Healthcare boards are losing sleep over how to ensure their healthcare systems are delivering quality care to their communities while keeping costs under control. There are two areas where most boards have done a particularly good job. The first is tracking and evaluating key metrics for their organization’s financial performance. The second is measuring the quality of patient care. While commendable, measuring financial and care quality metrics without a focus on the talent that delivers and supports care may cause organizations to miss a critical component of the healthcare quality equation.

A Culture of Complacency

All CEOs talk about attracting and cultivating the best people, but during these days of high unemployment, it’s common to hear human resources (HR) officers say, “We don’t really have a recruitment issue right now. We have more applicants than openings. We don’t even look through all of the resumés.” This is a red flag. It often means that your organization is only skimming through the top 10% of the inbound resumés to hire on an as-needed basis—hardly a proactive approach to securing the best talent.

The economy is largely to blame for this dynamic. Economic challenges have made it difficult for professionals to relocate. Even discontented employees are often held captive by the uncertain job and housing markets. The result is a dangerous mix of pent-up frustration and organizational complacency in an industry where discontented workers are a serious liability.

Measuring financial and care quality metrics without a focus on the talent may cause organizations to miss a critical component of the healthcare quality equation.

Tomorrow's Improved Care Quality Starts with Recruiting

Boards and their CEOs owe it to their patients and their communities to set and enforce high employee performance standards and hold their people accountable by using stringent metrics and proactive management. In organizations where improvements are needed, the first step is to tighten systems for sourcing and screening prospective employees, through such methods as:

Passive Candidate Sourcing. Often the best candidates are employed and not actively looking so organizations must proactively develop a pipeline of future prospects by building talent communities. This can be done through a combination of Boolean searches, social media (Twitter, LinkedIn and Facebook). The network of their existing employees, and by keeping an eye on your competitor’s top talent.

Screening for Pre-Requisites. Electronic screening processes and applications that require candidates prove they meet a minimum set of required qualifications before moving on in the process.

Profiling for Performance. An effective approach for improving the caliber, impact, and longevity of new hires is to develop improved analytics based on the profiles of current exceptional employees. The process involves capturing, tracking, and analyzing all of the characteristics of a successful employee so that a predictive instrument can be developed. Criteria to consider should include education, career experience, organizational memberships, personality
types (e.g., extroverts vs. introverts), and hobbies.

Online Behavioral Assessments. There are many available online surveys, such as the Wonderlic Congnitive Ability Test, that help with cultural fit by identifying candidate behavioral characteristics desired by the organization. Using a standardized survey that consistently captures the same information makes it easier to compare candidates for a position.

Behavioral Interviews. Typically conducted by phone, these interviews are a more personal way to capture approximately the same behavioral details as an online survey and help gauge the likelihood of a good fit with the organizational culture. To make the most of this process, organizations should identify the key behaviors they are looking for in advance.

Electronic Reference Checking. Automating the process by arranging for the electronic questionnaire to come in the form of an e-mail from the candidate leads to results that are more thorough, detailed, and useful than those typically captured during a phone call.

Data As Decision Drivers

Knowing that you are getting the best talent available for your organization is a science based on collecting and examining a great deal of quantitative and qualitative data. By looking at broader organizational goals and how recruiting integrates with and supports those goals, executives and board members can be confident their organization has recruited high performers and will be armed with the data to prove it. Following are the three tiers of metrics that should be used for evaluating and improving your healthcare recruiting process.

  1. Basic Metrics. Basic metrics are the first line of defense. These include:
    Time to fill: Determine your average time to fill a position and how it compares to the industry standard. Best practice organizations benchmark this time every month, every quarter, and every year. You should track your own trends and compare internal departments with one another. The American Society of Healthcare Human Resources Administration (ASHHRA) provides an annual survey that every HR person should review to see how their organization stacks up against the national average.
    Cost per hire and cost of vacancy: Best practice organizations know their cost per hire and cost of vacancy, and track whether they are paying more or less than the competition or their own organization during previous periods. National averages are also available from ASHHRA. Cost of vacancy can be calculated by considering the impact of not filling a position, the lost revenue, or the cost of compensating for the vacancy through overtime and temporary staffing charges. Cost per hire is determined by calculating expenses such as postings on job boards, advertising, direct campaigns, and contingency search charges.
    90-day retention: This metric tells you how well your recruitment process is working in terms of organizational fit. If your organization loses more than 10% of new hires within the first 90 days, the approach to recruiting, screening, and orienting new people should be examined. More often than not, losses stem from misaligned expectations that can be remedied by taking the time to conduct a more thorough pre-hire orientation and explanation of the corporate culture. However, basic metrics alone are not enough to empower you to consistently hire the best people.
  2. Predictive Insight. The second tier of metrics provides a more detailed level of intelligence and insight. At this level, organizations are capturing:
    Time to productivity: Organizations that measure and track which employees “get up to speed” faster are able to guide the selection process more effectively. Research has shown that employees who “connect” with their company at the beginning of their employment stay with the company significantly longer.
    Hiring ratio of BSNs to ADNs: More magnet hospitals and health systems strive to hit a target of 85% bachelor’s degree-level nurses.
    First-year performance ratings: Organizations need to perform employee evaluations to capture and track how new hires are performing at the end of the first year: whether they are exceeding expectations, merely meeting them, or in need of development.

  3. High Performance Benchmarking. Finally, high performing organizations strive to integrate overall hiring metrics with key organizational metrics. They examine:
    Impact on patient satisfaction scores. Most hospitals measure patient satisfaction. Recruiting clients of Cielo that work in the field of providerside care consistently see a correlation between patient satisfaction and staff satisfaction. According to former Cone Health System President and CEO, Tim Rice, “When we moved our employee satisfaction into the 80th percentile, the patient satisfaction followed right behind.”
    Status of employee engagement scores. Cielo conducts regular surveys of employee engagement and satisfaction as a measure of the success of their new employee placements.
    Profiles of high-performing employees. Profiling high performers enables an organization to standardize effective hiring practices so that they can be confident they are hiring top talent throughout the organization. Data points include:
     - Where high performers have come from (what school and what organizations)
     - The characteristics and credentials they typically process
     - How they answer behavior-based and culture fit questions
     - What experience they have had in their careers

Some of these metrics and tools aren’t necessarily owned exclusively by the recruiting function, but if recruiting isn’t using them to benchmark and inform predictive hiring, they are missing a critical piece of the puzzle.

Healthcare organizations have a duty to the communities they serve to apply the most rigorous methods for evaluating and tracking talent. By capturing the advanced metrics outlined above to consistently target and attract the best new hires, your organization can seize this opportunity to find top-grade talent and build tomorrow’s dream team.