Keepers: How to retain and empower your best employees

By Shelly Waggoner, MS, CEBS, SHRM-SCP
August 1, 2017
Body of Knowledge Domain(s):

Your employees play an outsized role in your organization’s success. You’ve taken the time and energy to recruit them and bring them on board. Your best employees — they are keepers. But today’s job market means many practice administrators are facing tougher competition for talented employees.

Multiple factors appear to be shaping this headache for medical practices. Largest among them is the rising demand for care: The baby boomer generation is aging into a stage of life that generally requires more care, which is shifting the balance of available caregivers. The ratio of potential caregivers to elderly patients is expected to fall 40% between 2010 and 2030.

That growth in demand for healthcare places an incredible amount of stress on providers attempting to keep pace. In a 2017 healthcare retention report, the Work Institute found that two of the top three reasons healthcare workers gave for leaving their jobs — work-life balance and management behavior — outpaced those same rationales given by workers in non-healthcare industries.

Employee demographics also are affecting certain positions. In the realm of nursing, more than half the registered nurse (RN) workforce is age 50 or older and nearing retirement age. Though entry-level baccalaureate programs for nursing recently saw an enrollment increase, the resulting workforce of graduates is not expected to meet projected demand for RNs in the coming years.

The improved economic health of the country gives workers more options in finding the right fit with an employer. Gallup’s State of the American Workplace 2017 report found that the percentage of Americans who said it was a good time to find a quality job more than doubled in a span of four years, from 19% in 2012 to 42% in 2016.

These factors play a large part in the turnover rates seen across the healthcare industry. A May MGMA Stat poll found that 41% of respondents had less than 10% turnover in their organization in the past year. Poll participants reported that their greatest turnover occurred with nursing staff. Just more than 50% of respondents said clinical support staff — including medical assistants, licensed practical nurses and RNs — saw the highest rates of turnover in their organizations.

While the healthcare job market for employees has improved significantly, one thing hasn’t changed much: The cost to your organization in handling turnover. The expense of recruiting, hiring and onboarding, paired with potential revenue loss from the lost productivity of an open position or the expense of bringing on temporary employees, can range anywhere from 50% to 150% of the position’s annual salary.

There are several ways to set your organization apart so that current employees build a connection to their workplace and, ultimately, remain rather than look for a new job.

The minute you think you’ve “arrived” at a certain point in your work life is often the point where you’ve lost your way professionally. I recommend that you coach your employees — and yourself — to never settle.

Begin with engagement, then go beyond

The State of the American Workplace report points to only one-third of the country’s 100-million-plus full-time employees feeling “engaged” at work, which is defined as loving their jobs and working to make the respective organizations better. That leaves 51% “not engaged” and 16% “actively disengaged.”

Evaluating employee engagement can take the form of an annual or semiannual survey, but that may not be enough. Without backing it up with a cultural infrastructure to develop the kind of workplace environment you want your employees to experience, you’re unlikely to see the positive gains you want reflected in employee satisfaction survey results.

Two leading experts on workplace culture — Adrian Gostick and Chester Elton — emphasize two steps beyond achieving employee engagement:

Enabling employees with the proper support, training and equipment, and then working toward energizing them so that they enjoy both their specific role and the organization.

But first you must lay the groundwork in your employee engagement, whether that is regular recognition for a job well done or some other strategy. Knowing your organization’s mission and values is necessary to tie that recognition back to the broader goals of your team.

Enabling via growth opportunities

One thing I stress to my colleagues at MGMA is to avoid these three words: “I’ve made it.” The minute you think you have “arrived” at a certain point in your work life is often the point where you have lost your way professionally. I recommend that you coach your employees — and yourself — to never settle. The best way to stay ahead in today’s marketplace is by investing in lifelong learning.

Many midsize and large healthcare organizations have an infrastructure that lends itself toward career pathways, so that early-career employees can plot a course for advancement that involves continuing education or specialization. Smaller medical practices can implement this on a scale that is manageable. Ask yourself: Are your nonphysician providers (NPPs) working at the top of their licensure to provide the fullest range of care possible? Are there opportunities for team care collaboration?

Practice administrators should focus on the highest turnover rates in their practice and start a dialogue on how to develop a course for employees’ career growth in the organization. Even if resources are limited, communicating to your employees that they have an opportunity for professional development with the organization’s support sends a message that they are valued, regardless of whether they pursue it.

Energizing with stay interviews

The value of regular communication with employees extends beyond simply knowing about daily operations in a medical practice. Making the time for everyday engagement with your providers and staff helps build a connection between employees and the organization that can pay off later.

Consider stay interviews with members of your team in the form of a formal conversation that allows you as a manager to remind employees how valuable they are, as well as to learn more about employees’ views on how things are going in their position, what they would change about their job and how they feel about their working relationship with you.

While these conversations may feel awkward initially, the feedback you receive from any one employee may yield valuable insights for your performance as a manager or about the perception of your organization and its culture. The stay interview will give you information that can help drive your organizational culture toward a state where your employees enjoy coming to work and connect to the organization’s strategic purpose.

The Society for Human Resource Management recommends that a manager ask a standard set of open-ended questions and then listen and gather ideas from an employee’s responses. As you work through these questions, summarize the employee’s responses and use that to develop a plan for a positive work relationship going forward — why you want the employee to stay and how to make your organization a great place where the employee will want to continue working.

Good, old-fashioned compensation

This may not surprise you, but staying competitive on salary and benefits in your market goes a long way. Check salary benchmarks to see if you are paying at the median; then look at the demand for physicians, NPPs and administrative staff in your area. Determine if you can raise salaries to prevent your best talent from looking for a bigger paycheck elsewhere.

If giving your employees raises just isn’t feasible, keep in mind offering other types of benefits is a way to set your organization apart from other healthcare employers. Keep your employees in mind as you develop your benefit offering. Do you have employees who show an interest in seeking out new certifications or pursuing a degree that would enhance their performance or allow them to pursue a career pathway to a new position in your organization? Look at what level of reimbursement you provide for certification courses and tuition and how it will strategically benefit your organization and employees to keep them learning and growing while working with you.

On a broader scale, smaller efforts such as team lunches, access to a local or on-site gym and an employee assistance program may make a difference in how your employees feel about being part of the organization. Ultimately, your role as a leader should be to develop and maintain a level of morale that both leads to better productivity and diminishes the potential for your employees to look for a new job elsewhere.

Shelly Waggoner, MS, CEBS, SHRM-SCP, vice president, MGMA Human Resources, MGMA

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