CEO Report — Addressing Staffing Challenges

MHA Rounds Report - Brian Peters, MHA CEO

“There is time for work. And time for love. That leaves no other time.” — Coco Chanel

MHA CEO Brian PetersHospitals have displayed tremendous resiliency over the past year and a half responding to the COVID-19 pandemic. That resiliency has come from the healthcare heroes who have served on the front lines of this crisis and experienced extreme physical and mental stress over the course of three trying surges. Yet that toll has elevated staffing, an already existing concern, to the top of every hospital executive’s mind.

We have said throughout the pandemic that the most significant determining factor of a hospital’s capacity is not physical space, beds or technology — rather, it is available staffing.  Even before the pandemic, we understood that healthcare staffing was a challenge. We currently have a population where the baby-boom generation is maturing, leading to an increased demand for healthcare services. It just so happens that many of those baby boomers also work in healthcare, and the incredible pressures brought about by the pandemic have accelerated their retirement plans.

On top of that dynamic, it has become very difficult for hospitals to recruit and retain staff in an increasingly competitive labor market where many opportunities exist outside of healthcare that offer competitive wages, signing bonuses, free or low-cost training, and the like. Nationally, 80% of nursing leaders have reported an increase in nurse turnover due to the pandemic. According to a 2021 study by Incredible Health, the demand for intensive care and emergency nurses grew by 186% over the past year. We are simply in a situation where the demand for labor currently outpaces supply, with 1.4 million job openings currently in the national healthcare sector according to the Labor Department’s Job Openings and Labor Turnover Summary. In Michigan, simply visiting the Careers webpage of your local hospitals will likely show the dramatic number of openings that are currently available.

Lastly, pent-up demand for healthcare services has stretched existing staff over recent months, as those who were hesitant to receive care for fear of contracting COVID-19 delayed seeing a provider and are now visiting our emergency departments (EDs) at very high levels. In fact, we have seen a 16% increase in hospital ED visits during the latest quarter compared to pre-COVID times in the second quarter of 2019. This pent-up demand is increasing the pressure on our hospitals and staff as people use the ED as a point of entry to the healthcare system.

A contributing factor to the staffing shortage prior to the pandemic was the rate of stress and burnout in the healthcare setting. It is apparent that there are certain jobs, especially those dealing with direct patient care, where the burnout factor is especially pronounced. In response, the MHA has assisted our members in recent years in adopting the Quadruple Aim, a framework that focuses on achieving better healthcare outcomes and has the added goal of improving the mental wellness and work/life balance of healthcare providers to address the issue of burnout. The pandemic has added new urgency to this work.  

In addition, our member hospitals and health systems throughout the state have been active in identifying solutions for our healthcare heroes. Some have offered bonuses and hazard pay to staff to show their appreciation for their hard work. Hospitals are also deploying more resources toward behavioral health support to help staff cope with the traumatic stress that they have experienced over the past 17 months. During Michigan’s three COVID-19 surges, many hospitals also brought in contract workers and traveling nurses to supplement their existing workforce due to staffing shortages, the cost of which came well above standard rates due to the demand. Hospitals have also gone to great lengths to procure record amounts of personal protective equipment for their staff — yet another unplanned and unbudgeted expense.   

For years, the MHA has advocated strenuously to support graduate medical education (GME) in the state budget process, and we have hosted in-person GME Advocacy Day in Lansing events in the past with our partners at the Michigan Osteopathic Association and the Michigan State Medical Society to connect medical residents with their elected officials. GME is critical to attracting medical students and residents from around the globe to Michigan.   

In addition, we advocated for passage of House Bill 4359, which modernized the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). Rural providers have a difficult time hiring anesthesiologists, and this new law will allow 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 by eliminating the state requirement that a CRNA must work under direct physician supervision. We appreciate all the stakeholders that made this bill possible, as it eliminates a costly regulation while maintaining patient safety.

The MHA has also been active in bringing together stakeholders to identify solutions to healthcare staffing. The MHA Service Corporation (MHASC) Human Resources (HR) Committee was created as a collaborative body for HR leaders to come together and address issues specific to healthcare workforce issues. Led by Peter Schonfeld, senior vice president, policy & chief operating officer, MHASC, the committee has met to discuss current HR leadership priorities and review its role in guiding the purpose and direction for the MHASC efforts to address workforce resources, education, data staff development and more. The committee has also addressed priorities including vaccination policies, staffing shortages, and diversity, equity and inclusion.

We also recently formed the MHA Human Resources Council as a resource for healthcare professionals to provide input on legislative and regulatory issues relevant to healthcare employers. Staffed by MHA COO Nancy McKeague, the council will provide networking and educational opportunities for HR professionals, dissemination of best practices, and data collection and reporting relating to hospital and health system workforce metrics.

The MHASC has also been providing staffing solutions to our members through both the Unemployment Compensation Program and our Endorsed Business Partner (EBP) Program. The Unemployment Compensation Program has seen a dramatic increase in the number of cases filed since the pandemic began, processing over 70,000 unemployment claims in the last year alone, from clients in Michigan and across the country. Their decades of expertise have saved our client organizations tens of millions of dollars while addressing unemployment fraud that has become rampant recently.

We currently have six EBPs that focus on workforce solutions, including Merritt Hawkins, which provides permanent physician recruiting and consulting services. These EBPs have been carefully vetted to ensure they provide high-value services for our members in need of workforce assistance. In fact, we recently added NextJob as our newest EBP to help hospitals better support healthcare workers with re-employment services, which enhances the work of our unemployment program. I’m extremely happy that we have these services available, with other EBPs in this space focusing on compensation, workplace violence training, consulting and performance coaching.

Finally, as we look to the future, we know that telehealth and virtual care, which has seen an acceleration during the pandemic, has the potential to be real game changers for the delivery of healthcare. We will need to do all we can to help ensure that new technologies are adopted in such a way as to maximize access and affordability for all populations, while also doing right by our healthcare staff.

As you can see, the staffing challenges hospitals face are complex; yet across Michigan we are pursuing every tool in our toolbox to create solutions that both bring in top-notch caregivers and retain our healthcare heroes who have treated over 125,000 COVID-19 patients during the pandemic. Michigan hospitals remain committed to protecting our staff and doing everything we can to ensure they feel safe and protected while caring for their patients. From physicians and nurses to environmental service workers and support staff, our hospitals need all levels of team members to efficiently and effectively operate 24/7/365.

As always, I welcome your thoughts. 

CEO Report – Adding Value to Your Membership

MHA Rounds Report - Brian Peters, MHA CEO

“If people like you, they’ll listen to you.  But if they trust you, they’ll do business with you.”
― Zig Ziglar

MHA CEO Brian PetersSeveral months ago, I celebrated my 30th anniversary with the MHA. As you can imagine, the operating environment for our association has changed dramatically from the day I first walked in the door as an intern working for legendary MHA President Spencer Johnson. I shared an office with another intern by the name of Amy Barkholz, who of course is now our MHA General Counsel. Amy and I used typewriters to compose memos, sharing a bottle of white-out to correct any mistakes (she didn’t make many, but I sure did). There was no email, no voicemail, no internet and no Zoom calls. Smoking was permitted just about everywhere, including inside the MHA offices. Different times for sure.

As I reflect on the last few decades, it is clear to me that one of the MHA’s strengths has been a diversified business model. And as I look to the future, there is no doubt that this diversified model will become even more important. Allow me to explain.

The MHA is widely known as an advocacy organization and, by any metric, we have consistently been among the very best in this regard. Whether it is the legislative, regulatory or legal domain — at both the state and federal levels — we have the connections, experience and clout to make good things happen for our members and the patients and communities they serve. 

But not every challenge confronted by hospitals and health systems lends itself (at least not solely) to a solution in the public policy arena. In a military situation, sometimes you need the Army, sometimes the Navy, sometimes the Air Force (or the Marine Corps or Coast Guard)  — and sometimes you need all the above, working closely together in harmony. In our world, the equivalent “three-legged stool” is the traditional 501(c)6 trade association (or as Spence used to call it, the “junkyard dog” always advocating for our members), but also a 501(c)3 nonprofit arm — the MHA Health Foundation and MHA Keystone Center, and a for-profit arm known as the MHA Service Corporation (MHASC).   

Through the Foundation, we have been able to provide outstanding educational programming, including issue-specific webinars, major conferences and events, an Excellence in Governance Fellowship and a Healthcare Leadership Academy. Through the Keystone Center, we have been able to provide nationally and internationally renowned leadership in the field of safety and quality improvement. And through the Service Corporation, we have been able to meet the unemployment compensation needs of our members through our Unemployment Compensation Program (UCP) and their healthcare data needs through our Data Services division. More recently, our Endorsed Business Partner Program has created even more capacity to meet new challenges in the healthcare operating environment.

To be more specific, since the pandemic began and caused staffing upheaval, the UCP has seen a dramatic increase in the number of cases filed. Representing over 300 employers in Michigan and numerous other states, the UCP last year alone processed over 70,000 unemployment claims, and saved client organizations tens of millions of dollars, while directly addressing the unemployment fraud that has become rampant in Michigan and throughout the country.

Our Data Services division is home to four decades of hospital data with the Michigan Inpatient Database and Michigan Outpatient Database. Their flagship products — Data Koala and Community Benefits Tracker — are used by more than 500 healthcare entities nationwide to formulate market strategies, track community benefits and improve care quality. The Data Services team has also played an integral role in our state’s pandemic response, working directly with our members and the state to collect and compile key data metrics that are used to guide our state’s strategy and response to the spread of COVID-19.

The launch of the MHA Endorsed Business Partner Program in 2018 was an important step in identifying business partners for our member hospitals and health systems that provide the highest quality products and services in key strategic areas, including staffing, workplace safety, financial services, 340-B drug program management and more. We currently have 14 business partners that have been carefully and thoroughly evaluated, ready to work with our members to address some of the most pressing issues of the day.

Lastly, as an association we obviously create and disseminate a very large number of communications, ranging from advocacy reports to event invitations and much more. Years ago, we decided that, rather than contract for this work to be done off-site, we would not only keep this business in-house, but look to serve the needs of our members as well (after all, every hospital has numerous events and annual fundraising galas, and we have produced the materials for more than a few). Today, we offer our world-class Graphic Design & Print Services to both our association members and a very large and growing list of external clients that includes the University of Michigan and Michigan State University. We have even handled the governor’s holiday cards! I consistently receive positive feedback from clients related to the quality, pricing and customer service that our team provides in this space — and I am confident that they are the best in the business. 

Bringing all this together: think about the issue of workplace violence — a growing problem whereby nurses and other front-line caregivers are put in harm’s way. We attempted to address this problem through our advocacy arm, supporting legislation that would create new penalties for those who commit acts of violence in a healthcare setting. But we also addressed it through the Foundation, offering educational programming that featured expert speakers and case studies, and through the MHASC, as MHA Endorsed Business Partner HSS provides violence prevention consulting services tailored specifically to hospitals. Because we know that one-size-fits-all legislative mandates are usually not the optimal way to govern the delivery of healthcare, we have been able to lift up the extraordinary work of the Keystone Center as a more effective path forward to improve patient safety for Michiganders. The examples of the importance of the “three-legged stool” could fill far more space than this column will allow, but you get the point.

But wait — there’s more! Not only do our members benefit from our diversified business model in the ways described above, but because these other arms of the MHA continue to generate their own revenue streams, they have helped to ensure a strong, effective association while eliminating the need for sizeable dues increases. In fact, MHA dues today represent a significantly smaller portion of our member hospitals’ total expenses than they did back when Amy and I were wrestling with typewriters and white-out.

Across the entire MHA enterprise, we are committed to our shared mission to advance the health of individuals and communities. And we are also committed to a culture of trust. When you do business with us, you are doing business with an organization that has now been around for over a hundred years.  Now more than ever, I can assure you that our entire team understands that we must demonstrate value and earn the trust of our members and clients, every single day, in everything we do. 

And I have never been prouder of them for doing exactly that.

As always, I welcome your thoughts. 

MHASC Board and HR Committee Address 2020-2021 MHA Action Plan Priorities

The MHA Service Corporation (MHASC) Board of Directors held a virtual strategic planning retreat Oct. 13 to assess and further develop programs and services to support key initiatives in the 2020-2021 MHA Action Plan. MHASC-specific goals outlined in the action plan include increasing revenue opportunities to support the MHA, exploring partnerships with other states to expand potential business opportunities and improve value, and coordinating activities of the MHASC Human Resources (HR) Committee to address healthcare workforce issues. The board also discussed the MHASC’s response to the COVID-19 crisis, outlining lessons learned, continuing concerns and how to apply these lessons to strengthen response to this ongoing crisis.

The board received a report from MHA Endorsed Business Partner Medical Solutions outlining current nationwide and Michigan-specific staffing challenges and their impact on hospitals’ ability to provide quality patient care, while also reducing hard and soft dollar costs. Medical Solutions provides workforce solutions that streamline healthcare staffing through fully customized programs. The company sponsored a virtual reception of the board at the conclusion of the planning retreat.

The board also reviewed a demonstration and presentation from ProCredEx, which recently became the MHA’s newest Endorsed Business Partner. ProCredEx is rolling out a pilot with a consortium of industry partners to create a digital marketplace for exchanging verified credentials information for all members of the healthcare industry. Representatives from Spectrum Health provided valuable feedback on implementing the pilot.

The MHASC HR Committee met Oct. 7 to address the current impact of COVID-19 on healthcare professionals and workplace preparedness, including lessons learned, ongoing challenges and ideas for partnership/collaboration. Both the HR Committee and the MHASC board discussed ways to address health equity and implicit bias. 

The MHASC provides critical support to the MHA in the form of nondues revenue through its Endorsed Business Partner Program, Data Services and Unemployment Compensation Program. More information about member resources is available on the MHA Business Services webpage. Questions regarding the MHASC board and HR Committee should be directed to Peter Schonfeld at the MHA.