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The essence of the "People Flow Continuum", as we call it, is a model of how people progress in sequential stages in their life with an organization. Though there are always going to be nuances that create exceptions, this model and its foundational principles are very sound. How an organization decides, consciously or unconsciously to work with this model can have a profound impact on the effectiveness of the human system of the organization. If approached strategically, it can be a great competitive advantage both in the human resource health of an organization as well as a stronger financial position based on better utilization of resources and the reduction of turnover and the extreme cost that accompanies it.

One could approach this model with the mindset of standing on the bank of a river with a canoe. How is your effort most effectively spent; paddling up stream against the current or paddling downstream with it? It seems almost silly to even ask this question, but how many different business practices and organizations are paddling upstream expending a tremendous amount of resources and energy, but really aren't getting anywhere tangible. Effort is mistaken for progress. The biggest mask is that there is some progress made, giving enough positive reinforcement that the person paddling puts on blinders as to what the possibilities are that could be accomplished with a little more strategic approach and better understanding of the dynamics of the river. A little positive reinforcement can be the thing that most perpetuates mediocrity. (Though a whole other conversation, that same positive reinforcement is the very thing that keeps many organizations from re-inventing themselves and becoming complacent.)

"The enemy of the 'best' is the 'good'." ---Steven Covey

All of this is very true when it comes to strategically addressing your human system. If you choose to take a bit of time, understand some basic principles that govern this system and choose to work in congruence with them, you have the ability to both save cost as well as enhance your success through the development of a superior and more effective human team.

Within this analysis and explanation, we will look briefly at the continuum itself and its components. We will also look at some of the dynamics that exist and the reasons people don't work in congruence with them more and address management recruitment in a most strategic, and therefore effective manner.

As an aside before going further: Understand that different types of positions and individuals all have different dynamics and how they are perceived, utilized, and approached within the organization. A CFO and a staff nurse may both have great value as individuals to the organization, however the dynamics that surround each in the following areas are different. Physical therapists vs. housekeepers, physicians vs. CEOs, new grads vs. experienced individuals; all have uniqueness in their dynamics. The People Flow Continuum has to be approached strategically and individualisticly!


Simply Defined: 

Recruitment is the process of the development of the group of candidates for a position from which you will have to select from.

Selection is the process or set of tools you utilize in making the decision of which candidate should be hired by the organization.

BREAK POINT: at this point, you now "own" these individuals, they are part of your organization.

Training and Development is the formal or informal process of acclimating people into your organization and helping them to develop the hard and soft skill in order to be successful both in their position and in the organization and its culture. This is both an initial and ongoing function.

Motivation is the ongoing reinforcement of an individual to be an enthusiastic and positive part of the organization. This can be multi-facetted and as with retention, can be a combination of cultural and compensation components.

Retention is the strategy or set of strategies incorporated with the intention of incentivising individuals to remain a part of your organization. These can be things such as promotions and positional advancement, the development of a positive culture that offers great intrinsic value, and/or a set of compensation mechanisms to encourage retention.


Universal Truths and Principles:

If Recruitment and Selection are done right, then Training & Development, Motivation, and Retention resources are more prudently invested with better returns. All these things, to be most effective, must be perfected in this order. Any other order is a partial or band-aide practice/approach.

You must ask yourself:

  • If you were a potter, "What kind of clay am I working with?"

  • "For whom am I spending my money and resources to train and develop?"

  • "Who am I trying to motivate?"

  • "Who am I working at retaining?"


Have you ever stopped to consider the positive implications of getting the right people in the recruitment and selection process? You would spend less time and money training and developing them (they may come with a developed skill set), they would be more self motivated, and by nature easier retained?

If you are a leader and want to spend your time leading vs. managing, find a resource that can get to know you and spends their time finding and identifying the very best clay for you to craft.



Relative to the continuum, all roles are not created equal. 

There are several distinctions to make as one evaluates the dynamics of a position relative to the People Flow Continuum:


  1. The level and type of position. First we need to make a distinction between staff and management positions. Though the continuum holds completely true for both, there are different dynamics that apply to different types of people. Addressing the People Flow Continuum relative to someone on the management/executive team is going to be very different than someone at a staff position. You go through the process many more times in a staff position. There are different recruiting dynamics that exist (see Recruiting is Marketing). If you are continually hiring staff such as nurses, development of core competencies and sophisticated selection tools makes much more sense than doing this for a Director of Laboratory Services or a Chief Financial Officer. In those cases one should focus on the recruitment of the very best pool of people to choose from. There is a change in recruitment strategy to more of a mindset that you are looking for at the executive level vs. a core skill set at the staff level.

  2. Supply and demand dynamics of the marketLike any commodity, good available talent can fluctuate in availability. Once one of the more difficult to recruit and most sought after individuals, physical therapists are now seeing a decrease in demand for their services, primarily due to reimbursement changes. The supply/demand of nurses has been a roller coaster and is back in a shortage in many places.

  3. Industry dynamics. Changes in the healthcare delivery system have seen the elimination, evolution, and creation of many roles.

    • -- Hospital CEOs have had to adapt and develop new skills as managed care and reimbursement changes have shifted their role from an internal one to a more external role. Not all have been able to make the transition. Modern Healthcare reports that CEO turnover is at a ten year high.1 (Stop and analyze the reasons and dynamics behind this)

    • -- The Director of Marketing position of ten years ago has seen the evolution to Director of Managed Care to Director of Business development. Again, not all have been able to make the skill set transitions. Just the differences in personality needs in the evolution create fallout.

    • -- Directors of Case Management, Directors of Physician Practice Management, MSO, IPA, PHO, etc. are all newer positions of great impact that have evolved.

  4. The impact of an individual to the organization. As an individual, one truly is not of more value than another, but the functional skill set that one brings to an organization can have a higher business value than another. Therefore, it makes sense to look at the incremental value differences that different individuals contribute to the financial health of the organization. In doing so, one can more strategically allocate resources along the People Flow Continuum. For example, it makes much more sense to have a retention incentive program for a good CEO versus someone on the clerical staff. Also looking at the above dynamics helps to make choices as to how much you invest at what parts of the People Flow Continuum. There reaches a point that the cost of training and development and risk of someone internally moving into a senior management role is more than the acquisition of a proven producer. Studies have also shown that the more complex a job, the higher value peak performers provide. In a healthcare setting, revenue producing departments fall into this evaluation. For example: how much impact does the nurse manager of your med/surg unity create variation to your bottom line vs. an entrepreneurial Lab Director?


The point is that each position and each part of the People Flow Continuum needs its own strategy based on multiple dynamics. 

Too often global, versus position specific strategies, are incorporated with the result being and a very hap hazard human organization. To those it seems inexplicable as to why some organizations are more effective than others are.



  • Understand the dynamics of who and what you are truly looking for.- If it is management and executive talent, then realize the cost of a recruitment and selection error.-- Therefore, be very strategic in the acquisition of this type of talent.-- This may mean that you find a scout or a professional recruitment/selection resource.-- Understand that world before you jump into it. There are as many types of recruiters as there are lawyers. (Unfortunately, some have had no better experience with one than the other)- If it is a staff position, know your rate of turnover, cost and difficulty of recruitment, then balance that with the cost of retention programs.

  • Understand that this is a circular model and is highly interactive within itself. For instance, one of your best retention tools is your recruitment program. If you train and develop people properly there is much less likelihood of frustration and turnover.

  • The higher you move up the organizational chart, the more fluid and customized your approach must be. Things become much more individualistic vs. departmentalistic and thus have to be more considerate of the group dynamics that exist at that level.

  • All of these components are facets that reflect and build a culture. Culture when positive, understood, and distinct is one of the most powerful immunizations an organization can have.

  • This model is not intended to give specific answers. It is intended to give a frame of reference, a paradigm and to create a more conscious awareness of these principles.. The strategies and specifics of each type person or position are too numerous to address in this format. Once these principles are embraced and understood, your process can not help but to improve. How much it improves will be contingent on the time you devote to it or the resources you enlist to consult with.


(c) Copyright, 1999, Donald J. Rottman, The Rottman Group, LP

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