Background checks: coming up short

In this article, the author spells out the flaws and omissions in the way background checks are conducted, especially by hospitals. He provides pointers on avoiding these flaws and their potential costs.

Accountable care organizations: legal concerns

The Accountable Care Organizations (ACOs) shared savings program has serious concerns about anti-trust and anti-fraud laws. Additionally, ACOs present several other legal concerns relating to the duties and responsibilities of the physician-hospital partnership. The federal regulations hold physicians who participate in the ACO shared savings program to the highest standards of care without offering them protection from liability. The structure and procedures required of ACOs may be detrimental and may significantly impact the liability of its contracting physicians. Therefore, it behooves physicians to obtain legal advice regarding one's estate planning and legal asset protection or wealth management techniques, and to thoroughly review the agreement with one's attorney before signing a contract with an ACO.

Is your hospital safe? Disruptive behavior and workplace bullying

The author defines disruptive behavior; distinguishes among disruptive, impaired, and incompetent behavior; describes the prevalence of disruptive behavior; and identifies some recommendations to prevent and resolve disruptive behavior in hospitals. The proactive prevention and management of workplace bullying have implications on managing costs, quality, and satisfaction in hospitals among patients, families, staff, and physicians. The author describes an evidence-based framework and recommends that hospital administrators use it to design an organizational approach to promoting a work environment that is psychologically and physiologically safe and that enables staff to focus on delivering high-quality, cost-effective, and satisfying care.

Mental health. 'Death by a thousand pin pricks'

People with mental health problems are subject to a variety of prejudices and inequalities affecting everything from promotion opportunities to social lives. Awareness campaigns in England have been hampered by a lack of funding while better-funded initiatives in Scotland and New Zealand have enjoyed wider success. Tackling stigma will only be effective if backed by legislation.

Resident duty hours in American neurosurgery

The unexpected death of Libby Zion, at New York Hospital in 1984, led to a series of investigations that recently resulted in profound changes in resident duty hours. On July 1, 2003, the Accreditation Council for Graduate Medical Education (the governing body of all residency programs in the United States) mandated the following work hours rules: no more than 80 hours per week, no more than 24 hours of continuous patient care (with an added 6-hour transition period), 1 day in 7 free of patient care responsibilities, and a minimum of 10 rest hours between duty periods. These rules are based on a considerable body of scientific study indicating that sleep loss affects cognitive performance and, possibly, patient care. The new work hours have stimulated vigorous debate, both pro and con. Those arguments are reviewed.

[Physicians working part-time]

In order to ensure the best possible medical care and high-quality research, hospital medical staff must be well educated and highly motivated. Part-time work can help to provide good human resources. Moreover, part-time jobs are often necessary as a means of juggling work and family responsibilities. The aim of this study was to illustrate the legal and educational groundwork for part-time work for physicians in Austria and to outline the advantages and drawbacks of part-time work. In March 2003, all medical doctors working part-time at hospitals in the Austrian state of the Tyrol (n = 60) were surveyed by means of a written questionnaire with the aim of finding out their motives for taking a part-time job as well as the positive and negative aspects involved. The response rate was nearly 70% (n = 40). Most of the part-time hospital physicians were female. The vast majority chose part-time employment in order to better balance family and job. Problems involved in part-time work are legal issues (part-time employment does not always qualify for medical training), the comparatively low salary and the fewer career opportunities. All respondents agreed that patient care, teaching and research are not compatible on a part-time basis. Another negative aspect is the generally strong time pressure experienced in part-time jobs. Despite these negative aspects of working part-time, advantages are considered more important, especially the better balancing of job and family and the possibility of an important early professional reintegration. Better acceptance of part-time jobs would help to make part-time work more attractive. An important improvement is associated with the forthcoming changes in the laws governing part-time work and medical training.

Improving human resource management in Chinese healthcare: identifying the obstacles to change

Health sector reform in China has led to increasing responsibility for hospital managers in the management of staff,but constraints continue. New personnel reforms offer new opportunities but face a number of difficulties. Drawingon research in Chinese hospitals in 1997 this paper identifies two major obstacles to improved human resourcemanagement: wage policy and lack of control by local managers over staffing.

Protect your facility and staff with effective discipline and termination

Minimize the effects of disciplinary action and termination with well-designed policies and procedures.

Violence: the duty of the employer and remedies by the employee

May, a ward sister in the accident and emergency department, was on duty at the weekend when a patient was brought in by two friends. It was clear that they had all been heavily drinking. It appeared that the patient had serious injuries following a fall. She attempted to arrange for the patient to be taken into a cubicle, but in so doing was struck by one of the friends and suffered a serious blow to her face. What rights does she have in law?.

At-will employment doctrine--are patient care employers vulnerable?

This article analyzes the importance of changes in the at-will rule of employment law to hospital and other health care employers. A survey of wrongful termination cases brought against health care defendants is presented, and recommendations as to employment procedures are made.

Employment references: walking scared between the minefield of defamation and the specter of negligent hiring

In present day reference checking, many of the same organizations that seek as much information as possible about people they wish to hire resist giving out more than a bare minimum of information to other organizations. The strongest force driving this minimal reference information release is fear of legal action taken because of something said about an individual (defamation, supposedly). Many employers appear so frightened of being sued for libel or slander that they share nothing of substance, usually not realizing that in trying to protect themselves against defamation charges they are increasing their legal risk associated with negligent hiring charges. However, truthful reference information can be provided with minimal risk if it is provided in good faith, given only to someone who has a legitimate need to know, is related strictly to job in character, and is not communicated maliciously. Also, reference always must be answered completely objectively with information verifiable in the individual's personnel file.

Verbal abuse

The Health and Safety Executive includes verbal abuse in its definition of work-related violence (HSE 1997). Verbal abuse is 'any remark made to or about a client which may reasonably be perceived to be demeaning, disrespectful, humiliating, intimidating, racist, sexist, homophobic, ageist or blasphemous'. Examples include making sarcastic remarks, using a condescending tone of voice or using excessive and unwanted familiarity (UKCC 1999).