Evidence gleaned from 30 studies demonstrates that how a physician dresses has a bearing on patient compliance rates and patient satisfaction rates. But for some specialties, attire is less of a factor, researchers conclude.
What can incent a patient to trust a physician, follow her directions, and remember the interaction with satisfaction?
One recent study released this week in The BMJ suggests that a conservative and professional style of dress—complete with the quintessential white coat—is where trust, patient compliance, and patient satisfaction begin.
The study finds that the majority of patients prefer physicians in professional attire, as defined within the study as "a collared shirt, tie and slacks for male physicians and blouse (with or without a blazer), skirt, or suit pants for female physicians." This came as no surprise to the study's lead author, Christopher Petrilli, MD, an internal medicine resident at the University of Michigan Health System, who spent several years in the buttoned-down financial industry prior to beginning medical school.
"Every time a patient comes in to the clinic or sees physicians on the wards, there's a certain expectation of how their physician will dress," says Petrilli. The data overwhelmingly suggests that first impressions do matter, though Petrilli and his colleagues find that patients are less concerned with attire after the first visit.
The Demographics of Dress
The researchers aggregated data from 30 studies originating in 14 countries and found that a majority of patients prefer physicians who dress professionally. The results were a bit more diverse when factoring a physician's specialty, geographic region, and care setting.
While 70% of studies analyzed found that patients prefer professional attire with or without white coats, Petrilli's team also found that four out of seven studies focusing on surgeons, gynecologists, and physicians working in emergency medicine, found that their attire was less important than that of a family or general physician.
"Those who are more acutely ill don't seem to prefer formal attire as much as in an outpatient setting. If you're sicker, you probably are more focused on getting appropriate care than on what your doctor is wearing," explains Petrilli.
So, while a skilled surgeon or emergency department doc might be able to bend the wardrobe rules, someone practicing in an outpatient setting should stick to the white coat and tie, he suggests.
There was also a regional component to the study. Patients in the United Kingdom and Ireland felt most strongly that physicians should dress in a conservative fashion (four out of five studies analyzed from this region found a strong preference for professional dress with a white coat).
Americans are more conflicted on the subject.
Petrilli's team analyzed 10 U.S. studies on dress expectations for physicians, six of which found patients had no preference for professional attire or scrubs—a trend likely to continue as younger, more casual physicians enter the workforce. But American patients over the age of 45 still "strongly prefer professional attire," cautions Petrilli.
More than anything, patient preferences have to do with physicians projecting confidence, trustworthiness, and respect, he says.
Examining The Evidence The study came about when Petrilli's coauthors noticed that in contrast to many young clinicians, he was always dressed in a tie and a ironed shirt—a holdover from his banking career, he says.
"[My coauthor] said he liked that," Petrilli remembers. This conversation sparked the question of whether or not physicians had evidence-based practices they could follow regarding professional dress. "Everything we do in healthcare is supposed to be evidence-based. We found that lots of articles touched upon physician attire, but there was no actual, evidence-based study. We then asked ourselves if we wanted to do a systematic review of the topic," Petrilli remembers.
The study findings suggests that since the image a doctor presents has such bearing on whether or not patients perceive her as trustworthy, patients are more likely to be honest about subjects such as medication compliance, their sexual histories, and end-of-life wishes when physicians are dressed professionally.
"If physician attire has even a marginal impact on how some patients feel toward their provider, leads to any increase on compliance with medication or other instruction from a physician, prevents a hospitalization, or increases patient satisfaction, then dressing professionally becomes worthwhile in itself," says Petrilli.
Seasonal staffing crunches are just one of the scenarios where travelling nurses might be a better option than maxing out OT or bringing in per diem nurses.
Flu season hits. Your hospital has agreed to send some nurses to local health fairs, churches and community centers to tout the benefits of vaccination. It's a strain on schedules, but worth it.
Then, amidst all the flu activity, three nurses announce that they're pregnant—and they're due within weeks of each other.
Should you hire one or more new nurses, knowing you might not need them after the pregnant nurses return from maternity leave and flu season is long over? Should you max out OT and try to get through the crunch? Or should you bring in some per diem nurses?
Here's another popular option: Bring in some travelling nurses. Similar in principal to a locum tenens physician, a travel nurse is a short-term contractor usually employed through an agency that specializes in travel nurse placements.
Bill Heller, president of RN Network, a travel nurse staffing company headquartered in Boca Raton, FL, says he's seen a lot of younger nurses who want to experience working in different parts of the country before being tied down to one place.
On the other end of the age (and experience) spectrum he sees nurses who wish to enjoy the latter part of their careers by working in desirable locales.
Heller offers reasons travel nurses ought to be considered as a staffing solution:
1. Seasonal or Situational Staffing Shortages
Ahhhhh, winter: It's that time of year when sun worshippers and those sensitive to cold weather head to warmer states, such as Florida (where the state population increases by 4% in winter), Texas, Arizona and California.
"Travel nursing used to be seasonal, and seasonal work is still a large part of the business," says Heller. Winter resorts and summer colonies both see massive seasonal variations as travelers come and go, but seasonal fluctuations don't end there. College towns with large student populations and farming communities with an influx migrant workers also see their healthcare needs spike.
In colder climates, hospitals may want more hands on deck to handle flu outbreaks. For these short-term challenges, it simply does not make sense to bring another nurse onboard fulltime when the demand will subside after a few weeks or months.
2. Need for Scheduling Flexibility
Bringing on travel nurses allows permanent nursing staff the chance to take long-term breaks. Vacations, leaves of absence, and maternity leaves create temporary vacancies that can be filled by travel nurses.
And having extra nurses on hand enables nurses to take on special projects, such as community outreach, or to transition to different roles within the hospital.
How many nurses should be travel nurses at any given time? "There's a sweet spot," says Heller, Most hospitals he works with find that maintaining no more than 10% to 15% of nurses on duty as travel nurses is a comfortable ratio. "That number allows for flexibility, and allows the hospital to be much more nimble."
3.Skills Gaps
Travelers have seen it all. Or most of it. Be selective. Look at where candidates have worked before. Heller suggests bringing on a traveler who has worked with equipment your hospital plans to purchase soon, and have him or her help with training.
And travelling nurses should be asked to share best practices they've picked up along the way. The knowledge transfer is a bonus.
Cost Considerations
A common argument against bringing on travel nurses is that it would be less expensive to hire on either per diem staff or even another fulltime nurse. Not so, says Heller. "It's really not that much more expensive than a permanent, full time nurse. It works out to a three-to-seven dollar per hour differential."
Because the staffing agency picks up costs such as malpractice insurance, hospitals save money in those areas. Assignments usually last about 13 weeks, although stays up to 26 weeks are not unheard of.
Travel nurses are one more weapon in your arsenal to ensure patients are getting the best care possible, even when your population fluctuates, you get hit by the worst flu season in a decade, or multiple nurses go on maternity leave at the same time.
And, if the nurses get to enjoy some time in a nice locale in the process (namely, yours!), you'll all be better for the experience.
More than half of physicians regularly get patient information necessary to coordinate patient care from sources other than EHRs, a study finds.
Despite a federal mandate to adopt electronic health records systems, many physicians remain woefully behind in how they receive patient data, researchers say.
Patient history and reason for referral to outside provider
Consultation with an outside provider
Hospital discharge information
The study found that more than half (54%) of physicians who regularly received information regarding care coordination did not receive that information electronically. While 64% of physicians surveyed said they routinely receive the results of a patient's consultation with a provider outside of their practice, they were often just as likely to receive the patient information through non-electronic means as they were a an electronic health IT system.
Researchers found that providers using EHRs were slightly more likely to receive these records in a timely manner and to use the information in a way beneficial to the patient than physicians who relied on fax, telephone, or photocopies as sources of patient information.
Nevertheless, the president-elect of the AMA blasted EHR systems last year, saying there is "a crying need" to make electronic health record systems "time-saving rather than efficiency-diminishing."
The barriers toward EHR adoption can feel intimidating to some physicians, explains Chun-Ju "Janey" Hsiao, PhD, MHS, a health services researcher at AHRQ, who served as the study's main coordinator and has compiled data on EHR adoption rates by physicians.
Cost Concerns "The high costs associated with adoption and implementation historically have prevented the widespread adoption of EHRs," she says. "There is also a learning curve associated with using EHRs that often requires clinicians to change their workflow."
Even for physicians who are comfortable with the new technologies and willing to pay for them, the road toward integration hasn't always been straightforward, since most commercially available EHR systems are not interoperable—plus, practices and healthcare systems have had little incentive to make sharing patient data convenient, says Hsiao.
Interoperability "When properly used, health information technology can enhance information sharing. However, if the EHRs do not 'talk' to each other, clinicians have to rely on manual means to share patient data," she continues.
Interoperability has long been an elusive goal of providers, payers, and technology vendors and was sure to be top of mind at ONC's annual meeting in Washington, D.C this week.
In October, the American Academy of Family Physicians, the American Medical Association, the Medical Group Management Association, the National Rural Health Association, and several large health systems submitted a letter to HHS Secretary Burwell, complaining that proprietary barriers, complex requirements, and an accelerated timetable put forward by HHS have made it difficult to realize interoperability.
On Friday, ONC released draft 1.0 of the HIT interoperability roadmap based on months of input from HIT experts and policymakers. National Coordinator for HIT Karen DeSalvo, MD, pledged continued cooperation with "federal, state, and private sector partners to see that electronic health information is available when and where it matters."
Some physicians find the burden of EHR adoption heavier than others. Physicians in private practice or who work in community health centers have had a lower rate of adoption than physicians in hospitals or larger practices.
Additionally, says Hsiao, physicians in non-primary care specialties have a lower adoption rate than physicians in primary care specialties, as do physicians and practices in rural areas.
But Hsiao believes that change might be on the horizon. "A 10-year vision for a more interoperable health information technology infrastructure has been outlined," she says, which she hopes will help smooth adoption woes in the near future. When properly integrated, EHRs help ensure care coordination, says Hsiao—but it's up to each healthcare system and physician to make sure their patients are reaping the benefits of modern health IT.
Military service can teach the value of responsibility, the importance of cultural diversity, and it can prepare enlistees to step into leadership roles.
When looking for loyal team players who will work hard without complaint and have leadership experience, what do you look for on a candidate's resume? An MBA? Someone who volunteers at a soup kitchen on weekends? Someone who whose career started at McDonald's?
A stint in the armed forces might be the key suggests Lisa Rosser, founder and CEO of The Value of a Veteran, an organization which provides human resources consulting and training for organizations that seek to improve support, recruitment and retention of military veterans. "Hiring a veteran isn't just patriotic—it's good business," she asserts.
Rosser has worked for years to promote the benefits of hiring veterans, and awareness is growing. President Obama vigorously endorsed the idea during last Tuesday's State of the Union Address, "…to every CEO in America, let me repeat: If you want somebody who's going to get the job done, hire a veteran."
Rosser cites three benefits of hiring military vets.
1. Work Ethic A few years of service in the military can teach the value of responsibility, discipline, and persistence—like sticking with a job when it isn't all that fun.
"It's a constantly changing environment—soldiers go from serving in Afghanistan to responding in natural disasters on US soil…. They have to be fluid and flexible. The military operates as a team," explains Rosser. If a member of the military finds they don't like their new combat mission as much as they liked peeling potatoes in Fort Polk, LA, too bad— a soldier can't just turn down an assignment because they don't like it, says Rosser.
Compare this to the American university system, where a student can change their major or drop a class if it becomes overwhelming or they decide a course of study isn't for them. At an age when many of their peers were enjoying frat parties and road trips, most service men and women were learning about the potentially deadly consequences of a poor judgment call, the importance of teamwork, and to value the needs of their organization over their own.
Veterans know how to handle stress, follow orders, and evaluate situations realistically.
2. Cultural Competence / International Experience As the national cultural becomes increasingly diverse, hospitals and health systems that mirror the communities they serve by employing linguistically and culturally aware workforces stand to best serve their patients.
"Many people only associate military with war and forget natural disaster and humanitarian response missions," says Rosser. "As a soldier, you have to care for the population being affected [in a disaster or humanitarian mission]... If the mission is to care for the injured or ill, we do that, and we do it well."
The military has many jobs which require understanding of a foreign language and culture, including foreign area specialists, translators, and intelligence analysts.
Even soldiers who don't directly work in a capacity with foreign nationals or who never see combat are often stationed abroad at some point, in regions as diverse as Germany, Saudi Arabia, and Japan. Many of these men and women will learn at least a little bit about the language and culture of the area where they are stationed.
3. Leadership Experience How many 22-year olds do you know who are ready to step in to a leadership position at a moment's notice? If you've spent any time around members of the military, you probably know quite a few of them. "The military operates as a team—everyone is trained to take charge when the need arises. At any moment… your current leader could get injured and killed. In those situations, you can't open a req and wait for it to be filled," Rosser says.
Soldiers are usually prepared for supervisory positions within three to four years of enlisting—usually sooner if they're commissioned. After an additional year or two, the soldier is likely to be moved to a managerial role, which is fast in comparison to corporate America.
Additionally, of the more than 7,000 occupations within the military, 81% have direct civilian equivalents, including food service, security, janitors, plumbers and human resources associates—not to mention doctors, nurses, and other medical specialists.
"It's not that service members don't have the right skills, it's that leaders don't know how to translate them to civilian skills, and vets don't know how to put them into the right terms [so hiring managers and HR teams can understand what they mean]," says Rosser.
If a veteran gives you the military occupation code of the job they did during their service, look it up online or simply ask them what they did in that role—even in cases where there isn't an exact civilian match, there are almost certainly skills that they learned that can be applied to civilian jobs.
"Look at this from talent management perspective," suggests Rosser. "Do you have high turnover? Is it difficult to fill critical positions? Whatever you pain points are, filling a position with veteran talent is a good solution."
When you hire a veteran, you're not just doing something patriotic or a serving those who have served their country—you are hiring an experienced professional who will bring a unique skill set to your team.
Some of the most noticeable changes in healthcare staffing and structure are occurring at the top, in the executive suite. One recruiter expects 2015 is the year titles with their roots in value-based payments will become more familiar.
A growing emphasis is on value-based care and keeping entire populations of patients healthy, is giving way to shifting job titles at hospitals and health systems, says James U. King, senior partner, chief quality officer and children's hospitals practice lead at executive staffing firm Witt/Kieffer.
"The question everyone is asking now is, 'how do we manage health of a population? What should we be doing from primary care base—and who are the leaders who can lead that service line?'"
New Jobs at the Top Some of the most noticeable changes in healthcare staffing and structure are occurring at the top, in the executive suite. The titles may differ by location, but the job functions will exhibit some consistency.
While the title Chief Medical Officer is not new, the role can be expected to change significantly over the next five to seven years. This title has traditionally been held by a physician, but that is changing, as more organizations realize that nurses are often ideal candidates for this role. One significant change in the role: The CMO can expect to work more extensively on population health initiatives in addition to overseeing quality of care, hospital safety, and analyzing clinical outcomes.
One of the fastest-growing titles is that of Chief Integration Officer. "Typically, a physician leader gets put in this role," says King. "His or her job is to develop the strategy for how you drive clinical integration and care coordination across a healthcare system." A Chief Integration Officer will work closely to identify quality initiatives, and take a coordinated approach to improving quality and safety across the system.
The Chief Transformation Officer can expect to be charged with extensive levels of care redesign. "This is the person who asks the question, 'What does the new care delivery model need to look like in our organization?'" says King. This executive will build an entire care delivery model that uses the full continuum of care. "Population health…. Quality of care, safety, forming ACOs and medical homes; this is all under the CTO's umbrella," he says.
Organizations that are considering bringing a Chief Population Health Officer on board or already have one, may consider hiring a Chief Innovation Officer instead. "Organizations that do this will be the ones taking an innovative approach—they're the organizations asking, 'how do we redesign the care delivery model to be more efficient and cost effective for all patients we're serving,'" says King.
This executive may also work with payers to serve at-risk populations and create products that will help keep those populations healthy.
King also predicts that the Chief Ambulatory Care Officer will become popular in the next few years. "Lots of organizations already have someone in charge of ambulatory care, but there's been a bigger emphasis on having leaders at highest level oversee the ambulatory practice recently. There's a real…. shifting of care to the outpatient setting, and a greater need for senior level executives to move to a role overseeing that," he says.
Innovation at All Levels
The C-suite isn't the only area experiencing transformation. The transition to value-based care is creating new roles at every level in healthcare. Several new jobs have been created to help patients as they move across the care continuum and deal with multiple providers and health problems.
Care Coordinators will manage patients' interactions with a healthcare system across different specialists and create care plans for the patient. Most people who find their way into this role are either RNs or advanced practice nurses (APRNs). Health Coaches are somewhat similar to Care Coordinators, but usually come from a social work background and focus on motivating the patient to make positive changes so they can improve their health.
With the exponential growth of electronic medical records systems, it has become necessary for some providers to employ Clinical Documentation Specialists who maintain and evaluate patients' medical documents, including diagnostic results, insurance claims, and other records. And the role of Medical Scribe—a real-time note taker who focuses on maintaining records of practitioner, patient interactions so the physician can focus on the patient, is projected to take off in 2015.
King also forecasts greater growth in the area of behavioral health. He foresees more vice president-level roles around this specialty, with a focus on both addiction treatment and primary care.
President of Population Health, President of Accountable Care, President of Medical Homes and Senior Vice President of Innovation are other titles King says he anticipates hearing in the next few years. Each of these roles will manifest in its own unique way within each healthcare system, he says.
"If you've seen one healthcare organization with a certain title and job description, well, you've seen one specific job. We're seeing a multitude of titles across different organizations, and a multitude of roles. Each system is different, as is each job—and each employee."
As the nation's population grows more diverse and hospital reimbursements are increasingly tied to patient satisfaction scores, clinicians must become more culturally aware.
Many Americans have experienced watching a foreign film and feeling like they missed something, whether it be the British political jokes in The Life of Brian or the nuanced treatment of the Spanish civil war in Pan's Labyrinth, something has been lost in translation.
But what if what's missing is something more serious? What if what's missing is an important element of patient care?
As the nation's population grows more diverse, it's increasingly important to be aware of the influence of culture on everything from a patient's diet to attitudes about death and dying as we move to a patient-centered care model, says Joe Betancourt, MD, director of the Disparities Solution Center at Massachusetts General Hospital in Boston. He is co-founder ofQuality Interactions, an organization that seeks to spread cultural competence in healthcare.
"There is strength in diversity, but there are also challenges," says Betancourt. "Studies have shown that greater difficulties in communication lead to poorer patient experience, lower adherence, and ultimately, worse outcomes."
HR, he says, is in the perfect position to make decisions that can lead to a more culturally aware and competent hospital. Unfortunately, this is an uphill battle for healthcare workers to fight.
"Research shows that if you have two patients in an emergency room where everything is identical—they have the same income, the same insurance, are both dressed professionally, but they are just different races, the minority patient will receive a lower quality of care."
"Often, it is due to communication challenges," Betancourt explains.
1. Understanding What Lies Beneath
Patients aren't always as forthcoming as clinicians would like them to be, and cultural differences can be a factor, especially when a clinician isn't aware of a patient's culture. But even United States natives can have problems communicating with medical staff.
As a Boston local, Betancourt sees many second-generation Americans of Irish decent. "They will often provide short answers of 'yes, Doctor, no, Doctor,' because they don't want to disappoint the physician." He explains this is a cultural holdover their parents brought across the Atlantic with them. In these cases, Betancourt is certain to ask the patient multiple questions to ensure that they understand what he has told them.
Another example: Patients from Appalachia may be hesitant to disclose information pertaining to domestic violence or substance abuse. These are life-threatening risk factors a culturally insensitive clinician might miss.
2. They're Right Under Your Nose
One strategy is to hire locals who speak the language and understand the culture.
"It takes effort to go out and look for [culturally aware] people and identify them," says Betancourt. "Maybe this is not the person with 'best' resume—but think holistically about what the candidate brings to your organization and the healthcare experience," he suggests.
Hospital serving members of a specific culture likely already have members of that group working for them. Some may be frontline workers and as members of the community, they understand the unique problems their peers face and their unique language and way of life.
Employee development programs can be helpful in engaging and retaining culturally competent employees who have an insider's view into a hospital's patient population.
3. Good Listening Skills
Clinicians don't have to be local or a members of a minority group in order to be culturally competent—what they need most is a questioning and open mind. "Being culturally competent means having the skills and tools to communicate with anyone, regardless of their background, or your own," says Betancourt.
It's vital to ask questions and find out what aspects of a patients' life create obstacles for them in getting and staying healthy, he says.
An example Betancourt uses is asking overweight patients what barriers they face to exercise. If asked in an understanding, open way, the physician might learn that the patient lives in a neighborhood where it is not safe to walk at night—or possibly even during the day.
"In this case, we ask them, 'how can you do this in your community,' says Betancourt, saying that some suggestions he's received from patients over the years have included taking the stairs rather than the elevator when at work or home and taking walks at lunchtime. "We try to mitigate the negative impacts of their environment," explains Betancourt.
Cultural competence is not just a nice thing to have. "Physicians and nurses today need the skills to communicate with anyone, of any background," says Betancourt. Maybe the next foreign film they see will seem a bit less foreign.
A sole practitioner who works long hours in rural Virginia, Rob Marsh, MD, values both his independence—and his community.
John Otho "Rob" Marsh, MD, is not a complainer—he's a doer. Toughened by years in the military, he calmly looks for solutions where others would simply throw in the towel or panic. But being a primary care physician in private practice in a rural area isn't easy for anyone, even a stalwart former soldier like Marsh.
John Otho "Rob" Marsh, MD
The long hours, vast distances, increased regulation, and Internet connections that never seem to work right all make his job a Herculean task. Marsh, 59, at least has been recognized for his work. He is the recipient of the 2014 'Country Doctor of the Year' award, bestowed by the physician staffing organization Staff Care annually since 1992.
Though the job is tough, he says can't let his patients down. "These are the people I take care of. That's what motivates me... My patients are my friends. I couldn't sleep well at night if I closed the door at 5:00 and was closed for the night, even if a patient needed me."
Marsh's career began as an Army medic. With assistance from the military, he went to medical school, then became a physician and served in the Army's Delta Force unit. After Operation Desert Storm, he intended to become a family doctor, but couldn't stay away from the service. He completed a third tour of duty that took him to Mogadishu, Somalia, where he was injured in the line of duty.
After his injury he moved back to his hometown of Middlebrook, VA to work at the nearby University of Virginia, but he soon realized he preferred the independence of private practice.
Country Life
Getting to a doctor's office can be a challenge for people who live in the Shenandoah Valley farming community Marsh calls home. "I have patients who will wait two or three hours to see me," he says. He himself has to drive half an hour each way to get to the hospitals where he does rounds.
He keeps two offices—his original clinic in Middlebrook and a newer office at a truck stop in nearby Raphine. Truckers frequently stop by for Department of Transportation physicals or if they need care during a haul.
"The truck stop is busier, and has a great Internet connection," says Marsh. It's become his de facto primary office—partly for the quality of its broadband—and partly because he enjoys meeting new patients through the trucking population. He also practices at two local hospitals in Augusta and Fishersville.
Marsh's day usually begins at 7:00 AM, with an hour of rounds at the hospital in Augusta. He usually arrives at one of his offices between 10:00 and 10:30, where he stays until around 7:00 PM. He then goes home to have dinner and spend time with his family for a few hours, but his day does not end there.
"I usually round at the hospital later that night, at 10:00 or 11:00, and stay for a couple hours" says Marsh. If no patients in the hospital need his care, he'll visit his patients in nursing homes.
Somehow, Marsh also finds time to update his EMRs, keep abreast of new healthcare legislation, care for the animals on his family's small farm, and manage his staff.
The End of an Era for Rural Healthcare? He insists that he loves his work. "I do it because I want to do it. No one forces me to do this," he says. "It's very rewarding and fulfilling work." He says he is thankful he had the option to work in private practice, and acknowledges young physicians face hurdles different than his own.
"It's difficult for a young physician to start a practice on his own," he says. It's difficult for a private practice physician to stay on top of billing, coding, manage staff and implement EHRs. Plus, most newly minted MDs today carry heavy student-loan debt.
"Your financial reward may be greater in an urban area," Marsh admits.
And yet, he is not entirely pessimistic about the future of the rural physician. He believes that government or community sponsored rural healthcare initiatives that would incentivize young physicians to practice in rural areas could keep rural areas well-served.
He does recognize that fewer physicians are willing to put with the hours he keeps. "I [can] tell you of numerous doctors in my area who do the same thing. I guess it was just the older generation…. I consider myself a bit of a dinosaur in that regard," he chuckles.
Rural communities make up a quarter of the American population, but only 10% of doctors practice in rural regions. Americans who live in rural areas are, on average, older, poorer, and in worse health than their urban counterparts. And, as solo practitioners like Marsh approach retirement age, the question of who will care for rural Americans looms, unanswered.
For Marsh, the appeal of his job runs deep. "I've always been a loner, a rebel. That's why I'm in a rural area. We live here because we want to be more independent."
Mentoring can not only help a child in need, it can also help foster culturally competent, engaged physicians in tune with the particular needs of their communities.
For many disadvantaged youth, the dream of becoming a physician, nurse or pharmacist feels just as out of reach as winning the lottery or marrying a millionaire. But with proper mentoring and role models, hospital leaders can help make a future in healthcare a reality—and, at the same time, improve clinician engagement and even create a pipeline for future hires.
Lynne Holden, MD
Lynne Holden, MD, a physician who specializes in emergency medicine at Montefiore Medical Center the Bronx, NY and president and executive director of Mentoring in Medicine, Inc., was introduced to her first mentors by an aunt who dreamed of helping her niece fulfill her childhood dream of becoming a doctor.
Holden's aunt, a nurse, persuaded two physicians—Muriel Petioni, MD, and Melissa Freeman, MD, to let her 13-year old niece spend her spring break shadowing them as they did their jobs. Both agreed, and both remained mentors to Holden throughout her career, guiding her at every step from teaching her how to study to helping her create mentoring opportunities for the next generation of clinicians.
"It was through watching them that I decided [being a physician] was amazing, and that I wanted to be like them," Holden recalls. "I looked at them and saw myself." Inspired by her experiences, Holden founded Mentoring in Medicine, Inc., to help raise awareness of the need for mentors in healthcare.
Age-Appropriate Mentoring Mentoring can begin as young as in elementary school, says Holden, and the earlier the better. "Medicine in general is a field where you have to look and act a certain way," explains Holden. "You have to know how to play the game. Not all children are raised in an environment where they have that sort of tutelage."
In elementary and middle school, it's important that children learn how to be a leader, interact with their peers and respect authority—all things a mentor or mentoring program can assist with. "They need to know how to color inside the lines," says Holden.
Elementary school is the perfect time to take advantage of a child's natural curiosity and expose her to the possibility of a career in health or science [or technology]. After school programs are popular for this age group—and can help keep kids occupied and out of trouble.
High school age level is perfect for lunch-and-learn programs about health careers, school clubs, and volunteer programs. "If [your organization] can come up with some time… to spread the word about whatever interests these kids, do it!" urges Holden.
In college, the tone of mentoring shifts from keeping kids involved and engaging their curiosity to setting the course for academic and professional development. It has more to do with helping students apply for admission to programs. Holden says, "We need to ask them, 'what do you need to do during the summer? What classes do you need to take?'"
By the time a student reaches medical school, she should know which specialty she wishes to enter, which professional organizations she needs to join, and should know people within her chosen specialty, both locally and nationally, says Holden. "When [the student's] name comes across the table for a residency program, they should be a known entity."
A Place for Human Resources Youth who go through local mentoring programs and complete their education often feel drawn to return to their communities for residencies or to practice medicine, often feeling a strong desire to practice alongside the mentors of their youth.
Also, professionals with local ties understand the needs of a community and its unique culture. They are also likely to be engaged in both the community and the organization for which they work and to love what they do.
"If you start to groom someone early for a place at your hospital, you probably won't have to waste a lot of money on a search firm," says Holden. "You'll have the cream of the crop right there."
Mentoring programs, however, are often siloed within departments, a practice which prevents other areas of the hospital or Human Resources departments from meeting potential clinicians. There may be multiple potential candidates from a position who have gone through mentoring programs in an organization, but only one who is known to hiring managers. This can be rectified through better collaboration between departments' mentoring programs and HR.
A major first step can be taking a survey of all current mentoring programs, meeting with their departmental leaders, and working out a plan to keep communication between each program and HR steady and active.
An additional benefit of this, says Holden, is knowing something about potential candidates before they apply. "We've had some students who have applied that didn't make it past volunteer office…. if they apply again, a red flag will go up…. You get to know people by their work ethic, their personality, and how they work under stress," she says.
Mentoring is a major win-win-win for hospitals, communities, and tomorrow's healthcare leaders. And, if it sets hiring managers up with known candidates who are culturally competent and engaged in their communities—well, that's just an added plus.
To replace aging leaders, hospitals and health systems are more open than ever to executive candidates from backgrounds outside of healthcare. Methods of interviewing candidates and retaining clinical employees are also changing.
It's time to get back to work. Many organizations hire multiple positions in January, so now is a good time to take the temperature of the job market, economic climate, and trends in healthcare to get a good idea what the recruiting and hiring scene will be like in 2015.
"We're seeing an aging out of C-suite executives," says says Kimberly Smith, FACHE, board vice chair and managing partner for the eastern region with the executive search firm Witt/Kieffer. She's seen a lot of CFOs retire over the past year, which is true across most career capstone roles as baby boomers begin to retire, she notes.
New Rules for Leadership Searches To replace aging execs, hospitals are more open than ever to executive candidates from backgrounds outside healthcare. Popular backgrounds will include human resources, business development, communications, and hospitality, as healthcare organizations seek to distinguish themselves from the competition through patient experience and learn new skills from candidates who have experience in other industries.
A more important factor will be a candidate's previous employer, Smith believes.
"Organizations are looking for candidates who worked for companies that are on 'best places to work lists'; companies with strong reputations… [organizations with] a customer focus mentality and tradition of breeding leaders." What matters most, she says, is that the candidate has the right set of values, and has a history of working for organizations with strong values.
As older executives retire, their replacements won't have a lot of time to get up to speed. "Search committees are looking for 'fully formed executives,'" says Smith. "They want someone who has already fully arrived, has all the necessary skill sets and competencies. These organizations have no desire to nurture or groom these leaders—they must have someone who can do it all from day one."
A World of Possibilities for Clinicians For ambitious MDs and RNs, the world is their oyster this year, says Smith.
"[Recruitment for clinicians will] certainly be very competitive at the executive level. At staff level—I think it's hard to say, there is lots of variability by specialty. Primary care, for example, is a hot commodity, as are advance practice nurses and physician assistants."
While supply and demand are roughly equal for entry level nursing jobs, there aren't enough nursing leaders to go around, Smith believes. Many hospitals are at risk of losing their nurse leaders to colleges and universities, who seek leaders who can teach the next generation of nurses. Hospitals will have to remain competitive to hold on to their nurse leaders, says Smith.
While Smith believes the traditional role of CEO "is in decline," physician leaders—including physician CEOs—are about to get hot, along with other physician-executive roles.
"This is most common in New England, but pretty prevalent everywhere in the United States, especially in academic centers and community hospitals," Smith says. Physician and nursing leaders are likely to see opportunities open up for roles in operations management, patient experience officer roles, and various executive jobs.
A Virtual World Let's say you operate a hospital in New York City. You are doing your first round of interviews, and several of your candidates hail from the west coast. Do you fly them out for this round?
While you probably would have five years ago, this is no longer as common, says Smith. "To fly a candidate across the country for first interview just doesn't make sense for some organizations." Instead, many organizations now make use of live video interviewing, either using proprietary interviewing software or simply using free services available to consumers such as Skype or Google Hangouts.
"My personal preference is to see [the candidates in person], but it's not always possible, especially for physicians with practices or who already hold leadership roles," said Smith.
"It wouldn't surprise me if [video interviewing] continues to pick up," agrees Kenneth Hertz, FACMPE, Principal at the Medical Group Management Association, who says it's becoming standard practice to do a video meet up even for the second round of interviews if one or more candidates aren't local.
And, adds Smith, once the position is filled, that role might be filled remotely. There is no question that telemedicine programs are about to accelerate. "More of my clients talk about it. It's really grown exponentially… It's difficult to recruit deeply experienced people for these roles, but more physicians with innovative, creative mindsets will begin looking for these opportunities.
Salaries Following a trend set in recent years, any increases in salary are likely to be modest. "I think they'll go up slightly. We're also seeing more and more transparency around compensation," says Smith.
Hertz agrees. "If any, there will be modest increases," he says. "We're going to need to get a couple months into the year to see how the country reacts to the new Congress before making those kinds of predictions."
And recruiters should not expect the same raise in budget for their searches. Both Smith and Hertz agree that organizations will expect strong results for searches through technology tools, from LinkedIn to complex candidate management software. "The days of massive direct mail campaigns… are probably behind us," Hertz says.
Ultimately, 2015 is a year ripe with both opportunities and challenges for both recruiters and job seekers in healthcare—especially for organizations and candidates who are willing to think outside the box and try something new.
"I think the outlook is good," says Hertz. "Our success is limited only by our imagination in healthcare."
If your organization's leadership isn't using performance evaluations correctly, it's time to make some changes. For starters, leaders should be evaluated primarily on how well they lead.
Dreaded by employees and managers alike, yearly reviews can be a contentious topic even among HR professionals. The Harvard Business Review reported in 2012 that 45% of HR leaders don’t think annual performance reviews are an accurate appraisal for employees' work. Indeed, there are many organizations across all industries for which yearly performance evaluations are simply a meaningless bureaucratic exercise.
But in healthcare, being focused on goals and aware of responsibilities means the difference between receiving strong HCAHPS scores and weak ones; full Medicare reimbursement or not; and, frequently, the difference between life and death for patients.
HR is in the perfect position to ensure yearly reviews are used as a tool that will propel organizations in the right direction.
"It is within HR leadership's toolkit to redesign performance evaluations to become a meaningful process to help the organization meet its objectives," says Carol Boston-Fleischhauer, managing director of educational services at The Advisory Board Company, a consultancy which specializes in healthcare improvement headquartered in Washington, DC. "Performance evaluations are an opportunity to get employees aligned with where the organization is moving, and excited to be a part of that journey."
1. Understand What a Performance Evaluation is Not It is vital to keep the purpose of performance evaluations clear: They are a check-in to gauge an employee's contribution in helping the organization to meet its goals. That means it's not a good forum to discuss personal goals, such as taking a public speaking class or going back to school.
"I suppose managers do that more out of convenience than anything else," says Boston-Fleischhauer, "If you track individual goals and professional development goals as part of the cycle of performance evaluation, there's a convenience there, but frankly, I can't identify why some organizations bundle them," she says.
Additionally, performance evaluations are not just an end-of-the-year exercise—they are something that should be worked on throughout the year. It's much easier for a manager to write a fair, accurate evaluation of an employee if they have been taking notes and documenting incidents—both positive and negative—throughout the year.
2. Different Ranks, Different Reviews Most sample review sheets you would find on popular HR websites or other one-size-fits-all sources typically evaluate the employee on their responsibilities and behaviors. Boston-Fleischhauer doesn't think this is necessary for employees in leadership roles.
"What we suggest people think about when building a performance evaluation strategy is: What is the focus of a performance evaluation at each level? We find frontline staff needs clarity. Frontline employees are focused on primary responsibilities. We find you don't need that as you go higher and higher up in the organization.
"Create performance evaluations with the assumption that those in leadership roles know what their duties are. Are they using their duties to advance the organizational goals? They should demonstrate behaviors from the leadership standpoint to mobilize those who work under them," suggests Boston-Fleischhauer.
In short, low-level employees' duties need to be spelled out in evaluations. Leaders, however, should be evaluated primarily on how well they lead.
3. Keep Goals Focused Yearly, the organization's leadership and HR team should look at areas where improvement is needed and set goals around these findings. Performance goals for employees should be designed to move the organization in the direction of accomplishing those goals.
"Keep the performance goal setting process as focused as possible, in alignment with the strategic plan of the organization," suggests Boston-Fleischhauer. Start with goals for the CEO, then the other C-suite executives. Then, have the execs draw up goals for their reports based on those goals, who will draw up goals for their reports, and so on. "Goals should be cascaded from the CEO down to frontline employees," she added.
Treat performance evaluation as a tool, not a task. Their purpose is to make sure all employees across the organization are on the same page and are clear regarding what actions they should take to contribute toward the organization's success.
4. Fight Grade Inflation Remember how some teachers in high school gave every student in their class a C or above, even if they never did their homework and slept through tests? Some managers use the same strategy when doing performance evaluations—everyone gets an automatic "commendable performance."
This is a problem because it doesn't allow that department to accurately describe their progress in helping the organization to meet its goals. It also allows lackluster employees—not to mention lackluster managers—to hide within your organization. The fix for this is to hold managers accountable for defending their evaluations. Do a comparison of ratings at the end of the year in each department and compare ratings to overall unit performance. "The ratings should be a direct reflection as to whether or not [the department] met its goals. If all employees were rated as "commendable" or above but the department is mediocre or below in performance, there's a flaw," says Boston-Fleischhauer.
If your organization makes a concentrated effort to view performance evaluations as a tool to ensure everyone understands their goals and responsibilities, your evaluations can be transformed from an intimidating exercise in checking off boxes to a genuine driver to help the organization become successful.
"We're in an A for outcomes world," says Boston-Fleischhauer. "We're not paid for process or effort, we’re paid for results. If the system is not focused on targets set in terms of results, the organization will suffer."
And there's never a better time to make sure everyone is focused than when creating goals for the year ahead.