Hiring As If Your Patients’ Health and Satisfaction Depended Upon It

Urgent message: Hiring the right candidate for a job at an urgent care center is an art and a science, but a variety of tools exist to facilitate the process.

WILLIAM MARTY MARTIN, PSYD, MPH, MA, MS
This article is designed to equip urgent care clinic owners with the tools they need to hire better than they have in the past. After reading it, you will be able to: (1) organize your hiring process around the high-impact hiring model; (2) align your hiring process with the vision, mission, and strategies of your urgent care center; and (3) leverage the science of selection to hire well more systematically and routinely. Those goals seem understandable enough, but many of us get in our own way in reaching them.

What is a successful hire?
Selection of a candidate to fill a particular position is outcomes driven. Your hiring decisions and processes should be aimed at successful hiring. That is, attracting, selecting, and retaining high performers for every position in your urgent care center, from the receptionist to the board-certified physicians. Table 1 lists the six indictors of successful candidate selection, but keep in mind that performance is the ultimate test of whether you made a good selection decision or not. Do not leave selection to chance. There is both an art and science to hiring well.

Table 1. Six Indictors of a Successful Hire

The new hire quickly learns the tasks of the job and integrates well with the urgent care center and staff members. The new hire not only creates value but also adds value beyond that which is required for “simply doing your job.” Other members of the staff comment on how this was a great hiring decision and demonstrate their investment in the success of the new hire. The new hire tells others in his/her family, personal, and professional networks about how well organized and just your hiring process happened to be and how proud he/she is to be associated with a well-run organization, not just an urgent care center. The new hire is “up and running” faster than you anticipated. You feel proud about your hiring decision and you do not have to make excuses for or rationalize about why you hired this new staff member.

Models of Hiring
The selection of a high-performer is no accident. It is an outgrowth of following four specific high-impact hiring processes:

• Forecasting the number and type of professionals to hire, which is the first step. As such, hiring needs must be anticipated by employing forecasting models that take into account fluctuations in patent demand; changes in available staff at your urgent care center; substitution of labor by technology, outstanding or deskilling; and alignment of hiring goals with strategic goals.
• Defining the elements of successful job performance. All recruitment and selection devices must be tailored with those specifications in mind, in contrast to “warm-body” hiring, in which the goal is to fill a vacancy quickly.
• Implementing a process for attracting high-performing applicants. This is known as employment branding. Make sure that the “word on the street” is that your urgent care center is really selective and not anybody can work there. Table 2 lists five evidence-based urgent care center an experience worth talking about in town.¹
• Identifying the “diamonds in the rough” and “panning for gold” is warranted after you have attracted top-notch candidates through your branding initiative. You are not looking for “fool’s gold.” To protect you against hiring “fools gold,” this article will present empirical evidence on selection methods with an emphasis on three tools designed to separate the “wheat from the chaff”: work sample, cognitive tests, and behavior-based interviewing.

High-impact hiring begins with the end in mind, not just for a single applicant being selected for a single position but also in terms of aligning your urgent care center’s staffing model with its overall strategy.

Table 2. Five Evidence-Based Tips for Employer-of-Choice Branding

Make sure that the work environment and the role align with the candidate’s interests. Make sure that the work environment is based upon collegiality and a focus on teamwork. Make sure that your total rewards package is at a minimum not distracting or a seed for resentment but serves as a motivator. Make sure that you intend to invest in further development of the new hire and that he/she knows about your orientation, training, coaching, and career development programs. Make sure that your application process is a meaningful and respectful experience for the applicant, particularly if you are in a small town and people talk.

Strategic Staffing: Beyond Staff Scheduling Systems
A strategic staffing perspective begins with attracting talent but does not end with brining the newly hired employee on board. The three other key steps in strategic staffing are developing, optimizing, and retaining talent. Theoretically, combing these four steps increases employee engagement, which increases productivity, which increases business results.
For example, if your urgent care center is implementing an electronic health record (HER) and expanding into workers’ compensation services, then you will need talent that can drive implementation and use of the technology. You will also need staff who have expertise and interest in workers compensation. In short, you need to recruit and retain talent with the skill and the will to perform at a high level. You must have both. Skill is not a substitute for will and vice versa. As an urgent care center grows over time, talent is needed that can grow with it or push the organization toward strategic growth. As with other relationships, talent can “grow apart over time” from the vision, mission, and strategy of your urgent care center. For instance, a one-site urgent care center in a rural community will attract, select, and retain different talent than a multi-site operation owned by a hospital with plans to open up in other communities and expand services behind urgent care. The aforementioned discussion on strategic staffing assumes that everything goes according to plan. That is not reality. As such, it is critical t adopt best practices in hiring well in a crisis.

How to Avoid a Hiring Crisis
A hiring crisis is the unplanned, unanticipated loss of a high performing or marginally performing employee who you need just to get through another day, week, month, or next couple of months. In short, although these employees may not be the stars of your urgent care center, their presence is better than nobody showing up at all, even if they only half-heartedly work through their shifts. Table 2 lists five approaches to avoid getting into a hiring crisis.
Most employees who leave voluntarily drop “breadcrumbs” over time in the form of subtle indicators that they intend to quit. In fact, the vast majority of employees quit “psychologically” before they actually quit “physically.” They exhibit withdrawal behaviors, such as coming in a bit later, leaving earlier, or taking longer breaks than usual; not contributing to meetings about the future; dressing more formally on some days; taking off blocks of time in a given day rather than a block of days; and expressing dissatisfaction to the urgent care center founder, owner, manager, co-workers, and even patients. All of these are signs that an employee has psychologically quit although he or she keeps punching the clock or seeing patients every day.

Table 3. Five Ways to Prevent ‘Crisis’ Hiring

Focus on hiring the “best person” from the beginning. Orient the “best person” to the community, the center, the department, the team, and the job. Check-in with the “best person” at 30, 60, 90, and 120 days to test for “fit” and cut your losses early. Give feedback about how the “best person” is doing in their job, first focusing on his/her strengths and then areas of improvement. Pre-qualify candidates for positions for which you would hire them, if you had other vacancies. Put these “best pre-qualified candidates” on your short list to cut down on the time to hire in case a staff member resigns with short notice and you need to make a quick (but qualified) hire.

Hiring Well: Leveraging the Science of Selection
Whether you are assessing candidates from outside your urgent care center or determining whether an existing employee should be promoted or move to another position at the same level, it is essential that you apply empirically validated and time-tested selection techniques.² Selection, like medicine, is both an art and a science. Begin with the science and then apply the tools of the artist once you have sufficient experience and a documented track record of hiring well.
The predictors of successful hiring are selection tools, the most common of which are the resume and the interview. According to Carison et al, the bests selection tools or predictors of performance are work samples, general mental ability tests, and structured interviews, in that order.² Other selection tools include integrity tests, resumes, GPAs, and references. Table 4 described each one of these selection tools.
After choosing more than one selection tool (predictor), you will synthesize the data collected from all of the selection tools you have used. Then it is time to make your selection decision. All decisions involve risk because they are predictions. The goal is to increase the predictive validity. One of the challenges inherent in using more than one selection tool is how to analyze results form on eversus another. For instance, assume that a candidate has a great resume and great references but he/she did not do so well on the interview. If you have a multiple-cut off approach, then you would not select this candidate because he/she did not meet the minimum on all three selection devices. If, on the other hand, you used a compensatory approach, then you might select the candidate because the candidate’s strengths overshadowed his/her weaknesses. Clarify your decision strategy approach at the beginning, not while you are making the decision.³
If you have an interview team or more than one person contributing to the hiring decision, each individual should make a selection on his/her own before the group or committee makes a decision so as to reduce the conformity effect and “group think.”⁴ The last consideration is quickly communicating the decision to the candidate selected and to all others who were interviewed, some of whom may be pre-qualified candidates, as previously discussed.

Table 4. Selection Tools for Urgent Care Centers
Selection Tool	Best Used When Selecting for …
Work samples: The legendary typing test is an example of work sample. The purpose of the work sample is to determine how well a candidate can perform essential duties associated with a position. The benefits are a closer relationship between the predictor and the criterion because they are the same and a more realistic view of the job for the candidate, which increases retention.	Technical Dimensions of Performance Knowledge Skills Abilities
General mental ability tests: These types of tests are also known as intelligence tests. At first blush, there is no negative reaction to assessing intelligence in a work setting or falsely assuming that individuals in all positions have or do not have a certain level of intelligence. Academic achievement is correlated with intelligence but there are many individuals who have not achieved academically but are highly intelligent.	Technical Dimensions of Performance and Adaptability: Intelligence Adaptability Cognitive capacity regardless of years of formal education
Structured interviews: These are also known as behavior-based interviews. These interviews ask candidates questions seeking to tap their past ability to handle specific tasks and situations. Unlike a hypothetical interview question, behavior-based interview questions are framed in the past not the future. These types of interviews add value for not only predicting use of knowledge, skills, and ability but also “fit” with the team and urgent care center. An example is “Tell me about a time when you had a conflict with another employee and how you handled that situation”	Interpersonal Dimensions of Performance and Organizational Fit: Alignment with vision, mission, and values. Interpersonal competency Communication skills Emotional intelligence

Conclusion
Returning to the question that opened this article, how do you know if you have successfully hired? The answer set out at the beginning of this article was to hire well. After reading this article, you should be in a better position to apply specific tools to hire better and hire as if your patients’ health and satisfaction depended upon that decision. In fact, they do.

References

1. Berthon P, Ewing M, Han LL. Captivating company: dimensions of attractiveness in employer branding. International Journal of Advertising. 2005; 24(2): 151-172.
2. Carison KD, Connerley ML, Mecham RL. Recruitment evaluation: The case for assessing the quality of applicants attracted. Personnel Psychology. 2002; 55(2): 461-490.
3. Elrod T, Johnson RD, White J. A new integrated model of noncompensatory and compensatory decision strategies. Organizational Behavior and Human Decision Processes. 2004; 95: 1-19.
4. Janis IL. (1982). Groupthink (2^nd ed.). Boston: Houghton Mifflin.