Effective Measurers for Recruiting Wound Clinic Staff

  In this evolving era of outcomes-based, cost-effective medicine, wound care programs are challenged to meet a new standard of improved healing rates and diminished liability – all at a lower cost. Gratefully, the science of wound care has evolved into an unofficial medical specialty that is devoted to implementing best practices so that programs can meet financial challenges. However, one real hurdle remains: implementing best wound care practices across the healthcare continuum in order to create a new standard for the treatment of chronic wounds.   The industry has seen tremendous growth in hospital-based outpatient wound clinics as hospitals recognize the importance of adding wound care and hyperbaric medicine as both a service and a business line. This expansion, along with the expertise of management and consultant services that have driven clinical and financial success in these outpatient programs, can be credited with helping to develop a new standard of care. With many years of experience, along with more data and research to refer to, we as providers have a better understanding of how to treat chronic wounds in a cost-effective manner.   Still, outpatient wound clinics currently treat only a small subset of patients who can benefit from these new best practices, and the industry needs to further expand its knowledge and clinical expertise for patients — many of whom face limitations in their ability to get specialty care due to their own financial challenges or being homebound or housed in a skilled-nursing facility.   Many times, when skilled-care facilities and home health agencies need to ensure best practices are being met, they turn to the expertise of recruitment, staffing, and consultation agencies that can provide clinicians who can maintain the appropriate standard of care needed and expected in today’s complicated wound care industry. Through education, certification, and training, these companies can produce needed staff members (on a permanent and /or temporary basis) who can work in any setting across the continuum. But in order to staff one’s wound care center appropriately and effectively, an honest, comprehensive assessment must be made internally so that the proper clinician(s) can be recruited. This article will help both longstanding and new wound centers determine the recruitment needs for their respective organizations and how to follow up on addressing those needs adequately.

A Need for Recruitment

  As wound care has developed into a subspecialty service (both clinically and operationally) and physicians as well as allied clinical experts have devoted their careers to this field, we must find innovative ways to create and implement wound care experts into underserved settings. An article published by David G. Armstrong, DPM, MD, PhD, et al examined five-year mortality rates for neuropathic and ischemic diabetic foot ulcers, amputations, and various other conditions (including more prevalent types of cancer).¹ (See Figure 1.) Mortality rates for prostate and breast cancers were found to be 8% and 18%, respectively, showing a sharp decline in previously much higher rates for these conditions. This is likely a result of applying research knowledge, data, and clinical expertise across the entire healthcare industry to create a standard of care for best practices. When standards of care are in place, all patients, regardless of setting, can be offered protocol that’s based on a best-practice model and that’s implemented to promote optimal outcomes. However, it was also found that 45-55% of all patients diagnosed with a neuropathic or ischemic ulcer, or with a diabetes-related amputation, will die within five years.¹ (See Figure 1.) For those clinicians working in a best-practice environment, these statistics may seem extremely inflated, if not appalling. We must remember that most patients with these conditions do not have the resources to come to a best-practice environment, and the clinicians, facilities, and agencies caring for these patients have not had the training and education to implement what we know as standards of wound healing. This has left a gaping hole in wound outcomes across the continuum of care. Without appropriate education to the programs and the physicians caring for patients outside of a dedicated wound center, we will continue to see a discrepancy in care and the presence of “reactive wound care” as opposed to cost-effective, proactive prevention and more appropriate healing clinical guidelines. Organizations like recruitment agencies can assist hospitals and wound centers in acquiring well-educated, experienced staff members to promote best practices. However, when seeking staffing resources it’s incumbent upon the hiring party to focus its search on the most relevant staff to recruit. Depending on the size of a wound program, recruited staff may just be responsible for daily wound care practice for each (smaller programs) or more administrative roles such as staff management and delegation. There are several steps that can be taken in order to determine proper staffing for the wound center. Here are a few of the most critical:   1. Devise a “skills list.” Some programs choose to have an all-nursing staff. While this is an admirable goal, is it completely necessary and cost-effective? Consider which duties could be managed safely and efficiently by a licensed practical nurse or a medical assistant. Registered nurses are needed for nursing assessment, diagnosis, and case management; but how much of their time is spent on non-essential paperwork, phone calls, or tasks such as cleaning and preparing patient rooms and administrative medical record management? Make a list of the skills that coverage is specifically needed for, and let that guide your recruitment needs.   2. Develop job descriptions. Once the essential duties and skill sets are known, these needs can be addressed by devising job descriptions that can be used for determining performance evaluations and making the interview/review process for candidates that much easier.   3. Determine compensation. Existing pay scales and compensation policies may already be in place, but if any changes to a position have been made these items should be reviewed. Remuneration must provide adequate incentive and be comparable and equitable with similar positions.   4. Conduct all methods of recruitment. Consider seeking candidates through Internet searches, print advertising, job fairs, and word of mouth.   As we have learned more about the science of wound care and the need for an individualized and aggressive diagnostic and treatment approach to ensure best outcomes, wound care has become a physician-driven specialty. The need for physician-driven services lies at the core of the advanced practice standards for debridement, biologic dressing, hyperbaric oxygen therapy, and customized medicine such as genetic testing and compounding. Therefore, the ideal wound program will be led by a physician who’s committed to continued education, comfortable with overseeing a staff and implementing best practice programs, and ensuring appropriate practice is followed. (The development of a multidisciplinary team approach can be implemented to utilize all available resources at hand.)

Evaluating Potential

  When utilizing the services of a recruitment agency, hiring the best staff member becomes a crucial task and test of a wound center’s manager. Making the best hire affects a facility’s overall costs, turnover, staff relations, overall morale, and, patient satisfaction and outcomes. When the “wrong” person is hired, other staff may become resistant, morale may drop, patient care may be compromised, turnover and training costs rise, and life for the manager can become complicated. Finding good staff members is not based on whims or when “the right person comes along.” Although the hiring process can be tedious, time consuming, and even expensive at times, there is no doubt that the effort spent will be extremely beneficial. No matter how good people think they are at judging the character of others, there is a lot that goes into making a successful hire. These steps should be used:   1. Candidate screening: Review resumes and select candidates who best match the qualifications stated in the job description, and perhaps conduct telephone pre-screening interviews. Select the top candidates and send those resumes to the hiring manager for review. Ideally, at least five candidates should be identified for an in-person interview.   2. Formal interviews: Tailor each interview to the job opening. Use the job responsibilities and analyze the candidates to measure the specific qualities needed to perform selected duties. It’s important that the chemistry with the candidate, the company, and the onsite team are compatible. Evaluate the whole person and not just his/her capabilities to perform a task by using well-designed questions and well-developed listening skills, and exploring the candidate’s propensity to carry out the job responsibilities with particular regard to an appropriate level of compassion and commitment to productivity.   3. Reference verification: Conduct verification of licensures (if applicable) and reference checks for professional performance and personality profile to ascertain whether a candidate has those traits that make the greatest contribution to the overall success of the team.   4. Second interview: A second interview conducted with the most ideal candidates for consideration should be conducted to help make a final decision. The most critical consideration when bringing a new employee into the organization is ensuring the selection will support the program’s reputation.   Once a new employee is hired, administration should foster an advantageous environment to allow the individual to excel. When possible and appropriate, orientation should include a mentoring or shadowing process. Chris Morrison is executive medical director of Healogics Specialty Physicians, Jacksonville, FL, and medical director of Wound Systems, Atlanta, GA.

Reference

1. Armstrong DG, et al. Are diabetes-related wounds and amputations worse than cancer? International Wound Journal. 2007;4(4):286-287.