Our research team breaks down this week’s top healthcare news.
In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.
Late last week the Food and Drug Administration (FDA) authorized and the Centers for Disease Control and Prevention (CDC) officially recommended a third shot of Pfizer or Moderna COVID-19 vaccines for immunocompromised people. The immunocompromised population makes up nearly 3 percent of the U.S., around 7 million people. This group is significantly more likely to get severely ill from COVID and make up over 40 percent of hospitalized breakthrough cases. Immunocompromised individuals have been shown, through CDC studies, to have a lower response to the standard two-dose vaccine regimen, with antibody response improving for those who receive a third dose. It is estimated that nearly 1 million immunocompromised Americans have already received a third dose. The CDC recommendation would make it easier for those individuals to obtain a third dose from their providers.
This week U.S. officials announced that all adults who received the Pfizer or Moderna vaccines would be eligible for booster shots eight months after their second dose, starting the week of September 20. The first groups eligible to receive their booster beyond the immunocompromised will be the same groups initially prioritized for the vaccine — healthcare workers and those over age 65. Booster shots will remain free to all and will be offered at the same 80,000 locations offering initial vaccination. Individuals who received the J&J vaccine would also likely need a booster shot at some point, though additional data is needed to inform that recommendation and the timing.
The vaccines remain highly effective, but there is concern of immunity waning over time and the rapid spread of the Delta variant. There is clear data indicating improved immunity from a third shot for immunocompromised persons. The goal of opening up boosters to all adults is to get ahead of variants and potentially diminishing immunity, particularly for the most vulnerable populations. Having a rollout plan in place for booster shot eligibility may help to minimize vaccine chaos for the third dose. Many hospitals are already identifying their immunocompromised populations to bring them in for third vaccines immediately. Working through immunocompromised persons first will help health systems and pharmacies prepare for a potentially larger round of booster shots this fall.
While the eight-month time frame to receive a booster shot does not represent a sudden drop-off in immunity, it is based on data from the U.S. and other countries that vaccinated large portions of their population early. In both the U.S. and Israel, those who were vaccinated earlier have higher breakthrough infection rates now than those vaccinated a few months later. While infections in the vaccinated population usually continue to be much less severe, these individuals can still transmit the disease to others. More data will likely still be needed to understand if all populations will need a third dose. The earliest populations to be vaccinated were also some of the most at-risk groups, so it is possible immunity may last longer in healthier populations. Boosters are likely to have a significant positive impact on immunity for the high risk and immunocompromised, and potentially for the entire population, but the best way to reduce transmission remains getting all eligible populations their first doses.
As the pandemic has worn on, “quit rates” across most industries have increased. Nearly 4 million workers in the U.S., or 2.8 percent of the workforce, left their jobs voluntarily in April of this year, a record per the U.S. Bureau of Labor Statistics. June’s rates were not far behind. People are leaving their jobs for a variety of reasons, but a clear driver has been the impact of the pandemic. Essential workers faced daily safety risks and unknowns, as well as new procedures, protocols, and responsibilities, often with reduced staff. Many non-essential workers were asked to work remotely, and despite the elimination of a commute and increased time to spend with immediate family, workers have reported high levels of stress related to balancing work and household responsibilities, including childcare and at-home schooling, increased workload and meetings, and fading boundaries around what constitutes a typical workday as many companies have moved closer to expecting around-the-clock monitoring of and answering emails. One communications worker summarized the change in a recent Business Insider article, “everything was so constantly urgent.” Workers are leaving their jobs to seek higher pay, a better fit, more flexibility, the opportunity to relocate, or reduced safety risk, and others are leaving because of fear of returning to an unsafe workplace.
Some are calling this “epiphany quitting,” the idea being that the pandemic has given many an opportunity to reflect on their life priorities and evaluate whether their job fits into the picture. Others, like National Public Radio (NPR), are calling this the “great resignation,” as employers increasingly experience labor shortages. A labor economist at the job finding website Glassdoor.com commented on rising labor shortages on NPR recently, saying, "We haven't seen anything quite like the situation we have today."
Healthcare provider organizations have seen an especially acute version of worker resignations, exacerbating the pre-COVID nursing and healthcare worker shortage, as was discussed in an edition of Chartis Top Reads from May 2021. Jodi Barschow, a registered nurse and the President of the Oregon Federation of Nurses and Health Professionals, discussed the current state of burned-out healthcare workers in an interview with Oregon Public Broadcasting. “People are just done. They want to leave the profession altogether,” she said. “They want to be able to work safely in an environment, have the staffing that they need to safely care for patients and keep communities healthy.” Instead, workers are faced with high volumes of patients, higher acuity patients, medically fragile patients, and vulnerable populations that haven’t gotten care for a year or more because of COVID, and patients with psychiatric or psychosocial needs. “All of that, combined with the shortages and staffing and not just nursing, but all of the health care professionals and the ancillary staff around that really need to support the patients to keep them healthy” is leading many to leave their jobs.
The pandemic has changed many things about our lives. Tsedal Neeley, a professor at Harvard Business School, emphasized that “We have changed. Work has changed. The way we think about time and space has changed.” For healthcare workers, the changes experienced have been incredibly stressful — even traumatizing. As the Delta variant creates new surges, hospital capacity challenges and understaffing issues, some who have stuck it out until now are hitting their breaking point.
The current state of affairs at hospitals and healthcare provider organizations, along with the general “quitting” trends driven by the desire for more flexibility, better pay, and more support on the job, could hurt the healthcare industry and lead to further staffing shortages. However, this may be an opportunity for healthcare provider organizations and employers to make meaningful changes to healthcare workers’ jobs, based on listening to and understanding workers’ changing expectations and desires. Roles and responsibilities could be adjusted, available support could be augmented, opportunities for more flexibility could be considered, and alternative salary and benefit packages could be created.
The goal would be to retain experienced staff while also attracting new workers. And there appears to be a sizeable opportunity for new workers in the next several years. Nursing school applications have increased substantially — by 25 percent at some schools — as young people beginning their careers also experienced the pandemic, want to help, and may also see the real long-term job security in healthcare, given the ever-present need. However, historical data shows that of the roughly 155,000 new registered nurses who join the workforce each year, as many as half leave the within two years. Finding ways to keep these new and eager workers in the healthcare field will be critical to our healthcare system’s ability to function in the future.
Some changes that healthcare organizations can consider to attract and retain healthcare workers are easier (at least operationally, if not financially), such as offering substantial sign-on bonuses and/or retention bonuses, as was discussed in Chartis Top Reads a few weeks ago. Other changes are more complex but crucial, such as building comprehensive support systems for workers to prevent and address stress and burnout. Finally, some initiatives require significant time, capital, personnel, and other resources. This last category includes developing training programs, potentially in partnership with schools of nursing and other allied health professional educational programs. These might include specialized training programs (e.g., home care nursing or aide training); advancement courses for more experienced nurses or healthcare professionals looking to extend their career potential; and augmented general training, onboarding, and support for new nurses entering the field.
Providence Health has created Providence Nursing Clinical Academy and recently added a new nurse onboarding program called “Residency,” as Lisa Powell, Vice President and Chief Human Resources Officer at the health system, describes in an interview with Oregon Public Broadcasting. The program includes comprehensive training, mentorship, and regular check-ins. The feedback has been positive, and turnover has been lower at Providence. Despite the potential complexity, smaller health systems than Providence can also create these programs. Forbes described the StaRN program at Sunrise Hospital in Las Vegas, which recruits newly graduated registered nurses to provide training in a structured environment and support immediate need. The year-over-year nurse retention rate was about 50 percent when the program launched in 2015; in 2021, it reached a new record of 93 percent.
While the healthcare staffing constraints and quitting trends may appear grim, health systems should create opportunities to listen to workers’ concerns and needs, then build new programs, protocols, schedules, and opportunities around those to retain staff and attract new workers entering the field.
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