This article was originally published on the blog at on Jan. 19, 2024.

AdventHealth, a nonprofit 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 more than 50 hospitals across 9 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 shortage marked by retirements, burnout, and industry challenges. The U.S. Department of Health and Human Services reports a current shortfall of 100,000 nurses, with an expected annual deficit of more than 60,000 registered nurses over the next decade. 

Addressing these challenges, Tom Nesteruk, senior vice president HR and associate chief people officer at AdventHealth, recently outlined the organization’s innovative HR strategies in a webinar with HiredScore (a Workday company) Founder Athena Karp. 

Below, we highlight the critical takeaways from the conversation, emphasizing AdventHealth’s use of AI to tackle post-COVID-19 challenges and labor shortages in healthcare. We also delve into the provider’s 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-19, we had nurses leave to join agencies and make higher wages, which increased the cost to our healthcare systems and contributed to this labor shortage,” said Tom Nesteruk from AdventHealth. “We have more than 50 different hospitals, and with those hospitals, there’s a CEO that runs each facility. And when we spoke to them, their number one priority was 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 that recruitment and retention was our focus,” Nestseruk added. “From a technology standpoint, this is where HiredScore came into the picture.” 

Deciding factors that helped AdventHealth determine where to begin its AI journey:

  • Macroenvironmental challenges. Postpandemic, 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.

  • ‍High-level organization strategy. AdventHealth’s HR strategy had to align with its 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 such as HiredScore to improve its recruitment processes.

  • Faster HR processes. “Our hiring managers, not just our recruiters, are seeing the benefits of using an AI tool like HiredScore,” Nesteruk said. “For instance, we had the biggest challenges in getting our hiring managers to disposition candidates, which I think is probably common in most companies. 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 reviewing resumes to taking the next steps of scheduling interviews and statusing candidates. That has greatly helped our overall speed to hire.”

HiredScore’s features also enabled AdventHealth 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, AdventHealth 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.

“Since we implemented HiredScore about seven months ago, we’ve seen a 40% decrease in our hiring manager decision time, from reviewing resumes to taking the next steps of scheduling interviews and statusing candidates.”

Tom Nesteruk Senior Vice President HR and Associate Chief People Officer AdventHealth

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

“We reduced our agency spend drastically by just under $100 million; in fact, around $68 million to be exact,” Nesteruk said “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-19, and it’s because we tied our HR strategy with our executive and CEO strategy at each of our facilities,” he continued. “It’s paying dividends to our hospitals, not just from a financial stance but from an experience stance as well.”

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

  • Business priorities alignment. The organization’s primary business objectives include addressing the labor shortage through strategic recruitment, retaining exceptional talent, and minimizing expenditures on external agencies.

  • ‍Implementing tools for achieving HR goals and larger business objectives. By implementing HiredScore, AdventHealth significantly bolstered hiring efficiency and effectiveness. HiredScore not only helped accelerate the time-to-fill for positions and enhanced the overall candidate experience but also 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 such as cost reduction. 

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

“Across our network of facilities and hospitals, over half have seen an increase in their patient safety ratings, a metric we measure using Leapfrog,” Nesteruk said. “This improvement is largely attributed to being fully staffed in critical areas. I’ve had CEOs tell me, ‘We don’t have any nurse openings. It’s the first time I’ve seen that in the 10-plus years that I’ve been here.’”

“It’s had a direct impact on our facilities and how we treat and service our patients,” he added. “We have all the data to back it up through our safety scores, not to mention that we’re seeing in a lot of our facilities that even our patient satisfaction score is impacted, with those scores on the rise.”

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

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

Journey so far: AdventHealth embarked on a transformative journey to integrate advanced AI technologies such as HiredScore into its operations. This initiative, however, faced challenges due to the initial resistance to technological adoption. Particularly within its 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 human capabilities. As adoption increased, many initially tentative recruiters began to acknowledge the positive impact of AI on their efficiency and effectiveness. 

As [AI] adoption increased, many initially tentative recruiters began to acknowledge the positive impact of AI on their efficiency and effectiveness.

Looking ahead: AdventHealth’s strategic focus extends beyond the 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. 

5. What advice would you give to talent acquisition leaders looking to implement AI for the first time within their talent acquisition team?

“When we decided to implement HiredScore, it was a comprehensive business decision, not solely an HR initiative,” said Nesteruk. “This involved soliciting feedback from various stakeholders, including the markets we serve and 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.”

Nesteruk’s advice to talent acquisition leaders looking to implement AI for the first time is threefold: 

  • 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. 

  • 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 the business internally and externally, particularly in relation to patient care and hospital operations. 

  • Continuously review and adapt. 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 might not have been initially considered.

To learn more about AdventHealth's decision to select Workday to support its commitment to whole-person care, read the newsbrief

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