Recruitment & Retention in the GCC Healthcare Sector
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Recruitment & Retention in the GCC Healthcare Sector
- 1. RECRUITMENT AND RETENTION CHALLENGES WITHIN THE HEALTHCARE SECTOR IN GCC COUNTRIES
- 2. • Jill Turner, MSc Director of Human Resources Global Medical Solutions Hospital Management LLC email: jill.turner@gmshm.ae • Environment and dynamics • Addressing demands • Retention Introduction Environment & Dynamics Addressing Demands Retention Summary INTRODUCTION
- 4. ECONOMIC CONTEXT A nation’s development depends on both “hard” and “soft” infrastructure (Farid & Khayal, 2013) “ Without health workers, there can be no health services” World Health Organisation (WHO, 2014) Introduction Environment & Dynamics Addressing Demands Retention Summary
- 5. GLOBAL POPULATION ON THE RISE Current global deficit of around 7.2 million skilled health professionals estimated to increase to 12.9 million in 2035 • 1.9 billion extra people seeking healthcare access in 2035 (estimated) • 107 of the 186 countries will be affected by the global deficit prediction for 2035 Adapted from: UN Population projections and WHO Global Health Observatory 186 countries, physicians, nurses and midwives Regional Deficit Per Population South East Asia 48% Africa 25% Western Pacific 11% Eastern Mediterranean 11% Americas 4% Europe 1% Region‘s population predicted to surpass 50 million by 2020 (IMF) Introduction Environment & Dynamics Addressing Demands Retention Summary
- 6. UNDERSTANDING THE GCC HEALTHCARE WORKFORCE Continual rise in health spending BUT major healthcare workforce shortages still exist Medical Personnel CAGR: 2006-2011 Bahrain: -12.1% Saudi Arabia: -4.6% Kuwait: -0.1% Qatar: 1.6% UAE: 2.3% Oman: 3.5% Introduction Environment & Dynamics Addressing Demands Retention Summary
- 7. HEALTHCARE WORKFORCE IN THE REGION Shortage of doctors, nurses and beds per population: • UAE the lowest number of beds • KSA the lowest ratio of nurses and physicians Kuwait, 4,000 doctors and 10,000 nurses for new hospitals by 2016 Abu Dhabi, 3,100 doctors by 2020… Introduction Environment & Dynamics Addressing Demands Retention Summary
- 8. GCC REGION HEALTHCARE MARKET 2013 – 2018 UAE healthcare market set to expand from US$ 10.0 billion to US$ 18.6 billion 12.0% p/a GCC growth anticipated from circa US$ 39.4 billion in 2013 to US$ 69.4 billion by 2018 Higher prevalence of obesity and diabetes increases demands for specialised healthcare services Region‘s population predicted to surpass 50 million by 2020 (IMF) Ageing population numbers of 65+ to increase from 1.2 million in 2015 to 14.2 million in 2050 UAE medical tourism growth rise to US$ 1.69 billion in 2013 from US$ 1.58 billion in 2012 Healthcare IT spend rising US$ 444 million in 2011 to US$ 551 million by 2015 Sourcing and retaining staff will continue to be a priority… Introduction Environment & Dynamics Addressing Demands Retention Summary
- 10. COMPETITION FOR EXPATRIATE TALENT • Material / Non-material Reward and Recognition (RR) H. Younies, B. Barhem & M. Z. Younis, “ Ranking of priorities in employees’ reward and recognition schemes: from the perspective of UAE health care employees”, International Journal of Health Planning and Management 23 [2007] 357-371. • Cash • Paid vacation • Health insurance • Benefits package • Frequency and bonus amount Introduction Environment & Dynamics Addressing Demands Retention Summary
- 11. COMPETITION FOR EXPATRIATE TALENT • Material / Non-material Reward and Recognition (RR) • Connecting pay and performance • Training and education • Opportunity to use new technology • Flexibility of working hours Introduction Environment & Dynamics Addressing Demands Retention Summary
- 12. COMPETITION FOR EXPATRIATE TALENT • Why will health professionals come to your country? • Why will they come (and stay) with your organisation? • Are you able to compete with rewards/benefits? Introduction Environment & Dynamics Addressing Demands Retention Summary
- 13. CHALLENGES EXPERIENCED BY EXPATRIATES IN THE GCC COUNTRIES • Rising gap between salary and inflation • High housing rent expenses • High general living expenses • Limited training opportunities • Adapting to new work culture • Employment and career insecurity • Changing employers • Benchmark regularly • Benchmark regularly • Benchmark regularly • Review CME provision • Communicate appropriate information • Honest and transparent conversations • Become an employer of choice Introduction Environment & Dynamics Addressing Demands Retention Summary
- 14. TIME TO HIRE • A lengthy process… Impact: • Candidate “un-attraction” / withdrawal Solution s Introduction Environment & Dynamics Addressing Demands Retention Summary
- 17. THE COST OF TURNOVER high risk to service, financial cost and operational disruption ‘Turnover’, 2010 CareerBuilder Health Care Survey, 1000+ participants Most Common Reasons Staff Leave Lack of advancement opportunities 51% Work overload 40% Poor salary 40% Too few staff 38% Poor organisation culture 37% Lack of mentoring 25% Poor personal fit with boss 24% Not enough access to technology 23% Lack of training 22% Introduction Environment & Dynamics Addressing Demands Retention Summary
- 18. “ …create an environment where employees want to work” 2010 CareerBuilder Health Care Survey • Ensure appropriate Reward and Recognition • Focus on continuing medical education • Focus on addressing pressure ratios Staff-to-bed Staff-to-patient ‘Turnover’, 2010 CareerBuilder Health Care Survey, 1000+ participants Introduction Environment & Dynamics Addressing Demands Retention Summary
- 19. SUMMARY Health care professionals are in short supply Economically/geographically demand will continue to grow Strategic planning is required Facilities offering this will be at a decisive advantage Expatriate health care professionals are looking for competitive remuneration and continuing development opportunities Develop home country healthcare talent pools Foster an holistic regional approach to licensing Introduction Environment & Dynamics Addressing Demands Retention Summary
Notes de l'éditeur
- Arab Health Recruitment and Training Fair, October 2014 Human Resources Conference
- Successful strategies for sourcing and retaining staff are highly dependent upon 3 key factors the economic and geographic environment, and the dynamics around the industry candidate pool
- To create a successful recruitment strategy, it is important to understand the economic environment in this region. GGC countries typically have a high focus on the development of their economies and infrastructure; and healthcare infrastructure has a proven link to a nation’s level of economic development. “Hard” infrastructure (water, power, transport) usually comes first, is visible and easy to measure. “Soft” infrastructure (eg healthcare systems) typically follow, and progress is more difficult to measure (Farid & Khayal, 2013). A Healthcare system has many needs to address, labor-intensive and quality is dependent upon the number and diversity of its healthcare professionals. The current surge being seen across the region with the building of new hospitals, specialist clinics and medical facilities is in keeping with the regions’ economic development; and naturally leads to increased demand for staff to meet the service growth needs. In order to sustain growth and the provision of quality healthcare services, retention of healthcare professionals is equally as important as securing transportation and power. A simple truth is that health services cannot exist without a workforce (WHO, 2014). In the current regional environment, retention is a serious matter for employers to consider; this is fuelled by high demand to recruit; staff availability from within and outside of the region; and in many cases, extended timeframes for sourcing, mobilizing and onboarding staff from outside the region.
- Fundamental to strategic planning is the consideration of the geographic context and available talent pool . A couple of numbers that are food for thought, it is estimated that an extra 1.9 billion people will be seeking access to healthcare access by 2035 and by 2020, the GCC region’s population is predicted to surpass 50 million (IMF). According to UN population projections and WHO data gathered across 186 countries there is a current global deficit of 7.2 million health professionals, specifically physicians, nurses and midwives; which is projected to increase. Looking at the table/data from the same research it indicates a deficit relationship exists between Higher/Lower income countries - Americas and Europe will experience the lowest deficit, countries most affected by the global deficit prediction being South-East Asia and the African region. With a limited global and regional talent pool, a structured approach to talent acquisition is essential.
- There is a GCC county-wide rise in health spending however major healthcare workforce shortages still exist. GCC countries are net importers of healthcare staff Regional shortage of home country physicians and allied health professionals To cope with demand most jobs are taken up by expatriates Notable over the last 9 years (Medical Personnel CAGR: 2006-2011) Qatar, recruitment of medical workers has grown rapidly along with infrastructure building Oman, has shown a high increase in physicians due to high recruitment focus UAE is employing increasing numbers of physicians, nursing and midwifery staff Bahrain, showing a declining ratio of medical workers from 2011 following an increase in the previous 7 years Saudi Arabia, indicates decreasing trend across all roles over the period
- It is interesting to take a quick look at the make up of the healthcare workforce in the GCC region There is a shortage of doctors, nurses and beds (comparing GCC countries to developed nations)/per population: Increasing demands continue UAE, Qatar, Kuwait building infrastructure Saudi Arabia heavily recruiting doctors from outside the GCC and has a focus on increasing the number of home country doctors UAE facing shortages of skilled medical staff despite increasing numbers of healthcare professionals
- There are a number of regional governmental and reported statistics that illustrate the ongoing high need to attract qualified healthcare professionals to the GCC. There is also the growing spotlight on the need to develop home country professionals For the time Saudi Arabia is expected to continue to have the largest healthcare market (45%) in the GCC, followed by UAE at around 26/27%. Qatar is expected to have the most rapid growth in its healthcare market compared to the rest of the GCC countries, followed by the UAE.
- With a global shortage of healthcare professionals; and, as a region, a high ongoing demand the questions to be addressed are “How are the quality and quantity of staff required going to be acquired to meet growing needs?” Some key areas of focus are: Competition for talent Time/speed to hire Sourcing and attraction techniques Candidate organizational/personal culture fit Shared in this presentation are a few thoughts on ‘Competing for talent’; and ‘Time to hire..
- From the current numbers of home country peoples employed in the GCC healthcare sector, it is evident that there will continue to be a strong reliance on expatriate workers for the foreseeable future. To plan effectively key motivators for expatriate healthcare workers coming to the UAE have been reviewed. (H. Younies, B. Barhem & M. Z. Younis) A 2007 study of UAE based, public and private sector (250) healthcare workers, revealed their preferences for material and non-material forms of reward and recognition. The study was made up of around 70% physicians, nurses and allied health professionals, with 50% being from organisations with 500+ staff. Participant responses indicated that the top five material motivators being cash, paid vacation, health insurance, benefits package, frequency and bonus amount.
- Likewise when it came to Non-material factors, the financial component of connecting pay with performance was the most desired reward by participants from all functional areas. The high value placed on training and education as a benefit requires thought. With Continuing Medical Education being particularly highly valued by physicians and registered nurses. Keeping up with latest medical technology and being adequately staffed to ensure flexibility and work/life balance also figured highly.
- The slide gives three questions to ask, when creating a competitive recruitment strategy in the GCC and when competing for quality healthcare professionals with other high income nations. It is important as part of a recruitment strategy to identify and communicate any unique environmental factors that may be an attracter. People move from their home country for a multitude of reasons - this is a highly researched topic. It is also important to ask “What distinguishes our organisation from others?” Identifying and clearly communicating this to prospective candidates helps to ensure you attract the ‘right fit’ candidates who will thrive within the organizational culture. One of the keys to retaining the staff you recruit is to ensure they are fully aware of the environment they are entering; and the work activities they are required to perform. Finally a good hard look at your Rewards and Recognition framework will indicate whether you are able to compete in the GCC and global market for the health professionals you wish to employ. Noting the study findings, cash was clearly the most desired reward, also high on the list was performance based bonus. Budgeting an adequate provision for expatriates Continuing Medical Education is necessary, especially if you want to retain quality physicians.
- On the left are some of the challenges stated by expatriate workers working in the region; with some of the possible employer responses that require regular review and action to ensure optimum attraction and retention of healthcare professionals.
- “Time or Speed to Hire”, fast or slow, it impacts an organisation’s ability to secure, mobilize and on-board quality candidates; and is a well known recruitment critical success factor for any industry. Good candidates who are in high demand will potentially have a number of options open to them. Completing the recruitment process for many of the essential healthcare roles includes an additional time challenge around candidate credential verification and licencing. With high global demand for healthcare professionals and in some cases lengthy hiring processes, people can be inclined to simply “not be bothered” or “start the process, give up and go somewhere else” where their existing licensing is either accepted or licensure is faster. With external candidates potentially exiting the recruitment process prior to joining, additional pressure is placed on hiring from the in-country market. To to be competitive in onboarding and retaining candidates it is not only essential to have an appropriate remuneration and rewards strategy, a fast, efficient recruitment process is also key to success.
- It is important to invest time and energy into clearly mapping all stages of your recruitment process. It is then possible to identify areas that can be targeted for streamlining and improvement. All steps and stages can be reviewed for speed and efficiency and changes made where possible. Some points to consider being: All touch points with clients and candidates Processes that are linear rather concurrent Response times - ensuring staff are knowledgeable and equipped to deal with enquiries and issues arising Maximizing use of technology where possible to reduce manual and or repetitive tasks/processing
- Having invested heavily in securing your candidates as employees, the next key step is to retain them.
- As a high employer of expatriate staff, the GCC countries healthcare services can be placed at risk by high staff attrition. There will inevitably be a higher level of turnover in the region compared to countries where the percentage of home country nationals working in healthcare is high, with expats there will always be some degree of “transient mentality”. There is a high cost both financially in sourcing replacement staff and operationally in the strain placed on covering empty roles with notice periods and potentially extended hiring times, not always matching. Retention is therefore one of the key priorities for organizations in the region. Two strategies to consider are: Creating and nurturing an environment that enables healthcare employees to continue to thrive will encourage them to stay; and growing the percentage of home country nationals and providing clear career development pathways in order to help mitigate the risk of expatriate attrition. In order to form robust retention strategies, it is important to understand why health professionals choose to leave. A survey, undertaken in the US asked over 1000 healthcare professionals “why they leave organizations’. Out of 15 questions, the 9 shown in the slide table received the highest number of responses. It is interesting to see how the information correlates with the earlier data from UAE professionals on Reward and Recognition.
- To summarize some keys to boosting retention are: Implementing a Reward and Recognition system that specifically addresses healthcare workers’ needs. In other words, benchmark and respond to salary market trends with existing employees. Consider how employee performance is routinely reviewed and rewarded and budget adequately for CME, especially for physicians. Plan effectively and monitor key operational performance measures. (Turnover’, 2010 CareerBuilder Health Care Survey) Research indicates that high turnover can occur in environments where: Health workers are asked to take on additional responsibilities above their comfort level, and Environments with low staff-to-patient ratio There was found to be a direct relationship between these factors, worker stress and medical errors. In addition, when staff are spread so thinly, majority of time is spent on patient care, leaving little time for the continuing education necessary for career development or advancement.
- To sum up Recruitment and Retention Challenges in Healthcare in the GCC.