Courage and Commitment: Staffing for Crisis Care

Rakowski: I've really been encouraged by some of the creativity and things that communities have done to really mobilize and support the healthcare workers. Everything from putting up signs and artworks in their communities so when they're coming home they're seeing them. Food has certainly been a way that people have been expressing gratitude. I also think that the travel industry has stepped up. We've seen airlines offering free travel. We've seen hotels open up for health care workers to stay if they decided the risk is too great to be with their family. That's been really helpful to see. And I love, I absolutely love, all the masks being made and sending them to workers or to others. So it's just been, I think, really inspiring to see the creativity and the level of effort that folks have taken to really support our healthcare workers in any way they can.

Speaker 1: Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast, focusing on the ongoing coronavirus pandemic.

For an inside view of what it's like to manage healthcare systems and personnel during a global pandemic, we connected with Kelly Rakowski, an alumna of the University of Michigan School of Public Health. She's the Group President and COO for Strategic Talent Solutions at AMN Healthcare, the largest healthcare solutions and staffing organization in the United States.

Rakowski: Prior to the outbreak, I was responsible for leading our managed services and strategic sales and our account management teams. We have workforce technology solutions and other strategic outsourcing solutions. So everything related to supporting our clients through comprehensive solutions around staffing and workforce needs.

Post the outbreak, I still continue in that role but certainly in an entirely elevated level of urgency and focus, and what's really become through crisis management mode. Generally speaking what we've seen at AMN is a significant increase in demand for crisis staffing for all types of clinicians: nurses, doctors, respiratory therapists, and other allied health professionals, plus operational leaders.

So at this point between us and many of our partners, we have mobilized well over 10,000 healthcare professionals since the start of the crisis around early May, and we continue to respond to increased demand as different areas of the country and different health systems and communities are continuing to see that need. As part of that, we're working with several locations to stand up and operate what we call surge facilities, which has been about deploying our staffing and technology platforms at really lightning speed.

It's been a seven-day a week endeavor to provide them with logistical, human, and technology resources needed to stand up and staff these healthcare facilities in very short order. So we are all in as an organization doing whatever we can to step up when our clients have needed us the most. And though it's been extremely challenging, it's also been incredibly gratifying to see that we have the capability and certainly the commitment to respond to a crisis of this magnitude and be able to support the solutions during this very trying time.

So it's been really fascinating to see how quickly communities or states or markets have responded, and finding the right kind of facility to do that. We've had some hospitals who converted units, one converted a parking garage into a facility and treatment facility. We've seen hospitals that have closed come back online, like in Southern California, were supporting a couple of convention centers, and New York, and Michigan. There was one that's being planned using a sports arena, state fairgrounds, open facilities that have the appropriate ventilation, plumbing, and space to accommodate the needs. So there's been a real variety and some innovation around re-deploying and repurposing different spaces out there.

Speaker 1: And then there's the people who are needed to staff all the spaces where patients are treated.

Rakowski: When the crisis first hit and we started hearing about some of the demand, it was a little bit daunting. Our core business has been around supplying both travel nurses as well as local per diem nurses to use in exactly situations like this, um certainly not at this level.

We primarily use travel nurses and other allied health professionals, in which they are moving across to state lines and going to where the needs are. And we've also seen a number of workers really come off the sidelines, if you will. We've called them hand-raisers. Where they've been either retired or out of the workforce for various reasons, who really came forward to say, “I have the skills, I have the experience and I wanna be part of supporting the needs.”

Some areas of the country where we saw shut downs of services and they've had furloughed workers who also wanted to get to high demand areas. So we did partner with some organizations to help them redeploy, if you will, their furloughed nurses to go and work in New York, Michigan, California. So, it’s not easy, particularly moving staff across state lines when you have different regulations, different credential needs. The state boards, the various nursing agencies and physician agencies, have really come forward to appropriately restrict licensure requirements in order to expedite that time that's normally needed to apply for those type of jobs. So I've been really impressed by the way the industry came together quickly to problem solve around some of that as well.

Speaker 1: Across the country, healthcare’s response to the pandemic has been shifting most or many regular functions to be prepared for COVID-19 cases. People are still giving birth, dying of other diseases, and seeking diagnostic and primary care appointments. The transition has demanded incredible flexibility and incredible expertise.

Rakowski: For a while we had this really high demand for resources to respond to COVID-19 needs. We did experience declines in other areas of our business. I would say on whole, it's been almost a 50-50. So the high demand has accounted for the slow down in other parts of our business. So our primary mission became really about how do we pivot our resources to respond to the incredible needs for clinicians to get them to where they needed to be? Truly in a matter of days we ended up re-deploying and re-training about 400 of our corporate team members to assist with all the activities related to getting our clinicians to the front lines, whether that be in recruiting, staff deployment, and credentialing, which is a significant undertaking. 

Early on, we stood up 24/7 crisis teams, we revamped our internal and external communications, which included enabling 100% of our workforce to work from home which was no easy task. And we had to do that in a matter of days as we started moving into stay at home requirements around the country. We also in a matter of days stood up a specific COVID-19 website, which we continue to manage and update. And that provides much needed support for our health professionals and our clients with the relevant data that they need answers to questions that we are getting from all different areas and other resources, kind of a one-stop shop, if you will. It's really been about how do we kind of forgo normal operations, and make everything all hands on deck to respond to the need.

Communication is the number one need during a crisis, no doubt. And for us it meant the ability to effectively communicate internally to our team members who are across the country, to our clients who have questions and needs so that partnership is really critical, to the health professionals who are out there. So many of our travelers for example, we're already out and deployed, and they started facing situations that they are being put into, difficulties traveling home, needs that they had to be met. And you just can't follow normal communication channels. They're too slow, if they're too fragmented. And so the ability to communicate at scale and at pace to multiple constituencies has been a really important part of all of these efforts. Getting their questions answered, getting the support they need and the guidance they need to effectively make decisions as well. So I would say this was an area we were just kind of okay at prior to the crisis, but we really galvanized quickly. We've learned a lot. And it's certainly gonna be an area that we'll take some of these lessons learned not only to better prepare us for the next crisis, but also in helping to have more effective communications.

The ability to collaborate and communicate over these remote platforms, where we're used to being office-based and working with each other, the technology has been significant. People have quickly adapted to video platforms and in some ways our teams have even come together even more. A lot more daily huddles, a lot more shorter burst communications as needed. But I think that's actually helped facilitate the organization staying mobilized and organized around critically important tasks.

Speaker 1: It can be difficult to find silver linings amidst suffering and heartache, but the courage, dedication, and expertise of the healthcare workers has kept Rakowski’s team going, along with so many of us.

Rakowski: Predictability around needs has certainly been a challenge. I had some markets like New York that got overwhelmed very quickly and we had to respond accordingly, and others which now I would say are probably over-prepared a bit. If you can be over-prepared in a situation like this and deployed resources that maybe won't fully be needed. Which is a wonderful problem to have. But that creates its own impact on resources that were deployed to support that.

And I think that the biggest part has been the health and safety of our health professionals. There's been a lot of coverage in the media about the challenges to getting adequate PPE and protection, the rates of exposure. We've shared those same challenges along with many other healthcare organizations. But through the challenges our aspirations and inspirations have really come from really the tens of thousands of nurses, therapists, physicians, other professionals who raise their hand and even knowing those circumstances, knowing the risks of what they'd be facing, their are willingness to accept those really tough assignments knowing they're going into some of the hardest hit areas and higher risk areas and treating those patients.

The power of social media, I think has been tremendous. The stories, the videos, and hearing from the health professionals coming off of a shift and the raw emotion of what they've had to deal with, those are the things that have kept us going.

We are looking forward and I think as any strong leaders, especially those in healthcare, we need to find the things that provide hope and optimism for the future. Certainly, the courage and commitment of our healthcare professionals has been it for me. We really liken it to how the first responders were to the tragedies of 9/11. They're running into the buildings when everybody else is trying to get out. That's what our healthcare workers have done. The outpouring of support emotion and gratitude for them has been just wonderful to see.

It's a privilege to work with these folks on an everyday basis and we get to do that, but our broad communities don't necessarily do that. So the support and appreciation and love for them has just been gratifying and I think will hopefully carry over and we won't see our healthcare workers get taken for granted in the future.

Speaker 1: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we’ll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in between special edition episodes, be sure to check out our website publichealth.umich.edu, subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter and follow us on Twitter, Instagram, and Facebook @umichsph.