Hospital Aims for Culture Where Employees Never Want to Leave

February 2, 2005
Job applicants at Saint Francis Medical Center can hope for more than just an offer. Usually, they get to test-drive their new position before signing on.

Since early 2004, nearly all prospective employees--from housekeepers to managers--have spent at least an hour or two shadowing the job they want to fill. The results of these "realistic job previews," as they’re dubbed, have sometimes surprised everyone involved.

    One job candidate arrived at the nonprofit Nebraska hospital with great references and experience working the front desk of a local hotel, says Lee Elliott, vice president of human resources and fund development. Then she sat behind the admissions desk in a far more unpredictable environment, the Saint Francis emergency room. "At the end of an hour she said, ‘I don’t want this,’ " Elliott says.

    Job previews don’t just reduce turnstile turnover, says Regina Rathman, the hospital’s employment coordinator. The experiences also can serve as bait, she says. They seal the deal. She recalls one management candidate who ranked at the top of everyone’s must-hire list. But naysayers said the hospital wasn’t offering her enough money. "She accepted, no questions asked," Rathman says. "Because she loved the environment, she loved the people who worked there. We didn’t need to throw the bells and whistles at her. The culture sold her on it."

    The job-preview effort is one of numerous initiatives launched by Saint Francis officials in the last four years, after staffing shortages resulted in some patients being diverted to other hospitals. As Saint Francis officials revved up recruitment, in a hospital-wide effort, they quickly decided that simply attracting a larger applicant pool was not sufficient.

    Preventing turnover can save valuable time and money, particularly given the shortages in some high-demand positions, Rathman says. When the hospital lost five respiratory therapists in 2003, it took an average of 284 days to fill four of those positions, she says. As of late January, the fifth position was still open.

    To boost overall retention, Saint Francis officials have broadened their search to include nontraditional health-care applicants, such as local farmers. And they’ve worked harder to assure that the candidate and the position are well suited to each other. "Your best recruiting is retaining your current employees," Rathman says. Saint Francis officials, she says, are working "to create a culture where people want to be here, want to stay here, don’t ever want to leave."

    Turnover at the 189-bed hospital in Grand Island is down, from 20.6 percent in 2000 to 15.7 percent in 2003. Meanwhile, the hospital has enjoyed a surge in applications. An average of 11.3 people applied for each opening in 2003, compared with 3.7 in 2000.

Finding the right job fit
    Adam Hinrikus is accustomed to working long hours, after growing up on his father’s 900-acre corn and soybean farm. But Hinrikus, 22, (turns 23 in April) is also realistic about the long-term stresses and uncertainties involved. "With farming, the way the economy is going, I wanted something to fall back on," he says. "Something," he jokes, "to support my farming habit."

    Since 2000, Hinrikus has worked at Saint Francis, first as a nurse’s aide and more recently as a registered nurse, after completing his degree in 2002. He works primarily in the intensive care unit and shoulders a Herculean schedule, generally pulling three 12-hour shifts Friday through Sunday before working most of the week on the family farm.

    To attract farmers, policemen and others yearning for a career change, Saint Francis holds periodic "recareering" nights at its storefront location at a local mall. "They’ve worked someplace--they know what it’s like to have a job," Rathman says. "If we get a recareered person, they know what a work ethic is like."

    In addition, Saint Francis hosts orientation sessions at the hospital to encourage high school students and help them focus their health-career aspirations. "We had a lot of kids who were calling and wanted to job-shadow," says Marlene Hinrichs, clinical manager of the radiation therapy department. "Sometimes we found out that they didn’t know what area they wanted to job-shadow once they were here."

    Hinrichs helped develop the twice-yearly events, called Career Scene Investigations. Participants, nearly 250 to date, are given a whirlwind tour of as many as six hospital departments, spending about 10 minutes in each before moving on. The local junior college also participates, providing information about the training and prerequisites students need to pursue a particular health field.

    Parents are encouraged to attend, in the hope that they will become excited about health care’s stable employment prospects, says Hinrichs, herself a mother of five. "I truly believe that you can steer your kids based on how you feel."

Understanding interpersonal dynamics
    In the last couple of years, Saint Francis has also invested in voluntary psychological tests for employees to help them better understand their emotional strengths and weaknesses. Health care, Elliott says bluntly, attracts very high-tech people but not necessarily always emotionally sophisticated people. So far, about half of the hospital’s 1,200 employees have completed the voluntary testing.

    The hospital gives test results to individual employees, as well as an overall score to departments, says Judy Sandstrom, employee assistance program administrator for Family Resources of Greater Nebraska, which provides employee-assistance and testing services to Saint Francis. Departments learn how successful they are at problem-solving and handling change, among other issues, she says.

    The pastoral department, for example, attracts people with a high stress tolerance and the ability to work independently, Sandstrom says. "They don’t rely on a lot of people to make their decisions." Still, teamwork is sometimes necessary, and the department is now developing ways to work better as a team.

    An added benefit of the psychological tests, Elliott says, is that staffers have gotten to know the employee assistance staff, which may encourage them to seek help if other personal stresses or difficulties arise. Since 2001, the hospital’s mental-health bill has declined, from 7.4 percent of total health insurance costs to 4.1 percent by mid-2004.

Staying tuned in
    Elliott remains committed to staying tuned in. "Listen to what your employees tell you," he says. "We weren’t deaf. But in terms of intense listening, no we didn’t."

    Take the respiratory therapist turnover situation. In recent meetings with therapists, both current and former, Elliott and Rathman have learned that the clinicians think some hospital policies prevent them from performing skills, such as intubations, for which they have been trained. At this point, Rathman says, hospital officials are "in the baby stages" of talking about possible solutions.

    Such conversations are never easy. But addressing conflicts directly, Saint Francis officials attest, can save money and frayed nerves down the road.