In general, Samaritan Health System's managers see the new pay-for-performance paradigm as a useful tool, albeit a time-consuming one. Workers are skeptical of the program's intent and its mechanics.
To gauge how the program feels from the ground, MODERN HEALTHCARE*talked to a handful of people at the system's Maryvale Samaritan Medical Center on the west side of Phoenix.
Eileen Bacus, medical-surgical director and a registered nurse, said nurses' response has been "a real mixed bag." Those comfortable in their role and their pay aren't threatened by the new program. Younger nurses who may be new to Samaritan "are struggling with how long it's going to take to get up to the `competent' pay zone," Bacus said. Before, nurses could boost their incomes quickly by climbing a "clinical ladder" and improving their skills, she said.
"It would be very hard to reach the `master' level," said nurse Robin DeWelles, echoing Bacus' comment. "You have to walk on water." She thinks she'll probably be rated "competent" and therefore get only mediocre raises. "I've only been a nurse five years," she said.
John Henderson, a plumber by trade, has been with the hospital 18 years. He thinks he should be rated "master," but he's doubtful of the whole thing.
"They keep changing horses on us," Henderson said. Last year they zigged one way, this year they zag another. "We're now supposed to be masters of our trade-if you want to get paid. Otherwise they take money." Henderson snapped his fingers. "Snap! `You are now developing and you take a 3% pay cut.'*" Referring to the lengthy help-wanted listings for plumbers in the newspaper, he added: "They say they want qualified people. They're not going to get them."
Dennis Charney, a respiratory therapist for 26 years, observed that, like with anything new, there is initial pessimism. Still, his pay-for-performance review in February left a positive impression.
As preparation for their evaluation, employees write up a self-assessment for their supervisor. "All the things I did during the year-I was surprised at all I had accomplished. Before, it didn't really matter in the evaluation process what you thought you had done," Charney said.
He doesn't especially appreciate the fact that the process steers most people toward the middle of the competency range and, necessarily, to a middling pay increase.
"It's a way to get you not to be a master performer," DeWelles commented.
But Charney understands the larger principles involved. "Personally, I have a hard time looking at patient care as a product," he said. Yet he also knows Samaritan must learn to behave more like a business. Now, everyone is held accountable not only for knowing his or her job but for serving the customer.
The new program forces the old-timers to perform, and that's good, he thinks. "I see a lot of deadwood around, and I'm not management.
"People need to have some insight into what the system needs," Charney said. "It can't come just from the managers. Managers don't have all the answers. It has to come from all the employees in the system. It's kind of neat that employees can make their own fate."
"They do," chimed in Sharon Larson, a food services supervisor. "There are people in the system who realize they do not want to challenge themselves to better themselves. Some of those have found employment elsewhere. That's OK."
The action plan for employees is another useful innovation, Charney said. "It's like a contract. You agree to do certain things to attain your goals. You have a chance to set yourself up as a winner with the system," he said.
Yvonne Chase, who supervises 38 people in patient services, said the program has the potential to eliminate the inconsistencies and inequities that had calcified in Samaritan's old compensation system. Pay-for-performance even gave her the courage to let several people go during the probationary period.
"We used to reward them for occupying a seat," Chase said. "There was no encouragement to take initiative. Some of my people, they say, `I'm just a clerk.' (Under the new program) you can't just say, `I'm not going to do it' anymore."
The pessimism, Larson said, is coming largely "from older people who aren't secure about how well they do their jobs." The pay-for-performance regimen is widely perceived, even by those who wrote it, as hard on workers who might have trouble keeping the pace or learning new skills. If they don't step it up, their pay will ratchet downward.
"Loyalty is not looked on highly," is how DeWelles expressed it. "The people who have worked here a long time are over the maximum (pay). They'll be cut. Then what?"
It's supposed to be a wake-up call, said Terri Kubicek, director of women's and infants' services. "The ladder's been raised.*I think most will change their performance rather than jeopardize their pay. They could go to work elsewhere, but it's unlikely because they are at the top of their range."
Overall, Kubicek said, the rollout of pay-for-performance has ignited no mass revolt. "It's pretty bold of Samaritan. They've been such a traditional organization."