Latest / Becker’s Healthcare Podcast / Optimization in Uncertain Times: Why Leadership, Stability, and Showing Up Matter More Than Ever

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Optimization in Uncertain Times: Why Leadership, Stability, and Showing Up Matter More Than Ever · Becker’s Healthcare Podcast

0:00
Hi, everyone. This is Lucas Voss with Becker's
0:02
Healthcare. Thanks so much for tuning in
0:04
to the Becker's Healthcare podcast series. It's great
0:07
to have you for our episode
0:09
on tackling optimization in uncertain times, why leadership
0:13
stability and showing up matter more
0:16
than ever right now. And I'm so excited
0:18
to be joined by Brian McKellip. He's the
0:20
president of physician solutions at AMN Healthcare where
0:23
he leads sales recruitment and financial performance across
0:25
key service lines including locum tenants and permanent
0:28
physician staffing. With more than fifteen years in
0:31
the staffing industry, Brian brings deep expertise across
0:33
sales, operations, and account management along with a
0:35
strong track record of driving growth and building
0:38
lasting client partnerships. He's known for his client
0:40
first mindset, which we'll hear about here in
0:42
a little bit, and his ability to lead
0:44
high performing teams with clear results driven vision.
0:47
Brian, it's so great to have you. Thanks
0:48
so much for being here. Thanks for having
0:50
me. I'm blushing. What a great infection. Oh
0:53
my goodness. You know? Thank you. That's what
0:55
that's what all almost two decades in health
0:58
care gets you. I guess so. Fucking. Yeah.
1:00
I guess so. Yeah. No. I'm excited to
1:02
be here. What a great topic and,
1:05
looking forward to discussion.
1:07
I could probably talk all day about these
1:08
topics, but, I I think you probably got
1:11
some pretty concise questions for me. I'm glad
1:12
that answers when I got some good dialogue.
1:15
You're right. It would take us all day.
1:17
I do wanna start us off with part
1:19
of the title, which is uncertain times, which
1:22
we certainly live in right now. And I'd
1:23
love to know, again, from your experience, from
1:25
where you're sitting,
1:27
what are the most significant sources of uncertainty
1:30
health care systems are navigating right now,
1:33
and how is that changing those conversations
1:36
that you're having with health system leaders?
1:40
It's so I guess, I wish there was
1:42
a silver bullet to say a few things
1:44
that are just really, really that kind of
1:47
percolate, but I'd say it's it's less about
1:49
a single disruption, more about consistent change.
1:52
Right? So it's it's constant.
1:55
And, you know, leaders are are operating in
1:56
environments where assumptions don't really hold for very
1:59
long. You know, workforce decisions now, again, my
2:02
perspective, the hat that I wear, you you
2:04
have to account for speed, resilience, and sustainability
2:07
simultaneously.
2:11
Long are the days where you can sort
2:12
of silo these things. You've got to be
2:14
really nimble through the process. And let me
2:16
let me illustrate, I guess, by an example.
2:18
Lots of conversations over the past decade or
2:20
so around,
2:22
the volume,
2:23
expected impact of volume of outpatient versus inpatient.
2:26
And it's always been this, we're gonna see
2:28
this additional outpatient volume growing. Well, and the
2:31
reality of it is, those of you who
2:32
are ingrained in this understand payers
2:35
help define what outpatient means.
2:37
So the reality is that outpatient growth,
2:41
is definitely growing, but hospital encounters including overnights
2:44
are steadily increasing. Right? So we have this
2:46
juxtaposition
2:47
and change that's coming. So we're planning for
2:49
one thing, all of a sudden we see
2:51
this exponential growth
2:53
within hospital settings
2:55
regardless of the definition. So it's just that's
2:57
one little example
2:58
of how you have to be dynamic and
3:00
thoughtful around all of this change that's coming,
3:03
that's in our world today, and how we
3:05
manage that accordingly. So when I think about,
3:07
again, the hat that I wear,
3:09
that example I just illustrated,
3:12
how do you plan for that? Right? When
3:13
you're when you're predicting to have outpatient encounters,
3:16
but in reality,
3:17
they are sitting in your hospital beds, and
3:19
they're and they're they're in ICUs, and you're
3:22
you you you don't you're not staffed or
3:24
optimized for hospitalists
3:25
or, you know, whatever other specialties you need
3:28
to to have to help fill those gaps.
3:29
So I would say it's the workforce planning
3:32
that goes around that. Alright. How do you
3:34
optimize
3:35
for the uncertain times? I would say in
3:37
a nutshell,
3:38
that's probably the biggest piece that you've got
3:41
to solve for as you have constant change
3:43
and evolution within your own programs within these
3:45
systems groups, clinics, whereabouts might be.
3:49
You've talked about the fact that being nimble
3:51
is so important.
3:52
Right? And being able to adapt is so
3:54
important. Often, those things have to happen
3:58
on a strategic level. They have to happen
4:00
on an enterprise
4:01
scale, and that's where the leaders come in.
4:04
That's where leadership comes in. And I I
4:06
know that you've talked about this too
4:08
as in in terms of workforce optimization
4:11
being a a leadership responsibility
4:14
rather than just a simple staffing function.
4:18
Yeah. Can you talk a little bit about
4:20
what that distinction looks like in practice, and
4:23
what mistakes
4:25
and where do you see leaders making mistakes
4:27
with this?
4:29
Well, that's such a great great question.
4:33
Yeah. It absolutely is a leadership function. I
4:35
I think about staffing as it exists today,
4:37
and most folks in leadership capacity in in
4:39
these systems
4:40
think of it as sort of this one
4:42
trick pony. The reality is
4:44
staffing is essentially the table stakes, and it
4:47
has to be done. It has to be
4:48
done really, really well. Make make no mistake.
4:50
Right? You've patient continuity care, absolutely critical. You've
4:53
got to fulfill those needs from a staffing
4:55
perspective
4:56
in a really robust way.
4:59
However,
5:00
the ultimate goal is to support our clients
5:02
in developing and implementing an optimized model. Right?
5:05
So you're essentially putting a band aid on
5:07
on a problem if you're not thinking about
5:09
that optimization, you're not thinking about workforce planning.
5:11
So you've got to really
5:14
align between the short term coverage decisions and
5:16
the long term strategy is essentially what you've
5:18
got to balance. Right? Leaders and I'll get
5:20
to some of those mistakes that those leaders
5:21
are making in that realm in a second.
5:23
But I think again,
5:24
I love anecdotes. I'll share a recent example
5:26
of something that that I think will resonate
5:28
to sort of drive that point home. Large
5:30
health care system in the Midwest. I was
5:32
just with the CFO, CEO, and they had
5:34
an anesthesiologist,
5:35
67 years old. I feel like I I
5:37
have this happen to me regularly. But this
5:39
is, like, literally, this happened last week and
5:41
it happens probably once a month. I got
5:43
a million examples of this.
5:45
Time to retire. And the health system, even
5:47
though you know 67 year old anesthesiologist isn't
5:50
gonna be around for very long, pretty common
5:52
sense,
5:53
hadn't properly prepared for that. Right? And so
5:56
how do you go about that process of
5:58
coverage? Well, of course, the immediacy was Brian,
6:00
help me with the local. How do I
6:02
and, of course, we do. Again, back to
6:04
the stable stakes, you've gotta do that, but
6:06
that's not fixing the problem. Right? And so
6:09
I look at some of the data and
6:10
analytics we have.
6:12
We have as proprietary third party as well
6:14
as the client. And there's a million different
6:16
data points, and this is a whole another
6:18
topic because not all data, not analytics
6:22
is is worth a a dang. Yeah. But
6:25
if you've got the right things that are
6:26
meaningful for a client, you can help to
6:28
discern patterns. You can help to understand,
6:31
predictably,
6:32
how you need to move and migrate
6:34
staffing. Right? This is true workforce planning.
6:37
So when I had that conversation with that
6:39
CEO,
6:40
we started going down the rabbit hole. And
6:41
by the way, we have a partner that
6:43
can tell me
6:44
with over 80%
6:45
accuracy, if a provider's gonna leave
6:49
a an environment, a work for a work
6:51
environment within within a six month window, 80%
6:54
accuracy. Right? That's a data point that's really
6:55
meaningful.
6:56
And you combine that with about 98 others,
6:59
a 100 data points, 99 data points, you
7:01
can literally create a calculation of workforce planning.
7:04
So I started walking through,
7:07
well, do you really need that anesthesiologist?
7:09
Can you use three or two CRNAs?
7:12
And what about CAAs? And what about the
7:14
output for those four surgeons that that anesthesiologist
7:17
is supporting? The revenue that's being generated from
7:20
that. Right? So, yes, you need to put
7:22
a band aid on it with a locum.
7:24
How do we start bridging the gap with
7:25
a permanent solution? It's a on average, $350,000
7:29
to $400,000
7:30
just to recruit
7:32
just to recruit
7:33
an anesthesiologist.
7:35
So are you being gun shy there? Are
7:36
you being thoughtful on that approach? Are you
7:39
maximizing the time commitment in order to fulfill
7:41
that role? And you can start to spit
7:43
out an ROI.
7:45
Right? Based on the surgeries that are happening,
7:48
the vacancy cost for that anesthesiologist,
7:51
the backfill role with either CRNAs. There's a
7:53
cost that goes into that, right, with my
7:55
locum. Right? So you start to really calculate
7:57
the impact.
7:58
And that's one little example of one little
8:01
surgery center and one very large health system.
8:03
Imagine multiplying
8:05
that for a system
8:06
and creating a pathway, a true dedicated pathway
8:10
to maximizing coverage for patient continuity,
8:13
consistency of workflow,
8:15
better work, physician engagement and workforce. Like, just
8:19
holistically, it's this wonderful snowball
8:21
that you can create
8:23
to allow a better experience for your patients,
8:25
your providers,
8:27
and and your mid level everybody involved. It's
8:29
a better environment, better way to do that.
8:32
So that there's a lot there. I just
8:33
kinda threw up on you. I'm kinda what
8:34
some of that is? I'm super passionate about
8:36
that. But some of the common mistakes,
8:40
it's it's sort of being shortsighted, honestly. Right?
8:42
Because they're so oftentimes, our our health systems
8:45
are always find themselves behind the eight ball.
8:47
Again, not knowing how to plan effectively,
8:49
they're reactionary.
8:51
Right? They they the cheat is transactional
8:53
as or as a task. And we've gotta
8:55
get away from that that mindset and that
8:57
process. We've got to and then by the
8:59
way, that's the responsibility
9:00
of folks like me. It's not the health
9:02
system.
9:03
Their their focus is health care. My focus
9:06
is optimization. My my focus is workforce planning.
9:09
So we've got to step up. Right? Folks
9:12
like me, we have to step up and
9:13
force that behavior. We have to teach them
9:15
that there is a way to do this
9:17
that allows them to be more proactive in
9:19
their view.
9:21
Another piece that folks typically
9:23
sort of miss the mark on,
9:25
and there's a reason why I occupy both
9:27
the locums and the perm space continuity,
9:30
A lot of leadership sort of silos that.
9:32
And that's a that's a big miss. Right?
9:34
You've got to have some some consistency there
9:36
on how to bridge the gap with locums
9:39
and permanent staffing.
9:41
All too often, we've got
9:43
disparate leadership over both of those things and
9:46
they're they are counter to what each other
9:48
are trying to accomplish. And that's a big
9:50
reason why we miss some marks when it's
9:52
come when it comes time for planning. They're
9:54
just not talking. They're not communicating effectively. So
9:56
I would say those are some of the
9:57
common mistakes.
9:59
Plenty others that happen or, again, the data
10:01
analytics,
10:02
not knowing how to compress that information
10:04
and give meaningful results for that. We have
10:07
data coming out of our ears, but so
10:08
what? Right? How do you take that and
10:10
actually have meaningful results and impacts? Those are
10:12
some of the common ones that I see.
10:14
Can you talk a little bit more about
10:16
the fragmentation piece and why that's so risky,
10:19
that fragmented approach and the silos that you've
10:22
touched on just now.
10:23
Why is it so crucial
10:25
to not have those silos, and what are
10:28
the downstream risks when you're approaching this from
10:31
a fragmented perspective?
10:33
Yeah. It's the the short term coverage
10:35
strategically,
10:37
isn't aligned to support the long term goals.
10:39
It's probably the the easy answer to that
10:42
question.
10:42
There becomes a higher risk of overreliance
10:46
on the short term staffing,
10:48
without really a true path to stability.
10:50
Right? Because you're constantly just sort of in
10:52
the churn. You're not slowing down to speed
10:54
up. You're not planning appropriately.
10:56
That, of course, increase your costs,
10:59
often
11:00
duplication of processes, inefficiencies.
11:03
You're you're being super reactive to decision making.
11:06
And also,
11:07
it creates this is a little bit more
11:09
nuanced, but it creates this environment where you
11:12
become,
11:13
more accustomed
11:15
to just that quick hit adjustment. Right? And
11:18
you're not really thinking strategic about the market
11:20
or what's happening within the the census of
11:23
your area. You're just you're just being reactionary
11:24
filling that need. It becomes easy. It's the
11:27
easy button, a locum. Right? If you don't
11:29
have the proper blueprint,
11:30
then you have to rely on that locum.
11:32
And that's part of the siloing that we're
11:34
seeing is that you don't have that continuity.
11:36
You're not having that conversation and cross pollinating
11:38
between the perm and the locum's piece to
11:41
be able to deliver that that,
11:43
that that overall solution.
11:45
And also, it really you know, there's a
11:47
reduced organizational
11:49
agility
11:50
during a lot of uncertainty or disruption.
11:53
And I think,
11:54
if you have the plan, if you have
11:56
sort of this SOP type of approach on
11:58
how to staff for that, you become less
12:01
resilient or reliant, excuse me, on the locums
12:03
component. You're you become you become more confident
12:07
in your solution when you have that, that
12:09
joint approach to locums and perm.
12:13
You've talked about the example of the 67
12:15
year old anesthesiologist,
12:16
right, that just decides to leave and there's
12:19
no real plan in place. And then you
12:20
also touched on the cost affected with, like,
12:22
well, great. Now we have to replace them
12:24
300,000, $400,000
12:26
just to be able to say, okay. We
12:27
can fill that somehow. Right? And I I
12:30
do wanna talk a little bit about more
12:32
about this piece specifically because, again, we know
12:34
that the market is extremely competitive.
12:37
Right? Physicians have lots of options. They can
12:40
do whatever. They can retire. They can leave.
12:42
They can just disengage with the organization and
12:45
not care anymore, which is certainly one of
12:46
the outcomes that's the most terrible for patients.
12:50
What are some of the specific commitments or
12:52
actions
12:53
that you feel like really move the needle
12:55
for organizations right now when it comes to
12:57
trust and retention.
12:59
Right? And what are those conversations look like?
13:01
What should those conversations look like?
13:04
So important. Yeah. It's this is yeah. Supply
13:07
and demand. Right?
13:08
The the demand continues to increase. The supply
13:10
of of quality providers continues to be a
13:13
challenge.
13:14
I I would say
13:15
physicians stay
13:17
when leadership reduces friction,
13:19
increases
13:20
control, and demonstrates follow through.
13:22
You know, it's the communication component. I I
13:25
would say if you're clear and honest
13:28
about challenges, particularly staffing challenges. Right? We know
13:31
to be open and honest around what the
13:33
plans are around that.
13:35
Share predictable sustainable coverage strategies. Right? Make sure
13:38
they're involved in that process.
13:40
I'm starting to see where we have super
13:42
high provider engagement
13:44
is when providers have the ability to do
13:46
things like self schedule.
13:48
Right? They have they have autonomy.
13:51
Addition to that, there's schedule stability.
13:55
Equitable call distribution is another one. Right? So
13:58
you're you're talking through these things with the
14:00
provider and they have line of sight to
14:02
where the gaps within these
14:05
biggest challenges that they face are. Right? The
14:07
burnout is a real thing. Let them be
14:09
part of the solution and be super transparent
14:13
around that process. Give them some control.
14:16
It's it's really, really important. The other piece
14:18
I would say,
14:19
sticking with the leadership aspect here, is that
14:21
visibility and and presence
14:23
during these high pressure moments is critical. I
14:26
mean, I think AMA data AMA just put
14:28
out a report. It shows that where leaders
14:31
solicit and follow-up on physician input, the the
14:34
it's it's through the roof. The the the
14:36
stickiness of the provider just goes up immeasurable.
14:39
So you've got to ask those questions, but
14:41
you also have to make sure that you're
14:43
involved with them. Your sleeves are rolled up
14:45
and they're in the trenches with them through
14:47
that process.
14:48
I would I would say too,
14:50
you have to make sure that you're not
14:51
you're not being overly exhausted to the to
14:53
the permanent teams. If you have the locums
14:55
that come in, you've got to strike that
14:57
balance. Again, back to the scheduling component of
14:59
that, but coverage models that support in a
15:01
multi pronged approach. Right? You have to balance
15:04
that locum with the perm,
15:05
again, allowing them to have continuity and some
15:08
control of that scheduling to understand the balance
15:10
to strike that most effectively when it comes
15:12
to leveraging some contingent labor and locums versus
15:15
the permanent the the permanent team.
15:18
And then, of course, the, the leadership component
15:21
that I think matters most
15:23
is demonstrating,
15:24
not saying, but demonstrating the commitment to the
15:27
continuity of care and the professional respect of
15:29
these providers. You've got to put your money
15:31
where your mouth is. And that that piece
15:33
is really, really important,
15:35
and it can't be overstated.
15:37
Turning this around, obviously,
15:39
my question is going to be the opposite
15:41
of everything. The answer to my question is
15:43
going to be the opposite of everything that
15:45
you just said.
15:46
But if there is one thing,
15:49
if you had to point to one thing
15:51
that should absolutely be avoided,
15:54
what would that one thing be?
15:57
I'll tell you,
16:00
such a good one.
16:01
Stop asking providers
16:03
to become more resilient
16:06
instead of fixing the systematic problems. Stop ask
16:09
stop going back to the well. Right?
16:12
Why do you think we have a burnout
16:13
problem? And I hear this consistently.
16:15
Right? We're trying to maximize profits. We have
16:17
to increase census.
16:19
That's not solving the problem. Right? You're not
16:22
you're not staffed appropriately. You're not you've not
16:25
done back to the workforce planning. You've not
16:26
done that effectively,
16:28
so you're causing this challenge for your providers,
16:30
and you're telling them to roll up the
16:32
sleeves and get and get more ingrained in
16:34
it. That's not fixing it. Stop asking for
16:36
resiliency
16:38
and and get in the weeds and fix
16:39
the systematic problems.
16:41
That is and I can go, again, all
16:44
day there on a million different topics of
16:46
what that looks like, but I would if
16:47
I had to boil it all down, I'd
16:49
say that is the biggest number one thing.
16:51
Well and it comes full circle to what
16:53
we touched on earlier in their conversation, which
16:55
is in fact that this is a leadership
16:57
responsibility right now. It needs to be top
16:59
of mind for leadership, not just the staffing
17:01
issue. It needs to be part of the
17:03
strategy, which is so crucial.
17:05
As we close our conversation here, Brian,
17:08
if health system leader is listening today
17:11
and they're realizing,
17:12
hey. I'm clearly not doing what Brian is
17:15
telling me to do. Yeah. I'm not doing
17:17
the right thing. I'm not as resilient as
17:19
I thought.
17:20
What's that first step you're encouraging
17:23
to take and to reach out. Right? And
17:26
what should they expect that journey to look
17:29
like? Well, first of all, you're not alone.
17:31
Alright? Like, everybody's in this situation if you're
17:33
that leader.
17:34
No. Secondly,
17:36
reach out to me. Alright? But super slug,
17:38
happy to help there. But I I would
17:40
say, you know, really
17:43
start looking at through different lens. Right? We
17:44
talked a little bit about workforce planning, but
17:46
you the way most folks are looking at
17:48
this as a retention problem, so they're trying
17:50
to fix retention rather than start to really
17:52
understand the risk.
17:54
Right? So it's a risk problem assessment versus
17:56
the retention
17:57
challenge. And so it's not around sentiment.
18:00
It's not around engagement scores. Right? That's that's
18:03
retention.
18:04
Right? It's real near term risk of loss,
18:07
disengagement, and burnout. You have to be thinking
18:09
about that risk,
18:10
and then that sort of fixes the retention.
18:12
Right? So you sort of reverse engineering that
18:14
process,
18:16
and everything else sort of flows from there.
18:18
You you start to evaluate the short term
18:20
staffing decisions. Right? Versus, again, we talked about
18:23
that versus the long term workforce planning goals.
18:25
If you're thinking about the risk, again, you're
18:27
being more strategic looking around the corner rather
18:29
than focusing on right right in front of
18:31
me, the band aid, the locum. You're thinking
18:33
more strategically about that. And then you start
18:36
to look across coverage, utilization,
18:38
costs,
18:39
the the the provider experience. All of those
18:41
sort of things start to percolate and become
18:43
more meaningful if you're thinking about it through
18:45
the lens of understanding that risk
18:48
rather than that retention. And that is a
18:50
dynamic shift that a lot of a lot
18:52
of teams have not been
18:54
conditioned to do,
18:56
and not not being disparaging. It's just the
18:58
way that we've been structured or or or
19:00
geared and raised in our environments
19:02
to, to allow us to not think that
19:04
way strategically.
19:06
So I would say resilience begins with leadership,
19:08
you know, owning and then having the willingness
19:10
to step back and recalibrate.
19:12
I think if you start looking at through
19:14
that lens and you say, you know what?
19:15
It's not working. I'm not gonna
19:17
use the often misquoted Einstein quote of doing
19:20
the same thing over again expecting a different
19:22
result. Right? You've got to challenge the status
19:24
quo
19:25
and you've got to augment where appropriate. Right?
19:27
Not not taking into consideration
19:29
loss of continuity of care. You've gotta do
19:31
things in a strategic way and look at
19:33
them through a different lens. And the more
19:35
strategic you can be, the better outcomes you're
19:38
gonna receive.
19:39
Challenging the status quo starts with a call
19:41
to Brian. You've heard it here
19:43
first. Brian, so great to have you. Thank
19:46
you so much, for your time and insights.
19:47
What a great conversation. Great to have you.
19:49
Luke, it's always a pleasure, my friend. Anytime
19:51
you wanna have a conversation, just let me
19:53
know. And we'd also want to thank our
19:55
podcast sponsor, AMN Healthcare. You can tune in
19:57
to more podcasts from Becker's Healthcare by visiting
19:59
our podcast page at beckershospitalreview.com.