With Labor Day right around the corner, employers in most every sector might mark the holiday by reflecting upon what we don’t have: labor.

Back in March, workforce watchers warned that as the pandemic ends, as many as half of all workers plan to find a new job. This voluntary job leaving adds to the hiring and turnover woes that businesses of every ilk were already experiencing. Is it time to call our current situation a “crisis”?

Before deciding, it bears considering the implications of a high job vacancy rate for health care and human service organizations, many of whom have faced the pandemic months with challenges on every front that required creativity, dedication and a committed army of employees. First, it’s obvious that a huge total of unfilled positions means less work is accomplished, especially in “high touch,” people-jobs that require human interactions. This means less service to the public during a time that requires more workers to meet the burgeoning need for care. Not only does this make delivering on the historic expectations of patients or clients a significant challenge, but it also makes the expansion of service or the growth in new programs much less achievable.

For example, in the state’s community mental health system — 10 not-for-profit organizations that are the backbone of New Hampshire’s emergency mental health safety net — the 270 or more unfilled positions make it much more difficult to care for the 40,000 children and adults who depend upon it each year. While the demand for treatment services is increasing, the changes needed to improve access, create new services and programs, and achieve better outcomes all require more personnel than the system has at present.

In the state’s network of 23 hospitals, there is a worsening shortage after the COVID-19 surge for many positions from RNs to environmental service staff. These shortages are forcing patients far from home for inpatient care, recently even requiring out-of-state transfers. All of the hospital’s chief medical officers and chief nursing officers are once again meeting daily to plan statewide bed management, now not because of the pandemic but because of staff shortages.

Second, this reduction in work activities brings the consequence of a reduction in revenue. To be sure, not-for-profit enterprises like hospitals and community mental health centers don’t have shareholders that expect dividends but we do have stakeholders who rightfully expect financial stability. A lesser number of employees can mean lesser sustainability. In 2020, 47 hospitals in the United States went into Chapter 11 bankruptcy protection. Twenty-one of those hospitals closed their doors permanently. In Laconia, Lakes Region Hospital declared Chapter 11, as did Springfield Hospital in Vermont. Concord Hospital took over Lakes Region and Springfield recently came out of Chapter 11, but continues to be in deep financial trouble.

Third, the high rate of vacancy and turnover in workforce makes retaining existing employees all the more critical. When positions stay unfilled for long periods of time, the burdens and stresses of the work multiply for the others who remain. This increase in workload often becomes the precipitant for people to rethink their tenure and dust off their plans to find something new. Unfilled positions in health care and human services organizations also drive increasing wait times for care. Waiting to be seen by the physician or clinician without the normal support staff will cause those times to further increase.

Many individuals have delayed care because of the pandemic. Now add in the staffing issues that are driving increased wait times for ancillary testing. The health outcomes of our community can only be negatively impacted.

These phenomena can make managers alter their expectations, policies, and plans for the future, as they follow the age-old advice that “a bird in the hand is worth two in the bush” even when the output of that bird is less than it should be. With today’s spike in COVID-19, some managers are hesitant to mandate vaccinations of their staff for fear that those opposed to the shot get up and leave.

So, are we at a point of crisis? While it is tempting to define the word at a time of emotional pain, urgency or sudden change, it might be better to recall that “crisis” also means “turning point.” The massive disruption brought on by the pandemic, the rapid escalation of digital technologies and the aging population in a state like ours are likely bringing us to a decisive moment. These complex problems will certainly require more than simple solutions.

One thing seems certain, however. All of us looking for anything, from a heart transplant to a hamburger, may have to adjust our expectations to the new realities employers face. Perhaps the time we find ourselves in is a crucial period in which all of us, employers, workers, lawmakers, and stakeholders, must align to discover new solutions which, by necessity, require rethinking traditional assumptions. It is doubtful that employers by themselves will be able to solve the workforce challenges.

Phil Wyzik, MA, is CEO of Monadnock Family Services. Dr. Don Caruso is the president & CEO of Cheshire Medical Center, and chair of the Board of Trustees of the N.H. Hospital Association.

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