College of American Pathologists
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  Saving Faces: Selling your health
  system, your lab and the job


cap today



December 2006
Feature Story

Anne Ford

If the most important factors in real estate are “location, location, location,” the most important factors in dealing with the current laboratory labor shortage may be “retention, retention, retention.” As Robert DeCresce, MD, chair of the Department of Pathology at Rush Medical College, Chicago, says: “The smartest thing you can do is keep the people you have.”

A recent audioconference, “The Lab Brain Drain: Strategies for Finding and Keeping Laboratory Talent,” offered by G2 Reports, Kennedy Information, and the Institute of Management and Administration, outlined ways for laboratories to retain employees and to attract those employees in the first place. In a 2005 American Society for Clinical Pathology poll, 44 percent of laboratories surveyed reported they had trouble filling positions and that it took them an average of 2.2 months to find and hire a medical technologist. If laboratories don’t take extra measures to woo both job candidates and existing employees, said audioconference co-leader Jeff Smith, HR director for Carilion Labs in Roanoke, Va., those workers “will find other opportunities in this labor market, and you will have lost them and be scratching your head and not understanding quite why.”

Perhaps the most important tool in retaining employees: a department-specific retention plan that includes specific ways to recognize employees who have done well. Carilion, Smith said, goes so far as to tailor that recognition to the employee’s personality and preferences. So while some workers might like to receive kudos in front of their coworkers, others might prefer more discreetly delivered praise, such as written notes from their managers.

To recognize employees who have worked especially hard or put in overtime during a volume-heavy period, Carilion managers sometimes mail personal notes to employees’ homes. Not only that, said Smith, but “a lot of times we’ll throw in a couple movie tickets and say ‘Hey, thanks for putting up with us requiring a little extra work, and we want you to know that you’re recognized, and we hope you have a nice movie night out on us.’”

Dr. DeCresce can testify to the power of recognition in retaining employees. “We have a lot of recognition things and a lot of reward things all the time,” he told CAP TODAY. “In the end, people have to have a place they like to work at. An individual’s relationship with their supervisor, their coworkers, and the rest of their staff goes a really long way,” and honoring employees for jobs well done is one way of ensuring those relationships are positive.

Other ways to recognize high performers include asking them to conduct peer interviews with potential hires. “This is a nice way for the med tech who’s doing great to get involved with a different part of the process,” Smith said.

Ideally, retention begins even before the employee is hired, during the interview stage. Carilion uses an interview testing tool that provides a behavioral profile and makes the company aware, among other things, of how the applicant is likely to cope with stressful situations. “We had a recent hire whose profile showed that under stress, she is a little more aggressive than the cultural norm here,” Smith said. “So we made her aware of that.” The first time the new employee displayed that aggression, “we just pulled the report back out and said ‘Hey, we thought this might happen… Let’s talk about a plan.’” That allowed the employee to feel supported by—and likelier to remain at—her new workplace, rather than attacked.

Carilion has also embraced “onboarding,” a way of integrating new hires into the laboratory that’s designed not only to let them become productive quickly, but also to make them feel as comfortable as possible in their new workplace. Otherwise, Smith said, “It’s too easy to bounce back to that old company.” Rather than undergoing a traditional orientation, which often entails spending the entire first day or two trying to absorb the employee handbook, new Carilion hires receive benefits information ahead of time so that on their first day on the job, they’re ready to ask questions. Also on their first day, they’re shown how to access more company information on their computers at their own pace; that way, they can alternate learning more about their workplace with actually doing work. Smith calls it “a much more blended approach” that helps new employees feel like they’re part of a productive team from the beginning.

Then, too, each new hire is assigned a “buddy,” an experienced employee who will show him or her the ropes. “It is a tremendously high percentage of people that will stay if they’ve got a best friend at work,” Smith says. Carilion uses the buddy system for all levels of employees.

The audioconference’s other leader—Tara Kochis, senior vice president and managing partner with executive search firm Slone and Associates, Centreville, Va. —said, “A lot of what we’re talking about involves proactive initiation.” That is, rather than scrambling to fill a position when an employee quits or retires, laboratories should monitor their workers’ ages, years of experience, and performance records to predict and prepare for staff openings. Smith calls this “succession planning.” At Carilion, the HR staff monitors the number of employees in each department who are eligible or will soon be eligible for full retirement. That way, he says, they can tell the department head, for example, “You might be close to losing a couple of med techs. Should we go ahead and start recruiting someone now for you?”

That monitoring process allows managers to keep track of which employees are performing especially well and therefore likely to outgrow their current job. “If you don’t have something planned, you’re going to lose them,” Smith warned. By staying abreast of the situation, managers can promote or give more challenging responsibilities to high-performing employees to prevent them from becoming bored and looking elsewhere for work. (Reimbursing employees for tuition for classes related to their jobs is another way to keep them challenged. Dr. DeCresce says of his workplace, “As people get additional training, we have built-in financial incentives as they advance in their skills at work, and that tends to encourage people” to stay.)

Keeping track of vacancy rates of high-demand, hard-to-fill positions such as medical technologists also allows Smith to see temporal patterns that help predict when an employee is most likely to leave. He’s learned, for example, that “if we get them through the first nine months, there’s a good chance we’re going to keep them for five years.” Being aware of benchmark times such as those can help a manager take action to retain an employee, or, failing that, be prepared to replace him or her.

Speaking of replacement, how can laboratories attract candidates from the ever-shrinking pool of health care workers? Both Smith and Kochis emphasized the need to find a “passive candidate,” which Kochis defined as “someone who’s happy and productive in their work today, who, before receiving a call... from you or your HR folks wasn’t contemplating a leave or a change, and thus would come to you for all the right reasons—because of the opportunity, because of what you have to offer,” not because they’re trying to flee a bad work situation. She recommends creating a database of passive candidates filled with names gathered from trade shows, conferences, and employee referrals, among other methods.

In addition to a database, Carilion maintains a waiting list of candidates. “The openings and the candidates don’t always exactly match. Sometimes you’re going to have one need right now in a department, but we get three quality applicants,” Smith said. “We keep track of candidates that we’ve seen, we’ve made contact with, and feel are good candidates that we’d want to hire. We just go back about once a month and send them an e-mail and say, ‘We’re still interested in you. Are you still interested in us?’” Then when a position is open again, “hopefully we’ve got a list of candidates ready and available.” Even better, since those candidates have often already been through the interview process, “we can go ahead and make an offer,” Smith said.

He’s also a fan of the “grow your own” approach. Carilion addressed its phlebotomist shortage by creating a phlebotomy training program and then hiring members of the graduating class. Similarly, it offers a specimen processing class, in which students who take the class have their tuition reimbursed if they’re hired after graduation and stay on board at least 60 days. “It’s sort of ‘Pay me now, we’ll pay you later,’” Smith said.

Another means of building a candidate database: employee referrals. Carilion management tells its highest performers, “Give us three to five names of people you’d want to work with.” “That was really intriguing,” Smith said. “At first they were a little cautious, because they’d never been asked a question quite like that.” After a couple of people were hired that way—and the referring employees received bonuses as a result—the referrals began flowing in faster. Now Smith knows of one Carilion employee who “literally makes almost as much in referrals per year as he does in his base salary, because he is just such a great ambassador.” Carilion pays referral bonuses of between $250 (for phlebotomy and specimen processing) and $2,000 (for MTs and cytogenetic technicians).

In addition to awarding referral bonuses, Smith and his colleagues in HR will go to department meetings and ask for names. Everyone who supplies a name is entered into a prize drawing on the spot. “It might be dinner at Applebee’s, or it might be two movie tickets,” Smith said. Even though the employee who supplies a successful referral will get a monetary bonus down the road, the short-term reward is motivating, too: “You give a referral, and you might get dinner that night.”

It’s all part of what Kochis called a “recruiting culture.” “It’s not about ‘You’re lucky to be here,’” she said. “It’s about ‘How great it is to be here, and I love the people and the atmosphere, and I would love for more people I know to be a part of this.’”

Once referred candidates come in for an interview, Smith suggested “spoiling them a little.” He greeted one high-level candidate recently with a welcome sign and a bag of small gifts. “I’m not sure that’s what put it over the edge, but the person did accept,” he said. “You never know. If it had not worked out with that person, she may have gone back and known two other people in her network who might have been right and referred them to us.”

He also does his best to schedule all of a candidate’s interviews for the same day, to avoid having to tell the applicant, “‘Oh, I’m sorry the technical director of the lab wasn’t available to be here today. Can you come back next Thursday?” Multiple, uncoordinated interviews strung out over a long period all but invite the candidate to lose interest and accept an offer elsewhere.

Smith summed up the sometimes ruthless world of laboratory retention and hiring by paraphrasing a quote from an old episode of Cheers: “It’s a dog-eat-dog world out there, and we’re wearing Milk-Bone underwear.”

“You’ve got to understand, the candidates now have competition,” he said. “With the economy improving, folks can go work someplace else. So we’ve got to understand that we’re constantly in the space of selling our health system, our lab, and the job. And if you can’t translate that, then you’re in trouble.”

Anne Ford is a writer in Chicago.