Recognizing the Early Warning Signs of Clinical Staffing Instability

What if the warning signs of workforce instability were hiding in plain sight? Many healthcare leaders realize too late that subtle shifts in staffing dynamics signal larger problems. Recognizing these warning signs early offers an opportunity to act strategically, ensuring operational efficiency and staff well-being.

During the Cracking the Code: Solutions for Clinical Workforce Stabilization session hosted by Medicus at Becker's CEO + CFO Roundtable, four healthcare leaders reflected on the early warning signs they missed and the steps they took to address instability. Their experiences provide practical insights into how healthcare leaders can identify and respond to workforce challenges before they become crises.

Four Key Indicators of Workforce Instability

1. Increased Clinical Staffing Strain

Could subtle workforce dynamics hold the key to avoiding operational disruptions? Chad Tuttle, Senior Vice President of Clinical Shared Services at Corewell Health, emphasized the value of monitoring early indicators in partnership dynamics.

Tuttle's Key Warning Signs:

• Extra Shifts: Frequent requirements for providers to take on extra shifts.
• Unmet PTO Requests: Frustration among providers unable to secure requested time off.

"These were things we wouldn't normally look at," explained Tuttle. "Today, we look at things we want to see, like what the group's recruitment pipeline looks like. We want to see what the productivity of individual providers looks like. We want to know how often they are mandating extra shifts, and we want to have a line of sight into financials.".

2. Shifts in Engagement and Alignment

Strong partnerships thrive on collaboration and shared goals. When that alignment starts to fray, the consequences can be significant. Chuck Sherwin, President of MyMichigan Medical Center Midland, recounted signs of instability during an effort to expand the hospital's cardiac service line.

Sherwin's Key Warning Signs:

• Reduced Collaboration: Conversations became less collaborative.
• Rising Costs: Expenses increased, yet there were no noticeable improvements in outcomes or collaboration.

"You start to lose the sense that we're working together as a partner and as a team," Sherwin explained. "Those are some of the things for me that are signals of really just trying to figure out: Are we in this together, are we working together, are we moving together? When you start to feel that crumbling, there are problems in the contract, and it may not survive."

3. PTO Limitations and Hiring Challenges

Resilient teams thrive when supported by proactive planning. Dr. Mohammed Minhaj, Chair of Anesthesia at Endeavor Health/Northwest Community Hospital, highlighted how signs of strain underscored the need for early intervention.

Dr. Minhaj's Key Warning Signs:

• Unmet PTO Requests: Persistent challenges in allowing providers to take time off.
• Recruitment Challenges: Ongoing difficulty hiring in a competitive market.
• Unsustainable Practices: Requiring staff to work pre- and post-call, further adding to burnout rates.

"In hindsight, one of the things we could have done better is perhaps moved even earlier," Dr. Minhaj reflected.

4. Growing Backlogs and Complacency

Even longstanding relationships can falter if warning signs go unnoticed. Mason Van Houweling, CEO of University Medical Center (UMC), described how challenges arose within his radiology program.

Van Houweling's Key Warning Signs:

• Growing Backlogs: Up to 2,000 imaging studies per day went unread.
• Recruitment Barriers: Non-compete clauses limited local hiring, forcing reliance on out-of-state providers.

"We got too comfortable," Van Houweling reflected. "All the flags were there." UMC responded by increasing leadership oversight and improving contract management.

The Medicus Transition Program provided critical support during this period. Van Houweling described Medicus as "our cavalry," helping stabilize operations and enabling UMC to expand services, extend hours, and introduce new procedures.

Proactive Steps to Address Workforce Instability

The reflections from these healthcare leaders reveal common warning signs of workforce instability and offer practical strategies for addressing them proactively:

• Monitor Workforce Metrics: Regularly review metrics such as PTO usage, mandated shifts, and recruitment pipelines to identify emerging pressures.
• Foster Collaboration: Strong partnerships require open communication and alignment on mutual goals.
• Engage Across Teams: Involve staff at all levels to surface concerns and build trust.
• Act Early: Address potential issues at the first signs of strain to prevent larger disruptions.
• Leverage Interim Staffing Agencies: Interim provider staffing solutions like the Medicus Transition Program offer healthcare organizations the opportunity to stabilize and rebuild.

By monitoring early warning signs and fostering proactive relationships, healthcare leaders can navigate workforce challenges effectively, ensuring strong operations, a supportive environment for their teams, and, most importantly, continuity of care.

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