questions and case

after looking over chapter 7 please answer….. Given two equally qualified job applicants – one from inside and one from outside how would you go about deciding which one to hire?

after reading the experimental exercise/case at the end of the chapter please answer …. How often do you think this type of discrimination occurs in healthcare?

CHAPTER 7 Copyright 2021. AUPHA/HAP Book. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. RECRUITMENT AND SELECTION Bruce J. Fried Learning Objectives After completing this chapter, the reader should be able to understand the major steps and decisions involved in recruitment and selection; discuss the factors considered by potential employees in deciding whether to accept a job offer; design a recruitment and selection effort for a particular job; address the advantages and disadvantages of internal and external recruitment and other sources of job applicants; explain the concepts of person–job and person–organization fit and their application to recruitment and selection; and identify alternative selection tools and determine their relative value in the selection process. Introduction This chapter focuses on staffing an organization, which refers to getting the right people into the right positions in a timely manner. Staffing requires several interrelated processes, including determining where to find applicants, defining criteria for selecting the most appropriate applicant, and doing all we can to keep people—retain them—in the organization. Thus, recruitment refers to generating a pool of qualified applicants. Selection involves a choice: Who among the applicants should be chosen for a particular position? Retention refers to keeping people in the organization after they have been hired. In this chapter, we address the topics of recruitment and selection. Chapter 8 focuses on employee retention. The effectiveness of recruitment and selection processes inevitably affects the degree to which organizations can retain staff. Recruitment and selection processes are interrelated. That is, the success of recruitment efforts determines, in part, how selective an organization can be in hiring. An organization can be more selective when there is a relatively large supply of qualified applicants from which to choose. The stringency and specificity of criteria used for selecting job applicants depend, to a large degree, on the success of the recruitment effort. Similarly, a successful recruitment effort depends, first and foremost, on the existence of an accurate, current, and comprehensive job description. Before a recruitment plan for a position is developed, the job should be analyzed, yielding an accurate, current, and comprehensive job description, as well as explicit identification of job requirements and the desired qualifications of successful applicants. A rigorous review of the job is a necessary step in the recruitment and selection process. Without a clear understanding of the job, the selection process EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE AN: 2925405 ; Carla Jackie Sampson, Bruce J. Fried.; Human Resources in Healthcare: Managing for Success, Fifth Edition Account: s7451151.main.ehost 168 can become chaotic and may cause conflict and misunderstanding among stakeholders and decision makers. Developing selection criteria is not a routine process. In developing selection criteria, managers may find themselves in the position of focusing exclusively on the technical and regulatory (e.g., credentials, licenses) aspects of the job. Required knowledge, skills, and credentials are certainly essential for the successful applicant. However, the key to selecting a successful employee may lie beyond technical competencies. Depending on the job, factors such as motivation, commitment, career goals, adaptability, and ability to work as part of a team may be critical to success. While less tangible qualities may be regarded as more difficult to assess than technical characteristics, valid assessment methods are available and addressed later in this chapter. Except for positions that are temporary or otherwise time limited, organizations place a high value on employee retention. Retention and turnover are discussed in detail in chapter 8, but it is important to remember that recruitment and selection play an important role in employee retention. Hiring someone with the required technical competencies is necessary, but it is insufficient to maximize the probability of retaining that person in the organization. “Intangibles,” as noted earlier, can play an essential role in turnover and retention. Consequently, an important measure of the effectiveness of recruitment and selection is the extent to which the organization can attract committed and high-performing employees who remain with the organization over a specified period. As with all human resources (HR) management functions, recruitment and selection processes must be carried out within legal and regulatory guidelines. For example, federal, state, and municipal laws related to employment discrimination must be taken into account in the design and implementation of employee selection processes. Recruitment HR executives consistently report that their single greatest workforce challenge is to create or maintain the capacity to attract talented employees to their organization. The goal of recruitment is to generate a pool of qualified job applicants. Specifically, recruitment refers to the range of processes that an organization uses to attract qualified individuals on a timely basis and in sufficient numbers and to encourage them to apply for jobs in the organization. When considering recruitment strategies, attention often focuses on a set of key questions: Should we recruit and promote from within, or should we focus on recruiting external applicants—or both? Should we consider alternative approaches to filling jobs with full-time employees, such as outsourcing, flexible staffing, and hiring part-time or temporary employees? How important is it for employees to fit in with the culture of the organization? Should we favor applicants who better fit the culture but may require additional skills development to improve their technical skills? In earlier decades, organizations tended to favor a rational approach to recruitment, in which recruitment was largely done in-house. The organization conducted a job analysis, determined the job’s compensation, and then posted the job. From the end of World War II until the 1970s, about 90 percent of hires were made internally through promotions or lateral moves. Today, as Cappelli (2019) notes, the majority of people who take a new job were not searching for a job, but “somebody came and got them.” Only about 28 percent of talent acquisition leaders value internal applicants as a productive source of applicants. Instead, the focus has turned to “passive candidates”—that is, applicants who were not necessarily looking to change jobs but might be willing to do so for the right price. However, it has been noted that external hires require three years to perform as well as internal hires in the same job. Strikingly, internal hires require seven years on average to earn as much as outside hires are paid. According to a large survey conducted by LinkedIn, the top channels for quality hires were employee referrals (48 percent), third-party websites or online job boards (46 EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 169 percent), social or professional networks (40 percent), third-party recruiters or staffing firms (34 percent), and internal hires (28 percent) (Capelli 2019). An organization’s recruitment success depends on many factors, including the attractiveness of the organization and the job, the community and the labor market in which it is located, unemployment and the nature of the economy, the organization’s work climate and culture, managerial attitudes and behavior, and workload. Recruitment can be challenging for many organizations and specific jobs. A 2016 report by the Society for Human Resource Management (SHRM) found that more than two-thirds of HR professionals reported challenging aspects of recruitment. Half of the surveyed organizations reported factors such as a low number of applicants, a lack of work experience among applicants, and competition with other employers. Among HR professionals, 84 percent reported that they had seen skill shortages in previous years. Organizations involved in healthcare, social assistance, and manufacturing reported the greatest difficulty with recruitment. Not surprisingly, 84 percent of organizations said they use social media in their recruiting (Maurer 2016). In the next section, we look at the factors that people consider when seeking jobs and accepting job offers. An understanding of prospective employees’ needs and expectations is central to the development and implementation of effective recruitment strategies. Factors That Influence Job Choice What do potential employees look for in a job? Once an individual is offered a position, how does that person decide to accept or reject the offer? People consider several factors related to the attractiveness of the position and the organization, as well as factors specific to the individual. Applicants consider their competitiveness in the job market and whether alternative positions that provide better opportunities are available. They are also sensitive to the attitudes and behaviors of the recruiter, or whoever is their first contact with the organization. First impressions are very important because job applicants often decide at this stage whether they “fit in” with the organization; early negative first impressions may be difficult to reverse. Questions foremost in the applicant’s mind are “Is this the kind of place I can see myself spending 40 or more hours a week?” and “Will I fit in?” Applicants may also be concerned with opportunities for career mobility and promotion. Job choice has both cognitive and emotional elements. On the cognitive side, applicants evaluate compensation, opportunities for growth, and other tangible factors. On the emotional side, research has consistently found that applicants’ attraction to an organization is maximized when they are familiar with the organization and see the organization as having a positive reputation and possessing values and attributes consistent with those of the job seeker. The implications of these findings are clear: First, more information is better—the more applicants know about the organization, the more likely they are to seek employment, assuming that they perceive a fit between their values and those of the organization. Second, organizations must be aware of their image and reputation in the labor market. It is also important for an organization to assess its promotional strategies to ensure that its public image has a positive impact on potential job applicants. If this image is inconsistent with the organization’s ideal view of itself, strategies must be developed to better understand public perceptions and, ultimately, design messaging to improve the organization’s image. These considerations lead to the important issue of how organizations communicate their values to potential job applicants. The factors that predict actual job acceptance are dynamic and vary greatly among applicants. The relative importance of these factors depends on the individual, the organization, the job, and environmental factors such as the level of unemployment. A helpful way to think about job acceptance is to consider the characteristics of the organization and job; individual needs, preferences, and values; and the fit between the organization and the individual. Individual characteristics are personal considerations that influence a person’s job decision. The factors considered by a family physician who chooses to accept employment with a rural health center may be quite different from the factors that drive a nurse’s decision to accept employment with an academic medical center. An almost infinite number of individual factors may affect job EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 170 choice, but for any individual at a particular point in time, a few key factors may play a decisive role. One’s life or career stage, for example, may affect the salience of different factors. Organizational characteristics, on the other hand, are factors associated with the organization as a whole, notably, total compensation, advancement opportunities, job security, and geographic location. Each of these factors is explained next. Total compensation is a major factor affecting an individual’s decision to accept a position. The relative importance of compensation to employees is complex. Under certain circumstances, employees may leave an organization for another to obtain only a small increase in compensation. In other cases, employees may stay with an organization even when offered a generous improvement in compensation by another organization. For some healthcare positions, compensation is complicated by differential pay rates, hiring or signing bonuses, and relocation assistance. Hot-skill premiums —temporary pay premiums added to base pay for employees with in-demand skills—have become common in healthcare, although premiums usually remain in place even after market pressures ease. These premiums may be structured in a number of ways, including incorporating the premium into the individual’s salary, providing a hiring or annual bonus, or slotting an employee into a higher salary range than is usually warranted for that job (Berthiaume and Culpepper 2008; Mercer 2014). For many people, an important factor in job choice is the amount of challenge and responsibility presented by the job. This element is particularly salient for professionals, who often express an interest in maximizing the application of their competencies (Lu et al. 2012). Another consideration is the value that prospective employees place on the potential for career advancement and professional development. However, there are often limited opportunities for clinical staff to advance while continuing to do clinical work; advancement opportunities for professionals may be limited to management positions. However, assuming management responsibilities may lead clinicians to feel a sense of loss of their professional identity. Even more important is the fact that clinically trained people often do not have the required management skills to work in a managerial capacity. A study of public health nurses’ job satisfaction funded by the Robert Wood Johnson Foundation revealed interesting findings about the relationship between compensation, job satisfaction, and promotional opportunities. The survey found that 85 percent of the nurses were happy with their career choice, and 90 percent felt they were making a contribution to their community. Regarding compensation, 40 percent reported that they were being compensated fairly, and 30 percent felt their salaries were inadequate. Most striking, however, was the finding that 56 percent felt they would not be able to receive a promotion, and 64 percent said they hoped to obtain additional training to advance their career. Fewer than half (49 percent) reported that their health department recognized employee accomplishments through promotions or other methods. These findings are reinforced by a parallel survey of key informants within local and state health departments. About 70 percent of local health departments and 63 percent of state health departments reported that promotion opportunities were often unavailable to registered nurses (University of Michigan 2013). Dual career ladders is one option to enable professionals to advance in the organization without forgoing their clinical competencies and responsibilities. A dual career ladder is a method by which employees can advance in the organization without having to assume managerial responsibilities (SHRM 2020). This approach enables employees to advance even if they are not interested or inclined to pursue a management or supervisory track. The Cleveland Clinic is well known for offering multiple career paths for nurses. The organization notes that “career enhancement offers an environment where nurses can grow in their profession and remain personally and professionally challenged . . . and provides a diversity of career paths in nursing that fulfill the desires of nurses for new and innovative opportunities that advance nursing practice.” The Cleveland Clinic provides professional development opportunities in four careers: Leadership, Clinical Expert, Advanced Practice, and Specialty Nursing. Each track includes courses, experiential learning, and supporting activities (Cleveland Clinic 2020b). Job security is clearly an important determinant of job choice. The current healthcare and business environment is characterized by great uncertainty. Fear regarding job security was once EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 171 limited largely to blue-collar workers, but today, professionals and managers also feel at risk. Geographic location and other lifestyle concerns may be very important to applicants, particularly for individuals in dual-income families, for whom the potential for a spouse’s employment may play a significant role in acceptance decisions. Employee benefits continue to grow in importance in job acceptance. In some highly competitive fields, many companies have moved beyond traditional benefits, such as health insurance and vacation pay, to provide benefits such as membership in country clubs or health clubs, on-site day care, and financial counseling. However, given the increasing financial pressures facing the US healthcare environment, it is likely that employee benefits will be reduced in coming years. Job security is clearly an important determinant of job choice. The current healthcare and business environment is characterized by an unprecedented number of mergers, acquisitions, and reorganizations, which lead to frequent downsizing and worker displacement. This phenomenon was once limited largely to blue-collar workers, but professionals and employees in middle and senior management roles are equally at risk. The importance of job security is evident in labor union organizing and collective bargaining. Traditionally, compensation and benefits were the most highly valued items in labor negotiations. However, job security has become a matter of great importance in employees’ decision to unionize. While job security has become more tenuous, evidence shows that unionized employees enjoy greater job security than those who do not belong to a union. As employees consider their preferences, employers go through a similar process of making their organizations attractive to prospective employees. As discussed later in this chapter, determining whether the applicant will fit into the organizational culture is a challenge for both the organization and the job applicant. Applicants are more likely to accept positions in organizations that share their values, beliefs, and work style. Implicitly or explicitly, organizations engage in a signaling process in which they communicate their values to the public. This process should occur early in the employee selection process, and certainly during a job interview. The hiring manager can emphasize what is important to the organization, convey how it goes about its work, and provide the applicant an opportunity to withdraw if the applicant does not find the corporate culture appealing (Lukens 2014). Signals about mission and values are also included in the organization’s public recruitment messages. In the case of nurse recruitment, Magnet Recognition by the American Nurses Credentialing Center receives prominence in the recruitment materials of hospitals, as it indicates that the organization values nursing talent (ANCC 2020). Consider this extract from the nurse recruitment message for the Cleveland Clinic, which highlights the organization’s clinical leadership, support for nurses, and personal and professional development activities for nurses: Cleveland Clinic has a long history of excellence, and has been consistently recognized as one of the top hospitals in the nation. To continue our legacy of world-class care, the need for registered nurses remains critical. As a large research and teaching hospital, we offer nurses exciting opportunities to experience the cutting edge of nursing care, use state-of-the-art technology and new treatment options, and have at hand a broad spectrum of support to affect nursing practice and improve patient care. Here at Cleveland Clinic we strive to provide unique benefits and opportunities for our nurses both in and out of the workplace. (Cleveland Clinic 2020a) Similarly, the Mayo Clinic’s recruitment message includes statements about its commitment to teamwork, respect, and professionalism: As a Mayo Clinic nurse, you will become a vital member of a dynamic team at one of the world’s most exceptional health care institutions. You will also discover a culture of teamwork, professionalism and mutual respect, and—most importantly—a life-changing career. (Mayo Clinic 2020a) The Mayo Clinic also highlights the recognition it has garnered as an excellent place to work, listing accolades for its Magnet status and recognition from other prominent organizations that rate EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 172 best places to work: “We are recognized for high-quality patient care more than any other academic medical center in the nation. These endorsements are very gratifying, but also humbling. They remind us of the tradition that has been entrusted to each one of us, and the legacy of excellence that we uphold every day” (Mayo Clinic 2020b). In its effort to attract new nurse graduates, Kaiser Permanente promotes its Regional New Grad Registered Nurse (RN) Program, which is designed to “ease the transition of a new graduate RN into professional practice” by strengthening clinical and analytical skills and promoting professional growth, self-confidence, and independence (Kaiser Permanente 2020b). Similarly, Johns Hopkins Medicine appeals to job applicants by describing the diversity of its workforce and work settings: Our patients come from all over the world—and so do our staff members. They come to be part of a professional and diverse health care team; to work beside the unequaled talent of Johns Hopkins physicians, nurses and providers; and to enjoy extensive benefits and opportunities for personal and professional growth. (Johns Hopkins Medicine 2020) Healthcare organizations vary in their ability to attract and retain a talented workforce, and rural hospitals face particularly challenging obstacles, including physician recruitment (Noguchi 2019). To attract physicians, rural hospitals may have to offer more attractive compensation and benefits packages, and they may rely on such programs as the National Health Service Corps to meet physician staffing needs. In some instances, hospitals increase their use of midlevel providers, such as nurse practitioners and physician assistants. Other approaches to physician recruitment include loan repayment programs, which usually include an obligation to work in an underserved rural community for a specified period, and physician shares, which may involve joint contracts with physicians between hospitals (Kutscher 2013). Exhibit 7.1 illustrates how three hypothetical job applicants may assess the relative importance of particular job features. Although the table oversimplifies the job choice process, it shows how personal preferences and life circumstances may affect job choice. The first column describes each applicant. The second column states each applicant’s minimum standards for acceptance along four dimensions: pay, benefits, advancement opportunities, and travel requirements. These four dimensions are sometimes categorized as noncompensatory standards—that is, no other element of the job can compensate if these standards are not met; they are deal breakers. The third column provides a description of a hypothetical job being considered by the job applicant. After looking at the minimum standards for job acceptance, consider how each of the three applicants would assess the acceptability of the particular job. For example, person 2 views health insurance as an absolute requirement for acceptance, while person 3, who does not like to travel, will be unlikely to accept a job that requires substantial travel, regardless of any other consideratings. EXHIBIT 7.1 Three Hypothetical Job Applicants EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 173 The HR Plan and Recruitment The foundation of the recruitment process is the organization’s HR plan. An HR plan includes specific information about the organization’s strategies, the types of individuals required by the organization, recruitment and hiring approaches, and a statement of how HR practices support organizational goals. Those involved in recruitment and selection must have a thorough understanding of the position that needs to be filled, including job requirements and their relationship to other positions within and, at times, external to the organization. The recruitment process should begin with a job analysis, which outlines job tasks; knowledge, skills, and abilities; and the development of specific qualifications required of successful applicants (see chapter 6 for a discussion of job analysis). An early stage of the recruitment process involves examination of the external environment, in particular the labor market, the estimated number of potential job applicants, and the relative competitiveness of the position. This analysis should also examine the compensation and benefits given to individuals who hold similar jobs in the organization as well as in competing organizations. With any position, organizations are concerned with external competitiveness—that is, being able to compete successfully for job applicants—while also ensuring that salaries are internally equitable. Another helpful approach is to evaluate external recruitment sources, such as colleges, competing organizations, and professional associations, to determine which of them have been successful recruitment sources in the past. Other aspects to consider in this assessment are the logistics and timing of a recruitment effort; for some positions, seasonal factors play a role in the recruitment process, such as graduation dates from nursing school. The process should then review past recruitment efforts for the position and similar ones: Will this job require an international, national, or regional search, or will the local labor market suffice? Optimally, a human resources information system (HRIS) will provide useful information during the EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 174 recruitment process. While the sophistication of organizations’ HRIS varies, many such systems include some or all of the information described in exhibit 7.2. A skills inventory database maintains information on every employee’s skills, educational background, training acquired, seminars attended, work history, and other job development data. This inventory optimally should also include data on applicants who were not hired. A well-managed database broadens the pool of possible applicants from which to draw. EXHIBIT 7.2 Human Resources Information System Recruitment Data Applicant sourcing is of critical importance so that recruitment resources are used productively and not expended on sources that generate few or no qualified applicants. The internet and social media have dramatically changed the recruitment process, having transitioned from traditional print classified advertisements to increasingly sophisticated use of analytics and artificial intelligence in generating and evaluating applicants. In addition to individual companies’ use of the internet for recruitment, the use of job search websites continues to grow. Exhibit 7.3 reports some common job search engines, according to the website Career Sidekick. Some websites are general in scope, while others market to a particular industry or job category. Among the most commonly used healthcare jobs websites are Health eCareers, JAMA Career Center, MedicalJobs.org, and MedJobsCafe.com. EXHIBIT 7.3 Common Job Search Engines EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 175 Note: This list is not exhaustive but rather is intended to be illustrative of common search engines. Sources: Career Sidekick (https://careersidekick.com/tools/job-search-websites/); Smart Recruiters (www .smartrecruiters.com/blog/best-healthcare-job-boards-for-recruiters/). It has become routine for job seekers to use websites, and particularly mobile apps, to learn about and apply for jobs (Gulati 2015). Therefore, companies must have not only a website but also the facility to use it for recruitment purposes. Johannson (2017) notes that a recruitment website can be used to sell the company culture, engage passive candidates (e.g., those who are not actively looking a job), and provide more information than is possible on a job board. In an environment in which competition for talent is tight, a recruitment website must make a positive impression on potential job applicants. Citing previous research, Laja (2020) reports that people make judgments about whether to stay on or leave a website within 0.05 seconds. Further, design accounts for 94 percent of the basis for these assessments, while the actual content accounts for only 6 percent. In fact, poor interface design causes people not only to reject and leave a website but also to distrust its content. A number of factors are associated with poor website design, including pop-up advertisements, small print, too much text, and lack of navigation aids (Laja 2020). Just as technology is used by job seekers, multiple technologies, including artificial intelligence (AI), are used by employers to evaluate job applicants. In 2018, 67 percent of hiring managers and recruiters surveyed by LinkedIn said that AI was saving them time. Among the companies providing AI recruitment services to employers are HireVue, which uses an algorithm to analyze applicants’ response to questions. Similarly, LinkedIn Recruiter, ZipRecruiter, and Ideal use a variety of AI technologies to screen and evaluate applicants. Interestingly, Ayra claims to be able to predict whether an employee is likely to leave his or her old job and take a new one. There are numerous ethical and legal issues involved in the use of AI in recruitment. In 2019, the Electronic Privacy Information Center filed a complaint with the Federal Trade Commission and asked that the agency EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 176 investigate companies for potential bias, inaccuracy, and lack of transparency. The Equal Employment Opportunity Commission has also begun investigations dealing with employment discrimination through the use of AI (Heilweil 2019). A fundamental question in recruitment is whether to recruit internally through promotions or transfers or seek candidates from outside the organization. Organizations may have preferences for internal or external hiring but tend to use a combination of strategies depending on the specific circumstances. Each strategy has merit and potential risks. Exhibit 7.4 summarizes the advantages and disadvantages of internal and external recruitment. On the positive side of internal recruitment, candidates are generally known to the organization—the organization is familiar with their past performance and future potential. Internal candidates tend to be well acquainted with organizational processes and procedures and may not require as much socialization and start-up time. Internal recruitment may also be used as a motivator, morale builder, and retention strategy because of the opportunities provided for upward mobility in the organization. EXHIBIT 7.4 Advantages and Disadvantages of Internal and External Recruitment EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 177 Recruiting from within the organization may encourage highly valued and productive EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 178 employees to stay with the organization. A classic study of employees in the banking industry examined the performance of internal versus external hires. The study found that internally promoted workers exhibited significantly higher levels of performance during the first two years than those hired from outside the organization. Internal recruits also had lower rates of voluntary and involuntary turnover. Interestingly, external hires were found to be paid about 18 percent more than internal recruits, and workers who were promoted and transferred simultaneously exhibited lower levels of performance than those promoted from within (Bidwell 2011). On the negative side of internal recruitment, however, is the possible manifestation of the Peter Principle, a common phenomenon in which successful employees continue to be promoted until they reach one position above their level of competence (Peter and Hull 1969). According to the Peter Principle, employees may be promoted regardless of their aptitude for the new position. This phenomenon is noteworthy in healthcare, where individuals with strong clinical skills may be promoted to supervisory and management roles without the requisite skills and training. For example, a world-renowned clinician and researcher may be promoted to vice president of medical affairs even though he or she lacks management competencies or experience. Effective organizations seek to prevent this phenomenon by ensuring the accuracy of job descriptions and by requiring the successful candidate to meet the specified job qualifications. If an individual who does not possess all the job qualifications is hired, the manager has to be cognizant of the person’s need to be trained in areas requiring remediation. Companies such as Microsoft and GlaxoSmithKline have resisted the Peter Principle in their selection of CEOs through intensive scrutiny and testing of eventually successful internal hires (Carey and Useem 2014). Internal recruitment may also have the disadvantage of causing disarray in the organization. At times, promotion creates a ripple effect—one individual moves into a different position, leaving a vacancy; that vacancy, in turn, is filled by someone else who causes another vacancy, and so on. External recruitment seeks applicants outside the organization, who may be identified through a number of sources. An advantage of external recruitment is that candidates may bring in new ideas. In addition, the organization may be able to more specifically target candidates with the skills needed rather than settle for an internal candidate who may be acquainted with the organization but lack specific competencies. External candidates also tend to be unencumbered by political problems and conflict and may be relatively easy to bring into a difficult political environment. This is often the rationale for selecting a CEO from outside the organization. Many applicants are not easy to characterize as coming from either an internal or an external source. For example, hiring candidates who have worked for the organization in a contingent or part-time capacity, including contract employees, is not uncommon. This practice is common in nursing, where traveling or agency nurses may apply or be recruited for a full-time position. As a general rule, it is advantageous to obtain as many qualified job applicants as possible. This permits greater selectivity and sometimes may even stimulate a rethinking of the content of the job. For example, an applicant may be found to have additional skill sets not directly relevant to the job as currently designed but useful nonetheless. Successful organizations are flexible enough to take advantage of these opportunities. Employee referral is an excellent source of job applicants because current employees tend to know the organization and the applicant and thus can act as an initial screen. A person identified and hired through this mechanism may bring advantages of both internal and external applicants. Yield ratios tend to be higher with employee-referred applicants than others, and they tend to stay longer with the organization and exhibit higher levels of job satisfaction than do employees recruited through other mechanisms (Schwartz 2013). Evidence also indicates that employees who make referrals are more productive than other employees, and they are less likely to quit after making a referral (Burks et al. 2013). Some employee referral programs give monetary rewards to employees whose referrals are successful—that is, if the new hire remains with the organization for a defined period. For example, Kaiser Permanente has a website devoted to employee referrals (Kaiser Permanente 2020a). In 2016, a study of more than 14 million applications found that employee referrals delivered more than 30 percent of all hires overall in 2016 and 45 percent of internal hires. According to Amber Hyatt, vice president of product marketing for the company SilkRoad EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 179 Technology, “Employee referrals have excellent conversion rates from interview to hire, as well as typically longer tenure with the organization. Recruiting teams are very aware of the benefits of leveraging employee referral programs to cost-effectively recruit, speed the time to hire and secure top talent to fill hard-to-fill positions” (Maurer 2017). A potential downside of employee referrals is that they may result in a more homogenous workforce: We tend to refer people who are like ourselves. Physician recruitment presents additional challenges, and peer recruitment is consistently considered an approach with relatively high probability of success. A recruiting consultant with a large California physician group noted that “peer referrals are the most powerful recruiting tool. When I get a referral in-house I know the candidate is going to have the skills and the interest, because a colleague has already made the contact” (Zappe 2006). Former employees may also be a fruitful source of applicants. Employees who have left the organization as a result of other employment opportunities, organizational downsizing or restructuring, relocation, or other personal factors sometimes may seek or be available for reemployment with the organization. Their capabilities and potential are usually well known to the organization. Returning employees may also send a message to current employees that the work environment is sufficiently positive to attract them back to the organization. Depending on the position involved, employment agencies and executive search firms (both state sponsored and private) may be useful as applicant search and screening vehicles. Agencies may specialize in different types of searches and typically work either on a commission or on a flat-fee basis. Content of the Recruiting Message An important objective of recruitment is to maximize the possibility that the right candidate will accept the organization’s job offer. Four types of information should be communicated to applicants: 1. Applicant qualifications: education, experience, credentials, and any other preferences that the employer has within legal constraints 2. Job basics: title, responsibilities, compensation, benefits, location, and other pertinent working conditions (e.g., night work, travel, promotion potential) 3. Application process: deadline, résumé, cover letter, transcripts, references, and contact person and address for the application packet 4. Organization and department basics: name and type of organization, department, and other information about the work environment Recruitment Messages and Realistic Job Previews The recruitment message is a central aspect of recruitment. Researchers have found that providing additional information about a job has been linked to position attractiveness and that more information increases the credibility of the information (Allen, Mahto, and Otondo 2007). Of particular interest is the view that providing realistic information about a job results in applicants obtaining clearer and more realistic information about the job (Breaugh 2010). Considerable research is available on the effectiveness of a realistic job preview. The goal of a realistic job preview is to present practical information about job requirements, organizational expectations, and the work environment. The preview should include both negative and positive aspects of the job and the organization, and it may be presented to new hires before they start work. The use of realistic job previews is related to higher performance and lower attrition from the recruitment process, lower initial expectations, lower voluntary turnover, lower turnover overall, and higher ratings of role clarity and organizational honesty (Breaugh 2013; Earnest, Allen, and Landis 2011). A realistic job preview can be presented in a number of ways: verbally, in writing, or through media. Certainly the most straightforward approach is for the prospective or new employee to hold frank discussions with coworkers and supervisors. In addition, the new employee may observe the work setting, perhaps shadowing an employee doing a similar job. EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 180 Evaluating the Recruitment Function Organizations can improve recruitment by evaluating the effectiveness of recruitment efforts. A useful evaluation process depends on the existence of reliable and comprehensive data on applicants, a well-functioning HRIS, the quality of applicants, the applicants’ disposition, and recruitment costs. Numerous metrics may be used to evaluate the effectiveness and efficiency of recruitment and selection processes, as well as the usefulness of specific recruitment strategies and sources. Exhibit 7.5 illustrates the variety of measures that may be used to evaluate the recruitment process. A good HRIS and cost-accounting system can help the organization establish the costs associated with recruitment and selection. EXHIBIT 7.5 Measures of Recruitment Effectiveness and Efficiency EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 181 EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 182 EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 183 Sources: Adapted from Academy to Innovate HR (2020); Fitz-enz and Davison (2002). Common measures of the success of the recruitment function include the following: Quantity and quality of applicants. Appropriate recruitment methods and sources can yield a substantial number of candidates (depending on the market supply) with at least minimum job requirements. However, every applicant incurs a cost, and receiving applications from unqualified applicants is associated with increased recruitment costs. Therefore, minimum job requirements need to be established and communicated to maintain the quality of applicants. A well-designed recruitment effort will bring in employees who have the appropriate education, qualifications, skills, and attitudes. Overall recruitment cost and cost per applicant. The overall cost per applicant and the cost of the recruiting methods and sources should be examined. This analysis provides the opportunity to assess the cost-effectiveness of alternative recruitment methods. The financial impact of using part-time or temporary help while looking for the right applicant should also be considered, because these costs can be substantial. Diversity of applicants. Assuming that one goal of the recruitment program is to identify and hire qualified candidates who represent the diversity of the service population or to address other diversity goals, the organization can consider its recruitment goal met if it can show that candidates from diverse cultural and demographic backgrounds have been considered or are holding positions for which they are qualified. Recruitment time or time-to-fill. The more time spent on proper recruitment, the greater the chance that the ideal candidate will emerge. However, a lengthy recruitment process also results in greater costs, disruption of service or work, and potential dissatisfaction of current employees who end up filling in for the missing jobholder. International Recruitment A topic of great interest is the recruitment of health professionals from other countries to address healthcare workforce shortages in the United States. In an increasingly interconnected world, the movement of people and information across international borders has become almost routine. As skilled healthcare providers, physicians and nurses have had opportunities to seek employment internationally for several decades, and foreign-trained professionals are important parts of the healthcare systems in many countries. Nearly one-quarter of practicing physicians in the United States are international medical graduates (IMGs) (American Medical Association 2020). IMGs are physicians who received their basic medical degree from a medical school located outside the United States and Canada. The IMG designation is based on the location of the medical school, not the physician’s citizenship. Thus, US citizens who graduated from medical schools outside the United States and Canada are considered IMGs, but non-US citizens who graduated from medical schools in the United States and Canada are not considered IMGs (ECFMG 2019). There is substantial variation among physician specialties. For example, only 6.5 percent of specialists in emergency medicine are IMGs, while more than 50 percent of geriatricians are IMGs. In a recent survey, 118,817 physicians in family medicine were identified, with IMGs representing 23.8 percent (n=28,227) of the US patient care workforce. Of the 9,579 residents in family medicine, 36.0 percent are IMGs. In total, 35.9 percent of IMGs attended medical school in the Caribbean, 19.9 percent in south-central Asia, and 9.1 percent in Southeast Asia. Just over 40 percent of all IMGs in family medicine held US citizenship upon entry to medical school. IMGs make up almost 40 percent of the family medicine workforce in Florida, New Jersey, and New York (Duvivier, Wiley, and Boulet 2019). Internationally educated nurses (IENs) make up a substantial proportion of the US nursing workforce. Recent estimates indicate that IENs represent 5 percent of the US nursing workforce (Smiley et al. 2018). There is much variation within the United States in the representation of IENs. EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 184 About one in five registered nurses in California, Nevada, and Washington, DC, was trained abroad, while there are almost no foreign-trained nurses in Wyoming and North Dakota (Cortés and Pan 2015). The international migration of physicians and nurses is complex and a source of ongoing debate. While physicians and nurses who migrate to other countries can benefit from better working conditions or salaries in their destinations, their movement can exacerbate inequalities in the worldwide distribution of healthcare workers, particularly in middle- and low-income countries. These countries not only lose their investments in education and training, income tax revenue, and potential for national growth, they also see adverse health effects on their populations. In countries where healthcare workforce shortages are already severe, emigration further depletes the health system’s resources and exacerbates inequalities in healthcare between countries. Recruitment of workers from abroad has important ethical implications, which have not been adequately addressed by international organizations and countries (Pittman and Pulver 2020). In 2010, the World Health Organization established the Global Code of Practice, which is largely voluntary. Other countries, such as the United Kingdom, have established similar policies that are also mostly voluntary in nature (NHS Employers 2019). Interestingly, a study of compliance with the Global Code of Practice reported “no significant policy or regulatory changes to health worker recruitment in their countries as a direct result of the Code due to its lack of incentives, institutional mechanisms and interest mobilizers” (Tam, Edge, and Hoffman 2016). The movement of international medical and nursing graduates into the US healthcare system raises several important issues for managers and leaders. In particular, managers must be aware of issues of ethical recruitment, regulation (visas), credentialing, and adaptation for foreign-trained physicians and nurses. Careful consideration of all of these areas is necessary to facilitate the successful recruitment and incorporation of foreign-trained healthcare professionals into the US healthcare system and to minimize migration’s negative effects on sending countries. Selection Employee selection is the process of collecting and evaluating applicant information with the goal of identifying the best person for a position. Employee selection is a predictive process to determine which applicant is most likely to achieve success. Success may be defined as not only proficiency in the job but also longevity in the position and fit with the culture of the organization. Selection must be distinguished from simple hiring. In selection, an applicant’s knowledge, skills, and abilities are carefully analyzed, as well as attitudes and other relevant factors. Ideally, an employment offer is made to the applicant who scores highest on specified selection criteria. Not infrequently, however, offers are made with little or no systematic collection and analysis of job-related information. A common example is the hiring of an individual based on political considerations or the applicant’s personal relationship with the owners of or the managers in the organization. In such instances, non-job-related factors may take precedence over objective measures of job suitability. In circumstances in which a position has to be filled urgently, or when a labor shortage exists in a particular area, an organization may simply hire whoever is available, assuming the individual possesses the minimum level of qualifications. This occurs at times in the staffing of health centers in remote or otherwise undesirable locations. Applicant availability, rather than the comparative competence of the applicant, may be the key criterion for selection. The Question of Fit Traditionally, employee selection is based on ensuring that the person fits the job. As noted earlier in this book, an accurate job description provides the foundation for selecting a candidate who has the required qualifications for the job. In practice, managers tend to be concerned mostly with assessing whether applicants possess the technical competencies to do the job. However, organizations have come to value the importance of person–organization fit, or the extent to which an applicant’s values are consistent with the values and culture of the organization. Person–organization value congruence is the overriding principle of person–organization fit (Boon 2017). EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 185 Organizational fit includes how work is done in the organization, how people are treated, what behaviors are rewarded, and whether the culture is characterized by competition or cooperation. Research suggests that applicants conduct their own assessments of person–organization fit, and these perceptions are likely to change throughout the recruitment process and affect job choice decisions (Swider, Zimmerman, and Barrick 2014). This finding changes the dynamic of hiring, from a selection method that is based on concrete and observable indicators of person–job fit to a selection approach that seeks to assess person–organization fit. However, selection methods to assess fit are far from perfect and largely untested. Arthur and colleagues (2006) state that if person–organization fit is used as a selection criterion, then measures must be held to the same psychometric and legal standards that apply to more traditional selection tests. While the idea of person–organization fit is appealing, there remains the important question of whether fit is actually predictive of job performance. The evidence shows mixed results. Hoffman and Woehr (2006) found that person–organization fit is weakly to moderately related to job performance, organizational citizenship behavior, and turnover. In their meta-analysis of studies in this area, Kristof-Brown, Zimmerman, and Johnson (2005) revealed that person–organization fit is strongly associated with job satisfaction and organizational commitment and moderately correlated with intention to quit, satisfaction, and trust. However, the same study found a low correlation between fit and overall job performance. This evidence should not discourage efforts to achieve person–organization fit, but organizations need to have realistic expectations for higher levels of performance as a result of fit. What does this line of inquiry imply for healthcare organizations? First, in some cases, making hiring decisions based on person–organization fit may be unrealistic. For example, in positions that are difficult to fill, whoever meets the minimum qualifications may need to be hired. Known to some sardonically as the “warm body” approach, this situation is defined by Rosse and Levin (2003, 9) as when a manager hires “anyone with a warm body and the ability to pass a drug test.” Whether this type of hiring is effective in the long run is debatable, and certainly hiring without concern for fit may lead to poor long-term outcomes. Second, in situations in which fit can be taken into consideration, the importance of job fit versus organizational fit depends on the nature of the job and work environment. No fixed rule can be used for deciding on the appropriate balance between the two types of fit, but this balance should be discussed explicitly among hiring decision makers. Both person–job and person–organization fit have great importance in hiring a nurse on a psychiatric unit. However, person–organization fit is arguably less important in hiring a medical data-entry clerk. Among the most well-known approaches to measuring fit is the Organizational Culture Profile (OCP) (O’Reilly, Chatman, and Caldwell 1991). The main difficulty with the OCP is that it is labor-intensive and susceptible to respondent fatigue. Therefore, if person–organization fit is used as a selection criterion, an easy-to-administer, valid measure of person–organization fit needs to be established for use in parallel with measures that assess technical job competency and person–job fit. The use of fit as a selection criterion has potential legal implications and concerns for diversity. If we exclude people who are not “like us,” does this action reflect a closed culture in which hiring managers are interested only in people from a narrow segment of society? Perhaps the flip side of hiring for fit is the practice of “ritual hiring,” in which organizations or individuals apply well-worn but possibly obsolete hiring practices without assessing whether these procedures predict performance or perhaps even favor lower-performing applicants (Rosse and Levin 2003, 9). Organizations and jobs change, and so do job requirements. Thus, selection methods need to be current and consistent with the demands of the job. Managers must question “tried and true” selection methods to determine whether they are in fact useful and helpful, and these methods deserve serious discussion by those involved in and affected by hiring decisions. Through such processes as targeted selection and behavioral interviews, successful selection based on person–organization fit can be made. For example, Women & Infants Hospital of Rhode Island made an explicit effort to select employees on the basis of their fit with the culture, believing that a “person must be qualified to do the job, but they also require the right personality” (Greengard 2003, 56). After starting a hiring program using behavior-based interviews and in-depth analysis of candidates, the hospital saw patient satisfaction rise from the 71st percentile to the 89th percentile EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 186 nationally, while turnover declined by 8.5 percent. Labor disputes also decreased, while productivity increased (Greengard 2003). Similar positive outcomes have been found in other healthcare organizations, such as Houston Methodist’s Hire4Fit for fit program (Healthcare Source 2020). Job Requirements and Selection Tools The primary goal of selection is to identify among a group of applicants the person to whom a job offer should be made. On what basis should such a decision be made? Selection tools refer to the procedures or systems used to obtain job-related information about job applicants. These include the job application form, standardized tests, personal interviews, simulations, references, and any other mechanism that yields valid information about job applicants (see exhibit 7.6). Having a clear understanding of job requirements should guide the choice of selection tools. While this statement may seem obvious, it is not uncommon for a selection process to move forward without adequate information about job requirements and necessary competencies. EXHIBIT 7.6 Common Selection Tools EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 187 Source: Adapted from EEOC (2007). EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 188 Selection tools should evaluate the full range of job requirements, including the intangible requirements of the job, such as interpersonal skills, attitude, judgment, values, fit, ability to work in teams, and management abilities. Without an in-depth understanding of the job, the organization runs the risk of hiring someone who is a poor fit for the job, the organization, or both. In particular, the job needs to be analyzed with respect to both its current and future content and requirements. Jobs change, and using the content of the job from the past may easily overlook critical aspects of the job. The analysis may include seeking out the views of individuals who currently hold the position or who are in a similar position, and obtaining the perspectives of supervisors and coworkers. A more formalized critical incident analysis may also be used to identify the hidden or less formal aspects of a job. A critical incident analysis is designed to generate a list of good and poor examples of job performance by individuals who are knowledgeable about the job. Examples are then grouped into job dimensions. Evaluative measures are developed for each of these job dimensions. The critical incident approach involves the following steps: 1. Identify job experts and select methods for collecting critical incidents. Incidents may be obtained from the jobholder, coworkers, subordinates, customers, and supervisors. Different job experts may have varied views of the same job and may identify dissimilar critical incidents; this range of perspectives is the strength of this method. 2. Generate critical incidents. Job experts should be asked to reflect on the job and identify examples of good and poor performance. Note that critical incidents may also be used as a form of performance appraisal, whereby the supervisor maintains a list of employee incidents illustrative of excellent and less than optimal behavior. Each critical incident should be structured such that it is specific and pertains to a specific behavior; it focuses on observable behaviors that have been, or can be, exhibited on the job; it briefly describes the context in which the behavior occurred; and it indicates the positive or negative consequences of the behavior. 3. Define job dimensions. Job dimensions are defined by analyzing the critical incidents and extracting common themes. This information may then be used to inform the selection process. Exhibit 7.7 provides examples of critical incidents associated with four jobs and the job dimensions related to each incident. This exercise yields a thorough understanding of the job’s technical requirements, the job’s formal qualifications, and the informal but critical aspects of successful job performance. Not only does a critical incident analysis provide a solid foundation for selection, it also provides protection against charges of unfair hiring practices as it specifically identifies how key job requirements are related to job performance. EXHIBIT 7.7 Critical Incident Approach to Identifying Job Requirements EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 189 Reliability and Validity of Selection Tools Not all selection tools are equal in their ability to predict job performance. Ideally, applicants who score better on selection instruments should consistently exhibit higher levels of job performance than individuals who score at lower levels. Therefore, to be useful, selection tools must be both reliable and valid. From a measurement perspective, reliability is defined as the repeatability or consistency of a selection tool. According to this definition, a selection tool is deemed reliable if it provides the same result over and over again, assuming that the characteristic that the selection tool is attempting to measure does not change. In other words, a reliable selection tool is one that yields the same findings regardless of who administers the tool or in what context (e.g., time of day, version of the tool) the tool is used. In general, physical and observable traits and skills (e.g., height and weight, the ability to lift a given weight, the ability to compute manually) are more reliably measured than are psychological or behavioral traits (e.g., competitiveness, intelligence, tolerance). Exhibit 7.8 provides an overview of the relative reliability of the measurement of different human attributes. EXHIBIT 7.8 Relative Reliability of Measurement of Human Attributes EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 190 Sources: Adapted from Albright, Glennon, and Smith (1963); Gatewood, Feild, and Barrick (2011). In contrast, validity refers to the relationship between a selection instrument and job criteria. In essence, validity focuses on whether a selection instrument measures a characteristic that is related to job performance. Validation of a selection test addresses the question of whether individuals who receive high scores on a selection test will perform well on the job (Hardison et al. 2015). Content validity is the extent to which a selection tool representatively samples the content of the job for which the measure will be used. According to this strategy, a selection tool that includes a sufficient amount of actual job-related content is considered valid. Expert judgment, rather than statistical analysis, is typically used to assess content validity. One may look at content validity in designing a knowledge-based selection tool for laboratory technicians. A test that requires applicants to describe procedures associated with the most common laboratory tests is likely to be judged to have content validity. More specifically, construct validity refers to the degree to which a selection tool accurately measures a construct that is associated with effective job performance. We may consider, for EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 191 example, integrity as a construct. This may be defined as an employee’s honesty, dependability, trustworthiness, and reliability. If an organization administers an integrity test to job applicants, how certain can the organization be that the test actually measures integrity? A criticism of this type of test is that applicants may fake their responses, that is, respond in a way that creates the desired impression. Criterion-related validity is the extent to which a selection tool is associated with or predicts actual job performance. Criterion-related validity can be demonstrated through two strategies. The first of these strategies, concurrent validity, involves administering a selection tool to a group of current employees. These employees’ scores are then correlated with actual job performance. For the selection tool to demonstrate concurrent validity, a strong correlation must exist between the score on the selection tool and actual job performance. An alternative and more complex approach to assessing criterion-related validity is by assessing a tool’s predictive validity. Here, the selection tool is administered to a group of job applicants but is not used as a means of selection. Because the selection tool has not yet been validated, actual selection decisions are made on the basis of other measures and criteria. Over time, data are obtained on the actual job performance of those selected for the job. The two sets of scores—those from the selection tool being validated and scores derived from employee’s actual performance measures—are correlated and examined for possible relationships. A strong correlation between performance on the selection tool and future job performance would provide evidence that the selection tool is valid. Unfortunately, many organizations employ a range of selection tools but pay little or no attention to their reliability and validity. In the following section, the reliability and validity of some common selection tools are examined and suggestions are offered on how they can be improved. Reference Checks Organizations typically perform background checks on prospective employees, which may include verifying educational credentials, assessing legal status to work in the United States, checking credit references, reviewing criminal records, and performing online searches. Employers face restrictions on background checks, many at the state level. For example, several states restrict the use of credit histories in hiring decisions, while other states place restrictions on the use of criminal records in employment decisions (Workplace Fairness 2020). To avoid negligent hiring, checking references from former employers is a potentially useful tool. However, many organizations refuse to provide information about former employees for fear of defamation lawsuits. A study conducted by SHRM found that while 98 percent of respondents indicated that their organization verifies dates of employment for current or former employees, 68 percent would not discuss work performance, 82 percent would not discuss character or personality issues, and 8 percent would not disclose a disciplinary action (Meinert 2011). This finding certainly limits the usefulness of reference checks beyond verifying past employment. The Equal Employment Opportunity Commission (2014) has established guidelines for employer background checks that address a variety of issues, including the need to obtain an applicant’s written permission to conduct a background check and the importance of applying the same standards to all applicants. Adding to the difficulty in using information from references is the lack of data on the reliability of using reference checks to gauge performance in previous jobs. Researchers have sought to determine the level of agreement (interrater reliability) between different individuals who provide a reference for the same applicant. Reliability estimates are typically poor, at a level of 0.40 or less. This finding may be explained by a number of factors, including the reluctance of many referees to provide negative feedback and the real possibility that different raters may be evaluating different aspects of job performance. Studies of the validity of reference checks have found that this tool has low predictive validity (Ladimeji 2014). Several explanations have been suggested for the poor predictive power of reference checks: Many measures used in reference checks have low reliability; when reliability is low, validity must be low as well. EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 192 Individuals who provide references frequently only use a restricted range of scores—typically in the high range—in evaluating job applicants. If virtually all reference checks are positive, they are still unlikely predictors of performance for all individuals. In many instances, job applicants preselect the individuals who will provide the reference, and applicants are highly likely to select only those who will provide a positive reference. How can the validity of reference checks be improved? Research in this area offers the following conclusions (Gatewood, Feild, and Barrick 2011): The most recent employer tends to provide the most accurate evaluation of an individual’s work. Reference checks are improved when the reference giver has had adequate time to observe the applicant, and the applicant is the same gender, ethnicity, and nationality as the reference giver. Reference checks are more accurate when the old and new jobs are similar in content. Exhibit 7.9 provides some basic guidelines for the appropriate use of references. EXHIBIT 7.9 Guidelines for the Appropriate Use of Reference Checks EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 193 Job Interviews The job interview is used for virtually all positions, largely because those involved in hiring simply wish to find out more than can be obtained from the application, references, and other documentation. The interview is often given the greatest weight in hiring decisions. Job interviews, however, typically have low reliability and validity, are often unfair to applicants, and may be at least partially illegal. They frequently are not reliable because questions vary from interviewer to interviewer, and two applicants vying for the same position may be asked different questions. Similarly, the manner in which answers to interview questions are interpreted and scored by interviewers may vary substantially. Strong evidence suggests that some people are capable of, and often engage in, “faking” of answers such that they appear more appealing to the organization and that individuals with particular personality profiles are more likely to engage in this behavior (O’Neill et al. 2013). While differentiating between honest and faking interviewees can be difficult, the less transparent the interview format—that is, the less apparent the socially desired response—the better the chance of obtaining honest responses. The predictive validity of the job interview—that is, whether a positive interview actually predicts job success—has also been questioned. Job interviews present several problems. First, the questions are usually not provided to applicants in advance and may have little relationship with the candidate’s performance in the future. This format may be seen as unfair because candidates are not given the opportunity to prepare answers that would showcase their knowledge, skills, and abilities. On the other hand, not providing questions in advance may reduce the opportunity for applicants to game the system by preparing socially desirable responses. Second, interview questions are often not standardized, causing applicants to be treated differently because each interviewer poses different questions and each applicant is asked a different set of questions. Lack of standardization prevents the interviewer and the organization from obtaining the information necessary to make informed decisions. Third, untrained interviewers may pose legally dubious questions that violate the law or compromise ethical principles, such as inquiries about plans for starting a family or for maternity leave. Notwithstanding these problems, the job interview can be an effective and efficient method of acquiring job competency information and assessing the applicant’s suitability for a position and fit with the organization. Furthermore, it can be used as a valuable recruitment tool because it allows the interviewer to highlight the positive features of the organization, the department, and the job. Those involved in selection can choose between unstructured and structured interview techniques. Unstructured interviews present few constraints in how interviewers go about gathering information and evaluating applicants. As a result, unstructured interviews may be subjective and thus tend to be less reliable than structured interviews. However, because of the free rein frequently given to interviewers, unstructured interviews may be more effective than the structured type in screening unsuitable candidates. In a structured interview, the questions are clearly job related and based on a thorough job analysis. A discussion before the interview among the selection team members is advantageous because it provides the team an opportunity to decide on what responses would be considered high and poor quality. This decision, in turn, allows the team to score applicant responses. Situational, experience-based, job-knowledge, and worker-requirement questions are most commonly posed during a structured interview. Situational questions relate to how an applicant may handle a hypothetical work scenario, while experience-based questions ask how the candidate previously handled an issue that is similar to an issue that may be encountered on the new job. Following is an example of a scenario and related situational and experience-based questions. The constructs being assessed in this case are the ability to handle a stressful situation, competency in dealing with the public, and professionalism. Scenario: Seven pediatricians work in a busy medical practice, and Monday morning is the busiest time of the week at the clinic. The waiting room is crowded, and two of the pediatricians are unexpectedly called away from the office—one for a personal situation and the other to EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 194 attend to a patient in the hospital. Children and their parents now have to wait up to two hours to see the remaining doctors, and their level of anger and frustration increases as they wait. They are taking out their anger on you. Situational questions: How would you handle this situation? What and how would you communicate with the remaining physicians about this situation? Experience-based questions: Think about a situation in your last job in which you were faced with angry and upset patients or customers. What was the situation? What did you do? What was the outcome? Situational questions should be designed in a way that allows alternative, not just expected, responses to be evaluated or scored. If a panel—two or more people—conducts the interview, each panelist should be able to confirm answers and their meaning with each other. Job-knowledge questions assess whether the applicant has the knowledge to do the job. These questions and follow-up probes are predetermined and are based on the job description. Similarly, worker-requirement questions seek to determine whether the candidate is able and willing to work under the conditions of the job. For example, applicants for a consulting position may be asked if they are able and willing to travel for a designated portion of their work. Whatever form is used, job interviews must be conducted with the following guidelines in mind: 1. Prepare yourself. For an unstructured interview, learn the job requirements. For a structured interview, become familiar with the questions to be asked. Review information about the job applicant. 2. Create a respectful physical environment for the interview. 3. Describe the job and invite questions about the job. 4. Put the applicant at ease, and convey an interest in the person. A purposely stressful interview is not desirable, as other reliable and more ethical methods can be used to assess an applicant’s ability to handle stress. Furthermore, a purposively stressful interview may reflect poorly on the organization. 5. Do not come to premature conclusions (positive or negative) about the applicant. This guideline is particularly important for unstructured interviews. 6. Listen carefully, and ask for clarity if the applicant’s responses are vague. 7. Observe and take notes on relevant aspects of the applicant’s dress, mannerisms, and affect. 8. Provide an opportunity for the applicant to ask questions. 9. Do not talk excessively. Remember that the interview is an opportunity to hear from the applicant. 10. Do not ask questions that are unethical or that put the organization in a legally vulnerable position (see exhibit 7.10). 11. Explain the selection process that comes after the interview. 12. Evaluate the applicant as soon as possible after the interview. This evaluation includes engaging with other interviewers who may be interviewing the same applicant. EXHIBIT 7.10 Inappropriate and Appropriate Job Interview Questions EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 195 EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 196 EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 197 Note: Questions listed here are not necessarily illegal. For example, it is not illegal to ask an applicant’s date of birth, but it is illegal to deny employment to an applicant solely because he or she is 40 years of age or older. In this case, the question is not illegal, but there may be a discriminatory motive for asking that is illegal. Unknown or ambiguous motive is what makes any question with discriminatory implications inappropriate. If an individual is denied employment, having asked this and similar questions could lead the applicant to claim that the selection decision was made on the basis of age, gender, or another characteristic for which it is illegal to discriminate. COVID-19 and the Job Interview Process As this book goes to press, the world is in the midst of the COVID-19 pandemic, which has touched all areas of life. This period has been marked by changes in the way we relate to each other, accomplish our work, and carry on with the daily tasks of living. People and institutions have adapted to this reality, and at this time, it is unclear which of these changes will become permanent. Prior to the pandemic, we were already seeing job interviews being carried out virtually through a variety of communication platforms. As technology has advanced, we have gradually adapted. However, the pandemic forced change upon us rapidly, leading to the development of new technologies and increased use of extant technologies. During the pandemic, it became common for individuals to apply for a job, participate in a job interview, and accept a job offer without ever seeing their employer in person. As in other areas of life, these adaptations are also experiments in which we test the effectiveness of socially distanced patterns of interaction and learn how to improve on them. Innumerable articles have been written to provide advice to employers and job seekers about how to deal with these adaptations in recruitment and selection processes. Much of this advice may be robust and have staying power, while new technologies may emerge to improve on the methods currently being used. Some of these articles may no longer be available or relevant after the pandemic. Regardless, they demonstrate how changes can dramatically alter how we work in a relatively short period of time. For example, sites such as LinkedIn provide advice on how employers can best adapt to the virtual interview format (Anderson 2020; Seaman 2020). SHRM has published advice for job applicants on engaging effectively in a virtual interview during the pandemic (Yate 2020). The job search site Indeed.com (2020) offers advice for employers on best practices for virtual interviews. Applications and Résumés Application forms and résumés typically contain useful information about job applicants. The major drawback of these tools is that they may misrepresent qualifications. Several methods can be used to improve the usefulness of application forms. First, create an addendum to the application that asks applicants to provide information that is specific to the open position. This way, particular knowledge, skills, and abilities can be targeted for different jobs. Second, include a statement on the application form that allows the applicant to indicate that all the information he or she reported is accurate; the applicant should then be required to sign or initial this statement. Third, ensure that illegal inquiries about personal information (e.g., marital status, height, weight) are excluded from the form. Ability and Aptitude Tests Ability and aptitude tests (including personality, honesty, integrity, cognitive reasoning, and fine motor coordination tests) are available, and many of them demonstrate reliability and validity. A number of firms specialize in developing and assessing tests (see, e.g., Walden Personnel Testing and Consulting at www.waldentesting.com). Debate is brewing about the issue of situational validity—the notion that the nature of job performance differs across work settings and that the validity of tests may vary according to the setting. In general, studies have concluded that results of a test on basic abilities are generalizable across work settings, assuming that the test is valid and reliable. The key is to ensure that such tests are actually representative of the work involved in a particular job. Assessment Centers The use of assessment centers is a highly sophisticated and multidimensional method of evaluating EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 198 applicants. The term assessment centers may refer to the physical locations where testing is done, but it may also refer to a series of assessment procedures that are administered, professionally scored, and reported to hiring personnel. Traditionally, assessment centers have been used to test an applicant’s managerial skills, but they are also employed for a variety of hiring situations. Typical assessment formats include paper-and-pencil tests, leaderless group discussions, role-playing intelligence tests, personality tests, interest measures, work-task simulations, in-basket exercises, interviews, and situational exercises. Evidence indicates that positive statistical relationships exist between assessment center scores and job performance (Jackson, Stillman, and Englert 2010; Lehman et al. 2011). Summary Recruitment and selection are key HRM functions, especially in a competitive, pressurized environment such as healthcare, where the consequences of making the wrong hiring decision may have life-and-death consequences. Healthcare organizations and their HR departments face enormous challenges. From a recruitment and selection standpoint, they need to seek employees who (1) have specialized skills but are flexible to fill in for other positions, (2) bring in expertise and are able to work in groups whose members are not experts, (3) are strongly motivated yet are comfortable with relatively flat organizational structures in which traditional upward mobility may be difficult, and (4) represent diversity yet also fit into the organizational culture. From a retention standpoint, they need to identify factors related to retention and develop innovative strategies to improve retention. By doing so, healthcare organizations will be better able to meet challenges in the coming decades. Discussion Questions 1. Given two equally qualified job applicants—one from inside and one from outside the organization—how would you go about deciding which one to hire? 2. For a variety of reasons, some healthcare organizations are unable to pay market rates for certain positions. What advice would you give such an organization about possible recruitment and retention strategies? 3. The use of work references is increasingly viewed as unreliable. How can employers legally and ethically obtain information about an applicant’s past performance? What measures can be taken to verify information contained in a job application or résumé? 4. What are the advantages and disadvantages of using the internet for recruitment? What advice would you give to a hospital that is considering using the internet for recruitment? Experiential Exercises Case Sexual Orientation Discrimination Note: This case was written by Brian Cooper. Kathleen, director of physical therapy at Wabash Community Health Center, smiled as she reflected on her meeting with Jerry, the chief medical officer (CMO) of the health center. Jerry had just made the decision to unfreeze a vacant position in Kathleen’s department, a position that had been vacant for more than a year. Since one of the physical therapists (PTs) retired one year ago, the remaining four PTs in the department had begun to feel burned out. Only one PT could take vacation or be off work at a time so that the health center would have enough PTs to staff its physical therapy clinic. Until now, the vacant position had been frozen by the CMO because of the health center’s recent EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 199 financial troubles and declining volumes. Even if the position had been available, finding a PT to fill it would have been difficult because the health center was located in a rural county in Mississippi. Kathleen was interested in finding a new hire, not only to fill a much-needed position in the department, but also to introduce some diversity into the team. The current PTs were all white women, the youngest aged 42 years. Kathleen was concerned that in the future she would struggle to keep the clinic staffed because the current PTs would continue to retire with a shortage of replacements to fill the void. Kathleen was therefore very pleased when she received the application of Keith, an African-American man who had just graduated from the University of Alabama at Birmingham. She received the application one week after HR posted the position, and thus far Keith was the only applicant. Kathleen was unsure whether she should interview Keith immediately or wait for more applications to emerge. I should probably reel in the first catch I get, she thought. After all, a bird in the hand is worth two in the bush. While looking over Keith’s application materials, Kathleen noticed that he did not have any physical therapy experience on his résumé, but he had only graduated from the program a month ago. Kathleen wondered why Keith chose to move to Wabash County after living in a large city like Birmingham, where he might find higher-paying work, but she surmised that he might have been from the area originally and that he probably moved back to be around family. Kathleen decided to bring Keith in for an interview. When Keith walked into her office on Monday morning, he seemed very polite and professional. He appeared to be in his mid-twenties and to be in good health, capable of doing the necessary work of a PT. Before proceeding with the official interview questions, Kathleen wanted to make some brief conversation, during which she curiously inquired about what brought Keith to Wabash County. Expecting to hear something about family, she was surprised when she heard him explain, “My partner lives here, and I moved to Wabash to be close to them.” Kathleen did not notice a ring on Keith’s finger and was surprised that when Keith referred to his partner in the previous statement, he used the pronoun “them.” Kathleen thought nothing of it at the time, and she began asking the professional questions. Keith did very well when answering the questions concerning clinical physical therapy practices, and he even showed promise as a leader when answering questions about his methods of interpersonal conflict resolution and personal initiative. When the interview was complete, Kathleen thanked Keith for coming in. She sat at her desk for a moment, reviewing her notes from the interview. She was certain that Keith would be a great fit for the team and that Keith had terrific competency concerning the duties of the job. While Kathleen was reflecting on this, one of the PTs whom she supervised rushed into her office and closed the door behind her without saying a word. Kathleen’s head shot up from her paperwork and she stared, bewildered, at the very concerned face of Linda. The PT clinical supervisor, Linda managed the other three PTs on staff, creating work schedules and serving as support if needed. “That young man that was just in here, who just walked out, that’s one of the men who just moved into my neighborhood!” Linda exclaimed, taking a seat while slowly regaining composure. She cleared her throat and explained, “One of my neighbors, Becky, told me that two men just moved into our neighborhood, you know, together. They’re living an ‘alternative lifestyle.’” She demonstrated the quotes with her fingers in the air as she said the last two words. Kathleen was taken aback by this remark, almost in shock that her PT clinical supervisor, who was usually very professional and appreciative of diversity, was choosing to point out this fact to her. After coming back from two seconds of speechlessness, Kathleen asked, “Well, if in fact what you have just said is true, is that an issue for you?” “Yes,” Linda stated, almost with a pedagogical tone. “I can accept a lot of things about people. But I will not accept someone who lives that kind of lifestyle. It’s just not morally right.” Kathleen was once again taken aback, but she tried to calm Linda down and to perform damage control in the situation. “Linda,” she softly said, “I advise you to think about what you’re saying. We EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 200 don’t know that this information is true about Keith. Even if it is true, this is not a factor that I would consider when assessing an applicant. I realize that his choices may violate your personal beliefs, but you and I both know that we need to work with people who have different beliefs from our own.” “You’re going to hire him, aren’t you? I can see it already. Why, the job has only been posted for one week and you’re just going to hire the first guy that comes in?” Linda held up her index finger as she ordered, “Do not hire him. I do not want him on my staff.” Kathleen leaned forward in her chair and answered, “Keith is an excellent applicant and he will be considered for this position. If you have a behavioral or experiential issue to point out about him, I’m happy to hear about it, but I will not entertain the issue of sexual orientation among our criteria for hiring someone.” Linda became very angry and rose from her chair. “If you think I’m going to have a homosexual on my staff, you’re dead wrong.” She pointed at the door and continued, “If you hire him, I’m going to walk right out that door and you will have to find another supervisor.” With a huff, she marched out of the room. Kathleen sat at her desk, unsure of how to react to this situation. Was Linda simply blowing off steam, or was she making a real threat to leave if Keith was hired? Linda did have a tendency to get emotional, especially when changes occurred around the health center. Perhaps she would get over this in a day or two. Kathleen decided to leave the matter alone for now and to have a talk with Linda the next day. At 8:05 the next morning, Kathleen got a phone call from the personal assistant to Jerry, the CMO of the health center, asking Kathleen to be present in the second-floor conference room at 8:30 a.m. When Kathleen walked into the room, Linda and Jerry were already sitting at the conference table. Jerry motioned for Kathleen to take a seat, and began speaking. “I understand that you and Linda had a disagreement yesterday concerning an applicant that is under consideration for employment. I understand and appreciate diversity as much as you do, Kathleen, but Linda has raised some important concerns about this applicant. The residents of this county do not appreciate the lifestyle that this applicant is alleged to have, and the practice of physical therapy involves a great deal of touching and general interaction with patients. I am concerned that his sexual orientation will lead to problems in our delivery of care. You know how quickly news travels in this community, and patients will not want to receive services from a homosexual physical therapist. If he is hired here, I am concerned that patients will either mistreat him or that they will take their business elsewhere. The health center is already hurting due to lack of volume, and I am afraid that the decision to hire this applicant would ultimately result in a collapse of your department. I, therefore, ask that you do not hire him. If you’re concerned about staffing, keep in mind that the job has only posted for one week. If we have made it this long without a fifth PT, we can make it until the right applicant comes along. Do you understand?” Discussion Questions 1. What would you do in Kathleen’s situation? 2. Identify the facts of the case. Try to distinguish the facts of the case from what has been alleged or perceived. 3. Is it feasible for Kathleen to not hire Keith without liability? 4. Do you think Linda has any hidden motives to prevent Keith from being hired? 5. How often do you think this type of discrimination occurs in healthcare? Chronic and worsening healthcare workforce shortages are likely in the foreseeable future. The objective of this project is to learn about how hospitals and other healthcare organizations are coping with healthcare workforce shortages. Specifically, how do organizations perceive the causes of turnover, and what strategies have they found successful in improving both their recruitment and retention? Project 1. Identify one professional group (e.g., nurses, laboratory technicians, radiologic technicians, information technology personnel) that is known to be experiencing recruitment and retention EBSCOhost – printed on 3/10/2024 11:35 PM via CAL STATE UNIVERSITY NORTHRIDGE. All use subject to https://www.ebsco.com/terms-of-use 201 1. problems. 2. Choose two healthcare organizations that employ this professional group. 3. Locate the individual or individuals most directly accountable for recruiting and retaining professionals in this group. This person may be a staff member in the HR department, a nurse recruiter, or another employee. 4. Find the approximate number of professionals in this group needed by the organization. 5. Obtain the following information on this group: a. Current vacancy rate b. Turnover and retention rates for the last five years 6. Discuss with the appropriate individuals their perception of the causes of recruitment challenges and of turnover and the reasons people choose to stay with their organizations. If possible, interview front-line staff in this professional group to obtain their perceptions on these issues. 7. If possible, explore the costs associated with recruitment, retention, and turnover at the facilities you have selected. Do the organizations keep track of these costs? If not, why? If so, do they use this information to make decisions concerning future recruitment and retention efforts? 8. In your discussions, explore the strategies both organizations have used to increase the success rate of their recruitment and retention efforts. Do the organizations know which strategies have been successful and unsuccessful? If so, which strategies have proven successful? Which strategies have not been effective? What strategies may be effective but are difficult to implement? References Academy to Innovate HR. 2020. “19 Recruiting Metrics You Should Know About.” Accessed November 18. www.analyticsinhr.com/blog/recruiting-metrics/. Albright, L. E., J. R. Glennon, and W. J. Smith. 1963. The Use of Psychological Tests in Industry. Cleveland, OH: Howard Allen. Allen, D. G., T. V. Mahto, and R. F. Otondo. 2007. “Web-Based Recruitment: Effects of Information, Organizational Brand, and Attitudes Toward a Web Site on Applicant Attraction.” Journal of Applied Psychology 92 (6): 1696–1708. American Medical Association. 2020. “2018 Physician Specialty Data Report.” Accessed July 12. www.aamc.org/data-reports/workforce/interactive-data/active-physicians-who-are -international-medical-graduates-imgsspecialty-2017. American Nurses Credentialing Center (ANCC). 2020. “About Magnet: New 2020 Magnet Mission and Vision Statement.” Accessed November 18. www.nursingworld.org/organizational -programs/magnet/about-magnet/. Anderson, B. 2020. “7 Tips for Conducting a Seamless Video Job Interview.” LinkedIn. Published March 12. https://business.linkedin.com/talent-solutions/blog/candidate-experience/2020/tips -for-conducting-seamle…

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