Q&A With Dawn Javersack, CFO for Nicklaus Children's Health System

In a recent episode of HealthLeaders' podcast, Javersack discussed her organization's solutions to deal with its most significant financial challenges.

The year 2022 may be behind us, but the challenges hospitals and health systems have been facing over the last 365 days are far from over. But just because obstacles like expenses, labor shortages, supply chain issues, and inflation are still around, it doesn't mean healthcare leaders haven't found solutions to help ease the financial impact these issues are causing.

Dawn Javersack, the chief financial officer for Nicklaus Children's Health System recently appeared on an episode of the HealthLeaders Podcast, where she discussed labor challenges impacting the industry, and the strategy the organization put in place to reduce its reliance on travel nurses. Javersack also provided insight into Nicklaus Children's Health System's growth strategies and financial well-being plans for this year.

This transcript has been lightly edited.

HealthLeaders: Can you give us an example of a financial challenge Nicklaus Children's faced in 2022, and how the organization resolved this?

Dawn Javersack: There have been many challenges during 2022, many of which are continuing impacts from the pandemic. And while not all of these challenges have been solved, we've tried to implement solutions in order to mitigate the impact of those challenges. I think one of the most significant challenges that all healthcare providers are facing is in the workforce. Both in the availability of resources as well as the cost of labor as a result of the shortages from a staffing perspective.

We've spent a lot of time on that over the course of the last several years. First, we've made a concerted effort to focus on employee engagement—trying to work with our workforce and connect them to our mission. We started a program called September to Remember in 2020, which is a month-long celebration of employees, whereby every week we have a different theme. We have giveaways, we have ice cream socials, we send [gifts] to employees' homes, all with the intent to cement that connection back to the mission.

We've been providing more flexibility, particularly for those employees who can work remotely. As everybody started to work remotely in 2020, we found that in some of those instances, like our corporate staff, for example, they enjoyed that kind of environment. So, we've offered greater flexibility as an organization to try and accommodate that wherever it's possible, dependent upon their role. As a result of those two initiatives, plus many others, we've improved our employee engagement up to the 75th percentile as compared to our peers across the country.

HL: Contract labor has been a much-needed tool through the pandemic, but it has come at great expense to organizations. How has Nicklaus Children's dealt with this?

Javersack: We established an internal traveler pool for our nurses to minimize our reliance on external travelers. Within that program, we increased the rate of pay for nurses who sign up and make a commitment for a six-week period to work an additional 24 hours each pay period. We do pay them a higher wage, but it is still less than the cost of an external traveler. We started that about six months ago, and since that time, we had a total of over 26,000 hours that have been worked by our own employed internal traveler pool.

HL: What is Nicklaus Children's doing differently from other hospitals, whether it's pediatric-specific or general to maintain the organization's financial stability?

Javersack: Within our strategic plan, we have four pillars that frame the focus of our strategic plan. One of those pillars is called 'operational excellence.' And we define operational excellence as providing the best clinical care and support services in the most cost-effective way without compromising quality service or safety. And we as an organization have made a sustained commitment to process improvement and scaling efficiencies.

As part of that pillar experience, we entered into a process of engaging middle management leaders to focus on one subject of continuous improvement for a 120-day period. We refer to this as a 'workout.' Our first workout was focused on the elimination of waste. We had a little bit of fun around it. We called it Margin Madness, and we put our management team into teams and used a tournament format like what you see in March Madness.

The leaders were expected to identify two changes—big or small—that they could implement every 30 days, over that 120-day period. Each manager or director was expected to implement eight changes over the course of that period of time. We set a target for the elimination of waste at $6 million within that 120-day period.  And when we concluded it, I was thrilled with the results because our middle managers were able to identify and implement almost $14 million worth of changes in a short period of time, all working on the elimination of waste in their particular area or collaborating with their peers and their colleagues to implement changes that might be multidisciplinary in nature.

HL: What opportunities for growth do you see coming down the pipeline for 2023?

Javersack: As a pediatric facility, we do have a dominant market share in our primary service area. We have almost 70% inpatient market share in Miami-Dade County, which represents our primary service area. That said, our services aren't limited to our primary service area, and so I think there's a lot of opportunity, particularly in our secondary service areas. Those are the two counties to the north of Miami-Dade including Broward and Palm Beach counties, and also to the west of us out going towards the west coast of Florida, in Collier County.

Over the course of the last two years, we have focused on partnering, or developing relationships with other healthcare systems and in particular adult systems in our market. That started with a relationship with Baptist Health of South Florida, which is a large organization that spans the three-county market area in South Florida. We now provide pediatric coverage in their existing facilities. One of their main facilities exited the pediatric space, so we developed a transfer agreement whereby those children are now seen at Nicklaus Children's.

So, I see us focusing a lot on developing partnerships, particularly with adult systems for the provision of pediatric care. We're also focused on building our four institutes, which cover heart, neurosciences, orthopedics, and cancer services, and all of that tied in as well to growth within our employed physician network.