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Perspectives

Technology and culture could expand roles for women working in hospitals

Health Care Current | April 17, 2018

This weekly series explores breaking news and developments in the US health care industry, examines key issues facing life sciences and health care companies and provides updates and insights on policy, regulatory, and legislative changes.

My Take

Technology and culture could expand roles for women working in hospitals

By Terri Cooper, Global Health Care Sector Leader and Chief Inclusion Officer, Deloitte LLP

Health care is an exciting and dynamic field—it is why I’ve been focused on it my entire career. The health care sector is on the cusp of incredible change, where everyone from executives to hourly employees could be impacted. This transition will likely be driven by two emerging, but powerful forces:

  • Inclusion: In an inclusive environment, everyone in the organization feels that they can be themselves, and can bring their unique perspectives to the table.
  • New technologies: Hospitals are beginning to adopt emerging technologies, such as artificial intelligence (AI) and cognitive analytics.

These two trends can impact the overall workforce, but also could have specific implications for women—potentially altering roles, job satisfaction, and retention.

Why inclusion is essential for health care

The nation’s hospitals collectively employ fewer than 2 million men, but employ nearly 5.5 million women. While women make up roughly 75 percent of the overall hospital workforce,1 they represent only 26 percent of hospital CEOs.2 Moreover, women make up 27 percent of hospital boards and 34 percent of leadership teams.3

These numbers are specific to hospitals, but the trend is not unique. Many industries are struggling to cultivate diverse and inclusive cultures. For health system leaders in particular, recruiting and hiring the right staff is a priority, according to a recent Deloitte survey of health system CEOs. CEOs told us that workforce recruitment and retention is one of the top issues they lose sleep over. Retention might be the bigger issue given that some hospitals face significant turnover. In response, many hospital leaders are trying to develop a more effective strategy for retaining staff.

Inclusion can be a make-or-break factor for today’s workforce. In another recent Deloitte report of employees, 80 percent of survey respondents indicated that inclusion is important to them when choosing an employer. Moreover, 39 percent of all respondents said they would leave their current organization for a more inclusive one. This trend has not gone unnoticed—69 percent of executives rate diversity and inclusion as an important issue.

Six traits of inclusive leadership

What can leaders do to foster an inclusive culture in their hospitals? To truly shift forward, we should challenge organizations from the top down, to potentially redefine leadership, and rethink the role that each of us can play. What were once considered soft skills are often now seen as critical for leading an organization. Inclusive leadership can be essential for organizations to advance their inclusive cultures. We have identified six traits of inclusive leadership:

  1. Commitment: Treat everyone with fairness and respect, foster environments where team members can be themselves by modelling authenticity, and empower each other’s well-being.
  2. Courage: Engage in tough conversations when necessary. Identify opportunities to be more inclusive, take ownership, and engage others.
  3. Cognizance of bias: Be aware of unconscious biases so decisions can be made in a transparent, consistent, and informed manner.
  4. Curiosity: Listen attentively and value the viewpoints of others.
  5. Cultural intelligence: Seek out opportunities to experience and learn about different cultures, and be aware of other cultural contexts.
  6. Collaboration: Create teams that are diverse in thinking.

It’s up to each of us to embody the traits of inclusive leadership and bring that to our organizations on a daily basis.

Technology could enhance some hospital jobs

The second major trend on the horizon is emerging technology. The hospital workforce is likely to be altered by technologies that can take on the menial tasks, many of which have traditionally been performed by women.4

For some types of work, this trend could lead to new opportunities, or make careers more fulfilling. Nurses, for example, typically spend more than 80 percent of their day performing administrative tasks (e.g., paperwork, searching for medications and supplies, coordinating lab results, and even helping deliver patient meals), according to our recent paper on the global hospital of the future. That means less than 20 percent of a nurse's workday is spent caring for patients. Moreover, some estimates predict that by 2025 the health care industry will need 3 million nurses—but only 2.8 million are likely to be available.

Using robotics to automate some of these tasks could generate considerable cost and time efficiencies, and improve reliability. Robots, for example, can deliver medications, transport blood samples, collect diagnostic results, and schedule linen and food deliveries. This could give nurses more time in areas where they can really make an impact, like caring for patients.

But what about other employees in the hospital, such as administrative staff or billing department workers? Robotic processes can be used for certain hospital revenue cycle and accounting/finance functions, such as scheduling and claims processing. A disproportionate number of these jobs are now performed by women. As technology takes over some of these functions, hospital leaders will likely need to determine new opportunities for the workforce of the future, and help train displaced employees to fill those emerging roles.

As hospitals invest in exponential technologies, they should also consider investing in employees by providing opportunities to develop corresponding digital skills. An augmented workforce and use of new technologies requires existing staff to manage and work alongside the robots and AI processes. Rather than replacing employees, talent and technology can work together.

According to our recent paper on the future of work, hospitals that fail to effectively merge employees and technology could face:

  • A dispirited workforce with growing nursing shortages and high levels of burnout
  • A marginalized ability to attract and retain highly skilled clinicians and non-clinicians
  • A reduction in quality of care
  • A loss of position as a patient’s provider of choice

Although 100 percent of health care providers surveyed in the 2017 Deloitte Human Capital Trends report intend to make significant progress in adopting cognitive and AI technologies in the next three to five years (and 33 percent say they consider it a priority to train employees so they can work side by side with robots and AI), none report that they have made significant progress in adopting these technologies.

Ready or not, the future is coming

There has never been a more exciting time to be in health care. As the workforce, the workplace, and the technology continue to evolve, the role of leadership will likely become more important. Hospital leaders should consider proactively addressing these issues and view them not as challenges, but as opportunities to engage the women in their ranks.

First, leaders should consider advancing inclusive cultures in their hospitals by modelling the traits of an inclusive leader and empowering others to do the same. Not only can an inclusive culture help hospitals attract and retain talent, it also can bring new and innovative ideas to the table. Second, leaders should consider ways to embed technology into everyday experiences. They should consider offering training opportunities to help staff develop needed skills, and highlight how these new roles (particularly those typically filled by women) could become more fulfilling.

Through both cultural and technological shifts, the role of women is changing in health care. I, for one, think it’s going to be for the better.

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1 Data USA: https://datausa.io/
2 Modern Health Care, February 2017
3 Thomson Reuters 100 Top Hospitals, 2017
4 New York Times, January 2017: https://www.nytimes.com/2017/01/04/upshot/why-men-dont-want-the-jobs-done-mostly-by-women.html

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In the news

CMS finalizes 2019 rules for health insurance exchanges

On April 9, the U.S. Centers for Medicare and Medicaid (CMS) issued the Notice of Benefit and Payment Parameters for 2019—final rules for the Affordable Care Act (ACA) health insurance exchanges. The rules lay out the benefit and payment guidelines for health insurers selling products through HealthCare.gov and state-run exchanges.

The final rule includes the following provisions:

Also on April 9, CMS issued new guidance on expanding hardship exemptions. Under this guidance, individuals who live in counties with no insurers or one insurer operating on an exchange will qualify for a hardship exemption from paying the ACA’s tax penalty for not having coverage. While the individual-mandate penalty is slated to disappear on January 1, 2019, some people might need a hardship exemption to qualify for catastrophic coverage. The guidance also allows CMS to consider a range of circumstances for which consumers might qualify for hardship exemptions.

Finally, CMS issued a bulletin on April 9 that will allow state insurance regulators to extend transitional health insurance plans (i.e., non-grandfathered plans that do not fully comply with ACA requirements) in the individual and small-group markets for one additional year.

The final rule, along with the additional guidance, comes as many health insurers are busy developing insurance products for the 2019 open-enrollment season. Some state deadlines are just weeks away.

(Source: CMS, Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2019, FR Doc. 2018-07355, April 9, 2018)

New study indicates Medicaid increases access to care

Medicaid beneficiaries are several times more likely to have access to important health care and preventive services than the uninsured, according to a new study from America’s Health Insurance Plans (AHIP).

After adjusting for factors associated with coverage type, AHIP found that adult Medicaid beneficiaries are 4.6 times more likely than uninsured adults to have a usual source of care and to have received a routine check-up within the last year. Researchers also found that just 8 percent of Medicaid enrollees did not have an annual check-up, while 38 percent of uninsured adults failed to have a regular check-up. Compared to uninsured adults, adults with Medicaid coverage were also 4.7 times more likely to have had their blood pressure checked, and 4.4 times more likely to have had a cholesterol test.

The study found the same pattern among children. Children with Medicaid coverage were four times more likely than uninsured children to have a usual source of care. In addition, both commercially-insured and Medicaid-covered children were more than twice as likely as uninsured children to have received routine check-ups and vaccinations.

The authors concluded that, despite the challenges of providing care to Medicaid beneficiaries, the program gives members increased access to care. They noted that this study joins a growing body of literature with similar findings, and cautioned against citing studies that rely on older data to show poorer outcomes among Medicaid beneficiaries.

The study relied on data from the Medical Expenditure Panel Survey, an annual, large-scale survey of families and individuals administered by the Agency for Healthcare Research and Quality (AHRQ). The study’s main findings are based on data from 2013 through 2015. In addition, the study analyzed data from 2007 through 2009 to account for any changes that might have occurred after the passage of the ACA. They found that, even before the ACA’s passage, the Medicaid population was more likely to have access to medical services than the uninsured population.

(Source: “The Value of Medicaid: Providing Access to Care and Preventive Health Services,” America’s Health Insurance Plans, April 2018)

DOJ and HHS recover $2.6 billion from anti-fraud actions

The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) recently released a report on recoveries from health care fraud actions that occurred in fiscal year (FY) 2017. Highlights from anti-fraud actions in FY 2017 include:

Fraudulent activity included:

  • Clinicians operating “pill mills” out of their offices (operations where a clinician prescribes narcotics inappropriately, or for non-medical reasons)
  • Fraudulent billing 
  • Companies paying kickbacks for prescribing drugs or services
  • Developers of electronic health records misrepresenting their products

The Health Care Fraud and Abuse Control Program is run by HHS’s Office of Inspector General (OIG), and coordinates law enforcement activity at all levels to uncover fraud and abuse in health care. After the Health Care Fraud and Abuse Council recovers fines, penalties, or damages, those funds are returned to the Medicare Trust Fund, the federal government, or to private individuals.

New Hampshire, Congress take further action on opioid crisis

New Hampshire hospitals have committed $50 million in funding over five years to combat the opioid crisis. The funds will be used for substance-use disorder treatments. Governor Chris Sununu (R) announced the investment and applauded the hospitals’ commitment to work with the state on this crisis. New Hampshire is among the states with the highest rates of drug-overdose deaths.

Related: Congress continues to make the opioid crisis a key focus of hearings and legislation. The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing on proposed opioid legislation on April 11. The Opioid Crisis Response Act of 2018 is a package of legislation resulting from six bipartisan hearings on the crisis. The Senate HELP Committee plans to hold a mark-up session on the legislation on April 24.

The House Committee on Energy and Commerce (E&C) also held a hearing on April 11 to look at ways Medicare and Medicaid can improve the treatment of patients with opioid-use disorder. A principal deputy administrator from CMS testified on ways in which the agency is combatting the epidemic. This includes recommended prescribing guidelines, encouraging alternative pain treatments, increasing access to evidence-based treatment, and leveraging data to target outreach and fraud, waste, and abuse detection.

Maryland governor signs reinsurance program for state exchange into law

Maryland Governor Larry Hogan (R) signed a bipartisan bill on April 12 that is designed to stabilize premiums for health coverage sold through the Maryland Health Benefit Exchange (MHBE). The law intends to minimize premium rate increases by creating a reinsurance program to cover catastrophic claims. The state estimates that without the law, premiums would increase by 50 percent for the 2019 plan year.

Maryland intends to submit a 1332 waiver to request federal funds for the program. Waivers provide states with flexibility to experiment with their exchanges as long as changes do not increase the federal deficit and continue to provide protections for enrollees. The MHBE’s board must approve the waiver request before the state can submit it to CMS. A tax on health plans will help to fund the reinsurance program.

West Virginia passes biosimilar law

West Virginia recently joined 40 other states and Puerto Rico in enacting biosimilar substitution laws. Biologics are therapies derived from living cells, and biosimilar drugs are their “similar” equivalent. Biologics are more chemically complicated than small-molecule drugs because they are manufactured from cell lines of living organisms. Common biologics on the market today include injectable treatments for arthritis, medicines for cancer, diabetes, Crohn's disease, psoriasis, and the Hepatitis B vaccine.

The recently-enacted law in West Virginia allows pharmacists to substitute biosimilars for biologic drugs, as long as the prescribing clinician has approved it. Pharmacists are also required to notify the patient and the prescribing clinician of the change. Clinicians can request that only a brand-name biologic is prescribed.

Breaking boundaries

Collaborative public health initiative aims to help patients receive care in an emergency

The Sequoia Project, supported by a diverse group of health care stakeholders, is working on a way to transmit data from electronic heath records (EHRs) to emergency responders and health care providers who treat patients after a natural or man-made disaster. The Sequoia Project operates the eHealth Exchange nationwide network to share clinical information using a standardized, secure process. The initiative aims to make the health care people receive during and after a disaster more seamless.

The initiative builds on the Patient Unified Lookup System for Emergencies (PULSE), a demonstration program in California. PULSE is a public-private collaborative created to help ensure counties, cities, and states across the country are prepared for a disaster. The system allows disaster workers to look up patient records, such as prescriptions or recent test results, for anyone who comes to an emergency room, pop-up field hospital, or evacuation shelter. PULSE retrieves data from health information exchanges, hospitals and health systems, pharmacies, and other sources. HHS, the California Association of Health Information Exchanges, and researchers are providing financial and technical support for the initiative.

PULSE was tested during the southern California wildfires in late 2017. The test revealed important early lessons. PULSE was simple to use, though connectivity depended on access to the internet, EHRs, or health information exchanges. In the future, connectivity will likely come from satellites or mobile microwave systems. The goal of The Sequoia Project’s new initiative is to support broader deployment of PULSE beyond California. The Sequoia Project has a presence across all 50 states, serving several agencies within HHS, as well as medical groups, hospitals, dialysis centers, and pharmacies.

Analysis: Technology has helped improve the way emergency health care is provided in the wake of disaster. The rising prevalence of EHRs since Hurricane Katrina in 2005 means that tens of thousands more patients could be spared from having their paper records washed away in weather disasters. Significantly more providers were using EHRs during the 2017 hurricane season. EHRs help providers get immediate access to patient information for people who are evacuated to other parts of the state. The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted in 2009 and provided funding for EHR adoption, partially in response to the lessons learned from Hurricane Katrina.

However, across the country, interoperability—or the ability for providers who are in different networks to exchange and share information—is still limited for many patients. If patients need to go outside of their provider network, they might need to have their records faxed. Health care stakeholders have long recognized this challenge and are working to address this lack of interoperability in an emergency. In the years since Katrina, federal officials have been working on PULSE as a solution to EHR gaps in an emergency.

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