Futurescan 2023: Healthcare Trends and Implications (Futurescan Healthcare Trends and Implications)

52 Pages·2023·14.133 MB·English

by  American College of Healthcare Executives, Society for Health Care Marketing and Strategy Development

FUTURESCAN
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22002203-2025
HEALTH ADMINISTRATION PRESS
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ABOUT FUTURESCAN 2023
This is the latest in a series of publications for health care FUTURESCAN
leaders that the American Hospital Association’s Society
for Health Care Strategy & Market Development (SHSMD) HHeeaalltthh CCaarree TTrreennddss aanndd IImmpplliiccaattiioonnss
22002203-2025
in collaboration with the American College of Healthcare
Executives (ACHE) has published annually since 1999.
In Futurescan 2023, a panel of eight thought leaders provide
their insights on key trends affecting health care organizations.
Their expert perspectives are supported by data from a
survey of health care executives across the country. The
Futurescan national survey, conducted from January through
March 2022, asked 1,980 hospital CEOs and leaders from
SHSMD’s membership their opinions about the future
trajectory of a variety of important issues. A total of 398
responses were received, for a response rate of 20 percent.
HEALTH ADMINISTRATION PRESS
FutureScan 2023 Front Cover
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Administration Press.
© 2023 by the Society for Healthcare Strategy & Market Development. This publication, or parts thereof, may not
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FUTURESCAN
Health Care Trends and Implications
2023
Introduction page 2
New Strategic Realities in a Post-COVID World
by Ian Morrison, PhD
1. Workforce Trends page 5
The Great Resignation
with Corey Bruner
2. Competitive Environment page 11
Today’s Disruptors: Innovators and the Competitive Environment
with Sam Glick
3. Cybersecurity page 17
Cybersecurity: Attacks and Protections
with John Riggi
4. Consumer Trends page 22
Market Forces and Consumer Demographic Trends
with Joan Kelly, EdD, MSEd, and Chrissy Daniels
5. Health Equity page 27
Diversity, Equity, and Inclusion: A Health Care Priority
with Mary “Toni” Flowers, PhD, DHL, and Elaine Batchlor, MD, MPH
6. Artificial Intelligence page 32
The Evolving Role of AI in Enhancing Clinical Care and Business
Operations
with Juan C. Rojas, MD
7. Capacity Planning page 37
Flexible Responsiveness to Surges in Capacity: Lessons Learned from
the COVID-19 Pandemic
with Peter Fine and Marjorie Bessel, MD
8. Culture of Trust page 43
At the Core of Health Care Lies the Essential Element of Trust
with Jeff Goldsmith, PhD
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INTRODUCTION
New Strategic Realities in a Post-COVID World
with Ian Morrison, PhD, author, consultant, and futurist
Throughout the COVID pan-
demic, hospitals and health sys-
tems played a pivotal leadership
role in serving their communi-
ties. While the last Futurescan reported
on the changes that were still emerging
under the cloud of the pandemic, this
edition chronicles how some of these
new realities have become permanent
fixtures in the health care environment.
It spotlights subject matter experts in
workforce recruitment, marketplace dis-
ruption, cybersecurity, emerging demo-
graphic trends, health equity, artificial
intelligence (AI) in clinical and business
operations, responding to capacity surg-
es, and the essential element of trust.
As health care executives strategize for
a future that no one could have imag-
ined three years ago, they will find this highlights multiple factors leading to the Health care must adjust to provide
edition of Futurescan to be a thoughtful turnover tsunami: flexibility to all staff to remain competi-
resource on how and where to lead their tive. Bruner provides practical advice on
organizations in a post-COVID world. • Workers in all industries have how to craft compensation and benefit
reevaluated their life and work schemes that lead to increased workforce
Workforce Trends priorities and used the high-demand retention and aid in recruitment.
Personnel shortages have emerged as environment (partly induced by
the top concern among CEOs, and all federal stimulus and escalating wage Competitive Environment
levels of employees have been affected. rates) to find new roles and positions. Before COVID-19 emerged, the health
Burnout is one of the most prominent • Many workers see hybrid and remote care arena was seeing an influx of
reasons for turnover, and the employees work as the new normal and will shift interlopers from nontraditional organi-
left behind necessarily take on the addi- organizations to maintain it. zations such as Amazon and Apple, but
tional work, leading to a ripple effect. • Many workers in finance, the pandemic spurred changes in how
Corey Bruner, director at global con- administration and information health care services will be delivered
sulting group Huron, expects this trend technology have skill sets attractive to going forward. Sam Glick, global leader
to continue over the next few years. He employers in other industries. in Health and Life Sciences at Oliver
About the Subject Matter Expert
Ian Morrison, PhD, is an author, consultant, and of several books, including the best-selling The
futurist. He received an undergraduate degree Second Curve: Managing the Velocity of Change.
from the University of Edinburgh, Scotland; a Morrison is the former president of the Institute
graduate degree from the University of Newcastle for the Future and a founding partner of Strategic
upon Tyne, England; and an interdisciplinary Health Perspectives, a forecasting service for
doctorate in urban studies from the University clients in the health care industry.
of British Columbia, Canada. He is the author
2 FUTURESCAN 2023
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Wyman, discusses the new competi-
tors and why it may be time for health
care executives to reconsider the legacy
health system model.
It would be foolish to dismiss indus-
try newcomers, Glick says; they will
inevitably raise consumer expectations
for greater responsiveness from health
care, and some of them will succeed at
scale and become serious competitive
forces. Glick believes health systems can
use a focused approach to stay compet-
itive and even claim a new leadership
position within their markets.
Cybersecurity
John Riggi is a highly decorated 30-year
veteran of the FBI and serves as the first
national advisor for cybersecurity and
risk for the American Hospital Asso- for over 50 years. They believe that con- responsibility officer at LCMC Health
ciation and its thousands of member sumer trends and market forces are ush- in New Orleans, identify what needs
hospitals. According to Riggi, cyber- ering in a dramatic sea change in how to change in order to achieve a diverse,
attacks represent perhaps the greatest hospitals and health systems collect and equitable and inclusive health care
external threat to clinical operations use patient-experience data to humanize system.
and can cause real financial pain. As care delivery. Social determinants of health have
health systems are increasingly digitally Four distinct age groups, each with put residents in communities of color
connected to consumers, the cloud and differing opinions on what is important at a disadvantage when trying to stay
the internet, the potential risks esca- in access and care provision, influence healthy. Health follows wealth, Flowers
late. The outcome of an attack can be the status quo in health care. Kelly and says, underscoring how an absence of
disastrous for hospitals, health systems Daniels give detailed examples in their transportation, healthful groceries, and
and patients. When a hospital is hit with discussion, as well as insights on the broadband internet access contributes
a high-impact ransomware attack and ways the LBGTQ+ community and var- to worse health outcomes in some
the hospitals in that region are operating ious ethnic groups perceive health care. communities. Batchlor and Flowers also
under strain, there is strong positive cor- Addressing these diverse viewpoints emphasize that racism in health care still
relation between the attack and regional will require health leaders to customize exists and that it must be reported and
excess deaths. solutions that recognize the values, life- investigated when it occurs. They argue
Despite the apparent sophistication styles, priorities, preferences and needs for a concerted, society-wide focus on
of cyber criminals, their primary source of various demographic cohorts. Issues addressing inequities.
of access to any system is very simple: such as childcare, caregiving support,
human vulnerability. Phishing attempts, hybrid and remote work, training and Artificial Intelligence
often via email or text message, remain career planning, environmental pol- With current data generation exceeding
the most common avenue for hackers to icies, and commitments to diversity the capacity of human cognition to
penetrate an institution’s security pro- and inclusion in the workplace will all quickly and reliably manage informa-
tections. Riggi recommends that every have to be factored in when crafting the tion, the use of AI will only continue
institution implement layered technical organization of the future. to grow. Juan Rojas, MD, a pulmo-
defenses, endpoint protection systems nary and critical care specialist at the
and a well-practiced, cross-function Health Equity University of Chicago with expertise in
cyber-incident response plan to address Few times have brought the issues of the application of machine learning to
this threat. diversity, equity and inclusion to more electronic health record data, expects
widespread attention in American soci- that much of AI adoption will be in the
Consumer Trends ety than 2022. In their article, Elaine areas of clinical care and business oper-
Joan Kelly, partner in strategic con- Batchlor, MD, MPH, chief executive ations. However, these more complex
sulting at Press Ganey Associates, and officer of MLK Community Healthcare tools require an information technology
Chrissy Daniels, chief experience officer and MLK Community Hospital in Los infrastructure sophisticated enough to
at Press Ganey, have collectively been Angeles, and Mary “Toni” Flowers, support them, experts to monitor their
involved in assessing patient experience PhD, DHL, chief diversity and social use and safety, and a willingness of users
HEALTH CARE TRENDS AND IMPLICATIONS 3
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the various therapeutic options available
to me,” he says. “Instead, the central
question was who would I trust to help
me resolve the problem?” Trust is foun-
dational in health care relationships,
whether it is between patients and their
caregivers, among clinicians, or between
clinicians and the institutions for which
they work.
How can hospital executives best
address the challenges of economics and
trust? Goldsmith gets to the heart of the
matter. Health care is unlike any other
industry, and we are not just consumers,
shopping for care. As a patient, you
must trust those who care for you, and
that trust can and should be earned by
health systems and staff. When done
right as Jeff Goldsmith argues, it leads to
on the front lines to engage with these of the situation. Bessel and Fine a virtual cycle of better outcomes, higher
more complicated models. agree that effective communication is patient and provider satisfaction and
AI and machine learning must be crucial to mitigating strain on hospital increased patient and provider loyalty.
part of the future of health and med- resources. Clear, concise and transpar-
icine. AI can enhance and support ent communication empowered their Conclusion
clinical decision making, help engage workforce and allowed the organization As our nation continues to grapple with
consumers, provide vital analytics and to work collectively to solve problems. the impact of a virus that refuses to
insights, and automate routine adminis- be contained, health care leaders may
trative functions. Culture of Trust need to accept that, in reality, there is
The final article in this edition of no more status quo. The economic and
Capacity Planning Futurescan examines the importance of social changes sweeping our society as
The COVID-19 pandemic spotlighted trust in health care and is based on the the result of the pandemic are here to
the importance of preparation for surges real-life experiences of Jeff Goldsmith, stay. It is likely that the situation will
in hospital demand. Marjorie Bessel, PhD, a recognized expert on manage- continue to evolve over the next five
MD, is chief clinical officer at nonprofit ment and policy issues relating to health years along with our understanding of
health care provider Banner Health, care services. At the age of 65, Gold- complex data, management of patient
where Peter Fine is CEO. In their smith was diagnosed with head and neck surges, the factors affecting health care–
article, they discuss their award-winning cancer. Over the course of the next two purchasing decisions, the incentives for
surge-mitigation measures. and a half years, Goldsmith underwent retaining critical personnel, and cyber-
Considerations for managing surges a total of five major surgical procedures, criminal sophistication. By applying the
in capacity needs can be grouped in each addressing a different malady. The wisdom and lessons learned from our
three major categories, Bessel says: experience changed his life and altered subject matter experts in this edition of
supplies, physical space and workforce. his view of health care forever. Futurescan, hospitals and health systems
Prioritizing these considerations will “For me, the central challenge of hav- can better position themselves for
depend on the immediate requirements ing cancer was not molecular biology or changes and challenges yet to come.
4 FUTURESCAN 2023
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1
WORKFORCE
TRENDS
The Great Resignation
with Corey Bruner, Director, Huron Consulting Group
The COVID pandemic has had a
devastating effect on many areas
of human life. For health care
workers on the front lines—
enduring so many months of patient
surges, a mounting death toll, and sheer
exhaustion—the pandemic has been es-
pecially detrimental and, in many cases,
life-altering. The resulting wave of resig-
nations that hospitals and health systems
have been experiencing has brought
unprecedented staffing challenges unlike
any other time in recent history.
Corey Bruner, director at Huron,
a global consulting group, highlights
multiple factors leading to the turn-
over tsunami. “Burnout is widespread
among health care workers and one
of the most prominent reasons for
turnover,” he states. “As their colleagues employees have been affected. The most executive officers in 2021 (American
leave, the employees left behind have to telling statistic is the registered nurse College of Healthcare Executives 2021).
pick up the slack, leading to a down- vacancy rate. According to the “2022
ward ripple effect. The fact that other NSI National Health Care Retention Key Challenges Facing the
economic sectors such as hospitality & RN Staffing Report,” 24 percent of Health Care Field
are also in competition for workers is organizations reported a vacancy rate Employee shortages are likely to con-
only compounding the situation. This greater than 10 percent in 2019 (NSI tinue over the next few years. The results
competition for labor has contributed to Nursing Solutions 2022). As exhibit 1 of a recent study attest to that predic-
wage inflation and is driving a notable shows, that number had grown to 36 tion, even among nurse leaders. Accord-
exodus of workers from the health care percent in 2021. A survey conducted ing to a longitudinal study conducted
industry.” by the American College of Health- by the American Organization for
The most at-risk positions for turn- care Executives found that personnel Nursing Leadership (2021), there was
over are registered nurses and entry-level shortages overall was the top-most a 116 percent increase in the number
roles, but Bruner notes that all levels of concerning issue cited by hospital chief of leaders considering leaving nursing
About the Subject Matter Expert
During the past 10 years with Huron, Corey complex, multifaceted engagements for health
Bruner has worked with more than 50 hospitals, care, higher education, and AMC clients, and he
health care systems, universities, and academic partners with them to ensure satisfactory and
medical centers (AMCs) to examine and redesign timely achievement of their objectives. Most
their human resources (HR) policies, processes, recently, Bruner has been leading a number
structures, and business operations. Bruner is of Huron’s talent strategy engagements,
an expert in organizational structure and design, focusing on driving significant improvements to
business process redesign, HR total rewards recruitment, retention, and engagement efforts
analysis and strategy, and service delivery design. for organizations and their most critical asset:
Bruner has a proven track record of managing their people.
HEALTH CARE TRENDS AND IMPLICATIONS 5
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Exhibit 1
Healthcare Organizations’ Reported RN Vacancy Rates, 2017–2021
RN Vacancy Rate 2017 2018 2019 2020 2021
Less than 5% 18.2% 15.8% 21.9% 19.3% 23.9%
5.0% to 7.49% 31.8% 30.5% 22.8% 18.2% 13.8%
7.5% to 9.9% 27.3% 28.4% 31.6% 30.7% 26.6%
10.0% to 12.49% 9.1% 12.6% 12.3% 15.9% 22.9%
Greater than 12.5% 13.6% 12.7% 11.4% 15.9% 12.9%
Source: 2022 NSI National Health Care Retention & RN Staffing Report
between February of 2021 and August formal leadership track demonstrates to flexible in how care is delivered and
of 2021. Nearly 41 percent of those workers that they are valued and have a how you assign workers in day-to-day
respondents were planning to leave long-term trajectory with the organiza- operations,” Bruner says. “With the
within one year or less. According to tion. It is an excellent way to build the shortage of nurses, are there support
the study, notable drivers include stress talent pipeline from within the health positions such as certified nurse assis-
caused by staffing shortages, declines system.” Leaders who have successfully tants whom you can elevate in their
in reported emotional health, and low bridged this advancement in the health roles at the bedside? Are there some
morale and burnout. system should be prominent advocates clinicians, such as pharmacists, whom
Continuing to provide quality care for other employees to join this track you can upskill to work at the top of
with a diminishing workforce is clearly within the organization. their licenses?” Health care executives
going to be a challenge for health care “One health system offers down- may also want to consider establishing
executives. “I believe we will see some payment assistance on a new home,” internal float pools to redeploy employ-
stabilization in the next five years,” Bruner continues. “This is actually ees where they are needed most, to
Bruner notes. “But the reality is that better than a sign-on bonus. It helps adjust staffing levels as necessary, or to
until then, we may have to do things a new worker put down roots in the institute flexible scheduling.
differently than before if we do not get community and fosters a good amount Bruner acknowledges that the cost
back to pre-pandemic staffing levels. of loyalty. It also signals a long-term of labor is at an all-time high, at 60 to
That includes how we manage care investment in the employee. This is both 70 percent of an organization’s overall
delivery, how we structure programs a recruitment and a retention strategy.” expenses. “The situation is not sus-
to retain employees and keep them Bruner expects that the cost of total tainable,” he admits. “Registries are
engaged, and how we recruit new rewards packages will continue to esca- very expensive and can tend to alienate
talent.” Bruner suggests the following late, and health care executives appear employees who are doing the same job
strategies to manage the shortfall over to agree. Just over half of the respon- but making less. These same employees
the next five years. dents in the latest Futurescan survey (51 often have to train their new temporary
percent) predicted that the cost of their counterpart, which can cause tension
Reexamine the total rewards package. organization’s total rewards package will among team members.”
The traditional total compensation rise 20 percent by 2028. Eight percent It is also important to be strategic
package of salary, benefits, and retire- of the respondents reported that they about the pay offered for positions that
ment plan is no longer competitive in are already seeing that escalation in total are harder to fill. Many organizations
the current environment. Inflation is compensation expenses. offer premium pay for a night shift or
putting additional pressure on employ- Bruner recommends that managers extra shift bonuses, but employees can
ers to pay more. Bruner says it is critical at all levels be able to clearly articulate become inured to the extra money.
to ensure that base pay scales are com- the total rewards package to potential “These premiums can be hard to pull
petitive. He also urges health care execu- new employees during the recruitment back from,” Bruner says. “I advise
tives to be creative in adding additional process. He offers one caveat in advocat- clients to make sure that these bonuses
incentives, such as enhanced paid time ing for creative solutions to total rewards are temporary with clearly articulated
off, parental leave, educational subsidies, packages: “Be sure that anything you triggers, such as volume and vacancies,
and clearly delineated leadership tracks. create is sustainable over the long term.” to drive the appropriate and intended
“Tuition assistance and other subsidies behaviors.”
can help employees to reach the next Redesign workforce strategies. “With Being supportive of employees is
level in their career,” Bruner states. “A reduced staffing, it is imperative to be also important when staffing is reduced.
6 FUTURESCAN 2023
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FUTURESCAN SURVEY RESULTS
The Great Resignation
Health care executives from across the nation were asked how likely it is that the
following will happen in their hospital or health system by 2028.
By 2028, our hospital or health system’s total rewards cost will have increased by at
least 20 percent.
Already Very Somewhat Somewhat Very
Neutral
happening likely likely unlikely unlikely
8% 30% 21% 36% 5% <1%
By 2028, given the workforce shortage, our hospital or health system will be able to meet
the anticipated demand to perform 20 percent more work by leveraging the same amount
of staff members we have today.
Already Very Somewhat Somewhat Very
Neutral
happening likely likely unlikely unlikely
4% 16% 26% 24% 19% 12%
“We have found that nursing manage- looking for candidates, and rethinking in Pittsfi eld, Massachusetts, a small iso-
ment needs to be more visible than what the ideal versus the acceptable can- lated community over two hours from
ever in this environment,” Bruner says. didate looks like.” Some hospitals and Boston. “Th ere are not enough trained
“Clinical staff needs a clear connection health systems are even building a talent health care workers in our area, making
and needs to know where to go when pipeline before recruitment by going recruitment of qualifi ed candidates very
they need support. For nonclinical into middle schools and sharing with diffi cult,” says Patrick Borek, vice pres-
employees, continuing to off er remote students the possible careers in health ident of human resources. Like many
work may be an incentive to stay with care. Other organizations have estab- hospitals, BMC experienced increased
the organization but should be evaluated lished programs that provide internships turnover during the pandemic, further
in conjunction with the organization’s or job shadowing. burdening the employees who remained.
broader remote work strategy.” Th e human resources leadership at “In order to meet our needs, we had
Finally, organizations should rethink Berkshire Medical Center (BMC) to take a more prominent role not only
the overall recruitment process. “Th e is employing a grassroots strategy for in developing our current employees
way we have been doing recruitment is developing its own pipeline of future but with the training programs around
not working,” Bruner asserts. “It calls for health care workers. Th e 298-bed us,” Borek says. “We are getting more
being more innovative in where we are community teaching hospital is located involved in recruiting students into the
HEALTH CARE TRENDS AND IMPLICATIONS 7
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to streamline their operations. Digital
strategies came into the limelight during
the pandemic, and as consumers have
embraced them, they seem likely to
become viable, permanent additions to
the health care continuum. “Artificial
intelligence is being used successfully
in chatbots that triage patients to the
appropriate level of care or that assess
patient health status,” Bruner notes.
“Telehealth visits eliminate the need
for staff to make appointments and
check in and room patients. Taken
together, these technologies can allow
hospitals to utilize staff in more efficient
ways.” Many paper processes could
also be automated. Bruner adds that
hospital-at-home programs provide care
remotely and enable staffing efficiencies,
local community college health care pro- the use of our electronic health records. requiring fewer clinical staff onsite.
grams.” One technical school in the area There is no learning curve when they Finding new ways of working is
has a program to train licensed practical start employment. Our doctors describe paramount. According to the Futurescan
nurses (LPNs). In talking with school them as some of the best MAs with survey, 19 percent of respondents said
administrators, BMC discovered that its whom they have worked.” that in the next five years, even with the
February 2022 class was only half full. As to the cost, Borek says that with workforce shortage, they will be able to
The primary reason was that students tuition, fees, stipends for students, perform 20 percent more work by lever-
could not afford to work part-time while and other expenses, BMC is spending aging the same number of staff members
they went to school. BMC built a pro- $350,000 per cohort. “We are doing this they have today. Another 26 percent
gram where those students could work because patient access was at risk and said that they would be somewhat likely
at the hospital 16 hours a week as nurs- we needed the staff,” he explains. The to achieve that 20 percent increase in
ing assistants and receive full-time pay employee development strategy is work- performance. Achieving those new levels
and benefits. In order to qualify, they ing so well that BMC is in the process of of performance will require efficiencies.
must commit to working at BMC for creating a registered nurse program that
two years after graduation. In the first could cost $900,000 for each 20-person Double down on organizational cul-
cohort of students, 15 people started cohort. “Much of our staffing is done by ture. “When turnover is high, it becomes
the program, and 13 are still active and travelers, and that is extremely expen- harder to maintain an organization’s
expected to complete it. Borek says that sive,” Borek notes. “The rate has been as culture, and morale can enter a down-
BMC plans to support two cohorts a high as $200 per hour, and that is not ward spiral,” Bruner notes. “This is the
year and has initiated a similar program sustainable. We believe these strategies time for health care leaders to redouble
at a local community college, which also are getting us to a more reasonable staff- their efforts to maintain a healthy level
offers an LPN program. ing contingent. If someone is oriented of employee engagement.” The visibility
This initiative is similar to another to and socialized within the organiza- of leadership and its willingness to foster
BMC program aimed at developing tion, they will be more engaged and will connections with employees is critical.
medical assistants (MAs) to work in stay longer.” Soliciting employee input on the chal-
physician practices. Established in Borek says that BMC will soon begin lenges they face and the solutions they
2021, the six-month curriculum at the taking a more prominent role in visiting can offer is also key. “Employee round-
local community college begins with local high schools and middle schools to ing is an excellent means of obtaining
full-time classwork and then transitions provide advice and information on the employee feedback,” Bruner notes.
the students into internships in actual broad spectrum of health care careers “Town hall meetings, focus groups,
practices. “We had a severe shortage of and to begin the recruitment pipeline at online surveys and even suggestion boxes
MAs, causing problems with patient an even earlier stage. all can work as well. It is important to
access,” Borek states. “A benefit of this use more than one tactic for the broadest
approach is that the MAs are being Embracing technology to do work reach possible. Keep in mind, however,
trained consistently and according to differently. With a reduced workforce, that management needs to be prepared
BMC’s policies and procedures, and in hospitals and health systems may have to address employee feedback.”
8 FUTURESCAN 2023
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