Today’s post comes to us from The Workforce Institute advisory board member Nanne Finis, RN, MS, chief nurse executive at UKG.

As we approach the end of 2022, one cannot help but think about the past year and what resulted — especially in healthcare. I have been talking to healthcare leaders across the country, reading all predictions and healthcare news that I can access, and pondering on my own.

I am optimistic about our future as I look toward 2023, but I still find myself reviewing some of the most salient healthcare trends in 2022. My hope is that we individually consider how we can take action to impact some of these most pressing healthcare trends and processes from 2022 as we look ahead to 2023.

Pondering 2022

As I look back at the year that was in 2022, I realize:

Planning for 2023

As I look ahead to 2023, several topics are top of mind:


Thank you for taking the time to reflect with me. I am surrounded in my personal life and in my work by others who push the possible and educate me on all fronts. I am proud to be a healthcare leader and a nurse. These last few years have offered me, and many whom I interact with, a renewed perspective of what is possible. I am hopeful that there is one nugget in my learning that can trigger some action from within you.

Happy New Year to each and every one of you!

Additional Resources

The following references informed Nanne’s article:

Today’s post comes to us from The Workforce Institute’s executive director, Chris Mullen, Ph.D., SHRM-SCP, SPHR, and it previews new episodes of the “No Suits, No Slides!” video series featuring The Workforce Institute advisory board member John Frehse.

Everyone’s favorite video series has returned! The ever-popular “Leadership in the Labor Shortage” series — also known endearingly as “No Suits, No Slides!” — is back with three new episodes looking at what’s going on with the labor market from three different angles.

If you’re new to the show, this series began amid the pandemic about two years ago and features casual (but still informative) conversations about the current state of the economy, especially when it comes to labor (or lack thereof). It’s co-hosted by The Workforce Institute advisory board member John Frehse, senior managing director of labor strategy at Ankura, and Dave Gilbertson, vice president at UKG.

As the name implies, you won’t find any formal presentations or prepared statements in these videos. But don’t let John and Dave’s light-hearted banter and good-natured jabs fool you. They’ve both spent their careers studying the economy and what it means for employers, informed by their decades of experience and the latest workplace activity data and economic reports from the U.S. Bureau of Labor Statistics.

The first new episode, which is actually Episode 12 in the overall series, builds upon John’s prior article about the importance of corporate surveys and how leaders must continue to focus on fostering great workplaces for all people. Culture requires commitment, and how you treat your employees every day has a direct impact on your people and your business — especially in a tight labor market.

In the second new episode, John and Dave chat about the differences between the economy and the labor market. While the economy certainly impacts the labor market, and vice versa, they are not the same. In Episode 13, the co-hosts breakdown the relationship and discuss how, sometimes, bad news for the labor market can actually be good news for the economy.

The third new episode (Episode 14) of No Suits, No Slides! zeroes in on the healthcare industry — how it’s already been impacted by the labor shortage, and what may be in store for healthcare in the coming months, especially with respect to the current labor market and talks of a looming “jobful recession.”

I hope you enjoy watching these new episodes as much as I did. And, remember, if you’re new to the No Suits, No Slides! series, looking for your next great bingeable show, or just want to catch up (or re-watch) past episodes, you can check out the entire series here.

Today' post comes to us from Nanne Finis, Chief Nurse Executive at UKG.

A special thank you to Anne-Marie Schenk, DNP, MBA, RN, NE-BC, UKG Chief Nurse Executive Advisory Board member, Nurse Executive and Founder of Lead.2Gether, who contributed her real-world nurse leader perspective to this article.

In my role as the Chief Nurse Executive at UKG, I have the opportunity to talk with and learn from nurse leaders across the U.S. Based on these interactions, here are some insights into the COVID-19 experience from the nursing perspective that healthcare leaders must pay attention to now.

This Pandemic is a Clinical Crisis.

COVID-19 has poured gasoline on the already difficult role of nurse leaders. Nurses and physicians have been the leaders in this fight, and it's evident that business leaders have had to rely on them to manage the business of healthcare like never before. This expanded responsibility for operational control has led to increased emotional burden and stress on nursing leaders, as they have borne increased responsibility for the success or failure of their organizations and have had to lead those they used to follow. The view of the organization through the eyes of the nurse leader portrays a uniquely different place than a year ago. Essentially, the goal for every nurse leader in 2020 was simply survival. The three most prevalent focus areas of nurse leaders and their organizations are:

  1. Focus on Finance

The surgical volume is the bread-and-butter of hospital finances and without this surgical revenue hospitals cannot survive. Labor costs associated with salaries as well as recruitment, retention and training are a major burden to hospitals. This fact, coupled with the loss of hospital revenues and increased non-labor expenses, challenged organizations to manage day-to-day finances without forecast or prediction models---knowing that the future was uncertain.

Nurse leader impact

Nurse leaders have been under constant pressure to keep the volume rolling, despite staffing, process, and often limited supply resources to support the volume. Nursing leaders have had to navigate the fine balance between finance and safety as many nurses have left  to take lucrative assignments elsewhere, leaving already understaffed units even more vulnerable.

2. Focus on Workforce

With the on-again-off-again elective surgical volume, hospitals have had to figure out how to keep staff working when elective surgeries were canceled. Once elective surgeries resumed, nurse leaders had to scramble to find staff to work on a dime. As the aforementioned travel contracts and "life-changing" salaries were offered (out of clear desperation), hospitals across the country began “recirculating” the same resources, leading to enormous salaries while driving down quality. States paid huge sums of money for crisis staff. In retrospect, many continue to wonder if this money might have been better-allocated by providing staff incentives to stay in their home organizations, still costing money, still allowing them to benefit, but not negatively impacting quality.

A February 2021 AONL COVID-19 longitudinal study report highlights many critical changes that have occurred since July 2020. The most critical data point from this study concerns nurse managers: 24% of the manager respondents indicated that they are not or not at all emotionally healthy. Nurse managers also are more likely than Chief Nurse Executives to leave the profession of nursing.

Nurse leader impact

For a nursing leader, staffing is simply their daily work; they begin learning staffing the first day on the job as a staff nurse. During COVID-19, approvals for incentives to increase staffing often came to organizations too slowly. These leaders likely knew what was needed but had little control over solving the problem. They were left powerless, watching the impact on both their staff and their patients. Absences due to exposures and illness crippled many nursing units. Many organizations were reluctant to monitor absences, because they were concerned this would drive staff to come to work ill. Some staff took advantage of absences without consequence, further burdening their peers, while others were simply caught between the desire to fulfill work commitments and their own personal time stresses, including childcare and schooling. Pre-COVID hospitals had attendance policies and procedures to keep absences in check, but those controls were no longer reasonable in this new environment. As the year progressed, maintaining the morale of staff became more and more challenging and further drained the leaders, who themselves needed a cheerleader.

Attention to the issues that impact nurse retention and wellbeing is a challenging but critical priority for leaders today. According to the AONL study mentioned above, managers and employees at all levels are experiencing stress and burnout symptoms in different ways, with those closest to point-of-care, including nurse managers, experiencing the highest levels stress.

3. Focus on Safety

The politics of COVID-19 bled into the workplace. Politicization of masking mandates and quarantine guidelines in hospitals often created hostility between non-clinicians and the clinical staff mandated to follow CDC guidelines. Process changes associated with COVID-19 (both for prevention of transmission and supply chain shortages) had to be designed and executed and the impact of staffing on patient care had to be measured in new ways.  Quality nursing care takes time and requires the application of consistent evidence-based practices. COVID-19 created significantly worse staffing and the increase of contract staff often negatively impacted compliance with care “bundles” and practice guidelines.

Nurse leader impact

Nurse leaders found themselves emotionally drained as they often had to defend the science and the regulatory requirements to their non-clinician peers. For the non-clinical leaders, it was just “opinion”. For the nurse leaders, their license, profession and job called them to drive safe care. This led to exhausting daily review and redesign of processes. Nurse leaders were responsible for creating new processes and executing on successful change. Errors most often are born from process errors, rather than people errors. Burnout related to negotiating the new processes with stakeholders and maintaining responsibility for any errors associated with the new process created additional burden to the leaders' emotional stability. Nurse leaders everywhere found themselves with a deep desire and professional commitment to deliver high-quality care to every patient in the face of limited resources created a constant state of distress.

A New Playbook is Needed

The work, the workplace, and the workforce have all dramatically changed in the last year and the nursing playbook must be completely rewritten and re-tested. Public health officials are still warning caution but also beginning to see reasons for hope as millions of people around the world are being vaccinated. We have depended on our nurse leaders for guidance during this time and we will continue to depend on their leadership for the future. We find ourselves at a daunting place, but one that may also be a time of innovation and change that will be professionally rewarding. 

There is emerging science and technology that can help to predict both workload and workplace stress that can hopefully be used to better plan for future pandemics where we can better support our nurse leaders.

Key resources used:

Today's post comes to us from Workforce Institute board member and Chief Nurse Executive at UKG, Nanne Finis.

As a nurse currently working in a corporate position, I often take the opportunity to think about my healthcare colleagues and about the state of the healthcare industry at large. As we embark upon what is sure to be a challenging winter with COVID-19, some of the questions I find myself asking are:

I have no doubt whatsoever that we will survive as an industry and dramatic improvements and innovation will result. I am a firm believer that beyond any crisis there is deep learning followed by creativity and energizing change.

Some of the incredibly positive changes or shifts that I have seen include:

As a nurse, I am deeply engaged in watching this evolutionary time in our healthcare system and in my own personal life. While we grieve during this period of worldwide devastation, and feel the pain in our local communities, we are constantly reminded of the richness of our connections and relationships, the importance of health and wellness, and the bright future of change and innovation that now has a stronger foothold in our world. 

Happy Holidays!

Note: The American Organization for Nursing Leadership has a wonderful compendium of leadership resources that was helpful to me in drafting this article and is a terrific resource for anyone managing in healthcare today.

In addition, this interview in McKinsey Quarterly with Admiral John Richardson, a retired four-star admiral and former chief of naval operations, is also a wealth of information and gave me much to think about.

Today's post comes to us from Workforce Institute board member Nanne Finis, RN MS and chief nurse executive for Kronos Incorporated.

As I ponder the current state of our healthcare system in the U.S., I have mixed emotions. Without a doubt, this pandemic has exposed various processes that are in dire need of repair and improvement. At the same time, I've never been prouder of my colleagues in the healthcare profession for the bravery and dedication they have shown in meeting this pandemic head-on. After giving 40+ years to the healthcare profession as a clinician and leader in an academic medical center, a consultant, and a business leader serving on many advisory boards, I'm sure I'm not alone in finding myself questioning whether I have had any impact at all on a system that has so many opportunities for repair and improvement.

Healthcare Complexities

As nurses who care for those who enter our doors and the populations we commit to serving, it is more clear than ever that healthcare is a local phenomenon. Inside the organization, the focus is on teamwork, research and applying evidence-based principles, process improvements, innovation, and a laser-like focus on safe/quality care for our patients and their families.

But outside of those hospital walls, so much happens. A population of patients are living their lives and using the hospital for both dire needs and convenience stops in the Emergency Departments. Funding of hospitals supports community work and focus on the population, but that work has often resulted in discrete community screening or celebratory events and perhaps done little to change the health dynamic of the total community.

The health of our community has been relegated to our local public health departments. But, public health has often been under the radar and underfunded and it has never been given its full due.

The Emergence of the Need for Public Health

Over the past several months, multiple forums to discuss the importance of public health have been publicly available. Michelle A. Williams, an internationally renowned epidemiologist and public health scientist and Dean of the Harvard University T. H. Chan School of Public Health, has hosted a series of online symposiums called “When Public Health Means Business” and she plans to launch a curriculum later this year aimed at helping business leaders more fully understand public health and its application to business. Williams has stated that perhaps it is time to have a new role, a Chief Public Health Officer, at the senior leadership table of organizations in diverse business sectors.

Public Health (PH) as a science promotes the study and application of theory for populations of people vs. individuals. PH professionals have been involved with epidemics and pandemics before and know that the potential for crises like our current one has always existed. COVID 19 is a novel virus that we are learning about, in real-time, as the pandemic evolves. We need to combine knowledge from our scientists focusing on public health with that of medical professionals studying infectious disease and epidemiology and with other professionals dealing with matters of incidence, distribution, and possible control and outcome of disease. None of our population has natural immunity to this new virus and all are susceptible to the virus, so now is the time to make change.

We Know How to Do This

For those of us who have “grown up” in hospitals, we know that most of our Infection Preventionists and Infection Control Physicians are trained in epidemiology and are skilled at collecting and using data to design prevention and mitigation interventions.

These specialists have training in the principles of public health and have expertise in “viewing an infectious event” from the perspective of a population and directly managing an outbreak. They have experience managing the isolation process for infectious persons - from what  equipment is needed to what isolation precautions must be taken - all while educating and mentoring the multiple care teams on the mitigation of risks to their personal safety and to the safety of others.

There are published staffing models that scientifically lay out the ideal numbers of such experts based on the population of patients served, intensity of surveillance and regulations. For example, The Joint Commission requires that hospitals identify the individual responsible for leading the infection prevention control program and allocate needed resources for the program.

These infection prevention programs have always been the conduit to local public health experts, primarily focused on mandatory reporting requirements. But, though our worlds of public health and provider healthcare organizations have worked together in the past, we can and must advance this relationship further.

What to Do

The COVID-19 pandemic has rapidly brought discussions of worker physical safety to the forefront of all leadership. As organizations across all business sectors contemplate returning to work, the focus on safety for all employees, visitors, and most importantly vulnerable patients in a healthcare setting has become a mandate for organizations. The World Health Organization (WHO) has even selected _Health Worker Safety: A Priority for Patient Safety' as the theme for World Patient Safety Day 2020.

Here are some specific steps I would recommend to start making Public Health a priority in your organization:

If you are a healthcare leader, SPEAK OUT and SHARE YOUR KNOWLEDGE. Take control of this situation - we are experts and know what needs to be done. The safety of our communities and the populations that we service are at stake, and our own families and friends are looking for us to lead. Let's not let them down.

It takes a time of significant crisis - like the one we find ourselves in now - to appreciate how the whole system should work with the critical inclusion of public health professionals. I would suggest it is time to understand and formally integrate public health into our daily work in healthcare and across all industries.

A special thanks to my friend and colleague Barbara Soule for her wisdom and guidance over many years and for her deep commitment to the science of Public Health and Infection Prevention and Control.

Today's post comes to us from Workforce Institute board member and Chief Nurse Executive at Kronos, Nanne Finis. Nanne has spent forty years in the healthcare industry focused on the profession of nursing and patient care delivery. Here she reflects on the bravery, knowledge and skills of nurses on the front line of the Covid-19 pandemic.

Nurses are unique individuals; I know because I am one.  As I reflect on the global condition and consider the millions of nurses involved in the care of others I am struck by the bravery, knowledge, skills, and ability of my colleagues that care directly for patients and residents daily.

The curriculum for nursing offers a framework of theory, science, human psychology, and practical skills. This training has provided me an abundance of lifetime skills. My clinical background offered me the opportunity to care for emergency department patients, medical and surgical patients, and to lead many clinical departments including one unique intensive care unit - a Surgical ICU where the most complex trauma and surgical patients were cared for. When I consider over a decade of my career in this ICU and in the Emergency Department, I am awed by the learning that I garnered during those years.

During crises or emergent situations, I learned that my decision-making process must remain factually based and my emotional responses had to be suppressed. There obviously is a time and place for human emotion but in a period of crisis the confidence and directed action of the nurse is critical for all. Nurses are taught to act on the rigorous process and critical thinking skills that becomes second nature in practice. 

I learned a great deal from the clinical experts in that ICU. Those memories have formed my ideal image of nursing and the passion and excellence of care delivery. It is a memory that I remember endearingly. Patients arriving to the ICU would come directly from the operating room following hours of life saving surgeries and often with more IV lines than an individual nurse could count. These nurses always started their review of the patient from head to toe–a rigorous, consistent and detailed process of assessment and interpretation. All IV lines were traced to the origin of the line and labeled one by one starting with the most toxic of the intravenous drips. The sheets of the beds that these patients lay on were taut, without one wrinkle. Patients were turned routinely, provided back rubs and foot massages when appropriate, and they quickly became part of that unit's family. These nurses modeled expert clinical and emotional care for every patient in their midst and expected the same from the many excellent physicians who serviced patient there.

It is amazing how the rigor of professional training when witnessed over and over becomes inbred in your ethos and spirit. In pictures and news clips of nurses these past several weeks, I notice the faces of the many nurses. They must be frightened for their own lives and families, but their full attention is on the patient before them. The routines of care, decision making, and rigorous assessment take hold and they perform in a caring and sensitive manner.

It is an honor to watch nurses perform. In this year of the nurse, we must honor their work and hold them up as heroes in our midst. Thank you for all you do and thank you to all the wonderful nurses who mentored and taught us the skills that today are impacting the world.

This post was previously featured on the Kronos Industry Insights Blog.

Today's post comes to us from Workforce Institute board member Joseph Cabral, Chief Human Resources Officer and President of Workforce Solutions at Press Ganey.  We recently did a podcast with Joe to talk about the importance of analytics to improving patient outcomes and making the delivery of health services more efficient and cost effective.

Today's healthcare Chief Human Resources Officer (CHRO) has moved beyond managing traditional personnel and administrative functions. As key strategic business partners, they are not only responsible for overseeing benefits and compensation, employee experience, diversity and regulatory compliance–they also help drive the clinical and financial performance of their organizations.

CHROs are expected to deliver better patient outcomes, work environments and bottom lines. This is not check-the-box work. This is rebuilding a human capital management system from the ground up in order to create and sustain an organizational culture that engages the workforce, promotes innovation and bridges operational silos.

Achieving this ideal requires CHROs to leverage data analytics to evaluate the effectiveness of talent management programs. With the right insights, CHROs can target areas of improvement while informing new workforce strategies that account for global labor trends, available talent and next generation leadership. This will enable them to transform their organizations' human capital strategies, replacing traditional practices like hiring freezes and flex scheduling with evidence-based best practices that keep pace with industry and workforce changes.

Evolution is challenging–and inevitable. Adapting and innovating is essential to succeed in the new health care landscape. CHROs must be prepared for new regulations, cybersecurity crises, medical errors, mergers and acquisitions, competitive threats and more in this era of disruption. Furthermore, they must be prepared to present change and prepare our workforces for it.

None of this is easy, but all of it is rewarding. Healthcare CHROs have the honor of working with people, and more importantly, people in healthcare. In the ongoing challenge of evaluating our processes and strategies to meet their unique needs, we get to help those people save lives.

 

Healthcare is always a hot topic in the US.  From the fate of the Affordable Care Act to the continually rising costs of healthcare services, it's a top of mind issue for employers and their workers.  In March, over 40,000 attendees gathered in Las Vegas for the annual HIMMS conference to learn about how information and technology are being used to improve the quality, safety and cost-effectiveness of health and healthcare.  According to the 2018 HIMMS U.S. Leadership and Workforce Survey  results released during the conference, cybersecurity and data analytics are the top two IT concerns for healthcare industry IT leaders.  This survey also revealed that while IT executives are having an increasing influence within hospital settings, they are also challenged to staff their projects with 51% indicating “their organization elected to place on hold or scale back an IT project or initiative in the past year due to a workforce challenge”.

I recently interviewed two guests for the Workforce Institute Radio podcast who can shed more light on these and other challenges for IT leaders in healthcare.  Joe Cabral is chief human resources officer and president of workforce Solutions at Press Ganey Associates.  Press Ganey partners with healthcare providers across the continuum of care to create and ”‹sustain a high-performance environment that will improve the patient experience.  My second guest was John Short, a Kronos professional services practice director focused on our US healthcare customers with many years of experience helping organizations to deploy technology that will help them achieve better employee and patient experience.

We discussed what they are both hearing from the executives at the healthcare organizations they work with when it comes to the role technology can play in improving patient outcomes and making the delivery of health services more efficient and cost effective. You'll hear from Joe and John how predictive analytics and artificial have the potential to transform healthcare delivery systems as we know them while improving the experience of both patients and healthcare professionals.

You can listen in on our conversation below.

 

 

 

Today's post is from Joyce Maroney, Executive Director of the Workforce Institute.

This week I had the pleasure of speaking with Peter Navin, the senior vice president of employee experience at Grand Rounds, a company that provides an employer-based solution that gives employees and their families the technology, information and support they need to make decisions about whether and where to receive medical treatment. Before joining Grand Rounds, Peter has had a long and varied career in human resources leadership at companies like DocuSign and Shutterfly. He has also recently authored a Harvard Business Review article with Workforce Institute Board member David Creelman and fellow HR luminary John Boudreau on the topic of Why More Executives Should Consider Becoming a CHRO.

In this podcast recording of our conversation, you'll learn how Peter's career led him to the CHRO role and what advice he has for others who are CHRO's or who aspire to be.  He shares his four principles for creating a culture of engagement and performance as well as how executives aspiring to the CHRO role can prepare to make that move.

You'll also hear his responses to the following questions, among others:

Listen to the podcast below:

Are you an HR professional?  What would be your tips for someone who wishes to advance in the profession?

October 5-11 is Emergency Nurses Week here in the US.   At Kronos, our single largest customer population is in healthcare.  From standalone long term care facilities to the biggest healthcare networks in the world, we are helping healthcare providers help their patients.

In the latest installment in our 1 in One Hundred Million video series celebrating workers, we talk to Vanessa, an ER nurse in Massachusetts.  Like most nurses you meet, her overwhelming focus is on providing care.  Watch, enjoy, and share with a nurse who's made a difference in your life.

You can watch Vanessa's story here:[youtube=://www.youtube.com/watch?v=oRGQ32hbKyI&w=560&h=315]

Prior Posts About Why We Value Nurses:

Kronos Video Tributes to Nurses

Thank You Post to Dad's Nurse, Katy

The following guest blog post comes from our newest board member, Dr.Tim Porter-O'Grady.  Given the historical vote in Congress last night, coupled with the rising call for evidence-based medicine, Tim's perspective from the trenches is very timely.  You can also read Tim's recent article in Nurse Leader magazine on the case for clinical nurse leaders in the 21st century.

One of the big challenges with leaders and clinicians these days is the overwhelming amount of data that must be collected, codified, generated, and analyzed. A big temptation in this necessary effort is to watch data management convert from means to ends. As I travel around the country working with a wide variety of health care agencies, I see clinicians overwhelmed with trying to balance the collection and management of data with the demands of patient care. While data is important, leaders must remember that clinical and management data should be directed to supporting, improving, and advancing patient care not simply a nonaligned means of the measure of process.

When the demand for measurement becomes overwhelming, it moves from tool to goal. When data becomes a goal it moves from facilitator of practice to an impediment to work. In fact, it begins to undo its very purpose and itself become a "workaround" and just another barrier to effective patient care. For many clinical leaders the demand for information and the urge to collect and provide it becomes more important than the real sustainable achievement of value or outcome. One wonders how many clinicians are now working to instrumentation measures, making those measures their performance goals, losing focus on their patient in the process. While the collection of this data is certainly essential to the methods and techniques essential to measuring the presence of effective process, they are indicators, not results.

It must be remembered, in the midst of all this data collection, that clinicians are providing a service deeply embedded in the context for caring to persons experiencing one of the most significantly vulnerable points in their life's journey. These patients are expecting that the focus, attention, and center of clinical activity are directed to helping them cope, respond, and accommodate their healing journey. The real value-driven measures are those that well articulate a goodness-of-fit between the needs for caring and the resources necessary to assure that it occurs efficiently and effectively.

The best measure of the utility of data is that which assures that mission, purpose, resources and care interface in a mosaic where the patient expresses exuberance with their experience, the clinician expresses satisfaction with her or his impact and management recognizes value in the efficiencies leading to sustainable outcomes. The achievement of these ends is reflected in the essential dance between the stakeholders and the organization and the music is the information that demonstrates their convergence.

So, finally, it is important for each stakeholder to both recognize and enumerate value in the collection and analysis of data related to the dynamic of caring for patients. Equally important is to acknowledge that data is reflective of value and action, it is not, however, itself value and action. Measurement of the meaningful delivery of service is not the service itself but, rather, is indication of the effectiveness and efficacy of the service. There are three things that must continuously be kept in mind when interfacing data management with clinical care:

In the final analysis, sound relationships are the best indicators of both efficacy and meaning. The relationships between health organizations and their clinicians, between clinicians and those they serve, and between health organizations and their communities are the clearest indicators of effectiveness. Data and measurement devices are the lenses through which the value and impact of these relationships can be assessed for both their quality and effectiveness. If all stakeholders in this dynamic keep focused on the ends of advancing the health of those we serve, the data means we use will provide the evidence we need for the validation we seek in fulfilling the central purpose of the caring we provide. Quite frankly, that is why we are here.

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