Proven Workforce Strategies to Recruit and Retain the Best Clinicians

By Debra Wood, RN, contributor

February 20, 2012 - Recruiting and retaining the best clinicians--be they physicians, nurses or allied health professionals--requires creating a healthy culture in which they can thrive and deliver quality care, where people are engaged and can collaborate as part of a team with supportive leaders and are recognized for their achievements.

“The most successful [organizations] are hiring for fit and striving to create and sustain a culture that will meet that vision of being a place where patients want to come for care, providers want to practice and employees want to work,” said Kristin Baird, RN, BSN, MHA, president/CEO of Baird Group in Fort Atkinson, Wis.

Culture is critically important for getting the desired results, added Allen R. Nissenson, M.D., FACP, chief medical officer at the kidney dialysis provider DaVita in El Segundo, Calif.

Creating the culture

Employers must create a just culture where leaders are providing clear direction about the mission, vision and values; aligning people; and then holding them accountable, Baird said.

“Patients are a good barometer of the culture,” Baird said. “If you have clinicians unhappy and not performing well, patients will know it and will give you poor patient satisfaction scores and that adds up to a decrease in reimbursement.”

Jack Lahidjani, CEO of Dean Co., the management firm at Mission Community Hospital in Panorama City, Calif., said healthcare providers have to care. To change the culture at his institution, he and organization leaders met with all employees and emphasized the need to treat people with respect and dignity.

“We call it the language of care, the fundamentals of interacting with patients and families and how to kill them with kindness,” Lahidjanu said.

Leaders should face the current environment and then mentor, model, manage and coach people to follow a compelling vision and take steps to move one step closer to it every day, Baird said.

“It’s up to nurse managers to translate the vision of a healthy work environment and set the tone for the unit,” added Mary Bylone, RN, MSM, CNML, vice president of patient care services and chief nursing officer at The William W. Backus Hospital in Norwich, Conn., and a national board member of the American Association of Critical-Care Nurses (AACN). AACN issued standards for healthy work environments in 2005. Bylone said such environments are recognizable by the presence of six characteristics: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership.

Tracy Barron, MS, director of business excellence at AACN, added that the association has developed a free tool ( to assess and track progress toward achieving a healthy work environment.

Measuring success

Measuring how well you are achieving human capital goals is vital. While many employers survey employee satisfaction, Baird recommends focusing on and measuring employee engagement. People can be satisfied but not performing as desired. She described them as “retired in place.” Organizations can put a dollar value on what tolerating disengaged employees’ costs the company.

Engaged employees feel valued, that their opinions are heard, that people are treated fairly in compensation or in disciplinary matters, and that they feel connected to the organization’s mission. Employees also should feel they have an opportunity to advance, Baird said.

“Employees want to know they are working for a leader they can trust, cares about them as a person and will help them progress in their career,” said Todd Harris, Ph.D., director of science for PI Worldwide in Wellesley Hills, Mass. He said employers must invest in the training and development of their people.

He added that survey data indicates only 25 to 30 percent of employees feel engaged and are putting forth their best effort. He said, organization officials must understand the world from the employee’s viewpoint and then build policies and approaches that take that perspective into account. Harris recommended leaders coach and collaborate rather than dictate.

Hiring staff

Building a good clinical team requires hiring the right people. Harris recommended determining the skills, abilities and experiences desired in new clinicians before recruiting, and then assessing qualified candidates objectively.

Alan Allard, a healthcare consultant and coach in Atlanta, suggested using a validated behavioral assessment tool to learn more about how the person approaches problems, makes decisions and his or her natural pace.

More employers are relying on data from validated assessments, tests and performance scores when hiring and promoting within, added Harris.

“Our clients will look at personality data of top-performing doctors or top-performing nurses and identify what type of personality traits do those people have, what skill sets do they have, what experiences do they have, and then let those data-driven trends inform what they do going forward,” Harris said. “Data increases the likelihood someone will be successful, and [the employer] is in a position to make a decision in a more rational and data-driven way. That takes a little of the risk and guesswork out.”

New employees should be brought onboard with an understanding of the organization’s history and culture. But then the unit must live that. Preceptors must buy into the mission, vision and values and should be star performers, Baird said.

“New nurses should learn during onboarding that they will share responsibility for keeping their work environment healthy,” said Clareen Wiencek, RN, Ph.D., ACHPN, ACNP, nurse manager on the Thomas Palliative Care Unit at Massey Cancer Center at Virginia Commonwealth University Health System in Richmond, Va., and a national board member of AACN. “You might say they become co-owners of their work environment. True collaboration means more than lip service. It’s a culture where joint communication and decision making among all disciplines becomes the norm. It’s an ongoing process that builds over time.”

Hiring physicians

Recruiting physicians often requires different tactics but should begin in a similar fashion.

“The most important practice is to think about what your goal is,” said Kate Tulenko, M.D, director of clinical services at Intrahealth International, a healthcare software firm, and an associate with the Johns Hopkins Bloomberg School of Public Health in Baltimore. That may include someone who will bring status to a program, deliver services or establish a research program or service line. She says not to forget considering physicians completing a residency or fellowship.

“It gives you an opportunity to grow your own talent,” Tulenko said.

Tulenko suggested tailoring the compensation package to what the candidate values. If salary is topped out, consider adding more vacation time.

At DaVita, Nissenson said the company tries to find medical directors who share the company’s mission of delivering high-quality care and thinking of patients holistically.

“It starts with getting a cultural mission and values match,” Nissenson said. Then the physician must be able to work well with a team, show leadership capabilities, follow regulatory guidelines and understand managing populations.

“A team-based approach is becoming more important in the modern workplace,” Harris added. “With the explosion of information, which we see in healthcare, it’s becoming harder for an individual person to have all of the pieces of the puzzle to get a job done. Increasingly, employees have to work with and through others to get the results they need.”

Drew Stevens, Ph.D., a practice management coach for chiropractors, suggested hiring people for their innate skills and then to communicate consistently and relentlessly, because people typically leave bad managers, rather than bad clinics.

Retaining staff

The real key is in retention, Baird agreed, explaining that it’s easy to grab a candidate’s attention with great offers but what matters is keeping good talent.

Harris said following the recession, employees’ trust of employers has fallen sharply. He said only about half of employees would recommend their employer as a good place to work to friends or family. He recommended employers build flexibility into talent-management policies to enable a good work–life balance for clinicians, to focus on results and to deploy the latest technology.

And that comes back to providing a culture where providers want to practice and people want to work.

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