Mary Free Bed Recruits and Retains High-Performing Employees in Small Labor Pool

Added on Dec 20, 2018

Mary Free Bed: Recruiting and Retaining High-Performing Employees in a Small Labor Pool
By Andrea Fitzgerald

Robust efforts to recruit, onboard and retain caregivers in a competitive labor market are helping employees find joy in their work and deliver better patience experiences at Michigan-based Mary Free Bed Rehabilitation Hospital.

This journey began in 2015 when the not-for-profit, acute-care inpatient rehabilitation facility underwent a series of disruptive changes, among which were the implementation of a new call light system, the addition of 87 inpatient beds, the opening of a new building addition, an expansion of its hospital network and a leadership reconfiguration. The hospital also elevated expectations for caregivers to provide interdisciplinary care, which meant more staff on the units.

“We were asking our clinicians to change not only where they work, but how they work and who they work with—all during a time of intense labor competition,” said Karen Powell, vice president of Human Resources, during a presentation at the 2018 Press Ganey National Client Conference. With record low unemployment rates and a dense medical community comprising Mary Free Bed, three other local hospitals, Level 1 and Level 2 trauma centers, an emergency department and an OB-GYN practice, competition for clinicians in Kent County is fierce, she explained. 

For Mary Free Bed, this supply problem was further exacerbated by the hospital’s extreme growth. From fiscal years 2011 to 2018, the number of beds quadrupled, and the number of patients served nearly did as well, increasing from 11,699 to 41,557. To keep up with demand, the workforce more than doubled in size. The population of inpatient nurses alone increased by 230%. Faced with the challenge of filling more positions than ever before in an increasingly competitive environment, the HR and organizational development leaders at Mary Free Bed set off on a journey to revitalize their strategies for recruiting and retaining caregivers.

The organization began seeing results two years into this journey, and has continued to sustain them. Across its inpatient clinics and programs, patient satisfaction ranking rose from the 87th percentile in fiscal year 2015 to the 99th percentile in fiscal year 2017 and has remained in the top decile since then. RN engagement also ranks in the 99th percentile. Employee engagement, a metric that includes all members of the workforce, rose from the 59th percentile in 2015 to the 90th in 2017. Furthermore, RN turnover has dramatically decreased since fiscal year 2016, dropping from 29.81% to 16.96% in fiscal year 2018. Year to date, the turnover rate is at an all-time low of 6.0%.

There is no “magic potion” to achieving these results, Powell stressed. “The key is to use creativity and take risks in applying engagement techniques in recruitment, onboarding and retention.”

Involving the Workforce in Recruitment and Hiring Efforts

With the opening of its new West Building addition in March 2015, Mary Free Bed became the fifth-largest independent rehabilitation hospital in the United States. The amount of square footage that staff had to cover likely doubled, according to Powell, and the need for high-performing day- and night-shift workers to staff newly opened units and facilities intensified as well. 

“As we moved into a more aggressive stage of marketing and advertising, particularly for hiring RNs, we wanted to shift the messaging from need to value,” said Emily Babson, director of Organizational Development and Leadership Training, during the presentation. “The goal was to communicate to applicants that working for us would enrich their lives and careers as much as it would enrich our organization and our patients’ lives.” To advance this idea and echo the organization’s mission statement—restoring hope and freedom through rehabilitation—recruiting and marketing collateral began incorporating the sentiment, “Change a life. Change yours.”

Mary Free Bed took on this personalized approach in its social media marketing as well. Partnering with the marketing department, organizational development leaders began collecting testimonials from staff in different roles, units and departments about what it meant to be an employee of the organization. They then posted those testimonials on the website, included them in marketing resources for career and on-site recruitment fairs and disseminated them through Mary Free Bed’s social media feed. “For example, instead of posting something like ‘RN positions available!’ on Facebook, we began talking about who our nurses are and what they like about their job. We included pictures of them interacting with patients and colleagues, and just having fun at work. That human interest piece really helped get us more clicks across our platforms,” Babson said.

To reach an even wider audience, leaders in the marketing and organizational development departments decided to harness Mary Free Bed’s brand power in a series of billboards targeting RNs specifically. One said “Our Growth. Your Opportunity,” and ran concurrently with a series of interviews and radio appearances by Mary Free Bed leaders discussing the organization’s multimillion-dollar expansion project. Initially, the CNO and other leaders didn’t believe this type of advertising would have a high return on investment, but they gave Babson and others their approval. The payoff exceeded all expectations, according to Babson, including her own. In the nine-month period during which the billboards ran, 65% of applications were sourced from them. 

Prioritizing Quality among Recruitment Goals

In conjunction with these innovative recruitment efforts, the hospital began constructing a new unit that needed enough staff to provide 24-7 care to patients. This meant there were 21 RN openings at a time when the hospital was receiving one or two applications a week, according to Babson. “One of my major concerns about hiring at a much higher rate than we usually did was not whether we could do it, but ensuring that quality was not sacrificed for quantity,” she explained. In order to achieve this ideal, Babson and her colleagues decided to hit pause on hiring and, first, revamp their hiring process and acceptance policy.

Their first change was requiring every applicant to submit a behavior-based assessment designed to validate their potential fit for the role. Babson and others then created structured interview guides and peer interviewing teams to further assess a candidate’s prior aptitude and predict how they would perform at Mary Free Bed.

Babson lauds the value of peer interviewing in particular. To demonstrate the exceptional value of empowering staff in the hiring process, the organization grants peer interviewers the ultimate decision-making power, meaning that once a manager completes the structured interview guide and sends candidates A and B to peer interviewers, the interviewers get the final say over which candidate is hired, Babson explained. There are two benefits to this. “First, the candidate who gets hired knows they were chosen by their team, who they’ve already met, so there is camaraderie even before the new hire starts the job. Second, the peer interviewing team becomes more involved as preceptors and mentors because they have a greater stake in their candidate’s success,” she said.

Finally, Babson and her colleagues made shadowing part of the hiring process. Though it was a heavy lift—“Making sure candidates have their flu shots and sign confidentiality sheets are only two boxes that need to be checked off,” Babson noted—shadowing has become an essential component of the hiring process at Mary Free Bed, particularly for new hires and teammates on the night shift. “Because most peer interview teams are made up of day-shift staff, shadowing offers equal opportunity for input, decision making and camaraderie to the night-shift crew,” Babson said.

Despite the ambitiousness and scope of these change efforts, Babson knew her team, and the hospital, could not afford lengthy hiring times. “Beds were being built and we needed staff to man them,” she noted. This determination paid off. Thanks to the revitalized effort, all open job positions were filled and the organization’s time-to-fill remained static at 36.6 days, more than 10 days below the health care average.

With zero job vacancies in the organization, leaders turned their attention to the hospital’s retention strategies and techniques.

Re-recruiting New Hires and Veteran Employees

Demonstrating the interdependency of the stages of the employee life cycle, Powell and others in the HR department began leveraging recruitment techniques in their retention efforts. Some of the resultant strategies have become best practices, and include
  • Welcome post cards handwritten by members of the executive team,

  • A 60-Day New Hire Lunch, during which employees identify early wins and challenges in a survey,

  • "Wow" moments to empower staff to take risks and use their creativity to go beyond expectations in improving the patient experience, and

  • Total compensation statements that outline additional employee benefits, including health insurance and retirement savings.
The impact of these and other engagement activities throughout the hiring, onboarding and retention stages can be measured in many ways, according to Powell. One way is by viewing them as a proactive cost that prevents the larger expense of turnover, “which can amount to millions of dollars a year,” she noted. Another is by viewing them as integral to the comprehensive change efforts that have enabled Mary Free Bed to excel in the face of disruption and continue to drive performance improvement in the domains of patient satisfaction, workforce engagement and RN turnover.

Most important is the impact these efforts have had on the workforce and organization as a whole, which cannot be easily calculated, Powell and Babson stressed. Not only have they progressed the organization toward its vision of becoming a national leader in high-value rehabilitation and post-acute care, but they have empowered caregivers to carry out the Mary Free Bed mission of restoring hope and freedom to patients every day.