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As hospitals and health systems navigate the transformation from volume to value, it’s critical that they have the skill sets and leadership capabilities to move the organization forward. Human resources and executive leadership are pressed to identify capability gaps within the organization and find ways to develop and expand the roles of current employees, as well as identify the necessary outside talent to help the organization achieve its strategic objectives. Health Forum convened a panel of health care executives and industry experts Nov. 12 in Chicago to discuss how hospitals and health systems can succeed in building the workforce of the future. Health Forum thanks all of the participants for their candid discussion, as well as CareerBuilder for sponsoring this event.
MODERATOR (Bob Kehoe, Health Forum): How do you leverage human resources within your organizations? How does HR help to fulfill the organization’s strategic directives?
MARK HERZOG (Holy Family Memorial): We are a stand-alone hospital in Manitowoc, Wis., but we’re in a pretty competitive area. In 2008, we did an organizational assessment in which we explored our organization’s role in the marketplace. What’s our strategic advantage? What do we have control over? We decided that we have control over culture and that culture is also our strategic advantage. Since then, we have focused on workforce and organizational culture. It’s one of our top strategies. It will be extremely important as we transform our care delivery system. We’re trying to fortify our leadership team so that it can thrive in the second-curve world, starting from a traditional first-curve, conventional culture. HR is an important part of that.
JONI DUNCAN (Ann & Robert H. Lurie Children’s Hospital of Chicago): We are trying to make our leadership development programs more robust. It’s important given everything that we’re facing — market consolidation and the shift toward value-based care. Our leaders must be able to address and speak to all of the different situations that exist within the organization and the field at large. When I talk with Pat Magoon, our president and chief executive, we discuss the need to hire smart people capable of handling the complexity of health care. It’s not as simple as it used to be. We don’t just need good clinicians, we need good clinical leaders. We’re working hard to determine what skills will move the organization forward.
MODERATOR: Who is ultimately accountable for hiring in your organization? Who owns the responsibility for ensuring that we have the right talent, the right competencies and the right leadership skills?
HERZOG: The expectation certainly must come from the top. I work closely with Laura Fielding and others to set expectations. We need to be more entrepreneurial and innovative. We’re focusing on trying to make sure that our operational leaders, who come from traditional clinical backgrounds, develop a second-curve mentality. And we’re hiring for that as well.
It’s a shared responsibility in our organization. The expectation is set at the top. To actually bring it to life and make it happen, it has to be fully embraced by the operational leadership. And we get it right most of the time.
LAURA FIELDING (Holy Family Memorial): I completely agree. We rely on senior leadership to set expectations. They work closely with us to determine the type of employee we want to hire. With our emphasis on culture in recent years, we focus increasingly on behavioral competencies, in addition to technical competencies. We closely involve middle managers in the hiring process. They are responsible for making the ultimate decisions. We conduct the screenings and make recommendations, but it’s important for them to make the hiring decisions based on the skills they need, as well as finding the best cultural fit for their departments. We want forward-thinking individuals who understand that change is important. We want adaptable, innovative people. So, we’re working closely with our leaders to find the right matches to fulfill our needs for the future.
MODERATOR: How do you identify adaptability? What are you looking for in those areas?
FIELDING: As Mark mentioned, we conducted a cultural assessment a few years ago. We used that to determine what organizational culture would lead us to success in the future. What we found was a gap between what our culture was presently and what it needs to be in the future. As a Christian organization that’s been around for more than 100 years, we had a conventional, dependent, hierarchal culture. The ideal culture, interestingly enough, was identified as a much more humanistic, encouraging, self-actualizing and achievement-oriented culture. We used that to help shape our values. And when we hire individuals, we look for people who are going to match those values through behaviors with the work that they do at our organization. We filter that down through our leadership development efforts to be sure that we can find and promote the right individuals.
PETER BUTLER (Rush University Medical Center): About 10 years ago, Rush found itself at a pivotal time when it was not performing well financially. We had an ambitious agenda ahead of us that required us to have a stronger financial footing. Rather than diving right into the to-do list, we revisited our mission, vision and values. We identified five values, known as our I CARE values: innovation, collaboration, accountability, respect and excellence. And we spread that throughout the entire organization. It became the primary filter for evaluating everything we were doing. I CARE accounts for one-half of our employee yearly performance evaluations, for example. And it’s the primary filter for our new hires. And as Mark said, it must be a collaborative process. Our managers need support from HR to make the best hiring decisions, to make sure we’re getting the best people possible. Execution of our values is dependent upon the leaders that we select. We need to empower our managers and develop them as leaders. If you rely solely on authority at the top, you won’t inspire or motivate the workforce and you won’t meet your objectives.
MARY ELLEN SCHOPP (Rush University Medical Center): We’ve been pretty intentional and systematic over the last four years in reinforcing our values through our leadership competencies and tying those through our accountability system so that all leaders in the organization understand and are clear about their roles and our expectations. Beyond that, we’ve embedded those same elements into our orientation process so that when employees come into the organization, they immediately learn about our values. It is a cultural transformation. It becomes our foundation, what we stand for both internally and externally.
My background is in consumer packaged goods. Overall, we were pretty advanced when it comes to some of the things health care organizations are exploring and using today, such as talent management systems, leadership development and understanding culture. Health care is on the right path. We just have a little way to go to catch up with other industries.
HERZOG: To follow up on my earlier point, back in 2008 when we identified culture as our top focus, we realized that part of the problem with our culture at the time fell on senior management. It wasn’t a fun moment. We were structured as a first-curve organization. That model would not succeed going forward. HR works closely with our managers to help them identify the best cultural fit with the organization.
PAMELA LAKSANA (CareerBuilder): One of the challenges we continue to see is that the health care field still faces a supply-and-demand issue. Organizations often turn to staffing agencies and job sites to procure qualified candidates. That can free up HR to focus on other important organizational issues, such as leadership development and culture.
MODERATOR: How do you ensure that you have the right analytics to measure your organization’s performance in recruiting, developing and retaining key leadership, and growing leaders within the organization?
HERZOG: We have a number of metrics around engagement and culture. We track them down to the departmental level. It’s part of our annual benchmarking and performance assessment process. One of the things we try to measure is whether we’re a cool place to work. That may sound trite, but we’re in a relatively small market. Manitowoc County has a population of about 82,000. We’re kind of in the middle of nowhere, although we’re not far from some larger metropolitan areas, including Milwaukee. So, we have to do things a little differently to attract talent. It’s worked for us. When we advertise for a leadership position, we get really good applicants now, as opposed to just six years ago. That’s due in large part to our work around culture.
We try to find the right balance of promoting within and hiring from outside. I feel that if you hire from the outside more than 30 percent of the time, you’re not doing a good enough job of bringing people up. That’s a number I came up with; it’s not an exact science.
FIELDING: Engagement is one of our measures for success. We conduct biannual surveys to evaluate engagement in the organization and break it down to the department level. We look at a number of measures to assess whether we’re successful with onboarding and organizational fit. And, then, we’re looking for up-and-coming leaders to ensure that they have what they need to grow in their roles.
SCHOPP: We just completed our strategic planning process. In drafting our strategic plan, our employees were engaged from all levels across the organization. It creates commitment, alignment and understanding of our goals for the next three to five years. Our strategic plan is made up of four pillars, one of which is 'best people.’ We want to be recognized nationally as an employer of choice. We have to be clear about how we want to be known so the direction is clear. It starts with the people. We strive for diversity and have a five-year plan in place to enhance diversity. And, because we’re an academic medical center with a medical school, nursing school and college of health sciences, our diversity initiative applies to students, faculty and management. We have a robust measurement system in place to track our performance.
MODERATOR: Mark and Peter, how regularly do you review these data? Where does this fall on your list of priorities?
BUTLER: It’s part of our balanced scorecard that covers financials, quality, satisfaction and engagement, among other things. Engagement is one of the measures that is annually set and approved by the board. We monitor it throughout the year.
HERZOG: We talk daily about having the right people in the right roles. And I’m not being flip about that. We don’t talk about metrics all the time, of course. As a community hospital, we spend a good deal of time trying to make sure we have the right people. It’s all about continuity and achieving our ideal culture in the future. For new hires, we’re looking for someone who is an 80 percent match for our current culture, but consistent with our goals for the future. The stakes are really high. We can’t get one wrong because if we do, it’s a significant blow for us. It’s a big priority.
FIELDING: Like most organizations, turnover is a significant metric for us. This may sound strange, but we’re actually pleased right now to see an increase in turnover. We’ve made a concentrated effort to invite the disengaged to leave the organization. It’s essential to have the right people in the right positions. We’ve worked with our leaders to help them hold their staff accountable and if they’re not doing what we need them to do, we would rather they leave the organization.
DUNCAN: We also went through a rough period about 14 years ago and we turned over our senior leadership team. At that time, one of our senior leaders, Pat Magoon, became our CEO, a role that he still holds. When he became CEO, he wanted to become a customer-focused organization. But the customer isn’t just the patients and their families. He wanted the focus to be on employees as well. The employees are also our customers and we work to engage them. That will pass on to the patients and families. We want our employees to feel as though this is a good place to work.
LAKSANA: Several of you have brought up some of the qualitative metrics that you review. Those are important metrics. We’re often asked by hospitals and health systems to assist them with developing quantitative metrics, such as cost per hire and cost of vacancy. These measures can be done through technology and can be available on a real-time basis, so the organization can focus more on culture and engagement.
MODERATOR: During this time of transition within the health care delivery system, how are you aligning your organization’s need to reduce costs with your clinical staffing needs?
SCHOPP: We see the transformation of the health care delivery system as an opportunity, actually. Historically, health care has a traditional, hierarchal structure. One of the things we’ve learned from outside of the industry is that there’s an opportunity to flatten our organization by providing people with broader roles to increase their agility, adaptability and capability of managing change. We’re looking at our structure to identify opportunities to expand roles within the organization. We want to use this as a learning opportunity for employees to grow and develop, especially our clinical leaders because they’re the ones who haven’t historically had the opportunity to move into leadership roles within the organization. I look at this as being a glass-half-full situation, and that’s one way that we’re embracing the need to cut costs — by managing our talent and growing people.
HERZOG: Creating adaptability and openness to adaptability is foundational work and essential within our organization. What we’re doing as an organization is changing how we’re structured to fit within the second curve. We don’t view this as a time of gloom and desperation.
FIELDING: In terms of leadership development, we’re doing exactly as Mary Ellen described. We’re working to flatten our organization and empower our staff to step up and be part of the change. It’s also about finding the right people for the right positions — those who can be accountable for the work that needs to get done.
BUTLER: The biggest change in recent years is the availability of data to help the organization focus on improvement opportunities. It’s hard to keep up. All of us have invested significantly in information technology and we continue to invest in ways to be more efficient and to optimize data delivery and usage. It makes a big difference.
DUNCAN: Our leaders are adapting. They want to grow and develop, and they want to take on more responsibility. That’s been a really good thing. We need to make sure that they have the skills to do that, and that’s what we’re working to develop. We want to help bring them along and get them to that place. For example, we’ve taken nonclinicians and put them in roles that traditionally have been held by clinical leaders. Just because someone doesn’t have a nursing background doesn’t mean he or she isn’t able to take on certain roles. It’s good to have some cross-functionality.
As to cost-reduction, when we began our initiatives, we included our physician leaders from the beginning. Their buy-in is essential. We have a five-year cost-reduction plan and as we look at what we need to do, we share the list with our physician leaders so they can provide input on the items they have control over, such as physician preference items. The key is making sure they’re on board.
LAKSANA: In terms of cost savings for many hospitals and health systems, a big line item in HR is on agency spend, hiring temporary staff to fill pressing needs. Through better data and analytics, organizations can be more resourceful around recruiting and be able to understand where the dollars are going so they can focus more on the post-hire phase.
MODERATOR: What are some best practices that organizations can follow to ensure that they are working with the best data, and how can that be integrated into such things as recruitment, hiring and staff development?
LAKSANA: A big focus should be technology and integrating information systems to be able to pull qualitative and quantitative data real-time, as I mentioned earlier. That will help the organization to become more agile and capable of making timely decisions going forward. Another important component is building the organization’s brand through social media, making sure that the organization’s message is reaching a wide audience. The message should not be limited to recruitment; rather, it should be used as an opportunity to educate potential hires about the organization. It’s a chance to build engagement in the pre-hire process. Video is an effective medium to communicate your message, for example.
Another aspect is to review your hiring platforms. About 50 percent of CareerBuilder traffic comes though mobile phones these days. If you aren’t mobile-friendly, you should be. I recommend that HR specialists test their application processes. If they can’t do it, a potential job candidate certainly won’t do it. It has to be user-friendly. The message needs to be clear and concise, and the transaction should replicate an online retail sales transaction.
SCHOPP: Those are important points. I’d say that close to 99 percent of our employees carry smartphones. The smartphone is a great mechanism to reach employees internally. And it can be a great way to reach new candidates. We need to think more like a retail or consumer product organization. We really need to brand ourselves both internally and externally. Branding ourselves internally will drive culture and create cultural awareness. Communication is key.
We have a transparent process for posting new positions. We have an employee referral incentive program to help when demand is high and supply is low. We turn away a lot of applicants, but we don’t want to turn them away permanently. We want them to keep coming back. There may be a time when we need them.
FIELDING: We have an ongoing internal referral program that rewards our employees for their efforts. Word of mouth is our most effective hiring tool. We focus on branding. We created an internal mantra several years ago, 'Inspired Caring.’ That’s our organizational focus. We’re in a small community, so we don’t have a large talent pool for our needs. We are working with the local colleges and technical schools to grow the talent we need within the community. We’ve even partnered with some of our competitors to assist in this process. We all need the same people, and we all want talented individuals, so this is a way that we can work together.
BUTLER: Our background is a little different. In 1969, we were a teaching hospital called Presbyterian-St. Luke’s Hospital, and overnight we became a degree-granting health university. We resurrected a dormant medical school charter, Rush Medical College, which started in 1837, and became known as Rush-Presbyterian-St. Luke’s Medical Center. At that time, 100 percent of the medical staff were private. You can imagine starting a medical school in which the entire medical staff and faculty were private. That would be unheard of today. But we took the vice president of medical affairs and made him the dean of the medical school. The vice president of nursing became the dean of the college of health sciences, and so on. Suddenly, we had joint teaching and practicing roles. To this day, it’s been an important part of who we are. We have our own pipeline of students upon which we draw heavily. But we graduate more students than we can use. Our health management master’s program has about 500 alums, and about 40 of them are working for us right now.
SCHOPP: The same is true of our nursing students, many of whom also work at Rush. And we have a tuition reimbursement program for nurses who want to further their education. They can go back to school for free.
DUNCAN: That’s an enviable position to be in, and something we wish we could provide. We provide our staff with a number of on-site programs to ensure that they receive continuous education. Whether you are in environmental services or the supply chain, we probably have an on-site, educational program. It’s important to provide these opportunities so that we aren’t always looking externally for candidates.
Laura mentioned Holy Family’s internal branding campaign. We have one as well: 'It Starts With You.’ We want to empower our employees to go out and get the things they need to do their jobs. And we’ll help them with that. The other part of it is to empower employees to grow professionally and personally. It’s been extremely helpful.
MODERATOR: In your current relationship with your CEO or with your HR director, what’s working and what’s not working right now? What’s your biggest challenge?
DUNCAN: I report directly to our president and CEO who values human resources. He wants that interaction because of the link HR has with the organization’s employees. He wants to understand the pulse of our staff. He’ll bounce things off me to assess how our employees will respond. I have the resources I need to do the things that I need to do to support him and our organization. It works really well.
BUTLER: We’re proud of the fact that we’ve worked hard in the last year reassigning roles to align ourselves with a strategy going forward. Our employees feel engaged and there is a level of confidence in our senior management team all the way through to the board.
Our challenge is trying not to overwhelm everyone with all of the different priorities that we face as an organization. With the amount of change that’s going on in the market and the number of initiatives that we have to respond to internally and externally, it’s still a work-life balance. Just the practical list of things that we can actually focus on and execute is daunting, no matter how hard you try to prioritize.
SCHOPP: Speaking as a newcomer to health care, we’re still growing best practices that have existed outside of the industry for quite some time. HR leaders are charged with focusing on strategy, organizational growth, development and senior leadership succession planning, among other things. We are constantly juggling priorities. The challenge is always prioritization and execution.
LAKSANA: One thing that’s easier in health care is the focus on the patient and patient care. It’s much easier to get people aligned behind patient care. The service aspect stands out first and foremost.
MODERATOR: What are some of the new skill sets organizations will need going forward? What resources will HR directors need to build a successful workforce for the future?
SCHOPP: The first thing that comes to mind is enhancing accessibility. In all likelihood, we won’t be doing everything that we do from one campus in the future. Accessibility for our patients is huge, and we need to be responsive. Technology will help by enhancing our ability to communicate with future employees, future students, patients and our existing workforce.
We need to build up our HR information system. It’s not flexible for our employees. Our workforce spans multiple generations and we have really different stakeholders. Faculty needs are different from staff needs, for example. We haven’t done a good job yet of segmenting our workforce and thinking about its unique needs. There’s going to be a greater demand for us to do that if we really want to be an employer of choice. HR needs greater access to technology and the ability to leverage that, and increased flexibility around our processes and systems.
FIELDING: We know there is a need for critical-thinking skills. We need people who can think and do things differently. We need customer service skills. That wasn’t as important 10 years ago. We need to treat patients as our most important customers, and our employees need to understand that as well.
We, too, have a limited HR information system. It’s segmented and a challenge to pull together, especially information around talent management. HR needs an HRIS. We don’t necessarily need to interface with patient records, but we do need to interface with finance and other areas of the organization. The talent management piece is essential if we want to continue to grow our employees to be successful in the future. We need data to be able to do that. Our employees want to be involved in the organization, and they want opportunities to grow. To do that, we need to know their areas of interest and what opportunities are available. We need to reduce silos.
LAKSANA: Many organizations don’t have an HRIS, or an applicant-tracking system. If they do, the systems often don’t interface. There’s a great deal of information that can be gleaned from applicants and new hires. Where did they come from? What does the ideal candidate look like? When these systems speak to each other, HR executives can see the big picture.
BUTLER: Senior management needs to become more involved with HR issues, particularly when it comes to developing strategy and achieving the organization’s strategic objectives. Academic medical centers have a unique culture. I frequently say that an academic medical center is the only place where a 99–1 vote means a tie. The bureaucracy of the AMC does not accommodate the second curve and that needs to change. We have to change the mindset of senior leaders and others throughout the organization. But changing how we make decisions is a resource-intensive effort.
Sometimes it requires making a bold move. When we invested more than $1 billion in our campus a few years back, including building a new hospital, we knew we had to be creative in how we received input on the design and development of our new facility. We felt that if we asked managers to invest 5 percent of their time to help in the design, we would get incremental, patchwork feedback. So, we set up an office of transformation and dedicated a team of senior leaders to spend five years focusing on functional design. We wouldn’t have made bold decisions unless we formally set up a group outside of our structure and culture.