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Leading with Passion and Purpose

Dear ASHHRA Members:
The theme of this year’s conference is “Leading with Passion and Purpose.” As health care professionals, we share a special passion for our work, for our profession, and for our patients. Our responsibility as human resources experts is to lead our organizations purposefully toward their respective missions and toward the greater good of community service. The annual conference provides opportunities for us to grow and develop in this very important strategic leadership role.

I’m especially excited to tell you about our conference opening ceremony keynote speaker, Barbara Glanz. Talk about passion! Barbara brings her “Care Packages for the Workplace” to health care, showing us how we can lead with our hearts as well as our heads.

Look for more information about Barbara and our other fantastic conference speakers in the coming weeks. In the meantime, I encourage you to register now for the conference while the early bird prices are still in effect. Click here to go to the ASHHRA conference Web site.

Happy Valentine’s Day!
Regards,
Jeanene Martin
2008 ASHHRA President


Headlines

ASHHRA News
ASHHRA Advocacy Update: News From Washington, D.C.

Legal
"Bush Administration Intends to Change FMLA Regulations"
"What Employers Should Know About Compensatory Time Off"

Workforce
"Proper Nursing Staff Can Save Patient Lives and Reduce Healthcare Costs"
"Data Farming Used to Improve Nursing Capacity"
"Bordering on a Solution"
"UT Tyler Seeks to Stretch Nursing Tenures"

Compensation
"Health Workers Saying, 'Union, Yes'"

General HR
"Managing Demographic Risk"
"Ban the Bully"

Benefits
"The Aging Workforce"
"How Employers Save on Health Care: Auditing Workers"
"Adoption Benefits Find a Home in Corporate America"

Physicians
"Involve Physicians in Strategic Planning"

Management and Leadership
"Healing the Health Care Staffing Shortage"
"The New Leader's Guide to Diagnosing the Business"


ASHHRA News

ASHHRA Advocacy Update: News From Washington, D.C.

On Feb. 4, President Bush unveiled a $3.1 trillion budget that calls on Congress to continue robust spending increases for defense but proposes cuts or minimal growth for a variety of domestic programs. For health care, the budget would cut an unprecedented $182 billion from Medicare over five years, and $17 billion from the Medicaid program. Also, the proposal allows for only a 0.3 percent increase above FY 2008 funding levels for discretionary health care programs – far below the rate of inflation – as well as drastic cuts to health professions training, including reductions to allied health and nurse education programs.

Details of the FY 2009 health care budget are available at www.hhs.gov.

The next step in the budget process will be a series of hearings in both the House and Senate where members of Congress will debate the policies recommended in the budget. While most political observers believe that the budget proposal is “dead on arrival,” it will serve to highlight differences between the parties on a wide range of issues, including the deficit, tax cuts, and the cost of entitlements. Both the AHA and ASHHRA will actively oppose cuts to health care that would jeopardize our ability to care for our patients.

The following chart represents the Federal Budget Timetable:

February 4 - President Bush submits his FY 2009 budget request to Congress

February 5 - Congressional Committees begin hearings on the FY 2009 budget request

April 15 - Statutory deadline for Congress to complete its annual budget resolution

May 15 - The date after which the House may consider appropriations bills

June 27 - Informal deadline for House passage of the 12 regular appropriations bills

August 8 - Informal deadline for Senate to complete action on the 12 regular appropriations bills

September 8 - House and Senate return from summer recess with 23 days to negotiate their differences and clear all appropriations bills before the new fiscal year begins

October 1 - Beginning of new fiscal year

In other news, the Senate Health, Education, Labor & Pensions Committee is scheduled to hold a hearing today, Feb. 12, on ways to address health care workforce issues for the future. The committee expects to focus on how to address continuing shortages of allied health care professionals.

Hearings are also tentatively scheduled in both the House and Senate on the Family Medical Leave Act (FMLA), looking back on progress and problems with the law over the past 15 years.

Lastly, the Department of Labor is drafting regulations that would implement the recent expansion of the Family Medical Leave Act included in the National Defense Authorization bill. The provision requires employers to provide up to 12 weeks of FMLA leave to immediate family members (spouses, children or parents) of reservists or members of the National Guard who are called to active duty in the U.S. military. The employer must also offer up to 26 weeks of unpaid leave for employees who are providing care for family members who are wounded while serving in the U.S. military. There is no indication of when the regulations will be finalized.

To contact your regional ASHHRA Advocacy Committee representative, click here
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Legal

"Bush Administration Intends to Change FMLA Regulations"
Workforce Management (01/25/2008) Schoeff Jr., Mark

In Jan. 24, the U.S. Labor Department submitted a proposal that would reform the Family and Medical Leave Act (FMLA) to the Office of Management and Budget (OMB), which has 90 days to review the proposed reforms. Experts predict the reform proposal will be published in the Federal Register in mid-February, and the public will have 30 days to make comments before the Labor Department issues final regulations. Some of the proposed FMLA revisions would include requiring workers to provide employers with notice before taking leave, and officials also plan to revise the medical certification process. The Associated Press reported the revisions could include up to 26 weeks of leave for injured military service members. National Partnership for Women & Families President Debra Ness said, "The Bush Administration should do nothing more than...clarify the penalty for employers who do not properly designate and notify employees about FMLA leave."
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"What Employers Should Know About Compensatory Time Off"
San Francisco Chronicle (01/23/08) P. C4

Federal and state laws include a number of specific regulations governing employee compensation, and employers should keep abreast of local and federal laws. Some states allow compensatory time off (CTO), which provides an employee with time off instead of overtime pay. If an employee is exempt from overtime, they should qualify for CTO with little problem. When an employee does qualify for overtime, the use of CTO must be done properly to prevent employees from becoming exempt. In the private sector, federal regulations do not usually allow CTO. According to the Fair Labor Standards Act, employers must pay workers for all time worked and cannot give time off instead of paying them. However, employers can regulate compensation by controlling the hours in their work week. So if an employee works over 40 hours one week, they can work less than 40 the next week to make up for the additional time. On the state level, some states are stricter than others, like California. If CTO is allowed, it has to be used in place of overtime and be given at the regular rate of pay. This means an employee must get at least an hour and a half for each overtime hour worked. Before entering into this agreement, companies must work with their HR department and with employees to ensure the organization remains in compliance.
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Workforce

"Proper Nursing Staff Can Save Patient Lives and Reduce Healthcare Costs"
University of Central Florida (01/25/08) Kotala, Zenaida Gonzalez

A recent University of Central Florida (UCF) study published in the January issue of the American Journal of Nursing highlights the impact appropriate staffing levels can have on patient care, including outcome improvement. UCF associate professor Lynn Unruh says determining the best nurse-to-patient ratios for hospitals and various units improves patient care, increases staff morale, and reduces healthcare costs. Unruh says ratios can be determined by how severe patient injuries in various departments are, but standards should not be one-size-fits-all and should reflect the needs of individual hospitals' demographics. Increases in nurse staffing levels reduced negative patient outcomes, including lower death rates, pneumonia, and post-operative complications. Unruh says the study shows that as patient outcomes improve, costs for healthcare insurance firms and other payors fall. In geriatric and obstetric units, malpractice liabilities are reduced when instances of medication errors decline. The study indicates replacing a nurse can cost up to $160,000 per new hire.
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"Data Farming Used to Improve Nursing Capacity"
Healthcare IT News (01/04/08) Manos, Diana

The University of Memphis Center for Healthcare now uses data farming to help nurses handle their complex, daily workflow. Data farming uses computer simulation to play out thousands of possible hospital situations on imaginary patients, which can help nurses provide the best quality patient care with the least amount of strain on their time and resources. Data farming can help facilities determine how new purchases or changes to the hospital environment impact the facility's functions. For example, one simulation may show different ways of grouping patients together to minimize the amount of walking nurses have to do and discovering how the change impacts care quality. Dr. Joseph Ketcherside, who is senior vice president and chief medical informatics officer at Methodist Le Boneur Healthcare, points out that it is essential for hospitals make nurse's jobs as stress-free as possible because "what nurses do in a day is 10 times more complicated in terms of workflow than what anyone else does in a day." In addition to helping nurses better manage patient flow, experts say data farming also shortens patient stays, improves nurse retention, and reduces nurse-to-patient ratios. Once the Memphis Center for Healthcare completes its preliminary data farming tests, it plans to publish a report and run workshops on how the technique can improve healthcare.
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"Bordering on a Solution"
San Diego Union-Tribune (01/13/08) P. A1; Dibble, Sandra

Hospitals suffering from nurse shortages have long looked to the Philippines to find highly-skilled, English-speaking workers, but significant obstacles still prevent Mexican nurses from gaining jobs north of the border. The biggest challenge for Mexican nurses is English. Graduates from four-year nursing schools often have qualifications on par with nurses from U.S. schools, but language barriers prevent these workers from passing skill evaluation exams and using hospital equipment. "Their bedside manner, their caring for patients are some of the best I've ever seen," says Kaiser Permanente Chief Operating Officer Tony Minks. "Where they need help is with the technology that we have." California, for example, could benefit most from an influx of Mexican nurses due to its close proximity to Mexico. The state also has the lowest number of RNs per capita, with only 622 nurses per 100,000 residents compared with the national average of 787. Beyond the language barrier, there are numerous accreditation standards in Mexico that make hospitals wary of hiring those nurses. While nursing schools in the Philippines and several other countries follow training models similar to those found in the United States, Mexican nursing programs often focus on different disciplines. However, with the national nurse vacancy rate hitting about 120,000 as Baby Boomer age, hospitals will seek new sources of talent to fill those gaps.
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"UT Tyler Seeks to Stretch Nursing Tenures"
East Texas Review (02/07/08) Bell, Kelly

The University of Texas at Tyler (UTT) College of Nursing and Health Sciences carried out a study to examine the connection between job incentives and nurse retention, which was led by Professor of Nursing Jacqueline M. Braithwaite and Dr. Lynn Wieck. Through a $50,000 grant from the CHRISTUS Foundation, the university directly asked nurses what environmental elements and incentives prompted them to remain employed at one facility over another. Dr. Wieck said the survey indicated hospitals should consider offering a "menu" of incentives from which nurses can choose the ones most important to them. She also noted stress-reduction programs could impact nurse retention significantly. The top incentive among nurses surveyed at 22 hospitals across four states was "pleasant working conditions where you work with people you like and who like you." However, younger nurses placed a greater emphasis on higher salaries for weekend and holiday work, while older nurses, over age 40, thought pensions and retirement benefits were a higher priority. The survey also discovered that nurses do not prefer to be frequently moved to unfamiliar units because it increases their stress levels. With Baby Boomers set to retire in the next few years, nurse vacancies could rise as high as 800,000 by 2020.
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Compensation

"Health Workers Saying, 'Union, Yes'"
Modern Healthcare (02/04/08) Evans, Melanie

The U.S. Bureau of Labor Statistics reported a 10.4-percent jump in union representation among professional and technical healthcare workers, including registered nurses, laboratory technicians, and physician assistants, in 2007, surpassing the sector's employment growth rate of 2.7 percent. Not only has the Service Employees International Union refocused its recruitment on the healthcare industry, but nursing associations, like the California Nursers Association, also are expanding beyond their state borders to increase membership rolls. In 2007, the Labor Department estimated about 13.5 percent of professional and technical healthcare workers were unionized, and wages for these union members exceeded wages of their nonunion counterparts by 11 percent. With curbs on healthcare spending from both employers and insurance firms, hospitals are under intense pressure to limit workforce expenses, which is why experts say increases in union membership come at an inopportune time. Experts advocate the establishment of clear communication lines between medical workers and healthcare executives to build strong relationships and limit the need for union intervention. Like other employers, hospitals and medical facilities are feeling the healthcare crunch and seeking ways to reduce costs, which is why some have passed healthcare expenses onto their nurses, physicians, and support staff. However, critics urge hospitals and other facilities to move away from these strategies because they often spur unionization movements. Human resources and healthcare executives need to work with medical staff to reduce stress levels, workloads, and other elements that incite unrest among staff to improve morale and productivity.
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General HR

"Managing Demographic Risk"
Harvard Business Review (02/08) Vol. 86, No. 2, P. 119; Strack, Rainer; Baier, Jens; Fahlander, Anders

In most developed nations, the average age of the workforce is rising while Baby Boomers age and birth rates decline. As older workers approach retirement age, industries could face severe labor shortages and decreased productivity, which is why organizations need to find ways to transfer valuable knowledge onto new workers. To do this successfully, managers must first analyze the workforce supply to determine the long-term effects of the aging workforce, especially its impact on productivity. An organization determines capacity risk by evaluating expected future demand for workers and workforce levels, then estimating how difficult it would be to fill in the gap between the two. Evaluating productivity risks involves studying the implications of having older workers and breaking those figures down by location and job category. Jobs are broken down into three categories that contain a group of workers with similar skills, which can be transferred to other jobs with training. Using the taxonomy, executives will be able to visualize the size and immediacy of potential shortfalls for each job function, as well as whether it will be possible to replace retiring workers with internal candidates. This capacity risk analysis should take into account the experience and knowledge that will be lost as workers retire, and it can be used to determine how much productivity is lost for each group. Managers can then take steps to mitigate the worker shortage through training programs, additional worker recruitment, and outsourcing. Managers also may want to increase productivity through special workforce accommodations for older workers, additional training and compensation, and preventive health policies.
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"Ban the Bully"
Human Resource Executive (01/08) Felton-O'Brien, Michael

Roughly 54 million U.S. employees suffered from workplace bullying at some point, according to a recent poll by Zogby International and the Workplace Bullying Institute. In response, supporters of "Healthy Workplace" projects submitted legislation in 13 U.S. states to protect and support intimidated workers. These laws would resemble federal and state anti-discrimination laws, providing protection to all employees regardless of race, age, or gender; but victims would have to prove their health had been harmed by the incidents in question. Moreover, employees would have the option to accept workers' compensation benefits in lieu of filing suit against their employers, according to the proposed legislation. One former emergency-room secretary is pushing for the legislation in Vermont after she lost her job at a local hospital after complaining to the hospital board about a nurse manager and other supervisors' bully-like behavior. She says hospitals that allow bullying to take place are not only placing workers in danger, but patients as well. Experts, on the other hand, are urging human resources (HR) departments to devise their own anti-bullying policies to stave off workplace skirmishes and future litigation. Victims of workplace bullies often cite subsequent health problems, including depression. In one case pending in Indiana's court system, a perfusionist is suing his former hospital employer for over $325,000 in damages after being bullied by a heart surgeon. According to the Workplace Bullying Institute, bullying can go beyond verbal threats and involve work interference and humiliation.
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Benefits

"The Aging Workforce"
Hospitals & Health Networks (01/08) Runy, Lee Ann

The surge of retiring Baby Boomers will hit many industries hard, including healthcare. Hospital administrators must look beyond the recruitment of younger workers to retain older, more experienced healthcare professionals who can work beyond retirement age. According to the AARP, 69 percent of workers intend to remain on the job after the age of retirement, and hospitals that continue to recruit and retain workers over 50 say these practices bring a satisfying return-on-investment. "If you put the effort in up front, it is worth it," says Mercy Health System President and CEO Javon Bea. To retain these older workers, hospitals and medical facilities must tailor benefits and the work environment to meet various physical and emotional needs of these workers. Experts highlight the use of flex-scheduling, phased retirement, benefits packages with prescription medication and hearing aid coverage, and mentoring. Other possible incentives include the use of wellness and longevity programs, alternative roles within the organization, programs to reduce physical stress of workers, and additional training and educational opportunities.
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"How Employers Save on Health Care: Auditing Workers"
Houston Chronicle (01/12/08) Lewis, Katherine Reynolds

An increasing number of employers are auditing their employees to make sure that all insured dependents are actually eligible. Consultants estimate that up to 12 percent of enrolled dependents are ineligible, costing companies an average of $3,000 a year per dependent. An audit usually begins with a written reminder of qualification guidelines and an outline of the proof that will be required, which can include proof of marriage or confirmation that a dependent is enrolled as a full-time student. Some employers offer an amnesty period, allowing employees to remove ineligible dependents with no penalty, or assistance in purchasing transitional coverage. Audits can save companies a lot of money, such as the $1.5 million the Tribune Company will save every year after removing 850 ineligible dependents from its health insurance policy. However, employers must be careful to explain the audits, which employees sometimes see as an accusation of dishonest behavior or an attempt to reduce benefits. The removal of ineligible dependents allows companies to lower healthcare costs and reduce employee premiums. To run a fair series of audits, companies should provide an appeals process and make the consequences of an ineligible dependent clear, which could include the repayment of previous premiums and claims. Experts said that most eligibility problems are honest errors, such as not realizing that when a child drops out of college, they are no longer eligible. However, there still are some employees who attempt to take advantage of the system by adding extended family members with the same last name onto the company plan.
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"Adoption Benefits Find a Home in Corporate America"
Workforce Management (01/01/2008) Kiger, Patrick J.

A growing number of organizations are now offering adoption benefits to workers, helping them cope with the time and cost of the adoption process. A recent survey by Hewitt Associates shows 47 percent of U.S. firmss offer some kind of adoption assistance, which is up from just 12 percent in 1990. For the most part, firms offer workers financial stipends or additional paid leave, but some firms are turning to incentives or support programs for adopting parents. These benefits are not used as readily as others, which means they cost little to implement; but they are a great employee recruitment and retention tool, say experts. A recent Harris Interactive poll shows 95 percent of Americans believe employers should institute adoption benefits. Benefits can range from as little as a $500 stipend and a week of paid leave to as much as $20,960 in reimbursements and 16 weeks paid vacation. The average reimbursement is about $4,700 and five weeks paid time off, say experts. Forecasters predict adoption benefits among organizations' benefit packages will rise between 3 percent and 5 percent annually. In addition, more employers are expected to create in-house support programs. Some initiatives already in place include adoption guides and in-house forums.
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Physicians

"Involve Physicians in Strategic Planning"
Healthcare Executive (02/08) Vol. 23, No. 1, P. 64; Erwin, Duane L.; Lifton, James G.

When making major strategic decisions, hospitals and healthcare centers benefit most by involving physicians in the planning process. Aspirus, a Wisconsin-based healthcare system, set about reorganizing and streamlining its operations when a competing healthcare system moved into the area, and the healthcare system utilized about 50 physicians and dozens of community leaders throughout the planning process. Physicians were involved in discussions with CEOs, senior managers, and board members. A 2006 Aspirus human resources study of staff found the administration's "willingness to involve physicians in strategic decisions" had the greatest impact on a physician's perspective of administrators. Administrators discovered through this process that one physician cannot represent the perspectives of all physicians on key operational matters, and physicians prefer face-to-face communication to email. Additionally, administrators and physicians learned perception improvements take time to implement.
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Management and Leadership

"Healing the Health Care Staffing Shortage"
Trustee (02/08) Isgur, Benjamin

With the impending clinical knowledge shortage expected to leave over 24,000 physician and about 1 million nurse vacancies, hospital leaders and trustees must develop a workforce model to close these gaps. According to experts, the best workplace model includes training and retraining to foster workforce sustainability, the creation of public-private partnerships, the use of technology-based training, increased availability of flexible roles, and the use of performance metrics. Public-private partnerships start with discussions between hospital leaders and community stakeholders about the medical needs of the community and whether the facility can meet those needs and how. Partnerships with colleges and universities can help provide students with reimbursements and new education programs that aim to fill in staffing gaps. Technology-based training should include physician-ordering systems and other telemedicine tools to decrease medical workforce costs, promote care quality and efficiency, and improve workforce morale by reducing paperwork. Hospitals also find that flexible contracts with physicians and nurses help them recruit, but also nurses indicate competitive salaries and a culture of care improvement are important as well. With quality improvement a mainstay of the healthcare field, particularly as Medicare reimbursements dwindle, hospitals must assess staff performance in terms of patient care quality to retain the most talented workers and sustain revenue flow. Ascension Health Senior Vice President of Clinical Excellence Dr. David Pryor notes, "We have found that a stable nursing workforce with experience at the facility as well as with specific patient populations, combined with good communications with physicians, leads to high quality." Nurses are on the front lines of patient care, which makes nurse turnover a top priority for hospital reform; if nurses are satisfied, communication channels regarding patient data are not interrupted by low morale or turnover. Nurse shortages can result in operating room, scheduling problems, bed closures, and other snafus in patient care; performance metrics can illustrate how these shortages and turnovers impact patient outcomes and care quality, fostering action from healthcare leaders and trustees.
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"The New Leader's Guide to Diagnosing the Business"
Harvard Business Review (02/08) Vol. 86, No. 2, P. 63; Gottfredson, Mark; Schaubert, Steve; Saenz, Hernan

The average tenure of chief executive officers (CEOs) declined over the past decade, with almost 40 percent of CEOs who departed in 2006 having served an average of just 1.8 years. Incoming CEOs only have a few months to show they can improve operations and increase profitability and market share. To effectively approach these goals, a new executive must identify the organization's strengths and weaknesses, as well as its potential threats and opportunities. A systematic diagnostic template can give new executives an overview of the organization to guide performance-improvement efforts. One way to determine the position of an organization is to analyze costs and prices, which decline over time in almost every industry. Forming cost and price experience curves and comparing costs with those of competitors can illustrate some improvement opportunities. The position of a firm within an industry defines their options, so a new executive must assess market size, trends, share and capabilities. The profit pool is another important aspect of operations that should be studied because profits change constantly and the organization must respond to changing consumer needs. Experts note an executive in need of quick results can identify places where complexity should be reduced, which can be accompanied by faster growth and a decrease in costs. Once the diagnosis is complete, a new executive can then decide which initiatives will help the organization meet its goals.
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