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Retaining Good Employees in Tough Times Retention of valued employees is essential to maintaining liigh levels of quality service and efficiency in consideration of the tight labor supply and an increasingly competitive health care market. Health care organizations that desire to become "employers of choice" must devise strategies and innovative programs which will satisfy a spectrum of both work ;uid personal needs. Such initiatives include tangible rewards such as competitive compensation and benefits, and, more important, valued intangibles Uke quality of work life programs.

In a more attractive environment, employees will make a long-term commitment. Key words:

employee retention, employee retention strategies Peggy Anderson, PhD Professor of Human Resource Management College of Business and Economics University' of Wisconsin-Whitewater Whitewater, Wisconsin Marcia Pulich, PhD Professor of Human Resource Management College of Business and Economics University of Wisconsin-Whitewater Whitewater, Wisconsin I NTODAY'S tightlabormarket, retention of existing employees is now as important as recruitment of new ones. In addition to finding better ways to attract people, organi- zations also face major challenges from em- ployees who are willing to "jump ship" for various inducements offered by competitors.

Attracting good people is just one side of the employment equation; retaining them once they have been hired is the other.

The so-called traditional model of em- ployee behavior, in terms of expected loyalty and commitment in retum for guaranteed employment, is no longer the norm. Younger workers now entering the labor market do not have the same work priorities of those who joined the labor force in eariier years. They also have learned that lifetime job security is no longer guaranteed. This becomes evident when one looks at the myriad of mergers, consolidations, and re-engineering activi- ties, with their resulting staffing cuts, which have taken place in the past decade. The health care industry in particular has been directly involved in these restructurings. In- 50 Health Care Manager. 2000. 19(1), 50-58 ©2000 Aspen PubUshers, Inc. Retaining Good Employees in Tough Times 51 creased operational efficiencies are necessi- tated by continuing changes in government initiatives, regulations, and reimbursement policies, along with intense pressures from constituent groups such as patients, con- sumer advocates, employers, and insurance companies.

As a result, more restructuring through the use of improved technologies and processes can be expected, which in turn will affect staffmg requirements and increase pressure for retaining quality employees.

Health care organizations can attain the status of "employer of choice" by offering current employees a well-designed package of tangible and intangible incentives and motivators, thereby developing a competi- tive advantage in recruiting and retaining staff.

This article will address ways in which employers can develop strategies and pro- grams for improving employee retention.

WHAT DO EMPLOYEES WANT FROM THEIR JOBS?

In order to become an "employer of choice," an organization must first determine what people are most concemed about and want from their jobs.

This information can then be used to develop programs and prac- tices that assist in attracting and retaining good employees.

Employees want compensation and benefits comparable to what theii" peers in other organi- zations receive. Tliis includes a competitive wage or salary and a basic benefits package such as insurance, sick leave, and retirement plan. Further, employee expectations include benefit options flexible enough to meet their personal and professional needs.

Employees want to work in an environ- ment of trust and respect where they feel they are making a real contribution to organiza- tional goals and objectives. Employees de- sire to be viewed as team members and val- ued partners in providing quality patient ser- vices and care. They would like to be given the necessary professional autonomy, deci- sion-making authority, and cutting-edge re- sources to perform theii"jobs properly, effec- tively, and efficiently. They want to feel free to challenge the way things are done and offer recommendations for change. Profes- sionals and support stciff, regardless of their functional areas, wish to be treated as, and work with, other professionals. In short, they want a positive climate in which to work.

Employees also want opportunities for professional growth and development.

These can be provided through ongoing training, education, and mentoring pro- grams. Furthermore, advancement opportu- nities must be clearly delineated so that every employee is knowledgeable about his or her career patli alternatives and the approximate timetable associated with each.

Additionally, employees want some rec- ognition from management that family and personal time is important. From the employ- ees' perspective, management should dem- onstrate respect for and support of family responsibilities tlirough flexible work sched- ules, job sharing, and similar options.

In organizations that claim to have family- friendly policies, supervisors and unit man- agers should make it easy for employees to use these poUcies.

In other words, manage- ment "walks the talk." Finally, employees want to have a good working relationship with their supervisors.

Supervisors acliieve a positive relationship with their subordinates by being approach- able, demonstrating respect, providing sup- port and encouragement, listening to con- cerns, and showing genuine sensitivity. 52 THE HEALTH CARE MANAGER/SEPTEMBER 2000 Employees are more likely to experience dissatisfaction with their supervisors and or- ganizations when these factors are absent.

Organizations that emphasize these interper- sonal behaviors will have more highly satis- fied employees.

For the most part, what employees desire from their jobs is not radically new. Most managers have known for quite some time what is important to employees, but they have not responded. However, by addressing to these needs, health care institutions will be contributing to the accomplishment of orga- nizational goals and objectives, especially higher quality patient care.

Costs also will be lowered in both the short- and long-run due to decreased turnover rates.

Finally, sti-ess lev- els should become lower as employees are no longer forced to work excessive hours or cover higher patient loads.

STRATEGIES FOR RETENTION One of the most effective ways to mini- mize the need for recraiting is to develop strategies for retaining current employees.

Therefore, management's special challenge today is first to hire people who are a good "fit" with the organization's culture and then create a work environment that gives these employees every reason to stay.

Though it is the responsibility of each organization to determine and develop its own effective retention strategies, several factors can be identified as universally im- portant and applicable. These include im- proving organizational climate, hiring right, socializing new hires, offering competitive compensation and valued benefits packages, and being proactive in resolving quality of work life issues.

Improving Organizational Climates One of the most critical steps in developing an effective retention sti'ategy is to assess the organization's overall work climate, culture, and atmosphere. An effective way to accom- plish tliis is to answer tlie basic question of "why would people want to work here." Impor- tant inputs include employee surveys, exit in- terviews, and retention rates by position.

Leading organizations strictly adhere to high standards of patient care and are willing to adopt new procedures, techniques, and equipment to enliance quality. As much as possible, every employee and work team is included in some aspect of planning and decision making. Problems are identified, discussed openly, and resolved. Perfor- mance is recognized and linked to valued rewards. Professional growth and develop- ment are actively fostered. Supervisors and managers continually support all employees, and work is performed in an atmosphere of mutual trust and respect.

Typically, what is needed is not a major organizational overhaul, but rather the iden- tification and emphasis of those intangibles that differentiate "employers of choice" from those who are not. The former pay particular attention to elements such as organizational fairness, shared communication, and organi- zational values. These contribute to a posi- tive and proactive work climate.

Organizational Fairness Wliile it is difficult to accurately measure tlie degt^ee of fairness present in an organization, employees are very sensitive to any action that violates their perception of fairness. Certain characteristics are evident where an organiza- tion clearly is attempting to treat everyone in an Retaining Good Employees in Tough Times 53 equitable manner. The "acid test" is how poli- cies and procedures are implemented and ad- ministered. Rules are enforced impartially.

Performance standards are clear and nonambiguous, fuid those with higher ratings are not thought of as "favorites" because of who they know. Rewai'ds correlate with perfor- mance. Employee input into proposals that direcdy affect them is invited.

Perhaps no single factor will create a dis- gruntled employee more quickly than the perception of unfairness. Conversely, a sin- cere effort to manifest fairness in all matters will help create mutual trust between em- ployees and the organization.

Shared Communication Where there is an atmosphere of trust, there is an opportunity for extensive, meaningful communication across different occupa- tional levels.

While most organizations make statements about practicing open employee communications, many find it truly difficult to implement the practice completely. When employees believe that their opinions are really considered in organizational decision making, the goal of shared communication has been achieved. Evidence of specific con- tributory dialogue, which must be implicitly based on mutual respect, may be found in the following examples:

the formulation and dis- semination of overall group objectives; the sharing of agendas; information disclosure; opportunities for constmctive feedback; and diversity and dissent of ideas and sugges- tions.

Consequently, bonding between indi- viduals and the organization is optimized.

Organizational Values All health care institutions operate within a framework of guidelines and beliefs that de- fine organizational standards of perfor- mance. These guidelines and beliefs consti- tute the real values of the entity and, when embraced by employees, are referred to as shared values, A fundamental value, underlying any organization's policies relating to die em- ployee-patient relationship, is excellence in patient care.

Employees are committed to an organization that expects core standards of excellence and high skill from every caie provider. These standards are embedded in all policies affecting patients.

Another central value is the beUef that employees and their intellectual capital (i.e., collective employee knowledge and skills) really are the key assets of any health cai'e organization. As a result, investments are made in employee development. Employees are treated as professionals in their respec- tive disciplines, at all levels. They also ai"e given support in both work and personal issues, resulting in a higher degree of work hfe balance.

Yet another value is cooperation in attain- ing organizational goals. High commitment and high performance teamwork is more highly esteemed than individual contribu- tions.

Similarly, achieving these goals through cross-functional coordination is as important as accomplishing in-unit results.

A final dominant value is tlie leadership and support provided by management.

Excellence of performance is encouraged when management becomes meaningfully involved. Taken one step further, manage- ment's actions clearly model the same high standaids that all employees are expected to attain. Management is also receptive to ideas that would improve health care service. A commitment is made to provide state-of-the- 54 THE HEALTH CARE MANAGER/SEPTEMBER 2000 art technological resources. Finally, man- agement must make every feasible effort to hire, retain, and develop quality staff, for they ti'uly ai-e the organization.

Hiring Right People usually join an organization with certain expectations about their job and work environment, and these determine their choice of one organization over another.

Unfortunately, many new employees have unrealistic expectations about the organiza- tion or new job.

When these expectations are not fulfilled, then the employee experiences "reality shock" with varying degrees of dis- satisfaction. As a result, costly turnover is most likely to occur among newer employees who are unable to resolve tlie differences between their expectations and reality. The organization frequently contributes to this situation by failing to provide applicants with a realistic view of the job and work environment.

During the recmiting process, applicants should be provided with a realistic job pre- view (RJP). Such previews provide a bal- anced picture of the positive and negative aspects of a given job in that organization.

The rationale of using RJPs is to provide applicants with the opportunity to decide if such a job would be a good professional and personal fit for them.

Designing and conducting RJPs can be accomplished in various ways. Often, an organization will collect the views of experi- enced employees about job and work setting characteristics. These may be incorporated into booklets or video presentations for ap- plicants. Another frequently used technique is to provide an opportunity for applicants to meet with current employees and discuss matters of concern or interest about the orga- nization. Whichever method is chosen, RJPs can be effective in preventing turnover.

Socializing New Hires Though RJPs may be used during the hir- ing process, new employees may continue to hold unrealistic expectations about the job and the actual work environment. Thi s can be expected, as words and testimonials cannot always fully describe what it's like to actu- ally perfoiTn a job in a particulai" work set- ting. In an attempt to bridge these potential gaps, many organizations provide orienta- tion sessions for new employees. Such pro- grams provide important, formal informa- tion regarding work-related policies and procedures, benefits packages, and enroll- ment procedures. However, in addition to formal orientation, new employees need to learn about the norms, roles, and personality styles that are characteristic of a particular environment and have an understanding of "how things are done around here." Department or unit supervisors have the re- sponsibility for developing an effective social- ization program for new employees. Major goals should include assisting in learning the tasks of the job, providing an understanding of tlieir role in the department and/or unit, helping in becoming an accepted and productive New employees need to learn about the norms, roles, and personality styles that are characteristic of a particular environment and have an understanding of "how things are done around here." Retaining Good Employees in Tough Times 55 member of the work group, and providing timely feedback on perfonnance.

Often a senior member of the work group will be assigned the responsibility of guiding the new employee through the socialization process. In its most basic form, this is known as mentoring and transfers knowledge from those professionals with greater learning and experience to those employees who have recently joined the organization. Mentors aie important to career success because they perform developmental functions including sponsorship, coaching, and protection.

Sponsoring involves actively helping the employee to get needed job experiences and to obtain desirable visibility with key indi- viduals in the organization. Coaching in- volves offering advice and practical tips on how to accomplish job objectives and achieve recognition. Protection is provided by alerting employees to potentially harmful situations or experiences in the workplace that could prove damaging to career progres- sion. Mentors often provide valuable assis- tance, .such as role modeling, in which the employee is provided with a pattern of values and behaviors to emulate, and which is im- portant to becoming a valued and productive organizational member. Though effective mentoring programs require time and com- mitment on the part of participants, such programs ai^e beneficial to all parties.

Unlike most new employee orientation programs, effective sociahzation is viewed as a long-term process with no established time limits, and is designed with each new employee's requirements in mind. Those whose socialization needs have been ad- dressed can be expected to become produc- tive and committed members of their respec- tive department or unit.

Offering Competitive Compensation and Valued Benefits The compensation and benefits package is a major factor in designing strategies to re- tain employees. Continual assessments of an organization's position relative to the mar- ketplace must be made. For difficult-to-fill positions, where cun-ent market salaries may be substantially higher than salaries paid to job incumbents, the resulting compression issue must somehow be addressed. Where salary adjustments cannot be made to effec- tively deal with compression, some organi- zations give annual loyalty bonuses to valued long-temi employees. These bonuses are designed to show management's apprecia- tion to those who remain with the organiza- tion. Another variation of using compensa- tion as pait of one's retention strategy is to offer stock options to various groups of em- ployees, particularly within the professional ranks.

Though this incentive is limited to organizations that issue stock, options ai"e often used by startups in the health sciences industry as a means of attracting and retain- ing quality personnel.

A well-designed benefits program is also a major ingredient in an organization's retention strategy. Benefits are a significant portion of total labor costs, and must include tliose fea- tures most valued by employees.

This theme of providing valued benefits can be most effec- tively implemented by developing a cafeteria or flexible benefits plan. Employees do not automatically receive all offered benefits, but select those that fit their current life-cycle needs.

The intent is to provide employees with a given number of doll ai's or points with which to purchase desired benefits. Many of the benefits employees want at certain stages 56 THE HEALTH CARE MANAGER/SEPTEMBER 2000 in their lives are obvious. However, ques- tionnaires and personal interviews can be used to determine varying needs and to de- sign plan offerings accordingly.

Enhancing Quality of Work Life Offering employees a competitive and val- ued compensation and benefits package will not by itself be sufficient to retain them in the long run. Employees in today's labor market increasingly expect that the work climate will be attractive and accommodate both professional and personal needs. To accom- plish this, health care organizations inter- ested in retaining their employees should develop an attractive quality of work life environment. This is accomplished through the design and implementation of quality of work life (QWL) programs. Those found in the health care field usually focus on job redesign, work time and/or place issues, and professional development and growth opportunities.

Job Redesign In today' s competitive health care environ- ment, organizations constantly seek organi- zational efficiencies through job redesign.

Those who are successful will undertake new initiatives that are responsive to both organi- zational and employee needs. People expect to work in an environment where their jobs are interesting, challenging, and contribute to quality patient care.

An innovative approach introduced at sev- eral community-based hospitals is called employee-centered work redesign. The ob- jective is to encourage employees to assist in redefining their work roles, to tlie extent tliat such changes benefit both the organization and the employees. This program is not in- tended to replace more traditional work rede- sign methods such as job rotation but rather is considered an employee-initiated en- hancement. In making proposals for work redesign, employees must be able to justify how such changes will improve quality of service, support organizational and depart- ment goals, and contribute to employees' professional growth. The process provides employees with the opportunity to become actively involved in improving their quality of work life. In turn, this has led to higher levels of commitment and improved reten- tion rates among the organization's most valued employees.

Another effective approach in improving quality of work life through job redesign is the increased use of teams.

This involves changing from a work group structure found in a more traditional unit or department, to self-managed or self-directed teams. These operate with a high level of autonomy and, to the greatest extent possible, have a high level of cross- training. Everyone is expected to accept and exercise tlie responsibility necessary to do both their own jobs and assist others. The result is often an intense focus on a shai'ed sense of purpose, tliat of serving the patient.

Alternative Work Arrangements Organizations increasingly attempt to im- prove employee quality of work life through the use of alternative work arrangements.

Such flexibility has become a significant factor in both employee recruitment and re- tention. This is particulaiiy true when dual- cai"eer couples and single parents factor child care considerations into their employment decisions. Some options which employers may wish to consider are as follows.

Flexible scheduling The more traditional approaches to imple- menting alternative work scheduling in health care include flextime, compressed Retaining Good Employees in Tough Times 57 workweek (40/10, 36/10, 30/10—Friday.

Saturday. Sunday), or per diem an-ange- ments. In instances where severe labor short- ages exist, healtli care organizations are even resorting to employee-designed schedules.

This might be expressed in temis such as:

"We'll schedule you to work when you are available." Though frequently impractical from a total organizational perspective, us- ing and maximizing scheduling fiexibility as a recruitment and retention technique for difficult-to-fill positions may be a necessity.

Job sharing Job sharing permits two individuals to hold one full time job.

Each may work half-time or some other uneven art^angeinent, as long as the job is covered 40 hours a week. This adaptation allows the organization to retain the services of two good employees instead of needing to hire one full time replacement.

When employees give notice of their intent to quit, supervisors and human resource managers need to become creative in at- tempts to retain them. First ascertain why they wish to quit; if the reason involves a desire to work fewer hours, explore job shar- ing possibilities.

Pc^tponing full-time retirement Frequently, people who are planning to retire are employees whom the organization might wish to retain, even on a reduced time basis.

When individuals give notice of their intent to retire, supervisors and human re- source managers should determine if they would be willing to work part-time.

In some organizations, retirements can be phased in incrementally. This type of ar- rangement benefits both parties. The organi- zation still has the services of a trained, knowledgeable employee. The employee transitions into retirement and prepares for it gradually. For example, a person might change to half- time status and delay official retirement. Or an individual who wishes to retire and begin collecting retirement ben- efits might desire to earn additional income.

Other options also exist for retaining the services of such people. Job sharing, fiex time, and telecommuting aiTangements are examples. Another is a special project as- signment whereby the retiree works so many weeks or months a year, earning up to the amount allowed by Social Security. This might be particularly attractive to an organi- zation as routine job duties are usually ac- corded preference over special projects.

Telecommuting An often overlooked alternative work ar- rangement is telecommuting. With modern communications and processing technolo- gies readily available and requiring only moderate set-up costs, any job that involves analysis, writing, records documentation, data entry, or programming should be viewed as a potential candidate for off-site work. Some examples include medical records technicians, coding specialists, and data entry clerks who are employed in hospi- tals, clinics, health maintenance organiza- tions, insurance companies, and physician practices.

Professional Growth and Development Health care professionals tend to refer to themselves in temis of their mediciil specialty, such as medical technology, physical tlierapy, or acute care nursing. They tend to locus on their skills and competencies because that is what they offer in the marketplace. Having invested extensive time and resources in pre- paring for professional qualification in their field, they are fully awai-e of the need for continual career development to remain up-to- 58 THE HEALTH CARE MANAGER/SEPTEMBER 2000 date.

Organizations tliat support on-going edu- cation and learning, and are willing to provide career enliancement programs usually find, as a retum on their investment, heightened com- mitment to tlie organization from their profes- sional employees.

These career development programs should be designed to fit both professional and per- sonal needs of employees, focusing on career mobility within the organization. Where pos- sible, more formal career channels should be developed, along with the required supportive resoui ces to make tliem work.

For example, for difficult-to-fiU specialty registered nurse (RN) positions, such as in acute caie or pediatric oncology, hospitals now offer fellowship pro- grams to young, nonspecialty RN employees.

These programs offer comprehensive, fully paid training within tlie host facility, using mentors, career counselors, and other support services.

Because health cai^e professionals are in- herently committed to their profession and to the patients for whom they were trained to care, they respond favorably to a work envi- ronment offering the latest high-quality tech- nology, equipment, and facilities. Organiza- tions that wish to maintain their staff will supply the resources required to provide ex- cellent patient care.

CONCLUSION In today's tight labor market, health care organizations must be actively committed to retaining valued employees. A competent, qualified employee who is not satisfied with a cuirent employer will have few problems finding another.

"Employers of choice" have strategies and specific programs in place to strengthen reten- tion outcomes.

They especially provide a work environment that offers employees the oppor- tunity to feel pride as organization members.

This is accomplished by using the latest tech- nology and state-of-the-art equipment; de- manding high-quality standards of patient cai'e; rewarding outstanding performance; building positive work relationships; and honoring em- ployees' needs for quality work life.

At all organizational levels, an awareness must be demonstrated that human capital is truly the most valuable of assets in the health care equation. It must be carefully selected, nurtured, developed, accommodated, and, especially, retained.