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High Business Office Staff Turnover in Rural Hospitals

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Hospital turnover rates are a serious concern for leaders in the healthcare industry. The healthcare industry as a whole experienced a total employee turnover rate of 20.6% in 2016, versus 17.7% in 2014. The voluntary turnover rate jumped from 12.1% to 14.7% during that same period. The U.S. Bureau of Labor statistics shows 581,000 job separations in healthcare and social assistance services for January 2018, and for 2017, a percentage of 33.2.

While these same numbers affect rural hospitals, when drilling down to each department in the hospital, administrative positions, which include those in the Business Office, show 47.4% of staff plan to leave their position within two years. Even more startling is that 69.0% plan to leave within five years.

RCM Staff Turnover Pain

New staff recruitment and training is expensive. The Society for Human Resource Management (SHRM) determines that the cost to recruit and train a new employee is six to nine months of the employee’s annual salary. If you pay a revenue cycle management team member $40,000 per year, that means you’re paying and additional $20,000-$30,000 after you factor advertising, recruiting, interviewing, testing, and training. The cost for recruitment of mid-level management can be as much at 150% of the annual salary. Negative impact from reduced staff and inexperienced personnel affects all departments, creating the potential for lack of continuity, communication, and customer service.

A hospital's revenue cycle management suffers when there is a lack of experienced employees to manage accounts receivables. Diminished productivity from employees struggling to take on additional tasks leads to decreased job satisfaction and can spark a downward spiral of unhappy staff which leads  to the loss of more essential business office employees.

Rural hospitals walk a tight line to stay profitable. Shifting payment models and increased patient responsibility are only two of the challenges facing hospitals. Losing staff members with experience in tackling aging accounts and denials further jeopardizes their financial success. Your business office must have a staff retention plan to keep staff engaged and effective at their job.

Why Employees Leave

New employees can bring fresh ideas to your department, so some employee turnover can benefit the revenue cycle department. Keeping hospital employee turnover at 10% or less is an admirable goal, but more importantly than the number of employees that leave is who is leaving. If your top performers are leaving, it’s time to evaluate why.

High employee turnover disproportionally affects rural hospitals. Critical access hospitals have fewer staff dedicated to the revenue cycle, and the loss of even one employee can strain remaining staff members who are trying to pick up the slack. In addition, being in located in a rural area may make it difficult to attract and hire qualified applicants.

Employees leave for a variety of reasons: retirement, relocation, life changes, job stress, conflict with other employees, etc. You can’t control all that; however, if your staff is leaving for another hospital which provides a higher salary, better benefits, or career opportunities, you need to evaluate your hospital’s contributions to employee turnover.

A recent Harvard Business Review article outlines what Facebook leadership found when they started tracking why employees left Facebook. They determined employees didn't quit because of their bosses, in fact, they were quitting because their jobs weren’t enjoyable, their strengths were under utilized, and they weren’t able to grow their careers. This appears to disprove the axiom that people don’t quit jobs, they quit bosses.

Here's our tips for reversing high turnover in the business office:

Strategies for Retention

Create a process to interview each employees who gives notice. A personal interview is always best, but at least have an electronic questionnaire or worksheet. Ask specific questions and leave room for the employee to elaborate. Then evaluate their answers. Create a spreadsheet with the reasons why employees are separating from your department and plan to address each concern.

Your employee retention strategy goals should aim to improve employee experience in the business office. Positive outcomes of employee retention includes maintaining institutional knowledge, keeping morale high, encouraging organization growth, encouraging individual employee growth, and fostering high customer satisfaction.

Job Descriptions, Recruitment, and Interviews

Evaluate your department’s job descriptions. Do they accurately describe the duties associated with the positions? There’s no need to create an encyclopedia of job information, but at the very least, the job description should outline the tasks assigned to the position and the expected contributions to the team. Ask your top performing employees for input on the descriptions.

Once the job descriptions are complete, meet with your recruitment team. Give them the updated job descriptions and list of personality traits and skills an individual will need to succeed in the position. Review e-testing programs that will identify the critical skills essential to each position. Use behavioral interview techniques to get insight into how applicants might respond to stress, analyzing workloads, and working with other team members.

Employee Training

Use seasoned employees to train and evaluate new hires during their initial training. In fact, you should use your star staff members to create your policies and procedures, since they’re the ones implementing them everyday and performing at top levels. Remember, each person learns at their own pace and make your training program adaptable. Spend time with the ones who need it and let the ones who don’t test the waters as soon as they’re comfortable. Assign an experienced team member to take responsibility for the new member and be ready to help when it’s needed. Additionally, offering cloud-based training videos and assessments allows new employees to learn at their own pace.

Create an Employee Feedback Process

Give all team members a method for providing feedback. You can institute an open-door policy, but you should remember that not everyone is comfortable walking into your office for a face-to-face, so allow for anonymous submissions. Then act on the feedback! Team morale improves significantly when staff members feel free to speak their mind and share their ideas. Cultivate an atmosphere which allows everyone to contribute as much as they want. Implement weekly or monthly meetings to bring everyone together and honor those meetings. Show the team that the meetings are important to you and hospital leadership and you will foster a team that feels appreciated and respected. Use these meetings to review morale issues, find out why staff members are unhappy, and give support to them. The meetings don’t have to take a lot of time. If you identify larger issues, schedule individual time with affected team members.

Keep Leadership in the Loop

Make senior leadership aware of your activities. Track your results with improved morale, retention, communication, and training and give feedback to senior management, including HR. Involving hospital leadership allows you to show them improvement in department retention, justifying the program, showing savings to the hospital, and teaching other departments how to do the same.

Tools for Success

Give your staff the tools they need to perform their best. In addition to keeping office technology updated and ensuring all systems are current and operational, invest in your employees’ professional development. Provide them with opportunities to learn new skills or knowledge. Offer tuition reimbursement, give them opportunities to attend conferences and workshops, or create an in-house mentoring program. Investing in your employees’ future and present will foster strong employee engagement and loyalty.

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The consequences of high staff turnover in the business office are longer AR cycles, slow claims management, overwhelmed staff, and rising claim rejections that go unworked resulting in decreased cash flow. It's a justification to hospital leadership who may not be on board with overhauling employee retention processes.

Employee retention in the business office really boils down to treating employees with integrity, respecting them as individuals, providing a challenging work and showing them that your hospital cares about them individually and wants them to succeed at their job.