2014 alfa conference reducing turnover

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1 2014 Frederick P. Morgeson. All rights reserved.

Will They Stay Or Will They Go? Reducing Turnover through Improved Hiring

Practices in Long-Term Care

Frederick P. Morgeson, Ph.D. Morgeson Consulting and Michigan State University

Scientific Advisor, HealthcareSource

www.morgeson.com [email protected]

20 – May – 2014

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My Goals for Today

The turnover

problem Why people leave The hiring process

as a key solution – Recruitment – Selection – Onboarding

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The Turnover Problem

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Turnover is High…

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Turnover is High…

Median Registered Nurse Tenure Rates • Offices of Physicians = 1.57 years • General Medical and Surgical Hospitals = 1.50 years • Specialty Hospitals = 1.20 years • Home Health Care Services = 1.17 years • Nursing Care Facilities = .97 years

National Median: 4.40 years

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…Is Costly… • Nurse turnover costs

– $42,000-64,000 per nurse – 150 nurses and 20% turnover

• Yearly estimated cost of $1.25-2 million a year

– Average facility loses $300,000 per year for each percentage increase in annual nurse turnover

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…Is Costly Because… • Financial costs

– HR staff time – Manager’s time – Contingent/

temporary staff

• Organizational costs – Quality of care – Accidents/errors – Teamwork – Loss of patients

• Replacement costs – New hire’s

compensation – Hiring

inducements – Orientation

program time

• Training costs – Formal and

on-the-job training – Mentoring – Socialization – Productivity loss

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…And Likely to Be Increasing

Top 10 Occupations with the Largest Projected Employment Growth Occupation Employment Change

2010 2020 Number % 1. Personal care aides 861 1,468 607 71 2. Home health aides 1,018 1,724 706 69 3. Medical secretaries 509 719 210 41 4. Medical assistants 528 690 163 31 5. Registered nurses 2,737 3,449 712 26 6. Physicians and surgeons 691 859 168 24 7. Receptionists and information clerks 1,049 1,297 249 24 8. Licensed practical and licensed vocational nurses 752 921 169 22 9. Construction laborers 999 1,211 212 21 10. Landscaping and grounds keeping workers 1,152 1,392 241 21

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Why People Leave

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What Is Turnover? • Turnover

– The departure of employees for any reason

• Involuntary turnover – Departure initiated by the organization

(often including those who prefer to stay)

• Voluntary turnover – Departure initiated by the employee

(often including those who the organization would prefer to keep)

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Classifying Turnover

Turnover

Voluntary

Functional Dysfunctional

Unavoidable Avoidable

Involuntary

Unavoidable Avoidable

False Positives

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Turnover Drivers • Work Design • Leadership • Relationships • Work Environment • Individual Characteristics

Key Attitudes • Job Satisfaction • Organizational

Commitment

Shocks/Scripts

Turnover

Withdrawal Process • Thinking of Quitting • Job Search • Alternatives • Turnover Intentions

Why People Leave

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Key Attitudes • Job Satisfaction • Organizational

Commitment

Shocks/Scripts

Turnover

Withdrawal Process • Thinking of Quitting • Job Search • Alternatives • Turnover Intentions

Why People Leave Nurses are four times more dissatisfied

than workforce in general… 0% 10% 20% 30% 40% 50% 60%

Lack of advancement opportunitiesWork overload

Poor salaryToo few staff

Poor organizational cultureLack of mentoring

Poor personal fit with bossLimited or not enough access to technology

Lack of trainingNot enough time with patients

Too many administrative tasksLack of interesting assignments

Poor shift availabilityPoor personal fit with coworkers

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The Hiring Process as a Key Solution

Recruitment Selection Onboarding

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Big Applicant Pool

Small Applicant Pool

Job Candidates

Hires

New Employees

Recruitment

Selection

Onboarding

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Recruitment • Traditional purpose of recruitment

– Develop an appropriate number of applicants – Meet goals regarding workforce composition – Increase the success rate of the selection process

• But, could also focus on turnover… – Potential implications for

• Recruitment messages, sources, and activities

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Recruitment Messages

Presenter

Presentation Notes

What messages are being sent? What implications does this have for turnover? Golden Living: http://www.goldenliving.jobs/our-culture/ Genesis: http://www.genesishcc.com/career-opportunities Life Care Centers of America: http://www.lcca.com/career_info/

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Recruitment for Retention: Sources • Sources vary in retention rates • Focus on sources that produce higher levels of

retention – Employee referrals – Previous employees

• Analyze sources for retention

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Recruitment for Retention: Activities

• Realistic job previews (RJPs) – Provide important and candid information about

the job and the organization to the candidate

• They work… – Reduce initial job expectations – Self-selection based on fit – Honesty builds commitment

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RJP – Lists Negative

• Work around people with contagious diseases; bodily fluids and blood

• Work holidays, evenings, or weekends

• Work 10+ hour shifts

Positive • Help your community • Make a difference in

people’s lives • Develop relationships

with residents • Develop and learn • Never boring; always

changing

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RJP – Descriptions

Presenter

Presentation Notes

United Healthcare: http://careers.unitedhealthgroup.com/careers/data/jobs/healthcare-delivery/540515-nurse-practitioner-complex-care-optum-a-unitedhealth-group-company-akron-oh-full-time.aspx

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RJP – Videos

Presenter

Presentation Notes

http://www.youtube.com/watch?v=9or5FdkY6pw http://www.youtube.com/watch?v=DzX9wMroivY http://www.youtube.com/watch?v=2Oim9uaCfxg

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Selection • The procedures employers use to determine

which candidates to choose for particular jobs within the organization

• Basic principles – More applicants than open positions – Variability in capabilities OR tendencies that can

be measured before hiring – Use this information to hire “better” people

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Selection for Retention • What constitutes “better” people?

– Traditional approach is to focus on job performance

– Yet, applicants possess characteristics and tendencies that are predictive of turnover

• Can measure these prior to hiring to predict turnover likelihood

Will they stay or leave?

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Selection for Retention: Three Domains

Biographical Data (Biodata)

• Information on past behavior, life experiences, feelings about specific situations

• Indication of embeddedness and habitual commitment

Work Attitudes

• The positive or negative evaluations made about people, issues, or objects

• Confidence and employment motivation

Personality

• Stable individual characteristics

• Conscientiousness and emotional stability

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Selection Examples • How many of your close personal friends

work for this organization? (EMBED) • How many months did you work at your last

job? (HabComit) Biodata

• I expect to do well at this organization. (SC) • Once I make a decision, I feel fairly

confident that it is a good one. (DEC) • I feel very committed to this organization.

(MOT)

Attitude

• I put a great deal of effort into my work. (C) • I become irritated when others criticize me.

(ES) Personality

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Person Job Team Org.

Selection for Retention: Fit

Focus on the fit between workers and the job/team/organization

The Varieties of Fit Needs-Supplies Match between

individual needs and what the job or

organization provides

Demands-Abilities Match between

individual abilities and the job or organizational

demands

Values Match between worker

values and organizational values

Presenter

Presentation Notes

Find and select people who enjoy developing relationships? Serving others?

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A Focus on Fit

"We aren't just looking for people with a certain certification or degree. We also are looking for people with the passion and intrinsic motivation that makes them view their work as more than simply a job."

Mary Swartz, Vice President of Human Resources, Ebenezer Society

Ryan Ellis, Director of Organizational Development, EMA Communities

Presenter

Presentation Notes

Ebenezer: http://www.agingservicesmn.org/newsletters/view/3299/404f10e83fc51ce22c1aac432b6c540d/full

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What is Onboarding?

• The process of helping new hires adjust to social and performance aspects of their new jobs quickly and smoothly – How the new hire will fit

in with what the organization does

• Why it is important – Employees get about 90

days to prove themselves in a new job

– The faster new hires feel welcome and prepared for their jobs, the faster they will be able to contribute to the organization

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Outcomes of Onboarding

• Jump start relationships

Increase Job Satisfaction

• Clarify expectations and objectives

Increase Performance • Provide support

via feedback, coaching, and follow-up

Inoculate Against Turnover

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Approaches to Onboarding

Structured and Systematic • Set of written policies and

procedures that assist an employee in adjusting to his/her new job in terms of both tasks and socialization

“Sink or Swim”

Highly Formal Highly Informal

• Process by which an employee learns about his/her new job on their own without an explicit organizational plan

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Onboarding Tips • Formalize program

– Develop a written onboarding plan – Have clear goals – Use formal orientation programs – Consistently implement program

• Program components – Clarify new employee

• Objectives, timelines, roles, responsibilities – Make onboarding participatory – Use technology to facilitate process – Periodically check up on employee progress

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Concluding Thoughts • A key underlying principle

– Standardization in HR practices

• A slightly different focus

– Driving down turnover and enhancing retention

• Considering the levers at every step in the

hiring process

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2014 alfa conference reducing turnover