Workforce pipelines and onboarding programs, AI uses cases and executive governance, workplace violence and behavioral health interventions — these were among the essential topics hospital leaders discussed at Children’s Hospital Association's 2024 Annual Leadership Conference. Get an overview of key strategies and compelling results presented by children’s hospitals who are finding success in workforce, innovation, and operations. CHA members can access presenter slides and contact information for each session.
Innovation
AI use cases
The Hospital for Sick Children in Canada and Children’s Hospital Los Angeles (CHLA) are piloting generative AI in several areas. Administrative uses include generating PowerPoint presentations from Word documents or PDFs, taking ambient notes, providing in-basket responses, translating discharge notes, scheduling appointments, and delivering items with robots. Clinical uses include reading X-rays, training clinical and soft skills through simulations, supporting clinical decisions with longitudinal data, managing scoliosis remotely, and updating ED wait times. Both hospitals emphasized the need to ensure safety, efficiency, and ethics. In addition to review boards and advisory groups, hospitals should create a secure “AI hub” to allow safe and controlled use of advanced AI models with organizational data.
Safe and ethical AI
Children’s Hospital of Philadelphia’s governance structure addresses three major concerns with AI:
- Efficacy and safety, which includes harm events and unvalidated performance.
- Equity and bias, including ineffective or unsafe algorithms and products based on assumed or unaccounted for differences in race, gender, or other sociodemographic groups.
- Ethics and privacy, which concerns confidential patient information and consent.
To mitigate these risks, the hospital created a multidisciplinary governance committee that reviews all potential AI use cases, provides comprehensive guidelines, and offers continual education.
Virtual nursing
Akron Children’s Hospital and Texas Children’s Hospital are using technology to bring nurses into patient rooms remotely. For example, virtual nurses (VNs) can give discharge instructions to families, freeing up bedside nurses to provide hands-on care. Akron Children’s partnered with a technology vendor to introduce VNs on a high-turnover med-surg unit. Texas Children’s started in its NICUs and facilitated communication using parents’ smartphones. At Akron Children’s, VNs made 163 “good catches,” saved bedside nurses 1,300 hours, and reduced the frequency with which nurses skipped lunch or stayed late to complete documentation. At Texas Children’s, VNs returned 881 hours to bedside nurses and helped discharge patients 17% faster. Both hospitals will expand VNs to additional units in 2025.
Cybersecurity
Cybersecurity threats are escalating in health care. Children’s hospitals must be ready to address and quickly respond to incidents, including managing a technology crisis with incident command, operational subgroups, and communication. At one children’s hospital, a cyberattack took pharmacy claim services offline for 21 days, affecting 10,680 prescriptions. The hospital established four workstreams to assess the impact, including digital technology services, communications, clinical operations, and finance and revenue cycles. External resources also helped protect the hospital environment and ensure continuity of services. Despite challenges, they achieved a 98.8% revenue recovery due to the team’s quick decisions and collaboration.
Operations and systems
Behavioral health
Children’s Hospital Colorado developed a coordinated system of behavioral health care encompassing programs from early intervention to crisis care. The system includes four pillars: prevention and early treatment; outpatient services; acute intervention and inpatient; and community-based and residential services. It not only invested in comprehensive patient care but also in robust career pathways in mental and behavioral health starting with a behavioral health technician. The behavioral health initiatives resulted in a 50% drop in staff turnover, an 86% reduction in injuries, and improved staff utilization and team member experience.
Workplace violence
Two children’s hospitals have developed strategies to ensure the safety of their employees and patients. Children’s Healthcare of Atlanta created targeted initiatives, focusing on enhanced security, role clarification, de-escalation techniques, system support, and thorough data reviews. Between January and September 2024, the hospital mitigated 2,608 potential threats, implemented more than 30 recommendations, and created a streamlined process to ensure victims are contacted within 48 hours of an incident. Nemours Children’s Health created a tiered response system for behavioral escalations. An Emergency Response Needed Immediately (ERNI) call is made prior to calling a Behavioral Emergency Response Team (BERT). The ERNI response resulted in 82% successful de-escalations.
Improving margins
CHLA is taking a tactical, data-driven approach to improve financial margins. The hospital’s Performance Excellence at Children’s (PEAC) initiative looks for opportunities in clinical performance, revenue and staffing optimization, and resource management. Between fiscal years 2022 and 2024, team members identified 65 initiatives with the potential to generate $100,000 in cost savings. Using historical volume data, contract data, fiscal year budgets, and external sources like CHA’s Pediatric Health Information System (PHIS)®, CHLA saw operating margin improvements exceeding $50 million. PEAC initiatives included improving radiology capacity and creating multidisciplinary action plans to expedite care, reduce unnecessary tests, streamline orders, and decrease communication errors.
Go for Magnet
Why should children’s hospitals invest money and time pursuing a designation? Children’s Health in Dallas and Arkansas Children’s COOs say hospitals are already investing significantly in quality and employee engagement efforts. Magnet helps propel them forward through an evidence-based framework shown to drive outcomes. The Magnet model improves patient outcomes, increases nurse retention, and boosts revenue. It differentiates organizations in the market by lending credibility in the eyes of potential applicants. In all, it means healthier patients and a healthier hospital. To achieve Magnet designation, hospitals need to demonstrate empirical outcomes and create heartfelt stories.
Workforce
Pipelines
Lurie Children’s Hospital’s workforce development began 25 years ago with one staff member and seven students. Now it encompasses a series of programs and structured pathways, offering year-round clinical educational internships, workshops, and training for students from elementary school to college. Its signature program, Discovering Health Care Careers, is a six-week paid summer internship for high school students that includes workshops in resume writing, team building, and interactive sessions with clinical and operational leaders. In 2023, 50 people were accepted from 301 applicants. Around 75% of graduates from the program end up working for the hospital. In addition to offering training and education, the program addresses social needs such as transportation, nutrition, and mental health.
Onboarding
SSM Health Cardinal Glennon Children’s Hospital implemented a tiered orientation program to improve new graduate nurse (NGN) retention and patient outcomes in their PICU. Introduced in 2019, the program evolved from a fragmented system to a structured, three-tiered model. The 18-month onboarding utilizes consistent preceptors and provides ongoing support. Each tier includes two classes and a clinical curriculum. Tier one involves 12 weeks with a preceptor and five months of individual work. During tier two, the NGN completes six shifts with a preceptor and one year on the unit. Tier three involves three shifts with a preceptor, focused on specific patient assignments. This new approach reduced NGN turnover from 30% to 0% and improved patient outcomes, including two years without a CLABSI.
Recruiting
Nearly four years ago, Arkansas Children’s did not have a national recruiting strategy. As the hospital evaluated its recruitment and retention approach, it asked how to differentiate itself, attract more candidates, and utilize technology. The hospital implemented robust onboarding and training programs and measured time-to-fill and applicant volume. Recruitment teams leveraged LinkedIn for enhanced visibility and AI tools such as Job Pixel and Paradox for efficient hiring. They also established a seasonal staffing program, converting many seasonal workers to permanent staff. These innovative solutions resulted in rapid growth, from 3,200 to 5,300 employees and a significant reduction in time-to-fill positions, from 72 days to 53 days.
Workforce advocacy
A CHA workforce assessment found high vacancy rates among key physician specialists, subspecialists, and non-physician professionals, such as respiratory therapists and psychologists. To address these workforce needs at the federal level, CHA is working to secure robust funding for the Children’s Hospitals Graduate Medical Education Program (CHGME) — advocating for federal investment in hospital-based training and retention efforts and broadening eligibility for existing health care workforce loan repayment and scholarship programs. Liz Brown, CHA’s vice president of federal affairs, said federal support for health care workforce initiatives is often provided for adult hospitals and primary care providers. “We’re different than our community hospitals and adult-focused providers, but we do the same job. We need that same support,” she said.
