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I'm sure you remember. It was your first job. You wondered whether or not they would like you. You thought to yourself, "Will I be able to do the job?" Peer pressure seeped in when you walked into the hospital the first time. However, it's not about your skills. It was whether or not the culture would accept you. Would people embrace you and give you the understanding of the "ins and outs" of this particular hospital?

Leadership told you that you would be onboarded, that murky process when the hiring manager pulls you aside and has you fill out all the employment forms as well as to confirm you are up-to-date with your compliance training. Perhaps you get to meet your boss, some coworkers and go out to lunch. How would you be received? 

Where is Onboarding?

The fact remains that onboarding, as a discipline, is often neglected not only in the healthcare industry but also by other industries as well. Little has been said about the onboarding process since usually confined to employment forms and compliance training. The reality is that onboarding is an integral part of the employee lifecycle and can make a difference to whether or not you can stave off the challenges of attrition for years to come.

In the market, the healthcare industry has suffered an average of 28% turnover year-over-year (Note 1). As baby boomers continue to retire, reports show us that two-thirds of nurses over the age of 54 will be considering retirement in the next three years (Note 2). If these predictions continue, it appears that we will be 1.2 million nurses short by the year 2022 (Note 3). The challenge is real and current.  The need to address onboarding is an immediate one.

Let's take Different Perspective

Human Resource scholars from Portland State University, Talya Bauer and Berrin Erdogan, decided that they would assume the challenge to define better and address the lost art (and science) of onboarding.

Bauer and Erdogan define organizational socialization (read "onboarding") as "a process through which new employees move from being organizational outsiders to becoming organizational insiders" (Note 4).  Their conclusions suggested that it is more important to take the time to socialize new employees into the institution early on in their employment history to ensure greater levels of employee satisfaction and organizational commitment, while at the macro level, reducing turnover and increasing personnel performance.  They offer a set of steps that organizations can take to help in the socializing process.  These measures consist of socialization tactics, formal orientation, recruitment and realistic previews as well as, providing organizational insiders as preceptors.

Socialization Tactics

In essence, this step suggests that the organization could intentionally connect new employees into the social structure of the institution. Some socialization tactics utilized, unconsciously, may be described as a "sink or swim" approach in which the employee is made the struggle to figure out the associated organizational norms and how they are to fit in. Though a tactic such as this has been effective to highlight self-directed employees, it is not very predictable in its outcome (Note 4).

An example a socialization tactic that is more useful and predictable is that of providing an activity that brings together current and new employees. Often, the perception of team building is as an activity without an outcome, however, in this case, the journey is far more beneficial than the destination. Having the opportunity to intentionally interact, at a social level, with new colleagues, makes the onboarding experience, not only more useful but also pleasant.

An example of a good onboarding socialization tactic is present at UCLA Health, where new residents are invited to participate in a day long ropes course activity to assist in establishing clear communications and building trust.  These activities also help in the future when teamwork and critical problem–solving skills are required.

Formal Orientation

This particular step is fairly traditional and has a place in the onboarding process. Not only can formal orientations help new employees feel welcome and provide them with the appropriate information for success, but it also shows the employee that the organization is rigorous and well-structured, that it has the best intentions for their success in their new job. Research does indicate that orientation programs can be effective when discussing the goals and the history of the particular institution. Evidence also shows that face-to-face orientation has greater levels of benefit over computer-based orientation when it comes to understanding the job (Note 4).

One hospital in the East utilizes the Wizard of Oz as the primary vehicle to present strong leadership skills.  Each new staff member is required to watch the Wizard of Oz movie before their formal orientation so that they can discuss leadership principals in the movie and at the hospital.  This approach is efficient and memorable when they are in the midst of the hustle on the hospital floor.

Recruitment and Realistic Previews

We have already recognized that social events are essential in the onboarding process, but it should not stop there. Bauer and Erdogan also suggest that a good onboarding process continues to recruit the employee even after the candidate becomes a formal employee. The recruitment process, during onboarding, is not like the recruiting process when discussing a job with the candidate, but more so in providing a realistic view of the job to be performed. A realistic preview encompasses showing the new employee the company culture, in action, and giving them as much accurate information about what is required (Note 4). Often, onboarding processes provide a glossy and unrealistic view of the organization and the associated job, therefore, eroding a proper understanding.   A better approach to this situation is to conduct ongoing job fairs and other cross functional activities so the new employee can continue to embed themselves in the institution and have a more realistic view of what is required.

An example of recruitment and realistic preview come from a national senior living healthcare provider.  Every year, they conduct an operational meeting where many of their 20,000 employees converge at headquarters to hear from senior leadership and take corporate training.  During their stay for the week, there is also a department "fair."  Picture a large convention hall with many tables set out representing the various departments and major projects currently at the organization.  This strategy allows new employees as well as veterans to see what is happening across the groups and potentially provide a vision to serve in different capacities within the company.

Organizational Insider

One of the more significant discoveries of organizational socialization research is the use of a mentor, or preceptor, assigned to the new employee. Having a one-on-one relationship between mentor and new employee allows for specific questions to be answered as well as job instruction, offering social support during the socialization process. Continued research has found that new hires are more likely to internalize key values of the organization, and its associated culture if they attend social events and spend time with an organizational mentor (Note 4).

Meet Steve and Katrina Greer.  Some time ago, Steve contracted Leukemia and admitted to the Penn State Hershey Medical Center (Note 5).  Katrina, Steve's daughter, spent many a day and night at the hospital with her father as he underwent treatment.  Katrina, concerned about her father, observed the nurses take care of him.  Katrina had plans to become an orthodontist, however, after seeing the critical role that nurses play in our healthcare system, she deiced to become a nurse herself.  "Nurses saved my father," Katrina states.  She especially connected with one of Steve's nurses, Angie.  It was Angie's actions that convinced Katrina to take up nursing.  Mentorship is a powerful force.

Though there are many influences in the onboarding of clinical staff in a healthcare institute, organizations must begin to tackle the onboarding process in a more proactive way. As the job market continues to be challenging for healthcare institutions to satisfy their need, these same institutions must take heed to current lackadaisical onboarding processes and take advantage of an intentional approach. By examining these four areas with relation to your current onboarding processes, you may be able to be in a better position to provide greater levels of organizational socialization thus achieving better odds in increasing retention, improving performance and overall employee satisfaction.

Onboarding alone is not the answer.  There are many factors that contribute to attrition and productivity.  It is for that reason that Cornerstone is conducting a four-part series focused on healthcare talent issues.  We would love to have you attend the next session on on October 19th where we will be focusing in on engagement.  Interested? Here is the link to register and we look forward to seeing you there.

Notes:

1 https://www.healthecareers.com/article/healthcare-news/staff-turnover

2 http://www.theatlantic.com/health/archive/2016/02/nursing-shortage/459741/

3 http://www.beckershospitalreview.com/human-capital-and-risk/how-5-health-systems-are-recruiting-retaining-nurses-during-an-rn-shortage.html

4 Bauer, T. N., & Erdogan, B. (2010). Organizational socialization: The effective onboarding of new employees. In S. Zedeck, H. Aguinis, W. Cascio, M. Gelfand, K. Leung, S. Parker, & J. Zhou (Eds.). APA Handbook of I/O Psychology, Volume III, pp. 51-64. Washington, DC: APA Press

5 Cornerstone Client Story: Penn State Hershey Medical Center. (2015). Retrieved September 21, 2016, from https://www.youtube.com/watch?v=c1HsVpXoP4Y