This leader discusses how to bridge the gap between health systems and unions.
Recently, there has been an increase in nursing strikes and union activity throughout the United States.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
To get the bigger picture, we sat down with Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, to discuss the underlying causes of strikes and how to communicate with unions to achieve better outcomes.
Healthcare CFOs know the pandemic cost them big, but now there's a number attached for one state.
After years of tight margins made worse by the pandemic, many hospitals are beginning to feel a measure of relief. But how much financial strain did the pandemic really put on hospitals and health systems?
In Pennsylvania, it was $8.1 billion worth of strife.
You read that right. The total COVID-19 related expenses and lost revenue reported by Pennsylvania hospitals and health systems between January 2020 and December 2022 were $8.1 billion, according to the report by The Pennsylvania Health Care Cost Containment Council and The Hospital and Healthsystem Association of Pennsylvania.
While this report only spotlighted Pennsylvania, there are a few key insights that are applicable to CFOs nationwide.
So what was the true financial impact?
As mentioned, Pennsylvania hospitals and health systems reported a staggering $8.1 billion in total COVID-19-related expenses and lost revenue during the pandemic.
Although most hospitals and health systems remained financially stable due to COVID relief funds, those funds have since dried up while the same challenges still exist.
Of this sum, COVID-19 staffing costs emerged as the most significant expenditure, reaching $1.3 billion. According to the report, other costs included:
Testing expenses: $374 million
Supplies and equipment expenses: $679 million
Construction expenses: $28 million
Housing care expenses: $9 million
Other expenses: $434 million
Revenue loss: $5.3 billion
When it comes to the staffing costs, the amount highlights the immense financial strain incurred by hospitals in responding to the staffing demands posed by the pandemic. CFOs still need to scrutinize these figures to gain a nuanced understanding of where financial resources were concentrated and explore avenues for financial resilience moving forward.
The report also shed light on how the pandemic has exacerbated workforce shortages in Pennsylvania's healthcare sector.
Hospitals reported an average statewide vacancy rate of over 30% for key clinical positions, such as registered nurses, nursing support staff, and medical assistants, by the end of 2022.
This intensification of workforce shortages continues to pose an ongoing challenge to hospitals, hindering their ability to provide comprehensive care and potentially impacting patient outcomes. And as we know, these staffing shortages have been the catalyst to the increasing number of workforce strikes.
As mentioned, CFOs must strategize to address staffing shortages, focusing on recruitment, retention, and workforce optimization.
But what about other states?
A previous study showed that COVID-19 care prompted higher operating expenses and rapidly escalating labor costs for CFOs nationwide. In fact, hospitals in the United States experienced a total loss of over $200 billion because of an estimated 45% decrease in operating revenue just between March and June of 2020.
Pennsylvania's data through 2022 gives healthcare CFOs across the nation a granular look into these costs, providing valuable insights into the continued long-term financial repercussions of the pandemic.
The report's focus on COVID-19-related expenses and lost revenue underscores the continued need for robust financial planning and risk management, especially as many CFOs are still clawing their way out of the red.
CFOs should conduct thorough audits of their institutions' pandemic-related financial data, identifying areas for potential cost containment and revenue enhancement. Leveraging data can not only assist CFOs in forecasting future financial scenarios and implementing proactive measures, but help them push their current margins in the right direction.
Two leaders share their insights and strategies to help CNOs work together with staff and problem solve.
Right now, it seems like every day there are new cases of nurses striking or unionizing at health systems all across the country.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
Here's what CNOs should know about preparing for strikes.
With competition from disruptors increasing and the industry under pressure to make healthcare more convenient and less expensive, health system leaders need to take CES seriously. Here are a few takeaways from the recent event
As CES 2024 slides into the rear-view mirror, here are some of the key takeaways for health system executives who either attended the show or kept track of the goings-on from a distance.
Keeping the Consumer in the Loop
CES is all about the consumer experience, a strategy that many healthcare organizations have been slow to embrace. But with HCAHPS scores and Joint Commission reviews giving more weight to the consumer experience, the emphasis for healthcare leaders is not only in improving consumer engagement but creating a dynamic that allows providers and patients to work together on care management.
(Of course, one of the enduring ironies of healthcare conferences is that while the patient is becoming more of an active participant in the industry, very few patients are actually invited to these conferences.)
CES does have the advantage in that everything is geared toward the consumer, so all the technologies on display—in the area designated for digital health as well as in all the other halls—are designed to be sold to the consumer. In digital health, that means creating a marketable product that a consumer will be interested in buying and using, which again isn’t a strong point of clinical grade devices or platforms. In fact, the healthcare industry has long struggled to bridge that gap between consumer-friendly and clinically relevant technology.
But the stakes are higher now, thanks to Amazon, Walmart, Apple, Walgreens, and others who are taking the consumer experience in other industries (like retail, banking, and travel) and applying lessons learned to healthcare. Health system executives need to pay attention to those trends and take a look at wearables, consumer-facing apps, smart home technology, and other products that can allow them to make a connection with their patients and improve care.
Creating a Connected Health Experience
Smart technology was all the rage at CES, from toilets and showers to beds and pillows to refrigerators and ovens to, believe it or not, grills, patio furniture and fireplaces, birdhouses, exercise equipment, and beer-making and bartending machines (thankfully, sex technology seemed to be on the way out this year). In short, data is king, and anything that can gather data on the user experience and use that data to make the experience better is in play.
No more so than in healthcare, where doctors and nurses are coordinating and managing more care based on data outside the electronic health record. The shift away from episodic care and toward value-based care means that providers (and payers) are interested in the entire patient journey, and health and wellness are part of that ecosystem. They need to collect data from the patient’s everyday life and experiences, from the home to the office to the school to the car and everywhere in between.
Health system executives looking at this shifting landscape need to understand not only the technology available for gathering and disseminating data but the platforms needed to connect those disparate devices and points. This puts an emphasis on infrastructure management and interoperability. It’s nice to have a bed and a toilet that can tell you how a person is sleeping and, ahem, pooping, but is that data being transmitted seamlessly back to doctors who can use it to improve care?
Homing in on … the Home
One of the bigger themes in healthcare is the shift from the hospital to the home, or the understanding that healthcare can be delivered in locations outside the traditional care setting At CES, the focus was on technology and smart home products that could help consumers improve their health and wellness.
At the Digital Health Summit, the focus shifted to how a tech-enabled home could help healthcare providers improve monitoring and care delivery. That might include the Hospital at Home strategy, in which health systems provide both in-person and virtual care at home for patients who would otherwise be in a hospital. But it also offers opportunities for health systems to gather and use data from the home setting to manage and coordinate care, working with consumers to prevent serious health issues from cropping up.
The key is in understanding what the consumer wants out of healthcare.
“It’s life care,” Leslie Saxon, MD, executive director of the USC Center for Body Computing and a professor of medicine at USC’s Keck School of Medicine, said during a panel discussion on healthcare in the home. “Traditional medical care [providers] have to believe that the patient is the consumer. … And the people who are going to drive this market are the patients.”
All in on AI
As with every other conference over the past year, AI was a part of almost every conversation and panel presentation at CES.
A lot of the talk in the digital health space centered on how the technology could make things easier for consumers to access healthcare services. Integrating AI tools into the back end can help match consumers to the right resources, selecting the appropriate care providers and locations, while also speeding up the registration and insurance/payment processes. AI has the ability to sort through large amounts of data, speeding up the process and taking pressure off nurses and other office staff.
The technology will be particularly helpful in gathering and sorting data coming from devices and other locations outside the healthcare setting. Roughly 80% of that data is unstructured, and needs a little coaxing to be able to fit into the medical record, where providers can use it to improve care pathways.
“I think the greatest advance that we are going to see in the next few years is the ability to take unstructured data and use it,” Lee Schwamm, MD, SVP and chief digital health officer at the Yale New Haven System and associate dean of digital strategy and transformation at the Yake School of Medicine, said during a panel on AI and the future of healthcare.
Simplicity Matters
Above all else, CES was about consumer convenience, and the key to digital health success will lie in making healthcare access as convenient as possible for consumers. That means embracing tech tools and platforms that make the process intuitive.
“Healthcare is more confusing, more complex, and more costly than ever before,” Glen Tullman, the former Allscripts executive who launched a digital health startup focused on chronic care management and now fronts Transcarent, said during a closing session with billionaire businessman Mark Cuban.
That’s why disruptors like Amazon, Walgreens, and Cuban’s own Cost Plus Drug Company are drawing consumers away from traditional healthcare organizations amid what some are calling the “battle for primary care.” They’re cutting through the complexity and using technology to give consumers what they want in an easy format.
Phil Wright, CEO of Memorial Regional Hospital South, joins HealthLeaders strategy editor Jay Asser for a discussion on altering approaches to solve workforce challenges and his leadership style in his first few months on the job.
CNOs must be ready to strategize and solve key issues in nursing this year.
On this week’s episode of HL Shorts, we hear from Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, about the top five challenges CNOs are facing in the new year. Tune in to hear her insights.
What do you predict will be the top 5 biggest challenges in nursing in 2024?
Dolan: Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.
Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.
I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.
Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.
And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].
Elevance Health announced at CES that it will give free smartphones to Medicaid program members to help them access healthcare services
Elevance Health is addressing a critical care gap for its underserved members by giving them a smartphone to connect with healthcare resources.
The Indianapolis-based insurer formerly known as Anthem, which announced the program at CES 2024 this past week in Las Vegas, is targeting a Medicaid population that faces barriers to accessing the care they need. According to Elevance, roughly one quarter of American households making $30,000 or less a year aren’t using a smartphone, and 43% don’t have home broadband internet access.
"The lack of sufficient internet connectivity and technology access remains a significant barrier for many – increasing health inequities," Kurt Small, president of Elevance Health’s Medicaid business, said in a press release. “This program aims to directly address this challenge and helps improve the health of the people we serve.”
The program targets a glaring care gap that both payers and healthcare organizations are trying to address through digital health and telemedicine. Consumers who have trouble accessing care often end up in a clinic or hospital later on with a serious health issue that could have been prevented, and which now will cost more to treat and affect long-term clinical outcomes. That, in turn, puts stress on Medicaid and Medicare programs that support those populations.
CES, through its Digital Health Summit, often focuses on using consumer technology to close gaps. This year’s summit track and exhibit halls featured a wide variety of strategies and technologies aimed at helping consumers monitor their health and connect with care providers at the time and place of their choosing.
Elevance Health is targeting the root of the problem: Communication. The company is offering qualified members on Medicaid programs a smartphone with unlimited data, talk, and texting services, as well as customized access to healthcare resources, both digital and virtual, and instructions on how to use the phone.
“Increased availability of digital technologies, such as a smartphone, as well as fast, reliable internet is critical to supporting a person’s health journey," Omid Toloui, Elevance Health’s vice president of innovation, said in the press release. “We believe the digital tools and the custom, curated experience offered through this program can help improve health, make healthcare more affordable, and serve people more equitably.”
The program is supported with funds from the Federal Communications Commission’s Affordable Connectivity Program (ACP) and offered through partnerships with Verizon, Samsung, AT&T, and T-Mobile.
Two leaders share their insights and strategies to help CNOs work together with staff and problem solve.
Nurses everywhere are going on strike.
Right now, it seems like every day there are new cases of nurses striking or unionizing at health systems all across the country.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
Underlying causes
According to Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, there are several reasons that nurses have been going on strike, starting with the staffing crisis and its impact on overall nurse wellbeing. Workplace violence, unmanageable workloads, exhaustion, and the feeling of not being heard are also contributing factors.
“There is a generalized dissatisfaction of the current state [of the industry] from nurses,” Boston-Leary says, “and I think that the phenomenon that’s happening right now is nurses are really saying ‘no more.’”
Due to staffing shortages and heavy workloads, nurses are not able to spend as much time with their patients as they want to, and according to Boston-Leary, they often leave work feeling like they did not provide the best possible care.
“We have unintentionally set up a system that pulls nurses away from what matters most to them,” Boston-Leary says, “which is spending time with their patients.”
COVID-19 exacerbated the issue. It forced nurses and other healthcare professionals to be introspective, and to reassess what their priorities were in terms of job structure and how work should balance with their personal lives.
“I think COVID is an accelerator and illuminator,” Boston-Leary says, “and it just adds fuel to everything that we [already] knew.”
Boston-Leary believes that nurses are using unions as a last resort to find their voices in health systems, and that they are voting to make sure that things are changed for the better, for themselves and for new nurses. If they do not see the issues being addressed, nurses might feel a need to turn toward the more compulsory, structured approach.
Boston-Leary also states that in all her experience leading and working in unionized hospitals, the unionized environment does not impact the dedication that nurses have to their profession.
“Nurses have a right to voice their concerns,” Boston-Leary says, “and [they] find a number of different ways to do that through shared governance, through leadership, and in some cases through unions.”
Are strikes avoidable?
Last year, Temple Health was close to a nursing strike, and the issue up for negotiation was staffing. According to Dr. Chaudron Carter, Executive Vice President and Chief Nurse Executive at Temple Health, they were able to avert the strike by sitting down with the nurses and adjusting staffing based on acuity and many other criteria.
“We essentially averted a strike by really just getting together and agreeing to some changes in our staffing guidelines,” Carter says.
Temple implemented a new set of staffing guidelines that do not include ratios, and they developed a process where the guidelines are looked at on a monthly basis, and any necessary adjustments are made. Leadership focuses on a different unit each month, and they provide the union with updates about new staff and other information. The meetings last for eight hours, four are dedicated to discussing topics on a shared agenda, and the other four are spent assessing the staffing guidelines and making changes if needed.
To Carter, it is crucial that the nursing staff show up for these discussions, and that they continue to deliver on quality of care, as part of the effort to foster shared governance.
“Leadership can make decisions,” Carter says, “however, if it is not the right decision to drive the change that we want, it won’t work.”
Communication and action
With the principles of shared governance in mind, the responsibility falls on CNOs and other nurse leaders to be able to strike a balance between the unions and health systems in a way that is beneficial for everyone.
According to Boston-Leary, the nurses will know that the CNO is listening when their questions and concerns are answered and addressed.
“I’ve learned the hard way that it’s not enough to have an open door,” Boston-Leary says. “You have to walk the walk and talk the talk and really show people that you’re listening.”
CNOs can find out what their nurses are going through by asking them directly. Boston-Leary recommends setting up a shadow board in the department so that nurses can give feedback in a structured way. It is also vital that leaders give feedback to nurses about actions being taken to make progress and to keep them updated on that progress.
“We have to get to a point of resolving a lot of these issues and managing these pain points, because it’s at the point of being unbearable for nurses,” Boston-Leary says, “which is why we’re seeing all the [union] activity that we’re seeing.”
Additionally, CNOs can maintain relationships with their nurses without always involving the unions. Boston-Leary states that nurses are a part of a CNO’s team regardless of union presence, and it’s important to still have conversations with them.
“You should have relationships with the people that are under your leadership because those relationships are important,” Boston-Leary says, “and the unions don’t necessarily have to come between [those] relationships.”
For Carter, communication is also key. She recommends stepping onto the hospital floor and spending time listening and talking to staff to better understand the pain points that might arise in union discussions. That way, CNOs can get ahead of the curve and develop strategies before negotiations that will help move the problem-solving process along.
“If you could develop a strategy before you get to go into negotiations around what those topics may be, and the organization develops a strategy on how to combat those issues,” Carter says, “I think you’ll position the organization better as it relates to going into negotiations and averting a strike.”
Trust is another important ingredient. Carter believes that open dialogue and transparency can help create a trusting relationship between the two parties, so that even when there are disagreements on approach, there are still shared goals.
“We don’t always see eye to eye,” Carter says, “[but] we’re here for the same reason, we’re here for safe patient care, [and] to make sure that the staff is taken care of as well.”
Have a contingency plan
For CNOs working in union environments, preparation is essential.
Carter highly recommends that any organization embarking on contract negotiations should have a contingency operations plan in place. The plan should detail how to continue operations at the hospital if the nurses go on strike.
Carter suggests that this could involve pulling from other departments within the health system, such as housekeeping or radiology, or hiring an agency to bring in a contingency workforce. CNOs should determine where and how to downsize and distribute staff so that they can still provide the same quality patient care.
“The plan is huge because nursing touches all aspects of an organization,” Carter says, “and so you have to think of the most minute things to the larger scale items.”
At the end of the day, unions are an inevitable part of dealing with the workforce.
In her time leading in a unionized environment, Boston-Leary took the approach of enlisting the support of the unions and keeping them informed in order to help tackle nursing issues. She found it important for nurses to see their leaders working together for their benefit, rather than an adversarial relationship where no progress is made.
“I learned that I cannot treat unions as if they were the bad guys, because that was a non-starter,” Boston-Leary says. “If they’re here, they’re here, and you have to work with them and partner with them.”
Mark Cuban and Glen Tullman are two of the many disruptors aiming to make healthcare more convenient for consumers. Their advice to healthcare execs: Do more by doing less
As CES 2024 winds down, the message to healthcare executives is simple: Do more by doing less.
The healthcare industry has become too complicated, frustrating patients and stressing out doctors and nurses. As a result, consumers are looking elsewhere for their healthcare, to retail companies, pharmacies, and online companies that promise convenience and transparency.
“You need to start questioning the long-held beliefs of the way you thought things needed to be done,” billionaire investor and businessman Mark Cuban said during a closing session of the two-day Digital Health Summit.
In other words, healthcare executives need to find a way to cut through the complexity and return to the simple process of health and care. And technologies like digital health and AI will help them make that transformation.
Cuban, who launched the Cost Plus Drug Company in 2022 to give consumers access to generic medications, shared the stage at CES with Glen Tullman, the former Allscripts executive who now heads the integrated healthcare benefits company Transcarent. The two are part of the growing ranks of disruptors aiming to make healthcare more consumer-friendly.
Their appearance capped two days of sessions on the value of consumer-facing digital health technology to address a healthcare ecosystem that many say is broken. Advocates say digital health tools like AI can take on some of the industry’s biggest pain points by automating tasks, improving workflows and boosting clinical outcomes.
The challenge is in getting health system executives and payers to take notice. Few made it to Las Vegas this week, giving attendees just a few examples of how health systems are using technology to improve operations and little evidence that payers will pay for it.
Tullman, who launched the successful digital healthcare startup Livongo prior to developing Transcarent, said the industry needs to focus on the consumer experience, embracing new technologies and ideas that make it easier for the consumer to access healthcare at the time and place of their choosing. Technology, he said, should be the foundation of that experience.
“But if people are talking about the technology, that’s a problem,” he added. “Look for technology to simplify things rather than [produce} complications,”
That’s one reason that AI is such a hot topic, at CES and elsewhere. Health systems and hospitals are embracing the technology as a means of reducing administrative and data-intensive tasks, giving clinicians more time to focus on healthcare delivery and giving consumers an easier path to that care.
“There are many practical uses,” said Tullman, whose company has developed an AI tool called 10X—designed, he said, “to make physicians 10 times more proficient.” He predicted AI would “simplify the paperwork” and “improve the quality of the experience.”
Cuban said AI will change the entire healthcare industry, and he predicted “millions” of models and applications. It will, he said, democratize healthcare.
Both said the key to the transformation of healthcare lies in putting healthcare in the hands of the consumer. If health systems and hospitals are slow to make that adjustment, they’ll lose patients to the disruptors who are making the experience more convenient and less costly.
Cuban told a story about his son needing an MRI. Through their health plan, that MRI would cost roughly $2,000. Cuban called the doctor’s office and asked for the cash price, and was told the MRI would cost $470. Some providers, he pointed out, would prefer cash in hand rather than going through the process of scheduling and billing.
“Healthcare is more confusing, more complex, and more costly than ever before,” Tullman added.
Allina Health's new chief nursing executive has a background that includes leadership positions at Jefferson Health, Baylor Scott & White, VCU, and UnityPoint Health.
D'Andre Carpenter, DNP, RN, knew he wanted to be a nurse at age 13. For a while, he was convinced not to go into nursing, and worked in computer science and software engineering instead. However, he never stopped thinking about his dream of being a nurse, and so he decided to pursue becoming a registered nurse full time while working and raising a family.
Carpenter has held leadership positions at Jefferson Health in Philadelphia, Baylor Scott & White Health in Dallas, and the Virginia Commonwealth University Health System in Richmond, Virginia. He also served as senior vice president and chief system nursing officer for UnityPoint Health in Iowa.
He was recently appointed senior vice president and chief nursing executive at Allina Health, where he will be developing strategies to improve retention rates and patient satisfaction.
For our latest edition of The Exec, we sat down with Carpenter to discuss his thoughts on recruiting and retention strategies, diversity, equity, and inclusion (DEI), technology in nursing, and how to prevent workplace violence. Tune in to hear his insights.
