Solutions to expand Hawaii’s health workforce

There is a healthcare shortage in Hawaii.

Hawaii needs an estimated 710 to 1,008 physicians (not including nursing, dental, and mental health professionals) to ensure that people can receive the care they need.

I was excited to attend the 2022 Hawaiʻi Health Workforce Summit, a one-day conference for all healthcare professionals in Hawaiʻi. The summit focused on solutions to the workforce shortage and physician burnout.

Dr. Kelley Withy and the Hawaii/Pacific Basin Area Health Education Center (AHEC) did a fabulous job, as always, of putting together panel discussions on topics resolving around geriatrics, substance use, rural health, and provider resilience. It was amazing to see so many people take time off to talk about solutions, share their experiences, and create a feeling of energy and excitement in the room.

The first panel discussion, “Active and Emerging Solutions to the Workforce Shortage in Hawaii,” set the optimistic and practical tone for the summit. Nadine Tenn-Salle, MD spoke with healthcare leaders from diverse backgrounds, including practicing physicians and healthcare administrators.

As a healthcare administrator for a Hawaii nonprofit organization, I felt a shared experience when speakers talked about the administrative burden of healthcare, low payments, and high caseloads that challenge healthcare professionals everywhere.

All attendees and sponsors were invited to prioritize 5 of the 38 solutions to expand Hawaii’s health workforce for AHEC to focus on in the coming years, in the areas of professional factors, family issues, financial factors, training pathways, and models of care delivery.

Here are my top five solutions for healthcare in Hawaii:

1. Increase health insurance plan payments and salaries to health care providers. Medicare and Medicaid payments are lower than commercial payments (employer-sponsored plans). By increasing payments rates, adding cost-of-living or inflation adjustments, and creating allowances or incentives for rural communities where it is hard to find and retain healthcare providers, healthcare providers could have fewer barriers to working in Hawaii – and fewer reasons to look for a job outside of Hawaii.

• Expand telehealth services and ensure equitable payments for telehealth services. A 45-minute visit could turn into a 2-hour visit when factoring in traffic and parking, and can cost patients more in terms of time off from work, gasoline, transportation, and parking. Telehealth services are a practical and effective way to increase access to care for people with transportation or mobility issues, people on Neighbor Islands or rural communities, and people with caregiver responsibilities.

• Expedite health care provider credentialing with health insurance plans. Healthcare professionals cannot receive payments for their services until they are credentialed with health insurance plans. At our center, some healthcare plans take 2-4 weeks to approve providers, which others can take 4-6 months. With expedited credentialing, healthcare professionals could see patients sooner and healthcare organizations could receive payments for their services.

• Eliminate the general excise tax (GET) on health care. Food and healthcare are basic necessities, and should not be subject to the general excise tax. Without the GET, private practice physicians and clinics could see an immediate 4% savings, which could help them to hire, train, and retain healthcare staff.

• Expand training programs for health care providers. Looking to the future, we need to encourage students today to consider a job in healthcare and provide greater access to training, as well as support people who are considering a job in healthcare or who want additional licensing or education.

The ultimate goal of these discussions about health workforce shortages and barriers to practicing medicine is for each healthcare provider to find joy in healing (again).

What has been your experience with your primary care physician and your health insurance plan? If you are a healthcare provider, what drew you to healthcare – and what would encourage you to continue to practice in Hawaii?

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“Influencing Changes from Within” with Pono Shim

We all struggle with change, especially when we are told to change because it’s the right thing to do.

People and organizations try to change our behavior, like campaigns to stop bullying, stop drinking, stop doing drugs, drive electric, be kind. Or change our minds, like what policies are good for our community and the best ways to reduce crime, reduce poverty, reduce conflict.

We cannot change people.

Change comes from within, shares Kahu Pono Shim in a seminar about “Influencing Changes from Within” at the 2021 Hawaii Health Workforce Summit.

Change starts with aloha. And aloha is about connection, emphasizes Kahu Pono, not correction.

Aloha is when we pause and empty ourselves of our thoughts and judgments, create a space for someone to breathe and heal, and create a sense of connection with them.

Instead of telling people that they are wrong, aloha is about inviting people to be part of the conversation.

Instead of trying to convince someone that we are right, we can ask, “How can I earn your trust?”

I work for a Hawaii nonprofit, and recently a coworker shared some thoughts about our organization. I found myself thinking of Kahu Pono. I intentionally paused, tried to let go of my ego and defensiveness, and listened. I made a deliberate choice to hear what she was saying.

Afterward, I thanked her for her honesty. It takes courage to be honest, and I hope that I showed her that she can trust me with her concerns.

Aloha is not something you know, Kahu Pono says. It’s something you struggle with.

There was so much more to Kahu Pono’s talk, and his preceding keynote about helping the healers heal. Instead of writing more, I invite you to think about moments when someone made a connection with you, shared a medicine or truth that caused a change within you. What changed in you after you heard the medicine?

Aloha is about connection and connection starts with emptiness, Kahu Pono believes. What does that emptiness feel like? How do you feel when you earn someone’s trust and start to truly connect with someone else?

Note: Any mistakes or misinterpretations of Kahu Pono’s words are my own. I’m condensing a small part of his knowledge and storytelling into a few short sentences, without his eloquence or serenity.

Radical self-care and the positivity bias

“Good self-care is determined by the quality of your actions (or inactions) and the degree to which they are life-affirming,” stated psychologist and researcher Dr. Paul Hutman in his presentation on “Radical Self Care” at AHEC’s virtual 2020 Hawaii Health Workforce Summit.

He went on to say that “Good self-care comes from you, and it changes over time.” Because we change over time, our needs change, and our perspectives change.

What is the basis of good self-care? Instead of jumping into a list of self-care practices, Dr. Hutman began by explaining something we have probably all experienced: the negativity bias.

“Positives are in abundance, yet our minds focus on and magnify the negative,” he said. We more quickly identify aggressive faces than happy faces. We tend to discount previous positive experiences. We can list more flaws than strengths.

Awareness of the negativity bias is not enough, Dr. Hutman insisted. We need regular practice to correct it. We need to create a positivity bias, a habit of looking to the positive. By paying attention and practicing the positivity bias, we can turn positive states into positive traits.

To correct the negativity bias, Dr. Hutman shared the HEAL method:

Have a positive experience. It might be a sensation (drinking water on a hot day), emotion (how you feel when someone gives you an unexpected compliment), insight (something that changes your perspective), or mood.

Enhance it. Give the positive experience your full attention and focus. When your mind wanders, as it will, gently bring your attention back to the experience.

Absorb it. Immerse yourself in the experience. Envision light filling you or water surrounding you. Consider expressing it with your body or a gesture, such as a smile, placing your hand over your heart, or a movement.

Link the positive experience to negative material in order to soothe it and even replace it. (Dr. Hutman didn’t share this advanced step, but I looked it up later. If we left it at just HEA, it could be an acronym for “Happily Ever After.”)

Dr. Hutman also revealed a few perspective shifts that he has experienced. From the humor of Wes Nisker, he learned that our subatomic particles are replaced every seven years – we are literally renewed every seven years! From the philosophy of Allan Watts, he learned that the universe is both out there and within us. And from the insight of Pema Chödrön, he learned that compassion is a relationship between equals – we have a shared humanity.

What positive experience have you had recently? The next time you have a positive experience, what will you do to enhance it and absorb it? What positive bias habits do you already practice?

Happiness and healthy boundaries

“The Giving Tree” has been on my mind the past few days.

Last weekend, I attended AHEC’s virtual 2020 Hawaii Health Workforce Summit, and psychologist Dr. Nicole Eull gave a wonderful plenary talk about “Telling Tales: Stories That Can Improve Your Work Life.” One of the books she read was “The Giving Tree” by Shel Silverstein, a book about a selfless tree and a… needy… boy.

I remember reading it when I was young, and feeling very uncomfortable at the end. I put it away and never read it again, not even to my son when he was young.

Dr. Eull touched upon what made me so uneasy about the book: the lack of boundaries, and how a healthy tree became just a stump. She asked, “How do we create a life where we don’t feel like the used-up, tired old giving tree at the end of the day every day?”

Many of us are working harder than ever, especially health care workers and first responders. But the COVID-19 stay-at-home orders also touch people who are working from home, where the boundaries between work and home are blurring.

Through stories, Dr. Eull shares three pillars to help you create a happier and healthier life:

1. Autonomy and support. You can mitigate stress and burnout when you have a sense of control or autonomy over your work and work environment, and feel supported.
2. Meaning and purpose. You can increase your sense of well-being and happiness by making meaningful connections with something outside yourself – a social group, a cause, nature, or a spiritual community.
3. Emotional intelligence and communication. You can decrease burnout and increase professional satisfaction showing your appreciation for others and assuming that people are acting out of good intentions, instead of assuming that they have bad intentions.

Meanwhile, one of the attendees posted a link to Topher Payne’s parody alternate ending “The Tree Who Set Healthy Boundaries.” I highly recommend it! Payne’s version starts at the point when the boy asks for a house, and the tree says, “Okay, hold up. This is already getting out of hand… First it’s the apples, then branches, then the trunk, and before you know it that mighty beautiful tree is just a sad little stump. Boy, I love you like family, but I am not going down like that.”

PS This alternate ending was created to help The Atlanta Artist Relief Fund. Payne says that it’s available to print for free, and asks you to consider a donation to support artists during COVID-19.

“The medical field will be a wonderful, magical place where people can thrive,” Dr. Eull encourages. “We can all spread positivity and good intent, and extend grace to other people… We have the power to transform our own world and own career and all the people around you.”

What boundaries have become blurred during the COVID-19 stay-at-home orders? What boundaries do you need to re-establish in your own life?

Creating a strategy for burnout

“Burnout is not a problem,” declares Dike Drummond, founder and CEO of The Happy MD. “It is a dilemma. And you address a dilemma with a strategy.”

It was a Saturday afternoon, and I was attending the Hawaii Health Workforce Summit for the first time. I’m not a healthcare provider, but I work for a nonprofit counseling center in Hawaii. And I was feeling the strain of talking with clients, supporting our staff, and trying to grow our center.

Drummond’s energizing presentation about “Provider Wellness: Leading Change from Within the System” came at just the right time to remind me that healthcare providers and staff need to take care of ourselves before we can take care of others.

The stakes are high. Burnout –exhaustion, a growing cynicism, a feeling that we aren’t making a difference – is bad for patients and bad for caregivers. But it’s not a problem that can be solved, Drummond states. It is a balancing act between the energy burn of work and our ability to recharge.

What can we do?

As individuals, we can choose 3-5 new actions – things we can do to take care of ourselves – and make them habits. This will help us manage our physical, emotional, and spiritual energies so we can maintain that balance.

As organizations and leaders, we can create a “Quadruple Aim Blueprint” to maximize the health and well-being of our providers, colleagues, and staff.

1. Education. We can teach people about stress and stress management at work. We can normalize healthy conversations about stress and burnout. We can add burnout training for all new hires, too.
2. Culture and connection. We can build social ties by creating entertainment and fun, family events. We can create a social calendar and put some money behind it. I’ve planned a couple of staff picnics, and he said something I really needed to hear: Don’t worry about the people who don’t show up – have fun with the people who do show up!
3. Crisis management. We can put plans in place to react to a crisis, such as sharing a 24/7 hotline; and to be proactive in a crisis, such as acts of kindness when a staff member is in distress. It’s the first time I learned about Code Lavender, a code that healthcare providers can use when a stressful or traumatic event occurs at work.
4. Quality improvement. We can ask staff about the biggest sources of their stress, and try to reduce or eliminate them. This shows that we are listening and that we care.

It won’t happen overnight, but Drummond gave me a starting point – and an end goal.

What 3 things can you start doing to take care of yourself? How does your company help to reduce stress at work?