Tag Archives: ethics

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, 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, 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, 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, Emergency Management, Politics, Society, Technology

Messaging as an Ongoing Process

Just after midnight on March 24, 1989, the Exxon Valdez ran aground in the Prince William Sound off of the Alaskan coast causing the 36th largest oil spill in history (Baker, n.d.; Fearn-Banks, 2011; Holusha, 1989; Moss, 2010). Though the initial ecological insult was severe, Exxon’s poor response to the emergency is noted as having the most significance (Baker, n.d.; Holusha, 1989). According to Fearn-Banks (2011), the initial public relations response was swift, but the public perception, especially with the obvious absence of CEO Lawrence G. Rawl from the public spotlight, was that the company did not view the incident with the importance that it deserved (Holusha, 1989). “The biggest mistake was that Exxon’s chairman … sent a succession of lower-ranking executives to Alaska to deal with the spill instead of going there himself and taking control of the situation in a forceful, highly visible way” (Holusha, 1989, para. 6). Rawl made comments about being technologically obsolete as a reason for not responding to the incident personally, and in a later television interview, Rawl explained that it was not the responsibility of the CEO to read specific response plans, then he went on to blame the media for the crisis (Baker, n.d.; Fearn-Banks, 2011).

According to Fearn-Banks (2011), Don Cornet, Exxon’s Alaska public relations coordinator, rushed to the scene and instituted a plan focused on the clean-up upon hearing of the incident; however, resources were scarce and the plan was slow to implement. Alaskan oil industry regulations held that the Alyeska Pipeline Service Company, an oil company consortium, was ultimately responsible for the initial response, which was soon taken over by Exxon. It was Alyeska’s involvement in the incident that introduced George Mason, an experienced crisis communications public relations expert for the company that represented Alyeska, into the spotlight. Mason worked with Cornet to streamline the media response and did much to limit the impact of Exxon’s poor media relations, even in light of Rawl’s disastrous commentary. Without the efforts of Mason, Cornet, and a few others, it appears that Exxon’s reputation would have suffered much more.

The primary issues identified in Exxon’s response to the Valdez incident, according to Baker (n.d.), are 1) a lack of resources and preparedness for a crisis of this magnitude, 2) failing to commit to prevention efforts in the future, and 3) the perceived indifference to the ecological shock.

According to Holusha (1989), Exxon’s response to the Alaskan spill was immediately identified as highlighting what not to do in responding to a crisis. Holusha compared Rawl’s messaging and response with that of the Ashland Oil spill and the Union Carbide incident in Bhopal, India, in which both CEOs responded immediately, availing themselves to the media to answer questions and respond to scrutiny.

The Exxon Valdez spill was significant, large, costly, and affected many industries and lifestyles in Alaska. Rawl’s response should have been immediate, and he should have taken responsibility to be apprised of all efforts being undertaken to rectify the situation. Legitimizing Rawl’s concerns of being a distraction to local efforts, he could have held frequent press conferences in the mainland United States, which would have limited the media’s need to send so many representatives directly to Alaska. This would have helped to show cooperation with the media as well as allow Rawl to address any concerns that the public might have. The messaging should have been that Exxon will do everything needed to return Alaska back to pre-spill status no matter the cost or manpower required.

Today, social media presents a unique opportunity for companies to address their public. Recently, Connecticut Light and Power utilized Facebook and Twitter, two popular social media programs, to provide real-time updates to their affected customers during a freak early snowstorm that put most of Connecticut without power for weeks (Singer, 2011; State of Connecticut, Department of Emergency Services and Public Protection, 2011). Though there are still concerns that Connecticut Light and Power were unprepared for such a crisis, without the deliberate effort to maintain communication with customers, the corporate image would have been much worse, as Exxon experienced.

It is a common precept in crisis communications that crises will occur and hopes can only be made to minimize their effect (Fearn-Banks, 2011). While preparing for such a crisis, a focus on communication and messaging should be paramount. The more the public trusts that the company will respond to the emergency effectively, the more apt they will be to acknowledge the difficulties involved in such a response. Messaging should be open, honest, and realistic. Every effort to use a multitude of media (e.g. radio, television, print, internet, telephone, et al.) to maintain a sense of transparency should be used to promote messages that accept responsibility and sets realistic goals. These communications, however, should not be unidirectional. A conversation needs to take place where the public can have their concerns and curiosity addressed in a fair and open environment.

By addressing the concerns of all stakeholders in a timely, open manner, corporate images will fare much better even in light of the worst crisis imaginable.

References

Baker, M. (n.d.). Companies in crisis – What not to do when it all goes wrong: Exxon Mobil and the Exxon Valdez. Retrieved from http://www.mallenbaker.net/csr/crisis03.html

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). “Textbook” crises. Crisis communications: a casebook approach (4th ed; pp. 90-109). New York, NY: Routledge.

Holusha, J. (1989, April 21). Exxon’s public-relations problem. New York Times. Retrieved from http://www.nytimes.com/1989/04/21/business/exxon-s-public-relations-problem.html

Moss, L. (2010, July 16). The 13 largest oil spills in history. Mother Nature Network. Retrieved from http://www.mnn.com/earth-matters/wilderness-resources/stories/the-13-largest-oil-spills-in-history

Singer, S. (2011, November 4). CT utility takes heat over winter storm response. News 8 WTNH. Retrieved from http://www.wtnh.com/dpp/weather/winter_weather/ct-utility-takes-heat-over-winter-storm-response-

State of Connecticut, Department of Emergency Services and Public Protection. (2011, November 8). Winter storm October 29, 2011 (Situation Report #49). Retrieved from http://advocacy.ccm-ct.org/Resources.ashx?id=802e4723-2e4a-4a61-896e-f51eafbbd4c0

Academia, Emergency Management, Society

The Importance of Planning

To borrow from the motto of the Boy Scouts of America (2011), “Be prepared!” There is no possible way to fully predict with perfect accuracy when and where a crisis will develop. However, with some foresight, the adoption of a comprehensive crisis communication plan will allow an immediate response to any emergency, disaster, or other crisis that might arise. Gray (2008) discusses how JetBlue might have benefited from such a plan. JetBlue, if they had focused on developing a crisis communication plan, might have uncovered the not unlikely possibility of a major storm grounding many of its passengers. In this case, JetBlue would have been in a more proactive position to mitigate the effects such a storm might produce on passengers and their east coast operations. According to Fearn-Banks (2011), the impending storm prediction would have been a warning sign, or prodrome, that JetBlue could have responded to in order to prevent the crisis. Had JetBlue contacted the passengers prior to their arrival at the airports, they might have been able to secure better and more comfortable accommodations than the airports had to offer. Additionally, the company would have presented themselves proactively instead of taking the defensive posture noted by Gray.

In December 1984, Union Carbide, a pesticide production company, was the subject of the worst industrial accident in history. At their plant in Bhopal, India, an employee purposefully allowed water into large tanks of a chemical called methyl isocyanate (MICN) which caused a chemical reaction (according to Union Carbide management), bursting the tanks and releasing MICN gas into the environment killing more than 3,000 people (some estimates exceed 25,000 dead) and injuring 100 times that amount (Venkatasubramanian, 2011). According to Muller (2001), MICN was stored in large above ground tanks, a water valve was connected to the tanks, and employees had largely unrestricted access to these tanks and valves. When liquid MICN and water are mixed, MICN rapidly expands to a gaseous state and can quickly overwhelm holding tanks. Had Union Carbide conducted an investigation of potential crises while constructing a crisis communication plan, these circumstances might have been uncovered and considered prior to the accident, allowing company officials the opportunity to mitigate the potentially deadly situation and avoid the catastrophe in 1984. Additionally, had this crisis occurred regardless of mitigation, the company would have been poised to provide helpful instructions and recommendations to public safety officials and the public to minimize the loss of life. Union Carbide was eventually sued for billions of dollars, which it has never paid.

Another incident that might have benefited from a crisis communication plan is the Massey Energy Upper Big Branch mine explosion that occurred in West Virginia on April 5, 2010. Venkatasubramanian (2011) describes this explosion as the worst mining accident in four decades, killing 29 people. Like the Union Carbide example above, Massey Energy initially tried passing the blame to employees and single system failures, but eventually the company closed its Kentucky Freedom Energy Mine #1, and the CEO, Don Blankenship, stepped down. This after being confronted with the over 600 safety violations in 2009 and 2010. Again, the implementation of a crisis communication plan would have focused on potential accidents and allowed a window for mitigation and prevention. Upon completion of the effort, when the accident occurred, there would have been clear directives on how to proceed, which might have helped to save the company’s reputation; although, in this case, that is unclear.

Only when a company’s management realizes that safety is important and that crises do occur can they set forth means of mitigating their risk. One important way to mitigate risk is to consider that no matter the attempts at prevention, errors and failures can always occur and it is best to be prepared for the worst-case scenarios in hopes that they never do occur. By being prepared for the worst case scenarios, mainly by having drafted crisis communication plans along with incident action plans, the company representative has focus and direction on how to proceed with response efforts both publicly and internally. The benefits are appearing with a unified message of adequately responding and recovering from the crisis, and bringing a sense of strength and direction to that effort that the public, employees, and shareholders alike can appreciate and find faith. It is always best to be prepared.

References

Boy Scouts of America. (2011, March). Overview of Boy Scouts of America. Retrieved from http://www.scouting.org/About/FactSheets/OverviewofBSA.aspx

Fearn-Banks, K. (2011). Crisis communications: a casebook approach (4th ed.). New York, NY: Routledge.

Gray, S. (2008). Without crisis plan, your reputation could be at risk. Las Vegas Business Press, 25(8), 22. Retrieved from http://www.ebscohost.com/academic/regional-business-news

Muller, R. (2001). A significant toxic event: The Union Carbide pesticide plant disaster in Bhopal, India, 1984. Rural and Remote Environmental Health, 1(10). Retrieved from http://www.tropmed.org/rreh/vol1_10.htm

Venkatasubramanian, V. (2011). Systemic failures: Challenges and opportunities in risk management in complex systems. AIChE Journal, 57(1), 2-9. doi:10.1002/aic.12495

Academia, Emergency Management, Society

Defining Crisis

A crisis is any problem that has a significant impact. Most simply, a crisis is a decision-point of change, for better or worse. For example, a new father seeing his child for the first time might have a crisis of faith. A beautiful and healthy child may trigger thoughts of awe and trigger a divine revelation; whereas, a seriously ill child may bring feelings of doubt and religious contempt. In the field of crisis management, Coombs (2012) defines crisis as “the perception of an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes” (p. 2). In this definition, Coombs suggests that crises are both negative and unpredictable events that effect others. While I agree with the scope of the definition, as I stated above, crises do not necessarily have to be negative events, and frequently, they can be predicted. Predictable negative crises are usually caused by negligent management, such as economic crises (Berg & Pattillo, 1998; Compagnon, 2011; Feldstein, 2010; Roubini, 2010).

A crisis usually develops from a less significant issue and, if understood and contemplated, can be mitigated early (Coombs, 2012). A crisis stemming from an issue finds a causal relationship with risk. Risk can be categorized by human, systematic, and process or random (Youndt, Snell, Dean, & Lepak, 1996). Human and systematic risk can be mitigated easily; however, process risk is inherent and requires substantial process change to minimize.

The British Petroleum Deepwater Horizon event, which occurred on April 20, 2010, was said to have been fraught with risk of all three types. A New York Times article by Barstow, Rohde, and Saul (2010) describes the event and attempts to elucidate what went wrong. Initially, according to the article, there was a blowout of the Macondo Prospect well, a risk that is inherent to drilling, especially in deep water. Next, every single “formidable and redundant defenses against even the worst blowout” (para. 10) failed. This was certainly a failure of process errors (geological “bursts” causing the well blowout), systematic errors (“One emergency system alone was controlled by 30 buttons” [para. 18]), and human errors (“members of the crew hesitated and did not take the decisive steps needed. Communications fell apart, warning signs were missed and crew members in critical areas failed to coordinate a response” [para. 15]).

On a micro-organizational level (the rig), these failures are evident and allowed risk to develop into an issue, which developed into a crisis. On a macro-organizational level, however, the response seemed to be swift, but the focal response to the incident and the public relations response appeared very disjointed, which was compounded by both the media and the federal government, that is, until the U.S. Coast Guard took control. It was apparent very early that both British Petroleum and the federal government were concerned with reputation over response and recovery from the focal incident. This translated to poor support for both by the public. I believe the U.S. Coast Guard is the only managing entity involved in the response to have managed to maintain dignity throughout the effort.

Crisis management is promoted as a multifaceted approach to mitigate, alleviate, respond to, and recover from crises of different types and scope. Although there are many aspects to organizations that require attention during these efforts, it needs to be understood that some have higher priorities than others, and reputation is a culmination of all of these.

References

Barstow, D., Rohde, D., & Saul, S. (2010, December 25). Deepwater Horizon’s final hours. New York Times. Retrieved from http://www.nytimes.com/2010/12/26/us/26spill.html

Berg, A. & Pattillo, C. (1998). Are currency crises predictable: a test (Working paper #98/154). International Monetary Fund. Retrieved from http://books.google.com/

Compagnon, D. (2011). A predictable tragedy: Robert Mugabe and the collapse of Zimbabwe. Philadelphia, PA: University of Pennsylvania Press.

Coombs, W. T. (2012). Ongoing crisis communications: planning, managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Feldstein, M. (2010, June 14). A predictable crisis: Europe’s single currency was bound to break down. The Weekly Standard, 15(37), 1-3. Retrieved from http://www.weeklystandard.com/articles/predictable-crisis

Roubini, N. (2010, May 17). All crises are predictable: Contrary to beliefs, history shows there’s nothing new in debt or inflation. Gulf News. Retrieved from http://gulfnews.com/business/features/all-crises-are-predictable-1.627708

Youndt, M. A., Snell, S. A., Dean, J. W., & Lepak, D. P. (1996). Human resources management, manufacturing strategy, and firm performance. The Academy of Management Journal, 39(4), 836-866. doi:10.2307/256714

Academia, Culture, Emergency Management, Emergency Medical Services, Health Care, Politics, Public Health

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.

References

Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Academia, Health Care, Public Health

Self-Assessment: Finding My Niche

 Combining the business-sense with the altruistic nature of health care, a health care manager is truly unique in focus. Some of the virtues and qualities a health care manager must posses for a long and rewarding career include a high sense integrity and of one’s self, emotional intelligence, the ability to think critically and globally, and must be equitable and just to both colleagues and clients, customers, and patients (Buchbinder, Shanks, & McConnell, 2012; Buchbinder & Thompson, 2010a).

A qualitative self-administered inventory instrument, presented by Buchbinder and Thompson (2010b), provides some insight into the qualities and virtues useful and, perhaps at times, necessary to pursue a management career in health care. The instrument, designed in Likert fashion, presents quality statements with which the subject is to agree or disagree, whether strongly or not (Likert, 1932). Although this instrument is based on the authors’ opinion, albeit expert, and there is no scoring mechanism recommended aside from high is better than low, I performed the inventory as a self-assessment to help identify some of my strengths and weaknesses (Buchbinder & Thompson, 2010a). The scoring was performed by assigning values to the the statements: 5 for strongly agree, 4 for agree, 2 for disagree, and 1 for strongly disagree, and dividing the sum of the answers scored by the median neutral value of 3 (Garland, 1991; Likert, 1932).

My score using the instrument was 153 out of 180 (85.00%). According to Buchbinder and Thompson (2010a), I possess more skills than not for a management career in health care. The lack of import placed on time management and project management seem to be two of my weaknesses, according to the instrument; although without further scrutiny, it is hard to tell if these particular items may actually suggest otherwise (Buchbinder & Thompson, 2010b; Clason & Dormody, 1994). The instrument helped to identify my critical thinking skills and my communication skills as strengths that would be useful in a health care management career (Buchbinder & Thompson, 2010b). It also showed that I have a strong ethical focus on integrity and equity.

Qualitative self-assessment instruments, such as the one developed by Buchbinder and Thompson (2010b), allow the subject insight as to the appropriateness of something like a career choice or lifestyle. Being honest with one’s self in using these self-assessment tools will also help to inform the subject of characteristics in need of cultivation.

References

Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010a). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010b). Healthcare management talent quotient quiz. Career opportunities in health care management: Perspectives in the field (pp. 5-7). Sudbury, MA: Jones and Bartlett.

Clason, D. L. & Dormody, T. J. (1994). Analyzing data measured by individual Likert-type items. Journal of Agricultural Education, 35(4), 31-35. doi:10.5032/jae.1994.04031

Garland, R. (1991). The mid-point on a rating scale: Is it desirable? Marketing Bulletin, 2, 66-70. Retrieved from http://marketing-bulletin.massey.ac.nz/V2/MB_V2_N3_Garland.pdf

Likert, R. (1932). A technique for the measurement of attitudes. Archives of Psychology, 22(140), 1–55.