VITAS uses recognition to address serious labor issues

MIAMI —When VITAS Innovative Hospice Care accepts the responsibility of helping a patient with end of life care, they endeavor to treat the whole patient — body, mind, spirit and family. When the company accepts the responsibility of providing a nurse with a rewarding career, they stop at nothing less than providing a wholly fulfilling experience.

"When we treat our patients we provide a team: chaplains, social workers, nurses, home health aides, grief counselors," explains Kal Mistry, senior vice president of human resources for VITAS, the largest hospice provider in the U.S. "We anticipate our patients' needs and provide ways to meet those needs."

"Our employees are no different," says Mistry. "We pay attention. We listen. We know what they need from us to thrive because we asked and we will continue to ask. That enables us to put programs in place, to train managers, to communicate to employees about the things that matter most to them and meet their needs in a more proactive way." Being proactive has been Mistry's method of operation since she came to VITAS in 2002. When she discovered the organization had not done an employee survey in at least 10 years, Mistry went to work.

"I remember discussing the decision to do the survey," says VITAS President, David Wester. "As a management team we talked about the notion that if you're going to do a survey you have to take action, because if you don't take action you'll lose credibility with employees. We needed to be prepared to deal with the results before we ever committed to do the survey."

Fortunately for VITAS and its employees, the senior management team had the courage to find out what they didn't know and went forward with the survey.

"The results were very encouraging and very informative," says Mistry. "We found out our workforce was extremely committed to our mission, and they identified 10 issues where we could improve. For the most part, it came down to the fact that they wanted more attention. They felt that management was not quite in touch with them."

As a result of the survey Mistry set a multi-year project in motion designed to formalize performance programs, enhance retention initiatives, update technologies, develop innovative recruiting methods and create compelling employee recognition opportunities.

She began by assembling an employee satisfaction and trust committee. Members were asked to talk to people all over the organization and find out what they really wanted. The committee discovered VITAS employees felt there was a greater need for a formal recognition and reward program.

As a result Mistry, partnered with O.C. Tanner recognition advisor Dan Norman to institute recognition programs at several levels in the organization. From daily recognition practices to recognition for years of service, quarterly performance recognition at the local level, and an annual national recognition award, recognition has become a main event at VITAS.

"To be great, we have to hold our employees to high standards," says Tim O'Toole, CEO of VITAS. "By using recognition to reinforce actions that reflect those high standards we are able to show our appreciation of the stars in the organization while we motivate underperformers by giving concrete examples of the VITAS values in action."

The survey also revealed that VITAS values are a major factor in why people choose to join the organization.

"The values are a major factor why people choose to build a career here," says Mark Cohen, senior vice president of communications and public relations. "All of the award decisions for our national employee recognition awards program are based on how well people live the values. Nobody gets the nurse of the year award because somebody sends in a nomination form that says, 'Susie is a great nurse.' That doesn't do it. What wins the award is, 'Susie is a nurse who lives the VITAS values by doing...' Everything is focused on the values and that helps our employees understand their significance in the scheme of things."

And examples of great work are exactly what VITAS is hoping to pass on to new generation of nurses.

Since Mistry joined the company in 2002 VITAS has experienced explosive growth that continues today. Currently the company has more than 9,000 employees in 16 states and revenues of over $700 million. VITAS expects to double in size in the next five years, adding thousands of nurses and many new locations.

"We are at a critical time for HR at VITAS," says Peggy Pettit, EVP and Chief Operating Officer. "Like all other healthcare providers we are faced with a labor shortage at just the time we are expecting unprecedented growth. We must do all we can to face that challenge head on and plan for it. Strong recognition practices are something we can do to keep the nurses we have and create the type of work environment that is attractive to employees looking for a place to begin a career."

Currently, nurses make up 40 percent of the VITAS workforce. Their average age is 48 years old and many of the most senior nurses are expected to retire within six to eight years.

"The competition for skilled nurses is unbelievably intense. There is a crisis in nursing today," says O'Toole. "We are doing everything we can to minimize turnover and attract the right people. We are making a strategic investment in solid recognition practices because it's the right thing to do for our people, our shareholders, the taxpayer's dollars we work with, everyone.

"It's a labor-intensive business; a people-intensive business," continues O'Toole. "Obviously if we can reduce turnover and attract new employees by recognizing the actions of our people and making sure they feel rewarded for their efforts, the company's financial situation will improve. But you know what's even more important than that? If we keep more nurses, the same nurse can go to the same patient— and that improves the quality of the care we offer."

And improving quality of care is what matters most to VITAS employees at every level of the organization.

"Our recognition programs, all of them, are really critical to our retention effort. And they do make a difference. We've had a significant impact in reducing turnover, and the recognition programs have been a big part of that," says Bob Miller, senior vice president of clinical development and bioethics. "Being proactive about making sure nurses, staff and aides feel content about where they work, translates into better patient care. The more nurtured our nurses feel, the more confident they feel in the organization, the more they project that to patients and families.

And it's a good cycle — the better they are feeling about themselves and their work, the more they create that kind of environment for patients and families, and then they get that feedback from patients and families about how good they are at providing the care the families need, and it creates a really nice cycle of caring. The bottom line is that if we don't do a good job of taking care of each other and recognizing the value each person brings, we won't do a good job of taking care of patients and families either."

Susan Phillips, VITAS director of employee relations says recognition can often make the difference at critical moments for employees.

"Nurses are often asked to stop by and visit an additional patient on their way home from work. That can be frustrating when they are trying to get home to their own families," says Phillips. "But what makes the difference at the end of the day in how that employee feels about the extra effort they've been asked to give is whether or not their manager recognizes them for it. If they get a phone call from the manager saying, 'You saved the day, you came through, because of you the patient was cared for by a VITAS nurse and we made a difference,' it makes all the difference in whether or not that employee who goes home feeling stressed, thinking this job is just too much, or instead goes home and tells their family how much they love their work because they really feel like they made a difference and that they're appreciated. To work in an organization where management wants to do those things is really a great thing."

Because VITAS realizes the value that employee recognition brings to its business results and the quality of their employees, work experience, they have made recognition one of the five strategic pillars of the VITAS CARES initiative.

CARES, which stands for Coach, Assist, Recognize, Engage and Satisfy, is a management training program launched by Mistry and the senior management team to offer company leaders the training and tools they need to better support VITAS employees.

"Recognition acts as a catalyst for the employee-manager relationship," says Mistry. "If employees leave us, we find it is most often because of issues with managers and supervisors. So reducing turnover and producing positive business results really starts with good management and supervision. The VITAS CARES initiative teaches our managers that if you treat employees well and recognize what they are doing, they are more likely to be happy in the workplace."

Quarterly recognition award recipient Maria Gonzalez agrees, "VITAS constantly says thank you in many ways, but to be recognized among colleagues, supervisors and senior executives at a formal event, makes it extra special. I think it's important for managers to recognize great performance for retention, but also to improve the quality of work. When people are happy, they work better."

Each manager receives regular CARES training and a kit that contains tips and tools for implementing each of the five pillars of CARES in their work areas. The kit covers everything from behavioral interviewing guidelines and tips to best practices in managing a multi-generational workforce.

"Recognition is a practice that creates a circle of care, particularly for our nurses and support staff," says Dian Johnson, general manager of VITAS' Dade-Monroe facility. "Because of the nature of what we do — go into people's homes and give the care they need, we're very spread out geographically. Recognition is a way to connect VITAS employees back to the organization and let them know that what they are doing is important. Hopefully, the recognition and connection they feel turns this into more than just a job."

For many recognition recipients, VITAS' decision to implement recognition as a regular practice is a reflection of the company's commitment to its values.

"As an employee, the recognition is significant because it makes you want to do better and give the best of yourself," says recognition recipient Lorena Ortiz. "If companies don't recognize, employees get tired and look for another job that's going to fulfill them. But a company that's constantly recognizing the employees and showing them that they care is not only showing that we want to keep you as an employee, but that they live up to their values, their mission as a company."

In the end, recognition is an important way Mistry and her team help the organization realize important business results such as reduction in turnover and improved communication. But even more important is the bond it creates between managers, employees and the VITAS mission.

"The main reason people join us is because of our reputation in the industry," says Mistry.

"But the reason they continue to stay with us is because of the relationships with their managers, supervisors and their team of co-workers. Strong recognition practices help us in both areas — to attract and retain in a very competitive labor market."