Emergency Department Directors Academy Phase II. May 19-23, 2014 Dallas, TX. Breakout Session III: Hiring and Retention - Transforming the Workforce

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1 (+)Ghazala Sharieff, MD, MBA, FACEP Emergency Department Directors Academy Phase II Breakout Session III: Hiring and Retention - Transforming the Workforce Urban hospitals compete for qualified staff, rural hospitals face recruitment retention challenges and all hospitals are facing record numbers of retiring staff. Workforce planning can provide a significant competitive edge. Participants in this interactive session will share and review their best practices in hiring, retaining and improving hospital workforce management. Key strategies around predicting workforce needs and reducing the time from resignation to position filled and individual oriented will be addressed. Examples of using technology to improve the scheduling and recruiting process will also be addressed. Objectives: Describe ways that workforce transformation best practices can improve recruitment and retention staff. List strategies to reduce the time from resignation to position filled and staff oriented. Use technology to enhance scheduling and workforce planning. 5/22/14 3:45 PM - 5:00 PM Course Number: TH-25 Trinity Ballroom III May 19-23, 2014 Dallas, TX Dr. Sharieff completed her Physician Executive MBA at the University of Tennessee, Knoxville in December She was selected by her peers to be the first Class President and won the outstanding physician leader of the year award. Since then she has lectured on several management topics including conflict management, patient satisfaction, essential traits of an effective leader, the importance of strong RN and MD director relations, and the art of sustaining a team environment. She serves as Medical Director, Quality and Medical Management, at Scripps Health, San Diego and is also the Director of Pediatric Emergency Medicine for Palomar-Pomerado Health System in San Diego, California. She is a Professor of Pediatrics at the University of California, San Diego. Dr. Sharieff is a nationally and internationally recognized lecturer on topics in pediatric emergency medicine and has been awarded several regional and national teaching awards. She has served on many national committees, including Past Chair of the ACEP Pediatric Emergency Medicine Committee; Past Chair of the ACEP Pediatric Section; the ACEP Public Relations Committee; the AAEM Board of Directors; and was also the Co-Chair of the AAEM Education Committee. She is well published and has authored multiple research articles, book chapters, and review articles. (+)LesleyAnn D. Carlson, RN, MSN Rady Children's Hospital San Diego for over 30 years and in a Leadership role for over 25 years. Her last 10 years has been as the Director of Emergency Services which included a 36 bed / 70,000 visit Emergency room, 4 offsite Urgent Cares, and a level One Trauma Center. In her tenure with the ED, the Emergency Nursing staff in her departments have exceeded the National benchmarks for NDNQI survey results the past two years and have a greater than 50% certification of CPEN. LesleyAnn Has been awarded the San Diego YMCA TWIN award that recognizes Woman leaders in the community as well as receiving the Leader of Excellence Award nominated by staff at her organization. She is a member of ENA and Association of California Nurse Leaders (+)No significant financial relationships to disclose

2 Hiring and Retention GHAZALA Q SHARIEFF MD, MBA LESLEY ANN CARLSON, RN, MSN Physicians As Leaders Physicians are motivated by: Respect Control Money ** Respect and control are the most important. If these are not there, money becomes the motivator! 1

3 Proof! One Kaiser physician stated I truly think that we don t necessarily need monetary recognition or gifts. All those things are nice, but I think it is far better if leadership just walks by you in the hall says You are really doing a good job and I appreciate what you have done. Hire Wisely A body is not necessarily better than no body! One negative person can change the culture of an entire group They ridicule the efforts of individuals and organizations that are working hard under incredibly difficult circumstances The best predictor of future behavior is past behavior 2

4 Factors in Attrition Turnover is defined as all reasons for leaving a practice, including voluntary separation, termination, retirement and death Retention Survey, 73 % left due to voluntary separation, 14% due to termination, 11% due to retirement and 2% due to death. Voluntary separation is the only category where we can possibly influence the outcome. Making sure that new physician hires assimilate well into both the practice and the community is vitally important! Provider Attrition Rising? 6th annual Physician Retention Survey Cejka Search and the American Medical Group Association 2013 total turnover was 6.8%, compared to 5.9% in 2009 and 6.5% in 2011 Mid-level turnover 11.5% 3

5 Burnout in Healthcare Burnout is more common among physicians than among other US workers. Physicians in specialties at the front line of care access seem to be at greatest risk. Shanafelt et al. Arch Intern Med. 2012;172(18):1-9. A survey of practicing physicians nationwide found that the majority (almost 87%) are moderately to severely stressed...stress and burnout can lead to turnover. Interview Cost Model NEJM Career Center 4

6 Sample Cost Analysis NEJM Career Center Physician Retention: Lessons From Baylor Hire for cultural fit Behavioral-event questions focusing on difficult situations were added to the interview process to gauge how a candidate's personality and attitudes would fit 5

7 Behavioral Interviewing Competencies related to Business/Technical Skills Strategic Focus Financial Responsibility Creativity Problem Solving Quality Improvement Organizational Skills Clinical/Technical Skills Behavioral Interviewing Describe a process or system in your area that makes it difficult to get the job done. Have you addressed the issue? How? What has been the result? Describe an experience you have had working with a culturally diverse family customer. What did you have to do professionally to accommodate the family s/customer diversity? What was the outcome? What did you learn from the experience? Tell me about a particularly hectic day. How did you decide what to do first? How did you handle that day, the customers and the workload? What was the outcome? 6

8 Behavioral Interviewing Competencies related to Service Excellence Relationships Human Resources Development Teaming Initiative Flexibility Communication Skills Behavioral Interviewing Tell me about a time when a positive working relationship with a team member, client, physician, family or staff was threatened or challenged. Why did this happen? What made the interaction difficult? What did you do? What was the outcome? Describe a time when you were dealing with a very angry/irate customer. Why were they angry? What did you do? What was the outcome? Describe a time at work that challenged your flexibility. Why was you ability to be flexible challenged? What did you do? What was the outcome? 7

9 Physician Retention: Lessons From Baylor Optimize on-boarding practices developed a pre-hire to post-hire checklist to ensure that new employees were guided through the first few months at the organization. Mandatory Manager Check-in and introduction meetings Don t underestimate the value of welcome dinners /gifts for physicians and their families Simple things like parking passes/name tags/library access/computer access/desks/computers/printers should be built in to the process Year long program has improved success as turnover peaks at 2-3 years in practice Physician Retention: Lessons From Baylor Establish a buddy program Rather than use a senior member of the team use someone who embraces the culture of the organization 8

10 Physician Retention: Lessons From Baylor Mentoring Makes a Difference in Reducing Turnover The majority of medical groups (73.8%) believe mentoring reduces turnover, but only 56.1 % assign a mentor to newly hired physicians. For those who do assign a mentor, a formalized program makes a difference. The turnover rate was 1 percent lower (6%) for groups that have written goals and guidelines compared with those who do not assign a mentor (6.8 %). Physician Retention: Lessons From Baylor Build leadership Develop a list of expectations for the physician leaders, including: Provide opportunities for the physician to influence and be involved in the work environment Hold the entire team accountable for effective on-boarding of new physicians 9

11 Physician Retention: Lessons From Baylor Build social and community connections for the family Create a "workplace of choice" This entails ensuring that fundamental needs for work, such as autonomy and a sense of belonging, are being met Definition of a Satisfied Employee Science Daily Satisfied employees are those with a sense of wellbeing The presence of positive emotions such as joy and interest The absence of negative emotions such as apathy and sadness 10

12 Be Creative Encourage split shifts Take care of the older physicians in your group have a plan in place before they have to ask Market-based compensation Productivity bonuses Flexible schedules Mid-level support Scribes Retention bonuses. Why do you stay at your job if admin sucks? I stay because of our medical director. I know that she has our back on everything, from salary to foundation issues. 11

13 Strategies for Minimizing Time from Resignation to Filling Position Open door relationships Posting of positions Internal Transfer Potentials/Recruitment Anticipatory Planning and Trending of Vacancies 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% RCHSD San Diego California 18.0% 16.0% RN Turnover 6.0% 14.0% 4.0% 12.0% 2.0% 10.0% RCHSD 0.0% % San Diego California All Employee Turnover 6.0% 4.0% 2.0% 0.0%

14 RN Hires & Terms over past 7 years *2010 Reflects PPH Acquisition (52 hires & 4 terms) Hires Terms * FY11 (Jul-Sept) Turnover for Qtr 1 FY11 (Oct-Dec) Turnover for Qtr 2 FY11 (Jan-Mar) Turnover for Qtr 3 FY11 (Apr-Jun) Turnover for Qtr 4 Ttl Turnover for FY Emergency Room 9.68% 3.33% 1.64% 1.59% 16.24% Hem/Onc & Infusion Ctr 0.00% 0.00% 0.00% 9.52% 9.52% Hem/Onc Inpt Unit 0.00% 1.85% 0.00% 1.75% 3.61% Critical Care (IMU & PICU) 2.38% 1.82% 0.60% 2.47% 7.27% Medical Unit 3.00% 3.13% 3.49% 0.00% 9.61% Medical West Nelson 0.00% 0.00% 0.00% 10.00% 10.00% Medical Grossmont 0.00% 0.00% 0.00% 0.00% 0.00% NICU Main 2.47% 3.09% 3.77% 5.23% 14.56% NICU & Medical PPH 0.00% 0.00% 0.00% 4.35% 4.35% NICU Encinitas 8.33% 0.00% 0.00% 0.00% 8.33% NICU La Jolla 0.00% 3.13% 0.00% 3.23% 6.35% PACU 0.00% 0.00% 0.00% 0.00% 0.00% Surgical Unit 0.00% 3.51% 1.45% 4.48% 9.44% Operating Rm 0.00% 0.00% 0.00% 7.32% 7.32% Respiratory 1.10% 1.11% 0.00% 0.00% 2.21% 13

15 Things To Discuss When Hiring Benefits of partnership Staffing issues Effect of midlevel providers Effect of house staff Expected patients per hour Shift-length Number of shifts per month Weekends, nights, holidays Expectations of outside dept involvement Clues to Organizational Fit Recommendations of current staff! How does the applicant treat the secretary? How does the applicant treat the server during meals? How responsive is the applicant to s? Try to speak to ancillary staff from prior organizations Staff participation in interview 14

16 Work Force Planning & Technology for Scheduling 7,000 6,000 5,000 4,000 6,061 6,168 5,850 5,690 5,776 5,401 5,246 5,404 4,577 4,740 4,718 4,909 5,102 5,054 4,984 5,130 4,687 5,0194,562 4,887 4,409 4,440 4,269 4,193 3,000 2,000 1,000 - Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 15

17 6,000 5,000 4,000 3,000 2,000 1,000 - The key is a sense of autonomy API ANSOS others 16

18 10 Best Practices Kaiser Permanente 1.Realistic job expectations and behavioral screening 2 Timely orientation 3.Provide essential start up resources 4.Provide enculturation and sense of belonging 5.Robust mentoring program 10 Best Practices Kaiser Permanente 6.Perceived control over practice environment 7.Accurate, effective, timely feedback 8..Recognition, opportunities for advancement 9.Open communication with leaders that listen 10.Reduction of stress in the workplace -scribes, voice recognition,scheduling 17

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