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How can hospitals improve staff retention? Tech and training, experts say

It's possible to rekindle the passion of doctors and nurses in providing care, even as many eye an exit.

Worries over the state of the American medical workforce has been a dominant theme at the HIMSS annual healthcare conference, overshadowing the typical futuristic discussions about the potential of technology in the industry.

Attendees in Orlando this year instead returned again and again to the foundation of the medical system — its doctors, nurses and staff — who are leaving in droves, and without whom very little of that futuristic tech capability is possible in practice.

Despite the attrition, which has hit hospitals especially hard, experts are optimistic that if healthcare organizations cut down on pain points, prioritize staff well-being and improve people management, they can boost retention.

Medical workers join the field because they feel a calling, and it's possible to refuel that spark even after two years of COVID-19 that has stoked fatigue and frustration among healthcare staff, experts said at the conference.

To be sure, statistics point to a bleak outlook for the American healthcare workforce.

By the end of this year, a third of nurses plan to leave their jobs, surveys show, and a quarter of medical workers expect to depart in the near future. Additionally, almost half of U.S. doctors and nurses are considering leaving their current role in the next two to three years.

The studies on exit plans come amid historic staffing shortage in healthcare, created by what industry experts call a perfect storm of aggressive job competition, generational change and record burnout stemming from COVID-19.

For more than two years, wave after wave of coronavirus patients coincided with the acute stress of providing healthcare in an environment where some patients refused to believe there was a pandemic, and rising reports of assaults and verbal violence against healthcare workers.

"With the pandemic, things got worse, and people started leaving their jobs and looking for other opportunities," Tamara Sunbul, medical director of clinical informatics at Saudi Arabia-based Johns Hopkins Aramco Healthcare, said at a HIMSS panel on the workforce.

Despite recent job gains in healthcare making up for some pandemic losses, the sector is still down 306,000 jobs, or almost 2%, from pre-COVID-19 levels, according to the Bureau of Labor Statistics.

Another contributor to the rapid turnover is the growing percentage of millennials and Gen Zers in the workforce, generations that are more likely to move from job to job than their predecessors, experts said.

"Gen Z will hop. Period," Johnny Taylor, CEO of Society for Human Resource Management, said at the conference. For those workers born in the mid-to-late 1990s, or Gen Zers, the social contract between employer and employee is different, he added.

"They think if they've given you a year, you're lucky," Taylor said.

That changes the entire people-management paradigm. Despite nurses and doctors entering the profession because they feel they have a calling, if met in healthcare with stress, a rigid and inflexible atmosphere, low wages and a mountain of tasks unrelated to providing care, they're going to leave — especially if they're younger and less likely to stay as it is, experts said.

There's also the attraction of higher wages and better hours at non-healthcare jobs, which are also aggressively pursuing talent in a tight labor market.

"We've had nurses who have quit their jobs and come to work at Best Buy stores," Jayedo Kinikar, VP of virtual care at Best Buy Health, said at the conference.

Eric Eskioglu, executive vice president and chief medical officer at regional system Novant Health, said his system recently lost two medical assistants to Target because the retailer offered them $1 more an hour in pay, in addition to paying for their college tuition. 

"I'm competing with industries I never thought I'd compete with before," Eskioglu said.

Using digital tools to solve workforce pain points

Technology can play a huge role in enabling doctors and nurses to operate at the top of their licenses, while reducing burnout and improving job satisfaction and retention, HIMSS attendees said.

Though click fatigue is a perennial compliant for medical staff, EHR vendors and tech-savvy providers are working to ameliorate this by using tools like artificial intelligence and voice-to-text to streamline and personalize the medical documentation experience.

Paul Brient, chief product officer at Athenahealth, said in an interview that the health IT software company is investing in the configurability of the EHR, specialty-specific workflows and even personal preference workflows.

Primary care network One Medical uses natural language processing and AI to route EHR requests to the best worker who can answer it most quickly. That results in providers having 40% fewer tasks within the EHR by 4 p.m., according to John Singerling, One Medical's chief network officer.

"That may not sound like a lot, but in terms of recruitment and retention for providers, it's a huge thing," Singerling said.

Hospitals interested in retaining their workforce also should try to use technology to get staff the data they need when they need it, all in an actionable format, HIMSS attendees said.

Nurses in particular can benefit from this. Providers should implement technology and tools that gives nurses comprehensive patient data as soon as they enter the room, without having to sign in and search up various metrics, according to Susan Heichert, president of consultancy Cedar Isles Organization.

"You know as a nurse what you're going to look for. Why do you have to go looking for it?" Heichert said.

Serving up insights appropriately in the workflow is a major request of physicians as well. As medical data compounds at a surging rate — doubling every 73 days, by one estimate — doctors need it to be actionable and have tools that remove the friction out of the deluge of data, according to industry experts.

This area — using technology to tap the core medical workforce more efficiently — also is attracting interest from investors, who note capitalizing on existing employees is more inexpensive than hiring and training new ones.

"One of the big things the pandemic has exposed and accelerated is the need to optimize your current workforce," Taylor Whitman, a partner at Concord Health Partners, said at a panel on healthcare venture capital. "That's the cheapest way."

Finding less costly ways to combat staff attrition is especially important for small, rural hospitals, which are in an increasingly precarious financial situation after two years of COVID-19 that has winnowed margins. Such facilities often don't have the cash to compete for travel nurses and temporary replacement workers, which have charged elevated rates during the pandemic.

Technology also may help with staff shortages by replacing them in some areas, as more patient interactions are likely to go digital in the coming years. That coincides with greater adoption of tools like personalized clinical decision support, bots and omnichannel communication, robotic process automation, AI and virtual care.

Patients want self-service, and hospitals are increasingly investing in areas that require no additional human interaction, said Raymond Gensinger, chief information officer at Hospital Sisters Health System. 

"I think we're going to be pivoting quite a bit where doctors and nurses will only be delivering care to those who need hands-on care. The rest of the interactions will be digital, which will help solve some of the staffing issue," Gensinger said at a panel discussion.

Money talks, but so does a bottom-up, empathetic management approach

Even the most streamlined workflow and actionable data won't get doctors and nurses to stay if they're not being paid enough or finding meaning in their work, experts said at HIMSS.

"Money matters. Let's start with that. That's table stakes. You've got to pay people competitively if you want them to work," SHRM's Taylor said. That's followed by purpose, and the importance of "really reinforcing, at every turn, that what you do really matters," Taylor added.

"That at times can exacerbate some of the issues we're seeing, if they don't feel connected to the healthcare system — if they're just thinking 'I need to show up and get my paycheck,'" said Albert Marinez, Intermountain Healthcare's chief analytics officer.

At the same time, hospitals need to better train their managers, Taylor added. According to a recent survey by Ernst and Young, a majority of Americans said they left a previous job because their manager wasn't empathetic.

Women with children who are school age or younger, along with people of color, are more likely to stay with a manager they think is empathetic, said Diane Swonk, chief economist and managing director at Grant Thornton.

That relational aspect and sense of belonging is key, and is helped by managers listening to and soliciting feedback from their employees.

"It's really about providing to the leadership the employee view in, not our view out. They have to meet in the middle," said Mary Clancy, chief digital officer of Premier Health.

Hospitals also need to provide opportunities for professional growth, have a flexible work design and ensure their employees feel valued, experts said. Healthcare workers put in long hours, many for relatively low pay, and that — along with the pandemic — can chip away at their passion for providing care.

Management needs to make sure they make reigniting that passion a priority in order to become competitive in today's difficult labor market.

"People will come for money, they will come for the benefits you provide, but what's going to retain them is that calling," Johns Hopkins' Sunbul said.