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At a health care consortium owned by Alaska Natives, HR is overcoming multiple challenges in short order.
Consider this scenario: Three employees—each doing the exact same job—fall under three entirely different personnel systems. As a result, all three workers are paid different salaries, receive different benefits, have different job titles and are granted different holidays.
As if that’s not enough, the three separate personnel systems define exempt and nonexempt employees differently, and have varying rules regarding who is paid overtime and who is not, and who qualifies for compensatory time off and who does not.
Sound like an HR nightmare? It’s business as usual for Sonya Conant, SPHR, senior director of human resources at the Alaska Native Tribal Health Consortium (ANTHC) in Anchorage. Coordinating the three systems is “like doing a merger,” Conant says.
Why three personnel systems? The explanation for this nonprofit group’s unique mix of direct-hire employees, federal civil service workers and U.S. Public Health Service Commissioned Corps officers lies in the history of the organization and its transformation from a federal health care system to a tribally owned and operated entity. (See “Public Health Service or Civil Service?”.)
The tri-part personnel system is just one of the challenges, albeit a major one, facing this young organization, which has the lofty mission of providing the highest-quality health services and ensuring that “Alaska Natives are the healthiest people in the world.” Yet, despite the challenges it has faced, the ANTHC has made remarkable progress in a very short time.
From Federal to Tribal
The ANTHC, formed in December 1997, is the end result of a major cultural shift for Alaska Natives (members of Alaska’s native tribes). After many years under the control of the Indian Health Service, ownership of statewide federal health programs and services was transferred to the Native people of Alaska through their tribal governments and regional nonprofit organizations.
Now, says ANTHC CEO Paul Sherry, all Alaska Natives are both customers and owners of the consortium. The transition to self-government authorized by the Indian Self-Determination Education Assistance Act of 1975 (Public Law 93-638) is a process that has taken nearly 30 years to complete, he says.
Representing 229 tribes and 39 tribal health organizations, the ANTHC serves 125,000 Alaska Natives, more than half of whom live in small, often primitive villages with limited access to basic health services. Many of these villages are located in some of the harshest, most remote environments in America and are accessible only by plane or barge. “Travel is a barrier to health care access in Alaska,” says Sherry.
For HR management, another barrier is the three-part personnel system, which resulted when the newly established consortium inherited an all-federal workforce. “On the day we signed the government contract to form this company,” says Sherry, “I was the only tribal employee.” As he began adding staff under the direct-hire system, he retained the hospital’s federal employees through contract arrangements with the Public Health Service and the U.S. Civil Service.
Certainly it would be simpler to convert all jobs to direct-hire positions, and the consortium is moving toward that goal. However, says Sherry, most employees with several years of federal service are not willing to give up their federal benefits. Says Conant, the direct-hire benefits package is “pretty competitive, but I don’t know if we’ll ever be able to compete with the federal government on health care.”
The consortium could drop its federal contracts and require all employees to convert to one personnel system, but Sherry says it would lose federal staff in some hard-to-fill positions and create morale problems for those who remained. “I prefer to try first to let it change by attrition.”
Out with the Old, in with the New
Conant, who came to the ANTHC four years ago from the Norton Sound Health Corp. in Nome, Alaska, was excited by the opportunity to participate in building a new organization for her fellow Alaska Natives. “I feel like we’ve been given a piece of clay that we are molding,” she says.
But throwing out one set of rules and starting over from scratch isn’t easy. Shifting from a rigid, bureaucratic federal system to a tribal system was full of pitfalls. At first, says Conant, the organization swung from one extreme to the other, going from highly structured to “no structure.” Over the last two and a half years, the emphasis has been on achieving a balance between too much control and too little.
“When I first came,” she says, “I had a big target on my back. I’d go into meetings and get beaten up” as she attempted to put new systems in place. While Conant had plenty of experience in strategic HR management and planning for a tribal health organization, she says she “had never had to deal with that ‘other animal [the federal personnel systems].’ ”
The lack of HR infrastructure also was a big challenge, she says, hampering recruiting, retention and workforce planning efforts. However, HR took a big step forward in 2005 with the installation of a human resource information system that allowed it to begin tracking data that Conant says will help it evaluate the success or failure of its efforts.
The added complication of working with three employment systems has been “both a blessing and a curse,” says Sherry. Having the flexibility to hire from three separate employee pools means “I save money in some professions by buying a government employee,” he says. “On the other side, the comp and benefits structures are apples and oranges.”
Benefits manager Patty Billingsley, PHR, agrees. It’s hard to build a single compensation and benefits program, she says, because “one size does not fit all.” Although all ANTHC employees, federal and nonfederal, are subject to the consortium’s rules, federal employees have separate forms and separate pay systems—and a separate personnel department.
A federal HR office located on the consortium campus maintains personnel files for federal employees. Since Conant’s office must get all federal records from this office, it can be difficult to track the ANTHC’s federal workers when handling Family and Medical Leave Act issues and workers’ compensation claims, Billingsley says, and “OSHA reporting is a nightmare.”
Further complicating legal compliance is the fact that the ANTHC, as a tribal entity, is required to follow some—but not all—federal and state laws. For example, the organization is not required to file an affirmative action plan, nor is it subject to the Americans with Disabilities Act.
Staffing also brings an unusual wrinkle for the ANTHC because its federal employees—both civil service and commissioned corps, who make up a third of the organization’s staff—are subject to mandatory deployment to disaster areas, similar to National Guard call-ups.
In addition to hiring both federal and nonfederal employees, the ANTHC follows a Native Preference policy that gives first consideration to Alaska Natives and American Indians. Native employees currently represent 43 percent of the staff, and the consortium is working to raise the percentage of Native hires to 60 percent by 2010. Within 10 years, Sherry predicts the number will reach 90 percent to 95 percent.
“There are plenty of Native applicants for entry-level jobs,” says Conant, and “we should be 100 percent [Native hires] there.” However, a shortage of qualified medical professionals and engineers among the Native population makes it difficult to fill many professional and managerial jobs with Native hires, she says.
To address the lack of qualified Native candidates, the consortium is working on several long-term initiatives, including providing education and training for Alaska Natives through its internship and scholarship programs. (See “Internships and Scholarships”.) “We need to start in elementary school,” says Conant, “to educate students and encourage them to consider health care careers.”
Meanwhile, many hard-to-fill vacancies must be filled by non-Natives, and that, too, can be a challenge. Although the University of Alaska has a nursing program, there are no medical schools in the state, so the hospital must look outside Alaska for doctors.
In spite of these challenges, HR’s recruiting efforts have been increasingly successful. “We’ve been able to hire two neurosurgeons from the lower 48, and we just hired a pulmonologist, and they are hard to find,” says Dr. Ed Gilkey, chief physician executive at the Alaska Native Medical Center (ANMC) hospital. The ANMC and its tertiary and specialty medical services account for nearly three-quarters of the total workforce of the ANTHC.
Accentuating the Positives
Candidates who have never been to Alaska may wonder whether they really want to move to a remote locale where the winters are long, cold, dark—about four hours of daylight each day by December—and isolated. A flight from the East Coast to Alaska is as long as a flight to Europe, so “you won’t be going home for every birthday and anniversary,” says Gilkey. Doctors who visit bush villages during the winter travel by dogsled.
However, the ANMC’s congenial work atmosphere and the opportunity “to create the future” for the Native population is a draw for many people, including Gilkey. “I would call it a delicious opportunity,” he says. That opportunity appealed to him when he came to the hospital a year ago, and he says it attracts other doctors as well.
Recruitment and staffing manager Marilyn Cooper agrees with Gilkey that the hospital has a number of attractions for the right candidates, and she and her staff promote them tirelessly. For example, those with an “adventuresome spirit” who enjoy traveling and learning about other cultures are attracted to the state, she says.
There are a number of other pluses as well. A huge bonus for doctors at the ANMC is the fact that they are protected from personal malpractice suits. Unlike doctors at competing private hospitals, ANMC doctors are employees of the hospital and thus are covered under the Federal Tort Claims Act.
Another attraction is Alaska’s lack of health maintenance organizations, whose onerous restrictions—which emphasize the number of patients seen rather than patient-centric quality care—often frustrate doctors in other states. “It’s like the golden age of medicine I saw in the late 1970s and early 1980s,” says Gilkey. “Here it’s 30 years behind, and it’s wonderful!”
Doctors are also interested in the broad range of medical knowledge they can gain at the tribal hospital, Cooper says. Doctors from other hospitals moonlight at the ANMC for a chance to learn more about treating diseases such as diabetes and tuberculosis, which are, unfortunately, widespread in the Native population, says Cooper.
Gilkey says ANMC salaries are “pretty competitive with doctors in the lower 48, but we’ll never be competitive with [doctors in private practice in] Anchorage,” where a neurosurgeon can earn $1 million to $2 million. “But when you start making a million dollars, you know darn well you’re working 75 to 100 hours a week,” he says.
By contrast, the ANMC attracts doctors who want some balance in their lives. “We have an orthopedist who runs 200-mile marathons across the wilderness,” says Gilkey, “and we just hired a urologist who wants to take her dog mushing skills to the next level.”
For the right person—a candidate “with an altruistic bent and the willingness to trade more control over your time for money”—says Gilkey, his hospital is a perfect fit. “One person really can make a difference here,” he says.
Nurses, too, are attracted to the ANMC by the congenial working conditions and by its high professional standards, as illustrated by the hospital’s “magnet” status. Magnet designation, which indicates the hospital nursing program has met specific standards of excellence, is difficult to attain: The ANMC is the only magnet hospital in the state, and only 1 percent of hospitals achieve the designation nationwide.
Cooper points with pride to the hospital’s low vacancy rate for nurses. In a recent five-month period, she says, the rate dropped by nearly 4 percent, from 7.26 percent at the beginning of the period to 3.29 percent five months later. In addition, the ANMC has attracted candidates from the two private hospitals in Anchorage, both of which are unionized and pay signing bonuses.
“We pay competitive salaries, but we made a conscious decision not to use signing bonuses for our nurses,” says Julie Palm, director of adult inpatient services, because “we don’t want ‘money sharks’ who hop from job to job.”
Finding The Right Fit
For the right person, the ANTHC can be ideal. The key is finding the right people and putting them in the right jobs.
To assess a candidate’s fit for the organization and for the job, HR follows the Disney-style recruiting method, which includes group interviews and the use of behavioral interviewing techniques. Cooper says they take a whole system approach. “If they’re not right for one job, they may be right for another,” she says.
But the ANTHC won’t hire candidates who are not a good fit for the organization. “We keep a separate database of these candidates so we won’t call them again,” says Cooper. Once the right candidate has been identified, HR moves quickly. Cooper says they’ve been able to get the time required to make a job offer down from six months to less than four hours.
A Work in Progress
As the ANTHC moves forward in growth mode, Sherry says it will continue to need three superstructures in place: “You’ve got to have IT, finance and people [HR],” he says, “and two-thirds of our expenditures go to the people.”
Continuing to educate employees about the reasons for the three personnel systems remains an ongoing effort, says Conant, especially when Congress votes a 3 percent increase for federal employees, for example, but the consortium budget allows for only a 1 percent salary increase. “That gives us an unfunded mandate that requires us to shift resources to pay this,” she says.
Fortunately, says Conant, she has a really good HR staff. She promotes professionalism by requiring new HR generalists, known as “advisers,” to become PHR-certified within three years of hire, and the organization provides classes to help them prepare for the exam. The HR staff also has the opportunity to participate in Anchorage’s active Society for Human Resource Management chapter. (Billingsley currently serves as secretary of this group.)
Although HR continues to meet employee resistance to its administrative actions from time to time, says Conant, the consortium staff is solidly behind the organization’s mission to improve the health of Alaska Natives. And most employees are pleased with the organization. In the last employee survey, 75 percent of respondents said they were satisfied with the ANTHC and would recommend it as a great place to work. The remaining 25 percent were essentially “neutral,” says Conant, neither extremely satisfied nor extremely dissatisfied.
“The organization’s been great about resourcing us [HR],” Conant says, and the CEO understands the value of a strong HR department.
“I operate under the assumption that people come to work every day wanting to do well,” says Sherry. “We need to set up the best [HR] system and stand out of the way” to let employees do their jobs, he says.
And what about HR professionals, specifically? Sherry says: “I cherish and value those who do it well.”
Ann Pomeroy is senior writer for HR Magazine.
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