Emergency Department Directors Academy Phase II Breakout Session III: Hiring and Retention Best Practices: Transform Your Workforce May 2011
Katherine Haddix Hill, Hill, RN, MSN Define workforce transformations Identify today s challenges hll Discuss physician turnover and recruitment strategies Review approaches to retention and discuss strategies to reduce time from resignation to position filled and staff oriented Discuss the role of technology in recruitment and retention 1
Utilizing an Audience Response System At the end of the session or when you leave please return your clicker to an attendant Aligning processes, people, services, technology with the vision i or strategic t plan Ensuring the right people are in the right place at the right time Sounds easy but.. Culture impacts a transformation 2
Nurses and physicians who are resistant it tto change, comfortable with the status quo, aren't willing to make investments in the organization, informal leaders, and sacred cows Definition of Insanity: To keep doing things the same way and expect different results Albert Einstein 3
MD Shortage 70 60 62.9 50 40 39.6 30 20 10 0 Before Reform After Reform 150,000 physicians in next 15 years 4
Job content Level of responsibility Company culture Low growth potential Lack of challenge Salary Work environment Harvard Business Review Lack of communication Lifestyle No recognition, don t feel appreciated Culture of organization No personal ties to team Working conditions Harvard Business Review 5
Nurses are least satisfied with their jobs Senior leadership identified as a major influence of nurse loyalty and retention Lack of communication, really listens to employees Responds promptly to most problems, relevant and timely feedback Lack of appreciation, awards, recognition, thank you s Fair and consistent treatment Working conditions Enough staff to provide safe and quality care Lifestyle, shifts Level of involvement in decision making Compensation 150 200 direct reports leads to increased issues 6
New phenomenon Down sizing Restructuring organizational chart Increased efficiencies Lay offs HR Consultant Right Management Growing physician shortage Demanding more while frustrations are high High workload volume patient overload 6.7% turnover rate Most vulnerable in first 3 years 46% left in first three years 12% first year 51% poor cultural fit and family Mismatch between physician expectations andorganization goals Loss of autonomy Bureaucratic red tape 20% Community fit 32% Low reimbursement levels 17% Work schedule 2006 Physician Retention Study, Cejka Search (www.cejkasearch.com) and American Medical Group Association (www.amga.org) 7
Separation costs: Administrative i ti functions related to termination separation/severance pay Replacement costs: Marketing Interviews Travel/moving expenses $250,000 How Much Does Your Employee Turnover Cost? By William H. Pinkovitz, Joseph Moskal and Gary Green More important than the hard costs Decrease in morale Toxic work environment that affects patient care Damage to reputation and customer service scores Decrease in revenue 8
Recruiting the right physicians and staff Warm body syndrome Balancing act Competencies Aligning the hire with the organization s strategy Fit individuals to the right role Create the culture Foster innovation hire for innovation talent Create the ED that ought to be Embrace constant stream of change; structure, shape, form, practices Increase employee engagement Onboarding and training Build Communication channels to build trust Incentives (What is in it for me) Improved utilization of resources and new technologies Jason Krieger Senior Consultant for Gallup 9
Today s workers are more mobile The ED is a high stress and chaotic environment Volumes: high vs low Location Location Location Competition i 24/7 process Shift work 10
Generations, Millennial, Gen X, Baby Boomers Work is second Maturing workforce Recruit constantly and at national levels Today s candidates are Internet savvy Internet networking tools Social media Specialty society websites Blog and industry groups Search engines / boolean search strings Job board posting Mailers and email blasts Talent Mining 11
Talent pipelines and communities School partnerships Sourcing for applicants Talent Mining Sorting, extracting and aggregating social media databases for pertinent information Automated job matching Certified Internet Recruiters /Job aggregators Know the idiosyncrasies of small town life and communicate the challenges Everyone in everyone s business Isolation /Lower socioeconomic status Big fish in a small pond Great starter environment Stepping stone Different pace Rural allowance per year Provide extra leave Utilize Locum Tenens Rotate physicians 12
Behavioral based interview questions with diverse teams Peer interviews Include partner and family Assess for cultural fit Candidates will be interviewing you while you are interviewing them. Collaborative effort between hospital and physicians i Hospital rules and regs TB testing, trauma and stroke CMEs, quality Collaborative effort between hospitals for leadership development Outside consultants Packets / flash drives 13
Obvious Pay them well Provide a beautiful community with lots of fun things to do Keep the partner happy James Hoekstra, MD, FACEP Professor and Chairman Department of Emergency Medicine Wake Forest University Health Sciences Not So Obvious Opportunities i for growth, career development Administration Group leadership EMS Education Productivity incentives Teaching opportunities Equitable scheduling Collaborative and supportive working relationships 14
Every physician should have a voice Lack of a voice leads to disgruntled workers and a high degree of journeyman ship in the physicians Open books: Every physician should see the results of their productivity, and see where the money is flowing Leads to less disgruntled workers, and no griping about the man stealing their income Incentive or profit sharing Tying a significant amount of compensation to productivity Strong group leadership Bonus incentives for longevity James Hoekstra, MD, FACEP Professor and Chairman Department of Emergency Medicine Wake Forest University Health Sciences Successful implementation Reduce turnover Improve morale Only a few organizations have targeted physician retention that adequately meet the needs of the physicians 15
Anticipate department needs Current capacity / new growth Pregnancies, Graduations, Retirements, Military moves Staffing mix changes Employee engagement survey Attrition rate of high performers Prediction models Based on historical data University partners Constant and aggressive recruitment Over hire Post vacant position ASAP Immediate interviewing Shadowing Hire relief employees Promote nursing students Cross train staff between hospitals or units Residency programs Effective orientation programs Succession planning 16
Create a culture of retention Value employees as people Support employee development Empower employees Opportunities for growth Offer new challenges Build strong teams Offer training and reimbursement packages Progressive benefits like childcare Greater involvement in decision making Web based scheduling for physicians Electronic scheduling program for nursing staff Electronic medical record Electronic bed board Telemedicine Robots 17
Discussed how workforce transformation best practices can improve recruitment t and retention of staff. Reviewed strategies to reduce time from resignation to position filled and staff oriented Described different technologies to enhance scheduling and workforce planning 18