Rachel Woods: You talk to health leaders in other countries every day. What are the kinds of organizations that you talk to and what kinds of challenges are they facing in 2023?

Paul Trigonoplos: So Advisory Board International is a dedicated research team that serves any client whose headquarters is located outside of the United States. We're in about 25 countries — payers, providers, governments, tech firms, but mostly health systems is where we focus and in terms of what they're dealing with, we're seeing a lot of commonality in other countries with health systems and what health systems in the U.S. are dealing with.

Costs are rising higher than revenue or income. A lot of operational issues, whether it's ED demand or throughput or access or equity, health equity or behavioral health, aging populations dealing with vague reforms and sort of this murky like navigating whatever the government's telling you situation and disintermediation is happening too with surgical care and virtual care and of course, staffing.

Woods: So other countries are grappling with a lot of the same issues that the U.S. has been dealing with. That feels significant. Is that normal? Is it normal for there to be times in which the challenges that health systems are facing are as universal as they feel right now?

Trigonoplos: The way I think about it is in the lens of globalism and health systems relationships and their postures towards their peers in other countries, and globalism has existed in healthcare for a long time. Supply chains have been global, movement of clinicians and recruitment. Even some insurance companies have been global for a few decades, but when it comes to hospital operations, there's always been a, "No, we're going to operate the way our country operates. I'm not really going to pay attention to what's happening elsewhere."

I think COVID brought a stress test that every hospital around the world dealt with and it brought some perspective to the provider space. There's a more of an acknowledgement now that other countries have solutions that are worth your time and attention. In my eight years on the team, I've never seen the appetite for overseas stories and insights as high as it is now.

Alex Polyak: One thing I'd doubt, Rae, is that perhaps perversely, we are now all facing the problems of being victims of our own success in healthcare across specifically the last 50 years. Whether I'm talking to someone in Australia, in Saudi Arabia, in Latin Am, the fact that we're dealing with an aging population, a population which is living longer, but living sicker means that we're all having to reconstruct healthcare.

Even last night, Paul and I were on a call where we were talking to a former politician who also is a GP who is a physician, and he said to us, "When we created our funding for physician care in Australia, care was episodic." You went in once a year, twice a year, you might go years without ever engaging with anyone.

And now that you have chronic conditions, now that you have an aging population, this idea of funding for episodic care, it doesn't exist anymore. And that's something you see around the world. You see different problems based on different health systems and different funding models, but at the heart of it, we overall dealing with the fact that people are living longer or living sicker.

Woods: And we're seeing healthcare industries react in similar ways, which creates new sets of challenges. Paul, you've been on this podcast before talking about site of care shifts, something that is happening across the globe as an example of exactly what you're talking about, Alex, an aging population and an industry reacting to that and dealing with its ripple effects.

I guess I'd love to know in all your conversations, be it Australia or Japan or wherever, in between, is there a central challenge that you think that leaders are grappling with today no matter where they are across the globe?

Polyak: The obvious one is workforce. That is perhaps the greatest common denominator that every single health system in the world, regardless of how you structure it, has two things in common, patients it serves and people it needs to serve those patients. And everyone we talk to, private or public health system, Saudi Arabia, Finland, Australia, the U.S., everyone is struggling desperately and struggling desperately, I would add, not just for any one type of clinician, but struggling desperately for doctors, for specialist doctors, for specialist nurses as well as registered nurses.

And in many cases, it trickles on down to a lack of pharmacists in some countries to a lack of dedicated imaging professionals as we increasingly see in the U.S. We see that in many other countries as well. Everyone is crying out for more in the way of workforce.

Woods: And by the way, that is deeply connected to the other major challenge that you just mentioned, Alex, which is an aging population. People are getting older and sicker and in need of more complex care, which often means more or at least different caregivers that we just don't seem to have anywhere or we don't have enough of them everywhere.

Polyak: When you think about most of our industries, and this is something that Paul absolutely can speak to better than I can, but most of our industries have been able to dramatically scale without having to dramatically scale their workforce.

Healthcare has not been able to solve that, but our ratios, yes, we now can expand them in some ways based on new technologies and clinical protocols, but by and large, we're still dealing with a one-to-one type of care in a way that very few other industries are when you're faced with such a demand.

Woods: I don't disagree that this is the kind of global challenge that healthcare needs to figure out. I think where our audience might frankly be a little bit frustrated is that this is a conversation that we have been having at Advisory Board on Radio Advisory in healthcare for a very long time.

We've certainly been having it since the acute phase of the pandemic, but we all know that the challenges in workforce design and staffing existed long before we were dealing with COVID-19. I guess my blunt question is if everyone is facing this challenge, has anyone figured out an answer to the staffing crisis?

Trigonoplos: My sense is that no country as a whole has figured it out. What we're seeing internationally is pockets and specific organizations solving the problem in their own unique ways. And this is really coming up in partnerships. We've been doing a sort of international partnership archetyping piece of research lately, and one of the big goals we're seeing global partnerships pursue is improving staffing issues.

There are a few types of partnerships we're seeing. So first, we're seeing organizations partner with nursing and medical schools to increase pipeline in clinical placements. One example here is Ochsner and the University of Queensland in Australia partnered to create a new med school and students train for two years at one and train for two years at the other, and ideally at the end of it, they'll be a better place to go to Ochsner or University of Queensland.

Another one is partnering for training purposes to engage your staff. We're seeing a lot of clinical rotation programs where especially residents can operate at hospitals in different continents to both be engaged in their job, get a new training opportunity, but it's also labor for each of those hospitals as part of the partnership.

Three, partnering to get virtual support overseas. We're seeing a lot of systems access remote second opinions from Asia because it's a different time zone. So at night, you can call a doctor that's awake in a country like India, that's 12 hours ahead. And then lastly, on a macro level, and this is not organizational, this is more government, we're seeing a huge focus on partnering with governments to really get an immigrant pipeline to support clinician ability and ideally pipeline that way.