Doing More with Less: How to Amplify Your Workforce

While lots of talk in healthcare continues to center around staff turnover, much of the conversation – especially among industry leaders – has flipped to a discussion of the growth opportunity created by these challenges. In fact, according to Denny Morrison, Ph.D. Chief Clinical Advisor at Netsmart, “We believe there are technology strategies that organizations can now use to recruit, retain and empower staff.”

At a recent OPEN MINDS webinar sponsored by Netsmart, Morrison hosted a panel discussion of these topics with three other leading experts in technology and healthcare: Peter Flick, VP and General Manager of Bells Netsmart; Mike Dordick, Senior VP Post-Acute Strategy, Netsmart and President, McBee; and Danielle Ross, VP and Virtual Chief Information Officer, Netsmart. All agreed that COVID accelerated the magnitude of the workforce issue among healthcare organizations, but it wasn’t the start of it.

State of the workforce

Since 2015, the average hospital has turned over almost 90% of its workforce. Additionally, it is projected that healthcare will have a deficit of 3.2 million workers by 2026. Morrison reported similar findings from the behavioral health sector:

• By 2025, the projected number of behavioral health workers will be 250,000 less than the projected demand
• More than half of U.S. counties have zero psychiatrists
• 60% of practicing psychiatrists are over age 55 and nearing retirement

Obviously, these trends began long before COVID, yet the pandemic made a bad situation worse, according to Morrison. “I know of no organization that isn’t currently looking for people. It’s pretty clear the industry has been challenged.” Since the start of the pandemic:

• 60-70% of clinicians have reported burnout
• 1 in 5 healthcare workers have left the field
• $27-58K is now the cost to replace a single nurse

“If you look at turnover rate (22.7%) for RNs in behavioral health,” Morrison pointed out, “it means that in five years, an organization is turning over 100% of their nurses. This is unsustainable.” There is, however, a silver lining according to the panelists: workflow, system and personnel optimization through technology. Let’s look at some key insights from the conversation.

How do we help clinicians practice at the top of their license?

One method to foster satisfaction among hard-to-find clinicians is to create a culture that enables them to do what ONLY they can do. Unfortunately, many organizations are trying to take the same number of patients with decreased staff. Clinicians are spread too thin and often bear a heavy administrative load. “Anything we can do from a technology or operational standpoint to help clinicians feel they are helping their patients is critical,” Dordick said.

On the human services side, it’s a similar pattern, according to Flick. “[We should] one, look at how much time staff is spending on non-client-facing work – like documentation – and compress it so they have more bandwidth. That’s a really good use case for technology. Two, [find] a way to triage services. Can you incorporate more case management, attending care, peer support into your overall mix and provide tools to arm staff so that you can keep them within credentials?”

Ross echoed these observations, suggesting organizations have an obligation to protect the time of staff who must do clinical-level work in their field of expertise. “About five years ago, a lot of organizations made the decision to go lean when it came to their operational and administrative structure, and they did so with the anticipation that they would leverage technology. But the problem was they never actually leveraged the technology … and guess who the work that still had to be done fell to? In a lot of cases … clinical staff.”

This is problematic amid the Great Resignation, Dordick warned. “If you can’t, as an organization, solve that issue, someone else is going to solve it for you and they’re going to take your staff.”

How can we configure technology to address the people AND process issues?

As Ross noted, many healthcare leaders start out with good intentions regarding technology implementation, but without a strategic plan for operationalizing it across their organization, they fall short of maximizing its potential. According to Ross, the best technology is technology that is mapped to what a good clinical process actually is.

“Many orgs spend a whole lot of time focusing on the implementation of a tech tool or product or many different solutions but don’t go to the next step of adoption and operationalizing the use of those tools in their day-to-day business,” Ross explained. Morrison concurred, “[Technology] implementation is the starting point, not the end point. You begin at the implementation and iterate and better from there.” Unfortunately, people often don’t think about configuring technology strategically; they think about it tactically.

“When people think of technology investments,” Ross noted, “they always think about what ROI is going to be, about efficiency and how it’s going to solve this pain point or that pain point. Rarely do they think, ‘my technology should be a differentiator for me when it comes to how I recruit and retain staff.’” 

Morrison added that ROI, specially today, should include minimization of turnover. “I have to think about how I implement technology from the person’s perspective and if it makes their life better. If I reduce my turnover 1% or 3%, what does that look like in an ROI analysis?”

Flick agreed that to drive optimization, organizations must take a more holistic view. “What is the persona whose life we are trying to make easier? It can have a magnitude of difference on your organization when you implement a solution based on driving certain metrics.”

Can artificial intelligence be utilized to impact workforce issues in healthcare?

In the technological transformation of healthcare, AI is the next iteration of enhancement. Where are we seeing its impact? Flick said that by zeroing in on providers and studying what they do and how they do it, AI – specifically natural language processing – is cutting in half the time clinicians spend on non-client tasks, like documentation.

Flick was quick to point out that technology is not doing the clinical work; it’s helping improve the quality of the work and facilitating getting clinicians’ thoughts documented quickly. “Supervisors and master-level clinicians are getting to spend more time [on] strategies to intervene with a client who’s not progressing the way they want. It’s allowing them to be more strategic – most of them want to be creative and change people’s lives,” Flick said.

Of course, the elephant in the room when it comes to AI is the possibility of job elimination. Flick is certain that won’t happen. “It’s going to help bring people into the space that may have been intimidated by the documentation aspect, and it’s going to empower and energize clinicians to be able to focus on what they’re doing. Our vision is for them to feel like rock stars that just show up at the concert and play their instruments and don’t have to deal with the AV equipment or where to park. AI is going to amplify what they can do and help them enjoy it.”

As much as AI is helping now, it will be indispensable in the future. Dordick predicted, “Five years from now, without it, clinicians won’t be able to do their jobs because they won’t be able to take care of patients.” Morrison added, “The half-life of knowledge in the behavioral health industry is 11 years. In 11 years, half of what we know will be obsolete. With the tsunami of information we’re getting, we’re not going to be able to stay on top of the literature about what works or doesn’t work. So, we’re going to have to have tools like this that can help us do the job better.”

What common mistakes are made with technology and optimization?

Based on her experience helping healthcare organizations work through issues like the workforce challenge, Ross said the number one mistake she sees is assuming technology only belongs to the IT department. “They disown [technology] from where it belongs, which is at a strategic seat at the table, because it crosses all their organizational structure – from service delivery, to RCM, to data and outcomes, to what they need for business decisions.”

Another mistake Ross highlighted is failing to operationalize the tools you’ve invested in and make them integral to how you function. Ross also noted that many organizations don’t adopt technology into an ongoing plan of optimization. “When they operationalize the use, specifically of the EHR system, they’re not making sure it becomes part of their overall process improvement strategy – and that it’s a continuous thing.”

“We say it, and you can’t say it enough,” Dordick agreed. “It’s a constant process.”

What’s the critical role of leadership regarding technology and the workforce?

Healthcare leaders can do a lot to leverage technology and strengthen their care teams. Ross mentioned examples, like making interaction with technology tools part of core job descriptions and including it in staff training, but she clarified that the only way to avoid siloed operations and the pigeonholing of technology is to have executive leadership sponsor it as part of the larger corporate culture. “They need to say, ‘We are championing this. It is not a side project for us. We actually look at how well we’re adopting technology as a key indicator of our performance.”

Flick drilled down on this idea: “What the CEO or executive team can bring is a strategic view of the whole field, and they can connect dots in ways that staff in certain silos can’t. It’s important for the executive team to engage and lean in … and define what would make this project a wild success.” While an organization might say they need software to do certain tasks, if the technology isn’t tied to a key metric or outcome, it won’t drive the efficiencies and workflows needed to be successful.

For Dordick, leaders must also not limit their thinking to EHRs. “I think the strongest leadership teams are open to technology even outside of the care record. A lot of leadership teams say, ‘we updated, we’ve got the best technology out there,’ but what do you need to do to keep the people you have? There’s technology that can look at employee behavior and determine patterns,” Dordick said. “And there are great partners out there with other technologies that will help you with clinician satisfaction – with patient satisfaction – that are not the EHR but maybe a bolt on. With everything that’s happening in the world right now, we need to make sure we’re doing everything we can to look at it.”

Where will we be 10 years from now?

Not only does technology offer tremendous hope for organizations to thrive amid today’s challenges, but it also stands to drive our communities forward in meeting future healthcare demands. One lesson from the pandemic was that virtual care delivery isn’t as problematic as assumed, and with technology, these formats may become more established. “I think it’s going to be an on-demand service delivery model where technology will be the big key connecting clients directly to providers,” Ross predicted. “A lot of the organization or operational structure is going to start to go away – it will still be there, but it is going to diminish significantly.”

Dordick projected the use of more two-way communication and real-time care with technology tools at the clinician’s disposal, no matter what the care setting. Then again, framing what will be in place a decade down the road is just as nebulous as today’s scenario was ten years ago. “A lot of the things we’re talking about now will be totally out of the picture,” Dordick concluded, “because of the technology that will be in front of us.”