In The News

How to Keep Your Best Employees

By Joe Sansone
CEO, TMC Orthopedic

Today in the healthcare field, employers are faced with personnel shortages and an insufficient number of experienced staff, forcing healthcare organizations to put forth an even greater effort to attract and keep current employees. While most physicians are spending their time in clinic and running a practice, interviewing the steady stream of qualified applicants that walk through the door can be a daunting task. The easiest way to relieve yourself of the pressure of hiring new personnel is to decrease the occurrences of employee turnover. Employee turnover is costly and disruptive, and the resulting strain on a physician's practice or business cannot only limit your ability to compete effectively in today's medical climate, but also lead to significant decreases in revenue. If a 1000-employee hospital loses 84 nurses a year (approximate average), the facility will spend nearly $5,000,000 in replacement costs. That comes to $416,000/month. The first step in increasing employee retention is to understand the incredible value in retaining your personnel vs. the expenditure of funds to replace a valued employee. The cost of hiring and training a new nurse for an Emergency Department is approximately $80,000 for the first year based on a salary of $47,000 and administrative costs of $33,000.

The United States Department of Labor estimates the cost of employee turnover at one-third of the annual salary of a newly hired employee. Many costs of employee turnover are measurable, such as recruiting, screening, interview costs, advertising for replacements, background checks, and training expenses. Additional costs to consider are the loss of productivity while the position is vacant, the detrimental effect of the remaining co-workers when a valued colleague resigns, patients lost to another provider due to lack of organization, and the cost of reduced efficiency as the new employee learns their job.

Employee loyalty is way down according to a recent survey conducted by Sibson & Company; 55 percent of employees plan to quit or think often of quitting. Physicians and practice managers should be asking themselves how they can keep talent from leaving their practice. Employee turnover cannot be completely alleviated; it is a fact of business that people change jobs. You can however, reduce needless employee turnover by doing all that you can to make sure that your current employees are happy with their job.

Recently, the Families and Work Institute published a national study of the changing work force, and they found that earnings and benefits have only a 2% impact on job satisfaction, while job quality and workplace support have a combined 70% impact. Management icons, such as Frederick Hertzberg and Abraham Maslow, have long maintained that the quality of work and workplace support are far more important to employees than their salary. Physicians and management must adapt an attitude that they will take the necessary steps to increase employee retention. Healthcare organizations must come to the realization that if they keep their employees happy, the employees will then give an honest, productive day's work and remain loyal. The problem is, words like job quality and workplace support are intangibles. It is difficult for employers to know exactly what they can do to impact their employees in a positive manner.

Healthcare organizations must come to the realization that if they keep their employees happy, the employees will then give an honest, productive day's work and remain loyal.

The following outlines programs employers can put into place to increase employee retention:

• Compensation - It is important to understand that while compensation may sometimes cause employees to leave, it is not generally the major motivating factor in an employee's happiness. The fact remains that increased compensation is a powerful tool to entice employees to remain loyal to their company. Imagine if you paid salaries 5-10% above the market average for your employees. How many fewer employees would you lose? (Remember again the cost of high employee turnover.) While employers cannot simply throw money at its employees and hope that this makes up for shortcomings, paying above industry standards for a particular position will give an employer a new sense of security that he is less likely to lose his star employees.
• Be Sincere - Management must exhibit their commitment to their employees in such a manner that employees are not on guard and waiting to see what the "catch" is. If employees feel patronized or feel as if management is insincere, then efforts at employee retention will be wasted. Physicians and management must adapt the attitude that they will do what it takes to make their employees happy, and in return, their employees will give them an honest day's work. Employee retention means employee happiness. You cannot have employee retention without having happy employees. What are the benefits of happy employees? Magnet hospitals as designated by the American Nurses Credentialing Center showed lower turnover and better patient outcomes than non-magnet facilities, and showed savings not only in turnover costs but also in the form of shorter patient stays.
• Management Must be Supportive - Many studies indicate that the most common reason for high employee turnover is what is viewed by employees as unfair treatment by management. When physicians and managers are supportive of the needs of their employees, they are oftentimes viewed as treating employees fairly. This does not mean that the employees must be pandered to, but they should be treated in a respectful manner. Throughout years of interviewing multitudes of job applicants, there are a few common traits that ring true for applicants' favorite managers.

"Firm but fair" is the overall consensus of the best description of a good manager. Also remember, a successful manager must be flexible, willing to bend the rules for employees on occasion. Working with employees, lets your staff know that they are valued, and you are willing to accommodate their needs. Oftentimes, it is the smaller problems that cause once happy employees to become disgruntled employees and start them down the pathway of looking for a new job. Sometimes, it is just worth it for a physician or practice manager to allow an employee a little bit of latitude if it means the company does not suffer, and employees are happy.

• Provide Adequate Training - Unfortunately, it is not uncommon for a practice to hire a replacement in haste as the work piles up for the new hire. In these instances, training usually consists of the new hire sitting with a co-worker for a day or so, and then the employee is thrown to the wolves. These scenarios almost always doom the employer-employee relationship from the start. Since employees inherently want to do a good job, it is imperative that employers offer adequate training to their new hires, so that employees can do their job effectively. If your new hires do not receive adequate training, and they are forced to ascertain how to do the job themselves, then usually by the time the new hire has learned their way around, it is too late, and they are destined to become poor performers.
• Provide Guidelines - It is important that employees know exactly how management wants them to carryout their job duties. It is absolutely necessary to have written protocols and procedures so that an employee knows what is expected of him/her. If the employee does not have a set of rules to follow, then how can they perform to management's satisfaction? In addition to providing employees with a framework as to how to carry out their daily job duties, protocols are also invaluable when turnover does occur. Having correct protocols in place keeps the employer from being forced to "reinvent the wheel." It is frustrating and a waste of time to constantly re-train new hires on information that was known only by the person who previously held the position.
• Opportunity for Advancement - Why are employees in this industry forced to move from one job to another in order to receive promotions? It should be possible for physicians and management to realize who their stellar employees are and find a way for them to grow within their organization. Employees must know that there is an opportunity for advancement within your practice or organization. This does not necessarily mean that every employee has the potential of joining the ranks of management; it does mean, however, that employees can become a valued and integral part of your organization or the team lead person in their department.

Career development planning has become a hot topic amongst HR professionals. Career development planning is an increasingly popular process by which management establishes long-term career pathways for its employees. The purpose of having an effective career development plan in place is to allow employees to take charge of their career and know that should they desire to climb the ladder, employees will not have to leave their job for a brighter future. These stellar employees can be developed to grow with the practice and add valuable tenure to help your healthcare organization run smoothly.

• Human Resources Support - Employees must feel that someone within your organization is accessible and can assist them with their needs. This may take the form of lower management or Human Resources personnel. Without a compassionate go-to person, employees feel as if there is no mechanism in place to voice legitimate concerns without giving the appearance of being a complainer. For example, if an employee receives a denied vacation request with no explanation as to why their request was denied, they could soon become embittered with the callousness of management. Taking the 2 or 3 minutes, however, to explain to an employee why they cannot have a day off may diminish the resentment the employee has toward the company. Management may find that the employee does have a legitimate reason for the vacation request. With a go-to person in place to talk to, the employee can shed some light on this situation. One misconstrued conversation can become the "straw that breaks the camel's back" and causes a star employee to leave their job. Remember, sometimes it doesn't do an employer any good to be right if being right causes him to lose a star performer. Be flexible and understand the needs of your employees.
• Be Creative - What creative things can you do to keep your employees happy and let them know that they are appreciated? What stories do they tell about their employer when they go home to their spouses or talk to their friends? Are they inclined to discuss their health insurance and the fact that they had an easy day at work, or are they more likely to talk about how the physician or someone from management took the entire department to lunch because they had a record billing month? Time and time again, I have received the compliments of motivated, happy employees who appreciate the small things that a company can do for them.

There are a number of incentives that you can offer that cost little or nothing, and time requirements are not obtrusive:

1. Personal Notes Thanking Employee for Achievement
2. Desirable Assignments
3. Peer Recognition
4. Titles
5. Tickets to Sporting Events and Shows
6. Free Beverages and Snacks and Occasional Meals as appropriate

Fun Days have proven to be an effective tool in helping businesses maintain employee morale. A physician can close his office one Friday afternoon at 2 o'clock to allow his staff to go to the movies or bowling. Rest assured your business will not dry up and go away if you take 3 hours off one Friday afternoon. Physicians and management can still have access to their pagers via the answering service or if necessary allow someone from management to stay at the office to hold down the fort. These small tokens of appreciation go a long way toward letting your employees know that you appreciate the hard work that they do for you. Imagine the good will created when your employees brag to their associates how much fun it is to work for your organization.

• Acknowledge Achievements - Because of the time constraints placed on physicians and management, oftentimes the only time employees may hear from their superiors is when they are reprimanded for some indiscretion. All too often, we hear of stellar employees who left their job after years of devotion to a physician because the physician failed to acknowledge him/her with positive feedback. Oftentimes, performance reviews are not given, and pay raises are put off until a later date. The later date never comes, and the employee feels as if they should not have to beg for their scheduled annual review.

Have you ever lost a stellar employee that you later pleaded with to stay and offered them unimaginable pay raises or concessions in an attempt to retain the employee? In many occasions after you have received the resignation, it is just too late to salvage the relationship. This valued employee possesses such a level of dissatisfaction that they have given up on their current employer, and are now looking forward to working for a new physician who is excited about all that they have to offer. Imagine how much time and money could be saved by taking the 30 minutes to give the employee their evaluation, pat them on the back, and give them a small raise versus losing this valued employee and starting all over again with a new hire.

Physicians and management must let their personnel know that they are appreciated - catch them doing something right. When an employee does a good job, tell them. During a busy clinic when an employee comes to you excited about a claim that was paid or a patient compliment they received, do you patronize them and stifle their exuberance by shrugging them off with, "That's nice"? Or do you sincerely tell them how proud you are of their achievement and recognize them in front of their peers?

Remember the golden rule: If you take care of your employees, they will take care of you. You must invest in your employees' happiness in order to reduce your turnover. This reduced turnover will reward your business many times over.

Joe Sansone is the founder and CEO of TMC Orthopedic. With more than 12 years of experience as CEO of TMC orthopedic, a Houston-based company specializing in the provision of products and services for the Orthopedic Industry, Sansone has authored numbers articles on healthcare-related issues and is a frequent lecturer throughout the country. Sansone led TMC Orthopedic to be named an Inc. 500 Company in 1998; the Houston 100 in 1996, 1997, and 1998, and the Small Business 100 in 2003 and 2004. He has been named three times as a finalist for the Ernest and Young Entrepreneur of the Year and received the US Small Business Association's top award as Small Business Person of the Year.

Sansone attended Rhodes College and received a Bachelor of Science degree in Microbiology from the University of Memphis. He offers a level of consulting expertise to healthcare companies and physicians, which includes capturing revenue from the provision of DME, customer service, AR management, human resource issues, and strategic planning. Sansone has been recognized nationally as an innovator in the industry and has served on many advisory boards, including the Business Advisory Counsel for the National Republican Congressional Committee

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