Significiant changes in healthcare workforce

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It was noted that historically, medical care began in homes, and then moved to hospitals and centers where medical technology including computers was located. Now, technology can be almost anywhere, and most people do not receive their care in hospitals. An advantage of care in the home, Embrey said, is a greater involvement of and support from the family with regard to compliance and follow-up.

Turner said one valuable aspect of care is the time of the provider, because it may be more efficient in general for patients to go to where the doctor is located.

However, there are a number of reasons why it might be better for the provider to go to the community or to the patient directly, and she added that with the models that community practitioners discussed, there is potential to reach previously underserved populations in their homes.

Priest suggested payment drives where care is delivered, not what is the most efficacious route of delivery. The move toward community-based care is a result of evolving payment paradigms under the ACA. Workshop co-chair Georges Benjamin, executive director of the American Public Health Association, alerted participants that state-based professional associations have a lot of control over what types of providers can offer what types of services.

Despite demand for various types of providers, if the associations do not allow them, then they will not happen. He cited the example of the position of dental therapist, which has been successful in reaching underserved populations in Alaska, but has been met with significant resistance in other states. Challenges such as these may continue to be a barrier to workforce innovations unless buy-in happens on a broad level.

One example of these is Section under Title 5, where the law creates a public health sciences track at selected health educational institutions to merge public health and clinical practice and emphasize team-based service.

The grants program for fellowship training in public health has also been expanded, and there are public health recruitment and retention programs, including a loan repayment program. Turner said that although it is useful to look at the big picture broadly across the country, one must then take into account the reality at each location on the ground.

With regard to physician supply, for example, big-picture planning helps to coordinate training programs and funding to educate new physicians, but there is also the opportunity to better align supply and demand in geographic area or across specialties.

In terms of defining roles, Turner said there is a spectrum of health care services that is required by an individual or a population, from advanced subspecialty care to interventions that can be performed by someone with hardly any medical training.

At each step along the way, various people can perform any of those functions, with overlap across roles. There is not necessarily one right way to define roles, she said, and incentives need to be in place to measure innovation when defining new health care roles and take care that they are financially feasible. DeSalvo raised two related concerns about the training of the physician workforce.

First, physicians are generally not trained in incident command management principles or emergency preparedness. As a result, they often arrive at the site ready to volunteer, but do not know who to contact, where they fit in, or how to be the most useful. Second, physicians are becoming more and more distanced from basic skills and procedures in their everyday work e. Cairns concurred and cited a study of the procedural experience of medical students entering residency programs.

The study found that less than 10 percent had ever inserted a central line, and half had never started an intravenous IV line Promes et al.

To have a prepared workforce, it is important to ensure that medical schools are training doctors in these basic procedures, and not just first responders. As they become more distanced from these basic procedures, their ability to give help and support on the ground lags, which could limit capacity to respond in a disaster. By contrast, Cairns said the special operations medics at Fort Bragg have each inserted hundreds of central lines and must insert about six or seven IVs and central lines during training to be considered competent.

Priest agreed, but cautioned that there is currently no real evidence base for what skills are needed. Citing his own experiences, Priest noted that the military focuses on stress inoculation, preparing the medical responder to make a good decision under difficult conditions.

Priest suggested that there are pedagogical ways to teach this that do not take a lot of time, and that could be incorporated into different courses in professional schools. Embrey said that in a crisis normal standards of care may not be possible, and there needs to be a training to prepare providers and the community for this possibility.

While specific training may not be standardized, many communities have begun to have conversations within their health care coalitions about developing standards of care for allocation of scarce resources. Making decisions with incomplete information when lives are at risk is a part of emergency medicine, Cairns added.

Expanding health care workforce training to include some of these important pieces, at all levels of practice, can augment responding capabilities in an emergency, as well as contribute to more streamlined routine care.

For a more specific listing of all occupations included in the calculation of the U. MESH is a nonprofit, public—private partnership focused on enabling health care providers to respond effectively to crisis events and remain viable through recovery. MESH does clinical education and training for providers, community-based planning, health care intelligence, and policy analysis. Turn recording back on. Help Accessibility Careers. Search term. Highlights of Main Points Made by Individual Speakers 1 Care is increasingly being provided outside of the hospital setting, and mid-level practitioners e.

Leveraging nonphysician clinicians can go a long way toward alleviating projected physician shortages. An emerging care paradigm, referred to as mobile integrated health care practice or community paramedicine, centers on the concept of patient navigation to reduce preventable emergency department visits and readmissions and to increase capacity of the health care system.

Medical and public health preparedness programs could look to the military for lessons learned regarding successful team-based medical care and training providers in decision making under stress. Overall growth in the health workforce across all occupations in health care delivery. All forecasts of the demand for physician services predict shortages in the coming years.

The number of physicians is increasing roughly 1 percent per year. Medical school enrollments are growing faster, but there is a narrowing of the pipeline when they reach graduate medical education.

In contrast, the number of nurse practitioners and physician assistants is increasing 5 or 6 percent per year. The educational pathway to becoming a physician is the longest of all health professions. Currently, about 75 percent of clinicians are physicians, but Turner predicted that if current trends continue, then it may be closer to two-thirds in the coming decades. Leveraging nonphysician clinicians can go a long way toward alleviating the projected physician shortages, Turner said.

Demand for services, leading to demand for workforce. Expanded coverage under the ACA is projected to increase demand for services. In addition, the population is growing at about 0. The increased demand for health care from baby boomers may not be fully felt for another decade or more, Turner noted, until they reach ages 75 to 85 or older.

Pressures to reduce costs and changes in reimbursement. There is continuing pressure to reduce health care spending and the rate of growth in health care spending.

As a result, Ebeler added, there is a push for greater efficiency in the delivery of health care and a move away from fee-for-service and toward methods of payment that are value-based.

The incentives are changing, allowing more flexibility in providing care e. Increasing consolidation and integration within the health care delivery system. Integration is occurring both vertically and horizontally. Physicians are grouping together into larger practices and single-physician practices are becoming rare. More practices are now owned or affiliated with hospitals.

Most hospitals also now offer home health care services and hospice services. Additionally, providers are rearranging themselves with a goal of team-based care. In the context of preparedness, Turner said, greater integration would make it easier to communicate, mobilize, and coordinate care in an emergency situation. Mobile Integrated Health Care: Community Paramedicine and Patient Navigation As an example of new provider roles in the community, Matt Zavadsky, Director of Public Affairs at the MedStar Mobile Community Health Program, described how MedStar is evolving from an emergency medical services EMS organization into a mobile integrated health care organization, and how this has impacted the workforce and local community.

Extending the Health Care Workforce From a workforce perspective, MedStar has been able to train community paramedics and other providers who are very adept at managing patients through a health care crisis.

Patient Care in the Home A few participants discussed further the concept of moving care out of the hospital and into the home. Procedural Knowledge Needs DeSalvo raised two related concerns about the training of the physician workforce.

Copyright by the National Academy of Sciences. All rights reserved. In this Page. Other titles in this collection. Recent Activity. Clear Turn Off Turn On. When thinking about new hires and developing employees to take on new challenges and roles, our interviews showed that the shift to virtual work has led to a realization that organizations should focus on certain skills and capabilities:.

The CHROs we spoke with acknowledged most executives in their organizations thought work should be done in the office. However, our research shows that both leaders and employees are seeing innovation and new ways of working resulting from the shift to virtual work. Slightly more health system employees reported their organizations were introducing new ways of working. Many CHROs told us that while consensus has a role and some decisions do require deliberation, the profound shift in the workplace forced them to execute new plans quickly.

Now, we are making more enterprise-level decisions. The shift has also led to the need for more meaningful—and more frequent—communication and different ways to interact.

Many CHROs report that meetings and discussions, when not onsite, must be more deliberate, and they predict this is leading to reduced micromanaging. The focus should be on empowering employees to work effectively, developing a process for streamlined decision-making, and minimizing or getting rid of low-value tasks. Some organizations are exploring new technologies. Many health system CHROs told us the shift to virtual visits has reverberated throughout the organization and is spurring gains in digital transformation—a shift was clearly happening before COVID see previous Deloitte research on the hospital of the future.

One organization is exploring augmented reality AR. Though even before COVID, this organization was dealing with the reality of travel budgets and the burden on employees, the pandemic spurred leadership to look for ways to accomplish business outside of conference rooms or even videoconferencing.

People can draw on a virtual whiteboard, just as if they were in the same room. Employees have to cope with a lot—the pandemic and concerns about health risks, the social unrest we are experiencing, and the need to adapt to changing routines and norms. Many of the CHROs we spoke with are making sure communication from leadership is constant and transparent. They are scheduling more time for smaller group check-ins and making sure people have access to resources they need.

Some organizations are strengthening their child-care and elder-care benefits. But the CHROs we spoke with, and many of the news and business-trade publication articles about the shift to virtual work, are focused on burnout from working too much. Without the physical separation between work and the rest of life, CHROs were noticing that many people have trouble stopping work. Burnout has huge costs for employees and their organizations. Obviously, some of their challenges are different, including stress about contracting the virus or passing it on to loved ones.

But, some of the strategies to address mental health and well-being are the same for front-line and back-office workers:. While the shift to virtual work happened quickly, the return to work for many organizations will likely be much more gradual, with many opting for a hybrid approach of virtual work and onsite. Doing virtual work well means developing and sustaining new strategies and accepting new ways of working. It also means finding opportunities to reimagine the workplace, discovering new ways to innovate, and improving how the organization meets the needs of customers and employees.

Now is an opportunity like no other to consider new ways of working and set them up for long-term resilience. Based on our research, here are strategies health care organizations should consider implementing:. One of the first steps for organizations to meet the challenges ahead and embrace the future of work is to recognize that elevating the customer, member, or patient experience is synonymous with elevating the workforce experience.

Exponential impact starts when organizations address the human experience —aligning and connecting customer, workforce, and partner experience to shared values. The workforce is the face of the organization. View in article. Deloitte, Support your Black workforce, now , Erica Volini et al. Amir Rahnema et al. Tiffany McDowell and Siri Anderson, Making the invisible visible: How network analysis can lead to more successful organizational redesigns , Deloitte Insights, Volini et al.

Kulleni Gebreyes et al. Transforming the hospital business model , Deloitte Insights, June 25, Innovation starts with insight and seeing challenges in a new way. Amid unprecedented uncertainty and change across the industry, stakeholders are looking for new ways to transform the journey of care.

Comprehensive audit, advisory, consulting, and tax capabilities can deliver value at every step, from insight to strategy to action. She also leads the Future of Work in Health Care signature issue. With more than 20 years of experience in life sciences and health care, Radin is a national speaker and key advisor to health care leaders, helping them transform their organizations to execute strategies for growth that improve clinical outcomes, enhance patient and family experiences, improve affordability and access, and increase caregiver engagement.

She is based in New York. Casey Korba, MS, is health policy manager for the Deloitte Center for Health Solutions Deloitte Services LP , where she provides comprehensive regulatory, legislative, and policy analysis in areas including the transition to value-based care, emerging technology, and consumer engagement. See something interesting? Simply select text and choose how to share it:.

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Social login not available on Microsoft Edge browser at this time. Viewing offline content Limited functionality available. Welcome back. Still not a member? Join My Deloitte. Article 21 minute read 12 November Jennifer Radin United States. Casey Korba United States. Executive summary What have health care organizations learned about virtual work? Loss of organizational culture is a top concern for employees and leadership Organizations are leaning in to the social consciousness movement and working to increase diversity, equity, and inclusion strategies and priorities in a virtual environment Consider that not all employees are experiencing virtual work the same, and plan accordingly The shift in how and where we work has opened up opportunities for innovation and new ways of working Mental and spiritual health and well-being are paramount and can require different strategies in a virtual environment Implications for health care organizations: Reimagining the workplace in a rapidly changing world.

Executive summary At the start of , few health care organizations imagined that within months, most of their nonclinical and in some cases, clinical workforce would be working from home. Study methodology The Deloitte Center for Health Solutions surveyed employees of health care organizations around the country: 66 of the respondents were from large health systems 34 were from health plans 44 were in middle management, while 56 were in senior management or were executives Topics covered in the survey included the availability and usefulness of tools and technologies respondents had access to while working remotely; communication from leadership and their teams; whether or not their organizations were introducing new ways of working or new innovations since shifting to remote work; and questions around culture, well-being, productivity, and performance management since shifting to remote work.

What is culture, and why does it matter? Thinking beyond skills: What capabilities are health care organizations focusing on to meet the challenges ahead? When thinking about new hires and developing employees to take on new challenges and roles, our interviews showed that the shift to virtual work has led to a realization that organizations should focus on certain skills and capabilities: Ability to communicate.

We heard that the messages employers should convey to employees are different—and so are the vehicles used to convey them. Some of the CHROs said they want to hire people who can think about challenges innovatively or challenge the status quo.

But things are changing. People can disagree more easily and challenge each other. So those individuals can help us progress. According to CHROs, in an increasingly challenging world, it is critical to be able to read people and respond accordingly, and to be able to put ourselves in one another's shoes.

We heard that one organization rolled out change-management training in response to the public health crisis and social equity movement. Ability to make connections across the ecosystem. Some CHROs mentioned they are increasingly interested in hiring from other industries and bringing in people who like to network and help the organization think through more external partnerships.

We should stay abreast of what is going on externally and come back and apply it. We are not insular anymore. Acknowledgments Project team Regina DeSantis supported the qualitative interviews, writing, and editing. Cover image by: Daniel Hertzberg. Endnotes U. View in article Deloitte, Support your Black workforce, now , View in article Erica Volini et al. View in article Amir Rahnema et al. View in article Tiffany McDowell and Siri Anderson, Making the invisible visible: How network analysis can lead to more successful organizational redesigns , Deloitte Insights, View in article Volini et al.

View in article Ibid. View in article Kulleni Gebreyes et al. View in article Show more Show less. Learn more Get in touch.

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But, some of the strategies to address mental health and well-being are the same for front-line and back-office workers:. While the shift to virtual work happened quickly, the return to work for many organizations will likely be much more gradual, with many opting for a hybrid approach of virtual work and onsite.

Doing virtual work well means developing and sustaining new strategies and accepting new ways of working. It also means finding opportunities to reimagine the workplace, discovering new ways to innovate, and improving how the organization meets the needs of customers and employees. Now is an opportunity like no other to consider new ways of working and set them up for long-term resilience.

Based on our research, here are strategies health care organizations should consider implementing:. One of the first steps for organizations to meet the challenges ahead and embrace the future of work is to recognize that elevating the customer, member, or patient experience is synonymous with elevating the workforce experience.

Exponential impact starts when organizations address the human experience —aligning and connecting customer, workforce, and partner experience to shared values. The workforce is the face of the organization. View in article. Deloitte, Support your Black workforce, now , Erica Volini et al. Amir Rahnema et al. Tiffany McDowell and Siri Anderson, Making the invisible visible: How network analysis can lead to more successful organizational redesigns , Deloitte Insights, Volini et al.

Kulleni Gebreyes et al. Transforming the hospital business model , Deloitte Insights, June 25, Innovation starts with insight and seeing challenges in a new way. Amid unprecedented uncertainty and change across the industry, stakeholders are looking for new ways to transform the journey of care. Comprehensive audit, advisory, consulting, and tax capabilities can deliver value at every step, from insight to strategy to action.

She also leads the Future of Work in Health Care signature issue. With more than 20 years of experience in life sciences and health care, Radin is a national speaker and key advisor to health care leaders, helping them transform their organizations to execute strategies for growth that improve clinical outcomes, enhance patient and family experiences, improve affordability and access, and increase caregiver engagement.

She is based in New York. Casey Korba, MS, is health policy manager for the Deloitte Center for Health Solutions Deloitte Services LP , where she provides comprehensive regulatory, legislative, and policy analysis in areas including the transition to value-based care, emerging technology, and consumer engagement.

See something interesting? Simply select text and choose how to share it:. COVID as catalyst has been saved. COVID as catalyst has been removed. To stay logged in, change your functional cookie settings. Social login not available on Microsoft Edge browser at this time. Viewing offline content Limited functionality available. Welcome back. Still not a member?

Join My Deloitte. Article 21 minute read 12 November Jennifer Radin United States. Casey Korba United States. Executive summary What have health care organizations learned about virtual work?

Loss of organizational culture is a top concern for employees and leadership Organizations are leaning in to the social consciousness movement and working to increase diversity, equity, and inclusion strategies and priorities in a virtual environment Consider that not all employees are experiencing virtual work the same, and plan accordingly The shift in how and where we work has opened up opportunities for innovation and new ways of working Mental and spiritual health and well-being are paramount and can require different strategies in a virtual environment Implications for health care organizations: Reimagining the workplace in a rapidly changing world.

Executive summary At the start of , few health care organizations imagined that within months, most of their nonclinical and in some cases, clinical workforce would be working from home. Study methodology The Deloitte Center for Health Solutions surveyed employees of health care organizations around the country: 66 of the respondents were from large health systems 34 were from health plans 44 were in middle management, while 56 were in senior management or were executives Topics covered in the survey included the availability and usefulness of tools and technologies respondents had access to while working remotely; communication from leadership and their teams; whether or not their organizations were introducing new ways of working or new innovations since shifting to remote work; and questions around culture, well-being, productivity, and performance management since shifting to remote work.

What is culture, and why does it matter? Thinking beyond skills: What capabilities are health care organizations focusing on to meet the challenges ahead? When thinking about new hires and developing employees to take on new challenges and roles, our interviews showed that the shift to virtual work has led to a realization that organizations should focus on certain skills and capabilities: Ability to communicate.

We heard that the messages employers should convey to employees are different—and so are the vehicles used to convey them. Some of the CHROs said they want to hire people who can think about challenges innovatively or challenge the status quo. But things are changing. People can disagree more easily and challenge each other. So those individuals can help us progress.

According to CHROs, in an increasingly challenging world, it is critical to be able to read people and respond accordingly, and to be able to put ourselves in one another's shoes. We heard that one organization rolled out change-management training in response to the public health crisis and social equity movement. Ability to make connections across the ecosystem. Some CHROs mentioned they are increasingly interested in hiring from other industries and bringing in people who like to network and help the organization think through more external partnerships.

We should stay abreast of what is going on externally and come back and apply it. We are not insular anymore. Acknowledgments Project team Regina DeSantis supported the qualitative interviews, writing, and editing. Cover image by: Daniel Hertzberg. Endnotes U. View in article Deloitte, Support your Black workforce, now , View in article Erica Volini et al. View in article Amir Rahnema et al.

View in article Tiffany McDowell and Siri Anderson, Making the invisible visible: How network analysis can lead to more successful organizational redesigns , Deloitte Insights, View in article Volini et al.

View in article Ibid. View in article Kulleni Gebreyes et al. View in article Show more Show less. Learn more Get in touch. Download Subscribe. Related content Interactive 3 days ago. More on the future of health care. How the virtual health landscape is shifting in a rapidly changing world Article 2 years ago. Rethinking the physician of the future: Embracing new technologies, empathy, and new models of care Article 2 years ago. Is the hospital of the future here today? Article 2 years ago.

The future of virtual health Article 2 years ago. The role of health services innovators in the future of health Article 2 years ago. The future of health Collection. Casey Korba Health Policy Manager Deloitte Casey Korba, MS, is health policy manager for the Deloitte Center for Health Solutions Deloitte Services LP , where she provides comprehensive regulatory, legislative, and policy analysis in areas including the transition to value-based care, emerging technology, and consumer engagement.

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