AdventHealth, a non-profit, Seventh-day Adventist healthcare system based in Altamonte Springs, Florida, is the largest not-for-profit Protestant healthcare provider in the United States. With a network of 52 hospitals across nine states, it serves over 6.7 million patients annually. Central to its mission is a commitment to holistic care, supported by a dedicated team of professionals. However, the healthcare sector, including AdventHealth, faces a significant labor crisis marked by retirements, burnout, and inherent industry risks. The United States Department of Health and Human Services reports a current shortfall of 100,000 nurses, with an expected annual deficit of more than 60,000 RNs over the next decade. Addressing these challenges, Tom Nesteruk, Senior Vice President HR/Associate Chief People Officer at AdventHealth, recently outlined the organization's innovative HR strategies in a webinar with Athena Karp, Founder and CEO of HiredScore. 

This recap highlights the critical takeaways from the webinar, emphasizing AdventHealth's use of AI to tackle post-COVID challenges and labor shortages in healthcare. It also delves into their innovative HR operating model and the role of a cross-functional HR team in addressing these significant issues: 

1. How did you decide where to begin the AI at AdventHealth journey? Why did you specifically focus on the business problems that you did? 

“During COVID, we had some interesting challenges in healthcare. We had nurses leaving by the droves to join agencies and making exorbitant amounts of money, which increased the cost to our healthcare systems and created this huge labor shortage. We have 55 different hospitals, and with those hospitals, there's a CEO that runs each one of those facilities. And when we spoke to every one of them, their number one priority or business priority and strategy was solely focused on recruitment and retention. So it's no surprise when we're looking at our HR strategy and trying to align it with our high-level organizational strategy, recruitment and retention was our focus and so from a technology standpoint, this is where HiredScore came into the picture." 

Deciding factors that helped determine where to begin the AI journey:

1. Macro Environmental Challenges: Healthcare was one of the hardest hit sectors during COVID. The pandemic created a substantial labor shortage, not just in healthcare but across all sectors but this was compounded in healthcare by a trend of nurses leaving for agency work, which in turn increased costs for healthcare systems like AdventHealth and exacerbated labor gaps. Post-pandemic, AdventHealth navigated a complex financial landscape, simultaneously tackling distinct challenges in recruiting and retaining nurses and frontline healthcare workers. Addressing these issues required innovative HR strategies and operational adjustments to adapt to the changed healthcare landscape.
2. ‍High-level Organization Strategy: AdventHealth owns 55 hospitals and each hospital has its own CEO. Every CEO’s priority was to recruit and retain the best talent. Hence, AdventHealth’s HR strategy had to align with our high-level organizational strategy, focusing primarily on recruitment and retention. This is where technology, particularly AI, played a pivotal role. AdventHealth recognized the necessity of integrating cutting-edge technology like HiredScore to improve their recruitment processes.
3. ‍State of existing HR Processes: "Our several hundred recruiters, pre-HiredScore, they have to open up every single resume that came into their assigned requisitions and scan through and read those and look through them and rank and sort them. And you can imagine the time that takes, or is taking to do that. And that’s one feature of HiredScore that I'll talk about here in a second, that we're already seeing efficiencies seven months into this. And in fact, even our hiring managers, not just our recruiters, are seeing the benefits of utilizing an AI tool like HiredScore. For instance, our hiring managers, we had the biggest challenges in getting them to disposition candidates, which I think is probably common in just about any company. This is particularly why it slowed the whole hiring process down. And since we implemented HiredScore about seven months ago, we've seen a 40% decrease in our hiring manager decision time from when they review resumes to taking the next step of scheduling interviews and statusing candidates. And so that has greatly helped our overall speed to hire." 

HiredScore's features also enabled AdventHealth’s recruiters to revisit their existing candidate database, something that was previously unfeasible due to time constraints. This led to the recruitment of approximately 300 qualified nurses, representing the organization's most critical role and constituting 35% of its job requisitions. Additionally, their recruiters have been able to double the number of job requisitions they close in a 90-day period, showing the significant impact of AI on their operations. This technological advancement, though initially a leap in a sector traditionally lagging behind others in tech adoption, has proven to be a game changer for AdventHealth in addressing the unique challenges faced by them and the larger healthcare industry, in the post-COVID era. 

2. How can HR leaders and HR practitioners be connected to the business, know the business that they’re in, serve the business they’re in with total alignment? 

"We were able to reduce our agency spend drastically by right under $100 million, in fact around $68 million to be exact. And you know, that's not a small amount of money; it's a large amount of money. In fact, even this year, since we implemented HiredScore, we're able to reduce even further. So in our organization, across our 50 plus hospitals, our agency utilization is actually lower than it was pre-COVID, and it's because we tied our HR strategy with our Executive and CEO strategy at each of our facilities, and it's paying dividends to our hospitals not just from a financial stance, but from an experience stance as well, that we're bringing to the organization and our team members." 

Initiatives AdventHealth’s HR organization took to align with the larger business strategy: 

1. ‍Business Priorities Alignment: Reflecting the concerns voiced by AdventHealth's hospital CEOs, the organization's primary business objectives include addressing the labor shortage through strategic recruitment, retaining exceptional talent, and minimizing expenditures on external agencies. In response, AdventHealth's Human Resources division has tailored its strategy to concentrate on these three critical areas.
2. ‍Implementing Tools That Help Achieve HR Goals and Also Larger Business Objectives: By implementing HiredScore, AdventHealth was able to significantly bolster hiring efficiency and effectiveness. HiredScore not only helped accelerate the time-to-fill for positions and enhance the overall candidate experience, but also substantially reduced turnover costs and dependency on external agencies for hiring. As a result, there's a notable decrease in agency-related costs, aligning seamlessly with key business priorities like cost reduction. HiredScore's integration into HR workflows not only transformed AdventHealth’s recruitment process but also contributed tangibly to the broader financial and operational goals of the business.

3. How can the efforts of HR or TA in a hospital be linked to outcomes - customer or CEO outcomes? 

"Leveraging HiredScore has significantly impacted our recruiting process, as I've discussed with the impact it has on our hiring managers. This, in turn, profoundly affects our ultimate customers—our patients. Across our network of facilities and hospitals, over half have seen an increase in their patient safety ratings, a metric we measure using Leapfrog. This improvement is largely attributed to being fully staffed in critical areas. I've had CEOs literally tell me, 'We don't have any nurse openings, Tom. It's the first time I've seen in 10 plus years that I've been here.' We're connected to our business outcomes at a very high level, our corporate CEO is extremely proud to say that, yes, our HR team has been able to fill the gaps. It's had a direct impact on our facilities and how we treat and service our patients. We have all the data to back it up through our safety scores, not to mention we're seeing in a lot of our facilities, our patient satisfaction score is even impacted, with those scores on the rise." 

4. What are the most significant HR challenges you foresee with the increasing number of workers aged 65 and above either retiring or seeking fractional work instead of full-time roles? Additionally, how do you envision the deployment of AI to address and solve these emerging problems? 

"I'm sure everyone is aware that we have a big, you know, predicted nursing shortage. In fact, I don't want to say it's coming; it's already here. Looking at our candidate funnels and focusing always on the quality of candidate and being able to expedite the best candidate in the quickest manner possible, to remain ahead of the competition. I don't know where we'd be if we didn't implement this type of AI technology with HiredScore and how we compete with our other competitors, particularly while we're in growth mode." 

2024 marks a significant demographic shift, often referred to as 'Peak 65.' This term signifies an unprecedented number of people reaching 65, traditionally seen as retirement age in the U.S. 

This demographic shift poses considerable challenges for workforce planning, impacting every industry, every aspect of business across various roles and positions. In anticipation, AdventHealth has been engaged in extensive planning, research, and data gathering. Part of their strategy involves leveraging existing technology to mitigate these challenges. For instance, during the pandemic, Advent Health launched an internal staffing agency, a self-sustaining model primarily serving their nursing staff. Known as 'Staff Flex,' this program allows them to efficiently allocate nursing personnel across their various facilities. 

A key focus for AdventHealth has been integrating the HiredScore technology with this new candidate pool, which differs significantly from their usual pool. HiredScore and AdventHealth are collaborating closely to optimize this integration, to effectively address the looming challenges, especially with the anticipated retirements in 2024 and 2025. 

5. How are you thinking about the technology roadmap and AI possibilities at AdventHealth? 

“Our goal in the end is not just enhancing our technology but it’s really focused on the HR side on team member experience - both our frontline employees taking care of patients and the team members that leverage our self-service technology. It is important to make sure that it is all connected and seamless and easy.” 

Journey so far: AdventHealth, recognizing the significant technological lag in the healthcare industry, embarked on a transformative journey to integrate advanced AI technologies like HiredScore into its operations. This initiative, however, faced substantial challenges due to the inherent resistance to technological adoption prevalent among healthcare professionals. Particularly within their recruitment team, some of AdventHealth's most experienced and nationally recognized recruiters initially viewed AI as a threat to their expertise rather than a complementary tool. 

Change management played a huge role in implementing AI at AdventHealth. It was important to demonstrate that AI tools are designed not to replace human talent but to enhance and streamline their capabilities. As adoption gradually increased, many initially skeptical recruiters began to acknowledge the positive impact of AI on their efficiency and effectiveness. 

Looking ahead: AdventHealth's strategic focus extends beyond the mere implementation of new technologies. The organization is committed to fostering a cultural evolution, emphasizing the importance of embracing AI as a vital component of modern healthcare practices. This commitment is part of a broader vision that includes upgrading to an AI-embedded Human Capital Management system. This system, while a significant step forward, is just one piece of a larger puzzle that includes harmonizing various technologies to improve overall operational efficiency and employee experience. 

AdventHealth is dedicated to overcoming these challenges over the next two years, focusing on the dual goals of technological enhancement and cultural shift towards a more efficient, interconnected, and effective healthcare system. 

6. What advice would you give to a TA leader looking to implement AI for the first time in their talent acquisition team? 

“When we decided to implement HiredScore, it was a comprehensive business decision, not solely an HR initiative. This involved soliciting feedback from various stakeholders, including the markets we serve, hospital CEOs, and understanding their priorities. Our aim was to identify the most suitable technology that aligns with our overall business strategy, not just our HR goals.” 

Tom’s advice to TA leaders looking to implement AI for the first time is threefold: 

1. ‍Understand the Impact of AI Technology: Don’t underestimate the importance of adopting AI and similar technologies. These are new and unfamiliar, and it's vital to clearly explain their capabilities and how they can enhance job efficiency. Effective communication about the benefits of AI can significantly facilitate its adoption.
2. ‍Evaluate Post-Implementation Results: Post-implementation, it's crucial to assess whether the technology has delivered the expected benefits. This involves examining its impact on our business internally and externally, particularly in relation to patient care and hospital operations. As AdventHealth’s mission emphasizes whole-person care, they needed to consider if the technology eases the jobs of their internal team members and addresses HR challenges like burnout and well-being.
3. ‍Continuous Review and Adaptation: Finally, it’s essential to continually evaluate the decision and partnership with the AI vendor, and to keep exploring how to leverage this technology in new ways that you might not have initially considered.

For additional insights on strategic approaches to AI in HR, specifically AI in healthcare and hospital systems, be sure to view the complete webinar embedded above.