This case was developed in collaboration with Caroline LeGarde, Operations Project Administrator, Johns Hopkins Medicine, Baltimore, Maryland Grayson County Regional Health Center is a private, not-for-profit, 225-bed acute care hospital located in a rural community in a southeastern state. The hospital provides a broad range of inpatient and outpatient services, including cardiology, obstetrics, gynecology, general surgery, internal medicine, urology, family medicine, dermatology, pediatrics, psychiatry, radiology, nephrology, ophthalmology, occupational medicine, and rehabilitation services. The Center offers 24-hour emergency care. The Center is built on a 96-
acre site, and its service area includes Grayson County as well as parts of three neighboring rural counties.
Grayson County’s population is 60,879, with African Americans making up 53 percent of the population, Caucasians making up 42 percent, and Hispanics and other groups making up 5 percent. Agriculture is the main industry in the area, with cotton as the major crop. Fifteen percent of the labor force works in manufacturing, which includes molded plastics, metal fabrication, paper and wood products, textiles, rubber materials, and clothing. In the last 20 years, the region has suffered severe economic setbacks. Most of the textile industry has moved out of the region because of outsourcing, and the town itself has fallen into disrepair. An increasing proportion of the population—33 percent of children and 22 percent of the elderly—lives below the  poverty line. The county has a civilian labor force of 27,568 and currently has an unemployment rate of 13 percent. The county’s infant mortality rate is 12 percent, and 24 percent of the population does not have health insurance.
The Center has approximately 85 physicians, representing 29 subspecialties, on staff. It has affiliation relationships with two academic health centers—one is located about 90 miles away, and the other is located 100 miles from Grayson. The Center currently employs more than 800 employees, is fully certified by the Joint Commission, and is certified to participate in CMS programs. The Center is governed by an 18-member board of trustees, which includes the chief of the medical staff, the immediate past chief of the medical staff, the chief executive officer, and 13 members selected by the board from the community at large. Criteria for board election, as specified in the corporation’s charter, include an interest in healthcare, aptitude in business, and evidence of a strong moral and ethical background. The board is required by the corporation’s charter to reflect the economic, racial, and ethnic diversity of the service area. The Center has strong community ties and is active in the community. Its staff participate in such activities as community health screenings, health education programs, and health fairs. It serves as the meeting place for many support groups.
Although it has been under financial stress for the last five years, it continues to have strong support in the community.
The employee turnover rate at the Center is 40 percent. Over the last few years, the turnover rate for nurses has ranged from 15 percent to 50 percent. Physician recruitment and retention are also major concerns.
Currently, only one radiologist is practicing in Grayson County, and there is a shortage of physicians in all specialties. The Center relies heavily on Medicaid and Medicare revenue, leaving the hospital in a difficult financial condition. It is unable to pay market rates for nurses and other professionals. As a result, nursing units are understaffed, and nurses have expressed concerns about being overworked and underpaid. This has also resulted in concerns about the quality of patient care.
A local newspaper article reported that patients at the Center were often left on stretchers in the hallway for long periods of time, that staff were unresponsive to patient and family concerns, and that hearing crying in the hallways is not unusual.
Nurses and other professional groups report poor communication between senior management and employees. Poor relationships between middle managers and frontline staff are also a problem in some departments.
This situation became particularly difficult two years ago when the Center embarked on a large building project. Employees could not understand how the Center could afford to build new facilities but was unable to pay market rates to its staff.
The nursing turnover problem at the Center has reached crisis proportions. Recent exit interview surveys indicate that financial concerns are the major reason for leaving. The Center has tried numerous strategies, including improving the work environment by adding amenities (such as lowering prices in the cafeteria) and training middle managers.
For a short time 18 months ago, nurse salaries matched market rates, but the Center fell behind again shortly thereafter. The RN vacancy rate currently is 18 percent.

Exercise

As a consultant to the Center, you are expected to make recommendations to address the nursing shortage. Specifically, you have been asked to develop short-term strategies to cope with the current crisis as well as long term strategies to improve the overall recruitment and retention picture.

Project

1. How will you go about identifying the most important reasons for the current shortage?
2. How will you proceed with developing short-term and long-term strategies?
Chronic and worsening healthcare workforce shortages are likely in the foreseeable future. The objective of this project is for readers to learn about how hospitals and other healthcare organizations are coping with healthcare workforce shortages. Specifically, how do organizations perceive the causes of turnover, and what strategies have they found successful in improving both their recruitment and retention?
1. Identify one professional group (e.g., nurses, laboratory technicians, radiologic technicians, information technology personnel) that is known to be experiencing recruitment and retention problems.

2. Choose two healthcare organizations that employ this professional group.
3. Locate the individual or individuals most directly accountable for recruiting and retaining professionals in this group.
This person may be a staff in the HR department, a nurse recruiter, or another employee.
4. Find the approximate number of professionals in this group needed by the organization.
5. Obtain the following information on this group:

a. Current vacancy rate

b. Turnover and retention rates for the last five years 6. Discuss with the appropriate individuals their perception of the causes of recruitment challenges and of turnover and the reasons people choose to stay with their organizations. If possible, interview front-line staff in this professional group to obtain their perceptions on these issues.

7. If possible, explore the costs associated with recruitment, retention, and turnover at the facilities you have selected. Do the organizations keep track of these costs? If not, why? If so, do they use this information to make decisions concerning future recruitment and retention efforts?
8. In your discussions, explore the strategies both organizations have used to increase the success rate of their recruitment and retention efforts. Do the organizations know which strategies have been successful and unsuccessful? If so, which strategies have proven successful? Which strategies have not been effective? What strategies may be effective but are difficult to implement?
9. Summarize your findings in a five-page paper.