ASHHRA Goes Green for
the '09 "Call for Presentations"
In an effort to reduce paper consumption, ASHHRA
is moving the conference RFP process online. The new RFP Web site will be
available Sept. 1, 2008 for the 2009 Annual Conference.
If you have great information to share and would like to present it at the ASHHRA 45th Annual Conference & Exposition,
Nov. 1 through 3, 2009, be prepared to submit your RFP beginning Sept. 1,
2008.
Look for more information to come in the next couple of weeks via e-mail
and on the ASHHRA
Web site. Return
to Headlines
You Can be a Grassroots Advocate
ASHHRA Advocacy Committee challenges
you to "step up," "raise your voice," and lead by
example. Not sure where to begin? Learn how you can participate in
grassroots advocacy.
Register for the FREE Webinar, "Learn to Advocate." Return to Headlines
Hospital Victories and Unfinished Business for the 110th Congress
Strong advocacy efforts by hospital leaders led to major victories on
Capitol Hill this year. Together with our state, metropolitan, and regional
association partners, and our personal membership groups, we quashed the
Administration’s budget proposals to cut Medicare and Medicaid
funding by nearly $200 billion over five years; blocked implementation of
six harmful Medicaid rules; and secured legislation allowing Federal Home
Loan Banks to issue letters of credit on hospital and other tax-exempt
bonds. Equally important, hospitals worked for the passage of the Medicare
Improvements for Patients and Providers Act that provides $1.1 billion in
funding for rural providers.
Lawmakers headed home on August 1 for a five-week recess leaving several
critical pieces of hospital legislation and other issues unresolved. When
they return in September, Congress is scheduled to be in session less than
a month. Here are a few of the key unresolved issues that affect HR
professionals:
Appropriations bills – Earlier in the year, most observers predicted
that Congress would have difficulty passing the 2009 Fiscal Year (FY)
appropriations bills that fund various segments of government. That
prediction has come true. To date, the House Appropriations Committee has
approved only five of the 12 regular appropriations bills; the Senate
Appropriations Committee has approved nine. The appropriations bill that
funds activities and programs – including nursing and allied health
education -- under the jurisdiction of the Departments of Labor, Education,
Health and Human Services, Education and Related Agencies is among the
measures remains unfinished that Congress will have to tackle when it
reconvenes. While both the House and Senate leadership hope to finish at
least one appropriations bill before the start of the fiscal year (October
1), the most likely scenario is that all unfinished bills will be folded
into a Continuing Resolution (CR) which would continue funding for programs
at last year’s levels.
The Emergency Nurse Supply Relief Act – On August 1, the House
Subcommittee on Immigration, Citizenship, Refugees, Border Security and
International Law approved H.R. 5924, the Emergency Supply Relief Act by a
vote of 7 to 2. The bill exempts foreign-educated RNs from the current
Employment-based (EB) visa caps for three years, setting aside 20,000 EB
visas per year for RNs and Physical Therapists. The bill also bolsters
domestic supply by establishing a grant program for nursing programs to
educate more nursing faculty. Finally, the bill creates a pilot program
designed to retain nurses in the workforce and enhance career training for
health care workers. At this time, it is unclear when the full House
Judiciary Committee will consider the bill.
ADA Amendments Act of 2008 (H.R. 3195) – On June 25, by a vote of
402-17, the House approved compromise legislation amending the Americans
with Disabilities Act. The legislation is aimed at addressing recent
Supreme Court decisions that some interpret as limiting reach of the ADA. H.R. 3195
clarifies the definition of “disability,” retaining the current
requirement that an impairment must “substantially limit a major life
activity” in order to be considered a disability. The measure also
excludes the consideration of mitigating measures in determining whether an
individual has a disability – with the exception of ordinary eyeglasses
and contact lenses. In addition, the bill provides that an individual is
“regarded as” having a disability if he can establish
discrimination because of an actual or perceived impairment. Lastly, the
bill retains current law requiring the employee to bear the burden of proof
demonstrating that he is qualified and able to perform a job. The bill now
moves to the Senate where its disposition remains unclear.
Mental Health Parity – An agreement has been reached in both the
House and Senate on mental health parity. Key provisions of the agreement
include:
- Benefit Mandate —
Allows group health plans to determine the extent of their coverage.
Does not impose a broad benefit mandate, instead it allows states to
legislate any individual mandates.
- Medical Management —
Protects medical management in health plans by preventing state laws
from infringing upon protection. This is vital because employers rely
on medical management of benefits to ensure the quality of care and
the affordability of coverage.
- Preemption — The
compromise creates a federal standard for parity, but also allows
states to enact more extensive laws for state-regulated insurance.
- Network Coverage —
The compromise mandates out-of-network coverage if the health plan
offers any other benefit on an out-of-network basis.
The agreement, which has not been
assigned a bill number, could be considered in September pending a decision
on funding.
Employment Verification – The Department of Homeland Security (DHS)
free, voluntary E-Verify program will expire on November 30 absent
congressional action. The E-Verify program is an online system jointly
operated by the DHS and the Social Security Administration (SSA).
Participating employers can confirm the work eligibility of new hires
online by comparing information from an employee’s I-9 form against
SSA and DHS data bases. Several alternative measures have been introduced
to address employment verification, including H.R. 6633 (Giffords-AZ));
H.R.1951 (Ellison-MN)); H.R. 5515 (Johnson-TX); and H.R. 4088 (Shuler-NC).
Individually and collectively, these unresolved issues impact
hospitals’ ability to take care of patients and provide the services
communities depend on. The August recess, when members of Congress are back
home, is an ideal time to contact your lawmakers and let your voice be
heard.
To contact the ASHHRA Advocacy
Committee representative in your region, go to http://www.ashhra.org/ashhra/advocacy/committee.html.
Return to Headlines
"Caregivers in the Crosshairs"
Risk Management (08/08) Vol. 55, No. 8, P. 42; Milano, Carol
Missed work time and on-the-job distractions related to employee caregiving
to family members costs employers an estimated $33.6 billion a year.
Employers also face the risk of family responsibility discrimination
lawsuits, the number of which has risen 400 percent over the past decade.
No federal law specifically bans family responsibility discrimination, but
the Equal Opportunity Commission released guidelines in 2008 that specify
employer obligations to employees who provide care for children, the
elderly, or disabled. Many of these lawsuits have been successful because
the bias against the employee is so easy to prove and juries usually side
with employees. Experts predict that more class action lawsuits will be
filed in the future, so employers need to take steps to reduce their
liability. Adding a FRD component to an existing training program can help
managers familiarize themselves with the legal guidelines and change the
way they handle leave caregiving situations. Complying with the Family and
Medical Leave Act can help employers keep experienced employees and
wellness programs can help them balance caregiving and work
responsibilities. Nine out of 10 FMLA-covered employers said that the law
has had a neutral or positive effect on their company's profit. Giving
employees the option of working from home can increase productivity,
because there is less turnover and workers do not deal with the
distractions of the office.
Return to Headlines
"Cash-Balance Plans Not Discriminatory, Court
Rules"
Workforce Management (07/08) Geisel, Jerry
The Second U.S. Court of Appeals found that the benefits included in a
cash-balance plan are more valuable to younger employees than to older
ones, but do not violate the federal age discrimination law. According to
the July 9 ruling regarding the cash-balance plans of Verizon
Communications and Equitable Life Assurance Society, the difference in
value is related to the time and compound interest on the accounts, which
is outside the scope of employer liability and does not constitute age
discrimination. This recent case marks the fourth time an age
discrimination suit over employer-sponsored benefits has come before an
appeals court. The Seventh Circuit Court of Appeals set the precedent in
2006 when it overturned a 2003 ruling by a federal judge in Southern
Illinois; the ruling stated that IBM's cash-balance pensions did not
discrimination against older workers. Two other cases followed in 2007 from
the Third and Sixth Circuit Appeals Courts against PNC Financial Services
and World Color Press, respectively. Nancy Ross, a partner with
Chicago-based McDermott, Will & Emery, believes these decisions
"should be the death knell of cash-balance plan litigation” and
"will quash participants' desires to challenge these plans." One
more pension case is still pending--the Southern California Gas Co. is
currently awaiting a verdict from the Ninth U.S. Circuit Court of Appeals.
Return to Headlines
"Severance Strategies"
HR Magazine (07/08) Vol. 53, No. 7, P. 95; Segal, Jonathan, A.
When ending an employment relationship, many companies tend to stick to a
one-size-fits-all form of severance, but this approach can be costly for
organizations, particularly if litigation occurs. Form severance agreements
can be especially risky because courts are constantly revising severance
litigation and an agreement can become outdated quickly. Human resources
personnel must examine severance agreements in terms of an employee's age,
whether their termination is part of a group or an individual event, and the
state in which the employee works. When it comes to age employees over
40-years-old must be given at least 21 days to consider a severance
agreement, unless they are being terminated as part of a group, in which
case they must be given 45 days. Once these older workers agree to the
severance arrangement, they must be allowed one week to reconsider their
position and possibly revoke their approval. While younger workers do not
have these protections, employers may want to consider offering similar
grace periods, especially if the younger workers are likely to pursue legal
action. When workers are terminated as part of a group, employees must be
given data on which positions were considered for termination, such as a
department, unit, or division. After defining the group considered for
termination, the employer must then identify the job titles and ages of all
members within the group as well as eligibility factors used by the
program. Some courts have ruled that employers must provide information as
to why certain employees were selected for termination over others. All of
these factors must be accounted for in the severance agreement process to
minimize litigation and other business risks.
Return to Headlines
"Employee Motivation: A Powerful New Model"
Harvard Business Review (08/08) Vol. 86, No. 7, P. 79; Nohria, Nitin;
Groysberg, Boris; Lee, Linda-Eling
Managers are constantly striving for new ways to motivate their employees.
Researchers have identified four behaviors that motivate employees--the
drive to acquire, the drive to bond, the drive to comprehend, and the drive
to defend. To determine what specific actions managers can take to satisfy
these internal drives, researchers surveyed 385 employees working for two
international companies and 300 employees from Fortune 500 companies.
Researchers utilized four measurements for job motivation--engagement,
satisfaction, commitment, and intention to quit. When employers satisfied
all four motivational drivers, it accounted for 60 percent of a worker's
motivation. Reward systems are the tool most often used by employers to
satisfy motivational drivers because it rewards good performance and offers
the best opportunities to those employees who are dedicated and talented.
Meanwhile, creating a teamwork culture can help satisfy a worker's need to
bond through collaboration and open communication. Managers also must
create jobs that are meaningful to workers, but that also challenge them.
With fair, honest, and transparent performance management and
resource-allocation processes, employee's drive to defend can be easily
met, say researchers.
Return to Headlines
"Nursing Generations in the Contemporary
Workplace"
Public Personnel Management (Quarter 3, 2008) Vol. 37, No. 2, P. 137;
Blythe, Jennifer; Baumann, Andrea; Zeytinoglu, Isik U.
To maintain the size of its workforce, the healthcare industry must recruit
more young workers and convince older workers to stay with the organization
after they become eligible for retirement. The different generations in the
current workforce have different priorities and needs, so different
incentives may need to be offered to meet the needs of nurses of differing
ages. Researchers carried out a study of nurses at three large teaching
hospitals in Canada,
working with 10 focus groups of registered nurses and four focus groups of
managers. Many nurses also were randomly chosen to take a survey to measure
organization commitment, career commitment, and job satisfaction. Results
showed that older nurses are generally more committed to their individual
hospital, but nurses between the ages of 20 and 29 are more committed to a
career in nursing. Most nurses were least satisfied with their pay and
benefits, even though they were mostly satisfied with the type of work they
did. One suggested way to keep older workers is to offer partial or phased
retirement programs that do not negatively impact the employees' pensions
or benefits. Nurses between the ages of 40 and 49 were not pleased with
their chances for a promotion, so offering them a mentorship role could
open up new opportunities and allow them to pass their skills onto the
younger generation. Offering workers between the ages of 30 and 39 higher
pay and an opportunity to participate in decision making could keep them
from switching jobs, note experts. To recruit more young workers, hospitals
should offer more full-time positions and help younger nurses reach career
goals by offering specialty training.
Return to Headlines
"Online Learning as a Staff Risk Management
Education Option"
Journal of Healthcare Risk Management (07/01/2008) Vol. 27, No. 4, P.
31; Oppenberg, Andrew A.; Walters, Clifford A.; Stottlemyer, Debra L.
Researchers have developed an online risk management and patient safety
program that consists of 15 lessons taught in three different online
courses. Internet-based training is a helpful alternative to classroom
training for busy resident physicians and other healthcare workers. The
program was designed using documented needs from other studies and the
recommendations of practicing risk management professionals. It can be
implemented through Blackboard, an electronic virtual classroom. The
courses require physicians to actively participate by reading assigned
materials and answering weekly questions on an online forum. Around 86
percent of participants passed the course between 2002 and 2005, with over
61.7 percent grading it as an "outstanding" or "above average"
program. Healthcare organizations with limited resources could partner with
commercial or educational organizations to fund this and similar training
program for healthcare workers.
Return to Headlines
"Changes Possible to Area Wage Index"
Healthcare Executive (08/08) Vol. 23, No. 4, P. 48; Ferman, John H.
Health Policy Alternatives Inc. Principal John H. Ferman urges the nation's
3,530 acute-care hospitals to pay close attention to the notice of proposed
rulemaking issued by the U.S. Centers for Medicare and Medicaid Services
with regard to the FY 2009 acute inpatient prospective payment system
slated for implementation on Oct. 1, 2008. The final rule is set for
publication on Aug. 1, and it could revise the hospital wage index and
impact other healthcare facilities. Ferman says the issue is of great
importance because a 10 percent adjustment in the wage index would impact
Medicare payments. The proposed revision was called for under the Medicare
Improvements and Extensions Act, a provision of the Tax Relief and Health
Care Act of 2006. The provision indicates that several things must be taken
into consideration when revising the wage index, including challenges tied
to defining labor markets; modifying or eliminating geographic
reclassifications; minimizing differences in adjustments among urban labor
market areas and statewide rural areas; the impact of the proposal on
providers in all regions of the United States; and staffing practices,
patient safety, care quality, and other "occupational mix"
issues. A report on the Medicare index prepared by the Medicare Payment
Advisory Commission shows that small percentage changes in wages would be
experienced by a majority of hospital categories, though geographically
reclassified facilities and those granted special exceptions would be
negatively impacted by the changes. The biggest drops in the wage index
likely would occur in Arizona, Colorado, Idaho, Montana, Nevada, New
Mexico, Utah, and Wyoming, according to the report, while the biggest gains
would be reported in Alabama, Kentucky, Mississippi, and Tennessee.
Payments in urban hospitals combined would rise 0.1 percent, but a 0.7
percent decline would be posted by rural hospitals as a group.
Return to Headlines
"The Calculus of Incentive Pay"
Modern Healthcare (07/28/08) Vol. 38, No. 30, P. 32; Hefner, David;
Hastings, Kathryn
The first step an academic health center (AHC) must take when creating an
effective incentives program is to unify its performance goals. Next, the
center should determine if it is serving the community to its fullest
capacity, and if not, how financial health and community service could both
be improved by stronger overall performance. Experts say incentives programs
compel physicians to perform to a higher standard; however, this also
requires that leaders clearly define goals, track performances, and send
regular performance updates to their staff. The AHC should choose a handful
of specific performance goals--for both the organization and the
individual--that are reasonable and address strategic priorities within the
healthcare network. To ensure the incentives program is effective and
serves its purpose, an academic health center should: define the program's
purpose; name the person in charge of oversight for the program; determine
the performance measurement period; determine who is eligible to
participate in the program; set objective performance goals and measures
that apply inside and outside the AHC; establish minimum performance levels
for incentive pay; and define award opportunities. A successful incentives
program both improves an AHC's overall performance, and gives executives a
clear framework for determining a physician's pay. Additionally, it sets up
a structure through which hard work is identified and rewarded by
supervisors.
Return to Headlines
"Nice Job, Bob!"
Christian Science Monitor (07/14/08) P. 13; Gardner, Marilyn
Employee-appreciation programs are growing among small and large
organizations as managers realize that recognition can improve
productivity. A recent Recognition Professional International survey of
10,000 workers from Fortune 1,000 companies indicates that workers leave
their jobs because they do not feel appreciated. As a result, companies
like Intel and Cargill Inc. have created entire departments devoted to
recognition program development and administration. Human resources
professionals often say that worker morale is low when bosses fail to make
time to talk with their workers. While recognition comes in many forms,
with many employers using cash or gifts, workers do not place the same
emphasis on monetary recognition. Older workers from the World War II
generation may shun a public awards ceremony, whereas the 20-something
children of baby-boomers generally expect regular praise and recognition.
Heftier rewards can include paid vacations, golf club memberships, or
expensive dinners, but more modest rewards like free ice cream, movie
tickets, or personalized thank-you notes also work.
Return to Headlines
"Nurses Wrestle With the Pros and Cons of
Pay-for-Performance Plans"
Nurse.com (07/14/08) Kirchheimer, Barbara
The U.S. Centers for Medicare and Medicaid Services (CMS) will no longer
reimburse hospitals for eight hospital-acquired conditions, including four
that the National Quality Forum identified as "nursing-sensitive"
outcomes. Among the nursing-sensitive outcomes are catheter-associated
infections and patient falls, and CMS could eliminate hospital
reimbursements for hospital-acquired ventilator-associated pneumonia, which
is considered another nursing-sensitive issue. This decision will most
likely increase the attention paid to nurses' roles in patient outcomes, which
experts believe will showcase nurses' contributions to the healthcare
system. Nurses have historically not been a high priority for data
collection, but hospitals must put a greater focus on their performance.
The new CMS regulations will force hospitals to become more accountable,
and some are concerned that hospitals will cut costs or not assign nurses
to patients at risk for complications. Experts, on the other hand, note
that the problems stem not from poor nursing care, but a shortage of
nurses.
Return to Headlines
"Hot Commodity"
Modern Healthcare (07/14/08) Vol. 38, No. 28, P. 26; Robeznieks, Andis
Recruitment strategies for internists, pediatricians, and family practice
doctors now include "loan forgiveness" agreements and additional
compensation for administrative tasks. These positions are increasingly
difficult to fill for hospitals because salaries are not as competitive as
they are in other medical fields. Modern Healthcare's 2008 Physician
Compensation Survey revealed some of the disparities; plastic surgeons
questioned for this year's survey earned upwards of $790,000 a year, while
first-year pediatricians made a yearly income of $140,000 on average.
Radiology, cardiology, orthopedic surgery, and gastroenterology rounded out
the top-five highest paying fields in medicine; family practice,
psychiatry, hospitalists, and neurology are among the lowest paying fields.
Other forms of remuneration are increasingly necessary because "new
levels of physician compensation may be unsustainable going forward,"
admits Phil Villacci of the medical consulting firm Beacon Partners.
Hospitals are starting to hire their own physicians as part of a
"defensive" recruitment strategy to benefit both healthcare
systems and doctors. Hospitals offer to pay a physician's medical school
debt in exchange for several years of work; in addition, doctors can work
in research trials and perform administrative duties for additional income.
By working in a larger healthcare system, physicians reduce their liability
risk, share their workload, and receive compensation or commission based
upon the procedures they perform.
Return to Headlines
"Black Nurses Earn Less Than Whites"
Crain's New York Business (07/06/08) Scott, Gale
Black nurses working in New York City make less than their white
colleagues, according to a study by the Center for Health Workforce Studies
at State University of New York (SUNY) in Albany. White nurses with 30 or
more years of experience earned 11 percent more than their black
counterparts. New York City Councilwoman Letitia James said she will ask
the city to look into the study's results. One possible reason for the pay
gap is that white nurses are more likely to work at private hospitals,
which generally pay more than public hospitals. Around 57 percent of nurses
in private hospitals are white, compared to 20 percent at public
facilities. However, the group plans to study the reasons behind the pay
gap in a second survey. Anecdotal evidence suggests racism, with one nurse
stating that she was paid $20,000 less than her white colleagues and upon
asking if her race contributed to the pay decision was given a large raise.
Return to Headlines
"Nurse to Patient Ratios and Quality Health Care
in Ohio"
Injury Board (07/30/2008) DiCello, Nick
A group of healthcare advocates in Ohio are pushing for a new law to
reinforce lower nurse to patient ratios. Hospitals across the country are
understaffed, and it is normal for one nurse to juggle between 10 and 12
patients in one shift. Extensive research shows that high nurse to patient
ratios contribute to inferior care and attention, higher rates of infection
and injury in the hospital, and even mortality. In response, California
established its own law in 2004 setting a minimum nurse-to-patient ratio
for hospitals throughout the state. Nurses are to attend to no more than
four patients on each shift to ensure patients receive the best care and
attention. In Ohio, proponents of nurse to patient ratios want state
legislators to pass the Patient Safety Protection Act of 2008, which
supplements and enforces healthcare policy already in place. According to
the bill's supporters, Ohio's hospitals may be paying too much attention to
cost efficiency and are not examining the risks of overloading nurses.
Instead, proponents say patient safety makes necessary a law that
reasonably lowers nurse to patient ratios. High ratios not only compromise
patient safety, but they can cause quick burnout for nurses. Reporter Diane
Suchetka recently published an article for the Cleveland Plain Dealer
describing the "horrors" she had seen in some Ohio hospitals
where nurses were overrun with patients, and how some nurses quit because
of too much pressure.
Return to Headlines
"Study Confirms Widespread Cheating on Job
Exams"
Boston Globe (07/22/08)
A recent study conducted by Cisco Systems Inc. and Pearson VUE showed that cheating
on job certification systems is more prevalent than expected. Out of
200,000 exams monitored, Cisco identified 1,400 possible cheaters,
approximately 1,000 of whom were found to be taking the exam for someone
else. These "proxy" test takers where most common at testing
centers in China, India, Hong Kong, and Pakistan. In order to reduce the
risk of cheating, Cisco will soon launch the new test-security system that
was used to detect cheaters during the study. Features of the new system
include data forensics technology that can track abnormal performance and
digital storage of test-takers photographs that allow employers to match
results with the photo. In addition, Cisco will deploy undercover test
takers to help catch cheaters in the act.
Return to Headlines
"Hospital Bullies Take a Toll on Patient
Safety"
MSNBC (07/09/08) Aleccia, JoNel
The medical community has finally reached a point of intolerance for temper
tantrums and general bad behavior among doctors and nurses. Though only a
small percentage of medical workers resort to flagrant physical and
emotional intimidation--between 4 percent and 6 percent, according to some
estimates--a majority of medical practitioners have been on the receiving
end of this behavior. According to a new study published in the journal of
Obstetric, Gynecologic & Neonatal Nursing, 70 percent of the nurses
surveyed see a connection between erratic behavior and adverse patient
outcomes, and one-quarter see a direct relationship between bad behavior
and mortality rates. Forty percent of respondents in a separate study of
doctors and nurses by the Institute for Safe Medication Practices (ISMP)
said that on at least one occasion they kept quiet about medication
concerns to avoid a confrontation with an unpleasant doctor. The Joint
Commission will soon require all hospitals to implement a behavioral code
that identifies unacceptable behaviors and lays out a disciplinary plan.
These actions can include practicing business etiquette and giving sincere
apologies to the patients and families who witness inappropriate behavior.
These policies should not only address physical behaviors--throwing things,
shoving, yelling, or cursing--but also emotional behaviors--ignoring
colleagues, condescension, and insults. Hospitals must formally address
this issue starting January 2008, though it could be years before medical
professionals consider it unseemly to behave badly at work.
Return to Headlines
"Easing the Burden of Employee's Debt"
HR Magazine (07/08) Vol. 53, No. 7, P. 61; Weaver, Peter; Rollins, Gina
As the economic outlook remains dim, more employers are taking the time to
help their employers protect themselves by improving their financial
education. To this end, employers are pursuing a number of options
including workshops, courses, online resources, and one-on-one sessions
with financial counselors. HR professionals say equipping workers with the
knowledge to maintain their financial health is just as important as wellness
programs aimed at improving workers' health. Credit unions and other
employee organizations already offer financial management courses, but many
of these programs focus on general investment advice rather than on
budgeting or debt management. Employers interested in offering these
financial education programs should consult with a financial professional
or organization to develop and provide instruction. However, whoever is
chosen to provide financial education to workers, employers must first
perform due diligence to ensure these providers are the best option.
Additionally, employers must inform employees that these consultants and
organizations are not recommendations, but merely resources for them to use
if they choose to do so.
Return to Headlines
"How to Glean More Relevant Information From
Exit Interviews"
Compensation & Benefits for Law Offices (07/08) Vol. 2008, No. 7,
There are several strategies companies can use to gain valuable information
from exit interviews. This includes formulating a consistent policy for
handling exit interviews, for which participation must be voluntary.
Questions should be thoughtful and probing but not intrusive or personal.
The aim is to uncover why a person is leaving to find patterns in voluntary
departures, says Hal Gueutal, associate professor of management at the
University of Albany. Departing employees might be asked such things as
level of satisfaction with their salary, benefits, and working conditions,
work/life balance, colleagues and managers, supervision, training, career
development, and advancement. Companies should also discuss their legal
responsibilities related to confidentiality. Interviewers should be
provided with guidance on follow-up questions, and interviews should be
held as close as possible to the expected departure. In addition, a company
should create an environment that fosters communication and feedback on an
ongoing basis. This could take the form of gathering data from
employees--with personal information omitted--to form annual, semiannual,
or quarterly reports for senior management.
Return to Headlines
"Better Scheduling Boosts Productivity"
Health Data Management (07/08) Anderson, Howard J.
Staff scheduling software is a productivity enhancement tool that
executives say has even more uses than just improving staff scheduling
efficiency. Some executives indicate these programs can ensure union
contracts are met, state-regulated nurse ratios are complied with and labor
costs are reduced. Resurrection Health Care, which runs several
Chicago-area hospitals, says it will use its scheduling software as a labor
management tool to ensure the right nurses with the appropriate skill
levels are on duty to meet patient acuity needs. For instance, the
frequency of blood draws on a chemotherapy unit will require a set number
of nurses. The hospital system will combine the scheduling software's
functions with its time and attendance and admission/discharge/transfer
systems to allow nurse managers to evaluate and alter schedules on a
shift-by-shift basis because real-time data is available. Some hospitals
find the software can be adapted to ensure target care hours for given
patients are met on each shift, which managers can use to explain why
nursing levels are higher on some days rather than others. Integrated
scheduling programs also enable nurse managers to ensure union contract
overtime requirements are met and payroll is efficient. Additionally,
software coding can help managers gauge how long orientation programs take
and how much time nurses spend learning new systems or attending meetings.
Return to Headlines
"To Your Health"
Wall Street Journal (07/14/08) P. R5; Zhang, Jane
Approximately 6.1 million people are eligible for health savings accounts
(HSAs) as of January 2008, according to America's Health Insurance Plans.
However, about 40 percent of those eligible for these plans still have not
taken advantage of them, and experts indicate employees are not investing
in HSAs because they do not believe they have enough information to make
sound decisions. HR professionals must provide workers with the information
the need regarding HSA enrollment and use. Younger workers who are
healthier should be informed of the tax and insurance advantages of HSAs,
which can be used to save for healthcare expenses that emerge as they age.
HR staff also need to inform employees about the variety of HSA products
available from banks, credit unions, insurance companies, and other
financial firms. This information will help employees choose the accounts
to meet their needs, but HR professionals also need to keep workers abreast
of contribution limits. Experts report that users should invest up to the
deductible amount to avoid exceeding the HSA contribution limits, which
will incur excise taxes. Employees with HSAs should carefully shop around
for doctors and hospitals that meet their needs and their budgets. Experts
recommend that workers shop around for each individual non-emergency
procedure to find physicians that provide quality, cost-effective care.
Although users find tax incentives of these plans beneficial, employees
should not file their taxes until they receive a copy of IRS Form 5498,
which discloses the HSA-custodian's contribution to the plan. Finally, HR
professionals should ensure employees are aware that funds in their HSA
accounts transfer from year to year, making it important to maximize their
contributions and save as much as possible for their retirement years.
Return to Headlines
"Controlling Healthcare Costs"
HR Zone (07/04/2008) Burfitt, Tom
Many employers looking to reduce healthcare costs are turning to modular
insurance plans. However, many benefits sales teams continue to focus
cost-saving initiatives on stripping benefits from employer programs, which
means some personalized modular plans are not providing the benefits that
workers need. If healthcare plans do not meet the needs of workers, staff
morale can diminish, especially if coverage is inadequate. Organizations
need to determine how much coverage an organization needs given the budget
for the expense. HR, finance, and a benefits consultant should work
together to examine the number and severity of claims to determine
organizational trends among those workers using health insurance benefits.
Once a plan is selected, organizations must still keep tabs on absence and
sickness rates among workers to ensure the health benefits remain cost
efficient. Furthermore, experts suggest choosing a healthcare plan that
encourages wellness and preventive care, instead of focusing on existing
conditions.
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"A Call for Quality Care"
Human Resource Executive (07/08) Vol. 22, No. 10, P. 30; Preter,
Maurice; Kahn, Jeffrey P.
Employers are increasingly aware that mental health care is essential for a
happy and productive workforce. Mental health can impact productivity,
morale, and focus of most workers, especially as stress levels rise.
Depression, which is common among workers, can stem from an illness,
marital problems, financial issues, or mood disorders. However, employers
should not assume that all mental illnesses can be treated in the same way,
which means processes should be established to help workers identify their
ailments, seek appropriate treatment, and address the problem.
Psychologists should be recommended to those showing signs of anxiety or
depression on the job because only trained professionals can determine the
root case and offer treatment. For example, one organization hired its own
in-house psychiatrist, which reportedly reduced short-term disability
claims by more than half.
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"Seven Steps to Successful Medical Staff
Development Planning"
Trustee (07/08) Vol. 61, No. 7, P. 30; Lifton, James
Governing boards should attempt to create a medical staff development plan
that is helpful to strategic and business planning. These plans can help
recruit physicians and justify major facility projects. Medical staff
development planning should contain an assessment of physician supply and
demand in a number of physician categories. Healthcare facilities also
should consider non-physician clinicians, such as psychologists and
midwives, in the planning process because they play a larger role in
healthcare. New physicians spend an average of 15 percent fewer hours in
practice than the previous generation, a statistic that must be considered
when hospitals seek to replace retiring workers. A hospital also must have
a variety of practice options for physicians, including flexibility for
part-time practices and relationships with existing practices. Moreover,
experts indicate efficient work environments go a long way to improving
employee and staff morale, patient satisfaction, and profitability. Those
hospitals that make it easy for physicians to come aboard will have a
competitive advantage in communities where physician demand surpasses the
supply, note experts.
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"Docs Resist Staff Standard"
Modern Healthcare (06/23/08) Vol. 38, No. 25, P. 8
The American Medical Association (AMA) could drop out of The Joint
Commission if the new revisions to MS 1.20, the standard that oversees
medical staff bylaws, are not adopted. The American Hospital Association
pressured The Joint Commission into delaying the implementation of MS 1.20,
and physicians contend revisions to the rule are heavily biased toward
hospital control. The earlier draft guaranteed doctors' rights to
self-governance and ensured that the full medical staff participated in the
creation of a patient safety culture in hospitals. Hospitals contend the
draft MS 1.20 passed in 2007 undermines collaborative efforts between
doctors and hospitals. The Joint Commission MS 1.20 task force will
continue to review the draft, and it could possibly make changes to the
draft. The crux of the bylaw change would allow medical executive
committees access to hospital boards and administrators, but critics are
concerned that these committees are composed of physicians with financial
ties to hospitals, which can color their views on various reforms.
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"Primary Care Gap Affects Bay State
Reforms"
National Underwriter (Life and Health Financial Services Edition)
(06/20/08) Reid, Tiffany
The shortage of primary care physicians is acute in Massachusetts where the
state established new regulations requiring all residents to obtain some
form of health coverage or lose their state income tax exemption. Physician
shortages across the United States continue to be a problem, but in
Massachusetts, some patients reporting having to schedule appointments with
primary care doctors up to four months in advance. Massachusetts
Association of Health Plans President Dr. Marylou Buyse says, "Half of
the primary care practices in Massachusetts are closed to new patients[,
and] many community health centers, which typically serve the poor, have
placed temporary freezes on enrollment." Because specialists are paid
more than primary care doctors and many medical students carry hefty debt,
students turn to specialties, leaving a dearth of qualified primary care
doctors. As the shortage continues to impinge care in the state, even under
the new Commonwealth Care system, state lawmakers are drafting legislation
to establish a primary-care physician recruitment center to fill some of
the gap. Meanwhile, Bank of America Corp. is donating $5 million to help
repay medical school loans for primary care doctors who agree to practice
in state community health centers.
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Management and Leadership
"Building Partnerships: Addressing Overuse,
Underused, and Misuse of Care"
Healthcare Executive (08/08) Vol. 23, No. 4, P. 9; Wennberg, David;
Berkson, Doug; Rider, Betty
Geography plays a significant part in determining the quality, quantity,
and cost of healthcare, according to research from the Dartmouth Institute
for Health Policy and Clinical Practice. The 2008 edition of the Dartmouth
Atlas of Health Care details a number of unwarranted variations in
healthcare quality impacted by location, particularly in terms of effective
care and patient safety. Although all healthcare facilities value quality
care, the level of quality considered acceptable may be influenced by
poorly understood care processes, a failure to learn about these processes,
and inadequate systems to support quality care, as well as financial
incentives for less effective care. The second unwarranted variation
effects preference-sensitive care, which can adversely impact patients with
a number of different treatment options. Physician-patient role confusion,
inadequate decision support for patients and physicians, and financial
incentives that may bias care preferences can all negatively influence the
doctor-patient decision-making process. The final unwarranted variation is
supply-sensitive care, which is strongly connected with the resource
capacity of each healthcare system as well as serving as a indicator of the
efficiency in that system. The causes for unwarranted variation in
supply-sensitive care include mismatches between capacity and need, the
assumption that financial incentives will encourage more supply-sensitive
care, and the tendency to mistake quantity for quality. The mark of a
high-performing healthcare system is one that works to effectively reduce
the three types of unwarranted variation. To counteract these unwarranted
variations, hospitals should increase transparency, create and reward
system-level changes, establish benefit structures for providing effective
care, and base payments upon system performance. Additionally, hospitals
will want to ensure physicians, staff, and patients have quality tools,
shared decision-making support, and access to risk-benefit evaluations.
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"The Right and Wrong Way to Handle Worker
Layoffs"
Investor's Business Daily (07/14/08) P. A7; Stettner, Morey
Workers often have very emotional responses when laid-off or fired from a
position, which is why managers should refrain from babbling out of
nervousness or the need to fill the silence after communicating a simple
message to the employee. Managers must craft a simple, clear message before
asking the employee to meet in person; once the message is delivered, the
manager should ask if the worker has questions and wait for the employee to
speak. Bill Nolan of Squire, Sanders & Dempsey in Columbus, Ohio,
observes that the best thing to do is avoid arguing or over-explaining the
decision. Additional, unnecessary conversation on the part of the manager
can lead to regrets later on, says Nolan. Managers must also prepare for a
range of emotional responses, including silence, crying, and anger. If
workplace termination papers need the worker's signature and they refuse to
sign the papers, managers should simply tell the terminated worker that
their refusal has been documented. Arguing about the signature simply
escalates emotional responses. Managers also should prepare to answer
questions regarding health insurance, termination packages, and whether a
good recommendation is available to the worker. Nolan says that while
lending a sympathetic ear is admirable, managers should not give the
impression that the decision can be reversed.
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"Identifying High Performers"
Human Resource Executive (07/08) Ronn, Kurt
The top characteristics companies should seek in job candidates are an ability
to get results, have influence over others, demonstrate leadership, pursue
greater education and learning, and an ability to competently use job
skills. Leadership IQ's recent survey reveals that recruiters and HR staff
are likely to have an easier time locating top talent in today's market
because only 20 percent of low-performers are seeking new jobs, while about
50 percent of high-performers are looking for new jobs. HR experts note
that consistency is the best indicator of whether the job candidate will
produce quality work over a long period of time. Experts indicate recruits
who work well with bosses and colleagues, are able to get their point
across convincingly, and are willing to work with people inside and outside
an organization are the best candidates. Moreover, high-performers will
often take on more responsibility because they are capable of executing
tasks effectively and leading others when necessary. Additionally,
high-performers are often those that seek out learning opportunities in
their fields that can be applied to their current positions.
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"Why Do Employees File Discrimination Complaints
and Grievances? Advice to Managers and Supervisors"
FedSmith.com (07/08/08) Opperman, Steve
Employees file equal employment opportunity (EEO) suits for a number of
reasons, according to Steve Opperman. Many of these EEO suits stem from
poor communication or miscommunication. For instance, an employee may come
to believe that they are being singled out for discrimination due to such
factors as race, color, national origin, sex, sexual orientation, religion,
age, or disability. Miscommunication may also contribute to an employee's
belief that supervisors or managers are biased or are participating in stereotyping,
even if unconsciously. A recent poll conducted by the Washington-Post and
ABC News found that 30 percent of American's acknowledge feelings of racial
bias, and these feelings are likely to effuse into the workplace. If these
perceptions persist and workers make complaints about discrimination, the
situation can be further exacerbated by a supervisor or manager who fails
to respond in an appropriate and timely manner to complaints or concerns.
To avoid EEO litigation, managers and supervisors must remain open to
complaints and concerns, ensure all workers are aware they are available to
deal with grievances and complaints, and deal with each complaint in a
timely manner. Another positive tactic managers can use is to mingle with
team members, converse with them about their workplace environment and
satisfaction, and address concerns workers may have that could impact
morale.
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