Episode Transcript
Speaker 1 00:00:08 Well, hello everybody. This is Josh Berson. We are going to talk about one of the most groundbreaking studies we have ever done. And it's the beginning of a whole series of studies in the global workforce intelligence project. And I'm going to introduce Kathy ands our senior VP of research. But before I do that, let me just tell you briefly what this project is. We set out about a year ago to look at these terrible talent challenges that companies are having in many, many industries and virtually every organization of every size. And we discovered that what was going on was industries were emerging and combining, and not just digitizing, but changing and the job roles, the job titles, the skills, the career pathways, the pay models of the people they were trying to hire were different and new to the ones that they already had and creating talent challenges.
Speaker 1 00:01:02 And so we embarked on a large project using data from eightfold and other sources to study this industry by industry. And the industry that we started with is the healthcare industry and Kathy Andris. Who's our senior VP of research while introduced right now actually comes from the healthcare industry. And so she led this research. So we're gonna talk about it for 20 or 25 minutes, and then we're going to be launching the research, the middle of September, those of you who are members can get access to all of the materials. And we're also introducing a healthcare collection in our research membership. For those of you that join, we hope you all join. So there's gonna be lots more coming. So Kathy welcome. Why don't you start with a little intro about who you are and what you do here.
Speaker 2 00:01:44 Thank you, Josh, super excited to be here with you, Kathy and senior vice president of research. What I do here is lead all the research that we are doing here at the Josh Wilson company, which includes many different areas of HR and talent and learning, but then also the new research that we're doing now, industry by industry and what uncovered is kind of fantastic and mind blowing. So I can't wait to share all.
Speaker 1 00:02:06 So let's talk about healthcare. First of all, you worked in healthcare. Tell us a little bit about your background and then what is going on in this industry?
Speaker 2 00:02:13 So my background in healthcare, I worked at Kaiser Permanenta, who is a very large 220,000 employee healthcare, uh, organizations, both in the insurance and healthcare delivery space here in the us for about almost eight years. And what I learned, I loved actually working in the healthcare industry because what I learned working in the healthcare industry about the people and the, the business there is it's, uh, an industry full of people that are motivated by doing good, by caring for others, by giving back to patients and, and each other, quite frankly. So it's a very mission driven industry. It's a very complex industry. That's actually the reason why I joined that industry as a practitioner because it's extremely complex. And as we look now from outside of not being in a healthcare organizations, but in the industry overall, we had discovered how complex it really is in terms of roles that they have to have two to three times more roles in healthcare than for example, we compared to two financial services. Each of the roles is extremely complex in terms of the skills, the capabilities, the requirements for professionals, whether they're in clinical delivery or whether they're in a support function, very, very complex industry full of life in that situations, quite frankly, because if you think about it, when I worked in healthcare, that the environment that you create for your workforce can impact patients' lives and meaning really somebody could die if their situation is bad. So that kind of impact is both empowering and frightening, honestly. So it's a very interesting industry I gotta say. And,
Speaker 1 00:03:48 Um, well thank you. I think that occurred to me about it as we've learned about it is that it's like all of the things you have to do in a regular business plus life or death, medical procedures of all different shapes and sizes and all the systems and technologies and drugs, exactly. Procedures around that. Okay. It turns out it's also the largest employer in the United States. Yes. Close to 15% of Americans work in the healthcare industry or something along those
Speaker 2 00:04:10 Lines. Yes,
Speaker 1 00:04:10 Exactly. So the way that GWI works is we look at the roles by clusters by type of role. And then the challenges. What did you learn about the different types of roles that people play in healthcare and where the talent challenges are? When
Speaker 2 00:04:25 We looked first at clustering, all the roles that are in healthcare, we identified not surprisingly that over 80% of all the roles are in the clinical care delivery area, which it should be right in by itself. Healthcare is by its nature care delivery business. What we also identified as we look deeper into these roles and role clusters, we call them role clusters is by far the biggest role cluster is the nursing cluster and the nursing cluster doesn't just include RNs, but it also includes LPNs and LVNs and a R PNS. If you don't know all of these acronyms, it's basically different levels of self noticing population. So more than 50% of the roles overall in healthcare, actually in that nursing population. So the nurses make or break healthcare, basically nursing population.
Speaker 1 00:05:11 So of all of the roles, whether it be it, administration, facilities, consulting, whatever the clinical delivery is more than half yes of the individuals of the people. It's somewhere around almost 60%. As I remember the
Speaker 2 00:05:25 Overall care delivery is more than 80%. So of those there's nursing people in there is physicians and other people. So nursing is more than 50% yeah. Of the overall.
Speaker 1 00:05:35 And what did you learn about the gap and challenge and talent challenge and shortages in that area?
Speaker 2 00:05:41 I mean, everybody has probably heard about the nursing shortage, right? It's no surprise that every time you look at open jobs, reports and nurses are one up the top five open jobs. And in the us here, we have, every time I look at it, 700,800,000 nursing roles overall. So it seems to be a big challenge when we interviewed a lot of healthcare to, they also told us the number one problem we have, not just in the talent of people area, but overall business problem is actually the capacity to deliver care. One of the CES told us, we asked him about tech talent and I'm like, yeah, tech talent is fine. But what I really need is somebody to deliver care because I can't run my business, my care, my hospitals on data scientists, right. Who's gonna deliver care. So that's, it is not just a people problem.
Speaker 2 00:06:26 It's actually a business problem. So CEOs for the first time, in 70 years, more worried about the nursing gap than about financial pressures before it's always financial pressures because reimbursement rates and everything else is another challenge in its own in healthcare. But for the first time in 17 years, it's on the top list of CEO priorities. It's also a CFO priority of course, because a labor cost arising a lot. So how do you make sure that you actually control that labor cost? Because in healthcare, you can't just pass it on to the consumer. There's a lot of restrictions on how much you can pass on. So it's a big, big
Speaker 1 00:07:00 Problem. So the number one challenge in healthcare is the availability of nurses and nurse related roles. And it makes up somewhere around 50, 55, 60% of the people exactly. In the industry. Exactly. There are about seven or 800,000 jobs open right now, anytime.
Speaker 2 00:07:16 Yeah.
Speaker 1 00:07:16 What have we learned about filling those rules? What is the potential gap going forward? Tell us about how the analysis worked.
Speaker 2 00:07:22 So that was a fascinating analysis where we wanted to quantify, how big is the gap E even going to get? We know right now, 700, 800,000 nurses positions are open. Everybody tells us it's only going to get bigger because a lot of nurses are for retirement. Not many people enter into the nursing profession and the population is getting older and older as birth rate is going down. So that's kind of this, somebody called it a silver tsunami, basically that we're up against because people are getting older and need more care while also a silver tsunami of the nurses or each age of the nurses is actually 52 or 53. So lots of people are gonna go into retirement. So how big is the gap going to get? So we identified that we are going to be up against the challenge of 2.1 million nursing people missing by 2025. So that's a huge gap,
Speaker 1 00:08:12 2.1 million, 2.1 million missing. Yes. So how do you take us through the numbers? Because given that something like 14 and a half to 15% of Americans work in this industry, and there's 800,000 jobs open today, 750, we're gonna be short 2 million.
Speaker 2 00:08:29 Yes.
Speaker 1 00:08:29 Yeah. In the next three years to figure that out. Yeah.
Speaker 2 00:08:32 So we figured that out, we looked at how many nursing professionals do we have today in the us? And we, based on BLS numbers, we figured out there's 5.8 million people in the nursing profession today in the us. We predicted that by 20, 25, we'll need a little bit more because of the aging population and everything else. So about 6 million people will be needed by 2025, which doesn't look that bad. Right? Five point 0.8, 6 million, 200,000 people was not that bad. But then when we looked into how many people are actually going to leave, we are predicting retirements. In the next few years, we found out that 3 million people will actually leave the professional together. They either, many of them will retire. Others will opt out of the professional together because they get frustrated or the profession for a number almost
Speaker 1 00:09:17 60% of the existing nurses are going to leave the profession in the next three
Speaker 2 00:09:21 Years. That's right. That's right. Exactly. Wow. So you'd only have 2.8 million people then in the profession and you need 6 million. Well, some will also come into the profession. So we predicted based on people, passing nursing certificates and, and other things that 1.1 million people will enter the profession. So when you add 1.1, two, 2.8, 3.9 million people. So if you need 6 million and you get 3.9, that's a 2.1 million people gap, basically that will see.
Speaker 1 00:09:50 Whoa, okay. Basic healthcare organizations are slipping behind very, very quickly. Yes. In filling this gap, there's a gap today of seven or 800,000 jobs open. Yes. And it's gonna get bigger. It's
Speaker 2 00:10:02 Gonna get a lot
Speaker 1 00:10:03 Bigger. Okay. So what did we figure out on how to fill that? Tell us more about what the next finding was. And
Speaker 2 00:10:09 When we talked with all these CES of these healthcare organizations, like big, large healthcare organizations, they're all kind of pulling that hair out because they're saying I have this big gap. I already have a big gap. I don't know how, how big it's gonna be in my organization. It seems like a huge problem. I can't really operate without that. So of course, a lot of them are focusing on recruiting, right? We get a higher, more people into nursing. Can you maybe balance the talent pool from states where there's more nurses than you need to states where you don't have enough nurses? Can you predict retirements and not fill just backwards, moving but plan for basically these openings to come up because organizations of course know many people in their organization up for retirement, all of these, can I add more recruiting technology? Can I add more recruiting head count?
Speaker 2 00:10:54 Of course, recruiting will continue to be a big drive up all of that. But we found out and what we figured out and predicted is of that 2.1 million people gap about 350,000 people can be hired into the profession. So not that big, nowhere near closing that gap, recruiting alone. There's just not enough people out there quite frankly, that can hire, right? So you can push the problem around from one organization to the other and recruiting and maybe attract people, bring people from different places, but it's not gonna fill that gaps. There's also a lot of driver on focusing on retention, right? Because nurse turnover has actually increased significantly in depend on organizations. It has increased to 6%, but even across the profession, it has increased by 10 percentage point or from 18 2% to 28, 30% overall. So retaining people in the professional, retaining people in your organization of course is very important too.
Speaker 2 00:11:48 And that's gonna help mitigate that gap too. But still the I impact of that is not gonna be that big. So we identified that about 400,000 people give or take, can be retained in your organization or in the professional together. Well, if you add that to the 350,000 yards, 750,000 people still know when you're closing that gap, the next, maybe more strategic and forward looking strategy, that organizations also deploy that we call reskill, of course, reskilling people, maybe in your organization, in your industry. Can you upskill, for example, people that might be displaced in the more administrative, maybe a receptionist, those kind of areas of healthcare, where jobs are gonna be automated away. Could you reskill them into nursing? And of course that's a really good strategy. It's a longer term play because we don't get up in the morning and in the afternoon you're a nurse, right?
Speaker 2 00:12:40 You need to, usually you still need a four year degree or some organizations are actually revisiting the four year nursing degree altogether to say, how can we break up all of these RN jobs into some lower, skilled, lower level nursing jobs to add to that as well? So reskilling is really big career pathways is a really, really big theme here. And what we mean by career pathways, literally a different profession. So somebody might be a clean person and what they call an environmental health person basically. Well, a lot of these kind of jobs will be automated away or augmented with technology might not be needed in the future. Can you help them build a career into a nursing profession? We call that career pathways and there might be a lot of skills and capabilities that people already have from these service jobs that might go away to move into nursing jobs.
Speaker 2 00:13:27 So that's another really strategic piece and career pathways into these professions. Some organizations, we had a great conversation with rec till from Providence, a big healthcare system in the west coast here in the us. They are actually building career pathways from outside of their organization too. And what they mean by that is they're working with Amazon. When Amazon trains their B skills, they displaced warehouse workers because out of robots will carry the boxes around. Amazon gives them a career pathway, help them get their education that they need and of that for free on Amazon's work, time to become a nursing professional and that Providence place them so really innovative way to actually help.
Speaker 1 00:14:12 So how much of the 2.1 million gap do you think the reskilling can fill
Speaker 2 00:14:16 About half a million, so about give or take half a million? So if you add all of this up, you are still about 850,000 people short, so there's still a significant
Speaker 1 00:14:25 Gap. So if you, so if you do the absolute best you can do in recruiting, the absolute best you can do in retention, the absolute best you can do is reskilling. You're still short 800,000 people in three years.
Speaker 2 00:14:36 That's right. Exactly. You're still gonna be sure that, so, so
Speaker 1 00:14:40 What are these healthcare companies gonna do?
Speaker 2 00:14:42 So they are actually what we call redesign. So they are thinking about new job models, new work opportunities, new employment ways, gig the work, for example, redesigning the jobs itself themselves to, uh, bring in team based work, to bring in automation and augmentation, um, taking work apart and putting it together into different pieces. We identified that this is actually the biggest opportunity. So this is gonna get you 850,000 people close to
Speaker 1 00:15:12 Closing. It's reducing the number needed, not increasing the supply. That's exactly. Let, just make a comment on this, on these four RS. So these four RS recruit, retain reskill redesign mm-hmm <affirmative> are the core architecture of the GWI. We found this in every industry we're going after is that all four of these things have to work together. Yeah. Now on this fourth, one of the redesign talk about the nurse job and operating, working at the top of your top
Speaker 2 00:15:41 Of your life.
Speaker 1 00:15:42 That that concept is really important in every single industry. It's
Speaker 2 00:15:45 Very important in every single industry in every single job and what they, so this is concept in healthcare. That's called work. The top of license. What it means is you could apply it to other people that are not licensed top of your profession. What it means is that most of the time, maybe 90%, 95% of the time you do work, that you are uniquely qualified for like top of what you're qualified for. So in nursing, it means most of the time, 95% of the time you do nursing work, work that's patient related clinical in nature, not updating charts, not giving discharge procedures, not cleaning up when somebody gets sick, not giving out medication, not things that machines or lower skilled people could actually do better, faster, cheaper. So that's what
Speaker 1 00:16:31 It's really. So it's really org design it's job design it's decomposing, work into pieces and then finding other roles that could do the less skilled part of the nursing profession.
Speaker 2 00:16:41 That's exactly right. Yeah. So nursing aids, for example, a lot of these healthcare organizations we talked with they're using nursing aids and nursing aids are really people that might only have a high school degree and you train them on, for example, giving these charge procedures.
Speaker 1 00:16:55 So, okay. So we've, so we've taken apart the problem to these four components and, and almost half of the gap has to be filled through redesign it's by the way, this is true in every other industry we're finding how ready are healthcare organizations for this. And what did we find about the highly effective healthcare organizations versus the average?
Speaker 2 00:17:13 Yeah. So how ready they are. We actually used our own studies in all of these areas, recruiting and talented organization retaining, uh, through employee experience. Re-skill in learning and development and redesign with organization and work design. We and the Josh person company have studied all of these and now know how effective healthcare organizations overall are compared to the market, all industries basically. So what we identified on these four areas, we identified healthcare organizations are really good at recruiting because they had to be, they have to staff up with thousands and thousands of new people and other professionals in a year. So they're very good at recruiting. They bring in automation, they bring in a lot of recruiters. Of course, they have a pretty easy way of framing the profession in a very empowering and meaningful and purposeful way. Low value proposition is very grabbing and of course, very core to what people wanna do when they turn these clinical professions. So recruiting them much better actually than industry average in the retention area and employee experience a little bit worse than the industry average overall. So they're lagging a little bit because they tend to be ver not very individual centric that tend to be a very compliance, heavy
Speaker 1 00:18:26 Second category of, of employee experience. We talk with some, some analysts at MIT and there's a huge variation in the way nurses are treated. Yes. And we don't mention company names. Yes. But there are hospitals that are really good at retaining nurses. And there are hospitals that are terrible at it.
Speaker 2 00:18:42 Yes. It's huge variation. So it's not all one side spits all of it. So reskilling learning and development, they limp way behind the industry. So healthcare organizations are not very good at reskilling because they tend to have a lot of more compliance, oriented training that they have to do. Of course, there's a lot of regulations that they always need to train people up that doesn't really grab people's growth opportunities there, like what they wanna do with their career, so that they tend to be a lot less sophisticated as a mature in the reskilling area and learning and development.
Speaker 1 00:19:16 And that doesn't surprise me because they, because they've got a lot of compliance training to do that's
Speaker 2 00:19:20 Right, exactly. They have to all
Speaker 1 00:19:21 The time. And then in the redesign, tell us what you learned about the high performing group versus the low performing
Speaker 2 00:19:26 Redesign, the overall kind of on par with, with other organizations. But when we looked at how do advanced healthcare organizations compare to the, the healthcare industry? Now we're talking about the most sophisticated, most mature healthcare organizations compared to the rest of the industry healthcare. We found out that those advanced organizations have a lot more tech roles, which is maybe not surprising. So they have developed a lot more technology and then maintain it a lot better, which is kind of what we expected. But the interesting part of that was they also have a lot more transformation roles, innovation managers, consultants, process managers, lean, and six Sigma workshop facilitators. They actually don't just build the technology. They know how to deploy it and to take the jobs apart and put them back together in a different way, which is really better.
Speaker 1 00:20:13 So isn't as simple as automation. It's not as it's really transformation. This is in other words, healthcare organizations have to have consulting skills, transformation, consulting, change, and tech. Absolutely.
Speaker 2 00:20:25 Exactly. That's where it comes in because just having the technology, you might have these medication robots, but the Santa Dakota, because nobody knows how to deploy them and your workflow hasn't changed. So you're not really using them. So it doesn't really help you. So the technology is in most cases already there, but if it's not used correctly, if it's not used at all, you don't get any impact.
Speaker 1 00:20:45 Let's wrap up. And I wanna ask you one more question, then make a couple comments. So Kathy, now that you've spent close to a year doing this, looking at all this data, studying the industry, looking at hundreds and hundreds of companies, we looked at work profiles from millions of employees to do this analysis. That's
Speaker 2 00:21:01 Right.
Speaker 1 00:21:01 Mm-hmm, <affirmative>, what's the big message here about healthcare and how does this translate to what's going on in other industries?
Speaker 2 00:21:07 The big message for me is just doing what you've been doing. Probably won't ever get you to close your problem, close the gap in this case, the problem is the nursing gap. So being very clear about what is your problem, quantifying the problem, but then also thinking about the problem in new ways. So that redesigned, that had such a big impact was a big aha for us. We didn't expect that. But when you also look at how it's prioritized, you probably have 10 people sit in a corner, most organizations that do some kind of transformation work or workshops or job designs, those kind of things. Meanwhile, you have 500 recruiters, right? So can you prioritize the things that actually make a big impact? So that was for me, was the big insight
Speaker 1 00:21:48 That you said, what do you think, do you think three years from now the healthcare industry's gonna fill these gaps?
Speaker 2 00:21:52 I think they can. I think they really can, but they need to focus on it. They need to really prioritize that and stop just doing the doing and think about the future and build for the future as well.
Speaker 1 00:22:01 Okay, Kathy. Well, thank you so much. Let me make a couple of comments and then I'll wrap up. So this, this four R model is very, very powerful. We're gonna explain it a lot more in the other industries we're looking at, we're already into banking. We're finding out the same issues in banking, although in a different sector of the workforce, I would say what I learned about the healthcare industry, working with you, Kathy, and talking to a lot of the CHROs. This is one of the most passionate, creative, innovative HR professional groups of any we've seen, but they're dealing with problems that are almost an order of magnitude, more complicated than most companies, because they have the changes of technology, the services, the human relations issues, the certification, the compliance, the technologies, and the business in general operating. And we think what's going on in healthcare is because of the passion of the healthcare HR executives that we've met is these are mission driven organizations and that they will make this transformation, but there's a lot of lessons to learn here. And interestingly enough, we did a massive study of organization design just a few months ago and wrote the book on this. And Kathy, what, what would be your couple of closing thoughts on what companies need to think about as they redesign jobs to fill these gaps?
Speaker 2 00:23:14 One of the big themes that we identified in the organization and work design study was laser focus and accountability. So knowing exactly who's accountable for what that goes also with the top of license concept, who's,
Speaker 1 00:23:26 Who's accountable for meaning the, the beds and who's accountable for cleaning the floors. Exactly. And not just let all this stuff get all thrown into the nurses cuz they're there.
Speaker 2 00:23:34 Exactly. So very clear about one party is accountable for it and then let, let them do the work as well. Right? So if one party is accountable for that, that's one piece, the other piece was teaming. So that agile teaming around patients in this case, the agile teaming around patients' needs bringing in different capability areas, creating agile care delivery teams. Exactly. And um, yeah, just putting the human in the center too. So not designing for the nurses, designing with the nurses because nobody knows the nursing's job like the nurse does. So don't try to reinvent it without the nurse in the middle because you and I can't do it. Right. We are not nurses. So redesigning the work, not just for the employees, with the employees. Yeah. That's the other piece.
Speaker 1 00:24:17 Well, so many lessons for every other industry. Thank you, Kathy. Thank you so much for your time today. We'll be talking a lot more with you about some of these other studies. So check out the GWI for those of you on the, there's just so many things to learn here, whether you're in healthcare or not. Thank you so much for.
