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A Study of the Use of Structured Healthcare Interviews to Predict Future Performance of Employees in Long-Term Care Facilities

Tom Morgan, Ph.D. and Donna Crecelius, Ph.D.


Candidates for Nurse’s Aides in Training (NATs) and Certified Nurse Assistants (CNAs) were interviewed at two long-term care facilities in St. Louis, Missouri. These interviews were designed to evaluate the effectiveness of a structured interview tool consisting of 22 questions to assess candidates based on specific attributes. The structured interview was used for all 1:1 interviews; candidates were asked identical questions with the responses analyzed by trained interviewers. This interview yields measurable results based on attributes such as: building relationships, purpose driven, delivering results, and growth and progress. For the four attributes, 11 subcategories were identified. At various times, the results were reviewed with the Human Resource Directors at the facilities to determine the contribution of these interviews to the hiring process. The hired candidates were followed for a period of 18 months. Based on results of 107 interviews, 16 of these candidates were recommended and hired. Of these, two of the 16 left the facility for various reasons. The remaining 14 candidates have proven to be excellent employees and were still working at the facility a minimum of 18 months. The facilities also hired 34 candidates with marginally to moderately predictability (not recommended but hired) by our interview results. For a variety of reasons, none of these employees are still working at the facility. Additionally, 57 candidates were not recommended for hiring through interview results and were not hired. The data indicates a distinct pattern of scores within these three groups of candidates. Those who are still working scored highest on the interviews, the second group (hired and not working) displayed the next lowest scores and had a high level of attrition, while those not hired had the worst interview scores overall. A timeline of employment shows that the candidates not recommended for hiring according to interview results but were hired, showed an exponential drop in retention over the course of the study. The study indicates that these structured interviews can provide important information about a candidate’s behaviors, actions, beliefs, values, and potential for high performance as part of the staff of a long-term care facility.

Introduction and Background Information

One of the biggest problems facing the long-term healthcare industry is staff turnover and retention. The national average annualized turnover rate for all disciplines in long-term care has been calculated to
be 49%. Surveys indicate that turnover rates for registered nurses (RN) are 44%, licensed practical nurses (LPN) 44%, and 70% for NATs and CNAs (those with most patient contact). These numbers vary when looking at individual facilities. This “turnover crisis” has been worsening through the years and the cost to replace lost employees has become significant. For example, during one year a long-term care facility had a turnover rate for LPNs of 75% which cost the home $62895. The high turnover rates result in hiring personnel from outside sources, time spent in hiring and training new personnel, bonuses, and a loss of income for the facility. However, most importantly, the turnover rates result in inconsistent and suboptimal patient care. Certain characteristics of long-term care employees have been shown to be essential in providing high quality care to patients. Some of these traits include empathy, cooperation, optimism, effective communication skills, sociability, carefulness, and striving for excellence in delivering care to patients (1).

When designing an interview for a long term care employee, these traits should be incorporated into the questions. In the past, healthcare interviews have been unstructured with the interviewer free to ask any question to each candidate. This “non-standardized” approach can lead to problems including the use of questions of different types and quality for candidates for the same position. This can sometimes make it difficult to make distinctions between candidates. If candidates compare interviews afterwards, it can lead to possible charges of discrimination or favoritism. In order to standardize this process, this study investigated the use of structured interviews which were designed to address specific attributes, behaviors, and traits.


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