A cure for the clinician shortage? Let's talk reinvention

Although there has been a nurse and physician shortage for years, the pandemic accelerated the issue. Healthcare systems were unprepared for the fatigue and burnout that have resulted in a mass exodus of clinicians. The shortage is putting further pressure on patient access as it drives up labor costs. Hospital labor expenses rose almost 40% between 2019 and early 2022.^[1] Our recent blog mentions that the clinician shortage is affecting the patient experience, increasing the burden on the remaining clinical staff and having a negative impact on health systems’ performance.

In the United States, healthcare systems competing for a shrinking talent pool are trying to maintain access by getting creative about how they find and keep talent. According to a recent AMN Healthcare survey, 54% of healthcare facilities in the US are offering hiring incentives and 43% are hiring additional temporary staff. However, this doesn’t sustainably address the fundamental issue.

Some executives are turning to technology solutions to alleviate the talent gap – 35% have expanded telehealth services to flex capacity more effectively, and 18% have adopted other new technology solutions. However, nearly as many have resorted to solutions that restrict patient access: 18% have reduced service hours, 14% have canceled or postponed elective procedures and 11% have eliminated some clinical services.^[2]

These approaches have not been a ‘magic wand’ to solve this challenge. Virtual care and telehealth are still a 1-to-1 labor equation for the most part, as much as they may allow for a marginally better distribution of existing resources. Executives must begin exploring and quickly implementing new solutions now to prepare for the future. Technology is an essential enabler, but equally important is the ability to build an agile and resilient culture ready for continuous change.

Reinventing workflows

Most clinicians chose their profession because they genuinely wanted to engage with and help people. Unfortunately, they discover very quickly just how much of their job is consumed with non-patient activities.

One study estimates that primary care doctors spend less than half their time interacting with patients.^[3]

Even for floor nurses, the time spent directly interacting with patients was only 35%, with between 26% and 41% of time spent either creating or reviewing clinical documentation^[3]. Other interruptions in care and the need for high-friction coordination activities such as locating resources, physicians and colleagues comprised an additional 16%.^[4] And with the sharp increase in the use of external agency nurses, it is inevitable that the veteran floor nurse will spend a substantial amount of their time upskilling their ‘traveling’ colleague.

All of these are necessary activities, but most could be accomplished without dedicated clinical focus. Automating or shifting these tasks away from the clinician workflow would create capacity that can be redirected to care and improving patient experiences.

Rethinking work delegation

Given that most of these tasks must still be done, how can health systems enable clinicians to practice at the top of their license and avoid compromising access? Recently, one of our clients asked us for help to minimize the impact of nurse shortages. We created clinical and business protocols to enable a remote nurse expert to participate in huddles, integrate into floor activities and support the unit in other ways. This innovative process enhanced the capabilities of new nurses, lifted the burden off veteran nurses and reduced overtime costs. This client is looking for ways to deploy this care model to other units.

The opportunity to shift some work to patients and their caregiving family members is also significant and can not only improve capacity, but also convenience. Other industries – including transportation and banking – successfully adopted these practices many years ago. They save time and money and increase customer satisfaction.

Healthcare consumers are willing to participate in self-service. Among respondents to our 2021 Accenture Patient Experience Benchmark Survey, 73% are “highly” or “somewhat” likely to use digital chat/messaging (e.g., web chat, text, direct messaging) as a first step to a virtual or in-person visit to collect symptoms and get help reaching the right site of care. Furthermore, 83% are “highly” or “somewhat” likely to provide check-in information in advance of services at a hospital or facility. Some health systems already offer these services, and their impact will only improve as technology matures.

Adventist Health System (AHS) implemented self-service technology to increase staff productivity and reduce administrative costs by enabling patients to access account balances and bill payment services online. This new service channel is capturing additional revenue through recurring payments, it is reducing billing and collection costs by 10% (including through lower credit card transaction fees) and it shortens patient registration time by four minutes per visit.^[5]

Pressing the release valves

The impact of the clinician shortage on patient access is unsustainable and quick-fix solutions won’t solve the fundamental issue – there simply aren’t enough clinically trained resources to address growing demand. That said, short-term strategies can be pursued while health systems position for more sustainable approaches. Healthcare leaders must be creative in helping teams accomplish necessary tasks and they could utilize workers with scarce clinical skills. Perhaps most important, leaders must be committed to change.

Health systems can begin taking action to address clinical capacity and prevent the erosion of financial sustainability. Some immediate steps to consider include:

• Stabilize the existing workforce. Advanced analytics can proactively identify the highest-risk employee groups so organizations can target where they must reduce the front-line pain. This can highlight where to offer task-shifting, bring flexible compensation and work packages, and offer career path options. This will also help to reduce attrition in the war for skilled talent.
• Source talent more flexibly. Less expensive clinical and non-clinical support can be sourced in new ways. Expensive ‘agency’ resources may fill immediate gaps, but task-distributed work models will create opportunities for institutions to broaden the labor pool and reduce reliance on agencies. Using outsourced or automated solutions can address the low-risk, scriptable and protocol-driven portions of the care workflow.
• Deploy top-of-license clinicians more effectively. Returning time to front-line clinicians will not only increase productivity, but also improve job satisfaction and reduce burnout by allowing workers to focus on patient care. Numerous studies have shown that higher job satisfaction improves clinical outcomes.
• Reskill Among the first steps in building a more agile response to continuous change is to build an agile management culture. An environment of empathy and psychological safety dramatically increases resilience, productivity and loyalty. Leaders must master the skills necessary to support such a transformation.

Initially, making these changes may feel uncomfortable and disrupt the workflow. However, human + machine collaboration is essential to enabling us to meet society’s healthcare needs with quality and compassion. There is no enduring solution to our healthcare challenge without a reinvention of the way we are delivering care.