Recruit and retain staff following a customer service model of employment

Hospice expands skills set required of staff

As hospices become more competitive and challenged by the 21st century market forces, some are searching for more efficient ways to hire and retain the team-working staff they most desire.

One way to improve the recruitment and retention process is by moving from a clinical model to a customer service model.

While clinical capability and competency remain the chief characteristics managers look for in new hospice employees, the Hospice of the Cleveland Clinic in Independence, OH, has added some new skills to the list, and some are a little more challenging to assess.

"We also look at someone who possesses good communication skills, can demonstrate good boundaries, and we do that through new processes we have put in place, such as behavioral interviewing," says Barbara Volk, RN, BSN, MBA, administrator of Hospice of Cleveland Clinic.

The goal of behavioral interviewing is to learn more about a particular job candidate's other important attributes, including integrity, honesty, and team work, Volk says.

"The usual and customary way that health care looks at hiring practices was looking at professional licensure," says Cheryl Carrino, RN, manager of program development for Hospice of the Cleveland Clinic.

"Now what we did was begin to look at skill sets within the staff we're hiring," Carrino says. "We began to look at the initiatives that give us the desired skills, and we were looking more at the person themselves."

Assessing new job candidates is done in two phases, Carrino says.

First, the human resources department screens people for clinical capabilities, and those who are selected in this phase then meet with a manager who conducts a behavioral interview, Carrino explains.

"The manager is looking for behaviors of that person through questions, and then we move the candidate on to a peer interview," Carrino says. "The peer interview is done by a designated team of employees in our hospice program, who then are part of the process of making the eventual selection."

Peer interviewers are asked to evaluate candidates through a set of questions in which they assess the person's communication skills, team work boundaries, and prioritization ability, Carrino says.

"Can the person adapt and commit to our type of culture here?" Carrino says. "We want people who are open to learning and growth and development, so the interview becomes a way to make a connection with this employee and make a connection with our organization."

Peer interviewers evaluate job candidates' answers to their questions in terms of behavior, she adds.

Using a decision matrix, the questions asked are selected based on the skills a particular job requires, as well as what the job candidate's prior employment and skill sets were, Carrino says.

"Each question is weighted from is it essential or not important, and each response is scored from one to five, with one being poor and five excellent," Carrino says. "Each member of the team does a score, and then they come together and look at what everyone else scored the candidate and average those scores as a team before presenting the scores to management."

After changing the recruitment process to better reflect the hospice's goals for staff skills, hospice managers changed the orientation process, Carrino says.

"We made major revisions in terms of adding customer service pieces to the orientation," Carrino says. "Now we're doing a clinical orientation and are working on a customer service orientation, in terms of how to prevent hospice services, how to communicate with patients and families."

Also, the hospice has added some initiatives for improving telephone service and feedback to referral sources, as part of a goal to improve processes and communication with all customers, she says.

"Another thing we've done is to enhance the orientation experience," Volk says.

When new employees are hired, their manager will send them a letter welcoming them to the organization and follow it up with a phone call, Volk says.

"The manager will meet with new employees weekly, if necessary, depending on what the person does," Volk says.

Even past the orientation and probationary period, the manager will continue to have personal contact on a weekly or monthly basis with the new employee to make certain the person is comfortable with the organization and on the right track, Volk adds.

The orientation itself is competency based, requiring employees to demonstrate they understand their role and can function independently, Carrino says.

It's divided between structured formal classes and structured field time, and soon the hospice will implement a preceptor program with formal training, Carrino notes.

The preceptor program will give experienced staff an opportunity to grow professionally without having to move into a managerial position, she says.

Each selected preceptor would receive formal training and productivity standards, and each would receive financial incentives, including salary increases.

Preceptors would be given some time apart from their regular work to help new employees with orientation, Carrino says.

"We're beginning with registered nurses and will eventually look at rolling this out to all disciplines," Carrino says. "Right now the people who are preceptors are the people we call 'high performers,' the people who serve on committees and who contribute to the organization by doing presentations for other staff."

Each preceptor will take a new employee out into the field for about 2.5 to three weeks, Carrino says.

"We really want them to focus on the competencies necessary to coordinate patient care, and focus on things such as admissions, discharges, overall case management in terms of medication supply, and focus on the necessary competencies to manage a caseload," Carrino explains.

"In the structured formal classes, new employees learn about the coordination of care and technical pieces of hospice and conditions of participation and bereavement care and psychosocial care," Carrino says. "In the field they are teaching new employees the application of these pieces."

After the four week period, the preceptor then becomes an informal preceptor, a go-to person for the new employee, Carrino adds.

"The ultimate goal is that the preceptor will move them and help them get integrated into their own clinical team," Carrino says.

Another change the hospice has made to enhance its customer service focus is to script the admissions process for staff, Volk says.

"We make sure everyone is presenting the information and material in a somewhat similar fashion, with the same message," Volk says.

For example, the admissions script would have the admission nurse introduce herself and the organization by saying, "Hi, my name is so and so, and I am here today to do this," Carrino says.

Other examples of scripted messages for the admission process are as follows:

- "Our care is designed to assist both you and your family to coordinate your health care from home."

- "The goals of care are driven by the needs of you and your family and are focused on comfort and not cure."

- "Under your benefit for hospice care Hospice of the Cleveland Clinic is responsible for coordinating the care related to your hospice diagnosis."

- "Therefore, when services are needed, Hospice of the Cleveland Clinic is responsible for managing your care for this diagnosis."

- "Your traditional Medicare part A and B benefit/Medicaid are waived for this diagnosis only. You can still use your Medicare/Medicaid benefit for medical care not related to your hospice diagnosis."

The idea is that the nurse will help patients and families set their expectations during the explanation about services and disciplines and what the roles are, she says.

"One reason we've done the scripting is because we want to present hospice services in a positive manner," Volk explains. "We want to put a positive spin on our services."

A scripted opening will prevent the natural tendency of staff to focus on drawbacks, such as what the hospice benefit might not pay for, Volk adds.

"We've heard the staff say, 'We can't do this or that,' and we say, 'That's not the way to look at it,'" Volk says. "By listening to staff and doing role playing, we found that we needed to flip the switch and find a more positive manner to do this."

Also, the script includes a closing statement at each interaction with patients and families: "Thank you for choosing Hospice of the Cleveland Clinic," Volk says.

Need More Information?

  • Cheryl Carrino, RN, Manager of Program Development, Hospice of the Cleveland Clinic, 6801 Brecksville Road, Independence, OH 44131. Telephone: (216) 444-9819.
  • Barbara Volk, RN, BSN, MBA, Administrator, Hospice of the Cleveland Clinic, 6801 Brecksville Road, Independence, OH 44131. Telephone: (216) 444-9819.