Nursing and physician shortages aren’t the only staff challenges providers are facing. According to a new STAT poll from the Medical Group Management Association, a majority of healthcare organization leaders said their group can’t find enough qualified applicants for non-clinical positions either.
The poll was conducted on May 1, 2018 with 1,299 applicable responses.
More than 60 percent of respondents said their organizations had a hard time recruiting non-clinical staff. The reasons include larger organizations offering better pay, low unemployment rates and difficulty recruiting in rural areas. One respondent said “recruiting millennials is a completely different game” and another cited lack of future career advancements in the billing and coding field.
“Lack of medical training in colleges and technical schools and reliance on ‘on the job training’ means less qualified non-clinical applicants,” MGMA said.
Other reasons include competition from other medical groups, hospitals and health systems as well as competitive pay from other industries that trigger turnover.
One-third responded they haven’t experienced this shortage, citing low turnover. Those respondents also said they had increased wages to retain staff, MGMA said.
A past poll has shown this high-turnover is prevalent in front-office staff, which some experts have argued are the face of a practice and the first ones to interact with patients, often setting a tone for the care episode making it a crucial influence of patient satisfaction.
When there is high turnover, new employees are often not as well-versed in office policies and procedures because they likely haven’t been there very long. This can lead to mistakes, inaccuracies and bumpy interactions with patients who expect staff to know operations inside and out. It can also lead to costly errors not just on the part of new employees, but veteran staff who are busy training and juggling multiple tasks at any given moment. The trickle down effect could mean patients wait longer to be seen, appointments go longer and collections and claims may be riddled with mistakes.
Medical group leaders know that it isn’t just doctors and nurses who make their practices successful and run smoothly, so they would be well-advised to treat retention of non-clinical staff with urgency.
Since a third of respondents reported lower turnover after raising wages for non-clinical staff, decision-makers for practices may want to consider researching current competitive rates for these positions and potentially raising wages such that staff would be less inclined to seek higher-paying employment elsewhere.
Practices also might consider how else to boost employee benefits and the workplace environment so that employees experience greater satisfaction. Turnover leads to operational hiccups, less efficient service for patients and lower satisfaction rates.
“While finding qualified candidates is a challenge for medical groups, practice leaders can begin by assessing how they are approaching retention of their best employees and mitigating turnover before it becomes an issue,” MGMA said.
So far in 2018, approximately 12 hospital and health system executives have suddenly left their roles. While there are myriad reasons for the departures — ranging from being ousted to personal issues — most of them occurred with little or no notice. Whatever the reason, the question remains: How can executives mitigate the potential fallout?
According to Cody Burch, executive vice president at healthcare executive consulting and search firm B.E. Smith, any potential fallout from a sudden departure can be mitigated if executives remain positive and transparent.
“It doesn’t necessarily have to have a negative impact on [a] healthcare executive’s chances of landing another job,” he says.
There are several reasons behind a healthcare executive suddenly stepping down from their role. Common ones include burnout, termination for cause, personal issues and structural changes in the organization, says Mr. Burch. More recent reasons include consolidation, facility closures and demand for new skill sets. An executive may find they are not the right fit for the role anymore as the demands of the role or organization have changed.
An executive who has suddenly left an organization may find they have fewer opportunities in the job market. Mr. Burch says sometimes organizations looking to fill positions may only consider candidates who are currently employed, so executives who have recently left their roles may see a narrower job market than before.
Job seekers with a sudden departure on their resume may have to navigate challenging waters as they look for new opportunities. Here are five key considerations for these executives:
1. Remember honesty is key. Healthcare is very well connected. Healthcare executives and recruiters know each other, often having crossed paths over several years working in the same industry. The best strategy for executives who are looking for a new job after an abrupt departure is to be honest about their past circumstances.
“It is easy for people to find out the real story in an industry like healthcare,” says Mr. Burch. “Communicate about it honestly.”
2. Proactively address the one question every recruiter will ask. Most recruiters will ask the inevitable question, namely some version of, “Why did you leave your previous role?” Mr. Burch suggests healthcare executives expect that question and address it before the recruiter can even ask it. This gives the executive control over the messaging and narrative.
Mr. Burch says executives need to prepare their response to the question carefully. As much as possible:
• Try to disconnect the reason you are no longer in your previous role from the future.
• Communicate what you learned from your previous experience.
• Keep your answer short and focused on the positives.
• Reiterate your qualifications for the current opportunity.
• Explain why you are great fit for the new organization.
3. Stay positive. Although an abrupt departure can be a negative experience, it is important not to lose your positivity and perspective. “I think there is something to be said for either [the executive] or the employer identifying that the fit just isn’t there in the current organization,” says Mr. Burch. “Being able to come to a conclusion and reflect, truly reflect, on why it didn’t work.”
Finding an organization that is a better fit for the executive is a good thing for both the executive and the organization. It is important not to become bitter or emotional. Take the high road regardless of how things ended with the previous employer.
4. Keep networking. Keep your CV up to date and leverage your relationships within the industry, Mr. Burch says. Networking is always critical, but especially so at times of sudden change. Don’t be afraid to ask for help with your CV and partner with a recruiting firm if needed, he adds.
5. Leverage interim leadership. Executives looking to get back into the industry after a sudden departure can look for interim leadership roles. Use these roles to build confidence and demonstrate their value, says Mr. Burch. This will also help connect you to new people within the industry and potentially, new advocates for your leadership expertise.
“If you handle that transition well and get into a good opportunity for your career, the transition no longer matters,” says Mr. Burch. “People aren’t going to look back at that situation unless it happens commonly and frequently [in your career].”
A conversation with Bill Haylon, CEO of Leaders For Today
Economic anxieties need not correlate with a high unemployment rate. Take it from business leaders across multiple U.S. industries: Their biggest challenge is not a lack of job openings for thousands of qualified candidates — it’s a lack of candidates for thousands of openings.
HR professionals are used to hearing about skill shortages in manufacturingand other blue-collar work, but perhaps more understated are gaps in the STEM fields.
Careers in nursing and medicine, which often require years of additional, specialized education are hard to fill. Physician assistant openings were one of the most in-demand fields near the end of 2016, according to the American Staffing Association. But hospitals aren’t just struggling to find people to staff operating rooms. They face a much bigger challenge in a lack of leadership skills.
HR Dive/Healthcare Dive spoke with staffing firm Leaders For Today’s CEO Bill Haylon about the root of leadership gaps in healthcare, and how hospital HR departments can confront the problem. Our conversation has been lightly edited for length and clarity.
HR Dive: When hospitals come to a healthcare staffing firm like Leaders For Today, what are they asking for?
Bill Haylon: What we’re really doing is helping them find people who have particular sets of skills. We provide staffing on an interim basis. A hospital or healthcare system comes to us and says, “we really need somebody who can fix and lead our case management department,” “we need somebody who’s got certain technical skills and leadership skills.” We’re not actually training individuals, we’re finding people who fill those slots.
We’re going out and finding people, who they can either hire full time or on an interim basis. We’ll look for, on average, a little more than six spots, and we’ll start from a pool of people that we have that we’ve worked with before.
We’re not really doing training, but training is one of the problems in the healthcare world.
HR Dive: When you look for potential staffers, what kind of skills do they have? What stands out the most to the healthcare systems you work with?
Haylon: There are certain skills that go across all positions, and there are certain skills that are specific to a position because we can hire for. For example, we have a team that focuses on OR people, while others focus on case management, hospital finance, physician management, practice management, etc.
Across the board, what we focus on is, first and foremost, trying to find people who have been steady with or who have stayed with an organization for some period of time and developed within that. In other words, we try and stay away from what we call “jumpers” — people that have a job for a year, two years, and then try and go on their next role.
Unfortunately, that’s counter to what occurs in the industry. People in the hospital industry jump all the time.
We try and get some stability in their job, because we believe they learn more that way [when it comes to] both the technical skills and leadership skills. Of course, you look for the basic things: education, undergraduate work, master’s degree and other certifications.
You’re trying to vet the person along, so a lot of time you’re talking about different situations, different experiences, how they’ve handled them in the past or how they might handle them in the future. It could be a difficult position to deal with, a union situation, a quality situation, a safety situation. And you try to understand what their thought-making process is.
HR Dive: What skills are hardest to come by in the medical world, given that a lot of industries are seeing skills shortages?
Haylon: There’s an enormous shortage of talent within the hospital industry in all key levels. It was going on before Obamacare, and now with Obamacare and more people being covered, each organization is seeing a big uptick in the number of patients they see. It’s really gotten to be a very critical moment.
The most difficult job category is the O.R., the second hardest is case management and the third hardest is physician practice management.
From a skill set perspective, it’s leadership. Most of those in leadership positions are people who were nurses or doctors. When you go to school, you do not learn about financial statements, management skills or leadership. You’re learning how to suture, avoid infections and open up rib cages.
You take a person who has been a staff nurse for [a certain number] of years, and they decide they want to go into a leadership role. Because there’s a shortage of people, they are put in those spots well before they’re ready. They don’t have any training; hospitals do not train people for career development or leadership, and so you’re just kind of winging it. You get people who are very quickly over their head in their positions.
HR Dive: What can hospitals change about the way they operate to help develop those skills, or is that simply not possible given their bandwidth?
Haylon: They make it harder than it is. The reality is that hospitals consolidate, so they’re parts of bigger systems. You have a director in the O.R. who could be managing 440 people. That’s a lot of people. This was the case for one hospital we worked with, and the person running that OR had been a staff nurse and morphed to this role. But her [previous] role had been running a small hospital where she had 30 people, and now she’s up to 440 people, and it’s over her head.
So the reality is that they need to start thinking about different skill sets, and the obvious one is an MBA. When you’re the director of a 440-person O.R., you’re not seeing patients anymore. You’re doing hiring and scheduling. You’re developing quality programs and safety programs. You’re trying to get the surgeons on board. You’re never seeing a patient; that’s a different set of skills.
You don’t need to be clinical, you need to be a manager and a leader. It could be an MBA, it could be a master’s in health. But you need more than clinical training.
So what hospitals do [by recruiting for a certain skillset] is totally reactive as opposed to being proactive and developing people.
HR Dive: Do you see a shift in terms of the skills that physicians and other professionals are being taught in school?
Haylon: You’re being taught technical skills, clinical skills, whatever your specialty is. You go to medical school, do your residency, maybe followed by a fellowship, and it’s all technical skills. Physicians [are also] getting way more specialized than they used to be.
Typically the people who have jobs [in healthcare leadership] have gone and gotten additional training and education on their own.
Physicians and nurses are not trained in school to run big organizations. Plus, they’re doing research, and they’ve got to handle anybody that comes into the OR and the ER. It’s hard enough to get training for it, and it’s beyond belief if you don’t have training.
HR Dive: What else should hospital systems be mindful of when looking for leadership in the medical workforce?
Haylon: When you look at survey data from across the hospital industry, you see that people are staying in positions for incredibly short periods of time. Forty percent of people right now in key positions in hospitals have been in their position two years or less. Another 40% expect to leave in the next two years. What happens is that hospitals have a hole, and they need better leaders, so they poach from somebody else.
So the director of a surgical department will be a manager at a small hospital, then become a manager at a bigger hospital, then a manager at a bigger hospital, then a director at a small hospital, then a director at a bigger hospital, and finally a director at a bigger hospital. They just keep poaching from each other.
The problem is it’s the same people who are circling through. The people you’re hiring never had the time to put in place good, quality programs, [including] safety programs and productivity programs, because they’re not there long enough. They can’t make it stick in just two years; these are very complicated things.
And so that’s the result of what you’re talking about. The lack of training and development shows itself in this poaching and job hopping in the hospital world. It is like no industry you have ever seen before.
In other industries, an enormous amount of resources are put into training, so people stay in those industries and move up. You take up greater responsibilities, but they invest a lot in you as a developing person. The hospitals invest almost nothing. It’s up to the individual to go and figure it out on your own. Get your MBA, take this class, get a certification from the hospital association. But you’re not developing your own people.
Other organizations develop their own people because they want to be the best at what they do — they want to differentiate themselves. The only way they can do that is to develop their own people. Because hospitals don’t do that, there really is no differentiation, and hence, they struggle.
So this lack of training and the lack of development ends up creating an industry where everybody knows they’re going to jump all the time. You’ve got hospitals that have hired their sixth CEO in seven years. So the question is: If you’re a patient and you have knowledge of this, would you want to go to that hospital?
If you have that sort of instability at the top spot, then it’s going to trickle all the way down. Healthcare is complicated; it takes a while to figure out orders in place that are going to work. If they have quality problems, or safety problems, you can’t fix them that quickly. You’ve got to have someone who understands the lay of the land and can make a difference.
“You can give out bonuses, trinkets, t-shirts and keychains. But at the end of the day people want to be listened to and feel valued, respected and cared for by their colleagues and the leadership team.”
While most organizations measure turnover and try to improve it, many don’t really understand its cost or causes, and fewer still take a holistic, effective approach to attracting and retaining the best talent, at every level of the organization.
This interactive panel discussion will explore turnover from multiple perspectives. HR leaders from two of the nation’s largest not-for-profit health systems and an expert in hiring, selection, and turnover will discuss the cost of turnover and the ROI of improving retention, the issues and variables that drive turnover, and their impact on broader organizational goals. After exploring what really goes into understanding turnover, the panel will share what they’ve learned about what works, what doesn’t, and an approach to the problem that can be tailored to your situation – and that can be sustained.