With increasing regularity, staffing shortages have adversely impacted the delivery of healthcare and the availability of diagnostic and therapeutic resources. The ongoing scarcity of employees negatively influences the quality and depth of many primary and support roles at every level throughout the healthcare workforce—including physicians, dentists, advanced practice clinicians, allied health professionals, practice assistants, and front- and back-office specialists. Staffing shortages, exacerbated in recent years by the pandemic, have also contributed to elevated levels of stress and burnout.
Factors Contributing to Staffing Shortages
Although shortfalls in team staffing have historically resulted from training program capacity, multiple factors in recent years have created challenges for employers in maintaining stable and fully functional operations.
Traditionally, disparities in compensation packages between urban and rural communities have created gaps in the nature and extent of services and staff available in a geographic location. Individuals will often leave a job for a position in a different location that pays better or offers more desirable benefits, such as continued professional training, more comprehensive onboarding education, access to networking opportunities through trade organizations, or even a friendlier working environment.
The world experienced a near-cataclysmic event with the advent of the coronavirus. Its rapid onset and spread to pandemic status presented extraordinary challenges in diagnosis and treatment, especially with the periodic evolution of new viral strains. The pandemic created a Herculean burden for the healthcare community that taxed resources and personnel.
Developing quarantine, testing, and treatment protocols required vast coordination and administration. The pandemic’s effects on practitioners were overwhelming as they attempted to cope with significantly increased workloads, implement the myriad office safety protocols recommended by the CDC and other authoritative or governmental sources, transition to virtual practice environments, and adjust to an often severe financial adversity created by the calamity. Not surprisingly, the pandemic escalated stress and burnout in the healthcare community, adding to the staffing crisis at every level.
The pandemic also created an operational quandary that has directly affected patient safety and quality of clinical outcomes. In-office safety procedures—such as maintaining social distancing, limiting seating capacity in reception areas, questioning patients prior to examination, and disinfecting common surfaces frequently—have generated delays in delivering efficient care. These actions also reduced the number of patients who could be treated each day, discouraged individuals (especially the elderly and underserved populations) from seeking medical attention, and produced friction within office settings that occasionally resulted in threats or acts of physical violence.
The situation has steadily improved with significantly enhanced testing technology, the development of new vaccines and treatment options, the implementation and acceptance of telehealth by the public and the medical community, better and more consistent messaging by government entities on best practices, and enhanced reimbursement by CMS and private third-party payers. Regardless of these advancements, many practitioners and staff retired or significantly reduced the volume and scope of services they offered or the amount of time spent working in an attempt to cope with the strain created by rapidly evolving conditions.
Patient Safety Strategies
Staffing shortages continue to jeopardize efforts to provide optimum healthcare services. What can be done to address this problem and ensure patient safety? No single easy answer exists. Consider the following strategies to help ease the problem and reduce stress among the healthcare team:
- Review and revise workflows to follow current recommendations on how to streamline office procedures for safe and efficient patient care. Consider operational improvements to reduce administrative tasks. (See our article, “The Patient Safety Risks of Burnout—and the Path to Professional Fulfillment.”)
- Explore innovative options for utilizing telehealth as a treatment alternative consistent with the licensing requirements imposed by state licensing boards for furnishing remote and interjurisdictional professional services. (See our Telehealth Resources.)
- Provide formal onboarding and orientation programs for temporary staff, locum tenens, and new hires. Assign mentors to new providers and staff.
- Provide continuing professional development opportunities. Implement cutting-edge in-house training and make programs from outside vendors available to improve employee satisfaction and skills. Survey staff regularly to assess ongoing needs as well as employee understanding and recommendations.
- Develop opportunities for promotion for each job category and promote advancement within the organization as a priority to retain highly skilled and motivated performers.
- Institute employee recognition programs (e.g., for making good catches), with rewards such as gift cards or movie tickets.
- Be proactive in surveying alternative compensation packages offered to support staff in the community. Packages may include competitive hourly wages or salaries. Provide salary adjustments, cost-of-living increases, or bonuses to help attract and keep employees.
- Support collaboration and input by everyone in the organization to foster an inclusive and Just Culture environment that promotes teamwork and blame-free reporting of adverse patient safety events.
- Introduce short daily meetings (briefs or team huddles) for planning purposes with set written agendas. Encourage open communication and candid discussions of operational processes. Promote active team member participation and enhance workplace camaraderie by soliciting and valuing team members’ opinions.
- Lead debriefs after errors and adverse events—without being judgmental or accusatory toward participants while advancing an atmosphere of collegiality, acceptance, and accountability. Ask “What went well/what didn’t go well?” and assign follow-up on identified system issues.
- Develop relationships with medical schools, nursing programs, and other healthcare training programs for recruitment and retention, as well as providing approved patient care during clinical rotations. Assessing the content of clinical rotations periodically will help ensure that best practices are implemented.
- Adjust staff schedules, rotate staff, and create internal float pools when feasible.
- Create clearly defined written policies and procedures for staff to follow when performing frequent practice tasks.
- Participate in and offer staff peer support and wellness programs, such as those available through professional organizations, healthcare insurance, or employee assistance plans.
- Conduct leadership rounds to promote visibility and support and to answer questions from staff.
Establishing a professional environment of patient-centered care that seeks optimum clinical results with an emphasis on employee satisfaction may significantly decrease the risks associated with staffing shortages and otherwise avoidable iatrogenic errors.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
Richard F. Cahill, JD, Vice President and Associate General Counsel, and Patti L. Ellis, RN, CPHRM, Patient Safety Risk Manager II, The Doctors Company.