Kathleen Wessel (Host): Hospitals and health systems continue to experience workforce challenges, including shortages, as many healthcare workers retire, and as even more leave the healthcare field altogether. Welcome

to a HA Associates Bringing Value, a podcast from the American Hospital Association. In this series of podcasts, we speak with a HA associate program, business partners check in in their efforts and learn how they support a HA hospital and health system members. I'm Kathleen Wessel, vice President and business Management and Operations at the a HA and today I'm joined by Patrick Polinsky, founder STO at Simplify.

And Amy Beard, chief Nurse Executive Advisor at Simplify. Amy and Patrick, welcome to the podcast.

Amy Beard: Thank you, Kathleen. It's a pleasure to join you.

Patrick Beard: Yeah, really excited to be here.

Kathleen Wessel (Host): Today we are discussing a topic very familiar to our members, workforce challenges. While workforce challenges are not new, This is something we have been talking about my entire career, um, and stretches probably even before that. But a j members are reevaluating their workforce strategies, including their labor stack. So let's start there.

Amy. Patrick, can you walk us through what a labor stack is?

Amy Beard: Sure I'll start. The labor stack is a labor resources that each organization or within that organization, each department uses to predict and respond to staffing and volumes. I would say the goal of the labor stack is to build it so that it facilitates a balanced workforce that results in fewer unfilled shifts and minimizes reliance on premium labor spend.

Typically, that labor stack will see it comprised of core float pool contingent and agency, or you may hear it referred to as workforce layers as core flexing agency.

Patrick Beard: I think, uh, you know, to kind of expand a little bit on what Amy said there, at the end of the day, you've, most hospitals are, all hospitals have their core staff, right? It's their full-time, part-time unit, dedicated, dedicated number of shifts per month, per hour, per week, and they're there as your core.

And that at a certain point, whether you just don't potentially have enough of those core or you have a higher volume than expected or budgeted. You've gotta figure out ways to fill, shift to take care of your patient's, right? And so you start stacking on that. You, maybe you pull in overtime for your core staff, or you get to the point where you also have to incentivize them.

As you do that, you're obviously pulling up your average cost per hour for your workers. And so what we've seen since, especially since COVID, is hospitals doing float pools, right? Float pool, there's lots of names for them, right? There's flex pools and float pools and internal agency, but essentially it's this group of staff that can be deployed out to different locations, whether it's hospital centric or system centric.

And then from there, the next stacks would be what we call Flex Esto, flex A, the more of the gig model that Amy referenced where there are employees, right. And for the hospital standpoint, it's an external employee. Someone else is managing them. But they're made available to be kind of able to turned on and turned off pretty quickly as needed.

And then the very last layer of that stack would be your classic contingent labor, your agency staff. When we look at a stack, we look at that, that holistic view of all these different resources that hospitals can bring to bear to take care of their patient's and fulfill their missions.

Kathleen Wessel (Host): Great and actually this wonderful context and I actually maybe wanna backtrack just a little bit 'cause you both bring such, you know, rich backgrounds in history and looking at solutions for these challenges. Could we take a second to tell the audience a little bit about yourself and your, your healthcare expertise?

Amy Beard: Certainly I am a nurse executive with 29 years of experience. 18 years of that experience has been serving in various executive level positions at both for-profit and not-for-profit health systems, both hospitals and systems. My experience really spans across all service lines of specialties. Um, I most recently served five years as chief nursing officer for an organization with a large academic health system in the southeast.

Prior to that, I served as a CNO for 654 bed for-profit hospital in Birmingham, Alabama. I'm presently employed, uh, with Edify Advisors as Chief Clinical and Quality Officer, and I serve in a chief nurse executive advisory role for simplify.

Patrick Beard: Awesome. I've had about 20 years of experience, uh, in healthcare, mostly the acute care setting, starting off in supply chain process improvement, business development, ending up in a COO ops type role. So in that role, I always remember sitting in these staffing huddles with my nursing leader, friends and colleagues, and just watching them struggle with this idea of open shifts.

And I remember distinctly thinking, I'm so glad I'm never gonna have to work in our staffing. Never say never, right? Because now that's what I do. It's become the love of my career of just this very challenging problem to tackle. And so in 2017, my business partner Heather Anderson, and I left the acute care setting.

We created STO go around this idea of helping them fill open shifts. And then in 23, we were, uh, we became part of the simplify family as, as they've gone out really as a company and tried to find different ways to help organizations as an MSP, other than just the classic, you know, here's your traveler.

Really helping them in other ways as they talk about that stack, right? How, how can we help you across that stack? So that's my history. That's where I went from. That's how I'm here today.

Kathleen Wessel (Host): Wonderful. Thank you both actually for everything you've done in the field. That background, it provides some rich context to this discussion. Where do you suggest listeners start when looking at their labor stack?

Amy Beard: If I were looking at my hospital, I would focus on the department or the division you're trying to staff. I would look at my current staff experience and tenure, my patient population, um, the acuity, the financial health of my department. I would look at financial metrics like the average hourly rate, the percent of overtime I was using, the percent of premium labor in my current and predicted turnover.

I would begin to evaluate, fill, rate, and time to fill against current vacancies. I would say each layer of the stack has a different value add, uh, census. You know, ask yourself, are census and volumes consistent? Perhaps you have a higher percentage of core staff if your census is consistent.

If you have peaks and valleys in your census, I would build depth in my float pool, uh, gig and contingent stack.

Patrick Beard: It's a lot of moving pieces, and I think that coming from an ops standpoint and, uh, especially the process improvement side, for me, I would be looking at a lot of things as related to throughput metrics, right? As we know in hospitals, throughput is often backed up at the very end of the line where you're trying to put an a patient into a bed.

So things like your l watch, your left without being seen, left without being treated your mm-hmm.

Amy Beard: PACU

Patrick Beard: holds your diversion hours, your ER holds, and all those other places where you're taking care of patient's where you don't wanna take care of 'em for very long, right? You wanna move them up into the units. You know, the ROI we always talk a lot about with clients is if you can reduce contingent labor, there's ROI there you can, you know, the lower your price stack, which is a hundred percent true, but like there's also a large return on additional revenues gained by being able to have a higher throughput yield, you know, through all of your different inputs coming into the hospital.

So staffing impacts that so much. Obviously what Amy said is a hundred percent true, but I would also be looking at some of those throughput metrics to understand kinda where am I getting backed up?

Kathleen Wessel (Host): Yeah, I like the perspectives there. That's helpful. What should members be thinking about when diversifying their workforce staff?

Amy Beard: I think tying into what Patrick just shared with us, I believe priority needs to be on assuring that your labor stack is appropriate to execute on your strategic business plan. You know, ask yourself, do you have the labor resources you need to execute on your mission and assure that your targeted outcomes, both financial and quality are achievable?

Patrick Beard: I would say that, you know, do you know how to track your stack? Right? Let's, let's make up a word, a little phrase here. So do you understand what it is that impacts that? Do you have the tools in place to help you understand on a day-to-day basis and start creating some leading indicators, right?

To understand what's coming, what's happening? And then what I would really focus on is, can I pull those levers today? If I had to have a contingent labor or contingent staff come in today, what does that take? Is it gonna be a week? Is it gonna be 10 days?

Do I have an appropriate flex level gig work type pool where I can turn 'em on and turn 'em off like this to help me get over the hump, if you will, in certain situations? So not only is it about, you know, all the places that I would use this, but do I have the ability to really operationalize that as I, as I move forward and continue to stay proactive?

Kathleen Wessel (Host): It's helpful putting a financial frame on this. How can an ideal stack help establish the right size labor costs?

Amy Beard: I would say as an industry, we have to move beyond being reactive to proactive. As Patrick just shared, your ideal labor stack is your ideal stack. It's likely to different from your competition, and it should differ based on each departmental needs and volume trends. My goal would be to build that core stack component as solid as possible.

I think This is important for labor cost control, and it's also important for improvement quality outcomes through consistent staff. You build that core staff through solid recruitment strategies. Strong preceptorship programs internally and externally and retention efforts. You know, your flex staff, that stack allows you to respond to peaks and senses and unexpected leaves of absence.

And then I wanna talk about the contingent labor stack. That's a taboo word in some organizations, but contingent labor is not always a negative thing. Contingent labor can increase the capacity of your preceptor programs. It can allow you, as Patrick shared earlier, to stay off diversion. Uh, keep your beds open, keep your PACU flowing and execute on your overall business strategy.

We are finally seeing, um, you know, contract labor rates coming down across the nation. We're seeing the gap between contingent contract labor costs compared to core labor, uh, who are being paid overtime and incentives. We're seeing that that spread between those rates are not as wide as we've historically seen.

You know, I would encourage hospitals to partner with a managed service provider who understands that contingent labor serve a purpose and must be managed with care. A good managed service provider will help an organization to constantly assess where they're at with their labor stack and look for ways to right size each workforce layer or component of the stack and reduce contingent labor when possible.

And then the other thing I guess I would say is obviously gig work. It's still a relatively new topic in Buzz World and healthcare, although we're very lucky to have Patrick and a content expert with us. But I would say this resurgence of local PR and staff, or what we're calling gig work is really not new.

But with technology like STO and with the demands of flexibility from healthcare workers, we're seeing heightened awareness about how to routinely leverage the workforce strategy. We saw the concept for gig work, really first in transportation. You know, if you think Uber And the restaurant business, and now we're seeing the concept in healthcare and other industries, and Patrick can talk about gig work and how that component of the labor stack really compares to float and contract.

Patrick Beard: It's been really fascinating. It's been a lot of fun to learn. Again, like I said, we became part of Simplify sto Go then, And we immediately launched the STO Flex program. And that idea is we go out And we build a, a pool for you in, in your local market, customized to what your needs are, right?

So it's whether you have ic, critical care, step down, med surg, but it's been fun to see the nurses who have chosen this, right? They really wanna work in a hospital, but they don't necessarily wanna work for a hospital, right? And so this option to give them this like, Hey, I can just dip my toe in when I want.

It's amazing what we've seen. We have active military is a big group, right? Because they, it has the flexibility to allow them to keep their active service. Firefighters who are nurses, school nurses, retired nurses, I mean it's competitors, nurses coming across the street to try your location out. It's been very encouraging for us because our philosophy was like, there's still capacity left.

We've just gotta find it. The technology that we have, OMFS obviously really helps. And you know, one of our clients, it's four or 500 shifts a month that we're filling for gig work. And it's just been a real boost. And, and I think to Amy's point, when we talk about strategies, why gig is so important to me, I mean, obviously it's something that we're doing, but if you look month to month, it's like 300 shifts, 500 shifts, 200 shifts, 400 shifts.

And it is as they're, just as they're trying to work on their labor stack, right? And they're trying to force more of that work down to their core. Sometimes their core can't handle it. The very last thing I'll say about this because I think This is an important point for what I think should be a good focus of hospitals as they do this stack, is the, is the cost of the labor oftentimes And in most of our clients, the cost, the way we have a very unique cost structure, it's cheaper than their core staff when you consider their on overtime and getting these incentives to fill additional shifts, right?

So. It takes it away from this like contingent bad thing and it says, okay, contingent is a great strategy to help us lower our overall cost, you know, average hourly cost or however you wanna look at that. So anyway, it's been something I've been really excited about and and been fun to learn the last couple years.

Kathleen Wessel (Host): Thank you for diving into that. There's so many advantages to it. Um, just the flexibility and even the idea of, as a nurse, it could provide an on or off ramp to working, you know, not just for retirement, but for different transitions that you have to make throughout your career.

I mean, it's just an amazing opportunity to dip in where and when you can, as opposed to kind of providing certain segments. Do you have any final thoughts for a HA members as they develop strategies to maintain their ideal stack?

Patrick Beard: Every year we do, the Simplify organization does a, a labor summit in Colorado Springs. They call it the Red Summit. It's 50 ish executive leaders coming. It's been fascinating to listen to all these really brilliant people facing these really difficult problems. The thing that I get from it the most is that it's constantly changing.

You said it at the very beginning And the initial opening of like, This is not something that you solve today and tomorrow it's fixed. Yesterday it was nurses and now we're having a hard time finding people that work in the cath lab and work in Interven interventional radiology. And so that's constantly moving.

So my thing that I would say to people is like, your stack is your stack and it's based on your environment, your location, what's going on in your organization. And then secondly, what I would say to people is that it's kind of the old saying of like, don't get ready, get started.

Like just find something today, tomorrow, understanding where you are versus do I even know what my stack is? And most of them are probably going to, if so, do I know what my ideal stack is? Do I have future strategic things coming up to where I'm gonna have to tweak?

And just take a step towards one of those today to really try to get to that point where you can be a lot more with like what Amy said earlier, proactive around getting in front of those problems today versus waiting, or, you know, trying to plan more as as you go down the road.

Amy Beard: And I would say that utilizing predictive scheduling solutions that leverage technology against your ideal labor stack. Must be a reality for health systems. I think it is critical that we balance our most significant financial spend, which is labor against rising healthcare costs. To reduce payer reimbursement, I believe we've gotta get outside of the four walls of our organization and stop relying on what we've historically done.

We've gotta address generational work-life balance needs, work-life harmony needs. I would encourage healthcare organizations to partner with industry leaders and workforce strategy, like simplify. You know, companies like Simplify can help reduce contingent labor utilization and spend while providing a dedicated service team that leverages best in class vendor management system technology.

I would also encourage utilization of an MSP who embraces a vendor neutral model for times when it's necessary to utilize contract labor. You know, as Patrick mentioned earlier, That is one effective tool to focus on the rate and not necessarily the label of what we call the workforce stack strategy.

An intense focus needs to be on the gig model as This is one of the best tools to address the current nursing shortage. I think the shortage is not going away anytime soon. You know, according to the committee on the future of nursing 20 20, 20 30, the shortage is expected to persist through 2030, despite initiatives to increase the supply of nurses in the workforce.

So I think there's a lot that we can do to define our labor stack and embrace how we move forward.

Kathleen Wessel (Host): Excellent points, uh, both of you, Amy. Patrick, thank you so much for joining me on the podcast today and sharing your takeaways with a HA members. It's been, uh, incredibly enlightening for me And for our listeners. For our listeners, if you'd like to learn more about Simplify And the a, a Associate program, please visit us@sponsor.aha.org.

This has been an Associates Bringing Value Podcast, brought to you by the American Hospital Association. Thanks for listening.