In this economy, you can't afford to lose good hospice employees

Happy workers won't leave when job markets open up

[Editor's note: This is the first of a two-part series that examines strategies for employee retention. This month we look at the importance of patient satisfaction surveys and exit interviews. Next month, we'll look at specific programs that enhance retention.]

The 161 employees at Rainbow Hospice and Palliative Care in Park Ridge, IL are accustomed to annual employee satisfaction surveys, but the 2010 survey was a little different than those from previous years. Results of the nationally benchmarked survey resulted in their agency's selection as one of Modern Healthcare's Best Places to Work 2010.

"We are committed to doing an employee satisfaction survey every year but this year, like all other hospices, we've been on a fiscal diet," says Pat Ahern, chief executive officer of the hospice. "Although the hospice's retention rate of 83% is higher than the national average of 80%, we want to continue looking for ways to keep employees satisfied and surveys enable us to identify needs. We chose to participate in the Modern Healthcare employee survey because it gave us an opportunity to benchmark our results against healthcare organizations throughout the country."

There is no participation fee required, and full reports that include employee feedback and comments can be purchased to give hospice agency managers an opportunity to address concerns, Ahern points out. (See resource box on p. 135 for information about the survey.) "We were able to conduct a survey without spending a lot of money," Ahern adds.

Although Ahern and her management team were only expecting results that they could use to identify areas to improve employees' perception of the agency as a work environment, the surprise result was being named as one of the top 100 Best Places to Work. "We don't have a specific strategy that identifies employee satisfaction or employee retention as an organizational goal, but we have set a goal of enhancing internal resources," says Ahern. The most valuable internal resource is the staff, so several new programs reflect the agency's efforts to give staff members tools to help them perform their job or recognize their value to the organization, she adds. Electronic medical records, tuition reimbursement and a leadership development program are three programs implemented in recent years as a result of feedback from employee surveys, she points out.

Retention is an important issue for hospice managers but it may not be at the top of everyone's mind, admits Moses Altsech, PhD, founder of Marketing Hospice, a Madison, WI-based marketing consulting service specific to the hospice community. Managers understand that continuously hiring and training new staff is more costly than retaining existing quality staff members, but many "talk the talk, but don't walk the walk," he points out. "Right now, the slow economy has meant that employees are less likely to change jobs because of the uncertain job market, the loss of seniority, and the risk that the new job may be eliminated due to budget cuts," he explains.

This situation won't last forever, so now is the time for hospice managers to make sure their employees are happy so they won't leave when other hospices start hiring, he recommends. "If you wait for the economy to improve to work on retaining your employees, you'll be too late," he warns.

Use surveys to measure morale

Employee satisfaction surveys are essential for any organization that wants to improve retention, says Altsech.

"It's important to pay your employees well, because pay is an expression of their value to the organization, and it's important to offer recognition programs that thank them for doing a good job, but satisfaction surveys give you an opportunity to identify significant issues that affect job satisfaction," he explains.

How you conduct the survey, evaluate the data, and communicate the results is another way you let employees know how seriously you take their opinions, Altsech says. "It is best to use a third party to develop and conduct the survey to maintain confidentiality and credibility," he suggests.

Another way to identify issues that affect retention are exit interviews, suggests Julia Houck, vice president of human resources for Madison, WI-based HospiceCare Inc., which has been named "No. 1 Best Place to Work" by Madison Magazine in 2010 and 2008. "We've set an organizational goal for 92% to 94% retention of employees, and we are currently at 93.5%," she says. "We've been in a growth mode for several years and have increased our staff from 55 employees to 550 employees in 10 years."

Because the hospice already is hiring many new employees as it expands, it is critical to retain existing employees, she says. "When an employee does leave, we conduct an exit interview to identify the reasons for leaving," says Houck. "We track the information gathered in the exit interviews and look for trends."

For example, an employee might be dissatisfied with the way paid time off is handled or might not think that he or she was supervised well, she explains. "We'll use a focus group of employees to explore the issue and get more details," she says. "If an employee who is leaving has a complaint, you can be sure that other employees who are staying are aware of the issue, and a focus group is a good way to get specific information that can help us address the problem."

Career Pathing is one program implemented at HospiceCare to address employees' desire for advancement, says Houck. In addition to the typical annual performance evaluation, all employees also meet during the year with their supervisors for an interim session that includes discussion of career aspirations, she says. "Our job descriptions are linked to competencies so if we have a nurse who wants to eventually be a team leader, the supervisor can compare the two job descriptions and conduct a gap analysis with the employee," she says. By comparing the nurse's current role responsibilities with the future role responsibilities, the supervisor and nurse can develop a plan to help the nurse gain the experience or education she needs to be a candidate for team leader, she adds.

Although employee surveys and development of programs to enhance career advancement take time and money, hospice managers cannot afford to ignore them, says Ahern. "A hospice's most valuable resource is its employees," she points out. "When our treasured assets go home at night, we want them to want to come back the next day."