The Way Forward: 'Staffing is the Biggest Challenge'

Top executives from across the country are set to participate in a special HealthLeaders leadership summit next month in Atlanta.

Staffing shortages are the primary challenge as health systems emerge from the crisis phase of the coronavirus pandemic, says Eric Eskioglu, MD, MBA, executive vice president and chief medical and scientific officer at Novant Health.

Eskioglu is one of more than a dozen healthcare executives set to participate in The Way Forward, a HealthLeaders leadership summit scheduled for next month at the Loews Atlanta Hotel in Georgia. Eskioglu will serve on a clinical care panel, and there will be panels for CEOs, chief financial officers, and chief information officers.

The focus of The Way Forward will be on sharing of plans, thoughts, strategies, and impressions of the future of the industry. HealthLeaders coverage of the leadership summit includes a Q&A interview of each panelist. The transcript of Eskioglu's interview below has been edited for clarity and brevity.

HealthLeaders: Now that the crisis phase of the coronavirus pandemic has passed, what are the primary clinical challenges that you are facing?

Eric Eskioglu: Staffing is the biggest challenge. Everybody knows about the nursing challenge in healthcare, but we are facing challenges beyond nursing—it's spread into respiratory therapists, phlebotomists, medical assistants, as well as physicians and other healthcare workers. So, the whole environment has been completely disrupted.

Part of the problem is generational. The millennials and increasingly the Gen-Z generation are looking for a different variety of experiences. They do not want to be tied down to a place for more than a year or two. So, there is a pattern of contract labor, travel nursing, and other travel professionals that seems to fit their lifestyle.

HL: How are you addressing these workforce shortages?

Eskioglu: For the next two to three years, for every 10 healthcare workers we used to employ, we are probably going to employ five, contract out traveling healthcare workers for about three, and have the other two automated.

I have been a big proponent of artificial intelligence and natural language processing. We have got to get to the point where we automate a lot of the mundane things that the nurses and the physicians do. Once AI takes over in areas such as documentation, what is left are tasks that require human intelligence that helps us through judgment, which AI cannot do yet. If you ask nurses, they just want to have meaningful work—they do not want to have work that is mindless.

We are trying to make work more meaningful, get rid of hunting and gathering, and eliminate as much of the documentation burden as we can. We want healthcare workers to come to us to work not only because we offer good compensation and good benefits but also because they love the work that they are doing. That is how we are going to differentiate ourselves from everybody else.

HL: Now that the crisis phase of the pandemic has passed, what are your primary COVID-19 challenges?

Eskioglu: The pandemic phase has passed, and we are now in the endemic phase, which means this disease is going to be with us for years to come. Over the past six to nine months, it has been like Whac-A-Mole. We had a wave of delta variant cases at the beginning of the year, then the first omicron variant spiked up, then the second omicron variant spiked up. I do not know whether the next stage of the endemic is going to be a huge spike, with lots of hospitalizations, or whether it is going to be more of a drawn-out spike with less hospitalizations.

We are prepared for all of the scenarios because we have to be prepared—we do not have a choice. But I am hopeful that the new boosters targeted at omicron will be effective.

There also are other infections that we need to address. We have done an incredible job managing monkeypox—we have been able to limit the spread of that disease unlike what we could not do for COVID. We are also going into our flu season, so we are facing a triple threat in the coming months. We feel confident that we can rise to these challenges.

HL: In the next year, in what areas would you like to launch clinical initiatives?

Eskioglu: We are going to have more mental health issues as a country. If you look at national and international events, whether it is the national discourse, the war in Ukraine, inflation, or the recession that might be upon us, a lot more people are going to have mental health issues and there is going to be exacerbation of people who have pre-existing mental health issues. We are going to have more depression and anxiety.

We are focusing on how to address mental health needs better through initiatives such as telemedicine. We are having a lot of touch points with our mental health patients.

Over the next year, we are also going to be focusing on our AI initiatives—that is where we are going to change healthcare in the long run.

HL: Give me an example of where you see AI making a difference at Novant in the next year.

Radiology is a good example. On a busy ER night, you could have as many as 50 images pile up on the radiologist, and everything in the ER is STAT. The problem is that the queuing system is so old-fashioned that you face a logistics challenge. Often, it is first come, first served. That makes it difficult to find the image that might be the ticking time bomb. If radiology images pile up on a radiologist, the first 49 images could be normal and not require an intervention, but the 50^th image could be a ticking time bomb with a brain bleed, and it could take 30 minutes to get to it.

We are developing a radiology AI module that collects images from the source and using machine learning it automatically updates the queue to put abnormal findings at the top of the radiologist's queue. It puts the most emergent images at the top of the queue with a differential diagnosis. One of the benefits has been that the radiologists are less anxious—particularly on busy nights—because they do not have to worry about ticking time bombs. It has helped reduce physician burnout and anxiety.

HL: Do you have any other insights on the way forward now that the crisis phase of the pandemic has passed?

Eskioglu: There is going to be more disruption led by Microsoft, Amazon, Apple, Google, Oracle, CVS, and Walmart. Amazon CEO Andy Jassy has said that healthcare needs to be reinvented. There are altruistic motivations behind that statement, but it is also financial—Amazon is a very large, publicly held company that has a for-profit mentality.

I expect the tech companies to make more forays into healthcare, and the feeding frenzy has started. Amazon has bought One Medical, which is a huge primary care group. CVS has bought Signify Health, which is a home health group with lots of physicians.

The tech companies are trying to establish their own niches. Microsoft has taken the role of creating an ecosystem that can nurture and support the healthcare system—provider systems like Novant and other healthcare organizations. Apple wants to be the company of choice for wearable devices.

Amazon is probably the company that is disrupting the most—they are not only disrupting in a big way but also trying to transform and innovate. Amazon is seeking to establish itself in the most lucrative parts of healthcare such as ambulatory care and pharmacy.

Oracle is trying to be the software of choice. They want to be the data repository of choice for healthcare data.

CVS is well ahead of Walgreens because they have bought Aetna, and they are getting into the provider space by buying Signify Health.

Walmart is another disruptor to watch. In all of their neighborhood clinics, they are implementing EPIC, which is the electronic health record that most health systems use. They have also announced a collaboration with UnitedHealth.

All of this disruption does not have to be a negative development for providers like Novant. It is time to think outside of the box. You have seen megamergers happen such as with my competitor Advocate, Aurora, and Atrium. I would not be surprised to see companies such as Amazon, Apple, or Google take a minority interest in health systems to get people on our boards and learn from the inside-out, rather than from the outside-in.