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In Change Management, High Stakes, J|Insights, Quick Think

Arnold and the Art of Capturing Attention

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: Arnold Schwarzenegger speaks to Russians in emotional plea against war in Ukraine

A masterclass in communications.

The headline tells you exactly what happened late last week. But it comes nowhere near capturing the why, the how, the pure power of one public figure wading with deep authenticity into geopolitics. But powerful it was. Catching our attention. Holding us rapt. Moving us.

Watch it twice. Once to feel it. And then again to understand how it works.

We’re witnessing an extraordinary moment of powerful communications and communicators.

Russia’s brutal invasion of Ukraine has unleashed a parallel communications battle the likes of which we haven’t seen in this generation and which is beyond the scope of our weekly Quick Think. No surprise if textbooks are written about the situation, featuring, among other things:

  • The eloquent, razor-sharp messages – delivered through words and deeds – of Ukraine President Volodymyr Zelensky.
  • The harnessing of social media for “You Are There” journalism and “Are You Really There?” manipulation.
  • The Orwellian efforts by Russia to change the narrative against a sea of troubles, to block a tide of digital and tragically tangible information that cannot be denied.

But for today, we look at a single example from someone whose career trajectory broadly mirrors that of Zelensky – from kitschy actor to prominent politician. That training alone is worth noting when it comes to communications.

Outlandishly long in our distracted age of no attention spans, Arnold Schwarzenegger’s unexpected video – viewed by more than 30 million watchers within in 24 hours of its release – speaks directly to the people of Russia. We’ve captured several outstanding aspects of his compelling, at times personal message. If you take away just one thing, let it be this: The messenger must match the moment. Nothing brings home profound facts and difficult calls to action more than clear-eyed honesty and personal stories well and sincerely told.

Beyond that, a bit of video analysis…

  • It’s built for maximum reach. Schwarzenegger starts by telegraphing a basic communications principle. He says that he’s posting the video on multiple channels to make it as accessible as possible. It’s also subtitled in both Russian and English.
  • It’s built to target specific audiences. Difficult to pull off in a single piece, Schwarzenegger speaks sequentially to Russian soldiers, Russian citizens and Russian leaders – and then even more directly to Putin. The core message remains consistent as the specifics are adjusted for the audience. And in doing so, he is never manipulative. He tells viewers exactly who he’s speaking to – no games, no obfuscation, full transparency.
  • It’s direct about the goal from the start. Schwarzenegger begins by looking into the camera and giving a personal message to the people of Russia, expresses his life-long connection and affection for them, and then explaining where he’s going with it all. The environment is set to emphasize the directness and empathy: a tight shot of him at a table with a sober, but soft, expression.
  • It’s anchored by stories. After his intro, Schwarzenegger tells a story about his connection with Russia and the conflict that connection caused between him and his father – because of his father’s own painful connection to Russia from World War II. Throughout the remaining minutes, he continues to weave in personal stories.
  • It establishes credibility and rapport. Before detailing how the Russian people have been lied to, Schwarzenegger says, “No one likes to hear something critical of their government. But…as a longtime friend of the Russian people, I hope you will hear what I have to say.” By this point he’s already demonstrated his affinity for those very people. He also points out his consistency. He’s not targeting Russians but is “speaking with the same heartfelt concern” that he did to Americans after January 6, 2021.
  • It points no fingers (except at Putin and the Kremlin). He is surgically careful to separate the people to whom he is speaking from their leaders. He is explicit that they are not to blame. On the contrary, he assures them they have been misled. In effect, he comes alongside them with an arm around the shoulder rather than facing them down.
  • It’s methodical. Schwarzenegger knocks down the major points of current Kremlin propaganda one at a time. The Russian people, he said, have been told the invasion is a rescue operation to de-Nazify Ukraine. “This is not true,” he intones. He states facts and frames them with stories. Not only is Ukraine not being led by Nazis, but the current president is a Jew “whose father’s three brothers were all murdered by the Nazis.”
  • It offers emotional context for facts. For example, he shares the fact that civilian centers have been targeted and backs it up with the emotional stories and images from the deaths of mothers and children in the maternity hospital bombing. Even relatively dry data is given emotional weight. He doesn’t just say that the UN has condemned Russia. He adds that 141 members voted against Russia – with only four voting in favor.
  • It includes clear calls to action. Schwarzenegger asks the various audiences to understand they’re being fed propaganda and to consider that what he says is the reality. He asks people to spread the truth. He asks soldiers to consider the effects of the action they’ve been told to take. More than 11 million Russians have family connections to Ukraine and so, “Every bullet you shoot, you shoot a brother or sister.” He calls on Putin, by name, to end the invasion. But for every viewer, an unspoken challenge is clear: Now that you know, what will you do?
  • It ends with words of support and encouragement. To those Russians who have protested and spoken out he says, “The world has seen your bravery. You are my new heroes.” It’s true, and it helps the medicine go down.

A masterclass indeed.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think

The Quick Think: Engage Your Readers With This One Simple Trick

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

A good Monday morning to you: Today’s Quick Think is 773 words, a 3-minute read.

1 Big Thing: Axios Wants Us to Read Everything in Bullet Points

A four-year-old media company has risen rapidly to provide excellent reporting in an ultra-consistent, bullet-based format that is arguably changing the way we look at our inbox.

  • Katie Robertson, writing an Axios-style article in The New York Times, says, “The company’s executives think its short-format writing will build back trust in the media among busy audiences and can teach corporate America to quit its long-winded jargon.”

Why it matters: because in true absurdist fashion it gives us an excuse to pile on and, like the Times, pay our own homage to the newsletter phenomenon sweeping our inboxes. Seriously, we just checked our subscriptions and came up with Axios AM, Axios PM, Axios Vitals, Axios Sports and Axios Nashville. Not to mention competitors Morning Brew and 1440 Digest.

Why it really matters: Because the Axios style of communication works, and we see it every day with clients. Lament short attention spans all you want, but tight prose and well-written bullets are extraordinarily effective at getting the point across.

What’s happening: The rise of sound-bite newsletters is one of two things, or more likely a bit of both.

  • It’s the latest signal in the ongoing evolution of how America consumes media – short and sweet, but with rock-solid reporting behind the tiny word counts and templated format to capture our ever more fragmented attention.
  • It’s a market response to the interest people have in consuming a lot of information. Axios is communicating in a way that their audience tells them they want, but, impressively, with both high volume and a commitment to quality on every level from national to local.

Between the lines: During the pandemic, we observed – and may have occasionally participated in – the overwriting of a lot of content.

  • Provider organizations were trying hard to get large volumes of rapidly evolving, complex information out their communities.
  • Confusion and skepticism led many to use a lot of words. It’s very difficult to explain in soundbites how pandemics progress, or how a virus functions, or why we need the vast majority of the population to get vaccinated.
  • “During the pandemic we may have overcorrected from the Twitter approach and now we’re seeing a swing back to the middle,” mused our CEO David Jarrard. 

Reality check: The Axios model provides lessons for healthcare marcom, as well.

  • When navigating any kind of change, offer consistent, concise information through channels that your audience is already connected with.
  • That means building FAQ and toolkits your team can adapt with the details of any given situation, and then delivering those messages through email, posters, direct voicemail, townhalls, etc.
  • The ultimate goal is to give just enough detail to get the point across and drive a desired action. Then, if people want more or you need to backstop with additional data or context, you can point them to supporting long-form material – in Axios’ case, “Go Deeper.”

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Special Report, Strategic Positioning

Special Report: Recruitment Starts with Retention

“Mom, today I found out how I can own my own store.”

Was that the first thing you said as a teenager coming home after your first day of your first job slinging guacamole at a fast-food restaurant? Nope? Wasn’t for us either.

But that did happen to a teen whose orientation at Chipotle included a pathway to go from line crew to store manager to franchisee. And what a profound lesson for healthcare organizations struggling with staffing, said Dan Collard, co-founder of Healthcare Plus Solutions Group, who recently shared the story with us.

As Collard sees it: Recruitment starts with retention when companies give employees a reason to stay and grow.

Healthcare’s persistent workforce shortage is one of the industry’s most daunting issues right now. Everything’s on the table: large sign-on bonuses, retention bonuses, raises as everyone competes to staff up, whatever it takes. Many, especially rural hospitals, are barely hanging on. A few numbers to illustrate the point:

BY THE NUMBERS

96

Rural hospitals having difficulty filling nursing roles

11

Increase in salaries and benefits reported by HCA in 2021

54%

Rural hospitals significantly increased reliance on travel nurses

75

Nurse leaders citing employee emotional health as key concern

We all know the problem illustrated by those numbers. But how did it get so complicated?

Social context. The great resignation is affecting every facet of the workforce, with retention of hourly employees particularly tenuous.

Damsky

Expectations for greater pay, better benefits, improved work-life balance, career development opportunities and a desire for a better connection with employers are leading employees to push for change and/or leave their position in pursuit of it. Nurses, techs and shared services employees are expressing those same expectations but with the added layer of the intensity of their work.

Different process. “How people are going about getting talent has evolved as nursing recruitment has been empowered by technology. That’s making it more costly and more competitive,” said Pamela Damsky, director and Performance Practice co-lead at Chartis.

Jung

Jeffrey Jung, engagement manager at Chartis, pointed to the rapid rise of placement firms and “matchmaking technologies” that help connect provider organizations with talent. Jung said the matchmaking software can increase the speed at which a nurse can be placed and make better matches on the front end to boost retention. “It’s cheaper than just using placement firms because of the technology, but the overall cost is increasing because there are so many more applicants being hired,” he said.

Jennifer O’Meara, senior digital strategist at digital marketing firm Eruptr,

O’Meara

said the recruitment campaigns her firm ran online before COVID-19 tended to be “as needed” and focused on RN recruitment. Now though, Eruptr is involved in comprehensive recruitment campaigns that run constantly across platforms. Budgets, she said, “are double and triple what we were running previously, and it’s not just SEM, it’s Facebook, it’s Instagram, it’s display ads, it’s YouTube… it’s everything.”

More competition. Atop increased cost due to shifting talent acquisition processes is the pressure to raise compensation through bonuses and higher salaries to compete with other organizations in the market for a smaller and, perhaps, more selective talent pool. Hospitals are vying for the same nurses and trying to fend off the travel firms. At the same time, nurses and other staff have far more options, with outpatient clinics and health services companies delivering outstanding care and offering attractive careers.

Frayed relationships. The pandemic has accelerated a breakdown between title bands. Leaders are working to keep the whole operation running, staff are keeping things clean and caring for patients, managers are liaising between the two. Nurses aren’t happy. They’re being asked to do more with less. The LinkedIn post from nurse Kelly Fassold illustrates it well. Fassold compellingly expresses the anger many nurses feel towards administration, regulators, hospital groups and anyone else trying to codify salary caps – or even just discuss nurse compensation. The relationship between administration and staff is broken, and nurses feel like they are – or actually are – on the outside looking in as discussions about their value take place. It understandably leads to the sentiment of being both disrespected and undervalued. “You’ve left us out of the conversation and you don’t understand what we do so how can you tell us what we’re worth?”

Surviving then solving the nursing shortage

The healthcare staffing crisis isn’t intractable, but it’s not going to be solved in the short term. Right now, healthcare execs and HR teams are doing whatever is necessary to have just enough staff on shift to deliver care. Whatever it takes. That only adds to the unsustainable feedback loop and the feeling that we’re in the middle of a land grab, making it that much harder to plan for the long term. But plan we must. In fact, we must redesign the whole thing.

To do that, we have to establish the environment for long-term change to take root. First, a few thoughts on the tactics hospitals and health systems can employ.

Current Tactics for Recruitment & Retention

Hospitals and health systems are activating a variety of strategies to staunch the bleeding of the workforce crisis. We’ve curated a list of short and long-term interventions in force today and arranged them by feasibility for different types of provider organizations. After all, very few health systems have the financial wherewithal to buy a nursing school the way HCA did with Galen College of Nursing nearly three years ago.

Remember that nursing challenges arise indirectly as well when other areas of the organization break down. Take environmental services. When that department is understaffed, nurses end up with additional responsibilities because who else will change the linens? It’s more rocks in the nurses’ backpack.

Collard referenced a health system that was struggling with retention among environmental services and other support staff. Leadership changed the employee onboarding process so that, instead of following up with new techs after 30 and 90 days, those conversations happened on days one and two. That kept new hires engaged and allowed managers to uncover questions and problems instantly rather than letting them fester, improving the likelihood that the individual would stick around.

Again, wise to stay vigilant on the indirect disruptions that spill over onto nurses and address them promptly.

Building a culture of retention

Our experts agree there’s no easy solution, and the hard, sustainable solutions involve completely rethinking how we deliver care. But then they cite something that absolutely can be accomplished: building a culture that makes people want to stay. And when people stick around, you save on acquisition and training costs, maintain workforce stability and naturally gain advocates who may recruit others.

But O’Meara cautioned: “If you have to talk so much about culture and sell people on it when recruiting, do you really have a good culture to begin with? Is that culture reflected once you get past the advertising and the recruiters who make you feel so great about everything? Is it reflected once a new hire gets into the clinical setting?”

When you look up “employee retention” on stock photography sites, this is a lot of what you’ll find. But this represents a “what not to do” approach.

Professional development

Collard

Back to guacamole. After telling the story of the young man’s first day at Chipotle, Collard drew the contrast with healthcare organizations. “On Day One, we’re more interested in getting people set up with their password for the electronic medical record and showing them which gloves to wear,” he said.

In the push to get people working on their floor as quickly as possible, there are so many priorities to check off the orientation list that nothing is a priority. In contrast, Collard asked rhetorically, what if hospitals were more like Chipotle? “What would it be like if we began to engage our clinical staff on the day they started?” He mentioned research findings that indicate nearly four of five millennials will take a job with lower pay if it’s a job they feel connected with and that provides them a clear career path. It’s not always about the money. (Although yes, the Chipotle post below does feature the money along with the career trajectory.)

Jung emphasized this point, too, but with less avocado and red onion. Before COVID-19 there was less enthusiasm for bringing in a new graduate “because they require so much hands-on involvement,” as he put it. That hesitancy to hire novice nurses and techs is changing, and what’s becoming important now for retention in a smaller labor pool is giving people a clear pathway to move and grow.

Carter

A specific example of this in healthcare comes from Dawn Carter, a veteran healthcare strategist and founding member of the Rural Healthcare Initiative. She said that from the moment they initially consider a healthcare career throughout their time with an organization, people need to see how they can grow in their job or grow into another one. Hospitals that are already helping finance additional technical/educational investments have a massive leg up – they should do everything to make those opportunities known.

Carter cited a speaker from the 2022 South Carolina Hospital Association meeting who suggested hospitals ensure that high school students understand the low-cost path to a high-paying job. Someone paying two years of technical college tuition and coming out of it with an RN can enter the market making $60,000, but there’s the potential for $200,000+ by pursuing a CRNA.

Another example? Take the entry-level hospital employees working in “central sterile” cleaning surgical equipment. The skill level is such that they could work at an Amazon warehouse for more money and skip the dirty equipment. Hospitals, Jung said, can and should create a defined career ladder for techs. Many techs are in nursing school, and if you create those relationships and provide the opportunities, they’ll eventually want to come back or continue employment when they graduate, he said. “It’s the difference between a very transactional, ‘We need you here’ and a relational, ‘We’re going to invest in you – and we’d love for you to go back to school,’” he said.

Nurse-manager relationships

Go back to that LinkedIn post above. The post, and several comments below it, are built on the idea that unless someone has done the job they can’t know what it’s worth. It’s a push against salary caps, but it also reveals the significant gap between the suits and the scrubs. And it’s a fair point. The system is broken, staff see their census and patient acuity steadily increasing and the message many hear from managers and administration is a combination of, “Keep going,” and, “We can’t give you what you want.”

But again, sometimes what people want isn’t necessarily money. “We need to be sure we have salaries that match the market, but it’s more than dollars,” Damsky said. “It’s also treating nurses with respect and meeting their needs and creating an environment where they want to be.”

Carter highlighted the desperate need for leaders to spend time with staff, having heartfelt conversations about what they’re experiencing and humbly – not defensively – discussing leadership’s position on the issues and the various imperatives they’re balancing.

Sometimes it’s effective for managers and executives to share their own stories. We’ve heard from clients whose leadership spoke during town hall meetings about their toughest moments during the pandemic. Showing that level of vulnerability was powerful and helped dampen some of the tension that had been building.

Note that these conversations shouldn’t be used as distractions from or substitutes for practical interventions. They should be a supplement, a way to both solicit helpful information about what staff need and to demonstrate that the organization is working towards a collective solution.

Leadership development

Over the past couple of years, particularly during the omicron surge, we’ve seen an increase in non-clinical staff stepping in to help fill gaps. There are stories of managers running to get blankets, leaders helping empty trash. It’s certainly not happening everywhere or all the time, but more frequently than ever before.

That’s all well and good…but interestingly, our experts noted that it’s not necessarily the best thing. Plugging holes is an important crisis response and it’s great for showing staff that leadership is engaged, willing to do whatever it takes. Even so, there are drawbacks. “Leaders have been rolling up their sleeves and diving in,” Collard noted. “If I’m in that position, it means I’m spending less time leading and more time doing on the unit.”

Reconsidering Compensation

NOT EVERYONE WANTS TO BE A TRAVEL NURSE

— Nurse A 🖤🩺 (@Nurse_Lyss) February 5, 2022

We reference compensation throughout this piece and noted that it’s not always about the money. Two reasons for that:

  • First, the key thing organizations should be providing people with is an environment that attracts them and keeps them engaged. Which, again, isn’t to say that our industry shouldn’t be taking a long hard look at financial compensation.
  • Second, the current money isn’t sustainable – for anyone, but especially rural and independent facilities. The key is remembering that different people want different things, and any given organization can highlight the things it offers that will be attractive to someone, if not everyone.

 

According to Eruptr’s Jennifer O’Meara, hospitals in bigger cities with more competitive markets are relying more on bonuses and the financial incentives, while rural facilities and systems lacking competition but without the financial wherewithal are focusing on the intangibles. Think quality and cost of living. She said that in many recruitment campaigns there’s less emphasis on the standard “great culture” line and “a big push in online campaigns and in discussions about how making this move can be better for your quality of life.”

Cessna

Joel Cessna, Eruptr’s vice president of sales pointed out another example of alternative compensation for rural locations and those that can’t compete financially: creative benefits packages. For example, five weeks of vacation vs. three. “That’s a critical thing nurses are looking for, especially when you think about the exhaustion and burnout today,” he said.

Organizations need to find ways to get leadership out of staffing and back into leading, while equipping them to lead effectively. It’s the management version of practicing at the top of one’s license. It doesn’t mean someone never steps in to do something that isn’t in their job description. It means they’re doing their best so that they can help those in their care and on their team do their best.

“Leadership development becomes really important,” said Damsky. “It’s the thing that falls by the wayside because who has time for it?” There’s a cost when leadership development is put on the back burner and, conversely, a clear benefit when it’s maintained. Damsky mentioned a client who tracks employee engagement against their organizational development work. “They ask questions like, ‘Does my manager make me feel valued?’ and track that against staff turnover. They’re looking for negative correlation,” she said.

Helping staff feel valued involves moving leader rounding beyond checklists and perfunctory appearances. Collard said that it’s training leaders and giving them the space to have relationship-centric conversations. He said, “So when a leader says, ‘How are you doing?’ it means, ‘I’m not just asking, I’m really interested. It’s just me and you right now. How are you? What do you need?’” Collard cited a large medical center where a high-caliber ER nurse quit suddenly. When the team did some digging, they found out she hadn’t left for an agency to make more money. Instead, there were things at home affecting her ability to stay at the hospitals. Per Collard, the nurse executive said, “Oh my gosh, if we’d only known, we could have done something to help her!”

Eventually, healthcare provider organizations will be able to shift some of the focus from the crisis of filling shifts to the long-term structural change that will make staffing far easier. Many had laid such groundwork pre-COVID. And there is an array of remarkable health services companies rolling out software and innovative care models to solve the problem. Artificial intelligence, remote nursing, hospital at home, standardizing meal prep across a system, automated revenue cycle – everything that will put nurses and staff in a position to do what they do best and offload much of the rest.

We’re not there yet, but the foundation is in place and the frame is starting to take shape. In the meantime, provider organizations must step back to ensure that even as they continue the necessary scramble to fill shifts, they’re laying the groundwork. That means giving everyone in the organization permission and practical support to keep going. Starting on Day One.

A Note on Nursing Labor

Nurses unions have been talking about staffing levels and compensation for years. Now, the conversation has come to them. Hospital advocacy groups could push back saying that it didn’t make sense to implement rigid staffing requirements; organizations of different types and sizes and locations needed flexibility. But on the heels of the pandemic, staffing has become a core concern, both among the public and healthcare workers – a point proven by the most recent Jarrard Inc. national survey.

47

The public citing staffing shortages as a top concern

64

Healthcare workers citing staffing shortages as a top concern

In addition, the business side has come to the forefront, and with it a rising skepticism among nurses and staff about the intentions of their employers. Some feel organizations are holding patient care over nurses’ heads while, in the background, pushing the business forward. The response is essentially: “We can’t be the only ones carrying the weight of our mission. If you expect us to be the only mission-driven people, we’ll go travel or organize and strike.” In addition, the employee-manager relationship is starting to ring hollow. Historically, a core argument against organizing is that a union only adds complexity, getting in the way of those direct conversations. But more and more nurses are feeling – or recognizing – that they don’t actually have that relationship and their voice isn’t valued. In that case, they’re not giving anything up by bringing in a third party.

There’s no easy fix for provider organizations. The solution is long term – doing the slow, hard work of engaging employees, giving them a real voice in conversations and training leadership to lead effectively. Before making any statement about valuing nurses’ input or taking any action to ostensibly boost engagement, ask whether the move represents a true, long-term commitment or is simply lip service, an attempt at a quick fix. Worried about organized labor? Give people a way to not need that third party.

Questions about employee engagement? We can help.

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In Change Management, High Stakes, Quick Think

The Quick Think: The Lorax

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

2-minute read

The Big Story: Staffing overtakes financial challenges as top concern among hospital CEOs, survey finds

The workforce shortage is perhaps the biggest topic of conversation across the industry right now. While some providers and staffing agencies are offering large sign-on bonuses, others are going for retention bonuses and raises. Everyone is trying to staff up, whatever it takes. Many, especially but by no means exclusively rural hospitals, are barely hanging on.

What it Means for Our Healthcare System

Pandemic shortages accelerated the growth of temp and travel nursing, effectively changing the compensation model for RNs. That’s created a feedback loop where the shortage has become both cause and effect. Hospitals can’t maintain the tab for travel nurses – yet many can’t properly staff up without them. The jaw-dropping $40,000 signing bonuses are stopgap and not sustainable.

Dawn Carter, a veteran healthcare strategist and founding member of the Rural Healthcare Initiative, likened the situation to The Lorax, Dr. Seuss’ foray into environmentalism that describes the dangers of overusing a resource to the point that it disappears. We need nurses, and they deserve to be well-compensated. Full stop. It’s incumbent on us to design a system that allows that to happen. A system that sustains the forest.

While many are working feverishly to discern the long-term foundational changes necessary to compensate caregivers what they’re worth while keeping labor costs manageable, the land-grab nature of the current healthcare recruitment push continues. And it just might be catastrophic for smaller providers who can’t keep up.

We’re not parachuting in with 750 words to solve a very complex problem. But we do think Carter’s insight on how provider organizations, particularly rural and independent hospitals, might mitigate the damage now with their existing staff – is imminently shareable. Her suggestions cover both tactical interventions and messaging.

An extra week off. Literally, give your staff an extra week off. Maybe two. More hospitals are taking this approach because that time away may help with burnout and is a relatively low-cost benefit to the employee. Many hospitals are already offering other smart benefits – subsidizing gym memberships, meal delivery services and so on. But if we’re talking about people who are thinking about leaving, giving them extra space to recharge may be a wise step towards keeping them.

Professional development. What else can your employees do? Whatever it is, show them that. From the moment they first consider a healthcare career through their entire time with your organization, make clear the ways a team member can grow in the job or grow into another one. Many hospitals are already helping finance additional technical/educational investments. They should make those opportunities known.

Carter cited a speaker from last week’s South Carolina Hospital Association virtual meeting who suggested hospitals ensure that high school students understand the low-cost path to a high-paying job. Someone paying two years of technical college tuition and coming out of it with an RN can enter the market making $60,000, but there’s the potential for $200,000+ by pursuing a CRNA.

Clarity. Carter noted that much of the money paying for those stopgap measures like travel nurses is stopgap funding (federal stimulus and relief dollars). It’s temporary. This is an important point to make when addressing staff nurses who are justifiably frustrated seeing the compensation packages for their traveling peers while they’re receiving far lower raises/bonuses. Hard conversation, but it’s worth sitting down with staff to really talk about the current dynamics and explain why those levels of compensation aren’t sustainable as the one-time relief funds run out. Yes, you’ll still hear questions about why that one-time money is going to temps and not staff, but it will hopefully provide helpful context.

Connection with leadership. The critical message is that the core problem is a broken system, not uncaring leadership. This is no time to be defensive and complain about trying to operate a hospital in today’s brutal environment, especially with nurses who’ve been stretched beyond reason by the past two years. The point, rather, is to have deep, heartfelt conversations with staff about leadership’s position on the issues and the various imperatives they’re balancing.

To imbue those messages, Carter underscored the enduring value of leader rounding and one-on-ones. Find time to build relationships with staff, listen to their concerns and show genuine humanity. Sometimes that means telling your own story, too. We’ve heard from clients whose leadership spoke during town hall meetings about their toughest moments during the pandemic. Showing that level of vulnerability was powerful and helped dampen some of the tension that had been building.

Note that these conversations shouldn’t be used as distractions from or substitutes for practical interventions. They should be a supplement, a way to both solicit helpful information about what staff need and to demonstrate that you and the organization are working towards a collective solution.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

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In Change Management, High Stakes, Quick Think

The Quick Think: Nursing Gigs and Workplace Culture

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

3-minute read

The Big Story: The gig economy is trying to solve health care’s burnout crisis

Nursing on demand? Is it shape of things to come?

Startups are building platforms to plug nurses looking for shifts into organizations with shifts to fill. Sorta like if you needed a ride and there was an app to connect you to a driver. (Someone should look into that.)

Point is, tech platforms can ostensibly help organizations staff up to the levels they need while giving nurses more control over where and when they work.

What It Means for Provider Organizations

Seeing caregivers leave for more flexible roles is one of many things putting a pit in the stomachs of healthcare executives. It’s painful for acute care providers, yet the idea of a nursing gig economy makes a lot of sense when we look at the convergence of two ongoing trends. And the ball is in organizations’ court to respond in a way that attracts, retains and supports those looking for more control.

We know nurses are burned out. Many feel disconnected from their employers. And 40 percent of healthcare workers employed within a health system don’t see that environment as their ideal. Instead, they’d prefer travel nursing, health tech, maybe even those enticing flexible gig jobs.

We also know hospitals are getting flak for being greedy Big Business. A recent New York Times video blames the deficit of hospital caregivers on hospitals’ intentional understaffing to increase their margins. These examples go right to the heart of what our research shows is a perceived gap between hospitals’ missions and their approaches to the business of healthcare. And that gap is part symptom and part source of the unsettled workforce.

When it comes to nurses, the problem is that if you can’t give these thoughtful, mission-oriented individuals an environment where they feel supported, connected or even sure that you’re prioritizing patients over money then they’ll look to leave for higher pay, a more comfortable work environment or both. Who wouldn’t?

This presents a brilliant opportunity for health services and health tech companies. If healthcare workers aren’t sure a big hospital is their ideal, then other types of providers can that professional home. Which means that today the competition between provider organizations is real and, unfortunately, there’s a zero-sum element to the whole thing.

Question is: How can we use this great reshuffling and try to get away from a zero-sum recruiting battle? Can we better support caregivers and help the right people land in the right roles, whether that’s at a huge national system or an innovative specialty clinic?

We think so, and the approach is right up Marcom’s alley:

Build personas. Consider the people you need in those nursing roles and who might want them. Younger nurses may be harder for hospitals to recruit now if they’re not tied to one place and would like to travel and make more money while doing it? Others may relish an exciting stint as a staff nurse in your level one trauma unit. Nurses with families or later in their career may be looking for the stability and consistency. Different personas are looking for different things. Know what those things are.

Learn about preferences. The best way to find out exactly what people are looking for is to ask. Yes, money may be one of the things that comes up, and it’s fair to note the discrepancy between a staff nurse’s hourly pay and that of the travel nurse filling a vacancy in the next room. But it’s not always money. We’ve heard from health systems that, based on their surveys, what employees are looking for is relatively simple. They want to be heard and recognized for the work they do. And they want to know what’s going on with the organization. Yes, financial compensation is sometimes part of it, but not all.

Show what you can offer those targeted personas. Maybe it’s the benefits and career advancement available in a large system. Or the entrepreneurial vibe and relative independence of a young health services company. Highlight how you’re unique and speak directly to those who find those characteristics compelling. Basic marketing.

Solidify your culture. Concurrent with your recruiting efforts, reinforce your good culture so current employees stay and newcomers join – and stay. You can’t fake culture. For hospitals, that means not just paying lip service to something like “having a direct relationship with our nurses.” It’s actually having a direct relationship with nurses and being able to point to exactly how you’re doing it.

A note on sustainability: Building meaningful culture requires talking and listening to employees on a regular basis. It entails aligning your recruiting and HR efforts. Organizations with success in their staffing campaigns have a chief nursing officer working closely with HR and the strategy team. With the reality of limited resources, efficiency will be a watchword in healthcare going forward. Make sure you’re aligning everyone towards the common goal of staffing.

Want more? Listen to partner Kim Fox and senior vice president Tim Stewart discuss culture and communications in our latest podcast.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Strategic Positioning

Special Report: Aligning Needs, the Sound of Silence and Healthcare Predictions for 2022

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Try and predict the future? It’s exactly what we all do in mid-December.

This week, we checked around with friends in our network for their takes on 2022. Friends from investing, legal, a hospital association, strategy and planning and rural healthcare.

We asked them about challenges, investing, partnerships, trust, the media – and what gets them up in the morning when they think about healthcare.

Notice that we don’t quote our clients – healthcare providers. They’re impossibly covered up and looking towards another tough year, so it’s just not a great time to bring out the crystal ball.

Several clear themes emerged. Full quotes from the interviewees follow the themes section.

Staffing alarm bells are ringing. The cost of labor is going to put a crimp on provider operations, with unsustainable travel nursing rates on one side and healthcare workers leaving (due to burnout or mandates) on the other.

Behavioral health will be a point of emphasis. The pandemic laid bare what many in the mental/behavioral health space had long been saying: Our system of caring for behavioral health isn’t good enough. Several respondents market this space as one to watch in 2022.

Technology is poised for a breakthrough. More AI, more digital tools, more ways for patients to engage with providers on both their physical and mental health needs. At the same time, technologies that saw significant growth during the pandemic – most notably telehealth – will be reassessed to bring them back in line with a more natural, sustainable level. All of this came with the caveats that 1) regulation needs to keep up and 2) we need to see proof from the many digital health companies that have taken significant investment in recent years.

Value is coming (finally?). Value showed up as both a challenge and recipient of big investment. Partnerships that advance value-based arrangements also got a nod. Now that more primary care groups have waded into value and taken on more risk, expect to see the same for specialty practices.

The sound of silence. Just as interesting as what was said might be what wasn’t. While no providers were officially interviewed, we understand from our client base that following two incredibly challenging years in the trenches, no one’s really comfortable looking into the crystal ball at year three. Providers quietly tell us it’s going to be a very tough year for them, with ongoing uncertainty. That caution and concern is a theme in and of itself.

Transparency matters in all respects. Respondents who addressed “building trust” synced on this: Communicate, and do it clearly. Be open about pricing (and not just because CMS said so).

Care models must shift. We mentioned telehealth above. Hospital at home also got a shoutout. All told, a combination of better technology, patient expectations, the steady march towards value and the influx of investment for new entrants is pushing care out of hospitals and into, well, anywhere else.

Payer-Provider relationships will thaw. Multiple respondents suggested that payer-provider partnerships will be successful contributors to the move towards value. The implication seems obvious: Delivering the care and paying for it in the most efficient way will force collaboration between often antagonistic stakeholders. As Jesse Neil of Waller put it, “The traditional ‘zero-sum’ relationship has changed.”

Needs are aligning. Dawn Carter, founder and senior partner at Ascendient, summed it up well with a story about robots delivering food in a restaurant due to workforce shortages. It’s an anecdote that demonstrates how a reduced pool of labor, improved technology and the need for reduced cost and streamlined operations can flow towards a single solution.

Dawn Carter

FOUNDER & SENIOR PARTNER

Ascendient

Where do you think the biggest investments will be made?

Non-traditional sites of care, such as hospital@home and more virtual/high-tech options. I’m hearing more and more conversations about addressing behavioral health, particularly in light of how the pandemic has exacerbated what was already not working.

What will be the biggest driver of change for healthcare?

  • Workforce challenges, which should be driving innovation. There was a recent news story about a robot delivering food in a restaurant because of staff shortages…That technology has been developed in less than two years. We are woefully behind in healthcare in terms of using AI/technology to reduce our dependence on humans.
  • Payors – public and private – with a continued push to true value-based payment models, including CMS’ goal for all beneficiaries to be in value models by 2030.

What are you most excited about for our industry in 2022?

Opportunity is ripe for extreme innovation. Who will step out of a traditionally-minded industry and take advantage?

What's the biggest challenge facing healthcare providers?

Dawn Carter

FOUNDER & SENIOR PARTNER

Ascendient

 

Human resources, particularly retaining sufficient levels of direct care providers. Premium pay for a high percentage of travel clinicians is not sustainable, yet the pandemic has exhausted the workforce, particularly nurses. I recently heard of an RN in her early 30s who has worked a COVID unit at an academic medical center since the start of the pandemic. She’s leaving because she can’t do it anymore and is taking a job working from home.

Eller Kelliher

MANAGING DIRECTOR

Jumpstart Foundry

What's the biggest challenge facing healthcare providers?

No question, it’s talent recruitment and retention. Nurse and physician burnout has been an issue facing the healthcare industry for many years, however, the COVID-19 pandemic (starting to turn endemic) has put further strain on individual providers. Whether it’s doctors, nurses or administrators, this challenge is top of everyone’s mind.

Where do you think the biggest investments will be made?

  • The biggest investments will be in technology that optimizes and extends the efforts of existing personnel. There has been a massive flood of capital into digital health/healthcare IT in the last year and I believe we’ll continue to see investors fueling innovation.

What will be the biggest driver of change for healthcare?

COVID-19 changed the way that individual patients engage with their providers and in some ways empowered them to take a front seat role in their own health decisions. That said, I believe evolving payer-provider relationships and their incentive to drive utilization will be a major force for change in the industry. It will shift not only how care is delivered, but also the roles each party plays in the overall system.

Where do you think we’ll see the most / most successful partnerships?

Over time, I think we will continue to see the industry move towards stronger payer-provider relationships. However, I’m particularly excited and bullish on the idea of retail brands – who have built a lot of trust with consumers – partnering with providers to drive both access and engagement with hard to reach patient populations. Retail brands have the opportunity to impact accessibility, affordability, and possibly even adherence. (Think of how much power brands have in influencing consumer behavior!)

What’s the one thing healthcare organizations should do to build trust with patients and the public?

Be transparent with patients and treat them like consumers who have CHOICE. This is something I’m hopeful for in 2022, but know will likely take years for the industry to actually implement.

What impact, if any, has the media had on healthcare in 2021?

It’s hard not to say that the media continues to drive division and skepticism in our country. However, as it relates to healthcare, I believe the media helped facilitate the adoption of new models of care and certainly the acceptance of telemedicine as a trusted option for care.

What are you most excited about for our industry in 2022?

We all know that the healthcare industry is slow to change, but the pace of innovation has never felt faster or more urgent than it does now. I’m excited to see how the dynamic between payer, provider, and patient shifts in 2022 and how willing each party will be in the change that seems inevitable and, frankly, needed.

Pete Lawson

CEO

Lawson & Associates

What's the biggest challenge facing healthcare providers?

Staffing a facility has always been a difficult, but necessary challenge. It was surprising that some health systems were so quick to lay off workers during a shortage. This was compounded by inevitable lawsuits against the Executive Branch vaccine mandate. In 2022 and beyond I think systems will wait for the legal dust to settle before jumping the gun.

Where do you think the biggest investments will be made?

In terms of the most common investments, we’ll see IT expansion and upgrades. Relative to the most significant cost, it’ll be hospitals investing more in ambulatory care.

What will be the biggest driver of change for healthcare?

Payment expansion for telehealth along with federal legislation allowing telehealth state to state.

Where do you think we’ll see the most / most successful partnerships?

Academic health systems and community hospitals.

What’s the one thing healthcare organizations should do to build trust with patients and the public?

Communicate regularly on staffing expansion and safety.

What impact, if any, has the media had on healthcare in 2021?

Continued expansion into telehealth, especially in the rural space.

Ken Marlow

PARTNER

K&L Gates

What's the biggest challenge facing healthcare providers?

Ongoing pandemic concerns and the incredible toll that the pandemic has placed on clinicians. There is a continued threat of variants that may be resistent to vaccines that will continue to place significant stress on health systems and further erode their revenues. Coupled with that will be a workforce that is burning out due to stress, mental and emotional fatigue and politicization of healthcare in what seems like an endless war against COVID.

Where do you think the biggest investments will be made?

Over the past few years, we have seen an increase in the number of megamergers of regional/national health systems, as well as an increase in the aggregate value of the combined health systems. We expect that this trend will continue as one of the biggest investments in healthcare. In addition, expect to see a tidal wave of investments in digital health and artificial intelligence.

What will be the biggest driver of change for healthcare?

The consumerization of healthcare. Patients now more than ever have a voice in their healthcare, and that is requiring providers to respond to patient demands, whether in terms of the site of care, the manner in which a patient receives care or transparency in pricing. In addition, these expectations are now bringing new and nontraditional entrants into the market, and they are further driving change.

Where do you think we’ll see the most / most successful partnerships?

Healthcare organizations should collaborate with community partners that are representative of the different constituents within the community. This will allow for advancements in combating healthcare inequities. As part of this collaboration, healthcare providers should listen and take constructive feedback from their community partners and use this information to enact positive change.

What are you most excited about for our industry in 2022?

Historically, the healthcare industry has been slow to adopt change, even when change was clearly required and long overdue. We are now in an era of change that is occurring at lightning speed, and it’s exciting to see the advancements in how care is delivered, the use of technology and AI to create better clinical outcomes and provide for a better patient experience, recognition of social determinants of health and the role it plays in an individual’s health outcomes. In the midst of incredible adversity, our industry has worked collaboratively to save lives and in the process make considerable advancements, and I’m looking forward to seeing the evolution of changes in 2022.

Jesse Neil

PARTNER

Waller

What's the biggest challenge facing healthcare providers?

The uncertainty around the demand and permissibility of telehealth services is a wildcard for 2022. It’s no secret that physicians’ use of telehealth increased dramatically during the COVID-19 pandemic in 2020—jumping from 25 percent of physicians in 2018 to almost 80 percent of physicians in 2020, according to the American Medical Association. While some heralded the trend as a new day in healthcare, a closer look shows that telehealth use may continue to flourish in some limited areas, such as mental health or chronic care management, but that overall usage rates may settle back into more normal levels. Additionally, many of the emergency telehealth rules put in place during the pandemic have expired—meaning that many states will need to make regulatory changes to allow for the continued widespread use of telehealth services.

Where do you think the biggest investments will be made?

Collaboration with other providers has become an important tool for healthcare companies across the care spectrum, and that remains the case as we approach 2022. Valuations are strong across the board, and behavioral health, telehealth, dental and healthcare IT are of particular interest for private equity firms and other investors. Sellers are commanding higher valuations as a result of increased competition between buyers. An increase in home-based services has also been an area of increased valuations and interest, as has the orthopedic space, which notably leads the way in the shift toward value-based care among physician practices.

What will be the biggest driver of change for healthcare?

Providers, operators, investors, and policymakers agree that home-based healthcare options are transforming how healthcare is delivered and the economics that drive it. Regardless of the specialty, care at home implicates a discrete set of local, state and federal legal issues. At the same time, the regulations have not fully caught up with the various business models being adopted, and CMS and states are actively experimenting with waivers, pilot programs, and new reimbursement methodologies. Anticipating this trend, we have seen increased investment by providers, payors, and private equity firms into both provider platforms and technology companies that facilitate care at home.

Where do you think we’ll see the most / most successful partnerships?

The traditional “zero-sum” relationship between providers and payers has changed and they are no longer in their own silos. Post-acute care providers are likely to find ways to leverage clinical excellence to partner with payers and assume up- and down-side risk under value-based arrangements.

What’s the one thing healthcare organizations should do to build trust with patients and the public?

Carefully-calibrated transparency across the board but in particular clinical outcomes and pricing.

What impact, if any, has the media had on healthcare in 2021?

I can’t remember a year where the media had a bigger impact on healthcare than 2021 – except perhaps 2020. I think policymakers are realizing that the media is one of the most important stakeholders when executing on public health initiatives. I don’t think any agency or media outlet has found the “secret sauce” but that responsible media coverage will be rewarded in the end.

What are you most excited about for our industry in 2022?

Providers are actively experimenting with the new value-based regulations to take advantage of the added flexibility. If our healthcare system is equipped to do anything, it is to innovate in terms of technology and, increasingly, delivery models. I’m excited to see patients reap the benefit. Getting healthcare spending on a sustainable path is one of the biggest domestic public policy challenges we have in front of us, and these new regulations are a step in the right direction.

Shawn Rossi

VICE PRESIDENT OF COMMUNICATION & MEMBER ENGAGEMENT

Mississippi Hospital Association

What's the biggest challenge facing healthcare providers?

Nursing shortages

Where do you think the biggest investments will be made?

Technology – specifically EHR APIs and telehealth

What will be the biggest driver of change for healthcare?

Workforce challenges

Where do you think we’ll see the most / most successful partnerships?

Wide-scale collaboration between payers and providers, community-based organizations and hospitals, and public health departments and hospitals.

What’s the one thing healthcare organizations should do to build trust with patients and the public?

A focus on the patient experience and health equity.

What impact, if any, has the media had on healthcare in 2021?

The media has both helped educate the public about COVID-19 and contributed to spreading misinformation. “Media” is too broad a term to consider as one these days with all of the niche news.

What are you most excited about for our industry in 2022?

A growing determination by hospitals to begin work on community health and affect social determinants of health.

 

What's the biggest challenge facing healthcare providers?

The biggest challenge facing healthcare providers in 2022 is a combination of a few factors:

  • Rapidly approaching compliance dates for rulemakings that have important implications for how hospitals do business;
  • The continued uncertainty surrounding the public health emergency; and
  • Diminishing public support for healthcare providers.

In many ways, regulators have returned to “business as usual,” with new or revised rules becoming effective in January 2022. However, healthcare providers are still experiencing waves of COVID, but this time with lower staffing rates and without the public support for healthcare heroes seen in 2020. In addition, many waivers that have been a lifeline to healthcare providers during the public health emergency (PHE) – from hospital at home services to the expansion of telehealth services – are at this time set to expire in January 2022, with little to no time built in for providers and their patients to gradually transition away from these flexibilities. While the PHE is likely to be extended, the pressure on healthcare providers – from staff nurses to the c-suite – to navigate such significant changes simultaneously while COVID measures are still very much in effect will be the biggest challenge for providers in the year ahead.

Where do you think the biggest investments will be made?

I expect to see investments in both organic and inorganic growth. With regard to organic growth, hospitals and health systems are focusing investment in services lines that have gained traction and reimbursement parity during the PHE. For example, hospital at home services, as well as digital health across practice areas – not just behavioral health, but also in areas in physical therapy and primary care. Wellness programs and wellness tools are also experiencing growth through commercial payer investment to help people take control of their own health beyond seeing their primary care providers. In general, areas that can empower patients to engage with their care and allow healthcare providers to provide much-needed care at lower costs are likely to win the year. In addition, many providers are “back on track” with regard to strategic acquisitions and affiliations in core business areas.

What will be the biggest driver of change for healthcare?

New market entrants and non-traditional players in healthcare will continue to be one of the biggest change drivers for healthcare in 2022. We’ve been following this trend for several years now and the past two years have underscored that the challenges facing healthcare and the demand for innovation are things that cannot be tackled in siloes. Perspectives from new healthcare entrants like retail and tech, the influx of funding from PE and VC investors, partnerships between traditional healthcare companies and new entrants, and collaborations between providers in different services areas or markets, are all drivers of change that will shape not just 2022, but the next several years in healthcare.

Where do you think we’ll see the most / most successful partnerships?

Some of the most successful partnerships will be ones that improve the patient care experience while seamlessly working within clinician workflows. Whether these partnerships are between “traditional” providers, or among traditional providers and parties from outside the healthcare space to launch something completely new, the successful ones will be where and the product or solution supports patients without overburdening clinicians, all while fitting within the complex healthcare regulatory landscape. It’s a tall order, but from what we’ve seen, parties are more than up to the challenge.

What are you most excited about for our industry in 2022?

Continuing to see what comes from the novel partnerships between hospitals and health systems and other market participants, as getting the best of both worlds working together on bold innovations is truly exciting.

Principal

Private Equity

What's the biggest challenge facing healthcare providers?

Increasing labor/other input costs and declining reimbursement. Providers will seek to adapt, and think this will accelerate a shift towards value-based arrangements to get paid for the value they deliver to patients and payers.

Where do you think the biggest investments will be made?

Specialty value-based care. As risk-bearing primary care groups seem to optimize their performance, there will be increasing focus on specialties and moving towards value-based care. Also much more focus on technology enabling provider groups and health systems to optimize performance and care delivery redesign.

What will be the biggest driver of change for healthcare?

A shift to value-based care over the next several years and its impact on improving patient experience and outcomes. Also expect to see more emphasis on preventative care versus reactive care.

Where do you think we’ll see the most / most successful partnerships?

Enablement of value-based care, with providers better enhancing payer-provider collaboration.

What’s the one thing healthcare organizations should do to build trust with patients and the public

Overcommunicate and be transparent.

What impact, if any, has the media had on healthcare in 2021?

The media has highlighted the importance of providers and the services they deliver and trust built between the public and healthcare providers. It will be important to expand on that over the next several years and elevate care delivery to meet and exceed consumer demand.

What are you most excited about for our industry in 2022?

Continued change that improves quality, reduces cost, and enhances the patient experience. Consumer expectations are increasing and we are being forced to keep up.

In Change Management, High Stakes, Issue Navigation, Quick Think

Bite Your Tongue or Speak Up?

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: The CEO “Talking Trap”

CEOs, you might want to bite your tongues.

A new survey from the Brunswick Group says you’re overestimating the necessity and effectiveness of your organization’s communication on social issues. Yes, there’s enormous pressure on organizations to respond to everything that’s happening. But doing so without careful consideration can come off to the public as inauthentic. “The effort may come from a place of earnest engagement, but it is not being perceived that way,” the report observes. So if you choose to talk the talk, your organization needs to walk the walk.

What it Means for Your Health System

For leaders, the decision to speak is fraught. The Brunswick Group refers to it as “the talking trap.”

Basically, while corporate intentions around speaking up on hot social issues may be well-intentioned, audiences are disregarding these efforts due to “the broad alienation that most Americans (Democrats and Republicans) feel toward people and institutions of power.” If communications about an issue are poorly received, there’s the potential for them to be reputationally harmful.

Yet at the same time, we know there are times when leaders do need to speak. That’s part of being a leader, isn’t it? And with everything going on in the world, the range of topics on which they might be asked to weigh in is wider than ever.

So then how to do it effectively? The Brunswick Group report closes with excellent general recommendations to avoid the talking trap. Read them all – after you finish this note with ideas tailored for healthcare leaders and marcom officials.

It all boils down to integrated communications, similar to integrated care teams. The core structural issue is to know who’s in what lane and to coordinate appropriately. When clinicians aren’t aligned, they step on each other’s toes, information gets lost and patient care suffers. Similarly, communications efforts can be derailed by too many people trying to offer their own version of the message or offer it at the wrong time. When dealing with sensitive topics like social issues, the results can be damaging.

Consider these steps to ensure your message is received with the authenticity intended.

  1. Speak well – within your lane. You and your organization are experts on healthcare, and the public does want to hear from you on the things you know. Previous Jarrard Inc. surveys have shown that the public expects providers to speak up on healthcare topics. So before getting deeply involved in a range of issues, ensure that you are clear and consistent, firm yet humble, on the topics directly related to your work. 
  2. Do well – within your lane. Back up your message with actions. Better yet, back up your actions with your message. The Brunswick Group emphasizes the importance of tangible and significant investment (financial or otherwise) in causes related to the issue. For hospitals, that’s likely community partnerships and charity care. It’s also your work to support employees, professional development opportunities, and defined, financially-backed programs to help close racial disparities within the organization. Your mission is strong, so make sure the work you do reflects it.
  3. Recognize that there is more than one lane. “Health” encompasses so many issues, and we’re seeing a growing conversation about how social issues are health issues. Granted, we just suggested building credibility by staying in your lane. But that’s a lot harder when your lane is very wide – or when there are multiple lanes. Basically, your team needs to define the terms and come to some internal consensus on how you view the continuum of health and the myriad factors that contribute to it.
  4. Define who can and should be speaking out in each lane. One way to handle the complexity and the expectations is pretty standard: Break the work up into manageable bites. Within your organization you have nurses, administrators, physicians, social workers, care navigators and so many others. Find the right individuals within these roles to talk about the issues most closely aligned with their work. Social workers can talk about mental health or homelessness. Leadership can talk about the delivery of care to different communities. With people in the right spot, there’s minimal stepping on toes.
  5. Coordinate, prepare and activate. Whether it’s one person who will be speaking or five, define the expectations. For example, what’s appropriate for people to say as representatives of your organization – versus on their own time? As always, bring in outside voices like community leaders to help inform your thinking on the issue and your approach. Set up mechanisms for feedback – even if it’s uncomfortable. That in itself goes a long way towards demonstrating your authenticity and commitment. Finally, go out and speak – humbly, kindly, quietly but firmly – acknowledging what you know to be true and what you’re still learning, as well as how you and your organization are responding.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think

One-to-One: Building Community & Pursuing Equity

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Read: Together – The Healing Power of Human Connection in a Sometimes Lonely World

We usually link to a quick article. But hey, we’re going into a holiday week so of course you have time to read a whole book, right? Surgeon General Vivek Murthy’s work, which was published last April, caught our attention as we’ve been thinking a lot about myriad issues that rise to the surface during the holidays – relationships and connection, equity, community and gratitude.

What it Means for Us

(a two-minute read)

Today we’re leaving the boardroom, C-suite and exam rooms.

Health and community belong to all of us. We frequently talk about social determinants and what can be done at the institutional level. Moving into the holiday season, we’re reminded of the power of our individual, one-on-one actions to support others and our ability to directly impact – for better or worse – their health.

On paper, many of the issues facing healthcare seem disparate. But looking closer, the common thread is a need for human connection. Take the health system whose employees are burnt out and threatening to quit. Or the community hospital where marginalized populations have higher readmission rates – if they were able to access care in the first place. And then there’s the metro facility where food services employees feel left behind and look toward unionization. In each, a fundamental problem is that the people involved don’t feel seen or heard. So, the solution starts with the same first step: Listening in personal, thoughtful settings.

Healthcare inequity takes many forms: gender gaps, racial inequity, mental health stigma, socioeconomics, access to care and so much more. As we think about our personal role in solving inequities, we must first ask, “What’s the win?” How do I define progress? How do I build this human connection to understand the needs? Here’s a place to start:

  • Approach people with an authentic desire to build connection. What’s their story? What do they value, and what do they need from us to feel valued? We listen to understand, and we listen so others will feel seen and heard.
  • Elevate marginalized voices. Take what you learn from your conversations and bring it to those who have the agency and tools to drive change, whether it’s the CEO or employee supervisor or neighborhood group. Help them create structures that open two-way communications, dismantle communications barriers and empower the marginalized to be heard by those decision makers.
  • Partner with those affected by our decisions. People are more accepting of a decision or change when they feel heard, even if the change isn’t what they wanted. Moreover, without the input of those who are directly affected, there’s never a complete solution. Of course, no decision will satisfy everyone. But we can listen to every voice and let everyone feel heard and seen.
  • Remember that giving someone a voice doesn’t mean taking it away from others. We’re adding to the conversation and creating richer experiences for all. We’re widening our personal and institutional perspective so that we can find better solutions that benefit everyone.

Human-to-human connections have been devastated by almost two years of physical separation and growing polarization. We as individuals and as representatives of our various organizations need to be cultivating relationships between people, both for our sake and theirs. It’s a way to repair some of the damage of the past and the burnout many are feeling now.

We can’t solve every problem, the solutions to get better aren’t simple and we won’t please everyone. But we can make progress with people who are willing and eager to partner with us – if we give them the opportunity and are willing to partner with them. And that’s a win.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think, Strategic Positioning

Health, Not Healthcare

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: CVS Health Launches $25 Million Ad Campaign Focused on ‘Healthy’

The idea of “health” is too complicated, too fragmented. That isn’t going to work in an environment where expectations for simple, convenient and integrated experiences continue to grow. CVS is one example of a provider organization working to make health – and, by extension, the healthcare they provide – more accessible to patients consumers.

What it Means for Your Health System

“People often feel overwhelmed by the concept of ‘healthy.’”

Pause on that quote from the linked article, just for a moment.

Seriously. What the hell are we doing? We’ve overcomplicated healthcare to the point that people are “overwhelmed” by the idea of eating a salad and taking walking breaks. And they’re frustrated by it.

According to the latest American Consumer Satisfaction Index, healthcare – including ambulatory care, hospitals and insurance – retains the trust of the public but lags other industries in customer satisfaction. In fact, healthcare and hospitals reached their lowest index score in nearly two decades, per the study. (Health economist Jane Sarasohn-Kahn covered the study in a recent blog post worth reading.)

We all know consumers are frustrated by the fragmentation. Good news is that forward-thinking health enterprises are already bringing everything under one roof. That includes risk, care delivery, education, tech and health-related consumer goods.

And that’s why companies like CVS-Aetna are doing so well. They’re pushing hard on giving the public a reframed, integrated perspective on health while also finding the service lines and payment models to make it profitable. A retail chain buys a health insurance giant and now offers everything from urgent care to mental health services to renal care. And they’re marketing those services in a way that fits the customer journey.

Clever startups and health services companies are building technology platforms and care delivery models that are based on collaboration, interoperability and user experience.

On the business side, money and planning is going into integration so that control of the entire care continuum stays under that one roof. On Tuesday, Fierce Healthcare covered a recent survey from HFMA that found three-fifths of health systems are looking to bring more risk management in house by diving into Medicare Advantage. This approach, the article points out, parallels payers who have stepped into care delivery.

And finally, private equity has been – and looks ready to continue – pouring record money into healthcare in 2021. It’s a trend Paul Keckley reviews in his latest newsletter.

Time, energy and money are being deployed to integrate health(care). Each category of player has advantages in that work:

  • PE has money, operational acumen and enthusiasm – they don’t have to drive change, they get to.
  • Traditional providers have public trust based on proven expertise in care delivery and the medical acumen.
  • Startups and health services are quick, flexible and have fresh thinking on technology and patient experience.
  • Retail has consumer perspective and data, along with technological power. Moreover, people are already spending time in retail settings so it’s easy and familiar. And you can find a parking space at CVS.

There’s another fundamental difference that underpins the CVS ad campaign. Traditional healthcare providers see people as patients, whereas the new entrants and retail-based providers view them as consumer. Though hospitals are expanding beyond just offering sick care, the historical approach has been, “We know medicine. Come to us when you have a problem, we’ll take care of you.”

On the other hand, the underlying philosophy behind the CVS ad campaign is that a consumer-centric mindset puts more responsibility on people to care for themselves.

Whatever angle a provider organization is coming from, that patient-as-consumer must be the destination. Integrating the business and technology and risk management is the operational mechanism to do so, but the work must be built on a culture that prioritizes integration and experience.

Investor-backed providers have the flexibility of starting from scratch but lack the institutional knowledge; traditional providers have the institutional knowledge but have to retrofit the tools.

As you work to triangulate on the right solutions to streamline care and redefine “health,” here are some questions to ask about your organization’s culture in terms of innovation and integration to get the conversation rolling. These questions can lead to solutions that can help you render “health” an accessible concept, not one to fear.

  • Do you think about things like “integration” and “transparency” in the context of CMS or other regulation? Or in the context of patient and provider experience?
  • Do conversations about other categories of providers focus on how to defend against their encroachment or what can be learned from them?
  • Similarly, does your approach lend itself to collaboration and partnership? Or does it insulate your organization?
  • Do you check in regularly with clinical and back-office staff to learn about bottlenecks and hear their ideas?
  • Practically, are you integrating processes and software?
  • How long does it take you to test and evaluate a new system? Can you shorten that timeline?
  • As a health service company or startup, do you have a clear story to tell traditional providers about how you can support existing systems? Do you understand the constraints they’re under?
  • As a traditional provider, do you listen to the new entrants with an open mind rather than a concern about what can’t be done?
  • Do you have educational and marketing materials that simplify and humanize you to your patients and that put them at the center of the story?
  • Do you have people testing the experience patients and employees have when they interact with you?

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes, Quick Think, Strategic Positioning

Mad Dash to Digital Turns to a Trot

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: One big reason healthcare access is hard

“Healthcare brands invest enormous sums of money in marketing campaigns, websites, and apps that will never be effective until a consumer can overcome the data barriers to healthcare access.” And that deficit could have ripple effects as consumers get frustrated with providers.

What it Means for Your Health System

(2-minute read, 15-minute podcast)

Providers are juggling more challenges than ever… ICUs full of the unvaccinated. Media coverage of questionable billing practices. Disruptors from tech and retail growing their investments and pushing the envelope. The ongoing push-pull narrative regarding the effects of consolidation. Breaking through the perpetual avalanche of bad news to highlight the good is no easy task for marcom pros today.

The frustration builds when big-name companies without a history of delivering care get rosy headlines, while traditional providers face seemingly endless scrutiny from the media, regulators and parts of the public. Scrutiny – warranted or not – then leads people weary of traditional healthcare to look for someone else to do it better. Enter a company like Amazon, which fits the bill because it knows people, what they want and how to get it to them. Not because it “knows healthcare.”

Healthcare organizations are certainly aware of the challenge. Providers ramped up their use of digital tools last year, moving towards a more patient-friendly system out of necessity. But the advance has slowed, according to a recent study. Providers who lose momentum are not only missing out on a chance to streamline care, but also to counter some of the negative press pointing fingers at those delivering it.

So then how to flip the script? How do you leverage the current moment, building trust and telegraphing a better future? Here are six patient-friendly questions to ask your organization to help ID areas to bolster or to brag about:

  • How are you making it simpler to receive care? This covers tools to seek, schedule and manage care. It starts with the table stakes that so many patients complain about but few providers get right – basics like online scheduling tools and check-ins. It extends to back-office functions like billing processes that affect the underlying efficiency of patients’ care. Anything to cut down on the number of disparate tools and to better integrate those you need.
  • Where are you providing care? A silver lining to the pandemic? The rise of alternative models of care. However, that means programs like telehealth and ambulatory surgery centers are no longer differentiators in 2021. (Yep, back to table stakes.) You’ll need to push a lot further to show what’s unique about your version of those offerings. Now if your organization is one of the few which have ramped up “advanced” models like hospital-at-home or mobile care, talk about those. A lot.
  • How are you targeting care for your specific community? Put your marketing cap on for this. Depending on geography, infrastructure and patient demographics, the same tool could either help or hinder a patient’s trust and comfort. Telehealth can make sense for different reasons: time saved fighting traffic, ability to seek care when you don’t have access to transportation, ease in scheduling, expanded hours and more. And those reasons can vary for an urbanite, a rural dweller, a family with small children, an elderly person, a blue collar worker, etc. Your marketing should be precise in what it says and in exactly whom it is targeting. People will trust you more if they see you offering services and communicating in ways that work for them.
  • How are you making it simpler to understand care? People don’t trust what they can’t understand. Now is a good time to scrub your communications materials for simplicity and to clearly define terms. If you want to take it up a level, look at how your organization trains patient-facing staff to ensure they’re communicating clearly and simply with patients. Always be asking, “Are we talking to consumers in a way that helps them make a good decision quickly?”
  • How are you making the financial process easier? So much of the scrutiny of hospitals today comes from questionable or downright bad billing practices. Merely setting up a simple billing portal will not negate the previous damage caused by suing patients over unpaid bills. However, setting expectations early on about things like financial responsibilities and billing process, tools and options, will go a long way in avoiding situations that are traumatic to patients and reflect poorly on your organization. Work with your front office and rev cycle teams to educate patients on the finances of healthcare, offer proactive communications about what they could owe and yes, give them easy ways to pay.
  • How are you improving access and health equity? Your mission is to provide the best possible care for the people in your community, which means that in some way everything you do comes back to access and equity. People are paying more attention to the issue than ever before. So are you. So talk about it. Northwell Health, for example, highlighted the importance of its new partnership with Walgreens for health equity. Other benefits like efficiency and convenience were framed as contributors to access and equity, rather than standalone features. That’s a playbook worth copying.

Want more? Check out the 15-minute conversation with Reed Smith, Jarrard Inc.’s VP of Digital Services.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.