Workforce Disruption in Health Care—What’s in Your Plan?
As temperatures cool and the colors of fall pop, the football season is in full swing. Those of you who watch football realize that if your favorite team has the wrong mix of players or overpays for an underperforming running back, the season can be very long and painful. A poorly constructed workforce plan can have a similar impact on your organization, especially in today’s value-based world.
Workforce planning has been top-of-mind for Sg2 this year. We believe that it must go hand-in-hand with your hospital’s strategic goals. Traditionally, it has been a reactive process driven by population-based forecasts and anticipated retirement. Today, the math is not so simple—organizations are seeking the right workforce algorithm to strengthen their brand, expand their services and enhance their patients’ outcomes, all without breaking the bank. In fact, results from a recent Sg2 poll indicate ample opportunity to enhance workforce planning by considering novel factors, such as technology, site of care expansion and new care delivery models.
Which Factors Have You Included in Your Workforce Demand Analysis?
Plus, the financial stakes are high due to the cost of physician employment and a foggy transition to value-based care that’s driving the need for expanded access. So, where should you begin? Start by considering the 2 fundamental questions below.
- How will health care landscape changes impact future workforce needs?
- What strategies should we consider to develop tomorrow’s workforce plan?
Let’s start with the most significant factors influencing workforce supply and demand.
- The economy is growing and health care is leading the charge, with almost 25% of all new job growth from the health care sector and almost 40,500 health care jobs added in August alone. This growth will drive competition for health care talent.
- Providers in some specialties are in short supply. Workforce planners are faced with increased demand overall and shortages in highly skilled positions such as internists, intensivists, hospitalists, general surgeons, pharmacists, behavioral health providers and experienced RNs.
- Each market is its own labor ecosystem. Supply and demand vary dramatically between rural North Dakota and urban New York. The US Bureau of Labor Statistics estimates a national surplus of RNs by 2025, but a significant RN shortage in western states such as Arizona and Colorado. Planners must understand and prepare for the dynamics in their individual markets.
- Technology is making roles and locations more fluid. Technologies such as telehealth, electronic monitoring and robotics are enabling leaders to redesign roles and enhance situational awareness. They facilitate the same or better quality care at a lower cost, in a more convenient setting.
So, given all these changes and the supply and demand challenge, what strategies should we consider to develop tomorrow’s workforce plan?
1) Maximize the care team—enhance collaboration across roles, adopt new care models.
- Encourage the development of new roles that support evolving patient needs and care model design, such as medication coaches, health educators, patient navigators and advanced practice providers (APPs).
- Integrate APPs into clinical units, such as critical care, where physician supply is limited and an intensivist can cost $283,000 per year. An APP, whose salary is less than half that, has broad potential to provide effective care.
- Develop a system-wide governance structure that incorporates state scope of practice regulations and ensures leaders are expanding roles to the top of practice regulations.
- Elevate physicians’ scope of practice so that they become team leaders on their units; establish quality-based protocols; and support APPs when difficult clinical situations arise.
2) Optimize resources—use technology and care redesign to liberate clinicians from nonclinical work.
- Use technology to enable 24/7 provider coverage and leverage resources across geographies and settings. At a Southeast health system, remote intensivists monitor the sickest ICU patients off-site, allowing on-site APPs and RNs to actively manage remaining patients. Expect to see more remotely monitored units as the technology improves and value-based reimbursement supports this approach.
- Implement rapid cycle care redesign at the bedside/point-of-care, and evolve the roles of interdisciplinary care team members. One Southeast organization completes 3 care redesign initiatives per year, supported by the CEO and cross-organizational initiatives. These initiatives shift team roles and hours to meet patients’ needs or reshape demand to better leverage limited access to technology, space and providers.
- Develop a system-wide workforce planning process so managers can staff with confidence during peak seasons, patient surges and declines, and on staff sick days. Leading organizations are using predictive, data-driven models to project staffing needs up to 120 days out and illuminate workforce gaps and avoidable overtime.
3) Balance provider compensation while transitioning to value-based care models.
- Align the goals of physicians, APPs and nurses so they are practicing at the top of their license in multidisciplinary teams. Physician compensation goals should include time to train and supervise APPs and ensure care protocols are in place. Quality-based incentives will vary by organization—the majority of organizations we spoke to still have 75% to 100% of their physicians’ pay tied to productivity.
If you are hoping for a solid future with a strong team, you can’t hire your way out of some of the workforce challenges ahead. Provider shortages and workforce costs will get the best of you if you migrate to value-based payment using the old math of hiring physicians and acquiring practices. Instead, you will need to redesign care, maximize your care team and optimize your resources to come up with a winning workforce plan.