Unit 4 - Staffing & Controlling

Sole proprietorship

simplest and most common form of business in the U.S.

this is a structure that allows the owner to have total control over company operations, and full respnsibility for financial liabilities. owners of sole proprietor businesses report their income on their personal tax return and pay self-employment taxes to the IRS.

Partnership

formed when two or more people run a business together. each partner has equal share in profits, losses and financial responsibilities of their business. like a sole proprietor, each partner reports their income on their personal tax return and pays self-employment taxes to the IRS

Limited liability company

Set up from tax structure to be protected as an individual - the company will be sued but not the individual. this protects inviduals from partner’s poor choices

This costs more

Corporation

all healthcare is set up this way - this is why we have to pay the organization’s liability insurance and all of the licensing fees for the doctors

this makes them an employee of the org so that if they are sued, it is the corporation that is responsible - not the individual doctor

for ex - CA does not track limes disease, so from a care delivery perspective, they don’t have to track it - however pa does track it

if a patient in pa has limes disease, this gets reported to the dept of health, but not in the state of CA

For-profit orgs

they set themselves up as a “for profit” meaning they have shareholders that all gave money to the org in order to become an entity or business

these shareholders want a return on their investment, for-profit orgs pay their shareholders

they will pay taxes on any revenue generated

after taxes the net amount of money left over gets divided amongst shareholders

Not-for profit orgs

they arguably can make more money than for-profits; they do not have to pay any taxes. however they must put all of their money back into the organization to provide charitable care - paying for people that don’t have insurance

Section 501©(3) - religious, educational, charitable, scientific

Is there a difference in quality between the two?

There is no difference in quality between for-profit and not-for profit orgs despite public perception; everyone is competing for the same people

for-profits may have a better perception of quality of care due to shinier machines and such, but perception is reality for that person

Internal vs external

Ceo - external

C-suite - both (COO, CFO, CIO)

Controller/treasurer - internal

CEO

has delegated authority from the board and manages all organizational operations, but all fiscal issues are controlled through the finance committee of the board. this allows power and money to be separated, so that one person does not have all control

COO

has delegated authority from the CEO and is responsible for all day to day org operations, such as staffing, policies, procedures, and general operating activities

CFO

can be comboned with COO position, but specifically has delegated respnsibility from CEO n two primary areas: accounting and management of all financial assets; such as loans or investments. has two officers, treasurer and comptroller

Comptroller/controller

is respnsible for all accounting management such as account receivables, budgets, taxes, and patient accounts

Treasurer

responsible for financial assets such as loan, investments, cash management, and endowment funds

CIO

has delegated authority from CEO and is responsible for all information and data systems. for instance, the management of electronic medical record systems and admissions

Salary Budget

this is the budget for figuring out how we are going to pay our employees and how much they are getting paid

manager creates an FTE (52 weeks * 40 hours/week = 2080 hours/yr)

29 hours + or anything above 30 is full time which includes benefits - an additional 30% (taxes, healthcare PTO etc)

How is PTO calculated

PTO rates are NOT calculated in the wages, as not all employees receive this. It is calculated in the total position cost.

How to decide how many full time and part time

Go back to what ratios are by law - usually full time over 29/30 hours

most full time positions 40 hours/week

Shift Differential

an additional amount of money we pay a person to work an undesirable shift, night shifts will be paid more

Benefit Budget

this is how the organization justifies equality - it assures all employees who should receive benefits are receiving them, and are receiving the same percentage based on what the org decides that is

employees can purchase additional benefits at their cost

at the dept level, this is included within the FTE budget

Recruitment Budget

this is needed for finding highly specialized positions

we don’t need a lot of money for food deliverers, however we do need a lot of money if paying for a dietician

this includes the amount of money that will be needed for the position we are hiring and the money we spend on advertising

for ex - we will find a doctor in a trade journal, not on linkedIN

HR department budget

assures all day-to-day operational expenses for dept are allocated. for ex, office suplies and equipment repairs are budgeted on a yearly basis to maintain compliance proper operations

Training Budget

assures all employee training needs are within the allocation of the training budget. the process of assuring compliance to the training budget is the training process. this process assures all regulatory compliance training needs.

Union Budget

this is particular to the union dues. if there is a conflict to any union workers contract, where is that money going to come from?

this is why there has to be a separate budget for the union

managing unions is a large component of HR management, and has the most impact on org departments

3 Considerations of HR

Strategic, Administrative, Environmental

Strategic component of HR

• Competition for labor

• Strategic assets, employees

• Achieve organizational business strategy

Administrative component of HR

• Ensure qualified and motivated personnel

• Recruiting, retaining, developing staff

  • Non-clinical administrative staff

  • Clinical staff

  • Support staff

Environmental component of HR

• Declining reimbursement

• Declining supply of workers

• Increased need

• Increased competition - we are spending all this time and money on you what can we do to make you stay

• Accountability and performance - holding employees accountable for the job in which we are paying them

HR as Organizational Performance

The org holds HR accountable for making sure our employees are competent and able to perform the job we are asking them to do

Return on investment - contribution to bottom line in terms of

• Recruitment

• Training

• Staff Developed

What are the 2 key functions of HR?

The two key functions of HR are staffing, which involves recruiting and retaining qualified personnel, and controlling, which encompasses performance management and ensuring accountability within the workforce.

Key Functions of HR

• Workforce planning and recruitment (linkedin)

• Retention

• Ratio method used to determine staff to patient ratio

  • taking staff from other depts in order to meet ratios (ie there needs to be a certain amount of nurses in a unit, HR is the one making sure ratios are met)

• Employee assistance programs - benefit offered by a third party contracted with healthcare entity

  • Purpose

  • Value

Recruitment

Filling open positions with the right people

• Advertising, screening

• Interviewing, selection

• Negotiation, hiring

• Orientation - HIPAA

When planning for recruitment, the org needs to determine the patient-to-staff ratio, this is a ratio influenced by the financial and/or tax structure (for-profit vs not), but often driven by regulations or the company value structure

Advertising

process used to target potential employees and generate interest in organization. can occur in many different materials, all developed by HR

Private recruitment

processes such as “head hunter firms” can be used. in this type of recruitment process, the org will pay the firm a fee for finding the employee. highly specialized positions often hire through this method. for ex, travel nurse, or financial analyst

Educational programs

programs that train employees for specific positions such as a medical record technician, nurses, or x-ray technicians. in this type of recruitment process, the org would recruit directly from the education school of training

Job fairs

another source of employee recruitment and are often localized. this is an opportunity for HR to go into the public and meet with potential employees who are seeking employment

Screening

process of sifting through all applicants obtained through advertising methods and to determine who will be interviewed. first opportunity for org to evaluate potential candidate via online application

candidate solely represented by resume and cover letter in this step

HR will also screen resume for employment eligibility

Additional recruitment process

interviewing to meet potential candidate. first face-to-face impression. selection is the process of choosing the best candidate of those interviewed. negotiating is the process where candidate can discuss salary and benefits. hiring is the process of making an official offer

HIPAA

Health Insurance Portability and Accountability Act (1996)

Goal is to assure individuals’ health info is properly protected while allowing the flow of health info needed to provide and promote high quality health care and to protect the public’s health and well being. limited employers use of employee health records for employment purposes

Retention

Training and continuing education

Evaluations - feedback 360

Compensation

• Benchmarking

• Job pricing

• Incentive pay

• Gainsharing

• Other incentives

Benefits

• Sick time

• Vacation

• Holidays

• Heath Insurance

• Life Insurance

• Retirement

• FSAs

• EAPs (employee assistance programs)

• Other

3 Performance Evaluations

• An orientation performance evaluation is used after completing orientation and evaluates if the employee is competent in basic assigned tasks as defined by the org

• A yearly performance evaluation is more comprehensive and evaluates an individual’s ability to perform all tasks assigned. These are completed yearly and are used to determine continued employment

• A 360 evaluation is often used to evaluate managers and seek feedback not only from manager’s employees, but their peers

Conflict Resolution

Why employees have org conflict…

• Unclear expectations and guidelines

• Poor communication

• Lack of clear jurisdiction

• Differences in attitudes, values

• Operational or staffing changes

Conflict resolution styles

• Withdrawing (avoiding)

• Forcing (competing)

• Smoothing (Accomodating)

• Compromising

• Confronting (collaborating)

Avoiding

conflict is avoided. used best by management when employee issue is trivial or manager has no chance of winning. can also be effective when atmosphere is emotioanlly charged and space and time need to be created. sometimes issue will resolve itself, but “hope is not a strategy” and avoiding is generally not a good long term strategy

for ex - employee may be complaining about paperless system implemented for paychecks. new process cannot be changed, and after employee adjusts to a paperless system the complaining generally disappears

Competing

this is the “win-lose” approach. this can happen when manager acts in assertive way to achieve goals, without seeking to cooperate with employee. may be appropriate for emergencies when time is of essence, or when you need quick, decisive action, and people are aware of and support approach

for ex - manager may make immediate decision to collect payments upon check in, instead of check out, and this decision is made without consulting with employee

Accomodating

when a manager may cooperate to a high-degree, perhaps at most expense of or against a goal. this approach would be most effect for a manager to use when employee has a better solution. it can also be effective for preserving future relations.

for ex - manager may know that collecting fees should occur at intake to avoid patients who leave practice without checking out; thus avoiding payments. but the employees are resisting change and the manager does not force the change to occur

Compromising

this is the “lose-lose” scenario. it may be appropriate for scenarios where you need temporary solution, or where both sides have equally important goals, but in the end, the manager will not have accomplished anything

for ex - manager wants to change the fee collection process, the employees do not, and so they agree to ask at check-in for fees, but do not push to collect

Collaborating

where manager and employee work together to achieve or resolve both objectives. This can be effective for complex scenarios where managers need to find a novel solution. the downside is that it requires a high-degree of trust and reaching a consensus can require lots of time and effort

HR’s role in conflict resolution - Job Design

The systematic and purposeful allocation of tasks to individuals and groups within an organization

the purpose is to increase both employee motivation and productivity

Job enlargement

can be used to increase motivation by giving employee’s more and varied tasks - keeping them engaged so they want to keep their job

Job rotation

allows an employee to work in different departments or jobs in an org to gain better insight into operations

Job enrichment

allows the employee to take on some responsibilities normally delegated to management

Work simplification

the analysis of a job’s most basic components to restructure or redesign them to make the job more efficient

Job Descriptions

A detailed statement of an employees tasks to be performed

Defines:

• Knowledge required

• skills

• responsibilities

• training

• experience

• certifications/licenses

• line of reporting