The Way Forward: Providence Focused on Workforce Shortages and Clinical 'Slippage'

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

Staffing shortages and slippage in some clinical areas such as quality are primary challenges as Providence emerges from the coronavirus pandemic, says Hoda Asmar, MD, MBA, executive vice president and system CMO at the health system.

Asmar is one of more than a dozen healthcare executives set to participate in The Way Forward, a HealthLeaders leadership summit scheduled for this month at the Loews Atlanta Hotel in Georgia. Asmar 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 healthcare industry. HealthLeaders coverage of the leadership summit includes a Q&A interview of each panelist. The transcript of Asmar's interview below has been edited for clarity and brevity.

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

Hoda Asmar: The challenges are multifaceted, but one of the main things we are facing is workforce-related challenges. Do we have enough staff? Do have enough people wanting to relocate or to take new roles? We have a shortage of licensed professionals, and we need more flexibility in the work schedule. What is happening with the workforce shortage is we are asking the same people to take on more and more shifts. There are also workforce concerns around burnout and the well-being of the staff who are on the frontline.

A second challenge for us that is related to the pandemic is a slippage in some of the clinical measures such as quality. So, Providence is focused on going back to the march toward top quartile and top decile clinical performance and being able to regain some of the performance that was lost during the pandemic.

HL: Give an example of where you have experienced slippage in quality.

Asmar: An example is managing sepsis. We are focused on managing sepsis, which is a diagnosis that carries with it high morbidity and mortality. Before the pandemic, our sepsis performance was better than expected—we had bent the curve significantly to better than expected on metrics related to sepsis management. During the pandemic, we lost some of that ground. Now, we are focused on getting back to better than expected.

HL: How are you addressing workforce shortages?

Asmar: We have a senior team that is focusing on workforce shortages, including our chief nursing officer.

We are taking a multifaceted approach. We are looking at the principle of functioning at the top of license—we are looking at people's roles and functions and trying to reduce the tasks that someone with a high-level license does not need to do. We are also looking at the schedule and offering our workforce more options in flexibility, types of shifts, and the shifts they work.

We are piloting a virtual nursing program at Covenant Medical Center in Texas. On one nursing unit, we are supporting the in-person nursing team with a virtual nursing team for tasks that do not need to be done directly in-person. This pilot will be ongoing for 90 days, and we hope the virtual nurse model will support frontline nurses.

For the virtual nursing program, we had the nursing staff at the hospital sit down with the hospital's senior leaders. They went through every task that is being done to separate the tasks that have to be done in-person with tasks that can be done virtually. The tele-nurse checks with the patients on any tasks that can be done virtually. Examples of virtual tasks include checking on the patient verbally, tasks related to documentation, and tasks in the electronic medical record.

HL: In this new phase of the pandemic, what are your primary COVID-19 challenges?

Asmar: Now that we are in the endemic phase of COVID-19, there are a couple of things we are focusing on. We need to remind people that for us to remain in the post-pandemic phase, we still must take infection precautions. We also are hoping that the vaccines will become like the flu with annual vaccinations. We want people to stay alert about COVID-19.

The good news is we are seeing less acute patients and less inpatients, but we must remember that COVID-19 is still here. It is in an endemic phase, and we still must practice certain precautions and certain measures such as vaccination to be able to continue to protect our patients, our staff, and our communities. We must make sure that we do not go back to the first and second waves of COVID-19 and the negative impact we had with morbidity and mortality. We do not want to go back to the height of inpatients that we had with COVID-19.

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

Asmar: We are in the middle of preparing for our 2023 priorities. We will continue to be focused on safety measures such as reducing mortality for sepsis as well as hospital-acquired infections and complications, including central line- and catheter-associated infections. We are also going to be focusing on falls, particularly falls with injuries. These are the clinical initiatives we are focusing on in terms of quality and safety.

Another area we are going to focus on is supporting our caregivers including our physicians in terms of resiliency, well-being, and mental health. In the past two years, staff on the frontlines have taken on a lot.

HL: Can you give some examples of initiatives you are going to be launching related to the resiliency and well-being of your staff?

Asmar: We launched in 2022 and we will enhance in 2023 an initiative that we call No One Cares Alone. We trained more than 10,000 caregivers basically to support each other. Through this intervention just in 2022, we have identified 300 caregivers who have had signs of depression and even suicidal ideation, and we were able to support them.

In behavioral health, we have taken a telehealth approach and have been providing training and raising awareness for staff well-being. We have been measuring success based on the number of caregivers who access services, surveys on well-being and resiliency, and specific measures such as when we identify someone who may have early signs of depression or burnout. We measure the response to the interventions.