Life is full of challenges: Some are a quick fix, but others take time and often require thorough assessment, planning and persistent dedication to tackle. The challenges that often confront organizations today are generally the persistent sort, though ev
by Site Staff
January 27, 2006
Life is full of challenges: Some are a quick fix, but others take time and often require thorough assessment, planning and persistent dedication to tackle. The challenges that often confront organizations today are generally the persistent sort, though everyday challenges are common as well. For the health care industry, the obstacles have been sizeable and all too frequent. The most common ones today are nurse, physician and other allied health-care professional labor shortages, limited funding and declining reimbursement, increased competition from rival networks and staff efficiency. But perhaps the largest ongoing challenge and concern is patient care, safety and satisfaction, which historically has not been met on a consistent basis.
The unique challenges faced by CLOs in the health care sector offer numerous lessons for learning leaders in all industries. Like organizations in the health care industry, many businesses in other fields also manage multiple locations nationwide or worldwide and juggle large numbers of employees, all while trying to provide the best service in the most professional, cost-efficient and organized fashion. Chief learning officers direct multiple initiatives to combat both short-term and long-term challenges through learning and development. Whether in health care or not, education is universally regarded and employed as a remedy to deal with these challenges.
“The keys to retention, employee engagement, efficiency, etc., are really the skill sets and abilities of frontline supervisors and leaders to really engage their employees and tap into their knowledge and their wisdom to help resolve problems and move forward,” said Jean Ann Larson, chief learning officer at Beaumont Hospital, a nationally recognized hospital offering services to the suburban community of Detroit. “But we also need to make sure that we keep our efforts focused on the strategic business objectives of the organization for a couple of reasons. You need to make sure that you are spending where you want to be spending, and even if you have scarce resources, it is a good way to make sure that you are focused on the priorities of the organization. You need to be constantly asking yourself, ‘What is it that is keeping the top executive team awake at night,’ whether it is the shortage of RNs in our industry or in another industry that has shortage elsewhere.”
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Combating Labor Deficits
Organizations should already be prepared to deal with labor shortages�especially with the onslaught of retiring baby boomers. With the first wave of baby boomers projected to retire within the next five years, it is imperative to implement a strong succession planning initiative that includes developing strategic partnerships with universities, providing education incentives, boosting recruitment efforts and continuously improving on-the-job learning and development programs to draw in and retain future candidates. The average employee in the health care sector is more than 40 years old. �We are fortunate enough that our vacancy rate is only 5 percent, whereas across the country it is in double digits,� said Kathleen Gallo, Ph.D., RN, chief learning officer and senior vice president for North Sore-Long Island Jewish Health System (North Shore-LIJ). �But that doesn�t mean that we sit on our heels. We have been very proactive in what we do with labor shortages.�
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During the past five years, North Shore-LIJ has centralized both its learning and development and HR functions to improve the overall functionality of its 14 hospitals and other health care businesses. �Before I had this role and before we had HR reporting to a person that is actually not an HR person, we brought in talent from the outside. We had to reorganize HR, and we centralized recruitment across our entire health system,� Gallo said. �So we have really sharpened our skills as to how we bring talent into the organization because we don�t just want anybody.�
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In fact, North Shore-LIJ creates its own pipeline of nurses through internal career advancement into nursing roles with full tuition reimbursement, strategic partnerships with several nursing schools and critical-care fellowship programs. Like Gallo, North Broward Hospital District�s Chief Learning Officer Carol Maietta, RN, has implemented numerous strategies that have supplied a pipeline of future nurses and leaders. �The National Center for Health Workforce Analysis projects that by the year 2020, Florida will need 61,000 more nurses than what is expected to be available, and the projected growth rates of our population, as well as that of our industry, suggest that other health professions will also experience workforce shortages,� Maietta explained.
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In order to prepare for these projections, North Broward began implementing workforce-planning initiatives, with more than 40 different initiatives to date. �My first step as CLO was to convene a high-level workforce planning committee to review the top workforce priorities compared to the top organizational strategies. I conducted a comprehensive workforce gap analysis to discover any workforce gaps, vacancies, impending retirements, diversity gaps, succession gaps, etc.,� Maietta said. �As a result the workforce committee, under my direction, devised three levels of goals to guide interventions: short-term, mid-term and long-term. Short-term goals would net results within 30 to 90 days, intermediate in 90 days to one year and long-term in one year and beyond. Each goal was also written to fall in one of three categories: partnerships, recruitment, and training and development.�
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Although the North Broward Hospital District has realized many benefits from the 40-plus initiatives it has implemented�such as the Health Summer Science Institute, Spend a Day With a Nurse events, succession planning program and strategic partnerships�its RN vacancy rate is a notable improvement. Before the initiatives were implemented, the district�s RN vacancy rate was 15 percent. Currently it is just over 5 percent.
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Dealing With Declining Reimbursements
Implementing such programs and developing strategic partnerships with universities comes with its own set of challenges. All health care organizations experience the same Medicare, managed care and Medicaid reimbursement issues, as well as the deficit between the money received compared to the money needed for indigent care. �Insurance companies are making hand over fist, and the hospitals are not,� Gallo said. �There is less money coming in, yet we still need to deliver the same care and actually deliver the care to people with no insurance. You wouldn�t see this in the car industry. If you don�t have money to buy an Explorer, you can�t buy the Explorer, whereas if you show up at an emergency department with chest pain�whether you have insurance or not�you get your labs done and you get a stint if you need it.�
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Declining health care compensation and repayment for patient care are not the only reimbursement issues. �There is always the need to do more with less, and sometimes we can get technology to help with that, but sometimes that doesn�t always help, and that is a huge issue,� Larson said. �We are a teaching hospital and when we offer schools and scholarships to try to make sure that we have enough RNs and others in the pipeline, obviously we are not being reimbursed for that. So that comes out of our operating funds, which then leads to staff efficiency issues.�
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Declining reimbursement directly impacts staff efficiency, and many health organizations are combating inefficiency through learning and development. North Shore-LIJ�s corporate university has been the catalyst to streamlining staff processes. �One of the things that we are doing with our corporate university to bring about efficiency and to decrease variation of processes is through our Six Sigma and Lean processes,� Gallo said. �The teams learn how to uses these methodologies and are mentored by our Black Belts to tackle the challenges and the heartburn issues that the executives have and actually begin to streamline complicated clumsy processes.�
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Beaumont Hospital and North Broward Hospital District also are banking on their education incentives, as well as leadership and management development to improve staff efficiency. �Staff efficiency and quality outcomes are major concerns for us in health care. Our regulatory body, the Joint Commission on Accreditation of Healthcare Organizations, continues to expand and tighten their standards, including those for patient safety and employee competency,� Maietta said. �Additionally, new customer service survey standards are being suggested, which guides how we monitor patient satisfaction. So in order to meet such requirements, all learning and development initiatives must be linked to these regulatory standards in some way in order to have a positive and direct impact on staff behaviors and thus patient care.�
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Better Patient Care by Communication
In all industries, satisfying customers is a top priority�especially in today�s competitive marketplace. And in the health care industry, patient care, safety and satisfaction are just as important, if not critical. �Delivering service excellence is vital, and health care in general doesn�t necessarily do that well on a consistent basis,� Gallo said. �Also, because health care is now consumer-driven�patients, being consumers, are actually deciding to go to hospital A over hospital B�location experience is becoming very important. And very often patients judge the hospital not necessarily on the quality of the clinical services, because patients generally have no problem with that, it is the whole experience in terms of how they are treated by the staff.�
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Like many long-term challenges, the challenge to combine quality care with an exceptional patient experience is dealt with through education. Every level of a health care organization must not only understand the importance of quality patient care, but also actively provide that quality care on an everyday basis. In order to get this message across to every employee, it must be continuously communicated from top organizational leaders to frontline supervisors to management and so forth. According to Gallo, frontline employees at North Shore-LIJ were not aware of the external environment before it launched the corporate university. �In New York, it is extremely competitive and patient satisfaction is an imperative at this point. And before the corporate university, employees didn�t have that information and the fact that they are now educated and we have classes around a multitude of these things, they are on board and helping us be one of the national leaders,� she said. �Senior leadership can�t pull this off themselves�they need the whole organization behind them, and the more information and the transparent that you can be for the employees, the better it is.�
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Advice From Health Care
Because the health care industry has historically faced and continues to be tested by both internal and external difficulties, many lessons have been learned as chief learning officers nationwide have stepped up to these challenges and battled them through education. Maietta, Larson and Gallo all agree that organizational alignment is the critical first step that every learning executive must achieve before stepping onto a challenge-ridden battlefield.
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�Alignment is the number-one success factor for an organization and certainly for the learning department. Because if you are not aligned and if you are just doing your own thing in isolation of the organization�s strategies, eventually you are not going to be needed,� Maietta said. �It is the reason for chief learning officers to do their jobs. I found that the better relationships that I had, the better alignment I could have because people would accept your ideas and would accept you linking learning to their strategies.�
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The support of senior leadership plays a strategic role in alignment, and therefore it is important that the chief learning officer and his or her team members develop strategic partnerships and relationships with leaders, supervisors, managers, stakeholders, etc. Also, continued measurement, gap analysis and feedback also are vital to ensure that an organization�s learning initiatives not only link to the strategic business objectives, but also help identify future organizational demands.
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For Gallo, communication is perhaps the overriding factor that makes any challenge war successful. �We have 38,000 employees, and if they are not all moving in the same direction, we are never going to be able to achieve our goals. And how do you get people to move in the same direction? You have to share information with them,� Gallo explained. �When it comes to patient satisfaction, nobody wants to be at the bottom of the pile. I have seen people get energized by data. And that is where the corporate university comes in, it gives employees and the managers the tools that they need not only for them to be successful, but also for the organization to be successful.�
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�Cari McLean, carim@clomedia.com