Health Care Management Unit VIII

 management action plan (MAP) 

Community Memorial Hospital Recruiting and Retention

Management Action Plan

You are the CEO of Community Memorial 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 were all in specialty role:

cardiology, orthopedics, pulmonology (no new primary care doctors for some years).

The hospital board of directors made it your top priority to recruit more family practice 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 physicians for two of the positions, and you also agreed to pay off

student loans for two U.S.-trained physicians for the other two positions. All 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 staff, you have

polled the young family practice doctors, and none of them are planning to stay beyond the end

of their 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 affecting the hospital’s ability to

keep family practice doctors are:

 limited recreational activities for young doctors and families once they are in the

community,

 heavier 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 daily 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 you 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 problem at Community Memorial Hospital (CMH) is recruitment and retention

of family practice providers. 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 on at CMH. Once family practice providers 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 providers to remain on staff

with CMH.

B. Determine the reasons for the shortage of family practice providers 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 then 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 providers.

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 retention problem with the current primary care providers. 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, 2010).

a. According to a survey of Massachusetts physicians regarding recruitment and

retention of primary care physicians at community health centers (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 establishes 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 patient 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 remain 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 competitive with surrounding HCOs.

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 understanding 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 administrative

responsibilities 75%. Less important is productivity incentives (43%) and

increase in mid-level providers (41%; MassAHEC Network, 2010).

b. Providers 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. Only 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 physicians by service lines, HCOs are more able to document

clinical excellence, forming a foundation for privilege and compensation

negotiations that allows both the HCO and physicians to earn incentives under

more recent compensation plans (White & Griffith, 2010).

e. Promote and reward a leadership environment by involving physicians in

the decision-making process; HCOs show physicians they are valued

members of a productive team. HCOs with a high level of physician

engagement receive 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 examinations,

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 not recruit just from within the United States. Cultural competence 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 (White & 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 important. This is

followed by wanting a specific geographic region (63%) and wanting to live

near family (52%; MassAHEC 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 review may be used as a benchmark for evaluating which

recruitment incentives are customary and competitive in today’s physician job

market. In addition, the review 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 settings into which

physicians are being recruited (Merritt

Hawkins, 2011).

i. 76% were offered a signing bonus of, on average, $23,790.

ii. The average income offered for family practice providers 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 productivity 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 simple such as a cold. This

is a twofold incentive for providers and patients. 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 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 associates from

each area are represented.

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 bold font for the most effective key action steps.

B. Use strikethrough 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 projected manning

requirements.

F. 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 stipends.

VI. Accountability

A. Create a process-improvement council whose sole objective is improving recruiting

and retention within the organization. Ensure that associates from each area are

represented. Immediately implement the team. Caregiving teams will head up the

council. The council will 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 ensure 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 stipends. 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 satisfaction. 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 and

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 health centers: A survey of Massachusetts physicians. Retrieved from

http://www.umassmed.edu/uploadedFiles/CWM_CHPR/About_Us/RecruitmentRetention

PCPs_CHCs_January2010

Merritt Hawkins. (2011). 2011 review of physician recruiting incentives. Retrieved from

http://www.merritthawkins.com/pdf/mha2011incentivesurvPDF

White, K. R., & Griffith, J. R. (2010). The well-managed healthcare organization (7th ed.).

Chicago, IL: Health Administration Press.

HEALTHCARE MANAGEMENT

Instructions

In Unit VIII, you are required to submit a management action plan (MAP). Instructions for this assignment can be found by viewing the Unit VIII assignment instructions below.

Additionally, you can view an example of a completed MAP attached.

Your MAP can be either a “real-world” management problem within your own healthcare organization or one of the scenarios shown below. For this assignment, please present a one-paragraph summary of the problem to your instructor for approval by submitting it here in Blackboard. Your paragraph will describe the scenario as well as the reason why you believe a MAP is warranted for this scenario.

1. Deciding on for-profit, not-for-profit, or public status for your hospital

2. Managing third-party payer relationships in health care

3. Implementing Healthy People 2020 standards in your community

4. Implementing evidence-based medicine in your hospital

5. Implementing CMS quality initiatives in your hospital

6. Developing a workplace safety plan for your hospital

7. Implementing telehealth services in your facility

8. Conducting a complete risk assessment for your facility

9. Developing an accountable care organization for your organization

10. Developing a marketing plan for your healthcare facility

Management Action Plan (MAP)

Please include documentation of all six steps in your submission of the MAP assignment. You should begin working on the MAP at the beginning of this course. It is due in Unit VIII.

 

I.  Clarify the Problem or Opportunity for Improvement (OFI)

Clearly describe the problem or Opportunity for Improvement (OFI) that you have selected for your MAP. Why is it important to resolve this problem right now? What are the consequences of not resolving this problem right now?

 

II.  Clarify your Measurable Goal

Clearly describe the desired outcome from your MAP implementation? What are you trying to accomplish? How will successful MAP implementation be measured and assessed? What realistic constraints do you have as you begin creation of your plan? Consider limits on time, money, and other resources that are specific to your MAP.

 

III. Prepare a List of Possible Actions

Consider possible root causes of the OFI. Why do you believe the problem exists? Brainstorm and present a list of all possible actions that you may need to take in order to achieve your MAP goal. At this stage, focus on generating as many different options and ideas as possible. It is likely that not all of your ideas will make it into you final MAP. Write down your ideas just as they come to your mind, trying not to judge or analyze them at this stage.

In your brainstorming, be sure to consider ideas* involving:

 

  Leadership 

  Governance 

  Clinical Performance 

  Physicians 

  Nurses 

  Clinical Support Services 

  Knowledge Management 

  Human Resources 

  Financial Management 

  Internal Consulting 

 Marketing

 

*It is understood that some of these areas may not apply to your particular MAP, but all areas should at least be considered in this process.

 

IV. Organize your Key Action Steps into a Management Action Plan

Decide on the sequencing of your Key Action Steps. For each Key Action Step, what other steps must be completed before that specific action can be taken? Rearrange your Key Action Steps into a sequence of ordered activity. Then look at your plan once again. Are there any ways to simplify the plan further before presenting it?

 

V. Accountability

For each Key Action Step, assign a responsible party or group within your organization (by position, department, or team name, not by individual name), and assign a suspense date by which the Key Action Step must be completed. Then, based upon all of your Key Action Steps and their suspense dates, provide a realistic completion date for the entire MAP.

 

VI. Measurement and Monitoring

Now, explain in detail how you will measure the success of your MAP following implementation and how you will monitor ongoing performance to prevent regression and loss of the positive change that has taken place.

 

References

Textbook:

Safian, S. C. (2014). Fundamentals of health care administration. Upper Saddle River, NJ: Pearson.