RS MGMT CH 8 Recruitment, Selection, and Retention in Health Information Management

Interviews are generally categorized

- Structured - Unstructured - Semi-Structured

Objectives of a Compensation Plan: Step Two: Wage Determination cont'd (Pay grades and COLA)

A combination of job evaluation and market pricing allows for jobs to be placed into pay grades. -Each pay grade has a minimum, midpoint, and maximum range that allows an employee to progress through the pay grade, receiving pay increases for longevity or improving skills. -For example, a new department director may be hired at the minimum amount of pay within the pay grade. Upon successfully earning her master's degree, she may be given an increase to just above midpoint in the pay grade. Pay-for-performance increases also move an employee along the pay scale. Longevity increases are in the form of cost-of-living adjustments (COLA). -COLAs are generally pay increases tied to a change in the consumer price index (CPI) published by the US Department of Labor, which measures purchasing power between time periods (usually one year). - These increases are not linked to performance or acquisition of new skills but are in place to keep wage and salary administration in line with inflation in the United States. - Each year the minimum and maximum pay rates are adjusted within the pay grades, and employees receive an adjustment to keep their wage in line with the rest of the pay grade. Each employee receives a base pay rate, but the employee's amount of pay may increase through incentive or bonus programs. -Incentive programs are intended to motivate employees through increased productivity, while a bonus is a reward given related to the performance of an entire organization or individual. Incentive programs in HIM are most often found in transcription and coding. -Individual transcriptionists are paid a base rate and then earn a per character or per line incentive amount once they reach a standard character or line count. -The procedure is similar in coding, where coders are paid a per chart amount once they reach a standard production amount. The incentive pay is then added to their hourly base rate. Bonuses are generally awarded based on the meeting of performance goals of an entire organization. The performance goals are stated in advance, and bonuses are awarded either to the entire organization or to those individuals deemed to have had the most effect on reaching the goals. Team compensation can be tricky to administer as the team is made up of individuals, each having contributed their own part. Regardless of how teams are compensated, successful plans start with clearly defined and agreed upon goals so that there are performance outcomes based on common performance standards.

Interviewing Techniques: Semi-structured Interview

A semi-structured interview is a combination of the structured and unstructured interviews. Generally, the interviewer will have a few predetermined questions to start the interview but then will respond to the interviewee's answers with more probing follow-up questions. For example, the interviewer may ask a behavioral question and, based on the answer, might follow up with a request for a second example or ask for further insight or details about the first answer. While less reliable than a structured interview because all the questions are not the same, the semi-structured interview has a higher validity rating because the probing follow up questions can shed light on characteristics and behaviors not elicited during a structured interview.

Interviewing Techniques: Structured Interview

A structured interview, also called a directive interview, focuses on the job to be filled, using the job description as the starting point. The job description is reviewed in detail, giving the applicant a clear idea of the job requirements and expectations. The interview has a predesigned format that is followed with each applicant; questions are developed prior to the interview and usually asked of each applicant in the same order. -This structure makes it easier for the HIM professional to compare candidates, as each person is presented with the same information and asked the same questions. - Structured interviews have a higher degree of reliability than other interview types due to the fact that the questions are replicated. -Structured interviews have a lower degree of validity, however, due to the fact that their inflexible nature does not allow for detailed probing about the candidate or areas not covered by the questions. - Structured interviews also conform to best practices from an HR viewpoint. The standardization of questions prevents the interviewer from asking potentially discriminatory questions.

Objectives of a Compensation Plan

An organization has four purposes when creating a compensation plan. 1. any compensation plan should link to an organization's strategic plan and mission and vision statements and support its corporate culture. There must be a belief that compensation is part of the culture of an organization and matches the values set forth by the mission and vision statements. 2. the overall compensation should be high enough to recruit quality employees to the organization. 3. compensation practices should be such that they motivate current employees to remain with the organization. 4. an organization must be able to pay its staff and remain fiscally solvent. and be antidiscriminatory

Interviewing Techniques: Unstructured Interview

An unstructured interview, also called a nondirective interview, is the opposite of a structured interview. In general, no questions are planned in advance, although certain topics may be targeted. An interviewer may begin with one question, and then ask follow-up questions based on the interviewee's answer. The questions are not necessarily job-related, and the interview may resemble a conversation rather than a question-and-answer period. The random nature of an unstructured interview makes it better suited for identifying unsuitable candidates rather than suitable candidates. This type of interview is less reliable because it cannot be replicated among candidates and is difficult to do well. An interviewer must be able to ask open-ended questions and adjust to the interviewee's responses while still trying to gather useful information on how the candidate would fit the job. However, an interviewer must also be careful when using an unstructured interview not to inadvertently ask discriminatory questions during the interview.

Objectives of a Compensation Plan: Step One: Job Evaluation Job Grading Method

Another method of assigning jobs to a pay grade is job grading. Job grading, or job classification, requires the establishment of predetermined categories and the various jobs sorted into these categories. Again, the HR department is the best choice for creating categories and sorting jobs due to their organization-wide knowledge of jobs. The categories are then assigned to a pay range. Categories may be established according to responsibility such as department head, supervisor, lead position, or nonsupervisory. Similar to job ranking, jobs are sorted into classifications using the entire job and there is a degree of subjectivity, although not to the level found in job ranking. Difficulties may also arise if jobs seem to fit into multiple categories, or if jobs do not fit easily into any category.

Retention Strategies contd

Communication A common saying in the workplace is, "employees do not quit their jobs, they quit their bosses." Improved communications can go a long way to mitigating this statement. -Managers must listen to ideas and concerns presented to them by their employees and then act in good faith to resolve or address them. Taking the time to listen and respond is imperative; during the interview process, a manager must do more listening then talking. -Understanding employee motivation depends on communicating with employees, and job design and analysis require both written and oral communication skills. -Job crafting (chapter 7) is a collaboration but depends on the employee bringing the idea to the manager. -Performance appraisals (chapter 9) require trust and honest communication about goals and productivity. -Open communication allows for positive relationships to develop, encouraging subordinates to trust in and want to work with their bosses; as a result, the employees are more likely to stay committed to the organization. Working Conditions Working conditions are the environment in which an employee works and include noise levels, lighting, compensation, stress, overtime, benefits, and safety. Employees care about their physical working conditions just as they care about the psychological or mental aspects of their working conditions. -Methods for improving physical working conditions include flexible scheduling such as compressed workweeks, job sharing or flextime (chapter 6), working remotely from home, ergonomics and other safety measures provided in the workplace, and on-site childcare. -One strategy for influencing the psychological aspects of working conditions is providing a sense of job autonomy, or individual control, to a position. For example, one aspect of a release of information (ROI) job is to monitor and respond to requests for copies of health records. (manager controls all aspects of workflow and process OR the manager becomes involved when necessary) -Other retention strategies include providing adequate training for job competency, equal treatment across the department on disciplinary matters, opportunities for career development, award and recognition programs, and the presence of performance appraisals and fair job performance standards. These latter two strategies link to the goal-setting theory of motivation detailed in chapter 3.

Compensation Practices

Compensation is all direct and indirect pay earned by employees. This includes wages, mandatory benefits such as unemployment insurance and workers' compensation, and benefits such as medical insurance, life insurance, childcare, elder care, retirement plans, long- and short-term disability insurance, and longevity pay. How an organization compensates its workforce is generally established by senior management with the assistance of the HR department. A manager may be involved in explaining overtime or incentive pay to a new hire, fielding questions about annual wage increases or benefit changes from other employees, and overseeing an operating budget in which more than half of the expenses fall under wage and salary administration. Not only do managers influence the compensation of their employees, they are subject to the same compensation influence from their superiors. Employees generally have two concerns about what they are paid. 1. they are paid what they feel they are worth to the organization in general, and their department specifically. 2. Employees expect to be paid correspondingly to what other employees in the same or similar positions receive.

Retention Strategies contd again

Competitive Compensation Practices Financial compensation may not be the only reason that employees leave an organization, but it is certainly one of the reasons Retention strategies with a financial component include tuition assistance or reimbursement programs, free parking, loan forgiveness, retirement plans, and benefit plans. Flexible benefit plans, or cafeteria plans, allow employees to choose those benefits that appeal to them the most. Other Retention Strategies The ability to work remotely may not be an attraction to an employee who enjoys the social aspect of the workplace. - on-site childcare It is the responsibility of the organization to continually monitor through data collection and employee feedback, which strategies are working, when they are working, and why they are working, and then make the necessary changes based on that feedback. An HIM manager can implement retention strategies on a smaller scale. - Begin a reward or recognition program or implement flexible scheduling to a practical extent within an him department. Communication issues are within the control of the individual manager. Performance appraisals and necessary disciplinary action should be carried out promptly and fairly with no discrimination involved. An HIM manager can also monitor turnover within their department and investigate when data indicates there may be a problem area or supervisor. Even though setting compensation is outside the scope of a manager's position, a manager must understand and support the overall compensation practices implemented by the organization.

The costs of employee turnover

Direct Costs and Indirect costs see image

There are two other types of turnover: functional and dysfunctional.

Functional turnover occurs when poorly performing or disruptive employees leave the organization. Functional turnover also occurs when an organization downsizes out of financial necessity. This action allows for the organization to make a commitment to refocusing efforts on their long-term fiscal health. -there are organizational benefits with functional turnover. -Morale and productivity improve when subpar performers leave and are replaced by new, motivated employees. -Even layoffs and restructuring benefit the organization in the long run, allowing the organization to improve its financial position. Functional turnover is usually involuntary but can be voluntary depending on the circumstances of the employee exit from the organization. Dysfunctional turnover occurs when valued or highly skilled employees leave the organization or a number of employees leave a critical work area. Dysfunctional turnover can hurt the organization from both a quality and financial standpoint. Recruiting and selection costs are much higher for difficult-to-fill positions. If multiple positions are vacated in a short period of time, quality and productivity suffer. If the positions are in critical areas, patient care could suffer too. Considering the various categories of turnover, the type that managers must be most concerned with is voluntary, dysfunctional turnover. Some voluntary turnover is unavoidable, as in the cases of retirement or a spouse transferred out of town, but for voluntary turnover that can be avoided, such as leaving a high-stress position, an HIM manager must look at how the turnover affects the organization.

Job Retention

If recruitment and selection are attracting and choosing the right people for the right jobs in an organization, job retention is keeping those people from seeking employment elsewhere. The cost of recruiting, selecting, and training employees is high, and represents an investment the organization makes in its workforce. If an organization builds on the work done during recruitment and selection, they will retain their employees. Retention means keeping the right people employed; turnover means people are leaving the organization.

Objectives of a Compensation Plan: Step One: Job Evaluation Job Ranking Method

In job ranking method, each job is rated according to how valuable it is to the organization. Organization-wide, this process is completed by the HR department with input from other departments as necessary. Because the HR department has access to pay data across the organization, one method is for HR to rank jobs as a whole, with the more valuable (higher paying) jobs at the top of the order and the less valuable (lower paying) jobs ranked at the bottom. A second method is to rank jobs within departments and then the HR department combines the department rankings into an organizational report. The job ranking method is fairly easy to do, but highly subjective. Since there are no criteria attached to the ranking, decisions are based on perception of value to the organization and this may be difficult to defend to employees. Feelings of inequity are more common when the job ranking method is used.

Advanced Recruitment Tools

In some cases, these traditional recruitment methods do not result in any qualified candidates for a position. This may be due to a specific issue such as poorly written or poorly placed advertisement, but often the demand for a position exceeds the supply of qualified candidates. Such is the case with HIM coding professionals, as the demand for coders in the United States is expected to grow more quickly than the supply. The United States Bureau of Labor Statistics classifies coders as health information technicians, and the employment of these professionals is projected to grow 13 percent through 2026, faster than the average for all occupations (BLS 2018). The shortage results in unique recruiting and staffing models implemented throughout the industry. Method 1 One such program is to "grow your own" coders (Endicott 2014). Hospitals are developing their own in-house training programs and offering them to internal eligible candidates. These programs range in duration from 8 to 12 weeks up to 8 months. Most programs require candidates to hold a current coding or HIM credential in order to participate, but it is possible to create a program that is open to all employees, regardless of whether or not they hold a coding credential. The intent is to hire the graduates of these grow-your-own programs for permanent coding positions. Method 2 recruit and hire HIM professionals is a postgraduate apprenticeship program developed by the American Health Information Management Association (AHIMA) Foundation. The AHIMA Foundation's mission is to "improve lives by supporting leadership in health information governance and informatics through research, education, and life-long learning" (AHIMA Foundation 2019a). The AHIMA Foundation accomplishes this mission with advancement programs such as the apprenticeship program. Apprenticeships are offered in the following positions: hospital coder or coding professional, medical coder or biller, professional fee coder, inpatient coding auditor, clinical documentation improvement specialist, and privacy and security officer. The program accepts applications for apprenticeships from candidates who are new graduates of HIM programs and who possess the required HIM credential. The specifics of the apprenticeship program are: • An apprenticeship is a paid position that bridges education and employment in an organization. • Apprentices' salary is determined by the employer. Pay increases occur as competencies and skills are demonstrated and training hours are met as evaluated. • Apprentices are employees. • Apprentice qualifications vary according to role. For example, a coding professional apprentice may hold a clinical coding associate (CCA), registered health information technician (RHIT), or registered health information administrator (RHIA) credential, while a data analyst apprentice must hold a minimum of an RHIA credential. • An apprenticeship program lasts from one to two years, with the goal of continued permanent employment. The apprentice candidate gains real-world working experience that can be of substantial work to any company

Recruitment Step 3. A decision must be made as to whether a position should be recruited internally, externally, or via a combination of both

Internal candidates are individuals already employed by the organization. An internal candidate may be promoted from within the HIM department or promoted or transferred from another department in the organization. There are advantages to recruiting from within an organization: • The candidate is already known and has proven themselves to the organization • Candidates have an understanding of the culture and procedures of the organization • Acts as a motivating factor for current employees' performance • Improves morale and a sense of loyalty for current employees • Is generally a quicker process than recruiting externally There are also disadvantages to recruiting from within an organization: • Contributes to a culture of sameness • May promote discriminatory hiring practices over time • May lead to hard feelings and lowered morale if an employee is not chosen for the position • Some managers may recommend poor performers for transfer to other departments External candidates are individuals from outside of the organization. External candidates come from educational institutions such as high schools, community colleges, and universities; other competing organizations; staffing agencies; or vendors of HIM-related services. There are advantages to recruiting from outside an organization: • Candidates contribute new ideas to an organization • New graduates are trained in the most up-to-date methods • Candidate may introduce a specific skill or knowledge set not present in the organization • Usually offers a larger pool of candidates • Candidates do not have predetermined opinions of the organization and can start fresh There are also disadvantages to recruiting from outside an organization: • Can be a demoralizing factor to current employees • Time is lost while a candidate adjusts to the new organization • It is unknown as to whether the candidate will fit the culture of an organization despite having the necessary technical skills Most organizations have a "promote from within" policy to encourage employees to stay with the organization. Qualified employees are promoted to new positions and outside candidates are recruited into the lower-level positions, allowing for both internal and external recruiting.

Interviewing Techniques

Interviews may be done by a group (panel), either with all group members present or with each group member individually. A 360-degree interview involves three different interviews, with the supervisor of the position, peers of the position, and subordinates of the position.

Step 6 of Recruitment Evaluation of Recruitment Methods

Once recruiting has ended and a position is filled, it is important to evaluate the effectiveness of the recruiting methods so an organization can begin to gather data on which methods produce the best applicants and ultimately the best employees. Some measures of effectiveness include: • Evaluating each recruitment tool to determine how many qualified applicants were cultivated and hired as well as how long they worked at the organization • Measure direct costs for advertising, search firms, travel to job fairs, and employee referral bonuses • Measure indirect costs such as lost productivity due to open positions and training new employees • Measure the time from job requisition to interview, offer, acceptance, and start date • Evaluate the diversity of the applicant pool Most organizations have an HR information system (HRIS) that provides extensive history and data on each position. An HIM manager does not need to keep their own data if the organization's HRIS can provide the necessary information.

Objectives of a Compensation Plan: Step Two: Wage Determination cont'd

Once salary information is gathered, an organization must decide how they want to position themselves relative to external competition. Most organizations place themselves in the middle of the market, or what is referred to as the second quartile. A quartile represents one quarter of the market position: the first quartile is 0 to 25 percent, the second quartile is 25 to 50 percent, the third quartile is 50 to 75 percent, and the fourth quartile is 75 to 100 percent. A second-quartile approach means that an organization belongs to the quartile where 50 percent of organizations pay below-market wages and 50 percent pay above-market wages. A first quartile strategy positions an organization so they belong to the 25 percent of organizations that pay below-market wages while 75 percent of organizations pay market or above-market wages. -An organization would choose the first-quartile strategy if they do not have the financial resources to pay market or above-market wages, or if there is an abundance of workers in the market place. -Organizations that pay below-market wages will experience higher turnover rates as employees leave for better-paying jobs. Some organizations choose to place themselves in the third quartile. -This means they belong to the 25 percent of organizations that pay above-market wages while 75 percent of organizations pay market or below-market wages. -Organizations that pay above market wages can be more selective in who they hire and generally experience higher retention. -However, these organizations also expect higher productivity from their employees to justify the higher pay rates.

Objectives of a Compensation Plan: Step Two: Wage Determination

Once the job evaluation process is complete, the next step is to determine what wage will be associated with each pay range. To help with this, organizations look to external forces and use a market pricing approach. Market pricing is determining the going pay rate for similar jobs in a particular labor market. An organization may choose to conduct its own salary survey to collect this data, and this may be the best choice to compare wages in a local or regional labor market. For hard-to-fill jobs, or jobs that are recruited nationally (for example, chief executive officer), an organization may obtain salary data from surveys conducted by private consulting firms, the Bureau of Labor Statistics, or professional organizations. AHIMA conducts periodic salary surveys and breaks down responses based on work setting, job level, and credential. Care must be taken to obtain salary surveys from reliable sources, and also to make sure similar jobs are being compared to one another. The job tasks assigned to an HIM technician in one organization may not be comparable to job tasks for an HIM technician in a different organization.

Candidate Selection

Once the results of the selection tools are compiled and all interviews are complete, the HIM manager must make a decision about which candidate to hire. Consideration should be given to the experience of the applicants, the attitude and personality demonstrated during the interview, and any other results that are pertinent—drug testing, ability test results, and whether or not this is a promotion opportunity for the candidate. A manager may decide to use a rating system, assigning point values to each selection tool used and then rank the candidates. Using the job description as a guide, an HIM manager should be careful to match the person to the job, not the job to the person. One option that remains is that if an ideal candidate is not found, reopen the recruitment and selection process. It may be necessary to review the job posting to make sure the qualifications were clear, to expand the search area, or to even consider an apprenticeship or grow-your-own program to locate the best candidates.

Retention Strategies

Organizations invest considerable time and money into bringing a new employee on board, and an HIM manager needs to pay attention to retention as well as turnover. Retention strategies are designed to keep employees interested and satisfied enough in their workplace that they want to remain with the organization. Select the Right Employee -The recruitment and selection processes are key to finding the employee who will want to remain with the organization -Relying on professional practice experiences, apprenticeships, or grow-your-own programs to identify new employees can also result in increased retention, as these employees are looking for specific employment in the position for which they have been recruited. New Employee Orientation -Orientation is the organization's opportunity to sell itself to a new employee. -Creative methods of welcoming new employees with breakfast, balloons, and an introduction by the chief executive officer help set a positive atmosphere. Many organizations pair new employees with a seasoned employee or buddy to show them how to get around and get along in their new workplace. Monitor Turnover The HR department should monitor turnover on an organization-wide basis, and HIM managers should monitor turnover in their departments. Trends may identify key areas in the department that experience higher turnover, or specific managers or supervisors that experience higher turnover among their direct reports. Both are opportunities to examine if improvements can be made to processes or workflows that result in decreased employee turnover. -A supervisor with high turnover among direct reports may be connected to a mentor who will help build communication skills and create a less stressful environment for employees. Exit interviews and surveys completed by employees as they leave the organization can provide additional information about areas that might need improvement. Interviews are done face-to-face, and surveys are given to employees to complete on their own and return to the HR department. -For this reason, surveys provide more anonymity than interviews, and exit interviews or surveys should be administered by a neutral third party such as an HR representative or a firm contracted for this purpose (of confidentiality and not reflected in a reference) -Periodic employee satisfaction surveys are another way to gather information about why employees may be thinking about leaving the organization.

Job Recruitment

Recruitment is the process of finding, soliciting, and attracting employees. The job description contains the qualifications necessary for the position, such as required credentials, experience, and level of education. These elements are important to include in any recruiting tool so potential applicants or recruiters know up front what a position needs. a potential applicant with the necessary credentials and required level of experience may decide to take a chance on the position. Early in the recruiting process, the HIM manager partners with a representative from the human resources (HR) department to create a plan for filling the open position with a goal of finding a qualified pool of applicants and then selecting the individual who presents as the best fit for both the position and the organization. Step 1. The HR department should be instrumental in providing a history of the position in regard to how long it has taken to fill previous positions. This is an excellent opportunity to raise awareness of HIM skills among HR personnel. Take the time to explain that HIM is a versatile field with many different job functions. Introduce them to the AHIMA website and invite them to the department to see firsthand what tasks the new employee will be performing. Step 2. Early in the recruiting process, it is necessary to determine the competitive nature of the position. Will the position be easy to fill? Is there a shortage of qualified applicants for the position, making it potentially difficult to fill in a timely manner? What is the prevailing wage for the position? An HR representative usually gathers this information (fair wages, salary data, job specifications, local/regional competitors) so that survey practices throughout the organization are uniform. An HR representative has the background and experience to collect data on different types of positions, and they know what questions to ask to efficiently gather the right information.

Introduction

Recruitment, selection, and retention are basic functions of any health information management (HIM) manager's responsibilities. As the electronic health record (EHR) becomes the standard in healthcare organizations An organization must hire and retain qualified individuals as part of any strategic plan.

Step 5 of Recruitment Legal Aspects of Recruitment

Regardless of the source of the candidates and tools used to recruit them, an HIM manager must be mindful of the legal aspects of the recruiting process. Equal Employment Opportunity Commission (EEOC) guidelines that must be followed when interviewing individuals for open positions. The same information applies to the recruiting process Application forms and position advertisements generally include the statement that the organization is an equal opportunity employer. The HR department should provide direction for an HIM manager who is unsure of the legalities of recruiting.

Each of the selection tools should be measured for both reliability and validity.

Reliability is a measure of consistency of data items based on their reproducibility and an estimation of their error of measurement. In other words, the chosen tool should produce the same results regardless of who administers the tool or how it is administered. Example: Excel spreadsheet information gathered through a reference check could certainly vary depending on who was asking for the information. If a letter of reference is provided, there is no consistency from writer to writer and no common questions asked, so the information provided cannot be considered reliable. Validity is the extent to which an instrument measures what it purports to measure. If a coding test is created using examples of coding scenarios at the facility, the test will measure what it is supposed to measure. However, a coding test with one- or two-word phrases may not be as valid an instrument. In other words, the coding test must show that those who score well on the test will be good coders after they are hired. Data should be kept that illustrates that connection between scores and coder performance so that the validity can be proven if questioned.

An overall compensation plan is the responsibility of upper administration.

The HR department will have input, and some organizations bring in a consulting company to review and revise compensation practices. An organization does not often start from scratch when developing a compensation plan; other factors influence the need to align pay structures. Over time salaries for hard-to-fill positions may have increased faster than the rest of the organization, or efforts to keep people in highly skilled positions may have resulted in pay inequities. Technological advances have impacted jobs as well. As new jobs are created and previous jobs change as a result of EHRs and other forms of technology in healthcare, the compensation rates may not have been properly assigned or adjusted.

Objectives of a Compensation Plan: Step Three: Benefits

The final component of a compensation plan is employee benefits. Offering benefits to employees is a significant investment for any organization. Research shows that the cost of benefits can be anywhere from 20 to 40 percent of wages and salaries. That means if an HIM supervisor makes $40,000 per year and the organization's benefit package is 30 percent, the supervisor is realizing an extra $12,000 in benefits for a total compensation package of $52,000 per year. Benefits are also considered part of a recruitment and retention program. Creating and administering a benefits plan is the responsibility of the HR department, but managers still must understand the basics of the benefits package. Some benefits are mandated by law to be covered: Social Security, unemployment, family and medical leaves, and workers' compensation benefits fall into this category. Other benefits, considered voluntary, include the following: • Health, dental, and vision insurance, and prescription drug coverage • Disability insurance • Life insurance equal to a portion of or full salary • Wellness programs such as providing a fitness club membership • Employee assistance programs for behavioral and mental health wellness • Retirement plans • Tuition reimbursement • On-site child care or adult day care The cost of providing benefits changes each year and organizations evaluate their benefits package to determine if a specific benefit is cost effective.

Objectives of a Compensation Plan: Step One: Job Evaluation Factor Comparison Method

The final job evaluation method is factor comparison. Factor comparison is more quantitative than job ranking or grading because it breaks down each job into compensable factors and assigns a dollar value. Compensable factors are characteristics used to compare the worth of a job (skill, effort, responsibility, or working conditions). Each compensable factor is further broken down into subfactors. An organization may decide that the compensable factor of skill is further divided into education and experience. For example, the HR department, with input from other departments, assigns a dollar value of $3.47 to an associate's degree, $5.25 to a bachelor's degree, and $8.68 to a master's degree. Under responsibility, supervising 5 to 10 employees is assigned $9.45 and supervising more than 20 employees is assigned $13.51. Once each factor and subfactor are assigned dollar values, a job is analyzed to see which compensable factors are part of that position. The dollar values are then added to determine the monetary value of that job. Jobs with similar monetary values are grouped together in a pay range. Point Method A variation on the factor comparison method is the point method. The point method places weight (points) on each of the compensable factors in a job and the total points associated with a job establish its relative worth. Jobs that fall within a specific range of points are assigned to a pay grade with an associated wage. Because of the quantitative nature of the factor comparison method, it is less subjective than either job ranking or grading. There is a greater sense of fairness associated with factor comparison, and this makes it easier for all employees to support. Both the factor comparison and point methods are extremely time consuming to implement, making them more expensive to use as well.

Objectives of a Compensation Plan: Step One: Job Evaluation

The first part of beginning a compensation plan is to perform a job evaluation on each position. A job evaluation is the process of applying predefined compensable factors to jobs to determine their relative worth to the organization. A job evaluation begins with an in-depth review of the job description, job specifications, and any job analysis that might have been done A job is evaluated to determine the necessary skills, education, complexity, responsibility, and working conditions to perform the job effectively. Job evaluations are generally performed by the HR department with input from the HIM department. Once the job evaluation is complete, the data collected are analyzed and jobs are assigned to specific pay grades. There are different ways to assign the jobs and each organization will choose the method that works for them. Three of the most common methods are ranking, grading, and factor comparison.

Once the type of interview is determined and questions are written, it is time for the HIM manager to prepare for the interview itself.

The following suggestions will help make the interview go smoothly and be less stressful for both the HIM manager and the candidate. • Prepare. Read over the job description a few times and review the questions that will be asked. Even an unstructured interview will have a few questions or topics that must be covered. Become familiar with the candidate's resume or application form so that gaps in employment or other areas of concern or interest are highlighted for discussion. • Arrange for privacy and no interruptions. If the interviewer does not have an office, try to borrow an office or arrange to use a conference room or an isolated area of a location such as a cafeteria or library. • Set a time for the interview to be over. This helps to keep the interview on track. • Put the candidate at ease by being welcoming. Offer a glass of water, ask general questions intended to relax the interviewee such as "Did you have trouble locating the office?" and, "How did you find out about the job?" • Listen carefully and take notes if necessary. The candidate should do most of the talking. A good rule of thumb is for the interviewer to talk only about 30 percent of the time. • Maintain a professional yet friendly tone. Do not let the conversation get too personal. • Make sure the candidate has a thorough understanding of the job responsibilities and expectations. It is a good idea to share the job description if they have not already seen it. • Ensure the candidate has an opportunity to ask any questions they may have about the job or the organization. • Explain the rest of the selection process such as how much longer interviews will last, when a decision is expected to be made, and how they will be notified of the outcome of the search.

When the decision has been made on which candidate to hire, an offer of employment is presented to the candidate.

The offer of employment is a formal job offer usually in a letter or a telephone call followed by a letter. The offer of employment should include, at a minimum, the position title, salary, and start date. Most organizations prefer to have an offer of employment come from an HR representative rather than from the department manager. Having the HR department make the offer provides consistency and prohibits a department manager from giving out erroneous information if the candidate asks about salary or benefits. Once the candidate has accepted the offer, all other candidates should be notified that the position has been filled. Again, this should be done by the HR department and not the HIM manager.

Turnover

There are many different factors that influence an employee's decision to leave an organization. Some factors such as transfer of a spouse, retirement, life choices (such as returning to school or deciding to stay home with children), and medical problems are out of the control of the HIM manager. Other factors such as job-related stress, lack of recognition, and low morale are concerns that need to be addressed. One survey found that the top five reasons employees reported voluntarily leave an organization are better growth and earning potential, more time and flexibility, increased financial compensation, enriched culture and work environment, and improved benefits When employees choose to leave an organization, it is called voluntary turnover. When an employee is fired, laid off, or otherwise terminated by the organization, it is called involuntary turnover.

Selection Tools

There are numerous tools that can be used to rate candidates; the choice depends on the job. In general, the more complex the job, the more complex and time-consuming the selection tool. For example, an HIM professional hiring a new supervisor may use a variety of selection tools but may use only one or two tools when hiring an entry-level position such as a scanning clerk. • Employee application form or resume: An application form is a standard form developed by the organization to collect basic information from candidates, such as name, contact information, education and work history, credential or license numbers, references, and volunteer experience. A resume serves the same purpose but is created and submitted by the applicant. -Some organizations will accept a candidate's resume in lieu of an application. Information collected must comply with EEOC guidelines in regard to discrimination. -To prevent inaccurate or falsified information, applications should have a statement for the candidate to sign that attests to the truth of the information. Applications and resumes should be reviewed as an initial check to make sure the candidate meets the minimum qualifications for the job. -If the minimum qualifications are not met, a candidate should not be moved forward for further consideration, but it might be possible to consider the candidate for a different position. -Applications of qualified candidates not chosen for the position are often saved for a period of time in case the position comes open again. • Ability tests: Ability tests measure the ability of the candidate to perform certain functions of a job. HIM examples would be coding tests for coders, the use of pivot tables to analyze data, the use of Excel to create graphs and spreadsheets, and typing tests for transcriptionists. Such tests are appropriate if they pertain directly to the job functions and measure what they are intended to measure. • Simulations: Simulations are similar to ability tests in that they demonstrate a candidate's job-related skills. A simulation is more hands-on and real-time; for example, a candidate for a data analyst position may be asked to extract data and format a report from a database application.

The equity theory of motivation (chapter 3) reminds us that employees pay attention to the balance of their inputs in relation to their outputs, compared to both the organization and other workers.

This theory is illustrated using compensation. Situation: an employee views their inputs to be the work they perform, and their outputs to be the pay they receive for that work. 1. When comparing their pay to that of the work they do, employees expect to see equity or balance. They want to be paid a fair wage (output) by the organization according to how much effort, time, and skills (input) they provide. 2. when comparing their pay to that of others doing the same work, they expect to see equity too. An employee who views his inputs as equal to that of others will expect the same outputs as others doing the same tasks. According to equity theory, an employee experiences overpayment inequity when their perceived inputs are less than their perceived outputs; the employee feels he or she is being overpaid for the work they do, and therefore feels guilty. Conversely, an employee experiences underpayment inequity when their perceived inputs are greater than their perceived outputs; the employee feels he or she is being underpaid and feels angry. If an employee perceives this relationship to be out of balance, the manager will be the first person asked to address the issue. Therefore, a manager must understand compensation administration and the objectives of a compensation plan.

Recruitment 4. Determine recruitment tools to use

Traditional Recruitment Tools recruiting tools come at a price, and an HIM professional must be mindful of any approved recruiting budget set for a specific position. • Advertisement: Newspapers, business journals, and industry publications (such as the Journal of AHIMA) can be found both locally or nationally. Web-based ads Ads can be expensive, so there may be a limit placed on how long the ad can run in a specific medium. Ads may be used to recruit locally if there is a known supply of potential candidates in the region. • Networking: Networking—that is, cultivating a mutually beneficial, active circle of acquaintances and associates—gets the word out about a job through personal contacts. Networking occurs in person through contacts made at conferences or professional events, educational institutions. Job openings are discussed among friends, relatives, and other acquaintances to get the word passed from one person to another. spread the word about a specific job opening to a select audience for no cost. • Internet: The internet offers access to job search websites. Job openings can also be posted on job boards on professional social media sites. According to one survey, 92 percent of employers indicate reaching qualified candidates through social media is a worthwhile recruiting strategy. The internet offers the ability to reach a large amount of potential candidates without the high cost of direct advertising. • Job fairs: Job fairs bring a number of employers together in one physical location in an effort to reach many potential candidates. Job fairs are held on college campuses, at business conventions, and by community civic organizations. Interested candidates can meet face-to-face with employers who have job openings and discuss employment opportunities. Employers have the opportunity to meet a number of potential applicants at one time and collect resumes or contact information for the future should a need arise. -The downside to this method is that there are often multiple types of health professionals in attendance, all looking for jobs, and an HIM manager may have to talk to individuals who are neither qualified nor interested in the HIM positions available. Timing is also an issue. • Search firms: Search firms employ professionals, or headhunters, to seek out job openings and match specific individuals to specific jobs. Headhunters represent both job seekers and organizations looking to fill positions. Due to the high cost, headhunters are usually not the first method chosen to recruit for a job. It is not uncommon for a search firm to charge up to one-half the annual salary of the position they have been contracted to fill. • School affiliations or professional practice experiences: Colleges, universities, and even high schools can be a source of potential job candidates. An HIM manager should connect with local or regional HIM programs to post job openings and recruit graduates. New graduates have up-to-date knowledge and an enthusiasm for the profession that can offset a lack of experience. An HIM manager who opens his or her department to professional practice experience (PPE) students from an HIM program gets a firsthand look at how students conduct themselves in a work setting. When a job opens up, the manager has a list of available people who might be interested in applying.

Recruitment 4. Determine recruitment tools to use contd

Traditional Recruitment Tools recruiting tools come at a price, and an HIM professional must be mindful of any approved recruiting budget set for a specific position. • Outsourcing: Organizations also outsource certain positions, designating certain positions or functions to be filled either temporarily or on a permanent basis by contracted employees. These individuals are employed by a third-party company that specializes in the required function. When some, or all, of the outsourced work is sent to another country, it is called offshoring. -Within a healthcare organization, outsourcing may be found in revenue cycle management, information technology, and human resources. Common examples of outsourced functions in the HIM department are transcription, coding, release of information, and management. Outsourcing is an option when there is a serious lack of qualified applicants for a position. -Having an outside company take over the function fills the position quickly and can be cheaper than paying a full salary with benefits. -Outsourcing may be appropriate for a task that is performed on an occasional basis, such as preparation of a cancer program's annual report or survey preparation. -Outsourcing may also be used on a temporary basis to reduce backlogs that have developed. -Outsourcing is also an option when an organization restructures and decides to focus on core initiatives, leaving other functions like HIM department management to an outside company. Any organization considering outsourcing HIM functions should perform due diligence to verify business practices, ensure conformance to contract terms, and mitigate potential risks of Health Insurance Portability and Accountability Act of 1996 (HIPAA) violations Contracts should detail the metrics that will be used by the healthcare organization to determine whether or not the outsourcing company is meeting their agreement. If offshoring is in place, different laws and cultural barriers need to be considered. Both outsourcing and offshoring situations need to be assessed for risks such as: ○ Poor security ○ Hidden costs ○ Lack of or improper communication ○ Poor resource management ○ Unbalanced work distribution or dissemination ○ Lack of technology ○ Quality problems ○ High turnover rates ○ Legal problems

Figure 8.1. Recruitment plan workflow

see image 1. Obtain position history 2. Gather data about the competitive nature of the position 3. Decide on internal or external (or both) recruitment 4. Determine recruitment tools to use 5. Consider legal aspects of recruiting 6. Evaluate recruitment methods used

Job Selection

the HR department offers only qualified candidates to the HIM manager for consideration. The next step is selection, or the process of choosing the right person for the job. An HIM professional has many selection tools (interviewing techniques) from which to choose to rate candidates in order to determine the best applicant.

Selection Tools: Assessment Centers

• Assessment centers: Traditionally, assessment centers are used for managerial and executive positions, but some organizations choose to use them for a variety of jobs, including very specialized or high-turnover positions. Testing is done by professionals; applicants are given a series of individual and group exercises that are then scored and shared with the employer. Paper-and-pencil tests such as personality, psychological, and aptitude tests are given, and oral and written communication skills are measured. An individual applicant may also be asked to perform an in-basket exercise. In this case, a pile of memos or list of emails is presented, and the applicant must handle each item in some way within a given time period. Team behavior may be measured with leaderless discussion groups. These involve applicants being placed together to solve a common work situation such as recommended disciplinary action for an employee with a behavior problem; this exercise demonstrates team behavior. Role-playing activities are also used to test team behaviors. Applicants assume managerial and subordinate roles and respond to scenarios such as employee disciplinary action, budget requests, and employee appraisals.

Selection Tools: Reference Checks

• Reference checks: Reference checks include both telephone calls to and letters of reference from previous employers, professors, or other individuals who might be able to attest to the candidate's work habits. They are a good way to verify the employment and education history provided on applications and resumes. Some organizations go beyond traditional reference checks and delve into the background of candidates by performing credit checks and checking driving and criminal records. -An organization may run the risk of being charged with negligent hiring. A charge of negligent hiring can be made against an organization if a current employee in some way harms a patient or another employee, or if he or she commits a serious offense when the organization should have known about the employee's tendencies through completing a thorough background check prior to hiring. -Because of the sensitive nature of reference checks, most organizations require them to be handled by the HR department. Information given to potential employers is usually restricted to what is available in the employee's personnel file. Information gathered relates only to the position for which the applicant is being considered. The question that most prospective employers want answered by a previous employer is: Would you rehire this person? -Increasingly, reference checks also include a review of a candidate's digital footprint. According to one survey, 70 percent of employers report using social media to screen candidates before hiring Best practices for using social media in the hiring process include: ○ Limiting the search to necessary information such as professional history ○ Focusing on public sites and reviewing the candidate's own posts, not what others have said about them ○ Having someone outside the decision-making process conduct the search, disregarding non-job-related information ○ Checking social media later in the hiring process, after the candidate has been interviewed ○ Reviewing social media on all candidates, not just selected candidates ○ Documenting the use of social media as part of the hiring process in case the decision is questioned later (Cifolelli 2018)

The following types of questions may be asked during a structured interview:

• Situational: Situational questions are intended to show how the candidate would react in hypothetical situations. They begin with "How would you..." or "What would you do if..." For example, a candidate interviewing for an evening supervisory position might be asked how they would handle a scenario in which two or three nightshift employees call in sick at the last minute. • Behavioral: These questions are experience-based, and the intent is that the best predictor of future behavior is how a person acted in a similar situation in their past. Behavioral questions are "Tell me about a time..." or "How did you...." For example, a candidate interviewing for an HIM audit technician position might be asked to describe a time when they disagreed with their supervisor and to explain the outcome of the encounter. • Job knowledge: Job knowledge questions are intended to determine if the applicant knows how to do the job. For example, a person interviewing for a privacy officer position might be asked about their experience with HIPAA regulations and privacy breaches. A potential data analyst might be questioned about their knowledge of spreadsheet and database applications. • Work requirement: While an interviewer must be careful not to ask any illegal questions, it is perfectly allowable to ask if a potential employee is available to work weekends or holidays if that is a job requirement. If travel is a part of the job, an applicant might be questioned on their availability for overnight travel. The questions must be framed so as not to be discriminatory, and all applicants must be asked the same question.

Recruitment 4. Determine recruitment tools to use contd Traditional Recruitment Tools

• Temporary agencies: One alternative to filling open positions is to work with a temporary agency. A temporary agency hires its own employees in a variety of areas such as clerical, healthcare, industrial, and engineering, and then contracts with organizations to provide coverage on an as-needed basis. Temporary employees can fill positions that are empty due to family and medical leave absences. Temporary agencies are used for short-term replacement of open positions, whereas outsourcing is used for long-term or even permanent replacement of open positions. • Employee referral: Current employees of the organization can be an excellent source of recruiting if they can recommend potential applicants. -The employee has knowledge of both the organization and the candidate and can offer insight to both parties. Often there is a monetary reward if the candidate is hired.