Achieving Standard of Care Through Employee Recruitment & Retention

Wound clinic program managers may encounter obstacles when it comes to providing appropriate wound management. In most instances, a lack of standardization to clinical and business practices is the culprit. For an area of care dependent on a multidisciplinary team approach, what can we do at the clinic level to help improve industry standards? This article will discuss how the appropriate hiring and training of staff members, as well as staff retention, can greatly impact the wound clinic’s patients. 

BEST EMPLOYEE PRACTICES 

“Standard of care” is a term we often speak of and hear about in the wound care setting, but do we really know what it means? Generally, its defined as the degree of care and skill of the average healthcare provider who practices a specific specialty while taking into account available medical knowledge.¹ Standard of care can also refer to informal or formal guidelines that are generally accepted in the medical community for treatment of a disease or condition, or a clinical practice guideline that follows specific protocols (ie, a “best practice”).² For any business to have even a remote chance of instituting a pattern (ie, standard) for best practices, the common thread that will drive success is the employees, including those in management positions. In a patient-centered model of care, a focus on the customer is important. Our patients require the right treatment at the right time in order to experience positive outcomes. Likewise, having a strategic plan for the recruitment and retention of the “right” employee can ensure the success of any wound clinic. Having the right person placed in a position that will maximize his/her skill set and provide the staff member with the right tools and opportunities is invaluable. This all starts with the program managers and the administrators. All members of management who are responsible for overseeing the clinic must have an equal, consistent understanding of every clinical and business-related aspect of that clinic in order to provide the proper training that all employees need and deserve. Thus, ensuring that the right leaders, meaning managers, are in place is Job No. 1 for any wound clinic. Only then can an expectation for consistent and effective hiring processes, training protocols, and employee development that results in strong retention rates be realized. Before program managers “decide” that these realities already exist in their clinics, they should be asking themselves: What are the tools/training materials that we provide our staff members with for them to succeed? Are we hiring employees whom we’d describe as “top performers” consistently? What is our employee turnover rate? Are we losing our top performers too often? Are our employees engaged, or do they seem disengaged? Consider some of these statistics:

• 63% of workers are “not engaged,” which means they’re unhappy and pretty much “checked out.” They maintain the minimum workload necessary to keep their jobs.³
• 24% of workers are “actively disengaged,” which means they are really unhappy, act out, undermine the company, and distract the people around them. Basically, they “hate their jobs.”³
• 13% of workers are “engaged.” This means they feel a sense of passion and connection to what they do and to helping the company move forward.³
• 40% of employees who left their jobs in 2013 did so within six months of starting.⁴
• The average direct cost for a new employee (not including training) is $57,968.⁴
• Of nearly 1,000 companies surveyed, only 9% of senior management believes turnover is an “urgent issue.”⁴
• More than 50% of voluntary turnover happens within a year of the new hire’s start date.⁴
• Only 35% of applicants are actually qualified for the jobs they apply to.⁵
• While the average length of a candidate interview is 40 minutes, 33% of 2000 surveyed bosses indicate they know within the first 90 seconds if they will hire that candidate.⁵ 
• 66% of employers said they experienced negative effects of bad hires in 2012.⁶  
• 43% of study respondents cited the “need to fill the positions quickly” as the main reason for bad hires.⁷
• As much as 80% of employee turnover is due to “bad hiring decisions.”⁸

THE HIRING PROCESS

A successful career to some may be defined as making the right amount of money to pay their bills and to live their life “comfortably.” To me, a successful career for a healthcare professional should be one that allows the individual to share that skill, education, and passion for treating patients in a manner that produces enough positive outcomes that the clinician can truly enjoy going into the clinic each day and know that he or she is equipped to do what’s right for the people being served. Those who apply to a job are going to have varied reasons for doing so. Wound clinic program managers, however, need to keep the same goals in mind when interviewing applicants: Hiring the individual who will be best suited to care for the patients who are seen at one’s clinic and ensuring the applicant possesses the necessary qualifications to fit one’s organization. Those involved in the hiring process should “huddle up” prior to and after each interview to discuss how the candidate’s curriculum vitae and interview performance align with the company’s goals. Hiring managers should prepare for each applicant interview by discussing the types of questions that will be asked and the types of responses being sought. (For a list of suggested general interview questions, see the Table. However, consult with the human resources (HR) department for company processes and guidance. When asking interview questions, remember: 

• Personal questions (ie, marital status, pregnancy) should not be asked.
• Don’t agree with (verbally or nonverbally) people as they answer interview questions.
• Look at body language. This speaks volumes and you will know when someone is comfortable. If someone appears uncomfortable, try to put him or her at easy with a friendly demeanor. 
• Evaluate eye contact. Expect the applicant to make eye contact with all interviewers.
• Eliminate distractions by turning off cell phones and other devices.
• Use a scoring system for the candidate’s answers. 
• Plan for at least an hour’s discussion with the candidate.
• Provide a tour of the facility if possible. 
• Escort each candidate out of the department.
• Inform candidates that HR will contact them after all interviews are complete. 
• Open-ended questions are best. 

Additionally, each candidate should be offered the opportunity to ask questions of the interviewers. Having a sound interviewing process will set a positive first impression for applicants, set expectations from the start, allow consistency with applicant selection, and be a “marketing moment” for the facility. Typically, interviewers will talk more than listen, and that can lead to the hiring of people who do not fit the organization. Hiring the wrong person may cost the organization as much as 40% of the employees annual salary in training⁹ and may take up to two years for new employees to reach a productive level.¹⁰ 

If one’s turnover rate is high, staff will not reach adequate performance levels and expenses will increase. Ultimately, disengaged employees will deliver less than optimal care, and this is where processes can break down and fail to produce consistent best practices. An American Management Association survey suggests that future success requires candidates to have four main skills: 1) critical thinking and problem-solving; 2) communication; 3) collaboration; and 4) creativity and innovation.  

TRAINING

The training process is as equally important as the hiring phase, regardless of the new hire’s skill. The new hire will become productive and efficient if training goes well. Planning ahead and being consistent with the training process for all new hires will be a win for the organization because it provides job satisfaction, equips the staff with necessary knowledge, is a terrific recruiting tool, and improves overall skill level and morale. Training always starts with the manager. Has he/she been trained to manage? If “yes” (and it must be “yes”), who conducted that training? Just because one may be a clinical “expert” does not make him or her the right person to manage a clinic.  The Bureau of Labor Statistics found that companies with fewer than 100 employees gave only 12 minutes of manager training every six months. Organizations with 100-500 employees provided just six minutes.¹¹ Research tells us that more than 70% of learning on the job occurs informally.¹² A 2016 “State of the Industry Report” found that businesses are providing employees with an average of 32.4 learning hours per year.  Also, 40% of employees who receive poor job training leave their positions within one year.¹³ Organizations are deterred from training employees because of expenses, but those who do nothing may be moving engaged employees to the disengaged category. Ask yourself how much time was spent on training employees and keeping them educated in 2016 alone. The cost of training staff is much less than the cost of replacing employees.   

RETENTION

How does one keep “top performers” from leaving the organization? Well, giving them proper, consistent orientation and providing them with the appropriate training is a start. It’s recommended to give employees clear expectations, treat them as if they matter, and give them a sense of ownership while focusing on ongoing staff development. Also, consider flexible work schedules and recognize people for jobs well done to enhance motivation and to keep the organization as part of their life/career goals. When employees do leave, for whatever reasons, HR should conduct exit interviews to learn of those reasons. The top turnover reasons among healthcare providers include supervision issues, schedule/hours, lack of appreciation/respect, limited promotions, and unreasonable work demands.¹⁴ A Gallup study revealed 89% of employers believe workers leave their company for more money.¹⁴ In reality, only 12% of workers left for more money. Often, people quit bosses, not jobs. Program managers have a responsibility to promote best practices in a consistent manner and become patient advocates. Concentrating on the employee is crucial in facilitating this responsibility. Effective hiring, training, and retention helps create a team of individuals that collaborates to do what’s right for those we serve while promoting the same level of care throughout wound clinics.