Innovative Solutions in Tough Times: Tackling the Health Care HIT Workforce Crises

1. Innovative Solutions in Tough Times:Tackling the Health Care HIT Workforce Crises

2. We Will Inform You About: • Northern Virginia Health Care Workforce Alliance • PricewaterhouseCoopers Study • GWBOT Health Care Task Force • NoVaHealthFORCE Strategies & Action Plan • GWBOT Study Recommendations • Northern Virginia Workforce Investment Board

3. Northern Virginia Health Care Workforce Alliance

4. Why the Northern Virginia Health Care Workforce Alliance? Regional health care worker shortage • Current regional shortage obvious but not quantified • Projections call for worker demand to continue growing over next 30 years • Current capacity of training & education system inadequate to meet projected demands

5. What is the Northern Virginia Health Care Workforce Alliance? • Private sector, business, government, community, health care and educational leaders • Mission: establish a long-term, business-driven, sustainable strategy to address the Northern Virginia health care worker shortage

6. Outcome: A Business-driven Sustainable Strategy • Concept of “business-driven” is key • Businesses must see themselves as having a vested interest • Health care workforce shortage must be seen as more than a hospital problem

7. Outcome: A Business-driven Sustainable Strategy • Solution must provide upward mobility for “New Americans” and underemployed • The solution must address workforce utilization in health care industry • Solution must be self-perpetuating and out-live the Alliance

8. What Did The Alliance Do: • Commissioned PricewaterHouseCooper Study • Develop comprehensive regional strategies • Changed Name to NoVaHealthForce

9. PricewaterhouseCoopers Study

10. The Health Care Workforce Shortage: An Analysisof the Scopeand Impact

11. PricewaterhouseCoopers was engaged by the Northern Virginia Health Care Workforce Alliance, a Coalition of business, academic, and community leaders to: • Identify the issues • Analyze the scope and impact of the health care • workforce shortage on Northern Virginia.

12. Objectives and Approach • The objectives were to identify: • current and future Northern Virginia health care workforce needs for 24 selected health care professions • current and future gaps in the health care workforce and the driving forces leading to these gaps • training and education, recruitment, and retention best practices within Northern Virginia and other regions of the country. • The approach included: • a quantifiable independent survey of a sample of health care • providers in Northern Virginia • interviews with local health care providers, academic institutions • and economic development authorities • a literature search

13. Health Care Professions Studied Professions Studied RNs Nursing Aides Medical Records/ HIT Dental Assistants Medical and Nurse Managers Home Health Aides Dental Hygienists EMTs/Paramedics Radiologic Techs LPNs Physical Therapists Physical Therapist Assistants Occupations Therapists Respiratory Therapists CT Scanning Techs Medical and Lab Technologists MRI Techs Speech Language Pathologists Pharmacy Techs Pharmacists Surgical Technologists Medical and Lab Techs Phlebotomists Surgical Techs

14. Northern Virginia is a Dynamic Community • Demographics pose specific challenges and solutions: • High growth rate • Low unemployment rate • Highly educated • High levels of employment • High salaries (comparatively) • Ethnically diverse • Large percent of foreign born • Growing focus on life sciences • Large information technology focus

15. Education Graduate Schools Community Colleges/Universities Technical Schools High Schools • Government • National Institutes of Health • National Science Foundation • Defense Advanced Research Projects Agency Intellectual Property Protection Advancement Private Capital/Gov. Funding • Private Sector • Think Tanks • Technology Councils • IT Industry • Pharmaceutical Industry • Life Sciences Industry Research Entrepreneurial Spirit • University • Academic Medical Centers • Teaching Hospitals • Specialty Research • Health Sciences Technology/Science Discovery Northern Virginia: A Medical and Health Care Information Technology Incubator “The greater DC Metro Area and Northern Virginia are poised to be the one of the world’s primary centers of biotechnology. The region sits at a crossroads between world class education and research with a foundation of drivers to advance discovery and the implementation of new technologies.” -- President - Large Northern Virginia Medical Technology Foundation

16. Key Findings • A shortage of health care workers exists in Northern Virginia • Estimated shortage of about 2,800 professionals in the 24 occupational categories • Average vacancy rate of about 10 percent • Without interventions, vacancy rate is anticipated to grow to over 41% by 2020

17. Key Findings (cont) • Anticipated vacancy percentages are estimated to range from 27 - 56% depending on the profession • RNs dominate the current and projected shortage, with more than 1,000 current vacancies • Other hard hit professions are medical records and health information technicians and imaging • The forecasted growth will continue to put immense strain on the availability of health care workers through 2020. Without interventions, vacancies will increase to 16,600 positions with a total demand of over 40,000 positions

18. Future Demand is High Current and Estimated Demand by Health Care Occupation Through 2020 Note: “Estimated Shortage” calculation assumes no change related to increased retirements, etc.

19. Vacancies Could Increase by 2020 Without Intervention Anticipated Growth in Vacancy Rates for Select Occupations • 2004 • Vacancy Rate • 2010 Estimated • Vacancy Rate • 2020 Estimated • Vacancy Rate

20. Other Key Findings • Access to health care, quality of care, and quality of life may be negatively affected as a result of the shortages • Increased demand for services due to the aging population • Concurrent aging of the health care workforce and resultant retirements • Shortage of nursing and allied health profession faculty, schools, and clinical experience sites and the inability to find replacements

21. Other Key Findings (cont) • Concurrent aging of clinical faculty and the resultant retirements • Difficulties with having market competitive salaries for clinical faculty • Nature of the profession • Low unemployment rates and high cost of living

22. Hospitals Expect Biggest Future Difficulties in Hiring Staff Change in Workforce Needs for Hospitals All of the Northern Virginia hospitals surveyed expected to either retain their current workforce or hire additional workers. Nine hospitals reported that they would grow their health care workforce in the year ahead. Number of responses Source: PwC Analysis of Northern Virginia Workforce Survey

23. Gaps Will Be Exacerbated by Lower Supply Occupations with High Demand and Low Supply

24. Medical Records and Health Information Technicians • Rising health care demand • Increased scrutiny of medical documentation • Continued emphasis on the electronic medical record • Growth will be primarily distributed among physician offices/clinics, hospitals, and long-term care facilities Increased demand for medical records technicians will be fueled by:

25. Medical Records and Health Information Technicians (cont) • Third-party payers and government regulators are expected to add to the demand • Issues with quality of the available medical records staff surfaced repeatedly in the interviews

26. Additional Gap by 2020 Additional Gap by 2010 Current Gap Current Supply More Medical Records/IT Technicians Will Be Needed An 11% shortage of medical records technicians or 172 open positions was reported. To eliminate the shortage and keep up with anticipated demand and population growth, Northern Virginia will need to add over 363 technicians by 2010 and another 675 by 2020. An average of seven medical records technicians graduated each year from colleges between 1999 and 2003. At this graduation rate, an additional 49 technicians will be added to the workforce by 2010, 314 below market demand estimates. Medical Records and Health Info Technicians Additional Demand for Workers (Current and Future) 1,200 Positions

27. Recruitment and Retention Challenges Inability to Retain Occupation Awareness Access to Training • Many training programs are at capacity • “There will be a critical shortage of faculty as the programs scale up. Presently there is a serious faculty constraint,” said one education leader. • A shortage of clinical training sites is a critical element in increasing the number of nursing and allied health student graduates. • Educators said that more of their students are foreign-speaking. Providing instructors in a multiplicity of languages is expensive and difficult. • Lack of awareness about certain occupations • While students may be aware of what a nurse or pharmacist does, many are not familiar with the role of a surgical technologist, speech pathologist or CT scanner. • Misconception about the occupations • Students don’t realize that many health care careers are “high-tech.” Said one hospital executive: “Technology is a large aspect of health care jobs and will continue to increase. This is not a particular awareness that students or teachers have.” • Low pay • While some positions pay well, many lower-level jobs pay poorly. • Poor hours • These are “labor intensive jobs with too much responsibility and unattractive work hours.” • High turnover • High turnover becomes a self-fulfilling prophesy. Most employers interviewed cited burnout as a common problem. Often, other workers must take up the slack when their co-workers quit. This burns them out and leads to more turnover. • When asked about the consequences of vacancies, one employer said: “Nursing staff must work more hours.”

28. Workforce Best Practices • Education and Training • Providing health care training to persons new to health care or encouraging advanced training to persons inside of health care. Most programs achieve this through free training and education, paid training and internship opportunities, and accelerated training programs. • Recruitment • Initiatives aimed at recruiting new workers into the field of health care. Strategies include awareness programs, enhanced benefits, loan forgiveness, increased marketing of health care careers, and flexible work hours. Focus on English as a Second Language. • Retention • Retention tools often include innovative benefits such as employee driven scheduling, development of clinical specialist and manager positions, market rate adjustments, career ladders, child care job satisfaction, focus on the over-40 worker among others. • Specific challenges are retaining the experienced employees who are so important in training and mentoring the less experienced employees. Without mentors, the less experienced professionals are apt to leave. • Creative compensation.

29. No. Virginia Health Care Providers Adopt Innovative Ways to Maintain a Strong Health Care Workforce • Expand best practices: • Create awareness of the professions • Provide specialized training and on-site training • Focus on retention and job satisfaction • Encourage new innovative ways to provide health care services • Develop a synergy among the health care providers, the educational institutions, and the economic development authorities and workforce planning commissions

30. Greater Washington Board of Trade Health Care Task Force

31. Who Cares?Report Objectives 1. Review national health care workforce shortages and strategies to address them. 2. Assess Greater Washington’s health care workforce shortages, current workforce training efforts, and best practices. 3. Develop recommendations to strengthen Greater Washington’s health care workforce.

32. Greater Washington: The Region • Northern Virginia - Arlington, Fairfax, Fauquier, Loudoun, Prince William, Stafford and Spotsylvania (7 counties); Alexandria, Fairfax City, Falls Church, Leesburg, Manassas, Manassas Park, Fredericksburg, Vint Hill (7 cities) • Suburban Maryland - Anne Arundel, Calvert, Charles, Frederick, Howard, Montgomery, Prince George’s and Saint Mary’s (8 counties). • Washington, DC

33. Methodology • Gathered Primary and Secondary Data (i.e. Bureau of Labor Statistics, Dept. of Labor Occupational Employment Statistics, Maryland Higher Education Commission and State Commission on Higher Education for Virginia, survey Data, etc.) • Conducted Interviews and focus groups with over 40 individuals throughout the region from the business, government, academic, and nonprofit sectors. • Identified 23 occupations in high demand, required less than B.A. degree, potential for career ladders.

34. Educational Supply & Industry Demand • Scan of public and private 2- and 4-year institutions and private education/training providers in targeted area. • Graduate numbers are based on 2003-2004 data from MHEC and SCHEV and self-reported data from individual institutions. • Data on number of graduates is only an estimate for this scan; they should be systemically validated in future studies.

35. Washington PMSA: Top 10 Occupational Projections 2000-2010(By Annual Total Openings)

36. Greater Washington Health Care Workforce:Educational Supply & Industry Demand

37. Greater Washington Health Care Workforce:Educational Supply & Industry Demand

38. Greater Washington Health Care Workforce:Educational Supply & Industry Demand

39. NoVaHealthFORCE Strategies and Action Plan

40. NoVaHealthForce Strategies: Goal 1: Increase capacity within the health care education and training system Goal 2: Develop and sustain an ongoing supply of persons interested in entering health care career fields Goal 3: Nurture Innovation

41. NoVaHealthFORCE Action Plan: • Action plan developed by eight working groups • Working groups consisted of stakeholders from: education, healthcare industry, local, state and federal government, social service agencies and economic development authorities

42. Capacity: • Address the lack of nursing and allied health faculty • Address the need for additional clinical training sites and clinical faculty

43. Capacity (cont): • Address the projected increasing population in the western and southern portions of Northern Virginia. • Ensure optimal resource utilization to increase capacity and output of Northern Virginia educational health care institutions.

44. Pipeline: • Increase awareness of the healthcare career fields • Improve healthcare career preparedness in the school systems • Provide upward mobility opportunities • Facilitate foreign trained healthcare personnel to enter the workforce

45. Innovation: • Enhance the adoption in Northern Virginia of Information Technology • Harness the potential of the healthcare consumer • Create innovative approaches in healthcare human resource management

46. Innovation (cont): • Nurture the career fields of tomorrow • Develop a forum to share best practices • Designate an organization to coordinate the implementation of these actions

47. Greater Washington Board of Trade Study Recommendation

48. Study Recommendations • Raise Awareness: Educate stakeholders throughout Greater Washington regarding health care workforce challenges, issues, and potential ways to solve them. • Convene the Region: Provide a forum for all stakeholders to address the region’s health care workforce shortage. • Advocate for Change: Develop a policy agenda that supports regional efforts to increase recruitment, training, and retention of health care workers.

49. Next Steps • Working to develop a cross-sector, regional initiative to create a robust, sustainable health care workforce. • Hold a series of focus groups with providers, educational/training institutions, workforce investment agencies, and social service organizations to garner input, build support. (Fall 2005)

50. The Role of the Northern Virginia Workforce Investment Board in Responding to Our Regional Healthcare Workforce Shortage