Predictive Indexing: Reduced Turnover Enhances Health Care Quality and Profitability


Visiting Nurse Association of Northern New Jersey, Morristown, New Jersey.
Agency Description:
The Visiting Nurse Association of Northern New Jersey (VNA) pioneered the concept of home health care in its region in 1898 when the agency’s first nurse set out on a bicycle to assist residents of greater Morris County area. Since that time, VNA has been at the forefront of addressing major public health concerns and has established itself as one of the state’s leading comprehensive home care providers. In fact, VNA made more than 144,000 visits last year and achieved patient outcomes and satisfaction levels that were among the best in the state.
Strategic Partners:
Elizabeth Faircloth, Vice President of Augur Inc., a PI Worldwide Member Firm. VNA embraced the use of the Predictive Index (PI), a scientifically-validated tool that accurately and efficiently reveals key characteristics and traits which are indicators of compatibility with specific workplace roles. In fact, the Predictive Index provided the critical element—the personality measure—needed to fully execute and realize the benefits of Scott’s Clinical Ladder. Scott’s Clinical Ladder is designed to recognize and motivate ongoing development of expertise and professionalism of nurses.
Project Description:
In recent years, VNA has confronted challenges common to all health care organizations including third-party reimbursement constraints, uncertainties related to health care reform, and a shortage of nurses and other skilled health care professionals. With an annual nurse turnover rate slightly below industry averages at 17 percent, this could be attributed to external factors such as the competitive local employment market which encompasses nearby New York City and the prohibitive cost of living where VNA is headquartered in New Jersey's most affluent county. However, the executive leadership of the organization conducted a rigorous review of internal factors contributing to turnover with the goal of finding means for improvement.

That internal review examined how the nursing shortage was impacting retention, succession planning, productivity, profitability, and patient satisfaction. It identified that employee behaviors which contributed to the turnover included a lack of motivation and disengaged staff. The review quantified additional operating expenses and waste resulting from high turnover and determined that higher recruitment and training costs, and financial incentives were not solving recruitment gaps.

Several initiatives and solutions were implemented in the aftermath of the organizational review, including a proprietary Clinical Ladder designed to more clearly delineate nursing competence levels. These tools established a foundation for stronger recruitment, retention, and employee development. However, the turning point was the introduction of the Predictive Index which ultimately allowed VNA to "connect the dots" and integrate the Clinical Ladder and other missing elements into its hiring practices. Most importantly, the PI assisted the organization with establishing a corporate definition of talent.

To introduce VNA to PI, Faircloth led a Predictive Index Management Workshop where HR and senior managers completed the assessment themselves and then learned how to interpret and apply the behavioral insights derived from its use. The group was also trained in Performance Requirement Options (PRO), a job analysis tool used to define behavioral requirements for specific roles. In fact, VNA integrated the PI results of several top performing nurses with PRO results to determine the best job model for that position based upon behavioral characteristics common to all of the successful nurses such as lower levels of dominance and a strong desire to abide by the rules.

Using this data, hiring managers now quickly and accurately compare a candidate’s PI to the job PRO and conduct a fit-gap analysis. "PI prompts all parties involved—the candidate, the hiring manager, and senior management—to collectively recognize what a candidate will bring to the table and what training, mentoring and support will be required," observed Lisa Salamone, VP, Chief Operating Officer. “We've also discovered that when gaps are detected using this process, it does not immediately disqualify a candidate. It creates awareness and gives us the ability to talk openly about potential concerns and challenges.”

VNA now requires job applicants for all positions to complete a PI. All interviewers are provided with a copy of each applicant’s PI and a PRO and that information has made it much easier to reach a consensus about each candidate and make joint hiring decisions.

As a result of this success, the PI and the PRO are now being integrated into an array of other HR activities at VNA:
  • Customized PROs are being successfully used to staff some hard-to-fill positions such as nursing roles with the burgeoning private care division which require an ability to work with clients who fund their own care and thus can sometimes be demanding because they are unconstrained by third-party payer and insurance plan standards.
  • New hires and employees are being groomed for management positions based upon PI results since those who demonstrate slightly higher levels of dominance are likely to require advancement to management roles to remain engaged in their work.
  • New hire orientation is customized based upon PI information that affords VNA team leaders with a greater understanding of their new colleagues’ behaviors. For instance, a leader may amend how he or she communicates or delegates to better align with how an individual learns and functions, thus making the onboarding process much smoother.
  • The PI is used to optimize the employee review process. By reducing subjective content, it facilitates more productive discussions and allows managers to more effectively deliver feedback in a non-judgmental manner that employees prefer. Since evaluations are given at the end of a new hire’s introductory period and again annually, managers use the PI to track the fits and gaps between the individual and their role so they can establish a roadmap for coaching and mentoring.
Since the introduction of PI, the VNA has experienced some dramatic improvements:
  • Employees are being successfully groomed for promotions into leadership roles and strategic positions are no longer left unfilled.
  • In a highly competitive nursing market, candidates under consideration by VNA are impressed with its dynamic hiring process and excited about the prospect of working there. 
  • PI has been the catalyst for new initiatives including a program for recent university graduates. The PI has been instrumental in helping VNA assess job fit/performance for a new generation of workers who have not yet acquired robust work experience. It also supports the onboarding and career planning process for this new generation by offering insights into how their motivation, communication patterns, and behaviors differ from older, more experienced colleagues.
  • VNA is studying how PI can help to sustain its exceptional client satisfaction rates and patient outcomes. Client feedback is being used to identify staff behaviors, such as extroversion and patience, that enhance staff/client interactions and that data should help managers bridge potential gaps in the delivery of outstanding patient service.
  • PI has allowed VNA talent to align with positive attitude in the workplace.  Also, the PI has created healthy competition for upward mobility among staff. There is a clear demonstration of higher capacity of each staff.
Outcome Measures:
  • Clinical turnover rates are now substantially below national averages.
  • Turnover dropped by more than 50 percent from slightly more than 17 percent in Q1 2010 to less than 8 percent in Q1 2011 and has maintained a consistently lower rate through 2012.
  • A record low turnover rate of 5.3 percent was achieved in Q3 2011 while the national average for the same period was 19.5 percent (Hospital and Healthcare Compensation Service 2010-2011).
  • Vacancy rates fell from an annual high of 11 percent in 2010 to 6 percent by the end of 2012.
  • VNA is realizing cost savings related to reduced recruitment, training, and retention incentives. Staff education costs alone have dropped by 30 percent per new hire.
  • 100 percent of positions are filled for the first time in the organization’s history and its talent pool is overflowing.
Barriers to Implementation:
VNA has a long, distinguished tradition of caring for the homebound that spans 114 years. The key to its success has been an unwavering commitment to excellence and a willingness to embrace new ideas and technologies to achieve that goal. The recent integration of PI into the organization’s business model is consistent with that philosophy and is playing an important role in ensuring that the home care provider is well-positioned for a second century of service.