Framing the Issue
With their immediate future dominated by patient satisfaction surveys, reducing readmissions, reporting on quality measures and coming to terms with new financial and payment realities, looking ahead to the year 2025 might seem like a luxury no hospital executive can afford. But at Lawrence (Kan.) Memorial Hospital, Chief Executive Officer Gene Meyer and his colleagues say gearing up for a dozen years from now is hardly a waste of time, especially when it comes to workforce issues.
With a flood of boomer retirements on the horizon, the hospital has launched an "emerging leaders" group for employees in their 20s and 30s. And it's positioning itself as a go-to place in the intensifying competition for primary care doctors. Every chance he gets, Meyer talks up projected vacancies to the 250 University of Kansas premed students who volunteer at his hospital every year.
In one telling sign of the changing times, Lawrence Memorial deliberately avoids meddling in employees' use of social media, even though all that Facebook and Twitter time can tax the hospital's bandwidth. "We're probably being more liberal [with social media policies] than we should," says Meyer. "But we've been reluctant to ban any of that simply because this is a way of life for so many of the folks who work for us."
Thinking ahead to a workforce that will look very different from today's is essential, says Jaciel Keltgen, a health care workplace consultant and assistant professor at Augustana College in South Dakota who specializes in hiring, training and retaining Millennial employees. By 2025, Millennials — a generation that currently ranges from middle school-age to their early 30s — will dominate the workforce, perhaps as much as 75 percent, according to a 2011 study by the Business and Professional Women's Foundation. The size of the Millennial generation is double that of its immediate predecessor, Generation X. And its members will be filling a gaping void left by retiring baby boomers.
Learning how to recruit and retain Millennials is "one more wrench thrown into the works" for hospital leaders already dealing with multifaceted disruption in their field, Keltgen says. Hospitals are "going to have to figure out what Millennials expect, and what they can do to attract them to their institutions and keep them there."
Human resource departments will have a lot of ground to cover in the coming years, acknowledges Stephanie Drake, executive director of the American Society for Healthcare Human Resources Administration. "They've started talking about how they're going to attract and retain Millennials," she says. "But no one's there by any means. And there really isn't a lot out there to guide them."
Jobs will change, too
There's one more factor that will complicate matters: Some significantly different kinds of skill sets will be needed to meet the demands of a transformed health care system.
The push toward patient-centered medical homes puts primary care front and center; to make up for the shortage of primary care physicians, the need for advanced practice nurses will surge. A July report in Medical Care predicted the number of nurse practitioner jobs will climb from 128,000 in 2008 to 244,000 in 2025.
Hospitals will be compelled to hire more community health care workers to increase outreach, promote wellness and reduce unnecessary emergency department visits and readmissions.
With population health a growing imperative, employees with expertise in data collection and analytics combined with an understanding of health care will be in high demand.
A mandate to keep patients out of the hospital and in their homes means clinical and nonclinical staff with advanced telehealth skills will be sought.
None of this takes into account the aging of the patient population and the need for many more staff members with geriatric training. Or advances in genomics to better predict disease and personalize treatments that will require a specialized knowledge base. Or the head-spinning advances in information technology that will continue to revolutionize health care in ways no one can precisely predict, but that somebody in the hospital had better be able to assess and, if appropriate, implement.
Rick Sherwood, a senior consultant at Towers Watson who advises health care clients, says the most desirable employees will be nimble in areas that in the past haven't been lumped together — for instance, having the clinical skills of a nurse, but also expertise in using electronic health records and handheld devices.
Because of the increasing complexity of health care as a business, Sherwood says managers will need training in skills borrowed from other industries, like Lean principles from manufacturing and management-consulting principles from financial services.
However, experts caution, before hospital executives decide to create new positions or redeploy staff for future contingencies, it would behoove them to understand how younger professionals differ from their elders temperamentally and otherwise, and how that will impact the organization in the future.
As noted in earlier installments of Hospitals & Health Networks' Generations in the Workplace series, Millennials tend to be hungry for praise, impatient with certain processes, superconnected to IT, eager to advance and insistent on a balance between their work and their personal lives. They will balk at long meetings and excessive paperwork. They will flout workplace rules they view as rigid and still in place "just because that's how we've always done it."
Not even the most hidebound hospital executive should be surprised to know that Millennials will look to IT to communicate with colleagues and patients, to place and fill medical orders, and to find answers to almost any question that may arise — even before they consult with their more experienced elders.
Social media is 'an everybody thing'
Jay Kuhns, the high-energy vice president of human resources at All Children's Hospital in Tampa, Fla., doesn't pretend to know what the health care workforce of 2025 will look like. But that doesn't mean he can't start preparing now.
Everyone talks about an ongoing nursing shortage in the next 10 years that only will become more dire. His take: "There are plenty of nurses. I just need to make sure they're working at my hospital."
The best way to get that done, Kuhns figures, is to make sure the right people bump into All Children's repeatedly on all the social media channels. And the content should be engaging — telling stories with words, photos and videos.
" 'Career-minded, self-starter,' " Kuhns scoffs, conjuring job board jargon. "That stuff just bores me to death."
At All Children's, a new nurse blogs about her experiences behind the scenes. The transport team writes a periodic series about their adventures. The hospital home page features "Shift Change," a one-minute video with action music that includes fast-paced scenes from a single day at All Children's mixed with shots of Central Florida night life and beach sunsets.
The hospital also has a Pinterest site that includes patient stories; a hip-hop hand-washing video produced internally that won a public service Emmy; and a picture of cute kids participating in the hospital-sponsored Walk to School Day.
Social media isn't a "young person's thing," Kuhns insists. "It's an everybody thing." Nevertheless, the hospital staff definitely skews young. Though Florida has the highest 65-and-older population in the country, the average age of an All Children's employee is in the low 40s right now, "and we continue to attract younger and younger employees," he says.
Hospitals also should bring social media into their internal communications strategy, says Jeanne Meister, a corporate consultant who writes about the future workplace for Forbes. For instance, a platform called Yammer allows administrators to quickly survey employees, lead discussions on creative solutions to problems, and find out how new vendors or hospital policies are working out.
"Companies are beginning to research different generations of employees the way they would research a new product or service," Meister says. "In many hospitals, they have a culture survey or a vision-and-values survey. One of the things they're starting to do is add a generation screen to understand the different needs for the delivery of training." There's less interest in classroom training among younger employees, she notes, and more use of mobile devices and online games as teaching tools.
All staffing needs are local
In northeastern Ohio, training a new generation of workers is especially challenging because more Millennials are moving out of the region than moving in, says Elliott Kellman, chief human resource officer for University Hospitals. "The statistics are working against us," he says. "Our population's getting older, not younger."
To keep their employee pipelines flowing, four competing hospital systems in Cleveland — UH, MetroHealth, the Cleveland Clinic and St. Vincent's — have struck up a collaboration. Using a $50,000 grant from a local foundation, they've hired a consultant to put together a report on what the future health care needs of the region will be and what the existing resources are at area colleges.
Once the report is complete, they'll partner with the colleges to make curriculum changes that better fit their needs. Two universities — Case Western Reserve and Cleveland State — already have signed on.
"If we're going to make this successful, we have to cooperate with the schools and cooperate with each other to grow the workforce for the future," Kellman says. "Our intention here is to do a good workforce assessment — not on 100 jobs, but get down to two or three or four jobs that we know are going to be in short supply."
The final results aren't in yet, but Kellman anticipates the most immediate need will be for advanced practice professionals, including physician's assistants and nurse practitioners.
UH also brought in a career coach to work with employees and increase internal hiring. "That Gen Y group — and it's not just entry-level employees — has no idea how to manage their careers, or write a resumé, or manage an interview," Kellman says.
In the year since the career coach signed on, internal hiring has increased by 198 jobs.
In Minneapolis, Fairview Health Services consults statewide demographic information compiled by the Minnesota Hospital Association to help determine the needs of its future workforce. Relying on self-reported information from 107 hospitals, the database tracks workers in 38 different job types. The findings can be eye-opening; for instance, in 10 job categories, more than 30 percent of workers are nearing retirement.
"This data can be really powerful because as a big system, and as a state, we can present the information to our college partners," says Laura Beeth, Fairview's director of talent acquisition. "So if we say, 'We're going to need more nurses,' we have concrete data so they can see how many slots they have to train and educate nurses."
How rewarding is a smoothie?
Hospitals may not have the glamour quotient of a DreamWorks Animation, where the workforce is 20 percent Millennials, the retention rate is 96 percent and juice trucks parked on campus hand out free smoothies. What they can offer Millennials is the chance to make a difference in a big way, says leadership consultant Erica Dhawan. "To actually connect hospitals together across the world and learn and share with each other — that would be something that would really excite Millennials, Dhawan says. "Or finding ways to use social technology to help solve problems and tell stories about patients. Or to connect with patients. That would excite Millennials."
Hospitals actually score well in a 2013 survey of 9,000 high school and college students and young professionals, conducted by the National Society of High School Scholars. When asked where they would most like to work, respondents gave health care organizations seven of the top 20 spots.
Mike Supple, senior vice president for B.E. Smith, a health care leadership recruiting firm, is optimistic about hospital management in 2025, with entrepreneurial Gen Xers running the show and plugged-in Millennials right behind in middle management positions. "It's a really nice combination of having both experience and youth to bring different innovations and efficiencies to the market," he says.
Andrew Chastain, managing partner of recruiting firm Witt/Kieffer, says, "There are stereotypes of [Gen Xers and Millennials], about their desire, their work ethics, their priorities. I don't run into that at all. People who have been successful are hardworking and stimulated by the industry they're in. They're no different than executives at that level 15 years ago."
Supple agrees. "It really is striking how similar these generations are in regard to what's important to them," he says. "They want opportunities for advancement. They want work that is challenging. They want opportunities to learn."
— Laura Putre is a freelance writer in Cleveland.
University Hospitals in Cleveland and Fairview Health Services in Minneapolis have campuses in neighborhoods where people are eager to work, but don't always have the necessary education. With training, they can be hired for entry-level positions and eventually go to college and move up within the hospital. Elliott Kellman, chief of human resource at UH, and Laura Beeth, director of talent acquisition at Fairview, shared some of their approaches to developing talent close to home.
What are some of the challenges you face?
Kellman: We find a lot of folks who are Gen Xers and Millennials, who want to go to school, and then they fail because they're not ready. We have a program called Bridge to Your Future in which we prepare people. One hundred and eighty-four employees have gone through the program; 51 have graduated from college and 27 found jobs at UH.
What sort of neighborhood outreach do you do?
Beeth: We start young. We have initiatives with high schools. We're the corporate sponsors for their health care programs. We also do community-type work. We have a weeklong health care scrubs camp for people who live in the neighborhood around our largest hospital. We have 74 people in it. They tour our facility, take classes and learn about the different health care professions. We offer a new program called Fellows for people in community colleges who may not have a clinical rotation but want to work in health care. Instead of working at McDonald's, they can work with us in more entry-level jobs until they finish their education.
How can workers move into more skilled positions?
Kellman: We have a program called Pathway to PCA specifically to move service workers into patient care positions. Ten employees have gone through that program. We also have GED classes and we're partnering with the Literacy Cooperative of Greater Cleveland to teach adult basic literacy. We've been trying for the past year and a half to get people to take the GED, then go to Bridge to Your Future, then go to our career coach.
Email? Facebook? That's Grandpa's social media
If they want to recruit younger employees, hospitals whose social media policy consists of posting on Facebook a few times a week will need to step it up, says Jill Schwieters, president of Pinstripe Healthcare, a talent management and recruiting firm. "We all need to learn how to communicate and interact with Millennials. These are young people who are used to talking with six different people while playing Xbox. This is a workforce that's been communicating on Facebook. They don't text anymore; they certainly don't send and receive emails. Everything's two- and three-word answers."
She advises hospitals not only to devote more resources to external social media, but to turn their gaze inward, as well, so people can communicate efficiently within the organization. "Look at internal communications and technologies that you're investing in, so you've got a platform where people can be communicating department to department or hospital to hospital," she says. "If you think about a health system, how many different departments, how many different hospitals, how many different venues will there actually be? You need to make sure you've got the right digital platform to support real-time accurate and effective communication. And as it advances, keep up with those advances."
What will social media comprise in 2025? With communication tools changing constantly and quickly, trying to foresee that is an exercise in futility, Schwieters says. "My son would say, 'Grandma ruined Facebook, so we're doing Instagram now.' "
She advises hospitals to stay connected to area colleges and bring young job interns into the organization to stay current. "Those will be the folks who keep you in sync with what the trends and the best modes of communication are," she says.