Human Resources Management for Health Care Organizations

A Strategic Approach

Joan E. Pynes, Donald N. Lombardi

• Publisher: Jossey-Bass
• Year: 2011
• ISBN:
  9781118152744
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This book is a comprehensive guide to the essential areas of health care human resources management, and is an immediately useful practical handbook for practitioners as well as a textbook for use health care management programs. Written by the authors of Handbook for the New Health Care Manager and Human Resources Management for Public and Nonprofit Organizations, the book covers the context of human resources management in the unique health care business arena from a strategic perspective includes SHRM and human resources planning, organizational culture and assessment, and the legal environment of human resources management. Managing volunteers and job analysis perfor­mance appraisal instruments, training and development programs, and recruitment, targeted selection and hiring techniques are covered. Compensation poli­cies and practices, employer-provided benefits management, implementation of training and organizational development programs, as well as labor-management relations for health care organizations and healthcare human resource information technology are covered, with practical examples and proven strategies amply provided in each chapter.

Part 1

Human Resources Management in the Health Care Business Arena

Chapter 1

Introduction to Health Care Human Resources Management

Learning Objectives

• Identify the components of the unique health care business arena
• Delineate the five critical change factors in the health care business environment
• Understand the basic leadership roles and functions of the emergent health care organization
• Recognize the context for progressive human resources management in a health care organization

Health care in the United States is provided by organizations that are singularly unique in nature and construction, and that have few comparative models across American industry. Many health care organizations are among the best-known institutions in their geographic area, yet they typically operate as nonprofit entities. Although they employ a large number of local citizens, their pay scale and compensation levels are normally below those of many of the much smaller for-profit organizations in their service community. Very few community hospitals are truly public institutions, yet because they provide emergency care for absolutely everyone coming through their doors, they are widely perceived as public institutions supported largely and directly by federal, state, and local tax revenue.

This chapter explores in a general way the composition of American health care organizations as it relates to human resources management to set a working context for specific organizational development and human resources strategies. Although these organizations can range in size from a small neighborhood or rural clinic to a large metropolitan hospital employing thousands of professionals, there are many instructive similarities, which will be examined first broadly, and then with a specific focus on human resources management. This chapter details the roles and responsibilities of the executive cadre and respective operational ranks of the administrative and patient care sectors of a health care organization, and then describes the causal relationship between a progressive health care organization and its customer-patient community. In addition, this chapter begins to introduce the components of a progressive, successful health care organization by establishing the mainstay foundation—strong human resources management that extends from the human resources office to the executive suite, through the medical ranks onto the patient floors, and across the entire organization. Finally, the chapter concludes with a practical discussion of the critical and significant role that human resources management plays in the daily operations and ongoing success of a progressive health care organization.

Defining Elements of Progressive Health Care Organizations

Most health care organizations are among the largest employers in their service community and are nonprofit institutions that rely on a very complicated labyrinth of reimbursement funds, charitable contributions, physician fees, and an assortment of other revenue sources to meet their budgetary requirements. Because federal law dictates that no American can be denied health care services from any community medical center's emergency room, for example, health care organizations are perceived to be community bedrocks in the same manner as public schools. Such organizations as the U.S. Department of Veterans Affairs, which includes nearly 120 large medical centers employing an average of three thousand people as well as nearly four hundred community-based outpatient clinics, are indeed formidable community players, especially in current times.

Many health care organizations also share a laudable history with their respective communities. Urban New Jersey provides three excellent examples of health care organizations that share a wonderful legacy, lore, and legend with their community. In Hoboken, New Jersey, commonly known as the birthplace of Frank Sinatra and the centerpiece of the classic movie On the Waterfront, Hoboken University Medical Center (HUMC) has served its diverse community—which features constituencies ranging from Wall Street stockbrokers to newly arrived immigrants living within two miles of the Statue of Liberty—since 1863. In that year, the medical center opened its doors, as did many organizations that were founded during the nineteenth century, as a de facto hospice in which doctors sent severely ill patients to receive terminal care or critical services. Through the years Hoboken University Medical Center, in a city featuring waterfront, education-based, technology-based, and tourist businesses, evolved into both a major community employer and a health care organization that can lay claim to having the most sophisticated technology tracking and assessment system in the state of New Jersey.

Furthermore, HUMC is a community-driven health care organization that seriously embraces the charter of providing its community with stellar “cradle to grave” services—everything from childbirth to pediatric services to emergency care, and across the spectrum of critical and elective surgery care. Health care organizations maintaining this charter are the ones that the majority of experts believe will be most likely to thrive in an era in which American health care constituents are more exacting, demanding, and educated, because they represent the first defining element of a progressive health care organization:

We do everything here.

Newark Beth Israel Medical Center (NBIMC) opened its doors in 1898 in the state's largest city. By 2009 it had become one of the flagship organizations of Barnabas Health, the second-largest employer of any kind in the state of New Jersey—particularly noteworthy when one considers that New Jersey is the most densely populated state in the United States—with nearly 24,000 employees, six major medical centers, and over forty clinics and ambulatory care centers. Despite the religious resonance of the system's name (based on its flagship medical center, which coincidentally is also the state's oldest), Barnabas Health is secular and nonprofit, and rates second only to the state of New Jersey itself as major employer, human services provider, and educational center in terms of employee populace. Since its opening as a prototypical general hospital, Newark Beth Israel Medical Center, now 3,585 employees strong, also includes the Children's Hospital of New Jersey and one of the highest-rated cardiology centers in the United States, and is the major provider of virtually every type of health care service needed in the state's largest urban center. As an organization that prides itself on “growing its own and hiring from within the community,” it is not uncommon to find employees at NBIMC who are third-generation “Beth employees.” Further, one of the current vanguard initiatives of NBIMC is the Start On Success (SOS) Program, which is the epitome of a community employee development program. This program provides selected high school seniors in the City of Newark public school system with an opportunity to complete their education in the morning on the campus at The Beth (as NBIMC is commonly known across the organization and in its service community). In the afternoon the students undertake responsibilities in part-time jobs that provide training in such areas as patient transport, entry-level nursing, security, food services, and other critical vocational areas that are always in demand in a health care organization. With this everyday, resonant charter, proven over a hundred years now, The Beth personifies the second defining element of a progressive health care organization:

Quality care begins with quality people.

Across town, in Belleville, New Jersey, made famous as the home neighborhood of pop icons Frankie Valli and the Four Seasons and Connie Francis, Clara Maass Medical Center (CMMC) has been in business since 1888. Originally named German Hospital because it tended at its inception to the majority community population of recent American immigrants from Germany, CMMC—still with its original, formidable brick facade—became the local provider of choice, establishing a reputation as a training center for medical and nursing personnel. In fact, a cohort of physicians and nurses not only provided research and direct patient care in the areas of general medicine in the late 1880s but also became pioneers of critical medical research. Specifically, a group of physicians and nurses from German Hospital worked assiduously for a cure of yellow fever. One of the nurses—Clara Maass herself, a young German American nurse from the neighborhood—not only participated in the research but also offered her life in volunteering to be the first human subject for the vaccine that eventually cured the malady of yellow fever. The hospital was rightfully rechristened in her honor and to this day exemplifies the third defining standard of a progressive American health care organization:

What we did yesterday might be good enough for today, but we constantly have to learn anew and face the challenge of being better tomorrow.

Health care organizations such as these three have survived the conundrum of how to provide quality health care by adhering to these principles, which, as we will see, take root in strong health care human resources management.

Current Perceptions of Health Care Organizations

At present many customer-patients consider themselves to be educated about health care and, thanks to mass advertising through traditional media sources and on the Internet, often pride themselves on being informed consumers. As already mentioned, many American health care organizations possess a reputation, sometimes good and sometimes not so good, in their community based on history and past performance. However, with the recent spotlighting of health care by politicians and legislators, among other factors to be discussed later in this chapter, health care organizations today endure more scrutiny than ever before.

This scrutiny begins at the physician's office, the time-honored entry point of health care in the United States. Starting with this interaction, the health care consumer believes the what of health care—that is, the actual product of health care, augmented and supported by cutting-edge technology and the latest medical devices—is likely to provide a sure cure at the highest possible level of care. However, what is being more closely assessed now than at any other point in health care history is the how of health care—that is, the “human touch” that is afforded to customer-patients by all employees, volunteers, medical professionals, and administrative leaders that they encounter through their healing experience. Because health care customer-patients pay more, and believe that they are better educated than health care consumers of previous generations and are aware of more dimensions of care, the element of health care that we define as the human touch—and that traditionally has been referred to as bedside manner—often supersedes the actual product when patients evaluate care. This reality demands a strong human resources management department that can help maximize the organization's human capital on a daily and progressive basis.

On a related note, a consumer and a customer, as per the traditional thinking in marketing, can be two different people in health care. The consumer, for example, in an equation involving services for the aging, could be an aging parent. The customer—that is, the person making the decision—could be the son-in-law or daughter-in-law of the aging parent, because he or she is most likely to be objective in the decision making and the most demanding, wanting to achieve the highest possible level of satisfaction with the outcome. However, the customer patient's overall perception of the quality of care, which is always founded on the quality of his or her interaction with staff members, is still the primary consideration in the customer-patient's decision making.

The fact that health care nationally represents one-sixth of the U.S. economy by most government estimates, comprises organizations ranging from physicians' offices with a dozen employees to organizations like the Barnabas Health system that employ tens of thousands of employees, and offers a distinctive “high-demand, essential need” product only complicates the calculus when assessing the unique health care environment. Furthermore, 18 percent of the national workforce works in the traditional delivery of health care, with another 9 percent estimated to work in ancillary organizations that provide products directly to health care organizations, such as food services organizations; uniform distributors; technology management firms; and others that help support these organizations, many of them with massive physical plant facilities. In numerous cities health care organizations are among the largest employers; in fact, in every one of the thirty largest U.S. and Canadian cities, health care organizations represent at least three spots on all lists of the top twenty employers. In the early 1960s any of those lists would have been replete with manufacturing organizations—service organizations now dominate those lists, and the largest organizations, both in terms of physical plant size and number of employees in the service sector, are part of health care.

Spheres of Influence Model

Figure 1.1 demonstrates the Spheres of Influence Model, which is a very useful tool in charting the various...

Table of contents

• Cover
• Title Page
• Copyright
• Tables and Figures
• Dedication
• Preface
• The Authors
• Part 1: Human Resources Management in the Health Care Business Arena
• Part 2: Methods and Accountabilities of Health Care Human Resources
• Part 3: Maximizing Health Care Human Resources
• Bibliography
• Index