This article is sponsored by Gale Healthcare. In this Voices Interview, Skilled Nursing News sits down with Tony Braswell, Founder and President, Gale Healthcare, to talk about how a new generation of digital platforms can help solve staffing challenges for skilled nursing providers. He shares how his background in healthcare and technology led him to develop a platform for “on-demand” nurse staffing, the efficiencies platforms provide, and issues skilled nursing providers should consider when choosing a staffing partner.
Skilled Nursing News: What career experiences do you most draw from in your role today?
Tony Braswell: I’ve spent 30-plus years in health care, mostly working with post-acute providers. So, I have a deep understanding of how they operate and the challenges they face.
I didn’t start out in health care. In college, I majored in computer science. My first job was working for a Medicare and Medicaid peer review organization in Florida, I spent five years developing systems, until one day, I learned I had cancer. I realized I didn’t want to spend the rest of my life writing code. Shortly after, I got a call from a recruiting company that wanted me to help hire IT talent. I accepted, but before I even started, they asked if I would focus on health care. That’s where I started learning about health care workforce challenges.
I was always interested in starting my own business, and a few years later, I opened a health care staffing company. We focused on hiring nurses and nurse aides to help clients cover shifts on a per diem basis. I’ve been working to help solve nurse staffing problems ever since. For 25 years, I ran a small staffing company in Florida. We worked hard, but we could never get ahead in terms of meeting client demands. It was so frustrating knowing shifts were going unfilled.
In 2016, after seeing on-demand apps pop up for all kinds of needs, I realized we could do the same thing for nurse staffing. That’s when my tech origins and all my health care staffing experience converged. We launched what we believe was the first digital platform for nurse staffing, and named it Gale, after Florence Nightingale. She revolutionized nursing back in her day and that’s what we wanted to do for nurse staffing.
Staffing is a huge challenge for skilled nursing and other health care providers. As someone who’s been working on this issue for 30 years, what has made the biggest difference to date?
Platform-based staffing has been a game-changer. Before Gale, I was a small staffing company with a few hundred nurses serving local clients. Today, we have more than 400 employees to support more than 60,000 clinicians nationwide. We serve thousands of clients across 40 states.
I often say, when I first started, tech-based staffing was having a roll of quarters to call a nurse from a pay phone to see if they could accept a shift. A little later we got voice mail and pagers and fax machines. No matter the tool, the process was the same. We had to talk with a client to see what they needed and then start reaching out to nurses one at a time to see if someone could go. We were limited by the number of connections we could make. But with a platform, all that works goes away. The provider posts their open shift online. A clinician looks on their phone to see the shifts available and accepts the one they want. They go to work without a person involved.
This approach is vastly more efficient. It has transformed health care staffing much like online shopping has done for retail. This morning, I bought a book on Amazon at 9:00 am and got an automated message saying it would be at my house by 6:00 PM. It’s so much better than getting in my car and driving to a bookstore – where it may not even be in stock. That’s what health care staffing platforms are doing. They provide the “on-demand” staffing solution that skilled nursing communities and other health care providers need.
Do you think nursing platforms will replace traditional staffing companies?
Yes, 100%. Traditional staffing firms are not able to provide service as quickly or reliably or at the scale that platforms can. They are going to have a hard time competing.
Staffing Industry Analyst, Inc. recently came out with a report that said that there are nearly 20,000 staffing companies in America, and right now, about 90% are very small firms. They mostly operate the old-school way. For those in health care, they are limited in how many clinicians they can connect to open shifts. Again, they’re doing it manually, one at a time.
Meanwhile, we’re adding more nurses and nurse aides to our platform every day. We hire more clinicians in a single week than many staffing companies have on their total roster.
Are all the platforms similar?
Platforms are similar in their basic model of using technology to connect health care providers and health care workers. When a nurse manager or scheduler realizes they have an open shift, they can go onto a mobile or desk-top app to post the assignment, specifying the skill level they need. Clinicians on the platform get notifications of the open shift. The more clinicians on the platform, the more likely that shift gets covered.
But there is one key difference. Some platforms, including Gale, hire clinicians as W-2 employees. We handle payroll taxes, provide workers’ compensation insurance, and offer health insurance options and other standard benefits of employment, which is consistent with how nurses have worked traditionally.
Some newer platform companies are set up differently. They treat clinicians as 1099 independent contractors. Their position is they only “match” workers and clients with their platform. They don’t employ them and so aren’t responsible for employee-related costs. This independent contractor model imposes risk for patients, for nurses, and for the health care providers where they work. Health care providers can be considered a “joint employer” of the staffing platform, and held accountable for unpaid taxes, overtime pay and other costs.
We’re seeing increased legal action against platform companies that are misclassifying clinicians as independent contractors, and against health care providers where these clinicians work. A Department of Labor rule on worker classification expected to be finalized this Spring will bring even more attention to this issue. I would advise any health care organization considering a staffing partner to make sure they understand the type of clinicians they are getting. Having misclassified clinicians providing care can bring significant financial and legal exposure.
Beyond being a W2 employer, are there other differentiators for Gale?
Our deep understanding of the health care industry sets us apart. Some of the newer platforms that sprung up during the pandemic are from the tech world. They saw the urgent need for health care workers, and they jumped in with apps to help fill it.
At Gale, we bring all the advantages of technology, but with all the knowledge that comes from a career serving the health care industry. I know so many dedicated nurses and nurse aides, and managers working in health care. Understanding their needs is what enables us to keep improving our platform. Everything we do is with their needs in mind.
For example, one thing we offer clinicians is daily pay. Most clinicians are paid less than eight minutes after they’re done working. Why do we offer this? Because the average nurse working for us is a single female, age 44, with two kids. She’s working hard to get ahead, and the sooner she can access her pay, the sooner she can meet her family’s needs. This provides more financial freedom that can help reduce stress, and hopefully, keep them coming back so health care providers have the temporary support they need.
What else can be done to help meet more nursing needs?
We have to find ways to support our nursing workforce and help grow it. Platforms like Gale give nurses more control over their lives. If we can make it quick and easy for them to find and accept work, we can reduce stress, ease financial burdens, and ultimately, help get more shifts filled.
We also need to invest in nursing education. Last year, we created the Gale Health care Foundation to provide scholarships for people who wanted to go to school for nursing or pursue higher level skills. But we quickly realized we’ve got nurses or aspiring nurses facing other challenges. Sometimes, before you can worry about school, you’ve got to make sure you can keep a roof over your head. And so, we’ve expanded our mission to help with broader needs. If we can help people with housing, medical emergencies, or other crises, then hopefully, they can get the support they need and stay in nursing.
Platform-based staffing has been a game changer in terms of helping providers secure the staff they need. What’s the next major disruption you see?
AI and other technologies will allow us to continue improving service for health care providers and for clinicians. With digital platforms, you can look at data and trends so much more quickly and easily than when working manually, with hand-written notes and spreadsheets. All this data provides valuable insights about how to make technology work better.
For example, you can see exactly when a particular health care provider is most likely to need help, and what skill type they will need. And based on those past records, you can see the clinicians most likely to accept their shifts. You can then set it up to give those clinicians priority in accepting the assignment. It rewards the nurses that have supported that health care community, and it helps the health care community with continuity of care.
With our deep understanding of health care, our industry-leading platform, and all we’re learning from looking at client and clinician trends, we can help skilled nursing centers and other health care providers find solutions to their staffing challenges.
For me, this work is about more than running a business. It’s personal. My mom is about to enter a skilled care center following surgery. My dad spent time in a similar setting, as have many other loved ones. And so, I get up every day thinking about ways to help people in these situations get the care they deserve, so they can maintain quality of life and dignity. I consider it a privilege to work in a field that benefits so many people.
Finish this sentence: “In the skilled nursing industry, 2023 will be the year of…”
…choice.
Editor’s note: This interview has been edited for length and clarity.
Gale Healthcare launched the first digital platform for healthcare staffing in 2016, and it continues to lead with innovations that serve healthcare clients and clinician. Today, Gale employs more than 60,000 clinicians and serves thousands of healthcare partners nationwide. Get “on demand” access to nursing staff, 24/7 support, and a team of long-term care veterans who can help find solutions for your staffing needs. Reach out here to learn how Gale can help or to schedule a demo.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].
