Arguably, the most important thing organizations should do in their quest for a high-performance culture is “hire for the right” fit. Jim Collins, author of “Good to Great,” expressed this sentiment in his bus trip analogy. Rather than leading a company to greatness by first articulating a vision and direction, he maintains that it is better to “… start by getting the right people on the bus, the wrong people off the bus, and the right people in the right seats.” In “If Disney Ran Your Hospital,” Fred Lee seems to concur, “Great managers…know the most important skills needed in every role and have learned that it is better to hire someone who already has the talent (read: habits), than to train someone who doesn’t.”
But just because hiring for the right fit is widely acknowledged as essential to achieving service excellence doesn’t mean that organizations have cracked the code on how to do it consistently. After all, how can you tell if a job applicant possesses the “DNA” needed to be a top performer within your culture?
Determining an applicants “fit” is especially difficult as we are referring to “soft skills” — those traits that don’t show up on a resume, that are even hard to detect during a job interview. We are talking about the kind of emotional intelligence, values and instincts that separate average performers from those who make a lasting favorable impression on patients and their families. These traits are quite separate from clinical skills and far harder to assess. As Nancy Miko, clinical recruiter for Saint Mary’s Hospitalin Waterbury, Conn., said, “It’s easy to know if someone has the clinical skills we need, but much more difficult to know how he or she treats others.”
The following article explains how healthcare organizations can screen potential employees for those soft skills and thereby improve their ability to build a culture of service excellence.
Defining service excellence
Press Ganey Associates reported in 2010 that the top priorities for more than three million inpatients in 2,162 hospitals were: effective communication, empathy and relationship building.[1]
Interestingly, the staff’s clinical competence or the quality of the patient’s actual therapy did not make the top of the list. Indeed, these three drivers of patient satisfaction are not even healthcare specific.
In examining how well hospitals’ stated values mesh with those findings, SkillSurvey studied the service excellence statements of the 32 organizations listed first in an Internet search of “service excellence hospital” discounting consultants, vendors, etc. They then analyzed the frequency of mentions and general emphasis placed on various behaviors and qualities in those statements to identify which were most common. Four themes emerged: positivity, respect, commitment and responsibility.
Certainly, people hired for their positive attitude, respect for others, commitment and sense of responsibility will likely provide patients with the effective communication, empathy and positive relationship they find satisfying. The difficulty, though, is in translating those qualities into performance standards that are applicable role by role and day to day… and then screening job applicants for those behaviors.
The value of service excellence
With the implementation of the Value-Based Purchasing Program by CMS, patient satisfaction scores on the Hospital Consumer Assessment of Heathcare Providers and Systems survey are to dictate reimbursement rates and incentive payments. For discharges occurring on or after Oct. 1, 2012, CMS will reimburse acute-care hospitals that take part in the Social Security Act’s Prospective Payment System, in part, based on the patient satisfaction scores they receive.
Putting the impact on reimbursement rates and incentive payments aside (although it is significant!), patient satisfaction scores can, of course, directly impact revenues from returning patients and their families and friends. In the healthcare industry, for every 100 customers that experienced deficient service, about 70 customers would be unlikely to patronize the same organization again. In addition, for the same 100 customers who have experienced deficient service, about 75 of them will go on to tell on average nine family members and friends about their experiences. So, for every 100 patients experiencing deficient service — in reality or in their perception — about 675 people will hear about it![2]
If we apply that formula to the average medium-to-large hospital in the United States, the financial impact becomes astounding. Let’s assume that a hospital treats 12,000 patients a year and that 10 percent of them, or 1,200, are dissatisfied with their service. (This is a “generous” assumption; the national average for patients saying that they would not recommend the hospital to friends and family is 30 percent.) That would mean that approximately 840 patients would not return, and that 900 of those dissatisfied patients would spread the word to a total of 8,100 potential patients. That’s equivalent to 67 percent of the hospital’s annual patient population!
If we further assume that the average profit from a hospital stay is $16,000 (based on AHRQ data from 2007), the ripple effect from 8,100 people who’ve heard of the poor service amounts to an opportunity loss of approximately $130 million. (See Fig. 1)
A 360° solution
So, how can hospitals assess an applicant’s competencies as they relate to delivering service excellence? How can recruiters and interviewers tell if a candidate will display positivity, respect, commitment and responsibility on the job? One way that is gaining popularity among progressive hospitals is to gather candid feedback from people who’ve had an opportunity to observe the candidate in action: managers, peers and subordinates. They are applying the concept of 360-degree feedback, often used in performance development, to reference-based assessments.
Since traditional telephone reference checking is not generally very informative, many hospitals around the country are using the Internet to send a candidate’s references an electronic survey containing approximately 20 questions pertaining to the skills and behaviors that correlate with success in that position. In the case of hospital workers, these include:
- Core items: The hard-to-measure attributes that all employees should possess and that will support service excellence and ultimately HCAHPS scores (such as a tendency to show respect toward others or the ability to communicate effectively)
- Job-level items: Factors that are linked to operating as an individual contributor or to managing others
- Job-function items: Skills related to specific job responsibilities, such as a nurse’s practice of instructing patients on home-care procedures, for example.
In this way, hiring managers can glean insights into a candidate’s performance that are not otherwise to be gained until the person is on staff and in action — in other words, until it is too late if the right competencies/tendencies are found wanting. And when the assessments are collected prior to the interview process, hospitals can use the insights from references to guide their interviewing technique and content.
Overall recommendations
In general, there are several steps that hospitals can take to ensure that their recruitment process supports their service excellence goals. We recommend that you:
- Re-examine your service excellence statements. Compare it to those of your peers, but realize that each institution’s statement should be highly individualized. Dig deep to identify the root behaviors that determine an excellent performer in your environment. Revise your statement and evaluate employees on those stated behaviors.
- Recommit to conducting behavioral interviews. Consider adopting some sort of peer-interview system.
- Through your selection process, focus on those attributes that are non-negotiable. Bring everyone into the loop and be consistent in the interview process across HR/recruitment, line managers, peers, etc. so that everyone is assessing the same qualities.
- Conduct reference assessments earlier in the screening process and then use the feedback to drive interview questions.
- Sell your strategy and vision up the organization. Demonstrate what you’re doing to lower turnover, and improve care levels.
- Measure and communicate. Use your positive results as a way to position your department as a profit center, not just a necessity of doing business.
In building and sustaining a culture of service excellence, hospitals are faced with the classic catch-22: They must ensure that people have the right qualities, motivations, and tendencies before they’re hired. Yet, until recently, they’ve only been able to screen people for those traits after they’re on board. New technology that allows others to provide insights into candidates’ innate natures — as borne out on past jobs — is changing that.
Brian Gilbert is the director of business development at SkillSurvey,® Inc. (www.skillsurvey.com), the inventor of Web 2.0 reference assessment solutions, such as Pre-Hire 360®. You can reach him at bgilbert@skillsurvey.com or at (302) 478-1856.
Footnotes:
[1] “2010 Press Ganey Hospital Pulse Report: Patient Perspective on American Health Care,” PressGaney.com, January 20, 2011.
[2] Lee, Pui-Mun, Khong, PohWah, and Ghista, Dhanjoo, N., “Impact of Deficient Healthcare Service Quality,” The TQM Magazine, 2006, Vol. 18, Issue 6, Pages 563-571.
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