NOTE: This message was emailed on Wednesday, Feb. 16, to all Ballad Health team members from Alan Levine, Ballad Health’s chairman and chief executive officer.
Dear colleagues:
Good morning. I have a couple of important things to announce to you, and some updates – most importantly, the new, major investment Ballad Health is planning to make in a massive expansion of affordable childcare for our team members. More on this below.
As always, though, I would like to begin my message by saying thank you. Each of us contributes to the improvement of human life and the human condition through the work we have chosen to do. And without a doubt, our calling in healthcare has been tested over the past two years as we have each pitched in to serve our region. More than 450 team members, including all the way up to our senior leadership, have volunteered in our Helping Hands program to assist frontline caregivers. Nurses and volunteers have helped us provide the Safe at Home program – which has served more than 5,700 people – helping to avoid thousands of hospitalizations which most certainly would have overwhelmed our hospitals even more. And so many other examples of people helping other people.
Sustained quality
Through it all, we learned yesterday that, based on the data we track through the Premier Healthcare Alliance, seven of our quality measures are now performing in the top decile of the United States – our most ever. This has happened at a time when the New England Journal of Medicine is reporting studies that show a terrible deterioration nationally in healthcare associated infections and complications. These studies indicate the magnitude and severity of COVID-19 surges, combined with staff burnout and shortages, and repurposing of quality and infection prevention support staff to help respond to the high transmission rates of COVID-19, have all contributed to the impact nationally.
While not surprising, we join our colleagues nationally in expressing disappointment given the major improvements that had been made before COVID. That said, it reveals the opportunity to rebuild resiliency in our processes to regain the advancement the industry made before COVID. I’m excited to share that over the next few weeks, we will provide more information to you on the investment we are making in the creation of the Ballad Health Center for Clinical Transformation, an initiative approved by the Ballad Health Board of Directors. This effort will be intended to engage with our clinical teams throughout Ballad Health to help us sustain the incredible top-decile performance we have achieved, while finding other opportunities to institutionalize the improvements in patient outcomes we all seek.
I applaud our staff, including our surgeons – whether part of Ballad Health Medical Associates or part of independent groups – who have engaged with us to implement the ERAS (Enhanced Recovery After Surgery) initiative, for example. This initiative, combined with a systemwide effort to focus on reductions in post-surgical infection, has resulted in our lowest surgical site infection rate for colon surgery in the history of Ballad Health – a 16% improvement in the rate. Ongoing work continues, but the relentless focus on quality is making a difference.
Similarly, our falls with hip fractures remains among the best performing top decile in the nation. Again, despite the staffing challenges. You deserve enormous credit for this. And I want to thank the general surgeons and orthopedic surgeons throughout the entire region – whether part of Ballad Health Medical Associates or independent groups – who are partnering with Ballad Health through co-management agreements targeting elimination of variation, improved quality and reduced cost for patients and payers. These partnerships are key to our success in delivering high-value healthcare.
Step One in recovery as we look forward – staffing
There is no doubt the hospital service sector is experiencing unprecedented shortages in clinical staffing. The most important contributor to quality outcomes is to have well-trained staff – from nurses to lab technicians – and to be fully staffed to ensure appropriate and qualified staff are available based upon the number and acuity of patients. Nowhere is this staffing challenge more severe than in rural and non-urban America. As we continue to deal with this pandemic, the Board of Directors and leadership of Ballad Health are committed to concurrently identifying opportunities to reverse these trends and rebuild our staffing.
Months ago, we announced several initiatives – from more than $125 million of annualized investment in wage increases for nursing, nursing support and in other areas, including lab and imaging – to a major effort to increase support for nursing. And as you know, we are paying all team members below the position of Executive Vice President a special bonus. I will update you on these initiatives later in this message.
Before I update you on those initiatives we already announced, I do want to share with you some major news about steps we are planning to take now:
- A new, major investment of tens of millions of dollars of capital directed toward expansion of affordable childcare and ongoing subsidies for team members, in order to sustain affordability.
- Our team members have shared with us that childcare options are an important consideration for them as they build and sustain their families. Already, Ballad Health operates two childcare centers, one in Johnson City and one in Elizabethton. Hospitots in Johnson City and the Childcare Center in Elizabethton are rated by Tennessee with 3 stars, the highest rating available. But, like most childcare centers, there are wait lists.
- Along with our team members, independent research has shown that 98% of parents of children under age 5 within the Appalachian Highlands region have indicated that inadequate childcare has hurt their work productivity and career opportunities.
- Yesterday, our Board of Directors made millions of dollars of investment available to expand our existing two childcare centers and build as many as 11 new centers throughout the region for the primary purpose of serving members of the Ballad Health team with subsidized childcare options. This is a major capital investment combined with the ongoing annual investment in the provision of subsidies to help make childcare more affordable for our team members.
- In some communities, we may partner with community organizations to enhance limited options for other organizations with significant need. We will be flexible in each community, as we seek to be good community partners, particularly in our rural areas where childcare options are severely limited.
- We will communicate more to you soon as we begin to implement this initiative. Our plan is to assemble a representative group of team members to participate in the planning for these services. We will move as quickly as possible, recognizing that building and staffing these facilities will require some time. We will share our timeline with you as the plans are completed.
- Finally, our network of child care centers will be brought under the newly created Niswonger Children’s Network, as we seek to integrate services for children throughout the region, from well-child early childhood development to in-school access for medical and behavioral care to hospitalization, if necessary. These child care centers will also serve a pivotal role in our Strong Starts and Strong Futures programs, designed to help moms and babies get their children on a trajectory for kindergarten readiness and to reduce the incidence of childhood trauma.
- Scholarships for team members – Ballad Health will provide full scholarships for any eligible team member who pursues higher education in certain clinical disciplines. Based on the educational program, Ballad Health will cover 100% of tuition, fees and books for team members who pursue higher education for an initial degree in nursing (RN and LPN), imaging, medical technology, surgical technology and catheterization lab technology.Additional details include:
- These scholarships cover tuition, fees and books –
- up to $1,500 a term for LPN
- $2,500 a semester for team members pursuing an associate degree (RN, surgical technology, catherization lab technology and medical technology)
- And $4,500 a semester for team members pursuing a bachelor’s degree medical technology.
- Ballad Health will assist team members with contacts to the admissions process to various colleges if needed, and team members can still work while pursuing their degrees.
- We are now accepting applications for the student scholarship program for team members.
- These scholarships cover tuition, fees and books –
Our Ballad Health vendor partners, such as Ensemble Health Partners and Compass One Healthcare, are also eligible for the scholarship application process.
This is a great opportunity to continue working in your current position, while obtaining advanced skills in very needed clinical professions. If you are a certified nursing assistant, this is an opportunity to advance to becoming an LPN or an RN! If you are a nonclinical person who has had a desire to enter the nursing profession, or to perform diagnostic imaging, this is an opportunity to do that at no cost to you financially, with good economic benefit once you achieve the degree. To request a scholarship application, please contact HR4U.
- Tuition reimbursement – Existing team members who wish to pursue a higher level of professional education may receive up to $2,500 a calendar year in tuition reimbursementwith attainment of eligible grades. Active RNs with an associate degree may receive tuition reimbursement for the pursuit of a Bachelor of Science in Nursing (BSN) degree. Eligible team members should submit their application to HR4U by March 31, 2022, to be considered for the 2022-2023 academic year. The updated application will be posted to Policy Manager soon and attached to the Ballad Health Tuition Reimbursement policy.
- Special incentive payout– Earlier this month, we announced team members who were paid an average of 60 hours or greater per pay period (regular, overtime, PTO and MML) during the timeframe of July 4, 2021, through Jan. 31, 2022, will receive a special bonus of $1,250. Of that, $750 will be paid on March 25, as a special payment separate from the regular paycheck, and $500 will be paid in July as a special payment separate from the regular paycheck. Team members who work less than 60 hours per pay period on average will receive a special bonus of $625. Of that, $375 will be paid on March 25, and $250 will be paid in July. Team members must be actively working at the time of payout to receive the payment.
- If you are a partner with Compass One Healthcare, you will receive the same bonus I’ve mentioned in this message.
- If you are an associate of Ensemble Health Partners or STAT Information Solutions and you work in a Ballad Health hospital facility, you are eligible for the bonus, as well. As I mentioned in my original announcement, we know some people with Ensemble Health Partners do not work in our hospitals but do support us and other health systems in other ways. We have confirmed with Ensemble Health Partners they have generous incentive and bonus programs which benefit you, as you so well deserve.
- PTO cash-out – All Ballad Health team members actively working in May 2022 will be eligible for a special PTO cash-out of up to 40-hours, payable in May 2022. Human Resources will provide more details on this soon.
- Recruitment bonuses– Any Ballad Health team member is eligible to earn up to $2,500 as a special bonus for referring an experienced RN who is ultimately hired; $1,500 for referring experienced LPNs (acute care, skilled nursing and physician office), RTs, surgical technologists and medical technicians/technologist; and $500 for referring a certified nursing assistant, phlebotomist and certified medical assistant.
- Nursing support plan – As you may recall, last summer, before the Delta variant hit us, we announced several initiatives resulting from feedback from nurses in terms of how we can provide support beyond filling the vacant positions. All of these initiatives are underway, limited only by our ability, in some cases, to find available talent in a very tight labor market. I do want you to at least be updated on where we are with these initiatives, which include, among other things:
- Nursing Ambassadors — This program, originally suggested by one of our own nurses, allows us to engage team members who trained at schools outside our region to assist in recruitment from their respective programs. This program will be launching shortly and is an opportunity for team members to engage directly in helping us fill vacant nursing positions. More information coming soon on how you can participate.
- Addition of clinical CNA educators– These were approved and hired to expand the Certified Nursing Assistant (CNA) program at Ballad Health with the goal of increasing the total number of nursing assistants available. This is underway, and we continue to enroll additional CAN students to fill the pipeline.
- Addition of 13 system clinical educator positions – These were approved to foster at-the-bedside education and support for new graduate nurses in the transition to professional nursing in this challenging healthcare environment. This is under way; however, in the current environment, more folks are thankfully remaining by the bedside to assist with staffing needs. We anticipate these positions being filled as the inpatient census from COVID-19 stabilizes.
- Decrease span of control for nursing managers – By decreasing the number of people under the supervision of each manager, this enables the manager to spend more time providing support and guidance for team members. During the peak volumes we have experienced, this remains underway, but likely will not come to full pass until the volumes stabilize and we fill more of the staff positions. The leadership positions are approved.
- Multiple unlicensed or clerical positions – These were approved to be added to patient care units across the health system, and efforts continue to hire for those positions.
- Balladeers Club for children and families – Another idea which originated from our team members is the creation of an affinity program for Ballad Health families and children. This free benefit is being added in the form of a club for families and children of team members intended to strengthen family bonds and relationships amongst our Ballad Health family.
- The program, to be launched later this month, will create opportunities for team members, and their children, to gather for social engagement, benefit from various discounts offered to Balladeer Club members, engage in sponsored events and expose children to new friends and learning opportunities.
- If you are interested in enrolling your family in the Balladeer Club, you can sign up on the Ballad Health external website link here. This is merely a form expressing your interest in enrollment and does not commit you to anything. More information about the Balladeer Club will be provided in the coming weeks.
CMS vaccine mandate
As you know, to remain eligible for Medicare and Medicaid participation, Ballad Health must comply with the Centers for Medicare and Medicaid Services (CMS) COVID-19 vaccination mandate and ensure our team members are vaccinated unless they have an approved medical or religious exemption. Last Friday, Feb. 11, was the deadline for all Ballad Health team members to be vaccinated with at least one dose.
I have been quite vocal about my concerns implementing a national mandate in the midst of an historic shortage of staffing occurring at the very time our hospital capacities are being tested. As you may recall, as recently as a few weeks ago, we had more than 1,000 team members who were not vaccinated and had not sought religious or medical exemptions. This obviously was of great concern to us as we strive to continue serving the needs of our region. We reported publicly that our plan was to engage with every team member possible to answer questions about the vaccine, and to encourage our team to remain as part of Ballad Health so we can continue to work together to serve our region. We announced a special team member bonus intended to say “thank you” and also to help encourage people to remain with us.
I applaud the work of our team members, supervisors and managers who, each day, methodically worked to help team members make the best decisions for themselves, with the ultimate goal to sustain our staffing, and mitigate additional damage through loss of more staff.
The result?
Ballad Health has approved 1,700 medical or religious exemptions, and of our total of more than 13,800 team members, 63 team members have chosen not to vaccinate by the deadline or request a religious or medical exemption. Approximately 45 of these team members are direct clinical or clinical support. This means, when removing those who are exempt, deferred or who chose not to vaccinate, our total vaccination rate is approximately 86%. This is an impressive result. When including those who have religious or medical exemptions or deferrals, we will be at 100% compliance.
With respect to those who have chosen to opt out of vaccination, and who do not have an exemption, the Medicare Conditions of Participation require that Ballad Health not permit these team members to provide service. These individuals are being contacted individually and are being informed that Ballad Health will place them on inactive status for 90 days. During this period, these team members may choose to be vaccinated and return to work. Or, they may choose to request termination, or voluntarily resign with eligibility for rehire if they become vaccinated in accordance with the regulation. After 90 days, if there is no activity, the team member’s employment will be terminated involuntarily in accordance with policy.
Importantly, we have approximately 250 unvaccinated team members who have deferrals, as they either tested positive for COVID-19 or received a monoclonal antibody treatment (MAB) within 90 days of the first dose-vaccination deadline last Friday. These team members will be notified by email, letting them know of the upcoming expiration date of their deferral, along with instructions on next steps and deadline requirements.
Finally, we remind everyone that the deadline last Friday was for the first shot of the Pfizer or Moderna vaccine – unless you chose the Johnson and Johnson vaccine, in which case you have fully completed your requirement. Approximately 450 team members fall in the category of having gotten the first shot, but still need to get the second shot by the deadline, which is 5 p.m. on March 11, 2022. Documentation of receiving the second dose needs to be presented to Team Member Health.
In closing
A healthcare system is more than just a bunch of buildings or care sites. It is more than the technology, equipment and tools used to care for patients. The differentiator that makes a healthcare system special is its people. Yes, Ballad Health offers the latest and best technology, including the latest robotics, diagnostics and treatment modalities. But most importantly, it’s the caring, compassion and spirit of family that gives people confidence in us.
As we now pivot from crises related to COVID-19 toward rebuilding from the damage done, we will work together with all of you to emerge stronger, more resilient and more trusted to care for people when they need us. We believe in the investments we are making in our people through expanded childcare, scholarships, additional support and building stronger, more resilient relationships.
James 1:2-4 says, “Count it all joy, my brothers, when you meet trials of various kinds, for you know that the testing of your faith produces steadfastness. And let steadfastness have its full effect, that you may be perfect and complete, lacking in nothing.”
We have all been tested. Don’t let the noise and the headwinds diminish our steadfastness as we rebound together.
Thank you and God bless,
Alan
Alan Levine
Chairman and Chief Executive Officer
Ballad Health
