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Proceedings Executive Summary
November 30, 2001
"Workforce Solutions and Readiness"
This year's 18th Annual Health Care Systems Leadership Retreat was re-scheduled from its original venue following the terrorism events of September 11th, and re-formatted to include the vital topic of workforce disaster readiness. As in years past, the Retreat carried on the tradition of health system colleagues networking and learning in an intimate setting, as well as advising the Health Care Systems governing council and the AHA Board of Trustees on issues of great importance to health system members. The theme of this year's Retreat, Workforce Solutions and Readiness, was derived from last year's Retreat when workforce was selected as one of the top priorities for the new millennium, as well as discussions by the Health Care Systems governing council at their spring and summer meetings. The future of the entire health delivery workforce was coincidentally identified as a top priority of the AHA Board this year, as witnessed by the formation of a Commission on Workforce for Hospitals and Health Systems and the AHA legislative and policy agendas for 2002 and beyond. Hence, the outcomes of the Retreat dialogue were intended to benefit all health systems as well as the broader work of the AHA Board.
Objectives of the Retreat discussion were to:
- explore facts surrounding today's health care workforce, its shortages and future demands;
- discuss newly-released national research on employee commitment in the health care field, employees' perception of organizational performance, and the workplace practices that drive workforce commitment;
- discuss implications of disaster readiness and response and the impact on staff and staffing;
- identify key system workforce/workplace strategies and ideas that are working; and
- recommend advocacy, policy development, education and/or services AHA might consider to help members address these issues.
The day's format included presentations on the status of the current health care workforce and charge to the AHA Workforce Commission; Healthcare @Work 2001, a national study of employee commitment in the health care field; and the workforce readiness experience of Saint Vincent Catholic Medical Center on the front lines of Ground Zero. Two health system executives showcased workforce initiatives underway in their systems and a dialogue concluded the day where participants shared recommendations with members of AHA's Board and executive management on strategies the AHA can employ to support workforce efforts now and in the future. Highlights of the Retreat presentations and dialogue follow.
Today's Health Care Workforce
Jim Bentley, AHA Senior Vice President for Strategic Policy Planning, kicked off the Retreat with remarks on the challenges of today's workforce shortage. Noting the operational challenges associated with forces increasing costs and decreasing revenues, Jim discussed the current shortage of workers throughout health care-nurses, pharmacists, radiology and laboratory technicians, food service workers, housekeepers, and IT professionals. He stated this is not a short-term shortage and, while the shortage may diminish as the economy weakens, it will not go away and more likely will become worse with time.
Several causes are identified with the current shortages:
- the workforce is aging and as baby boomers retire, the cohorts behind them are smaller
- fewer are choosing health care as a favored career option because it is perceived as low tech, less secure, shift work, offering less psychic reward, and more choices for women
- employee dissatisfaction is high in health care attributed to the stressful environment, amount of paperwork, and desire for more communication and growth
AHA's response to this information was the creation of a Commission on Workforce for Hospitals and Health Systems, comprised of 27 members inside and outside of health care, charged with developing bold goals and actionable recommendations. With a final report expected in April 2002, the Commission has developed a framework around five themes: work partnership, work design; broadening the employee base; partnerships; and societal support.
Leo Brideau, President and CEO of Columbia St. Mary's Hospital in Milwaukee, and a member of both the AHA Board and Workforce Commission, addressed the Commission's desire to provide doable strategies that can be employed today to prepare for longer term solutions. Included in the multi-faceted solutions is the need for employee accounting systems, attracting non-traditional people into health care, enhancing educational partnerships and increasing clinical training sites.
Members felt the Commission is headed in the right direction and suggested the Commission consider the following:
- impact of physicians on other health employees and the work environment
- pay and benefit issues across time for employees in the same position
- initiate market research and a positive image campaign
- create ways to expand labor pool (specifically to attract minorities, males and youth) and retain simultaneously
- consider renaming/re-branding health care
- redesign the deployment of the professions
- frame the issues (important-positive)
What are Health Care Workers Telling Us?
David L. Stum, Ph.D., president and founder of Aon Consulting Loyalty Institute in Ann Arbor, shared results from the second year of Aon Consulting's state-of-the-workplace report, Healthcare @Work 2001. This research establishes the first healthcare Workforce Commitment Index-the national measure of employee behaviors that define commitment-and investigates the organizational factors and conditions that influence that level of commitment.
The Loyalty Institute has defined Workforce Commitment as a measured outcome stemming from responses to six specific questions pertaining to Productivity, Pride and Retention. Nationwide employee focus group research revealed that committed employees:
- Work hard to improve themselves, increasing their value to their employer, and they make personal sacrifices to ensure the employer's success. They are productive.
- Recommend their organization as a good place to work and recommend their employer's products and services. They have pride in their work and organization.
- Intend to stay for the next several years even if offered slightly higher pay elsewhere.
They are retained by the employer.
Employees' commitment is influenced by organizational attributes that are controllable, as opposed to societal, economic and psychological factors that influence individual commitment and motivation but are uncontrollable variables. Aon's 'Performance Pyramid' model parallels Abraham Maslow's 'Hierarchy of Needs' model of the 1950s, with five levels of workforce needs: Safety/Security, Rewards, Affiliation, Growth, and Work/Life Harmony. Research results assert that needs at the foundation of the Pyramid (beginning at Safety/Security) must be met before attending to those at higher levels (ending at Work/Life Harmony) and that these five workforce needs are essentially the "drivers" that influence workforce commitment.
Aon's 2001 study, based on feedback from over 3,400 employees, focused on how healthcare organizations can retain their key talent. The results indicate there is not a single or easy solution but rather a multi-faceted approach that encompasses reducing stress, increasing staffing levels, competitive pay and benefits, effective management/supervision and opportunities for growth. The most significant lesson from the study to realize is the overall need for improvement in all workplace practice areas in health care. Healthcare performance scores in 2001 are 9% to 28% worse than the scores found in all U.S. workers. These data confirm the call to action across the health care field to re-think the health care work environment and re-invent the workplace practices that take care of employees with the same emphasis given to taking care of the patient.
See Aon's 2001 Healthcare @Work Report for detailed results.
Health Care Workforce and Hospital Emergency Readiness
Although Saint Vincent Catholic Medical Center, located on 7th Avenue in Manhattan, conducted internal disaster drills twice a year and city-wide drills annually, it had never had to respond in a way necessitated by the terrorist attacks on the World Trade Centers on September 11th. Mark Ackermann, Senior Vice President and Chief Corporate Services Officer, chronicled (recounted) the events of September 11th and the ensuing anthrax scare in terms of its impact on his medical center staff, communications, finances, the media, and future preparedness.
Mark shared some areas for improvement from their lessons learned:
- improved policies on volunteers and blood donors
- improved sharing of patient information among facilities
- improved patient access in emergency areas so that regular appointments can be reached
- additional system-wide and city-wide communications
- 'Business Interruption Insurance'
- increased advocacy efforts to enhance timeframes in working with FEMA and other government agencies to receive financial assistance
As a result of this experience, preparedness for nuclear, biological or chemical (NBC) events is underway at all levels. Examples of activities follow.
Regional NBC Preparedness Efforts:
- working with regional hospital associations and city-wide OEM to develop ability to better communicate
- developing new EMS protocols on transport of contaminated patients (biohazard suits needed for personnel)
- developing redundant communication systems
- developing a data sharing system that enhances surveillance and detection, and identifies excess resources
Saint Vincent Catholic Medical Center System-Wide Preparedness Efforts:
- system-wide NBC communication is developing NBC protocols for incorporation into all system facilities' disaster plans
- focus on staff training, pharmacy, medical supplies, facility needs, development of communication disaster response plans and system communications to assure efficient sharing of resources
Workforce issues to consider, at the forefront of all these plans, include:
- short- and long-term emotional and psychological effect on employees work and employment
- need for continued education for NBC events with employees and larger community
- decision on policy regarding employees during a NBC event: will employees stay during a NBC event or leave to be with their families?
Mark estimated the costs of Saint Vincent's preparedness efforts to be $10 million. Stating, "I never thought if and now I think when," he concluded by saying that some New Yorkers are beginning to forget September 11th. A Wall of Hope and Remembrance has been built by Saint Vincent Catholic Medical Center so that this day will never be forgotten.
Participants were most appreciative of the story shared and lessons learned from this tragedy. The primary issue raised-how much preparation, storage, investment is enough?-was discussed but not resolved. Following the discussion a 20-minute videotape depicting an actual Israeli bio-terrorism disaster drill was shown, in order to share ideas of where we may be headed. Personal copies were provided to members for use at their institutions.
Small Group Discussions: System Workforce Ideas that Work
Steven Lipstein, President and CEO of BJC HealthCare in St. Louis, and Jolene Tornabeni, Executive Vice President and COO of Inova Health System in Falls Church, shared workforce initiatives underway in their health systems that are addressing workforce redesign and workplace environments. Participants then used this information as a springboard for joint dialogue and discussion on ideas at work in their systems.
Next Steps: The Leadership Challenge
A member dialogue followed the afternoon's group discussions, where feedback was solicited on recommended strategies the AHA should employ to support workforce initiatives and key activities for systems to demonstrate leadership in meeting workforce needs. Suggested ideas included:
- separate the Workforce Commission agenda into two components: (1) issues of today and (2) issues of the future (ways to recruit young people into the profession)
- conduct market research on successful ways to attract people into health care professions
- create a 'positive image' campaign and market it aggressively
- recognize recruitment and retention are parallel concepts, continually impacting one another
- clarify and remove regulatory wedges between physicians and health systems
- collaborate with others (e.g. Department of Labor) as appropriate on economic issues
- work to promote appropriate physician supply
- create a stimulus package to attract people to the health care profession (e.g. loan forgiveness in exchange for years worked in a certified health care facility)
Recognition and thanks were given to the Retreat sponsor, WebMD, for its generosity and to all the day's presenters, discussion group leaders and participants.