Community Health Foundation Health Leadership Fellows Program

Promising Practices in the Care of Elders: Innovative Ideas Grown in CNY

May 4, 2010

Beyond a Warm Body Strategies for Improved Recruitment in

Central New York State and Retention of Frontline Healthcare Workers

CNY MAVENS• Cheryl Coolican, Director of Admissions, Loretto Health and Rehabilitation Center• Mary Bishop – Executive Director, CPEP, St. Joseph’s Hospital• Deb English – Director, Cayuga County Nursing Home• Tammy Marshall – Vice-President Mission Integration and Quality Workplace, Loretto Health and Rehabilitation Center• Helen Stepowany – Associate Executive Director, Upstate Cerebral Palsy

Beyond a Warm Body - Phase I

BASIS FOR STUDY

• Research indicated that many if not most healthcare organizations face a continuing struggle to recruit, hire and retain frontline healthcare workers.

• Unfortunately research also indicated that the number of individuals requiring care will rise in the coming years, but the number of people available to provide that care is expected to remain the same.

• Healthcare worker turnover impacts the quality of patients care and patients lives, drains organizational resources, and costs our healthcare organizations millions of dollars.

• Development of an interviewing tool to identify core attributes which are important predicators of a successful frontline healthcare worker who is BEYOND A WARM BODY

Beyond a Warm Body - Phase I

DEVELOPMENT OF THE HIRING PROCESS AND INTERVIEW TOOL

•Begun in early 2006•Evaluation of impact of front-line employee turnover•Defined front-line workers as residential counselors, certified nurse assistants and mental health counselors.•Researched “best practices” thinking for choosing the attributes that make a successful front-line worker.•Research assistants from the Maxwell School performed a literature review identifying best practices nationally and the various process improvement steps employed in the best practices institutions.•In conjunction with the Syracuse University Leadership Institute, a “mind map” was created to provide a graphic representation of movement from current state to the ideal state of the hiring process. •Ten essential attributes were identified for inclusion in the interview tool.•Piloted at four sites; Loretto Health and Rehabilitation Center, Cayuga County Nursing Home, St. Joseph’s Hospital CPEP and Upstate Cerebal Palsy

Beyond A Warm Body - Phase IIThe goal of the project is to produce a screening tool and process that will increase the likelihood of hiring appropriate individuals for front-line healthcare positions, who possess attributes of caring, compassion, and a strong sense of responsibility.

• Utilizes the hiring process and tool developed in Phase I, and continues a full scale research project. The scoring for each question on a 1 - 5 scale is as follows:

1= Does not exhibit desired characteristic 4=Strongly exhibits

characteristics 2= Minimally exhibits characteristics 5=Exceeds

desired standard for characteristics 3= Satisfactory

• Includes an in-depth analysis of current research and replicates the study utilizing a multi-site experimental group.• Analyzes the statistical data of the research project, and the analysis will drive any modifications of the tool and process.• Modifies the interview tool by assigning a weight of 1 – 3 to each question based upon the overall relative importance of the attributes. • Requires a score of 72% or higher on the interview tool for candidate to be considered for employment. However, exceptions can be made with written justification.

Category Behavioral Interview QuestionComment on Candidate’s Response

Score Assigned Score

Weighted Score

(1) Commitment to care

Tell me about a time at work or at school where you really went the extra mile to make sure things got done right.

(2) Compassionate caring

Tell me about a time at work or school when you tried to help someone out who was failing at something or was going through hard times.

(3) ConflictManagement

Tell me about a time at work/school where you disagreed with a boss/teacher.

(4) “Thinking on your feet” / Critical Thinking

Tell me about a time at school, work or life experience, when you had to learn something quickly.

(5) Setting Priorities

Tell me about a time at school or work were you were very busy and had to prioritize your care and practice activities.

(6) Leadership

Tell me about a time when experience you’ve had at work or during school where you had to lead others.

(7) Communication

Tell me about a time when you realized that a patient/family member had difficulty understanding what you were explaining.

(8) Organization

Tell me about a time at work or at school where you were in a situation where it was really important to keep track of things and how did you do it?

(9) DiversityAs a rule what kind of people do you find it easiest and/or hardest to work with?

Physical Presentation(body language, general clean appearance)

Observation

Beyond A Warm Body Phase II - REVISED INTERVIEW TOOL

COLUMN A B CCategory Weight Assigned Score

(1 to 5)Weighted Score

(A x B)

(1) Commitment to care 3(2) Compassionate caring 3(3) Conflict Management 3(4) “Thinking on your feet” / Critical Thinking 2

(5) Setting Priorities 2(6) Leadership 1(7) Communication 3(8) Organization 1(9) Diversity 2(10) Physical Presentation (body language, general clean appearance)

1

Beyond A Warm Body Phase II - INTERVIEW TOOL SCORING MATRIX

Total Weighted Score (Column C) / Total Maximum Score (105) = %

TOTAL FOR COLUMN “C” (ADD NUMBERS IN COLUMN)  

Beyond A Warm Body Phase II - TESTING THE INTERVIEW TOOL

Test Sites Beginning in July 2009, after the completion of on-site training, the following began using

the INTERVIEW TOOL•Loretto Health and Rehabilitation Center, Syracuse•Mercy Hospital and Rehabilitation Center, Auburn, NY, •Home Aides of Central New York, Syracuse •Upstate Cerebral Palsy (UCP), Utica, NY•Enable of SyracuseFacility

Control Test

Test > 72%

Test < 72%

No. Test Hired

Avg. Score

Range Scores

Loretto 20 10 8 2 10 82.3 69 - 98Home Aides 81 54 35 17 27 69 0 - 100UCP NA 49 22 27 24 65.3 39 - 86Mercy NA 18 14 4 12 76.3 57 - 94Enable                101 131 79 50 73 73.23 0 - 100

Test Results (as of 3/1/10)

Beyond A Warm Body Phase II - TESTING THE INTERVIEW TOOL

NEXT STEPS

• Each test site is tracking employment status of those test subjects who were hired using the interview tool• Final employment status will be determined as of 5/1/10•Each test site will complete an evaluation form on the use of the interview tool• Retention rate of the test subjects will be compared to historical retention rates of each test site• Complete statistical analysis will be conducted to discern anomalies and trends in hiring data

EXPECTED OUTCOMES

Beyond a Warm Body - Phase II

Short Term•Lower employee turnover rate•Increased employee satisfaction•Greater customer satisfaction•Greater profit potential•Competent, stable work force•Greater middle management satisfaction

Long Term• Improved quality of care•Opportunity for program enhancements•Improved quality of life for care recipients•Improved access to health care•Organizational satisfaction

Beyond a Warm Body - Phase II

Anecdotal feedback received so far…• Interviewees generally understood the questions on the interview tool when asked•There was a modest learning curve for interviewers in using the interview tool• For the most part, users of the tool expressed satisfaction with the behavioral nature of the questions, which reinforced the attributes they were seeking in employment candidates. • Sites reported an actual reduction in turnover due to the current state of the economy. In other words, since other employment opportunities are limited, there is little opportunity for front-line health care workers to find other jobs; therefore, they were more likely to stay in their current jobs.