Hospitals and health systems have been dealing with staffing shortages for years, but the pandemic exacerbated the problem as hospital volumes declined and many hospitals experienced significant financial losses. The gap between the unemployment rate and job openings in the health industry by the end of 2021 was at its highest level in 15 years, and the turnover rate in the health care industry increased by 20% over the past five years. Don Briones, Senior Manager, ECG Management Consultants, who authored a recent AHLA article on this topic, discusses what hospitals and health systems are facing in this current environment and how they are responding.
Don’s panel includes Baljeet S. Sangha, MPH, FACHE, Chief Operating Officer, Deputy Director, San Francisco Health Network, San Francisco Department of Public Health; Jim Wells, MSHQS, BSN, Vice President of Operations, Kingman Regional Medical Center; and Andrew Helman, Partner, Dentons.
From the Enterprise Risk Management Affinity Group of AHLA’s Hospitals and Health Systems Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
Hospitals and health systems have been dealing with staffing shortages for years, but the pandemic exacerbated the problem as hospital volumes declined and many hospitals experienced significant financial losses. The gap between the unemployment rate and job openings in the health industry by the end of 2021 was at its highest level in 15 years, and the turnover rate in the health care industry increased by 20% over the past five years. Don Briones, Senior Manager, ECG Management Consultants, who authored a recent AHLA article on this topic, discusses what hospitals and health systems are facing in this current environment and how they are responding.
Don’s panel includes Baljeet S. Sangha, MPH, FACHE, Chief Operating Officer, Deputy Director, San Francisco Health Network, San Francisco Department of Public Health; Jim Wells, MSHQS, BSN, Vice President of Operations, Kingman Regional Medical Center; and Andrew Helman, Partner, Dentons.
From the Enterprise Risk Management Affinity Group of AHLA’s Hospitals and Health Systems Practice Group.
To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.
This episode of HL, a speaking of health law is brought to you by HLA members and donors like you for more information, visit American health law.org.
Speaker 2:Hi everyone. This is Don Brianna and I'm a management consultant at ECG management consultants. Today, we are going to be discussing what is considered to be one of the hot topics in the healthcare industry today, staffing shortages and the responses and risks at hospitals and health systems. We're joined today by a tri of executives that will provide the listeners with great insight to what their organizations and many others are facing today. The first of the trio is B Sanga from the San Francisco department of public health and the San Francisco health network. Hi, BJE.
Speaker 3:Hello, Don. Thanks for having me great to be here. Um, and my role as well, I've been the chief operating officer for the county run healthcare healthcare delivery system, the San Francisco health network. And for the past year, I've served in the dual role as the incident commander for the department of public health response.
Speaker 2:Great, awesome. B thank you. Next is Jim Wells from Kingman regional medical center. How you doing Jim?
Speaker 4:Doing great. Thank you for having me. Uh, I am currently the vice president of operations here at Kingman regional medical center. We're a 235 bed, uh, rural hospital, uh, in Mohave county in Arizona, uh, prior to taking the role of vice president of operations. I served as the chief nursing officer here.
Speaker 2:Okay, great. Thanks Jim. Last but not least. We have Andrew Helman from the law firm of Dentons Bingham green bound. Welcome Andrew.
Speaker 5:Thanks Don. Thanks. I appreciate it. As Don said, I'm a law, I'm a lawyer with the law firm Dentons and I'm a restructuring attorney and I work with, uh, healthcare businesses when they're facing insolvency in and distress. Um, and I very often help them restructure debts in chapter 11 or sell their assets free and clear reliability so that they can keep operating and helping people get the healthcare that they need.
Speaker 2:All right. Great. Thanks Andrew. Appreciate it. Um, okay. So, uh, before you start the discussion, I wanna set age of it with some initial insights from some of the research and interviews that we did on this topic. Um, so, you know, the first thing is really the situation before the pandemic and what we found in, you know, most of the listeners may know this, the industry was already experiencing staffing shortages. Uh, you physicians were opting out quite a bit due to the burnout situation. Uh, there were already nursing shortages in many markets and employees. Uh, particularly those with high analytical skills were jumping to more lucrative positions, uh, particularly in the tech startup world and other emerging industries. So when the pandemic hit in March, 2020, and we started to see hospital volumes decline by as much as 60% of normal re uh, very quickly, um, you know, many hospitals experience, significant financial losses, and as a counter measure found many ways to balance these losses. And, uh, you know, a lot of these losses were balanced primarily from layoff, as well as staff S so as volumes, uh, as volumes and the patient confidence started to come back, um, at least to, uh, what we found about the 90% of the normal levels, um, in 2021, um, you know, some of the jobs did as well. They started coming back, but, uh, many decided not to come back or in some cases leave their jobs outright. Uh, some key statistics are worth mentioning. Um, first the gap between the unemployment rate and job openings in the health industry by the end of 2021 was at its highest in over 15 years. And what this suggests is that the gap between the demand for jobs and the available workforce to fill those jobs is at its highest level within this 15 year period. So 2021 was at height. Um, second the turnover rate in the healthcare industry. You know, if we look at the last five years, increased overall 20% from 20, from 2016 and nursing in particular, their turnover increased 28% with an average time to fill a nursing position at about 90 days. So, you know, this is clearly a statement that this trend, you know, has been accelerating and increasing over these last five years. And many of many of know that this continues to increase well into 2022. Um, additionally nurses really, aren't also, uh, aren't the all only highly impacted physicians about this many markets. Um, you were seeing respiratory therapists, we're seeing lab and imaging techs. We're seeing medical assistance even, you know, for, uh, uh, you know, have these sort of material increases in these turnover rates. Uh, we saw a recent survey that, um, where we found that one of the, some of the top reasons for the staff turnover and the ability to retain staff include the fact that a lot of the aging workforce, you know, is retiring so many are leaving because of retirement, uh, difficult working conditions that ultimately lead to burnout, um, compensation and the need to look for for better compensation, as well as, you know, potential career advancements and those individuals who are seeking to try to go up into the organization. Um, one final insight we wanted to share is that rating agencies are now taking notice. And they're also seeing the, and they're, they're recognizing and seeing the effects of the labor shortage as a long term risk for credit downgrades. So in the most recent industry outlook from fit, uh, from fit ratings, uh, their position is that accelerating wages currently will need to be sustained or possibly increase in order to keep that gap between job openings and available staff from widening even further. And that, you know, this dislocation will continue well after the effects of the pandemic, which in essence then creates that risk for credit downgrades. So in essence, that's, that's really a lot of, uh, as a summary, some of the insights that we have, um, what we wanna do now is turn over, turn this over to our, to our group here, to see what they are seeing from their organizations and their clients. So, um, you know, let's start with BJI and then, you know, from there we can, uh, then have Jim and Andrew join in. Um, well, gee, what are you seeing in your organization now and, and the industry, and what are some of the trends are you seeing that you see are responding to the staffing sort of situation from your perspective?
Speaker 3:Yeah. Thanks Don. I mean, you've done a great job of laying out the, the key factors and the other variables at play here. One of the key things to keep in, in mind of what we're seeing is against the backdrop of now, we're at the official two year anniversary mark, where the world health organization declared that COVID 19, uh, would be characterized the pandemic. And at the time they pointed to about a little over a hundred thousand, I think, 118,000 or so cases of coronavirus across over a hundred countries. Now those in the numbers seem quite minuscule now 118,000 at the time to catalyze this versus the 450 million cases that we've seen and, and over 6 million deaths. So that's, um, and, and with, with COVID pretty much in every nation in the world. Now what we're seeing here, you know, California, we had, uh, our share, uh, over 9 million cases and, and, uh, what 90,000 deaths, but what it really highlighted is, and, and has shown us is that COVID 19 has really badly damaged a healthcare system that was already under tremendous pressure. And you, for a lot of the factors, you, you laid out, we're seeing this great resignation, uh, and it's, uh, one of the key components to really articulate as well is it's not just a direct care providers, not just the clinicians that, that you listed. It is indirect care providers, uh, engineers, environmental service workers, supply chain, technicians, security officers, everywhere. Um, anyone that you encounter going to receive healthcare. This is affecting everyone. And, and from a financial head, there's certainly been billions in law, us revenue, um, which, you know, here in California, about 45% of California's hospitals are operating in the red and about another 50% are, are barely treading water. So we have that with the financial piece, we have workers who are burned out, they're exhausted, they're depressed, suffering, moral injuries. You know, the healthcare worker ranks are no longer in the top coveted positions of, of, of, uh, careers. And so it's gonna take years for us to return to a place of stability and predictability where we can count on, you know, the right care being delivered at the right time and the right setting, um, care is being delivered. And then we're very proud of that. I think across our country of what we're able to do, but we do know that it is not, uh, with, within the optimal, uh, environments in the optimal ways we wanna deliver that care.
Speaker 2:Yeah. That's a great point. I mean, those are great points. I mean, you know, one that I, that I, that I heard you say is a, you know, that it's not just nurses, that it's support staff and, you know, a lot of folks feel that, you know, that is one of the areas of main areas of risk with staff, because, you know, it's not just the healthcare. Um, other healthcare organizations are competitors that are, that they're competing against. It's, you know, it's the, uh, um, uh, you know, it's Walmart, right? It's, it's, uh, you know, uh, uh, McDonald's, it's other types of, uh, non-healthcare organizations that are, they themselves are create are, are seeing their own staffing shortages and are raising their, their wages to try absolutely.
Speaker 3:Yeah. Spending it within healthcare. We have, you know, clinicians, you really you're, you're in healthcare, what's your clinician, it's wherever you deliver it. But with indirect in those non-clinician positions, you can stay in healthcare. You can say, you know what I want to go, I'd rather do, uh, become an engineer in a high rise building and, and be a, you know, security officer in a high rise building that is just in a business park. And so you're, you're spot on, I think the, the leakage for the indirect, uh, in my mind, I, I'm probably more concerned about the leakage of positions out into other sectors away from healthcare.
Speaker 2:Yeah. And, and, you know, you, I looking at Jim now, Jim, you know, from, from your situation, I mean, you're, I imagine you are seeing that and, you know, from your, if you can describe your situation, I think, you know, being in the, in the, a soul, you know, a community independent community hospital there, uh, you're probably seeing that effect even more GRA even greater in some ways.
Speaker 4:Yeah. I agree with everything that BJI just said, um, you know, it, it, it is hitting us and affecting us, you know, the exact same way. The difference is in, you know, uh, a rural area. We don't have a, a large pool to pull from. Uh, and so, you know, actually tomorrow is our two year anniversary from our first patient from COVID 19. Um, and I remember when that first came out, you know, and, uh, you heard the horror stories from, you know, the east coast and what was going on and, you know, everything was so unexpected at the time. Um, a lot of hospitals, you know, kinda, um, encouraged patients to not come unless they truly needed healthcare at that point in time. Right. And so we saw our volumes decrease, um, considerably from where they routinely were, uh, in the beginning, but we did everything we could to keep all of our staff whole, uh, you know, so that nobody had to, to worry about it decreasing their paycheck or anything along those lines. And ultimately as the two years had progressed, we, we essentially became the defacto county hospital for our county. Uh, there's, there's a total of four hospitals here in the county, but most of the COVID, uh, 19 cases were coming here, uh, for treatment. And we ran into those challenges, the same challenges Bauche just talked about, uh, and, you know, our workforce has, uh, gone down considerably we're we're north of 35% turnover, uh, through this whole process. Uh, you know, we've lost some people to, you know, retirement, we've lost some people to, um, travel, uh, agency jobs. Uh, we have the same issues with the, the non-clinicians with everybody, right. In their prices and, you know, us trying to compete with, with them as well. But not only that, we've also ran into problems where EMS, uh, services to be able to transfer patients out of our area. You know, they're decimated either with the illness or they've had people that have turned over. So it's even hard for us to push patients through the SI
Speaker 2:System. Yeah, that's, that's a, that's a great insight, Jim. I mean, many independent community hospitals that fill the need of their specific communities oftentimes are, are really integrated with their communities. It's not just the hospital that sits there. Right. I mean, it's, it's, it it's, you know, everything else that sits in the community and there's a lot of integration there. So when one system of a community falls, another part of it also starts to fall as well. So I mean, what you're describing sounds like a lot of, not only what may, what you're experiencing, but what other, uh, communities throughout the country, you know, in similar situations might be as well, right. If it isn't the EMS system, you know, it could be, you know, other parts of the, of the government. Right. So,
Speaker 4:Well, right. And even the, the larger, uh, areas that we transfer patients to, they were, uh, inundated, you know, either between people leaving or illnesses coming into the hospital, that beds weren't even available to be able to transfer patients. So that just created, you know, a, a lot more stress and burden on the system itself.
Speaker 2:Yeah. Yeah. Well, and you know, and Andrew, you know, thinking about, you know, from your perspective, what you're seeing, you know, with what BJI and what Jim is describing, you know, and, and what, you know, what do you see your clients, uh, and what you're seeing, you know, from your perspective, what, what that looks like.
Speaker 5:So I think that I'd probably put it this way. You know, the melody is the same, the notes are a little different, but, but the basic melody is the same. I mean, when COVID started, I was representing three different hospitals in chapter 11 cases and their cash flow dried up, and we didn't know what was gonna happen. They're all operating today. Right? We, we, we were successful. We pulled that off, but it's been incredibly stressful for the frontline workers all the way up to meant dealing with the operational stress. In addition to the, the shortages of staffing, what I'm hearing today is that the operational stress is still there. And I mean, it's the same as what Jim and, and Bob Jeter saying. And, and, and what I'm hearing, you know, is really concerning in that the wage adjustments that are resulting from the demands of workers who are legitimately facing difficult, difficult working conditions, uh, but the wage adjustments due to travelers and other types of short term working arrangements, uh, and other labor stresses are, are being viewed as permanent adjustments to the income statements. That's what I'm hearing from clients and their advisors. Again, when you bring that together with the ongoing and continuing supply chain shortages and operational stress, it's really concerning. And so when you have a, a, a standalone hospital that is the bedrock of healthcare in a community, probably the largest employer in the area as well, distress in the organization has the potential to have significant ripple consequences or ripple effects. So I look, I think that it's probably going to lead to more M and a activity where there'll be S validation for hospitals, where it makes sense for that to happen. There are gonna be hospitals that, that, or systems that can't do that who will still have distress, some will close, hopefully, um, hopefully some will reorganize or again, consolidate I, what this looks like going forward is likely to just be more consolidation, I think, and there will certainly be some hospitals that need to use tools like chapter 11 to reduce their balance sheet liabilities, to improve cash or negotiate with lenders and vendors, consensually, um, that to restructure payments. And again, just improve Ash flow, uh, as they try to wait this out.
Speaker 2:Yeah. That's yeah, absolutely. Andrew, and, you know, I, I, I wanted to, and stressing this directly with Andrew, but also wanted to open this up to both Baljit and Jim, I mean, you know, with, with the situation that is right now, you know, I'm wondering how, um, you know, from a regulatory perspective how some of these, some, you know, would be responding to help relieve some of the organizations. And I wanted to, you know, get some of your thoughts, um, each of you, you know, around that piece and to see what, what is out there, and ultimately, you know, are there are some of these things, items that you feel might stick?
Speaker 5:You know, it, it's interesting that you bring that up. Um, what we saw last November was that there were several members of Congress that were agitating to ask the executive branch in the white house to look into whether they're, and, you know, price gouging with the temporary staffing. And there are some states that have actually pursued legislation. And, uh, Idaho is actually an example where there's a bill pending right now, um, that would make it what we call an unfair trade practice, which is a bucket of law dealing with when there might be anti-competitive behavior or other trade activity that isn't fair, and it would make it, uh, an unfair trade practice to charge what I think it's an exorbitant or excessive increased price during an emergency for temporary health. So I think that, you know, there's at least some, some inclination to have a, a, a legislative look, whether that turns into law that gets enforced. I don't know, but I do think for, you know, our audience members at the a H L a who are regulatory lawyers or general corporate counsel for their healthcare clients, it's a good time to check in with your client and see what's happening and what, what the impact of all of this is. Cause there are tools that are out there to help clients and to help them figure out how to talk with lenders and vendors and, and, and try to work a deal out consensually before they get to the edge of a cliff.
Speaker 4:Yeah. I'd like to, uh, just talk about that for just a second, Andrew and kinda, I, I would like to hear, uh, everybody's perspective, you know, in Arizona, we kind of talked about as the wages kept going up through the travel companies, right. Um, you know, what do we do? How do we, how do we try and mitigate, you know, some of this, so, uh, that it's not so costly. And, and it's not a fact of not necessarily wanting to pay people what they're worth. Right. But the, the, the, um, manipulation from the companies, you know, in, in moving that price up considerably, um, part of the concern with bills like that, and I certainly would be supportive of, of something along those lines. That part of the concern is, well, if we do anything, then they just won't service our state. And then what, where does that leave us, you know, from a worker's standpoint?
Speaker 5:Well, I, I expect that that's exactly one of the, one of the issues that'll come up. And of course, you know, there's always gonna be a question or a debate about the extent of government intervention with pricing, right? I mean, that's, that's certainly an issue that will get attention, but I mean, I think at the end of the day, you know, the question is what does it cost to run the business, to provide the level of care that a community needs? And how does that way of looking at the business correlate to the payment systems that are operating in the background. And, and this is just my personal view. There's a bit of a disconnect there. The, the, the payment methodologies and systems don't always generate the revenue that's needed to run the, this, uh, or in some instances, the service lines may need to be adjusted to scale down to the revenue that a particular community or an organization can support.
Speaker 3:You know, I, I, you guys, everyone brings up really great points. I think Andrew and, and Jim, your, your points are well taken, particularly Andrew yours around engaging your reference to really make sure there's some additional eyes and ears on, on this. I think in, you know, in the early days of the pandemic, there was outreach from the department of justice and, uh, local field offices of the FBI, just wanting to hear about price gouging. And at the time it was more based around supply chain issues, um, masks that were beings evidently priced in fair, your items that were on the market. But really, as we see this price gouging is, is, you know, the unfortunate either synonym and, and certainly consequence of supply and demand with, with our supply of staff, uh, dwindling down, whether they're, um, again, calling out because they're sick and need additional time, whether they are, um, or earned out, but, and the demand is if not exceeding, it's certainly staying where it's at. So I think, you know, one of the key parts there is just really making sure that you have additional engagement from your council and from your local leaders and others, just to really make sure what is border, what is bordering on just a competitive market versus now we are still, certainly now in the realm of these prices are ones that we've never seen before. And they're certainly, um, in the realm of an excessive amount than we're even seeing across across the nation. So I think those are critical for all of our listeners pieces of information to take back, cuz that's really where we can start to affect some change. And whether that's through your local to leaders or just directly having a conversation, the, um, the, the partnerships there with our council plus with our regional colleagues has been really great where we can bind together and say, we can't compete against each other here for, this is not, um, us versus the hospital or the health system down the street. It's us overall addressing an issue here or within the, um, oh, within the system. And, and I think that's, it's a little harder cuz when you're in the mode to program to having to react and respond to a crisis as actively, you know, actively, um, developing it is hard to kind of pull yourself out to try to circle the wagons. But I think that's also what we're trying to see here is a better organized effort from healthcare systems and peers to really respond to that.
Speaker 5:So it it's, it's interesting Jim and, and, and B I mean, you, you are in very different areas, uh, of the country urban versus rural. And it's interesting to hear the same issue on, uh, sort of labor costs and supply chain. It's just, it's just ripped across the country and, and Don, you have clients with ECG in different places in the country. Are you hearing similar? I'm assuming you're hearing a similar issue from the client base as well.
Speaker 2:Right? Right. We, um, are with the clients that we have, we are seeing, uh, a, we, we we're seeing across the board, right. Challenges and what Jim and BJI are representing are really, are really focused in, on the types of clients we do have so independent community hospitals, you know, I, I think they're, they're showing what I, what we're seeing with clients. There is not only, um, challenges in order to get supplies, a supply of labor and workforce to go there, but also challenges relative to retention. Right. And you trying to find strategies in which to retain the, the employees and the workers that curly are there because of, you know, the, the different, the different, um, options that they have right now, whether if it is to simply retire because of, you know, they, they were thinking about it earlier or because they're, they're, um, uh, lured by, you know, the increase in compensation they could have as Jim described about going to, you know, from a Traveler's perspective with, you know, in, in organizations with like, like, um, with, with San Francisco, um, department of public health and, and, and in the more of an urban setting, you know, we're seeing that there's some supply, but really a lot of it is around is around, you know, competition with other organizations, you know, everyone's buying for the same qualified individuals. And so, you know, we're seeing, we're seeing some of our clients really move towards really a, a price war with these, you know, with these same folks and, you know, it's the, the, the, the, the employees or the work, the, the workforce really, um, you know, there is that case where, you know, they are in many cases accepting the highest bidder, right. Uh, knowing very well that, you know, at some point they're may, they may be able to come back to the same organization they were at before, you know, in, in some cases they're coming back to the same organization at a higher wage rate as well. Uh, either, either through, as, as an employee or, or even as a, uh, uh, someone who, uh, is coming back as a traveler. So we're, we're seeing these challenges with our clients, um, as well. What, one thing that we, we, one of the constant is that we are seeing their, the financial situation really grow as a result. And, um, while many organizations have, or are fortunate where their managed care contracts are time in, in such a way where they're at the point where they can negotiate. Many of the managed care contracts really are still really on term. And unfortunately you, you know, they, uh, are really, really, um, have to really face the type of, uh, rates that they currently have without, you know, or increases the costs that they currently have without the ability to be able to increase their, uh, their managed care rates. So, um, I, I I'm, I am, you know, uh, from a, from that perspective, interested in, you know, what, what retention strategies are, are being applied right now, and, and what, what you see are some, some potential strategies that, that have worked, or some, uh, ones that really, you know, offer, uh, you know, some of these workforce that they would actually, uh, would, would see that that would be the, the, you know, the kind to benefit that entices them to actually remain. So, uh, I wanted to kind of open that up to the group and get everyone's thoughts about, you know, from either their organizations or what they've seen in industry, what has worked well. Cause that seems to be one area that, that seems to be one area that, that, that, that many organizations are faced right now.
Speaker 3:No, I think it's a, that's a great question. Well, love to hear from my colleagues as well. I think prior to answering that, I do wanna, I do wanna widen the lens just a little bit here with that conversation. I mean, we, we've talked a bit about how these challenges aren't specific. They, they, they style and they spread across different geographical regions. They're spreading across different disciplines. We've talked about indirect, you know, uh, care providers, direct clinicians, but this also spreads across, um, different levels of, of tenure and, um, and your careers level. So we're not just talking again, frontline staff, we're talking executives, we're talking folks that are, you know, 30 years plus. And so with that being said, I think the, the, the mitigation strategies, aren't ones that we can only see in the balance sheet. So it's not only a conversation around what is a financial incentive to address this problem, what we're, what we are seeing then, you know, as we're living through the greatest public health emergency in a century that we have, it's no, not just healthcare folks and then everyone else in the world. Um, within healthcare, we are seeing a need to also effectively share public health information, not just with the public that's out there that we're serving, but our own staff need to know what's going on health inequities and staffing demographics. We also, you know, everyone who's in healthcare, isn't immediately, I'm a hundred percent gonna get vaccinated. So there's a vaccine hesitancy also within our own staff and teams and, and figuring out where to get trusted information. Um, and so all that tied into that, we, you know, as, as health systems and they're shifting resources to hotspots that really need to flex and, and staffing regulations, we are looking at filling the need for frontline staff. Uh, we are looking at filling the need for middle management. We're looking at filling the needs for even senior C-suite. And so we can certainly work and figure out a financial solution to this, but what, what we are seeing and what worked well is also really addressing the, the physical, mental, and emotional component of this. I mean, eventually the, the dollar amount you can, you might be able to get to a dollar amount that would make sense financially, but that mental, emotional, and physical drain is, is equally important. Um, and, and we see that again, I, and I, that's why I bring up the CEO and C-suite executives, folks are also equally concerned and walking away. And so what we're seeing is really embracing that empathy and that vulnerability and honesty with our staff in those conversations, that it is hard. It hasn't gotten easier. We are now having to do what we did the past two years. And in many ways, when things were shut down, it was a benefit cuz we're only focusing on the pandemic, but now we're doing pandemic and trying to reopen and continue delivering our standard services to our communities. And so really appreciating the fact that this is an ask that is really hard and our system and our people are buckling and not wanting to put on a false, you know, overly rosy optimistic perception that, oh, it's fine. And things are gonna go well. And, and we're great. I think that's, uh, we've seen a lot of appreciation from our staff, just addressing what they're experiencing and then also not figuring out ways to, to, uh, allow time for them to decompress and whether that then bringing in per DM or as staff. So folks can take some vacations if they have deferred for, for multiple years, whether that is an ability for folks to then take even even longer leaves than just PTOs and vacations. And then also just allowing folks the opportunity to really, uh, share how they've changed and how, what they've gone through the last couple years, whether that's, you know, a support group, whether that's opportunities to just have town halls just to share here's, you know, who I am and here's how I was affected. And here's how I have changed. And there's a great deal of power and really addressing that component of it with our staff that they really appreciated, um, because it shows that this is, um, not just happening to it to me or you in a bubble, but it's been happening to all of us and, and collect we are moving forward. So, so that's what we were seeing. But again, I would love to hear also Jim and Andrew's perspectives and, and from their vantage points on what they've seen.
Speaker 5:Well, you know, I'm, I'm not daily in the trenches, in a healthcare organization operationally. So I can't, you know, I don't have firsthand experie on that, but I mean, it's like anything, if you wanna be a team, you need to act like one, and that means taking care of people. And, you know, the, I think you make a really important point ball about the extent of, um, people exiting the workforce. Look, I, I was on the phone with an independent auto mechanic the other day. He's, he's folding up, he's folding up his tent and packing it up and leaving cuz he can't get staff and he's at a point in his own life where, you know, it's, it's, it's a marginal benefit to even keep the place open. He, he, he can retire. And so it's happening in different industries and you know, I think we're seeing it magnified in healthcare because of the significant stress of the job, especially at the lower levels, right? I mean the, the choice, it's a difficult job to be a CNA. And when, you know, Walgreens is paying$20 an hour, um, that might be easier in some respects. Right. But I would imagine Jim for you as the local hospital in your community, where there isn't the healthcare alternative that these issues are in some ways, um, magnified and in other ways dampen because you're it right? You're the place where people are gonna work. If they wanna work in healthcare locally, did I get that right?
Speaker 4:You did. And uh, you know, uh, BJI beat me too. The, uh, you know, the emotional factor that has really come into play for COVID 19. Uh, and then you talking about the other industries. I, I actually had somebody come up to me today and they drive 40 miles here to work every day. Uh, they're on the lower of the, the, um, spectrum from a, a, a pay perspective. And, uh, they told me today that with gas prices continuing to go up, they can't afford to drive the 40 miles. So that creates another burden for us now that we've got to try and overcome, but I do want to go back to that emotional and psychological effect that is taking place. I had a nurse that retired here, uh, a few months back. And part of the reason she retired is she was a critical care nurse for well over 30 years and, uh, has seen and done a lot, uh, during her career, she, she experienced, um, more death in the last two years than she had her previous career. And emotionally, it just took a toll on her and it has taken a toll on everybody in the hospital. Uh, even those that aren't direct caregivers, right? Um, even the people turning over the rooms and the dietary staff getting trays up and all it is emotionally affected everybody. And so some of things that we've been trying to do is support our staff, um, with mental health rounds and having some social workers and some pastoral care and things like that go up and, and sit and be available in the break room to talk to some of the staff, to help overcome some of those challenges and to help them find ways to, you know, adjust to the stress and, and to get rid of some of that stress, try and find some other alternatives, you know, to find peace and happiness, uh, you know, not just in their work life, but even when they go home, because they, they do carry these burdens with them when they go home, you know, and then it affects their family, uh, as well. Um, some things that I had heard that other organizations are doing and that we're also trying to do, you know, to help with, um, trying to recruit people back to the hospital, um, you know, is looking at paying off student loans. We've done for physicians for years, but we haven't done that for staff for years. Uh, at least, uh, not in the hospitals that I've been associated with in the past. A unique thing that I heard the other day that a hospital is doing is that they're paying up to$15,000 worth of closing cost on a house for some, anybody to be able to move. So it's things like that, trying to think outside of the box, you know, what is gonna drive people to our community, you know, and help we're, we're, we're a growing community and we're gonna need workforce to continue to keep coming in. So we're just gonna have to open up that outside of the box, thinking and try and figure out what do we do, you know, to get people people here?
Speaker 2:Well, this is, um, you know, all of you bring up really great points about the emotional dynamic and how to respond to, to do that. And, and, you know, one of the things that, um, some of our clients, um, have, have thought of and considered, you know, is I, how the role of technology simplifies work and simplifies process. And, um, you know, it's interesting because some of our clients, they're, they're looking at that as one of the potential solutions, right? Where, you know, like we have, for example, a couple of our clients that are on the revenue cycle side are increasingly applying robotic process automation or R F RPA rights to simplify those tasks, uh, better understand and prioritize accounts and those sort of things. Um, some other organizations, however, are, are really, are really at the stage where they're still really treading water. They're trying to stay above water. Um, and you know, from each of your perspectives, do you, how do you see, how do you see right now, the, the situation and, you know, a role like technology and how that might play in terms of, you know, helping ease, at least simplify the task that, you know, in the end would be otherwise would be a very stressful work process.
Speaker 3:Jim, actually, that I'd love to hear, hear his thoughts on, on this one.
Speaker 4:Yeah. Uh, so it's interesting that you bring that up. Uh, we are investing roughly about 4.6 million in technology, um, to try and help offset some of those things. Uh, one thing that we noticed during COVID, uh, especially when we were at no visitation is it was very hard to it that, um, patient and family communication process taken, you know, a, a hold and, and we feel like that, you know, visitation and at least being able to see and hear family members, that's part of the, the healing process. And it, it helps people. And we struggled with technology iPads weren't available. You know, there were issues with that. We ended up going to baby monitors and, you know, trying to view patients, you know, and make sure that they're staying safe without having to constantly Dawn PPE go into rooms, cuz that was such an issue. So we're investing in a, uh, we're currently looking at a product and, and have purchased it. We're installing it as we speak the wiring for it. Um, that will be an overall patient communication, uh, system for our hospital, uh, physician, uh, when they come into the room, it will identify who the, the physician is. Um, we can schedule calls with the family, the, the patient can, uh, as simple as almost like a Skype off of your phone, be able to call their family member. They can sit in and listen to the discussions, uh, that are taking place. Um, so that's one thing that we we're doing. Another thing we're doing is we're looking at retired nurses that, you know, maybe whether it's emotionally or physically can't do the work anymore at bedside, we're looking at virtual nursing opportunities. We have. So part of the, the other issue that we're dealing with, especially in a small community is we're limited on the number of students that we get. Right. Um, we have a local school and they put out good product, but, but they only put out, you know, 12 or 15 people at a time. And so some of these people, uh, haven't even been in clinicals, you know, prior to the last quarter, they, the last graduating class had never even done clinicals in the hospital. They had all done it through simulation. And so trying to help build their skill sets up. Uh, we'll have some virtual nurses that can look at some of the high risk things like titration of drips and, you know, important labs and things like that, and communicate with that bedside nurse to help foster that training and that experience and not, um, we think that that will be a great retention tool for us moving forward.
Speaker 5:Jim, I'd, I'd be curious to know, I mean, is, is the, I mean, look, we're all using video technology more than ever before and workplace flexibility. I mean, that's, that's the name of the game, right? As a, as a hospital in a more rural area, will you be able to provide coordination with specialty care more easily using this remote video technology? And does that help you lower costs by, uh, reducing what you need in terms of boots on the ground for specialists locally? I mean, is that, is that also part of the plan? Is that what I, the, the, the, of what you just described sounds great, but I'm also curious as to whether there's a, a cost savings or a service, you can maintain a service line at a lower expense, really, to continue to be the draw for your local community.
Speaker 4:Yeah. We are looking at technology. We, we use, uh, tele, uh, psychiatric services and teleology currently. Um, we don't have a neurosurgeon, uh, currently at our hospital. And so if somebody comes in with a, you know, a stroke-like symptom or whatever, we can send the films to'em, we can talk to'em on the phone. Those are patients we want to keep in our community as long as we can provide the appropriate levels of care for'em. So certainly that helps us, right. It's a satisfy in the community. Ultimately it does help us from a bottom line perspective, being able to keep that patient here locally. Um, you know, and then we can also track and see is the service line that we need to get into. You know, we, we've also struggled with getting a urologist here on a routine basis and we have to use locums to, to, to fill our needs. And so, you know, using technology to help us through this is absolutely something we're, we're gonna continue with.
Speaker 2:Our clients are considering, um, you know, virtual patient care models, mainly for access region, uh, reasons. Um, you know, while there may be a situation around cost effectiveness and cost management, it really is about the fact that, you know, because of the staffing shortages they have with nurses, for example, that the they're forced to actually have to turn away volumes. And this is a model in which to actually increase access pay, have patients come into their hospitals and from a financial perspective, retain the revenues associated with patient volumes coming in. Um, so we see that we see a lot of our clients actually considering it more, um, for top line line versus bottom line basis.
Speaker 3:You know, I think the, the, the, the access piece here is interesting. I mean, with a rural setting versus urban metropolitan setting, I, you know, Jim shared the example earlier of an individual driving 40 miles. Um, whereas, you know, San Francisco, Steven county, and seven by seven square miles, but I'd, I'd wager guess that the commute time to get across this city in San Francisco, uh, versus, you know, driving 40 miles in a rural setting may be comparable. And so we do have commute, commute and access issues with staff and with patients. And I think the virtual model and telemedicine and, um, is, is a phenomenal step in the right direction. I am certainly all in and supportive of that. But what we do see is that when, you know, one less, uh, patient in a room is one less room that needs to be clean, but we do have see some equity issues where, where we know that some clinicians may be able to deliver that level of care virtually, but we know non-clinicians have to then come in regularly. So the issues we're trying to navigate is how do these individuals oftentimes in a lower salary bracket that have to come in regularly than compare and, and to of those who are in a higher salary bracket and then can work remotely. And so I think there, there is a pathway, you know, forward, but it takes some change management, um, elements there. And then the other component I'd say about the virtual, um, and then just the, the technology aspect is really ensuring we're engaging the staff and the people that we believe this is going to be helping to ensure, you know, we wanna enhance the workforce experience and the care experience, but we also wanna make sure that what we aim to roll out is gonna be, uh, meeting that need. And so we, and by that, you know, I, I, I remember this example earlier in my career, uh, trying to install televisions in the waiting area because the waits were so long and so kind of stop and, and we step back and a patient says, Hey, you know, I don't wanna watch another cooking show instead of entertain me while I'm waiting. Why don't you just eliminate the weight? Right. So, so I think that is really one of the key things that we wanna make sure that we're as the technology that we're putting out there is really supporting them. And, um, and we're, you know, optimizations change manager workflows are all critical, but, you know, the technology is really gonna be, we wanna make sure supports the job and it, it doesn't of the interpretation. That's gonna put you out of a job. And I think that's really the, the balance there.
Speaker 5:Yeah. It, it's interesting because the there's significant stress that, you know, I've heard my clients talk about and that I'm hearing you guys talk about today and, you know, I don't think there's any dispute about that. And we're also hearing about stress and financial pressure driving ingenuity, right. And creativity and new ways of working, but at the same time, it, it it's, you know, I wonder whether healthcare, businesses and providers have the, you know, there, there, there's also the need, I think, for some companies to figure out what to do for the long term planning financially and how to find time to think about that while under the operational stress. You know, that's, I think that that's a tough question to answer. Right. But it seems to me that it's, you know, now's the time to do that before you're at the edge of that operational cliff, um, while everybody recognizes the importance of having access to healthcare in a, a way that I don't think people appreciated 36 months ago. Right. I think today, the, you know, the, the community response to access to healthcare may be different from three years ago, simply by virtue of COVID.
Speaker 2:Well, you know, this is all really good stuff. And, you know, I, I, this is a topic that, you know, we probably can speak probably three hours on. Um, I know that, um, you know, before we wrap it up, uh, what I wanted to do was give each of you an opportunity to respond to one more question, um, and that's, you know, future and the challenges and yeah. Wanted to get, uh, you know, your parting thought around what you see as the biggest challenge that we can see and where we may be facing over the next 18 to 24 months. And, uh, from your perspective. So, uh, if I can ask the group here to respond to that, that final question
Speaker 3:Sure thing, uh, I, I can take the first stab, I think, in the next 1824 months, I think what we're, what we're gonna see is really, uh, an emphasis and really the challenge we laid out today, we're gonna see that continue to be on the front burner as a front focus. Uh, I, I, I can't think of another challenge other than ensuring that the healthcare system and the healthcare delivery continues to have people to deliver healthcare. And so, um, one, one thing I will see though, and, and moving forward is really that relationship building, then both with our community, that what we're gonna be doing. And within our staff, I, I think in every relationship, you can't just have a dialogue with yourself or just a tight circle or team. So I think moving forward, what's gonna be the focus for us is really having a message to everyone what we're gonna be doing, but also what we're not gonna be doing. So we can, everyone can appreciate that consciously, that this really sends a message to our work staff and folks that, you know, we hear you, we know you can't keep doing it all. And here's what we're consciously deciding that we're gonna move, uh, either defer or table, or just it's a not right now issue. So it doesn't feel like we're continuing to ask our teams to keep doing more and keep doing extra without really filling the ranks or, or really meeting their needs and addressing what they're saying. And so it's not only gonna be addressed on the balance sheet with FTS and labor dollars. And, and that certainly is it, but the next cha the next step here in next, um, 18, 24 months will be filling their cups emotionally, physically, mentally,
Speaker 5:Y you know, that, that's very interesting. BJE, I mean, what I, what I wonder, and again, I'm not an operator I'm coming at it from, so someone who, who works with people in, in the industry, you know, I wonder whether we're entering a period where there's gonna be, um, divergent paths in a sense that people inside healthcare are still gonna be living and breathing, you know, a pandemic on a daily basis with, um, patient volume issues and some of the operational stress, right. And, you know, other people are gonna be getting back to normal, right. Or whatever that new normal might look like, which will create these divergent paths that folks are on. And so we're gonna have kind of, I think healthcare and a healthcare industry, that's still facing significant operational distress and financial distress, and potentially less political support for governmental support to assist, uh, hospitals and healthcare systems. And so I think that now is the time to start to plan for that, right. Again, before that cliff occurs right now is the time to take the deep breath and say, all right, what do we need to, to do to manage this next phase as we have, uh, you know, potentially less support politically, right? Or at least fewer governmental supports financially. Um, and I think it's, you know, that's, that's where I see a lot of important need. I mean, there's, you know, just the other day there was report, you know, another 800 rural hospitals are at deep peril. Um, and so, you know, now's the time to plan, I think, for where you want to be 12 24, 60 or 120 months from now.
Speaker 3:Yeah. I think this podcast is easily, could easily be titled ducks on a pond. I think the, uh, everything above water is what you're describing, what people will see, but with having to balance with underwater, the fear is paddling. The healthcare is gonna have to continue to do and really reconciling what folks are, you know, basically maybe unaware of that, a we're back to new normal, but, you know, really letting them know the only reason we are is because behind the scenes, there's this furious effort underway to make sure we can retain that normalcy.
Speaker 4:Yeah. From my perspective, uh, I would say that, you know, uh, trying to understand, again, what new normal looks like, uh, moving forward. I think part of that would, would be us looking at the, the core services that we currently provide and making sure that, that, that is a service we feel like we can continue to do, uh, and provide high quality care and that we are gonna have the, the resources available to be able to provide that particular service line, uh, that kind of goes into staffing and pay compressions. You know, those are gonna be issues we're gonna be dealing with for the next 12 to 24 months. Um, but the, um, the PT D from, you know, the emotional toll that this has taken, you know, PT D typically, you know, starts to, to make itself present after the event itself. So what effect does that have, uh, on our staff, our current staff and our new staff that we're trying to get into the healthcare market, you know, what service lines do we have to help with that transition.
Speaker 2:Okay, great. Thank you very much. And, uh, with that, I think it's a wrap. Uh, just wanted to first thank, um, a H L a for hosting this podcast. And specifically I wanted to thank, you know, our distinguished speakers. BJE Jim and Andrew. Thank you very much. It was extremely thoughtful, insightful discussion today. Thank you very much.
Speaker 3:Thank you. Thanks for having us.
Speaker 5:Thanks, Don.
Speaker 4:Thank you.
Speaker 1:Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L a speaking of health law, wherever you get your podcasts to learn more about a a, and the resources available to the health law community, visit American health law.org.