Q&A … With Terry Rusconi

The chief culture officer for The University of Kansas Health system and the region’s biggest hospital addresses the impact of the COVID-19 era on staffing, recruiting, and retention—issues that are not limited to health care alone.

Q: Health-care facilities, in general, are losing staff. Why?

A: Some of the latest studies show staff says they are leaving because they didn’t feel valued by the organization, didn’t feel valued by their managers, or didn’t feel a sense of belonging at work (caring and trusting teammates, flexible work schedule, and potential for advancement.) Work-life balance and feel engaged by the work.   

Q: What’s working to help you hold the line on retention?

A: Compensation is important, but solely focusing on that sends a message that we believe the only reason staff stays here is for a paycheck. We believe staff stays because they believe in the culture we have created, can truly do here what they came into health care to do, have a great and supportive team with whom they work, have a manager and an organization supporting them, have an organization and leadership who aren’t tone-deaf to what they are going through and communicates important information in a way that brings them under the tent. Then, culture and leader development and support.

Q: You had major hiring growth, then the pandemic. How did the system modify its entire package—benefits, working conditions, equipment/tech, scheduling, etc.—to help bolster retention through those waves?

A: Ensuring we recruit and retain the right people is critical to our approach. That’s why we continuously enhance and adapt our work-force practices, physical workplace resources, and total rewards portfolio. The growth and market dynamics of health care today require regular and purposeful enhancements in benefits and pay, as well as greater flexibility with scheduling (more emphasis on part-time, weekends only, etc.) More importantly, we are striving for a more holistic approach to supporting our employees through wellness programming, modernized policies, fair and competitive compensation strategies, and supporting our leaders so they can support our teams. 

Q: How do you address the mental-fatigue component?

A: On-site counselors are available for 20-minute ‘mental wellness check-ups,’ a strong repository of resources developed over the pandemic—psychologist, peer counselors, Turning Point programs and services, outside resources for those who feel more comfortable with those pathways. We increased the accrual of paid time off and flexibility to “bank” more PTO to use when needed and added remote work and flexible scheduling where possible. Then we began more frequent and less-formal check-ins between managers and employees to guide career development, increased amounts for tuition reimbursement and cash awards for professional certifications, and changed to Day 1 eligibility for our retirement plan, with faster vesting in company contributions.

Q: With regard to the pandemic-era stress on staff: What other steps have helped ease some of that mental and physical burden?

A: We reached out to organizations across the country that had experienced the earliest pandemic waves and asked them what they wished they had known. Their key learning was the importance of resources to support the staff. That allowed us to build up some really robust and easily accessible services. A strong repository of resources developed over the pandemic—psychologist, peer counselors, Turning Point programs and services, outside resources for those who feel more comfortable with those pathways, short articles, and webcasts to teach and support staff in their efforts to de-stress, daily communication of best information, best practices, ideas from professionals in the behavioral and mental health fields. 

Q: How does health care, in general, face retention challenges significantly different from those confronting other business sectors?

A: There are several challenges. The first is that health care workers are truly on the front lines of the disease. Early on, we didn’t know what we didn’t know about the disease, and the landscape was changing daily as CDC, FDA, WHO, and many others learned more about the virus. Recommendations changed daily (sometimes hourly), and there was and remains a lot of misinformation out there. So we have folks working at the front lines, watching patients (often who look a lot like them) struggle with and die of this disease. And many of our staff went home to their families worried about bringing the virus with them.

Q: Is that the same challenge today? 

A: One of the biggest challenges is just the frustration associated with having an answer to reduce infections and hospitalizations and yet still seeing patients arrive very sick and often die of the disease. This last surge was the worst we have seen in terms of the number of patients being cared for and, unfortunately, the number of patients dying of the disease. Staff are exhausted and, with each surge, feel a sense of powerlessness to effect change.

Q: Other factors straining personnel resources?

A: The recruitment of staff to “travel” across the country for wages significantly higher than what is being paid by hospitals and health systems for their permanent staff. And staff out because of testing positive for COVID. Even vaccinated individuals are being impacted by the Omicron variant and we have had large numbers of staff out on quarantine to protect them, their peers and our patients. While health care is not the only sector impacted in this way, other sectors can reduce their hours, cut their services, and more. Health care doesn’t have that option. This again wears on the staff who are picking up extra work to ensure patient care continues.

Q: Which departments within the system there have proven most challenging for the retention efforts, and what makes them tougher to defend?

A: Our Hospitality Services team has been one challenging area. This is due, in part, to the nature of the work, which is entry-level and can be physically demanding. Significant improvement is underway through competitive pay practices and manager and employee development opportunities.

Experienced clinical nurses are another focus of our retention efforts, including compassion fatigue, burnout, work and family support needs, and competition from alternative staffing models and services. These are just a few of the challenges on top of a national talent shortage in nursing.  

And those at the front line of the pandemic, like respiratory therapy, have also been significantly impacted. This is a respiratory disease, and every patient under our care requires the care of an RT. The volume and intensity of the work, coupled with many of the factors we’ve already talked about, hit this group early and hard.

We also are focusing extra retention efforts on many other specialized skill sets and talents across the health system—advanced practice providers, pharmacy, technicians, sterile processing, ambulatory, OR, and perioperative roles, to name a few.  

Q: The other half of the turnover coin is replacements; how has the organization adjusted its recruiting strategies and tactics to be able to bring in new folks?

A: We have implemented many near term-tactics to attract new talent and identified three longer-term areas of focus. Some of the near-term tactics that we’ve adjusted or innovative approaches we’ve adopted include increased social media awareness and presence through targeted campaigns and storytelling from an employee’s perspective, increased referral bonuses for some positions, partnering with non-traditional recruiting sources, career pathing programs and internships, and focused efforts and tools to grow and develop our team through mentoring, practicums, assignment reallocation, and cross-training.

Q: What’s changing, longer-term?

A: We’re supplementing our internal talent acquisition team with additional external resources to expand our recruitment capacity. And we’re streamlining our internal workflow and candidate experience through LEAN principles and process improvements. This also includes recruiting further upstream—earlier in the academic programs for those in health education programs. We’re also enhancing our marketing and building a new digital platform for our candidates.

Q: How do you address the lag time between the point of hire and completion of onboarding so they’re ready to roll?

A: I think the short answer is that the worst thing we could do is to short-cut the onboarding process. That period is critical to the long-term success of that individual; helping them integrate into the culture feel that sense of belonging we know is so important. The important part of this process has talented, engaged, and values-driven preceptors who are critical to setting these new staff up for success in their new roles.

We have made adjustments to help manage the volumes, as you know. We have deferred surgeries and reduced the appointments in our outpatient clinics so staff can take on COVID-related roles.

Q: We often hear that many workplace trends were in place before the pandemic hit and that the responses to it merely accelerated inevitable change. Is that the same in health care staffing?

A: There has been some data reflecting increased burnout in some specific health-care roles, and there was already a lot of work going on in health care to help address the causes of burnout. I don’t want to be tone-deaf and minimize the impact of the pandemic on our staff. But it has truly been humbling to watch the teams and the organization pull together and to see folks still driven by the passion that brought them into health care in the first place. Do I think there will be some staff shortages in the upcoming years? Yes, for some specialties and roles. But I also believe there are a large number of people whose values and desire to make a difference in their communities are still queuing up to enter programs that match their passion and skills.

Q: In the quest for talent, what processes do you have in place to provide a balance between experienced career workers and those just coming out of school?

A: Many of the experienced staff we are hiring are coming through the referral process. We have earmarked many roles for referral bonuses, and our staff is reaching out to those they went to school with, have previously worked with, or know of through other relationships to bring them into our organization. There truly isn’t a better way to bring experienced staff into the organization. We talked about recruiting strategies for those just coming out of school. And we continue to work to grow staff from within.