An advocacy group for older workers believes Gray-Americans can fill a big role in the solution to the healthcare staffing shortages that are plaguing the nation.
Cynthia Metzler, president and CEO of the Arlington, VA-based nonprofit Experience Works, says older workers—generally considered to be people age 50 or older—are excellent candidates to fill any number of jobs in the healthcare arena, including staffing medical, clerical, and administrative positions.
Why?
Well, for starters, there's a potentially large applicant pool, and it's getting bigger every day. In 2006, 37 million Americans were 65 or older. By 2030, that population will grow to 72 million, according to U.S. Census Bureau projections. Of course, that aging population will include the doctors, nurses, and other healthcare professionals practicing today.
Gray-Americans also tend to stay put. Once they get a job, they are far less likely to move elsewhere. And, Metzler says that contrary to popular belief, older workers aren't a significantly larger liability or health insurance risk because they tend to be more careful on the job.
And, they want to work, Metzler says. Fully one-third of retirees reenter the work force, usually because they need the money. Metzler says older Americans also possess a sense of pride and identity that comes with the job.
So, what's the holdup?
Metzler says one of the biggest obstacles against older workers is an unintentional ageism that relies on an out-of-date demographic. "It's a mindset that we've carried over from the last 20 years, a mindset that modern demographics won't allow to continue," Metzler says. "In many parts of the country you have a population that is aging in place and there aren't enough younger people coming along to satisfy those current job needs." Hospitals, physician groups, and other healthcare entities must understand the potential for these older workers, Metzler says.
Yes, it's unlikely that a 55-year-old person will go to medical school. However, that person may have a BS degree, and could possibly become a nurse's assistant or even an RN with a couple years of school and training.
Despite Metzler's enthusiasm, there are legitimate concerns that older workers might not be up to the physical demands that nursing requires. After all, we are hearing plenty of stories about nurses in their mid-40s who quit the field because of physical and emotional exhaustion.
Metzler says the physical demands of nursing and other healthcare jobs can be mitigated with a little planning. "Look at the jobs as they have been historically designed and see if they have to remain that way moving forward," she says. "Yes, somebody is going to have to be strong enough to move a patient, but I'm not sure that everybody on the ward needs to be able to do that."
So, there will have to be some adjustments made in the hiring process and job parameters if older Americans are to have a part.
"It has to be an attitude of looking at everybody based on skills and life experiences and potential," says Metzler, "and not have filters because somebody may have gray hair."
John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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Regardless of the outcome of this presidential election or other political agendas, the healthcare system of this country, which has been described by most industry observers as in crisis, is poised for significant change. One of the primary problems associated with healthcare is related to cost. Not only are healthcare costs significantly greater in the United States than other industrialized countries, but they continue to increase. The chairman of the Federal Reserve Board, Ben Bernanke, recently noted that healthcare represents about 15% of this country's gross domestic product and with similar growth will represent 22% by 2020 and 50% by 2050. This projected growth could have a devastating impact on the United States.
A compounding issue is related to population growth, as well as, increased life expectancy. The report, "Health, United States," by the National Center for Health Statistics indicated that life expectancy at birth has increased from 47.3 years in 1900 to 77.8 years in 2004. As our population lives longer, more healthcare resources are necessary, which increases demand for these resources. The baby-boomers have also begun to reach traditional retirement ages. The increase in demand for healthcare coupled with an increase in healthcare costs are the primary issues precipitating this crisis in our healthcare system.
The effective application of information technology has been suggested as a potential mitigating factor for this anticipated crisis. Leadership competence in information technology is crucial and can be enhanced through the adoption and application of an appropriate leadership style, such as transformational leadership.
Transformational leadership
This leadership model is described as a process in which followers trust, admire, and respect their leader, and are consequently motivated to do more than they were originally expected to do. The concept of transformational leadership was introduced by J.M. Burns in 1978 and enhanced my B.M. Bass in 1985. The four components of transformational leadership are charisma, inspiration, individual consideration, and intellectual stimulation.
Charisma. Transformational leaders motivate workers to exceed established performance standards and to transcend their self-interest for the good of the organization. For this to happen, workers must identify with their leader's values and vision of the future. This process is dependent on the leader's concern for workers in return for their trust. Transformational leaders can change an organization by identifying the need for change, articulating a new vision, and generating commitment to the new vision.
During the early part of the 20th century, Max Weber proposed the concept of charisma. Several components of Weber's concept are that charismatic leaders have outstanding traits and skills, they arise during times of crisis, they propose and support extreme solutions to crises, followers are attracted to charismatic leaders because of the inspiration they receive through their relationship with such leaders, and charismatic leaders' gifts are validated through successful experiences. Several personality characteristics are associated with charismatic leaders, including:
They are expressive verbally and physically.
They exhibit self-confidence.
They are self-directed.
They have insight into the needs of their followers and have the ability to use these needs to persuade followers.
They are free of internal conflict.
They are eloquent speakers.
Crises, such as anticipated in the healthcare industry, have been defined as situations that lead to the emergence of charismatic leaders who provide salvation to the people in crisis. People in crisis feel that they have lost control and charismatic leaders bring solutions and order. Successful, stable organizations might not need charismatic leadership. Conversely, failing organizations that must change to survive often need charismatic leadership, and crises need not be chronic to support a charismatic leader.
The followers of charismatic leaders seek fulfillment by association with their leader. By identifying with the leader, these followers can satisfy psychological needs. To gain the leader's approval, the followers meet the leader's high expectations and standards. A sense of responsibility is created by the leader's confidence in the followers.
Inspiration. Inspirational leaders motivate workers to go beyond self-interest. This ability is based on the leaders' capability of communicating a vision that motivates workers. Workers' acceptance of the vision expressed by inspirational leaders is essential. Workers must want to attain the vision, and the desire will change the workers' focus from daily concerns to a vision that stimulates their best efforts. Workers believe that inspirational leaders are:
Sensitive, enlightened, and knowledgeable. Generate pride in the organization.
Demonstrate high levels of activity, self-confidence, and determination.
Have a sense of mission.
Have expectations for high levels of performance.
An important ability for inspirational leaders is conveying the meaning of the organization's vision. These leaders can provide meaning with comparisons to competitors, ideals, goals, the past, traits, and other stakeholders. Inspirational leaders also might use symbols and slogans to help convey meaning, which can be useful for simplifying complex messages.
Inspirational leaders must be conscious of their impression on others because it will determine how they are respected, which will in turn affect their ability to influence. Impression management is important because people determine personal characteristics from limited information. The workers' perceptions of their leaders influence their confidence in the leaders. Leaders can manage the impression they make through their dress, speech, and appropriate connections with those they visibly interact. By managing the impression they make, leaders can make a positive impact on the success of their leadership.
Successful inspirational leaders establish high expectations of worker performance, and workers tend to meet expectations that can be difficult to achieve, but are reasonable. Workers who achieve high expectations also exhibit a sense of purpose that is expressed through strong feelings for the organization, its mission, and its vision. Leaders can increase their probability of success by managing the workers' expectations and sense of purpose.
Inspirational leaders must develop a realistic vision of the future that will motivate workers. The vision provides the goals that direct the activities of the organization. Leaders must be able to communicate the vision in such a persuasive manner that others are willing to commit to it. Successful implementation of a vision requires determination and persistence from leaders.
There are differences between charisma and inspiration. Charisma is related to workers' personal attraction to leaders. Inspiration is related to workers' attraction to a vision. Charismatic leaders may have both a vision and personal attraction for workers. Inspirational leaders do not have the same personal attraction as charismatic leaders, but they articulate a desirable vision.
Individual considerations. Individual considerations are related to interpersonal skills. Leaders exhibit concern for the workers' development through assignments that provide opportunities for growth. Important elements of individual consideration are insight and empathy. Considerate leaders know the developmental needs of each worker and should know what motivates and interests the workers. Through insight and empathy, leaders ensure worker's concern for organizational needs and their adoption of the organization's vision.
Intellectual stimulation. Intellectual stimulation is related to the encouragement for workers to become innovative and creative. It can cause workers to consider situations and issues in new and different ways. Four methods of intellectual stimulation have been identified, and leaders can use any or all of these methods.
Leaders can rationally try to convince workers to solve problems.
Existential leaders identify many possible solutions to a problem. An acceptable solution is developed by appropriately combining elements from the various possibilities.
Leaders might use empirical data gathered from other sources to identify a solution.
Idealist leaders can use intuition with a minimal amount of data to identify solutions to problems.
Transactional leadership
In contrast to transformational leadership, the principal concept in transactional leadership is the exchange that takes place between leaders and followers. Leaders define followers' actions as exchanges for something of value to workers. These leaders establish goals, provide directions, and reinforce behavior with rewards. In general, if the work and the environment do not motivate followers, leaders must provide incentives. This leadership style is defined by the dimensions of contingent reinforcement and management by exception.
Contingent reinforcement. Contingent reinforcement consists of rewards for workers who attain performance goals. The rewards are dependent on the workers' effort and attainment of specified goals. Leaders' behaviors can enhance this process. These behaviors include precise instructions, participation in standards development, support, and consistent performance.
The forms of contingent reward include benefits, praise, and recommendations. Benefits can take several forms such as pay increases, better assignments, a more desirable schedule, or additional time off. To be effective, praise must be based on work well done. Recommendations might take many forms, including additional pay, job advancements, bonuses, and recognition for outstanding job performance.
Management by exception. When leaders practice management by exception, they act on mistakes, faults, and failures to attain performance standards. Workers are informed of these deviations and punishments can be implemented. If performance standards are attained, workers are allowed to continue without additional direction.
Passive management by exception is when leaders take action after the deviations have been identified. Active management by exception is when leaders actively attempt to identify deviations by developing systems and processes to monitor for deviations.
Leadership continuum
Leaders can exhibit both transformational and transactional behaviors. This is especially relevant to healthcare chief information officers due to their need for vision development and execution of informational strategies of the organization. Transformational leadership enhances the effectiveness of transactional leadership; they are not mutually exclusive leadership styles. Transactional leadership satisfies the separate goals of leaders and workers, while transformational leadership ensures the close alignment of these goals.
This crisis of healthcare has been described as a point of inflection. Information technologies will have a significant role as healthcare organizations respond to this crisis, and these leadership styles can help healthcare information technology leaders more successfully address this healthcare crisis.
Larry Barnes is the vice president and chief information officer at Salina (KS) Regional Health Center. He also has a doctorate in management of organizational leadership.
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