February 2004
One lesson emerging from hospitals’ ongoing recruitment
and retention efforts is that unique job benefits can, over time, reduce
turnover. The challenge, however, is offering the right benefits for the
hospital and its employees.
The University of Maryland Medical Center believes it has
found an answer in expanded educational benefits — greatly expanded
benefits. “All employees can now find educational benefits that suit their
interests and needs,” says Ann Regier, the medical center’s director
of clinical practice and professional development. She notes that previously,
educational benefits were limited to tuition reimbursement for employees
pursuing an academic degree.
Regier explains that the expanded program is grounded in the
realization that not everyone has the same education needs. “We now define
education more broadly,” she says. “We recognize both formal and
informal educational opportunities.”
So, while the new program continues to provide tuition
assistance for degree-seeking employees (and in fact, increased that support),
it also covers seminars and workshops in their various configurations, from
half days to full days. In addition, it reimburses for dues paid to
professional organizations, and for subscriptions to professional journals.
Prep courses for critical care certification as well as the application fees
are covered. “Employees are eligible for $500 in broadly defined
continuing education support — a benefit that virtually every employee
should be able to take advantage of, ” notes Regier.
There is a further benefit for direct patient care staff and
their families (the only benefit so limited): Qualified dependents who attend
college are eligible for tuition assistance. “An employee could have three
children in college at the same time and still receive benefits,” Regier
notes. “In fact, the employee could be in graduate school or enrolled in a
continuing education program, and also receive a benefit.”
The medical center has not overlooked employees with younger
children, either: it has made a tax-advantaged 529 college savings plan
available. While these plans don’t include an employer contribution, they
do make saving for college easier for families that choose to take advantage of
them.
All the expanded benefits were launched at the same time, in
2002. While the medical center is measuring employee response, it is still too
early to judge the program’s longer-term impact on retention. In fact,
says Regier, employees are still learning how to access the benefit with the
broadest base, the $500 continuing education benefit. Use is, however,
increasing.
“While we’re still growing the number of
participants,” says Regier, “it’s really the sum of all these
parts that we’re interested in. We’re proud of crafting a plan that
has something to offer no matter where an employee is in life, and with so many
ways to use it.”
Contact:
Ann Regier
Director, Clinical Practice
and Professional Development
University of Maryland Medical Center
Phone: 410/328-6257
E-mail: aregier@umm.edu (Back to the top)
Calvert Memorial’s new pay strategy is designed to
address the unintended consequences of the hospital’s efforts to close the
nurse vacancy gap. As the hourly rate for relatively new nurses increased,
their compensation was creeping up on, or even exceeding, the rate paid to the
hospital’s more experienced nurses.
Carrie Forrest, vice president of human resources at CMH,
believes that the new strategy will not only eliminate the pay compression and
equity problems, but result in higher job satisfaction, lower turnover and
recruiting costs, and increased quality of care. “The compensation issues
related to recruiting and retaining experienced RN’s are no longer a
problem,” says Forrest.
CMH’s executive management team worked with
compensation consultants from Techinfocus, Inc., to analyze the hospital’s
previous practices and recommend steps to eliminate the pay compression
problem. Taken together, the data analysis, market research, and financial
modeling resulted in several conclusions. Pay compression did exist at CMH,
within a range of years of experience. New-hire rates were falling behind
market competitors’ rates. And overall pay ranges needed to be adjusted
for market movement.
Techinfocus designed a unique long-term pay strategy that
corrects current pay inequities, prevents future pay compression, and
recognizes the past gains of nurses whose performance has earned merit
increases.
Having defined the building blocks of the new model,
Techinfocus compiled data on relevant pay-related information for the
hospital’s RNs, as well as market data from multiple sources (including
Web-based research, local and regional hospital data, and independent salary
surveys). Actual average pay by years of service was compared to both the
existing CMH new-hire schedule and the schedule for competitive hospitals.
Best-in-class compensation practices were used to develop
the business rules that shape the program. These practices include incrementing
pay ranges for advanced degrees, setting a pay minimum equal to the new hire
rates, and customizing pay ranges to reflect specialties and shift
differentials. The new program has been implemented with approximately the same
cost to the hospital as its former across-the-board and merit increase
approach.
The building blocks of the new compensation strategy
include:
- Position in Range (PIR): Describes a nurse’s
current pay position as a percentage of the possible compensation within a
salary range. The minimum pay rate is described as 0 percent; the maximum, 100
percent; and the midpoint (or market) as 50 percent.
- Target Position in Range (TPIR): A structured
approach resulting in PIR progression through a salary range, based on years of
experience (YOE).
- Performance-Based Target Position in Range
(PBTPIR): Incorporating past and/or current performance evaluations to
increase TPIR for higher performers. For example, assuming two RN’s are
identical in every way except past performance ratings and increases, the RN
with higher past performance would have a higher hourly rate as the result of
higher merit increases. But if both were adjusted up to the same TPIR, the best
performer would have a smaller increase; the two nurses would, in fact, have
the same rate of pay. PBTPIR increments the best performer’s rate of pay
to restore past gains and promote future performance.
- Performance Spread: The difference in PBTPIR
between the lowest to highest performance levels.
The new pay strategy addresses all of these issues, within a
performance framework of fiscal responsibility. A Targeted Position in Range
schedule was developed for each level of performance, with higher performers
moving more quickly through the salary range. Keeping pay costs within budget
was facilitated by the ability to manipulate the financial model.
“CMH nurses now feel that their pay is competitive with
the external marketplace,” says Mattie Lowery, vice president of patient
care services. “And internal equity issues have also been resolved.”
Lowery says that the bottom line is that CMH now has the ability to recruit
experienced RN’s and is rapidly closing vacancy gaps. “The expected
increase in employee satisfaction and reduced turnover,” she says,
“will help Calvert Memorial Hospital meet our overarching goal of
providing the highest quality of care for our patients.”
Contacts:
Carrie Forrest
Calvert Memorial
Hospital
Vice President, Human Resources
E-mail:
mcforrest@cmhlink.org
Phone:
410- 535-8120
For more information or a copy of the complete case
study:
Janet Quigley, CCP
Techinfocus, Inc.
E-mail:
janet@ep2u.com
Phone: 410-561-8338
(Back to the top)
If you think that town hall meetings with their grassroots
approach to problem solving happen only in small-town New England, please think
again. The town hall concept is alive and well in the urban setting of
Baltimore’s Union Memorial Hospital. Furthermore, one of these quarterly
open-ended meetings with employees became the launching ground for a
collaborative nurse-senior management effort to lower the hospital’s nurse
vacancy rate — and quite a successful effort at that.
According to Rosalie Most, Union Memorial’s vice
president of patient care services, the hospital already had a supportive
environment for nurses when several of them spoke up at a hospital Town Hall
Meeting in October 2002. “They asked what management was doing about the
nursing shortage, and they offered their help in finding solutions.”
The nurses’ offer got taken seriously, with hospital
president Harrison J. Rider III working with the facility’s directors of
nursing to pull together a large group — about 70 representatives drawn
from nursing and hospital management — to create the President’s
Council on Nursing Initiatives. While members work in sub-groups focused on
such areas as recruitment and marketing, retention, pay options, and nursing
education, solutions are also brainstormed at the unit level and then brought
to the council.
This grassroots approach to identifying what will work in a
particular area is a great strength, says Most. “It allows each unit to
diagnose for themselves what will work. For one unit, it might be bringing in a
new piece of equipment. For another, it will be a new patient care model. In
another, it might be creating a new staff position.”
The latter approach has worked well in the emergency
department, which is the source of nearly half of the Union Memorial’s
inpatient admissions. The busy ER had a fairly high nurse turnover rate. One
issue was the time it took to move patients that needed to be admitted up to
the floor. The problem was addressed by creating a new “admissions
facilitator” position for the ER. With several of these new positions now
filled, patients are moved more quickly.
How, exactly, does presenting a nurse recruitment or
retention idea to the council work? It takes preparing a one-sheet proposal
that sums up the idea and reflects the expected costs and benefits.
“Preparing the proposal is a good exercise in building the skills of nurse
managers,” says Most. “The proposals can’t be phrased simply as
‘We want. . . .’ Instead the idea has to be presented in the larger
context of its impact – not just on staff, but on patients, and on
physicians.”
The majority of proposals have been accepted, says Most. And
they have clearly had an impact: In the fall of 2002, the hospital had 89 nurse
vacancies. It now has 28, which translates into about a 5 percent vacancy rate.
Use of agency nurses is down significantly.
Most is clearly pleased about the drop in agency use, and
how the hospital’s own nursing staff often serves as recruiters. “If
an agency nurse has been coming primarily to our hospital, one of our staff
nurses is likely to say, ‘If you like it here, you should go and talk to
human resources. With so few agency openings, you don’t want to lose the
opportunity to work here.’”
Contact:
Rosalie Most
Vice President of
Patient Care Services/
Chief Nursing Office
Union Memorial Hospital
Phone: 410-554-2275
E-mail: Rosalie.i.most@MedStar.net (Back to the top)
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