Category Archives: Emergency Management

Academia, Emergency Medical Services, Health Care

Financial Statements:

What to Use, When to Use It

Accounting in health care is very important in order to understand the economic health of the organization. Without understanding the financial status of the organization, directionality of growth and prosperity is certainly in question; however, with financial statements as a guide, one can make informed and logical decisions to develop a strategic plan to direct organizational growth in a fiscally responsible nature.

Ittelson (2009) and Penner (2004) outline the various financial statements and how they are used. I will review three financial statements (the balance sheet, the income statement, and the cash flow statement) and the means to use the values on these statements to provide meaning, through the use of ratio analysis, of the fiscal health of the organization.

Financial Statements

Balance Sheet

The balance sheet is one of two main organizational financial statements. Ittelson (2009) outlines the balance sheet as showing assets = liabilities + worth, in that the value of an organization’s assets (or, what an organization has) is the sum of the organization’s liabilities (or, what is owed) and worth (or, the value of the organization to the owners).

Assets are usually listed on the balance sheet in order of liquidity and include everything valuable within an organization, including cash, accounts receivable, any inventory (included at depreciated value, if applicable), expenses that were prepaid, and any other intangibles that offer intrinsic value to the organization (Ittelson, 2009; Penner, 2004).

Liabilities, according to Ittelson (2009), are listed on the balance sheet as groupings of term (short- and long-term) and include current liabilities (accounts payable, expenses, portions of contracted debt currently payable, and taxes), long-term debt (or, contracted debt payable outside of the bounds of the current statement), and shareholder equity (or, the sum of capital stock value and the amount of retained earnings). The shareholder equity is also the worth of the organization.

By definition, the balance sheet must be balanced in the end with the value of the assets being the total liabilities and equities offset by the shareholder equity. The balance sheet, with this comparison, provides the fixed financial picture of the organization at any particular date.

Income Statement

The income statement, which describes an organization’s profitability, is the other main financial statement of an organization (Ittelson, 2009). The income statement details the value of inputs and expenses required to develop a specific income for a defined period of time; however, according to Ittelson (2009), it does not provide timing on payments or an assessment of how much cash the organization has on hand.

The income statement accounts for the gross margin (net sales vs. cost of goods sold), operating expenses (e.g. sales and marketing, research and development, and general and administrative expenses), interest income, and income taxes to derive net income (Ittelson, 2009; Penner, 2004).

As the organization’s net income increases, reflections of increased assets or decreased liabilities will be seen on the balance sheet. Likewise, this link will also show the reverse to be true as decreased assets or increased liabilities (Ittelson, 2009).

Cash Flow Statement

The cash flow statement, as noted by Ittelson (2009) and Penner (2004), simply describes the movement, or flow, of cash within the organization. Starting with the amount of cash on hand at the beginning of the reporting period, the cash flow statement tracks how cash is paid and received, such as cash receipts and disbursements, purchases of fixed assets, money borrowed, stock sales, and taxes paid, ending with the amount of cash on hand at the end of the reporting period. However, this statement does not account for receiving inventory or delivering finished products to customers as these would account for non-cash transactions. Only when the organization pays for the inventory or the customer pays for the product would it affect the cash flow statement.

According to Ittelson (2009), the cash flow statement describes the velocity of cash, exclusively, within an organization, and accounts for a portion of the organization’s assets as well as some new liabilities (such as a new mortgage or loan) and old liabilities (debt being paid).

Ratio Analysis

Although the financial statements described above describe the general financial health of an organization, the relationships of particular items within those reports can provide more specific indicators of financial condition (Ittelson, 2009; Penner, 2004). The use of these relationships is called ratio analysis.

Ratio analysis can help to determine factors, such as profitability, liquidity, asset management, and leverage. Ratio analysis can also help to compare various organizations among various industries by using a statement conversion to “common size” (Ittelson, 2009, p. 194), which represents items as percentages of the largest item on each statement.

Profitability, according to Ittelson (2009), is the ability of an organization to generate a return of profit on equity, sales, and assets. The gross margin, as a percentage, is also a profitability ratio analysis.

Liquidity, as opposed to the measure of returning a profit, is a measure of an organization’s ability to maintain a financial cushion and show financial strength.

Asset management ratios are measures of the efficient or inefficient use of assets and the time generally taken from using inputs to receiving payment. According to Ittelson (2009), “asset management ratios provide a tool to investigate how effective in generating profits the [organization’s] investment in accounts receivables, inventory [sic] and fixed assets is” (p. 198).

Leverage, much like liquidity, is a safety measure that describes the organization’s ability to absorb loss and meet obligations. The leverage safety cushion is also referred by Ittleson (2009) as the “equity cushion” (p. 202). Too much leverage is risky, but too little leverage decreases the ability to maximize profit and growth. Leverage is the use of other people’s money to augment the owner’s investment in order to maximize profits.

Discussion

By using strict accounting guidelines and keeping accurate records, financial statements can be prepared that will provide insight into the financial health of an organization. These statements can help to compare the financial status of the organization at different times or to compare the organization with other organizations. Also, accurate financial statements will help to draw investors, secure lending opportunities, and comply with legal requirements.

References

Ittelson, T. R. (2009). Financial statements: A step-by-step guide to understanding and creating financial reports (Revised and expanded ed.). Pompton Plains, NJ: Career Press.

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

Emergency Medical Services, Politics

Political and Technical Budget Strategies

When preparing an agency or department budget, two strategies may be employed, usually in combination: political budgeting and technical budgeting (Menifield, 2009). While most budgets are defended politically, the technical budgeting stategy is most useful when defending mandatory and base expenditures of a legally mandated service, such as a police or fire department (Menifield, 2009). New programs, especially those viewed largely as ancillary, or “nice to have,” would be largely defended using a more polital than technical strategy.

Menifield (2009) explains the technical budgeting strategy as “[concentrating] on the numbers or budgetary facts [and] split into two categories: mandatory, [sic] and discretionary spending” (p. 43) with base expenditures “to maintain the same level of service” (p. 44) identified for each. Efficiency and productivity are foci of the technical budgeting strategy. The political budgeting strategy, according to Menifield (2009), is used to “sell” a program based more on its merits or public demand than on mandate or efficiency and productivity.

In the emergency medical services, since its provision is usually not a legal requirement of the government, it would make sense to defend the budget politically if the service was started within the last few years; however, a more technical budget in continuing years might help to buttress the perceptions of the public that it is actually a needed service. Continuing to defend an emergency medical services budget with a more political strategy could make it actually appear less important and subject to tighter budget controls. Additionally, as the emergency medical service is the only public safety entity that routinely charges user fees, the structure of a technical budget would plainly show revenue offsetting expenditures, making it less likely to suffer cuts. Again, both strategies would be used proportionally to their need.

References

Menifield, C. E. (2009). The basics of public budgeting and financial management: A handbook for academics and practitioners. Lanham, MD: University Press of America.

Academia, Culture, Health Care, Society

Human Resource Challenges

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

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

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

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

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

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

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

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

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

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

References

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

Academia, Culture, Emergency Medical Services

Establishing S.M.A.R.T. Goals

“Employees learn better when they actually become involved in the process” (Fallon & MCConnell, 2007, p. 192), so what better way to grow than to define the process?!

Meyer (2006) outlines a methodology, referred to as S.M.A.R.T., of developing goals and a plan to attain them. The S.M.A.R.T. goal methodology that Meyer describes is reflected in the acronym of the name: specific, measurable, attainable, realistic, and time-bound. However, as Rubin (2002) points out, the acronym is dynamic and variable to include any number of variations: simple, specific, sensible, significant; meaningful, motivating; acceptable, achievable, action-oriented, accountable, agreed, actionable, assignable; realistic, reviewable, relative, rewarding, reasonable, results-oriented, relevant; timelines, time-frame, time-stamped, tangible, timely, time-based, time-specific, time-sensitive, timed, time-scaled, time-constrained, time-phased, time-limited, time-driven, time-related, time-line, toward what you want, and truthful. Even more dynamic, as Rubin points out, some add “efficacy” and “rewarding” making S.M.A.R.T. goals S.M.A.R.T.E.R. goals!

Regardless, however, of the actual mnemonic, the methodology represents the continuum of goal-analysis, goal-setting, and goal-attainment in a systematic manner that is tangible and results-oriented. The philosophy remains true and valid.

Setting a Goal

In the past, one of my goals was to obtain a college degree. I knew that I was intelligent and should have no problem, otherwise, attaining this goal, but life always seemed to place obstacles in my path. One day, not so long ago and with chiding from my father, I decided to put a date to this goal: December, 2012. I was lacking this one important motivational step for so long, but because I finally made my goal time-sensitive, I was finally able to measure my progress in a specific manner. I feel that because I developed a realistic time-line to attain this goal, I will obtain my bachelors degree this year.

Now that I am close to completing one goal, it makes sense to reflect and determine my next set of goals, but how can I apply the S.M.A.R.T. methodology of setting one? Reviewing Meyer (2006) and Rubin (2002), I find that, first, I need to conceptually understand that goals should be simple and realistic. Next, my goal needs to somehow be constrained by time so that it is measurable and my progress is quantifiable. Further, my goal, itself, needs to be motivating and rewarding.

My goal cannot be something as simple as make more money or be a better person. These goals are broader, I feel, than the methodology is designed for. However, breaking one of these goals down to measurable steps seems to be preferred. Instead of make more money, a more specific goal might be to earn a six-figure income by a set date.

Specificity

According to Meyer (2006), the first question is if this goal is specific. Yes. If I continue to earn any less than $100,000 in a single year, I have not met my goal.

Measurable

The next question: Is it measurable? For the same reasons that it is specific, it is measurable. Additionally, my progress is measurable by the year-to-date column of my paycheck, which should increase towards my ultimate goal amount.

Attainable

Is this goal attainable? As I take stock of my current income and skill set with the addition of my bachelors degree and other certifications and licenses, I do feel that a six-figure income is attainable.

Realistic

In order to be a realistic goal, others in my profession must have attained this goal, or I must be willing to change professions. I am hard-pressed to leave the emergency medical services, and there are a number of positions available within the emergency medical services that earn six-figures. These positions are mostly administrative in nature, but I feel that I have the experience to start considering these positions as realistic.

Time-bound

Setting a time-frame for completion of my last major goal underscores the importance of this step, but it is my weakness, and I acknowledge that. However, as I expect to obtain my bachelors degree later this year, realistically, I would have to give myself another year or two to find a position for which I could apply. I would, then, need another year in order to actually earn the income. The 2015 tax year seems appropriate, though unrealistic, perhaps. Still, I will set this time-line and reconsider each objective of my goal as 2015 draws closer.

Discussion

Setting a goal is a difficult task. It is sometimes difficult to look to the future, and often times, we are haunted by our failings in the past. Using a methodology, such as S.M.A.R.T., can help us to reflect on realistic and meaningful goals that can ultimately help us work toward the more obscure long-term goals, like being affluent or saving the world.

References

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

Meyer, P. J. (2006). Attitude is everything. Retrieved from http://www.oma.ku.edu/soar/ smartgoals.pdf

Rubin, R. S. (2002). Will the real SMART goals please stand up? The Industrial-Organizational Psychologist, 39(4), 26-27.

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

Burnout: “What a Star—What a Jerk”

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

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

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

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

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

References

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

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

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

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

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

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

Footnotes

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

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

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

Employee Retention

I am familiar with a local EMS organization where the perception of the employee-base is that middle management sacrifices requisite supplies in order to regain budget losses, losses that were incurred due to their overall mismanagement. Sacrificing supplies in the emergency medical service arena equates to negligence and could, indeed, prove harmful to patients. This, coupled with the notion of incompetence, has a negative effect on morale, especially as this is one of the only divisions within the larger company that experiences these types of problems. Many have considered leaving (in fact, I have been told that most consider it quite often); however, the compensation package that they receive cannot be met by any other provider in the area. This leaves the employee in an ethical quandary. This issue is not isolated to this particular company, though. Although many private ambulance companies in the region face the same mismanagement, they do not offer comparable compensation packages and are much easier to leave.

Fallon and McConnell (2007) discuss how pay and benefits are vitally linked to overall job satisfaction, and I agree with their determination. However, there are other components, such as conscience. Duffy (2010) explains, in the light of pharmacists refusing to dispense abortion pills as a right of conscience, how “medical professions are among those where ethics and morality are of paramount concern” (p. 509). Consider Duffy’s explanation in reverse as this particular company is forcing their employees not to care for patients who they would otherwise be able to treat. The result is a significant emotional and psychological toll, I can imagine, but the employees cannot just walk away from their paycheck. This company, I feel, has learned to balance some of the positive working conditions with some of the negative working conditions, and the company relies heavily on wages and benefits to do so. According to Fallon and McConnell (2007), this tactic helps to relieve employee turnover rates; however, if the company would mitigate the negative aspects of the job, the wages and benefits offered could be used to attract employees with higher skill levels. Instead of leveraging ambition and affecting positive psychology within the workforce, as Amabile and Kramer (2011) recommend, the typical leverage is financial at a cost of ambition and morale.

In contrast, I have worked for agencies that paid far less in compensation than their competition, but the appreciation on the part of management was evident and allowed me to overlook the compensation gap with the other companies where the employees were always complaining and just seemed unhappy. Unfortunately, the gap grew to a point that was unbearable and I had to ultimately leave, but it was quite a while before I found another agency that commended professional evolution and progress, such as described by Amabile and Kramer (2011) — the company discussed above, however, is not.

Amabile and Kramer (2011) describe the withholding of resources to be a “toxin” that negatively effects morale. By improving supply requisition, a “catalyst” to improve morale, and improving recognition and supporting a free exchange of ideas, this company could improve morale significantly and focus on hiring skilled and experienced providers rather than those that will merely acquiesce to their ambiguous demands.

References

Amabile, T. M. & Kramer, S. J. (2011). The power of small wins. Harvard Business Review, 89(5), 70-80.

Duffy, M. E. (2010). Good medicine: Why pharmacists should be prescribed a right of conscience. Valparaiso University Law Review, 44(2), 509-564.

Fallon, L. F. & McConnell, C. R. (2007). Compensation and benefits. In Human resource management in health care: principles and practice (pp. 201-218). Sudbury, MA: Jones & Bartlett.

Academia, Culture, Emergency Medical Services, Health Care

Hiring by Organizational Fit

The Prevailing Organizational Culture

Recruiting new employees involves being mindful to the predominant organizational culture and how the applicant will relate and interact with the current employees (Cable & Judge, 1997; Fallon & McConnell, 2007). For instance, in a highly team-structured, or cooperative, environment, a highly competitive applicant may find difficulty in overall acceptance by the team, and both the applicant’s job performance and that of the team may suffer (Chatman, 1989). However, when the organizational values match that of the applicant’s, then a prediction can be made that job satisfaction and organizational commitment will be higher (Cable & Judge, 1997; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999).

This paper will discuss organizational culture and the benefits and drawbacks of recruiting processes focused on maintaining or altering the status quo.

Recruiting Organizational Culture

The term organizational culture has been used since the early 1980’s to capture the perceptions, values, behavioral norms, and expectations inherent in an organization (Vandenberghe, 1999). This culture could be a result of certain pressure from the leadership or a natural environmental attainment; however, hiring practices certainly have an impact on the organizational culture by adding the influences of new personalities into the culture (Cable & Judge, 1997; Chatman, 1989; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999). Recruiters and managers, by hiring based on organizational fit, are able to exert influence over the direction of the organizational culture as well as help to limit turnover and attrition (Cable & Judge, 1997; Chatman, 1989; Christensen & Wright, 2011; Tsai, Chi, & Huang, 2011; Vandenberghe, 1999).

One problem surrounding the use of organizational fit is the propensity of applicants to utilize influence tactics to alter the perceptions of the interviewer (Higgins & Judge, 2004). As Fallon and McConnell (2007) discuss, an inexperienced interviewer could be overly influenced by an applicant. “No one has yet devised a reliable way to separate the applicants who simply talk a good job from those who will later do a good job” (Fallon & McConnell, 2007, p. 179). A very charismatic applicant might benefit over a more qualified applicant.

The benefits, however, of considering organizational fit and value congruency between applicants and the organization are best appreciated after job fit, or the consideration of qualifications and experience, is determined. In a hiring process where applicant qualifications and experiences have already been vetted and references already checked, organizational fit can be used to further the success of both the organization and the applicant (Christensen & Wright, 2011; Tsai, Chi, & Huang, 2011).

Another benefit considering organizational fit is public service motivation. Christensen and Wright (2011) explore the relationship between applicants who have strong motivations towards public service and organizations, whether public or private, that share that motivation. Christensen and Wright show a result of increased job satisfaction when public service motivations are congruent between applicant and organization; however, this link appears fairly weak when compared to financial incentives.

Relying on Résumés and Portfolios

While most assessments of organizational fit are made in the interview environment, résumé contents offer useful information. Although Higgins and Judge (2004) regarded self-promotion tactics (résumés and portfolios) as “weak and nonsignificant” (p. 630), ergo, less powerful than personal influence tactics, Tsai, Chi, and Huang (2011) later show that specific pertinent résumé content improved perceptions of employability: “to select applicants with suitable attributes, recruiters would refer to specific résumé content as the basis for making inferences about applicants’ values or personality” (p. 236). Work experience and extracurricular activities, according to Tsai, Chi, and Huang, provide the most insight into an applicant’s values and personality, which would influence organizational fit.

One drawback to relying on a document, such as a résumé or a portfolio, to provide insight into an applicant’s values or personality is that often these documents are prepared by a third party whose personality and values might influence the choice of content, thereby influencing the reader.

Legal and Regulatory Implications

Fallon and McConnell (2007) readily discuss the legal requirements and implications of the hiring process and making judgments of the applicant that are not directly related to the job; however, if intangible traits can be related to improved job performance, it is recommended to probe for these after ensuring adequate qualification and experience. In order to show that these intangible traits (e.g. innovation, team orientation, stability, attention to detail) are relevant, the job description could be altered in effect to demonstrate this and limit legal implications of a subjective hiring process. Certain prohibitions will still stand, such as disability, race, color, creed, religion, et al.

Discussion

By understanding the culture of their organization, managers and recruiters can, to a degree, help to shift the cultural paradigm by choosing applicants who share similar values and beliefs that would be believed to enhance the culture of the organization. Although each job requires an applicant with the requisite knowledge, skills, and abilities to perform the job, certain intangibles, including congruence with the prevailing organizational culture, will help to ensure a healthy and lasting employment relationship.

References

Cable, D. M. & Judge, T. A. (1997). Interviewers’ perceptions of person – Organization fit and organizational selection decisions. Journal of Applied Psychology, 82(4), 546-561. doi:10.1037/0021-9010.82.4.546

Chatman, J. A. (1989). Improving interactional organizational research: a model of person-organization fit. Academy of Management Review, 14(3), 333-349. doi:10.5465/AMR.1989.4279063

Christensen, R. K. & Wright, B. E. (2011). The effects of public service motivation on job choice decisions: Exploring the contributions of person-organization fit and person-job fit. Applied Psychology: An International Review, 60(2), 231–254. doi:10.1111/j.1464-0597.2010.00434.x

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

Higgins, C. A. & Judge, T. A. (2004). The effect of applicant influence tactics on recruiter perceptions of fit and hiring recommendations: a field study. Journal of Applied Psychology, 89(4), 622-632. doi:10.1037/0021-9010.89.4.622

Tsai, W., Chi, N., & Huang, T. (2011). The effects of applicant résumé contents on recruiters’ hiring recommendations: The mediating roles of recruiter fit perceptions. Applied Psychology: An International Review, 60(2), 231–254. doi:10.1111/j.1464-0597.2010.00434.x

Vandenberghe, C. (1999). Organizational culture, person-culture fit, and turnover: a replication in the health care industry. Journal of Organizational Behavior, 20(2), 175-184. doi:10.1002/(SICI)1099-1379(199903)20:2<175::AID-JOB882>3.0.CO;2-E

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

The Hiring Process & Social Media

Social media has blossomed in the past few years beyond what many could have imagined. Today, it seems that many people engage others on the internet and social media without regard to their own personal privacy. Additionally, according to Jones and Behling (2010), privacy settings within social media applications tend to be complex, which inhibits their effective use by privacy-minded users. The result is an open and rich source of personal data, the problem of which is context.

I view social media as personal advertising where, unless specifically stated in the terms of service, the information posted by others is considered to have entered the public domain; others may view social media in the light of property rights where, although many people might not lock their front door, the invitation to invade the space is not assumed (Rosen, 2009). Regardless of personal views, information seekers need to be mindful of three things: 1) the terms of service for using the application resources, 2) the privacy policy in effect for using the application resources, and 3) the context of entries and the audience each entry is meant to reach (Jones & Behling, 2010; Rosen, 2009). Considering that the personal data made available on social media applications is not typical of allowable employment interview scenarios, employers need to be mindful that searching out this information may lead to unethical and illegal hiring practices (Fallon & McConnell, 2007; Jones & Behling, 2010; Rosen, 2009). Still, employers use social media to further vet applicants (Jones & Behling, 2010). Another consideration along similar lines is the use of generic web-based searches that could uncover similar information (Rosen, 2009).

In the case study provided by Coutu (2007), Virginia performed an internet search on Mimi and know suffers the problem that one cannot unknow knowledge. Additionally, Virginia know feels ethically compelled to share this information with Fred, the CEO. While this information would not be pertinent in the hiring process of a line employee, staff employees require more scrutiny, especially those that are being vetted for significant leadership positions. Rosen (2009) states, “employers do have broader discretion if such behavior would damage a company, hurt business interests, or be inconsistent with business needs” (para. 15). With this in mind, I tend to consider the paradigm of privacy practices when confronted with public officials and celebrities. A public head of a company or division might not have the same expectations of privacy afforded to a typical job applicant, but this would be a question for lawyers, as Mimi alludes to in the case study.

Basing the decision to investigate Mimi via Google on the general welfare of the organization, I would recommend allowing Mimi to defend her position in order to minimize bias and assumption. Two questions could be asked of Mimi that may allow her to mitigate concerns stemming from the search: 1) Regardless of any past pretenses, do you feel that you can represent this company appropriately if faced with issues regarding international politics? 2) Do you have any concerns about operating effectively within a political environment, such as China? Asking these questions, however, assume that the legal ramifications have been assessed and that they have been deemed appropriate for these particular circumstances. Ultimately, however, the decision lies with Fred to formulate a team that he feels can further the goals of the organization. He may consider the search results inconsequential and hire Mimi regardless of these findings, which would also be appropriate.

References

Coutu, D. (2007). We Googled you. Harvard Business Review, 85(6), 37-41.

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

Jones, C. & Behling, S. (2010). Uncharted waters: Using social networks in hiring decisions. Issues in Information Systems, 11(1), 589-595.

Rosen, L. (2009, September 15). Caution! – Using search engines, MySpace or Facebook for hiring decisions may be hazardous to your business. Retrieved from http://www.esrcheck.com/articles/Caution-Using-Search-Engines-MySpace-or-Facebook-for-Hiring-Decisions-May-Be-Hazardous-to-Your-Business.php

Academia, Emergency Medical Services, Health Care

Job Analysis: Analyzing Position Descriptions

Every organization is formed with a purpose in mind, the vision. In order to achieve this purpose, positions within the organization must work toward attaining certain goals furthering the larger organizational vision, the mission. Those who administer these organizations must catalog and organize the requisite roles, tasks, duties, and responsibilities required to achieve the goals and vision of the organization. This process is called job analysis and results in position descriptions for each job required to facilitate the mission of the organization (Fallon & McConnell, 2007). Position descriptions serve as a framework to codify the chain of command, roles and responsibilities, and functional lists of duties to be performed (Fallon & McConnell, 2007). Position descriptions also help to determine the value and compensation requirements of each position (Fallon & McConnell, 2007).

Unfortunately, as Fallon and McConnell (2007) discuss, many organizations fail to create adequate position descriptions, putting the organizations at risk of possible litigation, or less severe, employee confusion and ultimate inefficient operations.

Taxonomy of a Position Description

Fallon and McConnell (2007) write adamantly that “job descriptions have a regular format, style, and language” (p. 119) and are a result of a vigorous job analyses. Fallon and McConnell outline the components of a valid position description: job title, FLSA status, a summary of duties, compensation (salary range), knowledge required to perform the job, particular skills required to perform the job, the level of physical, psychological, and emotional effort usually required to perform the job, responsibilities inherent in the position, typical working conditions, and other general statements describing the position. Position descriptions using this format and with a certain level of detail can also be helpful in evaluating employees already in the position.

Using this format, I will compare two similar health care position descriptions (Northwest EMS, 2007; U. S. Office of Personnel Management, 2012) and discuss their similarities and differences.

Comparing and Contrasting Position Descriptions

Northwest EMS: Paramedic

Northwest EMS, located in Tomball, Texas, is the municipal provider of emergency medical services. Either city or departmental human resources would have directed the analysis required to formulate the position description.

Strengths. This paramedic position description (Northwest EMS, 2007) clearly follows a similar outline as recommended by Fallon and McConnell (2007). Further, as this position requires particular licenses, certifications, and other qualifications, these are enumerated distinctly as minimum qualifications for the position.

The biggest strength of this position description, however, is the section which details very particular job requirements, both physical and non-physical, as they relate to the Americans with Disabilities Act.

Weaknesses. This position description does not provide a salary range for the position. Although this could be a result of the document lying in the public domain and quickly becoming outdated, a salary range should be communicated openly for applicants to consider. This would benefit both the organization and the applicant, ensuring recruitment resources are expended only on applicants with a continued interest in the position.

National Park Service: Paramedic

This position is within the National Park Service at Yellowstone National Park. The position description would have been developed through position analysis by the U. S. Office of Personnel Management at the direction of the National Park Service.

Strengths. This paramedic position (U. S. Office of Personnel Management, 2012) also follows a similar outline as recommended by Fallon and McConnell (2007) and also provides that certain licenses, certifications, and other qualifications are required; however, as this is a federal position governed by separate and particular rules, there are particular components within the position description that are unique to federal government job postings.

One strength of this position description that notably differs with the Northwest EMS description is the inclusion of the salary range.

Weaknesses. No FLSA status is noted within the position description, but the FLSA might not apply to this federal position.

Discussion

In analyzing similar position descriptions within municipal and federal organizations, there will be particular differences guided by the requisite employment rules and legislation for each; however, there are certain universal requirements for adequately describing the duties and responsibilities of each position, and it seems that both the Northwest EMS (2007) and National Park Service (U. S. Office of Personnel Management, 2012) position descriptions are, indeed, adequate representations of each paramedic job.

References

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

Northwest EMS. (2007). Paramedic job description. Retrieved from http://www.nwems.org/ employment_Paramedic.pdf

U. S. Office of Personnel Management. (2012). Health technician (paramedic). Retrieved from http://www.usajobs.gov/GetJob/ViewDetails/307171500

Academia, Culture, Health Care

Human Resource Management, Part 2

“Didn’t Cut It? Hire Another”

Human resource management (HRM), especially when considering employment contracts, is heavily reliant on the understanding of the laws and regulations governing the jurisdiction of practice, whether these laws and regulations are local, state, or federally mandated. Fallon and McConnell (2007) demonstrate that “many laws and other legal requirements exert considerable influence on the employment process …. [and,] managers must [also] be aware of many aspects and nuances of HR law….” (p. 127). Kathy Gray’s difficulty, as described in the Fallon and McConnell chapter seven case study, arises from a culture within the organization that does not appear to respect the utility of HRM as both necessary and effective for the business. In the scenario, Kathy Gray is tasked with hiring a clerk for an open position; however, as soon as she makes her determination of the candidates, Sam Weston undermines the authority bestowed upon her and hires the lesser qualified of the two applicants. This would be difficult for anyone in a similar situation.

There are a number of problems that could stem from this scenario. First, by hiring the less qualified candidate, the business will utilize resources in training the chosen candidate only to seek out a replacement before recouping the expenses related to hiring and training the individual. O’Brien (2010) describes “the process of recruiting, selecting, hiring, and retaining employees [to be] difficult and costly” (p. 113). It would seem obvious that the chosen candidate should be the most qualified to save both cost and effort. Second, by Sam Weston undermining Kathy Gray’s authority, he has made her less effective as a leader. Kathy Gray was hired as a business manager and must earn the respect of those within the organization that she leads. By undermining her hiring authority, Sam Weston creates the perception that she is not prepared in her role as a manager. Fallon and McConnell (2007) posit that Sam Weston should have merely prepared himself to be a resource for Kathy Gray had she met difficulty in carrying out her newfound responsibilities. I have to agree as this would have allowed Kathy Gray to develop confidence in her new role, and a clear message would be sent throughout the organization regarding Kathy Gray’s authority in matters pertaining to her office. Although Sam Weston did choose an inept candidate, I do not see any reason why Kathy Gray cannot terminate the employment of her subordinate herself, as is the organizational norm. That being stated, there are better methods of dealing with employment matters than ad hoc hiring and firing of personnel by managers (Fallon & McConnell, 2007; O’Brien, 2010).

Fallon and McConnell (2007) and O’Brien (2010) both agree that HRM is a systematic approach to employment matters with ethical and legal considerations and implications. Meadows Nursing Home, the organization discussed in Fallon and McConnell’s case study, would do well to employ a human resources specialist (if not a human resources department) to handle the vetting of applicants, from within the organization as well as without. By developing a working partnership with the human resource team, managers can be assured that chosen applicants have met the minimum requirements for job performance, that job descriptions are accurate and detailed, and that, in the event an employee must be separated from employment, it will be handled in a professional, legal, and proper manner.

Finally, consideration should always be given to applicants within the organization before looking outward to fill vacancies. Employing from within demonstrates to the current staff a culture and willingness to cultivate talent and allow professional growth as a reward for loyalty. Also, current staff are already familiar with the business processes that an outsider may find atypical, and this would lead to short assimilation time; however, the organization runs the risk of “organizational in-breeding” if not enough outside influence is achieved (Eisenberg & Wells, 2000). With this in mind, promotions from within should be the norm unless considering vacant management positions, which should be advertised both within and outside of the organization in order to ensure competition among the candidates.

References

Eisenberg, T. & Wells, M. T. (2000). Inbreeding in law school hiring: Assessing the performance of faculty hired from within. Journal of Legal Studies, 29(S1), 369-388. doi:10.1086/468077

Fallon, L. F. & McConnell, C. R. (2007). Department managers and the recruiting process. In Human resource management in health care: principles and practice (pp. 125-145). Sudbury, MA: Jones and Bartlett.

O’Brien, J. A. (2010). Recruit and hire the best fit for your practice. The Journal of Medical Practice Management, 26(2), 113–118.