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Exciting New Initiatives at ASHHRA

Dear ASHHRA Colleagues:

One of the great things about being an ASHHRA member is that we are encouraged to stand up and speak out about policies that govern both workforce and health care. As a part of the American Hospital Association, we have an army of advocacy specialists guiding us, looking out for our organizations, and teaching us about the power of advocacy.

This past May, I couldn’t have been more proud to be an ASHHRA member when I accompanied the ASHHRA Advocacy Committee on their annual trek to Washington, D.C. With the help of our AHA/Washington colleagues, we were able to schedule visits with our own local Representatives and Senators to inform them of the impact current legislation might have on our organizations and our patients. It was an empowering experience, one that convinced me that individuals certainly can make a difference. You can read more about our Hill visit in the fall edition of HR PULSE. For now, you can review the position papers we presented: www.ashhra.org/ashhra/advocacy/position.html.

Another great thing about being an ASHHRA member is the constant flow of new products, services, and tools made available. This month is no exception. I hope you all received the e-blast about the new ASHHRA E-Company Store. As HR professionals, we are often the purchasers of promotional and recognition products for our organizations. The ASHHRA E-Company Store is an online catalog of products you can customize for your organization. There are two advantages to utilizing the ASHHRA E-Company Store:
  • ASHHRA gives you the most competitive price

  • By purchasing products, you are giving back to ASHHRA because ASHHRA earns a royalty for every product sold.
In addition, products are chosen from careful research identifying the most successful and popular products on the market for health care organizations. I hope you try it the next time you need to order items for your organization.

Last, I want to again remind you to register for the ASHHRA 44th Annual Conference and Exposition in Austin, Texas. It’s only four months away!

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
Are You Prepared for Hurricane Season?

Legal
"Doctor Disciplinary Actions Down for Third Year"
"Lawsuits Test Disabilities Act"

Workforce
"The Human Resource Craze: Human Performance Improvement and Employee Engagement"
"Well-Versed in Diversity"

Compensation
"Saving Lives, Money"

General HR
"Managing a Downturn"
"Cutting Costs in Workers Comp"

Benefits
"Playing for Keeps"
"Brokers Battle Benefits Blues"
"Consumer-Directed Plans Slow Cost Rise"
"The Price of Health"

Physicians
"MD Recruiting: Finding the Right Fit"
"Hospitalists and Physician Leadership"

Management and Leadership
"Leadership Style and Organizational Commitment: Mediating Effect of Role Stress"
"The Bottom Line: Financial Management Skills for Nurse Leaders"
"Leadership's Online Labs"
"The Essential Role of Boards in Executive Succession"


ASHHRA News

Are You Prepared for Hurricane Season?

The ASHHRA Disaster Planning Guide, written and inspired by ASHHRA members, provides health care HR professionals with unique strategies and tactics for managing and assisting their employees before, during, and after disasters. Order your Guide today from the ASHHRA online bookstore and be prepared for the future.
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Legal

"Doctor Disciplinary Actions Down for Third Year"
American Medical News (05/12/08) O'Reilly, Kevin B.

The number of disciplinary actions against doctors issued by state medical boards fell for the third straight year in 2007, according to the Federation of State Medical Boards. Overall, disciplinary actions are down 15 percent from an all time high in 2004. Over a dozen states are considering legislation to strengthen the power of their medical review boards. Legislation in the Kansas House would give the medical review board power to act on a single complaint, instead of waiting for a documented history of misconduct. Other states are considering legislation that would increase funding, allow for temporary emergency suspensions, and give the board the power to deny a medical license for anyone with a criminal record. Some officials argue the statistics are inaccurate because they do not take into account a state's effort to rehabilitate troubled physicians. "We don't get any credit for correcting our physicians and helping them to improve their ability to care for patients," said Drennan A. Clark of the Nevada State Board of Medical Examiners.
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"Lawsuits Test Disabilities Act"
Wall Street Journal (06/04/08) P. D1; Zhang, Jane

Two pending lawsuits are testing the extent of employees' rights under the Americans With Disabilities Act (ADA). Phillis Dewitt, an employee with Proctor Hospital in Peoria, Ill., and a Wyoming couple working for PacifiCorp were both fired and filed "association discrimination" suits, a provision of the ADA that deals with employers who discriminate against employees with sick family members. A lawyer with the U.S. Equal Employment Opportunity Commission (EEOC) attributes the growing number of suits--from 194 in 2007 to 253 this year--to a number of factors, including a slow economy, more women caretakers in the workforce, and high healthcare costs. Plaintiffs in these cases must prove their employers fired them not because of cost-cutting, which is lawful, but for discriminatory reasons. On several occasions, Dewitt claims her bosses at Proctor Hospital told her that medical bills for her husband Anthony's cancer treatments were too high. "This is outrageous behavior incompatible with the idea of health insurance as protection when you need it. If employers are permitted to do this, then everyone with a serious illness is at risk," says AARP Public Policy Director John Rother in reference to the Dewitt case.
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Workforce

"The Human Resource Craze: Human Performance Improvement and Employee Engagement"
Organization Development Journal (Quarter 2, 2008) Vol. 26, No. 1, P. 69; Endres, Grace M; Mancheno-Smoak, Lolita

Human resources (HR) departments focus on human productivity improvement and employee engagement as a way to create a competitive advantage for their organizations. The American Society for Training and Development released a human productivity improvement model consisting of business, performance, and cause analysis to improve productivity. Once the cause is determined, the model focuses on selecting and implementing a solution, then evaluating the results. A 2004 Gallup survey estimated that low productivity by disengaged workers costs the U.S. economy approximately $300 billion a year. Employee engagement can ensure innovation, growth, and productivity within the workforce, but currently there is no clear definition of the term. Some view employee engagement in terms of a workers' satisfaction with their work, while others define it as how workers connect to the company, co-workers, and customers. Development Dimensions International recommends organizations ensure workers' efforts are aligned with the overall strategy, empower workers to innovate and do their jobs well, encourage teamwork, recognize achievements of workers, and help employees develop and grow. There are many factors that a company must consider when developing an engagement improvement strategy, including workforce demographics, organizational model, and cultural norms.
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"Well-Versed in Diversity"
Modern Healthcare (05/19/08) Vol. 38, No. 20, P. 27; Donovan, Gail

Cultural diversity must be embraced by hospitals if they hope to remain competitive in the search for talented workers. Moreover, cultural diversity must be accepted by hospital employees to ensure patients of all cultures are accepted and treated with respect. A commitment to diversity must come from the board, senior managers, and employees. At Continuum Health Partners in New York, the four-hospital system adopted voluntary guidelines for senior and middle managers to use during the interviewing process. Each manager must have a set of criteria by which each candidate is judged for a particular position. Diversity programs also should involve transparency in recruitment and retention procedures. Surveying staff about their concerns and issues in the workplace--whether dealing with older workers or those from different cultures--can highlight how human resource departments can improve worker relations and ensure diverse patients are cared for without misunderstandings. Hospitals should consider mentoring programs to develop talent from within the organization, and succession plans that maintain a sense of diversity can help minorities break through the glass ceiling of management. Communication also is key in any diversity program to ensure that employees have the tools and knowledge to interact with a variety of cultures and generations.
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Compensation

"Saving Lives, Money"
Modern Healthcare (06/02/08) Robeznieks, Andis

According to the Leapfrog Group, physicians, nurses, and other clinical staff at the forefront of infection prevention should receive rewards for meeting their goals. The group unveiled the HAC-focused gainsharing model, which Reynolds & Co. President James Reynolds says could dole out incentives between $500,000 and $5 million depending upon the size of the hospital and how well staff members prevent infections. Reynolds' estimates account for just four hospital-acquired conditions--pressure ulcers, pulmonary embolism/deep vein thrombosis, sepsis, and ventilator-associated pneumonia. Recent studies indicate that the 194 hospitals in the New York Statewide Planning and Research Cooperative System database could reduce instances of those four conditions and save $82.8 million in net income and free up over 116,000 days of bed capacity. Leapfrog CEO Leah Binder notes the gainsharing model will have to be vetted against a recent U.S. Centers for Medicare and Medicaid Services rule to stop reimbursements for "never events," which will be implemented on October 1.
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General HR

"Managing a Downturn"
HR Magazine (05/08) Vol. 53, No. 5, P. 48; Wells, Susan J.

Surviving an economic downturn is viewed by many business leaders as something of an art form. Judgment is needed to determine whether a difficult situation will pass or develop into a long-term trend; but instead of relying on instinct alone, leaders must generate an emergency plan. A good plan will address what should be done if revenue falls by 20 percent, including whether certain programs should be cut or eliminated or whether further investments are necessary. Human resource staff must track salaries, bonuses, benefits, consulting expenses, and temporary staff costs, and when those costs rise above a certain target, adjustments must be made. Cost-benefit analyses can pinpoint which departments have too many workers and which have too few. Staff also can use the data to determine if too many staff or too little staff is more detrimental to the business over the long term. Understanding the financial nuances of human capital costs can help HR determine the best strategy to weather a recession or downturn. Experts also note that the best talent is available during a recession.
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"Cutting Costs in Workers Comp"
Spokane Journal of Business (05/29/08) Proffitt, Emily

The Center of Occupational Health & Education (COHE), a pilot project funded by the Washington state Department of Labor and Industries, has reduced the cost and length of workers' compensation claims significantly since its genesis five years ago, according to a recent study. The University of Washington released a report in March that evaluates the long-term savings for participants in the two COHE programs in Spokane and Renton. The study showed that both COHE centers had fewer contested claims, fewer rejected claims, fewer reopened claims, less frequent use of legal counsel by participants, and a better pension rate for time-loss benefits than non-COHE centers. The centers deal with claims involving common work injuries--carpal-tunnel syndrome, lower-back injuries, and upper and lower limb fractures--which make up roughly 80 percent of all claims, according to Dan Hansen, director of the COHE project at Spokane's St. Luke's Rehabilitation Institute. After one year of follow-up, the UW researchers estimated the savings for each COHE claim was $500 and nearly $1,300 after three or four years. After three years, COHE patients accrued an average of nine fewer disability days than non-COHE patients, according to Hansen. Expert doctors in the field of occupational medicine receive financial incentives for filing claims swiftly and for coordinating return-to-work plans with patients. An official at the Spokane center says the program has increased employee morale and retention.
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Benefits

"Playing for Keeps"
Tire Review (05/01/08) Koeth, Denise

Employers often seek workers in the market, which entails a great deal of initial investment in training and other functions. However, experts agree employers also should focus on retaining the talented workers they already have. To ensure workers are satisfied, businesses must survey the workforce and ensure any answers given are kept anonymous, which will foster greater honestly about benefits, salaries, and other aspects of the business. Human resource departments should conduct exit interviews with any workers leaving the firm to determine why they are leaving--information that could be useful in preventing other defections. Health insurance benefits are often a touchy subject with workers, which is why organizations must explore all available options in the market and select the best option for their workers. Experts agree that health plans should encourage workers to be healthy and minimize their sick days. Some suggest a health savings account (HSA), which allows employees to automatically contribute a portion of their pay into a tax-free account. Funds in these accounts can roll over yearly and provide money for health expenses. Other benefits that must be considered are employee-matched 401(k) plans, end-of-the-year or holiday bonuses, and Employee Stock Option plans. Gift cards and parties can be used as rewards for good work, as well as comfortable break rooms and health club memberships.
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"Brokers Battle Benefits Blues"
Risk & Insurance (06/08) Tuckey, Steve

Human resource departments are charged with balancing the need for enticing benefits and pack packages with spending the least amount on labor. With rising medical costs and growing concerns from older workers about their ability to pay those expenses in retirement, HR departments and benefits brokers must work together to create insurance and benefits packages to satisfy workers needs more than ever if employers hope to retain top talent. Currently about 52 percent of employees depend upon their employer for retirement and health insurance benefits, which is why experts say wellness programs can improve employee health, reduce employer expenses, and ensure workers have appropriate health insurance. However, fewer than 25 percent of employers have implemented these programs. Other cost-cutting avenues employers are relying upon include the use of employee-paid supplemental plans, the use of percentage-based co-pays instead of flat rates, and the elimination of coverage for part-time and seasonal workers, notes the Eastbridge Consulting Group. Dental coverage, on the other hand, rate increases are much slower than healthcare premiums, at just 5 percent in recent years, and covered items are practically unchanged.
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"Consumer-Directed Plans Slow Cost Rise"
HR Magazine (05/08) Vol. 53, No. 5, P. 30; Miller, Stephen

With healthcare costs rising at twice the rate of inflation, employers should consider health savings accounts (HSAs) or health reimbursement accounts (HRAs) as an alternative to traditional employee health insurance plans. According to the Mercer's National Survey of Employer-Sponsored Health Plans, total health benefits cost employers an average of $7,983 per employee in 2007. HSAs and HRAs, also known as consumer-directed health plans (CDHPs), cost less than $6,000 per employee on average compared to $7,120 for health maintenance organizations (HMOs) and $7,352 for preferred provider organizations (PPOs). In Mercer's survey of 3,000 public and private companies with 10 or more employees, less than 10 percent offered CDHPs to employees, but 90 percent of those who did said their employees received appropriate medical care. Eighty percent of large employers coupled their CDHPs with employee wellness programs designed to improve health and productivity.
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"The Price of Health"
Human Resource Executive (05/08) Vol. 22, No. 6, P. 46; Starner, Tom

Harvard University and University of Michigan researchers recently reported that employers can improve employee medication compliance and reduce healthcare costs by eliminating or reducing co-payments for certain medications. The study analyzed more than 35,000 employees and dependents whose employers reduced co-payments and then compared those results with that of 70,000 controls where co-payments were unchanged. Over the course of the study, co-pays for the first group fell from $5 to free for generic drugs, from $25 to $12 for name-brand drugs, and from $45 to $22 for non-preferred name-brand drugs. For the control group, co-pays were consistently around $29 for name-brand drugs and $16 for generics. The researchers then studied how co-pay reductions impacted patients taking five classes of medication for chronic conditions. Drugs investigated included heart-protecting ACE inhibitors and angiotensin-receptor blockers, blood-pressure reduction medications, diabetes medicines, cholesterol-reducing statins, and steroids used to treat asthma. Four out of five of those classes showed a significant increase in medication compliance when co-pays decreased. Experts hope as more evidence of the effectiveness of this strategy appears, more employers will be willing to consider using co-pay reductions to cut their long-term healthcare costs and help employees live longer, more productive lives.
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Physicians

"MD Recruiting: Finding the Right Fit"
Renal and Urology News (05/06/08)

Properly recruiting physicians can be a time-consuming endeavor, but experts say that time is well-spent when it means establishing a long-term relationship. As Martin Osinski, president of NephrologyUSA points out, "Keeping retention in mind is key because it will cost significantly more to bring someone on, have them leave, and then have to replace them--in terms of goodwill with your patients, the community, your time, and the costs of the recruitment process itself." Physician recruitment can take an average of one year to complete from initial contact to the day the doctor begins treating patients. However, the process can take significantly shorter or longer depending on particular licensing and credentialing requirements. During the recruitment process, prospective employers should communicate clearly with candidates about compensation, day-to-day operations, ability to generate production, work ethic, and other expectations. Physicians, in turn, also need to consider compensation, community relationships, clinical responsibilities, business growth, work-life balance, and other issues that could impact their acceptance of the position. Direct communication by all parties will not only expedite the recruitment process, but also lead to smoother transitions and better prospects for long-term retention.
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"Hospitalists and Physician Leadership"
Trustee (06/08) Wellikson, Larry

Under the current conditions within the healthcare system, hospitals are scrambling to improve patient care and safety, while at the same time reduce expenses as the economy worsens. To accomplish these goals, physician leadership is essential, which is why many hospitals are turning to hospitalists, who are primarily trained in internal medicine. According to the American Hospital Association, there are currently more than 20,000 hospitalists working at more than 2,500 hospitals nationwide. Approximately 10 percent of hospitalists are pediatricians, while 3 percent are trained in family medicine and 3 percent in general medicine and pediatrics. These professionals can help reduce patient stays and the costs associated with those stays by efficiently using hospital resources and streamlining the discharge and transfer processes. Hospitalists also engage emergency departments to manage observation units and admit new patients more quickly. Moreover, the Society of Hospital Medicine, The Joint Commission, and the National Quality Forum continue to work on guidelines for patient handoffs and transitions of care standards. These physicians have the expertise and leadership to manage healthcare teams to reduce medical errors, prevent infections, and reduce complications, as well as serve as a resource for trustees and board members seeking the best ways to improve facility operations and workflow. Hospitals can improve the availability of hospitalists, who rotate shifts so one is available 24-hours per day to admit patients, by focusing on training, recruitment, and retention.
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Management and Leadership

"Leadership Style and Organizational Commitment: Mediating Effect of Role Stress"
Journal of Managerial Issues (Quarter 2, 2008) Vol. 20, No. 1, P. 109; Dale, Kathleen; Fox, Marilyn L.

Employees who are committed to an organization identify with its goals, feel involved, and are loyal. People who are committed are less likely to leave for another job and are more likely to be on time and not take sick days. Keeping such employees should be a high priority, and leadership style is one major factor in an employee's decision to remain or leave. This study compares the effects of two opposing leadership styles--leader initiating structure and supervisory consideration--on organizational commitment. Leader initiating structure (IS) is how a supervisor defines their role and the roles of their employees in terms of a certain goal. Most studies show that IS causes employees to feel as though they have more responsibility and are more involved in the organization's plan. Structured roles and rules also create a perception of dependability, another factor that increases commitment. However, some researchers believe that if a leader gives a great deal of direction to employees, workers will feel like they have less responsibility and less autonomy. Meanwhile, supervisory consideration is the degree to which a leader creates a climate of support, trust, respect, and friendliness. The support system can include listening to workers' issues, accepting employee suggestions for improvement, and treating workers like equals. Researchers have linked social interaction between a leader and subordinates with organizational commitment. A recent study of workers at a large manufacturer in the Midwest revealed a positive link between leadership style and organizational commitment and a negative relationship between leadership style and role stress.
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"The Bottom Line: Financial Management Skills for Nurse Leaders"
Nursing for Women's Health (05/01/08) Vol. 12, No. 2, P. 157; Stichler, Jaynelle F.

Successful managers, including nurses and physicians, must not only think positively and strategically, communicate effectively, and empower the workforce, but also have a working financial knowledge of how to allocate resources to provide optimal patient care and generate profits for the organization. First, nurse and physician managers must be able to use past data to track volumes, revenues, fixed and variable expenses, average length of stay, diagnoses, occupancy rates, and other factors to predict future budgetary trends. Once these trends are recognized and tracked, these managers can use these quantified results to speak with the chief financial officer about their department's budgetary needs and goals. This entails understanding hospital income statements, or statements of financial operations in the case of non-profits, and the trends report or flex report, which break down costs by department. Hospitals should provide nurse and physician managers with information about both income and expenses so they are able to determine how their department expenditures fit into the overall financial picture and breakdown operating and capital budgets for their departments. Managers must provide financial departments with accurate information on fixed and variable expenses for their departments and provide details about when volume is higher and what expenses are incurred, which can aid in the examination of hospital cash flow. Variance reports, meanwhile, help explain to the financial department why expenses exceeded budgetary constraints in a given period, which can provide managers and executives with additional resource allocation information to improve budgeting.
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"Leadership's Online Labs"
Harvard Business Review (05/08) Vol. 86, No. 5, P. 58; Reeves, Byron; Malone, Thomas W.; O'Driscoll, Tony O.

As technology and business cultures change, online role-playing games (RPGs), like World of Warcraft, offer a unique opportunity to glimpse how leadership will evolve. Because these games create virtual communities with thousands of players working collaboratively in real-time, leadership challenges are inherent, such as recruiting, assessing, motivating, rewarding, and retaining a diverse talent pool. IBM and Seriosity recently conducted an eight-month examination of game leadership through a series of interviews with veteran gamers. As a result, parallels between the business and gaming worlds emerged, including the need for quick thinking and adaptability as strategies and information changed. Like the game world, business decisions are often made with incomplete information, and then those decisions are reshaped as new information emerges. Online gaming also requires a great deal of risk-taking, as in real-world business, though penalties can be more severe in the business world. However, unlike real-world business, gaming has a more transitive quality to its leadership, where leaders are selected organically depending on the mission's required expertise. Experts contend that as business becomes more complex and globalized, firms may see the benefit of choosing leaders with particular skill sets to head up certain projects. Observers also note that managers interested in motivating employees should consider outlining incentives before assignments are given so workers know what they will receive as a reward, which should come immediately following a completed task. This setup will provide workers with a clear connection between performance and reward. A final lesson from online RPGs is the use of hypertransparency where all player stats and data are updated and available to all participants, though in the business realm this may be more difficult to accomplish.
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"The Essential Role of Boards in Executive Succession"
Trustee (05/08) Hanson, Eric

Healthcare organizations could see many of their top executives retire in the next five years, and board members must play an integral role in succession planning. While boards should not be solely responsible for designing and executing succession plans, members must oversee the search for a new executive and ensure there is a system in place to cultivate new leaders. One element of succession planning is a long lead time, allowing candidates to fill in experience and skills gaps and to work with the current CEO to promote organizational continuity. Another element in succession planning is active board involvement with developing position criteria, selecting candidates, and interviewing possible candidates. Executive role criteria should not only incorporate the current needs of the hospital, but also its future needs based upon market trends, strategic direction, and even possible regulatory impacts. The evaluation process for CEOs should be stringent for both internal and external candidates, which can include personality profiles, simulation exercises, and interviews. If an internal candidate is selected, they should begin the transition process by working alongside the current CEO, and outside hires will need to work alongside the CEO as well as be immersed in the organization's culture. Communication is another key element in succession planning, which means all members of the hospital must be aware of how the succession process is progressing. The board must be sure to inform the rest of the organization about the process, presenting to workers a timeline and explanation of decisions.
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