Key Takeaways
- Staffing shortages lead to downstream inefficiencies that cost the industry billions of dollars.
- Temporary measures to boost staffing end up costing more money in the long run and ultimately are detrimental to patient care initiatives.
- Different HealthTech companies are working to address staffing-related issues, and there is potential for growth in this niche.
One of the most costly and inefficient issues prevalent across healthcare in the U.S. today is staffing shortages. Mismatched staffing and scheduling lead to downstream hospital and workflow disruptions, inefficient patient care, and loss of revenue. The COVID-19 pandemic further highlighted these already existing inefficiencies — and made them worse.
Healthcare technologies have helped to reduce inefficiencies and improve different areas of patient care. Here we’ll address if, and how, healthtech is helping to address staffing issues, specifically.
Staffing & Operating Rooms
Healthcare staffing works in different ways at different levels. First, you need administrative support staff to assist with scheduling, billing/coding, medical records, and patient information gathering and storage.
Then, there are staffing requirements for different areas of the hospital. Given that operating rooms are the primary money-maker for hospitals, we’ll focus there as an example.
For surgeries, each operating room has a few minimum requirements
- Surgical Technologist – assists surgeons with surgeries, handling instruments, and maintaining sterility during a procedure.
- Circulating Nurses – assist with ensuring sterility, patient care needs, support for surgeons and the anesthesiologist during the case, and communication with outside operating room staff.
- Anesthesiology Team – resident trainees or certified registered nurse anesthetists (CRNAs) working with an attending anesthesiologist, or an anesthesiologist working on their own, who maintains appropriate anesthesia levels for surgery and assists with post-operative planning.
- Surgery Team – resident trainees, physician assistants (PAs), and attending surgeons who perform the case.
Then there’s the staff that supports the efficient running of operating room suites, including:
- Housekeeping – clean and prepare rooms in between cases.
- Anesthesia Technicians – work with anesthesia teams to ensure proper stocking of supplies, assisting with emergencies or unplanned events.
- Floor Runners – help with patient transport, and delivery and transport of critical patient-care items in the operating rooms.
- Nurse Managers – oversee all operating rooms to ensure that each is staffed appropriately, is running on time, and emergency case planning.
- Anesthesia Board Runner – work with nurse manager to ensure accurate staffing, efficient operating room turnover, and ensure unplanned events are taken care of in a timely fashion.
- Central Sterilization & Processing – area that cleans and sterilizes instruments once they’ve been used so that they are readily available for another case.
Regarding staffing availability and the ability to perform surgeries, the main operating room players are surgeons, anesthesiologists, circulating nurses, and surgery technicians. Without these four components, an operation cannot proceed.
Missing players in other staffing areas leads to longer wait times for tasks to be completed and inefficiencies that lead to surgical delays, and longer room turnover times.
Recovery Rooms
After a surgery is complete, patients are woken up by the anesthesiologists and taken into recovery, also known as the PACU (post-anesthesia care unit). Here, patients are allowed time to wake up fully, and immediate post-operative concerns are addressed before further discharge home, or to a hospital room.
Recovery rooms are staffed by registered nurses (RNs), with one acting as nurse manager for the day. This RN manager communicates with circulating nurses and ensures the efficient allocation of nursing resources to patient care as patients enter recovery.
Typical staffing ratios of recovery room nurses to patients is, 1:1 or at most 1:2. In other words, post-operative patients require close monitoring.
Staffing Operating Rooms & Costs
The cost of an OR minute ranges from $21 – $133 with an average of around $62 per minute. This includes staffing and equipment costs, plus the cost of keeping the lights on and paying the rent (this does not include the cost of anesthesia care).
While this cost varies depending on the hospital, location, and patient payor mix, in general one can consider that each minute the operating room is not used is $62 wasted. Put another way, surgical delays of 30 to 60 minutes cost a hospital $1800-$3800 without generating any revenue.
Bottlenecks
This is where staffing around the operating rooms becomes interesting. Operating rooms require fixed staff in each OR to work on a surgical case. However, recovery rooms can be variable. You may have enough physical beds to accommodate three patients entering a recovery room at once, but not enough nurses to care for those patients.
When there is insufficient staffing, ORs enter what is called a PACU hold. The operating room team must wait in the OR until PACU gives the go-ahead. And yes, the clock is ticking as long as the patient is in the OR!
As you can imagine, PACU holds can cause significant downstream delays. Start times for surgical cases to follow are pushed back and the availability of circulating nurses (who typically work a 12-hour day) becomes more tenuous.
Other bottlenecks that affect the OR: PACU discharge to a hospital room and PACU discharge to the intensive care unit (ICU). In both instances, there may not be enough nurses to maintain appropriate and safe staffing ratios.
Staffing & The Pandemic
The COVID-19 pandemic highlighted the shortcomings of our staffing models, and made them all worse.
During the pandemic, patients were sicker and required higher levels of care (e.g., ICU), staff became sick and unable to work, and resources for personal protective equipment were short and difficult to come by.
Since the pandemic, we’ve seen the Great Resignation. This phenomenon represents the highest quit rate of healthcare professionals, ever. Healthcare providers are burned out, overworked, underappreciated, and ultimately underpaid for the level of work they perform.
Temporizing Measures
Hiring healthcare providers is not as easy as it sounds.
Nurses go to school for at least 4 years to obtain their degree. Clinical skills are honed over time, and ICU-level care requires additional training. Physicians go to school for 8 years, followed by 3-10 years of clinical training depending on the specialty. To replace a doctor means waiting 11-19 years!
Mid-level staffing in the form of nurse practitioners, physician assistants, CRNAs and the like helps offset the staffing imbalance in some areas, but not all.
The solution has been to increase wages and entice workers to work in certain areas. Those who travel to different areas of the country to fill a critical need are known as “travelers”. This phenomenon is most commonly seen among nursing staff.
Costs Of Traveling Nurses
If you thought nurses made a lot of money, consider the traveling nurse (data from Bureau of Labor and Statistics): Average weekly salary in the US: $2181
Average weekly salary of full-time RNs with a four-year degree: $1449
Actual pay varies based on the field of medicine and which part of the country you’re located. Just looking at averages, however, there’s a significant pay gap.
There are several downsides to hiring and depending on travelers. For one, they are not invested in the growth and success of a hospital or practice since they are temporary; they are often looked at and treated with hostility by full-time workers and are much more expensive in the long term.
Downstream Effects of Staffing Shortages
Fewer staff lead to a lower patient census. In 2022, shortages in nursing rehabilitation facilities and home health agencies alone cost $19.5 billion.
Aside from the very expensive financial burden of temporary employees and resulting limitations to the patient census, patients themselves suffer from the shortages.
The Joint Commission, which oversees hospitals and health facilities, reported a 19% increase in adverse effects in 2022. Adverse events include poor patient outcomes, injury, and other potentially preventable complications.
Can Technology Help Mitigate Staffing Strains?
Not mentioned so far is the cost of hiring a new employee, temporary or not. In healthcare, working in different states requires a new license (which costs money and takes time), then there’s hospital credentialing (more time and more money), then scheduling and onboarding (familiarizing a new employee with the facility).
In other words, a new hire can take weeks to months depending on the traveler, the state, the institution, and the specific area of the hospital for the hire.
To better understand which technologies (if any) are being used to mitigate these roadblocks, the team of experts at Langar conducted a brief survey.
The questions asked related to current or planned use of different technologies to improve efficiency around staff hiring, scheduling, onboarding, and credentialing.
Survey Results
29 of the 100 people emailed completed the 13-question multiple choice survey (8 technology-based and 5 demographic questions), which also included free-type responses.
Demographics
82% of those surveyed are physicians, 13% are administrators, and 3% noted they are “other, or industry employees.
58% of surveyors work at academic institutions; 20% are employed at public hospital systems; 17% each at private hospitals and private practice groups; 24% work for not-for-profit hospitals and 3% stated they work at an IDN (integrated delivery network).
41% of respondents have 5-10 years of work experience; 31% are early in their careers, in practice for 1-5 years; 17% are well seasoned, working for 10-20 years, and 10% have been in practice for over 20 years. None of the respondents have retired from clinical work.
Specific Question Responses
When questioned about the use of scheduling systems, 37.9% endorsed using it for patient appointments, and 34.4% endorsed using it for staffing schedules. The most common program for staffing schedules was Qgenda, and there were unique hospital-based apps or EPIC for patients.
Almost half (48%) of those surveyed endorsed using technology to improve provider workflows. The most common system mentioned was Dragon for dictation.
Technology-based treatment algorithms are being used by just over one-fourth (27%) of the respondents to help improve the efficiency of patient care. Commonly used technologies for creating and implementing these algorithms are EPIC and MIDAS.
Many hospitals have a significant patient backlog. With fewer providers in practice, it can take patients weeks or months to get an appointment. While the majority of surveyors did not know the extent of their institution’s backlog, those who did stated it is 1-4 weeks, and 7% said it is over 3 months. Almost half (48%) endorsed workplace technology to address this issue. A significant player here is telehealth and features like EPIC MyChart that allow patients to contact their healthcare providers directly through electronic medical records, and avoid in-person visits.
Regarding onboarding of new hires, only 24% of those surveyed were aware of technology to improve onboarding and shorten credentialing times for new hires. Of this group, they did not know specific names of programs but endorsed automation to help with credentialing.
Once someone is hired, the human resources department must process the paperwork. Automated technologies to increase throughput efficiently were endorsed by only 24% of respondents, citing Workday and RPA programs. Over half stated that they did not know of any such advancements in their workplace.
For billing costs, 34% stated their process was automated using EPIC or third-party billing companies which used their own technology to increase efficiency and reduce time to reimbursement.
As mentioned earlier, central sterilization departments are an important part of the operating room workflows and critical to ensuring that surgeries occur. When surveyed regarding the use of automation or technology to improve workflow inefficiencies in central sterilization, 72% of respondents were unaware of any such integrations.
Survey Discussion
It’s clear from the survey data that technology is already playing a role in addressing staffing inefficiencies.
An interesting point to note is that EPIC, a technology originally for gathering and storing patient data, has now expanded to include MyChart (assist with patient communication, scheduling, and telehealth), and a chat system wherein physicians can efficiently communicate with each other. Perhaps, this is an example of how already existing technologies, that have a footprint across various health systems, can further incorporate features that solve other pain points.
Backend automation to facilitate onboarding, training, and credentialing of new hires can significantly shorten the wait time for new hires to begin work. Going forward, this kind of healthtech is likely here to stay as it also decreases administrative costs.
The incorporation and growth of access to care companies that use telehealth is another way to indirectly improve hospital workflows and operations by offloading in-person patient visits and their hospital footprint.
Our surveyors were unable to provide more information on central sterilization departments; however, given that operating rooms are a key money maker for hospitals, this is an important area where healthtech can help. Further innovation and development here is likely to save the hospital money and make turnover times in the operating rooms more efficient.
The Future Of Staffing & HealthTech
There is much room for growth in the area of staffing and scheduling, and it’s needed. The population is aging, elderly healthcare professionals are approaching retirement age, and younger ones are quitting.
Going forward, artificial intelligence is likely to play a bigger role. While nothing and no one can replace a real life physician and healthcare professional, AI driven chatbots can converse with patients and address common questions, assist with scheduling appointments in real-time, and serve as a way for physicians to optimize their billing/coding/documentation. The ultimate effect is to help existing healthcare professionals free up their time for more patient care.
Another side of the staffing issue is addressing the reason for burnout and quitting. While professionals are tired and overwhelmed, there is also room for improvement in healthcare culture to support the workers we already have so that they can do what they do best, and not quit in the first place.
Sanjana Vig MD, MBA
Dr. Vig is a co-founder and Chief Marketing Officer of Langar Holdings. She is a board-certified anesthesiologist specializing in Perioperative Management. She is also the founder The Female Professional, a website geared toward empowering professional women in life and their careers.
