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Scheduling ‘Bottom of the Ladder’ Workers

Thank you to WFI board member David Creelman for the following guest blog post regarding Jody Heymann’s Profit at the Bottom of the Ladder (Harvard Business Press).

The book marshals the evidence for investing in ‘bottom of the ladder’ talent. (The fact she landed with that awkward ‘bottom of the ladder’ phrase to describe this group is a sign of how neglected these workers are; in more regular management parlance the term is “low skill workers” or “bodies”.)

One insight Heymann shares is how important scheduling flexibility is to this group. Whereas flex-time and telecommuting are the norms for professionals “b of the l” workers often don’t even get any paid time off.  Because professionals have flexibility it may not occur to them just how much lack of flexibility hurts “b of the l” workers and how much the organization stands to gain by building some flexibility into their schedule.

It may take a little thinking to make flexibility possible. Heymann reports that Autoliv Australia (an auto parts manufacturer) has four different shift start times: 6, 7,8 and 9 a.m.  People may not be able to get the shift they want immediately but with some cross-training and patience that can get the shift that suits their situation. (Note: Ricardo Semler, CEO of Brazil’s Semco, would scoff at the notion that management has to work hard to come up with a solution to providing flexible schedules for workers. He’d say just give that responsibility to workers; they’ll figure out a way to make it all work.)

We often think of worker scheduling as a way to minimize costs, but Heymann opens our eyes to the notion that creating scheduling flexibility may be the way to attract, motivate and retain A-players in the ‘b of the l” jobs- ­something that can have big impact on profitability.

Profit at the Bottom of the Ladder

I just received my own copy of Profit at the Bottom of the Ladder – Creating Value by Investing in Your Workforce. I haven’t read the book yet, but our board member David Creelman has.  His reflections follow below:

Imagine two retail giants: Crown company and Foote company. Crown has a stellar top management team, 70% are A-players and 30% are B-players. Foote has only 30% A-players in top management. Now before you lambaste Foote there is one more fact you should know. Crown’s front-line workforce is 70% B-players and only 30% A-players; whereas Foote has a stunning 70% of A-players in those “low-skill” roles. Which company would win the competitive battle?

One can imagine a vibrant argument over who would win; an argument filled with the same passion as teenage boys debating whether Batman could beat up Spiderman. You can imagine the argument but you would never hear it because America has pretty much decided it’s the top jobs that matter. In fact, it’s widely believed the route to success is in lowering wage rates, even if that means potentially filling the working ranks with C-players.

However, there is a convincing argument that investing in superior talent in low-end workers is a winning strategy. Jody Heyman has gathered the evidence in the thought provoking Profit at the Bottom of the Ladder (Harvard Business Press). Heyman makes us wonder if the term ‘low skill’ job blinds us to the reality of what ‘bottom of the ladder’ workers bring to the organization.

This blog is not the place to review all the arguments but I hope you walk away wondering if a retail chain with superstar management could ever really beat a chain with superstar workers. If we refused to believe that those jobs at the bottom were ‘low skill’ and that investing in selection, motivation, training and retention were just as important as for management jobs then what would be wrought?

Most of us have had defining experiences with front line workers that have either made us raving fans or detractors of certain companies.  We’d love to hear your war stories.

Nursing Workforce Planning: a System Not a Process

Following is a guest blog from our board member Tim Porter-O’Grady. I particularly like his discussion regarding the importance of evaluating the supply chain of nurses in one’s local geography, and deploying strategies to develop and augment the supply by investing in available employees. Effective workforce planning requires both micro- and macroeconomic approaches as Tim aptly discusses below. We’d love to hear your comments!

Workforce planning and management requires more than simply responding to current issues and levels of concern related to how many resources and what kind are necessary for rendering good patient care. In fact, workforce planning activities should be a major construct of ongoing nursing leadership responsibilities in both the short and long term. While this is not a revolutionary notion, many of the mechanisms used to plan workforce strategy are often missing from the conceptual and content foundations of the role and practices of nurse leaders.

Of course, workforce planning should be systematic. Included in its activities should be the following discrete yet integrated activities related to effective workforce utility:
• patient population and care characteristics
• population demands and clinical needs
• clinical demands and intensity measures
• skill level demands and staff competency needs
• nursing age distribution and clinical competency levels
• nursing education and developmental opportunities for and responding to care demands and related competency
• performance expectations, quality measures, and evidence of clinical value
• support service availability, clinical technology and tools, resource allocation, and financial factors affecting budgeting

These major arenas of workforce planning require that nurse leaders have a systematic approach to fully managing the resource capacity of the organization in relationship to matching patient needs with appropriate levels of clinical service response. Of course, response to these various arenas of workload and service planning should reflect understanding of the state-of-the-art, available research, and full comprehension and management of the resource configurations available to support workload planning within a particular organizational milieu. Effectiveness in any one of these areas does not assure well managed resource planning activities unless the integration with all of the elements associated with effective use of knowledge workers is equitably addressed.

Often, recognized standards and data which reflect them are not consistently used as a basis for establishing a rationale for good workforce planning activities. Contemporary understanding with regard to educational levels and clinical experience suggest that there is a direct relationship between the two that influences competence, capacity, and clinical outcomes. However, the continuing production of the most limited prepared practitioner in huge numbers has done nothing to improve or accelerate value, clinical outcome, quality measures, or patient safety. One might even suggest that low levels or challenges in each of these areas can be directly related to the percentage of nurses prepared at the most foundational levels of nursing education. This is not to suggest that such nursing education is not appropriate for access or entrée into the profession. It does suggest however that if that remains the foundational level of education of the practitioner, there is a direct limitation of impact on advancing clinical outcomes, service quality, value, and patient safety.

A good workforce planning model should include the recognition of these realities and incorporation of them in the selection of strategies related to particular workforce planning activities. For example, if a hospital or health service is in an area where limited access to baccalaureate and above nursing preparation is unavailable, much more attention needs to be paid to continuing education and development as well as competency and outcome assessments driven from the employing institution to compensate for what isn’t available in the educational arena. This differentiates from the academic medical center which may have ready access to higher levels of BSN education and continuing education than does the more isolated or rural counterpart not having access to such resources. Both are influenced by their prevailing reality and their workforce planning priorities should reflect this differentiation.

Every nurse manager and executive should have a specific model that addresses each of the above workforce planning elements in her or his own institution. Seeing workforce planning as a system rather than a response ensures that each of the elements affecting nurse utilization, competence, and clinical impact are carefully considered, linked and integrated in a way which presents a whole-systems picture of continuing workforce force needs as they influence and inform management priorities and clinical values and measures. In fact, the ability to demonstrate both challenge and value with regard to workforce resources and positive patient outcomes can’t be sustained without this more systematic and effective approach.