Recruiting new staff is a big challenge. I have found the job interview to be especially unrewarding. It is time-consuming. And the results are often disappointing, in terms of finding the best team members.
I am no HR guru, and no expert on the use of screening programs for hiring. But I have been involved in interviewing and recruiting many new employees for my practice and the hospital where I worked as CMO.
Based on discussion with administrators at other hospitals, it seems no one has a system that effectively identifies new team members who will be both effective and a good cultural fit.
But there is a tool that seems to help. With it, you can screen out those without the necessary skills and those that exaggerate their experience and expertise. I call it the Root Cause Analysis Approach to interviewing.
Interview Tactic for the Job Interview
Most of the information gleaned during an interview is not that useful. It's not that people lie, but it's human nature to present the best version of themselves. They may try to answer honestly. But they leave out certain facts and emphasize others.
Ther is a tactic that has been shown to help weed out unqualified or dishonest applicants. It involves digging very deeply into one of their stated skills during the job interview. This requires someone in the organization that knows a technical area well, in order to honestly assess their expertise. The interviewer asks about a particular skill, and digs into the specifics.
How did they use the skill, and under what circumstances? Were there specific tools used? Can they explain the details of the tool and its strengths and weaknesses? This process is stikingly similar to a root cause analysis.
A root cause analysis (RCA) is designed to find the root causes of an adverse outcome, error or broken process. It was originally used in manufacturing to determine how to fix mistakes and improve production. Once root causes are identified and corrected, the production of faulty products will be prevented.
This process has been effectively applied to analyzing errors in medical care. The Joint Commission has formalized the process for hospitals to identify the factors causing sentinel events and other adverse outcomes.
One feature of the RCA is to ask the question “Why” at least five times to get to the root cause(s) of an error.
Brief Example
Consider a case in which a patient has an allergic reaction to a medication. On investigation, it is determined that the patient was known to have an allergy to the medication. But nursing staff administered the medication in spite of that fact. Let's follow the progression of questions and answers:
A patient experienced a medication error…
- Why was the patient injured?
Answer: His nurse gave him an overdose of medication.
2. Why was an overdose administered?
Answer: Because it was mis-labelled as a lower concentration than it actually was (proximate cause).
3. Why was it mis-labelled?
Answer: The concentration was manually entered into the bar-coding system improperly.
4.Why was it entered improperly?
Answer: The process was manual and therefore open to operator error.
5. What were the root causes of the operator error?
Answer: There were several root causes that may have contributed:
– the technician was new and not fully trained,
– he was working back to back shifts (probable fatigue),
– he was inadequately supervised during the training period, and,
– the staffing at the time was less than recommended (probable overwhelm).
Use the Root Cause Analysis Technique
Now let's apply this approach to a job interview. The idea is to NOT ask superficial questions, but to focus in on one or two areas in a manner similar to an RCA.
Consider an example in which I am interviewing a potential chief quality officer for a mid-sized hospital. One of the requirements of the job involves oversight of length of stay initiatives.
During the job interview, the conversation may go something like this:
Thanks for spending the day with us, Susan. I'm very pleased to meet you and discuss this position with you. According to your CV, you were administratively responsible for quality improvement and inpatient length of stay at your previous job. You probably noticed that our LOS has been going up in recent years. Do you believe you would be able to help us improve our LOS?
Absolutely. I was responsible for the oversight of our program for five years. I am fairly proficient at analysing and addressing LOS issues in the hospital setting.
Excellent. What were the main components of your LOS program?
We addressed it at several levels. We developed and followed evidence-based protocols for all of our high volume diagnoses. We had an aggressive case management program. We aggressively used observation care. And we implemented a post acute care process that enabled us to move patient to the nursing home quickly. We had an LOS oversight committee. We measured our LOS regularly and reviewed reports on a monthly basis.
(So far, so good).
That sounds great. Measurement of LOS is very important. That is one area where we will need to focus. What system did you use to track your LOS?
The reports were provided by our Decision Support team. I'm not sure which system we used for that.
Do you know if the data for LOS were risk adjusted, and if so, what method of risk adjustment was used?
I'm not sure about that. We used standard methods.
Do you recall the types of risk adjustment that might be applied in similar situations here?
I'm not really an expert on risk adjustment. I would need to get some help on that.
(Starting to see some knowledge gaps here).
OK. Earlier, I didn't hear you mention anything about involvement of documentation and coding staff on the LOS team. Were they involved at all? And if so, how?
I'm not sure what you're asking. Those services reported to the billing department and didn't have much to do with the LOS committee.
(Here is another knowledge deficit).
Review of Interview
The conversation starts out well. But as we get into the details of this specific topic, the applicant demonstrates a lack of understanding of the topic.
Susan should know the importance of coding and documentation in managing length of stay (if coded inaccurately, the expected LOS may appear to be much shorter than expected). It appears that she may not possess the specific experience required. The candidate's candor in describing her level of expertise is also starting to be questioned.
Ideally, the candidate will answer each deeper level of questioning appropriately. Alternatively, if the applicant were to honestly admit to her knowledge gaps early, it would have been more reassuring about her integrity. Then she might still be hired, but with efforts to provide her the necessary training over time.
Summary
Using the Root Cause Analysis Approach to performing a job interview is one of the most useful ways to discern whether new candidates have the necessary knowledge and attitudes for the job. You can assess both their honesty and their expertise by digging deep, rather than asking a broad set of superficial questions.
If the applicant fails the RCA approach, think very carefully about whether to proceed with an offer. But be certain to discuss your concerns thoroughly with your HR professionals before making any final recommendations.
Following this interview method will not guarantee hiring success. But it will greatly increase the odds of identifying unqualified candidates.
Have you tried this method? Has it helped?
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And feel free to contact me directly at john.jurica.md@gmail.com
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