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Continuing the ASHHRA Journey: 2008-2010

Dear ASHHRA Member:

Last month at the annual conference, I unveiled the new ASHHRA Strategic Directions for 2008 – 2010. You can now access a full copy on the ASHHRA Web site.

As the 2007 president, I have had the great privilege of not only executing the final year of the previous strategic plan, but leading the ASHHRA Board of Directors through a strategic planning process that results in this exciting new roadmap for our organization's future.

Each strategic direction contains a list of goals that speak to specific actions ASHHRA will take to accelerate your HR leadership by meeting the needs of members and advancing the healthcare HR profession. Periodically, we will communicate to you the progress we are making in meeting these goals. Your job is to hold us - ASHHRA leaders – accountable. Let us know how we’re doing by contacting us individually, or by calling the ASHHRA office.

As a valued member, we want to assure you that ASHHRA is your primary source for the tools needed to support your growth, development and effectiveness as an HR leader. As you learn more about our new strategic directions, we are certain you will find them to be an invaluable support for the transformation of healthcare HR in your organization.

Join us on the Journey and Accelerate your Leadership!

Molly S. Seals
ASHHRA 2007 President



Headlines

ASHHRA News
Conference Photos Now Online

Legal
"Acute Pain Emerging as New Area of Liability"
"Doctors Say They Need Protection to Apologize"
"Clooney Case Puts Patient Privacy Under Microscope"

Workforce
"Power Nap: Why Sleeping On The Job Boosts Safety"
"Shifting Priorities"
"Calculating the Cost of Absence"

Compensation
"Nurses, Consumer Satisfaction, and Pay for Performance"

General HR
"Customer Service 101 for the Hospital Front Office"
"Continuously Monitoring Workers' Comp Can Limit Costs"
"Technology Dramatically Changes FMLA compliance"

Benefits
"Concierge in the Workplace"

Physicians
"Sharing the Quality Agenda With Physicians"
"Investing in the Three Rs"

Management and Leadership
"Self-Directed Coaching: Secret Weapon for Cost Effective Development"
"The Isolation Factor"


ASHHRA News

Conference Photos Now Online

Revisit the 43rd Annual ASHHRA Conference and Exposition . . . in pictures. Photos are now available to view and download. Click here for photos.

Be sure to register early for the 44th Annual ASHHRA Conference and Exposition, Oct. 12 through 14, 2008, in Austin, Texas. Click here to register for 2008!
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Legal

"Acute Pain Emerging as New Area of Liability"
Healthcare Risk Management (11/01/07)

Industry experts are concerned about a possible increase in the number of malpractice claims over acute pain management. Healthcare risk managers primarily deal with end-of-life pain management liability, but those claims are often successful for plaintiffs, making the risks associated with postoperative acute pain management claims more daunting. Some contend hikes in acute pain management claims could lead to more effective pain relief for patients, but others indicate it could negatively impact doctor performance. Many physicians already are questioned if they put a patient on a narcotic for more than a week, which forces them to refer patients to pain management specialists. However, if those specialists provide substandard care, referring physicians could still be held legally accountable. For instance, anesthesiologists should monitor patient's respiratory conditions closely to prevent respiratory depression, patient-controlled analgesia, and neuraxial opioid administration, which can result in brain damage. Risk managers must devise preventative measures to protect their organization from these liabilities and increase the care quality. Risk managers should implement new training programs to help pain managers take the appropriate steps to minimize the likelihood of permanent damage and a malpractice claim.
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"Doctors Say They Need Protection to Apologize"
Boston Globe (10/31/07) Kowalczyk, Liz

Consumers, insurers, and regulators hope legislation aimed at getting healthcare providers to apologize to patients will break down the walls of secrecy in the medical profession and bolster doctors' relationships with their patients. However, doctors and medical groups are pushing for provisions in the legislative proposals that would prevent apologies from becoming evidence in medical malpractice cases. The Massachusetts Medical Society continues to lobby lawmakers to protect doctors from further malpractice liability. The state's Health Apology Pilot Program "would make statements of guilt inadmissible only for doctors and hospitals that promptly acknowledge and apologize for mistakes and agree to offer injured patients 'fair settlements' that would have to be negotiated with the patient's attorney." In Massachusetts, apologies and between parties involved in accidents are not admissible in personal injury suits, and trial attorneys indicate the same should be true for doctors expressing sympathy to patients. Four other states have issued regulations protecting apologizing doctors from liability, and patient safety advocates indicate doctors who apologize for medical errors are not sued by their patients because patients would rather have honesty in their relationships with physicians.
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"Clooney Case Puts Patient Privacy Under Microscope"
NJ Biz (10/29/07) P. 1; Gaudio, Thomas

Though hospitals have taken major steps in recent years to safeguard patient privacy by complying with federal regulations, confidentiality efforts still need improvement, as illustrated by a recent data breach involving movie star George Clooney. In October 2007, 27 employees at the Palisades Medical Center were suspended for entering George Clooney's medical records without authorization. The illicit access was uncovered during a routine audit that reviewed patients' electronic and paper trails. Over four years ago, the U.S. Health Insurance Portability and Accountability Act (HIPAA) was passed to ensure that hospitals and other groups would protect patient data. Two federal agencies oversee HIPAA, but the healthcare industry is expected to police itself. Some say the managing agencies should hire more individuals to aggressively enforce HIPAA's regulations. At the Palisades Medical Center, software notifies workers when they access a medical record without authorization. However, to guarantee continuity of care, all records are accessible by all medical personnel.
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Workforce

"Power Nap: Why Sleeping On The Job Boosts Safety"
Hospital Employee Health (11/07)

Hospitals across the country, especially VA hospitals, are implementing a new program designed to combat the effects of fatigue on medical workers. Studies show fatigue can impair the performance of nurses in the middle of long shifts, with the effects of being awake for 17 straight hours equal to drinking two alcoholic beverages. The Institute of Medicine recommended limitations on shift length, but VA hospitals have taken a different approach, encouraging healthcare workers to sleep for short periods of time during extended shifts or overnight shifts. The Strategic Nap Program stemmed from a test showed the benefits of taking short naps in the middle of a long, overnight shift. A group of medical professionals who took a 40-minute nap performed better at the end of their shift, showing faster reaction times than those who did not take a nap. Sleep experts say naps should be between 15 minutes and 40 minutes long to avoid grogginess, and these napping programs should become part of an overall safety culture at healthcare facilities. Hospitals implementing the program do not need to bring in any additional staff because the naps take place during scheduled breaks, and most hospitals already have areas suitable and available for staff naps. The pilot program run in the VA Palo Alto Health Care System showed employees working the overnight shift were more likely to take part in the voluntary program. Although officials acknowledge it will be difficult to change preexisting attitudes, with a recent survey showing that over 25 percent of nurses suffer from insomnia, facilities and managers helping workers to organize their schedules will see hikes in productivity and improvements in safety. The Strategic Nap Program could cause the medical community to rethink the ways in which they combat fatigue.
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"Shifting Priorities"
Health Management Technology (10/07) Brown, E. Victor

Although the best long-term solution to the nurse shortage is to attract more people to the field, hospitals can prosper in the short-term by effectively using their current workforce, following the example of the Phoebe Putney Memorial Hospital. PPMH has a staff over 3,400 that see 53,000 yearly patient visits. Although PPMH has over 2,200 nurses, several problems in the shift scheduling process caused the hospital to turn to a staffing agency to fill in the gaps. The problems included a structure that assigned nurses to a specific floor instead of a central office, a tendency for floors to call different staffing agencies for the same opening, and offering vacant shifts on a first come, first serve basis that cut the resource pool in half. In order to fix these problems, PPMH implemented software to streamline the scheduling process by allowing nurses to register with the program and sign on and bid for open shifts. The program was a success, with 400 nurses registering in the first 12 hours of the program and 87 percent of registered users praising the system's ease of use. By the end of the first year, PPMH reduced annual agency staffing costs from $500,000 to $200,000, and the hospital found it easier to fill less attractive shifts by providing nurses with an incentive for filling those vacancies.
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"Calculating the Cost of Absence"
Risk & Insurance (10/07) Vol. 18, No. 13, P. 64; Hall, Robert

Managers find that to accurately appraise a company's productivity, a variety of factors must be considered, including employee absenteeism, presence, and ability or inability to give 100 percent. The 2005 report, "How to Present the Business Case for Healthcare Quality to Employers," shows that worker absences add up to $55 billion in lost productivity each year--approximately $74 billion if the collateral effects of absenteeism, such as lost sales and overtime costs, also are tabulated. However, many workers fall between the extremes of unproductive and fully productive. Employees with stressful situations at home or chronic health problems, like asthma or back pains, contribute to lost productivity while at work, as do workers returning to their jobs after periods of illness or injury. Assigning a monetary value to productivity gives managers a specific reference point as they encourage wellness and productivity within their firms. One method of calculating worker output is the Employer Measures of Productivity, Absence and Quality (EMPAQ), a rubric designed by the Washington, D.C.-based National Business Group on Health and various partners to evaluate the efficiency of disability and absence management programs. Firms that fail to calculate and address the effects of absenteeism face lost revenue, lower profitability, and significant expenses to replace workers or pay overtime, health management experts say.
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Compensation

"Nurses, Consumer Satisfaction, and Pay for Performance"
Healthcare Financial Management (10/07) Lutz, Sandy L.; Root, Deedie

Experts say hospital executives need to turn their attention to workforce issues, particularly those involving nurses and their satisfaction on the job, in response to Medicare's new pay-for-performance initiative. In the next couple of months, patient ratings of hospital care and nursing quality will be posted on the agency's Web site, allowing patients to see how a particular hospital compares to others across the country; hospitals that do not want to lower their Medicare payments will have to participate in the patient satisfaction survey. The shortage of nurses interested in working in hospitals could play a significant role in hospitals' ratings, as overworked nurses and limited staff resources for patient care could translate into lower ratings--especially since 14 of 22 survey questions related to the patient experience deal with care delivered by nurses. A survey by PricewaterhouseCoopers' Health Research Institute reveals that 50 percent of new nurses change jobs after their first two years in the field, which experts say underscores the importance of pinpointing the reason for nurses' dissatisfaction. In addition to beefing up staffing through public-private partnerships and collaboration with nursing schools, hospitals are encouraged to enhance flexibility in nurses' schedules, using technology that lets them spend more time with patients instead of concentrating their efforts on shift changes and other nonpatient duties. Among other things, performance-based metrics should be introduced; and nurses should be given the opportunity to bid on open shifts.
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General HR

"Customer Service 101 for the Hospital Front Office"
CRM Buyer (10/28/07) Williams, Jeni

Hospitals need to not only train workers to address insurance and payment concerns of patients, but also how to be empathetic to patients' situations, while determining who to bill for services rendered. The University of Pittsburgh Medical Center (UPMC) uncovered a lack of soft skills among its finance department workers, which were "reflected in our patient satisfaction scores and in the 'secret shoppers' that we do, and we really saw it evidenced in our customer service complaints," noted Karen Shaffer-Platt. Through the collaborative efforts of the finance and human resources departments at the hospital, employees were engaged in customer service training courses over one week, and new job candidates were selected based upon their customer-service backgrounds. After three years under the new training program, UPMC reported an increase in patient satisfaction scores, with a 90th percentile rank in three of four key service areas. Shaffer-Platt said co-pay collection rates hover at 87 percent, customer complaints continue to decline and no-show rates have dropped, while employee retention rates in finance continue to rise and patient registration accuracy has bolstered. Healthcare executives note the best way to improve customer satisfaction is to train workers in customer service skills, ensure they have a thorough understanding of hospital systems and revenue cycles and remain personable even when asking for co-payments or other fees. Training programs can include on-site presentations, e-learning programs, role-playing, mentoring and workbook exercises. A monitoring program, which can encompass a supervisor posing as a patient caller, can ensure the finance department staff does not generate higher numbers of complaints or claims denials.
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"Continuously Monitoring Workers' Comp Can Limit Costs"
Crain's Cleveland Business (10/14/07) Vol. 28, No. 40, P. 21; Agnoni, Michael

Employers who actively manage their workers' compensation programs via three key strategies are more likely to improve employee safety while reducing premiums and controlling related indirect costs, such as lost productivity. First, companies should manage new losses by immediately conducting accident investigations, which could involve taking statements from witnesses and photographs of the scene. Swiftly reporting a claim saves money, as delayed injury reports can boost claims costs by nearly $3,000 per event, according to recent studies. Companies should be equally aggressive about resolving old claims. Developing a plan of action for every claim file can increase the odds that injured workers will return to work and can prevent lingering claims from hurting premiums. Finally, stopping future losses from happening is the most effective way to decrease workers' comp costs and can be accomplished by pinpointing unsafe equipment, conditions, and practices. In addition, rather than depending on a third-party administrator to direct the workers' comp program, employers should shift the responsibility to a safety committee comprised of senior managers, supervisors, and staff. However, if the company prefers to outsource the program oversight role, it is crucial to hire someone with expertise in claims settlement, accident investigation, loss prevention, and workers' comp jurisdiction.
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"Technology Dramatically Changes FMLA compliance"
HR Pulse (10/01/07) P. 46; Harbison, Gary

Managing unexpected absences while adhering to the federal Family and Medical Leave Act (FMLA) can be costly as well as difficult for a hospital, such as the Illinois institution forced to pay over $11 million in damages. An automated system designed to be FMLA compliant can help hospitals efficiently deal with regulations that often are misunderstood due to overlapping state and federal laws. Another reason hospitals shift to an automated system is that the paperwork required for manual administration can be complex and take up too much administrative time, which could be utilized elsewhere. Automated systems can help hospitals by performing 10 tasks necessary to ensure FMLA compliance, including data sharing, identification of protected absences, and updating employee records. In addition, administrators must remember state and local laws can overrule FMLA and employees do not have to classify the type of leave they are taking.
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Benefits

"Concierge in the Workplace"
Hartford Courant (CT) (11/05/07) Madkour, Rasha

One survey indicated 5 percent of U.S. firms hired personal assistance firms to offer workers car washes and other services as part of their benefits packages. For instance, Memorial Healthcare Systems in Florida offers workers access to oil changes, dry cleaning, and other services without having to leave work. With the tight labor market in the healthcare sector, more and more hospitals are signing on for concierge services as a way to recruit talented workers. These additional benefits allow healthcare and other workers to use their personal time off to spend with their families and friends, rather than completing chores they did not get to during the week. Memorial Healthcare Systems Admissions Director Jean Romano-Clark says the onsite office allows workers to purchase gift cards, develop photos, drop off dry cleaning, and get watches fixed, among other tasks. Experts agree more companies are signing onto concierge services as workers' lives become more hectic and they have less time to complete chores and find it more difficult to balance their home and work lives. University of St. Thomas Compensation and Benefits Manager Peter Ronza says, "Employers benefit by increased productivity because their workers aren't distracted by uncompleted errands."
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Physicians

"Sharing the Quality Agenda With Physicians"
Trustee (10/07) Gosfield, Alice G.; Reinersten, James L.

Physician and hospital relationships, essential to the development of high-quality healthcare and smoother operations within facilities, can only be improved through board involvement. Experts indicate that hospitals must look beyond traditional strategies of physician engagement, such as the use of partnerships to generate physician loyalty. The Institute for Healthcare Improvement provides a framework for hospitals interested in developing stronger relationships with physicians, which must be founded with a common purpose--improved healthcare quality. To garner the support of physicians, board members must conduct an organizational and cultural assessment of the hospital, which will guide decisions on how to engage physicians in quality improvement initiatives. Experts agree board members will obtain greater support from physicians by focusing quality discussions on how the hospital compares to others and whether improvements are being made, rather than simply relying on outside scorecard results to determine performance. Doctors gauge care improvement by how much time is saved through change and whether patient outcomes improve. Board members and hospital administrators will need to offer such incentives for physicians as monetary compensation, education programs and electronic medical records software, making sure they comply with the Stark Law and anti-kickback legislation. Through a variety of strategies, trustees can strengthen their relations with physicians; but should disagreements arise, trustees must remain firm in their decisions regardless of the financial and legal risks hospitals face from a group of disgruntled doctors.
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"Investing in the Three Rs"
Healthcare Executive (11/07) Vol. 22, No. 6, P. 56; Rice, James A.

Many hospitals and health systems implemented physician leadership programs several years ago in an effort to improve the performance of and relationship with medical staff. However, a recent study shows many physician leadership programs are hurt by insufficient skills development and confusion over roles. The report identified three things necessary for a successful program: collaboration, physicians with the appropriate mix of clinical and leadership skills, and instruction in a similar manner to how physicians learned medicine. These goals can be met through the three "Rs:" rounding, recognition and rewards. Rounding is a term used for instruction that utilizes real case studies and observation of a mentor or senior faculty member. While this is a technique used typically to teach medical students, it can be useful in developing leaders by allowing them to observe how their mentor leads the medical staff during a time of crisis. Although monetary rewards are beneficial in developing leaders because they encourage quality care, healthcare organizations also use recognition as a reward, showing appreciation by celebrating the successes of a physician-leader. A strong leadership program will include a successful mix of learning techniques, some possibly outsourced to consultants or universities. These techniques include mentoring, skills workshops, volunteer experience, and self-study. Experts say the program should include in-house and outsourced activities, with short sessions spread over several weeks.
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Management and Leadership

"Self-Directed Coaching: Secret Weapon for Cost Effective Development"
4Hoteliers (11/02/07) Houran, James; Keith, Alan

Employers must utilize training and coaching programs to their advantage to recruit and retain talented workers, and some experts indicate self-directed coaching is one of the best solutions for workers with an "internal locus of control." These workers tend to value knowledge and seek greater control over their careers. Self-directed coaching, however, requires detailed analyses of attitude and skill tests that determine professionals' level of ability with regard to leadership and other aspects of their jobs. Item Response Theory examines not only how high test takers score on leadership, among other skills, but also delves into how as leaders test takers would deal with conflict and other problems. Self-directed coaching can help professionals uncover their weaknesses, tailor their own programs to build up those skills they lack, receive instant feedback through online assessments that are taken when it is convenient for the professional, and allow professionals to remain flexible in a constantly evolving marketplace. Employers indicate these programs also can reduce training program costs, while at the same time they help companies achieve the performance improvements they seek from the workforce. Professionals interested in self-directed coaching should first take personality and skills assessments as they relate to leadership, creativity, team building, ethics, and other competencies necessary for their job function. Assessments highlight the areas in which workers need additional training and guidance, and motivated workers will seek out that training on their own to improve their career paths and productivity.
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"The Isolation Factor"
Healthcare Financial Management (10/07) North, MarieAnn

Hospital executives can lead their organizations, but to successfully engage workers, they must maintain their connections to operational details. Operational details can provide executives with a greater understanding of what frustrates underlings about their work and encourage the development of "big picture" solutions. As leaders progress up the career ladder, performance feedback loops often close; but executives can counteract that phenomenon by creating a diverse inner circle to keep them on their toes. These leaders provide a sounding board for executives and offer different perspectives on business issues; agreement among inner circle members at all times can be a sign of team disengagement. Beyond the inner circle, executives will want to interact with staff from all levels of the organization, including physicians, through exit interviews, informal interactions and yearly surveys. Surveys should hit upon the resources staff members believe can improve their job performance, what avenues of education and career development are available to them, which procedures help with efficiency and how satisfied they are with their jobs. Leaders also must understand themselves and their work style and ensure other staff members can critique it without hesitation.
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