Category Archives: Health Care

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.

Academia, Culture, Health Care

Human Resource Management

Mrs. Jackson’s Dilemma

In the dilemma of Mrs. Clara Jackson, as presented by Fallon and McConnell (2007), the emergence of health care professions created a vacuum of administrative roles that, until this time, were haphazardly fulfilled by senior clinical staff. Mrs. Jackson, professionally torn between clinical and adminstrative roles, understood that one would suffer for the attention spent on the other. As this realization set in, Mrs. Jackson allowed non-clinical supervisors to hire employees; however, this tended to decentralize the function of personnel management. This ad hoc methodology would eventually prove detrimental as regulations and legal requirements become standard. Mrs. Jackson could enlist an assistant to help with these administartive roles, but an unprepared assistant would prove as detrimental as the decentralized process previously discussed.

Caldwell, Troung, Linh, and Tuan (2011) show that “reframing an organization’s internal environment [by implementing strategic human resource functions] results in significantly higher organizational outcomes and financial performance that is superior to what firms can attain by implementing individual human resource program elements piecemeal” (p. 172); therefore, reorganizing and restructuring the processes used to handle these administrative personnel issues would benefit the hospital better than the ad hoc use of senior clinical personnel, such as Mrs. Jackson (Fallon & McConnell, 2007), especially with workforce legislation circa 1930 (e.g. workmen’s compensation, Social Security, collective bargaining).

These issues, requiring a sense of increasing specialization and knowledge, helped to form the field of human resource management (HRM) as we understand it today. HRM strives to use a form of “ethical stewardship[,] … a philosophy of leadership and governance that optimizes long-term wealth creation and that honors duties owed to all stakeholders” (Caldwell, Troung, Linh, & Tuan, 2011, 178), to “help their organizations add value to the lives of individuals and organizations” (Caldwell, Troung, Linh, & Tuan, 2011, p. 177). This philosophy helps to gain “commitment from employees which is the key to long-term wealth creation” (Caldwell, Troung, Linh, & Tuan, 2011, 178). Using this philosophy of ethical stewardship, HRM managers would have enlisted the help of Mrs. Jackson to formulate a list of requisite knowledge, skills, and abilities (KSAs) needed to perform each clinical job and hire nurses based on these, while meeting the requirements of employment law and regulation, so as to free Mrs. Jackson to perform her senior clinical role unimpeded.

References

Caldwell, C., Truong, D. X., Linh, P. T., & Tuan, A. (2011). Strategic human resource management as ethical stewardship. Journal of Business Ethics, 98(1), 171–182. doi:10.1007/s10551-010-0541-y

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

Academia, Health Care

Marketing Plans in Health Care

Health care marketing is interesting when considering military treatment facilities. Naval Hospital Pensacola, according to Ludvigsen and Carroll (2003), is limited in the scope and manner that administrators are allowed to use federal monies to fund marketing efforts. Since budget cuts forced many military installations to close, and with them the attached military treatment facilities, efforts have been made, through programs like Tricare, to redirect the military health care market to the civilian care providers; however, hospitals that remain in operation, such as Naval Hospital Pensacola, have found that their market share has decreased sharply over time.

Naval Hospital Pensacola developed a marketing plan in 2003 to address the 5,000 enrollment opportunities that were left vacant due to military restructuring and Tricare development.

About Naval Hospital Pensacola

Naval Hospital Pensacola, a 60 bed facility, is the second oldest Naval hospital. The services provided by Naval Hospital Pensacola are primarily primary care, but the facility also has five operating suites and also provides urology, orthopedics, obstetrics and gynecology, among other services and operates with a budget of $64.5-million (Ludvigsen & Carroll, 2003). Naval Hospital Pensacola’s pharmacy is said to be the fourth busiest in the Navy, according to Ludvigsen and Carroll (2003).

Marketing Naval Hospital Pensacola

Purpose

In order to analyze the potential for additional capacity, Naval Hospital Pensacola formed a committee whose recommendation was that an additional 5,000 enrollee capacity was possible. The hospital, at the time of the plan formulation, served approximately 19,000 enrollees. The Managed Care Department of Naval Hospital Pensacola then developed this marketing plan to answer the recommendations of the capacity committee. Additionally, “the hospital implemented a policy which requires TRICARE Prime enrollees moving within [Naval Hospital Pensacola’s] catchment area of 40 miles, to use [Naval Hospital Pensacola]” (Ludvigsen & Carroll, 2003, p. 1). This policy ensured that certain Tricare recipients must utilize services provided by the naval hospital and dissuaded them from using civilian services that other Tricare recipients were allowed to use. This policy, according to Ludvigsen and Carroll (2003), provided additional access to approximately 10,000 Tricare Prime recipients residing within the 40-mile catchment area of Naval Hospital Pensacola.

SWOT Analysis

The marketing plan (Ludvigsen & Carroll, 2003) provided internal and external analyses that showed staffing was adequate for the proposed growth and, unlike the civilian sector, the funding would be made available based on use as Naval Hospital Pensacola is a military treatment facility whose budget relies on enrollment and not on cost-savings. “Because [Naval Hospital Pensacola] derives its funds via Federal appropriations, [Naval Hospital Pensacola’s] administration does not experience the financial pressures that civilian counterparts face, and can focus on quality issues” (Ludvigsen & Carroll, 2003, p. 7). Additionally, Naval Hospital Pensacola relies on the concept of one-stop shopping for enrollee health care needs as a marketing strength.

However, the SWOT analysis detailed within Ludvigsen and Carroll’s (2003) marketing plan admits that the naval hospital suffers access of care issues as a main vulnerability. This, coupled with a broken promise image, allows three other area hospitals to fulfill this marketing void. “Effectively competing requires improving quality of care, creating access, improving facilities, providing amenities, and promoting these accomplishments” (p. 9). Examples of Federal legislation are provided to show the marketing disadvantages of military treatment facilities.

Objectives

The primary objective of the marketing plan (Ludvigsen & Carrol, 2003) is to increase enrollment by 5,000 Tricare Prime recipients, mainly within the internal medicine, family practice, and pediatric clinics. In order to be viewed as successful, the minimum additional enrollment must be 2,000 over the next two years, again targeting 5,000 additional enrollees.

Methods

The marketing plan (Ludvigsen & Carroll, 2003) of Naval Hospital Pensacola utilizes a combination of three models in order to focus the hospital efforts. The first model is the traditional marketing mix model detailed by four components: product, placement, pricing, and promotion. The second model, based on the hospital’s own consumer marketing studies, include four components, “the Four C’s” (p. 21): competence, convenience, communication, and compassion. The final model, based on the Institute of Medicine’s (2001) health care improvement aims and objectives, includes safety, efficacy, patient-centricity, timeliness, efficiency, and equity.

Using a matrix to match the qualities of each of the three models, criteria were developed to further synthesize the goals of the hospital, its marketing theory, and the expectations of the targeted health care consumers. Representation of this combined modeling, however, starts to confound the reader by unnecessary references to concepts of quantum physics. The model is concisely represented by three dimensional representation with patient-focus in the middle of a pyramid formed between product, access, efficiency, and promotion.

Discussion

Being a military treatment facility and being highly governed by Federal legislation, Naval Hospital Pensacola is not a typical health care organization. In order to market improved or underutilized services, the hospital requires a novel approach, which is outlined within the marketing plan of Ludvigsen and Carroll (2003).

Naval Hospital Pensacola does well to focus, first, on the strengths and weaknesses identified by internal and external analyses, then, developing a plan that exploits the strengths to develop a means of overcoming the identified weaknesses. By focusing on industry-accepted aims and objectives, Naval Hospital Pensacola demonstrates improvement in measurable areas to attract additional enrollment. It is important to note, however, that, being a military treatment facility, the hospital enjoys a rare advantage of being able to pass rules mandating enrollment of certain beneficiaries within the prescribed catchment area.

The plan is an effective means of overcoming certain identified obstacles. It is realistic, allowing for fail-soft situations (or, minimal standard improvement), and comprehensive plan that addresses a true marketing need for both the hospital and the target health care consumer.

References

Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press.

Ludvigsen, S. M. & Carroll, W. D. (2003). Naval Hospital Pensacola marketing plan. Retrieved from http://www.tricare.mil/familycare/downloads/marketing_plan.pdf

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

Measuring EMS: Patient Satisfaction

As a paramedic, I become discouraged when so-called academic literature, like that of McLean, Maio, Spaite, and Garrison (2002), Spaite (1993), and Stiell et al. (2008), turns up describing what little impact the emergency medical services, especially advanced life support procedures, have on patients. Instead of dismissing these writings, I tend to focus within the view of my own practice and experience on how I feel that I impact the patients that I see. This exercise allows me to confront the literature in a specific and meaningful manner that might be used in the future to publish a dissenting view. This discussion gives me a lens through which to dissect the import I feel that the emergency medical services has as a public safety entity.

Public safety is typically viewed as the amalgamation of police, fire, and emergency medical services. In all three, the public seems to have the idea that we stop threats before they take hold; however, we typically respond to the aftermath, the police to investigate crimes that have already occurred, the fire department to conflagrations that have already caused damage, and emergency medical services to traumatic incidents or medical conditions that have already caused distress. There are exceptions. The police have learned to integrate crime prevention techniques, the fire department has learned to adopt a fire prevention model of service, and the emergency medical services in many areas support preventative health clinics, such as community immunization, blood pressure checks, and CPR and first aid classes. The public, I feel, has a skewed perception of each one of these departments (e.g. the police should stop crime in progress, the fire department should save their house, and emergency medical systems should save their loved one whenever called upon to do so). Any deviation from the public perception is, in their minds, a failure of the system.

I ask myself, “What is that we, as the emergency medical services, do that really matters?” For the public, it seems that the answer can be given two-fold: “save me” and “make me feel better.” El Sayed (2012) describes the manner in which both aspects, outcomes and patient satisfaction, can be measured, as both are essential. Unfortunately, El Sayed does not go into much detail regarding patient satisfaction scores, except as a means of measure. In contrast, I feel that the most benefit that we offer patients is that we alleviate suffering. From a confident, yet compassionate, bed-side manner to effective and efficient treatment modalities, emergency medical personnel can prove to be the mediator between illness or injury and definitive hospital-based care. Emergency medical providers should be knowledgeable enough about the hospital to calm and educate patients as to what to expect. Further, medical knowledge allows the provider to restore a choking person’s breathing, to stop an epileptic seizure, and to minimize a crash victim’s pain. In my opinion, these measures are just as important, if not more, to quality management as mortality and morbidity. Again, El Sayed mentions the generality of patient satisfaction; however, with the abundance of competing literature questioning the effectiveness of the emergency medical services, patient satisfaction should be expounded upon as a legitimate and important aspect of quality patient care.

References

El Sayed, M. J. (2012). Measuring quality in emergency medical services: a review of clinical performance indicators. Emergency Medicine International, 2012, 1-7, doi:10.1155/2012/161630

McLean, S. A., Maio, R. F., Spaite, D. W., & Garrison, H. G. (2002). Emergency medical services outcomes research: evaluating the effectiveness of prehospital care. Prehospital Emergency Care, 6(2), S52–S56. doi:10.3109/10903120209102683

Spaite, D. W. (1993). Outcome analysis in EMS systems. Annals of Emergency Medicine, 22(8), 1310–1311. doi:10.1016/S0196-0644(05)80113-1

Stiell, I. G., Nesbitt, L. P., Pickett, W., Munkley, D., Spaite, D. W., Banek, J., Field, B., … Wells, G. A., for the OPALS Study Group. (2008). The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. Canadian Medical Association Journal, 178(9), 1141-1152. doi:10.1503/cmaj.071154

Academia, Health Care

Strategic Planning: Strategies & Tactics

Seattle Children’s Hospital (2011, n.d.) was the first pediatric specialty care hospital founded west of the Mississippi River. Seattle Children’s Hospital, supported by the philanthropic efforts of the community, performs at the cutting-edge of pediatric medicine and research. With nearly 60 pediatric specialties and award-winning research faculty, Seattle Children’s Hospital presents expertise in the field of pediatric medicine.

Services

Seattle Children’s Hospital (n.d.) is a pediatric specialty care center associated with the University of Washington to provide medical and surgical residents with the hands-on practical experience and education needed to succeed in the medical profession.

The hospital (Seattle Children’s Hospital, n.d.) has many specialized programs, or sub-specialties, within its pediatric specialty, including urgent and emergency care, oncology and hematology, craniofacial, orthopedic and sports medicine, a heart and transplant center, neonatology, neurosurgery, and general and thoracic surgery.

Seattle Children’s Hospital (n.d.) also boasts an award-winning research facility dedicated to treating and eliminating pediatric disease.

Strategic Planning

The strategic plan of Seattle Children’s Hospital (2011) focuses on the hospital’s vision and four specific goals:

  1. provide the safest, most effective care possible,

  2. control and reduce the cost of providing care,

  3. find cures and educate clinicians and researchers, and

  4. grow responsibly and provide access to every child who needs us (p. 2).

In order to succeed in reaching these goals, the hospital’s plan must have directives that outline the strategies and tactics useful in attaining the goals.

Strategy

Strategy is the broad means directed towards attaining strategic goals. As Seattle Children’s Hospital’s (2011) strategic plan demonstrates, in order to achieve the means of providing the safest, most effective care possible, “[the hospital] will standardize our care processes and strengthen our systems to prevent and respond rapidly to medical errors” (p. 5). This strategy is broadly stated, provides direction, and acknowledges that failures may still occur, which allows for the provision of a secondary, or backup, strategy for response to these failures.

Tactics

Tactics are the individual steps made within a strategy towards attaining a specific goal. Tactics should be moral, safe, efficient and effective towards the strategic goals. For instance, the strategy of “[standardizing] our care processes and [strengthening] our systems to prevent and respond rapidly to medical errors” (Seattle Children’s Hospital, 2011, p. 5) is well-stated, yet broad. In order to employ this strategy, tactics must be employed that are specific to meeting the described goal. In this case, Seattle Children’s Hospital (2011) has identified that “[completing] the transition to an electronic medical record system” (p. 5) is a specific means that can be used to help fulfill this particular strategy and meet the described goal.

Another tactic not presented in Seattle Children’s Hospital’s (2011) strategic plan but helpful in attaining the goal of improved patient safety and drawn from the strategy of “[standardizing] … care processes and [strengthening] … systems” (p. 5) would be the formation of an anonymous, voluntary self-reporting system in which a nurse or physician submits a card detailing a medical or surgical error in the spirit of identifying processes and systems in need of improvement.

Discussion

Strategic plans are guided by strategic goals, and strategic goals can have many strategies that are employed and useful in meeting the stated goals. It is also true that a plethora of tactics can be employed for each strategy.

Strategic plans are often based on lofty, yet attainable, goals. In order to meet these goals, one must only ask a simple question: How? With each broad answer, a continuous and recursive series of How? can be used to work the strategy into a number of manageable tactics to use to reach that lofty goal.

References

Seattle Children’s Hospital. (2011). Shaping the future of pediatric healthcare: Strategic plan 2012 to 2016. Retrieved from http://www.seattlechildrens.org/pdf/strategic-plan-2012-2016.pdf

Seattle Children’s Hospital. (n.d.). About Seattle Children’s. Retrieved from http://www.seattlechildrens.org/about/

Academia, Health Care, Technology

SWOT Analysis: Day Kimball Healthcare

Day Kimball Healthcare (DKH) is a non-profit health care organization serving the northeastern Connecticut, southcentral Massachusetts and northwestern Rhode Island communities. The mission of DKH (2011) is “to meet the health needs of our community through our core values of clinical quality, customer service, fiscal responsibility and local control” (para. 4). A comprehensive health care system, DKH offers primary care and a multitude of medical and surgical specialties along with sophisticated diagnostics by offering a comprehensive network of more than 1,000 employees including more than 200 physicians, surgeons and specialists. DKH is comprised of Day Kimball Hospital, four community health care centers, Day Kimball HomeCare, Day Kimball Hospice & Palliative Care of Northeastern Connecticut, Day Kimball HomeMakers, and Physician Services of Northeast CT, LLC.

Services

DKH provides a host of services to the community, including:

  • primary medical care,

  • emergency medical care,

  • surgical care,

  • palliative and hospice care,

  • home health care, and

  • social services

DKH appears to strive towards providing a comprehensive health care solution to the community that is robust, yet limited in specialty, especially critical care, trauma, and pediatric services.

Environment

Population

The primary catchment area for DKH includes the Connecticut towns of Brooklyn, Canterbury, Eastford, Killingly, Plainfield, Pomfret, Putnam, Sterling, Thompson, and Woodstock, and the Rhode Island towns of Foster and Glocester. According to the available U.S. Census data (2010), the population served is nearly 92,000 with average growth in the last ten years of nearly 9%. The median age of the catchment population (37.8) is merely 3 months older than the median age of the Connecticut population (37.4). The median household income is $66,422 (CT: $67,034).

Competition

DKH is the primary health care provider within the defined catchment area. Some of the population, however, rely on three other community-level hospitals, Backus Hospital (Norwich, CT), Southbridge Hospital (Southbridge, MA), and Windham Hospital (Windham, CT). Additionally, some of the population with advanced disease processes rely strictly on the primary and emergency care services of the nearest urban centers (Worcester, MA, Hartford, CT, and Providence, RI), with many of DKH’s emergency patients transferred to these tertiary care centers for trauma, critical care, and pediatric specialties.

Environment

DKH, as a health care organization, can be adversely affected by patterns of infectious diseases within the community. As each season mounts, the health care system becomes overwhelmed and requires coordination between other health care facilities in the area.

Additionally, a large disaster would strain the resources of DKH; however, this would be a temporary issue, resolving as the disaster winds down. There is ample opportunity within the catchment area for a disaster to unfold, including traffic on the major highway that divides the catchment area as well as the number of large manufacturing entities in the area.

Assessment

Strengths. DKH provides comprehensive long-term health care to community members. DKH enjoys a strong and comprehensive relationship with a large network of physicians and other primary care providers.

Weaknesses. DKH has no intensivists, physicians with expertise in critical care, and provides very limited critical care service. As a result, DKH must transfer many cases to other facilities to rule in or rule out critical illnesses or injuries, which negatively affects earnings.

Another weakness lies in DKH’s reliance on electronic patient care reporting. DKH uses a number of patient care reporting platforms that do not integrate with each other. This creates a need for over-redundancy and opportunities for patient care errors. Further, a fully integrated system would allow for health care partners to access up-to-date patient care information without delay.

Opportunities. Opportunities exist for DKH to expand their services by further decentralizing the current services offered and concentrating on which scopes of service to expand or improve upon. By improving laboratory reporting standards and facilitating full integration of patient reporting, patients of DKH will be able to obtain a more standardized level of care throughout the health care continuum.

DKH should cultivate their relationship with the public by being more active and visible within the community performing screenings, vaccinations, blood drives, as well as other public relations endeavors.

Another opportunity exists with the patient population who suffer from critical illness or injury that is yet to be determined. These patients face risk in transport to tertiary care centers when, often times, the transfer is unwarranted by later findings. By cultivating relationships with specialties in the tertiary care centers, these patients could be more fully determined to need (or, not need) transfer to tertiary care centers, keeping the financial reward of caring for patients in-house while obtaining specialist coordination.

Threats. The largest threat to DKH, as with any organization, is its reputation within the community. Funding, which is largely based on governmental and private insurance providers, is also a considerable threat that must be managed continuously. However, other threats are significant and can be actively managed.

Pandemics are unlikely to occur but present catastrophic scenarios if they do, indeed, occur. Pandemic influenza, as well as other pandemic diseases, presents a situation of an increasing need for awareness and preparation.

Unpredictable weather in the northeastern Connecticut presents a likely and significant threat to the provision of health care. Recent and historical storms have proven to impede access and egress to and from patients both out in the community and at the hospital.

Discussion

This SWOT analysis is limited by the a posteriori knowledge and perceptions of the author, a paramedic who is active within the health care system, and it is limited in the scope of an academic exercise to practice SWOT analyses.

However, DKH has overcome many adversities in the past and continues to grow, but seemingly without proper direction. The efforts thus far seem disjointed and without a clear structure or coherent path into the future. DKH would benefit from an internal SWOT analysis that could be performed without the limitations inherent herein.

References

Day Kimball Healthcare. (2011). Day Kimball Healthcare. Retrieved from http://www.daykimball.org

U.S. Census Bureau. (2010). 2010 census data. Retrieved from http://www.census.gov/