Staff Shortages - Is Healthcare Committing Slow-Motion Suicide

Physician, Nurse, and care team staff shortages are rampant in healthcare and becoming more so. To address the problem, Admin, for the most part, becomes a one-trick pony, doing what it has always done and getting the same results—more shortages.

What’s Really Going On?

Let’s start with a fact that has eluded virtually all in healthcare, from the C-suite to the stockroom.

Staff shortages, like nearly all the woes of healthcare, are systems problems.

Healthcare is delivered in some of the worse, most stressed, most dysfunctional systems in any industry (yes, healthcare is now highly industrialized).

Fact: Approximately 94% of outcomes produced in healthcare, good and bad, are a function of the systems in which staff works, not the efforts of staff. Even the best people cannot win over a bad system.

The systems in healthcare are becoming progressively worse because they have been resisting change in a changing environment for many years. Covid brought to a boil long simmering systems problems.

Nobel Prize-winning Systems Science is Driving Healthcare Change

The Nobel-prize winning Law of Dissipative Structures tells us systems that resist change become ever more stressed. Stress causes dysfunction.

Without transformation, systems become so stressed/dysfunctional they cannot contain the stress energy and enter “reorder”, a flight toward chaos. This highly stressed condition is the current state of many of the systems in which staff deliver care are today.

Worse for staff, systems stress is passed on to staff as long term, fear-based, emotional stress. Here we have identified the primary root cause of staff shortages, stress induced burnout, moral injury, dissatisfaction, low morale, depression, and early retirements.

Don’t Forget Med and Nursing Schools

We talked about why staff is leaving. We might also speak to why there is also a shortage of new staff coming into healthcare.

Schools have the exact same problems as healthcare—systems problems. The highly stressed systems in both med and nursing schools pass that stress on to both facility and students. Facility leave. Now we have a shortage of facility in both med and nursing schools and so must cut student admissions. Stress on students also drives some of them out of school.

The entire pipeline of healthcare staff from school through now early retirement has, for the most part, become one highly stressed system to another.

Code Blue! Beware the Positive Feedback Loop!

Notice that with the outflow of staff, stress is increased on both the systems and people left behind. This creates more dysfunction in the systems and drives those still on the job toward burnout and early retirement.

We are nearing a tipping point, a positive feedback loop, whereby shortages of staff cause more shortages of staff. Healthcare must avoid this tipping point at all costs, as it will be difficult to recover from it.

A New Strategy

It appears that taking a systems-based approach to resolving staffing problems, including engaging staff in finding and eliminating root causes of shortages, never sees the light of day in healthcare C-suites. This must change.?????

The only sustainable way to address the staff shortage/burnout problems is to fix/de-stress the systems in which care is delivered and taught.

Leadership might look to the 3D Problem Solving Model being implemented at UAB Medicine, which starts with the voices of the entire care team being heard: https://lnkd.in/d5ZaGUeD . Notice the renewed energy of nurses, physicians, and support staff.

UAB is submitting two peer reviewed papers to major journals on implementing 3D to specifically address the burnout problem. We trust, to reduce burnout more broadly and heal those still on the job, these publications may open mainstream healthcare to the efficacy of 3D.

Regardless of whether one adapts a 3D approach to resolving systems problems, healthcare must wake-up to the fact its staffing issues are systems problems and take a systems-based approach to resolving them. Doing more of the same expecting a different result will only contribute to the problem.

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Please share this article with leaders in the C-suite who care about the well-being of staff.