Staffing Issues Facing Transplant Centers in 2021 and How to Tackle Them

By Koren Axelrod

While COVID-19 has brought many new challenges to transplant centers, staffing is one that has existed long before the pandemic.

When caring for a complex—and increasing—patient population, limited budgets combined with high turnover rates have always been top concerns for transplant center administrators.

In the past several years, many things have increased the demands on an already over-burdened transplant center staff, including:

  • Increased regulatory requirements
  • Caring for sicker patients
  • Use of more marginal organs
Transplant Professionals

This situation has been made even more difficult by the pandemic; calls and questions from patients seeking clinical advice on things like the COVID-19 vaccine have soared.

At the same time, hospitals need to:

  • Encourage non-patient facing staff to work from home when possible
  • Staff screening stations at patient entrances
  • Administer vaccines in public clinics depleting already limited transplant center resources

The additional workload and expanded opportunities for higher-paying work elsewhere also appear to increase the already high turnover rate of staff in transplant centers. The result leaves transplant center leadership wondering:

  • “Where did everyone go?”
  • “How do we maintain high-quality outcomes?”
  • “What can we possibly do to meet the requirement of hospital leadership to increase volumes?”

If this is where you find your transplant center in early 2021, you are not alone.

There are, however, a few possible solutions to consider.

Reallocation of Responsibilities

Start with the easy one—reallocation.

This involves taking a hard look at the responsibilities of each staff member. Don’t leave anyone out, and physicians are fair game here too. Reallocation is about moving the pieces around to get more out of the team as a whole.

  • Involve the Team This will require A LOT of creative juices, so get everyone involved in the process. This will help with buy-in as well. The staff will have lots of ideas, and by including them in the process they will be more likely to ensure success of the final product. This will require letting go of old norms and things that are comfortable, so be ready to provide the team with lots of support and encouragement.
  • Use Tools Process maps, brainstorming with sticky notes, and shared Google documents are great tools to stimulate creativity and innovation. If you aren’t familiar with these tools, reach out to your hospital quality- or project-management office. If they are unavailable, we have several other articles in this series that may be able to help as well.
  • Ask the Tough Questions – The goal is to have every staff member working to their fullest potential and license abilities.
    • Some things may be nice to have, but do you really HAVE to have them? And if you must have them, do you really have the right person doing them?
    • Reach out to other transplant centers to see how they are doing things. There is no need to reinvent the wheel.
    • Be open to utilizing staff outside of your center for some tasks. For example: reception or centralized scheduling.
    • Be sure to re-read the regulatory guidelines. Over the years, there have been many myths propagated about who is required to do what. Re-reading the guidelines may open opportunities to shift responsibilities.
    • Take advantage of technology. If there are tools in your EMR that help to automate things, use them!

Request for Additional Staff

I’m sure you rolled your eyes when you read that. Asking for additional staff? During a pandemic? Sounds crazy, right?

It is possible, though, to ask for additional staff and get approval right now.

  • Word the Request in Terms of New or Additional Volume – Organizations want to be able to increase volume—especially right now. If your staffing proposal can demonstrate how this addition in staff will help to reach that goal, you have a much better chance of getting it approved
  • Be Creative with What Staff You Request – We are sometimes quick to think that a new fulltime coordinator is what we need. However, focus on the work that is needed.
    • Level of Staff Needed – Could the work be done by a different level of staff that may be less costly—like a medical assistant or secretary? Or by a staff member that could fill other roles—such as a social worker or an NP. (Remember, an NP can independently bill for services, which can be a bonus when justifying a position).
    • Hours Per Week Needed – Do you really need a fulltime position, or would a half- or even three-quarters-time position meet your need? Remember, those who are less than fulltime not only cost less in salary but are also less expensive in benefits and even in the space they need.
    • Shared Positions – Is this a position you could share with another department?
  • Don’t Forget the Cost Report Be sure to include how much of this new position can be reimbursed through the Medicare cost report each year.


Outsourcing is the opportunity to purchase the service from an outside vendor.

A typical example of this is a system like Buckeye Transplant Services, which helps with covering organ offers.

However, there are other companies out there that can offer different services, from prior-authorization work to waitlist management services.

Outsourcing offers many benefits over a standard staffing model.

  • Reduced Cost – A service such as this can often be much less expensive than adding even one new staff member. Outsourcing provides the additional work capacity without adding the expense of benefits, space, and training.
  • Reduced Burden on the Center – In this scenario, the outside company is responsible for staff turnover, hiring, training, and performance management. This can free center staff from countless hours of work over the course of a year.
  • Flexible Solutions – Outsourcing can be much more flexible than hiring additional staff. You can typically adjust the amount of time you pay for—with some notice of course—as you need more or less assistance. Also, if there is a time when the services are no longer needed the contract can be ended.

No matter how you choose to address your short-term staffing issues, creating the right culture within your center is the key to long-term resolution of these issues.

Staff who have a sense of satisfaction with the work that they do—and feel valued—will work harder and stay for longer periods of time in their positions.

Developing a sense of true teamwork and focusing on what really matters (the patients we care for), will keep staff motivated day to day … even in a pandemic.

Explore XynCare to see how waitlist management or administrative support services could make a difference at your transplant center.

Learn how XynQAPI can provide you with simplified access and insights into your transplant center’s QAPI data.

Koren Axelrod

Koren Axelrod has over 20 years of experience in transplant, both as a transplant administrator and transplant quality director. Her passion lies in patient engagement and quality improvement. She is currently a Sr. Business Analyst for Digital Products at CareDx and focuses on developing technology for transplant centers, doctors and patients.

Koren Axelrod