Management in Healthcare Organizations

Course Objectives for Assignment:•
•
Apply risk analysis, problem solving, planning, and communication skills to identify and
recommend improvements in the quality of healthcare programs.
Develop and communicate plans to utilize human, technical, and financial resources to
manage healthcare organizations.
Formatting:
•
•
•
•
APA 7th Edition
APA Formatted Title Page
Human Resources Report on Your Selected Scenario
APA Formatted Reference Page: Include at least 2 references with correlating in -text
citations.
Instructions:
Select a Healthcare Setting of Interest: (Select 1 Setting from the List Below)
Select a Staffing Function of Focus: (Select 1 Focus Area from the List Below)
Human Resources Manager Assignment Scenario: You work for a large healthcare system that
offers the entire continuum of care services from hospitals to home health, every aspect of care
delivery is part of the healthcare system that you work for in this scenario. You will be playing the
role of a human resource manager at your selected healthcare setting of choice, based on the
healthcare setting list provided above, and you will select a staffing function focus area, based on
the list provided above, to present to your leadership team during your next organizational
operations meeting. You will be meeting with the different team members to discuss your selected
staffing area of focus, which needs to be improved. During this meeting, you will be discussing the
importance of your selected staffing function and provide your team with an overview of your ideas
to improve this focus area.
Human Resources Report: Write a report that you will provide at the next operations meeting that
includes the following information:
1. Share your healthcare setting and your selected staffing function of focus.
2. Share why this specific staffing focus area is important to your selected healthcare setting.
3. Using the planning function lens, discuss how you will improve this staffing focus area for your
selected setting by identifying and describing three implementation steps.
An Example Overview:
•
•
•
Your selected healthcare setting is an urgent care setting and you selected the focus area
of scheduling needs.
You will share with the team why scheduling is important to the urgent care. (You will
research scheduling topics associated to an urgent care setting in order to determine the
significance of this staffing aspect. Example: impact on patient care, employee fatigue,
patient to provider ratios, etc.)
You will select three hypothetical staffing issues to address and provide an overview of
how the team should implement the steps to address the issue. (Note: This is a highlevel planning overview, not a detailed plan, as a detailed plan should involve numerous
areas of management, leadership, clinicians, and other support team members. Example:
Staffing Issue: Scheduling Breaks Plan: Work with scheduling manager to cover breaks,
rotate times, and create a schedule that includes proposed break times.) Again, this should
not be a detailed plan but an overview of the issue and proposed implementation planning
steps to address the issue or concern.
Copyright 2019. Health Administration Press.
All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.
CHAPTER 7
STAFFING: OBTAINING
EMPLOYEES
Our employees are our greatest asset.
Business slogan
Learning Objectives
Studying this chapter will help you to
➤➤ define staffing and the seven staffing processes;
➤➤ describe how human resources specialists help managers with staffing;
➤➤ understand the importance of diversity and inclusion in staffing;
➤➤ realize how laws, regulations, and court decisions affect staffing;
➤➤ explain how managers plan staffing;
➤➤ describe how managers design jobs; and
➤➤ understand how managers recruit, select, and hire staff.
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AN: 2144509 ; Peter Olden.; Management of Healthcare Organizations: An Introduction, Third Edition
Account: s4264928.main.eds
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Management of Healthcare Organizations
HERE’S WHAT HAPPENED
Partners HealthCare revised its mission and developed ambitious goals to improve the
quality and cost-effectiveness of patient care. More specifically, managers intended to
use technology to improve four priority health conditions: diabetes, heart attack, stroke,
and colorectal cancer. To achieve their goals, managers had to staff the organization.
They planned which jobs were required (e.g., telemonitoring nurse) and how many
positions were needed for each. They organized and designed jobs by identifying the
tasks, responsibilities, authority, and qualifications required for each job. For example,
the telemonitoring nurse job was responsible for monitoring remote patients’ vital signs
via telehealth technology, responding when the telehealth system signaled that vitals
were abnormal, and guiding patients through biweekly heart education. Managers
had to recruit applicants for the positions and evaluate the applicants using selection
criteria. Careful selection of telemonitoring nurses was needed because some nurses
prefer working with patients by standing at the bedside rather than by sitting at a
monitor. After managers decided whom to hire for each position, they prepared job
offers with compensation, starting dates, and other essential information. By performing the staffing function, managers progressed toward their goals for patient care.
staffing
Obtaining and retaining
people to fill jobs and
do work.
A
s we see in the opening Here’s What Happened, healthcare organization (HCO)
managers must obtain people to do the work to achieve the HCO’s mission and
goals. This is part of the staffing function—the third of the five fundamental
management functions we learned in chapter 2. We can think of staffing as the process
of obtaining and retaining people to fill jobs and do the work. Previous chapters on planning (the first management function) and organizing (the second management function)
referred to workers, employees, jobs, positions, and staff. Building on that discussion, this
chapter and chapter 8 teach us how managers staff their organizations. Staffing requires
managers to perform several of the management roles we studied in chapter 2: monitor,
entrepreneur, disturbance handler, resource allocator, and negotiator.
As we learned in chapter 4, healthcare is often a service, and services are performed
by people (rather than manufactured by machines). Most HCOs are labor intensive and
depend on many people to perform the services. These people may be called staff, workers,
employees, associates, personnel, human resources, workforce, or talent. Even though we
might be impressed by the amazing medical equipment used in many HCOs, we must
remember that people (human resources) are needed to operate the equipment (physical
resources). Further, some medical work and much nonmedical work (e.g., management
itself ) does not involve fancy gadgets and equipment. Healthcare is a service provided by
people, so managers must excel at staffing.
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Chapter 7: Staffing: Obtaining Employees
Many organizations, including HCOs, proclaim, “Employees are our greatest
asset.” How can managers obtain their “greatest asset”? How can managers then retain
their “greatest asset” to avoid the time, expense, effort, and lost revenue of replacing
workers (and avoid receiving negative comments on employer review websites such as
Glassdoor)? Chapters 7 and 8 answer these questions. First, we identify seven staffing
processes that HCOs use. Then we examine three special concerns for staffing HCOs.
After considering this background, we study in more depth the seven staffing processes.
The first three are explained in this chapter and focus on obtaining workers. The other
four staffing processes are explored in the next chapter and focus on retaining workers.
When you become a manager, you will soon become involved in staffing. Chapters 7 and
8 will help you prepare for that work.
The staffing of some HCOs includes physician jobs. As we learned in chapters 4
and 5, physician jobs may be quite different from other types of jobs. People who perform
physician jobs might—or might not—be employed by the HCO where they work. If they
are employed, they are usually obtained and retained differently than other employees are
and in ways that are beyond the scope of this book. Thus, chapters 7 and 8 will focus on
nonphysician staffing.
159
planning for staff
Forecasting the
staff (workforce) the
organization will
require in the future
and planning how to
effectively obtain and
retain that future staff.
designing jobs and
work
Determining work
tasks to be done by
a job, along with the
job’s qualifications,
supervision, working
conditions, rules, and
schedules.
hiring staff
S ta f fin g P r o c e s s es
Recruiting and
The management staffing function can be divided into seven processes that managers should
perform. These processes are shown in exhibit 7.1 and entail the following (Fottler 2015b;
French 2007; Fried and Gates 2015; McConnell 2018; Noe et al. 2016):
selecting people
for jobs, which may
include reassigning
existing workers by
promotion or transfer.
1.
2.
3.
Planning for staff—forecasting the staff (workforce) the organization will
require in the future and planning how to effectively obtain and retain that
future staff
Designing jobs and work—determining the work tasks to be done by a job,
along with the job’s qualifications, supervision, working conditions, rules, and
schedules
Hiring staff—recruiting and selecting people for jobs, which may include
reassigning existing workers by promotion or transfer
developing staff
Helping employees
acquire new
knowledge, skills,
attitudes, behaviors,
and competencies for
current and future jobs.
appraising
4.
Developing staff—helping employees acquire new knowledge, skills,
attitudes, behaviors, and competencies for current and future jobs
performance
5.
Appraising performance—evaluating workers’ job performance and
discussing those evaluations with them
discussing those
Evaluating workers’
job performance and
evaluations with them.
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160
Management of Healthcare Organizations
Exhibit 7.1
Seven Staffing
Processes
Planning for staff
Obtaining staff
Designing jobs and work
Hiring staff
Staffing
function
Developing staff
Appraising performance
Retaining staff
Compensating staff
Protecting staff
compensating staff
Determining and
giving wages, salaries,
incentives, and
benefits to workers.
protecting staff
Ensuring that workers
6.
Compensating staff—determining and giving wages, salaries, incentives, and
benefits to workers
7.
Protecting staff—ensuring that workers have proper and safe work conditions,
their rights are protected, and their opinions are considered by managers
have proper and safe
work conditions, their
rights are protected,
and their opinions
are considered by
managers.
diversity
The range of human
differences that include
the primary (internal)
dimension such as
age, gender, race,
ethnicity, physical and
mental ability, and
sexual orientation
and the secondary
Which of these processes have you noticed in a summer job or part-time job during school?
As mentioned, this chapter studies the first three staffing processes, which get people
in the door to start working. Chapter 8 explains the other four processes, which keep people
working rather than walking out the door. These seven staffing processes interact with
and affect each other. For example, designing a public health inspector’s job may lead to
developing current inspectors to perform new competencies, which then may lead to higher
compensation for the inspectors. Also, all these processes can contribute to both obtaining
and retaining staff. For example, hiring obtains staff, and if it is done well, the staff stay
and are retained. Compensation must start high enough to hire people, and it must later
increase to keep people.
Managers should ensure that all seven staffing processes are done well to help their
HCOs survive and thrive. In doing so, they should keep in mind three special concerns:
staff diversity and inclusion; centralized, decentralized, and outsourced staffing; and laws
and regulations. These are explained in the following sections.
(external) dimension
such as thought styles,
religion, nationality,
Workforce Diversity and Inclusion
socioeconomic status,
Chapter 1 reported US demographic trends that indicate HCOs’ labor supply and patient
population will continue to become more diverse in multiple ways. “Diversity refers to
the range of human differences that include the primary or internal dimension such as age,
gender, race, ethnicity, physical and mental ability and sexual orientation; and the secondary
belief systems, military
experience, and
education.
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Chapter 7: Staffing: Obtaining Employees
or external dimension such as thought styles, religion, nationality, socio-economic status,
belief systems, military experience and education” (Trustees of Boston College 2016).
The primary, internal dimension may be referred to as human diversity and the secondary,
external dimension as cultural diversity (Evans 2015). Together, these dimensions create differences among staff in many aspects of work, including status, communication, authority,
teamwork, professional behaviors, and use of time.
A diverse workforce, including a diverse management team, can improve organization
performance, population health, patient experience, community relationships, and other
expectations of HCOs’ stakeholders (who are also becoming more diverse). For example,
many HCOs have been unable to hire enough nurses, pharmacists, and primary care physicians to fill job vacancies. However, HCOs that are open to a diverse workforce—and are
perceived favorably by diverse workers—have a larger supply of labor from which to hire.
Having positions filled (rather than vacant) enables better clinical performance, customer
satisfaction, and patient experience. Also, patients may prefer providers and caregivers of
their own ethnicity who understand how that ethnic group experiences disease and feels
about medical care. These and other cultural factors affect patients, patient care, clinical
outcomes, and community population health. A diverse workforce can help an HCO successfully compete in diverse communities, reduce disparities in patient care, and thereby
achieve financial benefits (Evans 2015). A diverse workforce brings a wider range of ideas
and innovations for managers and decision makers to consider. However, if diversity is
not valued in an organization, it may create conflict, avoidance of coworkers, less teamwork, biased or constrained decisions, illegal actions, and other negative outcomes. Thus,
managers must lead and manage their HCOs to value diversity and use it to strengthen
the organization.
Hiring a diverse workforce is not enough; HCOs also must ensure inclusion of its
workforce and staff. “Inclusion involves the active, intentional, and ongoing engagement
of our diversity, where each person is valued, respected and supported for his or her distinctive skills, experiences and perspectives, to create a working and learning environment
where everyone has an opportunity to experience personal fulfillment and participate fully”
(Trustees of Boston College 2016). Many HCOs can do more to eliminate disparities,
improve diversity, and be more inclusive. How can they do this? By applying management tools, methods, processes, and ideas from this book. For example, during strategic
planning (chapter 3), an HCO can include diversity and inclusion in its mission, vision,
values, and goals. When organizing its jobs, departments, and structure (chapters 4–6),
the HCO can assign diversity and inclusion responsibilities to specific jobs and departments and then provide sufficient resources for them. When staffing the organization,
an HCO can recruit a chief diversity officer, hire a diverse workforce, provide training
to develop cultural competence for working with diverse populations, and appraise and
reward employees based on how well they support diversity and practice inclusion. Later
chapters in this book will provide more ideas to help you and your HCO reduce disparities,
161
inclusion
The active, intentional,
and ongoing
engagement of
diversity, where each
person is valued,
respected, and
supported for his
or her distinctive
skills, experiences,
and perspectives, to
create a working and
learning environment
where everyone has
an opportunity to
experience personal
fulfillment and
participate fully.
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162
Management of Healthcare Organizations
CHECK IT OUT ONLINE
The American Hospital Association, Institute for Diversity in
Health Management, and National Center for Healthcare Leadership recently developed an assessment tool that HCO managers
can use to ensure their organizations reflect the communities
they serve (Institute for Diversity and Health Equity 2018):
A Diversity, Equity and Cultural Competency Assessment
Tool for Leaders helps health care organizations assess their
progress to create high-quality, inclusive, equitable and safe
care environments aimed at eliminating health and health care
disparities to improve the health and well-being of our neighbors and communities. A Diversity, Equity and Cultural Competency Assessment Tool for Leaders includes four sections:
• Assessment Checklist: A tool that hospital and health
care leaders can use as a starting point in evaluating
the equity, diversity, inclusion and cultural competency
of their organization and identifying what activities and
practices are in place or need to be implemented.
• Action Steps: A suggested “to do” list for how to use this
tool to raise awareness within your organization.
• Case Studies: Examples of hospitals and health systems
that are implementing leading practices. You will find a
description of their activities, as well as information for the
key contact within each organization so you can learn more.
• Bibliography: Resources to help you and others in your
organization learn more about diversity and cultural competency.
The assessment tool is available at the Institute for Diversity
and Health Equity website (www.diversityconnection.org/diversityconnection/membership/Resource%20Center%20Docs/
Assessment%20Tool%20v4(20-page%20bklt).pdf ). Check it out
online and see what you discover.
increase diversity, and be more inclusive. By doing
so, you will better serve your populations, employees, and stakeholders.
The Check It Out Online sidebar describes
a useful resource for HCOs striving to become
more diverse, inclusive, and culturally competent.
The Using Chapter 7 in the Real World sidebar provides examples of how two HCOs have
improved their workforce diversity.
In the United States, aging of the
workforce, delayed retirements, and changing
demographics have led to increased workforce
diversity based on age and generation. An HCO
may have workers born in five generations: traditionalists, baby boomers, Generation Xers, millennials (Generation Y), and the newly emerging
Generation Z (Wagner 2017). The nonphysician
workforce at Baptist Health Lexington in Kentucky consists of 29 percent baby boomers, 47
percent Generation Xers, 22 percent millennials, and 2 percent from the other two categories (Wagner 2017). Having five generations of
workers is unusual and expands age diversity in
the workforce. The workforce can also be diverse
in terms of employment status, such as full-time,
part-time, contract, per diem, freelance, and
other kinds of “gig worker” status.
The generations have important differences
(and similarities) in their attitudes and expectations about work. Managers staffing an HCO
must understand, respect, and adapt to these differences. One size will not fit all generations with
regard to an HCO’s compensation plan, work
schedules, company loyalty, performance reviews,
career opportunities, and other staffing-related elements. Managers should first understand the differences (and similarities) among the generations
of employees and then develop staffing processes
for a wide variety of workers (Fottler 2015b).
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Chapter 7: Staffing: Obtaining Employees
163
USING CHAPTER 7 IN THE REAL WORLD
University Hospitals Health System (UH) is based in Cleveland and serves northeastern
Ohio. To increase the diversity of its workforce, UH has partnered with community organizations that help train local people of diverse backgrounds for both healthcare and
nonhealthcare jobs. By supporting these local partners, UH helps develop a diverse,
local labor pool from which it can hire diverse workers. UH’s governing board members are from diverse backgrounds, and the board monitors diversity and inclusion data
(Hegwer 2016).
Henry Ford Health System in the Detroit metropolitan area actively develops its diversity, believing that doing so gives it a competitive advantage. System leaders provide
diversity training, host book clubs, and use immersion strategies to engage and educate
the HCO’s workers. Each business unit has a diversity committee to handle diversity
issues locally. Seven distinct resource groups support African-American leaders, LGBT
(lesbian, gay, bisexual, and transgender) staff, women, millennials, Arab Americans,
caregivers, and Latinos. Annual events and ceremonies celebrate diversity heroes and
champions. Diverse teams provide a variety of perspectives that enable innovation.
These and other diversity initiatives strengthen the organization (Hegwer 2016).
c e n t r a L I z e D , D e c e n t r a L I z e D , a n D o u t s o u r c e D s ta f f I n g
Top managers must decide if staffing will be done internally by the HCO’s employees
or outsourced to external consultants and companies. When the work is done internally,
top managers must decide which portion of that work will be done by centralized human
resources (HR) specialists and which will be done by decentralized line managers throughout the organization. In HCOs large enough to have HR specialists, these employees
perform some staffing-related tasks and provide advice, tools, systems, and procedures to
line managers that enable them to perform staffing work for their areas of responsibility.
Some organizations decentralize much of the staffing work to department managers and
do not have a traditional HR department (Fottler 2015b).
Let’s consider a small HCO, such as a new home care business in Riverside.
Initially, it might have only an owner-manager, a few nurses, and a clerical assistant.
The owner-manager will likely do the staffing work, perhaps with help from an external
consultant. When the business grows, the owner-manager might hire specialized HR
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164
Management of Healthcare Organizations
employees to assist with staffing. When the HCO becomes even larger with more employees and staffing requirements, it might create an HR department with internal specialists
for hiring, development, compensation, and other staffing processes. The home care
business might use external consultants for some staffing work, such as comprehensive
job analysis, recruitment of hard-to-find employees, and design of compensation plans.
By this time, the HCO will have a management team with lower-level managers who
make staffing decisions in their areas of responsibility, such as nursing, physical therapy,
occupational therapy, and durable equipment. Eventually, the home care HCO might
be acquired by a large health system or corporation with an advanced HR department
or service center to support staffing of smaller acquired HCOs. Alternatively, some
businesses have downsized their HR departments and shifted more staffing work to
operating departments and outside staffing companies (Fottler 2015b). In each HCO,
top managers have to decide which staffing work will be done at the centralized corporate
level, which will be decentralized to lower levels throughout the entire organization, and
which will be outsourced.
Line managers in a vertical hierarchy are usually responsible for staffing in their
department or work unit (e.g., hospice). To do this, they are often supported by the HR
department and specialists. A centralized HR department creates staffing programs, policies, and procedures for all managers to use with their employees throughout an HCO.
For example, HR specialists may prepare an onboarding program for all new employees,
create a social media approach to recruiting new staff, and design a performance evaluation
rubric for appraising employees.
An HR department supports other departments with information systems, mobile
apps, and other technology for staffing. The HR staff can manage databases for many
aspects of staffing and thousands of applicants, employees, and former employees. This
database management can help line managers identify approved positions, track applicants,
measure diversity and inclusion, manage employees’ benefits and compensation, identify
which employees are due for performance appraisals, and track employee safety problems.
Having centralized HR staff gives lower-level operating managers throughout an HCO the
tools, methods, and systems they need for staffing their departments and work units. The
centralized programs, policies, and procedures improve consistency and fairness throughout
an HCO. However, line managers are ultimately responsible for staffing in their departments and work units.
Supervisors and managers can all benefit from working with HR staff and experts.
Although managers should work closely with the expert HR staff, some do not. Why would
managers turn down free, expert help? In HCOs, conflict sometimes arises between managers of departments (e.g., informatics, outpatient infusion, supply chain, community health
education) and HR staff. Some managers might think the HR staff is bureaucratic and
hinders the staffing process with too many forms and procedures. However, such forms
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Chapter 7: Staffing: Obtaining Employees
165
and procedures can help HCOs avoid lawsuits, negative publicity on social media and job
review sites, and difficulty recruiting workers in the future. Those forms and procedures
also might prevent a manager from making a serious mistake that could reflect badly on the
manager’s performance.
L aw s a n d R e g u l at i o n s
Staffing is greatly influenced (actually, controlled) by laws, court decisions, and regulations at
the national, state, and local levels of government. Laws and regulations affect how managers recruit staff, interview applicants, compensate
employees, promote or discharge employees, and
CHECK IT OUT ONLINE
perform most aspects of staffing. For example, if
you have had a job, you probably know that laws
require workplace safety and forbid discriminaThe US Department of Labor has a practical online resource for
tion in hiring. In addition to these types of laws,
employment laws (www.dol.gov/elaws/). It explains many laws
state governments regulate and require licensure
and regulations affecting small businesses and workers. The
for many healthcare jobs. Exhibit 7.2 identifies
guide is especially useful to people who need hands-on inforimportant laws that affect staffing in HCOs (Dunn
mation on topics such as wages, benefits, safety, health, and
2016).
nondiscrimination. This valuable resource can help you learn
Labor law is complex, and it changes. Local,
more about staffing laws now and during your career. Check it
state, and federal governments may pass new laws
out online and see what you discover.
and regulations, weaken or strengthen enforcement
of existing laws, or revoke laws. Court decisions
also cause changes in labor laws and regulations.
Managers and supervisors should educate themselves about legal aspects of staffing
via training and online resources (see the Check It Out Online sidebar). HCO managers
often consult HR specialists and labor attorneys; some large HCOs hire their own labor
attorneys. In addition to acting legally, fairly, and consistently, managers and supervisors should also carefully document all staffing processes, decisions, and actions. Job
applicants and employees might file lawsuits if they feel they were unfairly denied a job,
promotion, pay raise, or even a preferred work schedule. The saying “If it isn’t documented, it didn’t happen” means managers must document their staffing actions in case
a legal challenge arises.
P l a n ni n g f o r S ta f f
Now we begin studying in depth the seven staffing processes identified earlier in this chapter. The first is planning for staff. In chapter 3, we learned that during strategic planning,
HCOs create a mission and goals along with implementation plans to achieve them. “A
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166
Management of Healthcare Organizations
Exhibit 7.2
Staffing Legislation
Administrative or
­Enforcement Agency
Legislation
Concern or Content
Fair Labor Standards Act
of 1938
Minimum wage, overtime
pay, and record keeping
US Department of Labor
Fair Employment Act of
1941
Prohibits discrimination‡
Committee on Fair Employment Practices
Equal Pay Act of 1963
Compensation relative to
the sex of a worker
Equal Employment Opportunity Commission
Title VII of the Civil Rights
Act of 1964†
Sex, color, race, religion,
and national origin
Equal Employment Opportunity Commission
Age Discrimination in
Employment Act of 1967
(amended 1978)
Age (protection for those 40
to 70 years old)
Equal Employment Opportunity Commission
Occupational Safety and
Health Act of 1970
Workplace safety
Occupational Safety and
Health Administration
Rehabilitation Act of 1973
People with disabilities
US Department of Labor
Employee Retirement
Income Security Act of
1974
Pension and healthcare plan
rules
US Department of Labor
Immigration Reform and
Control Act of 1986
Employment eligibility
verification
US Department of Labor
Employee Polygraph Protection Act of 1988
Prohibits use of polygraphs
by most private employers
Secretary of Labor
Americans with Disabilities
Act of 1990
People with disabilities
Equal Employment Opportunity Commission
Family and Medical Leave
Act of 1993
Permits unpaid leave for
certain reasons
Employment Standards
Administration
Health Insurance Portability and Accountability Act
of 1996
Health insurance coverage
US Department of Labor
Nursing Relief for Disadvantaged Areas Act of 1999
Permits temporary employment of alien/foreign RNs
US Department of Labor
Source: Dunn (2016, 401).
†
As amended by the Equal Employment Opportunity Act of 1972, the Pregnancy Discrimination Act of 1978,
and in 1991 when a cap on punitive damages was applied.
Applied to national defense industry.
‡
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Chapter 7: Staffing: Obtaining Employees
critical need exists to elevate the discussion about workforce planning and development
to ensure it becomes a standing, rather than crisis-driven, component of comprehensive
strategic planning for hospitals and health systems” (McNally 2018). We will examine two
broad activities managers use to plan for staffing:
1.
Forecasting the organization’s future required staff (workforce)
2.
Planning how to obtain and retain the forecasted required staff (workforce)
To forecast the HCO’s required staff (workforce), managers must forecast several
factors based on input from supervisors, managers, and others:
◆◆ Expected turnover, retirements, resignations, and other departures, as well
as promotions, transfers, and other transitions—all based on historical data,
future plans, and good judgment
◆◆ Numbers and types of positions and workers—and their required
qualifications and competencies—needed to achieve the organization’s
mission and goals for the coming years
To plan how to obtain and retain the required staff (workforce), managers must
analyze internal and external factors, perhaps using a SWOT (strengths, weaknesses, opportunities, and threats) analysis that has been customized for staffing:
◆◆ The HCO’s internal factors, strengths, and weaknesses pertaining to staff,
such as funds to pay competitive wages, support for a diverse workforce, and
working conditions that are attractive to Generation Z employees
◆◆ The HCO’s external forces, threats, and opportunities pertaining to staff,
such as changes in labor laws and regulations; changing availability of
workers from four or five generations; customers’ demands for empathetic
staff; plans of nearby vocational schools; diversity of the local labor supply;
and developments in artificial intelligence, robots, chatbots, and virtual
assistants
Given these factors, managers can anticipate staffing needs and plan accordingly.
How many retirees must be replaced next year, and in which positions? How many
mental health counselors will be needed to staff the new primary care clinics? Given the
nursing shortage in our area, should we contract with a nursing agency and freelance
workers? Which changes in hiring could improve the diversity of our workforce? Which
compensation and benefits would help retain millennials and Generation Z workers?
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Which changes in staffing processes are needed to improve employees’ engagement in
their work and jobs?
As a result of the staff planning process, an HCO might determine it needs to hire
three nurse practitioners, two data analysts, and one compliance officer, and eliminate two
supply clerks. The HCO will probably change some staffing programs, policies, systems,
methods, and tools so that it can obtain and retain the required workers. To accomplish
this, the organization might plan the following types of changes to the other six staffing
processes during the coming year:
◆◆ Job designing. Centralize the final approval of new job descriptions by the vice
president of human resources.
◆◆ Hiring. Decentralize hiring decisions to department managers, and revise the
policy for hiring military veterans.
◆◆ Developing. Develop workers’ competencies for interacting with disabled
clients.
◆◆ Appraising. Revise performance appraisal methods to require each employee to
do a self-evaluation.
◆◆ Compensating. Revise the policy for using paid days off to better meet the
needs of employees with young children.
◆◆ Protecting. Create a workforce diversity celebration to recognize and celebrate
the diversity of the staff.
Staffing involves much work, especially in large businesses and HCOs. Performance
management systems and other technology are available to help manage the hiring, developing, appraising, and other staffing activities for hundreds, thousands, or many more
employees.
D e s i g n in g J o b s a nd W ork
Recall from chapter 4 that the terms job and position are similar but not the same. “A job
consists of a group of activities and duties that entail natural units of work that are similar
and related” (Fottler 2015a, 143). Some jobs, such as president, are performed by just one
person. Other jobs, such as nurse, are performed by more than one person if the amount of
work is too much for one person. There are multiple nurse positions, and each is filled by a
person who performs the nurse job. “A position consists of certain duties and responsibilities
that are performed by only one employee” (Fottler 2015a, 144). Thus, five people may fill
five nurse positions that all perform one nurse job.
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Chapter 7: Staffing: Obtaining Employees
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J o b A n a ly s i s
In chapter 4, we studied how work and jobs are designed as part of organizing work in an
HCO. This task is also linked to staffing. Job and work design involves determining which
tasks and activities must be done and how they should be organized into jobs, positions,
teams, and work units. Workers in the healthcare industry perform hundreds of distinct
jobs. For example, in the Here’s What Happened at the beginning of this chapter, Partners
HealthCare designed the telemonitoring nurse job to include monitoring patients’ vital
signs along with other tasks. Job analysis dissects jobs to identify the specific tasks, activities, and behaviors of each job and their relative frequencies.
Historically, job analysis assumed jobs were stable and constant. The analysis simply
defined the tasks and activities of a job. Today, however, managers view jobs as more flexible
and even adaptable to fit particular people and situations (Fottler 2015a; Noe et al. 2016).
Many HCOs now use competency-based job analysis. A competency is a set of related
knowledge, skills, and attitudes (e.g., interpersonal) associated with job performance (Fottler 2015a). Jobs also are being redesigned for team-based work and performance. HCOs
have adopted these newer, flexible approaches to job analysis because internal and external
factors (e.g., the trends described in chapter 1) cause continual change in HCOs. Because
flexibility is needed, many job descriptions include the statement “Other duties as assigned.”
Managers and HR staff analyze jobs using several methods, including observation, written surveys, and interviews. This information is used to create job descriptions
(also called position descriptions). Although HCOs use different formats and content, all
job descriptions state the job title and (in varying detail) the work to be done. Many job
descriptions describe minimum qualifications, such as traits, education, skills, competencies, and licensures for the job. More detailed job descriptions may include authority,
reporting relationships, equipment and materials used, working conditions, usual work
schedule, mental and physical demands, interactions with others, and salary range (Dunn
2016; Fottler 2015a).
Line managers, including lower-level beginning supervisors, work closely with HR
staff and top managers to do job analyses. Accuracy matters because job analyses guide
other staffing processes used to obtain and retain staff. Managers use job analyses and job
descriptions to
◆◆ plan how many of which types of jobs are needed,
◆◆ write announcements of specific job openings,
job description
A statement that
indicates the job
title and work to be
done; often includes
minimum qualifications
and describes the
job’s authority,
reporting relationships,
equipment and
materials used,
working conditions,
work schedule, mental
and physical demands,
interactions with
others, and salary
range. Also called
position description.
◆◆ decide which applicants could best perform various jobs,
◆◆ evaluate each employee’s job performance,
◆◆ determine how to train and develop employees,
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◆◆ decide the pay for each job and worker,
◆◆ recognize potential dangers of some jobs, and
◆◆ perform the staffing processes in general.
Incorrect or sloppy job analysis can lead to bad hiring choices, employee lawsuits,
poor organization performance, and an HCO’s failure to achieve its goals. Think of the
trends discussed in chapter 1 and recall that, for instance, HCOs are striving to improve
population health, patients’ engagement in their care, workforce diversity, patient safety,
and mobile health. Adapting to such trends requires accurate job analyses.
Work Rules and Schedules
Besides job descriptions (written from job analyses), designing jobs and work involves creating work rules, schedules, and standards of behavior. Managers are responsible for this,
and sometimes workers participate in the process. Although people may feel that rules are
confining, most employees desire the structure, predictability, and civility in their workplace
that rules can provide. When creating rules, managers must balance the needs of the HCO
with the needs of employees. For example, rules may limit socializing at work to ensure
patient care is not delayed while employees discuss sports scores or weekend parties. Rules
continually evolve to address issues, such as what employees may view online during work
or tweet on Twitter after work. If two employees do not like each other, can one bully the
other on Instagram? Managers may have to create work rules for such situations.
As a manager, you will have to create work schedules as part of job design. Scheduling
can be challenging for any organization, especially for HCOs that operate 24/7. Is it Jose’s
turn to work weekends? Did Zainab work nights last month? Can Brittany work on New
Year’s Day? Managers must balance the needs of the HCO and patients with employees’
schedules. Scheduling often permits some flexibility to let employees arrive (and depart) at
different times. Some staff members may work five 8-hour days per week, whereas others
may work four 10-hour days. HCOs may allow telecommuting and working from home or
other remote sites. However, some organizations have reduced this option in favor of actual
(not just virtual) human interaction among workers, which millennials and Generation Z
may prefer (Schawbel 2017). Scheduling must consider full-time and part-time jobs and
how they fit into a schedule. Contingent, temporary, gig, per diem, contract, and on-call
workers may be assigned part of the schedule. Complications arise and must be addressed
when an employee is on vacation or out sick. Managers should work closely with the HR
department to ensure their department schedules adhere to labor laws and are consistent
with the HCO’s overall staffing policies.
Managers should remember that workers of different generations have varied preferences and expectations about their work schedule, work–life balance, family obligations,
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Chapter 7: Staffing: Obtaining Employees
and control of their lives. The work schedule is a big factor in how employees feel about
their job and employer.
H i r in g S ta f f
After designing jobs and work, managers must obtain people to perform those jobs. For
this task, HCO managers usually hire people as employees on the HCO’s payroll. These
employees may be full-time, part-time, on-call, per diem, permanent, temporary, seasonal,
or some other status. Alternatively, some HCO managers contract with a healthcare staffing company (e.g., HealthCare Support), a temporary (“temp”) staffing agency (e.g., Kelly
Services), or some other outside business (e.g., Aramark) that assigns its own employees to
the HCO, as we saw in chapter 5. In this chapter, we will focus on how an HCO’s managers hire employees on the HCO’s payroll, which is the most common approach to staffing
HCOs. Even when putting people onto its payroll, the HCO might outsource some work
to a recruiting company, a staffing search firm, or external consultant. Managers must
continually decide how much staffing work to do internally and how much to outsource
to specialists.
Hiring staff involves recruiting and selecting people for jobs, which may include
reassigning existing workers by promotion or transfer. Some HCOs refer to this as talent
acquisition. Perhaps you have been a job applicant and participated in this process. It includes
◆◆ recruiting applicants,
◆◆ selecting from among applicants,
◆◆ making a job offer, and
◆◆ sometimes reassigning a worker (e.g., promotion, transfer).
To begin recruitment, managers and HR staff should ensure that a current, accurate
job description is available to guide recruitment and later selection. Then, upper management must authorize filling a vacant position (this authority may be delegated to HR staff).
Vacant positions are not always filled right away, and a decision must be made about each
vacancy. For example, if a decline in workload is expected, vacant positions may be frozen
and not immediately filled. Later, when workload is forecasted to permanently increase,
managers would probably approve hiring to fill those vacant positions.
Recruiting
HR staff (or contracted recruitment firms) perform most of the recruiting process. Larger
HCOs with larger HR staffs may have one or more specialized recruiters. Smaller HCOs
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may handle recruiting or perhaps outsource this work to a recruiting company. Can you
suggest ways to recruit people? How did you find out about jobs you have applied for?
Internal recruitment seeks applicants from inside the HCO for promotion or transfer (Fried
and Gates 2015). This approach uses the HCO’s printed and electronic job boards and
newsletters, networking among staff, and managers’ conversations with current employees
about open jobs.
Managers also use external recruitment, which seeks applicants from outside the
HCO. This involves going to job fairs and professional conferences, networking beyond
the HCO, and posting job openings on the HCO’s website and job search websites. Additional methods for external recruitment include talking with representatives of schools and
colleges, contacting former employees, using search firms and employment agencies, and
placing ads in newspapers, professional newsletters, and trade magazines. Social media (e.g.,
Facebook, LinkedIn) and job websites (e.g., CareerBuilder, Glassdoor, Monster, TweetMyJobs, JobsInHealthcare, Health eCareers) are also useful and enable an HCO to “e-cruit”
externally and easily reach many potential applicants. This approach creates a connection
that goes beyond one-way methods. Many applicants respond well to recruiting via social
media and mobile devices when these media and devices are optimized and designed for
easy use. Such recruiting efforts may include virtual-reality previews of the job and organization that also are used at job fairs and professional conferences.
Managers will have to decide how extensively to recruit—internally, externally, or
both? Locally, regionally, nationally, or globally? They must use appropriate recruitment
processes and methods to obtain a strong applicant pool and achieve the HCO’s diversity
requirements and goals. According to Schawbel (2016), some businesses are trying to improve
the recruiting and hiring experience because applicants who have had a bad experience
share their stories on Glassdoor and other employer review websites.
What are the pros and cons of internal and external recruiting? Take a minute to
jot down some ideas, and then read exhibit 7.3.
Managers and HR recruiters must prepare job announcements carefully when
recruiting—especially for external applicants. The announcement should include a clear,
realistic, and thorough description of the job and HCO so job seekers can properly decide
whether or not to apply. Fried and Gates (2015) suggest giving potential applicants the
following information:
◆◆ Required qualifications, such as education, experience, and preferences (that
are legal)
◆◆ Job information, such as job title, department and company name, work to be
done, work location and schedule, and compensation
◆◆ How to apply, such as whom to contact, what information to provide, and the
deadline for applications
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Chapter 7: Staffing: Obtaining Employees
Internal Recruiting
Advantages
Disadvantages
Applicant already familiar with HCO and
thus more likely to fit in
Employee may apply for promotion and
then be upset if not promoted
Applicant already known by the HCO
Employee may become boss of former
coworkers, which can create problems
Employees see opportunities to grow,
which strengthens employee morale and
retention
Fewer new ideas, methods, innovations
brought into the HCO from outside;
inbreeding
Inexpensive
Small pool of potential applicants
Helps retain good employees
Creates a new vacancy
Fast
Employee may require extra coaching and
mentoring to be fully prepared
173
Exhibit 7.3
Advantages and
Disadvantages
of Internal and
External Recruiting
External Recruiting
Advantages
Disadvantages
New ideas, methods, innovations brought
into the HCO
Can be expensive for some methods
Large pool of potential applicants
HCO may be viewed as not supporting
current employees, lowering morale
Applicant comes without awkward
political relationships or problems with
coworkers
Time and effort required to onboard and
acculturate new employee
Can find applicants with all required
competencies
Applicant not known by HCO, so more
time and effort needed to select and hire
Creates awareness of the HCO
Sources: Adapted from Fried and Gates (2015) and Noe et al. (2016).
This information may be provided in different ways, including online, in print, via multimedia, in person, in meetings, and in phone calls. Many companies offer this information
in preapplication job previews for potential applicants before they apply. Doing so can save
everyone time in the hiring process.
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TRY IT, APPLY IT
Suppose you work at a small, suburban hospital near a big city such as Orlando, Detroit,
or Las Vegas. The hospital’s director of marketing will retire in six months, and a replacement must be hired. How could you recruit diverse applicants for this job? Use what you
have learned in this chapter to outline a recruitment plan.
Here are several other ideas to keep in mind when recruiting:
◆◆ Offer incentives to applicants and to current employees who refer applicants.
◆◆ Focus the recruiting process on applicants and design the application process
from their perspective; respect them by making it easy to apply for the job
and by not contacting them at their current place of employment.
◆◆ While recruiting, subtly sell the HCO as a place to work by honestly
identifying things an applicant might appreciate.
Managers should evaluate how effective their recruiting effort is. For example, they
can measure the quantities and qualities of applicants overall (including specific types of
diversity), for each job opening, and for internal and external recruiting. Recruitment time
and cost per job opening also should be tracked.
Selecting
Managers select the applicant to whom they will offer a job. A hiring decision has important
short- and long-term consequences for the HCO, so managers should invest time and effort
to make a wise selection. An unwise selection may lead to voluntary or forced turnover
followed by repeating the costly, time-consuming hiring process. Other consequences may
include tension and stress among coworkers, lost revenue, and delayed service for patients.
The rest of this section describes a general approach to selection; many variations exist and
depend on the organization’s size.
The manager of the department with the job vacancy, plus the immediate supervisor for the vacant job, confer with HR staff. They must all agree on selection methods
that comply with laws and the HCO’s policies and that are appropriate for the particular
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Chapter 7: Staffing: Obtaining Employees
staffing situation. Methods vary depending on the organization and the job. More time and
assessment are needed to fill higher-level jobs. Some situations are more urgent than others.
The immediate supervisor for the job must be involved in the selection, and commonly a
team also participates (Fottler 2015b). This team might include future coworkers of the
person to be hired, from both inside and outside the department. HR staff is responsible
for ensuring compliance with laws, organization policies, and the job description (White
and Griffith 2019).
Selection criteria help determine which applicant to hire. At first, a supervisor might
say the person who can best perform the job should be hired. Someone else might suggest
hiring a person who can perform the job well and is likely to stay with the organization for
many years. Which criteria in the job description absolutely must be met (e.g., licensure)?
Which criteria are important yet could be modified (e.g., two rather than three years of
prior experience)?
The criteria almost always include fit. What is fit? Traditionally, organizations hired
based on applicant–job fit, emphasizing how well someone could perform the job. Now
managers also take into account applicant–organization fit, which considers an applicant’s
values, behaviors, attitudes, and overall work style (Fried and Gates 2015). For example,
to what extent is an applicant competitive or cooperative? How well a new employee will
fit into the organization and with other workers is more important now than it was in the
past. Some companies hire applicants for fit and develop their skills afterward. However,
research does not strongly show that better fit is related to better job performance (Fried
and Gates 2015). Managers must also be careful that hiring for fit does not deter hiring
for diversity or violate labor laws.
The rest of this section explains a general approach to selection that may be used
with both internal applicants (for promotion or transfer) and external applicants (for new
hires). This approach includes HR staff. If they are not available, then the manager and
support staff would do the HR work. Of course, each company develops its own approach
depending on the job to be filled.
After the HCO receives applications in response to its recruiting, HR screens them
using preset criteria to select applications for further consideration. Pop quiz: What did
we learn in the second staffing process that would provide useful standards for screening
applications? Did you say job descriptions? These indicate basic qualifications, skills, and
competencies applicants should have. Job descriptions can be used to eliminate unqualified applicants and identify qualified applicants for further consideration. HR staff or
electronic scanners read each application (or resume) and compare it against criteria in
the job description. Applicants who do not meet an essential requirement (e.g., having a
nursing license) can be eliminated.
The hiring company and the applicant continue assessing each other. Many companies enable applicants to use electronic assessments, realistic job previews, and “tryouts”
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for the job (Fried and Gates 2015). These may be done online or in multimedia meetings
with current employees. Applicants can learn more about the job and organization and
what it would be like to actually work in that job and organization. The company presents
the good and the bad about the job. Current employees may say what they like and dislike.
Then applicants can better decide if they are still interested. They can answer their own
questions: Would I fit well with that job in that HCO? Do I want to work there? Meanwhile, the hiring company further evaluates applicants by asking them legal job-related
questions to more fully understand their skills, attitudes, behaviors, and fit with the job
and the organization. After this interactive question-and-answer part of the job preview,
the organization should have a better understanding of each applicant. Will this applicant
fit well with our job and our HCO?
The hiring manager (or team) selects applicants who possess the required qualifications and seem to fit with the organization. In some cases, managers may choose someone
who does not currently have all the required skills yet seems to fit the HCO well and could
be trained to do the job tasks. This is the “hire for fit, train for skills” approach. In some
cases, managers might give preference to internal candidates, which could strengthen overall
employee retention in the HCO.
The HR staff may next arrange tests of applicants. One-third of organizations in
the United States test for personality traits such as flexibility (Noe et al. 2016). A hiring
manager might also test applicants to measure and learn about their knowledge, aptitude,
skills, mental ability, and physical ability. Other tests may be used for drug screens, jobrelated medical problems, past criminal records, and fluency in English (Fried and Gates
2015). Managers should use tests that are valid, reliable, and not culturally biased.
Managers then interview candidates—perhaps three to five—selected from among
the top candidates who also passed any necessary tests. The first interview may be done by
telephone, teleconference, or videoconference, especially if the applicant lives far away. If
that interview goes well, an on-site, face-to-face interview, which is more expensive and
time-consuming, is arranged. Guidance from the HR staff is essential to help all interviewers
understand how to conduct a fair, effective interview. For example, they must know which
questions they may (and may not) ask during interviews. Laws generally forbid questions
about applicants’ race, religion, age, country of origin, gender, marital status, family, health,
disabilities, and personal lives. The few exceptions (e.g., asking whether the applicant is
legally old enough to work or legally eligible to work based on citizenship or work visa)
must be narrowly and carefully worded (Fried and Gates 2015; McConnell 2018).
Interviews help the selection team understand applicants well enough to select
someone. HCOs often hire based on applicants’ traits (e.g., flexibility, initiative) rather
than only technical skills (e.g., taking blood samples, writing code). Interviews, more
than applications and resumes, enable managers to judge an applicant’s fit. However,
interviews are neither highly reliable nor highly valid (Fried and Gates 2015). Interviewers do not always ask all applicants the same questions in the same manner, which may
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Chapter 7: Staffing: Obtaining Employees
lead to different responses. Interviewers also interpret applicants’ answers and emotions
differently. Some applicants look online to find and then rehearse recommended answers
to common interview questions.
Managers in many HCOs use behavioral interviewing (also called competency-based
interviewing) to predict how an applicant might fit in the organization and perform in a
certain situation or role. This approach can help managers judge who has the required
competencies. For example, during an interview, an HCO manager in Hattiesburg might
say, “Conor, describe a situation in which you had to work on a team with people you did
not know” or “Debbie, please tell me about a time when you helped a confused client.”
The manager judges the applicant based on the applicant’s reported behavior in the jobrelated situations.
Effective interviews take much time and effort. The following tips can improve
interviews and help managers make good choices (Dunn 2016; Fried and Gates 2015;
McConnell 2018; Noe et al. 2016):
◆◆ Decide who (e.g., the manager, immediate supervisor, coworkers in the
department) will participate in the interview and if they will meet with the
applicant together or separately.
◆◆ Prepare by reviewing a current job description, the applicant’s file, and other
information.
◆◆ Contact applicants via their personal phone number or e-mail address; do not
contact them at their current job.
◆◆ Give applicants sufficient advance notice to arrange time off from their
current job and to prepare.
◆◆ Arrange a suitable time (without interruptions) and a comfortable place for
everyone involved.
◆◆ Ensure the work site will leave a good impression on the applicant.
◆◆ Begin with brief chitchat to help the applicant relax.
◆◆ Ask questions that require more than a few words to answer.
◆◆ Ask questions that require answers that reflect how well the applicant could do
the job (is capable), would do the job (is willing), and would fit in the job and
organization.
◆◆ Ask situational questions for which the applicant must explain how she would
handle a job-related situation.
◆◆ Avoid questions that are inappropriate, illegal, biased, or culturally insensitive.
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◆◆ Allow time for the applicant to think before speaking, and wait for the
applicant to answer.
◆◆ Listen closely for content and feeling; pay attention to the applicant’s body
language, voice, emotions, and responses.
◆◆ Be respectful, friendly, genuine, and professional toward the applicant.
◆◆ Gather information about the applicant’s abilities, personality traits, and
expectations.
◆◆ If an applicant gives only vague, safe, or socially acceptable answers, ask
probing follow-up questions.
◆◆ Softly sell the job and the HCO, but do not overdo it or misrepresent
anything.
◆◆ Be sure the applicant understands the job, expectations, schedule, pay and
benefits, and what working at the HCO will be like.
◆◆ Ask for and fully answer the applicant’s questions.
◆◆ Avoid taking many notes during the interview, but do write detailed notes
soon afterward.
As a manager, you might interview applicants whose native language and culture
differ from yours. You might participate in selection decisions that consider culturally
diverse applicants. Such situations require careful communication, sensitivity, and emotional
intelligence. The preceding guidelines can help ensure a fair, useful interview. Chapter 15,
on professionalism, gives more advice on how to handle potential language and cultural
barriers when interviewing and selecting people for jobs.
Promptly after each interview, the manager should gather feedback from everyone
who interacted with (or even observed) the interviewee. Include HR staff, everyone who
interviewed the applicant, and even a receptionist who observed how the applicant behaved
while waiting outside the manager’s office. These people should not let biases influence
them. They should make thoughtful judgments based on evidence and avoid premature
assumptions and safe political choices.
In most cases, the final selection decision is made by the immediate supervisor of the
new employee (Dunn 2016; McConnell 2018). That person’s decision should be based on
extensive input from other selection team members, future coworkers, the direct supervisor’s own boss, HR staff, and others who participated in the selection. Depending on the
HCO’s hiring process, a committee might make the final decision. Sometimes the choice
is difficult; all candidates may have strengths and weaknesses and perhaps no candidate
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Chapter 7: Staffing: Obtaining Employees
TRY IT, APPLY IT
The recruitment plan you prepared for the Try It, Apply It earlier in this chapter was a
huge success. Many applicants applied for the director of marketing job. Three diverse
applicants have been chosen for in-depth interviews. Use what you learned in this chapter to plan how you will conduct the three interviews. Write an interview plan outlining
(1) who will be involved, (2) where and when interviews will be held, (3) what will be
done before and during interviews, and (4) seven questions to ask (and three questions not to ask). How would you make the interview convenient and appealing for the
applicants?
stands out as the best. Some people might look qualified in an application but not perform
well in a live interview. Managers should openly involve others in the selection process to
obtain different perspectives.
If necessary, another interview can be arranged to further evaluate an applicant.
Although a second interview requires more time, it can lead to better hiring decisions.
Managers must strive to avoid poor decisions by being thorough. A bad choice will haunt
the manager and hurt the HCO. Chapter 13 offers good advice on making decisions. As we
will see, some managers use intuition in making decisions—including hiring decisions—and
may rethink a preliminary decision if it does not feel right the next day.
At some point during the selection process, HR staff will perform reference checks
to confirm information the application provided (e.g., college degree) and try to obtain
new information (e.g., work ethic). The timing of reference checks varies depending on the
situation. Confirmation of a college degree may be done early in the process by contacting
the applicant’s college. Talking to an applicant’s current boss by phone may be done after
obtaining the applicant’s permission. If the applicant does not want her boss to know she
is looking for a new job, this reference check might be done after the job offer has been
made subject to satisfactory reference checks.
While it seems prudent to check references (and most managers do), this step is
not a strong predictor of how well someone will perform in a new job (Fried and Gates
2015; Noe et al. 2016). Why is that? When asked to provide a list of references, applicants
list people who will speak favorably. Also, references often are vague and rarely identify
an applicant’s weaknesses or past problems. In many businesses, HR policies do not allow
much information to be shared about former employees (other than dates of employment
and job title) for fear of being sued (McConnell 2018).
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Because official references often are too vague or minimal to be useful, some hiring
managers search online and look at social media to learn about applicants. Managers might
do this during the initial screening process to verify applicants’ prior employment and to
gather information that may help them decide which applicants to interview. Later, a manager might informally contact someone on LinkedIn whom the applicant and manager both
know. That approach may yield more information than an official reference. Members of a
search committee might look for applicants on Facebook. Conceivably, a manager might
not hire someone because of information obtained from social media. This raises ethical
and legal issues related to privacy, justice, validity, and the employer’s obligation to avoid
hiring incompetent or dangerous workers. Arguably, only HR staff (not hiring managers)
should conduct reference checks and obtain only references that the applicant has given
written permission for (McConnell 2018).
Once the supervisor, manager, or team decides which applicant to hire, HR staff
extends a firm job offer to the individual with a starting date and salary. The offer may be
made subject to reference checks and background checks (e.g., for drug abuse or criminal
conviction) if those were not already done. After the candidate accepts the job offer and
clears all background verifications, the HR staff should ensure the HCO has documented
the specific reasons each other applicant was not hired. This documentation is essential
because, months or years later, the HCO might have to legally justify its hiring decision.
However, if applicants call and ask why they were not hired, the HR staff should simply
say that a more appropriate candidate was chosen, without going into detail (McConnell
2018). Giving reasons for rejection may be neither helpful nor needed, and it could lead
to problems (Dunn 2016, 452). HR staff may just say the applicant’s qualifications did
not sufficiently match the job requirements.
One More Time
The management function of staffing involves obtaining and retaining employees to do
the work required to achieve the HCO’s goals and mission. Staffing may be understood by
studying seven interrelated processes. This chapter explained the first three processes
(chapter 8 will explain the other four). While performing all staffing processes, managers
should be attentive to three special concerns: staff diversity and inclusion; centralized,
decentralized, and outsourced staffing; and laws and regulations.
First, managers plan for staff—forecasting the staff (workforce) the organization will
require in the future and planning how to effectively obtain and retain that future staff. This
work involves planning new approaches to the other staffing processes, such as new job
design and job descriptions, new methods for hiring workers, new development of staff,
new compensation methods, new ways to evaluate workers’ performance, and new approaches for protecting employees.
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Second, managers design jobs and work—determining the work tasks to be done by a
job, along with qualifications, supervision, working conditions, rules, and schedules. HCOs
have been shifting to more flexible job design to adapt to frequent changes in healthcare
and external environments.
Third, managers hire staff—recruiting and selecting workers for jobs, which may include
reassigning existing workers by promotion or transfer. Managers can recruit internally, externally, or both, using informative job announcements. When hiring for a job, managers
use the current job description to evaluate applicants’ qualifications and fit with the job
and organization. Tests are also used to judge applicants. Several applicants are chosen
for interviews with the job’s immediate supervisor, a higher manager, future coworkers, and
others. Based on candid input from interviewers, a final selection is made, usually by the
person who will supervise the new employee. A job offer is then made by HR staff, subject
to reference checks.
HR specialists, departments, or consultants often assist managers with the staffing
function. The HR experts are usually responsible for creating programs, policies, procedures, methods, and tools that managers and supervisors throughout the HCO use to staff
their individual departments. This approach creates consistency and fairness throughout
the organization. It also helps managers comply with the many laws, court decisions, and
regulations that affect how managers staff their HCOs.
FOR YOUR TOOLBOX
• Seven staffing processes
• Internal and external recruiting
• Job analysis
• Job interview methods
• Job description
For Discussion
1.
Briefly describe the seven processes that managers use to staff an HCO. Discuss how
each process is necessary for an HCO to succeed.
2. Which information is typically included in a job description? How are job descriptions
used with other staffing processes?
3.
Discuss the advantages and disadvantages of internal recruiting for different jobs in
HCOs. Then do the same for external recruiting.
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4. Give examples of questions that are appropriate and not appropriate for a manager
to ask an applicant during a job interview. Why are some questions inappropriate?
5.
Reflect on the list of tips for effective job interviews (near the end of the chapter).
Which of these tips do you feel are most important? Why?
case stuDy QuestIons
These questions refer to the Integrative Case Studies at the back of this book.
1.
“I Can’t Do It All!” case: Mr. Brice realizes he must make “serious changes” so that
his vice presidents will make decisions. Explain how he could use staffing processes
to increase and improve decision making by his vice presidents.
2. Increasing the Focus on Patient Safety at First Medical Center case: How could job
design, job analysis, and job descriptions support the focus on patient safety at First
Medical Center?
3.
Managing the Patient Experience case: Consider the pros and cons of internal and
external recruitment. How might Mr. Jackson’s prior jobs and work experience affect
his success as chief experience officer at Academic Medical Center?
4. Rocky Road to Patient Satisfaction at Leonard-Griggs case: How could Ms. Ratcliff
and the manager of human resources use job design, job analysis, and job
descriptions to implement the patient satisfaction surveys at the physician practices?
RIVERBEND ORTHOPEDICS MINI CASE STUDY
Riverbend Orthopedics is a busy group practice with expanded services for orthopedic
care. It has seven physicians and a podiatrist, plus about 70 other employees. At its big,
new clinic building, Riverbend provides extensive orthopedic care. Several technicians
provide diagnostic medical imaging, from basic X-rays to magnetic resonance images.
The physicians perform surgery in their own outpatient surgery center with Riverbend’s
own operating nurses and technicians. Therapy is provided by three physical therapists and one part-time contracted occupational therapist. In addition to staff providing actual patient care, the clinic has staff for financial management, medical records,
human resources, information systems/technology, building maintenance, and other
(continued)
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Chapter 7: Staffing: Obtaining Employees
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RIVERBEND ORTHOPEDICS MINI CASE STUDY (continued)
administrative matters. Occasional marketing work is done by an advertising company.
Legal work is outsourced to a law firm. Riverbend is managed by a new president, Ms.
Garcia. She and Riverbend have set a goal of achieving “Excellent” ratings for patient
experience from at least 90 percent of Riverbend’s patients this year.
Riverbend currently has one HR manager with expertise in all aspects of HR and one
compensation specialist. Ms. Garcia wants to obtain more HR support for staffing, but
she is unsure whether to hire more HR specialists (full-time or part-time) or contract with
an HR consulting firm for expertise when needed. Also, Ms. Garcia and Dr. Chen want to
strengthen workforce diversity and inclusion at Riverbend.
m InI c ase s tuDy Q uestIons
1. Which factors and information should Ms. Garcia consider when deciding how to
increase HR support for staffing Riverbend Orthopedics?
2. Suggest how Ms. Garcia and Dr. Chen could strengthen workforce diversity and
inclusion at Riverbend Orthopedics. You may make reasonable assumptions and
inferences.
references
Dunn, R. T. 2016. Dunn and Haimann’s Healthcare Management, 10th ed. Chicago: Health
Administration Press.
Evans, R. M. 2015. “Workforce Diversity.” In Human Resources in Healthcare, 4th ed., edited
by B. J. Fried and M. D. Fottler, 123–42. Chicago: Health Administration Press.
Fottler, M. D. 2015a. “Job Analysis and Job Design.” In Human Resources in Healthcare, 4th
ed., edited by B. J. Fried and M. D. Fottler, 143–80. Chicago: Health Administration Press.
. 2015b. “Strategic Human Resources Management.” In Human Resources in Healthcare, 4th ed., edited by B. J. Fried and M. D. Fottler, 1–34. Chicago: Health Administration
Press.
French, W. L. 2007. Human Resources Management, 6th ed. Boston: Houghton Mifflin
Company.
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Fried, B. J., and M. Gates. 2015. “Recruitment, Selection, and Retention.” In Human
Resources in Healthcare, 4th ed., edited by B. J. Fried and M. D. Fottler, 181–234. Chicago:
Health Administration Press.
Hegwer, L. R. 2016. “Building High-Performing, Highly Diverse Teams and Organizations.”
Healthcare Executive 31 (6): 10–19.
Institute for Diversity and Health Equity. 2018. “Institute Resource Center: ‘A Diversity,
Equity and Cultural Competency Assessment Tool for Leaders.’” Accessed August 20.
www.diversityconnection.org/diversityconnection/membership/Institute-ResourceCenter.jsp.
McConnell, C. R. 2018. Umiker’s Management Skills for the New Health Care Supervisor,
7th ed. Burlington, MA: Jones & Bartlett Learning.
McNally, K. 2018. “The Imperative for Strategic Workforce Planning and Development: Challenges and Opportunities.” Published February 28. www.aha.org/news/insights-andanalysis/2018-02-28-imperative-strategic-workforce-planning-and-development.
Noe, R., J. Hollenbeck, B. Gerhart, and P. Wright. 2016. Human Resource Management: Gaining a Competitive Advantage, 10th ed. Chicago: McGraw-Hill Higher Education.
Schawbel, D. 2017. “Workplace Trends You’ll See in 2018.” Published November 1. www.
forbes.com/sites/danschawbel/2017/11/01/10-workplace-trends-youll-see-in​-2018
/#300c33e24bf2.
    . 2016. “Workplace Trends You’ll See in 2017.” Published November 1. www.forbes​
.com/sites/danschawbel/2016/11/01/workplace-trends-2017/.
Trustees of Boston College. 2016. “Diversity and Inclusion Definitions.” Updated December
16. www.bc.edu/offices/diversity/diversity-and-inclusion-statement.html.
Wagner, K. 2017. “Harnessing the Strengths of a Multigenerational Workforce to Leverage
Opportunities.” Healthcare Executive 32 (6): 10–18.
White, K. R., and J. R. Griffith. 2019. The Well-Managed Healthcare Organization, 9th ed.
Chicago: Health Administration Press.
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Copyright 2019. Health Administration Press.
All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law.
CHAPTER 8
STAFFING: RETAINING
EMPLOYEES
A company is only as good as the people it keeps.
Mary Kay Ash, entrepreneur and businesswoman
Learning Objectives
Studying this chapter will help you to
➤➤ explain how managers develop staff,
➤➤ understand how managers appraise staff performance,
➤➤ describe how managers compensate staff,
➤➤ explain how managers protect staff, and
➤➤ understand how onboarding improves staff retention.
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HERE’S WHAT HAPPENED
When implementing their new strategic goals, managers at Partners HealthCare performed the staffing function. This function enabled Partners to obtain new workers
and retain existing ones. An essential part of staffing was to determine the financial
compensation for each position and employee. Compensation included base pay,
incentives, and bonuses, as well as benefits such as paid vacation days, health insurance, and retirement plan contributions. In making compensation decisions, managers
had to figure out what compensation would be needed to obtain and then retain the
people Partners wanted. Managers had to understand and comply with dozens of laws
regulating compensation and other aspects of employment. They also had to decide
how to evaluate staff job performance and how performance evaluations would affect
future compensation. Partners HealthCare’s strategic goals were going to require
innovation and change, so managers knew they would have to develop employees
through training, coaching, and mentoring for changes in their jobs. Through these
and other staffing processes, managers were able to achieve ambitious goals and
the Partners HealthCare mission.
A
s we see in the opening Here’s What Happened, staffing a healthcare organization
(HCO) is complex and requires much thought by managers. Staffing is another
way managers make a difference and add value to their HCO. Chapter 7 identified seven staffing processes and explained the first three, which are used to obtain workers.
This chapter builds on that discussion and studies the other four staffing processes, which
help to retain workers: developing staff, appraising staff, compensating staff, and protecting
staff. The processes overlap to some extent because they are interconnected and because
some processes support both obtaining and retaining workers. This chapter concludes with
a discussion of onboarding, which combines several staffing processes to improve retention of new employees. If an HCO’s managers perform these seven staffing processes well,
they can obtain and retain the workforce needed to succeed. Employees will not wonder,
“Should I stay or should I go?”
These seven processes can also improve employee engagement. Employees engage
when they are emotionally committed and actively contribute to their work, workplace,
and organization goals (Dye 2017). Employee engagement is an important challenge
for organizations, including HCOs. Opinion surveys have shown that overall employee
engagement in work is low and declining (Dye 2017). As a result, many concerned businesses are improving the “employee experience” by increasing training and development;
expanding compensation and rewards; and improving employees’ physical, mental, and
financial well-being (Schawbel 2016). Learn to do the staffing processes well so you can
engage your HCO’s employees in their work, which will in turn help people in the community live healthier lives.
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D e v el opin g S ta f f
In chapter 7, we defined developing staff as helping employees acquire new knowledge, skills,
attitudes, behaviors, and competencies for current and future jobs. (Continuous learning, talent development, and other terms are also used.) Staff development is done through training,
coaching, mentoring, job rotation, formal education, and other methods. Managers must
develop employees to motivate them, help them feel competent, enable them to succeed
in their jobs, and give them opportunities to grow (McConnell 2018). Employees need
development to continually perform their jobs well; some employees need it on their first
day of work. Accreditation and professional licensure standards also require training and
continuing education. Training, coaching, mentoring, and other approaches to developing staff enable HCOs and their workers to adapt to changes in the external environment
(e.g., the changes described in chapter 1). If an HCO does not prepare workers for those
changes, the organization and its workers will quickly fall behind because the half-life of
learned skills is only five years (Schawbel 2017). Besides developing workers for current
jobs, HCOs should also develop staff for future promotion and transfer to other jobs that
help them grow and succeed. Do you see how this can improve staff retention?
Despite these reasons for staff development, some HCOs spend inadequate time and
funds on it. White and Griffith (2019) urge managers to view training and development as
an investment in the organization’s workforce rather than a costly expense. Better HCOs
invest to enable employees to perform work according to the HCO’s preferred methods,
meet service standards (e.g., empathy and responsiveness), and feel supported.
We will first study orientation of newly hired employees to help them successfully
begin working. Then we will consider how to develop all employees so they can improve
their performance and prepare for growth and promotion.
O r i e n tat i o n o f N e w S ta f f
After a manager hires a new employee to work in her department, she (and her HCO) then
must orient the new employee to the department and the HCO. How well the orientation
is done (or not done) will strongly shape the new employee’s perceptions and feelings about
her job, her coworkers, and the HCO, as well as her decision whether to stay in the job.
Orientation of new staff should focus on both the technical aspects of work (how to do the job
well) and the social aspects of work (how to fit in and get along with coworkers). Managers
must orient new workers to help them succeed—which then helps the managers succeed.
HCOs differ in how they handle orientation of new staff (Kaye and Fottler 2015).
At some HCOs, orientation may start online after workers have accepted a job but before
they begin their first day of work. Smaller HCOs may provide a shorter, more casual, and
less organized orientation than big HCOs do. New, start-up HCOs may not yet have a
planned orientation, and new workers will become oriented day by day. In large HCOs,
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orientation might be part of a comprehensive, months-long onboarding process (described
at the end of this chapter). Top managers orient all new employees to the HCO. Middleand lower-level managers orient their new employees to their specific work departments.
They might use videos, online tutorials, webinars, e-handbooks, online manuals, interactive
meetings, mobile learning, buddies, mentors, and checklists.
Managers are likely to spread employee orientation over several days (or even weeks)
so that new workers are not overloaded with information. For example, suppose Juan, the
reimbursement manager at a healthcare system in Berkeley, hires Erin as a Medicare reimbursement specialist. Juan and the human resources (HR) department arrange for Erin to
complete her payroll forms, enroll in the health insurance plan, and buy a company parking permit online, all before her first day of work. Juan then schedules time to orient Erin
to the reimbursement department when she arrives there on her first day of work. Erin’s
department orientation includes
◆◆ a gracious, supportive, and enthusiastic welcome to the healthcare system and
the department;
◆◆ introductions to her supervisor and a few immediate coworkers;
◆◆ a tour of the work area, department, and places such as restrooms and break
room;
◆◆ specifics of the Medicare reimbursement specialist job—what, why, when,
where, and how to do it the way Juan expects it to be done (which might
differ from how Erin has done similar work elsewhere);
◆◆ information about work schedules, breaks, meals, and overtime;
◆◆ information about her workstation, equipment, and supplies;
◆◆ an explanation of essential policies, procedures, rules, and standards of
behavior—especially those that pertain to the department (rather than to the
entire HCO); and
◆◆ helpful, supportive answers to Erin’s questions.
Juan and Erin then meet with Carla (an experienced reimbursement specialist), who
will be Erin’s mentor or buddy. Carla and Juan have already discussed this arrangement,
and Carla has agreed to provide on-the-job guidance to Erin and help Erin socialize with
others. Juan will talk with Erin at the end of her first day and during her first week to see
how she is doing. He will gradually introduce her to further information to help her do
her job well and become more engaged.
At some point Erin will participate in orientation to the whole organization. Whereas
department orientation should begin the day an employee begins, organization orientation
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can be done later. Much of it is information that may be distributed via multimedia in
small doses over a period of time. Most organizations include some “meet and greet” time
with the HCO’s senior leaders, perhaps on the first day of each month. Returning to the
example in Berkeley, the HCO’s top managers and HR staff may welcome Erin and 16
other new employees from 9 different departments who started the previous month. They
may describe the healthcare system’s mission, vision, values, and goals and give inspired
messages about the HCO. Staff may describe or provide multimedia presentations on
◆◆ the organization chart and management team;
◆◆ essential policies, procedures, rules, and standards of behavior that pertain to
all employees, such as those related to safety and customer interactions; and
◆◆ employee benefits, career-planning resources, and other support that is
available to all workers.
After an hour of organization orientation, new employees should be better informed but
often are restless. Break time! Snacks are provided, people chat informally, and new employees
meet and socialize. Some HCOs may then include a brief tour of the facility.
In the real world, managers sometimes struggle for weeks or even months to keep a
department going while a job is vacant. People work extra days to cover the job’s tasks until
a new employee begins. When a new employee finally arrives, everyone wants her to jump
right in and get to work. The manager should resist a quick “Here’s what I want you to do”
orientation. A new employee will have questions and feel anxious about the new job, new
place, new people, and so forth. She will feel supported—or not—depending on how her
first day goes. The first day, first week, and first month will greatly affect how well the new
employee does her job and how she feels about her job and the organization. Without an
adequate, supportive orientation, she may soon be wondering, “Should I stay or should I
go?” If she goes, then the manager, department, and HCO have to redo the hiring process.
As a manager, remember: Employee orientation improves employee engagement and satisfaction—which then improves employee performance and retention. For the employee,
manager, department, and organization, it’s a win-win-win-win!
T r a i n i n g S ta f f
Although employees might have graduated with the latest knowledge and skills or might
have years of experience, their knowledge will not be “best practice” forever. In fact, it can
become outdated within months because of rapid changes in the external environment
of HCOs. A manager must train and develop employees so that they can adapt to those
changes and stay current. Partners HealthCare did this in the chapter’s opening Here’s
What Happened. Many hospitals trained staff to better satisfy patients when Medicare
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began reimbursing hospitals based partly on patients’ satisfaction scores. Many HCOs offer
training to prepare workers for developments and challenges in healthcare (some of which
we saw in chapter 1): patient engagement, patient experience, clinical care coordination,
diverse cultures and multiple generations in the workforce, burnout, bullying, interactions
with others, ethics, harassment, mobile health, population health, pay-for-performance,
disaster readiness, safety, high-performing teams, embracing change, conflict resolution,
and many others (Kaye and Fottler 2015; Ryan 2017). For example, Main Line Health in
Philadelphia has been providing all managers with two days of experiential learning about
diversity, respect, and inclusion. Similar training will be provided to all staff, including
physicians (Lynch 2017).
When you are a manager, you will have to ensure your workers are trained for their
jobs—the equipment, methods, processes, and so forth. Who provides the training? Who
trained you for a job you once had? As manager, you will do some of the training. Experts
in your department or in other departments such as information technology or infection
control will provide training for their areas of expertise. Large HCOs are likely to have a
department for education, training, and development. People in that department could
help you plan and implement training for your staff. Many HCOs outsource some training
to consultants with specific expertise, such as training in conflict resolution and teamwork.
Vendors who sell products and equipment to HCOs are responsible for training the HCOs’
employees in how to use the products and equipment.
Sometimes an HCO is in such a hurry to train staff that it does not take time to
create effective training. Good training that has a lasting effect is not simple. How can
managers prepare and provide effective training? They can use the training methods shown
in exhibit 8.1 that are based on training models. To really stick, training must be done
well—and be reinforced by leadership and organization culture, which will be studied
in later chapters.
D e v e l o pi n g S ta f f
Managers should develop their staff for transfers, promotions, and career growth. This
development goes beyond training for an existing job and prepares workers for other jobs
in the HCO. Educational programs for workers, which are longer and more comprehensive than short-term training, can be planned by managers using the methods listed in
exhibit 8.1. Managers can provide internal or external coaches and mentors to help workers grow and develop for higher-level jobs and promotions. If an HCO does not provide
development and opportunities for career growth, it will have trouble retaining younger
workers. Further, many employees in clinical fields—such as nursing and therapy professions—seek career ladders that provide promotion into advanced clinical jobs rather than
promotion into supervisory jobs. Offering promotions up clinical career ladders can help
retain clinical workers.
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Chapter 8: Staffing: Retaining Employees
1. Needs assessment: Determine what training is needed (in the short term and long
term) for the HCO and for specific employees. Examine prior planning for staff,
employees’ job performance appraisals, employees’ career development plans,
on-the-job safety reports, customer satisfaction data, employees’ input, surveys,
strategic plans, job redesign, and other relevant information. Needs may be
prioritized and the most important ones addressed first.
2. Purpose and objectives: For each chosen training need, write the specific purpose,
objectives, and desired outcomes. Which new knowledge, skills, attitudes, behaviors,
and competencies should employees have as a result of the training?
3. Content, methods, and instructors: Decide appropriate curriculum, content teaching
and learning methods, instructors, and resources to achieve the desired purpose,
objectives, and outcomes. Keep it simple, practical, and job related. Use appropriate
methods, media, and technology, which may include videos, online apps, self-paced
tutorials, teleconferences, webinars, games, assignments, simulations, lectures,
interactive demonstrations, workshops, team-based learning, discussions, role-play,
written materials, case studies, mobile learning, job shadowing, on-the-job training,
behavior modeling, and mentoring. Allow time for trainers and facilitators to practice,
revise the content and methods, and rehearse again before going live. If necessary,
increase both organization support for the training and trainees’ readiness (e.g.,
motivation) for the training.
4. Implementation: Make training as convenient as possible (e.g., schedule it on
different days and times) for the trainees. Find out which days, times, and locations
would avoid disrupting their usual work. Ensure all supplies and resources are
available. Avoid trying to train too many employees at once. Be flexible and adjust as
needed during the training. Deliver the training.
5. Evaluation: After the training is complete, evaluate all aspects of the training and
monitor (initially and later on) how well it achieved its purpose. Consider how trainees
feel about the training, what they learned, which behaviors changed (and for how
long), whether the training objectives were achieved, and return on investment. Make
notes on how to improve the next training.
191
Exhibit 8.1
Training Checklist
Sources: Information from Cummings and Worley (2015); Kaye and Fottler (2015); McConnell (2018); Noe et al.
(2016).
Often in HCOs, the “best” worker is promoted to supervisor when that position
becomes vacant. If he is not properly prepared for the job, that new supervisor is likely to
make mistakes and perhaps fail in this new job. He might maintain peer-to-peer relationships rather than shift to superior–subordinate relationships. He might hesitate to delegate
tasks to other workers. A new supervisor might avoid giving necessary, critical feedback to
the staff. Job development programs are essential to help workers prepare for promotion to
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