The Crisis Might Be Over, but Challenges Remain on the Healthcare Workforce Front

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.

“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?

“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.

“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.