Tag Archives: health care

Clinical, Culture, Emergency Medical Services, Health Care, Society

101 Things We Should Teach Every New EMT

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Originally posted at TheEMTSpot

I do not usually steal content or original writings, but this post is too important not to share (and keep for reference).  This was originally posted, with all credit due to the author of origin, at: http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/

Though this list is focused towards emergency medical technicians, it has inferred and inherent application in many clinical and non-clinical professions.

1) You aren’t required to know everything.

2) You are required to know the foundational knowledge and skills of your job. No excuses.

3) Always be nice. It’s a force multiplier.

4) There is no greater act of trust than being handed a sick child.

5) Earn that trust.

6) Don’t ever lie to your patient. If something is awkward to say, learn to say it without lying.

7) Read Thom Dick’s, People Care. Then read it again.

8) You can fake competence with the public, but not with your coworkers.

9) Own your mistakes. We all make them, but only the best of us own them.

10) Only when you’ve learned to own your mistakes will you be able to learn from them.

11) Experience is relative.

12) Proper use of a BVM is hard and takes practice.

13) OPAs and NPAs make using a BVM less hard.

14) Master the physical assessment. Nobody in the field of medicine should be able to hold a candlestick to your physical assessment skills.

15) Keep your head about you. If you fail at that, you’ll likely fail at everything else.

16) There is a huge difference between not knowing and not caring. Care about the things you don’t yet know.

17) Train like someone’s life depends on it.

18) Drive like nobody’s life depends on it.

19) Pet the dog (even when you’re wearing gloves).

20) Have someone to talk to when the world crashes down.

21) Let human tragedy enhance your appreciation for all that you have.

22) Check the oil.

23) Protect your back. It will quite possibly be the sole determining factor in the length of your career.

24) Say please and thank you even when it’s a matter of life or death.

25) Wipe your feet at the door.

26) When you see someone who is really good at a particular skill say, “Teach me how you do that.”

27) Nobody can give you your happiness or job satisfaction; it is yours and yours alone, and you have to choose it.

28) We can’t be prepared for everything.

29) We can be prepared for almost everything.

30) Check out your rig. It’s more meaningful that just confirming that everything is still there.

31) Tell your patients that it was a pleasure to meet them and an honor to be of service.

32) Mean it.

33) Keep a journal.

34) Make it HIPAA compliant.

35) Thank the police officer that hangs out on your scene for no good reason.

36) Recognize that he or she probably wasn’t hanging out for no good reason.

37) Interview for a job at least once every year, even if you don’t want the job.

38) Iron your uniform.

39) Maintain the illusion of control. Nobody needs to know that you weren’t prepared for what just happened.

40) Apologize when you make a mistake. Do it immediately.

41) Your patient is not named honey, babe, sweetie, darling, bud, pal, man or hey. Use your patient’s name when speaking to them. Sir and Ma’am are acceptable alternatives.

42) Forgive yourself for your mistakes.

43) Forgive your coworkers for their quirks.

44) Exercise. Even when it isn’t convenient.

45) Sometimes it’s OK to eat the junk at the QuickyMart.

46) It’s not OK to always eat the junk at the QuickyMart.

47) Don’t take anything that a patient says in anger personally.

48) Don’t take anything that a patient says when they are drunk personally.

49) Don’t ever convince yourself that you can always tell the difference between a fake seizure and a real seizure.

50) Think about what you would do if this was your last shift working in EMS. Do that stuff.

51) Carry your weight.

52) Carry your patient.

53) If firefighters ever do #51 or # 52 for you, say thank you (and mean it).

54) Being punched, kicked, choked or spit on while on duty is no different than being punched, kicked, choked or spit on while you’re sitting in church or in a restaurant. Insist that law enforcement and your employer follow up with appropriate action.

55) Wave at little kids. Treat them like gold. They will remember you for a long time.

56) Hold the radio mike away from your mouth.

57) There is never any reason to yell on the radio….ever.

58) When a patient says, “I feel like I’m going to die,” believe them.

59) Very sick people rarely care which hospital you’re driving toward.

60) Very sick people rarely pack a bag before you arrive.

61) Sometimes, very sick people pack a bag and demand a specific hospital. Don’t be caught off guard.

62) Bring yourself to work. There is something that you were meant to contribute to this profession. You’ll never be able to do that if you behave like a cog.

63) Clean the pram.

64) Clean your stethoscope.

65) Your patient’s are going to lie to you. Assume they are telling you the truth until you have strong evidence of the contrary.

66) Disregard #65 if it has anything to do with your personal safety. Trust nobody in this regard.

67) If it feels like a stupid thing to do, it probably is.

68) You are always on camera.

69) If you need save-the-baby type “hero moments” to sustain you emotionally as a caregiver you will likely become frustrated and eventually leave.

70) Emergency services was never about you.

71) The sooner you figure out #69 and #70, the sooner the rest of us can get on with our jobs.

72) People always remember how you made them feel.

73) People rarely sue individuals who made them feel safe, well cared for and respected.

74) You represent our profession and the internet has a long, long memory.

75) Don’t worry too much about whether or not people respect you.

76) Worry about being really good at what you do.

77) When you first meet a patient, come to their level, look them in the eyes and smile. Make it your habit.

78) Never lie about the vital signs. If the patients vital signs change dramatically from the back of the rig to the E.R. bed, you want everyone to believe you.

79) Calm down. It’s not your emergency.

80) Stand still. There is an enormous difference between dramatic but senseless action and correct action. Stop, think and then move with a purpose.

81) Knowing when to leave a scene is a vital skill that you must constantly hone.

82) The fastest way to leave a scene should always be in your field of awareness.

83) Scene safety is not a five second consideration as you enter the scene. It takes constant vigilance.

84) Punitive medicine is never acceptable. Choose the right needle size based on the patients clinical needs.

85) Know what’s happening in your partner’s life. Ask them about it after you return from your days off.

86) If your partner has a wife and kids, know their names.

87) No matter how hard you think you worked for them, your knowledge and skills are not yours. They were gifted to you. The best way to say thank you is to give them away.

88) Learn from the bad calls. Then let them go.

89) When you’re lifting a patient and they try to reach out and grab something, say, “We’ve got you.”

90) Request the right of way.

91) Let your days off be your days off. Fight for balance.

92) Have a hobby that has nothing to do with emergency services.

93) Have a mentor who knows nothing about emergency services.

94) Wait until the call is over. Once the patient is safe at the hospital and you’re back on the road, there will be plenty of time to laugh until you can’t breathe.

95) Tell the good stories.

96) You never know when you might be running your last call. Cherish the small things.

97) You can never truly know the full extent of your influence.

98) If you’re going to tell your friends and acquaintances what you do for a living, you’ll need to embrace the idea that you’re always on duty.

99) Be willing to bend the rules to take good care of people. Don’t be afraid to defend the decisions you make on the patients behalf.

100) Service is at the heart of everything we do. The farther away from that concept you drift, the more you are likely to become lost.

101) There is no shame in wanting to make the world a better place.

See more at: http://theemtspot.com/2014/03/22/101-things-we-should-teach-every-new-emt/

Academia, Health Care, Politics, Public Health, Society

Paying for Health Care, Today and Tomorrow

Before delving into the substance of this discussion, I must say that my personal beliefs are contradictory to many globalized health care efforts. Penner (2005) discusses some benefits of discussing and comparing health care economics between various nations. However, as we combine efforts to target specific health concerns across the globe, we lose the ability to innovate, promote evidence-based discussion, and promote the sovereignty of each country involved in the global effort. This globalization of health care deteriorates the ability to compare and contrast best practices of various countries. Unfortunately, most of the published works promote an insidious form of social justice and do not address how globalization efforts reduce the sovereignty of nations and people. Huynen, Martens, and Hilderdink (2005) support this deterioration by promoting a foundation for a global governance structure that would lead to better dissemination and control of globalization efforts.

Campbell and Gupta (2009) directly compare some claims that the U.K. National Health System (NHS) has worse health outcomes than the traditional U.S. model. Though Campbell and Gupta provide evidence disparaging many of these claims, they also seem to provide some insight as to the woes the NHS has recently faced and are working to correct. Under a system promoted by Huynen, Martens, and Hilderdink (2005), we would ultimately lose the comparison between nations as to best practices. The U.S. is currently debating the value of nationalizing health care, and similar arguments are arising based on the inability for interstate comparisons of effective and efficient delivery of health care among the various states.

References

Campbell, D. & Gupta, G. (2009, August 11). Is public healthcare in the UK as sick as rightwing America claims? The Guardian. Retrieved from http://www.guardian.co.uk/society/2009/aug/11/nhs-sick-healthcare-reform

Huynen, M. M. T. E., Martens, P., & Hilderink, H. B. M. (2005). The health impacts of globalisation: a conceptual framework. Globalization and Health, 1, 1-14. doi:10.1186/1744-8603-1-14

Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Academia, Clinical, Emergency Medical Services, Health Care, Public Health

Discussing Cost-Effective Analysis

This week I was directed to provide insight to the cost-effective analysis (CEA) provided by Penner (2004) in A Cost-Effective Analysis for Proposed Alternative Interventions to Post-Procedure Surgical Pain Reduction. Within the CEA, three alternative treatments (guided imagery, hypnosis, and biofeedback) are proposed to reduce post-operative pain. The CEA is used to determine the efficiency that each intervention offers comparably to each of the other two alternatives.

I developed a PowerPoint™ presentation [click here] to provide a summation of the CEA and visually present the information for a quick rationalization of the chosen intervention. I will explain each slide of the PowerPoint™ as it pertains to the CEA.

The Cost-Effective Analysis

The CEA provided by Penner (2004) describes the various costs and benefits of using guided imagery, hypnosis, and biofeedback therapies to reduce post-operative pain (as defined on slide #3), which improves the overall healing process. The objective, as noted on slide #2, is the importance of effective pain control. The author of the CEA concedes that all three interventions similarly meet the therapeutic objective of limiting post-operative pain in a safe and low-risk manner; however, the cost differences are significant.

Benefits

As provided in the CEA, the most significant tangible benefits, as mentioned above, are providing effective pain management in a safe, low-risk manner. Additionally, and as a result of reducing pain effectively, increased patient satisfaction, better patient compliance, and overall better healing leads to reduced costs associated with post-operative recovery, such as reduced length of stay and reduced need for post-surgical care (e.g. nursing care, physician care, rehospitalization, medications). Slide #4 of the presentation outlines these similar benefits.

Costs

The costs of each intervention are significant factors in deciding which intervention to promote. Once the annual cost for each intervention if figured, each of the identified costs are distributed across the expected patient volume of 197 and further distributed over the likelihood of each of three surgical procedures (spinal fusion, total hip replacement, and auto hema stem cell transplant) being performed. Though this is largely unnecessary, it does provide perspective for how the costs will be distributed and raise the overall cost for each surgical procedure performed, as shown on slide #8. The total annual cost for each intervention, as well as the per-patient cost, is outlined on slide #5 and graphed on slides #6 and #7.

The fixed costs for guided imagery include a psychology consultant, a surgery PA coordinator, wages for clerical staff, and training for the surgery PA.

The fixed costs for hypnosis includes a psychologist skilled in hypnotherapy and wages for clerical staff. The amount of resources for hypnosis are significantly less than for guided imagery; however, the intervention is more substantial requiring significantly more hours per week paid (12 for hypnosis vs. 2 for guided imagery).

The fixed costs for biofeedback are more equivalent to, though slightly more than, those of guided imagery. Biofeedback requires a psychology consultant, a surgery PA coordinator, wages for clerical staff, and training for the surgery PA, but the fixed costs for biofeedback also include specific equipment, including skin sensors, two video monitors, VCRs, and carts.

The total identified costs for guided imagery is 32.18% less than biofeedback and 64.56% less than hypnosis.

Result

Based on the CEA, the most cost-effective intervention for impacting and controlling post-operative pain on patients undergoing one of the three surgical procedures outlined is guided imagery. This result is stated on slide #10.

Discussion

The appropriate management of pain is crucial to patient care. Assuming that the three interventions investigated are equally effective towards the objective of reducing and controlling pain, the cost of each intervention is the deciding factor when considering which of the three interventions to employ. In this case, guided imagery is the most cost-effective intervention and is the recommended intervention, per the CEA.

It is important to understand that these costs will be borne by not one but three different departments – the pain clinic, the orthopedic surgery department, and the patient education department. This cost-sharing removes the burden of providing the intervention from a single department and disperses the burden over the budgets of three different departments.

References

Penner, S. J. (2004). Introduction to health care economics & financial management: fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Academia, Health Care

Investment in Capital Improvements

To Buy or Not to Buy, That Is the Question

Outlays for capital improvements can be daunting, whether for a business or within a personal budget. It makes sense to invest in capital improvements when a realistic return on the initial investment can be expected. Computers, motor vehicles, and homes are all good examples of large personal investments that can generate significant returns or provide security that increases stability. In health care, outlays for expensive imaging devices, real property, and specialization programs can generate the same returns or stability to seek returns, especially when resulting from strategic business planning. Penner (2004) describes these outlays, or expenses, “as inputs or costs incurred in the process of producing goods and services” (p. 65). These inputs are designed to enhance existing revenues streams or provide for additional revenue streams.

Although health care budgeting is much more complicated than personal budgeting, the concepts are very similar. Penner (2004) demonstrates various types of budgets that account for many more revenue and expense items than is typically seen in personal budgeting. For instance, a hospital would account for every charge for every patient seen in each department seen. The hospital would also have to account for a number of expenses, such as personnel costs and the cost for each piece of patient care equipment (Penner, 2004). However, budgets can be consolidated and simplified the further they move from direct care (e.g. budget overviews used by the board of directors would not be so specific to account for each patient’s stay; instead, the budget overview would reflect revenues and expenses departmentally with references to the budgets of each specific department).

Recently, I made two large purchases that had to be budgeted: a) a Chevy Suburban (financed) and b) a Harley-Davidson motorcycle (cash). With both purchases, I needed to be sure that I needed the vehicle and I would benefit from the purchase. For the Suburban, because it was financed, required me to budget $500.00 / month; however, the vehicle allows me to get back and forth to work to earn my living, is reliable in all types of weather (important because I am required to report to duty even in severe weather), and maintains a high resale value. This purchase also required me to budget increased fuel costs due to poor fuel economy. The motorcycle purchase, admittedly largely recreational, also required significant forethought and budgeting; however, the excellent fuel economy certainly allows me to offset the Suburban’s fuel consumption during moderate weather. The motorcycle was also priced at a significant discount and requires little maintenance.

Again, the basics of budgeting are the same for business and personal finances; however, business budgets can get fairly complicated fairly quickly. For personal budgeting, the level of complexity is mainly determined by the needs of the individual. Tracking income and monthly bills requires little detail, though planning for a major future purchase or savings goal requires more significant accounting and detail.

References

Penner, S. J. (2004). Introduction to health care economics & financial management: Fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Academia, Health Care, Politics, Society

Mind Your Own Business: Health Care Economics

Regardless of funding levels or overhead, health care must be provided ethically. The goal of the health care industry is to improve health, and unlike other industries, this market is driven not by choice but by need. Other markets perform, according to Friedman and Friedman (1980) and Smith (1910), only when mutual benefit can be achieved, that is, without external force, coercion, or unnatural limitation. Penner (2004) presents the economy of health care representative of many of the ideals that were accepted at the turn of this century. However, the current state of health care economics is the result of the unnatural force of these ideals in attempting to mold the market against natural market pressures, as described in detail and warned against by Friedman and Friedman and Smith.

Health care demand is based on need. Within that need, demand is reflective of pricing. For example, patients do not elect coronary bypass surgery, but if needed, the demand could be reflected by pricing constraints realized in negotiations of hospitals and insurance carriers. In this case, the patient may be transferred to a center that has negotiated reduced rates with the carrier for coronary bypass procedures. Ergo, health care demand is reflective of patient need and is variable only in the context of insurance pricing. It is within this negotiation that the aspects of quality, access, and cost are accounted. Government policy, however, has a negative and downward effect on these negotiations. If health care institutions are perceived to be able to provide the same services at discounted prices for government payors, then the institution should be able to provide these same services to private payors for the same or similar cost. This cost adjustment conversely affects quality and access.

Penner (2004) makes a logically flawed argument in respect to regulation arguing that increases in skilled nursing facility (SNF) safety regulations created a demand for more nursing assistants; however, this is an increased input to be provided by the SNF, not an output to be demanded by the patient. The cost will be borne by the private insurance payor, ultimately, and not the regulatory agency or the patient, which increases premiums decreasing access to private health insurance. Regulations negatively impact the relationship between supply/demand, quality, access, and cost. This is not to say that safety should not be a concern, as it is one of the few areas that I agree should be regulated, though, minimally.

Penner (2004) goes on to state “one role of government is to intervene in cases of market failure” (p. 21), using the pharmaceutical industry as an example. Unfortunately, with the focus on the new and significant health care and health insurance legislation and regulation, many academic discussions surrounding health care economics are now outdated and trivial. Without entertaining a constitutional debate, recently, governmental involvement has shown to have a negative effect on the health care industry actually causing market failures instead of alleviating them. Recent over-regulation by government on the pharmaceutical industry has resulted in a significant and dangerous shortage of life-saving emergency medications (Malcolm, 2012). This economic constraint will lead to higher demands of other, inferior, medications and increase the price, effectually increasing cost and decreasing both access and quality. This effect is also seen in the emergency medical services when states fix the price that can charged to users leaving the municipal taxpayer to face tax increases or decreases in access to emergency services and the quality of the services delivered (American Ambulance Association, 2008). Over-regulating an industry without regard to survivability is inefficient and unethical, limiting access and quality while increasing costs.

Insurance companies have sought to minimize their exposure to the rising costs of health care (Penner, 2004). By developing common sense incentives, insurers can advocate for their customers financially while expressing desire for optimal outcomes. By maximizing consumer and provider choice, these incentives can be used as natural pressures within the market to improve upon cost, quality, and access (Penner, 2004). This realization, according to Penner (2004), resulted in the emergence of the health maintenance organization (HMO) — the first widely accepted form of managed care. Unfortunately, HMOs faced scrutiny in the 1990’s and later augmented business models to reflect newer preferred provider organizations (PPO) and point-of-service (POS) plans. PPO and POS plans were created to promote the more inexpensive use of general providers and those providers that have negotiated fees. Unfortunately, Penner writes, the pressures of these PPO and POS plans on the consumer limit choice within the market; however, the consumer still has a choice of insurance carrier, which minimizes the pressure faced within each plan. This freedom is not expressed in governmental plans, such as Medicare and Medicaid.

As health care costs rise, the writings of Friedman and Friedman (1980) and Smith (1910) would suppose that we lessen regulation within the industry, allow new and novel approaches to insurance paradigms, and create an environment with as little unnatural market pressures as possible in order to allow natural market pressures to ensure equitable cost, access, and quality through competition

References

American Ambulance Association. (2008). EMS structured for quality: Best practices in designing, managing and contracting for emergency ambulance service. Retrieved from fitchassoc.com/download/Guidebook-April08-V2.pdf

Friedman, M. & Friedman, R. D. (1980). Free to choose: a personal statement. Retrieved from http://books.google.com/

Malcolm, A. (2012, January 4). Vast web of federal regulation causing drug shortages. Investor’s Business Daily. Retrieved from http://news.investors.com/article/596775/201201041859/big-government-behind-drug-shortages.htm

Penner, S. J. (2004). Introduction to health care economics & financial management: Fundamental concepts with practical applications. Philadelphia, PA: Lippincott Williams & Wilkins.

Smith, A. (1910/1957). The wealth of nations (Vol. 1). Retrieved from http://books.google.com/

Academia, Culture, Health Care, Society

Human Resource Challenges

Human resource management is a comprehensive support paradigm for both the employer (and his or her agents) and the employee. Most of the discussion regarding human resources revolves around problem employees and how human resources management can be used to deal with them. This week, however, we get to appreciate how human resources management can be effective at mediating employee concerns. Presented with two scenarios involving employee concerns, we will choose one and explore the fundamentals of human resources management as it relates to the challenges presented.

Throughout the past two weeks, Paul, a physical therapist, has been receiving in his work e-mail inbox some disturbing messages from an unknown sender. Many of the messages are sexual in nature and some even refer to Paul’s coworkers. Paul has reluctantly confided in the head of the organization’s HR department to help him with the issue. He is very embarrassed about the situation and is concerned that an investigation might jeopardize his relationships with coworkers and even his position with the organization.

As internet technology and systems management is a forte or mine, it is difficult for me not to take the easy path by selecting scenario 1. For this scenario, Paul would only have to enlist his manager in engaging the IT department to track the emails, which is a very simple process (most people do not understand how much information is generated in server logs and attached to email messages). The sender of the offensive emails would be found out and dealt with, and/or future messages of this type would be blocked by the email server, and Paul would no longer be distracted by these offensive emails.

However, as I stated previously, I prefer a challenge and will review the problems and some potential solutions regarding scenario 2.

For the past year, the nurses’ union at Good Health Hospital has been meeting to discuss grievances against Good Health’s management. In particular, the nurses are concerned with the way managers treat them; many feel overworked, undercompensated, and underappreciated. They have recently submitted a proposal to Good Health’s executives asking for better management practices, an increase in nurse staffing, and better compensation and benefits for nurses. The executives have enlisted the help of Good Health’s HR department in addressing the concerns in the proposal; they are concerned about budget constraints as well as the possibility of a nurses’ union strike.

Scenario 2 involves organized employees threatening a work stoppage if, at least, some of their concerns are not mitigated. Work stoppages, or strikes, are detrimental to any organization. The nurses’ union at Good Health Hospital have presented grievances that are typical in health care (Fallon & McConnell, 2007). It is a wonder why these concerns were not identified early. As Fallon and McConnell (2007) point out, “the best time to address a problem is before it becomes a problem” (p. 281). In this case, effective management would have identified these concerns early and developed a plan, perhaps integrating potential solutions through the organizations strategic plan, and prevented the growing acrimonious and bitter discontent amongst the rank and file employees. Though Fallon and McConnell discuss various types of organizational leadership, I prefer to lead with libertarian values in mind; ergo, both respect and responsibility must be virtues of both employee and employer, and both must work hard for the other. Fallon and McConnell discuss how trust and mutual respect lends to an effective, efficient, and rewarding work environment. Unfortunately, in scenario 2, it seems that we are beyond mitigation and prevention and, legally and contractually, they must be addressed.

Good Health Hospital administrators should take heed to the complaints noted in the nurses’ grievances. Although many managers and adminstrators dislike unions, ignoring them is not the answer. In this case, the concerns are probably real. Fallon and McConnell (2007) tell how information pertinent to employer-employee relations does not typically transcend the ranks, and this set of grievances may be the first indication to upper management that there is an issue. Still, the hospital adminstration, depending on the organizational schema (for-profit, not-for-profit, public, private, et al.), has a responsibility to its stakeholders and must ensure both operational feasibility and cost containment. Answering to these grievances could jeopardize one or both of these. A work stoppage would be detrimental to the operation and prove costly while meeting the demands in full would unrealistically obliterate the profit margin (note: the demands are not listed within the scenario; however, we can infer that they are significant).

If I were in the position of dealing with these grievances, I would, first, separate the demands by genre: safety and ethics, emotion, and economics. First and foremost, any ethical or safety concerns should be dealt with immediately, anyway. By identifying and dealing with these issues first, the perception of a receptive and action-oriented administration is gained. The solutions for these issues can also be highly visible and can be made to work for the organization by way of press releases outlining improvements in safety if not mere visible changes in the work environment and culture. Second, addressing emotional issues, such as poor treatment by managers and the perception of a lack of appreciation, can be solved by the employees, themselves. For instance, a “grade your manager” program might be cost neutral and provide some insight for future coaching. This would also give a sense of the prevailing attitude of the employees in the way comment cards give businesses a sense of the clientele. Another way of addressing emotion is to direct each manager to inquire of their staff periodically about any minor concerns they might have. This would give a sense of open communications, something that appears to be lacking. Finally, it is time to address the economical concerns.

Many times, the pay and benefits that are offered to unionized workers are stipulated in the collective bargaining agreement. These, fortunately (or, unfortunately) cannot be changed until the contract is renegotiated. Ethically and respectfully, the compensation package should hover near market levels. Fortunately for Good Health Hospital, we have already addressed a few concerns, so we have latitude in addressing the economic issues. As Fallon and McConnell (2007) state, working conditions are just as important as financial incentives, and employees may sacrifice pay and benefits for a decent working environment.

Regardless of the hospital’s ability to meet the nurses’ demands, I would insist on meeting with them, out of respect, to hear their concerns; however, the meeting would be official and the labor relations attorneys would be present to ensure compliance to the National Labor Relations Board regulations.

References

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

Academia, Culture, Emergency Medical Services, Health Care, Society

Burnout: “What a Star—What a Jerk”

The character, Andy Zimmerman, in Cliffe’s (2001) fictitious hypothetical is obviously intelligent and hard-working; however, he appears to be suffering from “burnout”. Korczak, Huber, and Kister (2010) describe the contemporary definition of burnout as essentially equated to work-related syndrome, which is characterized by “emotional exhaustion, depersonalisation [sic] or cynicism and reduced professional efficacy” (p. 3); however, the authors acknowledge a plethora of symptoms, definitions, and theories in the literature and call for standardization for improved diagnosis and research. Maslach and Leiter (2010) describe burnout as “[reflecting] an uneasy relationship between people

and their work” (p. 44). In the case of Andy Zimmerman, it appears that he has depersonalized his work, evidenced by his egoism and rage towards his co-workers. Also, from reading the fictitious account, assumptions can be made: 1) Andy Zimmerman did not start his job by acting in such manner; therefore, this is a change that Jane Epstein would not be privy, and 2) Andy Zimmerman may feel that his work is falling from his own personal standard and finds blame in others, which goes towards his egoism. In all, these might account for some level of reduced professional efficacy. However, as Korczak et al. discuss, there is no valid diagnostic criteria of burnout and application is difficult as burnout has strong correlation with depression and alexithymia (see footnote 1), each of which could contribute to Andy Zimmerman’s attitudes and outbursts.

Employees who are suffering burnout or other psychosocial maladies have a negative and detrimental effect on other co-workers (Maslach and Leiter, 2010; Korczak, Huber, & Kister, 2010). In the case of Andy Zimmerman, his relationship with his work environment is certainly reducing the efficacy of others. Is it possible that Andy Zimmerman’s tirades are the only reason that he is the top performer? Could it be that culling inappropriate behavior would more than make up for the loss of one man’s productivity?

According to Fallon and McConnell (2007), many employees that are suffering personal problems to the degree that they interfere with work are able to benefit from managers pointing out how their work has been suffering, but employees that are identified as possibly suffering from burnout syndrome (or, any major personal problem that adversely effects work) should be referred to the employee assistance program, if at all possible. Fallon and McConnell go further to state, and rightly so, that managers should not give advice on personal matters but only provide a means of rectifying professional performance. Managers are poorly equipped to handle counseling of a personal nature. Instead, Fallon and McConnell demonstrate the utility of the progressive discipline model to both educate an employee about his or her responsibilities and allow him or her to rectify the situation. Unfortunately, however, behavior problems sometime end with termination, though “experts note that when an employee is released for a serious infraction, the problem has been corrected by removing its cause” (Fallon & McConnell, 2007, p. 260).

In regards to Jane Epstein’s troubles with Andy Zimmerman, double standards of employee conduct cannot exist (Fallon & McConnell, 2007). Jane must do something to quell the growing rift within her department. First, Jane must document everything in regards to Andy (Fallon & McConnell, 2007). This, most of all, will support the premise that Jane used all possible solutions before considering termination. Next, Jane should ensure that Andy understands that the behavior will not be tolerated any longer. This could, perhaps, be coupled with a statement referencing the employee assistance program or other route of anger management counseling. Finally, Jane might consider that the work being performed is not well matched for Andy. Mismatched work is a significant cause of burnout, and if this is suspected, Jane could discuss the potential for professional growth with Andy, which might alleviate the outbursts (“Don’t take your people for granted,” 2010; Maslach & Leiter, 2010). Finally, if Andy continues to fail to conform to the department policies, he must be terminated. Jane needs to view her responsibilities to the department over any she might feel towards a single employee (Fallon & McConnell, 2007).

References

Cliffe, S. (2001). What a star — what a jerk. Harvard Business Review, 79(8), 37–48.

Don’t take your people for granted. (2010). Healthcare Executive, 25(4), 40.

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

Hosoi, M., Molton, I. R., Jensen, M. P., Ehde, D. M., Amtmann, S., O’Brien, S., … Kubo, C. (2010). Relationships among alexithymia and pain intensity, pain interference, and vitality in persons with neuromuscular disease: Considering the effect of negative affectivity. Pain, 149(2): 273–277. doi:10.1016/j.pain.2010.02.012

Korczak, D., Huber, B., & Kister, C. (2010). Differential diagnostic of the burnout syndrome. GMS Health Technology Assessment, 6, 1-9. doi:10.3205/hta000087

Maslach, C. & Leiter, M. P. (2010). Reversing burnout: How to rekindle your passion for work. IEEE Engineering Management Review, 38(4), 91-96. doi:10.1109/EMR.2010.5645760

Footnotes

1. Alexithymia is defined as a lack of emotional awareness and the inability to identify or label emotions, which is demonstrated by difficulty identifying and describing feelings and difficulty with externally-oriented thinking (Hosoi et al., 2010).

2. In response to Cliffe’s (2001) “What a Star—What a Jerk”:

  • Mary Rowe calls on Jane to show laissez-faire leadership in which she does nothing directly but tries to “work with Andy” to come to a workable solution, relying on upper management to provide discipline. In the writing, Jane has already approached Andy and discussed his attitudes towards his co-workers; however, the positive result of this conversation was short-lived, and Andy reverted to his tactics of ill-temperment and hostility. In my opinion, these attitudes have no place in the workplace, and Jane should be adamant about this point before Andy directs his rage towards her, further undermining her authority.
  • Chuck McKenzie, however, makes some good points on how to work with Andy (so long as there is actual value in Andy remaining employed with TechiCo). Mr. McKenzie calls for some innovative changes in the organizational structure to separate Andy from the rest of the team, capitalizing on increased productivity all around. Additionally, creating a specialized team of high performers might alleviate burnout (if, in fact, that is what Andy is suffering) and demonstrate to Jane’s superiors that there are ways to isolate and reward top performers while tolerating average performers. Before doing anything, as Mr. McKenzie points out, Jane needs to become a leader and stop acting like a manager.
  • While Kathy Jordan elucidates more of the same philosophy as Chuck McKenzie in regards to leadership, she advocates trust and positivity between Jane and Andy. I feel that trust and positivity are a product of a viable working relationship and are more goals than standards. Ms. Jordan is right, however, that Jane must prove her mettle in a very short time.
  • Finally, James Waldroop provides some real insight into how Jane might best lead and mold Andy into a star employee. Either that, or Jane has started the time table for Andy’s departure. All in all, leaders need followers, and leaders cultivate followers; however, if a subordinate does not wish to follow, then the leader cannot lead or cultivate. In this case, the relationship has failed.
Academia, Society

Pay and Perks: Google Versus Health Care

A Comparison of Compensation Packages

According to Cable News Network’s (2012a, 2012b) annual Fortune Magazine 100 Best Companies to Work For, Google sets the standard for employer-provided compensation and fringe benefits. This paper will discuss, compare, and contrast the differences between some of the more interesting and innovative employee benefits offered by Fortune Magazine’s best company to work for, Google, and Southern Ohio Medical Center, Fortune Magazine’s leading health care organization, according to the same list.

The Importance of Investing in the Employee

Fallon and McConnell (2007) clearly demonstrate that employers must be current and competitive with respect to compensation in order to attract and maintain a competent and able workforce. The need for each level of competency and ability differs from employer to employer, and even between industries, which provides employers the flexibility to match compensation levels with the level of talent required. Employers merely requiring entry-level, unskilled talent will more than likely provide less total compensation than those employers who wish to be cutting-edge and innovative, requiring a pool of innovating and proven leaders in their field.

Employees who are more comfortable and accepted in the workplace tend to be more productive, especially when assured that outside influences, such as illnesses, childcare issues, and, according to Google’s Executive Chairman, laundry, are mitigated (Fallon & McConnell, 2007; Google, n.d. a). Employees, however, have different needs, and employers need to stay mindful as these needs change by offering a comprehensive array of flexible benefits at a cost conducive to use (Fallon & McConnell, 2007). Many organizations fail to consider this and end up wasting valuable resources on less than attractive benefits.

Google

Google, a relatively young company that was incorporated in 1998, has pushed the boundaries of technology, but the company has always maintained the philosophy of focusing on a single thing and doing it well (Google, n.d. b, n.d. c). Striving for technological excellence, to Google, means striving to attract the most innovative workforce (Google, n.d. a). To this end, Google offers a compensation package that no other can rival.

According to their website, Google (n.d. a) provides a host of benefits, including the typical health, dental, and vision insurance plans, sick days, vacation days, and a very attractive commitment towards each employees retirement, but they also offer atypical fringe benefits, such as gift matching employee donations, adoption assistance, financial planning, and an on-site physician, among others. Free gourmet meals and snacks as well as on-site oil change and car wash services, bike repair, fitness classes, gym, massage therapy, hair stylist, and dry cleaning top off the total compensation package offered to Google employees.

It is no wonder that Google heads the list of best employers, but how can a typical health care organization stack up against the world’s leading search engine provider (Cable News Network, 2012a, 2012b)?

Southern Ohio Medical Center

Southern Ohio Medical Center (2010a) is a 222-bed hospital located in Portsmouth, Ohio, and employs 2,200 people in addition to 140 physicians and specialists. Southern Ohio Medical Center is a more typical example of a large employer, and it might even be unfair to compare and contrast benefit packages with such an atypical company as Google, but I will do so, anyway.

According to Fortune Magazine (Cable New Network, 2012c), Southern Ohio Medical Center has cultivated a culture of teamwork and compassion that permeate the ranks, and this intangible characteristic helps to make this hospital one of the leading employers in the country.

Working for Southern Ohio Medical Center entitles employees to a comprehensive array of benefits. Though not as comprehensive as Google, Southern Ohio Medical Center employees to enjoy the typical health, dental, and vision insurance plans, sick days, vacation days, and an attractive retirement plan (Southern Ohio Medical Center, 2010b). Southern Ohio Medical Center (2010b) also offers atypical fringe benefits, such as sick child care, pet health insurance, a wellness program, and a number of discount programs for employees to enjoy.

According to Fortune Magazine (Cable News Network, 2012c), Southern Ohio Medical Center enjoys excellent growth with controlled turnover. The compensation package offered to this hospital’s employees reflects the simply stated cardinal value of the hospital: “We honor the dignity and worth of each person” (Southern Ohio Medical Center, 2010a, para. 7). It would seem that this could be the reason that Southern Ohio Medical Center maintains the #36 spot on Fortune Magazine’s (Cable News Network, 2012a) list of best employers of 2012.

Discussion

As stated above, it is almost unfair to compare and contrast these two very different organizations; however, both organizations seem to share some core values that promote the integrity and innovation within their cultures necessary to succeed in their vision. This is emphatically apparent as both organizations hold respectable rankings as Fortune Magazine’s (Cable News Network, 2012a) best employers.

As a prospective employee, I certainly realize the importance of most of the benefits offered by both organizations, especially health and retirement programs, and the atypical fringe benefits offered by both seem to convey a sense of investment in the employee, which helps to shape each organization’s culture. By investing in each employee and cultivating the organizational culture, the financial implication, it would seem, would benefit the organization as a whole, allowing for positive growth and innovation, especially within a health care organization.

This paper should clearly demonstrate the sometimes not-so-obvious link between an organization’s value statement, the actual values of the organization, the leverage of these values on the employee, and the result towards achieving the organization’s goals. Compensation packages appear to have direct correlation between organizational values and the organizational value placed on the individual employee. As such, human resource managers, when preparing or analyzing compensation packages, should first look to the organization’s value statement to guide and inspire them to continue to promote the value of the employee.

References

Cable News Network. (2012a, February 6). 100 best companies to work for. Fortune Magazine. Retrieved from http://money.cnn.com/magazines/fortune/best-companies/2012/

Cable News Network. (2012b, February 6). Google – best companies to work for 2012. Fortune Magazine. Retrieved from http://money.cnn.com/magazines/ fortune/best-companies/2012/snapshots/36.html

Cable News Network. (2012c, February 6). Southern Ohio Medical Center – best companies to work for 2012. Fortune Magazine. Retrieved from http://money.cnn.com/magazines/ fortune/best-companies/2012/snapshots/36.html

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

Google. (n.d. a). Benefits. Retrieved from http://www.google.com/jobs/lifeatgoogle/benefits/

Google. (n.d. b). Google history. Retrieved from http://www.google.com/about/company/ history.html

Google (n.d. c). Our philosophy. Retrieved from http://www.google.com/about/company/ tenthings.html

Southern Ohio Medical Center. (2010a). About SOMC. Retrieved from http://www.somc.org/ about/

Southern Ohio Medical Center. (2010b). Employee benefits. Retrieved from http://www.somc.org/jobs/benefits/

Academia, Culture, Emergency Medical Services, Health Care

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.

Discussion

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.

References

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

Academia, Criminal Justice, Culture, Health Care, Society, Technology

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.

References

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 http://www.esrcheck.com/articles/Caution-Using-Search-Engines-MySpace-or-Facebook-for-Hiring-Decisions-May-Be-Hazardous-to-Your-Business.php