Benchmarks: investing in civil rights and diversity

HSL talks to leaders of four healthcare organizations in various states of developing programs for ensuring a workforce representative of the communities they serve. Programs range from internships for future leaders to creating diversity ambassadors among the workforce.

Rethinking the future of tenure in the health professions: new wine in old bottles

The purpose and meaning of tenure and the tenets surrounding it are not likely to change. The uses of tenure and accountability on the part of the giver and holder of tenure are both under scrutiny. Tenure or the process for attaining it is not appropriate for health professionals who intend to be providers of health care. Not everyone needs to be tenure to perform a quality service. The constraints of tenure for today's practicing health professionals are discussed.

A civil rights primer for healthcare organizations

"Diversity helps us build a better product for the diverse customers we're serving," says University of Michigan Hospitals' Ellen J. Gaucher. And several healthcare organizations stand out for their efforts to build a diverse workforce. Leaders agree that an atmosphere open to diversity starts at the top. They identify four major steps that board members and senior executives can take to ensure a system that welcomes all racial and ethnic groups into the fold.

People: overlooked by re-engineering

Three years ago, re-engineering became the "next big thing" with the publication/Re-engineering the Corporation: A Manifesto for Business Revolution by Dr. Michael Hammer and James Champy, who proposed that marketing, sales and service people could be formed into streamlined "process" teams which, with less supervision, would combine tasks and make the most of computer technology. The concept, designed to cut costs, is now a catch-all for layoffs and unreasonable performance expectations.

Hospital leadership for quality: theory and practice: II. Quality performance evaluation

Hospitals need excellent leadership to be efficient in the use of scarce stakeholder resources and to be effective in the competitive provision of services to multiple customers. This paper is the second report on a study conducted with cooperation of the executive team at a large government-funded hospital in Brisbane, Australia. The overall study focused on linking the leadership concepts and attributes of the members of the executive with an overall evaluation of quality practice in the hospital. The first paper reported the leadership results. This paper reports the quality practice and its links with leadership. The study revealed use of data, understanding of processes and the formation of supplier partnerships as the areas of hospital activity most limiting the ability to improve. Little impact of leadership attributes was found, contrary to studies conducted elsewhere. This may be due to the strong influence of different professional groups within the hospital, since domains of leadership influence largely coincided with these groups.

The EEOC's new ADA mental disability guidelines: an EAP is a pretty reasonable accommodation

The EEOC's enforcement guidelines for psychiatric disabilities may present a significant challenge for the small employer. The authors discuss the parameters of this challenge and consider the ADA mental disability guidelines in the context of an operational framework to assist employers. It is pointed out that an EAP or a managed behavioral health firm with knowledge of ADA can be useful in identifying cost-effective accommodations for employees claiming mental disabilities.

No health for all without better trained management

This article notes that existing health professionals and managers constitute the first 'generation' working in a world where Health for All is a practical possibility because, if founded on community-based public and primary health care with hospitals in support and good intersectoral help, we now have the appropriate technology, access to finance and adequate numbers of health workers. What we still lack are sufficient health professionals, at all levels, with the managerial skills and experience to apply the technology, generate the funding and motivate the staff; making full use of community involvement, the co-operation of other sectors and good relationships with local and central government. Management can be learned both at the workplace and in the training room, and from the managers a few of them will emerge as leaders, with the vision to secure the willing support of others in reaching worthwhile health goals. A very useful publication is the Training Manual on Management of Human Resources for Health, WHO/EDUC/93.201 from World Health Organisation, Geneva, Switzerland. The paper closes with examples illustrating four principles for health management development: finding key points of entry; reaching large numbers; accelerating national self-sufficiency; and international.

Using TQM to improve management of home health aides

Home health aides are at the front line of the home health industry, raising quality of care issues and human resource (HR) management challenges. Total quality management (TQM) provides a framework to help meet those challenges. The authors investigated the relationship between TQM and HR effectiveness in home health agencies. Results suggest that TQM practices are related to HR effectiveness. Suggestions are offered to make human resource management consistent with a TQM culture.

Auditing senior management communication practices in the NHS: a regional study

Increasingly, organizations are being confronted with significant strategic change. This process can only be managed effectively if human resource implications, including how effectively managers and staff communicate with each other, are taken into account. This paper outlines how communication audits provide managers with insights into patterns of communication within their organizations. The nature of communication audits are briefly delineated and explained. An investigation from within the National Health Service (NHS) is offered, which illustrates how a communication audit focusing on relationships between regional, district and local levels of management illuminated patterns of communication between senior managers at these levels. This resulted in the development of an action plan for the improvement of communication practices. The generalizability of these findings to the NHS is discussed.

From controlled to committed

Most of us agree that people are our most important resource. Yet we spend a minimal amount of time learning more about human behavior, communication, and how our attitudes and behavior impact employee performance. Instead we rely on traditional methods of negative reinforcement in an attempt to control our areas of responsibility. While these methods can render some short-term success, managers and organizations that succeed during these times of change and fierce competition will be those that take the time to understand and capture the power of a committed workforce. The committed workforce is energized, not simply compliant, as a result of having basic human needs for achievement satisfied, belonging to a group, and receiving recognition for its contributions. Committed workers typically describe the manager as one who has the ability to give them a great degree of control over their area of influence. We all know that we don't change our leadership style like we change clothes. Old habits die hard. it takes a personal commitment and lots of practice to rid outselves of habits and behavior that no longer serve our departments and facilities. This commitment, however, is crucial to survival. As managers, we must cope with increasing ambiguity and uncertainty in the workplace. To survive these challenges, we must improve our interpersonal skills and ability to successfully bring out the best in others. I believe that success will continue for managers who not only increase their knowledge and technical ability, but who also inspire their workers to move forward with a collective sense of enthusiasm and purpose.

Implementation of ISO 9000 in the healthcare sector: a case study

In order to compete at the international level, companies are beginning to recognize ISO 9000 registration as a virtual necessity. As a result, the number of ISO certifications issued in the U.S. and Canada tripled between 1992 and 1994. By means of a case study, this paper describes how a large healthcare manufacturing organization recently achieved its ISO 9001 certification. Specifically, the strategies and the process used by the organization in obtaining the registration is explained.

Development and validation of scales to measure organisational features of acute hospital wards

In order to make comparisons between wards and explain variations in outcomes of nursing care, there is a growing need in nursing research for reliable and valid measures of the organisational features of acute hospital wards. This research developed The Ward Organisational Features Scales (WOFS); each set of six scales comprising 14 subscales which measure discrete dimensions of acute hospital wards. A study of a nationally representative sample of 825 nurses working in 119 acute wards in 17 hospitals, drawn from seven Regional Health Authorities in England provides evidence for the structure, reliability and validity of this comprehensive set of measures related to: the physical environment of the ward, professional nursing practice, ward leadership, professional working relationships, nurses' influence and job satisfaction. Implications for further research are discussed.

Maintaining morale in the midst of rapid change

Change--even when it's change for the better--can strain the fabric of any organization. Here's how Healthsource Maine has been able to maintain employee commitment during five years of rapid growth.

Groups and decision making

A hallmark of clinical service management in particular, and contemporary health care in general, is the team approach. Yet, many managers do not have appropriate background and skills for group leadership. This article reviews some essential characteristics of groups and suggests strategies for facilitating group decision making.

Leadership in the '90s--what does it take?

Leaders are those who have the ability to identify necessary steps and the right things to do, which will be crucial in the next several years of home care. These individuals possess special competencies that differ from the skills of good workers or managers. What skills are unique to leaders?