strategies to attack workforce challenges in 2016
TRANSCRIPT
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Strategies to Attack Workforce Challenges in 2016
Moderator: James M. BerklanEditor
McKnight’s Long-Term Care News & McKnight’s Assisted Living
Presenter: Mark Woodka
CEOOnShift
Presenter: Irene FleshnerRN, MHA, FACHE
Principal, Reno, Davis & Assoc. Inc.SVP Strategic Nursing Initiatives,
Genesis HealthCare
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Before we start
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Workforce Focus In 2016
Employee engagement & retention
Finding qualified candidates
Managing labor costs
Career development
Scheduling to resident needs
Hiring process improvement
Government reporting compliance
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Attacking Major Challenges
Wage Pressures2.5M
Journal
Workforce Shortage
44.4%Direct Care Turnover1
Payroll BasedJuly
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Attracting Millennials
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The Millennials Are Here
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“By 2025, Millennials will dominate the workforce, perhaps as much as 75 percent so we’re going to have to figure out what they expect, and what we can do to attract them to our organizations and keep them there.“
- Post Acute Care Executive
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And They Are In Your Communities
Millennials Generation X Baby Boomers
77.94%
16.55%
5.52%
* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016
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No Yes
65.00%
35.00%
Are You Adapting?
* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016
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Competition Across Industries
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Who Are These People?
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They’re Doing Research
Nursing Allied Healthcare Physician Other Healthcare
12
14
16
13
Number of different resources used before applying to a job
* CareerBuilder 2015 Candidate Behavior Study
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Your Brand Matters
• HR & marketing must work together– Employee referral program
– Include the benefits of working at your organization on social feeds
• Organization events
• Community outreach
– Track top talent in your organization & recruit to be brand ambassadors
• Post reviews to Glassdoor
– Sell sheets to attract candidates
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Simplify Applications
• Most employers use long applications to eliminate unserious candidates– 40% of recruiters have not tried
to apply for a job they have posted
• Today’s jobseekers prefer brief and simplified application processes– 60% of candidates have quit an
online application mid-process due to its length and complexity
“Almost anyone with the right
attitude can train for competency.”
Blair Minton, President, RPM Management
* “How Candidate Experience is Transforming HR Technology,” which was conducted by Harris Poll on behalf of CareerBuilder, 2014
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Go Mobile For More Candidates
• Initial applications should take 1 – 2 minutes
• 45% of healthcare employees have searched for jobs on a mobile device
• Yet 90% of employers don’t feel they are missing out on quality candidates by not having mobile friendly applications
* CareerBuilder/Harris Mobile Recruitment Survey, 2013 & 2014
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Become Transparent
• Set “day in the life” expectations
• Provide salary range• Identify scheduling
expectations
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Finding The Right Fit
• Behavioral based questions
– Answers to open ended behavioral based questions will help predict future behaviors
– Listen more than you speak
– Allow periods of “awkward silence”
• Profile assessments
– Peer benchmarks
• Gain perspective from all angles
– Include different roles in interview• Their manager, coworkers and those they
will serve
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Offsetting Today’s Wage Pressures
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Largest Expense Getting Larger
• Proposal to increase minimum pay threshold for overtime-eligible workers– From $455/wk to $970/wk
($23,660/yr to $50,440/yr)
• Minimum wage on the rise– LA & NY mandates minimum
wage of $15/hr by 2020
– 14 states raised their minimum wage in 2016
Wage Increase Study• 110 unit AL with 55 FTEs• Increased entry-level
wage by $1.50/hr
Results• 10.2% Increase in annual
payroll • 4.5% Increase in total
expense• 3.4% decrease in net
operating margin
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Implement Data-Driven Processes
• Identify key cost control metrics:– Labor budget adherence
– Overtime management
– Staff satisfaction
– Hiring costs
– Operational efficiencies
• Speed & timely analysis of data is key for success
– Predictive analytics is ideal
– Real-time information is a must
– Historic data has little value
• Integration of disparate staffing systems is important
“Measurement is the first step that leads to control
and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you
can’t control it. If you can’t control it, you can’t
improve it.”
- H. James Harrington
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Focus On Daily Staffing Levels
• Benchmark staffing levels against budget/Five Star Quality Rating
• Evaluate staffing requirements every shift– Allow for activity and manage like an
employee absence
• Get good at flexing – Alert management when approaching
staffing risk
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Get Predictable & Flexible
• Adjust staff as needed– Cancel shifts or call in staff as
needed
– Re-allocate staff to direct care positions – be sure this is documented
• Correlate labor staffed to needs based on estimated future census
• Keep overtime top of mind
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Control Your Overtime
• Set an OT target: 2-3%• Eliminate OT built into
schedules• Look out for clock riders
– Compare punch ins/outs with schedule
• Mix of part-time/full-time workers
• Consider OT when filling call-offs
• Set OT approval process
0 - 2% 3 - 5% 6% or more
14.35%
36.71%
48.94%
* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016
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Significant Cost Savings
Overscheduling Reduction Annual Savings, Single Facility (100 beds)
.1 PPD $75,600
.2 PPD $151,200
Overtime Rate Reduction % Annual Savings, Single Facility (100 beds)
1% $24,000 – $60,000
5% $120,000 - $300,000
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“What proved to be even more exciting was that I turned around and
reinvested $1.8 million of those dollars back into the centers’ staffing models to enhance my nursing hours
per patient day and increase my professional nursing staff mix.”
Dale Zaletel, Senior Operations Consultant, Post-Acute Strategist & Former CEO of Lexington Health Network
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Turning Around Turnover
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Impact Of Employee Turnover
Resident/cus-tomer satisfac-
tion
Quality care & service
Efficiencies within the community
Staffing level compliance
Labor costs Coworker satis-faction & turnover
* “Workforce Insights” OnShift & McKnight’s Long-Term Care News, 2016
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Engagement vs Satisfaction
• Are they the same?– Employee Satisfaction: A measurement of an
employee’s “happiness” with current job and conditions; it does not measure how much effort the employee is willing to expend
– Employee Engagement: A measurement of an employee’s emotional commitment to an organization; it takes into account the amount of discretionary effort an employee expends on
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Engagement Pays Off
• Lower turnover– 18% engaged employees
vs. 49% disengaged
• Lower absenteeism• 147% higher earnings per
share
Engaged employees lead to higher
Service & Quality
Employee Productivity
Customer Satisfaction
Employee Retention
Company Profit
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Keep Employees Engaged
• Profit sharing
• Rewards & incentives– Awards program
• $200/refer a friend
• $1,000/refer a resident
• Sports tickets, gift cards, etc.
• Have the fortitude to move along those who are disengaged
• Senior leadership town hall meetings with associates – Supervisors not in the room
National Research Corp.SNF with a high rate of
employee satisfaction have fewer survey deficiencies
and a higher Five Star quality rating
Top 2 drivers of resident and family recommendation are
both related to employees — care (concern) of staff and competency of
staff
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Create a Mentor Program
• Mentors – Not necessarily the most
senior person
• Honor to be a mentor– Involved in hiring,
onboarding, ongoing education
• Certify mentors
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• Comprehensive orientation• Associate care programs• Flexible PTO policies• Volunteer opportunities• 401k with matching and 60-day vesting
Adopt Employee-Centric Practices
“Worker-centric policies contribute to engagement and profits.”
- Workplace Options Research
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Employee Schedules
• Give staff more control over their schedule– Identify work preferences &
availability
• Make scheduling transparent• Offer convenient, mobile
access• Work in repeatable schedules
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Proven Success
• Overview– 9 communities in NC, FL, SC, GA, IN
• Strategic Priority 1. Improve Employee Satisfaction 2. Staffing Visibility Across Communities3. Labor Cost Management
• Top Issues– Scheduling was a top employee complaint
at each community– Manual process was inefficient and
caused confusion among staff– Labor costs were managed based on
historic data
Results• Improved staff satisfaction
– Turnover decreased by 15.6%
– Scheduling is no longer a top complaint
– Call-offs decreased for 2 straight years
• Five Star Quality Rating– Average increase from 3.5 stars to 4 stars
• Greater efficiencies – Call-off fill time has been reduced by 50%+
– Time spent scheduling has been reduced by 75%+
• Reduced labor costs– Saved $300,000 annually by monitoring
punch variances
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Payroll Based Journal
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Payroll-Based Journal • Quarterly electronic
staffing & census data • Full implementation by
July 1st, 2016• Believed to be used in
Five Star Quality Ratings in 2018
Focus On Staffing Transparency
“The inclusion of verified staffing
information based on payroll data is especially
important, as staffing levels are often the best
proxy for quality.”
Cheryl Phillips, M .D .Senior Vice President of Public Policy
and Advocacy, LeadingAge
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Payroll-Based Journal Submission Details
• Direct care worker information – including agency & contract workers– Unique ID
– Hire & termination date
– Pay type code (Non-exempt, Exempt, Contract)
• Daily hours worked by employee– Include job title code for services provided
• 37 codes have been provided by CMS
• Census on the last day of each month, broken down by primary payer (Medicaid, Medicare, Other)
All staffing hours worked must be
able to be verified through payroll, invoices and/or tied back
to a contract
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• Identify & classify all direct care staff in accordance with CMS codes
• Assign primary role for each employee & shift
• Define data collection processes– Contract & agency work
– Corporate staff at a community
– Salaried staff
• Understand what hours count, what doesn’t– Ex. If a salaried employee works 10
hours but is only paid for 8 hours, only 8 hours should be submitted
• Conduct an internal audit
Get PBJ Ready
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Meet PBJ staffing regulations Eliminate data gathering complexitiesImprove reporting accuracy with checks and balances
Coming Soon
OnShift Payroll-Based Journal ReportingOur PBJ software and our post-acute care staffing experts will:• Set up data collection processes• Gather staffing information –
including contractor & agency hours• Highlight potentially missed staffing
hours• Simplify the submission process
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Utilize Technology
• Too many moving parts with information in multiple systems to do this all manually:– Integrate hiring, scheduling, time-clock,
clinical systems
• Software can provide the needed insight to get predictive & proactive:– Identify positions to hire
– Meet PBJ/Five Star staffing goals
– Automate scheduling & labor management
– Staff to resident need, acuity levels
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QUESTION & ANSWER
Mark WoodkaCEO
OnShift
Irene FleshnerRN, MHA, FACHE
Principal, Reno, Davis & Assoc. Inc.SVP Strategic Nursing Initiatives,
Genesis HealthCare
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Learn More About OnShift
• Best Practices & Information – Staff Scheduling– Payroll Based Journal– Hiring– Workforce Analytics
OnShift.com
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To view this webinar on demand, please visitwww.mcknights.com/January28webinar
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