english

Good laws make it easier to do right and harder to do wrong.

—Old Proverb

CHAPTER OBJECTIVES

· Outline the development of the regulated environment within which the healthcare supervisor must function.

· Identify 1964 as the pivotal year during which legislation affecting employment marked the onset of the federal government’s practice of shifting social responsibility to employers.

· Present a chronology of legislation affecting employment and thus affecting the supervisory role.

· Describe the cumulative effects of employment legislation to date.

KEY TERMS

Employment Legislation: Within the context of this chapter, employment legislation consists of federal laws that have a bearing on the employer–employee relationship and in some manner influence the role of the supervisor.

THE LEGAL ENVIRONMENT

This chapter provides an overview of the laws affecting various aspects of the employment relationship. Each law is described in nonlegal terminology, focusing on its stated or apparent intent and noting the effect it might conceivably have on the functioning of the supervisor. Some of the effects of the more significant laws are considered, and in a few instances some apparently unintended effects are described.

This chapter is intended to provide sufficient background and information of

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Human Resources (at the time still called Personnel in most organizations) began to change dramatically in 1964, when sweeping civil rights legislation came into being. Title VII of the Civil Rights Act of 1964 marked the beginning of significant changes in relations between government and business, as well as a change in philosophy that would result in a completely new direction for government in its concern for its citizens.

Pre-1964: Minimal Regulation

Before 1964, businesses were free to deal with employees essentially as they chose, except for the requirements of wage and hour laws and labor relations laws. Prior to 1964 the only laws that had a noticeable impact on the employment relationship were the Fair Labor Standards Act (FLSA) and related state laws, and the National Labor Relations Act (NLRA).

The Fair Labor Standards Act governed—and to this day, as regularly amended, continues to govern—wage payment and certain other conditions of employment. This and similar laws in some states are commonly referred to as wage and hour laws.

The National Labor Relations Act (and similar laws in some states), governing relationships between work organizations and labor unions, was relevant only to organizations in which employees were unionized or where there was active union organizing.

Thus, before 1964 there were few legal restrictions on how employers could operate and how supervisors could manage. Most business organizations complied with the wage and hour laws as a matter of operating routine, and those organizations having a union presence, either actively organizing or in place, generally complied with applicable labor laws.

The turning point of 1964 represented a change in philosophy concerning government’s relationship with business. For years the governing philosophy had largely been one of “hands off” to the maximum practical extent; employers needed to concern themselves only with wage and hour requirements and labor relations restrictions. But 1964 marked a significant change in the direction government

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THE RELEVANT LAWS

Norris–LaGuardia Act (1932)

The first legislation to significantly address the growing organized labor movement was the Norris–LaGuardia Act of 1932. This Act marked a significant shift in public policy concerning labor unions, from a posture of legal repression of unions and their activities to one of encouragement of union activity. Although the Act essentially legalized union organizing and affirmed workers’ rights to organize for collective bargaining purposes, it did little to directly restrain employers in their conduct toward labor organizations.

National Labor Relations Act (NLRA) (1935)

The National Labor Relations Act, also known as the Wagner Act, established rules for the behavior of both unions and employers in labor organizing and collective bargaining situations. Although the NLRA seemed to favor unions and encourage their presence, it also set some boundaries on what unions could do in their organizing activities. In addition to affirming employees’ right to organize, the NLRA made it illegal for an employer to simply refuse to deal with a union provided the union had conducted a legal organizing campaign and had won a proper representation election.

The NLRA created the National Labor Relations Board (NLRB), the body charged with administering the Act by conducting representation elections to determine whether employees in particular groupings (“bargaining units”) wished to have union representation.

The Act specified that a union chosen by the majority of the employees in an appropriate unit would be the exclusive representative of all the employees in that unit. The NLRA was later modified by the Taft-Hartley Act and the Landrum-Griffin Act.

Social Security Act (1935)

The Social Security Act established a basic system of contributory social insurance and a supplemental program for the low-income elderly. The system was expanded in 1939 to provide benefits to survivors of covered workers and dependents of retirees. Subsequently it was further expanded to cover workers who had become

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Fair Labor Standards Act (FLSA) (1938)

One dimension of the congressional intent of the Fair Labor Standards Act was to reduce the high unemployment rate that typified the years of the Great Depression by reducing work-week hours to a uniform standard, thus spreading available work over a greater number of workers. In addition to defining a “normal” work week, the FLSA set minimum pay rates, established rules and standards for the payment of overtime, and regulated the employment of minors. The FLSA remains the country’s basic wage and hour law.

Labor Management Relations Act (1947)

This Act, popularly referred to as the Taft-Hartley Act, was an amendment to the National Labor Relations Act. The NLRA clearly favored unions over employers; the principal effect of Taft-Hartley was to level the playing field to some extent by more appropriately balancing the responsibilities and advantages of union and employer. Taft-Hartley also listed specific unfair labor practices. Although still viewed by many as a law favoring labor unions, Taft-Hartley was clearly a swing in the direction of management’s rights. When we presently see or hear mention of the NLRA, the reference is actually to the NLRA as amended by Taft-Hartley. This law was itself amended in 1975 to address not-for-profit hospitals by removing the exemption that had been in place under Taft-Hartley since its passage in 1947.

Labor-Management Reporting and Disclosure Act (1959)

Commonly known as the Landrum-Griffin Act, this was another amendment to the National Labor Relations Act. Among its numerous provisions, this Act required employers, including not-for-profit hospitals and other nonprofit healthcare facilities, to report in detail to the U.S. Secretary of Labor any financial arrangements or transactions intended to improve or retard the process of unionization. Various reporting and disclosure requirements were also placed on unions.

Equal Pay Act (1963)

The Equal Pay Act was actually an amendment to the Fair Labor Standards Act. It prohibited the payment of unequal wages for men and women who worked for the same employer in the same establishment for equal work on jobs requiring equal skill, effort, responsibility, and performed under similar working conditions.

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Title VII of the Civil Rights Act of 1964

With the enactment of this pivotal legislation, business in general began to experience steadily increasing regulation of the employment relationship. Title VII provided the legal basis for all people to pursue the work of their choosing and to advance in their chosen occupations subject to the limitations of only their individual qualifications, talents, and energies. This legislation defined unlawful employment discrimination as:

· The failure or refusal to hire an individual, or to discharge an individual, or to discriminate against any individual with respect to compensation or other terms, conditions, or privileges of employment because of that individual’s race, color, religion, sex, or national origin.

· Limiting, segregating, or classifying employees or applicants for employment in any way that would deprive them of employment opportunities or otherwise adversely affect their status as employees because of race, color, religion, sex, or national origin.

The Civil Rights Act of 1964 also established the Equal Employment Opportunity Commission (EEOC) to enforce the anti-discrimination requirements of Title VII. The Act was amended in later years to compensate for perceived erosion of its strength and effectiveness owing to a number of U.S. Supreme Court decisions.

Age Discrimination in Employment Act (ADEA) (1967)

The Age Discrimination in Employment Act legally established the basic right of individuals to be treated in employment on the basis of their ability to perform the job rather than on the basis of age-related stereotypes or artificial age limitations. The ADEA prohibits discrimination in employment on the basis of age in hiring, job retention, compensation, and all other terms, conditions, and privileges of employment. The threshold for defining age discrimination is 40; workers age 40 and older are a “protected class” for EEOC purposes.

The ADEA has had a direct effect on retirement. Before the ADEA, employers were free to mandate retirement at a specific age, most commonly 65. The ADEA raised the limit such that employers could no longer mandate retirement at any age younger than 70. When the ADEA was amended in 1986, the age 70 limitation was

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Occupational Safety and Health Act (OSHA) (1970)

Passed in 1970 and effective in 1971, the Occupational Safety and Health Act represents highly influential legislation concerning employee safety in the workplace. Before passage of this law, efforts to ensure health and safety in the workplace were minimal. The intent of Congress in establishing OSHA was to provide all employees with a workplace free from recognized hazards that are causing or can cause death or serious physical harm to employees. This legislation created the Occupational Safety and Health Administration (OSHA), the federal agency authorized to promulgate legally enforceable workplace safety standards, respond to employee complaints, and make on-site inspections as necessary to follow up on employee safety complaints or on lost-workday injury rates that are considered excessive. (Both the agency and the legislation are referred to by the same acronym, OSHA).

There are lists of more than 1,000 substances considered hazardous under OSHA regulations. In addition, a number of states now have “right to know” laws with similar requirements.

Generally, under federal and state standards for the handling of hazardous substances, employers must disseminate material safety data sheets, make certain that warning labels are always in evidence on workplace containers, and at all times be able to produce a written employee orientation program. It ordinarily falls to the supervisor to ensure that these requirements are fully satisfied within the department.

Rehabilitation Act (1973)

Consolidated Omnibus Budget Reconciliation Act (COBRA) (1986)

This complex piece of legislation addressed many concerns; most pertinent to employment is that COBRA allowed for the extension of group insurance coverage to employees and their dependents on a self-pay basis for set periods of time (ranging up to 36 months maximum, depending on the “qualifying event,” i.e., the reason for accessing COBRA), for those who would otherwise lose group health or dental coverage because of loss of employment, change in employment status, or certain other defined events. By making it possible for these employees and dependents to remain on the group contracts under which they had been covered, COBRA shifted to employers some of the cost of health coverage for many individuals who would otherwise be uninsurable except under government programs. As far as health insurance is concerned, COBRA is simply stopgap coverage; those who continue coverage under COBRA must secure other coverage after the eligibility period expires. Coverage can be continued up to 18 months for laid-off employees, 29 months for the disabled, and 36 months for dependents following separation, divorce, or the death of the employee. However, should the employer go out of business or for some other reason terminate its health insurance plan, rights under COBRA cease immediately.

Immigration Reform and Control Act (IRCA) (1986)

This Act required employers to review and as necessary modify their hiring practices, instituting procedures to verify that job applicants are either U.S. citizens or are otherwise legally authorized to work in the United States. This law established civil and criminal penalties for knowingly hiring, recruiting, referring, or retaining in employment persons designated as unauthorized aliens if so identified on or after November 6, 1986. The Act also prohibited employers from discriminating against job applicants on the basis of citizenship status or national origin.

Most employment legislation specifies the minimum size organization to which it applies; for example, the Family and Medical Leave Act (FMLA) applies only to employers of 50 or more employees. The Immigration Reform and Control Act pointedly applies to all employers of one or more employees, based on the premise

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This legislation created work in the form of a verification document known as the “I-9 Form,” which is ordinarily completed in Human Resources as part of the hiring process. The new employee or employee-to-be must furnish certain proofs of identity and, in the instance of legal aliens, proof of authorization to work in the United States. After examining (and usually copying) the appropriate documents, a representative of the employer signs the I-9 to attest to having seen those documents. Completed I-9 Forms are retained in employees’ personnel files, where they are subject to inspection and audit by Immigration and Customs Enforcement (ICE) and certain other agencies. Financial penalties are imposed for missing or incomplete I-9s. Also, there can be significant legal repercussions should illegal aliens be discovered in the workforce.

Pension Protection Act (1987)

This Act requires organizations with underfunded pension plans to make additional payments to the Pension Benefit Guarantee Corporation (PBGC), an agency established to guarantee benefit payments to participants of legally qualified defined-benefit pension plans. In addition to increasing employers’ payments to the PBGC, this legislation reduces or eliminates the deduction of contributions by employers for better-funded plans.

The Drug-Free Workplace Act (1988)

The Drug-Free Workplace Act requires organizations having $25,000 or more in federal contracts or grants to make good-faith efforts to maintain a drug-free workplace and to establish drug education and awareness programs for employees. As a precondition to receiving a contract or grant, the law requires the organization to certify that it will provide and maintain a drug-free workplace. There are a number of requirements to be fulfilled by the manager of any department involved in any portion of a federal contract or grant.

All healthcare institutions have an interest in keeping the work environment free from the dangers to patients, visitors, and employees created by the use of illegal drugs or controlled substances. For a number of years the drug abuse problem in the workplace has made it necessary for employers to develop and implement various means of addressing this growing problem. Although the requirements of the Drug-Free Workplace Act apply only to employees engaged in federal contracts and grants, conscientious management suggests that a comprehensive policy and drug-free awareness program be implemented for all employees. Surely conscientious departmental management will have a strong interest in maintaining a drug-free work environment whether or not there are external requirements for doing so.

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This legislation prevents most private-sector employers from requiring job applicants or current employees to take polygraph (lie detector) tests. Under EPPA, routine use of polygraph tests is permitted only in organizations that produce and distribute controlled substances and those involved in nuclear power, transportation, currency, commodities, or proprietary information.

In most organizations an employee may be asked to submit to a polygraph when “other evidence” gives management reason to suspect an individual employee; we may hear this referred to as “reasonable suspicion” or, somewhat inaccurately, as “reasonable cause.” However, an employee may not be disciplined or discharged based solely on the results of a polygraph test. Under EPPA the employer may not:

· Ask an employee or applicant to submit to a polygraph test (other than in instances covered by legal exceptions)

· Take adverse action against an individual for refusing to take a polygraph test

· Initiate any adverse action based on a polygraph test an individual may have submitted to for a different reason (in other words, the results of a polygraph test a person has submitted to for one specific reason cannot be used for a different purpose).

Worker Adjustment and Retraining Notification Act (WARN) (1988)

This law requires employers with 100 or more employees at any individual site to provide advance notification of major reductions in force. The employer must provide 60 days’ notice of an impending layoff of 50 or more employees, and must also notify local government and the state dislocated worker unit that provides employment and training services.

Americans with Disabilities Act (ADA) (1990)

This Act provides individuals with disabilities with the same protections afforded minorities and other protected classes under the Civil Rights Act of 1964, calling for access equal to that available to others in regard to employment; services and facilities available to the public, whether under private or public auspices; transportation; and telecommunications.

Disabilities are broadly defined under the Act and include hearing and visual impairments, paraplegia, epilepsy, HIV or AIDS, and literally dozens if not hundreds of other conditions. The list of recognized disabilities is long, and it continues to expand as legal wrangling continues over what is or is not a disability.

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From time to time, the supervisor may have reason to become familiar with some aspects of the law concerning disabilities. Involvement surely will come the supervisor’s way should there have to be a “reasonable accommodation” for one or more employees in the department. However, it is not always possible to tell on sight whether an individual is disabled. Unlike race or gender, a disability may not be readily identifiable.

The supervisor need not be concerned unless he or she knows factually that a disability exists. To obtain the protection available under anti-discrimination laws, an employee must identify himself or herself as disabled; if a disability is neither apparent nor declared, the employee in question should be treated the same as any other employee. If as a manager you suspect the presence of a disability, but if one has not been declared, do not ask the employee. Moreover, do not give an employee unsolicited advice about some possible but undeclared problem; to do so is considered “disparate treatment.”

Family and Medical Leave Act (FMLA) (1993)

Applying to employers of 50 or more employees, FMLA permits eligible employees (those having been employed for at least 1 year and having worked at least 1,250 hours during the previous 12 months) to take up to 12 weeks of unpaid leave during any 12-month period when unable to work because of a serious health condition; to care for a child upon birth, adoption, or foster care; or to care for a spouse, parent, or child with a serious health condition. Under certain circumstances, leave may be taken intermittently or on some reduced leave schedule, potentially stretching any given leave over a period longer than 12 calendar weeks. Employees who are entitled to a certain amount of paid time off are ordinarily required to use that time as part of their 12 weeks, which most employees on leave ordinarily do rather than experiencing the entire leave without pay.

While on approved leave, employees must continue to receive healthcare benefits but are not entitled to accrue vacation, sick time, or seniority. The employer must guarantee that upon returning from leave an employee will be reinstated to the previous position held or placed in a fully equivalent position with no loss of benefits.

In many instances the Family and Medical Leave Act has made life considerably more difficult for supervisors. When an employee in an essential position takes leave, that position must be covered; some positions cannot be left vacant for a few days, let alone for a 12-week period. Filling the position and later returning the employee to “an equivalent position” is not often readily accomplished; “equivalent” has repeatedly been interpreted by courts and other external agencies as essentially the same in all ways—pay, benefits, tasks, responsibilities, often even hours and shift. The strict interpretation of “equivalent” often makes the safest course of action the preservation of one’s original position, so the manager is left to juggle coverage—perhaps with temporary employees, overtime, reassignments, and other means—until the employee returns from leave. The FMLA has thus made staffing and scheduling more difficult and time-consuming for some managers.

It is likely that the FMLA, along with the ADA, will be affected by periodic adjustments and clarifications for some time to come.

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The Retirement Protection Act strengthens and accelerates funding of underfunded pension plans and increases Pension Benefit Guarantee Corporation (PBGC) premiums for plans that pose the greatest risk, improves the flow of pension-related information for workers, and increases PBGC’s authority to enforce compliance with pension obligations.

Small Business Job Protection Act (1996)

Despite the name of this Act, its provisions are not applicable to small businesses only. This legislation included the 1996 increase in the minimum wage. It also increased pension protection and made it easier for workers to roll over their retirement savings upon changing employment. It also somewhat simplified pension administration and reduced the vesting period for certain multi-employer plans from 10 years to 5 years. It also made it possible for certain smaller employers to establish simplified 401(k) plans.

Health Insurance Portability and Accountability Act (HIPAA) (1996)

When it came upon the scene in 1996, as far as most persons working in health care were concerned, HIPAA had little effect. At the time the most visible portion of HIPAA addressed “portability and accountability” in reference to employee health insurance. The intent was to enable workers to change jobs without losing coverage. This let workers move from one employer’s plan to another’s without gaps or waiting periods and without restrictions based on pre-existing conditions. A worker could move from plan to plan without interruption of coverage.

Not a great many managers in health care concerned themselves with HIPAA in 1996. Human resource managers were the ones who became most aware of this new legislation because it affected their benefit plans. However, even many HR managers had little involvement with HIPAA; in most instances the required notifications were handled by the employers’ health insurance carriers, so there was little for HR to do other than answering employee questions. At that time nothing about HIPPA affected the role of the individual non-HR manager. In the minds of many who did not look beyond the simple implications of the law’s title, the organization had little more to do than ensuring the portability of health insurance. However, the real impact of HIPAA was yet to come, and its arrival was a surprise to many.

HIPAA consists of 5 sections or “titles” each addressing different topics and different areas of responsibility:

• Title I. Healthcare Access, Portability, and Renewability.

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a) Preventing Healthcare Fraud and Abuse

b) Medical Liability Reform

c) Administrative Simplification.

· Title III. Tax-Related Health Provision.

· Title IV. Group Health Plan Requirements.

· Title V. Revenue Offsets.

The portion of HIPAA having the most far-reaching effects is Title

II. The formal name of the section is “Preventing Healthcare Fraud and Abuse, Administrative Simplification, and Medical Liability Reform,” but it is generally referred to as just “Administrative Simplification” (which for many has proven to be anything but “simple”).

Managers within health care, some to a greater or lesser extent than others, are finding or are yet to find their jobs affected by portions of HIPAA. Eleven separate “Rules” have been designated. Not all of them have yet been released for implementation, so for healthcare managers HIPAA implementation will be a continuing process for some time to come.

The controversy over the intent versus the reality of HIPAA primarily concerns the requirements of the Privacy Rule. The intent was to strike a balance between ensuring that personal health information is accessible only to those who truly need it and permitting the healthcare industry to pursue medical research and improve the overall quality of care. Essentially, patient privacy is at the center of most current interest in HIPAA.

The Patient Protection and Affordable Care Act of 2010 (PPACA)

The PPACA was signed into law on March 23, 2010 and was immediately amended by the Health Care and Education Act of 2010, which became law on March 30, 2010. The PPACA is, of course, the currently controversial “health care reform” undertaking of the Obama Administration. The law includes provisions that take effect over several years, including expanding Medicaid to cover more lower-income people, subsidizing insurance premiums for persons of a certain income level, providing incentives for businesses to provide healthcare benefits, prohibiting denial of claims or coverage because of pre-existing conditions, and other fixes aimed at expanding coverage to include greater numbers of people, controlling costs, and reducing the deficit.

The passage of the PPACA did not stem the continuing controversy over how the nation should address the widespread problems of health insurance cost and availability; if anything, controversy increased as the law came under criticism

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Some of the changes called for during the first year of enactment (2010-2011) included: insurance companies were barred from dropping people from coverage because of illness; young adults could remain on their parents’ plans until age 26; coverage was made possible for uninsured adults with pre-existing conditions; insurers were forbidden to deny cover to children with pre-existing conditions; and a number of changes affecting Medicare. Changes targeted for 2011 included: Medicare bonus payments to primary care physicians and general surgeons, and Medicare coverage of annual wellness visits as well as other changes to Medicare and Medicaid.

Additional reforms are indicated for implementation during 2012, 2013, 2014, and 2015, with some new requirements designated for as far in the future as 2018. One extremely controversial feature scheduled for implementation in 2014 is the requirement for most people to obtain health insurance coverage or pay a tax if they do not do so.

The PPACA is likely to affect most healthcare supervisors in two ways. First, the supervisor may be affected as a participant in the employer’s health insurance plan. Depending on the nature of the plan and its features, there could be changes that affect coverage for all employees including the manager. Second, the individual supervisor is likely to be asked questions by employees who want to know how the plan’s changes will affect them and what will happen to their present coverage. The supervisor will need to be knowledgeable enough to respond to general questions and to know where in Human Resources to go for more complete answers. For the most part the interpretation of the features and effects of plan reform on the organization’s health insurance plan will reside with the benefits-management function in the HR department.

FOR THE ORGANIZATION: GREATER

RESPONSIBILITY, INCREASED COST

The foregoing chronology is not complete. There are numerous state laws to contend with, as well as other federal laws that sometimes have employment implications. The closing decades of the 20th century saw government spreading its influence over an increasing number of aspects of the employment relationship. Fortunately, the proliferation of employment legislation has slowed since the turn of the 21st century. In addition to creating added work for Human Resources, many of the laws affecting employment, in designating what cannot be done or what must be done, have proscribed boundaries within which management must manage.

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Some new laws have required only minor changes in procedures or modest alterations in recordkeeping practices. However, most have clearly increased the cost of doing business because the provider organization, and eventually its customers, are the only ones available to pay. Legislators know very well that it usually costs something to implement a new law in the workplace (although the legislators and the organizations that must comply with the law are often far from agreement about how much it will actually cost). When legislators create a new program, they undoubtedly know there are but three ways available to pay for its implementation: (1) they can discontinue an existing program to free up some funds, but rarely does this happen because it is always a politically unpopular move; (2) they can raise taxes to pay for it, but suggesting to do so is even more politically unpopular; or (3) they can find someone else to pay for it. The “someone else” who has been paying to implement all these laws affecting the employment relationship is business and, eventually, the consumer.

A CUMULATIVE EFFECT

Exhibit 7-1 lists the laws discussed by decade of passage. It is not difficult to see the shift from the pre-1964 concern with collective bargaining and wage and hour issues to the growing post-1964 concern with social responsibility.

Exhibit 7–1 Employment-Related Legislation by Decade

1930s

Norris-LaGuardia Act (1932) National Labor Relations Act (1935) Social Security Act (1935)

Fair Labor Standards Act (1938)

1940s

Labor-Management Relations Act (Taft-Hartley) (1947)

1950s

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1960s

Equal Pay Act (1963)

Title VII of the Civil Rights Act (1964)

Age Discrimination in Employment Act (1967)

1970s

Occupational Safety and Health Administration (OSHA) (1970) Rehabilitation Act (1973)

Pregnancy Discrimination Act (1978)

1980s

Consolidated Omnibus Budget Reconciliation Act (COBRA) (1986) Immigration Reform and Control Act (IRCA) (1986)

Pension Protection Act (1987) Drug-Free Workplace Act (1988)

Employee Polygraph Protection Act (1988)

Worker Adjustment and Retraining Notification Act (1988)

1990s

Americans with Disabilities Act (ADA) (1990)

Older Workers Benefit Protection Act (OWBPA) (1990) Civil Rights Act of 1991

Family and Medical Leave Act (FMLA) (1993) Retirement Protection Act (1994)

Small Business Job Protection Act (1996)

Health Insurance Portability and Accountability Act (HIPAA) (1996)

2000s

The Patient Protection and Affordable Care Act (PPACA) (2010)

A simple comparison of the pre-1964 years with the present day should serve to demonstrate how significantly the employment environment has changed. Although a few of the laws replaced features of earlier legislation, most of the laws passed since 1964 have exerted new and different influences on how employers treat employees and how managers can manage their departments. The accumulation of more than 4 decades of legislation affecting the employment relationship has placed upon the average supervisor countless “rules” for managing employees.

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Q:2 What can an individual do to ensure the maximum possible employability in today’s health care environment?

Chapter 10

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A sound orientation is the institution’s best opportunity to ensure a positive employee relations climate while developing productive and knowledgeable workers.

—Martin E. Skolar

CHAPTER OBJECTIVES

· Establish the primary objectives of an employee orientation program, both organization wide and department specific.

· Highlight the general contents of the organizational orientation common to all new employees.

· Establish the means of determining the needs of a department-specific orientation program.

· Convey the importance of affording each new employee a strong, knowledgeable start on the job.

· Enumerate the specific departmental values that must be communicated to all employees early in their employment.

· Review the primary sources of information and assistance used to round out a new employee’s introduction to the department.

· Provide a means of evaluating the departmental orientation program to maintain its quality and completeness.

KEY TERMS

General Orientation: Orientation to the overall organization, ordinarily provided by human resources but sometimes by a separate education department, to expose new employees to information of importance concerning the organization and its operations.

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ORIENTATION TIMING

It should go without saying that every new employee should be brought into the organization and department in a manner that ensures each person’s comfort into what for most will be a new and perhaps potentially bewildering environment. But when should this introduction occur, or at least when should it begin? The obvious answer is “day one.” Yet in many instances a significant part of each new employee’s orientation is delayed.

In a healthcare organization of any appreciable size such as a hospital, there will ordinarily be two important orientations: general orientation, the introduction to the total organization, and departmental orientation, the introduction to the new employee’s assigned work group and job.

A small organization, for example a rural hospital of a relatively few number of beds, may not offer a general orientation but rather rely on new-employee intake in human resources or departmental orientation to cover everything. In a small organization weeks may pass with only an occasional new hire occurring. A mid-size or large institution will likely offer a formal, general orientation, but this will not occur at the ideal time; that is, it will not happen on every new employee’s first day of work. Full, general orientation may be presented but once each month, or perhaps every week or 2 in a large institution. The only control that an individual supervisor has concerning general orientation is to ensure that his or her new employees attend when they are scheduled to do so. But the individual supervisor has total control over departmental orientation and can ensure that this begins on day one—and ensure that certain information that will be provided in detail later in general orientation is summarized during the departmental orientation to the extent that the employee may need this information.

It is often a great temptation for a supervisor to allow or even encourage a new employee to skip general orientation; it is not uncommon for the supervisor to be feeling the pressure resulting from a work backlog owing to a position that has been vacant for some time. Do not give in to this temptation; the general orientation might sometimes seem like an expenditure of time that could be put to better use, but there will always be some important aspects of general orientation that do not come up in departmental orientation.

At no other time is there a better opportunity to establish open lines of communication with new hires than at new employee orientation. New employees

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· Provide a checklist to ensure that all topics in the orientation process are covered.

· Encourage employee feedback on the effectiveness of the orientation program.

TEN IMPORTANT ASSUMPTIONS

· The organization’s mission, vision, and values

· The organization’s history and structure

· Overview of the compensation and benefits structure

· Bloodborne pathogens, TB control

· Confidentiality of patient information

· Electrical safety, the Safe Medical Device Act

· Emergency preparedness, disaster plan

· Fire safety

· Hazardous communications, the Right-to-Know Law

· Risk management

· Incident reporting

· Infection control

· No-smoking policy

· Patients’ rights

· Professional misconduct

· Security

· Overview of personnel policy manual

· Employee identification tag

· Confidentiality statement

· Employee handbook review

As previously suggested, it will likely be the rare employee for whom general orientation occurs on the first day of work. Therefore, it will be necessary for the departmental orientation to cover, at least briefly, a number of general orientation items that the new employee needs to know when they first begin work.

The final item on the previous list, the employee handbook review, is extremely important. This should ideally be addressed on an employee’s first day, usually in human resources where the employee, before being turned over to the department supervisor, is given the opportunity to review the handbook and sign and submit the handbook receipt. This receipt becomes an important part of the employee’s personnel file, verifying that this handbook of policies and rules has been received.

NEEDS ASSESSMENT FOR DEPARTMENTAL

ORIENTATION

The conceptualization of a departmental program starts with an analysis of what is

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Most new employees arrive loaded with questions. Whether or not they are consciously aware of doing so, they are looking for someone to help them reach a level of comfort and familiarity with their new environment. Orientation planning is greatly improved by addressing the following questions before they are actually asked by the new hires:

· Where is my workstation? And where are the cafeteria, restrooms, and parking areas?

· What are my duties and responsibilities?

· How do I answer the telephone, obtain supplies, and operate the computer and other office equipment?

· How will I know if I am doing satisfactory work?

· Why do I have to do the things that have been assigned to me?

· Why must we do things this particular way?

· What are my starting and quitting times, when do we get breaks and how long are they, when is payday, and when does my probationary period end?

· To whom do I report? Who will answer my questions, evaluate my work, or be my friend?

PREPARATIONS FOR THE ARRIVAL OF NEW

ORIENTEES

There are many ways to prepare for the arrival of new employees:

· Send letters of welcome. Include verification of date, time, and place of reporting, and provide the first day’s agenda and any special instructions or suggestions, such as what they should bring or wear.

· Arrange your schedule so you can devote most of the first day to the newcomer(s).

· Review the orientation and training check-off lists.

· Prepare an agenda covering the first week.

· Prepare an orientation packet that includes:

1. A statement of departmental vision, mission, values, and goals

2. A department organizational chart

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4. The personnel policy and procedures manual (employee handbook)

5. Orientation and training schedules

6. Checklists and program evaluation forms

7. Performance appraisal forms

8. Probationary evaluation form (if different from appraisal form)

9. Safety, infection control, and quality assurance policies, procedures, and rules

10. Names, titles, and locations of trainers

11. Key telephone numbers or a condensed telephone directory

FIRST DAY: WELCOME WAGON

New employees usually report first to the human resources department. Get off to a good start by meeting your new people there. Greet them as you would visiting friends. Have a few well-prepared remarks and deliver them with enthusiasm. For example,

“One reason we selected each of you is that you’ve shown the kind of attitude we always look for. As you know, the major goal of your position is to meet or exceed our customers’ expectations. Our customers include patients, the patient’s families and visitors, clinicians and other care providers, third-party payers, teammates, students and trainees, and departments we serve. I know you understand the importance of customer service, and you’ll soon learn how we want you to deliver that service. You’re obviously not allergic to work or to change, and in your past jobs you showed the flexibility and innovativeness we like.”

Finally, review the agenda of the orientation program and give the new employees their orientation packets.

“NUTS AND BOLTS” TALKS

On the second day, ask the new employees how their first day went. Then establish a dialogue based on the following:

· The mission, corporate values, and goals of the organization (which they may not have been tuned in to during the organization-wide orientation or

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· Each employee’s position description and performance standards. Refer to these documents as contracts that must be honored. Describe the behavior that is rewarded and that which is unacceptable.

· Survival information: work hours, overtime rules, compensatory time, vacation and sick leave policies, assignment of lockers, and completion of personnel data.

· How performance is evaluated and reported.

· Current managerial initiatives. These may include reengineering, new quality improvement or cost-cutting strategies, employee empowerment, or self-directed team building.

· Current educational or marketing programs relating to customer service. For example, telephone courtesy, point-of-care testing, cost cutting, or improvements in quality or turnaround time.

· Other information you want them to have. This could include your personal likes and dislikes, your preferences for behavior, and whatever else you believe they should know about you and your management of the department. Obviously, they will not find such information in the formal documentation. It is better to let them know these things up front rather than having to correct them after the fact. You may want to cover:

1. How you prefer to be addressed (formally or on a first name basis)

2. That you expect innovativeness of everyone

3. That you welcome suggestions and insist on hearing about any complaints or other comments from customers (Say, “In this department we don’t kill messengers who bring bad tidings, we applaud them”)

4. Things that annoy you (for example, tardiness, abuse of sick leave, chronic lateness for meetings, untidy clothes, or expressions, such as “That’s not in my job description,” “I only work here,” or comments suggesting that customers get in the way, such as “I wish those relatives would stop making all those nuisance calls”)

· How each job has a chain-reaction effect on other staffers’ ability to do their jobs, which therefore eventually affects customers.

· The list of internal and external customers and the critical importance of customer satisfaction. Remind them how hard your unit has worked to attract customers and how important it is to keep them. Explain how poor service creates stress for all parties and how they’ll gain benefits when they treat customers properly. If true, state, “Your pay and advancement will depend on how well our customers are served.”

· Your interest in the development of their (the employees’) potential rather

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MEETING COLLEAGUES

It is recommended that you limit the number of introductions during tours of the department. Some employees do not like to be interrupted in the middle of their tasks, and their reaction or lack thereof may be misinterpreted by the orientees as signs of unfriendliness. Also, the new folks can become confused by all the faces, names, and titles when these are encountered in rapid succession. Make the introductions during break times when people are relaxed and more inclined to be amiable. Also, present newcomers at a staff meeting. Encourage them to talk about their educational and recreational interests at that time.

When you introduce someone, explain how that employee’s responsibilities or interests relate to those of the newcomer. An introduction might go like this: “Joyce, I’d like you to meet Sue Smith. Sue is in charge of our main storeroom. If you can’t find something there, see Sue.” The new employee should meet with each senior member of the staff, preferably in his or her office.

GET HELP FROM YOUR SPECIALISTS

In medium to large departments, certain staff members have special expertise or responsibilities that make them better qualified to cover certain topics. In the absence of these specialists, you are responsible for this training.

Trainer or Educational Coordinator

If you delegate training, have the new employee meet the trainer early in the orientation process. Pick trainers with care. Prerequisites include teaching ability, professional or technical expertise, sufficient time to be thorough, willingness, and loads of enthusiasm. Trainers should be aware of the qualifications and experience of the new employees so they can tailor the training to the particular needs of each individual.

Give trainees folders in which to keep their continuing education records. Most departments have requirements for the number of educational hours required for each job category. Show the trainees how to keep these records, and remind them that it is their responsibility to do so.

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Some departments have a safety coordinator who shows new hires the location and proper use of safety equipment and reviews safety policies and regulations. New people often have questions about the dangers of hepatitis, AIDS, and other infectious diseases. The safety expert can allay these fears while explaining the best way to minimize the dangers. When discussing AIDS, the expert must also warn against disclosure of confidential information.

Quality Assurance or Quality Improvement Coordinator

This person may be the chair or the recorder for the quality assurance committee. The coordinator may limit the discussion to the global aspects of the program, leaving specific quality control details for the new employee’s immediate supervisor to cover.

Mentors and Buddies

Mentors are experienced employees who willingly share their wisdom or political clout with their protégés. They are unofficial advisors, supporters, and confidants. Encourage new employees to find and to establish alliances with those individuals who go out of their way to please customers. In some departments the buddy system is used; each new arrival is assigned to an experienced employee in the same work section.

TRAINING THE NEW EMPLOYEE

The triple approach to success in customer satisfaction is train, train, train. It is no accident that much of this text is devoted to that subject. Training is especially important during and immediately after new employee orientation because new hires are most open to learning at these times. Encourage good work habits, behavior, ethics, and attitudes before bad ones develop. Assign your best people to do your training. This is a long-term investment that pays off early and continues to pay.

Training during the orientation phase must be tailored to each orientee’s needs, and those depend on his or her previous education and experience. At this juncture, list all the skills necessary to handle the job, and prepare check-off lists of tasks to be learned. Divide the individual tasks or responsibilities into those that can be learned on the job, those that must be taught formally, and those that can be self-taught. Prepare a rough timetable for achieving the training goals.

At the completion of the formal orientation or training program, solicit feedback

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Exhibit 10–1 Checklist for Evaluating the Orientation Program

Check all of the items with which you agree:

____ 11. I received much more praise than criticism. When my work had to be corrected, they always explained why.

____ 12. During the first few days I met not only my colleagues but also important people in other departments.

____ 13. I now understand how my job fits into the big picture of what our organization is all about.

____ 14. I know how the communications systems work and how to make full use of them.

____ 15. I had plenty of opportunities to ask questions and express my opinions.

____ 16. I am familiar with the salary and benefits package and how performance is evaluated.

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Think About It

One of the surest ways to stimulate unwanted turnover is to turn new employees loose with little or no departmental orientation or personal guidance in finding their places in the group. Even a skilled professional can feel abandoned, left to survive alone and unaided, in a new and possibly strange environment. Many of those who feel lost or in over their heads early in their employment simply bail out of what they see as a disappointing situation.

Questions for Review and Discussion

1. Describe how you might try to avoid information overload during a new employee’s first few days.

2. Much of the material in the chapter conveys the need to imbue the new employee with a sense of the mission, vision, and values of the organization. Why is this important?

3. Why do we need to offer a relatively formal orientation, complete with checklists of items to cover?

4. Why do we need to bother with individual orientation for a new employee who is a trained specialist hired to perform exactly the same tasks performed at a previous job?

5. Why should we be more interested in developing employee potential than in obtaining immediate output?

6. What do you see as the primary advantages of a strong new-employee orientation? Why?

7. Explain why the chapter states that new-employee orientation begins before the new employees arrive.

8. What are the primary advantages of a mentoring relationship as part of a new employee’s orientation?

9. What, if anything, is wrong with the apparently time-honored practice of letting new employees learn by trial and error and by watching others?

10. Why not simply have the department supervisors provide all of a new employee’s orientation rather than have a separate organization-wide orientation as well?

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Assume you have just been hired from outside of the organization to serve as a first-line supervisor in one of the clinical support areas (laboratory, radiology, pharmacy, etc.). Staffing in the department has been lean, with some staff positions having been open for weeks, but as luck would have it, you were able to fill both open positions during your first 2 weeks on the job.

Being new to supervision and new to this organizational environment, the Friday before the two new employees were scheduled to start work you asked a more experienced supervisor, “Is there anything special I’m supposed to do with these new employees when human resources turns them over to me on Monday?” The response was simply, “Nothing other than your standard departmental orientation.”

You asked each of your employees in turn about their departmental orientation. Their answers were consistent: There was no departmental orientation. They were simply shown their workstations and told where the cafeteria and restrooms were located.

Instructions

In written form, describe what you intend to do about (1) the two new employees who start work on Monday and (2) other new employees who join your department in the future.

Case: The Inherited Employee

Soon after she became a supervisor in the building services department, Donna Paine decided that a housekeeping aide named Sally Clark was emerging as a problem employee. An employee of about 4 months, and thus a month past the end of the probationary period, Sally was frequently idle. She seemed always to do exactly what she was supposed to do, if only at a minimally acceptable level, and then do nothing until specifically assigned to another task. Donna grew especially sensitive to the situation when she began to hear complaints from other employees about Sally not doing her share of the work.

Donna pulled the file the previous supervisor had started concerning Sally. There was very little in the file. She set up an appointment with Sally. In opening the discussion, Donna said, “I am unable to find your 3-month probationary review. Do you still have your copy?” The reply was, “What review? I never had one.”

Donna then asked, “What about your orientation checklist from when you started in the department? Still have your copy?”

“Never got one. I don’t think I had any orientation.”

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“I watched someone else—Janie, I think her name was—for a couple of hours. But Janie left that week.”

At this point Donna dropped her tentative plans to address what she considered Sally’s substandard performance. Instead, she thought she had best look into the apparent absence of a probationary review and attempt to determine why Sally had never received an orientation to the department.

Questions

1. What should Donna do about the departmental orientation that Sally had apparently never received?

2. Sally has apparently gone beyond the end of the standard probationary period without receiving a probationary evaluation. What can Donna do about this, and how might this affect Sally’s status?

REFERENCES

The deadly enemy of great performance on the front line is high turnover.

As work processes become more complex and employees assume more responsibilities, workforce stability becomes increasingly important. A reasonably stable workforce is essential to long-term organizational success. Vulnerable to the impact of the loss of experienced workers, employers must recognize the importance of personnel retention. People who remain on the job create efficiency and effectiveness by sustaining productive business relationships with customers, suppliers, and associates.

When unemployment rates are low and there is a limited pool of talent from which to draw, that is, when it is a “seller’s market” in employment, it can be difficult to attract and retain the best people. The people who resign during such a labor market are often among the top performers who are being lured away by what they perceive as greener pastures.

Relatively high unemployment, such as that experienced in this second decade of the twenty-first century, can have a somewhat stabilizing effect on some organizations’ turnover rates. Many workers are not as willing to “jump ship” when the jobs are not there to lure them away. However, unemployment rates vary by geographic area and by industry, so there are always places where workforces are more or less stable than elsewhere.

Needed: A New Paradigm of Loyalty

Corporate loyalty, that traditional bond between an organization and its employees, is rapidly becoming an obsolete concept. Formerly, the loyalty of employees was measured in terms of how long they remained with the organization. When workers leave for whatever reason, some supervisors are likely to complain about the workers’ lack of loyalty. When a reduction in force occurs, even one that is undeniably appropriate, employees voice the same complaint against their employers.

Divided loyalties abound in our increasingly complex healthcare institutions. Employees often find it easier to remain loyal to their professional specialty groups or unions than to their managers. Indeed, there is today a growing tendency for skilled technical and professional workers to feel greater loyalty to occupation than to organization. Supervisors, especially, experience a built-in divided loyalty. They are expected to serve both their superiors and their subordinates, and if they lean too far in either direction they are accused of being disloyal by one side or the other.

The first casualty of disloyalty is productivity. Sloppy work, mediocre quality, and poor customer service follow, and eventually apathy takes over. Disloyal employees lower work standards, withhold information, conceal problems, file grievances, and create ill will.

The causes behind loss of loyalty are principally those that destroy morale. Major factors relate to working conditions, compensation, and leadership skills. Other factors are job elimination, limited labor availability in some sectors, and an increasingly mobile workforce.

Almost everyone is loyal to something, be it an organization, a person, or a concept. Loyalty in the organization may range from resigned acceptance to fanatical commitment, and it is closely related to work ethic and duty, the unwritten contract that requires employees to be faithful to their professions, their employers, and their colleagues.

A New Employer–Employee Model

The new employer–employee model is based on two realities: (1) employers cannot guarantee permanent employment and (2) resigning from a job is not a sign of disloyalty.

Enlightened executives realize that workers no longer accept the passivity and humility that in the past were regarded as signs of loyalty. They now know that

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Better organizations replace the career ladders, which tend to disappear with reengineering and flattening of most organizations, with new roles, challenging assignments, and other opportunities for individual growth. They replace job security with new opportunities for their employees. Supervisors earn worker loyalty by effectively representing the interests of workers to higher management.

Supervisory Loyalty

The most important step that supervisors can take is to find a substitute for guaranteed employment. The best substitute for guaranteed employment can be described as the safety net of employability. Managers who encourage employees to learn skills and who provide the means to accomplish this reduce the spread of unemployment and increase their employees’ opportunities for more rewarding careers. Other measures for strengthening loyalty include the following:

· Be honest with employees. Tell them the truth about policies and plans that may affect their jobs.

· Make your expectations clear. Position descriptions, performance standards, orientation, and training are the essential tools for conveying expectations.

· Expect the best. Look for strengths. Either eliminate weaknesses or make them irrelevant.

· Be perceived as a supporter, defender, and facilitator rather than a judge, bottleneck, or nit-picker.

· Be consistent, fair, impartial, and trustworthy. Live up to your promises and earn your coworkers’ respect.

· Practice true participative management.

· Show that you value every employee.

Employee Loyalty

Some employees, primarily those in the older segments of the workforce, feel guilty offering anything less than absolute loyalty. A more rational approach is to accept the proposition that if employees are reliable and can be trusted and consistently meet their employment obligations, they are loyal. Loyalty is refraining from castigating one’s organization, colleagues, or boss, at least in public. Loyalty is not revealing confidential information to competitors or to the press. It is behaving ethically and morally, reducing criticism, and respecting confidences.

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Communality is important from a loyalty standpoint. This is a sense of belonging to a work group. It concerns issues of interdependence, mutual respect, and a sense of responsibility for other people. The core of loyalty is genuine caring for the well-being of the others involved in a relationship.

WHY EMPLOYEES SEEK GREENER PASTURES

Employees are often lured away by competitors who offer higher salaries or better benefits, or so it seems. What management often fails to realize is that many departing employees are not lured away by competitors but leave of their own volition because they cannot stand their supervisors or managers. Other factors driving employees away are boring work, dissatisfaction with career development, or lack of appreciation for their efforts. Many overworked employees believe they are being taken advantage of, they are forced to neglect their families because of work, or are experiencing burnout.

In today’s culture of job insecurity, employees must be looking for the skills, information, and knowledge they can take with them in case of another downsizing. Insightful organizations provide those security blankets, but many hesitate to provide development programs for fear their employees will leave with their newfound skills and credentials.

Organizations that base their retention initiatives entirely on compensation find themselves in bidding wars with competitors. The more insightful corporate leaders identify morale problems and correct them. They assess the workplace environment and make needed improvements, often based on the findings of their periodic employee morale surveys.

Because supervisors have little control over salaries, they feel absolved of accountability for the departures and identify the employer as the bad guy. Managers often are misled by what they find in letters of resignation or by the information obtained from exit interviews. It is easy to challenge the validity of exit interviews. For several obvious reasons, departing employees are reluctant to reveal the real reasons they are leaving. Instead, they simply say they have been offered better jobs elsewhere. Often, the real reason for their leaving is how they were treated by their immediate supervisors.

Few employees are assertive enough to confront their superiors. Instead, they sublimate their feelings by directing their ire at top management or at the ever-suspect “they.” When employees say they do not receive recognition, they are

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ANALYZING A RETENTION PROBLEM

To determine whether a genuine retention problem exists, collect and study information from the following sources:

· Records of actual rates of turnover, grievances, and requests for transfer

· Exit interview documentation

· Recruiters and recruitment-retention committees

· Focus groups

· Employee attitude or morale surveys

· Performance evaluations, coaching and counseling interviews

· Personal observation

Ask yourself several questions: What attracts employees to your organization? What do they like or dislike about their jobs and the workplace? Is there really a problem? If so, when did it start? Are only certain shifts or job categories affected? (Normally, turnover rates are higher for night shifts and nonexempt workers.) How bad is the problem? Is it getting better or worse? Are there manifestations that suggest a general morale problem? What has been our response to date, and how effective have these measures been?

Consider these possible causes that directly contribute to turnover:

· Lack of competitive pay, benefits, or appealing work environment

· Location of facility, parking, and other external factors

· Weak recruiting and selection processes

· Inadequate orientation and training program

· Lack of supervisory support

· Lack of opportunity for promotion, advancement, or education

· Inability to adjust to changes, as in mothers or others who have been away from the work world for some time

RETENTION INCENTIVES

Cash-Oriented Compensation Plans

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· Treating and compensating employees as professionals

· Carefully selecting benefits and rewards

· Providing a safe and comfortable workplace

· Supporting and encouraging career development

· Keeping employees advised of what is going on in their organization

· Providing flexible and equitable work schedules

· Offering mentoring programs

IDENTIFYING AND MEASURING TURNOVER

Questions continually arise as to how turnover is defined and calculated and how the resulting information is presented and interpreted. Truly defining turnover requires knowledge of what separations are included and what time period is involved.

Turnover is generally understood to be expressed as a rate, some activity per time period, usually a month or year. What does it mean if a manager reports department turnover at 6%? Without knowing the time period involved there is no way of knowing what this number means. Turnover for this group might be reasonable or not far from reasonable if it is only 6% per year, but it could be alarming if it is 6% per month because this annualizes to 72% per year. Thus any expression of turnover must be qualified with the appropriate time period. It is probably best to do so with annual or annualized rates, but a reasonable annualized figure requires at least several months of data.

A working definition of turnover should initially focus on voluntary separations, excluding individuals separated because of illness, death, or retirement. It is then necessary to consider involuntary departures, especially persons who fail to pass the probationary period or who do not meet minimum standards of job performance. Such involuntary departures, while not “quits,” suggest the possible presence of turnover-affecting problems such as lax recruiting practices, poor orientation, or weak supervision. But certain other involuntary departures, such as employees who are discharged for cause, are often considered “desirable” turnover and left out of turnover figures.

What must be measured is undesirable or controllable turnover: people who leave for other employment, those who depart for personal or unstated reasons, and employees released for failure to pass probation or failure to maintain minimum job performance.

Also to be considered is the impact of work status. Healthcare organizations,

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Although the use of FTEs provides the most accurate rendering of productive capacity turning over, it is misleading in some other respects. Recruiting and training costs are essentially the same whether an employee is full-time, part-time, or per diem, so filling an open full-time position with two part-time employees costs twice as much as filling it with a full-timer. Thus the human resources department may track some of its activities with statistics other than turnover FTEs.

It is suggested that turnover be defined in one of two ways, providing the entire organization is consistent in the use of the definition: Either FTEs or the total of full-time and part-time employees (per diems not included because they work no regularly scheduled hours).

And what about internal transfers? Should these be counted as turnover? After all, a transfer going elsewhere leaves a hole to be filled. Yet a vacancy in one department becomes a position filled in another department, and total positions in the organization remain unchanged. It can be helpful to maintain transfer statistics, but these should be kept separate and not considered part of turnover.

Overall, it may make the most sense for the organization to track turnover by FTEs to provide the best picture of the ongoing loss and replacement of productive capacity, but also to track by total scheduled employees to provide the best picture of the organization’s continuing recruiting load. Regardless, as an individual supervisor you should make it a point to know how turnover is reckoned and what departures are included in the calculation.