Attracting, Onboarding, & Retaining Employees Within the Healthcare Industry

It goes without saying that without good, qualified employees, you cannot serve your patients, their families, and the community. Hiring the right people and engaging and retaining your employees will result in higher morale, lower employee turnover, and a much stronger bottom line.

As we face global unprecedented demographic, economic, and competitive challenges, and other industries experience layoffs and cutbacks, most analysts have projected that the health care industry will be the fastest-growing segment of the economy over the next ten years and will account for at least three out of every 10 new jobs created. Developing an effective talent acquisition strategy is a challenge, especially within the health care industry as the shortage of health care professionals grows.

Unfortunately, there is no industry that is more archaic in recruiting and talent management than health care. The approach and overall attitude found in many health care recruiting functions is often antiquated. This assessment is based upon my 21 years of observation and experience working with a number of health care organizations and professionals within in the USA and globally to improve the impact of their recruiting and retention efforts.

Not all health care organizations are awful at recruiting; those who have mastered 21st century recruiting approaches achieve phenomenal success. Unfortunately, the vast majority (90 percent) seem as dedicated to generating excuses for their shortcomings as the leading 10 percent is to making a difference.

In health care, the ability to quickly screen, hire, and onboard medical personnel can have a direct affect on patients’ well-being. As such, recruitment and retention in the health care industry must remain a top priority.

By many estimates, the number of Americans nearing retirement will increase by more than 30 percent, while the population of young adults entering the workforce will rise by less than 3 percent. The need for health care organizations to make talent management a top priority is further emphasized by the pending talent crisis and the need to hire and retain key employees when we consider this fact and the other challenges such as a growing number of current workers leaving the field and more stringent budget cuts, the likelihood of increased governmental regulation and global competition.

Talent Management Accountability involves four key areas:
• Attracting employees—sourcing, hiring and new employees.
• Onboarding new employees – training, educating and getting new employees comfortable
• Retaining existing employees—managing, engaging and developing employees.
• Transitioning employees—expanding responsibilities of, transferring and knowing when to let go of employees.

Attracting the Right Employees
Everything begins with hiring the right employees. In his book Good to Great: Why Some Companies Make the Leap… and Others Don’t, Jim Collins says that the best companies “get the right people on the bus, the right people in the right seats, and the wrong people off the bus.” Collins says great companies have a corporate culture that finds and promotes disciplined people to think and act in a disciplined manner. Collins states:”…if you have the wrong people, it doesn’t matter whether you discover the right direction; you still won’t have a great company. Great vision without great people is irrelevant.” Yet the right employees are often elusive, and becoming more so—especially in the health care industry.

Competition for a shrinking talent pool is keen. Potential health care employees have more choices of where to work. Globalization makes skilled workers prime recruiting targets of health care organizations around the world, and the Internet makes it simple for health care employees to find and compare job opportunities. Finding prospective employees is the first step. Finding the right employees from among the prospects is the second. And then quickly getting the right employees geared up, motivated, productive, and confident in their new responsibilities is the third.

Whose job is it to source? To interview? To hire? To orient and train new employees?

Health care Organizations of all sizes implement a variety of new processes and procedures—usually through their human resources departments—to make sourcing, hiring, and onboarding more effective. Technology, for example, plays an ever-bigger role in many organizations. Facilities can now implement software applications that initiate a requisition to staffing, post jobs to job boards and corporate websites, extract resumes to databases, track candidates through prescreening and reference checking, schedule interviews, stay in e-mail contact with candidates, and make employment offers.

Many organizations also design and implement standardized job descriptions, interview guides, reference checking procedures, outsourced recruiting assistance, and other processes to help their hiring managers reach the job offer and acceptance stage. Then, retooled employee orientation, training, and mentoring programs help get new employees up to speed quickly. In these ways, HR adds real value to the process, freeing managers to focus on their day-to-day operational issues.

But these value-added tools and techniques can backfire when managers rely too heavily on them to bring new people into the organization or when they take the “it’s HR’s job” approach to this key accountability.

Unit managers always have been and must continue to be ultimately responsible for attracting new employees to the health care organization. They know the job that needs to be done, they know the culture, they know the team dynamics, they know the results that both they and the facility need. They are also the ones tasked with developing their health care professionals now and in the future—and transitioning them into expanded job responsibilities when the time is right.

Managers need to embrace the responsibility for recruiting the right health care professionals into their facility and unit. And that means fulfilling their roles in all three “attracting” accountabilities—sourcing, hiring, and bringing people on board.

So, what does that look like?
When the best managers are studied, they demonstrate these accountabilities in the following ways:

Sourcing: Top managers create and nurture a qualified pool of health care candidates for current and future positions. They work effectively with internal support functions while maintaining overall responsibility for this effort. They focus not only on the existing requirements for a position, but also on the future direction of the facility and the skills it will need in two to five years. Those managers continually define “best-fit” candidate requirements, which include motivation and attitude in addition to knowledge and skills.

Managers who employ best practices during the sourcing process use creative techniques to maintain a steady stream of internal and external candidates. They know the search never ends, even after they select a candidate for a specific position.

Hiring: Successful managers get the right people into the right jobs on their unit. They use best practices such as planned and structured approaches when interviewing, asking appropriate questions to accumulate the data that allow them to objectively compare candidates and make the best choices. They look beyond the urgency of filling a position to find the employee who offers a fresh perspective and another dimension to the team—adding a diversity of ideas, approaches, and backgrounds. The best managers also understand the importance of representing the health care organization well, making a good impression on the candidate and communicating the organization’s vision and values. They show respect to all health care professionals by treating them with concern and honesty—allowing the candidates to determine whether they are a good match for the health care organization.

Onboarding: Onboarding refers to the process of integrating new employees into the organization, of preparing them to succeed at their job, and to become fully engaged, productive members of the health care organization. It includes the initial orientation event and the ensuing months thereafter.

Successful on boarding is one of the most effective weapons in your arsenal. Studies have shown that a well-designed onboarding program can turn a new hire into a dedicated employee, reducing the costs of turnover. In a recent case study of a Washington DC hospital, they explained how a human resource executive at an area hospital had a simple, but powerful idea. The hospital decided to begin onboarding even before the new nurses started their first day.

Instead of waiting and hoping the new hire would make it through the recruiting frenzy that continued through the moment of accepting a new job to their first day, each nurse manager now proactively introduces the new hire to their team of nurses. The team of nurses then follows up by personally signing and sending a welcome card expressing their excitement to work with the new hire.

Although simple, creating a logical and emotional connection between the new hire, the organization, and their new team has proven particularly effective. New nurses now feel more connected and pre- and post-start attrition has decreased dramatically.

“Great employers begin the process before new hires arrive on-site,” reports Workforce Management in a recent article, Onboarding Secures Talent for the Long Run. “During the final interview or at time scheduled before the official ‘start date,’ introduce team members… complete the paperwork… Employees are usually eager to dive in on the first day, so bypassing administrative tasks and focusing on the work to be done will keep enthusiasm high.”

Human Resources Solutions recently called such onboarding practices ‘Delivering on the Promise,’ saying, “Ultimately, when people are made to feel welcome, they are more productive, less stressed, and more team focused. This all translates into lower turnover rates.”

Getting new employees comfortable, connected, and productive as soon as possible is the manager’s role. When managers communicate the “big picture,” new employees can understand how their roles support the health care organization’s goals. When a manager takes the time to build a relationship with an employee, that employee becomes a member of the team. The availability of resources is also important to new employees. The best managers create a support network for their new hires to help them quickly get up to speed. These managers also realize that being available to answer questions and provide feedback is a critical investment of time. When it comes to attracting the right employees, hiring managers at every level within the organization need to take bottom-line responsibility for finding, hiring, and onboarding new employees. Managers who are proactive throughout the entire attracting process ensure that the organization has the talent best suited for today and tomorrows needs.
Onboarding Suggestions:

To start, employers should make sure new staff members are properly welcomed to the organization and briefed on important information. Here are a few things you can do:
1. Appoint a point person or mentor, in addition to the supervisor, who can welcome and orient the new staff member to the organization. Make sure the mentor has specific tasks to cover for the first day, week, and following three months.
2. Send a card or letter welcoming him/her to the agency. Include needed paperwork, employee handbook, benefits, etc.
3. Send an agenda, along with the offer letter, letting the employee know what to expect on the first day.
4. Order business cards (if applicable).
5. Have any ID and security cards ready.
6. Send a welcome e-mail, along with a new hire FAQ sheet and/or the necessary forms to be filled out.
7. Make sure the employee’s work area is ready.
8. Make a new hire announcement and on the first day, introduce the new staff member to co-workers.
9. Create lunch plans for your new hire’s first few days, helping her/him feel at ease.
10. Don’t leave new hires to figure out the organization’s culture and unwritten rules on their own. For instance, what is the preferred method of communication – e-mail, phone, or meetings? How are decisions made? When are employees expected to act on their own.
11. With the right people on board, the battle shifts to retention.

Retaining Existing Employees:
The annual turnover rate among health care employees is startling. Some turnover is unavoidable: people get married, move away, go back to school or retire. But other types of turnover are preventable. According to the Human Resource Management Association, 20.4 percent of health care employees (one in five) quit their jobs every year. The number easily exceeds the 12 to 15 percent turnover rate experienced in most other industries.

It costs over $50,000 to recruit and train a new nurse. To replace an experienced Critical Care nurse can cost as much $120,000. In today’s tumultuous economical environment, your health care organization can ill-afford a revolving talent door.

Staff turnover can be minimized when there is a high level of job satisfaction among staff.
Managers are key in retaining their health care professionals, as management practices can greatly influence turnover intention. Supervisors must pay attention to staff needs and help create a positive working environment.

Managers must look for ways to keep their employees engaged. In a recent article, “Nurses Rank as Least Satisfied,” hospital employees emphasized the need for leaders to pay more attention to their concerns. They cite it as the best chance for improving the working environment.

Engagement has been defined as a persistent state of work fulfillment. This fulfillment translates into enthusiasm and passion, higher than average levels of concentration, focus, and energy. Take away any of these factors and engagement suffers

Employee engagement has become a hot topic among managers because there’s growing evidence that employee engagement correlates to individual, group, and organizational performance in the areas of productivity, retention, turnover, patient care, and loyalty. Since experiencing catastrophic events such as 9/11, our nation’s employees’ attitudes towards careers has taken a dramatic shift, and they need to see that their work matters. Employees become engaged when they see a connection between their work and the organization’s success. This message is successfully conveyed when there is clear communication between the supervisor and staff member

Stay Interviews
Employee interviews are usually conducted when an employee starts or finishes a job. Beverly Kaye, one of the world’s leading experts on career development, mentoring and talent retention, suggests that “stay interviews” should be conducted monthly on a one-on-one basis with the employee in a neutral setting.
According to Kaye, the most important thing managers should do is ask, “What can I do to keep you? You are important to me, and I want to know what I can do to keep your talent on my team?” If an employee says it’s about money and you do not have latitude on pay, be truthful and say, “My hands are tied on the issue of salary, so tell me what else I can do?” It is about communicating, being up-front, and telling the truth.

Kaye outlines in her book, Love ‘Em or Lose ‘Em: Getting Good People to Stay, the following suggested questions to include in stay interviews:
• What about your job makes you jump out of bed?
• What makes you hit the snooze button?
• If you were to win the lottery and resign, what would you miss the most?
• What would be the one thing that, if it changed in your current role, would make you consider moving on?
• If you had a magic wand, what would be the one thing you would change about this department?
• If you had to go back to a position in your past and stay for an extended period of time, which one would it be and why?

Employees also have the responsibility to ask for what they need and express these feelings and concerns to their supervisor. Supervisors are not mind readers.

Of course, compensation is important in attracting and keeping employees, but it is not necessarily the only factor in a person’s decision to take or keep working at a job. There are many other surrounding non-monetary issues which help support employee engagement and retention.

Employees who are treated well feel a sense of obligation to their job and organization. As a manager/supervisor, there are simple, yet powerful actions you can take to influence job satisfaction, morale, and productivity.
• Treat people with courtesy, politeness, and kindness.
• Maintain open communication and encourage staff to express their opinions and ideas.
• Listen to your staff and try to respond to their requests.
• Implement policies and procedures consistently and fairly.
• Include staff in meetings, discussions, trainings, and events.
• Make staff meetings a time to celebrate.
• Give employees their birthday off.
• Give staff some time off (hours, half day, full day) as an incentive for doing something special/extra.
• Spend time with employees. Involve employees in determining their career path goals and development plan. Provide opportunities for training and professional development.
• Provide opportunities for advancement.
• Coach employee skill development.
• Praise more than you criticize and encourage praise among coworkers.
• Foster teamwork. When employees work toward a common goal, performance improves.
• Lead by example. Lead from Mission and Vision.
• Delegate. Employees want job autonomy. Help establish goals for your department and work unit.
• Set understandable expectations and goals for each staff member. Communicate them in a clear, concise manner.
• Manage gossip. Otherwise, interpersonal relationships can be damaged, thus ` disrupting employee motivation and morale.
• Create a culture of accountability. At meetings have an agenda; start and end on time, and follow-up.
• Create a motivating workplace. Integrate values such as integrity, empowerment, perseverance, equality, discipline, and accountability into the organization.
• Think positive! There’s a lot of power in optimistic thinking.
• Let staff know they matter and make a difference.
• Utilize your staff’s talent and skills. Avoid burnout. Give workers added responsibilities, new challenges, and advancement opportunities.
• Say thank you. Give them a card of thanks in your own handwriting.
• Respect the work/life balance.
• Laugh. Have some fun. Laughter contributes to positive morale, a major factor in retaining valued employees.
• If applicable – cover a group for your employee so he/she can “catch up” with paperwork.
• Have a “spring cleaning” day when staff can have a day off from their typical schedule to clean up their work space – and/or catch up on paperwork.
• Implement their ideas.
• Involve them in committees to be a “leader” in something they are interested in and knowledgeable.
• Make clinical supervision a weekly priority which can only get cancelled in emergencies
• Get to know your employees. Ask them (safe) personal questions about their family life, hobbies and interests
• Know it is your duty as their manager/supervisor to give your staff the care, tools, and resources they need to be successful.
• REFLECT: What am I doing to take care of and give my staff these things?

Hiring and keeping the best health care professionals means creating a talent plan to reenergize and refocus your management team. Health care organizations must attract and retain qualified clinical professionals to ensure quality care. They must constantly monitor their employee value proposition. They must source and develop talent carefully, keeping employees engaged and committed, while removing underperformers. And they must ensure that every manager in the health care organization understands the rules of engagement and embraces a leadership role in talent management.

For further information on attracting, onboarding and retaining employees within the health care industry contact Nadia Gruzd at 858 229-5939 or