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ASHHRA 2007 Annual Report

Dear ASHHRA Members:

As a member of ASHHRA leadership, I am passionate about practicing what we preach - modeling the HR Leader competencies, making impactful strategic decisions that lead us further into the transformation of the health care profession, and providing you with essential and current materials and resources. As an ASHHRA member, I want the best value for my membership dollar, as you do. This past year, ASHHRA made incredible strides to increase the member/value ratio by providing more resources and learning opportunities, and laying the groundwork for new programs. In the spirit of transparency, I am proud to invite you to review the ASHHRA 2007 Annual Report (click here).

The Annual Report represents true organizational excellence. It embodies successful implementation of a mission-focused strategy. Foremost, the report reflects leadership that listens to its members and responds with a purposeful plan of action.

In response to member needs voiced in 2007, ASHHRA introduces two new programs this year: the Leader Institute, and the ASHHRA Mentoring Program. The Leader Institute responds to the needs of health care HR executives who want more strategically-centered learning and knowledge sharing opportunities. The ASHHRA Mentoring Program responds to two specific member groups: those who want to grow professionally by reaching out to seasoned professionals, and those who want to strengthen their leadership skills by guiding and coaching up-and-coming health care HR leaders. You can look forward to hearing more about these wonderful opportunities in the weeks and months ahead.

Please feel free to send feedback to me after you have reviewed the report. This is your organization. We want to respond to your professional needs.

Regards,
Jeanene Martin, M.Ed., MPH, SPHR
2008 ASHHRA President


Headlines

ASHHRA News
Studer Group Study Needs Your Help with Work/Life
ASHHRA Advocacy Update: News from Washington, D.C.
Now Available: ASHHRA Semi-Annual Labor Activity Report

Legal
"Didn't Approve That OT? Tough."
"Employment Aptitude Tests Draw Ire"

Workforce
"Case Closed. Now What?"
"Just the Rx for Ailing Unions"
"Nursing--By the Numbers"
"Power to the People"

Compensation
"You Get What You Pay For"

General HR
"Talent Management for the Twenty-First Century"
"Right on Schedule"

Benefits
"Be a Second-Time Buyer the First Time!"
"The Dangers of Disability"

Physicians
"Employment Reemerges As Strategy to Align Incentives"
"Acquiring and Managing Physician Groups"
"Shortage of Surgeons Pinches U.S. Hospitals"

Management and Leadership
"Leadership, Culture and Medication Safety"
"Vision Plan"
"When Participative Management Leads to Garbled Communication"
"Talent Talk"


ASHHRA News

Studer Group Study Needs Your Help with Work/Life

ASHHRA urges you to encourage your female employees to participate in a groundbreaking Studer Group study regarding work/life balance for women employed in health care.

The two-fold goal of this groundbreaking study is, first, to better understand how women employed in health care can achieve a stronger balance between home and work, relieve their stress load and enhance their quality of life. Second, this study will help health care employers determine necessary actions that they can take to attract and retain female workers through an enhanced work environment which, ultimately, produces improved patient care.

The survey was launched March 1 and will be available online through March 31. It takes about 15-20 minutes to complete.

To participate in the study, women should use the following online link: www.studergroup.com/womensstudy. Below* is a sample e-mail message that you may send to your female employees encouraging them to participate.

The broader the participation, the better the results. The results of the survey will be shared across the industry and, most importantly, with you.

Many thanks in advance for your help in making this study one that can significantly impact the improvement of work/life balance among your female health care workers.

Studer Group is an outcomes based health care consulting firm devoted to teaching evidence-based tools and processes that organizations can immediately use to create and sustain outcomes in service and operational excellence.

*SAMPLE E-MAIL TO SEND TO FEMALE EMPLOYEES
I am writing to encourage you to participate in a groundbreaking study regarding work/life balance for women employed in health care. This survey will take 15-20 minutes. Your response will be anonymous, but it will be very important in providing us data to better understand what actions we can take to help you achieve a stronger balance between home and work, relieve your stress load and enhance your quality of life. (Name of your organization) cares about your personal and professional well-being and looks forward to more fully understanding how we can better serve those needs.

To take the survey, go to http://www.studergroup.com/womensstudy. The survey is open from March 1 through March 31.

Many thanks in advance for your participation in this significant Studer Group survey. We look forward to sharing the results with you and continuing to make (name of your organization) a better place to work.
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ASHHRA Advocacy Update: News from Washington, D.C.

House Panel Approves Fiscal Year 2009 Federal Budget.
The fiscal year (FY 2009) federal budget takes center stage in Congress this month. Both the House and Senate Budget Committees began consideration of their respective blueprints for spending and revenues which would cover a five-year period. On March 5, the House Budget Committee unveiled a $3.06 trillion spending and revenue plan covering 5 years, and after an all-day session, approved their version of a budget plan on a straight party-line vote of 22-16. As we go to press, the Senate Budget Committee is working on their budget resolution.

For health care providers, the House Budget Committee’s proposal is good news. The Committee measure rejects Medicare cuts to hospitals; however, language in the committee-passed resolution leaves the door open to reconsider Medicare reductions later in the process.

In addition to rejecting Medicare cuts to hospitals, the House budget plan assumes increases in domestic discretionary funding, including boosts to programs that prepare the health care workforce. Details of the House Budget Committee plan can be found at http://budget.house.gov.

Employee Verification
Legislation (H.R. 5515) that would create a new mandatory national employee verification process for U.S. citizens and immigrants was introduced on Feb. 28. The proposed legislation would create a paperless Electronic Employment Verification System (EEVS) that would replace E-Verify, the federal employment verification system run by the Department of Homeland Security (DHS) that expires at the end of this year. According to its sponsors, Reps. Sam Johnson (R-TX), Ron Lewis (R-KY), Keith Brady (R-TX) and Paul Ryan (R-WI), the proposal is designed to allow employers to confirm that their new hires are legally eligible to work in the U.S. The bill has been referred to the House Ways and Means Committee.

In related news, some House members are seeking expedited consideration of a competing Employee Verification measure, H.R. 4088, introduced by Rep. Heath Shuler (D-NC) and cosponsored by 139 of his colleagues. The “Secure America through Verification and Enforcement Act” would require all employers to verify that all employees, both prospective and those already hired, are legally entitled to be employed in the U.S. by confirming their identities through the DHS E-Verify program.

Both H.R. 5515 and H.R. 4088 are designed to discourage employers from hiring illegal immigrants. Further information on H.R. 5515 may be found at www.shuler.house.gov. Details on H.R. 4088 can be found at www.samjohnson.house.gov.

To contact your regional ASHHRA Advocacy Committee representative, click here
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Now Available: ASHHRA Semi-Annual Labor Activity Report

The ASHHRA 30th Semi-Annual Labor Activity Report, produced in partnership with IRI Consultants, is available now online. As a valuable member resource, the report provides you with important and timely information about labor activity in the health care industry.

You can access the report on the ASHHRA Web site: click here. You will need your member login information. Return to Headlines


Legal

"Didn't Approve That OT? Tough."
National Law Journal (02/25/08) Baldas, Tresa

The U.S. Court of Appeals ruled in Chao vs. Gotham Registry Inc. that employers must pay an employee's overtime even if the employee did not get approval for it. The ruling is expected to impact a large number of wage-and-hour cases still pending. As a result, management-side law firms are advising companies to closely monitor and enforce overtime restrictions. The ruling will be particularly difficult for staffing agencies that have no way to control or monitor employee hours. Attorneys argue the ruling should have required the hospitals approving the overtime to pay for it rather than Gotham Registry Inc., the nurse staffing agency. Other firms are urged to enforce any overtime restrictions they may have in place before overtime is taken. Employment practices attorneys note the ruling is not about pay, but the ability of managers to recognize what overtime is approved and what is not before workers engage in overtime duties. If workers obtain overtime without approval, employers have the right to issue warnings for policy violations, deny them additional shifts or hours, and terminate workers if overtime issues continue. However, the ruling indicates denial of overtime payments is not a lawful remedy, say attorneys. Employers indicate managers should be aware of the correct disciplinary actions at their disposal for overtime policy violations.
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"Employment Aptitude Tests Draw Ire"
National Law Journal (02/18/08) Baldas, Tresa

The U.S. Equal Employment Opportunity Commission (EEOC) warns the growing use of aptitude tests in the workplace will lead to more cases of discrimination and ultimately, more lawsuits. When used properly, aptitude tests can determine a potential hire's ability to perform math, reading, and writing skills requisite for a position, but plaintiffs in class-action lawsuits argue these tests often work against minorities. Ford Motor Co. is one of several companies that has paid millions of dollars in court settlements as a result of such lawsuits, and EEOC legal counselor Reed Russell says greater use of tests will lead to greater abuse. "If more and more employers are using tests and more and more employees are taking these tests, the likelihood of charges being filed and/or lawsuits being filed challenging these tests is going to go up," claims Russell. Human rights lawyers believe aptitude tests are unlawful under the Americans With Disabilities Act (ADEA) because they can expose mental illnesses or disabilities in job candidates. Employers are more supportive of aptitude testing, in moderation. Vanessa Griffith, an attorney with Houston-based Vinson & Elkins, says many companies are experiencing a "growing dissatisfaction" with current acceptable hiring practices that tend to leave employers in the dark about a job candidate's abilities and past experiences.
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Workforce

"Case Closed. Now What?"
HR Magazine (02/08) Vol. 53, No. 2, P. 69; Agnvall, Elizabeth

When a workplace investigation ends in termination, reassignment, or a lawsuit, HR and others should attempt to restore harmony to the workplace. However, a majority of employee complaints do not culminate in severe adverse actions against workers and do not have clear outcomes. Without clear outcomes, experts say investigations can result in rumors, bitterness, and anger against an accused party. The first step in smoothing over workplace unrest is to communicate the results of the investigation without violating the confidentiality for the parties involved in the complaint. Witnesses in the investigation should be thanked for their participation and alerted that a resolution was reached; offering explanations of the issues raised in the complaint can be helpful as well. HR and managers should consider a group meeting to discuss the resolution of the investigation, though without disclosing specifics. Some investigations can require additional staff training about diversity, sexual harassment, fairness, or sensitivity. HR also must remind the accused that the accuser had a right to complain, and any actions against the accuser could be construed as unlawful retaliation. On the flip side, the accused cannot be continually punished by co-workers, though the accused must understand they are being provided with a second chance to prove themselves. Overall, experts note investigations can help HR departments and executives examine complaint processes to ensure employees have a fair and open process.
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"Just the Rx for Ailing Unions"
Futurescan: Healthcare Trends and Implications 2007-2012 (02/01/08) P. 39; Manheim, Jarol B.

The Employee Free Choice Act of 2007, which is likely to come before Congress again, would allow unions to request neutrality from employers while the union garners signatures from workers who support the union. If the union garners 50 percent of the workforce's signatures, the employer would have to recognize the union without an election. Currently, labor unions must undergo a secret-ballot process overseen by the National Labor Relations Board, and upon winning a majority of votes become the representative of the workers. Employers are opposed to the "card-check" process proposed by the Employee Free Choice Act, while union leaders claim it is fairer to workers. In recent years, unions have lost membership, accounting for only 7 percent of all private-sector workers in the last few years. To bolster membership rolls, unions are engaging hospital workers in the union debate. Campaigns to unionize hospitals target not only hospital workplace issues, but also the hospital's ability to remain funded, meet tax-exemption status requirements, adhere to quality care standards, cover uninsured patients, and broader issues facing the financially strapped healthcare industry. Seventy-nine percent of Futurescan 2008 respondents believe unions will exploit their hospital's vulnerabilities. Tactics often employed by unions against hospitals include white papers attacking hospitals for discrimination in billing practices, calling board members, warning patients about sanitary problems at facilities, and flooding emergency rooms with indigent patients. Hospitals find it best to work with unions through a political or economic alliance, though some opt to fight off the allegations raised by unions' campaigns. Managers and executives can limit the impact of union activities by educating personnel about union tactics, highlighting improvements within the hospital that address union concerns, and adopting the union's perspective to reassess the organization and its community and workplace relationships.
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"Nursing--By the Numbers"
Business and Economic Review (Quarter 1, 2008) Vol. 54, No. 2, P. 22; Tyrell, Mary D.; Hewlett, Peggy O.

Hospitals, which rely heavily on nurses, will face not only staffing issues but also quality care issues as experienced workers in the Baby Boom generation prepare for retirement. In many parts of the country, hospitals, physician practices, nursing homes, and other facilities that accommodate large volumes of patients employ the largest numbers of RNs. One way to bring new workers into these settings is by raising compensation, say experts. Although on average RNs consume the largest percentage of hospital staffing expenditures nationwide and additional staffing and compensation would not be insignificant, the improvements to quality care would outweigh the costs of injury, disability, and death that occur with staffing shortages. National trends seem to indicate human resource (HR) administrators are in a bind and may not be as choosy about a job candidate's educational background as in previous years. One statistic cited by experts says the number of nurses holding an associate's degree or higher dropped from 34.3 percent in 2000 to 33.7 percent in 2004, with many new hires now coming in from overseas. States are addressing the staffing and care issues through legislation. South Carolina's Critical Needs Nursing Initiative Act of 2007, for instance, calls for higher nursing faculty salaries, the opening of new faculty positions, and stipends for nurses seeking graduate degrees. Healthcare administrators in the state believe increases in the number of nursing faculty will lead to higher student enrollment for baccalaureate and advanced degree programs, and within a few years, South Carolina's hospitals can enjoy larger, well-trained nursing staffs.
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"Power to the People"
Incentive Magazine (02/08) Vol. 182, P. 34; Barker, Julie

Creating a culture of employee empowerment is vital to increasing service quality and reducing employee turnover. One of the benefits of empowerment is that it motivates employees to do better, more meaningful work because management trusts them to make good decisions. The Ritz-Carlton, a large hotel chain, has a long-standing reputation of offering outstanding service to hotel guests. To create and maintain a culture of empowerment, Ritz-Carlton trains each employee every day with a 15-minute meeting at the beginning of a shift to reinforce the company's 12 service values. Statistics show this new training program reduced employee turnover from 50 percent to around 20 percent, and customer engagement has risen as well. Qualcomm takes a different approach to employee empowerment by allowing workers to design their own job descriptions to illustrate their growth and new-found skills. The company offers over 500 courses and 500 online programs to teach employees skills they may need to solve problems, and these program offer them the freedom to choose what they will learn. Qualcomm also emails one story per week illustrating the corporate culture at the firm to new workers, which can include a successful product launch or the reasons behind a failed initiative. Park Ridge Hospital in Hendersonville, N.C., has a program that gives every employee the power to handle complaints. To deal with unhappy customers, employees are allowed to hand out gift cards, with values based upon an assessment of the customer's emotional state.
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Compensation

"You Get What You Pay For"
Workforce (02/01/08) Kujawa, Patty

Denver-based Three Value Logic Sales and Dallas-based Affiliated Computer Services Inc. (ACS) are two of many companies now using goal-based compensation to cull optimum performance from employees. Activity-based pay scales require employees to meet certain performance goals to receive financial rewards. "Not only do we get what we're paying for, but we get better results," says Three Value Founder and CEO Townsend Wardlaw. Tom Blodgett, head of ACS' Business Process Solutions Group, gives each employee four or five key, clearly-defined objectives by which s/he can measure their progress on a daily basis. Wardlaw and Townsend find these metrics save money and produce high-quality work. Conversely, both executives say under-performing employees are quicker to notice when they come up short and will often leave their positions before being asked to leave. While poorly designed performance goals might encourage shoddy work, ACS has seen work quality increase from 92 percent to 97 percent; productivity also rose by 30 percent.
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General HR

"Talent Management for the Twenty-First Century"
Harvard Business Review (03/08) Vol. 86, No. 3, P. 74; Cappelli, Peter

Most organizations fail to sufficiently anticipate labor needs and rely upon strategies that hire outside workers. Talent management used to rely upon internal development, offering executive coaching, job rotation, and programs to foster leadership among current workers. Beginning in the 1950s, smaller firms enticed workers away from larger firms after only a few years to reduce their own training expenses. Now, talent management programs resemble supply chains in that inventories of workers are no longer kept on the sidelines because it is too costly and because firms run the risk of losing talented workers to competitors. Organizations now rely upon just-in-time strategies to manage their talent pools, estimating the number of workers the firm will need ahead of time. While developing talent internally is preferrable, supplementing candidate pools with outside hires can fill in gaps if worker needs are greater than estimated. Forecasting talent needs of the future is difficult, but HR personnel and executives should aim to develop fewer workers than they project and use outside hiring strategies to fill any talent gaps. New hires should be taken on in smaller groups to ensure the talent pool is not solely new graduates, who will require additional training. Initial training programs also should provide new hires with general competencies, making them viable for a variety of positions that could become available; once positions open, candidates can be provided on-the-job or job-specific training. While federal laws prevent firms from charging workers for training courses tied to their current positions, firms should feel free to seek contributions from workers engaged in developmental programs that aim to catapult them into new positions. Other firms will ask employees to sign contracts tied to development programs, requiring workers to stay at the firm for a specified period as a condition of their participation in the training program. To bolster retention, 80 percent of firms, surveyed by Taleo, utilize internal job boards to make it easier for workers to apply for open positions within the firm. Offering employees constant opportunities to take a different role in the organization is a good way to keep talented workers from leaving for another company.
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"Right on Schedule"
Incentive Magazine (02/08) Vol. 182, P. 38; Palmer, Alex

Hospitals use online scheduling programs so nurses can choose their own schedules, and they offer rewards to improve morale and ensure all shifts are fully covered. For example, Arizona's Sun Health Boswell Hospital turned to an online program to overcome scheduling problems because nurse managers spent up to 15 hours filling a schedule, calling nurses to take open shifts and convincing nurses in other units to fill in coverage gaps. According to hospital officials, the program has more than paid for itself, allowing workers to bid for overtime shifts, which are provided to workers accepting the least amount of pay. However, many hospitals chose not to implement the bidding system because they do not consider it professional and do not want to create a competitive atmosphere. Some scheduling programs will offer points for those nurses taking on additional shifts or signing up for scheduled shifts early, and those points can be redeemed for gift cards, free hotel stays and other incentives. Nurses and hospital officials say these programs allow hospitals to fill in scheduling gaps without hunting down a staffing firm. Spartanburg Regional Medical Center estimates it saved around $2.5 million with online scheduling in the first 12 months, and experts note the accompanying rewards program helps bolster staff morale and reduce turnover rates.
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Benefits

"Be a Second-Time Buyer the First Time!"
CDHC Solutions (02/08) Vol. 4, No. 2, P. 25; Harward, Scott

Employers interested in setting up health savings accounts (HSAs) for workers must first select a high-deductible health plan (HDHP). First-time buyers of HSA components will ask questions about insurance broker referrals, bank interest rates, and what services are offered by banks participating in HSAs. Experts suggest employers also determine where the best HDHP plans are, what the best design components for an HSA are, and how HSA or flexible spending accounts do not mesh with their HDHP selections, as well as what ERISA issues can arise as the result of these health insurance programs. Questions experts think employers should ask include how to educate workers about how much, when, and how to contribute to the HAS; how employees should evaluate HSAs in comparison to other options; what their tax reporting obligations are, and how to track their qualified and non-qualified expenses. While some employers fund these HSAs upfront for workers, experts say periodical contributions eliminates the loss of funds should a worker leave before the year is over and their funds are gone. Employers offering periodic contributions will want to select technology to aid them in tracking the payments and deposits into the HSA. Employers will want to select custodial banks of HSAs that offer not only traditional account services, but also HSA management tools and a call center employees can rely upon to answer their questions. Experts also suggest employers seek out custodial banks that are independent of their insurance program because should the need arise to change insurance carriers, employers will not run the risk of shifting HSA ownership to workers.
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"The Dangers of Disability"
Human Resource Executive (02/08) Vol. 22, No. 2, P. 42; Starner, Tom

As the Baby Boomers grow older, the number of employees who have medical problems that require short- or long-term disability claims are on the rise. It is estimated that $7.5 billion in disability claims were paid in 2006, and the number of recipients of Social Security Disability Income rose 51 percent over the past decade. Although employees generally pay for disability coverage, companies are still losing productivity. Employers need to take steps to help their employees get back to work sooner or find ways workers can avoid disability leave. The best way to do this is to be flexible with employees who are suffering from injuries. Allowing them to telecommute or have altered schedules can prevent an employee from filing a disability claim. Some employees may be unable to fulfill their original job description, but may be able to handle alternate duties or assignments. The duration of many disability claims is lengthened by psychological problems related to serious medical problems, such as diabetes or cancer. Employee assistance programs (EAPs) can help prevent these mental health problems, including depression, and keep employees from taking a long-term disability leave. One study found that the average disability claim for employees who used EAP services was almost 20 days shorter than those who did not. Employees who suffer major medical problems generally want to return to work, and EAP services can help them reach that goal before they develop any clinical problems.
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Physicians

"Employment Reemerges As Strategy to Align Incentives"
Futurescan: Healthcare Trends and Implications 2007-2012 (02/01/08) P. 30; Kaufman, Nathan S.

Physician-hospital relations is one of the biggest issues facing hospital leadership because of physician shortages, poor reimbursement levels, and work-life balance desires of doctors. By 2020, the industry could have about 130,000 vacancies for specialist positions and 60,000 for primary care physicians. In spite of the physician shortage, however, reimbursement rates continue to fall or remain flat, despite hikes in inflation and increases in demand for medical services. Inpatient care reimbursements have fallen, making it less lucrative for physicians with practices to offer their services to hospitals; As a result, hospitals are turning to an inpatient labor force--hospitalists, intensivists, traumatologists, and laborists. Increasingly, practicing physicians are opening outpatient service centers in competition with hospitals, creating joint ventures to provide inpatient services, or demanding reimbursement for services, like emergency department on-call, that were often offered voluntarily. These strategies are siphoning more money away from hospitals, and with up to 3 percent caps on reimbursement rate increases from Medicare and Medicaid, that leaves little to fund hospital operations. One of the most feasible solutions to the problem for hospital leaders it to directly employ physicians because it does not require additional overhead like a joint venture would and it can align physician compensation with hospital needs. However, experts caution there is no one-size-fits-all approach to mending these relationships, but a core infrastructure to set forth the quality and productivity goals of the hospital with the work of physicians can help ensure proper compensation, patient satisfaction, and minimal confusion. Once physicians are employed, hospitals should pilot-test new delivery methods, allowing physicians to access hospital records from their office and ensure physicians have an access to the hospital board and CEO.
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"Acquiring and Managing Physician Groups"
Healthcare Executive (02/08) Vol. 23, No. 1, P. 16; Fabrizio, Nick

Smaller physician practices that partner with larger medical facilities can bring in more revenue, increase bargaining power for lucrative contracts, and attract more physicians. To avoid the pitfalls that come with purchasing a practice, a healthcare organization should decide whether the practice fits into the organizational model for care and whether the resources are available for acquisition. Additionally, organizations should consider physician retention rates and leadership because pre-existing problems will be carried into the hospital-practice relationship. Physicians at the smaller facility must be involved in the acquisition process, allowed to offer their concerns, and explore the positive and negative repercussions of the partnership. If the relationship looks promising and both administrators and physicians are willing to endure a merger, they should proceed with a formal structure that works best within the desired healthcare model. The four main options are direct employment by the hospital, where the group practice is closely tied to the system; an affiliated group-equity model that allows a practice to keep its own billing systems while affiliating directly with the hospital; a management service organization model, where certain administrative functions are contracted out to a different organization; and a hospital-operated clinic model, in which the physician practice provides the staff to perform services in the clinic, the hospital pays the practice when services are rendered, and the practice distributes the payments to each physician. No matter what model is selected, an administrator must regularly monitor performance.
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"Shortage of Surgeons Pinches U.S. Hospitals"
USA Today (02/29/08) Davis, Robert

The exodus of retiring Baby Boomer doctors does not bode well for already overworked hospitals, which are set to suffer dire surgeon shortages within the next decade, especially in rural areas. Roughly 212,000 physicians currently work in towns with populations of 2,500 or less, and fewer than 10,000 of these physicians perform general surgery, a field that covers a variety of medical procedures. Medical schools lifted the 25-year voluntary cap on admissions that was in place between 1980 and 2005; enrollment increased by approximately 1,800 students in the past few years. However, because many of these recent graduates are strapped with debt, they seek specialized care fields that generate larger incomes than general surgery or family practice medicine. Medical students also choose fields in which they can balance their work and family lives. Boston-based Beth Israel Deaconess Medical Center Chair of Surgery Josef Fischer says, "My generation neglected our families. We neglected our children. We were always operating. This current generation, much to their credit, says, 'We're not going to do that.'" To attract new physicians to hospitals, the American College of Emergency Physicians hopes changes in liability and reimbursement practices, providing compensation to doctors for midnight visits and time spent with patients nursing chronic health problems, will help. Meanwhile, rural hospitals are seeking ways to supplement rural physicians' income while they work in general surgery and other low-paying areas of medicine.
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Management and Leadership

"Leadership, Culture and Medication Safety"
HHN Most Wired (Quarter 1, 2008) Vol. 7, No. 1, P. 34

With 1.5 million Americans injured by medication errors yearly and annual costs to hospitals estimated at $3.5 billion, hospital executives at an October 2007 Health Forum panel highlighted the need for effective patient safety systems that develop redundancy to avoid these mistakes, such as an online order entry system. The executives indicated that technology could improve patient safety to some extent, but a cultural shift from silo-oriented approaches to teamwork within the hospital is necessary, requiring early involvement from executives, physicians, nurses, and other medical staff to modify procedures. Hospitals often find behavior is easier to change in nurses, and Advocate Health Care Senior Vice President and CIO Bruce Smith says physicians need incentives. Executives report that physicians and medical staff must be convinced that technology programs, like medication reconciliation systems, will be selected with their input and address productivity needs as well. However, while bar-coding systems are prevalent in healthcare, without standards its use will not be mandated, says Accenture's Brian Shea. Executives also said technology can empower staff members by providing everyone with the same access, allowing them to question medical decisions, and ensure quality patient care. University of Illinois at Chicago Medical Center CIO Rose Ann Laureto says healthcare staff should be educated early on in their training about teamwork in patient care, such as confronting a physician who fails to follow hand-washing protocols. As with any systemwide change, CEOs, CFOs, and other executive leaders must be visible throughout the process and praise participants when benchmarks or care improvement goals are reached.
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"Vision Plan"
SmartBusiness (02/08) Cottrill, Mike

John Matuska, president and CEO of Mercy Hospital, part of the Catholic Health East system, underscores the importance of getting the hospital's 2,000 employees to support his vision plan. While the vision plan was under development, Matuska opened the lines of communication so staff could participate in strategic planning, budgeting, program development, and other core processes. In addition to providing a vision statement composed of no more than 25 words to ensure employees would read it, Matuska says he made an effort to listen. He invites physicians and program directors to attend yearly leadership retreats on strategic planning and holds numerous town-hall meetings at various times of the day and on weekends so employees have the chance to voice their opinions. Accountability is another important aspect of the vision plan, making employees assume responsibility for implementing and maintaining the plan. Matuska notes that patient satisfaction surveys are used to determine how well the hospital is doing overall, and employee satisfaction surveys are used to gauge managers' weaknesses; action plans are developed to improve low-scoring areas. Finally, Matuska says integrity is a crucial component of leadership and building trust. "People watch how I behave, how I treat people, what I say, how I say it and then judge whether or not I'm living those core values," remarks Matuska. "If I'm not doing that, and I don't set the example or my behavior or my decision-making is inconsistent, then other people are not going to believe that we're really living those core values."
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"When Participative Management Leads to Garbled Communication"
Healthcare Financial Management (02/08) Nowicki, Michael; Summers, Jim

The participative management style, in which the manager solicits input from employees before making a decision, is prone to vague and ambiguous communication. Managers with this style should make sure they are not sabotaging their own effectiveness. The use of passive voice, common among participative managers, should be used sparingly, as managers seeking to appear friendly end up sounding tentative and afraid to assign accountability. Mismatched emotional tones are another problem, which happens when managers use phrases such as "I want to share something with you" when they are simply giving an order. Managers should not use the collective "we" when they are assigning a responsibility to an individual or group of employees. Using "we" when assigning responsibilities generally highlights a manager's fear of confrontation or their inability to delegate to subordinates. Experts agree employees prefer clear direction and unambiguous communication.
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"Talent Talk"
Chief Executive (02/08) No. 231, Pellet, Jennifer

Many companies rely on the help of temporary workers to pinch-hit for employees who are out for medical or personal reasons. While the temporary workforce traditionally takes over clerical roles, employment gaps left by retiring Baby Boomers and other staffing issues leave companies no choice but to place temporary workers in a smattering of more professional positions including those in finance, IT, accounting, and healthcare. Adecco CEO Tig Gilliam says companies often fail to realize the potential of the contingent workforce despite millions of dollars worth of investment. "Our best clients are those who say, 'I need a work force strategy and part of that strategy has to include a contingent group. I need to optimize that entire workforce--made up of full-time, long-term employees; overtime workers; part-time people and contingent workers--in terms of cost, productivity, and quality," he says. To increase productivity, reduce costs, and control turnover, organizations might consider turning to the contingent workforce for full-time staffing solutions. Firms can approach this staffing challenge through HR software solutions or by contracting with human resource consultants. By making this initial investment, experts say most companies see improvements in cost, productivity, and quality over the long-term.
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