IPMI Fireside Chat | Future-Proofing Clinical Talent Acquisition

Speaker A: Jeff, I appreciate you being here and appreciate all of you for sitting and listening and uh, hopefully there's something valuable that you can take away. So we'll start with introductions. Why don't you kick it off, Jeff?

Speaker B: Uh, Murphy. I'm the vice president of Comer Children's Hospital, which is part of UChicago Medicine. We like to call ourselves a free leaning children's hospital. We're technically in a freestanding building, but we are not freestanding. So we're part of the larger adult enterprise. I've been there for about six years and over the children's hospital for about five.

Speaker A: My name is Zach Coffey. I'm vice president of strategic partnerships at Human. So Human, we're recruitment process, outsourcing organization. I've been there for almost ten years. Um, excited to be here and just a quick overview of Human and what we do before we dive into how we work with commerce and um, the impact we make there. Our RPO recruitment process outsourcing is our largest, uh, service line within our organization. Rpo, essentially for anyone not familiar, is when a talent acquisition team outsources any piece of their talent acquisition function to an outside vendor. Um, when they outsource recruitment process outsourcing to us, it can look different, it can be different shapes and sizes, um, from one full time dedicated resource to enterprise, uh, outsourcing. And so we look at five key areas and you see them here, the people, the process, technology, digital recruitment, marketing and reporting. So for us it starts with dedicating, um, our recruiters to our partners. So I was a recruiter when I started here and my email address came from my partner email, my LinkedIn, my phone number. Everything looked like I was 1,000 miles from where I was. Um, but the most important thing is I really understood the culture of my partners and it's extremely important. Um, and the only way to do that is to dedicate those resources. Those resources are managed as well. So a lot of eyes and ears and a lot of thought and um, hands that are touching. The partnership second piece is the process. So we are not a group that dictates the process or says you have to do this this way or that way. So we learn your process and then uh, Jeff, as you'll talk a little more, we adapt with you with those processes and make recommendations to streamline and increase efficiencies there. Um, in the technology we work nine times out of ten in our partners applicant tracking system. We work with technologies that they use. But as an organization we are intentionally technology agnostic and we start to bring where they can reduce a recruiter's administrative burden, um, ultimately provide more throughput through that ta function in that system. Uh, recruitment marketing is a huge piece. So we as an organization are about 500 employees and about 40 folks there, um, are on our digital recruitment marketing team. They're a huge piece of our solution and they are the folks that know how to play nice with the Googles and the indeeds of the world and go out and find candidates, uh, to fill open positions. Um, we bring the strategy as well as the budget. Um, they're just an amazing team in the work that they do. I'm sure we'll talk a little bit about that then. The last piece is the reporting. Um, love to take anyone that's interested through one of our, uh, Power BI dashboards and really let you know, hey, this is what you see when you partner with human and you're never going to not know what's going on. Um, reporting is a huge piece. When you take these five key areas and you say, hey, we want to apply and our solution to our partners, um, what you get are really holistic, transformative results when it comes to talent acquisition. And so I know when I'm looking out at all of you that you're saying I have nothing to do directly with talent acquisition or hr. And we understand that. However, um, you are the end users and it does impact you when you don't have staff or you're worried about patient care, all of those things. And so, um, Jeff, I'll kind of start there. Um, so when you think about these five pillars and the five things here, what would you say are the most effect or the most, uh, impactful for you from a day to day perspective in your role as a cno?

Speaker B: I think for us it was really around the people, like always the people number, uh, one and then the process, uh, and that's not because it's the first two, but I think the people especially. I was telling Zach that I went to look up one of the recruiters the other day in our directory and I forgot, oh, they don't actually work for us, they work for a different company. And so it's, they really are embedded in our group and really part of the team. And you know, we've done a great job of matching recruiters to managers and they've always not been great matches. When they're bad match or when they're matches that they don't quite sync, we make changes. And I think that's one thing that you guys are great about is finding the right recruiter for the right manager. So they learn what they're looking for. They learn the ins and outs of their unit. They're able to glean some insight for us when we're trying to figure out why we're having recruitment challenges. Uh, and then the process and this actually evolved for us a lot over the last three years. As we came out of 2021, we were facing a fair amount of recruitment challenges which isn't new, but was new for us. We are a union shop and pay well and think we have the best staffing in the world. Um, and so we have not ever really struggled recruiting nurses. And we were which took us a bit to adapt to. And so um, between our nurse executive team, our human partners and our human resources group, we were able to put a weekly meeting on the books where we got information that we had no idea prior to. So some of our managers habits around recruiting and hiring and interviewing things that we didn't have great insight to, we were learning in a weekly meeting. We were able to go back and course correct. I think we recognized earlier on than perhaps some of our frontline leaders that we were not in control of the market anymore. And so we were going to have to change and be different. And like we've heard through this entire conference, as meeting people, we need to change and meet people where they are. We need to be more creative and flexible. Some of our managers really struggled with that and our recruiters had been trying to press that message forward but it wasn't getting through. And so this change in process allowed us to really literally, we sat down and looked at every single interview, every offer that was made. If they declined or if the manager said they weren't going to recruit the person, why we're able to say good fit isn't a good reason anymore. We need actually more than that. And so we're able to make m a lot of progress um, just by that little change in process.

Speaker A: Sure. So talk to me a little bit about uh, and I'm spitballing here at you, so talk to me a little bit about uh, just the trust and building the trust between an outside vendor and your managers that are probably looking at you and saying why are we doing all of these things?

Speaker B: Right. Yeah. Some of our managers who've been with the organization for a long time really struggled with this idea that you don't have to be a nurse for 20 years to work at the PICU or in the surgical ICU that we need to take some of that off and move to a more competency based model. People really struggle. And the recruiters were really trusted messengers when they were working with, uh, managers. That may have been a little. First of all, they were saying, why are you all of a sudden involved in this? Why are you calling me about this offer that I didn't make to the candidate? They helped kind of moderate some of that messaging. Um, and I think they have great success. I was telling Zach earlier, I looked at our PICU manager statistics. Now I didn't know the stat beforehand, but, uh, his time to fill was is 21 days for a PICU nurse, which on the national average is 90 days. I didn't know any of these stats existed, but that's the kind of result that is impactful. Or the managers, they're feeling like they're getting the right candidates in so they're not wasting their time. So true.

Speaker A: Yeah. So how, um, I guess what was the change there with the hiring managers in order to say, I know you said, hey, listen, maybe we changed these experience requirements or maybe we not being a good fit is no longer, uh, an excuse.

Speaker B: Right.

Speaker A: But what were some of the other major obstacles you had to overcome there?

Speaker B: I think some of that was just forcing people's hand, to be honest with you. But we've seen, you know, there was big worries we're going to hire people and we're going to have to move them out of roles. And although that's happened, I don't, I mean, I don't have any statistics back it up, but I don't think it's at any greater degree than it was. We're not getting bad people into positions. And as an organization we've tried to pivot a little bit to say if this isn't the right fit for you, where is the right fit for you within the organization? Um, we made some other changes that were really designed to help recruitment around. We've always had a nurse extern program that was great. Um, but like we've talked about many times this week or these two days already, it's, you know, you got to hook them early and you got to really hook them. And so we developed an external program that we called it an intern program where you are recruiting people after the first year of nursing school. We're paying for their last year of nursing school in agreement that they will come and work for us afterwards. And so, um, that means that the managers have to schedule them over the course of a year for a day here and there to work. And it really was based on what they needed and what they could do. But, um, it allowed us to, in our areas where we have long orientation times, the operating room, the PEDs ICU, the neonatal ICU, to really get them orienting a year before they're done with school. It's a big investment for the organization, but, um, very successful. Uh, and then one of the shifts that we made was around our BSN requirement. We had, for the longest time, not even entertained interviewing ADN nurses because of our magnet requirements. And I've always had a little bit of an issue with that. And when I came to the University of Chicago, I understood why. And that's because we couldn't recruit anybody from our community. So we had trouble recruiting nurses that look like our patients, talk like our patients had the same experience our patients did because all those folks had ADN degrees. And that was a detriment on so many fronts. And so we. I will give her Sano, at the time credit. She was able to get the organization to agree to, uh, we will hire and pay for them to go back and get their bachelor's within 30 months. Um, that's part of the deal to come and work for us. Now, we learned telling a single mom of three that she also has to finish a bachelor's degree in 30 months isn't quite the win that we might have thought it was. So we had to pivot a little bit and figure out how to support those individuals. But it's been successful. We've had over 100 folks who, through the program when most of them have been successful. And so those were the kind of. We threw it all at the wall at once, which got a lot of questions from our managers and got some questions from our finance team around, why are we doing all of this at once? And I think that's what made us successful, is being able to do everything, um, to kind of get over the hump.

Speaker A: Yeah. Talk to me about the financial impact of that.

Speaker B: It's interesting. I was telling Zach earlier, if we were to propose all these things today, I'm not sure that we would have as much luck getting them pushed through as we did two years ago. Um, but. But it's a good example. I tell leaders all the time, this is why you spend your career building political capital. Because at the time, the individual pushing this through had a tremendous amount of political capital that they expended on this. But I think we're seeing our adult hospital, maybe last month celebrated a year with no agency and no contract folks in any of their Inpatient areas, which is unheard of for us as an organization. In the children's Hospital, we're down to, I think, five contracts, which will age out in April. Now, we're seeing in the areas that do have contract labor what the tremendous financial impact difference is in those areas. And, you know, some of the changes that we've all talked about, per diem, staff, registry staff, all those things that you can help support that were maybe not part of our old mindset because it's more work. Um, those have made tremendous impacts financially. I mean, and a time to fill of 20 days. And that alone is. I mean, I can't even put a number on how much money that saved us.

Speaker A: Sure, right. And that contract labor is expensive.

Speaker B: Yes, it is expensive.

Speaker A: Talk a little bit about the culture impact of reducing that traveler and contingent labor force.

Speaker B: You know, it's interesting. Uh, you know, it's some of this, as you've. We've heard before, you know, at several presentations since we've been here, this is a lot more work for the managers. Right. Like what all of these things we're doing are a lot more work for the manager. So as yesterday when we were listening about the year of the manager, I like, we have got to take that and put it into place because all of these things are more work for them. And I don't know that we've done a great job supporting them as they. As much as we could to do some of this now. They've been great because ultimately, what does the manager want is a fully staffed unit where they're not calling everybody on a Saturday at 6pm Trying to get people to work. That's the win, right? That's the win. Win for the frontline leaders. And so I think that allows us to build better culture. You know, it's tough to make great change when you're profoundly understaffed. It's just hard to move people forward. So I think being able to fix those things first allows you to engage folks to do the stuff that they all want to do, that we all want them to do.

Speaker A: Sure, yeah. So as you think about kind of your priorities, whether it's talent acquisition, um, when you think about 2025, knowing that, hey, um, contingent labor isn't a big issue, and you think about some of these changes that still need to be made. What's the top of your priority lists as it. As it relates to staffing?

Speaker B: I think for me, especially in our areas that have been chronically understaffed for the last three years, like getting people the time off that they've wanted to have, getting our managers the time off that they wanted to have, allowing people to participate in, you know, committees and extracurricular work that they wanted to do that we haven't really been able to do for staffing, or they've had to do it above their fte, like allowing people to participate in those kind of things for their growth, for the organizational benefit. That's what I look forward to in the company year.

Speaker A: Um, well, Jeff, I kind of want to go back to some of those major process changes that you made. Um, can you talk to me about some of the most difficult ones or the toughest pills to swallow for some of your managers?

Speaker B: I think it was that, you know, it was interesting. We just didn't know some of the decisions that were being made, and I don't know that we didn't know. We didn't know. Uh, and when we got together for our first weekly recruitment meeting and they started running through, we were all just kind of staring at the zoom screen, like, whoa. You know, we. There was. You know, we took peer interviewing off the table initially, uh, which caused a tremendous outcry from the leaders. And so we said, you know what? If you could do it, you got to do it. But we told people, if you have a candidate, you have to make an offer before they leave the building. Like, you can't let people out the door. Because the. We were finding we were losing candidates in a day. You know, they were being sucked up by other organizations. And so getting managers to be able to commit, trusting their peers. We told them, if you can't do the interview, you need to find a friend that can, and you need to trust their judgment. So find somebody that you trust. That was really tough for people to not be able to be part of that decision. Uh, it was really tough for people to adjust to that. The idea that all these experience requirements that we had in place that we've now seen, really, they didn't get us anything. Um, I think what we've lost on the back end is a tremendous amount of knowledge in nursing that the folks that retired took with them when they left, and there's no way to get that back. Requiring experience doesn't get us that back. And so I think. But although I was having a conversation with a PICU nurse before I left on Thursday, and she said, can you please stop recruiting new grads? Can you find some PICU nurses with experience? And I said, those people do not exist for the 500th time. So I think people still are yearning for this old way that just doesn't exist. We're still, you, uh, know. So I think those are the things that are tough for people that have been at it. And then one of the things that I didn't think we would encounter or I hadn't anticipated was we're getting a lot of, why did these people get it when I didn't? Like, I had to really work hard when I was first a nurse. Why do these people get everything? And I don't have a good answer for that other than, so what's your

Speaker A: response now if you get asked that

Speaker B: question, do you want a staff unit or not?

Speaker A: Understood.

Speaker B: Yeah. Uh, I struggle a little bit with that question because times change and they're different. And the old way wasn't the right way. The way we did it wasn't the right way. It didn't support people. It didn't support the organization. So hearkening back for those times is not where we should be. We should have always been meeting people who are there. We always should have been supportive of people. So I don't think saying you didn't get that is a good argument.

Speaker A: Talk a little bit. Um, so something human. We really pride ourselves on finding the right camp for our partners. And, um, something that we're very proud and I tout is a 1.7 to 1 interview to hire ratio across all roles at our organization. Um, what's the impact of bringing in a bad candidate? And I'm sure that hiring managers, that was a fear, right?

Speaker B: Yep, it was a big fear. Like we're moving the process too fast. What if we bring in people that aren't a right fit for the organization? What if we bring in people that aren't qualified? And some of the way we mitigated that was they're only seeing candidates that were at least qualified for the job and, you know, weren't overtly problematic. And I don't think we've had many slip through, to be honest with you. Yeah, Um, I think that. And people seem to have gotten past that. People can see that we're, you know, their time is being used. Is used. You know, was telling Zach, we don't ever talk about recruitment. And until we're talking about recruitment because it's a problem. Right? We're not. We're not generally talking about it when things are going well and the managers are the same way, it falls to the bottom of their priority list often. And so having a recruiter that is keeping them on track is, you know, escalating. Things when they need to be escalated is really imperative to ensuring that they step the unit. A month can go by really quickly and then you're, you know, behind the eight ball. It happens to all of us. And so I think that partnership and finding a good recruiter that matches up with that manager so they can kind of ping them in the ways they need to be pinged.

Speaker A: Right.

Speaker B: Send them the people they want to be sent.

Speaker A: Yeah, well, that's it. Right. That relationship piece and, um, constantly refining, what do these candidates look like? Uh, who are you looking for? Right. There's, there's the UCM and the commerce culture, but there's also a culture of that unit, of that hiring. And so it's so important. Um, I had a really great question, Jeff, and I just slipped my mind. Oh, I remember.

Speaker B: You had a great answer.

Speaker A: Yeah, yeah, I'm ready for you to rock this one. So, uh, we talked outside a little bit about just those weekly meetings and you mentioned them several times here. Could you kind of back up? And I love to give something tactical. Right. Um, as we think about those process changes and some of the impactful changes that you made, you mentioned those weekly meetings as being kind of that sounding board and that point to say, what's happening. Um, let's take a look at all these candidates that move through. Could you just kind of give us a real life example of, hey, this is what these weekly meetings look like. These are the things that we chat about, whether it's managers, whether it's the recruitment team, kind of talk us through that.

Speaker B: So it starts with a high level summary. These are the number of interviews that were completed. These are the number of offers we made. Here's what's still pending. Um, any candidates that said no to us, we wanted to know specifically was it around pay? Because we were able to make some market adjustments as we needed to. Um, was it around culture, things like that? Um, we were able to pick out, it was interesting. We were able to pick out some people that were up for interviews. And our people, strategy people were like, I know that person. They've been here before. Let's get them off the list. We avoided some of that. Um, and then we looked at specifically, um, if a hiring manager said no to a candidate, specifically why. And our managers, like everybody else in the world, when you don't think anyone's watching, you give the easy answer. Not a good fit, lack of detail.

Speaker A: It's.

Speaker B: So we ended up having to press the managers on. We're not going to tell you to hire Someone that you can't, don't think could be successful. But you need to give us a little bit of reason why. You need to be able to articulate why. You know, we caught some things that were probably not quite as legal as they should be around why folks were saying no to candidates as we're able to do some education and course correction on that. But that's a level of detail that I don't think even in my own areas I ever was paying that much attention to, uh, because it takes a fair amount of time to gather all that information. And so it was really helpful and allowed us to, you know, we, we were saying we want to be different, we want to meet people who are there, we want to be new. And we were saying that message, but it wasn't necessarily getting the practice of our managers. And so this allowed us to pick out the folks that were still struggling, the individuals that were kind of, you know, using old practices and be able to target information to those individuals. And there were some recurrent individuals that came up often, but it was, it truly was helpful. We still do them now. We still do them now. And uh, we do every other week now. But we still, I don't think any of us are willing to let it go.

Speaker A: Are you still making process changes? Are you still adapting things?

Speaker B: I'm trying to think if we made for a long time those Monday meetings started with, um, our previous CNO saying, okay, I have a crazy idea, just hear me out. And it would turn into this. We'd implement some new process. We haven't had much of that because we're at a little steadier state. But I think the meetings keep the option open.

Speaker A: I do have a question, kind of for everybody in the room. So by a show of hands, uh, how many folks are making offers immediately after an interview to clinical staff? 1, 2, 3, 4, 5. Okay, a few. So obviously there's going to be pushback there.

Speaker B: Right?

Speaker A: And so you mandated it. Um, what other things did you get the most pushback on, would you say? When it came to changes the experience

Speaker B: from our critical care areas, that's probably the number one piece of pushback we got. It's interesting because when we dug into it, it's not really based on having evidence. It's an old, it's just the way we've always done it. Um, for such a science based profession, we do some things that are just not logical or based in any sort of science. And so that was probably the biggest pushback, especially if you had a manager who'd been in the role for 10, 15 years, especially in an area that had not ever had recruitment challenges like our surgical icu, you couldn't get a job there for anything for many, many, many, many years. That manager to then have to hire an inexperienced nurse was like the end of the world for that person. And so some of it was around. That's a real problem we need to address. We need to help that person through that. But even in our areas that were chronically understaffed in our pediatric icu, we still saw some bullying of people that were inexperienced that we had to address because they didn't feel like they should be there. Um, which is very odd for our profession that you're so short staffed, but we're still pushing people in the role. So that was the number one thing, the. And then trusting your peers. The idea that a manager that someone else would hire for a manager was like an obscene statement that they could not wrap their heads around. And in the end, I don't think we've had any candidates where a manager said, that person made a bad decision for me. Um, they got to find that best friend at work that they can lean on to make that decision.

Speaker A: Sure. So we have close to five minutes left, and I want to save some time for questions. We have you here, Jeff, that I know can give some great answers. But, um, as we start to think about your career and obviously you are a very, uh, bold leader, right? You're gonna tell. You're gonna tell folks what they may not want to hear, right? And you're gonna be honest with them. You're gonna look, you look at data and you look at all of those things. Um, what has been the, the, the key to your success as a leader?

Speaker B: Uh, I think that changes over time. Right. Like I will say currently, you know, probably maybe four or five years ago, I, I had some great advice from a mentor that was, like, really felt like, centered on humility and approaching our work from a very humble place. And I work with a group of six nurse executives who are we all one. Many of us have the same birthday, we're all born the same season. It's very weird. Uh, but we really all function with this same kind of mentality. So we've been sending this message for the last five years around humility and being humble, and the rewards from that have been amazing. It allows you to build a team that will support you through anything. And so I don't know that I knew that when I was a younger leader. And so we were Trying to give that message. It is a much easier way to live your life. It's a much easier way to do your work. And so I'm going to attribute my success to the people that I have the chance to work with that really foster and hold you up.

Speaker A: Look at you. And humble, too. Yeah, Jeff. Well, why don't. Why don't we talk about, you know, technology a little bit as we think about, uh, technology, marketing, the reporting, all of those things? Um, are there any tools, uh, data points, anything that you're going back to with managers and saying, hey, we have to make a TA change because of X, Y or Z, and here's the

Speaker B: evidence that we have not traditionally done. Interestingly, you know, some of the data that's available, I just learned. And it was, you know, I was trying to make a case for something else. And so I was trying to demonstrate that the manager had done all they could do, and we still needed a few agency nurses. Um, and so some of the data that I got, I didn't even know we collated. So I'd asked for all the time to fill for all my areas so we could create a little healthy competition. You know, it really. I. I was a little stouted that it's 90 days of the average. I don't know why I thought it would be less. Um, but those are some metrics that we should monitor, you know, because we. I'm sure I. I can see it now. If you have a manager who's struggling, their time to fill is gonna start increasing because they're overwhelmed. It's a leading indicator for kind of how they're doing the work and how they're gonna be successful. And so, um, I've been putting some thought into how do we look at that across the organization. And really, um, I think we're lucky enough that we have great recruiters, great HR partners, that they're distilling all of this data down to what we need to know. Um, but it makes me think, are there other things we should be asking for?

Speaker A: Sure. So as you think about going back to your team, if this was something that you were having to do today, maybe you somewhere else, and you said, hey, I need some help on a TA side. What would be the conversations that you would start to have to say, hey, this is what needs to be done, and who would you have those conversations with?

Speaker B: Ooh, that's a good question.

Speaker A: Stumped.

Speaker B: Yeah, there we go. You know, I was thinking back to, like, previous, you know, we've struggled, you know, I guess you take for granted what's working well. And we haven't really struggled with recruitment, you know, since I've been at the University of Chicago. And, you know, I was thinking back to previous roles where we really did struggle with getting the time commitment. And, you know, so I think that's the piece that I would sell. You know, it has been a bit hands off for us. Even when I was a director and we were. It was helping with recruitment, a lot of this stuff just happened automatically. You know, we don't have the resources that we're going to dedicate to that as an organization. And so that's where I would start. It really is a time saver for folks. And when you, you know, I don't know how you quantify getting the right candidates in front of the managers, but there's some serious time lost and some, you know, financial implications. I don't know how you quantify that. You all probably can do that. I'm sure that's. But, you know, that's, that's the benefit. The fact that we haven't talked about it is, you know, an indicator to me that it's not a huge problem because that's generally, you know.

Speaker A: Yeah. Uh, we're out of time. Can you believe that?

Speaker B: I can. You told me go by fast.

Speaker A: It's going to go by fast. It went by fast.

Speaker B: Thank you, everybody. We appreciate it. Thank you.