Program Outcome 2 Please respond to the following discussion topic. initial post should be a minimum of 150 words in length. Then, make at least two thoughtful responses to your fellow students’ posts

CHAPTER 14

Human Resources Management: A Line Manager’s Perspective

CHAPTER OBJECTIVES

• Outline the functions of human resources and indicate how these relate to the role of the manager.

• Provide an overview of the individual manager’s responsibilities in the management of human resources.

• Describe actions that the manager can take to ensure that he or she will obtain appropriate service from human resources when needed.

• Guide the manager toward the establishment of a working relationship with human resources that will lead to improved human resources service to the department.

• Review pertinent areas of legislation that the manager should know and that generally influence the manager’s relationship with human resources.

“PERSONNEL” EQUALS PEOPLE

As a professional managing the work of others, you are charged with the task of facilitating the work performance of a number of people. Quite literally, you are there primarily to make it possible for your employees to get their work done better than they could without your presence. In this role you are expected to ensure that the efforts of your group are applied toward the attainment of the organization’s objectives. This must be done in such a way that the group functions more effectively with you than it would without you. And as a first-line manager, there are some days when you can use all the help you can get in fulfilling your basic charge. Help is where you find it in your organization—and one place where the manager can find appropriate help in many instances of need is the human resources (HR) department.

HR is today’s more comprehensive title for what most organizations once called “personnel.” Whatever the label used, the true operative word is people. Management is frequently described as getting things done through people. People do the hands-on work and other people supervise them, and still other people oversee those who supervise and manage.

As surely as the most sophisticated piece of medical equipment requires periodic maintenance to ensure its continued functioning, so too, do the human beings who supply patient care and otherwise support the delivery of care require regular maintenance. Given that the human machine is generally unpredictable and varies considerably from person to person in numerous dimensions, the manager’s maintenance encompasses many activities.

There are many places in the organization where the manager can go for help with various tasks and problems. For people problems, however, and for some straightforward people-related matters that cannot yet be described as problems, the manager’s greatest source of assistance is the HR department. It remains only for the manager to take steps to access that assistance. It is to the individual manager’s distinct advantage to know exactly what should be expected from HR and how to get it when needed.

A VITAL STAFF FUNCTION

As a service department, human resources should be prepared to offer a variety of employee-related services in a number of ways. HR should anticipate numerous kinds of difficulties and needs and should communicate the availability of assistance throughout the organization. For example, a personnel policy manual dispenses advice and guidance in employee matters, and top management’s instructions to managers to seek one-on-one guidance from HR in matters of disciplinary action are essentially “advertising” for human resources services.

Even though HR should be prepared to help in a variety of ways and should have so advised all levels of management, the HR department cannot anticipate every specific need of each individual manager. To truly put the HR department to work, the manager must be prepared to take his or her needs to that department and expect answers or assistance.

The terms human resources and personnel are still often used interchangeably and are currently used about equally as the designation for this particular service. This organizational function sometimes exists under other names—for example, employee services, employee affairs, and people systems. Fairly common, among a few other designations, are employee relations and labor relations. These latter two labels have also found use as descriptors of subfunctions of modern HR, with employee relations referring to dealing with employee problems and labor relations referring to dealing with unions. Regardless of label, however, the mission of this particular service department should remain the same—to engage in acquiring, maintaining, and retaining employees so that the objectives of the organization may be fulfilled. As a critical staff function, HR does none of the actual work of the healthcare organization; rather, it facilitates the work of the organization by concerning itself with the organization’s most important resource.

A SERVICE OF INCREASING VALUE

The HR department has long been a source of increasing value to the organization at large and the individual manager in particular. Its value has increased because of rational responses to a number of forces, both external and internal to the organization, that have resulted in additional tasks for someone. Two major forces have been the expansion in the number and kinds of tasks that have fallen to HR and the proliferation of laws affecting aspects of employment. A third major force is the continuing trend toward organizational “flattening” evident among present-day healthcare organizations.

INCREASE IN EMPLOYEE-RELATED TASKS

Like the majority of departments in a modern organization, there was a time when HR did not exist. Also like other departments, HR arose to fill a need. The earliest HR departments, which were commonly known as employment offices, were created as businesses grew large enough to see the advantages of centralizing much of the process of acquiring employees. Employment and employment-related recordkeeping initially constituted all the work of the employment office.

When wage and hour laws came into being, the employment office absorbed much of the concern for establishing standard rates of pay and monitoring their application relative to hours worked. These tasks marked the beginnings of the compensation (payroll) function.

As organizations, in response to new laws and other pressures both internal and external, began to provide compensation in forms other than wages, the employment office took over the administration of what became known as fringe benefits. As organizations responded to labor legislation and to labor unions themselves, labor relations functions were added to the growing list of activities that shared a common theme: all had something to do with acquiring, maintaining, or retaining employees.

Other people-related activities were added as needed, and what had once been the employment office became personnel—the body of people employed by the organization. During the last quarter of the 20th century, the term personnel was increasingly replaced by the term human resources, but the essential meaning remains the same. All the while, the HR function grew in value as it took on an increasing number of employee-related functions.

Proliferation of Laws Related to Employment

A number of laws were, of course, primary in causing much of the increase in employee-related tasks. For example, the establishment of Social Security, workers’ compensation, and unemployment insurance all created tasks for HR, and much labor relations activity was brought about by laws affecting relationships with unions. In addition, various antidiscrimination laws, including the Civil Rights Act of 1964, the Age Discrimination in Employment Act, and the Equal Pay Act, brought with them much new work for HR.

The antidiscrimination laws have forever changed the way many organizations do business. They have created a strongly legalistic environment in which lawsuits and other formal discrimination complaints have become routine HR business. They have also turned employee recruitment in general, and specific processes such as employee evaluation and disciplinary action, into legal minefields filled with traps and pitfalls for the unwary. In the process, these laws have created more work for HR and have created myriad reasons for the individual manager to turn to HR on more occasions.

The passage of new major legislation affecting employment seems to have slowed, if only temporarily. Nevertheless, amendments to existing laws and “case law” arising from judicial decisions continue to expand the accumulation of potential legal obstacles that can influence how a manager runs a department and how HR serves the manager. For the most part, these continuing changes simply add to the regulations that affect employment; rarely do such changes remove or replace existing regulations.

The Effects of Flattening

The tendency toward organizational flattening and its attendant elimination of entire layers of management has not appreciably added tasks to HR or increased the inherent importance of the HR function in and of itself. However, it has markedly increased the importance of HR to the individual manager.

Recent years have seen financially troubling times overtake many of the nation’s healthcare provider organizations. As reimbursement is tightened and income grows at a lesser rate than costs, the resultant financial pinch is often felt in staffing, including numbers of management personnel. Usually the first managers to suffer, whether in health care or other settings, are middle managers.

Financial problems have caused significant reductions in middle management positions, but all such reductions have not occurred solely because of money problems. Increasing reliance on management approaches calling for increased employee participation and decision making also have resulted in the necessity for fewer middle managers.

Regardless of how it occurs, a reduction in the number of middle managers means that more decisions must be made closer to the bottom of the organization. As a consequence, certain decisions that might once have been made by a middle manager—such as sanctioning an employment offer that is higher than the normal entry rate or deciding how far to proceed in a situation that includes a high degree of legal risk—are forced down to the level of the individual first-line manager. The more employee-related decisions are forced to the first line of management, the more the first-line manager has to depend on the guidance and support of the HR department. Thus, the tendency toward flattening has increased the value of HR to the manager.

Some Directions in Human Resources

Just as organizations have been flattened, management layers eliminated, and various activities combined or otherwise streamlined, so, too, has HR been affected in some organizations. HR has not been completely immune to the effects of mergers and affiliations and the general belt-tightening and other “downsizing” efforts undertaken in many healthcare organizations. Like other departments, HR may be called on to fulfill its responsibilities with fewer staff—to do as other departments are required to do in maintaining or improving service with fewer hands.

One effect of reduced HR staffing is a tendency toward decentralization of some activities, which effectively places more responsibility for certain HR-related activities with individual departments. For example, where once employment recruiters from HR would attend outside conferences and conventions in search of new employees, this task may now be done either jointly with or exclusively by professionals from the departments. Perhaps a major department such as nursing services or clinical laboratories now takes on the task of coordinating annual performance evaluations for its own employees—a job formerly handled centrally by HR. The upside of decentralization is that department managers become more intimately familiar with HR practices affecting their departments. The potential downside to decentralization is a significant one—it can lead to duplication of certain activities and especially duplication of records and files.

As HR department staffing becomes leaner in some organizations, it becomes increasingly important for the individual department manager to make it as convenient as possible for HR to provide its services. Any problem or issue taken to HR should be thought out in advance, with individual questions being refined and perhaps even possible solutions prepared. Advance preparation should also be seen as including appropriate familiarization with applicable personnel policies. For example, a manager facing the need for employee discipline should be able to determine from a brief review of policy whether the appropriate steps have been taken in support of the manager’s proposed action.

In working with HR, as in working with one’s own immediate superior, the age-old concept of completed staff work should apply. Do not simply submit a problem and ask in effect, “What should I do?” Rather, clearly define the problem, consider which possible actions might apply, indicate the option you believe may be best, and then request HR input.

LEARNING ABOUT YOUR HUMAN RESOURCES DEPARTMENT

To be able to get the most out of your organization’s HR department, it is first necessary to understand the nature of the HR function, know how HR relates organizationally, and be familiar with the functions performed by your particular HR department.

The Nature of the Function: Staff versus Line

Human resources has already been described in this chapter as a staff function. As opposed to a line activity, a function in which people actually perform the work of the organization (e.g., nursing or physical therapy), a staff function enhances and supports the performance of the organization’s work. The presence of a staff function should make a difference to the extent that the organization’s work is more effectively accomplished with the staff function than without it.

The distinction between line and staff is critical to appreciate because a staff function cannot legitimately make decisions that are the province of line management. Operating decisions belong to operating management; they must be made within the chains of command of the line departments. The primary purpose of human resources in enhancing and supporting work performance is to recommend courses of action that are (1) consistent with legislation, regulation, and principles of fairness and (2) in the best interests of the organization as a whole.

It is not unusual for some managers to blame HR for decisions other than those they would have made themselves. Complaints such as “this is the HR department’s decision” are not uncommon from managers whose preferred decisions are altered because of HR’s recommendations. In general, however, HR does not—and should never—have authority to overrule line management in any matter, personnel or otherwise. If, as occasionally is the case, a personnel decision of line management must be overruled for the good of the organization, the overruling must be done by higher line management. HR may have to reach out and bring higher management into the process when a manager insists on pursuing a decision that HR has recommended against, but it must remain line management that actually makes the decision.

Whether line management really listens to its advisers in HR depends largely on the apparent professionalism of the HR function and HR’s track record in making solid recommendations.

The modern HR department should report to one of the two top managers in the organization. Depending on the particular organizational scheme used, HR might report to the president or chief executive officer or perhaps to the executive vice president or chief operating officer. Generally, HR should report to a level no lower than the level that has authority over all of the organization’s line or operating functions.

Human resources must be in a position to serve all of the organization’s operating units equally and impartially. This cannot be done if HR reports to one particular operating division that stands as the organizational equal of other divisions. If, for example, HR reports to a vice president for general services who is the organizational equal of three other vice presidents, HR cannot equally serve all divisions because it is ultimately responsible to just one of those divisions and will likely be seen as “owned” by the division to which it reports.

Be wary if your HR department reports in the undesirable manner just described. Regardless of how well the HR function might be managed, at times of conflict, when inevitable differences arise concerning personnel decisions, you may conclude that the division that “owns” HR is usually the division that wins. Independence and impartiality are essential for HR to function effectively for the whole organization, and independence and impartiality are impossible in perception and unlikely in actuality if HR is assigned to one of several operating divisions.

Be wary also of the occasionally encountered practice of duplicating HR functions within the same facility. For example, one will encounter the occasional hospital in which the department of nursing has its own HR function while another HR office serves all other departments. Although there are sometimes advantages to be gained from basing some recruiting activity in the nursing department, splitting or subdividing other HR activities tends to create duplication of effort while increasing the organization’s exposure to legal risks.

There are almost as many possible combinations of HR functions as there are HR departments. A great many activities that may generally be described as administrative can find their way into the HR department. For purposes of this book, however, the discussion will focus on the significant activities or groups of functions that are often identified as the tasks of HR. These basic HR functions are as follows:

• Employment, often referred to as recruiting. This is the overall process of acquiring employees—advertising and otherwise soliciting applicants, screening applicants, referring candidates to managers, checking references, extending offers of employment, and bringing employees into the organization.

• Compensation, or wage and salary administration. This is the process of creating and maintaining a wage structure and ensuring that this structure is administered fairly and consistently. Related to compensation, as well as to other HR task groupings, are job evaluation, the creation of job descriptions, and maintenance of a system of employee performance evaluation.

• Benefits administration. This activity is a natural offshoot of wage and salary administration, because benefits are actually a part of an employee’s total compensation. Benefits administration consists of maintaining the organization’s benefit structure and assisting employees in understanding and accessing their benefits.

• Employee relations. Generally, this activity may be described as dealing with employees and their problems, needs, and concerns. It may range from handling employee complaints or appeals through processing disciplinary actions to arranging employee recognition and recreation activities.

These four general activities are at work in essentially every HR function, regardless of its size and overall scope. In a very large organization, these will be separate activities or groups within HR, each with its own head and its own staff and perhaps including multiple subdivisions. In a very small organization, these are likely to be the tasks of a single person who has other duties as well.

One additional basic function that might be encountered is labor relations. Although labor relations may be a functional title that identifies a whole department or simply an HR department activity, it is also a relatively generic label that applies to the maintenance of a continuing relationship with a bargaining unit—that is, a labor union. Again, depending on size, labor relations may be a subdivision of HR in its own right or simply one of several responsibilities assigned to one person.

Other activities that might be found within HR include the following:

• Employee health. Often part of HR, in healthcare organizations it sometimes will be a part of one of the medical divisions.

• Training for both managers and rank-and-file employees. With the exception of nursing in-service education, which is traditionally a part of the nursing department, if a formal training function exists it is most often part of HR.

• Payroll. In the past, payroll was often a part of personnel, but in recent years it has usually resided in the finance division; however, a working interrelationship of personnel and payroll has always been essential. Recent times have brought about integrated personnel-and-payroll systems, and have seen the beginnings of payroll’s organizational shift back toward HR.

• Security and parking. With increasing frequency, these services, because of their strong employee relationships, are becoming attached to HR. At present, however, they are more likely to be found attached to an environmental or facilities division.

• Safety. As with security, safety is becoming increasingly attached to HR but is just as likely to be found in the facilities division.

• Child care. As an activity characterized largely as an employee service, an organization’s child care function is most likely assigned to HR.

Using the foregoing paragraphs as a guide, determine exactly which functions are performed by your organization’s HR department. Furthermore, take steps to attach a person’s name to each function. Strive to be in a position to understand how the HR department is organized—that is, who does what, who reports to whom, and who bears overall responsibility. Moreover, it is important to know the organizational relationships of the sometimes-HR functions (e.g., security) that belong elsewhere in your particular organization, to ensure that matters are taken to the correct department.

Next, take the time to make a list of the management activities or activities that can lead you to seek information or assistance from HR. The lists of most managers may have a great deal in common, such as:

• Employment—finding a sufficient number of qualified candidates from whom to fill an open position

• Benefits—providing information with which to answer employees’ benefits questions

• Compensation—providing information with which to answer employees’ questions related to pay

• Employee problems—determining where to send a particular employee who is having difficulty with a given problem

• Job descriptions and job evaluations—determining how to proceed in questioning the salary grade of any particular position

• Policy interpretations—determining the appropriate interpretation of personnel policy for any particular instance

• Disciplinary actions—determining how to proceed in dealing with what appear to be violations of work rules

• Performance problems—determining how to proceed in dealing with employees whose work performance is consistently below the department standard

• Performance appraisals—securing guidance in doing appropriate performance appraisals and finding out how much to depend on human resources to coordinate the overall appraisal process

The foregoing list can be expanded by each manager who may refer to it. One helpful method of expanding the list includes leafing through your organization’s personnel policy manual and employee handbook; this activity will bring to mind additional areas of concern.

The first, simplest, and most valuable advice to be offered for getting the most out of the HR department involves the age-old two-step process of initiation and follow-up. It is but a slight variation on a practice followed by most successful managers. The successful manager knows that any task worth assigning is worth assigning a specific deadline. Planning on doing things when you “have a little time to spare” or whenever you happen to think of something that needs doing breeds procrastination, delay, and inaction. An assignment—necessarily a well-thought-out, specific assignment—must be accompanied by a target for completion, a deadline that although perhaps generous or even loose leaves no doubt as to expected completion. When that deadline arrives and no results have been forthcoming, the manager then exercises the most important part of the total process—faithful follow-up. Faithful follow-up is the key; the manager who always waits a week beyond the deadline is behaving in a manner that tells the employees they always have at least an extra week.

Anything needed from the HR department should be addressed in a similar manner. Relative to the HR department, the process might be summarized as follows:

• Make certain the function of interest is part of HR’s responsibilities, and determine, if possible, who in HR would be the best person to approach on the topic.

• Refine your question or need so that it is sufficiently specific to permit a specific response.

• If an answer is not immediately available, ask when one will be supplied.

• If the promised reply date occurs later than your legitimate need date, negotiate a deadline agreeable to both you and HR.

• If your agreed-on deadline arrives and you have not received your answer, follow up with the HR department. Follow up politely, follow up diplomatically, but follow up faithfully. Never let an unanswered deadline pass without following up.

This process should be applied not just to problems, issues, and concerns that you as a manager would consider taking to HR. It should also—and especially—apply to questions and concerns that employees bring to you. If an employee’s question in any way involves HR concerns and you are unable to respond appropriately, then take the question to HR as if it were your own.

The HR department exists to assist individual managers and their employees—to assist, in fact, all employees from the chief executive officer to the newest entry-level hire. HR can be of considerable help to the department manager, but only if the manager is willing to reach out and request assistance when needed.

Expect the HR department to house the organization’s resident experts on all organization-wide personnel practices. Respect HR’s knowledge of personnel policy and procedure, and never hesitate to ask HR for clarification of any policy or practice that relates to employment and employee relations in any way. In those occasional instances when HR cannot immediately and completely respond to an inquiry—say, for example, the issue is one that requires input from legal counsel as well as HR—you should nevertheless expect HR to secure the answer.

When a personnel question has legal implications, as many such questions do, there is all the more reason to take it to HR to minimize management’s exposure to the potential results of a faulty decision. It is far better to ask than to inadvertently put the organization at risk.

Often HR has exactly the information the department manager needs and is more than willing to share this information. Take the initiative to reach out and ask HR—and expect answers.

Any number of management needs present opportunities to put the HR department to work. The more frequently encountered of these are described here.

There are any number of points in the employment process at which the manager and HR must work together. Fulfill your end of the working relationship, and expect HR staff to fulfill theirs. For example, if none of the candidates HR has supplied for a particular position is truly appropriate, ask for more; do not settle for only what is given if it is genuinely not enough. For your part of the arrangement, do not continue to call for more applicants in a search for the “perfect” candidate if you have already seen two or three who meet the posted requirements for the job.

Also, stay in touch with HR concerning the extending of offers, the checking of references, and the scheduling of pre-employment physical examinations and starting dates. Do not be unreasonable; recognize that these activities take time. By making your interest and attention known, however, you will encourage completion of the process.

The manager ordinarily has a significant responsibility in maintaining current job descriptions for the department. The HR department usually has the responsibility for associating a pay level with each job and for maintaining central files of up-to-date job descriptions. Job descriptions should be written in large part by those who do the work and those who supervise the doing of the work; however, it is important to involve HR deliberately in contributing consistency to every necessary job description and ensuring that each job is properly placed on a pay scale. Once again, your visible interest in the process will encourage timely completion of HR’s activities.

Regardless of the extent of HR involvement in the disciplinary process, it is not the HR department that decides on disciplinary action. The HR department disciplines no one except employees of the HR department, as necessary. Any employee deserving of disciplinary action must be disciplined through his or her immediate chain of command.

In most organizations, it is a requirement for the manager to take proposed disciplinary actions—at least those entailing actions more severe than oral warnings—through HR before implementation. Whether or not this is true for your organization, you are advised to always take your best assessment to HR and ask for advice. Expect sound advice, whether in the form of a single recommendation, complete with rationale for doing so, or as two or more alternatives, each with its own possible consequences fully explained. The decision is theoretically all yours, and if it is a poor decision you will bear much of the blame. Never let HR avoid responsibility by failing to provide specific direction; insist on complete HR participation in deciding on disciplinary action.

One of the most important tasks of the supervisor is the appraisal of employee performance. No formal system of performance appraisal can function consistently throughout the organization without the central guidance usually provided by HR. Although it is certainly possible to evaluate employees’ performance without the assistance of HR, you can do a much more consistently acceptable job of evaluation with HR involvement. Most of HR’s involvement in evaluation should occur automatically as far as the manager is concerned. The HR department should provide forms, instructions, schedules, and reminders throughout the process. If, however, the HR department is not always on top of the manager’s employee appraisal needs, according to the needs of the moment the manager should take the following steps:

• Keep track of scheduled review dates and ask HR for forms and timetables if not supplied automatically.

• Ask for periodic instruction in how to apply rating criteria, especially if criteria have changed and refresher instruction is not supplied.

• Keep HR advised of how changing job requirements may be affecting the application of criteria based on previous requirements.

• Periodically ask HR for rating profile information that reveals patterns in the manager’s rating practices and shows whether those patterns are changing with time, and perhaps also shows how this specific manager’s rating patterns compare with those of other managers.

If the HR department has responsibility for any employee training—and in most healthcare organizations there is a better-than-even chance that this is so—do not wait for needed training. If there are training needs in your work group, take them to HR. If, for example, several employees require training in basic telephone techniques, take your well-defined needs to HR, negotiate a timetable for providing the training, and offer to become personally involved in the training. (With appropriate HR involvement, every manager is a potentially valuable instructor in some topic.)

The foregoing are presented as a few specific suggestions but are offered primarily to convey a general idea to the manager. This idea is that the HR department exists as a service function for all employees and that it remains for the supervisor to take each legitimate personnel-related need to HR and to ask for—and expect—an honest response.

In addition to the previously mentioned activities, there are occasionally other times when the manager is well advised to turn to HR:

• When examining staff turnover patterns and attempting to determine what might be done to increase the chances of retaining key employees

• When planning for potential future staffing needs

• For periodically examining staff pay rates relative to the community, the region, and the occupations employed

• For using HR as a sounding board, a “safe harbor” for venting frustrations without involving employees, peers, or superiors

• When looking for confidential guidance in addressing difficult situations experienced with others

• For drawing on HR experience and resources in celebrating individual employees as appropriate (e.g., employee of the month) and in periodically recognizing various occupations (e.g., National Nurses Week, Physical Therapy Week)

The most effective HR departments are not one-way dispensers of information and assistance. Effective HR departments are responsive to the needs of the organization’s work force; however, the HR department can go only so far in anticipating needs and meeting them within the limits of available resources. To be fully effective, the HR department must learn of employees’ needs from employees and managers and must in turn go to top management with solid proposals for meeting the most pressing needs.

Some employees, usually only a few, take their own questions, concerns, and suggestions to the HR department. But most employees will never do so for themselves; their needs, whether conveyed through words, actions, or attitudes, must find their way to HR and eventually to top management through their managers.

Among the kinds of information that the manager should pass along to HR are the following:

• Reactions to various personnel policies, especially when policies seem to have become less appropriate under changing conditions

• Employee attitudes concerning pay and benefits, especially perceptions of inequities and alleged instances of unfair treatment

• Complaints—and compliments as well—about employee services such as the cafeteria and parking

• Comments on the appropriateness of various employee benefits, and perceptions of benefits needed or desired as opposed to those currently given

• Potential changes in any or all means of acquiring, maintaining, or retaining employees who might afford the organization a competitive edge in its community

It is relatively easy to determine what HR as a department does within the organization. However, it is necessary to go beyond what and develop an appreciation of why—that is, why HR does what it does and why it sometimes must espouse a position in opposition to a line department’s position.

Consider the case of a manager who appeals to the HR department to help her resolve a seemingly unending series of difficulties by agreeing to the termination of a particular employee. The manager says, “I simply can’t do any more with this person. She’s chronically late in spite of all my warnings. Her absenteeism disrupts staffing; she uses up her sick time as fast as she earns it. Her attitude is absolutely terrible; she’s been rude to patients and families, and the way she talks to me borders on insubordination much of the time. Her clinical skills are just average at best, and she’s a disruptive influence within the group. I’ve been patient longer than anyone has the right to expect me to be, but nothing has changed. I want to discharge her.”

As often occurs in such circumstances, the HR practitioner hearing the manager’s request briefly reviews the employee’s background and immediately recommends against termination. This may understandably disappoint and upset the manager and leave her displeased with the HR department. She may complain, with some justification, that she ought to be supported in her efforts to get rid of an unsatisfactory employee. She may well view HR as obstructive and adopt an adversarial position, perhaps even attempting to solicit the assistance of her own higher management in opposing the HR position.

Why would HR be automatically protective of any employee whose relationship with work is as bad as described by this manager? The differences lie in, first, the manager’s perspective versus the HR perspective, and second, the frequently cited employee personnel file—“the record.”

The manager is legitimately focused on the good of the patients and the good of the unit, and the behavior of the employee in question threatens both. By contrast, HR must view the issues in two ways that conflict with the manager’s perspective: (1) in micro terms, HR must be concerned with the rights of the individual and (2) in macro terms, HR must be concerned with the good of the total organization. The organization is, of course, no more than the sum total of a number of individuals. Nevertheless, in focusing on the one and the all, the HR perspective fails to match that of the manager, which is necessarily focused on more than one but much less than all.

Then there is “the record” to consider. In this example, it turns out that all of the manager’s “warnings” concerning tardiness were informal oral warnings of which no record was made; the same was true for warnings for absenteeism, except for a single written warning that was far too old to give weight to current disciplinary action. No other warnings appeared in the personnel file. In fact, although in the mind of the manager this employee had always been less than satisfactory, the personnel file included several performance evaluations that, while not glowing with praise, suggested at least nominally acceptable performance. In short, there was no basis for termination except perhaps in the manager’s mind.

When it comes to problems such as that just described, the HR department is fulfilling two responsibilities:

• Defending the rights of the individual, not only because doing so arises from a sense of fairness but also because there are many laws requiring the organization to do so

• Protecting the organization from a multitude of legal risks

Whenever there is a risk that an employee problem or complaint will be taken outside of the organization, it is best to think of any criticism of employee conduct or performance in a single light: if it is not reflected in the record, it never happened. Except in instances of termination for major infractions calling for immediate discharge (and these days even many of these actions are successfully challenged), a discharge must be backed up with a paper trail describing all that occurred leading up to the termination. It is legally necessary to be able to demonstrate that the employee was given every reasonable opportunity to correct the offending behavior or improve the unsatisfactory performance.

A number of areas of legislation—federal, state, and in some instances local—define how work organizations must deal with employees in certain respects. Any work organization is, of course, subject to many laws that bear on essentially all aspects of the conduct of business. A great many laws applicable to business are essentially invisible to the individual manager. For example, nothing done in the normal course of business by the manager of rehabilitative services has any bearing on corporate compliance with certain financial reporting laws. However, some laws directly shape the relationship between employer and employee. It is this collection of laws affecting employment that concerns the manager, and it is this general area of employment legislation for which HR is the source of most of the individual manager’s guidance.

The National Labor Relations Act (NLRA) of 1935, known otherwise as the Wagner Act, originally provided the basis for most labor law in the United States. It was significantly amended in 1947 by the Labor Management Relations Act, otherwise known as the Taft-Hartley Act. Taft-Hartley is the primary reference applicable when discussing aspects of union organizing. Numerous references to the NLRA are actually references to the NLRA as amended by Taft-Hartley, which provides the framework for all modern labor law.

Before 1975, not-for-profit hospitals were exempt from all provisions of Taft-Hartley. However, in 1975 the act was amended to remove the not-for-profit hospital exemption. Before 1975, hospital employees were covered only in special sections of the labor relations laws of some states. The 1975 amendments provided hospitals, because of the nature of their business, with certain legal protections not available to other industries. For example, there is a requirement that 10 days’ notice be provided prior to any picketing, strike, or other concerted refusal to work—a requirement not applicable in other industries. Overall, however, the effect of the removal of the exemption essentially made not-for-profit hospitals and certain other healthcare institutions equally subject to union organizing as organizations in other industries.

The individual manager needs to know the general impact of labor law as it applies to day-to-day operations within the department. If the organization’s employees are not unionized and if there is no active threat of union organizing, labor law will be of little immediate concern, and common-sense management will prevail. If there is a union in place, much of the manager’s behavior concerning employees will be governed by a collective bargaining agreement (contract). If there is no union, but active organizing is occurring, the manager’s conduct in regard to employees will be governed by provisions of the NLRA. In either case, the manager’s primary source of guidance will be the human resources department.

Of primary interest is the Fair Labor Standards Act (FLSA), the federal wage and hour law, and as such the model for the wage and hour laws of many states. Occasional points that might not be addressed in federal law may be covered by pertinent state laws. Generally, if the same points are covered by both state and federal laws but differences exist between the two, the more stringent legislation will apply. For example, the minimum wage required by some state laws may be higher than the one allowed by federal law in the amended FLSA, and employers in those states are required to pay the higher minimum wage.

In general, the wage and hour laws spell out who is to be paid for what and how. They specify who can be exempt and who must be considered nonexempt—where exempt literally means exempt from the overtime provisions of the law. Exempt employees—certain executive, administrative, and professional employees who meet special legal requirements—do not have to be paid overtime pay. Nonexempt employees as defined under the law must receive time-and-one-half the regular rate of pay for hours in excess of 40 in a week.

In 2004, a number of changes were made in the rules used for determining who is or is not eligible for overtime pay. Some significant issues surrounding these rules remain controversial. Many agree that the FLSA is antiquated and confusing, particularly the portions addressing overtime pay. The newer rules mandate overtime pay for more low-income workers but at the same time appear to render certain white-collar workers and professionals ineligible for overtime pay.

The entire overtime question can sometimes be confusing to the individual manager, but the status of overtime regulations at any given time is usually known in the HR department.

Human resources and the organization’s payroll department are usually the manager’s two primary sources of advice and assistance concerning the wage and hour laws. At the very least, the individual manager should be aware of the status (exempt or nonexempt) of each person in the work group and understand how time reporting and wage payment are handled for each. The wage and hour laws are actually extremely detailed and extensive, and fortunately only a relative handful of regulations will apply to any individual manager’s situation.

A specific section of the FLSA, as augmented by the Equal Pay Act of 1963, requires covered employers to provide equal pay for men and women who are performing the same work. In 1972, coverage of this act was extended beyond employees covered by FLSA to an estimated 15 million additional executive, administrative, and professional employees, including academic and administrative personnel and teachers in elementary and secondary schools, and to outside salespeople.

Title VII of the Civil Rights Act of 1964, as amended by the Equal Employment Opportunity Act of 1972, prohibits discrimination because of race, color, religion, sex, or national origin in any term, condition, or privilege of employment. As enforced through the Equal Employment Opportunity Commission (EEOC), Title VII covers the following entities:

• All private employers of 15 or more persons

• All educational institutions, both public and private

• State and local governments

• Public and private employment agencies

• Labor unions with 15 or more members

• Joint labor–management committees for apprenticeship and training

The EEOC investigates job discrimination complaints. When it finds reasonable cause to believe that charges are justified, it attempts, through conciliation, to eliminate all aspects of discrimination revealed by the investigation. If conciliation fails, the EEOC has the power to take the employer to court to enforce the law. Discrimination charges may be filed by individuals (job applicants as well as active employees) and by organizations on behalf of aggrieved individuals.

Title VII was modified and strengthened by the Civil Rights Act of 1991 in an effort to reverse the effects of several U.S. Supreme Court decisions that had the effect of weakening the law. The 1991 legislation also made possible increased financial damages against organizations found guilty of discriminatory practices. It is civil rights legislation that causes the most potential difficulty for working managers. Therefore, it is in this area of concern that the HR department, usually backed up by the organization’s legal counsel, is most prepared to advise and support department management.

Passed in 1990 and largely made effective in 1992, the Americans with Disabilities Act (ADA) affirmed the right of persons with disabilities to equal access to employment; services; and facilities available to the public, including transportation and telecommunications. The ADA requires employers to provide “reasonable accommodation” for disabled individuals who are capable of performing the essential functions of the positions for which they apply. This may include altering physical facilities to make them usable by individuals with disabilities, restructuring jobs about their essential functions, and altering or eliminating nonessential activities so that disabled persons can perform the work.

Amendments passed in 2008 placed new requirements on employers and the courts in deciding whether an individual can be considered sufficiently disabled to receive protection under the ADA. Also, a number of court decisions have had the effect of increasing the number of conditions that may be considered disabilities for ADA purposes.

The EEOC is responsible for dealing with complaints filed under the ADA.

The Family and Medical Leave Act (FMLA) of 1993 makes it possible for an eligible employee (one who has been employed at least 1 year and has worked at least 1,250 hours) to take up to 12 weeks of unpaid leave in a 12-month period for certain specified reasons without loss of employment. Qualifying reasons are as follows: for the birth of the employee’s child or the care of that child up to 12 months of age; for placement of a child with the employee for adoption or foster care; for the employee to care for a spouse, child, or parent having a serious health condition; and for the employee’s own serious health condition involving the employee’s inability to perform the essential functions of the job. An employee returning to work within the 12-week limit must be returned to his or her original position or to a fully equivalent position in terms of pay and benefits and overall working conditions.

The FMLA can be relatively complex in its interrelationships with other laws, conflicting in instances with the ADA, the FLSA, and various states’ workers’ compensation laws. Once again, HR, backed up with corporate legal counsel, stands ready to advise the manager.

Sexual harassment has been prominent in society for a number of years, and it continues to be an active concern in work organizations and elsewhere. The number of sexual harassment complaints filed with the EEOC and various state agencies continues to increase, as do the numbers of employers involved and the monetary penalties. In recent years, sexual harassment has been one of the two leading causes of legal complaints against employers (the other is age discrimination).

Sexual harassment is a form of sex discrimination under Title VII of the Civil Rights Act of 1964. It consists of unwelcome sexual advances, requests for sexual favors, or other conduct of a sexual nature in these conditions: if submission is either an actual or implied condition of employment, if submission or rejection is used as a basis for making employment-related decisions, or if the conduct interferes with work performance or creates an offensive work environment. A key concern in the foregoing resides in the word unwelcome; conduct is considered unwelcome if the employee neither solicits nor invites it and regards it as undesirable or offensive. Whether a particular occurrence is or is not sexual harassment sometimes depends largely on the perception of the victim.

Sexual harassment can take a number of forms. Sexually explicit pictures or calendars, offensive sexually related language, sexual humor, other sexual conduct that creates a hostile environment, sexually explicit behavior, indecent exposure, sexual propositions or intimidation, offensive touching, and participation in or observation of sexual activity are all examples of sexual harassment. Also considered sexual harassment is something as seemingly innocent (to some) as repeatedly asking a coworker or subordinate for a date after having been turned down. This adds the dimension of repetition to some harassing behavior; asking a time or two might be considered reasonable, but asking repeatedly after having been turned down may be considered harassing.

Sexual harassment is not limited strictly to the workplace; it is also sexual harassment if it occurs off-premises at employer-sponsored social events and at private sites if it involves people who have an employment relationship with each other. In addition to involving employees, sexual harassment can involve visitors, vendors, patients, and others as either potential perpetrators or victims.

To limit liability for sexual harassment, it is necessary for the employer to promptly and confidentially investigate all complaints, take appropriate corrective action, and create and retain complete and accurate records.

A sound prevention program is vital where sexual harassment is concerned. At a minimum such a program should include a published sexual harassment policy and a detailed procedure for investigating complaints. All employees, and especially all managers, should be educated in the recognition and prevention of sexual harassment.

Violence in the workplace often results from stress. It frequently occurs when a person becomes stressed to what is for that individual an unbearable level. When stress becomes unbearable, some people become ill, some break down, some walk away from the sources of stress, and some become violent. Violence is similar to other forms of human behavior in that it is action in response to a condition, need, or demand.

Every change that alters employees’ expectations becomes fertile ground for chronic anger, which can lead to reduced productivity and quality, increased fatigue, burnout, depression, and violence. One of every six violent crimes occurs in the workplace. Motor vehicle accidents are the leading cause of death for working men, but murder is the leading cause of death for working women.

The highest-risk areas for nonfatal assaults are the retail trades, such as grocery stores and eating and drinking establishments, and service organizations, such as hospitals, nursing homes, and social services agencies. During the late 1990s, almost two-thirds of all nonfatal workplace-associated assaults occurred in hospitals, nursing homes, and residential care facilities, and most cases involved patients assaulting nurses.1

The department manager’s best approach to workplace violence is awareness and prevention. There is no consistent profile to describe a person who commits violent acts in the workplace, but violence is often perpetrated by someone who has the following characteristics:

• Is experiencing family problems

• Has problems related to the abuse of alcohol or drugs

• Has a history of violence

• Is a known aggressive personality

• Is experiencing certain mental conditions (e.g., depression)

• Possesses a poor self-image or low self-esteem

People commit violent acts for a variety of reasons, which have been known at times to include these conditions:

• The inability to cope with what to the person is extreme stress

• Drug reactions

• Problems involving job, money, or family

• Reaction to the loss of employment

• Reaction to the loss of a relationship

• Frustration with long waits or rude or indifferent treatment

• Confusion or fear

• Perceived violation of privacy

One can never tell for certain who may resort to violence. However, there are steps to consider for preventing violence.

• Treat everyone with respect and consideration.

• Keep all potential weapons stored beyond the reach of patients and visitors.

• Take threats seriously and report them immediately.

• Know your security procedures, alarms, and warning codes.

Be extra alert to the possibility of violence if a person meets any of these criteria:

• Appears to be under the influence of alcohol or drugs

• Appears to have been in a fight

• Is brought into the facility by the police

• Is already being restrained

Visible indicators of potential violence include the following:

• Obvious possession of a weapon

• Nervousness or abrupt movements

• Extreme restlessness, such as pacing and obvious agitation

When observing an individual who appears to be on the edge of losing control:

• Notify other staff and call security

• Stay alert but remain calm

• Maintain a safe distance, giving the person plenty of space; do not turn your back and do not touch the person

• Keep obstacles between you and the individual

• Be certain you have a way out; avoid deadend corridors or corners

• Listen; do not display anger or defensiveness and do not argue; speak slowly and quietly

Some departments, such as the emergency department, are more prone to violence than others, but violence is possible anywhere. Every department’s staff should have some orientation in how to deal with violent behavior. If violence does occur:

• Protect yourself to the extent necessary

• Sound the alarm or call the appropriate code

• Help remove others from the vicinity, if necessary

• Do not try to disarm or restrain the person yourself

• Give the individual what he or she is demanding, if possible

Before 1964 there were not a great many legal concerns affecting the work of HR and department managers. As long as the organization was compliant with wage-and-hour law, labor law, and a few state regulations, there were not many legal requirements to be aware of. However, Title VII of the Civil Rights Act of 1964 was a major “game changer” in that it launched a legalistic phase of employee relations: a series of new employment-related laws came on line over three decades or so. Major new employment legislation slowed with passage of the FMLA of 1993, but there have been and most likely always will be periodic amendments to existing laws and changes wrought by case law as various legal challenges are dealt with in the courts. Present indications are that employers can expect to see increasing activity toward mandating paid sick leave in many organizations that do not offer this particular benefit. Overall, the effects of accrued employment legislation have been to legally make employers more socially responsible for their workers.

Although the issues described in this section are those of greatest concern to the manager (especially civil rights, wage and hour, and possibly labor relations), many other federal, state, and local laws can affect the employment relationship. It may seem at times as though this is excessive legislation and that all of these rules and regulations may not be truly necessary. Remember, however, that managers are employees as well and that the protections afforded employees under legislation such as equal pay and civil rights also extend to managers. All working managers should be willing to recognize that the laws affecting employment represent a well-defined part of management’s boundaries, those limits within which it is necessary to learn to work in the fulfilLment of management’s responsibilities.

As a staff function, HR is organized as a service activity. Service activities render no patient care; they do not advance the primary work of the organization. Rather, they support the performance of the organization’s work and in a practical sense become necessary. For example, if a pure service such as building maintenance did not exist, the facility’s physical plant would gradually self-destruct. Similarly, without HR to see to the maintenance of the workforce, the overall suitability and capability of that workforce would steadily erode. Recognize HR for what it is: an essential service function required to help the organization run as efficiently as possible.

Learn what the HR department does, and especially learn why the department does what it does. Provide input and forge a continuing working relationship with the HR department, making it clear that you expect service from this essential service department. Challenge HR to do more, to do better, and to continually improve service—and put the HR department to work for you and your employees.

One morning, well before the start of your department’s normal working hours, you were enjoying a cup of coffee in the cafeteria, shaping up your calendar of tasks and appointments for the day, when you were approached by one of your employees. The employee, Millie Norman, one of your two or three most senior professionals in terms of service, seated herself across from you and said, “There’s something going on in the department that you need to know about, and I’ve waited far too long to tell you.” You reacted internally with both impatience and annoyance—you were not prepared to interrupt what you were doing, and you had not even invited Millie to join you.

Millie proceeded to tell you (“In strictness confidence, please—I know you’ll understand why”) that another long-term professional employee, Cathy Johnson, had been making a great many derogatory comments about you throughout the department and generally questioning your competence.

For 10 minutes Millie showered you with criticism of you, your management style, and your approach to individual employees, all attributed to Cathy Johnson. On exhausting her litany, Millie proclaimed that she did not ordinarily “carry tales” but that she felt you “had a right to know, for the good of the department—but please don’t tell her I said anything.”

Although Millie’s comments were filled with “she saids” and “she dids”—the “she” being Cathy—and generally twice-told tales without connection to specific incidents, something extremely disturbing clicked in your mind while you were listening. Recently your posted departmental schedule had been altered, without your knowledge, in a way indicating that someone had tried to copy your handwriting and forge your initials. Two separate, seemingly unconnected comments by Millie together revealed that only one of two people could have altered your schedule. Those two people were Cathy Johnson and Millie Norman herself.

As Millie finally fell silent, you were left with an intense feeling of disappointment. You wondered if you could ever again fully trust two of your key employees.

Write at least a fully developed paragraph in response to each of the following questions:

1. What should be your immediate response to Millie Norman? Why?

2. Do you believe you have the basis on which to proceed with disciplinary action against someone? Why or why not?

3. How can the HR department help you in your present concern?

Carol Greely had been a registered nurse for 25 years and a nurse manager for more than 10 years when she was asked to take over as nurse manager of a particular medical–surgical unit known throughout the hospital—none too affectionately—as the “hot seat.” Although she had heard a few things about this floor, because of the size of the hospital and her recent assignment in a relatively removed area, Carol had little information about why the hot seat was so designated.

After 3 months on the job, Carol had formed some strong opinions regarding the bases of many of the unit’s problems. To her, the majority of staff on the unit exhibited a complete lack of professionalism. Carol became convinced of this for a number of reasons, including the following:

• There were many appearance problems and many violations of the department’s none-too-often-enforced dress code. If there were a worst-dressed list maintained, Carol concluded, surely her nurses would be on it.

• The unit’s rate of absenteeism was the worst of any unit within the nursing department.

• Two (thankfully unsuccessful) attempts by unions to organize the hospital’s nurses had apparently originated with the nurses in Carol’s unit.

• Carol had never before seen a unit with such a high level of schedule juggling—shift trades, requests for specific days off, and especially changes to the schedule at the last minute.

It was not long before Carol found herself becoming highly cynical about the unit and its future. It seemed to her that nursing meant no more to many of these people than the paycheck and that they constantly put their social lives and personal preferences before the needs of the patients.

When she had been on the job 6 months, Carol received a startling piece of secondhand information from a friend in the nursing department who swore her to secrecy as to the source. It was apparently a closely guarded secret in nursing administration that her particular unit was deliberately maintained as a concentration of marginal employees. It was, in the words of Carol’s friend, “to keep the butterflies and malcontents all in one place as much as possible, so they won’t disrupt other units.” Carol was further led to believe that she could expect to be reassigned after about 18 months on the job, when it would then be someone else’s turn to sit in the hot seat.

Carol’s initial reaction to what she had learned was anger. However, the more she thought about the position in which she found herself, the more she became determined to do something with the time left to her in the unit. She decided she was going to do everything in her power to turn the hot seat into a real nursing unit.

Develop a fairly detailed plan of action for Carol Greely to follow in attempting to accomplish her admittedly difficult objective or to go as far toward accomplishing it as possible. Highlight those steps in her plan for which the HR department can probably provide positive advice or assistance, and describe the likely nature of the HR involvement.

1. Preventing Violence in the Workplace, Group Insurance Agency, Inc. (Albany, NY: Healthcare Association of New York State): May 9, 1997.

Healthcare Administration Capstone – Week #2 Lecture 1

In this week, you will continue your research and dive deeper into your identified problem. The course outline contains some questions that might assist you in conducting your research. Normally, your problem statement, or Chapter 1 as it is called in the realm of research, will contain a historical overview of your problem. When did it first appear? Who does it affect? What, if anything, has been done historically about the problem?

Your problem statement will then move from a historical perspective to a current analysis. What is the significance of this problem? What is currently being done? What role does management play within the context of this problem? Is the problem tied to cost, access, or quality or a combination of these? What, if anything, is currently being done about the problem?

As you start to dive into your problem, you will begin to peel the layers. Like an onion, your problem has various layers that will need to be considered to fully develop your research project. Let’s look at an example of how this layering may unfold. Assume that you have identified the issue of the elderly not being able to afford their medications (a growing problem to say the least.)

As you begin to research your problem, the first layer is that of medication affordability. Are the physicians prescribing name-brand medications? Are there less costly generics available? What about dosing? Could the physician prescribe a higher dose that could be cut in half or thirds thereby reducing costs? After the above questions have been answered, the next layer can be addressed; that of insurance coverage. Do the elderly being researched have insurance? Are there Medi-Gap plans available that are not being utilized? The next layer would be that of monthly income with its own associated questions and research angles. Eventually, all layers will be addressed.

A quick word of caution is in order. Where last week, you were cautioned to not move too quickly, this week you are cautioned to choose your research sources wisely. Times have certainly changed. It wasn’t that long ago that a researcher would have to physically go to libraries or universities to obtain information. Today, thanks to technology, a veritable unlimited amount of information is available with just a few keystrokes. However, not everything that is available online is factual, nor should it be used for research purposes.

Sites such as Wikipedia, Ask.com, and others of this nature, are full of information and are a tempting place to gather data for your research project. Unfortunately, the information posted within these websites is not validated. It is nearly impossible to know if the information is accurate. Can you imagine pinning your whole research project on what turns out to be false data?

Does this mean that you should simply ignore these sites all together? No, not necessarily. Although it is highly unlikely that you have not been exposed to your selected problem within the many classes you have taken thus far, if you knew nothing about a particular topic, these sites are actually good for initial exposure. By reading the information contained within these sites, you will develop a better sense of the problem and can then use this to search more reputable sources.

In short, avoid the aforementioned sources, as well as avoid magazines, blogs, and most .com websites. For research purposes, sites ending with .gov are normally valid sites. Where possible, use peer-reviewed articles and journals as these contain validated information. Again, if you have any questions, please ask them in the “Project Questions” forum.

As you conduct your preliminary research, be sure to accurately record your references as you will be accumulating quite a few. It is difficult work to try and relocate sources. Keeping a current reference page will assist you tremendously in completing both the Literature Review (Chapter 2 – discussed next week) and your Chapter 5 – References (discussed in week 6).

Be sure to complete all of your work in APA format. In the Grantham University Library, click on General. Under Documenting, take the time to review the APA Writing Guide.

As you begin to write, do not be afraid to use headers and sub-headers to alert the reader of topic changes. The use of headers and sub-headers will assist you in remaining organized.

By the end of this week, you should be finished with Chapter 1.

The following resources are recommended at this juncture:

Evaluating Sources: https://owl.english.purdue.edu/owl/resource/553/01/

Choosing Credible Sources: https://www.ivcc.edu/stylebooks/stylebook6.aspx?id=14724

Using Headers and Sub-Headers: https://owl.english.purdue.edu/owl/resource/560/16/