Focused training is necessary to prepare the next generation of the health care facilities workforce.
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The health care facilities profession is on the cusp of a “silver tsunami.” Baby boomers retire daily and reportedly at rates greater than they are backfilled. This means an exorbitant amount of knowledge is walking out the door with them. What can health care institutions do to attract new talent to their engineering and maintenance departments and prepare those with management potential?
Attracting talent
The potential for a career in health care facilities is not widely communicated in schools or well established by the health care field. Current facilities managers have a duty to seek out talented individuals who desire lifelong, fulfilling careers.
Community colleges, trade schools and high schools with skilled trade programs are ideal places to start educating younger generations about the benefits of a career in health care facilities.
The Texas Association of Healthcare Facilities Management has successfully connected trade school students and graduates with local hiring facilities managers. The prospective talent pool also includes those who began their careers in construction because they often seek stable work as they mature or elevate their professional goals. Veterans finishing their military careers are also well-qualified candidates because they possess a desire to serve and are trained in technical, critical thinking and leadership skills.
Facilities managers should collaborate with their human resources counterparts to develop recruitment messages to effectively communicate the benefits of a health care facilities career. Facilities support functions differ greatly from clinical functions, so it’s helpful to include someone with detailed knowledge of the work when developing those job descriptions, recruiting qualified talent and screening candidates for placement potential.
When interviewing skilled laborers, it’s also important to explain how and why health care is different. First and foremost, the work is patient-centric. Improving the lives of patients, their visitors and the local community is extremely fulfilling and provides a sense of purpose.
Most health care facilities jobs offer a set, guaranteed work schedule and at least a partially conditioned work environment. The job responsibilities are dynamic and challenging so that workers continuously feel a sense of achievement at the end of their shifts. Salaries and benefits are often competitive with other major industries. Working with a skilled team offers the opportunity to cross-train with other disciplines and expand individual knowledge bases.
Most health care organizations are structured with several levels of management that include team leads, supervisors, facilities managers and more. This vertical structure allows multiple advancement options for employees instead of requiring them to wait on one person to be promoted or retire.
Relevant job descriptions
Operational changes frequently occur in the health care environment, and job competencies can quickly become outdated because of new regulatory requirements, equipment installations, strategic initiatives and staff reorganizations. Thus, facilities leaders should regularly review and update their department’s job descriptions similar to updating management plans and other documents.
Long-standing job positions are especially susceptible to change due to greatly evolved health care trends. Best practices have encouraged health care organizations to consolidate job functions and then separate them into specialty skills, only to generalize them again.
For decades, the health care field has debated the outsourcing versus insourcing model depending on a facility’s size, age, specialty, location and other factors, and these analyses greatly affect which job positions remain relevant and necessary. Regardless of benchmarking results and resourcing portfolios, it is advantageous to maintain accurate job descriptions because they are the vehicle that attracts qualified candidates to open positions and holds current employees accountable for their duties.
Job competencies should be detailed, specific to each position and consistently worded across all positions. They also should be actionable and measurable such as, “Demonstrate an understanding of common health care-related codes and a fundamental knowledge of how health care occupancy varies from other building occupancy types.” This competency is general enough to serve as a standard for all department positions while also holding employees responsible for interpreting and applying job-related regulatory requirements.
Some facilities leaders prefer to include a documented competency that addresses all other duties as assigned. This allows them to utilize employees for non-job-specific tasks, especially during emergencies when employees are asked to do other jobs to support the hospital. Other facilities leaders prefer to document this job requirement as an expectation rather than a competency; or to be more specific with phrasing such as, “Observes, enforces, and performs emergency response procedures and other hospital support functions as directed.”
Regardless of the approach, these expectations and competencies should be clearly communicated during the hiring and onboarding process with specific examples. They should then be reiterated through the work culture and revisited as necessary during team or department meetings.
The job description review process also should encompass education requirements for technicians and other skilled laborers. If education, certifications and licenses are preferred but not required, they should be documented as such in the job description.
Facilities managers should remove as many hiring barriers as possible for qualified candidates who have been trained in nontraditional ways. A high school diploma or its equivalent, for example, might be preferred but not required for technicians.
Marcus Venison, director of engineering at Children’s Health in Dallas, recently changed the high school diploma requirement for his technicians from required to preferred. “Changing this requirement allowed us to hire skilled technicians who may have worked for a family business or learned their trade in other informal ways,” Venison says. “These are extremely talented individuals who have taken a different educational path but are still valuable to our organization.”
Employees may still need to earn a diploma to reach a supervisor’s position or higher, and most health care organizations offer tuition assistance to help employees achieve educational goals.
Fundamental knowledge
Baby boomers are retiring every day from upper management and skilled trades positions. Their successors are not always well equipped to replace them because they have limited related job experience.
Focused, proactive training is necessary to prepare the next generation of the health care facilities workforce. Otherwise, decades of knowledge walk out with the retired individual. Structured “shadowships,” boot camps, apprenticeships and other training programs are useful for transferring knowledge from one person to another or even a group of people with similar job functions.
Years of work experience are captured for training materials and used for immediate and future training purposes. This process can take months, so careful planning is required. Once they’re established, it’s important to maintain these training materials with regulatory, infrastructure and process updates so they remain relevant and useful.
Training isn’t limited to just knowledge transfer exercises that fill in retirement gaps. Health care facilities often develop and administer their own training materials for onboarding, upskilling and cross-training purposes. A proposed framework for these internal programs is provided in the following paragraphs and sectioned into key areas:
Compliance. It’s often said that health care is the most regulated industry other than nuclear plants. This example will focus on life safety requirements, which are prescribed in the health care occupancy chapters of the National Fire Protection Association’s NFPA 101®, Life Safety Code®.
The concept of “defend in place” is unique to health care. It means that occupants in danger from fire must evacuate to a separate, protected building compartment rather than evacuate the hospital entirely. Patients often are incapable of self-preservation, so all hospital staff should be trained on RACE (rescue, alarm, confine and extinguish) and PASS (pull, aim, squeeze and sweep) to support defend-in-place strategies.
Fire protection building features include rated doors and assemblies, paths of egress and exits, and fire alarm and suppression systems. These features must always function properly to protect occupants. When a fire door doesn’t latch or another life safety deficiency occurs, an assessment is completed to determine if temporary measures should be implemented. Facilities staff must be trained to identify these deficiencies, report them appropriately and adhere to the temporary measures established by management.
Patient care environment. The patient care environment includes the functional areas of the physical environment, including safety, security, hazardous materials and waste, fire safety, medical equipment and utilities.
Every hospital has policies, procedures and management plans in each of these areas. The facilities team should know how to locate policies, apply related forms and report safety incidents identified during rounding and everyday activities. They also should understand how hospital operations differ from other building types.
Health care facilities operations are critical and continuous, so there are additional risk considerations that don’t exist outside of the patient care environment. Staff should recognize the impact that could occur if any element within the patient care environment fails, how to mitigate those risks and how to respond when a deficiency or failure occurs.
Emergency management. Emergency management involves risk mitigation strategies like hazard vulnerability assessments and emergency operations plans, plus all phases of emergency response. Through drill training, the staff should know how to quickly respond to an emergency, coordinate efforts with the community, and establish an incident command system during real events.
The Centers for Medicare & Medicaid Services requires hospitals to complete two emergency response exercises each year to allow staff to practice their roles. Real events can count as an emergency response exercise if an after-action report is completed. The after-action report is a full analysis of the staff’s response to the event. The report details areas of improvement and success, what could be done differently the next time and any new mitigation strategies that could be implemented.
Infection control. Facilities staff greatly impact infection control efforts, including preventing health care-associated infections.
HVAC systems affect indoor air quality in critical spaces. Staff training should include identifying which spaces have temperature, relative humidity, filtration, pressurization and other requirements and what these requirements are. Technicians should learn how to monitor these spaces for compliance and how to respond when parameters fall out of range.
Similarly, water systems are at risk of waterborne pathogens, which could cause harm to immunocompromised patients. Hospitals are required to have a multidisciplinary water management committee create a water management plan. These plans identify potential risks such as piping dead legs, water heaters and decorative fountains. To help manage these risks, staff should be trained on how to perform routine flushing procedures, respond when elevated pathogen levels are detected and related activities.
Even though testing for waterborne pathogens is not required, the committee should perform a risk assessment to determine if the building’s risk level warrants it. Facilities staff should be trained on these testing procedures and how to interpret the results, even if the tests are performed by a service provider.
Administration. Facilities managers lead multidisciplinary teams and are usually asked to wear many different hats. Their roles could expand beyond facilities to include other support services such as security, environmental services, health technology management, emergency management, and planning and design.
Training should address these other facets (as appropriate) in addition to key upper-level skills like project management, finance, risk management and personnel management.
It’s critical that these managers are proficient in their expected documentation requirements for regulatory compliance and can effectively manage their budgets. They also should be equipped with the necessary communication skills to run a meeting, present a business case or strategic initiative, engage with other departments and the community, and professionally resolve conflict.
The right candidates
Health care facilities are in constant competition with other fields for skilled workers. Managers should be able to highlight the benefits of health care and have updated, relevant job descriptions available to hire the right candidates. Ultimately, it’s up to all health facilities professionals to retain expertise and pass it on to the next generation.
Health care’s competitive edge
A career in health care facilities can be especially rewarding as the work contributes to caring for patients rather than just increasing profits. Hiring managers should explain to their interviewees and new hires that they will, directly and indirectly, impact patient health and safety, which makes their work critical and valuable to the organization.
As a non-patient-facing department, facilities can easily become siloed from the rest of the hospital if managers do not proactively engage their employees and build relationships across other departments. Leaders must consistently remind their teams of why and how their work is critical and then provide specific examples of how they impact patient care.
For example, the positive air pressure they corrected kept an immunocompromised patient from becoming sicker; the fire door latch they repaired ensured those in the area would have time to safely evacuate patients during a fire; and the emergency lights they tested in the operating rooms reassured surgeons that they could safely operate if normal power is lost to the building.
Facilities leaders are responsible for helping technicians stay engaged with their department and the organization. Technicians want to feel that they have a voice in health care operations and that their opinion truly matters.
Leadership should conduct periodic rounding with individual team members and give them an opportunity to openly express their thoughts. When multiple technicians have the same opinion or idea, it should be addressed with the entire department during team meetings. Facilities leaders should encourage technicians to praise their team members during rounding and share these accolades with the rest of the department.
When technicians feel valued and included by their organization, they are more likely to perform well at work, lead by example and commit to continuing their careers with their current employers.
About this article
This is one of a series of monthly articles submitted by members of the American Society for Health Care Engineering’s Member Tools Task Force.
Taylor Vaughn, MBA, CHFM, CHC, CLSS-HC, is a facility manager at Children’s Health in Dallas and Lindsey Brackett, CHC, CHFM, SASHE, is the chief empowerment officer at Legacy FM. They can be reached at taylor.vaughn@childrens.com and lbrackett@legacy-fm.com.
