In this episode of Elevate Care, hosts Kerry Perez, Liz Cunningham, and Nishan Sivathasan tackle the ever-changing world of healthcare labor trends and workforce technology in a post-pandemic era. From the shifting cost narrative to the rise of flexible workforce models, they explore how healthcare systems are adapting to new challenges. The discussion dives into the game-changing role of technology in staffing solutions, the power of data-driven decisions, and why integrating workforce strategies is key to improving patient outcomes. If you’re navigating the complexities of healthcare staffing, this episode is packed with insights you can’t afford to miss!
In this episode of Elevate Care, hosts Kerry Perez, Liz Cunningham, and Nishan Sivathasan tackle the ever-changing world of healthcare labor trends and workforce technology in a post-pandemic era. From the shifting cost narrative to the rise of flexible workforce models, they explore how healthcare systems are adapting to new challenges. The discussion dives into the game-changing role of technology in staffing solutions, the power of data-driven decisions, and why integrating workforce strategies is key to improving patient outcomes. If you’re navigating the complexities of healthcare staffing, this episode is packed with insights you can’t afford to miss!
Chapters
AMN Healthcare Podcasts (00:00.34)
Welcome to Elevate Care. I'm your host, Keri Perez, and I'm thrilled to be joined by two other co-hosts of Elevate Care. We've got Liz Cunningham and Nishan Savathisian. Welcome to the show. Thanks, Keri. Awesome. We're doing a little bit of a different format, kind of a roundtable. So hoping to have a little bit of discussion. In this first segment, we are going to be talking about current labor trends and the evolution of workforce technology. So first question and dialogue for us, we're talking about
Thanks, Karen.
AMN Healthcare Podcasts (00:29.154)
post pandemic trends. feel like we talk about that a lot. One of the things that I'm curious about is the cost narrative. Is that still a prevailing theme? What are some other prevailing themes that we're seeing within the healthcare space post pandemic?
I think the cost theme was a big theme certainly coming out of the pandemic, but now it seems to be less and less so. I think folks really believe the cost from a bill rate perspective has played out. There's no more room or things to be removed there. From an overall total cost of workforce, I think folks are still working through that. But really what you see is a key shift to, how do I think about my workforce more strategically with more flexibility? What's the right mix? What are the right models?
That's how I've seen conversations evolve recently, but Liz, I don't know what you're seeing on your end.
Yeah, I agree. The rate narrative, think, has flattened out. Something interesting I read the other day was that wages, specifically in the travel nurse space, from pre-pandemic to now increased 21%. But inflation in those wages actually has gone up 23%. So even in the travel nurse, we're actually slightly below inflation. But I do think, to Nishan's point, it's basically flat. And then what we're seeing with the labor mix is
we're actually seeing volume kind of come up slightly in some of the lower acuity discipline specialty areas. where you might see prior, you know, we might see demand for two nurses, two RNs, right? Now we might see demand for one RN and two CNAs. So the cost is kind of changing because you're having, you know, one at that higher bill rate and then two at the lower. So your overall cost is actually coming down as a result. So those mixes are definitely impacting the overall rates too.
AMN Healthcare Podcasts (02:12.654)
Well, it's interesting you mentioned the lower acuity because on the other end of the spectrum, we're seeing a lot more demand in the locum space. So I don't know, thoughts there of what we're seeing.
Yeah, I know the locum space specifically out of any markets within healthcare staffing is the only growth market right now. I believe it's projected to grow about 10 to 15 % versus the other ones are still retracting. We're also seeing in that space more of a demand for technology as the growth kind of, we're seeing the growth continue to come up. So looking at ways where VMSs can come into play or different platform plays to really bring together that demand to help with that demand increase.
to Liz's point, we've seen consistent growth in that locum space or market over the recent years and that just continued. nothing really further to add there.
Okay, great. Well, you gave me two other threads to pull on. The first one, Nishan, you were talking about those flexible models as we're thinking about kind of the workforce strategically. We know over the past several years a lot of desire to build internal float pools and internal agency. Talk to me a little bit about those flexible models where we're seeing success, where, you know, things are sort of shifting and how important it is.
Sure, what I would say is pre-pandemic, I think these were discussed and talked about a lot, but I actually think coming out of the pandemic, a lot of the larger hospitals and healthcare systems actually invested in these internal capabilities, whether it's internal float, internal agency. And so when you think about flexibility, some of the things that we've seen really resonate in the market is folks are looking for tools and technologies to manage their overall workforce. So an example might be, hey, if I have a role that's open, how do I go to my internal float first, then internal agency before I look at
AMN Healthcare Podcasts (03:54.266)
externally at third party. So those are some of the more new age sort of flexibility components. You see a larger adoption of those capabilities with larger hospital healthcare systems. The smaller ones, of course, just don't have the size and scale where they need that. But those are some of the newer trends that I've seen from my end.
One, what's great about it too is companies like ours and other companies in the healthcare staffing industry, we have to think about our solutions differently. whereas prior, you know, a float pool or an internal agency were really thought about as standalone solutions that likely the HR department or the talent acquisition department of one of our clients was working on, right? And they maybe were using Workday to manage it or they were using Smartsheet or even just Excel, right, to manage these different pools.
we're trying to offer our clients flexibility to have a partner and a platform that they can innovate with, right? So, hey, say you want to try out internal agency and it seems kind of scary, right? You're going to have to think about housing and travel and meals and incidentals and per diems and everything else, right? Well, you know, let's partner with you if you want to try it with, you know, maybe 10, 20 internal travelers, leverage our platform. We'll help you in addition to the traditional contingent labor. So I do think
Because clients are thinking about these pools differently, we as their consultative partners need to help them facilitate and innovate with these solutions to help scale them for what they're looking for.
Well, hold that thought on platform. I want to come back to that. But maybe one other potential controversial point there. I've also seen in the news a little bit recently some systems that have been trying internal agency, realizing that it's actually very expensive or internal travel. Have you been seeing that same thing? And, you know, what are your thoughts?
AMN Healthcare Podcasts (05:37.218)
there. I was actually thinking about this earlier in the locum space. So I'll tell a little like history story. So probably maybe seven, eight years ago, internal agency was really, really trendy in the locum space. So we there were, you know, large clients out there that were actually buying staffing firms. So I think like Vista was owned by a large, large physician group, Team Health that owned DNY at one point. And it was really a big trend that we kept an eye on.
And that has really actually faded back into the background where it's more traditional locums. Now, I don't think that doing internal agency for physician groups is the same as what we're talking about on the travel nurse and the allied side. My main point is I don't want to prevent our clients from trying something new. I think that you need to be a partner to help them try something new. And in some organizations that are set up well, it will be successful. In others, maybe it's not something that they are best in class in and they decide it's not.
worthwhile to try, my whole point is I don't want to prevent any of our clients from trying it, and I'd rather be a partner to support them in that innovation. And yeah, they realize they might not want to have a housing and travel department in their internal HR staff, and that's OK. So I think it depends on what the client's looking for, but just having the right partner to help them navigate through that conversation.
Well said. Nishan, anything else to add there?
No, I think you're probably going to hear a recurring theme from me. Liz summed it up well. The only things I would add is there's a cost benefit analysis for all systems, right? When the bill rate delta between perm and contingent was exceedingly high coming out of the pandemic, some of these internal investments made a lot of sense, right? As you start to see that delta narrow, right? So one data point we pulled up is if you look pre-pandemic, the delta between perm and contingent wages was about 15 to 18%.
AMN Healthcare Podcasts (07:29.74)
Now it's down to 11, right? And so it's cost benefit at the end of the day. I think some of the folks that are managing some of these capabilities internally, you know, when the Delta was significantly larger, it made a lot of sense. And as it's come down, you're maybe not seeing the efficiencies that you once saw before. But to Liz's point, you know, if our clients want to do it and want to experiment, you know, we owe it to them to be their partner to it, through it to the best of our ability.
And there's always a cyclicality of trying some things and sometimes it may be the right time or it might not be the right time and it comes back again and then it is.
Well, your market matters too, right? So if I think about the clients that I'm seeing be really successful with things like this, they're the metro area clients, right? They have a lot of supply. They have a lot of different locations to move people around on. Some of my clients that are in rural areas, that are having a hard time attracting supply in general, probably aren't going to stand up an internal agency. So I think it's also just being aware of what that supply looks like around your health system to then determine
Hey, is this something that is gonna be a low barrier to entry for me or is this something that's not gonna click in my market because of the supply demand issues?
And you brought up a good point there with, you know, the actual supply, but you do need the tech to basically enable them to work. I know we recently launched WorkWise, but Nishan, curious your thoughts on kind of that, how we sort of consider looking at tech being a first offering for health systems and what does that look like in combination with what we traditionally knew as staffing?
AMN Healthcare Podcasts (09:06.422)
Yeah. So what I would say is I think across the board, we see a lot of health systems making some real meaningful investments in technology. And so that's why it's kind of coming a little bit more to the forefront these days. The other thing that's really impacting things too is with in this lower demand environment, folks are looking more to technology for those flexible solutions. You know, when, when demand returns to normal, you know, sort of whatever that is, you know, who knows at that point, I supply will be the primary key and source, but technology is just playing a key role.
in how people solve for flexibility is how I think about it just to sum it up.
Anything else to add, Liz?
Yeah, I think there's also a shift from point solutions into more enterprise technology. And I also think we're at an interesting point where a lot of our clients are actually upgrading. Don't quote me on any of this time frame, but I feel like we're at this upgrade point for a lot of the EMR, EHR implementations that happened 10, 15 years ago. So a lot of our clients are having to upgrade that. And as a result, they're rationalizing their broader technology suite.
Do I really need five different technologies to manage my workforce scheduling, onboarding, et cetera? So that consolidation is what our clients are asking for. Specifically in the workforce space, I don't see clients needing more than an HRS system, an ERP, and then a workforce management technology, whether it's a VMS or a broader platform play like WorkWise. So that consolidation continues to happen and we're continuing to see also CIOs be part of our conversation.
AMN Healthcare Podcasts (10:40.268)
Before, when we're talking about workforce tech, the HR person is making the decision, right? Now, the technology, chief technology officer is actually coming in because they're looking at all of their tech as a portfolio versus, let me let HR figure out this decision here. So there's that shift in enterprise technology.
So there's, know, well said, I'll echo Nishan's theme, well said. But I thought you brought up the interesting point of kind of this death by a thousand point solutions into a lot of platform plays that we see in several different places, ourselves included. You also mentioned kind of talking about some of the features with the scheduling. I'm also interested, maybe Nishan or whomever, how do we sort of rephrase to talk about the...
the benefits you get from an integrated tech platform, not just the features that are there.
I think it really just comes down to the outcomes, right? So ultimately, what everyone's really solving for our patient outcomes specifically with a high quality workforce, right? In the technology solutions we offer them, just give them the flexibility to do and manage both is how I think about that.
The end to that point is in order to facilitate those patient outcomes and Ashaan mentioned, ensuring you have a happy, healthy workforce is part of it. And prior, when we had more point solutions, a lot of these different labor pools were kind of being sourced and managed independently. So maybe your float pool was in a different solution than your core staff. Maybe your per diem was sitting over in some other technology. And it really
AMN Healthcare Podcasts (12:15.458)
didn't allow our clients to have that enterprise view of what does my overall workforce look like, what is my attrition, my satisfaction look like so then I can make sure that the best care is being provided at the bedside. So that enterprise view of transparency into the data and visibility then allows them to facilitate those outcomes around patient experience.
And how important is it becoming to have tech that can serve both clinicians and providers? So nurses allied and the locums. I think before we might have seen, hey, you get a solution for your nurses, you get a solution for allied professionals, and now there's locums. It feels like there's an opportunity to be able to look at it in one breath.
I'd add another and to that, and non-clinical. It's actually everything. I would actually say before it was like non-clinical was over here, Locom's was over here, and then nurse and allied was a separate solution. Having that enterprise view and that transparency and visibility is a must have. And that is what we offer our clients and try to push our clients. But there are some barriers to having to do that. Traditionally, different departments actually run those different programs.
even in some hospitals, know, allied's a completely different department than nursing. Non-clinical is most definitely always a different department. Physician is, you know, sometimes even a separate physician group that's not even part of that, you know, health system specifically. not only is it getting the data together, but then it's also bringing the experiences together in the different buying groups within a health system to be able to facilitate that.
I think it's really about having a consolidated opportunity, both on the client side as well as the healthcare workforce side, right? So from a client perspective, you are seeing a consolidation, a real need to consolidate to a single tech specifically, to Liz's point earlier, less about point solutions, but more one platform choice. And on the workforce side, I think folks just want to go to one place to figure out and find any and all opportunities in the market. And that's what we're effectively trying to solve for on that side.
AMN Healthcare Podcasts (14:16.654)
How do we guide our clients that we're talking to to be able to pull the right people in the room to make a single decision? It seems like it's also a flex and a change that might be for them too.
The thing that's unique about healthcare is any decision that is made is usually a group decision, right? But usually there's a primary that they're solving for at that point. It could be nurse or it could be ally or it could be locums. And in some cases it's language services, right? And so where it makes sense to bring some of these disparate buyers together, we'll certainly try to help facilitate and encourage that. But where it doesn't, that's okay.
but the buying process, selling process, whatever you want to call it in healthcare, just seems to get more more elongated as additional stakeholders are brought into it. But that's kind of the beauty of it is that they're actually trying to work together to solve for this. But what you need to be clear on is what is the problem that you're solving for? And when you're trying to solve for everybody's problem, you're solving for no one's, right? So I think for us, at least for me, when I think about it is like, who's the primary buyer? How do we solve for their needs? And who are the other key stakeholders they need to be
on in that decision from a client perspective and we try to help facilitate that as best we can.
makes sense. Anything else on that one?
AMN Healthcare Podcasts (15:37.1)
I guess I'll push it back to when I was a buyer on the IT side, right? You source and look for the right platform to accommodate your vision, but you're realistic in terms of what you can implement right away. So there's probably a balance of finding a platform that gets to that end vision that will eventually please everyone, but then being realistic about, OK, let's roll out nursing first, and then we'll continue to iterate is just another way to think about it so that it doesn't take forever to implement this whole enterprise solution.
Maybe backtracking to kind of round out this segment to some of the visibility that you're referencing of the data that we're able to get into a platform. What is that sort of data that feels like it is the most important to be looking at that will help our workforce?
challenges. I mean, it's volume, and then it's a lot of the payroll data. So if I'm just simplifying it, it's it's the patient volume. So looking at, know, lot of the data from the EMR, right, and this is you thinking about how you actually appropriately predict, or forecast what your needs are going to be. It's around patient volume, it's around vacancy rates, really looking at, you know, what is that inflow into the hospital? And then how are is your staff meeting those needs? So that's the one piece. Then the other piece on the payroll side is about
know, rates and types of rates and types of, you know, not to be like really get into the nitty gritty, but like the time entry codes, right? Am I over utilizing on the overtime space? Do I have FTE that aren't actually filling their full-time schedule? So it's combining that utilization of the staff with the patient demand that really will help you get to that optimal mix.
So I agree with much of what was shared. I'd also say that I think it evolved and it changes a little bit. So I tend to think about, what's not going to change and what will change. So that what won't change will be patient outcomes, number one, and workforce engagement, number two. And then how you get there or the other inputs, I think those ebb and flow a little bit. And so you need to have some level of flexibility to just effectively put a different lens on it. Because if you want to have a drive, a different outcome or improved outcomes,
AMN Healthcare Podcasts (17:41.808)
I think looking at the problem through different lenses certainly helps you to get there. So that's something I try to encourage our clients do. There's your traditional set of metrics and data and measurements and it's just, if you looked at it like this, do you actually come up with a new set of ways to actually tackle and approach this thing?
That's a good point. Layering the experience metrics on top of some of your day-to-day that gets to that kind total experience. And I do think that we're not seeing that be layered in as much as it could be in today's market.
Yeah, because typically people think about it as, here's my function. I'm done. But from a patient experience standpoint, you're looking at it more end to end. The patient, their experience doesn't just stop here at this. Right. Right. And it's more about the end to end journey and trying to capture that from a patient experience.
Okay, great. Well, that was a rich conversation. There's more to talk about in some future roundtables. Thanks for joining us on Elevate Care and we will see you next time. Thank you for joining us today on Elevate Care. If you found this episode valuable, please consider sharing it with a colleague and subscribing to our show on your favorite podcast platform. You can learn more about this episode and our show on our website at amnhelfcare.com and follow us on social media to stay updated on new episodes and the ever-changing world of healthcare.