The healthcare workforce is at higher risk of harm due to violence than other professional fields. Recent increases in workplace violence represent a major barrier to both staff and patient safety, prompting the need for additional resources, training and education.
The MHA Keystone Center Patient Safety Organization (PSO) Annual Meeting brings together national safety and clinical experts each year to discuss trending topics in healthcare.The 2023 meeting will be held virtually 9 a.m. to 3:10 p.m. May 3, focused on workforce safety and security. Speaker presentations include:
Stephen Weiler, emergency management specialist at HSS, an MHA Endorsed Business Partner, will provide an overview of HSS and its physical risk assessments.
Brian Uridge, deputy director at the University of Michigan Division of Public Safety will outline actions health systems can take to address and reduce healthcare violence. He will also provide examples of safety training procedures and policies for members to replicate.
“The country is lyric, the town dramatic. When mingled, they make the perfect musical drama” — Henry Wadsworth Longfellow
Having just returned from the annual American Hospital Association (AHA) Rural Health Care Leadership Conference, where I was joined by a strong contingent of MHA members and staff, the future of our rural hospitals has been top of mind.
When I was in graduate school at the University of Michigan many years ago, I recall clearly our discussions related to rural health. In short, we were taught that rural America was statistically older, poorer and sicker than the rest of the country – and this demographic and socioeconomic reality led to all kinds of challenges for those responsible for the health of rural populations and the viability of rural hospitals.
Fast forward to the most recent (2020) census and this dynamic remains true. In addition, we discovered that between 2010 and 2020, rural America actually lost population for the first time in history. Here in Michigan, the latest projections indicate that while the total state population will grow moderately over the next 20 years, the population in rural Michigan will remain flat or even decrease.
The operating environment has never been more difficult for healthcare organizations, for reasons we have documented at length in prior CEO Reports. This statement is particularly true for rural hospitals – 100 of which from across the country have actually closed since 2005. Many more have had to make the difficult decision to terminate service lines or otherwise scale back their operations to keep their doors open. What is driving these challenges? A few items come immediately to mind:
An older and poorer population translates into a higher percentage of government payors (Medicare and Medicaid), which traditionally do not fully cover the true cost of care.
The traditional volume-based reimbursement model that has been one of the cornerstones of American healthcare does not serve rural providers – which often lack sufficient volume – particularly well. The pitfalls of the volume-based model were on full display during the worst days of the COVID-19 pandemic, particularly when non-emergent procedures were suspended.
Recruiting physicians today most often involves recruiting a spouse as well; in other words, there must be a good job match for both parties to spur a relocation. Physician recruitment is more difficult in rural communities for the simple fact that there are fewer potential jobs for that spouse. In addition, the on-call coverage demands can be particularly significant in rural areas, because the number of available rotating on-call clinicians is simply fewer. I would be remiss if I didn’t mention the Merritt Hawkins firm, which is one of our original MHA Service Corporation Endorsed Business Partners, and is dedicated to working with our members to create solutions to some of the most vexing challenges of the day.
Lastly, it is no secret the country is in the middle of a behavioral health crisis, with a lack of available placements leading to behavioral health patients boarding in emergency departments throughout the state, awaiting placement in a more appropriate setting. Hospitals are experiencing higher costs caring for these patients, increasing security to protect other patients and staff, while receiving little to no reimbursement since these patients have yet to be admitted to an inpatient psychiatric unit. This lack of access is even worse in rural areas. For example, the Upper Peninsula only has one licensed child psychiatrist for the entire region.
The reality is that when we think about rural Michigan and the more densely populated areas of the state, we are all inextricably linked. There is no “us and them.” People from the big city travel every day to rural communities for conferences and events, meetings, sales calls, deliveries, vacations and visits with friends and family (and people from rural communities come to the big city for the same reasons). While we want to ensure the vibrancy of a hospital in a rural community so that the residents have access to quality healthcare, we should all want the same thing, because we never know when we might be on one of those sales calls or vacations and need that same access. This is not just theoretical, as I have countless stories about this phenomenon playing out in real life, and I suspect you do as well.
Moreover, hospitals are one of the largest – if not the largest – employers in many rural Michigan communities, playing a crucial role in the economic vibrancy of the state. Healthcare careers provide stable, good paying jobs and positively impact lives every day. Not only are hospitals important for access to care, but also as economic drivers. 121,000 total workers are associated with the healthcare sector in rural Michigan, including 81,000 direct jobs. These direct healthcare workers received $7.6 billion in total wages, salaries and benefits and contributed $1.4 billion in local, state and federal taxes. In addition, the existence of a hospital nearby is one very important item for businesses of all kinds when considering investment in a new factory, office or headquarters.
So, the vibrancy of our rural hospitals should be a priority. What is the MHA doing about it? As it turns out, we have done a lot. Beyond our advocacy on the traditional Medicaid and Medicare budgets, certificate of need, medical liability, workforce funding and many, many other public policy issues that affect all our members, here are just a few of our rural advocacy highlights:
We fought hard to secure passage of the Healthy Michigan Plan (our Medicaid expansion program) and have advocated for full funding in every budget cycle since. For the reasons cited above, this is particularly impactful for our rural hospitals.
We worked to pass, implement and protect the Critical Access Hospital program, which has created an important lifeline for 37 Michigan hospitals. And the MHA was successful in changing existing statue at the end of 2022 to make adoption of the new Rural Emergency Hospital designation possible for our members.
We have worked very hard to protect the 340B drug pricing program, which is vital to many rural hospitals and their ability to provide access to care to all in their communities. Our work includes advocacy with both the state legislature and Congress, and even in the federal courts, where the MHA has filed amicus curiae briefs related to recent 340B cases.
The MHA successfully advocated for two new supplemental Medicaid payment pools that specifically benefit our rural members with implementation of the rural access pool in fiscal year (FY) 2012 and the obstetrical stabilization fund in FY 2015. Our advocacy efforts were also successful in securing Medicaid outpatient rate increases in FY 2020, the first increase in two decades, followed by an additional increase in FY 2021. These increases resulted in a 63% increase for critical access hospitals and a 21% increase for all other hospitals compared to Jan. 1, 2020, rates.
We successfully advocated for an extension of both the Medicare-dependent Hospital and Low-volume Adjustment programs during the 2022 Congressional lame-duck session, which provide critical support to many rural hospitals.
Finally, we have successfully advocated for passage and implementation of state legislation that modernizes the scope of practice for certified registered nurse anesthetists and allows flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care.
Our advocacy is also focused on ensuring our members can tell their story and connect with lawmakers, both at the state and federal levels. The MHA hosted its first ever Rural Advocacy Day last September in Lansing to facilitate conversation between rural hospital leaders and members of the Michigan Legislature. The MHA also accompanied members in February for the National Rural Health Association’s Rural Health Policy Institute event. MHA members met with Michigan’s congressional delegation and staff during the trip to discuss rural health issues facing Michigan hospitals. And if you haven’t yet had the opportunity to listen to the Rural Health Rising podcasts, I encourage you to tune in to our friend JJ Hodshire, the CEO of Hillsdale Hospital and an MHA Board member, as he does a fantastic job shining a light on a wide range of rural health issues – with an impressive set of special guests – in real time.
Successful advocacy and storytelling require teamwork. As mentioned above, for years we have partnered closely with the AHA and the National Rural Health Association. We have also enjoyed a close partnership with the Michigan Center for Rural Health (MCRH), and I am pleased to share Hunter Nostrant, CEO of Helen Newberry Joy Hospital, is a member of both the MHA Board of Trustees as well as the MCRH Board.
The mission of the MHA is to advance the health of individuals and communities, and in that context, we have always strived to represent all our members and communities. Each hospital is vital to the health of our great state. While the path forward may be difficult, I’m encouraged by the many rural hospital leaders – some of the nicest, and most talented people that I have met – that have developed innovative and strategic ways to address these challenges and position themselves to be able to care for their communities for years to come.
The MHA Service Corporation (MHASC) board began its Feb. 8 meeting addressing current strategic priorities including exploring innovative solutions to support hospital financial viability, workforce restoration and wellbeing, behavioral health improvements, health equity and more. The board considered strategies to continue to diversify and increase opportunities to support members through potential products, business opportunities and Endorsed Business Partner (EBP) expertise. The board also recognized the MHA Unemployment Compensation Program for expanding its consultative approach to managing unemployment claims in Ohio, Idaho, New Mexico and more. The MHASC and MHA leadership teams will continue to evaluate the performance and availability of existing and potential endorsed services to ensure they align with the MHA strategic action plan.
MHA EBP Demand Workforce/Qodex presented to the board, outlining an innovative, on-demand mobile app that is transforming healthcare staffing by providing a simple, user-friendly platform that enables hospitals to fill open shifts quickly and efficiently. Members are invited to register for free webinars from 12 to 12:30 EST Feb. 22 and March 8 to learn more information.
In addition, the MHASC Board passed a resolution in honor of the upcoming retirement of longtime MHA Chief Operating Officer Peter Schonfeld and celebrated recent organizational changes to integrate business development and marketing support for both the MHA and MHASC, including the promotion of Ruthanne Sudderth to senior vice president and chief strategy officer. A lunch with the MHA and MHASC Board was jointly sponsored by partners from Merritt Hawkins, AMN Leadership Solutions and Demand Workforce/Qodex.
The MHASC provides critical support to the MHA and MHA members through its Data Services products, Unemployment Compensation Program and Endorsed Business Partner program to address workforce, financial and other operational needs.
Questions regarding the MHASC board should be directed to Ruthanne Sudderth at the MHA.
DataGen is hosting a national webinar to review the 2023 Medicare fee-for-service outpatient prospective payment system final rule and hospital impact analysis at 3 p.m. on Nov. 30, 2022. This webinar is available free of charge but registration is required. The MHA will provide hospitals with an impact analysis of the final rule within the next few weeks. Members with questions should contact Vickie Kunz the MHA.
MHA Endorsed Business Partner NextJob is hosting a free webinar on Actionable Neuroscience Insights for Improved Workplace Performance at noon ET Dec. 7, 2022 to educate employees about the brain processes of perception, cognition and neuro-linguistics and share tips to help improve performance at work. MHA members are invited to register and share information about the webinar with their colleagues. To learn more, visit the business partner profile page for NextJob or contact Paul Dzurec at NextJob.
“The world-altering powers that technology has delivered into our hands now require a degree of consideration and foresight that has never before been asked of us.” ― Carl Sagan
A long-held practice utilized by businesses of all stripes is the ubiquitous SWOT (strengths, weaknesses, opportunities and threats) analysis. For a hospital or health system in 2022, there is no shortage of candidates to fully stock the “threat” category. In this column, I want to draw attention to one that deserves increased attention because of its potential to cripple an organization in an instant: cybersecurity.
The wonders of technology have dramatically improved healthcare in Michigan and beyond. Advancements include imaging technology that identifies serious disease at a much earlier stage, robotic devices that permit surgical interventions that were previously considered too risky to attempt, remote patient monitoring and telehealth, and electronic medical records that facilitate better tracking and coordination for patients across various sites of care — the list is impressively long. And amid our current workforce shortage crisis, we often describe technology in healthcare as a “force multiplier” that can supplement and extend our limited staffing resources to help ensure adequate access to care.
Make no mistake, healthcare still has one foot on the proverbial dock and one foot in the proverbial boat. That is, many of our communications and services remain in the “analog” world, while a growing share have become electronic, digitized and inter-connected. This phenomenon — coupled with the fact that the personal health information we collect and store has more value on the black market than any other data — has painted a neon target on our back for a growing cadre of cybercriminals and adversarial nation states. It is no accident the FBI has identified healthcare as the number one target of these bad actors. And simply put, a cyberattack on a hospital is a “threat to life” crime. We must act accordingly.
The statistics on healthcare attacks are enough to keep any executive up at night. An attack on a midsize hospital creates an average shutdown time of 10 hours and costs on average $45,700 per hour, according to an Ipsos report. In the same report, 49% of the respondents said their annual compliance budget for cybersecurity wasn’t enough. According to IBM, a data breach at a healthcare organization costs more than any other sector at $10.1 million. And the threat continues to grow, as healthcare cyberattacks have increased by 84% from 2018 to 2021, according to Critical Insight. Michigan hospitals, health insurance companies, physician offices and others have been the victims of ransomware attacks and related cybercrime in recent years.
If this wasn’t bad enough, a spotlight was shone on cybersecurity this past spring during Russia’s invasion of Ukraine, when cyberattacks on the Ukrainian government and critical infrastructure organizations had the potential to ripple across multi-national organizations and infect U.S.-based operations, including healthcare. Experts believe this scenario will be part of every future global conflict. And unfortunately, for many hospitals and health systems who welcome patients from multiple foreign countries, and who have business partners outside the United States, the practice of “geo-fencing,” or blocking all incoming email traffic from outside the country, is not always a viable approach.
So where can hospitals and health systems turn for help? At the national level, the American Hospital Association anticipated this trend several years ago and employs John Riggi as the national advisor for cybersecurity and risk. John has been a resource for the MHA in the past and as a former leader within the FBI’s cybercrime division, he maintains close ties with all the relevant government agencies.
And here at the MHA, we are also very committed to strengthening our own cyber defenses, while doing the same for our members. We have appointed Mike Nowak to serve as our own Chief Information Security Officer. Several years ago, Mike and his team helped to launch, and have subsequently helped to operate, the Michigan Health Security Operations Center (Mi|HSOC) for hospitals and health systems. Created for healthcare providers by healthcare providers, this first of its kind entity has the proven ability to prevent, detect, analyze and respond to cybersecurity events. Operating 24/7/365, the Mi|HSOC has developed strong relationships and communication with law enforcement at various levels, including the Michigan State Police Cyber Division, FBI and Secret Service.
An organization that helped form the Mi|HSOC is CyberForce|Q, which is now an MHA Service Corporation Endorsed Business Partner. In addition to sharing tactical information on emerging threats with the members of the security operations center, CyberForce|Q offers a variety of additional cybersecurity services to our members and other healthcare clients.
The bottom line — the MHA and our partners have helped Michigan become a leader in this space. By mitigating potential risk, physicians, nurses and staff of our member hospitals have the best opportunity to provide exceptional patient care without any external interruptions. While the advocacy, policy and safety and quality areas of the association often receive public attention, our cybersecurity efforts are constantly at work, often without much notice, to protect healthcare in Michigan.
But we need your help. I am the farthest thing from an expert in this field, but one thing I have learned is that the “human factor” is the most critical element of our defenses — and therefore the most vulnerable. Think twice before opening a suspicious email or text message, safeguard your electronic devices and passwords and take the time to educate yourself on all of the best practices to follow in the midst of this new, online world. The health of your patients and communities may depend on it.
By Tammy A. Mullin, chief marketing officer at NextJob, an MHA Endorsed Business Partner
All the talk these days is about “The Great Resignation.” The healthcare industry has lost anywhere from 20% to 30% of its workforce over 2020 and 2021, with more than a third of employees considering leaving their current positions and 60% currently rethinking their career. The sector ranks third in industries experiencing significant labor shortages at 9%, beat out by only accommodations and food services and leisure and hospitality. MHA members are scrambling to fill positions as well as keep existing employees engaged.
While most employers are focused on higher pay and enhanced benefits as a top strategy to attract and retain talent, it turns out that’s not what drives employee satisfaction and engagement. A 2021 study from Indeed, The Work Happiness Report, revealed some interesting data regarding what matters most to employees. Pay ranks 12th on the list of what makes people happy at work.
The top drivers of workplace happiness — feeling energized, a sense of belonging and a sense of purpose — are well within the reach of organizations whose existence is generally tied to a clear mission. The key is in providing clarity on the organization’s vision, mission, impact and employees’ contributions to each, as well as helping workers navigate their relationships with coworkers and into roles they love and where they will thrive.
To help its customers better engage with coworkers and build a better sense of belonging, MHA Endorsed Business Partner NextJob is hosting a webinar on “Workplace Communication Skills” at noon ET July 18. MHA members are invited to register and share information about the webinar with their employee base. In addition, an on-demand recording and presentation slides are available to MHA members free of charge from a webinar on The Great Resignation and Strategies to Maintain Workforce that NextJob presented May 11.
NextJob is available to answer questions and further explore MHA members’ interest in its career development services to help engage and retain employees during these difficult times.
MHA members not only receive discounted pricing on NextJob services;for a limited time, members will also receive their first career development or outplacement package free of charge.
To learn more, contact Paul Dzurec, senior account executive, NextJob, at (860) 933-8424. For more information about the EBP program, visit the program’s webpage.
The MHA Keystone Center is partnering with MHA Endorsed Business Partner HSS to offer in-person security risk assessments for its members. This assessment aims to provide an objective evaluation of threats to patients and staff and develop a corrective action plan.
To be selected for an in-person security risk assessment, hospitals are required to consistently submit Occupational Safety and Health Administration data into KeyMetrics and fill out an online application. In-person security risk assessment spots are limited. Hospitals incurring the greatest costs, highest incident rates and severest outcomes associated with staff harm will be prioritized for selection. Applications are due May 23at 5 p.m. MHA members may contact the MHA Keystone Center with questions about the assessment or application.
The nursing labor shortage is not going away any time soon. There’s no magic wand for addressing the short supply of clinicians. So, what can be done now? Retain staff.
Medical Solutions is an endorsed business partner of the MHA and a leading provider of innovative staffing support through its Managed Services Provider program. A new blog titled How Retention is the New Recruitment from Medical Solutions looks at the value of retention. It addresses the real cost of turnover as well as the challenges created by nurse burnout. Finally, it outlines steps that facilities can take to better retain their valuable staff.
To learn more about Medical Solutions, contact Mike Daeges at (402) 704-1429. For more information on the MHA Endorsed Business Partner program, contact Rob Wood at the MHA.
At its Feb. 9 meeting, the MHA Service Corporation (MHASC) board focused on supporting MHA Strategic Action Plan priorities including behavioral health, workforce sustainability, data strategy, cybersecurity and diversifying MHASC products, services, and partnerships. To receive an update on the action plan, members are invited to register for the Feb. 24 MHA Strategic Action Plan Forum.
The board discussed strategies for re-designing care and how the MHASC can support efforts in this space. MHA Endorsed Business Partner care.ai sponsored a joint lunch for MHA and MHASC board members and provided an opportunity to demonstrate its Smart Care Facility Operating Platform.
The MHASC Human Resources (HR) Committee met Jan. 31 to discuss current HR priorities and review its role in guiding the MHASC’s purpose and direction as it addresses issues including workforce sustainability, retention and recruitment, talent development, well-being and safety. Members provided feedback on current workforce-related legislative efforts and shared valuable insights with colleagues during a round-table session addressing workforce shortage issues. The MHASC is working with the HR Committee to develop future educational programming and networking opportunities, including the potential for holding an upcoming Michigan Healthcare Human Resources Conference. Finally, the committee received a report from new MHA endorsed business partner LifeWorks, highlighting virtual mental health therapy guided by professional therapists with the same clinical efficacy as traditional cognitive behavioral therapy.
The MHASC provides critical support to the MHA in the form of nondues revenue through its Data Services, Unemployment Compensation Program and Endorsed Business Partner program to address workforce, financial and other business needs. Visit the MHA Business Services webpage to learn more about resources available. Questions regarding the MHASC Board and MHASC HR Committee should be directed to Peter Schonfeld at the MHA.
By Paula Allen, global leader and SVP, research and total wellbeing, LifeWorks, an Endorsed Business Partner of the MHA
Mental health is central to everything. This is a definitive statement because it is so true. Mental health is central to our quality of life, relationships, work experience and even participation in the economy. Many people take it for granted, but if there is any benefit to the strain of the past twenty months, it is that it has become clear that no one can or should ever take their mental health for granted. Since the Spring of 2020, there has been a significant decline in the mental health of working Americans.Life and work has been filled with massive change, uncertainty and unprecedented risks and demands. People are tired.
While the holiday season is a time for celebration and connection, the work demands of this season can potentially overshadow the benefits of this time of year. When this happens, stresses can actually feel more stressful than at another time of year. Now more than ever, it is important to take stock of your situation and your opportunities. Gratitude grounds us and focuses the mind. Simple and unexpected kindness can foster the connection to someone else which changes how we experience stress. At times, however, we might need more. With this MHA has launched AbilitiCBT. It offers evidence-based and effective mental health therapy for anxiety, depression and other issues. Two of the most important benefits are that it can fit into any busy schedule given digital access, but the process is also guided by a therapist who is there when needed, and who ensures the right path for each individual.
Mental health cannot be taken for granted. AbilitiCBT is here for you to use.
“The world-altering powers that technology has delivered into our hands now require a degree of consideration and foresight that has never before been asked of us.” ― Carl Sagan 
