When COVID-19 cases surged in Texas in the summer of 2021, health systems buckled as bedside nurses dwindled. Houston officials warned that “a breaking point” was near due to the high demand of care and low supply of labor, according to the AP.

One organization impacted by this shortage was Memorial Hermann Health System, a 115-year-old organization with 17 hospitals across the Houston area. Turnover hit nearly 30% as the pandemic intensified, and the hospital saw the steepest decline in its nursing workforce in 20 years, according to the health system’s SVP and CHRO, Lori Knowles.

The nursing shortage pushed Memorial to test new staffing models, explore upskilling efforts and invest in staff support. HR teams across the U.S. made similar changes, Knowles noted, as they responded to the pandemic and other crises that marked 2020.

“The employer-employee pact that had been in place for so long fundamentally shifted,” Knowles said. “We met a confluence of pressures and influences we had never seen before. And organizations looked directly at HR to solve all of that.”

Still, Knowles chose to look on the bright side. “I’ve seen so many amazing things come out of this time,” she said.

It started with staffing

Memorial Hermann is a large operation. It employs more than 32,000 people across its 265 sites, which includes 17 hospitals. It’s one of the largest not-for-profit healthcare systems in Texas, and the biggest in Houston.

“Our vision is to create healthier communities now and for generations to come,” said Knowles, who has served as the organization’s CHRO for five years. “We talk about that all the time. It shapes how we think about the work we do. It shapes, from my perspective, how we think about our people.”

This mission guided Memorial as it first began to deal with the labor shortage and related challenges. Like many healthcare organizations, it turned to contract nursing, a fix Knowles was quick to critique. She noted its expense — rates for travel nurses exploded during the pandemic. In January 2020, the national average weekly pay rate for travel nurses was $1,894, according to nurse staffing platform Vivian Health. By December 2022, that figure had risen to $3,173.

Knowles also noted another downside of using contract nurses. “It’s detrimental to culture. It creates challenges with equity. It’s all these things when a large percentage of your workforce aren’t your employees who you’re paying a premium for.”

To ease these frustrations, Memorial Hermann looked to its internal staffing agency of more than 1,000 floating employees. Through this group, the organization now offers a number of flexible work programs, each prioritizing something different. One program caters to employees who want more time off, offering 13 weeks of work, followed by six weeks off. Another allows employees to work at the four closest hospitals to their homes. Yet another enables nurses to earn a higher rate by working at whichever hospital needs them most.

Memorial Hermann still uses contract nurses, but usage is down by more than 80% since the height of the pandemic, Knowles said.

“We’ve had to be creative to meet the needs of people while still providing great care to our patients,” Knowles said.

What emerged at Memorial: ‘Well Together’

As Knowles witnessed the events of 2020, she received a daunting task from Memorial Hermann CEO David L. Callender.

“We’re in the fall of 2020 and it’s dawning on all of us that COVID is not a short-term affair,” she recalled. “My CEO says to me: ‘We’re about to see a level of PTSD we’ve never seen. We’re going to have to figure out how to address that here.’”

Knowles wondered how to tackle such a project. She landed on listening: First to experts, then to her fellow leaders and finally to her employees.

As she listened, she learned. Her first realization was about the nature of the trauma she and her colleagues were experiencing. “This wasn’t going to be traditional PTSD. This was going to be collective,” she said. “And people were going to have to manage their day-to-day lives while going through this.”

Knowles next needed to learn how her people would manage this stress — and how her organization could help them through it. So, with HR, hospital chaplains, employee wellness directors, and physicians and nursing leaders, she began to study the employees that make up Memorial Hermann. The team borrowed a tactic from marketing and conducted a persona study. Eight types of employees emerged.

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