Best Places: Companies, employees that know how to thrive in uncertain times

While the state and federal health insurance exchanges under the Patient Protection and Affordable Care Act are open for business, the number of people who will buy coverage won't be known for months. Technical glitches that have marred the opening weeks of many exchanges haven't helped with those estimates. And the final roster of states planning to expand Medicaid also remains undetermined. The industry transformation has healthcare employment experts and hiring managers bracing for major changes, but there's little consensus on what those changes will mean.

“It's a scary time,” says Russ Jones, partner with the human resources consultancy First Transitions. “Even those organizations that are financially sound, they're taking proactive moves organizationally to reduce costs, consolidate, make changes that will positively affect their bottom line in anticipation of the changes that are coming.”

Ed Edwards, principal of Edwards Healthcare Search, says his clients are all over the map in terms of how they're responding. “The huge word is uncertainty. Everybody's uncertain about what's going to happen when this hits. We'll have all these uninsured people who have insurance, who will be looking for healthcare, which will put great demands on the system. You have to have people in place to meet that demand. They're doing a great deal of assessment trying to figure out what the demands are going to be, and what their needs are going to be.”

The 100 providers, suppliers and payers on the ranking of the Best Places to Work in Healthcare for 2013, as determined by Modern Healthcare and the Best Companies Group, are already working to stay ahead of the curve by using a multitude of innovative approaches to attract and retain the best talent.

Leading this year's ranking is Texas Health Flower Mound hospital, with 398 employees. It's also No. 1 among midsized employers, those with 100 to 999 employees. The highest-ranking small employer, those with 25 to 99 employees, is Aspen Advisors, 72 employees, and No. 4 overall. The top firm among large companies, those with 1,000 employees or more, is the Advisory Board Co., with 2,160 employees. It ranks No. 10 overall.

Other organizations in the top 10 on the ranking of the Best Places to Work include: The Women's Hospital, 460 employees, No. 2 overall and also among midsized firms; Lovelace Women's Hospital, No. 3 overall and in midsized firms, 515 employees; CQuence Health Group, No. 5 overall and second in smaller firms, 29 employees; Black River Memorial Hospital, No. 6 overall and fourth in midsized firms, 315 employees; CTG Health Solutions, No. 7, 314 employees; Weatherby Healthcare, No. 8, 407 employees; and RNnetwork, No. 9 overall and third in smaller firms, 90 employees.

Profiles of the top finishers in each category along with write-ups for the second-, third- and in some cases fourth-place finishers, begin on p. 16. The Women's Hospital and Southern Ohio Medical Center, second in the large category and No. 17 overall, were profiled in 2012 so they aren't featured this year (See modernhealthcare.com/bestplaces for all companies profiled in the previous five years of this program).

Modern Healthcare and Best Companies Group found broad differences in how well employees rated companies in the Best Places ranking vs. those not on the list. Among the widest discrepancies of positive responses overall were “leadership and planning,” where companies on the list received 91% positive responses vs. 78% for those not on the list; “corporate culture and communications,” also 91% vs. 78%; “training and development,” 84% vs. 70%; and “pay and benefits,” 87% vs. 74%. Across all categories of evaluation, companies on the list received 91% positive responses, compared with 81% for those employers not on the list.

There's also wide differentiation in specific responses among companies on and off this year's Best Places to Work, especially in areas such as work-life balance and vacation/personal time. Some of the widest differences were in paid time off for community service activities (65% of responses for companies on the ranking vs. 44% for the rest), telecommuting options (57% vs. 46%), subsidized or free meals and snacks (82% vs. 64%), immediate families invited to corporate events (83% vs. 70%), meetings and staff events held during work hours only (70% vs. 58%) and extra monetary or time-off compensation after overnight travel (32% vs. 17%).

Employment managers are working harder and more creatively to retain their best talent, especially given the stresses and challenges companies are facing during rollout of the Affordable Care Act along with other industry dynamics, Edwards says.

“Every organization is asking every employee to do more with less, take on more duties,” he says. “There is more emphasis on employee engagement and satisfaction, so you can reduce that cost of turnover (and) reduce the stress it puts on the organization when you have positions vacant. ... There is that trend to go to a 'rewards mentality'—to look at the overall package. It's not just, 'We've got a base salary or an hourly wage, plus a benefits package.'"

Joey Dizenhouse, healthcare consultant with Towers Watson, agrees that healthcare providers are facing a major overhaul in how they do business, which, in turn, affects how they work to attract and keep employees.

“Fundamentally, (the industry) is undergoing an overhaul. Something as simple as how they make money is changing,” he says. “Providers will over time be more rewarded for potentially using fewer services. ... They're looking for ways to strategically position themselves. A lot of them are growing through acquisition. Figuring that out means bringing on new groups of people, and all the people issues associated with that.”

Mike Horton, retirement practice leader at Towers Watson, has heard plenty about cost cutting, too. “I've heard from a number of clients that traffic is down in the emergency rooms, the beds aren't filled, they're looking at cuts in their reimbursement rates, they're looking at reducing the cost of providing medical care,” he says. “They definitely have to strike a balance between being an attractive place to work ... and delivering medical care at a very small profit margin.”

Creative benefits and rewards have definitely been part of Aspen Advisors' human resources strategy. The No. 1 small employer provides a $1,000 bonus at the three-year anniversary and a four-week paid sabbatical at five years, says Shawna Schueller, director of marketing and business development. And Aspen provides quarterly bonus incentives based on performance. “We have high expectations, but several employees each quarter go beyond them,” she says.

Jones of First Transitions says he has received several requests recently to help structure what he calls “stay-put bonuses” for key people clients want to make sure they keep. “They want those people to be there during whatever time frame when there is all this change going on,” he says. “You take care of your best people. In times of changes, those are the people most likely to be recruited elsewhere. We want to work hard to retain those people who are high performers.”

Healthcare benefits are one of the central items that attract top talent, starting with medical insurance, but also including pharmacy, vision, dental, disability coverage, wellness policies and more, Dizenhouse says. Hospitals and other healthcare providers hold an advantage over other types of employers in that they have the ability to steer their employees to their own operations, which more of them are doing, he says.

Pay and benefits are among the most significant differences between companies that made the Best Places to Work for 2013 and those that did not. Employees of top 100 employers were satisfied with their pay 82% of the time and benefits packages 89% of the time, while responses from employees of companies that didn't make the cut were 68% and 75%, respectively.

No. 1 finisher Texas Health Flower Mound made compensation a priority after the hospital experienced 50% turnover in its first year in existence three years ago, says Spencer Turner, CEO of the 72-bed hospital. “Our pitch to the board was, we're spending a fortune on turnover,” he says. “If they would allow us to use that money to pay these people, we could get it to where we don't have turnover. We've got the right people in place; let's pay them for it.” That strategy helped limit turnover to 4% this past year, Turner says.

Part of the reason healthcare organizations are trying to avoid turnover is that top talent has become deeply rooted and risk-averse, so they're staying put in their current positions, Edwards says.

“It's harder right now to get somebody to make that decision to make a change if they don't need to, if there's not the concern that their job is going to be merged away through a reorganization,” he says. “Even when you get a really desirable job, getting people to think about selling a house, going through the financing process to buy a new house, it's tougher than ever.”

That's partly because of the uncertainty surrounding healthcare organizations themselves in an age of increased mergers and acquisitions, Edwards says. “Everybody wants to know, 'What's the future of this organization? How long are we doing to be independent?' ” he says.

That uncertainty of ownership has led to the employment equivalent of “pre-nups,” Jones says. “We're seeing more—I shouldn't say contracts—but formalized agreements for severance in the event that there are changes in control,” he says. “In the event my job does go away, at least I will be provided with certain benefits, transition services and my family is going to be taken care of. ... That does have a way of helping people say, 'Maybe this is a good place.' ”

The best places to work have been taking care of their people all along, Jones says, and it's challenging—especially in uncertain times—for organizations that haven't adequately addressed such issues to shift employee perceptions.

“People question how sincere the change really is,” he says. “It has to be sustained long enough that it becomes a cultural shift, as opposed to, 'OK, they're all doing all these nice things for me. What's going to happen now?' It can't be a program du jour. ”

Open communication and positive reinforcement can help to drive out fear, both among top managers and line employees, Jones says. “It's OK to say to somebody that maybe they're doing something wrong,” he says. But if someone already fears for their job, “I'm going to think, 'I don't have much time left at this organization. I'd better find another job.' Whereas at another organization, it's seen as an investment in people to tell them what they're doing wrong. ... The No. 1 reason people leave organizations is because they're not being recognized.”

Communication—or lack of it—remains one of the top factors in whether companies are included in the Best Places to Work ranking. Employees of firms on the list gave positive responses 93% of the time when asked whether corporate communications are frequent enough, and 92% of the time when asked whether those communications are detailed enough. For companies not on the list, those figures were 81% and 79%, respectively.

The question of whether the organization “treats me like a person, not a number,” drew a 92% positive response from employees of companies on the list, while “this organization gives enough recognition for work that is well done” received positive responses 87% of the time among employees of companies on the list. For employers that didn't make the ranking, those figures were 77% and 70%, respectively.

Healthcare organizations are also more risk-averse, preferring to hire people into top positions who have been there before, Edwards says. “I have a job I need done, and I want someone who's done it successfully in the past,” he says. “They want proven success within a specific set of metrics. They want somebody who's already done it for somebody else.”

Some of this nervous churn would still be happening without the Affordable Care Act, Jones says. But he says the law has contributed to the uncertainty and “raised the bar even higher.”“People in healthcare today are very concerned about what might happen to them. Are their jobs secure? My question to people is, is any job really secure? ... The smart people are those who are thinking about, 'What if my job goes away?' ” Jones says.

Other more noticeable trends on Edwards' radar have been a re-emphasis on direct employment of physicians “to gain control over all aspects of your delivery system” and a surge in the use of social media to post jobs—and to research applicants and find out what they can about their backgrounds. Edwards says one of his clients recently decided not to hire someone after looking at the person's Facebook page. “They said, 'He's not the type of person we want in our organization.' ”

The Women's Hospital in Newburgh, Ind., No. 2 on this year's ranking, has noticed the challenges inherent in different generational mindsets, says CEO Christina Ryan. “Right now, we have this big melting pot of generations,” she says. “We have to help them both understand that they think about (employment) differently. It doesn't make one right. It doesn't make one wrong. It's just the way they were brought up.”

Employees of all generations have needed to become more flexible as changes such as electronic health records have scrambled roles and responsibilities, Ryan says. “You might find that you're changing people out, one type of job category for another,” she says. “You have to bring those employees on board and let them know. The days of being so regimented, and black-and-white—this is my job description, and this is the only thing I do—those things are changing.”

Work-life balance is an issue that most employers have become aware of and are addressing adequately, based on survey responses garnered by Modern Healthcare and Best Companies Group. While companies among the Best Places to Work did modestly better than others, the divergence is less than on other questions: 90% of employees with companies on this year's ranking said they were able to maintain a reasonable work-life balance, while 84% of employees of other companies also responded positively to that question.

Communication and transparency with employees are also critical to becoming a favored place to work, Ryan says. “What we try to instill in management ... is that employees will perform better and enjoy work more if they understand the 'why.' We're in such an ever-changing world in healthcare, trying to keep up with regulatory changes, and healthcare reform, and population management. ... You get more compliance and support from employees when they understand what's going on.”

Ryan holds “town meetings” three times per year with employees to make sure they understand, and she leaves time for questions at the end, in part to address the rumor mill. “We're faced with hospitals around us cutting staff and eliminating programs,” she says. “Everybody's trying to get that 20% expense reduction. … I want my employees to be observant and know and be in tune with things. They pay attention to everything.”

The hospital also has been working to ensure that employees are included in its long-standing strategic goal to improve the health and well-being of the community, Ryan says. “Sometimes, we forget that our employees are part of the community, as well,” she says. “When we look at population health management, we forget that our employees are part of that population. Why not bring innovative programs and ideas for our employees? You can almost use it as a test pilot.”

Pat Kennedy, president of provider staffing firm Weatherby Healthcare, No. 8 on this year's list overall, envisions a surge in demand with the opening of the health insurance exchanges, which she believes will strengthen healthcare organizations' bottom lines.

“The requirement that employers provide healthcare will mean the need for more doctors,” she says. “What we hear from our clients is the very same thing: It is such a competitive environment, where we need to not only find top quality people, but keep them.” Kennedy also says another concern for providers is “how to get their arms around the regulatory requirements; how to weave through all the red tape.”

At Weatherby, Kennedy believes culture is the top reason the firm has succeeded with its own employees. “People ask me what keeps me up at night. It truly is being able to maintain our wonderful, people-centered culture as we grow year after year,” she says. “Our growth is the result of putting people first, rather than the other way around. We know that if we succeed with that highly engaged culture, the results will follow.”

The company has seen compounded annual growth of 31% in revenue and 44% in profits during the past five years, up six-fold from seven years earlier. Weatherby's growth rate is three times that of its competitors, who average 6% to 8%, Kennedy says. Why? “It is our culture,” she says. “It is the only differentiator. ... It's almost a patriotism associated with what we do. And we talk about it all the time.”

Weatherby offers a variety of employee events and rewards programs, and employs five full-time employee engagement specialists. The firm takes a multipronged approach to retaining employees, Kennedy says, starting with the “knights of our culture” at the senior executive level, whose responsibility is to create a place “where people want to be, where they get up in the morning and they're excited to come to work.”

The organization works to teach line leaders “how to have healthy conversations; how to coach people in rather than coach people out,” Kennedy says. And the firm tries to teach employees “how to quiet down that naysayer in your ear” while performing ethically and evenhandedly. “We hire for culture; we don't hire for skills,” she adds.

Weatherby also has significant leadership development and employee development programs, staffed by nearly 20 people, to ensure it's “romancing winners,” Kennedy says. “We view leadership development and employee development as separate from skills and training. ... We teach people to be candid and transparent and have healthy conversations without fear of retribution.”

Ken Applegate, director of human resources at 230-bed Southern Ohio Medical Center, Portsmouth, No. 2 on this year's large-employer ranking of the Best Places to Work and No. 17 overall, sounds similar themes. “We are one big family,” he says. “We live in a rural area. There's not a lot of employment in this area. A lot of people don't pick this portion of Ohio to come to once they get out of college. We grow our own.”

The medical center spent $750,000 last year alone on tuition assistance, paid directly to the school in question, Applegate says. “Most people at Southern Ohio Medical Center started in other positions and moved into the positions they're in now,” he says. “That sense of being able to come in here and grow and learn and better yourself promotes a great culture.”

Southern Ohio provided nearly 60,000 hours of in-house employee education during fiscal 2012, according to the medical center, including daylong Leadership Development Institutes that cover techniques such as rounding for results, holding critical conversations with staff, breaking down communication barriers and providing adequate staff recognition.

Implementation of the Affordable Care Act also will provide challenges, Applegate says. “We need to make sure we can still survive and carve out a reasonable operating margin,” he says. “We'll get less reimbursement for the same work. We see, in the future, probably less (staff). We're just trying to look at the current positions we have to make sure they're appropriate, that we're maximizing every position.”

Ed Finkel is a freelancer writer based in Evanston, Ill.