Category Archives: Emergency Medical Services

Hiring by Organizational Fit

The Prevailing Organizational Culture

Recruiting new employees involves being mindful to the predominant organizational culture and how the applicant will relate and interact with the current employees (Cable & Judge, 1997; Fallon & McConnell, 2007). For instance, in a highly team-structured, or cooperative, environment, a highly competitive applicant may find difficulty in overall acceptance by the team, and both the applicant’s job performance and that of the team may suffer (Chatman, 1989). However, when the organizational values match that of the applicant’s, then a prediction can be made that job satisfaction and organizational commitment will be higher (Cable & Judge, 1997; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999).

This paper will discuss organizational culture and the benefits and drawbacks of recruiting processes focused on maintaining or altering the status quo.

Recruiting Organizational Culture

The term organizational culture has been used since the early 1980’s to capture the perceptions, values, behavioral norms, and expectations inherent in an organization (Vandenberghe, 1999). This culture could be a result of certain pressure from the leadership or a natural environmental attainment; however, hiring practices certainly have an impact on the organizational culture by adding the influences of new personalities into the culture (Cable & Judge, 1997; Chatman, 1989; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999). Recruiters and managers, by hiring based on organizational fit, are able to exert influence over the direction of the organizational culture as well as help to limit turnover and attrition (Cable & Judge, 1997; Chatman, 1989; Christensen & Wright, 2011; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999).

One problem surrounding the use of organizational fit is the propensity of applicants to utilize influence tactics to alter the perceptions of the interviewer (Higgins & Judge, 2004). As Fallon and McConnell (2007) discuss, an inexperienced interviewer could be overly influenced by an applicant. “No one has yet devised a reliable way to separate the applicants who simply talk a good job from those who will later do a good job” (Fallon & McConnell, 2007, p. 179). A very charismatic applicant might benefit over a more qualified applicant.

The benefits, however, of considering organizational fit and value congruency between applicants and the organization are best appreciated after job fit, or the consideration of qualifications and experience, is determined. In a hiring process where applicant qualifications and experiences have already been vetted and references already checked, organizational fit can be used to further the success of both the organization and the applicant (Christensen & Wright, 2011; Tsai, Chi, & Huang, 2011).

Another benefit considering organizational fit is public service motivation. Christensen and Wright (2011) explore the relationship between applicants who have strong motivations towards public service and organizations, whether public or private, that share that motivation. Christensen and Wright show a result of increased job satisfaction when public service motivations are congruent between applicant and organization; however, this link appears fairly weak when compared to financial incentives.

Relying on Résumés and Portfolios

While most assessments of organizational fit are made in the interview environment, résumé contents offer useful information. Although Higgins and Judge (2004) regarded self-promotion tactics (résumés and portfolios) as “weak and nonsignificant” (p. 630), ergo, less powerful than personal influence tactics, Tsai, Chi, and Huang (2011) later show that specific pertinent résumé content improved perceptions of employability: “to select applicants with suitable attributes, recruiters would refer to specific résumé content as the basis for making inferences about applicants’ values or personality” (p. 236). Work experience and extracurricular activities, according to Tsai, Chi, and Huang, provide the most insight into an applicant’s values and personality, which would influence organizational fit.

One drawback to relying on a document, such as a résumé or a portfolio, to provide insight into an applicant’s values or personality is that often these documents are prepared by a third party whose personality and values might influence the choice of content, thereby influencing the reader.

Legal and Regulatory Implications

Fallon and McConnell (2007) readily discuss the legal requirements and implications of the hiring process and making judgments of the applicant that are not directly related to the job; however, if intangible traits can be related to improved job performance, it is recommended to probe for these after ensuring adequate qualification and experience. In order to show that these intangible traits (e.g. innovation, team orientation, stability, attention to detail) are relevant, the job description could be altered in effect to demonstrate this and limit legal implications of a subjective hiring process. Certain prohibitions will still stand, such as disability, race, color, creed, religion, et al.


By understanding the culture of their organization, managers and recruiters can, to a degree, help to shift the cultural paradigm by choosing applicants who share similar values and beliefs that would be believed to enhance the culture of the organization. Although each job requires an applicant with the requisite knowledge, skills, and abilities to perform the job, certain intangibles, including congruence with the prevailing organizational culture, will help to ensure a healthy and lasting employment relationship.


Cable, D. M. & Judge, T. A. (1997). Interviewers’ perceptions of person – Organization fit and organizational selection decisions. Journal of Applied Psychology, 82(4), 546-561. doi:10.1037/0021-9010.82.4.546

Chatman, J. A. (1989). Improving interactional organizational research: a model of person-organization fit. Academy of Management Review, 14(3), 333-349. doi:10.5465/AMR.1989.4279063

Christensen, R. K. & Wright, B. E. (2011). The effects of public service motivation on job choice decisions: Exploring the contributions of person-organization fit and person-job fit. Applied Psychology: An International Review, 60(2), 231–254. doi:10.1111/j.1464-0597.2010.00434.x

Fallon, L. F. & McConnell, C. R. (2007). Human resource management in health care: principles and practice. Sudbury, MA: Jones & Bartlett.

Higgins, C. A. & Judge, T. A. (2004). The effect of applicant influence tactics on recruiter perceptions of fit and hiring recommendations: a field study. Journal of Applied Psychology, 89(4), 622-632. doi:10.1037/0021-9010.89.4.622

Tsai, W., Chi, N., & Huang, T. (2011). The effects of applicant résumé contents on recruiters’ hiring recommendations: The mediating roles of recruiter fit perceptions. Applied Psychology: An International Review, 60(2), 231–254. doi:10.1111/j.1464-0597.2010.00434.x

Vandenberghe, C. (1999). Organizational culture, person-culture fit, and turnover: a replication in the health care industry. Journal of Organizational Behavior, 20(2), 175-184. doi:10.1002/(SICI)1099-1379(199903)20:2<175::AID-JOB882>3.0.CO;2-E

The Hiring Process & Social Media

Social media has blossomed in the past few years beyond what many could have imagined. Today, it seems that many people engage others on the internet and social media without regard to their own personal privacy. Additionally, according to Jones and Behling (2010), privacy settings within social media applications tend to be complex, which inhibits their effective use by privacy-minded users. The result is an open and rich source of personal data, the problem of which is context.

I view social media as personal advertising where, unless specifically stated in the terms of service, the information posted by others is considered to have entered the public domain; others may view social media in the light of property rights where, although many people might not lock their front door, the invitation to invade the space is not assumed (Rosen, 2009). Regardless of personal views, information seekers need to be mindful of three things: 1) the terms of service for using the application resources, 2) the privacy policy in effect for using the application resources, and 3) the context of entries and the audience each entry is meant to reach (Jones & Behling, 2010; Rosen, 2009). Considering that the personal data made available on social media applications is not typical of allowable employment interview scenarios, employers need to be mindful that searching out this information may lead to unethical and illegal hiring practices (Fallon & McConnell, 2007; Jones & Behling, 2010; Rosen, 2009). Still, employers use social media to further vet applicants (Jones & Behling, 2010). Another consideration along similar lines is the use of generic web-based searches that could uncover similar information (Rosen, 2009).

In the case study provided by Coutu (2007), Virginia performed an internet search on Mimi and know suffers the problem that one cannot unknow knowledge. Additionally, Virginia know feels ethically compelled to share this information with Fred, the CEO. While this information would not be pertinent in the hiring process of a line employee, staff employees require more scrutiny, especially those that are being vetted for significant leadership positions. Rosen (2009) states, “employers do have broader discretion if such behavior would damage a company, hurt business interests, or be inconsistent with business needs” (para. 15). With this in mind, I tend to consider the paradigm of privacy practices when confronted with public officials and celebrities. A public head of a company or division might not have the same expectations of privacy afforded to a typical job applicant, but this would be a question for lawyers, as Mimi alludes to in the case study.

Basing the decision to investigate Mimi via Google on the general welfare of the organization, I would recommend allowing Mimi to defend her position in order to minimize bias and assumption. Two questions could be asked of Mimi that may allow her to mitigate concerns stemming from the search: 1) Regardless of any past pretenses, do you feel that you can represent this company appropriately if faced with issues regarding international politics? 2) Do you have any concerns about operating effectively within a political environment, such as China? Asking these questions, however, assume that the legal ramifications have been assessed and that they have been deemed appropriate for these particular circumstances. Ultimately, however, the decision lies with Fred to formulate a team that he feels can further the goals of the organization. He may consider the search results inconsequential and hire Mimi regardless of these findings, which would also be appropriate.


Coutu, D. (2007). We Googled you. Harvard Business Review, 85(6), 37-41.

Fallon, L. F. & McConnell, C. R. (2007). Human resource management in health care: principles and practice. Sudbury, MA: Jones & Bartlett.

Jones, C. & Behling, S. (2010). Uncharted waters: Using social networks in hiring decisions. Issues in Information Systems, 11(1), 589-595.

Rosen, L. (2009, September 15). Caution! – Using search engines, MySpace or Facebook for hiring decisions may be hazardous to your business. Retrieved from

Job Analysis: Analyzing Position Descriptions

Every organization is formed with a purpose in mind, the vision. In order to achieve this purpose, positions within the organization must work toward attaining certain goals furthering the larger organizational vision, the mission. Those who administer these organizations must catalog and organize the requisite roles, tasks, duties, and responsibilities required to achieve the goals and vision of the organization. This process is called job analysis and results in position descriptions for each job required to facilitate the mission of the organization (Fallon & McConnell, 2007). Position descriptions serve as a framework to codify the chain of command, roles and responsibilities, and functional lists of duties to be performed (Fallon & McConnell, 2007). Position descriptions also help to determine the value and compensation requirements of each position (Fallon & McConnell, 2007).

Unfortunately, as Fallon and McConnell (2007) discuss, many organizations fail to create adequate position descriptions, putting the organizations at risk of possible litigation, or less severe, employee confusion and ultimate inefficient operations.

Taxonomy of a Position Description

Fallon and McConnell (2007) write adamantly that “job descriptions have a regular format, style, and language” (p. 119) and are a result of a vigorous job analyses. Fallon and McConnell outline the components of a valid position description: job title, FLSA status, a summary of duties, compensation (salary range), knowledge required to perform the job, particular skills required to perform the job, the level of physical, psychological, and emotional effort usually required to perform the job, responsibilities inherent in the position, typical working conditions, and other general statements describing the position. Position descriptions using this format and with a certain level of detail can also be helpful in evaluating employees already in the position.

Using this format, I will compare two similar health care position descriptions (Northwest EMS, 2007; U. S. Office of Personnel Management, 2012) and discuss their similarities and differences.

Comparing and Contrasting Position Descriptions

Northwest EMS: Paramedic

Northwest EMS, located in Tomball, Texas, is the municipal provider of emergency medical services. Either city or departmental human resources would have directed the analysis required to formulate the position description.

Strengths. This paramedic position description (Northwest EMS, 2007) clearly follows a similar outline as recommended by Fallon and McConnell (2007). Further, as this position requires particular licenses, certifications, and other qualifications, these are enumerated distinctly as minimum qualifications for the position.

The biggest strength of this position description, however, is the section which details very particular job requirements, both physical and non-physical, as they relate to the Americans with Disabilities Act.

Weaknesses. This position description does not provide a salary range for the position. Although this could be a result of the document lying in the public domain and quickly becoming outdated, a salary range should be communicated openly for applicants to consider. This would benefit both the organization and the applicant, ensuring recruitment resources are expended only on applicants with a continued interest in the position.

National Park Service: Paramedic

This position is within the National Park Service at Yellowstone National Park. The position description would have been developed through position analysis by the U. S. Office of Personnel Management at the direction of the National Park Service.

Strengths. This paramedic position (U. S. Office of Personnel Management, 2012) also follows a similar outline as recommended by Fallon and McConnell (2007) and also provides that certain licenses, certifications, and other qualifications are required; however, as this is a federal position governed by separate and particular rules, there are particular components within the position description that are unique to federal government job postings.

One strength of this position description that notably differs with the Northwest EMS description is the inclusion of the salary range.

Weaknesses. No FLSA status is noted within the position description, but the FLSA might not apply to this federal position.


In analyzing similar position descriptions within municipal and federal organizations, there will be particular differences guided by the requisite employment rules and legislation for each; however, there are certain universal requirements for adequately describing the duties and responsibilities of each position, and it seems that both the Northwest EMS (2007) and National Park Service (U. S. Office of Personnel Management, 2012) position descriptions are, indeed, adequate representations of each paramedic job.


Fallon, L. F. & McConnell, C. R. (2007). Human resource management in health care: principles and practice. Sudbury, MA: Jones and Bartlett.

Northwest EMS. (2007). Paramedic job description. Retrieved from employment_Paramedic.pdf

U. S. Office of Personnel Management. (2012). Health technician (paramedic). Retrieved from

Human Resource Management, Part 2

“Didn’t Cut It? Hire Another”

Human resource management (HRM), especially when considering employment contracts, is heavily reliant on the understanding of the laws and regulations governing the jurisdiction of practice, whether these laws and regulations are local, state, or federally mandated. Fallon and McConnell (2007) demonstrate that “many laws and other legal requirements exert considerable influence on the employment process …. [and,] managers must [also] be aware of many aspects and nuances of HR law….” (p. 127). Kathy Gray’s difficulty, as described in the Fallon and McConnell chapter seven case study, arises from a culture within the organization that does not appear to respect the utility of HRM as both necessary and effective for the business. In the scenario, Kathy Gray is tasked with hiring a clerk for an open position; however, as soon as she makes her determination of the candidates, Sam Weston undermines the authority bestowed upon her and hires the lesser qualified of the two applicants. This would be difficult for anyone in a similar situation.

There are a number of problems that could stem from this scenario. First, by hiring the less qualified candidate, the business will utilize resources in training the chosen candidate only to seek out a replacement before recouping the expenses related to hiring and training the individual. O’Brien (2010) describes “the process of recruiting, selecting, hiring, and retaining employees [to be] difficult and costly” (p. 113). It would seem obvious that the chosen candidate should be the most qualified to save both cost and effort. Second, by Sam Weston undermining Kathy Gray’s authority, he has made her less effective as a leader. Kathy Gray was hired as a business manager and must earn the respect of those within the organization that she leads. By undermining her hiring authority, Sam Weston creates the perception that she is not prepared in her role as a manager. Fallon and McConnell (2007) posit that Sam Weston should have merely prepared himself to be a resource for Kathy Gray had she met difficulty in carrying out her newfound responsibilities. I have to agree as this would have allowed Kathy Gray to develop confidence in her new role, and a clear message would be sent throughout the organization regarding Kathy Gray’s authority in matters pertaining to her office. Although Sam Weston did choose an inept candidate, I do not see any reason why Kathy Gray cannot terminate the employment of her subordinate herself, as is the organizational norm. That being stated, there are better methods of dealing with employment matters than ad hoc hiring and firing of personnel by managers (Fallon & McConnell, 2007; O’Brien, 2010).

Fallon and McConnell (2007) and O’Brien (2010) both agree that HRM is a systematic approach to employment matters with ethical and legal considerations and implications. Meadows Nursing Home, the organization discussed in Fallon and McConnell’s case study, would do well to employ a human resources specialist (if not a human resources department) to handle the vetting of applicants, from within the organization as well as without. By developing a working partnership with the human resource team, managers can be assured that chosen applicants have met the minimum requirements for job performance, that job descriptions are accurate and detailed, and that, in the event an employee must be separated from employment, it will be handled in a professional, legal, and proper manner.

Finally, consideration should always be given to applicants within the organization before looking outward to fill vacancies. Employing from within demonstrates to the current staff a culture and willingness to cultivate talent and allow professional growth as a reward for loyalty. Also, current staff are already familiar with the business processes that an outsider may find atypical, and this would lead to short assimilation time; however, the organization runs the risk of “organizational in-breeding” if not enough outside influence is achieved (Eisenberg & Wells, 2000). With this in mind, promotions from within should be the norm unless considering vacant management positions, which should be advertised both within and outside of the organization in order to ensure competition among the candidates.


Eisenberg, T. & Wells, M. T. (2000). Inbreeding in law school hiring: Assessing the performance of faculty hired from within. Journal of Legal Studies, 29(S1), 369-388. doi:10.1086/468077

Fallon, L. F. & McConnell, C. R. (2007). Department managers and the recruiting process. In Human resource management in health care: principles and practice (pp. 125-145). Sudbury, MA: Jones and Bartlett.

O’Brien, J. A. (2010). Recruit and hire the best fit for your practice. The Journal of Medical Practice Management, 26(2), 113–118.

Human Resource Management

Mrs. Jackson’s Dilemma

In the dilemma of Mrs. Clara Jackson, as presented by Fallon and McConnell (2007), the emergence of health care professions created a vacuum of administrative roles that, until this time, were haphazardly fulfilled by senior clinical staff. Mrs. Jackson, professionally torn between clinical and adminstrative roles, understood that one would suffer for the attention spent on the other. As this realization set in, Mrs. Jackson allowed non-clinical supervisors to hire employees; however, this tended to decentralize the function of personnel management. This ad hoc methodology would eventually prove detrimental as regulations and legal requirements become standard. Mrs. Jackson could enlist an assistant to help with these administartive roles, but an unprepared assistant would prove as detrimental as the decentralized process previously discussed.

Caldwell, Troung, Linh, and Tuan (2011) show that “reframing an organization’s internal environment [by implementing strategic human resource functions] results in significantly higher organizational outcomes and financial performance that is superior to what firms can attain by implementing individual human resource program elements piecemeal” (p. 172); therefore, reorganizing and restructuring the processes used to handle these administrative personnel issues would benefit the hospital better than the ad hoc use of senior clinical personnel, such as Mrs. Jackson (Fallon & McConnell, 2007), especially with workforce legislation circa 1930 (e.g. workmen’s compensation, Social Security, collective bargaining).

These issues, requiring a sense of increasing specialization and knowledge, helped to form the field of human resource management (HRM) as we understand it today. HRM strives to use a form of “ethical stewardship[,] … a philosophy of leadership and governance that optimizes long-term wealth creation and that honors duties owed to all stakeholders” (Caldwell, Troung, Linh, & Tuan, 2011, 178), to “help their organizations add value to the lives of individuals and organizations” (Caldwell, Troung, Linh, & Tuan, 2011, p. 177). This philosophy helps to gain “commitment from employees which is the key to long-term wealth creation” (Caldwell, Troung, Linh, & Tuan, 2011, 178). Using this philosophy of ethical stewardship, HRM managers would have enlisted the help of Mrs. Jackson to formulate a list of requisite knowledge, skills, and abilities (KSAs) needed to perform each clinical job and hire nurses based on these, while meeting the requirements of employment law and regulation, so as to free Mrs. Jackson to perform her senior clinical role unimpeded.


Caldwell, C., Truong, D. X., Linh, P. T., & Tuan, A. (2011). Strategic human resource management as ethical stewardship. Journal of Business Ethics, 98(1), 171–182. doi:10.1007/s10551-010-0541-y

Fallon, L. F. & McConnell, C. R. (2007). Human resource management in health care: principles and practice. Sudbury, MA: Jones and Bartlett.

Measuring EMS: Patient Satisfaction

As a paramedic, I become discouraged when so-called academic literature, like that of McLean, Maio, Spaite, and Garrison (2002), Spaite (1993), and Stiell et al. (2008), turns up describing what little impact the emergency medical services, especially advanced life support procedures, have on patients. Instead of dismissing these writings, I tend to focus within the view of my own practice and experience on how I feel that I impact the patients that I see. This exercise allows me to confront the literature in a specific and meaningful manner that might be used in the future to publish a dissenting view. This discussion gives me a lens through which to dissect the import I feel that the emergency medical services has as a public safety entity.

Public safety is typically viewed as the amalgamation of police, fire, and emergency medical services. In all three, the public seems to have the idea that we stop threats before they take hold; however, we typically respond to the aftermath, the police to investigate crimes that have already occurred, the fire department to conflagrations that have already caused damage, and emergency medical services to traumatic incidents or medical conditions that have already caused distress. There are exceptions. The police have learned to integrate crime prevention techniques, the fire department has learned to adopt a fire prevention model of service, and the emergency medical services in many areas support preventative health clinics, such as community immunization, blood pressure checks, and CPR and first aid classes. The public, I feel, has a skewed perception of each one of these departments (e.g. the police should stop crime in progress, the fire department should save their house, and emergency medical systems should save their loved one whenever called upon to do so). Any deviation from the public perception is, in their minds, a failure of the system.

I ask myself, “What is that we, as the emergency medical services, do that really matters?” For the public, it seems that the answer can be given two-fold: “save me” and “make me feel better.” El Sayed (2012) describes the manner in which both aspects, outcomes and patient satisfaction, can be measured, as both are essential. Unfortunately, El Sayed does not go into much detail regarding patient satisfaction scores, except as a means of measure. In contrast, I feel that the most benefit that we offer patients is that we alleviate suffering. From a confident, yet compassionate, bed-side manner to effective and efficient treatment modalities, emergency medical personnel can prove to be the mediator between illness or injury and definitive hospital-based care. Emergency medical providers should be knowledgeable enough about the hospital to calm and educate patients as to what to expect. Further, medical knowledge allows the provider to restore a choking person’s breathing, to stop an epileptic seizure, and to minimize a crash victim’s pain. In my opinion, these measures are just as important, if not more, to quality management as mortality and morbidity. Again, El Sayed mentions the generality of patient satisfaction; however, with the abundance of competing literature questioning the effectiveness of the emergency medical services, patient satisfaction should be expounded upon as a legitimate and important aspect of quality patient care.


El Sayed, M. J. (2012). Measuring quality in emergency medical services: a review of clinical performance indicators. Emergency Medicine International, 2012, 1-7, doi:10.1155/2012/161630

McLean, S. A., Maio, R. F., Spaite, D. W., & Garrison, H. G. (2002). Emergency medical services outcomes research: evaluating the effectiveness of prehospital care. Prehospital Emergency Care, 6(2), S52–S56. doi:10.3109/10903120209102683

Spaite, D. W. (1993). Outcome analysis in EMS systems. Annals of Emergency Medicine, 22(8), 1310–1311. doi:10.1016/S0196-0644(05)80113-1

Stiell, I. G., Nesbitt, L. P., Pickett, W., Munkley, D., Spaite, D. W., Banek, J., Field, B., … Wells, G. A., for the OPALS Study Group. (2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. Canadian Medical Association Journal, 178(9), 1141-1152. doi:10.1503/cmaj.071154

Coordinated Community Response to Crime

Victims, especially those that find difficulty in coping, have similar needs and concerns independent of the type of crime committed against them. Victims in need share the same litany of psychological responses to crisis, such as fright, helplessness, nervousness, insecurity, anger, et al. (Roberts & Yeager, 2009). All victims of crime could potentially benefit from community support in the form of coordinated community response teams (CCRTs; Guo, Biegel, Johnsen, & Dyches, 2001; Roberts & Yeager, 2009).

A Google Scholar search of the terms coordinated community response -domestic -violence revealed a dearth of information regarding CCRTs, aside from those dedicated to domestic violence (which yielded a large portion of the result when the Google Scholar search term was limited to coordinated community response). As I consider the possibilities of an effective CCRT dedicated to a crime other than domestic violence, which enjoys an apparent steady and potent growth in activism, I envision a CCRT that is prepared to intervene for victims of crime in general.

In many communities, today, an effort is ongoing to develop Community Emergency Response Team (CERT) programs. The aim of this effort, headed by the Federal Emergency Management Agency (FEMA), is to prepare and train a broad citizen base to help respond to and aid victims of disasters when emergency services are overwhelmed, either by a multiple-seated disaster (a disaster involving a large geographical area where emergency resources are spread thinly throughout) or a small but involved emergency such as a search and rescue mission or a building collapse. This infrastructure of trained disaster responders is prime to include training in crisis intervention for victims of crime.

As respected members of the community, the CERT would be familiar with the community as a whole and would be trustworthy. Many CERT members are local fire officials or family members of fire officials.

In order to augment disaster response services with coordinated community response in crisis intervention of crime, the team, again, would require training in crisis intervention and must establish a cadre that is ready and willing to respond more often than official CERT requirements. The cadre must prepare a list of community resources available to assist victims of crime, such as psychological and psychiatric counseling if lethality is present or indeterminable or if a general need for counseling exists (Lewis & Roberts, 2001; Roberts & Ottens, 2005; Roberts & Yeager, 2009). Other important resources to include are state victim services organizations, safe housing, legal advocacy, judicial avenues of protection, such as instructions on obtaining no contact orders from the court, press contacts to prepare organized press releases when the crime is of such a magnitude that community outreach is desired. This program with additional assistance from licensed social workers, psychologists, and psychiatrists could also benefit the community by providing traditional mobile crisis intervention services, crime notwithstanding.

Guo et al. (2001) examines the usefulness of mobile crisis intervention teams. Redundancy being a limitation in a small community, CERT provides an existing framework of trustworthy and available community members that might be willing to augment their training in order to further service their community in a time of need.


Guo, S., Biegel, D. E., Johnsen, J. A., & Dyches, H. (2001). Assessing the impact of community-based mobile crisis services on preventing hospitalization. Psychiatric Services, 52(2), 223-228. doi:10.1176/

Lewis, S. & Roberts, A. R. (2001). Crisis assessment tools: the good, the bad, and the available. Brief Treatment and Crisis Intervention, 1(1), 17-28. doi:10.1093/brief-treatment/1.1.17

Roberts, A. R. & Ottens, A. J. (2005). The seven-stage crisis intervention model: a road map to goal attainment, problem solving, and crisis resolution. Brief Treatment and Crisis Intervention, 5(4), 329-339. doi:10.1093/brief-treatment/mhi030

Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Third Judicial District Conference. (1999). Characteristics of an effective coordinated community response. Retrieved from CharacteristicsCCR.pdf

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).


Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Practical Use of Strategic Planning

 In this writing, I will describe the similarities and differences of planning versus strategic planning, and I will use these concepts to compare and contrast two very different strategic organizational plans within the health care industry. In my view, strategic planning should be bold, effective, prescient, and ethical, and the reader should keep these attributes in mind when considering the plans for themselves.

Planning is described as the directed implementation of the “blueprint for the future” (McConnell, 2012), or the means of expressing the organizational vision in order to achieve the organizational goals; whereas, strategic planning institutes planning with a consideration and focus towards the forces, whether or not controllable, that might both help and hinder the desired outcomes (Casciani, 2012). One example of an uncontrollable force, especially in health care, are the expectations of the patient or client. Crawford et al. (2002) provides a discussion on the increased propensity to involve patient views in the strategic planning of health care organizations, though at the time of the writing, there was no evidence as to the effect that the involvement of these views provided. Caution must be exercised when eliciting input from the client or patient. For instance, many patients complain about the amount of time that it takes at emergency departments for test results to be returned. As impressive as it would be to have test results returned within just a few minutes, this should not be attempted to the detriment of the accuracy of the tests. Perhaps, in this instance, considering the role of point-of-care testing might be more beneficial than attempting a costly overhaul of the laboratory processes. Approaching problems as they apply to an open system, looking from outside in, provides a better perspective than regarding the organization as an isolated microcosm.

To be effective, strategic planning must be all-encompassing and address the goals of each functional unit, or microsystem, to bring them into alignment with the plans of the macro organization (Kosnik & Espinosa, 2003). To wit, as an organization can only be measured by the outcomes of the integrated microsystems, an analysis of each or any functional unit can tell much about the goals and visions guiding the organization.

Children’s Hospital and Regional Medical Center

The Children’s Hospital and Regional Medical Center (Children’s; 2006), located in Seattle Washington, provides the first of two strategic plans I will review. On the opening pages, as with most strategic plans, the organization defines its mission and vision, and they are certainly bold statements including the elimination of pediatric disease and being the best children’s specialty care center. The only thing that I wish was stated on these first pages is some sort of organizational value statement. The value statement does much to intertwine an ethical approach to the mission and vision. However, I do not doubt the ethical approach Children’s relies on, which is evident by the whole of the plan.

Children’s (2006) is a true regional medical center that serves much of the northwest portion of the United States, including Alaska. An argument could be made that Children’s serves such a vital role to the region that it is too important to fail, yet the organization still seeks to ensure financial stability and “secure Children’s financial future” (p. 5). In health care, especially in today’s political climate, the future of funding sources are unclear, and the most ethical approach to the organizational delivery of health care is to provide it without burden to the community it serves. Children’s exemplifies this approach by maintaining charitable foundation to “expand philanthropy to the community” (p. 16), as well as ensuring sound and responsible investments and maximizing efficiency under cost controls while still ensuring quality and safety improvements.

Additionally, Children’s (2006) focuses its efforts at being the best, which means attracting the best clinicians, performing cutting-edge research, and providing the best care to achieve the best outcomes possible setting the standard for health care across the nation. Children’s holds a bold, effective, prescient, and ethical strategic plan that outlines some goals of many of the microsystems within the organization.

U.C. Davis Health System

The U.C. Davis Health System (2011) strategic plan, unlike the Children’s (2006) plan, immediately outlines the values, or “guiding principles” (p. 3), of the organization. Financially, however, U.C. Davis Health Systems seems less focused on self-reliance, financial security, and community involvement than Children’s and more focused on their stated goal of socially responsible environmental stewardship.

Although the U.C. Davis Health System (2011) strategic plan uses the word bold on the front cover, I find it to be less so and without many specifics and, instead, relying on generalized language that might promote the vision but does nothing to engage it.

It is apparent in the U.C. Davis Health System (2011) strategic plan that they wish to become a leader in many different areas while attracting the best workforce. This is a commendable, bold, and ethical position that helps to ensure quality and safety in the delivery of health care at U.C. Davis Health Systems.


Many different variables drive the production of strategic plans, including politics, community, workforce, investments, geography, and the current status quo of health care delivery. Many of these differences can be seen immediately when comparing various strategic plans, yet by virtue of being a health care organization, many of the stated goals will be similar. Without being informed as to the climate of the organizational operation, it is difficult to appreciate the potential each plan has in regard to success or failure.

As a health care manager, the strategic plan is an obvious resource when deciding on possible employment. As a potential administrator, the strategic plan offers a view into how the administration seeks to direct the operation of the organization. Being responsible to help implement these plans, one must consider the alignment of his or her personal values with those of the organization. A manager might find it difficult to lead in an environment that demonstrates and promotes a different value system.

Strategic plans offer a significant advantage to organizations during their growth providing a clearly written prescription as to what is important to the organization so that it may guide decision-makers to develop and enhance programs to provide a cohesive effort towards future prosperity and relevance.


Casciani, S. J. (2012). Strategic planning. In S. B. Buchbinder & N. H. Shanks, Introduction to healthcare management (Laureate Education, Inc., Custom ed.; pp. 3-23). Sudbury, MA: Jones and Bartlett.

Children’s Hospital and Regional Medical Center. (2006). Our children deserve the best: Laying the foundation for the next 100 years (Strategic plan overview). Retrieved from

Crawford, M. J., Rutter, D., Manley, C., Weaver, T., Bhui, K., Fulop, N., & Tyrer, P. (2002). Systematic review of involving patients in the planning and development of health care. British Medical Journal, 325(7375), 1263-1267. doi:10.1136/bmj.325.7375.1263

Kosnik, L. K. & Espinosa, J. A. (2003). Microsystems in health care: Part 7. The microsystem as a platform for merging strategic planning and operations. Joint Commission Journal on Quality and Safety, 29(9), 452-459.

McConnell, C. R. (2012). Planning. In S. B. Buchbinder & N. H. Shanks, Introduction to healthcare management (Laureate Education, Inc., Custom ed.; pp. 131-139). Sudbury, MA: Jones and Bartlett.

University of California, Davis Health System. (2011). 2011-2016 strategic plan: Creating a healthier world through bold innovation. Retrieved from strategicplan/2011StrategicPlan.pdf

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.


Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.