Episode 98: Revolutionizing Healthcare Staffing with Flexibility, Innovation, and Technology

May 17, 2023


Welcome to the Handoff, the podcast for nurse leaders from Trusted Health. I'm Dr. Dani Bowie. Today I'm thrilled to welcome Dr. Kristin Shelley as our guest. Kristin is a seasoned healthcare leader and an expert in workforce management and technology implementation. She has a background in clinical nursing and a doctorate focused on the use of technology and practice. She offers a unique and valuable perspective on modern nursing. Today we discuss her experiences with incentive programs, the role of international nurses in addressing staffing shortages and her current work at Trinity Health, where she's driving the implementation of a cutting edge staffing and scheduling technology platform. Here's my conversation with Kristin. Welcome, Kristin.


Thank you. I'm excited to be here.


Kristin, as I mentioned, you and I have had a longstanding history and even some work history together, but I would love for you to share a bit more about your journey because it is very unique and specialized. And so if you can tell the listeners a little bit about yourself, your career journey, and what led you down the path regarding workforce specialization and technology.


You know, when I first became a nurse leader, I think like many leaders, what I really enjoyed about being in a leadership role is being able to make an impact. So, you know, I understood, like I had been a bedside nurse for many years. I understood what it was like to be a bedside nurse, how chaotic it could be. You know, the patient care is very demanding. Um, and you have limited resources to really do what the best that you want to do on a day-to-day basis.

So, over my tenure as a nurse, you know, I think I, I don't think I've ever seen a time where we've had enough nurses where we said, stop hiring nurses. We're good <laugh>, you know, we've never quite gotten in there. So, you know, the challenges today are even greater, as we all know, coming out of the pandemic and patients are sicker, more complex, you know, and it's a challenge to really keep nurses at the bedside. There's physical demands, emotional demands that takes it's very attack thing. Um, but it's, you know, work that, you know, if you become a nurse, you wanna be a nurse, you wanna take care of patients. So as a leader, you know, I think of aim to really do what I can, um, in my leadership capacity to make it better for, for nurses and not just our bedside nurses, but other healthcare providers, um, and leaders.

So I was in a, a hospital leadership role for about 10 years, you know, in the acute hospital environment. Um, always really passionate about staffing and scheduling and trying to come up with creative and innovative new ways to improve staffing. You know, whether it was creating new programs to incentivize our current nurses, our programs to attract new nurses into the organization, retain our nurses, you know, really motivate them, um, to wanna stay, you know, so how do you improve their work environment? And, you know, a big piece of that is creating the flexibility, you know, in their work life. So I did have, uh, I really enjoyed being able to, IM impact that piece of it. Um, you know, in my prior place of employment, a new division was being created from a sys, you know, a system level. And it, and I hadn't seen it yet in the organization being so specialized, and it was nursing workforce.

So I got super excited that this role or invest team was being created. So I joined a role as a, as a system director of nursing workforce. And that's kind of how I got into a very specialized pathway of looking at program development and, um, implementing technology to support staffing and scheduling and the nurse leaders and, and, um, providing the, the things that our frontline nurses really wanted, you know, from scheduling, for example. So that's kind of how I, I got into the role I'm in today. So, and, and I've transitioned into a new role that's very much more tech focused, and it's been exciting as well. Um, and I can talk about that more in a little bit. Um, but ultimately, you know, looking at leadership from a different perspective, from that technology perspective has been very interesting. Something I never thought I would get into, um, before I did.

Yeah. And now it's kind of that pathway and then journey, um, that I'm really excited about, kind of transforming what it looks like for, um, the flexibility and the, the transparency of resources and, um, all those things that come with technology, um, and how to impact not just nurses, but like I said, healthcare staff in general, um, and ultimately impacting improvements in patient care.


I am really impressed with your journey and your ability to pivot and move into these new spaces as a leader in workforce, a problem solver, and kind of taking on an entrepreneurial role for, you know, Bon Secora, mercy Health, and then your, in your new role at Trinity Health. And as you know, this season is around workforce, and I'm asking leaders across the country, what does flexibility mean to these leaders and unique spaces in health systems as well as, you know, to the nurses they're leading.

So from your perspective, Kristin, as a nurse leader who's had years of experience in this space, what does flexibility for the workforce mean to you, but also what does it mean to the nurses that you lead?


Yeah, and as you said, you know, workforce, uh, flexibility, that is a term that's kind of thrown around. So I'm glad that you asked, you know, what, what does it mean to me? You know, in, in my leadership style and in in the work I do, you know, what do I think of when we say at work? Flexibility. So it means a couple of things to me. I think we know today's nurses are really, or really any kind of healthcare staff or designing flexibility in their work schedules that can accommodate that healthy work-life balance. You know, we've always talked about how do you achieve the helping work-life balance and, you know, and now it's really time to pay attention to that.

You know, we're having a difficult time keeping nurses at the bedside. We need to be, we need as leaders need to be flexible, right? And meeting the needs and the demands of our, our nurses and other healthcare workers. So scheduling flexibility, I feel is a top priority when you're implementing new scheduling technology. So the technology needs to be able to accommodate that support the goal. So, for example, being able to self-schedule or select a preferred schedule is foundational for scheduling, autonomy and flexibility. So the tech really needs to support that. I feel like that's a foundational piece in scheduling technology. Um, other things like trading shifts, picking up shifts, requesting time off, all those things need to be built in the technology and having it available at, you know, the end user's fingertips that, you know, our nurses fingertips having a mobile option, you know, so we know that everyone does everything on the phone.

So we need to make sure that they have that level of ease and accessibility, um, to do their staff. And in scheduling functions, you know, we know that schedule and what you're working is very important, you know, piece of, you know, being happy in your job. So the other side I think of work flexibility comes from really breaking out of the traditional schedules that we've known for so long. You know, for example, 12 hour shifts. That's been a standard in the inpatient, um, hospital environment for years and years. Um, so in that type of shift may work, it may be desirable for many healthcare, uh, providers, nurses, you know, and other pieces of our workforce. But there's also a growing population of nurses that want other options. So how do we think outside the box, look at other programs, you know, are we, can we offer shorter shifts or variable shifts when we look at programs like weekend programs or summers off programs?

Um, those are a couple things that I've seen, you know, recently that have kind of, uh, tried to meet that need of the flexible workforce. Uh, we're also looking and seeing more of telehealth or virtual care models. So those programs are definitely big outside the box programs and they really offer nurses that are maybe transitioning away from the bedside, but really wanna remain in patient care. Um, they get that option to provide, still provide that care, but in a physically less demanding capacity. Um, and yeah, I think it provides that flexibility to really keep our tenured nurses, our more seats than nurses involved with our patient care teams, um, by providing that level of flexibility. So obviously work, work flexibility is so important and we really can't ignore it.


It's music to my ears, Kristin, when you talk about building technology and then ensuring the foundations are in place, self-scheduling, we know that that's a big ask of the, of the workforce trades.

And also just pushing the limit to ensure that your tech build supports these foundations. And then you can move into broader innovation. I'm curious, uh, if you could talk a bit more around, you know, technology is key. How do you gain perspective from the frontline as well as use from nurse leaders in this, in this space? Cuz it's there, but oftentimes it can be a challenge in getting tech in place. And so is there anything that you could share with the listeners about, from your experience, some tactics or things to think about as they look at technology or they wanna bring it into practice and make it meaningful for the users, but also adopted by the leaders and the frontline clinicians?


Yeah, so as far as, you know, understanding what it is that, you know, our nursing workforce or healthcare workforce really wants to see from the technology, but some of that ends up being kind of user groups as far as, you know, finding out just talking to nurses and, and those that use the technology.

Now, what would be an improvement that would add value? You know, we don't wanna just roll out technology that doesn't add value, you know, it is just gonna sit there and not be used. So what's meaningful to them, you know, is it, you know, I really wanna see my schedule at a glance, you know, and I can't do that today. Is it, like you mentioned, you know, some of those functions, um, that they do on a regular basis, like picking up shifts, like is it, can I get a text message from the system and say, yes, I wanna work this shift and boom, I'm on schedule. You know, those type of um, ease of use of technology I think are important things to evaluate and try to design or configure into any new staffing and scheduling technology that you're going to invest in and implement in your organization.

And, and you know, you mentioned the adoption piece that's so important as well, like I said, but if you're designing something with the end user in mind, in in with the input that they provided, this is what I want. If you're providing those functionalities, you would expect some adoption, um, with improvement, um, because it's a meaningful technology. But, you know, I think you need to have support from the top down, right? So what is the expectation for the use of the technology? Why are we using this technology? You know, how's it gonna help me as a a leader? How's it gonna help me as a frontline nurse? You know, and making sure everyone understands the why behind the change and how it should ultimately, right? Make your life a little bit easier in the workplace. So getting that buy-in and understanding, but also that expectation from your executive level sponsors.

Um, so that we're all using the technology, uh, platform at a consistent manner so that we can pull data from it, we can do analytics and look at either future staffing needs, um, or trends and adjust accordingly.


I like the ease of use and then build for the user creates the adoption. And you know, I, I hear kind of this multifaceted approach that you're taking, which is hear from the frontline, hear from your stakeholders, which is gonna be your nurse managers, and then also the engagement of your executive leaders as well. It's a holistic process. Staff means scheduling is the biggest move that people take when they implement tech and it can be the most painful thing. Um, and so I think those are really great call outs as I know a lot of health systems go through this transition is thinking about setting up those programs to get that feedback from the frontline to build with their perspective in mind and then to also ensure that you have different support at different levels, support that success and sustainability around that.

Just great, great callouts Kristin. And yeah, that's part of my passion is workforce technology and even the reason I joined Trusted Health, cuz I just saw such great innovation around our tech, but also it was designed with a clinician in mind and the nurse manager in mind to ease their operational burden. Uh, so just really passionate around that. A little bit more about your role at Bon Secours Mercy Health. And I know that you've done some really innovative things there as you mentioned, you know, starting in a space that didn't exist before, building at the system level, and there's some unique programs that you helped design, specifically international nursing and an incentive program that was proactive. And I would love if you could share a little bit more around some of the programs you designed and anything that would be helpful for the listeners, because I know international nursing's a hot topic and everyone's looking at it, incentivization and OpenShift management is another space that has been a pain point through the last three years of the pandemic.

And just would love to hear some of your, um, input around the innovative program. So you designed there.


Yeah, sure. So my role at Bon Secours Mercy Health was, was that system director of nursing workforce. So, um, as you mentioned, you know, it was a, a new type of role. So it was, it, it evolved in the time that I was in the adult. So, um, you mentioned international nursing, so I can start there. So obviously with the nursing shortage and the challenges that everyone has been faced with, we're really looking for new pipeline, you know, new nursing pipeline, and, one of the things that I implemented Bon Secours was the international nursing program. So that work really started pre pandemic. So it wasn't an afterthought like, oh, we're in the pandemic now, we need this international nursing program. It was, it was a work that was already underway prior to pandemic.

Uh, but by the time, you know, we were coming outta the pandemic, you know, we were fully implemented into the program and seeing, you know, probably about 30 nurses arrive every month, uh, to start to the organization. So it was a great new pipeline program. The nurses were coming in with great experience, you know, sometimes you worry about, you know, these are, you know, nurses coming from other countries, you know, what, what you don't know what to expect. But, you know, we were getting very high quality experienced nurses and part of that was the design of the program and making sure, you know, they were being oriented correctly and transitioned. You know, we wanted to make sure they felt included in their teams and not just their teams and the departments, but also in the communities that they're living in. So that's really a key and important piece of having successful international program.

Um, so there was a lot of collaboration multidisciplinary with multiple teams and all the various, um, hospital sites and their nursing leaders to make sure that we had things in place to really support the nurses. So it was a great program. We developed a toolkit, you know, so that not only the incoming nurses felt supported, but also the, the teams that were already in place, um, as far as what to expect. And, you know, we saw some great early successes, especially the critical thinking skills. You, these nurses are coming in with 10 plus years of experience, so they're really bolstered that support for our newer nurses where, you know, we've seen, you know, a lot of nursing units have low levels of experience just by nature. Um, so bringing in the international nurse really helps support that growth and support for the new nurses.


You mentioned a toolkit, which I think is fantastic.

You also talked about cultural assimilation, which is a key piece of not only learning your skills as a nurse, but then assimilating into the, the new country that you've, you've come into, uh, and team that you're working with. As you think about that toolkit, you know, and I'm sure leaders listening are like, man, I wish I had that toolkit that you could say, like, these are some of the pieces of the toolkit that we included, and this is, it went to the frontline leaders in support, uh, so that they, as other health systems are designing and building these programs, they could think about some different subject lines of that toolkit or program development that they, that they should be mindful of.


Yeah. So, um, some of the pieces that the toolkit, yeah, some of it was more overview for the leaders, the nursing leaders that were taking these international nurses onto the unit.

So more about the vendors and the contracts and those sorts of things. But then, you know, we get into, you know, it's important to have preceptors and mentors for these nurses that have a key set of characteristics and attributes that really support, um, that type of learning for these specific to the international candidate. Um, so it's how to iden some of the toolkit was how to identify those individuals and then how to, um, develop those type of support models. Uh, for the incoming, uh, nurses. Some of it was that cultural assimilation training for our current staff. Some of it was orientation specific to the international candidate as far as what to be mindful of. You know, we work with other, you know, multidisciplinary teams to really identify where, you know, where these initials are coming from, which countries and what we should be mindful of in their learning plans.

So really creating individual orientation and assimilation plans for each nurse, um, I think is really important. And those are outlined in that toolkit, um, really trying to create a successful environment for nurses.


That's great. Thank you for sharing more around that. I was curious, and if I'm curious, I'm sure others are too. So that was really helpful. Uh, and then also I know that you created a really innovative incentive program at Bon Secours Mercy Health, which as I mentioned was another pain point for a lot of health health systems and what I know to be true about that. It was unique in that it was proactive. So if you could talk a little bit more around how that program was built, the intention of proactive recruitment and some of the, you know, even the pain points and implementation and how you think the incentive program should continue to evolve as we think about the workforce.


Sure. Yeah. So the main focus that the revised incentive program was, as you mentioned, early incentivization. So, you know, the, one of the biggest challenges I think many of us see across the organizations is that if we're gonna incentivize nurses with a higher dollar amount to work an extra shift, you know, sometimes, uh, nurses and others may hold out, right? And so the last minute hoping that the dollar amount will be raised because we're we're desperate for help, right? So this program was trying to get ahead of that curve. So how can we offer, you know, that higher level amount early, and then as you get closer to the start of the shift, you decrease that amount. So you're really trying to steer, you know, nurses into picking up those extra shifts early on. And that way you can better plan, you know, you know what's covered and what's not.

And then nurses aren't necessarily holding out for that last minute, uh, bump and pay. One of the biggest challenges that we experienced during this implementation was we were in the middle of a pandemic. So it became very challenging to hold to the standard of the new program simply because, you know, we had just like everyone else, nurses were out on leave, you know, they had, they were exposed to Covid or they had family members exposed as well. So our workforce was dramatically, uh, impacted. So it was difficult to stick to some of the standards, but as we came out of the pandemic, we, it was kind of a refocus, like, okay, this was a, you know, this is the aim and the goal of this new incentive program, um, and let's get back to it. I think we did see some benefits coming out of that and some cost savings just because you have better control over your spending, um, you know, ahead of time.

You know, when you post your schedule with open shifts, you can, um, tag those shifts with that highest level incentive to start with. So, you know, this is the maximum of what I'm committing to spend. And as we get closer to the schedule, hopefully we have fewer, um, open shifts remaining, and the dollar amount for those remaining shifts is gonna be lower. Um, but much easier to budget as far as what you anticipate spending if you need to in this incentive spend. And then keeping a consistent program with, that was the other piece. Um, we saw that our incentives programs were so variable and so different across the organization and sometimes in the same region, you know, possible to the hospital. Um, we saw inconsistencies and, and nurses talk, right? So they know hospital over down the road is offering more money, so it's not fair here.

So, so we created some equity and fairness by consolidating at least across the market levels as far as what incentive amounts could be offered, just though we had a consistent practice across the different, uh, regions in the organization.


Yeah, you, you move from a variety of different, um, policies and practices in place to a standard standard approach, uh, within mindset of early incentivization and then market vari variability per pricing. So it sounds like you did a fantastic job leading that and trying to break out of what you mentioned, which is the pain of, of all incentive programs is holdouts, or I call it gamification, where the clinician, and they're smart, why wouldn't, well, you know, nurses are smart, so they're understanding, Hey, I'm gonna hold until it's last minute and then get the highest dollar amount. So I, I really like hearing that and, uh, kudos to you and your team for being able to take that on during such a challenging time and create that standardization for a lot of nurses, uh, over seven states.

I wanna transition, uh, quickly and, and talk just a bit more about, uh, your work at Trinity Health. And we talked about this in the beginning of kind of you've transitioned into these unique workforce roles, but can you help explain to the listeners specifically, um, what you're doing at Trinity Health and how your role is focused over the next couple of years around technology and flexibility, the workforce?


Sure. Yes. So I have, um, been at Trinity just for a few months now, just transitioned. Um, but I will say the vision and the mission of the organization is in direct alignment with the work I've done for many years now and has Spotlight home in a way. So it's a great organization, it's a large organization. I've seen many innovative and creative strategies in place, and like I said, I haven't been even been there that long, but my current role is a senior consultant of working of, uh, workforce management.

And I interned with, um, a system-wide implementation of staffing and scheduling a staffing and scheduling tech platform that's aimed to bring flexi flexibility to the clinicians. Um, but I am responsible for, um, ensuring that successful implementation and adoption and optimization of the scheduling component in particular. So, um, it's right up my alley, you know, it's where my passion is and I've been super impressed that, you know, with this technology that's being implemented, um, I'm not singing shortcuts, you know, so it's that bull scale package, you know, and it's really exciting that the organization has invested in this technology for, you know, all the colleagues there, um, all the bells and whistles that will really make a difference. So it's not just, um, like I said, it's not before, it's just, it's not technology just to say we implemented new technology, it's really intended to create efficiencies and the flexibility like we've mentioned, or the workforce and, and it should impact, have a positive impact from the frontline staff all the way up through top level leaders.

As I, as I mentioned, having that standardized tech platform, which eventually over the next couple of years will get fully implemented. You have a transparency and a consistency on how you're receiving data around staffing and scheduling, and you're able to conduct those analytics instead of trying to piece them together from several dis different systems. So it's really exciting, um, to be a part of that. Um, our first wave is set to go live this summer, and I'm excited to be a part of that and to be, you know, side by side with these leaders to really help, um, make sure everyone understands that technology and support them through how do we make it, um, you know, set it up for individual's preferences so that it works the best for them. That's what my current role is, and I'm sure it'll will evolve over time, but I'm really excited to be, uh, part of that technology implementation, um, score in, in helping nurse leaders and other leaders and frontline staff really understand how and why this technology is being, um, put in place to help support what they do every day, day in and day out.


You sound like the perfect person to be doing this work. And the reason I'm saying that is you, you have experienced doing it in the past at Bon Secours Mercy Health, but you're also a clinician and you're a doctorally prepared clinician. So you have led and seen all the different ways that clinicians interact with the system you've built before and you're doing it again. And in fact, I, I believe I know this to be true, you also doctorally your thesis was around technology and user use of that technology in practice. And so I, you know, I, it it's wonderful to see how your career has grown into kind of this niche, but I think you are a perfect person for it with the clinical view, but also the techno technological understanding of staffing and scheduling policies, workflows, and roles that need to, need to go into that.

Can you, uh, also as I just called out your doctoral journey and thesis, uh, give a little insight into that about, you know, how you, you studied and what your thesis was about, and then, uh, before we move into some final questions.


Sure. Yeah. So my, uh, doctoral project was focus things set on technology, but a little bit different than the staffing and scheduling component. The hospital I was working for at the time was using technology that, you know, that staff were locator badges. And so you could track their time through the system of how much time they're spending in patient rooms, how much time they're spending, you know, in the medication room, how much time were they in the break room, how much, you know, and it wasn't intended to be a big brother type of technology. It was really to help us improve our workflows.

So I did a study looking at patient satisfaction. Um, as we know, that's a very important piece of leadership in the, in the hospital setting in particular, um, and other settings as well. But you know, you're reimbursed based off of your patient satisfaction, so it's an, an important metric to pay attention to besides the fact that you of course wanna make sure your patients are sat satisfied with their care. The study that I conducted from my doctoral project was focused on, hey, if we increase time at the bedside while we increase our patient satisfaction scores, whether it's, you know, communication with nurses or, or whatever, uh, piece of that patient satisfaction it might impact, it was kind of a explorational study to see what happens. The study involved asking the nurses to document, do all their documentation at bedside. So although that's not necessarily direct patient care at the moment, you are physically in the room with the patient inac accessible to that patient and their family to ask questions or whatever it may be.

Um, so we did a, about a, a month, uh, period, um, to see if that increased time at the bedside, um, improved patient, uh, satisfaction scores. And in a couple, I did three units, I believe it was two out of three units we did see an in the scores, and that is a, that's a published article as well.


Great. Well, we'll have listeners, uh, uh, nursing management is the journal, Dr. Kristin Shelley is the author about leveraging technology and, uh, the way that the, the experience of, of the patient can improve with the clinicians engaging in technology. Kristin, this has been really insightful. I appreciate, again, your unique perspective around workforce flexibility technology and the way that you've embraced this as a clinician and a leader, which is really impactful. And I think just the model that we as a profession need to replicate leaders embracing technology.

Uh, I would like to just end the, the podcast with asking you the, the question we ask all of our guests is, what would you like to hand off to our listeners today?


Well, I think, yeah, well, based on what we've discussed today, you know, surrounding technology in healthcare, staffing and scheduling, I think it's just important to stay in the know, right? We know technology and staffing practices are constantly changing. They're outdated very quickly, so we need to stay networked, you know, stay networked with your colleagues across different organizations, do the research, you know, what's new and innovative that's being done and you haven't done it yet. So, and also as we spoke to earlier, I think we need to listen to our workforce and find out what it will take to make their work lives better. So, um, constantly adapting and changing to the needs of our workforce. I think that's the key takeaway, and we know that technology can really help support that.


As we look for flexible solutions, you hit the nail on the head. We, as leaders in health systems, need to be flexible and adapt to the changes that are at play and the research that is new. Dr. Kristin Shelley, thank you so much for your time, your insight, and your expertise. And I can't wait to hear all the success stories around the health systems that you help with technology and the workforce. So thank you so much.


Thanks, Dr. Bowie.