Keeping Your Employees

High employee turnover is a costly problem. Training expenses, overtime pay, and agency expenses are just the beginning. High employee turnover has a devastating effect on your overall operations and reputation. The problem is, with the huge demands on your time and the mountains of red tape you must untangle, focusing on an intangible like employee satisfaction seems an impossible luxury.

High staff retention is one of the major keys to service and operational excellence. Happy employees are part and parcel of an excellent hospital-and that's why reducing turnover must be a top priority.

High employee turnover is a symptom of a larger problem. The most satisfied employees work in organizations that have systems and processes in place that are designed to sustain service and operational excellence.

The following steps create the type of organization that attracts and retains the cream of the health care worker crop. For example:

Craft and nurture a culture of excellence.
To keep employees happy and just plain keep them, you need an organizational culture in which high achievers can flourish. Every decision you make should work toward this end. Keep that in mind as you work on your culture. Everything you do should be aimed at creating an environment where the best employees want to work.

Get to know your employees and what's on their minds.
If you didn't know that communication is critical for a healthy company, you wouldn't be a high-level leader. But getting to know your employees means going beyond token efforts; it means you must make talking to them an integral part of your job. The best way to do this is to interact with staff on their own turf. CEOs should make daily rounds and ask employees specific questions about what they need to do their jobs.Be sincere (people can tell when you're faking it) and invite honest feedback. When someone shares a problem, do something about it.

Realize that the little things matter.
What you might consider a little thing may not be so little to someone else. At my first day at a new hospital, I asked a nurse what I could do to make her job better, and she said she was frightened walking to her car at night because of the tall bushes by the parking lot. While she worked that day, I had the bushes trimmed and put up a small fence. Though it sounds like a little thing, to that nurse it was a big deal-it made her feel safe and, more to the point, valuable to the hospital.

Manage up.
In essence, managing up means positioning people well. It means passing along positive comments to people whenever you hear them, spreading good news around and giving credit when it is due. This is an invaluable tool for getting buy-in for goals, creating more autonomy within the organization, saving time and more. When you consistently look for the positive and communicate it, you create a culture where people want to work.

Schedule regular meetings with new hires during the "honeymoon phase."
You probably know that more than 25 percent of employees who leave health care positions do so in the first 90 days of employment. So it makes sense to rev up your retention efforts during this critical period. You might consider having supervisors meet with new employees at the 30- and 90-day marks and ask the following questions: How do we compare with what we said in our interviewing process? What is working well? What systems or ideas do you feel warrant improvement? Are you experiencing anything that could cause you to think about leaving?

Get rid of low performers.
It is easy to spend too much time with low performers and not enough with high performers. Strive to do the opposite. And here's a major point to remember: you must deal with low performers. When I started working at one hospital, I met a rude woman with an extremely negative attitude. When I mentioned her to others in administration, they said, "Oh, you met Mary. We just ignore her." Unfortunately, Mary is an example of the truism that what gets tolerated, gets accepted. Don't be afraid to let disruptive people go. If you don't, these low performers will affect your high performers, causing them to 1. leave the organization, 2. channel their positive energies into outside interests, or 3. pace themselves and slow down.

Harvest intellectual capital.
A worthwhile Bright Ideas program—not to be confused with the old-fashioned suggestion box—fosters accountability and positively affects your bottom line by increasing efficiencies and lowering costs. Encourage employees to contribute innovative and quality ideas that higher-ups such as CEOs and senior administration who aren't on the front lines may not have considered. When employees bring forward great ideas, reward them financially.

Create and develop leaders.
If we allowed an untrained clinician to care for a patient, it would be considered medical malpractice. Since an engaged, aligned workforce is so critical to hardwiring excellence, I believe that not investing in leadership development is the equivalent of organizational malpractice. We have found that most RNs leave their job because of their relationship with their supervisor. That's why the best thing you can do for your staff and your organization is to invest in leadership training. Good leadership ensures that you'll keep your great employees rather than driving them to look for greener pastures.

Incorporate the personal touch.
Nothing garners as much genuine appreciation and sense of pride as a personal acknowledgment of a job well done. Encourage leaders to regularly e-mail you about employees who deserve a compliment. Ask them to include details so that you can write a descriptive message thanking the employee for his or her contribution. Make sure the note is handwritten and mailed home; typed letters or e-mails won't cut it.

Leverage employee relationships in your recruitment efforts.
One of the best ideas I have heard involved the CEO meeting with all new RNs at around 100 days. As the nurses share their first 100 days, the tone is usually very positive. The CEO then gives all attendees a 60-minute phone card and asks them to call nurses they know who may want to work in this culture. It's been long enough that the RN feels confident about recommending the workplace, yet recent enough that she still has relationships with nurses in her old work or school environment. Even if they don't make calls, the card is not expensive and it gets RNs in the word-of-mouth recruitment mindset.

When it's all said and done, employees want three things. They want to know that the organization has purpose; they want to know that their job is worthwhile; and they want to feel like they are making a difference. Convert your organization's culture to one that embraces all aspects of excellence, including employee loyalty and high performance. When an organization commits to excellence, it creates a culture where employees want to work. Isn't that the kind of culture we should all strive to create?

This article originally appeared in the September 2004 issue of HME Business.

About the Authors

Joseph L. Devary manages the Resource and Ecosystems Management product line at Pacific Northwest National Laboratory. He has more than 20 years of experience in geosciences research and environmental consulting and has directed groundwater investigations in Washington, Arizona, Ohio, New Jersey, and California. He can be contacted at (509) 376-8345.

Laura Robinson, Healthcare Industry Analyst, RSA Security, Bedford, Mass. has more than 15 years experience in technology, including IS security, electronic imaging and networking, in healthcare and medical industries as well as government. She is healthcare industry analyst for RSA Security and is on the ASTM E31.20 standards committee for data and system security for health information.

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