Recruitment, retention, and revenue: the three Rs of successful group practice management

Recruiting a physician to your medical practice can be an expensive proposition. But what is the cost of losing a physician, or of failing to fill a vacancy? This article examines the ramifications of physician recruitment and retention, from the perspective of its financial impact, by providing the framework for a strategy meant to increase the odds of successfully recruiting a new physician. The article also offers suggestions to help the medical practice manager retain productive doctors by considering physician retention as an extension of the recruitment effort.

The Nurse Manager Academy: an innovative approach to managerial competency development

The quality of nursing leadership has a powerful impact on nurse retention. Hospitals that employ effective nursing leaders report increased nursing satisfaction, increased group cohesiveness, decreased job stress, and decreased turnover (Wells, Roberts, & Medlin, 2002). The Institute for Johns Hopkins Nursing has developed a unique training program for nurse managers that employs a learner-centered approach and is designed to teach the leadership skills essential to successful nursing management. The Nurse Manager Academy prepares nurse managers to assume management roles with confidence and competence, making them more likely to succeed in one of the most challenging jobs in health care today.

Accepting leadership responsibility: preparing yourself to lead honestly, humanely, and effectively

Many who enter management are ready and willing to accept the benefits of their positions, but not all are readily accepting of the full responsibilities of leadership. All too frequently, modern leadership appears self-serving, with the needs and desires of the leaders taking precedence over the needs of the followers and even the needs of the clients or customers. True leadership, however, should primarily benefit the followers rather than the leader. Leaders lead and followers follow for essentially the same reason, fulfillment of needs, so leaders and followers are fundamentally little different from each other. Every manager at every level has organizational superiors, so every leader is a follower as well. A true leader among managers is one who subordinates personal needs to the organization's needs, places employees well above self in importance, models appropriate behavior for employees, and functions as a facilitator in the employees' continuing efforts to get the necessary work done efficiently and effectively.

[Management of human resources in neurology]

Neurology human resources comprise of the persons who make up the staff. Management tries to make the team both effective and efficient; consequently clear and quantifiable objectives together with resources according to real care needs, teaching, research and management are required. To calculate human resources, the suitability parameters recommended by scientific organisations must be used. To cover global care, 3.7 neurologists are needed for every 100,000 inhabitants. Management is the planning and selecting of staff and their incorporation into the dynamic of the team. It is also work performance training, job evaluation and the offering of opportunities to correct and improve. Personal competence is not a sufficient guarantee to ensure adequate performance. Motivation, team member encouragement to favour promotion, and support for professional career development are needed. Management is fomenting team work and stimulating staff participation in management organs, committees and hospital commissions.

How (un) ethical are you?

Answer true or false: "I am an ethical manager." If you answered "true," here's an Uncomfortable fact: You're probably wrong. Most of us believe we can objectively size up a job candidate or a venture deal and reach a fair and rational conclusion that's in our, and our organization's, best interests. But more than two decades of psychological research indicates that most of us harbor unconscious biases that are often at odds with our consciously held beliefs. The flawed judgments arising from these biases are ethically problematic and undermine managers' fundamental work--to recruit and retain superior talent, boost individual and team performance, and collaborate effectively with partners. This article explores four related sources of unintentional unethical decision making. If you're surprised that a female colleague has poor people skills, you are displaying implicit bias--judging according to unconscious stereotypes rather than merit. Companies that give bonuses to employees who recommend their friends for open positions are encouraging ingroup bias--favoring people in their own circles. If you think you're better than the average worker in your company (and who doesn't?), you may be displaying the common tendency to overclaim credit. And although many conflicts of interest are overt, many more are subtle. Who knows, for instance, whether the promise of quick and certain payment figures into an attorney's recommendation to settle a winnable case rather than go to trial? How can you counter these biases if they're unconscious? Traditional ethics training is not enough. But by gathering better data, ridding the work environment of stereotypical cues, and broadening your mind-set when you make decisions, you can go a long way toward bringing your unconscious biases to light and submitting them to your conscious will.

Developing a provisional standard for clinical supervision in nursing and health visiting: the methodological trail

The authors outline the process that led to the development of a provisional professional standard for clinical supervision, focusing on design, data collection, and analysis methods. The work was undertaken in an ethos of new paradigm/fifth-generation approaches and used the "manifold of subjective knowing" to gain a holistic understanding of supervisors' experience as represented by experiential, presentational, propositional, and practical knowing. They show how they arrived at the indicators of the standard: Professional Support, Learning, and Accountability. Each of these indicators consists of further elements related to Time, Environment, Relationship (Professional Support), Focus, Knowledge, Interventions (Learning), Organizational Support, Recording, and Competency (Accountability). Findings confirm that clinical supervision practice is complex, and the authors describe proportionally complex methods of analysis.

Executive dialogue: The excellent manager

In an H&HN roundtable, health care human resources executives and consultants examine characteristics of excellent managers and how to identify them in the hiring process.

Assertive outreach teams in London: staff experiences and perceptions. Pan-London Assertive Outreach Study, part 2

BACKGROUND

The job satisfaction, burn-out and work experiences of assertive outreach team staff are likely to be important to the model's sustainability.

AIMS

To describe self-reported views and work experiences of staff in London's 24 assertive outreach teams and to compare these with staff in community mental health teams (CMHTs) and between different types of assertive outreach team.

METHOD

Confidential staff questionnaires in London's assertive outreach teams (n=187, response rate=89%) and nine randomly selected CMHTs (n=114, response rate=75%).

RESULTS

Staff in assertive outreach teams and CMHTs were moderately satisfied with their jobs, with similar sources of satisfaction and stress. Mean scores were low or average for all sub-scales of the Maslach Burnout Inventory for the assertive outreach team and the CMHT staff, with some differences suggesting less burn-out in the assertive outreach teams. Nine of the 24 assertive outreach teams had team means in the high range for emotional exhaustion and there were significant differences between types of assertive outreach team in some components of burn-out and satisfaction.

CONCLUSIONS

These findings are encouraging, but repeated investigation is needed when assertive outreach teams have been established for longer.

Establishing guidelines for employee dress and hygiene

Can you tell your medical practice staff how you want them to look? Where in your office they can eat? Can they chew gum at work? Can they wear red nail polish or a charm bracelet? In the pages that follow, the author suggests not only that you can establish rules for employee dress and hygiene, but why you should. This article suggests several good ways to structure staff rules for wearing uniforms and street clothing. It also covers possible rules for wearing practice nametags, cosmetics, jewelry, hair styles, neatness, stowing of personal possessions, personal hygiene, drinking, eating, smoking, and gum chewing. Finally, this article offers practical suggestions for establishing your practice's dress and hygiene "first aid" kit as well as guidance for making your practice's dress and hygiene codes non-discriminatory.

Productivity and quality patient care

Because of the need to control rising U.S. health care costs, managers today not only must focus on their staff and patients, but also on the business aspects of radiology, such as increasing productivity. Balancing productivity with quality patient care is not an easy task--it requires changes by the entire radiology team, including managers, technologists and radiologists. After completing this article, the reader should be able to: Discuss why health care costs continue to rise. Define productivity, how it can be measured and why it must be measured in today's health care settings. Recognize how patient satisfaction contributes to a health care organization's bottom line. Understand the health care team's role in simultaneously increasing productivity and patient satisfaction.

Sexuality, sexual harassment, and sexual humor: guidelines for the workplace in health care

Sexual humor is common in the health care workplace. However, it may be used inappropriately and present a challenge to the manager. Managers must set appropriate standards for workplace humor. When sexual humor is not effectively handled, legal action may result, which wastes time and money for all involved and damages interpersonal relationships.

Diversity management: an imperative for healthcare organizations

Historically, white males have represented the ideal manager in appearance, values, and behaviors, resulting in overt or subtle discrimination in selection, evaluation, and promotion practices in corporate America. Because women and minorities could not meet this ideal, they were often passed over for advancement. The author discusses key areas of diversity management for healthcare administrators to consider: the elements of diversity, the reasons behind diversity management, and solutions for addressing many of the issues involved.

An integrated analysis of nurse staffing and related variables: effects on patient outcomes

The objective of this article is to synthesize much of the research done on nurse staffing and patient outcomes; the impact of organizational characteristics on nurse staffing patterns, patient outcomes, and costs; and the impact of nurses' experience on patient outcomes. The author concludes research indicates that nurse staffing has a definite and measurable impact on patient outcomes, medical errors, length of stay, nurse turnover, and patient mortality. Moreover, the literature reports data that help determine what is, indeed, appropriate staffing. Ratios are important--a consensus seems to be emerging supporting a range of from 4 to 6 patients per nurse in most acute care hospital inpatient settings, with no more than one to two patients per nurse in areas of high patient acuity. However, ratios must be modified by the nurses' level of experience, the organization's characteristics, and the quality of clinical interaction between and among physicians, nurses, and administrators.

Reasonable accommodations for medical faculty with disabilities

An unknown number of medical school faculty have disabilities, and their experiences have generally escaped notice and scrutiny. Although most medical schools offer long-term insurance and extended leaves of absence for disability, relatively few have policies explicitly addressing accommodations for faculty with disabilities as they perform teaching, research, and clinical duties. We discuss accommodating active medical school faculty with disabilities, drawing on University of Pennsylvania School of Medicine initiatives exploring the concerns of faculty with sensory and physical disabilities. Anecdotal reports suggest that many faculty, fearing reprisals, resist seeking job accommodations such as those mandated in the 1990 Americans with Disabilities Act (ADA). Although some faculty with disabilities have found supportive academic mentors, others report that lax institutional enforcement of ADA requirements, including physical access problems, demonstrates a tepid commitment to disabled staff. Potentially useful job accommodations include adjusting timelines for promotion decisions; reassessing promotions requirements that inherently require extensive travel; improving physical access to teaching, research, and clinical sites; and modifying clinical and teaching schedules. Faculty with disabilities bring identical intellectual and collegial benefits to medical schools as their nondisabled counterparts. In addition, they may offer special insights into how chronic illness and impairments affect daily life.

Nursing shortages and evidence-based interventions: a case study from Scotland

In this report, key aspects of change in the labour market for nurses in Scotland are examined, and an integrated policy framework intended to improve nurse recruitment, retention and utilization is outlined. The purpose of this article is to provide an overview of the dynamics of the nursing labour market in Scotland and to draw some more general messages from the evidence base on the effectiveness of interventions to improve recruitment and retention of nursing staff. The paper has three main elements: it provides a backdrop of key trends in the Scottish nursing labour market; it summarizes issues related to planning and nursing shortages, including an assessment of the utility of current indicators of recruitment and retention difficulties; and it reviews the main potential interventions to address nurse recruitment and retention difficulties, drawing from key research/evidence from UK and other English language sources. Five main interventions are examined: integrating the planning of the healthcare workforce; improving recruitment; incentives to improve retention; improving staff deployment; and improving utilization/skill mix.

Measuring the quality of supervisor-provider interactions in health care facilities in Zimbabwe

OBJECTIVE

Measuring performance is the first step on the road to improving it. This report presents the results of an exploratory study sponsored by the Quality Assurance (QA) Project to describe and quantify the quality of supervisor-provider interactions in health care facilities in Zimbabwe in 1999. Supervisors were district and municipal nursing officers who are responsible for guiding, assisting, and motivating health providers at government and missionary health facilities.

DESIGN

The study's design was qualitative. It involved the triangulation of data from various sources: structured observations of supervisors, audiotaping of supervisor-provider interactions, recording of all supervisory activities, and interviews with supervisors and supervisees. A team composed of current and past supervisors, along with researchers, determined the supervisory practices that would be measured.

STUDY PARTICIPANTS

Sixteen district-level government, municipality, and Zimbabwe National Family Planning Council supervisors from four provinces participated in the study.

RESULTS

The study found that supervisors devoted <5% of their time to patient care issues. The supervisors' main strengths were in giving feedback on technical standards, discussing and analyzing data, and developing a rapport with the providers. They were most deficient in making suggestions, seeking client input, problem solving with the providers, and building on previous (and future) supervisory visits. None of the supervisors observed achieved the threshold set in advance by the team for exemplary performance.

CONCLUSION

The study concludes with recommendations to the Ministry of Health and Child Welfare on how the quality of supervision in Zimbabwe could be improved.

When bad implementations happen to good systems

Successful technology implementation requires thorough, consistent change management.

High-quality healthcare workplaces: a vision and action plan

Looking into a future marked by intense competition for talent, growing numbers of employers are striving to create "workplaces of choice." Yet, despite the consensus that health human resources are a vital piece of the healthcare reform puzzle, few health service organizations have developed comprehensive strategies to address work environment issues. The cumulative impact of years of cost-cutting, downsizing and restructuring have left Canada's healthcare workforce demoralized, overworked and coping with working conditions that diminish both the quality of working life and organizational performance.

A framework for effective training for supervisors

The purpose of this paper is to identify the key theoretical and empirical considerations that should underpin effective training for supervisors. Decisions about the content of training courses are complex because there is no appropriate model of supervision in medicine. This paper argues that, in the absence of an explanatory model, effective training for supervisors should be based on existing relevant understandings about learning processes and models of supervision, together with relevant empirical data. It explores some useful models of supervision, considers helpful aspects of theories about learning from experience and identifies some relevant empirical findings to identify some key theoretical and empirical considerations that should underpin effective training for supervisors. This paper offers a framework, derived from both empirical and theoretical work, to guide the content of effective supervision training courses. It does not prescribe structure or organization of training but suggests a basis for devising specific courses for response to local needs.

A strategy for improving nurse retention and recruitment levels

A nursing shortage in one trust prompted a full investigation into the retention and recruitment of nurses. Workload, staffing levels, skill mix and working conditions were all problem areas for staff. The project highlighted the need to support the development of strong nurse leadership within each of the trust's directorates and to create more educational opportunities for staff.

Conducting a hospital maintenance department survey

Maintenance Department employees can be your friends and allies or the source of your biggest headaches. By working with maintenance personnel, the securing of maintenance areas can be made a lot easier.