In this episode, Becky Kahn, Healthcare Workforce Solutions & Staffing Leader & Chief Client Officer at Works & Trusted Health, discusses the future of contingent labor & healthcare.
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Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- Why hospitals and health systems are reducing their reliance on travel nurses
- How health systems are restructuring their labor pools to reallocate clinical resources
- How this workforce redesign improves retention strategies for clinicians
- What challenges hospitals face when transitioning from a reliance on travel nurses to internal staffing solutions
- What role technology plays in optimizing workforce management
- How Works platform support a reduction in reliance on contingent labor
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We are pleased to welcome Becky Kahn. Becky is an experienced healthcare workforce solutions and staffing leader. She joined the company in 2019 as the Head of Client Solutions and took a brief hiatus from the company to serve as the Chief Executive Officer at Republic Health Resources, a mid-sized hospital staffing firm. She later rejoined Works & Trusted Health as the Chief Client Officer and is responsible for the development of the company’s account management and direct staffing efforts, significantly growing the Trusted presence across the US. Before joining Works & Trusted Health, Kahn served as the Managing Director, UK Operations, at Medacs Global Group, the largest provider of international healthcare staffing and workforce solutions in Europe. Prior to that, she spent nearly 16 years at AMN Healthcare, where she held several executive leadership positions and was responsible for the oversight of AMN Healthcare’s travel nurse client sales and services and local staffing divisions. Kahn launched AMN’s managed services solution and grew it to over $2 billion in spend under management. In this episode, we’re discussing the future of contingent labor and healthcare. Welcome, and thank you for joining us, Becky.
Becky Kahn: Kelly, thanks so much for having me today.
Kelly: Well, let’s go ahead and jump in. So, why are hospitals and health systems reducing their reliance on travel nurses?
Becky: Well, coming out of the pandemic, there was significant usage of nursing resources. I mean, we all lived it, and was there, and the entrance of very sick people through the ER, the biggest usage was nurses. And so, the demand grew significantly over a couple year period, and we saw several nurses leave the bedside, go out and do contract nursing, because the actual– what they could make in their hourly pay grew pretty significantly. I think more than any of us anticipated, just because the demand was so high. So, coming out of that, budgets, there was specific financing at the time available for organizations to fund those additional resources, but health systems definitely overspent to keep up with the demands from their local communities, and to serve the patients and to provide the care that they needed to during the very tough time.
So as a result, coming out of the pandemic, budgets started to reduce pretty significantly. Funding went away that was specifically designated by the Federal Government. And as a result, healthcare systems really focused on trying to right size their budgets and be able to bring those nurses back to their bedside to actually work directly for themselves. So, the focus really moved away from using contingent labor, external resources, and focusing on improving the work environment, providing more flexibility, and bringing those nurses back to their employment and back to their organizations. So, we’ve seen a big movement across the country to focus on what will it take to bring those nurses back, and other caregivers back to the organization, provide the flexibility that they want, but do so in a cost-effective manner that allows them to stay fully staffed.
And so that’s where we are today. Organizations are really beginning to look at what are the initiatives, how do they provide that flexibility, and how do they bring those clinicians back to the bedside and keep them working for them and do so in a cost-effective manner. Doesn’t mean that there’s not a place for travelers anymore. I think there’s probably 5-7% of your staffing that it fits really well for external travel labor. Maybe temporary spikes, you see with winter census, or longer FMLAs that you may see with leaves of absences that happen with maternity leaves, etc. Those make a lot of sense to use contract labor, but overall, the fulfillment of daily shifts, being able to stay fully staffed is all about providing flexibility and using technology to automate that process. So, your leaders can continue to lead and be able to stay available to support their workforce, but be able to stay fully staffed.
Kelly: It’s definitely been an interesting shift. So how are health systems restructuring their labor pools to reallocate clinical resources?
Becky: So, one of the things that we’re seeing is you have your permanent staff. Those are the ones that are hired, they’re hired to a specific unit and they’re on that unit and they’re staffed, and they stay there. So, most facilities schedule 6-8 weeks out. They pull that permanent staff together, they put their schedule together based on who’s available to work over that 6-8 weeks, and then they step back and look at what gaps do we have at this point in time. So, what we’re seeing is several organizations creating dedicated float pools. So, these are full timers that are really paid and incentivized to fill in in a float capacity. So, you may see ICU float positions, med surge float positions where they’re not dedicated to a specific unit, but when that schedule is set, they then fill in gaps in those particular specialties. Once that is done– and they’re full time, so they’re just full-time float, they’ve agreed to be able to work across whatever unit needs them when that schedule gets put together. We then see a move to, again, providing that flexibility.
You may have clinicians that have stepped away that don’t need to work full time. Maybe they want to work part time, maybe they’re parents, taking care of loved ones, whatever the scenario may be, but they need benefits. So, they may agree to work 20 hours a month, for instance, and so they’re another type of internal flexible pool, but they need to work so many hours to keep those benefits. They tend to be the next phase that’s used so that they can meet the benefits threshold, but then have the flexibility to not work full time. And then what we’re seeing a big movement to is that pure, what several of our clients are calling gig workers. So these are clinicians that have, perhaps they’ve been full time, perhaps they’re older now and they don’t want to work, three 12s, five 8s, full time, but they want to be able to work and have the ability to keep their skills up, make money when they want to work, and be able to stay engaged with maybe their peers and have a community where they have a sense of belonging. So those workers are purely gig workers.
But they’re still employed by the organizations, but they’re really there to just pick up shifts. So with, that’s where we see the most engagement today is with the use of technology and we’re fortunate that Trusted has created a technology platform that integrates with scheduling systems and timekeeping systems, and allows us to take those different layers of internal contingent float resources all the way from that full-time float to part timers to pure gig workers and allows us to automate the releasing of any open shifts to those different workers and be able to work with the healthcare organizations, placement roles, if they’re unionized, union roles and be able to automate the release of those shifts in a way that saves the facilities money, but then also gives the choice to those clinicians, especially the gig workers. They can actually set preferences within our mobile app to say, I want to work these days. So again, they’re not obligated to work full time, they want to work when they want to work, but they also don’t want to be called or taxed when they’re not interested or they’re not available. So, they can actually set their preferences and say, “On these days, over the next 90 days, I’m available. So, if a shift comes up, let me know. And if I’m available, I can work.”
So, we’ve automated that whole process to make it efficient to allow the facilities to grow the retention of those different labor pools, keep them happy, but not over inundate them with calls or texts when they’re not available. So, it’s a win-win for both sides. It allows managers to really be able to manage their teams, focus on providing quality and being a leader to their working staff, and it uses technology with an AI-type focus to automate and make it easy for organizations to stay fully staffed. And again, if they have to go outside then, and they still don’t have enough resources, they can release out to those external contingent travelers or local per diem agencies if they need to, all within the same platform.
Kelly: Yeah, it sounds like a pretty cool platform. Sounds very flexible and very much in line with what we’re looking at today for staffing. So how does this workforce redesign improve retention strategies for clinicians?
Becky: So how does it work for clinicians specifically? We’ve some wonderful testimonials from organizations. We’re fortunate that we worked with a health system out of the Midwest, Mercy out of St. Louis, who was an innovation partner with us and helped us really build this. They saw the future and what they needed to do coming out of the pandemic, and actually in the middle of the pandemic and all the way throughout it. And one of the things that we’re so fortunate about is they were a great innovation partner with us and we’ve been able to get really close to their internal workers. And we’ve got some great video testimony from nurses that speak to how our Works technology and this partnership that we have with Mercy has allowed them to really be the best person that they can be. They can work when they want and keep their skills up as a nurse, because they’re very proud of being a nurse and of contributing to their community, but they are a full-time parent and they want it to be available for their kids, and they also, were very involved in staying healthy and having a type of work where they could go out and work out and do yoga and things this. So, we have this amazing testimony from a couple of our nurses, where they talk about how this flexibility allows them to stay engaged with the organization that they love and that they want to continue to support, but work when they want to work. So, they can set, again, their preferences and they can get notified when shifts are available and only when they want to work.
So, it’s really allowed them to stay engaged, stay working as a nurse, which they love, but do it when they want to and be able to support their family and their personal needs for mental health and wellness. So, it really allows the workforce to have that flexibility that they need, but still stay engaged and be able to contribute and be a part of their communities when they want to be. Our technology even allows for the older nurses, or those that just a 12-hour shift is hard to do. We can actually break those shifts down to partial shifts. So, if you want to work 4 hours and not 12, you can pick up 4, and then the technology calls out the other 8, and somebody can pick up 8. So, it really truly does provide that flexibility, and it improves the retention of the workforce. So, if you don’t want to step away completely, and you want to still continue to care and give back, you can do so with the hours and when you want to work. So really improves retention and flexibility for the organization. And that all reduces your need to go external to other contingency labor.
Kelly: Right. No, I love all of that. I mean, having that flexibility is so key now. I mean, for me personally, I think it sounds fantastic. So, what challenges do hospitals face when transitioning from a reliance on travel nurses to internal staffing solutions?
Becky: That’s a great question, Kelly, because it is not as simple as, oh, I want to do this. I want to eliminate and just go inside and improve these flexible pools. So, you do have to step back and take a look and do some standardization to be able to automate. So, you have to– Betty Jo, the Chief Nursing Exec at Mercy, speaks about how they went from 5,000 job descriptions to 10 across their health system. So, you do have to take a step back and you have to standardize your jobs across your organization. What does float look like, what does full-time float, what does part-time look like, what are those roles that you want to implement, so that there is some standardization? And then, what rules do you want in place or rules of engagement for those gig workers? They are clinicians, and they do want to– the organizations do want them to keep their skills up. So most likely working one shift a year doesn’t work. But is it one shift every 90 days that they have to work at least as a minimum to maintain their compliance requirements, their credentials to be able to stay fully compliant to work?
So, you do have to take a step back as an organization, look at all of the different resources and when they’ll work. Again, if you have a union environment, what are those union rules that you’ve negotiated with your bargaining unit to make sure that you can follow those in compliance? So, you have to take a step back and automate the workflows and the different groups. And then, we can partner with you to standardize that and build it into a technology platform that allows us to release jobs in a way that allows you to meet those roles and your standards and also engage the workforce and allow the flexibility that you want to be able to provide to that workforce. So, it’s not as simple as just saying, oh, let’s stop using, and let’s turn over here. You do need to step back and look at policies, procedures, workforce groups, and how do you want to engage them.
Kelly: Definitely, yeah. So, what role does technology play in optimizing workforce management?
Becky: Our technology really helps you be able to automate those rules and through AI and through learning, we can do things. It’s not uncommon for healthcare organizations to use incentive money to incent their staff to pick up those open shifts that I talked about earlier. So again, you set your schedule, you’re set for the next six to eight weeks and now you have some openings or maybe even once you set your schedule, you have call offs that happen for people that get ill or sick or home situations that force you to maybe take a day off. And so, one of the things that we want to make sure that we do is look at, again, how do we automate that and be able to manage that incentive money? So, through AI, we can look and through machine learning, we can look at the number of shifts that are consistently open, what days, what shift, morning, days, nights, evenings. And then, what’s available from your working pool, both who have, either need to work, because they’re in a capacity where they’re full-time and they’re not fully scheduled yet, and they need to meet certain hours, or they said, I want to work. So, we look at demand, the number of open shifts, and we look at supply, the number of available clinicians that want to work. And then we’re able to run an algorithm that looks at that supply demand and we can start to predict based on certain shifts that open frequently, the percentage of those shifts and the amount of people available, and we can start predicting when those shifts were open and be able to help an organizations be able to stay more fully staffed. And so we may tell them and step back and look and say, you need to grow the number of people available to work these days, these shifts based on this data.
And furthermore, based on supply and demand, when normally you had a call off, and you would say, just offer $100 to fill the shift, we can now tell you that based on the supply that you do have available, that either need to work because they have additional hours to pick up, or they’ve signed up and said I want to work on these days if a shift opens up, you can do it at $25 an hour, or $5. So, we’re able to use machine learning and AI to be able to look at supply and demand, and dynamically predict what that staffing level should be, and what you should pay from an incentive perspective. So as a result, we’ve been able to save a significant amount of money for organizations and the amount of incentives that they offer and again be able to grow and improve the retention of those pools by being able to predict when those shifts open up.
Kelly: Yeah, sounds fantastic. Sounds very cool. So, tell me about the Works platform. I know you’ve talked quite a bit about it already, but how does it support a reduction in reliance on contingent labor?
Becky: Yeah, so the Works platform, again was built in partnership with an amazing organization, Mercy out of St. Louis. They were very innovative in what they wanted to do in terms of being able to provide flexibility and build a true gig workforce. So being workers that have worked for them in the past, but for whatever reason, want to be able to step away and not work full time, and work when they want to. So, we sat down, and we partnered with them, and it was important for us to build a platform that you didn’t have to replace your scheduling system with. So, organizations spend a lot of time going through processes to identify the scheduling and the timekeeping systems they want, and implementing those, and to be able to provide the scheduling and time keeping services that those organizations need, and they spend millions of dollars to do so.
So, it was important for us that our tool be able to integrate and complement those schedules and timekeeping systems. We didn’t want to have to replace because that’s time consuming and potentially very expensive. So, Works integrates with any scheduling system that you may have. We do have full integrations with certain systems in the industry today, so it does make it faster and easier, but we can really work with any scheduling system and any time keeping system that’s available. We go in again, when we want to partner, we sit down with their organization and we help them look at the different labor pools that they have, the rules and regulations around when they have to be engaged, how many hours they have to work. And then we’re able to set up those rules within Works and be able to load and put all of those different workers into the system. They then are able to– through a mobile device that we created, a native mobile experience, those clinicians then are able to, as the schedule gets set and those open shifts open up, they then are released in an automated, systematic way to the different workforce groups that that organization have.
Again, usually starting with your full-timers that have to work a certain number of hours to hit their full-time schedules to part time, to full gig time. And we’re able to look at when they’re in overtime, how much incentive money is used and offered and be able to then automate. And as those shifts are picked up, they released out to the mobile environment, the clinicians can see them. They accept those shifts, and it flows automatically right back into your scheduling system at that time. And so, there’s two-way integration. It allows us to keep the systems updated. So, the managers only have to work within their scheduling system. They don’t have to go into Works at all unless they want to be able to perhaps see some additional information, or if there’s an approval process they want to build in, but otherwise, if we’re fully integrated, the managers just work within their schedules. And the open shifts open up between their schedule and Works. They get accepted and filled by the clinicians through a mobile experience, and then those shifts that are claimed go right back into the scheduling system through a two-way integration. And the schedule is filled. So, it’s a great way to support that scheduling system, give it additional functionality with dynamic pricing, look at supply and demand and partial shift fulfillment, and be able to provide that flexibility that many of the scheduling systems don’t have today.
Kelly: Wow. I mean, it sounds like a very impressive system, easy to use from both sides. I mean, very cool. So, how are changes in staffing strategies affecting the overall budget and financial health of these health systems?
Becky: Well, it’s having a significant impact. I mean, already there’s lots of industry reporting that we as a staffing and workforce solutions company have access to that shows travel nursing in particular hit an all-time high during the pandemic as we discussed earlier, so a huge need for nurses to work in the ER and be at the bedside during the pandemic, but travel nursing has come down significantly. And so, as a result, those dollars that organizations spent on contingent labor, they’ve been able to reinvest into their permanent staff. We’ve seen nice increases for permanent staff as organizations want to bring those nurses back to their bedside and work full time for them. And then taking that extra step then to go in and look at how do they truly build that flexible workforce environment that the clinicians coming out of the pandemic very much value and want. Clinicians love being clinicians. They’re very proud of being a nurse, or being a therapist, or being a patient assistant, a PTA, but they want to be able to have the flexibility to take care of themselves through their mental health and take care of their families.
And so, organizations have been able to reduce that cost significantly that they spent on external labor and refocus and reinvest that into their permanent staff and into technology partners like Trusted & Works to be able to bring that flexibility to their workforce and be able to automate that. So, as we’ve seen, through our clients some pretty significant cost savings. We usually can do 10-15% on your incentive money and significantly reduce your use of contingent labor. Again, it doesn’t mean that there’s not a place for it; it’s just a much smaller reliance on external labor and allows you to really build that internal workforce and the flexibility that they want, and that you want.
Kelly: Most definitely. Yeah, sounds like a fantastic system that you all have put together. Thank you so much for joining us today, Becky, and for sharing your insights on the future of contingent labor in healthcare. We really appreciate all of these great insights.
Becky: Kelly, thanks so much for having me. I’ve enjoyed talking with you and speaking about the impact we’re having. Healthcare needs every bit of resources and help they can get today, and they’re making great strides to being able to be innovative. And the tools and resources are there, and we’re excited about impacting the communities and ultimately just making sure that everybody gets the care that they need, and that communities can be taken care of.
Kelly: Yeah, I love that. If a listener wants to learn more, Becky, or contact you to discuss this topic further, how best can they do that?
Becky: Well, great, Kelly. You can take a look at our website at trustedhealth.com and there’s a button in the upper right-hand side called Workforce Solutions, or you can actually reach out to works.trustedhealth.com as well and get more information specifically about our Works platform.
Kelly: Wonderful. Thank you for providing that. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
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