Collaborative Culture Helps Navigate Changing Workforce Needs

Changes to care and payment models are requiring changes to how hospitals are organized, staffed and managed. For hospital human resources professionals, that requires taking a leading role in reinventing the organization while simultaneously keeping it staffed.

Meeting that fundamental challenge means making dozens of difficult decisions on what current and emerging roles are needed; which specific clinical, technical and interpersonal skills are essential for those roles; what sources of talent should be tapped; and how clinical and administrative responsibilities should be split among the hospital and its partners and service providers.

It’s no easy task. There isn’t enough certainty on future requirements for HR professionals to understand all the skills they’ll need in the organization, and the best model for deploying them. Because there are so many unknowns, leaders that have started the transformation journey say HR organizations can best position their hospitals to thrive in the emerging environment by creating the culture and organizational flexibility to support change.

“There is tremendous recognition of the need to change, but there are not a lot of people who know how to do it,” says Amy Barry, who recently became a health care HR consultant after a 20-year career in hospitals that included serving as chief human resources officer for several health systems in the Southeast. “The organizations that are struggling are those that don’t want to change and want to manage to the fee-for-services model until they die on the vine. The hospitals that have been most successful are integrators and facilitators. They are changing their cultures by bringing teams together to solve complex problems.”

“Integrator in chief” is an emerging role that was highlighted during a 2015 American Society for Healthcare Human Resources Administration (ASHHRA) conference presentation. The presentation focused on how hospital leadership and operational roles are evolving, as summarized below.

Traditional, hierarchical organizational structures may not be the best fit for new models where care revolves around the patient, rather than around physicians and hospitals. That is a reason for the growth in new positions such as patient experience officers, nurses dedicated to monitoring telehealth patients, case managers, patient navigators, care coordinators and other positions — all of which are focused on post-discharge follow up and engagement with patients throughout the continuum of care.

According to the 2015 American Hospital Association (AHA) report Building the Health Care Workforce of the Future, “The current workforce and models of care will not be able to accommodate the influx of new patients.” The report advocates redesigning care and roles to create clinical-based teams, and notes, “research has demonstrated that high-reliability teams of providers are better suited to direct and manage care in the hospital setting, while also integrating patient care cross settings.”

Collaboration Creates Challenges
A team-based approach to care presents several challenges for HR. At a high level, it requires an organizational structure that can effectively manage and evaluate interdisciplinary teams. At the bedside, it requires individuals who can collaborate and communicate effectively, while still having the specific skills required for the job. “Traditional distinctions between leadership and functional skills or operations and strategy are breaking down in favor of new skills blends,” writes Mark Madden of health care staffing specialist firm B.E. Smith in the 2015 white paper Evolving Roles and Competencies in Healthcare Leadership.

Those needs could cause organizations to change what they look for in employment candidates, and in the workforce development programs they offer. The AHA presents recommendations for developing a team-oriented workforce in its paper Connecting the Dots Along the Care Continuum, excerpts of which are presented below.

“You need to look at how the staff is incented to do the right thing,” says Barry. “You can’t expect physicians and team workers to design a new experience if you are not designing something new for them. To change the culture you must look at the silos. All disciplines have traditionally been managed as verticals; now we need to flip it.”

One way to accelerate changes in culture is to hire from outside the health care field, an approach that B.E. Smith, Barry and others have advocated. As hospitals look to identify and adapt best practices for customer satisfaction, lean operations and compliance management, new employees from the hospitality, retail, manufacturing, financial services and other industries can provide new perspectives.

“One of the biggest challenges to improving safety and quality is getting everyone that is involved to understand the nature of process improvement,” says Richard Guthrie, MD, who in 2015 became the inaugural chief quality officer at Ochsner Health System in New Orleans. He spent much of his first year studying performance improvement models and health care organizations that have achieved sustained success in safety and quality improvements. “The right culture empowers everybody.”

No culture is right for all organizations, but all cultures should acknowledge the importance of flexibility and change. As Eileen Brown, MPPM, director of HR transitions management at Confer Health Solutions in Frisco, Texas, noted in her remarks after receiving the 2015 AHA Solutions/ASHHRA Gary Willis Leadership Award for HR leadership, “With the rapid changes in health care I’ve witnessed, I’ve seen that HR professionals must be open to change. If you can’t change, you can’t expect employees to. You need to lead by example, and always be honest and transparent.”