July 7, 2020

Looking back to move forward: How the pandemic highlighted the healthcare sector’s biggest workforce challenges

Here are three predictions for how the COVID-19 pandemic will change healthcare for good – and how this will affect its already strained workforce.

For many years, healthcare providers have been white-knuckling their way through a series of complex challenges. The COVID-19 pandemic has brought some of the issues underlying the sector – chronic staffing shortages, unequal access to care, and precarious payment structures to name a few – to a boiling point. These realities will still be waiting for us when we reach the other side of the acute crisis we’re facing today, but with even more complexity. The only way forward is through widespread, systemic change to the healthcare system, starting with solving the workforce challenges that were there all along.

Stretched to the limits

Even before the pandemic hit, healthcare providers were often struggling with staffing, especially in emergency rooms. For years demand has consistently outpaced supply, and that gap is growing still, due to a rise in chronic diseases and a large cohort of baby boomers experiencing the effects of aging and retiring from the healthcare workforce at the same time. And while electronic medical records have helped with tracking patient data for more consistent care and better outcomes, they’re also labor intensive for providers. One study found that a group of first-year residents only spent 13% of their day engaged in face time with patients [1].

Prior to the pandemic we were also only just beginning to fully understand and address the impact of social determinants of health – poverty, physical environment, homelessness, and race or ethnicity. How these factors severely limit access to preventative care and treatments for those who are disadvantaged is now under a microscope due to the disproportionate impact of COVID-19 on certain populations. According to a report in The Lancet, the fatality rate from COVID-19 is six times higher in predominantly black counties than in predominantly white counties, for example [2]. The pandemic has heightened the urgency to find solutions for better population health and more equitable access to services – especially preventative care.

The impact of the pandemic

We’re facing a prolonged period of strain on the U.S. healthcare system as a result of the pandemic, one which will far outlast the disease outbreak itself. According to McKinsey’s Health System Financial Resilience Survey, nearly half (45%) of the CFOs surveyed expect it to take more than 18 months to return to pre-COVID-19 revenues, and 84% believe the negative impact on their operating margin to persist through 2021 [3].

The result will be an increased need to “do more with less,” which will put significant pressure on a workforce that was already stretched to capacity prior to the pandemic. Healthcare organizations will need rethink how they work if they want to improve health outcomes for citizens and address issues like inequality at a time where operating margins are painfully thin. Solutions will need to address both the past and the future: Leaders will need to simultaneously look back at what was already broken before the pandemic, and forward to how the healthcare system will change for good as a result of it.

Here are three predictions for the future of healthcare, and how existing workforce challenges will need to be addressed to prepare:

Prediction #1: We will redefine the healthcare setting and how care is provided

One widely publicized effect of the COVID-19 pandemic is the strain on hospitals, and intensive care units in particular. The result was the real possibility that preventable deaths would occur simply due to a lack of space or resources to care for them in hospitals. This reality has healthcare providers reconsidering the role of hospitals as a “hub” for patient care, with the alternative being to spread out care among skilled nursing homes, walk-in clinics, in-home care, and pharmacies [4].  Another possibility would be integrating clinical care with non-clinical services, such as schools, public housing, and social services, would also be needed to address the social determinants of care, increase preventative care, and improve population health [5].

The steep rise in demand for urgent healthcare services during the pandemic also led hospitals to reallocate physicians and nurses who normally focus on elective procedures to the front lines, while schools allowed fourth-year medical students to graduate early and join the cause. Regulations were also relaxed to allow nurse practitioners and physician assistants to perform procedures without supervision [6]. Continuing on this path would take some strain off of physicians, who could focus their efforts elsewhere.

So, what does this mean for the healthcare workforce? It means we’re likely entering into a prolonged period of significant structural change, one where workforce resilience and adaptability will be essential. Technology will undoubtedly play a key role in helping the healthcare workforce gain the skills they need to adapt to new ways of working. For example, the right learning platform can be personalized to serve up a relevant set of courses and learning moments embedded right into that person’s daily work. It can also be used as part of a change management strategy to align employees’ work and interests with where the organization wants to go.

Prediction #2: There will be a second pandemic of PTSD and burnout

The rate of burnout among healthcare practitioners was already a serious issue prior to the pandemic. A 2019 survey by market research company InCrowd found that 68% of participants reported experiencing some level of burnout [7]. With staffing shortages, the resulting increase in absenteeism and higher turnover becomes a vicious circle that breeds further burnout, ultimately resulting in a lower quality of patient care. In fact, the ERCI Institute placed burnout in third place on its list of the 2019 Top 10 Patient Safety Concerns [8]. The COVID-19 pandemic has put a tremendous strain on a group that was already understaffed and facing a shortage of skilled talent.

Then the pandemic hit and the stakes became even higher. A story in The New York Times outlines what healthcare providers are facing under COVID-19 – trying to comfort dying patients who are isolated from family and friends while dealing with extreme overwork, and the fear of contracting the disease and passing it to their own families [9]. While measures have now been introduced to address mental health concerns, the World Health Organization (WHO) released a policy brief that cautioned the response may not be enough because of the lack of mental health promotion, prevention and care prior to the pandemic [10]. For healthcare organizations, it’s important to consider how to make caring for the caregiver a priority all the time, not just during times of crisis.  

As organizations continue to embrace and accelerate adoption of human capital management technology as a way to improve operational efficiency and training, they should also seek to understand how these tools can help to improve workforce mental health and wellness. One way is by reducing the administrative burden on clinical staff with more efficient scheduling and workforce management workflows, allowing more time to focus on patients. Another is through tools like sentiment analysis, which measures patterns in the emotional states of employees through data analytics, and employee pulse surveys. These tools allow managers and leaders to better understand how their employees are doing, and what factors are actively causing disengagement, stress, absenteeism, and turnover, so that action can be taken.

Prediction #3: The transition to telemedicine will be permanent

Prior to 2020, telemedicine (also known as telehealth) had minimal uptake. It was largely used as a way to support healthcare services for rural areas with less access to healthcare services. In fact, a 2017 report sponsored by Avizia found that 82% of study participants had not used telehealth services [11]. Fast forward to today and the majority of non-urgent healthcare services are happening online or over the phone due to the pandemic. Regulations governing telehealth have been relaxed and emergency laws passed to allow for the change to happen practically overnight [12].

It’s expected that telemedicine will remain a more common piece of the healthcare puzzle after the pandemic is over, as it fits well with our modern, tech-driven society. That means healthcare organizations will need to ensure their workforces are prepared to provide best-in-class care virtually, rather than simply getting by during the pandemic. Integrating telemedicine into the healthcare system for the long term means not only teaching providers to use the technology, but also revisiting scheduling and triaging processes, billing practices, and the soft skills needed to facilitate successful patient interactions [13]. A learning platform can help customize that breadth of training to individuals with different capabilities, roles, and learning preferences.

Moving forward

In unprecedented times, there is an opportunity for greatness. People are rising to the challenges, but we also need to think about the structural changes that are needed in the healthcare sector to support our caregivers. To deliver top quality care, our caregivers need to receive top quality support.

Read our Prescribing the Future guide for strategies to build a future-ready healthcare workforce

 

[1] Krisda H Chaiyachati, MD, MPH MSHP, Judy A. Shea, PhD, Davide A. Asch, MD, MBA, et al, Assessment of Inpatient Time Allocation Among First-Year Internal Medicine Residents Using Time-Motion Observations, JAMA Network, April 2019

[2] Elissa M. Abrams, Stanley J. Szefler, COVID-19 and the Impact of Social Determinants of Health, The Lancet, May 2020

[3] Bee Broome, MD, PhD, The Financial Impact of COVID-19 on Health Systems and How CFOs are Responding, McKinsey & Company, June 2020

[4] Stuart M. Butler, PhD, After COVID-19 – Thinking Differently About Running the Health Care System, JAMA Network, April 2020

[5][5] Stuart M. Butler, PhD, After COVID-19 – Thinking Differently About Running the Health Care System, JAMA Network, April 2020

[6] Robert S. Huckman, What Will U.S. Health Care Look Like After the Pandemic?, Harvard Business Review, April 2020

[7] Persistence of Burnout Among Physicians ‘Alarming,’ Survey Finds, Safety and Health Magazine, August 2019

[8] 2019 Top 10 Patient Safety Concerns Executive Brief, ERCI Institute, 2019

[9] Jan Hoffman, “I Can’t Turn My Brain Off”: PTSD and Burnout Threaten Medical Workers, The New York Times, May 2020

[10] United Nations Policy Brief: COVID-19 and the Need for Action on Mental Health

[11] 2017 Closing the Telehealth Gap, Avizia, 2017

[12] How Access to Telehealth is Increasing Across the US During COVID-19, Technology Networks: Informatics, April 2020

[13] Bill Siwicki, Telemedicine During COVID-19: Benefits, Limitations, Burdens, Adaptation, March 2020

Jarrett Jedlicka

Jarrett has held a number of senior positions at leading healthcare and technology organizations and is a contributing author to Ceridian's thought leadership. 

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