Employee Retention Begins With Recruitment

Health care organizations face many challenges in building and maintaining high-performing teams in today’s rapidly changing recruitment landscape. It is a continuous battle to recruit and retain physicians, nurses, pharmacists, and other trained medical personnel, thanks to the COVID-19 pandemic, surging infection rates, and widespread provider burnout.

Recently, there have been unprecedented increases in disability, employment outside the health care delivery setting, family caregiving, part-time employment, retirement, or unemployment.¹ Additionally, historically high inflation, rising labor costs, and supply chain challenges further stress the health care system. Labor costs account for more than 50% of most health care systems’ operating expenses, increasing by approximately 15% each year, adding $24 billion nationally in labor costs in 2021.² These growing costs are determined largely by staff turnover and higher wages paid for contract labor, overtime work, and part-time employees. Organizations seeking new team members compete with different industries and settings, with higher expectations forthe ability to work remotely, flexibility, and better work-life balance.

Recruiting Landscape

Demographic shifts and the pandemic’s impact have changed the recruitment landscape. In today’scompetitive environment, it’s more important than ever to complete the hiring process quickly, efficiently, and effectively. Organizations can lay the foundation for a collaborative team approach by creating clear job descrip-tions with well-defined roles and responsibilities. Hiring for fit will maximize the chances of forming lasting and productive partnerships between the organization and each new employee.

As health systems evaluate and refine their recruitment approach, they should review the landscape of creative ideas to attract candidates. Well developed job descriptions establish salary ranges, define performance expectations, and include performance evaluations. They also can be crucial to a successful recruitment effort.³

Because the turnover rate is so high in health systems, employers must provide incentives to stay, such as sign-on bonuses and tangible benefits. For example, if employees are entitled to generous vacation time but are unable to take time off because of a shortage of other employees, that vacation time is not an effective benefit. This is a common reason for employees to leave.

Similarly, allowing employees to choose their shifts or provide autonomy in other situations can increase job satisfaction. In addition, a well-organized onboarding process gives them the confidence to start comfortably in their new roles. Introductions, facility tours, a team lunch, or another staff activity can make the new employee feel welcome.

Recruiting individuals from within the department or the organization creates internal growth opportunities and may result in greater employee retention and staff loyalty. Internal recruitment may also be less disruptive and expensive. In contrast, recruiting outside candidates expands the number of potential candidates and the experience available to the organization. It brings in new talent and discourages reliance on seniority as the primary basis for promotion. When looking to effectively recruit from outside the organization, consider the following:

• Advertisements in professional journals, newspapers, state professional society newsletters, and state and national professional organizations
• Oral and written recommendations from colleagues
• Personal discussion or correspondence with potential candidates
• Recruitment visits or emails to colleges of specific professions (eg, pharmacy colleges or nursing schools)

The job offer should be made as quickly as possible after completing the interview. Offers should be made to candidates with enthusiasm and should include a deadline for response. In addition to salary, other commitments made to a candidate should be expressed in writing as part of the formal offer.

Onboarding Programs

Onboarding programs can generate significant return on investment through reductions in burnout and turnover, improved quality of care, higher productivity, enhanced provider engagement, improved patient access, and increased patient satisfaction. Interestingly, health care organizations spend 46% less on employee education and training than other industries.⁴

Unfortunately, onboarding programs have experienced significant declines and disruptions over the past 3 years. Data collected in 2022 showed that only 24% of organizations have a formal onboarding program for advanced practice providers in the acute care setting, and just 56% have a formal onboarding program in the ambulatory care setting.⁴

As health care organizations transition from the pandemic to the new normal, they must reinvest in onboarding programs for all new hires, including mentoring and peer support. It is also critical to provide additional support for new graduates, whose training may have been disrupted by pandemic restrictions.

Burnout continues to hamper the performance of the health care system and exact a heavy toll on the dedicated individuals who care for us. The World Health Organization’s International Classification of Diseases, Eleventh Revision has categorized burnout as a syndrome that results from “chronic workplace stress that has not been successfully managed.”⁵ In the United States, 83% of providers cite burnout as a public health crisis exacerbated by the pandemic.⁵

Authors of a recent article discussed the premature attrition of clinical pharmacists who provide comprehensive medication management across various health care settings.⁶ Clinical pharmacists have numerous responsibilities, including patient care activities as well as administrative, teaching, and scholarly responsibilities. Many of these pharmacists report a high degree of burnout and stress. Some factors associated with barriers to retention and contributors to attrition of clinical pharmacists include burnout, absence of provider status, and inability to generate revenue for institutions, because pharmacy services are typically not reimbursable.

Pharmacy practice models across the nation vary significantly, which is another challenge in maintaining longevity in clinical pharmacy practice. For example, at some institutions clinical pharmacists rarely have distribution responsibilities, and most of their time is spent on patient care, research, and teaching. Meanwhile, at other institutions, distribution responsibilities and clinical roles are integrated, with 1 pharmacist executing all of these duties for assigned patient care units. There is no guidance on pharmacist-to-patient ratio, productivity metrics, or administrative duties.

Another reason clinical pharmacists leave the health system is a perceived lack of career advancement. Strategies to mitigate and prevent premature attrition include encouraging the use of paid time off; minimizing stressors outside of work; implementing wellness activities such as regular exercise, mindfulness, and adequate sleep; and providing mentorship, recognition at work, and a sense of importance to the organization.

Staff turnover is costly. The time required to recruit and train new employees has been shown to cause temporary workplace productivity loss.⁷ Staff turnover also has a negative impact on staff morale, which may further reduce productivity and increase turnover.

Every organization should identify and assess retention factors by examining the unique aspects of each department and organization. For example, a committee could be established to determine major retention factors, and a retention plan could be developed based on this assessment. The recruitment plan should be reviewed periodically as the needs of employees change; employee surveys may help determine these. Lastly,an exit interview should be scheduled with a department director, the human resources department, and the exiting employee to understand why they are leaving.

Conclusion

Improving employee retention in health care is imperative for all health care organizations. Health care leaders who understand why employees leave can build a working environment that supports staff members and lets them know they are valued.

References

1. Gamble T. Healthcare workforce lost 333,942 providers in 2021. Becker’s Hospital Review. October 24, 2022. Accessed April 25, 2023. https://www.beckershospitalreview.com/workforce/healthcare-workforce-lost-333-942-providers-in-2021.html#:~:text=Definitive%20found%20117%2C000%20physicians%20left,of%20the%20workforce%20in%202021

2. Massive growth in expenses & rising inflation fuel financial challenges for America’s hospitals & health systems. American Hospital Association. Accessed April 25, 2023. https://www.aha.org/guidesreports/2022-04-22-massive-growth-expenses-and-rising-inflation-fuel-continued-financial

3. American Society of Health-System Pharmacist. ASHP guidelines on the recruitment, selection, and retention of pharmacy personnel. Am J Health Syst Pharm. 2003;60(6):587-593. doi:10.1093/ajhp/60.6.587

4. New ATD research: 2019 State of Healthcare Training Report. News release. Association for Talent Development. Accessed April 25, 2023. https://www.td.org/press-release/new-atd-research-2019-state-of-healthcare-training-report

5. Burnout in healthcare: a report for today’s leaders. Spok. September 2021. Accessed April 25, 2023. http://cloud.spok.com/EB-AMER-Clinician-Burnout-Report.pdf

6. Rech MA, Jones GM, Naseman RW, Beavers C. Premature attrition of clinical pharmacists: Call to attention, action, and potential solutions. J Am Coll Clin Pharm. 2022;5(7):689-696. doi:10.1002/jac5.1631

7. Waldman JD, Kelly F, Arora S, Smith HL. The shocking cost of turnover in health care. Health Care Manage Rev. 2010;35(3):206-211. doi:10.1097/HMR.0b013e3181e3940e

About The Author

Deepali Dixit, PharmD, BCPS, BCCCP, FCCM, is a clinical assistant professor at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway, and a clinical pharmacy specialist in critical care at Robert Wood Johnson University Hospital in New Brunswick.