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D-H tries creative solutions to workforce shortage

New Hampshire Union Leader

July 20. 2018 9:45PM
Dr. Joanne Conroy, president and chief executive officer of Dartmouth-Hitchcock, speaks during an interview with the Sunday News in this file photo. (DAVID LANE/UNION LEADER)

MANCHESTER - As chief executive officer and president of Dartmouth-Hitchcock, Joanne Conroy is feeling the pressure of New Hampshire's workforce shortage.

"It's what keeps me up at night," says the leader of the state's largest health care system and, with 13,000 workers, its largest employer.

The Lebanon-based health care provider is struggling to fill 900 positions, Conroy said in a recent interview with the New Hampshire Union Leader, and is resorting to some creative solutions.

Conroy touched on a wide range of topics, including consolidation among hospitals and the ongoing opioid epidemic, as her one-year anniversary as head of Dartmouth-Hitchcock approaches on Aug. 7. But workforce issues were clearly top of mind.

On the day she met with Union Leader editors and reporters, the state Department of Employment Security announced that the unemployment rate for June was 2.7 percent, with more people at work in New Hampshire than at any other time in the state's history.

For an organization that needs everything from janitors and cafeteria workers to psychiatrists and nurse practitioners, the challenges are immense. To further complicate matters, the main location of the health care system in Lebanon is far removed from the population centers in the southern part of the state.

Housing is also a key issue and Dartmouth-Hitchcock could get into the business of building its own workforce housing if that's what it takes, according to Conroy.

"We are thinking about working with local people in the Upper Valley to see if we can have public private partnerships to build affordable housing," she said. "People want to live close to work."

Some nurses are commuting from Nashua, Boston and the Seacoast to Lebanon. "They couch-surf," Conroy said. "They do three 12-hour shifts and sleep on friends' couches."

The situation has become so desperate, that creative entrepreneurs are seizing the opportunity. "One woman is selling beds for $25 a night," she said. "We are talking about building dormitory housing."

"We have to think differently about work, about who works, about telecommuting," Conroy said. "We are trying to be creative about telecommuting and changing our language on full-time vs. part-time positions. We have a number of retired physicians who have come back to work."

Like many health care providers, Dartmouth-Hitchcock has had to find creative ways around the workforce shortage to maintain the same level of care. That includes extensive use of travelling nurses, itinerant professionals hired to work in a specific location for a limited amount of time - typically 12 to 13 weeks. They move around the country depending on where they are needed.

"We've filled the gaps with some travelers," Conroy said. "We have 125 nurses who come as travelers for 12-week periods, where they provide services in certain specialty areas. They are quite experienced, decide they want to travel."

The nurses are paid a premium, put up in a hotel during their term, and some decide to stay. It's a costly proposition that raises medical costs for consumers, according to Conroy: "When we have travelers, we spend twice as much for that nurse per hour than if we employed them. Even though they are well-trained, the best scenario would be to hire our own employees, have them live in the community and be part of that.

"The question is, how do we attract people to New Hampshire? We should be able to. It's such a great place."

One area in which the health system has struggled is in meeting its contractual obligations to staff and manage New Hampshire Hospital, the state's in-patient psychiatric facility in Concord.

After a tumultuous two years in which management of the state contract shifted from the Geisel School of Medicine at Dartmouth College to Dartmouth-Hitchcock Medical Center, Conroy said the situation is stable.

State officials confirm the hospital is now in full compliance, as staffing levels are monitored weekly by New Hampshire Hospital Chief Executive Officer Lori Shibinette and Department of Health and Human Services Commissioner Jeffrey Meyers.

"DHMC is in full compliance with the required staffing levels, with the exception of the medical students, who are on site during the school year but naturally are less available during the summer break," said Jake Leon, DHHS spokesman.

In addition to the appropriate number of psychiatrists, NHH also has what Conroy called "an incredible cadre of nurse practitioners" with their own patients.

"We ended up in a good place," she said, "but I'm not going to say it wasn't stormy and tumultuous to get there."

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