Does your applicant have what it takes for continuing care?

Let’s be honest. Hiring and retaining employees is more challenging in continuing care than in other segments of the healthcare industry. Working with patients/residents and their families is fulfilling, but it also is physically and emotionally demanding. Employees who thrive in this environment require a different mix of skills and behavioral competencies than individuals who work in acute care settings.

Unfortunately, most continuing care organizations have not found ways to identify applicants who have these skills and who will “fit” within the organizational culture. The result is high turnover and poor employee retention. Consider the facts:

• A study of nine long-term care facilities found that turnover ranged between 28 percent and 115 percent, with an average of 66 percent
• The national median tenure rate across all jobs in the United States is 4.4 years, according to one white paper [PDF]. The median tenure rate for registered nurses (RNs) in home healthcare services is 1.17 years, however, and in nursing care facilities, it’s 0.97 years.
• According to the U.S. Bureau of Labor Statistics, high levels of employment growth are projected for nursing care facilities. This growth will result in more competition for talent, and retention will become an even greater issue for continuing care organizations.

And turnover is expensive. Replacement cost estimates vary widely—for example, ranging from $36,500 to $44,000 for RNs, according to two studies (find one here and the other here) to $64,000 for specialty nurses, according to another study, and those figures are per departure. Of course, these estimates depend on numerous factors, but if we conservatively assume that each nurse turnover costs $30,000 and an organization has 150 nurses and a 25 percent turnover rate (low, by the way, for continuing care), then the estimated cost of turnover is $1.125 million per year. Further, it has been estimated that for every one percent increase in annual nurse turnover, the average facility loses $300,000 per year, according to one white paper. Or, thinking of it the other way, for every one percent reduction in turnover, a typical facility will save $300,000 per year. Even small decreases in turnover, therefore, can result in big savings.

Screening applicants

Finding the right applicants before making an employment offer is a proven way for continuing care organizations to improve employee retention and lower the costs associated with turnover. Measurements of variability in applicant capabilities and tendencies during the hiring process can be used to hire applicants who will perform better on the job, deliver higher-quality resident care and be more compatible with the organizational culture. When hired applicants are a better fit for the job and organization, they are more likely to remain with the organization over the long term.

Behavioral assessments conducted before hiring can effectively measure the underlying behavioral competencies  predictive of performance, compassion and likelihood that an individual will remain with an organization. Assessments that collect two types of information can help predict retention.

• Biographical data, or biodata, reflect information about past behaviors, life experiences and feelings about specific situations. Biodata can tell us how embedded an applicant has been at previous employers as well as their habitual commitment level. An example of a question that assesses habitual commitment: “How many months did you work at your last job?” All else equal, applicants with a longer work history have a tendency to work longer at subsequent jobs.

• Personality data. This information sheds light on stable individual characteristics, including behavioral tendencies oriented toward staying or leaving a job. An example of a question that assesses emotional stability: “Do you become irritated when others criticize you?” Continuing care work can be stressful, and emotionally stable applicants are better able to manage the inevitable stresses that will arise on the job, leading to greater retention and lower turnover.

To obtain optimal results with behavioral assessments, use three best practices:

1. Implement a behavioral assessment designed for healthcare environments. In healthcare, certain behavioral competencies are more important than they are in other industries. Try to find an assessment solution that focuses on healthcare-specific competencies such as compassion, customer focus, energy, work ethic, teamwork and flexibility.

2. Find an assessment that has continuing care (not acute care) norms. Norms represent the “normal” or typical performance in a group of assessment-takers. They are helpful when interpreting the meaning of assessment scores because they allow employers to compare individual assessment scores with those of a reference group. Because work in continuing care organizations is different than working in acute care, it makes sense that the profile of a successful continuing care employee will look different than that of a successful acute care employee. When using assessments, it is essential to compare continuing care applicants with their peers. Using continuing care norms helps hiring organizations understand what constitutes high or low levels of a given competency and enables better hiring decisions.

3. Leverage assessment results in behavioral-based interviews. The best assessment solutions incorporate each applicant’s assessment results into a customized, structured interview guide. These guides provide follow-up behavioral interview questions that enable managers to probe on low-scoring areas. The questions are designed to reveal examples of past performance that uncover an applicant’s proficiency in various job-related situations. Structured, behavioral-based interviews increase the reliability and consistency of the interview process. In addition, they more accurately predict an applicant’s potential for success than other types of interviews.

Continuing care organizations can attack the problem of employee turnover before extending employment offers. Many organizations have had success implementing a structured, standardized evaluation process for all applicants that uses behavioral assessments as its foundation. The key is finding an assessment designed for healthcare and evaluating results using applicant norms that are specific to continuing care organizations. The result is new hires who are more likely to deliver a great resident experience and are less likely to leave.

Morgeson is the Eli Broad Professor of Management at Michigan State University, Lansing, and a scientific adviser to HealthcareSource, a Woburn, Mass.-based provider of talent management software for the healthcare industry.