Last week in Part II of our blog series, we took a deep dive into our panel discussion, “Maximizing Organizational Performance in the COVID Era.” We heard from industry leaders Mark Solazzo of Northwell Health System and Dale Beatty of Stanford Health Care.
Nancy, as Dale Beatty pointed out, the focus on safety within health systems is paramount. From your perspective, what has been the impact on quality and performance over the last 18 months during COVID? And what have we learned that we can take forward?
Nancy Pratt: Well, I think that some of our momentum in driving a value-based approach to patient care has certainly slowed. We put things on pause, and appropriately so. I think there was a massive redirection of effort. We had to look at the results we were getting from taking care of COVID patients. So, the whole focus shifted to this communicable disease. And in fact, all the foot soldiers focused on our quality activity were repurposed. They were needed for different jobs. I’ve talked to quality directors who were hanging PPE in the UV area so that they could be reused for people. They weren’t doing their regular jobs.
I think our focus was entirely different. Now, as we’re beginning to emerge from the pandemic across the country, we are seeing the demand for preventative health care and all the other health-related activities that were put on hold during COVID. There’s going to be a re-emphasis on value-based patient care. People are coming back to address those health issues.
But think about this from a quality perspective, and population and disease management perspective. What about the patients where we didn’t identify health issues? These are now going to emerge. And maybe we’re discovering these issues later in the course of the disease than is otherwise optimal. That’s the echo of this COVID boom. The fact that we had to slow the pace of health care delivery for all non-COVID patients during this pandemic.
So, I believe that we will refocus our attention and get back to the work at hand. There will be the next wave of ask from the federal agencies in terms of quality measurement and management. But we are getting back to business now and looking to drive the outcomes that we need to have in healthcare. We suffered a big blow during this pandemic, but we learned a lot. And we learned it really fast. This will be extremely helpful in our future work. Because I don’t believe this is over. We’re going to have new variants that require booster shots. And there will be seasonal impacts. This is here to stay.
I recently had the opportunity to sit down for a conversation with Bonnie Barnes from The DAISY Foundation. We talked at length about the staggering number of early retirements within the clinician population. On top of this, we have also heard that there is an increasing number of nurses leaving their jobs to accept roles as “travelers” because it has become so lucrative. Both factors impact everything we’ve been discussing – quality of patient care, staff engagement, and health system economics.
How are you attempting to overcome these trends and manage the impact they have on your health systems?
Dale Beatty: CJ, one of the things that I’ve noticed in my career, particularly during times of great change, is that those health systems that have solid, healthy, engaging practice environments are winners. I had the opportunity to work with Dan Gross for a brief period in San Diego at Sharp. They had a very engaged culture. People want to work in that type of environment. If you can build an environment where people feel safe, supported, and engaged they will stay. Of course, economics will always be a driver. But people also want to know that they are making quality contributions. That’s also a key driver. Who they work with, how they’re supported, and what the culture is like, is critically important. So, when Dan talked about workforce engagement earlier, that work is crucial now, and in the future, to make sure that the practice environment supports the frontlines in the best ways possible. I believe that is a differentiator.
Mark Solazzo: I agree with Dale that engagement is key. It’s fundamental. It’s foundational. It’s part of your culture and you must constantly nurture that. At the same time, we are also seeing some of the trends that you mentioned, CJ.
The older workforce is looking toward retirement. So, we do expect greater turnover. We expect the overall workforce to be younger going forward. We have to think about how we engage with them. What’s the flexible workforce of the future? So, while nurses can’t be remote. You can have a revenue cycle person and a billing person work remotely. You can have HR and IT work remotely. So out of 75,000 people, it’s possible to have close to 25,000 that are remote.
So, we’re evaluating how to maintain productivity going forward. And, how to maintain engagement simultaneously. Because the remote workforce becomes a challenge in maintaining your culture. But there are techniques that will enable you to do that. So, I think the future is about flexibility in workforce design. Job sharing is not out of the realm of possibilities. Other organizations and industries have been doing this for many years now. We must think more creatively to keep our workforce engaged as we move forward.
Dan Gross: I would also add that we’ve got many influencing variables that impact your question, CJ. Meaning, we’ve got the whole pandemic experience. But we also have the issue of people leaving the workforce. Truthfully, we were dealing with that before the pandemic. One of the areas that we discussed earlier was engagement. Creating a culture that empowers the frontlines. I think continuing what we were already focused on coupled with lessons learned from the pandemic is key. Let’s also not forget about the generational values that we’re working on. These also play a role. We all know the baby-boomer nurse or employee is not the same as our 30-year-old workforce.
So, I think it’s imperative to step back and remember these key areas of focus. What motivates an individual? What stimulates them? What creates satisfaction and what drives retention for those people. Plus, we must add on what we’ve learned from the pandemic. I think the economic driver, in terms of your traveler example, is one that existed both pre and post pandemic. The only way we address the challenge is by creating an environment in which those people want to work. We must give them a supportive environment with meaningful challenging work where they have an impact and thrive. So, bottom-line, let’s not forget everything we were working on before the pandemic that we know is important.
Dale: I would add to your comments, Dan, that we should also keep in mind that there are professional organizations out there for leadership teams. They have articulated core competencies for leaders. I believe now more than ever; we need to build and strengthen the skills of our leaders to make sure they’re supporting our frontlines to the best of their ability. They need new tools and technologies, but they also need core competencies. My own professional organization, ACNL, has competency programs for leaders.
We also talked a little bit about diversity, equity, inclusion, and generational awareness and understanding of the workforce. Certainly, understanding information technology tools and systems is another piece. We need to make sure we’re empowering and structuring our leadership to support the frontlines in the best ways possible. It’s critically important. You can no longer learn through experience alone. You need the core competencies associated with being a leader.
Nancy: I think that’s even more challenging given the conversation we’ve just had about remote workers. It’s very different when you’re managing a remote workforce. A different set of tools are needed, and a focus on what touch points are needed for people working remotely. There are all sorts of norms that are emerging across the healthcare industry, not unlike other businesses. For example, should the norm be camera on or camera off? In the beginning of the pandemic a lot of people in our organization had their cameras off. My group made a conscious decision after talking about it that we need cameras on. We needed more face time. We needed to see one another and to connect as human beings. I believe we’re going to have more remote workers because of the pandemic. More telemedicine for healthcare visits. Both shifts, I believe, will stay with us. And, ironically they are at odds with one another – the need to be remote and the need for more human connections.
Mark: To build on that, we’re all involved in engagement. But now I think we must double down on wellness for both remote and onsite workers. We have a workforce that just came through a horrific situation. For us to think that everything’s fine because most of the patients have been discharged would be putting our heads in the sand. Everything’s not fine. There’s a lot of PTSD lingering. We have to support them throughout the next year and beyond to make certain they feel comfortable and are addressing the issues they’re facing. We must respond to their needs.
Dale: Mark, I would like to add to that as well. Something that I am hearing is that there is a moral distress in general. It stems from separating patients from their family members and significant others. The stories are not just about the frontline workforce, there’s also an impact on clinicians and physicians. And I don’t know if we completely understand this yet. I’m starting to hear some of those stories as well.
Marc: There are a lot of hidden stories there, Dale. Things that the public did not see.
Nancy: I totally agree. It’s scarring.
Dan: Mark, you stimulated a thought for me. We spend a lot of time focused on our frontline clinical workers and our physicians. I was wondering if the group has any thoughts about frontline managers, particularly middle managers. What have you seen in terms of team erosion, if any, and/or strategies to make certain that our leadership group is staying connected? I hear anecdotes like, we’re all on zoom call and someone just goes off on a tangent, so everyone just rolls their eyes. Or they’re on their cell phones chatting or texting. I don’t believe that existed to a large degree, pre-pandemic. What are your experiences and thoughts if any?
Dale: I think this gets back to Nancy’s comment about how we work and behave in our new world. This is particularly important on social and virtual networks, and in terms of creating guidelines and standards that the group agrees to. I think it’s critically important. If people don’t turn on their video, if they’re not engaged, or they’re texting with one another, business norms need to be established and agreed upon in a healthy way for the purpose of supporting the health system and staying connected.
It’s been interesting. To Nancy’s point, people have a greater need to connect with one another now because of the virtual world that we’re living in. But there are other ways to achieve that as well. There are breakout sessions and smaller chat rooms where people can engage in a variety of different ways than they have in the past. There are opportunities for us going forward. I think we just have to determine what these new processes, communication modes, and technologies are in our business practices and then agree upon the new norms.
Mark: Dan, I don’t know if the underlying feelings or emotions are any different today versus pre-pandemic. Maybe they’re expressed differently on a Zoom call versus an in-person meeting. I think people were texting instead of calling on the phones in the meetings, both before and after. I think it just comes back to the basics. It’s team-building. It’s engagement. We must work to do these things differently.
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