CHAPTER 10

Recruitment and

Retention

Recruitment and Retention Recruitment and Retention

• Begin with the end in mind• “The War for Talent”• “Talent Wins”• Health care

– Not only the best

– Credentialed, licensed

– Shortages of workers

Job Description Job Description

• Derived from job analysis• Boring, but extremely important• Need hiring manager’s input• Hiring manager’s responsibility

Job Description Job Description

• Job title• Reporting relationships• Committee responsibilities• Educational and professional certification

requirements• List of duties and responsibilities• Behavioral characteristics desired• Salary range, benefit level, and perks

Job Description Job Description

• Job title– Bigger, more interest

– Effect on other parts of the organization

– Ripple effect

– Room for mobility

– Must fit the culture

Job Description Job Description

• Educational and professional certifications• List of duties and responsibilities

– Most important, most difficult

– Better to be more specific

– “All other duties deemed necessary”• Behavioral characteristics

– Competency directory• Salary

Recruiting Plan Recruiting Plan

• Passive recruiting– Posting, advertising

• Active recruiting– Direct mail, email

– Networking• Telephone solicitation• Search engines

Recruiting Plan Recruiting Plan

• Active recruiting (continued)– Contingency search firms

• Paid on contingency• Need to establish specific rules• Check references• Establish terms of guarantee

Initial Screen Initial Screen

•

Call to get more information• Money, opportunity, location• Current situation, compensation• Qualifications, motivations• Available dates• Establish interest level

Onsite Interview Onsite Interview

• Coordination is key• All interviewers know about candidate, position,

and other interviews• Behavior-based questions• Left-field questions• Clear instructions, itinerary• Feedback process

Second Interview Second Interview

• More group meetings• Meets subordinates and other interested parties• Spouse may come• Set up meetings with real estate agent• Relocation assistance• Bonuses

Severance Packages Severance Packages

• In C-Suite and moving down• Protection for employees• Protection for those taking on risk• Promotes image of fairness• Protects the organization• Legal input

Onboarding Onboarding

• Helping the candidate start• First 90 days of employment• Outside coach• Feedback• Reduces costs• Improves retention

Retention Retention

• Pay– Not a “satisfier”

• Benefits– Important to employees

– Not taxable to the employee

• Education and career advancement– Tuition support, loan assistance

Managerial Guidelines Managerial Guidelines

• Establish a job description• Develop a recruitment plan• Conduct an initial screen• Conduct an onsite interview• Apply a multifaceted approach to retention

CHAPTER 12 Training and Development

• Training

– Addresses the skills that an employee needs in his or her current position

• Development– Adding new skills or experiences

– Promotional opportunity or a different career path

Training and Development Training and Development

Five major categories1. Orientation and new employee training

2. Job-specific training

3. In-service training programs

4. Outside continuing education

5. Career development

Improving Performance Improving Performance

• Build skills of teams and individuals• Understand strengths and weaknesses of

training-based solutions• KSAOs• Different training for different needs• Training not always most effective way to address

a performance need

Improving Performance Improving Performance

• Training is ideal for the employee who has demonstrated a lack of task-related skill

• Standard training on a very specific skill• New employee training

– Classroom training

– On-the-job teaching

• Development increases engagement

Training and Organizational Change Training and Organizational Change

• Respond quickly to environmental changes• Quality in patient care settings• Methodologies of manufacturing assembly• Focus on processes rather than individual

performance• Failure mode effects analysis

Training Design Training Design

• Instructional system design (ISD)– Framework for designing and implementing effective

training programs

– Comprehensive training needs assessment

– Training objectives and strategies

– Training evaluation is conducted

Training Design Training Design

Training Needs Assessment Training Needs Assessment

• Diagnostic process• Organization identifies performance gaps• Whether and how training can be used• Assessment occurs at the organization,

department, and individual levels

Assessment Assessment

• Organizational level– Discussed during strategic planning

– Planetree Model

– Studer Group BEST Approach

– HR key indicators

– Outside requirements

Assessment Assessment

• Individual level– Individual training plan

– Updated annually

– Rewards

– Work together

– Motivation

Training Methods and Approaches Training Methods and Approaches

• Match training needs, objectives, methods, and materials

• Each type of training has unique goals and specific objectives

Training Evaluation Training Evaluation

• Evaluations usually not done well• Limited resources, lack of leadership• Four levels

1. Reaction

2. Learning

3. Behavior

4. Results

Training Evaluation Training Evaluation

Training ROI Training ROI

• Rarely done• Effects of training must be isolated• Gather data before training begins• Convert effects into monetary values• Estimate cost of training program• Difficult

Motivation and Transfer Motivation and Transfer

• Training motivation– “Direction, intensity, and persistence of learning-directed

behavior in training contexts”

• Predictors of training motivation and outcomes– Attributes of the person, the job, their confidence, and the

situation

Training and Development

Leadership and Training and

Development

Leadership and Training and

Development

• Leadership support• Enhanced learning• Improved training transfer• Organizational priority• Continue their own training and development• Managers of all levels

Decision Making

Definition: the process of selecting one alternative from a number of other alternatives

Types: Programmed—refers to decision making surrounding

familiar issues that have a standard solution Nonprogrammed—refers to decision making surrounding

unfamiliar issues that do not have a standard solution Continuous process May be time consuming

Steps in the Decision-Making Process

1. Define the problem—distinguish between the symptoms and the problem.

2. Analyze the problem—assemble the facts, seek input from others.

3. Develop alternatives—consider tools such as brainstorming, the Internet, or discussion groups.

4. Evaluate the alternatives—test the options, assess risks and benefits, and consider timing and resource use.

Steps in the Decision-Making Process

5. Select the best alternative—must be ethical, of high quality, and acceptable to the group affected by it.

6. Take action.

7. Follow up—did the action resolve the problem?

Steps in the Ethical Decision Making Process.

The first step in the ethical decision making process is to stop and think. According to Josephine Institute," One of the most important steps to better decisions is the oldest advice in the world: think ahead. To do so it’s necessary to first stop the momentum of events long enough to permit calm analysis.“ Stopping and thinking will help us to make more concrete and right decisions.

The Second Step

The second step to ethical decision making process is to clarify what are the short and long term goals. Before you choose, clarify your short- and long-term aims. Determine which of your many wants and don’t-wants affected by the decision are the most important. The big danger is that decisions that fulfill immediate wants and needs can prevent the achievement of our more important life goals."

The Third Step

The third step in the ethical decision making process is to setup options while making decisions. One good way of doing this with our job is to talk to someone about the decision we are making to make sure we are doing the right thing.

The Fourth Step

The fourth step in the ethical decision making process is to consider the consequences. For every decision made we must look back and see how this will effect us and our company in the end. One wrong decision could cost us our jobs, and the companies that we work for reputation.

The Fifth Step

The fifth step in the ethical decision making process is to chose to make the decision. The matter of choosing is one of the most important decisions in the ethical decision making process.

The Right Decision

We must choose to make the right decision. The matter of choosing is one of the most important decisions in the ethical decision making process. By learning and applying the ethical decision model we can become

better critical thinkers and better workers.

Experiential Decision Making

Decision making guided by one’s past experience or that of other managers

Should not follow blindly without assessing the alternatives

“Hunch” or “Intuition”: recalling similar situations from the past

Other Methods to Support Decision Making

Experimental Decision Making Testing options

Scientific Decision Making Use of operations research techniques

Story time-Your Decisions

What process should you go through to create the best decision in a healthcare organization.

Coordinating Organizational

Activities

Seminar 2

Objectives

1. Explain the increasing need for coordination as a result of increased work specialization and fragmentation of patient care.

2. Define the meaning of coordination as linking together a multitude of activities.

3. Differentiate between cooperation and coordination.

4. Discuss the obstacles inherent in achieving coordination.

Objectives5. Discuss how managers should not treat

coordinating as a separate managerial function but as a byproduct of the five managerial functions.

6. Discuss the importance of good decision making and communication in achieving coordination.

7. Describe the internal and external dimensions of coordination.

Division of Work

Also known as specialization Breaks down a job into smaller tasks Separates employees into departments,

divisions, or units Creates need for coordination,

communication, and cooperation between the various units

William Petty

Petty made a practical study of the division of labor, showing its existence and usefulness in Dutch shipyards. Classically the workers in a shipyard would build ships as units, finishing one before starting another. But the Dutch had it organized with several teams each doing the same tasks for successive ships. His breakthrough was to divide up the work so that large parts of it could be done by people with no extensive training.

The Meaning of Coordination

If “management” is the process of getting things done through and with people, then “management” involves coordination of efforts.

For an “organization” to be effective, it must have coordinated activities.

Coordination is the connective process by which entities, people, and tasks reach their objectives.

Coordination

Integral part of the managerial function More difficult at the executive level than at

the supervisory level Distance from the tasks involved More tasks and entities to synchronize

Cooperation

The attitude or willingness of individuals to work with or help each other

Lack of cooperation can hinder coordination Coordination is a formal process of ensuring

planned execution of tasks through a structure relationship

Cooperation is an informal process

Collaboration

Individuals work together to determine how to achieve a common goal• Involves both cooperation and coordination• However, includes a willingness to think through

unplanned challenges to establish a path to complete the intended task

Difficulties in Attaining Coordination

Degree of specialization More specializationgreater difficulty Less specializationless difficulty

Automation Less communication between the individuals Potential for incompatibility between other

automated processesloss of information

Successful Coordination

Communicating planned activities Brainstorming alternatives Defining roles who will do what Ensuring the right number of staff are assigned Monitoring the activities for any unexpected

variances

Communication

Key to the success of any effort Most effective if “face-to-face” Other approaches:

Written Voice mail Intranets

Use a variety of methods to ensure all involved receive the message

Dimensions of Coordination

Vertical, horizontal, and diagonal Vertical—between different levels of the organization,

usually within the same functional group or formal division

Horizontal—between peer level departments, divisions, and units

Diagonal—between different levels of the organization, usually between different functional groups or divisions

Story time-Collaborate

What are some of things we can do to make sure that everyone feels free to speak their minds and give their ideas in team meetings and projects?

Female Pioneers in Medicine

Here are the many ways that women have influenced and enhanced the practice of medicine at the National Library of Medicine

Mary Stuart Fisher, M.D.

Dr. Fisher was a woman of “firsts.” Born on August 12, 1922 in Binghamton, NY to Stuart Banyar Blakely, MD and Miriam Brothers Blakely, Dr. Fisher was first in her Binghamton, New York high school class, first in her class at Bryn Mawr College, and first in her class at Columbia University College of Physicians and Surgeons. She was the first woman president of the Philadelphia Roentgen Ray Society (the oldest radiological society in the world), and the first woman physician to have her portrait commissioned and hung at Temple University Medical School. .

  Elizabeth Blackwell, MD

Elizabeth Blackwell wanted to be a doctor. Her stubborn determination opened the profession to women in the United States. Two years later she became the first woman physician in America, and a decade later the first woman to be listed in the Medical Register of the United Kingdom. She broke through seemingly impregnable barriers of male prejudice to gain recognition and eventual fame in her profession and was a founder of women’s hospitals and medical colleges in both the United States and England.

Edith Quimby, PhD

Her work provided the first practical guidelines to physicians using radiation therapy, she was the first to establish the levels of radiation that the human body could tolerate, and was the first female radiophysicist to be appointed as president of the American Radium Society. She received ACR Gold Medal in 1963.

Alice Ettinger, MD

A radiologist and educator who brought the technique of spot-film imaging to the United States in 1932, she was the first chairwoman of radiology at Tufts University School of Medicine. Then in 1982, Dr. Ettinger received an RSNA Gold Medal and in 1984 ACR Gold Medal.

Rosalyn Yalow, PhD

Rosalyn Yalow, PhD - recipient of the Nobel Prize in Physiology/Medicine in 1977, for the development of radioimmunoassay of peptide hormones. She received the ACR Gold Medal in 1993 and the RSNA Gold Medal in 1994.

Lucy Frank Squire, MD

Lucy Frank Squire, MD, was the first woman to be enrolled as a resident in Massachusetts General Hospital's radiology program in 1940 and the first woman radiologist to receive the AAWR Marie Sklodowska-Curie Award in 1986. Dr. Squire was an outstanding radiologist who became known as a medical educator and mentor to generations of students at the State University of New York (SUNY) Health Science Center. In 1964, Dr. Squires published the first edition of her landmark book Fundamentals of Radiology which has become a standard introductory text for radiology.

Communicating

Chapter 5

Haimann’s Healthcare Management 8th Edition

Objectives

1. Describe the communication model and the roles of senders and receivers.

2. Discuss how communication affects organizational performance.

3. Identify and discuss communication networks, channels, and barriers.

Objectives

4. Describe how managers can ensure more effective communication by overcoming roadblocks.

5. Explain the operation of the grapevine and its importance.

Communication

Is the process of exchanging information Implies mutual understanding of the message Links managerial functions by articulating plans and

goals Motivates and influences people Involves two or more individuals Is affected by individuals’ background, perceptions,

attitudes, and values

Communication

Requires a sender and receiver Both must understand the message Does not require agreement

Communication Network

Grapevine—Informal network Active 24 hours a day Information communicated through the grapevine has basis in

fact Source of rumors

Wishful thinking or anticipation Uncertainty Fear Malice

Communication Network

Policies, procedures, rules—Formal networks Network flows

Downward: Manager to subordinate Starts action by a subordinate

Upward: Subordinate to manager Facilitates assurances that messages are understood

Communication Networks

Horizontal communication—communication with peers or peer departments

Diagonal communication—passing of messages between different levels across different units

Modes of Communication

Verbal (oral and written) Both oral and written communicationcan result in misunderstandings Oral communication in a face-to-face mode allows feedback to occur

immediately Follow voicemail etiquette Written communication provides a permanent record:

Letters—For a formal situation Memos—For recording information, inquiries, and replies Reports—To convey information, analyses, and recommendations

Modes of Communication

Visual media (graphs, charts, pictures) Non-verbal (actions/behavior)

Model for subordinate

Action Assembly Theory

Action Assembly Theory (AAT) seeks to explain message behavior (both verbal and nonverbal). AAT is a communication theory that emphasizes psychological and social influences on human action. The goal is to examine and describe the links between the cognition and behavior-how and individuals thoughts get transformed into action. AAT describes the production of behavior in two essential processes: the retrieval of procedural elements from long term memory, and the organization of these elements to form an output representation of action to be taken. For example, assembly is considered a top-to-bottom process that begins with more general strategy and goes to a more specific idea about communicating the specific message.

Adaptive Structuration Theory

Adaptive Structuration Theory is based on Anthony Giddens' structuration theory. This theory is formulated as “the production and reproduction of the social systems through members’ use of rules and resources in interaction”. Groups and organizations using information technology for their work dynamically create perceptions about the role and utility of the technology, and how it can be applied to their activities. These perceptions can vary widely across groups. These perceptions influence the way how technology is used and hence mediate its impact on group outcomes.

Agenda Setting Theory

Agenda setting describes a very powerful influence of the media – the ability to tell us what issues are important. As far back as 1922, the newspaper columnist Walter Lippman was concerned that the media had the power to present images to the public. Two basis assumptions underlie most research on agenda-setting: (1) the press and the media do not reflect reality; they filter and shape it; (2) media concentration on a few issues and subjects leads the public to perceive those issues as more important than other issues.

Anxiety Uncertainty Management Theory

The theory was developed and defined by William B. Gudykunst. Uncertainty reduction involves the creation of proactive predictions about others attitudes, beliefs, feelings, and behavior, as well as retroactive explanations about others' behavior. Underlying the theory is the assumption that individuals attempt to reduce uncertainty in initial reactions with strangers when they will be encountered in the future, can provide rewards, or act in a deviant fashion.

Attribution Theory

We all have a need to explain the world, both to ourselves and to other people, attributing cause to the events around us. This gives us a greater sense of control. When explaining behavior, it can affect the standing of people within a group (especially ourselves). Our attributions are also significantly driven by our emotional and motivational drives. Blaming other people and avoiding personal recrimination are very real self-

serving attributions.

Cognitive Dissonance Theory

According to cognitive dissonance theory, there is a tendency for individuals to seek consistency among their cognitions (i.e., beliefs, opinions). When there is an inconsistency between attitudes or behaviors (dissonance), something must change to eliminate the dissonance. In the case of a discrepancy between attitudes and behavior, it is most likely that the attitude will change to accommodate the behavior.

Communication Accommodation Theory

When we talk with other people, we will tend to subconsciously change our style of speech (accent, rate, types of words, etc.) towards the style used by the listener. We also tend to match non-verbal behaviors. 

This signals agreement and liking. It should create greater rapport and them such that they approve of us more.

Cultivation Theory

Cultivation theory in its most basic form, suggests that television is responsible for shaping, or ‘cultivating’ viewers’ conceptions of social reality. The combined effect of massive television exposure by viewers over time subtly shapes the perception of social reality for

individuals and, ultimately, for our culture as a whole.

Information Processing Theory

Miller (1956) presented the idea that short-term memory could only hold 5-9 chunks of information (seven plus or minus two) where a chunk is any meaningful unit. A chunk could refer to digits, words, chess positions, or people's faces. The concept of chunking and the limited capacity of short term memory became a basic element of all subsequent theories of memory.

Story time-The Message

How do we make sure that the message we want to communicate gets communicated throughout the organization?

Barriers to Communication

Language Workplace diversity

Status and Position Resistance to change Filters (by sender and receiver)

Rejection of ideas or messages that conflict with one’s beliefs or other messages

Biases Semantics—multiple meanings to same word

Sensemaking

‘How can I know what I think until I see what I say?”

Seven elements are used in sensemaking.

Identity

1.Identity: The recipe is a question about who I am as indicated by discovery of how and what I think.

Retrospect

2.Retrospect: To learn what I think, I look back over what I said earlier.

Enactment

3.Enactment: I create the object to be seen and inspected when I say or do something.

Social

4.Social: What I say and single out and conclude are determined by who socialized me and how I was socialized, as well as by the audience I anticipate will audit the conclusions I reach.

Ongoing

5.Ongoing: My talking is spread across time, competes for attention with other ongoing projects, and it reflected on after it is finished, which means my interests may already have changed.

Extracted Cues

6.Extracted cues: The “what” that I single out and embellish as the content of the thought is only a small portion of the utterance that becomes salient because of context and personal dispositions.

Plausibility

7.Plausibility: I need to know enough about what I think to get on with my projects, but no more, which means sufficiency and plausibility, take precedence over accuracy.

Story Time-Making Sense

When your employees make sense of their work environment on past cues how can I help them make the leap to our new course for the healthcare organization?

Feedback

Managers must make sure that messages are accurately received Use affirmation:

Observe the receiver Monitor nonverbal clues Ask the receiver to repeat the message

Use repetition

Feedback

Managers need to listen to their subordinates and superiors Show sensitivity Stop talking Ask questions

Managers must display the attitude and actions they expect their subordinates to display

Legal Aspects of the Healthcare Setting

Chapter 6

Haimann’s Healthcare Management 8th Edition

Objectives1. Understand basic information on legal issues

affecting the healthcare environment.

2. Outline the basis of institutional responsibility for healthcare rendered to patients.

3. Recognize key causes for liability.

4. Identify employee litigation issues.

5. Understand the key concepts of major regulations affecting management.

Regulatory Environment

Regulations have many sources: FDA, CMS, JCAHO, HHS, DOJ, OIG, State, etc.

Statutes have many sources as well, often from the courts: Doctrine of charitable immunity

Injuries caused by healthcare organizations or their staffs may result in an obligation to compensate the individual(s) injured.

Liability

Liability: Obligation related to torts and organizational actions

Tort: Legal wrong, act, or omission that results in an injury to another For example, a visitor slips on wet floor left by janitor

Organizational Liability: Fraud, abuse, antitrust, etc.

Vicarious Liability

When one party is held responsible for another’s action Hospital that contracts physicians Contracted services Physicians participating in an HMO network

The first party is considered to have “checked out” the other party before allowing the other party to serve its patients or clients

Duty

Healthcare organizations and patient care givers have a duty: To use reasonable care, skill, and diligence similar to

other healthcare organizations or individuals under the same circumstances and/or in the same community

To provide premises and use equipment that are safe To employ trained and skilled staff

Negligence vs. Malpractice

When the organization or healthcare provider fails to carry out its duty Breach its duty

Negligence: When a reasonable person would do something that results in avoiding an injury or avoids doing an act that results in an injury

Malpractice: Professional misconduct, use of unreasonable lack of skill, immoral conduct.

Standard of care: What would a reasonably prudent person do?

Elements Necessary to Prove Negligence

Injury to someone Duty owed to the injured person Breach of duty occurred Breach is related to the injury

Respondeat Superior

The legal responsibility of an organization for the actions or omissions of individuals employed or over whom control is exercised

Drives vicarious liability Civil actions Does not release the individual from liability

Captain-of-the-Ship Doctrine

When an individual is held responsible for the actions of others whom he/she exercises control over regardless of whether they are his/her employees Borrowed servant theory Commonly seen in the operating room

Ostensible Agency

When the individual appears to be an employee of the organization Contracted hospital-based physicians Contracted janitorial services

Corporate Negligence

Landmark case: Darling v. Charleston Community Memorial Hospital

Organization is ultimately responsible for medical care rendered to its patients Obligated to monitor the quality of care delivered by others on

its property and to its patients Health Care Quality Improvement Act of 1986—peer review duties

Sources of Employee Litigation

Inappropriate dismissals Qui Tam—identifying employer wrongdoing Failure to make reasonable accommodations

Americans with Disabilities Act Family and Medical Leave Act

Inappropriate actions between employer and employee Sexual harassment

Other Regulations

OSHA—monitoring workplace injuries and making appropriate modifications to protect employees from injury

HIPAA—protecting patient and protected information; providing employees with the right to maintain their insurance after termination

Ethical Conduct

Proper accounting practices Proper management practices Proper employment practices Established controls to avoid misconduct, fraud,

and abuse Compliance with regulations

Ethical Conduct

Maintaining fair and appropriate behavior between organizational leaders and:

Vendors Subordinates Peers

Ensuring a safe environment for employees, patients, and visitors Abiding by laws, rules, and standards of conduct

Compassion

Compassion has an emotional element to it, but it is not just a blind feeling. Rather, it is also a way of perceiving the world. The world looks different through the eyes of the compassionate person. It is also a way of thinking about the world, a way of understanding it. Compassion has to make judgments about the nature and causes of suffering, and also about the possible remedies for suffering. Compassion, finally, is also a way of acting, a way of responding to the suffering of the world. Try to have compassion in dealing with your employees and customers.

Good Night!

Thank you for attending this seminar!