HR departments can avoid summer staffing snafus by creating and enforcing adequate time-off policies. Pro tip: Carrots are usually more effective than sticks.
Ahhhhh, summer. That delightful time of year when the weather is warm, the sun shines more often than not, and people call in sick so they can binge watch the fourth season of Orange is the New Black while sipping a fruity drink.
"People absolutely call in 'sick' more often during the summer," says Owen Dahl, an independent consultant with Englewood, Colorado-based Medical Group Management Association.
Data backs him up. As many as 39% of workers have called off a shift during the summertime simply to enjoy the season, according to a survey conducted by Harris Interactive.
And that's not the only example tricky personnel-related issues to expect over the summer season.
Other HR issues that come up include staffing snafus and inexperienced workers struggling to figure out their jobs while lives are on the line.
Healthcare organizations can make sure their teams enjoy summer responsibly by maintaining consistent internal policies year round.
Summer Staffing
"The idea is to set some parameters around who will take time off," says Dahl.
Some policies that might help keep the hospital staffed include limitations on time off for new employees or a first-come, first-served policy that asks workers to request time off as far in advance as possible.
Bret D'Vincent, recruitment team director at Aya Healthcare, a travel nurse staffing company, says that focusing on organizational culture has helped to keep staffing levels consistent year-long. "We do our utmost to foster a culture of teamwork so that everyone happily pitches in to share the workload when co-workers are out of the office," he says.
But what about employees who calls in "sick" when they aren't?
This is when having a strong attendance policy comes in handy. It is not inappropriate to request a doctor's note for absences, or to track absences in an attempt to determine who might be abusing the system, says Dahl.
But carrots are usually more effective than sticks. Offering a bonus for perfect attendance might be a powerful motivator for people to make it into the office in the summer.
One tip: "No $5.00 coffee shop gift cards for this," says Dahl. "Make this benefit worthwhile."
New Workers, New Roles
Summer can mean new people in new roles. Not only is the job market flooded with newly minted college graduates every summer, but June and July are two of the three months when workers are most commonly promoted, and, of course, July is when medical residencies start.
In short, there are more people just figuring their jobs out in the hospital during the summer. While a learning curve is to be expected, it can be made less steep by maintaining consistency, says Dahl.
"I would ask, 'what is your onboarding process?'" says Dahl. Ensuring new workers are properly trained and given proper guidance and enough time to come up to speed is vital.
If you know you'll be bringing on new people over the next few months, this is a good time to reevaluate your hiring criteria, says Dahl.
"Be careful with crisis hires," he adds—sometimes, it's better to leave a role unfilled than to fill it hastily, without properly vetting the candidate.
Dahl's advice is similar for helping the newly promoted adjust to their roles. "Hopefully their managers have done a good job giving them guidance and direction, and have confidence that they will able to handle the position."
He suggests coaching the employee and working closely with them for a period of time to ensure they get the hang of their new roles.
These issues can crop up any time of year, but it's especially important to be vigilant during the summer. With consistent planning and processes in place, things should go according to schedule—even if a few people decide to play hooky.
A retired lieutenant general in the US Army is teaching healthcare workers how to be better leaders and says the training is having "an unbelievable team-building effect."
There's been much discussion about leadership lessons healthcare can take from other industries, including both hospitality and entertainment, but one field that is often revisited is the military—and for good reason.
But perhaps the strongest area in which the military offers preparation is leadership development, says Mark Hertling.
He is senior vice president of global partnering, leadership development and health performance strategies at Florida Hospital, which has 26 locations throughout the state of Florida and is headquartered in Orlando.
Hertling, a retired lieutenant general in the US Army, says that his experience in the military taught him much about growing leaders.
He has written a book on applying military philosophies to healthcare leadership and created a training program for healthcare workers at Florida Hospital. Students are taught the following:
The characteristics of leaders and how leaders think
Dyadic leadership: One-on-one leadership within the organization, influencing and engaging others
Leading up: Leading managers and other leaders
Team building, team dynamics, and how to assemble a team
The organization: What does it do for you, and what can you do for it?
Of the 250 healthcare workers at Florida Hospital that have received the training, 180 are physicians, 50 are nurses, and 20 work in administration.
"It has an unbelievable team-building effect. Participants walk away speaking a common language and better understanding their colleagues. It allows for the development of trust, and breaks down the 'us versus them mentality.'"
Outside of military-accented training, there are other benefits to incorporating strategies borrowed from the military or hiring veterans, including:
1. Consistency in Culture
Over a career that spanned almost four decades, Hertling says he saw few changes in leadership technique during his Army service. The consistency is by design.
"The military has put over 200 years plus into studying and research into leadership in order to generate [positive] effects on the battlefield."
Healthcare is different. It needs to be more flexible in order to keep up with the changing business climate. But ensuring that key values and the culture of the organization remain intact will be noticed, both by employees and patients.
2. Purposefully Developing Leaders
The military ensures every soldier is equipped to lead at a moment's notice if necessary—a skill Hertling aims to have all of his training alumni acquire.
Physicians, nurses, and frontline workers all may have the experience and knowledge to lead and create policies that will better serve patients—they simply lack the leadership training and experience.
Increasingly, there is recognition that "just culture" in hospitals, which encourages employees to openly give feedback without fear of retribution, improves both patient and worker safety.
An employee that has been trained to "lead up" might feel more comfortable saying something if they observe a behavior that could become dangerous, such as a supervisor that engages in unethical behavior.
3. Courageous Communication
The military teaches soldiers to listen with more than their ears, says Hertling.
Soldiers are taught to observe and understand what people are telling them and respond with empathy. These are skills that might save their lives when in enemy territory.
"It's more than just talking and listening—it's how you communicate, the methods of communications you use, how you're empathetic when you communicate, and how you pay attention when you communicate," says Hertling.
Improving internal communication in a way that maximizes empathy can include policies that ask workers to discuss matters face to face rather than via email or text, and to engage in active listening.
These skills will serve clinicians, administration, and frontline workers well in their interactions with patients and each other, says Hertling.
"When you're dealing with other people, whether it's your patients or other members of the team, you have to be empathetic and understand that all people contribute things to the organization."
All of these qualities combined with training that emphasizes putting these learnings into action can help set your organization apart, says Hertling.
But the action part is important. "Leaders have to act. They can't just talk, they must do."
HealthLeaders Media Council members discuss their organizations' strategies for primary care.
This article first appeared in the June 2016 issue of HealthLeaders magazine.
Will Garand Vice President of Planning and Managed Care Community Memorial Health System Ventura, California
We have 13 outpatient clinics that we administer. Those locations have a mix of primary care and specialty care. Over the years, the main impetus for specialty care has been patient access to providers for Medicaid services. Our offices do not employ the physicians, as we are located in a Corporate Practice of Medicine state, and we also do not have a foundation. The way we engage with physicians is to use a friendly professional corporation that physicians contract with individually, and then we contract with the PC to staff the hospital.
We have plans to grow again substantially in the next four years, including plans to add significantly more primary care physicians during that time. This will be through a combination of physicians who are aligned through their own practices and also by adding sites.
We might be able to establish some new outpatient hospital departments in the community through our critical access hospital. Our existing sites are mostly in competitive markets. As we grapple with new restrictions in establishing outpatient hospital sites, we may need to pursue alternatives, which could include management services organizations in existing physician locations, or eventually establishing a foundation.
Rick Nordahl CEO Sanford Sheldon Hospital Sheldon, Iowa
Our primary care strategy centers around increasing our presence through expanded clinic hours. That doesn't mean, however, that we're going to run an acute care center—in a town of 5,000, we don't have the volume for that.
However, we have expanded our clinic hours to include lunchtimes and evenings, and we are now open from 8 a.m. until 8 p.m. Monday through Thursday, 8 until 5 in the evening on Friday, and from 8 until noon on Saturday. The integration of evening hours between 5 and 8 was the biggest change, followed closely by opening up lunchtime appointments from 11:30 a.m. until 1 p.m., when we had traditionally been closed.
Our intent is to get patients the healthcare access they really need, and to meet the consumer where they need to be met. The next step could be full availability on Saturday, possibly with part-day availability on Sunday. Without that, we really can't grab all of that market that we need to.
There have been changes in hiring as well. As we look to hire new clinicians to cover those extra appointments, we're filling more of these roles with advanced practice professionals, including nurse practitioners and physician assistants, in addition to enhancing the behavioral health portion of our primary care business with more counselors, plus health coaches to coordinate the program and improve care continuity.
Garrett Havican Vice President of Strategic Planning and Ambulatory Operations Middlesex Health System Middletown, Connecticut
On the shift in incentives: The federal government is incentivizing us to keep patients out of the hospital, so the hospital market is shrinking—a fact that drives our decision-making. But keeping patients out of the hospital is the right thing to do—the majority of patients can be treated in the community very effectively, so long as there's someone present to assist in care coordination. I think that incentives—or, better yet, the disincentives—for hospitals to retain patients are in play, and that's a big cause of this shift.
On developing a strategy: Taking inventory of where our 70 doctors and 10 facilities are located in the community is our first step. The second is to make sure we have the appropriate number of providers in each of these geographic areas based on needs. The third is to make sure we have a coordinated approach toward managing patient care. This includes ensuring that our network is consumer-friendly, that we're easily accessible to members of the community, and that we have an electronic medium we can use to communicate internally.
On driving growth: Those are our immediate priorities to ensure that we've spread our primary care base throughout our community. That's really the focus for the future of healthcare, along with population health management, ACOs, and the coordination of care. That is what's really driving that growth.
Donna Littlepage Senior Vice President of Accountable Care Strategies Carilion Clinic Roanoke, Virginia
Carilion has been very focused on primary care activities since we developed a patient-centered medical home back in 2008, and we're in a market where our hospitals frequently find themselves filled to capacity.
So, for patients who are better treated in an ambulatory setting, their not being admitted has been beneficial for us. The shift has not been as disruptive to our organization as it has for other providers that are still in the fee-for-service world.
Our organization is trying to determine the best way to share savings so everybody gets rewarded for doing the right thing, whether that is preventing disease, managing it properly, or sending a patient to a specialist. We're still determining the best way to incentivize the specialists, but for primary care physicians, we've added quality metrics to their scorecards so they're compensated for how well controlled their diabetic or hypertensive patients are, along with numerous other quality metrics. We realize that sometimes it can take more time to do these things than those quick, easy visits that they might otherwise do quickly and get paid for.
Our internal culture shift around primary care is more a matter of good communications between primary care clinicians and specialists, so that everybody understands what we're trying to do, how we're trying to do it, and how we can work together to be successful.
Two lawyers from the Equal Opportunity Employment Commission clarify the final wellness plan rules released in May and spell out implications for employers.
The Equal Opportunity Employment Commission released in May final federal regulations around employee wellness plans. The rules go into effect January 1, 2017.
Two lawyers with the federal agency, Chris Kuczynski, acting associate legal counsel, and Peggy Mastroianni, legal counsel, discuss in detail what these new rules mean for HR executives, healthcare workers, and plan participants.
The transcript below has been lightly edited.
HealthLeaders Media: What are the highlights of the new rules around wellness plans, and what do they mean for employees and employers?
Chris Kuczynski: These are rules that apply to wellness programs; primarily wellness programs that ask employees and their spouses for health information.
That information might be health information that is requested as part of the health risk assessment, including if people are being asked about what medical conditions they have or have had; and/or it may be in the form of a medical examination or tests for conditions like high blood pressure, glucose levels, or high cholesterol levels.
That's when these rules are going to apply—when the program includes getting information about employees' and their spouses' health information.
The bottom line is that employers who are offering wellness programs as a benefit of employment can have these programs, and can offer limited incentives in exchange for employees and their spouses to provide health information as part of wellness programs, as long as certain conditions are met.
Peggy Mastroianni: And another highlight would be confidentiality. There are very strong rules in place in addition to other, existing confidentiality rules.
HLM: Let's talk a bit more about these rules and what they mean for confidentiality.
The larger picture of this scheme includes the HIPAA rules, the rules under the Affordable Care Act (ACA), and also existing confidentiality rules under the Americans with Disabilities Act (ADA) and Genetic Information Nondiscrimination Act (GINA).
What these wellness rules do is that all the other confidentiality rules apply, but the wellness rules add some element to them.
CK: Employers can only get information back from a wellness program in aggregate terms that cannot reveal the identity of specific individuals and their medical conditions.
They can't know which of their employees have provided medical information, or what their medical conditions are.
HLM: I've heard that another key component is that these rules affirm that wellness programs will be considered voluntary, as long as an employers' incentives or discounts don't exceed 30% of the cost of an employee's individual "self-only" health coverage. Is that correct?
CK: That's right. That is the maximum incentive that can be provided to the employee, and when the spouse is also participating in the wellness program and provides his or her health information as well, the spouse's incentive is the same: 30% of the cost of the plan.
HLM: How will these rules specifically affect workers in the healthcare industry?
CK: These rules will apply to employers in the healthcare industry that have wellness programs in the same way that they apply to other employers, frankly.
In the sense of what kinds of incentives can be provided, limits on incentives, and the requirements that programs be reasonably designed to promote health and prevent disease is really the same in healthcare as in any other industry. All employers are subject to these rules, including healthcare employers.
The rules concerning notice [informing employees how their data is to be used], confidentiality, and other rules such as those prohibiting retaliation and prohibiting programs that discriminate under other EEO laws are the same.
HLM: What if an employee cannot meet wellness goals in order to earn an incentive due to a disability?
CK: There is an obligation to provide reasonable accommodation for someone with a disability.
It might be an employee who can't participate in a wellness program in the same way due to a disability, such as someone who can't participate in a walking program because they are in a wheelchair.
The employer would have to come up with some other way for that person to earn the incentive.
Or, there could be a situation in which the person has to attain a certain blood pressure or cholesterol level in order to get an incentive, but cannot do that because of a disability. That person would have to be offered a reasonable accommodation.
When the wellness program is a part of a health plan, there has to be a reasonable alternative standard to reach whatever goal is required.
HLM: How will this change the experience of the employee participating in a wellness program?
CK: As a practical matter, perhaps things won't change that much with incentives, because many wellness programs we're aware of and have seen don't offer incentives up to 30% anyway—they're offering incentives quite a bit less than that.
The rule makes clear that the programs must be reasonably designed to promote health and prevent disease.
So we hope that with this protection that when people are asked for their health information, that what they are going to get out of that experience is a program that really is designed not just to collect information about them, but to really improve their health and prevent disease.
Finally, the notice and confidentiality protections will give people greater assurance that if they're providing this information, which is very sensitive information, that it will be kept confidential and therefore will not be used to discriminate on the basis of disability or the basis of an employee's genetic information.
HLM: What are the next steps for these rules? What happens next?
PM: Two things need to happen now. First, we'll write a notice, which will be posted to our website for at least 30 days. Then, starting January 1, 2017, any wellness program that begins on or after that date will be subject to the incentive limitations and the notice requirement. Then, in 60 days, this will become part of the code of federal regulations.
Every year, "we have a large contingent of students and residents who decide they've done their time here," says Mark Dunn, a talent strategy officer at the health system. "Then, it's time to go."
Replacing healthcare professionals can cost more than 20% of that worker's annual salary, a number that doesn't include the inevitable slow down before the professional leaves, revenue decline during vacancy, or money lost as the new hire ramps up.
No age group is immune to wanderlust, but Dunn and his team have witnessed more young workers coming and going than any other group. Tired of his retention efforts getting trampled, Dunn decided that something had to be done.
One Strategy Does Not Fit All
Traditionally, recruitment, retention, and engagement have been one-size-fits-all.
It's been assumed that if something appeals to a middle-aged worker, it will delight a recent graduate equally. That strategy may have worked in the past, but differences among age groups must be taken into consideration says St. Louis-based healthcare recruitment consultant Kathy Jordan.
"For the first time in human history, we have four—soon to be five—generations working side-by-side," she says. Each generation was shaped by different forces and events, and is in different places in their careers.
"Millennials are social," says Dunn, referring to the demographic born between 1977 and 1996 and the one with the greatest turnover at UVHS.
Traditionalists (born 1925 – 1945), are very comfortable with formal work environments, value their privacy (don't expect them to add coworkers on Facebook—if they even have an account), and tend to trust and value experience.
In terms of career goals, many traditionalists crave the opportunity to end their careers on a high note, but might need a reduced schedule to manage it.
Contrast Traditionalists with Millennial workers, who are attracted to organizations where they feel they will be respected as a contributing team member from day one.
A member of Generation X (born 1965 to 1976), Dunn wondered whether providing a stronger social fabric for younger workers [Millennials] would help them stay put.
Most of this generation's cohorts are looking for jobs that will allow them to gain experience while paying the bills—but they don't want to "sell out" or sacrifice too much time with people or activities that matter to them to do it.
Both of these groups have something to offer an organization; each requires different engagement and retention strategies.
Different Demographics, Different Values
Almost half (48%) of healthcare workers belong to the Baby Boom demographic (born 1946 to 1964).
Regina Levison, vice president of client development at Jordan Search Consultants says "These are children of parents who respected authority. They took direction [from managers], and they stayed in companies long-term."
"Working in healthcare offers stability," she says, "but also fulfills the need [of Boomers] to give back and work in a profession that allows [them] to make the world a better place."
Convention doesn't appeal to Gen Xers or Millennials, who generally prefer an informal management style and more casual work environment. Boomers and Traditionalists may have worked 80-hour weeks at various points of their careers, but today's managers can't expect that, says Levison.
"Gen Xers were latchkey kids." Having spent their childhoods in empty houses without adult supervision, they balk at sacrificing family time, Levison says. They've seen parents get downsized and major institutions go under.
Work is important to Generation X and Millennials, but these generations believe family, friends, and personal values are enduring, while employers are more likely to come and go.
Generational Approaches to Retention
To engage members of older generations, remember that they will respond well to being told how greatly their experience is valued, suggest Jordan and Levison.
Formality also matters with these workers. Calling them "Dr. Smith" instead of "John" could be make or break. Also, many Traditionalists and Boomers relish the opportunity to impart the wisdom they've collected over the decades to a new generation, and seek out mentoring roles.
Engaging and retaining Generation X and Millennials requires a different strategy, most notably, ensuring they feel not only valued, but respected.
Millennials especially "don't look at managers as bosses, but as strategy guides that will [help] them through their jobs," says Jordan, who warns that the informal and egalitarian manner of younger workers might seem less respectful, especially to older managers.
"We're all in this together, and we all have something to give," sums up the younger perspective, she says.
It's also important to be mindful of different needs when designing benefits. Older workers may be enticed by part-time opportunities; younger workers with heavy debts might be enticed by retention bonuses, assistance with housing loans, or student loan relief.
Finding Their Place
Helping young workers find friends is key to retaining them, says Mark Dunn. He and his team in Charlottesville have been working to connect younger workers with the community.
Dunn asked his academic colleagues for best practices used to assimilate graduate students and faculty. He was advised to refer young workers to athletic groups, arts clubs, churches, and other community organizations.
For older Millennials and Gen X workers, Dunn suggests focusing on helping the entire family integrate into the community.
Helping the worker to find the right schools and activities for their children can go a long way toward creating permanency, as can events where spouses of healthcare workers can get to know each other and establish their own bonds.
"When you help workers get embedded into the community, it's not easy for them to leave," Dunn says.
Had Dunn been trying to retain Traditionalists or Boomers, his methods would undoubtedly have been different.
Accepting that different strategies will retain workers at different life stages is key, says Jordan. "Each generation has different needs—and that's true from both a professional and a personal fulfillment perspective."
Hospital workers may understand why their hospital has been slated to shut down, but that does not negate their concerns about their job prospects or the health of their community.
Few situations more are more divisive than a hospital closure. Interactions among leadership, clinical staff, and other workers are loaded with emotion, tinged with suspicion, and can easily turn negative.
As representatives of senior leadership's more human side, HR leaders can feel stuck between a rock and a hard place—HR workers might understand the administration's reasons for their decision, but that does not negate worries about employees and their future.
This drama plays out every time a physicians practice, hospital, or health system enters into a partnership agreement, agrees to be acquired, makes a bid for another organization, or has to announce that a facility is closing.
HR leaders have found themselves on both sides of the divide, sometimes playing the part of community organizer to keep hospitals open, and sometimes having to explain why a closure was necessary to enraged workers.
A closure is playing out right now in southern California.
Saddleback Memorial Medical Center - San Clemente, a 73-bed hospital which employs about 200 people within the non-profit MemorialCare Health System, is slated to close its doors permanently on May 31. The hospital's administration says it is averaging 2.75 admissions daily and two surgeries per week.
The MemorialCare Health System, which is headquartered in suburban Fountain Valley and had revenues of $2.2 billion in 2015, operates two other medical centers in Orange County and three in neighboring Long Beach, in addition to medical groups and convenient care services that are scattered throughout the region.
Approximately 45 physicians practice out of the San Clemente campus; about 20 of them have volunteered or provided financial support to the fight to keep the hospital open, says Gialamas.
He organized the group with the support of two other San Clemente campus physicians.
Below, two healthcare leaders with very different roles in the closure share best practices they were able implement. Tony Struthers is the administrator of Saddleback Memorial, San Clemente. Gus Gialamas, MD, is an orthopedic surgeon who has spearheaded a fight to keep the hospital open. The transcript below has been lightly edited.
HLM: What arrangements have you made for healthcare workers who will be displaced through this closure?
Struthers: We are grateful to the dedicated employees at the San Clemente campus. We are working with our employees to identify job opportunities within the healthcare system at our hospitals and numerous healthcare facilities, holding job fairs and providing one-on-one assistance.
Our job fairs feature representatives from our sister hospitals and outpatient centers, and our recruiter is expediting interview opportunities with our sister programs, facilities, and services.
We expanded our human resource hours, our question-and-answer sessions, and recruitment assistance. We are also offering a number of classes, including those on resumes, interviewing and networking; employee development department informational sessions and benefit sessions.
Of our 122 full- and part-time employees on the San Clemente campus, about 60 will have been placed within MemorialCare hospitals, outpatient facilities, and affiliated organizations in Orange and Los Angeles counties, thus far.
Many others have indicated that they have secured positions elsewhere and we continue to work to help our employees with the transition.
HLM: How has the HR department been involved in this closure?
Struthers: Since August 2014, we have reached out to thousands of employees, physicians, community organizations, elected officials, and other stakeholders throughout the region regarding our vision to convert the campus into a state-of-the-art ambulatory campus.
We have held regularly scheduled town hall meetings and other gatherings for employees. We have maintained an "update" column on the intranet to keep employees aware of key dates, timelines and other information.
[And] we have conducted outreach visits to physicians most active at the campus and sent written communication at key junctures during the process.
HLM: How did you involve local political leaders in your fight to keep the San Clemente campus open?
Gialamas: Over the last few years, we have formed a group called Save San Clemente Hospital and tried to educate our community, legislators, and city leaders as to the effects of a closure. Over the course of the last two years we've done a lot of outreach, and we have a website.
We've had two bills in the legislature and Senate in California, SB 787, both of which failed in Sacramento, for various reasons. But we just met with the healthcare agency, and had a public hearing on April 29.
Forty of our residents here in San Clemente gave public testimony about the negative impacts of closure. We're waiting now for the impact study from the Healthcare Agency of Orange County, which will be delivered to the California Department of Public Health.
HLM: What have you learned about organizing healthcare professionals to advocate for their hospitals?
Gialamas: Don't make it a political issue.
Listen, I've been a lifelong Republican, and this is Orange County. It seems like everything has been politicized. But I've learned that some things in life shouldn't be political. I've found myself looking for like-minded people who are advocating for [the community's] health, particularly those with unmet needs and underserved populations, such as seniors and the homeless.
I've also learned a lot about the challenge of organizing physicians. Many in our area have been reluctant to get involved. I think it's [exacerbated] by the burnout rate, which is another ethical crisis in America. But there are plenty of physicians in our corner who have been supporting us.
HLM: How can you find allies in the community to help get the word out?
Gialamas: I live in an area that has a homeowner's association, and I talked to our HOA president and asked him to send out a notice that our local hospital was in danger of closing.
The CEO of a local PR firm saw that note, and I hired his PR firm to communicate our message to the city. The first thing we did was to send out a message to 14,000 homes here in San Clemente and neighboring Dana Point and San Juan Capistrano advising people that the hospital would close and that this would have a negative impact on emergencies they may face down the line.
We then went to the press, issued press releases, spoke directly to the city council, and attended city council meetings almost every other week for the next year and a half, and finally, we got everyone's attention.
Once the community started talking about the possibility of losing a 911-service, they became engaged.
Our group spoke to the Rotary Club, Exchange club, HOAs, and other groups. I think we got our message across in a reasonable fashion. We want people to know that losing emergency care access and a hospital is not good for our community.
Despite Gialamas's efforts, the hospital is still slated for closure on Tuesday, May 31, a fact that makes him worry about the future of San Clemente. "Market forces should not dictate a community's ability to access emergency and acute care. It's the health and safety of our communities that is at stake here."
In our November 2015 Intelligence Report, healthcare leaders cited a variety of skills they find important for the CEO's executive team to possess. HealthLeaders Media Council members discuss areas of expertise that their organization will find valuable in the next few years.
This article first appeared in the May 2016 issue of HealthLeaders magazine.
Ronald Paulus, MD
President and CEO
Mission Health
Asheville, NC
Cost containment and physician alignment experience would be pretty high on my list of sought-after skill sets, but there are a few areas that are missing from the survey results or embedded in the broader categories.
Also, the cost-containment skill set is not just about cost containment; it's the ability to create better outcomes at lower costs. We believe firmly that when you create better outcomes, you lower costs.
One aspect that's missing from your survey results would be consumer engagement. I view the market as being in the midst of a transformation from its historic provider focus with traditional, fee-for-service care to a future that features a different way of engaging with consumer-patients, relating to them in ways and manners that meet their needs.
We put a lot of emphasis on consumerization of our system, so I would add consumer optimization as being one of the core skills for which I'm increasingly looking.
Another vital skill I would list as important is resilience. It's not likely that everything is going to work or that our industry is going to become easier—from here on out, it's a marathon, not a sprint. Someone who can stay upbeat, focused, energized, and stick with a game plan is highly desirable in this climate.
Glenn Crotty, MD
Executive Vice President and COO
CAMC Health System
Charleston, WV
My organization has taken on systematic review and development of our leadership system. In our leadership system, we have defined requirements for leadership, including defined competencies for leaders. There are some basic qualities we think a leader must have to even be considered for
a C-suite role.
A potential leader must be able to be a role model and an effective communicator. Those are qualities a leader needs before he or she even gets in the door.
With those satisfied, the competencies we think that the leader must have or quickly develop is to build commitment, be able to motivate, have the ability to self-review and adjust, make change last, be able to reward and recognize, and raise the performance of the organization.
The leader also must share our values of quality, respect, stewardship, safety, integrity, and service with compassion.
Referencing Darwin, the most adaptable survive. One of the key attributes we search for in C-suite candidates is adaptability. Most plans that are developed will last about six months, and then something will happen—there's a new regulation that comes out, or a new edict, a new something will come. We need leaders who can roll with these punches.
Regarding the physician CEO trend, it depends on the need. If the need is mergers and acquisitions, then the pendulum will swing away from physicians, because they usually don't have that skill set. But if the need is continuously improving quality and safety for patient care and fulfilling the Triple Aim, then I think the physician CEO trend will continue.
John Bishop, CPA
CEO
Memorial Medical Center
Miller Children's & Women's Hospital Long Beach and Community Hospital Long Beach Long Beach, CA
What I'm looking for on my team is people who are capable of learning from the past, but who are looking forward and embracing change. We're at a point right now where everyone talks about moving from fee-for-service to population health, yet there's a lot of uncertainty about exactly how to get there.
It's going to take considerable forethought, coordination, and vision to get us to the point where we're effectively taking care of our community under a population health model. It's about being forward-looking, adaptive, and really embracing change, because what we've done in the past isn't going to work in the future.
To me, culture is everything. You can have a great strategy, but if you don't have a team that works together and is really committed to the mission of the hospital and the health system, it's not going to be effective.
So we're looking for a team that is not only visionary but is committed to providing the best patient experience. The key differentiator as we're moving forward isn't just good outcomes—that's to be expected—but it's the patient experience. It's the little things, like the extra measure of empathy and compassion, making the patients know that you are there for them and not treating them as a unit of work.
David Fitzgerald
CEO
Proliance Surgeons
Seattle, WA
On cost-containment ability: Cost-containment ability is very important. Our business is much more focused on cost than a hospital—not because costs are good or bad, but because the net goes to the physicians' payroll, so costs are always much more immediate and much more "in your face" than at a hospital.
On IT skills: So much of healthcare is becoming data-driven. What you want is not just to have data, but to turn that data into good, useful information. All of a physician's decisions are based on data. The physician looks at x-rays, labs, feedback from the patient, and then he or she makes a decision—that's data.
Now physicians have to look at new things, and it's not data they had before or knew how to synthesize into that same decision-making. I want a leader who can take that IT piece and turn it into truly actionable data.
On determining an executive salary: The individual's experience and the compensation of peers are probably the two biggest elements in setting salaries. I look at the published averages for these positions, and I look at the candidate's level of experience. Have they already been doing this, more or less? Those are the greatest factors that go into my decision.
The Illinois-based health system uses telemedicine technologies as part of its employee wellness program.
Patients across the country are using telemedicine to get treatment when and where they want it for everything from mental health counseling to skin conditions. But what if you could offer your employees a wellness program with the same level of convenience?
OSF Healthcare's leadership thinks it may have created a program that offers its workers the convenience of a third-party administered wellness program with the in-house touches and security of a homegrown one.
OSF rolled out a pilot program using telemedicine technologies in February 2015, says , vice president of telehealth services at OSF. The program is available to workers employed at OSF's Peoria and Bloomington, IL campuses, but Hinderliter says OSF plans to make telewellness available to employees system-wide.
Services offered include all the programs expected of a wellness program, such as smoking cessation, weight management, stress counseling, and exercise therapy. But where OSF's program differs is that it enables workers to take advantage of telemedicine technologies, allowing flexibility and convenience to its employees.
The below interview transcript has been lightly edited.
HLM: How was the concept for an internal telewellness program introduced?
Hinderliter: We were looking at our strategy and management plans regarding how to increase wellness access for our employees. We have employees who work nights, weekends, off shift, and so on, and it becomes very difficult to get them in to have their wellness visit. You don't necessarily want to come back [for a wellness visit] after you've worked a 12-hour shift. So, what we were looking for was ease of access.
HLM: Tell me a bit about how employees can access their wellness counselors remotely.
Hinderliter: We provide up to five follow-up visits after the employee does their initial wellness profile, where they answer questions like, how much do you walk? Do you smoke? Or, how's your sleep quality? They also look over weight, blood pressure, and vital signs. Then we provide the follow up for that visit, which can now be done… with their smartphone, on a tablet, or a computer.
So, we schedule that visit with them, and then send them a link, which enables them to access their visit. They're able to complete that follow up wellness [visit] and review their profile. It's basically a video chat with the provider. They can see you, and you can see them. It's two-way audio, [and] video [in] real time. We're also able to share the screen, so they can pull up your profile and actually go through how you answered the questions, and show you your lab results, as well as discuss what your items for improvement are.
We can then set up specific appointments for you afterward to discuss specific issues, like if you needed more education on diet, how to prepare food, and what meals you should be eating, or instruction on how to do exercises.
HLM: Are the telewellness counselors employees of OSF? Would the employees using this service know them?
Hinderliter: They are employees of OSF, and you may know them.
HLM: Have you personally tried the program? What was your experience like?
Hinderliter: I was part of the pilot, and I loved it. To me, it's so much easier, and that's something that I'm definitely always looking —that ability to do something and not have to factor in travel or figure out parking. Especially with something like wellness, it's easy to put it off.
But, the benefit in the long run is, if you can get people through this, you can get them to start wanting to be in control of their own health management. That's really what this is about: Getting people on the right track and keeping people healthy.
HLM: The pilot program launched just over ago. Where do you see the program a year from now?
Hinderliter: We see this exploding with the use of mobile apps and wearable devices. We've been working on outfitting walking trails and other exercise venues with QR codes, so people can scan those with their mobile devices and say where they were. For example, if they walked up a staircase, they could scan a code at the top of the staircase. That information could be compiled to show how much exercise they got that day and keep fitness front of mind. We would be able to coach them based on how much they actually move.
Being able to utilize those types of apps and mobile devices is huge. You can do that with what you're eating, and activity monitors can also monitor how much you're sleeping, which can lead to us determining whether or not you might need a sleep consult.
We're really turning this into more of a full management service, with counselors who can help you manage your situation day-to-day. It's nice to talk to someone who will tell you, 'yeah, you need to lose 10 pounds,' and here are some diet tips and tricks and some exercises, but who is following up with that?
I think that's the next steps for this—the follow through. We will provide resources to help monitor and coach them to make sure that people are on the right track.
HLM: What would you say to people who have privacy concerns?
Hinderliter: Just like any of our wellness visits, we do keep the data separated. It's not information that goes into electronic medical records, like if you were seen in a physician's office. It's also HIPAA-compliant and uses data encrypted for medical use, so it's not just Skype of Facetime or any other vide chatting—this is another level of security. We're very serious about keeping things separate. Everything is very secure.
HLM: What advice would you give to other organizations considering starting a similar program?
Hinderliter: I think my advice would be to make sure all of your stakeholders are onboard. I was very lucky with the group I was working with. Our wellness group has very strong leadership, and they were very excited about doing this kind of program, and were very interested in innovation. It's difficult when you're working with a group that isn't necessarily onboard.
UPMC recently joined a small number of hospitals and health systems committed to offering a minimum starting wage of $15.00 per hour. UPMC's chief human resources officer explains why and how the decision was made.
But even among proponents, the question of how much of an increase is warranted is a divisive issue. Some advocates argue that anything less than a $15.00 hourly minimum denies workers a living wage. Opponents say higher wages will hurt competition and result in job cuts. In the healthcare sector, opponents also cite increased healthcare costs for patients, fewer employment benefits, and a reduced ability to provide charity care.
With hospitals and health systems often being the largest employers in a region, joining the national conversation on wages is inevitable for many healthcare organizations. Maine Medical Center in Portland, has said that a wage hike to $15.00 hourly would be fiscally unsustainable.
But Beth Israel Deaconess Medical Center in Boston, has announced that it will adopt a minimum $15.00-per-hour starting wage. And on March 29, University of Pittsburgh Medical Center (UPMC) became the latest health system to announce an increase to a minimum of $15.00 in its starting wage for hourly employees. The change is expected to become effective by January 2021, with the wage rising gradually each year until then.
"We wanted to do this in a very responsible and affordable way," says John Galley, chief human resources officer at UPMC. "Because we're such a large employer, we had to do this in a way that wasn't going to be inflationary in terms of healthcare costs."
Galley outlines three reasons behind UPMC's decision to move to a $15.00 hourly starting wage.
1. Recruiting and Retention
A primary driver behind announcing the wage increase was the desire to remain competitive in recruiting and retaining the region's best employees. "At UPMC, we believe in pay for performance," says Galley. Paying a higher wage is expected to attract top talent.
The move seems to have had a positive effect. "We usually get about 8,000 hits daily on our recruitment page, but we got over to 10,000 on the day this was announced. It was an almost 25% increase, just on the first day alone," he told me.
Galley says that current employees have had questions as to how the increased pay will affect them, but the feedback has been overwhelmingly positive. While it's still early, he and UPMC's leadership believe increased starting wage to be well-received by existing UPMC workers.
Galley is skeptical that increased pay alone can improve employee engagement, but believes that competitive compensation, when paired with a supportive work environment featuring supervisors that care about their workers and treat them with dignity and respect, can create engagement.
2. Supported by Data
"We are a data-driven organization," says Galley. He and his colleagues feel confident that now is the right time to increase their organization's starting wage.
"We asked ourselves, is this change going to help us provide better value in market? Will it improve patient care and experience?"
Employers may have enjoyed a buyer's market for the last few years, but that's no longer the case. The effects of the last recession are coming to a close, and now is the time to recognize to step up efforts to retain workers.
"There was no study that said [we] needed to move the wage to $15.00 per hour, but we look at wages, we look at unemployment, we run forecasts…. We look at where we need to be. The culmination of all those studies led us to this decision," says Galley.
3. A Chance to Show the C-Suite HR's Strategic Abilities
HR doesn't always get a chance to display its strategic abilities to the organization, but adjusting UPMC's starting wage was an idea that got started in the HR suite.
"The initiative was born by HR," says Galley. "HR worked to study the market, to do the forecast, to develop and price the plan."
UPMC's leadership and other departments got into the act early on and were supportive, says Galley, but this was an opportunity for HR to go to bat for the health system's employees and flex the department's long range planning and strategizing muscles. "All the rigor in creating and promoting the business case was developed by HR."
Adopting a $15.00 hourly starting wage is not a goal that is right for every hospital or health system, says Galley. "Each business needs to evaluate this on their own. We're not saying that what we're doing at UPMC is right for everyone else."
But Galley has this advice for organizations considering taking the plunge. "Be bold. Dream big, and don't be afraid to take big ideas forward."
Despite the popularity of workplace wellness programs, the effectiveness of such efforts varies.
This article first appeared in the April 2016 issue of HealthLeaders magazine.
Editor’s note: This piece is based on Lena J. Weiner’s February 22 online column. To see her columns, visit www.healthleadersmedia.com/HR.
Workplace wellness programs that encourage and incent employees to adopt healthful habits are widely popular with hospitals and health systems. Upwards of 80% of large organizations offer some sort of wellness program.
But their effectiveness is up for debate.
The programs are notoriously difficult to incentivize. Many employees who respond well to incentives for goals such as smoking cessation, more physical activity, and weight loss are already motivated, says Mitesh Patel, MD, assistant professor of Health Care Management at The Wharton School in Philadelphia.
Until recently there was little research on financial incentives to boost physical activity. But Patel recently published a study in the Annals of Internal Medicine suggesting that greater accessibility and proper framing of incentives can lead to greater effectiveness.
"A lot of challenges around workplace wellness programs are around engaging employees who need it most," says Patel. "We wanted to learn how best to design an incentive to do that." Patel spoke with me about his findings. The transcript of our conversation has been lightly edited for clarity and length.
HLM: What can you tell me about why you chose to study workplace wellness program financial incentives?
Patel: Some of the reason we did this study is that workplace wellness programs are growing in popularity across the country. More than 80% of large employers offer financial incentives for health promotion to their employees to help them achieve health goals, which includes things like physical activity. But the best way to design these incentives to help improve outcomes hasn't really been consistent.
HLM: How did you design your study?
Patel: We conducted a study using 281 people, randomly assigning them to four groups. We asked them to achieve 7,000 steps daily, tracking their steps using an app on their smartphones. We gave everyone daily feedback for 26 weeks based on whether or not their daily goal was met. At 13 weeks, three of the groups got a financial incentive based on whether or not they achieved that 7,000 step goal.
A quarter of them were a part of the game arm, which utilized an approach similar to what most employers use when designing workplace wellness invectives. If they did the work to meet their goal, we would pay them $1.40 for each day they met their goal once the study was completed.
Then, there was a lottery arm, featuring a lottery where the subjects could win money for the days they met their goal.
There was also a loss-framing arm, in which on day one of every month for three months we told the participants that $42.00 had been placed in a virtual account for them, and for every day that they didn't meet their goals, we'd take $1.40 away from that account.
We told all three of these groups that at the end of the study, we'd send them a check with all of their accumulated earnings. So everyone was getting paid the same way; we were just framing the incentives differently.
There was also a control arm, in which people just got daily feedback with no financial incentive.
HLM: Which group performed best?
Patel: The loss arm achieved their goal about 45% of the time, which was 15% higher than the control group. It is statistically significant.
The control arm achieved their goal about 30% of the time.
The lottery arm achieved their goal 35%–36% of the time, which is slightly higher, but statistically no different from not paying them at all, which was very interesting. We found that paying people $1.40 a day to achieve a fitness goal was really no different from not paying them at all.
HLM: What are some takeaways from your study that can help HR teams design better wellness program incentives?
Patel: There are a couple of key takeaways from our study. The first is that many people are interested in using incentives, but they often don't pay enough attention to how they design these incentives. Our study found that design is critical to success.
More specifically, we can leverage insights from behavioral economics. From that area of study, we know more people are motivated by losses and engaged by variable rewards more than they are by constant rewards. Also, they want to be rewarded now, in the present; people want immediate gratification.
They're less motivated by rewards that are offered later, and less apt to do something that will benefit them far in the future. Incorporating these lessons from behavioral economics into wellness program design can lead to better outcomes.
HLM: How can a wellness program be designed to engage more employees?
Patel: A challenge for many workplace wellness programs is that they attract employees that are already very motivated and physically active as opposed to the people who are sedentary or sitting at their desk all day and could benefit the most.
We designed our study to try to attract those people who could benefit the most, enrolling only people who were overweight or obese. The mean BMI in our sample was 33; BMIs of 30 and above are considered obese. So, this was a very heavy sample, and more high-risk than an average workforce.
We've also found that many workplace programs use higher goals, like 10,000 steps, because it's a nice, round number. But there's no evidence that number is particularly good for anything other than attracting people who are already fairly physically active. So, we aimed for 7,000 steps, because that's supported by the American College of Sports Medicine as the minimum you need to start gaining benefits from physical activity, and because it's 40% higher than the national average, which is 5,000 steps.
It's a reasonable goal to engage people who are sedentary at a baseline. We found that 96% of people finished the entire six-month study. That's even after turning the incentives off at three months. That's far higher than you'll see in a typical workplace wellness program.
We think part of the reason why so many participants continued even after the incentives were turned off had to do with the design of the study. It was a reasonable goal, and we used smartphones to track their steps.
It's easy, because 70% of Americans have smartphones. They're already used to carrying them everywhere they go and charging them, and we can pull the data passively from their phones and give them feedback without them having to do any work. We think the smartphone approach might be scalable to larger populations, such as employers who are very large.
HLM: Does this study indicate that using "carrots" or "sticks" is more effective?
Patel: It's really important to note that our study did not use "sticks," in that we did not take any money away from the employees' pockets.
We framed a carrot in three different ways, the most successful of which was that we would give it to you up front for not doing anything, and then take the carrot back if you didn't meet your goals.
Some people might interpret this finding as "sticks" being more effective than "carrots," but I think it's more about framing the reward differently. It's about being more creative and thinking about ways we can leverage the irrational tendencies to achieve better success.
