Regardless of whether they'll admit it or not, managers take turnover personally. The departure of a good employee has far-reaching effects: disappointed co-workers, lost institutional knowledge, unexpected employment holes. Some managers feign indifference--"If they think they can get a better job elsewhere, go for it"--but deep down, turnover hurts.
Resignations bring a lot of excuses: He wanted more money. He got a better job. He hated the commute. But the biggest reason employees quit, experts say, is because they don't like their jobs or they don't like their managers (or both).
An article in the Wall Street Journal once described a "bad job in a good company" as a marriage "where you live in a beautiful house but if your spouse isn't the right one, the house doesn't matter." It doesn't matter what an employee thinks of a company as a whole if her job stinks.
Often, as with a bad marriage, employees and managers don't seek counseling until it's too late. Exit interviews are great for figuring out what went wrong and ensuring it doesn't happen again, but these discussions won't save a broken relationship.
A "stay interview" might.
Used by a growing number of companies, stay interviews elicit feedback from existing employees about what keeps them at the company. Typical stay interviews ask: What motivates you? What are your goals? How can I or the company make your job better? The information gleaned from these interviews can be used to save someone on the brink of resignation or to determine if an employee can handle a bump in responsibility.
Even if an organization doesn't have a formal process for stay interviews, leaders can conduct them on their own by asking staff about their jobs, goals, and needs. Some leaders may think they're too busy "managing" to ask these types of questions, but in an industry facing major staff shortages, knowing what keeps employees happy is key to survival.
A few months ago I wrote about the importance of Weeding out the Weak--identifying low performers and moving them up or out. Working with high performers is just as important. How much time do you spend keeping good employees happy? It's important to get rid of the bad--but you also need to hold onto the good. If you don't, you'll end up with a whole lot of mediocre.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
A bill that has cleared a Kentucky legislative committee could pave the way for Bullitt County residents to get the hospital they have been wanting for years. The measure applies only to counties that have at least 60,000 residents and don't have hospitals. In such a county, an outpatient center that provides surgery, diagnostic imaging and 24-hour emergency care could add up to 60 inpatient beds. If passed, the measure would allow Jewish Hospital's outpatient center in Hillview to add up to 60 inpatient beds without having to gain regulatory approval from the state.
Heartland Spine & Specialty Hospital of Overland Park, KS, has settled with the remaining defendants in an antitrust lawsuit that alleged a conspiracy to put the hospital out of business. Heartland said that the conspiracy included insurers refusing to offer Heartland managed-care contracts. Heartland was founded in 2003 by about 30 physicians, and the case had highlighted tensions between community hospitals and physician-owned medical facilities. Most of the settlements remain confidential.
A radiology group whose contract with Florida Hospital is expiring is claiming that patients receiving X-rays, CT scans and other imaging services could experience diminished care. Florida Radiology Associates sent a letter to nearly 2,000 physicians affiliated with Florida Hospital saying images could be "interpreted by unknown entities with unknown credentials at unknown locations." The contract expires on June 3, but Florida Hospital officials say they are negotiating a new, exclusive contract with several "U.S.-based, board-certified, Florida-licensed" radiology groups that would result in no interruption in service.
AMA supports new model for payers' physician ranking programs. Plus, informed consent raised regarding reprocessed devices. [Powered by Trinity Healthforce Learning.]
Many of the solutions being offered to address problems of quality and efficiency in healthcare are based on the notion that physicians will change their behavior if you target their paychecks. Want to improve quality? Pay physicians for their performance. Want to reduce costs? Set up gainsharing arrangements that split cost savings with physicians. Want to address the primary care physician shortage? Increase compensation to attract more medical students into the field.
Not that financial incentives aren't effective or necessary; we're all responsive to financial rewards, and many of these programs have produced measureable results. But the dialogue is so heavily centered on changing physician behavior with monetary incentives that I wonder how many doctors are growing tired of being poked, prodded, and led around by a financial carrot.
Most physicians want to focus on their patients, not their pocketbooks, says Jose Greer, MD, assistant dean of academic affairs at Florida International University College of Medicine. His approach to improving healthcare delivery begins the first day prospective physicians begin medical school--he's developing an innovative pilot program based on what he refers to as outcomes-based education. "We set the competencies we expected our students to have upon graduation and worked our way backwards."
The goal is to produce well-rounded, socially conscious physicians; it's like a liberal arts education for medical students. Some of the more interesting classes cover the ethical and moral foundations of medicine, the role of medicine in society, and training in cultural competency, which includes not just race and ethnicity, but age, gender, lifestyle, socioeconomics, and other social determinants that often correlate to health factors.
From there, students venture out into the local community to work with interdisciplinary teams--nursing, public health, education, and law students--to track and manage the health of an underserved population. With medicine trending toward increased specialization and focusing on specific procedures or organs, a trend driven largely by financial incentives, Greer wants future physicians to take a step back and proactively treat patients in the context of their larger community by incorporating social determinants, epidemiology, and biostatistics as diagnostic tools.
Cheryl Holder, MD, medical director of North Dade Health Center, who is coordinating the community outreach program through her practice, thinks refocusing medical training can restore the connection with the community and the broad understanding of the patient that characterized old-style family doctors. "Hopefully we can take the students back to where the physician understood the community, understood factors playing in the community that cause what we diagnose. We hope to get a little more understanding, and through understanding more empathy to make us better physicians."
That last line might elicit some eye rolls from hard-nosed pragmatists, but Greer and Holder may be onto something when it comes to rethinking medical education. A study in this month's Academic Medicine found a dramatic "hardening of the heart" during medical school. Researchers saw a measurable drop in vicarious empathy, which not only affected how physicians interact with and treat patients, but can also determine which specialty a student chooses after training (i.e., students with higher empathy levels were more likely to choose primary care).
Greer plans to demonstrate a return on investment for the FIU program by reducing emergency room visits, improving health literacy, and increasing preventative care. If successful, the program will help address the challenges of providing medical care--improving quality, reducing costs, and maybe even alleviating primary care shortages--by allowing doctors to focus on patients, not paychecks.
The Bush administration says that new guidelines requiring physicians to make referrals for abortions or other procedures they don't wish to perform themselves may violate federal "conscience" laws. The new ethics guidelines were written by the American College of Obstetricians and Gynecologists, and questions remain about whether a doctor would actually lose his or her certification as a specialist for refusing to make a referral. Health and Human Services Secretary Mike Leavitt has sent a letter challenging the policy to both the American Board of Obstetrics and Gynecology and the ACOG.
Texas Sen. John Cornyn says that without immediate reforms to the way the government pays physicians under Medicare, Texas can expect a major decline in the number of physicians available and an ever higher spike in the cost of care. In this Op Ed piece in the Houston Chronicle, Cornyn says the country needs to change the way it pays physicians, and develop a system that provides incentives for reduced costs and quality care while protecting the eroded physician-patient relationship.
Redistributing a retired or semiretired doctor's patients can be challenging for all parties involved. For starters, physicians seldom give the practice enough notice of their slowdown or departure to plan for a smooth transition, says Neil Baum, MD, a urologist in New Orleans. "It is usually done by the seat of the pants, and then they stamp out forest fires and crises as they occur. As a result, instead of getting 100% of the existing patients staying within the practice, there's a loss sometimes of 50%-60%."
Despite the fact that today's patients are more mobile and apt to change jobs and health insurance--and thus doctors--many patients become uneasy about being forced to sever ties with a trusted primary care physician or frequently seen specialist, such as a cardiologist or OB/GYN. "Those bonds aren't broken easily, and the new doctor needs to understand the anxiety level of patients during this transition process," Baum says.
Patients in this situation need extra reassurance that you are well informed about their health concerns and willing to provide them the same kind of care they are used to. Therefore, it's essential you do your homework about inherited patients. At the very least, review the patient's medical record before the first visit and, if possible, contact the former physician with any questions or concerns. At best, sit with the former physician and go over active patients chart by chart, Baum says. "This takes hours of work, but is essential if you want to keep the patients in the practice."
The new doctor also faces the task of piecing together the patient's medical history and understanding the reasons certain actions were or were not taken, adds Bruce Genovese, MD, MHSA, a Michigan cardiologist. For example, in his speciality, doctors fall within a wide range as to how aggressive they are in treating heart problems. "We have doctors who have every patient get a procedure if there's even the slightest indication of an issue, and we have other doctors who are more conservative," he says.
If your style varies from the former doctor's, or even if you disagree with the choices he or she made, don't bad-mouth your colleague. "One of the worst things you can do is say, 'Well, he didn't handle this right.' You've got to, no matter what you really think, be sure that your patient feels that you've taken the doctor that they like seriously," Genovese says. "Either you're going to follow their way of going about things or you're going to give [the patient] a very valid explanation why your plans have changed."
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor's Office, a monthly newsletter by HealthLeaders Media.
Doctors and pharmacists say patients and caretakers are increasingly turning to tech-based drug-tracking tools, including interactive, consumer-friendly websites, to help keep medication regimens running smoothly and reduce errors. One such device is the Med-eMonitor, a device connected to a drug database through the patient's phone line and programmed remotely via the Internet. The monitor beeps and a large-print message pops up on the display screen as a voice announces when a pill is to be taken, reminds the patient when doses are missed, and alerts them to potentially dangerous medication interactions.
