r&r recruitment and retention in an rt department
TRANSCRIPT
R&R Recruitment and Retention in
an RT Department
John W. Salyer RRT-NPS, MBA, FAARC. Director Respiratory Therapy
Seattle Children’s Hospital Research Institute, Foundation
There is nothing more difficult to take in hand, more perilous to conduct, or more
uncertain in its success, than to take the lead in the introduction of a new order of
things……..Niccolo Machiavelli
May You Live in Interesting Times
Icons of Management
Style #1:
Compassion-the Servant Leader
Icons of Management Style # 2 Intelligence-the Analytical Leader
Icons of Management Style # 3: Vindictiveness
Icons of Management Style # 4: The Opportunist
Icons of Management Style # 5: Pushing the Envelope
Icons of Management Style # 6: The Motivating Power of Terror
Immutable Truths of RT Management
• Management and leadership are not the same thing
• The plural of anecdote is not data• It is a good idea to like your job• Good listening doesn’t just happen, you
have to work at it.• It’s all about processes• Do not sacrifice the good for the perfect
Immutable Truths of RT Management
• The main thing is to keep the main thing, the main thing
• Someone is going to be in charge• If a hospital can shut down your department,
it should.• Unwarranted variation is usually not good in
health delivery systems• Director/managers are often the last one to
know what is going on in their departments.
Immutable Truths of RT Management
• Folks don’t read much, if any, of the stuff you send to them.
• The burden of proof is on the advocate• All assumptions are suspect until proven
otherwise• The Six P Principle: Proper Planning
Prevents Piss Poor Performance• You cannot manage what you do not
measure
The House
Important Management
Skill #1: Pattern
Recognition
The Last 50 breathing treatments didn’t work....but this one just might be the one.
Because If They’re Not Breathing, They’re Not Doing Anything Else Either.
What Motivates You?
• Internal staff satisfaction• Patient satisfaction• Hiring Retention
Engagement Metrics
Metrics of Recruitment / Retention
Number of Hires
0
1
2
3
4
5
6
7
8
9
10
2004 2005 2006 2007 2008 2009
Hires Terminations
Reason Number* Internal Transfer
Family IssuesPerformance Issues
RelocateDisability
Career ChangeDisgruntled
Immigration IssuesDay Shift Elsewhere
655432221
History of Terminations 04-08
* Sleep/Home Care/Research
Turnover in Southern CaliforniaTurnover in Southern California
• Impact of economic downturn – Perceived stabilization of workforce
shortage– FY07 turnover - 13.44%– FY09 Turnover - 10.31%– Turnover 1/1/09-6/30/09 - 3.27%
Retention FactorsRetention Factors
• The quality of the supervision an employee receives is critical to employee retention.
– lack of clarity about expectations,– lack of clarity about earning potential– lack of feedback about performance– failure to hold scheduled meetings– failure to provide a framework within which the
employee perceives he can succeed.
Retention FactorsRetention Factors
• Talent and skill utilization• The ability of the employee to speak his
or her mind freely • The perception of fairness and equitable
treatment is important in employee retention
• Recognition– the employee never felt senior managers
knew he/she existed.
Practical IdeasPractical Ideas
• Provide for staff convenience:– Policy and equipment manuals– Supply chain
• Predictable-effective-staff staffing• Scheduling equity/transparency• A balance view of seniority• Training/inservice opportunities• Real competency assessment• Staff advocacy• Just culture• Set the bar high
Vacancy and Turnover Data
JobArea/
Region YearVacancy
RateTurnover
Rate
RRT&CRTT National 2000 5.8%
RRT Maryland 2004 17.0% 8.3%
CRTT Maryland 2004 9.9% 12.7%
RRT&CRTT-Full Time National 2005 8.7% 16.9%
RRT&CRTT-Part Time National 2005 12.5% 25.2%
RRT Kansas 2008 5.2% 7.2%
RN National 2009 8.1% 11.2%
Because Somebody has to be the Hospital’s Bitch
What Motivates You?
What are Safe Staffing Levels?
• No good national standards
• California has established maximum number of ventilators to RT ratio of 4:1
• According to a national survey, the average staffing is 1 RT for every 11 occupied ICU beds
• The important thing is to have a reliable, logical method of staffing your hospital
Staffing Systems• Fixed
– Basically the same number of RT’s per shift regardless of workload
• Flexible– RT’s are added or sent home,
depending on the predicted work load for the shift
– Recommended by the Society for Critical Care Medicine
– Use on-call and per diem– Requires “calibration”
Sometimes the Best Solution to Moral Problems is Just to Fire All of the Unhappy People
Calculation for Staffing ProtocolThis is a calculated value indicating the number of staff needed. The formula is:
The number 33 is the approximate number of 20 minute treatment units a staff member can do in a 12 hour shift. It is based on the following assumptions:
• Total minutes per shift 720• Non-Productive• meals 30• breaks 30• report 30• Productive 630• Divided by 20 minute units � 20• Number of productive units possible � 33
33)weighttreatmentsofnumber(
Staffx
=
-3
-2
-1
0
1
2
3
Jun Jul Aug Sep Oct Nov Dec
NightsDays
Und
erst
affe
d
O
ver S
taffe
dStaffing Effectiveness Analysis
(Actual – Predicted Number of Staff)
-3
-2
-1
0
1
2
3
Jun Jul Aug Sep Oct Nov Dec
NightsDays
Und
erst
affe
d
O
ver S
taffe
dStaffing Effectiveness Analysis
(Actual – Predicted Number of Staff)
Leadership is the Art of AccomplishingMore Than the Science of ManagementSays is Possible…………..Collin Powell