Keeping them happy

Top healthcare employers will need to be flexible in a time of flux.

Having mostly weathered the Great Recession intact—or at least in better shape than most of the economy—the sector has just begun its new journey into the high seas of healthcare reform and its uncertain implications for healthcare employers.

“Healthcare companies have continued to grow, generally. It's been one of the bulwarks of the economy through the recession and as we've come out of it,” says John Challenger, CEO of Challenger, Gray & Christmas, a Chicago-based outplacement consulting firm. “But there are a lot of unknowns out there, given the new legislation. … There are a lot of companies looking for where the new opportunities will be as the legislation begins to take effect. Others are likely to be damaged by the changes.”

The accelerated pace of mergers and acquisitions will continue as the marketplace changes, Challenger predicts. “Some companies are trying to grow, to leverage up, to try to take advantage of the new marketplace,” he says. “There are some companies that feel big is going to be better. … Some companies are trying to build up, to become larger and more complex and better able to manage costs. Inevitably, when you have mergers, you have job cuts. You don't need two headquarters.”

View the ranked list of the 100 Best Places to Work in Healthcare for 2010

Mergers will affect community-based health systems in particular, says Chris Terranova, managing director of the eastern region at Sullivan, Cotter and Associates, who agrees healthcare reform is “the paramount issue right now in the healthcare system.” She believes companies that succeed will go back to basics and rethink their employee compensation programs to produce a more holistic approach.

“Before, they thought about (compensation) in component parts: base salary, bonus program, health benefits, retirement benefits, each taken separately and sometimes added on piece by piece,” she says. “Now, they're looking to develop creative and comprehensive solutions that consider all elements … even within the rank and file, the broad-based employee population.”

Mergers and acquisitions require companies to think through their compensation systems and eventually merge them, as well, Terranova says. “Inevitably, they have different pay and benefit structures and strategies,” she says. “Over time, to make the system one system, reinforcing that through compensation programs is typically desired. Organizations are starting to think proactively about that.”

She adds, “Organizations have to think about a wise use of their dollars and putting (them) to work in places that are most critical, in employee populations that are most critical to the organization. They have to think about their resources in that light. It's a much more fluid approach. It's a much more holistic approach. We'll see a lot more around the issue of total compensation … and not just around their pay.”

Companies that have looked for opportunities to keep their employees happy during the downturn and the pending uncertainties of reform—sometimes through continued monetary investments and sometimes through nonfinancial means—are the ones who ranked highly on Modern Healthcare's third annual Best Places to Work in Healthcare list, compiled by the Best Companies Group, Harrisburg, Pa.

Back-to-back Best Places to Work winner Intelligent InSites, Fargo, N.D., expects to triple its revenue this year over 2009, for the third consecutive year, and has probably doubled its base of customers who seek medical information technology products and services, says President and CEO Mark Rheault.

As his company scales up, Rheault says Intelligent InSites has been working to formalize its alignment of corporate goals with bonuses and other compensation, roll out additional benefits such as life insurance, and continue to offer stock options company-wide to provide everyone with an ownership stake.

“We're trying to formalize some things while still remaining nimble,” Rheault says, adding that this approach has resulted in only one voluntary separation in the company's six-year existence. “We're making sure employees are getting good feedback, so that they understand what the goals are at the corporate level and also down to their individual level.”

As the company has scaled up, some employees have been understandably frustrated by the lack of well-defined processes, Rheault says, but the more modest growth this year—from 40 to 47 or 48 people, after skyrocketing from 15 to 40 last year—has provided “a nice digestion period.”

“People who are relatively new are training people who are relatively new,” he says. “We had a person last year who their spent first day doing job interviews for people they were hiring. But it's (getting) more reasonable.”

After breaking down the Best Places survey the first two years by type of company—providers, suppliers or payers—Modern Healthcare and Best Companies Group this time divided its list by company size: small (fewer than 100 employees), medium (100-999), and large (1,000 or more). Including Intelligent InSites, six of the top 10 companies were repeats from last year, and two have finished there all three years.

Michigan Health & Hospital Association, Lansing, placed second on the list of small companies and fifth overall. (The No. 1 company on this year's list and the top finisher in the small-employer category, Intelligent InSites, was also No. 1 on the 2009 list and was profiled last year). Clarient, Aliso Viejo, Calif., leads the list of medium companies and placed third overall, followed by the Comprehensive Group, Glenview, Ill., which placed ninth on the top 100 list. CHRISTUS St. Michael Health System, Texarkana, Texas, leads the list of large employers and placed second overall, after finishing third in 2009 and seventh in 2008.

The remainder of the top 10 were all large employers: Premier, Charlotte, N.C. (fourth, after finishing ninth in 2009), Southern Ohio Medical Center, Portsmouth (sixth), Holy Name Medical Center, Teaneck, N.J. (seventh, after finishing fourth in 2009 and sixth in 2008), Memorial Healthcare System, Hollywood, Fla. (eighth, after finishing sixth in 2009), and Valley Medical Center, Renton, Wash. (10th, same as in 2009).

Best Companies Group analyzed results of an employee survey about what makes a best place to work, contrasting those who responded from companies that made the top 100 list and those who responded overall; companies on the list consistently scored higher among their employees across most categories.

Among the questions that generated at least a 10-percentage-point differential:

• The employer offers telecommuting option, 56% overall vs. 66% in the top 100.
• Adequate planning of corporate objectives, 77% vs. 87%.
• Adequate follow-through of corporate objectives, 76% vs. 87%.
• Financial information is communicated well, 74% vs. 85%.
• Organizational communication is trustworthy, 77% vs. 87%.
• The organization treats employees like people, not numbers, 79% vs. 89%.
• Work recognition is adequate, 72% vs. 83%.
• Staffing levels are adequate, 68% vs. 80%.
• Employees trust what the company says about advancement, 70% vs. 80%.
• Chances to explore career opportunities,66% vs. 76%.
• Good work can lead to raises, 64% vs. 75%.
• Good work can lead to promotions, 60% vs. 71%.

Many of these differences struck a chord with employment experts. Although sometimes employees feel happy just to have a job during a difficult economic stretch—and employers don't necessary have the budgets to stretch their wallets—employers need to find other ways to ensure retention and create the kind of reputation that makes recruitment a downhill glide, Terranova says.

“Because the employer recognizes that it doesn't have the pocketbook it may have had in the past, it really forces the employer to look at different ways of keeping employees happy,” she says. “That's through better management and leadership, better communication, creating a work environment that is satisfying to people. Those are all very positive things. Most often, surveys will tell you that pay is not the reason that people stay.”

Continuing-education programs that advance employees' careers, particularly those geared toward developing organizational leaders, have become more prevalent among healthcare organizations, Terranova says.

“There's definitely more of an emphasis on creating career leaders and on emphasizing development of employees, identifying employees who may be eventual leaders of the organization in their particular domain, or their particular division, or on a system-wide basis,” she says. “In that respect, healthcare is becoming a little more like general industry. The emphasis is not just skills, but the emotional IQ related to being excellent in customer service, or a team leader.”

Work-life balance also has become a powerful differentiator for employers that have embraced the issue and realized that one size does not fit all—families with young children have different needs from empty-nesters, for example, Terranova says.

“People aren't being called in when they least expect it. They're not working on a Saturday because something needs to be done Monday,” she says. “These organizations not only respect work-life balance, but they're figuring out a way to provide it to their employee population. … The organization that's able to flex is the one that's going to retain their employees. That's where money, while important, isn't the whole picture.”

Challenger also sees employees looking to quality-of-life as a top-tier issue in deciding where to work—and how long to stay.

“Telecommuting, particularly, can be beneficial to people who have family responsibilities, to have the personal life balance they're seeking,” he says. “Sometimes people feel like they're being over-worked, and we may be seeing some more of that as the economy starts to grow and companies are still keeping a tight lid on hiring.

“As they start to get more inquiries and more opportunities come across their desks, your highest performers begin to value things like a good culture, a good boss, clear-cut information from the company, consistency,” he adds.

Advancement opportunities also are important. “There has to be a sense that the company doesn't take people from the outside, that there's room to move up,” Challenger says. “Young people (need to) feel like if they're going to work long, hard hours, that there's potential for them.”

Other top finishers in the Best Places to Work contest cited and lived out many of the same priorities and qualities.

Fourth-place finisher Premier, an alliance among hospitals and healthcare providers that provides group purchasing services and disseminates best practices, has made significant investments in employee wellness through certified coaches and in corporate social responsibility, with 3,000 hours of community service to 40 not-for-profits in the Charlotte region, says President and CEO Susan DeVore.

But Premier's organizational mission, especially in a time of flux, is what motivates employees the most, she says. “They feel like this is a place where innovation is happening. We're trying to transform healthcare,” DeVore says. “The creativity and the new ideas and the openness to trying things differently excites people. It feels like meaningful and important work.”

With Premier's leadership team spending much of its time on the road visiting member hospitals and healthcare providers, the communications department has kept the employee base feeling connected to them through a regular “where in the world is our executive team” videoconference.

“It's so easy today to stream back video from the road,” DeVore says. “We put music to it, and they ask us where we are and what we're doing. It's the real world, not a prepared message, if you will. It keeps them in touch.”

Since the passage of healthcare reform, Premier has kept communication flowing about what it will mean for employees so they're not caught off guard,” says Jill Lewandowski, senior human resources director.

“We've stayed ahead of the communication to our employees about, what does this mean, not only for our members and the hospitals we're serving, but what does it mean to you, as an employee?” she says. “Our benefits team has stayed so on top of that. What will it mean for open enrollment this year?”

Premier sought deep employee input when contemplating moving its headquarters location, which will happen between now and Feb. 1 to a new “green” LEED-certified building (recognition by the U.S. Green Building Council's Leadership in Energy and Environmental Design program). The new building is on the outskirts of Charlotte near the airport. Leadership not only consulted employees but insisted that the landlords and developers present to several groups of the rank-and-file.

“They were like, ‘Nobody ever does this. We're not used to doing this,' ” DeVore says. “At the end of the day, with the decision we made, not everybody got their first choice, but everybody felt they had input.”

Southern Ohio Medical Center is not located on the outskirts of anywhere in particular; people from the area tend to love it, but those who move in from elsewhere often don't stay, says Ken Applegate, director of human resources for the organization, which holds sixth place in the top 100 Best Places to Work and third among large employers.

That's led the medical center to develop a “Grow Your Own” program that provides 100% upfront tuition, not reimbursement after the fact, to current employees who want to advance their careers by pursuing a nursing degree, for example, through partnerships with several area universities. “We have placed a lot of folks into their (current) positions,” Applegate says.

Southern Ohio has committed to communicating significant expense reductions—and noting at the same time where the organization strategically hasn't cut back—during the difficult economic times of the past few years, says Vicki Noel, vice president of human resources.

“For example, tuition assistance would be a low-hanging fruit expense that you could just cut,” she says. “But when we have a philosophy of growing our own, how could we do that? We communicate what we did and what we could have done and did not.”

The medical center laid off 60 employees in 2008, about 40 of whom have since been rehired; they've returned at least in part because instead of escorting them to the door with an hour's notice, Southern Ohio communicated the likelihood of such a move a couple months before it happened, then gave 30 days' notice and as much as six weeks of severance pay depending on years of service, Applegate says.

“Every business, no matter if you're a great employer or not, is going to fall on hard times,” he says. “It's how you react to those situations and how you treat your employees that separates the good employers from the not-so-good ones.”

Last year, Southern Ohio cut $15 million from the budget without any layoffs after asking department directors to solicit cost-cutting suggestions from their employees. “They came up with a lot of those,” says Teresa Bryan, director of social work. “They know the business better than we do, down on the floor.”

Work-life balance, professional development, and the “Care to Share” program that facilitates employee-executive communication are the three top recruitment and retention differentiators for the Comprehensive Group, which provides rehabilitation services to hospitals, rehab facilities, senior communities and schools nationwide, says Barb Hernandez, people services manager.

Compressed work weeks, flexible schedules and medical, dental and vision benefits for part-time employees are among the paeans to work-life balance provided by the organization, which placed second among medium-sized companies and rose from 25th overall last year to ninth on this year's list.

With regard to professional development, the Comprehensive Group provides up to $4,000 per year in tuition reimbursement and up to $6,000 per certification. Employees sometimes seek to be cross-trained so they can work in more than one of the service lines the agency provides, says Julie Bringas, director of marketing and business development.

“If they're working in the senior service line, and they just feel like they're getting burnt out—they have a baby, or they have a child who's going to school—we provide cross-training to work in a different setting, like a school system,” she says. “You can change positions in the organization without ever leaving the company.”

During the “Care to Share” meetings, CEO Sandye Lerner and other executives travel to client sites and meet with frontline employees to find out what's going well and what could be better, Bringas says. “It offers employees a great opportunity to talk to the CEO and voice their opinions.”