Human Resources Consulting

Every organization wants their new hires to thrive and contribute to their high-performance teams. A commitment to structured onboarding is the key to this outcome. Organizations can set high expectations but often fail to deliver on the promises they create during recruitment – resulting in an onboarding experience that’s underwhelming.

As a complement to EnsuriseHR’s webinar session on Onboarding and the First 90 Days, we summarize how to create a structured and effective onboarding process that helps retain new hires for the long term .

Fact: Not Using Structured Onboarding is Expensive

Structured onboarding leads to more engaged employees who stick around and lowers turnover in your high-performance teams by welcoming new hires like they are the rock stars you hired them to be. Consider these statistics:

 69% of employees who have an exceptional onboarding experience are likely to stick around for at least three years and employers report it boosts retention rates by 52%

Effective onboarding helps new hires feel a whopping 18x more committed to their new employer and 30x more likely to feel overall job satisfaction

 New employees who have a good onboarding experience show 56% increase in job performance, 50% drop in turnover risk, and 75% fewer sick days in year one.

Employers offering active and effective onboarding journeys witnessed revenue growth of 2.5 times and profit growth of 1.5 times.

Unfortunately, most organizations don’t use structured onboarding so instead of thriving new hires we see 20% of employees quit within the first 45 days. Why? Well, 60% of employers haven’t set milestones or goals (something we know that high performers crave) and only 12% have a solid onboarding process, according to employees, causing new employees to leave at high numbers.

Remote workers and employees of small businesses report the most problematic experiences. Turnover can be as high as 50% in some organizations, even though replacing employees can cost the equivalent of 6-9 month’s salary. (That’s a distraction that makes a real impact on your business.

What is Structured Onboarding?

Beyond a warm welcome, new employees are anxious to learn, integrate, and achieve. Remember, they want to demonstrate their abilities and bring value to your organization as soon as possible. The solution is in your structured onboarding – you want to inform, guide, measure, and recognize your new hires from their first day.

Design your program intentionally to determine what the new employee will experience, not just on their first day, but first 30 days, first 60 days, first 90 days with your organization. Giving them milestones helps high-performers feel productive right from the start. A mutually beneficial process is going to include these five specific things:

A defined program.

You can’t just scramble at the last minute! Investing in a defined program is work that pays off by ramping up your new hires faster, reducing turnover and saving a lot of time and money. Include leaders to continue the bond that’s created during the recruiting, hiring, and pre-boarding processes. Use key performance indicators to structure the learning and make sure the support and resources to meet the expectations are available. Completing required trainings are part of early job success; this training matters.

Leaders are often key to why a candidate accepts your job so their involvement in onboarding is a critical factor accounting for up to 70% of the variance in engagement. There’s no substitute for creating a cadence of one-on-ones with a new hire, simple but structured sessions checking on what is going well, roadblocks or frustrations, and the overall learning progress. This gives the leader the information that they need to be able to better enable collaboration with colleagues and clients during this learning period.

Communicate roles and accountabilities.

The single most common reason employees cite for leaving within the first six months is lack of role clarity, so make the role deliverables and expectations as clear as possible. These four elements will help: reference the job description, provide ample access to trainings and standard operating procedures, communicate requirements and emphasize accountability, and be explicit about when new hires are expected to perform tasks with little or no supervision.

Cultural integration.

In the United States we’re really good at recognizing problems but we’re not as good at recognizing good work. A cadence of recognition and office traditions are absolutely essential in a structured onboarding program. Find ways to build community and rapport –team lunches, Zoom happy hours, gifts. Regularly acknowledging good work helps build trust, fosters a more positive and supportive relationship between managers, employees, and among colleagues, and lowers turnover rates.

Affiliation with office culture and friendships as an indicator of engagement and retention; 17% report that a friendly environment could make them stay in their current workplace, without the thought of quitting. And, 56 % of new hires said an onboarding buddy or mentor helps tremendously to clear up simple doubts or queries that might make them feel embarrassed to ask.

Moreover, organizations who connect each employee to the organization’s mission or purpose and demonstrate how the employee and the job they do is important create retention. Feeling like your job matters is an underrated aspect of performance, not only influencing brand advocacy but reduces absenteeism, improves safety and quality of work. This has important implications from both a customer standpoint (when employee fails to represent the brand in your marketplace) and from an employment perspective (when current employees are not able to advocate for the organization as a place to work.)

Purpose, brand, and culture need to be defined woven into everything. What makes your organization unique? Why is your mission, your products, your services are distinct and valuable? Make sure new employees are exposed to your brand, mission and values so they experience what you want your customers to feel.

Personalized growth.

The first day is a significant milestone. You want every new hire to go home at the end of their first day feeling like they have made a great decision joining your organization. A first day checklist ensures these high expectations are met and exceeded. The first day checklist is a good starting point.

Personalized growth plans create a roadmap for onboarding that’s tailored to the job, with day one, week one, month one, two and three plans by job. These structures keep your new hire and your supervisors on track during that crucial first 90 days.

Schedule check-in programs for pre-planned intervals, such as 30, 60, 90 days, to help monitor the employee’s experience and satisfaction at work, providing the opportunity to change course if needed. A smooth first week helps your new hire get comfortable with people, process, workflows, so have a structured schedule through the first week. Begin ramping up and getting into the flow of work in the first month, and moving into months two and three, the scope is larger but your new hire still needs support. Check-ins give you early indicators that something’s wrong when you have a chance to course correct and avoid losing a good person.

Conclusion

If your new hire is struggling, spend the time to answer questions, offer insights, and clear up confusion. The manager should take an active role in onboarding because the same content lands different for a new employee when delivered by a manager. The manager, supported by key employees, should plan to spend time reviewing the duties and responsibilities, work styles, communication preferences, role-specific trainings and attending the required meetings. Make sure they have a meet and greet with the leadership to understand the organization’s key goals and how this job fits into them.

Set new hires up for success by using a structured checklist that includes items such as HR check ins, access to tools and resources, peer meeting, insider best practices, introduction to social groups, structured meetings with cross-functional teams or external stakeholders, and establishing one-year goals. A monthly employee feedback check in really helps management assess how their onboarding program is functioning well and where it can be improved. One of the most important questions to ask is “What has surprised you during this job?” because it uncovers so many important details that really make a huge difference.

The majority of employees who leave a job within six months report that it is because they’re looking for clear job responsibilities and effective training.  The transition from candidate to employee should feel like a natural handoff that continues the momentum of the interview process. By keeping culture and mission in the forefront and investing in training and relationships you’ll create a ‘stickiness’ that you can’t build any other time in the employment relationship.

Performance evaluations should not simply be a check-the-box exercise. It’s worth the investment to create a process that is meaningful and reflective of the organization’s culture and strategic needs.  Structured performance feedback programs with goals in alignment with the annual strategic plan energizes the team. Using key organizational goals that have a natural, meaningful alignment with the core competencies create a powerful positive amplification loop.

There are three components of the performance management cycle: goal setting and planning, ongoing feedback and coaching, and appraisal and reward.  Employees are best served with a regular cadence of structured one-on-ones plus an annual review, creating a collaborative effort that builds on open communication displaying both care and candor – honest, direct, and genuinely respectful.  Less formal one-on-one meetings can work in lieu of an annual process, but providing feedback matters deeply.

As a complement to EnsuriseHR’s webinar session on Performance Feedback That Works we summarize how to approach sensitive conversations with confidence and empathy.

How, When, Where, and What

Decide who’s eligible for an annual review, build a timeline for the evaluation process and communicate that to your employees so they understand how the process will flow so that they’re neither surprised by nor waiting for a meeting.  Invest in making your review meetings effective with thoughtful preparation for this very important conversation.

Most commonly a self-evaluation, a standard supervisor-completed review, and sometimes 360° feedback on leadership skills comprise a full assessment. (Having an online performance evaluation system increases the likelihood that a 360° process will be an effective tool.)

The most effective evaluations are rooted in core competencies tied to the values and needs of the organization. In the highest-performing organizations, core competencies are defined in advance and used in hiring, evaluation, and promotion – and reflect how the organization presents itself and executes the mission. A useful annual evaluation also provides feedback on core functional skills – both general and role-specific skills.

A non-numerical, descriptive 3-tier rating system provides a helpful framework and avoids a debate around the difference in performance between a 2 and a 3. For example:

Building momentum, demonstrates growth and effort, works toward consistent improvement.

Reliably strong, consistently meets or exceeds expectations and shows dependable performance.

Exemplary achiever, consistently delivers outstanding results and sets a high standard of excellence.

Do not neglect to provide feedback on what has gone well in the performance period, help or improvement needed, and any concerns or issues to discuss. Regardless, the conversation is key. By talking first, and then providing the written evaluation after, a supervisor has the opportunity to present in person rather than leaving the employee to stew on it overnight.

10 Simple Rules for a Written Review

No surprises.  Performance feedback should never be shared for the first time in an evaluation, if it can possibly be avoided. If not, acknowledge that the issue hasn’t been raised before.  For example: “I recognize we haven’t discussed your attendance. But I feel it’s important to bring this issue to your attention now because it’s going to impact you in the new year.”

Don’t let the form get in the way. Your organization may use any number of review formats (online, pen and paper, etc.), but the key is to think deeply about what to say before diving in.  List a few positive behaviors to recognize and reinforce and a few problems or challenges to discuss, then complete your document making sure nothing is missed.

Avoid the recency error trap. Base feedback on the whole term, not just recent highlights or challenges. Don’t trust your brain to remember everything through the course of the year. Create a system to record items that need to be documented in the evaluation and review your notes, highlighting trends throughout the evaluation period and from year to year. If the message differs from previous evaluations, be ready to explain.

Avoid an evaluation that comes back to haunt you. An evaluation covers the prior performance period.  Your highest performers want to focus on the future, but it’s important to avoid predictions like, “I expect great things in 2026”, or “they have a fantastic future with the company” – which could create a sense of entitlement.

It’s okay to give an A. Focus on authentic praise and recognition, citing specific behaviors rather than general statements. Say thank you for a job well done, recognizing special achievements, ongoing contributions, and continued hard work.

But, don’t give everyone A’s. While it is possible every member of the team is amazing, it’s a leader’s job to distinguish between superior performance and overall good work.  Try ranking your staff from most to least crucial contributor. As the leader, you must help them grow. Work on customizing each evaluation with specific feedback and development plans to create a process that will benefit everyone.

It may be appropriate to add disciplinary language.  If it becomes apparent that an employee is really struggling, this might be the right time to add disciplinary language.  Introduce the disciplinary issue with something like, “In addition to documenting that your overall performance for this period does not meet company expectation, this annual evaluation will also serve as a performance improvement plan.”  Make sure to work with HR to get everything in place.

Understand how your words can be used against you and the company. Remember to adhere to labor law. The annual evaluation is given more weight in an employee compliance claim because it covers an entire year’s work, so mention disciplinary issues during the year, and record progress to make sure that you are compliant.

Do not include any discriminatory language. Just talk about the work. The evaluation may not document or reference anything that is protected by privacy laws, federal laws, or state discrimination laws. Sometimes, it’s completely inadvertent, referencing personal information or the reason for a leave of absence, which could run afoul of the Americans with Disabilities Act. No references should be made to person’s age, their ethnicity, their sexual or gender orientation, religious beliefs, medical history – or anything protected under Title VII or state worker protection laws.  These things could be used against you and the company in a court of law.

Avoid the word ‘attitude’.  It is a very subjective term and can be viewed as a difference of opinion. Instead, describe the behavior that created a negative or positive perception of the team member in the eyes of others.

The Conversation is Key

To design and support a competencies-based performance process and effective evaluation system requires time and thought.  Though feedback and performance processes may vary, there’s no substitute for providing clear, meaningful feedback to your team during the course of the year.

• Notify the reviewee at least 2 weeks in advance to leave ample time for all parties to gather and review documentation. Put the team member at ease by explaining the process.
• Schedule a private time and place to talk.
• Take care to avoid personal bias and accurately evaluate the “glows and grows” of your own supervisory performance.
• Outline or consider goals for future performance, moving the conversation from reflection to ambition. Brainstorm the solutions for areas needing improvement and build on strengths.
• Pause, ask for thoughts and feedback throughout. Create an environment that encourages two-way communication where both participants feel comfortable expressing care and candor
• If there is substantial disagreement, take a break, finalize it later. An employee who isn’t accepting feedback often has a trust issue. People like to be good at what they do and if they can find a trusted leader they listen and adjust behaviors accordingly.
• Create a set of answers to have ready in case common questions come up, like why am I not rated highest in everything? What will it take to get there? Why was I rated differently than last year?
• Excellent resource: Performance Evaluation Phrases for Core Competencies – for each competency, the book has phrases that for a reviewee who meets or exceeds expectations, or who needs improvement, plus goals for each competency.

For an organization to thrive, it needs people with both functional skills and a desire to be a part of the organization’s success. Behavior-based interviewing focuses on skills and behaviors to build the right team. The goal is to understand the candidate’s values, thoughts, feelings, and reactions to common situations – because if they match expectations, there’s an infinitely higher chance that this new hire will be part of a high performance team. As a complement to EnsuriseHR’s webinar session on Effective Recruiting & Insider Tips for Interviewing we summarize how to manage a structured, behavior-based interview process.

Effective Preparation

Effective interviewing starts long before the interview itself, and the first step is to truly understand what is needed from a role. A good position description will provide functional skills plus the qualities the organization values. Combined, these insights and skills will illuminate crucial job requirements. Don’t just repost what was used three years ago! Reflecting on what was wonderful about the last person who did the job and what didn’t work as well can help build a stronger description resulting in a better hire. While it may be tempting to use AI to generate a job description, it will still need to be thoughtfully reviewed and edited by a human who really knows the job.

Once the position description is written, highlight what matters. This is the foundation for an effective interview, uncovering core functional skills, but more importantly, the candidate’s ability to fit, thrive and add to the team’s success.

Resume Screening

Understand that a hiring manager can’t know everything about a candidate just from their resume. However, focusing on skill and will can narrow the candidates to a group that’s worth advancing in the hiring process.

Does the resume suggest stability and reliability, employers, dates of employment gaps? Look for the closest skill match, relevant experience, and qualities like ability to learn new skills, a work history that shows direction and progress, and a resume that’s thorough and well-presented. A candidate that meets many (but not all) of the functional skill requirements and has good alignment should be carefully considered. If employment dates or other details are unclear, ask for clarification in a screening interview or a pre-hire background check.

While AI can be used for these screens, it’s still recommended that it’s done by a person familiar with your organization and culture. State legislation is evolving with regard to AI employment screenings, specifically in California, Colorado, Illinois, New York City, with more pending, so if AI is used for screening, make sure that it meets the legal requirements.

Of course, the hiring manager wants the full package – but sometimes that is elusive. In these cases, it may be necessary to re-evaluate your criteria, categorizing attributes as non-negotiable versus nice-to-have, which may open up the process to additional candidates who will be great in the role.

The Interview Process

An interview process with three or more stages provides organizations with the best hiring information. Take your time – hire slow and find the right person for the position.

Stage one begins with a brief screening interview over telephone or Zoom. In 15-20 minutes, the screening staff can clarify any red flags on the resume get an initial confirmation of motivation and match. This step helps filter out the mismatched applicants so that the best possible candidates move forward.

Your applicant tracking system should have a screening checklist of required functional skills, structured questions around values, what the candidate wants in a workplace and in a manager, and finally confirming that they’re in agreement with details like the work site and base pay. The objective here is to evaluate if it makes sense for the candidate to meet the hiring manager.

Stage two is the heart of the effective hiring process – a structured interview. Research confirms that important body language cues are muted over screens, so it’s recommended to conduct interviews in person when possible. The hiring manager has two goals: to sell the candidate on the company and position (30%) and to learn about the candidate (70%).  So, don’t get lost in the conversation and make sure the candidate does most of the speaking.

Organizations that add a second level interview to the process have even higher success rates and are less likely to hire candidates who interview well, but may not be an actual match for the role. Additionally, panel interviews work really well for a structured, scripted interview process.

Sadly, this isn’t something to do casually – even the most experienced manager should use a scripted interview at the core. While it may feel awkward, it’s incredibly effective. This interview is meant to find out if they can do the job, a little about if they want to do the job you actually have, how they will fit with your company culture, and especially important, how they will get along with the team.

In stage three, reference or background checks are conducted to confirm employment information and ensure the candidate does not have any red flags that puts the organization at risk. It’s best to use a third-party vendor to do these background checks.

In stage four, the hiring manager or team evaluates the candidates and determines if they want to make an offer. Because recruiting is also marketing, we want every candidate to have an amazing experience, even if they don’t get the job. You never know how that candidate could engage with the business in the future, so it’s considerate to notify applicants who are not interviewed, and call those who were, thanking them for their time.

What is a Structured Interview?

A structured interview follows a specific, prepared strategy. The hiring manager might start with a brief introduction.

“Hello. Today’s interview may be a little different from other interviews you’ve done.  I’m going to ask a predetermined set of questions to get us started. I’m using the same questions for all of the candidates. This type of interview is called a structured interview. It may feel less conversational, but it will help me compare our candidates equally.”

After the intro, it can be helpful to ask an easy opening question to set the tone.

“Tell me what you already know about this role in the organization.”

Once the interview is opened, use the prepared questions related to skills, and move to additional behavior-based questions to evaluate motivation and fit. Ask the same questions of each candidate so that you can discuss all of the candidates in an apples-to-apples basis. Finally, answer all of the applicant’s questions, close the interview and let them know what will happen next. (Great candidates hate to be left hanging.)

Preparing Useful, Appropriate Interview Questions

Behavior-based questions that ask the candidate about what they did in an actual previous situation gives the best insight into what they will do in similar future situations. A behavior-based question is not a hypothetical. Telling stories gives much more information than close-ended questions – stories are harder to lie about, and the story will reveal both what the candidate did and how they did it.

“Tell me about a time someone didn’t comply with a procedure that impacted your ability to get things done. What was that procedure like?”

A question bank containing a balance of questions relating to achievements and challenges is a helpful tool. The best questions create parallel scenarios that help you uncover both the skill and will.  In your question bank, categorize questions for different skills, because you won’t use every question for every job search. Select ones you want to use for each position with intention.

Some interview questions, while not illegal, have so much liability potential in a discrimination lawsuit that they should be strictly avoided. These include any interview questions that are related to a candidate’s age, race, ethnicity, color, gender, sex, country of origin, birthplace, religion, disability, marital or family status or pregnancy. If a candidate offers information about their personal life, do not pursue it further or allow the interview turn into a chat session. Stick to the script and focus on questions that make good use of the interview time.

Active Listening is a Skill

After asking a question, stop talking and listen.  Don’t participate in the story (no matter how good it is) but smile, nod, lean forward, show engagement and indicate to them that the story is helpful. It may be helpful to take factual notes to support evaluation afterward. When a comment can be substituted for a question, it will feel less investigative, especially in this structured format.

Often follow up questions are needed if a story seems too good to be true or doesn’t match the rest of the answers. Ask for clarification, another example, or more detail – even  which of their references might be able to speak to the situation. If you sense extreme discomfort, the story may not be entirely accurate. For a definitive “I don’t remember,” try rephrasing the question, offer multiple choice options,  ask as a more closed-ended question, return to the question later or ask a related question. People who are comfortable will talk freely. To maintain rapport, we strongly encourage you to use positive body language to bring out the candidate’s best.

Evaluating Candidates

Remember that everything is part of the interview – from how they behave in the waiting area to how the candidate says goodbye – not just responses to interview questions. To evaluate candidates after the interview, review notes for keywords and ideas. They should be descriptive, but factual. A standard interview evaluation form to ensures consistency.

When the structured interview process is complete, you’ll be ready to make a hiring decision. The ideal candidate is the candidate who’s both willing, a great culture fit, and able, a great skills fit. The easy no is for the candidate who doesn’t have the skills and they’re not really interested in what you’re doing as an organization. We recommend you also say no to any candidate who’s able but not a match for your culture. (They rarely succeed.) But, if you have a willing, capable candidate who’s a great culture fit and you have the ability to train, these willing and not-yet-able candidates can be amazing hires.

Conclusion

While experienced hiring managers rely heavily on gut feeling, pairing it with a sensible structure generates the most helpful information. The best tool available is behavior-based interviewing, because research says that the single best predictor of a candidate’s future job performance is past job behavior. Building high-functioning teams through effective, structured interviews doesn’t just happen, it requires investing time and energy into building the process and training teams.

As a starting place, do some simple homework. Select a position, identify essential functional skills and essential culture fit skills, then write behavior-based interview questions, and practice with a partner, probing for detail and counter evidence.

Hiring right the first time, not being surprised by something expected to be great and isn’t, is worth the investment every time.

Creating and maintaining high-functioning teams requires leaders willing to try new approaches. We’re all familiar with the saying that nothing worthwhile is easy — but data shows that high-functioning teams offer organizations a higher return on their recruiting, training, and retention investments, making the effort worthwhile. Did you know that high-functioning teams have been measured to…

Achieve more with less, demonstrating enhanced productivity and efficiency.

Take risks, share ideas, and foster innovation and creativity.

Have strong collaboration skills with greater problem solving capacity.

Feel valued and empowered, leading to greater job satisfcation and employee engagement.

Inspire trust and mutual support through a postive workplace culture.

Learn from setbacks and become better equipped to handle unexpected challenges.

Build stronger customer relationships.

Author Patrick Lencioni describes a few basic team-building principles in his work, The Five Dysfunctions of a Team. While simple to understand, consistently applying these ideas takes commitment. Lencioni’s framework creates a structure with each principle building on the one before, creating a step-by-step strategy for mastering one concept before moving on to the next. Below, we summarize the key principles as a complement to EnsuriseHR’s webinar session on Building High Functioning Teams. 

Trust is Foundational

Trust is the foundation of leadership and teamwork, as anyone who has participated in an exceptional team environment knows well. While building trust takes time, the process can be greatly accelerated when these three factors are consistently present:

Competence. The team sees the leader as an expert, and one who generously spotlights the expertise and confidence of other team members.

Integrity. Leading by example, the team leader is transparent, trustworthy, and reinforces positive team behaviors.

Benevolence. The leader creates an environment where people want to be, with respectful social activities that establish emotional ties and build relationships.

Sometimes, individuals bring past negative workplace experiences to the team. These team members will need to see that the leaders and the rest of the team are trustworthy before they can believe it — and that won’t happen overnight. Make a commitment to earning their trust, then be patient. Building trust takes consistent, positive actions over time.

Constructive Conflict is Essential

Without debate, good ideas are missed and bad ideas are executed. Even a very low-conflict workplace needs to support constructive disagreement about ideas. When your team always agrees, you can be sure that they are either disengaged or holding back. Engaging in unfiltered, passionate debate around issues— not personal attacks— may be a little uncomfortable, but it’s possible to disagree without being disagreeable. Healthy conflict among team members requires trust.

Establish your organizational culture’s norms and expectations around conflict to keep fear of disagreement from deterring regular, productive debate. A skilled manager will facilitate the discussion through focused listening, finding common ground and coaching the team through the collaboration needed to achieve resolution.

Failing to build these skills causes the team to work around the leader, creating frustration between team members and unhealthy conflict. Utilize these strategies encourage healthy conflict:

1 | Recognize the natural conflict styles on your team, and reference them openly. Offer generous praise for participating in constructive discussions about ideas and taking the risk to share differing points of view.

2 | Establish common ground rules for expressing opinions in an open, honest, respectful way. Then practice using them, ecouraging and supporting your team in healthy debate about ideas. Listen carefully to the ideas and acknowledge them without judgement.

3 | Remind the team that conflict around ideas is a creativity generator! Productive conflict allows a variety of perspectives and ideas to be heard so a winning solution can come to the forefront. At it’s core, conflict is always about solving a problem.

4 | To keep the conversation constructive, ask open-ended questions that keep people engaged, and maintain calm, solution-focused behaviors. Inquire about why to really understand and guide the conversation towards common ground that most can genuinely support.

5 | Highly competitive team members care deeply, but score keeping between one another is counterproductive. Don’t be afraid to pause or parking lot sticky issues and try again to get everyone growing in the same direction.

While one of the hardest steps to actualize, once a team has some direction on how to handle conflict they are prepared to consistently achieve commitment.

Commit to an Idea

Everyone craves unanimous agreement, but this can slow the pace of work to a problematic level. Leaders coach their teams to achieve alignment, not agreement. It requires understanding a decision has been made and each member of the team is committed to implementing that decision. These are actionable strategies that allow the team, even those with dissenting opinions, to achieve commitment.

Communicate.The leader must clearly communicate the big picture goal, the rationale for the decision, and the individual deliverables needed to meet the goal.

Support. Provide the resources and support to help the team succeed, and celebrate achievements along the way specifically and authentically.

Track. Update deliverables in a structured, consistent way. Use the tools that your organization provides to ensure agendas, deadlines, action items, and follow ups are clear and understood by the whole team.

Review. As a leader who has achieved commitment, ensure that these commitments are confirmed.

Commitment & Accountability Go Hand-in-Hand

A desire to avoid interpersonal discomfort often prevents team members from holding one another accountable. On high-functioning teams, accountability occurs directly among peers while the leader demonstrates a willingness to confront difficult issues. The best opportunity for holding one another accountable occurs during regular reviews of individual and team scorecards.

Regardless of your style, find a way to ensure each person on your team knows what is expected. The work starts with establishing job duties, deliverables, and team goals — making sure that the team knows both what needs to be done and the standards for delivery. Once there is clarity in these areas, there’s a foundation for regularly discussing progress (or lack of progress). An employee-driven one-on-one creates a cadence of accountability.  The employee owns responsibility for the deliverables while the leader reconfirms strategies and deadlines. When someone misses a deadline or task, reference this agreement to discuss how to fix it.

Ensure Everyone Works Toward the Same Objectives

Goals help connect daily tasks to the larger organizational strategy. When the team understands the purpose of their work and has a say in setting the goals, they become more engaged, motivated, and invested. The desire for individual credit erodes the focus on collective success, so the leader must focus on what the team is trying to achieve, rather than any members’ personal interest.

Keeping score creates structural tension — the gap between where you are and where you want to be – and it’s a known motivator for high-functioning teams. Establish a scoreboard that makes progress visible, fosters accountability, offers benchmarks for improvement, and enables celebration of the achievements.

If leaders are going to invest in developing high-performance teams, they need to exercise some important skills that make winning more unachievable. Applying Lencioni’s strategies will guide your organization in unlocking precisely the sort of  leadership that gives birth to high-functioning teams.

During COVID, patients and healthcare providers were forced to opt for virtual care, even if it wasn’t their preference. Since then, the virtual care model isn’t limited to urgent care; it has really expanded to find it’s place in a wide swath of  healthcare specialties. Now with five years of practical experience, research confirms the effectiveness of this new practice.

Though favored by many patients, telemedicine is nevertheless an underused modality. With the potential to transform modern healthcare, understanding the benefits of telemedicine – why it’s important and how it’s affecting patient experience – is a critical issue for employers and benefits administrators to grapple with this year.

Data Reveals a Harsh Truth

Calculating transportation time and waiting for in-person visits adds up to significant lost productivity and lost wages, which affects both employees and employers. In one study, telehealth visits saved patients an average four hours saved – per visit.  Another study documented 11,000 cancer patients that collectively saved 30,000 hours and 3.8 million miles in 14 months. These are big numbers.

Consider also the costs of vehicle wear and tear, risk of car accidents, exposure to contagious illnesses, and greenhouse gas emissions, which are all reduced when patients take advantage of telehealth options.

In terms of saving money on the care itself, findings universally demonstrate that access to virtual care lowers the overall costs. One study reported that visits with 24-7 copayment-free telemedicine programs were 23% less expensive than in-person visits for the same conditions. As an employer with claims utilization metrics affecting renewal increases, this is not insignificant. Redirecting care from emergency rooms and urgent care centers to telehealth saves between $309 and $1,500 per visit, but cost savings are there for routine visits as well.

Between social impact, premium cost increases, worker productivity and the very real cost of care, telemedicine has economic effects that are getting noticed. In fact, telehealth is seen as an essential healthcare option by employees. For employers to be competitive in their recruiting and retention strategies, they need to have virtual care options included in their benefits package.

But, How Does It Work?

While there are many telehealth vendors, CloseKnit Health is a completely virtual (also known as virtual first care, or V1C) provider practice that has been part of the CareFirst benefit plan since 2021. Care through CloseKnit is available to every CareFirst member (not an add on) and a free CloseKnit smartphone app helps make the services easily accessible when and where it’s needed.

All the services of an in-person provider practice are available with virtual care, including appointments, referrals, doctor’s notes and prescriptions. Indeed, in-person care is always available to Carefirst members even if they’ve chosen to try CloseKnit virtual care.

CloseKnit benefits are completely virtual and in-network. Wherever you are – at home or away – patients are paired with providers that can write prescriptions in the state where they are located. And, urgent mental and physical care will always be addressed by in-network providers, regardless of the member’s specific medical plan.

While some employers may be just a little intimidated with trying a new tech-based service, the oldest Closeknit patient in 2024 was 94 years old! This speaks volumes about the accessibility and ease of use.

Available When & Where You Need It

Virtual care services are available to help patients manage their healthcare in every capacity – from urgent, one-time needs to coordinated routine care and management of chronic conditions.

Urgent Care | Often, urgent care is the first time a patient experiences virtual care. It may happen during a holiday, weekend, or vacation where the patient’s providers are not available to help address a medical concern.  Serving patients as young as 2 years old, CloseKnit urgent care is available every day and at all hours for 24/7/265 accessibility. The goal is to get the patient triaged, treated, and moving on with feeling better as quickly as possible – it takes roughly 10 minutes to be connected with an urgent care provider.

Primary Care | For more routine medical attention, CloseKnit primary care is provided to members 18+ through a dedicated practitioner chosen by the patient, with appointments scheduled within a few days anywhere in the U.S. and at any time – so as to be convenient for unconventional schedules and locations. Bluetooth-enabled kits help providers remotely administer preventive care assessments and monitor chronic conditions, and a chat feature lets patients text with their care team to ask for prescription refills or follow up questions. The chat plus urgent care through Closeknit does an amazing job at helping to keep patients out of the emergency room (unless it’s for a true emergency.)

Mental Health | When patients aren’t sure how to get started with mental health therapy, an optional survey is available to help orient them. First appointments may take three-to-four-days to schedule. After the initial consultation, a treatment plan will be set with regular appointments for the appropriate duration.

Short-term therapy based on Cognitive Behavioral Therapy (CBT) typically lasts for 8-12 weeks. CloseKnit patients who completed short-term therapy have reported seeing their anxiety decrease by 63%, depression down by 61%, and stress down by 49%.

Long-term therapy can go for as long as the patient and therapist deem necessary to address complex mental health issues like ADHD, trauma, or substance abuse. A psychiatrist would join the care team if any type of medication management is needed.

And More | After choosing a primary care provider, a nurse practitioner and other CloseKnit providers will coordinate to ensure that everything is working the way it should behind the scenes for your medical wellness, mental health care and coordinating prescriptions. Additionally, parents can schedule appointments with a lactation consultant, a doula, a nurse, or a prenatal therapist. Behavioral therapy and urgent care are available for children, and nutrition services help provide evidence-based guidance for members ages five and above.

Conclusion

We know that the average number of Closeknit primary care visits is 6 per year, with additional support through the chat, and we can see that the utilization and coordination of care has been at its highest levels in 2024. With new reporting coming out next year, we’re interested to see how the data matures shows how virtual first care is impacts healthcare at large.

Despite being underused, virtual care is extremely valuable. The patient/provider relationships that can come about when you remove the barriers to accessing care help are essential to building a healthier workforce.

Ultimately, at every level of the healthcare supply chain – insurance carriers, benefits brokers, providers, employers, and end-users – we all need to be creative about ways to contain costs while still supporting health and wellness.  So, how can a health insurance carrier provide you with solutions that bring competent and quality healthcare to your employees?

Rising Costs

Employers and employees alike rank health-related benefits as the most important offered – more than paid leave, financial incentives, and retirement planning – and this value is shown in a positive ROI. In 2022, employer sponsored insurance (ESI) drove $275.6 billion in improved productivity, $101 billion reduction in direct medical costs, and $119.2 billion in tax benefits. Additionally, post-pandemic changes to health-related employee benefits include adding valuable services like telemedicine (93% of surveyed organizations) and mental healthcare (91%).

Healthcare costs have outpaced rates of inflation for decades, and we’re expecting this growth to continue, ultimately totaling nearly 20% of the U.S. economy by 2029. Data from the Centers for Medicare and Medicaid Services (CMS) indicate an increase in health spending tripled between 2000 and 2022 to $4.5 trillion. While multiple factors contribute to this growth, often cited are an aging population, labor pressure, and new high-cost prescription drugs.

In fact, we can see the cost of care increases reflected in the rising insurance costs over time with the average per-employee cost reaching a record high in 2023. Developments in the pharmaceutical market are apparent, with the pharmacy benefit cited as the fastest growing component of plan cost. Large employers have been mitigating these increases by increasing deductibles and out-of-pocket maximums, but this trend is difficult for the mid-size businesses to manage, as they’re subject to certain regulations but tend to have less ability to allocate additional resources to their employee benefits package.

What is Max Performance Plus?

Carefirst launched Max Performance Plus on June 1, 2024 as an add-on to a fully insured benefit that allows employers to receive a surplus of net-billed premium not used over the plan year. It’s essentially a funding mechanism that allows you to take a fully-insured product and adds the potential to receive 100% of the surplus, up to 15% of the net premium, at the end of the contract period.

The Max Performance Plus program carries a higher risk premium charge (a.k.a. retention item) and can be sold with any fully-insured Carefirst medical or prescription drug plan. It’s not a separate plan, it’s an add-on to the Carefirst fully-insured product portfolio. While you cannot cancel mid year, you can opt to remove the Max Performance Plus product at renewal and still continue with your fully-insured plan.

In contrast to a self-insured product, Max Performance Plus takes your current fully-insured product and adds a performance element. Many groups want to know how they are performing as a group. By adding Max Performance Plus, employers get the reporting function for more information about performance, while getting surplus back as a payment.

Remember, with a self-insured plan, the employer pays claims beyond what insurance will cover, up to a pre-set amount. Performance reporting allows groups to track that claim activity. Mid-size groups 50-150 employees are often not able to take full advantage of all of the self-insured product’s benefits, and these plans calculates surplus potential as a percentage of an administrative credit.

Surplus Payment

It typically takes 60-110 days to finish paying claims after the end of the plan year. At that point your surplus payment is given as a check or electronic funds transfer – not just a premium credit. Groups are eligible to receive their surplus payments as long as they remain in a fully-insured product with Carefirst and have paid in full – even if they decide not to renew the Max Performance Plus program. Deficits do not affect the surplus payment, nor do they carry forward.

Reporting

Groups of 51-99 employees using this program will have access to monthly reporting features they wouldn’t otherwise have on a fully-insured plan; Executive Summary and Account Experience Reports are easily access via the employer portal under Account Insights. Larger groups, which previously had access to reporting, will also see additional performance data around demographics, cost analysis, utilization, site of care, high-cost claimants and pharmacy use. The reporting data gives employers information that can help inform and educate employees about more cost-effective healthcare choices, such as the value of in-network providers and avoiding expensive ER visits for urgent care needs.