24 minute read
non-clinical personnel deficits
from REP March 22
The Healthcare Continuum Takes on Staffing Shortages
Supply chain leaders examine how their health systems are handling clinical and non-clinical personnel deficits.
By Daniel Beaird
Recently in California, the state’s department of public health temporarily
changed its coronavirus guidelines to allow asymptomatic, COVID-19 positive healthcare workers back to work without isolating or testing. The guidelines were in effect from Jan. 8 to Feb. 1 to curb the critical staffing shortages experienced across the healthcare continuum, the state health department stated. The California Nurses Association criticized the decision.
Many healthcare workers burned out by the pandemic have quit. Many that remain have tested positive for the coronavirus and are isolating. Healthcare facilities are busier than last year due to more demand for non-COVID related care. Where does this leave the nation’s health systems with staffing issues? How are they being mitigated?
The Journal of Healthcare Contracting (JHC ) surveyed supply chain leaders from health systems about the medical staff shortages.
JHC: There are staffing shortages amongst hospitals in general. Clinician burnout along with the resurgence of COVID-19 in high infection regions has pushed workforce management to the front of the line. How are staffing shortages affecting how you take care of your patients? George Godfrey, Corporate VP and Chief Supply Chain Officer of Baptist Health (South Florida):
We take incremental steps to make certain that patient care is never impacted. This takes additional time and resources to properly manage staff scheduling and deployment.
Erik Walerius, Chief Supply Chain Officer of UW Medicine (Seattle,
WA): Increased use of overtime and temporary labor to fill in staffing challenges to avoid clinical impacts.
JHC: Have noncritical services been cut back due to staffing shortages?
Erik Walerius
George Godfrey
Steve Faup, Divisional Director, Supply Chain of Capital Health
(Trenton, NJ): In some cases, there has been a scale back of available hours. An example would be Food and Nutrition Services. Their resources are focused on patient care. The pre-pandemic hours of operations and offerings for walkup service have been modified.
Godfrey, Baptist Health: At this time, only minimal cutbacks have been made to non-clinical services.
Walerius, UW Medicine: Earlier in the pandemic, supply chain services not directly related to clinical services were reprioritized to support pandemic-related efforts.
JHC: Have vaccine mandates contributed to staffing shortages?
Faup, Capital Health: There are many issues feeding the labor shortages. Mandates are contributing but probably not a significant factor.
Godfrey, Baptist Health: As an organization, we moved toward vaccine mandates for all employees during fall 2021. We created a vaccine campaign across the organization to provide not only the shots across our many hospitals and urgent cares, but also to provide information, research and clinical support for those employees who expressed reservations about the vaccine process. As a supply chain department, we reinforced the organization’s approach to get everyone vaccinated with strong, weekly communication to our teams to provide any necessary resources needed to get our team 100% vaccinated.
Walerius, UW Medicine:
Yes, but minimal.
EDITOR’S NOTE: Healthcare workers covered by the Biden administration’s vaccine mandate will have until March 15 to be fully vaccinated in the 24 states where the requirement was reinstated by the Supreme Court. Twenty-five states and Washington, D.C., continue to face a Feb. 28 deadline for covered healthcare workers to be fully vaccinated, as the mandate had not been blocked
UPMC launches in-house travel staffing agency to address nursing shortage
UPMC has created UPMC Travel Staffing, a new in-house travel staffing agency as a solution to the nationwide nursing shortage and to attract and retain highly skilled nurses and surgical technologists to its workforce. UPMC is believed to be the first health system in the country to launch its own staffing agency – initially for registered nurses and surgical technologists, with the potential to evolve to include additional job roles.
UPMC has brought in external travel nurses and surgical technologists to help at the bedside and in operating rooms throughout the past year. The goal of UPMC Travel Staffing is to rely less on outside agency staff and empower UPMC employees who would like to travel to UPMC hospitals across Pennsylvania, Maryland and New York – wherever and whenever the need is greatest. This new program will provide needed support for our frontline caregivers and career growth opportunities for UPMC nurses and surgical technologists interested in travel. Not only will the program be a retention tool for our current staff, it also will fuel a new pipeline to recruit nurses to UPMC and to bring people back who left UPMC, according to a release.
The advantages of this innovative program include competitive wages and excellent benefits that are unmatched by outside travel agencies, such as tuition assistance. The program also offers vast career growth opportunities and diverse clinical experience working and living temporarily in communities across UPMC’s footprint. UPMC Travel Staffing will rotate nurses and surgical technologists to different facilities for six-week assignments.
In December 2021, as healthcare staffing shortages began to mount due to the transmissibility of the COVID-19 omicron variant wreaking havoc across the country the CDC issued guidance designed to enhance protection for healthcare personnel, patients and visitors, and address concerns about potential impacts on the healthcare system. Maintaining appropriate staffing in healthcare facilities is essential to providing a safe work environment for healthcare personnel and for safe patient care.
The CDC said when staffing shortages are anticipated, healthcare facilities and employers should use contingency capacity strategies to plan and prepare for mitigating this problem. They included:
ʯAdjusting staff schedules, hiring additional healthcare personnel and rotating personnel to positions that support patient care activities. ʯ Developing regional plans to identify designated healthcare facilities or alternate care sites with adequate staffing to care for patients with infection. ʯ Allowing asymptomatic personnel who had a higher risk exposure to COVID-19 and are not known to be infected with COVID-19 and have not received all vaccine doses to continue to work onsite throughout their 14-day post-exposure period. ʯ Allowing personnel with infections who are well enough and willing to work to return. Those with mild to moderate illness who are not moderately to severely immunocompromised and at least five days have passed since symptoms first appeared and at least 24 hours have passed since last fever without the use of feverreducing medications, and symptoms have improved. ʯ If shortages continue despite other mitigation strategies, as a last resort consider allowing personnel to work even if they have suspected or confirmed infection, if they are well enough and willing to work, even if they have not met all return to work criteria.
in those states before the Supreme Court order that came down in January. The mandate, issued by the U.S. Department of Health Services’ Centers for Medicare and Medicaid – remains blocked in Texas (at time of publication).
JHC: How has pandemic burnout contributed to staffing shortages?
Faup, Capital Health: Absolutely, and it has become increasingly documented within a variety of industries and specific jobs. For example, nurses and truck drivers.
Godfrey, Baptist Health: We have seen this within both clinical and non-clinical positions during the duration of this pandemic. The return back to a fully staffed team is slow, at best. We are nearly 24 months into a remarkable and relentless pace due to the pandemic, with a constant push and pull on all fronts of our industry, and people are fatigued. Additionally, the added lifestyle impacts of being remote and remaining socially distant for so long have added to the stress, strain and exhaustion of our troops. If you take all of those factors and add them to the historic amount of workforce that has left the employment pool, our ability to maintain a fully staffed supply chain team in some areas has been difficult.
Walerius, UW Medicine: An increase has been seen in early retirements and moves to other hospital departments and transfers have increased.
JHC: What are you doing to attract staff and stave off shortages?
Godfrey, Baptist Health: We have been very communicative as an organization regarding our needs for staffing across the network. The organization has increased the referral bonus for employees in an effort to get our current workforce to refer qualified candidates for internal opportunities throughout our network. Additionally, our internal HR, training and development teams have been very forthcoming with information about our own internal training and internship opportunities for clinical and pharmaceutical careers to promote, teach and train our own team members who may want to pursue those areas.
Walerius, UW Medicine: Strategies include hybrid and remote working for applicable jobs and extensive HR recruitment tactics.
4 Critical Factors to Know When Choosing a Healthcare Surface Disinfecting Wipe
Healthcare-associated infections (HAI) are an unfortunately common complication of hospital care, and while there are varying factors associated with HAI, contaminated surfaces and equipment can contribute to the
problem. Although hand hygiene is an important disruptor of the cross-transmission of microorganisms, improved cleaning and disinfection of medical equipment and environmental surfaces is fundamental to reducing their potential contribution to HAI.1,2 Increased focus on the need for improved surface disinfection in healthcare settings – kill more germs!, take less time!, don’t damage my equipment! – has only added to the confusion many healthcare workers experience as they are trying to select the best possible product for their environment of care.
Long a mantra of GOJO®, inventors of PURELL® hand sanitizer,
formulation counts. As with many infection prevention products sold into healthcare, from hand hygiene to surface disinfection and beyond, not all products are created equally. Because of this, it is important for healthcare facilities to critically evaluate both the products that they have as well as those they are considering. For surface disinfecting wipes, there are 4 simple but important areas to consider when evaluating your options: efficacy against relevant pathogens, a good safety profile (non-toxic), high material/device compatibility, and ease of use.
Real-world Efficacy. The pathogens responsible for the majority of HAI, that also have the highest risk of mortality and resultant increased healthcare costs, are caused by a group of bacteria commonly referred to as ESKAPE pathogens. This group of bacteria is so named for their ability to “escape” the biocidal action of antimicrobial drugs. The ESKAPE acronym, or mnemonic, stands for Enterococcus faecium/ faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species. Using a patent-pending, ethyl alcohol-only formulation, the new PURELL® Healthcare Surface Disinfecting Wipes kill the problematic ESKAPE bacteria and seven of the most common drugresistant bacteria and viruses significant to the healthcare environment (including bloodborne pathogens, SARS-CoV-2, influenza A, respiratory syncytial virus, and norovirus) in 2 minutes or less. This broadspectrum efficacy with rapid kill time against these highly relevant healthcare pathogens is critical to help support busy clinical workflows.
Highest Safety Profile. As an EPA Category IV product (see Figure 1), the PURELL wipes achieve the EPA’s lowest toxicity rating (and highest safety profile) – meaning no personal protective equipment (PPE) is required for use – while also being FDA Food Code Compliant. Meeting the Food Code requirement means that the EPA has evaluated the formulation of the product and
Figure 1: Environmental Protection Agency (EPA) Toxicity Categories
has indicated that it is safe for use on food-contact surfaces without a postapplication water rinse. Reading the Instructions for Use (IFU) on many other healthcare-grade surface disinfectants will reveal language advising against the use on surfaces that food may come into contact with. This is a unique attribute as it is incredibly rare for hospital grade surface disinfectants to also meet the EPA requirements for use as no-rinse food contact surface sanitizers. Further, it is even more rare for a hospital-grade surface disinfectant meeting the EPA requirements for a no-rinse food-contact surface sanitizer to have such an extensive range of efficacy, including ESKAPE pathogens, drug-resistant bacteria, viruses, and bloodborne pathogens as previously discussed. This allows healthcare workers and hospitals the freedom to use surface disinfecting wipes anywhere from over-bed tables to NICU rooms.
Versatile Compatibility. Costs associated with damaged equipment are major concerns for healthcare facilities, and damaged surfaces (even if clean) can negatively affect patient perceptions of the aesthetics and cleanliness of the hospital and environment. Leveraging our history, experience and understanding of formulating with ethyl alcohol, the new PURELL wipes also offer hospitals a wide range of proven surface material compatibility, including electronic devices. While it is true that many materials in healthcare are chosen specifically for their resistance to chemical degradation (e.g., plastics – a lightweight and costeffective alternative to stainless steel), there are a group of materials used in healthcare despite known sensitivity to chemical degradation because of the important role they play. Some examples of these materials are aluminum (think walkers), acrylics (think incubators or sneeze guards) and polyurethane (think tubing or protective covers). The PURELL Healthcare Surface Disinfecting Wipes have been shown to be compatible with each of these sensitive materials, unlike products that contain actives such as bleach, hydrogen peroxide or quaternary ammonium compounds (quats).
Coverage You Can Count On. According to the EPA, if a surface dries more quickly than the required time for efficacy, known as the product’s “contact time”, another wipe should be used – and so on – until the desired surface area has been covered for the entire kill time required. Contact time is an important part of how much surface area one wipe can effectively keep “wet” for
Healthcare Terms
There are several terms used within healthcare that are often incorrectly used interchangeably. It is helpful to clarify them to avoid confusion:
Contact time
(wet time, kill time, or dwell time)
Dry time
Undisturbed contact time
The amount of time the disinfectant product must be “wet” and “in contact” with the surface to effectively kill all of the organism(s) that were tested.
Time from application until the surface is fully dry. This time should be at least as long as the contact time to ensure efficacy.
Time the surface remains untouched after product application. This term implies the surface does not need to remain wet for the contact time but just untouched. This term is sometimes used by industry or in the field, but it is an oversimplification and does not match regulations and guidance. Per the EPA and CDC, the surface must remain wet, and not just undisturbed, for the time specified on the label.
the required time (see “Healthcare Terms” for additional definitions) as visible wetness is a critical measure of product efficacy. In healthcare settings, surface wipes are chosen specifically because they offer the potential for on-demand disinfection that is both efficient and effective. Therefore, when facilities are considering surface disinfecting wipes, understanding how much surface area one wipe can effectively cover for the listed contact time is integral to how many wipes should be used to clean the needed surfaces, devices or equipment. In a head-to-head comparison, the new PURELL wipes were proven to cover 3X to 5X the average surface area covered by two of the leading healthcare surface disinfecting wipes on the market – allowing hospitals to do more with less.3
Only PURELL, the most trusted brand in hospitals, offers the efficacy you require with the compatibility you need and efficiency you want – all in just one wipe.
1 Otter JA, Yezli S, Salkeld JA, French GL. Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings. Am J Infect Control. 2013 May;41(5 Suppl):S6-11. doi: 10.1016/j.ajic.2012.12.004. PMID: 23622751. 2 Donskey CJ. Does improving surface cleaning and disinfection reduce health care–associated infections? Am J Infect Control. 2013;41(suppl 5):S12–S19. 3 *Based on 5 PURELL Surface Wipes vs 5 of each of the leading competitive wipes and two minute dry time. GOJO Development Lab, 2945R1R1; LIMS #:
P21-0084-001
An Unwelcome Guest
Inflation? Why now? What’s next?
Inflation – no matter when it strikes – is an unwelcome
guest. Still, providers are asking why now, when the American Medical Association reports that Medicare physician pay has increased 11% over the last two decades but the cost of running a medical practice increased 39% during that same time? Why now, just a few months after healthcare consulting firm Kaufman Hall projected that hospitals nationwide would lose $54 billion in 2021 and more than a third of U.S. hospitals would maintain negative operating margins through the year’s end? And why now, just as nursing homes were reported to have lost 220,000 jobs between March 2020 and October 2021 and were projected to lose $94 billion in 2020 and 2021?
Manufacturers and distributors are asking themselves similar questions, as the cost of raw materials and transportation keep going up.
How long will it last? How bad will it be? Well, in December, the Federal Reserve Board said it was committed to achieving “maximum employment and inflation at the rate of 2% over the longer run.” Other sources aren’t so optimistic. In the same month, mortgage financing firm Fannie Mae projected inflation would hit 7% in the Q1 2022 before decelerating to 3.8% by the end of 2022.
In the medical products and equipment industry, three factors will contribute the most to inflation in 2022, says Margaret Steele, senior vice president of med/surg for Vizient: rising labor costs, transportation costs and raw materials. “However, labor costs will likely have the most long-term impact as this metric doesn’t typically decline unless new technology is introduced to create more efficiencies in the manual labor aspect of production.”
An Unwelcome Guest
Labor costs
“COVID-19 had a dramatic impact on the world’s workforce and production that we’re still feeling today,” says Kim Anders, group vice president, strategic supplier engagement for Premier Inc. “Healthcare has also felt the pinch as workers in high-demand groups, from nurses to pharmacists to ICU physicians, have been in short supply and subject to a more competitive recruiting landscape. Early retirement and employee burnout have also contributed to the healthcare worker shortage.”
U.S. healthcare was experiencing a workforce shortage prior to the pandemic, but it has been exacerbated by the mental and physical strain of COVID-19, says Anders. She points out that healthcare had the secondhighest quit rate (6.4%) in November of all industries. Among nursing homes, employment remains far below pre-pandemic levels, and hospitals and health systems remain nearly 100,000 jobs below their pre-pandemic peak in February 2020.
In healthcare, workforce shortages mean higher costs, not lower ones. An October 2021 Premier analysis revealed that U.S. hospitals were paying $24 billion more per year for qualified clinical labor than they did pre-pandemic, says Anders. For the average 500-bed facility, this translates to $17 million in additional annual labor expenses.
“Many hospitals and health systems were forced to turn to staffing agencies to supply urgently needed health workers to care for the increasing number of patients,” she says. “However, the pandemic’s longevity has pushed hospitals to rely on these temporary workers more than ever – ballooning the typical costs for travel staff.”
Supply chain costs
As of mid-January, global logistics remained “an overloaded and stressed combination of port congestion, vessel shortages, equipment and container shortages,” says Anders. Not surprisingly, the cost of land, air and water transportation increased to record or near-record levels. Lead times for the manufacturing of additional cargo ships, shipping containers and freight trucks were also significant.
Although shipping container availability has improved slightly, costs remain at record levels, she says. Compared to prices in March 2019, freight rates from China to the U.S. increased 500 percent with spot rates up to about $10,000 per container, compared with the more typical price of $1,200. In addition, the pandemic and other restrictions have limited the availability of dockworkers and truck drivers, causing delays in cargo handling after it arrives at ports, she says. “There’s no clear consensus on how long this situation will last, with some experts assuming that these logistical challenges will remain for the foreseeable future.”
Raw materials
All that notwithstanding, a key driver for inflation in medical products lies at their very source – that is, the raw materials needed to make those products, says E.V. Clarke, CEO of Health Products Xchange, whose HPXConnect is an electronic marketplace connecting manufacturers, distributors, providers and others. In most industries, too much money in the market leads to inflation but doesn’t necessarily lead to a greater demand for medical products, he says. Instead, it increases the cost of the raw goods, such as minerals and resins and other natural resources.
“If metals are diverted from the medical side to making higher-margin goods, like washing machines, that will have an impact on the medical market,” says Clarke, who co-founded Health Products Xchange in 2018.
“It’s especially true for commodities, like crutches – though it also applies to things like suction canisters, OR towels and tubing,” he says. “In the case of crutches, there’s no sudden surge in demand, but the price of aluminum and logistics has increased 40% since the pandemic began. So you have a low-cost, bulky item – crutches – and the manufacturer can’t pass along all those costs, at least not immediately, given the nature of the U.S. healthcare system and the contracts between distributors, manufacturers and providers.” Consequently, manufacturers may lower their inventory of crutches and shift production to higher-margin goods.
The result is a shortage of crutches, which can push up prices of that commodity.
Clarke expects logistics and raw materials pricing to remain inflated for the next 12 to 24 months, and that’s not accounting for anomalies, such as rolling blackouts in China or domestic regulations about the sourcing of finished goods and even the raw materials used to make them. In economic storms such as the current one, alternative suppliers and brokers come out of the woodwork, he says. And that’s a market opportunity for digital marketplaces such as HPXConnect.
Todd Nelson, director of professional practice and partner relationships, and chief partnership executive for the Healthcare Financial Management Association, says that partnering with national, regional and local organizations will continue to be a key to addressing inflationary pressures. “For many it will take the form of looking at non-traditional partners to assist them in having access to products and equipment they depend on, which will require a level of creativity, building trust and relying on additional clinical and financial evidence to build that credibility with new partners.”
Think it through
What should providers and their suppliers do about inflation? For starters, avoid panicking.
Vizient believes inflation will continue through much of 2022, though at a lower rate than its most recent 7% pace, says Jeff King, research and intelligence director for Vizient. “Production costs will continue to put pricing pressures on product and service producers,” he says. “Vizient anticipates that raw material costs will decline, as resins already started their descent late last year. Unfortunately, the climbing labor costs won’t return to previous levels, and the issues impacting transportation appear to be long-term and will strain the ability of producers to maintain current price levels.”
“Everyone is facing increased costs,” says Steele. “However, it’s important that we look at these drivers individually. For instance, we may see some relief as it relates to ports and raw materials in the next few months, therefore those price increases should be temporary. However, labor shortages and increased labor costs are likely here to stay.
“Often, we look at all these factors collectively and accept the increased costs for the longer term,” she says. “We need to stay diligent and have transparent
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An Unwelcome Guest
conversations with suppliers. This should allow for appropriate, temporary adjustments to ensure supply and business continuity rather than allowing the water line to rise across the board.”
Pricing strategies
For suppliers, contracting and pricing strategies only work when the economy for a category of goods or services is balanced, says John Strong, chief consulting officer for Access Strategy Partners, a national accounts consulting firm. “If I were still a supply chain executive in a hospital or health system, I would be more concerned about having goods available at a price that is reasonable and stop worrying about whether I’m getting the lowest price on everything.”
Lowest price isn’t the only measurable factor that goes into a supply chain executive’s annual goals and objectives, he says. Supply chain professionals are more likely to get fired due to declining order fill rates and services to the people on the front line. “A balanced scorecard requires looking at service levels, real value analysis and other factors – not just price.
“I’m a big fan of bringing products back to the U.S. to manufacture and sell,” he continues. “It provides meaningful work for our own country and has the added benefits of a shorter supply chain (and less carbon footprint) as well as the possibility of rebuilding industrial deserts in our largest cities. Yes, it is going to cost more in terms of a direct price. But I must ask, What have been the indirect costs to this country of offshoring much of our manufacturing base – inside and outside healthcare?”
Nor can supply chain executives “source” or “procure” their way out of the difficulties in today’s med/surg marketplace, says Strong. “You cannot get manufacturers to make things if they can’t make a reasonable profit. Consolidation has brought us to a total of three national GPOs, and many products that can be aggregated by them in a reasonable fashion already have been. Having scale, size and influence is important, but you can still reach a point in the economics of any goods or services where they cannot be provided any longer at a contracted price, [especially] in a period of short supply, inflation, supply chain/logistics issues or other factors along the supply chain.
“It is similar to the so-called ‘hog cycle’ in economics,” he says. “More farmers start to raise hogs when prices are high. This leads to an overall lowering of prices because of the increase in supply. So farmers get out of hogs and into something else because the price has become too low, driving prices up again. The cycle repeats itself.”
Provider strategies
“While it may be difficult to identify what major U.S. or global events will impact the world’s economies and supply chain, Premier aims to arm our members with the information, tools and support needed to tackle cost imperatives,” says Anders. The company is accelerating the development of its MedSurg and ASCEND Inflationary Calculators so members can stay abreast of the most recent inflation estimates, she says.
In addition, through collaborations with Prestige Ameritech, DeRoyal Industries, Honeywell, Exela Pharma Sciences and VGYAAN Pharmaceuticals, Premier is producing “millions of domestically made PPE and pharmaceutical products ... thus helping to eliminate overreliance on overseas manufacturing and port congestion,” she says.
Meanwhile, the company continues to help hospitals and health systems deal with clinical and nonclinical labor shortages and rising labor costs. Its PINC AI analytics technology can provide health systems with productivity benchmarks to pinpoint areas in need of adjusted staffing levels, says Anders. Premier also has contracts to help health systems control the costs of FTE and/or contingent staff for both clinical and non-clinical assignments.
Buckle up
“Buckle up,” says Strong. “Many people working today don’t remember the Jimmy Carter years, when we witnessed a period of runaway inflation. I still remember being relieved to be able to get a three-year variable mortgage note on a condo at 14.5%. The average rate at the time for a fixed 30-year mortgage was somewhere around 18%.”
The demand for medical products and services won’t go away, he adds. “The question for [providers] is, What price am I going to have to pay in 2022 to see those goods arrive on my receiving dock?”
