Category Archives: Emergency Management

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.

Health Care Quality and Safety

Health care is a service devoted, by definition, to those who are vulnerable. People seek out health-related services during stressful times and may be easily swayed into trying less than effective methods, even ‘snake oil’ remedies, for treating their ails and pain. This being the case, the health care provider has a moral obligation to advocate for the patient. Advocacy entails considering only what is in the best interest of others, even to the detriment of one’s self. Patient advocacy helps to ensure both health care quality and safety. The Institute of Medicine defines health care as “[the] degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge” (as cited in Savage & Williams, 2012, p. 26). Savage and Williams (2012) discuss the importance of effective and efficient delivery of health care, which means avoiding overuse (providing services to those who will least benefit) and underuse (failing to provide services to those that would benefit) stating, “quality is important in health care because there are limited resources to improve the health of both individuals and the population as a whole” (p. 72).

According to Savage and Williams (2012), all stakeholders are affected by the level of quality in health care. From a patient’s perspective, health care delivery should be aimed at addressing the patient’s problem with the least invasive, yet most effective, therapy possible. Delivering health care is a high-risk endeavor that focuses the risk towards the patient, potentially causing harm and great suffering. The provider, driven by the desire to help without harming, would benefit greatly by the development of ‘best practices’, or evidence-based practice, in order to help the most people with the available resources. Additionally, providers wish to be paid a fair rate in exchange for the services performed, and this can only occur in an efficient system with little waste to impact revenue. On the other hand, third-party payors, the most prolific purchasers of health care, demand the most effective and efficient services in return for their payment in order to control the costs of their own services. Third-party payors, like Medicare, Blue Cross, and others, have such a large client base that they are able to effectively negotiate health care services for lower rates.

As a health care manager, it is increasingly important to ensure quality and safety in the delivery of health services. Medical malpractice litigation, according to Savage and Williams (2012), is costly to practitioners and organizations, even though it does little to deter poor quality. Rather than relying on the courts to make forceful recommendations, an effective manager can use tools already available to promote best practice within their organization. For instance, continuous quality improvement (CQI) programs promote systematic, data-driven process improvements focused by the customer’s perceptions. CQI can uncover interferring processes and can make modest to significant improvements that can indirectly improve other, linear processes, thereby, making greater improvements, overall.


Savage, G. T. & Williams, E. S. (2012). Performance improvement in health care: The quest to achieve quality. In S. B. Buckbinder, N. H. Shanks, & C. R. McConnell (Eds.), Introduction to healthcare management (Custom ed.; pp. 25-79). Sudbury, MA: Jones & Bartlett.

Leadership: Determining the Best Approach

 The true value of leadership is empowerment, or the ability to promote those traits through the chain of command for subordinates to use to effectively make decisions that are in the spirit of the vision of the leader (Buchbinder, Shanks, & McConnell, 2012; Kirkpatrick & Locke, 1991; Wieck, Prydun, & Walsh, 2002). When leaders make decisions, the focus is not on the myopic view of the here and now but reflects the nature of ethics and vision promoting the endeavor (Kirkpatrick & Locke, 1991).

Buchbinder, Shanks, and McConnell (2012), discuss various strategies and attitudes employed to both lead and manage the health care workforce. Though each of the styles presented are effectively used in certain scenarios, many managers and ineffective leaders misuse these styles due to misplaced attitudes, trust, and motives. These styles are authoritarian, bureaucratic, participative, theory Z, laissez-faire, and situational. The authoritarian and bureaucratic styles are closely related as dictatorial and at risk for involving micromanagement; however, authoritarians tend to be motivated by their responsibilities, whereas bureaucrats tend to disregard their responsibilities. The participative and theory Z styles are more democratic and egalitarian describing the usefulness of a majority opinion or consensus before moving forward. Though these styles could result in indecision, they are best implemented when a leader has ultimate decision-making capabilities and relies on his or her subordinates for input. Laissez-faire leadership is typically characterized as the hands off approach. Laissez-faire leadership, when used correctly, relies on the specialized training or focused scope of the work of the subordinates and lends guidance only when necessary. Laissez-faire leadership, however, can provide refuge for a lazy manager. Situational leadership is the use of all or some of the styles described above depending on the specific circumstances of a given situation. For instance, providing guidance to a new employee might benefit from an authoritarian approach; however, deciding on the best approach to implementing a new process might benefit from a participative style of leadership.

In the emergency medical services, a move has been made over the last decade to separate from the authoritarian leadership of the fire service. In my opinion (due to the gross lack of research within both the fire and emergency medical services), the attitudes of the fire service leadership do not correspond well with the manner in which paramedics wish to be led. As paramedics are formally educated and expected to perform as skilled clinicians in the field, they tend to operate independently and view their supervisors more as a resource tool than as tactical or clinical decision-makers. Combination departments, or those that operate both fire and emergency medical services, would do well with developing situational leadership skills to guide both operations (Mujtaba & Sungkhawan, 2009). Though paramedics may utilize an authoritarian style of leadership during an emergency call (and, do well to follow such styles in these environments), during normal day-to-day operations, paramedics respond much better towards a laissez-faire, or indirect, style of leadership that allows for independent critical thinking (Buchbinder, Shanks, & McConnell, 2012; Freshman & Rubino, 2002). For example, during a call, I expect that when I direct my crew to perform a certain task that it is completed immediately; however, between calls when I might say that in a particular scenario a certain intervention is necessary, I expect some discussion to aid in the learning of my crews and to help develop and hone their critical thinking skills.

True leadership has its own rewards, primarily, empowering those who follow to synthesize the traits of their leaders and evolve into leaders, themselves. This, in addition to watching your own visions take root and flourish.


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

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9. Retrieved from

Kirkpatrick, S. A. & Locke, E. A. (1991). Leadership: Do traits matter? Academy of Management Executive, 5(2), 48-60. doi:10.5465/AME.1991.4274679

Mujtaba, B. G. & Sungkhawan, J. (2009). Situational leadership and diversity management coaching skills. Journal of Diversity Management, 4(1), 1-55. Retrieved from

Wieck, K. L., Prydun, M., & Walsh, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34(3), 283-288. doi:10.1111/j.1547-5069.2002.00283.x

Leading the Way in Health Care

As the mantra states: when you have it, well, you just have it. As true as that may be in regards to political and social attributes, the statement does not preclude the ability of anyone to learn to ‘have it’, but what is ‘it’? Every enterprise is started by a singular idea, and many ideas may come together to form the basis of any enterprise, but it takes a visionary mind to manifest these ideas. The people with these ideas are leaders who, by their very nature, are agents of change. These leaders tend to seek each other out when they have a common purpose and create solutions and fill voids that address problems in need of answers. However, once the paradigm of the enterprise is expressed, manpower is needed to ensure its operation and success. Much of this manpower is entrusted to managers who may appreciate the vision and goals of the enterprise but lack the vision themselves to affect significant change, and although this statement sounds pessimistic towards the manager’s abilities, hope is not lost. Managers can, and do, learn to be leaders. Further, one does not require a management position to be a leader; leadership is both intuitive and learned (Buckbinder, Shanks, & McConnell, 2012).

Aside from being visionaries, leaders need to be socially adept in order to promote their views and constructs; therefore, in order to gain the trust and respect of subordinates, managers should strive to hone attitude and behavior to be more fit to lead (Freshman & Rubino, 2002). Mayer and Salovey describe four specific abilities that can improve one’s emotional skill set, also known as emotional intelligence (EI): “(1) the accurate perception, appraisal, and expression of emotions; (2) generating feelings on demand when they can facilitate understanding of yourself or another person; (3) understanding emotions and the knowledge that can be derived from them; and (4) the regulation of emotion to promote emotional and intellectual growth” (as cited in Freshman & Rubino, 2002, p. 3).

The importance of EI is evident in the highly ethically charged environment of health care. Many recommendations have been made to cultivate EI within health care, both with clinicians and administrators, yet it is not evident that this has been taking place, according to Freshman and Rubino (2002). Perhaps, at least philosophically, one must know themselves before attempting to truly know others, but being comfortable with one’s self and possessing the ability to relate and empathize with others, especially in the health fields where patients are vulnerable and providers are, themselves, empaths, will offer a manager leadership capabilities that will create trust and mutual respect in the workforce. Applied to health care adminstration, EI can be divided into five components (e.g. self-awareness, self-regulation, self-motivation, social awareness, social skills) that can be programmatically improved using training and career development opportunities with the organization.

Self-awareness goes back to the previous philosophical statement about knowing one’s self. We must take inventory of ourselves constantly in order to ensure that we understand our own strengths, weaknesses, as well as our motivations. Self-regulation, an important ethical descriptor, allows us to improve our own personal ethics in order to make difficult decisions more easily and without troubling remorse. Tough choices are made daily in the health care setting, and a leader should be able to make these decisions ethically with compassion and understanding. Self-motivation involves challenging one’s self daily to preserve the desire and passion personally and professionally. Social awareness is borne of the former components that allow one to consider the effect decisions have on others. Finally, social skills are necessary for effective communication, especially when considering the need to promote ideas and negotiate with others. These skills, inherent in great leaders, are beneficial to the health care administrator and beneficial, over all, to the health care organization.


Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management. Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9.

Profile of a Health Care Manager

According to Buchbinder and Thompson (2010), formal training in hospital administration did not exist until 1934 when Michael M. Davis, along with the University of Chicago, developed the first Health Administration program, combining both business and social education to meet the dynamic and unique needs of health care. In today’s economy of almost 10% unemployment nationwide, the health care field continues to grow, even in the face of uncertain regulation and remuneration (Fiscella, 2011; Sanburn, 2011; Scangos, 2009). However, as the economy continues to stagnate, health care providers still require to paid for their services. This is where the health care manager comes in.

A good health care manager is expected to make decisions that benefit both the organization and the client. Although health care is a business, one might say that it is expected to be the most ethical of all businesses as people’s lives are dependent upon its efficacy and continuity. As such, health care managers are expected, according to Buchbinder and Thompson (2010), to have a high ethical standard along with a requisite savvy business sense. Health care managers are also expected to have refined interpersonal skills, leadership, and integrity. Katz (as cited in Buchbinder & Thompson, 2010) defines the characteristics of an effective manager as possessing critical thinking and complex problem solving skills, expertise in their field, and the ability to effectively communicate with others.

Health care managers can work in a variety of settings and operate under many titles; however, these settings can be defined by two descriptors: direct care and nondirect care. Direct care settings, as described by Buchbinder and Thompson (2010), are those settings in which services are provided directly to the patient. Managers within direct care settings should be customer-focused with great interpersonal skills and dedication. These managers should also be excellent problem solvers, as direct consumers tend to require more expedient solutions than ubiquitous deadlines permit. A person may be better suited for this role if he or she enjoys dealing with the general public and solving complex problems with limited information. Nondirect care settings, on the other hand, can be described as health care support organizations as they might provide supplies, logistics, and expertise to those in direct care settings. Managers within nondirect care settings need to be more business savvy as they will typically interact with clients and associates on that level than, per se, a patient-provider level. Nondirect care managers must also be skilled in marketing and finance. Those with an affinity to these roles might possess more professional or technical skills, focusing more on business than personal relationships.

Both direct and nondirect care settings are important to the delivery of health care, today. Buchbinder and Thompson (2011) describe each as well-paying with opportunity, commensurate with education and experience, to advance within the field of health care management. Health care is both growing and changing, and it is a promising occupational arena.


Buchbinder, S. B. & Thompson, J. M. (2010). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Fiscella, K. (2011). Health care reform and equity: promise, pitfalls, and prescriptions. Annals of Family Medicine, 9(1), 78–84. doi:10.1370/afm.1213

Sanburn, J. (2011, August 18). Health care industry growth beginning to slow. Time Moneyland. Retrieved from

Scangos, G. A. (2009). Proceeding in a receding economy. Nature Biotechnology, 27(5), 424-425. doi:10.1038/nbt0509-424

Self-Assessment: Finding My Niche

 Combining the business-sense with the altruistic nature of health care, a health care manager is truly unique in focus. Some of the virtues and qualities a health care manager must posses for a long and rewarding career include a high sense integrity and of one’s self, emotional intelligence, the ability to think critically and globally, and must be equitable and just to both colleagues and clients, customers, and patients (Buchbinder, Shanks, & McConnell, 2012; Buchbinder & Thompson, 2010a).

A qualitative self-administered inventory instrument, presented by Buchbinder and Thompson (2010b), provides some insight into the qualities and virtues useful and, perhaps at times, necessary to pursue a management career in health care. The instrument, designed in Likert fashion, presents quality statements with which the subject is to agree or disagree, whether strongly or not (Likert, 1932). Although this instrument is based on the authors’ opinion, albeit expert, and there is no scoring mechanism recommended aside from high is better than low, I performed the inventory as a self-assessment to help identify some of my strengths and weaknesses (Buchbinder & Thompson, 2010a). The scoring was performed by assigning values to the the statements: 5 for strongly agree, 4 for agree, 2 for disagree, and 1 for strongly disagree, and dividing the sum of the answers scored by the median neutral value of 3 (Garland, 1991; Likert, 1932).

My score using the instrument was 153 out of 180 (85.00%). According to Buchbinder and Thompson (2010a), I possess more skills than not for a management career in health care. The lack of import placed on time management and project management seem to be two of my weaknesses, according to the instrument; although without further scrutiny, it is hard to tell if these particular items may actually suggest otherwise (Buchbinder & Thompson, 2010b; Clason & Dormody, 1994). The instrument helped to identify my critical thinking skills and my communication skills as strengths that would be useful in a health care management career (Buchbinder & Thompson, 2010b). It also showed that I have a strong ethical focus on integrity and equity.

Qualitative self-assessment instruments, such as the one developed by Buchbinder and Thompson (2010b), allow the subject insight as to the appropriateness of something like a career choice or lifestyle. Being honest with one’s self in using these self-assessment tools will also help to inform the subject of characteristics in need of cultivation.


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

Buchbinder, S. B. & Thompson, J. M. (2010a). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010b). Healthcare management talent quotient quiz. Career opportunities in health care management: Perspectives in the field (pp. 5-7). Sudbury, MA: Jones and Bartlett.

Clason, D. L. & Dormody, T. J. (1994). Analyzing data measured by individual Likert-type items. Journal of Agricultural Education, 35(4), 31-35. doi:10.5032/jae.1994.04031

Garland, R. (1991). The mid-point on a rating scale: Is it desirable? Marketing Bulletin, 2, 66-70. Retrieved from

Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 22(140), 1–55.

Future Threats

Aside from hoax attacks, where credible threats occur based on purposeful counter-intelligence efforts of terrorists, I suspect large-scale events to be the modus operandi of terrorists in the next decade. According to LaFree, Yang, and Crenshaw (2009), anti-U.S. terrorists have ample intent on attacking the U.S. on our soil; however, this would be a huge and logistically complicated undertaking. For this reason, any future organized act of terror on U.S. soil will be designed to be significant, causing extreme loss of life or toppling a significant structure or both.

Biologic weapons would be the choice for terrorists who wished to inflict harm to the greatest amount of people, though releasing biologic material lacks the sudden impact usually sought, and weaponized biologics are not easily grown or economical (Levitin, 2005). Chemical weapons are typically easier and cheaper to manufacture, though they lack effectiveness and tend to merely create a scare of equivalent magnitude of a hoax (Levitin, 2005). Aside from basic explosives, this leaves the radiologic threat, a threat that I believe, coupled with a significant target, will cause devastating effects not unlike 9/11.

A dirty bomb is a conventional explosive used to disseminate radiologic materials over an area. I foresee a coordinated attack on the financial districts of the U.S. using dirty bombs. The bombs would, first, cause physical destruction to the buildings causing immediate disruption of the financial sector of the U.S. economy, along with a large death toll. Second, the radiation dispersed over the area would cause difficulty in cleaning up the area, inhibiting recovery and further impacting the financial markets.

A law enforcement response to such an attack would certainly be large in scale. The local police department would be first to respond, along with state police, then the WMD Coordinator at the local FBI field office would be apprised of the situation. As responders start arriving on scene, personal radiation detectors would start to tone indicating the release of radiologic material. This further information would prompt the WMD Dictorate in Washington, D.C., to order a full asset response by the FBI and other federal terrorism partners (e.g. the Joint Terrorism Task Force). The response to this type of incident should be trained on in cooperative exercises involving all levels of law enforcement. Additionally, personal radiation detectors (and other detectors) should, at a minimum, be placed in police vehicles for early warning of environments immediately dangerous to life and health. Adequate training, equipment, and preparation are the only ways in which to prepare for responding to large-scale terrorist attacks.


LaFree, G., Yang, S., & Crenshaw, M. (2009). Trajectories of terrorism: Attack patterns of foreign groups that have targeted the United States, 1970-2004. Criminology & Public Policy, 8(3), 445-473. doi:10.1111/j.1745-9133.2009.00570.x

Levitin, H. W. (2005). Debunking myths: How law enforcement can help diffuse the public’s fear. On the Beat. Retrieved from

Fear of Terrorism

As terrorism becomes more prevalent within a society, concerns about the psychological effects are brought to the forefront. The psychological effects of terrorism, in general, should have an impact on the ability of law enforcement and the public to interface appropriately. A recent study by Bleich, Gelkopf, and Solomon (2003) of the psychological effects of terrorism on the public in Israel showed surprisingly low levels of post-traumatic stress disorder symptoms despite high incidences of direct exposure to terror events. This study demonstrated that, although up to a third of the respondents acknowledged a “limited sense of safety and substantial distress [they] reported adapting to the situation without substantial mental health symptoms and impairment, and most sought various ways of coping with terrorism and its ongoing threats [, possibly linked to] processes of adaptation and accommodation” (p. 619). The study found that the most effective and widely used coping mechanism was checking on the well-being of friends and family. As people tend to cope well with trauma, attitudes towards protective measures seem to acquiesce for the common good, and this can be assistive to law enforcement.

One of the protective measures people tend to adopt that would help law enforcement is a sense of hypervigilance (Bleich, Gelkopf, & Solomon, 2003). Hypervigilance allows the people to be more attentive to things out of the ordinary (e.g. unattended packages, suspicious loitering, anxious mannerisms of others, et al.). This promotes a line of communication with law enforcement not only regarding terrorism but for other criminal activity, also.

Another protective measure, which goes towards acquiescence, is the ability of the people, in general, to accept an increased presence of law enforcement in their daily lives. When faced with a proximal event, the bulk of the citizenship contend that it is, indeed, a function of government to protect the masses from further harm, and these citizens tend to accept limits on personal liberty for perceived increases in security (Klein, 2007). This is a double-edged sword, however. People tend to want to return to a normal state of affairs (Bleich, Gelkopf, & Solomon, 2003). Though an increased police presence is initially welcomed and embraced, the people will eventually resent the loss of liberty and require law enforcement presence to recede. How this occurs will either enhance or detract from the ongoing relationship with law enforcement. An example of this is easy to see when considering both local law enforcement and the federal effort of the Transportation Security Administration (TSA). Local law enforcement seems to have decreased their presence, at least in my area, and are respectfully viewed as helpful, whereas the TSA, an agency that continues to irrationally impede on liberty, is viewed negatively by the traveling public.

Law enforcement is a service-based industry where the public is the customer. Police need to understand both the rights and the fears of the people in order to maintain the appropriate level of service, which waxes and wanes.


Bleich, A., Gelkopf, M, & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. Journal of the American Medical Association, 290(5), 612-620.

Klein, L. (2007). Civil liberties and national security in the post 9-11 era: State power and the impact of the USA Patriot Act. Conference Papers – American Sociological Association, 1-8.