HIStalk Interviews David Howard, CEO, TeamBuilder

David Howard, MPH, MBA is founder and CEO of TeamBuilder.

Tell me about yourself and the company.

We started TeamBuilder in 2021. It grew out of almost 20 years of healthcare consulting. Much of that involved performance improvement, hospital and health system strategy, and the growth of health system employed physician practices.

Over the past 10 to 15 years, small private practices grew into large medical groups that health systems acquired. A lot of our work was focused around supporting that growth. The early stage of the TeamBuilder concept was studying how staff and staff management within those groups drive cost-effective access to care.

The reality then, as it is now, is that staff scheduling for these health system medical groups and smaller standalone groups is generally done on paper and spreadsheets. TeamBuilder was born out of that prior work to digitize the schedule process through a digital staff schedule that’s built for that care setting. We also apply data science to patient visit volume to align the team by hour and by day to drive cost effective access to care.

As for me, I spent 20 years in healthcare consulting in various aspects, from financial distress to performance improvement.

What challenges of paper scheduling can technology improve?

The scheduling of staff, and even providers, is more complicated than it seems. Dr. Smith might work Monday through Thursday, while Dr. Jones might work Tuesday to Friday. But when you’re talking about the staff – clinical, non-clinical, nurses, and front desk workers — every day is different, because different providers are in the office different days. Each provider sees a different number of patients for an array of reasons, such as the type of their patient panel and how busy their practice panel is. Monday to Tuesday to Wednesday to Thursday can be very different, and very different each week.

There’s a lot of turnover and callouts. A lot of mental gymnastics goes into setting the schedule a month or a couple of weeks out. I’ve got these callouts in the morning. My only front desk person called out. How I find the right person to backfill?

Schedules seem static and stable to an outsider, but a lot goes into it. If it’s a static piece of paper or spreadsheet, it’s hard to make changes and send them back out. Nobody has the right system of record or source of truth for what that schedule is on that given day.

Second is that provider practices, independent or not, don’t have a good way to understand the work that is needed to support that care. It involves a lot of heuristics. A rule of thumb might say that I need two nurses per doctor, but any benchmarks that are out there aren’t grounded in fact. How long does it take to check patients in, check patients out, room them, and come back in and give the injection or support a procedure in the office? It can be eye-opening for what is actually needed versus what managers, providers, physicians, and executives think might be needed .

TeamBuilder does both of those things.

What does your market look like?

When you think about the world of staff and staff scheduling, minds go towards existing legacy scheduling providers. Some great great solutions are out there, such as UKG Kronos, Symplr, Smart Square, and ShiftWizard. They focus on inpatient nurse scheduling solutions and provide the highest value there. It’s very different from the outpatient side of clinical practice and operations.

The outpatient ambulatory side of the house has been neglected over the years. That’s often surprising to people when we talk about TeamBuilder. Many health system executives don’t recognize the differences of staffing across the two.

What variables can be used to prevent overstaffing?

A lot of this is driven by visit volume by hour and by day for the office. In many cases, folks are just thinking, we’ll do 70 visits on this day, so I’ll need this number of people to work these shifts. But what does that look like over the course of the day? Is it 70 visits from eight until noon, and then nobody comes in from noon until 4:00? Folks often anchor by staff or provider, but we believe it needs to anchor on the visit volume and the visit volume throughout the day, not just in total. That is hugely important.

The other variable is how work occurs by specialty. We work with clients to understand their workflow. We have significant client cohorts, so we can say that within neurology, here’s how work is done and here’s how that team can be best aligned.

Do most organizations track productivity and staffing levels using external benchmarks, their own history, or nothing at all?

Some benchmark sets are out there, but the sample sizes are quite low and the questions are simple. The accuracy of the respondents to these benchmark surveys is not very high. The benchmarks that prevail most are the number of staff, which could be clinical or non-clinical, as a function of the number of providers. That becomes a problem, because providers could see 10 patients a day or they could see 35 patients a day. Why would you allocate staff the same if that’s the case?

Another common one is the number of staff per 10,000 RVUs. Relative Value Units is a metric that quantifies the amount of work effort. But it’s a billing designation that becomes a function of the acuity of the visit, how long it took and the complexity of the medical decision-making. But you don’t know any of these when scheduling a patient. So while it’s nice to be able to quantify using RVUs, it’s Monday morning quarterbacking. You won’t know the level of work effort until after it happens.

We anchor on visits. That’s what’s on the schedule and that’s what you need to set the schedule in the future.

What are the employee benefits of efficient scheduling?

It’s important to be able to quickly see your schedule on mobile or web. If the manager is putting out a paper schedule every other week that I take a picture of , what if it changes? Jenny calls out and now you don’t have an accurate view. That’s understanding your schedule, but it’s also important to be able to call out from your shift automatically so your manager doesn’t forget that you told her two weeks ago that you can’t come in.

People in all industries are looking for more flexible schedules. There’s remote work, or I want to be able to pick up a shift on my day off when someone calls out. Trying to manage a dynamic, flexible workforce is hard if you’re doing it on paper and spreadsheets.

Staff love the ability to see open shifts, pick up shift requests, and live in a more dynamic world. A lot of organizations are thinking about, should I pay a premium if I ask Joey to drive in from an hour away? If you pick up a shift inside of 24 hours, do I give you a little bit of a kicker? Staff are  excited about these things.

Can that help to reduce the cost of contracted workers, such as traveling nurses?

We often first think of managing the fixed workforce. You are hired to work Monday to Friday, 9:00 to 5:00, 40 hours.

How do I make sure that you’re providing that effort that you’re contracted for in the right place? Have I hired float pool or flex resources who I can tell where to report at a given time? Do I have per diem staff, either a little per diem group that is managed by the health system itself or engaged from nurse per diem companies to backfill shifts that I can’t fill from the first group? How do I get my best fit resource for the lowest expense and proper skill level alignment? 

Does AI have a potential role in your product?

It definitely does. We are constantly thinking about how to use AI behind the scenes, such as validating code or looking at user experience analytics. We use AI in a variety of ways today.

As we move forward, though, it’s important for our data science and analytics and recommendations to be well understood. Leaders and physicians and managers should be able to quickly understand why that recommendation was made, why this might be a better schedule, and how I should act on it.

At TeamBuilder, we are further clarifying what we do as an operational intelligence platform. We think of it as this intersection of  intelligence, which could include AI, and a practical reality that is well understood and explainable. The right answer can’t come from a black box, where nobody knows why the right answer today is 1.27 nurses.

I haven’t seen many CEOs and investors who have earned an MPH, which looks at how society can improve the health of the largest number of people rather than treating healthcare as a business. How do you see that intersection of healthcare and business?

I started in healthcare consulting out of business school after my MBA. I fell into it and grew to love it. Being able to drive business change inside of a clinical environment has been rewarding. When I was younger, I never foresaw myself getting into healthcare. I was doing turnarounds, distressed work, and strategy for health systems and growth. There becomes a time where you’re only looking at it through the business principles. I did not have as much exposure to the broader public health delivery ecosystem.

Going through the executive MPH program at Columbia rounded out that perspective. How is care delivered? Where does it need to be delivered? How is it done cost-effectively to provide value to community need?

There absolutely can be the intersection between running a business in an organization, but doing it in a way that benefits patients and providers optimally. The two are often at odds with each other, but don’t need to be. The backgrounds of the folks on our team let them live at this intersection between provider experience – which could be clinical or non-clinical – and business experience to be able to translate that. 

What factors will be important to the company over the next three or four years?

The care delivery environment continues to change. The mix of in-person, remote, inpatient, outpatient ambulatory surgery, and in-home care will need to be supported with flexible dynamism. The ways to support those settings are not well understood. A lot of our focus is to be nimble in helping organizations proactively recruit and retain talent and align it to drive care in different care settings.