SUSTAINABLE SOURCING WORKFORCE DEVELOPMENT: RECRUITMENT & RETENTION

1. SUSTAINABLE SOURCING WORKFORCE DEVELOPMENT:RECRUITMENT & RETENTION DBHDS SystemLEAD Capstone 2018 Kelly Cassell, LPC Daphne Cunningham, PhD Brandon Riley, PhD Teresa Smith, MSN, RN, PMEC Joyce Yearout, RN, MBA

2. Introduction • Employee recruitment and retention present significant challenges within the healthcare field. • High vacancy and turnover rates for medical, nursing, and other professional staff in Virginia’s behavioral healthcare system may result in employees moving on to other organizations.

3. Introduction • An aging workforce and the transition of millennials into the workforce require us to better understand the needs of the workforce in order to hire the staff necessary to sustain Virginia’s changing behavioral healthcare system. • Ability to care for individuals in our service lines is compromised secondary to the lack of available staffing resources.

4. Sustainable Sourcing Strategies • “Sustainable human capital management and sustainable sourcing for workforce development recruitment and retention” accurately describe the ongoing effort to hire and retain the needed roles with the right staff. • Recruitment and retention should be viewed as single activity that begins prior to hiring the rightemployee.

5. Sustainable Sourcing in Workforce Development: Recruitment & Retention • Getting the right person for the job from the beginning is the greatest factor for retention. • Marketing Strategists suggest that companies hire selectively and vet prospective employees thoroughly to ensure a good fit with the company and offer a competitive salary/benefits package. • Once the employee is onboard, strategies such as providing a comfortable work environment/work culture, offering training to all employees, recognizing accomplishments, listening to employees, and offering quarterly feedback and evaluations may facilitate retention.

6. Sustainable Sourcing in Workforce Development: Recruitment & Retention • Recruiting and retaining employees through a process that takes into account economic, social, environmental, and ethical factors and provides an organization a positive return on the investment over time. • Therefore, we want to know:

7. Research Question • What can we learn to promote recruitment and retention among employees in Virginia’s behavioral healthcare system?

8. Today’s Presentation • A multigenerational workforce: what today’s employees want • Vacancy/turnover numbers for DBHDS: a significant challenge • Job satisfaction survey results: what DBHDS employees tell us • Useful recruitment & retention tools: lighting the way forward

9. Methods • Literature Review • Internet Searches – Best Practices • Participated in presentations from the private sector • Collaboration with Virginia Department of Health- Office of Health Equity • Conducted a Survey

10. The Multigenerational Workforce

11. The Multigenerational Workforce

12. Millennials Tech Savvy Socially Conscious Diverse Team Oriented Compassion Civic Minded Multi- Taskers Pepperdine University (date). The Importance of Millennials in the Workplace.

13. Engaging Millennials (and Other Groups) Pepperdine University (date). The Importance of Millennials in the Workforce.

15. Workforce Challenges State Hospital Staffing Vacancy Rates – FY 18 • Direct care staff turnover is the highest in 10 years, a huge issue for state hospital census management. • The average salary trails the national market. Hospitals are facing staffing shortages and overtime is increasing as a result. • RN vacancy rate across nine hospitals is 28%; Direct care vacancy rate is 14.0%. • CSBs are losing case managers to the Health Plans who are paying $10-15,000 more with other incentives. “Pay not equal to workload" was among the top five reasons cited for leaving a case management position. RN = Registered nurse DSA = Direct service associate Slide courtesy of Deputy Commissioner Daniel Herr (October 2018)

16. Statewide Recruitment Data courtesy of Patricia Bullion, Workforce Development – DBHDS Central Office

17. Statewide Trends Data courtesy of Patricia Bullion, Workforce Development – DBHDS Central Office

18. Statewide Retention Data courtesy of Patricia Bullion, Workforce Development – DBHDS Central Office

19. Statewide Retention Data courtesy of Patricia Bullion, Workforce Development – DBHDS Central Office

20. State Hospital Changes Due To Last Resort Legislation State Hospital TDO Admissions • Since “Last resort” legislation was passed, a bed was provided for everyone under a TDO who needed a bed since the law was implemented July 1, 2014. • Since FY 2013, TDO admissions have increased294%. • Since FY 2013, medical care costs have grown by more than 90%. • In FY 2019, the trend continues as in prior years. Slide courtesy of Deputy Commissioner Daniel Herr (October 2018)

21. DBHDS Retention Data courtesy of Patricia Bullion, Workforce Development – DBHDS Central Office

22. DBHDS CO Human Resources 2018

23. Why so much Turnover? • Lack of recognition • Lack of competitive compensation • Lack of promotion opportunities • Toxic work environment • Poor training opportunities • Hiring and management practices

24. DBHDS CO Human Resources 2018

25. The Question of Stigma • A recent Medscape survey confirms that salaries are considerably lower in the public health sector than in traditionalhospital environments. Stokowski, L., McBride, M., Berry, E. (10 OCT 2018). Medscape RN/LPN Compensation Report, 2018 fromhttps://www.medscape.com/slideshow/2018-rn-lpn-compensation-report-6010589?faf=1

26. DON’T DO IT! • While organizations may equate employee turnover to salary, it is a mistake to assume that salary is the determining factor in employee retention.

27. Job Satisfaction Survey • Research questions: What attitudes do current DBHDS and CSB employees express regarding their current job (dis)satisfaction? How many have been actively looking at other jobs? What is the relationship between current job satisfaction and job-seeking? What factors do employees identify as important to the decision to either look for another job or stay with their current one? • Methodology: A brief, 7-question survey was developed using SurveyMonkey. With the kind assistance of Patricia Bullion, a link to the survey was sent to the VACSB and directors of DBHDS facilities for dissemination to employees. • 308 responses from DBHDS employees were analyzed.

28. Survey Results: Satisfaction • “Overall, how satisfied are you with your current job?”

29. Survey Results: Job-Seeking

30. Survey Results: Why Search?

31. Survey Results: Why Stay?

32. Survey Results: What They Said • The survey ended with an open question asking respondents to offer what they felt might be realistic steps that could be taken to help employees at their agency feel more satisfied with their work. • Themes that emerged from 275 respondents included: • improving pay to attract more/better staff • showing appreciation for good performance beyond token measures • improving teamwork; encouraging education and promotion of staff • improving communication and reducing gossip • reduction/elimination of mandated overtime • allowing more opportunities for voluntary overtime • allowing more flexibility in hours • Several respondents also expressed feeling unheard or unsupported by their supervisors and others in leadership positions

33. Survey Results: Tentative Conclusions • Despite the challenges we face, most employees are satisfied in their jobs; however, many are ambivalent • Dissatisfaction is correlated with readiness/attempts to find work elsewhere • Among people who indicated they have been looking elsewhere, compensation emerged as the #1 factor, followed by lack of appreciation and opportunity • Among those who reported they have not been searching, enjoyment of work and feelings of making a difference emerged as the #1 factor, followed by good relationships

34. Survey Results: Limitations • We initially wanted to include CSB personnel to compare/contrast with DBHDS but were unable to • It is unclear to what extent all DBHDS facilities were represented, as we did not ask respondents to identify where they work to protect anonymity • We also did not ask respondents to identify their department, so we cannot compare across disciplines or positions • General limitation of people not necessarily being accurate in their attributions of what influences their attitudes

35. Our Goal • Provide DBHDS and partners with a “toolkit” of resources, ideas and samples to enhance their recruitment and retention programs. • Copies will be made available for the senior leadership at each facility.

36. VDH – Our Partner in Workforce Development • Virginia Department of Health Scholarships and Loan Repayment Program • Mary Marshall Scholarship for Licensed Practical Nurses, the Mary Marshall Scholarship for Registered Nurses, and the Virginia Nurse Educator Scholarship Program • Program for International Medical Graduates who are not US Citizens waives the residency requirement of working for two years in their home country before returning to the US for employment if they agree to serve in designated shortage areas

37. Programs through VDH

38. Programs through VDH

39. Recruitment and Retention Tools • Virginia Community College System Career Pathways Program. • National Rural Recruitment Retention Network • University of Virginia Health System • University of Michigan Health System • Virginia HealthCare Workforce Data Center • SAMHSA

40. National Rural Recruitment and Retention Network

41. Recruitment and Retention Tools • The Virginia Department of Health Professions offers information to students who are seeking to work in the healthcare field, such as this interactive tool:

42. Retention Tools • Tools such as this Retention Risk Matrix utilized by the University of Michigan Health Systems may help employers and organizations predict the likelihood of employee turnover and develop mechanisms to increase employee retention.

43. Retention Tools • Retention interview example: https://hr.umich.edu/sites/default/files/sample-retention-interview.pdf • Web-based tools • The Nobscot Corporation offers a turnover prediction system, employee satisfaction system, and exit interview management system • HealthcareSource offers tools to help conduct effective interviews, identify opportunities for leadership development, and assessments to enhance efficiency. HealthcareSource also offers a 10-step strategy to help fill critical healthcare roles. They offer a behavioral science approach that seeks to ensure a strong organizational fit between a candidate and the company.

44. Retention Tools

45. Other Strategies • Training and development opportunities • Providing challenging and interesting work • Opportunities to engage in innovative thinking • Job security

46. Conclusion • Although no single strategy or specific combination of strategies will work best for all organizations, providing tools from which organizations can build their own approach to sustainable sourcing for workforce development recruitment and retention is the foundation for ensuring that DBHDS is positioned to meet the needs of the people served by Virginia’s behavioral healthcare system.

47. Questions