Hello ASHHRA Members,

As promised in last month's letter, I wanted to share the goals your ASHHRA Board is working very diligently on for this year. Each of the goals are aligned to our three year strategic plan. I am extremely pleased with the focus and effort to date and I am highly confident we will have a very successful year.

Board members Grace Moffitt, Maureen O'Keeffe, and I are exploring the whole idea of certification for health care human resources professionals. Since our business segment is going to explode with the advance of baby boomers needing health care services, we are exploring the idea of a valued product, an educational component, and a potential partner in this quest. This is very strategic and we are currently in the research phase.

Board members Karmen Reid and Tom McCawley are working on a laundry list of important actions to improve service to the chapters/regions including trying to increase chapter membership, assisting chapters with mentorship programs, and monthly e-mails to chapter leaders. For the regions, goals have been established to include more information on newsletters, regular calls with chapter presidents, and providing at least one advocacy representative at each state conference.

Board member Paul Morlock and President-elect Irma Pye have developed a three tiered approach to establishing an exciting and extremely valuable new program for you. They are currently working on Tier One. We will tell you more about it in the coming months, so stay tuned.

Board members Marit Brock and John Ostrom have defined very specific goals in increasing Non-Hospital membership by three percent, which is 20 additional members for this year. They are planning to reach out to several non-hospital professional groups for partnership opportunities and will develop a Non-Hospital Track of presentations for our annual conference and target market potential attendees. They will also ramp up the ListServ to include all current non-hospital members and propose to update our marketing road show presentation to market the non-hospital segment.

Board members Joe Miccuci and Paul Morlock have engaged the area of technology and have identified and reviewed six areas for potential improvement: optimization of technology, and proposed upgrades including online purchasing, launching e-books, a member spotlight, and establishing blogs, just to mention a few.

Board member Nicole Morin-Scribner and Immediate Past President Jeff Payne have begun work on the issue of wellness and establishing a culture of health in our organizations and providing the tools to our constituency for doing so. This effort will include communicating best practices and presenting findings, but most importantly providing you with the tools you need in your organization.

We have also identified opportunities for our organization to become more proactive in partnering with other Professional Membership Groups (PMG) within the AHA to include leadership in policy and advocacy, education and sponsorships, educational presentations in our field of health care human resources, and collaboration on important and pertinent initiatives in our field. ASHHRA Executive Director Stephanie Drake, CEO Board Member Melissa Kinnaird, and I are working on these initiatives with the entire Board of Directors.

Have a great month and I will continue to provide status on a quarterly basis.  

Robert Walters, SPHR
Corporate Director, HR Operations
Health First, Inc.
3550 North Harbor City Blvd.
Melbourne, FL 32932-0069
(321) 434-1957
bob.walters@health-first.org 

 

 

 

 

 

 

 

Hospitals willing to engage community-based organizations have a tremendous opportunity to maximize the impact of workforce development goals. It’s a concept that has strong and active collaborative stakeholders in Chicago united around a common goal: helping entry-level health care employees gain the skills and education needed to advance. The result is a win-win situation: engaged employees are funneled into high-demand careers, letting the employer fortify pipelines while attracting the best new entry-level talent to fill newly vacated positions.

The project’s roots took hold at a community hospital in the city’s near Southwest Side. In 2009, Saint Anthony Hospital introduced the innovative School at Work® (SAW) program, and successfully graduated its first class of 18 students last August.

SAW is a technology-based system created by Catalyst Learning Company, based in Louisville, KY. It combines coach-based mentoring with online health care-specific coursework, DVDs, and career development activities. SAW is unique in how it addresses the needs of entry-level adult-learners. Employees attended classes during the workday and received coaching on life/time management and career planning while completing the health care-specific curriculum.

Pamela Jones, director of Workforce Development at Saint Anthony Hospital was the hospital’s lead individual for implementing SAW. Jones, who has 15 years of experience developing and managing employment training programs throughout Chicago, decided to take the life management content to a new level and identified community partners to help students address barriers. Additional services were provided at the worksite, either during or immediately after SAW classes. With full support by Saint Anthony Hospital’s leadership, Guy A. Medaglia, president and chief executive officer, Jones created and executed a plan to bring educational opportunities to Saint Anthony Hospital’s employees; furthermore, she expanded the model to create a "one-stop shop" within Saint Antony that would give workers greatly expanded education and services to pursue post-SAW studies.

"We believe in investing in our community and our employees. By providing them with no-cost educational opportunities through SAW, we are helping them to broaden their skill sets. Also, their quality of life will be improved because they’ll be better able to support their families, enhancing the well-being of the community overall. Ultimately, we plan to offer this program to many more of our employees and open it for the entire community," said Medaglia.

The support and engagement showed in the astonishing results. All of Saint Anthony’s original participants enrolled in community college after completing the program. "All of my graduates worked really hard to achieve their goal," said Jones. "Their commitment and motivation fueled by the support of their managers and supervisors here at work is impressive. I can see they are already on the right path as they celebrate and make plans to continue with their studies."

The success caught the attention of city officials, which led to an evaluation to determine whether or not the model could be expanded throughout the city. "The model appealed to the Metropolitan Chicago Healthcare Council (MCHC) and (Chicago’s) Department of Family and Support Services (DFSS). Once they saw the outcomes and understood how the program was designed to provide a holistic solution, it provided an opportunity for our local association and the city to be part of something big," said Jones.

As a result, Saint Anthony and 12 other hospitals were awarded funds from the DFSS. In addition to the MCHC, community partners included the Eleanor and Steans Family Foundations (two organizations that provided funding to Saint Anthony for the 2009 SAW pilot), Heartland Human Care Services, Instituto Del Progreso, Central States SER, City Colleges of Chicago, Chicago Low-Income Housing Trust Fund, and the Chicago Economic Development Law Project.

The city’s top brass also took an interest. To address the need for an increasingly skilled workforce in Chicago’s health care industry, Chicago Mayor Richard M. Daley announced the launch of the project and designated Saint Anthony Hospital as the mentor organization.

One participating organization was Mercy Hospital and Medical Center. Nancy Hill-Davis, vice president of Human Resources/Risk Management was familiar with SAW, having first learned of it while attending the ASHHRA Conference in 2006. Mercy had long provided a range of opportunities for professional and clinical staff, but other than general customer service training, the organization lacked a systematic approach to helping frontline workers strengthen basic skills and enter workforce pipelines.

Though Hill-Davis was initially excited at the prospect of filling the gap, a lack of resources prevented her from doing so. Finally, in late 2009, the organization was in a position to launch SAW. Coincidentally, it was during the planning phase that she learned about the funding opportunity. Mercy moved quickly to join the growing collaborative of Chicago hospitals; in February 2010, 18 Mercy employees joined the citywide cohort.

Like at Saint Anthony, Mercy’s participants are achieving their goals. An example is Registrar Monica Caldera, who is enrolled in the nursing program at Malcolm X Community College. Caldera credits the support of her supervisors and Mercy leadership for her success. Genella Harper, supervisor of Sterile Processing, had two employees participate, which motivated her to attend the October graduation ceremony.

"The speech (my employee) Gerald gave inspired another one of my techs to enroll in the next session. I support this decision! This experience has changed my employees; they now pay more attention to the detail on their trays, which impacts the patients, doctors, and nurses."

Hill-Davis echoes that the supervisors, along with Mercy’s executive leadership, gave strong support to the students. "First off, I was surprised at how willing the supervisors were to let employees do this during the work time; there were absolutely no complaints. Upper-level management also got involved and has made recommendations for future participants. This investment pays off. We are committed to having the best and brightest here, and the effect trickles down to impact high-quality patient care and service."

At Resurrection Medical Center on Chicago’s North Side, 10 of the 11 participants enrolled in continuing education immediately after completion.

Lizette Wheeler is one such employee. Wheeler, a security officer who has been employed at Resurrection for four years, is also working toward a nursing degree at Malcolm X Community College. Like Caldera at Mercy, Wheeler credits the support of hospital leadership with helping her stay focused.

"I now have nurse mentors who are helping me with homework, and one doctor who saw my books has also taken an interest in encouraging me," she said.

For the second year in a row, all Saint Anthony’s participants have enrolled in community college. Jazette L. Moffitt is a graduate of the 2009 pilot who has since gone on to enroll in the business program at Wright College. Moffitt addressed graduates at neighboring hospital Sinai Health System in October. The medical claims analyst told the audience that, "This experience caused me to think on a larger scale about what I want to do for my children and my employer. It helped me know that I can achieve a goal if I plan and prepare."

A recent MCHC survey of 2010 SAW graduates indicated that 96 percent of participants have more motivation at work and 92 percent have increased interest in enrolling in continuing education.

"Results of the survey not only make the case for offering SAW to hospital frontline employees, but also to build on the momentum created by the program to promote career and educational advancement opportunities," said Mary Pat Olson, director of MCHC’s Health Care Workforce Institute.

MCHC is now working with its member hospitals and stakeholders at DFSS, Saint Anthony Hospital, Catalyst Learning Company, Wilbur Wright College, and Central States SER to develop a strategy to transition all interested SAW graduates into the community college system. In addition, MCHC is promoting resources and services from community partners that would give SAW completers and other eligible employees the opportunity to receive financial counseling and attend community college classes at the worksite.

The model shows sustainability; planning for year two of the Chicago SAW project is underway. MCHC plans to incorporate key components of the further academic success action plan. Amy Santacaterina, deputy commissioner of Workforce Services for DFSS, says that, "We are very pleased with the success of Chicago School at Work and think this is a quality curriculum. We are excited about continuing it in 2011-- if we can get more people to advance, that will really help our hospital partners grow their own and help fulfill a need with employees who have proven themselves to be dedicated and hardworking. Plus, it gets people on a career path to sustain their families and earn good wages."

At Saint Anthony Hospital, where it all originated, employees continue their path to educational success and career advancement as a result of the SAW program. "Our objective is to ensure that our employees grow in every way possible. Our mission as a community hospital is to care for all, which includes providing opportunities for our associates so they can reach their full potential for themselves and their families within our community. Thanks to our strong partnership with Catalyst Learning, we are helping them achieve their goals," concluded president and CEO Medaglia.

 

 

 

 

 

 

Human resources professionals often do not have time to pontificate on the role of ethics in business and health care. Milton Friedman, the legendary economist, was quoted as saying, "The business of business is business (1970)." Others would argue that ethics do matter. Ethical scandals have plagued health care companies like Columbia/HCA, a featured case study in Business Ethics: Ethical Decision Making and Cases (Ferrell et al., 2008), a leading business ethics textbook. Ethics in human resources in health care is not solely academic; it is a matter of strategic and reputational importance to any senior leadership team and board.

Staying Out of the Headlines... and Off YouTube
Some would argue that health care, particularly nonprofit health care, is different than other industries in terms of having an ethical compass. A glimpse of some recent headlines would not support the claim that health care is different. A headline appearing in the New York Post reads, "Sickening bonuses: Hosp CEO snag $1M amid big health cuts (Klein & Edelman, 2009)." Yet another headline "Hospital bullies take a toll on patient safety: Bad behavior by doctors and others undercuts morale, leads to errors (Aleccia, 2008) appearing on www.msnbc.com. Do you have a plan in place to prevent and manage what the public, at least the media, is regarding as ethical scandals?

It's More Than Staying Out of the Headlines... and Off YouTube
At the door of the HR office, there are some common human resources decisions with ethical dimensions such as:

• Off-shoring
• Outsourcing
• Child labor
• Reneging on pension and benefits
• Cutting hours
• Layoffs
• Electronic surveillance and monitoring.

Are these ethical issues the domain of the ethics committee and/or human resources? The ethics committees in most hospitals are to be commended for addressing those issues that fall under clinical ethics but far too many do not focus upon organizational ethics. In fact, it has been argued that there is a risk for hospital ethics committees to address business ethical issues because of being co-opted by institutional values (Boyle, 1990). In short, it is akin to "the fox guarding the hen house." Winstanley and Woodall (2000) argue that human resources management holds the moral stewardship of organizations. Furthermore, it has been argued that human resources management is a key part of business ethics (Trevino & Nelson, 2010).

This means more than ensuring legal and regulatory compliance. It is well known that what is legal may or may not be ethical (Trevino & Nelson, 2011). For example, it is legal to offer executives incentive bonuses while at the same time freezing pay for frontline workers and even laying off workers in certain departments. However, this may not be ethical.

Ethical Decision Making: Organizational, Group, and Individual Perspectives
Decisions are made at multiple levels in all organizations. Accordingly, it is critical that it is clear which body and/or individual has the responsibility to engage in particular ethical decisions. Nelson (2005) recommends using a "...deliberative, systematic decision-making process (page 14)" to address ethical conflicts. This ethical decision making process should be supported by an ethical infrastructure (Nelson, 2005) characterized by the following critical success factors:

• Mission statement of organization
• Values statement of organization
• Code of conduct/ethics
• Ethical standards and expectations

An example of how important it is to clarify who is making an ethical decision involves billing and collecting delinquent accounts. Generally, finance is responsible for accounts receivable (A/R). Given the Provena Covenant Medical Center legal case in which the state disqualified the property tax exemption of Provena for aggressive billing and collection policies and practices (Salinsky, 2007), the question arises as to whether HR should be involved by weighing in on decisions regarding the outsourcing of revenue cycle management services, the training of A/R staff of the ethical issues involved in collecting and even training in emotional intelligence to demonstrate caring and compassion even when collecting a delinquent account. The Provena case shows the role of ethics in the community. According to Trevino & Nelson (2011), the community is a stakeholder. In health care, the community has taken on special importance with the introduction of the Form 990 as well as Schedule H and the resurgence of the community benefit standard.

Organizational Level
At the organizational level, the board and senior executives formulate policy decisions and strategic decisions that impact the current and future state of the organization. In fact, board members are regarded as fiduciaries. This fiduciary duty extends beyond overseeing finances. It now encompasses overseeing patient safety and quality (Callendar et al., 2007). This means that they must regard each decision from the perspective of what is in the best interest of the entire organization. Organizations are complex and have multiple stakeholders. What is best for the organization today financially may not be best for current employees today in terms of their income or benefits, for instance, converting a defined benefit plan to a defined contribution plan or increasing health insurance deductibles, premiums, co-insurance, and co-pays?

In short, human resources is vital to the cultivation and maintenance of an ethical organizational culture through the design and delivery of formal systems such as selection systems and performance management systems (Trevino & Nelson, 2011). Do your selection, orientation, training, performance management, and reward systems include values and ethical expectations?

Group/Team Level
At the group or team level, leadership and management teams as well as steering committees make decisions which impact not only operations but patient care systems, the workforce and the community. For instance, a steering committee decides to streamline vendors to approve administrative efficiencies and as a result "underserved" small businesses are no longer eligible to bid on projects. Will this administrative streamlining result in the closure of that small business that relied upon the hospital to meet payroll?

Another illustration is the increase in pay-for-performance (P4P) programs for physicians and other direct-care providers. Wharam and colleagues (2009) have identified eight potential ethical problems with P4P programs. These eight ethical problems sit at the interface among clinical decisions, population health decisions and human resources management decisions. Is HR invited to the table to participate in these decisions which have an ethical implication or does HR have to invite itself to the table because of its unique role, knowledge and skills?

Individual Level
At the individual level, as an example, a nurse manager has to balance the ethical responsibilities to a patient against the ethical responsibilities to employees (Toren & Wagner, 2010), for instance, mandating overtime to cover the shift. HR professionals can use examples such as this one about the nurse manager as vignettes for selection interview questions, as case studies for training and even as dimensions of performance.

At all three levels, an ethical decision-making framework is required for organizations, groups, and individuals to methodically work through prior to formulating a decision. This will not always result in the optimal decision. There will still be ethical lapses. But if deliberation has occurred, then this can prevent many ethical lapses. An ethical decision-making model (Markula Center, 2011) is highlighted below for the use of HR professionals and those that they interact with both inside and outside the organization.

1. Recognize the ethical issue
2. Get the facts
3. Evaluate alternative actions
4. Make a decision and test it
5. Act and reflect on the outcome.

A related ethical decision-making tool for HR professionals is to differentiate distributive justice from procedural justice. Distributive justice answers the question, "Was the outcome fair?" And procedural justice answers the question, "Was the way in which the outcome was decided fair?" HR professionals must attend to both and aim for the following response to both questions: Yes.

Recommendations
These recommendations are based upon the assumption that HR assumes a key role and responsibility for designing and managing not only ethical programs in the organization but also creating and sustaining an ethical culture. This suggested role on the part of HR does not diminish the role of clinical or hospital ethics programs but serves to complement those programs.

1. Appoint a well-respected and well-trained individual to serve as Chief Ethics Officer or in a similar role.
2. Develop a set of ethics policies, procedures and code of conduct aligned with the mission and strategies of the organization.
3. Educate and train all managers and staff, including the voluntary medical staff, on spotting ethical dilemmas and then making deliberate ethical decisions before taking action.
4. Conduct an ethical culture audit of all HR processes and systems to make sure that ethics is woven into the fabric of all HR processes and systems.
5. Design an ethical reporting process that encourages individuals to report ethical violations in a psychologically and career-safe atmosphere without fear of reprisal.
6. Integrate the work of ethics in human resources with other organization-wide initiatives like quality, safety, marketing, materials management, legal, compliance, community benefits, risk management and governance.
7. Differentiate your organization from others by developing a reputation and brand for corporate social responsibility, integrity and ethical sensitivity.

References
Aleccia, J. 2008. Hospital bullies take a toll patient safety: Bad behavior by doctors and others undercut morale, leads to errors. Healthcare on MSNBC.com, July 9, 2008 (accessed on January 26, 2011). Available at: http://www.msnbc.msn.com/id/25594124/ns/health-health_care/.
Boyle, P.). Business ethics in ethics committees? Hastings Center Report, 20 (5), 37-38, 1990.
Callendar A.N., et al.: Corporate Responsibility and Health Care Quality. Office of the Inspector General, U.S. Department of Health & Human Services and the American Health Lawyers Association, 2007.
Ferrell, D.C., Fraedrich, J. and Ferrell, L. Business ethics: ethical decision making and cases. New York: Houghton Mifflin Company, 2008.
Friedman, M. The social responsibility of business is to increase profits. New York Times Magazine, September 13, 1970.
Klein, M. and Edelman, S. 2009. Sickening bonuses: Hosp CEOs snag $1m amid big health cuts. The New York Post. December 15, 2009 (accessed on February 12, 2011). Available at: http://www.nypost.com/p/news/local/sickening_bonuses_8pL0AI56MMF7wcPa3ibFDM.
Markula Center 2001. Ethical decision making framework (accessed on February 26, 2011). Available at: http://www.scu.edu/ethics/practicing/decision/framework.html.
Nelson, W. An organizational decision making process. Healthcare Executive, July/August, 8-14, 2005.
Salinsky, E. What have you done for me lately? Assessing hospital community benefit. National Health Policy Forum Issue Brief, 821, April 19, 2007, 1-19.
Toren, O. and Wagner, N. Applying an ethical decision making tool to a nurse management dilemma. Nursing Ethics, 17 (3), 393-402, 2010.
Trevino, L.K. and Nelson, K.A.. Managing business ethics: Straight talk about how to do it right. Hoboken, NJ: John Wiley & Sons, 2010.
Wharam, J.F., Paasche-Orlow, M.K., Farber, N.J., Sinsky, C., Rucker, L., Rask, K.J., Figaro, M.K., Braddock, C., Barry, M.J., and Sulmasy, D.P. High quality care and ethical pay-for-performance: A Society of General Internal Medicine Policy Analysis. Journal of General Internal Medicine, 24 (7), 854-859, 2009.
Winstanley, D. and Woodall, J. (Eds.) Ethical issues in contemporary human resource management. Basingstoke: Macmillan, 2000.

 

 

 

It's no secret that budgets are lean in this economy. Employers estimate an average increase in health care costs of 8.9 percent for 2011*, which means employees may feel the pinch with higher out-of-pocket costs. Since benefits are linked to attracting, retaining and motivating top-performing employees, HR professionals in the health care industry are continually faced with the challenge of identifying ways to make their benefits packages more attractive without increasing costs.

To help offset rising health care costs and continue to provide an attractive benefits package, a growing number of health care employers are turning to voluntary auto and home insurance benefits, and for good reason. Here are five compelling reasons why hospitals and health care systems are leveraging the advantages of voluntary auto and home insurance benefits plans.

1. Broad appeal of employer-sponsored auto and home insurance. Most employees drive a car and own a home. Considering auto insurance is a legal necessity in most states and home insurance is required by mortgage lenders, it's easy to see why employer-sponsored auto and home insurance is a benefit that's both appealing and relevant to the majority of the employee population. With premiums 100 percent employee-paid, no minimum participation requirements and availability to part-time and hourly employees, it's a viable no-cost benefit solution that's generating a lot of interest in the forward-thinking health care industry.
   
2. Money-saving opportunity for employees and their families. Voluntary auto and home insurance benefits typically offer special program savings. With insurance shopping on the rise, hospitals and health care organizations can provide employees with economical program rates for auto, home and renters insurance that are probably lower than what employees can get on their own. "Since we decided to offer this program a few years ago, many employees have commented that they have saved significant amounts by moving their auto and homeowners policies to Travelers through our group insurance partnership program," said Debby Patrick, Vice President of Human Resources at the Lehigh Valley Health Network. "We are so pleased to be able to offer such a valuable benefit to our employees and the positive feedback we have received has exceeded our expectations."
   
3. Year-round enrollment. Unlike most benefits, there's no designated enrollment period with voluntary auto and home insurance programs. Life events, such as buying a new car or home, getting married or receiving a rate increase, can trigger shopping and purchasing a new policy. As a result, effective and renewal dates vary from person to person. Regardless of when an employee's auto or home insurance policy is up for renewal, employees can call their insurance provider and get a free, no-obligation quote in minutes from licensed insurance consultants and easily enroll in the voluntary auto and home benefits program. It's all taken care of by the provider so there's no added workload for health care benefits managers.
   
   For those who prefer to do their research online, auto and home insurance providers offer online resources with real-time quote and enrollment services in addition to coverage information to help employees make informed decisions. A link is easily added to the hospital's or health care system's intranet site or employee portal.
   
4. Carriers coordinate and fund communications. Of course, it's essential to clearly communicate the availability of the auto and home insurance program, the advantages it offers employees, and how to request quotes and enroll. Most often, auto and home insurance providers have proven marketing programs and educational materials that are readily available. An experienced provider will identify all available communications vehicles and put together a benefit communications plan tailored to meet specific needs.
   
   An integrated awareness campaign can consist of pre- and post-implementation articles, posters, emails, ads and tent cards to name a few. However, the most effective communication method is the enrollment kit, which is mailed directly to the employee's home. It's effective because deciding on something as important as auto and home insurance is often made jointly with a spouse or significant other in the household. While it may seem costly and time consuming, a good provider will administer and pay for all auto and home insurance program promotions. Considering that employees who are aware of the benefit are twice as likely to participate, it's important to keep the program relevant with ongoing communications.
   
   It's also advantageous to feature voluntary auto and home insurance benefits on the hospital's public website. This enhances the attractiveness of the entire benefits package to job seekers.
   
5. Portability. A growing number of hospitals report policy portability is an important feature of voluntary auto and home benefits for their employees. Employees can keep the benefit upon separation of employment, thus increasing the perceived value. Employees will lose the convenience of payroll deduction; however, many carriers offer alternate payment options, such as automatic electronic funds transfer, credit card, phone and online payments.

When you can strengthen benefits programs without affecting your budget, adding voluntary auto and home insurance programs seems to make good business sense. After all, you really can't go wrong helping employees save money on necessary household expenses, especially when there's no impact on your budget and workload.

Wayne Tryon is an ASHHRA member and the business development director for the Travelers Affinity Auto & Home Program specializing in the health care industry. He has primary accountability for working with hospitals and health care networks to develop and execute voluntary auto and home insurance benefits. He has more than 30 years of experience in the insurance industry and has achieved the designations of Chartered Property Casualty Underwriter (CPCU) and Chartered Life Underwriter (CLU). Travelers is also an Associate Member of AHA. To learn more about offering voluntary auto and home insurance benefits, visit www.travelers.com/affinity and contact Wayne Tryon at 800.328.2189, ext. 79831.

*National Business Group on Health

 

Health care organizations, just like most other employers in the United States, are facing an unprecedented tsunami of poor employee health. Chronic health problems, increased absence and disability, turnover of key talent and loss of productivity are undermining many hospitals' ability to properly execute their business strategy.

Recognizing these factors, some forward-thinking HR leaders and administrators are taking steps to address both the health and the health care needs of their employees. These health-focused health care providers are partnering with their employees to create and implement preventive health care solutions that aim to optimize their health and behaviors, not just eliminate risks.

What Outcomes Can Hospitals and Health Care Systems Expect?
Sibson recently conducted a Healthy Enterprise Study to both examine the business case for being a healthy enterprise and explore whether the nature and scope of employers' healthy enterprise efforts make a difference to their return on investment, as measured by savings. Nearly 300 employers, including 50 health care organizations, participated in the study. The participants represent more than 2 million employees, headquartered in 44 states, the District of Columbia and Canada. (For more information, see Results from Sibson's Healthy Enterprise Study at http://www.sibson.com/publications/surveysandstudies/HealthyEnt.pdf.)

The study found significant variance in each of the outcome metrics reported – health cost per employee, health cost increase per employee, turnover, unscheduled absence, extended absence, and workers' compensation cost as a percentage of payroll. As the table below shows, the 90th percentile is always more than double the 10th percentile (the level at which 10 percent of respondents reported a lower outcome). This relationship is also consistent even after adjusting for industry and demographics.

Differences in Outcome Metrics by Percentiles of Respondents*

* For each metric, the percentiles of respondents reflect the lowest to highest dollar amounts or percentages.
Source: Sibson Consulting

To better understand the organizational drivers for this variance, Sibson developed a Healthy Enterprise Index, which rates organizations from zero to 100 percent, according to how well they partner with their employees on health initiatives. The average Healthy Enterprise Index score is 57 percent.

Although not every health care organization will aim for a Healthy Enterprise Index of 100 percent, its leaders may want to determine their index and, if it is low, develop strategies to improve it. Sibson has found that a higher Healthy Enterprise Index is associated with lower health care costs. On average, a 10 percentage-point increase in the index equates to a $160 reduction in health care cost per participant. An organization that has an average of 1.5 dependents for each employee could experience a reduction in annual health care costs of $400 per employee by increasing its index by 10 percentage points.

Participants in the top quartile of the Healthy Enterprise Index achieve better outcomes across the board, as shown in the following table.

Comparison of Average Adjusted* Outcome Metrics for the Top Quartile Compared to All Others

* Sibson adjusted each outcome metric for various factors, such as industry and demographic (i.e., age and average family size). For information about which adjustments were applied to each metric, refer to the online supplement to this report that discusses the study methodology, which is available on the following page of Sibson's Web site: http://www.sibson.com/publications/surveysandstudies/HESsupp2.pdf
Source: Sibson Consulting

The ROI of becoming a healthy hospital is potentially considerable. For example, a recent meta study (a study of studies) conducted by Harvard University concluded that the return can be 3.27:1 on medical costs and 2.73:1 on absence and related costs. The programs that were the subjects of the reviewed studies generally were crafted carefully with the intent of measuring an outcome. This suggests that hospitals need to design their healthy hospital initiatives carefully to ensure they, in time, will produce a healthy ROI.

What Steps Should Health Care Organizations Take to Become Healthy?
The results of Sibson's Healthy Enterprise Study suggest that hospitals that want to become healthy hospitals should:

• Establish a dedicated initiative leader and a wellness committee. This can ensure good program leadership and oversight.
• Develop a healthy hospital strategy that is aligned with the organization's strategy. An aligned strategy clarifies the vision of the desired state, makes the initiative more real to employees and helps leadership understand how the initiative supports their objectives.
• Inventory and assess the "current state." This is an assessment of where the organization stands in achieving its vision and may include the services and offerings currently available as well as the outcomes achieved and the perceptions and effectiveness of these programs. (For further insights, see the sidebar "So, How Healthy Is Your Organization?")
• Involve key stakeholders. They include leadership, employees and other potential internal partners.
• Re-evaluate the many investments the organization makes to become a healthy hospital. It may be possible to invest differently without spending more. For example, many hospitals provide financial counseling – which can have a beneficial effect on employees' health to the extent that it relieves stress – in a fragmented way: through retirement programs, employee assistance programs and voluntary benefit programs. These resources can be redeployed as part of a financial wellness program that provides more comprehensive and independent financial counseling.
• Take steps to get employees to embrace the initiative. Employees need to not only participate, but embrace the initiative enthusiastically, which requires leadership support, a broad set of effective resources and communications focused on changing behaviors.
• Create an effective workplace. Employees cannot and will not tend to their personal needs if they are working in a toxic environment where there are various forms of aggression (e.g., harassment and bullying) and a lack of trust and respect. They need the appropriate tools and resources to enable them to be efficient and successful.
• Pay attention to dependents. Dependents can represent half or more of an organization's medical costs. Moreover, dependents can significantly influence the behaviors of employees. As a result, it is important to think about the strategies employed to engage dependents and to address their unique needs.
• Measure outcomes. It is important to identify the metrics that will determine if the organization is achieving its stated strategy. Measuring success, shortcomings and failures is as essential as measuring costs. Health care organizations should share these key metrics across various constituents within the organization, both to foster support and to show progress.

In addition to the cost savings associated with being a healthy hospital, there may be productivity gains to the extent that healthy employees are more satisfied with their jobs and more engaged in their work than are unhealthy employees.

Trying to become a healthy hospital right out of the blocks can be a daunting task that is outside the scope of most hospitals and health care organizations. A more realistic approach is to start by defining a strategy that clearly aligns with and supports the business strategy. Health care organizations can then begin by making investments that optimize success within the current culture. Many hospitals start promoting health and productivity by repackaging the programs and services they already have in place to support the strategy. They then add resources (e.g., health-risk assessments and screenings) to help employees and their families understand their risks and conditions and to better manage them through behavior modification (e.g., using health coaches, education, and other tools).

So, How Healthy Is Your Organization?
There are different levels at which an employer can partner with its employees on health initiatives. Based on investigations of best practices and our independent research and experience with clients, Sibson Consulting developed a Continuum of Maturity model that identifies three levels of maturity based on how proactive an organization is at addressing its employees' health issues:

1. Focus on Treatment. In the first stage of the continuum, the organization's focus is reactive rather than preventive. It addresses behaviors and health issues after they occur. Many organizations become aware of workforce problems through large claims increases or workplace incidents and concentrate in the short term on reducing costs rather than improving health and behavior. Organizations that focus on treatment may overlook the costs associated with productivity losses caused by health-related absences or disruptive workplace behavior.
2. Focus on Prevention/Management. In the second stage of the continuum, the organization's focus is more proactive. It promotes better physical and mental health for employees and family members by helping them identify health risks and conditions and then address them through supportive resources. Organizations in this stage are increasingly proactive in sharing responsibility and encouraging safety, personal accountability, and health risk and condition management through healthy personal and workplace behavior.
3. Focus on Optimal Behavior and Health. In the third stage of the continuum, the organization's focus moves beyond risks and conditions to a demonstrated commitment to improve the health and behavior of employees and the organization. This is imbued throughout the culture as a means to enable employees to engage fully in their work and their personal lives. Evidence of a "healthy culture" is reflected in all aspects of organizational behavior, from encouraging a team-based environment with a climate of trust and respect to maintaining a smoke-free environment. Healthy behavior is encouraged, exhibited and rewarded. Many proactive healthy organizations also consider the financial wellbeing of their employees as part of the total picture.

A number of factors differentiate the three stages of a healthy hospital. For example, where a hospital in the first stage will primarily be reactive in treating conditions and dealing with unacceptable behavior, a hospital in the second stage will focus on managing risks and conditions by shaping behavior. A hospital in the third stage, however, will focus on optimizing health and behavior by maintaining a healthy culture that is evident at every level.

In addition to this strategic orientation, each stage of maturity is characterized by its approach to addressing the various elements of its programs/initiatives, such as health plans, time-off programs, workplace support, behavioral health programs, communications, organizational behavior, and measurement and metrics. See the table below, for a sample of key distinguishing features.

Key Distinguishing Features Along the Healthy Enterprise Continuum

Source: Sibson Consulting

Conclusion
Most health care organizations seek to optimize their workforce by reevaluating all of their investments to determine what is essential to carry out their business strategy while enhancing the organization's culture. A well-thought-out healthy hospital initiative can help an organization better control its health care, turnover and absence-related costs while helping its employees stay engaged, healthy and productive.

Steven F. Cyboran is a vice president and consulting actuary in the Chicago office of Sibson Consulting. He leads Sibson's Healthy Enterprise Initiative and has been actively involved in a variety of projects focusing on cultural transformation. He can be reached at 312.984.8558 or scyboran@sibson.com. Glenn M. Alonzo is a senior vice president and national hospital and health care market leader in the Hartford office of Sibson Consulting. He can be reached at 860.678.3013 or galonzo@sibson.com.

 

 

 

 

Many people remember seeing encouraging comments written on the top of their elementary school homework assignments. The friendly green ink and accompanying colorful stickers always seemed to bring a smile to an ordinary moment during the day. Teachers make these comments to build their students' self-esteem, and to show their hard work is noticed and appreciated. In turn, children take these words to heart, soaking up the praise and reveling in a sense of accomplishment.

It turns out an individual's need to be recognized does not change all that much as he or she gets older. According to a recent study conducted by HR Solutions Inc., recognition is the key driver of Employee Engagement¹. Some might find it surprising that recognition surpasses many other important motivational factors, such as adequate training, relationships with co-workers and career growth. These results illuminate that even as adults, people still want to feel appreciated for a job well done.

Tapping into this engagement driver seems simple enough, yet research has shown that many organizations' efforts have been ineffective in this regard. Only 59 percent of employees say their supervisor lets employees know when they have done a good job. These findings reveal that many employees do not feel as though their manager acknowledges their accomplishments. Surely, more than 59 percent of managers appreciate when their employees have done a good job, so there must be a common disconnect somewhere in the process of showing recognition.

It is important for managers to consider their employees' perceptions of receiving recognition, and how this can differ from their own perception of giving recognition. Although managers may think they are frequently recognizing employees, many employees may not feel the same way. According to a recent study by Michael C. Fina, Millennials, generally characterized as people born between 1980 and 2000, like to be recognized seven times each day. To some tenured employees, this may come across as an indulgent and unrealistic expectation. While that might have been true many years ago, American culture has shifted dramatically over the years, causing workforce culture to change as well. For instance, Millennials are famous for growing up in an era where 13th place ribbons actually exist. To attract and engage this new generation, company recognition efforts must keep up with the times.

Although recognizing employees seems fairly straightforward, there is more structure and planning that goes into a successful recognition program than many people might realize. It is great to tell someone they have done a good job, however, it makes a difference what they are recognized for, how they are recognized and how often they are recognized. Creating a program that appropriately caters to all of these aspects can be challenging.

To help simplify this process, HR Solutions has compiled a list of 10 best practices for developing an organizational culture of recognition:

1) Define what should be recognized
When establishing a recognition program, it is important for an organization to define the behaviors or outcomes that are deemed worthy of recognition. A great way to develop a guideline is for senior leadership to brainstorm a list of employee actions that contribute to the organization's success and mission. Ideas can range from bringing in a certain amount of revenue, to receiving a positive comment from a patient or customer, to simply volunteering to help a co-worker. This list should be shared with all supervisors and used as a guideline for giving recognition. When the desired actions or outcomes are clearly defined, employee recognition can be streamlined throughout the organization, helping to create a culture of recognition.

2) Be sincere
All too often, companies turn recognition programs into just another task that needs regular attention. Employees can tell when a manager just "goes through the motions" of providing recognition, but has lost genuine interest in showing appreciation for staff members' efforts. This lack of sincerity and enthusiasm can make recognition diminish in meaning, even if the reward remains the same. The reason recognition is so powerful is because people thrive on the warm, fuzzy feeling of being appreciated. If sincere appreciation is lost from a recognition program, it will no longer be effective.

3) Recognize in public and in private
Public and private recognition can be appropriate in different situations and the best results come from employing both methods. Public recognition is highly effective because it gives employees structure so they know what to expect. If top-performing employees are recognized at each monthly meeting, employees have a goal they can work toward. For many employees, being congratulated in front of peers can actually be the most rewarding aspect of receiving praise.

Providing private recognition can also be very effective in showing employees they are appreciated. Private recognition is easier for managers to give more frequently and it is as simple as a quick "on-the-spot" verbal thank you. Whether it is an email, voicemail, hand-written note, or just stopping by in person, letting an employee know they have done a good job goes a long way and only takes a few moments.

4) Balance criticism
Criticism is an important factor that affects employee perception of recognition. Unfortunately, it can be common for employees to focus on the criticism they received, rather than the recognition. With that in mind, managers should not shy away from providing constructive feedback because they are afraid it will hurt an employee's feelings. They should, however, be aware of how criticism can affect an employee's perception of recognition efforts overall. If a manager has been providing more constructive criticism than usual, it could be a good idea to increase recognition efforts when employees perform well.

5) When in doubt, ask!
The type of recognition or reward is not a benefit if the person does not want it. It is unwise to assume all employees want the same things. Ask individual employees how they like to be recognized. Although this is the most straightforward approach, oftentimes, managers overlook the simplicity of communicating openly with employees. There does not have to be anything secret about recognition and managers do not need to be illusive with employees. Telling employees you want to recognize them in a way that is meaningful to them shows genuine interest and appreciation in advance, which is a great first step in providing effective recognition.

6) Equal does not necessarily mean fair
Employee recognition does not have to be equal. After all, some things have to change in adulthood! To make recognition meaningful, it needs to be appropriate for the effort or accomplishment. In a perfect world, all employees would be equally dedicated and successful, but in reality, it is very unlikely that will happen. Organizations will generally have certain employees that consistently outperform others. If managers do not recognize and reward these employees, they will go elsewhere. Health care organizations in particular should keep this in mind, as the anticipated shortage of nurses looms on the horizon. Instead of losing talented employees who feel under-appreciated, senior leadership should focus on retaining top performers by increasing recognition. To cut back on perceptions of favoritism, top-performers can be rewarded more frequently in private. Making employee recognition equal is not a risk worth taking.

7) Do not overdo it
Although employees can thrive on recognition, it is possible to have too much of a good thing. Over-recognizing can quickly dilute the meaning and heighten the risk of seeming insincere to employees. In addition, if an employee is congratulated for every single task they complete, they could have little motivation to work harder or do a better job. Managers should recognize at their discretion, while considering the possibility of over-recognizing.

8) Appropriate rewards
Rewards and gifts are the cherry on top of recognition. While not always necessary, it can be a great addition to simply telling an employee they have done a great job. With that in mind, the reward must be appropriate for the action or outcome. Giving a reward that is disproportionately smaller than the amount of time or effort expended can actually decrease the value of the recognition and possibly be perceived as a de-motivator.

9) Educate employees on your efforts
It is important for employees to understand the importance their organization places on recognition and the effort managers undertake to ensure employees are recognized. For example, if managers are privately rewarding employees with gift cards or extra paid time off for a job well done, all staff members should be made aware of those initiatives. When employees see the whole picture of actions taken to help increase their recognition and engagement, they are much more likely to have a positive viewpoint on the recognition they receive.

A best practice for involving employees is to ask for feedback on new initiatives they would like to see. When management is aware of employee opinion, it is much easier to make the changes employees desire. Any changes that are made as a result of employee feedback should be clearly communicated to staff members. A hospital newsletter or bulletin can be a great vehicle for educating employees.

10) Encourage employees to recognize one another
To create a true culture of recognition, everyone should be involved. While senior leadership should manage organizational recognition efforts, employees should be encouraged to recognize their colleagues' hard work as well. A best practice for involving employees is to post a white board in a high-traffic area or online through an internal intranet system where employees can publically recognize each other. In hospitals, nurses can use white boards in patient rooms to recognize the care team on staff. Rather than simply posting that Carol is the head night nurse, staff could also post that Carol is passionate about nursing and well-known for her dedication to patients. Not only will this initiative contribute to employee engagement, but it should help build trust with the patient and patient's family.

A strong recognition program can be the difference-maker in an engaged workforce. Although employees no longer need smiley-face stickers on returned assignments, they do need recognition for a job well done. Luckily, it is easy for managers to begin increasing recognition immediately. A great way to start a new initiative is by setting a calendar reminder to recognize one employee each day and increasing this number over time. When providing frequent recognition becomes second-nature, employee engagement should increase as well, creating a workplace culture headed toward organizational success.

¹HR Solutions' International Normative Database is comprised of over 3.3 million survey respondents from 2,400 organizations across various industries.

About HR Solutions, Inc.: Noted for its comprehensive research and actionable data, HR Solutions, Inc. is an International Human Capital Management Consulting Firm located in Chicago, IL, specializing in Employee Engagement and Exit Survey design, implementation, and results. HR Solutions is the exclusive endorsed provider of The American Hospital Association (AHA) for Employee, Exit, and Physician Surveys. For more information, please visit www.hrsolutionsinc.com.