Improving healthcare service quality through performance management

PURPOSE

Healthcare service quality in the USA has gained importance under value-based payment models. Providing feedback to front-line staff is a vital component of managing service performance, but complex organizational dynamics can prevent effective communication. This work explored the performance management of appointment desk staff at Mayo Clinic Arizona, identified barriers to effective management and sought to standardize the process for monitoring service performance.

DESIGN/METHODOLOGY/APPROACH

Multiple data sources, including qualitative inquiry with 31 employees from the primary care and surgery departments, were used. The research was conducted in two phases - facilitated roundtable discussions with supervisors and semi-structured interviews with supervisors and staff six months after implementation of service standards. Participants were probed for attitudes about the service standards and supervisor feedback after implementation.

FINDINGS

While all staff indicated a positive work environment, there was an unexpected and pervasive negative stigma surrounding individual feedback from one's supervisor. Half the participants indicated there had been no individual feedback regarding the service standards from the supervisor. Presenting service standards in a simple, one-page format, signed by both supervisor and the patient service representative (PSR), was well received.

ORIGINALITY/VALUE

Combining rapid-cycle quality improvement methodology with qualitative inquiry allowed efficient development of role-specific service standards and quick evaluation of their implementation. This unique approach for improving healthcare service quality and identifying barriers to providing individual feedback may be useful to organizations navigating a more value- and consumer-driven healthcare market.

Career orientation and its impact factors of general practitioners in Shanghai, China: a cross-sectional study

OBJECTIVES

To understand the career orientation and impact factors of general practitioners (GPs) in Shanghai.

DESIGN

A cross-sectional study was carried out from August 2014 to December 2015 using the Career Orientations Inventory (short form).

SETTING AND PARTICIPANTS

We conducted a cross-sectional study of 1159 GPs, of which 1067 (92.06%) completed the assessment tools, from 223 community healthcare centres in Shanghai RESULTS: The top career orientation was organisational job security (71.60%), followed by technical competence (12.18%). Compared with female GPs, male GPs scored higher in managerial competence (p<0.001), creativity and entrepreneurship (p<0.001), and lower in organisational job security (p=0.034). Compared with GPs younger than 40, those aged 40 years and older scored higher in sense of service (p=0.003) and lower in autonomy (p=0.022) and lifestyle integration (p=0.039). Compared with GPs with lower education levels, those with at least a bachelor's degree scored higher in managerial competence (p=0.001 and autonomy (p=0.025). In addition, those with fewer than 10 years of work experience scored higher in managerial competence (p=0.008) and scored lower in geographical security (p=0.032) compared with GPs with longer durations of work experience. GPs with senior professional positions scored higher in technical competence (p=0.012) compared with those with lower professional positions.

CONCLUSIONS

The search for job stability and the lack of career prospect planning are two factors that impact community GP growth. Individualised skills training and career development planning should be provided to GPs of specific genders, educational background and vocational competence, in order to enhance their job satisfaction and service quality, thereby achieving retention of this staff group.

An assessment of a performance-based management agreement initiative in Ghana's health service

BACKGROUND

As part of its efforts to improve efficiency, accountability and overall performance, the Ghana Health Service (GHS) introduced annual Performance-based Management Agreements (PMAs) in the year 2013. However, no assessment of this initiative has since been made in order to inform policy and practice. This paper provides an assessment of this policy initiative from the perspective of managers at various levels of service implementation.

METHODS

Mixed methods were employed. Questionnaires were administered to managers through an online survey (using Google forms). Descriptive and inferential statistical methods were used to analyze and present quantitative results while qualitative data was analyzed via thematic analysis.

RESULTS

The content and objectives of the PMAs were observed to be comprehensive and directed at ensuring high performance of directorates. Targets of PMAs were found to be aligned with overall health sector objectives and priorities. The directors felt PMAs were useful for delegating task to subordinates. PMAs were also found to increase commitment and contributed to improving teamwork and prudent use of resources. However, PMAs were found to lack clear implementation strategies and were not backed by incentives and sanctions. Also, budgetary allocations did not reflect demands of PMAs. Furthermore, directors at lower levels were not adequately consulted in setting PMAs targets as such district specific challenges and priorities are not usually factored into the process. Insufficient training of staff and lack of requisite staff were key challenges confronting the implementation of PMAs in most directorates. Weak monitoring and evaluation was also observed to significantly affect the success of PMAs.

CONCLUSION

There is the need to address the weaknesses and improve on the existing strengths identified by this assessment in order to enhance the effectiveness of PMAs utilization in the Ghana health service.

Development and validation of an instrument to measure and manage organizational process variety

Organizational processes vary. Practitioners have developed simple frameworks to differentiate them. Surprisingly, the academic literature on process management does not–it typically strives for one method to manage all processes. We draw on organizational information-processing theory to systematically develop a new, theoretically motivated classification model for organizational processes. We validate this model using survey data from 141 process practitioners of a global corporation. We derive three distinct types of processes and demonstrate that an understanding of process variety based on process dimensions can differentiate processes better than existing frameworks used in practice. Our findings can enable process managers to make informed decisions and serve as a basis for contingent process management.

International Nursing: Nurse Managers' Leadership and Management Competencies Assessed by Nursing Personnel in a Finnish Hospital

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

Views from the front line: is the NHS workforce at crisis point?

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a report revealing that hospital doctors are concerned about their ability to deliver safe patient care over the next 12 months.

An investigation of perceptions of programme quality support of adult basic education programmes

This study was designed to identify the degree to which the directors of adult basic education programs perceive they have program quality support, as evidenced by a well-defined mission and role in the community, a management system, human resources management, and a suitable learning environment. NSCALL's Evidence-based program self-assessment (2006) was modified and administered electronically to administrators of adult education programs in a mid-southern state. Findings indicated that most directors perceive they are implementing the indicators of program quality support in all of the areas surveyed. A research-based annual self-study that considers the quality indicators is recommended, leaving a need for an update to the NCSALL assessment for use as a program assessment instrument.

Evaluating Transformational Leadership Skills of Hospice Executives

Health care is a rapidly changing environment requiring a high level of leadership skills by executive level personnel. The hospice industry is experiencing the same rapid changes; however, the changes have been experienced over the brief span of 25 years. Highly skilled hospice executives are a necessity for the growth and long-term survival of hospice care. This descriptive study was conducted to evaluate the leadership skills of hospice executives. The study population consisted of hospice executives who were members of the state hospice organization in Ohio and/or licensed by the state (88 hospice providers). Three questionnaires were utilized for collecting data. These questionnaires collected data on transformational leadership skills of participants, participants’ personal demographics, and their employer’s organizational demographics. Forty-seven hospice executives responded (53%). Key findings reported were high levels of transformational leadership skills (mean, 3.39), increased use of laissez-faire skills with years of hospice experience ( P = .57), and positive reward being a frequent leadership technique utilized (mean, 3.29). In addition, this was the first study of leadership skills of hospice executives and the first formal collection of personal demographic data about hospice executives.

A Model of Supervisor Decision-Making in the Accommodation of Workers with Low Back Pain

Purpose To explore supervisors' perspectives and decision-making processes in the accommodation of back injured workers. Methods Twenty-three semi-structured, in-depth interviews were conducted with supervisors from eleven Canadian organizations about their role in providing job accommodations. Supervisors were identified through an on-line survey and interviews were recorded, transcribed and entered into NVivo software. The initial analyses identified common units of meaning, which were used to develop a coding guide. Interviews were coded, and a model of supervisor decision-making was developed based on the themes, categories and connecting ideas identified in the data. Results The decision-making model includes a process element that is described as iterative "trial and error" decision-making. Medical restrictions are compared to job demands, employee abilities and available alternatives. A feasible modification is identified through brainstorming and then implemented by the supervisor. Resources used for brainstorming include information, supervisor experience and autonomy, and organizational supports. The model also incorporates the experience of accommodation as a job demand that causes strain for the supervisor. Accommodation demands affect the supervisor's attitude, brainstorming and monitoring effort, and communication with returning employees. Resources and demands have a combined effect on accommodation decision complexity, which in turn affects the quality of the accommodation option selected. If the employee is unable to complete the tasks or is reinjured during the accommodation, the decision cycle repeats. More frequent iteration through the trial and error process reduces the likelihood of return to work success. Conclusion A series of propositions is developed to illustrate the relationships among categories in the model. The model and propositions show: (a) the iterative, problem solving nature of the RTW process; (b) decision resources necessary for accommodation planning, and

Core Values and Evaluation Processes Associated with Academic Tenure

This study replicated the 1989 national study by the Carnegie Foundation for the Advancement of Teaching in which the relative importance of teaching, scholarship, and service in tenure decisions was examined. The deans of the National League for Nursing accredited programs (N= 187) and deans of Allied Health programs belonging to the Association of Schools of Allied Health Professions (N=75) were surveyed to identify the core values and evaluation processes used in granting tenure. Most deans who participated stated it is difficult to achieve tenure in the absence of publication in refereed journals. The number of journal publications, reputation of the journal, presentation at scientific conferences, and published reviews of the scholars' books are considered critical in granting tenure. Furthermore, advising students, service in the department and university, and course evaluation by students were considered critical to granting tenure. Overall, the opinions of the nursing and allied health deans on the core values and the evaluation processes used in tenure decisions were similar, but divergent from those of the "health sciences" faculty members in the Carnegie Foundation study. These findings suggest a shift in the criteria used in tenure decisions today.

District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study

BACKGROUND

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs).

METHODS

This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews.

RESULTS

The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs.

CONCLUSIONS

The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Occupational health management system: A study of expatriate construction professionals

Due to its direct impact on the safety and function of organizations, occupational health has been a concern of the construction industry for many years. The inherent complexity of occupational health management presents challenges that make a systems approach essential. From a systems perspective, health is conceptualized as an emergent property of a system in which processes operating at the individual and organizational level are inextricably connected. Based on the fundamental behavior-to-performance-to-outcome (B-P-O) theory of industrial/organizational psychology, this study presents the development of an I-CB-HP-O (Input-Coping Behaviors-Health Performance-Outcomes) health management systems model spanning individual and organizational boundaries. The model is based on a survey of Hong Kong expatriate construction professionals working in Mainland China. Such professionals tend to be under considerable stress due not only to an adverse work environment with dynamic tasks, but also the need to confront the cross-cultural issues arising from expatriation. A questionnaire was designed based on 6 focus groups involving 44 participants, and followed by a pilot study. Of the 500 questionnaires distributed in the main study, 137 valid returns were received, giving a response rate of 27.4%. The data were analyzed using statistical techniques such as factor analysis, reliability testing, Pearson correlation analysis, multiple regression modeling, and structural equation modeling. Theories of coping behaviors and health performance tend to focus on the isolated causal effects of single factors and/or posits the model at single, individual level; while industrial practices on health management tend to focus on organizational policy and training. By developing the I-CB-HP-O health management system, incorporating individual, interpersonal, and organizational perspectives, this study bridges the gap between theory and practice while providing empirical support for a systems view of health management.

Is the Annual Confidential Report system effective? A study of the government appraisal system in Gujarat, India

BACKGROUND

Effective performance appraisal systems can not only motivate employees to improve performance but also be important for the performance of organizations. However, the appraisal systems in civil services called the Annual Confidential Report (ACR) systems can be ineffective and do not contribute to employees' learning and development. With this background, the current study aimed at understanding the ACR system and assessing its effectiveness. The research aims to contribute in filling the knowledge gap in the existing literature on the need as to why the ACR system in civil services is an important human resource management (HRM) function.

METHODS

The analysis is based on policy review to understand the extant appraisal-related rules and policies. Nineteen in-depth interviews with medical officers (MOs) working with the government health department of Gujarat, India, were conducted. The main objective of the research was to assess the effectiveness of the actual appraisal system called or referred to as the ACR as perceived by MOs. Thematic framework approach was used to analyze qualitative data using NVIVO 9. Themes were built around five features of an effective appraisal system, i.e., purpose, source, feedback quality, link of the ACR system with other human resource functions, and administrative effectiveness.

RESULTS

The five features of the effective appraisal system studied in the current research (purpose, source, feedback quality, link of ACR system with other HRM functions, and administrative effectiveness) indicate that the overall appraisal system is ineffective. The overall appraisal system was perceived to be subjective and one directional in character by the study respondents. Furthermore, respondents perceived the appraisal system to be a ritual and where MOs hardly got to know about their performance, especially good performance. Hence, the feedback loop, an important feature for an effective appraisal system, was absent. The overall ACR system functions in isolation with no link to other HRM functions such as training and counselling, and a weak link with salary administration and promotion.

CONCLUSIONS

Addressing the five features or domains of an effective appraisal system can lead to improved perceived fairness MOs have on the current appraisal system which may further influence the satisfaction and motivation positively. Improved motivation and satisfaction with the appraisal system can influence two important human resource for health-related outcomes, i.e., performance and retention.

The crossover of psychological distress from leaders to subordinates in teams: The role of abusive supervision, psychological capital, and team performance

This study examines the underlying mechanism of the crossover process in work teams. Drawing on conservation of resources theory, we hypothesize that a leader's psychological distress positively influences subordinates' psychological distress through abusive supervision. We further hypothesize that team performance attenuates the association between a leader's psychological distress and abusive supervision. In addition, we expect that psychological capital attenuates the positive relationship between abusive supervision and subordinates' psychological distress. Participants were drawn from 86 business teams, and multisource data were collected. The hypotheses were tested with multilevel analysis. Results supported the crossover of psychological distress from leader to subordinates, and abusive supervision serves as a mediating mechanism. The positive relationship between a leader's distress and abusive supervision is stronger when team performance is lower. In addition, the positive relationship between abusive supervision and subordinates' psychological distress is stronger when subordinates' psychological capital is lower.

Evaluation of a youth agency's supervision practices: A mixed-method approach

This research presents the findings from an evaluation and organizational development initiative that was requested by a Canadian youth agency working in a large urban setting. A team of four researchers affiliated with the Center for Research on Educational and Community Services (CRECS) at the University of Ottawa conducted the evaluation. The purpose of the evaluation was to identify the supervision needs and challenges of coordinators and front line staff, assess the efficiency of the current supervision practices, and evaluate the supervisors' and supervisees' satisfaction with these current practices. A literature review was performed to help provide a clear definition of 'supervision' and the different professional roles it encompasses. Additionally, research evidence pertaining both to what contributes to supervision efficacy and supervisor competency was reviewed to distill the most robust findings in the existing literature. The lines of evidence consisted of a document and file review, an online employee survey, group discussions (i.e. focus groups), and interviews with key informants. The results of the evaluation helped the research team formulate recommendations to the agency for the development of enhanced supervision practices across its various service areas.

Perceived clinical skill degradation of Army family physicians after deployment

BACKGROUND AND OBJECTIVES

Deployment away from regular clinical practice is necessary for Army family physicians, but no current information identifies specific procedures or clinical encounters where they feel less comfortable after deployment. This study identifies specific clinical areas and amount of perceived degradation in skills after deployment to combat zones.

METHODS

Active duty Army family physicians were invited to participate in a web-based and anonymous survey rating comfort level performing clinical encounters or procedures prior to and after military deployment. Participants rated their comfort level using a 5-point Likert scale. The analysis included descriptive statistics about each physician's deployment history. The composite data for each clinical encounter or procedure were analyzed with McNemar's Chi-Square test.

RESULTS

A total of 179 eligible Army family physicians (54% of total) fully completed the instrument, with 39% deploying once and 10% deploying more than five times in their career. Deployments ranged from 1 to >24 months, with 42% having a last deployment of 12 months duration. With statistical significance, providers reported being less comfortable post-deployment with managing first-trimester bleeding, ACLS codes, acute abdominal pain, asthma exacerbations, central line placement, chest pain, COPD exacerbations, CVA/hypertensive emergency, lumbar puncture, neonatal fevers, pediatric codes, sepsis/septic shock, and vaginal delivery. These physicians reported statistically significant increased comfort with the care of major trauma after deployment.

CONCLUSIONS

Family physicians deploying to support combat operations feel less comfortable with critical clinical skills across the spectrum of care. Refresher training could be provided with standardized approach to these needs with a goal of maintaining full scope primary care providers.

Supervisor competencies for supporting return to work: a mixed-methods study

PURPOSE

Line supervisors often play an important role in the return to work (RTW) process; whether they possess the competencies needed to carry out this work effectively is unknown. The aim of this research was to determine the competencies supervisors need in order to facilitate a worker's RTW following absence due to a mental health condition or a musculoskeletal disorder.

METHODS

Supervisors from five Australian industries with high rates of compensable claims participated in focus groups to elicit the knowledge, skills, and personal characteristics required to support returning workers. From a multi-stage analysis of responses, RTW competencies were developed, allocated to clusters of related items, and incorporated into an online survey administered to rehabilitation professionals.

RESULTS

29 supervisors participated in 1 of 5 focus groups. Analysis of focus group data identified 84 generic competencies, eight specific to mental health conditions, and two to musculoskeletal disorders, arranged in 11 clusters. Survey respondents (n = 344) represented a variety of rehabilitation professionals and jurisdictions. Nearly all agreed that supervisors should receive training to support RTW. Over 50 % of respondents rated 90 of 94 competencies as very important or essential. The highest ratings were for competencies relating to personal attributes, knowledge of RTW processes, and empathetic support of the worker.

CONCLUSIONS

Supervisors and rehabilitation professionals perceive effective support of RTW requires supervisors to have a range of knowledge, skills, and personal characteristics. Our competency model should undergo workplace testing to evaluate its validity.

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown. Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.

Managerial practices regarding workers working while ill

Surveillance data indicate that handling of food by an ill worker is a cause of almost half of all restaurant-related outbreaks. The U.S. Food and Drug Administration (FDA) Food Code contains recommendations for food service establishments, including restaurants, aimed at reducing the frequency with which food workers work while ill. However, few data exist on the extent to which restaurants have implemented FDA recommendations. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study on the topic of ill food workers in restaurants. We interviewed restaurant managers (n = 426) in nine EHS-Net sites. We found that many restaurant policies concerning ill food workers do not follow FDA recommendations. For example, one-third of the restaurants' policies did not specifically address the circumstances under which ill food workers should be excluded from work (i.e., not be allowed to work). We also found that, in many restaurants, managers are not actively involved in decisions about whether ill food workers should work. Additionally, almost 70% of managers said they had worked while ill; 10% said they had worked while having nausea or "stomach flu," possible symptoms of foodborne illness. When asked why they had worked when ill, a third of the managers said they felt obligated to work or their strong work ethic compelled them to work. Other reasons cited were that the restaurant was understaffed or no one was available to replace them (26%), they felt that their symptoms were mild or not contagious (19%), they had special managerial responsibilities that no one else could fulfill (11%), there was non-food handling work they could do (7%), and they would not get paid if they did not work or the restaurant had no sick leave policy (5%). Data from this study can inform future research and help policy makers target interventions designed to reduce the frequency with which food workers work while ill.

Voices from the front lines. Four leaders on the cross-border challeng they've faced

Executives on the front lines of managing across borders share their insights: Luc Minguet, of France's Michelin, talks about the importance of cultural training not just for managers taking on assignments abroad but also for local employees who work with colleagues from around the world. He describes how his own experience learning to communicate across cultures reflects the tire-maker's broader practices. Eduardo Caride, of Madrid-based Telefónica, explains how the relatively young multinational is investing in a diverse talent mix as it strives to become a truly global company. Whereas early on, leaders relied on exporting Spanish managers abroad, he notes, the street now runs both ways. Takeo Yamaguchi, of Japan's Hitachi, details his efforts to create standardized global HR systems and processes across the conglomerate's 948 separate companies. "Three years ago, we had no systematic way of tracking employees, evaluating performance, or identifying future leaders," Yamaguchi says. "Today we do." And Shane Tedjarati, from the United States' Honeywell, talks about how the industrial powerhouse is shifting its strategy toward new regions, such as China, India, vietnam, and Indonesia. "We call these markets 'high-growth regions' instead of emerging markets," says Tedjarati, "because they now account for more than half of Honeywell's total growth."

West Virginia nursing homes: are they up to the standard?

Quality measurement and performance monitoring are under continuous assessment in Nursing Homes (NH). Through this research project we assess the quality of care provided in the NH in the state of West Virginia by publicly accessible quality measurements. The methodology for this research study was through the retrieval of data from the Nursing Home Compare website in which a total of 80 NH were located and analyzed. The results demonstrate that more than 50% of NH in West Virginia are at or above the national average when compared using the Five Star Rating System by CMS, in overall rating (59%), health inspections (57%), nursing home staffing (63%) and quality measures (55%). Contrary to the prevailing reputation, the nursing homes of West Virginia are at or above the nation's average in overall rating, health inspections, nursing home staffing and quality measures.

Safety intelligence: an exploration of senior managers' characteristics

Senior managers can have a strong influence on organisational safety. But little is known about which of their personal attributes support their impact on safety. In this paper, we introduce the concept of 'safety intelligence' as related to senior managers' ability to develop and enact safety policies and explore possible characteristics related to it in two studies. Study 1 (N = 76) involved direct reports to chief executive officers (CEOs) of European air traffic management (ATM) organisations, who completed a short questionnaire asking about characteristics and behaviours that are ideal for a CEO's influence on safety. Study 2 involved senior ATM managers (N = 9) in various positions in interviews concerning their day-to-day work on safety. Both studies indicated six attributes of senior managers as relevant for their safety intelligence, particularly, social competence and safety knowledge, followed by motivation, problem-solving, personality and interpersonal leadership skills. These results have recently been applied in guidance for safety management practices in a White Paper published by EUROCONTROL.

HIPPA compliance for vendors and suppliers

Between 30 to 45% of breaches in Protected Health Information (PHI) involve vendors, yet in most cases it is the hospital that is held liable for the breach. In this article, the author explores the practice of relying on vendors to conduct their own background checks of employees they assign to hospitals. He provides guidance on how hospitals can insure that such checks are up to the standards of the hospital's own background procedures without taking over that responsibility from vendors.

Building effective workforce management practices through shared governance and technology systems integration

In integrated delivery networks (IDNs) with complex management structures, shared governance in nursing is a proven model for health care delivery. After Advocate Health Care, the largest IDN in Illinois, implemented shared governance in its nursing, clinical, and non-clinical departments and restructured the organization's technology use, it benefited greatly from a new, shared decision-making process. After listening to business consultants, clinical professionals, and information technology experts, hospitals should take the blended, or comprehensive, approach to new projects. They can succeed by promoting communication supported by an integrated computer platform that helps nursing and business executives reach a consensus. Traditional modes of operation, in which individual administrative, clinical, and technology departments separately introduce innovation, do not deliver an advantage. However, models that incorporate open communication, integration, and knowledge sharing will help large IDNs and other complex health care organizations make the best possible use of their resources and investments.

How do you manage early or late clock-ins?

My current practice has historically been very strict with hourly employees. The workday is 8:30 a.m. to 5 p.m. for most employees. They are to clock in and out at exactly those times unless overtime has been approved. (Staff working with late patients are exempt.) My business manager is constantly fighting over clock-ins 15 to 20 minutes early or late, with similar clock-outs. Staff may have a stop to make and would like to make up those 15 minutes. We do grant paid time off in an initial minimum block of 30 minutes to assist with some of this. ... The issue is not overtime, as we're well aware that we have to pay for it when appropriate. It's simply to streamline our policy and make it fair. ... I'm looking for practice policies that deal with employee variances from the 8 a.m. to 4:30 p.m. clock-ins. For example, someone wants to come in 30 minutes early in order to leave 30 minutes early for an appointment. Or someone comes in 22 minutes late due to traffic and wants either to make it up or to take the minimal half-hour paid-time-off time.