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Progress Report

Jason Pacheco doesn’t like using that phrase ‘new normal’ any more than anyone else these days.

It’s more than a little tired, and in most settings, it’s been retired.

But when it comes to the workforce issues facing healthcare providers these days, it ultimately works. Four full years after the height of the pandemic and maybe a decade after some not-so-subtle shifts in the workforce landscape, especially the retirement of Baby Boomers, there is what appears to a new normal, and one that will continue for the foreseeable future.

It’s no longer a crisis, in the true sense of that word, although there are certainly many challenges, said Pacheco, director of Workforce Planning, Analytics, and Compensation for Baystate Health.

He noted that Baystate and other providers are no longer using large numbers of very expensive travel nurses, and there is no longer a sense of desperation over if and how vacancies will be filled. But in this new normal, there are still many open positions at any given time — more than before the pendulum started to swing.

“Baystate has implemented several key training programs … for example, we’ll go out and recruit a cohort of medical assistants. Instead of people having to go to school to become a medical assistant, we’ll hire them, and we’ll pay them to train to become a medical assistant.”

There is also a greater need to be competitive with compensation, benefits, and other perks; added emphasis on retention and the many elements of that equation; many more pay-to-train programs, education-assistance efforts, and other inititiatives to get individuals into healthcare and then provide them with the skills to succeed at one job and then advance to others; greater collaboration with area colleges to train existing employees and help them advance; and an ever-growing need to listen to employees and create an environment they want to be part of.

Dr. Robert Roose says a focus on culture has helped to “reset” the workforce crisis.

Dr. Robert Roose says a focus on culture has helped to “reset” the workforce crisis.

“Baystate has implemented several key training programs … for example, we’ll go out and recruit a cohort of medical assistants. Instead of people having to go to school to become a medical assistant, we’ll hire them, and we’ll pay them to train to become a medical assistant,” said Pacheco, adding that the system is partnering with Holyoke Community College to deliver a medical assistant training course, just one of myriad examples of how providers and systems are being proactive, and getting creative, when it comes to recruiting talent and retaining it.

Dr. Robert Roose, chief administrative officer for the Springfield market of Trinity Health Of New England, overseeing Mercy Medical Center, Johnson Memorial Hospital, and the affiliates of both, said both elements of the equation are equally important.

And as he acknowledged that the workforce crisis in healthcare has eased — or “reset,” he said — there are many reasons for this, including, at Mercy and elsewhere, a healthy emphasis on culture.

“Our colleagues have found that culture is what has ultimately compelled people to come to a system and stay within a system and continue to engage in the wellness professions,” he told BusinessWest. “We’re looking at how we better redesign work to attend to the ways that healthcare delivery has changed and will continue to be changing, and looking at ways to reinforce what matters to people to retain them in our hospitals and healthcare systems, while recruiting more individuals.”

Emily Davis, senior director of Human Resources at Cooley Dickinson Hospital, concurred.

“From a retention standpoint, it comes down to … how do we provide an environment where employees feel not only appreciated, but where, in every position, they can understand and feel the impact they’re having on patient care?

Emily Davis says it’s important for employees to feel they are appreciated — and to feel the impact they have on patient care.

Emily Davis says it’s important for employees to feel they are appreciated — and to feel the impact they have on patient care.

“Also, how does the environment they work in every day contribute positively to not just their livelihood, but their lives?” she went on, adding that providers’ ability to answer those questions in a positive fashion will go a long way toward determining their ability to retain the employees they have worked so hard to attract and invested so much in terms of onboarding and continued training and professional development.

For this issue and its forcus on the healthcare workforce, we’ll get back to those questions, how systems and individual providers are answering them, and how they are looking to make additional progress in living with this new normal.

 

Hire Power

As he talked about the workforce issues still confronting healthcare providers — but also about the progress made on some levels — Pacheco used numbers to help get his points across.

He said the system has been averaging 1,600 to 1,650 job vacancies at any given time, a number that is more than double what the system was averaging (maybe 700 to 800 vacancies) before the pandemic, but a significant improvement over the more than 2,000 vacancies at the height of COVID.

Meanwhile, more than 600 individuals are currently in the onboarding process at Baystate, including more than 200 nurses, many of them recent graduates of area colleges, he said, adding that these numbers are one indication of the system’s ability to bring more individuals into postitions, an improvement over a few years ago.

“We’re looking at how we better redesign work to attend to the ways that healthcare delivery has changed and will continue to be changing, and looking at ways to reinforce what matters to people to retain them in our hospitals and healthcare systems, while recruiting more individuals.”

“We are making significant progress in terms of bringing people in,” he said. “For example, we’ve implemented a number of new training programs — we’re training medical assistants, patient care technicians, and our newest one is a sterile process technician; we’re teaching folks how to clean and work with surgical instrumentation. However, all of that requires a significant investment in orienting people.”

Meanwhile, when it comes to retention, while there has been some progress in bringing those vacancy numbers down, “we have not yet returned to a normal place, like what we experiencing pre-pandemic, for turnover levels,” said Pacheco, adding that the system is averaging roughly 19% turnover, with much of it coming in the first year of employment.

Michele Anstett

Michele Anstett says competition for workers in the home-care arena is fierce, and there is little loyalty to employers.

“So, are we making headway in terms of bringing people into healthcare? Absolutely,” he went on. “Do we still have a long way to go? You bet.”

Roose agreed, adding that, at both Mercy and Johnson Memorial, there has been recorded progress in both hiring and retention, with a roughly 40% reduction in turnover the past two years — 50% at Johnson Memorial and 35% at Mercy.

“Reducing those that are leaving the organization to levels that are under 20% has been very stabilizing,” he said. “And while reducing turnover, we’ve also, over the past several months, seen that the number of people coming into Mercy and Johnson Memorial has outpaced the number of those leaving, so the balance has shifted.”

This is true across many professions, especially nursing, where there has been reduced turnover and improved recruitment, he said, adding that other realms, such as transport, food and nutrition, and others, have recorded less progress.

Indeed, while things have stabilized somewhat, building and maintaining a workforce remains quite challenging for most healthcare providers.

Michele Anstett, president of the West Springfield-based home-care provider Visiting Angels, said conditions have improved somewhat since the height of COVID, when people were afraid to enter others’ homes. But competition for workers is intense, and the biggest problem is retention.

Indeed, there is comparatively little loyalty to employers, she said, adding that workers will often chase an additional dollar an hour in wages or some other benefit. She stays ahead of the game, if can be called that, first by “hiring, hiring, hiring,” as she put it, and then taking steps to try to hang on to some of those she brings in.

“People tend to fly more; because of the economy, because of society and everything being on the move, and people being really strapped, they go where they can best provide for their family,” she said. “So I’m going to hire faster than they go; I’m hiring about five a week. How many go a week? Maybe two. That’s how we’re adjusting to this new reality.”

“For a mom in the workforce, the most important thing is her family and making sure she can get them to doctors’ appointments, she can get to school functions, she can make sure that if they’re sick, they’re taken care of without repurcussions from the employer. And those are things that we find are intangible and so important to our workforce, so we do our best to make sure that their family needs are met.”

When it comes to retention, Anstett says she has what she calls a magic formula — a focus on the work-culture factor.

“It’s about how they’re treated, how we respect them, how all those different qualities that they find in an employer make them want to say,” she said, adding that working in such an environment often weighs more heavily with employees than an additional dollar an hour.

“About 95% of our employees are women, and I would say 80% of those women are moms with dependent children,” she went on. “For a mom in the workforce, the most important thing is her family and making sure she can get them to doctors’ appointments, she can get to school functions, she can make sure that if they’re sick, they’re taken care of without repurcussions from the employer. And those are things that we find are intangible and so important to our workforce, so we do our best to make sure that their family needs are met.”

 

Staying Power

Addressing the broad subject of retention, those we spoke with said there is strong need for being creative and showing employees at all levels that they are valued and part of something larger than their own job.

And it all starts with listening, Davis said. “A lot of it is really paying attention to our workforce — what they’re telling us, but also what we’re learning from paying attention to them, not only in their words, but what we see them struggle with and what we see them strive in doing.”

Another key to retention is effective recruitment, she said, attracting people who understand — and value — the environment they’ll be working in and the team they will be joining, and want to be part of all that.

“The key to successful recruiting is agility,” Davis said. “It’s changing our strategies as we see what’s happening outside our walls, what’s happening in our area from the standpoint of where we have people that we can attract, and how we attract them.

“What we’ve been doing recently is getting back into what I call the ‘milk and cookies’ of in-person recruitment,” she went on. “We’ll have a team of talent-acquisition partners, along with leaders, and have a day when people can come in for a given position. They can fill out the application, they can interview with the talent-acquisition partner, interview with the manager, and have a decision about their hiring right on the spot. And then they can meet with the onboarding coordinator. So before they even leave the building, they have an answer, and they’ve started on their journey.”

Elaborating, she said this strategy was recently deployed for the successful hiring of several environmental-services personnel, but it can be used — and has been — for other positions as well, including nurses.

Another key element in the equation is compensation, said all those we spoke with, adding that systems and individual providers must continue making the investments needed to remain competitive — to the extent they can, given the hard reality that reimbursement rates for care provided by those facilities continue to lag far behind the cost of providing that care.

Davis agreed, but said providers who want to retain talent have to go beyond compensation. And this brings her back to that notion of making employees at all levels feel valued.

“Compensation matters,” she said. “But what matters when you get your foot in the door is … how do I feel about the place that I work at? Am I valued? Am I making a difference? Am I treated well? Do I feel like I belong?”

There are many factors that go into how employees will answer those questions, she went on, listing everything from wages and benefits to flexibility in schedules to the willingness of leadership to listen to employees and repond to what they are hearing.

At Cooley Dickinson, there are surveys, said Davis, but the more important strategy is the rounding conducted by members of the leadership team and the visbility of those leaders.

“The staff needs to understand that there is someone there that they can check in with, someone that will get back to me, whether it’s an answer I want or an answer that I wish was different,” she said, adding that rounding, an ever-evolving practice that takes place on many different levels, is key to all-important visbility as well as the listening process.

Roose agreed, noting that Mercy and Johnson Memorial have placed additional emphasis on listening and responding to what is heard through initiatives such as a ‘new-colleague culture experience,’ to start later this month.

“We’ll provide every new colleague that enters our organization with an opportunity to really focus on what about the culture they do identify with and how we can best attend to that during the early period of their orientation and work with us,” he explained. “We find that most people who are going to leave the organization leave within the first year, and a lot of that has to do with expectations around work and whether they’re able to connect with what brought them there.”

 

Bottom Line

But there are other strategies as well, including educational assistance that will help existing employees seize other career opportunities.

At Baystate, the system has essentially doubled the amount allowable per year for tuition assistance, said Pacheco, adding that the new ceilings went into effect in January, and the investment (probably an additional $300,000 to $400,000) is already showing signs of paying off.

“We have people studying to become nurses, we have folks working on various lab occupations … it varies,” he said. “As long as there is a connection to the healthcare system, we’ll support them with educational assistance.”

Returning to the subject of pay-to-train initiatives, Pacheco said that, in addition to the program for medical assistants, there are others for patient-care technicians (another partnership with Holyoke Community College) and other positions, as well as apprenticeship programs, including one that trains individuals to read heart monitors.

All these initiatives are part of a broad response to a new reality — yes, a new normal — one that should prevail, and test healthcare providers across the board, for the foreseeable future.

Opinion

Editorial

 

Second Chance Animal Services calls it a “trifecta of challenges that demand immediate attention.”

First, a rising tide of inflation has led to food insecurity for both people and their furry companions, as the cost of pet-care essentials skyrockets. Housing costs, too, are soaring, forcing families to make wrenching decisions about their living situations, often resulting in the surrender of beloved pets.

Second, a veterinary-care crisis persists, with burnout among professionals causing a shortage of crucial services.

Finally, shelters are reaching capacity across the country — and not just in the South, where overpopulation has long been a problem — forcing many to euthanize perfectly adoptable pets when they are out of space.

North Brookfield-based Second Chance, which runs four community veterinary hospitals, never euthanizes for space and is taking in as many transports as it can, but its space is limited as it grapples with an increase in surrenders from local pet owners.

“We are being stretched to our limits, and I am deeply concerned,” Second Chance CEO Sheryl Blancato said recently.

But there’s hope, too, she added, citing her own organization’s efforts to keep pets with their families, from subsidized rates at its hospitals and a pet food pantry to community vaccine clinics and veterinary care at senior-living residences.

But it needs help: more volunteers, more donations, more awareness of the problem.

Meg Talbert feels the same way, as she told BusinessWest in the story that begins on page 4. The executive director of Dakin Humane Society says volunteers and foster families are critical to the nonprofit’s work, but so is financial support.

“A corporate donation or a foundation or individual giving, they really let us do the work. They are that bridge that allows us to go that extra mile for the animals, and to help people out when they’re coming to us,” she said, whether they’re at the point of surrendering an animal or having trouble affording veterinary care.

The goal, in almost every case, for organizations like Dakin and Second Chance is to keep families and their pets together. Not only is it heartbreaking to have to surrender an animal, but every pet back in the shelter system is one more animal adding to an overcrowding problem that is not letting up.

That’s why, Talbert said, every adoption of a dog, cat, or other critter actually saves two lives: the adopted animal’s life, and the animal that adoption makes room for at the shelter. Just as every surrender compounds the problem, every rescue adoption improves it.

We encourage families who want to add a pet to their home to consider adopting first, not only to reduce the overcrowding issue, but to literally save a life worthy of saving — a pet with plenty of love and appreciation to spare.

Speaking of appreciation, Dakin, Second Chance, and other animal-welfare organizations are always grateful for not only financial gifts, but volunteers. As the season of giving commences, that’s something that should give us all paws — er, pause.

Opinion

Editorial

 

Gov. Maura Healey presented her first budget a few weeks back, and it contains some proposals that could help the state navigate its way out of an ongoing workforce crisis.

Chief among them is something called MassReconnect, which would fund free community-college certificates and degrees to Commonwealth residents who are 25 years and older and have not yet earned a college degree.

Based on initiatives in Michigan and Tennessee, MassReconnect actually goes further than those programs by covering more than just tuition; it also covers mandatory fees, books, and various support services. It is designed to remove barriers to getting the college degree that is needed to succeed in most jobs today, and it holds significant promise to do just that.

So do some of Healey’s other proposed investments in higher education, including a 3% increase in public college and university base spending, as well as $59 million to stabilize tuition and fees at the University of Massachusetts and other public institutions.

But it is free community college that is getting the most attention, and rightfully so. In fact, Senate President Karen Spilka has been working on legislation to achieve just that, saying that reducing the cost of getting a degree will help close equity gaps and build a more educated workforce to meet the needs of important industries in Massachusetts..

Indeed, while the bottom-line cost of a community-college education is much lower than at four-year schools, it is still a burden to many and a roadblock when it comes to attaining not just a job, but a career. In that sense, this proposal could open doors to individuals who have seen them closed for one reason or another, while holding considerable potential to bolster the state’s 15 community colleges and the state’s economy as a whole.

Indeed, the Commonwealth’s community colleges, long considered a key component in any region’s economic-development strategy, and especially here in Western Mass., have been struggling of late, and for many reasons.

Smaller high-school graduating classes are just one of them. A strong job market has traditionally had the effect of impacting enrollment at community colleges — they thrived during the Great Recession, for example — and that pattern has held for roughly the past decade or so. Meanwhile, the pandemic certainly hasn’t helped.

This region needs its four community colleges — Berkshire Community College, Greenfield Community College, Holyoke Community College, and Springfield Technical Community College — and it needs them to be strong and vibrant if it is to create, and maintain, a strong pipeline of workers coming into fields ranging from healthcare to cannabis to hospitality.

Meanwhile, community college serves as a place to start one’s secondary education. Many graduates of these schools move on to four-year colleges and degrees that lead to a wider range of job, and career, possibilities. But first, students need to begin.

That’s why this proposal holds such potential. It is designed for non-traditional students, those who haven’t started in college, or who have started but haven’t completed, for one reason or another. These are the individuals who hold the most promise for bringing some real relief to the region’s ongoing workforce crisis, one that is impacting businesses in every sector of the economy.

The concept of free community college has its skeptics, and some will wonder where the money will come from and whether the state can afford to do this.

Looking at matters from an economic-development lens, however, one could argue that the state can’t afford not to do it.

 

Coronavirus Cover Story

On the Home Front

On one hand, it’s good to be working — many people during the COVID-19 crisis have lost their jobs. However, those who continue to clock in every day, only from home, often face challenges they never had to contend with before, from balancing work with their kids’ education to the anxiety and loneliness that can accompany a lack of face-to-face contact. But that’s today’s new normal, and no one can predict for sure when people might start heading back to the office.

As the office manager at Architecture EL in East Longmeadow, Allison Lapierre-Houle has plenty to do, but enough time to do it. Usually.

“I handle all the administrative tasks — anything HR-related, financial-related, pretty much everything outside what the architects do,” she said, adding that she’s never had to work outside her set hours — until recently.

“Now, I’ve been working on weekends a little bit, at night a little bit, because I have to take constant breaks in between for homeschooling, and all of the distractions that come with running a house and doing my job at the same time.”

Like so many others right now, Lapierre-Houle is still doing that job, only she’s doing it from home — as a single mother of a first-grader and a third-grader, ages 6 and 9.

While the school provides a remote learning plan that students are expected to follow, and daily assignments to complete every day using Chromebooks and Google software — as well as Zoom meetings with classmates — children that young aren’t exactly self-directed, she noted.

“If they were in high school, it would be completely different. In first grade, she literally just learned to read, and now she’s expected to go on the Chromebook and complete assignments. So I do lot of side-by-side work with the kids, while also trying to manage the eight employees for the company, who are all working remotely as well. That’s been the biggest challenge.”

Allison Lapierre-Houle to balance working at home

It’s challenging for Allison Lapierre-Houle to balance working at home with two young kids — but at least they can help take a photo for BusinessWest.

David Griffin Jr., vice president of the Dowd Insurance Agencies in Holyoke, is able to split the child-tending duties with his wife, who works for Travelers in Hartford. They’re both home these days, juggling their jobs and home responsibilities as parents of two young ones, ages 2 and 3.

“We’re making the most of it,” Griffin said. “She has a more set schedule than me. Obviously, I have clients calling me, and I can’t plan when the client calls me with questions I have to go through. I get as much done as I can in the morning and late at night, and answer calls and help customers throughout the day. Right now is their greatest time of need, so I have to make myself available and be there for them to lend an ear and give some advice.”

Jim Martin knows that feeling — of working from home at a time when customers have more pressing needs than perhaps ever before. As a partner at Robinson Donovan specializing in corporate law and commercial real estate, he’s been working with clients on their submissions for the Paycheck Protection Program, deciphering the regulations and grappling with an ongoing series of often-confounding changes to them. “My clients need straightforward legal advice on what needs to be included,” he told BusinessWest.

“I do lot of side-by-side work with the kids, while also trying to manage the eight employees for the company, who are all working remotely as well. That’s been the biggest challenge.”

He’s providing that advice — and much more — largely from home, as the firm’s Springfield office is maintaining the core minimum of personnel needed to connect everyone else during a trying time.

“We were well-prepared for this; we had anticipated this may be necessary, so we had a network in place that allowed people to remotely access their desktops from home,” he explained. We got everyone equipped, so when someone comes in with mail, it’s scanned and distributed to every lawyer and the support staff. And we have remote dictation, so I can dictate right to my adminstrative assistant from home. We feel we were pretty well-prepared to make the transition to working remotely.”

While Martin doesn’t have children at home, he empathizes with those who do, as day cares are closed and people generally can’t come by to babysit.

He does, however, sometimes have to vie for the landline with his wife, a clinical doctor of psychology who continues to see patients, who are dealing with all sorts of issues, from depression to anxiety to domestic violence, all of which can be exacerbated by the current health and economic crises.

“People who need therapy, they need it more now,” he said. “She fortunately has access to certified confidential means of communication, video communication and things, but sometimes it’s over the phone if folks don’t have technology. So, I’m in one room, she’s in another, and sometimes it’s stressful in the house.”

Workers from most sectors are dealing with the same situation — doing their part to keep their companies afloat while often keeping a household together. But they’re recognizing something else as well — a general patience and understanding among those they deal with, and a recognition that we’re all in this together, even as people grow more anxious to get back to their old routines.

Alone Time

Before COVID-19, Seth Kaye, a Chicopee-based photographer, would get up each morning and go to his office to work and have meetings with clients.

“For me, that’s the biggest difference right now, just not being around people at all,” he said. “I would routinely have coffee breaks or lunch with friends and colleagues; that’s how meetings would be done, face to face. Right now, everything’s over Zoom, which has been fantastic, but nothing face to face.”

Seth Kaye

Seth Kaye is among many professionals who miss face-to-face interaction with clients.

He brought his entire workstation home, so he’s able to stay in contact with clients and even book new work.

“In terms of contracts, there’s nothing for me to photograph right now, as the commercial events have all been canceled for the foreseeable future. Weddings are the lion’s share of what I do, and people are postponing those to later this year or 2021. But business is still going on. People are still getting engaged. I’m still booking new couples to 2021. The world hasn’t stopped, and people are still planning for the future. That gives me an enormous amount of optimism.”

And also a chance to pivot to other business needs, Kaye added. “I’m trying to take the to work on my marketing and work on personal projects and try new things.”

Griffin said the team at Dowd is pivoting in other ways. “We have five offices and 47 employees, and we’ve been able to get everyone up and running from home; we’re still at full capacity. Of course, the insurance industry is considered an essential business.

“Everyone wants to make this work, but it’s been tricky to say the least,” he added, noting that technology has been a huge help. Because the company uses an internet-based telephone system, everyone was able to take their phones home and plug them into their computers.

“Our receptionist is working from home, and she answers live and transfers the calls,” he said. “And most of the staff have two computer screens in the office, and they brought one of the screens home. So it’s funny — if you go into the office and see all the desks with nothing on them, it looks like we’ve been robbed, but that’s not the case.”

Lawyers are as busy as insurance agents these days, and Martin is a good example, whether it’s helping small businesses with federal stimulus programs or assisting companies scrambling to prepare for all contingencies during the pandemic.

“I spent some time over the last two weeks dealing with transfer ownership issues between shareholders and and/or partners, so if people own a company, either shares or in a partnership, they are now feeling it’s important to establish and confirm in writing how the shares will be transferred … and what the conditions are,” he explained.

Meanwhile, employment laywers are dealing with unemployment and leave issues, while real-estate attorneys grapple with pending projects held up by wholesale postponements of meetings with planning and zoning officials, and estate planners see an uptick in business from families getting their affairs in order (see story on page 24).

The list goes on — and most of the work is being done remotely.

“It is a challenge, if you haven’t worked from home before,” Martin said. “I know some people work from home regularly, but for those of us who haven’t, it’s a big adjustment period. At least it is for me.”

It certainly has been for Lapierre-Houle, and also her kids.

“I definitely find myself, especially in the evening, saying to them, ‘it’s a school night,’” she said. “For them, it doesn’t feel like a school night. They think they can get up whenever they want and stay up as late as they want, but I’m trying to keep us on schedule — they get up like for school, and I sign on to work at 8.”

Convincing students to treat these days like regular school days is undoubtedly something parents of older kids grapple with as well. And kids of all ages are likely tiring of the social isolation.

“They can’t see their friends except behind a computer screen … that’s a significant emotional challenge because they don’t understand the social aspect. But they still have to learn and do their schoolwork,” Lapierre-Houle noted, adding that the warmer weather gives a reprieve in that they can go outside — but also provides an additional distraction because they want to be outside, rather than inside doing schoolwork.

She does appreciate her boss, company president Kevin Rothschild-Shea, who, she says, has always emphasized work-life balance, which has made this transition a little easier for employees. “He’s always been very flexible with families or children, but there’s still pressure to get work done, not to mention all the distractions at home.”

New Routine

Clients have been equally understanding of the current situation, Griffin said. “They’re not giving us a hard time — ‘I need this in two hours.’ Again, turnaround times are out the window, and people have been very accommodating and very understanding of that.”

On a personal level, he does miss meeting clients in person. “There’s nothing like going out and seeing clients face to face and talking with them, trying to see what their energy level is, how business is going … I do miss that. I’ll be excited to get that aspect of things back because it is missed. Now we have to make do with what we have, and everyone is in the same boat together — it’s not like we’re at a competitive disadvantage because of it.”

“It’s funny — if you go into the office and see all the desks with nothing on them, it looks like we’ve been robbed, but that’s not the case.”

Kaye told BusinessWest that’s been a challenge for him as well.

“I would see people regularly, just in passing or at the coffee shop — the day-to-day stuff we take for granted, now that we’re not able to have that routine. The routine now is different,” he said. “Hopefully, it’s a temporary new normal, but that human contact is gone right now.

“I’m taking the quarantine thing seriously, aside from pharmacy drives and having people put food into the trunk of my car when I order it from local farms,” he added. “I haven’t had any face-to-face contact in about three weeks. Some of my friends are doing the same. Some of our parents are not, which is interesting. But the social aspect being gone is definitely challenging.”

As the virus has still not peaked, the next couple weeks will bring more of the same, and though people he talks to are starting to go a bit stir crazy, they’re adapting as best they can, Kaye said.

“The people I’ve been speaking with, whether it’s clients not sure what their plans are going to be for 2020 or talking about postponements, they’ve been really nice about it. They have their needs as business owners, and I have my needs and concerns, and so far everyone has been really great.”

That first coffee-shop meeting will still be pretty satisfying, though — whenever that might be.

Joseph Bednar can be reached at [email protected]

Health Care

Under Pressure

A changing healthcare landscape has doctors feeling stressed, unsatisfied, and burned out like never before — and that could have dire effects on patient care. That’s why the industry is focused on diagnosing the problem and prescribing remedies.

Every day, patients rely on doctors to tackle their chronic health and wellness issues and make them feel better.

But what if it’s the doctors feeling miserable? Or stressed-out, anxious, and overwhelmed? Unfortunately, that’s happening constantly.

Burnout among physicians has become so pervasive that a new paper recently published by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Mass. Medical Society, and the Mass. Health and Hospital Assoc. deems the situation no less than a public health crisis.

“A Crisis in Health Care: A Call to Action on Physician Burnout,” as the document is titled, includes a number of strategies aimed at curbing the prevalence of burnout among physicians and other care providers, including improvements to the efficiency of electronic health records (EHRs), proactive mental-health treatment and support for caregivers experiencing burnout, and the appointment of an executive-level chief wellness officer at every major healthcare organization (much more on all of these later).

But the report also details just how extensive the problem is, and why it should be a concern for patients. In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians said they experience some symptoms of professional burnout — loosely described in the survey as feelings of emotional exhaustion, depersonalization, and/or diminished sense of personal accomplishment.

Physicians experiencing burnout are more likely than their peers to reduce their work hours or exit their profession. And that’s concerning in itself; the U.S. Department of Health and Human Services predicts a coming nationwide shortage of nearly 90,000 physicians, many driven out of practice due to burnout.

“The issue of burnout is something we take incredibly seriously because physician well-being is linked to providing quality care and favorable outcomes for our patients,” said Dr. Alain Chaoui, a practicing family physician and president of the Massachusetts Medical Society. “We need our healthcare institutions to recognize burnout at the highest level, and to take active steps to survey physicians for burnout and then identify and implement solutions. We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.”

Dr. Alain Chaoui

Dr. Alain Chaoui

 “We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.”

While some have pointed to the passage of the Affordable Care Act (ACA) in 2010 — the most significant recent change in the American healthcare landscape — as a stressor, the roots of the crisis date further back, the report notes. For example, EHRs, mandated as part of the 2009 Reinvestment and Recovery Act, have dramatically changed the way doctors allot time to their jobs. And the 1999 publication of the Institute of Medicine’s “To Err is Human” report, highlighting the prevalence of medical errors, directed new attention to the need for quality improvement, physician reporting, and accountability — and brought heightened pressure.

In the past, the report notes, some have proposed ‘self-care strategies’ — such as mindfulness or yoga — as a response to burnout and presented some evidence of limited success with such approaches. However, physicians typically don’t have time to fit such coping strategies into their routine. They also don’t really address root problems.

“Such an approach inaccurately suggests that the experience and consequences of burnout are the responsibility of individual physicians,” it continues. “This is akin to asking drivers to avoid car accidents without investing in repairing and improving hazardous roads. Simply asking physicians to work harder to manage their own burnout will not work.”

Digital Dilemma

As the report noted, a broad consensus has formed that a major contributor to physician burnout is dissatisfaction and frustration with EHRs, which have become ubiquitous in recent years. While the goal of transitioning to electronic records has been to improve quality of care and patient communication, the results have been mixed at best.

“The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” said Dr. Ashish Jha, a VA physician and Harvard faculty member. “There is simply no way to achieve the goal of improving healthcare while those on the front lines — our physicians — are experiencing an epidemic of burnout due to the conflicting demands of their work. We need to identify and share innovative best practices to support doctors in fulfilling their mission to care for patients.”

As Dr. Atul Gawande, a Massachusetts surgeon, writer, researcher, and CEO of the nonprofit healthcare venture formed by Amazon, Berkshire Hathaway, and JP Morgan Chase, recently described it, “a system that promised to increase physicians’ mastery over their work has, instead, increased their work’s mastery over them.”

That’s because the patient encounter is now dominated by the demands of the EHR, undermining the crucial face-to-face interaction that has long been at the core of a satisfying doctor-patient encounter, the report notes, adding that, “for many physicians, EHRs impose a frustrating and non-intuitive workflow that makes excessive cognitive demands and detracts from, rather than reinforces, the goals of good patient care.”

Dr. Ashish Jha

Dr. Ashish Jha

 “The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients.”

In addition, the quantity of mandatory documentation imposed by EHRs — due to regulatory and payer requirements — means physicians typically spend two hours doing computer work for every hour spent face to face with a patient, including numerous hours after work. And they’re frustrated by spending so much time on administrative tasks they feel have little to do with actual patient care.

One promising solution, according to the report, would be to encourage software developers to develop a range of apps that can operate with most, if not all, certified EHR systems.

Improved EHR usability is, in fact, required by law. The 21st Century Cures Act of 2016 mandates the use of open health care APIs (application programming interfaces), which standardize programming interactions, allowing third parties to develop apps that can work with any EHR. This would allow physicians, clinics, and hospitals to customize their workflow and interfaces according to their needs and preferences, promoting rapid innovation and improvements in design.

Another promising but less-developed approach to reducing the HER burden on physicians, the report notes, is the development of artificial intelligence (AI) technologies to support clinical documentation and quality measurements.

Mind Matters

The report spends plenty of time on mental health, and for good reason.

“It is clear that one can’t have a high-performing healthcare system if physicians working within it are not well,” it notes. “Therefore, the true impact of burnout is the impact it will have on the health and well-being of the American public.”

To that end, it calls on hospitals and other healthcare organizations to improve access to, and expand, health services for physicians, including mental-health services — while reaching out to doctors and encouraging them to take advantage of such services in order to prevent and manage the symptoms of burnout.

That’s easier said than done, of course, as a stigma still exists around seeking help for mental-health issues.

“Physician institutions — including physician associations, hospitals, and licensing bodies — should take deliberate steps to facilitate appropriate treatment and support without stigma or unnecessary constraints on physicians’ ability to practice,” the report argues.

Last year, the Federation of State Medical Boards (FSMB) adopted a policy reconsidering ‘probing questions’ about a physician’s mental health, addiction, or substance use on applications for medical licensure or renewal, as the existence of such questions may discourage physicians from seeking treatment. “To the extent that such questions are included,” the report says, “those questions should focus on the presence or absence of current impairments that impact physician practice and competence, in the same manner as questions about physical health.”

The FSMB is also calling for state medical boards to offer ‘safe-haven’ non-reporting to applicants for licensure who are receiving appropriate treatment for mental health or substance use. Such non-reporting would be based on monitoring and good standing with the recommendations of the state physician health program (PHP).

Speaking of which, Physician Health Services Inc. (PHS) — a charitable subsidiary of the Massachusetts Medical Society that serves as the PHP for Massachusetts physicians — intends to reach out in a broader way to physicians and hospitals to encourage doctors dealing with burnout and behavioral-health issues to seek appropriate and confidential care.

“Many PHPs in other states have expanded their outreach,” the report notes. “Hospitals and other healthcare institutions should complement and support this effort by acknowledging physicians’ concerns with seeking mental healthcare and clearly identifying avenues and opportunities to receive confidential care, particularly for residents and trainees, who are at a vulnerable stage of their careers.

Finally, the report calls for the appointment of executive-level chief wellness officers (CWOs) at all healthcare organizations. “CWOs must be tasked with studying and assessing physician burnout at their institutions, and with consulting physicians to design, implement, and continually improve interventions to reduce burnout.”

“Patients do not like being cared for by physicians who are experiencing symptoms of burnout, which is significantly correlated with reduced patient satisfaction in the primary-care context. Evidence further suggests that burnout is associated with increasing medical errors.”

The key responsibilities of the chief wellness officer, in addition to acting as an advocate and organizational focal point, may include studying the scope and severity of burnout across the institution; reporting findings on wellness and physician satisfaction as part of institutional quality-improvement goals; presenting findings, trends, and strategies to CEOs and boards of directors; and exploring technological and staffing interventions like scribes, voice-recognition technology, workflow improvements, and EHR customization to reduce the administrative burden on doctors, just to name a few.

CWOs could benefit physicians not just in hospitals, the report continues, but across health systems, and in affiliated practices. “Departments, units, and practices can survey for burnout, begin to identify their areas of focus and barriers to success, and collectively develop solutions. The CWO can help lead this process and provide best practices and other supports.”

Lives in the Balance

In the end, physician burnout is a problem with many triggers, which is why the authors of “A Crisis in Health Care” encourage a multi-pronged approach to counter it. But it’s also an issue with many potential consequences, not just for doctors and their employers.

“Patients do not like being cared for by physicians who are experiencing symptoms of burnout, which is significantly correlated with reduced patient satisfaction in the primary-care context,” the report notes. “Evidence further suggests that burnout is associated with increasing medical errors.”

Dr. Steven Defossez, a practicing radiologist and vice president for Clinical Integration at the Massachusetts Health and Hospital Assoc., said hospitals in the Commonwealth place a high priority on the safety and well-being of patients, so combating burnout will continue to be an area of focus.

“In particular, we recognize the need to further empower healthcare providers and support their emotional, physical, social, and intellectual health,” he said. “This report and its recommendations offer an important advance toward ensuring that physicians are able to bring their best selves to their life-saving work.”

Joseph Bednar can be reached at [email protected]

Opinion

Opinion

By Tom Flanagan

Burnout among the nation’s physicians has become so pervasive that a new paper published by the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society, and the Massachusetts Health and Hospital Assoc. has deemed the condition a public health crisis.

In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians surveyed said they experience some symptoms of professional burnout.

The paper includes directives aimed at curbing the prevalence of burnout among physicians and other care providers, including the appointment of an executive-level chief wellness officer at every major healthcare organization, proactive mental-health treatment and support for caregivers experiencing burnout, and improvements to the efficiency of electronic health records. 

In a 2018 survey conducted by Merritt-Hawkins, 78% of physicians surveyed said they experience some symptoms of professional burnout. Burnout is a syndrome involving one or more of emotional exhaustion, depersonalization, and diminished sense of personal accomplishment. Physicians experiencing burnout are more likely than their peers to reduce their work hours or exit their profession. 

“The issue of burnout is something we take incredibly seriously because physician wellbeing is linked to providing quality care and favorable outcomes for our patients,” said Dr. Alain Chaoui, a practicing family physician and president of the Massachusetts Medical Society.  “We need our healthcare institutions to recognize burnout at the highest level and to take active steps to survey physicians for burnout and then identify and implement solutions. We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.” 

By 2025, the U.S. Department of Health and Human Services predicts that there will be a nationwide shortage of nearly 90,000 physicians, many driven away from medicine or out of practice because of the effects of burnout. Further complicating matters is the cost an employer must incur to recruit and replace a physician, estimated at between $500,000 and $1,000.000.

The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” said Dr. Ashish Jha, a Veterans Affairs physician and Harvard faculty member. “There is simply no way to achieve the goal of improving healthcare while those on the front lines — our physicians — are experiencing an epidemic of burnout due to the conflicting demands of their work. We need to identify and share innovative best practices to support doctors in fulfilling their mission to care for patients.” 

The full report is available at www.massmed.org.

Tom Flanagan is Media Relations manager for the Massachusetts Medical Society.

Health Care

A Different Kind of Health Crisis

Dr. Gaurav Chawla

Dr. Gaurav Chawla describes suicide as “a very unfortunate, tragic outcome of a complex set of circumstances.”

It’s a common, but certainly not universal, refrain when an individual takes his or her own life.

Friends and relatives will say they didn’t see any signs that this was coming, said Kate Hildreth-Fortin, program director, Emergency Service & Mobile Crisis Intervention with Behavioral Health Network (BHN). Or they’ll say that they could not see any apparent reason for this outcome, that the individual in question seemed outwardly happy and was enjoying life.

That’s what people said about celebrity chef Anthony Bourdain, designer Kate Spade, comedian Robin Williams, and countless others, famous and not at all famous.

“But almost always, there are warning signs, and there are reasons,” said Hildreth-Fortin, one of many who spoke with BusinessWest about a subject that is timely, immensely complicated, and a true healthcare crisis probably on the same level as the one involving opioid addiction.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide, and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Timely not just because of those celebrity suicides several months ago — although they always help bring attention to the problem — and not just because of a recent report from the Centers for Disease Control and Prevention on the growing problem.

It’s timely because the numbers continue to rise, as does the overall toll from suicide, which goes well beyond the individuals who take their own life, said Dr. Gaurav Chawla, chief medical officer at Providence Behavioral Health Hospital, part of Trinity Health Of New England, who estimated that six lives are directly impacted by each suicide.

“If you think about the cost society pays due to undiagnosed mental-health conditions, due to emotional crises and stressors leading to loss of function and ultimately to suicide,” he went on, “and how many lives are directed affected by suicide … when you think about all that, this is a public health crisis.”

Getting back to the numbers, they are eye-opening and quite alarming:

• The most recent surveys show there are 45,000 completed suicides in the U.S. every year;

• That number has steadily risen since the start of this millennium, with suicides up a total of 28% since 2000;

• Massachusetts has the third-lowest suicide rate in the nation, but the rate of suicides in the Bay State has increased 35% since 1999, well above the national average;

• Women attempt suicide at a higher rate than men, but men complete suicide at a higher rate than women;

• Firearms are used in more than 50% of suicide attempts;

• Middle-aged white men (those in their 40s to mid-50s) have the highest suicide rate, particularly when they are single, but there is another peak involving individuals over 84; and

• Among individuals ages 14-34, suicide is the second-leading cause of death after accidents.

Perhaps as disturbing and frustrating as the numbers themselves are the forces behind them. They are numerous, often difficult to see, and very difficult to combat.

But there are common denominators of a sort. For starters, suicide usually results from a combination of factors, not one in particular, said Chawla, who summed things up succinctly, noting that “there is never one reason for someone to take their life; suicide is a very unfortunate, tragic outcome of a complex set of circumstances.

Kate Hildreth-Fortin

In almost all cases, Kate Hildreth-Fortin says, there are warning signs with someone contemplating suicide.

“You will often see the assumption that undiagnosed mental illness or inadequately recognized or treated mental illness is the cause,” he went on. “However, that is a myth; 50% of the suicides do not have a diagnosed mental illness behind them.”

As for what is behind them, that list is obviously quite long, said Hildreth-Fortin, and could include biological and genetic factors, increasing stresses of life, relationship crises, financial and occupational stressors, poor coping styles, increased substance use, and many others.

Another common denominator is that those contemplating suicide generally feel trapped in a life that does not bring them happiness or make them fulfilled, said those we spoke with, adding that this descriptive phrase can be applied to people at every age, every income bracket, and every walk of life.

Slicing through it all, such individuals need a way out of that trap and can’t find one or are unwilling to try, said Chawla.

“Suicide is a confluence of circumstances that lead one to conclude that they’re trapped in a hopeless circumstance, sometimes without purpose, in a painful existence from which there is no other way out,” he told BusinessWest.

Meanwhile, providing a way out, especially to those suffering from behavioral-health issues (and that’s a large percentage of those who contemplate or complete suicide) is made more difficult by the persistent stigma attached to seeking help for such conditions, and then finding help in a system plagued by a shortage of resources.

These are the reasons why this is a healthcare crisis, even if the same politicians who are quick to give such a label to the opioid epidemic are mysteriously reluctant to do the same with suicide.

For this issue, BusinessWest takes a long, hard look at suicide, going beyond the numbers in a quest to explain why they continue to rise, and also looking at how area professionals are helping those who are in that aforementioned ‘trap’ and need a way out.

A Failure of the System

Hildreth-Fortin, like the others we spoke with, said that, while it is somewhat regrettable that it often takes celebrity suicides like Bourdain’s and Spade’s to bring heavy media attention to the problem of suicide, she’s happy for the attention and a chance to bring the conversations to the forefront, instead of the background, where they have been for too long.

That’s because a brighter light needs to be shone on this crisis to bring about any kind of change in the current trends. With that attention, she said, there is hope that the stigma attached to mental-health issues and seeking help for them might be diminished; hope that more resources might be brought to bear to address the crisis, as has happened with opioid addiction; hope that friends and loved ones might become aware of the warning signs — what to do when they see and hear them; and hope that those feeling trapped might be more persistent in finding a way out.

That’s a lot of hoping, but in this battle, those fighting it will take whatever help they can get, especially with regard to that stigma concerning mental health.

“Suicide is a word we use every day; it’s something we deal with every day,” said Hildreth-Fortin, whose program handles roughly 1,300 assessments a month, and 70% of these individuals, in her estimation, have suicidal thoughts. “There’s a lot we can do with prevention; we need to reduce the stigma, improve education, and treat suicide the same way we would diabetes — ‘what can we do to help someone?’”

Chawla agreed, and said the stigma attached to both suicide and mental illness and seeking help for it often contributes to a lack of understanding concerning why someone commits suicide.

That is certainly the case with celebrities such as Bourdain, Williams, and others, he went on, adding that, to most of the rest of the world, these people seem happy and content with their lives.

But it’s not the world’s perception of these individuals that matters; it’s how they view themselves, and this is true of people across all income levels and social strata.

“It’s about perceptions of who you are, how you fit in your world, and how meaningful you find your existence,” he said. “That’s what ultimately leads to or doesn’t lead to such acts.”

But while suicide is seemingly an individual act, it isn’t, and each act represents more than one person choosing that tragic outcome.

“Suicide is taken as one event by one individual, and that’s not what it is,” said Chawla. “It is the final outcome of the failure of the system. Along the way, there are many lives affected, there’s a lot of loss of function, and there is opportunity that’s missed.”

Hildreth-Fortin and others at BHN agreed, and said one huge key to perhaps reducing the number of suicides is to seize opportunities rather than miss them.

And there is quite a bit that goes into this equation, she noted, listing everything from proper training of police officers, teachers, and others to being aware of the many warning signs; from knowing what questions to ask those at risk (and asking them) to knowing how to respond to the answers to those questions.

And this means not overreacting or underreacting, and, above all, connecting people at risk with services that provide help, said Hildreth-Fortin, who, like Matthew Leone, assistant program director of the crisis unit at BHN, is trained in something called QPR, which stands for question, persuade, refer — the three basic steps in suicide prevention.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help,” Leone explained, adding that, in his role, he does a lot of training in the community on how to recognize suicide.

Which brings him to those warning signs. There are many to watch for, some subtle, some most definitely not, he said.

“This is training given to anyone in recognizing the risk factors, how to persuade the person to get help, and how to refer that person for help”

They could and often do include people saying ‘goodbye’ or ‘nice to know you’ on Facebook and other platforms, individuals giving away possessions, young people suddenly drawing up a will, people losing interest in things they enjoy doing, a decrease in performance at school, and many others.

“A more overt sign might be when they start stockpiling medication or another means of following through on their plan,” Leone went on, adding that, in addition to these warning signs, which are clearly red flags, there are also risk factors.

And there are many of those, he said, starting with being a middle-age male. Others include financial distress, depression, divorce, loss of a job, being given a terminal diagnosis, and, of course, a combination of some of these.

Questions and Answers

The next part of the equation is knowing what to do when warning signs are recognized, or with someone who outwardly seems at risk, said Hildreth-Fortin.

She acknowledged that having a conversation with such an individual and asking the questions that need to be asked is awkward and often very difficult (some fear that just asking the questions can help promote a suicidal act) but it needs to be done.

“A big piece of QPR training is teaching people how to ask the question, to get someone comfortable with asking someone if they’re suicidal,” she said, adding that this training is often given to first responders and educators, but parents, spouses, friends, and employers also fall into the category of individuals who need to ask questions and need to know how to ask and also how to respond.

Questions should focus on what thoughts people are having, how often they’re having them, and whether they’ve acted on these thoughts in any way before, said Hallie-Beth Hollister, assistant program director, Community Relations for BHN, adding that the answers will generally reveal just how at-risk someone might be.

Jenni Pothier

Jenni Pothier says those working with those contemplating suicide need to create a comfortable, non-judgmental, open space for dialogue to occur.

One key, she went on, is not asking leading questions that would enable the individual to give the answers the questioner might be looking for.

“Don’t say, ‘you’re not thinking of killing yourself, right?’” she said by way of example.

But, as noted, recognizing warning signs and asking the right questions are only parts of the equation. Responding to the signs and the questions to the answers is another big part, said Leone, adding that that many people balk at asking questions, or especially difficult and specific questions, because of anxiety about the answer.

“‘What do I do if the answer is yes?’” is a question that unnerves many, he went on, adding that there’s a reason for this; the response can be complex.

“We talk with people all day who mention that they’ve having suicidal thoughts,” he explained. “Some have the intent to follow through, others do not; some have vague suicidal ideation where there’s no real plan to it.”

Which is why overreaction is possible and should be avoided.

“Many times, with suicide, when someone says they’re having those thoughts, instead of starting a conversation, it ends the conversation,” he explained. “People will jump in and say, ‘we need to get them to the hospital, we need to get them help now,’ when the person is just reaching out to talk about it for help.

“And this overreaction can have a negative effect to it because then the next time the person is experiencing those thoughts, they may not say anything,” he went on, adding that the key is generating the proper response given the individual’s risk factors, warning signs, the strength of the connections in his or her life, and other factors.

Jenni Pothier, director of the Tenancy Preservation program for Springfield-based Mental Health Associates, agreed. In the course of her work, which involves helping individuals who are at risk of homelessness — a stressful situation to say the least — the subject of suicide often comes up.

“Because we know that suicide includes risk factors like poverty, experiencing potential homelessness, and a lack of access to resources, people are in crisis,” she explained. “So we’re assessing people regularly for suicide.”

And those assessments involve asking those questions mentioned above, asking them in an effective way, and responding in the appropriate manner.

“As practitioners and clinicians in the community, you need to create comfortable, non-judgmental, and open spaces for dialogue to occur,” she explained, “so people can express to you how they’re feeling without the fear of the stigma or that you’re going to instantly call 911 to get them hospitalized if they say they’re contemplating suicide or having suicidal ideations.”

Bottom Line

As she talked with BusinessWest about suicide and, more specifically, the problems many have with asking the questions that must of asked of someone at risk, Hildreth-Fortin related the story about an educator who, during a QPR training session, admitted not only that she would have difficulty asking such questions, but also that she would be upset if someone put those questions to her child.

“I had a real hard time responding to her, because it spoke so greatly to the stigma attached to this,” she said. “If your child had a stomach ache, you wouldn’t have a problem with him going to the nurse. You talk about what hurts, what kind of pain it is … we have to treat suicide the same way we would any medical symptom. We have to talk about it.”

It will take a confluence of factors and a great deal of resources to reverse the current trends on suicide, but getting people to talk about it and respond to the talk is the big first step, said Chawla, adding that only by doing so can those missed opportunities he mentioned become real opportunities to do something about a true healthcare crisis.

George O’Brien can be reached at [email protected]