Payment reform based on knowledge gleaned from business intelligence and data analytics tools in hospitals and health systems is no longer optional. It's imperative. If you're not up to the task, start lobbying for additional resources now.
Healthcare finance executives are like the knife thrower's assistant who stands rigid while gleaming blades flicker past her head one after the other: declining Medicare reimbursements—phhhffft—falling inpatient volumes—phhhffft—rising expenses—phhhffft.
Each glinting blade threatens to draw blood. Or worse.
The shift from fee-for-service to a value-based payment structure is not only a potential implement of evisceration hurtling toward hospital finance and operations executives, it also means more work for healthcare IT execs.
That's because financial leaders "are trying to set up their organizations to move toward value-based purchasing and shared-risk arrangements… by using business intelligence tools and data analytics to be able to operate in that changing environment," says Healthcare Financial Management AssociationPresident Joe Fifer. He spoke with HealthLeaders in advance of the annual HFMA ANI conference in Las Vegas this week.
"93% of struggling hospitals with continuing negative operating margins confirm they have prioritized capital investments in over the next twelve months in coding, value-based support software, collections, and [revenue cycle management] outsourcing." — Black Book Rankings
But like strongmen straining under a stack of barbells, HIT execs are already struggling to stay on their feet as the weight of MU attestation, EHR implementation and ICD-10 implementation bears down on their quivering legs, backs, and arms.
CFOs realize that there is payment reform-related work that can't wait, and the good ones know that if their IT departments can't get the job done, the next best solution is to outsource it to a group that can.
Outsourcing brings its own headaches, as anyone who has ever paid the neighbor's kid to clear a snowy sidewalk knows. Your idea of "clear" and "sidewalk" and Skippy's may vary significantly.
But the decision to outsource an HIT project shouldn't come with any stigma.
IT leaders should embrace the help, headaches and all. In fact, CIOs and CTOs should lobby for outsourcing. Then they can ensure that the right partnerships are formed. [Vetting vendors and consultants carefully to weed out the Skippys of the world.]
In high-functioning organizations CIOs and CFOs work together to solve problems such as how to improve collections, reduce bad debt, and identify claims denials. Business intelligence and data analytics solutions, such as billing and revenue system implementations and upgrades are too important to be handled as just routine IT projects.
This is true regardless of an organization's size. Take physicians groups. If joining an accountable care organization is leadership's chosen path to fiscal health, then that means investing in an EHR system. The upfront costs can be daunting, even when eventual cost savings generated by the ACO are factored in.
Enter Farzad Mostashari. You'll recall his well-timed departure as National Coordinator for Health IT at the Department of Health and Human Services in 2013. Last week he announced the launch of Aledade, which offers primary care physicians services and technology needed to establish an ACO "with no upfront costs."
One of the company's goals is to "put primary care back in control of health care, with 21st century data analytics and technology tools," says Mostashari on the company's website. Specifically, Aledade offers:
To assist with EHR optimization and workflow design
To provide integrated data and technology platform
Quality reporting (Meaningful Use, PQRS and ACO)
Provider and practice performance benchmarking
Payment reform can't happen without IT, not even at the ACO level.
Whether you're in charge of a large health system's complex data analytics implementation solution or a relatively straightforward EHR system for a small physician's group, the task may feel monumentally challenging. It all depends on your budget, depth of staff, priorities, and deadlines.
If you're challenged, make the case for additional resources. The financial life of your organization—and the health of your own tender neck—may depend on it.
The events leading up to the abrupt closure of a regional hospital in a remote corner of Massachusetts are complicated. But many community hospitals across the country are equally vulnerable, and more will close.
Tucked into the northwest corner of Massachusetts in a valley between the Taconic mountain range to the west and the Berkshires to the east sits the state's smallest city, North Adams.
Cotton, wool, and textile mills fueled the growth of this town generations ago. Today on the sprawling site of one of those industrial complexes, the city boasts a world-class contemporary art museum.Still, incomes are low and jobs are scarce.
Things have been particularly rough lately. Residents endured a mercilessly long winter punctuated by two pronounced arctic blasts. In January, after 170 years, the North Adams Transcript published its last issue. Last week, strong winds and rain toppled the town's cell phone towers, leaving most people without Internet or mobile phone service.
On Friday, events took a turn for the worse.
With only three days' notice, North Adams Regional Hospital, operated by private, not-for-profit Northern Berkshire Healthcare, locked its doors and laid off 500 workers. Now anyone who is sick or hurt and in need of a hospital has to drive over twisting roads for 18 miles north to Southwest Vermont Medical Center in Bennington or 21 miles south to Berkshire Medical Center in Pittsfield, MA. That could be a torturous drive in an emergency, especially in bad weather.
The events leading to the abrupt closure of the hospital and services from the VNA, hospice, and other providers are complicated. What happens next is unclear. Federal and state lawmakers and local officials are scrambling to craft a fix.
Critical Access Death Spiral
This hospital closure is neither unprecedented nor unexpected. Small and isolated hospitals serving rural communities are vulnerable everywhere. More closures will come. In Georgia, one advocate for rural healthcare access bluntly states that critical access hospitals "have about a seven-year death spiral that's a function of the cost-to-charge ratio."
North Adams Regional Hospital is not a CAH, and that may have aggravated its financial distress. CAH designation was not granted because the hospital failed to meet at least two requirements—it is less than 25 miles from the nearest emergency department, and it has 36 inpatient beds, which is above the 25-bed cutoff.
But that special designation is just semantics for the people of North Adams, Williamstown, and other tiny communities in the region. NARH has provided critical access to the people living around it since its founding 129 years ago.
Governor Deval Patrick (D) and Attorney General Martha Coakley (D), a North Adams native, were in the community on Tuesday to fashion a way to allow Pittsfield's Berkshire Health System, which runs a 302-bed community hospital, to reopen and operate the now-shuttered emergency department at NARH.
A letter from Patrick to the community late Tuesday acknowledged that it could take 10 days before emergency services might be restored.
Meetings, church vigils, protests, legal actions, and uncertainty follow years of financial problems at NARH. But workers, many of whom toiled there for decades, didn't see this coming. Neither did members of the community. Patrick said a deal to keep the hospital open looked imminent—until the very end.
Coakley says she'll press for an investigation into the NARH board and its actions. But whether the board acted properly or not is almost beside the point. This hospital has been in financial straits for years. Reports are swirling that it will soon file for Chapter 7 bankruptcy protection.
I'm reminded of these lines from Hemingway's The Sun Also Rises: "'How did you go bankrupt?' Bill asked. 'Two ways,' Mike said. 'Gradually and then suddenly.'"
People without access to healthcare suffer the consequences immediately. Communities sink into their suffering gradually. In the case of North Adams, going from bustling mill town to once-proud mill town took about 130 years.
The root of the hospital's trouble is familiar—dwindling Medicare and Medicaid reimbursements. Ironically, while the price of providing healthcare to low-income populations is steep, withdrawing care is even more costly.
The stunner in this community is not only that the hospital closed its doors, but that it slammed them shut so abruptly. The people who live in the northern Berkshires need access to medical care.
If a CAH designation would keep NARH operating, then it's time to amend CAH requirements. They were written long before thinning Medicare and Medicaid reimbursements and other economic slings started shuttering community hospitals and hurting people who deserve better from their leaders.
Poor coordination among providers, payers, and federal regulators is making it difficult for HR to perform its part in ICD-10 preparation. The strategic way forward is to proactively assess your organization's needs and immediately start recruiting, training, and retaining HIT and coding professionals.
If there isn't a code in the ICD-10 diagnostic code set expressly for the anxiety that comes from trying to comply with specific federal regulatory mandates, there ought to be. And why not? The expansive catalog of codes includes conditions as detailed as being pecked by a chicken (W6133XD) and enduring a prolonged stay in a weightless environment (X52).
Surely the stress of preparing to meet the Oct. 1 deadline for transitioning to the ICD-10 diagnostic code set is an affliction familiar to hospital and health system CIOs, CMIOs, IT directors, and HR staff. It's ironic, perhaps, that the new code set omits a specific reference to the very pain it inflicts. The closest I can find is "reaction to severe stress, unspecified" (F439).
One of the biggest obstacles to meeting ICD-10 compliance requirements is the poor coordination among providers, payers, and federal regulators, says Medical Group Management Association Senior Policy Advisor Robert Tennant. "This is a recipe for disaster if all of these pieces don't come together," he said in a recent interview with HealthLeaders Media.
This chaos makes it difficult for HR to perform its part: recruiting, training, and retaining workers who will get the ICD-10 job done. According to the global talent management firm Tek Systems, "many healthcare organizations do not know exactly what competencies will be required, and to what scale."
If you don't know which competencies your organization lacks and which positions need to be filled, you need a strategy to identify the gaps. One way is to seek a greater understanding of your organization's needs by forging better relationships with the CIO, CTO, and other health information technology leaders.
A Proactive Stance
Don't wait for them to ask for help with recruitment. Ask them to help you identify and anticipate staffing needs as ICD-10 moves through its lifecycle: from preparation to implementation, to training, testing, and into maintenance mode.
Just the training aspect alone requires an HR strategy of its own. Some ICD-9 coders will be lost by attrition. They will have to be replaced with trained ICD-10 coders, and the pool of qualified candidates is not deep (fall into empty swimming pool, initial encounter, W173XXA).
The coders who remain will all need to be trained, which will, for a time, slow productivity and further strain resources. Your organization may need to bring in temporary coding staff and remote workers to make up for the lag (slowness and poor responsiveness, R464).
And depending on the size of your organization, HR may be tasked with securing training resources and documenting employee certifications (other physical and mental strain related to work, Z566.)
The Consequences of Not Being Prepared
The consequences of not having a workforce that's fully prepared cannot be understated. First, organizations that fail to comply with the ICD-10 mandate face the possibility of federal fines.
Potentially worse is the loss of revenue stemming from lower payments associated with coding errors. Every bill that is incorrectly coded opens the door to a financial loss.
HR's power to affect revenue is often overlooked. This is an opportunity for HR leaders to re-assert that power. Pointing out skill and resource gaps and filling them before revenue loss is felt is the kind of leadership story that strengthens teams, builds careers, and in extreme cases could make or break an organization.
Act Now, Don't Delay
The ICD-10 deadline has already been postponed for a year, and it's probably not out of the question that it could be delayed again. But don't bet on it. The negative consequences of under-preparedness are too great, and could lead to many sleepless nights for healthcare executives (nightmare disorder, F515)
Instead, get out in front of your organization's ICD-10 needs now. Any extra time CMS grants providers and payers will be a bonus. Failure to do so could result in a code Z565.
Has your organization resolved to be a better place to work in 2014? Good for you. Now what's your strategy?
Do you know the secret to making healthcare organizations a great place to work?
Chris Van Gorder, President and CEO of Scripps Health
That's a trick question. Since no two health systems are exactly alike, there are multiple ways to answer the question. Just look at the diversity of top-ranked systems on the latest list of "Fortune's 100 Places to Work" based on data compiled by Great Place to Work. Twelve hospitals or health systems are on Fortune list published this month. And four are in the top 25. Given that roughly one in five jobs in the U.S. is a healthcare job, that's not bad.
But running Southern Ohio Medical Center, the top-ranking healthcare organization this year and #18 overall, is not the same as running the Mayo Clinic, which came in as the tenth-highest-ranked healthcare organization and #53 overall. SOMC has 2,401 employees and Mayo has 44,297.
But there are some strategies that exceptional workplaces share. Good leaders tailor them to fit.
1. Make Workplace Excellence a Core Metric in Performance Evaluations
Scripps Health has earned a place on Fortune's list for theseventh consecutive year. Chris Van Gorder, president and CEO, says Scripps' effort to be acknowledged as a great place to work goes back many years.
After a couple of early attempts failed to land Scripps a coveted spot on Fortune's list, Van Gorder made workplace quality one of management's four core metrics in performance evaluations, along with patient satisfaction, quality, and financial measures.
The successful effort is driven by Van Gorder's philosophy that healthcare is delivered by people, not technology, which he has been working to instill in the organization’s operations. “My job is to take care of people so they can take care of patients.”
In the early years, Scripps treated the Great Places to Work survey feedback as an independent employee survey. Incorporating the results into the overall planning process was "hit or miss," he says.
Now the takeaways are built into Scripps' organizational planning process. The responses "are about more than money," says Van Gorder, who says he reads every comment. The outcomes from employee comments include:
Lifecycle benefits for employees
Retrofits of aging facilities
Keeping staff informed of changes in healthcare
A fair process for promotions
Career advancement opportunities
"We'll never get everything everybody wants," Van Gorder notes. "You get an extreme response of asking for something ridiculous, and then at the other extreme of someone just being thankful for a job, and everything in between. You take it all in context."
Van Gorder made waves when he announced that Scripps would cut spending by $300 million by 2016—without laying off any of the 12,800 employees. The no-layoff policy "is pretty profound in healthcare or any industry." But he's even more proud of Scripps' seven-year tenure on the list. "The hard job these days is sustaining performance," he says.
2. Make Employee Health and Wellness a Priority You've probably seen the reports about the failure of corporate wellness programs, but the jury seems to still be out. The Great Places to Work survey found that:
Ninety-seven companies on this year's list pick up at least 60% of the cost of employees' annual health care premiums, and 68 pay for 80% or more of those costs.
95% offer flu shots
A majority offer high blood pressure (86%) and cholesterol (84%) health screenings
The tide of favorability on corporate wellness programs may be turning as employees' out-of-pocket healthcare costs continue to ratchet up.
3.Grow Your Own Leaders
If you're offering tuition reimbursement as an employee benefit, good for you and for them. But there's something even better that you could be doing to prepare he next generation of leaders: offer on-the-job training.
While companies on and off the Best Companies list tend to offer the same amount of tuition reimbursement, the top-rated organizations offer nearly double the hours of on-the-job training. Usage of tuition reimbursement programs is shown to be marginally higher at companies not appearing on the list.
Greatness doesn't it come easily. It needs to be backed by a philosophy and a strategy.
Hospital and health system HR departments rarely receive injury reports from surgeons, but the financial consequences—specifically among orthopedic surgeons—are high, and the problem will only worsen as the workforce ages, a study shows.
Workplace injuries in healthcare are not uncommon among nursing staff, who are exposed to needlesticks, back injuries, and even acts of violence.
It's a big problem and it is financially draining. The cost of total workplace injuries in the United States reaches into the billions of dollars annually, when direct costs (medical care) and indirect costs (lost productivity) are factored.
But hospital and health system HR departments rarely receive injury reports from physicians and surgeons, who have an even higher financial impact than RNs. The lack of reporting isn't because physicians aren't getting hurt, though. A study of occupational injury among orthopedic surgeons published in the Journal of Bone and Joint Surgery demonstrates that injuries are not rare.
"Performing orthopaedic surgery requires many hours per week in body positions known to contribute to musculoskeletal injuries," the report states. Among the most physically demanding procedures are total joint replacement of the knee or hip, spine cases, and femur fractures in trauma patients, report author Manish K. Sethi, MD, told me in a phone interview.
The study, based on surveys sent electronically to every orthopedic surgeon in Tennessee (28% of 495 responded), found that:
Manish K. Sethi, MD
44% of surgeons had sustained at least one occupational injury in their career and 10% of respondents missed work due to their injuries
25% reported an injury to the hand, followed in frequency by the lower back (19%), neck (10%) and shoulder (7%)
38% of injured respondents reported no institutional resources available to support them as they recovered
"Some of these injuries were significant, having an impact on operating room performance and causing the surgeon to lose three or four weeks of work," Sethi says in a Vanderbilt University publication.
At 35, Sethi has been a surgeon for a decade, but he has so far evaded any "real injuries." A member of the orthopedic trauma team at Vanderbilt University Medical Center, he does acknowledge some occasional hand stiffness, however.
No Relief via Technology Technologies to alleviate the strain on surgeons' bodies are scarce. Aside from OR tables that apply traction and minimize the physical force a surgeon must exert, there has been "no game-changer in over 50 years," says Sethi.
Somewhat counterintuitively, technological advances that have led to surgeries such as knee arthroscopy increase the risk of injury for surgeons. That's because these surgeries take a toll on the muscles that control fine motor movements, which can cramp and strain from positions such as "holding a camera all day" in the OR, Sethi explains.
Yet surgeons are not inclined to report injuries when they occur. Sethi says that's because surgeons often have independent employment contracts with hospitals that typically do not mention what happens with on-the-job injuries. Surgeons often don't know where to report such issues, he adds. "Most hospitals don't have anything set up" in the way of a formal reporting structure.
Cost Implications I wonder if ego also comes into play. Known for their competitive spirit, surgeons as a group, and orthopedic surgeons in particular, project resilience. It's not hard to imagine that they would prefer to "play hurt" rather than bother with tracking down which OSHA forms to file. That can be costly. According to the report:
"Physician injury has substantial economic consequences as missed work can reduce the supply of orthopaedic care and result in large costs associated with the investments involving training personnel, and overhead in each surgeon."
Because the demand for orthopedic services is expected to grow at an exponential pace at the same time that the workforce is aging, Sethi views the matter as "very serious."
"How do we maintain the health of an aging workforce?" he asks. As surgeons, "we have to start thinking of issues of policy." The report calls on hospitals and health systems to establish occupational safety as an "institutional priority with support from high levels of management."
HR Readiness The financial impact of workforce injuries is clear. Less clear is the reason for the apparent neglect of the matter by hospital and health system executives. Senior HR leaders who take heed of the coming confluence of aging workers and the growing demand for healthcare services have a chance to spare their organizations the negative financial consequences of injured healthcare providers.
They may even put themselves in a position to steal market share from competitors who have not prepared and can't meet the demand for services.
Sure, they're both based in the Bay Area of California. Both are staffed by vigorously active and healthy-looking workers. And both organizations are industry standouts. (Google is almost an industry by itself. The A's have won nine World Series titles, four since the franchise has been in Oakland.)
But the most interesting characteristic they share is how they use data to achieve competitive advantages. Both employ sophisticated data analysis tools to make decisions that move their organizations forward, including staffing decisions.
During Oakland's 2002 season, team manager Billy Beane famously adopted a strategy of making roster decisions based on batting averages, RBIs, and a multitude of other stats, rather than the guesses and gut instinct of scouts.
The result? The team finished first in the American League West that season. Beane's management style took only a few weeks to transform from old school gut-check calls to the data-intensive style recounted in Michael Lewis's bestseller Moneyball and the Brad Pitt film of the same name.
Google, of course, has always been in the numbers business. Some of its massive data projects include the workplace. With Project Oxygen, Google hopes to make better bosses by analyzing data about managers. The company is also delving into workforce data to understand the effectiveness of its own HR strategies and practices.
Can your healthcare organization head down the same path?
2. HR Will Get Out of the Benefits Business, Part I
HR strategists, who are keenly aware of what's happening in the health insurance marketplaces, see the beginnings of a major market upheaval. While employers have been shifting healthcare costs onto workers for years, the real game-changer is on the near horizon: Employers will one not-too-distant-day stop offering commercial health plan policies as part of their benefits packages. Instead they'll provide employees with a financial incentive to use a health insurance exchange to select coverage, much as 401(k) plans have replaced company-sponsored pension plans.
The reason is simple, as explained by MarketPlace Money: it's money. "… [S]ome employers who have tried this have offered employees anywhere from $2,500–$3,000 per year to shop with on private health exchanges. That amounts to less than they'd have to pay for insuring workers under traditional company plans on average."
This will be a huge shift for both employees and employers, who might not need to retain as many benefits administrators as they currently have on the payroll. If that gets you steamed, check out the lively discussion on LinkedIn last week in reaction to a provocative post, Why We No Longer Need HR Departments.
3. HR Will Get Out of the Benefits Business, Part II
Speaking of lightening the load of benefits managers, here's another thought. We know that wellness programs often don't work well. Instead of trying to improve them, a better idea might be: Don't do a thing.
The accelerating interest in population health programs as a way to cut healthcare costs signals that there's a bigger, better-funded push behind getting your employees to lose weight and take their meds—and it's more powerful than anything your HR department can do on its own.
Re-examine your budget and your people strategy. Some of what you can safely stop spending on nutrition lectures and smoking cessation class vouchers will be much better spent on analyzing the data that's pertinent to your hospital or health system's staffing strategy.
Workplace stress causes absenteeism, productivity losses, and increases in healthcare costs. Employers that help workers manage stress factors see significant financial benefits. But wellness programs alone don't get the job done.
With hospital and health system job losses ratcheting up, healthcare can no longer be thought of as a rock-solid source of jobs growth. Those fortunate enough to have healthcare jobs are eyeing the brisk pace of consolidation and paying more for health insurance as employers shift some of those costs onto workers.
That was the finding of the recent Staying@Work Survey, conducted jointly by professional services provider Towers Watson and the National Business Group on Health. The survey, which set out to examine corporate health and productivity programs, was completed by 892 employers in North America, Latin America, Europe, and Asia between May and July 2013. There were 199 U.S participants: 59% are public companies, 22% are private, and 19% nonprofit or government agencies.
What Causes Stress in the Workplace? The study finds that 78% of companies put stress at the top of the list of workforce challenges. But employers and employees don't agree on the causes, not by a long shot. According to employee data from a different Towers Watson survey with 5,070 U.S. respondents, there is a glaring difference of opinion between employers and employees.
Employers cite "lack of work/life balance (excessive workloads or long hours)" as the number-one cause of stress. Employees cite "inadequate staffing (lack of support, uneven workload or performance in group)."
Note that these issues are mirror images. Both boil down to too much work and not enough time to do it in—a classic recipe for stress. By labeling this cause as "work/life balance," employers, intentionally or not, thrust some of the onus onto employees to rebalance themselves. Employees citing "inadequate staffing" place the blame on management, who often have limited or no control over hiring budgets.
The solution to this endless conflict is for employers to gain a better understanding of the stressors that impede employee health and align benefits programs accordingly.
Why Employee Stress Levels Matter The Towers Watson report spells out clearly what HR professionals already know: "Employers are recognizing that health is a total business issue and a lack of it affects workforce performance." A few statistics compiled by the American Psychological Association [PDF] reinforce the point:
74% of employees say work is a significant source of stress, and one in five has missed work as a result of stress.
52% of employees say they have considered or made a significant career decision because of workplace stress, such as looking for a new job, declining a promotion, or leaving a job.
Job stress is estimated to cost U.S. industry more than $300 billion a year in absenteeism, turnover, diminished productivity, and medical, legal, and insurance costs.
It's strategically important for employers to help workers manage the stress factors that cause absenteeism, productivity losses, and increases in healthcare costs.
Wellness Programs Aren't Helping
One tactic many employers have been trying is wellness programs that incent workers to make lifestyle changes such as weight loss and smoking cessation. The idea is that as the health of a workforce improves, the employer's costs for health insurance and lost productivity go down. There's just one hitch: wellness programs aren't really working. A few reasons:
Lack of a clear strategy
Lack of alignment between employer goals and employee goals
Poor data tracking
Lack of employee accountability
Organizations where wellness is valued by senior leaders and line workers alike don't rely on wellness programs alone. These companies and groups, which Towers Watson terms "high-effectiveness organizations" (HEOs), embrace a holistic view of health and productivity.
Build a Culture of Health
Work environments in which work-related causes of stress are well understood and mitigated exhibit one of the building blocks of a culture of health, Towers Watson says. HEOs also provide easy access to high-quality health care and measure health and productivity outcomes.
These investments in employee healthcare translate to direct financial benefits, Towers Watson says. HEOs "are 40% more likely to report financial performance above their peers over the last year than low-effectiveness companies (63% vs. 45%). In fact, high-effectiveness companies are nearly 80% more likely to report their financial performance as significantly higher than their peers (20% vs. 11%)," the report says.
Towers Watson finds that among HEOs in the U.S., "there is a differential in annual healthcare costs of more than $1,600 per employee, giving a company with 20,000 employees a $32 million cost advantage over low-performing organizations."
That alone should be reason enough to work toward reducing stress levels among your organization's staff.
Government data shows continued but mild job growth in the healthcare sector during the month of October. And an HR problem in the NFL dominates headlines for another week and raises questions about hostile workplace cultures beyond the locker room.
October 2013 Job Growth Moderate
Healthcare continues to create jobs despite the brisk pace of mergers and acquisitions, which are often associated with job losses. These jobs are not growing at the same rate as just a year ago, however.
The preliminary data in the Employment Situation Summary [PDF] released Friday by the Bureau of Labor Statistics says "Health care employment increased over the month (+15,000). Job growth in health care has averaged 17,000 per month thus far this year, compared with an average monthly gain of 27,000 in 2012." The unemployment rate bumped up slightly to 7.3%.
Employment increased in leisure and hospitality, retail trade, professional and technical services, manufacturing, and healthcare. As in recent months—October, September, and August—growth in the healthcare sector took place primarily in ambulatory healthcare settings (11%). Hospitals (2.2%) and nursing and residential facilities (1.8%) showed relatively modest expansion.
Accusations of Workplace Bullying The HR story of the week is the still-unfolding situation surrounding two Miami Dolphins players, the Dolphins organization, and the National Football League. If you missed it, here's a recap: Offensive tackle Jonathan Martin abruptly left the team Oct. 28, following a lunchroom incident with his teammates.
Dolphins guard Richie Incognito was suspended by the team indefinitely on Nov. 3 after allegations of bullying and harassment surfaced. Details of Martin's allegations against his teammates came to light this week. His attorney, David Cornwell, said Thursday, "For the entire season-and-a-half that he was with the Dolphins, [Martin] attempted to befriend the same teammates who subjected him to the abuse with the hope that doing so would end the harassment. This is a textbook reaction of victims of bullying"
As for the NFL, it now says it will investigate, a process that it says could take weeks. The repercussions could impact the Dolphins front office and eventually league rules about hazing, harassment, and behavior among players, coaches, and other staff.
How did things get so bad? Is this what the culture is like in other NFL locker rooms?
I don't know the answers to either of those questions, but I sense that the root of Miami's current mess—the organization's alleged brutish culture—is nothing new. What is new is our reaction to a case of alleged bullying in a wholly unexpected setting.
School bullying, long ignored, has received national media attention in recent years following teen suicides that apparently came after harassment. This trend may have opened the door for the Dolphins' saga to surface.
This sordid tale of alleged player-on-player violence has me thinking about hostility in healthcare settings, in particular among nurses. Harsh workplace cultures are intractable. If you've ever worked in one, you know they stem from top leaders who more often than not, unknowingly lead by miserable example. The noxious environments that result are more often fueled by indifference than by malicious intent.
HealthLeaders has written about "lateral hostility" among nurses and the need for nurse leaders to step up and change an old pattern of backstabbing, intimidation, and hostility.
The Wall Street Journal has called the NFL locker room "An Office Without Human Resources," but HR can't change a fetid culture, not by itself. The need for change must be acknowledged and must begin at the organization's top.
Veterans Day Veterans Day (today) is one of those tricky holidays that, outside of the federal government, is observed inconsistently by states, municipalities, schools, and businesses. The post office is closed, but your child's school may be open. Your bank may be open, but the one across the street may be closed.
Workers at hospitals and health systems outside of the federal system may or may not get paid time off or be paid at the holiday rate, which may lead to questions from employees. If you're a non-federal employee, your organization sets its own holiday and vacation policies. This FAQ from the U.S. Office of Public and Intergovernmental Affairs may help clear up any questions.
In this week's HR headlines, Kathleen Sebelius faces members of Congress, a federal jobs report projects healthy growth in the healthcare sector for years to come, and a wellness program posts impressive stats.
Kathleen Sebelius
We've all had bad days at work every now and then, but few of us can say we've had one as rough as Kathleen Sebelius last Wednesday.
That was the day the Secretary of Health and Human Services faced a panel of lawmakers demanding answers about the rocky rollout of healthcare.gov. It was an unenviable position to be in, but Sebelius took command in the opening moments by putting the responsibility for what she called the "debacle" on her own shoulders.
"You deserve better," Sebelius said in her opening remarks before the House Energy and Commerce Committee. "I apologize. I'm accountable to you for fixing these problems." Her willingness to take responsibility, however, didn't make the grilling [VIDEO] that was to come any easier to endure.
Nearing the end of the three-plus hour hearing, Sebelius's irritation was evident in an exchange with Rep. Greg Harper (R-MS) and in a remark to an aide, which was caught on a hot mic.
So should the secretary stay or should she go? Even before her appearance on Capitol Hill, calls for Sebelius's ouster were ringing throughout Washington. But the White House is not likely to ask for a resignation, at least not soon. For one thing, replacing Sebelius would require recruiting and vetting a replacement and then getting the nominee though a Senate confirmation.
Still, you have to wonder what morale is like these days at HHS and CMS, where workers are toiling in the shadows of a high-profile failed launch, an embattled leader, and the prospect of another government shutdown in January.
Healthcare Jobs Aplenty
Morale in the private sector varies, of course, from organization to organization. But healthcare workers can take comfort in knowing that the industry will continue to add jobs, at least through 2020, according to government data.
It's been almost a year since the Bureau of Labor Statistics released its employment outlook for 2010 to 2020 [PDF]. The bureau's economists concluded then that "The healthcare and social assistance sector and the professional and business services sector will account for almost half the projected job growth from 2010 to 2020."
Hot healthcare jobs unsurprisingly include nurses, medical billers, and medical coders. But some of the hottest jobs in healthcare are in the executive suites of hospitals and health systems, according to Nashville-based recruiting firm DHR International. They are
Chief medical officer
VP of patient experience
Informatics officer
Recruiters at Merritt Hawkins say the role of "chief experience officer," which didn't exist until 2007, is now "one of the best paid, most common, and popular executive positions." Chief strategy officers, too, are now being sought by healthcare organizations.
Wellness Pulls Into Town
Much has been written about wellness programs as a vehicle for lowering employer healthcare costs, but we're still learning how well they actually work. But if a Wisconsin trucking company's results are any indication, a committed workforce and a good plan are success keys.
Truckers share a couple of unhealthy traits with healthcare workers. Both professions are fraught with unpredictable schedules and both types of workers have limited access to healthful food (truck stops and hospital cafeterias).
Now truckers are getting help with getting healthy with a push from the Truckload Carriers Association, a 73-year-old member-driven organization, which promotes weight loss and lifestyle changes for its members through health fairs and weight loss competitions.
Through its association with TCA, Superior, WI-based Halvor Lines committed to bettering the health of its 380 workers by:
Participating in a blood pressure study with the University of Minnesota College of Pharmacy
Elevating a health and wellness director from part-time in January to full-time status last month
Over a 10-week period, the 12-person Halvor Lines team lost 380 pounds combined, a 13.2% drop in the team's combined weight. This won them the TCA's third Trucking's Weight Loss Showdown.
The workplace challenges facing truckers and healthcare workers are similar enough that hospital employees can reasonably view truckers as inspirational figures on a journey toward wellness.
This week Thomson Reuters released its annual study of the nation's top hospitals and with it, a list of the top 100. The study evaluates performance in key areas: mortality; medical complications; patient safety; average length of patient stay; profitability; patient satisfaction; adherence to clinical standards of care; and readmission rates for acute myocardial infarction (heart attack), heart failure, and pneumonia.
As I scrolled the list, I thought about what a boon these awards must be for, among other things, physician recruitment purposes. Whenever a hospital trying to woo a doctor can demonstrate that it's performing at a high level, sealing an employment deal with a new doctor is just that much easier.
But recruitment of doctors is getting tougher. A recent report by the Association of American Medical Colleges predicts that the national shortage of doctors will quadruple to 91,500 doctors by 2020.
"The doctor shortage is reaching crisis proportions," said Mark Smith in a statement. Smith is president of physician search firm Merritt Hawkins. The firm has announced a pro bono physician search program designed to place a physician in a medically underserved area.
The usual cost for the service is between $20,000 and $30,000, a steep price for many hospitals, but especially for those in financially struggling communities. Merritt is waiving its fee both to assist an area that may be strapped but ailing, and to bring awareness to the growing problem of physician insufficiency.
The search competition is open to any hospital, medical group, or community with a critical, unmet need for a physician. Applications are due August 15. Merritt Hawkins will review them and select one winner based on the severity of need, the duration of the search, and the negative effect of not having physician services.
"When a community lacks a doctor, there is a domino effect,” Smith said. "Families leave and it is hard to attract new business."
As for Thomson Reuters' top 100 hospitals, the top major teaching hospitals are listed here. To see the top large, medium, and small community hospitals, scroll down. Make note: Thomson Reuters gives special recognition to hospitals that delivered the greatest rate of improvement over five years. Those are called Everest Award winners, and they are identified by asterisks.
Large Community Hospitals
Advocate Good Samaritan Hospital - Downers Grove, IL
Allegiance Health - Jackson, MI
Baylor All Saints Medical Center at Fort Worth - Fort Worth, TX
Beverly Hospital - Beverly, MA
Boone Hospital Center - Columbia, MO
Centennial Medical Center - Nashville, TN
Central DuPage Hospital - Winfield, IL
CHRISTUS St. Michael Health System - Texarkana, TX
Community Hospital - Munster, IN
Edward Hospital - Naperville, IL
Genesis HealthCare System - Zanesville, OH
Martin Memorial Medical Center - Stuart, FL
Memorial Health Care System - Chattanooga, TN
Missouri Baptist Medical Center - St. Louis, MO
Saint Thomas Hospital - Nashville, TN
Silver Cross Hospital - Joliet, IL
Southwest General Health Center - Middleburg Heights, OH
St. David's Medical Center - Austin, TX
Trinity Mother Frances Hospital - Tyler, TX
Trinity Rock Island - Rock Island, IL
Medium Community Hospitals
*Augusta Health - Fisherville, VA
Aurora Sheboygan Memorial Medical Center - Sheboygan, WI
Blanchard Valley Hospital - Findlay, OH
Cleveland Clinic Florida - Weston, FL
Columbus Regional Hospital - Columbus, IN
Holland Hospital - Holland, MI
Memorial Hermann Katy Hospital - Katy, TX
Mercy Hospital - Coon Rapids, MN
Mercy Hospital Anderson - Cincinnati, OH
Mercy Hospital Clermont - Batavia, OH
Mercy Hospital Fairfield - Fairfield, OH
Middlesex Hospital - Middletown, CT
Minden Medical Center - Minden, LA
Paoli Hospital - Paoli, PA
Reid Hospital & Health Care Services - Richmond, IN
Saint Joseph East - Lexington, KY
Sycamore Medical Center - Miamisburg, OH
Thomas Hospital - Fairhope, AL
West Anaheim Medical Center - Anaheim, CA
Winchester Hospital - Winchester, MA
Small Community Hospitals
Andalusia Regional Hospital - Andalusia, AL
American Fork Hospital - American Fork, UT
Baylor Medical Center at Waxahachie - Waxahachie, TX
Central Michigan Community Hospital - Mount Pleasant, MI
Flaget Memorial Hospital - Bardstown, KY
Harlan ARH Hospital - Harlan, KY
Kosciusko Community Hospital - Warsaw, IN
LeConte Medical Center - Sevierville, TN
Memorial Hermann Sugar Land Hospital - Sugar Land, TX
Mercy Hospital Cadillac - Cadillac, MI
Moberly Regional Medical Center - Moberly, MO
Payson Regional Medical Center - Payson, AZ
Ponca City Medical Center - Ponca City, OK
*Russell Medical Center - Alexander City, AL
Spectrum Health United Memorial - Greenville, MI
St. Elizabeth Community Hospital - Red Bluff, CA
*St. Joseph Health System - Tawas City, MI
St. Joseph Mercy Livingston Hospital - Howell, MI
St. Mary's Jefferson Memorial Hospital - Jefferson City, TN