Retention strategies needed to ease health care’s recruitment woes

Recruitment and retention issues in health care were the focus of this year’s National Healthcare Leadership Conference in Winnipeg. Regular Canadian HR Reporter contributor John Butler, writer, consultant and former health-care executive, reports from Manitoba.

Day care, employee assistance programs, improved personal leave policies, greater say in how things are run. These are a few of the ways to keep employees, according to health-care leaders who gathered in Winnipeg last month to tackle staffing issues.

Health care’s human resources requirements, recruitment, retention, renewal and remuneration were the theme of the 2001 National Healthcare Leadership Conference, sponsored by the Canadian Association for Community Care, the Canadian College of Health Service Executives and the Canadian Healthcare Association. Ten years ago, a health leadership conference would have focused on downsizing and dealing with workforce curtailment. Today though, the vast health sector faces shortages in most technical, managerial and clinical areas, and finds itself in greater competition with the private sector.

Toronto television host and producer Irshad Manji, of Citytv, set much of the tone for the conference by pointing out that her generation is “young and restless,” preferring more flexible and promising career paths in the private sector. This generation, said Manji, wants to avoid what they see as the over-bureaucratized, stress-ridden and unimaginative career paths available in health care and other public sectors.

The nursing profession is the flashpoint as Canadian employers compete with each other, but also with the U.S. employer pool for nurses. Some employers turn to Third World countries as recruiting grounds for nurses, but this leaves them increasingly open to accusations of pirating nurses from countries that can ill afford the loss of citizens they have been able to train with their modest education budgets.

What was clear at the conference though, is that recruitment is far from enough. Nurses in particular tend to abandon their field after a decade or so, seeking new professions and challenges. Retention will be crucial in the next decade, to help health agencies staunch the bleeding away of the workforces they already have. And pay isn’t the crucial issue. More important are the stress, power imbalances and uncertainty faced by nurses who are told they are valued, but can often only find entry as casual employees.

Judith Shamian, chief nursing officer for Health Canada, pointed to the increased levels of illness and absenteeism among employed nurses as a warning sign for the whole health system’s workforce.

But the problem is not limited to nurses. Kurt Davis, executive director of the Canadian Society for Medical Laboratory Sciences, pointed out that his organization has been warning governments for more than five years about an impending crisis in the supply of medical laboratory technologists.

Some health organizations are developing a “complete picture” approach, tying recruitment and retention issues together and embedding them into their business plans. Hugh MacLeod, vice-president of human resources and organizational development for the Vancouver/Richmond Health Board and Vancouver Hospital, noted that the South Fraser Health Region will need to add 1,200 new employees each year for the next 10 years, above and beyond the 8,000 employees it will have on its payroll by the end of 2001. The enormity of this growth cannot be handled on an ad hoc basis, said MacLeod.

“Many of our employees feel that they have ended up in workplaces that see them as cogs in a machines, as disposable, of little value. They are unclear about the present and fear the future” said MacLeod. He said senior leadership must “lead the charge to be the best” by believing that people matter, behaving in accordance with that belief, and focusing on connecting with employees about the business.

One issue that clouds the picture is the role of middle management in supporting initiatives to increase staff retention. CEOs may face the double challenge of initiating retention strategies, through benefits and improved working conditions that have price tags attached, while at the same time facing stringent bottom lines in terms of dollars to spend. This challenge can be passed on to middle managers who are expected to retain staff without spending more to do it.

Inez Power, manager of operations for Homewood Behavioural Health Corporation’s employee assistance program, in Guelph, Ont., confirmed the vulnerability of middle management. Based on her own experience as a Homewood middle manager during a time of change in the early 1990s, Power pointed out that the role of the CEO in supporting middle management is crucial.

“We were developing a strategy to survive,” said Power. “The CEO’s role in challenging middle managers, while also supporting and coaching them, was crucial to making the change process work.”

Bill Innes, CEO of the York Region Community Care Access Centre in Ontario, questioned whether there really is a paradox between cost and retention, arguing there is much that can be done to support retention while keeping costs down. He urged CEOs to conduct surveys to determine the state of mind of employees. A recent survey in his organization, for instance, pinpointed job security as a key concern, allowing him to develop a strategy geared to job security issues.

Innes also stressed the importance of telling staff about both internal and external environments, since one of the prime causes of job disenchantment is a sense of not knowing what’s going on. Innes recently mounted a campaign to solicit employee suggestions about how to redesign the organization to cope with workload and cost pressures. He was able to accept about three-quarters of the suggestions, and to let employees know which were accepted, which weren’t, and why.

Like Macleod, Innes believes in connecting with employees — and letting them know the manager feels as well as thinks. “A few years ago I would not have shown my staff how I felt or how hard I worked in the middle of tough decisions,” said Innes, “but now I do.”

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