Healthcare Staffing Outlook: Challenges, Opportunities, and Strategies for Success

Healthcare Staffing Outlook: Challenges, Opportunities, and Strategies for Success Presented by: Thad Dufelmeier, CEO, RN, CCWP Theodore Drew & Associates Tim Bell, Chief Revenue Officer People 2.0 Moderator: Adrianne Nelson, Senior Director Global Membership Products, CCWP Staffing Industry Analysts Sponsored and presented by October 18, 2017 10 am PT/ 1 pm ET This webinar is broadcast through your computer speakers via the audio broadcasting icon on your screen. You may adjust the sound volume by using the slide bar on the audio broadcasting icon. If you cannot access the audio, you may dial into the call by dialing 1-650-479-3208 and using access code 663 866 536. Need further assistance? Contact SIA customer service at 800-950-9496. Thought Leadership Series 2017 by Crain Communications Inc. All rights reserved. 1

Listen through your computer by turning on your speakers after you log into the event. Sound will be coming through this icon: Logistics Do not close this audio broadcast box. To increase the volume of sound coming through your computer speakers adjust the sound bar on the audio broadcast box shown above. Q & A: To get assistance or ask questions use the question function on the webcast control panel Tech Support: If at any time you are experiencing problems with the webinar call global services at 800-950-9496 or our Webex assist through the Q&A. The webinar is broadcast through your computer speakers, if you are having trouble with the sound, please send a message to the webinar host using the Q&A function. Slides: Copies of the slides used will be distributed to all attendees within 48 hours following the webinar and a replay of the webinar will be available at www.staffingindustry.com for a limited time Thought Leadership Series 2017 by Crain Communications Inc. All rights reserved. 2

Welcome to the Staffing Industry Analysts Thought Leadership Series Suppliers Of Staffing Services Share Their Expertise The Staffing Industry Analysts Industry Thought Leadership Series provides the perspective of the suppliers of staffing services. The views expressed in this webinar are those of the sponsor and not necessarily that of Staffing Industry Analysts. This webinar is broadcast through your computer speakers via the audio broadcasting icon on your screen. You may adjust the sound volume by using the slide bar on the audio broadcasting icon. If you cannot access the audio, you may dial into the call by dialing 1-650-479-3208 and using access code 663 866 536. Need further assistance? Contact SIA customer service at 800-950-9496. Thought Leadership Series 2017 by Crain Communications Inc. All rights reserved. 3

Today s Speakers Thad Dufelmeier, CEO, RN, CCWP Tim Bell, Chief Revenue Officer Moderator: Adrianne Nelson, Sr. Director, Global Membership Products Thought Leadership Series 2017 by Crain Communications Inc. All rights reserved. 4

HEALTHCARE STAFFING OUTLOOK: CHALLENGES, OPPORTUNITIES, AND STRATEGIES FOR SUCCESS

WHO IS THAD DUFELMEIER? First began working in healthcare staffing in 2000 Launched his first company in 2007 focused on Joint Preparation. CEO of Theodore Drew & Associates (Founded 2009). Published author and recognized Workforce and Quality Management Expert 30+ Healthcare Staffing Organizations currently on retainer providing one or more of the following services: 1. Joint Preparation 2. Joint Maintenance 3. Clinical Oversight 4. Full Spectrum Credentialing 5. Candidate Sourcing

OBJECTIVES 1. Review the current state and size of the market Identify the major segments and characteristics. 2. Address retention challenges and strategies to assist with these challenges. 3. Discuss in detail healthcare staffing compliance credentialing and the Joint Certification Process. 4. Share what may be the next disruptive change in Healthcare Staffing.

THE HEALTHCARE STAFFING MARKET

HEALTHCARE STAFFING CURRENT CYCLE

MARKET SEGMENTS Source: Staffing Industry Analysts

SEGMENT CHARACTERISTICS Time to Fill (Credentialing) Order Lead time Length of Assignment Allied Health Per Diem Travel Nursing Locum Tenens 4-6 weeks Ongoing readiness Typically 13 weeks (Offer Per Diem to Permanent) Hours 8 hours days 40 hours / week Day to Day sometimes long term or Mastered in for years Client Need Fill hiring need Backfill for Sick Days or Vacation 5 weeks 3 to 6 months Traditionally: 13 weeks, but things are opening up here 12 hours / day 12 hours shift 36 hour / week Seasonal or Routine Maternity FEMLA 6 weeks to 6 months Provider controlled up to 60 hours / week Fill hiring need Source: Harris Williams & Co.

NURSING SHORTAGE, WILL IT PERSIST IN THE FUTURE?

LONG-TERM SUPPLY AND DEMAND Source: Staffing Industry Analysts

RN SUPPLY AND DEMAND Source: Staffing Industry Analysts

NURSING SCHOOL GRADUATES Source: Staffing Industry Analysts

TECHNIQUES FOR OVERCOMING THE UNIQUE CHALLENGES OF RETAINING TRAVELING NURSES, PER DIEM EMPLOYEES AND REHAB PROFESSIONALS

RETENTION CHALLENGES Healthcare in General: Practice/Environment is different than expected or explained Unique to our Segment/Industry: The work for a staffing agency is considered experimental or temporary in nature Lack of, or poor feedback during first months Desire to be closer to family Overcoming the perception of being less credible than provider employers Industry lacking commitment/ability to provide hallmark retention benefits Healthcare Coverage, Paid Time Off, Retirement Challenges Adjusting to New work Environment Never comfortable in the city or community Travelers Unique Lack of control over practice Locums/ LIPs Source: National Rural Recruitment Network

Recruiting as Retention Retention Planning Define the criteria and requirements clearly set accurate expectations Orientation Add depth to the matching process Screen for the best fit on criteria and knowledge of organization and service area Establish common expectations during interview and discuss Key is to maintain regular contact with placements after the assignment starts Dedicate time to placement acclimation to location/unit facility Be prepared to address professional and personal issues and activities should be addressed Integrate retention into the interview process

RECRUITING PROCESS Sourcing Screening Contacting - Follow Up Hiring/ Credentialing Submission/ Interview Process Recruitment - Closing Orientation & Relocation Completion Retention

HOW TO CULTIVATE A STRONG NURSING REFERRAL PROGRAM TO BOOST YOUR BUSINESS

CREATING A STRONG REFERRAL PROGRAM Positive Experience Existing Employee Compensation Plans

FINANCIAL EXPECTATIONS

TRAVEL NURSE PROFIT MARGIN HOURLY BREAKDOWN 2015 Aggregate revenue breakdown $26.13 + $18.66 = $44.79 Source: Staffing Industry Analysts Figures represent 2015 segment size and 2014 2016P CAGR

BEST PRACTICES FOR JOINT COMMISSION CERTIFICATION AND RECERTIFICATION

CERTIFYING HEALTHCARE STAFFING AGENCIES 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 1. Ensure the most cost effective seamless certification 5. Develop and Implement Consultation Plan 10. Joint Review success! 6. Initiate assembly of company specific, Master Joint Binder 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews

CERTIFYING HEALTHCARE STAFFING AGENCIES 1. Ensure the most 1. Ensure cost the most cost effective seamless certification certification 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 5. Develop and Implement Consultation Plan 10. Joint Review success! 6. Initiate assembly of company specific, Master Joint Binder 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews

COST EFFECTIVE SEAMLESS CERTIFICATION L E G E N D H O U R S 1000 Healthcare Staffing Agency using a mid-level employee with annual gross earnings of 500 $75,000.00 (36.75/hr.) to manage Joint Certification project 100 C O S T Healthcare Staffing Agency using a Consultant and the same mid-level employee with annual gross earnings of $75,000 (36.75/hr.) to manage Joint Certification project

CERTIFYING HEALTHCARE STAFFING AGENCIES 1. Ensure the most cost effective seamless certification 2. Complete the 2. Complete the Joint Application Joint Application 3. Joint Standards Review 4. Provide all policies and practices 5. Develop and Implement Consultation Plan 10. Joint Review success! 6. Initiate assembly of company specific, Master Joint Binder 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews

CERTIFYING HEALTHCARE STAFFING AGENCIES 1. Ensure the most cost effective seamless certification 2. Complete the Joint Application 3. Joint Standards Review 3. Joint Standards Review 4. Provide all policies and practices 5. Develop and Implement Consultation Plan 10. Joint Review success! 6. Initiate assembly of company specific, Master Joint Binder 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews

JOINT COMMISSION CPRS

JOINT COMMISSION LEADERSHIP STANDARDS

JOINT COMMISSION HUMAN RESOURCES MANAGEMENT STANDARDS

JOINT COMMISSION INFORMATION MANAGEMENT STANDARDS

JOINT COMMISSION PERFORMANCE MEASUREMENT AND IMPROVEMENT STANDARDS

CERTIFYING HEALTHCARE STAFFING AGENCIES 1. Ensure the most cost effective seamless certification 2. Complete the Joint Application 3. Joint Standards Review 4. all 4. Provide policies and all practices policies and practices 5. Develop and Implement Consultation Plan 10. Joint Review success! 6. Initiate assembly of company specific, Master Joint Binder 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews

CERTIFYING HEALTHCARE STAFFING AGENCIES 1. Ensure the most cost effective seamless certification 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 5. Develop and Implement Consultation Plan 10. Joint Review success! 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews 6. Initiate assembly of company specific, Master Joint Binder

CERTIFYING HEALTHCARE STAFFING AGENCIES 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 1. Ensure the most cost effective seamless certification 5. Develop and Implement Consultation Plan 10. Joint Review success! 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews 6. Initiate assembly of company specific, Master Joint Binder

MASTER JOINT COMMISSION ELECTRONIC BINDER

CERTIFYING HEALTHCARE STAFFING AGENCIES 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 1. Ensure the most cost effective seamless certification 5. Develop and Implement Consultation Plan 10. Joint Review success! 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews 6. Initiate assembly of company specific, Master Joint Binder

CERTIFYING HEALTHCARE STAFFING AGENCIES 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 1. Ensure the most cost effective seamless certification 5. Develop and Implement Consultation Plan 10. Joint Review success! 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review 30 days in advance of review 7. Conduct File Reviews 6. Initiate assembly of company specific, Master Joint Binder

CERTIFYING HEALTHCARE STAFFING AGENCIES 2. Complete the Joint Application 3. Joint Standards Review 4. Provide all policies and practices 1. Ensure the most cost effective seamless certification 5. Develop and Implement Consultation Plan 10. Joint Review success! 9. Finalize Preparation of the Joint Binder 8. Conduct Mock Review (30 days in advance of review) 7. Conduct File Reviews 6. Initiate assembly of company specific, Master Joint Binder

JOINT COMMISSION CERTIFICATION AND RECERTIFICATION BENEFITS Joint Certification can help Improve the performance of your organization Secure larger accounts Reduce exposure Decrease insurance costs

SPECIFIC COMPLIANCE STEPS REQUIRED TO START AND MAINTAIN A HEALTHCARE STAFFING FIRM

CREDENTIALING/COMPLIANCE Receive Candidate from a Sourcer Verify Candidate Compile Credentials Sort & Label Documents Create Checklist for the Candidate Send Request for Credentials Email Run Online License Verification Run SAM, OIG, NSOPW and OFAC Save/Print Save/Print Sanction on License Hit on Background Check Clinical Liaison/Director Reviews & Decides Eligibility Conduct Reference Call Save/Print Call Candidate & Follow-up Email Upload Credentials Check Test Results Run Criminal Background Check Order Drug Screen Review for Completion Score 80% or > Score < 80% Clear Background Check Hit on Background Check Pass/Negat ive Fail/Positiv e Save/Print Retake Exam Save/Print Save/Print End of Application Score 80% or > Score < 80% Upload Credentials Save/Print Candidate Starts Assignment

CREDENTIALING/COMPLIANCE Receive Candidate from a Sourcer Verify Candidate Compile Credentials Sort & Label Documents Create Checklist for the Candidate Send Request for Credentials Email Run Online License Verification Run SAM, OIG, NSOPW and OFAC Save/Print Save/Print Sanction on License Hit on Background Check Clinical Liaison/Director Reviews & Decides Eligibility Conduct Reference Call Save/Print Call Candidate & Follow-up Email Upload Credentials Check Test Results Run Criminal Background Check Order Drug Screen Review for Completion Score < 80% Clear Background Check Hit on Background Check Pass/Negat ive Fail/Positiv e Retake Exam Save/Print Save/Print End of Application Score 80% or > Score < 80% Upload Credentials Save/Print Candidate Starts Assignment

CREDENTIALING/COMPLIANCE Receive Candidate from a Sourcer Verify Candidate Compile Credentials Sort & Label Documents Create Checklist for the Candidate Send Request for Credentials Email Run Online License Verification Run SAM, OIG, NSOPW and OFAC Save/Print Save/Print Sanction on License Hit on Background Check Clinical Liaison/Director Reviews & Decides Eligibility Conduct Reference Call Save/Print Call Candidate & Follow-up Email Check Test Results Run Criminal Background Check Order Drug Screen Review for Completion Score 80% or > Score < 80% Clear Background Check Hit on Background Check Pass/Negat ive Fail/Positiv e Save/Print Retake Exam Save/Print Save/Print End of Application Score 80% or > Score < 80% Upload Credentials Save/Print Candidate Starts Assignment

THE CONTINUUM OF CREDENTIALING Relationship Timely communication and persistent follow up Persuasive communication Creating a positive experience Building lasting relationships Technical Sorting Large PDF files >50 pages Labeling each document Organizing in folders and sub folders Uploading into internal software into VMS platforms Favorable contribution to time to fill KPI s

INTEGRATION/SEPARATION OF DUTIES CREDENTIALER Communication & Follow up Persuasive communication Positive Experience Building relationship BACK OFFICE/SOURCING Posting jobs Screening resumes Sorting and Labeling Organizing documents Uploading files RECRUITER Screening & Interviewing candidates Makes verbal job offers Hiring and determining staffing needs Persuasive communication

CLINICAL OVERSIGHT/QUALITY MANAGEMENT Joint standards are the basis of an objective evaluation process that can help health care organizations measure, assess and improve performance. The objectives of JC are to evaluate the organization and to provide education and good practice guidance that will help staff continually improve the organization s performance.

PREVENTION AND MANAGEMENT OF DO NOT RETURN NOTICES: A QUALITY IMPROVEMENT PROCESS FOR SUPPLEMENTAL STAFFING NURSING AGENCIES

DNR DO NOT RETURN PROCESS 1 2 3 4 Client shares a complaint from a facility about the employee s performance. This is documented in the Complaint Management Report. Complaint Management Report is shared to the Clinical Liaison. Clinical Liaison conducts investigation about the incident. If Clinical: The Clinical Liaison will conduct counseling, discuss point of termination scale and any follow up with facility if necessary or report employee to Licensing Board. If Professional: Clinical Liaison conducts counseling, and ensures the recommended course is completed prior to returning to work. Data Reporting: Performance Measure Do Not Return-Clinical, Do Not Return- Professional and Completeness of Personnel File are to be entered ongoing due to the requirement for data reporting to the Joint Certification Measurement Information Process.

You worked on 9/8/2017 and took care of patient in room 1019. The daughter complained that during your shift the patient asked you if she can go to the restroom before her ultrasound. Your respond was 'then get up and go'. The husband who was at the bedside told you that she is blind and your response to him was 'then get up and help her'. The husband said he can't because he might drop her. When you assisted the patient to the restroom, you crashed her 3 times to the wall and refused to help when she was asking for the toilet tissue. Your response was 'it's right there, can't you see it?' You also left the patient 3 steps away from her bed, she found her way back on her own.

Community Hospital

WHAT S NEXT?

NEW GRADUATE RESIDENCY PROGRAM

RATIONALE INCREASING DEMAND FOR NURSES is exceeding Supply Annually Magnitude - 500,000 more Openings than Hire in US Healthcare Job Market Multiple Factors Contributing to Long-term Worsening Problem Training New Grads Dismissed as a Viable Option to Combat Nursing Labor Shortage Identifying and Defining Solution - NEW GRADUATE RESIDENCY PLACEMENT NGRP PROGRAM Review of Expected Objections to Early Adaptation by Health Systems

KEY FACTS Travel recruiters are not allowed to call and recruit new grads. The best recruiters in the business are with staffing firms and staffing firms are not allowed to recruit new grad RNs, as all nurse staffing contracts in the country disallow the placement of new grad RNs on a temp basis. There s 143,000 new grad RNs per year. Only 39,000 temporary RNs available in the US while there s 450,000 RN job openings. The top 3 nurse staffing companies in the country employ 10,000 temporary RNs combined. Generating an estimated 1 Billion in revenue in temporary nursing alone. Because new grads are not allowed to be placed through staffing firms, the 143,000 new grads per year represent an untapped pipeline. How do we get these nurses engaged sooner?

NEW GRADUATE RESIDENCY PROGRAM New Graduates PRECEPTOR ACUTE CARE HOSPITAL/SYSTEM

KEY PLAYERS Online Curriculum Experts 3 Modalities (Online, Face to Face, Blended) Online Curriculum Education brings new expertise and resources to colleges and universities assisting in the development, accessibility and delivery of academic programs in highdemand fields. Nursing School (BSN Highly Preferable) Traditional Brick and Mortar University. Many Brick and Mortar Universities founded in early mid 20 th century seek to combine education for professional competency with the tradition of service to society with current delivery methods of o- line for profit education. Contingent Workforce Expert An individual or organization specializing in, Health-Care Staffing is necessary to operating the recruiting screening credentialing and compensation portions of the enterprise Acute Care Hospital/System Preferable one of the larger employers in the Community, with campuses in multiple locations to allow for the program s growth and expansion.

BENEFITS OF PRECEPTOR PROGRAM For Staffing companies Pull new nurses into the system, quicker Fill more jobs with quality nurses, quicker Build stronger relationships with the nurses, quicker Improve retention rates & grow the company, quicker For Hospital groups Increase pool of available nurses Reduce overtime expenses Reduce risk Reduce stress

PRECURSORS PROGRAMS CURRENT IN PLACE AMN GOTHAM WITH NYP New Graduate Per Diem Program - Designed to assist the new graduate nurse transition from student to professional nurse by providing the new graduate with the necessary clinical experiences and competencies to begin a successful career as a RN. VERSANT Transitioning new graduate nurses by defining a comprehensive baseline set of measurements and outcomes, evidence-based structure, processes, and content. Integrating, teaching, monitoring, and managing adherence to those standards and objectively evaluating successinachieving the RNResidency goals. Parallon StaRN Program Intensive, 13-week program for nursing graduates combines classroom instruction, a robust simulation experience and hands-on clinical training done in conjunction with a regional academic partner. Upon completion, the nursing graduates are equipped with the knowledge and skill set typically found in more experienced staff nurses. AMN Healthcare with National University Through The Center for the Advancement of Healthcare Professionals at AMN Healthcare. The Center offers customizable, high-quality education and training programs for healthcare providers to build theirfuture workforces.

TIME FOR YOUR QUESTIONS Tim Bell, Chief Revenue Officer People 2.0 timb@people20.com (610) 429-4111 Thad Dufelmeier, CEO, RN, CCWP Theodore Drew & Associates info@theodoredrew.com (310) 567-1491

November 13-15, 2017 The Fairmont Dallas, TX Register Today! The Healthcare Staffing Summit takes a deep dive into the healthcare segment of staffing and features sessions specific to the strategic and tactical needs of firms focused on nursing, locum tenens and allied health among other segments. www.healthcarestaffingsummit.com @HCStaffSummit #HCStaffSummit

Thought Leadership Series Upcoming Staffing Industry Analysts Webinars: November 7, 2017, 10 AM Pacific / 1PM Eastern November 14, 2017, (EMEA FOCUS) 15:00 GMT Proprietary. 2017 by Crain Communications Inc. All rights reserved.

Thought Leadership Series THANK YOU! Copies of the slides and a link to the audio recording will be distributed to all attendees within 24 hours following the webinar. A replay of the webinar will be available at www.staffingindustry.com Proprietary. 2017 by Crain Communications Inc. All rights reserved.