Seton Medical Center Harker Heights, one of six hospitals in the LPH Hospital Group, is a new 83-bed hospital that opened its doors in June 2012. Harker Heights, a community of about 27,000 in Central Texas, is situated between Austin and Waco, about 60 miles from each, and is about 20 miles away from a Veterans Administration hospital in Temple. It’s also located near Ft. Hood, the largest active-duty armored post in the U.S. Armed Services, serving a population that is young (median age 28) and transient due to military deployments.
That makes employee recruitment and retention a challenge, according to Mona Tucker, the hospital’s director of human resources. “We are in an Army community, a transient community. A lot of folks are here for two or three years and go. It’s difficult to build a team and keep the momentum going when people are coming and going all of the time,” she says.
It’s especially challenging to recruit for director-level positions, she says. The hospital recruits from out-of-state quite a bit, and it experienced high turnover during its first year of operation. Many of those employees had difficulty adjusting to the area, she says. She also notes that it is challenging to open a hospital from scratch, with all of the work of establishing policies and procedures, implementing an electronic medical record, and building databases from the get-go.
Because the hospital is new, it is focused on recruiting directors who have enough prior experience to build a foundation. Although there are other hospitals in the area, those organizations are already established, and high-level employees are often reluctant to move to a new care setting, which makes it difficult to recruit employees from the immediate area, she says.
Staff levels for specialty positions have also taken a little longer to recruit for, although she adds that the hospital has “a pretty good pipeline of nurses” coming through the area. One advantage to the hospital’s small size is that it is able to act quickly to hire qualified staff. Although the hospital has had quite a few contracts with agency nurses over the last year, it is presently down to its lowest level in agency nurse use, and its goal is to reduce that number to zero, she says. To fill staffing requirements, Tucker prefers to use per diem nurses, which gives the hospital the flexibility to cancel without penalty, rather than a travel contract that requires a commitment of 36 hours a week, she says.
Right now, Seton Medical, together with the other five hospitals in the LPH Hospital Group system, is evaluating time and attendance software that also does analytics. “That provides the ability to actually forecast and do prospective staffing, rather than retrospective, like most systems are set up now,” she says. “We are looking at being proactive and fiduciary with our resources and good stewards of our resources, and appropriately staff the areas based on acuity.” Currently scheduling is done manually, and managers base their decisions on yesterday’s information. Once the automated system is selected, all six hospitals in the LPH Hospital Group will standardize on it, she says. She expects a system to be implemented within the next year.
Tucker says analytics will help the hospital get a better handle on time and attendance policies, and monitoring shift differentials, PTO and payment. Once it is in place, the staffing goals for each unit will be on an acuity basis, with man-hour requirements that are tied to time and attendance data will be at the fingertips, she says.
In Tucker’s opinion, there is adequate technology in the market for hospitals to automate their staff allocation processes. She says that in order for a system to be effective, it’s critical to have individuals who champion it and to make sure it is used once it is implemented. From an HR standpoint, the upgrade will be huge, providing the ability to accommodate staffing changes on a timely basis, and to schedule PRN nurses more effectively to fill holes in the schedule after full-time and part-time staff is scheduled, she says. It will also be important to staff, noting that the ability for clinical staff employees to do self-scheduling is an important employee satisfier, she adds.
In addition to technology deployment, Tucker says that staff communication and education are central to and engaged workforce. Employee satisfaction is monitored and feedback results in action plans that are followed through on, she says. Monthly or quarterly, depending on the size of the department, directors conduct face-to-face encounters with each staff member for feedback or address employee concerns.
The hospital has an structured on-boarding process for new employees, which takes as long as a year. Patient satisfaction is emphasized: “It is very important to teach our associates from day one all of these measures, and that they are accountable for those measures,” she says, adding that patient satisfaction scores are shared with the staff. Employees are educated in value-based care, and what it means in terms of patient care quality as well as income for the hospital.