BY: BRIAN E. FORSCHNER, PhD; JAMIE J. HOUSEMAN; BETH A. LUKEN; and TIMOTHY C. DRESSMAN
Dr. Forschner is president, Senior Health and Housing Services,
Mercy Health Partners, Cincinnati; Ms. Houseman is executive director, Mercy
St. Theresa Center, Mariemont, OH; Ms. Luken is executive director, Mercy Franciscan
Terrace, Cincinnati; and Mr. Dressman, formerly executive director, Mercy Franciscan — best
Park, Cincinnati, is now executive director, The Franciscan at St. Leonard,
Leaders of a Long-Term Care Organization Tell How They Eliminated
the Need to Hire Temporary Staff
Like many other health care organizations, Mercy Health
Partners of Southwest Ohio's Senior Health and Housing Services, Cincinnati,
struggled in recent years with a shortage of professional staff. As a result,
the organization (see below) found itself spending $2 million annually on temporary
agency help. Such an expense was unsustainable. In early 2000, therefore, we
who lead the organization decided to make it agency free. We set Labor Day as
our target date.
Fortunately, we had a firm basis to build on, in that the organization
was already well organized and well run. These characteristics lent themselves
well to our effort to become agency free.
In kicking the initiative off, we formed 12- to 15-member teams
in each of our four facilities. The teams met weekly from four to six hours,
working over a period of 12 weeks to implement a performance improvement plan.
Team members included administrators, directors of nursing, supervisory personnel,
nursing assistants, housekeepers, maintenance employees, nurses, and other line
Each facility's team was given considerable leeway in the techniques
it chose to use to achieve the overall goal. The teams developed plans containing
both weekly and 12-week goals. These goals were then incorporated in a performance
contract that was signed by all committee members and approved by management.
We leaders reviewed each facility's weekly report, which included graphs charting
"call-offs" (occasions in which an employee scheduled for work calls to say
that he or she will be absent), turnover, open positions, and spending. Accompanying
each report was a narrative explaining the team's techniques and "best practices,"
as well as an assessment of its progress.
The organization's senior executives — the chief nursing officer,
vice president of Human Resources, and vice president for Marketing and Public
Relations — met once a month to support the teams and help them solve problems.
The teams found that the most common causes of employee turnover
- Poor employee selection
- Inadequate orientation
- Lack of fun on the job
- Inflexible scheduling practices
- Negative employee attitudes
Consequently, the teams proceeded to focus on these areas.
Poor Employee Selection Studies done by Maun-Lemke, Inc.,
Omaha, a consulting firm engaged to aid the effort, indicate that 36 percent
of all long-term care turnover results directly from poor job orientation; 25
percent of employees leave during their first 90 days on the job, for example.1
In their book, First Break All the Rules: What the World's Greatest Managers
Do Differently, Marcus Buckingham and Curt Coffman say national survey results
show that employees need three things to succeed on the job:
- Knowing what is expected of them
- The materials and equipment necessary for doing the work correctly
- An opportunity every day to do what they do best2
Our four teams suggested ways to ensure that applicants were
truly interested in the jobs they applied for. The facilities had hitherto relied
on unfocused newspaper advertising to attract potential employees, most of whom
simply walked in off the street. We began to improve our methods for recruiting
In our advertisements, for example, we focused on what we called
the "star employees" at each facility. The new ads — which featured photographs
of the "stars" along with quotes from them — invited potential employees to visit
the facility and meet them. An applicant responding to the ad would be greeted
by one of these "stars," who in effect became a recruiter.
Applicants would typically spend time observing an employee at
work to see if the job in question was one they were interested in. Sometimes
this experience itself eliminated as many as half the applicants. Meanwhile,
tours led by "star" employees or their colleagues allowed applicants to ask
questions. This aspect of the process also permitted staff members to observe
applicants and decide whether to urge management to offer them jobs. Partly
because of this process, we were able to reduce hiring time, once a job candidate
was selected, from three weeks to seven to 10 days.
Inadequate Orientation Our teams also revised the orientation
process. We appointed mentors to meet with new employees daily for their first
two weeks on the job. We launched an interactive orientation program that includes
discussions of our passionate commitment to our residents, a scavenger hunt — like
activity that gives participants an opportunity to explore the facility, skits
on safety issues, and a presentation on disaster procedures. This approach conveyed
our enthusiasm for our work to our new employees, enthusiasm we have found to
Lack of Fun on the Job Realizing that our staff members
generally spend more waking hours on the job than they do with their families,
we decided that we must have a joyful atmosphere at work if we were to retain
In this regard, exit interviews and staff discussions proved
to be revealing. We found that, although our facilities were mission-oriented
and well managed, they were not considered "fun" places to work. So our teams
began looking for ways to change this. Each team appointed a committee whose
job it is to celebrate birthdays and anniversaries and plan special events.
It is now customary for our facilities to host pizza parties, "Hat Days" (when
the dress code is relaxed and employees are allowed to wear their favorite hat
on the job), "Survivor Days" (a scavenger hunt and summer cookout using the
popular television show as a theme), and other special occasions. Even routine
accomplishments, such as coming to work on time every day for a week, are recognized.
All this has helped contributed to a more joyful atmosphere.
Inflexible Scheduling Practices Traditional work shifts
do not always meet the needs of today's employees. Aware of concerns in this
regard, our facilities' leaders first held employee focus groups, then followed
up by experimenting with different types of scheduling. They introduced job
sharing, established overlapping shifts and shifts of different lengths, and
made accommodations for weekend preferences.
Negative Employee Attitudes To increase job performance,
our teams also focused on attracting "positive" employees — individuals who, instead
of simply complaining about problems, would suggest solutions to them. Those
staff members who wanted to join what we called "High Performance Teams" promised
to bring complaints or potentially troubling issues to the right venue and device
potential solutions for them. When a group was commissioned as a High Performance
Team, we gave its members buttons bearing the letters "BMG" and a slash across
them, which meant "No bellyaching, moaning, or groaning!"
We had launched our campaign believing that reducing agency help
would improve our resident satisfaction scores on the Parkside Associates' survey,
increase staff satisfaction as measured by the Developing Organizational Capacity
survey, strengthen our financial position, and reduce employee turnover.3
The day before Labor Day 2000, our facilities said good-bye to
the last agency employee. In the next 30 days, we administered both employee
satisfaction surveys and resident satisfaction surveys. A comparison of 1999
survey results with those for the first seven months of 2000 showed employee
satisfaction scoring an excellent 60 percent. Improvement was particularly dramatic
at Mercy Franciscan at Schroder, where employees embraced the new recruitment
and retention concepts with extra effort and commitment.
We plan to use the results of the 1999 employee and resident
satisfaction surveys as the benchmark for later surveys. New surveys were conducted
in September and October 2001, and we expect those scores to indicate continuing
Meanwhile, survey results have shown that resident satisfaction
improved at all four facilities in 1999-2000. In addition, all four showed significant
financial improvement by the end of 2000. According to anecdotal evidence, staff
members were more pleased with their work, residents and family members were
happier, and the overall quality of the four facilities had increased. The health
status of residents had also improved, as revealed by decreases in incidence
of bedsores, falls, and urinary tract infections among residents. Across the
four facilities, employee turnover rates were cut nearly in half, from 56 percent
to 29 percent.
Staff's Cooperation Is Vital
Our campaign to become agency free was driven by our staff's desire
to take better care of our residents, improve their working environment, and
ensure the organization's financial solvency. The results seen since we reached
our goal strongly suggest that the whole effort was worthwhile.
Permanent, facility-based staff members who are properly screened,
oriented, and recognized for their work will stay in their jobs longer than
those who are not. Moreover, staff members who are treated properly become committed
to the organization's mission and values and provide residents with high-quality
care. All this contributes to financial success because it helps the organization
eliminate the use of costly temporary agency help.
- Clint Maun, Dale Lind, and Greg Efta, Recruitment, Selection and Retention
of Top Quality Staff, Maun-Lemke, Inc., Omaha, 2001, p. 22.
- Marcus Buckingham and Curt Coffman, First Break All the Rules: What
the World's Greatest Managers Do Differently, Simon & Schuster, New
York City, 1999, p. 27.
- Parkside Associates, Inc., Partners in Quality: Long-term Care Survey,
Park Ridge, IL, 2000; Jeff Monroy and Diane Fassell, Mercy Health Partners/Greater
Cincinnati Region Employee Satisfaction Survey, Newmeasures, Inc., Boulder,
Mercy Health Partners of Southwest Ohio
Mercy Health Partners (MHP) is an integrated, holistic health care
delivery network with more than 80 care delivery sites in southwest Ohio. The
system has a staff of more than 7,800 employees and more than 4,000 affiliated
physicians representing a wide range of medical and surgical specialties.
MHP's Senior Health and Housing Services comprises four facilities
in the Cincinnati area. They are:
- Mercy Franciscan Terrace
- Mercy Franciscan at Schroder
- Mercy Franciscan at West Park
- Mercy St. Theresa Center
Copyright © 2001 by the Catholic Health Association of the United States
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