Health care innovation to tackle the workforce crisis

Todd Pruzan:                     Welcome to today's Harvard Business Review Analytics Services webinar, Tackling the Health Care Workforce Crisis. I'm Todd Pruzan, Senior Editor for Research and Special Projects. I want to thank all of you for joining us today, and I want to thank Optum for making this webinar possible.

                                             Work volumes, staff shortages, and long hours are testing the limits of healthcare workers and may increase the risk that prospects will avoid the sector. Many doctors and nurses feel stressed, exhausted, frustrated, and burned out. And to tackle this crisis, healthcare needs to innovate. Now, typically, healthcare innovation makes us think of cutting edge technology, but even transformative technology is not a solution on its own. It's an enabler of human innovation. A recent HBR Analytic Services report looked at ways healthcare organizations are using technology to help the workforce innovate.

                                             In today's webinar, Alex Clemente, Managing Director of HBR Analytics Services will explore the findings of this report and share his insights on its implications for the healthcare workforce. He'll discuss the report's findings with Lisa Collins, Optum's CEO of Advisory and Implementation, and Kristy Duffey, Chief Nursing Officer of Optum Health and Chief Operating Officer of Optum Home and Community Care. They'll examine the healthcare workforce crisis and how innovation can help solve it, talking about the reexamination of the healthcare workforce in the pandemic era, how technology can be transformative in enabling human innovation, the mental health and wellness of healthcare professionals, and how forward-thinking healthcare organizations are reimagining their workforces and reaping tangible benefits.

                                             As a reminder, we are live, and this is an interactive webinar, so if you have any questions or comments at any time, just type your question into the Q&A chat box. If you'd like us to ask your question anonymously, please let us know that. And if you need help at any time, please click on the yellow question mark help icon. This webinar is being recorded. Lisa, Kristy, thank you so much for being with us today, and thank you Alex. And Alex, let's start with you. Can you tell us a little bit about the objectives of this research?

Alex Clemente:                 Yes, and thank you first for that introduction. And I'd also like to thank Optum for sponsoring this body of research in addition to today's panel. The pandemic presented the industry with new challenges and an opportunity to examine both traditional and new ways of providing healthcare. And given this timing in particular, we were interested in knowing what the impact that this cataclysmic pandemic event was having on the employer-employee relationship. And in order to do so, we needed to understand the level of stress that's really unique to the healthcare industry worker.

                                             For example, healthcare is a human-centric field that revolves around caring for other people's physical, emotional, and mental wellbeing. And people drawn to the work in the healthcare sector tend to be focused on the needs of others more so than themselves. So this focus on others can compound their stress as they worry about others, both inside and outside their workplace, especially when we think of people like working mothers.

Todd Pruzan:                     Okay. And so what did the research uncover?

Alex Clemente:                 Well, for starters, there was some pretty stark data. According to the American Nurses Foundation, three quarters of acute care nurses, and this research was conducted in May of last year, reported that three quarters feeling stressed, frustrated, and exhausted. And more than half of them, 60% reported feeling burned out. And the data on physicians were similarly grim also. A survey by Medscape, which had over 9,000 physicians last October, found that more than half of doctors said that they were burned out. And nearly one quarter of them, 23% reported signs of depression. And many believe this is now the highest level of burnout experienced in their lifetimes.

Todd Pruzan:                     Definitely some challenging numbers. Alex, given this environment, what can healthcare employers do to improve workforce spirit?

Alex Clemente:                 Yeah, we'll dig into this deeper, this particular question deeper in our panel discussion. But to provide you an answer, there are innovations happening at both the human and at the technological levels. These aspects in healthcare that can provide relief, and when you put the two of them together, the human and the technical, the combination can be exponentially effective.

Todd Pruzan:                     Thanks, Alex. Lisa Collins of Optum, what is the state of the healthcare workforce today? What impact are you seeing on healthcare workers and on their organizations?

Lisa Collins:                        Yeah, thanks, Todd. Yeah, absolutely agree with what the research is showing is what we're seeing with our clients and our customers. Certainly at the macro level, burnout, turnover, rising costs with thin margins. All of the organizations we're working with have very thin margins and they're managing through that. Skill gaps, unable to work at the top of your license because you're trying to fill in for all the staff, lack of supply of staff, and then just supply overall. We're seeing decreased supply in general. And just physical demands on those bedside caregivers has been very stressful and feeling just very overworked. And I think on top of that, we're seeing a lot around aging populations so there's other disruptors occurring with the aging population. Overall wage increase, demands of wage increase, of course, travel labor, a lot of the premier costs around getting traveling nurses and traveling physicians. And then the demand from, in general, all of us in our society, the demand for flexibility and being able to work remote.

                                             So that demand is really a struggle when you need bedside care. And just, I would say on top of that, a lot of folks are trying a lot of different things around technology and a lot of pilots, which is great, and that's what we need to do. At the same time, again, that's pretty stressful for a workforce that's trying to take care of patients and always thinking about how do I use this new technology? Generally speaking, we're seeing the cost of turnover is increasing. So even from '20 to '22, '21 to '22, there's been a rise of 13.5% in just a cost of one staff nurse turnover is risen 13.5%, and that average cost is $52,000 to recruit, onboard, train. So if you think about that, just one percentage point change in turnover either direction, whether it's a cost or a savings, is about $308,000 annually for our organizations that we're working with.

                                             So massive impact to them. And so again, that's just some of the things we're seeing. And again, it's a snowball effect. So as you've seen premier talent coming from traveling nurses, they're trying to give them bonuses and all sorts of interesting ways to attract people to come to work for them or even from the traveling nurses to come. Now your tenured folks are in there also being very frustrated because they're not getting the bonuses and they're getting more of the work effort that's remaining because there's been such turnover. So all of those are sick, just a snowball effect on that. My side, I'd like to turn over to my colleague, Kristy, also is from a more clinical side. Kristy, maybe you can share a little bit what you're seeing as well.

Kristy Duffey:                    Yeah. Thank you, Lisa. Thank you, Todd. And thanks for the opportunity to be here. And before I jump in, I have to give a shout-out to Happy Nurses Week to all the nurses who are on the call. Thank you for all that you do from one nurse to another. Really appreciate the great work you do every single day. And this topic is obviously really near and dear to my heart as we're living in this situation, in this crisis for the last few years.

                                             I'd just like to underscore a few points. What we do know is that over the last two years, 100,000 registered nurses have left the practice. 600,000 nurses have an intent to leave by 2027. And as Alex said, 50% of physicians say they're burnt out, which is up 10% pre-COVID. And so obviously, burnout is a major concern. But then the compounding factor, which Lisa was alluding to, is not only are we seeing this mass exodus, but we're also seeing an increase in demand.

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Kristy Duffey:                    ... but we're also seeing an increase in demand. 10,000 baby boomers are aging into Medicare every single day. By 2030, 73 million people will be over the age of 65 living with multiple chronic conditions. And we're also seeing one in six primary medical students coming out of med school going into residency. Only one in six are going into primary care. And so we have this, like I said, compounding effect of people leaving the profession and then having people living longer with these multiple chronic conditions, and supply not meeting the demand. And this is something that I think about every day on how we've got to utilize our workforce in a different capability. And so, by having this effect, we're going to start seeing a lot of impacts on our patients: decreased access to care, increased wait times, increased cost to the system, unnecessary use of the ER and hospitalizations. And so these are problems that we need to solve collectively so that we can keep up with what the healthcare needs are of our patient populations in the US and abroad.

Todd Pruzan:                     Okay. So some pretty difficult sobering landscape you're talking about. Question for you both, for Lisa and for Kristy Duffey. Can you describe some areas of innovation, best practices, creative solutions that you're seeing organizations using to improve healthcare workers' jobs? Any examples of technology supporting other types of workforce solutions, so everyone on the team can work at the top of their skillset? Lisa, maybe we could start with you.

Lisa Collins:                        Sure. Yeah, I think interesting point, what Kristy brings up of, first of all, thinking about how do you keep patients even out of the hospital, so the demand of the labor and the dependency on labor isn't as much either. So a lot of technologies around the home care, how do you do physical therapy in the home when you're in a post-acute care situation. They could do physical therapy when you've had a knee replacement or something in the home using the Alexa devices and things like that. So a lot of home type devices, home monitoring, which even just keeping patients out of the hospital in the first place, or at least getting them out of the hospital sooner and be able to do that care in the home. It's a lot of pilots and a lot of scaling that's starting to happen there.

                                             At the same time, we're not going to remove the need for bedside nursing. We must have bedside nursing, but I think we just need to make it easier for our healthcare workers so there isn't so much, whether it's entering data in the EMR or those kinds of dependencies on things that are really non-value add as far as patient and patient care and quality of care. So reducing the dependency on our healthcare workers to do those types of tasks has really been the focus of how do you reduce that? And that's where technology comes into play. How do you create more flexibility so they can work, either have better work-life balance, be able to work remotely, use a technology, and then just reduce dependency in general? Some of the things we're seeing, so machine learning, AI, certainly being able to predict volumes, it's so that you can do much more on demand staffing.

                                             For instance, I know working with a customer in the northeast area, after an Eagles game, for instance, on a Sunday evening, they know their spike in ED visits or their spike in volume might go up. So how do you staff to that? So how do you get much more with the data and with analytics and with AI to get much more predictive of volume, so now you're starting predicting to predict supply of labor and predict just supply of just regular supplies and everything else, so all the trickle-down effect. Ambient listening, the use of Alexas in the patient rooms even, to do things like turn down their own heat or turn up the heat or whatever. So that's things that a patient can actually do and they probably prefer to do, and they probably do a majority of it in their daily lives today. So we're seeing a trend on those kinds of things. I mentioned already Alexa in the home, post-acute care surgery, how do you do more with that, whether it's physical therapy or senior care and other things.

                                             The other thing we're seeing is use of robots. And we've had an organization call them literally Cobots, so they're like colleagues so they don't feel so intimidating. But use of robots to do, again, low-value tasks that there's not a clinical need to be able to do those tasks. So removing those tasks from the nursing workflow, whether it's getting drugs from the pharmacy, being able to just have a Cobot go down and do that. And use of real-time location services, and location sensing has also been a behavioral change as far as nurses that hoard infusion pumps, because you want to be able to find those infusion pumps. So use of those kinds of technologies to reduce that, and we've seen reduced lack of access by 25%. So the improvement around that, being able to not do that type of hoarding, by the use of realtime location sensing.

                                             So a lot of different things that folks are trying. We're starting to see some scale in certain areas and absolutely just pilots in other areas. But I think the good news is there's a lot happening to try different things, and I personally believe that it's really required in order to disrupt and be able to move the needle on the healthcare crisis and labor challenge that we're under right now, we're going to have to do some of these kinds of things. I love what Alex said though about it's human-centered. It must be human-centered, and that is I think very critical, and being able to really understand and embrace what is the nurse's workflow, hearing your staff, listening to your staff and understanding what is it they do today in their workflow, and being able to not insert technology where not appropriate, but insert technology where it does really enable. So I think that's really critical. It must be human-centered and there's got to be a lot of intentional thinking around change management and adoption when it gets into that.

                                             And so Kristy, maybe I'll turn it over to you and what you're seeing within our area as well within Optum and what you've been trying on your side.

Kristy Duffey:                    Thank you. I want to piggyback on a few things that you talked about and then I'll talk about some specifics that we're doing within Optum Health. The first thing though, talking about really resonates with me is an enabler. It's not a replacement of the human touch and human design work. And one thing that I know and many people on this podcast know is that the clinician has to be paired up with the tech to ensure that the clinicians get what they need, otherwise they won't use the tech. And so, one of the things, just an example of how we have had to really innovate quickly, and I would say one of the good things that has come out of COVID is that we've been able to innovate things very quickly that we probably would've never gotten to as quickly as we have.

                                             And one of them is what we've experienced within our skilled nursing facilities in the post-acute space is not a rebound from COVID, since this is still about 75%, patients that are being discharged to skilled nursing facilities are much more acute and they do not have the staffing in the facilities. And sometimes it's one nurse in the whole building trying to manage all of the care. And so what we've had to do is partner with the robots to actually be our eyes and ears when we aren't in the facilities to assess those patients and then do a virtual visit with our clinicians, either our nurse practitioner, our nurse or our physicians, on can we take care of that patient virtually because we're in another facility, or even just trying to manage these patients 24/7.

                                             The other thing that we've also started is biometrics so that we can actually see heart rate, blood pressure, did they get out of bed? Did their activity status change? Because we want to make sure we're being more preventative versus reactive and everybody knows that. And then I would say the other big area of focus when we think about tech is just remote patient monitoring. And when you think about patients who live in rural markets, and we have a 13% primary care provider shortage just in those markets, utilizing remote patient monitoring for their virtual care so that those patients get the care that they need and that they deserve. And so the other big area that I would say that we've also had to tap into is virtual specialist-

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Kristy Duffey:                    ... that we've also had to tap into is virtual specialist, utilizing our virtual technology so that when we're taking care of patients and we have an issue with diabetes, we can virtual consult in right with the endocrinologist to help manage their A1C or their acute issue. That has really been instrumental that we didn't have before COVID. But as we think about our workforce, I lead a team of more than 8,000 clinicians, primarily advanced practice clinicians, nurse practitioners, and physician assistants, and when I look at my workforce, and I think Alex said, 92% of my workforce are female. And when you think about that workforce and what I loved in the report too is, people who have been clinicians or nurses less than 20 years and those that have been clinicians greater than 20 years, they want very different things. And as I look at my landscape of clinicians, I have to meet the needs of all of them.

                                             So when I look at what they're looking for versus what I was looking for 29 years ago, gosh, I'm getting old, as a nurse, I just had three twelves one week, four twelves the other week. That was my job. No exceptions. Graduated NP school, worked Monday through Friday 8:00 to 5:00 and took call 24/7, that was it, that's your job, and you can't complain about it. And if you did, there was a stigma to that like you're weak. And when I look at the workforce thinking about I'm going to need to hire 10,000 more advanced practice clinicians at Optum Health in the next few years, already talked to you about the issue that we're facing, we have to ensure as employers that we're meeting the needs of our care teams. And so what I mean by that, we've had to go from these rigid schedules to, yes, you can work four tens. Yes, you can work part-time. You don't have to take on call.

                                             In fact, one thing that we've done that has really resonated with our team is nurse practitioners and PAs working 10 months out of the year, having two months off in the summer and paying them for the whole year. As well as when we start looking at burnout. So in primary care practice, seeing a lot of burnout, how we can have hybrid schedules where we can do primary care two days a week and three days a week be in the home or in the post-acute setting. So really trying to ensure that we have the flexible shifts and even job share, job sharing with people where I can do two days and you do three days and we have the same panel size. What I'm finding with my team is it's not necessarily about work-life balance because I don't really believe you ever have a balance, but work-life integration and how are we integrating their needs and meeting their needs where they're at at their point in time?

                                             And then I just want to hit on two more things, mental health, mental health. The United Health Foundation partnered with the American Nurses Foundation and announced a three year, $3.1 million grant partnership to fight nursing burnout. The pilot programs are underway in three clinical settings and nurse focused on nurse mental health, and we will be expanding that nationwide. So really helping try to support our nurses and how we move forward. And then the other big thing that we've done within my organization which had never done before, we actually hired a board certified chaplain during COVID to have a safe space for our clinicians to share their stories about how COVID has really impacted their lives, both at home and at work. And so what we've done is we have a safe space that we call a bonfire. And so everyone will write down their thoughts and then our chaplain will read them out loud anonymously. And the idea is, if we were together and we could have done this in person, that we would throw all of our burdens into the bonfire.

                                             Our bonfires are still going on. They haven't stopped and, in fact, we have had more than 10,000 participants participate in these bonfires. And then the last thing, which isn't the last thing, but I don't want to take all the time, the last thing that I would say that I focus on every day is retention, retention. You talked a lot about the cost of losing clinicians and there is almost a 0% unemployment rate rate for nurse practitioners and PAs and the unemployment rate for nurses is 2%, minimal. When we hire people, we have to keep them employed and we have to provide them opportunities to advance in their career. We have done a lot of work around benefit assessments, ensuring competitiveness, and it's not always about compensation, but being competitive and also offering more educational opportunities, clinical fellowships, rotational programs, and even we provide backup childcare so that you can get to work and receive 10 days free childcare a year.

                                             And then the last thing that I would say and really resonated with me in the report is you have to listen. You have to be with the front lines. You have to be in the field. You have to see what's going on. I still practice. I still go out and do ride-alongs. You have to be close to it because when we talk about functioning to the top of your license, the only way we can make that happen is really knowing what's going on in the field. So we have to rethink and reframe things otherwise things will not change.

Lisa Collins:                        Kristy, I love what you said about, I love what you said about the flexibility and integration into life. If you think about those costs, I mentioned $52,000 just in recruiting, training, hiring, all that kind of thing, I mean, 10 months, are you paying for a whole year? Well worth it, because you're going to spend a lot more of that in order to try to track the talent, even if you can get the talent.

Kristy Duffey:                    And I'll tell you too, our attrition levels are actually going back to pre-COVID levels, because of a lot of these things that we've done, you see the return on investment.

Lisa Collins:                        That's great.

Todd Pruzan:                     Lisa, before we get to audience questions, hopefully, we'll have a couple of minutes for that, but can you talk about any strategies you've seen organizations use to make sure their innovations do improve outcomes for their workforce and their patients and for their organizations?

Lisa Collins:                        Sure. And Kristy hit great ones, what she just said as well, which I think it's extremely critical. Three things, really, what we're seeing, and it's such basic blocking and tackling really at any point, but change management and workflow change and process change that's required around any of this, and that gets down to the people and being human-centered, even from the time of design all the way to roll out and adoption and continuing to understand the requirement around that. What I've seen is organizations underestimate that and they under plan for it. And that hinders adoption and at the bottom line it'll hinder overall success and you'll feel like, "Okay, that didn't work", which the technology or the thing you were trying might very well work, it's just the wraparound that you maybe forgot to plan for. So I think it's really important on that, number one.

                                             Number two is culture. I mean, I think it's somewhat tied together, but really understanding culture because there is a resistance. Let's face it. When you're bringing in some things, it's going to feel like you're trying to work around eliminating my role, which is absolutely not the case, as you can understand from this whole discussion. It's absolutely trying to make it where it's better for you and you're working at the top of your license. So understanding culture and understanding what you're up against in that culture and getting buy-in, and communicate, communicate, communicate as much as possible of the why. Why are we doing this? What are we trying to do? What is our intention? And, again, from the time of design to incorporate as many of the clinicians into this as possible from the time of design all the way through rollout.

                                             And then I would say third one, Kristy already mentioned it, oh my gosh, just listen. Listen to our folks. Listen to our teams. That goes for any of us. Again, so easy, but it's, really, folks just want to be heard. They want to be understood. They want their ideas inserted into what you're doing and what you're trying, and that's how you get the buy-in as well. So it's very liberating. We're trying to really liberate them from redundant tasks and enable them to focus on the patients, which is really the reason they've all signed up to be in this position and to be down in this career field, in this field. So those are some of the things. I'm mean, change management, workflow, culture, and listen. Kristy, what about you?

Todd Pruzan:                     [inaudible 00:27:02].

Lisa Collins:                        Oh, go ahead. No...

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Lisa Collins:                        Listen. Kristy, what about you?

Todd Pruzan:                     So a lot-

Lisa Collins:                        Oh, go ahead. No, sorry.

Todd Pruzan:                     I'm sorry. Can I just cut in with a... We're getting really, really good questions and I wanted to make sure that we asked one from Marco [inaudible 00:27:11] who's asking about the generation gap or a generation gap, if there is one. Are you seeing that as far as technology adoption? And if you are, what can an organization do about that?

Lisa Collins:                        So I love that question. Actually, the data also shows just a note, and I was going to mention this, folks that are under 35 and they've been in a bedside caregiver role in less than a year, that's where we're seeing the highest turnover. So that demographic is very interesting. That's where we're seeing the greatest amount of turnover. So that's from a data side of it. From adoption of technology, yeah, sure. I think that there's a much more appetite to embrace technology and to want to be able to adopt it so they can have that more integrated, flexible work-life balance or integrated work-life balance. So that's from my side, I'm seeing. Kristy, I don't know if you want to chime in on that as well.

Kristy Duffey:                    Yeah, it's a great question because from Baby Boomers all the way to Gen Z, there's a huge difference. And what I would say is as I'm starting to see more Millennials and Gen Zs coming into the clinical workforce, they expect and demand very good technology. They want it to be like LinkedIn and Facebook and Snapchat and have less patience for a lot of manual work. And I would say that's a huge driver on satisfaction. And that think about when you go to a provider and you fill out the information ahead of the visit and then you go in and you have to fill out the same information.

                                             And so for me, the Gen whatever, X, I'm used to that. But when you think about the generation coming up and coming in, that's not satisfactory. And we're not all in the United States going to be on the same electronic medical record, but we've got to have data interoperability so that the clinicians can function to the top of their license. And as that report talked about, the doctor spending or the provider spending on average 21 minutes documenting in front of their patient and 12 minutes with the patient and then another 11 minutes documenting, that is not going to be satisfactory. And our tech has got to get up with all of the FANGs, right? Facebook, Amazon, Netflix, Google, because that is the expectation.

Todd Pruzan:                     So thank you for that. I'd like to sneak in just one last quick question if we can, and I wish we had time for more. There are a lot of great questions. But Kylie Sage is asking what about a smaller healthcare organization that maybe doesn't have a lot of resources for AI, for robots. How do you advise an organization like that to support their staff and protect against burnout?

Lisa Collins:                        I can jump in.

Todd Pruzan:                     Maybe I'll join-

Kristy Duffey:                    Go ahead, Lisa, and then I'll go.

Lisa Collins:                        Okay. Yeah, I mean, from a technology side of things, there's actually some, I think, relatively inexpensive things you can do. I mean, think of some of the Alexa devices in the room, things like that. I mean, that might be a little bit more expensive to do, but I think there's also some areas that you could take advantage of other organizations that are doing this and innovative teams that are doing it.

                                             I mean, I know we, for instance, are helping a lot of organizations in a very cost-effective way in doing some of these by really sharing what others have done and being able to not start it from scratch, but be able to start with something that's pretty much well-built and well-designed so that you're not trying to innovate in and on your own. I would say partnerships absolutely is key. We're seeing a lot of organizations partner and being able to just accelerate and leapfrog so they're not, again, out there on their own trying to do this type of thing. I mean, those are a couple areas I know from a... And Kristy, maybe I'll let you chime in since we only have a second left.

Kristy Duffey:                    I think you captured it all. I think the biggest thing too is please reach out to us because at Optum we can really help and partner with you as we have these capabilities. And then I do think there's some things that smaller organizations can do from a virtual care perspective that are pretty inexpensive, but then can help enable your providers. So please reach out to us.

Todd Pruzan:                     This is an amazing conversation. I wish we had time to continue. We are out of time for today. But Lisa and Kristy, thank you so much for all of your insight and I want to thank all of you for joining us, especially Lisa Collins and Kristy Duffy from Optum. Thanks also to Alex Clemente from HBR Analytics Services. Our producer at HBR today is Alex Shore. So thanks to her and to our partner on 24. And a big thanks to Optum for making this discussion possible. This concludes our presentation. Have a great day.

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