© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. Becoming an Employer of Choice: StaffPulse/ExitPulse Prepared for: NACHC Winter Strategy Meeting January 24, South Lake Ave., Suite 680  Pasadena, California USA T:  F:  

A rigorous survey conducted among a nationally representative, random sample of 6,000 employees in 40 health centers Comparisons are provided when possible to the Insightlink U.S. norms for employees in total and those working in the healthcare industry

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 3 Recommended Minimum Target for Employee Satisfaction 65% Recommended Minimum Target for Employee Satisfaction 65% Overall Job Satisfaction

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 4 Job Satisfaction By Position

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 5 Most/Least Satisfying Aspects of Health Centers Most Satisfying 1.Fulfilling their health center’s major purpose of providing health care to those who might otherwise not receive it 2.Working with their colleagues and co-workers 3.Enjoyment of, and dedication to, the work that they do Least Satisfying 1.The amount of work they are expected to complete 2.Dissatisfaction with compensation 3.Difficulties with management/supervisors/co-workers and a feeling that senior management does not listen and/or respond to staff concerns 4.Lack of effective communications throughout the health center 5.Issues with politics and perceived favoritism 6.Feeling that their work is not appreciated/recognized

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 6 Employee Loyalty & Engagement Matrix Industry: 57% U.S.: 50% Industry: 25% U.S.: 26% Industry: 13% U.S.: 17% Industry: 5% U.S.: 6%

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved How well job responsibilities are defined 2. The degree to which the work done is respected 3. The effectiveness of communications 4. How well work is divided within departments 5. The health center’s program/policy of reward and recognition 6. How well the health center fulfills its mission 7. The degree to which staff abilities and skills are used 8. Immediate supervisors 9. Documentation/paperwork/record keeping 10. Opportunities for advancement Top Ten Drivers of Job Satisfaction

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 8 EQUITIES (High contribution and high performance) Work is respected Abilities and skills Immediate supervisors Motivations & Drivers Analysis OPPORTUNITIES (High contribution and moderate performance) Job definition Fulfillment of mission WEAKNESSES (High contribution and low performance) Communications Division of work Reward and recognition Opportunities for advancement Documentation/paper- work/recordkeeping

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 9 Workload

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 10 Fulfillment of Health Center Mission Recommended Minimum Target for Fulfillment of Mission 75% Recommended Minimum Target for Fulfillment of Mission 75%

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 11 Commitment Commitment to Health CenterCommitment from Health Center Total StaffPulse HC Norm US Norm Commitment Gap26 points15 points13 points

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 12 Satisfaction with Overall Communications

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 13 Top 5 Recommendations to Improve Communications 1.Ensure timely, systematic and equitable distribution of critical information through the appropriate means 2.Foster an environment where staff opinions are encouraged, valued and acted upon by senior leadership 3.Encourage transparency in communications as much as possible and avoid the “habit of secrecy” 4.Emphasize the need for responsiveness to requests at all levels 5.Share information more readily and more often between departments and sites

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 14 Satisfaction with Compensation

A national database of aggregate results among participating health centers and representing almost 5,000 departed employees

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 16 Primary Reasons for Leaving By Position The top five work-related problems are: (1) Unsatisfactory leadership of senior management, (2) unsatisfactory work environment, (3) poor relationship with immediate supervisor, (4) unfair internal practices and (5) dissatisfaction with compensation.

© Copyright 2009 National Association of Community Health Centers. All rights reserved. © Copyright 2009 Insightlink. All rights reserved. 17 Preventable vs. Non-Preventable Departures Preventable 42% (Organization could have prevented the departure) Non-Preventable 58% (Departure is outside of the organization’s control)

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 18 Preventing Departures 1.When asked what could have prevented their departure, staff primarily recommend changes to the work environment, relating to management, communications, teamwork, culture, etc. 2.Running second to the work environment issues are requests for pay increases and/or improved benefits. 3.Third in importance is to address the specific personal circumstances that led to their decision to leave.

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 19 The Costs of Staff Turnover Tangible costs of employee turnover include: Termination costs − administrative costs for processing separation, unemployment tax impact, severance payments, accrued vacation time, retirement plan contributions, and any extension to benefits. Replacement costs − attracting applicants, entrance interviews, any travel expenses for new hires or recruiters, relocation costs, pre- employment testing costs and administrative expenses. New hire training costs − formal and informal training costs and new employee orientation. Intangible costs of include loss in organizational knowledge/skills, reduced productivity/growth, and negative impact on satisfaction and commitment among employees who stay at the organization. Evidence suggests that these indirect costs can be greater than the direct costs of turnover.

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 20 An Example of Turnover Costs Using a conservative estimate of direct turnover costs at 25% of total compensation, the average level of turnover among Medical Directors, Physicians, NPs and PAs in a health center of 400 employees likely costs that health center… $260,000 per year If their preventable turnover also matches the average, then up to $109,000 of that expenditure could be avoided every year as long as the health center implements an action plan to reduce turnover.

Summary Highlights And Recommendations

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 22 Summary Highlights and Recommendations Health centers clearly have a lot to offer as employers, especially the motivation and commitment that comes from providing quality health care to those who are less fortunate. However, there is room to improve overall job satisfaction, primarily by…  Improving communications at all levels and demonstrating that senior management values and respects staff opinions.  Managing the division of work and workload expectations.  Ensuring that staff are regularly recognized, rewarded and valued for their loyalty and commitment.  Offering concrete opportunities for career enhancement/ advancement.  Re-evaluating the documentation and record keeping expected of staff.

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 23 Summary Highlights and Recommendations Furthermore, health centers should carefully consider:  How well they are fulfilling their mission, and  How equitably they are providing compensation, with an eye to making improvements wherever possible. Adding urgency to these opportunities is knowing that more than 40% of current health center turnover is likely preventable.  Increasing staff retention creates opportunities to reduce both the formal and the informal costs of turnover. This preventable turnover is being driven by:  Systemic problems in the work environment which match the identified among health centers in general, and  To a lesser degree, problems at the individual staff level, particularly disagreements with immediate supervisors.

© Copyright 2013 National Association of Community Health Centers. All rights reserved. © Copyright 2013 Insightlink. All rights reserved. 24 Final Thoughts Direct action to improve communications, to increase staff recognition in meaningful ways, to manage how much is expected of staff members, to address perceived inequities in compensation and to reinforce the health center mission will help raise overall job satisfaction and reduce turnover, leading to a more engaged and committed workforce within America’s health centers.