Hunter Colleran:

All right, I think we're at terminal velocity. We can go ahead and get started.

So thank you everybody for hopping on and joining us this morning. Welcome to Rethinking Healthcare Hiring. This will be a discussion moderated by Tim Sackett. For those of you that have not heard of Tim Sackett before or are just meeting him for the first time, he's an analyst and influencer with over 20 years of experience in the TA/HR space, an author of the book The Talent Fix. So this should be a fantastic discussion.

And for those that you who are not familiar with us, Paradox, we're a leading conversational recruiting software trusted by industry leading organizations to source, screen, hire, onboard workers to best solve your employer's hiring challenges.

And for this context, of course, we'll be talking in terms of the healthcare industry. So we're joined with two healthcare hiring veterans, Teri Cayler, Systems Senior Director at SSM Health, and Carlos Fernandez, Director of Talent Acquisition at Houston Methodist.

Just a little housekeeping item before we get started. If you have any questions during the presentation, please type them into the question box in your Zoom control panel and we'll save time at the end for some Q and A discussion. This is going to be a very casual conversation back and forth between Tim, Carlos and Teri so feel free to take participation in your Q and A and enjoy. We are recording this webinar as well, that we will send out to registrants afterwards so that you can rewatch, you can rewind, you can share as you would like. But without further ado, I'll turn it over to Tim. Tim, take it away.

Tim Sackett:

All right. Thanks Hunter. Hey, everybody. We were just, pre-show stuff, which we always should just record the pre-show stuff because that's when all the real kind of magic happens. Because we have three people on, with Carlos, Teri and I, that are passionate about hiring, passionate about healthcare and the mission that's there. And also just the overwhelmingly difficult time that we've had for a long time. The pandemic has made it worse, but it is also not really getting better anytime soon. So we'll talk about all of that. And so I'm excited to have both of you on. Teri and Carlos, tell people, we'll start, Teri, with you, where are you at right now? What part of the country are you in? Where are you coming from?

Teri Cayler:

Yeah, thanks. I'm in Nashville, Tennessee and I support markets in St. Louis, Oklahoma, Wisconsin, and Southern Illinois for SSM Health.

Tim Sackett:

And Carlos?

Carlos Fernandez:

I'm here in Houston, Texas. So we're a system of eight hospitals here locally, seven hospitals, one LTACH, 28,000 employees, Greater Houston area.

Tim Sackett:

All right. So a lot of hiring, big systems. Real quickly, as a percent, because we'll talk a lot about nursing because it seems like that becomes a bigger percentage of all the hiring we make. What percent of hires are nurses comparable to the rest of hiring? Carlos, for you first.

Carlos Fernandez:

Absolutely. Yeah, on average we're about 7000 plus hires annually. So we've been, year over year, exceeding those numbers as we continue our growth. But from a nursing perspective, we're about 30% of our vacancies, 30% of our workforce as well.

Tim Sackett:

Okay.

Teri Cayler:

That percentage would be the same for me as well. We're a little higher in terms of the numbers. We're anticipating in 2023, we'll hit somewhere around 17,000 hires.

Tim Sackett:

Yeah. And again, whether we're doing PT, OT, doctors, ancillary, folks across the board, techs, phlebotomists, it doesn't matter what it is, all of these things tend to have some of the similar issues. We're going to get into some bigger questions, but I'm going to start here with one that is really around secret sauce. And Carlos, I'll start with you. When we think about being a healthcare provider and sourcing great talent, what are some of the things for you that are working really well now, or as well as they could, and then conversely, is there anything that used to work that you guys relied on that just kind of stopped or isn't working the way it should or isn't working the way that it had in the past?

Carlos Fernandez:

Yeah, absolutely. So first off, I think with us being a spiritual care provider, and we serve the community first and foremost, patient care. Our ICARE values, integrity, compassion, accountability, respect, and excellence, are core to what we do from that patient care delivery model. And it carries into how we serve the community, how we interface with our colleagues and constituents. And so that definitely carries into our candidate experience perspective and it definitely is a journey. So we are looking at an iterative process to really drive results from a standpoint of how we engage with candidates from initial sourcing to interview process to then definitely that higher selection process and ultimately becoming an employee with the organization.

So to answer your question, really personalized experience is the direction we're going to really drive that, whether it's a candidate applying to our role, whether they're connecting with our sourcing or recruitment team, engaging with our hiring leaders or ultimately getting the offer to join our organization.

And then just to add to that, as far as what has worked, maybe a direction that we have an opportunity to really drive into is we're certainly the post and prey, which we're so definitely working towards, and then also leaning on our brand. So I think that what that brand looks like and looking internal first within our workforce to really tell the story to the external audiences is one of the other areas we're really looking closely at.

Tim Sackett:

Yeah. Teri?

Teri Cayler:

So I would go single source of immediate satisfaction really relies on mobile and text right now. That's probably the biggest component because we can get that same gurney of needing speed. Those things allow for that instant gratification so to speak.

Tim Sackett:

Yeah.

Teri Cayler:

However, one of the biggest challenges that we're having is just the competitiveness of the market, from a nursing perspective. We seem to be able to get and garner candidates in the other functions, but nursing has just turned around. It's completely competitive. You don't have the ability to post and pray anymore. You've got to spend time sourcing. By retransforming, we're not there yet, but we're working on transforming that app to offer time, that offer to start time, so that each of those are in a very minimal amount so that candidates feel like, "Hey, I applied for a job today and I got one tomorrow," and that's really what they're looking for because it's a gig economy today.

Tim Sackett:

Yeah, for sure. It's interesting when you say that, because the post and pray thing has been around forever. In fact, if that's your primary strategy for recruiting, not just for you guys, but anybody that's on the webcast or that's going to listen to this later, don't feel bad. 90% of the world, that's their primary strategy right now. For the most part in corporate talent acquisition roles, we tend to post jobs. We try to advertise them a little bit, try to get them out on the boards, all that good stuff. And then we hope that somebody sees them and applies. That's what we do.

Now, one of the reasons we do that, and when I was running a healthcare system, a TA leader in healthcare, when I first came in, my average recruiter had 75 recs. That's the only thing I could hope they could do would be post and pray because they were never going to really manage or work those. It's probably the question I get asked most across the board is how many reqs should my recruiter have. And again, it's very company specific, very position specific, very recruiter specific, but in healthcare, what do you think is manageable for a req load for a recruiter where they can actually actively recruit, do that personalization like you talked about, Carlos, and get away a little bit from that post and pray. What do you think that number is on average? And you guys can break it down in any way you want. Teri, I'll start with you. Yeah.

Teri Cayler:

Okay, so I have some very definitive thoughts on this. The first is that it depends on what the journey is, right? If your goal is the journey to be fast and in getting people to the finish line quickly, the req loads have to be low. It's difficult for recruiters to really handle a full desk if they're actually having a bazillion recs. So we are trying to keep our nursing requisitions lower than all the other ones obviously so that they really can truly cultivate what that experience is. And then the ancillary positions are at a higher level. They might be more like in that 60, 65 range, but our RN requisition loads, we want really low. Carlos, I'm hoping you're going to tell me the same thing.

Carlos Fernandez:

No, I 100% agree. We have kind of a grid that we look at, probably similar to Teri. You have those visible positions, whether they're leadership or nursing or really hard to fill positions. And then you have positions where you have high volume applicant flow and it's really more of management of that requisition. But at the same time, you have the clients that you also want to definitely interface with to get to know their departments and really become that true partner and liaison. So the first number that jumped out to me, Tim, was 30 to 50. But as you say, not all requisitions are weighted equally, certainly. So probably that's the kind of general range, but certainly varies by skillset.

Tim Sackett:

Yeah. Go ahead, Teri.

Teri Cayler:

Can I touch onto that too? Because Carlos, one of the things that I see is we've started back into hiring event mode. Right? So forget the post and pray. We may still get 10 applicants for one job, but we really needed 30, right? And so we've found that in person hiring events now are really becoming very popular and people are coming and they're getting a job on the spot and they're able to see the path. I'm curious if you guys are doing in person yet.

Carlos Fernandez:

We are. We're doing a little bit of the hybrid where we have virtual chat, we have in person. It's interesting because it's almost a throwback that we're seeing as we continue and evolve. And so people are really excited about us opening our doors and meeting with candidates in person. We definitely see it on the graduate nurse front. So early nurse professionals to really meet hiring leaders, meet recruiters, meet our organization and be ambassadors as well. So yes, we're definitely seeing a lot of movement around that.

Teri Cayler:

Love that.

Tim Sackett:

It's really funny because I think as we take a look at where the future of TA is going, obviously if we build out a lot of automation within our tech stack using things like Paradox, and they're hosting this, obviously, what it allows then for us as TA leaders is to build recruiters that their real goal is building those deep relationships with candidates. And you only do that by making more phone calls, by seeing more people in person. When I hire new recruiters and they start to work and we have some that will succeed and really quickly, and when you take a look at their actual data, and we're going to get into how we measure success, I always find that the number of connections and conversations they're having immediately equates to success. The activity doesn't necessarily, because I have some recruiters that will go, they're nonstop sending out emails and InMails and all of this other stuff, but they're never talking to anybody in real life.

Teri Cayler:

Pick up the phone, people. Pick up the phone.

Tim Sackett:

Especially when we're hiring younger, Gen Z, younger Millennials, they're still, "Oh no, nobody wants that." And you're like, "Yeah, but would you ever accept a job that you never talk to somebody in person?" It just doesn't happen. Now, the great part of automation is by having that immediate contact with somebody who hits your career site and by having that kind of screen that happens, it allows your recruiter now to have this warm conversation with somebody who's already interested in getting involved really quickly, which I love, but that becomes one of those difficult.

So my buddy, Jim D'Amico, he ran Spectrum Health out of Grand Rapids and now he's actually in Dallas-Fort Worth running Solenis which is a big chemical company. He was the first one that I saw do this where he broke up his recruiters by requisition in teams. And he called them swim lanes for lack of better words, could be buckets, could be whatever, but it was basically three kind of levels of volume, right?

If you were doing cafeteria workers and janitors and patient sitters and all these other things that were high volume, you were going to be in swim lane number three. You could handle that 50 to 60 req load or whatever it is. If you were in swim lane two where you had maybe mid-career, easier, I say easier with a quote, nursing positions to fill, entry level nurses or people that were easier to find, you were in swim lane two. And maybe you only had 20, 25. And then if you were in the really difficult, executive, IT, critical care, third shift, emergency room nurse, whatever that was, whatever that crazy kind of thing was really hard, they might only have eight or 10.

So when we talk about these numbers and positions, people always just want to go, "Oh, well, on average, my recruiter should have 25 or 30 or 40 or whatever." And you're like, "Well, again, you really need to break up your buckets of work." And maybe three lanes don't work for you, maybe you need four or five or whatever that might be, but to really understand the volume it takes for that recruiter to actually fill those positions is critical. And I think that's what's missed sometimes.

So in person events are working really well, and I agree, not only in healthcare, we also see that, we do a lot of technology recruiting. Ironically, it works there too. And I think it works everywhere because they're sick of the black hole. They're sick of, "Oh, I applied on your career site and never heard anything." And yet when I go to an event and I can talk to a recruiter or talk to a hiring manager in person, they don't feel like they're being black holed. Is there anything else like that that you feel is working really well, is worth the ROI that you're putting into it?

Carlos Fernandez:

Yeah, I'll jump in. Teri hit on this earlier. Texting, conversational AI, absolutely, virtual chat and just providing mechanisms. And certainly the tech stack is very key to that, but I think the other piece to it is getting on the phone with the particular hiring leader, recruiter, sourcer, to be able to connect and then be that direct gateway to that role and ultimately the goal to get an interview and ultimately get an offer certainly. But the first piece of that is the interview. So I think that's the important piece of the backend process so that there is that human interaction regardless of the tech stack, because you can have a great technology, but if there is not that follow up piece, there will be challenges around that.

Teri Cayler:

One of the things we did a couple weeks ago, which was super fun, we invited our nursing clinician leaders to come into the bullpen. And we brought our recruiters in, back in that old style day, smile and dial, right? We used Paradox to set up an event. We invited 1500 candidates to sign up. "Hey, talk to a recruiter, talk to a leader today," right? We sent out this list, I think on a Tuesday, and by the following two weeks, we were booked. We were booked. And you had all these people sitting in a room, making those phone calls. And the energy that was there, back in the day of having that, people feeding off of that.

Tim Sackett:

Yeah.

Teri Cayler:

Really engaged the candidates that were there too. It was a super fun exercise for our team.

Tim Sackett:

Another thing that we did that works really well, and you can do this with nursing managers, if you think about every nursing floor or however you guys kind of manage your nursing staffs or nursing management staff, most of us use Outlook. And your IT department can give a recruiter, let's say they had a group of 10 nursing managers that they were responsible for or whatever. It seems like a lot, but whatever. And if you have a great relationship with that nursing manager, what you can say is say, "Look, I'm going to be sending out emails from you to these candidates because they will respond to you."

Teri Cayler:

Right away.

Tim Sackett:

And when they respond, I will respond back as you. And what I'm going to say is, "Oh my gosh, I'm so happy that you're interested. I'm going to connect you with Tim. He's our recruiter. I'm going to copy Tim on this email and he's going to get you and I connected in person right away through our schedules or whatever." And then you go.

We were literally getting 10% responses from nurses as recruiters. And we would get sometimes 60, 70% response rate from nursing managers to nurses. And so it was one of those kind of, again, we weren't trying to be shady or anything like that. We immediately turned it into, "We're going to have you talk to a recruiter." By the way, it was in the nursing manager's email, in their inbox, so they saw it. And then what we would do as recruiters would be every Friday kind of give an update to those nursing managers of saying, "Hey, by the way, I sent 25 messages from your email to these people," just in case it came up in conversation. You didn't want them to feel like they were out.

We had some nursing managers that were like, "Oh, hell no. You're never going to get into my email." Right? And then that was always problematic to me as a leader, because I would go, "You know that's a work product, right? Whatever you're doing in your work email that you don't want us to see, I can see, or an executive could see at any moment." And then they would look at you like, "Wait, what? I thought that was private." And you're like, "No, it's a work product."

But then most of them were like, "Oh no, that's great." And then we started doing that with all of our ancillary type things as well, but it was always kind of one on one and it was for a position specific and we figured out a way to make that work. But again, it got back to that. How do you personalize and scale to be able to have real conversations? And I think that works out really well.

Teri Cayler:

Carlos, we could do that with text.

Carlos Fernandez:

Yes. Yeah. Absolutely.

Teri Cayler:

No, I wouldn't want to do that.

Tim Sackett:

You can for text as well. Same exact thing. In fact, what works really great, because we did this too, is in a nurturing campaign, so that first text might come out from the recruiter and then they didn't respond. And so the next text comes out from the hiring manager or then somebody else, even the CEO you can do. Again, the perception from them is, "Oh my gosh, I can't believe that this director of nursing or the CMO would actually text me a message as a nurse." And again, they don't know any difference, right? Because the response is still happening and coming. It's pretty strong. It's a cultural thing within your organization because you'll have some old school people that would be like, "Oh, heck no. Don't even come near me with that."

Carlos Fernandez:

Yeah. And I'll just add to that. Part of it is definitely that personal touch. And then the other piece is where can automation come into play? So definitely staying engaged with candidates, candidate drop off. And candidates have a number of opportunities in this environment. And so where can we definitely position our sourcers, recruiters, hiring managers to connect with talent, but then also be able to then have that backend process to be able to keep candidates informed ultimately. Whether it's self service, they can go in, "Okay, this is where I am in the interview process." Or, "By the way, John, heres here's where you stand in the interview."

Teri Cayler:

You'd have to be careful if your list had employees in it so you're not trying to recruit your employees again.

Tim Sackett:

Yeah. There's always some data stuff there, right? Real quick level set for everybody that is on. If you have any questions, you know the drill, it's Zoom, there's a Q and A button at the bottom, click on that. Put your question in. We will try to address those if we can during or we'll get to them at the end, but please feel free to get us.

So we started talking a little bit about numbers and data, and I know we want to talk about how do we determine the recruiting data around what determines TA success. And so I'm going to start with that conversation, even though it was a question we thought we kind of pushed down, but we've already kind of opened up the door to it. So Teri, I'll start with you. Give us the two or three most important data points that you look at for determining TA success in the healthcare environment. And my guess is it's going to be any environment, but we'll start here.

Teri Cayler:

Yeah. 10, 15 years ago, it was all time to fill.

Tim Sackett:

Yeah.

Teri Cayler:

It was time to fill. And how many hires did you do this year? And now I think it's a partnership between the org to get people to day one. Right? And so now to me, I think the most important measurement is being able to see the SLA process. How quickly did we review them? How quickly did we get them from the hiring manager and how quickly did we get them an offer? And then from offer to start, did we have barriers that are in the way that didn't get them to day one in time? And so I think every one of those are the most important measurements that we have today. And that highlights the partnership between the hiring managers and the recruiting team.

Tim Sackett:

I like to call that a hiring velocity where you're almost working backwards, right? Where your recruiter and the hiring manager are getting together and saying, "Hey, when do you need to fill this position by?" Of course, every hiring manager is going to go, "Yesterday," and you're like, "Shut up. You're stupid." I can't make that happen. Even if we post the job and we find a candidate and we interview and they put their two weeks in, if you start putting that timeline together, you might go, "Oh, okay. If today is, what is it today? August 25th. Maybe we can get there by October 25th. 60 days. Whatever that might be."

But then you start working towards that date because now that you have that shared kind of ownership of, "Hey, hiring manager, you have to give me those dates to be able to get interviews in." And our operations people have to work harder and our vendors that are checking backgrounds and drug tests, all that stuff has to work better. Right? So everybody has a piece of it. There was zero correlation to, "Oh, we went from 37 to 36. We were so much better." You're like, "No, it means nothing. There's no correlation you're better because you dropped one day.

Teri Cayler:

Well, and Carlos and I were talking about this a couple of weeks ago. By now highlighting that data for the hiring managers, they're more apt to actually help get us to that door because they see that there's actually some ability to understand what the timing is and how they impact it. Carlos, this was a big deal for us. What do you think about that?

Carlos Fernandez:

Yeah. And I think, Tim, you hit on previous business cases to CFOs and such. It's all about the hard costs, right?

Tim Sackett:

Yeah.

Carlos Fernandez:

In this environment, it is something that really is telling because it is hiring manager investment. It is that vacancy cost to the organization, especially on the clinical operations side. And so that definitely adds a layer to it.

I'll just add too, Teri, a couple kind of different metrics that we look at is applicant drop off rate is really big for us because it's telling the story of how likely are applicants completing their application once they start the fullest process. It tells us on our tech stack how successful we are from a tech stack perspective to be able to ultimately engage with candidates formally. And then the annual surveys that we conduct. We partner with an outside organization to gather intel of the experience from candidate perspective, whether they're selected, not selected, hiring manager feedback, especially in the last couple years and such with different positioning, having to rescale positions, reset positions, repost and in some cancel positions altogether in this environment now. So those are some telling stats that we look at.

Teri Cayler:

And I would also ask, Carlos, when we think about that and those additional measurements, when you're looking at candidate drop off, are you taking the where on the drop off to understand, "Hey, how can we fix these pieces?" Because that's one of our biggest challenges today is understanding, "Hey. Yeah, we have the tech stack that's showing us the where, but are we nimble enough as an org to be able to make the changes that are needed?" And that's where our rub is happening right now. What about you?

Carlos Fernandez:

Yeah, we partner with an outside agency on monitoring where the frequency of applicants are coming from. So whether they're going from SEO or search engine or whatnot, or they're coming directly to our career site or our consumer site, it's interesting because probably the top four sources for us at the core are, I won't say, but one of the job boards, it's a big four job boards, but then we have certainly the search engines, you have our consumer site, our direct career site. And so it's more and more, we're seeing that traffic rather than them coming from a specific job site, coming directly from different searches that they're conducting. And then we can see that secondary source of where they, they might not apply that first time, but that second time they'll say, "Oh, that's right. Houston Methodist is where I want to apply," and go through that route.

Teri Cayler:

But what about the journey? So when they're actually in the door, right? So you're interviewing them and maybe they drop. Because we're seeing a lot of drop off happen after the offer and before the start. And so are you seeing that? And if so, what are you doing to combat that?

Carlos Fernandez:

Yeah, one of the things that we are doing is we've kind of built in through our ATS to have that automated text around positioning. So when a candidate's in process of receiving an offer, once they've started their pre-boarding process and then ultimately when they completed their pre-boarding process, so that really front door, they have that full intel of where they stand in the process.

Teri Cayler:

Oh, yeah.

Carlos Fernandez:

Additionally, they can go in through their application and see, "Okay, I'm interviewing, I'm selected. I'm not selected," but ultimately, if they have interviewed, our goal is to connect with them on the phone and kind of give them a heads up of where they are.

Teri Cayler:

Tim, he nailed it.

Tim Sackett:

Yeah.

Teri Cayler:

The transparency of knowing where they're at in the process is what people want today.

Tim Sackett:

Oh my gosh, so much so. Yeah.

Teri Cayler:

You can see it everywhere. Yeah.

Tim Sackett:

Carlos started off with, "Oh, we're really trying to get personalization." What we know today, personalization is not some jammed spam email that has your name in a different font at the top of it. That's not personalization, that's spam, and people hate that.

Teri, you had made a comment about SLAs. And I think when we see what Paradox has done to high volume hiring, is we traditionally had SLAs that were like 24 hours, 48 hours. We're going to get back to this candidate. And that was even difficult to do. But now when we have some of the high automation that's put in place with conversational AI, that SLA has become literally 24 to 48 minutes. And I say that just because we're making an equation to the day, it's really immediate. And I'm wondering when did we start thinking every single position we have, they're going to want, or they're going to desire that expectation of having somebody connect with them right away and tell them. Because the moment they're interested, and it could be Sunday night at 9:00 PM, you have an emergency room nurse that just got off a shift that's sick and tired of working for her hospital. She's ready to go over to your hospital. And if you wait until Monday afternoon or Tuesday or whatever, at that point, that interest might be gone. Right?

So how do you connect? And I think that's one of the things that a lot of this new technology has done. Have a really good question that I want to give to both of you from Andreas that came in and part of it's why did they decide to make this leap to the future of hiring, especially through a Paradox and that kind of automation? I think the real question there, it's how do you get your, because historically healthcare has been really kind of a laggard when it comes to, especially around talent recruiting technology. How did you guys get your organizations to make that decision to say, "Hey, we have to move." My guess is obviously there's business reasons there, but I want to hear it from you guys of how did you guys make that leap? Because there are still so many healthcare organizations that are not there yet.

Teri Cayler:

Carlos, do you want to go first?

Carlos Fernandez:

Sure thing. I think we're fortunate in that we have support on the innovation side. One of the business cases that our leadership and we worked with our operations side is we have a center for innovation at our hospital. So part of that R and D certainly to be able to explore, pilot, it's a fail fast, learn faster, adapt faster environment that we positioned as an organization. And so one of those certainly was around how to connect with candidates more efficiently, more effectively, how can we really identify opportunities on the TA and recruitment side? And so that's where the business case came about. And we were able to position it definitely through Paradox and our team as really a supplement to our process and really engage with the recruiters early on in the process so that this isn't something we're replacing anything from a process standpoint. We're supplementing the process to be able to enhance our delivery.

Teri Cayler:

So I would piggyback off of that. I think that's exactly where we are too. We have a very supportive organization that says, "Hey, we want to be first and we want to have the technology to be able to support it." But I'll tell you, when we implemented Paradox's scheduling component, I think it was last year, we did kind of a re-implementation with some changes that we had within the org earlier this year. And we went anywhere from two to three days to three minutes as an average response time by using the scheduling component through Paradox. You can use it in any organization, there's plenty of them out there, but getting your team to understand the importance of speed is really, really important when yet to have a tool like this.

And so really for us, it was training. We needed to train them around that, but it answered our hopes and dreams and wishes better than we could have expected. We were expecting to see, "Hey, go from two to three days to 30 minutes." And I think it did that in the first week. And then once we were actually rolling with it, we were seeing three or four minutes. And in addition to that, I think 79 or 78% of the people that we invited to schedule were actually doing so. And so that's a pretty great number.

Tim Sackett:

That's amazing. Yeah. I think when I first got to the health system, I was at typical, traditional dinosaur level, senior executives who were doctors who thought they were God. We all run into those kinds of traditional healthcare executive teams. I think as we see it today, a lot of those are advancing more and being more business like.

One of the things I had to do was first get somebody in finance on my side. So I invited them to lunch. That's the great thing about being in the HR community, is if you invite somebody from another function to lunch, they come because they're not exactly sure why. They're like, "Wait a minute."

Teri Cayler:

What are you going to ask for?

Tim Sackett:

"It could be a promotion. It could be I'm getting fired. I don't know. I'm just going to go." And then we did the same thing with another peer from IT and then from marketing out of our organization. And the four of us then had a monthly lunch and we would come back and kind of level up to our executive VP, senior VP types of what we were actually talking about and doing. Because what I needed was I needed a priority in IT. I needed a priority in finance. I needed all these people that were going to be my champions and back me to say, "Hey, we have hiring problems and here's what I need to fix it."

And if it was just me saying it, that could get lost, but if it was everybody else in a room going, "Oh yeah, and here's why. Here's how we can help." And all of a sudden those things kind of come together. So it's also trying to break down those silos that we see traditionally across healthcare and figure out how do we all come together for really that mission of we're here to save lives. We're here to make lives better. And we only do that if we find great talent and keep great talent working for us. And I think our CEOs get that, but they don't get how to do it. They get the concept, but we need people to do it underneath that.

All right, so I want to keep talking a little bit about data. One of the things, Carlos, you talked about, was measuring the drop off. I will tell you, I would guess 80% of organizations, not even in healthcare, across the world, have no idea how many people are hitting their career site and dropping off. If you don't have that basis, because what they'll say is, "We need more applicants." And you're like, "No, you don't need more applicants. You need to convert the applicants that are actually interested in you that you're just letting come and go without any idea that they're actually there." So that's part of that conversation, because you would be amazed, once you know how many people hit your site, all of a sudden you're shocked at how many you're converting.

The other one that I like is from the number of applies, the percentage of apply to interview. What I want to say to my recruiter and to a hiring manager if I have them sitting in front of me is that should be 100%. If a recruiter finds somebody, screens that person and sends them to you to think you should interview this person, there should be no hesitation. You should be, "Yes, I want to interview that person."

Teri Cayler:

That's right.

Tim Sackett:

But we still have this old school mentality of, "You send me three or five. I'll pick one or two." And you're like, "No, there's so much waste in that system." Because you're saying, "No, wait a minute. I sent you five good ones. Why wouldn't you interview all five?" Or, "I sent you three good ones." And we have too many hiring managers that just think there's an endless flow of more candidates coming down the pipeline. "Oh, you sent me 10. I don't like them all."

Teri Cayler:

Yeah, and it's waste.

Tim Sackett:

It's waste.

Teri Cayler:

It is.

Tim Sackett:

It's complete waste.

Teri Cayler:

And then not only waste, it's also one of those scenarios where you've got, "Hey, if you don't interview this person, what happens when the person you just interviewed and offered says, 'I got a better offer', and now you've got to start all over?"

Tim Sackett:

Oh for sure.

Teri Cayler:

Why?

Carlos Fernandez:

Yeah. Absolutely.

Tim Sackett:

We always put that goal at 90% so I'll give them one out of 10 that a hiring manager might see the resume and go, "You know what? I actually know Carlos, and I've worked with somebody else that worked with him and he's not going to be any good," whatever. I'll give them one, but as soon as that percentage goes under that, I love to bring in the hiring manager alone with just me and say, "Hey, it looks like you're app to interview percentage is around 50% with this recruiter. I wanted to talk to you because I'm getting ready to let that recruiter go because they're so bad." And they go, "Whoa, whoa, whoa, whoa, wait a minute. They're not bad."

They don't understand that waste. They don't understand, "Hey, this person's actually going through." Now, if the hiring manager would go, "Well, yeah, they're posting and praying. They're getting a bunch of resumes and just shoving them to me and they have no idea if the person's good or not." Okay, well now we have an issue, right? Now we have a problem that's different.

For the recruiters that are on this and watching, I never use data as a hammer. To me, data's all about development. If you only have a 30 or 40% app to interview ratio, how can we help you make sure you get that to 90 or 100%? How can we develop you to get you to be able to get more of that stuff through the funnel? And I think that's where people want to feel like they're being micromanaged, but that's the only way we know the true capacity of our teams. Thus, as leaders, we can go back to the CFO and ask for more stuff. Here's the data. Otherwise, we have this thing of, "Oh, we're just going to work harder." And working harder is not a TA strategy. It's a strategy for failure from that standpoint.

Carlos Fernandez:

Yeah.

Teri Cayler:

And it's not like we have an endless supply of candidates either. We are in static markets. It's not like we just have people passing through saying, "Can I get a job there? I'll stay." That's not how it works.

Hey, one thing you mentioned earlier, Tim, is you said something about the organization struggling to turn on that process and that thought process. I think some of that is also because the organization is used to taking, and organization, I mean hospitals. So hospitals are used to taking care of their employees. I've never worked for a hospital company until now. And what I learned just through the onboarding process, they want to make sure we got vaccines. "If you need your vaccine, come and we'll take care of you. You can come to our hospitals and our places." And I think that the struggle is the gig economy where they don't necessarily need slash want benefits and the organization saying, "Let me take care of you." And I think that is where we're struggling to come to terms with those applicant numbers because of that.

Tim Sackett:

Well, we definitely have to be a little bit more unique in our comp philosophy and practices because not every employee wants the Cadillac benefit plan. Some do, and that's great, and that's been traditionally what we did in healthcare. You will not have better health insurance than if you work for a health system, but if you're an IT person that goes, "No, I'm really just looking to work on this kind of new project or this new build or whatever for 18 months and then I'm going to be out," it's not about all these other ancillary benefits he's going to get. It's about, "Hey, I need cash." And we have so often struggled with that.

We wanted to talk about long term kind of solutions of nurse recruiting, building sustainable nurse populations in the future. And then is there kind of similar ancillary health professional issues, which we know there are, but how? Carlos, I'll throw it to you first, what's the long term solution for us to get out of this problem?

Carlos Fernandez:

Well, I'll have to echo Teri, is really we have to compete with the external staffing agencies because that's where our talent is getting picked off in some cases. And in some cases, it is kind of that more, I wouldn't say short term, but just a different mindset for different candidates. It might be, "You know what? I need to go on that project." Like you said, Tim, "And go through that implementation and then maybe I'm ready for my next role." And we need, as employers, challenge ourselves to create those opportunities.

I'll tell you, one of the gaps we have is we have our time and attendance system. We can only have one position for each individual. So if I'm a nurse, I want to pick up an extra shift at a different campus in a different role, I have some limitations beyond that. So those are some nuances that we have that we definitely were looking into technologies to definitely account for that. But I think that's one nuance that we see. So for the long term future, it's positioning it for say I want to pick up an extra shift, I want to work on the weekends, evenings, et cetera, in addition to my standard, to do that dual weekend shift as well.

Teri Cayler:

And I love that you said that because fortunately we don't have that limitation, but it's a perfect example of how we're having to compete with those agencies. So they'd get a job with us and then they'd go pick up an agency here and they'd pick up an agency there. And I think we as an org, and I'm proud of us because we're actually designing some solutions that can allow for multiple PRN or float opportunities, but in that process, we're having to relearn and reengage on how we sell it.

Tim Sackett:

Yeah.

Teri Cayler:

"Hey, you let go of your contract with your agency? Great. What happens when you finish your 12 week assignment with us?" So we have to have a plan for that.

Tim Sackett:

Yeah.

Teri Cayler:

And so we're having to rethink what that looks like within this organization.

Tim Sackett:

Well, it's the crazy part of saying you had a traveler nurse for maybe one season that was making whatever, and for argument’s sake, let's just say it's 50 bucks an hour, and then they took off and then they come back and they're like, "Oh, I'm willing to come work for you outside of agency." And you're like, "Oh, okay, well we're willing to pay you 35." And you're like, "Well, wait a minute, I can just go work for the agency at 50." And so it's one of those weird kinds of things where we have to be able to give, saying, "Hey, they only want to come. They don't want benefits. What's the value of all these other things?"

I actually had a CEO of a health system start their own staffing company because he couldn't get his HR and comp people to figure this out. So he's like, "If I'm going to give up 30% margin, sometimes more, 50% margin, I'm just going to have our own staffing company. We'll own it. We'll have them run it. The travelers will come through them. At least I'll still make the money." And he's like, "Because it's dumb that we're just giving away money because we can't figure out internally how to have all these different kind of rules and segments and stuff like this." I think that's one. The traveling thing has gotten out of control. There's a lot of people making money on limited money that we have in terms of reimbursement. And so we have to try to figure that out.

Teri Cayler:

They are dropping too. So what we've seen, and Carlos, I'd love to hear your thoughts on this, but I know we, and some of our markets, dropped agency rates that we would be willing to pay. And so you're taking a risk, right?

Tim Sackett:

Yeah.

Teri Cayler:

Are they going to go somewhere else? But in truth, by many hospitals saying, "We're done," then we've been able to see some of those fruits. Not enough.

Carlos Fernandez:

Yeah.

Teri Cayler:

And there's still agencies out there, but we're seeing some of those. So Carlos, I'm curious where you're at on that too.

Carlos Fernandez:

Yeah. We are putting incentives definitely to our workforce to be able to match up and be more competitive, whether it's different premium pay or sign on bonuses and et cetera. So we are kind of positioning ourselves to start moving the needle on transitioning there, but it does exist within our organization. And it's something we're looking at. The long term could be, "Hey, this is the new normal." We have a percentage, but definitely high volume is among us in the last couple years.

Tim Sackett:

Yeah. I wouldn't think that you would ever fully get away because there's capacity issues. There's ups and downs. We've seen this. So you have to have a percentage of your workforce that's going to be contingent from that standpoint because you need that.

One of the things that I've found, the biggest struggle when I first came in was that HR under the umbrella of TA, we had no control or visibility to our traveler spend and it was all done through each unit. And so I had to go down and really kind of sit with the CFO to figure out how do I bring all of that spend into TA, because what I'm theoretically saying is that if I have $3 million in traveler spend, is a $3 million mistake in TA because we can't actually find these positions? So for every dollar I reduce of that three million or whatever that number is, I should then be able to give that into the TA budget to get the right tech stack I need or whatever. And so if I go in one year and say, "Okay, hey, I went from three million to two million," theoretically to my CFO, I should say, "You owe me a million dollars for my tech stack and my team." Now, we know that won't happen, but...

Teri Cayler:

I was going to say, "Good luck."

Tim Sackett:

It makes a really great conversation, but I can't have that conversation at all if I have no idea what that spend is in the organization. And so I tell people all the time, heads of TA, heads of HR, you need to control that spend, not just for that, look at all the consultants that are being hired in IT or all those kind of outside types of influences that are because we don't staff appropriately. We're having to spend exponentially more money to get external talent coming in. Once I know every single person, this is actually how we started, is I went to security and said, "Any single person who has a badge that can be in our hospital, I need to know. I need to know every single person in my barn." And then I could actually break those up to say, "Here's my own employees. Here's the health system employees. Here's agency employees. Here's consultants. Here's this. Here's that."

And then I could really figure out which one of those could I control and then going to the CFO and getting budgeting changed. So I say, "Okay, now if a nursing manager or a PT manager, leader, whatever needed to hire a temp or an agency person, they had to come through and get approval through TA to do that." And that became a different conversation, right? Because it was like, "Well, wait a minute, why?" And you're like, "Oh, well that recruiter's had that opening for 180 days and didn't fill it. That's why." And you're like, "Okay, now we have a real conversation to take place."

Teri Cayler:

We are regularly having those conversations. We're still setting those parameters. I'm a little newer to SSM Health so we're going through that process right now. Fortunately, our workforce planning group has done a good job of setting parameters of what that looks like, but that's going to evolve for us over probably the next 90 to 180 days.

Carlos Fernandez:

Yeah. We're in the same situation. It definitely is a collaboration effort with definitely our workforce analytics and our different sites really owning the number of agency workers that they have at each of their campuses.

Tim Sackett:

The only reason I even talk about it was because I was constantly in the situation of not being able to have enough resources in TA that I thought we could be effective. And I'm like, "Well, wait a minute, we're spending all this money because we're not effective. If we spend less of that money, then that should be able to come back to TA." And I think it's a great way for us to sit down and have a really educated business conversation with our CFOs, with our CEOs, to determine how do we go out and get this great technology? How do we go out and buy the Paradoxes of the world to be able to get this kind of immediate reaction or relationship with a candidate?

Longer term, we have a problem. Demographically, we have a problem. We're not growing enough nurses and doctors and PTs and OTs and everything else in our world. Is there anything we can do through immigration, through government regulation? Where are you guys trying to get your organizations to lobby to have a longer term impact?

Teri Cayler:

So we actually are just building and rolling out the TA org and what that's going to look like. Traditionally, because you had the post and pray and it worked for everybody, you really didn't have a pipeline development team. You might have a recruiter who builds his own pipeline, but you didn't have that person who really filled the pipelines.

So what we're looking at is a workforce development team and that team will have sourcers. They will also have college recruiting will sit underneath that. And we'll also have a pipeline development. So international nursing is going to sit there. All of those pieces that will fill the pipeline and allow recruiters to pull from it will make us more successful in the long run. Earlier, Carlos and I were asked the question about, "Hey, how do we make that leap into the future of healthcare hiring?" Well, we did it by saying, "Hey, what does the future need?" And right now, since we know we're not growing enough nurses, we have to pad the pipeline with anything we can put in there. And so having a team to be able to support that is going to be really, really critical.

Carlos Fernandez:

Yeah.

Tim Sackett:

Carlos?

Carlos Fernandez:

Oh, sorry. I was just going to say graduate nursing, how we create that experience for early professionals looking to build their careers is very critical. Right now, nursing is probably at the top five of professions out there potentially depending on what publications you're looking at. But from that standpoint, we need to differentiate ourselves as employers to create that experience. Just like we are with those hard to fill positions.

And right now, we have three cohorts annually that we look at to promote our different opportunities across our campuses. And so what we're working on is really creating experience in person, virtually and simplifying the process ultimately so that it is that one touch process, whether someone applies at our Willowbrook Campus versus our Sugar Land Campus versus our Baytown Campus. And then be able to express their interest and then ultimately get a hire on the spot. So we are working through that, but I think the future is definitely those early professionals providing certainly that farm system, if you will, that pipeline, and definitely going where the puck is going, not where it is currently.

Tim Sackett:

Yeah. When you speak to higher ed, clearly they're like, "Look, we have more capacity to put more people through the pipeline, but we don't have educators." And I think that's where we, as healthcare leaders, have to figure out how do we figure out some kind of pseudo relationship between, we all have relationships with universities and all of this stuff, but the question would be is how do I keep that nursing manager as an employee for two or three days a week, but they can also be a nurse educator for two or three days a week over at the health system and still maintain all the benefits and everything else that comes from that? And more and more, it seems like that's the struggle. And we just have to get really innovative.

And I think one of the issues, when I talk with senior executives within health systems, they're like, "Well, Tim, if I give up, let's say, 10 nursing managers to go be educators and go through this process and working in both and blah, blah, blah, then the health system across town is just going to take advantage of that and take all those nurses." Okay, well then how about we all just come together and they give five and you give five and they give five. And knowing that, at that point, then it becomes your brand and how you treat people and your culture and all that. And we'll put it on that, but the answer is not to do nothing, right?

This isn't a healthcare issue. This is every industry right now is we've just done a crappy job of building our own. If we go back in history, we used to have all the apprenticeship programs and we would build our own. And now we expect higher ed and high schools are going to build employees for us, but they don't. We have to take control of that. And to me, I think TA owns that. I think TA has to find a way of how do we come together? And if there's four or five or six or 12 health systems in your area, how do we come together as TA leaders and have this kind of summit to figure out how can we do this that makes sense? Is everybody always going to come out equal in this? No, but at the end of the day, we have to flood the market with more healthcare professionals and we're not doing that now.

So we have about five minutes. If anybody has a question, please bring it in. Did you guys have other things you want to share while we wait and see if any questions come?

Carlos Fernandez:

I just want to say, Tim, that was a fantastic point because one of the things that we're looking at is those grant programs, apprenticeship, upscale programs here locally, collaborating through different organizations with our competitors down the street to be able to provide early professionals, whether it's nursing, whether it's nursing support, what we call PCAs, patient care assistants. And different grant programs to be able to build cohorts within that to establish part of our farm system as well if you will.

Teri Cayler:

I would just tag onto that too. One of the things Carlos talked about in a prior session was really about smart hospitals too. So we have to get back to the technology front as well, because we have a real lag in some of those professions to be able to support the technology that's coming out in the actual facilities. So just a thought.

Tim Sackett:

No, Teri, I think one of the misses that we see, and I see this in government too, because I hear from a lot of government organizations that are like, "We can not get IT people to come work here." And health systems, and even in higher ed, which seems silly, they can't either. But to me, the health system thing for the IT is really being able to sell that mission. When you're coming in, and yeah, you might be a backend developer of whatever, you might be a database something, but at the end of the day, everything you're doing is coming back to that mission of saving lives, making lives better and extending life, whatever that might be.

We do a great job of that to the people who already know the mission, but to all those people who don't know the mission, all of those accountants and IT people and people like that don't really get it, because when I first came in as a TA person into healthcare, I just thought, "Okay, another TA job. I've got to fix this thing. We've got to make it." And every day when I got up, I was like, "I could hire somebody today that's going to save a life." And that's super powerful. And I think we don't get that message enough out to the people who are non-healthcare providers that we rely on, I think, within our health systems.

Really quick question before we leave, came in from Christina. Thank you so much. "Is there a specific place within the recruiting process where automation has been most beneficial for you guys?"

Teri Cayler:

I'll let Carlos go and then I'll go.

Tim Sackett:

Okay.

Carlos Fernandez:

Yeah, for us, it's on the sourcing side, to really help us connect with candidates through automated scheduling, the leg work, what we call administrivia here locally. So taking that off the recruiter's plate and really help them do what they do best, connecting with talent, engaging with their hiring leaders and getting themselves motivated through making offers and hires. So as much as we can take that off the plate, that's where we want to go.

Tim Sackett:

Excellent. Yeah. Teri?

Teri Cayler:

I would say the exact same thing.

Tim Sackett:

Yeah.

Teri Cayler:

It's insourcing. If we can get rid of the administrivia, that would be great. And that's the best word I've heard of all day.

Tim Sackett:

Yeah. And again, it goes back to being able to measure who's coming in and how fast and quickly you can get them. Once they're interested, just make it, it's completely idiot proof for them to show your interest and your interest at them and make it happen.

All right. I want to thank you guys so much for all of this. If you have questions and we didn't get to them, Paradox will actually get those, we'll answer them, we'll send them out in email. They love doing that kind of stuff because it's extra content for them. And then also we will send out a recording of this if you missed anything for sure. So I want to thank everybody, obviously, Carlos, and then I'll get to you Teri. Carlos, tell people how they can connect with you easiest.

Carlos Fernandez:

Absolutely. They could either connect with me on LinkedIn, Carlos Fernandez, Houston Methodist, or send me an email and I'll probably share it with the Paradox team and we can connect from there.

Tim Sackett:

Perfect. Teri?

Teri Cayler:

The same. LinkedIn is probably the best place. I do try to get to everybody who sends me messages. It might take me a day or two, but I do. You can also send me an email and Paradox has that for you.

Tim Sackett:

Unless you're sales people are trying to sell them stuff, stop doing that. It's cheesy to connect and also do the sales pitch at the same time.

Teri Cayler:

The worst is when they send you an email that says, "I emailed you three days ago. Do you not want to talk to me?" I'm like, "Ah, you're killing me."

Tim Sackett:

Yeah. And it's not even them, it's their CRM, which is so bad.

Teri Cayler:

Yeah. There you go.

Tim Sackett:

All right. All right. Thank you guys so much. We could have this conversation every quarter and just talk about other stuff because this has been amazing. I could talk with you guys for hours on this stuff. And thanks Paradox for putting this on and we hope you guys enjoyed it. Thank you so much.

Teri Cayler:

Thanks everybody. Take care.

Carlos Fernandez:

Thank you everybody.