All right, I'm going to go ahead and kick this off. My name is Nicole Knight, and I'm the Senior Vice President of Revenue Cycle Solutions and Consulting at Medaxium, and I'm happy to be joined by Audrey Fisher, who's the Chief Executive Officer of Virginia Heart, and Jamie Warren, who's fairly new to our Medaxium team, but she is a VP of Consulting. And today, this is part two of our staffing series, and we're going to talk about recruitment and retention strategies. Just a reminder on your Zoom controls, now that we're on a different platform from our usual webinars, your handouts will be located in the chat box. There'll be a link for you to retrieve them there. And then if you have questions as we go through the session, please type them into the Q&A section, and we will answer them at the end, or we'll provide you a response after the webcast if we don't get to all the questions. Today, we're going to cover, Audrey's going to take us through culture and team building in her organization, and some things that they've done for a path forward. And then Jamie's going to touch on recruitment and retainment strategies around our non-invasive diagnostic testing areas. And I'm going to close us out with just a little bit about remote workers and having the virtual staff. So excited to get started, and go ahead, Audrey, thank you. Great. Thank you so much, Nicole. I appreciate the introduction. So as Nicole said, I am the CEO for Virginia Heart. We're a large independent physician-owned cardiovascular and sleep practice in Northern Virginia, D.C. area. We have over 75 providers, over 300 staff, 10 clinic locations. We see over 150,000 patients per year. We have a really strong physician culture. We have an equal share model, which really drives that. And we recently signed a 10-year PSA with our local health system. But we do practice in multiple venues, including not-for-profit, for-profit, and community hospitals. And you'll see in my Zoom background, the San Francisco Golden Gate Bridge, that's where I'm originally from. I moved to Northern Virginia in September of 2020, because if the pandemic wasn't enough, I just needed to uproot my whole family and move cross-country and start a whole new job. So let's see if I can get the slides to go. There we go. So the current milieu that we're dealing with, of course, COVID, has really upended the world in so many ways, and really just, I think, made a fundamental shift in how people are thinking about their priorities and their life. And we've really seen that among health care workers. There was already a shortage of health care workers prior to the pandemic, and that has only become more exacerbated. We've also seen an inflation of health care wages, because there is so much demand that's not being met for health care workers. And I see it in my own community, it's kind of like gas wars, and we're constantly driving things up and making wages higher and higher, which is making it even worse. Of course, there's been a lot of burnout and loss of connection in our health care communities, be it because we're having virtual meetings, masking, social distancing, few work functions that are social, the list goes on. And in my particular case, because we're really gluttons for punishment, we transitioned our EMR last year in 21 to EPIC. And so we've really been feeling the pinch because that required a lot more resources. So I'm sure many of you have experienced walk-offs of your employees. I know I have. And what we really want to get to is a positive walk-off. So let's talk about how we can get there. So many of you may be familiar with this quote by Peter Drucker, that culture eats strategy for breakfast. I truly believe this. It's all about the people. If we think about health care, we're serving other human beings. And we have to remember that our team are valuable people as well. And we really need to bring the humanity back to health care. I think as we've become more digitized, electronic, some of those connections have been lost and that sometimes we forget what our most valuable thing is that we have to offer. It is our people, and we need to treat them as such. And so we've really declared this to be the year of the employee at Virginia Heart, although for me, every year is the year of the employee, but to draw special recognition to this. And I'm sorry, the slides don't, oh, there we go. So I don't know about all of you, but my bucket kind of looks like this right now. It's got a lot of holes and things are pouring out and we're putting Band-Aids on things. So we'll talk about tactics. And I know Jamie will give you some specifics. And so we'll nickel on that. That's filling the bucket. But until we can actually fix the bucket, it's just going to keep pouring out. And so that's what I really want to talk to you about today is culture, because to me, that's really the long range strategy to this issue. So our path forward really for me means having conscious leadership. And so what does that mean? It really means as leaders that we have to have self-awareness and awareness of our team members. So I recently read a really good book on authentic leadership. If you're interested, it's called True North by Bill George, who was the CEO of Medtronic for many years and is now a professor at Harvard Business School. I think it's important for every leader to really understand who they are authentically and to be able to bring that to the table. And then once again, to also recognize in your team members who they are, what their skills are, what their strengths and weaknesses are, so we can meet them where they are. I'm truly a believer in servant leadership. And that is my job as CEO is to serve every single person in my organization. And the only way that I can do that well is being conscious and being self-aware. Pascal's principle says that water seeks its own level. So if we can't recognize the things in ourselves, we can't see them in other people. As I said earlier, we really need to be more humane and more human. You have to lead with your heart as well as your mind. And we can't forget that our behaviors as leaders in an organization really shape the culture. And so we have to hold ourselves and other leaders accountable and incentivize what we want and disincentivize what we don't want, micro behaviors that just may not be contributing to a positive culture. So when we talk about retention and what makes people stay, we'll be talking about these things in culture, and then I will go over some general tactics as well. So what is great leadership? It starts with team at the top. So for me, that means my executive leadership team is acting as a collaborative team, that we have open communication, that we're transparent, that we're leaning on each other, utilizing each other's skills. If you don't have it at the top, it's hard to have it further down in the organization. And once again, lead by example. Your behaviors as a leader are what are going to be modeled by others. Once again, servant leadership being mission-driven and humble. It's very important to have humility. Nobody knows it all, and we can always learn from each other. I learned from everybody in my organization, and every role is equally important to me. It's also important to be visible and accessible so that people know that they can reach out to you and share with you and communicate. And having that consistent, transparent communication and great listening skills is also essential. I think another area that we sometimes fail is in providing constructive feedback. Oftentimes, leaders shy away from having crucial conversations. They're afraid of hurting somebody's feelings, of negative pushback, et cetera. But I've really found throughout my career that when you lean in and you lead with your heart and you're really invested in helping another person improve, that you can deliver constructive feedback. And it may not be always easy to hear, but in the end, people usually thank me for it, and they're better for it. And the same for me. I always ask people to give me constructive feedback as well. It has to go both ways. It's really important to be conscious, trustworthy, authentic, self-aware, and empathetic. And as I mentioned, the authenticity, that's a big one for me. It took me a while to find my authenticity as a leader, but I just always show up as who I am. I'm never trying to play a role or be something that I think I should be because that's the way another leader is. And I want to show you a clip on empathy, because this was really an eye-opener for me. It's by Brene Brown. And I thought I was an empathetic leader until I saw this video. So, what is empathy, and why is it very different than sympathy? Empathy fuels connection. Sympathy drives disconnection. Empathy, it's very interesting. Teresa Wiseman is a nursing scholar who studied professions, very diverse professions where empathy is relevant, and came up with four qualities of empathy. Perspective-taking, the ability to take the perspective of another person or recognize their perspective as their truth. Staying out of judgment, not easy when you enjoy it as much as most of us do. Recognizing emotion in other people and then communicating that. Empathy is feeling with people. And to me, I always think of empathy as this kind of sacred space when someone's kind of in a deep hole and they shout out from the bottom and they say, I'm stuck, it's dark, I'm overwhelmed. And then we look and we say, hey, I'm down. I know what it's like down here. And you're not alone. Sympathy is, ooh, it's bad, uh-huh. No, you want a sandwich? Empathy is a choice and it's a vulnerable choice because in order to connect with you, I have to connect with something in myself that knows that feeling. Rarely, if ever, does an empathic response begin with at least. I had a, yeah. And we do it all the time because you know what? Someone just shared something with us that's incredibly painful and we're trying to silver lining it. I don't think that's a verb, but I'm using it as one. We're trying to put the silver lining around it. So I had a miscarriage. At least you know you can get pregnant. I think my marriage is falling apart. At least you have a marriage. John's getting kicked out of school. At least Sarah is an A student. But one of the things we do sometimes in the face of very difficult conversations is we try to make things better. If I share something with you that's very difficult, I'd rather you say, I don't even know what to say right now. I'm just so glad you told me. Because the truth is, rarely can a response make something better. What makes something better is connection. So for me, I definitely connected with the at least part. I'm definitely, I'm guilty of it. And I'm now working on it since watching that. Like I said, I really consider myself very empathetic, but I do try to put the silver lining on things. And so I'm working on not doing that anymore. So next, let's talk about meaningful work. This is something that's really important to me. I think it's really important for people to be able to contribute ideas and solutions from the front lineup. So I'm really a big fan of the Toyota lean production system model, which when I first heard of it, I thought, how can building cars have anything to do with health care? But it has some really great principles that I adopt and use. One of them is respect, respecting everybody. And the other is that leaders need to go to where the work is being done and to listen to people and to be there, not to tell them what to do, but to hear what their struggles are, to hear what their ideas are, to empower them to make a difference in how they're doing their work, to change their workflows, to experiment. And so there's a term called Gemba, which comes from the lean system, which means that the leaders walk to and go to the work. And so this is something that I've introduced at Virginia Heart, and it's been extremely powerful. It's been wonderful when the entire team shows up and they're engaged and they've got ideas and they really want to make a difference in things. That really makes you feel valued and valuable as an employee. And I think that's what we all want. It also makes you feel like you have control over your environment and that you can make a difference. And I find that when you do this for people and you empower them, you get so much more out of people because they're engaged and they feel like they can really make a difference. It's also important to set context for people. And so I frequently connect people from different parts of the organization so they can understand how their work is impacting other people. So if the front desk doesn't put the insurance information in correctly, how does that impact everybody downstream? So really just trying to connect people together so they can see the whole picture and not be in their myopic box of just doing whatever they're doing without seeing what that impact is downstream or upstream. I think it's also important to work at the top of license. I find in my organization, even for physicians, sometimes they're doing menial things that are not what they should be doing. So really just trying to scope that out and ensure that people are performing at their peak performance and skill level. And that obviously makes their work more meaningful. And then I think the most important thing to me is connecting to our mission and vision and values, our why, be it our personal why and the organization's why. I've always been a why person. In fact, when I was in school, I was frequently sent to the library because I was asking why too many times. But it's really what drives me. And I'd like to share with you my personal why in just a second. Another piece on this that I wanted to call out is I think it's really important for physicians to understand how crucial their role is to making people feel part of a team. And I'm constantly asking my physicians to lean in, to get to know people, to ask how their families are, to ask how their weekend was. It's the simple things, to say thank you for a job that's been well done. Those things go a long way. It's the day in and day out that really make a difference. And so I've got another video for you on why. How do I know? A lot of people, when they think of the phrase how do I know, they always want to put the what behind it. How do I know what I'm supposed to do? The question that you really should ask is how do I know why I'm here? Because when you know your why, your what becomes more clear and more impactful. If you know, like for instance, people know that I do comedy, but that's what I do. My why is to inspire people to walk in purpose. So I can do comedy, I can write books, I can be in a movie, because all of it is motivated by my why. In fact, I have a new web series out called Michael Jr. Break Time. We probably just did the sixth episode. It's on YouTube. So every single Wednesday at 3 o'clock, we drop a new episode on YouTube of Michael Jr. Break Time. What it is is it's me, I travel around the country, and I do stand-up comedy in case you didn't know. And in the middle of my comedy set sometime, I'll stop and just talk to my audience. And we've been filming this, and it's, you know, it's pretty cool. So we're in Winston-Salem. I'm going to show you a clip from Winston-Salem. And I'm just talking to this guy in the audience, and he tells me that he's a musical instructor at a school. So I was like, all right, you're a musical instructor. You know, can you sing? Let me hear you sing a song. So this is what happened at the last episode of Michael Jr.'s Break Time. Check it. So you're a musical director. Yes, sir. All right, so let me get a couple bars of like Amazing Grace. Can you do the first part of that? Go ahead. Amazing grace, how sweet the sound that saved a wretch like me. Wow. That bruh could sing. You know what I'm saying? All right, all right. Now, why don't you give me the version as if your uncle just got out of jail. You got shot in the back when you was a kid. I'm just saying, let me see the hood version real quick, if you know which version I'm talking about. Just see if that exists. Let me see what you got. Amazing grace, how sweet the sound that saved a wretch like me. I once was lost, but now I'm found. I once was blind, but now I see. OK, here's what I want you to catch. The first time I asked him to sing, he knew what he was doing. The second time, he knew why he was doing it. When you know your why, your what becomes more impactful because you're walking towards or in your purpose. So I thought that was pretty powerful. And I think we all need to find our why, our personal why. So I'm going to tell you a story about my personal why. Back in the 1970s, when I was about five years old, my grandmother, who was in her 40s, had to have emergency aortic valve replacement. And this is a ball and cage valve. It was one of the earliest valves of this technology. So it was a very new technology, very scary time. I was in California with my family. She was in upstate New York. And we flew out to be with her during and after her surgery. And I was just so in awe, not only of the science and the technology and that they could fix my grandmother's heart, but the caring and compassion of all of the health care team members who really carried us through this very terrible and challenging time for my family and were able to save my grandmother's life. And it was at that point that I realized that I wanted to give back in some way. And fortunately, my grandmother is still alive. Here she is on her 33 acres in upstate New York. She's 91. She still has the same valve that was put in back in 1976. I can still hear it ticking away in her chest. And so that's really what drives me every day. And then seven years ago, my daughter also suffered from a very serious vascular malformation in her brain and had to have urgent procedure for that as well. And once again, I just found myself humbled and so grateful for medicine and to be able to contribute and to give back. So those things drive me every single day. That's my why. So now we'll move on to team building as it relates to culture. And I'm really big on having social events and having people connect outside of work. I think it's so important. The more that we see each other as human beings, people with families, people with hobbies, people that like to do things, the closer we are and the better we work together. And it doesn't mean that we all have to be best friends, but it means that we can appreciate the humanity in each other. So for St. Patrick's Day, you can see that we're So for St. Patrick's Day, you can see I actually hired a leprechaun, which I didn't even know was possible, and had him come out and give out pots of gold to everybody at a local restaurant for my management team. We had a lot of fun. And so, you know, I am a fan of doing in-person events, but obviously through COVID, we've had to come up with virtual fun and there are ways to do that. So we've had virtual happy hours monthly. We've done a virtual improv and we've done a virtual employee parties as well. Fortunately, we're able to get back to some in-person events. We had a nice big party last night, a retirement party with about 100 people. And it was so great to be with everybody outside of work. So we play I mean, we work hard and we have to play hard as well. It's really important. Employee engagement. We have an employee advisory council that reports directly to me and gives me feedback about how we can improve the organization. We also have a community excuse me, I'm tripping over my time, a community service group that allows our employees to participate in giving back to the community. And most recently, we formed a not for profit foundation once again to help the underserved in our community. We also do regular employee feedback surveys. We use a tool called Amplify, and it's it's been really great. What's really important, though, is not only that you survey, but that you actually act upon and then communicate back to the employees. OK, you gave us this feedback. Here's what we've done with it because of what you've said to us. And it's really important to encourage participation. What worries me is when people are silent. And I was so proud because in our last survey, I think we had 94 percent participation in our engagement survey. And to me, whether it's negative or positive, as long as people are talking and giving me the information, that's what I want. And also encouraging relationship building. You know, once again, as we talked about providers leaning in, if you've got multiple locations, having people do field trips so they can cross collaborate and get to know each other. Mentorship and buddy programs are great, especially for new employees. Connect them up with somebody on the first day so they already have a connection there at the company and they're not just on their own. And then you can also look at doing things around diversity and inclusion like calendar plugins for Outlook. That really helps people to feel like they're being recognized and seen. Another huge piece for me around culture and team building is our managers. So I read a recent article that stated that only 18 percent of managers are skilled at leading. And it's no wonder, because how do we end up with managers and health care? Typically, it's Joe who's a great nurse or Jane who's a great tech. And let's promote them and make them manager. And we're just going to drop them in and we're going to let them figure it out. And they're going to be great. Well, that's not really fair. And it's been something that's been really a pet peeve of mine for many years. And all the organizations I've been in is there. There are very few management development programs, very few training programs for managers. We just expect people to somehow know how to be a manager and a leader. And so I started a weekly development sessions with my team. And I have the managers themselves actually lead these because then they're invested, they're researching the topics and they're presenting it back to their colleagues. It's much better. I could give lectures on all of these topics, but having them do it, it really, once again, empowers them and gets them involved in the process. I also bring in outside coaches for people that have particular deficits or areas that they need to improve upon. And I certainly do that if I have a manager who is is not doing well in a certain area or just really needs somebody to give them some feedback on blind spots that they have. And then we also use outside opportunities. MGMA, I've brought in speakers on crucial conversations, ACHE, et cetera. Also, regular communication from leadership is critical. Be it through town halls, in-person rounding, as I mentioned. I started CEO Coffee Talk this year. So basically, I do this several times a month. I block off my calendar and 15 minute increments. And anybody and everybody from the organization is welcome to come and schedule into that. And they can come and have coffee with me in my virtual sitting or in my sitting area in my office, or they can join me virtually. I wasn't sure how well it would go over, but it's been extremely successful. I feel like I'm selling tickets to a Beyonce tour. Every time I open up, they sell out immediately. And it's been really great. Everybody's been so appreciative. And a lot of my colleagues in my executive leadership team said, Audrey, you're crazy. You're just going to get a bunch of people complaining to you. I said, well, if that's what happens, that's what happens. But it actually hasn't been the case. People are very constructive. They really want to help improve things. And they just really appreciate the time and being heard. And I really appreciate them. I've gotten so many great ideas on how to make things better for the company through this. So it's been a really, really good, successful strategy. We talked about empowering people, employee appreciation. Once again, I think that it's more impactful when it's on the daily. It's the thank yous. It's the recognition. But there are also fun things to do. We have pet therapy, which I hadn't seen in an ambulatory side before. You see it a lot in the hospitals. But we're doing that now. And everybody loves that, including the patients. And we also have Exceeding Expectations, where we call out people at the beginning of every meeting. And we have a Caring Hearts program for employees to nominate others for great things that they've done. And then we've got another program that came from our employee advisory committee called Behind the Mask, About Me, which once again selects several employees each month from a department. And they're able to fill out a profile that describes who they are more personally. Once again, just kind of bringing that humanity back. And just some fun pictures. We do our Employee Appreciation Week once a year. We don't do Nurses Week and Doctors Week. We celebrate everybody all together. But once again, we have a great time. We did an omelet station. We did ice cream socials. We had the pets out, which you can see were a huge hit. So once again, just always celebrate as much as you can. So now I'll talk about some tactics for innovative recruiting, retention, and restructuring. So first of all, I think we need to have a talent mindset and realizing that employees are not commodities. We're not just going to churn and burn and go through people. They are, our employees are our biggest asset in healthcare. They're also our biggest expense. But the more that we can retain great employees, it actually is less expensive than turnover. Turnover is extremely costly. And then you've got to go through training again, and you're not able to form the team connections. You're not able to get the most out of your teams when people are constantly coming and going, right? Because we're all at our peak performance when we're working with a team that we know, that we gel, that we can anticipate, that we can communicate with. And we cannot forget, it is an employee's market all the way right now. So the tactics that we had in the past, that you should just feel lucky to be hired by us, doesn't work anymore. And frequently I'm hearing not only in my own company, but in other companies that people are scheduling interviews, not even showing up, not even calling to say they're not going to be there. In my market, I recently read, I think there are three to four job openings for every job seeker right now. So we have to do things differently. So we are, some of the things that we've been doing is we created a recruitment task force that's multi-generational. And it's been really great because I've been able to pull in the Gen Z and millennial perspective. And they've told me, Audrey, we can't just put job descriptions out on Indeed and LinkedIn. You've got to reel these people in, show them what a great culture we have, what great benefits we have, the flexibility that we have. That's what people are looking for. And so it's been really wonderful to get the different perspectives from different people, instead of just leaving it on my HR team and my recruiter to figure out how do we do things differently? How do we meet people where they are today? And so a few things that I'll just point out is having active recruiting and pipelines. And you might want to look at non-traditional sectors. Hospitality is a great one, which got hit hard during the pandemic, but that's where they learn customer service. I mean, it's the foundation of hospitality, right? So I definitely encourage you to look at hospitality workers that you might be able to train up. And also utilizing your internal network. We all know a lot of other people in healthcare. So I always tell everybody, talk to your friends, your family, put it out on your LinkedIn, on your Facebook that we're hiring. It's a great way to source candidates. Connecting with local universities and career fairs is also another good way. I've brought in external recruiters for hard to fill positions, and that's been very successful as well. Also, even though we may feel desperate during this time, I always say, please don't hire out of desperation. You need to focus on hiring the right people, not the quick people. Because when you hire somebody out of desperation and then they're not a good fit, not only are they then not doing their job well, they're bringing down the whole rest of the team. And then you're having to start over again in a few months. So it's better to just wait and hire the right person, even though it might feel like you just want to fill that hole right now. Another thing that I see in other organizations doing and that I'm actively developing is internal training programs. So for example, taking somebody that's working at the front desk and training them into an MA role or a cardiac tech role. I think it's really, it's a great way of helping to fill those positions. And it's also gives internal mobility for people. We've also had internship programs. So over the summer, largely, but sometimes throughout the school year where we have college students come in and they help with some of the more menial tasks and take that off of our clinicians. And it's great. You know, we pay them at minimum wage, they get some experience, make some money. And then they've also have a connection with us that they may come back and work for us after college. We've also worked on competency, I can't speak, competency-based hiring. And so once again, just looking for the skills and perhaps having somebody shadow for a clinical position or demonstrate actual skills that they need on the job to make sure we're getting the right fit. And we talked about top of scope work. We're really working on defining our roles very clearly on who's doing what and making sure that we're utilizing everybody effectively. I also really encourage you to look at your new employee orientation. That is really your opportunity to inspire vision and to make people feel connected to the company from the moment that they walk in. And then a lot of companies do exit surveys. I really suggest doing onboarding surveys. Ask your employees, how was your onboarding experience? Did you get enough training? Did you get what you needed to be successful? What can we do better? And then do stay surveys. Don't wait until people are ready to leave to ask them what's going on. Ask them while they're there so you can make those changes. We have done retention bonuses, I'm sure many of you have, and that's been very helpful. We've been re-imagining how we work. And Nicole will tell you more about virtual work later. We've converted about 25% of our workforce to fully virtual. And then of course, don't forget to leverage your technology and work smarter, not harder. And then just some basics. Make sure that your salaries are keeping up with the local market. It seems to change in my market on the weekly basis. So I'm constantly scanning and getting feedback and making changes as necessary. We've been having sign-on bonuses for our nurses and techs up to $10,000. And as a result, I didn't want my current staff to feel shorted. So I gave them all the equivalent bonuses as well that I've been paying out as loyalty bonuses. It's important to have a performance evaluation system that allows people to get salary increases based on merit. And I rolled one of those out at Virginia Heart last year. Once again, we talked about mobility and growth. It's really important for people to have those pathways and see how they can continue to grow with the company and to continue to learn. And then of course, your benefits package should be highly competitive and including mental health right now, especially. So I just want to highlight where we're at in the journey real quickly. So our call center is now fully virtual. It was kind of interesting last summer, we were running out of space in our call center, which was at that time, fully on site. And I asked my manager, Christy, what do you think you've got a couple of people that you could send home part-time and they could kind of split that up so that you have an extra seat. And she was very hesitant about it. She didn't think it was going to work, but she said, okay, I'll go to try Audrey. Let me see how this goes. I talked to her a month later and she said, Audrey, the pilot was so successful that I moved the entire team remote. So they are now fully remote. They are so happy. Our service levels are through the roof and we have made such amazing success in our turnover. Our turnover was 85% in our call center. And in the last six months, it's down to 11%. I've only seen a couple of people leave. And one became a teacher, got her credential, which she had been working on, and another person had to move out of state. So we've had great success with that. So overall, in the interest of time, I won't read through all of this for you, but we've had really positive outcomes in moving the dial. Once again, changing culture doesn't happen overnight. And you can't expect that results are going to be there overnight, but it's incremental progress. And it's something that I encourage all of you to start the journey on because the sooner you start it, the sooner you're going to get there. At the same time, I know that you need to have the now tactics. And I can't say that we've definitely won the World Series yet, but I feel like we're well on our way. And I'm very proud of my team and my organization and happy to serve them. And with that, I will turn it over to Jamie to talk to you about some more tactics on the non-invasive side. Thank you, Audrey. My name is Jamie Warren. I'm the newest member to the MedAxium consulting team and very excited to be with you all today. I want to spend just a couple minutes talking about specifically your non-invasive imaging departments, but first hitting the pause button and say a very special thank you to Audrey for the examples and showing to us that this can be done. I think sometimes even post COVID, we hear of these different examples and we think there's no way we're going to be able to do that at our facility. And I think there were some real key takeaways that you could immediately put into where you are today with your facility. So today I'm going to talk a little bit about keeping that teammate within your department and then how you can find some new teammates to come in. Take the next slide for me. So one of the things you're going to hear very loudly with the new teammates that are coming in is that our traditional schedules that we've always done. So think about it. We were five days a week, eight hours a day. They took call rotating and you worked every third weekend. That is no longer what is accepted or wanted with the staff that is coming into our departments. So this is a great time to hit the pause button and say, do we have a mechanism to be flexible with our schedules? Could we do a 10 hour shift? Could we do a 12 hour shift? Could we learn from our other partners in healthcare? Nursing has been doing this for quite a period of time. Could we take their best practices or key takeaways and apply that to an imaging department? This also spins over into weekends. Is it possible to have a wow position where someone would come in and work two twelves or the on-call schedule? What does that look like? It may even be if you have multiple facilities combining your teams to be able to decompress how much call that they have to take each night or that weekend coverage. And then I'll also challenge you to take a look at your start and end times. I would bring the team in and say, if you had the perfect schedule, what does that look like? And then be able to take pieces of that and apply it back to your schedule. So a couple of things to keep in mind when you're looking at schedules, a lot of the jobs or the tasks that are done in diagnostic imaging does have a physical component to it. So you do want to make sure that if your sonographer is rearranging a patient room or having to move a patient around and they're working a 12 hour shift, that they're not getting to the end of the day. And the quality of their work that they're doing is almost being jeopardized just from physical tiredness. The other piece to this is we do have guidelines out there for us to help us say, OK, well, how long should it take us to do a particular test? And would advise for you to go and look at the accrediting bodies for their guidelines and standards for timing. Next slide. In an imaging department, and this is not something that we've really focused on, but I will say has probably been highlighted a lot from COVID, is taking a look at what we have and who we have and where we have in our department. And the first thing that it starts with is what is their professional title? It starts with instead of calling someone a technician when they actually went to school board certified and maybe licensed in there, a technologist or a sonographer. And as small as that sounds, that is a huge win within a department if now I am being called by the professional title of what I went and had my education done for. The second part of this is including the diagnostic imaging personnel, teammates, teams into the patient care inside of that patient care team. They are the eyes and ears. They're the ones that are seeing that patient as they're going through that exam or that test. And they can provide that feedback, that handoff of sorts back to the next caregiver. Working to the top of scope, Audrey also talked about this. It's very important to take a look at your staff and say, okay, so what can we do? Are there additional roles and responsibilities? How can we grow in this particular area? And then this is your first action item. And this is a two-part question. Who is providing education in your department? So there's two pieces to this. First thing is, who's doing your annual competencies? Who's training the new person that's coming in? And then the second piece to this is, how are you growing your staff? What often happens in these smaller departments is you end up with a non-invasive leader who may be the one who is the educator, who is also the one trying to figure out growth paths. And I think after COVID, they're a little tired too. And it's hard to come up with new ideas and new pathways. And if leadership could come in and provide a little extra support in that area, I think it really will bring some positive impact to your department. Next slide. So creating a culture of inclusion, using appropriate terminology to your audience. And I'll use an example. And this is a standard employee engagement survey and is a little hard to change the terminology, but if you have the ability to do that. So an employee engagement survey went out to every teammate within a healthcare organization where the wording was used unit. So that was to describe their place of employment, where they worked was unit. And that is not common terminology, especially in the diagnostic imaging area. And so there was a lot of teammates that would come to the table and say, are they even talking about me? Is this question relevant to me? Should I write in a, how do I answer this question? So if you have the ability to add in wording, that's a little bit more inclusive of the team that is working there. You might be able to see some different answers that come out, but then they also feel like they are part of belonging. I got this survey. They want to know my opinion. They understand where I'm working. Then the next one, organizational initiatives, including allied health input. So a lot of times goals come down that you get into a diagnostic imaging department and you think, how can I actively assist in this goal? And so having them lean in at the table, bringing them to the table when those goals are being brought together is really important with their getting their buy-in and then also being able to move the needle in that goal. And that just flows over into the very next thing. So initiatives and goals. Next slide. So always who is part of the fun committee party of one. If you go and ask your non-invasive leader, they're probably going to tell you they are the committee. It's it's me. And after, and I've said this a couple of times after COVID, they're a little tired. So I would offer as a suggestion to go seek out who has the most robust and effective program from an employee engagement and mirror what they're doing. Go and ask for resources that are very similar to do that. So instead of trying to recreate the wheel, you can already learn from best practices of what has worked well in a particular area. And then from there, I do say, go and ask the crew who else can join me on the fun committee, but do have the ability to take those ideas and implement them. Second thing I would say is use your facility community methods to highlight the team and then dividing that even down into providing education to the rest of the patient care team about the diagnostic imaging departments. You will often find that there is a misconception of what the educational background is for someone who's working in diagnostic imaging to the point that someone else on the patient care team may not know that they're clinical. And so having that pause button to be able to provide some education on what it looks like to be highly specialized in a particular imaging area builds more of a culture of a team working together versus a they versus we, we versus they. And then the last thing here is create a space to celebrate. And that could be a one week that you celebrate everybody that's in your facility, or you could even do specifically a cardiovascular week. The last organization that we were in, we did this cardiovascular week right at Valentine's Day. And so we would talk with our vendors. We would have lunches brought in. Sometimes we would have a cookoff where someone would bring in desserts. We would have games. We would purposely try to carve out even just a couple minutes throughout the day to get them into the break room, take a picture. We had those where you had the different cutouts and the hats and the scarves just to add a little bit, inject some fun back into the department. Next slide. Okay, so on the listserv, I have seen a lot of comments and I say please use the listserv because you all have the most creative ideas. But one of those things is, okay, how do I find more people? We, we have everybody in the department. We have these unfilled positions for like six months, 12 months. How do we find these people? Should we just start our own school? So one of the things I would give you as an action item is to go and actively seek out what schools are around you in even a couple of states out. There are a couple of schools that are offering online portion of the didactic piece of the imaging component. I would say look for an accredited program and pair with them where you are providing the clinical sites. So you may have somebody that works directly with that student who is in physically into your lab, but they're able to get the didactic part of it from an accredited program, which will basically make the pathway easier for them to be able to sit for their boards. And then being able to have somebody physically in your facility that's providing that hands-on training, you're creating a spot where that student may be, hey, this is going to be my next place to work. One of the things that you may hear in the educational piece is that there's a 15 year cycle. The first five years and 15 year cycle in education. And the first five years, it's where we have this like giant pool of schools everywhere. And we're pumping out sonographers and technologists and the market cannot handle the amount of people that have hit the market. And so what happens is the school's close. And then the next five years, the market settles with hiring those teammates, people making other decisions, wanting to pick different jobs. And then we fast forward into the last segment of the five years. And this is where we just don't have enough people to do the job. Unfortunately, I think COVID has highlighted this even more. People are coming out on the tail end of this five years and picking different healthcare professions that it goes, okay, what do we need to do to now ramp back up with the schools? And I would say, pick up the phone, send emails, let your schools know that you are an active partner and active participant with that school to then bringing a program in. Next slide. So I am going to say this specifically to my non-invasive leaders, be a noisy wheel. And we are all on the same boat. And unfortunately, it's sinking just a little bit, but just know you're not alone. We're all working on that same goal to be able to bring in more teammates, more valuable teammates, not just a warm body. I would also say that you are the eyes and ears. So when someone is doing a market share, when your compensation department is doing, looking at what is the market pay for this particular group, they may not be looking at the smaller teams. They may be looking at where is bedside nursing, because it's the largest group that's in their organization. And you can be the eyes and ears to say, this is what I'm hearing in the market for starting pay, sign on bonuses, retention, or loyalty bonuses. I would say, use your network with the listserv, ask out, see what the market is doing when it comes to salaries and bonuses and other type of retention plans that are in place for keeping and retaining your staff. Stay current. I, for instance, have, I have indeed emails that would come to me for ecotechs and nuclear medicine techs and vascular ultrasound techs. So I could see who was posting jobs. And many times you could even see where the sign on bonuses was from that particular area. And then the other thing is, is provide educational reimbursement. Really take a look at what other programs are doing within your healthcare organization and see how that can be applied to your imaging personnel. Next slide. Okay. Thank you. Thank you, Jamie. Appreciate it. Boy, y'all are hard acts to follow. Just wanted to share a couple of things before we close out. So the mixed messaging and, you know, among Manaxium, we're always sending the latest articles and we're always looking and gathering as much information as we can. And it was interesting, they recently posted this survey. And with this was, you know, balancing your talent retention and acquisition in your changing labor market. And when you read the article and there's a link to the complete survey that was done by PWC, it was interesting because there were conflicting messages. You know, we're expanding our permanent remote work options for roles that allow it. Then it's we're reducing our overall headcount. We're encouraging employees who recently left to rejoin. We're lowering or dropping bonuses. We're rescinding offers. So this survey highlighted some areas and it was, you know, a good sample size. But it was interesting because we are getting those confusing messages. And as Audrey and Jamie have went through all of those things that we can do to help our employees with communication. And when we look at virtual care and our employees moving to a remote environment, you know, there's reported advantages. I don't have to tell you what that is. We're finally beginning to see some data in this space. But there are many challenges as well. It does help with the retention. Everyone likes to work differently. I think we talked about many of those examples. It can reduce cost. But in some ways, if you're not set up to provide services to your patients and follow the HIPAA and all of those different things that we have to jump through those hoops for, it can be a cost. So really looking at what those advantages are. I will tell you the one thing we hear and being on the revenue cycle side, if I put that hat on for this, you know, we hear for managing a virtual team and an in-person team, when you have the lack of communication and balancing that autonomy and structure and measuring and reporting their productivity, we don't do that well sometimes for in-person. And the shift in culture, you know, is there a shift in culture? All the things that Audra addressed, you have to still maintain that for your remote staff. I think as we move forward through this transition, it's important to make this a part of your strategic plan and really identify how this is going to impact both your culture, your teamwork, and there are a lot of success in many of these areas. But we do have to start thinking differently. So we provided you with a couple of slides on remote work. Obviously, the survey is interesting to look at and having to balance the confusion of all the headlines that we're seeing now, increasing that communication to your staff, and also being inclusive. And I think if that was any of the key takeaways for this session, the culture drives it. And if you have that culture in your clinic, you have to have that culture for your remote teams as well. All right. Well, Audra and Jamie, it looks like we'll open it up for questions. I don't see that we have any questions so far. This was really great. Love the videos. I think it's so inspiring to see those. And we appreciate you so much, Audra, sharing your story, both personally and at Virginia Heart and your journey. And Jamie, welcome to the team. And now we have that expertise for our diagnostic teams to continue to expand at MedAxiom. And we appreciate everyone attending today. If you have any questions, feel free to email any of us or enter those within the Q&A box, and we will respond to those after the session.

recruitment

retention

healthcare

flexible scheduling

culture

employee engagement

training

partnerships

remote work