If you are amongst the a lot of folks in current years who have had to wait six months or additional to get a doctor’s appointment with a rheumatologist, for instance, or an oncologist, you will be interested in what MyMichigan Well being President and CEO Lydia Watson had to say about how the hospital is attempting to resolve that issue.
In an expansive, hour-lengthy interview, Watson discussed staffing challenges that the Midland-headquartered well being method shares with healthcare providers nationwide, amongst a lot of other subjects.
Watson answered concerns from Day-to-day News Editor Dave Clark and Managing Editor Dan Chalk about subjects ranging from MyMichigan Health-related Center Midland’s Magnet recognition for nursing excellence to MyMichigan’s efforts to replace retiring physicians to the death of former CEO Diane Postler-Slattery and her husband, Don, in a plane crash.
Following are some of the highlights of the interview.
In 2022, MyMichigan Health-related Center Midland became the initial health-related center in the Fantastic Lakes Bay Region to attain Magnet recognition as a reflection of its nursing professionalism, teamwork and superiority in patient care.
The American Nurses Credentialing Center’s Magnet Recognition Plan distinguishes organizations across the globe that meet rigorous requirements for nursing excellence. There are at the moment 580 Magnet recognized hospitals worldwide and, of these, only 14 are in Michigan.
MyMichigan Well being President and CEO Lydia Watson explained the significance of that achievement, what it will take to hold it and how the late Diane Postler-Slattery inspired hospital employees to function to earn the designation.
Midland Day-to-day News: What is a Magnet hospital?
Dr. Watson: Magnet is a plan designated by organizations exactly where nursing leaders have effectively aligned their nursing strategic ambitions to boost the organization’s patient outcomes. So there’s a direct hyperlink among a Magnet organization and patient outcomes. I’ll speak a small bit additional about what these are particularly and exactly where we have observed important improvement by taking this journey.
Interestingly sufficient, it was Diane Postler-Slattery, who was a nurse herself and had knowledge coming from a Magnet organization in Wisconsin just before she came to us, who definitely lit the fire below our nursing leadership to think about becoming or applying for Magnet recognition. So the push for becoming magnet was inspired by her.
MDN: How does this make for much better outcomes for sufferers?
DW: The plan begins as a road map on how to attain nursing excellence. There’s a concentrate on enhancing specific hospital metrics, so the ones that I can inform you that particularly had been enhanced in our organization and in most Magnet organizations are greater patient satisfaction, in particular with nurse communication at the bedside, getting proper discharge facts (and that is commonly offered by our nursing employees), Magnet hospitals have reduce 30-day mortality prices all round … so, a reduce threat of mortality in the initial 30 days following you leave the hospital.
There have a tendency to be reduce infection prices in Magnet hospitals, greater job satisfaction amongst the nurses, reduce nurses leaving the organization, so decreased turnover of nurses in that organization.
What it requires is for nursing leadership to make a commitment and appear internally at their structure. So one particular of the factor that took spot in our organization is there definitely wasn’t an organization of nursing leadership, chain of command, and methods of disseminating facts nicely and regularly. What they did was to type nursing councils. Every nursing council has a leader, and each and every of these councils oversees (a subject) of value. There’s a high-quality and security council, for instance. Councils are charged with overseeing specific regions and generating confident they have efficiency measures that they meet.
MDN: And it is all employee-driven?
DW: It is all employee-driven all nurse-driven. They are accumulating their personal information, they sit down and critique the information and see exactly where their possibilities exist, and then they come up with initiatives to make improvements and make points much better. After you are designated Magnet – and there are only 14 hospitals in Michigan that are at the moment designated Magnet, 600 across the nation – you hold that recognition or that certification for 4 years. Then you have to reapply.
MDN: How has the Magnet designation impacted the morale of the nurses at this hospital?
DW: You know, I would say the day that they received the national designation – and I occurred to be attending in the area exactly where the recognition was offered – the excitement was palpable. The pride in that group of what was achieved was heart-warming and it was just an outstanding knowledge. So they had been quite proud of themselves, as they really should have been.
You know, when we initial began the journey, there was a couple of naysayers. After they had been all on board – and that is due to the fact the leaders instilled in them the value – (this) was going to effect patient care and aid us to deliver greater-high-quality, safer care. In the approach it brought, I would say, a closer-knit group collectively due to the fact they had been sharing the journey collectively – much better communication, much better satisfaction, much better outcomes.
MDN: How had been they in a position to earn the Magnet certification in the course of the pandemic? Mainly because that has to have been one particular of the most stressful occasions to be in medicine, right?
DW: I definitely think it is due to the fact they had a target. They had leaders who had been regularly providing them the very same messages, complimenting them on their achievements, reminding everybody of the why – why it is nevertheless critical to concentrate on carrying out these points so that we give the greatest care to our sufferers and deliver the higher-high-quality, outstanding care to our communities.
CLARK: Let’s speak about the doctor shortage. There appears to be 3 points at play: There’s not as a lot of folks going into medicine. There’s the retirements that constantly take place as careers wrap up. And then there are “early retirements” – folks who are selecting to leave the profession substantially earlier than their predecessors.
WATSON: You are specifically ideal. These are the buckets. This is not just us this is a national issue. We are all seeing the very same trends and have the very same issues. I study a thing not as well lengthy ago that stated that in 2022, there had been additional physicians that retired or left the practice than there had been health-related students that graduated. That is alarming. And so, yes, there is a shortage.
It is quite competitive ideal now to attempt to recruit physicians. We are not suffering due to the fact of any retirements due to the fact we’ve either had succession preparing or as we knew folks had been retiring, we had been currently recruiting to fill these spots just before folks left. When required, we will use agency physicians, Locum Tenens, to fill gaps if there is a gap.
CLARK: I’m guessing that you saw this coming a couple of years out. What was the strategy to prepare for this?
WATSON: Properly, I assume we’ve constantly had a excellent strategy. We have a approach exactly where we, with normal cadence, about each and every two years, attempt to interview physicians that we know are later-profession and get a really feel for what their retirement plans are. And then we have, we get in touch with it a recruiting map, of what we do we will need to recruit this year, what do we will need to recruit subsequent year, what do we will need to start off recruiting for some of these difficult-to-recruit even earlier than we commonly would for additional regular spots.
So there is a approach exactly where we attempt to determine what our requirements are going to be, and get these positions authorized ahead of time so we can start off recruiting.
What is diverse nowadays than our standard, standard recruiting approach is that we had early retirements partially due to the fact of the tension of COVID.
Physicians and nurses worked exceptionally difficult in the course of these occasions. If we required aid and you got named, folks came in. But I assume a lot of that, we had been all operating on adrenaline to do what we required to do to take care of what we required to take care of. After points began to let up, that is when we began to see some of our physicians say, “OK, I’m carried out.” So in these distinct regions, we’ve had to do added recruiting.
We’ve had to get revolutionary in recruiting. We have partnerships with Michigan State University and Central Michigan University. We are a website exactly where their health-related students are on campus with us. We’ve carried out some early recruiting of students and residents. We have two residency applications in our organization, each family members practice and one particular of our largest requirements is constantly major care. So we will start off recruiting residents and hopefully sign them even in their initial or second year of residency if we know they are candidates that we want to hold.
CLARK: What are the largest regions of will need ideal now at this hospital? Exactly where are your staffing numbers low?
WATSON: A couple of our largest requirements ideal now are rheumatology, endocrinology, and hematology/oncology. 1 of the advantages that we have is our partnership with the University of Michigan. Michigan Medicine owns a minority interest in us. Mainly because of that partnership, they regularly can aid us if we are going by means of a gap, exactly where their physicians can come up and aid to fill that will need till we can recruit. Plus we can attempt to recruit from their residency applications.
When we named to say we are in will need of rheumatologists, due to the fact it is taking us six months and longer to get sufferers in, they told us that they themselves, Michigan Medicine, are quick 16 rheumatologists. So it is a national shortage. I would say, rheumatology, endocrinology, it is nationally.
Hematology/oncology, we take place to just have a provider who retired that we had been preparing for, along with a husband and wife doctor group that decided to leave the state and one particular of them was an oncologist. We have a greater will need for oncology (from our) sufferers. So heavily recruiting. I assume that I heard final week that we are close to signing two.
CLARK: So when folks in Midland knowledge waiting for a doctor’s appointment – like I have a doctor’s appointment two weeks from now that I scheduled in July – this is the fallout of that national doctor’s shortage?
WATSON: Right. That is element of it. And once more, we are heavily recruiting.
We know that access is constantly going to be a major-of-thoughts concern, and it is one particular of our focuses ideal now.
We will need to get our sufferers into practices additional rapidly. And some of that is manpower-driven.
CLARK: What’s the answer? How do you resolve this issue?
WATSON: Generating confident that we determine provider burnout. Attempting to address that early sufficient so that we do not have folks that are leaving early-profession due to the fact they’re burnt out. That is No. 1.
We have some important efforts taking spot for provider burnout. The Strosacker Foundation just gave us a $300,000 grant and it is particularly for workforce burnout efforts. So not just providers, but for all workforce. That is quite thrilling.
No. two is to do some other points for retention. We established a Provider Leadership Institute a couple of years ago following we had been introduced to it in carrying out our burnout function. There was some proof displaying that if you offered leadership possibilities inside your personal organization, as physicians go by means of their profession, if they know there are some other positions, in particular in leadership, that they will have access to, they are additional probably to keep in your organization rather than jumping about.
We place collectively a Provider Leadership Institute – final year we graduated our initial cohort of ten providers. They received specific education in not only leadership, but points like negotiation expertise, conflict management, alter management, well being care law, getting in a position to deal with some of these points.
Currently we have observed that various of them have currently taken on leadership positions or at least have applied for leadership roles. So we’re currently seeing that bear fruit. If we speak about how do we retain staff in common, it is to do points that make us stand out as getting welcoming, wanting you to keep right here, and getting prepared to listen to your requirements. Our HR division ideal now is attempting to come up with additional versatile advantages. What can we do that will make our staff say, “Wow! Your advantage alternatives and your advantage package is a thing I am going to keep right here for, due to the fact it is distinctive and it is additional customized.”
CLARK: How substantially does revenue play a part in these choices of exactly where physicians go? Mainly because there’s constantly going to be a different method out there that is prepared to provide a medical doctor additional revenue.
WATSON: Right. That was one particular of the challenges triggered by COVID.
What occurred with COVID is, when folks began to spend greater wages, a lot of, in particular of our nurses, and some of our providers left to take greater-paying jobs. The issue is that the amounts of revenue that had been getting paid are not sustainable for any individual. So if you hear that healthcare organizations are concerned about their finances and sustainability ideal now, it is all due to the fact of that.
We made a monster when that occurred. Now we’re attempting to reel it back.
We’re attempting to restabilize the workforce, pull back some of the premium spend that we had utilized and rather, rather than just paying folks additional revenue, additional revenue, additional revenue, we’re carrying out additional retention bonuses and saying, “OK, you left our organization to take an agency job. We want you back. You can come back and nevertheless be at the very same seniority level that you had been, the very same advantages that you had been when you left. We’ll even give you a retention bonus, but you have got to keep two years to get it.”
Cash is critical, but revenue is not as critical nowadays as it was in the course of these days when (hospitals) had been prepared to give (physicians) unbelievable wages.
CLARK: How is the hospital carrying out financially?
WATSON: We are carrying out OK. We are not carrying out as nicely as we would like to be. We are focusing on our workforce shortages and attempting to do away with premium spend, agency function, due to the fact that is a enormous expense – millions of dollars a month. We also have some margin enhancement initiatives that are taking spot and we’re focusing on enhancing access, due to the fact if we can get sufferers in, then we can deliver the solutions that also aid us to create the revenue.
We are not in a terrible circumstance. We’re not panicking.
We’re not exactly where we would like to be, but we are focused on finding back on track.
CLARK: Is that monetary concern due to the medical doctor shortage or is that also some of the remnants of COVID care charges?
WATSON: I would say that the two largest points are nevertheless paying agency and premium spend and the other factor that we are searching at is length of keep.
Our sufferers are admitted to the hospital, and primarily based on the way that payers or insurance coverage firms or Medicare and Medicaid spend you, you get a specific quantity of revenue for a diagnosis, irrespective of whether the patient is right here for two days or 32 days. As you can consider, if you are right here for additional than the anticipated length of keep for the typical patient with that diagnosis, we are spending additional revenue to continue to take care of these sufferers with out finding reimbursed for it. Our (patient) length of keep is greater than it ever has been in the previous.
Once again, it is a mixture of components. 1, there are sicker sufferers with additional complicated challenges. The other factor is it is been quite tough when sufferers are prepared to be discharged and will need to go to lengthy-term care facilities. We’ve had sufferers right here for a couple of months waiting for a lengthy-term care bed. The very same goes for behavioral well being.
That mixture of points is costing us additional with much less reimbursement and that is placing us out of balance.
CLARK: It appears like we are just scratching the surface exploring the benefits of telemedicine. Is that a thing that could aid address staffing concerns?
WATSON: Yes. And surely that is one particular of the points we’re searching at as we’re attempting to boost access. Our target is definitely to make care hassle-free, timely, and so we’ve got to get much better at carrying out some technological points as well. I can sign myself up to get a massage or a haircut or a table in a restaurant just by making use of an app on my telephone. We really should be in a position to enable our sufferers to do self-scheduling. We are operating on it ideal now to be in a position to achieve that.
We are focusing on access and I assume that if we can generate access, every thing else is going to fall into spot.
CLARK: Do physicians like telemedicine?
WATSON: Yes, they do now. When we initial went into COVID, we had been piloting our initial telemedicine plan. We struggled to get physicians that would volunteer to be the initial folks to pilot it. We had only carried out, I do not know, 50 visits in six to nine months. Now, we’ve carried out additional than ten,000. Primarily, each and every discipline is now making use of it.
That was one particular factor that COVID basically helped us to be effective in.
CHALK: It appears like Michigan’s Suitable To Perform law is going to be repealed. Do you anticipate to see any impact right here?
WATSON: I would say in Midland I am not as well concerned about it. All through our organization we do have some unions, so we’re waiting to see. We just renegotiated union contracts with nurses in Alma and Alpena.
CHALK: As we wrap up, we want to go back to March 2022. It is been one particular year due to the fact the death of (former MyMichigan Well being CEO) Diane Postler-Slattery and her husband, Don. How did losing Diane influence you personally?
WATSON: At the time I was the Chief Health-related Officer, so Diane was my boss. But I had, as nicely as my husband, created a friendship with Diane and her husband Don. (Their deaths came as) a full shock. I can don’t forget when we had been notified, Greg Rogers and I had been in a meeting collectively. Our administrative assistant just came flying in by means of the door and gave us the news. Greg and I just looked at each and every other and stated, “She can not be ideal. No way. This didn’t take place.”
We had to strategize rapidly how to get the facts out and in what order, due to the fact we didn’t want the neighborhood to know just before the board knew, just before our staff knew. So we got Millie (Jezior) and the rest of the PR group collectively and came up with a strategy, and inside a couple of hours we had to notify everybody.
(It was) just profound shock I assume to the point exactly where the shock was so intense that it kicked our adrenaline in. We had been in a position to assume by means of, all ideal, this is a crisis, we know how to deal with crises. What do we will need to do? That period in all probability took spot more than 4 or 5 days. Just after that is definitely when the grief set in.
(We had been) figuring out how to console each and every other and other employees members: Be readily available, be transparent, be open, be visible. All of these points had been super critical.
I assume that one particular of the points that we all agreed upon early on is that one particular of the greatest methods that we could aid our employees and staff get by means of that grieving phase was to honor some of the points that we had been inspired by, that came from Diane. And so I just created a small list of some of the points that we did, that we continued to concentrate on and honor.
Very first of all, (Diane) focused on folks and relationships, and so we continued to do that internally. She balanced function and striving for excellence and was adamant about pushing and meeting ambitions and not slacking off, due to the fact it was all for the ideal factor. It was all for the excellent of our neighborhood and the well being of our sufferers and our employees. We nevertheless strove for excellence. We didn’t let the foot off the gas pedal with the initiatives we had in spot, points like Magnet (certification).
We continued to concentrate on generating confident that we balanced function with enjoyable. That was quite critical to (Diane). Something that was in spot, we attempted to hold points as standard as feasible as far as schedules go and what our expectations had been, and that seemed to aid. Numerous of us went to their funeral in Wisconsin. I assume that helped these of us who felt definitely close to her to have some closure. Then the service and tribute that we gave to her back in Midland, also nicely attended. The staff had been in a position to express how they felt.
Her loss made a lot of alter. Promptly Greg Rogers stepped in. He had been the chief operating officer. He stepped in as CEO till we figured out what the strategy was going to be. She and Don passed away in March – Greg was preparing on retiring in April. We initial replaced his position, so Brian Cross became the Chief Operating Officer. That left a vacancy in Midland, so Chuck Sherwin became the president there. I ended up getting vetted by the board and interviewed for the CEO position and was named subsequent CEO so that Greg – (who had been) attempting to retire for 3 or 4 years – lastly was in a position to retire effectively.
When I took that position, it left a vacancy for Chief Health-related Officer, which Dr. Paul Berg filled. And that left his president of the doctor enterprise position open, and we just inside the final two weeks filled that spot with Dr. Dave Jordahl.
So that entire approach took from June till March, to get the succession of leaders reorganized and in spot. The excellent news is that none of these folks had been new. I assume that helped our employees. If we would have brought a lot of external folks into new positions, that could have had important damaging repercussions. So even even though a lot of of us are in diverse positions, at least we’re identified. And the majority of our staff are quite comfy due to the fact of that.
We’re focusing on culture to make confident we sustain the culture that Diane helped to initiate. It is a culture of excellence, a culture of teamwork, getting patient-centered, and of not providing up. We’re hard, we’re resilient.
We, for years now, have been carrying out a thing named “Three Very good Items.” We promoted that a lot in the course of this transition period. Any time we spoke to our staff or did videos, we would finish with 3 Very good Items. Ahead of you go to bed, you recall 3 excellent points that occurred to you or for you in the course of the day – private, at function, what ever. If you create them down, there are basically scientific research that show that carrying out that for a period of two weeks increases sleep, decreases anxiousness, and is as excellent as Prozac. I personally just do it each and every day.
CHALK: I get the feeling that points could have gone a lot differently. It was a pivotal moment final March exactly where you had just had a profound loss. If the ideal folks hadn’t been in a position to take the ideal positions, it would have stopped a lot of momentum, a lot of progress that had been created up till she died.
WATSON: That is a wonderful summary. Diane spent a lot of time selecting the group that she constructed. Mainly because of that, we had been in a position to step in and do what we required to do with comfort and, in her honor, to make confident that we didn’t shed any of the progress we had created though she was right here.
CHALK: 1 year later, how would you describe the hospital nowadays? How are you carrying out?
WATSON: I would say we are carrying out nicely.
We are led by wonderful leaders who embrace the culture that she helped to initiate, and we are carrying on.
We are focused on supplying outstanding care to our communities and taking care of each and every other.