The news is good for job seekers, but ongoing high demand for clinicians and leaders means hiring managers might benefit from thinking creatively about retention strategies.
Uncertainty rules as hospital and health system leaders wait to see how the incoming Trump administration makes good on its promise to repeal and replace the Patient Protection and Affordable Care Act.
Even so, healthcare HR leaders can reliably expect a few challenges involving staffing in the new year, owing to the continuing demand for workers, a fact that is not expected to change this year, regardless of what happens to the ACA.
The healthcare sector added an average of 35,000 jobs monthly in 2016, according to the Bureau of Labor Statistics' January jobs report, and job growth shows no sign of slowing.
"The demand for talent is rising across the board," says Brian McCloskey, senior vice president of candidate sourcing and digital marketing at AMN Healthcare, a healthcare staffing firm based in San Diego. "It's been strong for the past two years, at least. Healthcare continues to be the fastest growing and strongest job producer in the national economy."
That's good news for job seekers and for the overall economy, but the continuing high demand for workers is putting a strain on hiring managers and recruitment executives.
1. Allied Health Workers in Demand
The healthcare workers in greatest demand this year will be allied health professionals, McCloskey predicts. Physical, occupational, and respiratory therapists, in addition to speech and language pathologists, will be among the hottest hires of the year, he says.
"Healthcare is now incentivizing people to stay healthy, and therapists are where look to support that strategy." These roles used to be "easy to fill, but are less easy than before; the shortage is starting to mirror the shortage for nurses and physicians."
Given the demand for these positions, HR leaders can expect fierce competition in recruitment. Once these workers are hired, aggressive retention efforts may be necessary to hang on to them.
2. Boomers Aging Out of the Workforce
Attrition is a constant in HR, but it is may be especially noticeable in 2017, with as many as 10,000 Baby Boomers retiring daily.
This is expected to affect all medical professions, but nursing is likely to get hit especially hard. "Nursing is a big piece of our total business. We saw the demand start to rise in 2014, and it hasn't stopped," says McCloskey.
With 40% of practicing nurses over the age of 55, creating new job opportunities for younger workers and room for existing nurses to grow moves higher up the HR agenda.
The same is true for physicians, says McCloskey. "There is high demand across every specialty," he says. "We have an aging physician population, and more demand on them, with fewer coming into the market." This has been observed for at least the last two years.
3. Temps Filling In
The last thing any HR leader wants is chaos or uncertainty, but both are possibilities when there's turnover—especially at the top. One solution is to fill executive leadership roles with interim workers, says McCloskey.
"Sixty-four percent of HR workers we surveyed said they have trouble finding candidates for these jobs." This is especially true when a CEO leaves. "About a quarter of the time, the COO, and often the CFO, leave when the CEO leaves as well," he says.
Interim workers who temporarily fill senior executive roles often serve as consultants in the search for a permanent replacement.
Meanwhile, the practice of using locum tenens practitioners continues. A recent survey by AMN subsidiary Staff Care found that 94% of healthcare facility managers surveyed reported using locum tenens physicians sometime in the last year.
"Interim and temporary staffing has been strong at every level," says McCloskey.
While the nation waits to see what happens to the ACA, he remains optimistic that healthcare will remain an economic powerhouse in 2017. "I don't see anything to suggest there will be a decrease," McCloskey says.
Overseas partnerships and campuses are on the rise. Here's what HR leaders need to know to manage healthcare workers abroad, whether local or expat.
Managing and supporting a diverse US workforce can be a challenge, but human resource issues rise exponentially when a healthcare system expands overseas.
International projects, partnerships, and campuses are proliferating, and renowned organizations like the Mayo Clinic, Cleveland Clinic, and Partners Healthcare have international programs.
University of Pittsburgh Medical Center has had an international healthcare presence for more than 20 years, with agreements and partnerships in 15 countries. Along the way, UPMC has honed its expertise in managing international teams of healthcare workers.
From communication barriers to cultural differences among clinicians, international projects demand special considerations from HR, says Cheryl Brill, RN, senior vice president of clinical operations and quality at UPMC.
Brill spent five years at ISMETT, UPMC's transplant facility in Palermo, Italy, and has been UPMC's key operations contact for collaboration in Singapore.
Brill advises HR professionals to be aware of differences, both in language and culture, between US workers and foreign workers. These differences do not always emerge in ways you might expect, she says.
Managing Locals: Be Aware of Differences
Often, a language barrier may only be a small part of the issue, she says. For example, if a report or project is due Monday, most American managers would expect it by the time they went home that evening.
In countries such as China, however, deadlines and meeting times can be seen more as suggestions rather than absolutes.
The American manager might assume that a Chinese worker who failed to meet a deadline did not understand it due to language problems, but the issue could be that they did understand, but have different cultural expectations as to what deadlines actually mean.
"We have our own approach to finishing things and moving projects forward," says Brill. "The Chinese may be slower to start, but they are fast finishers."
It's important to manage one's expectations and avoid alienating the foreign partners, she says.
Managing Expats: You Will Be Their Lifeline
Any relocated employee will need some TLC as they adjust to their new home, but most expat American workers need HR to go the extra mile.
"It's the little things," Brill says. "The food you can't get. Being a minority for the first time. All the new rules and regulations. Cultural differences and customs you might not understand or might not make sense. … Just the experience of living internationally."
Living and working abroad is an enriching experience, but coming up to speed can be a challenge for workers, even if they have lived abroad previously. It's important to properly prepare them prior to departure and provide ongoing support once they're abroad, says Brill.
"It starts before you send person to their assignment … it's very important for human resources to hire a local agency to help with transition elements, such as the bureaucratic process—even just getting your TV hooked up."
Providing these workers with list of local tips such as where to buy groceries, local restaurants popular with expats, and social groups can be helpful during the beginning of the transition.
"HR is a lifeline," says Brill. "I talked to my HR director routinely when I was abroad. Knowing I could contact them was very important."
Despite the challenges, international programs and the exchange of ideas and culture between healthcare professionals they facilitate are critical and worthwhile, says Brill.
"I get to meet people, and they're not really so different from me, and I'm not so different from them," she says. "We're working together to make things better in a healthcare setting, where it's really needed."
Offering hospital workers the ability to work from home can be a powerful morale builder, but managers must implement work-from-home policies carefully.
Is there a home for home-based workers in healthcare?
Nearly 3% of the total U.S. workforce telecommutes at least half the time, according to Global Workplace Analytics. And since 2005 the total number of employees working from home at least half the time has grown 103%.
Healthcare places unique demands on workers, but at least two industry leaders say that accommodations can be made.
"It's been a benefit," says Yvonne Chase, manager of patient access and billing services for Mayo Clinic's Florida and Arizona campuses.
Based in the Phoenix, AZ area, Chase and her fellow managers have had difficulty filling medical coder positions. Many workers had commutes that lasted more than an hour, and would frequently call off shifts because of commonplace setbacks such as car trouble or minor illness.
Mayo Clinic chose to allow working from home and to use this benefit as a recruiting tool—a strategy which has worked to shorten recruiting time and increase retention, says Chase.
While not advertising as aggressively that employees can work from home, Moffitt Cancer Center in Tampa, FL, has recently allowed more workers to take advantage of the benefit, says Lynne Hildreth, director or revenue cycle and patient access at Moffitt.
Chase and Hildreth agree that offering employees the option to work from home is a powerful morale builder that can improve attendance, if managers implement work-from-home policies carefully.
Protect Patient Privacy
Patient privacy is always a major concern. "Our collections team was nervous about employees working from home, and I can appreciate why," says Hildreth.
So she and her team took cues from other industries that routinely handle sensitive information "Clearly, there's a way. If banking is doing it, we can do it."
One policy they've instituted: To protect the patient data, Moffitt and Mayo Clinic both ban home workers from printing any work-related documents at home. "If the patient needs something printed, we have it printed in-house," says Hildreth.
Keep Tabs on Workers
Stay aware of what your remote employees are doing. The first step is to make sure they have a work area carved out for themselves away from distractions, such as TV or loud family members.
"We visit workers' homes and have them send us pictures of their home offices… and if workers move, they are obligated to let us know." says Chase. An employee moving and not letting their employers know might sound far-fetched, but it's a situation Hildreth has encountered.
"An employee decided to spend summer working from Colorado. You can't just do that," she says. Hildreth and her colleagues learned about the move when Moffitt was contacted by Colorado's department of revenue seeking income tax.
In addition to ensuring workers have an appropriate home office in one location, it's important to monitor their online activity and ensure that they are consistently online and productive during business hours.
Both Mayo and Moffitt make use of instant messaging platforms to take attendance. For employees who work out of a queue, such as those in billing and coding, managers can monitor productivity, and, for employees who answer phone calls, such as customer service agents, they can monitor phone calls and call volumes.
Neither Hildreth nor Chase reports problems with workers slacking off. But working from home won't work for everyone.
Some jobs simply need to be in-house. Hands-on clinicians, greeters, and other high-touch patient care roles will need to remain on-site. It's also worth noting that Mayo and Moffitt both require workers to pass a probationary period prior to moving to a home office, and to maintain good standing with high productivity.
While both Chase and Hildreth say that the work from home trend is here to stay, the practice has its limits.
"People will start to get lonely, says Hildreth. "We'll have people wanting to come back to the hospital setting soon."
A cardiologist recommends salary transparency, networking opportunities, and checking assumptions about what women want.
It's no secret that female healthcare professionals face multiple barriers professionally, especially in male-dominated specialties. Cardiology is one example:
In a recent ACC survey of more than 2,000 female cardiologists, 63% said they have experienced discrimination or have been passed over for a promotion.
Toniya Singh, MD, an invasive, non-interventional cardiologist and managing partner at St. Louis Heart and Vascular in Missouri, aims to change that. Singh is working to promote groups where female clinicians can network, support each other, and create change within the profession.
In October 2016, she founded a chapter of the Women in Cardiology (WIC) section of The American College of Cardiology.
Recently, Singh spoke with HealthLeaders Media about her experiences and the difference that groups can make in the lives of women working in healthcare. This interview has been edited for length and clarity.
HLM: Talk about your experiences as a female physician working in this male-dominated specialty.
Singh: I went to an all-girls medical school in India where they taught us to think and do things very independently. So I "grew up" in medical school surrounded by women who were all very motivated and excited to be doing what they were doing.
Then I moved to the United States, and the differences were a surprise to me.
People here make assumptions about female physicians, such as that because you were a woman and married, you wouldn't want to work too hard, or that if you had children, you would want to work part-time.
They didn't expect me to want a leadership position, they didn't even ask me. Coming from a school where women were the leaders, I got used to being thought of as an individual and being judged on my merits, rather than being judged as a man or a woman.
I felt like I had to remind people that I was working just as hard as everybody else. I just wanted to be judged on my work, and go from there.
HLM: Why did you start the WIC section?
Singh: Part of the reason I did this was to help all women find a place. We are a minority in our profession. Since we all work in different locations, sometimes we can feel very isolated. I don't have any other women in my practice—I work with 14 men—and many other women are in similar situations.
HLM: How does this group help other female cardiologists?
Singh: The chapter allows women a focus group where we can interact, network, share, and learn from each other's experiences.
We can also meet medical students and residents looking to join cardiology and show them that we have normal lives and love what we do, and provide them with information, mentorship, and sponsorship.
HLM: What HR policies would aid women working in healthcare? How can we retain female specialists?
Singh: I think one helpful policy is having transparency around salaries. We know that women get paid less than men do. But if salaries are transparent, people will feel more comfortable.
Also, judging people based on productivity rather than hours worked makes a difference, too—using number of patients seen and procedures done rather than the number of hours worked as the primary metric would be very encouraging.
HLM: What is a common mistake healthcare leadership makes?
Singh: People make assumptions and treat all women as if they are the same. Not all women want a family, not all women are married, and we all have different goals and situations.
Inequities persist in the workplace, but HR executives at healthcare organizations can advocate for change.
It's time for HR executives to start thinking about the policies that will matter in 2017.
Healthcare disparities reduce access to care, keep minority workers in poverty, and reinforce the Cycle of Oppression.
Changing HR policies can set some of these wrongs to right.
Acknowledge Wage Inequality
Women represented almost half of medical students in 2013, yet they continue to face hurdles, including access to quality care and equal pay.
A JAMA InternalMedicine study published in September that found female physicians earn, on average, 8% less than their male counterparts. That might not sound like much, but it comes out to about $20,000 less in annual earnings.
How does this happen? "The first conclusion is that women are less inclined toward negotiation or feel they have less negotiating power when it comes to salary setting," says Anupam B. Jena, MD, lead author of the study.
But he also makes clear that discrimination—intentional or otherwise—plays a role. "I think that [overt discrimination] is less common than subjective-type discrimination, but it's hard to comment how often that actually happens. We don't have any data on it."
Address LGBT Concerns
Being a woman is just one workplace hurdle; being LGB or T, is another.
Catalyst, a non-profit organization that specializes in accelerating progress for women through workplace inclusion has found that more than half of LGBT workers hide their sexual orientation in the workplace, and 90% of the transgender population has experienced harassment or mistreatment on the job.
There are no easy fixes to many of these societally ingrained disparities, but as providers of care, it's should be core to a healthcare organization's mission to remove inequalities and eliminate disparities.
Enforcing tough anti-harassment rules in the workplace and generally fostering an atmosphere of collaboration, where workers of all backgrounds feel comfortable is an important first step.
HR leaders can who notice departments with high turnover of minority workers, or where men have higher paychecks, can ask why, and can push for changes.
Bring in Diversity Specialists
Organizations that are fully committed to the principles of a diverse workforce and have the means to do so are hiring chief diversity officers.
HealthLeaders Media Council members discuss their organizations' experience with process redesign efforts.
This article first appeared in the December 2016 issue of HealthLeaders magazine.
Emilio Vazquez, MD
Chief Medical Officer
Dekalb Health
Auburn, Indiana
Process redesign has encompassed many different things at DeKalb Health. One aspect we are looking at in particular is our charge-capture process, which we hadn't really examined in a number of years.
We aren't only looking to see that the charges are correct, but we're examining the way we capture charges, especially on the floor. We're making it easier for nurses to scan in supplies as they are used for patient care, and for materials management to figure out where stuff has gone. That is all in process now, so I can't say for sure whether we've received any benefit from it at this point—it's something we've just started.
Another area we're redesigning is our admissions process, especially for patients who don't have coverage. We've involved a company that works with individuals who come into the hospital without insurance. They work with these patients to help them apply for health insurance or grants. It's not-for-profit, and it helped us find a way to get those applications for coverage in through someone outside the hospital. This helped us to recover $90,000 in payments through these patients that we otherwise would not have received. For a hospital of our size, that is not a drop in the bucket.
Jack Kolosky
Executive Vice President and Chief Operating Officer
Moffitt Cancer Center
Tampa, Florida
From my point of view, our process redesign efforts have been spread throughout the organization. I've seen them in clinical, research, and administrative areas. There really isn't a part of the organization that has not been involved in process redesign.
Probably the most notable of those efforts currently is what's going on with our outpatient clinical design. Moffitt is about 70% outpatient, and that percentage is growing.
We've asked everyone in the organization to participate in these initiatives, and we received over 400 different ideas that workers think we should explore, or that are immediate opportunities to better manage our costs or processes.
People are an amazing resource. So far, we have successfully avoided doing layoffs. I think that's for two reasons: We've been able to redeploy workers into different areas, but also, the growth of our organization has been steady. The opportunities for us have more to do with efficiency rather than downsizing or layoffs.
Keith Alexander
Regional President
Memorial Hermann Health System
Houston
I think this issue hits home for many healthcare leaders; challenges face them in the emergency department, including long wait times to get patients into the ER, and then long waits once a decision to admit patients to the hospital has been made. This combination often leads to lengthy turnaround times, patient dissatisfaction, and quality and patient safety issues.
We've done a significant redesign around those processes, including appointing a "bed czar" to oversee bed management functions throughout the hospital. This person is connected to our emergency department as well as operating rooms, which are the other areas that tend to drive inpatient admissions. Potentially, if you have long lengths of stay in all of your inpatient units, it's key to work on that problem in order to create more bed capacity in a more expedient fashion.
ED throughput is one of our core measures in terms of CMS quality standards for value-based purchasing. It also drives patient satisfaction and our ability to have patients seen more quickly in the emergency department. Our focus on shortened inpatient length-of-stay, ED admission throughput, and reduced ED waiting time is paying dividends. The entire system is much more efficient and benefits both patients and staff.
This process redesign has been fairly transformative for a few of our hospitals, and we're trying to replicate that redesign in other hospitals across the Memorial Hermann system.
Jack O'Connor
Vice President for Cardiovascular Service
McLeod Health
Florence, South Carolina
At McLeod Health, we have a value analysis committee, which regularly examines our products. If a product is adding cost, there needs to be some sort of benefit down the road or in the global picture. For example, it might reduce readmissions. We've expanded on that further to look at existing procedures we currently do and new procedures.
If a device or procedure is a money loser for us, the committee will look into finding ways to make those procedures cost-neutral, or even money-earners. They also analyze new procedures before we get started on them to ensure we've got that process streamlined and have reduced variation as much as is possible.
On controlling labor costs: For us, the biggest cost is the training and hiring of new staff. We have some entry-level units where nurses begin their careers, and as they progress, they want to grow within the organization. There are some units that are more popular destinations; we're happy to move up good workers, but this can cause turnover in some of the entry-level units to be quite high.
The cost of hiring, recruitment, and training additional staff is probably our biggest expenditure from a cost standpoint. It requires paying additional staff to do training, education, and orientation. But we do a lot of work to try to retain workers and reduce turnover, and generally try to maintain employee satisfaction.
Most healthcare employers will throw a holiday party or organize a gift exchange this year. But here are some more permanent and lasting ideas for HR leaders.
The holiday season can be an awkward time in healthcare workplaces. Questions about the appropriateness of holiday décor, whether or not to serve alcohol at holiday parties, and what to do if an employee gives an inappropriate present are all very real questions that annually vex HR leaders.
However, there are ways to avoid these issues. For example, the organization could spend its time and resources on something that could stay in place well into 2017 and beyond. Here are a few ideas you could consider implementing in the holiday spirit.
Establish a charity or group of volunteers to address an important issue in the hospital's community. This is a great way to build trust between the hospital and people living in the surrounding neighborhoods.
A good example of this in action is The Surplus Project, a Rush University Medical Center-based organization that provides unused meals from local cafeterias to Chicago-area families facing food insecurity.
HR departments are in an excellent position to encourage a culture of philanthropy within their organizations and set a good example for other workers.
HR has an opportunity to educate department leaders about the value of "a culture that embraces giving and thanking," said William Mountcastle, president and principal consultant at Health Philanthropy Services Group, LLC, in Columbus, OH.
"You have an opportunity to create an attitude of gratitude."
2.Go Above and Beyond
Some organizations go the extra mile for their workers. In February, this column examined Scripps Health's work life services program.
In one heartrending situation, Gloria, an 83-year old healthcare worker, realized she was nearing the end of her life. With no surviving close friends or family members, Gloria called her HR department.
"She told me that she was ready, but she didn't want to die alone," said Helen Neppes, director of work life services as Scripps, who helped Gloria to make end-of-life arrangements and also ensured she wouldn't be alone during the last days of her life.
Gloria died surrounded by her co-workers, who kept vigil over her at all times as the end neared.
Not every hospital HR department has the resources to coordinate an extensive work-life services program, but look into options to help your organization go above and beyond to take care of workers' needs. This might be a good New Year's resolution for 2017.
3. Ensure Fair Wages
A raise is probably the best gift any healthcare worker could receive. Last spring, John Galley, chief human resources officer at University of Pittsburgh Medical Center explained why UPMC decided to transition to a $15 hourly minimum wage.
"At UPMC, we believe in pay for performance," Galley said. UPMC's leadership believed there was evidence to support paying workers a higher wage, as the economy continued to shake off the effects of the last recession.
In September, Anna Ortigara, RN, organizational change consultant at the Paraprofessional Healthcare Institute, shared some of the hidden costs of low wages for some healthcare workers, including health aides and CNAs.
"If we start offering a reasonable wage, I believe we will attract wonderful workers who want to do this work. It's about respecting and being valued," she said.
Sure, no one will complain if you decide to celebrate with another holiday party … but why not make a change that will continue to impact your organization for years to come instead?
Responsible hospitals are training staff to ensure that transgender patients receive equal care. The "assume nothing" mantra is working for one Massachusetts hospital.
Sue Boisvert, a risk management professional from Maine, never expected the "important news" her daughter had to share after her first semester in college was that she had begun the transition to become male.
Within a year, Sue's child had legally changed his name, began taking testosterone, and had his birth certificate, driver's license, and insurance updated to reflect his male gender identity. As a supportive parent, Boisvert accompanied her son, who had taken the name Emile, to his medical appointments.
While most healthcare providers treated Emile with respect, the Boisverts soon realized they couldn't take professionalism for granted.
When Emile contracted a urinary tract infection and had to seek urgent care at a local clinic, he told the nurse completing his registration that he was taking testosterone. The nurse made "very inappropriate comments," clicked her tongue, and rolled her eyes, says Boisvert. "It was very hurtful to us."
But this experience is not uncommon for transgender people seeking care.
An estimated 1.4 million adults in the United States identify as transgender and they face discrimination regularly. In 2015, one in five transgender people reported postponing or skipping healthcare in the last year due to fear of discrimination.
"Transgender individuals are often subjected to what's called 'microaggressions,' " says Boisvert.
In these cases, healthcare workers may subtly show disrespect for or discomfort with a transgender patient by rolling their eyes or other gestures, refusing to take the patient's condition or gender identity seriously, using incorrect pronouns, or through condescension.
But ensuring transgender patients receive appropriate care isn't just the right thing to do, says Lisa Rabideau, director of patient relations and service excellence at South Shore Hospital in Weymouth, MA. Hospitals have a responsibility to provide excellent care and treat all patients with dignity and respect.
While South Shore Hospital, a 370-bed hospital 15 miles south of Boston, sees only about "half a dozen" transgender patients yearly, its staff make it a point to ensure they feel welcome, says Rabideau.
When providers fail to do that, patient trust suffers. There are multiple ways HR can encourage fair treatment of transgender individuals within their health system.
South Shore Hospital, where Emile has received care, offers frequent training series on diversity. "We do diversity training throughout the year, every year," says Rabideau.
In addition to monthly classroom programs focusing on diversity, Rabideau and her team have hosted lunchtime kiosks on diversity-related topics in the hospital cafeteria and have hosted webinars staff could download at their own convenience.
All South Shore Hospital staff and clinicians are required to commit to the facility's ASPECTS (Accountability, Service, Professionalism, Etiquette, Communication, Teamwork, and Safeguarding) standards even before applying for a job at the hospital.
South Shore's administration takes the standards seriously, says Rabideau. It's also important to make it clear that deviating from these standards of care for any patient is unacceptable.
Assume Nothing
When doing outreach or training healthcare workers to be aware of transgender patients and their needs, make "assume nothing" a mantra.
When in doubt, it's wise to ask what pronoun a patient prefers. "One thing that I've learned working with LGBT-identified people is that it's important to not make assumptions," says Rabideau. "What these people really want is to be treated equally."
She adds, "We have never had a patient complain about being in a room with a transgender patient."
Helping transgender patients feel welcome and comfortable isn't just good for transgender patients, says Rabideau—it ensures that the entire community trusts the hospital to provide non-judgmental care.
"People wouldn't come here if we didn't treat everyone equally," she says.
Several factors influence the number of clinicians available in an area as well as clinician retention and recruitment. Educational resources tops the list.
Location and culture are among the key factors that affect local healthcare delivery, says Allison Squires, PhD, associate professor at the NYU Rory Meyers College of Nursing.
None, she suggests, is more important than educational resources.
Squires has published her research examining the factors that lead to successful healthcare infrastructures in Human Resources for Health. Her conclusions indicate that investment in training homegrown staff is almost always a good policy for hospitals and health systems.
Squires recently answered questions from HealthLeaders Media about the implications of her findings. The transcript below has been lightly edited.
HLM: Tell us about your study and its findings.
Squires: This study looked at what national factors produce more nurses and physicians. What we found is that there's a specific combination of factors that helps to produce more nurses and physicians, from a contextual perspective.
Our study found that a more educated populace creates more nurses and physicians. Our models show that education, and educational resources, are what we want in terms of producing new clinicians. There are also other factors, such as the political environment, gender issues, and health systems factors as well.
I would say among the most important findings were how significant the correlations were between the average years of schooling of a population and the average number of nurses and physicians in a country. Education for nurses was correlated 59% to years of schooling, and for physicians, the correlation was 72%.
That is what we call a "significant relationship," meaning that the likelihood of this occurring by chance is very, very small. That is, I think, the most significant explanatory factor in this model.
HLM: What are some of the implications of your findings for rural hospitals in the United States?
Squires: It suggests that, when working with rural health professionals, we must support medical schools and getting people educated in rural areas, because if you educate people in rural areas and they train there, they're more likely to stay working in those rural areas.
I spent a couple years working at a critical access hospital in very rural Nebraska, and they were very dependent upon getting physicians that had done rural health rotations through their facility to stay in the community, in addition to making sure their staff had a rural nursing program to attend for training.
For many people, that was an associate degree or LPN program, but it also became a priority for them to get their nurses educated at the bachelor's degree level, because they needed to increase the expertise they had on staff to increase quality.
You get more emphasis on increasing quality of care in a bachelor's degree program than you do through an associate degree or LPN program.
HLM: And what are some implications for urban hospitals?
Squires: Urban hospitals don't have as much trouble hiring people, but I think this model has potential when looking at macro-level planning, whether on the city level or state level. We need to figure out the most efficient way to invest in education for health professionals.
HLM: How should these findings impact hiring strategy for hospitals and health systems?
Squires: The great thing about this model is that you can translate it to what it means for your local community. If your hospital is in a community with a high poverty rate, it may be worthwhile to attract members of the community who wish to become health workers and support them while they're going to school in exchange for coming back to work at the facility.
If you're investing in your local communities in terms of your people, bringing them to work back there will create a more sustainable workforce.
HLM: What should HR leaders and clinician managers take away from this?
I'd say the biggest takeaway is that investment in staff education really has the potential to pay off in terms of retention. It also might help figuring out what migration risk might be, and give a greater perspective on attrition.Several factors influence the number of clinicians available in an area as well as clinician retention and recruitment. Educational resources tops the list.
A healthcare leader shares the benefits of hiring military veterans: great training, discipline, and commitment.
What's the best way to thank a veteran for their service? Hire them. It will benefit your organization too, says one healthcare leader.
"There are characteristics about healthcare that are similar to the military," says Mac McMillan, CEO and cofounder of CynergisTek Inc., a healthcare privacy, security, and compliance firm headquartered in Austin, TX. "There's a singular focus on missions," he adds, admitting he has "a soft spot" for vets.
McMillan spent 21 years in the Marines, retiring as a Lieutenant Colonel in 2000. After transitioning to civilian life, he found the healthcare industry to be a natural fit, and when McMillan began hiring for his organization, he found vets often had in-demand skills in the areas of both technology and healthcare.
In honor of Veteran's Day, which is on Friday, November 11, McMillan took some time to discuss unique strengths vets bring to the table. This transcript has been lightly edited for length and clarity.
HLM: Do you seek out veterans to work for you?
McMillan: We don't seek out veterans to the expense of others. I think the better way to put it is that we always try to find the best individuals we can for the openings we have whether they have a military background or not. But, we do particularly recruit from the military ranks, or from former military folks.
And there's a lot of reasons for that. Number one, they get great training in the military, which is something they can put to work immediately when they come to the private sector.
The other things that we look for are people that can operate independently, that are responsible, that we can trust, that we can expect to do the right thing. What we've witnessed with many former military folks is that they bring all those things that they learned in military with them to the private sector. The discipline, organization, the leadership, the commitment.
Having said that, I think my organization is about 40% veterans. The majority of our workforce is not former military. But we look for those same traits in everyone we hire.
HLM: What skills do vets bring to the table that workers from a civilian background might not?
McMillan: In our organization, something we do well is that we take all skills and strengths our workforce brings to the table, and blend it very well. I think our civilian employees learn a lot from their military counterparts, and vice versa.
Every once in a while, you'll see folks who grew up on the civilian side with a resistance to picking up or deploying quickly when needed, as opposed to some of our military folks—if you call a veteran at any hour, day or night, and say, "I need you to be at hospital XYZ by tomorrow morning," they're going to get there. The military breeds that into you.
But sometimes on the civilian side, we have the idea that we're not supposed to bother people on the weekends. But I have to be careful saying that, because our civilian workers rise to the same level. They watch their military counterparts do this, do it themselves, and they don't question it like they did before.
That's one of the great things about having veterans on your team—they bring that commitment to service and to selfless action to the rest of the team that the others might not have experienced before.
HLM: What's an unexpected benefit of previous military service future employers of soldiers are likely to enjoy?
McMillan: A strong sense of loyalty and camaraderie with other workers.
When first came to the private sector, something I was taken aback by was the lack of loyalty to organizations, or even to one another. Unlike in military where there is intense loyalty all around, I didn't see that in the private sector. I even had people tell me that loyalty is overrated. I fundamentally disagreed with that from day one.
When workers feel committed to something, both personally and from mission perspective, they will go above and beyond.
