Rachel Schiff
Rachel Schiff

Workforce shortages are well understood challenges of the healthcare industry. However, the skilled nursing industry has always been hit the hardest. This market is characterized by tight margins and facilities facing the challenges of limited workforce availability with limited resources, inefficient processes and very basic technology — often little better than pencil and paper.

Many industries, including acute-care settings in healthcare, have modernized and implemented intelligent workforce management solutions and processes, resulting in greater efficiencies. But nursing homes have lagged significantly. Though it will take time and require a patient and careful approach, it’s time for the post-acute world to integrate and modernize its workforce management processes in order to not only survive, but thrive, going forward. 

The ongoing nursing workforce shortage

The United States has been experiencing a growing gap between the available nursing workforce and the demand for nurses in acute and post-acute care, and this is expected to worsen as aging generations and increasing burnout drive nurses into retirement. This challenge is further compounded by the fact that nursing schools have not been able to keep up with ever-growing demand. 

As the supply-demand gap continues to widen in post-acute nursing, facilities have had to resort to such extremes as forced overtime and wide-scale reliance on costly outside staffing resources. The nursing home industry is facing a real crisis amid the perfect storm of low margins, high-stress and rampant burnout. 

Workforce shortage compounded by COVID-19 

The pandemic shed harsh light on chronic workforce problems, including insufficient training and staffing levels in nursing homes. These challenges have been consistent across the healthcare continuum, however other sectors have been able to respond more appropriately to the demands of the pandemic by using modern staffing and workforce management technology. 

The more sophisticated the approach, the more productivity the organization can get out of their existing workforce, while reducing burnout and improving quality of patient care, and post-acute nursing will need to embrace these more sophisticated approaches to meet the many workforce and market-based challenges it faces.  

What does good workforce management look like? 

Good staffing and workforce management require a multipronged, integrated approach that focuses on staff sourcing, optimal allocation of staffing resources and training:

  • Nursing home facilities must leverage technology intelligently to match available resources to the demand of shifts that need to be filled. 
  • Sophisticated analytics and AI can help to ensure shifts are filled with the most appropriate staff in terms of training and cost, and to minimize burnout, while addressing other relevant variables like seniority and union rules. 
  • Ensuring each staff member has the appropriate education qualifications to work in a facility and the certifications and training to fill specific roles and responsibilities is also critical.

When executed strategically, these three buckets are very synergistic. If one or two buckets are leveraged, but not the third, it may result in filling a staffing slot with someone who is underqualified, or over-investing in outsourced staffing agencies. In a perfect world, technology, staffing resources and education work together in harmony, ensuring that all shifts are filled with the most appropriate candidate possible. 

Achieving optimal workforce management 

Understanding the key elements of effective workforce management is an important first step, but knowing what to do and finding the time and resources to do it are very different things, and just the idea of embracing advanced workforce management best practices can often be daunting. It’s important to know that nursing facilities do not have to do everything at once. Most organizations will benefit from taking things slow and working one step at a time as their organization and culture acclimates to new ways of working. Ultimately, these organizations can make steady progress and see incremental improvements until they are finally enjoying the full benefits of advanced workforce management technology and best practices. 

The first and most critical step on that path is capturing basic data on utilization and resources. Until organizations get off of paper and paper-equivalents (looking at you Excel), the essential information required to support more advanced practices will remain inaccessible.

Digital scheduling and staffing software will not only track internal employees, but also any outside or per-diem staff. Super-sophisticated scheduling systems with overwhelming features and capabilities are not required at this stage. A simple digital scheduling system that has some capability to engage workers with conveniences like text messaging will start to give post-acute care facilities the engagement and data necessary to ultimately transition to more advanced levels of analytics-driven improvements.

Another critical early step is organizing and optimizing staff training and onboarding. Organizations typically have big gaps in certain skill and certification requirements, and using digital tools here can achieve a better understanding of staffing inventory and onboarding. Knowing how long it takes to bring new staff online, where the biggest gaps in available skill sets are and getting measurable feedback on the quality of training resources all represent major advancements in workforce management efficiency. 

With this data compiled and analyzed, organizations can start to identify root-causes of inefficiency and ways to enhance current processes. This includes leveraging data and technology for a more sophisticated approach to addressing issues like integrating temporary  agency staff into unified scheduling systems. 

Once the available staffing resources are evaluated holistically using digital tools, organizations can further increase the sophistication of their workforce management process, with techniques like:

  • Calibrating overtime and other incentives for filling shifts using AI and predictive modeling 
  • Building in rules to improve patient satisfaction and safety, while reducing burnout
  • Automating regulatory and union compliance 
  • Optimizing use of gig-model staffing resources to decrease mandatory overtime and outsourcing costs
    • This can include creating on-call pools – a strategy that improves outcomes by emphasizing care team consistency.

There is a huge delta in the market between post-acute workforce demand and what is actually available. The pandemic has only worsened these challenges, exacerbating the consequences for patients and staff. By embracing more sophisticated workforce management practices and technologies, the staff sourcing, education, and scheduling processes in the nursing facility can be dramatically improved, yielding benefits for patients, staff and the bottom line. By taking small steps and building on small victories, organizations can reasonably tackle these ongoing and chronic issues at a pace that is comfortable to them. 

Rachel Schiff is the senior vice president of product management for IntelyCare, a leading intelligent workforce management solution for post-acute facilities.