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    Christian Green
    Christian Green, MA

    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders, “What is your org's top improvement priority?” The majority (42%) said “operations/HR,” followed by 30% who stated “revenue,” 16% who responded “productivity,” and 8% who noted “shift to value.”

    The poll was conducted Nov. 2, 2021, with 719 applicable responses. Among those who responded “operations/HR” the majority said that staffing/recruiting, retention, and employee engagement were vital in keeping their practices running smoothly. Medical practice leaders noted:

    • Recruiting is the number 1 issue for our clinic. Without enough staff, workflows and everything else suffers. We are unable to give the time to projects and day-to-day tasks when we have lost 20% of our pre-COVID staff.”
    • Recruiting folks to join our team is a top priority. Otherwise, we won't have the manpower needed to appropriately care for our patients without delay.”
    • Cross-training wherever we can for support staff for now, but will need to focus on retention and employee engagement so they stay. A holiday party won't be enough after how rough the past two years were.”

     The ongoing issue of staffing

    Medical practices have acknowledged staffing challenges throughout the COVID-19 pandemic — from a March 17, 2020, MGMA Stat poll in which 40% of respondents reported staffing shortages to a Sept. 21, 2021, MGMA Stat poll in which 73% of respondents noted that staffing is the biggest pandemic challenge heading into 2022. However, practice leaders have long pointed to staffing as one of their biggest concerns before COVID-19, which exacerbated the issue.
    For example, a Jan. 7, 2020, MGMA Stat poll showed that medical groups' five most important priorities heading into 2020 were:  

    1. Staffing (hiring, retaining, retiring of management, staff and providers)
    2. Cost and revenue (cost reduction, collections, contracting, revenue streams)
    3. Practice transformation issues (growth, mergers and acquisitions, consolidation)
    4. Technology (adding and updating software, EHR)
    5. Operations (practice efficiencies, workflows).

    In recent years, staffing shortages have centered on clinical support positions. For instance, a May 30, 2017, MGMA Stat poll reported that more than 50% of respondents said that clinical support staff positions — medical assistants (MAs), licensed practical nurses (LPNs) and registered nurses (RNs) — experienced the highest turnover. However, it wasn’t that long ago that the MA occupation was proliferating: According to data from the 2017 MGMA DataDive Cost and Revenue compared to 2006 MGMA DataDive Cost and Revenue data, there was a 26.6% increase in MAs/nursing aides in practices during that 10-year period.
    More indirectly, this concern has been voiced in additional MGMA Stat polls, including a Sept. 28 poll in which 76% of respondents said that their practices made operational changes this year due to staffing shortages. In addition, 33% of respondents in a June 22 poll said they’ve added or expanded bonuses to recruit staff this year.
    As mentioned in last week’s MGMA Stat article, “Even as COVID-19 pandemic eases, a physician burnout epidemic continues,” staffing practices was an important theme during last week’s Medical Practice Excellence: Leaders Conference in San Diego.

    Particularly for larger groups with multiple clinics, it’s been challenging to ensure that each location is suitably staffed to provide the best care for patients and make certain that staff and providers are performing at the top of their license. There are many staffing models, such as team-based care and Rush University Medical Group’s staffing-to-demand (S2D), that have been profiled recently by MGMA; yet, sometimes all it takes is addressing shortcomings in practice culture when attempting to retain staff and providers.
    Beyond connecting staff and providers to their organization’s purpose to help make them more passionate about their roles, another key to promoting culture is employee engagement. This has been especially challenging with MAs, as detailed in a May 4 MGMA Stat poll, and noted by Jenny Lanier, director of ambulatory operations, the University of Texas Medical Branch (UTMB), at the Leaders Conference in “One Session at a Time: Eliminating the Staffing Shuffle,” which focused on ways practices can use analytics to address staffing needs.
    “We had a decent amount of turnover in the last couple years,” noted Lanier about the difficulty for her organization to retain MAs. “So we started talking to our MAs and our front office staff and doing some exit interviews.” What she found was that although it was using analytics to determine how MAs should be floated, the organization wasn’t addressing the “person aspect,” which led to dissatisfaction among the MAs. 
    During their exit interviews, a common theme arose among the organization’s MAs. As Lanier related, they would often point to their desire to be kept in the loop when it came to scheduling. They simply wanted to know a couple days in advance when and where they were going to be floated so that they could become familiar with a particular provider and his or her expectations. By doing so, the MA could better support the provider.
    This simple policy can go a long way in ensuring that all front-line employees are fully engaged. As Lanier pointed out, practices simply can’t manage staffing if they don’t have input from all staff and providers.


    Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit Polls will be sent to your phone via text message. 
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    Christian Green

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