The following article comes from Dave Wilkins, Chief Strategy Officer at HealthcareSource:
We’re facing a critical nursing shortage and an aging population. That’s a bad combination, no matter how you look at it.
In discussions with healthcare organizations across the country, I’m often presented with some version of this statement: “We’re having a really difficult time hiring nurse managers. There just doesn’t seem to be enough people in the market for these kinds of jobs. How can we hire more effectively for this role? What are we missing?”
To this, I usually look for a diplomatic way to say, “You’re doing it wrong. You shouldn’t be hiring for this role at all – you should be growing these folks internally and promoting from within. Your external hiring should be focused on more junior talent with a strong emphasis on behavioral competencies, retention markers, and long-term growth potential. You should only hire externally for critical roles when you absolutely have no choice, which should be rarely if you’re proactively engaged in workforce planning conversations. This is especially the case for nurse leaders, where culture fit and systems understanding are so critical to success on the job.”
Of course, you’ll need to put a solid talent management infrastructure in place to accomplish this. Here are 10 key steps to help you achieve this goal.
1. Identify Your Hard-to-Fill, Critical Roles
For healthcare organizations, nursing is an obvious starting point. Nurse managers (and leadership overall), neonatal nurses, nurse anesthetists, dialysis nurses, home health nurses — these are all critical, hard-to-fill roles for most organizations. Therapist roles (OT, PT, or speech) are also in high demand. But you really need to understand your own organization’s specific gaps, which you can determine by reviewing your time-to-fill metrics by role.
2. Prioritize Your Roles for Internal Mobility
Identify those hard-to-fill, critical positions that would benefit most from an internal mobility strategy and rank them by potential impact. Look for two key factors:
- The position should have a clear path related to skill and competency progression.
- Your organization should have a significant number of people in roles at the beginning and along this path.
Together, these factors ensure that the role requires skills and competencies you can grow over time through mentoring and training. It also ensures your investment of time and energy will have positive business impacts, because you’ll have enough turnover to support a healthy pace of mobility.
3. Do Your Diligence to Identify the Requirements
Take one of the critical roles from your prioritized list and identify the required skills, competencies, accreditations, licenses, etc. Interview employees currently in that role to better understand their complete career paths. Are there patterns in the roles they previously held? Try to understand what they like about their current role and what attracted them to it in the first place.
4. Chart a Career Map
Using the information you’ve gathered, create a career map for the target role. Describe the position in terms of core requirements (skills, competencies, accreditations, and licenses), typical career paths, and common experiences. Also, note any commonalities you discovered in shared attitudes of current top performers and shared beliefs about why they were attracted to the role.
5. Create a Learning and Development Plan
The learning and development plan should include all the necessary formal learning associated with the career map. Be sure to include observational requirements and anything that needs to be obtained externally, such as licenses and certifications.
6. Consider Feeder Roles
If you identify a clear pattern of feeder roles that repeatedly lead to the critical job you are targeting, repeat the first five steps for all of them. If additional clear patterns emerge, repeat the process again. Follow that trail back until you find job roles filled with generalists or a highly varied list of positions. If you don’t identify the major arteries leading to the critical, hard-to-fill role, you run the risk of propagating the problem one level deeper in the progression. Make sure there are enough candidates and employees at each stage. Too few and the whole process grinds to a halt and you are back to hiring externally, albeit perhaps a few levels deeper in the progression.
7. Communicate the Plan
Once you have your strategy for a specific critical role, put together a change communication plan to all hiring managers and organization leaders. Have one-on-one meetings with those who have feeder roles on their staff, as they will be the most affected parties. If you can, look for ways to reward them for being a talent incubator. Once the leaders are on board, roll out a broad communication to the organization, highlighting the benefits of this approach. Include a visual career map for the role with the requirements for each step of the journey. Highlight the support available in the form of training or performance development tools.
8. Develop Pipelines from Bottom to Top
Begin putting this plan into motion by increasing the number of viable candidates and potential hires at the first-level feeder roles. When you have a strong pipeline of folks in progress, move up a level and do the same. Keep moving up until you begin building a pipeline for the role that started you on this journey. By now, you should have a solid foundation that will support the full career lattice that leads to your critical, hard-to-fill role. Along the way, you will almost certainly have addressed another critical role or two, or likely laid some foundation for another family of roles.
9. Measure, Adjust
Measure the impact. Compare the before and after turnover rates for the critical, hard-to-fill role you’ve been targeting. Compare job performance, average salary, and rates of change in the affected role vs. that across similar clinical roles. Compare time-to-fill, and then calculate cost-of-vacancy reductions from your reduced time-to-fill. Use your savings to justify continued investment in this process, including, if necessary, headcount additions for your team.
10. Repeat
When you are ready, start tackling the next role, ideally building on some of the foundation you’ve already built.
While the above list will undoubtedly seem daunting to most readers, the alternative is far more daunting. If you decide to ignore the ever-growing talent gap, then your biggest problem with external hiring will be that you’re paying significantly more to ultimately get lower performance and an increased risk of both involuntary and voluntary turnover. Separately, these are overwhelming challenges, but collectively, they represent business risks that will threaten the financial viability of even the best-run healthcare organizations.
In the end, the real question is whether you want to be in control of your own destiny or remain at the mercy of larger market forces that you can’t control. A strategy focused on growing your own talent means you can reduce your dependence on the market and exert far greater control over your hiring practices for critical roles, reducing your overall business risk for years to come.