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Dear ASHHRA Member:

As I reflect upon 2007, I am in awe of the progress we've made in twelve short months. ASHHRA leaders have listened to your membership and professional needs, and they have risen to the challenge. We now have an online buyers guide, an online career center, and this wonderful monthly News Brief, giving you many new ways to find information and resources.

The new governance structure has proven to be successful, providing our organization with a wealth of professional expertise, helping us to reach out to a diverse group of healthcare leaders. We have gained insight into the needs of the CEO and those HR Healthcare professionals not in hospitals. We have discovered new opportunities to service HR professionals new to healthcare.

I am especially proud of the ASHHRA Foundation, established this past September. Through the Foundation and the sponsorship of MetLife, ASHHRA awarded nine conference scholarships to HR professionals who did not have the funds to attend the conference. In 2008, we hope to grow the Foundation to provide many healthcare HR professionals with grants and scholarships.

While it is true, ASHHRA has come a long way, we have so many more opportunities to grow and develop in service to our members. I look forward to serving as your immediate past president in 2008 and continuing to be a part of this incredibly dynamic organization.

Thanks for a great 2007! Have a happy and safe holiday season.

Best regards,

Molly Seals
ASHHRA 2007 President


Headlines

Legal
"HCWs Face Violence, Abuse From Patients"
"HIPAA Regulatory Alert: HIPAA Should Trump Other Privacy Laws"
"A Common Goal: Partnering With HR for SOX Compliance"

Workforce
"Improve Patient Education Skills by Making Them Part of Annual Competencies"
"Getting in Shape"

Compensation
"What's Work Got to Do With It?"

General HR
"No Matter the Workplace Size, Handbooks Can Play a Vital Role"
"HR Challenges in Virtual Worlds"

Benefits
"Why Enrollment Strategy Is Important and What to Consider"
"Utilization Side of the Story"

Physicians
"Increasing Value"
"Doctors Don't Report Colleagues, Errors"

Management and Leadership
"Why You Must Build Management Capability"
"Building a Leadership Infrastructure"
"A Leader's Framework for Decision Making"


Legal

"HCWs Face Violence, Abuse From Patients"
Hospital Employee Health (11/07)

A recent National Institute for Occupational Safety report shows major gaps in hospital security, but in states with regulations designed to prevent violence against healthcare workers, hospitals have safer working conditions. Experts indicate hospitals must implement better training programs and a uniform method for reporting incidents, as well as foster greater coordination between security workers and staff members. In California, legislation obligates healthcare organizations to track and prevent security risks and provide periodic employee safety training. New Jersey Health Department Deputy Commission for Public Health Services Eddy Bresnitz says, “There’s no part of this country that doesn’t have significant populations [with] drug or mental health problems or other problems that could contribute to violence in an emergency department.” A recent analysis of workplace violence prevention programs at 50 New Jersey hospitals showed the hospitals were concerned about safety, with additional training or equipment in place to mitigate security risks. However, nurses and other hospital workers remained concerned about their safety. About 85 percent of assaults recorded in New Jersey hospitals between 1992 and 2001 were committed by patients, and 43 percent of those incidents involved nurses. Moreover, employees missed work 33 percent of the time after an assault took place, and more often than not, abuse is verbal. Seventy-two percent of survey respondents never reported the incidents to hospital administrators. Over 80 percent of the New Jersey hospitals studied had training programs in place to prevent violence, but experts believe hospitals need to do more to protect workers in emergency departments. Consistent reporting and monitoring procedures must be in place to ensure all staff members know which code words or color labels signify that patients are a violence risk. Interactive training for all medical and administrative staff should be conducted periodically throughout the year to prepare staff to identify violent patients before incidents occur and to react appropriately to threats or assaults.
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"HIPAA Regulatory Alert: HIPAA Should Trump Other Privacy Laws"
Healthcare Risk Management (11/01/07)

The American Hospital Association is calling for standardized privacy rules to ensure that healthcare providers can access needed data at the point of care and facilitate the adoption of information technology. Currently, multiple sets of privacy rules exist, making it arduous to pinpoint and comply with all pertinent rules. Noel Williams, senior vice president of HCA Inc., contends federal privacy laws as outlined in the Health Information Portability and Accountability Act (HIPAA) should take priority over state and local privacy laws to facilitate compliance. Linda Kloss, CEO of the American Health Information Management Association, points out that while HIPAA standards require the adoption of the X12-837 standard for claims, there are over 1,000 accompanying instructions for that standard in the healthcare industry. Implementing technological initiatives, like electronic health records, is hard to accomplish without standardization in IT applications and health data, says Williams. However, there are many hurdles to the adoption of uniform standards, including the contentious issue of physician reimbursement and the lack of technical standards, which would sustain interoperability while safeguarding sensitive data.
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"A Common Goal: Partnering With HR for SOX Compliance"
Risk Management (11/07) Vol. 54, No. 11, P. 20; Gamble, John B. Jr.

The passage of the Sarbanes-Oxley Act (SOX) placed more responsibility on management to protect all assets, including those related to a firm's human resources. While most public companies left SOX compliance efforts to their legal and accounting departments, cooperation between the risk management and HR departments can be vital. Since the HR department plays an important role in almost every individual employment decision, including the hiring and disciplining of employees, their participation is needed for the internal controls mandated by SOX's Section 404. Risk management also needs to measure threats against the company and determine the best way to resolve claims. There are many different areas of SOX compliance that HR and risk management can help with, including the protection of confidential information and data. HR can negotiate non-disclosure clauses into employment agreements to prevent employees from giving data to a competitor, as well as work with risk managers to inform employees the company has the right to monitor their computer use. A company also needs to develop an electronic data retention policy to prevent the loss of data, leaving the firm exposed to litigation risk. Risk managers and HR officials must monitor employee expense reports, because an employee guilty of handing in fake expense reports could be committing fraud on a larger scale. Another important component of SOX compliance is setting up a procedure for the anonymous submission of fraud complaints, and risk managers and HR staff must ensure workers are aware of the whistleblower protections they have under SOX Section 806. HR must be prepared to defend any employee termination, and HR and risk managers must understand the criminal liabilities associated with concealing or falsifying records.
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Workforce

"Improve Patient Education Skills by Making Them Part of Annual Competencies"
Patient Education Management (11/07)

Including patient education in annual competencies and job evaluations reminds staff members that education is an integral part of quality patient care. Moreover, a growing number of healthcare organizations realize the effectiveness of merging teaching with other competencies. For example, at M.D. Anderson Cancer Center, a committee reviews annual nursing competencies to ensure they contain, when appropriate, a teaching portion, says Nita D. Pyle of M.D. Anderson. For example, to demonstrate personal expertise in the operation of a patient-controlled analgesia pump, part of the nursing competency involves showing how the patient is taught to use the pump. When designing a competency, experts consider both the high-risk skills and the proficiency skills personnel must possess. Reviewing available data also can establish where individuals struggle in practice or where individuals need to enhance their abilities. Patient safety initiatives are other sources to consider when developing a competency. Finally, an evaluation procedure must be instituted to ensure staff members practice strong patient education methods. The best way to assess patient teaching abilities is through observation; when managers are pressed for time, they may want to use a guided inquiry or checklist.
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"Getting in Shape"
Crain's Cleveland Business (12/09/07) Vol. 28, No. 48, P. 13; Kadleck, Chrissy

The philosophy behind the American healthcare system is changing from one that simply treats diseases to a model that focuses on wellness. In light of this shift, many hospital groups are building fitness centers to improve patient rehabilitation and prevention services. According to the Medical Fitness Association, last year there were 875 facilities that combined medical and fitness assistance, with a combined membership of over 3 million people. By 2010, 1,700 medical fitness facilities are expected to be in operation serving over 4 million members. The cardio and weight equipment, health and wellness programs, exercise classes, and indoor tracks and pools are common features. Some facilities also include spa services, like massages, Reiki healing, pedicures, and manicures. Despite the luxurious settings, many of these centers offer their services at affordable prices in the hope that patients, who may not otherwise choose to go to a gym, use their services. Unlike most gyms, medical fitness centers are not geared toward improving cosmetic appearance, but are focused on improving the lives of high-risk patients, generally those who are older and likely to be out of shape. To best assess the needs of their patients, fitness experts evaluate the needs of each new member through body fat assessments, blood work, endurance tests, and flexibility evaluations, and the results are used to tailor a wellness regime that maximizes patient safety and satisfaction.
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Compensation

"What's Work Got to Do With It?"
HR Magazine (11/07) Vol. 52, No. 11, P. 101; Segal, Jonathan A.

The Fair Labor Standards Act (FLSA) mandates employees must be paid time and a half for any work done beyond 40 hours per week. To avoid unintentional violations of FLSA, organizations must determine whether preparation or break time should be compensated for under the law, such as activities required before or after work. For example, the U.S. Supreme Court ruled employees must be paid for the time it takes to put on and remove essential uniforms and protective gear, though exceptions can be made for gear considered "nonunique" to a particular position. Experts warn businesses to err on the side of caution when it comes to this rule; but if employers believe workers are taking too much time to prepare for work, they should handle it through counseling, disciplinary action, or dismissal. However, employers should not dock pay for excessive preparation time, but they should pay workers for breaks less than 30 minutes. Requiring workers to sign in and out for breaks can reduce pay discrepancies; workers should not be allowed to do work, while on break. Experts also note if work is completed while on break, employees should be compensated for the entirety of the break, not just the time used to complete the work. Furthermore, supervisors must monitor employees who arrive early and leave late to ensure they are not performing any tasks for which they should receive compensation.
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General HR

"No Matter the Workplace Size, Handbooks Can Play a Vital Role"
Crain's Cleveland Business (11/18/07) Vol. 28, No. 45, P. 26; Prizinsky, David

As the organizational cultures grows more concerned with risk management, keeping an employee handbook can be a smart defensive strategy. Even for organizations with 20 or fewer employees, more pressure is on to provide staffers with a uniform statement of policies; without a handbook, executives could face greater liability if an employee brings litigation, according to some labor law experts. Handbooks are manufactured easily and should ideally cover about 50 different issues, including nondiscrimination, general attendance, military leave, the Family and Medical Leave Act, health insurance, and retirement plans. Experts recommend handbooks include some vague language to give executives the freedom to make non-binding decisions about insurance and performance reviews. "In preparing a handbook, keep it simple and give yourself flexibility," advises Elizabeth Milito, senior executive counsel for the Washington, D.C.-based Legal Foundation of the National Federation of Independent Business. Some firms skirt around potential dangers by keeping handbooks short and by using simple, direct language. Once policy is written down and in the hands of all employees, it does become organizational law, and this could put executives in a sticky situation if a necessary management decision goes against those policies. Firms should consult an attorney before distributing the handbook.
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"HR Challenges in Virtual Worlds"
HR Magazine (11/07) Vol. 52, No. 11, P. 85; Krell, Eric

Virtual communities, like Second Life, provide a myriad of human resources opportunities, including the ability to seek out potential hires. Even once employees are hired, virtual worlds allow employees, business partners, and clients to communicate without the costly restrictions of business travel. Experts also agree virtual worlds can help organizations meet corporate governance, compliance, and business continuity goals. For example, if a real-world office is forced to close, some business processes can remain active through the virtual office. For all its advantages, HR managers should be aware of the risks virtual world participation can pose, such as inappropriate behavior and intellectual property theft. To minimize these risks, organizations should institute consistent guidelines to help their employees navigate virtual worlds. First, managers should make sure their employees are aware they may be exposed to inappropriate user behavior in public virtual worlds and provide those workers with basic training regarding the ins and outs of virtual social interactions. Next, employees must be warned that anything they say or do in a virtual world can be recorded, which means workers must follow organizational standards regarding intellectual property and other assets. Employee-behavior policies in the virtual world can and should be shaped by existing employee-conduct standards. In-world hires should also be given a sense of legitimacy to encourage proper behavior. HR managers must take the time to confirm the identity of greeters, designers, and other virtual contractors. Finally, organizations should engage legal council to help them find the best course of action when dealing with virtual world HR issues.
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Benefits

"Why Enrollment Strategy Is Important and What to Consider"
Health Insurance Underwriter (12/07) Vol. 55, No. 12, P. 40; Abramson, Roger

Few employers take the time to develop an effective enrollment strategy, choosing instead to focus on the benefit package. While the benefit package is crucial, the enrollment process is valuable in that it gives the employer an opportunity to market other products. Each group of employees is a captive audience of targeted individuals who stand to benefit from the plan. Therefore, companies should use inventive communication strategies to explain and sell benefits to workers. Before marketing various benefits, employers should consider the nature of the benefit and whether it will require a large transition or something simple, like an increase in co-pays. If a plan is complex, human resources must clarify the plan as much as possible, especially if multiple plan choices are offered. Employers should bear in mind the workforce's demographic makeup, as annual income is often an accurate predictor of how much employees will care about tax benefits, with those on the lower end of the income ladder typically caring the least about consumer-directed health plans and other tax benefits. Finally, the level of worker satisfaction will impact enrollment, as happy workers are more likely to participate in employer plans than disgruntled workers.
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"Utilization Side of the Story"
Risk & Insurance (11/07) Vol. 18, No. 14, P. 62; Bowling, Maddy; Huth, David

Traditionally, pharmacy benefits managers (PBM) focus on drug pricing in an attempt to reduce employer costs, but with workers’ compensation claims, medication uses are often more important than their costs. If an employee is not getting the correct treatment, it can lead to higher costs, including more lost work days and unnecessary prescription costs. To avoid these pitfalls, the necessity, appropriateness, setting, intensity, and duration of care should be assessed for each claim, and these criteria must be used to evaluate medications prescribed to claimants. Experts suggest that to reduce workers’ comp costs, employers should seek out PBMs with workers’ comp expertise because they can approximate drug effectiveness based on injury type and claim duration. As claims lag on, a majority of the costs are associated with prescription refills; for example, a claim reaching year six can post medicinal costs up to 30 percent of the total claim. Experts also note PBMs can navigate regulatory changes and ensure all practices and systems are in compliance. Moreover, PBMs have systems to identify questionable prescriptions or early refills, which can help lower expenses and highlight potential employee problems. Employers and PBMs should coordinate efforts to reduce the need for third-party services tied to prescription payments for workers’ comp recipients, such as the creation of a prescription card that claimants can hand over to pharmacies to ensure prescription bills are received more quickly by employers. If third-party services are needed, employers should choose PBMs with collection agency experience.
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Physicians

"Increasing Value"
Medical Construction & Design (12/07) Vol. 3, No. 6, P. 22; Reeve, John; Siepel, Cindy

As competition among healthcare providers increases, revenue and growth depend greatly on how physicians use time. Two popular methods used by hospitals to retain physicians and increase service offerings are the center-hospital model and the healthcare delivery model. In the center-hospital model, hospitals integrate smaller, specialty care practices with diagnostic tools and high-tech imaging devices, which bolster the services the hospital can offer its patients while physicians have greater access to the hospital's X-ray machines and larger tools. The healthcare delivery model, on the other hand, creates a hospital with complementary services that surrounding specialists can use to improve efficiency and quality care. For instance, at St. John's Health System in Missouri, the hospital created an on-campus ambulatory surgery center to help orthopedic, plastics, ophthalmology, and oral surgeons service patients efficiently and satisfactorily. The building houses physician offices on the upper floors with express elevators to get doctors upstairs more quickly and operating suites for quick turnarounds of surgical cases. Orthopedic surgeons who also cover the trauma ward at the hospital are able to return to patients at the ambulatory surgical center more quickly when necessary. Additionally, St. John's created a discharge area at the back of the center for discreet pick-ups, and the facility houses a spa on the uppermost floors. Experts also indicate placing storage and supplies near patient rooms can reduce wait times and travel distance for staff members.
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"Doctors Don't Report Colleagues, Errors"
Boston Globe (12/04/07) Kowalczyk, Liz

Doctors endorse a certain set of professional obligations, including honesty with patients; but a recent study regarding whether those principles hold true in practice reveals that over 50 percent of doctors fail to report medical errors or impaired or incompetent colleagues. Critics are concerned physicians are not given enough training to deal with compromised colleagues. Another 33 percent indicate they would order unnecessary MRIs for persistent patients, even though most physicians believe they should not waste resources. One percent of those surveyed lied to a patient's family in the last three years, and 3 percent reportedly withheld important information over the same period. The consumer-driven climate prevalent in the healthcare sector appears to be a double-edged sword with physicians relying on patient satisfaction surveys to prove their worth to employers. Modernizing the professional obligations of doctors is seen as another prong in the fight to improve patient care, and Institute for Healthcare Improvement President Dr. Donald Berwick says, "It's not just about being a solo operator now. It's about being a member of a collective and a system." The American Board of Internal Medicine, the American College of Physicians, and the European Federation of Internal Medicine revamped the Hippocratic Oath to address financial conflicts of interest, the use of technology, medical mistakes, and racial inequities in care. However, less than 80 percent of doctors surveyed believe professionals needed to be re-certified periodically.
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Management and Leadership

"Why You Must Build Management Capability"
Workforce Management (11/28/2007) Goldberg, Edie

As the job market continues to tighten, one of the best ways for organizations to attract and retain employees is to have competent, supportive managers. Unfortunately, managers are asked to spend more time performing tasks that cut into the time they spend actually managing workers, with about 90 percent of their time spent on administrative or technical tasks and only 10 percent of their time managing and developing workers. As companies strive to save money, they expect more productivity from fewer staff members, and managers are often not given the training nor the motivation to manage effectively. Organizations that fail to emphasize the role of a good manager will find that more workers leave the organization for reasons well within management's control to correct; these reasons range from insufficient feedback and coaching to a lack of reward or recognition for work well done. Human resources (HR) leaders can improve management conditions by showing good managers are valued through either public recognition or other means. HR can also set an example for leaders within the group, ensuring supervisors spend sufficient time coaching their subordinates at all levels of the organization. Firms must establish positive messages for and about managers and set up clear expectations for managerial behavior. Managers should be selected based on a set of skills, including those skills that foster goal setting, coaching, feedback, and a solid vision of company culture. Once managers are selected, the group must set managerial goals and corresponding rewards and consequences for meeting or failing to meet those goals. Monetary rewards are not the only option, and organization must tailor rewards to fit the individual manager to keep them motivated. Management construction can be time consuming and costly, but in the long-term, providing managers with the best tools and motivations can improve overall organizational performance.
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"Building a Leadership Infrastructure"
HR Pulse (12/01/07) P. 32; Abrams, Michael; Ott, Bill

For organizations to adjust to organizational changes, experts agree a strong leadership infrastructure must be in place. These structures should identify and leverage talent within the organization, engage workers with career planning and other programs, foster accountability, generate further talent from its ranks, reduce the time and cost associated with replacing workers and filling open positions, and solidify the firm's position as a top employment choice. The first element of the infrastructure should be clearly defined job roles, complete with missions, duties, relationships, accountability, and decision making functions. Secondly, clear competency assessments must be completed of managers and workers to foster interaction among workers with varying strengths. Training programs should be tailored to encourage workers to build their leadership skills, which could be necessary when the organization undergoes a transition or is in need of additional direction. Individual development plans can help workers set and achieve clearly defined goals more readily and guide them into the proper training programs. Performance evaluations must be linked to specific goals to be effective, note experts. Finally, succession plans should cultivate leaders from within the organization and funnel them up through the firm in a clearly defined path. Experts also warn these leadership structures must be tweaked on a regular basis to meet the changing needs of an organization.
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"A Leader's Framework for Decision Making"
Harvard Business Review (11/07) Vol. 85, No. 11, P. 69; Snowden, David J.; Boone, Mary E.

A new technology can help executives handle real-world problems, synthesize complex concepts, and see things from new perspectives. When leaders face scenarios necessitating a variety of responses and decisions, skills learned in business school or on the job may be insufficient. David J. Snowden and Mary E. Boone developed a framework called "Cynefin" to help leaders navigate these contexts. Based on complexity science, this technique enables executives to handle real-world problems, synthesize complex concepts and see things from new perspectives. The framework can help leaders with anything from engaging workers in policy-making to creating new product strategies. Under the system, leaders are taught to classify the issues they face into four contexts: simple, complicated, complex, and chaotic. By identifying which context they are in, executives can make better decisions. Simple contexts have a clear cause-and-effect relationship and require monitoring and simple management, while complicated contexts could have multiple right answers requiring leaders to analyze various scenarios and solutions before taking action. However, a danger in both these decision-making contexts is falling into traditional ways of viewing these situations and failing to seek out innovative solutions from experts or outsiders. Complex contexts often have unknown solutions, which is why leaders must carefully watch the situation for the appropriate course of action; chaotic circumstances require careful, though immediate, action to stabilize the situation. Leaders who want to function well in spite of the world's increasing uncertainty must possess a profound understanding of the context, maintain a flexible leadership style, and clearly communicate decisions to the entire organization.
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