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Services The majority of departments or divisions in an organization produce prod- ucts, coordinate programs, or deliver therapeutic remedies. Such outputs generate revenue. Rather than creating revenue, human resources depart- ments provide important services to an organization. Section II introduces four important services of a typical HR department. Chapter 7 (Employee Training) explores a variety of topics and different methods of delivering information. Chapter 8 (Compensation and Benefits) introduces the related concepts of pay and additional incentives. Few employees will work for free. A small number of benefits are required by law; the rest are provided at the discretion of senior managers or a governing board. Chapter 9 (Performance Appraisals) discusses methods for periodically evaluating employees. Chapter 10 (Succession Planning) reviews approaches used to replace organizational leaders.

S E C T I O N

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Employee Training

Chapter Objectives

After reading this chapter, readers will be able to:

• Appreciate the importance of training and development as continuing activities

• Outline the essential role of department managers as teachers • Appreciate the importance of new-employee orientation • Understand applicable principles in addressing staff training and

development needs • View cross-training as a means for improving employee capability

and departmental effectiveness • Know how to approach on-the-job training • Understand employee mentoring • Appreciate the importance of developing potential managers • See how human resources can help managers meet departmental

training needs

■ CHAPTER SUMMARY

Training is one approach that leaders use to ensure that the organization to which they belong will have the best possible chance to survive and grow in the future. It helps to ease an individual’s transition into an organiza- tion and facilitates movement within an entity that is larger than any of the individuals that compose the organization. Training takes many forms. New-employee orientation, mentoring, and on-the-job and off-site train- ing are common examples. Managers often provide training in formal or informal settings. Cross-training of employees with similar types of jobs provides organizational flexibility. Giving developmental opportunities to potential leaders facilitates succession planning.

C H A P T E R

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Case Study: A Blue Monday

“Monday mornings should not be so complicated”—at least that is what Sam, the health commissioner, thought. The new epidemiologist was sched- uled to report for work that Monday at 10:00 a.m. A second new employee was scheduled to begin on Friday. “Two new people on two different days in the same week,” thought Sam, with an air of defeat.

Sam had been reading about the importance of developing potential new managers. The usual departmental duties would not diminish. Because the previous Friday was a state holiday, the morning volume of email was extra heavy. This had become more of a problem since a prankster had spread Sam’s email address to websites that specialized in body reshaping surgery or drugs to enhance performance. “Why couldn’t both new employees start tomorrow?” mused Sam. What advice would you give to Sam?

■ INTRODUCTION: THE ROLE OF TRAINING AND DEVELOPMENT

Senior managers in most healthcare departments can be counted on to sup- port and praise the value of continuing education. Unfortunately, many man- agers drop training and development when budgets get tight and expenses must be reduced. This is partly because of the difficulty of pinpointing cost savings that can be attributed to continuing education. Most individuals in management believe or know intuitively that education ultimately saves money. The problem is that it is more difficult to measure the results of education in terms of costs versus benefits than it is to measure cost savings in most other areas of organizational activity. As a result, money spent on education is often viewed as expending resources with few tangible results.

As important as training and development are to every healthcare or- ganization, in many instances they receive minimal attention from upper managers. Simply reminding department managers that they have a re- sponsibility for employee development is insufficient. Managers should be encouraged to view training and development as important because they keep valuable employees interested and challenged.

Factors that motivate employees are found primarily in the nature of work. Among the strongest motivating factors are the opportunity to do interesting and challenging work and the opportunity to learn and grow. Better-performing employees are usually so motivated. They are also the individuals who are most likely to leave in search of more interesting and challenging work and greater overall opportunities. One way for depart- ment managers to increase the chances of retaining their better employees is through visible support for training and development.

A department that places no emphasis on training and development may seem to be standing still. In reality, such a department is essentially going

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backward because the world continues to move ahead. With technologic, economic, legislative, financial, and social change constantly occurring, no department or organization can afford to stand still. A certain amount of forward progress is necessary simply to remain abreast of change. As contrary as it may sound, one must move ahead to stay even. Therefore, maintaining or improving the abilities of staff must be an ongoing effort. Continuing education is essential.

The Manager’s Role in Employee Training Under the blanket heading of training is an entire range of employee devel- opment activities, from providing new-employee orientation to assisting employees in moving up into management. Employee development should be one of the most important aspects of a manager’s job.

Managers are likely to have a greater depth and breadth of technical knowledge and expertise in the areas or activities they manage than is found anywhere else in an organization. Managers tend to be educated in the fields in which they work. In addition, they have the advantage of practical education acquired through experience. Therefore, managers are primary re- sources for information about their departments and the work they perform. Department managers are uniquely positioned to pass on their knowledge and expertise to others. Department managers have the responsibility for maintaining and improving the capability and competence of their staff.

The Manager as a Teacher Because the department manager is usually well versed in the department’s tasks and activities, the manager is best suited to provide some, although probably not all, of the teaching in the department’s continuing educa- tion program. For some of the topics, the manager will clearly be the most qualified individual and the most readily available instructor, but chances are there will be a few topics that other individuals can better address. For example, a supervisor in health information management (formerly medi- cal records) who is interested in cross-training several assistants in chart completion review might prefer to use the person regularly assigned to this task as the instructor. With proper encouragement and assistance, the per- son who knows best how to perform a given task can be the best resource for teaching that task to others. Regardless, however, even if the depart- ment manager does not do all of the teaching, this manager nevertheless remains responsible for the department’s continuing education program.

Teaching a class can loom as a formidable task to the manager who has not previously done so. But a manager who is hesitant to adopt the role of instructor can rest assured that just about everyone involved in teaching or any other form of public speaking has experienced similar qualms. It helps to regard one’s early experiences in teaching as learning experiences in themselves, remembering that one is not a professional teacher and that the department’s employees are familiar faces, not a group of unknown

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“students.” The keys to building one’s effectiveness as an instructor are preparation and practice. The more one teaches a given subject, the better it can be taught in the future. The more often one faces a group of learners, the less troublesome the feeling of uneasiness about teaching will become.

A manager who will serve as a teacher is advised to acquire knowl- edge of adult learning principles. Pertinent information is available from a number of sources, including some of the resources listed at the end of this chapter. Most healthcare organizations of any appreciable size have internal resources to tap. Depending on organization size, human resources (HR) may have a training function that can assist managers, or a separate education department may be available. At the very least it is usually pos- sible to obtain information about adult instructional methods from nursing in-service education. From a manager’s perspective, teaching should be an integral part of management’s role. Teaching is also an essential part of managerial delegation. Unfortunately, in the pursuit of everyday business, employee development is often overlooked.

External Requirements The importance of continuing education and training is underscored by the extent to which different accreditation and regulatory agencies assess training activities during their periodic surveys. For example, The Joint Commission (TJC) (formerly the Joint Commission on Accreditation of Healthcare Organizations [JCAHO]) publishes specific requirements for the continuing education of doctors, nurses, and certain other personnel. The accrediting organization checks regularly to see if employee orienta- tions are routinely scheduled and attended. Some states have requirements for all-employee orientations to address certain particular topics and offer annual refresher education on the most critical topics.

Another indicator of the importance placed on continuing education externally is the fact that many healthcare practitioners are required to provide evidence of completing a certain number of continuing education units each year to maintain their professional licensure.

■ NEW-EMPLOYEE ORIENTATION

All healthcare department managers should have a new-employee orienta- tion plan for their own department. There should be a separate orienta- tion plan for the organization overall. Orientation plans are required by accreditation and regulatory agencies.

An organization usually provides a general new-employee orientation that addresses common matters. Ordinarily prepared by HR, a general orientation addresses such topics as the organization’s structure and leader- ship, employee benefits, the performance appraisal process, the organiza- tion’s dress code, employee parking, facility security, infection control, and

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universal precautions. Employee health and other benefits, the employee assistance program (EAP), employee work rules, and generally applicable policies are also typically included.

A department orientation should provide an introduction to the people in the department and program areas and to the physical space, equipment, processes, and any special department policies, as well as on-the-job guid- ance in getting started doing the work for which the new person was hired. One of the most inappropriate ways of treating new employees is simply to allow them to begin working without the benefit of an orientation. Even experienced and well-educated new employees require some guidance concerning variations specific to a particular department or program area, as well as some time to ask questions about the new job.

As part of a new employee’s orientation, it may help to appoint a mentor. A mentor is an experienced person who can provide guidance through the new person’s first few days or weeks on the job. Mentoring offers valuable benefits; it provides a personally guided orientation for a newcomer, and it affords an opportunity for further development to an experienced employee.

■ TRAINING TO CORRECT PERFORMANCE PROBLEMS

Training must (or at least should) be a high priority for every manager. Running a program area and getting out the expected work is a supervisor’s number-one priority; nevertheless, training is important, especially regarding new or revised work procedures and the correction of performance problems.

When assessing employee performance, supervisors continually compare observed performance with expectations. Managers may have to be teachers when helping employees correct performance problems. When an employee displays performance problems that command a manager’s attention, it is always appropriate to consider whether reasonable efforts are being made to help the employee succeed. Many employees fail at their jobs because they were inappropriately trained, insufficiently oriented, or inadequately supported.

It may sometimes be necessary to impose a requirement for a particular kind of education or training as a condition of continued employment. For example, an individual whose telephone manners have elicited many com- plaints may be required to complete a program in telephone etiquette, or an individual whose job requires writing but who has experienced problems with grammar may be required to take a remedial English-language program.

■ DETERMINING DEPARTMENTAL LEARNING NEEDS

If a variety of learning needs seem to be present throughout a department, then it is helpful to conduct a needs analysis for basic remediation. One approach consists of making a simple chart for each job description in a

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department, with columns indicating the principal required skills and rows listing the employees whose work includes those activities. It becomes a matter of assessing all employees in terms of whether their skills are ad- equate to meet normal job expectations. Each assessment that falls short of normal expectations indicates a learning need. This approach helps managers focus training activities on areas of greatest need. In addition to managers’ assessments, noticeable performance problems also indicate areas of need, as do tendencies toward repetitive errors or actions that generate chronic complaints by customers, coworkers, and others.

A manager’s initial assessment of training needs is translated into train- ing objectives. Learners must know initially where they are headed. Once a goal is determined, learners and managers can consider how to get there.

A learner’s motivation is a key to the eventual success of training. Managers must be prepared to help employees answer one particular question about what they are being asked to learn: “What’s in it for me?” In correcting a severe performance problem, the answer may be as basic as, “You get to remain employed.” There are numerous other possible responses, such as, “You get to learn something that may eventually help you to be promoted,” “You get more variety in your work,” or “You get to do something more challenging than what you’ve been doing.”

Employee Training Within a Department The following principles may assist a manager when addressing staff training and development needs. All employees who are expected to learn something deserve to know why they are learning, and all employees should be advised of specific goals and objectives. Employees learn better when they actually become involved in the process. The more hands-on or learn-while-doing components that can be incorporated, the more likely a training program is to be successful. Employees will more quickly and more accurately absorb material that applies to their daily work rather than having to learn material that they see as irrelevant. Thus, in-department employee training should be practical and immediately applicable rather than theoretical.

Most employees will accept new ideas more readily if these ideas support their previous beliefs. New material, techniques, and processes are best pre- sented within the context of a department’s mission. For example, “We’re still here to serve members of the community, but now it can be done more quickly and at lower cost.” Some employees learn best when allowed to pursue their own areas of interest or needs at their own rate. For these em- ployees, managers must provide clear expectations, necessary information and materials, and general guidance. Many employees must be encouraged to find learning pleasant. For some employees, the possibility of education of any kind essentially means going back to school, which renders them resistant to training. These people must be shown what is in it for them.

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Cross-Training for Efficiency Department managers who supervise employees working in comparable positions in terms of job grade or pay scale have the opportunity to im- plement cross-training. For example, an office manager may have three clerical-level employees who are assigned in different capacities: a file clerk, a program secretary, and a data entry specialist. These three jobs reside in the same pay grade. As long as the three people simply do their own jobs, the department has limited flexibility. If one person is on vacation or is ill, no one is trained to assume the missing person’s duties. If all three people are capable of doing all three jobs, the employees can be moved around as needed. Resources can be shifted as workloads or backlogs demand, and any of the three people can cover for any of the others as necessary.

This type of flexibility can be obtained by training the three employees in one another’s jobs. This requires time and effort. Each of the people can train the other two in job particulars, with the supervisor providing general guidance. This training will ultimately repay the time and effort involved. A department gains considerable flexibility in addressing backlogs and covering for vacations and illnesses. The individuals gain greater interests and challenges associated with their work through increased task variety.

On-the-Job Training On-the-job training is appropriate under many circumstances. For some learning needs, it may be the best available approach. Much on-the-job training is best accomplished under the direct supervision of a manager or under the direct guidance of an experienced employee. Employees receiving on-the-job training receive step-by-step instructions on how to accomplish a task while actually performing it. After employees perform the task a suf- ficient number of times under this direct guidance, the instructor may then reduce or eliminate the verbal guidance and simply watch the employees until assured that the activity is being performed in a satisfactory manner. Thus assured, the instructor may further withdraw to a position of being readily available to answer questions.

On-the-job training is not simply allowing employees to learn by trial and error with only a rough idea of expected results. However, this is precisely what it becomes when managers decide that they are too busy to address training in a proper manner and simply turn new employees loose on the job.

Improper or inadequate on-the-job training can be dangerous or destruc- tive. Employees may learn to perform their tasks in a highly inefficient or incorrect manner, creating inappropriate work habits that will become deeply ingrained and difficult to correct. It is far better for managers to ensure that sufficient time and attention are devoted at the start of the learning process so that on-the-job training can succeed as intended.

Another common but inadequate approach to training, or at least to satisfying annual in-service education requirements, is to give staff members

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files or folders of information to review. Often, accreditation agencies or state regulations require these documents to be reviewed. A reading package is circulated among the staff with instructions for each recipient to review the documents as required, check off to indicate that they have done so, and pass the material to the next person. This is the loosest and weakest approach to training. Short of questioning each recipient in detail, there is no way to ensure that the material has been read and absorbed.

Most people recall a certain portion of information they hear (approxi- mately 10%), a somewhat greater portion of what they both see and hear (estimated to be 20%), and almost all of what they simultaneously see, hear, and do (often 90% or more). This suggests that the most effective job-related training should include a combination of lecture, demonstra- tion, and hands-on practice.

Using multiple channels of sensory input increases the likelihood of learning. This is why personal reading alone can be the least effective way of learning, and why lecture alone is not a great deal better. When multiple senses are used simultaneously, the chances of learning increase. Repeating the same material after a lapse of time, and presenting it in varying forms, can be highly effective in ensuring that the material will be retained.

Effective Mentoring Mentoring can be most effective if it is officially sanctioned. It need not take place within the context of a formal program, but it should be acknowledged as an actively used employee development technique rather than simply an ad hoc practice whereby people might happen to link up with each other. The extent of the formality required may be minimal. A new employee and an experienced employee or mentor are intentionally brought together by a department manager, and all three parties agree on the objectives of the relationship, specifying what the new employee is expected to learn. The manager remains close enough to the process to be able to evaluate both the new employee and the mentor during and after the relationship period.

By officially addressing mentoring as a means of employee development, an organization sends a strong message to all employees concerning its com- mitment to their development. Although mentoring is one of the least costly development tools available, it can be extremely effective. Its visible use proclaims that the organization cares about the development of its people.

For a new employee, a mentor can be a valuable facilitator, sounding board, and source of advice and guidance. The mentor benefits as well. Mentoring can provide a sense of fulfillment and satisfaction, especially for a senior employee who is in need of additional challenges and who can benefit from more interesting work experiences. The process helps mentors further refine their skills and keep them sharp.

Employees most likely to realize significant benefits from a mentoring relationship are those who demonstrate a willingness to learn, are proactive

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in expressing this willingness, and are ambitious and enthusiastic. Effective mentors are able to assume full responsibility for their own growth and development. They are receptive to coaching and constructive feedback and have the ability to change behaviors based on positive experiences.

Experienced employees who are considered for mentoring responsibili- ties should be persons who are willing to serve voluntarily and give the undertaking the time and energy it requires. No mentor should ever be unilaterally assigned or forced to serve. Similarly, managers should not force new employees to work with any particular mentor. Both parties should have an option to change a mentoring relationship if either becomes dissatisfied. Potential mentors should possess sufficient knowledge and expertise in the new employee’s areas of responsibility. They should have good interpersonal skills and patience, and they should be supportive, friendly, and effective listeners. Above all else, potential mentors should demonstrate interest in the development of others.

Developing Potential Managers An essential part of every supervisor’s responsibility is to help identify and develop new managers. This includes identifying and developing one or more potential successors. Many managers fall short of properly address- ing the latter need.

The development of potential successors is closely associated with the practice of proper delegation. This is the primary means by which succes- sion planning evolves. It is an area of concern or threat for some managers, especially people who are often insecure in their positions and fear the competition provided by intelligent, up-and-coming subordinates. Many managers simply do not think beyond the present. They are ill prepared to imagine being moved up or out or becoming incapacitated and no longer able to function in their positions.

Development of a potential new manager may not occur within a de- partment because it requires serious and progressively more responsible delegation. This takes time and planning on the part of management. Such development requires delegating tasks that are increasingly more respon- sible. Suitable tasks are often sufficiently appealing or important that man- agers retain them personally rather than giving them up to subordinates.

At the very least, the manager who has a potential successor in the pro- cess of development usually has readily available coverage for vacations and illnesses as needed. No person is or should be absolutely indispensable, but the loss or absence of a group’s leader when there is no ready backup person can create significant inefficiency and inconvenience to an organization.

A manager who entertains ambitions about advancing higher in the or- ganization should take seriously the need to develop a potential successor. Higher management will often look closely at a manager’s track record in delegating tasks and especially at whether that manager has one or more

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capable successors in the wings. Enlightened higher management may well conclude that a supervisor who has paid no attention to developing a potential successor shows little strength in delegation, a skill that becomes increasingly important as one moves up in an organization. Executives in an organizational hierarchy may be unwilling to promote a manager if doing so means having to conduct an external search for a successor or promoting an untried insider.

No manager wants to lose good employees. However, some of them are going to be lost regardless of a supervisor’s actions. Managers who put time and effort into developing potential successors may see many of them eventually lost to other departments or other organizations as they take advantage of opportunities to advance their careers. But these employees are likely to be lost to the organization anyway if they are not given op- portunities to develop. Some of them will be lost even sooner if they remain unchallenged in their jobs. Therefore, prudent managers should take full advantage of the talents that are available in their groups by delegating tasks to the better and more willing employees and helping them to develop.

Only rarely does a manager have anything to fear from a subordinate who is encouraged to develop and grow and learn some aspects of the man- ager’s job. In fact, having one or two sharp, up-and-coming employees is often just what a manager needs to remain effective and to continue to grow.

How Human Resources Can Help It is customary for an organization’s general new-employee orientation to be presented or at least coordinated by HR. As far as this orientation is concerned, ordinarily all a manager has to do is ensure that each new employee attends. However, some managers have to be reminded of the necessity for all new employees to attend the orientation. Some of these new employees may be filling positions that have been empty for some time, and the department may be behind in its work. Occasionally, managers may decide that new employees cannot be spared for the few hours required for orientation. There may be a tendency to regard orientation as just another HR thing that intrudes on a manager’s ability to run a department or pro- gram. In most instances, a general orientation to the organization includes topics that are required by accreditation or regulations. Orientation then becomes partly a response to external requirements and partly a service performed to get new employees pointed in the proper direction.

Beyond ensuring that new employees attend general orientation, it is the manager’s responsibility to be aware of training needs and either attend to them or refer them as necessary. When addressing issues of employee train- ing and development, a department manager should expect HR to work with supervisors to diagnose particular problems and determine the kinds of training or education that might be helpful, to provide certain kinds of needed training, to secure the involvement of other in-house training

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expertise, to identify external sources for specifically required training, to determine how these sources are accessed, and to guide employees in using an organization’s tuition assistance program when appropriate.

Training needs should be addressed on a continuing basis, both to assess present circumstances to determine the skills and attitudes that must be adopted or improved to meet current needs, and to attempt to determine future needs based on trends that appear to be coming during the next one or two years. Information for evaluating training needs can be gathered in a variety of ways, including questionnaires completed by managers and employees, focus group discussions, individual interviews with manag- ers and employees, and exit interviews at which departing employees are asked for their opinions concerning developmental needs. Subjects that are frequently mentioned merit consideration as potential program topics.

Human resources can contribute information relevant to determining training and development needs from direct contact with people on the job, both managers and rank-and-file employees; from reviewing performance appraisals, performance improvement records, and disciplinary actions; and from monitoring trends in public health.

When guiding training and development activities, HR may recommend involving both managers and employees in preparing training agendas and determining program content. It often starts with needs that employees appear to be the most strongly motivated to address. Human resources focuses on present jobs and needs first, then looks to the future, focusing primarily on behavior, in the belief that if skills are appropriately implanted or modified then proper attitudes will follow. It will use on-the-job ex- periential learning to the maximum practical extent, supplemented with training from other sources.

When evaluating training efforts, HR will attempt to determine whether the needs assessments that were conducted were accurate, whether targeted skills have been learned and incorporated in new behaviors, and whether employee attitudes appear to have been modified. Human resources must assess what has been learned and how this audit of results can support the next cycle of training.

■ CONCLUSION

Training and development should be ongoing and essentially continuous activities. Managers are central to training efforts, identifying needs and often serving as trainers. New employees must be properly and completely oriented to a healthcare department as well as their own specific program areas. Cross-training provides flexibility, especially in times of crisis. On- the-job training is important and often conducted by a mentor. Potential new managers rarely emerge without assistance. They must be nurtured and developed by providing opportunities for them to actually supervise others

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or guide programs. Human resources personnel may provide assistance in training and development.

Case Study Resolution

Returning to the harried health commissioner in the opening case study, Sam should seek volunteers to serve as mentors for the new employees. This will provide support for the new people and give Sam a chance to evaluate the leadership potential of two subordinates. Sam should decide to take the new employees to lunch on their third day of employment.

Although it would be efficient to provide one initial orientation session for both new employees, Sam should avoid the temptation. This would require the epidemiologist starting on Monday to either start without any training or to waste four working days. Either alternative sends a negative message to the new employee.

One year later, both new employees had become fully integrated into the health department. One of the mentors seized the opportunity to shine and was promoted seven months later. Both mentors reported increased job satisfaction. Sam noticed the improvement in their job productivity. The epidemiologist volunteered to serve as a mentor in the future.

SPOTLIGHT ON CUSTOMER SERVICE

Customer Service and Employee Training

Providing employee training on the topic of customer service would seem to be an obvious priority for organizations interested in promoting the concept. With that commitment made, the next decision becomes how to provide the necessary training and what modality or approach to use. A common response is to hire a consultant to teach employees the fundamentals of customer ser- vice. Another less common approach includes using data from questionnaires completed by people that have received or purchased products, programs, or services (Thies, 1999). A third (Darby & Daniel, 1999) obtains input from senior managers.

Each approach has advantages and disadvantages. Purchasing a generic training package will reduce expenses, but at the cost of including situations that are unique to the organization. Gathering data from users via ques- tionnaires should provide information focused on the unique needs of an organization. Obtaining such premium data would demand premium prices. Tapping into the ideas of senior managers would not be expensive but would include local biases.

The most pressing truths are the importance of customer service and en- suring that all employees are adequately trained.

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References

Darby, D. N., & Daniel, K. (1999). Factors that influence nurses’ customer orienta- tion. Journal of Nursing Management, 7(5), 271–280.

Thies, S. (1999). Customer service: Moving from slogan to point of differentiation. Medical Group Management Journal, 46(5), 34–38.

Discussion Points

1. Why are training and development opportunities important to some employees but apparently not to others? To which employees do they appear most important?

2. Why is having training and development opportunities available to employees important even if many do not take advantage of them?

3. Why must in-service training or on-the-job education be continuing? 4. Why is education usually one of the first line items to be reduced or

eliminated when it becomes necessary to cut budgets? Is such an action organizationally prudent? Why?

5. What activities could a department manager undertake to continue in- volving employees in education with little or no direct budgetary impact?

6. How you would implement a program of cross-training among three or four roughly comparable positions? Use actual or hypothetical positions as an example.

7. How do a department manager’s skills as an instructor, teacher, or mentor relate to the ability to delegate tasks?

8. Why should a department manager who plans on remaining in place for as long as practical develop one or two capable employees as potential successors?

9. It is frequently claimed that it is difficult if not impossible to quantify the cost effectiveness of education. Do you believe this to be true? Why?

10. What are the advantages of using capable senior employees as mentors or trainers for newer employees?

Resources

Books Baume, S., Pink, D., & Baume, D. (2005). Enhancing staff and educational devel-

opment. New York: Taylor & Francis. Bradford, D. (2005). Reinventing organization development: New approaches to

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