Employee retention: Everyone has a stake
August 1, 2000
Employee retention: Everyone has a stake
By Steve Gregory, RPh, MBA
Principal, Delta Resource Alliance
Kansas City, MO
(In last month’s Drug Utilization Review, part one of this series outlined the economic penalties associated with an organization’s inability to retain its valuable employees and examined how to retain those employees. In part two, the focus is on organizational strategy.)
At its most basic level, retention strategy has two components. First, you must hire the right person through an effective screening, interviewing, orientation, and training process. Second, you must create an environment in which that individual wants to stay. You do this by demonstrating how each individual’s daily activities contribute to the overall success of the pharmacy department and, ultimately, the entire organization.
You will notice that this approach de-emphasizes pay and benefits. Full appreciation for work performed and a feeling of being in on things are the top two attributes of an ideal work environment. Pay and benefits, if they are comparable to the competition’s, will bring candidates to the screening and interview process but will not be a significant factor in keeping them once they are hired. Yet managers continue to tell me that it is their perception, in absence of a formal exit interview process, that employees are "jumping to the next employer" for a $1 to $2 per hour increase in salary.
In response, I ask them to put themselves in the departing employees’ shoes and consider this: If you do not feel like your work is appreciated or that you are not a part of the team, would you think you have failed in some way? If you decide to work elsewhere, you will probably find it is easier to point the finger of blame at the company rather than at yourself.
Unfortunately, if your organization does not have a formal exit interview process, the manager’s perception becomes a reality. As a result, most approaches to employee retention focus on pay and benefits. If the root of the problem associated with employee turnover involves a poor working environment, no amount of improvement in the pay and benefits policy will solve it. Such improvements may delay an employee’s ultimate departure, but they won’t prevent it.
Hiring the right person in the first place solves half of the problem. However, in today’s climate of low unemployment and insufficient supply of pharmacists, many organizations have fallen into the trap of hiring the first warm body that walks through the door. Next thing you know, three months have gone by and you’re looking for another applicant because the one you hired did not seem to work out.
Why so many failures?
Why do so many new hires fail to succeed? Employee turnover that occurs within the first 12 months is usually associated with one of these factors:
• Poor screening and/or interviewing: A problem applicant who has learned what to say and leave unsaid in an interview could be your next employee if you do not screen properly or ask the right questions. Such employees’ true colors become evident only after they have been on the job for a time. As one hospital CEO shared with me during a discussion on employee turnover, "They look so good on paper. How can we be so blind?"
• Poor orientation and/or training: Because many departments are understaffed or work with a lean and mean philosophy, there may not be enough people to provide orientation or fully train the new hires. If you have hired a problem person, this compounds the issue. If you have hired the right person but are incapable of providing the orientation and training that allows him or her to deliver expected levels of performance, that person, more than likely, will give up on you and look for a better environment.
To ensure that you consistently hire the right person, take these steps:
- Develop a screening process: In conjunction with your human resources (HR) department or representative, develop a process that screens out problem applicants before they make it to the interview. Many organizations employ outside firms to investigate applicants’ backgrounds by checking for criminal activity, litigation (such as wrongful termination suits or professional liability claims), employment verification, and alcohol/ drug abuse.
If the individual makes it past the background check, continue screening by assessing the candidate’s values, attitudes, and behaviors. Assessment forms can help determine if a candidate’s values align with the organization’s. Those assessments also will identify negative attitudes and behaviors that may interfere with job performance.
Some assessments determine the ideal behaviors and interpersonal and task skills for a job (such as for a night-shift pharmacist) that can be used to match the right person to the right job.
- Develop an interviewing process: Along with HR, develop a process involving all levels of the department. It’s best to design the interview long before it is ever used and train everyone who will conduct interviews. Include HR to ensure appropriate questions are developed. Part of the interview strategy should be to ask the same questions in different ways so the interviewer can check the consistency of the candidate’s answers.
The first person interviewing the candidate should be from HR to ensure that only viable candidates are presented to the pharmacy interviewers. During pharmacy interviews, make sure some of your inquiries are "what if" questions that place the candidate in imaginary situations that will provide insight to their ethical, legal, and moral character to further assess their values. Immediately after everyone has interviewed the candidate, those involved in the interview process should meet while impressions are still fresh to discuss the candidate’s potential.
- Develop an orientation process: Again, this should be designed long before it is needed. To begin connecting the new hire to the organization’s success, someone from administration (preferably the CEO or administrator) should start by discussing the organization’s vision, values, and strategic initiatives. Expectations regarding customer service and internal codes of conduct should be outlined. Policies and procedures from an organizational standpoint should be covered by HR. The pharmacy orientation should involve representation from all levels, including the support staff.
Policies and procedures specific to pharmacy should be reviewed, and management’s expectations regarding performance and how it will be measured should be clearly understood. A communication process should be established to ensure the new employee’s questions and requests for additional information are handled easily. Assigning the new employee to a mentor is very helpful during this time.
After the administrative areas have been covered, rotate new employees through each area and shift they will be expected to cover after the orientation period has ended. Usually, a week in each area will ensure that the new person meets the key individuals specific to that area, such as nurses, clerks, and physicians; understands the specific functions of that area; and knows where to go for supplies, forms, and charts.
- Develop a training process: During orientation, assess new employees to determine their current level of performance. Ask questions to determine how much experience they have had in the different pharmacy services provided by your department, such as patient counseling, preparation of IVs, chemotherapy and/or radiopharmaceuticals, physician rounds, and pharmacy involvement in codes. Talk about situations new employees might face and determine if their approach is appropriate.
Once you have determined the current skill set that new employees have, meet with them to co-develop a training plan to ensure they have the skills and knowledge necessary to be successful. The training plan should have measurable outcomes in order to monitor their progress and ensure that everyone agrees on what is expected from the new addition to your staff.
- Develop an exit-interview process: You may have gone through all of the necessary steps to ensure hiring the right person. However, if your new hires are consistently leaving, you need to know why. If you do not know what factors are causing good employees to voluntarily resign, you will not be able to correct the deficiencies. To ensure that you are obtaining honest feedback, an exit interview should be conducted by your HR representative or a consulting firm that provides this service. A third-party interviewer is more likely to convince departing individuals that their answers will not burn any bridges than is an interviewer in the pharmacy department who may be called upon for a reference.
Once you know that employees understand how their attitudes and behaviors contribute to the performance of the organization and you are satisfied you can hire the right person, the next task is to ensure that these successful individuals are provided the environment that meets or exceeds their needs in terms of job satisfaction. Here is a five-step plan to achieve that goal:
o The process begins with a "vision framework." In this context, your vision is a mental snapshot of where you see your organization in the future. In their book, Built to Last, James Collins and Jerry Porras document the long-lasting success of organizations founded prior to 1950 (average life span was 90 years). They concluded that visionary organizations were more successful than those without a vision.
There are many different definitions and recipes for a good vision statement. However, Collins and Porras appear to have the best. They talk in terms of a "vision framework" that includes core ideology (a culture defined by your core values and purpose) and an envisioned future (the vision-level goal you want to achieve in the next 10 to 30 years with vivid descriptions of what it will be like to do so).
The vision framework sets the direction for your future, guides you in the decision-making process, serves as a source of inspiration, and ensures that you accomplish your goal with integrity, honor, and consideration for what is right.
Once the vision framework has been developed, the department leadership must meet with every individual to discuss the attitudes, behaviors, actions, knowledge, and skills that will be required to achieve the vision. Wall hangings, desktop replicas, and business cards with the vision framework serve as powerful reminders of what it is you are striving to achieve.
When interviewing candidates for pharmacy positions, the vision framework should be shared with the candidate to ensure that their personal vision, values, and purpose align with those of the department. But words alone will not ensure success. Everyone in the department must be committed to achieving the vision and demonstrating the behaviors that reflect the core values and purpose by every action taken. If your actions are not a true reflection of your vision, values, and purpose, the vision framework merely becomes a piece of decoration.
o Connect the vision framework to your organizational strategies and operating practices. Your vision framework will serve as the reference for most decisions and actions that must be taken with regard to the future of your department. The steps you must take to make your vision a reality must be listed and prioritized. As an example, the pharmacy leadership may develop these operating objectives:
Years 2000 through 2003.
• Provide a pharmacist to each floor and patient care area within the scope of a centralized pharmacy operation.
• Develop expert pharmacists through credentialing and post-graduate studies in areas that best serve the needs of the hospital and recruit when needed to fill any voids.
• Provide management and leadership development opportunities to all pharmacy staff.
• Form the following committees:
— public relations, whose purpose is to attract and recruit pharmacy students for clinical rotations and pharmacy candidates for employment opportunities from the region;
— professional relations, whose purpose is to demonstrate the expertise of pharmacy staff to all stakeholders who depend on pharmacy services;
— performance improvement, whose purpose is to constantly assess and improve all practices and processes carried out by the pharmacy department.
Years 2004 through 2007.
• Make the physical transformation from a centralized pharmacy operation to a decentralized pharmacy operation.
Years 2008 through 2010.
• Benchmark current pharmacy practice and services to the premier pharmacy practice sites throughout the nation and develop a strategy to incorporate the best practice models into the pharmacy operation.
o Connect individual activities to your organizational strategies and operating practices. This step is one of the most critical in the process of creating the ideal work environment. At this stage, the individuals in your organization will participate in project teams and work individually to implement the organizational strategies and operating practices (OSOPs) that were developed in Step 2.
In addition to the measurable performance standards related to their job descriptions, staff contributions during this step should become part of the performance management process, as well. Individuals get involved by matching their talent, skills, and desire to the current OSOPs and, with participative planning between manager and subordinate, developing a set of individual goals aimed at helping the department achieve the current OSOPs. As an example, these goals for 2000 to 2003 may be those of an individual with an interest in growing into a management position and becoming an expert in nutrition support:
• Complete executive leadership development workshop by the fourth quarter of 2000.
• Coordinate development of policies and procedures for satellite pharmacists by the second quarter of 2001.
• Become board-certified in nutrition support by the fourth quarter of 2003.
This same individual may have been selected to participate in the public relations committee that has the following goals:
• Develop mission statement by the third quarter of 2000.
• Define areas of expertise for which the pharmacy department will be known by the third quarter of 2000.
• Develop policies and procedures by the fourth quarter of 2000.
• Develop recruiting process for attracting new pharmacists with an interest in the department’s areas of expertise from the region by the first quarter of 2001.
• Develop clinical rotation in two of the areas of expertise by the third quarter of 2001.
• Complete recruitment campaign for four pharmacy students to begin their rotation during first quarter of 2002.
When everyone in the department has a set of comparable goals, you have created a force whose goals and activities are aimed at achieving the departmental OSOPs and, ultimately, the vision defined in Step 1. By doing so, you have provided the structure that allows individuals to feel like they are in on things. But chances are, if you do not perform the next step of this process, the progress toward your vision will be short-lived.
o Reward individual and departmental successes. One of the fundamental truths of human nature is this: Behavior that gets rewarded gets repeated. If you want your staff to stay committed to achieving the daily goals and activities that will ultimately lead to your vision becoming reality, their contributions and successes must be acknowledged and rewarded. Many managers balk at this recommendation because they feel these goals and activities are "just my people doing their jobs!" Some are hesitant because of cost considerations. Cost considerations should not be an issue: As experts will tell you, acknowledging or rewarding an individual does not need to be expensive to be effective.
A simple thank-you note or a memo to their personnel files showing your appreciation for a job well done suffices in most cases. A pizza party for the entire department when you meet one of your departmental goals also will show your appreciation. (1001 Ways to Reward Employees, a book by Bob Nelson, is an excellent reference.) Remember, if you fail to perform this step, you will fail to provide the No. 1 attribute of an ideal work environment, which keeps staff happy and on the job.
o Continuous assessment and improvement. The constantly changing economical, political, societal, and industry climates will present opportunities for those who see them first and threats to those who see them last. Continuous assessment and improvement is an ongoing system of identifying or anticipating opportunities or problems in order to perfect the quality of the products or services supported or provided. This principle is based on the belief that even excellent products and services can be made better by improving the practices and processes that make them possible.
Every day that you march closer to your vision, you must develop in your staff the desire to constantly assess and seek improvements to the goals, practices, and processes in the department. When an improvement is implemented and the desired effects are achieved, reward the individual(s) who made the contribution (behavior that is rewarded is repeated). You will see that this part of the process, alone, contributes significantly to showing full appreciation for work performed and the feeling that everyone is in on things.
This philosophy of continuous assessment and improvement applies to long-term goals, as well. One of the biggest mistakes the leadership can make is to consider a long-term vision and/or the OSOP as set in stone when certain changes make achieving that vision or the OSOP unwise.
For example, let’s consider that you are in year five of your 10-year vision and are about to begin transitioning to a decentralized pharmacy operation that will require six additional pharmacist full-time equivalents and $750,000 in capital for space reconfiguration and equipment purchases. It would be unwise to pursue that course of action if you just learned that administration is planning to reduce the work force by 15% at the end of the fiscal year if the financial health of the hospital does not improve. It would be best to push the time lines back until more certainty about the financial health is known.
Why does this approach work? Simply put, everyone likes being on the winning team. If you have ever played on a sports team that won a championship or a recreational league tournament, you probably remember the motivation and desire that was created as everyone focused on the goal and the sense of accomplishment when awarded the trophy. A similar feeling of accomplishment and belonging occurs for everyone involved in the production of a play when the final curtain call comes. That feeling also can happen in the work environment when everyone understands their part and knows that their achievements count toward organizational success. Rewarding those achievements ensures the team will repeat its performance.
The road to No. 1
From the files of real-life examples comes the report of a hospital that followed those steps. A part of this hospital’s vision framework involved its becoming the No. 1 hospital in the county. Realizing that current leadership behaviors and management styles needed to improve first, every department head participated in a leadership development process. During that process, their roles and responsibilities toward achieving that vision were outlined, and a process to involve the entire organization was created.
One of the OSOPs developed to help achieve the hospital’s vision was to improve the operating margin by 100%. Using the steps outlined in this article to implement OSOPs, everyone in the organization understood their role in achieving that financial goal and carried out their responsibilities toward that end. At year’s end, the chief financial officer reported that the operating margin had improved by 188% and, for the first time in the hospital’s history, everyone received a generous holiday bonus.
[Steve Gregory is a national speaker, management consultant, executive coach, and principal of Delta Resource Alliance in Kansas City, MO. 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 more details, contact him at (816) 350-9800, [email protected], or visit his Web site at www.deltaresource.com.]
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