Liz Hatton:                    

Welcome everyone to today's webinar, how Mercy grew By Over 1,000 Internal gig nurses and cut travel agency spend by 50% in 2022 while improving vendor's experience. I'm Liz Hatton withBecker's Healthcare, thank you for joining us today.

Before we begin, I'm going to walk through a few quick housekeeping instructions. We'll begin today's webinar with a presentation, and we'll have time at the end of the hour for a question and answer session. You can submit any questions you have throughout the webinar by typing them into the Q&A box you see on your screen.

Today's session is being recorded and will be available after the event. You can use the same link you used to login to today's webinar to access the recording. If at any time you don't see the slides moving or have trouble with the audio, try refreshing your browser. You can also submit any technical questions into theQ&A box, we're here to help.

So with that, I'm pleased to welcome Betty Jo Rocchio, the Senior Vice President and Chief Nursing Officer of Mercy Health Systems, and Dani Bowie, theVice President of Clinical Strategy and Transformation at Trusted Health. Thank you both for being here today. Dani, I'll now turn the floor over to you to get us started.

Dani Bowie:                  

Great, thank you. Thanks for having us. So I want to jump right into it. Present day nursing capacity challenges continue to be top of mind for most health systems, and I wanted to share some relevant data pertaining to recent trends to set the stage for the presentation today. Over 90% of CNOs say that they're not staffed, that they want to be, with nearly 65% of their nurses saying they're planning on leaving their career within the next five years.

And if you really dig into capacity metrics at an individual specialty level, the trends become even more alarming. With over 100% percent annual turnover in specialty areas such as behavioral health or ICU. And if that's not enough, there's a nearly four month recruitment cycle to bring in experienced specialty nurses as well. So thinking about our ORs, our EDs, ICU. And unfortunately, the projection for the nursing profession shows a shortage on the horizon.

The picture presented here today is pretty bleak, and many health systems are rallying around workforce strategies that will give them a competitive advantage and sustainability for the future. I'm excited to hand the presentation over to Dr. Rocchio to share how Mercy has developed innovative workforce strategies paired with technology that have allowed them to stay ahead of the curve, as well as become a destination for top nursing talent to practice. Dr. Rocchio?

Betty Jo Rocchio:          

Thank you very much. It is such a pleasure to be here with you today. Such a hopeful presentation. I'm going to talk a little bit first about Mercy where I practice. We do have a reputation for delivering fantastic patient care. We are one of the 25 largestUS health systems, and we are one of the largest accountable care organization.So that's important from the patient perspective. We are a highly integrated, multi-state healthcare system. We have more than 40 acute care hospitals. We have managed specialty hospitals, and we have a lot of JVs that we have across our footprint. We have 900 physician practices, we have 3,400clinics and physicians, advanced practitioners, and we have 40,000 coworkers across eight states. Over 10,000 of those 40,000 coworkers are our nurses, so we are just a large percentage of the coworker population.

So let's talk a little bit now as we move forward into what we're going to look like here in the future. How this all began in Mercy really has been just an incredible, multi-year journey. We've had workforce challenges just like everybody else out there, and staffing continues to be at the top of our mind almost every single day. You'll note that five years ago, the UnitedStates Bureau of Labor Statistics projected the need for over a million new nurses by 2022. And guess what? We're in 2023, and we have an even greater need for nurses today.

Before the pandemic, a couple years even before the Pandemic, Mercy was experiencing some staffing challenges. There's a perception of heavy workload on individual units, and just a lack of flexibility about the way we continue to look at the nursing workforce. So even before the pandemic, we started developing a workforce strategy that was going to address this crisis, and the nursing shortage, and taking a look at things in a little different way.

So instead of saying, "Right, we have a nursing shortage," the hypothesis was that it wasn't a standalone issue, this workforce problem. It's a failure for how we design the staffing model, really in response to the healthcare delivery model. So instead of saying we have a nursing shortage, in our minds we were saying, "Do we have a failure to design the healthcare delivery model to meet the workforce that we have today?" And that's a very different way to look at this. So when you flip that hypothesis around a little bit, you can see why we are starting to look at things from more of a flexibility perspective.

So in order to take a look at this, my nursing leaders and myself, we really went on a journey to look at what would a complete workforce transformation look like?How could we redesign that staffing model so we weren't in crisis every single day? So we turned to the literature. Like all good nursing leaders embedded in evidence-based practice, we went out and did our literature search to see the five common themes right across the multi-generational workforce that was becoming important. How should we start to address this problem? How should we flip our mindset to a place where we can make some strides?

And you'll notice for those of you out there that are familiar with synthesis tables, you will notice there is a synthesis table on here. I'm not going to go over it, but you will notice that there is a generational workforce design, and taking a look at the things that matter most. Which are how do we use technology in the right spots? What would that new vision for a nursing career look like, which is so important to our nursing workforce? What does flexible compensation really mean?

Before the pandemic, flexible compensation met paying an incentive to have people work, but the way in which we were doing it was largely manual. Work-life balance was always an important consideration, and that flexibility or control over our schedules. One of the things about being a nurse is you have to show up every single day for your patients, but that flexibility sometimes is needed to work around your family or other commitments that you have.

And so how do we design this workforce so it makes sense? And you'll notice across all the generations, there's very little variation in those five common themes that we looked at across the generations, which was interesting. Because you would think that in a little bit more experienced nurse, that technology integration wouldn't be as important. But that's not what the literature showed us.

So out of the literature, how did we start to think about this even before the pandemic?So the literature gave us just some guiding principles as we were designing our new workforce model, which we're going to talk a little bit about here in a couple minutes. But some of the things that were non-negotiables were choice on how nurses work. Some nurses wanted less flexibility but wanted to make more money, and others wanted more flexibility around work-life balance, and were willing to take a little less compensation. So there was not consensus among any of the generational workforce models, so we knew that we had to build in maximum flexibility for our nurses.

We also needed to give our nurses the ability to access the workforce layers at different periods in their life. We know that the coworker life cycle might start on one side, and end up on the other side. And what's driving it is people's personal lives put them in different spots, and you want different things in your career as you advance through the years of your career. And we also did take into account some of those generational workforce things that come up that make picking up shifts or working different, and you're going to hear a little bit about some of the things we brought from outside industries into that nursing workforce model.

So what does that new, flexible workplace model look like? There were many different ways we could have gone with this, but one of the places we started was decreasing that reliance on any workforce layer. So if we've learned anything during the pandemic, it's been three guiding principles. Number one, flexibility and pay is important. Number two, nurses want to work how and when they want to work.And number three, no one workforce layer is going to take you into the future where you need to be.

And so in the past, especially during the pandemic, we saw as high as a 25% reliance on travelers. Now those travelers are agency, they are domestic agency, they're also international agency nurses. We also saw about 67% of core staff, which is why we were so heavy in agency. And when we looked in the middle, we saw a flexible layer that met about 8% of our needs. And so one of the things that was very important in the literature was that flexible model. So how do we expand that model to get to where we are today?

So I'm going to give you some early results here, but our new flexible workforce model is yielding about 10% travelers, 60% core, which is fine. I know a lot of you are saying, "Betty Jo, you decreased your core." But look at the increase in the flexible staffing layer that is coming up, a 30% flexible staffing layer, which gives you that wiggle room to work exactly when you need them, right? All productivity is not the same, and so that flexible layer allows us to plug in. And we're going to talk here in a little bit about exactly what that flexible layer has given us, both in utilization as well as some of the rates that we're able to see. Our average hourly rate has really shored up with that flexible staffing model.

So we're going to take a little bit deeper dive here into the flexible workforce layer.So at the very bottom of everything is our core coworkers. And when I say the bottom, I mean the most important layer. Meaning they are the largest layer, they are our tried and true staff, they are the nurses that get this done every single day. We have full-time and part-time, and PRN unit-based nurses that sit in that layer. So for example, we're very flexible on the number of hours, the FTE. And no longer do we schedule by shift, we schedule in hours. Now I'm not saying everybody is on totally flexible hours. But instead of saying we schedule from a 12-hour shift, we say we schedule in blocks of 12hours. And that becomes really important as you start to look at that flexible layer, and we're going to dive a little bit deeper into that here in a minute.

In the middle was that flexible... We have a regional float pool and a local float pool. Region means that you have to be able... You're a full-time or part-time coworker, but you have to be able to travel to different hospitals in our regions. The local float pool also still exists, and it's just working multiple units within one hospital. So you can see that flexible layer really starts to split out, and gives people options right here in our health system. And so if you wanted to make a little bit more money, have a little bit less flexibility, you're in that regional float pool model and you're very flexible on how and when you work. If you want a little bit of flexibility but not quite as much as regional, you're going into that local float pool. And there are defined layers there, they have exact definitions and they are compensated according to that flexibility model.

The other thing is that flexible model now, this is the new piece of it, includes a gig workforce. This is a completely new workforce layer to nursing. It's not your typical incentive shifts, but it is really about the nurses that want to workin a completely flexible format. And let's slide just a little bit into what the gig coworker is. So the only way this flexible model works is that you have strict definition for each of these layers, and you have a clarity and purpose on what's driving the layer.

And so for that gig coworker, number one, they are Mercy nurses. They are hired by Mercy, they are not contracted workers that float in and out of our facilities, but they are internal Mercy nurses. They are nurses that are interested in occasional shifts. Now, they may have working in Mercy as their only job, or they may work in some of our hospitals surrounding us, but they give us their extra time. So if they want to work overtime, if they just want to pick up extra money for something that they're doing on the outside, they're able to come into Mercy and do that. There are no benefits associated with the gig nursing workforce, and little commitment to ours. They are a zero-based FTE.They are hired and have the same qualifications of our Mercy nurses. So they go through a talent interview, we have a Mercy fit interview-

Betty Jo Rocchio:          

... go through a talent interview. We have a Mercy fit interview, and they take the same core competencies as our full-time and part-time core staff. Here's the difference. This workforce layer uses a mobile app to pick up shifts, and we're going to talk a little bit about where that technology comes in and a little bit of the psychological mindset that comes in with having an app here in a minute. They are a max of 30 hours per week, and currently today they have to pick a minimum up of one shift every 90 days to stay active in the Mercy system.

Where do they report? Do they have a manager? How does all that work? That was some of the burning questions on the nursing leaders' minds before we started this. We have a float pool center, a hub if you will, that directs some of our patient care as well as it directs our staffing. And those gig coworkers have an actual manager in that hub. So they are connected to a manager in Mercy.

How are they paid? That's the next question. They do have a flat base rate of pay like all of our nurses, like our core coworkers have a flat base rate of pay, but those incentives are driving them to pick up in the areas of greatest need. And so we're going to talk a little bit about how the technology works, but one of the core things that's important here is the app is driving how they pick up the shifts and the incentives are driven from our staffing and scheduling system. So we are looking at whether we increase the requirement for the gig nursing workforce, but today it is 12 hours every 90 days. This offers a great amount of flexibility for both nurses that are working outside of the system for their full-time job and are coming in to pick up extra, or if they're making this their full-time type of employment.

So what's needed? You'll notice when we did the literature search, technology was a big piece of this. So a lot of people are probably sitting on this call today going, "Well, we kind of do this. We have a regional and float pool, we have a per diem type of workforce that we're paying more money to go to other places." But unless you have the technology connection, you're missing out on being able to pick up in places that are automated with some dynamic scheduling that can happen in the background. So if you're doing it, you're probably doing it on the backs of your managers or your workforce team instead of using technology to make that bridge. And so I wanted to talk next about how you can make this a system-wide rollout with automation, and this is very important, the intelligence that allows you to spend exactly the money you need to incentivize people to get the hardest to pick up shifts.

So one of the things if you're a nursing leader is nights and weekends are the hardest to cover. Using a technology platform allows you to put the incentives where you need them based off of some math in the background. So it's not somebody trying to decide, but the automation literally can calculate in the background based off of fill rate. So let's level set here for a minute and talk a little bit about the pieces of technology that are hanging this strategy together. I'm going to start on that right side because everybody today has some type of staffing and scheduling system. There are multiple ones out there.There are basic scheduling and there's advanced scheduling systems. In order to take advantage of this automation and this workforce platform, we had to go to an advance staffing and scheduling system. And so on the right-hand side, that's the very base system for staffing and scheduling.

On the left-hand side, you'll notice there's a Works credentialing system that has an accounting of every single nurse that works in Mercy. Regardless of what workforce layer they work in, no nurse works in Mercy without being in ourWorks credentialing system. And this does two things. It allows us to make sure that the nurses are competent, they have all of their credentials entered, they have an active current license, and we also know where they're competent to work. So for example, you could be an ICU nurse, you could work on step-down, you could work on med-surg. So we have a complete profile and a work system that allows us to know every single person that's possibly available to work. And so what the app does, they are intelligent shifts that are taken, the holes are taken out of the staffing and scheduling system, so if we have places where we need nurses and we do, it is accounted for in that system.The works credentialing system is on the other side and this app goes into the staffing and scheduling solution, picks up the needed hours, transfers over to the work system and says who's available to work for us, and then pushes it out to those nurses in our app driven way.

And so today, we're going to talk a little bit about what the nursing manager does if you don't have this system, and then what that workflow looks like for those nursing managers who are extremely busy. So it takes needs, matches them with candidates that are available to work, and pushes it out to only those candidates that are available to work.

So MercyWorks On-Demand is the overall system that we talk about, and it's an app that is created a fantastic user experience. And so just as nurses are used to using other apps on their phone, this app works seamlessly into that system. In fact, you pick up this app on the App Store, and once you're credentialed in the Mercy system, this app is released to you and your credentials are obviously in our Works platform. And so it meets the changing needs across some workforce layers. Now if you are thinking about what that does to your core co-workers, we also have them included in this app as well because they are picking up some of our shifts on those incentive shifts that are needed. And so our core coworkers use this app to pick up their incentive shifts, where today it might be a manual process or manual offering in some health systems, it's technologically driven today. And that same math in the background is allowing those nurses in the credentialing system to pick up. So if they want more money, they're picking up in the areas that are posting the most money. If they want to stay on a couple of units, they're more comfortable there, they're up on the units for the money that's listed. So our core coworkers are picking up all incentive shifts in this app and our gig, per diem, flex coworkers are also picking up the shifts.

Now, there's a priority to how this app posts these things. So we're posting to our internal core coworkers incentive shifts first, and that's at the 28-day mark. So in the staffing and scheduling system, if there are holes on any of the units across the entire health system, it is picking up those in the work and pushing it to the Works platform and pushing it to the app to our internal coworkers. At that 14 day mark, it opens it up to our gig nursing workforce to be able to pick up. That workforce tends to be more impulsive in how it picks up. So that 14-day mark seems to be that sweet spot for them. And so they're able to pick it up after our internal coworkers have had the opportunity, which was important, to make sure that we were fair to our core coworkers.

So let's talk a little bit about the technology that's driving the results. The app replaced the desktop for picking up directly into our staffing and scheduling system. No longer are nurses picking up on a desktop, it's all completely app-driven. The choice and flexibility are definitely there, and it's sent through the app, allowing our nurses to pick up from two scheduling options. Our core coworkers pick it up, they're able to float on their incentive shifts based on the price that we're listing, the days of the week that we need help on. The core shifts maximize that possibility of them working on their home unit. So there's a lower flat rate incentive for nurses staying on their home unit. If they're willing to be more flexible, they're able to earn more of that incentive money. And so we're completely app-driven now for picking up all of the incentive shifts, whether they're gig or core.

So how does this work in action? So it's really hard to visualize, I think, if you haven't worked in this. So I want to walk through a day in the life of the technology and what it does for our nurses that are picking it up today. So our credentialing system's right there underneath number one, you can see on the screen. That credentialing system has everybody in it. It has identified and stratified that flexible workforce layer, but we have all the credentials in that first system.

In number two, what happens is we identify open shifts from the scheduling system. So if our managers have open shifts, they are all in the staffing and scheduling system and they're pushed across to Mercy Works On-Demand.

We identify then nurses that are available to pick up the shifts. So if we have four open shifts on med-surg, it will go into the Works platform, it will pick up everybody that's credentialed to work on med-surg, and will look at the experience level. It does a lot of automated things and it pushes those available shifts to those that are eligible to pick it up. And that's important for the user experience. So nurses aren't getting a ton of alerts all day long, they're only getting those alerts that apply to them and giving them the option based on price of incentive shift to be able to pick it up. So when they have the app in front of them, they can see how much the incentive is, what unit it's on, and have the ability to choose based off of that.

In number five, you can see that right within the app, the nurse confirms, can swipe and pick up the shift, and it automatically goes back into the staffing and scheduling system and places that nurse who picked it up into the staffing and scheduling system. So the staffing and scheduling system is always the source of truth for who's going to be working, the app just merely is a relay system in between. And then we're able to take a look with the data in the background and match the most successful candidates, and we can literally watch fill rate pick up. One of the most important things on this is that it does go back into the staffing and scheduling system. So we're not trying to work manually between two systems to see who's going to be picking upshifts.

So I want to flip this over. Now that you can see that the coworker experience is fully automated, they have full control in their palm of their hand with the app and they're deciding how, when and really why they're working, what units they're working on. Let's go over now and take a look at the workflow of the nurse manager because it has dramatically reduced the amount of time that the nurse manager spends trying to fill shifts.

So you'll see I have a nurse manager there on the screen and Marge is the frontline nurse manager and she has 25 shifts that need to be filled in a 10-day period. So in the legacy staffing and scheduling system is where those 25 shifts are showing up. We are pushing all that over into Works, finding the available people that can work and pushing those shifts out to them. And you'll notice where they're going. They're going to all kinds of places. They're going to our internal PRN, they're going to our full-time coworkers, they're going to our part-time coworkers, they're going to our gig coworkers, they're going to any external PRN, they're going to our international travel nurses, and that's how that's working. And so you can see with the order that we release it, we're releasing it to core coworkers first. And so they get the ability to pick these up first, and then from there we go out to all our other gig coworkers and other external sources. So that's an important point because all the manager has to do is load their six-week schedule into the staffing and scheduling system, and move on, and the automated system and our workforce team do the rest.

So we do have a workforce team that has done an incredible job of managing these layers.So I have to give a big shout-out to our labor strategic team. And we have coworkers in staffing and scheduling in each of our hubs that are managing these processes all day long. But the technology's doing the bulk of the work to give us more time.

The other thing that the technology's doing is giving us data in the background. And while I do not compare this to Uber or Lyft, the math in the background is functioning exactly like Uber and Lyft. So if we have decreased fill rates...And fill rate is defined as the number of hours we need on a unit to take care of a patient, it's calculated out of the staffing and schedulingsystem, divided by the number of hours we have scheduled, that's your fill rate. And so the lower the fill rate is, the more people you need to fill in your hours, the higher the incentive goes up. And it works just like the highdemand periods of Uber and Lyft. And that's an important point because before we're releasing incentive shifts based off of how we feel, and how desperate we might feel, instead of off of data to make that decision.

Betty Jo Rocchio:          

... and how desperate we might feel instead of off of data to make that decision. You're going to see some results here. We were spending an excess amount of money trying to get our shifts filled without that data in the background. So today, we don't do that. Today, it's a math equation. You need more people, you have less people working. It fires higher shifts to the right people that can pick it up. So it's a very targeted approach with an app in between driving the user experience. For example, a nurse could be on vacation and wanting to pick upshifts the following week to pay for the amount of money that they've spent on vacation. They can literally be sitting on the beach, pull up the app and pickup some shifts rather than waiting until they get home, looking at a desktop.So it creates a mechanism where it's a self-fulfilling prophecy on being able to make your fill rates go up while watching the amount of money you spend on incentive shifts.

All right. So let's talk a little bit about outcomes. So the proof's in the pudding and data is telling the story coming out of the pandemic. One thing that the nursing leaders and myself, along with our labor strategy team has been looking at, is watching this data the entire time. So we released this onto a pilot unit back in November of '21, and by May of '22, we had implemented this across the entire health system. So every single one of our hospitals, all 40 plus hospitals, have access to this system. So when we went up, we went up in a big bang. So you can imagine that we were going through some pretty heavy change management and PDSA cycles to make this happen. So we were watching data weekly to make sure that we weren't missing anything in any of these workforce layers.

One of the things we were most concerned about was that our internal co-core workers would have a lot to say about the incentive shifts that they picked up. So far, so good. Here's where the results come in. These are our ministry wide outcomes across all of our hospitals rolled up. And where we used to watch core coworker numbers fairly carefully, we're watching fill rate even more importantly than core coworkers, understanding that our co coworkers may decide to go to gig and may drop down into a different workforce layer. So we're watching total fill rate as our primary top metric. So out of 9,000coworkers eligible today, 6,100 are using the app or interested in picking up additional shifts. We have 80 plus clinical care locations picking up in the app, and there's been 105,000 shifts picked up or claimed through this process.

What has this enabled us to do? Now I want to be clear here that the technology is working in all of the workforce layers. So the technology is driving the results, not specifically the gig layer, but the technology is really doing the lion's share of the work. The gig just allows us to be a little bit more flexible. So we've realized to date, our labor per equivalent patient day, which is our upper top box metric, is decreased by 13% coming out of the pandemic. Our average hourly rate, our cost of that resource, regardless of what we're paying, our average hourly rate has all of our agency, international agency, gig, resource models, and our core and part time. Every single dollar spent has decreased by 12%. Agency spend specifically, that layer has decreased by 60% across the health system, being able to fill in with other pieces of our workforce model.

At the same time, we are sitting on results for retention that are pretty much unheard of right now. Everybody's still playing that retention game. That RN and LPN turnover has decreased 2%, and our unlicensed personnel, our patient care techs turnover has decreased by 4%, which might not seem like much, but across all of our coworkers, it's starting to trend back in the right direction, getting us back to where we were pre pandemic. And you'll notice a 9.5 million reduction in agency and premium labor spend. We are still on the path to hit 11 million by the end of June. Our fill rate, that important fill rate that I talked about, went from 83% up to 86%, and there's been a 20%reduction in hours spent by the staffing and workforce team because the technology has taken over and done a lot of that work for them.

So when you take a look at the outcomes, it's pretty impressive. But it starts with defining your workforce layers correctly, knowing where you want to head, and then putting the technology and automation into it, and then having a great data platform to be able to measure your results and tweak things along the way as we're playing with these workforce layers.

I'm going to just buzz through this because I want to leave enough time for questions. But when you see our biggest hospitals, and you'll see, you'll say,"Betty Jo, you've got 30 hospitals represented." We ran out of room.But those smaller hospitals from 10 to 30 are some of our smaller hospitals that don't have as many holes in our schedule, but our largest hospital, you can see those total shift claimed by hospital. And you can see the engagement, the unique users in red that are picking up all of those shifts. So, you can see that, and then the engagement level is the gray dots, what that looks like. So we are monitoring this by hospital. The important top roll up here is the ministry total shifts claimed, we've seen a 4% increase from the start of this calendar year, and the ministry total users continues to climb as we keep adding on this workforce gig layer.

All right. Let's dive down into some of the demographics on the gig workforce.So imagine your health system bringing in an additional 3,800 applicants into your health system. When we launched this in the beginning, back in May, when we started with our recruiting division, we had almost 1000 applicants immediately, which was shocking. We were not planning this fast of a rollout, but we got there very quickly. So today, where we sit is we have 3,800gig applicants. We have about 1,200 gig RNs hired. The important point here is that with this additional layer, we brought back some of the nurses that left our health system to travel. They came back into that gig role. So 81% of our gig nursing workforce today were rehires coming back to us or transfers, those that were looking maybe to leave the health system because they wanted more flexibility. They transferred over into this gig layer and we retained them in the health system.

So it was very important that we started to capture some of this data so we knew where this gig team was coming from. So 50% are rehires that came back. So 591candidates right here came back into Mercy. 364 were transfers. We retained them in Mercy rather than losing them outside of the system, so 31%,which speaks to our retention numbers. And our new hires, those that had never engaged Mercy, or at least not for a long time, are 20% of our gig nursing workforce. 232 came into the health system as new hires.

We continue to see this climb. This is not an end point, but we continue to watch this pay period over pay period. And you can see here, we split it out by month for you so you could see. You'll see in May when we launched, May andJune, you can see where those thousand applicants came from. And we saw a spike up in November. We do have it broken out by region here. We have four distinct regions in Mercy, which allows us to take advantage of a local model, a regional model, and a ministry wide model. You can see where we're sitting on this conversion of those qualified gig applicants to hire. So we are taking our time, making sure that we're hiring people in the right way, so we keep our quality up and we're able to have our managers support our gig nursing workforce.

All right.So 838 of the people who are credentialed as a gig coworker have at least one shift claimed in Mercy Works on Demand. You can see there I have the number of total gig workers that were onboarded. So 75% have picked up at least one shift on Mercy Works on Demand. We've also converted some of our gig coworkers into core, and moving through that flexible workforce model, you can work atMercy in many different ways. You just have to pick the way you want to engage and earn your money with us. You could see some other stats there, but gig coworkers have picked up about 21% of total shifts, amounting to about 102 FTEs equivalent across the health system, and it represents about 23%of our total hours claimed that would've likely gone unfilled. We would've made up for it in different ways and had a higher workload on our units.

All right.Now let's talk about, this was not an easy transition. I don't want to lead anybody to believe that putting this much automation and technology when you are literally messing with people's time and money takes a lot of consideration. So pick your technology and automation partner very carefully because they have to iterate things on that end while you're trying to make changes to your workforce model. So think about that before you launch this on10,000 coworkers. I have to give a shout out to our nursing leaders and our office of transformation and nursing excellence teams and our labor strategy team that have led the way. We all got together and we were committed to this change, and we led by example. So the technology gave us the platform, but the leaders really did the hard work to make sure that this rolled out in the way that was consistent with our dignity for the coworkers and our values, which if you know anything about Mercy, you'll know that guides us in our everyday pursuit of patient care.

So this took a lot of thinking behind the scenes. We're a Catholic faith health system, and even our resources and mission were by our side helping us, making sure that we were considering all the possible things that could happen to the workforce layers. Our biggest change was shifting that frontline leader thinking. Think about it, for years and years in nursing, we were used to doing a schedule, and any holes in the schedule gave us heartburn that we weren't going to have people day of, which is why nursing went to incentive shifts.When there was a lack of nurses, one of the things we did was we started offering incentive shifts. That's how we got to where we are today. But pretty soon, money wasn't the barrier. People were the barrier. So working with some of our transformation and change management specialists were key because nursing leaders had to embrace the philosophy that there will be holes in your schedule, but that this app will help us fill those holes in more realtime than you're used to.

But you have to trust in the process. So showing the data to watch that fill rate go up was very, very important. And it allowed greater buy-in as time went by.We showed the metrics every single week. We had a call with all of our nursing leaders across the ministry and showed all the metrics clear down to the unit level. So it's not a ministry wide roll up. They're actually looking at their unit and what effect releasing these workforce layers has done for their units.We also wanted to hear when things weren't working right, and believe me, launching this at a system-wide level this quickly and getting adoption, there were issues. I mean, we had to work through shifts not crossing over, as you can imagine, and this is where your technology partner comes into play because you have to be agile in order to get these shifts filled.

But we worked through it. We finally have a model that we're comfortable with, and I will just say the pandemic accelerated the change. We started this work before the pandemic, but the need from the pandemic provided the why and the burning platform to move it forward. So I don't think we need another pandemic as nursing leaders. We need to learn from others and apply those learnings to practice, so you're ready for that next crisis that's going to come. And these workforce layers have us ready for whatever hits us because we know that we have an automated system to be able to get us what we need to be able to function in the future. So it's been really, really important that we do this across our health system.

Last thingI'm going to leave you with before I turn it back over to Dani to give us some last remarks is workforce transformation, it really is a journey. It's not a destination. You're never going to arrive with an endpoint in mind. There are many things we're going to have to work through, but understanding what that platform looks like is key. So as you need to make changes, you have the technology, the data, and the clear definition in each layer to be able to make this into something that works-

Betty Jo Rocchio:          

... mission in each layer to be able to make this into something that works for great patient care. Dani, I'm going to hand it back over to you to bring us home.

Dani Bowie:                  

Great. Thanks Betty Jo. Just an exciting journey of transformation to listen how you've led Mercy, and really done so in a fundamental but progressive fashion, and addressing all areas of workforce transformation, particularly-

Betty Jo Rocchio:          

Hey, Dani. You'll notice ... I forgot this slide, sorry. It's my fault. We are expanding this across our health system. It's not just for nurses, but our unlicensed personnel on February 5th begin to pick up incentive shifts in the app. We're bringing up our respiratory department, our lab, our EVs coworkers, anybody that might need an incentive shift to fill holes, is going on this system. We're staying with the same consistent philosophy and using the same technology across the whole health system, helping us in other areas that have workforce layered needs.Sorry, that's my fault. I handed it over a little bit early.

Dani Bowie:                  

Hey, not a problem. A lot of people were actually asking how this is expanding beyond nursing, so I think we can dive into that in the Q and A session, but it's a great call out and important element of what Mercy's doing.  As I mentioned, you've been very, very progressive in your approach to workforce transformation, and really touched on three core pillars that I've often encountered as I've led workforce transformation for other health systems, looking at people, process and technology. Now, as you mentioned, workforce transformation is a journey, not a destination and this can be somewhat overwhelming I think for leaders to hear and listen to of, this is a wonderful story, how do I start? We've just listed out some ways that health systems can start to think about how to start, and how to start today, and then build into the future.

First and foremost, I think it's important to look at mobilizing your existing workforce.What do you have today with your workforce and how can you create the cross-sharing opportunities and effective open-shift recruitment to really expand capacity of existing resources? And then as you start to really build into what you have today, as Betty Jo mentioned, and you've built your gig workforce, looking at programs to really aid in flexibility and innovation to engage the workforce. Gig is one, Internal Agency. There's a lot of different programs that are starting to pop up across the country to really help build new opportunities that the workforce has been asking for, which is autonomy and flexibility over their schedule.

And thenBetty Jo, you really touched on this one, the automation and the process. As we build these programs, how to elevate the work of the frontline manager, ensuring that they're operating to the top of licensure, and to do so with the support of technology. We know staffing is a very tedious and manual process, so any way that this can be reduced is going to be fundamental to scaling enterprise programs and seeing those outcomes. Then looking at your analytics and how can we start to create PDCA cycles and ways that you can start to innovate and transform your health system, both at understanding where you started and where you're going, and continually iterate on those different elements of mobilizing existing workforce or looking for new opportunities and bringing it all together.

Now with that being said, I just want to talk about one fundamental pillar that's really important to us here at Trusted, which is technology. Betty Jo, as you've mentioned, your use of Works, and Works OnDemand, and your gig credentialing, I just wanted to share with those on this webinar what we're up to at Trusted, and how important this transformation is to us. We're here to solve the nurse staffing challenge and really take this crisis head on. As you think about the app, and how it's been used at Mercy, and the credentialing and solution, we're excited to say that this is not just for nursing. The solution of the app is beyond the nursing workforce, and really can be applied to any type of frontline worker within healthcare because we recognize that it's great to get nursing staffing right, but if you still have a dirty room or you aren't getting support with dietary needs, the work of the nurse is still not at top of the licensure. So, how can we continue to support the whole ecosystem to deliver effective care to the patients?

Additionally, communication is quite challenging as we think about the staffing problem. AsI've led staffing offices, we would average thousands of phone calls a month to support staffing activities. And so in the app for Works, we have the ability to really enhance communication between the clinician, the staffing office, and the manager. Our goal is to reduce all of those phone calls that are coming into the staffing office and really aid in the right placement and deployment of the workforce.

Think about gig credentialing, it can be quite challenging to think about building such a big workforce. With our technology here at Trusted and Works, we're able to automate the process for gig credentialing or any type of workforce credentialing from the point of entry, onboarding through the whole approval process, to ongoing compliance. We really can help aid in building that flexible workforce layer.

I think one of my most exciting features that I'm really excited about with Works OnDemand, is our ability to help nurse managers with incentive shifts. Betty Jo, you mentioned this in the presentation about staffing might feel like, I feel likeI need to get this done. As a nurse manager, I know I've struggled to know when do I need to incentivize an open shift, at what price point shouldI be offering, and how far in advance? Oftentimes, it was last minute, I was really struggling to get this done. With Works OnDemand, we are able to look at all open shifts, and then we're able to also start to dynamically price those open shifts in correlation with your incentive policy to ensure that you're effectively pricing those shifts and you're not overpricing or underpricing to compromise fill rate. In fact, we can do this weeks ahead of time. As Betty Jo mentioned, this does not require the push of a button or the manager to go ahead and make this happen. It's configured and then it automates as you go through the whole recruitment process.

And then lastly, we just want to make sure that we're holistically looking at the workforce. How can we support competencies and engagement of the workforce as health systems look to build those flexible layers and really transform their workforce experience for their existing nurses and the future clinicians that they continue to recruit?

With that being said, I want to turn this over to the Q and A session, and just continue to have the dialogue around workforce transformation, and open up the questions, Betty Jo to yourself, and to myself for some of the technology questions. I'm going to start first, a bit more about the gig workforce. A lot of questions have been coming in around the gig workforce. One of the questions was, "Are you expanding this gig layer outside of the clinician and the nursing space?"

Betty Jo Rocchio:          

Yes, we are. In fact, we're going to use this for anything in our entire health system that needs an incentive shift. It will be the prime way that we post incentive shifts. In fact, we've done away with all other technology, to make sure that we're not paying people in any other ways. We had many ways to pay people an incentive shift and all those are going away, except for being able to use this platform because it's more predictive in nature. Yes, anybody who needs it and is in advanced staffing and scheduling, that's the other requirement, will be on this app.

Dani Bowie:                  

Now another question is,"How did you create engagement? You talked about the nurse manager and shifting their mindset, but how did you also create the engagement for the frontline nurse or clinician to pick up in the app? Was that a challenge for the frontline to embrace this? If so, how did you overcome that?"

Betty Jo Rocchio:          

No, surprisingly that was probably the easiest thing because the app is set up just like any other app that they use on their phone. No, they loved it. I was shocked. I thought we might have to do some educational sessions, but the nurse managers just, they taught them how to download the app, and it was there, and they picked up their shifts. That was one of the easiest things, actually, but that's a good thought because I thought about that too. Is this going to be a lot of work to have1,200 people try to learn to use an app? It was very intuitive. It was a great user experience, and I believe, this is Betty Jo's personal belief, that it's allowed us to have people pick up more of our incentive shifts because the app is so easy to use.

Dani Bowie:                  

Great. And we've had some questions coming in around the app. I'm going to pull those up in a second, but one last question around the flexible layer. A lot of questions were coming in."Are you using this for day-to-day shifts or is the flexible layer also more of a traveler assignment and a 13 week assignment? Can you talk a little bit of how you're operationalizing your flexible workforce layers?"

Betty Jo Rocchio:          

Yes. No, they aren't. There's no contracts. There's no 13 week assignments. When I say the gig nursing workforce is the most flexible layer, the only thing they have to do right is pick up one shift in 90 days to stay active on the app. They don't have to work any certain amount of hours, no certain days. No. We're letting the incentive drive people where they want to work, instead of making a mandate that you work so many weekends or nights. What we're doing, is releasing it out, and the incentive shifts, the most amount of money's going to those that are the hardest to fill, which probably for nursing is nights and weekends. That's where we're using our money. No, it's been seamless when you consider using math in the background.

Dani Bowie:                  

Great. Now, we've had some questions come in around the app as well. One of the questions, "Can nurses filter their open shifts in the app? I.e. only openings to the ICU shifts offered based off of a certain amount  of money. And what typeof scheduling solutions do you need to work with this?"

I'll jump inhere and take this one. I think what's important to note about the app and Works, provided through Trusted, is that the nurse can filter the types of shifts that they want to work. They have to be credentialed and competent to work in that area, but if they only want to see shifts on their home unit, they're able to filter the types of notifications to only receive notifications for those open shifts.

In addition to the types of scheduling solutions that we can work with, nowBetty Jo mentioned some advanced scheduling. We can work with scheduling solutions across the country, and there's a variety and a handful of those scheduling solutions, so we're happy to talk to anyone about that. There are the primary solutions out there, such as the UKG Dimensions, or Smart Square, et cetera, we're able to work with those solutions to make sure that we're able to offer those open shifts.

Now, one question I did want to get back to Betty Jo, which I forgot to ask, about the gig workforce. "Are you inquiring them to do the same type of mandatory education as your core workforce and your internal workforce?"

Betty Jo Rocchio:          

Yes. They have to. By state board regulations, they have to do the same exact education. Yes, they get the same exact thing that our core nurses get. Yes.

Dani Bowie:                  

Perfect. I think there has been multiple questions coming in. I could spend all day asking questions about how you have accomplished such great things at Mercy. I recognize we have two minutes, so I'm going to actually hand the presentation back over to ourBecker's team.

Liz Hatton:                    

Thank you. That is all we have time for today. I want to thank Betty and Dani for an excellent presentation and Trusted Health for sponsoring today's webinar. To learn more about the future of nursing, please check out the resources section on your webinar console, and fill out the post webinar survey. Thank you for joining us today. We hope you have a wonderful afternoon. 

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