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Recruiting, Retention, and Workforce Planning
Healthcare Organization and Management · Chapter 14: Human Resource Management in Healthcare OrganizationsSection 14.1 · lesson 81 of 10511 min · free with a free account
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In this lesson
Forecasting staffing supply and demand and choosing how to close gaps.
- Distinguish establishment, budgeted positions, filled positions, and vacancy rate
- Forecast staffing demand and supply with written assumptions
- Choose a mix of recruit, develop, redesign, and reduce-demand responses to close a gap
- Explain recruitment strategy, time to fill, and vacancy chains
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Transcript
Everything said in the video, section by section (1,516 words). Read along, or search it.
Opening Case
Two Years of Travel Technologists
Tom Brennan, Larkfield's chief financial officer, has a two-year bill in front of him. Travel technologists have covered the same three laboratory posts every single month. Odette Marchand, the director of laboratory services, is asked to advertise the job again, this time with a signing bonus. She has advertised medical laboratory scientist posts four times in two years. She's hired one person. So is a bigger ad the answer? Or is the lab short of something an ad can't buy?
Workforce Planning
Planning Sits Upstream of HR
Odette takes the question to Marcus Bell, HR's workforce analyst. Workforce planning, he says, is matching the staff you'll have to the staff you'll need, over a defined future period. It sits upstream of everything else in HR. Recruiting, scheduling, development and retention are all tools for closing a gap that planning finds. A department that recruits without a plan is answering vacancies. A department with one is answering requirements.
Key Terms
Establishment, Budget, and Vacancy Rate
Marcus starts with four words people use loosely. The establishment is the staffing the hospital has agreed a service requires. For the lab, that's twenty-four scientist posts. Budgeted positions are the posts with money attached. A savings target cut the lab's to twenty-two. Filled positions have a person in them: twenty-one. The vacancy rate is the share of budgeted posts that are empty. One of twenty-two is under five percent, which sounds healthy. But the lab is three people short of its own establishment. Vacancy is measured against budget, so two of those three never show up as vacancies.
Demand Forecast
Four Assumptions Behind Demand
Now the forecast. Demand asks how many staff, of what kind, the service will need. Four assumptions drive it, and each should be written down. Service volume: the activity expected. Larkfield's emergency department is expanding, and the lab expects more overnight urgent testing. Model of care: which tasks are done, by whom, and where. Changing it moves the staffing number more than anything else. Then skill mix, and the productivity assumption that turns work into posts. At today's model, the extra overnight work needs two more scientists. Demand is twenty-six. The usual mistake is to stretch today's staffing by the volume growth. That freezes the current model of care, so the only answer left to any gap is recruitment.
Supply Forecast
Attrition, Retirements, and the Pipeline
Supply asks how many staff the lab will actually have. Start from the twenty-one in post, and subtract who will leave. Attrition comes from past turnover, split by type. A single rate that mixes retirements with first-year resignations forecasts badly. Marcus expects one resignation. The retirement profile is the most predictable number in the whole exercise, and the most often ignored. Five of Odette's twenty-one scientists can retire within three years. Two have confirmed for this year. And the training pipeline: the one regional program that trains scientists graduates a small class. Larkfield can't control it, only build placements with it. Twenty-one, minus one, minus two. Supply at year end is eighteen.
Closing the Gap
Four Responses to an Eight-Post Gap
Demand twenty-six, supply eighteen. The gap is eight posts, and a gap admits exactly four responses. Recruit: bring people in from outside. Develop: build the skill inside, which is slower, and the only answer when the market has no one. Redesign: change the model of care, so the work needs a different mix. Reduce demand: change what the service does, or how much. That last one is the response organizations least like to name. It's also what happens by default, whenever the other three fail. So a plan says which responses it uses, and in what proportion. Closing an eight-post gap by recruiting alone, for a role nobody can find, is just the gap with a hopeful verb.
Quick Check
No Vacancies, Still Short
Quick check. Picture 4 South. Its establishment is forty posts. Thirty-six are budgeted, and all thirty-six are filled. The manager reports no vacancies. Which statement is true? Pause, and decide. It's four below its agreed need. Every budgeted post is filled, so the vacancy rate really is zero. But the hospital agreed the unit needs forty, and funded thirty-six. A ten percent vacancy rate would be measuring against the wrong number.
Unrecruitable Roles
When Agency Use Becomes a Strategy
Back to Odette's question about the ad. Some roles can't be recruited at any reasonable price, and the signs are consistent. Posts advertised again and again with few applicants. Offers declined. Competitors with the same trouble: Northgate's lab is short too. And a national shortage in the training pipeline. When a role is truly unrecruitable, more money doesn't reopen the recruit response. It only spends the time in which another response could have been built. That's how agency dependence grows. Each month's decision to book a traveler is rational. Two years of them add up to a strategy nobody chose. Travelers on the same posts month after month mean the need is permanent, and only the response is temporary. The cost isn't just the premium: it's continuity, and staff orienting a changing crew.
Response Mix
Redesign, Develop, Reduce, and Recruit
So Odette treats 'recruitment won't close this' as a finding, not a complaint, and works the other three responses. Redesign carries the most. About a third of a scientist's day, specimen processing, doesn't need a scientist. After checking federal lab rules and state law, lab assistants take it on: three posts' worth. Develop: two lab technicians can qualify as scientists through a two-year program. That helps after the shortfall, not during it. Reduce demand: a handful of rare tests go to a reference lab. That's one post, and it moves the problem rather than solving it. Recruitment stays open for two. She names the trade-offs. Scientists will give up work they value and supervise others doing it. And travelers still bridge the gap while the trainees train.
Recruitment Strategy
Channels, Value Proposition, and Job Previews
Rosa Delgado, the HR director, joins for the recruiting part. Recruitment strategy follows the plan. It doesn't come first. It has three parts. Sourcing channels: internal posting, direct advertising, employee referral, training placements, and specialist search. Each trades speed against cost. The employer value proposition: an honest account of what joining offers. Pay, but also development, schedule, team, and the work itself. Its job is to attract the right people, not the most. And the realistic job preview: showing the hard parts of the role alongside the good ones. For the lab, that means the overnight shifts and the pace. Fewer people apply. Studies find a small but consistent gain in how many stay, because some who'd have quit at month four withdraw now, before a hiring cycle is spent on them.
Time to Fill
Hiring Delays and the Vacancy Chain
Rosa adds two warnings. Time to fill, from a post going empty to a new person starting, isn't just an HR statistic. Every week is paid in overtime, travelers, or a tired team. Nationally, recruiting an experienced registered nurse took about two and a half months in twenty twenty-five. Two stages dominate most delays: approval to recruit, and the checks after the offer. Second, the vacancy chain. Promote a senior scientist to lead, and her old post opens. Fill it from inside, and another opens. Staffing doesn't improve until the chain reaches outside. Each link takes its own time to fill, and chains tend to end at the entry level, the place least able to absorb a gap.
Quick Check
Three Posts Filled, One Person Added
Quick check. Larkfield's imaging department promotes a senior technologist to supervisor. Then it promotes a staff technologist into the senior post. Then it hires an outside technologist into the vacated staff post. Three posts are filled. How many people has imaging added? Pause, and decide. One. Only the outside hire is new to the department. The other two moves just shifted people up the chain, each leaving a post open. Three new staff is tempting, but it counts the same people twice.
Planning Horizons
International Recruitment and Two-Year Plans
Two last pieces. International recruitment is a legitimate strategy for roles the domestic pipeline doesn't supply. But it carries costs organizations underestimate: verifying overseas licenses takes time, work authorization rules apply, and onboarding must cover clinical conventions and the practical business of relocating. Recruit abroad for an urgent gap, then give standard onboarding, and early resignations hit exactly the people you invested most in. And horizons. Plans are often requested for five years and are rarely useful beyond two. Retirement profiles hold for years. Models of care and payment change much faster. So a two-year plan reviewed every year works best, with a longer view only for retirements, demographics, and pipeline lead times. Odette's two-year trainees fit inside it.
Case Resolved
A Traveler Bill With an End Date
Back in Tom's meeting, Odette doesn't bring a bigger ad. She brings a plan with four responses and a number beside each. Tom asks whether the signing bonus is still worth trying. Odette says yes, for the two posts she still expects to recruit. Not for all eight. And the traveler bill? It shrinks as the redesign lands, and ends when the trainees qualify. For the first time, it has an end date.
Key Takeaways
Workforce Planning Essentials
To recap. Plan first: forecast supply and demand, with every assumption written down. Establishment, budgeted posts and the vacancy rate measure different things. Four responses close a gap, and a plan names the mix. Steady agency use on the same posts means a planning gap, not a booking problem. Count the whole vacancy chain, and show candidates the hard parts of the job.
About Healthcare Organization and Management at UPI Study
Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.
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