3 Keys to Healthcare Staffing at NYC H+H During COVID-19

While NYC Health and Hospitals developed a nationwide recruiting strategy, a centralized approach to onboarding, and new training tools amid COVID-19, leaders attribute the system’s successful healthcare staffing strategy to flexibility, communication, and technology.

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In a recent Health Affairs commentary published on June 11, leaders from NYC Health + Hospitals’ Office of Ambulatory Care, Office of Patient Centered Care/Nursing Administration, and Human Resources shared how the nation’s largest public health system successfully staffed 11 acute care hospitals and three new field hospitals to manage overwhelming volumes of COVID-19 patients.

“To care for an immense wave of critically ill COVID-19 patients, NYC Health + Hospitals had to develop new systems and tools to redeploy, recruit, onboard, and train thousands of staff and volunteers in record time,” wrote lead author Chris Keeley, assistant vice president at the Office of Ambulatory Care.

But achieving those goals required that the health system “innovate rapidly, communicate effectively, and adapt readily to address emerging challenges” in order for the strategies to be “foundational elements of surge staffing plans for public health emergencies in the years to come,” Keely et al. stated.

Flexibility was the most essential factor in healthcare staffing during the pandemic, the leaders agreed.

“Early on, we realized that our processes would need to be iterative,” Keely et al. wrote. “Taking advantage of the Plan-Do-Study-Act (PDSA) model of health care improvement inherent to our daily work life at NYC H+H, we brought together multidisciplinary groups to devise new strategies and systems. We monitored our results in real-time and, egos aside, made changes to improve efficiency.”

The best example of that was the health system’s new approach to onboarding, according to leaders.

To effectively manage a surge of COVID-19 patients, NYC Health + Hospitals’ rapidly redeployed staff to areas of the system experiencing higher volumes. But the health system quickly had to develop a nationwide recruiting strategy with the help of private staffing agencies, the Department of Defense, and volunteers. This led to a slow down in onboarding processes and diverted staff from patient care.

“The solution was a cross-departmental team that included leadership and staff from the Office of Ambulatory Care, Medical and Professional Affairs, Human Resources, and Information Technology,” Keely et al. explained. “In the span of three days, the team designed and deployed a tool that automated the onboarding process, enabling new staff and volunteers to be deployed within 48 hours of submitting completed applications.”

The tool was a single-source portal that enabled staff and volunteers to submit required documents, such as medical licenses. Within 24 hours of submission, a centralized credentialing team reviewed the application while Human Resources accessed the same information to create employment records and IT enabled EHR access.

By the start of April, the provider recruitment team was processing an average of 250 applications a day. However, the single-source portal was revised at least once a week to streamline the process for the team, the article stated.

For example, the IT team redesigned document submission processes after applicants reported difficulty uploading medical licenses. The team also developed a new drop-down menu to capture agency affiliation after the provider recruitment team encountered challenges with tracking the information.

“Clear and ongoing communication among members of the cross-departmental teams—along with the creativity and flexibility of IT staff—were essential to the smooth and effective operation of the new systems,” Keely et al. wrote.

Communication was also key to the health system’s successful healthcare staffing strategy, the leaders emphasized.

As part of the new centralized approach to onboarding, the health system created three new staff positions to facilitate communication. The positions were an “air-traffic controller” who helped timely routing of new staff and volunteer application information; a data lead for maintaining credentialing, human resources, IT, and EHR access data in a centralized location; and a team member responsible for managing volunteer communications.

To respond quickly to changing needs, the health system’s C-suite leaders, ambulatory care chiefs, and critical care leaders also communicated regularly via conference calls, daily e-mails, and tele-town halls with New York City Mayor Bill de Blasio and other community leaders, the article stated.

Finally, technology in the form of web-based systems for onboarding and training made it possible for the health system to staff up quickly and effectively, Keeley et al. reported.

In addition to a single-source portal, the health system also developed web-based training materials and an external web portal to quickly educate new staff and volunteers on proper COVID-19 care while complying with social distancing policies.

While NYC Health + Hospitals boosted internal training capacity with interim educators from local colleges and universities as well as the new Department of Defense providers, the health system uploaded course content on the EHR system and developed a COVID-19 checklist.

On-demand, self-paced COVID-19 training was also provided by the IT leadership team to clinical and non-clinical staff. The team also established a schedule of daily online training for new staff and volunteers on how to use the EHR system.

In total, the technology enabled the health system to train over 20,000 staff in March and April.