Nurse scheduling often is a complex, high-level puzzle that needs to balance the demands of hospital operations and nurses' personal needs.
Ilana Borkenstein, a registered nurse, saw this persistent challenge during her shifts working in the bone marrow transplant inpatient unit at Memorial Sloan Kettering Cancer Center.
"My assistant nurse manager was amazing, but she sat in her office during most of her shifts in front of two screens. One had a spreadsheet on it, and one had her email open, and there were sticky notes framing both of the monitor and paper strung across her desk, and she always needed her phone because she was texting us and calling us and really trying to solve this Tetris problem that is scheduling," Borkenstein said.
"Because she put so much thought and care into it, retention on my specific unit was actually quite high. We were able to make the demands of our job work with the rest of the priorities in our lives, and she was so thoughtful about how to customize the work experience for each of us. But, all of my nursing school friends who work on other units or at other hospitals had a very different experience. I thought, 'How can we productize what my assistant nurse manager was doing?'"
In 2022, Borkenstein and her Harvard Business School classmate Eric Gruskin launched M7 Health (M7 was the name of the bone marrow transplant unit where she previously worked) to modernize nurse workforce management.
M7 Health was built "by nurses, for nurses," Borkenstein insists. "'We are nurse-first, nurse-DNA and nurse-led," she said during an interview to offer a first look at the series A funding round.
"A quarter of our employees here at M7 are nurses. We know that you could look at staffing and scheduling like a math problem, but if you miss the human element of this, and you don't try to quantify staff preference and staff sentiment and bake that into this complex problem, then you will never succeed," she said. "Every single product feature we build, we ask ourselves two questions. One is, 'How does this impact the nurse experience?' And two is, 'How does this impact the bottom line for health systems?'"
Through her first-hand, frontline experience, Borkenstein saw how broken systems and rigid staffing models made it harder for nurses to do their best work, and amid COVID, how hospitals throughout the country struggled to manage and retain their teams.
"Even in an environment on a unit like mine, M7, we were literally curing cancer for people, it was perplexing to me that we could not solve the workforce management and distribution and staffing and scheduling problems," she noted.
The startup raised $10 million in series A funding, led by Threshold Ventures, to scale its platform to more hospitals and health systems. Investors First Round Capital, 25m Health and Lakehouse also supported the series A round. M7 Health has raised $17 million total to date.
The company will also use the funding to build out its AI scheduling capabilities and expand it teams across engineering, growth, product and operations.
Borkenstein, Gruskin and their teams designed M7 as an end-to-end platform to make nurse scheduling, staffing, and communication seamless and fair. The aim is to align the needs of individual nurses with the realities of hospital operations to help teams create balanced, transparent, personalized schedules with far less administrative burden.
"We help nurse leaders collect preferences from staff members as it relates to scheduling. We help synthesize all of that input and give nurse leaders a first pass of a fair and balanced schedule. We quantify everything we do. We quantify the percentage of preferences honored for staff, and we quantify and ensure you have all of the right skills, competency, experience-level credential on your unit," Borkenstein said.
"We also have smart shift filling. We have automated how shift filling happens and ensure that shifts are filled sooner and in the most cost-effective way and in a way that aligns with staff members' preferences, also reducing the noise that staff members hear day-to-day," she said.
The platform also offers a "house view" that provides a central staffing view to give nurse leaders and hospital administrators a bird's eye view of what staffing looks like for a set of units at a hospital or a set of hospitals, she noted.
Deploying better workforce tools can create better work experiences, which helps create a more sustainable workforce and drives better patient outcomes, Borkenstein noted.
Health systems can attract and retain nurses by offering flexible and predictable work environments and M7's technology helps to achieve that, she said.
M7's platform is being used by 13,000 healthcare professionals across more than 60 hospitals. The company has agreements in place to double its footprint by year-end.
The company boasts a 90%+ staff engagement rate with its technology.
"Customers have told us they've never seen engagement like this with a technology platform among the nursing workforce outside of the electronic medical record, which they are really required to use every shift," Borkenstein said.
With these workforce planning insights, M7 offers robust workforce analytics that can notify nurse managers about staff members who are at the highest risk of turnover and provide reminders to check in with certain team members based on scheduling and staffing patterns, she said.
The use of automation and easy-to-use tools helps to save nurse managers time, with the company reporting a 50% reduction in time spent scheduling by nurses. Users also report a 40%+ reduction in overtime and the elimination of contract nursing labor at hospitals using the platform.
Nurses also report greater work-life balance, fairer schedules and even inquire about job openings based on where M7 has been adopted, executives say.
Nurses are the largest sector of the healthcare workforce, and M7 Health is tackling a big, intractable problem facing most hospitals. In the past five years, the average hospital has turned over more than 100% of its nursing staff. Burnout remains high, labor costs keep climbing, and outdated staffing models can’t keep up with a modern, diverse nursing workforce, according to executives.
The nursing workforce also has become more complex with a mix of full-time, part-time, PRN, travel, and contract nurses working side by side.
"Pre-COVID, the majority of the workforce was full-time or part-time employees. And even in the pre-COVID world, the task of balancing a schedule was very challenging for a nurse leader. You have to ensure that everybody is working requirements in alignment with their FTE, or what they are contracted to do, but you also want to honor as many of those staff members' work-life preferences as possible in order to create this environment where they stay. That's not so easy to do because there are constraints with what you can do with a schedule based on the patient care needs on your unit," Borkenstein explained.
She added, "You need certain skill sets, certain competencies, certain credentials, certain levels of experience represented on each shift, and that all of a sudden turns this task of we need X number of nurses on any given day into a much more complex problem with several variables. Then you overlay that against the mandates of what a union says you can do, for example, honoring seniority, that gets complicated."
During the COVID-19 pandemic starting in 2020, the composition of the nursing workforce changed drastically, with a mix of full-time, part-time, per diem, contract and travel nurses and agency nurses.
"Not only do they all cost the health system something different for that hour worked, but nurse leaders now have new variables they have to take into consideration, and no tools to help them do it. They're also getting pressure from staff who want to be nurses and want to do good work, but also need to ensure that they can live their lives. And there's more pressure than ever from hospital administrators to ensure that we are staffing the units in a cost-effective way," she said.
Nurses today expect flexibility, predictability, and autonomy in their role, according to M7. Health systems have to adapt their processes to meet these expectations. Blanket retention strategies also do not work, according to executives. Health systems must get to know their nurses and customize each nurse’s experience to meet individual needs.
"We call ourselves the technological olive branch between the nursing workforce and hospital administrators. I know that if you create transparency in what the incentives are for both parties—what are nurses at the individual level optimizing for and what are health systems optimizing for—not to be against nurses, but to ensure that we can continue to provide care for the patients in our community. M7, in addition to creating an optimal staffing and scheduling model, is creating transparency behind those incentives to align the incentives between the two parties, and no other system has done that successfully," Borkenstein asserts.
As the healthcare industry continues to innovate with AI, Borkenstein believes AI could be "game-changing" for nurses both in clinical delivery and alleviating administrative burden.
"Nurses have to have a seat at the table when discussing how nurses are going to use AI and I find that nurses are often missing from that conversation. It should not add any additional steps to a nurse's workflow. We already have enough to do on a given shift. It should remove steps. And I think that only nurses themselves can tell you whether a product or a tool will actually expedite workflow rather than add to the workflow," she noted.
AI-enabled staffing and scheduling tools also enable experienced nurses to spend more time on clinical-oriented tasks and less time on administrative work, she added.
There is a growing ecosystem of startups tackling nursing workforce and staffing challenges. In-House Health launched to tackle inefficiencies in hospital staff management through a technology-based approach. The startup, based in Denver, developed an artificial intelligence-driven scheduling and management platform for modern nursing teams.
Last year, Float, a nurse staffing and pharmacy referral company, closed a $10 million series A funding round.
Other well-funded startups include ShiftMed ($250 million raised), a mobile app that connects healthcare workers and providers, ShiftKey ($300 million), a healthcare staffing technology company, Incredible Health ($100 million), a tech-enabled career marketplace for healthcare jobs, Trusted Health ($175 million), app-based marketplace Clipboard Health and nurse staffing platform IntelyCare ($174 million) and online healthcare jobs marketplace Nomad Health ($200 million raised).