If you want the solution to staffing challenges in healthcare, try asking your staff.

Erika Grotto: Career development in a strained workforce, today on HFMA’s “Voices in Healthcare Finance” podcast. Hello, and welcome to the podcast. I’m your host, Erika Grotto. Today, I’m talking with Julie Hamilton, a career transition and leadership coach with a long history in healthcare. If you’re a leader, a job seeker or even just a person thinking about the future of your career, you’re going to want to hear this one. There’s truly something for everyone. But first, we’ve got some healthcare finance news. Here’s HFMA Policy Director Shawn Stack and HFMA Senior Editor Nick Hut.

Nick Hut: Alright, everybody. We’re talking about a bit of a hot button and arguably controversial topic. If you’re an HFMA member, that means there’s a good chance you’re a hospital finance professional, and that means you may kind of shudder or recoil a little bit at our discussion of this topic, so fair warning, but the topic is the notion of capping hospital prices as a way of controlling healthcare spending. This has been a discussion point in policy circles for a long time, but just recently, the Congressional Budget Office issued a formal report on this at the request of the House of Representatives Budget Committee. So at least on a preliminary level, Congress is now taking a close look at potentially drastic approaches to tackling healthcare spending. Hey, Shawn, when you see this in the news, what’s your reaction?

Shawn Stack: Well, my reaction is they’re coming at this from all sides. They have three policies kind of impacting or looking to impact and create price reductions in healthcare. We have the promotion of price transparency. We have the promotion of the competition among providers, now that all of these contracted rates are published as of July 1 with health plans and the insurers. And then, like you said, just this new identified capping of the level of growth of prices by the CBO study. So the other two, the impact is estimated to be on the smaller side of reduction of healthcare prices, but this capping of the level of growth of prices is really showing an impact of moderate to large price reductions for providers. So this could have massive impact or access to care, quality of care, depending on how capped these prices get, right?

Hut: Yeah, totally. Just to add a little bit of context, when CBO first took price caps, they were specifically talking about setting limits on the amounts that providers can receive from commercial insurers and/or capping the annual growth rate of those amounts. And just to follow up on what you said, Shawn, if those sorts of policies were to get implemented, the projection is a price reduction of 3-5% during the first decade. In comparison, the projected decrease would be less than 1% for policies that emphasize price transparency, which has been underway for almost a couple of years. So the 3-5% is a meaningful decline, but is it worth the impact on individual organizations? So if we’re talking about a hypothetical scenario in which this policy did get implemented, what do you think would be the effect on hospital operations? Obviously it would vary from one organization to the next.

Stack: It certainly would vary from one organization to the next, and my thought is, Nick—and I don’t know if you agree with me—when the CBO is releasing this estimated capping, they’re really coming at it from, in my opinion, more of an implication of the federal budget, so each of those three policy approaches would reduce the federal deficit around healthcare. If CBO’s assessment on commercial payers is correct, the commercial payers would pass on most of their savings, supposedly, quote unquote pass on most of their savings, from paying lower prices onto their customers, their members, by reducing premiums, thus decreasing federal subsidies for health insurance, especially in the exchange and in Medicare Advantage programs. So they are looking for a federal budget save here as the Medicare deficit grows and the Medicare Trust Fund is under more budget restrictions and issues. So I think they are attacking it from one side and looking at it from one side, but the unintended consequences this could have on quality of care, staffing at hospitals, given that we have such increase in staffing wage cost and supply cost, this could have detrimental effects on health systems, especially those in community settings, that it’s harder for them to negotiate supply charges, wage negotiations, things like that. So the unintended consequences, I agree, could be very detrimental to hospitals in the provider market over the next 10 years.

Hut: Yeah, that’s great insight, and CBO does acknowledge that in the report. They acknowledge that such policies could very well affect healthcare quality and access, especially if the caps were set at a pretty restrictive level, that would get the spending reduction closer to that 5% mark. And just to note, CBO does not advocate for policies. They simply lay out the consequences for federal expenditures and other implications of applying a given policy. Shawn, any more to add, especially in the context of the current financial state of affairs for hospitals?

Stack: Yeah, Nick. This comes at a very inopportune time for many, many health systems, probably the majority of health systems. Coming out, as I talked about, coming out of the pandemic public health emergency. Labor costs are at an all-time high. Inflation’s at an all-time high with real estate leases that the hospitals are paying. Supply costs are still really, really high as we all see at the grocery store. Hospitals are seeing the same thing with their medical supply costs. And hospitals are really, really, truly operating on a 2% margin, margins that they have not seen, very slim margins over the last couple of years. So a reduction in pricing that we’re talking about here could really stress our healthcare system in the United States. It will be interesting to see how this rolls out, how we weather this, and some creative ways to approach these increased costs that are real in our healthcare market.

Hut: So this clearly is a hot button topic, like we said, that we surely will  be keeping an eye on. HFMA is focused on leading the discussion around cost effectiveness of health—in other words, efforts to keep people healthy in the most cost effective way. So what we’ve just been discussing really speaks to the need for stakeholders to try to get ahead of the curve before potentially severe policies are ever imposed. So definitely stay tuned to HFMA for news, insights and best practices related to this whole discussion around pricing. Thanks, everyone.

Stack: Thanks, Nick.

Grotto: These days, it seems like every industry is dealing with some sort of workforce issue, but as we all know, healthcare has been hit especially hard. Shortages, financial constraints and changing expectations on the part of workers and leaders have created a situation that is difficult to say the least. So I called upon a guest with a unique perspective to discuss it. Today, Julie Hamilton is a career transition and leadership coach with Core Rising, but she previously spent nearly 30 years in healthcare, mainly in compliance. I was excited to get her perspective on how the needs and wants of job seekers have changed over the years and how leaders should be adjusting, especially in an industry with a strained workforce.

Hamilton: People are definitely looking at wanting to do something that they really want to do. So there’s a lot of things where people are coming to me because they may have been in a job where they didn’t have any advancement opportunity or development opportunity. And they’re like, “I’ve done this job for 10 years and I need to do something different.” So we do some exploration there. What does that look like? What would you like to do? I have people who have come to me, who I’m currently working with, who have been in an environment that is not supportive. And when I say “not supportive,” that means their leadership isn’t listening, asking them how they’re doing, wanting to have conversations about what their path looks like, which I think is very important and I think we’ll talk about that a little bit. Those are the couple of things. Either they’re leaving a place they’re unhappy with and they want to find something more empowering and meaningful to them, and much more—I don’t want to say comfortable, but a better fit. And then people who are, like I said, have been somewhere for a long time and they’re just not seeing advancement opportunities, and their leadership isn’t helping them navigate that, so they’re looking for somebody to help them figure it out.

Grotto: Let’s talk a little bit about those conversations between staff and leaders. They might not always be happening, but when they do happen, what should they look like?

Hamilton: When you do annual reviews or performance reviews, whatever that cycle looks like, it’s a great opportunity to say, hey, what are you interested in and how can I as your leader support you in growing whatever skill set it is that you want to focus on? Because anytime somebody’s learning and growing, it ultimately benefits the team. There are many transferable skills, soft skills, hard skills that could be beneficial, and if the employer or the team member is coming to you excited because they’re learning something new, you’re going to get a better version of them.

Grotto: One of my favorite things to do, I love to read advice column, and I read a lot of workplace ones.

Hamilton: Sure.

Grotto: And I read in one a question recently that basically said, I got my dream job. This is what I’ve been working toward for years, and now I hate it. What do I do? What happens when you get to a point where you go, oh no, this isn’t actually what I want to do?

Hamilton: I think a couple of things. One thing that I always worked with my team on and also now as a coach I work with people on, is getting really clear about what it is in your day-to-day work that you do that you really like. What do you like to do? And many of us don’t do that. We don’t have that thought process. We think of a title. We think of compensation. We think of status or power or whatever it might be. But I ask everyone, tell me what you really like to do, and let’s get clear on this job that you’re aspiring to. What’s involved in that? Is there alignment there between what you like to do, what you don’t like to do, and what the job’s gonna require? So in my example with my team, I shared with them the things I liked to do that were part of my role and the things I didn’t like to do and yet had to do as part of the role so that they were clear on what does it mean to take on this chief compliance officer role. So try to have open conversations with them, but like I said, as a coach, I actually have everyone do somewhat of a tedious exercise of, write down, what are the things you really like to do, what makes you excited, brings you energy. What are the things you really don’t like to do? Because it’s better for us to be really clear on that when you’re maybe looking for a new opportunity so that we don’t wind up doing what you’re saying which is getting into a position where we’re like, oh my, this job has 80% of what I don’t like to do involved in it and being clear about that when they’re maybe interviewing or having networking conversations, those kinds of things. So I actually have people do that exercise.

Grotto: Job seekers are asking more questions of potential employers, and you’ve heard for years, it should be a two-way interview. It’s not just do you want me, it’s do I want to come work for you, but it seems like people are finally getting that a little bit more and really thinking about, is this job what I want to do, is this organization one that I believe in and want to work for, what is the culture—all of these questions people are finally asking before they get there.

Hamilton: I have that exact conversation with every one of my clients, because for the most part, people are still in the mindset of, I want a job, I need a job, I need the money. And that’s true for most of us. But I’m trying to help them turn the page on, let’s find something that works for you. Let’s ask the culture questions. Let’s ask the leader how supportive are they of their team and in what ways. Let’s ask open-ended questions. And I think that’s why people are looking at coaching a little bit more, is, how do they navigate that conversation because that’s something we’ve done historically. We’ve gone into interviews where we try to sell ourselves and then hope that we get an offer and don’t have a two-way dialogue. I just constantly am pushing on people to ask the culture questions, the leadership questions, the team, the hybrid work, remote work, all the things that people want right now. Maybe they always wanted it but they couldn’t do it before. It’s a great opportunity, like you said, because things are different.

Grotto: Yeah, absolutely. So I want to pivot a little bit and talk about healthcare specifically. And maybe it’s not. I don’t think it’s specific to healthcare, but we’re talking a lot about shortages in the workforce. At the same time, there are financial constraints. We’re hearing about hospitals and health systems laying people off. So we’ve got, basically, teams that are stretched really thin. How can healthcare organizations show appreciation for their overwhelmed, overworked workforce? Whether it’s clinical, whether it’s rev cycle. Whoever it is, how can they show appreciation in a meaningful way?

Hamilton: Well, like you said, I think in this current environment, healthcare workers in particular have had an extra burden, right, of going through COVID and taking care of the very ill in our society and community. So I was thinking about this, and I’ve asked a number of leaders what they’re doing, and I think the first thing I would say is, ask your people what would be meaningful to them. Because there’s a lot of information out there about flexibility in the workplace and we’ve all done this as leaders, for example, where putting happy hours on the calendar and asking everyone to participate because we think they’re engaging them, we’ve done a lot of things as leaders that we have tried to see if we can engage people in that way. But I think the thing maybe we haven’t done enough of is asking people, what would help you? Be a good listener. Have the ear towards what do people want and need. Maybe they actually need to get off an hour earlier on a regular basis. Maybe they need to adjust their hours, and again, healthcare is challenging because clinicians are face to face with patients for the most part. And it is challenging, but that doesn’t mean we shouldn’t ask our people what do they need, what would help them. They’re suffering from burnout and stress more so maybe than other industries. And that would be my first suggestion.

Grotto: What are some ways that leaders can engage staff members in feedback just about the way things go in their jobs?

Hamilton: It’s challenging for sure for the leaders who have very large teams. I would say a couple of things that I’ve seen through my career, and I have personally been involved in that I think worked well. Especially in healthcare, and I’ve seen this with leaders, where they do have, almost like when you’re in school and your teacher has open office hours kind of thing. It’s a little bit along those lines, and typically what I’ve seen in healthcare, hospital systems, has been, a leader maybe brings their big team—let’s say they have a couple hundred people—they schedule a one-hour a quarter where everyone comes together who can come into the room at that time and then typically in healthcare it’s a 7 a.m. or 7 p.m. But allowing the opportunities for people to see their leader, hear from their leader, ask questions. They typically call it like an open forum. Physicians do this all the time. They have their open forums and continuing education type of things happening. That does really help because it’s really hard. You can’t have one on ones with 500 people, but you could have an open forum for one hour or 30 minutes every quarter so that people have an opportunity. They can submit questions ahead of time. They can ask questions in the moment. So I would say that’s probably the most important thing, give people the opportunity to see you and talk to you and ask questions. One thing I was going to mention was this McKinsey study that just happened, they published it in July, a global study that they did, and this was a statistic that really shocked me. Forty percent of the people that were part of the study said they were considering leaving their job in the next 3-6 months, which is a lot, right, 2 out of 5 people. That was very interesting to me, and the top, I’m going to say four reasons, because we’re talking about leadership and meaning, the first one is lack of career advancement, development and advancement. The second one is compensation, but the third one is uninspiring leaders. So I think speaks a lot to what we’re talking about, which is, how do you engage with your team, how are you visible, how do you support them. You have to ask them what they need. Those kinds of things. And the fourth one is lack of meaningful work. The thing about healthcare and the reason I stayed in healthcare for so long was, there was a lot of meaning for me personally and for all, I think, people that work in healthcare were taking care of other people. There’s a lot of meaning there, but we want to know that our leaders also feel like they care about what we’re going through. And it’s not enough to say, I’m a healthcare provider. It’s, I need leadership who’s going to support me in all the things I’m dealing with in my life.

Grotto: I’ve definitely heard more than once, people don’t leave their job, they leave their manager.

Hamilton: That’s true.

Grotto: Yeah.

Hamilton: I would say the same.

Grotto: Yeah.

Hamilton: When we think about people’s career path and what’s happening now post-pandemic and all the things and, this is a healthcare organization, and I know that they’re dealing with this even more significantly dealing with COVID and the ramifications of it. But I think it’s still important for everyone to understand these reasons why people are leaving that are different than what they were prior to COVID. And the fact that the career development and advancement is No. 1 speaks to what we just spoke about here a couple of minutes ago around leaders needing to engage with their people and ask them what do they want, what do they need, how can I as your leader support you in getting that, even if it means a year from now you’re going to step out and go do something different. The reality of this whole situation is, people are doing that anyway, so you might as well help your people, grow them, advance their skills. They’re going to be a better employee for you in the moment, and overall, everyone’s going to just be happier, have better energy.

Grotto: A lot of good food for thought here for the leaders out there listening. Lot of good food for thought for somebody who might be looking for a new opportunity or considering looking for a new opportunity. Maybe you’re rethinking what you want to do and where you want to go. So Julie Hamilton, thank you so much for sharing these thoughts with me.

Hamilton: Yes, thank you Erika for having me. I’m so grateful. It was great.

Grotto: Voices in Healthcare Finance is a production of the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Sound editing is by Linda Chandler. Brad Dennison is the director of content strategy. Our president and CEO is Joe Fifer. If you’d like a transcript of any of our episodes, they’re available at hfma.org. Just click on podcasts and find the episode you’re looking for. And if you want to talk to our team, we want to talk to you too. Reach out at [email protected].

Career development in a strained workforce

As healthcare is hit hard by workforce shortages, financial constraints and changing expectations on the part of workers and leaders, the industry struggles to find solutions. According to Julie Hamilton, a career transition and leadership coach with nearly 30 years in healthcare, leaders need to find new ways to listen to and support staff.

Many workers are dissatisfied with their jobs because of lack of development and advancement opportunities, she said.

“Either they’re leaving a place they’re unhappy with and they want to find something more empowering and more meaningful to them,” she said. “And then there are people who … have been somewhere for a long time and they’re just not seeing advancement opportunities, and their leadership isn’t helping them navigate that.”

Listening posts

Hamilton had advice for both leaders and staff members who wanted to have better conversations about career development and advancement.

1. Performance reviews. Regular meetings to discuss an employee’s work also can be an opportunity to ask about what work they enjoy and want to do more of, or what skills they want to focus on. It also can be a good time for staff members to bring up these topics.
2. Job interviews. Workers considering a new position [at another company] should ask questions to determine whether a job is the right fit. Hamilton encourages people to ask questions about company culture and consider how much of the job will be tasks and responsibilities they enjoy, rather than focusing only on title and compensation.
3. Office hours. Hamilton recommends leaders have regular times on the calendar to meet with employees either one on one or as a group (depending on the size of the staff) to listen to concerns and recommendations for improvement.