On-boarding and Retention Practices:

A proposal for change

Respectfully submitted by:

Deidre R. Bradley
Masters Degree Candidate
Fort Hays State University

May 2015

In pursuit of earning a masters degree from Fort Hays State University, I have been tasked to
develop a project that would allow me to use the methods and models learned during this
semester and recommend change within an organization. I chose to look at an issue within Clark
Regional Medical Center, where I am currently employed as the Vice President of Human
Resources and Public Relations.
Background
Clark Regional Medical Center (CRMC) began as a non-profit entity in 1917 in Winchester,
Kentucky. In May of 2010, LifePoint Health, a leading for-profit healthcare company based in
Brentwood, Tennessee, acquired CRMC and completed construction of a new facility and
campus in 2012.
When the acquisition was complete, there was a change in operations and many departments lost
staff members in the process. They did gain support structures and corporate systems to allow
them to work more efficiently with less staff. This was a major shift in how they had operated
before. Moving from a non-profit organization to a for-profit system was needed to continue to
run operations; however, this brought about negative feelings toward Lifepoint Health.
Today, CRMC is a 79 bed hospital with 75 physicians, 500 employees and 70 volunteers. The
Administrative team is comprised of the Chief Executive Office, Chief Clinical Officer, Chief
Financial Officer, Assistant Administrator and Vice President of Human Resources & Public
Relations. The site of the facility is 20 miles from a very large city, Lexington, Kentucky, that
hosts several large hospitals which compete with our services and employees.
CRMC has grown over the last two years by adding new service lines and acquiring physician
practices to better serve the community. By providing these services, we allow patients in our
primary and secondary service areas to obtain quality medical care close to home and forego the
hustle and bustle of a big city, such as Lexington.
Overview of Problem
Retention is a substantial issue in our hospital. In 2014 we saw a 31% turnover rate overall for
the hospital. Engagement surveys and exit interviews report that a few people leave the hospital
because of pay and benefits and many in the organization do not feel we pay at the current
market rate. In addition to retention, we occasionally experience problems recruiting quality
staff as they could drive another 15 minutes to Lexington and make more money while getting
additional experience with higher acuity patients or in other service lines.
Pay is an issue that comes up from time to time. To ensure we pay appropriately, the market pay
grades have been reviewed and updated. Wage compression issues do abound. In 2014 several
employees pay was adjusted so that they were equitable to their years of experience. New
employees with far less experience were being paid at equal or higher rates than long-tenured
staff. These issues were identified and corrected. It should be noted that the Human Resources
Director role had been vacant well over one year, therefore, the market rates were not being
evaluated properly. As a result, many of the wages set were not in keeping with proper pay
ranges.

Additionally, moving from a non-profit entity to a for-profit system brought about the realization
of how merit increases are handled. The hospital has core measures that helps us to evaluate the
effectiveness of our practices. When we meet these targets, which include patient satisfaction,
quality scores and fiscal responsibility, then merit increases are given. When targets are not met,
then merit increases are not given. This also accounts for wage compression issues.
Pilot Program
Two departments were quickly identified as having high turnover trends, especially in the last
nine months to one year. I reviewed the turnover rates of each department and sought
information from our Staff Development department, who gave me good insight as to what new
hires are having difficulty with. I then developed a plan and met with the Administrative team to
get their buy-in and approval. Our Administrative team met with the two directors and me so we
could outline the reason behind the plan and to voice their support in the endeavor.
As I met with the two directors, I listened to them describe what they were doing in terms of
interviewing, on-boarding and recognition. We discussed many things and there were several
things that were going very well. I made a point to celebrate the good things that were already in
place. Where one of the directors struggled, the other one excelled. They agreed to meet and
swap ideas in the areas they needed help and would work to continue to improve in these areas.
Initially, there was a bit of resistance and defensiveness between the two directors. They were
concerned about their departments being targeted. I reassured them both that this was an
opportunity to help them. One of the directors spoke up and said that all of her staff leave due to
benefits and pay.
I explained that employees many times will tell their direct manager that those are the things that
make them leave; however, when exit interviews are completed, those issues rarely come up.
Recalling an article read for this class, I quickly explained that research indicated that regardless
of the decade and continent, the majority of employees surveyed state that the worst part of their
job is their immediate supervisor. (Burke 2011).
Knowing these two directors did not want to be the kind of leader that made people leave, I
explained that we needed to see what their teams perception of their leadership style was. Once
we could identify those things, then we would give them tools to help them be more successful in
those areas.
By the end of the meeting, it was clear that each director knew where they needed to change and
they came to the conclusion on their own. I gave them some tools to immediately help them and
offered to be a part of any portion of the process they felt I could contribute. We agreed to have
periodic check-ins, surveys completed by both department staff members and a follow up as we
neared the end of the project.
Areas that they each were going to work on included:
Interviewing (being more personable with the candidates and including their team
members to be a part of the decision making process). Citing Kurt Lewin on the

importance of group decision making, I felt it necessary to share his research from the
1940s and 1950s with the two. This appeared to make my argument more credible in
that it was important for them to engage their team in the interview process.
Once their new hire accepts the offer, immediately begin to communicate with them and
with the team to let them know itineraries and to answer any questions they may have.
On their first day, have their locker/phone/desk set up with all the supplies they need to
be successful; assign preceptor/buddy and have a welcome party with lunch to make
them feel recognized and accepted.
Recognition efforts need to be focused on specific behaviors or actions and rewarded;
have team building sessions and time for fun away from the hospital when possible.

I, too, left the meeting with things to work on, such as refining the exit interview process. This
was addressed a few weeks after our initial meeting with the entire leadership group. Directors
were responsible to have employees schedule an exit interview with Human Resources (HR) to
shore up any paid time off accruals, tuition payments, uniform returns and sitting down with the
HR staff to discuss their decision to leave. To date, this process has been refined yet it still needs
some work.
Another area for me to drive was sending out surveys for the staff members of each department
to weigh in on why they thought the turnover was high in their area. This was very revealing on
leadership styles and staffing models. As a result, our Administrative team decided to develop
the leadership skills of these two directors more thoroughly and to give them the tools they
needed in order to be successful. Staffing models are being reconsidered at present.
Both directors were good in their roles as a nurse and laboratory technician. They were home
grown leaders per se and had never really been taught how to be a good leader. Instead, they
knew what they did not like about previous leaders they had. Both directors will receive
executive coaching to help them develop their leadership talents. This is being planned at
present.
Additionally, regular meetings have been held with the directors and their team members along
with a member from the Administrative team. This has opened up lines of communication which
has not been all pleasant. Each director had a 360 degree evaluation and had to hear some pretty
tough comments. All of these things have to happen in order for them to get better. To date,
each has received the information in a manner that, while hard at first to digest, are making great
strides to change their leadership style. They are engaging with their teams more frequently and
in ways that are not always structured around work.
Both directors have identified their weaknesses, sought out help and have come up with some
truly great ideas on reaching out to their new hires before they begin work. One of the directors
sends a welcome card and has everyone sign it. The other one made the effort to go and buy a
welcome banner that everyone signs prior to her new hires first day. She has placed it on their
lockers and the staff seem to enjoy that very much.
I am very proud of the strides each one has made to step out of their comfort zone and do some
fun things in their work areas. This has been the most challenging portion. Both directors are

very task driven and do not make any provisions for their staff to have time to get to know each
other away from work. They do not know how to incorporate fun into a stressful job. This is an
area that will be slow going until they feel comfortable with this notion. I believe they will get
there in time.
While these two directors are doing better in the areas that their employees have noted and have
seen dramatically lower levels of turnover, there is still room for improvement. This area is in
the departmental orientation piece. We have a disconnect with many of our directors on how
long new staff should be oriented. Several of our directors only want to hire experienced staff so
they will not need as much orientation. This puts new hires at a great disadvantage and could be
viewed as unsafe.
It also provides the regular staff with a false sense of having help. They think that once someone
finishes in orientation they will have a full-fledged staff member to help them carry some weight.
Rather than help that new hire, they tend to turn them loose which causes new staff to feel
overwhelmed and frustrated. No amount of money will fix that feeling. I believe this is the
more pertinent piece to the puzzle. We must keep new hires, no matter their experience level, in
orientation as long as that person feels they can sufficiently and safely work alone.
This process has been much improved and we are gathering very good information on why
people leave. However, I do believe it would benefit the organization much better to focus on
why people stay and then celebrate those themes. Changing the use of turnover to retention
would be a much more positive approach. Nobody minds to tell Human Resources why they
love to work for our hospital. Rather, people do not want to be seen as causing trouble or
burning bridges so they do not always represent the truth during a face-to-face meeting with my
staff.
I respectfully propose that we take the lessons learned from the pilot, implement those via
discussions with each and every director; change the language to reflect a more positive focal
point (turnover vs. retention) and finally pilot studying retention and why people stay and then
celebrate those attributes and the leaders behind it. This would need to be a six month to one
year strategic focus to hardwire this thought process. I strongly believe we will see a very
positive change in behaviors and retention efforts.
References
Warner Burke, W. (2011). On the legacy of theory Y. Journal of Management History, 17(2),
193-201. doi:http://dx.doi.org/10.1108/17511341111112596
Burnes, B. (2007). Kurt Lewin and the Harwood studies: The foundations of OD. The Journal of
Applied Behavioral Science, 43(2), 213-224,227-231. Retrieved from
http://search.proquest.com/docview/236352406?accountid=27424