Yurdin, assistant vice-president of organisational effectiveness at US hospital
giant HCA, describes how a fresh approach to management skills increased staff
Interaction Management and Targeted Selection
Designed and delivered by: DDI, Keystone Place, Building B, Sefton Park,
Stoke Poges, Buckinghamshire, SL2 4JS
Phone: 01753 616000
Fax: 01753 616 099
HCA is one of America’s leading providers of healthcare services, with an
annual revenue of $18bn and 168,000 employees. From its Nashville headquarters,
HCA owns or operates 200 acute care, general and psychiatric hospitals in the
US, UK and Switzerland. Achieving its aim to provide the highest quality care
to its patients is highly dependent on finding and retaining nursing
professionals and other key staff.
Staff retention is a pervasive problem in the healthcare industry. Good
people who can fill certain clinical positions are in short supply, enabling
those with the right skills to change jobs frequently as healthcare facilities
compete fiercely for their services.
HCA’s mid-America division, covering Tennessee, Kentucky and Indiana, was
particularly aware of the need to stabilise staff turnover so as to maintain
the highest standards of care as well as achieve favourable business results.
Data obtained from an employee survey, focus groups and formalised exit
interviews showed that while compensation and benefits packages were certainly
important in retaining employees, most of those who had left HCA did so because
of their relationship with their supervisors, who were in many cases unsuited
to and ill-prepared for leadership roles.
HCA would promote people for their technical ability, expect them to be
effective and learn on their own, but then lost them because of their poor
management skills. The company needed to identify people who would be suited to
leadership roles, who could help HCA attract people to work at its hospitals
and stay with the company.
The research showed that its weak performance management system was a major
factor in high staff turnover, leading to insufficient professional development
opportunities, absence of clear ‘career tracks’, poor communication and little
connection between pay and performance.
Looking at research, it was clear that the best way to reduce turnover was
to give managers and supervisors the knowledge and skills they needed to create
a work environment that would attract motivated and engaged employees. They
needed not only to manage the career development of existing employees more
effectively so as to improve their commitment to HCA, but to select the right
people to work for them in the first place. HCA called on global HR consultancy
DDI to help implement a new retention strategy encompassing leadership
training, performance management and selection.
The first step was to launch a development initiative to provide managers
with basic knowledge and skills. The core curriculum included legal aspects of
HR, finance for non-financial managers, productivity and information systems.
In addition, DDI provided leadership skills training that would familiarise
people with the new performance management system. This included four modules
from DDI’s leadership development system – Interaction Management: tactics for
effective leadership; Performance Planning: setting expectations; Preparing
Others to Succeed; Facilitating Improved Performance; and Performance Planning:
reviewing progress. A module on effective communication was included in the
leadership curriculum to help participants apply those principles within the
context of the new performance management and compensation systems.
The leadership training was implemented in all the mid-America sites by
DDI’s certified instructors and also certified instructors from Nashville-based
consulting firm CG&A, LLC. The training modules were reinforced on an
ongoing basis by DDI’s e-learning tool, OPAL, which provides just-in-time
coaching and instruction.
With DDI, HCA designed a competency-based performance management process
that allowed employees to become more involved in determining the course of
their current jobs and professional development.
In the new process, each employee has their own personal development plan to
guide professional growth and prepare for future jobs or roles. This represents
a dramatic departure from the previous process which was driven by
backward-looking annual review discussions that focused on past behaviour and
contributed little to the support of individual development. DDI provided HCA’s
managers with training to build their confidence in driving performance and
To improve HCA’s ability to select individuals who would fit in with the job
specifications and organisation, DDI worked with the company at corporate level
to conduct job analyses and categorise positions into multiple job families.
Competencies and success profiles were assigned to the job families to drive a
more accurate selection process.
With the competency framework and job families in place, the mid-America
division then set about teaching HCA hiring managers how to interview more
effectively using DDI’s behaviour-based interviewing system, Targeted
Selection. This makes the interviewing process more consistent by setting out
technical and behavioural competencies against which candidates are assessed.
Customised interview guides, distributed electronically to interviewers through
a web tool, make the interviewing process more standardised. Hiring managers
were then given training in the new competency-based interview techniques.
Targeted Selection is a visible success. Those attending classes had never
been trained to interview. They arrived sceptical but left incredibly excited
about their ability to interview effectively.
"In the past, when it came to hiring, we had missed so many times
because we found somebody we liked or somebody was referred to us, and we
wanted to do right politically," says Paul Rutledge, president of the
"With this process, you interview for a job on the technical and
behavioural competencies, and use a specific interviewing methodology. We are
able to improve the quality of the job match by reducing variation in the
interviewing process. Those same behavioural competencies are then integrated
into the personal performance management plans."
The mid-America division has sent all of its 1,000-plus managers through the
leadership education and preparation modules and is in the process of
successfully implementing its new performance management and selection
Results from the first year of implementation are extremely positive.
"We’ve gone from 29 per cent staff turnover to 23 per cent turnover in 12
months for the whole division," says Rutledge. "And we’ve seen
significant improvement in our ability to retain registered nurses."
One facility in particular – Nashville’s Southern Hills Medical Center – is
a prime example of the impact of the DDI programme. Staff turnover has dropped
to 27 per cent from a high of 43 per cent in the late 1990s.
A new positive culture is emerging at Southern Hills, making it an employer
of choice within the Nashville healthcare community. Southern Hills HR director
Connie Yates is able to make new hires an unusual offer. "I tell them, if
you don’t like Southern Hills after three months, come back and tell me,
because you are going to like it. No-one comes back," she says.
"Our HCA leadership effort is more than just an HR matter, it’s a
management issue," concludes Paul Rutledge. "It has operational
outcomes that affect the company’s bottom line. This is about management being
given tools that make them more effective – and the company more
successful," he says.
The results achieved in the US have been so impressive that HCA in the UK
has also rolled out a leadership development and performance management
programme in partnership with DDI UK. HCA runs some of the most famous private
hospitals in the UK, including The Harley Street Clinic, The Lister, London
Bridge, The Portland, The Wellington and The Princess Gate. DDI has been able
to draw upon its experiences in the US and bring intimate knowledge of the
business issues HCA faces to the UK roll-out.
The outcome has been similarly successful. Staff turnover has fallen from 29
to 20 per cent, and sickness absence from an average of eight to 10 days per
person to 2.5 days. UK HR director Jasy Loyal says: "Working with DDI has
brought HR to the forefront and helped us to achieve strong goals."