How to Take the ‘Personal’ Out of Personnel Issues

How to Take the ‘Personal’ Out of Personnel Issues

By Jennifer Schraag

Fifty percent of the typical employee’s job satisfaction is determined by the quality of his or her relationship with the manager, according to the American Management Association.¹ Ambulatory surgery centers (ASCs) — and healthcare in general — face unique challenges in the realm of personnel issues.

The average length of stay for an employee in healthcare varies by job category. For example, with nurses, the rule of thumb could be anywhere from 18 months to two years, according to Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc. “That is usually the turnover point,” he says, “and if they stay beyond that, a lot of times then they stay for quite a long time.”

Employee retention is a challenge that spans all professions. “Employee retention has to be an overall effort by management; it has to be part of the corporate strategy,” Kruger advises. “A corporate strategy ensuring there is a conscious, deliberate effort by the whole organization toward workforce stability is imperative.” According to Kruger:

• One Saratoga Institute study says it costs as much as 25 percent of annual salary plus benefits for each employee turnover.
• Cost of turnover includes the cost of recruitment efforts, the hiring process, the training process, and when an employee leaves, there is the potential for unemployment insurance.

Employee retention begins from the very start, according to Kruger. “One key thing is to hire the right candidate for the job,” he says. “You have to let them know the pros and cons of the job right from the start. You don’t want them to start, realize there is something they’re not going to like about the job and then leave.”

Another key procedure is to train managers and supervisors how to properly deal with their employees: “Communication, management 101, in many instances, how to motivate; also, make them accountable for retention,” Kruger says. “If you see a particular department with significant turnover, first look at what type of job it is, then determine if there is a problem with the supervisor regarding how he deals with his employees. If you have a lousy supervisor, you usually don’t have good retention and you’re also susceptible to reorganizing.”

Adding a little spice to their life can improve numerous aspects among the work life of staff members. Simple, inexpensive gestures by management can increase staff loyalty, lower stress levels, establish higher communication rates, and provide overall good health within the ASC.

“Employee lunches can be productive on many levels,” points out Judith Katz, CEO of Count Me In, LLC. “First, when the company treats its employees to lunch, it conveys appreciation for their services and the valuable contributions they make to the organization. It also allows for a more informal, social atmosphere while establishing a teamwork mentality — all of which contribute greatly to reduced levels of stress. Employee lunch sessions or after-work ‘pow-wows’ often result in an open exchange of ideas and suggestions that can improve the way a company conducts business while simultaneously demonstrating that the company values and believes in its employees.” Caryl A. Serbin, RN, BSN, LHRM, president and founder of Surgery Consultants of America, Inc. and Surgery Center Billing, LLC, says you can take these “pow-wows” a step farther and offer door prizes, or maybe allow staff to have a fashion show, etc., all of which “work wonders on their cooperation level,” she says.

Employee burnout abounds among the healthcare community, and can provide serious detriments to employee retention. Kruger says many healthcare workers tend not to take their vacation time. “It’s a good idea to make sure that people take their vacation,” he advises. “The ‘use it or lose it’ policy sometimes is the one way to do that. Make sure to say ‘Hey, take your vacation so that you don’t burn out!’”

Deterring the repetitiveness of everyday tasks is huge step in lowering burnout rates as well. “I’m a strong believer in job enrichment — letting people learn new things and do new things, not to be doing the same thing all the time,” Kruger says. “Rotation of assignments and things like that sometimes can be helpful; depending upon the type of employee and the type of work of course.”

Katz points out the importance of informed and aware management as another vital deterrent. “This enables staff to receive whatever is necessary to perform the job,” she says, “whether that means additional training, delegating workload assignments better, or hiring additional staff as needed. Good communication not only helps employees feel appreciated, but it also promotes an open exchange. The employee who feels overwhelmed is destined to burn out, while the employee who is able to air his/her concerns allows management to do what’s necessary to improve the situation. People who feel appreciated are always happier, and happy people are far less inclined to burn out.”

today’s surgicenter magazine asked several professionals for guidance to aid in more efficient ways to power the reins within an ASC.

“GOOD communication and appropriate training. Communication is key — and not just verbally, but backed up with a comprehensive employee manual that address policies and procedures, including job responsibilities and expectations — not only in terms of what the company expects from the employee, but what the employee can expect from the company. With regard to training, there should be ongoing programs to ensure staff is knowledgeable about the company’s policies, strategies, products, services, and other important aspects of how it conducts business.”

— Judith Katz, CEO, Count Me In, LLC

“BETTER-than-average pay for better-than-average employees — good benefits, fair treatment by management and coworkers, slight variations in responsibilities from time to time. Have a policy regarding raises — state clearly if they are earned by measurable standards or if it is a generic cost-of-living increase; annually or semi-annually.”

— Caryl A. Serbin, RN, BSN, LHRM, president and founder of Surgery Consultants of America, Inc. and Surgery Center Billing, LLC

“PROBABLY the No. 1 thing that can be done is to create a great work environment. Set clear expectations by communicating in a respectful manner; treat people as you would want to be treated; create processes and operations that are effective and support the work that your staff is trying to accomplish. Certainly, the compensation and benefits plans are important too, but if your surgery center is not a rewarding place to be every day, then it’s hard to spend enough on compensation and benefits to compensate.”

— Tom Jacobs, president of MedHQ

Q: What should a manager do to provide recognition for employees? How important is it to regularly reward employees?

“RECOGNITION can be as simple as a verbal expression of appreciation for a job well done, to more formal, grander gestures, such as bonuses and promotions. But the company that offers regular employee appreciation programs, where everyone in the organization has the opportunity to earn recognition, is inclined to have a happy, productive workforce. Again, regularly scheduled employee luncheons, employee of the month announcements and/or certificates, employee appreciation functions — all go a long way in letting employees know they are valued — which is the name of the game to reducing turnover and maintaining a quality staff.”

— Judith Katz, CEO, Count Me In, LLC

“RECOGNIZING employees for accomplishments above and beyond the call of duty is an important morale booster and an encouragement to others to do more. Recognition can be a simple acknowledgement of their accomplishment at the employee monthly meeting, a blackboard announcement, a congratulatory balloon, etc. Also, it’s important to consider some sort of quarterly monetary bonus program for all employees based on measurable performance standards.”

— Caryl A. Serbin, RN, BSN, LHRM, president and founder of Surgery Consultants of America, Inc. and Surgery Center Billing, LLC

“IT is debatable whether compensation or recognition is most important to employees. What’s not debatable, however, is that recognition is important. There are many ways to recognize employees, some of them financial and some non-financial. Financial rewards are important where a person feels empowered to make a difference in some aspect of your operation, or feels part of a team pushing toward a goal; financial rewards not tied to specific goals, however, are not a wise use of your surgery center’s funds. Non-financial rewards can be anything from private recognition in oneon- one meetings, to increased responsibilities and attractive assignments, to public praise.”

— Tom Jacobs, president of MedHQ

“RECOGNITION is key. That’s actually an important aspect of retaining your employees. Even if it’s by a pat on the back or a letter of recognition. If they get a letter from a patient, make sure everybody knows they got a letter. A lot of hospitals will put up those letters and highlight the name of the employee that was recognized. Regularly rewarding employees —- there are numerous programs, inexpensive programs, that show the employee did a good job. A pat on the back; that does go a long way.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“YOU can reward staff in many different ways. Just as the success of individual retention- building initiatives will depend upon your particular environment, you also should choose your rewards based on what fits your staff the best. Here are some suggestions:

• Financial compensation — For some, simply earning more, either through raises or bonuses, is enough to keep them motivated.  Competitive salaries are very important for retaining any skilled employee and management should keep track of what healthcare professionals are paid in their city, state, or region.
• Additional training — While it’s important for mid-level managers to facilitate their staff members’ professional development, most managers also appreciate the opportunity to advance their own skills.
• Vacation time — Because it can be such a draining position, time off is crucial for staff, so additional vacation time can help keep them charged and motivated.
• Recognize efforts — Mid-level management can be a thankless job, so make sure that you offer plenty of recognition. This can involve everything from formal awards for successful programs, to simply giving managers well-deserved praise.”

— Grace Paranzino, MS, RN, CHES, FAAOHN, national clinical manager for Kelly Healthcare Resources

“LOYALTY is part of a reciprocal process that is established between a company and its employees. Again, the bottom line here is that employees believe they are valued and appreciated.”

— Judith Katz, CEO, Count Me In, LLC

“FROM the ‘Everything I ever needed to know in life I learned in kindergarten’ philosophy, one of the best ways to establish and maintain loyalty is to establish trust. In other words, keep your promises, tell the truth to your staff (especially when it’s difficult to do so), and keep your employees interests in mind when possible.”

— Tom Jacobs, president of MedHQ

“HELP develop a pride in the organization so they can point to that and say, ‘I’m part of this organization and I’m proud of it!’ Staff loyalty also means that a manager has to be loyal to their staff also. They have to not abuse them, they take care of them, listen to them, make sure that they’re compensated appropriately according to market, etc. So, it’s a double-edged sword.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“ONGOING education and training is critical. Some type of program should be offered at least every three months — more frequently if the company intends to incorporate new techniques, strategies, or policies into the way it conducts business.”

— Judith Katz, CEO, Count Me In, LLC

“ANNUAL in-services on required subjects should be provided by the center, either through a staff member knowledgeable in that field, or by having outside instructors. Other education can be provided by audio conferences or online conferences or outside instructors.

If your center is a joint-venture with a hospital, the hospital education department may be able to provide these services through a contract. For additional education, choose a topic of need/interest to several staff members and provide this education at least biannually.

Make sure the presentation is eligible for continuing education units. Also, encourage staff members to attend conferences and/or seminars by offering to subsidize at least a part of the fee. Set a limit and have it available to all staff members.”

— Caryl A. Serbin, RN, BSN, LHRM, president and founder of Surgery Consultants of America, Inc. and Surgery Center Billing, LLC

“IT is our belief that by providing continuing education programs, we demonstrate our commitment to lifelong learning for our employees as healthcare professionals. In addition, we feel strongly that professional development is a critical component of providing quality service, and well-informed temporary employees for our customers.

• Increase on-site education — As healthcare organizations face declining profits and budget cuts, on-site educational opportunities, including basic orientation programs, sometimes end up on the chopping block. While budget cuts are a reality that most organizations must face, when they cut education, they inadvertently sabotage one of their best retention tools. Effective training and mentoring programs are often cited as ways to keep employees interested in their work and avoid burnout, as well as bargaining chips to attract new staff. In addition, organizations with a highly trained, well-rounded staff can better cover shortage areas and improve the quality of care they provide.
• Encourage offsite graduate education — Facilities can also help promote continuing education of their staff at the graduate level by offering incentives such as tuition reimbursement at local educational institutions. Again, in the quest to retain quality employees, organizations have found that by subsidizing staffers’ need for educational and professional development opportunities, they gain a committed, highly-trained workforce.”

— Grace Paranzino, MS, RN, CHES, FAAOHN, national clinical manager for Troy, Mich.-based Kelly Healthcare Resources

“ONE of the main ways of maintaining your staff and helping them grow to be more functional is to provide continuous training and continuous development for them. So, yes you should provide it all different areas — whether it is time management, whether it is computer training, supervisory training, technical training in their area, whatever it may be, it’s always helpful, I believe.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“TIME and attendance is a weighty issue that can dramatically impact the productivity and success of an organization. Employees who have to do double the work to compensate for colleagues who are repeatedly late or absent feel taken advantage of and become resentful. It wreaks havoc with scheduling and the ability to adequately provide services. It can also lead to assumptions of favoritism when employees believe that their less-committed coworkers are receiving comparable benefits. The employer who is on top of employee time and attendance issues is armed with critical information that permits him/her to recognize both exemplary employees, as well as those who may require discipline.”

— Judith Katz, CEO, Count Me In, LLC

“THE attendance requirements for each person should be a function of the needs and requirements of the position. An accounts payable clerk has different responsibilities and coordination requirements than an OR (operating room) nurse. Remember, though, that flexibility in the workplace is a benefit similar to other compensation and benefits.”

— Tom Jacobs, president of MedHQ

“IT is, unfortunately, sort of a cultural thing that becomes part of some organizations. If you have a sick time bank, people assume that that is their time and not what it originally was intended to be which is sort of an insurance policy for when you are sick so you get paid. People think ‘Oh, it’s my time, I can just take it!’ One of the ways that people deal with that is to have paid time-off programs that typically isn’t specifically sick time anymore.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“COUNTLESS reports and surveys over the past few years testify to the fact that there is an acute shortage of nurses in the nation’s healthcare system, and that this shortage is only expected to grow despite numerous efforts to recruit and retain nurses in the field. However, in addition to the nursing shortage, there are others beginning to emerge: namely, the pharmacists, lab technicians, and other allied health and support staff members that are just as integral to providing quality care. Unfortunately, it is getting more difficult to attract recruits to healthcare careers because in recent decades, new employees entering the workforce have had an increased amount of choices in careers. Caring people who might have chosen a healthcare field are being lured away by the prestige and high salaries of fields such as information technology.”

— Grace Paranzino, MS, RN, CHES, FAAOHN, national clinical manager for Troy, Mich.-based Kelly Healthcare Resources

Q: How should the aging workforce be handled in healthcare?

“THE same as in any other work environment. Older workers should operate under — and be expected to comply with — the same rules and ethics that govern all employees.”

— Judith Katz, CEO, Count Me In, LLC

“IN a February 2004 article in the Monthly Labor Review, the federal Bureau of Labor Statistics projects that, from 2002-2012, the annual growth rate of the 55-and-older group will be nearly four times the rate of growth of the overall labor force. In fact, by 2012, the BLS projects young adults will constitute only 15 percent of the labor force, while prime-age workers (those between the ages of 25 and 54) will make up about 66 percent. Retaining access to mature workers will be critical in terms of talent and productivity. A key component of any long-term HR (human resources) strategy should be to engage older workers on the job as they are highly credentialed and often best suited to meet the demands of the marketplace. Mature workers are rated highly by our customers, and we find these employees are extremely focused, reliable, and offer our customers a greater bank of specialized skills and invaluable knowledge — particularly in the professional and technical sectors.”

— Grace Paranzino, MS, RN, CHES, FAAOHN, national clinical manager for Troy, Mich.-based Kelly Healthcare Resources

“ONE of the ways organizations deal with the aging work force is to establish temp pools in which retired workers can continue to come back and work. This creates more flexible scheduling, more part-time jobs for the aging workforce so they are able to continue to work.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive for the aging workforce so they are able to continue to work.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“BY listening to concerns, assessing the validity of complaints, and implementing steps to address the problem. Employees need to know that there are certain ‘absolutes’ within the organization, and that above all else, they must treat all others with courtesy and respect.”

— Judith Katz, CEO, Count Me In, LLC

“MOST personality conflicts are managed most effectively between the two conflicting individuals, with some occasional coaching from their supervisor(s). When one party chooses — and it is a choice — to turn a conflict into disruptive behavior, however, the supervisor or administrator needs to take action. In any team environment, social norms are established by the team over time. The administrator and supervisors must be leaders and set the proper tone. It is a judgment call on the part of the supervisors to assess who has crossed the line, but by being aware of your established norms, you are more prepared to take action when it is called for.”

— Tom Jacobs, president of MedHQ

“ONE of the best ways is to have people talk things out and find out what the issues are. Sometimes some people just don’t get along no matter what you do, but usually the process of talking things out helps more so than not. If there is a dysfunctional workforce because of interpersonal issues, there are various interventions you can take. Focus groups to let people speak out, have counselors come in and deal with the people to find out what the real issues are whether they are internal or external, sometimes there are personality clashes resulting from outside issues that have been brought to the workforce. It is really finding out what those issues are and figuring out how they would be dealt with depending on what they are.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“NO one should ever be surprised that the company is dissatisfied with his/her performance. Every effort should be made to recognize and address problems. If additional training or instruction is necessary to rectify a problem, it should be provided. And everything should be documented. That way, if an employee fails to improve actions or behaviors, an organization can be confident about whatever disciplinary steps it takes — whether that might be demoting an employee, docking wages, or terminating employment.”

— Judith Katz, CEO, Count Me In, LLC

“PROBABLY the most important thing is to be in control of your own emotions first. It’s easier said than done, but it helps if you can remember that the issues are not personal (even if the problem employees are trying to make it personal). People are who they are, and usually it’s best to let them act the way they want to act; keeping in mind that you must act in the interests of you, your other employees, and your ASC if they ‘cross the line.’ The second thing is to have good processes for disciplining employees when necessary and for handling terminations. Documentation is very important. And, even if they are not directly involved in every termination, it is good to have an attorney at your disposal to make sure you are doing things the right way. There are countless laws related to employment that must be adhered to, and if not, that puts your surgery center at risk of litigation.”

— Tom Jacobs, president of MedHQ

“IF a person is a problem employee, if they have been counseled or spoken to as to what their issues are; they’re aware of what the rules are. Levels of discipline would vary according to the crime. For instance, if it is a problem employee that gets into physical altercations with people or a problem employee that is insubordinate, you may take one level of disciplinary action which may be severe, or if it is just an absenteeism issue or lateness issue, you may take multiple disciplinary steps before you ultimately discharge the individual.”

— Ken Kruger, president of Healthcare Human Resources Consulting Consortium, LLC, and president of Executive HealthSearch Inc.

“SEXUAL harassment, like any other inappropriate workplace behavior, should be immediately addressed. Both the accused party and accuser should be questioned and counseled by management. If the complaints are determined to be valid, the accused should be warned, required to attend sensitivity training, monitored, and if necessary, terminated.”

— Judith Katz, CEO, Count Me In, LLC

The Ups and Downs of HR Outsourcing

What works best for some may not always work for others. Outsourcing human resources (HR) tasks provides as many challenges as it does advantages, and finding the right niche for your ASC can often be confusing.

“An HR management company provides expertise for your ASC that will have a significant impact on your surgery center’s operation,” says Jacobs. “An HR management company can significantly improve both outcomes by freeing up administrator and business office staff’s time to support operations, while providing competitive benefits and administration services to you and your staff.”

Budget is of course at the forefront of thought when considering which is more advantageous — employ an in-house HR specialist or outsource?

Kruger points out that some advantages to outsourcing can include cutting out such high-cost purchases as software packages needed to properly manage personnel and scheduling.

“I would assume an HR management company, most of them, usually have some sort of an HRS system in place which the organization wouldn’t have to purchase,” he says. “You should understand what other services that vendor can perform. Limiting your outside vendors is as important as limiting the number of direct reports that you manage.”

Kruger also advises there may be a level of expertise that a small organization wouldn’t necessarily be able to afford.

One of the downsides of outsourcing your HR department, according to Jacobs, is when that service provider loses — or never has — touch with your ASC and your industry. “It is critical to find a service provider that is committed to the specific needs of you and your industry,” he says.

Kruger agrees, “They are not part of the organization and they may not be the same level of employee advocate as a HR employee that is part of the organization and have the same sort of loyalty. HR can drive the culture.”