always have to figure out how to become more efficient in the process and making sure we're able to maintain the level of financial strength. We're AA, we're one of 26 health systems in the United States, that's AA rated by S&P. So, ensuring that we have the resources to do the next best thing for our community.

HL: What steps will you take to ensure financial and operational success as you move forward?

Wester: We have to be very efficient. It's not just looking at part of the organization, we've got to look at the whole organization. We created a new innovation center to look at this business differently, to be more efficient and be able to reward our physicians and our caregivers. If they have great ideas, we'll go work with them and maybe even produce some extra level of innovation dollars for them, personally. We call it the "reimagine approach."

We're a very large academic platform. We have almost 300 residents that are part of our learning environment, so we want to extend that learning across everybody within the organization, not just on the educational front, but across all disciplines.

HL: What needs to change to make healthcare better from a business perspective?

Wester: The incentives in the business aren't well aligned together, which causes this over utilization of services to redirection of services. We as an industry are losing sight of what's most important, which is making sure that we serve in a patient-centered mind, coordinated, collectively together as one. There's a lot of bouncing around in our industry, which then gets a lot of frustration to our patients because they either have insurance authorization issues, they get redirected for their clinical, care, maybe providers don't interact or collaborate about what's best for that individual based off of either scientific advancements or making sure there's coordination to ensure there's not issues that fall in the cracks of our system.

That's why organizations like Memorial are well positioned because our first understanding is we're here for our patients. We're here to make sure that we're able to walk them through that whole process without having to fall through some of those traditional cracks or traps that happen in other markets. That's our personal responsibility here at Memorial, to make sure that we do a much better job of that coordination of care, whether it's prevention, screenings, readmissions, to right level of care at the right place and the right cost.