Guest Columnist
Reducing Turnover and Improving Patient Care
By
Mar 5, 2010 - 4:35:29 PM

Making the Quality Hire rather than the Quick Hire


(HealthNewsDigest.com) - It’s difficult to read a newspaper or turn on the news without hearing about unemployment. Yet employers lament the lack of skilled workers to fill openings. It may seem a contradiction, particularly in the healthcare industry where the U.S. Department of Labor predicts that more than four million new jobs will be added by 2018. This represents a 24 percent growth rate, the largest of any industry sector. In fact, one quarter of all new jobs created in the U.S. economy by 2018 will be in healthcare and social assistance. The quandary is this: there are applicants, and there are openings, but how do employers identify the applicants who are ready to learn the demands of the job, who will stay and grow with the team, and who will contribute to improved patient care and safety.

Several large medical centers seem to have found an answer— a tool that helps them make the quality hire rather than the quick hire. As a result they have decreased their employee turnover significantly—possibly the best measure of ensuring the team continuity that leads to improved patient care, safety, and satisfaction. I’d like to highlight two of these enlightened institutions: Inova Health System in the Washington, D.C., metro region, and Shands Jacksonville Medical Center in Jacksonville, Florida.

Inova Health System

More than 300 applications per day flow into Inova’s human resources department for openings in two entry-level, unlicensed positions: Care Team Assistant (Inova employs about 200) and Care Team Clinical Technicians (Inova has about 300). Both positions involve basic procedures and a great deal of direct patient contact, making these individuals very important to overall patient satisfaction and safety. Turnover exceeded 50 percent when Patti DeiTos, MSN, RN-BC, PWD, and lead education coordinator for orientation, tackled the problem.

DeiTos and her team instituted several innovations, including pre-employment testing and an innovative apprenticeship program. A partnership was formed with the Virginia Community College System and the Virginia Department of Labor, with grant funding provided by the Council for Adult and Experiential Learning, to rework Inova’s selection process:

Candidates submit an online application.
Recruiters review applications and refer those meeting the job criteria to Northern Virginia Community College or an area workforce development office to complete ACT WorkKeys® assessments which measure workplace skills in Applied Mathematics, Locating Information, and Reading for Information. Applicants unable to achieve the minimum required scores are able to access training programs to help improve their skills.
The interview process begins once the required WorkKeys scores are confirmed.
Inova then administers its own tests and completes background checks for those applicants recommended by hiring managers.
New employees complete a week of general orientation and 40 hours of formal training.

Traditionally, apprenticeship programs have applied to skilled trades like electricians or plumbers. The healthcare apprenticeship program Inova instituted with its partners is the first of its kind in Virginia and offers workers the opportunity to earn while they learn. Apprentices for both positions must complete at least 144 hours of instruction and a year of full-time work under the guidance of a mentor—in this case, a registered nurse. Once employees successfully complete their apprenticeships, they are credentialed by the U.S. Department of Labor as nationally certified clinical technicians or assistants. And depending on their WorkKeys scores, they also qualify for a National Career Readiness Certificate powered by ACT WorkKeys assessments. This Certificate is widely recognized as a fair and objective measurement of workplace skills and is accepted nationwide.

DeiTos reports that turnover has diminished from approximately 49 percent to 13 percent. She also estimates that Inova saves approximately $1.3 million for each 25 percent improvement in turnover reduction.

“WorkKeys provides a realistic view of how a potential employee will be able to function in a job,” says DeiTos. “It has helped us improve the selection of employees for each position and has provided employees with confidence and a new awareness that they can develop into something more.”

Daniel Nichols, MA, MDiv, MBA, and Inova’s director of system recruitment/human resources information system, adds, “Hiring really comes down to a skills match. There is some risk in taking the easy way out—making the quick hire rather than the quality hire. With WorkKeys, you can make the quality hire more quickly.”

In part, as a result of the successful innovations described above, both DeiTos and Nichols have recently accepted a new challenge. Nichols is now the Executive Director and DeiTos the Clinical Director of the Military to Medicine program which began as a recruitment initiative for Inova Health System. Now available nationwide, this program is designed to deliver quality employees to healthcare organizations by establishing a bridge for the military community to healthcare careers. An integral part of the initiative is the use of five ACT WorkKeys assessments: the three that power the National Career Readiness Certificate, and two WorkKeys personal skills assessments—Fit and Talent.

Shands Jacksonville Medical Center

Like Inova and many medical centers across the nation, Shands Jacksonville was challenged by high turnover rates. Hiring managers were asking for applicants who could handle the demanding training once on the job and who would stay with the hospital, providing continuity of care and thereby strengthening the patient care teams.

Employing more than 3,500, Shands Jacksonville is a large academic medical center affiliated with the University of Florida College of Medicine and is one of seven hospitals in the Shands HealthCare family. As a teaching hospital, the medical center’s leadership team is heavily invested in creating a culture of employee development and learning. That may have helped when Pam McCaleb, director of the hospital’s Success Academy of nine training professionals, requested support for a computer lab onsite so applicants and employees could develop their workplace skills and take assessments to qualify for employment and promotion.

McCaleb had heard of WorkKeys assessments and began to explore their use in evaluating not only workplace skills, but workplace literacy skills—an all-important factor in ongoing training and development of employees. McCaleb also learned that the State of Florida was making WorkKeys assessments available at local WorkSource Center offices at no cost to employers or job seekers under the Florida Ready to Work program. Detailed job analysis called job profiling, was also part of the state’s program. In job analysis, a detailed task list is created for each job, clearly describing the position for applicants and providing role clarity for management personnel. To date, 14 positions have been profiled at Shands. McCaleb chose positions with a large number of employees, historically high turnover, and significant impact on patient satisfaction.

Once the profiles were complete, Shands began testing applicants in their onsite computer lab using ACT WorkKeys assessments. Personnel from the local WorkSource Center act as proctors. Results are posted electronically and available to the medical center’s recruiters. Interviews are not conducted until the required scores as defined by the job profile have been attained. McCaleb reports, “This saves time for the recruiters and for the hiring managers, because they can be sure of an applicant’s skill levels before they spend time interviewing, evaluating, and doing the requisite background checks.”

If an applicant does not meet threshold scores, the WorkSource Center proctor can recommend available skills training options. McCaleb reports that Shands Jacksonville has hired a number of applicants on the second or third attempt once score levels were met. Individuals who qualify may order a National Career Readiness Certificate through the ACT website.

Data are collected throughout the process by recruiters, hiring managers, assessment proctors, trainers, and human resources personnel. Anecdotal reports from hiring managers indicate they are:

Seeing a better quality of candidate
Spending less time interviewing
Observing faster learning curves among new hires
Experiencing lower turnover in the critical first 90 days
Documenting better attendance rates
Enjoying greater cohesion among team members, leading to improved safety and enhanced patient care


“Some managers resisted the process initially,” reports McCaleb. A few worried that the assessments would diminish the pool of applicants to the point where the medical center would not be able to fill open positions. Shands Jacksonville’s leadership decided that hiring warm bodies solves nothing—Shands needs qualified workers who are able to perform the tasks identified by the job profiles, which are the same tasks performed by current successful employees.

McCaleb also reports that for some positions, turnover has dropped by 35 percent; for other positions, as much as 50 percent.

A Closing Comment

Healthcare is poised to become perhaps the brightest opportunity for employment growth over the next decade. And there is little doubt that it will be a challenge to find skilled workers to fill the four million new jobs in this sector.


The workforce pipeline is likely to be less than full as medical centers and care facilities search for quality people—those who embrace lifelong learning and who will commit for the long term to excellence in patient care, safety and satisfaction. Whether management decides to “grow their own” future workers through apprenticeships, or enhance their hiring process through workplace skills assessments, we all stand to benefit.

Founded in 1959, ACT is a not-for-profit organization dedicated to helping people achieve education and workplace success. ACT provides a broad array of assessments, research, information, and program management solutions in the areas of education and workforce development. For more information about ACT, visit www.act.org. For more information about WorkKeys assessments and the National Career Readiness Certificate, visit www.nationalcareerreadiness.org.

WorkKeys is a registered trademark of ACT, Inc. in the U.S.A. and other countries.

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