Strategies to Attack Workforce Challenges in 2016

Strategies to Attack Workforce Challenges in 2016

Moderator: James M. BerklanEditor

McKnight’s Long-Term Care News & McKnight’s Assisted Living

Presenter: Mark Woodka

CEOOnShift

Presenter: Irene FleshnerRN, MHA, FACHE

Principal, Reno, Davis & Assoc. Inc.SVP Strategic Nursing Initiatives,

Genesis HealthCare

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Workforce Focus In 2016

Employee engagement & retention

Finding qualified candidates

Managing labor costs

Career development

Scheduling to resident needs

Hiring process improvement

Government reporting compliance

Attacking Major Challenges

Wage Pressures2.5M

Journal

Workforce Shortage

44.4%Direct Care Turnover1

Payroll BasedJuly

Attracting Millennials

The Millennials Are Here

“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

And They Are In Your Communities

Millennials Generation X Baby Boomers

77.94%

16.55%

5.52%

* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016

No Yes

65.00%

35.00%

Are You Adapting?

* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016

Competition Across Industries

Who Are These People?

They’re Doing Research

Nursing Allied Healthcare Physician Other Healthcare

12

14

16

13

Number of different resources used before applying to a job

* CareerBuilder 2015 Candidate Behavior Study 

Your Brand Matters

• HR & marketing must work together– Employee referral program

– Include the benefits of working at your organization on social feeds

• Organization events

• Community outreach

– Track top talent in your organization & recruit to be brand ambassadors

• Post reviews to Glassdoor

– Sell sheets to attract candidates

Simplify Applications

• Most employers use long applications to eliminate unserious candidates– 40% of recruiters have not tried

to apply for a job they have posted

• Today’s jobseekers prefer brief and simplified application processes– 60% of candidates have quit an

online application mid-process due to its length and complexity

“Almost anyone with the right

attitude can train for competency.”

Blair Minton, President, RPM Management

* “How Candidate Experience is Transforming HR Technology,” which was conducted by Harris Poll on behalf of CareerBuilder, 2014

Go Mobile For More Candidates

• Initial applications should take 1 – 2 minutes

• 45% of healthcare employees have searched for jobs on a mobile device

• Yet 90% of employers don’t feel they are missing out on quality candidates by not having mobile friendly applications

* CareerBuilder/Harris Mobile Recruitment Survey, 2013 & 2014 

Become Transparent

• Set “day in the life” expectations

• Provide salary range• Identify scheduling

expectations

Finding The Right Fit

• 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”

• Profile assessments

– Peer benchmarks

• Gain perspective from all angles

– Include different roles in interview• Their manager, coworkers and those they

will serve

Offsetting Today’s Wage Pressures

Largest Expense Getting Larger

• Proposal to increase minimum pay threshold for overtime-eligible workers– From $455/wk to $970/wk

($23,660/yr to $50,440/yr)

• Minimum wage on the rise– LA & NY mandates minimum

wage of $15/hr by 2020

– 14 states raised their minimum wage in 2016

Wage Increase Study• 110 unit AL with 55 FTEs• Increased entry-level

wage by $1.50/hr

Results• 10.2% Increase in annual

payroll • 4.5% Increase in total

expense• 3.4% decrease in net

operating margin

Implement Data-Driven Processes

• Identify key cost control metrics:– Labor budget adherence

– Overtime management

– Staff satisfaction

– Hiring costs

– Operational efficiencies

• Speed & timely analysis of data is key for success

– Predictive analytics is ideal

– Real-time information is a must

– Historic data has little value

• Integration of disparate staffing systems is important

“Measurement is the first step that leads to control

and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you

can’t control it. If you can’t control it, you can’t

improve it.”

- H. James Harrington

Focus On Daily Staffing Levels

• Benchmark staffing levels against budget/Five Star Quality Rating

• Evaluate staffing requirements every shift– Allow for activity and manage like an

employee absence

• Get good at flexing – Alert management when approaching

staffing risk

Get Predictable & Flexible

• Adjust staff as needed– Cancel shifts or call in staff as

needed

– Re-allocate staff to direct care positions – be sure this is documented

• Correlate labor staffed to needs based on estimated future census

• Keep overtime top of mind

Control Your Overtime

• Set an OT target: 2-3%• Eliminate OT built into

schedules• Look out for clock riders

– Compare punch ins/outs with schedule

• Mix of part-time/full-time workers

• Consider OT when filling call-offs

• Set OT approval process

0 - 2% 3 - 5% 6% or more

14.35%

36.71%

48.94%

* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016

Significant Cost Savings

Overscheduling Reduction Annual Savings, Single Facility (100 beds)

.1 PPD $75,600

.2 PPD $151,200

Overtime Rate Reduction % Annual Savings, Single Facility (100 beds)

1% $24,000 – $60,000

5% $120,000 - $300,000

“What proved to be even more exciting was that I turned around and

reinvested $1.8 million of those dollars back into the centers’ staffing models to enhance my nursing hours

per patient day and increase my professional nursing staff mix.”

Dale Zaletel, Senior Operations Consultant, Post-Acute Strategist & Former CEO of Lexington Health Network

Turning Around Turnover

Impact Of Employee Turnover

Resident/cus-tomer satisfac-

tion

Quality care & service

Efficiencies within the community

Staffing level compliance

Labor costs Coworker satis-faction & turnover

* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016

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

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

Payroll Based Journal

Payroll-Based Journal • Quarterly electronic

staffing & census data • Full implementation by

July 1st, 2016• Believed to be used in

Five Star Quality Ratings in 2018

Focus On Staffing Transparency

“The inclusion of verified staffing

information based on payroll data is especially

important, as staffing levels are often the best

proxy for quality.”

Cheryl Phillips, M .D .Senior Vice President of Public Policy

and Advocacy, LeadingAge

Payroll-Based Journal Submission Details

• Direct care worker information – including agency & contract workers– Unique ID

– Hire & termination date

– Pay type code (Non-exempt, Exempt, Contract)

• Daily hours worked by employee– Include job title code for services provided

• 37 codes have been provided by CMS

• Census on the last day of each month, broken down by primary payer (Medicaid, Medicare, Other)

All staffing hours worked must be

able to be verified through payroll, invoices and/or tied back

to a contract

• Identify & classify all direct care staff in accordance with CMS codes

• Assign primary role for each employee & shift

• Define data collection processes– Contract & agency work

– Corporate staff at a community

– Salaried staff

• Understand what hours count, what doesn’t– Ex. If a salaried employee works 10

hours but is only paid for 8 hours, only 8 hours should be submitted

• Conduct an internal audit

Get PBJ Ready

Meet PBJ staffing regulations Eliminate data gathering complexitiesImprove reporting accuracy with checks and balances

Coming Soon

OnShift Payroll-Based Journal ReportingOur PBJ software and our post-acute care staffing experts will:• Set up data collection processes• Gather staffing information –

including contractor & agency hours• Highlight potentially missed staffing

hours• Simplify the submission process

Utilize Technology

• Too many moving parts with information in multiple systems to do this all manually:– Integrate hiring, scheduling, time-clock,

clinical systems

• Software can provide the needed insight to get predictive & proactive:– Identify positions to hire

– Meet PBJ/Five Star staffing goals

– Automate scheduling & labor management

– Staff to resident need, acuity levels

QUESTION & ANSWER

Mark WoodkaCEO

OnShift

Irene FleshnerRN, MHA, FACHE

Principal, Reno, Davis & Assoc. Inc.SVP Strategic Nursing Initiatives,

Genesis HealthCare

Learn More About OnShift

• Best Practices & Information – Staff Scheduling– Payroll Based Journal– Hiring– Workforce Analytics

OnShift.com

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