The health system is experiencing staff shortages in all areas, including certified nursing assistants, registration, pharmacy, respiratory therapy, and registered nurses.
Workforce shortages are the biggest challenge at Clive, Iowa—based MercyOne, the health system's chief medical executive says.
Hijinio Carreon, DO, MBA, was named chief medical executive of MercyOne in May 2021. At the time he was elevated to the chief medical executive role, Carreon had been with the organization for more than 13 years, starting as an emergency medicine physician. Before being named chief medical executive, he had served as chief medical officer and vice president of medical affairs for MercyOne Central Iowa.
HealthLeaders spoke with Carreon recently about a range of issues, including physician burnout, clinical challenges now that the crisis phase of the coronavirus pandemic has passed, workforce shortages, and patient safety. The following transcript of that conversation has been edited for clarity and brevity.
HealthLeaders: What are the primary challenges of serving as the chief medical executive of MercyOne?
Hijinio Carreon: Similar to other hospitals across the country, we are experiencing critical staffing shortages. We are also seeing seasonal conditions such as RSV, influenza, and COVID that are compounding our capacity challenges.
There are challenges in attempting to stay focused on our strategy and not just the day-to-day operational challenges. The other overwhelming challenge and heightened concern is around moral injury and where our providers are in terms of their distress.
HL: How are you rising to these challenges?
Carreon: We are doing a lot around recruitment and retention. So, we are constantly reevaluating our benefit packages and determining how we can attract people into healthcare services. We are looking at our labor pool and partnering with schools—high schools and colleges. Our human resources staff has been going into high schools to highlight opportunities and increase our pipeline of individuals who might be interested in pursuing a healthcare career.
We are looking at statewide internal nursing traveler programs. We are advancing and redesigning our care models—we were the first in the state to start a virtual nursing program, and we are looking to expand that program. We have looked at our current care models to see how we can reinforce our nurses with care technicians, and we have looked at nursing ratios closely.
We are also focused on employee wellness and engagement—that is always going to be in the forefront. We continue to ensure that we have services in place to provide our healthcare workers with the support that they need.
Hijinio Carreon, DO, MBA, chief medical executive of MercyOne. Photo courtesy of MercyOne.
HL: What is the status of physician burnout at MercyOne?
Carreon: Burnout was pervasive before the coronavirus pandemic. Certain specialties such as the emergency department were reporting burnout levels of 50% of the staff. Now, you add the global pandemic, workforce shortages, and healthcare disruptors that have entered the arena, and it is difficult to suggest that yoga or symposiums are going to be sufficient tools to address burnout. We know all of these factors have had a significant impact on our colleagues, so the prevalence of burnout is extremely concerning to us. The extent has yet to be fully assessed and determined, but we have significant concerns in light of all the challenges we have faced over the past couple of years.
HL: What are the primary initiatives you have in place to address physician burnout?
Carreon: We are integrating with Trinity Health, and Trinity has embraced MercyOne into their culture. We have been leveraging some of their tools and expertise such as their Advancing Together webinars, which focus on a compassionate approach to healthcare.
We have a Colleague Care Circle program that features a peer group of behavioral health professionals and others who connect with our team members in high-volume and high-stress areas to provide high-touch comfort and support for them during real-time situations. The goal of this initiative is to reach all of our colleagues who are working shifts and provide active listening and empathy around concerns that may have arisen during a specific event.
We have been creating social events now that in-person meetings have become more acceptable. We are creating environments where we can build relationships and reestablish trust that may have been lost during the pandemic.
We partner with our employee assistance program. They have done a tremendous amount of work on physician burnout with us, and we have used some of their strategies and tactics in getting the message out about resources that are available to help staff through these difficult times.
HL: What are your primary clinical challenges now that the crisis phase of the pandemic has passed?
Carreon: Staffing is the biggest challenge. We have an aging workforce and some individuals have accelerated decisions to retire or leave healthcare. There are healthcare disruptors that are offering more flexible hours and remote work—those are challenges to our hospitals, and we need to become nimble and flexible and try to compete in this landscape, which has challenged us to be more innovative.
HL: What kind of workforce shortages are you experiencing at MercyOne?
Carreon: All areas are being impacted. It is extensive from certified nursing assistants to registration to pharmacy to respiratory therapy to registered nurses and many other positions. At the national level, there may be a belief that this is just a nursing shortage, but it is not. The shortages that we are seeing at MercyOne are in all areas.
HL: What are the main efforts you have in place to address workforce shortages?
Carreon: A main effort is increasing the pipeline—the individuals who are pursuing careers in healthcare. We are trying to attract staff and determine how we promote education within our organization; so, if they want a career path or higher level of education, we can allow them to do that in their journey as they become employed within the MercyOne organization.
We are trying to reach individuals as early as we can who may be interested in healthcare. Engaging these individuals is important to us. We are strengthening our relationships with universities. We have our Mercy College of Health Sciences in Des Moines, and we have been strengthening that relationship to ensure the offerings they have are consistent with the needs of the organization. We want to ensure that we can support clinical rotations and make them as robust as possible so that the students are getting not only a great education but also a great experience when they are at MercyOne that makes them want to remain a part of the organization.
One of the pieces is reconnecting individuals to professional purpose. That has been a big initiative for us. We want staff to get back to the mission of why they went into healthcare. We lost some of that during the height of the pandemic.
HL: What are the primary elements of patient safety at MercyOne?
Carreon: There are several main areas, and I will name a few. We are looking at preventable hospitalizations, and our 30-day readmissions. We are looking at our OSHA reportable injury rates, and at falls with injury rates.
HL: What are some of the metrics you follow to measure your performance in patient safety?
Carreon: There are the measures that I just mentioned. They are all tied to a specific numerical value. We establish our internal goals based off our historical performance. We are striving to get to zero harm. So, we are trying to improve these numbers with the objective of continuing on the path of high reliability.
HL: What kind of initiatives have you launched to become a high reliability organization?
Carreon: We are still early in our journey. We have been focused on serious safety event reporting. We want to establish a foundation of a just culture—we want individuals to feel comfortable bringing forward concerns and near misses, so that we can continue to refine our processes and try to mitigate any risk of harm to patients.
Christopher Cheney is the senior clinical care editor at HealthLeaders.
To address workforce shortages, MercyOne has launched several efforts in areas including hiring, retention, employee pipeline, and virtual nursing.
At MercyOne, physician burnout was a concern before the coronavirus pandemic and it has been worsened by workforce shortages and healthcare disruptors that offer more flexibility and remote job opportunities.
To become a high reliability organization, MercyOne has been working on serious safety event reporting to establish a foundation of a just culture.