Operational Efficiencies in Healthcare | E. 83

The Healthcare Leadership Experience

Around 100,000 nurses left the profession during Covid-19. Ryan Lee, CEO and co-founder of HireMe Healthcare, explains his passion for exploring and resolving giant problems at a deeper level, with Jim Cagliostro.

Episode Introduction

Ryan explains how appropriate staffing can transform patient outcomes, how nursing shortages haven’t changed much since 2001, and highlights the power of technology to humanize the hiring process. He also shares the #1 operational inefficiency, explains why there’s more to the talent shortage than burnout, and highlights the health system building meditation pods to promote staff well-being.

Show Topics

• Trying to do more with less and less

• Three critical issues affecting patient care

• The talent shortage is about more than burnout

• The high cost of travel nurses

• Technology humanizes the hiring process

• High staff turnover makes nurse training difficult

• Two key strategies to transform operational efficiencies

10:41 Trying to do more with less and less

Ryan said Covid highlighted the extent of operational inefficiencies in healthcare.

‘’(Studies) …found that the increase in responsibilities, the increase in travel nursing and the decrease in resources, greatly exacerbated the mental health strain on nurses. And this is obviously a tangent into how it's become a bit more uniquely of an American problem... We feel it a little more here than in others, but they also found that to be more common for hospital nurses, which checks out. But one of the best ways I've heard it said was speaking with a nurse manager from a major healthcare facility just the other day. It's about trying to do more and more with less and less. Yeah. And I was actually just speaking with a neurocritical care doc this morning and knowing I was coming on here, I said, "What would you say is the number one operational inefficiency in a healthcare system?" And she said, "There's too much administrative red tape put in place by too many people that don't have bedside experience." And that's not to say you don't need people with different backgrounds, it's critical to have that. But it was interesting to hear, and those are her words, not mine. But it's interesting to hear that take and these operational inefficiencies, and I am definitely way more qualified to speak to this in a nursing staffing context. So it just comes down to how much turnover there is. ‘’

14:53 Three critical issues affecting patient care

Ryan explained the impact of inefficiencies and said appropriate staffing could improve these areas.

‘’There's patient satisfaction for one, which with the rise of value-based care is an increasingly important metric, but the other two are patient outcomes and efficiency measures. And having safe staffing, which is also called appropriate staffing or evidence-based staffing has been shown to improve all of these components. So for patient outcomes, I mean you have anything from the frequency of cardiac arrests, a lot of it just has to do with what happens when patients are in the care of understaffed units. So an increase in cardiac arrest with subpar staffing, an increase in HAIs (hospital acquired infections), which can amount to tens of billions of dollars nationwide every year. That's a really expensive one. More instances of respiratory failure, failure to rescue becomes more common. And overall it increases inpatient mortality rates, which is the very goal of a hospital to avoid. And on the efficiency side, it impacts readmission rates, the length of stay, the turnover time in an operating room, the average time in the emergency department. And coming back full circle, it impacts the staff retention, which it's this vicious cycle that self perpetuates where nurses are understaffed, working in an understaffed unit impacts mental health and wellbeing, which leads to burnout, which leads to more turnover, which leads to more understaffed units. And then it's just this cycle, it's really terrifying to look at because of what kind of an impact ... ‘’

17:32 The talent shortage is about more than burnout

Ryan said issues causing the staffing shortage haven’t changed much since 2001.

‘’…..there is truly a talent shortage. That's a real thing. It's not just this burnout phase, this increase after COVID, nurses fed up with the status quo and everyone leaving in droves. We lost 100,000 plus nurses last year. It's not just that. There is an actual talent shortage here, and that comes from several things. There's a pipeline issue, for instance, education is a huge ... There's a shortage in faculty talent to train our nurses. There's way more qualified applicants for nursing schools than there are available seats in nursing schools. That's part of the recent ... A hundred million that the Biden administration just pledged to attack the nursing staffing crisis is addressing the education pipeline. So it'll be really interesting to see how that plays out. …..But there is a talent shortage and there's reasons. If you go back, I'll look to this survey done by an organization, a think tank called Health Workforce Solutions. This was in 2001 where they talk about the reasons for the American nursing shortage. And it comes down to an aging population, still more true today than it was back then. They were talking about Gen X being the primary generation in the nursing workforce, which now we're looking at Millennials, an aging nursing workforce, still the same. The average age of nurses is over 50, nationwide. They had to do a lot with the work environment. They said fewer resources and more demand. This was in 2001. None of this is new. … Everyone in a healthcare environment needs more money… There's so many different demands on finance, and often the nurses struggle to enact changes.’’

23:44 The high cost of travel nurses

Ryan explained how the pandemic changed the culture of travel nursing

‘’… the real basis for travel nursing was living in various places, having an adventurous life, getting a chance to fill in where needs were at a temporary high in certain areas, be it flu season, whether you're doing it to go fill in for a flu season in St. Louis or whether you just want to live in Denver, Colorado for three months. That was the basis of travel nursing up until the pandemic really. And that's when labor costs just skyrocketed for that. And it became almost imperative for the nursing side. You're looking at people making two, three times as much as you and the hospital's paying eight times that at some points. I mean, the average cost for an hour of agency labor got up to 275 an hour during the pandemic, which is utterly insane. That would be amazing money for a nurse if the nurse saw even close to half of that. But the average pay for travel nurses was still around $125 an hour versus the usual $50 an hour. I mean, so you're looking at being able to afford two and a half FTEs for the same price as a travel nurse, but why would you go take an FTE position when you can make almost three times what you're making? So it made sense for nurses to take on these roles. I knew a lot of nurses who were living in Charlotte and working in Winston-Salem, and they were technically a travel nurse, but not like when you were a travel nurse, Jim, where you moved to California to do your job. They were just driving from Charlotte to Winston two hours every day, and that made them a travel nurse and eligible for that kind of pay. So that's the system we made. And obviously, I mean, our health system nationally spent $24 billion in one year just on travel labor, which sounds absurd, but when you do the math, 275 an hour spent times our workforce that shifted into travel and the hours demanded of a short-staffed healthcare system. It was quite amazing to say the very least there.’’

28:34 Technology humanizes the hiring process

Ryan explained how HireMe Healthcare technology makes the application process easier.

‘’From the hiring side, it makes it more efficient, it simplifies it, and this may sound strange given that it's technology based, but it humanizes the process. And that's what HireMe Healthcare sets out to do is to humanize the process.. So let's go from the nurse perspective first. So you are applying for a job, but you're applying for multiple because you want to find that right fit. So you're going to fill out a new application, your resume exists, but it has no point because you have to fill out applications for hospital systems through their system and through their portal individually each time, typing the same information over. …technology can play a role by offering a one-stop shop personal profile. … it's a great way to have all the necessary boxes that need to be checked for a specific job can be in one place, and then you get to take the quick step forward towards the human side of the process. Is this nurse a good fit? And HireMe Healthcare uses matching technology to pair nurses based on individualized nurses, individualized job descriptions, looking to find the person behind the resume, and the person, the people, the team behind the job description. It's not just quantitative….. I mean by having our one-stop shop personal profile, and then each customized job description, it allows hiring managers to have these candidates ranked for them just based on the check boxes and the components. And then adding in qualitative components to find out what kind of a fit someone's going to be on a particular unit.’’

34:46 High staff turnover makes nurse training difficult

Ryan said when nurses ‘’flip’’ every 30 to 90 days, effective training isn’t possible.

‘’… Right now, it's hard to really focus on training your staff when they're turning over as quickly as they are. A lot of first year nursing students or first year grads entering the nursing workforce, they turned over some 36% I believe it was last year, and they're losing a third of grads that need the most training of all right off the bat, and that means they're going to bounce to another job. … if you're flipping to a new hospital every 30 to 90 days, like travel nurses or disgruntled first years that have a, this isn't what I expected. They're not around long enough to endure the proper training that they need. And also training comes into requiring resources, and those resources like the resources for hiring and everything else are becoming more scant, the time spent. We talked about, oncology is actually a great example of this. It's a hyper-specific practice that has a bunch of, just as they describe it, little things that make it very unique that only are necessary for oncology nursing, but they don't have the wherewithal to hire someone full-time, someone who's trying to transition into oncology. They don't have the resources to hire someone and just employ them full-time for the training necessary to become masterful in such a critical practice that has so many nuances. This is true across the board that not having enough resources to train your nurses leads to subpar training. And a lot of that training focuses, as I said, on protocols and those protocols can be unique.’’

40:02: Two key strategies to transform operational efficiencies

Ryan said embracing technology and taking action on mental health can make a difference.

‘’… a couple of things we've seen have been very effective, authorizing critical staffing pay has worked. Nurses getting paid for what they're actually up against. There's building in-house nursing staffing pools, float pools have been very effective within to really have labor that understands your protocols on hand. That's been very effective. Nurses like getting paid more, but when you really talk about what's the real trigger here, it's not "If I got paid more, I would be happy in this job." The most effective measures hands down are those that address the mental health and wellbeing of nurses. And I also see a lot of efficacy coming from those that are embracing technology. … And I would say the two biggest things hospitals can do are treat their nurses well, and I mean actually taking action towards mental health. Novant Health is building meditation pods, for example. I thought that was something really cool.‘’

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You’ll also hear:

From law school to HireMe Healthcare via Uganda, a passion for human rights, and a pandemic; Ryan’s varied career journey.

The current vacancy rate in nursing is causing problems in achieving nurse to patient ratio. ‘’… right now it's at 16% a little over, which is a lot of gaps to be filled. That's a lot of nursing positions that are needed.’’

The impact of Covid-19 on nursing turnover. ‘’At the height of the pandemic, turnover got up to almost 30%. It was a little over 28. And so that's almost a third of the entire national workforce just turning over. And that doesn't include the specialties that had significantly more.’’

How using an old address on a resume can filter applicants out, rather than in.

The impact of asking for nurses for voluntary overtime. ‘’According to the NSI retention report, 99% of hospitals are doing this, and it's not very effective as you can imagine, especially if we look at the impact on nurse wellbeing and nurse mental health.’’

Leadership lessons: The far-reaching impact of burnout versus the need for self-care, compassion, and gratitude. ‘’The best thing you can do for other people is take care of yourself.’’

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