This article was originally published in Infection Control Today on February 8, 2024

Discover insights from Cindy Gaines on healthcare challenges, including rising costs, workforce shortages, and perioperative care transformation in 2024.


In today’s dynamic health care environment, Cindy Gaines, MSN, RN, chief clinical transformation officer at Lumeon, provides crucial insights into the industry’s pressing challenges. Addressing rising costs, workforce shortages, and the need to prioritize both revenue and patient safety, Gaines offers illuminating perspectives and potential solutions.

This article explores Gaines’s insights, and a recent study on clinical workflow automation that she discussed with Infection Control Today® (ICT®), examining the intricate landscape of health care challenges in 2024 and effective strategies for managing them.


ICT: Can you elaborate on the key challenges the health care industry faces in 2024, especially regarding rising costs, workforce shortages, and the need to balance revenue and patient safety?

Cindy Gaines, MSN, RN The headwinds health care leaders face continue to be relentless. Although average health care organization margins have slowly edged up to 2.0%, 54% of health care organizations still report that their financial health remains worse than before COVID-19.

Add to that ongoing workforce shortages. The nursing workforce fell by 100,000 nurses by the end of 2021, the largest drop in 40 years, according to Health Affairs. Another 610,388 nurses reported that stress, burnout, and retirement would cause them to leave the profession by 2027.

Yet, as capacity constraints persist, the need for care will continue to expand rapidly as a large portion of the US population–Baby Boomers–will all be over 65 by 2030. As this population ages, the need for surgical care, such as joint replacements, increases. With this critical source of revenue at risk, health systems face the constant need to balance staff shortages, which jeopardize patient safety, making care readily accessible to the communities they serve. The common approaches—contracting with costly independent nursing agencies or pressuring existing resources to “do more with less”—are neither viable nor sustainable.

ICT: How do the identified challenges impact the perioperative process, and why do staffing constraints take precedence as the top concern, with cost and revenue deadlocked as second and third?

CG: A recent survey [“Care Orchestration Overcomes Today’s Challenges Surgery Market Research Highlights Automation Benefits”] of more than 300 health care leaders—a mix of clinical practitioners and business/operations and IT leaders—captured their perspectives on today’s challenges and the potential for investing in clinical workflow automation to transform the perioperative care process.

The survey found that 80% of clinical and information technology (IT) leaders agree that current approaches to care coordination, especially for perioperative care, are too complex, tedious, and expensive. The survey highlighted that there is strong consensus among executives that staffing constraints are the biggest challenge, while executives are evenly split about the next 2—reducing costs and increasing revenue.

Executives are aligned about the fact that nurse vacancy rates are at all-time highs, with most hospitals (51.4%) reporting rates over 15%. However, health care leaders need to reach a consensus about balancing revenue and cost. The notion that nurses can “do even more with even less” is simply not feasible. To become better aligned about viable solutions, stronger collaboration between chief information officers (CIOs) and clinical teams is needed. Giving CIOs more visibility into the pain points on the clinical side will shed more light on opportunities for automation to address them and enable CIOs to advocate with other executive leadership.

The survey also revealed that more than three-quarters of clinical and IT leaders cited challenges that technology should be able to address directly, including the reduction in manually intensive, wasteful activities such as checking patients’ records, digital rounding, gathering patient information, and ordering labs.

Looking deeper, the need for CIOs to be equipped to advocate for solutions is reinforced in that nearly two-thirds (63%) of nursing and surgical chiefs agree that automation allows time for better care, while only 36% of CEOs and financial chiefs agree. CIOs have an opportunity to highlight the potential for clinical workflow automation solutions to reduce costs and increase efficiency—directly addressing the pressures CEOs and finance leaders face.


ICT: Considering the critical role of surgery in revenue generation, what specific issues in perioperative care demand attention and orchestration, and how do these contribute to significant cost and waste in the health care system?

CG: Surgery is a vital source of revenue for health systems, making care coordination for perioperative care crucial to quality patient outcomes and financial performance. The process is particularly complex given clinicians’ need to coordinate joint efforts to understand the patient’s medical history, evaluate surgical risks, manage unforeseen incidents, and initiate post-surgical recuperation. Add to that the need to schedule and assemble the large, diverse clinical team at the same time and place.

If everything doesn’t come together as planned, there are significant potential risks to patients and financial impacts. This process is a source of substantial cost and waste— canceled surgeries account for $22.3 billion in lost revenue, $78 billion in waste due to lack of coordinated care, and $101 billion in waste from overtreatment.


ICT: The survey highlights conflicting perspectives on the importance of care coordination automation. Why do executives not prioritize it despite acknowledging its potential benefits, and what role do IT budget and staff constraints play in this decision?

CG: While the survey revealed general agreement that care coordination automation improves care, only a third of respondents deem it “very crucial.” Approximately two-thirds view it as either “important but not urgent” (44%) or “not a priority” (22%).

Budgetary constraints are the most likely cause for the lack of urgency. Over one-half (54%) of surveyed executives indicated that the most significant barriers to implementing care coordination solutions were IT budget and staffing issues. Budget pressure is not letting up as health systems are forced to use expensive nursing agency resources to address ongoing nursing staff shortages.

ICT: Given the prevalent nursing shortages, how can stronger collaboration between CIOs and clinical teams address the challenges on the clinical side, particularly in automating processes to alleviate the burden on nurses?

CG: Stronger collaboration between IT decision-makers and clinical teams is critical to forging the best path forward. By understanding how clinical workflow automation can address the challenges—from the point of view of front-line care teams and executive leadership—health care organizations can make strategic investments that deliver measurable, sustainable returns.

For perioperative care, this collaboration should focus on a comprehensive approach to holistically coordinating data and actions across platforms. For example, clinical workflow automation has been proven to effectively:

  •  Handle tasks typically performed by nurses, allowing them more patient-focused time.
  •   Aggregate essential data from patients, EHRs, and other sources to prevent redundant tests.
  •  Ensure all necessary steps are taken in advance, reducing last-minute changes or misunderstandings about surgery preparations.
  •   Assist in identifying patients needing additional care and guidance.

With a holistic view of perioperative care, data integration across systems and processes increases efficiency and enhances patient outcomes, resulting in substantial savings for health systems.

ICT: The report suggests a holistic approach to orchestrating care processes, particularly in perioperative care. Can you explain how such an approach, leveraging intelligent automation, can positively impact nursing capacity, patient care, and overall process efficiency?

CG: At the heart of clinical workflow automation is using automation to augment what clinicians do to create personalized care journeys for patients while relieving them of unnecessary work. For example, a large health system used automation to create a highly personalized process for patients while unlocking significant amounts of capacity.

Typically, when an order is placed for surgery, the patient’s information may be spread across multiple systems and locations, such as provider records, the hospital EHR, and other systems. Using automation, the system acts immediately when the order is placed to review available records and engage the patient to gather information needed for accurate risk stratification. For instance, when imaging is required for surgery, and the patient’s record shows a recent qualifying result, an unnecessary image is avoided, nurses do not have to track down that information, and care costs are reduced.

From the patient’s point of view, automation can dynamically adjust to their needs. For example, this health system required every preoperative patient to visit a nurse to complete a surgical intake.For most patients, this visit included gathering information about the patient’s medical and surgical history, order scheduling, and lab reviews, which are steps that can be automated. Automation makes for a seamless process whereby patients electronically complete intake forms, and this information is then documented directly into the patient’s medical record.This allows patients to move through the intake process digitally, eliminating most in-person visits while ensuring that nothing falls through the cracks. In parallel, clinical workflow automation brings patients needing more assistance to the attention of the care team, who now have more time available to provide that extra care.

This health system documented significant results. Within 60 days of go-live, 67% of patients bypassed an in-person visit they didn’t need. In addition, the health system surpassed its goal of gaining a 40% lift in productivity with a 60% lift, for its care team of 10 nurses, which translated to 5,340 hours—the equivalent of 2.5 full-time equivalents (FTEs)—of time freed up to focus on those patients who needed more attention and other patient care activities. For all patients, the experience is highly personalized, giving them precisely what they need when they need it to prepare for their surgeries.

Given surgery’s importance as a key revenue source for health systems facing ongoing staffing constraints and cost pressures, perioperative care is ripe for clinical workflow automation that can transform the process while enabling high-quality patient care.