Dani:

Welcome to The Handoff, the podcast for nurse leaders from the team at Trusted Health. I'm Dr. Dani Bowie, our Chief Nursing Officer. Today's guest is Dr. Rex Lomboy. Rex is a leader in the field of nursing workforce management, and shares relevant insights for this season's exploratory conversations about nursing and flexibility. Rex is responsible for overseeing staffing, scheduling and agency management across multiple hospitals and states. He works cross-functionally with key stakeholders to ensure optimal outcomes for both nursing staff and patients. We'll dive deep into the challenges faced by nursing leaders, the importance of leveraging data and technology to optimize staffing and evolving staffing models in today's dynamic healthcare landscape. Let's get started. I'm so excited. Dr. Rex Lomboy is joining us today for The Handoff. Dr. Rex, welcome to The Handoff.

Rex:

Good morning, Dr. Bowie. Dani, you can call me Rex <laugh>.

Dani:

Perfect. Will do. It's important though to give credit where credit's due and you worked really hard for that doctorate. So I'd like to intro you as the doctor doctorate, uh, doctorly prepared nurse, and your contribution to the profession in the way that you've progressed academically. So, so important. But again, thank you for being here and, and joining us on the handout to talk more about the workforce and flexibility, and you are quite an expert and have established a unique background in the work that you do. And I know that you work for Providence Health System. Rex, would you mind just elaborating and telling the listeners a bit more about what you do for Providence Health System?

Rex:

Absolutely. Thank you. First of all, thank you, Dani, for, for having me here and, and talk about some such an important topic. My name is Rex Lomboy, and I lead the Integrated Resource Center, uh, for Providence, which is the department that centralizes the acute care, staffing, scheduling, analytics, management of the agency and timekeeping services. So essentially a big nursing resource staffing office is that aims to put people at the right place and the right time. In a nutshell,

Dani:

That sounds pretty complex. And now when you talk about the work you do for Providence, is that for the whole health system, Rex?

Rex:

So currently we've done a restructuring where the providence is comprised of three divisions. So right now our, uh, IRCs focused on the staffing of the Divi, the central division, which is the Oregon, Washington, and the Texas ministries. So to answer your question, not the entire system, but there's a goal to be able to achieve that, uh, with our division partners, uh, such as the North division as as well as the South division in Los Angeles.

Dani:

Got it. Uh, well, I, I don't doubt the work you're doing today is, is quite complex and challenging and then expansion and growth and the vision setting of bringing this into a centralized model is really forward thinking and quite contemporary. Now, as we talk about the I R C and and scheduling timekeeping staffing deployment, um, would you mind also elaborating on some of the initiatives you are particularly focused on in the IRC?

Rex:

Well, we always, you know, go by with our, with our mission and ex and as an expressing our mission know me, care for me and ease my way. The Integrated Resource Centers really main objective is to put people at the right place at the right time while easing the way of our stakeholders. So understanding the challenges that we have and just managing multiple schedules and multiple hospitals, or we call them ministries, uh, in Providence and ensuring that we have the, this, you know, the support that we can provide to our nursing leaders so it doesn't take them away from what matters the most. And that's providing, you know, care to the patients remaining visible to the, uh, the staff that they, that they have, and just improving quality, uh, work in the hospital where it matters the most. So understanding, you know, the pain points of what it takes to put a person into the bedside, as well as utilizing the technology that we can avail and in order for it to be captured in such a short amount of time, efficient amount of time, then that's, that's our, our goal to be able to do that.

We're continuing our partnership with several stakeholders to just, you know, efficiently manage our continued workers for the travelers as well as providing them data that allows us to gain more visibility on where we can improve and where we can reduce or where we can be more cost effective in multiple ways.

Dani:

That's really great. And when you, you know, as I'm listening to you talk about the integrated resource center, creating the opportunity of aduring, you know, the right clinician at the right place at the right time, which is the golden standard and, and how we wanna operate as leaders. Um, can you just elaborate more on your stakeholders and who those are and how you can continue to support them with the work from your, your central team?

Rex:

Our stakeholders is comprised of our nursing leaders from the ministry perspective, the chief nursing officers, um, all the way down to our nursing staff. And so those are the, their stakeholders that we, we partner with and collaborate with in ensuring that we have the appropriate staffing numbers to care for the patients that we, uh, that we serve in the communities that we serve. We also partner with various non-clinical stakeholders such as, you know, the IT and the, the human resources to ensure that we are aligning our, our goals and vision towards improving retention and reducing turnover. It's all, it's, it's all part of this important work to reduce the amount of nurses leaving the, not just the organization, but also the profession in general. So there's a lot work that's comprised of achieving that vision and partnering with those stakeholders for us are key factors in order to achieve that.

Dani:

Yeah, I think that's great. And you know, a lot of the literature shows that managers and leaders are spending a significant amount of time doing staffing and scheduling work, and oftentimes the tools that they have, the support that they have isn't there. And what I love about what I'm hearing from the integrated resource center, the team that you're leading, the work that Providence is doing is the ministry is putting the resources where it needs to go to support those leaders and to help them operate to their top of licensure as well as what I'm hearing, which maybe you could elaborate on a bit more. Sounds like it's also analytics and data driven, and so you're creating a vision and a picture of staffing beyond just kind of, I think what we often feel is reactive staffing, kind of like, I know I need this person, but I don't know why, or I'm understaffed and I'm, I, and I know I shouldn't be understaffed, but it just keeps happening. Um, so as I'm listening to you talk, I'm just really excited that, you know, Providence has taken that on and you get to lead that work, um, in supporting those stakeholders. You know, what do you think in regards to the integrated resource center that you're doing is particularly innovative and forward thinking for the workforce?

Rex:

I think you touched a lot on the data piece, so I'd like to stay on that for a bit. I think data is very important, uh, in our society today where whatever industry you're in, but more importantly is how you utilize that data and leverage that data to, to story tell, to tell a story on what's, what happened, what is currently happening and what can we do in order for the digital work for us, essentially, one example that we currently leverage and provide data to our, our nursing leaders is called the, uh, the FTE leakage report. As it implies, we want to determine the amount or, or the number of, of employees or staff that are not working to their fullest FTE and then identify that and ensure that we either schedule them for, uh, a productive time or add additional a non-productive time.

It just, it's just a way for us to capture that, that those staff are working at the full extent of their FTE requirement. Now, it sounds simple, but sometimes, you know, with the amount of of scheduling errors that can happen, we sometimes missed those. And in the past we've, we've actually identified and put back over a hundred thousand hours back to the schedule and, and select ministries that itself is, you know, not only cost reduction or cost effective measures, but at the same time we were able to put those amount of hours back to the beds bedside to, for the patients that we serve.

Dani:

Yeah, that's fantastic. And that's a, that's a significant amount, did you say a hundred thousand hours?

Rex:

Yes.

Dani:

Wow. Was that annually in 2022 or, uh, I, I mean that is significant and that's a lot of opportunity gained from the potential of the workforce and ensuring that they're working to their hired FTEs. Is that something that, just, just to dive a bit deeper into the FTE leakage report and how you use that. Is that something that you produce when a schedule is made or prior to a schedule, or is it done on like a biweekly basis? What just, I'm trying to understand a bit more to maybe help the, the listeners if they too, are interested in making an FTE leakage report and how they, how you're using it today.

Rex:

Yes. The whole idea is prior to posting the schedule, we'll have to determine those, um, opportunities. So it's published five days before the schedule is posted in order for us to determine those gaps. You know, there's challenges, especially if you work in a, you know, in an environment where there's a union where there's collective bargaining, we wanted to make sure that we're aligning those, uh, efforts to that in the, in the contract. So we wanna make sure that when we post this schedule, uh, with, there's not that much disruption to the, to the schedule, so the, of our nurses and honor and respect those, those schedules.

Dani:

Well, I think the foundations you're building there, again, it's, it's quite impressive. And, you know, something that's a passion of mine and seeing health systems operate, you know, very, very effectively. And actually, I started my career at Providence for the medical center and really had some wonderful experiences working as a bedside nurse, a charge nurse, and a nurse manager through Providence, and just saw the contemporary way that we were operating back in, you know, 2012, the early to mid two thousands is when I worked there. And so, hearing the work that you're doing today, it sounds like you're just taking it further and further to continue to really manage the workforce effectively and, uh, help support those leaders. Now, how has the staffing model at Providence evolved in recent years? You know, if, if anything, and what is it as we look at the workforce and we really wanna continue to promote the flexibility, the autonomy and the choice, you know, what are you doing to offer flexibility to those nurses?

Rex:

And I think our staffing model is evolving and we are continuing to explore ways to really reduce the amount of burnout, you know, to ensure that our nurses are working at the top of their license while leveraging technology that aims to reduce the administrative burden. And things that, you know, that are not, are necessarily able to be captured or, or to be done by a, a non-nursing personnel. And also provide opportunities really for both personal and professional development. Understanding that visibility is support is, is at and ensuring our nurses are appreciated. Um, and those are some of our intrinsic efforts. But more importantly, I think in order for us to really achieve that vision of, you know, of supporting our nurses and helping them grow into that profession, we must provide them not only the support and the means to able to do it, but also appreciate them, um, as we go along.

Dani:

Yeah, I mean that, that's key, uh, appreciation, recognition. Everyone needs to hear job well done, particularly the job of the clinician and the nurse and such care that they provide to the patients. Um, so I think that's, that's fantastic from your perspective as, as a nurse who has worked in, um, different care settings as a nurse leader and what we've been talking to, um, leaders across the country is understanding the flexibility from the nurse leader perspective and you know, how that it that can support the frontline nurses that you serve. So what's your, um, vision and mindset around the flexibility of the workforce today and the flexibility of the workforce of the future?

Rex:

I think we are beginning to explore ways to really promote more flexibility to our nurses. A lot of our nurses today are cha our have significant challenges in meeting some of those requirements. So there's that per diem model that, you know, that currently exists today and, and are attracting a lot of our nurses to back to the bedside or to care to, to work more hours and provide more care to our patients. So I think there's, there's a future in, in a per diem, you know, model that allows more flexibility to pick up time or to pick up shifts when they can, especially for those that are caring for their children or caring for their family members. I think that's, that's a great opportunity. Beyond that, I think it's really important to also integrate, you know, technology in managing these schedules for these nurses. So, so having that platform when in terms of technology to identify, you know, ways to promote equity and, um, equality in the way that we schedule our staff members, not just with respect to their seniority, but I think it allows us to understand how we can support our nurses by giving them, you know, opportunities to have more work-life balance and, and as well as promoting more flexibility at work.

Dani:

You know, I wanted to, uh, double down and ask more questions around the PRN model or a per diem model. Um, and I'm, I'm seeing a, in the industry and an experience with a lot of different clients as well as some of the work that I've done building out these gig workforces, flexible workforces. Now, is that something that you're looking at developing internally or is it something that is an external source? Can you help elaborate a bit more for the leaders about what you're thinking around that per diem model?

Rex:

Yeah, I think we've explored this per diem, uh, model with external partners and it's been working well so far, allowing us to have more pool of, of workers beyond our, our caregivers, beyond our staff to really augment that staffing and, and help us serve our patients in that manner. So we've, we've been utilizing external partners such as CareRev and other agency companies to augment the staffing in, in a per diem model.

Dani:

Got it. Yeah, that's helpful. And so per diem, as an external worker that's supporting now, is there any thought or mindset of an internal per diem pool as well? Or what are, what's the mindset around and around that?

Rex:

I think there's, there's an appetite for that. I certainly would hope that there's a, there's a continued path to really ensure that we are exploring multiple ways to augment our staffing. So I would say that it's not, you know, it's, there's, there's an appetite and there's a goal to be able to achieve that.

Dani:

I think that's smart. Oftentimes I've seen or have built workforce strategies where it's multi-layered, you know, uh, one solution is not gonna solve it all. It's a variety of different offerings, which I'm here, you know, I'm hearing that that's what you're dealing at Providence Health System. Let's talk about, you know, you've managed to cut spend on contingent labor quite a bit recently, and how did you manage that? Any advice for other people who are listening? This is top of mind from any health systems as we're coming out of the somewhat post covid, you know, uh, last two years of staffing.

Rex:

I think it would, I would say it takes a village. It took a village to, to be able to achieve that. And it continues to take a village to do that. And I think if I were to narrow it down to two things is having that data analytics, having visibility to the data, you know, they say you can't expect what you don't inspect. So we wanted to ensure that we have the robust data to allow us to get to, to set a, a goal to achieve that. And I think, ha the second thing is having a collaborative partnership with the, you know, with our respective managed service providers and understanding what the national market data is and the regional market data are, and trying to really remain consistent in our practice and trying to communicate to all our stakeholders what our vision is in introducing.

So we've managed to, you know, to significantly cut down the amount of costs associated with, with contingent workers. We partner with our managed service providers who look at every single contract with, you know, with every single travelers and determine where we can lean in and cut down those costs. Now, there comes with a challenge where there's lot of supply and demand where certain nurses or certain clinicians are needed most at that. And we, we have to be agile and we have to understand that, you know, that those particular travelers might come with, with a cost and be able to remain sensitive to that one. I thing to to also say is that it, to your point, it's certainly been an uphill battle, you know, given the, the climate of, of covid and post covid and all these surge cases that continues to exist today. Going back again to, to those strategies, having that, that partnership, um, with your MSPs managed service providers or a as well as having that data are really the key to, to driving the cost down and remaining sensitive to the meets.

Dani:

It is a fine balance and partnership is key. I've often heard it, the use of traveler nursing or travel spend is, it's kind of like a ween weaning process. Just as we think about how we titrate people off drifts or things like that, you know, it's titrating down that you can't, there's a concern if you cut rationally and quickly for sure cost is important, but then what are the impacts on care? So being mindful of the care as well as cost is just so critical, you know, and, and contract labor is needed. And where do you think contract labor fits into our workforce strategy, if at all? Or if you maybe disagree with, uh, my statement of saying it is needed sometimes.

Rex:

So, you know, I have to say this, sometimes when people say that we, our goal is to eliminate contract labor, I, I get a heartburn because I don't think that you can, you can never eliminate contingent workers or contract workers. There's always gonna be a need bird. It's really finding the balance and making sure that we have the appropriate information at hand and the appropriate duration and timeline to be able to manage them. To your point, it's, it's, it's a balance. Right. And I appreciate your, your analogy of titrating, cuz it's certainly a collaborative concerted effort to be able to achieve that.

Dani:

Can you tell me a little bit more about Providence's Traveler conversion playbook and, and what that's all about?

Rex:

Well, this came about with, uh, during, you know, the high of covid and the height HAI of securing travelers all across the country. And we realize that, you know, we have all these travelers that are coming to our hospitals and to our ministries, and what a better way to really try to capture them and drive them into what to our caregivers, to our employees is, is through, you know, a process. And so what we've thought about is, is, is designing this traveler conversion playbook for our leaders. We're nursing leaders who recognize the opportunity to really convert travelers to Providence caregivers. We provide resources, uh, that are aimed to streamline, uh, and engage in a meaningful conversations with professionals and, and provide, you know, the ible information, uh, to secure that conversion. A one way of looking at a talent pool that we can cer certainly leverage as our own included in that are proms and tools and just like a one-stop shop of available for core leaders to sh to really share, you know, why Providence is the best place to work. And, and ultimately, you know, shifting to perception of travelers from that of a temporary to a valuable town and pool.

Dani:

I think that's wonderful and, and being able to really support your frontline leaders as they heard you, not only with scheduling, timekeeping, deployment of resources through your integrated resource centers, but also with tools to continue to build their pipeline. And I would agree, um, travelers and nurses who, who are agency nurses are wonderful parts of the workforce strategy and very valuable to the profession. And so being able to arm your leaders with the opportunity to capitalize on top talent is a really brilliant strategy that, you know, I really enjoy hearing that Providence is doing.

Rex:

And it's also important to understand, you know, from from my perspective, I've been a traveler myself, so I, I was able to share some ideas, but also we leverage a lot of our, our ideas and, and thoughts to our current travelers to pool of travelers as well as to our nursing leaders and what would make it successful to s to be able to convert these travelers. So it's a multifaceted approach and not just from, uh, single lens, but also from various, you know, lenses from nursing leaders, from the travelers, from, uh, the HR and everyone else that has, uh, the skin in the game on recruitment and also improving retention and, and reducing the turnover.

Dani:

I love it. I did not realize that you also had a work history of travel experience, and so that does provide you some unique perspective now as an executive leader over workforce and helping Providence continue to transform and innovate. I mean, that's amazing and a wonderful journey and I think very valuable to have that insight and mindset of a traveler and exposure. I'm sure you've had to a variety of different health systems. I've really appreciated the conversation today. I love learning about the integrated resource center, the work that you're doing, the data, the analytics, uh, which is music to my ears and, and a way that I know help systems are moving towards. And it can be a challenge to get there, but it's a worthy, worthy cause. And so I love hearing that you're making strides and progress there. We really like to leave our listeners with, you know, a final piece of advice. And so I just wanted to ask you, Rex, you know, what would you like to hand off to our listeners today is we've talked more about the workforce and, um, all the fantastic work that you're doing at Providence.

Rex:

You know, we live in a dynamic world that requires us to be agile, to be flexible and receptive to change. And so I think being open to forward thinking strategies and being committed to be the prime movers are the first movers of adopting, you know, innovation and something that is, it's something that can be remarkable, maybe not necessarily today, but in the future and believing in that, uh, because certainly, you know, our future depends on it. You know, there are different ways to be able to achieve a goal. And I think if we have an opportunity to share those best practices across each other or across the spectrum, I think that would be a way for us to, you know, augment or accelerate any, any change management or any technology adoption or innovation that we're trying to achieve. So remaining open to change, uh, being the first movers and, and finding ways to be able to share those best practices across would be my key takeaway for this conversation.

Dani:

Absolutely. Change is hard. Being a first adopter is no easy task. But what I also really appreciate in your hand off to list stairs is community. We're in it together to share best practice to learn from each other and to continue to advance the profession, uh, of nursing to the next level through that. So I really, uh, respect and appreciate your contribution to the profession, the work that you're doing and your openness to share with our listeners today about the innovative work at Providence. So thank you.

Rex:

Thank you Dani.