Retain your staff in a world where other jobs pay more

Here are ways to motivate longtime employees

Recruiting quality patient access services associates in this tight job market requires persistence and ingenuity. Employees know there are plenty of jobs out there that pay more for less demanding work. As one veteran access manager says, workers can serve bagels for close to the same pay and a lot fewer hassles.

In access management, frontline employees grapple with convoluted insurance requirements. They must sympathetically yet firmly discuss financial responsibilities with incoming patients. It’s not easy, and it’s small wonder that good registrars are hard to find.

The challenge of recruiting and retaining good workers is a dual one, says John Woerly, RRA, MSA, CHAM, a longtime director of access services who is now a manager with Cap Gemini Ernst & Young in Indianapolis specializing in patient access redesign. Too often, Woerly notes, employees who meet and exceed their goals lose their incentive and are lured away by other organizations or other departments within the hospital.

"If the pay range is $9 to $11, and they’ve been capped out at $11 for the past two years, they may say, Why should I kill myself to perform at a higher rate when it goes without a salary increase? I want to stay in this department, but I could go elsewhere for a better salary.’"

It’s important to realize, he says, that it costs more in the long run to recruit and train new employees than it does to provide financial incentives for existing employees. "As new staff go through the learning curve, the department’s data integrity may also suffer, resulting in rework and potentially negatively impacting accounts receivable [AR] days."

At one organization where he implemented an incentive program, Woerly adds, the program was not budgeted as a separate line item. He simply estimated that if the program cost $10,000 a year, for example, that amount would be recouped — in unspent advertising, interviewing, and train-ing expenses — by the retention of two or three employees who otherwise would have left.

Incentive plans benefit an organization in two ways: They help recruit quality staff, and they stand out when compared with competitors’ pay systems, Woerly points out. "The plan we put in place recognized performance, quality, customer satisfaction, and productivity. It looked not only at the individual, but at the group."

Woerly outlines three plans he has used to enhance staff performance:

1. Quality and productivity bonus. Employees in access areas such as customer service, preregistration, registration, and ambulatory scheduling received points based on improvements in various categories, each of which was assigned a different weight.

Group goals included reductions in AR days, queue wait time, call abandonment, and increases in upfront collections, among other things. Employees were rated individually in such categories as productivity and monthly quality standards. Depending upon their scores, employees could receive bonuses ranging from $50 to $150 each month. 

Amounts the access manager designated varied, of course, depending upon available funds, Woerly points out. "It could have been $20. It’s really just the matter of recognizing the individual effort. Surprisingly enough, the sheer symbol of recognizing high performance was a tremendous morale booster. It affected the associate who was already achieving and established a higher bar for others who had the opportunity to enhance their performance. Additionally, it made the standards come alive."

2. Overtime for focused initiative deployment. This plan was put in place at a time when the hospital was implementing improvements in the emergency department (ED) process, including discharge coordination, bedside registration, and quality assurance and training.

"We needed extra registration bodies in the ED to assist in a smooth transition," Woerly explains, "but not all staff within the department were cross-trained. Cross-training was not an expectation prior to this time. Staff were very specialized and were not fully trained to work in other areas within the department."

The overtime incentive plan included:

• Staff received a bonus of $2 per hour for working hours above the normal workweek (36 to 37.5 hours for full-time associates and 36 per two-week pay period for part-time associates) or additionally assigned hours as designated by management. That differential was in addition to the standard overtime rate for hours worked over 40 per week and evening/night/weekend differentials.

• Management decided which individuals were approved for the bonus plan based upon associate performance and organizational goals.

• To qualify for additional assignments, employees had to meet minimum productivity and quality standards for each category of tasks.

• Overtime was approved for targeted jobs as determined by management.

• An associate’s regular manager had to approve a request to work overtime in coordination with the patient intake team leader so it didn’t interfere with the associate’s regular job assignments.

• The patient intake team leader was responsible for establishing the number of associates needed and hours required, for training and competency validation, and for productivity/quality and outcomes reporting.

• Overtime limits were not to exceed 20 hours per week for a total of no more than 60 total hours worked per week.

3. Staff recruitment incentive. Employees who helped recruit another staff member received a monetary bonus after the new employee had performed the job successfully for three months.

Although the hospital had used several other ways of finding staff, this method brought the best results, Woerly says. "We had recruitment agencies looking for staff, had a job fair, and had talked to the deans at community colleges. But we found that if our people recommended a friend or a cousin, they’re motivated to want that person to succeed and also will assist in training to help make that happen."

Before leaving that organization, he notes, "I signed off on six or seven [recruitment bonuses] departmentwide over a three- or four-month period."

Participation in the various incentive plans, whether assisting in staff recruitment or working unscheduled overtime, also figured into employees’ annual evaluation and contributed to salary increases, Woerly adds.

Despite the frustration access managers sometimes feel when their best employees go on to bigger and better jobs outside their departments, it’s a good thing to assist in employees’ "career-building," Woerly maintains. During his various tenures as access director, he identified and encouraged a number of employees who advanced in their careers, many of them within the access department.

"One [access employee] had an interest in computers and an organized process mindset," he recalls, "and I told her she had the talent to work as a system administrator."

The woman expressed a need for more computer training, which Woerly arranged. She now serves as a system administrator at that organization.

"Be aware of people who have potential and assist them," he recommends. "It’s a matter of not settling for the mediocre as you’re hiring. Hire with the idea of allowing that person to gain knowledge and experience. Provide vehicles like training and attendance at meetings of professional organizations to build their skill set and allow staff to move up."

Even those who move on to other departments can provide a benefit to access services by enriching the knowledge about patient access in their new jobs, he says. Woerly cites another access employee who went on to become an executive secretary to the institution’s chief executive officer. Another associate received training in radiology and is now director of that service.

"When issues or problems came up [regarding access services], both individuals could say, I worked there, and I know why they do that,’" Woerly says. "These people can be positive communicators and supporters for your department."

[Editor’s note: Hospital Access Management would like to publish your staffing solutions. Please contact editor Lila Moore at (520) 299-8730 or to share ways you’ve found to attract qualified staff and keep them happy.]