Rae Woods (00:02):
From Advisory Board, we're bringing you a radio advisory. My name is Rachel Woods. You can call me Rae. On this podcast, there are certain topics that we come back to again and again, because they're even more urgent or maybe because there's a new perspective that can help leaders overcome this problem. One of those topics is the workforce crisis, or as we'll talk about today, this idea that there is a great resignation in healthcare. The new perspective that I want to talk about is that it might not actually be the great resignation at all, but there are things that leaders can do to cement themselves as the employer of choice. So to talk about all of this, I brought three leaders from Advisory Board, Alex Polyak, Monica Westhead, and Eliza Dailey. Alex, Monica, Eliza, welcome back to Radio Advisory.

Alex Polyak (01:04):
Thanks for having us.

Monica Westhead (01:05):
Thank you for having us.

Eliza Dailey (01:07):
Hey, Rae.

Rae Woods (01:08):
We're going to do something dangerous and we are going to have a conversation about lots of different aspects of the healthcare workforce today. Normally each of you is on to talk about just one sector, just the nurses, just the doctors, but we're all coming together to talk about the healthcare workforce writ large. I hope there is not going to be, dare I say, a brawl of one part of the healthcare landscape saying, "No, we are the folks that need more support." "No, it's the nurses." "No, it's the doctors." Poor Alex is just going to be stuck in the middle.

Alex Polyak (01:39):
It wouldn't be my first time.

Monica Westhead (01:43):
Healthcare is a team sport.

Rae Woods (01:44):
You're right, Monica. Healthcare is a team sport. All right. So by now I'm sure that each of you has heard this common term, that's not just in healthcare, but is in practically every headline that I see. It's this concept that there's a great resignation, certainly in America right now, as we deal with the ongoing effects of the COVID-19 crisis. This is of course not just affecting healthcare. This is affecting all industries, but I want to ask you, how is the great resignation impacting healthcare specifically?

Monica Westhead (02:29):
I think the great resignation is very much showing up in all industries, and we're seeing reflections of that in the healthcare world as well. What's potentially interesting is that, although we're seeing a lot of people leaving their jobs, they're not necessarily leaving healthcare entirely. So if we think about nursing, for example, what we've been saying is it's more of a great reallocation than it is a great resignation.

Monica Westhead (02:56):
Nurses aren't necessarily leaving nursing together, but they are certainly willing to leave their current organization and their current role for another role that provides them with something that aligns with what they need, whether that's more flexibility, or whether that's different hours, or even just better pay. So we've been thinking about it as the great reallocation rather than the great resignation.

Rae Woods (03:22):
And why is that nuance important, that it's more of a realignment/reallocation than an all-out resignation?

Monica Westhead (03:29):
I think it's a little bit of a silver lining. Certainly it's always really scary and really intimidating when you're seeing a lot of staff leave, especially in a critical role like nursing. But I think what the good news is in this case is they're largely not leaving the profession entirely. We're not seeing a mass exodus from people working in nursing. Now that doesn't lessen the pain of the churn and the turnover that organizations very much are seeing. But at the same time, I think it's important to realize this is not an exodus from being nurses. It is a desire to look for a role that better fits what an individual needs at a specific time.

Eliza Dailey (04:12):
That nuance is important too, because they are two different problems, and so they require different solution sets, and we'll get into that a little bit later. If your workforce isn't planning to leave healthcare, but is just looking for different opportunities that does mean that there is space for you as the employer to better retain them at your organization.

Alex Polyak (04:33):
It's not only the opportunity for a fix, but where I want to come back to what Monica and Eliza have said is that, yes, they're not looking necessarily to leave healthcare for other industries, but they are looking to other industries in terms of what benefits, what flexible work offerings, what type of new evolution of work-life balance you're seeing. Right? Even though we work in healthcare, we have friends in every other industry. And when it seems like every other industry has done something better for their employees during COVID, healthcare undoubtedly will come across as a bit of a laggard.

Rae Woods (05:07):
So there's this nuance in the healthcare space where there's all this inspiration coming from every other industry. But what we're not seeing is, let's make fun of ourselves for a second, consultants leaving their cushy healthcare business research job to, I don't know, open up a brewery in the rural parts of Ohio, which I may or may not have thought of at certain points during this pandemic. Instead, what we're seeing is exactly what we've talked about on this podcast before, Monica, where people are leaving their employer or their specific role or their specific job to find something that is better. Here's the thing. I have to believe that this might play out differently, depending on which stakeholder we're talking about. Monica, you obviously work with nurses. Eliza, you are our representative for the docs. And, Alex, you kind of work with everyone. Are there differences in how we're seeing this play out across the healthcare workforce?

Monica Westhead (06:04):
I think to some degree in the nursing world, we're dealing with systemic issues that have been in place for a long time, desire for more flexibility, that sort of thing. But now we're reaching a point where nurses are more willing to leave to get those things. And I think I totally agree with Alex when you were saying that they're looking to other industries to see what is out there. Now, what I will say is we've been hearing a lot, at least I've been hearing a lot, from nurse leaders about concerns about nurses moving into non-clinical or non-direct care roles. The reality is that there really are not that many positions available.

Monica Westhead (06:39):
So nurses that are leaving, they can't necessarily go to these non-direct care roles because they don't exist in the numbers that we would need them to for everybody who wants them to do that. So I think for nurses, it's more about how do we try to work on some of those older systemic issues, like flexibility, like rewards, like scheduling that would really have a significant impact on the way that they feel the level of respect that they feel in their jobs.

Eliza Dailey (07:12):
And I would say when we think about the physician side of things, I think we are seeing a little bit of this great realignment, but it's playing out to a lesser degree than what we're seeing in other roles. So generally physicians tend to be more risk averse. There's some structural barriers that tend to keep them in their jobs for longer. For example, they built up a panel. They've built up a practice. There's a huge opportunity cost for them to shift roles. They also have more regulatory things in place like non-competes and licensing. And so we do see a little bit of movement in the physician space, but less than what we're seeing in nursing, or maybe other roles in the workforce.

Rae Woods (07:54):
Do we have actual numbers to back up what the both of you are saying? Because I agree. These are things that I hear. There are definitely things that I hear from my conversations with healthcare executives, but how does it actually play out proportionally? Do we have actual data here?

Monica Westhead (08:10):
I will say that on the nursing side, we will. So we are in the process of putting together the results of a very large clinician survey that we did across the late spring. And that survey will speak to things like how many people are considering leaving their roles? What are the primary drivers that would make them make that decision? And what's keeping them in their current role. So a little bit of a spoiler alert, but we don't have the results just yet, but that certainly will be coming.

Rae Woods (08:38):
Eliza, do we have anything for the docs?

Eliza Dailey (08:40):
On the physician side, we do have some longstanding data going back to about 2012, so 10 years of data showing that about half of physicians have considered a career change. So this could be switching employers, retiring early, leaving medicine altogether. And then over that same period of time, we've seen that turnover has remained fairly constant. So you have about half of doctors who are considering a career change, but turnover has stayed around seven to 8% annually. I will say that we're seeing some data showing across the last year or so there may be a little bit more movement due to COVID.

Eliza Dailey (09:18):
You're seeing more physicians actually acting on that discontent, but that is more so maybe changing practice settings or maybe switching employers, not leaving the field altogether. And the one thing I want to say, because I don't want our listeners to hear this and think, oh, this is the same problem we've had for 10 years. They're not actually leaving. We don't need to do anything about that. The fact that half of our physician workforce is so unhappy that they're considering a major career change should set off huge alarm bells and should be something that all executives are focusing on and trying to fix.

Rae Woods (09:53):
This is tricky because as a leader, you should not be satisfied with the fact that people are so unhappy in their jobs that they are considering leaving, even if that is not what their actual behavior is doing. Alex, I'm curious if this is a trend that you're also seeing in the larger healthcare workforce, not just the clinical workforce, not just physicians. Are the preferences actually leading to change in where people are aligning themselves? Or is this the same problem we've had for a decade?

Alex Polyak (10:27):
No. It's actually a very new and kind problem. And what I would say is new and kind is actually born out by survey data over and over where through the 2000s, 2010s, really the last 20 years, every survey has shown that pay was the deciding factor of workforce preference in healthcare, but also frankly, in almost every other industry. Starting in 2020, for the first time ever, pay was no longer the first choice. It was always some form of my workplace cares about my wellbeing. My employer cares about my work life balance. My employer has some degree of social responsibility. Those are now top three along with pay, and this has changed. And there are two sort of mind shifts that I think healthcare leaders have to make. Both of them are things we've taken for granted, frankly. I was talking to a chief technology officer who asked me, do people no longer care about job security in healthcare?

Alex Polyak (11:31):
And I say quite bluntly, no, they don't because this is no longer the market for it. This is an employee's market. You can go out, get a new job within five minutes if you want. And frankly, I think there are people who are already being pinged every five minutes for a new job. But the second one, and I know Monica and Eliza can say a lot about this, is that we took our healthcare workforce were granted in terms of saying healthcare is unique. This is a mission driven industry. So whatever sacrifices you have to make, you make because you went into it with eyes wide open. And I don't think that sticks anymore. And if we're being honest with ourselves, it barely stuck before the pandemic.

Monica Westhead (12:10):
I totally agree with Alex. I think, especially in the nursing world, it was very easy to lean on the fact that nursing is a calling, that people are called to do this profession, and to serve others. And certainly many nurses, most nurses, go into the field, at least in part because they want to serve people and they want to play that role and they want to help. But at the same time, I think it sounds hollow to a lot of employees to feel like they're being told you're in this for the mission. You're in this for the calling when there are real systemic issues that make it difficult for them to stay in their current job and manage that with their home life as well.

Rae Woods (12:52):
If this is such a longstanding problem, why haven't we been able to get ahead of it? What is it about healthcare that is preventing us from doing the real hard work and instead just defaulting to the mission of healthcare, and I want to be the place where you can execute on that mission? Why haven't we been able to go deeper?

Eliza Dailey (13:13):
I would say one reason is that as much as workforce is in the spotlight right now, that wasn't always the case. And today we have the attention of the CEO, the CSO, the CFO, they all care about workforce today, but in the past, a lot of these issues have been relegated to HR or the respective clinician leaders. And so this really is a moment where we have the whole C-suite bought in to the fact that this matters, but that hasn't been the case in the past.

Monica Westhead (13:43):
I would also say that in many cases, staffing is seen as a cost center. So particularly when you think about nurses or you think about aids or other people that are not directly revenue generating like physicians, they can be seen as a target for cost cutting, as opposed to necessarily a critical part of the strategic organization.

Rae Woods (15:14):
That cost center challenge is most evident in the nursing workforce, perhaps more so than when I think about the physician landscape, which kind of gets me into the differences in the things that leaders are willing to do to address this problem look different when we look at different parts of the workforce. And to say the quiet thing out loud, I hear a lot of folks being willing to go much further in support of the physician workforce than I think they're willing to go in some of these other areas, nursing, certainly bedside nursing, RNs, not to mention the post-acute workforce, some of the other kind of lower level members of the clinical team. But what you're saying is we also can't rely on those folks to just believe that they're here for some kind of a calling. Right? We need to do more to support those people.

Monica Westhead (16:10):
I would actually argue that we need to start with focus on some of the unlicensed members of the care team as the most critical foundational part of engaging the entire care team. Because if you don't have enough CNAs, for example, someone's going to do that work. And that's probably going to be a nurse. It could end up being another member of the care team. And that is not only inefficient from a staffing perspective, but it's also really disengaging to feel like they don't have the support that they need in order to do their jobs. And so when I think about missed opportunities that a lot of organizations have when they think about staffing, putting some focus on those unlicensed roles, aids, and techs is definitely an area that I think is ripe for additional focus.

Alex Polyak (16:59):
I wanted to go off of that, Monica, because I remember hearing a very inspirational quote from a physician actually about the future of nursing. And he said unless we value the idea of a multidisciplinary nursing workforce, one that is almost all-powerful, omni-present, one where they develop multidisciplinary work streams where nurses actually take the lead and develop care in multiple different directions, then healthcare does not have a sustainable future. And again, that comes from a physician. So there's something there. And not only right in terms of CNAs, RNs, and nurse practitioners, but across that board so that you see in every one of those roles, as you say, not only a logical career progression, but a logical and consistent ability to develop yourself and feel empowered that this is a true vocation, not just a pay stub.

Monica Westhead (17:56):
I actually want to speak to something that you just said, Alex, and that is that it's a true vocation, especially in the aid level of staff, and I see this a lot in post-acute care as well. We find organizations not necessarily willing to invest in those staff in terms of education or other types of support because they figure they're going to turn over anyway, because those levels do have extremely high turnover. At the same time, it's important to realize that these individuals may want to use this position as a jumping off point to go back to school and become an RN. They might not. They might want to continue in this as a career, and if we're not willing to invest in them and we treat them as people that we know are going to turn over, we know we're going to leave in six months, it's going to be a self-fulfilling prophecy.

Rae Woods (18:46):
What you're both getting at is the fact that there are much bigger business consequences than I think the market is willing to admit to themselves. Right? This is more than just labor costs going up. Although to be clear, that is an incredibly big pain point right now. I want to give the three of you a moment to just kind of go back and forth and give our listeners a sense of the business consequences that are at stake if they don't get ahead of this problem. Labor costs is one. Turnover is another that we've talked about. What else?

Monica Westhead (19:20):
I mean, right off the bat, I think patient safety and patient experience are critical because if you are not able to have consistent staffing, if you're not able to have enough staffing, that has potential impact on patient safety. It also has potential impact on patient experience if people feel like they're waiting for care. The other thing that I often talk about executives with is this is something that can prevent you from growing. You can build a new tower. You can have all the demand you want, but if you don't have enough nurses and aids and techs and transport staff and phlebotomists to staff up those beds, you can't grow.

Eliza Dailey (19:58):
Those are such important points, Monica. And the other one that I would say is so much of this is interconnected. So there's a reason that we have the three of us on the podcast representing different segments of the workforce. If you look at physician turnover, for example, one of the top drivers is actually care team turnover and having inadequate care team support. And so if we want to retain our doctors, we also need to focus on retaining the rest of our staff. This also has huge implications for the pipeline. If we are seeing folks turning over early on in their career, then that will have downstream effects if we don't have enough tenured, experienced staff members. So one of the huge implications of this is that we need to take a cross workforce view of these challenges rather than sitting in our individual silos by role or by clinician type.

Alex Polyak (20:49):
I do want to go back though to just something we've been talking about, which is the idea, the perception, especially of nurses as a cost center, the idea of labor costs as being this continual crisis. And I don't want to suggest that it's not a continual pressure, but the real labor cost crisis is not actually how much we pay them, but how little time they actually spend working at the top of their license. That's where the real losses come to an organization. And this is for physicians. This is for nurses. This is frankly, even for a lot of medical aids, that if you are not working at the top of your license, meaning doing the things within your education and training, that only you can do, no one else can, then that is the most enormous waste of money for any health system.

Alex Polyak (21:42):
And the main reason why people don't work at top of license is because there aren't enough with them. That's why you have nurses making beds. That's why you have physicians doing so much more administrative work year by year, in and out. And so I often say to healthcare leaders, it's not about how you do more with less. It's about how do you actually reposition every employee to work in a way that maximizes both for education and for talent. And that's where healthcare, I think, has more opportunity even anywhere else in terms of cost savings and labor.

Rae Woods (22:17):
Well, let's talk about that opportunity because we're just getting off this kind of reality check of how widespread the business consequences are. What are the things that you want to see employers do first to start actually getting ahead of this problem?

Monica Westhead (22:33):
One of the things that employers really need to think about is benefits. So certainly compensation is important and is critical for keeping people happy. But at the same time, I think many healthcare organizations benefits do not match what can be found outside of healthcare. And so that is one area that I would start. The other area, which is, I think, is a little bit different, is thinking about ways in which you can use technology, not to substitute for staff, but to make staff members' lives easier. So we're seeing technology used to handle appointment scheduling, to handle staff scheduling, so a nurse manager isn't sitting there and assigning people to shifts every day and nurses can actually choose their own shifts. We're seeing a lot more technological support for care management. So anything that you can invest in that will supplement and help a clinician is certainly an area that I would want to see more organizations investing in.

Alex Polyak (23:37):
In terms of benefits, I always say that benefits have to be continually reevaluated because what people want, what employees want changes frequently. I know it's such a trite example on the face of it, but 10 years ago, no one talked about pet insurance. Now, if you look at it, that's one of the things that millennials and gen Zers definitely want, because if we're also honest, we're much more likely to have a pet than to have a child or to have a child much later on after they've had several dogs, let's say. And again, I know that sounds trite, but that is a real and tangible example of how you have to reassess benefits.

Eliza Dailey (24:18):
But I also think there's these core foundational things that haven't changed that we haven't been able to deliver on. So I'm thinking of things like, do clinicians have enough time to spend with patients? Do they feel like they have adequate support to do their jobs? Do they have autonomy that's meaningful and that they can experience in their day to day? And so it's really, how do we make the practice of medicine more sustainable? How do we make it more enjoyable? And it's nothing really sparkly and new. I wish I had something new and exciting to say, but it's really going back to the basics and figuring out how can we make clinicians feel more supported in their jobs. And like they have a more sustainable experience at work.

Rae Woods (25:03):
And I know you just described this as going back to basics, but I also think it's slightly more complicated to be thinking about all of the nuances of your benefits and all of the small things that you're doing to help real people than to just pay them more money, or then to just say, hey, we are here to deliver the best care and you can do it through us, which brings me to perhaps the biggest challenge that we've left unsaid in this conversation, which is that if competition for these employees is getting that much more complicated, who's offering pet insurance. Maybe I'm being a bit comical there, but really who's offering the right flexibilities and the right role and the right environment, but also we're seeing more people move to remote work. We're seeing people swap industries or move away from the kind of lane that they have been in for the last several years or maybe even decades. The bigger question is how can anyone actually cement themselves as the employer of choice, if the competitive landscape is that complex?

Alex Polyak (26:14):
It requires an enormous willingness to both innovate and be brave about, I hesitate to use the phrase sacred cows, but to attack the sacred cows of healthcare workforce policy. We talk about the three 12 nursing shift, the sort of gold standard that we've used for decades upon decades. But we know that especially for a lot of nurses who are late tenure, it's not sustainable for them physically or mentally. And is it better to have a nurse for 12 hours a week at that age or not at all?

Monica Westhead (26:53):
I think one of the big things to think about when thinking about becoming an employer of choice is understanding what the unique strengths of your organization are. So there are some people who for lifestyle or family reasons would really like to only work weekend shifts. That is something that a hospital can offer. When you think about a post-acute organization for a nurse, I think there is a real sense of autonomy that they can have in a skilled nursing facility or in a home health world that may not feel the same to them in a hospital. So it's thinking about what are the unique things about your setting, your organization, the patient base that you serve that will attract members of the care team to feel like this is the right place for me.

Eliza Dailey (27:42):
And I think it requires making hard trade offs. A lot of employers today, I think are trying to be everything to everyone. And I think what Monica's really getting at is that we can't do that, but if we can really zero in on the things that our organization is really good at and uniquely positioned to do, then that's going to attract the right people to our organization. So that means having a really clear sense of the things that we do offer, but also the things that we don't and really embracing those trade offs as an organization.

Alex Polyak (28:16):
And where I just want to sort of come back to what you're saying very Eliza is that everyone right now seemingly is competing on money. But when you create a new and kind employee value proposition around flexibility, around work life balance, around new and kind policies or better career development opportunities, those actually have been shown to cut through the noise much more efficiently than when another hospital is offering another $5,000 on their starting bonus or the like. And what's more, all of those are shown to actually retain employees much more than money. Like every academic study on this has shown definitively money might get people in the door, money does not retain your workforce.

Rae Woods (29:02):
We've been kind of dancing around one key part of being an employer of choice, and that is the role of compensation. Before we close, I want to give you a chance to actually speak to this specifically. What is the role of comp in all of this?

Eliza Dailey (29:18):
There are definitely some roles where you do need to be strategic about compensation. And I don't think compensation is the silver bullet that everyone thinks that it is. And I think often it can mask these deeper systemic issues that we're talking about. Comp is a tangible thing to point to. It's easy to market in a job description, but it doesn't have that longstanding impact on retention that Alex was just alluding to.

Alex Polyak (29:45):
I want to be clear too, that with inflation, with the economy the way it is, I'm not suggesting you can just do rock bottom salaries. That's not what we're talking about here. But in terms of a long term strategy, compensation is not going to be the be all end all. It's not a silver bullet. In fact, what I think most companies have to do is start thinking holistically about compensation, looking not just as salary, but also at benefits and really at work life balance flexibility offerings in a way that they haven't had to before. It's a complete package. And we know that. Employees find that much more appealing than just looking at the sheer salary.

Rae Woods (30:33):
When it comes to being the employer of choice, and when it comes to dealing with this great reallocation, what is the one thing you want our listeners to take away?

Monica Westhead (30:43):
I think the one thing that I would want leaders to take away is just the strategic importance of staff. And I don't want to imply that leaders don't know that already. I know that executives realize the importance of their staff and really want to commit to retaining that workforce. But I think it's an important mindset shift to get away from thinking about staffing as potentially a cost center. And thinking about it more as a critical strategic asset that without putting the investment and the focus on those areas, you run the risk of not being able to be successful in general. So I would say, just keep focus on your team and that will serve you well.

Eliza Dailey (31:32):
I'll leave our listeners with an action step and that's to identify one small, but powerful change that you can make that will make it easier and more sustainable for clinicians to do their jobs. We aren't going to transform medicine overnight, but those things do add up. So can you figure out how to reduce the number of clicks in the EHR or extend visits even by just a few minutes and make those marginal changes that eventually will help to make the practice of medicine more enjoyable for all clinicians.

Alex Polyak (32:07):
And I just want to end on a note of hope because I realized that this can be quite daunting to say there's no return to normal, to the way things were, but actually that opens up enormous, enormous opportunities for us to innovate, to develop a workforce that is truly sustainable for a healthcare future that is going to be incredibly dynamic, an industry that's undergoing enormous change. And if we get this right, it will play out, not just in terms of retention, but in cost savings, better top of license practice, and in running a much more sustainable healthcare enterprise. So the sky really is the limit in that regard.

Rae Woods (32:48):
Well, Monica, Alex, Eliza, thanks for coming back on Radio Advisory.

Monica Westhead (32:52):
Thank you, Rae.

Alex Polyak (32:53):
Thank you so much for having us.

Eliza Dailey (32:55):
Thanks, Rae.

Rae Woods (33:00):
Look, I don't want you to get defeated by this conversation. When we talk about the workforce, we often talk about the workforce crisis, but despite the reality of the situation, what Eliza and Alex and Monica all shared is that there is a lot that employers can do to support their workforce. And it all comes back to making sure that we're treating them like real people with real needs. There's a lot more that we can do here. So remember, as always, we're here to help.