CCHC CEO Mike Lauf talks staffing challenges, the housing crisis, system successes and more

Adequate staffing, particularly nurses, is one of the biggest challenges facing Cape Cod Healthcare hospitals and other facilities, Cape Cod Healthcare President and CEO Mike Lauf told a breakfast meeting of the Falmouth Chamber of Commerce recently.

“We have over 500 job openings at Cape Cod Healthcare. We have, today, 300 travelers (about half of these positions are nurses who travel around the country to fill in vacant hospital positions); 35 to 40 at Falmouth Hospital, alone,” he told the group at the Coonamessett Inn. “We have to hire those travelers, to ensure we can deliver on our mission. But it’s not a long-term strategy."

The problem became particularly acute after the COVID-19 pandemic, when a wave of nurses chose to leave part- or full-time status for per diem work, Lauf said.

“We haven’t lost nurses to off-Cape, per se. We’ve lost nurses to per diem status,” he said. “When you sign up as a regular employee, you have to work a certain number of weekdays and weekends. When you sign up as per diem, you have to work some weekends, but you get to pretty much make your own schedule. So, we’ve lost employees to flexibility and their pursuit of how they want to live.”

Exit interviews with departing employees have shown that nurses and others stay because they believe in Cape Cod Healthcare’s mission of caring for the community, regardless of who the patients are or what their resources are, he said. The interviews have also revealed that they stay because they are bonded with and committed to their coworkers.

“We have to capitalize on that to make sure they come back full-time or part-time,” he said.

One member of the audience told Lauf his daughter is a nurse, but she wants to work in Boston, where she believes there are more activities for young people.

“We need to communicate with younger nurses that we don’t mind if you’re going to leave in three years,” said Lauf. “But we’re going to invest everything we can in you, and you’re going to be incredible when you leave here. And, when you’re ready to come home and start a family, we’re going to be waiting,” he said.

Lauf reminded everyone that Cape Cod has many attractions that a Boston lifestyle does not, and potential workers need to be made aware of them.

“We can’t offer the same night life, but our community is vibrant year-round. We can offer them oceans; and we can offer them trails and hiking and biking. We can offer them outdoor spaces and 20 minutes across the Sound to Martha’s Vineyard.”

Increased Violence A Concern

Even though staffing is a challenge, the turnover rate at CCHC is well below the state average, Lauf said, at about 9 percent.

Increased violence from patients at CCHC facilities has also been a factor in staff departing, he said.

“What happened during COVID? Why did people suddenly go per diem or quit? I think, to be blunt, administratively, I could have done better. And, too, the violence. I don’t know if you appreciate what these people went through (during the pandemic). I do, and it was awful.”

Aside from worrying about their own and their families’ health and safety during the early days of the outbreak, patient assaults increased, and the problem has persisted.

“Every day, somebody gets verbally or physically assaulted in one of our facilities,” he said. “Did you ever think we would need a sign that says if you’re violent to an employee, you’re not welcome back?”

CCHC has developed innovative ways to help the staffing issue over the years, including partnering with the Cape Cod Community College nursing program, enabling nursing students to do all their clinical rotations at Cape Cod Hospital, and subsidizing their loans.

On the physician front, a partnership with UMass Medical School allows about 15 or so future doctors to do clinical rotations at the hospital, and this past year, CCHC hired two physicians through the relationship, Lauf said.

Housing Crisis

Finding affordable housing is also an issue for staff, Lauf said.

“Are we prepared to have the difficult conversations to get meaningful work done to solve the housing crisis? I’ve been here 16 years and we’re not. So, what do you do?

“I can tell you we are losing nurses to Plymouth and Boston because it’s cheaper to live there.”

Lauf cited a recent interview he did with the Cape Cod Times, in which he said he wanted to let the market take care of the housing shortage. “And then I realized the market wasn’t going to take care of the situation,” he said. “We’re going to have to be creative (to build more affordable units). We’re going to do something.”

Financially, CCHC has a strong balance sheet, Lauf said. “But it’s been a tough four or five years, and we have put all of our money back into this healthcare organization.”

Preparing for designation later this year as a level 3 trauma center, investments in oncology, neurosurgery, orthopedic surgery, general surgery, and in updates and renovations at JML Care Center in Falmouth were also key investments over the past few years, Lauf said.

Many Bright Spots

Cape Cod Healthcare delivered on its promises made to the Upper Cape community in 2013, Lauf said, including the privatization of all patient rooms at Falmouth Hospital, a new intensive care unit, and renovations to JML Care Center. Two urgent care centers, two dedicated outpatient centers and improved physician recruitment to a level of 20 primary care physicians and nurse practitioners on the Upper Cape are also part of the success story, he said.

The organization has also continued to hold to its promise of remaining independent, despite the growing pressures in the healthcare industry, he said.

“I am happy to say we’re still a not-for-profit, independent health system that is solely responsible to you, the people who live in this community. And, given all the things that are happening today all across the state, all across the country, all across the world, the fact that you control your healthcare system is very important,” Lauf said.

Partnerships with other entities is also a bright spot in the CCHC story, Lauf said. He mentioned the partnership with Beth Israel Lahey Health for cardiac surgery, Dana-Farber Cancer Institute’s Cancer Care Collaborative for oncology, and Boston Children’s Hospital for a pediatric in-hospital physician program.

And partnerships within the CCHC system are also important. A strong cardiology program in Falmouth means that patients receive excellent care there, and, if they need certain cardiac procedures, they can have it done at Cape Cod Hospital. Maternity services are also now based at Cape Cod Hospital.

“And, if we can’t take care of you on our campuses, we are going to make sure you have the services you need in greater Boston,” said Lauf.

Steward Health Bankruptcy

Lauf was asked how the recent Steward Health Care bankruptcy would affect Cape Cod Healthcare.

“It will have very little impact,” he answered. “We did contract with Steward for well over 14 years with our physician network – we have something called a physician-hospital organization. We were in that for risk deals, and years ago we saw the train going off the rails (at Steward) and we ended that relationship. Looking back on it, it was such a good decision. We now contract on our own,” he said.

CCHC will not be able to recruit patients or potential healthcare workers from any of the Steward hospitals (due to the distance of their hospitals), but it’s going to impact Massachusetts greatly, he said.

The advantage of being a not-for-profit with CCHC’s mission has meant that it was one of the few healthcare organizations that staffed every single bed during the pandemic, Lauf said. “Our board of trustees never once said you can’t staff beds (in order to save money, as is done in many for-profit hospitals). I’m really quite proud of that.”

Healthcare is evolving and is going to look very different in five years, Lauf predicted, including where it is delivered.

“In 2000, 80 cents of every healthcare dollar was spent in the hospital. Today, 20 cents of every dollar is spent in the hospital. Most care is happening in the ambulatory arena. It’s changing and it’s changing rapidly, and I’m anxious to see where we end up.”

Behavioral Health

Behavioral health continues to be an area where change is needed, Lauf told the group. He cited social media and the widespread use of smart phones by teens and even younger as something that has hurt their mental health.

“In 2008, when I got here, we would have seven pediatric cases a year. Now we have seven in a day. So, what has changed in 16 years?”

There are not enough beds in the state to satisfy the need for behavioral health care for all ages, Lauf said. Telehealth is useful in helping with assessment, diagnosis and counseling, he said, and he acknowledged the state is working hard to solve the crisis. They are working with CCHC to find ways to find partners on the Cape for not only behavioral health, but for other issues, like anorexia, he said.

CCHC has bolstered its behavioral health services in recent years, he noted. “I like the fact that we have a dedicated inpatient center on the Cape as well as a partial hospitalization program where you’re sick but not acutely sick, so we can take care of you during the day and you can go home at night.”

He also cited strong outpatient clinics, and talented and compassionate psychiatrists, psychologists, nurse practitioners and social workers.