COVER STORY
June 2025
Staffing is collapsing, risk is rising, and clinical leaders are on the hook. Patient safety demands bold workflows, tech-enabled care, and the courage to rethink everything. Fast.
COVER STORY
June 2025
Your Healthcare Workforce Is Gone. Your Risk Has Just Arrived.
Staffing is collapsing, risk is rising, and clinical leaders are on the hook. Patient safety demands bold workflows, tech-enabled care, and the courage to rethink everything. Fast.
TAKEAWAYS
- The No. 1 strategy to maintain patient safety when there are workforce shortages is to put processes in place and establish new workflows to ensure that staff can be successful.
-
Technological solutions such as virtual nursing can relieve burdens on staff who are working in an area experiencing workforce shortages.
- Provider-patient ratios are set with input from human resources and the finance team, and a CMO needs to serve as a clinical staff advocate to make sure provider-patient ratios do not compromise quality or patient safety.
TAKEAWAYS
- The No. 1 strategy to maintain patient safety when there are workforce shortages is to put processes in place and establish new workflows to ensure that staff can be successful.
-
Technological solutions such as virtual nursing can relieve burdens on staff who are working in an area experiencing workforce shortages.
-
Provider-patient ratios are set with input from human resources and the finance team, and a CMO needs to serve as a clinical staff advocate to make sure provider-patient ratios do not compromise quality or patient safety.
Nobody says it out loud, but in hospital C-suites across the country, the message is clear: if something clinical goes wrong, clinical leadership is on the hook.
As care teams shrink and patient acuity rises, the safety net is fraying, and patients are slipping through. Virtual nurses, AI scribes, cross-trained teams, and reimagined care environments are no longer innovative, they’re triage.
CMOs must walk a tightrope between fiscal responsibility and clinical reality, knowing that when the inevitable safety incident occurs, accountability stops at their desk.
But what if the real crisis isn’t the staffing shortage itself, but the belief that the work must be done the same way it always has been? Here’s how to lead the charge on change.
Coping with workforce shortages
“No. 1, you need to make sure that you have system processes in place that support your people,” says Kevin Post, DO, CMO of Avera Health. “In times of workforce shortages, you need to have workflows in place to make sure staff members can be successful.”
It’s a reality few want to face, but workforce shortages aren’t coming—they’re here. And when care teams are under-resourced, the fragile web of patient safety starts to unravel. According to Post, the response must be structural and swift.
To buffer these gaps, health systems are increasingly turning to virtual care models.
100,000
Expect a shortage of about 100,000 critical healthcare workers by 2028.
Source: American Hospital Association
“We use virtual sitters and virtual nursing, which allows one nurse at a virtual hub to monitor up to 16 patients at a time, which can relieve burdens on staff who are working in an area experiencing a staffing shortage,” Post says.
Beyond virtual monitoring, ambient AI is helping unburden frontline providers, automating documentation and easing cognitive load.
Kevin Post, DO
CMO of Avera Health
“We allow our providers to document patient encounters with the use of AI,” Post says. “This decreases the cognitive burden on our providers and increases the efficiency of documentation, which saves providers time.”
Shifting patients to alternative care environments is another lifeline. Jennifer Khelil, DO, MBA of Virtua Health, recalls how the pandemic forced a reimagination of capacity planning—and catalyzed long-term change.
“During the coronavirus pandemic, patients just kept coming and there were not enough beds and not enough staff,” Khelil says. “We learned that we could use new strategies.”
That shift included the creation of a hospital-at-home program—designed not only to decompress acute settings but to meet patients where they are, literally.
“When patients come into one of our hospitals, they are identified in the emergency department if they are appropriate for hospital-level services in the home,” Khelil says. “Some patients are admitted to the hospital for a day or two, then they are discharged into the hospital at home service.”
As part of the hospital at home program at Virtua Health, nurses visit a patient twice a day. Medications and meals can be delivered. Intravenous medications can be administered.
“The hospital at home program decompresses our hospitals, with the recognition that there are different ways of taking care of patients,” Khelil says.
But repurposing space and tech isn’t enough. According to Sylvain 'Syl' Trepanier, DNP, RN, of Providence, the key to safety is making sure everyone operates at full scope.
“When it comes to staffing ratios, those decisions are made mutually with human resources and the finance team, but a CMO needs to advocate for their people in the name of quality, patient safety, and employee safety.”
—Kevin Post, DO, CMO of Avera Health.
“The best way to ensure that you have a safe environment despite a staffing shortage in the moment is leveraging the entire workforce,” Trepanier says. “In healthcare, that means you leverage the entire care team to allow everyone to work at the top of their license.”
Jennifer Khelil, DO, MBA
executive vice president and chief clinical officer of Virtua Health
He warns that the status quo is not sustainable. If systems don’t fundamentally redesign how work is distributed and who delivers it, the future will bring more than burnout, it will bring breakdown.
“It’s going to get worse—we are never going to have enough people,” Trepanier says. “In fact, it does not matter how good we are at recruiting people—we are never going to have enough people if we continue to work the way we are working now.”
Rethinking care models means considering who really needs to be at the bedside and who can be remote, automated, or augmented through robotics.
“Robots can be introduced into the care environment, where they can do tasks that you do not need a human to do,” Trepanier says. “Robots can be used to move equipment. They can help supply patient rooms.”
Virtual care is central to this philosophy. Trepanier describes Providence’s co-caring model, where bedside teams collaborate with virtual nurses to expand bandwidth and improve sustainability.
“At Providence, we have a co-caring model that we have established, where we have nurses who are practicing virtually to support nurses at the bedside,” Trepanier says. “It allows for nurses to stay longer in the discipline because they work from home.”
Preparing for this future means investing now. Virtua Health’s proactive approach includes forging academic partnerships that ensure the next generation of caregivers stays close to home.
“One of the ways you can address a staffing shortage is to train-up your workforce,” Khelil says. “We have a partnership with Rowan University, where we are working alongside that university to identify our workforce needs and to develop programs that will support those needs.”
Virtua Health is conducting rotations for medical students who attend the Rowan-Virtua School of Osteopathic Medicine, then recruiting those medical students into the health system's residency programs.
“When patients come into one of our hospitals, they are identified in the emergency department if they are appropriate for hospital-level services in the home.”
—Jennifer Khelil, DO, MBA, executive vice president and chief clinical officer of Virtua Health
“We know that students who train in an area and do their residencies in an area tend to stay in that area once they graduate,” Khelil says.
Virtua Health is also working with Rowan University on a physician assistant program. The physician assistant trainees are receiving didactic education at Rowan University, then they rotate through the health system for their clinical training.
“The hope is that these students will see the great things we have to offer, then they will want to become part of our organization after their training,” Khelil says. “We are making a large investment in training the workforce of the future in anticipation of the shortages that are looming.”
Ensuring provider-patient ratios do not compromise patient safety
There are several strategies healthcare leaders can employ when patient volume increases and strains provider-patient ratios, which has the potential to impact patient safety.
One of these strategies is making sure that leaders are visible in the hospital setting, Khelil says.
“We have instituted a nursing leadership rounding program in our hospitals,” Khelil says. “The nursing leaders are literally going from room to room to make sure that the nurses have the resources that they need and the patients have what they need.”
Another approach to making sure provider-patient ratios do not compromise patient safety to pursue high reliability in hospitals, Khelil explains.
Sylvain “Syl” Trepanier, DNP, RN
chief nursing officer at Providence
“Part of that is a 'speak up' culture,” Khelil says. “If anybody, including non-clinical staff, sees a safety issue that could impact a patient, they are obligated to speak up. It is remarkable when you have all eyes focused on providing a safe environment. The information that you get back from all staff members is valuable, and the issues that are raised can be addressed in real time.”
Cross training care teams is another successful strategy, according to Post.
“This is how we can make our care team members useful in multiple areas, whether that is in clinics, hospitals, long-term care, or home care,” Post says. “Cross training allows staff members to be flexible and move to and from different treatment situations.”
“It’s going to get worse—we are never going to have enough [staff]. In fact, it does not matter how good we are at recruiting people—we are never going to have enough people if we continue to work the way we are working now.”
—Syl Trepanier, DNP, RN, chief nursing officer at Providence.
Managers should not be insular when the provider-patient ratio is strained in their department, according to Trepanier.
“There could be resources outside of the department that we might be able to draw upon,” Trepanier says. “For example, if you are in a traditional hospital setting, one unit may not have the resources that they thought they would have, but there may be a pool of staff that can be leveraged from another unit. Many hospitals are using a pool system of resources, so they can borrow from one unit to the next.“
Teamwork is essential when provider-patient ratios are inadequate for the patient volume, according to Trepanier.
“When provider-patient ratios are established, they are established on the assumption that you practice in a certain way,” Trepanier says. “You may not need the same provider-patient ratios when you approach the work from a team-based perspective. You can maintain safety for patients—you just look at the work differently.”
Managers need to leverage the entire team, Trepanier explains.
“I would look at not only how many providers I have but also how many other types of people I have in the environment,” Trepanier says. “Instead of approaching the work from a one-to-one basis, you can approach the work from a team basis. Instead of a provider or a nurse being committed to providing all things to all patients, you look at ways for team members to work together to meet the needs of the patients.”
Patient safety must be a top concern when provider-patient ratios are set in the first place.
“CMOs need to be advocates for their care teams,” Post says. “When it comes to staffing ratios, those decisions are made mutually with human resources and the finance team, but a CMO needs to advocate for their people in the name of quality, patient safety, and employee safety. If we do not have adequate staffing ratios, it puts our patients at risk and affects the well-being of staff members.”
The acuity of patients must be considered when provider-patient ratios are established in the hospital setting.
“There are obviously different areas in the hospital with different patient safety requirements,” Khelil says. “There are areas in the hospital with critically ill patients. The provider-patient ratios at units with critically ill patients are going to be very different than the ratios on a general medical floor.”
Christopher Cheney, CMO Editor, HealthLeaders
