The dire state of hospital finances (Part 1: Hospital of the Future series)

About this Episode

The majority of hospitals are predicted to have negative margins in 2022, marking the worst year financially for hospitals since the beginning of the Covid-19 pandemic.

In Part 1 of Radio Advisory’s Hospital of the Future series, host Rachel (Rae) Woods invites Advisory Board experts Monica WestheadColin Gelbaugh, and Aaron Mauck to discuss why factors like workforce shortages, post-acute financial instability, and growing competition are contributing to this troubling financial landscape and how hospitals are tackling these problems.

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As we emerge from the global pandemic, health care is restructuring. What decisions should you be making, and what do you need to know to make them? Explore the state of the health care industry and its outlook for next year by visiting advisory.com/HealthCare2023.

What does ‘quiet quitting’ look like at hospitals?

The trend of “quiet quitting” has recently gained traction on social media, referring to a phenomenon in which workers to reduce their enthusiasm at work and stick to the minimum expectations of their role. Some professionals, including Generation Z workers, have embraced the concept as an increased form of work-life balance, and others see it as a lesser-version of actually quitting. Regardless of how an individual interprets the idea, the concept is not new among the U.S. workforce or in healthcare, according to Jeremy Sadlier, executive director of the American Society for Healthcare Human Resources Administration.

“Before the term quiet quitting was in vogue, we were talking about employees who would ‘quit and stay,'” said Mr. Sadlier, who previously served as a market director of human resources and provided operational support at Advocate Aurora Health, an organization with dual headquarters in Downers Grove, Ill., and Milwaukee. “In essence, it’s the same concept with a nearly identical motivation. No matter the term used, many disengaged employees will stick around long after they’re finding motivation and stimulation in their work.”

In healthcare, this phenomenon has only grown. An April Gallup poll found that 34 percent of U.S. employees were actively engaged at work in 2021, compared to only 32 percent this year. Healthcare professionals saw the largest dip in engagement, with their engagement scores dropping nine points year over year.

Mr. Sadlier noted that this trend can have significant effects in the industry.

“Any lack of engagement on the part of staff ultimately impacts patient care, teamwork, safety and throughput, all of which impact the financial health of an organization and the patient experience. It’s incredibly important for leaders to focus on engagement, growth opportunities, and to recognize and reward hard work. These are a few ways to focus on your employees to help them feel engaged with their work,” he said.

Still, quiet quitting doesn’t look significantly different in healthcare than it does in other industries, according to Mr. Sadlier. “Colleagues in other industries like hospitality and retail, for example, all talk about a lack of willingness among workers to pick up extra shifts, or work beyond the bare minimum requirements. That’s a sign of growing disengagement and may be quiet quitting,” he said. It is greatly concerning that, while the motivation may not be largely different than in other industries, the effects of quiet quitting in healthcare have a direct connection to patient care, quality and safety, according to Mr. Sadlier.

He also said lower patient experience scores may indicate that a hospital is experiencing decreased employee engagement, which can spread among all its staff.

“There’s an absolute hierarchy [in healthcare], and it doesn’t require somebody to work in healthcare to recognize that when physician engagement falters, that impacts nurses, and when nurses don’t feel engaged, that impacts the rest of the staff, whether it’s ancillary staff, support services,” he said. “There’s a trickledown effect to a lack of engagement at any part of the organization. Inevitably that impacts every position and is ultimately felt by those we serve.”

Additionally, he pointed to financial struggles at U.S. hospitals as a contributing factor for workloads increasing. On Aug. 29, Kaufman Hall released a new report that showed hospitals are experiencing some of the worst margins since the beginning of the COVID-19 pandemic. This means some organizations have had to implement layoffs and other cost-cutting measures.

“Cost-cutting measures are becoming harder to accomplish without having a direct effect on the care patients receive. When [full-time equivalents] are affected, in many cases the responsibilities are shifted to other members of the team. The additional responsibilities can lead to frustration and burnout and negatively impact employee engagement. These factors are what then lead to quiet quitting,” Mr. Sadlier said.

To avoid quiet quitting or disengagement, he recommends that hospitals provide open and honest communication, set and maintain realistic work expectations, closely monitor employee engagement, recognize and reward high performance through options that extend beyond pay, and provide opportunities for career growth.

At the same time, he acknowledged there’s no absolute formula to identify disengagement at the individual level.

“The more you round, the more that you spend time with your staff, the more likely you are to recognize changes in demeanor and perspective,” Mr. Sadlier said. “The sooner you recognize it, the sooner you’re able to have an influence on it. So that’s where the regular engagement for leaders and supervisors has the biggest benefit — recognizing [disengagement] early and trying to find a way to reenergize and reengage staff.”

During an interview with Fortune, Katarina Berg, Spotify’s chief human resources officer, said her company is working to avoid quiet quitting by encouraging a culture of trust where workers feel psychologically safe.

Her advice for leaders is to talk about “the part of quiet quitting that has to do with people not [being] trusted, and they also don’t trust their management team. Therefore, they don’t find any other resolution other than doing this type of very silent activism. So, I think with culture you always have to be proactive … and you have to be very deliberate and intentional.”

A “perfect storm” is brewing in the healthcare workforce

https://mailchi.mp/bade80e9bbb7/the-weekly-gist-june-18-2021?e=d1e747d2d8

Plastic Possibilities: Resin Production Meets the Perfect Storm |  plasticstoday.com

A topic that’s come up in almost every discussion we’ve had with health system executive teams and boards recently is workforce strategy. Beyond the immediate political debate about whether temporary unemployment benefits are exacerbating a shortage of workers, there’s a growing recognition that the healthcare workforce is approaching something that looks like a “perfect storm”.

The workforce is mentally and physically exhausted from the pandemic, which has taken a toll both professionally and personally. Many workers are rethinking their work-life balance equations in the wake of a difficult year, during which working conditions and family responsibilities shifted dramatically. That, along with broader economic inflation, is driving demands for higher wages and a more robust set of benefits.

Meanwhile, many health systems are shifting into cost-cutting mode, due to COVID-related shifts in demand patterns and continued downward pressure on reimbursement rates, forcing a renewed focus on workforce productivity.

These combined forces threaten to create a negative spiral, which could lead to even worse shortages and deteriorating workplace engagement. It’s striking how quickly the “hero” narrative has shifted to a “crisis” narrative, and we agree completely with one health system board member who told us recently that workforce strategy is now the number one issue on his agenda.

No easy answers here, but we’ll continue to report on innovative approaches to addressing these difficult challenges.