The 0.35 FTE Leak: Why Your Healthcare Staffing Shortage Is Actually a Communication Systems Crisis

Every hospital leader knows staffing is tight. They also know this is not a cyclical problem. Demand and chronic disease levels are both rising as the population ages, while supply is shrinking through retirements and burnout.

In the US alone, a shortage of between 54,100 and 139,000 physicians is projected by 2033. The picture is similarly dire globally, with the World Health Organisation (WHO) projecting a global shortfall of 11 million healthcare workers by 2030.

And that’s only the visible pressure. There’s a more insidious pressure on support roles that rarely makes it into workforce dashboards. EVS, transport, dietary, and admissions teams are thinning faster than clinical groups, but the downstream impact lands squarely on clinicians. Lose a third of your transport team and nurses aren’t just losing support, they become the support.

This effect has a tendency to compound: A missing transporter adds twenty minutes to a nurse’s shift; a short EVS roster adds fifteen more for room turnover. All told, these tasks can drain two to three hours of clinical capacity every shift. What looks like inefficiency is simply the new baseline of task stacking and backlog.

And because no system can summon staff out of thin air, the next question is key: where is clinical time being absorbed by work we can remove immediately? The largest loss sits in a place that leaders rarely quantify: the invisible tax of communication overhead.

Communication Friction: The “Human Router” Problem

When units run lean, communication has a way of reshaping roles. Clinicians become human routers, relaying updates, tracking people down, and stitching together information that systems should surface on their own.

But an RN shouldn’t be the one who knows that Dr. Chen is in room 412 and reachable only by cell. That’s the kind of cognitive load that adds significant weight over time, especially with alerts overlapping and competing for attention. The mental effort required to judge that noise and combat alert fatigue while handling real patient care is now an important clinical problem. 

In some senses, the result resembles a hydraulic system with a slow leak. A unit that once processed four admissions an hour now manages two, simply because every admission requires twice the coordination. Staff exert more energy just to maintain previous output.

Fixing these leaks is the nearest lever leaders have to stabilize operations. Unlike hiring, the impact doesn’t wait on recruitment cycles. It starts as soon as communication stops depending on workarounds.

Why the Old Communication Playbook No Longer Works

Legacy communication models assume stable staffing. They falter when rosters shrink by a fifth and the nurses’ station is intermittently empty or run by two people managing a dozen priorities. The familiar hub of coordination is not so much a hub as an overburdened checkpoint.

Distributed care adds further complexity. Remote monitoring, virtual sitters, and hybrid consult teams mean the right person is often nowhere near the unit. Paging “the floor” works only when the floor holds the audience you intend.

Data issues compound the mismatch. Outdated on-call lists, disconnected transport systems, and stale phone trees add minutes to every escalation, on top of the frustration. Twenty minutes for a stat consult may feel like it ought to be an anomaly, until you realize the delay is baked into the infrastructure.

The emerging standard is a communications approach that automates who should receive what, when, and where, so staff can focus on the clinical reason behind the message.

What Comms Friction Means for Different Stakeholders

CNOs see the daily impact first: communication friction erodes retention. Staff are rarely leaving because they find clinical work difficult; they leave when administrative load makes difficult work feel unmanageable.

For CFOs, the numbers accumulate quickly. Two hours of coordination loss per nurse per shift becomes 730 hours a year. That’s the equivalent of 0.35 FTE tied up in overhead rather than patient care. In a 400-bed facility, that coordination tax can equate to losing dozens of full-time clinicians to paperwork and phone tag, without a single vacancy on the HR books.

CIOs face a different challenge: tool spread. Every new app adds one more login, one more training cycle, and one more failure point during peak demand.

Best Practices for Reducing Load During Labor Shortages

Our work with hospitals has shown a consistent pattern: manual consults create long, avoidable detours. A verbal request turns into an outdated on‑call list, a page to the wrong person, a callback, another page, a second callback for context, and a chart review before anything moves forward. In practice, teams tell us this sequence often costs about twenty‑two minutes and six interruptions.

When routing shifts to the system, that chain contracts. A request triggers the workflow, the platform selects the right clinician based on the live schedule and specialty, and the message includes the context needed to act. The result is closer to four minutes and a single touchpoint.

That contrast shows what strong communication design can return to the organization. The following steps don’t add staff, but they return hours per clinician each week—time currently lost to coordination theater.

• Unify entry points. Five apps for five tasks force clinicians into constant mode switching. A consolidated communication environment reduces both friction and error.
• Shift routing to the system. Role based, intelligent routing decides where an alert goes based on specialty, proximity, and current load. Charge nurses shouldn’t act as dispatchers.
• Create direct channels for nonclinical needs. Transport, EVS, dietary, and admissions requests shouldn’t pass through the nursing station. A discharge shouldn’t require a phone tree.
• Make communication contextual. Alerts with vitals trends, recent notes, or the reason for a consult eliminate the back-and-forth required to piece together a patient’s story.

Practical Steps for the Next 90 Days

The fastest way to understand where coordination is breaking down is through the eyes of your frontline staff. Use this checklist to identify and quantify your "coordination tax."

Phase 1: The "friction audit" (days 1–30)

• Shadow the "human routers": Spend a full shift with one RN, one Transporter, and one EVS lead. Goal: Count every time they stop their core work to act as an information intermediary (e.g., a nurse calling to see if a room is clean).
• Map the discharge trail: Trace a single patient from "Discharge Ordered" to "Bed Ready." Goal: Document every phone call, page, and login required. If it takes more than 3 "touches" to move the patient, you have a design leak.
• Identify the ghost alerts: Ask staff which 3 alerts they have learned to ignore. Goal: Pinpoint where your current system is teaching staff to ignore all alerts.

Phase 2: Data & infrastructure hygiene (days 31–60)

• The directory stress test: Pick five random names from your on-call list or phone tree and try to reach them. Goal: Measure the "Minutes to Connection." If the data is stale, your automation will fail.
• Consolidate the entry points: Audit how many apps a clinician must open to complete a single patient cycle. Goal: Identify "mode-switching" fatigue. Aim to move toward a single, unified communication environment.