Optimizing Rewards for Business Results
and Greater Employee Engagement
Lois Grubb, Vice President, Human Resources
Elmhurst Memorial Hospital
Eric Parmenter, Principal
Towers Perrin


August 4, 2009




© 2009 Towers Perrin
Presenters: Lois Grubb

                       Lois Grubb is Vice President, Human Resources for a 400+ bed
                       community hospital with more than 500 physicians and 3,000
                       employees. She reports to the CEO and manages a group of
                       17 HR professionals
                       Prior to that, Lois was Senior Vice President, Human Resources
                       for a $1.2 billion wholly owned subsidiary of AmerisourceBergen,
                       a Fortune 24 pharmaceutical supply chain management company.
                       Previously, she held HR leadership roles at Gundersen Lutheran
                       Medical Center in La Crosse, WI; CNA Insurance; GD Searle
                       and Co; and Mohr Development
                       Lois has an M.A. in psychology from Temple University, a B.A.
                       in psychology from Immaculate College and is an award recipient
                       from the Academy of Women Achievers, YWCA, City of New York.
                       Other credentials include the Executive Education Program in
                       Finance, Wharton School of the University of Pennsylvania, and
                       Executive Education in Strategy and Marketing, Tuck School of
                       Business, Dartmouth




© 2009 Towers Perrin                                                                      2
Presenters: Eric Parmenter

                       Eric Parmenter is a Principal in Towers Perrin’s Health and Welfare
                       practice. Located in the firm’s Chicago office, he has over 23 years’
                       experience helping employers develop innovative total reward
                       strategies that align with their business objectives
                       Eric is a recognized national leader in health care benefit design and
                       delivery. He is a frequent moderator of panel discussions and speaker
                       at seminars across the country. Eric is also an award-winning author
                       of articles on human resource and employee benefit topics
                       Prior to joining Towers Perrin, Eric was Midwest practice leader for
                       compensation and benefit consulting at Grant Thornton LLP. He also
                       owned his own benefit consulting, outsourcing and administration firm
                       Eric holds a bachelor of arts degree in psychology from the University
                       of Illinois, as well as multiple professional designations in underwriting,
                       finance and human resources. Eric also holds an M.B.A. degree from
                       the University of Chicago’s Graduate School of Business




© 2009 Towers Perrin                                                                           3
Today’s discussion


       Setting the Stage —
        Managing Talent in
   Challenging Economic Times



                          Addressing Elmhurst
                           Memorial’s Issues:
                       Total Rewards Optimization




                                                Key Learnings




© 2009 Towers Perrin                                            4
Signs that the global downturn is abating…

     U.S. Consumer Confidence Index improved in March and April —
     and rose to an eight-month high in May
     Although unemployment reached 9.4% in the U.S. in May,
     the rate of job losses decreased relative to prior months
     DJIA and S&P 500 have advanced significantly since early March
       January – February losses were nearly offset
     Housing sales were up 11% in June




© 2009 Towers Perrin                                                  5
…haven’t eased corporate concerns and caution

     Most U.S. organizations in a recent Towers Perrin survey
     project 2009 revenue declines
       52% expect decreases of more than 5%
       33% anticipate a drop of 11% or more
     A Q1 Business Roundtable survey of 100 CEOs revealed pessimism
       67% expect sales to decline in the next six months
       66% plan to shrink capital spending
       71% expect more job losses
     Health care providers are concerned about the economy
     and the implications of health reform both as an employer
     and as a provider




Source: Towers Perrin Cost-Cutting Strategies in the Downturn, May 2009;
Business Roundtable’s Q1 2009 CEO Economic Outlook Survey

© 2009 Towers Perrin                                                       6
Rising costs in a sinking economy mean
employers and employees take a double hit


             Employees/Retirees Face…                  Employers Face…
      Shrinking income and purchasing power   Unbudgeted cost increases due to
      Trade-offs between health care and        increased utilization of medical
      other necessities                         and disability plans
                                                increasing numbers of covered
      Job stress                                dependents due to widespread layoffs
      Unemployment                              increased COBRA exposure
      Capital losses                            postponed retirements

      Delayed retirement                      Lower employee engagement
                                              Lower productivity
                                              New concerns about health reform




© 2009 Towers Perrin                                                                   7
As a result of the economic crisis, employers are accelerating
reward changes and/or moving in new directions…

     53% are trying or considering benefit strategies they would
     not have considered otherwise
     47% have closed their DB plans to new participants
     Although less than 10% have suspended their 401(k) match,
     another 20% are considering it
     52% are increasing employees’ share of health care program costs
     62% are tightening prescription drug coverage
     38% of organizations are focusing more on cost reduction
     than talent management
     Most are holding the line on salaries by cutting merit budgets,
     freezing salaries or delaying planned merit increases (in that order)




Source: Towers Perrin Compensation in Crisis Pulse Survey, January 2009; Towers Perrin Benefits in Crisis Pulse Survey, March 2009

© 2009 Towers Perrin                                                                                                                 8
…and reacting to changes in the economy

                                                   North American employers tell us employees are
                                                       Postponing retirement (68%)
                                                       Requesting financial education or retirement
                                                       planning (40%)
                                                       Using employee assistance programs (35%)

                                                   In the U.S. specifically, employers tell us
                                                   employees are
                                                       Moving to fixed-income investments (55%)
                                                       Increasing loans and withdrawals from
                                                       retirement savings plans (50%) — or reducing
                                                       participation in these plans (44%)



Source: Towers Perrin Benefits in Crisis Pulse Survey, March 2009


© 2009 Towers Perrin                                                                              9
The outlook for health care and hospitals

     Health care and education have been hit less than other U.S.
     industries with fewer job losses
        some hospitals are performing well given the economy
        others hospitals are experiencing flat or decreasing revenues
     Fewer dollars are being spent on elective procedures
     Accounts receivable are growing, with more defaults on outstanding bills
     Patients skip important screenings and tests due to insurance worries
     Charitable care is increasing
     Impending health care reform legislation creates significant
     uncertainties for the future




© 2009 Towers Perrin                                                            10
Today, hospitals face unprecedented
demands and new challenges

                                                                 Employer Challenges
                                                         Sustainable growth and improved performance
                                                         Operating cost and risk pressures
                                                         Innovation and quality improvement
                                                         Employee engagement and patient satisfaction
                                                         Flexible, “on demand” workforce to address talent
                                                         shortages and gaps
                                                         Public relations and network contracting
                                                         New competition for labor
  Market Forces/Financial Pressures                                                                                   Demographic Forces
   Ballooning accounts receivables                                                                           Aging workforce
   Reduction in elective care and some needed care                                                           Increasingly diverse workforce
   Intense competition and shrinking reimbursement                                                           Changing patterns of retirement
   Governance pressures and regulatory oversight                                                             Increased job mobility
   Mounting regulatory pressures and opportunities                                                           Talent shortages
   Transforming technologies and outsourcing                                                                 Anticipated dearth of leadership
   Collective bargaining activities
   Consumerism payment strategies
   Transparency and quality
   Aging infrastructure and need to replace facilities


                                                                    Employee Needs
                                                         Financial security
                                                         Inspiring leadership
                                                         Challenging work
                                                         Involvement and control
                                                         Information and knowledge
                                                         Work/life balance
                                                         Physician experience and engagement

© 2009 Towers Perrin                                                                                                                            11
Labor and related costs accounted for 62% of the
expense growth for hospitals (from 2001 to 2006)

Labor is now the single largest operating cost item typically equal
to more than 40% of revenue



Change in number of
                                                                     Wages, salaries and employee benefits
  services provided
                                                                     41%
                  30%
                                            Costs of goods
                                            and services
                                            purchased
                                            62%
                                                                     Prescription drugs
                                                                     4%
                                                                     Professional fees
                                                                     3%
                 Intensity and other                                 Professional liability insurance
                                                                     2%
                               8%
                                                                     All other
                                                                     12%




Source: AHA analysis of 2001-2006 expense growth rates by category


© 2009 Towers Perrin                                                                                         12
The drivers of attraction, retention and
          engagement for employees in health care

         Top Attraction Drivers                              Top Retention Drivers              Top Engagement Drivers
Competitive base pay                             Satisfaction with the organization’s       Senior management sincerely
                                                 business decisions                         interested in employee
                                                                                            well-being
Competitive health care benefits                 Ability to balance my work/personal life   Organization’s reputation for social
                                                                                            responsibility
Vacation/paid time off                           Understand potential career track within   Seek opportunities to develop new
                                                 organization                               knowledge/skills
Flexible schedule                                Good relationship with supervisor          Organization quickly resolves
                                                                                            customer concerns
Convenient work location                         Can impact customer satisfaction           Organization rewards outstanding
                                                                                            customer service
Career advancement opportunities                 Fairly compensated compared to others      Input into decision making in my
                                                 doing similar work in my organization      department
Reasonable workload                              Organization quickly resolves customer     Can impact quality of
                                                 concerns                                   work/product/service
Caliber of coworkers                             Unit has skills needed to succeed          Improved my skills and capabilities
                                                                                            over the last year
Reputation of the organization                   People in my unit work well together       Unit has skills needed to succeed
as a good employer                               as a team
Competitive retirement benefits                  Senior management acts to ensure           Competitive career development
                                                 organization’s long-term success
Source: Towers Perrin 2007 – 2008 Global Workforce Study, U.S. Hospital Cut, October 2007

          © 2009 Towers Perrin                                                                                               13
Today’s discussion


        Setting the Stage —
    Attraction and Retention in
   Challenging Economic Times




                             Addressing Elmhurst
                              Memorial’s Issues:
                          Total Rewards Optimization




                                                       Key Learnings




© 2009 Towers Perrin                                                   14
Elmhurst Memorial Healthcare (EMHC): Key issues

     Community hospital located in western suburbs of Chicago
     Three components to our business
       acute care not-for-profit hospital
       Elmhurst Clinic
       home health/hospice
     Compete in a crowded marketplace
     Challenge of building a new hospital




© 2009 Towers Perrin                                            15
Begin with an integrated strategy framework



                                            Business Context


                                                                                   Strategic
       Talent
                                                                                   Workforce
     Management                            Employee Engagement                     Planning
                                         Measuring engagement
                                         Understanding drivers of
                                         engagement
Rewards and Recognition                  Understanding linkage between
 Ensuring consequences for
 performance and behavior                engagement and financial results
 Understanding what different                                                      Recruitment
 segments value
 Setting principles to guide decisions




                                Performance                         Training and
                                Management                          Development


     © 2009 Towers Perrin                                                                        16
Positioning for business results: It’s really about alignment


                                                The Employment Deal
                                  Monetary Total Rewards
                          HR       Pay (base and incentives)
                       Strategy    Benefits
                                  Nonmonetary Total Rewards
       EMHC’S
                                   Communication
    Mission, Vision
      and Values                   Performance Management
                                   Work Environment/Culture
                                   Recognition
                                   Leadership
                                   Career Development



                                   High levels of trust, commitment and loyalty



                                             Employer-of-choice status



                                            Outside recognition/awards



© 2009 Towers Perrin                                                              17
The first step in EMHC’s journey:
Focus on rewards benchmarking and optimization


                              Human Capital Optimization


                                                      Cost/Risk Reduction

                                          Reduce expenditures and growth rate for
                                          fixed-cost rewards
                                          Eliminate programs with low perceived value
                                          Streamline reward practices for greater efficiency


                Rewards
               Optimization                       Performance Enhancement

                                          Increase the variable component of rewards
                                          Redirect the overall reward spend toward
                                          pivotal roles
                                          Ensure transparency of reward system practices
                                          Strengthen manager effectiveness and support
                                          system




© 2009 Towers Perrin                                                                           18
The chosen reward changes and implementation plan
will be based in part on the answers to a series of questions

  Considerations                                    Framing the Issues
  Is the reward mix     Is EMHC’s current emphasis on fixed-cost rewards hampering business
  appropriate for       performance and flexibility? Do employees appreciate the level of security
  employees and         provided? Would greater emphasis on variable pay better attract critical skills?
  the company?          Are employees behind the curve in preparing for retirement and taking
                        responsibility for their health?
  How competitive are   What is the desired competitive position for rewards overall, and by component?
  EMHC’s rewards        Are there reward trends that could help attract and retain critical talent?
  versus the market?
                        Is EMHC within acceptable cost levels versus competition for customers?
  Do rewards align      Are metrics underlying incentives consistent with goals for growth
  with desired          and profitability?
  business              Do employees have a clear line of sight to what drives business performance,
  performance?          and do rewards reinforce the right behaviors and decisions?
                        Is the distribution of reward spend across roles reflective of their pivotal nature?
  What workforce        How will reward changes impact employee engagement? Given key
  disruption risks      engagement drivers, can we navigate change to minimize disruption?
  are acceptable?       Can the reward portfolio be restructured to balance cost and employee
                        perceived value?




© 2009 Towers Perrin                                                                                    19
Understanding what attracts employees and the
key elements of the work experience that motivate
employees will be critical to success

                                                   Age             Ages             Ages              Ages       Age 55
  Attraction Drivers                             Under 25         25 to 34         35 to 44          45 to 54   or Older

  Competitive base pay                                1                1               1                1          2

  Competitive health care benefits                    8                5               2                2          1

  Vacation/paid time off                              2                2               3                3          6

  Flexible schedule                                   3                3               4                4          8

  Career advancement opportunities                    4                4               7                5         —

  Competitive retirement benefits                    —                —               —                 8          3
Source: Towers Perrin 2007 Global Workforce Study ⎯ U.S. Hospital Industry


  Top Motivation for Work Overall                                            Top Motivation for Work — Hospitals

  Having good work/life balance (69%)                              Having good work/life balance (70%)

  Having a secure position for the long term (61%)                 Having a secure position for the long term (63%)

  Having adequate benefit protection (58%)                         Having adequate benefit protection (63%)

  Doing exciting, challenging work (49%)                           Doing exciting, challenging work (50%)

  Maximizing earnings (47%)                                        Maximizing earnings (48%)

Note: Percentages represent percentage of respondents including item in their top 5.
Source: Towers Perrin 2007-2008 Global Workforce Study, — U.S. and U.S. Hospital Cut, October 2007

© 2009 Towers Perrin                                                                                                       20
The challenge is to build people programs
         that create competitive advantage

         Optimal reward programs will attract, retain and engage employees
         and drive quality and operational performance
                                2008 Focus — Transactional Rewards

   People Programs                          Employee             Patient Satisfaction/         Operational
    and Processes                           Behaviors              Quality of Care             Performance
                                       Attracting the right       Loyal                     Improved productivity
                                       talent                     Informed consumer         Improved financial and
   Pay              Benefits           Engaging talent in the                               clinical performance
                                                                  Effective decision
                                       right behaviors aligned    making/compliance         benchmarks
                                       with a desired culture     with care                 Reduced costs
                                       Motivating talent to be    Consistent with the       Competitive advantage
 Learning                              healthy and productive     hospital’s clinical and
               Work                    Retaining the right
    and                                                           quality initiatives
            Environment                talent
Development                                                       (quality, safety and
                                                                  cost-effectiveness)



                         2009 Focus — Relational Rewards




         © 2009 Towers Perrin                                                                                   21
The rewards landscape: The evolution

                                                                         Transactional Rewards
                                   Pay            Benefits                 Short-term focus
                                                                           Critical to attracting top talent

                                                                         Relational Rewards
                               Learning and        Work
                                                                           Long-term focus
                               Development      Environment
                                                                           Critical to retaining top talent

                                                                       In the long run, relational rewards provide a higher ROI



                       % ROI             Maximizing Return on Reward Investments


                                                                             Investment in Relational
    Superior Returns
                                                                             Rewards ⎯ Work Environment
                                                                             and Learning and Development



                                                                              Investment in Transactional
 Competitive Returns                                                          Rewards ⎯ Pay and Benefits




                                                                                                               $ Investment
                                                   Fair/Reasonable    Additional
                                                     Investment      Investment


© 2009 Towers Perrin                                                                                                          22
Getting started at EMHC: Employee engagement survey findings

       Input from the employee engagement survey provided focus
       to the strategy and implementation
       For EMHC — input about pay and benefits led us to conduct
       an analysis of EMHC’s base-pay practices
       Towers Perrin conducted a review of EMHC’s benefits
       and their market competitiveness




  © 2009 Towers Perrin                                             23
What are the engagement mindsets at EMHC?




                       Disengaged
                           16%         Fully Engaged
                                             25%




                          Complacent
                             59%




© 2009 Towers Perrin                                   24
On the pay front, how does EMHC compare
with other local health care organizations?

                                                                                Base Pay

                 Of the 50 EMHC Positions Surveyed, the Majority Were
                      Either at Market or at the High End of Market

                                                         Higher end of market




                                                         At market




                                                         Lower end of market




Source: Metropolitan Chicago Healthcare Council (MCHC)

© 2009 Towers Perrin                                                                   25
All EMHC benefit programs were
benchmarked against the market

                                                                             Benefits

                       Medical

                        Dental

                        Vision

  Short-Term Disability

  Long-Term Disability

         Basic Life/AD&D

   Voluntary Life/AD&D

                       Pension

            403(b) Savings

                          EAP

              Paid Time Off

                                    Lower end of market   At market   Higher end of market




Source: Towers Perrin Competitive Benefits Review, 2008

© 2009 Towers Perrin                                                                     26
EMHC tactics/program changes reflect the strategy,
employee input and program performance assessment



                                   Pay
                                         Pay      Benefits
                                          The
                                 Learning Deal
                                                    Work
                                    and
                                                 Environment
                                Development

                       Pay and Benefits — Transactional Rewards
                         focus for 2008 and early 2009
                       Learning and Development and Work Environment
                       — Relational Rewards
                         focus for the balance of 2009 and 2010
                       Early results of engagement pulse survey
                       are promising




© 2009 Towers Perrin                                                   27
Early results of engagement pulse survey are promising
  My supervisor used the feedback to make changes
   59% favorable EMHC
   57% favorable healthcare norm
  All in all, I’m satisfied with my job
    80% EMHC 2009
    69% EMHC 2007
    73% healthcare norm
  I understand how my benefits compare
     64% favorable
     62% healthcare norm
  I understand how my wages compare
     61% favorable
  I understand how my performance impacts the organization’s
  performance
     91% favorable

© 2009 Towers Perrin                                           28
Introduce a new employer-employee partnership

  Hold employees
    accountable               In return, provide          Together,
 to perform, based            a comprehensive           we will deliver
on company values          total rewards program        stellar results
                                                       Outstanding clinical
                                                       quality/outcomes
  Partnership                 Pay         Benefits     Exceptional patient
  Respect                                              satisfaction
  Integrity                         You                Strong financial
  Determination                                        performance
                             Learning
  Excellence                   and
                                            Work       Significant market
                                         Environment
                           Development                 growth
                                                       Safety at the core
                                                       of all we do




    © 2009 Towers Perrin                                                      29
Today’s discussion


        Setting the Stage —
    Attraction and Retention in
   Challenging Economic Times




                             Addressing Elmhurst
                              Memorial’s Issues:
                          Total Rewards Optimization




                                                       Key Learnings




© 2009 Towers Perrin                                                   30
Key learnings: Managing the partnership
and moving forward together

Create a comprehensive strategy
Develop a total rewards strategy that supports business needs,
and align programs accordingly

Communicate and manage change
Commit to regular dialogue about total rewards
and what it means for employees
Provide transparency
Provide information about pay and benefit levels,
and how they correlate with employee performance
Move from transactional rewards
to relational rewards
Pay and benefits must be competitive; you must pay to play,
but you win through exceptional learning and development
and work environment gains



© 2009 Towers Perrin                                             31
Thank you


                       Questions?




© 2009 Towers Perrin                32
Our contact information

                       Lois Grubb
                       Vice President, Human Resources
                       Elmhurst Memorial Healthcare
                       lgrubb@EMHC.org




                       Eric Parmenter
                       Principal
                       Towers Perrin
                       Chicago Office
                       71 South Wacker Drive
                       Suite 2600
                       Chicago, IL 60606
                       eric.parmenter@towersperrin.com



© 2009 Towers Perrin                                     33

Optimizing Rewards for Business Results and Greater Employee Engagement

  • 1.
    Optimizing Rewards forBusiness Results and Greater Employee Engagement Lois Grubb, Vice President, Human Resources Elmhurst Memorial Hospital Eric Parmenter, Principal Towers Perrin August 4, 2009 © 2009 Towers Perrin
  • 2.
    Presenters: Lois Grubb Lois Grubb is Vice President, Human Resources for a 400+ bed community hospital with more than 500 physicians and 3,000 employees. She reports to the CEO and manages a group of 17 HR professionals Prior to that, Lois was Senior Vice President, Human Resources for a $1.2 billion wholly owned subsidiary of AmerisourceBergen, a Fortune 24 pharmaceutical supply chain management company. Previously, she held HR leadership roles at Gundersen Lutheran Medical Center in La Crosse, WI; CNA Insurance; GD Searle and Co; and Mohr Development Lois has an M.A. in psychology from Temple University, a B.A. in psychology from Immaculate College and is an award recipient from the Academy of Women Achievers, YWCA, City of New York. Other credentials include the Executive Education Program in Finance, Wharton School of the University of Pennsylvania, and Executive Education in Strategy and Marketing, Tuck School of Business, Dartmouth © 2009 Towers Perrin 2
  • 3.
    Presenters: Eric Parmenter Eric Parmenter is a Principal in Towers Perrin’s Health and Welfare practice. Located in the firm’s Chicago office, he has over 23 years’ experience helping employers develop innovative total reward strategies that align with their business objectives Eric is a recognized national leader in health care benefit design and delivery. He is a frequent moderator of panel discussions and speaker at seminars across the country. Eric is also an award-winning author of articles on human resource and employee benefit topics Prior to joining Towers Perrin, Eric was Midwest practice leader for compensation and benefit consulting at Grant Thornton LLP. He also owned his own benefit consulting, outsourcing and administration firm Eric holds a bachelor of arts degree in psychology from the University of Illinois, as well as multiple professional designations in underwriting, finance and human resources. Eric also holds an M.B.A. degree from the University of Chicago’s Graduate School of Business © 2009 Towers Perrin 3
  • 4.
    Today’s discussion Setting the Stage — Managing Talent in Challenging Economic Times Addressing Elmhurst Memorial’s Issues: Total Rewards Optimization Key Learnings © 2009 Towers Perrin 4
  • 5.
    Signs that theglobal downturn is abating… U.S. Consumer Confidence Index improved in March and April — and rose to an eight-month high in May Although unemployment reached 9.4% in the U.S. in May, the rate of job losses decreased relative to prior months DJIA and S&P 500 have advanced significantly since early March January – February losses were nearly offset Housing sales were up 11% in June © 2009 Towers Perrin 5
  • 6.
    …haven’t eased corporateconcerns and caution Most U.S. organizations in a recent Towers Perrin survey project 2009 revenue declines 52% expect decreases of more than 5% 33% anticipate a drop of 11% or more A Q1 Business Roundtable survey of 100 CEOs revealed pessimism 67% expect sales to decline in the next six months 66% plan to shrink capital spending 71% expect more job losses Health care providers are concerned about the economy and the implications of health reform both as an employer and as a provider Source: Towers Perrin Cost-Cutting Strategies in the Downturn, May 2009; Business Roundtable’s Q1 2009 CEO Economic Outlook Survey © 2009 Towers Perrin 6
  • 7.
    Rising costs ina sinking economy mean employers and employees take a double hit Employees/Retirees Face… Employers Face… Shrinking income and purchasing power Unbudgeted cost increases due to Trade-offs between health care and increased utilization of medical other necessities and disability plans increasing numbers of covered Job stress dependents due to widespread layoffs Unemployment increased COBRA exposure Capital losses postponed retirements Delayed retirement Lower employee engagement Lower productivity New concerns about health reform © 2009 Towers Perrin 7
  • 8.
    As a resultof the economic crisis, employers are accelerating reward changes and/or moving in new directions… 53% are trying or considering benefit strategies they would not have considered otherwise 47% have closed their DB plans to new participants Although less than 10% have suspended their 401(k) match, another 20% are considering it 52% are increasing employees’ share of health care program costs 62% are tightening prescription drug coverage 38% of organizations are focusing more on cost reduction than talent management Most are holding the line on salaries by cutting merit budgets, freezing salaries or delaying planned merit increases (in that order) Source: Towers Perrin Compensation in Crisis Pulse Survey, January 2009; Towers Perrin Benefits in Crisis Pulse Survey, March 2009 © 2009 Towers Perrin 8
  • 9.
    …and reacting tochanges in the economy North American employers tell us employees are Postponing retirement (68%) Requesting financial education or retirement planning (40%) Using employee assistance programs (35%) In the U.S. specifically, employers tell us employees are Moving to fixed-income investments (55%) Increasing loans and withdrawals from retirement savings plans (50%) — or reducing participation in these plans (44%) Source: Towers Perrin Benefits in Crisis Pulse Survey, March 2009 © 2009 Towers Perrin 9
  • 10.
    The outlook forhealth care and hospitals Health care and education have been hit less than other U.S. industries with fewer job losses some hospitals are performing well given the economy others hospitals are experiencing flat or decreasing revenues Fewer dollars are being spent on elective procedures Accounts receivable are growing, with more defaults on outstanding bills Patients skip important screenings and tests due to insurance worries Charitable care is increasing Impending health care reform legislation creates significant uncertainties for the future © 2009 Towers Perrin 10
  • 11.
    Today, hospitals faceunprecedented demands and new challenges Employer Challenges Sustainable growth and improved performance Operating cost and risk pressures Innovation and quality improvement Employee engagement and patient satisfaction Flexible, “on demand” workforce to address talent shortages and gaps Public relations and network contracting New competition for labor Market Forces/Financial Pressures Demographic Forces Ballooning accounts receivables Aging workforce Reduction in elective care and some needed care Increasingly diverse workforce Intense competition and shrinking reimbursement Changing patterns of retirement Governance pressures and regulatory oversight Increased job mobility Mounting regulatory pressures and opportunities Talent shortages Transforming technologies and outsourcing Anticipated dearth of leadership Collective bargaining activities Consumerism payment strategies Transparency and quality Aging infrastructure and need to replace facilities Employee Needs Financial security Inspiring leadership Challenging work Involvement and control Information and knowledge Work/life balance Physician experience and engagement © 2009 Towers Perrin 11
  • 12.
    Labor and relatedcosts accounted for 62% of the expense growth for hospitals (from 2001 to 2006) Labor is now the single largest operating cost item typically equal to more than 40% of revenue Change in number of Wages, salaries and employee benefits services provided 41% 30% Costs of goods and services purchased 62% Prescription drugs 4% Professional fees 3% Intensity and other Professional liability insurance 2% 8% All other 12% Source: AHA analysis of 2001-2006 expense growth rates by category © 2009 Towers Perrin 12
  • 13.
    The drivers ofattraction, retention and engagement for employees in health care Top Attraction Drivers Top Retention Drivers Top Engagement Drivers Competitive base pay Satisfaction with the organization’s Senior management sincerely business decisions interested in employee well-being Competitive health care benefits Ability to balance my work/personal life Organization’s reputation for social responsibility Vacation/paid time off Understand potential career track within Seek opportunities to develop new organization knowledge/skills Flexible schedule Good relationship with supervisor Organization quickly resolves customer concerns Convenient work location Can impact customer satisfaction Organization rewards outstanding customer service Career advancement opportunities Fairly compensated compared to others Input into decision making in my doing similar work in my organization department Reasonable workload Organization quickly resolves customer Can impact quality of concerns work/product/service Caliber of coworkers Unit has skills needed to succeed Improved my skills and capabilities over the last year Reputation of the organization People in my unit work well together Unit has skills needed to succeed as a good employer as a team Competitive retirement benefits Senior management acts to ensure Competitive career development organization’s long-term success Source: Towers Perrin 2007 – 2008 Global Workforce Study, U.S. Hospital Cut, October 2007 © 2009 Towers Perrin 13
  • 14.
    Today’s discussion Setting the Stage — Attraction and Retention in Challenging Economic Times Addressing Elmhurst Memorial’s Issues: Total Rewards Optimization Key Learnings © 2009 Towers Perrin 14
  • 15.
    Elmhurst Memorial Healthcare(EMHC): Key issues Community hospital located in western suburbs of Chicago Three components to our business acute care not-for-profit hospital Elmhurst Clinic home health/hospice Compete in a crowded marketplace Challenge of building a new hospital © 2009 Towers Perrin 15
  • 16.
    Begin with anintegrated strategy framework Business Context Strategic Talent Workforce Management Employee Engagement Planning Measuring engagement Understanding drivers of engagement Rewards and Recognition Understanding linkage between Ensuring consequences for performance and behavior engagement and financial results Understanding what different Recruitment segments value Setting principles to guide decisions Performance Training and Management Development © 2009 Towers Perrin 16
  • 17.
    Positioning for businessresults: It’s really about alignment The Employment Deal Monetary Total Rewards HR Pay (base and incentives) Strategy Benefits Nonmonetary Total Rewards EMHC’S Communication Mission, Vision and Values Performance Management Work Environment/Culture Recognition Leadership Career Development High levels of trust, commitment and loyalty Employer-of-choice status Outside recognition/awards © 2009 Towers Perrin 17
  • 18.
    The first stepin EMHC’s journey: Focus on rewards benchmarking and optimization Human Capital Optimization Cost/Risk Reduction Reduce expenditures and growth rate for fixed-cost rewards Eliminate programs with low perceived value Streamline reward practices for greater efficiency Rewards Optimization Performance Enhancement Increase the variable component of rewards Redirect the overall reward spend toward pivotal roles Ensure transparency of reward system practices Strengthen manager effectiveness and support system © 2009 Towers Perrin 18
  • 19.
    The chosen rewardchanges and implementation plan will be based in part on the answers to a series of questions Considerations Framing the Issues Is the reward mix Is EMHC’s current emphasis on fixed-cost rewards hampering business appropriate for performance and flexibility? Do employees appreciate the level of security employees and provided? Would greater emphasis on variable pay better attract critical skills? the company? Are employees behind the curve in preparing for retirement and taking responsibility for their health? How competitive are What is the desired competitive position for rewards overall, and by component? EMHC’s rewards Are there reward trends that could help attract and retain critical talent? versus the market? Is EMHC within acceptable cost levels versus competition for customers? Do rewards align Are metrics underlying incentives consistent with goals for growth with desired and profitability? business Do employees have a clear line of sight to what drives business performance, performance? and do rewards reinforce the right behaviors and decisions? Is the distribution of reward spend across roles reflective of their pivotal nature? What workforce How will reward changes impact employee engagement? Given key disruption risks engagement drivers, can we navigate change to minimize disruption? are acceptable? Can the reward portfolio be restructured to balance cost and employee perceived value? © 2009 Towers Perrin 19
  • 20.
    Understanding what attractsemployees and the key elements of the work experience that motivate employees will be critical to success Age Ages Ages Ages Age 55 Attraction Drivers Under 25 25 to 34 35 to 44 45 to 54 or Older Competitive base pay 1 1 1 1 2 Competitive health care benefits 8 5 2 2 1 Vacation/paid time off 2 2 3 3 6 Flexible schedule 3 3 4 4 8 Career advancement opportunities 4 4 7 5 — Competitive retirement benefits — — — 8 3 Source: Towers Perrin 2007 Global Workforce Study ⎯ U.S. Hospital Industry Top Motivation for Work Overall Top Motivation for Work — Hospitals Having good work/life balance (69%) Having good work/life balance (70%) Having a secure position for the long term (61%) Having a secure position for the long term (63%) Having adequate benefit protection (58%) Having adequate benefit protection (63%) Doing exciting, challenging work (49%) Doing exciting, challenging work (50%) Maximizing earnings (47%) Maximizing earnings (48%) Note: Percentages represent percentage of respondents including item in their top 5. Source: Towers Perrin 2007-2008 Global Workforce Study, — U.S. and U.S. Hospital Cut, October 2007 © 2009 Towers Perrin 20
  • 21.
    The challenge isto build people programs that create competitive advantage Optimal reward programs will attract, retain and engage employees and drive quality and operational performance 2008 Focus — Transactional Rewards People Programs Employee Patient Satisfaction/ Operational and Processes Behaviors Quality of Care Performance Attracting the right Loyal Improved productivity talent Informed consumer Improved financial and Pay Benefits Engaging talent in the clinical performance Effective decision right behaviors aligned making/compliance benchmarks with a desired culture with care Reduced costs Motivating talent to be Consistent with the Competitive advantage Learning healthy and productive hospital’s clinical and Work Retaining the right and quality initiatives Environment talent Development (quality, safety and cost-effectiveness) 2009 Focus — Relational Rewards © 2009 Towers Perrin 21
  • 22.
    The rewards landscape:The evolution Transactional Rewards Pay Benefits Short-term focus Critical to attracting top talent Relational Rewards Learning and Work Long-term focus Development Environment Critical to retaining top talent In the long run, relational rewards provide a higher ROI % ROI Maximizing Return on Reward Investments Investment in Relational Superior Returns Rewards ⎯ Work Environment and Learning and Development Investment in Transactional Competitive Returns Rewards ⎯ Pay and Benefits $ Investment Fair/Reasonable Additional Investment Investment © 2009 Towers Perrin 22
  • 23.
    Getting started atEMHC: Employee engagement survey findings Input from the employee engagement survey provided focus to the strategy and implementation For EMHC — input about pay and benefits led us to conduct an analysis of EMHC’s base-pay practices Towers Perrin conducted a review of EMHC’s benefits and their market competitiveness © 2009 Towers Perrin 23
  • 24.
    What are theengagement mindsets at EMHC? Disengaged 16% Fully Engaged 25% Complacent 59% © 2009 Towers Perrin 24
  • 25.
    On the payfront, how does EMHC compare with other local health care organizations? Base Pay Of the 50 EMHC Positions Surveyed, the Majority Were Either at Market or at the High End of Market Higher end of market At market Lower end of market Source: Metropolitan Chicago Healthcare Council (MCHC) © 2009 Towers Perrin 25
  • 26.
    All EMHC benefitprograms were benchmarked against the market Benefits Medical Dental Vision Short-Term Disability Long-Term Disability Basic Life/AD&D Voluntary Life/AD&D Pension 403(b) Savings EAP Paid Time Off Lower end of market At market Higher end of market Source: Towers Perrin Competitive Benefits Review, 2008 © 2009 Towers Perrin 26
  • 27.
    EMHC tactics/program changesreflect the strategy, employee input and program performance assessment Pay Pay Benefits The Learning Deal Work and Environment Development Pay and Benefits — Transactional Rewards focus for 2008 and early 2009 Learning and Development and Work Environment — Relational Rewards focus for the balance of 2009 and 2010 Early results of engagement pulse survey are promising © 2009 Towers Perrin 27
  • 28.
    Early results ofengagement pulse survey are promising My supervisor used the feedback to make changes 59% favorable EMHC 57% favorable healthcare norm All in all, I’m satisfied with my job 80% EMHC 2009 69% EMHC 2007 73% healthcare norm I understand how my benefits compare 64% favorable 62% healthcare norm I understand how my wages compare 61% favorable I understand how my performance impacts the organization’s performance 91% favorable © 2009 Towers Perrin 28
  • 29.
    Introduce a newemployer-employee partnership Hold employees accountable In return, provide Together, to perform, based a comprehensive we will deliver on company values total rewards program stellar results Outstanding clinical quality/outcomes Partnership Pay Benefits Exceptional patient Respect satisfaction Integrity You Strong financial Determination performance Learning Excellence and Work Significant market Environment Development growth Safety at the core of all we do © 2009 Towers Perrin 29
  • 30.
    Today’s discussion Setting the Stage — Attraction and Retention in Challenging Economic Times Addressing Elmhurst Memorial’s Issues: Total Rewards Optimization Key Learnings © 2009 Towers Perrin 30
  • 31.
    Key learnings: Managingthe partnership and moving forward together Create a comprehensive strategy Develop a total rewards strategy that supports business needs, and align programs accordingly Communicate and manage change Commit to regular dialogue about total rewards and what it means for employees Provide transparency Provide information about pay and benefit levels, and how they correlate with employee performance Move from transactional rewards to relational rewards Pay and benefits must be competitive; you must pay to play, but you win through exceptional learning and development and work environment gains © 2009 Towers Perrin 31
  • 32.
    Thank you Questions? © 2009 Towers Perrin 32
  • 33.
    Our contact information Lois Grubb Vice President, Human Resources Elmhurst Memorial Healthcare [email protected] Eric Parmenter Principal Towers Perrin Chicago Office 71 South Wacker Drive Suite 2600 Chicago, IL 60606 [email protected] © 2009 Towers Perrin 33