Becoming the Health Care System of Choice for Doctors, Nurses and Other Caregivers

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Key takeaways:

  • Doctors, nurses and other caregivers are our most important assets
  • Lee County suffers a 350-700 doctor shortage
  • Becoming the system of choice for physicians would help to eliminate the shortage, with easier recruiting and better retention
  • Suggest research with our current medical staff be done to assess their workplace, professional and non-work satisfaction and to further use the findings to plan improvements to make Lee Health doctors’ system of choice
  • Likewise, there is evidence that our positioning with nurses is about the same generally found elsewhere, which may be affecting our nurse recruitment and retention efforts
  • Research should be conducted to help better understand and to manage aggressive implementation of needed changes

Let me pose perhaps a ridiculous question. What would happen if you were sick or hurt and went to a hospital and there weren’t any doctors, nurses or other caregivers there?  

The answer, of course, is nothing – because there wouldn’t be anybody to treat you. 

Hospitals and their first cousins, ambulatory and urgent care centers, are simply buildings loaded with lots of expensive equipment that doesn’t come to life and make a difference until staffed with doctors, nurses and other caregivers.    

Said simply, as a health system our most important asset is our staff and taking care of them should be our number one, two and three priorities. If we take care of the staff and we give them the proper tools, they will do an excellent job of taking care of our patients.  

How do we know if we are doing a good job of taking care of the staff? It starts with knowing if they are engaged and if we have secured their loyalty.  That is, are the staff raving fans of Lee Health? Is Lee Health their system of choice as both a place to work and to be a patient? This means that when they’re asked, they tell their families and friends that there is no better place to be – that Lee Health is the best! 

Having a reputation of being the health care system of choice for doctors would make recruiting easier and more effective, and we all know having more doctors would be a good thing for Lee County. 

An often-heard complaint, especially among new residents, is how hard it is to secure a doctor’s appointment. Another frequently expressed concern is about doctors relocating and forcing patients to develop a relationship with a new physician.   

These concerns are not altogether surprising when Lee County compares its doctor-to population-ratio to the state and nation. We need about 350 more doctors to be at the Florida state average, and about 700 more to be the same as the country.  And, adding these doctors just gets us to the average and doesn’t account for Lee County residents requiring more medical care because its residents are typically older.  We need more doctors. 

Not being the health system of choice impacts cost, quality and service, too.  If medical staff, nurses and other caregivers don’t think Lee Health is their best choice, Lee Health risks having these key clinicians recruited away. 

  • New staff, until they are fully oriented, typically need assistance from others to avoid making mistakes and are therefore, always less productive than seasoned workers 
  • Turnover is expensive, with recruitment itself being costly 
  • Turnover and recruitment is risky, with unfortunately and all too frequently, the wrong person being hired, despite careful use of thorough selection processes 

So how does Lee Health stack up with its own doctors? 

There are signs that Lee Health is the health system of choice including: 

  • Growth of Lee Physician Group 
  • Success in retaining Cape Coral Hospital family medicine program residents 
  • The highly effective collaboration with the medical staff in managing the COVID-19 pandemic 
  • The hopeful efforts to create an internal medicine residency program at Cape Coral 

However, there are some worrisome indicators including the desire of physicians, expressed through the Lee Health Physicians Leadership Council, to be closer to the Lee Health Board of Directors and to have a larger role in managing Lee Health.  

Lee Health should be routinely assessing its position to understand how physician recruitment and retention efforts should be changed to be more successful. 

Findings from other health systems studying physician preferences suggest there are three primary factors to be considered: 

  1. A good workplace. This includes compensation, hours including call arrangements, quality of facilities and support staff, “burnout” usually related to documentation requirements/third party payer relations and autonomy/responsiveness of management and governance.  
  2. Professional satisfaction. This includes quality/relatedness of peer group, career options, role of medical staff in planning, budgeting, quality assurance, patient satisfaction and workforce satisfaction, access to medical consultants, continuing medical education, and academic affiliations.  
  3. Non-work-related issues. These include spousal/partner/family issues and general environment (growth, living conditions, schools, government, taxes, weather, etc.).  

Drilling down and understanding these factors would materially help Lee Health in managing its programming to ensure that it is the system of choice for doctors. 

And, how does Lee Health do with its nurses and other caregivers? The most recent (2019-2020) Lee Health Employee Engagement Survey suggests that Lee Health is good but again has some opportunities for improvement.   

One positive the survey noted is Lee Health employees are higher than the national norm on their agreement with the statement,  “If a family member or friend needed care, I would recommend Lee Health.” 

However, some troubling findings include: 

  • Lee Health employees are lower than the national norm on “Would recommend employment at Lee Health” 
  • Lee Health Employees are lower than the national norm on “I love working for Lee Health” 

Perhaps most concerning of all, because of nursing’s intrinsic role in patient care, is the finding that employees in the Registered Nurse Position (which has more workers at 2,545 than any other title) have significantly lower engagement than the Lee Health average and the all-employee national norm 

Findings from other systems suggest that nurses who have lower engagement often have less professional satisfaction, which is frequently related to nurse-to-patient staffing ratios being too high to allow positive nurse patient relationships to develop.  

The Employee Engagement survey results are reviewed against the “norm” as opposed to top quartile or decile performance.  If Lee Health is to be the system of choice, should we have as a long-term aspiration setting the benchmark to be at one of these higher levels? 

Management is keenly aware of these Employee Engagement findings, which presented them to the Board of Directors last fall. Action plans have been implemented to improve positioning. There is another survey due to be conducted this summer which will provide some insight regarding the effectiveness of the plans.  Keep in mind, there should be some caution used in reviewing the effectiveness of the plans because of the disruptive effects of the COVID-19 pandemic.   

There may be some urgency in addressing Lee Health positioning regarding nurse staffing. A status report on nursing supply and demand published in 2016 by the Florida Center for Nursing (the most recent report available) cited a growing increase in the number of hospital and home health agency nursing vacancies. This is consistent with Lee Health hospital management reporting challenges in recruiting nurses.  

Again, our most important asset is our staff. It is imperative that Lee Health be their top choice.  

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