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When it comes to recruiting, more has traditionally been considered better. In other words, the more applicants you attract, the more candidates you interview, the more hires you get.

But David Szary believes otherwise. “In reality, if you have that mindset, you start to increase unqualified applicants. You end up interviewing more unqualified people and the time, effort and energy this takes strangles your ability to spend time with high-quality candidates,” explains Szary, founder and partner of Lean Human Capital and The Recruiter Academy. In his view, the most efficient way to zero in on those high-quality candidates is to streamline the recruiting process using a continuous improvement methodology such as Lean principles, Six Sigma or theory of constraints. “By applying these methodologies, you can look at how to reduce waste, wait time and errors, ultimately improving the customer experience, reducing costs and increasing revenue,” Szary says. HR leaders who have implemented Lean recruiting practices and new service delivery models share Szary’s faith in the approach, given the results they’ve experienced firsthand.

“We define Lean recruiting as continuously trying to remove activities that don’t provide value, and identifying waste and delay in our process so that we can focus on providing more value-added activities,” says Carla Kennedy, MBA, Human Resources Recruitment Manager at Chicago’s Rush University Medical Center. Certified as a Green Belt in Six Sigma, Kennedy has teamed with Associate Vice President of Talent Acquisition Carmel Gaughan, MBA, RN to lead the hospital’s Lean recruiting journey for the past five years. “There have been multiple benefits, but first and foremost, we’ve improved service delivery to our customers,” Kennedy says. “Having our team and department positioned as a strategic partner to our hiring partners and client groups by providing value-added service to them has been a huge benefit. We’ve seen those results in our annual voice of the customer survey feedback, in emails and in anecdotal comments from our managers praising the changes that we’ve made over the past few years and that we’re continuing to make.” Previously, Rush had a transactional recruitment department that lacked metrics to benchmark against. “We had no ‘management by fact’ culture, no idea how we were performing and very little standardization of our processes and workflows,” Gaughan says. “Lean recruiting made us focus on ways to measure our performance and outcomes.”

In the two years since implementing Lean recruiting at Cedars-Sinai Health System, Janice Buehler, MBA, CHCR, Human Resources Director has achieved high client satisfaction ratings and a 22.4% increase in recruiter productivity. “Lean recruiting provides value to your organization in terms of being both effective and efficient,” she says. Being effective and efficient is particularly critical at Cedars-Sinai — it’s typical that within one year, they receive 120,000 applications for 2,000 jobs (one-third of which are filled with internal candidates). “We don’t want recruiters to “weed” through unqualified candidates, because that takes time away from those who we actually want to focus on,” she says. “We can’t stop people from applying, but we’re focusing our sourcing efforts more carefully, being mindful of how we post and what we do to source people for positions.”

As the former Director of Talent Acquisition and Workforce Planning at Baystate Health, Korinne Carpino, SPHR, HCS, RACR launched a Lean healthcare recruitment transformation journey as part of her effort to align talent acquisition with the system’s strategic goals, as well as turn around low customer and recruiter satisfaction levels. “We wanted to improve our time to fill, create a positive hiring manager and candidate experience, and simplify the process,” she says. Korinne credits the transformation journey with numerous benefits, including decreasing time to fill from 52 days to 36, substantially increasing team engagement, strengthening collaborative relationships between the talent acquisition team and its largest stakeholders, and having the team invited to strategize with management to proactively build pipelines for business growth and reorganization.

Align Scorecard with Customer Priorities

A performance management scorecard is an essential tool for measuring success throughout the Lean transformation journey. “I always advise building a scorecard that aligns with metrics important to your customer,” Szary says. He recommends developing key metrics for six dimensions: speed/responsiveness, quality of hire, quality of service, efficiency, cost, and productivity. In addition, he considers it critical for HR teams to measure themselves against a set of industry benchmarks. “At the end of every quarter, you need to step back and analyze your progress,” he emphasizes. That process involves celebrating the successes and improvements, figuring out where progress still needs to be made and determining next steps.

Equally important is the need to quantify progress and share it publicly with stakeholders. “I see so many recruiting departments working hard and doing great things, but no one knows about it,” he observes. “If we’re not going to be our own evangelists, our voice is not going to get heard. We need to say, ‘This is where we were, this is what we worked on, this is how we improved, this is where we’re going to go next.’ That way, you start to build a positive culture where your team is excited about continuous improvement and your executives are excited about your progress. That’s the win-win.”

The scorecard methodology and review has proven a winner for Cedars-Sinai. “If you can measure it, you can manage it,” says Buehler, noting that her team’s recruiters — called talent advisors — like to see their numbers. “On a quarterly basis, recruiters look at what their team and individual performance has been, and they present their data in a non-punitive, non-threatening meeting.” In addition to quarterly reviews, the talent advisors on Carpino’s team calculate their own metrics every two weeks to keep the focus on outcomes. “Data is everything. You must be able to measure everything you do in order to improve,” she says. Measurable improvement at Baystate has included increasing hires per recruiter from 190 to 213 and saving an estimated 3,000 hours by reducing the amount of time recruiters spend handling resumes from unqualified applicants, and hiring managers spend reviewing and interviewing candidates.

Carpino’s team has also saved a total of more than $800,000 by decreasing cost per hire by 14.5%, increasing positions filled to offers extended from 89 to 95% and reducing the time to fill for direct care RN positions open greater than 60 days by five days. Kennedy and Gaughan appreciate how their performance management scorecard quantifies ROI to key stakeholders, including senior leaders. “The language resonates with them, making it easier for them to buy into our roadmap for becoming a best-in-class organization,” Gaughan says. In their journey so far, they have substantially reduced their applicant to hire ratio and cut their time to fill from 60 days to 40. Kennedy notes, “That has tremendous implications on hiring manager time, evaluating and looking at applicants, interview time by recruiters and a host of other things.”

Like Buehler and Carpino, Kennedy and Gaughan hold quarterly meetings/team-building sessions to review progress and keep their team members engaged and excited. “We look at the return on the work we do but also celebrate our successes,” Kennedy says. In addition, at weekly Friday meetings, team members are encouraged to share what they’ve accomplished during the week. Then they review positions that have been open more than 60 days and brainstorm strategies. “This supports the work and change we’re trying to drive.”

Start with Value Stream Mapping

Lean transformation journeys typically begin with a value-stream mapping exercise. Szary explains, “You walk through each step in your process and ask yourself, ‘Is it actual work or is it wait time? How much time does it take? How much time is between this step and the next, and why?’ That way, you start challenging your team by figuring out whether an activity is a value-added or non-value added one.”

Equipped with value stream mapping insights, HR teams can then identify areas ripe for improvement. “For example, if it turns out there’s a huge wait time between submitting a candidate to a manager and getting feedback, you can start thinking about how to reduce that wait time,” he says. Szary advises starting small to avoid becoming overwhelmed by the scope of potential change. “Pick the five areas that are most important and where improvement is most achievable,” he says. “Think incremental improvement over time, such as doing 10% better each quarter.”

The team at Rush mapped out every single step in their process from start to finish, then identified any delay time between each one. “It was painstaking, but when we completed it, that’s where we had some of our aha moments,” Kennedy said. “I wouldn’t go down a Lean journey without doing a value stream map.”

The process also helped propel the Rush team’s transition from a transactional to a strategic partner.“To become proactive and consultative rather than reactive takes more time. If we’re bogged down with duplicative effort, waste and delays, we can’t find that time,” Kennedy notes. “We needed to clean up the process so our HR partners could spend face time with hiring managers doing intake sessions rather than waiting to be contacted and told who the managers wanted to hire.” Gaughan added, “You don’t build relationships when you’re transactional. Going through all those Lean pieces builds credibility. Our hiring managers started hearing different language when they talked with our recruiters, and our recruiters were more comfortable offering guidance. Now we are truly being viewed as content experts.”

Leading Through Change

Change management poses one of the biggest challenges for leaders who embrace continuous improvement methodologies. “You have to be prepared to hear from all stakeholders what isn’t working and be open to that feedback,” Carpino says. “And you have to be prepared to have failed experiments in process change, accept them and be willing to try another way.”

Szary points out that providing only a limited number of the best qualified candidates for managers to interview represents a fundamental shift for long-time managers who have always lived by the motto “more is better.” For HR leaders, the challenge is helping these clinical leaders understand that reviewing and interviewing non-qualified candidates is not a productive use of their time. “One of the great things about the Lean process is we can demonstrate how much time can be saved,” Szary says. “In one time study we conducted last year, we saved clinical leaders more than 2,500 hours, the equivalent of one full time employee. What could they have done with that time?”

Building credibility and confidence in the recruiting team goes a long way toward making this cultural healthcare recruitment transformation journey possible. “Hiring managers have to trust what you’re saying and doing and respect you for your knowledge,” Szary observes. To achieve this, recruiters need to do department rounds and spend time with managers to understand the skill sets they need on their team. “It sounds simple, but a lot of recruiters don’t take time to do that, or to build rapport, so they may not have earned managers’ trust,” he says.

Buehler emphasized the need for leaders to be clear about their goals and willing to fully engage staff in the new model. “We had individuals accustomed to doing things a certain way. When we switched from single full-cycle recruiters to a team-based approach, things changed dramatically,” she says. “We had a high performing team so it was not a matter of being dissatisfied. It was the issue of moving from good to great and always looking at what we could do to maximize quality of hires.”

“You have to understand how to lead your team through change,” Carpino says. “In our case, team members experienced change every two months. People need a tremendous amount of support to succeed at this.” At the same time, HR leaders need to honestly assess their team and make sure they have the right people to meet their goals. As Gaughan points out, “We had a transactional team and we knew we needed to become much more of a value-add, consultative team. We did make some changes, and we had all our recruiters complete The Recruiter Academy training to provide them with more formalized training and additional tools.”

Gaughan and Kennedy’s efforts have paid off. “Our team had to get to the point of embracing the change and understanding that we wanted to be the best. We wanted them to buy into that, and they did. We now have a team that looks at continuous improvement, recommends ideas, and is actively involved in the work we’re continuing to do to streamline our processes,” Kennedy says. “There’s never a perfect time to start this journey. You’re always going to have resource and technology issues. You just have to bite the bullet and make the decision to start, knowing that you may have to look at it in phases,” she says. “There may be quarters where you just don’t have the resources but you have to be able to stay the course. Ultimately, we want to improve our customer satisfaction, reduce costs, and improve turnover. That’s a continuous process, not a one-time fix.”


Editorial Note: A version of this article originally appeared in the Spring 2015 issue of HR Pulse magazine, and has been reprinted with permission by the American Society for Healthcare Human Resources Administration (ASHHRA) of the American Hospital Association (AHA). 

To learn more about how to optimize your healthcare recruiting strategy, watch a product tour of HealthcareSource Recruitment Optimization by Lean Human Capital and discover how your organization can embark on a healthcare recruitment transformation journey.* 

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About The Editorial Staff

The Editorial Staff is a team of writers with a passion for helping healthcare organizations manage their biggest and most important investment: their employees.