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From one battlefield to another: Designing structures to win during an extended healthcare crisis

This is the third post of a four-part series on applying military lessons to the healthcare workforce. 

Blog #1: Improving caregiver well-being in the face of COVID-19; Blog #2: How to foster leadership and retain top performers


Human beings tend to hunker down when things get bad. Something in our genes tells us that “this too will pass” to push us through difficult times. In fact, it seems we can live through anything as long as we know when it will be over. Changing the end date can have a devastating psychological impact on a human being. I experienced that firsthand when I was deployed to Afghanistan. We were supposed to fly home in early April. Then, when our departure was pushed back just a few weeks, I felt completely overwhelmed! Intellectually, I knew the delay wasn’t a big deal. But the emotional impact was huge. 

Those in the field of healthcare are still hunkered down right now, whether we recognize it or not. Our subconscious tells us that we just have to get through this current problem, then everything will turn out okay. Unfortunately, as Delta, Omicron, and the other new COVID variants keep reminding us, we don’t actually know when this will end. The pandemic keeps extending our deployment—and our people are suffering from it. 

Facing reality to win the battle

War is chaos. It’s fundamentally unknowable and uncontrollable, and it forces individuals to respond to crisis after crisis after crisis. But human beings can’t work in emergency mode forever. They will inevitably burn out. Military leaders address this problem by first accepting their circumstances for what they are, not how they want them to be. Second, they design structures that acknowledge their reality and build in flexibility to take action and move their goals forward. 

Let’s turn the lens on our industry and look at step one: What’s the current state of healthcare? We don’t have enough people to take care of the patients we're responsible for. This isn’t a new problem, but, for most of us, with burnout and turnover affecting hospitals nationwide, the sheer magnitude of this challenge is greater than ever before.  

Take RNs, for example. While the nursing shortage dates back to the 1970s, COVID-19 is a pressure cooker that amplified the impact to a much larger scale than pre-pandemic. It has caused health systems to compete for the RNs still available, then overwork them to the point of burnout. This isn’t sustainable, even in the short term. And the situation looks even more dire over time.  

Force multiplication in healthcare settings

In the military, it’s a fact of life that you need to work with what you have, not what you wish you had. So, how would the military deal with this problem of staffing shortages—particularly among RNs? Military leaders embrace the idea of force multiplication. A force multiplier gives personnel the ability to accomplish much larger tasks without a significant increase in effort or capacity. For example, replacing a 20-year-old radio with modern, new technology can streamline and accelerate communication, making an infantry unit 5x more effective than it had been previously.   

RNs are the special forces of the medical world. They are elite leaders whom we trust to assess conditions, solve problems, and act with bravery and conviction in extraordinarily complex situations. If we never have enough of them, what do we do? We use the principles of force multiplication to reorganize and reinforce our teams. Instead of creating a structure where RNs do all the work, we build a structure that puts them at the center of a multifunctional team.   

When we analyze what nurses do every day, we find they’re inundated with all kinds of things that don’t require their level of skill to accomplish—like taking patients to the bathroom, running specimens down to the lab, and answering the unit phone. Engaging other employees, nursing aides, techs, and clerks to do this work can allow RNs to focus on those things that only a fully trained nurse is qualified to do. Instead of hiring 5x more nurses, we make each one 10x more effective. 

What does this mean for the RNs? It’s huge! They will finally have the space to focus on the work they became nurses to do. And their morale and job satisfaction will soar. Our data has shown a strong correlation between high workforce engagement scores and improved performance in patient safety, employee safety, clinical quality, patient experience, and efficiency. When we empower our nurses and give them the tools to be successful on the front lines, the organization will experience across-the-board benefits.  

For more information on supporting operational leadership, process change, and your workforce as a whole, connect with the Press Ganey Strategic Consulting team here

About the author

Mike Hall is a Senior Associate at Press Ganey HPI, a firm that specializes in improving human performance in complex systems using evidence-based methods derived from high-risk industries. He brings over 23 years of experience transforming healthcare operations by creating tightly knit and successful teams through direct leadership or influence. He has successfully partnered with leaders at all levels to design and implement large-scale, complex change initiatives. Mike spent 10 years at Providence Health & Services, culminating in his recruitment by the President of Operations to synchronize systemwide and corporate operations and improve hospital operations in a $22B fully integrated health system with 100,000+ employees, 829 clinics, and 52 hospitals in 6 states. Mike led the provider contracting team at Kaiser Permanente in Hawaii and has provided consulting services to healthcare organizations. Prior to his civilian healthcare career, Mike spent 10 years as a Medical Service Corps officer in the U.S. Army, providing integrated medical support to combat and humanitarian operations, including deployments to Afghanistan and the Demilitarized Zone in the Republic of Korea. ​

Profile Photo of Mike Hall