Employee retention: Everyone has a stake
By Steve Gregory, RPh, MBA
Principal, Delta Resource Alliance
Kansas City, MO
(The April issue of Drug Utilization Review examined the shortage of pharmacists and the impact it has had on the delivery of quality health care in the United States. As a follow-up to that article, this two-part series will provide a strategy aimed at retaining those valuable employees and discuss the economic penalties associated with employee turnover. This article focuses on the individuals in an organization — regardless of rank — and their contribution to an employee retention strategy. Next month’s article will focus on the organizational strategy.)
As a profit center, a pharmacy department’s inability to attract and retain valuable employees can have a significant impact on the financial performance of the hospital. For a manager of that department, whose future success depends on retention and other performance measurements, this topic should be of particular interest. For staff pharmacists, it may be the first time you realize that your attitudes and behaviors have an impact on an organization’s financial health.
In retrospective interviews with organizations facing employee turnover issues, we usually can pinpoint early warning signs of trouble. The first signs usually include an increase in complaints, rumors, and finger-pointing from employees about the work environment, the workload, and their inability to deliver quality products and services. At this point, the organization is trying to deal with poor morale and negative attitudes.
Left unchecked, there will be a progression to increased tardiness and absenteeism with a subsequent increase in the employee turnover rate. When employee turnover is a significant issue, the factors associated with understaffing, the dearth of tenured employees, and the increased number of employees-in-training can cause quality to become an issue. If quality is not addressed in pharmacy, there may be a final warning sign — a near tragedy or fatal outcome.
If management is aware of the turnover rate (most are not), they oftentimes fall into the trap of comparing their rate to local, regional, state, and/or national averages. Once they discover that they are "within range of the average rate," most will decide they are doing as well as most and will not address the issue.
For example, if you determine that your department has had a 40% turnover rate for the last three years and, after some research, discover that the statewide average is 29%, you may decide that "10 points is close enough for government work." But if that rate is based on a department of 40 pharmacists in a large corporate hospital paying $70,000 per year, we could estimate that your complacency is costing your organization $373,333 per year. Looking at the three-year trend, you would realize that this attitude cost your organization $1,120,000.
Most experts dealing with employee turnover issues use the following equation to estimate the financial impact:
That figure represents the costs associated with advertising and recruiting for new positions, screening and interviewing, processing new employees, orientation and training, overtime, and agency staffing. Because human resource costs account for 50% or more of an organization’s operating costs, we can understand why employee turnover costs are referred to as the single largest hidden cost affecting the profitability of organizations. As previously noted, this equation only provides a retrospective estimate. To ensure the accuracy of this calculation, all of the activities associated with employee turnover should be identified, and the costs associated with those activities should be measured and monitored on a routine basis.
Another financial cost, the cost of poor quality, penalizes an organization when employee turnover remains unresolved. If you do not have the right people in the right place at the right time, it becomes difficult to deliver quality products and services. The costs associated with poor quality can be the result of waste and rework, low productivity, litigation, long cycle times, incorrect ordering and delivering, loss of goodwill, lost future customers (patients), lost current customers (patients), etc. Many experts place this figure at 20% to 25% of annual revenue.
If you feel that employee turnover is an issue in your organization but do not have the data to support your hypothesis, calculate the employee turnover rate for the past three years and estimate the annual cost associated with that rate for the past three years. If you feel that quality is also an issue, determine your department’s contribution to annual revenue and estimate the cost of poor quality over that same time frame. Summing these two estimates may provide you the motivation to proceed to a corrective course of action.
It’s all in the environment
Knowing that pharmacy is facing a severe shortage of pharmacists, it becomes a strategic advantage when you are one of the organizations that has a reputation for keeping good employees. The key to retaining employees is the creation of an environment where people show up to work each day because that is their desire instead of their penance. All too often, managers tend to think in terms of salary and benefits when trying to create the environment that will attract and retain good employees. While salary and benefits may attract a potential candidate to the interview, we find that these factors are not as important in retaining them once they are hired. In fact, surveys consistently show that employees across all industries feel that the ideal work environment is one in which there is/are (in order of priority):
1. full appreciation for the work they do;
2. a feeling of "being in on things"
3. help for personal problems (e.g., scheduling change in order to take elderly family member to medical appointment);
4. job security;
5. high wages;
6. interesting work;
7. promotion opportunities in the organization;
8. personal loyalty from the manager;
9. good working conditions;
10. tactful discipline.
Excluding job security and high wages, all of the factors associated with the ideal work environment require certain interpersonal skills and behaviors. Creating a place where people show up to work because they want to instead of because they have to, therefore, begins with a focus on the attitudes that will ensure the delivery of those behaviors.
Regardless of your position in the pharmacy department — director, manager, supervisor, or staff — you can make a tremendous contribution to the creation of this ideal environment just by choosing the right attitude.
Your attitude — how you feel about yourself, your profession, your colleagues, the situations you find yourself in, etc. — drives your behavior. Your behavior, the outward expression of your attitude, ultimately determines the results you will achieve. For example, imagine yourself as the manager of a pharmacy department who has just hired four new pharmacists. At your weekly staff meeting, one of the new pharmacists suggests a new way to process the STAT IV orders to improve the turnaround time. Your attitude and behavior in response to this suggestion may have the following results:
Attitude: In response, you think to yourself that new people should not be making suggestions until they have been here long enough to see how everything works.
Behavior: You politely thank the new pharmacist for the suggestion and tell him that you will meet with him to discuss this idea further. Knowing that this person has not been here long enough to formulate an intelligent suggestion, you never get around to meeting with the new pharmacist.
Result: Innovation and change never occurs in your pharmacy. Everything is done the way it was when you started working at the pharmacy. The new pharmacist is initially confused about why you haven’t met with him. This confusion later turns into anger, and he shares his frustration with the other new pharmacists. The four new pharmacists conclude that their new ideas will never be heard by this manager and decide that it is not worth the trouble to come forward. As their frustration mounts, morale may suffer, leading to the possibility that these new pharmacists may start looking for a different work environment and a more forward-thinking manager.
Now, consider the results if you, as the pharmacy manager, had a different attitude:
Attitude: You subscribe to Joel Barker’s philosophy that paradigm shifts (i.e., change and innovation) come from those who are new to the organization and, thus, welcome all new ideas, especially from newcomers. Barker is a futurist who is known for his research in organizational change and videos he has produced describing paradigm shifts.
Behavior: You meet with the new pharmacist to listen to his new ideas and suggest that he present his proposal at the next staff meeting.
Result: The new pharmacist feels a sense of belonging and affiliation. He demonstrates a 33% reduction in turnaround time, and the new process is implemented. Physician and nurse complaints about late IVs drop 76%, and everyone is happy. The new pharmacist shares his enthusiasm with the other new pharmacists. They conclude that their input is wanted and appreciated and feel that this is the perfect environment to begin their pharmacy career.
Whether you are a part of the management team or one of the staff pharmacists, a routine and honest assessment of your attitudes and behaviors will provide valuable insight with regard to the current results you are achieving in the personal and professional areas of your life. For the courageous, you can ask your colleagues or significant people in your life (such as your spouse, a close friend, or a family member) what interpersonal skills could be improved to make you a better person. For the noncourageous, assessment tools can help with this exercise.
While there are sophisticated assessments available to measure your attitudes, you can get an idea of how your current outlook is contributing to the current environment in your organization by answering the questions in Table 1, above. After answering the questions, total your points and compare your score to the key to determine if you have a positive or negative attitude toward the practice of pharmacy.
| Table 1-Attitude Check | |
| 1. How do you feel about your decision to become a pharmacist? | |
| A. Best decision of my life. (6 points) | |
| B. I'm just doing this until I decide what I want to be when I grow up. (3 points) | |
| C. Worst decision of my life. (0 points) | |
| 2. How do you feel when counseling a patient about discharge medications? | |
| A. I'm there to ensure a favorable treatment outcome. (6 points) | |
| B. I'm just doing this until I decide what I want to be when I grow up. (3 points) | |
| C. Why do I bother? (0 points) | |
| 3. How do you feel when a nurse calls asking where the medications are that were ordered 90 minutes ago? | |
| A. We are both here to serve the patient. (6 points) | |
| B. I'm just doing this until I decide what I want to be when I grow up. (3 points) | |
| C. This person is only worried about ending their shift on time. (0 points) | |
| 4. How do you feel about the people you work with and/or who report to you? | |
| A. This team is making a great contribution to our success. (6 points) | |
| B. I'm just doing this until I decide what I want to be when I grow up. (3 points) | |
| C. They're the biggest group of whining, incompetent jerks I've ever known. (0 points) | |
| 5. How would you feel if administration issued a directive for all departments to cut costs by 15% this year? | |
| A. Departments, hospitalwide, working together ensure overall success. (6 points) | |
| B. I'm just doing this until I decide what I want to be when I grow up. (3 points) | |
| C. The cuts will have to come from somewhere else; there's no "fat" here. (0 points) | |
| Source: Delta Resource Alliance, Kansas City, MO. | |
| KEY | |
| If You Scored Between | Your Attitude Is |
| 24-30 points | positive |
| 12-21 points | apathetic |
| 0-9 points | negative |
How did you score? If your score was 24 to 30, congratulations are in order because you are currently contributing to a positive environment or looking to improve your current environment by your positive outlook. For those of you who scored below 24 points, there is hope: You can change (if you want to)!
That’s the good news. The bad news is that changing our attitudes is not an easy task. There are two reasons this endeavor is difficult. First, according to behavioral scientists, 95% of our attitudes were formed by the time we were 5 years old, and most of those attitudes were negative. You would have to agree that the first three words children learn are mama, dada, and no. As children grow older, they hear things like, "Don’t touch" and "Don’t run." Later, they might hear, "Don’t speak unless spoken to" or "Children should be seen and not heard." Is it any wonder, then, that as adults, we are heard to say things like:
• "We can’t do that."
• "That will never work."
• "I can’t give a speech."
• "I don’t have time."
Do you see the correlation between the negative things we heard as children and the negative things we now say and think as adults?
The second reason it is difficult to change our attitudes is that change is a complex and time-consuming process that requires patience and persistence. The complexity arises because we change our attitudes indirectly by directly changing our behaviors and experiencing the positive outcome as a result of the behavioral change
As we continue to practice new behaviors and experience positive outcomes, our minds receive positive feedback and we begin to see a change in our attitude. Patience and persistence are required because we are dealing with longheld beliefs and are replacing behaviors that are usually unconscious and automatic (behavioral scientists claim that 78% of our behaviors are unconscious). You cannot change an unconscious behavior until you have brought it to the level of conscious behavior.
To illustrate how you might change your attitude, review your answers in Table 1. Your answer to each question may reveal your attitude in those different situations. Now, write down a list of the behaviors that you honestly know are a reflection of that attitude. For example, if you indicated that the people you work with are "the biggest group of whining, incompetent jerks" you have ever known, then you may have the following behaviors:
• failure to acknowledge their contribution to the team;
• failure to listen to their ideas or suggestions;
• lack of follow-up to their complaints;
• failure to delegate for fear that they cannot perform to your level of expectation.
The results you would attain because of these behaviors might include:
• poor morale leading to tardiness, absenteeism and, ultimately, employee turnover;
• lack of innovation or improvement;
• feeling overwhelmed and stressed because of poor time management (i.e., failure to delegate).
To improve your results, pick a behavior that you know must improve if you want to create the ideal work environment. Pick one that will be easy to monitor and should show prompt results. For example, improving listening skills is one of those behaviors that should deliver a "quick win" because it is something you do everyday and the improvement will be noticed right away (both by you and those with whom you communicate).
As previously mentioned, behavioral change is difficult because the majority of our behaviors are unconscious. Therefore, we must bring behavioral traits to a conscious level before we can replace them with the appropriate traits. To do this, you need to identify the situation (such as when your staff bring you new ideas or suggestions) that triggers the inappropriate behavior (such as poor listening skills) and document each time you are aware of that behavior. In the beginning of the change process, you will usually notice the behavior well after you have demonstrated it.
Remember, this is an unconscious behavior, so it is normal to notice the behavior after the fact. Because it will have come and gone before you notice it, you obviously are not in a position to make a behavioral change at this point. As time goes on, you will begin to notice the behavior in the middle of demonstrating that behavior; however, you probably will not be able change it.
At the end of the process, you will become acutely aware of the situation and be able to make a conscious choice to stop what you are doing, look people in the eye, and really listen to what they are saying without interruptions or prejudicial thinking. But that is not the end of the change process. Each time that situation presents itself, you must continue to practice the new behavior until it becomes automatic and unconscious.
When employee turnover is an issue, a strategy to overcome it must begin with personal change. An assessment of the attitudes and behaviors of each individual followed by formal training to develop the appropriate interpersonal skills, leadership traits, and management behaviors should be offered. Once attitude and behavioral change has begun at the individual level, the organization is ready to develop and implement the organizational strategy aimed at retaining its valuable employees. The organizational strategy will be presented in next month’s issue of DUR.
[Steve Gregory is a national speaker, management consultant, executive coach, and principal of Delta Resource Alliance. His expertise includes strategic planning, management and leadership development, customer service, and process analysis and improvement. Continuing education units are available from several of his programs. For details, contact him at (816) 350-9800, [email protected], or visit his Web site at www.deltaresource.com.]
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