T he well-documented dearth of healthcare professionals is enough of an obstacle to filling hospital staff positions, but to front-line managers and human resource professionals it’s the tip of the iceberg.
In nursing units and bustling clinical departments, personnel vacancies can last for months while the supervisors who need to fill those openings wait for applications to trickle in, sift through reams of resumes, identify who they think are good candidates and go through a process of discovery to find the best fit.
At Intermountain Health Care, it typically took more than 90 days to offer someone a job after posting it in want ads and with recruiters. Before the interviewing could get under way, hiring managers had to endure weeks of preliminary work to get a hiring request approved, advertise the position and amass the resulting applications, says Paul Jackson, assistant vice president for human resources at the Salt Lake City-based system of 21 hospitals and 85 clinics in Idaho and Utah.
That was before a Web-based staffing recruitment and retention system completely changed the hiring process starting early in 2002. By the end of that year, Intermountain had shortened the average time between job posting and job offer to 42 days, says Jackson.
In that transformation, the application process was made electronic, with everyone applying through the Web site, greatly reducing the burden of handling nearly 100,000 paper applications and resumes that had been collected for the 4,000 to 5,000 positions filled annually throughout the healthcare system, he says. Automation condensed the amount of time it took to get requisitions for job postings approved, widely post a notice containing detailed job qualifications and decide when the right complement of applications was in hand to begin interviews.
The cost reduction involved in the switch to an electronic system more than paid for the annual cost of contracting for the Internet-based software--the human resources department saved nearly $300,000 on newspaper ads alone.
Besides increased efficiency, hiring managers have improved their ability to match a candidate’s credentials and preferences to the position sought. Jackson says the online system is able to tally a job prospect’s pluses and minuses regarding a specific job’s skills and demands, which can help both candidate and manager evaluate fitness for the opening before any interviews are scheduled.
That helps head off misunderstandings about the candidate and the job that can result in an employee’s early exit after being hired--it’s not what the new employee had in mind or what managers thought they were getting. Better job information pays off in less turnover, a problem that can be as difficult as shortages.
Even if managers find the best fit and nail the hire, it’s still an appreciable wait from the time they post the opening until they have a good replacement functioning well. If they don’t hit it right, and the new employee doesn’t last the year, the hole in the staff is back--and the hiring headache starts over.
"This system does not solve workforce shortages," Jackson says. "It helps an organization to, in a more effective way, really get people to a position or a particular job that fulfills their desires at the present time."
Consequences of hiring delays
Intermountain officials say the Salt Lake City area has been less plagued by healthcare worker shortages than most regions of the country, partly because of local efforts to get high-school and even middle-school students thinking about opportunities in the field. But the nursing vacancy rate within Intermountain still got as high as 13 percent before the healthcare system acted to get its human resources function under control. With more than 4,000 nursing positions, every percentage point meant another 40 nursing jobs to fill.
On the day of the interview, Jackson was able to quickly determine that the nursing vacancy rate was 7 percent--precisely 282 openings at that moment. Any authorized person can see all openings for jobs in all facilities systemwide, which on that day totaled 993 for an overall rate of 4 percent among the workforce of 25,000. The details can be displayed by job title, facility, area of the state, specific job expectations and many other groupings.
It’s very different from the scattered, paper-clogged and data-deprived routine that characterized staff recruitment and retention at the system in the 1990s. For the most part, hiring efforts were handled separately at each of the 21 hospitals. A nurse looking for a job would apply to a hospital human resources department instead of a central point, and applications to multiple hospitals would be considered separately without sharing the information across facilities.
Applications for jobs posted in want ads would pile up for an indeterminate time, without much scrutiny into the candidates’ quality. Hiring managers had little control over the process or comments on how it was going. "In traditional recruiting, you put an ad in the paper and sit and wait," Jackson says.
It could take a week for a hiring request to be approved by an immediate supervisor and a human resources manager so the job could be posted, says Kevin McEwan, manager of staffing resources for four Intermountain hospitals in or near Salt Lake City. Instead of waiting for the requisition to wend its way to the right desks, "oftentimes I’d have to take this paper (requisition) and hunt those people down," he says.
McEwan oversees a department of 200 registered nurses, licensed practical nurses, certified nurse assistants and unit clerks that acts as a "float pool" serving the four hospitals. As a filler of open positions at flagship LDS Hospital and other busy institutions, it’s doubly important for the float pool to fill its own positions.
McEwan says he hires five to eight new employees each month after interviewing about 15 to 20 candidates. The pool was set up to handle patient-census shifts at hospitals as well as provide fill-ins for predictable wrinkles such as planned leaves of absence. But the 20 to 30 shifts it fills daily have come to include core staffing needs that aren’t met because of the nursing shortage, he adds.
Those needs have expanded along with a 1 percent to 2 percent annual increase in employee count across the healthcare system. Intermountain had to add six full-time employees per year from 1995 through 1999 to handle the paperwork, operate fax machines and otherwise get their hands around the deluge of applications, which reached 90,000 in 2000.
A checklist for hiring help
In late 2000, the healthcare system put together a strategic plan to address staffing and other workforce problems. Included was a call for a technological assist to resolve both widespread inefficiencies and a limited ability to take advantage of the skills and career aspirations of its existing workforce.
Among the objectives:
- Putting control of the hiring process in the hands of applicants and hiring managers, who want to give and get information from each other but were kept uninformed and biding time because of a bottleneck in human resources.
- Helping employees manage their careers by giving them an easy way to list existing and new skills for managers across the organization to evaluate when hiring. In the past, good employees would leave for a better opportunity outside Intermountain not knowing there were avenues within the healthcare system, Jackson says. "We wanted to retain talent within IHC."
- Giving managers a continuous ability to manage staffing needs. That included a way to check daily on any hiring effort as well as instant access to information on openings, applications, vacancy rates and other important issues.
- Devising a solution that would take enough cost out of the human resources budget to pay for the technology within two years. "We knew we had to fix this (hiring process), but we also knew that there was no new money," Jackson says.
After a product search, the healthcare system chose an information system by San Francisco-based Recruitsoft. Because the staffing management system is delivered remotely through the Internet and paid for as a rental service, it’s a recurring annual cost rather than an acquisition cost that can be paid off. Terms were not disclosed, but Jackson says the lease expense is more than offset each year by the operating efficiencies.
Double volume, half the time
The online system, accessible any time of the day from anywhere, has driven out a layer of costly and time-consuming procedures while hiring people in half the time and attracting more than double the number of applications.
Jackson says a concentrated effort during the past several years to promote the Intermountain brand in the marketplace has resulted in high visibility and traffic for its ihc.com Web site, and Utah job seekers quickly got the hang of looking for openings on the site. The Web site also has been promoted at national nursing conferences and in regional healthcare journals.
In addition to a 90 percent drop in what had been an annual $300,000 bill for newspaper ads, the system nearly eliminated all paper, expensive fax machines and manual data entry, along with the labor and supply costs. In the previous paper-based routine, for example, some employees’ jobs were to receive and fax applications all day long.
Intermountain is on pace to process more than 200,000 applications this year, but the human resources payroll has been reduced by two full-time-equivalent employees through attrition since 2000. At the six-a-year clip at which it had been expanding, the department’s head count would have increased by 18 during that time, Jackson says.
No employees were laid off, but some were transferred to other departments such as the business office and others were retrained for "more technical and higher paying jobs," Jackson says.
With 24-hour availability and Internet accessibility, job candidates from around the region and beyond can peruse the particulars of openings, and managers can check on response at home after work, he says.
In one instance, a small rural facility--which would normally face a challenge to fill such a spot--was looking to fill a management position and received 25 applications within two weeks from candidates in five states.
Speed is another advantage, McEwan says. "We can be checking the applicants as we go and (know) when to say, ‘We have enough, let’s start interviewing.’ " A list of applicants queues up with the strongest candidates at the top, each with a score reflecting how many of the job’s qualifications they said they have.
That saves hiring managers from poring through applications and talking with candidates before they know if a nurse has specific skills--advanced cardiac life support certification and trauma experience, for example--or wants to work nights.
Sometimes the best candidate can be plucked from the current staff. Employees have the option of filling out a skill and preference profile online if they want to be contacted about possible openings, and they’re prompted by e-mail every six to eight months for an update, Jackson says. And like anyone else, they can go online to check out openings at any facility.
Though the healthcare system is just beginning to use the software to its full advantage, the rate of first-year turnover--one indication of matching people appropriately to jobs--has dropped 7.5 percent so far, to 34.8 percent in 2002 from 37.6 percent in 2000. "We’re going in the right direction," Jackson says of the reduction in turnover. "We’ll be lower in 2003."
This article was also published in Modern Healthcare.