As hospitals scramble to bolster primary care staff, healthcare executives are discovering that the pool of eligible workers is rapidly shrinking into a sellers’ market. CareerBuilder reported in a recent healthcare study that the second most challenging staffing issue for 2013 is retaining top talent, with more than one-third of healthcare employers reporting they have open positions for which they can’t find qualified candidates. Add to that the fact that 34 percent of respondents plan to look for a new job in 2013, up from 24 percent last year, with 82 percent reporting that while they’re not actively looking for a job today, they’d be open to a new position if the right opportunity came along.

Potential employees are now carefully weighing job merits, including perks designed into the physical space: Should they take the position offering a higher salary but with a longer commute to an old building with limited parking and no lunch facilities? Or the job offering a shorter commute to a new hospital boasting a gym, WiFi, dry cleaner, and assigned parking?

Offering what they need and want
Several years ago, reduced talent availability wasn’t even on the radar because the healthcare industry was singularly focused on providing direct care through hospital services. Today, the emphasis is on efficiently shifting patients who require ancillary medical procedures out of the main facility and into offsite medical office buildings (MOBs). And that shift has revealed unexpected staffing gaps for acute care hospitals. Solving the shortage crunch, while also increasing bottom-line efficiency, reaches far beyond winning the competition of who has the best medical staff in town, says Andrew Quirk, senior vice president and national director of Skanska USA Building’s Healthcare Center of Excellence (Nashville). “You need to retain them,” he says.

It’s a daunting task. The Affordable Care Act is demanding greater streamlined efficiency through an increased number of general practitioners and nurses, but the more experienced nurses are starting to retire and doctors who may have once considered primary care practice have opted out of the poor reimbursements, low comparative income, and poor quality of work life in favor of training and practicing in more lucrative specialty medicine.

“Hospitals are now asking, ‘How do we do a great job with attracting staff in order to get good throughput?’” says Jeffrey Brand, principal at Perkins Eastman, (New York). The answer is simple: “If you can solve how to improve patient outcomes so they don’t linger and get home quicker, and solve the transient aspect for staff so they have everything there to do their jobs, you will improve your bottom line.”

The long and short of it
Staff retention issues, which touch other sectors of the industry including academic research hospitals, require a closer look at both short-term and long-term goals, says Sara Markovitz, principal at NBBJ (Boston), who’s currently working on several master plans and renovations for Massachusetts General Hospital and Brigham and Women's Hospital. She says immediate attraction is often tied to which facility has the best medical technology, while in the long run, staffers are most influenced by the work environment itself. “A great environment means the institution values the people who work there,” she says, citing examples such as improved access to public transit, ride-sharing perks, buildings with more natural light, interior and roof gardens, or even weekly farmers’ markets within the surrounding facility complex. “It’s an attempt to make the work environment more welcoming and efficient for both patients and workers.”

Adding greater efficiency in space flow is another perk. “If you can change a 10-hour day to an 8-hour day, this is something staff will really value,” Markovitz says. For example, a hospital that establishes an ambulatory surgery center just five minutes away from its main campus understands the need for doctors to keep timely patient appointments in both locations, while also cutting out the hassle they might face in cross-town traffic clogs. Likewise, providing ergonomically designed workstations or improved wayfinding measures to help traverse a large, unfamiliar hospital campus, or offering more convenient supplies locations are other ways to increase efficiency while decreasing worker fatigue and frustration.

“If I’m arriving at 6 a.m. and I can get breakfast, my life is easier. If I have a place where I can lock my stuff that’s closer to where I work, my life is easier,” Brand says, adding that other thoughtful environmental adaptations include rethinking traditional workspace conventions to answer the growing legion of smartphone and iPad-equipped staffers who are more comfortable working on the go than being tied to a desk. “We’re talking about getting away from offices and [having] the ability to walk up to a wireless workstation, having a place to do work when untethered,” he says.  

 “The whole face of the caregiver side is changing,” agrees Quirk. “Something like 10,000 people per day turn 65, and part of that generation is doctors.” With many of those physicians retiring from practice, he adds, there’s a new generation of younger doctors “who want to work fewer hours and have a more balanced lifestyle. The industry has to respond to this.” 

Calculating return on investment
Access to wireless workstations, quiet rooms, gyms, and gardens can certainly make a long shift more bearable, yet healthcare executives are understandably hesitant about going overboard. “Every decision a facility is making now—what trash company to use or what materials and services are provided—every question is looked at regarding what value it will bring back to the organization,” Quirk says. As a result, justifying any kind of amenity has to be analyzed in the larger context of overall efficiency.  “If you don’t have good return on investment, then you’re building too much,” Brand says. To anticipate ROI, facilities should research just how an upgrade will increase productivity in not just one, but several areas such as better practices, wayfinding, clinical outcomes, patient satisfaction, evidence-based design support, efficiency flow, patient and staff pathways, or improved communication and collaboration.

Markovitz employs what she calls the “Goldilocks principle” for measuring just the right amount of upgrade.  “We ask [the hospital], ‘What are your goals?’” If greater doctor or staff retention is the focus, she conducts a qualitative analysis of a facility’s competitors to determine whether the goal is a good investment. 

Other ways Markovitz measures upgrade payoffs are through customer satisfaction surveys, staff surveys, sustainability data research, competitor tours, simulation modeling, and even materials testing. For example, if a flooring material claims to hold up well and reduce staff fatigue, it will be tested to see if it does what it says it does, she says.

Work-life balance demands simple solutions
The focus on primary care staff and the nar
rowed talent pool may be the main influences behind increased amenity offerings, but there’s another frequently overlooked driver. “Reducing staff stress is what’s really important for staff retention,” says Markovitz, pointing out that a collaborative environment, easier wayfinding, reduced struggles to find items to complete a task—all of these factors help staff members be more effective in their jobs. It’s difficult to choose which upgrades to integrate, but there’s one thing executives can always remember: The hospital’s best long-term and short-term asset is its employee base. “They live the work day to day,” Brand agrees. “When you get into a room and talk to them about how they do their job, you can get real solutions that are logical and simple, and make sense.”

Gwynneth Anderson is a freelance business writer specializing in business finance and banking. She can be reached at