So I really appreciate the opportunity to participate today and so my first talk is about staffing, and we'll be addressing staffing throughout the day today. So for this talk today and my subsequent talks I have no financial relationships with commercial support to disclose. I'll start with a quote from John Cotter. John Cotter is a widely regarded voice on leadership and change from the Harvard Business School. The single biggest challenge we face as teams, organizations, and society at large is to adapt fast enough to match the increasing uncertainty and complexity around us. We have experienced this on a global scale throughout the COVID-19 pandemic. Any single organization success or failure at dealing with this increasingly fast changing world could affect the lives of many thousands of people. Certainly applicable to the healthcare industry. Well we survived 2020, and our challenges are different than they were last year. Patients at this point are willing to come in for care and some of that has been delayed. But overall we're seeing patients now. Workplace standards have evolved and across, you know, for our society, we're comfortable with COVID-19 safety practices and workplace standards. It's something we're used to, it's routine. But one question, can we deliver care well? And do we have organizational stability and resiliency? First polling question. Are you currently experiencing staff shortages in your practice? So obviously very common. And that's expected. Another polling question. This past year your staff turnover has increased, is stable, has improved? And this is a redundant question, but we'll see what everyone has to say. We have some new people on, so. Certainly has improved and that's not surprising as well. So last year, obviously, especially in phase one of the pandemic, unemployment rates were high. Many on this, you know, participating in this meeting had to lay off employees, you know, employees were laid off, furloughed, companies went under, shut down. The gig economy obviously suffered as well. We were really focused on practice survival, getting support, maintaining staff restarts and rebounds. So what challenges are we facing right now? This is an MGMA staff poll. And it's just one survey that is representative, I think, of the challenges that we're having. Difficulty hiring, turnover is high, as we all know. Staff are quitting, they're leaving for various reasons, which we'll talk about. Quarantines, you know, staff or even providers need to be home for a myriad of reasons related to COVID. Some people can't come into work and we are experiencing a vaccine mandate in Colorado. You may not, but this certainly potentially has an impact. There's some people that are willing to quit and not vaccinate. And that's just the reality. This is the same poll and just, I think, representative of staffing challenges that medical practices are having. So in this particular survey, three out of four medical practices rank staffing as their biggest pandemic challenge heading into 2022. And that's certainly the case for our practice. What are some leadership realities? As mentioned, patients are coming in. So we have reasonable patient demand. We may be surging, depending upon your community. But we may also have stressed patient care delivery, and that's not a good combination, right? Patient demand with more difficult delivery of care and service. We may have variably short staffed departments, higher turnover, and we're competing for new hires in different ways. It's a more competitive market and the market pool for applicants has shrunk. If you lose a seasoned employee, you're likely replacing experience with inexperience, and that has consequences, including the loss of institutional memory. The teams that are working in a short staff are stressed, and that affects workplace functions and efficiencies, and vaccine mandates may affect us as well. The economy is in an interesting state where we have high unemployment and we have a labor shortage. I think we're all familiar with this term, the great resignation. It's also been called the big quit. The great resignation was coined by Anthony Klotz, who is a professor of management at the Mays Business School of Texas A&M University. He coined that in an article in May 2021 that this would occur, and it certainly did. It's the ongoing trend of employees to voluntarily leave the workforce in the spring of 2021 to present, and it's primarily a U.S. phenomenon. Depending on which month and which statistics you look at, there's record amounts of people quitting their jobs, right? In surveys, a large number of Americans report looking for new jobs. The U.S. Bureau of Labor Statistics reported recently that 40% of people quitting actually don't have a new job lined up when they quit, and the hardest-hit industries include healthcare as well as retail, hospitality, manufacturing, and technology. What's driving this? And there's multiple factors. On one sense, there's an artificial backlog. Last year, many people were lucky to hold on to their jobs, and they weren't obviously ready to make a transition, but that's not the case this year. There's definitely a desire for more job flexibility and remote work. Some experience that, and they like it, and it works for them better for various reasons, and we'll talk about that more in the next lecture. A lot of people have had time to reflect and ask what's contributing to my happiness and well-being. You know, a pandemic is an existential crisis, and many people have tried to understand what's important to them and where does their job fit into that, right? And a number of people, I think, realized that they were maybe unsatisfied, felt undervalued, or in some circumstances exploited, but now empowered to do something about it. It's more common for millennials in the Gen Z generation to be quitting. Compensation plays a role, and certainly it's a buyer's market right now for employees, and they may leave a job for better compensation, better benefits, incentives. The impact of the emergency unemployment benefits, which have gone away, is debatable, but certainly there's a number of people that are still willing to stay home, even without that and that work. The gig economy has affected the healthcare industry in a different way, and I think we're aware of that, especially nurses and some of our techs have gotten into the gig economy. They're willing to travel with flexibility to make more money, you know, especially in the inpatient setting. For some people, it's a reset that may be forced on them, but they decided to get more education, make a career transition, or advance, and with the lower applicant pool, those with experience and skills are more likely to get a job. Burnout, mentioned by Sufjan, is a big issue, and I think he pointed out well that this existed prior to the pandemic, but it's definitely an issue for our workforce, right? And it's not just our staff, it's also physicians. I think a number of physicians have retired early. It's just kind of pushed them along a little bit faster than they would have expected. I think this is a big issue for managers that have survived all the COVID stresses and the ups and downs, and then have tried to function with short-staffed departments, inability to hire. It's very, very stressful, and I think it's difficult for managers. The stress level has also been reported to be higher for medical assistants, women and persons of color, those with high workloads, those with underlying health conditions or mental health conditions, and those that feel undervalued. And these are our patients, and these are our consumers. And again, this has been a challenging time that seems to keep going. Most Americans have experienced or are experiencing more stress. There's increasing frequency of threatening and violent behaviors and just short fuses. And so on top of the challenges we're dealing with, we have to take care of patients that may be exhibiting these characteristics, and they may be more difficult for our staff to take care of, to service, and to deal with, right? And so that certainly can affect performance and burnout for our staff and our providers. Another quote from the Harvard Business Review. The pandemic has caused many workers to think deeply about what's most important in their lives and how to spend more of their time focused on what gives them purpose. Humans have a fundamental need to perceive life as meaningful. When people are asked what gives their lives meaning, the most common response is close relationships with family and other loved ones. Another term that you may or may not be familiar with, the Great Reset. And this implies a worker-driven labor shortage. And actually, this is the fourth Great Reset that we've had, not the first. So there is precedent historically. This happened after World War I and World War II, after the Great Depression, and now after the COVID-19 pandemic. These usually last one to two years. There's a reset in the economy. The economy is not the same after that reset. It's different. Interestingly, in October, over 100,000 workers in the U.S. either participated or prepared for strikes. It's tri-October, it's been called. Some tips for leaders. You know, in the end, we have to face the reality. We're trying to run our practices under different circumstances. We've been reactive a lot in the past, especially in the beginning of this pandemic. But we need to be proactive, right? We need to be proactive in what we're doing to stabilize our businesses. We can't forget about the employees that are working for us. So we tend, with a lot of turnover, there's certainly a focus on hiring and staffing our departments. But don't forget about the employees that are working for you. They need to be engaged, especially one-on-one by the managers. What can you do to help them feel fulfilled and satisfied and able to stay within your practice and part of your practice? Don't ignore off-boarding. You need to understand why people are leaving as best as possible. I think it's good to have that be a positive, not a negative experience. We've had a few employees actually come back with a glad grass wasn't greener. So you may have some people that come back to your practice. This may sound counterintuitive, but you may have opportunities to upgrade talent. So when people leave unexpectedly, and you have to fill that position or a certain number of positions, you might be able to do that differently. You might be able to bring in different types of talent, more talent, or think about different ways that you can have those work tasks taken care of. That has happened for us. We'll talk about this, certainly. There are certain employees that expect job flexibilities. We need to be competitive in our market from a salary incentive and benefit perspective, but it's not all about the money. There's a book that I read several years ago called The Loyalty Effect, and you may have read that book. It's a fantastic book, but my concept of loyalty has really somewhat gone out the window, I have to say, over the past year and a half. Employees are empowered. That's a key point. They are empowered to do what's best for them. Even if they work for you for a long time, they're willing to make a change for various reasons. So we can't take our employees for granted. It's important to look at turnover always, I think, in a data-driven approach. This was true before the pandemic. It's true right now, and it will be true in the future. You need to try and understand some important things about why your turnover may be higher. Have you quantified those challenges? What's the impact on your key business metrics? Which departments are affected? What are the root causes, and how can you improve it? What can you do to improve retention and decrease turnover? Another stat poll, this is a little bit dated, but in this, 88% of healthcare leaders reported having difficulty recruiting medical assistants. We've certainly experienced that. We've had turnover with MAs and difficulty hiring. It's one of the realities that we've been dealing with. The front line and lower-level employees are really important in our practices. They're critical for effective and efficient patient care and service. In many respects, they're the first people that our patients interact with. But they may be more likely to have longer commutes. They are much less likely to utilize nannies and childcare. They are much less likely to utilize nannies and childcare centers. They have to rely on extended family and parent tag-teaming to take care of their kids. There's a higher divorce rates. They have portable skill sets, and they do have mobility. There's been poaching happening from practice to practice. Ghosting is a term I've become familiar with. Those that apply but don't show for appointments, but they're able to keep on employment benefits as they're applying for work. We have another polling question, Eden. Have you increased salaries this past year to improve hiring and retention? That's fascinating. And not surprising. Not surprising. Financial incentives. Obviously, our goal here is hiring and retention. And I would say earlier in the year when things were happening fast, we were a little bit more reactive. But we had to shift to be more proactive. So, in one sense, you need to be market competitive and do your best to understand what that market is. With salary surveys or other ways, where should you be on that curve of market salaries? Be wary of gamemanship. We've had certain employees threaten to leave because they're making $3, $4, $5 an hour somewhere else. You don't know if that's realistic, and you never want to make a decision based on one particular employee. But you need to be competitive. Also, remember that when you make salary changes, that's a long-term impact on your labor costs and your overhead. That's not going to change. So, you need to make those decisions wisely. Bonuses represent more of a short-term cost and also a short-term benefit for the employees. And we're all aware of the signing bonuses that are rampant in various industries. And we have implemented signing bonuses, and we have implemented referral bonuses. So, if an employee brings in another employee, they'll get a referral bonus. Be wary of retention bonuses. They have some challenges. Do you want an employee staying just for an extra certain amount of money every quarter? They may leave after that. If you tie that to requirement to stay in the practice a certain number of months, you can't just deduct that from their salary. If they leave early, you have to get consent for that, actually. So, those have some challenges. These are some AMA resources, which I won't go through, but you have them. I thought they were really useful. Creating a resilient organization for healthcare workers during a crisis. And caring for caregivers during COVID-19. So, to summarize and practice pearls, and we need to see the forest for the trees. First of all, we won't solve our current hiring retention problem just by applying solutions of the past. But many of these practices still apply. But we have to evolve. We have to be willing to rethink how we attract, retain, and manage staff. If we don't do that, we're going to be behind the eight ball. We're not going to move forward the way we should. Salary and incentives are important, but you need to look beyond that. And do what you can to promote meaning and value for employees. Create ways they want to work for your company. We'll talk about this more, but we need to consider remote flexible work options. Don't forget about those that are sticking it out and working for you. Try and keep people, try and retain in addition to focusing on hiring and staffing. And this is true always. A productive, engaged workforce is critical. We know that. Look for the silver linings. You may be able to do things more competitively. And whatever you can learn and do better is really important. Just a final quote. Simon Sinek is someone that has a few really good TED Talks. And he has a book called The Y and some other books. But a quote from Simon. Customers will never love a company until the employees love it first. Thanks.

staffing challenges

COVID-19 pandemic

employee turnover

vaccine mandates

workforce engagement