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In High Stakes, Issue Navigation, Quick Think

Speaking Up or Thoughtful Silence

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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 Note on Responding to Current Events, from CEO David Jarrard

2.5-minute read / 13-minute podcast

Do you weigh in as an organization?

It’s not a simple answer. It’s a challenge our clients have faced many times over the past two years as outlier events have swept across the globe. This is true again as Russia continues its brutal invasion of Ukraine. Our clients ask us: “Do we need to issue a statement? Can you help us create a message? We’re not sure what to say but we think we need to say something.”

The first question to ask: Why?

Thoughtful leaders want to acknowledge important moments. To take a stand. To show solidarity with those in trouble or in need. As you consider whether to do so for your organization, the answer may lie in how you’ve asked yourself the question. If you’ve asked, “Do I have to weigh in?” when no one is looking for your corporate position, then the answer is very likely “No.” But if circumstances or your mission call you to weigh in, the answer may well be “Yes.”

We all recognize that organizations speak with the greatest authority when the subject is aligned with their expertise and reputation. A healthcare organization opining about important healthcare issues is your natural lane (i.e. COVID vaccinations and health equity). It is expected that your organization would speak to these and other important matters; it’s desired and needed, in fact.

The further the subject strays from your organization’s mission and expertise – to national politics, for example, or events around the globe – the thread connecting the subject and your authority, credibility and relevance weakens. If you comment on one disconnected event to which you bring no authority, you create the expectation that you will be commenting on an array of disconnected matters in the future.

The cliché is true: If you have nothing to say, don’t say it.

But. But! Sometimes what may appear to be a distant matter is actually close to home. There may be local ties in your community that bring it to your doorstep. You may have a service providing care that is directly impacted by the issue. You may serve a community bound to the region affected. You may have staff personally affected by it. Then, the call to speak is strong, local and relevant.

Do you serve a Russian or Ukrainian community within your market? Do you have Russian or Ukrainian immigrants or their descendants working in your facilities? Do you have a unique service that offers aid to that war-torn region or even to others oppressed in or from violent areas? If yes, the call to speak – to make clear your position and expectations – is strong. In fact, you should.

There is a third scenario, one in which you don’t have a direct line to the situation but your heart and mission simply demand your voice. As you speak – and many will – we suggest you simply acknowledge the uniquely and tragically horrific circumstances that call for your voice so, again, you don’t find yourself expected to provide commentary on world events in the many days to come.

An unfortunate byproduct of the social media era is that everyone has an opinion on everything, and people, leaders and organizations often feel like they’re expected to say something. So they worry about getting called out if they don’t. It’s part of that social media hype chamber. If that’s you, and you’ve concluded that saying something isn’t necessary or directly connected to your mission, give yourself permission for intentional silence.

A final note: If someone does come after your organization on social media for not saying something, the best practice is to respond publicly while bringing the conversation offline. Reply, “Thanks for your feedback. I’d love to talk about this and hear your perspective. Can we set up a conversation?” The key is to be responsive and not react disproportionately.

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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 DigitaLee, High Stakes, Strategic Positioning

DigitaLee 2: YouTube for Healthcare and Social Media Polls on Twitter and LinkedIn

Orange text that reads "The Digital Future of Healthcare" with smaller text at the bottom saying "DigitaLee with Lee Aase" on a navy blue background

Welcome to DigitaLee: The home of digital and social media for healthcare.

We’ve partnered with Lee Aase, formerly of the Mayo Clinic and Mayo Clinic Social Media Network. He’s joining us every other week to look at the role of digital and social media in healthcare. Each week we’ll look at a news story related to healthcare social media, a digital platform healthcare providers should (or shouldn’t) consider, and a digital tip of the week.

Today we’ve got a story on how doctors use YouTube to connect with patients and work towards health equity, the value of YouTube as a platform for healthcare providers, and for our tip of the day it’s whether hospitals and physician practices should consider using Twitter and LinkedIn polls.

Listen and subscribe to the podcast or read the transcript below.

Read the Transcript

David Shifrin: This is DigitaLee from Jarrard, Phillips, Cate & Hancock. I’m David Shifrin.

Twice a month, we highlight the headlines, platforms and best practices in digital and social media that healthcare organizations need to keep up and –better yet – get ahead. Today, we’ve got a story on using YouTube to connect with patients to work towards health equity, the value of YouTube as a platform for healthcare providers, and for our tip of the day it’s Twitter and LinkedIn polls.

The news theme of the day is from an article in Business Insider. The title was, “This Doctor Says YouTube Is a Crucial Way That She Connects with Patients, Here Is Why.” So, with that clickbait headline, the point is that Dr. Lisa Fitzpatrick works in underserved communities trying to improve access and health equity and has found that YouTube is a powerful tool for approaching that work.

So, Lee, what was your take when you saw YouTube being considered as a platform for health equity?

Lee Aase: Yeah, I think YouTube is a platform for health equity and just general health information for people, because we’re talking about doctors who are the well-respected voice due to the fact that it says MD behind their name. People are trying to sort out: “What should I believe? What should I know?” What I found in my career at Mayo Clinic was that sometimes even the longer videos that were going into more depth on a topic could be among the most valuable ones because they’re really reaching people at their moment of need. They’re giving them that in-depth information that they really need about their condition. Being able to address commonly held questions and beliefs and being able to address them authoritatively is a great, scalable way to reach a lot more people who maybe wouldn’t even come into the doctor’s office regularly. But they find someone with whom they identify, with whom they resonate and can build up some trust. It’s a great way to get some good health messages to people who maybe otherwise wouldn’t darken the door of a medical office.

DS: Let’s keep going with something that you mentioned: The value of in-depth medical information, because that runs a little bit counter to so much of the marketing, communications, social media and digital principles where everybody’s talking about how attention spans are shorter than ever.

Normally, you have to keep it tight. What are you seeing when it comes to “in-depth?” How far can you go with that before you start to lose people?

LA: Yeah. I mean, attention spans are shorter when it’s something like a public health message because it’s something that’s intended for a mass audience. But, when you get a particular kind of sick, that’s all you care about. It’s something that you’d really like to hear about from someone who knows about it. Say, “How do I deal with acne?” or, “How do I deal with some other condition that’s affecting me?” So, the beauty of YouTube is that is the place where people can have essentially unlimited time to follow a bunny trail of information that relates to what they’re interested in, since YouTube also serves up related videos on those topics.

One of the better videos that we had in my Mayo Clinic days was 10 minutes, it was on a particular kind of cancer, a blood cancer, and it got tens of thousands of views. It wasn’t millions of views – it wasn’t funny cat video territory – but it was the right kind of patients or their family members who really had that as an interest to help them to better understand the condition.

DS: So that’s a perfect segue into the second part of this, which is looking at YouTube as a search engine. It’s about not just thinking about YouTube and kind of the news and trends, but also as the platform that we want to focus on here. YouTube is owned by Google, of course, and it is a massive, massive search engine – I believe it’s the second largest in the world.

So, when you’re in it, Lee, you just mentioned the ability to serve up related videos and content to whatever you happen to have pulled up in your initial search. Because it’s such a powerful place for people to go and look for information, what should providers be thinking about in terms of their strategy around using video and YouTube in particular, to make sure that they’re serving up the content that people need where they’re looking for it?

LA: I think one of the keys with YouTube is to be sure that you’re effectively using your titles and your descriptions, putting in captioning as you can, both for accessibility with ADA compliance, but also because it makes it easier. Doing so gives more terms to be found within search – so, titles and tags and descriptions.

It’s important to recognize that it’s the number two search engine owned by the number one search engine. When you’re searching on Google, one of the tabs is “Videos,” and for some things, the first thing that’s going to show up is a video.

It’s often geographically contextualized as well. So, some of the things that may be nearby would show up – there’s some geographic preference with it. I think you just need to be sure that you are not only communicating to humans in the video, but communicating to the algorithm by how you tag, describe and title the videos.

DS: Cool. Okay, thanks. Let’s move on to the tip of the day.

We’re going to switch platforms here and look at LinkedIn and Twitter polls. I’ve been seeing more and more of this. I think maybe it’s died off a little bit over the last couple of months – kind of tail end of the summer of 2021 – but lots of organizations and lots of people have been posting quick polls on LinkedIn and Twitter.

Anecdotally, I’ve seen this coming more from the marketing and businesspeople in my network than from the healthcare provider folks. But that said, I think we all have seen those, and we’ve all probably responded to them. Some of them are goofy, some of them are a little bit more serious.

I guess the simple question is, “Is that a useful tool for healthcare providers to be considering, or is it just yet another social media, digital fad that’s going to be gone in six minutes and we’ll all forget about it?”

LA: It all depends on what you’re trying to accomplish. I’ve seen some people use them for education. For example, where there is actually a right answer to the question and they’ll put up a quiz and then they’ll do a follow-up with the right answer, and then they can use it. That’s the educational perspective.

Now, Twitter does not represent the world, okay? It’s a subset of…

DS: Hold on, hang on, hang on. Whoa. Back up.

LA: Twitter is opinions. It’s especially the opinions of those who are posting. There is a distinct minority of people who do so much of the posting that they aren’t necessarily reflecting the rest of the user base and Twitter users in and of themselves. It’s a distinct subset of the country, of the world. And so, Twitter polls are certainly not a scientific representation of what people really think.

However, probably, you get more engagement among the regular lurkers on social media and on Twitter in a Twitter poll. Because it’s anonymous, people can vote what they really think versus what they are supposed to think. If you reply to a comment, your name can be traced to what you’re saying versus on Twitter the poll, where the responses are anonymous.

I think depending on what you’re trying to accomplish, it can be helpful. I also think that LinkedIn polls are probably more reliable because they’re less susceptible to some kind of an organized, “Okay, somebody put up a poll and I’m gonna torture them with the answer that they didn’t want.”

That has been known to happen definitely on Twitter, for sure.

DS: Alright, I think we’ll call it good there.

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In High Stakes, Issue Navigation, Quick Think

The Quick Think: Command Stations on Tax Exemptions

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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: Not-for-profit hospitals don’t earn tax exemptions, researchers say

“Not-for-profit and for-profit hospitals report similar levels of unreimbursed Medicaid costs even though not-for-profits receive billions of dollars a year in tax subsidies, new research shows.”

Key graf: “’The nonprofit hospitals have not done enough to deserve their tax subsidy,’ said Ge Bai, an accounting professor at Johns Hopkins University and lead author of the study. ‘Taxpayers subsidize hospitals to help struggling, working-class Americans, but many nonprofits are not doing enough.’”

What it Means for Health Systems

Another brick pulled out of the wall.

Hospital critics have picked up another powerful, compelling dataset in the national campaign to paint hospitals as Big Business more focused on profits than on care. Painful though it may be to hear, the Modern Healthcare article is a strong piece about the situation some hospitals across America find themselves in. Even our own research shows that just 41 percent of people strongly feel their hospital is a good community partner. In addition, these situations signal the expectations among the public and state and local regulators about where those community benefit tax-equivalent dollars are spent. In short, they want to see more than just sponsoring the local minor league baseball team.

This conversation isn’t going away. The Big Business narrative will continue to build momentum if hospitals don’t tell their own story, are unable to or, worst of all, have a story that doesn’t line up with the reality.

Two things to bear in mind about these articles:

  • There’s a careful, data-driven and emotionally charged campaign by critics seeking to pin the blame for our dysfunctional healthcare system squarely on hospitals.
  • There’s misalignment within hospitals in getting their mission-driven story across the finish line and making sure their words are backed up by their actions. The door to criticism is cracked open when there are disconnects between different departments and different initiatives. And – critically – between the different levels of the organization to identify problems and ensure that every move made is in service to the mission. Hospital critics then shove that door wide open, leading to Congressional hearings and class action lawsuits.

So here’s our advice this week:

Check your story. Now – Put time on your calendar to have a real conversation. Soon.

  • Non-profit hospital or health system execs – Connect with your marcom, finance and clinical leadership to compare notes about how your organization is talking about the work it’s doing in the community and how that lines up with what it’s actually doing in the community. And is it what the community actually needs? Baseball team sponsorship vs. affordable housing. Your call.
  • Marcom leaders – Initiate that same conversation with your colleagues and C-suite.
  • For-profit leaders – Sure, the tax-exempt piece won’t apply, but that doesn’t mean you should miss the chance to review where and how your charity care and other community benefits are delivered. You, too, have a mission and a story…and critics.
  • Health services company execs – Bring your leadership team around the table to discuss ways that you’re giving back and aligning ops with mission. You may not be under the gun for IRS status, but, like the for-profit crew, it’s still worth taking a look. Private healthcare companies, particularly those backed by private equity, are taking hits as well.
  • Healthcare attorneys – On your next call with a non-profit hospital or health system client, ask them if they’re checking their story. Encourage them to think beyond compliance and consider the whole picture around charity care and tax-exempt status as a function of their mission.
  • Strategy or operations consultants – Ask how the project at hand fits into the mission to care for your client’s community. Ask your client to review the numbers and projections and then work with marcom to align those outcomes to the story they need to tell.

The knives are out, the narrative has taken shape and the numbers very often don’t look great. It’s not a time to spin and, frankly, even if you wanted to it’s not going to work anymore. It’s a time to buckle down and get it right, to match the desired outcome with the actual outcome, to match the stated mission and the desire and passion of you and your team and your clinicians and staff with the way care is delivered – both medically and financially.

After those conversations, get ahead. What’s interesting about the tax-exempt line of attack is that there’s no mention of outcomes. The criticism is purely financial. The push from critics as currently constructed is to spend the money, not to spend the money and achieve <X>. So that’s a fantastic opportunity for provider organizations. Align on where the money is going – get clear on charity care and all the rest – and then talk about how you’re not just spending it but also moving the needle towards better outcomes and equity. “Our critics say we don’t spend enough in the right places. We’re not just spending it but investing it in our community, and here are the returns.” That’s a winning, mission-driven message to leapfrog the Big Business naysayers. Just make sure it’s true.

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 DigitaLee, High Stakes, Strategic Positioning

DigitaLee 1: Finding Health Information on Social Media, Clubhouse and Effective Healthcare Social Media Policies

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Welcome to DigitaLee: The home of digital and social media for healthcare.

We’ve partnered with Lee Aase, formerly of the Mayo Clinic and Mayo Clinic Social Media Network. He’s joining us every other week to look at the role of digital and social media in healthcare. Each week we’ll look at a news story related to healthcare social media, a digital platform healthcare providers should (or shouldn’t) consider, and a digital tip of the week.

Today we’re covering a story about the use of social media for finding health information, an overview of the audio platform Clubhouse, and considerations for how hospitals, health systems, doctor’s offices and health services companies can build a good social media policy.

Listen and subscribe to the podcast or read the transcript below.

Read the Transcript

David Shifrin: This is DigitaLee from Jarrard, Phillips, Cate & Hancock. I’m David Shifrin. This is our first real episode. So, if you stumbled in here and are wondering what it’s about, please check out the intro, episode zero, on whatever platform you’re listening on now. In short, we’ve got Lee Aase, a pioneer in digital and social media for healthcare who just retired from more than two decades at the Mayo Clinic, among other positions. Every other week, Lee and I will review three things: a trend or headline related to digital healthcare, a social media platform, and then a quick tip for healthcare Marcom and digital teams. Today, we’re covering a story about the use of social media for finding health information, an overview of the audio platform, Clubhouse, and considerations for building a good social media policy.

All right. So let’s kick this thing off with our first news story, an article from Forbes saying that one in ten Americans turn to social media for health information. I’m going to bias the conversation a little bit before I kick it over to you, Lee, by saying that I was really surprised that the number was only one in ten, only about 10%. I would have guessed, I don’t know, 40% maybe? But what’s your reaction to the rise of social media as a health information platform?

Lee Aase: Yeah, well, I think you need to put it in context that in the survey of a thousand patients like me, they found only 16% went to traditional news.

So, if you’re only at 16% for traditional news, the fact that you’re at 11% for social media isn’t that far behind. They did see that Google and disease and condition sites like WebMD and Mayoclinic.org, were kind of in that 30%-ish range, 30, 35%.

So, I think the reality is that people don’t go to social media, they go to their friends. It isn’t like social media in general, but they’re looking at what did the people that they connect with on social media have to say? So I think that’s the question: Who do they really trust?

And I think we’ve seen a declining trust in some of the various news outlets that has probably brought that down. I probably would have been predisposed to think it would, that number would be for social media going in, but I think what we’ve kind of just generally seen in society is kind of a breakdown in who your trusted source is.

DS: The participation versus trust gets to another finding in there, where they found only 2% of people actually trust social media. Nine or eleven, depending on which number you’re looking at, go to social media for information, but only 2% trust it. So, that implies that it’s exploratory.

All right. Let’s turn our attention to the platform of the week or whatever we want to call this thing. There’s a new-ish, I guess it’s really not that new at this point, but still, a relatively obscure platform called Clubhouse, which is essentially live audio rooms. And I think it’s become more popular among business types over the last year or so, it’s a different way for folks to engage.

But because we are starting to see more folks bring up the idea of this interactive audio approach rather than either live chats or text-based social media. Should healthcare providers be paying attention to Clubhouse? And if so, why?

LA: Yeah, Clubhouse is a really neat platform. Twitter Spaces is an analogous platform within the Twitter universe. The whole idea behind it is it’s live interactive audio chats that instead of just listening to a recording (for the most part), you’re able to interact directly with people. Compared to regular, old-fashioned Twitter chats where people are texting, where anybody can run into the conversation, they’re much more moderated and orderly. I think there’s been a lot of growth. I think Clubhouse had a good strategy when they made the platform invitation-only at first to give it a more consistent user experience and make it feel somewhat exclusive.

That way, people had to get an invitation to be able to join, and so they perhaps valued it more.

DS: So, my first Gmail address.

LA: Like that! Or, The Facebook back in the day, you know? Because it was somewhat exclusive, it was kind of a cool thing to get an invitation, to be able to participate in it.

I have found for a lot of the same reasons that people use podcasts, and where there’s been this resurgence in podcasts as led by Joe Rogan and then so many others after that, where the fact that you can multi-task by listening and driving is a great advantage. Also, you can listen to a podcast on something of very personal interest and go into it in great depth. Likewise, some of these Clubhouse chats can go on for half an hour, forty-five minutes, maybe even an hour where you’re having a conversation and it’s moderated by leaders who are inviting people in to share their perspective.

So, it isn’t as noisy. It’s got audio, but it’s not as noisy as a Twitter chat where anybody can use the hashtag and jump in with a point.

DS: Should providers be considering using this for, a weekly health chat and getting their physicians out in the world? Or is there relevance for Marcom teams?

LA: I think there’s something to be explored there to at least test it, to see how it works in your particular context. One of the beauties of it is that, unlike Zoom, Facebook Live, or some of the other platforms that include video, there just isn’t as much production.

It can be much more informal. You can just do it with a smartphone because that’s the only way you can do it. You don’t have to be worried about hair and makeup and lighting; you can be focusing much more on the nature of the content of the conversation without having to worry about some of the aesthetics. It’s kind of like video killed the radio star, you know, back in the day.

This is sort of like the radio stars’ revenge.

DS: All right, let’s move on to the final section. We’ll get better titles for each of these sections. Tip of the day. With so much happening around nurses and doctors getting more involved in talking about their field, work, and what they’re seeing within the four walls of their facility, there is much more noise and, frankly, anger on social media, on all sides.

Consequently, it’s a really good time to be evaluating your social media policy.

What are one or two key tips for a good, strong social media policy for a healthcare provider when they’re looking to ensure that their employees are staying in line without stifling the conversation?

LA: I definitely agree with wanting to facilitate it and make it encouraging, and putting up guardrails instead of roadblocks. I think the other one of the other elements is just to make sure that you’re legal with it. A lot of times people will want to put in a policy that says, you can’t say anything bad about our organization online that reflects poorly on us. The National Labor Relations Board has said that concerted efforts and discussions around wages, hours, and working conditions are protected speech and you need to guard people’s ability to do that. So, you have to realize that there will be the good with the bad, but that you can have standards for professionalism and for mutual respect.

That rule applies whether people are on duty or off. I think the other part of it is effective communication of the policy, and that the idea isn’t to be a “Gotcha!” thing. It isn’t, “Oh, good, we can fire you.” It’s, “How do we keep people out of the ditch. How do we keep people from doing things that will reflect poorly on the organization?”

It just isn’t good practice – they get into a heated discussion and they kind of spout off on something. It’s important just to be in front of people, to be giving them guidance with examples of the kinds of things that they can do and should do, then the things that they would be best to avoid. Training and education, I think, are the really key elements.

DS: Alright, well, thanks. First episode, first conversation, in the books.

LA: Magically edited to sound super smart!

DS: You know, that’s what I do.

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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 High Stakes, Issue Navigation, Quick Think

The Quick Think: Without Merit

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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 / 20-minute podcast

The Big Story: Brian Flores sues NFL, three teams as former Miami Dolphins coach alleges racism in hiring practices

The recently-fired head coach of the Miami Dolphins just rocked the sports world with a class action lawsuit alleging systemic racism, disparate hiring practices and incentivizing losing. The NFL came back with a near-instant response saying that Flores’ accusations were “without merit.” Dolphins owner Stephen Ross has responded with a statement that includes the very legal terminology of “false, malicious and defamatory.” Then on Saturday, the NFL sent around a memo saying the organization was bringing in outside council to review its policies.

Why We’re Writing About It

Why, indeed, is a healthcare communications firm writing about a lawsuit against the NFL?

Because this story encapsulates so much of the work we do, the advice we give and the best practices for how – or how not – to communicate in a crisis. Because sometimes it’s good to look at outside examples to shake us loose and give a fresh perspective on long-standing principles.

Principles such as…

Check your story. Remember all those times we’ve written about how hospitals need to be proactive and tell the story of the good they do for their community? Or, if faced with scrutiny, respond with a compelling story? If so, you’ll also remember the warning that comes along with it: Make sure the story you tell is consistent with what’s actually happening inside your organization. For instance, a hospital can’t brag about helping patients navigate their healthcare finances when they’re suing them for nonpayment.

In the NFL’s case, the organization’s immediate response of calling the accusations “without merit” looks rash since it came within hours of the filing. Was that really enough time to have actually gone through the dozens of pages and confirmed that they were in fact without merit? Put another way, are the NFL and three teams being sued REALLY sure that they’re not behaving as accused?

Take time. Inherent to checking the story is that it takes time to do so. The NFL probably could have afforded to wait just a breath before releasing it’s “without merit” statement. Is it a crisis? Yes. Could they have taken a little longer to review the claims and craft a better message rather than one that looks like it was copied and pasted from some sort of “In Case of Lawsuit Break Glass” document? Also, yes. If you find yourself in a crisis, don’t wait around. But don’t go so fast that you rush past a meaningful response.

On Saturday, the NFL did in fact commit to “reassess and modify” the way it goes about things. But coming days after the initial, definitive statement instead of being the first thing released by the NFL, the memo opened the door for additional skepticism.

Prepare. We’re not talking copy-paste here. But you need to have a crisis plan in place with the basic blocking and tackling components. Think general talking points, FAQ, list of potential spokespeople, overarching underlying message. Armed with that, you can use those critical first moments of a crisis to review and home in on the situation. You’re not going to recycle the same talking points for every situation. But having a plan built around the tools needed and the underlying, mission-based message that you’ll want to convey no matter what is the difference between reflexively saying, “Nothing to see here!” and “We’re committed to serving our community and want to ensure that our actions reflect that. We’ll be investigating <XYZ> thoroughly. In the meantime, here’s what we know right now.” Again, it’s the difference between the NFL’s initial statement and the Saturday memo. Better to start with the latter and not backpedal into it.

Know the limits of your credibility. In addressing a crisis, consider your community’s perception of your organization’s reputation. We all know the NFL doesn’t have the best history when it comes to responding to explosive allegations. Their handling of the concussion scandal (which also included an ugly element of racial bias) and various instances of violence and abuse by players has left the organization without much reservoir of good will. Or benefit of the doubt. That’s another reason the instantaneous “without merit” comment looks hollow. Better, perhaps, to acknowledge previous missteps and use that as a foundation to talk about what comes next.

Know the difference between the people and the organization. This is the White Coats vs Dark Suits element. People love their docs. They love their local hospitals. But they lean skeptical about the big business of healthcare. Likewise, in the NFL, people love their team and particular players on it. But then there’s the perception of the organization, the impression that it often cares more about protecting the brand than doing the right thing, its Big Business operations that burn through trust and credibility. The appreciation the public has for the people doing the work – players/caregivers – doesn’t necessarily radiate out to good feelings for the organization – NFL/hospital. If the organization behaves badly, it won’t have much cover from the individuals.

And so here, we see a highly successful and credible voice who has worked at every level of an organization over the course of two decades. He’s making a powerful, emotional and specific accusation. However it all plays out, the NFL reminds us of the two-fold process facing an organization under scrutiny: First, of course, is actually doing the work and doing the right thing. And then it also means taking the time to communicate in a way that is consistent with the stated mission and values of the organization…or risk leaving room for the implication that those aren’t really the mission and values at all.

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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: 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 High Stakes, M&A, Quick Think

FTC Goes “Modern” On Mergers

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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: FTC, DOJ ask for public input in antitrust ‘overhaul’

In a move entirely consistent with the executive branch’s stated goals on M&A, the feds are ramping up an effort to “bolster merger oversight” and “modernize enforcement.” They’re particularly concerned about vertical integration which, they say, may not lead to the efficiencies often promised. Plus, they’re eyeballing scaling health systems’ smaller acquisitions, as those transactions may “skirt regulatory review.”

What it Means for Your Health System

The FTC isn’t just giving lip service to looking more closely at mergers. They’re also digging deeper during the review process. Regulators are requesting more information from health systems and healthcare companies than usual and they’re soliciting public comment. Both, of course, slow down any given transaction.

That’s sure to raise eyebrows at any health system considering a partnership. And there are many of them talking about it in their board rooms right now. Some put a deal on hold due to the pandemic and are coming back to it. Others weren’t looking to partner until pandemic pressure created the need.

All in all, the ball is rolling downhill for the antitrust crowd. They have their target in sight and they’ll be flooding the comments. It’ll be tough for healthcare organizations to push back, but we at Jarrard Inc. don’t think it’s an impossible task. The goal, for starters, should be to balance the comments in a meaningful way and point out where the critics have the narrative wrong. Here’s what that looks like:

Be ready to engage. Don’t wait for anyone to jump in on your behalf. While there’s certainly value in coordinating with associations, you have a distinct story to tell about your organization and community. Focus there and don’t assume that aggregated advocacy will suffice. And when you do appropriately engage in the public comments process, be proactive, not defensive.

Engage with real stories. The prevailing narrative is that consolidation leads to higher prices, lower quality and reduced access. But what about the real stories about mergers that saved healthcare in communities, saved access and improved patient care? Tell those stories and explain how it will work in your community. Your adversaries are using both academic studies and emotional patient narratives. Numbers backed by real faces on camera are a powerful cocktail. You should do the same.

Be specific. Price, quality and access are the areas that FTC is scrutinizing. Hospitals need to give very specific examples of how their proposed deal would address those concerns. That means avoiding platitudes like “We’re going to transform healthcare,” or “This partnership will ensure care for years to come.” Instead, say, “We are going to ensure high quality care by…” and “We will improve access through…” Similarly, where there may be changes – like L&D services leaving a low-volume rural hospital – explain exactly why it may happen and how you’re going to help expectant mothers. When they speak, your critics give specifics rather than rely on vague allusions. Take the lesson and apply it.

*A note on the cost of care: Everything in society is getting more expensive, and according to our latest consumer survey, the cost of healthcare is one of the public’s top concerns. Price is a line of attack hospital critics bring out at every opportunity. When discussing the effects of a proposed merger, be ready with necessary nuance. Talk about how and why prices won’t go up due to the partnership, why it won’t be the merger that further accelerates the increase. If you are the buyside, be ready to show (or defend) your track record of prior mergers and how cost of care played out. And if increases are going to happen, be upfront about the reasons.

Drive change and educate. Talk frequently about the innovation your organization will continue or pursue thanks to the partnership. Get into the specific things you can do to control costs or improve access. Help the public understand that healthcare overall is working toward better utilization of care. Focus on ways that your organization is investing (or will invest) in getting people the right level of care at the right time. Explain that this doesn’t always mean more services, but rather helping patients avoid overutilizing expensive or unnecessary services. The bonus: This helps people understand how they can make better choices that benefit them.

Start internally. When talking about a merger, ensure your employees and physicians truly understand what it means. Our latest survey found that healthcare workers are somewhat more skeptical of mergers than the public, so it’s critical to allay the fears of those on the inside. Provide crystal-clear messaging about how it will work and how it will and will not affect them. Speak in terms that people can understand and give them opportunities to respond and question. Then do the same publicly.

Always answer the question, “Why is this good for the patient?” Need we say more?

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.