The Way Forward: ‘Staffing is the Biggest Challenge’

Top leaders from across the country will attend a special HealthLeaders leadership summit in Atlanta next month.

Staff shortages are the biggest challenge as healthcare systems emerge from the crisis phase of the coronavirus pandemic, says Eric Eskioglu, MD, MBA, executive vice president and chief medical and scientific officer at Novel health.

Eskioglu is one of more than a dozen healthcare leaders who will attend The way forward, a HealthLeaders leadership summit scheduled for next month at the Loews Atlanta Hotel in Georgia. Eskioglu will serve on a clinical care board and there will be boards for CEOs, chief financial officers and chief information officers.

The focus of The way forward is about the exchange of plans, thoughts, strategies and impressions of the future of the industry. HealthLeaders’ coverage of the leadership summit will include a question-and-answer interview with each panelist. The transcript of Eskioglu’s interview below has been edited for clarity and brevity.

HealthLeaders: Now that the crisis phase of the coronavirus pandemic has passed, what are the key clinical challenges you are facing?

Eric Eskioglu: Personnel planning is the biggest challenge. Everyone knows the nursing challenges in healthcare, but we face challenges that go beyond nursing—they affect respiratory therapists, phlebotomists, medical assistants, as well as physicians and other healthcare workers. So the whole environment was completely destroyed.

Part of the problem is generational. Millennials and increasingly Gen Z are looking for a different variety of experiences. You don’t want to be tied to one place for more than a year or two. So there is a pattern of contract workers, travel nurses and other travel professionals that seems to fit their lifestyle.

HL: How do you deal with this staff shortage?

Eskioglu: Over the next two to three years, for every 10 healthcare workers we used to employ, we’ll probably hire five, contract about three traveling healthcare workers, and have the other two automated.

I was a big proponent of artificial intelligence and natural language processing. We need to get to the point where we automate a lot of the everyday things that nurses and doctors do. Once AI takes over areas like documentation, that leaves tasks that require human intelligence to help us through judgment, which AI cannot yet do. If you ask nurses, all they want is meaningful work – they don’t want work that is meaningless.

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We try to make the work more meaningful, do away with hunting and gathering, and eliminate documentation overhead as much as possible. We want healthcare workers to come to work with us, not just because we offer good pay and benefits, but because they love their work. This is what sets us apart from everyone else.

HL: What are your biggest challenges related to COVID-19 now that the crisis phase of the pandemic is over?

Eskioglu: The pandemic phase is over and we are now in the endemic phase, which means that this disease will be with us for many years to come. It’s been like whac-a-mole for the last six to nine months. We had a surge of Delta variant cases earlier in the year, then the first Omicron variant surged, then the second Omicron variant. I don’t know if the next phase of endemics will be a huge spike with lots of hospitalizations, or if it’ll be more of a protracted spike with fewer hospitalizations.

We are prepared for all scenarios because we have to be prepared – we have no choice. But I’m confident that the new boosters targeting Omicron will be effective.

There are also other infections that we need to address. We’ve done incredible things in the fight against monkeypox – we’ve been able to limit the spread of this disease as opposed to what we couldn’t do for COVID. We too are entering our flu season, so we face a triple threat in the coming months. We are confident that we can master these challenges.

HL: In which areas do you want to start clinical initiatives in the next year?

Eskioglu: We will have more mental health problems as a country. If you look at national and international events, be it the national discourse, the war in Ukraine, inflation or the recession that we may face, many more people will have mental health problems and there will be an aggravation of people with already existing mental health problems. We will have more depression and anxiety.

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We are focused on how we can better address mental health needs through initiatives such as telemedicine. We have many touchpoints with our mental health patients.

In the coming year we will also focus on our AI initiatives – this is where we will change healthcare forever.

HL: Give me an example of where you think AI will make a difference at Novant over the next year.

Radiology is a good example. On a busy night in the ER, the radiologist can have up to 50 images stacked up and everything in the ER is STAT. The problem is that the queuing system is so old-fashioned that you face a logistical challenge. It is often the case that first come, first served. That makes it difficult to find the image that could be the ticking time bomb. If radiological images accumulate at a radiologist, the first 49 images might be normal and not require intervention, but the 50thth The image could be a ticking time bomb with a brain hemorrhage and it could take 30 minutes to get there.

We are developing a radiology AI module that collects images from the source and uses machine learning to automatically update the queue to place abnormal findings at the front of the radiologist’s queue. It puts the most striking images at the front of the queue with a differential diagnosis. One of the benefits is that radiologists are less anxious – especially on busy nights – because they don’t have to worry about ticking time bombs. It has helped reduce burnout and anxiety among doctors.

HL: After the end of the crisis phase of the pandemic, do you have any further insights into how to proceed?

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Eskioglu: There will be other disruptions led by Microsoft, Amazon, Apple, Google, Oracle, CVS and Walmart. Amazon CEO Andy Jassy has said healthcare needs to be reinvented. There are altruistic motives behind this statement, but they are also financial – Amazon is a very large, publicly traded company with a for-profit mentality.

I expect the tech companies to make more forays into healthcare and the binge eating has started. Amazon has bought One Medical, a giant primary care conglomerate. CVS bought Signify Health, a home health group with many doctors.

The tech companies are trying to establish their own niches. Microsoft has taken on the role of creating an ecosystem that can nurture and support the healthcare system – provider systems like Novant and other healthcare organizations. Apple wants to be the company of choice for wearable devices.

Amazon is probably the company that is disrupting the most – not only are they disrupting in a big way, but they are also trying to change and innovate. Amazon is trying to establish itself in the most lucrative areas of healthcare, such as ambulatory care and pharmacy.

Oracle tries to be the software of choice. They want to be the data repository of choice for healthcare data.

CVS is way ahead of Walgreens for buying Aetna, and they’re entering the provider space by buying Signify Health.

Walmart is another disruptor to watch. In all of their neighborhood clinics, they implement EPIC, the electronic medical record that most healthcare systems use. They also announced a collaboration with UnitedHealth.

All of this disruption doesn’t have to be a negative development for vendors like Novant. It’s time to think outside the box. They’ve seen mega-mergers like my competitor Advocate, Aurora and Atrium. I wouldn’t be surprised if companies like Amazon, Apple or Google took a minority stake in healthcare systems to get people on our boards and learn from the inside out instead of the outside in.

Christopher Cheney is Senior Clinical Care Editor at HealthLeaders.

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