By: Jeff Agner, MPH and Ali Broders, PMP
The following best practices and recommendations should be considered when planning for a new facility, a new service line, or when there is a significant increase in the number of staff to be hired for a department as a result of rapid volume growth.
If a department requires less than 10% net new staff to support the new initiative or change, the department is typically able to manage the nominal increase in new staff without significant support or resources. However, if a single department anticipates a net increase in staff greater than 10%, or if roles or management structures will also change, the following recommendations should be considered.
Develop a plan with a timeline and critical path milestones
Finance and Human Resources typically lead the hiring and onboarding initiative with guidance and approval from the executive team. The plan should include timing for the posting of open positions, recruitment, hiring, onboarding, and training. Consider the number of new employees required to determine the support and resources required to accomplish the work. Identify difficult-to-fill (DTF) and long lead-time positions and compare them to the standard position fill times and include these adjustments in the timeline. Solicit feedback regarding their dependencies, lead times and durations from each responsible party in the process including Finance, Human Resources, Talent Acquisition, Employee/Labor Relations, Education, and department trainers and/or preceptors.
Identify difficult-to-fill / long lead-time positions early
Work with department managers/directors early to identify positions in your region that are difficult-to-fill or require a long lead-time to find the right candidates. Some positions may require lengthy training before the employee is qualified to work independently in the unit. There may also be certain positions that need to be hired during certain seasons when they are available and/or graduating. For example, pharmacy and anesthesia are typically positions which are difficult-to-fill and candidates need to be recruited early and hired immediately post-graduation otherwise qualified candidates will have accepted offers elsewhere. Ensure the hiring plan includes adequate lead time and the financial resources to offer incentives at the appropriate time to recruit for these positions.
Identify any specific positions that will require significant number of new hires
Assess the headcount of new positions required by each department as well as across all departments in total. The organization should prioritize and incentivize the candidates based on the unfilled positions in each department. Additionally, it may be easy to find prospects that are interested in high profile units, but much more difficult to find a large quantity or to fill similar positions in less appealing departments. Lastly, if the organization will require a large influx of new staff for a similar position, consider the impact to current resources required to onboard large number of new staff within a narrow window of time.
Hierarchy of Hiring
When activating a new facility, rather than expanding a current service line, consider hiring priorities for critical positions. Begin with Executives/Vice Presidents for Patient Care/Operations, Support Services, IT/IS and Human Resources. Next are key department-level leaders to write job descriptions, policies and procedures, staffing plans, etc. The training team will need to work with the department leaders to develop the orientation and training program and confirm number of trainers. Finally, lead staff/champions will need to be hired to assist with the training and fit-up of the new department.
When relocating an existing facility and merging or splitting units, prioritize the establishment of the management structure. Staff are often hesitant to apply for a position until the manager is confirmed. Once the management structure is established, the identification of staff positions is much easier.
Ensure there are adequate resources to support the entire process
Evaluate the resources required to hire, onboard and train the expected quantity of new hires within the expected timeframe. This includes recruitment, posting of positions, filtering through applications, coordinating interviews, conducting background checks, navigating candidates through employee health requirements, scheduling new employee orientation sessions, and planning general facility orientation and department specific training events. Available resources can be depleted quickly when hiring and onboarding a large volume of new staff. If additional resources (personnel, classrooms, etc.) cannot be obtained, a longer timeline will be needed.
Streamline the interview process
Interviewing can be a time-consuming process. Evaluate manager capacity to participate in interviews and determine if the process can be streamlined. Consider interview fairs, alternate managers/designees to interview candidates or interview sessions in which multiple mangers can interview a candidate together.
Managers cannot do everything!
Managers will already have a heavier workload during the Transition and Activation. Without adequate support, managers will get burned-out and a secondary impact to their staff will follow. Even if managers are used to doing everything themselves, there is often simply too much to do. Assigning temporary administrative support to assist with scheduling meetings and other clerical functions allows managers to focus their time on the additional work required of them during this very busy time. Identify lead staff members as champions and engage them early. It is wise to anticipate that some managers and staff may resign prior to the opening of the new facility. Assess attrition possibilities and consider cross-training and the identification of back-ups for key vulnerable positions.
Develop a backfill plan
Department champions will need to be temporarily relieved of their day-to-day jobs to complete the required training activities in the new facility. Resources need to be identified to backfill staff to maintain coverage and ratios during these times. Consider per-diems, travelers, contract staff, registry, and, as a last resort, overtime. Overtime is not the recommended approach due to increased staff exhaustion and potential for burn-out.
Maximize training sessions
A large quantity of staff will need to be oriented within a limited window of time. Most organizations experience an additional roadblocks when it comes to completing the required training. Staff no-shows and sick calls create the domino effect of increased class sizes at other training times or the need for additional training sessions. In order to maximize attendance in training sessions, overbook training sessions when possible and provide additional spaces for staff to register on a waitlist if a space opens in a session. This will provide maximum capacity at the training events and reduce the need for additional training sessions. We also recommend that the organization’s leadership set and enforce the expectation that staff are required to attend scheduled training sessions.
Allow extra time
Build a buffer into your hiring, onboarding and training timeline. Some activities may take longer than planned. Allow a small amount of float time to cover any unexpected challenges or delays in schedule that may arise. This will allow for changes to the hiring, onboarding or training schedule without impacting the overall Transition and Activation timeline.
Develop a tracking system and dashboard
Establish a mechanism to track the progress of hiring and training. Determine which information that should reported to the leadership team and create a dashboard to share the data and communicate the opportunities for improvement. Graphs and metrics can be used to easily display data in a visual manner. Data may include: # open and closed difficult-to-fill positions, % hired of total positions, # interviews/week by role, and/or % of staff orientation and training complete.