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5 MANAGING RESOURCES Getting the Most from Today’s Workforce

Starting Point

Go to www.wiley.com/college/Lombardi to assess your knowledge of basic resource management. Determine where you need to concentrate your effort.

What You’ll Learn in This Chapter ▲ Legal and labor issues that impact human resource management ▲ Ways organizations recruit new employees ▲ Six steps for hiring new employees ▲ Performance appraisals for individuals and teams ▲ Methods of keeping, developing, and terminating employees ▲ Characteristics of office politics and interdepartmental conflict

After Studying This Chapter, You’ll Be Able To ▲ Practice ways to find and hire high-quality employees ▲ Examine training techniques for new employees ▲ Examine types of performance-appraising tools ▲ Compare ways of dealing with underperforming employees ▲ Practice techniques for dealing with office politics and conflict

Goals and Outcomes ▲ Master the terminology of resource management and recognize tools and tech-

niques associated with employee recruitment, hiring, training, evaluating, and terminating

▲ Understand laws and processes that affect hiring and developing employees ▲ Identify the negative effects of office politics and conflict ▲ Contrast methods of attracting and selecting employees ▲ Use tools and techniques to appraise employee performance ▲ Solve issues of office politics and conflict ▲ Assess employee training and performance ▲ Determine whether to terminate an employee ▲ Evaluate and select strong job candidates and employees

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INTRODUCTION As a health care manager, no resource is more vital to your department—or, indeed, your organization as a whole—than your human resources, your employ- ees. In today’s competitive career marketplace, utilizing strong recruitment tech- niques goes hand in hand with understanding the latest legal policies and labor practices. The process of selecting quality employees requires managers to go through six distinct phases before hiring. Orientation, training, and performance appraising are all activities managers engage in to develop strong employees. Turnover and termination compel managers to continually engage in the hiring and training process. Managers who respond appropriately to office conflict and politics shape a more productive workplace for themselves and their staffs.

5.1 Meeting Today’s Human Resources Demands

People, in all of their diversity, are essential in health care organizations. No one’s talents can be wasted in the quest for high performance or greater efficiency. In principle, at least, the following slogans say much about the importance of the human beings that make up today’s organizations:

▲ “People are our most important asset.” ▲ “It’s people who make the difference.” ▲ “It’s the people who work for us who determine whether our company

thrives or languishes.”

The basic building blocks of any high-performance health care organization are talented workers with relevant skills and great enthusiasm for their work. One manager summed up the situation as such: “If you hire the right people . . . if you’ve got the right fit . . . then everything will take care of itself.”1

5.1.1 Human Resource Management

Human resource management (HRM) involves attracting, developing, and maintaining a talented and energetic workforce to support organizational mis- sion, objectives, and strategies. In order for strategies to be well implemented, workers with relevant skills and enthusiasm are needed. The task of human resource management is to make workers available.

▲ Attracting a quality workforce involves human resource planning, recruitment, and selection.

▲ Developing a quality workforce involves employee orientation, training and development, and career planning and development.

▲ Maintaining a quality workforce involves management of employee reten- tion and turnover, performance appraisal, and compensation and benefits.

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5.1.2 LAWS AGAINST EMPLOYMENT DISCRIMINATION 123

Additionally, human resource management must be accomplished within the framework of government regulations and laws. All managers are expected to act within the law and follow equal opportunity principles. Failure to do so is not only unjustified in a free society, but it can also be a very expensive mistake resulting in fines and penalties.

The American legal and regulatory environment covers human resource management activities related to discrimination, pay, employment rights, occu- pational health and safety, retirement, privacy, vocational rehabilitation, and related areas. It is also constantly changing as old laws are modified and new ones are added.

5.1.2 Laws against Employment Discrimination

Employment discrimination is when someone is denied a job or a job assign- ment for reasons that are not job relevant. It is against federal law in the United States to discriminate in employment.

A sample of major U.S. laws prohibiting job discrimination is provided in Figure 5-1.

An important cornerstone of legal protection for employee rights to fair treat- ment is found in Title VII of the Civil Rights Act of 1964, as amended by the

Figure 5-1

A sample of U.S. laws influencing human resource management.

Equal Pay Act of 1963 Requires equal pay for men and women performing equal work in an organization.

Title VII of the Civil Rights Act of 1964 Prohibits discrimination in employment based on (as amended) race, color, religion, sex, or national origin.

Age Discrimination in Employment Prohibits discrimination against persons poverty; Act of 1967 restricts mandatory retirement.

Occupational Safety and Health Establishes mandatory health and safety standard Act of 1970 in workplaces.

Pregnancy Discrimination Act of 1978 Prohibits employment discrimination against pregnant workers.

Americans with Disabilities Act of 1990 Prohibits discrimination against a qualified individual on the basis of disability.

Civil Rights Act of 1991 Reaffirms Title VII of the 1964 Civil Rights act; reinstates burden of proof by employer, and allows for punitive and compensatory damages.

Family and Medical Leave Act of 1993 Allows employees up to 12 weeks of unpaid leave with job guarantees for childbirth, adoption, or family illness.

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Equal Employment Opportunity Act (EEOA) of 1972 and the Civil Rights Act of 1991.

▲ Equal employment opportunity (EEO): the right to employment with- out regard to race, color, national origin, religion, gender, age, or physi- cal and mental ability. The intent is to ensure all citizens have a right to gain and keep employment based only on their ability to do the job and their performance once on the job.

EEO is federally enforced by the Equal Employment Opportunity Commission (EEOC), which has the power to file civil lawsuits against organizations that do not provide timely resolution of any discrimination charges lodged against them. These laws generally apply to all public and private organizations employing 15 or more people.

Under Title VII, organizations are also expected to show affirmative action.

▲ Affirmative action gives preference in hiring and promotion to women and minorities, including veterans, the aged, and the disabled. Affirma- tive action ensures that women and minorities are represented in the workforce in proportion to their actual availability in the area labor market.2

▲ Affirmative action plans may also be adopted by or required of organizations to show that they are correcting previous patterns of discriminatory activity and/or are actively preventing its future occurrence.

F O R E X A M P L E

The U.S. Equal Employment Opportunity Commision Founded in 1965, the Equal Employment Opportunity Commission has as its mission “the elimination of illegal discrimination from the workplace.” Although the definitions of illegal, discrimination, and even workplace have all evolved over the last 40+ years, the Commission continues to be the final word on appropriate hiring and firing policies for all workplaces in the United States. For example, for the year 2004 alone, the EEOC received 15,376 new charges of disability discrimination and resolved 16,949 disability discrimina- tion charges (recovering more than $47 million for charging parties and other aggrieved individuals, not including monetary benefits obtained through liti- gation). Find what does and does not constitute discrimination (including age, disability, equal pay, nationality, religion, and sex) at its Web site www.eeoc.gov.

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5.1.2 LAWS AGAINST EMPLOYMENT DISCRIMINATION 125

The pros and cons of affirmative action are debated at both the federal and state levels, and controversies often make the news. Criticisms tend to focus on the use of group membership (for example, female or minority) instead of individual performance in employment decisions. The issues raised include the potential for members of majority populations to claim discrim- ination.3 White males, for example, may claim that preferential treatment given to minorities in a particular situation interferes with their individual rights.

As a general rule, EEO legal protections do not restrict an employer’s right to establish bona fide occupational qualification.

▲ Bona fide occupational qualification: criteria for employment that can be clearly justified as being related to a person’s capacity to perform a job.

The use of bona fide occupational qualifications based on race and color is not allowed under any circumstances; those based on sex, religion, and age are very difficult to support. Years ago, for example, airlines tried to use customer preferences to justify the hiring of only female flight attendants. It didn’t work; today men and women serve in this capacity.4

In addition to race and gender, which get a lot of attention in the news, other areas of legal protection against discrimination also deserve a manager’s concern. Listed below are four examples and brief summaries of their support- ing laws. The complexities of these laws would require further research into the context of any possible case to which the laws may be applied.

▲ Disabilities: The Americans with Disabilities Act of 1990 prevents dis- crimination against people with disabilities. The law forces employers to focus on abilities and what a person can do. Increasingly, persons with disabilities are gaining employment opportunities.

▲ Age: The Age Discrimination in Employment Act of 1967 (amended in 1978 and 1986) protects workers against mandatory retirement ages. Age discrimination occurs when a qualified individual is adversely affected by a job action that replaces him or her with a younger worker.

▲ Pregnancy: The Pregnancy Discrimination Act of 1978 protects female workers from discrimination because of pregnancy. A pregnant employee is protected against termination or adverse job action because of the pregnancy and is entitled to reasonable time off work.

▲ Family matters: The Family and Medical Leave Act of 1993 protects workers who take unpaid leaves for family matters from losing their jobs or employment status. Workers are allowed up to 12 weeks’ leave for childbirth, adoption, personal illness, or illness of a family member.

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5.1.3 Current Legal Issues in HRM

Legal issues in human resource management are continually before the courts. The more prominent among them are frequently in the news. Committed health care managers and human resource professionals need to stay informed on the following issues of legal and ethical consequence5

▲ Sexual harassment: Sexual harassment occurs when a person experi- ences conduct or language of a sexual nature that affects his or her employment situation. According to the EEOC, sexual harassment is behavior that creates a hostile work environment, interferes with their ability to do a job, or interferes with their promotion potential.

▲ Equal pay: The Equal Pay Act of 1963 provides that men and women in the same organization should be paid equally for doing equal work in terms of required skills, responsibilities, and working conditions. How- ever, a lingering issue involving gender disparities in pay involves compa- rable worth, the notion that persons performing jobs of similar impor- tance should be paid at comparable levels. Why should a long-distance truck driver, for example, be paid more than an elementary teacher in a public school? Does it make any difference that the former is a tradition- ally male occupation and the latter a traditionally female occupation? Advocates of comparable worth argue that such historical disparities are due to gender bias. They would like to have the issue legally resolved.

▲ Part-time and temporary workers: The legal status and employee entitle- ments of part-time workers and independent contractors are also being debated. In today’s era of downsizing, outsourcing, and projects, more and more people in all industries—including health care—are being hired as temporary workers who work under contract to an organization and do not become part of its official workforce. They work only “as needed.” Problems occur when these individuals are engaged regularly by the same organization and become what many now call permatemps. Even though regularly employed by one organization, they work without benefits such as health insurance and pension eligibilities. If they were legally consid- ered employees, these independent contractors would be eligible for bene- fits, and the implications for their employers would be costly. A number of legal cases are now before the courts seeking resolution of this issue.

▲ Labor-management relations: Union representation for health care work- ers is becoming increasingly common, particularly in larger cities where sizable groups of professionals with similar skills and employment oppor- tunities exist. Nurses of various levels, lab technicians, and even office managers can belong to unions. Health care labor unions are frequently involved in contract negotiations and unfair employment practices inves- tigations. Labor-management issues and their legal foundations are dis- cussed later in the chapter.

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5.1.5 HUMAN RESOURCE PLANNING 127

5.1.4 Labor-Management Relations

Another aspect of human resource management relates to the influence of orga- nized labor.

▲ Labor unions are organizations to which workers belong that deal with employers on the workers’ behalves. Labor unions act as bargaining agents, negotiating legal contracts that affect many aspects of human resource management.

Labor contracts typically include the rights and obligations of employees and management with respect to wages, work hours, work rules, seniority, hiring, grievances, and other aspects of employment.

▲ The foundation of any labor and management relationship is collective bargaining, which is the process of negotiating, administering, and inter- preting labor contracts.

Labor contracts and the collective bargaining process are governed closely in the United States by a strict legal framework.

▲ The Wagner Act of 1935 protects employees by recognizing their rights to join unions and engage in union activities.

▲ The Taft-Hartley Act of 1947 protects employers from unfair labor prac- tices by unions and allows workers to decertify unions.

▲ The Civil Service Reform Act Title VII of 1978 clarifies the rights of gov- ernment employees to join and be represented by labor unions.

Often, labor and management are viewed as win-lose adversaries, destined to be in opposition and possessed of certain weapons with which to fight one another. If labor-management relations take this form, a lot of energy on both sides can be expended in prolonged conflict.

This model is, to some extent, giving way to a new and more progressive era of greater cooperation.6 Today’s union leaders and corporate leaders appear to recognize that labor-management relations must adapt to changing conditions if they are to survive and prosper.

5.1.5 Human Resource Planning

Any health care organization should at all times have the right people available to do the required work.

▲ Strategic human resource planning: a process of analyzing staffing needs and planning how to satisfy these needs in a way that best serves the organizational mission, objectives, and strategies.7

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The foundations for human resource planning are set by job analysis conducted by human resource professionals with significant input from managers at vari- ous levels.

▲ Job analysis: The orderly study of just what is done, when, where, how, why, and by whom in existing or potential new jobs.

Job analysis—which often includes human resource personnel observing and interviewing employees who do a specific job and then collaborating with man- agers to write a comprehensive description of all that a job entails—provides useful information that can then be used to write and/or update job descrip- tions and job specifications, which can then be shared with employees and potential job applicants.

▲ Job descriptions: Written statements of job duties and responsibilities. ▲ Job specifications: Lists of the qualifications—such as formal education,

prior work experience, and skill requirements—that should be met by any person hired for or placed in a given job.

The elements in strategic human resource planning are shown in Figure 5-2. The five-step process outlined in the figure begins with a review of organiza- tional mission, objectives, and strategies, which establishes a frame of reference for forecasting human resource needs. Ultimately, the planning process helps

Step 2: Review human resource objectives

and strategies

Step 3: Assess current human resources

Step 4: Forecast human resource needs

Legal environment and government regulations

Make comparison

Step 1: Review organization mission objectives strategies

Step 5: Develop and implement human resource plans to

match resources with needs

Figure 5-2

Steps in strategic human resource planning.

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5.1.6 ATTRACTING A QUALITY WORKFORCE 129

managers identify staffing requirements, assess the existing workforce, and deter- mine what additions or replacements are required to meet future needs. The entire process, of course, must be implemented in a manner consistent with the legal environment.

5.1.6 Attracting a Quality Workforce

Attracting and selecting new members of your team can easily spell the difference between success and failure as a health care manager. When you select a top per- former, you have an individual from whom the entire team can draw inspiration and rely on for steady or stellar performance. Conversely, when you select an indi- vidual who is not a top performer, the negative results can be staggering.

Although far from being an exact science, the process of hiring and selecting new employees can take on some structure, complete with strategies and proven approaches for success. After a human resource plan is prepared, the process of attracting a quality workforce can systematically begin.

▲ Recruitment is a set of activities designed to attract a qualified pool of job applicants to an organization. Emphasis on the word qualified is important.

Effective recruiting should bring employment opportunities to the attention of people whose abilities and skills meet job specifications.

The three basic steps in a typical recruitment process are

1. advertise a job vacancy; 2. establish preliminary contact with potential job candidates; 3. perform an initial screening to identify all qualified applicants.

In recruiting potential nursing candidates soon to graduate from a health care training school, for example, advertising is done by a hiring hospital by posting short job descriptions in print or on Web sites through the campus place- ment center. Preliminary contact is made after candidates register for interviews with hospital recruiters on campus. Preliminary interviews typically run 20 to 30 minutes, during which time the candidate presents a written resume and briefly explains his or her job qualifications. To further screen the candidates, the hospital recruiter shares interview results and resumes with key decision makers at the hospital. They choose a final pool of candidates to be invited for further interviews during a formal visit to the organization.

Recruitment is certainly one of the most difficult endeavors for the modern- day health care manager. The reason for this is the ongoing shortage of quali- fied personnel in virtually all health care positions. This means you must work assiduously toward generating a good roster of candidates and use as many recruitment sources as possible.

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External versus Internal Recruitment

Recruitment can be either internal or external:

▲ External recruitment, in which job candidates are sought from outside the hiring organization. Newspapers, employment agencies, colleges, technical training centers, personal contacts, walk-ins, employee referrals, and even competing health care organizations are all sources of external recruits.

▲ Internal recruitment seeks applicants from inside the organization. This involves notifying existing employees of job vacancies. Most health care organizations have a procedure for announcing vacancies through newsletters, electronic bulletin boards, and the like. They also rely on managers to recommend high-performing workers as candidates for advancement.

Both recruitment strategies offer potential advantages. External recruiting brings in outsiders with fresh perspectives and provides access to specialized expertise or work experience not otherwise available from insiders. Internal recruitment is usually less expensive and involves people whose performance records are well established. A history of serious internal recruitment can also be encouraging to employees; it shows that one can advance in the organiza- tion by working hard and achieving high performance at each point of responsibility.

Recruitment Tactics

Health care managers rely on several tried-and-true methods to recruit quality job candidates. Although organizations have specific techniques and resources (consult with your human resources department), the following tactics are all useful:

▲ Job fairs: Whenever possible, try to attend job fairs in your specific technical area. Although many job fair attendees are simply shopping around and aren’t interested in immediate employment, collecting resumes and obtaining information on potential candidates is a continu- ous process for proactive health care managers.

▲ School liaisons: Many health care professionals maintain contact with the schools they graduated from. Contact the school’s placement office or a favorite teacher, and ask whether any up-and-coming talent may be suitable for your open position. School liaisons may also know alumni in the field who may be suitable candidates as well. If you are trying to fill an entry-level position, contact a guidance counselor at a local high school or vocational school and inquire about likely candidates.

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COMMUNITY-BASED RECRUITMENT 131

▲ Employment referral systems: Most organizations have an employee referral system in which employees refer qualified individuals to human resources for openings in the organization. If your organization does not have an employee referral system, or if you work in a small health care organization, discuss with your supervisor the possibility of providing a monetary reward to an employee who recommends a candidate for an open position who is subsequently hired.

▲ Professional contacts: Contact former colleagues or institutions and dis- cuss the availability of potential candidates. If you belong to a profes- sional organization, contact a representative within that organization to generate a list of potential candidates.

▲ Agencies: Many health care recruiters frown on placement and search agencies because recruitment services are costly and often yield less than satisfactory results. Contact an agency only with the assistance of your human resource department or your immediate supervisor. When you work with an agency, spend as much time as possible with the primary recruiter in developing a list of expectations and revised job descriptions.

▲ Advertising: Employment ads in print and online media can be some- what expensive, and unfortunately they can provide inconsistent results. If you run an ad, work with your human resource director and supervi- sor to craft the ad. Make certain the ad receives good placement within the newspaper or magazine, has a catchy logo, and contains a three-to- five-sentence depiction of the job, the salary range, and the name of a specific contact person. These elements will eliminate people who are simply job shopping or who are not in the salary range established for the position.

▲ Team/staff referrals: Members on your own team may know someone qualified for an open position. However, unless they are asked, your team members may assume you’re not interested in their recommendations.

Community-Based Recruitment

Smaller health care providers, particularly in rural areas or in distinct neighbor- hoods (of large East Coast cities, for example) use community-based recruitment. These institutions write a three-to-five-sentence depiction of the open position, the point of contact, and salary range, and make copies on their organization’s stationery. They post these copies on bulletin boards in key areas within the com- munity: supermarkets, convenience stores, libraries, community centers, post offices, and places of worship.

When using community-based recruitment, be sure to get permission from the appropriate authority at each posting area. Getting their permission is also an opportunity for you to gain their support and participation in the search effort

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• Identify and define human resource management, discrimination, Equal Employment Opportunity, sexual harassment, labor union, collective bargaining, recruitment, and affirmative action.

• List the three main activities of human resource management.

• Describe key laws and legal issues that affect hiring employees.

• Discuss the role of labor unions in hiring and managing employees.

• Explain ways human resource departments can plan for the future.

• Compare typical employee recruitment techniques.

S E L F - C H E C K

5.2 The Selection Process

To avoid the negative aspects of hiring a poor performer, you need to under- stand the selection process. Selection is the process of choosing from a pool of applicants the person or persons who offer the greatest performance potential.

Health care managers who successfully master the selection process not only diminish the chance that they have to terminate poor performers or address per- formance problems, but they also enhance all their management responsibilities by having the luxury of working with well-motivated, talented people.

F O R E X A M P L E

Using a Targeted Selection System The Shore Health System in Maryland (www.shorehealth.org) uses the CARE factors (community, accountability, respect, and excellence) as its organiza- tional standards during all hiring processes. Hiring managers and HR pro- fessionals at Shore Health System utilize a structured selection system with a set of 75 open-ended questions and interpretive guides to make sound decisions about recruiting, interviewing, and selecting top job candidates.

by reviewing the contents of your notice and discussing any potential applicants they might know among their customers or congregation. The business and reli- gious anchors in the community are typically positive allies in the health care recruitment process.

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Figure 5-3

Steps in the typical selection process and possible reasons for rejection.

Selection Process Reasons for Rejection

1. Formal application

2. Interview or site visit Insufficient ability, ambition, or

poor interpersonal qualities

Deficient qualifications

Poor test scores

Poor references

Physically unfit for the job

Overall potential is low

3. Testing

4. Reference checks

5. Physical exam

6. Analysis and decision

5.2.1 REVIEWING APPLICATIONS AND RESUMES 133

Figure 5-3 shows the six typical steps in the selection process, including

▲ completion of a formal application form; ▲ interviewing; ▲ testing; ▲ reference checks; ▲ physical examination; ▲ final analysis and the decision to hire or reject.

The following six sections explore each step of the selection process in greater detail.

5.2.1 Reviewing Applications and Resumes

Applicants typically use two forms to apply for jobs:

▲ The application form declares the individual to be a formal candidate for a job. It documents the applicant’s personal history and qualifications.

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The application should only request information that is directly relevant to the job and the applicant’s potential job success.

▲ The personal resume is often included with the job application and should accurately summarize an applicant’s special qualifications. As a recruiter and hiring manager, you need to learn how to screen applica- tions and resumes for insights that can help you make good selection decisions.

Your main objective in reviewing resumes is to determine whether the person can do the job. (The interview is where you determine what type of person the candidate is and how they would do the job.) Try to sort the resumes by your criteria, and organize the candidates into three basic categories: unqualified, pos- sible, and probable candidates.

▲ Unqualified applicants simply do not have the quantitative skills estab- lished on the job description. For example, they either do not have the required degree or years of experience required.

▲ Possible candidates have the quantitative skills sought and may have additional factors that merit consideration. For example, for the position of staff pharmacist, an individual in the possible category may have all the necessary degrees, including the specific professional accreditation to prepare for state compliance reviews, and a good range of years of pro- fessional experience.

▲ Probable candidates are individuals who seem almost perfect for the position. This is typically the smallest group of applicants.

Establish a short list of candidates, beginning with the probable group and including applicants from the possible group until you have approximately seven or fewer candidates. However, do not fall into the seductive trap of reading too much into a resume. Try to take the information at face value; remember that the resume is simply a summary of qualifications, not an in-depth insight into the applicant’s personality.

5.2.2 Interviewing

Interviews are extremely important in the selection process because of the infor- mation exchange they allow. The interview is a time when both the job appli- cant and potential employer can learn a lot about one another.

However, interviews are also recognized as potential stumbling blocks in the selection process. To avoid them, keep these general pointers in mind when you conduct a job interview:

▲ Plan ahead: Review the job specifications and job description as well as the candidate’s application; allow sufficient time for a complete interview.

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5.2.2 INTERVIEWING 135

▲ Create a good interview climate: Allow sufficient time, choose a quiet place, be friendly and show interest, and always give the candidate your full attention.

▲ Conduct a goal-oriented interview: Know what information you need and get it. Look for creativity, independence, and a high energy level.

▲ Avoid questions that may imply discrimination: Focus all questioning on the job applied for and the candidate’s true qualifications for it.

Proceed with caution when asking questions of job candidates in an interview situation. The following list covers some potentially illegal areas of job inter- viewing and suggests legal alternatives.

▲ National origin: Illegal—Are you a U.S. citizen? Legal—Are you autho- rized to work in the United States?

▲ Family: Illegal—Are you married? Legal—Would you be willing to relocate? Illegal—Do you plan to have children? Legal—Are you willing to travel as needed? Illegal—Who lives with you? Legal—This job requires occasional over- time; is that okay?

▲ Age: Illegal—How old are you? Legal—Are you over 18? ▲ Arrest record: Illegal—Have you ever been arrested? Legal—Have you

ever been convicted of a crime relevant to job performance? ▲ Military service: Illegal—Were you honorably discharged from the mili-

tary? Legal—What type of training did you receive in the military? ▲ Disability: Illegal—Do you have any disabilities? Legal—Can you perform

(some specific task) as an essential part of the job?

In traditional recruitment, the emphasis is on selling the organization to job applicants. Human resource professionals and hiring managers communicate only the most positive features of the job and organization to potential candi- dates.

Traditional recruitment may create unrealistic expectations that are diffi- cult to fulfill, and dissatisfied new hires may quickly leave. The cost of job turnover, including lost productivity, search fees, and recruiting costs, can be very high.

Realistic job previews, by contrast, try to provide the candidate with all pertinent information about the job and organization without distortion and before the job is accepted.8 Instead of selling only positive features of a job, this approach tries to be realistic and balanced in the information provided.

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With more realistic job expectations, new employees may be less prone to pre- mature turnover and often experience higher levels of initial job satisfaction.

5.2.3 Employment Tests

Whenever tests are used and in whatever forms, the goal should be to gather information that helps predict the applicant’s eventual performance success. Like any selection device, an employment test needs to measure exactly what it intends to relative to the job specification—for example, written communication skills or computer literacy. The test should also meet the criterion of reliability by yielding approximately the same results over time if taken by the same per- son. Furthermore, any employment test used in the selection process should be legally defensible on the grounds that it actually measures an ability required to perform the job.

New developments in testing allow for actual demonstrations of job-relevant skills and personal characteristics. Numerous larger health care organizations and hospitals now have assessment centers that help evaluate candidates’ potential by observing their performance in experiential activities designed to simulate daily work.

Another form of testing is work sampling, which directly assesses a person’s performance in the job. Here, applicants are asked to work on actual job tasks while being graded by observers on their performance.

5.2.4 Reference Checks

Reference checks are inquiries to previous employers, academic advisors, co- workers, and/or acquaintances regarding the qualifications, experience, and past work records of a job applicant.

Although they may be biased if friends are prearranged “to say the right things if called,” reference checks can be helpful. The Society for Human Resources Management (SHRM), for example, estimates that 25% of job applications and resumes contain errors.9 Use a reference simply as a vali- dation of what you may already have decided about a candidate, not as a revelation; certainly, in no case should a reference be the main factor in your decision.

Realize that U.S. labor law severely restricts the reference-checking process. Fundamentally, individuals who provide references are only required to provide limited information: the person’s name, position, length of employment, and approximate salary range.

5.2.5 Physical Examinations

Many health care organizations ask job applicants to take a physical examination. This health check helps ensure that the person is physically capable of fulfilling

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5.3 DEVELOPING A QUALITY WORKFORCE 137

job requirements. It may also be used as a basis for enrolling the applicant in health-related fringe benefits such as life and health insurance programs.

A recent and controversial development in this area is the emerging use of substance-abuse testing. This has become part of preemployment health screen- ing and is a basis for continued employment at some organizations. At a minimum, care must be exercised that any required test is job relevant and does not discriminate in any way against the applicant.

5.2.6 Final Decision to Hire or Reject

The best selection decisions are most likely to be those involving extensive con- sultation among the manager or team leader, potential co-workers, and human resource staff.

The emphasis in selection must always be comprehensive and focus on all aspects of the person’s capacity to perform in a given job. Just as a “good fit” can produce long-term advantage, a “bad fit” can be the source of many and per- haps long-term problems. Of course, you should also always remember that you’re not seeking the perfect person or perfect match for the position; you’re simply seeking the best-qualified person given the criteria for the job.

• Identify and define selection, realistic job preview, traditional job recruitment, and reference check.

• List the six typical steps in the selection process.

• Describe three useful categories for sorting potential job candidates.

• Discuss techniques to make job interviews effective and questions/topics to avoid for legal reasons.

• Explain appropriate uses of employment tests, reference checks, and physical examinations during the selection process.

S E L F - C H E C K

5.3 Developing a Quality Workforce

When people join any organization, they must “learn the ropes” and become familiar with the way things are done. Socialization is the process of influenc- ing the expectations, behavior, and attitudes of a new employee in a way con- sidered desirable by the organization.10 The intent of socialization in the human resource management process is to help achieve the best possible fit between the individual, the job, and the organization.

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5.3.1 Employee Orientation

Socialization of newcomers begins with orientation. Orientation is a set of activ- ities designed to familiarize new employees with their jobs, co-workers, and key aspects of the organization as a whole. This includes clarifying the organizational mission and culture, explaining operating objectives and job expectations, com- municating policies and procedures, and identifying key personnel.

The first 6 months of employment are often crucial in determining how well someone is going to perform over the long run. During this time, original expec- tations are tested, and patterns are set for future relationships between an indi- vidual and employer.

If orientation is neglected, newcomers are left to fend for themselves dur- ing this critical period. On their own or through casual interactions with co- workers, otherwise well-intentioned and capable people may learn inappropri- ate attitudes and/or behaviors.11 Good orientation, by contrast, enhances a person’s understanding of the organization and adds a sense of common pur- pose as a member.

5.3.2 Training and Development

Training is a set of activities that provides the opportunity to acquire and improve job-related skills. Training is appropriate and necessary for both new and established employees (particularly those who desire to upgrade or improve their skills to meet changing job requirements).

Training can take many forms:

▲ On-the-job training takes place in the work setting while someone is doing a job.

▲ Job rotation allows people to spend time working in different jobs and thereby expand the range of their job capabilities.

▲ Coaching occurs when an experienced person gives technical advice to someone else. This can happen on a formal basis by supervisors or co- workers. It can also occur more informally in the form of help sponta- neously offered in teams.

▲ Apprenticeship is a work assignment as understudy or assistant to someone who already has the desired job skills. Through this relation- ship, an apprentice learns a job over time and eventually becomes fully qualified to perform it.

▲ Modeling occurs when someone demonstrates through personal behavior what is expected of others.

▲ Mentoring occurs when new or early career employees are formally assigned as protégés to senior employees who then coach, model, and oth- erwise assist them to develop job skills and get a good start in their careers.

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5.4 Performance Appraisal

One of the most difficult responsibilities of a health care manager is the assess- ment and conduct of performance appraisals. Taking qualitative, subjective perceptions of performance and ascribing a quantitative, objective rating is gen- erally a difficult and complex task. This task becomes important specifically as most performance evaluations are tied to the individual staff member’s salary and potential salary increases.

Performance appraisals serve two basic purposes in the maintenance of a quality workforce:

▲ The evaluation purpose is intended to let people know where they stand relative to performance objectives and standards.

▲ The development purpose is intended to assist in their training and continued personal development.12

F O R E X A M P L E

Mentoring for Diagnostic Imaging Professionals In response to ongoing shortages of qualified job candidates in the diagnostic-imaging professions, including radiography and cardiovascular interventional technologists, the American Association of Cardiovascular and Pulmonary Rehabilitation (www.aacvpr.org) established a year-long mentor- ing program in 2004. The program pairs new and senior members in the organization, based on application responses. Although much of the men- toring occurs via phone or e-mail, members both new and senior have been very pleased with the program and the new connections they’ve made—35 pairs participated in 2004, and that number nearly doubled the following year. For more information about the AACVPR’s mentoring program, visit www.aacvpr.org/membership/mentorship.cfm.

• Identify and define socialization, orientation, and training.

• Explain the importance of orientation and training in the managing of employees.

• Describe common training tools and techniques.

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Performance appraisals should meet the criteria of reliability and validity. To be reliable, the method should consistently yield the same result over time and for different raters. To be valid, it should be unbiased and measure only factors directly relevant to job performance. These criteria are especially important in today’s complex legal environment. A manager who hires, fires, or promotes someone is increasingly called upon to defend such actions—sometimes in spe- cific response to lawsuits alleging that the actions were discriminatory. At a mini- mum, written documentation of performance appraisals and a record of consistent past actions is required to back up any contested evaluations.

5.4.1 Appraisal Methods

The following are performance appraisal methods commonly used in organizations:

▲ Graphic rating scales offer checklists of traits or characteristics thought to be related to high performance outcomes in a given job. A manager rates the individual on each trait using a numerical score. The primary appeal of graphic rating scales is that they are relatively quick and easy to complete. Their reliability and validity are questionable, however, because the categories and scores are subject to varying interpretations.

▲ The narrative technique is a written essay description of a person’s job performance. The commentary typically includes actual descriptions of performance, discusses an individual’s strengths and weaknesses, and pro- vides an overall evaluation. Free-form narratives are sometimes used in combination with other performance appraisal methods, such as the graphic rating scale.

F O R E X A M P L E

Criterion-based, Values-driven Performance Evaluation Systems A major motivational tool for both the marginal performer and the super- star employee is the annual performance evaluation. However, when the per- formance evaluation is merely a checklist review of the existing job descrip- tion, distinguishing between great and merely adequate employees becomes difficult. At Jane Phillips Medical Center in Bartlesville, Oklahoma (www. jpmc.org), managers use a performance evaluation that measures how an individual performs relative to job specifications; assesses the CARE or PACT factors of attitude orientation, people skills, and team orientation; and rec- ognizes contributions made beyond the set job description. This standard, multidimensional evaluative tool has been a key reason for a recent upswing in employee morale at this urban, nonprofit facility.

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▲ The critical-incident technique involves keeping a running log or inventory of effective and ineffective job behaviors. By creating a written record of positive and negative performance examples, this method documents suc- cess or failure patterns that can be specifically discussed with the individual.

▲ Multiperson comparisons formally compare one person’s performance with that of one or more others. Multiperson comparisons can be used on their own or in combination with some other method. They can also be done in different ways. • In rank ordering, all persons being rated are arranged in order of per-

formance achievement, with the best performer at the top of the list and the worst performer at the bottom; no ties are allowed.

• In paired comparisons, each person is formally compared to every other person and rated as either the superior or the weaker member of the pair. After all paired comparisons are made, each person is assigned a summary ranking based on the number of superior scores achieved.

• In forced distribution, each person is placed into a frequency distribu- tion that requires that a certain percentage fall into specific performance classifications, such as top 10%, next 40%, next 40%, and bottom 10%.

5.4.2 Designing and Implementing a Documentation System

Documentation is the process of objectively recording performance and perfor- mance levels. Managers and executives at all levels of a health care organization rely on documentation to provide proof that accepted standards of performance have been met.

Documentation does take time and effort, but without it, the compilation of a comprehensive performance appraisal is next to impossible. Keep the follow- ing documentation tips and strategies in mind:

▲ Set up a performance documentation logbook. A simple spiral-bound notebook (or organization-specific logsheets) is all that’s necessary to record the dates, significant incidents, and critical contributions for each staff member.

▲ Be specific. General notes like “has a bad attitude” or “never documents well on charts” have little use in preparing a performance appraisal. Whenever possible, note specific, quantifiable details and refer back to established performance objects. And always date any entry in logbooks.

▲ Note positive incidents, as well as negative. Performance appraisals should not be all gloom and doom. Keeping records of what employees do especially well can help your employees recognize their strengths and plan the future paths of their careers.

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Finally, realize that whatever form your documentation takes, your profes- sional notes cannot be used or subpoenaed in court. Many health care man- agers fear their notes may be used against them in a court of law. This is not the case, as the only documentation used in a court labor proceeding is the official performance evaluation filed with the health care organization. You use your professional notes—not anyone else’s. Use them to increase employees’ constructive performance and in turn provide stellar health care to your patients.

5.4.3 Delivering Performance Appraisals

By maintaining detailed, organized documentation, performance appraisals should be relatively easy to write. Sharing appraisals, however, can be another story entirely. The following guidelines can help you effectively deliver appraisals to your employees.

▲ Prepare fully for the evaluation. Ensure you fill out all paperwork correctly and completely. Consider how you want to present the perfor- mance evaluation, and simply conduct a review of what you have written on the evaluation.

▲ Create an appropriate physical environment for delivering an appraisal. Sit at your desk, a table, or wherever you are most comfortable; close the door; and avoid interruptions while delivering the evaluation. The occasion should be a private interchange between you and the employee.

▲ Provide the employee with a copy of the evaluation. The employee can use it as a guide, follow the discussion throughout the entire process, and keep the copy as a planning tool for future performance.

▲ Manage emotionalism. If an employee becomes emotional during the eval- uation, usually because of a negative reaction, ask whether the employee wants to take a break or reschedule the evaluation. If the employee elects postponement, schedule a follow-up meeting within a week’s time and deliver the appraisal fully at that time. If the employee again becomes emotional, either get assistance from your manager or the human resource department, or simply conduct the review in monologue fash- ion. (Use this last strategy when you suspect the employee is reacting poorly to the performance evaluation as an excuse for poor performance or as a means to avoid the evaluation completely.)

▲ Use a direct and objective style. Use clear terms, state your case objec- tively, and avoid personalizing the evaluation. Try to stay on an even keel, using emotion only as appropriate. At the same time, feel free to express dissatisfaction to an employee who is not performing acceptably or pride in an employee who is performing at an outstanding level.

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▲ Use a point-by-point strategy. Work through the evaluation from beginning to end. Stop frequently to ask whether the employee has any questions or would like elaboration on any part of the information given so far.

▲ Set a time limit for the appraisal and stay within it. For example, an hourly employee may take a half hour to complete a performance appraisal, whereas a skilled worker may need 45 minutes. Try to stay within these parameters, and keep that standard for all employees.

▲ Give closure. Ensure that the employee signs the performance-evaluation form and that all questions are answered. Remember, not all employees will be thrilled with their reviews.

5.4.4 Reviewing Group Performance

In addition to individual performance appraisals, many managers conduct team or group performance appraisals. While these appraisals may or may not be required by your specific health care organization, group performance appraisals can be worthwhile endeavors. Gathering together as a team to assess the group’s strengths and weakness, as well as discuss future goals can yield significant results in creating a workplace where employees feel part of a team.

To effectively conduct a group performance appraisal, managers must encourage staff to be direct and candid about their assessment of past perfor- mance as a group. Focus the conversation on performance, not on personality- based issues. Avoid referring to the personalities of former managers and other team members. In emphasizing performance, you discover areas for improve- ment and crystallize specific methods on how to improve performance through- out the department and within individual work roles.

Discussion about what we are doing wrong also helps establish trust. By acknowledging that the department is not perfect and that you as manager are not perfect, you remind everyone involved that you share the human quality of imperfection. By reviewing mistakes and concentrating on where a problem may exist, your staff will appreciate your commitment to them and therefore feel freer to share their thoughts on areas for improvement.

One way to facilitate a group performance appraisal is to have all team mem- bers brainstorm areas for improvement. First list events or work aspects that need improvement. Then, ask your staff to focus in on things they can control or are doing right relative to the problems or challenges cited. Finally, brain- storm situations and circumstances of which the department has either limited or no control.

In later sessions (or perhaps regular department meetings), you can continue to discuss as a group how the team can become stronger. This could include another

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exercise on how the team can meet the needs of the patient at an even higher level of quality and effectiveness. Use five basic questions to initiate discussions:

▲ Where does communication seem to break down? ▲ When do we operate as a team most efficiently? ▲ When do we operate as a team least efficiently? ▲ On a scale of 1 to 10, how would you rate the level of pride we have in

our department (1 � no pride, 10 � great pride)? ▲ What can we do better as a group?

These questions serve to facilitate a group process for discussion of specific areas needing improvement and, more directly, address areas in which the unit can work more strongly as a team.

• Identify and define performance appraisal and documentation.

• Explain the two purposes of conducting performance appraisals.

• Contrast various appraisal methods.

• Describe techniques for effective documentation and presentation for performance appraisals.

• Discuss the pros and cons of group performance appraisals.

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5.5 Maintaining a Quality Workforce

Attracting and developing a qualified workforce is only a portion of a health care manager’s responsibilities. For long-term effectiveness, a health care workforce must be successfully nurtured and managed. This requires proper attention to such maintenance issues as career planning and development, work-life balance, retention and turnover, and compensation and benefits.

5.5.1 Career Planning and Development

Career planning is the process of systematically matching career goals and indi- vidual capabilities with opportunities for their fulfillment. Career planning involves answering such questions as “Who am I?” “Where do I want to go?” and “How do I get there?”

While some suggest that a career should be allowed to progress in a some- what random but always opportunistic way, others view a career as something to be rationally planned and pursued in a logical step-by-step fashion. In fact, a

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well-managed career probably includes elements of each. The carefully thought- out plan can point you in a general career direction; an eye for opportunity can fill in the details along the way.

5.5.2 Work–Life Balance

Today’s fast-paced and complicated lifestyles bring with them inevitable pressures on the balance between careers and personal time. Human resource policies and practices that support a healthy work-life balance are increasingly valued. Work- life balance concerns include

▲ the needs of single parents, who must balance complete parenting responsibilities with a job;

▲ the needs of dual-career couples, who must balance career needs and opportunities of each partner;13

▲ the “family-friendliness” of an employer, including access to on-site day care, medical and dental offices, dry cleaning, and even video rentals.14

5.5.3 Retention and Turnover

The several steps in the human resource management process both conclude and recycle with the management of promotions, transfers, terminations, layoffs, and retirements. Proactive health care managers approach any of these replacement situations as an opportunity to review human resource plans and ensure that the best people are selected to perform the required tasks.

Some replacement decisions shift people between positions within the organization.

▲ Promotion is movement to a higher-level position. ▲ Transfer is movement to a different job at a similar level of responsibility.

F O R E X A M P L E

Ongoing Training, Every Day At Pascack Valley Hospital in New Jersey, a list of strategies for patient rela- tions—known as the hospital’s “Whatever It Takes” customer service pro- gram—is printed on the back of the laminated name badges that every employee carries and uses daily. The badges serve as a constant good reminder of the hospital’s standard of customer care, as well as the criteria that is used to evaluate all health care-specific workers in annual appraisals. Additionally, outstanding performances in one of the criteria listed on the badges are rewarded with merit bonuses, providing a needed financial incen- tive for the hospitals ongoing staff-development programs.

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Another set of replacement decisions relates to retirement, something many people look forward to—until it is close at hand. Then the prospect of being retired often raises fears and apprehensions. Many organizations offer special counseling and other forms of support for preretirement employees, including advice on company benefits, money management, estate planning, and use of leisure time. Downsizing is sometimes accompanied by special offers of early retirement—that is, retirement before formal retirement age but with special financial incentives.

The most extreme replacement decisions involve termination.

▲ Termination: the involuntary and permanent dismissal of an employee.

For the person being dismissed, accepting the fact of termination is difficult. The termination notice may come by surprise and without the benefit of advance preparation for either the personal or the financial shock.

5.5.4 Compensation and Benefits

When properly designed and implemented, compensation and benefit systems help attract qualified people to the health care organization and retain them.

▲ Base compensation is the form of salary or hourly wages that can make the organization a desirable place of employment.

Unless an organization’s prevailing wage and salary structure is competitive, attracting and retaining a staff of highly competent workers is difficult. A basic rule of thumb is to study the labor market carefully and pay at least as much as, and perhaps a bit more than, what competitors are offering.

The organization’s employee-benefit program also plays a role in attracting and retaining capable workers.

▲ Fringe benefits: the additional nonwage or nonsalary forms of compen- sation now constitute some 30% or more of a typical worker’s earnings. Benefit packages usually include various options on disability protection, health and life insurance, and retirement plans.

Interestingly, the ever-rising cost of fringe benefits, particularly employee medical benefits, is a major worry for health care employers. Some are attempt- ing to gain control over health care costs by becoming more active in employ- ees’ choices of health care services and providers. An increasingly common approach overall is flexible benefits, sometimes known as cafeteria benefits, which allow the employee to choose a set of benefits within a certain dollar amount. Employees gain when such plans are better able to meet their needs; employers gain from being more responsive to a wider range of needs in a diverse workforce.

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5.5.5 Contrasting Probation and Termination

Terminating employees is an unfortunate but necessary part of being a health care manager. Knowing when to fire someone can be as difficult as knowing how. When individual performance has deteriorated to the point of being counter- productive, it is clearly time for separation. In many cases, individuals are actu- ally relieved when terminated because they have become frustrated and ineffec- tive in their work roles.

Do not expect anyone to thank you for terminating them, however, or to admit that it was their fault for being terminated. Terminating an employee is a very difficult undertaking, and this section offers suggestions to make the ter- mination process as painless and productive as possible.

▲ Disciplinary probation is generally acknowledged as a final step before termination. Probation is generally a 3-month process in which poor per- formers are given the opportunity, usually one last chance, to turn performance around to an acceptable level.

Many health care managers think that probation is a farce because if the indi- viduals “behave” for 3 months, there is no guarantee that they will perform steadily for the rest of the year. In fact, they generally believe that performance will usually regress.

In many cases, employees who are on probation terminate themselves by securing other employment while on probation, thus saving the headache of hav- ing to fire them. In this regard, probation is a worthwhile practice and should be used in conjunction with a performance evaluation for an employee who is likely to be terminated eventually anyway.

5.5.6 When to Terminate

When should you fire someone? Each case deals with a unique individual and specific circumstances. You should terminate an employee if most of the fol- lowing conditions are present:

▲ Chronic poor attitude: An employee who regularly appears to be inflex- ible, overly aggressive or confrontational, irresolute, and tunnel-visioned and displays a poor work ethic and no sense of industry is a candidate for termination. Rarely are individuals who demonstrate these attitudes likely to change. In an industry that requires high adaptability, appropri- ately assertive behavior, perseverance, and a strong work ethic, these problems, which probably cannot be corrected, are unacceptable.

▲ Poor interpersonal skills: An individual who consistently demonstrates interpersonal behavior problems and creates conflicts may be a candidate for termination. In a people-oriented field such as health care, poor interpersonal skills do not make for long-term success.

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▲ Negative effect on others: When an employee’s negative behavior creates intradepartmental conflict and the employee has been counseled several times about the effect caused by these conflicts, termination must be considered.

▲ Poor performance documentation: If the employee’s pattern of perfor- mance documentation over a 1-year period has been largely negative, termination must be considered. Such individuals typically not only fail to grow and develop on the job, but they also usually regress to a level of performance that is less than what was expected for the current year. In short, individuals who have demonstrated a full year of poor perfor- mance have probably fallen into a pattern that cannot be remedied by probation or another year on the job. In essence, they are absorbing a salary that can be better spent on a better performer.

▲ Negative or no reaction to counseling: After a problem employee has been counseled by you, the human resource department, or other appro- priate individuals in your organization and the individual still fails to perform acceptably, chances are the situation is unresolvable.

▲ Outside negative input: If patients, peers, or other department members have constructively criticized the individual’s performance, most likely the performance is affecting the entire workflow of your department. To keep this problem from festering, termination must be enacted.

▲ Detrimental effect on the organization: A poor performer who is in a critical work position can adversely affect the entire organization. If you have clear evidence that this is the case, termination must be enacted quickly to maintain exceptional organizational integrity and performance.

▲ Regressive patterns, trends, and habits: A person who consistently demonstrates poor on-the-job behavior, inappropriate work personality, and poor work habits—all substantiated by your own documentation—is a candidate for termination.

5.5.7 How to Terminate

After determining that termination is necessary, you need to act quickly and effectively. The following checklist can help you through this difficult process.

1. Explain documentation. All prior appropriate documentation should be on hand for presentation at the time of termination. Explain in 2 to 3 minutes your overriding documentation and the reasons you considered termination as the only possible remedy. Documentation must be used as the basis for any discussion of termination.

2. Recap performance counseling. Quickly summarize all efforts made to resolve the performance problem.

3. Get to the point. Tell the individual that you are terminating them for cause. If the employee already guessed that he or she is being terminated and says so, simply acknowledge it and move on to the next step.

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4. Have a witness on hand. If you have never fired an employee, ask a third person (your boss or someone from the human resource department) to be present at the session. This allows you to have support on hand as well as someone to help guide you through the process.

5. Allow a monologue. If the person being fired feels like talking or wants to ventilate, allow them 3 to 5 minutes to do so. Then respond that although you respect his or her feelings, the decision has been made.

6. Get closure. Instruct the individual to gather his or her belongings and leave the premises. If necessary, call security to escort them off the premises.

7. Prepare an exit letter. A letter of termination delineating cause and signed by the former employee should go in the personnel file, along with the person’s comments, if any. Any other paperwork that completes the process should be included.

8. Communicate with your staff. Notify staff that you have terminated the individual and that you plan to fill the position quickly. You need not disclose the reasons for the termination. If your employees have ques- tions, recommend they come into your office on an individual basis and discuss. (If further discussion is desired, only the future of the depart- ment should be discussed, not the terminated employee.)

9. Reject additional input. After you terminate an employee, you need not accept further input from another employee. Your focus should be on the future, specifically on employee suggestions for filling the position.

10. Fill the position quickly. You have an opportunity to command trust and allegiance from your staff by providing them with a productive, pro- fessional new colleague.

Termination is never easy, but by using these techniques and enlisting the sup- port of your superiors and human resource staff, you can move through this dif- ficult situation.

• Identify and define career planning, promotion, transfer, disciplinary probation, base compensation, fringe benefits, and termination.

• Discuss common work-life balance concerns.

• Contrast typical replacement situations, including promotion, trans- fer, and termination.

• List typical reasons for probation or termination.

• Describe the steps of probation and termination.

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5.6 Dealing with Office Politics and Resolving Conflict

Unfortunately, exercising your talents as a health care manager will probably be tested by overtly political behavior, or at least annoyed by day-to-day dealings of “office politics.” It is important that health care managers avoid political quag- mires in the workplace in the interest of providing stellar, progressive services to patients and to the health care organization.

Office politics cause several significant problems for the health care manager and the health care organization as a whole.

▲ Politics inhibit productivity: Generally speaking, workers are not partic- ularly motivated to perform well for individuals who are more politics- minded than performance-minded. A great deal of time is spent avoiding power plays and preparing for counteractions. Consequently, productivity suffers, and worst of all the patient is deprived of receiving the full range of services the health care organization is capable of providing.

▲ Politics stifle creativity: Because politics can promote paranoia, team members may be reluctant to share new ideas or work in a group process that encourages creativity or innovation. As a result, staff growth and development are compromised, or top performers relocate to a less political or, better yet, nonpolitical environment. Again, the patient and the organization suffer.

▲ Politics cripples teamwork: Individuals who are suspicious of each other and have limited respect for each other end up resenting one another and avoiding open communication. Politics destroys allegiance and loyalty among team members and the overall objective of the team or organization. Group morale begins to diminish until finally individual employee motivation begins to erode.

▲ Overt negative politics alters communication: Overt negative politics include altered messages, altered presentation of messages, or flat-out non- communication in certain situations. Politics often begin after a third party enters the picture, creating an unbalanced dynamic and opportunity for two people to discuss a third person—often in an uncomplimentary manner.

5.6.1 Signs of Overtly Political Behavior

Whenever a premium is placed on politics as opposed to performance in the health care environment, the team or department finds itself at risk of falling apart—or at least beginning to be much less productive. Five basic indicators that can signal overtly political behavior include

▲ double-talk. Individuals who tell one story to one person and an entirely different story to another are double-talkers. Their motives may be to

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cover the bases on a particular issue, deliberately create disharmony, or simply try to pit two people against each other;

▲ backstabbing. Backstabbers overtly pledge allegiance to you and your ideas but covertly downplay them and insult your intelligence;

▲ power mongering. Power mongers try to control everything. These indi- viduals are also called turf protectors or empire builders because they often use resources and territory as the principal focus of their subversive efforts. As a health care manager, you may fall prey to a power monger’s claim of being in charge of something that in fact he or she has no con- trol of;

▲ victim role. Some individuals claim that the organization is out to get them and that you had better watch yourself. People with this mind-set are more interested in their own survival than in assisting fellow workers through the health care mission;

▲ game playing. Game players use phony behavior in trying to engender support. They play games with fellow staff as well.

5.6.2 Dealing with Overtly Political Behavior

As a manager, how do you deal with politics? Whether the politician is a mem- ber of your staff or a colleague, these five strategies may be useful:

▲ Avoidance is easy. Simply try to stay out of the way of political behavior whenever possible. If avoidance is not feasible on a daily basis, keep all contact on a business level and discuss only business issues. If someone tries invariably to shift the focus to a politically oriented level, firmly return them to the issue at hand. Remember that your primary manager- ial responsibility is to bolster staff motivation and productivity while con- tributing to your facility’s goal of high-quality patient care.

▲ Confront the person and let her know that you are aware of her politi- cal intent. For example, if you are asked a loaded question, simply counter by asking another question such as, “Why are you asking me that?” You risk incurring wrath, but you at least discourage overtly politi- cal behavior.

▲ Disclosure and support works if the troublesome individual is someone on the management team or someone who reports to your own manager. Simply present evidence of the political behavior to your supervisor, without judgment or opinion. Use objective reporting. For instance: “You know, a funny thing happened the other day. I was talking to (name), who seemed persistent in wanting to discuss (topic).” This approach indicates your apprehension in dealing with this individual and signals your need for specific assistance.

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▲ With direct input from your own manager, you can actively enlist sup- port. Simply tell your supervisor about the problem, review the evidence, and ask directly for assistance: “What would you do if you had this situ- ation?” (If you perceive your boss to exhibit excessively political behavior, you may want to request the help of another mentor within the organiza- tion in dealing with this behavior.)

▲ Gather documentation as evidence of political behavior by colleagues or staff. The more examples you collect, the better case you can make for termination (if the person is staff) or for limited contact (if the source is a colleague). Record evidence or examples of notable political behavior, and be sure to handle reports tactfully.

5.6.3 Symptoms of Intradepartmental Conflict

Despite a health care manager’s best efforts to establish trust throughout her work group and to avoid potential conflict, human nature unfortunately creates occa- sions for intradepartmental conflict. Intradepartmental conflict is any conflict that takes place within a single department or work group.

Initially, intradepartmental conflict takes place on an interpersonal basis. Inter- personal conflict, particularly within a work group, is potentially the most damag- ing type of problem a health care manager can deal with. If interpersonal conflict exists within a department and is not abated and healed, eventually it can have drastic negative consequences for the entire department—even implosion.

Numerous indicators signal intradepartmental conflict. Use your instincts and observations to examine the conflict in a cause-and-effect fashion. Follow- ing is a list of potential symptoms, causes, and effects on your department.

▲ Anger: Interpersonal adversity, loss of temper, lack of patience, or flat- out confrontational behavior may all be exhibited in certain kinds of interpersonal conflict.

▲ Avoidance: When an individual declines to work with someone or sim- ply avoids contact with that person, work may not be done and the team processes may be compromised. Avoidance is more subtle than anger and often more common.

▲ Blame: One individual may claim another person is entirely responsible for a mistake. Often the person blaming is attempting to cover for his own inability or failure to perform. Blaming creates hostility among team members and betrays basic trust and pride in the organization.

▲ Excuse making: One individual uses another’s behavior as a reason for not performing a particular task. The individual may focus specifically on a personality nuance as being the problem that gets in the way of accom- plishment. Another form of making excuses is to rationalize the negative behavior of others.

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5.6.4 RESOLVING INTRADEPARTMENTAL CONFLICT 153

▲ Isolation and fragmentation: Certain team members may exclude one or more players because of personality conflict. Isolation jeopardizes the group-participation process, and ultimately, one or more individuals may withdrawal the resources needed to get a job done. Extreme isolation may lead workers to organize into factions. This fragmentation can become particularly detrimental in any group process, especially one that requires quick, efficient response.

▲ Confrontation: Argumentative personality types use intimidation and confrontation to disrupt process, waste time, and demoralize others.

▲ Criticism: Continuous nit-picking severely diminishes morale. Ironically, others often respond to constant criticism by becoming defensive and in turn critical of the chronic criticizer.

▲ Erosion of performance: The quality and efficiency of work diminishes, resulting in ill feelings and costly overtime. Some staff begin to look for another workplace if the situation is not corrected by the manager.

▲ Regression: A performance continues to erode, worker may do less and less, bringing work process to a grinding halt. In an era in which health care must be progressive, every employee’s performance must contribute to its maximum potential.

5.6.4 Resolving Intradepartmental Conflict

Many organizations have recommended approaches to dealing with interdepart- mental conflict. As you gain more experience as a manager and see what does (and doesn’t) work, you’re sure to develop your own ways of resolving dis- agreements between staff members. The following six-step process can adapt well to a multitude of situations and organizationally recommended processes:

1. Go on a fact-finding mission. Begin any effort to resolve intradepart- mental conflict by performing thorough fact finding every step of the way. Fact finding is the process of collecting information from all involved parties before arriving at a decision. For example, when an intradepart- mental conflict takes place between two individuals, you may want to investigate by discussing the situation with both parties separately and by asking them the same two questions: what they think the problem and root cause may be, and how the situation can be resolved. At that point, bring both parties together, present both ideas for resolution, and once again state your optimism for correction as well as your refusal to toler- ate further interpersonal conflict.

2. Separate issues into two categories. First identify business-related attrib- utes of the problem—business outcomes, performance dimensions, and tech- nical areas. Then list personal issues that may bear on the conflict. Review this information completely with the involved party and reach consensus on

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the facts of the issues. If no one acknowledges the facts, you may have to state more directly your belief in their validity and supplement that state- ment with the pledge that you will not accept this behavior any longer.

3. Move the discussion to performance. Focus specifically on the business effects from the conflict. Cite work that is not being done; explain how the employee’s (or group’s) behavior affects other department members and how this behavior interferes with others’ getting their jobs done. Discuss further how this behavior affects other departments and, most important, patients.

4. Ask why this behavior has taken place and how it might be corrected. Try to get to the bottom of what the parties believe is contributing to the problem and how the cause can be alleviated. Following this discussion, present your own ideas on why the problem exists; however, spend most of your discussion on how the problem must be remedied.

5. State clearly, concisely, and resolutely your expectations, standards, and policies for future action. Explain what you accept as satisfactory behavior and what you consider poor performance or interpersonal con- flict. Future actions may include probation or other disciplinary action, including termination.

6. Express your confidence that the situation will be corrected and ask whether particular assistance is needed to do so. Try to strike a deli- cate balance between expressing optimism that the situation can be cor- rected and underscoring the fact that continued poor performance and intradepartmental conflict will not be tolerated under any conditions.

Interpersonal conflict is complex and can hinder progressive action. As a man- ager, you must deal with it resolutely and in a timely fashion so that the major- ity of your department is not adversely affected.

F O R E X A M P L E

Alternative Dispute Resolution Alternative dispute resolution (ADR) is a term that includes a wide range of techniques—conflict management, arbitration, mediation, and more—for resolving workplace conflict without involving expensive, time-consuming, and often unsatisfying legal professionals. Updated daily, ADRWorld.com (www.adrworld.com) collects and publishes news stories on alternative dis- pute resolution in the workplace. Membership in the community is free, and members can receive a weekly e-newsletter that has top stories and court decisions related to conflict resolution. Members also have access to a free searchable database of summarized news stories and legal rulings involving ADR in all 50 U.S. states.

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KEY TERMS 155

SUMMARY Human resources—your staff, employees, and team members—are the most valuable resources in a health care organization. Human resource management requires adherence to employment and discrimination laws, as well as savvy recruiting, thorough interviewing and selection, and efficient training and devel- opment. Regular performance appraisals—both of individuals and work teams— provides feedback and improves the overall function of the organization. Pro- moting, transferring, and terminating are all potential responses to retention and turnover in the workplace. Proactive managers monitor and effectively respond to office politics and conflict before their work environments begin to suffer.

KEY TERMS Affirmative action Preference in hiring and promotion to women

and minorities, including veterans, the aged, and the disabled.

Base compensation An employee’s salary or hourly wage.

Bona fide occupational Criteria for employment that can be clearly qualification justified as being related to a person’s capacity to

perform a job.

Career planning The process of systematically matching career goals and individual capabilities with opportu- nities for their fulfillment.

Collective bargaining The process of negotiating, administering, and interpreting labor contracts.

Comparable worth The notion that persons performing jobs of sim- ilar importance should be paid at comparable levels.

• Identify and define office politics and intradepartmental conflict.

• List four negative impacts of office politics.

• Identify five common types of political behavior.

• Discuss five ways to respond to political behavior.

• Describe five common responses to intradepartmental conflict.

• Detail a six-step response to intradepartmental conflict.

S E L F - C H E C K

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156 MANAGING RESOURCES

Disciplinary probation The final step before termination, generally a 3- month process in which poor performers are given the opportunity to turn performance around to an acceptable level.

Documentation The process of objectively recording perfor- mance and performance levels.

Employment discrimination Situation in which someone is denied a job or a job assignment for reasons that are not job relevant.

Equal employment The right to employment without regard to race, opportunity (EEO) color, national origin, religion, gender, age, or

physical and mental ability.

Fringe benefits The additional nonwage or nonsalary forms of compensation workers receive, including dis- ability protection, health and life insurance, and retirement plans.

Human resource Attracting, developing, and maintaining a tal- management (HRM) ented and energetic workforce to support orga-

nizational mission, objectives, and strategies.

Intradepartmental conflict A conflict that takes place within a single de- partment or work group.

Job analysis The orderly study of just what is done, when, where, how, why, and by whom in existing or potential new jobs.

Job descriptions Written statements of job duties and responsi- bilities.

Job specifications Qualifications (educational level, prior experi- ence, or skills) that should be met by any person hired for a given job.

Labor unions Organizations to which workers belong that deal with employers on the workers’ behalves.

Orientation A set of activities designed to familiarize new employees with their jobs, co-workers, and key aspects of the organization as a whole.

Performance appraisal Taking qualitative, subjective perceptions of performance and ascribing a quantitative, objec- tive rating.

Promotion Movement of an employee to a higher-level position.

Realistic job previews Opportunities during the selection process that provide candidates with all pertinent information

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KEY TERMS 157

about the job and organization without distor- tion before the job is accepted.

Recruitment A set of activities designed to attract a qualified pool of job applicants to an organization.

Reference checks Inquiries to previous employers, academic advi- sors, co-workers, and/or acquaintances regard- ing the qualifications, experience, and past work records of a job applicant.

Selection The process of choosing from a pool of appli- cants the person or persons who offer the great- est performance potential.

Sexual harassment Situation in which a person experiences con- duct or language of a sexual nature that affects his or her employment situation.

Socialization The process of influencing the expectations, be- havior, and attitudes of a new employee in a way considered desirable by the organization.

Strategic human resource A process of analyzing staffing needs and plan- planning ning how to satisfy these needs in a way that

best serves organizational missions, objectives, and strategies.

Termination The involuntary and permanent dismissal of an employee.

Training A set of activities that provides the opportunity to acquire and improve job-related skills.

Transfer Movement of an employee to a different job at a similar level of responsibility.

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158 MANAGING RESOURCES

ASSESS YOUR UNDERSTANDING Go to www.wiley.com/college/Lombardi to evaluate your knowledge of resource management. Measure your learning by comparing pretest and post-test results.

Summary Questions

1. Equal employment opportunity (EEO) is the right to employment without regard to race, color, national original, religion, gender, age, or physical and mental ability. True or false?

2. Collective bargaining allows unions to (a) establish the base wage for specific jobs. (b) purchase benefits for union members. (c) negotiate and interpret labor contracts on behalf of union members. (d) None of the above

3. Effective recruitment tactics include all of the following except (a) staff referrals. (b) sales forces. (c) school liaisons. (d) advertising.

4. Hiring managers need to be careful when asking job candidates questions on the topic of (a) military service. (b) age. (c) national origin. (d) All of the above

5. During a reference check, a hiring manager may attempt to verify an applicant’s qualifications, experience, and past work record; however, ref- erences are only required to verify the candidate’s name, position, length of employment, and approximate salary range. True or false?

6. Currently, it is legal to ask a job candidate to submit to a physical exam prior to extending a job offer to ensure that the candidate is physically capable of fulfilling job requirements. True or false?

7. The purpose of socialization on the job is to help the team form personal connections with one another, thereby improving productivity. True or false?

8. For a new employee, an appropriate and effective method of training and development would be (a) manuals. (b) modeling.

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SUMMARY QUESTIONS 159

(c) lectures. (d) projects.

9. Performance appraisals have two basic purposes: evaluation and promotion. True or false?

10. If you wanted to conduct an appraisal that evaluates an employee’s performance against another employee’s performance, you could use which of the following appraisal methods? (a) Graphic rating scale (b) Critical incident technique (c) Narrative technique (d) Multiperson comparisons

11. Group or team appraisals are most effective when the emphasis is on personalities rather than performance. True or false?

12. Effective career-planning requires managers to help workers balance work priorities and life demands. Today’s work-life concerns include (a) child care. (b) two-career households. (c) single parent families. (d) all of the above.

13. Disciplinary probation is often an ineffective tool for improving an employee’s work output or attitude. Many individuals simply behave dur- ing probation and return to old habits after. True or false?

14. When terminating an individual, do all the following, except (a) have your boss or an HR professional present during the termination

meeting. (b) hold an open question-and-answer session with remaining staff after

the termination. (c) allow the terminated individual to vent his or her frustrations for 3

to 5 minutes. (d) summarize quickly efforts made to resolve performance problems.

15. Office politics ultimately have a negative effect on a workplace for all of the following reasons, except (a) office politics stifle individuality. (b) office politics cripple teamwork. (c) office politics inhibit productivity. (d) office politics alter communications.

16. Isolation in the workplace can lead workers to organize into separate fac- tions, a process known as fragmentation. True or false?

17. The first step to resolving intradepartmental conflict is to ask yourself why a behavior has taken place and how it might be corrected. True or false?

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Review Questions

1. When an organization legally establishes and justifies criteria for employ- ment, the organization is relying on what legal principle?

2. How do job descriptions differ from job specifications? 3. In internal recruitment, an organization looks within its staff for perspec-

tive job candidates. What are some benefits of utilizing internal recruitment?

4. A manager assigns more responsibility to a single nurse because she doesn’t have to worry about the family obligations that married staff do. Which Equal Employment law does this violate?

5. At what stage during the six-step selection process would an applicant be asked to perform a work task while an observer watches and grades their performance?

6. Realistic job previews for job candidates are gaining popularity even though previews take time and have some costs associated with them. What benefits do realistic job previews offer?

7. After you sort job applicants into the three recommended categories, which applicants should you interview first?

8. You have an experienced team member give technical advice to a less expe- rienced member. What sort of on-the-job training are you encouraging?

9. What are some appropriate topics to include as part of employee orientation?

10. Graphic rating scales are popular tools for performance appraisals because they are quick and easy to use. However, what is their main downside?

11. What should you do if an employee begins crying or shouting during a performance appraisal?

12. In addition to wages or salary, fringe benefits play a major role in attract- ing and retaining quality employees. What are some examples of common fringe benefits an organization can offer?

13. After you terminate an employee, what are some things you should do in regards to remaining employees?

14. Although employees on probation rarely change their behaviors permanently, it can still be an effective tool. In what way?

15. Backstabbing and game playing are two indicators that your team may be struggling with office politics. What behaviors are involved in these activities?

16. Step 2 in the recommended process for resolving intradepartmental con- flict recommends separating issues into two categories. What are these categories and how do they differ?

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APPLYING THIS CHAPTER 161

Applying This Chapter

1. Roberto is encouraged by his manager to transfer to a less-demanding part-time position because he’s 55 and will probably be thinking about retirement in the next 5 to 10 years. Roberto feels somewhat uncomfort- able with his manager’s suggestion. What type of discrimination might be underlying the manager’s recommendation?

2. During an interview, you ask a candidate whether she’s ever been denied health insurance. You ask the question because you know your organiza- tion is having difficulties managing the cost of employees’ medical services and prescriptions. Why is your question most likely illegal?

3. As the clinic manager of a student-health center, you lead a team of eight nurses and nursing aides, many of whom are working their first health care job. Describe two ways you can incorporate coaching as a training and development technique in your role as the manager of a student- health clinic.

4. Upper management has requested that you quickly evaluate the performances of 20 staff members for report on the progress of implementing new charting requirements. You need to conduct and pre- sent your evaluation in 1 week’s time. What sort of performance appraisal tools would be fast and effective to evaluate your staff?

5. Because of his consistently poor attitude, confrontational actions with patients, and lack of response to counseling efforts, you decide to terminate Randall, a nurse on the team you manage at a pediatric hospital. What are some things you should do within your team after the termination?

6. Cameron says that other nurses in his department don’t respect him because they’re female and are only interested in helping other women. He comes to you, as his manager, and asks you to overlook the fact that he’s late to work once or twice a week because the stress of working in a hostile environment makes coming in on time difficult. What type of political behavior is Cameron engaging in?

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YOU TRY IT

Nontraditional Recruiting The medical laboratory you manage is consistently run- ning short on entry-level lab assistants to help the staff of four experienced technicians set up, execute, and clean up tests. Employees with post-college education are typically unsatisfied working in the lab assistant po- sition. How might you engage various individuals and organizations in your community to attractive appropri- ate job candidates?

Worthwhile Testing As the hiring manager for a multiphysician convenience clinic, you decide that you’d like to incorporate some form of job testing for all office-management candidates. Several past new hires had very weak computer, organi- zational, and/or customer service skills—and traditional interviewing didn’t reveal these deficiencies. What are some useful tests you might include in future interviews?

Cost-Effective Training As the office manager of a multiphysician, suburban medical clinic, you manage a group of 10 “specialists,” including a scheduler, several billing/accounting techni- cians, two insurance provider liaisons, and several customer-service representatives. You also have five ad- ministrative assistants who float among the specialists, assisting the specialists on an as-needed basis. You’ve identified that the high turnover rate in administrative as- sistants is connected to a lack of good training and career development opportunities. What are some cost- effective training and development programs you can put in place to improve the work experience (and job reten- tion) of the administrative assistants in your office?

Dutiful Documentation The manager of a nursing team at a nursing care facility documents the following performance note in an individ- ual performance logbook for Emily, a health aide who’s been with the organization for less than a year: “On March 31, Emily didn’t do her job today and got huffy

with me. She claims she was busy helping transfer pa- tient Leonard Crelborne to another facility. Crelborne’s family was upset about the transfer and Emily was able to calm them down by explaining the situation.” In what way is this an effective piece of documentation? In what way is this an ineffective piece of documentation?

Salary Comparisons While people are drawn to health care careers for many reasons, salary is an undeniably important motivation for many workers. Do you know the range of base com- pensation you can anticipate in your chosen health care career? While no resource or professional can tell you definitely the hourly wage or salary you’ll receive, several print and online resources can give you a range of salaries that your base compensation should fall within. Get started on comparing salaries by visiting Monster.com’s frequently updated, nationwide salary calculator at http://content.salary.monster.com/. The easy-to-use tool compares potential salaries in hun- dreds of health care careers, in thousands of geo- graphic regions across the United States.

Choosing Your Response Jayne, a pediatric nurse with more than 10 years of pa- tient-care experience at several hospitals, frequently refers to herself as the “top dog” in the department. She uses her experience as reason to trade off less- appealing patients with other nurses in the department. Jayne claims that she’s the only nurse in the depart- ment who knows how to operate several pieces of high-tech equipment and refuses to teach other staffers how to use the equipment. No one wants to work with Jayne because she’s condescending, yet nearly everyone must beg Jayne for help on a daily ba- sis because they don’t know how to do certain proce- dures she’s always responsible for. As Jayne’s man- ager, how would you choose to respond to the situation: avoid, confront, disclose/seek support, rely on direct input, or gather documentation?

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