A little TLC and some extra cash can make a world of difference to employees in crisis. Here's how one organization goes above and beyond for its workers.
Gloria, an 83-year old Scripps employee, knew she was dying. But, as an unmarried only child without children of her own, she had no living family members left.
A supportive childhood friend had figured prominently in her life, but she had also recently passed away, leaving Gloria with no one to help her with running errands, settling the last of her commitments, or even keeping her company during her last days.
With no one else to call for help, Gloria called her HR department.
Helen Neppes, director of work life services at Scripps Health, at first thought helping Gloria might mean an advance on her life insurance or offering money from the organization's employee assistance fund to help out with expenses, but Gloria's needs went beyond the financial.
Helen Neppes
"She told me that she was ready," says Neppes, "but that she didn't want to die alone."
Above and Beyond
While many hospitals offer an EAP or similar program, few offer employees the level of crisis assistance that Scripps' work life program does, says Neppes. The program does not replace Scripps' EAP, but works alongside it and provides more personalized care for employees—especially in a crisis.
"I worked with my CHRO… to try to figure out if there was anything out there that mirrored the program we were designing. I couldn't find anything in healthcare or otherwise. The closest was the [Morale, Welfare and Recreation] program for military service members and their families… We were aspiring to that."
Neppes, previously an HR director at Scripps, says her position was created in 2010 when the CEO recognized the need for a department that would support employees in a way that's more meaningful and sustentative than most EAPs.
All Scripps employees and affiliated physicians, including part time workers, are eligible for crisis support. Since 2010, Neppes has provided crisis help for more than 300 employees and their families. It employs more than 13,000 workers, plus an additional 2,600 affiliated physicians.
A crisis might be precipitated by a death in the family, severe illness, or serious injury. But sometimes, the assistance Neppes provides is as simple as helping new parents find the right child care. It makes a huge difference in the lives of the families she serves, she says.
Support for Staff
Sometimes, the best way to help an employee in crisis is through cold, hard cash. Scripps' Helping Our Peers in Emergencies (HOPE) fund can be tapped to help pay for funeral expenses or medical treatments. Usually, this fund only pays $2,000 per employee per crisis, but exceptions have been made—for example, when eight members of an employee's family were killed in a single bus crash in Mexico.
If the HOPE fund is involved, the employee must have worked at Scripps for at least six months and the request goes through a separate process that verifies need. "We offered the employee a higher level of financial assistance, and granted bereavement as if each family member was a separate case," Neppes says.
Employee donations of cash and paid time off, and a percentage of proceeds from gift shop sales and small fundraisers fund the HOPE account.
Often, just being there to support employees through a personal crisis is what makes the difference. This proved true when a Scripps employee's teenage son ran away from home. His car and cell phone were found in a remote area, but he was not with them.
Complicating the situation, the employee was caring for several young children and eight months pregnant with another, and couldn't travel to the search and rescue location.
Neppes gave her cell phone number to the employee and told her to call any time, day or night. The employee called her several times over the course of the search to talk about her concerns and fears. Thankfully, her son was found alive and well. When the employee finally met Neppes in person several years later, she thanked her for her help during that trying time.
Not all situations Neppes helps employees through have happy endings.
In addition to helping Gloria to settle her financial needs and to make arrangements for the end of her life, Neppes made sure someone was with her at all times. When members of HR or Gloria's coworkers couldn't be there, employees of Scripps' EAP took turns at her bedside. "We didn't want her to be alone."
Gloria died surrounded by her coworkers. It might not have been a perfect substitute for family, but, Neppes says, they were the people she had spent the most time with over the last few years of her life.
Being there to comfort an employee in her last moments isn't in HR's job description. But through its work life program, Scripps was able to go the extra, last mile with Gloria.
Not talking about the problem doesn't make it go away, but being prepared will help HR teams deal with it when the issue comes up—and sooner or later, it will.
No one wants to believe one of their employees is diverting drugs meant for sick patients. That makes frank discussion of drug diversion between management and employees uncomfortable and difficult.
The most well-known case of drug diversion may be the case of a contract radiology specialist caught after a stint at an Exeter, NH, hospital, who for years took advantage of lax screening and reporting policies to gain access to multiple health system's drug supplies. He was eventually apprehended once authorities realized he'd spread Hepatitis C to at least 46 patients nationwide.
Disturbing cases like this are why hospitals need proactive policies are necessary to deal with the problem.
"Drug diversion is something most organizations don't want to talk about, but we realize it's a concern, not just in our organization, but also nationally," says Donna Patty, RN, compliance specialist at University of Tennessee Medical Center. "We just chose to be very proactive in our approach instead of reactive."
By acknowledging that drug diversion is a real risk, human resources leaders can implement policies to protect patients, help addicted staff, and ensure that the organization is in compliance with regulations.
Stick to the Process
UTMC has a defined process in place for dealing with drug diversion, says Patty.
"Human resources informs compliance of any issue related to drug diversion. Compliance investigates, and then HR and the [suspected employee's] manager will determine what to do based on the results of that investigation.
If, during a reasonable suspicion drug test… the employee tests positive [for drugs], the employee is discharged immediately."
The employee might also be discharged if he tests negative but evidence is found during the investigation that he has been involved in drug diversion.
The process is in writing and has been vetted by all pertinent departments at UTMC. Employees and their managers are aware of it, and everyone in the hospital understands that drug diversion is unacceptable and will result in termination.
Not all organizations require that employees be terminated if caught diverting drugs. Some require that staff be moved to a non-drug dispensing role after attending treatment or have other policies. What's important is to have a policy before the issue comes up, and to ensure that all employees and department leaders are aware of it.
Amy Flatt
Amy Flatt, associate director of pharmacy at UTMC, agrees that being prepared is the key to avoiding drug diversion and handling it successfully when it does arise. "It's very important to determine what your policies are prior to an incident happening. You need to have a plan on what to do…. You must be ready as an institution."
Trying to figure out what to do "on-the-fly" usually backfires, says Julie Rice, RN, manager of health, wellness, and peer assistance programs at the American Association of Nurse Anesthetists. "[Organizational response] needs to be carefully organized and prepared."
"Start collecting all the facts," says Linda Stone, chair of the peer assistance advisors committee at AANA and associate director of didactic and clinical education at the Raleigh School of Nurse Anesthesia / UNC, Greensboro.
Now is the time to find witnesses, look at surveillance tapes, review electronic data, and start building your case. If the evidence warrants it, order a drug screen for the suspected employee. Once you have enough information to confirm your suspicions or a positive drug screen, it's time to move forward to the next phase of the process.
Confront the Employee
This confrontation shouldn't be chit-chat where the employee promises to get help or simply denies that he has a problem. Nor should it be a standard termination of employment. If possible, the confrontation should be an intervention, say Stone and Rice.
"The intervention needs to be carefully organized and prepared. It should not be [spontaneous]," Rice says. Whenever possible, involving the employee's family can be helpful.
Organization with employee assistance programs, should involve the EAP, says Stone.
Rice and Stone suggest designating a facility where the employee will go after the confrontation. This serves multiple purposes. First, it ensures them that help is available; second, it prevents them from immediately seeking employment before this incident is reported; and perhaps most important, it may prevent them from doing something regrettable.
"The chances of suicide are pretty high due to the risk to licensing—and to [the healthcare worker's] reputation," says Rice. The employee should not be allowed to leave the confrontation alone for this reason.
Rules for confronting employees vary according to state, so HR executives should check with the legal and compliance departments to ensure permissibility prior to proceeding.
Julie Rice, RN
The CNO or CMO should report the incident to the state boards and to law enforcement. This step is frequently avoided due to concern about negative attention, but avoidance puts communities at risk, says Rice. "if you know of diverting, you have an obligation to report it."
An Ounce of Prevention
Prevention policies that can minimize chances of drug diversion.
The first step is to educate healthcare workers about the dangers of narcotics and the signs of a coworker that might be diverting.
UTMC has sent members of its compliance team to talk to nursing, pharmacy, and medical students about the disastrous effects that recreational abuse of these drugs can have on life, health, and patient safety. Rice and Stone say their organization teaches awareness of drug addiction among clinicians and the signs of drug use at work.
Interdepartmental scrutiny also helps keep organizations on their toes. "Make sure the entire hospital works as a team…. everyone here could be affected by diversion in some way. Here, compliance looks at pharmacy. Pharmacy looks at anesthesia. We all monitor each other," says Flatt.
Another tip: promote a culture of safety in your hospital. "It influences relationships between coworkers. They realize situations can be handled fairly. Employees are more likely to report drug diversion if they think there will be safe handling," says Rice.
The key to tackling this tough topic is to start the conversation among healthcare leaders. Not talking about the problem doesn't make it go away, but being prepared will help HR teams deal with it when the issue comes up—and sooner or later, it will.
In our July 2015 Intelligence Report, most healthcare leaders said the status of their care transitions for care continuum providers or services was sufficiently strong, but indicated that there was room for improvement. HealthLeaders Media Council members discuss where they are finding success in improving care transitions outside of their facility.
Mitch Fillhaber
Senior VP for Corporate Development and Managed Care
The Shepherd Center
Atlanta, GA
The Shepherd Center is a 152-bed specialty clinic that functions as a rehab hospital with its own ICU. We have one of the youngest rehabilitation populations in the country, and we have a significant MS population who uses our outpatient care facilities. The continuum is a bit different for us than at a typical acute care hospital, and our care transitions are inevitably more complicated.
For many years, we've had a transition-support program that manages the return of high-risk patients and their families to the community, whether it be here in Atlanta, elsewhere in Georgia, or anywhere across the country.
As our patients are discharged, we're assessing the follow-up providers' capability and, if needed, providing education that creates a secure care environment for our patients who are going home. We're also working to provide education to patients and families to make sure they can maintain a positive health status once they've returned home.
We recently decided to invest in a medical call center along with a partner organization. It will be staffed by nurses who can give medical advice over the phone.
We try to be as hands-on as we can so that we never quite cut the umbilical cord between us and the patient, while using resources in the patient's community as effectively and efficiently as we can.
Sandra Bailey
Vice President of Care Transitions
Methodist Healthcare
Memphis, TN
We've foundthat employing care navigators has improved care transitions in our facilities. Navigators utilize multiple strategies in their roles, including leading interdisciplinary care teams, meeting with families, and determining resources the patient will need when they go home.
We have an evaluation team that determines whether the patient will benefit from home care. If they will, their physician then talks to the patient and tells them that they've recommended home care for them. We find it's a more proactive way to address the situation.
We also have teams that meet with high-need patients, and then those patients have a comprehensive discharge plan that's developed along with the family of the patient. That is initiated at the beginning of the hospital stay, revised throughout the stay if the needs or condition of the patient changes, and then, at the end of the stay, is coordinated by the case manager and a social worker along with the patient and their family.
We are also working with local churches in several areas that high-need patients live in. These churches are offering to help families with their special needs.
Patient education is critical. Methodist Healthcare is partnered with the Mayo Clinic system, so we have access to its educational material that we can add to our own ongoing education for patients and their families.
Jill Barber
Director of Managed Care Operations and Revenue Integrity
Southwest General
Middleburg Heights, OH
The seemingly counterintuitive answers to the survey don't surprise me. Everyone thinks that their continuum resources are sufficiently strong for how we have practiced healthcare in the past, but, as we get more involved in things—such as readmissions penalties, as well as being concerned about bundled payments and other alternative payment models—we're realizing that what has been good enough in the past is going to need improvement, or will no longer meet our needs at all.
We are really pushing forward in developing a preferred provider network for postacute care. In the near future, there are going to be rules about how postacute providers play within that network, how they join, how they receive referrals, and how they are also removed and replaced with another provider.
We are starting to realize that there's no one flavor of home health, there's no one flavor of skilled nursing, that one size doesn't fit all. For example, home health for a congestive health failure patient will be very different from home health for a patient with a knee replacement. We are trying now to coordinate a better postacute care model and care-continuum flow with a set process for each of our patient populations. We want to recognize that while also setting standards that providers must work within.
Terry Preite
President
Benefis Spectrum Medical and Regional Relationships
Great Falls, MT
On patient education: Educating patients is everything. We continue to modify our processes to incorporate more education throughout the patient's stay, and to our postdischarge programs. An example of that is our Safe Landing program, which is an extension of the discharge planning process. A nurse visits the patient's home and goes over the discharge instructions with them to ensure they understand everything.
On discharge planning: Discharge planning is no longer the last step in the process; it's the focus of the entire stay. What is this patient going to need when they go home, or go to their next level of care? We focus on patient education and on engaging patients in the healing process, both during and after their hospital visit.
On rural challenges: Benefis is the major tertiary center for a region that spans 40,000 square miles. Many towns in our service region have fewer resources available to care for patients. It's been difficult at times to ensure that patients returning to their homes have the support that they need. Improving communication with primary care providers in the patients' hometowns is part of this challenge. CMS recently awarded a grant to Liberty County Hospital—a member of our Northcentral Montana Healthcare Alliance—to work on improving care transitions to these small communities along with local critical access hospitals.
Telemedicine can alleviate recruitment woes and fill staffing gaps—and it can rein in costs. Banner Health's total cost of care has dropped 23% since it began using telemedicine, says its VP of care innovation.
Healthcare HR executives have a not-so-secret weapon that can fill gaps in clinical expertise, augment staff, and aid in recruitment: Telemedicine.
Would you prefer your employees work from home, or in an office? Is your health system having difficulty staffing around fluctuations in seasonal demand?
Telemedicine specialists, also called or virtualists, enjoy uncommon flexibility regarding location, which is convenient for both HR managers and workers.
"Our telepharmacists can work from home or in our pharmacy in Fargo, ND," says Win Vaughn, acting president of virtual health services at Catholic Health Initiatives, headquartered in Englewood, CO.
Vaughn says that within his organization, which includes 105 hospitals and offers multiple care settings from 30 critical access hospitals to four large academic medical centers, telemedicine helps bridge the gap and connect different specialists from different environments.
Most healthcare organizations ask virtualists to take 12-hour shifts, just like in the hospital. "It doesn't make any difference if you're an employed physician or contacted, everyone works 12-hour shifts," says Deborah Dahl, vice president of care innovation at Banner Health in Phoenix.
Deborah Dahl
Dahl says Banner's telemedicine specialists have the ability to do anything an in-person clinician can do other than touch a patient.
"They just do what a physician or nurse normally does at the bedside, whether that's writing orders or following up on care plans. They might even have an end-of-life discussion with a patient's family," says Dahl.
Some providers lack specialists. This is another area where telemedicine can lend some flexibility. Dignity Health has historically been cautious about telehealth partnership, but has chosen to partner with outside organizations for behavioral health, says Shez Partovi, MD, chief health information officer at Dignity Health.
"We just do not have enough [behavioral health] specialists," he says.
It's also less expensive to staff through a partner organization, says Dahl. " You're paying the same per-hour rate; you just don't have to worry about benefits, and can use the staff when needed."
Innovation Attracts Talent
Telemedicine can also be a recruiting tool to draw young clinicians who are excited about innovation and new care delivery models, says Suzanne Hinderliter, RN, vice president of telemedicine at OSF Healthcare. "I've found that younger physicians are very positive about telemedicine. They love technology."
CHI's Vaughn believes telemedicine will attract nurses who are excited about new ways to deliver care, such as remote monitoring and other new care models.
Telemedicine is not only solving staffing and recruitment challenges in healthcare, it's also proving to be cost effective. "We saw ROI on this service within 19 months, which was much sooner than we'd projected," says Hinderliter.
Dahl says Banner Health's total cost of care has dropped 23% since it began using telemedicine.
"[Telemedicine is also] instrumental in population health, and allows access for many patients that otherwise would not have access to care," says Hinderliter. It opens the door for collaboration between communities and organizations, she says, which might encourage clinicians interested in community health and outreach to get involved.
For hospital, it may not be such a hard a hard sell, says Dahl. "Improved quality of life and reduced cost… what’s not to love?"
From increasing access to influencing better patient outcomes, health systems are recognizing the benefits of virtual patient visits and remote monitoring—and finding ways to mitigate the costs.
Some patients are harder to reach than others.
Refusing to turn on his webcam, one telemedicine patient insisted on communicating only using the chat box on his provider's mobile app. Eventually, he admitted that he suffered from agoraphobia, germophobia, and social anxiety. This was the only way he felt comfortable seeking care.
Mia Finkelston, MD
Once the realm of science fiction, telemedicine has become a reality of care—and an option for patients that might once have been difficult to reach, including rural patients, professionals with busy schedules, and patients unable or uncomfortable seeking care in person.
Mia Finkelston, MD, medical director at American Well, the patient's Boston-based telemedicine provider says he is the type of patient who might not have received care without access to telemedicine.
Shez Partovi, MD, chief medical information officer at Dignity Health, says his organization alone performed 12,000 telemedicine consults in 2015—a number that he expects will increase to 20,000 in 2016.
But telemedicine is changing, and providers must be ready to exploit its possibilities.
1. Virtual Visit Volumes are on the Rise Gone are the days when telemedicine was a rarity; appointments are going mainstream.
Shez Partovi, MD
"I can't imagine seeing a primary care provider in the office for a sinus infection anymore," says Deborah Dahl, vice president of care innovation at Banner Healthin Phoenix, AZ. She says many traditionally brick-and-mortar services, such as visits for routine acute care, follow up care, e-pharmacy, and counseling are poised to move online.
While Dahl's sentiments may not yet be typical (telemedicine appointments are generally not reimbursed by the Centers for Medicare & Medicaid Services or most other payers), providers are paving the way for virtual visits to become the norm.
"I think more urgent and follow-up care will shift to the virtual space in the near future," says Peter Rasmussen, MD, medical director of distance health at the Cleveland Clinic.
He foresees regular online patient visits with a care coordinator or nurse for health maintenance, and visits to a clinic or doctor's office only for hands-on visits such as eye examinations, throat cultures, and comprehensive physical exam every year or two.
"We are laying the groundwork for a full virtual healthcare system," he says. While Cleveland Clinic's distance health program initially focused on uses such as providing care to rural areas, the ease of access for urbanites and busy professionals has become apparent, says Rasmussen.
2. Better Patient Monitoring Enables Faster Interventions Being able to reach patients in their home environments has distinct advantages, Dahl says, such as enabling providers to intervene early and influence better outcomes.
Deborah Dahl
Many patients with multiple chronic conditions take numerous medications that have not been checked for interaction, or even for necessity. To verify the necessity and safety of all medications, pharmacists at Banner Health interact remotely with patients via a camera on a tablet or mobile phone and have them go through the medications they take regularly, says Dahl.
After discussing regular medications, they often ask the patient to go into their bathroom and go through their medicine cabinet with them.
"They always have expired medications in their medicine cabinets," says Dahl. Not only is this an opportunity for the pharmacist to ask them to dispose of old medications, but this experience gives the pharmacist an idea what the patient may be taking on a supplementary basis.
A virtual house call is also an opportunity to look at the patient's home environment and intervene before a situation becomes dangerous. Among the conditions visible are fall hazards, squalor, and elder abuse scenarios. Dahl once observed an illicit drug deal happening in the background between the patient's caregiver—her grandson—and a guest.
Suzanne Hinderliter, RN
"The kinds of things you see unintentionally are amazing," she says.
Another sort of remote technology enabling clinicians to monitor for potential danger is the kind that Suzanne Hinderliter, RN, vice president of telemedicine services at OSF Healthcare, in Peoria, IL, says that her organization has adopted.
OSF uses a telemonitoring application "that gathers data from EMRs and bedside monitoring systems." It allows clinicians to see subtle changes to the patient's condition that otherwise might go unnoticed. Hinderliter says OSF has seen a 26% decrease in mortality and a 20% decrease in length of stay system-wide since they began using telemonitoring technology.
3. Partnerships Can Mitigate Costs Going it alone is going out of fashion.
Dignity Health has historically been hesitant to form partnerships in telemedicine, preferring to remain independent. But that's a notion that is "evolving," says Dignity Health's Partovi.
"We're at a point where we're looking at potentially partnering with other organizations," he says. During the program's growth phase, Partovi and his colleagues wanted to have more control over the services offered and costs associated with the program. But now, they're at a point in their growth where a partnership might be the next step to further growth.
Dignity Health is not alone. Its sentiments are echoed throughout the provider community—with so many different moving parts, it is becoming difficult, if not impossible, to go it alone in telemedicine.
"[Partnering] is almost mandatory," says Cleveland Clinic's Rasmussen, whose organization partners with American Well for technology infrastructure and supplemental clinician staffing.
The cost, he says, is "not an insignificant sum… [but] I don't think we could do the same [in-house] for less."
Peter Rasmussen, MD
OSF has partnered with Carena, a telemedicine provider in Seattle. "We were looking for someone to partner with us, not just provide service… Carena has been very collaborative," says Hinderliter.
The greatest advantage of partnering she sees has been that the infrastructure has already been built, which decreases cost. "If we'd had to build completely in-house, it would have been a lot more." Even when paying clinicians the same hourly wage as an in-house employee, supplemental staffing through a partner is less expensive.
American Well's Finkelston was able to encourage her agoraphobic patient to share more of himself with her over time, starting with a verification phone call, and later a photograph. Eventually, she was able to encourage him to seek in-person care to catch up on missed immunizations and a wellness exam.
"I told him I knew a trick; make sure you get the first appointment of the day. That's when there will be the shortest wait, and the fewest patients in the waiting room." Last time she spoke to the patient, he was willing to engage his webcam. All in all, the patient seems to be in a healthier place, says Finkelston, and she believes he wouldn't have gotten there without virtual care.
She says she wonders, however, how many others like him are out there—and how many routinely go without care.
Patient safety starts with hospital workers feeling comfortable about expressing concerns. Here's how HR can help establish a hospital culture that promotes safety.
One patient safety advocacy organization thinks HR can be instrumental in building cultures that can help keep both patients and workers safe.
"We talk about a culture where everyone is comfortable talking about errors, issues, or hazards that they see without fear of punishment," says Tejal Gandhi, MD, MPH, president and CEO of the National Patient Safety Foundation, headquartered in Boston. "And that the organization uses that information to learn and improve."
Tejal Gandhi, MD, MPH
What Gandhi is referring to is a "just culture."The term is used to describe policies that acknowledge that mistakes happen, and which strive to ensure a lack of blame.
Rather than pointing fingers and punishing someone when something goes wrong, a just culture emphasizes searching for the root cause of the error. "You make sure that the inquiry doesn't stop with, 'Dr. Jones should have known not to do that.'
Instead, you look to understand, 'Why did Dr. Jones do that? What contributed to her thinking that this was the right course of action?' That's how you learn how to prevent these situations from happening again in the future," says Gandhi.
The information that would help hospital leadership understand what went wrong—or is likely to go wrong in the future— is usually not hard to find, but hospital workers can find it tough to reach across the aisle to employees in other departments.
"Oftentimes, different departments become siloed… HR is in a unique position to break down those siloes," Gandhi says.
She recommends three ways that HR leaders can start instituting a more collaborative culture conducive to safety.
1.Educate Leadership Partner With: CEO, Board of Directors
Make sure hospital leadership understands why a just culture matters. An open, fair culture where workers feel comfortable sharing concerns and information across departments leads to improved patient outcomes, says Gandhi.
Teach hospital leaders about root cause analysis and ensuring that they are committed to resolving safety issues—not just assigning blame.
Also, leaders should be aware of the very real dangers that threaten healthcare professionals. For example, not only are nurses five to six times more likely to be assaulted than a cab driver in an urban area, but the high potential for on-the-job injury is enough to cause burnout.
"If your workforce is getting physically or psychologically harmed, it will be hard to deliver the best care to patients or achieve patient safety," Gandhi says.
2.Institute Executive Walkarounds
Partner With: CEO, CMO, CNO, Department Leaders
Hospital workers cannot trust executive leadership if they don't know them. Instituting executive walkarounds can help.
As a former Director of Safety at Brigham and Women's Hospital in Boston, Gandhi remembers how she and her colleagues were able to ensure communication among departments, the C-suite, and healthcare workers.
"I would go on walkarounds with a team of executives—usually the CEO, the CNO, and the CMO." Each week, they would choose a floor or department in the hospital to visit and they would talk to people who worked in each department.
The topics discussed would vary as the workers got to know the leaders better, but the discussions would usually come back to safety—both of workers and of patients. "Initially people were nervous, but then they talked about their concerns," Gandhi says.
So that workers knew their concerns were not falling on deaf ears, the executive team would create plans to address them on the spot, whenever possible.
The walkarounds helped show the hospital's frontline workers that they could talk about their concerns without getting punished. The program also helped to remind the executive team what life is like in the hospital's trenches—and that the job of a healthcare worker is not easy.
3.Establish a Physician Compact
Partner With: CMO, Physician Leaders
To clarify expectations as to workers' attitude and behavior, some healthcare organizations are asking clinicians—especially physicians—to pledge in writing that they're committed to good behavior and patient care, says Gandhi.
Known as physician compacts, these documents sets expectations for physician behavior at the hospital, establishing the importance of respect toward other physicians, nurses, hospital leadership, frontline workers, even housekeeping staff—but, above all, patients.
"Many leaders in safety say disrespect is a cancer that will prevent you from getting to a culture of safety," says Gandhi. While a physician compact is not legally binding, it does establish that the hospital expects physicians to act in a certain way.
But even that's not enough. "Leadership must be committed," Gandhi says.
In turn, she suggests adding a clause to compact stating that when physicians see a process they feel could be improved or which they feel is unsafe, they will not be punished for bringing attention to it.
Gandhi suggests expanding these compacts to other workers as well. They "really set expectations around behavior," she says.
Employee requests to bring emotional support animals to work should not be automatically dismissed.
As if the hospital didn't feel enough like a zoo already, the rising use of emotional support animal (ESA) is forcing some HR departments to re-examine their guidelines on animals.
Unlike service animals, which are defined as animals trained to perform specific tasks for their disabled owners, ESAs receive no standardized training and have just one job: to be constant companions. People who use ESAs typically suffer from a variety of emotional or psychological conditions such as PTSD, depression, or aging-related cognitive decline, and say the consistent presence of the animal is necessary to their emotional well-being.
Heather Owen
Given the nature of healthcare environments and professions, one might expect hospital workers with ESAs to have to leave their furry friends at home. But Jacksonville, FL-based attorney Heather Owen, of Constangy, Brooks, Smith & Prophete, LLP, a law firm that specializes in labor and employment law, says her firm has been asked to represent two hospitals in the last year in cases involving accommodation requests under the Americans with Disabilities Act (ADA) for animals in the workplace. One of the cases involved an emotional support animal.
"People are confused about what can and cannot do [with ESAs]… and there's really good reason for that confusion, and a lot of room for abuse," says Owen.
The growing use of ESAs shows little sign of stopping. In 2011 the National Service Animal Registry, a commercial enterprise that sells certificates, vests, and badges for service animals, signed up 2,400 ESAs. In 2013, it reported registering 11,000.
With little case law on the books about ESAs in the workplace, it makes sense to treat them as any other ADA accommodation being requested in the workplace, says Owen, and to determine whether or not the employee's request is reasonable on a case-by-case basis.
But to effectively evaluate these requests, you'll need to avoid three common assumptions.
Misconception #1: It Can't Be Done in a Hospital "My biggest warning is to not just assume it can't be done," says Owen. "Especially in a hospital setting, many assume that someone will have a problem with allergies or a fear of animals, and that they can't allow the animal in. Those are not necessarily assumptions can be made automatically."
Since ADA lawsuits are most frequently lost when employers don't effectively engage in the interactive process of seeking accommodation for employees' disabilities, it is important to make sure all options have been pursued, says Owen.
Even for clinicians that interact with patients, the answer might not be an automatic "no," she says. "Could the animal sit off to the side? Could it wait directly outside the patient treatment room [while the clinician is seeing patients]? Can it be leashed?"
One of the hospitals Owen's firm represented involved a hospital administration employee that requested the accommodation of a dog that would come to work with her daily. But the employee had a teammate who had a severe phobia of dogs.
Rather than concluding that the situation was a non-starter, HR simply moved one of the employees' cubicles to the other side of the office. The only time the two employees had to interact was during meetings, when the dog could be left with another worker. Six months later, the dog has not been an issue, says Owen, who suggests that similar arrangements could be made if a coworker has allergies.
The test is reasonableness, she says. If the request to take an animal to work turns out to be reasonable, it should be fulfilled. The arrangement should be tried on a provisional basis, and, if it appears that things are not going well for any reason, it should be communicated to the employee that the arrangement is simply not feasible.
Misconception #2: Documentation Will Be Sufficient Don't take documentation submitted by the employee at face value, says Owen.
The internet is rife with dubious websites that will certify a pet as an ESA in exchange for some cash and checking a few boxes.
"I'm of the opinion that an employer has right to justify the need for an animal," says Owen. "If an employee suffers from a genuine mental health or emotional condition, he or she should be seeing a therapist or physician that can provide documentation explaining why the employee needs this animal. If the employee is going to [a] doctor, it adds validity… It makes it real."
And the animal should be evaluated by a veterinarian, says Owen. "Seeing eye dogs and other service animals go through months of training. When they have that vest on, they know they're working, and people recognize the vest and respect that."
But ESAs receive no standardized training, and even well-behaved animals may panic in public—especially in environments where they are exposed to flashing lights and alarms, such as a hospital, says Owen. A vet can function as a non-partial party that gives the final approval on an animal—or puts the kibosh on an animal ill-suited to the hospital environment.
Misconception #3: There Will be a Backlash A common concern among employers is that if an accommodation is made for a single employee, others will want that accommodation, too, whether it be a $500 ergonomic chair or a cat that sits at the employee's feet. But Owen says jealous coworkers are rarely an issue.
"In the 20 years I've worked with ADA law, I've not had too many calls over backlash or discrimination claims due to accommodations… employees will typically figure out it's an accommodation situation," says Owen. And most often, employees disclose to their coworkers that they have a health issue that requires them to seek accommodation.
But what if an employee does ask why she can't bring in her pet Burmese python when her coworker is allowed to bring in her emotional support Siberian tiger?
"Tell them that, as an employer, we have to make decisions. We can't always discuss the rationale for these decisions, but we've decided to permit the tiger and not the snake. We can't discuss it with you," says Owen.
There is good news and bad news for healthcare leaders in the year ahead and beyond, according to experts who share five key points as part of their outlook.
When it comes to healthcare job growth, there's good news and bad news for hospital leadership.
The good news is that while other sectors of the economy seem to languish with a slow 8.9% projected growth rate from 2012–2022, healthcare is booming by comparison with a projected 26.5% growth rate.
And the trend shows no sign of stopping.
"By 2022, nearly one in eight U.S. jobs is projected to be in the healthcare sector," says Patricia Pittman, PhD, codirector of the GW Health Workforce Institute at George Washington University and associate professor of health policy and management, adding that the primary drivers of this trend are demographics and technology.
But hold up. Much of that growth is in non-hospital settings, says Pittman.
"Hospital employment is projected to grow the slowest between 2012 and 2022, increasing by 14% and adding 826,000 jobs," she says.
Source: Patricia Pittman, PhD, codirector of the GW Health Workforce Institute at George Washington University
Despite commonly held assumptions that Medicaid expansion would spur job growth, this has not been so, says Pittman, and new policies around value-based care have been geared toward keeping people out of the hospital through ambulatory care, home health, and preventive medicine.
So, there is opportunity—but much of the growth anticipated will be in jobs outside the hospital, for positions such as home health aides or physical therapists. It's up to hospital leadership to choose wisely when staffing in order to take advantage of the current wave of healthcare growth.
1. RNs: In Demand Like Never Before "[Registered nurses] are … the largest story" in healthcare growth, says Pittman, who expects the number of nurses hired to increase by as many about 526,800 over the next few years. "We're seeing an incredible spike in the hiring of nurses."
Much of this growth is will be in the areas of advanced practice nursing, licensed practical nurses, and licensed vocational nurses, says Pittman.
Some job availability in nursing will no doubt be due to the number of current nurses who are retiring, but that's not the whole story. As physicians are mandated to work fewer hours in many states, RNs are increasingly being asked to take on duties that had previously been the physician's responsibility.
"[This trend] started with restrictions on resident hours, [but is] now a major strategy to increase physician productivity and contain costs in hospitals," says Pittman.
Also, many states have instituted mandatory nurse to patient staffing ratios, which will spur hospitals in those states to hire more nurses.
This comes after a somewhat rocky entry into the field by many new nurse graduates near the end of the last decade. During the recession, many hospitals stopped hiring, and post-recession, many are still hesitant to hire new nurse graduates, Pittman says, adding that there is still a shortage of more experienced nurses.
Susan Salka, CEO, president, and director of AMN Healthcare Services, Inc., a healthcare staffing and recruitment firm, says she noticed the demand for nurses pick up in mid-2014, and hasn't seen it drop yet. However, "there's been a lot of job growth for nurses outside the acute care setting," she adds.
2. Population Health Development Continues As population health becomes an increasingly important part of healthcare reform, organizations will be hiring workers who specialize in data analysis, communicating and engaging with patients, and helping them to maneuver through health systems.
Patricia Pittman
"I think healthcare workers that are concerned with population health strategy will be in demand," says Salka.
Medical informatics roles are another employment area "that is newer and has grown over the last five years," says Salka. Clinical informaticists will have the opportunity to pioneer analyzing vast amounts of healthcare data and deciphering what it means. For a clinician that is ready to transition away from bedside care, this could be an excellent next move, she says.
Salka and Pittman say that social workers, behavioralists, community health workers, and outreach coordinators will be in demand to help hospitals educate communities and patients and to create opportunities for engagement.
Population health executives may be in demand this year, and many health systems will create population health departments or expand already existing programs in 2016, says Salka.
3. Patient Satisfaction: Still Hot As high-deductible plans force patients to pay for larger portions of their own healthcare, consumerism continues to grow as an important factor for HR leaders.
Clinicians with excellent "soft skills," like a good bedside manner, listening skills, or even a customer service background, will be first hired, says Salka. Patient experience or patient satisfaction officers will continue to be in demand in the new year.
While the chief patient experience officer role has been around for a few years now, Salka says she believes it will continue to grow in importance. "Your organization's reputation for the kind of patient experience you provide matters."
4. Health Tech Drives Hires Along with an aging populace, the increased availability of technology is the greatest driver of increased healthcare employment, says Pittman. Technologies that were pioneered in other fields, such as patient portals or videoconferencing tools, are making their way into healthcare. As healthcare leaders find the best uses for these tools, experienced technologists will be in demand.
Susan Salka
Another area gaining momentum is telehealth, says Salka. "It's an ideal role for a clinician who, for whatever reason, wishes to move away from face-to-face care." While these clinicians would have retired in previous times, that no longer has to be the case.
With today's physician shortage, "Every clinician is going to count," says Salka—and telehealth will allow some clinicians to continue working and seeing patients. As more states loosen their laws around telehealth and patients become more comfortable with seeing a doctor over their tablet or mobile phone, demand for "virtualists" will increase.
Pittman also says that with ICD-9 shelved in 2015, ICD-10-proficient coders will be in demand for the foreseeable future.
5. Someone to Manage it All With new workers joining the healthcare workforce, the HR suite is sure to expand, too, as more recruiters, generalists, and other human resources specialists are brought on to help hire and manage new employees.
But HR pros with tech and data analysis skills will be most in demand, say Salka and Pittman. Pittman adds that workforce planning will be important as healthcare organizations grow and become increasingly complex.
Another skill Pittman says should not be overlooked is the ability to engage workers. With physician engagement heating up as a topic, HR leaders can expect to list "employee engagement" as a sought after skill.
"It will be interesting from an HR planning perspective," says Pittman.
Meet Generation Z, the newest workers in the hospital. Find out what makes them tick and learn a few tricks for managing them.
There's a new generation entering the workforce this year: Generation Z. Three million members of the Baby Boom generation plan to leave the workforce in 2016, and Gen Z is poised to replace them—but are they ready for the professional world?
Generation Y grew up during the peaceful and prosperous 1990s, says Tulgan. In contrast, most of Generation Z cannot remember a time before the September 11 terrorist attacks of 2001, and have had life expectations shaped by events like the 2008 stock market crash and the Great Recession that followed.
Each generation is also shaped by the generation that raised them, he says. While Generation Y was predominantly raised by Boomers who had delayed parenthood, Generation Z was reared by stereotypically cynical Gen Xers.
With little faith in the system and having experienced layoffs and other corporate tragedies firsthand, it wasn't enough for Gen X to allow their children to feel like winners—Generation X wants their children to have every advantage so they can actually be winners, says Tulgan.
Cue the onslaught of BPA-free sippy cups; certified organic wheat-free macaroni and cheese; and children on leashesthat have become the hallmarks of Gen X parenting.
As a result, while Gen Z is usually book-smart and well- educated, many of its cohorts are lacking soft skills such as communication and problem solving abilities, or knowing who at work to go to for advice when sticky situations arise..
However, Generation Z is diverse. "It's important not to overgeneralize," says Tulgan. There are Gen Zers who have taken advantage of real world experience from a young age or are already assuming business leadership positions. So, don't assume a young worker lacks these skills until you have a reason to. But every generation has its pitfalls, and this one is no different.
"I think there are different skill gaps," says Christine Pirri, vice president of human resources, education, and volunteer services at Cobleskill Regional Hospital in New York. "Each generation works a different way and gravitates differently. For example, Gen X works very independently. Their skill gap was that they weren't initially very good collaborators."
Three issues that leaders often run into with Generation Z include confusion regarding scheduling, their love of both technology and collaboration, and their strong youthful energy and potential that needs to be managed correctly.
The Flex Generation
Pirri recalls an awkward situation she recently faced with a young new hire.
Christine Pirri
"Every Friday at around 2:30, she'd suddenly get up and announce she was heading out for the weekend." Pirri quickly figured out why the employee believed she could do this; she worked through her lunches every day and assumed that made up for two and a half hours on Fridays. But it didn't—Pirri's department hired this worker expecting coverage on Friday afternoons.
"This generation has higher expectations of control over their hours, environment, and working conditions," Tulgan says.
Having come of age in an era when breakfast can be ordered at McDonald's at dinnertime and a favorite Christmas movie can be queued up on Netflix in July, this generation doesn't automatically expect a predefined 9-to-5 schedule.
And for some jobs, this might not be a problem. Flexible hours are something people of any age can take advantage of, Pirri says. "I think other generations will see the value in [expanded paid time off and flexible schedules]. Boomers … who want to phase into retirement, especially if they have aging or ailing parents, will see the benefits of this as well."
But not every job can be flexible. In the case of Pirri's new hire, a quick conversation about scheduling was all it took to get back on track. " 'Now that I know those are your expectations, that works,' " Pirri recalls the employee saying to her.
Technology and Collaboration Generation Z is very tech savvy, which can be both a blessing and a curse for those who manage them. True digital natives, most Gen Zers never knew a time without the Internet or a robust search engine. "This makes them very valuable … they can find information in a fraction of the time it takes members of other generations," says Pirri.
But some managers report difficulty getting young workers to think critically or work through complex problems, says Tulgan. "They've kept [smartphones] in their pockets all the time and could look up the information they needed, so they never really developed the habit of puzzling over problems."
Many managers also report difficulty communicating effectively, especially in face-to-face interactions. It can take time to develop these skills. Asking a worker to sit down and think about the big picture before taking the next step is usually helpful.
But Mark Dunn, talent strategy officer at University of Virginia Health System in Charlottesville says there's an often overlooked quality that many Gen Zers possess.
Mark Dunn
"They are collaborative and have a strong desire for transparency. I'd say that they're perfectly positioned to take advantage of a sharing culture in business." While earlier generations felt more possessive of projects or data, sharing comes naturally to many Gen Zers, says Dunn.
Wanted: Leadership and Mentors Having been hyperaware of the competitiveness of a post-recession, post-9/11, post-globalized world since childhood, Gen Z worries about their chances for success. They're eager to establish themselves and create strong relationships with their coworkers and managers, but they need rules, guidance, and boundaries as they navigate these new challenges.
Dunn has been mentoring a Gen Z colleague he sees potential in. He gives his mentee frequent feedback in a highly structured way. "I've told him, 'When I coach you or ask you to see things differently, I'll give you context …. Let me explain what happened, and how I intend for you to use this to develop as a professional.' "
Dunn says his protégé has developed strong critical thinking skills and professionalism under his guidance and will be ready for a leadership role when he gets the chance. "We've set this person up for success."
Before being too critical of these workplace "newbies," it's important to remember that they are still young and adjusting to professional life, says Tulgan. "I'd say their challenges are about 50/50. Half of [their blind spots] are just that they're young."
Dunn, who can remember reading articles critical of Generation X in the 1990s, says, "I think some of these criticisms are less about the new people coming in, and more about the people currently on the job.
Over time, each generation grows and develops professionally. Like the Boomer, Gen X, and Gen Y employees before them, Gen Z has the potential to overcome any gaps in their soft skills as they grow into professionals. It's just a matter of giving them the right leadership and feedback.
A look back at the year's hottest issues shows them to be the growing influence of millennials in the workforce, regulatory changes affecting payroll, and where and how healthcare jobs are changing.
What issues mattered most to HR professionals this year?
Throughout 2015, the national news has been filled with unsettling data security stories, historic Supreme Court decisions, and, of course, the threat of workplace violence. All had implications for HR, from protecting employee data to keeping our workplaces secure.
But topics such as healthcare worker dress codes, new overtime regulations, and employee wellness programs also resonated most strongly with HR leaders in 2015. This year, I wrote 37 columns about the most pressing issues for HR. Here are the most-read, and a few personal favorites:
1. Underwear, Tattoos, and Patient Safety A health system in Ohio made a splash this year by announcing a surprisingly strict dress code that not only bans tattoos and piercings (which most health system dress codes do), but also specifies acceptable hair colors, beard lengths, and skirt lengths, and like your grandma, insists that pantyhose be worn with skirts or dresses. It also stipulates that employees must wear underwear to work.
I predict that this won't be the last we hear regarding hospital dress codes. More than three quarters of millennial workers believe they should be able to wear jeans to work, and post-Baby Boom generation employees are expected to make up 80% of the workforce by 2020.
Boomers, however, came of age during a more formally attired era and have expectations as consumers that reflect this. Since they will be the primary users of hospital services in coming years, rest assured that a culture clash is coming.
Professionally attired physicians already receive higher patient satisfaction scores, especially from patients over the age 45. It's possible that dress codes will relax as younger workers assume hospital leadership positions, but, with the current importance placed on patient satisfaction, I'd hang on to that white coat.
2. New Overtime Regulations Coming in 2016 The US Department of Labor spent much of 2015 planning new regulations that will make more workers eligible for overtime pay. Public comment on these regulations ended in early September, and it's anticipated that the final version of the regulation will be published in 2016.
The regulations propose raising overtime eligibility to the 40th percentile of earnings among workers—a figure which is currently equivalent to a yearly salary of $50,440. This will also remove exempt status from many managers.
Considering the many different kinds of workers employed in hospitals, including environmental staff, gift shop employees, and food service workers, it's easy to see that this could have major impact on hospitals financially. I discussed preparing for these regulations in detail in with an employment attorney last month.
She told me that there are objections on both sides. Some labor advocates say the regulations don't go far enough, while many employers say the regs create an undue hardship and might lead to layoffs or higher prices.
Ahead of issuing a final rule, the DOL is currently reviewing the thousands of comments it received. It will be interesting to see if the Obama administration will attempt to push the new rule through before the president leaves office in January 2017—and whether his successor opts to leave it intact.
3. The Trouble with Wellness Programs Employee wellness programs are often thought of as an innocuous perk, but privacy activists say there's a dark side to them.
With security breaches and data leaks continuously in the headlines, there is rising anxiety over employee wellness programs in some quarters, and for a good reason: They are not covered by HIPAA, are not required to report security breaches, and have been known to repackage employee data and sell it. "[Wellness program administrators] believe they can do what they want with [employee] information," privacy advocate Deborah Peel, MD, told me when I spoke with her in February.
But the programs remain popular among employers. Virtually all (99%) healthcare organizations offer them. Wellness programs can encourage employees to live healthier lifestyles and employee participation can be a way to keep healthcare costs down, but it's important to acknowledge and address the risks they present to employee privacy.
4. Five Healthcare Jobs Transformed by Reform Did you hire care coordinators, advanced practice nurses, and tech-aware clinicians in 2015? If so, you're in good company. Those jobs were either created by or have changed as a result of healthcare reform.
The growing importance of patient satisfaction and computer literacy coupled with the move to value-based care is changing the job descriptions of many roles within hospitals.
"Over time, healthcare may be changed in a really positive way," Bryan Basset, managing director at Health eCareers, told me in June. "We're now going to be much more focused on patient satisfaction, on treating the patient as a customer."
This means that the need for relatively new jobs such as care coordinators and scribes will grow, while jobs that have existed for decades, such advanced practice nurses and clinical pharmacists will be assigned new roles and responsibilities. We will see even more healthcare jobs change in 2016 as the effects of reform continue to ripple through the system.
Bryan Bassett
Now, I'd like to share some of my favorite columns from the past year about issues close to my heart, including youth mentoring, community activism, and cultural competency:
6. To Fight Hospital Closures, Activate Stakeholders
In March, I wrote about the importance of taking a stand. If you want to see HR, unions, hospital leadership, and the community band together, look no further than fighting the threat of a hospital closure.
"Everyone understands how important these hospitals in these communities are… These institutions are some of the most important institutions in the area," Ramon Rodriguez, CEO of Wyckoff Heights Medical Centerin Brooklyn, NY, told me.
7. Why Cultural Competency Matters in Hospitals
As our country grows more diverse, the demand for culturally aware staff will rise. In January, I wrote about the potential communication barriers a culturally unaware clinician can expect to encounter and the benefits of seeking out healthcare workers from diverse backgrounds.
What were your most memorable moments from 2015? Do you have any predictions for HR or healthcare trends in 2016? Tweet them to me @LenaJWeiner.
Happy holidays! Here's wishing everyone a peaceful and prosperous 2016!
