Turning the Tables on High Turnover with Peer Interviewing

By Sheri Underwood, MSN, BSN, RN

An organization’s biggest expenditure and asset is their human capital.

For healthcare organizations today, finding and keeping top-notch providers and staff is key to quality patient care and patient experience scores. But competition for higher-quality talent is fierce, and turnover can be high. According to Nursing Solutions’ 2016 Healthcare Staffing Survey, 67 percent of hospitals report rising turnover rates, with an average rate for bedside RNs of 16.4 percent. And according to the American Society for Healthcare Human Resources Administration, 20.4 percent of healthcare employees — one in every five — quit their jobs each year. In this era of constant change, how can an organization boost job engagement and retain talented staff?

St. David’s Georgetown Hospital, a 111 bed community hospital near Austin Texas, did just that. In 2011, their RN voluntary turnover rate spiked to over 21 percent, with the highest turnover among employees who had been at the hospital less than two years. Without a stable team of engaged staff who were committed to their culture and mission, patient care and physician satisfaction suffered and contract labor expenses skyrocketed. The team at St. David’s Georgetown knew they needed a renewed focus on hiring the right people in the first place.

“It was very apparent that we lacked the appropriate accountability around our hiring and onboarding processes,” says Hugh Brown, the hospital’s chief executive officer. “Our leaders were spending so much time overcoming the day-to-day fallout and inefficiencies caused by not having enough committed staff to care for our patients that they were simply going through the motions of peer interviewing.”

To turn the tide, hospital executives committed to setting the tone. They reviewed a list of all potential peer interviewers throughout the hospital and only used those who were formally trained in the process, were rated as “high performers” using the highmiddlelow®criteria, and who were people that the leaders “wished they could clone.”

Brown and other senior leaders then met with the peer interviewers to reinforce the importance of the process. “We made it very clear to them that they had an important role as the guardians of our culture,” Brown remembers. “We implored them to use the evidence-based behavioral interview questions to only let people on their team who were good fits with our mission and values. Ultimately, we empowered the interviewers and gave them permission to say ‘no’ by encouraging them to only allow us to hire people that they wanted to retire with.”

Human Resources also played a key role in emphasizing the importance of peer interviewing by sitting in on many of the meetings with candidates. Giselle Mackie, the senior human resources generalist at the time, recalls: “My job was to observe the peer interviewers and provide them with feedback about how they performed as interviewers. I would sometimes have to remind them why they needed to ask certain questions and I coached them on ways to dig a little deeper to understand the real character and values of the candidate. I constantly encouraged the peers and reminded them how much their co-workers were depending on them to make good choices.”

Finally, before an offer was made, the responsible executive would review the actual peer interview forms to ensure that they were completed appropriately and to confirm that all peer interviewers agreed to the hire. “Knowing that [we were] going to be looking at their comments caused the peers to take their responsibilities very seriously,” Mackie says. “I know it took some effort on the part of the senior leaders to review the packages, but it certainly made it clear to everyone that peer interviewing was important. In several instances, the CEO would even send a note to one of the peer interviewers thanking them for their insight on a particular candidate which really reinforced how important they were to the process.”

Within a year of truly hardwiring evidence-based peer interviewing, the hospital’s overall RN turnover dropped from 21+ percent to 8.5 percent, and it has hovered around 10 percent every year since. In addition to stabilizing the workforce, there have also been numerous unexpected benefits of the organization’s recommitment to peer interviewing including:

  • High performers re-recruit themselves by “managing up” their workplace during interviews with candidates     
  • Candidates get to see the organization’s mission and values role modeled by high-performers during the interview
  • New employees feel “selected” instead of just “hired”
  • Candidates go into their new roles with three new friends (the peer interviewers), further cementing their loyalty to the organization

“My advice to CEOs who are having issues with hiring and retaining high quality staff is to go back to the basics and insist that peer interviewing is performed with rigor and passion,” says Brown. “This tool is the key to raising the bar on the caliber of your new staff, but it takes focus and commitment on the part of senior leaders to hardwire it into your culture.”

Interested in learning more? The St. David’s Georgetown team will be presenting more information related to their improved turnover rates at What’s Right in Healthcare in Chicago, August 1-3.

Sheri Underwood is a coach for Studer Group® who works with the leadership team at St. David’s Georgetown Hospital.

Hugh Brown has served as the chief executive officer for St. David’s Georgetown Hospital since 2007.

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