Episode 119: Staffing Challenges

Speaker 1:You're listening to Your Practice Made Perfect, support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

J. Baugh: Everyone, and welcome to this episode of Your Practice Made Perfect. My name is, J. Baugh, and I'll be your host for today's episode. Today, we're going to be talking about three key strategies for addressing today's staffing challenges. And to help us discuss this very important topic, is Gretchen Napier. Gretchen, welcome to the show.

Gretchen Napier: Thanks, J., glad to be here.

J. Baugh: Well, we're glad to have you. We know this is an important topic, and I know that you'll have a lot of great information for our listeners. Before we jump into today's subject, can you tell us a little bit about yourself, Gretchen?

Gretchen Napier: Thank you for asking, J. At Vanderbilt, I studied human and organizational development, which really set my foundation for a lifelong learning about leadership. At the same time, I was also passionate about positively impacting the aging experience for older adults. So, I then went on to earn a master's in healthcare administration from UAB in Birmingham, and spent a few decades leading healthcare organizations with that focus, such as retirement communities and assisted living facilities.

Just prior to joining SVMIC, I sold a care management business that I had owned for a decade with a practice in Nashville and also one in Raleigh, North Carolina. That company was a team of 22 nurses, social workers, and physical therapists who provided expert guidance and advocacy to older adults and individuals with disabilities, as well as their families, as they navigated the healthcare system. I'm also a senior certified professional with the Society for Human Resources Management. At SVMIC, I worked for Steve Dickens in the Medical Practice Services Division, and we consult with our policy holders on all aspects of the business part of running their practice.

J. Baugh: Well Gretchen, it sounds like you have a lot of experience in this area, so we'll go ahead and get right into being able to talk about this important topic. So we're hearing from a lot of practices, that they're really facing a lot of staffing challenges right now. So, what's going on?

Gretchen Napier: Practice leaders are facing a lot of challenges affecting their staffing. In addition to the usual challenges, we're also facing a nursing shortage. According to the American Nurses Association, more RN jobs will be available through 2022 than any other profession in the United States. Employment opportunities for nurses are projected to grow at a faster rate than all other occupations from 2016 to 2026. And unfortunately, I'm hearing similar challenges relating to medical assistants or MAs.

Practice leaders have always had to be creative and sort of staffing their offices because hospitals paid more. So now more than ever, employees are choosing to work at a place that enhances their quality of life. Believe it or not, people are willing to forego a dollar more per hour in pay to work in a place that values them as human beings, that allows for some flexibility with their family and their personal life, and that adds joy to the many hours that they spend at work. So creating a more positive and inclusive practice culture, often centers around the right kind of communication. Within NPS, we have a few educational offerings that can help practices communicate more effectively and focus on improving the culture of the practice and employee engagement.

J. Baugh: So Gretchen, what is one way that practices can focus on their culture?

Gretchen Napier: One of the primary barriers to positive culture, is the lack of effective feedback to staff. And the main reason most leaders don't provide helpful feedback, is because it feels uncomfortable. Giving feedback, especially criticism, is painfully difficult, but it is still the duty of a leader to give it. On the other hand, some leaders deliver the feedback in a harsh or overbearing way that really ends up doing more damage than it helps. Leaders owe it to people to help them improve and to help them improve at the earliest possible moment.

So, we use a tool called, radical candor, that provides the framework for challenging an employee or peer directly when a problem is observed, but doing it in a way that demonstrates they care personally. So J., let's just say that you were having a problem showing up on time to work. I'm sure that would never happen, but we'll just pretend, for the sake of this-

J. Baugh: Okay. Just for pretend. Yeah.

Gretchen Napier: I can ignore that behavior and just hope that it magically gets better, but then everybody else on the team might decide to start coming in late too. Or they might grow resentful that you're getting away with it. I could also call you out publicly for being late and embarrass you, which wouldn't be good for our relationship, nor for the team's morale. But ideally, I'd have a private conversation with you where I'd ask if you're okay since being late is unusual for you. And I'd give you the opportunity to know that I've noticed the problem behavior, but also, I care about you personally. Once you've shared whatever you want to about the cause of being late, then we can work together on strategies to improve your timeliness.

As the leader, I would still need to hold you to the high standard of our team, that being on time is important, but there's a reason why I can't also care about you as a person, at the same time. Relatedly in healthy relationships, people give five to 10 positive to negative feedback. I'm going to repeat that because it's so important. Significant research shows that the ratio of positive to negative feedback and healthy relationships is five positives to one negative.

It's our human nature to sort of have this bias toward hearing internalizing negative feedback. When our spouse or coworker makes a negative comment about work, we magnify that in our minds and focus on that, over whatever positive things they might've also said. So to maintain that healthy balance, most of us have to work a lot harder to notice the positive things. And then mention them to important people in our lives, so they're not only hearing from us when we have something to complain about.

J. Baugh: So what would be another strategy that you would recommend to practices for creating a more engaged workforce?

Gretchen Napier: Working to make sure that their practice is a welcoming place for any new employee. Some practices have routinely hired people that all look the same and think or believe many of the same things. That can make people who look differently or believe differently, feel excluded. In a tough labor market, practices need to be welcoming all the most qualified staff, expanding the kind of people that want to work there, not limiting it.

And we all have biases, as a result, so do the organizations that we build and lead. But talking about these biases and feeling confident addressing them, remain difficult for most of us. Our Medical Practice Services Team created a presentation to gently empower attendees with information and step-by-step strategies to work against institutional bias of all kind. That could be gender, race, education, ice cream flavor, quiet people, talkative people, over 180 cognitive biases have been identified, so there're all kinds.

If we began with a foundation of research on how biases become embedded in our thoughts and our workplaces, then participants are guided through reflection questions, so they can privately examine their own personal biases. Checklists, case studies, and sample performance standards give them to all that they can use to take immediate action. In a divided culture, this session is designed to help us create a world that works for everyone, one person, and one practice at a time.

The session that we offer is just a first step in a longer, deeper process. As you know, J., it's taken SVMIC a full year to find the right consultants to help us develop the right skills and foundations for working through these difficult conversations. For both active allies and black, indigenous, or people of color, working to undo dysfunctional system requires getting comfortable with being uncomfortable. It demands patience and persistence, learning to address mistakes, and move forward. Humility, active listening skills, empathy, and patience are important qualities to nurture, as you navigate your way through disrupting the status quo. The MPS educational presentation does it do this deep work. We're just really introducing the topic to practices, and hopefully getting the ball rolling on a deeper process.

J. Baugh: So let's talk a little bit about the MPS educational presentation. Could you maybe share an example of something that you talk about during this presentation?

Gretchen Napier: Sure. Human bias is a fact of life. It's an annoying and frustrating part of life sometimes, but we've all been there where, we see and think, "Oh no, this is not really happening. How could this person think what he or she is saying?" Or the worst part, is when you say something and you think, "Did I just say that?" Most of us get paralyzed in those situations, not because we're bad people, but often because we don't want to make a bad situation worse.

One well-known study published in the British Journal of Social Psychology analyzed how often words were paired in order to understand where stereotyped messages about people might come from. The study found that we're immersed in a culture that creates and reinforces problematic associations. So in their study, black is most commonly compared with the adjectives, poor and violent, while white is paired with, wealthy and progressive. The study also found that males are described most often as, dominant and leader, while female pairs most often with the words, distant and warm. Which might indicate that we assess women for their emotional tone, while we expect men to assume leadership positions.

When you add to all of this, the fact that we each tend to believe that everyone else is the problem, that the need for reform lives outside of us, and it's just other people who need to change their hearts. Studies however, tell a different story. And analyzing 10 years of data about feedback of over 1.5 million raters, describing 122,000 leaders, it was found that the higher a leader rates him or herself on valuing diversity and practicing inclusion, the more likely those leaders are to overrate their effectiveness.

So if you think you're really great at this, you might actually be the worst. The truth is that everyone has bias. Bias is a natural, normal human tendency. Most bias is harmless. The stereotypes can lead to bias, if you believe them. Being aware of them allows us to control, conquer, and prevail over our biases. So one thing that's kind of a fun thing to do is, is to take Harvard's Implicit Association tests. You can just do Google, Harvard IAT. They have tests that rate your biases on everything from race, weight, and skin tone, to weapons, presidents, and sexuality. It's a great way to begin to just think about your own biases.

J. Baugh: Are there any other communication strategies that practices could implement to make the workplaces more appealing?

Gretchen Napier: Yes. Another communication thing that I'm really passionate about, is clarifying expectations. Only about half of employees would strongly agree that they know what's expected of them at work. The employees who agree that they have clear expectations at work are two and a half times more engaged. And we know that more engaged employees have reduced turnover, fewer safety incidents, and increased productivity.

Gretchen Napier: One of my favorite exercises to do with teams, is to help them take organizational values that are fuzzy and assessed in terms of aspiration, and turn them into actual behaviors that can be taught, measured, and evaluated. So for example, a practice might have an organization value that says, "We provide timely, compassionate, and effective care to our patients.", which sounds really great, but each employee might have a different idea about what timely means, as well as, effective, and or, compassionate. Not only can employees not necessarily envision what it means to do those things well, but you also can't measure their performance.

So, we work with teams to come up with specific behaviors that everyone agrees to, that might be something like, "We demonstrate our professionalism by being on time, answering the phone within three rings, returning messages within one business day, and working urgent needs into our schedule within the week." Another way we might turn that into something specific would be, "We submit patients information to insurance within 48 hours of each appointment. And we monitor accuracy through monthly audit." We find that just having this conversation among the team about what each of our organizational values looks like in practice, makes a huge difference in getting everyone on the same page, working toward the same values.

J. Baugh: Well Gretchen, you've certainly provided a lot of great information for this important topic about challenges in staffing a medical practice. As we get ready to wrap things up, do you have any last minute tips or advice for our listeners?

Gretchen Napier: There are lots of great communication tools out there. Some of them that we've talked about today were radical candor and the Harvard IAT tests, that can really help practice leaders improve their culture and increase employee engagement.

J. Baugh: Well Gretchen, thank you for providing that information about those tests. And we'll be sure to include that in our show notes so that our listeners can access that information, which would be able to help them with the issues that they have in staffing their medical practices. I want to thank Gretchen Napier from our Medical Practice Services Department at SVMIC for joining us today, with a lot of great information for our listeners. And once again, thanks for being here today, Gretchen.

Gretchen Napier: Thanks, J.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect. Listen to more episodes, subscribe to the podcast, and find show notes at svmic.com/podcast.

The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and change over time. All names in the case have been changed to protect privacy.