We sat down with Dr. Kate Kinslow, the former East Coast Regional President for Prospect Medical Holdings. Between AI-driven labor optimization, and a refreshingly unpretentious view of staff engagement, she believes healthcare has an opportunity to reinvent itself.

Let’s begin with some context – tell us a bit about your background, and how you see the state of healthcare labor today?

The healthcare labor market today is probably about the worst I have ever seen it. We’re at a time where this has not only caused a personal toll to people, but a professional one. So, I think it differs from crises we’ve faced before, and because of that, I think that the solutions need to be different. We can’t just think about this as a momentary challenge – we need to think about how we’re going to deliver healthcare differently so we can meet not only the needs of the patient, which are extremely important, but meet our societal needs and tackle the social determinants that affect care and drive repeat utilization.

I have been in healthcare a long time, and I’ve come up through the ranks, so I’ve had the opportunity to see healthcare clearly from both the bedside and multiple management positions. One thing that’s very different today than when I was coming up is education. I actually went to a diploma school, and at that time, education was based around on-the job learning. The scholastic, the didactic part, was there but not to the same extent and rightfully so. If you speak with young nurses, many of them will tell you right away they’re going to become a nurse practitioner, and they haven’t even done a full day in a clinical environment yet. They don’t have the clinical experience, so when they get there, they are really challenged on how do you prioritize and manage your load? The work nurses do is incredibly stressful, even more so when you don’t have the same depth of clinical experience, and that makes it imperative that facilities offer more support and mentorship. Relying solely on external education will shortchange us. And then I think another major problem in this--which ties into my background because I also have my Doctorate in Education--is that we don’t educate the team as a whole. Some educational programs get this right, but it’s often hard for young individuals, whether they be residents or nursing staff, to understand that when they get into the clinical arena, they’re actually part of a team, and you can’t be independently making decisions. So, I think those two components – the education and preparation of caregivers, as well as ineffective modeling of the team approach – have greatly affected and exacerbated the problems we’re seeing today with burnout.

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When we talk about models of care, and preparing staff, what are some of the most impactful things you see being done?

I think that the institutions that are most effective are the ones that understand traditional education needs to be augmented. That’s extremely important as new care providers come into the clinical arena. How are they being mentored and supported? So I think having mentorship programs is key. Some organizations are even creating Chief Retention Officer positions, which is, as the name would suggest, dedicated to looking at how you support young caregivers. And not just nurses, because there’s a very similar problem in medicine as well. How do you work to effectively bring the team concept together? Because direct caregivers are dealing with an increase of violence in the workplace from patients and families, while simultaneously finding that the care team isn’t being supportive of each other; or if they make a mistake, or ask too many questions, that there’s a suggestion that they aren’t as intelligent as everyone else. I think innovation stems from focusing on support and education rather than just on putting bodies in seats.

In a sense, what you’re really talking about is what could healthcare take from other industries. Rather than just focusing on checking the traditional boxes, it would be looking at culture, engagement, career pathing, succession, and even just basic decency in the workplace – emulating how businesses seeking the “Best Place to Work” title are. Would that be correct?

Yes, very much so. I think if you go outside and look at other industries who have done it better than we have, it is that support that they give. There’s often a process where they work with younger people to mentor them along the way until such point in time that they can be more independent. In healthcare, especially with nurses, you graduate, walk in, and it’s “here’s your set of patients, thank you, and this is where the medication cabinet is.” There are preceptors and there are orientation plans, so I’m not suggesting that hospitals don’t do anything, but it’s often not as refined or sophisticated a program as I have seen in other industries.

There’s that comment of how “nurses eat their young.” It’s been prevalent in the nursing field forever, and that has got to change. It starts with treating each other as human beings, understanding that we all come through this from a different perspective and valuing those perspectives. And as I think about younger generations, they’re looking for different things. They want work-life balance. They want to make sure that they have ability to progress. People are not solely driven by money, you know. Certainly, everybody wants to be able to pay their bills, but it’s the environment that you create. It’s the ability to have flexibility and to know your staff. I think as an administration, one of the greatest gifts that you could give is to listen.

In terms of creating that flexibility, what are some of the innovative labor strategies you’re seeing?

I believe it’s possible to do gig work in healthcare, especially with the advent of AI-driven scheduling since you’re able to more meaningfully forecast by unit, even in areas like your ED and Labor & Delivery where volumes are less predictable. It’s not yet perfected, but it’s certainly far easier to project staffing needs. I think organizations adopting that approach are going to be far ahead of the curve, because you’ll be able to have the staff at the right place at the right time. This was something we did extensively when I was at Thomas Jefferson University Hospitals, and it helped us staff more efficiently while simultaneously decreasing total cost of care through less reliance on premium labor.

I also think that the skill mix needs to change. When we look at what’s happening in healthcare, we’re seeing more and more behavioral health patients, or those with behavioral comorbidities, but nurses rarely have a lot of behavioral health education or experience. The skill mix needs more individuals who can help de-escalate and move those patients to the appropriate level of care. A hospital might say, “Well, how can we afford that?” But often, you can change the skill mix without increasing the amount of people, and the true cost would probably be less per unit of discharge than it is currently since you’d have the appropriate expertise present.

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In terms of optimizing labor through better attraction and retention, does that all start with org culture?

I do believe that it starts with your culture. And I think one of the other fundamental aspects is, where does your Chief Nursing Officer sit? They need to be at the leadership table, and in so many places they are not. And they need to be reporting directly to the CEO, and have facetime with the board. They’re a key voice in tracking what each generation is looking for. They’re a tool for cutting through the commoditization of your care teams. They can help look into what individuals need for growth, and when you do that, they will give back to you. They will be loyal to your organization, and they will work really hard for your success. It’s respect. It’s involvement. It’s really listening to their voices. You can’t do what they want all the time, but those types of things help cut turnover and drive your revenues because they encourage people to come work for you.

Most want labor to be about 35% of their net patient revenues, and that’s really hard. And I’m not naïve – certainly labor, supplies, and revenue cycle are your three controllables, and if you don’t control them and make money, you don’t have a hospital. But that being said, you have to balance that with the fact that you’re not talking about a piece of machinery. These are people who will walk out, or even worse, they could stay in your organization and undermine it, which you see all the time. Healthcare has become more of a business, but you’ve got to walk that balance.

Pay decent. Mentor. Make sure people have the support that they need. And establish a meaningful work-life balance. Everyone always says, “Oh, yeah, we have a great work-life balance,” and then you see their executive staff never goes home. People are on vacation and they’re calling or texting. That’s not work-life balance. You have to really use what you’re doing in your culture as a verb, and that’s where I think healthcare has failed so far. We’ve paid a lot of lip service – all these signs everywhere saying, “You’re a Hero!” That was great in the first couple of months of COVID, but now everybody’s saying, “Wait a minute.

I was a hero. What happened?” We need to stop disenfranchising people.

That’s an elegant and simple way to put it. Last question – where do you envision the labor optimization landscape will be in three to five years’ time?

That’s a great question. To my previous points, how you treat people is step one. That’s the water and shelter in Maslow’s pyramid. Going forward, we need to think about how we can leverage technology to dramatically change how we do things. Brick and mortar institutions are going to be less important as we accelerate our advancements in care delivery, which will inevitably alleviate some of the staffing pressures as we figure out ways to do more with fewer people. You’re already seeing it with remote nursing approaches that have spun off from eICU. I think technology is going to present an explosive opportunity over the next five years to decrease our reliance on labor. I did nurse anesthetist accreditation visits with the military, and I already saw how they’re doing more remotely. They have those big battleships, and you’ve got one anesthetist taking care of five or six patients, all facilitated by computers. We need to start asking why we aren’t doing the same.

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Dr. Kinslow is formerly the East Coast president of Prospect Medical Holdings.
She has more than 20 years of progressive management experience in all aspects of healthcare in a community setting, as well as an academic medical center, with a proven track record of strategic development, accountability, program growth, quality improvement, engagement, and strong stakeholder relationship development.

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