AN ATTRACTION AND RETENTION FRAMEWORK FOR THE CANADIAN FORCES HEALTH SERVICES GROUP

Introduction

Attracting, recruiting and employing highly skilled applicants into Canada’s military healthcare organization remains a critical factor in maintaining operational effectiveness of this institution.  For many years, the private healthcare sector has recognized these factors as the primary means of remaining competitive in an increasingly global healthcare sector.   To achieve their goals, civilian healthcare institutions have invested an abundance of resources (human, financial and material) in developing strategies that foster, promote and enhance their institutional capabilities to attract, recruit and retain highly skilled individuals that support their capabilities.  However, as the Canadian Forces Health Services Group (CF H Svcs Gp) continues to face an ever increasing reduction in budget allocations, in addition to transitioning to decreased operational environment, post-Afghanistan, we find ourselves approaching a potential shortfall in maintaining effective manning levels to support current and future Canadian Armed Forces (CAF) commitments and operations at home and abroad.  The attraction and retention of highly skilled uniformed medical personnel has always presented unique challenges to this institution. As articulated in the Surgeon General’s Report 2014, “All modern armed forces must commit significant resources to meet their diverse corporate operational needs and the health needs of their individual military personnel”.  Therefore, in today’s increasingly competitive work environment, the attraction and ongoing retention of our personal necessitates a new and progressive approach towards attraction and retention strategies.

Accordingly, one of our core initiatives is to establish and position the CF H Svcs Gp as an employer of choice for all future employees and a preferred employer for currently serving personnel.  By establishing a solid but sustainable foundation, the CF H Svcs Gp, will be able to attract and retain the required skill sets necessary to achieve its goals of delivering high quality healthcare services, under a full range of military operations, to all CAF personnel.  In order to achieve these goals, the CF H Svcs Gp, through the stewardship of the Directorate of Health Services Personnel (D H Svcs Pers), has developed a robust and supportable strategic framework, which outlines key components and strategies associated with attraction and retention.  The strategies presented in the strategic plan will strengthen our institutional foundation and introduce new approaches towards attraction and retention.  Addressing institutional attraction and retention issues requires an immediate short-term investment combined with a long-term vision; which has unwavering support from institutional leadership, is grounded in the development of internal and external partnerships/collaborations, continued input from all key stakeholders and finally an acceptance that real organizational change takes time and dedication.

Background and Context for Change   

 With a diminishing operational tempo, an increasingly restrictive fiscal climate and a highly competitive civilian healthcare market, the attraction and ultimate retention of highly skilled healthcare practitioners remains a complex and challenging endeavour.  As a healthcare institution, the CF H Svcs Gp manages 13 medical occupations and sub-occupations.  Each occupation plays a significant role in the delivery of high quality healthcare to CAF personnel.  By maintaining each medical occupation at the proper manning levels, the CF H Svcs Gp will continue to meet the ongoing requirements associated to supporting military operations.  As part of the annual occupational review, each occupation provides an overview of previous yearly intakes and presents a forecasted intake requirement for the upcoming fiscal year.  This forecasted intake number takes into account many factors including; current and/or future operational needs, occupational attrition rates created by retirement and/or end of service contracts, number of individuals currently undergoing training and the replacement of service personnel selected for out of occupation employment.  The resulting Strategic Intake Plans (SIP) therefore, sets the necessary conditions for overall occupational health, stabilization and future growth.  Although the CF H Svcs Gp has experienced some decline in certain medical occupations, the overall health of the institution remains strong.  As articulated by the Surgeon General, “In providing such capabilities, most modern armed forces, also face a difficult and chronic challenge to recruit and retain key clinical occupations for which demand exceeds supply, particularly medical [Officer] specialists whose production requires up to 16 years of post-secondary education”.

In order to continue the forward momentum established by the development of an effective health services SIP, the creation and staffing of an integral CF H Svcs Gp Attraction and Retention team is designed to implement and address the requirements of each medical occupation, thereby ensuring long term sustainability and growth while continuing to support military operations.  Therefore, to meet this desired end state, a concentrated and sustain effort is required to address the attraction and recruitment of highly suitable candidates along with a focused campaign to reduce the exit rate of qualified personnel.           

Operational Design

In order to tackle these ongoing challenges, the D H Svcs Pers, has developed and implemented an operational design, which is aimed at addressing the attraction and retention issues currently facing this organization.  The operational design will serve as a road map to assist and guide staff functionaries in achieving the established goals and desired end states established by the Chain of Command (C of C).  As such, the operation design is based on four Lines of Operations (LOO) with a clearly stated objective associated with each line.  Along each axis, there are pre-established markers (decisive points) that are designed to mutually support that LOO with the ultimate intent of achieving the desired end state.  The operational design will require routine measurement checks on successes and the continuous assessment of the operating environment to ensure it remains relevant.   As such, changes to various decisive points and/or operational lines may occur if required.  The four LOO are:

1) Attraction.  This LOO will focus on establishing the CAF (in particular the CF H Svcs Gp), as an employer of choice and will build upon the positive relationships established with academic institutions, professional organizations, Canadian Forces Recruiting Group (CFRG) and local Canadian Forces Recruiting Centres (CFRC), and other key stakeholders and partners;

2) Retention.  The decisive points along this line are designed to focus on addressing retention related issues.  Aspects of this LOO will be centred on finding initiatives intended to decrease the number of personnel exiting the CAF towards the civilian sector.  This LOO is about internal actions and activities that can be conducted and completed by CF H Svcs Gp;

3) Communication.  Maintaining effective and efficient communications remains a fundamental aspect in addressing attraction and retention difficulties.  As such, this LOO will focus on improving direct communication from Senior Leadership aimed towards the entire Health Services Group by utilizing various proactive communication techniques (Public Affairs campaigns, newsletters, communiques and routine bulletins).  To a lesser degree this LOO will attempt to improve communication with the civilian sector in order to attract motivated healthcare practitioners to the CF H Svcs Gp through various communication tools (brochures, social media, attraction venues); and

4) Leadership.  This LOO will be centred on fostering a positive attraction and retention culture through effective leadership at all levels.  Attraction and retention efforts must be seen as a key leadership responsibility which aims at remaining consistent in supporting the building and embracing of a positive institutional culture.

Attraction and Retention Framework   

As clearly articulated in the Attraction and Retention Strategic Plan, its ultimate aim is to “. . . foster an organizational culture through direct leadership engagement aimed at enhancing attraction and retention activities in order to force generate health services occupations to support CAF missions”. In order to achieve this desired end state, CF H Svcs Gp leadership must take a proactive approach in fostering a culture that attracts the best while retaining our most valuable resource – our people.  

Therefore, the CF H Svcs Gp Attraction and Retention Strategic Plan is designed to meet these challenges head on.  The development and implementation of an attraction and retention campaign, focused on attracting highly skilled and motivated healthcare practitioners while concurrently addressing retention issues, will stem the current decline in intake numbers, stabilize attrition rates and foster steady growth in under manned healthcare occupations.  Together, these measures will address not only the current attraction and retention challenges but will also shape the organizational culture which will foster and promote a long-term career in military medicine as a profession of choice. 

Short and Long Term Goals        

As mentioned previously, time and the application of dedicated resources remain key drivers in addressing attraction and retention challenges.  However, as any military campaign plan, the Attraction and Retention Strategic Plan can be divided into two separate phases, characterized by short and long goals.  Short-term goals are primarily designed to address the immediate demands by providing a quick impact orientated   results in an effort to enhance the attraction and retention climate while concurrently fostering a positively attraction and retention culture. As such, there are a number of initiatives that have a direct or indirect link to attraction and retention of current and future healthcare providers.  These short term goals are set up to have an immediate impact and include the following:

1. Attraction and Retention Cell.  Due to changing financial pressures and the re-allocation of internal funding, this organization lost the services of a full-time staff member.  The loss of this member had a significant impact on this organizations ability to ‘reach-out’ and establish collaborative partnerships with educational institutions and professional associations.  The re-establishment of the Attraction and Retention cell in August 2014, has had an immediate impact in clearing the backlog of applicant inquires, re-established contact with academic institutional and professional organizations and coordinated the participation in a multitude of career/employment venues across the country;
2. Professional Development (PD) Opportunities. In order for healthcare practitioners to remain clinically current in their specific field, it is critical that they be afforded PD opportunities.  A great dis-satisfier among clinicians, that fuels retention challenges, is the inability to maintain their clinical competency skills.  Therefore, it is important for our leaders to avail their personnel for PD opportunities.  Available PD opportunities include: Continuing Professional Education (CPE); Maintenance of Clinical Readiness Program (MCRP); and Post Graduate (PG) Training.  Funding for these PD requirements must be maintained and evaluated on a regular basis in order to ensure healthcare practitioners maintain the required medical skill sets and mandated certifications necessary to support CAF operations.  D H Svcs Pers has been working on streamlining some of the processes and approval mechanisms with the latest statistics  indicating a 97% CPE approval rate;
3. Advanced Training List (ATL) Rationalization.   As mentioned above, PD opportunities foster practitioner retention.  However, the allocation of ATL credits, associated with post-graduate (PG) training opportunities, must be based on the operational requirements in order to meet CAF core missions.  Currently, the CF H Svcs Gp does not have sufficient credits to meet existing operational demands.  As such, a detailed rationalization analysis of all assigned ATL credits is ongoing. The intent of this review is to identify the exact clinical requirements, prioritize them based on the need to increase shortfalls in capabilities, and finally, to reinforce their clinical importance in meeting the operational demands of the CAF, today and into the future.  In addition, rationalization will demonstrate that the ongoing production of medical specialist (General and Orthopedic Surgeons, Internal Medicine, Anaesthesiologist, Psychologist and Radiologist) is actually an operational core necessity and PG training opportunities promote, support and enhance the medical specialist in meeting the Advanced Clinical Operational Functional Point (ACOFP) requirement; 
4. Exit Surveys and Interviews.  Although generic exit surveys are routinely conducted and reviewed, it has been relatively ineffective in addressing retention issues.   Therefore, under the Attraction and Retention Strategic Plan, exit surveys and interviews will become a mandatory requirement.  Occupational advisors (or their representative) must conduct exit surveys and interviews for both Regular Force (Reg F) and Reserve Force (Res F) personnel exiting the service.  The intent is to determine precise reasons why our clinicians leave the CAF and once determined, address these issues head on;
5. Recruiting Allowances.  Although not designed to address long-term organizational needs, the re-activating of a recruiting allowance, when and where appropriate, can be used as a means of addressing critical personnel shortfalls.  The intent of a recruiting allowance would allow for a greater flexibility, at the strategic leadership level, to allocate financial incentives and resources towards medical occupations that are understaff as a means of simulating recruiting;
6. Medical Specialists Retention Strategy.  The intent of this strategy is aimed at reducing medical specialists attrition rates by providing promotion incentives, increased financial compensation more on par with the civilian sector and greater military responsibility associated with career advancement;
7. Reimbursement of Licensure.  As an additional incentive associated with retention, the policy associated with the reimbursement of mandatory licensure fees must continue.   In keeping with accreditation policies, all military clinicians must maintain licensure with their respective professional association.  Therefore, in order to enhance practitioner retention and to support a member’s continued affiliation with their professional association, CF H Svcs Gp will continue to support this initiative as part of the ongoing retention strategy; 
8. Professional Networking.  Continuing to identify and enhance existing strategic level networking with partners and internal and external stakeholders.  This will be an ongoing process and will continue to evolve in order to facilitate CF H Svcs Gp requirements;
9. Military Medical Training Plan (MMTP).   MMTP is an in-service selection program designed to provide an internal mechanism whereby currently servicing CAF members are selected for subsidized education leading to a medical degree.   Given the limited number of medical school positions, a major obstacle facing CAF personnel selected for the MMTP program is their ability to secure an unrestricted position at an approved Canadian medical college.  As the CF H Svcs Gp does not have dedicated medical school positions, in order to support MMTP candidates, the CAF would implement the concept of ‘purchasing’, in advance, a limited number of medical school seats, which would be reserved strictly for military personnel selected for medical training.  This initiative will allow for a consistent number of medical officers candidates entry service during a specific time period; and      
10. Re-engagement Counselling.  Re-engagement counselling is designed to provide re-engagement information and ongoing options to serving healthcare providers before they reach the end of their current service contract.  These options need to be presented to each member in a timely manner so that personnel can be afforded an opportunity to explore all available options before making a decision to remain or release from the service.  This is a key aspect in lessening the release rates amongst our healthcare practitioners.  Re-engagement counselling remains an important command function with shared responsibility between the organizations senior leadership, occupational advisor’s, unit Commanding Officers and feedback from the member.

Long-term goals are aimed at re-shaping organizational culture by continually improving and enhancing current and future attraction and retention initiatives and programs.  Long-term objectives will require; further development and refinement, detailed policy and governance analysis and research, and finally input and approval from higher level command authorities.  CF H Svcs Gp long-term initiatives include:

1. Pay/Benefits Analysis and Comparison.   In order to ensure that CAF healthcare practitioners are paid commensurate with their civilian counterparts, a detailed third party unbiased analysis needs to be initiated by Directorate of Pay Policy and Development (DPPD);  
2. Retention Allowance:  A detailed review between DPPD, DGMPRA and D H Svs Pers of potential retention strategies will be conducted in order to determine if this measure is feasible.  The initiative has been executed in the past for other occupations with mixed results.   Therefore, a detailed review will be done prior to potential recommendation to implement this initiative;
3. Director General Public Affairs (DGPA) Marketing:  CF H Svcs Gp will require assistance from CFRG and DGPA Marketing to develop professional grade handouts/pamphlets in order to assist in attracting interest from potential candidates.  Ongoing collaboration with stakeholders in the development of such products needs to continue and these products need to be made available at all attraction and recruiting venues and events; and 
4. Social Media. Exploitation of various social media sites such as Twitter, Facebook and LinkedIn will be developed through CFRG in order to garner the attention of the younger generation of healthcare clinicians.

Leadership Engagement

At the centre of change remains the ongoing willingness of institutional leadership to actively engage and participate, as the champion of change, in order to promote organizational re-orientation.  In order to achieve organizational change, the D H Svcs Pers has developed and implemented the Medical Officer Retention Focused Leadership Training (MORFLT) seminar.  The MORFLT will focus on the senior Medical Officer leadership, which will be centered on Regional/Base/Wing Surgeons.  The overall intent of the MORFLT is to target senior leaders and carefully lay out the roles and key responsibilities they have in fostering a culture that perpetuates retention of Health Services personnel while providing the optimal climate for attracting the best-qualified individual’s to the service.   

As already articulated, the overall driving force associated with the Attraction and Retention Campaign Plan is the creation of an operating environment that will support, promote and foster organizational culture through direct leadership engagement.  Direct leadership engagement is aimed at enhancing attraction and retention activities in order to force generate health services occupations to support CAF missions.   By maintaining a command/leadership centric bearing, the CF H Svcs Gp will remain proactive and take ongoing measures to address attraction and retention challenges currently facing this organization.  The engagement of the organizational leadership, through the establishment of the MORFLT, is one such proactive initiative designed to shape institutional culture by re-investing in our most scarce and valuable resource – our people.   Positive leadership engagement, at all levels, remains critical in shaping a positive culture and must be at the forefront of all attraction and retention activities.         

Conclusion

The ability to attract high quality people and subsequently retain experienced military practitioners remains the primary aim of this strategic plan. In establishing the CF H Svcs Gp as an employer of choice and a preferred career enduring healthcare institution, we are able to set the necessary conditions to support current and future CAF operations. All leaders remain an integral part in achieving the goals outlined in this campaign plan.  Effective and ongoing leadership will continue to shape organizational culture, which will positively promote attraction and retention activities.  By investing sufficient resources into the development and implementation of this strategic plan, we collectively, as a world leading healthcare provider, are setting the stage associated with the provision of high quality healthcare services to Canada’s fighting force, wherever they serve.     

Author:

Captain Lee Gagne

Attractions and Retentions Officer 

Group Headquarters Canadian Forces Health Services

Ottawa, Ontario.      

Date: 05/30/2019

Source: Medical Corps International Forum (4/2015)