Flexible Work Arrangements Best Practice

By: AARP Outreach & Service | Source: AARP.org | February 2 2009

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Organizational Profile

Lee Memorial Health System is a public health care system based in Southwest Florida. It supports more than 9,000 employees, who treat approximately 165,000 patients at many facilities, including five hospitals, a home health agency, a nursing home, outpatient-treatment and diagnostic centers, physicians' offices, a children's hospital, and a rehabilitation hospital.

Overview

Florida's volatile real-estate market was fueling a serious labor shortage, because the price of houses was inflated. Experienced workers were selling their homes and moving out of state. The health system turned to expensive staffing alternatives, such as hiring traveling nurses. But as more people moved, there were fewer patients to treat. Now the health care system had the opposite problem—too many staff. Instead of laying off employees, though, the organization created a variety of flexible-work programs that many older workers embraced, enabling the health system to hang on to skilled workers during good times and bad.

Business Challenge: Powerful Forces Affect Staff Retention

Like other health care organizations, Lee Memorial Health System has dealt with its fair share of challenges, ranging from soaring health care costs to delivering quality medical care to uninsured patients.

Several years ago, the system experienced double trouble. Besides dealing with the country's skilled labor shortage, the state’s real-estate market was also wreaking havoc on the organization's recruitment and retention efforts, said Jon C. Cecil, chief human resources officer with the health care system.

"We were the second-fastest-growing state in the country," he recalled. "We were having this huge growth in our patient population. Then property values went out of control, up by almost by 60 percent."

While good news for homeowners, it was definitely bad news for the organization. More than 100 of its experienced, long-term employees took advantage of the escalating real estate market and sold their homes, then moved to different parts of the country. Thousands of other state residents had the same idea. So when Florida's population began to shrink, so did the number of people requiring medical care or hospitalization.

At the time, the organization's turnover rate spiked by almost 100 percent—from between 10–14 percent to between 18–20 percent. To fill in the gaps, the health care system spent more than $12 million hiring traveling nurses in 2007. The expenditure was "breaking the bank," said Cecil, explaining that on average, the system's nurses earn $28 an hour, while traveling nurses are paid between $54 and $64 an hour.

Still more trouble lay ahead. In 2006, one out of four people in Florida under the age of 65 had no health insurance. Now it's one of out three, he reported. "Imagine you work at McDonald's, where one out of every three hamburgers you sell, you give away," he explained.

Faced with declining revenues, high turnover, more job vacancies than people to fill them, and suddenly having too many staff, HR began focusing on just about the only thing it could control—hanging on to employees.

"We [had] to retain our existing staff," Cecil said. "We could not lose our valuable workforce."

Business Solution: Filling in the Gaps

In 2005, the health care system began conducting a series of focus groups to find out why employees were leaving. Some nurses, for example, were resigning because of physically demanding work schedules. It was difficult for them to keep up with 12-hour shifts, three days a week—not to mention overtime.

"A portion of our workforce wanted to work, but could not work these schedules," Cecil says. "For things we could find a remedy for, we'd try to fix [those]."

Offering flexible-work schedules became a life-or-death matter for the health care system, where the average age of employees is 45. What's more, 35 percent of the organization's total workforce—and 60 percent of its managers and supervisors—are over the age of 50.

HR brainstormed different ways to accommodate the needs of mature workers and came up with five alternative work schedules. These the system introduced during the past several years, explained Kristy Rigot, the system director of HR:

Job-sharing: While many companies offer job-sharing, enabling two employees to share the responsibilities of one position, Rigot’s organization sweetened the pot. She said that employees in these positions are classified as part-timers, but still enjoy the same benefits as full-time staff, with two exceptions. They receive fewer vacation days and pay higher premiums for medical insurance.
Compressed work weeks: Whenever possible, employees can pick one of three schedules to best suits their lifestyles: They can work three 12-hour shifts, four 10-hour shifts, or a traditional eight-to-five schedule. More experienced nurses work all different schedules based on how physically demanding their jobs are, explained Rigot. For example, orthopedic nurses, who constantly lift patients, tend to prefer shorter shifts, while those in less physically challenging jobs—such as intensive care—opt for 12-hour shifts.
Temporary work: The system also formed a temporary labor pool of almost 1,300 workers (who do not receive benefits) to tap when patient volume increases. The temporary workers hold many different positions, ranging from nursing to clerical or housekeeping.
Flextime: Some employees can plan their own schedules. While the employees must work onsite for a certain number of hours each week, during the remainder of the week, they can work from home or anywhere else they choose—as long as they complete their assignments on time. Medical coders and transcriptionists are examples of employees in this category.
Seasonal months off: This program was introduced in the 1970s. It resembles a typical "snowbird" program, in which employees work for six months, then take off six months. HR recently changed the policy to enable employees to work six months, then take off one full year, if needed.

Even employees with non-work-related injuries on worker's compensation are encouraged to work part-time through the organization's "Transitional Work" program, added Cecil.

"We [wanted] to get them back to work as quickly as possible," he said, adding that many were brought back part-time but at their regular wage; however, these people do not often return to the same jobs. He said, "Our philosophy was, if we could get them back working and they didn't stay out too long, we could get them back to their original jobs after they healed or rehabilitated."

He tells the story of an intensive-care nurse—one of the hardest positions to fill—who injured her back at home and required surgery. After six months of working in a sedentary job in the organization's employee-health department, she returned to her job as a critical-care nurse.

Meanwhile, there was one more hurdle: getting buy-in from managers. Although managers were pressured to reduce staff because of lower patient volume, some managers still resisted.

"The hard part was getting managers to be flexible with their scheduling," he said. "We're telling managers, 'Do you want to lay people off in your department or be smart and try to keep some of your most valuable workers and not try to fill [positions] again until the season picks up?'"

To encourage staff participation, HR developed talking points for the organization's 450 "leaders"—anyone who supervises staff—to cover each flexible-work option in detail, said Alison Thurau, the system director of HR. HR representatives also attended monthly facility meetings at each of the organization's hospitals to review the flexible-work information, to brainstorm ways on how job-sharing or seasonal months off could be creatively used in their departments, and to promote the options with employees.

The strategy seems to be working—on both sides. More managers are promoting flexible schedules, and significant numbers of employees are willing to job-share or to work reduced hours—versus being laid off—mainly because of the new HR policies. Thurau said employees who choose the flexible options can still maintain their full-time benefits for up to one year.

Outcomes: Retention Achieved

One of the key reasons the system's flexible-work program is a big hit with experienced employees is because of the health-benefits offering. That's the primary reason many stay on the job, come out of retirement, and are willing to job-share or cut their hours, Rigot reported. Others choose flexible schedules as a way to gradually phase into retirement, to enjoy more leisure or family activities, or to care for elder members of their families.

"Particularly for job share, we've had a number of people say that without that program, they wouldn't be able to work," she said. "They're able to partake more in the recreational side of life. If they have obligations to care for their parents, they [also] have more flexibility to take them to doctors' appointments or care for their personal needs."

Although the flexible-work program is part of the organization's overall recruitment-and-retention efforts, it has contributed to several dramatic improvements:

Employee turnover has been cut by more than 40 percent—from 18–20 percent to 11.2 percent.
Last year, only 10 employees participated in the seasonal months-off program, most of them over the age of 50. This year, however, 50 employees are taking advantage of the program. Approximately two-thirds are age 50+.
The number of part-time workers above age 50 has increased by 79 percent over the past several years.
The number of new, age-50+ hires recruited has risen by 54 percent.
More than one-third—35 percent—of the system’s temporary workers are 50+.

Flexible-work programs have helped the health care system adjust to changing times and to keep its most valuable employees.

"Boomers have a lot to give back," explained Cecil. "I saw us sometimes wasting that, because we didn't design the jobs to maximize their knowledge and skills—that could walk out our door."