IDEAL CANDIDATES EXIST! STRATEGIES TO HIRE & RETAIN STAFF

Irene Fleshner – Principal, Reno, Davis & Associates & SVP Strategic Nursing Initiatives, Genesis HealthCare

Mark Woodka – CEO, OnShift

Solving Everyday Workforce Challenges in Post-

Acute Care & Senior Living

Ideal Candidates Exist!

• State of the workforce• Staff stability initiative and

tools• Biggest workforce challenges• Recruiting & hiring strategies• Staffing best practices that

improve satisfaction & care• Empowering and engaging a

multigenerational workforce

More People Will Need Our Post-Acute Services

2009 2014 2019404550556065707580859095

100105110

84.96

105.71

83.76

93.94

81.53 83.50 84.47

45.4651.98

60.28

Total Medicare Enrollment Will Grow Substantially, Resulting in Increased Volume Conservative AggressiveModerate

Graphic courtesy of Avalere

TOTAL MEDICARE ENROLLMENT(MILLIONS OF BENEFICIARIES)

YEARLY MEDICARE SNF VOLUME (MILLIONS OF DAYS)

Looming Workforce Shortage

Research from University of California San Francisco found that at least 2.5 million more workers will be needed to provide long-term care to older adults in the United States between

now and 2030.

2.5 Million Additional Workers Needed to Meet Demand

Turnover is Expensive…And Impacts Care

$4.1 Billion a year lost

$9,776 RN costs

$7,311 CNA costs Impacts your ability to provide high quality care

Lost productivity Residents/ families lose trusted care

takers Higher hospital readmission rate Increased falls, pressure ulcers

“The Cost and Benefits of Nurse Turnover: A Business Case For Nurse Retention,” Cheryl Jones, 2007

AHCA Cost of Turnover Calculator

Turnover, Retention and Stability

Employee Turnover

number of separations / average number of employees

Employee Retention

number of people on the payroll today that were on it a year earlier / average number of employees

Stability relationship between turnover and retention

Examples

• The nursing home averages 100 employees– If 80 percent of employees are retained and

turnover is 40 percent, the same positions have turned over 2 times

– If 50 percent of employees are retained and turnover is 60%, the same positions have turned over 1.2 times

Staff Stability: the number of times the same positions turn over

10090 10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.080 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.070 3.3 3.0 2.7 2.3 2.0 1.7 1.3 1.060 2.5 2.3 2.0 1.8 1.5 1.3 1.0

Retention % 50 2.0 1.8 1.6 1.4 1.2 1.040 1.7 1.5 1.3 1.2 1.030 1.4 1.3 1.1 1.020 1.3 1.1 1.010 1.1 1.00 1.0

100 90 80 70 60 50 40 30 20 10 0

Turnover %

Stability Index

High vs Low Stability Index

•Turnover is concentrated and requires targeted solutions.

High Stability

Index

•Turnover is wide spread and requires general solutions

Low Stability

Index

AHCA Increasing Staff Stability Goal

Decrease turnover rates among nursing staff (RN, LPN/LVN,

CNA/LNA) by 15% or achieve/maintain at or less than

40% by March 2018

AHCA Workforce Committee Goals 2014

1. Reduce staff turnover and improve retention through an increased focus and awareness of tools and resources available at AHCA’s website.

2. Assure “spread” and usage by creating a promotional campaign designed to ensure state affiliates and human resource directors are aware and using the materials.

AHCA Toolkit: 4 Strategies to Retain New Hires & Reduce Employee Turnover• Produced as a project of the AHCA Workforce

Committee

• The guide focuses on 4 main strategies:1.Interviewing New Candidates Employee Participation

2.Behavioral Based Interview Questions

3.Performing 30 – 60 – 90 Day Reviews

4.Walkabouts/Rounding on Direct Reports

• Contains a Cost of Turnover Calculator

AHCA Toolkit #1Participation in Interviewing

• Value in involving line staff to interview

• Gives different perspective• Fosters “buy-in” from key

staff• Select and train key line staff

AHCA Toolkit #2Use Behavioral Based Questions

• Answers to open ended behavioral based questions will help predict future behaviors

• Listen more than you speak– Allow periods of

“awkward silence”

Adaptability • Describe a time in which you had to

adjust quickly to changes over which you had no control. What was the impact of the change on you and on your work?

Analysis • Sometimes a small problem can be

identified and fixed before it becomes a major problem. Give me an example of when you have done this and what the result was.

Communication • Give me a recent example that best

shows your ability to communicate effectively.

AHCA Toolkit #330-60-90 Day Reviews• Identify areas where help and

development are needed• Excellent way to assess

effectiveness of training• Performance feedback during

introductory/probationary period– Make small corrections before

bigger problems ariseNew hires who stay past 90 days are more likely to stay in the organization long term

AHCA Toolkit #4Walkabouts and Rounding

• Rounding to engage with staff– Re-engages and reassures staff;

builds relationships

– Supervisors can see good ideas in action and to ask employees what the organization can do to improve

• Administrator and ALL supervisors– Drives accountability and process

Biggest Workforce Challenges

Recent survey of long-term care and senior living professionals*:1. Finding Qualified

Candidates2. Employee Retention

& Staff Satisfaction3. Scheduling Staff To

Meet Needs

Mix of modern and outdated

practices

Reactive and old school; time consuming and

disjointed

Innovative and

streamlined

* “Workforce Insights: Get Ahead” OnShift & McKnight’s Long-Term Care News, 2015

Gain Insight Into Hiring Needs

• Identify open positions

• Determine gaps in your schedule• Open shifts, overtime and

agency, call-offs

• Examine utilization• Understand employee

capacity

REACTIVE HIRING

cite employees leaving triggers the

hiring process*

50%* “Workforce Insights: Get Ahead” OnShift & McKnight’s Long-Term Care News, 2015

Don’t Hire Yet – Prioritize Current Staff Start by filling holes with current staff

• Prioritize underutilized staff to plug holes

– Measure hours staff are able to work vs hours worked

• Consider employee’s schedule preferences

– Make adjustments to employee’s schedules that have indicated they’d prefer to work different shifts

• Hire for remaining shifts

– Consider part-time and prn mix to add flexibility

Build Your Candidate Pool

• Be proactive in hiring - continuously recruit

• Grow your own – offer incentives and tuition reimbursement to help staff obtain RN degrees

• Collaborate with local universities to create LPN – RN programs

• Review wages – need to be competitive with hospitals

average positions to fill each month

per community7* “Workforce Insights: Get Ahead” OnShift & McKnight’s Long-Term Care News, 2015

The Hunt For Talent

• Utilize technology to expand your reach– Job boards, resume sites, social

media, virtual job fair

• Incentivize employee referrals• Leverage differentiators

– Technology

– Flexible scheduling

– PTO Policies

• Set correct expectations– “Day in the life” video

Hire The Right Fit

• Hire for attitude• Profile assessments – Benchmark against your

best staff members

• Gain perspective from all angles– Include different roles in

interview – including residents!

“Almost anyone with the right

attitude can train for competency.”

Blair Minton, President, RPM Management

Engagement vs Satisfaction

• Are they the same?– Employee Satisfaction: A measurement of an

employee’s “happiness” with current job and conditions; it does not measure how much effort the employee is willing to expend

– Employee Engagement: A measurement of an employee’s emotional commitment to an organization; it takes into account the amount of discretionary effort an employee expends on

Engagement Pays Off

• Lower turnover– 18% engaged employees

vs. 49% disengaged

• Lower absenteeism• 147% higher earnings per

share

Engaged employees lead to higher

Service & Quality

Employee Productivity

Customer Satisfaction

Employee Retention

Company Profit

Keep Employees Engaged

• Profit sharing

• Rewards & incentives– Awards program

• $200/refer a friend

• $1,000/refer a resident

• Sports tickets, gift cards, etc.

• Have the fortitude to move along those who are disengaged

• Senior leadership town hall meetings with associates – Supervisors not in the room

National Research Corp.SNF with a high rate of

employee satisfaction have fewer survey deficiencies

and a higher Five Star quality rating

Top 2 drivers of resident and family recommendation are

both related to employees — care (concern) of staff and competency of

staff

Create a Mentor Program

• Mentors – Not necessarily the most

senior person

• Honor to be a mentor– Involved in hiring,

onboarding, ongoing education

• Certify mentors

• Comprehensive orientation• Associate care programs• Flexible PTO policies• Volunteer opportunities• 401k with matching and 60-day vesting

Adopt Employee-Centric Practices

“Worker-centric policies contribute to engagement and profits.”

- Workplace Options Research

Consistent Assignment

• Consistent assignment staffing models– Educate staff, residents,

families

– Consider “best fit” pairings

– Make contingency plans

– Don’t overload high acuity cases

– Continually monitor & assess

Studies show:

29% in turnover

After 1 year of using the consistent

assignment model

Employee Schedules

• Give staff more control over their schedule– Identify work preferences &

availability

• Make scheduling transparent• Offer convenient, mobile

access• Work in repeatable

schedules

Proven Success

• Overview– 9 communities in NC, FL, SC, GA, IN

• Strategic Priority 1. Improve Employee Satisfaction 2. Staffing Visibility Across Communities3. Labor Cost Management

• Top Issues– Scheduling was a top employee complaint

at each community– Manual process was inefficient and

caused confusion among staff– Labor costs were managed based on

historic data

Results• Improved staff satisfaction

– Turnover decreased by 15.6%

– Scheduling is no longer a top complaint

– Call-offs decreased for 2 straight years

• Five Star Quality Rating– Average increase from 3.5 stars to 4 stars

• Greater efficiencies – Call-off fill time has been reduced by 50%+

– Time spent scheduling has been reduced by 75%+

• Reduced labor costs– Saved $300,000 annually by monitoring

punch variances

Coming Soon: Payroll Based Journal• Nursing facilities must submit

payroll data quarterly via an electronic means

• CMS will collect data that can be used to report on employee tenure and turnover

– Staff stability & Star Ratings will be used to judge facilities

• A manual or automated, technically specific upload of payroll and T&A data through QIES

AUG 2015Volunteer

registration

OCT 2015Voluntary

submission

End FY2016Nationwide

reporting

Employee Engagement by the Generations

Managing a Multigenerational Workforce

• Veterans– Respect authority & leadership hierarchy,

intense work ethic

• Baby Boomers– Love/hate relationship with authority,

workaholics, defined by their work

• Gen X– Mistrust authority, require constant feedback,

want input into processes and decision by consensus

• Gen Y – Relaxed polite view of authority, want quick

responses, want to be entertained and stimulated, thrive on team work

“By 2025, Millennials will dominate the workforce, perhaps as much as 75 percent so we’re going to have to figure out what they expect, and what we can do to attract them to our organizations and keep them there.“

- Post Acute Care Executive

Comments about a No Cell Phone Policy

• “You need to be on call for your own life and it's unfair to be kept off the grid so to speak.”

• “In an industry that is constantly looking for good hires this is a deterrent. If it came down to a job where I could have my phone vs one where I could not, I would pick the job where I was able to keep my device with me.”

-- Millennial in the Workforce

Millennials Crave Instant Knowledge

A cell phone is both a communication device and a computer

Key Benefits Of Proper Staffing

Higher Quality Care Cost Control

Five-Star RatingPerformance &

Efficiency Improvements

Summary

•Consider under-utilized staff prior to hiring•Always be recruitingBe Proactive

•Hire for attitude & train for competency•Include peers, residents in interviews

Find the Right Fit

•Consider employee-centric policies that promote engagement

Engage Employees

Learn More

Complete the Sign-Up Sheet to Get These Resources:• 5 Tips to Make Your

Workplace Employee-Centric

• The Definitive Five-Star Staffing Handbook

• Session Slides

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