In the healthcare industry, finding and
retaining nursing professionals and other key technical staff is a pervasive
problem. Good people who can fill certain clinical positions are in high demand
but low supply, meaning these people are in a position to change jobs
frequently as healthcare facilities compete fiercely for their services.
The fluid nature of this labor force runs
counter to the human capital stability that HCA’s
MidAmerica Division realized it needed to optimize patient care and
physician satisfaction—and see favorable bottom-line results.
Upon looking at data provided through
employee perception surveys, focus groups and formalized exit interviews, the
MidAmerica Division determined that while compensation and benefits packages
were certainly factors in why employees chose to stay or leave, most of those
who had departed its facilities did so because of ineffective relationships
with their supervisors.
"We were promoting people for
their technical (clinical) ability and expected them to be effective or to
learn on their own, but then firing them for their behaviors," said Donna
Yurdin, director, organizational effectiveness, HCA. "We needed to hire individuals
who would be a better fit with the various leadership roles, and then develop
behaviors that would make people want to come work at our hospitals, and want
to stay and be productive."
The research showed other causes
of the high turnover that, again, pointed back to the critical role of
supervisors, as well as the need to introduce or alter various organizational
systems and functions. These causes included an ineffective performance
management system, insufficient professional development opportunities, absence
of clear "career tracks," poor communication, and absence of a clear pay and
compensation strategy that linked pay to performance and contribution.
The MidAmerica Division’s
retention problem was a complex one that demanded an ambitious, multifaceted
and comprehensive approach.
The MidAmerica Division began
tackling the turnover issue by quantifying the problem and formulating a
comprehensive strategy for improving retention. This strategy included a set of
initiatives, under the umbrella name STARS, that addressed multiple facets of
employee retention. A development initiative was launched to provide basic
knowledge that managers needed to be successful. The core technical knowledge
curriculum for this initiative included learning around HR fundamentals,
finance for non-financial managers, productivity and information systems.
A concurrent preparation phase
of the leadership development initiative provided leaders with important skills
that would improve their ability to lead while also orienting them to the
systems the organization planned to implement. This training included several
modules from Development Dimensions International’s (DDI) leadership development
system:
- Targeted Selection®
- Performance Planning: Setting Expectations
- Preparing Others to Succeed
- Facilitating Improved Performance
- Performance Planning: Reviewing Progress
In addition, a module included
in this preparation curriculum served to provide education around the
principles of effective communication and prepare participants to apply those
principles within the context of the new systems.
"We quickly learned, through
looking at our research, that the best way to impact turnover was to give our
managers and supervisors the knowledge and skills they needed to create work
environments that would attract motivated, engaged employees," said Paul
Rutledge, President of the MidAmerica
Division. DDI certified instructors who
could deliver the training modules across all of HCA. Nashville-based
consulting firm CG&A, LLC, was charged with delivering the training for all
of the MidAmerica Division facilities. The learning imparted in the modules was
reinforced on an ongoing basis by giving leaders access to OPAL®, DDI’s online
performance and learning support tool, which provides just-in-time coaching and
instruction.
Our HCA leadership effort is more than a HR thing. This
is a management issue.
It has operational outcomes that affect the company’s
bottom line. This is about management being given tools that make them more
effective, and thus the company more successful.
Paul Rutledge, President, MidAmerica Division, HCA
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"It’s heartening now when you go
to a meeting and people are talking about key principles and treating people
with respect," said Yurdin, of how the business need-driven communication
cornerstones taught in the various modules are beginning to permeate the
organization. "They’re actually using these principles in their dialogue in
meetings."
To begin establishing
accountabilities, a competency-based performance management process was
designed that allowed employees to assume a more proactive role in determining
the course of their current jobs and professional development. This new
process, which utilizes DDI’s performance management system and in which each
employee has his or her own personal development plan to guide professional
growth and prepare for future jobs or roles, represents a dramatic departure from
the previous process, which was driven by backward-looking annual review
discussions that focused on past behaviors and contributed little to the
support of individual development.
"We don’t expect them to stay in
one job forever," said Yurdin. "We have opportunities for people to be
developed in health care."
To improve its ability to select
individuals who would be the right fit with both the given jobs and the
organization, HCA, at the corporate level, worked with DDI to conduct job analyses and categorize
positions into multiple job families. Competencies and success profiles then
were assigned to the job families to drive more accurate selection processes.
With the competency framework
and job families in place, the MidAmerica Division implemented a selection
process called Selecting the Right Person. A key tactic of Selecting the Right
Person was DDI’s behavior-based interviewing system, Targeted Selection®. To
quickly and easily customize interview guides and distribute them
electronically to interviewers, the Targeted Selection®: Web Interview Guide
Generator™ tool also was introduced. In addition, Targeted
Selection®: Quick Hire®, a system that makes it possible for hiring managers to
more effectively gather the information needed to evaluate a candidate through
a single, short interview, currently is being implemented.
"In the past, when it came to
hiring, we had missed so many times because we found somebody we liked or
somebody was referred and we wanted to do what was right politically," said
Rutledge. "Whereas with this process, you interview for a job on both the
technical competencies and behavioral competencies, and you use a specific
interviewing methodology. By reducing variation in the interviewing process, we
are able to improve the quality of the job match. Plus, those same behavioral
competencies are then integrated into the personal performance management
plans."
Rounding out the STARS strategic
initiatives are two separate initiatives planned around compensation. One is a
realignment of base pay. The other is a recognition compensation initiative
based on key elements of the performance management plans, including patient
satisfaction, employee satisfaction, physician satisfaction and financial
performance.
The MidAmerica
Division has sent all of its 1,000-plus managers through the leadership
education and preparation modules and is in the process of successfully
implementing its new performance management and selection processes. Results
have been extremely positive.
"For the whole division, we’ve
gone from 34 percent turnover in 1999 to 17 percent turnover in 2003," said
Rutledge. "And we’ve seen significant improvement in our ability to retain
RNs."
The STARS initiatives have
helped the nine-facility TriStar Health
System, of HCA’s MidAmerica
Division achieve several significant business outcomes:
- Improve employee retention.
-
Realize improvement in cost savings.
-
Attain significant increases in employee satisfaction.
-
Train managers who could facilitate the transition to, and effectively
lead in the new organizational culture.
-
Implement
integrated, behavioral competency-based selection and performance management
systems across the organization.
- Develop
an implementation planning process that addresses each HCA facility’s needs and sets
timelines and accountabilities.
-
Transfer
training capability and knowledge to empower clients to provide training on
leadership skills, effective interviewing skills, and the skills necessary to
drive a performance management system.
-
Make
training available across multiple modalities, including classroom-based and
electronic performance and learning support.
-
Provide
expert consulting on training program design and structure.
-
Design
and support implementation of competency-based selection, leadership
development and performance management systems.
Click here for related article by HCA consultant John Gering in The
Strategist’s Toolkit section of the guide.
(This article contains statistical and other
updates; original version available online at DDI.com. © Development Dimensions
International, Inc., 2002. All rights reserved.)
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