Becky Hultberg is the President and CEO of the Oregon Association of Hospitals and Health Systems (OAHHS) where she works with local and national government leaders to promote community health and continue improving Oregon’s innovative health care industry.
In this Q&A, Hultberg discusses how the workforce shortage affects hospitals, how the delta surge will affect hospitals in the long run, and how it affects every Oregonian.
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Patrick Jones: Can you shed some light on how increased capacities are affecting hospitals and hospital employees?
Becky Hultberg: “We’re experiencing a surge of the unvaccinated. Around 85% to 95% of the patients in a given unit are unvaccinated COVID 19 patients. The sheer number of those patients has overwhelmed the health care system in regions of the state. This is a hospital capacity crisis, but more importantly it is a patient care crisis. The impacts of the crisis affect care for the entire community. We’ve had thousands of elective surgeries delayed. Those are needed procedures that haven’t happened, and sometimes the delay will have a negative impact on that person. We’ve seen ICU over capacity. We’ve seen hospitals struggling to transfer patients who need higher levels of care.”
PJ: What problems are you seeing with the health care workforce and how are hospitals trying to mitigate these problems?
BH: “Workforce in health care was a challenge before the pandemic, and the pandemic exacerbated the challenge. We have caregivers who have come to work for 18 months to care for COVID patients in extraordinary circumstances. Many of them are tired, they’re frustrated, and some of them are leaving the profession. So we are at the most difficult time of the pandemic from a workforce perspective. It will take us years, or even decades, to normalize. Workforce has to be one of our most important priorities coming out of the pandemic. [We need to think about] how we rebuild our workforce, how we reevaluate our training programs, and how we can help our workforce recover.”
PJ: Are there any interventions that hospitals are currently implementing to try to retain employees and to try to hire new ones?
BH: “Hospitals have done many, many things over the course of the pandemic to help their employees and to recruit new employees. Those types of things are going to vary across systems, so it’s hard to identify specific things that are characteristic of all hospitals.
There have been bonuses paid, and there have been significant shift differentials paid. There are always active recruitment efforts going on to bring in new employees. Hospitals have launched special recruitment efforts. They’re turning over every rock to try to keep their current workforce, and to bring in new employees. But the challenge is that workforce is not just an Oregon issue, it is a national issue. We’re competing for the same workers as New York, California, Alabama, and Michigan. We have to address this problem at a state level, and we also have to look at it nationally as well.”
PJ: How is the rise of competitive wages for health care professionals impacting hospitals?
BH: “The rates that hospitals are paying travelers are extreme. We’re in the middle of response right now. At some point we will pivot to recovery, and we’ll be looking back at the financial impacts of this pandemic surge. They will be extreme. Hospitals are spending incredible amounts of money to both retain and to bring in new employees. We’re really going to have to reset after the pandemic.”
PJ: What do you think this reset will look like?
BH: “We are going to have to look back at the workforce implications of this pandemic and ask ourselves questions, ‘what does the workforce of the future look like? Does our current infrastructure support that workforce? And what do we need to do to increase the pipeline of trained healthcare workers and to retain the workers we have?’
We’re also going to have to look back at the financial impacts of the pandemic. The number one expense for hospitals is staffing, and we’ve had pretty significant increases of expenses around staffing. So, we’re going to have to look at that issue in light of the state’s health care cost growth target, see where we landed, and if we need to re-evaluate our trajectory.”
PJ: How is quality of care being affected by issues of capacity and workforce in this delta surge?
BH: “When you have a strained system, you’re trying to take care of more patients with the same or fewer resources. There will be concerns. We’ve had hospitals that have had to change the nurse staff ratio, because of the volume of patients seeking care. Those kinds of things do raise questions about quality. Our hospitals are working every day to provide the best care to every patient who walks through the door, but they’re doing that with finite resources. We have to raise the alarm bell over hospital capacity because we were concerned at their ability to continue to provide the best care to every patient given the resource constraints and the huge volume of patients coming through their doors.”
PJ: How have efforts from the governor’s office helped hospitals? Did hospitals see the National Guard and how helpful were they?
BH: “The state stepped in and the governor provided some resources that have helped significantly. I’ll talk about two of those things. The first was deploying the National Guard. The National Guard members don’t work in clinical settings, but they are providing much needed relief in other areas of the hospital. It’s also a morale booster for the staff to see the National Guard in the buildings. It’s a way that they can see that the state is supporting them as they’re doing this really taxing [and] hard work.
The second thing that’s been helpful is that the state has contracted with some private staffing agencies to provide some supplementary clinical staffing. That includes nurses and other medical workers. Those positions were critical to help regions of the state, severely impacted by the pandemic, to supplement their staff and give some of their clinicians some needed rest. We had clinicians working every day for a period of time and it was critical to supplement that staffing.”
PJ: What more can the government and governor’s office be doing to assist hospitals? Is enough being done?
BH: “I think we’re reaching the peak in case counts and hospitalizations — at least I hope that we are. So we need to continue with the resources we have to manage this surge. Beyond that, it’s going to be important to look at the public policy lessons we’ve learned through this pandemic. Workforce will obviously be a significant area of focus, but we also need to look at the issue of post acute care.
One of our biggest challenges during this pandemic was discharging patients. We regularly have over 400 patients sitting in hospital beds, who don’t need to be in the hospital. They could be in a lower level of care. So we need to dig into that issue to understand the barriers to discharge, and to try to create systems that will allow patients to move to the setting that can best meet their needs. It’s not good for people to be sitting in hospital beds if they don’t need to be there.”
PJ: How do these issues that we’re all seeing in hospitals affect all of us?
BH: “We all rely on the hospital as a safety net. We rely on the hospital to be there if we have a sick child who needs immediate care, we get into a car accident, [or] we have a fall while hiking. The value of hospitals is being there when you don’t need them, because we never know when we will need them. Very often we rely on that open door in our daily lives without even thinking about it. When our hospitals are full, it calls into question that safety net that we take for granted.”
This interview was edited for clarity and length.