Employee morale: What can you do when you can't give them a raise?
'Appearance of fairness and equity' key to keeping staff motivated
When your average employee is making $12 an hour, you face distinct and unique challenges. This is something it seems every director or manager of patient access knows personally and your responses to Hospital Access Management's annual reader survey reflect this year in and year out. Among your greatest challenges, you tell us, are staffing issues a poorly qualified labor pool, a pay scale that doesn't match employees' responsibilities, and a low level of respect for management. And hand in hand with those come your obstacles: employee satisfaction, morale, and turnover.
"Without a doubt, the issues relating to patient access can be attributed back to the staff," says Michael S. Friedberg, FACHE, CHAM, director of patient access services at Apollo Health Street and author of Staff Competency in Patient Access.
Friedberg recalls a CFO who came to him while he was working in the provider arena and said, "If it's a matter of money and you think it's going to help, I'll pay [registrars] a couple of bucks more." He asked Friedberg to do the math and let him know. "The difference between $12 and $14, or even $12 and $15, is not that big of a difference and will not improve the pool of applicants," Friedberg responded. Very few hospitals are going to go to $20 an hour for a registrar, which would make a difference in the applicant pool, he adds.
Of course, he says, factors such as where you're located and whether you're in a rural, urban, or suburban area play into what access employees are paid, but in general you're dealing with a lower-wage employee.
"So what happens when you have a problem such as the pay scale and you can't raise the pay?" he says. "You have to be creative and be a better manager." Therein lies the challenge.
"There are a number of ways to motivate staff," Friedberg says, "and there are a number of ways to build accountability into the system of daily work and life in access." As he says, it's a matter of creativity.
He emphasizes above all "the appearance of fairness and equity" in boosting and maintaining morale among your staff.
Judy Hebble, BS, CHAM, corporate director, access services for Meridian Health, a hospital system in New Jersey, says her boss, the vice president of financial services, "is very supportive" another important factor in employee morale "and appreciates that if we don't do what we do then the back end can't collect." She says Meridian's human resources department has done market surveys and reported back that billers could be making more. Her supervisor's response has been if access isn't going to get a raise, then billers don't get a raise, keeping the pay scale consistent across the department, which includes both access and financial services.
Incentive programs: The good and the bad
Friedberg suggests programs such as employee of the month as incentives. "If done well, if done right, if done so that it's not cheesy, it can be very effective because then people see that they're recognized for hard work." But you first must develop clearly established criteria, he says.
Implementing a quality assurance program or productivity standards also is a good step, Friedberg says, adding that it needn't be a full-blown QA endeavor if resource restrictions are an obstacle. But it should include benchmarks such as codifying that each registrar should do 30 registrations per shift and illustrating that in a graph that shows who did and who didn't accomplish the goal. That's a great motivator for staff, he says.
That's also building in the accountability that he talks about as key to morale. "When nobody is watching and you have two people on the same shift in the emergency room and one does 40 registrations and one does 12 because one's a conscientious employee and the other is a slacker, eventually the one who does 40 is going to get frustrated," he says. "And either they take it out on a patient, they take it on the other employee, or they leave."
As a caveat to emphasizing the positive, an important element in cultivating employee morale, Friedberg offers this story: He worked at a hospital and one of the senior VPs would walk around the hospital handing employees who he spotted doing something nice for patients a gold star. The practice was a great idea, Friedberg says, but didn't involve employees' individual day-to-day supervisors. So, this VP saw a particular employee doing something good and handed him his ubiquitous gold star.
"Little did he know," Friedberg says, "that I was in the process of preparing to terminate the employee the next day because he was an awful registrar. The VP happened to observe him doing something nice for a patient, which as it turns out was out of character." When Friedberg approached the employee about the problems he had had with him, the employee responded incredulously, saying, "Well, I got a gold star."
"Those types of accolades," Friedberg says, "should never be spontaneous. That's when you get into trouble."
The career ladder
One of the most effective tools Friedberg espouses is a career ladder. It's something Hebble uses in her department, which in addition to access and patient financial services includes central scheduling, IT, charity care, Medicaid, nurse bed managers, and an education department.
Beyond being a motivator, a career ladder also provides staff with more opportunities for promotions in pay and status. Hebble says employees at Meridian have to qualify every year and can't have any disciplines on their record for the corresponding year. "You need to write two policies and inservice staff on them," Hebble says. "You need to get more continuing education credits than Meridian qualifies that you get. For level three, you have to get your CHAA. You have to get a certain mark on your annual performance appraisal to get to different levels." (See Meridian's career path policies.)
Friedberg suggests adding elements such as: For level one, you must have a 90% accuracy rate, no more than five patient complaints in a year, no tardiness. Level two and three could require that employees receive CHAA certification and that they mentor a newer staff member for a couple of hours, he says.
It's easier to motivate already conscientious employees. So what do you need to look for? The qualities Hebble looks for are:
- the ability to multitask;
- the ability to be independent and be motivated without substantial outside praise;
- the ability to make decisions. (She says, for example, access employees need to know how much to push a patient or his or her family for information and when they need to stop and get it from another source.)
"We look for the personality traits as opposed to the skills," she says. Meridian also taps into its wide per diem pool when positions open in access or financial services a boon, as Hebble says. "That's a really important piece for us. We've gotten to test people and they've gotten to test us."
(For more information, contact: Michael Friedberg at [email protected] or (973) 233-7644 or Judy Hebble at [email protected].)
When your average employee is making $12 an hour, you face distinct and unique challenges.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content