Intro: The following SHSMD Podcast is a production of DoctorPodcasting.com.

Bill Klaproth (host): On this edition of the SHSMD podcast, we dig into Futurescan 2024, as we talk with Dr. Joanne Conroy about her article Redesigning Work While Meeting the Demands of the Workforce. So, we're going to talk about remote work, how you should evaluate your own staff for remote work. She's going to talk about what she did in moving non-patient care positions to fully remote. We're going to talk about the use of technology for bedside nursing, how that can help. And she's going to give us her main takeaways when it comes to redesigning work while meeting the demands of the workforce. So, let us get to work and get you this podcast right now.

This is the SHSMD Podcast, rapid insights for healthcare strategy professionals in planning, business development, marketing, communications, and public relations. I'm your host, Bill Klaproth.

In this episode, we talk with Dr. Joanne Conroy, CEO, and President of Dartmouth Health and AHA Chair Elect about her article in Futurescan 2024, Redesigning Work While Meeting the Demands of the Workforce, where she's going to discuss how Dartmouth Health and others are addressing today's workforce challenges. Dr. Conroy, thanks for being here.

Dr. Joanne Conroy: Thanks, Bill. Happy to be here.

Host: Absolutely. So, what are the workforce challenges that we're struggling with right now? And what are the factors contributing to this?

Dr. Joanne Conroy: Healthcare leaders have known for probably over 10 to 15 years that we have a pending nursing workforce crisis. However, the pandemic actually accelerated not only the nursing workforce crisis, but the fact that we realize we have capacity that we can't meet that demand in many other aspects of our healthcare workforce. So, we appreciate that pandemic has kind of disrupted our current concept of our healthcare workforce, and we have to figure out how do we use technology to replace vacancies, how do we actually increase the pipeline for people to enter their healthcare workforce, and most importantly, how do we do our work differently, understanding that we have fewer people that can physically be at the bedside to deliver care.

Host: Yeah. So, you asked all of those questions at Dartmouth Health. And then in 2020, in fact, you moved most non-patient care positions to fully remote. So, can you tell us how you came to that decision?

Dr. Joanne Conroy: We did. It was interesting that during the pandemic we appreciated that our remote workforce was actually functioning very well. So when we decided to bring people back on campus before we did so, we went through a job by job description analysis of what jobs across our entire health system could be performed completely remote. And then, once we had completed that analysis, we actually moved all of those individuals to full-time remote positions. It did a couple things.

Number one, it removed any indecision about who was going to be on campus versus who is going to be working for us remotely. Number two, we actually liberated a tremendous amount of space at the academic medical center. Number three, we kind of minimized some of the fears that people had about coming back to the academic medical center as the pandemic was starting to wane. And then, number four, we spent a lot of time really thinking about how do you actually develop, manage, and leverage a remote workforce in order to actually fill our gaps in healthcare workers.

Host: Yeah, it's really interesting. So as you said, the pandemic really accelerated a lot of things. Where we would be in 10 years, we're here now, and having a remote workforce is one of those. And it sounds like it was very well-received when you said, "You know what? We're going to move you to remote and you're going to stay there." Is that right?

Dr. Joanne Conroy: That's correct. Actually, our engagement of our remote workforce is higher than the engagement of the people on site. And I've spent some time thinking about that. Is it because they're kind of removed from a lot of the day-to-day kind of tensions of working in a high-intensity environment? Or is it the fact that they have a little bit more autonomy when they're working remotely? They have an opportunity to just get the work done in a different way. And we actually find that they do. They are far more productive and actually are far happier and more engaged.

Now, having said that, this is a new world for everybody. So, we have had to train our leaders how to manage a remote workforce, especially those leaders that have a hundred percent remote workforce. A couple things we realized for some people, it comes naturally, you know, how to create a level of engagement when you're not physically in the same space. But there were many leaders that said, "Well, how will I know they're productive?" And then, we had an opportunity to say, "How do you know they're productive if they're actually all sitting in the same room?" and they couldn't answer that question, which really was informative for us. We had to actually think about how you actually measure productivity, and that was a good lesson for a lot of our supervisors, both the people that are working remotely, but probably a lot of our supervisors on site. So, it's been actually a learning opportunity for the entire organization.

But I would say where we are in rural America, the ability to actually leverage and grow a remote workforce is so important for us. You know, you would think that post-pandemic people would want to move to rural America, and we have seen that distribution of people across the country when they could work remotely. But believe it or not, housing is expensive in many aspects, many areas of rural America, number one. And number two, when people have professional spouses, sometimes it's a little bit difficult to have both professional spouses in a fully remote capacity in order to actually live in a rural area. And so, we've actually leveraged that as best we can and that means that we employ remote workers in 35 states now.

Host: Wow, that's a lot of people to manage remotely.

Dr. Joanne Conroy: It is, it is. But they're really happy and they're engaged. And, you know, in rural America, you have to actually think very creatively about how you can attract talent in an area that's constrained in terms of other social resources in the communities.

Host: Well, I like how you said workers are happier and more engaged and, generally, the byproduct of that is they do better work.

Dr. Joanne Conroy: They do.

Host: And it really is important that we think about that as well. That's one of the benefits of this. So for other CEOs, Dr. Conroy, what should the C-suite executives evaluate as they look toward redesigning their own workforce? What should they do?

Dr. Joanne Conroy: They should begin by thinking what jobs could be remote. And I have to tell you that parking is no longer a problem here at the academic medical center, and we have an abundance of office space that actually we can repurpose. So, not only do you have a happier, more engaged workforce, but from a financial perspective, it's just a much smarter way to use resources.

The second thing that people need to think about is redesigning our work. And that would be the bedside work. And I would say, we still practice in a model of care that is almost apprentice-based. For physicians and for nurses, there are these long periods of orientation. And a lot of times, we have a lot of duplicative processes instead of really being thoughtful about who does what work.

The second thing is we have to move people to working at the top of their license. And if you look at anybody's work, they're going to be things that they do in their normal workday that are probably not appropriate for them to be doing. But if they're part of a team or need to get the work done, you know, most people just roll up their sleeves and do what they need to do. We need to be a lot more thoughtful about who does what work and making it as efficient as possible. I'd have to say for onsite employees, the thing that irritates them most is work that they shouldn't be doing, but they have to do. And they have to do it because of staffing gaps in other areas. And we just need to think about how much of that work really needs to be done and who needs to do it. That's where you get into thinking about using technology as an aid for individuals that are at the bedside.

Host: Absolutely. So when you talk about redesigning bedside work, how have you reevaluated it and what have you done at Dartmouth Health?

Dr. Joanne Conroy: We have leveraged our telehealth capabilities in order to do virtual ICU oversight, which really helps those newer nurses have a level of confidence that if they have a question about the management of an ICU patient, they can get somebody from our e-ICU on the screen immediately in order to help them with any questions they may have. They also provide a level of oversight in terms of how the patient is actually progressing with their care. e-ICU has often been used outside of the academic medical center, but we actually use it inside as well. We are experimenting with tele-nursing. We are experimenting with technology in our new pavilion that actually creates virtual whiteboards and identifies providers when they walk in the room recognizing their badge. So, the patient and the family members know who they're talking to and what role they play in the care team. We've also tried to use technology. We've got pharmacy robots and we're looking at food delivery robots that actually take work off the plate of the nurses and the MAs that are working at the bedside and allow technology actually to perform a lot of those functions.

Host: So, how has this been received by the patients?

Dr. Joanne Conroy: Oh, the patients love it in our new pavilion especially the ability to identify who's in the room caring for them at that time. We also give patients access to their chart and all of their lab values. And their electronic health record is fully accessible while they're in their bed so they can actually follow the progress of their care. And also, there are alerts if they're going to have an imaging test or going to have lab draw, they know what to expect during the day. And that's one thing that patients complain about a lot is when they're in the hospital bed, things come as a surprise. Somebody shows up and they say, "We're going to take you for an x-ray." And they're like, "What is that for?" And so, they actually can anticipate how much traveling they'll be doing on the day during their hospital stay between imaging and lab draws, et cetera.

Host: Yeah. That's really interesting. So in hearing you talk about this, you've really redesigned everything there from the non-care staff to the attending nurses. So, is this model for everyone?

Dr. Joanne Conroy: You need to do it with your staff and not to your staff. So when I say is it for everyone, I think every institution will design how they want to get their work done in a collaborative process with their staff. I think that just picking something up from another organization can be fraught with problems. And it's just like any change management process. People actually have to have their fingerprints on it in order to really embrace it.

But we have a lot more work to do. I would say there's a lot of opportunity in the perioperative suite in terms of how we use our resources to staff the operating rooms and how we use our really experienced OR nurses to actually probably have the more supervisory function off of over many operating rooms in order to actually mentor and develop the teams using their expertise rather than just limiting them to either being a scrub or circulating nurse in the OR.

Host: Right. So, I've done several interviews, similar topic. And what you're talking about, what you're doing at Dartmouth Health, this is not an outlier. This sounds like it's happening across the industry and this is the direction that it's going. Would that be fair to say?

Dr. Joanne Conroy: Yes. We have an aging population in the U.S. And actually Maine, New Hampshire, and Vermont are the oldest populations in the U.S. And we're not going to have enough people to take care of everybody. So, we have to start thinking creatively about how we use technology and other resources in order to actually put the right people at the bedside and everything else, how can we actually do it remotely in order to really use people and their commitment to healthcare in a very different way.

Host: All right. So, say I'm a CEO at another hospital, I call you up and I go, "Dr. Conroy, love what you're doing there. Can you share with me your key takeaways? What are the most important points I need to know about when it comes to redesigning my own workforce?" What would you say to me?

Dr. Joanne Conroy: I would say the first one is do it with your staff and not to your staff. And I tell them, your staff know what needs to be done. You just need to unleash them. I think the second thing is really think about remote work. I know that many industries are challenging remote work, but it is very attractive to employees and we have to figure out how to integrate that into our workforce at our academic medical centers as well as our community hospital sites. And I would say the third thing is just embrace the fact that the healthcare workforce has been disrupted, and there are things that we are going to have to consider that we never considered five years ago. And that may be gig workers. It may be an internal shared staffing agency. It may be reserve core that can actually serve multiple roles within your institution in order to fill gaps when you have them. Those are things that we all have to embrace.

Host: Yeah. I like how you said that, number one, do this with the staff, not to the staff. That's a great way to put it. Then you said, number two, be open to remote work. It is here whether you like it or not, or want to go back five years when everybody is in the office. Remote work is here to stay, and then embrace the fact that the healthcare workforce really has been disrupted. So, those are really key points. So, thank you for sharing those, Dr. Conroy. This has been fantastic. I know you go much more in depth on all of this in the Futurescan article. But as we wrap up, is there anything else you want to add when it comes to redesigning the workforce?

Dr. Joanne Conroy: I would just add that our employees are committed not only to their patients, but the organization. And we need to unleash them. They have tremendous insight and ideas from the housekeeper that will make you rethink how you clean rooms to the nurse who can identify the six things she seems to do repetitively every day, that adds 5,000 more steps to her regimen. They all have the answers that we are looking for in terms of how we redesign work.

Host: Absolutely. We need to unleash them. As you said, Dr. Conroy, this has really been illuminating and enlightening. I appreciate your time today and we all look forward to the Futurescan 2024 article, Redesigning Work While Meeting the Demands of the Workforce. Dr. Conroy, thank you so much.

Dr. Joanne Conroy: Thank you, Bill.

Host: And once again, that's Dr. Joanne Conroy, and she discusses this in length in Futurescan 2024. And if you've found this podcast helpful, and of course, how could you not? Please share it on all of your social channels and please hit the subscribe or follow button to get every episode. And remember to join us to SHSMD Connections 2024, September 10th through the 12th in Chicago. Register at shsmd.org. That's shsmd.org/education/annualconference. This has been a production of DoctorPodcasting. I'm Bill Klaproth. See you!