Unfortunately, Dick's mother passed away and he – at the end of that journey - felt like there had to be a better way for hospitals to rally around the patient to deliver a whole person care experience. And in Dick's experience and his mom's experience he felt like treatment options were not offered to her. Things she valued such as nutritional support, spiritual care, herbal medicine; those things were not offered. They weren't available and after she passed, Dick started to do a lot of research into cancer care and saw a huge opportunity to create a hospital that put the patient at the center of the entire model.
He founded Cancer Treatment Centers of America in a little town called Zion, Illinois, north of Chicago. Since then, we've expanded to a five-hospital system with hospitals in Tulsa, Oklahoma, Philadelphia, Pennsylvania, Phoenix, Arizona and Newnan, Georgia which is just outside of Atlanta.
At CTCA we really have a huge focus on talent. That comes directly from our Chairman, from Richard Stephenson, and it's also reinforced by our President and CEO, Steve Bonner, who is a tremendous advocate for talent. But the basic premise is clear. Anyone can build a beautiful hospital; anyone who has the type of funding available can invest in the latest and greatest technology; but it's the people who create the care experience. At CTCA we call the experience that we deliver "The Mother Standard of Care." We want to treat every single patient the way we'd want our own mother, brother, father, loved one to be treated. And in order to do that we have to ensure that we have healthy, loyal, fully performing employees whom we call stakeholders in every single role in the organization.
So our stakeholders create and deliver "The Mother Standard of Care" to our patients extremely well. That's what distinguishes CTCA and that's why we're so committed to building a talent-based culture. As Brad alluded, Dick Stephenson and Steve Bonner both were looking for tools that CTCA could use to enhance the way that we select talent and discovered the Topgrading methodology and Brad. And for us it's been a tool that we find very, very useful.
But I think evidence of the fact that it works is just looking across CTCA overall. Our turnover rate is low compared to our competitors. We run a 10% turnover rate and at the executive level it's far less than 10%. So to us that indicates that we're finding A players and then once they're engaged in the culture here we're keeping them engaged, because the thorough assessment that we've done means that we've identified someone that wants to always make a growing contribution to the organization.
Brad Smart: Patient care is obviously important to every employee. No one is role-playing, saying, "Thank you for using CTCA” the way you hear, "Thank you for shopping at K-Mart." Never, never! It’s all from the heart and you've done a wonderful job of using Topgrading to extract the values from candidates, to pick those whose values are consonant with the company. Eric Magnussen: I think probably in any organization the challenge is alignment and making sure that from the executive level of the organization on down that everyone understands why it makes so much sense to invest the amount of time that it takes to conduct a Topgrading interview. That's a challenge within CTCA, because we're a very patient-centered, patient-focused organization, and any time people are away from the patient they ask themselves, "Well shouldn't we be investing that time to spend more time with patients?" I think for us that's been the biggest challenge — really helping people understand the value of investing four to five hours to conduct the Topgrading interview. We found it helpful as we took people through the training process: It's one thing to talk about Topgrading and get it on an academic level; it's a very different thing to experience Topgrading for yourself firsthand. And so we found it effective to take our executive teams through the Topgrading training process because during that process you actually conduct a Topgrading interview. You can discover for yourself the power of the interview and the information that it can uncover.Brad Smart: Eric, what is the cost of mis-hiring a nurse?
Eric Magnussen: At least ten times their base salary.
Brad Smart: How long does it take for Topgrading to take hold in a company and see measurable productivity gains?
Eric Magnussen: Well, I think it's a journey really. Topgrading was introduced 12 years ago and I think it takes a leader at the top who consistently communicates the importance of talent to the organization and is willing to reinforce that by demonstrating that they'll conduct these Topgrading interviews themselves so that they can be role models. Once we conducted those Topgrading workshops across CTCA, the managers trained started using Topgrading methods.
Brad Smart: Someone from Dallas asked what's the best way to sell the idea of Topgrading in an organization that hired based on urgent need instead of waiting for the best candidate for the job and company. Tough question, Eric, we're desperate; we have to have a sales rep for this region or some of our best customers are saying they're going to go with our competitors. And we have some B's and we're certainly not going to hire any C's. What do we do?
Eric Magnussen: If you bring someone into your culture who is not aligned with the way that the organization thinks or is not aligned with your company's mission or vision for a purpose-driven company like CTCA, that's poisonous. So we're always quick to say, "I'm feeling pain right now, because I don’t have someone in this role; but I'm willing to hold out for the right talent, because we recognize that in our business we don't get any do overs."Brad Smart: Eric, someone asked what do you do at Cancer Treatment Centers prior to the Topgrading interview?
Eric Magnussen: We'll conduct an initial screening interview and that would involve a telephone interview. We then bring the person in for a face-to-face interview with the hiring manager if they pass that screening interview. If we think that the individual is still a strong candidate we have another assessment tool that we use to assess the individual. That gives us a read of their talent and then we apply the Topgrading interview as a part of the final round of group interviews that someone completes. So we do a Topgrading interview coupled with face-to-face meetings with the hiring manger or the other managers that are a part of the group, and for senior-level positions, that will involve everyone including the CEO either of the hospital or of the entire organization.
Brad Smart: What are some of the best ways to integrate Topgrading into performance management?
Eric Magnussen: What we find helpful is really when you focus on those competencies, identifying competencies that you can tie into performance. At CTCA we've defined a set of performance standards for each level of the organization starting with managers of self, managers of others, managers of managers, function managers, and business managers. So each of those leadership levels within the company has a set of performance standards. And those define how you should be doing the work. So those are helpful for us to look at especially when we're doing the Topgrading interview because we can test for that in the competency section.
Brad Smart: The Job Scorecard really becomes a basis for performance management. If we really nail down all of the competencies, the numbers to be generated as well as the soft competencies such as team player, you make all of those measurable and it’s the basis for measuring someone’s performance. It's when there's a vague job description that there's more of a problem there. Eric Magnussen: Brad, I think that's a key point, because we really do invest a lot of time building the Job Scorecard, what we call the Job Profile at CTCA.Brad Smart: How important is having two interviewers?
Eric Magnussen: We use tandem Topgrading interviews at CTCA. We find that very valuable, because it gives the hiring manager as well as the person within the talent function the opportunity to be at the same table and to listen to the candidate as he or she progresses through the interview. That's valuable to us, because one person hears something, another person hears something else. And afterwards you can work together to confirm and validate what you heard in the interview.
Brad Smart: Someone asked if rolling out Topgrading scares people: Does it hurt the organization's culture?
Eric Magnussen: For us it's been energizing. I think we're blessed by the fact that we have a very strong culture where all of our employees (we call them stakeholders) – if you were to walk up to a stakeholder in the hallway randomly and say what's CTCA all about, I guarantee you they'd say we're all about serving patients. So we're crystal clear on that. For us, whenever we identify something that gives us an opportunity to improve the way that we deliver care and service to patients, that's exciting to us. So when we did all the management training – Topgrading training at CTCA - we had a lot of very positive feedback and people were energized because they really want to find the best people to come in and help take care of patients.
Brad Smart: What criteria do you use to determine if you're going to use Topgrading in a position?
Eric Magnussen: We started using Topgrading as an executive assessment tool and so the criteria that CTCA uses today are we're looking at director level and above positions which are executive level positions within the organization. However, the exciting news is we're expanding it into the nursing ranks of the organization. As Brad discussed, you can use Topgrading for every level of the organization.
Brad Smart: Okay, Eric, as you're looking to the future, what are your thoughts about Topgrading and what you're doing, or how do you keep it going?
Eric Magnussen: That's actually a great question because the talent team from around CTCA is going to be in Chicago next week and we're going to be having our annual planning process. That's precisely what we're going to talk about - the selection process at CTCA and where we want to take Topgrading in the organization. So I think we certainly have an opportunity to expand the use of Topgrading from the executive level to other levels of the organization.Brad Smart: How important is top-level support for Topgrading?
Eric Magnussen: It's imperative to have CEO support or executive support for the program. HR is crucial, but would be less effective without CEO support. Brad Smart: Thank you, Eric, for your insights and wisdom! Eric Magnussen: Thank you, Brad; thank you everyone. Take care. Published April 23, 2013