Breaking Down the Healthcare Staffing Shortage: Insights from Industry Experts on Solutions and Challenges

Post-COVID update

Pam Damsky, managing partner and co-lead, Clinical Transformation line of business at Chartis, said "I would say it's different, not necessarily better, although statistics might suggest otherwise. For instance, overall nurse turnover has decreased. The latest data from 2023 shows that nursing turnover is around 18%, which is lower than during COVID and approaching pre-COVID levels. However, first-year turnover is still around 30%.

“What's happening is that there’s an experience drain. While the numbers may suggest improvement, it’s actually becoming harder for nurses on the floor because many of them are inexperienced. Once they're trained, they leave, so teams are constantly in training mode.

“Additionally, other supporting roles, like allied health and clinical services, are also experiencing high turnover. One statistic I recently saw noted a 30% increase in open allied health jobs compared to last year. When teams lack support staff, it makes the work more difficult."

John R. Mehall, MD, MBA, president, Innovative ECMO Concepts, noted "I think staffing is still a major challenge in healthcare. A big part of the reason is that healthcare staffing is hands-on work. There’s no remote nursing or remote caregiving—providers must go to a facility, whether it’s a hospital, physician’s office, or elsewhere. Many forms of care also require night and weekend work. Patients don't go home at 5:00 PM; they're still in the hospital overnight, on weekends, and during holidays. As a result, healthcare providers often have to take calls at night, work night shifts, weekends, and holidays.

“This hands-on, on-location work isn’t something everyone is interested in, and it limits the pool of potential workers. A large segment of the workforce isn’t drawn to this type of work or off-hour shifts. Over time, the demands of nights and weekends also take a toll. Many people in their 20s and 30s may be willing to work these hours, but by the time they reach their 40s, 50s, and beyond, they’re much less interested in it. This shortens the longevity of careers in many areas of healthcare."

A look at departments around the hospital

Steve Downey, VP, chief supply chain & support services officer, Cleveland Clinic, commented on several different areas. Regarding sourcing, Downey commented, "It's tough to find the right people because they need both specialized skills—like knowledge in orthopedics, cardiology, IT, or pharmacy—and the ability to negotiate, source, and contract. They often need to collaborate with end-users and gain credibility in that area. Clinical roles are highly competitive within health systems, and even indirect spending is competitive across the broader market."

As for operations, Downey noted, "Traditional supply chain roles, such as buyers, material handlers, and warehouse management, are highly competitive. This is because these positions are also sought after in other industries like retail and e-commerce."

Further, "Positions requiring both healthcare knowledge and systems expertise are in high demand today. These roles are highly valued across the market."

"Services such as SPD, Food, and Linen each have unique challenges. SPD in particular is the most competitive. Finding skilled SPD workers who are well-trained in procedures, cleanliness, and attention to detail is rare," Downey stated.

Damsky also commented on SPD; she said, “Sterile processing is an example of an entry-level job where staffing shortages have a significant impact. Without enough sterile processors, you can't run your ORs, and that’s a big issue. It becomes very difficult to have the necessary equipment ready, or things run slower, which creates a problem.”

Consequences

When asked about the consequences of not having enough staff, Chartis’ Damsky noted, "The biggest consequence is cost. Hospitals will ensure they have enough staff to deliver care safely, and I would also add access to that. To meet the needs of the population, they'll pay overtime, hire agency staff, or bring in travelers, although the use of travelers has decreased. They're also asking staff to stay late or even mandating overtime, creating situations no one really likes, which only exacerbates the problem.

“Hospitals may also reach a point where they have to close beds or reduce the number of open units due to staffing shortages. For example, on an inpatient unit, they may not have enough staff to safely support a full unit. Similarly, in areas like imaging, they may not have enough staff to run machines for as long as needed, or it takes longer to process patients through the system, leading to reduced access."

"I think the main issues are cost and access—longer wait times, longer turnaround times, and delays in getting things done."

Mehall commented on why individuals may not be so excited about the medical field. He said, “If you’re not in a healthcare position, when you go to bed, you're not at risk of your phone ringing, making you have to rush to the hospital within 30 minutes and perform a six- or eight-hour operation, where the patient's survival is uncertain. There's an acuity to that kind of work that’s probably underappreciated unless you're living it.

“Additionally, the constant need to be available for many years takes a toll. For example, when my family and I went out to dinner, we took two cars because I might have to leave at any moment to go to the hospital. People don’t often think about that side of the job."

He added, "So, there are just some people who say, 'I’m not signing up for that.' They’d rather work in a field that offers regular hours, no weekend shifts, and holidays off. And there’s nothing wrong with that. But you have to recognize that the demands and rigors of working in healthcare significantly reduce the number of people willing to take on those responsibilities."

New faces

When asked about how to retain and recruit staff, Damsky said, “Compensation is definitely a factor, especially for some support and entry-level roles. For example, a first-line worker in supplies can often get a job at Amazon, which pays more and is easier to obtain. It’s hard to turn that down.

“There is a strong value proposition in healthcare, like a commitment to the community and doing good, which brings a lot of people into the field. However, the challenge is when we don’t reinforce that commitment across the staffing continuum. Everyone, from top to bottom, needs to see their role as part of that service to the community.

“This commitment to culture and mission is reinforced to varying degrees depending on the organization.”

Damsky laid out four main areas that are crucial for creating a stable workforce:

1. Understanding the drivers of turnover: It's important to gain detailed, actionable insights into why people want to leave, beyond just the typical engagement survey. These factors vary by role, so role-specific surveys are necessary to identify what’s truly driving turnover.
2. Creating a cultural connection: Reinforce the organization’s loyalty to the individual. Whether it’s through career progression or a sense of community, these connections have, in some places, been lost.
3. Focusing on the daily experience: Working in healthcare can be challenging, even though it’s ultimately rewarding. We need to understand the specific issues that make the daily experience harder, which can vary by role, and work on addressing them.
4. Leadership accountability: Finally, leadership must be committed to addressing these issues. They need to measure and monitor progress, ensuring that the changes needed to create a stable workforce are being made and that they’re held accountable for it."

"I actually think the biggest imperative is to focus on retaining the staff you already have," Damsky added.

Mehall largely agreed. He said, “I do encounter young people who are interested in healthcare, and I encourage anyone who feels that calling to absolutely pursue it. If your heart is in it and you’re doing what you love, you’ll enjoy it. Yes, there might be higher-paying jobs elsewhere, but the compensation in healthcare is sufficient, and anyone doing full-time caregiving can make a reasonable living.

“As for making healthcare more appealing, I hadn’t really thought about it, but I do think that, at least on the physician side, there has been a loss of stature and prestige compared to 20 or 30 years ago. This likely mirrors the loss of autonomy and governance physicians have experienced. Most physicians today are employed, whereas in the past, many owned and managed their own independent practices. They had a lot of control over which hospitals they worked with and the care their patients received. In an employed model, that’s not the case. If you’re employed by a hospital, your patients are brought to that hospital, and if you're dissatisfied with the care there, you don’t have the option to send your patients elsewhere.

“Hospitals no longer compete for doctors in the same way—they don’t have to. Physicians have lost some of the control over how they manage their professional lives, which I think has contributed to the diminishing prestige of being a physician.”

Mehall went on to explain that another issue that impacts healthcare is that, when you’re on call, you can't control the volume of patients coming in during your shift. If the patient load exceeds the staffing available, there's often no good way to bring in more help, yet the work still has to be done. The nature of the people who go into healthcare is that they’re altruistic. They’ll give up their lunch break, work extra hours, or take work home to finish it. Over time, though, this sense of altruism can start to feel like it's being exploited, which is one source of burnout.

He commented, “Another source is the loss of governance and autonomy, and then, with staffing shortages, there’s simply more work than there are people to do it. This creates physical burnout from trying to handle too much or working too many hours."

Final thoughts

Cleveland Clinic’s Downey noted supply chain specifically. He said, "Supply chain is essential for patient care—it has to run smoothly. When staffing is too low, costs go up. Poor sourcing leads to higher expenses, existing staff has to work overtime to fill gaps, and mistakes like incorrect pricing can cause transaction errors. Waste increases, and if temporary staffing is needed to cover the shortfall, costs rise even more."

As for associations and awareness, Downey articulated, "I’m a big supporter of AHRMM, the supply chain division of the AHA, which works hard to educate and raise awareness about the field. Supply chain is a great career with many opportunities across various areas."

Damsky shared her outlook for the future, as well. She commented, "I haven't found a magic bullet, but in my experience, there are some key areas to focus on. EHR optimization is a big one. People are constantly working on that, but you can use reports to track 'pajama time' and focus on streamlining documentation. For example, how can we reduce the need to write everything down? How can we create standardized processes so that for patients with certain conditions, specific orders automatically appear, so we don’t have to request them?

“There are many ways to streamline the work, but it’s not a one-size-fits-all solution. It requires a specialty-by-specialty, component-by-component approach.

“Another promising area is technology, like ambient listening, which has shown significant reductions in provider time. While not everyone has access to these technologies yet, they’re starting to be more widely adopted, and I think we'll see even more of these tools in the future."

She concluded, “For me, addressing the workforce gap comes down to four key things: You need to identify where the problems are, reinforce the cultural connection people have to the organization, improve the daily experience for employees, and ensure accountability for delivering results."