Matt Heywood, CEO of recently-merged Aspirus Health, sits down with HealthLeaders strategy editor Jay Asser to discuss how health systems are weathering the current financial storm through M&A, workforce, and cybersecurity.
Apprenticeship is an effective model to grow your own healthcare workforce.
Editor's note: Carter is the Chief Human Resources Officer at FHN, an award-winning regional healthcare system committed to the health and well-being of the people of northwest Illinois and southern Wisconsin.
Healthcare employers at my organization and a handful of others recognized National Apprenticeship Week last November, likely for the first time. This is because the apprenticeship model for recruiting and training new career-starters in healthcare is new to many healthcare organizations, despite being proven successful in other industries.
The increasingly critical staffing shortages of the past several years have driven those of us in healthcare to find innovative ways to replace lost workers and find new ones.
At FHN, one approach we are taking in addressing this immediate urgency is focusing on projects that—on the surface at least—seem more like long-term efforts to build a sustainable talent pool. We all know it takes time to make these projects yield results because they involve building partnerships, changing policies, and creating internal programs to train that talent. But my purpose here is to explain how apprenticeships can be successful in healthcare not only for long-term investments in a talent pool but for immediate needs as well—because apprenticeships have been very successful for FHN.
Len Carter is the Chief Human Resources Officer at FHN. Photo courtesy of FHN.
The basis of our apprenticeship program came from working with the regional board at Workforce Connections; we built a program that would hire and develop more medical assistants and pharmacy technicians for our organization. We work with MedCerts and other organizations for the online or classroom training and preparation of our apprentices so they can pass their industry credential programs. We work with Workforce Connections to tap into grant funds from the Department of Labor’s Registered Apprenticeship Program, and FHN provides the mentors and the hands-on classroom experience for the apprentices.
This program has been so successful that we are developing apprenticeship programs for other needs at FHN; it is a model every healthcare employer should consider in this challenging workforce environment. Here are six reasons why.
Immediately expands the applicant pool: The apprenticeship model offers numerous benefits, not the least of which is removing barriers for applicants who lack prior healthcare training or experience. I cannot overstate the importance of this point. Apprenticeships are a crucial and foundational step in an industry where skilled labor shortages are projected to grow even worse over the next decade. It is equally crucial that the “classroom” training element be paired with hands-on learning. Our classroom training is online through our vendor but the hands-on clinical experience takes place on site and with our own staff. This lets us grow our own talent, and the individuals we have do not need previous healthcare experience—they just need the right aptitude and work ethic.
Reduces academic recruiting demands: Until the last several years, healthcare organizations could focus their recruitment efforts on a handful of partner institutions; more recently, with labor shortages making recruiting more competitive than ever, employers had to recruit at dozens of institutions. Since an apprenticeship program eliminates the requirement for applicants to have already earned a degree or credential, employers need not spread their recruiting efforts so thin across so many institutions.
Support is readily available: Apprenticeship programs are new to healthcare, where many executives and hiring managers are likely unfamiliar with the model; luckily, we can learn from successful programs in private industry and from workforce development agencies. Through FHN’s participation in state and regional workforce boards, we heard firsthand about thriving apprenticeship programs in other sectors and began to ask ourselves, “Why doesn’t healthcare do this?” Funding is available to pay for the training from state workforce development funds and grants from theDepartment of Labor(DoL). In the last two years, DoL has invested over $200 million in growing apprenticeship programs, including healthcare where DoL has deemed eight occupations as apprentice able.
Serves as built-in vetting: As new apprentices go through the program, employers have a bird’s-eye view into their work ethic, their attitudes, and their capabilities. Those who complete their training are ready to work and they’re already immersed in the company culture—there are no first-day surprises for the employer or the employee.
Creates career pathways: We have long focused our workforce efforts on retention at FHN, and our apprenticeship program is a natural fit here. Not only does it allow us to hire, educate, and train new staff for entry-level roles like medical assistants and pharmacy techs, but it also creates career growth pathways for existing staff in administrative and other support positions. Helping our employees to grow their careers is undoubtedly a contributor to our positive staff retention rates and it has allowed us to fill critical entry-level roles and support individuals who are working toward nursing or pharmacy degrees.
Builds a sustainable talent pipeline: When we first began to discuss implementing an apprenticeship program, some hiring managers expressed concerns about the time required for a new apprentice to complete their training and begin their new job. “But we need people now,” is a common reaction when healthcare leaders begin to consider an apprenticeship model. It was no different for us. We persevered, however, by explaining the bigger picture: We will need these employees now and in 10 months. By then, a class of apprentices will have completed the program and be working, already familiar with our organization and already trained specifically on the skills we need. Seeing apprenticeships as a viable model means stepping back from urgency to invest in a future where applicants are readily available, and the talent is homegrown.
At FHN our employee data tells us that if we can retain a new employee for 3 years, we keep them for 12. This is a metric we keep coming back to when envisioning how we staff and grow our organization. When the focus becomes retention over recruitment—which is a mission within our HR department—then apprenticeships make even more sense. Now in our third year, we can attest to apprenticeships successfully adding the kind of people we need into our employee base. As the sources of talent from the traditional feeder-school models dwindle, meeting the next decade’s workforce demands makes apprenticeships a rewarding and successful option to add into healthcare organization staffing plans.
CNOs must strategize to keep tenured nurses in the workforce longer.
On this week’s episode of HL Shorts, we hear from Gail Vozzella, Senior Vice President and Chief Nurse Executive at Houston Methodist, about how CNOs can bridge the gap between tenured nurses leaving and new nurses entering the workforce. Tune in to hear her insights.
As the industry assesses the financial damage of the cyberattack, healthcare execs will also be looking at how their technology strategies can be improved
The workaround is a popular healthcare technology term right now.
As healthcare organizations across the country assess the damage caused by the Change Healthcare outage, executives are not only looking at the financial fallout but also the technological repercussions. In short, what will health systems need to do to make sure this doesn’t happen again—or if it does happen, that they have the resources in place to minimize damage?
According to the results of an American Hospital Association survey of roughly 1,000 hospitals released on Friday, some 81% of hospitals found that workarounds enacted to keep operations going during the outage were only “somewhat successful,” while 11% found that workarounds didn’t work at all. And two-thirds of those responding to the survey said it difficult or very difficult to deploy workarounds, particularly in switching clearinghouses.
As has been well-reported, the financial implications are even more alarming. According to the survey, 94% reported being affected financially, with more than half sustaining “significant or serious” damage. About one-third reported impacted to at least half of their revenue and about 60% saw that impact to be more than $1 million a day. Some 44% expect the negatives to continue for another two to four months, and more than 20% have no idea when the tide will turn.
The takeaway is that healthcare executives will need to think long and hard about what they need to do to improve their technology infrastructure, on both the financial and clinical sides.
“These survey findings are another irrefutable reminder that the impact of this cyberattack is far reaching and far from over,” AHA President and CEO Rick Pollack said in a press release accompanying the survey. “When nearly every hospital says they are experiencing a financial loss and half of those say it’s ‘significant or serious,’ with no immediate end in sight, then the debate about whether we need to help them should be over.”
The AHA is one of several organizations calling on federal authorities to take action, and an investigation has reportedly been launched to see whether UnitedHealth Group did anything wrong that led to the attack or caused it to be so damaging.
“We continue to call on Congress and the Administration to take additional actions now to support providers as they deal with significant fallout from this historic attack,” Pollack said. “We also need UnitedHealth Group and commercial payers to step up and support patients and providers on the front lines by waiving prior authorization and timely filing requirements, as well as advancing payments that will allow providers to continue providing 24/7 care to communities.”
Beyond that, healthcare organizations need to take stock of how an incident like this affects clinical care. According to the AHA survey, almost three of every four hospitals reported a negative effect to patient care, and nearly 40% said patients had difficulties accessing care, most often because of disruptions to the health plan authorization process.
With rising costs in healthcare, CNOs need to brainstorm how to keep expenses down.
Cost containment is an issue throughout all of healthcare, and because of the nursing shortage, keeping costs down has become an even more difficult task.
According to Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, the nursing shortage drives up labor costs and turnover costs in nursing. Labor costs have gone down marginally with the consolidation of travel nursing, but many organizations are still requiring the use of agency nurses, which drives up costs.
“Every time we spend time training a nurse, it costs money,” Vozzella said, “[but once a nurse] feels that it’s not a good work environment… [they turn] around within those first three years and leave that organization or unit, [and] it is a significant cost.”
To combat this, CNOs need to focus on nurse retention and creating the right work environment where nurses will want to spend their entire careers.
Redesigning care
One cost containment strategy that CNOs should consider is using technological solutions to change the day-to-day workflows of nurses so that they have more time to care for patients.
At Houston Methodist, Vozzella said they meet with the deans of the surrounding nursing schools, and the number one reason why nurses go to nursing school is still to help people. Nurses want to be at the bedside, not typing into an electronic medical record, hunting supplies, or finding equipment.
“The nurse’s time is precious, and a good thing that’s come out of having a shortage is the focus on nurses doing things that only a nurse can do,” Vozzella said, “or what technology can pick up other tasks that are non-value added.”
Vozzella also recommends using ancillary support staff, such as phlebotomists, to do lab draws instead of the nurse. At Houston Methodist, Vozzella said they also partner with Rice University to help develop robotics that can screen trays to make sure the right tools are present before a tray goes into an operating room, so that the responsibility of checking the trays no longer falls on the nurse.
“[When] nurses have such a high value…and some ancillary support, we can redesign the work of that nurse in order to give that support,” Vozzella said, “so that it offloads that work and [nurses] are able to focus on caring for the patient.”
CNOs should be careful about the designation of work as well, and make sure that they support staff with communication efforts to make sure nurses understand the why of what they are doing.
“We tend to be a little controlling sometimes, or there’s factors like a very tenured ancillary person and a new graduation nurse,” Vozzella said. “It’s sometimes a challenge for that nurse to tell somebody else what to do.”
Care coordination
Additionally, efficient patient care management can help keep costs down by creating a better work environment. There are care milestones that patients must meet before they can go home, and those milestones are met with the help of care management, leadership, physicians, nurses, and advanced nurse practitioners.
According to Vozzella, improved care coordination is beneficial to both the patient and the nurse, as it improves the work environment and provides the patient with some insight into why certain processes are happening.
“It certainly helps patients with a shorter length of stay feeling like they’re a part of their care journey,” Vozzella said, “but it’s definitely helpful for the nurse too, because they feel [like a] part of something bigger than themselves and part of a team.”
Preventative care
Preventative care can also keep costs down. When primary care physicians can help patients manage diabetes or hypertension successfully, they are less likely to have an inpatient admission, Vozzella explained. Technology can help with this, so that patients can have more support at home without having to go into a doctor’s office or to the hospital.
Patient education is important to preventative care, because patients need to know about how different health factors affect their overall health, and nurses are a huge part of that.
“It is an exciting time for nurses to be part of that,” Vozzella said, “because it does offer nurses [the opportunity] to do more preventative care, but also to potentially do that virtually.”
CNOs should look at why patients are coming to the hospital in the first place and strategize ways to create support for them at home as well as in the hospital. Vozzella recommends having a case manager or social worker who can check in with patients and make sure they have transportation, food, and psychological support so that they attend their appointments and prioritize their health needs.
Leveraging technology
Over the past 15 years, according to Vozzella, health systems have moved toward rebuilding facilities to have better environments with natural light and private rooms, but it has just increased the amount of walking nurses have to do daily to see their patients.
“When [nurses] are in a room, they’re typically the only person,” Vozzella said, “and it’s so very isolating for, in particular, nurses that are newer in their career.”
However, bedside nurses are no longer alone with the addition of virtual nursing. Through virtual care, nurses can log in and come on the television screen in a patient room and act as a second set of eyes for the bedside nurse.
“I think virtual [nurses] can be a huge support, but it has to be implemented in partnership with bedside nurses,” Vozzella said. “We have to really work hard to understand where nurses tend to need support and make sure that’s our highest priority.”
AI adoption is fast outpacing governance, and with memories (or nightmares) of EMR adoption and the Change Healthcare outage on everyone’s mind, the pressure is on to set up guardrails
With HIMSS24 in the rear-view mirror, one of the biggest takeaways from the conference was the energy and attendance. Healthcare’s movers and shakers were here, at least for a day or two, and they were making deals and forging partnerships.
And while AI tools and programs were dominating the discussion and deals, a lot of talk was centered on Ai accountability.
While the year-old Coalition for Health AI (CHAI) made early news with its announcement of advisory boards and partnerships, Microsoft unveiled its own Trustworthy & Responsible AI Network (TRAIN), an intriguing collaboration of health systems and federal representatives that aims to create more structure in the move toward governance.
“When it comes to AI’s tremendous capabilities, there is no doubt the technology has the potential to transform healthcare. However, the processes for implementing the technology responsibly are just as vital,” David Rhew, MD, Microsoft’s global chief medical officer and vice president of healthcare, said in a press release. “By working together, TRAIN members aim to establish best practices for operationalizing responsible AI, helping improve patient outcomes and safety while fostering trust in healthcare AI.”
Rhew also commented on LinkedIn on how CHAI and TRAIN will co-exist.
“One way to look at it is that CHAI focuses on ‘the what,’” he wrote. “What is responsible AI (RAI)? What are the RAI principles and standards? ... while TRAIN focuses on ‘the how.’ How does one operationalize RAI? How can organizations collaborate in a privacy-preserving manner, such that data and IP are not exposed? How can we ensure that low-resource settings are able to apply RAI?
Simply put, CHAI helps develop the RAI standards, while TRAIN helps organizations implement them, through the use of technology-based RAI tools and guardrails.”
That post hints at the understanding that while everyone agrees the industry needs guardrails, how we get there will be a challenge. And with all the announcements and talk at HIMSS24 of health systems and hospitals launching AI programs, the urgency to create standards is growing by the day.
Many also don’t want the process to mirror EMR adoption two decades ago. The healthcare industry wasn’t prepared to embrace electronic medical records, leading to more than a few nightmares in implementation and the need for meaningful use guidelines. Now AI adoption is fast outpacing governance, and executives are in some ways nostalgic for the guidance offered by meaningful use.
Add to that the concern around the recent Change Healthcare cybersecurity attack some three weeks ago. The outage filtered into many a conversation at HIMSS24, creating a stir around the section of the exhibit hall given over to cybersecurity companies. While the incident has been tied back to a ransomware gang, more than a few people have wondered whether unchecked use of AI could lead to more data breaches – or whether AI could be used as a tool against attacks.
For example, Nordic Consulting announced at HIMSS24 a partnership with Microsoft Azure and Amazon Web Services to launch a Cloud Innovation Lab, addressing requests from healthcare organizations for help in expanding and managing their data storage capabilities, in part because of the increase in AI programs. Brijeet Akula, a Principal Architect at Nordic Consulting, said company was seeing a lot of business from hospitals and health systems spooked by the outage.
“They have sped up their desire to explore more security methods,” he noted.
So while security may be an outlier, it will add to the urgency to create guardrails around AI. The Biden Administration has set its course with an October 2023 Executive Order on AI and announcements of actions to come, but CHAI and TRAIN offer proof that there will be more players in the game.
Like CHAI, TRAIN has an impressive (and in some cases overlapping) roster. Along with healthcare technology company TrueBridge, participating health systems include AdventHealth, Advocate Health, Boston Children’s Hospital, Cleveland Clinic, Duke Health, Johns Hopkins Medicine, Mass General Brigham, MedStar Health, Mercy, Mount Sinai Health System, Northwestern Medicine, Providence, Sharp HealthCare, University of Texas Southwestern Medical Center, University of Wisconsin School of Medicine and Public Health and Vanderbilt University Medical Center, and the organization will be working with OCHIN, a non-profit innovation center with strong ties to Epic.
So even as these organizations are deploying AI in several, if not hundreds, of use cases, the talk in the background is around setting up accountability as soon as possible—especially before those use cases start involving patients.
“Even the best healthcare today still suffers from many challenges that AI-driven solutions can substantially improve,” Peter J. Embí, MD, MS, a professor and chair of the Department of Biomedical Informatics (DBMI) and senior vice president for research and innovation at Vanderbilt University Medical Center, said in the press release.”However, just as we wouldn’t think of treating patients with a new drug or device without ensuring and monitoring their efficacy and safety, we must test and monitor AI-derived models and algorithms before and after they are deployed across diverse healthcare settings and populations, to help minimize and prevent unintended harms. It is imperative that we work together and share tools and capabilities that enable systematic AI evaluation, surveillance and algorithm vigilance for the safe, effective and equitable use of AI in healthcare.”
CNOs must bridge generational gaps to maintain a strong workforce.
The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring and taking their knowledge with them.
CNOs must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.
Here's what CNOs need to know about connecting the generations in nursing, according to Cassie Lewis, chief nursing officer at Bon Secours Mercy Health, and Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist.
A HIMSS24 panel discusses how competition and uncertain reimbursements are forcing providers to change their business model
Healthcare providers are starting to rethink what being a provider actually means.
Stung by high costs and low reimbursements for acute care, some health systems are shifting their sights to care management and preventive care. And they’re making patient engagement a priority.
“A great deal of our future is in the outpatient side,” Tressa Springman, SVP and chief information and digital officer at LifeBridge Health, a five-hospital system based in Maryland, said during a panel session Tuesday at HIMSS 24.
She noted that more than 50% of the health system’s quality-based reimbursement score for the state is focused on the patient experience, making that more important than actual clinical care. So they’re now setting their sights on access, convenience, and outpatient interactions.
“We’re really focusing on the community,” she said.
Indeed, smaller health systems and hospitals are being forced to change their priorities just to stay in business. Rural hospitals are shutting down or shifting to emergency care centers. Others are closing their Eds and ICUs, referring patients to stand-alone urgent care centers, and looking more closely at a concierge care strategy.
The HIMSS24 panel, titled “Moving Beyond EHR Engagement: Deploy Consumer-Centric Strategies That Truly Empower Communities,” took a closer look at how providers are making engagement work. They’re listening more to their patients, embracing remote patient monitoring, virtual care, wearables and home-based services, and targeting care management and coordination.
“We want to know more about our patients,” said Eric Alper, MD, vice president, chief quality officer and chief clinical informatics officer at UMass Memorial Health. “The Joint Commission and CMS are actually [demanding] it.”
This strategy isn’t without its challenges. As the title of the session implies, a lot of the information providers need isn’t found in the EHR, and so health systems and hospitals are investing in bolt-on technologies and programs, weaving care in and out of the medical record. They’re paying more attention to social determinants of health (SDOH), and fashioning programs that revolve around the patient’s preferences and needs.
Michael Garcia, vice president and chief information officer at the Miami-based Jackson Health System, noted that his health system is making more of an effort to tailor healthcare to patients who typically have trouble accessing care. At Jackson Health, that includes significant numbers of homeless people, undocumented immigrants, and people who are either incarcerated or recently released from prison.
That strategy is based on necessity. If the health system doesn’t reach out and provide care when and where they need it, he said, those patients will end up in Jackson Health’s already-overcrowded Emergency Department.
All three panelists and their moderator, GetWellNetwork founder and CEO Michael O’Neil, noted that this type of strategy doesn’t have a gameplan or model to work from, and no one has come up with any best practices yet. Providers are on their own in developing these care pathways, and in many cases each is developing a unique strategy.
Then again, today’s consumers aren’t looking for a cookie-cutter approach to engagement.
“The ordinary person doesn’t care how much scale you have in your organization,” O’Neil pointed out.
Springman noted that disruptors are making the primary care space very competitive, and it’s difficult for providers to match what Amazon, Walmart, and others are offering. Somewhat ironically, that’s forcing providers to re-engage with their patients, establishing new relationships that technology has for the past few years interrupted.
“We actually are investing much more in well care than in sick care,” she said.
These nurse leaders outline best recruiting and retention practices for CNOs.
The biggest challenge facing CNOs these days is the workforce shortage. Not only are there not enough nurses entering the industry, but there are also many tenured nurses who are leaving the profession or retiring and taking their knowledge with them.
CNOs must implement creative solutions to recruit and retain nurses of all generations who will continue providing the best standard of care to patients.
During the recent HealthLeaders’ Nurse Labor and Compensation NOW Summit, Cassie Lewis, chief nursing officer at Bon Secours Mercy Health, and Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, spoke about strategies to retain tenured nurses, and how CNOs can help transition the knowledge of tenured nurses to new graduate nurses.
Connecting the generations
There are major differences in expectations between Traditionalists, baby boomers, Gen X, millennials, and Gen Z in the workforce. Life circumstances and work-life balance needs are different, some nurses might have children or elderly adults they need to care for, while others are younger and able to work at varying times during the week.
Due to the stressful nature of nursing and current workforce challenges, there are tenured nurses who are leaving the profession entirely and taking their knowledge with them.
CNOs need to strategize ways to keep the knowledge within industry, so that new graduate nurses can learn from them.
“Our environments are really physically and mentally demanding,” Vozzella said, “so what options can we give to somebody who’s at the end of their career?”
Flexibility
One strategy that CNOs should use is to sit down with tenured nurses before they decide to leave the workforce and ask them where they want their career to be in the next three to five years, Vozzella explained. Providing individualized flexibility is key and will keep tenured nurses working at the bedside longer.
“If a more tenured nurse wants to be off all summer, it would be better for us if we allowed that,” Vozzella said, “in order to keep that person working in an intensive care unit or an operating room for five more years.”
CNOs also need to make sure that tenured nurses feel valued. Lewis recommended taking a look at what offerings are being given to incoming nurses, and how that can be balanced with offerings for tenured nurses.
“When you go online, sign on bonuses are exponentially large in some areas, the compression factor is real,” Lewis said. “[We need to ensure] our tenured nurses feel the same value because we don’t want them to feel left behind.”
Compensation is not the only factor, the position of a tenured nurse could become hybrid, where half of their work is at the bedside and half is in a faculty position, Lewis suggested.
“There’s benefit to saying it’s not just monetary compensation,” Lewis said, “but we’re willing to work with you to create some level of flexibility that meets you where you’re at.”
Virtual nursing
One of the best options for keeping tenured nurses in the workforce longer is virtual nursing, according to Vozzella. Virtual nursing would retain the knowledge of tenured nurses and provide new nurses with support so that they feel less isolated.
“[The tenured nurses wouldn’t be] walking as much, but they could continue to speak to patients or…mentor new nurses that are starting out [while] not having to do such a structured 12-hour shift,” Vozzella said. “They could do it for four hours, [or] they could do it from home.”
Lewis agreed, adding that generally having more creative positions in nursing is how to keep tenured nurses from leaving the workforce. Virtual nursing creates opportunities for nurses to do virtual admissions and remote patient monitoring, which would keep tenured nurses from exclusively having to work at the bedside.
Mentorship opportunities
Another way to keep knowledge within the industry is to provide tenured nurses with opportunities to mentor incoming nurses. According to Lewis, one way to do this is to keep an expert or a tenured nurse on call, so that newer nurses can reach out if they need help with something.
“We’re starting to see [this] as a strategy [for] when we can’t get [tenured nurses] at the bedside,” Lewis said, “[and] how [we can] take that knowledge and really use it to help that novice nurse become safer in their practice and feel more confident.”
Lewis also recommended a nurse emeritus program, where seasoned nurses who are close to retirement can mentor newer nurses or even nurse leaders. Volunteer programs or nurse faculty positions are also helpful options since many nurses who leave want to stay connected to their patients.
“Our nurses really do feel connection and callings to do the things that we do every day,” Lewis said, “and so the more we can meet them where they’re at to share that collective knowledge, they’re willing to do it.”
This is part two of a two-part piece, part one was published Monday, March 11th.
In this episode of the HealthLeaders Podcast, we're joined by Monica Richey, VP of Physician Revenue Cycle for Grady Health System in Atlanta, Georgia. Throughout our conversation, we'll be...
