The hospital human resources department is where the uncertainties of health care transformation intersect with the realities of current skills shortages. The HR department has to meet the workforce demands of today while positioning the organization for an uncertain tomorrow, while yesterday’s approaches may no longer be an effective guide. Forward-thinking hospitals are succeeding anyway by innovating in how they acquire, develop and retain talent, and structure roles and responsibilities so staff can work more effectively and efficiently.
“It is very important today for HR to have a voice at the strategic level. The HR organization can be a great resource in helping drive change,” says Amy Goble, vice president of the Health Career Center.
David Wilkins agrees. He is chief marketing officer of HealthcareSource, which has provided talent management software to more than 3,000 health care organizations. “The common characteristic of the most successful hospitals we work with is that they have senior leadership that sees the value of talent, and invests accordingly,” Wilkins says.
He gives an example of how hospitals can benefit by taking a more strategic approach to HR. “Today I was at the Rural Health Care Leadership Forum and I had a conversation with an attendee who told me her hospital was really struggling to hire enough nurse managers. They did well at hiring senior people and could fill nursing positions, but finding nurses in mid-career with the right experience level was a challenge. I asked ‘Why are you hiring those people at all? Could you fill the positions from within through staff development? What are your established career ladders?’ It was like a light bulb went off in her head. Those are very strategic questions that just haven’t been asked at many organizations. They are getting asked more now, because executives are realizing they just can’t hire all the talent they need, they have to develop it from within.”
So how can HR operations become more strategic to prepare for an uncertain tomorrow while still fulfilling the demanding needs of today? Embracing concepts like “partnership” and “collaboration” are common themes among HR professionals that have been successful in overcoming skills shortages and positioning their organizations for sustained success.
“Your success at work depends on how well you collaborate with others,” says current American Society for Healthcare Human Resources Administration (ASHHRA) President Gary Pastore, CHHR, MSL. Pastore is also is director of human resources of HonorHealth Scottsdale Shea Medical Center in Scottsdale, Ariz., where his vision for the increasing importance of collaboration is changing what the organization emphasizes in hiring and employee development. “Interpersonal skills are becoming more important in our hiring decisions. Improving a person’s technical skills is easier than improving their interpersonal skills.”
The Health Career Center 2016 Healthcare Talent Scan reached a similar conclusion. It states: “As health care organizations continue to shift from volume- to value-based care, collaboration skills will be more important than ever….”
Changing Hiring Practices
Hiring practices need to change because the workforce pool is changing. In the next 10 years, one third of nurses working today are expected to retire,[i] and the physician shortage will swell to between 46,100 and 90,400. Many of those positions will be filled by millennials, who have very different expectations about the job than their predecessors. Millennials value benefits and scheduling flexibility more than salary and have high expectations for receiving training, development and a clear career path.[ii] Adding to the challenge of hiring millennials: Only 29 percent use online job boards.
The challenge of reaching millennials is an area where hospitals have used partnership principles successfully to meet their staffing goals. Goble notes there is a growing trend for hospital HR and marketing departments to work together so branding and communications to prospective employees is consistent. Marketing can also help HR understand the best ways to reach specialized target audiences, whether by demographic (e.g., millennial) or role (e.g., clinical informaticist).
“Attracting talent is a place where marketing is intersecting with HR in a really interesting way,” says Wilkins. “Almost every marketing technique I use as a marketing professional is being applied to health care recruiting. Lead tracking is being applied to candidate tracking. Search engine optimization is being used to guide and adjust job listings. Recruiting is becoming very sophisticated.”
Another growing way hospitals are acquiring talent is literally to acquire it, specifically by acquiring physician practices and specialty groups. The number of hospital-employed physicians more than doubled between 2014 and 2017, from 249,000 to 540,000, according to the 2017 AHA Environmental Scan. Hospitals are also doing more contracting with multispecialty practices and telehealth providers to fill skills gaps. These are expensive, strategic pursuits, which underscores why the HR organization needs to be included in strategy discussions.
HR can protect investments in employees through effective retention and professional development programs. That is important, because 90 percent of turnover occurs within the first 18 months, according to the 2015 Health Retention Study conducted by Frederick Morgeson, Ph.D., of Michigan State University.
“In my experience, people don’t leave their organizations, they leave their managers. That is why nursing leadership is critically important and has a huge impact on retention and recruiting,” says Maureen Swick, R.N., Ph.D., who is CEO of the American Organization of Nurse Executives (AONE). “Effective nurse managers makes sure their staff feels supported and mentored. That is why AONE focuses so heavily on nursing leadership development.”
Retention & Development Ideas
The recognition that interpersonal skills are becoming more important to individual and organizational success led Pastore’s hospital to create a new hiring methodology that includes use of an assessment solution intended to predict an employee’s success. Another health system, Central Maine Medical Family (CMMF), saw its first-year turnover decline from 22 percent of employees to 15 percent after it began using an assessment solution; nursing turnover fell from 20 to 11 percent.[iii]
Thorough orientation programs not only help retention, but also are a valuable asset to help recruitment, according to AONE’s Swick. “Nurses entering the profession today want to know how much training they’ll receive and whether there will be a preceptor to help them,” she says. “Many new nurses plan to go back to school, so things like flexible scheduling and tuition reimbursement are very powerful for retention. Creating a strong orientation and professional development program is one of the most effective things hospitals can do for recruiting and retention.”
Having a clear career path is one of the most powerful influences for retention and is highly valued by millennials and older workers alike. “Opportunities to advance” is the most important influence on retention, a 2016 ASHHRA survey[iv] found (see Figure 1). Compensation was third. Compensation also ranked third among millennials when asked what they cared about most when applying for a job, behind benefits and flexible working hours.[v]
Figure 1: Influences for Retaining Top Talent at Health Care Organizations
Source: HealthcareSource/ASHHRA 2015 Healthcare Workforce Executive Insights Survey
Many of the factors related to retention relate to employee engagement. Hospitals are making more use of leadership development training and wellness programs to promote employee engagement and retention.
“We spend a lot of time asking ‘How do you keep your high performers continually engaged while you help the lower-engaged performers make decisions either to move up in the scale or move out, and how do you help those leaders to foster engagement?’” says Pastore. “A big piece of that is partnering across the continuum of care, which is the theme for our 2017 ASHHRA conference. I’ve found greater successes when you partner with your clinical business throughout the facility so you get to know what their day is like and what their needs are.”
One way to keep employees engaged is to give them new roles. Role changes are also a pragmatic strategy hospitals are using to cover skills shortages by better utilizing the staff skills that are available. The most common method is to make more use of physician assistants and nurse practitioners. In December 2016 the U.S. Department of Veterans Affairs, which is the country’s largest employer of nurses, changed its regulations to give full practice authority for three types of advanced practice registered nurses (ANRNs),[vi] a move the American Nurses Association endorsed.[vii] Telehealth is another example of how care delivery and care provider roles are shifting, as are mentoring programs, school partnerships and the rise in hospital-employed physicians.
Management roles can also shift. Shared governance structures where executive and clinical staff regularly collaborate on policy and procedures is appealing to the next-generation workforce, according to Swick. “It’s about giving the clinical staff a voice in the organization,” she says. “It helps them take control over their environment and work together to solve problems.”
HR leaders are also creating new roles for themselves by orienting their departments as strategic service providers to other departments in the hospital. Goble notes: “The HR partner concept is nothing new, but organizations are taking it a step farther by providing more insight and metrics to other department heads and hiring managers. HR is releasing more information to help others understand retention, employee satisfaction and other things that are important to driving change.”
Internal Collaboration Helps Hospitals Attract, Develop & Retain Employees
Increasing collaboration with other departments is one of the clearest trends that Health Career Center Vice President Amy Goble sees in hospital HR departments. “HR departments are setting themselves up as a service agency for the entire organization,” she says. Here are three ways:
- HR is collaborating with marketing to make sure branding is consistent to patient and prospective employee communities, and to reach new labor pools.
- HR is collaborating with IT to overcome the stigma that hospitals aren’t doing cutting-edge work with data and systems.
- HR is collaborating with finance to improve the business skills of HR professionals so they can better understand business staff requirements.
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[iii] HealthcareSource “HealthcareSource Staff Assessment Enables Leading Continuing and Acute Care Facilities to Transform Their Hiring Process, Reduce Turnover, and Develop Employees” Accessed February 7, 2017 from http://www.healthcaresource.com/img/case-studies/hcs329-cmmf-messiah-client-profile.pdf.
[iv] HealthcareSource and ASHHRA “The 2015 Healthcare Workforce Executive Insights Survey Results” Accessed February 7, 2017 from http://www.healthforum.com/connect/resources/pdf-files/healthcaresource-2016-0216-survey.pdf.
[v] American Hospital Association Health Career Center “2016 Healthcare Talent Scan.”
[vi] U.S. Department of Veterans Affairs “VA Grants Full Practice Authority to Advance Practice Registered Nurses” December 14, 2016. Accessed February 7, 2017 from https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2847
[vii] American Nurses Association “ANA President Responds to Department of Veterans Affairs Final Rule on APRNs” December 13, 2016. Accessed February 7, 2017 from http://www.prnewswire.com/news-releases/ana-president-responds-to-department-of-veterans-affairs-final-rule-on-aprns-300377750.html.