PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Surveyor recruitment and retention difficulties pose a significant challenge for many State Survey Agencies (SAs),1 and may contribute to inconsistencies in citation of concerning deficiencies in facility performance.2 Competition for nurses, who constitute a major component of the surveyor workforce, is believed to be exacerbated by the national nursing shortage and surveyor salary limitations.2 Other aspects of the surveyor position, such as demanding travel requirements and the stress often associated with working in the regulatory setting, also are believed by SAs to contribute to recruitment and retention issues.1 In the face of these difficulties, many SAs are working to improve their surveyor recruitment and retention success. This issue brief presents examples of promising recruitment practices (some drawn from sources other than SAs), with emphasis on procedural aspects such as publicity approaches, effective interviewing, and streamlining hiring processes. Many retention strategies, with their aim to create a positive, fulfilling, and flexible work environment and position that will keep staff, also can help promote recruitment of new surveyors. Examples of SA retention practices are presented in other issue briefs produced under this project, particularly Retaining Surveyors: A Compendium of Promising Practices. Although some of the practices described in this issue brief may be well-established in the private sector or some SAs, they may be new for many other SAs. Agency leadership can benefit from learning how others have implemented useful practices. To help agencies more comprehensively assess their current recruitment efforts and identify areas that could be strengthened, a checklist of key recruitment strategies (again emphasizing procedural aspects) is provided in this issue brief. Illustrative practices are presented after the checklist and are organized by the categories on the checklist. The References and Relevant Literature section located at the end of this document provides suggestions for additional resources that may be helpful to agencies seeking further information on recruitment strategies. The SA practices featured in this issue brief are only a sampling of the recruitment strategies used by SAs across the country. Substantial efforts by the project's research team to identify promising recruitment practices began with e-mail requests sent to all state survey agencies (a small number of agencies were not successfully reached). The research team sent additional e-mails to many agencies that did not respond to initial inquiries and also contacted some agencies regarding specific practices, based on suggestions from the project workgroup. Only a relatively small offering of recruitment practices resulted from these efforts, compared to submission of a variety of retention practices, although staff at many agencies expressed interest in learning about other agencies' recruitment strategies. To obtain further information about selected practices, the research team conducted telephone interviews with agency staff and reviewed relevant supporting materials. Draft descriptions of each practice were reviewed by agency contacts to assure accuracy of the content.
This document is an issue brief describing recruitment strategies used in State Survey Agencies and other environments. The issue brief is one of a series by the Division of Health Care Policy and Research, University of Colorado Health Sciences Center, for the U.S. Centers for Medicare & Medicaid Services (CMS) highlighting promising practices in State Survey Agencies. The entire series is available online at CMS' Website, http://www.cms.hhs.gov/SurvCertPromPractProj. The issue briefs are intended to share information about practices used in State Survey Agencies and are not an endorsement of any practice.

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Checklist of Recruitment Strategies

The art and science of finding, attracting, and selecting the best people for a position.

Success in recruiting is strongly influenced by an organization's culture, its mission, values, priorities, and many other factors that create an attractive work environment.3 Many strategies can benefit both recruitment and retention by creating a flexible, rewarding position and a positive work culture; examples of State Survey Agency practices that target staff retention and also positively affect recruitment are described in another issue brief produced under this project, Retaining Surveyors: A Compendium of Promising Practices. A strong recruitment program also focuses on improving the procedural aspects of the recruitment and hiring processes, such as effectively publicizing a job and enhancing the speed and efficiency of the hiring process. The checklist presented below emphasizes recruitment practices intended to strengthen such procedural aspects. The checklist was developed based on a review of the personnel management literature*, with attention to the context and constraints of public sector employers, to provide a general framework to help your agency focus on some important strategies for recruiting. Recruitment factors can be grouped and presented in many different ways - the checklist below is just one representation and is designed to help you take the pulse of your agencys recruitment efforts. Use the checklist as a guide in your efforts toward developing recruitment strategies that work for your agency. For each category on the checklist, examples of relevant practices in place at State Survey Agencies or utilized in other environments are listed. These practices, organized by recruitment category, are summarized following the checklist. ___________________
* Reference materials that contributed to the ideas on this checklist are listed in the References and Relevant Literature section located at the end of this issue brief.

Gather Data on Recruiting and Hiring

Review current processes and establish baseline data, identify key measures (e.g., number of applications for job, average length of time positions are vacant) Monitor progress to determine impact of new recruitment strategies (e.g., change in number of applicants, change in average length of time to fill vacancies) Identify priority areas, where to direct recruitment resources Example Uses of Recruitment Data

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Know the Job

Conduct a job analysis Understand the real job responsibilities, schedule, workload, worker attributes, advantages, and challenges Develop a clear description of the job and the skills and attributes you seek in a candidate Example Job Analysis

Spread the Word Implement New Publicity Approaches

Consider new places to advertise Think about new audiences to target - maximize possible connections Develop marketing materials that convey your message and convince the target audience of the attractiveness of the position Emphasize the values of public service and the opportunity to make a difference Use the Web to your advantage - post job openings and provide details to help inform potential candidates of the job's many benefits, potential challenges, and necessary skills or qualifications Examples Texas: Marketing Techniques to Attract Surveyor Job Applicants Texas: Publicity Features on Website

Match Candidates to the Job

Based on your job analysis, identify characteristics you are seeking in a candidate Identify characteristics to avoid for this position Develop an appropriate applicant assessment approach Resist hiring people just to hire people - focus on a good match Example Hawaii: Letter-Writing Task to Assess Candidate Skills

Interview Effectively
Train existing staff on interviewing skills to increase the reliability and validity of the process Convey the real job to candidates - highlight the positive but clearly state all aspects so candidates know what to expect and can self-select (avoid later turnover!) Assess skills critical to the job by using standard interview questions and tasks Consider developing a structured behavioral and situational interview process Develop a standardized scoring system for interviews Example Texas: Overview for Prospective Surveyors
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Strive for Efficient and Effective Hiring Processes

Assess current systems and cut time, paperwork, redundancy where you can - don't be afraid to propose changes Create a flexible hiring process Examples Colorado: Continuous Job Posting

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PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Gather Data on Recruiting and Hiring

Collecting and monitoring data related to recruitment efforts and results can help organizations assess the effectiveness of their recruitment programs, identify areas for improvement, and inform development of recruitment strategies that will target key needs.3 The example in this section describes the role of data in monitoring and improving recruitment efforts.

Uses of Recruitment Data

Collecting and monitoring recruitment data can help agencies target specific areas for improvement, guide strategies to address these high priority areas, and remain informed on the overall effectiveness of their recruitment efforts.

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Gather Data on Recruitment and Hiring Uses of Recruitment Data

Summary To improve recruitment success, it is important to first establish a baseline of information that gives a picture of the current status of recruitment efforts and results. Relevant data might include the number of applications received for surveyor positions, the proportion of applicants meeting basic position qualifications, the average length of time positions are vacant, as well as other factors as determined by the recruiting organization. After establishing the baseline data for the selected measures, it is critical to collect data on the same measures over time, particularly after implementing new recruitment efforts. Managers can use the data to help assess the effectiveness of new efforts in improving the targeted areas (e.g., whether the number of applications for vacant positions increased). This information can be used to help identify particular recruitment aspects in need of improvement. For example, data trends can help managers determine whether efforts need to be made to increase the number of applicants in general or the number of applicants who meet specific job qualifications, issues that would benefit from different strategies. Data collection and monitoring can help agencies target priorities as well as remain informed on the overall effectiveness of recruitment efforts.
Source: National Academy of Public Administration (Human Resources Management Panel), 2001.3

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PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Know the Job

Before interviewing candidates for a job, it is advantageous for managers to be thoroughly familiar with the tasks of the job and to take the time to carefully consider the skills and personality traits that would make a candidate a strong match for the position. Job analysis methods, summarized in this section, are useful tools for managers to use when analyzing the tasks of a position and identifying the most important characteristics to seek when interviewing candidates.

Job Analysis

Job analysis is a structured process used to analyze the important tasks of a job. Conducting a job analysis can help managers clearly identify the skills and attributes to seek when interviewing and selecting candidates who will best fit a particular position. Job analysis also can help managers with identifying training needs for existing staff, establishing appropriate job classifications, and making decisions on compensation for particular job categories. Multiple methods are available for formal job analysis with some methods specifically geared to assist with effective selection of employees.

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Know the Job Job Analysis

Summary Job analysis is a structured process used to analyze the important tasks of a job. Conducting a job analysis can help managers clearly identify the skills and attributes to seek when interviewing and selecting candidates who will best fit a particular position. Job analysis also can help managers with identifying training needs for existing staff, establishing appropriate job classifications, and making decisions on compensation for particular job categories. Multiple methods are available for formal job analysis with some methods specifically geared to assist with effective selection of employees. Selectionfocused techniques aim to discern the differences among effective and less effective workers within a specific job, with the goal of yielding information that will facilitate selection of the most qualified individual for the position. Selection-focused job analysis helps managers identify the personal qualities that are important to effective performance of a job and may be difficult to cultivate in a person who does not naturally possess these characteristics. Well-known job analysis methods include the Position Analysis Questionnaire (PAQ), Functional Job Analysis (FJA), skill-based job analysis, and the Fleishman Job Analysis System. These formalized systems generally are conducted by Human Resources professionals. The approaches vary with respect to time and materials required and offer distinct advantages and disadvantages. Important factors to consider in the selection of a job analysis method are reliability, validity, collection of quantifiable data, and adaptability. Less formal methods of job analysis can include interviews with current employees and supervisors, questionnaires, observation, and compilation of background information such as job or duty descriptions to help examine the job tasks and identify the types of personality characteristics, skills, and experience that make an individual successful at and satisfied with the job.
Source: Hays & Sowa, 2005, pp. 97-124.4

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PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Implement New Publicity Approaches

Effective marketing strategies emphasize "selling" the job and the organization to the appropriate audience.3 Publicizing the surveyor job requires efforts to clearly explain the value and benefits of the job, convincing potential candidates of its attractiveness over competing opportunities, and to spread this message to a larger audience. One State Survey Agency's efforts to increase awareness of the availability and advantages of the surveyor position through outreach efforts, new brochures and other marketing materials, and Website features are described in this section.

Texas

Marketing Techniques to Attract Surveyor Job Applicants

Over the past two years, the Regulatory Services Division of the Texas Department of Aging and Disability Services has implemented a variety of marketing strategies designed to increase awareness of the surveyor job and attract more applicants, expanding efforts beyond their typical settings and methods.

Texas

Publicity Features on Website

The Regulatory Services Division at the Texas Department of Aging and Disability Services (DADS) maintains a Website linked to the main DADS site that provides information about the Divisions purpose and the role of the surveyor. Surveyor vignettes and a video depicting surveyor activities are featured on the Website to highlight the valuable service provided by surveyors and the attractive aspects of the position. Region-specific and general contact information to facilitate inquiries about the surveyor position also is provided on the site.

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Implement New Publicity Approaches Texas: Marketing Techniques to Attract Surveyor Job Applicants
Summary Over the past two years, the Regulatory Services Division of the Texas Department of Aging and Disability Services (DADS) has implemented a variety of marketing strategies designed to increase awareness of the surveyor job and attract more applicants, expanding efforts beyond their typical settings and methods. Intervention The agency uses a variety of approaches to disseminate information on the surveyor position to a broad base of potential applicants. Newly developed brochures and marketing packets, geared primarily toward nurses, highlight the value of the service surveyors provide, promote the advantages of the surveyor position compared to positions in many direct care settings, and note the easy transfer of clinical nursing skills and experience to the regulatory setting. The materials are used across the state's many regional offices to promote awareness of surveyor work in multiple venues. Agency staff attend community job fairs and college career days to generate interest and identify potential candidates, taking the opportunity to explain and promote in-person the agency's mission and the surveyor role. In the San Antonio region, retiring military personnel, particularly those with medical backgrounds in conjunction with their public service experience, are being tapped as a potential candidate source. The regional director collaborates with consultants who conduct exit interviews preparing military personnel for retirement to share information promoting the surveyor position as an option for a retiree's or spouse's post-military career. The Austin regional office supports a six- to eight-week internship program during which local nursing students shadow surveyors in the field, familiarizing interns with survey work as a job option to consider later in their nursing careers. On a national level, the agency advertises the surveyor position in ADVANCE for Nurses, a national publication targeting nurses. The ongoing advertisement provides an e-mail address linked directly to a mailbox monitored weekly by regional liaison staff in the Regulatory Services Division. These staff review and sort the inquiries and e-mail interested individuals the direct Web link for the job openings in their region of the state, eliminating the need for the potential candidates to navigate the DADS Human Resources Website to find possible positions. Implementation To help address ongoing surveyor recruitment difficulties, leadership staff from the State office assembled a workgroup composed of regional directors and program managers representing all programs and regions of the state to develop an agency-wide recruitment initiative. Management staff considered each of the workgroup's 73 recommendations and evaluated which practices or programs could be implemented without requiring a change in statute or rule. Approved recommendations were disseminated to the regional offices throughout the state. Some region-specific practices served as models and were implemented in other areas of the state. The workgroup developed much of the new marketing material, which is used across all regional offices to support local recruitment efforts. Impact The combination of outreach and advertising efforts implemented over the past two years is believed to have substantially increased the volume and quality of
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Implement New Publicity Approaches Texas (Cont'd)

applicants and hires for open surveyor positions in many of the state's regions. Agency management staff report that the number of vacancies for nurse surveyors has decreased. (See Texas: Publicity Features on Agency Website in this section, Implementing New Publicity Approaches, for information on other agency recruitment efforts.) Management staff found, as a result of the marketing efforts, that many nurses and other potential candidates are not aware of what surveyors do, the advantages of the position, nor that their skills, knowledge and experience would facilitate effective transition into this public sector position. Community outreach efforts appear to be successful in generating interest in the position; for example, participation in a recent job fair resulted in nearly 30 inquiries into available positions. Management staff believe that the involvement of representatives from each regional office in the recruitment workgroup strengthened the sense of cohesiveness and shared mission of the regional offices and State office and that pursuit of the workgroup's recommendations helps demonstrate the commitment of the State office to help the regions with their recruitment challenges. Lessons Learned Agency management staff advocate active networking in local communities, as participating in job fairs, disseminating information through military retirement exit interviews, distributing marketing materials at local colleges, and supporting a nursing student internship have been beneficial in increasing awareness of the surveyor position and its advantages. Although efforts targeting students or nurses early in their career may not produce immediate results, management staff believe that promoting general awareness of and interest in the surveyor career path can benefit the agency in the long run. Opportunities to promote the job in face-to-face settings allow agency staff to explain the job and its benefits, and to personalize state government work, which may be important for some potential candidates. Marketing materials should not be geared to try to compete with private sector financial benefits, but instead should emphasize the mission and value of surveyor work, the state benefits package, and other attractive features of the job, particularly in comparison to other nursing opportunities. It is useful to include contact information for local agency representatives on all marketing materials and note that, although the materials primarily target nurses, the agency also hires other credentialed professionals. Management staff also recommend designating a contact person in each region to list on marketing materials used by that region and to follow up on inquiries from the area, ensuring expedient responses to potential candidates. Contact For more information, please contact Chris Adams, Director of Survey Information Operations, Regulatory Services Division of the Texas Department of Aging and Disability Services at 512/438-5695 or [email protected].

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Implement New Publicity Approaches Texas: Publicity Features on Website

Summary The Regulatory Services Division at the Texas Department of Aging and Disability Services (DADS) maintains a Website linked to the main DADS site that provides information about the Divisions purpose and the surveyor position. Surveyor vignettes and a video depicting surveyor activities are featured on the Website to highlight the valuable service provided by surveyors and the attractive aspects of the position. Region-specific and general contact information to facilitate inquiries about the surveyor position also is provided on the site. Intervention To inform and attract potential surveyor candidates, the Website for the Regulatory Services Division (http://www.dads.state.tx.us/employment/regsvcs/ index.cfm) presents written vignettes featuring impressions from three surveyors and one regional director in describing their Life at DADS. The vignettes are designed to provide a voice from active surveyors and the regional director, a former surveyor, as they discuss the satisfaction and benefits they gain from their work. Individuals browsing the Website also can access a recruitment video (Come to Work Where Your Work Makes a Difference) that depicts selected surveyor activities and discusses the surveyor's mission and responsibilities as well as the benefits of working for the DADS Regulatory Services Division. In addition to being accessible on the Website, the video is used at job fairs and may be adapted for local Public Service Announcements. The vignettes and the video were made available on the Website in 2006. To facilitate access to information on position openings, the Website provides a general recruitment email address, which is monitored weekly by Regulatory Services staff who direct inquiries to the appropriate region. The site also lists names and contact information for representatives from all regions of the state. Impact Agency management staff indicate that an increased number of inquiries and applicants for surveyor positions has been received since the posting of the vignettes, video, and contact information on the Website. Lessons Learned Agency management staff invited Regulatory Division staff, rather than professional actors, to act in the recruitment video. Staff involvement in the video production, as well as in the vignettes, is believed to have a retention effect by giving dedicated employees an opportunity to reflect on their jobs and "leave a legacy behind". Contact For more information, please contact Chris Adams, Director of Survey Information Operations, Regulatory Services Division of the Texas Department of Aging and Disability Services at 512/438-5695 or [email protected].

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PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Match Candidates to the Job

Recruitment efforts focus on attracting and effectively identifying candidates who possess the skills and experience to successfully perform job responsibilities and who will "fit" with the organization's culture, work environment, and current staff. Efforts to develop approaches that help assess these attributes and predict a good match for the position pay off in the long term. This section presents one strategy used to help determine candidate skills in some areas relevant to the surveyor position.

Hawaii

Letter-Writing Task to Assess Candidate Skills

In 2001, the Office of Health Care Assurance at the Hawaii State Department of Health implemented a practice that enables interviewing staff to assess job candidates' basic computer and writing skills by assigning an impromptu letter to be developed during the interview process.

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Match Candidates to the Job Hawaii: Letter-Writing Task to Assess Candidate Skills
Summary In 2001, the Office of Health Care Assurance at the Hawaii State Department of Health implemented a practice that enables interviewing staff to assess job candidates' basic computer and writing skills by assigning an impromptu letter to be developed during the interview process. Intervention During the interview, interviewing staff ask candidates to develop a hypothetical letter to a provider regarding a specified topic area (e.g., receipt of a plan of correction). Candidates are timed during this task and are observed by agency administrative staff who also are available to provide assistance. After the interview, hiring staff review the letter and evaluate the candidate's efficiency, comfort using a computer, quality of writing, and ability to quickly adapt information and complete a new task. Impact Agency management staff believe that adding this task to their interview protocol helps interviewers assess candidate skills in some of the areas important to the surveyor position, including writing skills and the ability to organize thoughts and prioritize points. As the agency moves towards utilizing tablet PCs, this interview component also allows interviewers to assess candidates technical capabilities. Lessons Learned Agency management staff comment that it is beneficial to have administrative staff observe the applicant during the letter-writing task to obtain feedback regarding the applicants technical ability to complete the process (e.g., whether the applicant demonstrates difficulties with beginning the process, saving or printing documents, etc.). Management staff recommend providing written instructions that clearly outline the entire process and expectations as well as having the applicant print a copy before leaving the interview to avoid losing the document if it was not saved on the computer. Contact For more information, please contact Gerald Chung, Medicare Certification Information Officer, Office of Health Care Assurance, at 808/692-7420 or [email protected].

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PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Interview Effectively
Effective interviewing involves careful assessment by interviewing staff of a candidate's skills and suitability for the job. The interview also is an opportunity for the candidate to gather information about the position and organization that will help in determining whether the job is a good match with his or her interests, skills, and lifestyle. Prospective job candidates are interested in many aspects of an organization, including the product or service, compensation and benefits, organization culture and work environment, and factors related to work-life balance.3 Although it is critical to highlight the positive aspects of a position in order to attract talented candidates, it also is vital to ensure that candidates understand the full picture when offered a position and will be prepared for a job's more challenging aspects. This section describes an overview handout distributed by one State Survey Agency to promote job candidates' detailed knowledge of the surveyor position.

Texas

Overview for Prospective Surveyors

The Regulatory Services Division of the Texas Department of Aging and Disability Services provides a handout entitled "An Overview for Prospective Surveyors" to surveyor candidates during interviews. The handout documents detailed information about the position and is designed to help candidates make an informed employment decision.

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Interview Effectively Texas: Overview for Prospective Surveyors

Summary The Regulatory Services Division of the Texas Department of Aging and Disability Services (DADS) provides a handout entitled "An Overview for Prospective Surveyors" to surveyor candidates during interviews. The handout documents detailed information about the position and is designed to help candidates make an informed employment decision. Intervention The two-page overview for prospective surveyors, developed in 2006, covers multiple areas of interest to potential employees. The first two of the overview's six main sections describe the purpose and activities of the Regulatory Services Division of DADS and the extensive employment benefits offered by the State of Texas (e.g., health insurance, retirement benefits, longevity pay, merit salary increases, vacation and sick leave, comp time) as well as information on travel reimbursement and allowances. The overview's third section outlines the length and general content of the intensive training that surveyors receive to ensure that they are prepared to effectively conduct their work and notes that surveyors have a one-year probationary period and must pass required exams. Travel that may be required to complete training activities is noted. The fourth section clearly states that surveyor positions require a high frequency of day and overnight travel to conduct surveys and other responsibilities, and specifies the volume of travel (i.e., percent time) expected based on regional area and provider type relevant to a particular position. The fifth section describes the skills a surveyor needs to be successful at the job, highlighting writing ability (including writing detailed reports that must be able to withstand legal scrutiny), critical thinking and decision-making skills, ability to communicate with providers and team members in collaborative and hostile situations, and proficient use of computers. The sixth section describes the technology a surveyor uses, including accessing state and federal databases and software to gather information and prepare reports, the option to use a voice-to-document service for dictating survey results, the increasing role of laptops and/or tablet PCs in the survey process, and participation in computer-based and Web-based trainings and presentations. Impact Agency management staff believe that the overview helps candidates have a clearer understanding of the surveyor position, its advantages, and its potential challenges. Management staff find that new hires who have carefully reviewed the overview and know what to expect tend to be better suited for the position and are anticipated to stay in the job on a longer-term basis. Lessons Learned It is valuable to provide job candidates with clear written information describing what to expect from the position. The inclusion of information specifying the expected volume of travel and the skills necessary to be a successful surveyor, including the ability to communicate in collaborative and hostile situations, allows selected candidates to accept an offer and begin work with accurate expectations. The likelihood of longer-term retention is enhanced by reducing the chance that a new hire will find that the job is not what was anticipated. Contact For more information, please contact Chris Adams, Director of Survey Information Operations, Regulatory Services Division of the Texas Department of Aging and Disability Services at 512/438-5695 or [email protected].

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PROMISING PRACTICES IN STATE SURVEY AGENCIES

Issue Brief: Surveyor Recruitment Strategies

Efficient and Effective Hiring Processes

To compete for talented nurses and other qualified candidates, public sector organizations need to ensure the timeliness and efficiency of hiring processes, or risk losing candidates to other job offers.5,6 This section describes the practice of continuous job posting utilized at one State Survey Agency.

Colorado

Continuous Job Posting

To improve the ability to quickly locate and hire surveyors when positions became available, the Colorado Health Facilities and Emergency Medical Services Division of the Colorado Department of Public Health and Environment utilized continuous job posting for several years.

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Efficient and Effective Hiring Practices Colorado: Continuous Job Posting

Summary To improve the ability to quickly locate and hire surveyors when positions became available, the Colorado Health Facilities and Emergency Medical Services Division of the Colorado Department of Public Health and Environment utilized continuous job posting for several years. Intervention Continuous job posting refers to actively maintaining a job posting on the Health Department Website and other advertising venues on an ongoing basis, rather than closing the position after a specified time frame or when a particular opening is filled. Agency management staff used continuous job posting to draw a large volume of applicants during a period when numerous surveyor positions were or were expected to become vacant. Continuous posting allows potential candidates to apply at any time, resulting in a pool of candidates from which to draw when the agency seeks to fill positions. To maintain the system, Human Resources (HR) staff routinely monitored the posting to retrieve applications and screen them to determine whether candidates met required criteria. HR staff forwarded relevant applications to supervisor(s) with a job vacancy, or, if no positions were open at the time, added eligible applicants to the candidate pool. Supervisors could access the candidate pool as positions became vacant. Candidates could be contacted, interviewed and hired within days rather than weeks or longer. Implementation The agency began continuous posting in 2001 when seeking to fill a large number of open positions, and discontinued the practice in 2005 as hiring resources became more limited. Agency management staff collaborated with HR staff to develop a standard job description and establish a process for managing the flow of applications. Impact Agency management staff indicate that continuous job posting and the resulting candidate pool improved their ability to find candidates quickly and with substantially less internal paperwork and fewer administrative steps, thereby allowing them to fill vacant positions faster. The practice also expanded the recruitment pool by remaining open on an ongoing basis, catching promising candidates who otherwise may have missed a posting with a restricted time frame. Agency management staff also believe that continuous posting can help advertise or increase awareness of the surveyor role in general by providing the job description to individuals browsing through position postings. Lessons Learned Agency management staff commented that continuous job posting is particularly effective when seeking to fill a large number of vacant positions. Management staff found the practice to be extremely helpful in expediting the recruitment and hiring process. It is useful to specify details regarding experience requirements, such as the need for home health or long term care experience, as making the job requirements too general may reduce the number of qualified applicants. Contact For more information, please contact John Schlue, Interim Director, Health Information Facilities and Emergency Medical Services Division of the Colorado Department of Public Health and Environment at [email protected] or 303/692-2817.

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REFERENCES
1 - Walshe K and C Harrington, 2002. Regulation of nursing facilities in the United States: An analysis of resources and performance of state survey agencies. The Gerontologist, 42(4):475-486. 2 - United States Government Accountability Office, 2005. Despite increased oversight, challenges remain in ensuring high-quality care and resident safety. GAO-06-117. December. 3 - National Academy of Public Administration (Human Resources Management Panel), 2001. The Quest for Talent: Recruitment Strategies for Federal Agencies. 4 - Hays SW and JE Sowa, 2005. Staffing the bureaucracy. Chapter 5 in "Handbook of Human Resource Management in Government." 2nd Edition. Condrey SE (Ed.). John Wiley and Sons, Jossey-Bass. 5 - International Personnel Management Association (IPMA), 1998. Best Practices in Public Human Resources. 1998 IPMA/NASPE Human Resource Benchmarking Project. 6 - Lavigna R, 2003. Reforming public sector human resource management. Chapter 24 in "Public Personnel Administration: Problems and Prospects." Hays SW and RC Kearney (Eds.). Upper Saddle River, NJ: Prentice Hall.

RELEVANT LITERATURE
Association of State and Territorial Health Officials (ASTHO). State Public Health Employee Worker Shortage Report: A Civil Service Recruitment and Retention Crisis. ASTHO, Washington, DC. Buckingham M and C Coffman, 1999. "First, Break All the Rules: What the World's Greatest Managers Do Differently." New York, NY: Simon & Schuster. ISBN #0-684-85286-1. Langan S, 2002. Finding the Needle in the Haystack: The Challenge of Recruiting and Retaining Sharp Employees. International Recruitment and Selection Strategies. Washington, DC: International Public Management Association for Human Resources. Lavigna RJ, 1996. Innovation in recruiting and hiring: Attracting the best and brightest to Wisconsin State Government. Public Personnel Management, 25(4):423-437. Lavigna RJ and SW Hays, 2004. Recruitment and selection of public workers: An international compendium of modern trends and practices. Public Personnel Management 33(3):237-254. National Academy of Public Administration (Human Resources Management Panel), 2001. A Work Experience Second to None: Impelling the Best to Serve. September 2001. Roberts GE, 2003. Issues, challenges, and changes in recruitment and selection. In "Public Personnel Administration," 4th Edition. Hays SE and RC Kearney (eds.) Upper Saddle River, NJ: Prentice Hall. pp. 106-125. United States General Accounting Office, 2000. Human Capital. A Self-Assessment Checklist for Agency Leaders. Washington, DC: U.S. General Accounting Office/Office of the Comptroller General. GAO/OCG-00-14G. Version 1, September.
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