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Exciting New Initiatives at ASHHRA

Dear ASHHRA Colleagues:

I am so thrilled to tell you about two new initiatives at ASHHRA: the Mentoring Program and the ASHHRA Think Tank.

I've been fortunate to have had so many wonderful people help me grow and develop along my career journey. My involvement with ASHHRA has been a particularly valuable resource for finding great role models. The new ASHHRA mentoring program takes the role model concept one step further by creating a formal process to help new members connect with experienced health care HR professionals. The Mentoring Program is also a great opportunity for established practitioners to share knowledge and to practice their HR Leader competencies by becoming a mentor. I encourage you to get involved in this new program. It doesn’t cost you anything, and yet what you gain will be invaluable.

Another new and exciting ASHHRA initiative is the formation of the Think Tank. As you may recall, the Think Tank was a component of the new Board of Directors organizational structure entered into the ASHHRA Bylaws by membership vote January 2, 2006. Under the leadership of Immediate Past President Molly Seals, the inaugural Think Tank assembly, referred to as a Thought Leader Forum, commences July 24, preceding the AHA Leadership Summit in San Diego, Calif. Invited thought leaders, including CEOs from health care systems around the country, will discuss, “The Role of HR in Quality and Patient Safety.” Results of the session will be compiled in a published report and shared with ASHHRA members, as well as AHA-member CEOs. I am anticipating an energizing and forward-thinking discussion resulting in many new and innovative ideas for the future. In the meantime, I encourage you to review the Think Tank charter, as well as the 2008 Thought Leader Forum schedule on the ASHHRA Web Site.

I hope you received your copy of the ASHHRA 44th Annual Conference and Exposition brochure. Be sure you register before the early bird prices expire at the end of May.

And as always, if you have questions or concerns, please feel free to contact me. Have a great week!

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


Headlines

ASHHRA News
Advocacy News: The Latest from Washington, D.C.
AHA and ASHHRA Career Centers Combine Forces

Legal
"Nurse Staffing Laws: Should You Worry?"
"Nursing Great Expectations"
"Pandemic List Specifies Those Not to Be Helped"

Workforce
"Office Bullies"
"Workplace Coach: Managing in Uncertain Times Takes Sensitivity"
"Meet Your New Customers"

Compensation
"Nurses' Pay Topic of Discussion"
"Self-Audit of Compensation Plans Reveals Strengths, Weaknesses"

General HR
"10 Ways to Maximize Performance Reviews"
"Disparities in Human Resources: Addressing the Lack of Diversity in the Health Professions"
"The Brain Drain"
"Why Do Nurse Managers Stay? Building a Model of Engagement"

Benefits
"An Ounce of Prevention"

Physicians
"Measuring Physician Performance"
"Physician Workforce Crisis? Wrong Diagnosis, Wrong Person"
"The Physician On-Call Dilemma: Emerging Solutions?"

Management and Leadership
"Be a Better Leader, Have a Better Life"
"Developing Nursing Leaders"


ASHHRA News

Advocacy News: The Latest from Washington, D.C.

ASHHRA Advocacy Committee Lobbies Capitol Hill
Members of the ASHHRA Advocacy Committee visited Capitol Hill on May 5 and 6 to lobby for legislation that advances the ASHHRA advocacy agenda. After being briefed on current legislative issues, committee members met with Senators and members of Congress to discuss issues important to hospital human resource professionals. The ASHHRA issue papers can be accessed at: http://www.ashhra.org/ashhra/advocacy/position.html.

Employee Verification Focus of Hearing
The House Ways and Means Subcommittee on Social Security held a May 6 hearing on two legislative proposals that would require employers to verify the citizenship of their workers to ensure they are legally authorized to work in the U.S.

H.R. 4088, the “Secure America Through Verification Enforcement Act of 2007 (SAVE), introduced by Rep. Heath Shuler (D-NC), would mandate that employers use the current “E-verify” program, administered by the Department of Homeland Security (DHS) for all current and new hires. The bill has 152 cosponsors. A competing bill, H.R. 5515, the New Employee Verification Act (NEVA), introduced by Rep. Sam Johnson (R-TX), would tie employment verification with current state-based systems that are devised to identify “deadbeat” parents for child support. Under H.R. 5515, employers could access the system by telephone as well as computer.

U.S. immigration law prohibits employers from knowingly hiring or continuing to employ aliens who are not authorized to work under the Immigration and Nationality Act. Currently, newly hired employees must produce documents that show they are authorized to work in the U.S. The Social Security card is one of several documents that may be used, in combination with other identity documents, to demonstrate work authorization.

Both H.R. 4088 and H.R. 5515 respond to congressional concern about the influx of a large illegal immigrant workforce in the U.S. No further action on either bill has been announced.

Bill Would Ease Nurse Visa Backlog, Bolster Nurse Education
AHA and ASHHRA-backed legislation introduced last week by Rep. Robert Wexler (D-FL) would set aside 20,000 employment-based visas in each of the next three years for foreign-educated registered nurses and physical therapists. The bill (H.R. 5924) also would provide funds to help U.S. nursing schools expand the domestic supply of nurses, and establish a three-year pilot program aimed at keeping U.S. nurses in the workforce. The U.S. has a waiting list for employment-based visas for internationally-educated nurses, and its nurse education programs turned away more than 150,000 qualified applicants last year due to lack of faculty and clinical space.

Nurses Push for Staffing Ratios
In conjunction with National Nurses Week, May 5 through 9, nursing groups lobbied Congress for legislation requiring Medicare-participating hospitals to implement staffing ratios. H.R. 4138, the “Registered Nurse Safe Staffing Act of 2007,” introduced by Rep. Lois Capps (D-CA), currently has 29 cosponsors. The Senate companion bill, S. 73, was introduced by Sen. Daniel Inouye (D-HI) earlier this year. Congress has not announced plans to consider these bills.

To contact your regional ASHHRA Advocacy Committee representative, click here
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AHA and ASHHRA Career Centers Combine Forces

The American Hospital Association recently introduced a new national workforce initiative – the National Healthcare Career Network (NHCN). ASHHRA plays a significant role in this new program aimed at connecting health care organizations with health care professionals of all levels and expertise.

One of the first NHCN components to be implemented is the AHA Career Center, an online job search tool that integrates with the ASHHRA Career Center. Together, the AHA Career Center and the ASHHRA Career Center provide health care HR professionals better opportunities for quickly matching open positions to job seekers. Currently, ASHHRA has more than 4,000 job seekers listed – its largest list to date of valuable professional talent – a direct result of partnering with the AHA Career Center.

The AHA is seeking charter members for the new AHA Career Center, giving organizations a myriad of benefits, including a free ASHHRA membership per organization. Charter members also have a voice in the ongoing development of the NHCN. To learn more about the AHA Career Center and the NHCN, please contact Kathleen Wessel, director of Corporate Development, AHA Solutions, Inc, 312-895-2542, kwessel@aha.org.
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Legal

"Nurse Staffing Laws: Should You Worry?"
Hospitals & Health Networks (04/08) Thrall, Terese Hudson

A number of states are mandating that hospitals draft nurse staffing plans, including Illinois, Texas, and Oregon. The state legislatures passed legislation requiring hospitals to create committees, with at least half of the committee comprised of direct care nurses. Many newly-instituted nursing committees face serious challenges including how to best choose committee members, attendance rules, decision-making procedures, and ways to solve any conflicts that may arise. Washington and Ohio plan to pass similar legislation this year. Nine states have passed nurse staffing laws or regulations, and another 16 states have introduced similar legislation. Of the pending legislation, 13 would set mandatory nurse-staffing ratios, similar to the one in place in California. While nurse associations tend to lead the charge when it comes to staffing level mandates, some hospitals and hospital groups are looking to staff improvement as a means to improve quality care. While nurse-to-patient ratios are advocated by some nurse unions and trade groups, not all organizations agree that uniform ratios will solve the problem. "We believe it is difficult to establish a single staffing standard for hospitals in Oregon or any other state because the great variable between hospitals," says Oregon Nurses Association Executive Director Susan King. Hospital administrators and nurses should work together to create the best strategy for improving staff levels and patient outcomes, say experts.
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"Nursing Great Expectations"
Modern Healthcare (04/21/08) Evans, Melanie

As quality care issues come to the forefront, nurses could feel even further pressure to prevent medical errors as agencies and others seek ways to hold them accountable because "day-in and day-out care is led by nurses." Studies indicate a number of preventable errors, including bedsores, patient falls, failures to rescue, and infections near catheters and ventilators, stem from inadequate nursing. Hospitals are increasingly tracking medical outcomes and staff performance, but with the latest additions to the federal Medicare initiative that ties pay to performance measures, nurses will draw further scrutiny. Medicare plans to add four "nurse-sensitive" areas to the list by 2010, including bedsores, falls, rescue, and falls with injuries. The federal program also will no longer pay hospitals for treatment related to preventable injuries and errors, particularly bedsores, patient falls, and urinary tract infections associated with catheter use. Hospitals could utilize these reporting requirements to improve nurse performance, which could foster further investment in nursing staffs and increase scrutiny. However, the major stumbling block to these initiatives has been a lack of standards regarding information and performance data collections, which The Joint Commission plans will study over the next two years. Some advocates are pushing for data that determines a cause-and-affect relationship between quality standards and performance, and it is difficult to quantify such data without specific instructions for what to count and where to get information. While Medicare officials sort out their guidelines, several states--Maine, Massachusetts, Colorado, and Virginia--now have their own nurse-specific quality measures.
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"Pandemic List Specifies Those Not to Be Helped"
Denver Post (05/05/08) Tanner, Lindsey

A task force of physicians from the U.S. Department of Homeland Security, the Centers for Disease Control and Prevention, and other agencies and groups has written a set of guidelines for hospitals indicating which patients should not be treated in the event of a flu pandemic or other disaster. At the top of the list are the elderly, severely injured trauma victims, severe burn patients and severe dementia patients. Their aim is to get all medical personnel on the same page in the event of a disaster so that valuable resources such as ventilators, drugs and skilled medical professionals will be used uniformly. "If a mass casualty critical care event were to occur tomorrow, many people with clinical conditions that are survivable under usual health care system conditions may have to forgo life-sustaining interventions owing to deficiencies in supply or staffing," the report states. Georgetown University Public-Health Law Expert Lawrence Gostin notes that the list violates several federal age and disability anti-discrimination laws and represents not only a political and legal minefield, but also an ethical one. James Bentley, a senior vice president at the American Hospital Association, said the report will ensure those patients most likely to survive will have access to the finite resources available during a pandemic or disaster situation.
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Workforce

"Office Bullies"
Chicago Tribune (04/21/08) Swartz, Tracy

According to the Workplace Bullying Institute's 2007 survey, 37 percent of American workers were bullied at work, while 49 percent said they experienced or witnessed bullying at work. About 50 percent of bullying results in public humiliation of workers, but 32 percent of respondents say bullying happens out of sight. About 20 percent of states have introduced legislation to reduce workplace bullying, particularly those instances involving derogatory remarks, insults, and other comments; but none of these bills have been passed, leaving employers little recourse but to develop their own policies. Employers often create their own workplace policies to govern acceptable behavior in the workplace, though no universal definition is available legally. Many anti-bullying policies highlight yelling, insults, cursing, threats, rumors, and intentionally excluding workers from mandatory meetings as bullying tactics that are unacceptable. At a recent International Conference on Work, Stress, and Health, researchers indicated that workplace bullying could be more detrimental than sexual harassment. Bullied workers in the study tended to report higher job stress and less job commitment than those workers experiencing sexual harassment in the workplace. Bullied workers also were more apt to quit their jobs and exhibit poor mental and physical health. Supervisors are most often the perpetrators of bullying, which is why employees should have an alternate outlet for complaints, and some supervisors simply need additional training to help them tone down behaviors that co-workers find intimidating. "You don't even realize it that [your presence] could scare people," said Lisa Powers, a Nashville construction manager who completed a training program for aggressive female executives.
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"Workplace Coach: Managing in Uncertain Times Takes Sensitivity"
Seattle Post-Intelligencer (05/04/08) Moriarty, Maureen

The struggling economy is forcing a growing number of major employers to lay off part of their workforce. However, managers must clearly communicate the layoff strategy to the entire workforce before speaking with those impacted directly. Rumors are one of the major morale destroyers of any business, but managers providing consistent and clear messages about layoff strategies can ensure morale is not adversely impacted. For those workers losing their jobs, managers will have to field a number of questions about how layoff decisions were made and whether other opportunities exist at the company. Managers should offer recognition of contributions, empathy and compassion, and any support about laid-off workers' future career paths. Allowing the remaining workers to voice their opinions and emotions about the layoffs can ease tensions, say experts. While these steps cannot prevent morale decline, they can ease the minds of workers and ensure productivity drops are temporary.
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"Meet Your New Customers"
Marketing Health Services (05/08) Vol. 28, No. 1, P. 27; Nowak, Paul; Murrow, Jim

As the nursing and physician shortages become more of a reality, healthcare facilities and hospital must begin viewing their workers in different ways. Customer relationship management techniques often help hospitals and other facilities improve patient satisfaction, and experts agree that these techniques can be used to improve employee relations as well. A recent study of regional healthcare providers indicates that nurses act more as consumers in their employment service than as employees. There was a 53 percent difference between those nurses wishing to stay on the job and those anxious to leave their current employer. To reduce nurse turnover, researchers suggest offering mentoring programs, market-based benefits, and flexible work schedules. The study also suggested management must treat nurses as respected "customers" instead of as replaceable "cogs." Researchers indicate that happier workers translates into customer or patient satisfaction improvements, better working conditions, and an increased focus on patient needs, which translates into additional revenue. Additionally, making workers happy improves efficiency and productivity and reduces absenteeism. As more employees stay with their employers, the costs associated with additional recruitment and training decline.
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Compensation

"Nurses' Pay Topic of Discussion"
San Bernardino County Sun (CA) (04/10/08) Dulaney, Josh

Members of United Healthcare Workers and other groups believe inequitable pay among nurses and others has contributed to the current healthcare crisis in California and across the nation. In California, turnover rates among hospital nurses in Southern California rose to 17.3 percent in 2006 from 16.6 percent in 2005. Experts and union leaders indicate that equitable pay, benefits, and favorable work schedules can reduce turnover and improve patient care. Currently, hospitals turn to temporary staff when nurses leave. The top 100 hospitals in Solucient's list, which bases its analysis on process, efficiency, and clinical outcome standards, also had higher pay and benefits for workers, used 35 percent fewer temporary workers, and had lower overtime usage. Modern Healthcare noted recently that resolving labor issues can save hospitals and the system money and improve patient care. The Heritage Foundation recommends that benefit packages should be mobile for healthcare workers, allowing them to take their benefits from employer to employer. This would allow healthcare facilities to offer higher pay rates.
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"Self-Audit of Compensation Plans Reveals Strengths, Weaknesses"
HR.BLR.com (05/08/08)

Transparency and consistency are the cornerstones of a successful compensation program at any company or organization, and to ensure each worker is paid fairly, firms need to conduct self-audits of compensation. The first step is to closely examine how and why employees are paid, and to accomplish this goal, workers will need to be broken out into functional categories based upon level of responsibility and their role within the organization. A careful examination of employees in similar job functions can have variations in compensation, which should warrant further examination during the self-audit process. Dr. Stephanie Thomas says further examination can reveal "edge factors," which can represent tenure, additional experience, and other factors about individuals that lead them to receive higher pay. Any differences in pay between individuals should be clearly explained during the audit or the follow-up process where greater scrutiny is applied. Thomas recommends that compensation self-audits be conducted every year, but if the organization is in a period of growth or expansion, every six months could be more beneficial. She also notes, "You need to get the legal perspective on things, because there are confidentiality issues and attorney-client privilege issues. Talking to the legal department will help you cover your bases and make sure you're doing things correctly." The process can be expensive on the front end, but after the data is collected and the compensation structure is uncovered and remedied, the self-audit process gets easier and ensures employees are paid appropriately.
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General HR

"10 Ways to Maximize Performance Reviews"
Washington SmartCEO (04/08) Vol. 4, No. 4, P. 14; Wexley, Kenneth N.; Strouse, Douglas A.

Employers can utilize performance reviews as workforce development tools if those reviews carefully summarize worker accomplishments and offer constructive criticism and goals for workers to incorporate into their daily routines. Performance reviews also should provide workers an opportunity to evaluate their own performances. To ensure performance reviews help with employee development, managers should inform workers the two purposes of the review--performance appraisal and worker development--and encourage their participation in the process. Performance reviews should be given to workers before discussions are held so workers can have a period of self-reflection, which can raise questions and generate further feedback for managers. Managers also must remain positive about workers' achievements and offer support regarding workers' abilities to meet improvement goals. To ensure worker self-esteem is not hampered by performance reviews, managers should not heap on criticisms at mid-year or end-of-the-year review sessions, but schedule performance reviews when problems should be addressed quickly. Constant feedback throughout the year about worker accomplishments also can ensure workers do their best. Finally, managers should seek feedback from those supervisors and co-workers in the most contact with individual workers to provide the most well-rounded performance review for each worker.
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"Disparities in Human Resources: Addressing the Lack of Diversity in the Health Professions"
Health Affairs (Quarter 2, 2008) Vol. 27, No. 2, P. 413; Grumbach, Kevin; Mendoza, Rosalia

Research shows the racial makeup of the health professions--dentists, nurses, pharmacists, or physicians--largely do not reflect the diversity of the United State's population at large. Diversity among healthcare professionals can help eliminate racial health disparities, according to researchers. Furthermore, organizations find that diversity provides a number of customer service and competitive advantages because a culturally and linguistically diverse staff reflects the diversity of patients. According to the 2000 U.S. census, African Americans, Latinos, and American Indians collectively makeup about 25 percent of the total U.S. population, but those races only make up 9.9 percent of pharmacists and 5.4 percent of dentists. Researchers note that in spite of the recent increase in college applications among minorities interested in the healthcare profession, only the public health sector most accurately reflects the diversity of the population at large. From 1995 to 2005 the largest increase in minority representation in health-related programs was in nursing school, whether underrepresented minorities increased from 12 percent to 18 percent of enrollees. Minority enrollment in doctoral programs including medicine, dentistry, and pharmacy remained unchanged during that same time period. To improve minority representation in healthcare, experts recommend changes in the primary-education level through additional public-school funding, education reform advocacy, and increased partnerships between schools, colleges, and graduate schools and healthcare organizations. Hospitals and healthcare groups must consider how to best influence the makeup of college faculty and look beyond just racial data to ensure applicants meet the qualifications necessary to foster the proper education of healthcare students. Only with this attitude shift can the healthcare sector hope to eliminate subtle prejudices that prevent the industry from reaping the benefits of a more diverse workforce.
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"The Brain Drain"
Human Resource Executive (04/08) Vol. 22, No. 5, P. 43; Dickey, Marilyn

While employers in the private and public sector have known about the potential "brain drain" when Baby Boomers hit retirement, very few have taken action to retain the knowledge and skills of these workers. "If you ask companies about it, they say it's a very high priority, but if you ask them if they're doing anything, there aren't that many that are," says research leader Diane Piktialis of the New York-based business-research organization Conference Board. According to a recent study by the Center for Workforce Development, the average energy employee is nine years older than the average worker nationwide, and the industry's workforce may be halved in as few as five years. Employers are responding to the impending retiree exodus with several creative solutions, including phased retirements, financial incentives to continue working, mentoring programs, and short-term projects for retirees. However, another aspect of the workforce shortage problem stems from high turnover rates among middle managers, who often fill in the gaps of upper management when retirements occur. Another problem has been transferring knowledge from one generation to the next, which requires employers to adapt programs to variations in learning style. For instance, younger workers tend to like portions of information fed to them through technology and the ability to go back to the technology outlet to find additional information when they are ready. Deere & Co. encourages its employees to contribute to "communities of practice," online social networks where colleagues share their experiences and learn from others, which helps transfer knowledge between workers even before retirements become an issue. Moreover, workers at the firm update their own "internal resumes," which list their accomplishments and skill sets and are part of an internal career development database. The company also rehires older workers and retired workers on a contract basis to fill in other gaps. Monongalia General Hospital has focused its efforts on retaining its older workforce members by fostering in-service retirement through which a number of workers can find projects, schedules, and jobs to meet their needs and still collect their pension funds. Workers nearing retirement also are eligible for incentives if they stay on past the retirement age. Some workers will retire and come back as part-time patient caregivers, and others will volunteer their time in staff education booths and taking blood pressures of patients. Monongalia Human Resources Director Melissa Shreves says, "Trying to pull these people back in and engage them is a win for us and a win for them. We get their expertise and they get a little money."
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"Why Do Nurse Managers Stay? Building a Model of Engagement"
Journal of Nursing Administration (04/01/08) Vol. 38, No. 4, P. 166; Mackoff, Barbara; Triolo, Pamela Klauer

As part of a national qualitative study of nurse manager engagement, funded by the Robert Wood Johnson Foundation, researchers examined how organizational culture and structural empowerment can impact nurse manager job satisfaction and strategic involvement. After interviewing 30 nurse managers from six healthcare settings, five factors were uncovered that led to longer tenures and performance improvement. Many of the nurse managers discussed the importance of a learning culture that encourages learning, makes information accessible, and offers opportunities for continued learning beyond the individual unit. Another important factor for nurse managers is receiving acknowledgment that they are valued and respected members of the hospital staff, which can be achieved through soliciting nurse feedback and perspective on decisions, facilitating goal attainment, and empowerment of the nursing practice. Aligning hospital and healthcare facility goals and mission statements with that of their employees can help improve productivity and job satisfaction. Nurse managers also indicate that facilities that provide role models and mentoring, while offering approachable leadership, can achieve a generative culture. These factors can ensure staff members are socialized in terms of organizational roles, values, customers, and resources. The final factor highlighted by nurse managers in the study is to foster a culture of excellence in which a brand is created and communicated to staff, staff are encouraged to become invested in the organization's performance and reputation, and set high expectations and standards for all workers. Implementing these elements into an organizational structure and culture should improve nurse manager engagement, retention, and growth, according to researchers.
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Benefits

"An Ounce of Prevention"
Hospital & Health Networks (04/01/08) Bush, Haydn

With about 15 percent of the population responsible for about 85 percent of all healthcare expenses, healthcare experts are turning to wellness programs and other strategies to improve public health, reduce healthcare costs, and improve the lives of those with chronic ailments, like diabetes. The government is poised to use wellness programs to reduce medical costs, reducing Medicare payments for those taking part in wellness programs. Employers can now reduce health insurance premiums by up to 20 percent for workers enrolled in wellness programs and who reach specific wellness goals, according to the U.S. Department of Labor. Another option for wellness programs is the two-tiered system that offers a regular health insurance plan to all workers and the option for a discounted insurance plan, which requires workers to take risk assessments and then enroll in wellness programs to meet specific goals, like lower cholesterol levels. Overall, financial incentives are the most effective, according to benefits advisers and healthcare experts. Hospitals are joining in the wellness program trend as well, with the Cleveland Clinic no longer hiring workers who smoke. Meanwhile, the National Workrights Institute recommends that employers offer voluntary wellness programs.
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Physicians

"Measuring Physician Performance"
Health Management Technology (04/08) Hanson, Jeff

While health plans, employers, and government agencies agree that performance metrics are essential to improving care quality, measuring physician performance is tricky given the numerous variable present in patient care. While physicians often view performance measures as a way for health insurers and government programs to cut costs regardless of patient care, these insurance programs need to ensure patient care is of the highest quality and the most efficient. Doctors are interested in performance metrics that do not rely on inadequate or unreliable data that does not take into account the level of patient sickness nor whether patients comply with treatment plans. The use of physician performance metrics is unlikely to fade into the background as healthcare costs soar and consumers are increasingly interested in comparison shopping because they have consumer-directed healthcare plans. The Physician Consortium for Quality Improvement drafted evidence-based measures of doctor performance, which were approved by the National Qualify Forum for testing; the group also hopes to create measures for subspecialties and diseases. Physician organizations, on the other hand are creating their own performance monitoring and improvement methods through continuing medical education requirements and board recertification programs. Experts hope all of these initiatives will eventually come together to form one nationally accepted system that provides a standard set of clinical methods and treatments for prevalent diseases. Although standard clinical guidelines may soon be established, there are still a variety of conflicting ways of analyzing performance data. To narrow down these guidelines the U.S. Centers for Medicaid and Medicare Services and the Agency for Healthcare Research Quality have begun testing these methodologies and comparing their outcomes. However, greater cooperation between physicians and payers will be necessary to ensure physician measures are accurate and successful.
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"Physician Workforce Crisis? Wrong Diagnosis, Wrong Person"
New England Journal of Medicine (04/17/08) Goodman, David C.; Fisher, Elliot S.

According to the Council on Graduate Medical Education (COGME) there will be a 10 percent shortfall of physicians by 2020. In response to this problem, the Association of American Medical Colleges suggests a 30 percent expansion of U.S. medical schools and an increase in the Medicare funding cap for graduate medical education. Analysts, however, note that physician supplies tend to vary up to 50 percent between regions, and recent surveys of Medicare beneficiaries reveal that care is not better in regions where doctor supplies are voluminous. Higher supplies of physicians do not mean better care for hospitalized patients or better patient outcomes. However, some studies suggest because physician salaries make up a great deal of medical spending, healthcare costs overall will rise with the supply of doctors; some are concerned these trends could further worsen the inequities present in the current healthcare system. Between 1979 and 1999 four out of every five new physicians went to regions where the supply of doctors was high, which is why unchecked medical education expansion could further exacerbate the physician shortage, particularly since the reimbursement system favors specialists. Moreover, expanding the workforce could be cost-prohibitive, when increasing the number of physicians by 30 percent would generate expenses up to $10 billion per year before the students even graduate. Experts believe the physician shortage is a symptom of failures in the healthcare delivery system, which must be remedied. Some suggest increasing funding for medical schools in areas of primary, geriatric, and palliative care, which foster better care coordination and chronic-disease management. Also, policymakers should enhance reimbursement systems so that integration and care efficiency become top priorities.
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"The Physician On-Call Dilemma: Emerging Solutions?"
Mondaq (04/02/08) Clark, Lisa W.

Under the federal Emergency Medical Treatment and Active Labor Act (EMTALA), general hospitals must provide on-call physician coverage to avoid fines from the U.S. Centers for Medicare and Medicaid Services, malpractice litigation and other sanctions. They also could be found in violation of state licensure laws. EMTALA does not state a required number of on-call physicians, only vaguely indicating that hospitals have an on-call list "that best meets the needs of the hospital's patients" and institute a plan to be executed when physicians cannot be available at times when they are on call or performing elective surgeries at other facilities. Legal experts say hospitals must include on-call policies prominently in medical staff bylaws, ensure medical staff understand the disciplinary consequences of violating these policies and have a plan to involve the governing board when on-call disagreements arise between administrators and medical staff. Hospitals that lack a sufficient number of on-call physicians and offer incentive payments to make sure coverage is provided must be aware that the Stark law's self-referral prohibition makes on-call payments illegal, except when payments are based on the fair market value of services. The EMTALA Technical Advisory Group (TAG) could offer hospitals some relief, as it has recommended the elimination of a Medicare participation mandate that physicians provide on-call services. TAG also is looking into such on-call solutions as telemedicine and geographic physician pooling.
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Management and Leadership

"Be a Better Leader, Have a Better Life"
Harvard Business Review (04/08) Vol. 86, No. 4, P. 112; Friedman, Stewart D.

Many people feel overwhelmed by their work because they are ignoring other aspects of their life. The Total Leadership program helps leaders focus on their work, home, community and self in order to make them more effective. The program requires people to perform "experiments," in which small changes to their daily routines benefit each of the four parts of their life. If the experiment works, it can benefit the employee, employer, family and community. If the changes are not successful, however, the changes are abandoned and employees gain additional knowledge about themselves and their limitations. An example of one such experiment would be setting aside time in the morning to exercise a few times a week, which not only improves an employee's personal health but also might give the employee more energy at work, leading to better job performance and increased self-esteem. Improving self-esteem and job performance can help workers better interact with their family and community. Experts recommend that employees try only three experiments at once because usually two will be successful and one will fail. After conducting experiments in several of the nine different categories, a person should then pick the three experiments with the largest impact. The best experiments are usually not complex, instead offering some small progress toward a larger goal, which will be achieved over time, say observers.
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"Developing Nursing Leaders"
Journal of Nursing Administration (04/01/08) Vol. 38, No. 4, P. 178; O'Neil, Edward; Morjikian, Robin L.; Cherner, David

Management and leadership development programs are even more integral to hospital performance than in previous years as costs continue to rise and organizational reforms become more necessary to foster quality care. Nursing leaders in executive, mid-level, and frontline positions all face many challenges, including patient safety, workplace safety, time management, and budgetary constraints. Of the challenges pinpointed by nursing leaders and non-nursing leaders surveyed, budgeting for programs and development programs is a top concern for many executive level leaders and mid-level managers, but frontline nurses view time management as a top concern. Leaders with nursing backgrounds note that nurses need a curriculum with an integrated hierarchy of skills, while those without nursing experience tend to think leadership and development courses for nurses should be more situationally focused. Overall, non-nursing leaders find internal programs more beneficial than nursing leaders, even though both groups agreed that external providers offer higher quality service. Although existing leadership training programs receive high satisfaction scores, both nurse leaders and non-nurse leaders agree that time and budget concerns prevent additional training from taking place, especially among frontline workers. The most important competencies that nurse leaders need are those that help build an effective team, translate a vision into a sound strategy, and communicate the vision and values of an organization to staff and others. Nurse leaders also indicate leadership programs must focus more attention on vision development and process implementation of that vision.
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