Top Clinical Leaders Share Solutions for Workforce Shortages

Chief medical officers and chief nursing officers recently participated in a HealthLeaders virtual roundtable that focused on healthcare workforce issues.

The CMO/CNO panel at the HealthLeaders Healthcare Workforce of the Future virtual roundtable tackled a range of issues, including worker retention, adjusting care models, and using telehealth to address workforce shortages.

Workforce shortages have become a pressing issue for the clinical operations at health systems, hospitals, and physician practices across the country. The HealthLeaders Healthcare Workforce of the Future virtual roundtable was designed to focus largely on solutions to workforce shortage problems.

Strong leadership is essential to promote worker retention at healthcare organizations, panelists said.

"When you talk about retaining workers, you must have strong leadership in place. We need to develop local leaders and have a good succession plan for top leadership. When you have a good practice environment and clinicians feel empowered to come to work and do their job, that starts at the top of the organization," said Crystal Beckford, MHA, chief nursing officer and vice president of patient care services at Luminis Health's Doctors Community Medical Center in Lanham, Maryland.

"Leadership is crucial. There is a saying, 'People do not leave jobs—they leave managers,'" said Greg Kasper, MD, MBA, vice president of medical affairs-metro region at Toledo, Ohio-based ProMedica.

Employee engagement fosters worker retention, he said. "To succeed in retention, you need to engage the frontline staff.  Often times, it is as simple as asking them, 'What do you want? What are you looking for?' Obviously, pay is usually an answer, but that is difficult right now with the financial constraints that healthcare organizations are under. Retention should be more than just pay, and engagement and purpose are very effective keys. Brainstorming solutions in open houses can go a long way to retain staff."

Avoiding rigid schedules is an effective retention strategy, Beckford said. "To retain workers, you must be flexible. Whether it is eight hours, six hours, or four hours, we must have flexibility in our work schedules and flexibility in our programs. If someone only wants to work over the summer, we need to have flexible workforce programs that make that possible. We need to support staff in the way they want to work, so they see your organization as the preferred place to work."

To retain workers, healthcare organizations need to be sensitive to the values of different generations of workers—Baby Boomers, Generation X, and Millennials—said Deana Sievert, DNP, MS, chief nursing officer at The Ohio State University Wexner Medical Center in Columbus, Ohio. "One of my colleagues on the East Coast came up with a great idea—getting a generational mentor. Get a Millennial mentor. Get a Generation X mentor. Talk with them and find out what you could be doing differently to meet the needs of the generations. While core things such as pay are generally the same for generations, you can do little things for each one of the generations and meet them where they are."

Adjusting care models

One way to address workforce shortages in the inpatient setting is to change care models to ease pressure on nursing and physician staffing, panelists said.

"We know we need to be careful with our nurse-to-patient ratios. But one of the things that we have the opportunity to explore is related to infusing some of our other disciplines into the inpatient care teams. For example, we know that in our current practice we have tried hard to increase mobility for our patients. One of the best people for mobility care are our physical therapists and the physical therapy assistants. So, we are looking to change the model not just for nurses and physicians but also looking at other disciplines and infusing them into the inpatient care models," Sievert said.

Adjusting care models can be tied to having clinical staff work at the highest point of their licensure, she said. "When we talk about getting nurses to work at the highest point of their licensure, off-loading some responsibilities to some of our other disciplines is a very good strategy. We haven't always been good at that, and we haven't always been wise at allowing more people into the inpatient space as an every-moment partner. They have been transactional—they come in and they perform their care, then they leave the unit. We have to think differently about how we use other disciplines and incorporate them into our inpatient care team."

In adjusting care models in the inpatient setting, leaders need to adopt unconventional approaches, Beckford said. "We are going to have to think about care models in a way that is totally different from how we have thought about them in the past. The physical therapists are there, the occupational therapists are there, the respiratory therapists are there. But we are experiencing a worker shortage across the board. So, we must look more at roles that do not exist today or have been tried on a smaller scale. For example, we are looking at nurse extenders for documentation—that could definitely save nurses time and a non-nurse could help with that."

Telehealth solutions

Telehealth offers opportunities to address workforce shortages, panelists said.

"We are all struggling with workforce shortages, and in the rural areas it is particularly tough. You cannot recruit physicians to work in rural areas. It is hard to find ICU nurses to work in rural areas. We need to leverage our relationships between rural hospitals and hospitals in urban areas with telehealth. Using telehealth in this way is not limited to physicians. You can do it with nursing and respiratory therapy, for example," Sievert said.

Respiratory therapy is a great example where telehealth can address workforce shortages, Kasper said. "Any time you have that kind of role that requires an experienced, highly skilled individual, you can apply telehealth as a solution. We were looking at respiratory therapy in a remote ICU during COVID surges—with a goal of managing an ICU patient remotely from our tertiary and quaternary referral centers. You need a lot of ancillary skills to evaluate the patient locally, but much of the care can be done remotely. We were using telestroke monitors to remotely and accurately evaluate patients. As long as the patient had appropriate lines and monitors in place, they were able to be managed remotely in many situations."

Telehealth can be a vital workforce resource even in urban areas, said Jeanette Nazarian, MD, vice president of medical affairs and chief medical officer at Howard County General Hospital, which is part of Baltimore-based Johns Hopkins Medicine. "My hospital is in a very populated county close to two large quaternary health systems in Baltimore, and we still struggle to get some of the specialty services. The irony of COVID is, as horrible as the pandemic has been, it forced people to move into virtual realms in ways that we would have never been able to persuade people was acceptable in the past."

Using telehealth has allowed Howard County General Hospital to offer several specialty services, she said. "We have telehealth for ophthalmology. We have telehealth for rheumatology because the rheumatologists do not come to the hospital anymore. The most important area where we are using telehealth because it was a crisis is for pediatric psychiatrists—we did not have any available in the hospital. There are a whole bunch of pediatric psychiatrists at Hopkins, so we started doing virtual visits with the pediatric psychiatrists. We worried that parents would be in an uproar that their kids were not seeing a doctor in person, but they did not care. They just wanted their kid seen."

Telehealth is also cost-effective, Nazarian said. "We have tried to use telehealth in areas where we have low volumes and paying someone to provide that coverage is exorbitant and does not make sense."

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