Rae Woods (00:02):
From Advisory Board, we are bringing you a radio advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. The world is getting smaller and smaller, especially in healthcare, and as we look across the globe, we increasingly find leaders based with the same set of challenges and one of the biggest is the workforce crisis. Now, I'm not going to pretend that any country has all the answers, but we can look to each other for solutions. That's why I brought two international health experts to this podcast, Alex Polyak and Paul Trigonoplos. They talk about the current challenges facing healthcare organizations abroad and give lots of examples and tell lots of stories of solutions that you can use as inspiration at your home system. Hey, Paul. Hey, Alex. Welcome back to Radio Advisory.

Paul Trigonoplos (01:02):
Hey, Rae.

Alex Polyak (01:03):
Thanks for having us, Rae.

Rae Woods (01:05):
I feel like when I talk to the two of you as international healthcare researchers, I feel like I'm doing the equivalent of talking to a veterinarian instead of a physician. Do you know what I mean? Because you-

Paul Trigonoplos (01:16):
It's analogous.

Rae Woods (01:17):
It is because you have to understand how healthcare works, but also how healthcare works for every country, so it's not the same as how does the cardiovascular system work in humans. You have to know it for dogs and guinea pigs and horses. You're the veterinarians of Advisory Board research.

Paul Trigonoplos (01:32):
I love that.

Alex Polyak (01:33):
I don't mind that. Our goal is to keep everyone alive the same as a veterinarian, the same as any country.

Rae Woods (01:51):
Even though you two are international researchers and you spend your time speaking with organizations literally across the globe. Let's be honest, on this podcast, we do tend to focus on the US healthcare system. We are not going to do that today because as you two often tell me, there's a lot of benefit in looking outwards and seeing what is happening abroad. You talk to health leaders in other countries every day. What are the kinds of organizations that you talk to and what kinds of challenges are they facing in 2023?

Paul Trigonoplos (02:23):
So Advisory Board International is a dedicated research team that serves any client whose headquarters is located outside of the United States. We're in about 25 countries, payers, providers, governments, tech firms, but mostly health systems is where we focus and in terms of what they're dealing with, we're seeing a lot of commonality in other countries with health systems and what health systems in the US are dealing with. Costs are rising higher than revenue or income. A lot of operational issues, whether it's ED demand or throughput or access or equity, health equity or behavioral health, aging populations dealing with vague reforms and sort of this murky like navigating whatever the government's telling you situation and disintermediation is happening too with surgical care and virtual care and of course, staffing.

Rae Woods (03:17):
So other countries are grappling with a lot of the same issues that the US has been dealing with. That feels significant. Is that normal? Is it normal for there to be times in which the challenges that health systems are facing are as universal as they feel right now?

Paul Trigonoplos (03:34):
The way I think about it is in the lens of globalism and health systems relationships and their postures towards their peers in other countries, and globalism has existed in healthcare for a long time. Supply chains have been global, movement of clinicians and recruitment. Even some insurance companies have been global for a few decades, but when it comes to hospital operations, there's always been a, "No, we're going to operate the way our country operates. I'm not really going to pay attention to what's happening elsewhere." I think COVID brought a stress test that every hospital around the world dealt with and it brought some perspective to the provider space. There's a more of an acknowledgement now that other countries have solutions that are worth your time and attention. In my eight years on the team, I've never seen the appetite for overseas stories and insights as high as it is now.

Alex Polyak (04:29):
One thing I'd doubt, Rae, is that perhaps perversely, we are now all facing the problems of being victims of our own success in healthcare across specifically the last 50 years. Whether I'm talking to someone in Australia, in Saudi Arabia, in Latin Am, the fact that we're dealing with an aging population, a population which is living longer, but living sicker means that we're all having to reconstruct healthcare. Even last night, Paul and I were on a call where we were talking to a former politician who also is a GP who is a physician, and he said to us, "When we created our funding for physician care in Australia, care was episodic." You went in once a year, twice a year, you might go years without ever engaging with anyone. And now that you have chronic conditions, now that you have an aging population, this idea of funding for episodic care, it doesn't exist anymore. And that's something you see around the world. You see different problems based on different health systems and different funding models, but at the heart of it, we overall dealing with the fact that people are living longer or living sicker.

Rae Woods (05:42):
And we're seeing healthcare industries react in similar ways, which creates new sets of challenges. Paul, you've been on this podcast before talking about site of care shifts, something that is happening across the globe as an example of exactly what you're talking about, Alex, an aging population and an industry reacting to that and dealing with its ripple effects. I guess I'd love to know in all your conversations, be it Australia or Japan or wherever, in between, is there a central challenge that you think that leaders are grappling with today no matter where they are across the globe?

Alex Polyak (06:17):
The obvious one is workforce. That is perhaps the greatest common denominator that every single health system in the world, regardless of how you structure it, has two things in common, patients it serves and people it needs to serve those patients. And everyone we talk to, private or public health system, Saudi Arabia, Finland, Australia, the US, everyone is struggling desperately and struggling desperately, I would add, not just for any one type of clinician, but struggling desperately for doctors, for specialists doctors, for specialists nurses as well as registered nurses. And in many cases, it trickles on down to a lack of pharmacists in some countries to a lack of dedicated imaging professionals as we increasingly see in the US. We see that in many other countries as well. Everyone is crying out for more in the way of workforce.

Rae Woods (07:14):
And by the way, that is deeply connected to the other major challenge that you just mentioned, Alex, which is an aging population. People are getting older and sicker and in need of more complex care, which often means more or at least different caregivers that we just don't seem to have anywhere or we don't have enough of them everywhere.

Alex Polyak (07:35):
When you think about most of our industries, and this is something that Paul absolutely can speak to better than I can, but most of our industries have been able to dramatically scale without having to dramatically scale their workforce. Healthcare has not been able to solve that, but our ratios, yes, we now can expand them in some ways based on new technologies and clinical protocols, but by and large, we're still dealing with a one-to-one type of care in a way that very few other industries are when you're faced with such a demand.

Rae Woods (08:12):
I don't disagree that this is the kind of global challenge that healthcare needs to figure out. I think where our audience might frankly be a little bit frustrated is that this is a conversation that we have been having at Advisory Board on Radio Advisory in healthcare for a very long time. We've certainly been having it since the acute phase of the pandemic, but we all know that the challenges in workforce design and staffing existed long before we were dealing with COVID-19. I guess my blunt question is if everyone is facing this challenge, has anyone figured out an answer to the staffing crisis?

Paul Trigonoplos (08:57):
My sense is that no country as a whole has figured it out. What we're seeing internationally is pockets and specific organizations solving the problem in their own unique ways. And this is really coming up in partnerships. We've been doing a sort of international partnership archetyping piece of research lately, and one of the big goals we're seeing global partnerships pursue is improving staffing issues. There's a few types of partnerships we're seeing. So first, we're seeing organizations partner with nursing and medical schools to increase pipeline in clinical placements. One example here is Ochsner and the University of Queensland in Australia partnered to create a new med school and students train for two years at one and train for two years at the other, and ideally at the end of it, they'll be a better place to go to Ochsner or University of Queensland. Another one is partnering for training purposes to engage your staff.

(09:56):
We're seeing a lot of clinical rotation programs where especially residents can operate at hospitals in different continents to both be engaged in their job, get a new training opportunity, but it's also labor for each of those hospitals as part of the partnership. Three, partnering to get virtual support overseas. We're seeing a lot of systems access remote second opinions from Asia because it's a different time zone. So at night, you can call a doctor that's awake in a country like India, that's 12 hours ahead. And then lastly, on a macro level, and this is not organizational, this is more government, we're seeing a huge focus on partnering with governments to really get an immigrant pipeline to support clinician ability and ideally pipeline that way.

Rae Woods (10:48):
It strikes me that most of the examples that you just gave are meant to be kind of medium to long-term solutions except for maybe the consult telehealth example, but that doesn't necessarily change the fact that health systems right now don't have enough human beings to serve the acute needs of a complex population. And to Alex's point, those human beings can be physicians, they can be nurses, they can be psychiatrists, they can be medical assistants, anywhere up and down the chain of staff. Are there any examples in this world of partnership that help stave off some of the really traumatic supply demand imbalances that we're still seeing in 2023?

Paul Trigonoplos (11:31):
The one type of move we're seeing that has some immediate effect is the immigration partnership. We're seeing a lot of countries set up recruitment offices in different countries. So Newfoundland and Labrador just opened up a recruitment clinic for nurses in India, things like that. And a lot of countries, a lot of governments are going to India, going to Philippines, going to Malaysia, and setting up agreements with their governments to try to immediately get some pipeline to other countries. I'll say in pockets, it might work in the near term if you're an organization that has immediate benefit of it, but it's also not the most sustainable thing. For instance, the Philippines is the one country that a lot of healthcare leaders in the US think of when they think of overseas staff that come and work in the US. The Philippines has a shortage of a hundred thousand nurses and last year or the year before, the government capped the amount of nurses that they're allowing to be expats and go to other countries.

Rae Woods (12:30):
Wait, and it's because other countries were saying, "We need help. We are going to the Philippines to get nurses." And now the Philippines is short a hundred thousand.

Paul Trigonoplos (12:40):
Yes.

Rae Woods (12:41):
Oh my goodness.

Paul Trigonoplos (12:42):
There is a vying for talent from pretty much every country that has people right now. It's all fair game. And when you consider, I don't know how many, 50 to a hundred developed nations all trying to go to every country that has a lot of people to get these staff, it's not going to be that sustainable. Not every country out there can be fully staffed by these countries with a lot of staff that they're willing to have become expats.

Alex Polyak (13:11):
And the one quick point on that I want to make, it's not just talking about taking from developing nations. I had an Australian chief nursing officer say to me, "For the last 10 years, we were recruiting so many nurses from Ireland and we can't do it anymore. There are no nurses left in Ireland." And I actually, as she said that it was in a meeting, I hear a laugh from the back of a room, and it's another chief nursing officer who says, "Yes, and I was one of them."

(13:41):
The point I would also add though is that what a lot of countries are doing now is beginning to ask not who should provide care, but who can provide care, particularly when it comes to looking at new team-based models, particularly when it comes to looking at scope of practice. And I want to be really clear that I'm not saying we shouldn't ask who should provide care. Certainly, we are going and we have seen for years, if not decades, talk about scope of practice, particularly in the US around allied health professionals, APPs, Verizon, physician assistants and nurse practitioners, and of course the blowback from physician groups. And I'm not saying that there aren't valid arguments, there are, but we live in a permanent crisis at the moment where it just seems like there is never going to be, at least in the immediate next decade, a way out by just getting a larger supply of workers.

(14:42):
So we have no option but to ask ourselves a question, who can provide care, who currently is in the healthcare space, but can provide care at a baseline level of adequacy when it comes to talking about some of these areas. And that's what we see a lot of countries do a great job at. One example, I'll quickly give, one of the best team-based care models I see actually comes in the form of ACCHOs, which are healthcare communities for Aboriginal and Torres Strait Islanders in Australia, some of the most marginalized, economically deprived areas and populations in the country. And to be very blunt, historically, they have not been able to recruit nearly enough physicians and doctors because physicians and doctors, for a variety of reasons, for the economic reasons, frankly, for social and resist reasons, did not want to work in those communities.

(15:36):
So he said, "How can we expand the supply of existing aboriginal health officers, people who understand culturally sensitive care, people in the community, can we expand their scope of practice? Can we connect them better to existing models of care with pharmacies, create better forms of integrated care with primary care and acute care sites within those areas?" Which have to typically cover a much larger distance geography and a much larger population. Those models of care are now being trialed throughout for rest of Australian healthcare increasingly. And that's something that's before I would argue the last few years, no one would ever have looked at Aboriginal and Torres Strait Islander health districts as models of success to apply to the rest of Australia.

Rae Woods (16:28):
And it's a good example of why we need to look to other countries to creative ideas, to find solutions because what I'm hearing you say, which I think will resonate with a lot of US health leaders frankly, is that most of the short term pipelines have dried up. It may not be the same problem as the Philippines has where they have to say, "No, no, no one else can leave this country to practice nursing because we are a hundred thousand short." But certainly across the last few years, we've seen similar pockets of shortages pop up within the US when certain states, certain organizations say, we don't have enough people. Please send us an army of nurses. And we've done this kind of movement and seen short-term pipelines dry up. So then that leads me to what are the right steps that leaders should take to create a more, maybe the word is stable workforce.

Alex Polyak (17:27):
One of the things that we've seen other countries do a better job of frankly than the United States is the gradual recognition that we, as healthcare employers, are not just responsible for our employees' wellbeing in the workplace. We are equally responsible for their wellbeing outside of the workplace. One of the most popular resources that Advisory Board has put out in the last year comes from West Yorkshire and Harrogate Health Service in the United Kingdom where they created an informal caregiver's agreement. The idea being right that all of us have external responsibilities outside of a workplace and perform, in this case of caregiving responsibilities, whether you're looking after children, whether you're looking after a sick partner or a sick relative, whether it's looking at just trying to get some of the basic needs met, socioeconomic needs met of the rest of your family.

Rae Woods (18:24):
Maybe you're a new dog dad like Paul.

Alex Polyak (18:26):
Yeah, yeah, absolutely. The agreement very simply is part of their HRIS system where they can add this information voluntarily. Each employee can add this information to their employee profile so that their manager is aware of what responsibilities they have outside of the workplace and how therefore the manager can begin initiating conversations to be able to help them plan around those responsibilities, perhaps in the terms of different flexibility, in terms of shift work, in terms of remote work. But even more than that, just recognizing that they have pressures outside of work that frankly they bring to the workplace. We all do, and that creates a much healthier culture. Overall, I know we saw a lot of boost in the way of retention, the savings to the health system in terms of decreased turnover I know was definitely in the billions of pounds.

Rae Woods (19:29):
This is an example of kind of stopping the bleed of, "Oh my gosh, we have people who are leaving either healthcare in general or they are choosing a different employer," who's taking the approach that you're saying, Alex, which is again, creating this mismatch of supply and demand and these pockets where these staffing crisis is even worse than how others are feeling. And so step one maybe is you've got to focus on transforming what these roles are and how we see the clinical workforce so that they even want to stay.

Alex Polyak (20:06):
The other thing I'd quickly note there is that I think there is a cultural difference between the US and a lot of other nations in that, certainly in the US, we view it as entirely your responsibility, what goes on outside of the workplace, don't bring your personal life to work, but that's not feasible. We're human beings. What's more when it comes to these caregiving opportunities and to these responsibilities, if we weren't doing the caregiving, who do you think will have to take up the slack? The health system. So this is a way of actively helping us help you.

Rae Woods (21:50):
Alex, what you're getting to is what a lot of employees in general, not just in healthcare want, which is kind of the flexibility to be a whole person and to be thinking about what their lives are outside of just work. But that is one example of how we think about enabling flexibility. The other one is, frankly, I think a lot more literal, which is flexibility on where you work, when you work, what restrictions you have. Kind of what you were starting to get at when you talked about the APP and the backlash that we tend to see, what can we do there to use flexibility to get more out of the supply that we have because the mismatch mismatches so bad.

Alex Polyak (22:29):
It's something that in the US I would argue we're a little behind because we have the luxury comparatively to other industrialized nations of having a lot of workforce capacity. I know it doesn't feel that way, but comparatively, we do have per capita much more in the way of physicians and doctors, and we have a good international pipeline. So what a lot of US companies, US healthcare firms are completely missing is the need to move towards what's we call the Uberization of healthcare. The idea of all these different platforms which help you schedule a myriad set of shifts where someone can perhaps work six hours a week, but that will be that six hour shift, which no one else is willing to take on the graveyard shift as it were in some cases.

Rae Woods (23:21):
Wait, so you literally mean instead of hailing a ride, I can hail a nurse?

Alex Polyak (23:26):
Yes, that's exactly what it is. And in much the same way that you have an Uber driver who is saying, "I am available to take riders during these hours of operation," many of these platforms nurse Med do just that. They're taking the staffing availability of someone in the community, someone who frankly in many cases is a mother with small children, someone who has to look after elderly parents, someone who might even have a second job, but who has that qualification by clinical qualification and say, "I am willing and available to work in healthcare during these hours."

(24:13):
If you have availability, if you have need, we'll match you to it. And that's something that we are seeing much more frequently now in a number of European nations. It's something that we saw a few years ago in the way of Dorset integrated care system in the UK when they were staffing their urgent care centers, they developed an app essentially called the Dorset Passport, where they literally just populated it with all of these shifts that were needed, and then each employee could input their preferences and availability not just for shift, but also for site.

(24:51):
And the algorithm creates the best match so that when you, the employee, open it, you see from starting with the best match all the way down to what's available. Now, to be clear, I like Dorset because it's not purely in the hands of one or the other in terms of employer employee, rather it's saying, "Look, this is the best match we could give. You are still an employee. You have to choose something. You have to choose one of these options," but at least it's a negotiation. It's something that's taking into account your responsibilities to Dorset as your healthcare employer and your responsibilities outside of it.

Rae Woods (25:28):
I love this story, but I want to channel the voice of the past in my head that's going to be saying clinicians are not cars. How do we make sure that we are getting the right clinical experience, especially in the context of the huge demographic shift that we're dealing with as a community, as a country, as a world, how do we make sure that the right expertise is getting to the right place, not just the person with preferences for these hours?

Alex Polyak (26:01):
Well, these platforms do take into account the credentialing. They take into account the specialization of each clinician and they try to make this match really work as well. But I would argue, actually, one of the greatest open secrets in healthcare is how much talent there is lying around that we cannot bring in because we're trying to force fit it into existing shifts. I was talking to a chief HR officer over in West Virginia, WVU Medicine, and they created a special program, they call it the Nurse Commuter Program, where they essentially were just beginning to provide housing on campus for nurses. Because what they did, they looked at the number of nurses who left in the last five years was they realized hundreds of them close to a thousand I believe, lived 50 to a hundred miles away from Morgantown. Most of them had left to start families.

(27:06):
These were highly trained RNs. WVU Medicine is the only magnet accredited facility in West Virginia, and yet, it wasn't even so much about shift. It was about the fact that these people were living too far away to be able to dry three hours there, three hours back. But how can we try and beat the problem? Can we provide them housing? Can we try and find ways to restructure shifts? Can we bring in this talent in a way that is both sustainable and reflects, but changing realities of what they want from employment? And they did that. I mean, they did at a time, I think a few years ago when they had a vacancy rate, well over 10%.

Rae Woods (27:50):
So we've been talking about this global challenge of the mismatch of supply and demand, and it's happening all across the clinical workforce. But we've been talking a little bit more about nursing, which is I think where the problem is the most acute. And it's interesting that we're talking about how do we get more out of our supply with team-based care, with flexibility. I have to believe at some point there is a solution to this that is not just adding more humans.

Paul Trigonoplos (28:23):
You make a good point, and I think it rings true in the data. Healthcare is I think the only industry that has actually gone down in productivity over the last few decades.

Rae Woods (28:33):
Really?

Paul Trigonoplos (28:33):
Yeah. And this is something Alex talked about a few minutes ago, which is we haven't seen the same economies of scale and same innovations when it comes to technology and things like that. For a lot of reasons. It's hard. It's culturally and politically kind of difficult to implement things. We have privacy rules, et cetera. I get the pushback, but I think we're at a time now where there's a lot of opportunity when it comes to supporting nurses, and I want to emphasize that because physicians have long been the beneficiary of technology tools and especially AI. You help the person that makes the money, fine.

Rae Woods (29:09):
And by the way, people tend to think of nursing as a cost center, not necessarily ... That's just part of the problem.

Paul Trigonoplos (29:14):
Exactly. But we had a workforce summit with CEOs, chief nursing officers, chief HR officers in Brussels in October with a bunch of our European and Middle Eastern clients, and I heard two things when we talked about technology. One was that pushback, that I'm a CNO, I need nurse stories and examples. I don't need more physician data here. So that was that point well taken. And two was there was a Norwegian CNO that said they had mapped out all of the tasks that one of their nurses does, and they found that 128 of them could either be done by someone else or done by technology.

(30:02):
And years ago, when they were on a cost-cutting mission, they laid off a bunch of the support staff that could have handled that. I think that's a story that rings true in a lot of organizations and now, there's no one else supporting those staff. So when I think of AI and in nursing, when I think of technology in nursing, I'm seeing first AI can do a lot to help automate clerical tasks. Ambient listening tools can hear what's happening. The nurse, what's the nurse is saying, take notes on it can populate tests and medications. AI can also help with optimizing for scheduling. So we're seeing some stories where when there's specific RPM tools being used, a fetal heart rate monitor, blood glucose monitor. AI can help predict when the monitors need to be changed and the optimal number or the optimal cadence of in-person visits if you're kind of doing a house call, the optimal cadence of those based on the risk profile based on the data that's being collected.

(30:58):
So you don't have to just go show up at every single person's house every six hours. You can be a little bit more purposeful with your time. And then lastly, there's a ton of help being shown with AI for nursing in inpatient settings. So imagine like an observation ward, like an ICU, thinking about something like a virtual patient sitter who's sitting there in a room watching 24 patients at a time. There's AI tools that can help instruct them. When do you need to turn a patient to avoid bedsores? When do you need to take them to the bathroom? This is a huge engagement factor and productivity factor because the baseline now is you must go around on every patient at this amount of hours whether or not they need it, right? There's tools that are being used to sort of size the inputs to the care models.

Rae Woods (31:44):
And I can see something like that influencing the example that Alex gave around a program that captures the credentialing and the scheduling of people match that with but when does that person actually need to be there to best support patient care? And that's even more supply that you can get out of it. Frankly, I think the pushback that we're dealing with or the aha moment that we need to get the rest of the industry to accept is that healthcare is not different enough from every other industry that we cannot accept the same solutions that every other industry has found benefit in.

Alex Polyak (32:25):
It's a very short story, Rae, that when I used to do work on rural and remote recruitment and retention, and I would speak with a lot of different executives, and some of them would be from Northern Canada and from rural Australia and from hard to reach communities in the American Midwest, and we'd all talk about just how difficult it was specifically for them. And I remember thinking to myself, if you go back to your lit class in high school or college, the first line of Anna Karenina is, "All happy families are alike, all unhappy families are unhappy in their own way."

(33:05):
And I would say that to them, and we would all have a great big laugh because we sort of realize that yes, you can always get into a massive competition over who is more remote or who has it even harder to recruit for because how much more did we have to pay for that locum as opposed to you had to pay for your locum physician to come for six weeks, but these are the exact same problems. These are the exact same challenges, at least in structure, if not always in scope. And I think that is what we are beginning to realize more and more when we look at healthcare around the world.

Rae Woods (33:42):
Well then, when it comes to the global staffing crisis, what is your one messenger takeaway that you want to leave our listeners?

Paul Trigonoplos (33:50):
I want to double down on the concept of employer of choice, which I know is a phrase that some of our research has used. I like the phrase because it gets at the fact that for any healthcare organization to attract and retain the staff they need in the future, it is up to them to sort of make changes. I think we for a long time had a, if we build it, staff will come mentality, and that's not a guarantee anymore. The point I want to make though, when you think about how to make your organization an employer choice is that you cannot do every single thing you need to do to appeal to every single person that is employed by your organization.

(34:32):
You're going to have to pick a finite number of things and a finite number of roles to focus on to engage. We do have a tool, an employee expectation gap analysis to help members find the weak points and map it on to what they kind of need to focus on. And it uses a peer organization benchmarking kind of methodology to understand where are we here if we want to engage nurses or if we want to stay up to date, what the rest of the industry when it comes to flexible staffing and things like that. If I were a CEO, I would start there and I would pick the three biggest roles that I need to retain right now.

Alex Polyak (35:09):
Well, one thing that I would really add because I think that's a phenomenal point, Paul, is that we as healthcare leaders, as healthcare organizations can learn a lot from our peers around the globe. We can also learn from other industries. We can only do this if we create space and opportunity to do that. And there's an example that I love from Shiba in Israel, why [inaudible 00:35:33] is one of the greatest medical centers in the world, and I know we've talked about Shiba before on this podcast. We've published about it. They have a leadership development program called the Top PO program where they take five leaders from across the health system each year.

(35:49):
So including nurses, including physicians, different specialties, and they subject them, and I use the word deliberately, subject them to essentially a multi-year MBA style program where they go to learn about other health systems around the world as well as other industries, including, the one I love was they sent these five leaders to the Port of Haifa to study supply chain management and to study how different containers were loaded and unloaded to see how that could impact throughput. I mean, that's an enormous level of innovation. That's an enormous creation of a space to understand different perspectives, but you can even do it smaller.

(36:32):
 Here in the US, New York Presbyterian has a future of work committee bringing together leaders from across the system to really just serve almost as a book club to serve in many ways as a way of keeping track of different technological changes and very impact on the workforce so that you begin asking yourself not just what the technology's impact will be in terms of making our health system better, but what can we then do with that freed up time with those freed up FTE hours and they look at different examples from around the world in different industries. And so just holding that space and time and making it a part of your leadership portfolio has enormous distance.

Rae Woods (37:16):
Well, Paul, Alex, thanks for coming on Radio Advisory.

Paul Trigonoplos (37:19):
Anytime.

Alex Polyak (37:21):
Thank you.

Rae Woods (37:26):
If you couldn't tell from that episode, Advisory Board has an entire team dedicated to global trends and innovations in healthcare. You can find some of their work in our show notes and a ton of it on advisory.com. And like I said, this isn't the first time we've tackled the workforce crisis or the nursing crisis in particular on this podcast. We have an entire playlist related to our workforce challenges because remember, we are here to help. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts and leave a rating and a review. Radio Advisory is a production of Advisory Board.

(38:10):
This episode was produced by me, Rae Woods, as well as Katy Anderson and Kristn Myers. The episode was edited by Dan Tayag with technical support by Chris Phelps and Joe Shrum. Additional support was provided by Isis Monteiro, Carson Sisk and Leanne Elston. And one more thing. The podcast team wants to know how we can make the podcast better for you. So we created a quick listener survey at advisory.com/podsurvey. Please take it and let us know what you want to hear on Radio Advisory. Thanks for listening.