© 2013 HealthcareSource

HR Initiatives White Paper: 2014 HealthcareSource & ASHHRA Healthcare HR Initiatives Survey Results & Insights

White Paper

The fifth annual Healthcare HR Initiatives Survey found that

HR organizations continue to struggle with too many initiatives,

as well as budget limitations. An industry-wide response is

to streamline HR processes and improve employee retention.

Work is underway to improve employee satisfaction and to

increase employee accountability. These efforts will require

culture change and HR professionals must take the lead.

In the year ahead, healthcare HR organizations plan to

implement technologies to support applicant tracking,

eLearning, and performance management. Not only will

these systems help HR teams work more efficiently, well-

integrated systems can help break down barriers between

HR and education functions.

2 Copyright © 2013 HealthcareSource. All rights reserved.

The HR Initiatives SurveyHealthcareSource and the American Society for Healthcare

Human Resources Administration (ASHHRA) recently

conducted their fifth annual HR Initiatives Survey. The objective

of this survey is to better understand how healthcare HR

professionals are addressing three strategic goals: reducing

costs, improving patient satisfaction and safety.

The survey questions were developed jointly by

HealthcareSource and ASHHRA in 2011 with input from

healthcare HR professionals. This year’s HR Initiatives Survey

was available online from May 15–June 30. This year over 500

HR professionals at healthcare organizations across the United

States participated.

This white paper summarizes the HR initiatives that healthcare

HR professionals view as most important to achieving cost

reductions, as well as increased levels of patient satisfaction

and safety. Industry experts also reviewed the survey findings

and offered their insights. This group included:

•Frederick P. Morgeson, PhD., Eli Broad Professor of Management, Eli Broad College of Business, Michigan State University

•Ursula Pawlowski, MSHR, HR Concierge & Membership Specialist, ASHHRA

•Donna Wright, MS, RN, Consultant, Creative Health Care Management

HR Initiatives to Reduce CostsTight budgets and increased workloads continue to be facts

of life for healthcare HR professionals today. When it comes to

cutting costs, most organizations are pursuing HR initiatives

related to more efficient processes and employee retention.

Almost three quarters of respondents (74%) indicated that their

top initiative for reducing costs was streamlining HR processes.

A little over two thirds (69%) of survey participants noted that

they are trying to improve retention rates.

It’s interesting to note that compared to 2013, healthcare reform

has taken on less significance in terms of cutting costs. The

percentage of respondents concerned with healthcare reform in

2013 was 64%—twenty percentage points higher than this year.

Last year’s interest in HR processes and employee retention was

about the same —73% and 66% respectively.

Panel CommentaryThe panelists were not surprised at HR organizations’

continued emphasis on more efficient HR processes and

employee retention. They offered their thoughts about what

is occurring in healthcare organizations across the country.

Employee turnover is a chronic problem, but HR practices

can improve retention.

For as long as the HR Initiatives Survey has been published,

organizations have consistently focused on improving

employee retention rates as a way to reduce costs. Dr.

Morgeson feels like one reason is because retention is a

chronic problem in healthcare that is not likely to go away.

Healthcare work is stressful, people work long hours, and

there are potential scheduling challenges. In addition,

healthcare workers have skills that are transferable from

one organization to another. Switching jobs is relatively easy,

especially in larger cities where there are large numbers of

healthcare jobs and worker shortages. Turnover is costly

for organizations. When a person leaves, the cost to the

organization is the employee’s first year’s salary. Retention is

important from a financial perspective, but it’s also crucial for

continuity of care. “Since some of the highest turnover levels

are in healthcare, we’ve started to look at how HR practices

can increase retention,” said Morgeson. “Common levers

include leadership, work design, and employee initiatives.

During the hiring process, one effective approach is to

use assessments which identify people who are more likely

to stay.”

Copyright © 2013 HealthcareSource. All rights reserved. 3

Survey Questions1. What are your current HR initiatives to reduce costs?

2. What your current HR initiatives to improve patient satisfaction?

3. What are your current HR initiatives to improve patient safety?

4. What are your biggest challenges with achieving your HR initiatives?

5. What new technology are you planning to adopt in 2014/2015 to achieve your HR initiatives?

Respondent Job Level Respondent Job Level

HealthcareSource is the leading provider of talent management solutions for the healthcare industry. More than 2,300 healthcare organizations use HealthcareSource talent management solutions to recruit, develop, and retain the best workforce possible to improve the patient experience.

ASHHRA is the premier association of healthcare HR professionals, providing advocacy, research, publications, networking, and learning for healthcare HR professionals.

Questions were multiple choice, with the ability to select more than one answer. Respondents were also allowed to provide their own responses and comments.

4 Copyright © 2013 HealthcareSource. All rights reserved.

One aspect of streamlining HR processes is educating

employees selectively, rather than large scale training

programs.

It’s interesting to note that most organizations want to

streamline their HR processes, while only 22% are focused

on implementing education to comply with regulatory

bodies. Donna Wright felt that these statistics are consistent

with the trend she’s seen where healthcare organizations

are trying to assess educational needs and provide training

more selectively. “Part of streamlining processes is to filter

out which employee groups really need education. More

healthcare organizations are asking if the massive and

costly ‘let’s educate everyone’ initiatives are needed,” she

observed. As a result, many HR teams are applying critical

thinking to determine when to use education.

Streamlining hiring processes can save money in the

long run.

Many ASHHRA members are considering how to streamline

their hiring processes. Spending a little more time and

money upfront to hire the right candidate can improve

retention and save money. “Labor is the biggest expense

that healthcare organizations have,” said Ursula Pawlowski.

“As we hire, we must include assessments and interview

questions that will identify candidates who are exceptional,

will deliver on the hospital’s mission, and are committed to

providing a positive patient experience.

HR Initiatives to Improve Patient SatisfactionAccording to survey respondents, improving employee

satisfaction and creating a culture of employee accountability

are top priorities related to patient satisfaction. This confirms

the central role that employees play in delivering quality care.

Other popular initiatives for enhancing patient satisfaction

included creating a service-oriented culture and providing

employee education.

Top Initiatives for Improving Patient Satisfaction

•Improve employee satisfaction (79%)

•Foster a culture of employee accountability (68%)

•Create a service oriented culture (67%)

•Provide employee education (59%)

Copyright © 2013 HealthcareSource. All rights reserved. 5

Employee Turnover Is Unlikely to Go Away, but Modifying Hiring Practices Can HelpTrends suggest that employee retention will continue to be a challenge for healthcare organizations. As the economy has rebounded, healthcare turnover rates have increased. “As people feel more comfortable with their financial situations, they feel more comfortable quitting their jobs,” said Dr. Morgeson. “This is a dynamic that will persist.” Another factor is the anticipated growth in healthcare occupations. The latest data from Bureau of Labor Statistics projects from 2012 to 2022. Seven of the top ten occupations are in healthcare. “If you don’t have a retention and turnover problem now, you might in the future. If you have one now, it’s going to get worse because there will be more healthcare jobs available. That puts a premium on doing things from an HR standpoint to retain people,” said Dr. Morgeson.

Panel CommentaryImproving employee satisfaction doesn’t have to be costly, but

it does require a culture that values employee input and takes

action on that information. Making any type of cultural change,

however, can be difficult.

The key to employee satisfaction is listening to employees

and delivering what they need.

It’s important that employees feel their voice is heard, their

opinions are valued, and they are part of the decision-making

process. “Ask how employees would improve a process

or improve the work environment. If we then act on those

suggestions, it goes a long way with employee satisfaction,”

said Pawlowski. Healthcare organizations must support

employees because they are on the frontlines of delivering the

patient experience. Sometimes employees spend more time

at the hospital than they do with their loved ones at home. “It’s

not so much how much we spend to make employees happy,

it’s more about listening and helping deliver on their needs

within the hospital,” noted Pawlowski.

Creating a culture of employee accountability and service

excellence begins at the top.

Culture change is difficult. Organizations can have the best

strategy, but if they can’t execute on it, it’s pointless. A

commitment to better execution and integration has to start

at the top. “Senior HR people and other senior leaders must

make accountability and service excellence a strategic priority.

For that to happen, there must also be a mission and goals

focused on these elements. Without these things, organizations

will have a hard time with culture change,” observed Dr.

Morgeson. Leaders need to “walk the talk” and give employees

the resources and freedom needed to make decisions on their

own, as well as support when challenges arise.

Although employee education, HCAHPS, and other

certifications can contribute patient satisfaction, they

aren’t seen as the biggest drivers.

Only 59% of respondents said they will use employee

education to improve patient satisfaction, only 40% plan

to focus on HCAHPS, 31% will focus on Joint Commission

requirements, and just 18% plan to focus on supporting

Magnet recognition to increase patient satisfaction. Dr.

Morgeson believes that people may not see these types of

initiatives as critical to driving the patient experience. A positive

patient experience is comprised of many different things, so

trying different approaches is a reasonable one. Another factor

is that many hospitals are resource constrained. As a result,

organizations must prioritize their efforts and look for things

that will deliver the biggest patient satisfaction bang for their

limited dollars.

HR Initiatives to Improve Patient SafetyTo improve patient safety, healthcare organizations need

to drive behavioral change among employees. To improve

employee awareness and to encourage different types of

behaviors, healthcare organizations are focusing primarily

in two areas. The majority of survey respondents (69%) are

working to improve workforce education and development.

Over half of organizations (59%) are also trying to increase

employee satisfaction.

Top Initiatives for Improving Patient Safety

•Focus on employee education and development (69%)

•Improve employee satisfaction (59%)

•Hire for cultural fit (54%)

•Improve retention rates (43%)

6 Copyright © 2013 HealthcareSource. All rights reserved.

Panel CommentaryAlthough healthcare organizations are still focusing on employee

education, they are also looking at broader system issues that

affect patient safety. The percentage of organizations focusing

on employee education and development declined from 79% in

2013 to 69% in 2014.

Donna Wright believes that healthcare organizations are taking

a fresh look at what delivers results with regard to patient safety.

“In the past we gave people a lot of education, thinking that

would make patients safer. However, in most cases, safety issues

aren’t about knowledge deficits. It’s more about the broader

environment and system in which employees work,” said Wright.

“The decreased focus on employee education and development

may be due to the fact that healthcare organizations are peeling

back the onion, looking at the system issues, and figuring out

what employees really need.”

Employee Balanced Scorecards and EducationFor many years, organizations have created dashboards and balanced scorecards to evaluate departmental and enterprise-wide performance. Donna Wright is seeing more healthcare organizations creating individual balanced scorecards for employees. These shine a light on employees, how engaged they are, and how they are doing with regard to personal indicators. These dashboards or balanced scorecards help identify the education and training that will have the greatest positive impact on individual employees.

“People go into healthcare careers because they want to make things better. That’s what drives employee engagement. That gets diluted, however, when there’s a problem and the organization responds by educating everyone,” observed Wright. Employee balanced scorecards are a way to filter out which training will be most useful, based on individuals’ unique needs. “This is powerful because it’s the same application of critical thinking that healthcare professionals do at the bedside. This approach to education focuses more on outcomes than processes, which is the key,” said Wright.

That gets diluted, however, when there’s a problem and the organization responds by educating everyone,” observed right. Employee balanced scorecards are a way to filter out which training will be most useful, based on individuals’ unique needs. “This is powerful because it’s the same application of critical thinking that healthcare professionals do at the bedside. This approach to education focuses more on outcomes than processes, which is the key,” said Wright.

Copyright © 2013 HealthcareSource. All rights reserved. 7

Challenges in Achieving HR InitiativesSimilar to the prior year, survey respondents are challenged

by competing initiatives and insufficient budgets. Inadequate

technology is also a pain point for many.

Top Responses for HR Challenges

•Too many competing initiatives (67%)

•No budget to implement programs (49%)

•Insufficient systems and inadequate technology (43%)

Panel CommentaryThe panelists offered several recommendations to help HR teams

juggle multiple initiatives:

•Become part of the planning process. Many meetings occur in healthcare organizations. HR needs to be in the right ones at the right time when budgets are put together. “We must be part of those conversations, rather than someone handing HR a budget and saying ‘make this work’,” said Pawlowski.

•Ask how initiatives align with the organization’s strategic goals and mission. It’s important to prioritize and select the programs that are the most feasible and will have the biggest impact. Part of this analysis should include how programs will affect the patient and employee experience.

•Consider automating routine activities with technology. Often HR is bogged down fighting fires. These transactional activities require a lot of time, but not great thought. “It’s possible to outsource these routine activities to technology,” said Dr. Morgeson. “That’s a proven way to get yourself out of the administrative aspect of HR and into the more strategic parts where you can focus on initiatives that will move the needle.

New Technology Adoption to Support HR InitiativesHealthcare HR professionals recognize that technologies

can help as they try to meet their organizational goals while

simultaneously streamlining important processes and reducing

costs. Performance management systems, for example, save

time for both HR teams and frontline managers, while eLearning

content adoption helps mobilize talent in the workplace faster.

Given the tough financial climate, employees must get up to

speed quickly to meet the demands of patient care.

Top Responses for New Technology Adoption

•Performance management (30%)

•eLearning content (25%)

•Applicant tracking software (22%)

8 Copyright © 2013 HealthcareSource. All rights reserved.

Panel CommentaryAlthough performance and education reside in different

departments, it is possible to integrate and link these

functions more closely. The first step is to convince people

that the change will help them, and then show how it will

help the organization succeed and thrive. To bridge the gap

between performance and education, the panelists offered

the following suggestions:

•Develop cross-functional teams. This is a good way to start work on integration issues. “People like working on teams,” said Dr. Morgeson. “In these groups, employees develop relationships that supersede their departmental identities.” Organizing cross-functional teams around the organization’s goals is an effective way to align employee behavior.

•Consider an integrated performance and education system. According to Donna Wright, HR and education see each other through a glass wall, but their activities often aren’t integrated. Technology is a way for these functional areas to connect, identify the organization’s true needs, and evaluate the return on investment of different activities. “Too often systems are siloed. What we need is one integrated performance and education system,” said Wright.

•Move toward just in time education for employees. Looking ahead, Donna Wright believes that education systems will guide employees to the appropriate training for a specific point in time. “Many organizations engage in “spray and pray” education – they spray one type of training on everyone and pray that it improves outcomes,” said Wright. In contrast, just in time learning at the point of service is more engaging. “Employees need a more meaningful connection to education. It would be great if I was pulling an order to hang a unit of blood on a patient and the system recognized that it’s been seven months since I last reviewed the policy and there have been two updates in the meantime. It might prompt me to download a 15 minute module on how to do the procedure which included information from a new research study,” said Wright.

ConclusionDespite the fact that the healthcare industry is subject to continual

change due to the evolution of regulations and policies, care

delivery and payment models, and the rising demand for health

services—based on the past five years of data, it can be assumed

that healthcare talent management professionals will always be

expected to do more with less. Year over year, results have shown

that the main objectives are to deliver their services as efficiently

and as cost effectively as possible. This translates into the ever-

increasing interest in the adoption of technology solutions to ease

the burden of manual work by automating processes. When talent

management teams succeed in recruiting and retaining the right

employees, healthcare organizations are in stronger position to

deliver high quality care—translating into high levels of patient

safety, satisfaction and overall organizational excellence.

The 2014 HR Initiatives Survey highlights how healthcare HR

teams are looking to technology to help improve efficiency and

to work in a more cost-effective manner. Automating routine

work results in more streamlined HR processes and enables

HR professionals to focus on the higher value aspects of hiring

and employee development which contribute to employee

satisfaction and staff retention. Technology like eLearning makes

it possible to personalize education and evolve toward a model

of just in time learning that will increase employee engagement

and improve patient safety.

“ HR and Education see each other through a glass wall, but often aren’t integrated. Technology is a way for these functional areas to connect, identify the organization’s true needs, and evaluate the return on investment of different activities. Too often systems are siloed—we need one integrated system and processes.”

Donna Wright, MS, RN Consultant, Creative Health Care Management

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About HealthcareSourceWith more than 2,300 healthcare clients, HealthcareSource is the leading provider

of talent management solutions for the healthcare industry. The HealthcareSource

Quality Talent SuiteSM helps healthcare organizations recruit, develop, and retain

the best workforce possible in order to improve the patient and resident experience.

The company’s cloud-based talent management solutions include applicant tracking,

behavioral assessments, reference checking, employee performance, compensation,

competency and learning management, and eLearning courseware. A private company

focused exclusively on the healthcare industry, HealthcareSource consistently earns

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year, in addition to recognition in Healthcare Informatics 100, Modern Healthcare’s

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