Renee DeSilva, CEO of The Health Management Academy:  How Health System Leaders Are Tackling Workforce Challenges

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health where future-focused leaders in education, workforce development, and healthcare, explore new innovations and approaches. I’m your host, Van Ton-Quinlivan CEO of Futuro Health.

Being in the C-suite of a health system is a tough chair to occupy right now, given all of the challenges related to workforce shortages and various financial headwinds. We’re going to talk to someone today who works with leaders in the nation’s 150 largest health systems to get a better sense of how they are facing these complex problems and trying to shape the future of the industry.

Renee DeSilva is the CEO of the Health Management Academy with responsibility for a broad array of programs that provide research, knowledge sharing, and leadership development for hospitals and other healthcare companies. Prior to joining the academy, Renee served as chief talent officer of EAB, a leading provider of research, technology and services to education institutions, and she spent more than fifteen years at the Advisory Board company where she served as senior VP for sales and marketing, amongst other leadership positions. Renee also hosts her own podcast, The Table, featuring conversations with leaders and thinkers across healthcare. You should check out the one that I’m on, please!

Thanks very much for joining us today, Renee.

Renee DeSilva: I am happy to be here. Thank you so much for inviting me.

Van: Well, let’s start with a little background on The Health Management Academy and the ways that you serve your members.

Renee: Yes, I appreciate that question. So The Health Management Academy was founded about twenty-six years ago, and why we exist is we believe in the power of community to drive health forward — that’s how you and I got to know each other, in that context — and we do that through building small, very intimate gatherings with health system leaders and also healthcare company leaders and then we try to find ways to build connective tissue beyond those events. So, a lot of work around insights, learning and development and some really powerful alliances meant to solve some of the more pressing challenges in healthcare.

Van: Talking about pressing challenges, how are workforce shortages being viewed by the different members of the C-suite? So for example, the chief financial officers as opposed to the chief human resources officers?

Renee:  I would say if there’s a unifying theme across the issue sets among health system leaders right now, it is workforce. I think the issue manifests for every role and function in the organization. It may manifest differently, but it is both on the clinical side — trying to figure out ways to recruit and retain and continue to bring joy to work — and then also on allied health and other professionals is equally important. So, when we survey our members, which we do at least a few times a year, workforce is a top three issue across every major role in healthcare, so I don’t think any function is immune from having to focus on that.

Van: Do you see the temperament of the industry as hoping that as time passes, the workforce issues will go away? Or do they see a structural issue within the workforce?

Renee: Yeah, I think they believe it to be structural and perhaps sort of a new normal. I think over the last few years you saw a lot of health systems have to supplement using agency spend. You’ve seen them have to respond to creating good compelling job roles through really increasing some of the wage rate, and that is a permanent feature. Certainly the agency spend has come down, but we’re not going to see wage compression. And then we also see just supply/demand imbalances across some roles.

So, I think for most systems it’s a structural issue and one that they’ll have to accommodate against the backdrop of being really pressed on margins so they’re having to be creative and scrappy, which I’m sure we’ll talk about, but I don’t think anyone is naive enough to believe that we are putting those issues behind us. It will sort of be an evergreen area of focus.

Van: So, given that this is a new normal, I believe many of your members have begun leaning into, for example, high school pipeline workforce development, but also other forms of creative programming. I was wondering if you could share any innovations you’ve seen amongst the large health systems.

Renee:  I think there’s opportunity in every challenge, and it’s been really encouraging to see health systems really not so much bemoan the current reality and instead really moving towards creativity and how they solve it. So, I’d highlight a couple things.

One would be to really focus on skill-based hiring or ‘how do I think through removing challenges and friction in hiring people.’ So, that might mean that where I thought I needed to have candidates for an IT role have a bachelor’s degree, I may just need instead to train for competency and mastery and be a little bit more open to how I source talent. It might mean, as you noted a moment ago, going further upstream to the talent development and creating your own production line, if you will, for talent. And that could mean reaching into settings that maybe would not be quite as obvious, whether that’s a high school setting and trying to think about workforce development, or community college settings and building a bit more of a tighter linkage. But I think they are really trying to find ways to identify talent. You talk a lot, Van, about this talent that might be less visible, but that exists, and really pulling them through into what can be a really meaningful career in healthcare.

Van: As you hear about themes in their struggles with workforce development, what would be on the top of the wish list in terms of solutions for them?

Renee: I think you have to probably push on two thrusts, is what I hear from our members. One is you need to take scarce resources and have them work at the highest end of their license and work more productively. That gets you into different care delivery models, such as virtual nursing, to really be able to leverage some of the talent that might not be in the health system every day or on the unit every day.

It may mean finding AI use cases that really can bend some of the cost curve or at least have the work that’s done be executed by the right level in the organization to reduce some of the burden of getting work done. So, I think that’s one tranche of ‘how do we make it more productive?’ And healthcare is unique in that it’s the only industry where technology has not brought greater productivity and many health systems are really trying to buck that trend and find ways for it to be productive. So, that’s sort of thing one.

Thing two is the leaving no stone unturned and looking beyond the obvious.  I think as a practitioner of this, the obvious things would be you focus on recruitment and retention. That is now table stakes and you really need to start thinking through strategies. I’ll give you an example. If I have a pool of environmental services team members that I’m working with, what might I do to get those environmental team members equipped and ready for an allied health role? And what would it take to screen for that talent? What would it take to make it easier for them to go through programming and credentialing? How do I partner with philanthropy and other settings to fund those types of things?  I’m seeing a lot of creativity and partnership energy around solving the workforce challenge both structurally and long-term and then also just making the folks that we do have more productive and create more of a thriving environment around them.

Van: So for a moment, let’s skip to the research component of the work that the Academy does. What’s an example of an interesting research program that you’re undertaking right now?

Renee: There’s so much, and I feel like it’s picking your favorite child. I don’t necessarily have just one, but I’ll try to stay on some of the research that we’re doing that maybe gets to this core workforce theme that we’re talking about. So, one body of work that I think we’re really proud of is our nursing catalyst program, which is really all about research-led innovation topics that the chief nurse executive can sort of take and really figure out how to more quickly adopt change and innovation. But I think even more critically, as we think about workforce and really getting more from and giving greater agency and development to our staff, we’ve done a lot of work around nurse managers and really understanding their role. A little bit of this has come from our partnership with the American Organization for Nursing Leadership around what’s the right span of control? How do you really invest around nurse managers?

And then, how do you think through our nursing labs program which is a nine month sprint on innovation where you bring together cohorts of nurse managers across forty-five different health systems to really figure out how could we move the needle on some of these challenges.

When I go to that group and do a brief kickoff, the energy in the room for these nurse managers is so palpable and it sort of reminds you of why healthcare is such a great place to work. So, I think a lot of the work that we’re doing in nursing catalyst in particular, really gets to hearts and minds and it’s just an exciting place to be in healthcare right now.

Van: That does sound like a really exciting project.

Renee: Yes, and my prediction would be that I think we’ll see more nurses in CEO offices over time as you just sort of think through how much labor they oversee and how much of the ‘last mile’ healthcare delivery is at the bedside. I mean, I think that pool of talent is really equipped to be a big part of the C-suite in the future.

Van: Well, I hope you track where these nurse leaders go. Yes.

Renee: Yes, indeed.

Van: So, one issue I’ve heard at some of your convenings is a questioning of the tax exempt status of hospitals rooted in the perception that hospitals are doing well financially and don’t need or don’t deserve the exemption. I’m wondering how hospital leaders are responding to that challenge.

Renee: Yeah, I’ll try to address that one as simply as I can. I think there are a lot of headwinds facing healthcare institutions. I think on that issue, just to put into perspective, a typical health system margin  on a really good day is probably 4%, and on an average day closer to 2% or 3%. So, it really is razor thin margins. When you think about what we talked about earlier in terms of  increasing wage rates — and by the way, a wage rate for health systems is probably 50% to 60% of their overall expenses — you have a part of the healthcare delivery system that is far more constrained than you might see in other parts in other sectors.

So, I think the tax exempt thing is one that is a little bit of red meat. But if you sort of think through what health systems are really trying to push on, it’s thinking through their charity care and how do they get care to people who may have no coverage or maybe have less coverage. They’re also trying to think through what are the ways in which we impact the social determinants of health. If you think about the portion of your overall health and wellness that is due to healthcare services, it’s a slice of it. All the things that drive wellness and health include your access to food and your access to other things that aren’t controlled by the last mile of healthcare delivery.

So, the important thing that we work with our health systems on is telling our story effectively…telling how we contribute to the community in different and kind and powerful ways, connecting back to things that we do that really would not necessarily be a traditional healthcare experience. Those are the things that really tell your story and your narrative in a way where people are tracking with all the value and impact that you’re bringing. So, that’s how we work with our providers on that particular issue of ensuring that we stay there to meet the need when the communities have it.

Van: I remember in presenting to the CHRO, I was joined by Kaiser Permanente, which dipped into their community benefits funds in order to do workforce development and underwrite getting communities into these good jobs. So, hopefully, that’s part of the narrative that can be shared on the impact of these dollars or the status in the community.

Renee: Absolutely. Absolutely. And then just recognizing that if you look at how patients are showing up in health systems, they’re sicker than they were several years ago and you’re having to do more with less access to some of the resourcing that you might ideally need. So, I think it is a tough time to be a health system leader, and they’re just such a critical part of what we need as a society and as communities for employment perspectives that I feel strongly that we need to do a better job contributing to that fuller story of their impact.

Van: Well, Renee, you briefly mentioned generative AI. I know that is a topic top of mind for especially your CEO leaders. I was wondering what are some of the projects that are experimenting with generative AI?

Renee:  So, we do a lot in this space. We have an annual summit that we host in partnership with Microsoft. We have our own AI catalyst work that’s really trying to think through if you are in a provider setting, what is a maturity model that might help you understand the governance, the structural issues, the privacy, the ensuring that anything you do with AI doesn’t lead to further gaps and outcomes from a health equity perspective. When I look across that body of work where I know health systems are focused, there certainly are some ‘no regret investments’ where using AI is a no brainer, right? They’re being deliberate on back office functions and getting greater productivity and things like revenue cycle or different access functions.

I think health systems are being appropriately deliberate about where can AI be really impactful on the clinical side and doing that in a way where from a principal perspective, they’re not jumping too quickly. They’re being measured in that approach. Every vendor these days has an AI angle and they’re ensuring that there’s real credence and credibility to that. They’re using it as an assist, not as a replacement for, and I think we’re seeing some early case studies around how it’s being embedded that hopefully is removing some of this friction.

But I think we’re in the very early innings. It probably will advance faster than we all recognize.  I think there’s sort of a bifurcated focus on the ‘no regret’ move to back office work, and then the slow, deliberate ‘first do no harm’ approach that’s really important as you think about clinical deployment of AI solutions.

Van: Well, thanks for providing a forum for all the leaders to think through these issues and also share some of their practices.

Renee: Yes, absolutely.

Van: Now, Renee, you frequently are asked to speak on the issues of race and representation in healthcare leadership. What are some of the core messages that you would like to share with our audience?

Renee: It is an interesting time on this. We do a lot of work around health equity from the lens of ensuring that there are no gaps in clinical care. Part of that often becomes about representation… ensuring that your leadership team starts to maybe mirror your community. I’ve been encouraged to see that folks are still having that conversation and there’s still an awareness around it. But we are shifting the conversation from some of the simple representation metrics to things like belonging and inclusion and intersectionality.

We do this even internally. Health systems probably have four different generations in any workforce and so you need to think about an equity and inclusion approach that’s not just one dimensional. The maturity of these conversations that I note has been exceptional. I will say the headwind, if we were to be candid, is a little bit around every part of these organizations are constrained from a resource perspective. Equity needs to be not a thing, but a way that we do all things, and that really needs to be owned by every member of the executive team. It’s unreasonable to expect one role or one function to drive that through.

So, those are the conversations that I’ve been watching and observing. How do we architect a system that’s designed for equity and it just becomes a part of the way that we operate versus just a thing that stands on the side and is a series of statements? It’s much more about being integrated into the core DNA of an organization, and everyone is on their own journey on that.  Some are more mature than others. My approach is to meet people where they are, to call people in versus call people out, and then hopefully, through community, really continue to drive that conversation forward.

Van: Well, equity and inclusion, belonging…they are all part of the responsibilities of a healthcare leader, but just leaders in general. The leadership situation is so challenging at the moment. Things are so volatile, uncertain, complex. As a leader yourself, and you advise so many leaders, I’d like to get your insights on what do you think are the elements to effective leadership during such challenging times?

Renee: Yeah, it’s a really good question. We should continue to talk about this over a cup of tea at some point. I’m going to maybe make it more personal to me. I think it’s about continuing to be a student and to be a listener and to meet people where they are. The thing that I’m personally leaning into right now on my own leadership journey is just to know yourself and to have mastery over yourself and to make sure that you are really thoughtful about where you are best positioned to serve and to help and to drive. Then build the best team that you can around you and get out of their way. Enable them. Empower them. Give them agency and support. But do that from the lens of ‘I know my gifts, I know my strengths. I know what I’m not great at.’

A lot of what I try to do for myself, and what I admire in strong leaders, is that really thoughtful intention around where they put their attention and their energy and being very deliberate. I’m right now knee deep in planning for a couple of CEO events that we host so I’m reading a lot and there are two books that we’ve animated around recently. One is CEO Excellence: The Six Mindsets That Distinguish the Best Leaders from the Rest. This notion of being bold and having a clear vision and ensuring that you’re really thinking about your stakeholders as both the people that work with you and for you and have a view on your performance. Also, how do you think about the different seasons of your leadership? There’s a great little book, if you can find it, The Four Seasons of a CEO that sort of talk about different chapters and how do you do all that in a way where you’re building both redundancy into your organization and succession.

So, I think just being curious and being a student of leadership. I have this great lab in that I get to really observe personally, probably fifty plus CEOs of really large health systems. I don’t think I’d want their job, but it’s really interesting to see how each of them leans into their unique gifts. I think that’s where everyone has their power alley. So, that’s sort of what I’m contemplating for myself. I might ask you the same question if I was hosting this podcast, but I think it can be challenging times right now, and I think that’s sort of how I am channeling my own focus there.

Van: So Renee, let’s close out this interview by giving you a bonus question. I am so curious, what scares you about the future of care and what excites you about the future of care?

Renee: I think one thread would be that in some ways we’re sort of seeing multiple forces impacting our ability to deliver care well. We’re seeing challenges around affordability, we’re seeing, in some places, challenges around access and we’re seeing patients show up sicker and in need of more care. They’re being met by people who want to do the right thing, but we have a lot of work to do to make sure that we are keeping joy in our work in terms of care delivery.  I think all of those forces just create a ton of challenges in ensuring that we continue to meet the needs of the community. I have every confidence that we’ll figure it out, but it just feels like it’s really challenging times and every year it gets harder.

What excites me is, gosh, the pace of innovation, both from a sort of technology perspective and the way that work gets done. I think people put things on the table in terms of trying new things that maybe they would not have five years ago. So, I have confidence that there’s really some light at the end of the tunnel too, in terms of how do we change the way that healthcare is delivered to be more affordable, easier to access, more equitable. I believe so strongly in that triple aim and I know that the leaders that I get to interact with share that vision. So, it’s a hard gravel road, but one where I think people are motivated and really driven by the potential and I think we’ll get some assist from the pace of science and innovation and even technology to help us get there faster and, hopefully, more efficiently.

Van: Well, we learned so much. Thank you so much for being with us today, Renee, and for supporting all these health system leaders.

Renee: It’s my pleasure. Good to see you.

Van: I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you’ll join us again as we continue to explore how to create a future-focused workforce in America.