© 2013 HealthcareSource

2013 HealthcareSource and ASHHRA Healthcare HR Initiatives Survey Results and Insights

White Paper

The third annual HealthcareSource and ASHHRA Healthcare

HR Initiatives Survey found that HR is balancing numerous

demands, like healthcare reform, budgetary constraints and

lack of time to address initiatives.

As healthcare HR professionals strive to improve patient and

resident satisfaction and safety, they often struggle to attain

their goals. HR teams are also working to hire for fit, bolster

employee satisfaction and accountability, strengthen workforce

education and manage low performers.

Over the next year, healthcare HR teams plan to implement

technologies to streamline their processes. Technology is seen

as key for successful recruitment, performance management

and employee development. Talent management solutions,

such as applicant tracking, performance management and

learning management software are designed to help HR teams

work more effectively.

2 Copyright © 2013 HealthcareSource. All rights reserved.

The HR Initiatives SurveyHealthcareSource and the American Society for Healthcare Human Resources Administration (ASHHRA) recently conducted

their third annual HR Initiatives Survey. The objective of this survey is to better understand how healthcare HR professionals are

addressing three strategic goals: reducing costs, improving patient and resident satisfaction, and improving patient and resident safety.

The survey questions and answers were developed jointly

by HealthcareSource and ASHHRA in 2011, with input

from healthcare HR professionals. This year’s HR Initiatives

Survey was available online from July 1 through July 31,

2013. Response rates for the 2013 survey increased 91%

over 2011—the first year that the survey was conducted.

This year, 447 HR professionals at healthcare organizations

across the United States participated.

This white paper summarizes the HR initiatives that healthcare

HR professionals view as most important to achieving cost

reductions, as well as increased levels of patient and resident

satisfaction and safety. Industry experts also reviewed the

survey findings and offered their insights. This group included:

•Stephanie Drake, MBA, Senior Executive Director of the Professional Services Team, American Hospital Association

•Frederick Morgeson, Ph.D., Professor, Michigan State University, Scientific Advisor, HealthcareSource

•Michael Rochelle, Principal and Key Strategy Officer, Brandon Hall Group

•David Szary, Founder, LEAN Human Capital and the Recruiter Academy

It’s interesting to note that compared to 2012, healthcare

reform has taken on greater significance in terms of cutting

costs, while HR processes and employee retention are

somewhat less important. The percentage of respondents

concerned with healthcare reform in 2012 was 54%—ten

percentage points lower than this year. Yet, last year’s interest

in HR processes and employee retention was higher—90%

and 85% respectively.

Top Initiatives for Reducing Costs:

•Streamline HR processes (73%)

•Improve retention rates (66%)

•Plan for the effects of healthcare reform (64%)

HR Initiatives to Reduce CostsShrinking budgets and increased workloads are facts of life for healthcare HR professionals today. When it comes to reducing costs,

most organizations are pursuing HR initiatives related to more efficient processes and healthcare reform. Almost three quarters of

respondents (73%) indicated that their top initiative for reducing costs was streamlining HR processes. About two thirds of survey

participants noted that they are trying to improve retention rates (66%) and plan for the effects of healthcare reform (64%).

Represents 2013 results. Represents differences between 2012 and 2013.

Panel CommentaryThe panelists were not surprised at HR organizations’

continued emphasis on more efficient HR processes and

increased interest in healthcare reform. They offered their

thoughts about what is occurring in healthcare organizations

across the country.

The majority of respondents (87%) agreed or strongly agreed

that their organization had service-excellence and patient or

resident satisfaction related performance goals.

Lean initiatives could help further streamline HR processes.

•David Szary feels that many healthcare professionals have not yet connected the dots with respect to Lean and HR initiatives. LEAN Human Capital recently conducted a recruitment metrics benchmark survey with 172 hospitals. Almost three quarters (71%) reported that they had an internal Lean team in place. Yet, Szary believes that sometimes teams struggle to show how they can save money using Lean principles. “If you use Lean principles to reduce wait time and overall time to fill with critical job families like RNs, for example, you could show cost reductions,” he noted. LEAN Human Capital recently worked with an organization and showed how a 25% reduction in time to fill for RN positions could reduce agency and overtime costs by $4.5 million.

With regard to healthcare reform, healthcare organizations face a variety of potential Medicare cuts, as well as other issues related to reimbursement.

In response, there are a variety of HR initiatives that

organizations are considering:

•Serving newly insured patients. Perhaps the biggest unknown with healthcare reform is the influx of people who will soon have access to insurance for healthcare services. “We don’t know for sure what the healthcare workforce may need to be,” said Stephanie Drake. “Many healthcare organizations are becoming more efficient to be as streamlined as possible, so they can have the flexibility to cover more people who will be coming for services.”

•Structuring teams to deliver quality care. Healthcare reform is adding a lot of incentives and standards to provide quality care. Some incentives may be costly, so organizations need to reduce expenses while delivering high quality care. “Many organizations are looking at team-based care. They’re reducing costs to ensure that they have the flexibility to adapt to anything that may be introduced through healthcare reform,” Drake noted.

•Redesigning compensation and benefit plans. Insurance costs over the past twenty years have been steadily increasing. As a result, employee benefit costs have become a large expense for organizations. The employer mandate for health insurance coverage has been postponed

Survey Questions

1. What are your current HR initiatives to reduce costs?

2. What your current HR initiatives to improve patient and resident satisfaction?

3. What are your current HR initiatives to improve patient and resident safety?

4. What are your biggest challenges with achieving your HR initiatives?

5. What new technology are you planning to adopt in 2013/2014 to achieve your HR initiatives?

Questions were multiple choice, with the ability to select more than one answer.

HealthcareSource is the leading provider of talent management software for healthcare providers in the U.S. More than 2,000 healthcare organizations use HealthcareSource talent management software to source, hire, assess, and develop their employees.

ASHHRA is the premier association of healthcare HR professionals, providing advocacy, research, publications, networking, and learning for healthcare HR professionals.

Respondent Job Level

Copyright © 2013 HealthcareSource. All rights reserved. 3

4 Copyright © 2013 HealthcareSource. All rights reserved.

Innovative Approaches to HR Professional Development That Won’t Break the Bank

During tough times, one of the first things

that HR departments usually cut from their

budgets is training and development for their

own staff. HR teams are exploring out of the

box approaches to professional development

that are both economical and effective.

Stephanie Drake described a few of these techniques:

•Network with area colleagues. Local ASHHRA chapters are often a good place to connect with like-minded healthcare HR professionals.

• Find free or low-cost educational resources. HealthcareSource, for example, offers a variety of free webinars and white papers for healthcare professionals. ASHHRA also sponsors a free webinar almost every month, as well as online learning classes and a certification in healthcare HR which helps people demonstrate their mastery of healthcare HR skills.

•Develop mentoring relationships. Mentors are an effective way for healthcare HR professionals to deepen their knowledge and skills. Mentors may be found within the organization where a person works, or through networking with individuals at other healthcare organizations.

from January 1, 2014 to January 1, 2015. However, when it goes into effect, organizations that do not provide healthcare coverage for employees will pay a penalty. “In many situations, organizations do the financial analysis and realize that paying the penalty and giving employees an allowance to go to an insurance exchange may be more cost effective than providing insurance for staff,” said Drake. “They are also increasing deductibles so employees pay more of the out-of-pocket costs.” Drake commented that healthcare organizations are also thinking outside the box and looking at other benefits to offset employee healthcare costs, such as incentives related to wellness programs.

In the face of smaller budgets and more reform, organizations are re-examining the role of learning and talent development.

•Healthcare organizations recognize that the need for learning and talent development is greater than ever. “Healthcare HR teams are rethinking their approaches to learning and realize that the best ways to reduce costs is through technological enablement and eLearning content,” said Michael Rochelle. “Healthcare organizations are also pushing harder on social and collaborative networks. This moves organizations to a ‘tribal knowledge’ approach which is much less expensive than formal classroom

training,” Rochelle observed. While directors of nursing

strongly agreed with this question (65%), it’s interesting to

note that fewer RNs strongly agreed (45%). This suggests

a gap between leaders and frontline employees related to

person-centered care related performance goals. There

are several steps that organizations can take to address

this issue.

•Cultivate an atmosphere that values goals. One effective approach is to create a service-excellence council comprised of frontline employees. This group should establish goals related to patient or resident satisfaction and monitor scores over time.

•Set effective performance goals. Individual department goals should align with broader organizational objectives. In addition, employee performance should be evaluated through SMART (Specific, Measurable, Attainable, Relevant, and Time-bound) goals. Hugh Chatham Memorial Hospital evaluates staff after they have been on the job for 90 days and then annually thereafter. Goals are either job-specific or tied to one of the organization’s five Pursuit of Excellence pillars (people, quality, service, financial, and growth).

•Recognize success when employees reach their objectives. It’s important to have a system that facilitates a consistent online dialogue between employees and managers. Open communication helps employees focus on positive behaviors. Accountability is based on an understanding of organizational goals, rather than on fear. Experience has shown that high levels of employee satisfaction translate into high levels of patient or resident satisfaction.

•Track goals with a performance management system to ensure consistency and to embed goals into the organizational processes. Hallmark Health System has embedded its Standards of Achieving Excellence into the employee evaluation process. Managers must indicate a minimum of three standards that each employee exhibited during the year. They must also identify standards where the employee needs improvement and work with staff to create action plans for improvement.

Copyright © 2013 HealthcareSource. All rights reserved. 5

Top Initiatives for Improving Patient and Resident Satisfaction:

•Improve employee satisfaction (80%)

•Create a culture of employee accountability (78%)

•Improve the patient and resident experience (70%)

•Create a service-oriented culture (69%)

Panel CommentaryTo improve employee satisfaction, organizations should think

in terms of customizations targeted at particular employee

needs or populations. This is particularly important for roles

where retention problems exist. Dr. Morgeson made the

following recommendations:

•Give employees more flexible working conditions. Scheduling seems to be a common reason why people leave jobs. Smart organizations try to figure out ways to accommodate employees’ needs.

•Hire for fit. As organizations recruit new employees, they may want to focus on whether candidates fit the culture of the work group, as well as whether they fit the values and goals of the organization.

•Pay attention to the role that work environment plays in the employee experience. Organizations should consider how they can leverage a supportive environment that drives employee satisfaction up. One effective approach is to ensure that supervisors provide feedback that make employees want to stay with the organization.

Although aligning workforce with the organization’s mission

went down 31% between 2012 and 2013, Morgeson does not

believe this is due to reduced emphasis in this area. “I think that

alignment between employees and the organizational mission is

now well understood and well integrated in many organizations,”

he noted. “This practice has become institutionalized and is

simply seen as the way hospitals and healthcare organizations

do business.”

HR Initiatives to Improve Patient and Resident SatisfactionAccording to survey respondents, improving employee satisfaction and creating a culture of employee accountability are top

priorities related to patient and resident satisfaction. This confirms the central role that employees play in delivering quality care. Other

popular initiatives for enhancing patient and resident satisfaction included improving the patient and resident experience and creating

a service-oriented culture.

Represents 2013 results.

Represents differences between 2012 and 2013.

6 Copyright © 2013 HealthcareSource. All rights reserved.

Top Initiatives for Improving Patient and Resident Satisfaction:

•Improve workforce education and development (79%)

•Improve employee satisfaction (66%)

•Hire for cultural fit (55%)

•Identify and manage low performers (54%)

Panel Commentary“Organizations need to take on some heavy lifting in the area of

education and development to initiate the change management

process for employees,” observed Michael Rochelle. “Behavioral

learning takes time and resources. Since it takes time for

people to understand the importance of change, it’s not

surprising that so many organizations are using education

and development to drive improvements around patient and

resident safety.”

Compared to 2012, 23% fewer respondents chose identifying

and managing out low performers as a means for improving

patient and resident safety. Stephanie Drake attributes this

change to a shift in how organizations manage low performers.

The emphasis today is on a positive outlook around engagement

and employee communication. “With healthcare reform,

employees must understand that the quality care they deliver

affects reimbursement down the road,” she noted. “Hospitals

help employees comprehend the importance of outstanding

performance through communication and training.”

HR Initiatives to Improve Patient and Resident SafetyTo improve patient and resident safety, healthcare organizations need to drive behavioral change among employees. To help improve

employee awareness and to encourage different types of behaviors, healthcare organizations are focusing primarily in two areas. The

majority of survey respondents (79%) are working to improve workforce education and development. Two thirds of organizations (66%)

are also trying to increase employee satisfaction.

Gaining a Voice as an HR Professional and Selling Ideas to Senior Leadership

To implement an HR initiative, it’s first

necessary to get buy-in from senior

leadership. The panelists had three

recommendations about how HR

professionals can sell their ideas more

successfully within the organization.

1. Describe the initiative in a business case. It’s helpful to describe the project in terms that senior leaders will understand. “Identify the situation, describe the opportunity, and what the expected results are. Show the return on investment,” advises David Szary. It’s also essential to demonstrate how the initiative is aligned with corporate objectives. “If you can clearly connect the project to the overall objectives of the organization, that will make the business case even more powerful,” commented Michael Rochelle.

2. Remember that people with credibility are heard. Credibility results from likeability, trust, and being respected for one’s knowledge.

3. Emphasize the importance of talent to organizational success. HR professionals must explain how talent is the leading indicator for success. “Describe how talent will drive meeting and exceeding strategic objectives,” suggested Rochelle.

Represents 2013 results.

Represents differences between 2012 and 2013.

Copyright © 2013 HealthcareSource. All rights reserved. 7

Social Media for Recruitment

Organizations are just starting to figure

out how to use social media more

effectively for recruiting. David Szary

made the following observations about the

“big three” social media tools—LinkedIn,

Facebook, and Twitter.

• LinkedIn is arguably becoming the best external database for exempt-level hiring. With some healthcare organizations that LEAN Human Capital works with, as many of one third of their exempt-level hires come from LinkedIn. The site is easy to use and profiles are usually up-to-date. Looking ahead, LinkedIn will continue to grow and evolve.

• Facebook is a great way to share employment opportunities. Many organizations have found that it’s useful to ask employees and key evangelists to share job openings with their Facebook network. This is a more effective use of Facebook than trying to mine databases and contact people.

•Twitter can be used to broadcast open positions. One of LEAN Human Capital’s clients, Fairfield Medical Center, recently discovered how to use Twitter for recruiting. Several new employees mentioned that they were connected to their professors through Twitter. If the professors followed the Medical Center on Twitter, they would likely Retweet job opportunities and career fairs that the Medical Center posted. Just by using this Twitter-based recruiting strategy, the organization saw a huge hiring increase in one of their specialty RN areas.

Top Responses for HR Challenges:

•Too many competing initiatives (72%)

•Not enough time to focus on projects (65%)

•No budget to implement programs (48%)

Panel CommentaryIn healthcare, everyone is looking at spending and every

function has fewer resources. “Departments within healthcare

organizations that are not revenue generating—and nine times

out of ten, HR is not revenue generating—are being asked

to cut where they can,” said Stephanie Drake. One way that

cutbacks may affect HR is that open positions in Human

Resources may go unfilled.

Compared to 2012, two percent more respondents in 2013

cited lack of workforce support as a challenge when it comes

to achieving HR initiatives. One possible solution to this issue is

the use of Lean principles. At its core, Lean is about removing

time spent on non-value added activities, so more time can be

invested in value-added activities. “Time is the most precious

commodity we have,” noted David Szary. “Anyone who’s used

Lean principles and mapped processes sees how much waste

there is. It’s easier to see where to make improvements and to

capture lost time.”

Challenges in Achieving HR InitiativesSimilar to the prior year, survey respondents are challenged by competing initiatives, insufficient time, and insufficient budgets.

In particular, the impact of budgetary issues on HR was not a surprise for the panelists.

Represents 2013 results.

Represents differences between 2012 and 2013.

8 Copyright © 2013 HealthcareSource. All rights reserved.

Top Responses for New Technology Adoption:

•Performance management (29%)

•Social media for recruiting (27%)

•eLearning content (22%)

•Applicant tracking (21%)

Panel CommentaryOne of the major advantages of a technologically based

solution for performance management is that it helps with

standardization and consistency over time and over the

employee base. “The challenge of performance management is

doing it on a regular basis and doing it consistently across the

organization,” said Dr. Morgeson. “The more that performance

management can be automated and facilitated through

technology, the better. Organizations are recognizing the

advantages that accrue from having a standardized vehicle for

doing performance management. Performance management

is one of the best things you can do to enhance workforce

performance.”

Healthcare HR practitioners also emphasized the cost

savings and regulatory compliance benefits associated with

automating performance management. For example, Brenda

Reinert, HR Director at Tomah Memorial Hospital in Tomah,

Wisconsin, commented, “We are being asked to do more

with less and a performance management suite helps us do

that. It was easy to demonstrate the value that the system

provides and substantiate the cost to hospital leaders.”

Performance management solutions create a comprehensive

archive of employee information related to job descriptions,

goals, and manager feedback. This is essential for supporting

regulatory reviews. Joanne Davignon, Director of HR and

Staff Development at Union Hospital in Terre Haute, Indiana,

observed, “Our performance management system contains

all the information that is required by governing bodies like the

Board of Health and HFAB. When we had a recent Board of

Health Survey, they asked us to pull 40 to 50 employee files.

We showed them five files in the performance management

system. They felt so confident about our data that they didn’t

need to see the additional files.”

With different generations in the workplace who have

different learning styles, healthcare educational content has

to be dynamic to be effective. Michael Rochelle made four

suggestions for strengthening eLearning:

1. Organizations must offer just-in-time, just-for-me

learning. Access to the content is important, but the

relevance and impact of the content is just as important.

A one size fits all learning approach won’t work. Content

must be designed for different audiences, whether it’s

Generation Y or Baby Boomers.

2. Content must be attractive. Employees are under

no obligation to learn at work, beyond what is required

for compliance and proficiency. Organizations that provide

transformational learning create an attraction model.

New Technology Adoption to Support HR InitiativesHealthcare HR professionals are recognizing that technologies can help as they try to meet their organizational goals while simultaneously

streamlining important processes and reducing costs. In the area of performance management, for example, the number of survey

respondents adopting an automated solution increased by five percent between 2012 and 2013. This type of system saves time for

HR teams and frontline managers. A similar trend was evident with eLearning content adoption which can help mobilize talent in the

workplace faster. Employees must get up to speed quickly to meet the demands of patient and resident care in a tough financial climate.

Represents 2013 results.

Represents differences between 2012 and 2013.

Copyright © 2013 HealthcareSource. All rights reserved. 9

Their learning content draws people in. Meeting employees

halfway on learning is exceptionally important.

3. Content must support a blended learning approach.

To move the needle on performance, training content must

be a mix of formal, social, and collaborative learning. That

combination of content is what drives the blended learning

approach and drives improved application of training.

4. Technology is a good underpinning for blended learning.

A well-designed learning technology ecosystem can reinforce

blended learning. Bringing together a learning management

system and social collaboration makes learning impactful

because it reinforces just-in-time, just-for-me education.

In highly regulated environments like healthcare, organizations

need scalability, sustainability, reproducibility, and consistency

in learning. Rochelle believes this can’t be done with manual

processes and the best approach is through a technology

mediated, blended learning strategy.

ConclusionThe 2013 HR Initiatives Survey highlights how the issues

facing the healthcare sector affect all organizational functions,

including HR. This year, healthcare reform and budgetary

issues are top of mind for HR professionals. In response,

HR teams are seeking to deliver their services as efficiently

and cost effectively as possible. This translates into greater

interest in technological solutions that automate HR processes,

such as recruiting, employee learning and development, and

performance management. If HR teams succeed in hiring the

right people and providing them with professional development

opportunities, healthcare organizations will be in a stronger

position to deliver quality care that results in high levels of

patient and resident satisfaction and safety.

How HR Is Preparing for Healthcare Reform

Preparing for healthcare reform is top

of mind for HR professionals. As the

upcoming health insurance mandate

expands health insurance coverage to

all Americans, hospitals and healthcare

organizations will have to provide an

adequate number of staff to care for an

increase in patients. In addition, healthcare

reform initiatives, such as the Hospital

Consumer Assessment of Healthcare

Providers and Systems (HCAHPS)

survey, are often focused on employee

performance —another concern for HR

and hospital leaders.

The effects of these issues were clear in the HR Initiatives Survey results. When asked what HR initiatives senior leaders and HR professionals plan to implement in order to reduce costs, 64% chose planning for the effects of healthcare reform. The survey data revealed other noteworthy information about HR and healthcare reform:

1. C-level executives are most concerned about healthcare reform. The highest responses of those who believe preparing for healthcare reform is a top HR initiative to reduce costs comes from C-level executives—80%, followed by 64% of directors and managers, and 56% of individual contributors, such as HR generalists.

2. Many talent acquisition professionals are already aligning healthcare reform with

recruitment efforts. Within the individual contributor data, only 27% of recruiters believe that one

of their top initiatives is to prepare for the effects of healthcare reform in order to reduce costs.

The variance in the data could suggest that senior leaders believe healthcare reform preparation

is a top HR initiative, but recruiters do not see this as their top priority. However, it’s also possible

that talent acquisition professionals have already aligned healthcare reform with their recruitment

efforts. “Healthcare reform has been a reality within the HR and recruitment realm for so long that

it just isn’t at the forefront of our minds as an initiative because it’s now part of our day to day

routine. We are always thinking of how to recruit at a high volume, while keeping costs low,” said

Emily Miley, Human Resources Specialist, Bronson Healthcare.

3. Performance and learning teams are still catching up with healthcare reform. The HR

Initiatives results suggest that healthcare organizations are striving to become more sophisticated

in their use of technology by implementing performance management and learning management

software, along with eLearning content. When HR professionals and senior leaders were asked

what new technology they plan to adopt in 2013/2014 to achieve their HR initiatives 38%

responded learning management systems and eLearning content, which marks a 10% increase

since 2012. Another top technology initiative that 29% of HR professionals and senior leaders are

planning within the next year is implementing performance management software, which marks

a 5% increase since 2012. “When it comes to HR initiatives and healthcare reform, it makes

sense that hospitals are preparing by focusing on performance management software, said Dr.

Frederick Morgeson, Professor of Management and Valade Research Scholar, Eli Broad College

of Business at Michigan State University. “A key element of healthcare reform is to focus on the

patient experience, which requires a distinctive set of worker behaviors oriented around providing

high quality patient service and aligning performance goals with patient-centered care—things that

are further enabled by performance management technology.”

10 Copyright © 2013 HealthcareSource. All rights reserved. HCS228 10/13

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About HealthcareSourceWith more than 2,000 healthcare clients, HealthcareSource is the leading provider

of talent management software for the healthcare industry. The HealthcareSource

Quality Talent SuiteSM helps healthcare organizations acquire, develop and retain the

best workforce possible, in order to improve the patient and resident experience.

The company’s cloud-based talent management solutions include applicant tracking,

behavioral assessments, reference checking, employee performance, compensation,

competency and learning management and e-Learning courseware. A private company

focused exclusively on the healthcare industry, HealthcareSource consistently earns

high marks for client satisfaction and retention. KLAS Research recently named

HealthcareSource a category leader for Talent Management for the third consecutive

year, in addition to recognition from Modern Healthcare’s “Healthcare’s Hottest,”

Inc. 500|5000 and Deloitte Technology Fast 500.

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