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BY: SR. SHERRI COLEMAN, FSM

Sr. Coleman is public relations manager, SSM Rehab, St. Louis.

Quality Staff Selection Generates Positive Business Results

Facing a $2.8 million loss creates an organizational environment in which change is not an option, but a necessity. Take St. Louis' SSM Rehab, for example.

January 1999 marked a turning point for SSM Rehab, a member of SSM Health Care and one of Missouri's largest providers of comprehensive medical rehabilitation services, with more than a dozen inpatient and outpatient locations in the St. Louis metropolitan area. President Melinda Clark faced a situation of declining facility share and diminishing physician referral base and had to search for options to turn the organization around.

Reorganization needed to accomplish five main goals:

• Increase rehabilitation census
• Manage skilled nursing facility utilization
• Boost patient volumes in all settings
• Improve customer service to referring physicians
• Regain eroding market share

Inpatient rehabilitation is built on relationships with referring physicians. Historically, global marketing strategies had not delivered an increase in admissions to SSM Rehab. Therefore, in one attempt to address the above goals, Clark made the decision to switch from global marketing to direct sales.

According to Clark, the selection of a rehabilitation facility is much different from choosing an acute care hospital. "Patients seeking inpatient rehabilitation care think about admission when a catastrophic event such as a stroke or brain injury occurs," explained Clark. "Typically, it is near the time of discharge from acute care when a rehabilitation admission is pursued, usually on the referral of a physician."

Understanding that relationships with the referring physician were essential for building the admission volume was critical to SSM Rehab's reorganization goals. Throughout 1998, SSM Rehab had been rated last in facility share in the St. Louis area and had a declining admission rate in its facilities. Moving from a strategy based on global name recognition to one based on growth — putting actual patients in actual beds — was a significant change for SSM Rehab. This responsibility had to be met by direct sales staff.

The Recruitment Process Is Key
In recruiting for the direct sales positions, Clark, a registered nurse with 23 years of health care experience, recalled a hiring format that she and a team had developed in a previous position at Tampa General Hospital, Tampa, FL. Referred to as "Hiring the Right One," the process is well-developed, carefully organized, and ensures that the interview process selects the most dynamic, focused individuals for key positions. Clark made the decision to adapt this process to fill positions in intake and sales. The results have been impressive and long-lasting (see Box).

To assist her in carrying out the hiring plan, Clark included staff from human resources, education, risk management, business development, and finance as well as nursing, social work, and physiatrics (a specialty involving physical medicine and rehabilitation). Although Clark achieved her goals through the use of the process and would use it again to fill key positions, she admits that the process could not have been successful without hard work and staff support of the process itself (see Box).

Meeting an Aggressive Hiring Timeline
After internal posting of the positions throughout SSM Health Care entities in St. Louis, advertisements were placed in classified sections of local newspapers. From the dozens of resumes received, Clark and members of her team narrowed down the list of potential candidates. "We were looking for the strongest candidates," stated Clark, "those who demonstrated experience as well as successful outcomes in previous positions."

Twenty-five candidates were chosen to interview for a total of eight positions as intake specialists or regional marketing specialists. Clark contacted all potential applicants by letter, asking them to schedule an interview through human resources. Each interviewee received SSM Rehab background information, including the mission statement, statement of values, code of ethical conduct, and an interview agenda. The letter made it clear that the interview process would take three to four hours. "We were straightforward about the expectations of their interview," said Clark. "We knew that it might eliminate some candidates but also that the ones who continued in the process would be the most qualified and best prepared for the jobs." Clark also noted that there were candidates who notified her that they did not wish to proceed with the process because of the extensiveness of the interview commitment.

The interview proceedings focused on critical components of the sales position. Clark and her staff divided themselves into designated teams in specific areas to conduct the interviews. In one setting, candidates' social skills were evaluated; in another, their selling ability was assessed as they persuaded interviewers to buy a favorite product. In another group, candidates' financial skills were measured as they named the top 10 rehabilitation diagnoses and responded to scenarios related to recommended treatment for the patient. Another interview setting required candidates to conduct assessments on hypothetical patients and talk with staff physicians to convince them to select SSM Rehab for the care of their patient. (See Figure for sample question.)

"The preadmission screening part of the process was extremely important," said Clark. "Our top priority at SSM Rehab is our patients, and we needed to be sure that our first contact lets patients and families know the quality of our staff."

Twenty-five candidates were interviewed over a two-week period, and within 30 days eight new positions were filled. Three were regional marketing specialist positions, and five were rehabilitation intake specialist positions to be located in specific geographical locations throughout the organization. "The SSM Rehab staff who worked with me throughout the interview process were thrilled," said Clark. "We were all amazed how the shining stars among our applicants hit the top time and time again." Clark knew that this was how the process worked. "This hiring format will always draw out and affirm the best person for the job," she said. "The key characteristics that we're looking for in candidates will always surface — flexibility, energy, motivation and drive."

Although the process was geared toward learning about the candidates, Clark observed that applicants expressed appreciation in learning about the mission of SSM Rehab through their participation. "For any serious candidate, there was a need to know the kind of organization that we are — Catholic, not-for-profit, and committed to our patients." Even candidates who weren't selected made it a point to let Clark know how good the process made them feel. "We didn't overwhelm them with information about SSM Rehab, but we did make it available to them before their official interview," said Clark. "The main goal of our time with the candidate was to focus on the individual and his or her potential." For most candidates, this was a unique experience for an interview.

Benefit of Interview Experience
Jean Kestner has been a physical therapist for 24 years. She was one of the dozens to respond to the SSM Rehab advertisement for a regional marketing specialist. She had left a position as director of rehabilitation services in a rural Illinois subacute/skilled nursing facility, where she had also been extensively involved in marketing. Kestner had interviewed for other physical therapy positions and had been offered a position as director of rehabilitation for an Illinois hospital, but when she saw SSM Rehab's advertisement, she instinctively responded. SSM Rehab contacted her, set up an interview time, and mailed company materials for preparation.

"It was the most involved interview I've had in my career," said Kestner. "As soon as I realized the challenge of the interview, I decided that it was worth going through the process just for the experience." Kestner was also drawn to the position because it would take her in a slightly different career direction. "I had always been a clinician," she said. "But with the changes in Medicare reimbursement [the prospective payment system] going into effect in skilled nursing facilities, I was very concerned about where the more involved patients were going to be able to receive the rehabilitative services they needed. First and foremost," said Kestner, "I'm a patient advocate, and I had to consider how I could continue my advocacy for patients in a marketing position."

Kestner recalled spending four hours preparing for her SSM Rehab interview. "It was the best interview process I've ever gone through," she said. "I felt valued by SSM Rehab and sensed their sincerity in getting to know me and all the candidates."

SSM Rehab selected Kestner for one of the three regional marketing specialist positions, and she accepted. She has since been promoted to SSM Rehab marketing manager and has been a vital part of the direct sales process that has consistently increased SSM Rehab admissions since implementation. Kestner observed that the greatest change in the SSM Rehab marketing approach over the last two years is that it became driven by customer service. "A top priority is to stay in touch with our physicians," she stated. "This contact means finding out their needs, working to meet those needs, and overcoming any barriers that hinder physicians from referring their patients to SSM Rehab. SSM Rehab marketers are responsible for troubleshooting when physicians have any challenges with our services," she said.

Using an example of addressing challenges with referring physicians, Kestner identified how they were able to overcome an identified issue regarding medical management of referred patients. "Physicians had been concerned about losing control of their patients once they were admitted to SSM Rehab," said Kestner. "We communicated this challenge to our program information management department, and they developed a procedure to quickly grant temporary consulting staff privileges to the referring physician. With consulting staff privileges, the referring physician can consult and direct his or her patient's medical management while the SSM Rehab physiatrists direct the patient's rehabilitation care. We also worked with the medical staff office to increase the amount and type of communication going to referring physicians with the goal to keep them 'in the loop,'" she said. Kestner reported that these efforts have been received very positively by SSM Rehab's referring physicians.

Kestner and her marketing staff have tracked the consistent increase of inpatient admissions as a direct result of the ongoing commitment to physician relationship development. During 1999, the SSM Rehab marketers developed a physician database to keep track of all physician contact. Marketers also work with the therapists at SSM Rehab outpatient sites, which are separate from the SSM Rehab inpatient rehabilitation hospital or units. "In outpatient rehabilitation, physicians want to increase their contact with the direct caregiver, which is the physical or occupational therapist," said Kestner. "As marketers, we can open the door to that physician/therapist relationship by making the initial contact and scheduling the first meeting. Then we share customer service skills with the therapy staff so that they can foster and develop the relationship with the physician and his or her staff," she said.

According to Kestner, she and her team of marketers had no trouble beginning the work of enhancing physician relations once they came into their direct sales positions nearly two years ago. She attributes this to the thorough job interview process that firmly set performance expectations. "We knew exactly why we were being hired," said Kestner. "Having your performance goals and a strategy on how to meet them on the first day of a new job is a great advantage," she said.

Surpassing Business Goals Strengthens Mission Focus
At the end of 1999, SSM Rehab had moved from fourth to second in the St. Louis rehabilitation market. The number of admissions increased from 959 in 1998 to 1,028 in 1999; this rise increased further in 2000. Of most significance was overcoming a $2.8 million deficit to generating a $750,000 profit within one year's time.

This level of performance was beyond the expectations of Clark and her staff. In addition to fulfilling a business plan, Clark, who was part of an SSM Health Care team that developed a new mission statement for its 5,000 affiliated physicians and 20,000 employees, feels reassured that the hiring process she used to fill eight key positions adheres to the current mission statement: Through our exceptional health care services, we reveal the healing presence of God. "In this statement we promise to provide exceptional health care services, and within our organization, that service is rehabilitation," said Clark. "I feel responsible for seeing that everyone who needs our services receives them, and with our current marketing and intake staff, I see that becoming a reality."

MEASURES OF SUCCESS FROM 1998 TO 1999

• Increased admissions from 959 to 1,028.
• Rose in rank from fourth in rehabilitation market to second.
• Increased annual growth rate from 18.8 percent to 22.8 percent per facility share.
• Went from an operating loss of $2.8 million to an operating profit of $750,000.

STRUCTURED INTERVIEWS

The interviews used in this hiring process follow a particular structure. Strict adherence to the structure and the questionnaire used by interviewers creates continuity and useful data for each applicant.

Part 1: Presentations

• Presentation topics are mailed to candidates before the interview.
• Candidate makes oral presentation to small interviewing group; visual aids are permitted.
• Candidate is independently scored by reviewers.

Part 2: Pre-admission assessment

• Candidate reviews a mock patient chart and examines a mock patient.
• Candidate completes actual assessment form used at SSM Rehab.

Part 3: Physician conference

• Candidate presents the mock case to the physician.
• Candidate attempts to persuade physician to admit the mock patient.
• Candidate's efforts are scored by an observer.

Part 4: Finance review

• Candidate demonstrates knowledge of Medicare and Medicaid regulations.
• Candidate demonstrates competency in managed care concepts.

Part 5: Social skills

• Candidate describes his or her personal attributes.
• Candidate demonstrates persuasive skills.

Part 6: Face-to-face question/answer session

• Interviewer assesses candidate motivation.
• Interviewer answers questions from candidate.

Sample Interview Questionnaires

Face-to-Face Interview Questions

1. Why do you want to work for SSM Rehab?
2. Tell us what you know about SSM Rehab.
3. What are the components of this job that will make it "the best job ever"? Based on what you know about SSM Rehab and this position, what areas of the job interest you most?
4. What questions would you like to ask us?

Finance Interview Questions

1. Please tell us why a 25% rule is important to a comprehensive medical rehab unit. (Looking for: 25% of admissions to a comprehensive medical rehab unit do not have to be "approved" rehab diagnoses.)
2. How would you evaluate if an HMO patient was going to have a negative financial impact on SSM Rehab? (Looking for: knowing the rate paid to SSM Rehab by a managed care plan and the charges or costs the patient would create.)
3. What should you do if an insurance case manager calls you with an admission and asks that you accept a rate lower than our agreed-upon, contracted rate? (Looking for: do an assessment on the patient, determine the financial risk, and re-negotiate within policy, if appropriate.)
4. What is the difference in a Medicare risk and a Medicare contract? (Looking for: basic definitions.)
5. Can you list the types of payors that require pre-authorization? (Looking for: Medicare risk, Medicaid, HMO, PPO, etc.)
6. Can you identify the types of diagnosis that are considered appropriate for admission to a comprehensive medical rehab unit? (Looking for: stroke or cerebrovascular accident, spinal cord injuries, neurological conditions, hip fractures, muscular disease disorders, certain kinds of arthritis, major multiple trauma.)
7. Can you discuss the criteria for payment under Medicaid? (Looking for: approved rehab diagnosis, must be disabled after two years, have completed application for Medicaid, have no other form of coverage.)

Social Skills Interview Questions

1. Define who the key customers are for this position.
2. Describe your personal work ethic.
3. Pick a product you enjoy using (Coke or Excedrin, etc.) and try to convince me to use that product.
4. What do you enjoy most about working with people?
5. Tell me about a time you made a wrong decision. How did you remedy the problem?
6. How do you initiate dialogue when you first meet a new prospective customer/client?
7. What would the people you work with tell us about you?

Copyright © 2001 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.