Value-based recruitment is a challenge in healthcare, but multiple mini-interviews, which use a series of clinical scenarios, may offer a solution
Heathcare organisations are faced with the challenge of recruiting staff who have caring and compassionate values so need to ensure these can be identified at interview. We piloted multiple mini-interviews as a possible solution to recruiting healthcare assistants. This article outlines how these were implemented and highlights some of the pitfalls of using this approach. Although the work has not been evaluated formally we decided to share our early experiences of using this approach so others can learn from our practice.
Corder K et al (2014) How to recruit caring and compassionate HCAs. Nursing Times; 110: 13, 20-22.
Authors: Karen Corder is clinical educator and practice development coordinator/lecturer practitioner; Suzanne Medows is senior nurse practice development; Andrea Morgan is staff development officer, all at Newcastle upon Tyne Hospitals Foundation Trust.
- This article has been double-blind peer reviewed
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How do you test candidates’ caring and compassionate values in a job interview? This is the challenge for many healthcare organisations responding to the Francis report (2013) and the focus on caring and compassionate care highlighted by the 6Cs (Department of Health and NHS Commissioning Board, 2012).
Responding positively to the 6Cs (DH and NHS Commissioning Board, 2012) and ahead of the publication of the Francis report (2013) and the Cavendish review, (2013) Newcastle upon Tyne Hospitals Foundation Trust (NuTH) had explored how we could improve quality and training of our staff. The Francis and the Cavendish reports both referred to a shortage of qualified staff and increased demands on them within the ward environments. This has resulted in increasing amounts of hands-on patient care being delivered by healthcare assistants (HCAs) so improving the education and training provided to our HCA workforce has become a focus area.
In October 2013 we implemented an innovative “healthcare academy” designed to provide all new HCAs with a two-week induction that included education and training in fundamental skills. We felt that alongside this we needed to develop a new approach to interviewing candidates for HCA roles as we started to recruit to the academy.
In November 2010, NuTH centralised recruitment for HCAs. In June 2013, in response to the chief nursing officer’s 6Cs (DH and NHS Commissioning Board, 2012), the Francis report (2013) and in anticipation of the Cavendish Review (2013) we discussed how we could introduce values-based recruitment. The Francis report had recommended that staff recruited into the NHS should have their values and behaviours tested.
We decided to adopt the idea of using multiple mini-interviews (MMI), which have been successfully used to recruit medical students (Eva et al, 2012; 2009) and appeared to meet our needs. We adopted the idea of situational scenarios as part of our interview process, based on some of the key issues highlighted in the Francis report (2013) including dignity in care and raising concerns.
The scenarios and layout for the interview days mimicked the observed structured clinical examinations (OSCEs) used to assess medical students and nurses in clinical practice. This involved a circuit of six stations where candidates were presented with a scenario and then “tested” by two impartial clinical staff. Each station has different staff testing the candidates, rather than one examiner following a candidate throughout the whole process. We anticipated this style of testing would help triangulate views of the candidates and rule out some of the subjectivity involved in the traditional interview process.
Designing the process
It was agreed from the outset that we should include clinical staff when designing the process as we needed their support in implementing the new interview assessment technique.
A small group was formed to develop six clinical scenarios; this included a practice development coordinator and clinical educators as well as clinical ward sisters. In order to develop the scenarios we first had to decide which attributes to focus on. To do this we looked at patient feedback and complaints received by the trust to identify key themes involving qualified members of staff and HCAs. We also used feedback from the Friends and Family Test.
In general, patient feedback demonstrated high levels of satisfaction and where this was not the case, poor communication was highlighted as an issue. The group also used the trust’s core professional and leadership behaviours (PLB) as a benchmark (NuTH, 2013). Aligned to the NHS Constitution (DH, 2013) and the trust’s vision and values, the core behaviours require that staff are “Putting patients at the heart of activity, listening and responding to their needs compassionately and demonstrating respect for their opinions and wishes” (NuTH, 2013).
Using the PLBs as a benchmark, along with knowledge gained from patient feedback and key contemporary issues such as the 6Cs (DH and NHS Commissioning Board, 2012), helped our group to focus on developing scenarios to target these important areas for recruitment. Some of the key attributes were:
- Ability to follow instructions;
- Ability to prioritise workload;
- Ability to recognise when behaviours needed to be challenged and courage to challenge them;
- Good communication skills.
Examples of scenarios are outlined in Box 1.
Box 1. Sample scenarios
Scenario 1. Privacy and dignity
You are a healthcare assistant (HCA) on a ward working as part of the blue team. A relative of a patient being cared for by the red team informs you that their loved one is lying naked and exposed on the bed and asks you for help. Please discuss what you would do
- Scenario 1 aims to identify candidates’ basic reaction to a patient’s privacy and dignity, regardless of which team they are working with
Scenario 2. Handwashing
You are an HCA in a clinical area. Using the written instructions provided please wash your hands
- Scenario 2 is used to establish whether candidates can follow a set of simple instructions. Correct handwashing technique is not the main focus of this scenario; that can be corrected when successful candidates undertake their training at the healthcare academy before working in the clinical area
Testing out the scenarios
When all six scenarios were developed we had to consider how useful they would be in the recruitment process. The initial ideas were developed as we tested them on other members of the practice development team and non-clinical staff. Testing them on clinical staff helped us to assess exactly what issues each scenario was addressing. It was equally valuable to test them on non-clinical staff with no background in clinical care. This highlighted the importance of using plain language.For example, we changed the term “commode” to “portable toilet” as a result of feedback from a work experience student.
Although developed by staff who understood the underlying theme, one of the scenarios was modified when it was used on the first assessment day as it caused some unexpected confusion. Box 2 shows the original scenario question relating to smoking cessation. Staff were provided with model answers to assist them but candidates were picking up on issues of patient choice around cigarette smoking and health promotion rather than discussing the attitude of the staff involved.
Examples of this included:
“Well it’s not for the nurse to judge the patient for smoking, it’s their choice.”
“The nurse should ask the patient if he wants help to stop smoking and so she should give him some nicotine products.”
Both are good answers, but neither addressed the intended issue of raising concerns.
Candidates were not penalised and interviewers who identified those confused by the question steered them in the right direction. In an effort to be fair to all candidates the scenario remained the same until
the end of the interviews that day and was updated before further interview assessment days.
Box 2 shows the updated version of the scenario.
Box 2. Evaluating effectiveness of scenarios
You are a healthcare assistant (HCA) helping a qualified staff nurse to provide personal care to a breathless patient. The patient asks if he can go outside for a cigarette when he is dressed. The staff nurse responds abruptly to the patient: “No you cannot, that’s what brought you here in the first place.”
Please discuss your thoughts
You are a healthcare assistant (HCA) helping a qualified staff nurse to provide personal care to a patient. While delivering the care the staff nurse is rude and abrupt in her manner towards the patient.
Please discuss your thoughts
Selecting interview days
Candidates who met the essential criteria in the person specification were shortlisted. Those with an NVQ level 2 in an appropriate (health-related) subject or equivalent qualification/experience, as well as good numeracy and literacy skills, were contacted by letter by the human resources department.
Instead of being issued with a date and time for interview, candidates were asked to telephone and “self-select” an interview slot. This allowed them to opt for the most convenient time for them, which we hoped would reduce the number of candidates who do not attend on the day. It also meant that candidates who had secured employment elsewhere or indeed changed their mind about the vacancy did not receive an appointment unnecessarily. This in turn reduced the time wasted by staff waiting for candidates who failed to attend for their interview.
Venue and timing
Once the scenarios were finalised, the venue and timing had to be addressed as these were vital for the delivery of the assessment process. We needed space to welcome candidates, a waiting area, and rooms that allowed easy movement between scenarios yet avoided candidates overhearing the responses of others being interviewed.
Clinical staff who had volunteered to assist in the scenario stations were briefed on the day, “walked through” the stations and given an opportunity to ask questions.
A timetable was designed to allow candidates to move through the assessment process in groups of six, rotating round each scenario station in a clockwise manner. The candidates were given one minute to read the scenario then two minutes to discuss it with two members of clinical staff. A timekeeper ensured that candidates were instructed verbally to begin their reading time, discuss the issue with the clinical staff at that station and then rotate to the next station.
Scoring the candidates
Candidates were scored in each scenario from zero to three depending on their answer. The staff based in each station remained there for the course of the interviews to make the process more objective and fair for each candidate.
Scores from each scenario were then collated into a grid allowing the staff involved in the interviews to gain a more rounded picture of each candidate’s values and traits. Successful candidates were those who scored an average of 60% or higher. Interestingly, clinical staff who assisted in the scenarios were at times surprised by the scores from particular candidates:
“I’m surprised to see that particular candidate scored poorly in most stations… I thought they were very articulate. I scored them a three for my station and could see how they would fit into my team… I guess it [scoring grid] shows that they are not the ideal candidate after all.”
The recruitment process is receiving positive feedback from candidates and staff:
“I was terrified when I realised I was not just going to be talking to someone face-to-face… I just wanted to get it over and done with, but I have enjoyed it and it has helped me to see the kind of situations I might find myself in, and how I will cope if I do.”
“I have calmed down since I spoke face-to-face with the members of staff for the first interview questions… I really like this system… it gives us more than one chance to shine.”
Although initially apprehensive of the new recruitment process, clinical staff have come to trust it. This trust helps to reassure any ward sisters who have been unable to interview candidates themselves to feel confident that those who have completed the selection process are of a high calibre.
We need to be confident that the MMI approach to interviews does enable us to select in a more consistent manner than traditional interview. We plan to compare the number of HCAs employed and retention rates with those in previous years to measure the impact.
Qualitative feedback from ward sisters and the clinical staff involved in the interview process will also be sought. This will include feedback on their perception of the values and behaviours of staff recruited through this process.
- Staff recruited into the NHS should have their values and behaviours tested
- Multiple mini-interviews have been successfully used to recruit medical students
- Structuring interviews around a series of clinical scenarios can be used to test caring and compassionate values
- Local patient feedback and complaints can be used to inform scenarios
- Scenarios should be tested before they are used
Department of Health (2013) The NHS Constitution. London: DH.
Department of Health and NHS Commissioning Board (2012) Developing the Culture of Compassionate Care: Creating a New Vision for Nurses, Midwives and Care-givers. London: DH.
Eva KW et al (2012) Association between a medical school admission process using the multiple mini-interview and national licensing examination scores. JAMA; 308: 21, 2223-2340.
Eva KW et al (2009) Predictive validity of the multiple mini-interview for selecting medical trainees. Medical Education; 43: 767-775.
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: Stationery Office.
Newcastle upon Tyne Hospitals Foundation Trust (2013) Professional and Leadership Behaviours: Core Behaviours Expected of all Staff to Put Patients at the Heart of Everything we do (updated).