Staff Development

Balancing margin and mission in the business of healthcare requires collaboration between clinical and finance colleagues

January 22, 2021 12:48 am


  •  Finance professionals in healthcare chose this profession because we care about the patients and communities we serve.
  • The pandemic has heightened the need to continue strengthening ties between clinical and financial colleagues.
  • Supporting nursing colleagues must take into account the unique needs of multiple and sometimes changing care settings.

Editor’s note: During HFMA’s Digital Annual Conference June 26, Todd Nelson, HFMA’s director, partner relationships, and chief partnership executive, moderated “The Business of Caring: Increasing Value Through Outcomes-Based Staffing,” featuring  Pam Cipriano, dean of  the UVA Nursing School, and Robyn Begley, DNP, RN, NEA-BC, and CEO of AONL. See a recap of that session.

Most of us in the profession of healthcare finance could have chosen to be in a myriad of other finance-related industries, but we chose to be here. Or, were we chosen because of our strong focus on mission and community? This mission focus has at times created a good balance between our fiduciary duty and supporting the mission of the organization — but at times can cause us to struggle when financial times are tough. We have all heard the “no margin, no mission” phrase — and maybe even used it a few times.

The pandemic, like few other healthcare crises before, has placed the need for communication, coordination and collaboration with our clinical colleagues, especially in the nursing areas, squarely front and center. It has created a daily reminder of our mission focus, and dare I say flipped the phrase to “no mission, no margin.” As noted earlier, this is a careful balancing act we have all performed, and it is a call for strong leadership, tough choices and balancing multiple priorities.

In a recent McKinsey & Company report titled Future of nursing: Supporting nurses across care settings, the authors discussed how the changes in care delivery to non-acute care settings require leaders to rethink recruitment, retention and talent development strategies.

The report looked at several characteristics of inpatient, emergency, ambulatory and long-term care nursing. The notable findings for these settings are as follows:

  • Nurses in an ambulatory setting are closer to retirement age; 36% are over 55 years old as compared with less than 19% in the other three categories.
  • Ambulatory and LTC  nurses work shorter shifts and fewer hours than inpatient and emergency department (ED) nurses.
  • Ambulatory and LTC nurses report completing fewer training programs, such as residencies than inpatient or ED nurses.
  •  LTC and ED nurses perceive less support for their health and safety than inpatient and ambulatory care nurses.

The report focused on pre-pandemic data. However, when applying those findings to the pandemic, we can draw similar conclusions about the need for adaptive and flexible approaches and different strategies for attaining success in the non-acute areas.


The reality is much like any good strategy; the balance of resources needed to create a customized approach versus a one-sized fits all solution must be carefully considered. Although all areas of nursing are approaching retirement age, the consideration of targeted approaches to talent development, recruitment and retention appear to have the greatest need in ambulatory settings.

A few considerations for healthcare financial executives are:

  • Collaborate with universities to offer curriculum to ensure those entering the workforce are prepared for areas other than the acute inpatient care after graduation.
  • Consider rotations within your health system through ambulatory and long-term care settings as well as highlighting attractiveness of the shorter shifts and flexible hours (and for ambulatory care nurses, no weekend shifts), which may be attractive to those wanting advance degree.
  • Consider launching formal nurse residency programs in non-acute inpatient areas to increase training, awareness and development of skills needed for all care settings.
  •  Learn from and apply the more-developed retention strategies from other areas of the health system that have helped to lessen impact of workforce turnover and shortages.
  • Consider the additional impact on health and safety on nurses caused by the pandemic, and strategies employed to make caregivers feel safe and appreciated and apply them going forward.  

The pandemic saw a vast and expeditious proliferation of telehealth and remote care, which created the need for additional training and changed workflows for many teams. As more care shifts to the home, and a new set of technology enabled tools is unveiled,  ensure proper training and lessons learned from the pandemic are being deployed.

Finally, and maybe most importantly, work diligently and collaboratively with your colleagues in clinical areas to review shared challenges, understand common terminology, create mutually supportive dialogue and a safe space to serve our patients and communities. Many of the guiding principles in this paragraph are further outlined within the report HFMA released earlier this year in partnership with ANA and AONL.


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