Optum, McKinsey, and a former hospital CEO walk into a bar...
The October edition of Optum's "C-Suite Insights" series contains an interesting research report on the healthcare workforce crisis (https://www.optum.com/content/dam/optum4/resources/pdf/fact-sheet/WF8444804-c-suite-workforce-checkin-report-v5.pdf). To produce this report Optum queried some 150 healthcare executives from across the provider community (50%), health plans (35%), and state or federal government agencies (13%) about current workforce dynamics.
There were not a lot of surprises to be found at a macro-level; to wit: burnout, turnover, rising labor costs, and skill gaps are adversely affecting staffing across various healthcare settings and sectors. [This is consistent with the results of the annual survey of hospital/health system leaders undertaken by the American College of Healthcare Executives (ACHE) which, for 3 straight years, has cited "workforce issues" as the number 1 concern of hospital executives.] One also needs to appreciate that there are important differences among/between health provider organizations, government agencies, and payers so one needs to be careful about making broad generalizations among disparate settings, even if they all have a connection to healthcare. Nonetheless, there are some findings that are worth calling out from the Optum report; for example --
"(T)he cost to retain, attract, and train the workforce is an overwhelming pain point for all health organizations."
63% of leaders cited workplace errors as having the most impact while approximately 45% cited overwhelming current employees [with workload] as having the most impact.
Approximately 65% of respondents said the biggest obstacles to progress is finding skilled talent and the same percentage cited "agreement from other leaders on what adjustments to make".
63% of leaders named "staying resilient and maintaining optimism" as a top obstacle to progress.
In terms of investment priorities, the following 7 areas stood out (in rank order) across all 3 spheres (providers, payers, government):
wages and benefits
employee training and professional development
data and analytics
infrastructure to support process automation and digital workflows
administrative automation
staffing (ie, scheduling) automation
workflow redesign
The preceding probably matchup well if one were just querying hospital/health system leaders. Ditto the category, "top areas requiring partnership" (rank ordered):
AI machine learning, robotics
predictive analytics
virtual health expansion
infrastructure to support process automation and digital workflows
administrative automation
interoperability
workflow redesign
staffing augmentation
The Optum report concludes with a recipe for organizations to successfully address the welter of workforce challenges. Support at every level of an entity will be required to achieve:
a deeper understanding of the individuals you employ
an understanding of what they need to be inspired to stay
internal leaders with the time to assess needs, propose workflows and plan technology integration
a mission-driven culture of innovation and inclusion
[external] partners that can close workforce gaps and grow your base of skilled talent
strategic alignment among leaders around business goals (and I would add specifically for hospitals/health systems: alignment among leaders and clinicians around business and clinical goals)
With regard to the 6-point recipe described above, my colleague Paul DeChant, MD, MBA and I find in our work that too many hospitals and health systems rely inordinately on annual surveys of employee and medical staff satisfaction -- and typical hierarchical chains of command -- for obtaining their understanding and insight. I'm not suggesting that surveys or that traditional reporting relationships have no value, only that they only provide a limited window into one's workforce. To obtain that "deeper understanding of the individuals you employ" and "of what they need to be inspired to stay"; to create a "culture of innovation and inclusion"; and to obtain greater strategic alignment among leaders and clinicians requires a different way of leading. McKinsey calls these "shifts in mindset and ways of working: beyond profit to impact; beyond expectations to wholeness; beyond the command to collaboration; beyond control to evolution; and beyond competition to co-creation. Taken together, the five shifts redefine leadership for a new era." [Aaron DeSmet, et. al., "New leadership for a new era of thriving organizations", Leading Off, November 4, 2024 https://www.mckinsey.com/capabilities/people-and-organizational-performance/our-insights/new-leadership-for-a-new-era-of-thriving-organizations?cid=other-eml-mtg-mip-mck&hlkid=84fdcda91ad842d5a60c46066fa69120&hctky=1926&hdpid=1ee76f9f-1f54-4f74-bd6e-3925caf8e84a]
Solutions for Hospitals, Health Systems, and Medical Group Practices: Leadership-Driven Changes
The locus for curing clinician burnout and staffing shortages runs through the C-suite. Here are examples of leadership-driven changes to the workplace that my colleague Paul DeChant, MD, MBA and I often recommend:
> Regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays
> Consistently apply one or more of the improvement sciences (Lean, Six Sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches
> Expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)
> Create and require leader standard work (LSW).
> Develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors
> Judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add
> Support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")
> Get rid of superfluous or outdated policies, procedures, redundant approvals, and other stupid stuff (GROSS)
Ready to transform your hospital or workplace?
Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation Clinicians feel toward the C-Suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.
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