The Exec: Workforce Shortages, Individualized Care, AI, Data Utilization Key Elements of 'New Normal'

A Hancock Regional Hospital executive says workforce shortages are going to be a long-term challenge in healthcare.

Now that the crisis phase of the coronavirus pandemic has passed, healthcare providers need to adapt to the "new normal," a hospital chief medical officer says.

Julia Compton, MD, recently succeeded Michael Fletcher, MD, as CMO of Hancock Regional Hospital in Greenfield, Indiana. Before taking on the CMO role, she served as president of the Hancock Physician Network, which employs about 100 clinicians. Her clinical background is in radiation oncology.

Compton recently talked with HealthLeaders about a range of topics, including physician leadership, physician engagement, and clinical care predictions for 2023. The following transcript of that conversation has been edited for brevity and clarity.

HealthLeaders: Now that the crisis phase of the pandemic has passed, what are the primary clinical challenges at Hancock Regional Hospital?

Julia Compton: The biggest challenge is making sure that we have enough staff to take care of patients.

The other big piece is that there is a new normal and we have to adapt. That's tough. We need to pivot because what patients want has changed with the pandemic. For health systems like ours, we must pivot to the need of the patient. Traditional medical models are not going to be what patients want going forward. We will see that patients want much more individualized care. They want time with their physician.

HL: What are the primary elements of this new normal in addition to patients wanting more individualized care and more time with their physicians?

Compton: It's learning to utilize artificial intelligence. Learning to utilize data that not only helps the physician but also helps the patient. It's looking around and saying, "Who has built some of this capacity better that can help with patient care?" Physicians have never wanted to spend their time in the electronic medical record, and that is where traditional medicine has gone. What we are going to see is a pivot away from that. There is going to be more face-to-face time with patients, which could mean using more direct primary care models and other new models of care. It also could involve addressing the social determinants of health to help physicians provide the type of care that patients need.

Julia Compton, MD, chief medical officer of Hancock Regional Hospital. Photo courtesy of Hancock Health.

HL: What are the primary challenges of serving as CMO of Hancock Regional Hospital?

Compton: The biggest challenge we are facing now is labor shortage and how that is impacting not only our hospital but also all hospitals in central Indiana. The labor shortage is tremendous. Like many hospitals, we have a lot of agency nursing supplementing our nurses. We are trying to create a new opportunity where travel nurses may want to remain and become a part of Hancock Health.

On the floors and ICUs, we are seeing that nurses are young. They are brand new. They are fresh out of school. A lot of them did not have clinical training because of COVID, so what the nurses are trained to do now is very different than traditional nurses prior to COVID. Nurses that would have been doing the lead in terms of training have retired. All of this has a massive ripple effect on our physicians and advanced practice providers in terms of influencing burnout and concerns about patient safety.

HL: Are you experiencing physician shortages?

Compton: Recruiting physicians has become difficult. We are finding our best recruitment is from friends of friends. Person-to-person relationships and recommendations are crucial. But what we are seeing is that there are just not a lot of physicians out there. For us, the need for hospitalists is high. The need for certain subspecialties such as gastroenterology is high. Those physicians are very difficult to recruit now.

HL: How are you rising to that physician recruitment challenge?

Compton: We are looking to our own doctors to contact friends or colleagues who they would want to invite to our hospital. We have started offering a recruitment bonus to doctors who have candidate recommendations. There is a recruitment bonus if a candidate interviews and a recruitment bonus if a candidate is hired.

In our physician recruitment, we are accentuating the positives of working at Hancock Regional Hospital. Our hospital is relatively unique in that it is in a suburb area near Indianapolis, meaning that we have a smaller state feel but you are 20 minutes from the big city. So, we are big enough to be interesting, innovative, and cutting-edge, but small enough for physicians to have an impact on the community.

HL: What are the key elements of physician engagement at Hancock Regional Hospital?

Compton: During the pandemic, our doctors united and became engaged on every level to move the organization forward, to have a cohesive plan, and to have an incredibly fast and innovative response to COVID.

We had a new meeting three times per week with our doctors from noon to 1 p.m., and there was a lot of idea sharing. More than 90% of our doctors were engaged in those calls. We created triage clinics. We created respiratory clinics. We stood up monoclonal antibody infusion centers. We created several surge protocols. That engagement piece has continued. We want to keep that momentum going.

Instead of having a call three times per week, we have a call monthly. We also have other avenues to keep our physicians engaged. For example, we are inviting physicians to participate in large strategy sessions. All physicians and advanced practice practitioners are invited. The meeting is held from 7 to 8:30 a.m. We delay the start of clinics until that meeting is over, which provides everybody with the opportunity to participate.

HL: What are the keys to success for physician leadership?

Compton: People assume that physicians are natural leaders, and they are natural leaders in their own offices. But when you ask a physician to go into physician leadership at a higher level in the organization such as outside their own service line, one of the biggest keys to success is that you can no longer think as an individual. Instead, if a decision is made or if we implement a new strategy, there will be a ripple effect that impacts many people, and the many must be considered.

As physicians, we are taught to focus on a problem and to immediately solve it, and there are a small number of outcomes from the solution. In physician leadership, when you start working at different levels of an organization, you realize there is rarely one answer to a problem. There are many pros and many cons with every decision, and you must think through those pieces.

In addition to moving from thinking as an individual to thinking about the many, physician leaders need to learn how to listen very well. Physicians are used to having the answer—we need to have the answer if we have a very sick patient. In physician leadership, you find that there are many answers and there are many incredible brains around the table. In physician leadership, you are not always going to be the one who has the answer.

HL: Do you have any clinical care predictions for 2023?

Compton: One thing will be living with a new normal of labor shortages. Many people have been hoping it would end, but I don't think it is going to end. It is something that we will all have to adapt to and figure out how to manage the workforce differently.

Innovation is my second prediction. We are already starting to see big players innovate in healthcare. It will be interesting to see what Amazon does after some of its recent purchases in the healthcare arena. I assume they will be able to do things well, including virtual medicine. The opportunity for us at the hospital level to innovate will become even more important in 2023 and going into 2024.

There is going to be considerable healthcare fatigue in 2023. During the pandemic, ambulatory clinicians had difficulties they had to deal with and that was also true on the inpatient side. So, each type of physician and each type of advanced practice practitioner has seen COVID through a different lens, and now clinicians are genuinely tired.

There is going to be an increased emphasis on mental health in 2023, not only adult mental health but also child mental health.

The last prediction I would make is that we are going to see an increase in cancer diagnoses and chronic disease diagnoses. Patients are becoming sicker, and a lot of that has to do with the annual wellness visits that so many people either put off or could not get scheduled during the pandemic. As people get back into cancer screening and annual wellness visits, we are going to see a sicker patient population not only from chronic disease but also with oncologic diagnoses.

Related: The Exec: Emergency Medicine Great Background for Physician Leadership