Staffing Robot - Healthcare Staffing Technology, Design & Marketing Blog

My Interview on Staffing Talk

Last Friday, Gregg Dourgarian of Tempworks Staffing Software and the blog Staffing Talk had me on his call in show. We discussed several topics such as ShiftWise Healthcare Vendor Management, the current economic state of the healthcare staffing industry, the social media application foursquare, Social Media Marketing (SMM) and staffing agencies and my blog Staffing Robot.

Gregg is an active blogger and continues to try new things. He is definitely helping to further advance the use technology and social media in the staffing industry. Thanks for having me on your show Gregg.

You can watch the show here.

What is the Hospital Job Growth Outlook for 2010?

This article in Healthleaders Media talks about some encouraging signs that could point to increased job growth at hospitals in 2010. Interestingly, it also illustrates how dismal of a year 2009 was.

Bureau of Labor Statistics preliminary data show the healthcare sector created 267,000 new jobs in 2009. This is a significant drop from 2008 when healthcare created 363,600 new jobs.

One thing we've learned is that healthcare was not completely recession-proof over the last year and a half as we've seen a number of large-scale layoffs across the board," says David Cherner, managing partner of Health Workforce Solutions, LLC, a San Francisco-based research firm. But, certainly, it is much stronger than any other segment of the economy.

Here's to hoping the healthcare segment stays strong and proves to be a good year for jobs.

Should Hospitals Focus on Eliminating Their Agency Staff?

It's a question that never seems to go away. Can hospitals truly eliminate all of their agency usage? Perhaps a better question is - should they? From a management perspective, the healthcare staffing industry seems to be one of the last to see the usage of temporary labor as being negative.

By now we've all read the L.A. Times article that highlighted some bad practices of a few staffing agencies and used these examples to paint the entire industry with more negative stereotypes.

The American Staffing Association had a great response to the article that was necessary and expected. What was nice to see, however, is people like Rebecca Hendren from Healthleaders Media who has written a couple of excellent articles on how hospitals can better manage staffing agency professionals. In her first article Rebecca discussed how positive work environments and better orientation practices can improve the process for working with agency staff.

This week, Rebecca wrote another article about how hospitals are making effective use of technology to reduce their reliance on agency staff. She points out hospitals that have effectively deployed internal staff scheduling software to fill more shifts with internal staff, offer more scheduling flexibility and improve morale. The Healthleaders Media article made several great points on this topic and I wanted to add a few of my own.

1. It's no secret that scheduling software applications can dramatically improve a hospital's staffing situation. However, software won't solve the nursing shortage. It bothers me to say that. I'm a huge believer in technology but sadly, it will not solve all of our problems. Even though the economy has given us the illusion that the shortage of healthcare professionals has decreased, this is only a temporary situation (no pun intended). All analysis suggests the shortage will only continue to get worse. According to the Bureau of Labor, at 23%, the demand for nursing will be much greater than the average for all other occupations between 2006 and 2016. So no matter how efficient the software, if there's no staff to manage - there's no staff - and working with temporary labor is still necessary.
2. Deploying a solution to better manage your internal staff while ignoring the management of staffing agencies won't solve your hospital's staffing problem. Hospitals need a solution that will manage all of their staffing - both permanent and temporary.
3. The article includes some popular generalizations about the use of healthcare agency staff such as: using agency requires more organization and effort and that it "can sometimes lead to resentment among the permanent staff, who question why their hospital is willing to pay twice as much to agency nurses to fill open shifts as it pays to its own loyal staff."

Healthcare Vendor Management Systems ensure that the process for managing agency staff is simple and effective. Implementing such a system means that the same, if not less, effort than managing internal staff is required. In addition, nurses do not get paid 2x as much if they work for an agency. The mark up on pay rates to agency staff does not equate to being 2x the cost of internal staff (especially if you factor in other benefits for internal staff) and this money is not all paid to the nurse. Further, there is an implication in this statement that the mark up is unnecessary. The mark up exists to provide quality staff, often under short notice and goes to cover the business costs of properly recruiting, screening, hiring and placing these professionals.

The solution is to more effectively utilize staffing agencies - not work toward eliminating them. Attempting to eliminate agencies can actually end up being more costly to hospitals in the long run due to increased staff overtime, burnout/turnover and higher management costs due to a lack of efficient processes if/when using agency staff is necessary. Additionally, until the nursing shortage is over it's not feasible for every hospital to fully eliminate their agency usage. Therefore, a better goal is to focus on more effective agency management - not elimination.

In the past I've written about several reasons to use agency staff so I won't repeat myself here. I'll only close by saying that focusing on things such as improved orientation, better credential compliance management and process automation with a comprehensive workforce management system is a more effective solution for hospitals in regard to addressing their concerns with agency staff.

Top Healthcare Staffing Stories of 2009 and Predictions for 2010

Over the next few weeks both of my sons have birthdays and I plan on spending some down time with my family for the holidays. Therefore, this will be my last post until the new year.

I thought I'd use this post to highlight some of the big events that affected the healthcare staffing industry in 2009 as well as make a few predictions about the industry for 2010. (is it 'twenty-ten' or 'two thousand ten'?)

What the healthcare staffing industry looked like in 2009:

Major downturn in spending on healthcare temporary staff.

The biggest news in 2009 for the healthcare staffing industry was undoubtedly about the downturn in the economy. My second blog post ever was on the reasons hospitals were spending less on healthcare agency staff. The down turn in the economy even made people start asking the question: "is there still a nursing shortage?" From there, leading economists confirmed that not only was the economy bad but that it will take awhile for it to improve and return the healthcare staffing industry to pre-2009 levels. And finally, the Staffing Industry Analysts informed us that the nurse travel industry decreased by 44% this year and we saw this downturn reflected in the revenue loss reported by major public healthcare staffing companies.

Widespread adoption of healthcare vendor management.

In 2009 hospitals gave a big vote of confidence to vendor management as the preferred model for agency management. VMS has matured in the industry and delivered on its promise of saving hospitals both time and money on their staffing costs.

How healthcare reform will affect healthcare staffing.

The topic of how healthcare reform will affect healthcare staffing couldn't be avoided. Many debates about the pros and cons of healthcare reform occurred on my blog and many of us had the privilege of hearing former Senator Tom Daschle's view on healthcare reform at the healthcare staffing industry conference. AMN even produced results from a poll suggesting that hospital CEO's feel healthcare reform will benefit the healthcare staffing industry.

Technology VMS companies struggle.

Even though some healthcare vendor management technology companies thrived in 2009 as hospitals increased their adoption of VMS, many companies did not fair so well. A few healthcare VMS technology companies had to close their doors this year while some VMS companies struggled to pay their staffing agency partners. Additionally, some VMS companies found acquisition to be the best way to survive the turbulent year.

Increased use of social media.

2009 was the year that many hospitals and staffing agencies began to use social media. Many hospitals, such as Providence St. Vincents in Portland Oregon who found success with their 'pink glove dance video' that went viral, took full advantage of these tools. Some hospitals are still behind when it comes to social media while several hospitals are finding success with tools such as Twitter. Both healthcare staffing agencies and hospitals are now promoting and monitoring their brands online, as the online tools for brand promotion and management are starting to become more prevalent. I've even created some helpful tools for people to search for healthcare staffing industry information and follow companies in the healthcare staffing industry on Twitter.

As you can see, 2009 was a very eventful year for the healthcare staffing industry. So what will the next year bring?

My predictions for healthcare staffing in 2010:

More consolidation of staffing agencies and VMS companies.

After struggling through the economic downturn of the last 1.5 years many companies are now really feeling the effects. I see several staffing agencies closing their doors and many more acquisitions in 2010. I wouldn't be surprised if we even see some consolidation with some of the major players. In addition, I expect we'll see some more acquisitions of healthcare VMS companies.

Continued adoption of vendor management.

Hospitals will continue to choose vendor management for their agency management solution. As the rate of adoption continues to increase, I expect we'll see hospitals still choose vendor neutral healthcare vendor management companies over agency run managed service providers.

New technology players.

The industry has gotten a bit stale in terms of innovation and new technology options. In addition, we've seen a decent amount of consolidation of industry technology companies. Both of these facts suggest to me that new players will enter the market and hopefully they will bring with them some exciting and innovate technologies. As these players enter the healthcare staffing industry I expect we'll see more and more hospitals and healthcare staffing companies embracing technology to improve their staffing process. Stay tuned!

New marketing methods and opportunities.

As budgets tighten many hospitals and staffing agencies will look for more inexpensive and effective methods for marketing their services. Many more healthcare staffing organizations will turn to SEO/SEM and social media for company/brand promotion. 

The market will come back slowly. Kind of.

Even though there are some positive signs for the economy overall and there has been some slight improvements in the healthcare staffing industry I don't see anything that suggests we should get too excited. Earlier this week the Staffing Industry Analysts (SIA) hosted a webinar about the economic outlook for 2010. Their predictions suggested that every industry will improve in 2010 - except healthcare staffing. In fact, they are predicting an overall decline of -1%. Therefore, unfortunately, I believe 2010 will still be a year of struggle. There will be some positive bumps here and there but we won't start fully pulling out of this down turn until early/mid 2011.

What are your predictions for healthcare staffing in 2010? Please share them here if you have any.

I wish you all well - happy holidays - happy new year. See you in 2010!

Healthcare Reform & Healthcare Staffing: The Debate Continues

When I started my blog I promised myself I wouldn't talk about politics. However, since then, the heatlhcare debate went into full swing. This is an incredibly important issue to me and therefore, hard to ignore. I've blasted out several tweets and written some previous posts on why I think we need reform and what changes healthcare reform will bring to medical staffing. This has put me in the middle of a few debates with some people. 

This week I spent some time in Canada and wrote a post about how healthcare staffing works with our northern neighbors based on the conversations I had with some people on my trip. Gregg Dourgarian of TempWorks and the staffing blog - Staffing Talk wrote a rebuttal to this post. I was going to comment back on his blog but my response grew past an appropriate length for a comment. Therefore, below is my response to Gregg's post.

Of course it's easy to find examples of inefficiently run government healthcare systems as Gregg's post talks about. And yes, there are several stories of unsatisfied Canadian’s coming to the states for care, just as there are several stories of unsatisfied American’s who turn to Canada for care and cheaper medications. But lets be honest, you can also find the same inefficiencies in the private sector. It’s fair to say that both solutions are imperfect. However, according to the stats, the vast majority of Canadian's are satisfied with their system of care.

What about the current government run healthcare programs in this country such as Medicare, Medicaid and the V.A.? If you asked people receiving healthcare from one of these sources if they want their “government healthcare” taken away to be given private insurance instead I'd be surprised if you found any takers. When I left the military I received care from the V.A. for several years. It was some of the best, most efficient, cost effective care I’ve received to date. Everything I’ve done since with my private insurance has been a costly hassle.

In regard to my comment on "unnecessary for-profit medical centers." Often times, private hospitals, clinics and imaging centers will establish their entities next to competing medical centers creating a shortage of staff and a glut of beds or imaging equipment such as MRI’s. This equipment and these facilities are expensive. Their cost, as well as the increased demand now created for staff increases our country's overall healthcare costs. In addition, many of these private facilities get money from the government to start their new operations which comes from tax dollars.

These facilities are unnecessary in terms of needing more beds or care options in a particular area that already had a lack of demand. This situation has happened several times here in the Portland market causing situations of vacancy in the newly established medical center, as well as exacerbating those in the centers with which they’re competing. These new centers exist for one reason - to create profits for the individuals that establish them. While often times the newly established medical center offers lower prices and different medical options in order to compete, (thereby providing “the consumer with choice” as it was put in the Staffing Talk post), the greater cost of healthcare to society as a whole increases from these situations. You may personally save a $1 today but you’ll pay $5 tomorrow.

There's no question that having a privately run healthcare system in the U.S. has led to major advancements in healthcare and medicine for the world as a whole. However, what good are these innovations if the vast majority of Americans (or people in the world) can’t afford them and therefore, are denied access to them? I am a big believer in keeping things private and also believe that government creates bureaucracies and inefficiencies in most things it touches. However, the private sector has been running things for years and that is why we are now in this mess. If the private sector could deliver on its promise in healthcare we wouldn’t even be having a debate.

The costs of healthcare are simply too high, the system is broken and we need a new solution. Here's what private companies and a private healthcare system have produced for us over the last 8 years:

• Average family incomes are lower now than they were 8 years ago.
• What employers paid for workers increased by 25%, all due to healthcare costs. These costs are expected to rise by another 10% in the next year alone.
• The average cost of a health insurance policy for family of 4 from 2000 – 2007 more than doubled – from $6,000 to $13,000.
• 62% of all bankruptcies in the U.S. are caused by healthcare costs.
• We spend 50% more on healthcare than any other country and yet:
• • The U.S. is 45th in the world when it comes to infant mortality – behind Cuba.
  • When it comes to life expectancy the U.S. is 50th – behind Bosnia and South Korea. 
  • The U.S. is the only industrialized country without healthcare for its citizens.
  • 47 million Americans are without health insurance, 8.7 million are children.

I appreciate the debate Gregg. And, while although I agree that most things in this country should be run by private enterprise, healthcare is not one of them.

Related Posts:

How Healthcare Reform Will Affect the Healthcare Staffing Industry
 

Healthcare Staffing: Canadian Style

I spent the last couple of days in Canada and learned some interesting things.

1. Lots of people really do say "eh" and "a boat" (about)
2. It's really a lot colder that far North
3. Vancouver is a beautiful city and has tons of great restaurants
4. Green traffic lights blink for some reason
5. The walk sign (little white light man) is different than the one in the states

I also met with a Canadian based company that makes staffing software for hospitals and they gave me some interesting information on healthcare staffing in Canada such as:

• All hospital census is always at 100%. There are 0 vacancies. The theories as to why were everything from - there is a waiting list for care in Canada and no beds are ever empty to - there are too many, unnecessary for-profit healthcare delivery organizations in the states causing a consistent census gap, mismanagement and poor staffing.
• All hospitals employees are unionized and the same organizations that run the educational centers for healthcare professionals negotiate on behalf of the unions.
• All of the hospitals are not for profit and effectively owned by the government.
• Due to all of this, there is little to no market for healthcare staffing agencies in Canada even though there is still a shortage of healthcare professionals.
• When polled, consistently, the people of Canada approve of their healthcare system by 80+%
• The company I met with also makes payroll systems for countries all over the world and claimed that 1) the U.S. has the most complicated tax laws over any other country and that 2) no other country they work with has local or regional taxes.

This information is anecdotal, as it came from a handful of people. However, I'm interested in learning more about it so I'll be doing more research on it. If anyone else has information on any of this please let me know.

Good Sign for the Economy: Demand for Temporary Staff Increasing

Some potentially good news in regard to the economy and staffing: Demand for temporary workers is rising according to the American Staffing Association.

The staffing index of the American Staffing Association has risen in recent weeks. The index stood at 83 starting in mid October and jumped to 85 by mid November.

The 85 reading is still about 10% below year-ago numbers indicating that the job market remains weak. However, demand for workers has picked up 21% since July according to the American Staffing Association.

The staffing industry is considered a leading indicator for the overall performance of the general job market. Typically, a rise in temporary hiring usually precedes an increase in general hiring. With a current U.S. unemployment rate at the highest it's been in 26 years (10.2 %) this is welcome news indeed.

AMN Poll: Reform may worsen healthcare worker shortage

In partnership with The Council on Physician and Nurses Supply, AMN Healthcare released the results of a recently conducted poll of hospital CEOs suggesting that healthcare reform will exacerbate the shortage of healthcare professionals.

"While the short-term economic environment may have temporarily eased the ability to recruit and retain clinical staff, the long-term dynamics of an aging population will drive the need for thousands of additional healthcare professionals," Susan Nowakowski, president of AMN Healthcare, said. "Any plan to expand access to care would intensify an already anticipated critical shortage of clinicians."

Healthcare reform has been a big topic this year. How healthcare reform will affect the healthcare staffing industry remains to be seen. However, most people seem to think it will definitely have a positive impact on the healthcare staffing industry as the demand for healthcare staff increases.

Hospital Recovery Appears V-shaped

There have been some positive articles in the last couple of weeks suggesting that the financial health of hospitals is improving.

Health Leaders Media is reporting that hospitals are not only recovering but showing signs a 'V' shaped recovery (one that both declines and recovers quickly).

"There has been an improvement at the hospital level that has allowed them [hospitals] to ease up on the cost containments," he says. "To the extent that they can, hospitals do not want to get caught not operating at appropriate levels in terms of staffing because that is going to hurt them in the long run. Job growth may not come back to historical levels, but over the next 12 months it will definitely be up from what we have seen through much of this year."

Of course, the only thing to be leery of when predicting 'V' shaped recoveries is that the prediction is too early and in fact, what we're seeing is a 'W' (an economy that declines, recovers and declines again). There are several predictions being thrown around in regard to the healthcare staffing industry and the 2010 economic outlook.

Hopefully this won't be the case. Reading about specific regions, such as Texas, also seeing signs of hospital recovery is also good news.

The percentage of hospital revenue left over after regular business expenses increased from zero in the third quarter of 2008 to 4 percent in the second quarter this year. In Texas, the proportion increased from 6 percent to 8 percent.

via www.dallasnews.com

Only time will tell. But let's hope for the best.

Major Healthcare Staffing Companies Take Major Hit to Revenue

It's not news to talk about how much the economy has negatively impacted the healthcare staffing industry this year. No company in the space has been immune. However, reading the Q3 financial reports of some of the major, public healthcare staffing companies is just downright depressing.

After be delisted from the New York stock exchange late last year, Medical Staffing Network has continued to take a pounding. Medical Staffing Network Holdings Inc. (OTCBB: MNSW.PK), a Boca Raton FL-based healthcare staffing firm, reported third-quarter revenue fell 41.9% to $78.9 million from $135.8 million in the same period last year.

"The healthcare staffing industry is still experiencing a difficult economic environment, although we are beginning to see some very early-stage positive trends," said Chairman and CEO Robert Adamson. "We have experienced an increase in demand in October, up from September levels, seemingly due to the flu pandemic."

Medical Staffing Network posted a net loss of $15.2 million compared with net income of $2.5 million in the third quarter of 2008. The company reported a $14.0 million charge for goodwill impairment in the most-recent quarter as well as a $700,000 charge for impairment of intangible assets.

Medical Staffing Network Holdings Inc. (OTCBB: MSNW.PK)
For the third quarter ended Sept. 27, 2009, compared with the same period in 2008.
Revenue: $78.9 million, -41.9%
Net loss: $15.2 million vs. net income of $2.5 million

The largest company in the industry - AMN Healthcare Services Inc. (NYSE: AHS), reported third-quarter revenue fell 47.2% to $166.4 million from $315.0 million in the year-ago quarter.

Nurse and allied healthcare staffing revenue fell 62.2% on a year-over-year basis in the third quarter to $82.1 million. Physician permanent placement revenue fell 30.6% in the third-quarter to $8.7 million. And third-quarter locum tenens revenue fell 11.5% to $75.5 million.

"The unprecedented market contraction experienced by the healthcare staffing industry over the past year is a direct reflection of the rapid rise to historically high levels of general unemployment," President and CEO Susan Nowakowski said. "The decline in volumes we experienced during the first nine months of 2009 have certainly highlighted the importance of our ability to remain agile and disciplined in our execution."

AMN posted a third-quarter net loss of $2.0 million compared to net income of $9.5 million in the same period last year. The most-recent quarter included a restructuring charge of $6.2 million. Fourth-quarter revenue is estimated to decline 10% to 15% compared with the third quarter, according to the company.

AMN Healthcare Services Inc. (NYSE: AHS)
For the third quarter ended Sept. 30, 2009, compared with the same period in 2008.
Revenue: $166.4 million, -47.2%
Net loss: $2.0 million vs. net income of $9.5 million

Cross Country, who only a few short years ago held the #1 spot in the industry, also took a dramatic loss. Third-quarter revenue for Cross Country Healthcare Inc. (NASD: CCRN) fell 27.2% to $129.6 million from $178.1 million in the third quarter of 2008.

Third-quarter nurse and allied staffing revenue at the Boca Raton FL-based healthcare staffing firm fell 50.3% to $64.1 million from $128.9 million in the year-ago quarter. Clinical trials third-quarter revenue fell 35.4% to $16.4 million.

Travel nurse staffing volume rose 6% since mid-September, President and CEO Joseph Boshart said. "This improvement in staffing volume has resulted from a significant increase in demand since the spring, with current open order levels for travel nurses six times the levels seen prior to the summer."

Third-quarter net income fell 84.3% to $968,000 from $6.2 million in the year-ago quarter.

Cross Country estimated fourth-quarter revenue of $120 million to $123 million, a year-over-year decline of approximately 40% to 42%.

Cross Country Healthcare Inc. (NASD: CCRN)
For the third quarter ended Sept. 30, 2009, compared with the same period in 2008.
Revenue: $129.6 million, -27.2%
Net income: $968,000, -84.3%

Although I want to be optimistic and there are several signs out there suggesting stabilization, it's discouraging to still be seeing such dismal numbers from the top players.