Unit VIII Management Action Plan By the end of this course, you will need to prepare and submit a management action plan (MAP) addressing a specific healthcare problem or scenario.
Community Memorial Hospital Recruiting and Retention Management Action Plan You are the CEO of Community Me morial Hospital in Marion, Ohio: a town of 50,000 people. When you accepted your position five years ago, your community had a serious shortage of primary care physicians . This was due largely to retirement or death of several senior members of the medical staff who had helped to found the hospital 40 years earlier . Over recent years, the young doctors who returned to the community after training w ere all in specialty role: cardi ology, orthopedics, pulmonology ( no new primary care doctors for some years ). The hospital board of d irectors made it you r top priority to recruit more family p ract ice doctors for the community, and you were successful ! You were able to bring in four new family practice doctors , just coming out of residency, to join the medical staff . You achieved this by sponsoring the visas of foreign -trained physici ans for two of the positions, a nd you also agreed to pay off student loans for two U .S. -trained physicians for the other two positions . Al l four doctors agreed to a five -year term of service in the community . The hope of the board and the medical staff of course was that the doctors would settle into the community, start families in town, and stay for the remainder of their careers. Today you have some devastating news . At the request of your chief of s taff, you have polled the young family practice doctors, and none of them are planning to stay beyond the end of the ir five -year contracts . Their departure dates are scattered over the next 18 months, but all of them tell you that they are leaving . Your town, like many American towns, will now be without primary care again. Some of the problems that you are aware of that are a ffecting the hospital’s ability to keep family practice doctors are: limited recreational activities for young doctors and families once they are in the community, heavie r on -call burden for doctors due to a smaller total number on staff, slightly higher salaries for primary care doctors in neighboring larger communities, and not as large of a bonus on their contracts because the smaller community does not create as busy a dail y practice as a major city. You need to look into all areas that affect the hospital ’s ability to recruit and retain primary care doctors . There is no quick fix to this situation and no absolute right or wrong answer, but the success of the hospital and the entire community depends on you . Can you change the minds of any of the current doctors ? What can y ou do to bring in more doctors — ones who will stay this time? Community Memorial Hospital Recruiting and Retention Management Action Plan I. Clarify the Problem or Opportunity for Improvement (OFI) A. The prob lem at Community Memorial Hospital (CMH) is recruitment and retention of family practice provider s. I believe retention is a larger factor because four new family practice doctors were recruited; however, for whatever reason , they have chosen not to stay o n at CMH . Once family practice provider s are hired on, keeping them happy is just as important, if not more important, than recruiting new providers. B. The consequence of not resolving the problem right now is leaving a community of 50, 000 people with no family practice provider to meet their healthcare needs. II. Clarify Your Measurable Goal A. The benchmark set is to convince all four family practice provider s to remain on staff with CMH. B. Determine the reasons for the shortage of family practice provider s within the community by performing an employee assessment of current leadership performance . Determine why CMH struggles with the recruitment and retention of needed providers and the n work to make CMH a desirable place to work . C. The realistic constraints I face are funding and time . I have 18 months to convince the providers to stay on with CMH or to recruit more family practice provide rs. III. Prepare a List of Possible Actions A. Leadership Governance 1. A possible root cause is, as a leader, I should have been more engaged sooner . When taking over as CEO it should not have taken five years to realize there was a rete ntion problem with the current primary c are provider s. Workforce planning involves planning manning requirements over the next one to five years . This should be reviewed annually; therefore, I should have knowledge of a provider’s plans sooner than the 18 months ’ notice currently given. 2. Evaluate , restate , and re -commit to the current mission . I would determine whether the current mission statement of the hospital supports the community . Organizational excellence begins with and is measured by stakeholder satisfaction ; employees are stakeholders who have a vested interest in the success of the company they work for (White & Griffith, 2 010 ). a. According to a s urvey of Massachusetts physicians regarding recruitment and retention of primary care physicia ns at community h ealth c enters (CHCs) , 89% said believing in the mission of the organization was their first consideration in choosing a CHC . Regarding retention, 82% reported high satisfaction with the mission and goals of their current CHC (MassAHEC Network, 2010) . 3. Perform an assessment of superiors, peers , and subordinates to determine leadership effectiveness in providing a good cultural leadership foundation where associates are empowered and motivated to meet customer needs (White & Griffith, 2010, p. 41) . a. According to the Massachusetts survey, those providers who choose to stay at their current CHC gave a 50% satisfaction rating when given opportunities to participate in policy development and 36% satisfaction rating for opportunities to participate in community -based research (MassAHEC Network, 2010) . i. The final element of physician privilege is continuous quality improvement and peer review . This element establishe s that physicians will play an active part in their healthcare organization ’s (HCO ) continuous improvement process while also taking an active role in conducting and receiving peer review assessments . B. Clinical Performance 1. Determine if the hospital providing excellent patien t care with the current staff, equipment and facilities ? Distribute patient surveys to evaluate whether the hospital is providing safe, effective, patient centered, timely, efficient and equitable care to its patients and associates. 2. In order to remai n competitive and consistent with the HCO ’s needs, it is imperative to remain informed on market share improvements . Is CMH keeping up with the provider’s current and future technological needs ? I must ensure physicians maintain education levels equal to the current technology. C. Physicians 1. Develop a physician supply plan that is carried to small geographic areas because easy access to primary care physicians is important to patient satisfaction (White & Griffith, 2010, p. 196) . Ensure MCH is c ompetitive with surrounding HCO s. 2. Recruiting a. According to the Massachusetts survey, The interview process scored high in importance in all levels . 89% felt visiting the CHC was important, 87% wanted a site that met most of their professional needs, 85% wanted to meet other members of the clinical team , and 84% wanted an understan ding of the community of patients to be served (MassAHEC Network, 2010) . Change the interview process. D. Retention a. According to the Massachusetts survey, rated most important are the following categories: work/life balance 94%, support staff 85 %, professional development 82%, compensation 80%, and protected time for admin istrative responsibilities 75% . Less important is productivity incentives (43% ) and increase in mid -level providers (41% ; MassAHEC Network, 2010). b. Provider s also rated 52% satisfaction with administrations support for clinical practice goals, 46% educational/professional opportunities for family, 42% fringe benefits, 42% total compensation (MassAHEC Network, 2010) . c. Onl y 16% reported they were unlikely to remain at their site for five years and 19% were unsure . 50% reported that within 10 years they would be working somewhere else (MassAHEC Network, 2010) . d. By organizing p hysicians by se rvice lines, HCO s are more able to document clinical excellence, form ing a foundation for privilege and compensation negotiations that allow s both the HCO and physicians to earn incentives under more recent compensation plans (Wh ite & Griffith, 2010 ). e. Promote and reward a leadership environment by invol ving physicians in the decision -making process; HCOs show physicians they are valued member s of a productive team . HCOs with a high level of physician engagement receiv e higher revenue, increase referrals from engaged physicians, reduce recruiting costs , and sustain significant growth and profitability (White & Griffith, 2010 ). E. Nurses 1. Employ nurse practitioners who are able to perform physical examinatio ns, diagnose and treat certain acute and chronic medical conditions, provide health maintenance care and collaborate with physicians (White & Griffith, 2010, p. 238) . This will allow more time for current providers to spend on administration work and, hopefully, offer a less stressful working environment. F. Clinical Support Services 1. According to the Massachusetts survey, administration support rated as most important by 79% of the respondents. 2. Costs will not be cut in clinical support services to go toward provider incentive programs. G. Knowledge Management 1. Ensure proper training on all processes . H. Human Resources 1. Review and update the annual workforce plan , and ensure it is consistent with the long -range financial plan to ensure funding is available to support projected manning requirements. 2. Workforce development retention is an important focus because keeping valued employees costs less than recruitment and retraining new employees . One way to keep retention high is to promote a healthy workplace by promoting diversity and cultural competence . 3. Do no t recruit just from within the United States . Cultural competenc e and workforce diversity cultural competence is a set of complementary behaviors, practices, and policies that enables a system, an agency, or individuals to work and affectively serve pluralistic, multiethnic, and linguistically diverse communities (Whit e & Griffith, 2010 ). 4. The third function is workforce maintenance . Workforce maintenance goes hand in hand with retention efforts . Remain competitive in regards to compensation, retirement benefits, adequate training in order to complete the mission, employee safety, handling of grievances, and monitoring employee satisfaction . a. According to the Massachusetts survey, 50% of respondents participated in Visa and/or loan repayment programs; however, only 10% deemed the incentive as important . 51% rated fringe benefits as importan t. This is followed by wanting a specific geographic region (63%) and w anting to live near family (52%; M assAHEC Network, 2010) . b. The intent of the Merritt Hawkins 2011 Review of Physician Recruiting Incentives is to quantify financial and other incentives offered by our clients to physician candidates during the course of recruitment. The range of incentives detailed in the r eview may be used as a benchmark for evaluating which recruitment incentives are customary and competitive in today’s physicia n job market. In addition, the r eview is based on a national sample of search assignments and provides an indication of which medical specialties are currently in the greatest demand and the types of medical set tings into which physicians are being recruited (Merritt Hawkins, 2011) . i. 76% were offered a signing bonus of, on average , $23,790 . ii. The a verage income offered for family practice provider s is $178,000. iii. Most search assignments (44%) were for communities of 100,000 or more. iv. 92% of searches offered a relocation allowance averaging $10,454 . v. Signing bonuses, relocation , and continuing medical education allowances remain standard in most physician recruitment incentive packages (Merritt Hawkins, 2011) . c. Offer incentive packages for current and new providers . Include relative value unit bonuses versus per -patient bonuses . Relative value unit bonuses are a metric for determining physician productivi ty based on work units performed by a physician rather than the number of patients seen (Merritt Hawkins, 2011) . This incentive gives more points to patients who may require more time and care versus a patient seen for something s imple such as a cold . This is a twofold incentive for providers and patients . Eliminate educational loan forg iveness as only 29% of searches, and only 10% deemed it as important (Merritt Hawkins, 2011; MassAHEC Network, 2010 ). Also , include malpractice coverage, health insurance benefits, a relocation allowance, a signing bonus, a competitive and set salary , bonuses for profit sharing, and leadership and retention stipends . I. Internal Consulting 1. Empower associates involvement with process improvement teams. 2. Create a process -improvement council whose sole objective is improving recruiting and retention within the organization . Ensure that associate s from each area are rep resented . J. Marketing 1. Improve the organization ’s marketing strategy to attract customers and to aid in recruitment of future providers . IV. Analyze and Prioritize Key Action Steps A. Use b old font for the most effective key action steps . B. Use s trike through font for actions that can be dropped from the list without consequence. V. Organize your Key Action Steps into a Management Action Plan (revise order) C. Create a process improvement council whose sole objective is improving recruiting and retention within the organization . D. Perform an assessment of superiors, peers , and subordinates to determine leadership effectiveness . E. Review and update the annual workforce plan , and ensure it is consistent with the long -range financial plan to ensure funding is available to support proj ected manning requirements. F. Revise incentive packages for current and new providers 1. Eliminate educational loan forg iveness as only 29% of searches, and only 10% deemed it as important (Merritt Hawkins, 2011; MassAHEC Network, 2010 ). Also , include malpractice coverage, health insurance benefits, a relocation allowance, a signing bonus, a competitive and set salary , bonuses for profit sharing, and leadership and retention stipends . VI. Accountability A. Create a process -improvement council whose sole objective is improving recruiting and retention within the organization . Ensure that associates f rom ea ch area are represented . Immediate ly implement the team . Care giving teams will head up the council . The council w ill be ongoing with monthly feedback provided to the CEO . B. Perform an assessment of superiors, peers , and subordinates to determine leadership effectiveness . POC : Human resource management with the results of the assessment submitted within 60 days. C. Review and update the annual workforce plan, and ensure it is consistent with the long -range financial plan to e nsure funding is available to support projected manning requirements. POC : CEO with a completion timeline of 60 days. D. Revise incentive packages for current and new providers 1. Eliminate educational loan forgiveness as only 29% of searches, and only 10% deemed it as important (Merritt Hawkins, 2011; MassAHEC Network, 2010) . Also, include malpractice coverage, health insurance benefits, a relocation allowance, a signing bonus, a competitive and set salary, bonuses for profit sharing, and leadership and retention stipe nds . POC: Human resource management . Completion timeline of 90 days to be submitted for approval to the board . Final approval of plan completed within six months. VII. Measurement and Monitoring A. I will create a Recruiting and Retention Measurement and Review Committee . Surveys will be conducted quarterly to determine associate and patient satis faction . It is imperative that, during this process , the hospital maintain excellent patient care at all times . B. A review will be conducted within six months as to provider retention intentions an d recruiting efforts . If no progress is noted at that time, the review plan will be re – evaluated . References MassAHEC Network . (2010, January). Recruitment and retention of primary care physicians at community he alth centers: A survey of Massachusetts physicians . Retrieved from http://www.umassmed.edu/uploadedFiles/CWM_CHPR/About_Us/RecruitmentRetention PCPs_CHCs_January2010.pdf Merritt Hawkins. (2011). 2011 review of physician recruiting incentives . Retrieved from http://www.merritthawkins.com/pdf/mha2011incentivesurvPDF.pdf White, K. R., & Griffith, J. R. (2010). The well -managed healthcare organization (7th ed.). Chicago, I L: Health Administration Press.