Advice on Staffing and Turnover – Arch Collaborative Learning Summit 2022
When I came to work for KLAS, the Arch Collaborative Learning Summit became one of the events I looked forward to being a small part of every year. An event exclusively for members of the Collaborative, the attendees always show an overall spirit of cooperation, and there is an overwhelming willingness to learn together. I consider it a privilege to hear from the presenters. Each one is a healthcare leader who works hard to improve their corner of healthcare for their clinicians.
Tommy Rowley, KLAS’ Director of Customer Insights, moderated for the first panel about the clinician staffing and turnover challenges so prevalent in the industry today. The panelists were Dr. Laura Zimmermann, the Interim Division Chief of General Internal Medicine and Associate Professor of Preventative Medicine and Internal Medicine at Rush University Medical Center (Rush); Dr. Pat Patton, the System Chief Nurse Executive at UCSF Health; and Dr. Steven Martel, Associate Chief Health Information Officer at Children’s Health of Orange County (CHOC).
The following highlights came directly from their discussion.
The Contribution of the EHR
Of the clinicians that survey with KLAS, around 20% of respondents report they might leave their current organization in the next two years. Of those respondents, 60% point to burnout as the reason. Tommy and the panelists all acknowledged that although the EHR is not the primary cause of burnout and turnover, it is a contributing factor. So panelists were asked what role the EHR experience plays in retaining clinicians.
Dr. Zimmermann stated that the EHR at Rush is high functioning but that they are tackling issues with Epic’s product, In Basket. Their full-time clinical providers receive between 1400 and 1600 messages per month via In Basket. To help with this problem, they figured out different workflows for different message types and got other people involved, from clinic coordinators to RNs and pharmacists, to try and figure out who could work at top of license to deal with each message type.
Dr. Patton shared that if UCSF Health doesn't keep their nurses happy with the EHR, they can leave and go to other healthcare organizations in the Bay area. KLAS data is helping UCSF Health understand their needs, and his chief nursing informatics officer also had a great idea to create clinician informatics champions across the organization. The hospital is piloting the program this year and will have all the champions give 20% of their time toward the effort of improving the EHR. Dr. Patton said the program also makes these champions superusers that people can go to with questions or ideas.
Dr. Martel reiterated that we know from the data that the EHR experience is not the biggest contributor to burnout but suggested that the EHR “is one of the contributors that we as organizations and those of us who do this work can actually control and have an influence on and impact.” He advocated that anything done in the EHR should be done with the purpose of efficiency and optimization to lessen the growing administrative burden on physicians.
Addressing Turnover in Nursing
We all know that nursing is seeing the most turnover. To help retain nurses, Dr. Patton suggested that healthcare leaders make sure that each nurse is allowed to do everything they can within the scope of their license. This helps physicians by taking away some of the administrative burden, but it also helps nurses because they can then collaborate with physicians to provide better care.
Dr. Zimmermann agreed that encouraging nurses to work at top of license and decreasing the administrative burden helps. She added that leveraging nurses to do educational work like insulin teaching in the clinic brings them more fulfillment than being on the phones all day.
CHOC recently optimized their nurse intake process and decreased the number of required questions and the documentation burden because they discovered that so much of the past information served no useful purpose. Dr. Martel said they’ve gotten enormously positive feedback from their nurses on improving that process and hopes that continuing to improve operational efficiencies will impact retention.
Retaining Women in Healthcare
The discussion surrounding efforts to support women in the medical field was particularly full of suggestions for improvement. Dr. Zimmermann shared that even before the COVID-19 pandemic, women were on an uneven playing field. She said, “The big picture is basically that women are working harder at work and at home but are receiving less compensation and less recognition.” During the pandemic, many women decided it wasn’t worth staying in healthcare or that they just couldn’t stay because of mounting financial or physical burdens.
She recommended, among other concrete things, doing a “like-to-like” audit and being transparent about how salaries are determined and what everyone makes. She also said, “We need intentional efforts to address life-work integration by providing maternity leave, paid sick leave, and adequate PTO.”
As a nursing leader Dr. Patton works in an environment where 90% of the nurses are women. He purposefully goes through every manager’s salary without looking at names and looks solely at how many years of experience they have as well as their years of leadership experience, and what they are making currently. And then he adjusts salaries based on those qualifications. In addition to that, in the last year, he started looking at every single person hired, and every leader goes through him so they can have equity across UCSF.
Watching the Panel
Other topics panelists spoke on include the impact of COVID-19 and how to get executive support for initiatives that better support clinicians. The audience also had the opportunity to ask a few questions. If you missed the panel and want to listen to the discussion for more details, please check out the recording on KLAS’ YouTube channel.
Photo Credit: ashtproductions, Adobe Stock