Boosting healthcare workforce resiliency: Two solutions to create workforce supply and flexibility


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“We’re tired — emotionally, physically, mentally tired,” she said. “We’re all showing up, day after day. In the beginning, nurses were heroes. Today, we’re almost an afterthought.” This quote from a Massachusetts ER nurse summarizes two unsolved staffing problems from the COVID-19 pandemic for health systems: burnout and low morale.

More than half of nurses feel exhausted (51%), and 43% feel overwhelmed, according to a study from the American Nurses Foundation. Almost half (47%) say that work is negatively affecting their well-being, with a primary cause being insufficient staffing (45%). Nearly a third (28%) of respondents admitted that they wanted to quit their jobs; another study reports even more discouraging numbers (36%). A study from McKinsey showed that 60% of nurses looking to leave their jobs were more likely to leave since the pandemic began—largely because of insufficient staffing, workload, and burnout.

Although the current global pandemic has exacerbated these problems, these are chronic problems in health workforces. High rates of turnover, heavy staff workloads, and unsafe patient ratios have plagued health systems for years. These issues are taking their toll on more than just the nursing staff. They’re harming health systems’ bottom line and the quality of patient care.

Health systems are buckling under the burden of labor costs, which account for nearly 60% of health system operating costs. Hiring agency staff to supplement gaps in their workforce is a common solution to burnout and staffing shortages, but it’s not sustainable. Contract nurses command huge premiums in the market—at least double if not triple the pay of employee nurses—which is causing staff nurses to be increasingly disengaged. In some health systems, weekly pay for temporary staff is topping $8,000 to $10,000. And burnout among nurses costs health systems $9 billion annually.

Meanwhile, health systems are also struggling to maintain high-quality patient care. One study found that nurses’ emotional exhaustion, depersonalization, and low personal accomplishment were tied to a higher incidence of adverse events and lower-quality patient care. Other researchers raised concerns that burnout may contribute to “lowering of the quality of healthcare systems in terms of adherence to guidelines, poor communication, medical errors, and patient outcomes and safety.” When staffing is short, health systems also see more hospital-associated infections and higher patient mortality rates.

These staffing challenges aren’t going away anytime soon. 

Workforce: A framework for digital impact

To address these challenges, AVIA has developed a digital impact framework on workforce that targets two key levers: the supply of labor resources and demands placed on such labor. Both of these levers inform how digital solutions can drive impact. The broader framework also examines these levers across three dimensions: short-, mid-, and long-term workforce objectives that health systems must address. While we believe these workforce issues are enduring and demand a robust focus across these dimensions to build a sustainable workforce of the future, the current pandemic-induced staff shortages have necessarily shifted the focus to short-term labor supply-side solutions.

Addressing today’s critical workforce needs

To address these urgent concerns, health systems need to build staffing resiliency—the agility to quickly weather significant fluctuations in both labor supply and demand while maintaining high quality of care, managing employee burnout, and reducing premium labor costs. But many organizations remain mired in time-consuming, manual staffing processes. Studies show that 80% of nurse managers don’t know about technology solutions that can streamline staffing, including two app-driven tools: predictive staffing and marketplace staffing solutions. These tools can make an immediate, measurable impact on struggling health care systems, saving them time and money, alleviating burnout, and improving morale.

Optimize scheduling with predictive staffing solutions

Health systems are still reliant on paper-based, labor-intensive manual scheduling and staffing processes. A recent survey showed that 24% of managers use paper-based scheduling and staffing tools, 19% use digital spreadsheets, and 23% don’t use any tools at all. Managers might create a staff schedule a month in advance, but they’re building it based on their general knowledge of past patterns, not concrete data. 

As a result, clinical managers face a load balance conundrum: either there is too much work to do and not enough workers to do it, a burnout contributor, or there are too many workers for the work available, a driver of disengagement. Further, managers must ensure the right skillset to match patient demand needs, as shortages in the right skill level can impact patient care delivery, quality, and safety. Staffing slots with over skilled labor may lead to issues with staff working at top of license, which can weaken job satisfaction.

Predictive staffing tools avoid these problems. The solutions help health systems hire strategically and schedule wisely, with much greater predictability than manual, non-data-driven methods. These solutions ingest historical data from EHR and IT systems, analyze it using an AI-driven algorithm, and determine what staffing health systems will need for 30 days or more—and with 97% accuracy. One tool helped a health system fill 75% of open shift hours two weeks in advance, reducing open shift and bonus shift incentives by 50 to 75%. When one health system adopted a predictive staffing tool, staff went from spending 79.1 hours on creating schedules and post-scheduling tasks to just 18 hours, saving 61.1 hours of valuable time that could then be spent on patient care. These tools can also lower staffing costs by 7% or more while reducing overtime pay; one health system with a predictive staffing solution calculated its savings in labor costs were $4.3 million.

Predictive staffing also attacks the problems that contribute to burnout, including overburdened staff. One health system reported a 65% reduction in last-minute work requests and a 63% drop in core staff floating. As a result, the organization reported a 63-point increase in RN staffing satisfaction.

Expand the talent pool with marketplace staffing solutions

Sourcing health system staff is a time-consuming, costly process that will only become costlier, as the nursing shortage is predicted to grow. According to the U.S. Bureau of Labor Statistics, more than 500,000 registered nurses will retire by 2022, creating a need for 1.1 million new registered nurses.

And health systems are already short on staff, struggling to find enough people to fill shifts. As a result, existing staff are asked to work additional shifts, contributing to their burnout, and raising labor costs with overtime. Plus, when there aren’t enough staff to go around and a patient surge occurs, patients are held in the emergency department or are left to wait on gurneys in hallways , and ambulances may be diverted to other health systems. Additionally, patient care suffers, and infection rates increase with low staffing rates, while proper staffing ratios can reduce infections, lessen the risk of patient falls, and shorten patient stays as well as increase Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores.

To address shortages in the past, health systems have looked to float pools for short-term needs and agency hires for long-term vacancies. But now, new digital solutions are available to help health systems tap into the gig economy to attract staff on an as-needed basis.

Marketplace staffing solutions access a pool of talent, ranging from clinicians to front desk and registration staff, often as independent contractors. These workers may be highly qualified but unable to take on a full-time job with a health system because they have caregiving responsibilities at home. Or they may be employed part-time or full-time elsewhere but simply want to take on extra shifts to earn more money.

Here is how a typical locally-sourced marketplace staffing solution works:

  • The administrator inputs the details of an open shift into the solution.
  • The administrator can direct the system to first send the opportunity to existing staff; they can also tailor it so it sends the opportunity to staff who wouldn’t end up with overtime if they add a shift before sharing it more widely.
  • If no internal staff members take the shift, then the system opens the opportunity to the marketplace for independent contractors to consider.

In addition to offering ad hoc resources, marketplace staffing solutions also give leaders real-time visibility into staffing shortfalls, reduce the administrative burden of scheduling, and allow leaders to make smarter assignments designed to boost satisfaction and retention. Additionally, they eliminate reliance on traditional float pools and reduce the premium costs associated with long-term agency hires. One health care system projected $30 million in annual staffing cost savings after implementing a marketplace staffing platform.

Meanwhile, internal staff also prefer marketplace staffing solutions. Existing employees have the first opportunity to take a shift, so no external workers are taking a spot that someone else wanted. The solution also ensures that staff aren’t overscheduled, eliminating the need for double shifts and overtime and reducing the risk of burnout.

It’s time to update the health system staffing model

The pandemic has raised the stakes for dealing with the staffing problems that have plagued health care systems. Without immediate interventions, staffing shortages will hit a critical point as more nurses flee the workforce, the quality of patient care will continue to plummet, and budgets will rise sharply.

Health systems can target the short-term staffing crisis while positioning themselves for greater workforce success and resiliency in the future by elevating the discussion of technology and automation to a strategic level.  Building resiliency now through predictive staffing and marketplace staffing is a good place to start given the reduced supply of labor, but health systems will need to think differently about the demand side: how to deploy technology to optimize the engagement, capacity, and efficiency of their existing and future staff, as well as how automation can drive a redesign of the care model necessary for operating effectively in the new normal.

The team at AVIA’s Center for Operational Transformation is ready to work with you on this transformational journey to address workforce challenges through digital and automation. Contact us today to learn more about how AVIA can help your health system.