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. 

MHA CEO Report – Mental Health Impact from COVID-19

MHA Rounds Report - Brian Peters, MHA CEO

“Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary.” Fred Rogers

MHA CEO Brian PetersBefore COVID-19, increasing demands on physician and administrative leaders created an epidemic of burnout. The Triple Aim, a framework developed by the Institute for Healthcare Improvement, is built on achieving better patient outcomes, creating a better patient experience and lowering healthcare costs. Over the past several years, the model also began focusing its efforts on a fourth goal of improving the work/life balance of healthcare providers, while incorporating the other three aims, in order to address the issue of burnout.

Yet, even our most successful organizations that implemented the Quadruple Aim could not have foreseen the challenges faced by the healthcare workforce from the COVID-19 pandemic. Not only have they experienced significant physical demands, but they arguably have endured an even greater strain on their mental health. Besides their roles as physicians, nurses and clinicians, hospital workers are parents and caregivers. They have dealt with the stress and fear of treating patients with a highly infectious disease and possibly transmitting that disease back to their loved ones at home. They have shared the grief and loss of their patients at rates they may have never experienced before, all while providing comfort when patients’ loved ones weren’t able to be physically present due to new infection control protocols that include strict visitation policies.

According to a poll conducted by the Kaiser Family Foundation, over half of adults in the U.S. reported poor mental health due to worry and stress over COVID-19. Specific to healthcare professionals, a review conducted by the medical journal QJM found that the rates of anxiety could be as high as 70% with rates of depression as high as 40%. Other issues reported by these sources include insomnia, burnout, emotional exhaustion, difficulty eating, increases in alcohol consumption or substance use, and worsening chronic conditions.

While we have been successful in flattening the curve of hospitalized COVID patients in Michigan, the mental recovery needed for those suffering from these traumatic experiences can take months or years. This month is National Suicide Prevention Awareness Month and over recent years we have seen a tragic increase in physician suicide, which is now among the highest of any profession. We recognize that nurses and other clinicians are subject to similar stressors as well. We want to convey to the over 234,000 staff who work in our member hospitals that sharing your mental struggles and seeking help is encouraged. Resources exist and are offered through both our hospitals or health systems, and community partners.

To bolster those resources, the MHA successfully advocated for the distribution of $5.1 million in behavioral health grants to inpatient psychiatric hospitals and psych units from the prepaid inpatient health plans. The MHA appreciates the Michigan Department of Health and Human Services initiating the payments, which are being funded by the Coronavirus Aid, Relief and Economic Security Act (CARES) Act.

The MHA Council on Behavioral Health Integration also plays an important role in exploring and examining issues unique to our members who deliver behavioral healthcare services. Chaired by Selena Schmidt, director of outpatient services, Ascension Michigan and staffed by Laura Appel, senior vice president and chief innovation officer, MHA, the council develops recommendations addressing access and fostering integration with the greater healthcare delivery system. A key initiative currently being worked on is standardizing guidance for care of emergency department patients in psychiatric distress.

To increase awareness, the MHA is also hosting a Twitter chat from 1 to 2 p.m. Wednesday, Sept. 9 on the topic of mental health as it relates to COVID-19, which will feature input from guest expert Brian Ahmedani, PhD, Center for Health Policy & Health Services Research at Henry Ford Health System. For those unfamiliar with a Twitter chat, the MHA Twitter account will be facilitating several questions during the hour to spark conversation among participants on this very important topic. We encourage you to consider participating or having your organization participate to demonstrate your support for our healthcare heroes.

Lastly, the MHA is also receiving assistance from the American Hospital Association (AHA) on this issue. While circumstances related to the pandemic have necessitated the cancellation, the MHA was prepared to offer in partnership with the AHA a three-day retreat later this month to help physicians and other clinicians process the emotional toll and loss of normalcy created by the COVID-19 pandemic. We remain optimistic that similar offerings will be available in the future.

The health and well-being of our workforce continues to be a priority, and we will always assist and advocate for our members and the healthcare heroes that make up their organizations. The jobs of our healthcare providers rarely slow down, and as healthcare leaders, we must make sure our attention to safety goes beyond that of patients and includes our caregivers. They have selflessly served on the front lines of an unprecedented global pandemic and deserve all our support.

As always, I welcome your thoughts.