Selection and Retention in Healthcare

It Doesn’t Have to be Gut Feel


nyone who has been in a managerial position has at least one story of an employee that stands out as one of the most trying and frustrating experiences in their careers. My “favorite” began one morning as I arrived to work to find a handwritten note on my chair.  It was the resignation of my office administrator. She stated that she had been lying to office personnel, customers, and suppliers for the past several months.  What I didn’t realize at that moment was the repercussions of that day were going to carry over for not only days but weeks and into months before all the problems were finally resolved. On the flip side, there are those employees that we wish we could clone. They are dependable, require very little supervision, take direction well, and are considered a valuable part of the team.

This would seem to give credence to the adage that “All employees bring joy to the workplace. For some it’s when they arrive while others it’s when they leave.”

So what’s the difference? Both employees will typically present themselves well during an interview, have the skills needed for the position, and will present impressive credentials on their resumes.

Hiring practices are commonly neglected as a key aspect of an efficiently and well-run professional office. Too often, personnel are hired in haste with the aim of filling a vacancy as quickly as possible during a stressful time. The consequences of this approach range from poor quality work to high turnover rates. The hiring process can vary from unstructured interviews to the use of complex assessment tools and their application will have a significant impact on the type of employees hired.  This article will discuss three widely used hiring practices, highlight their impact on reducing turnover and upgrading the quality of employees selected, and provide insight into a “best practice” approach that could be implemented in most medical practices.


 Approximately seven years ago, the Society for Human Resource Management did a study where H/R Managers were asked to rate their effectiveness as recruiters and to validate their decision- making in selecting the right candidate. Most of the professional recruiters rated themselves as having 50% effectiveness and the best rated themselves about 60% effective.

Consider also that most interviews for administrative and management positions last from 20 minutes to one hour.  For hourly employees, the time allotted is generally 15 to 20 minutes. How can the interviewer really learn enough about a candidate in that short period of time to justify a hiring decision?

There are many objective studies that prove that the hiring decision is made subconsciously within the first 4 to 20 seconds of meeting a candidate. Consider the visual impact the candidate makes on the hiring decision based on the way he/she is dressed and presents him/herself during the introduction.   Research tells us that most of the hiring assumptions are made by both experienced and inexperienced interviewers before the candidate even opens his/her mouth. The real danger is that these are subconscious determinations that have been made without any rational process. All of the questions asked from that point onward are likely to be asked in a manner that will only confirm our previously made subconscious decision. The whole process is biased from the very beginning. In short, the interview is simply a poor technique if the interviewer’s goal is to uncover the factors that fulfill the candidate’s need for job satisfaction and ultimately retain a valuable employee.

 Intelligence Testing

Intelligence tests have been used in hiring for decades.  These tests measure verbal ability, math ability, reasoning skills, or cognitive ability. These tests are particularly effective when selecting employees for jobs requiring a high level of mental capability such as a scientist or an engineer. However, they are much less effective if job success depends upon the ability to consistently follow a routine or in jobs that offer very little variety or creativity.  Consider for example, a position in medical records. The job requires a person who is able to follow through on procedures, have a high tolerance for stress but still maintain a moderate level of sociability under such conditions. Additional factors might include an intuitive quality to plan ahead and perhaps an ability to analyze how the procedure might be improved. Therefore, the use of an intelligence test for such positions would not be appropriate.

Personality Assessments

Prior to the 1990’s, personality tests were mostly reserved for clinical applications.  Since then it has become one of the fastest growing trends in the field of human resources, specifically in the areas for predicting success of new employees and as a valuable tool for those in managerial positions.

When an employee is first hired they try very hard to be exactly what the company wants them to be and they will modify their “ natural” behavior somewhat to adapt to their new position.  Normally they return to their natural behavior after a couple months because it causes them a lot of stress to operate outside their natural behavior for an extended period of time. This is the reason why a manager would want to “match” the employee with the job responsibilities. If the employee is not working under stress but in his/her natural behavior then the probability of retaining them is greatly increased.

When considering the fact that 70% of people report a fractured relationship with their immediate manager (and not the organization) as the reason for leaving, the relationship a manager can expect to have with a new employee becomes critical when trying to reduce turnover within his/her department or medical practice.  This was confirmed in a recent study conducted by a Gallup Survey of over 80,000 managers in over 400 companies. It was discovered that although employee benefits (i.e. vacation time, profit sharing, day care capabilities, etc.) were important, the relationship between the employee and his/her immediate manager was more important. That relationship was shown to be a critical factor in determining how long the employee stays and how productive while there. Companies who realize the importance of this relationship will frequently hold the manager accountable for a high turnover in their department. This is why a good personality assessment that is grounded in behavior terms is not only used for pre-employment purposes but a management tool for ongoing employee development.

Recommended Approach

The U.S. Department of Labor estimates that turnover can cost a company at least one third of a new hire’s annual salary.  For a manager or executive position that estimates soar to well over 1 ½ times their annual salary depending on the additional benefits.  This fact only serves to emphasize how crucial the hiring process tends to be.

A recommended approach to begin the process of reducing turnover starts with having a clear evaluation of the duties required of the position. Once the job requirements are defined, the organization can then determine how stringent the criteria must be to screen the candidates.  Those candidates that meet the criteria should then be invited to take a well-established personality assessment prior to the actual interview. Considering the time demands required for interviewing and from a practical standpoint, the interviewer now has the objective information needed to more effectively manage the interviewing time in addition to being able to quickly       pin-point areas of concern for further investigation. Those who successfully complete the interviewing process are considered viable candidates for the final evaluation of compatibility within the organization based on their personality assessment.

In his article in the Journal  of Healthcare Management titled Retaining Our Workforce, Regaining Our Potential, Steven M. Barney of the American College of Healthcare Executives stated, “In the current healthcare industry environment – with its staff shortages, higher patient volumes and dwindling profit margins – the healthcare industry must understand that workforce retention is a major factor in an organization’s success.”


Ron Watkins, MA is an Organizational Psychologist with Mountain Sky Consulting located in Asheville, NC. He earned his undergraduate degree in the field of Clinical Psychology and his graduate degree in Behavioral Psychology. He has over thirteen years of experience in the field of psychology working with major national companies such as Schlumberger and the Marriott Corporation.He is certified in the use of the Hogan Assessment System.