EDUCATING MANAGERS ON EFFECTIVE PERFORMANCE APPRAISALS.

There is great belief that many managers and supervisors are not trained properly to conduct an effective job performance appraisal, and that many job performance appraisals designs are not delivering the outcomes organizations are expecting. Many times I have seen in my line of work individuals that have received a negative feedback on their job appraisal for a matter that was a) not brought up to their attention prior to the appraisal, and b) not part of the employees job requirement description.

HR and managers have a responsibility to the organization and to its employees. When an employee is hired by HR and the hiring manager, it is because that employee’s application was assessed and selected for the job. At that point a great responsibility falls on HR and mangers to ensure that the new employees assimilate, learn through job specific company training and orientation, and that they are informed on the expectation of the organization, and find ways where feedback can be provided so that employees can meet those expectation, and even excels.

 Henry Kibirige writes, in his article “HR malpractices that sap morale hurt productivity,” that “if a line manager only performs his or her operational duties and has not been groomed to become a people manager, who is to blame? HR has probably failed to institutionalizing a system which ensures that before appointing an employee as a line manager, he is given training on how to manage people.” Mr. Kibirige also expands his view on HR appraisal issues stating that “Failure to involve employees in their development seriously swaps their morale and leads to unplanned employee development. If no opportunity is given to an employee to project their development needs, it results in the training manager nominating employees to the wrong programs. Several firms even ignore line managers leading to failure to do proper gap analysis of skills and competencies. Wrong training is meanwhile extremely costly.” So not only are HR practices not providing the resources to managers to better assess and implement performance appraisals, but the impact of poor or unfair appraisals can be costly to any organization. It is very likely to hurt employee morale through poorly implemented performance appraisals, which in turn impacts employee performance, thus hurting an organization’s bottom line.

It is the responsibility of HR to groom and train mangers for the position of evaluating employees by providing him or her with the tools needed to conduct an effective performance appraisals. Managers should also be informed on the various performance appraisal errors that do exist so that they can become self-aware and conduct the appraisal as honestly as possible. HR should allow flexibility on appraisals so that it can be more specific for the job performance it seeks to evaluate.

Again, HR should not fail managers and employees when developing a well defined job description that both manger and employee can refer too. “Failure to clarify on deliverables is another bad HR practice. Absence of a well-defined job-description leads to lack of accountability. If neither the employee nor his or her immediate supervisor is able to define the job-deliverables, the result is loss of focus and interest” (Kibirige, 2010).

There are challenges to the design and implementation of many performance appraisals. In the article “Due process in performance appraisal: a quasi-experiment in procedural justice” by M. Susan Taylor, Kay B. Tracy , Monika K. Renard , J. Kline Harrison , Stephen J. Carroll; they state that “there is evidence that appraisal systems are a practical challenge to the academics who often design them and to the managers and employees who must use them.” Many job performance appraisals do not take in to account many factors that influence performance, such as work settings, work conditions, “explanation of performance standards to employees, to discuss how and why such standards must be met, and to provide for regular and timely feedback on performance.”

HR boost production and company morale by ensuring that appraisals meet the standard and expectations of each department it seeks to assess. HR should ensure that job descriptions are clear and can be assessed taking in consideration other factors such as work environment, etc. They should ensure that managers understand the job description that is being assessed and again, factors that could affect job performance. HR should ensure that mangers are trained and held accountable for conducting proper appraisals. And lastly, HR should make accessible to employees all the tools needed so that employees can take charge on the performance they are being held accountable for, such as ways to provide feedback, training, monthly performance meetings, expectations for the job, etc.

References:

Kibirige, Henry (November 2010). “HR Malpractices That Sap Morale Hurt Productivity.” Daily Monitor. Retrieved from URL: http://www.monitor.co.ug/Magazines/Jobs%20&%20Career/-/689848/1054736/-/4otls3z/-/

Taylor, M. Susan, Tracy, Kay B., Renard, Monika K., Harrison, J. Kline, Carroll, Stephen J. (1995). “Due Process in Performance Appraisal: A Quasi-Experiment in Procedural Justice.” Administrative Science Quarterly, Vol. 40, 1995. Retrieved from URL: http://www.questia.com/googleScholar.qst;jsessionid=C6E51BC01E51B8B3D85A66B27D4D63A2.inst3_2a?docId=5000363864

HSA 6342 - Human Resources Management Role in Reducing Malpractice Risks.

The increasing cost of healthcare has many scholars, attorneys and politicians blaming the medical malpractice system as a major contributor to the ever increasing costs healthcare. The Office of Technology Assessment wrote in a 1994 extensive report that the “medical malpractice system adds to the costs of health care directly through increases in malpractice insurance premiums, which may be passed on to consumers and third–party payers in the form of higher fees.” However, Human Resource Management (HRM) can be an instrumental asset for healthcare organization in reducing such risks.

Examples of these high premiums are seen now in states such as California, Pennsylvania, Nevada, and Florida among others. In California, by 2009 OB/GYNs were expected to pay more than $55,000 per year for insurance coverage; and insurance for general surgeons were expected to cost between $22,000 per year and $34,000 per year. In Pennsylvania, one of the average paying states, was expected to pay in 2009 the average malpractice insurance cost rates for general surgery to be as low as $28,000 annually and as high as $50,000; and Obstetricians/gynecologists were finding themselves paying up to $64,000 or more for coverage. In other states such as Nevada and Florida, where malpractice insurance rates  are between middle to high found themselves in 2009 paying one of the highest rates of insurance. In Nevada is for OB/GYNs, who may pay between $85,000 for malpractice liability insurance per year up to $142,000 per year for a premium plan by a prominent insurance company. Although the average annual salary for such doctors is around $180,000 in 2009, malpractice insurance is still considered a huge financial burden. Moreover, in Florida, which has some of the highest rates of liability insurance, a doctor in internal medicine was expected to pay in excess of $56,000 per year for insurance; a General surgeons, between $90,000 per year and $175,000 per year or more; and an OB/GYNs once again could expect the highest rates, with liability coverage ranging from $100,000 to $200,000 per year (Alexis Writing, 2010).

The cost of medical malpractice is undeniably a tremendous burden that threatens to cripple financially any healthcare organization. Nevertheless, strategies exist to lessen the risk of malpractice law suits and increase the organizations bottom line. Some of these strategies are:

a.      Preventing Diagnostic Error: “The top medical conditions involved in malpractice cases for primary care physicians are acute myocardial infarction; breast, lung, and colon cancers; appendicitis; and medication problems. Diagnostic error -- that could cut across many conditions -- account for more than one third of the claims” (Mark Crane, 2010). HRM can use different way to low risk in diagnostic errors. One example is proper selection, development and training of personnel/staff members. To provide the best an organization should strive in acquiring the best. Providing training and development resources to employees about new medical techniques and advances in diagnosing can be instrumental to physicians, nurses and ultimately Human Resources (HR) and the organization as a whole.  

b.      Preventing Medication Error: “Medication errors, particularly involving warfarin, result in thousands of hospital admissions each year. Close monitoring of anticoagulants is essential, and the treating physician must communicate to the patient potential interactions with foods and other medications. Following established monitoring policies and procedures is crucial” (Mark Crane, 2010). HR must emphasize continuously, through policies that establishes accountability if staff members improperly medicaid patients or fail to address the necessary care that goes along with medication given. Here again we see the importance of selecting and hiring adequate and knowledgeable employees.

c.      Implementing Proper and Accurate Documentation and Follow-up: “documentation is the major defense against law suits and complaints.” Doctors and nurses should be accountable for documenting every detail of a patient’s visit, by using a couple of minutes extra with each patient. HR should establish questionnaires and note-sheets that push doctors to ask detail information about a patients visit, and to write details on patient’s comments. Because many doctors don’t have enough time to fully document each patient encounter, many lose malpractice suits because they lack evidence (Mark Crane, 2010).

d.     Implementing Continuous Communication: HR has the duty to set standards on physicians-patient follow up and proper communication strategies. HR should constantly reinforce the importance of adequate feedback in reducing law suits."When patients sue, it's often due to a breakdown in trust with the physician. Patients and families get frustrated when the physician isn't forthcoming with an explanation of what happened. They are looking for answers and get angry when they perceive physician indifference. All of that can be averted with better communication" (Mark Crane, 2010).

e.      And more importantly, Implementing Customer- Oriented/ Satisfaction Measures: “Pay for performance and other measures that tie reimbursement to quality have turned an even brighter spotlight on the need to ensure patient satisfaction” (Mark Crane, 2010). Healthcare organization can dramatically reduce lawsuits and positively impact the bottom line if they implement customer service focus as part of their running strategy. The must implement “five-star customer service principles into care giving, encourage patients to take responsibility for their care, taka few extra seconds to create legible, concise documentation, and provide pay for such performance” (James W. Saxton, 2010). With customer satisfaction comes loyalty, referrals, and more tolerance.

“Nearly 40% of general and family practice physicians have been sued in their careers, as have 34% of general internists. Even worse, 1 in 7 primary care doctors have been sued at least twice” (Mark Crane, 2010). It is imperative for HR to take measures that are necessary to assist healthcare organization in reducing malpractice risks. Communication is key, then implementing the proper standards, accountability, open door policy to communicate and compensate those that work hard to achieve this goal is essential for a health organization to thrive in such a competitive market that is constantly evolving.

References:

Bruce J. and Myron, Fottler D. (2008). Human Resources In Healthcare, Managing for Success. 3^rd ed.

Crane, Mark. (2010). “Six Top Malpractice Risks in Primary Care”. Medscape Today. Retrieved from URL: http://www.medscape.com/viewarticle/728306

Office of Technology Assessment. (1994). “Defensive Medicine and Medical Malpractice.” Retrieved from URL: http://biotech.law.lsu.edu/policy/9405.pdf

Saxton, Esq., James, W. (2007). “The Satisfied Patient: A Guide to Preventing Malpractice Claims by Providing Excellent Customer Service.”  2^nd ed.

Writing, Alexis. (2010). ‘The Average Cost for Medical Malpractice Insurance.” EHOW. Retrieved from URL: http://www.ehow.com/about_5514154_average-cost-medical-malpractice-insurance.html

SAVING LIVES: THE IMPORTANCE OF HUMAN RESOURCES ROLE IN PREVENTING HOSPITAL ACQUIRED INFECTIONS

Hospital Acquired Infections (“HAIs”) are infections acquired by patients during their stay at the hospital while being treated for other illnesses. HAIs represent an increasing trend affecting thousands of patients and resulting in serious consequences to not only the patient, but also to  hospitals, the health-care system and tax-payers. Currently injuries to patients such as “hospital-acquired infections caused by medical interventions are increasing and responsible for 44,000 to 98,000 deaths per year,” with a “cost of $17 - $29 billion” annually (Gaynes, et al., 2001). This financial burden gets passed on to Medicaid and Medicare, and ultimately to us tax-payers. The irony of it all is that HAIs are preventable if only human resources departments at hospitals (“HR”) would be more proactive in implementing the appropriate measures.

The U.S. Department and Human Services and the Agency of Health Care Research and Quality reported in April of 2010 after a study conducted in 2009 that three health acquired infections such as bloodstream infections, postoperative catheter-associated urinary tract infections, infections due to medical care increased in 2009. Bloodstream infections increased by 8%, postoperative catheter-associated urinary tract infections increased by 3.6%, and infections due to medical care increased by 1.6% (Agency of Health Care Research and Quality, 2010).

This is only the tip of the ice-berg, there are many other HAIs reported and increasing. One example of is the story of Mr. McClearly, a healthy father and husband, who was admitted to the hospital in September of 2008 with a minor fracture to his ankle, was discharged 12 days later, but was readmitted to the hospital two days later because of a MRSA pneumonia, which Mr. McClearly acquired while at the hospital. MRSA pneumonia is a staph infection that causes fatal pneumonia. After three month struggling with the effects of the infection Mr. McClearly died (Day, Kathy, 2008). Stories such as that of Mr. McClearly are alarming and, as some studies suggest, could have had been prevented. Organizations such as the Center for Disease and Control (“CDC”) state that monitoring/ surveillance, accountability, education and training together with stricter policies reduce infections acquired at hospitals by a drastic percentage.

This is where HR comes into play. They are the vital source of resolving this increasing trend through educating and developing employees, increasing accountability and increasing technology support (Fried and Fottler, 2008). HR has the vital role to educate and train employees from janitorial staff all the way to physicians and nurses on the importance and impact of proper hygiene and safety control. I have heard stories of doctors coming in to work sick because of fear of being seen as slacking. Policies and education must come into play in situations like this.

HR has also the responsibility to implement accountability standards among staff members.  Studies suggest that increasing guidelines and policies in conjunction with the heightened awareness and reporting of patient personnel has had a tremendous impact on the decrease of infections. The findings suggest that increasing the accountability among hospital staff members and employees altered their behavior and the “perceived value of the data, relied on for decisions” (Center for Disease and Control, 2001).

HR’s role in implementing technological advances within the healthcare organization so that the organization can provide higher quality services and customer satisfaction is also vital in the fight against HAIs. An article written by Susie Cantrell for the Healthcare Purchasing News validates the importance of implementing surveillance monitoring systems. In her article she writes that “there are three basic reasons it is important to track infections: (1) it facilitates better patient care and patient safety; (2) it can help to reduce or avoid the financial burden of infection, such as increased lengths of stay, increased antibiotic use, reduced reimbursements by Centers for Medicare and Medicaid and others who are now following their lead; and (3) to comply with mandated reporting of HAIs”.

This further confirms how crucial HR’s role is in preventing HAIs. It’s frightening to know that a simple stay at the hospital can result in the loss of a love one, because proper education, awareness, accountability and an adequate surveillance/ monitoring system was not implemented properly by that hospital’s HR department. Pushing HR departments to be more proactive on avoiding such risks brings peace of mind to not only the patient and staff, but also to the health institutions and us tax-payers. Consequently, through these measures HR is able to positively contribute to the organization’s bottom line.

References

Agency for Healthcare Research and Quality. (2010, April 13). Retrieved August 27, 2010, from U.S. Department of Health and Human Services: http://www.ahrq.gov/news/press/pr2010/qrdr09pr.htm

Cantrell, Susan . (2010, June). Automated surveillance can stop infections in their tracks. Healthcare Purchasing News. Retrieved from URL: http://www.hpnonline.com/inside/2010-06/1006-IP.html

Day, Cathy. (2008). John McClearly of Main. The Safe Patient Project. Consumer Union. Retrieved from URL: http://www.safepatientproject.org/sys-hospital_acquired_infections.html#john_mccleary_of_maine

Fried, Bruce J. and Myron, Fottler D. (2008), Human Resources In Healthcare, Managing for Success. 3^rd ed., 978-1-56793-299-7

Gaynes, R., Richards, C., Edwards, J., Emori, T. G., Horan, T., Alonso-Echanove, J., et al. (2001, April). Emerging Infectious Diseases. Retrieved August 27, 2010, from Centers for Disease Control: http://www.cdc.gov/ncidod/eid/vol7no2/gaynes.htm

Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., et al. (2007, March-April). Estimating Health Care-Associated Infections and Deaths in U.S. Hopitals,2002. Public Health Reports, 122.

McKinney, M. (2010). Gaining Control: CDC:Infection rates drop, but progress still unclear. Modern Healthcare, 40(22), pp. 8-9.

Mirza, A., & Custodio, H. T. (2010, July 20). Hosptial Acquired Infections. Retrieved September 2, 2010, from Emedicine: http://emedicine.medscape.com/article/967022-overview

Scott II, R. D. (2009, March 12). Estimates of Healthcare Associated Infections. Retrieved September 1, 2010, from Centers for Disease Control and Prevention: http://www.cdc.gov/ncidod/dhqp/pdf/Scott_CostPaper.pdf

World Health Organization. (2002). Prevention of hospital-acquired infections: A practical guide. 2nd edition. Retrieved September 1, 2010, from World Health Organization: http://www.who.int/csr/resources/publications/drugresist/en/whocdscsreph200212.pdf

Human Resources: Inside a Consumers Perspective and Its Role in Healthcare Organizations

As an asthma patient and mother of an 8 year old girl and a 6 month old baby girl, Human Resources ("HR") is an important function within any health organization. It is where the valuable selecting and training of that vital doctor and staff member that one day you just might need, come into play. As an employee, human resources is that link between you, your skills, education, expertise; and the value an organization puts on those attributes. Unfortunately, HR has always been the department less spoken about in companies I have worked for. Once you are in it’s only about hellos, goodbyes and questions about pay scale or job postings.

However, the fact is that HR is a vital organ in an organization. It is responsible for staffing, educating, increasing technology support, reorganizing the design of an organizations work flow, and its responsible for nurturing the relationship between employer and employee, while following federal, state and local guidelines. HR plays a vaulable role in healthcare organizations, because it is the link between a healthcare organizations purpose, its outcome and performance. It is responsible for the staffing, development, compensation of the human resources that the organization holds as assets to achieve the bottom line. HR provides valuable information to decisions makers on how the organization can manage itsself efficiently while performing at or above expectations (Fried and Fottler, 20).

Many healthcare organizations have not fully embraced the role that HR and HR leaders play in their organization, and the competitive advantage they can provide the organization among competitors. HR leaders hold a significant role in quality and patient safety. Empowering employees on becoming more proactive when issues arise can allow HR and management leaders to identify the problems and find solutions to issues that affect the quality and the safety of patients and employees (Quick, 3).

HR has been always and will continue to be the crucial link between a company’s expectations and what it delivers. In healthcare organizations their role is even more critical because of the risk involved with patients. It’s only a matter of time before HR’s role becomes more in sink as a partner so that the bond between HR and the organization can be harmonious and fruitful.


Fried, Bruce J. and Myron, Fottler D. (2008), Human Resources In Healthcare, Managing for Success. (3rd edition).

Quick, Roger (2008), The Summary of Findings: The Role of Health Care Human Resources in Quality and Safety. Ashhra, Though Leader Forum. Retrieved from URL http://www.ashhra.org/ashhra/about/governance/files/TLF1Summary091608.pdf