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 vi Contents

HR Metrics 29
HR Analytics 30
Benchmarking 30
Balanced Scorecard 30
Human Capital Effectiveness Measures 32
HR and Quality Patient Care 32
Joint Commission (JCAHO)
and Healthcare Management 33
JCAHO Process 33
JCAHO HR Standards and Serious Adverse Events 34
Healthcare Reform and HR Practices 35
Case 36
End notes 37

C ha pter 3 Strategic HR Management 38

Healthcare HR Insights 39
Management of Human Assets in Organizations 40
Human Capital and HR 40
Human Resource as a Core Competency 40
Organizational Culture 42
HR Management Roles 42
Administrative Role for Human Resource 43
Operational and Employee Advocate Role
for Human Resource 44
Strategic Role for Human Resources 45
Human Resources and Strategy 45
Requirements for Human Resource
Contribution to Strategy 46
Human Resource Planning 48
Human Resources Planning Process 48
Environmental Analysis 48
Planning for External Workforce Availability 50
Economic and Governmental Factors 50
Geographic and Competitive Evaluations 51
Changes in the Conditions of Work 51
Changing Workforce Considerations 52
Planning for Internal Workforce Availability 52
Current and Future Jobs Audit 52
Employee and Organizational Capabilities Inventory 53
Forecasting HR Supply and Demand 54
Forecasting 54
Elements of Successful HR Planning 55
HR Management Challenges 58
Healthcare Reform and HR Practices 58
A Changing Workforce 58
Case 60
End notes 60

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 Contents  vii

C hapter 4 Legal Issues Affecting the Healthcare

Workplace 62
Healthcare HR Insights  63
Equal Employment Opportunity 63
Sources of Regulation and Enforcement 64
Major Employment Laws  65
Equal Employment Opportunity Concepts  66
Elements of EEO Compliance 68
EEO Policy Statement 68
EEO Records  68
Civil Rights Act of 1964, Title VII 72
Civil Rights Act of 1991 73
Executive Orders 11246, 11375, and 11478 73
Affirmative Action Program (AAP) 73
Managing Racial and Ethnic Discrimination
Issues 75
Sex/Gender Discrimination Laws
and Regulations  75
Pregnancy Discrimination 75
Equal Pay and Pay Equity 76
Managing Sex/Gender Issues  77
Sexual Harassment 79
Types of Sexual Harassment 80
Preventing Sexual Harassment 81
Disability Discrimination 81
Rehabilitation Act 81
Americans with Disabilities Act 81
Amendments to the ADA 82
ADA and Job Requirements  83
Claims of Disability Discrimination 85
Genetic Bias Regulations  86
Age Discrimination Laws  86
Age Discrimination in Employment Act 86
Older Workers Benefit Protection Act 87
Managing Age Discrimination 87
Religion and Spirituality in the Workplace 87
Managing Religious Diversity 88
Managing Other Discrimination Issues  88
Immigration Reform and Control Acts  88
Military Status Protections  89
EEOC Investigation Process  89
Employer Responses to EEO Complaints  90
Diversity and Cultural Competence Training 91
Ethics and the Law 92
Case 93
End notes  94

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 viii Contents

C ha pter 5 Job Design and Analysis 96

Healthcare HR Insights 97
Accomplishing Strategic Objectives through
Job Design 98
Productivity and Job Design 99
Nature of Job Analysis in Healthcare Organizations 99
Task-Based Job Analysis 100
Competency Based Job Analysis 101
Joint Commission Standards and Job Analysis 102
Uses of Job Analysis 102
Job Families, Departments, and Organization Charts 104
Job Analysis and HR Activities 104
Work Schedules and Job Analysis 106
Managing Flexible Work 108
Flexibility and Work–Life Balance 108
Legal Aspects of Job Analysis 108
Job Analysis and the Americans with Disabilities Act 109
Behavioral Aspects of Job Analysis 109
Current Incumbent Emphasis 110
“Inflation” of Jobs and Job Titles 110
Employee and Managerial Anxieties 110
Job Analysis Methods 111
Observation 111
Interviewing 112
Questionnaires 112
Computerized Job Analysis 112
The Job Analysis Process 112
Planning 113
Preparation and Communication 114
Conducting the Job Analysis 114
Developing and Maintaining Job Descriptions,
Job Specifications, and Performance Standards 114
Healthcare Reform and HR Practices 115
Job Description Components 115
Identification 115
General Summary 116
Essential Functions and Duties 117
Job Specifications 118
Performance Standards and Competencies 118
Disclaimer and Approvals 118
Case 119
End notes 120

C ha pter 6 Healthcare Recruitment and Selection 122

Healthcare HR Insights 123
Recruiting and Labor Markets 123
Labor Market Components 123
Healthcare Reform and HR Practices 125
Planning and Strategic Decisions Regarding
Recruiting 126

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 Contents ix

Internal versus External Recruiting 129

Flexible Staffing 129
Float Pools 129
Employee Leasing 131
Internal Recruiting 131
Job Posting and Bidding 131
Internal Recruiting Database 131
Promotion and Transfer 132
Current Employee Referrals 132
External Recruiting 132
Schools, Colleges, and Universities 132
Media Sources 133
Professional Associations 133
Employment Agencies 133
Executive Search Firms 133
Internet Recruiting 134
E-recruiting Media or Methods 134
Recruiting and Internet Social Networking 135
Recruiting Using Special Technology Means 135
Legal Issues in Internet Recruiting 136
Advantages of Internet Recruiting 137
Disadvantages of Internet Recruiting 137
Other Sources for Healthcare Recruitment 138
Clinical Rotations 138
Preceptorships and Internships 138
Fellowships 139
Summer Employment, Shadowing, and Volunteer Pools 139
Recruiting Evaluation and Metrics 139
Increasing Recruiting Effectiveness 140
Nature of Selection 141
Placement 141
Selection, Criteria, Predictors, and Job Performance 142
Validity and Reliability 143
Combining Predictors 144
Additional Legal Concerns 144
Selection Responsibilities 145
Reception and Job Preview/Interest Screening 145
Application Forms 147
Selection Testing 149
Ability Tests 149
Personality Tests 150
Selection Interviewing 151
Types of Interviews 151
Panel Interview 152
Criminal Background Checking 152
Legal Constraints 153
Medical Examinations and Inquiries 154
Making the Job Offer 155
Relocation Assistance 155
Case 155
End notes 156

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 x Contents

C ha pter 7 Organizational Relations and Employee Retention

in Healthcare 158
Healthcare HR Insights 159
Individual–Organization Relationships 160
Psychological Contract 160
Job Satisfaction and Commitment 161
Organizational Redesign and Morale 162
Employee Engagement and Loyalty 163
Employee Absenteeism 164
Types of Absenteeism 165
Controlling Absenteeism 165
Employee Turnover 166
Types of Employee Turnover 166
Measuring Employee Turnover 168
HR Metrics: Determining Turnover Costs 169
Detailing Turnover Cost 169
Optimal Turnover 170
Retention of Human Resources 170
Myths and Realities about Retention 170
Drivers of Retention 171
Organizational Career Opportunities 173
Rewards and Retention 174
Retention and Selection 176
Work–Life Balance 176
Healthcare Reform and HR Practices 177
Employee Relationships with Supervisors
and Coworkers 178
Retention Management Process 179
Conducting Exit Interviews 181
Retention Interventions 182
Evaluation and Follow-Up 182
Case 183
End notes 183

C ha pter 8 Training and Development in Healthcare

Organizations 186
Healthcare HR Insights 187
Nature of Training in Healthcare Organizations 188
Legal Issues and Training 188
Integration of Job Performance, Training,
and Learning 189
Healthcare Reform and HR Practices 190
Training as Performance Consulting 191
Organizational Strategy and Training 192
Strategic Training 192
The Training Process 193
Assessment of Training Needs 193

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 Contents xi

Training Design 194

Learner Characteristics 195
Instructional Strategies 197
Training Transfer 198
Types of Training 199
Orientation/Onboarding: Training for New Employees 199
Encourage Self-Development 200
Ongoing Training and Development 201
Delivery of Training 201
Internal Training 202
External Training 203
E-learning: Online Training 204
Evaluation of Training 205
Joint Commission Standards and Orientation, Training, and
Development 207
Developing Human Resources 208
Possible Development Focuses 208
Development Needs Analyses 209
Succession Planning 210
Benefits of Formal Succession Planning 211
Choosing a Development Approach 211
Job-Site Development Approaches 212
Off-Site Development Approaches 213
Management Development 214
Mentoring 215
Special Issues in Healthcare Employee Development 215
Academic and Credential Requirements 216
HR Development and Organizational Restructuring 216
Case 217
End notes 218

Chapter 9 Performance Management in Healthcare

Organizations 220
Healthcare HR Insights 221
Performance Management 221
Job Criteria 223
Performance Standards 224
Performance-Focused Organizational Cultures 224
Performance Appraisal 225
Joint Commission Standards and
Performance Appraisal 226
Conflicting Roles of Performance Appraisals 226
Decisions about the Performance Appraisal Process 228
Legal Concerns and Performance Appraisals 230
Who Conducts Appraisals? 230
Supervisory Rating of Subordinates 230
Employee Rating of Managers 231

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 xii Contents

Team/Peer Rating 231

Self-Rating 232
Outsider Rating 232
Multisource/360-Degree Rating 233
Healthcare Reform and HR Practices 234
Tools for Appraising Performance 234
Category-Scaling Methods 234
Comparative Methods 236
Narrative Methods 237
Combinations of Methods 239
Rater Errors 239
Recency 239
Central Tendency, Leniency, and Strictness Errors 239
Rater Bias 240
Halo Effect 240
Contrast Errors 241
Appraisal Feedback 241
Feedback Systems 241
The Appraisal Interview 242
Reactions of Managers and Employees 242
Effective Performance Management 243
Case 243
End notes 244

C ha pter 1 0 Employee Relations in the Healthcare Industry 246

Healthcare HR Insights 247
Nature of Employer–Employee Relations 248
Rights and Responsibilities 248
Statutory Rights 249
Contractual Rights 249
Implied Contracts 250
Employment Practices Liability Insurance 251
Employee Relations and Rights of Employees 251
Employment-at-Will 251
Wrongful Discharge and the Importance of Documentation 253
Just Cause 254
Due Process 254
Constructive Discharge 255
Work-Related Alternative Dispute Resolution 255
Balancing Employer Security and Employee Rights 258
Employee Records 258
Employees’ Right to Free Speech 259
Technology and Employer–Employee Issues 260
Honesty in the Workplace 262
Off-the-Job Behavior 263
Employer Drug Testing 263
HR Policies, Procedures, and Rules 264
Coordinating Policies and Procedures 264
Communicating HR Information 265

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 Contents xiii

Employee Discipline 266

Nonproductive Reasons for Not Using Discipline 266
Productive Reasons for Not Using Discipline 266
Training Managers 266
Healthcare Reform and HR Practices 267
Employee Relations Programs 270
Employee Assistance Programs 270
Employer of Choice Programs 270
Standards of Behavior 270
Case 271
End notes 272

Chapter 1 1 Labor Relations and Healthcare Organizations 274

Healthcare HR Insights 275
Unions in the Healthcare Industry 276
Why Employees Unionize 276
Why Employers Resist Unions 277
Labor-Relations Philosophy 278
Adversarial Relationships 278
Collaborative Relationships 278
Legal Framework for Union–Management Relations 279
Wagner Act (National Labor Relations Act) 279
Taft-Hartley Act (Labor Management Relations Act) 280
Landrum-Griffin Act (Labor Management Reporting
and Disclosure Act) 281
Civil Service Reform and Postal Reorganization Acts 281
Proposed Employee Free Choice Act 281
NLRA and the Healthcare Industry 282
The Unionization Process in Healthcare 283
Organizing Campaign 284
Authorization Cards 284
Healthcare and Bargaining Units 285
Representation Elections 287
Certification–Decertification 287
Contract Negotiation (Collective Bargaining) 288
Collective Bargaining Issues 288
Classification of Bargaining Issues 289
Collective Bargaining Process 290
Preparation and Initial Demands 290
Continuing Negotiations 290
Settlement and Contract Agreement 291
Bargaining Impasse 292
Planning for Strikes 292
Strikes, Lockouts, and Other Tactics 293
Contract Administration 294
Labor–Management Committees 295
Grievance Management 295
Grievance Responsibilities 295
Grievance Procedures 295

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 xiv Contents

Steps in a Grievance Procedure 296

Healthcare Reform and HR Practices 297
Case 298
End notes 298

C ha pter 1 2 Healthcare Compensation Practices 300

Healthcare HR Insights 301
Compensation Responsibilities in Healthcare
Organizations 301
Components of Compensation 302
Healthcare Compensation Approaches 303
Total Rewards 304
Compensation Philosophies 307
Decisions about Healthcare Compensation Levels 308
Perceptions of Pay Fairness 311
Legal Requirements for Pay Systems 312
Fair Labor Standards Act (FLSA) 312
Independent Contractor Regulations 315
Additional Laws Affecting Compensation 317
Development of a Base Pay System 317
Job Evaluation 317
Job Evaluation Methods 319
Legal Issues and Job Evaluation 319
Market Pricing 320
Wage Surveys 321
Different Pay Structures 322
Pay Ranges 323
Individual Pay 324
Rates Out of Range 324
Pay Compression 324
Issues Involving Pay Increases 325
Pay Adjustment Matrix 325
Seniority 326
Cost-of-Living Adjustments (COLAs) 326
Lump-Sum Increases 326
Healthcare Reform and HR Practices 327
Executive Compensation 327
Executive Salaries 327
Executive Bonus and Incentive Plans 328
Performance Incentives: Long-Term versus
Short-Term 328
Benefits for Executives 328
Executive Perquisites 329
Current Nature of Healthcare Executive
Compensation 329
Determining “Reasonableness” of Executive
Compensation 329
Case 330
End notes 330

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 Contents xv

Chapter 1 3 The Management of Benefits and Variable Pay

in Healthcare 332
Healthcare HR Insights 333
Strategic Perspectives on Benefits 334
Goals for Benefits 334
Benefits Needs Analysis 334
Funding Benefits 335
Tax-Favored Status of Benefits 335
Types of Benefits 336
Government-Mandated Benefits 336
Voluntary Benefits 337
Part-Time Employee Benefits 338
Security Benefits 338
Workers’ Compensation 338
Unemployment Compensation 338
Severance Pay 339
Retirement Security Benefits 339
Retirement Benefits 339
Retirement Plan Concepts 340
Retirement Plans 340
Individual Retirement Options 341
Legal Regulation of Retirement Benefits 343
Employee Retirement Income Security Act 343
Retirement Benefits and Age Discrimination 344
Social Security 344
Healthcare Benefits 345
Affordable Care Act (ACA) Requirements 345
Controlling Healthcare Benefits Costs 347
Increasing Employee Contributions 347
Consumer-Driven Health Plans 348
Healthcare Legislation Impacting Benefits Administration 348
Financial, Insurance, and Other Benefits 349
Financial Benefits 349
Insurance Benefits 349
Educational Benefits 350
Social and Recreational Benefits 350
Family-Oriented Benefits and the Family and Medical Leave
Act 350
Family-Care Benefits 351
Benefits for Domestic Partners and Spousal Equivalents 352
Time Off Benefits 353
Benefits Administration 354
Benefits Communication 354
Flexible Benefits 355
Benefits in the Future 355
Variable Pay: Incentives for Performance 356
Types of Variable Pay 356
Effective Variable Pay Plans 357
Individual Incentives 357
Group/Team-Based Variable Pay 358

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 xvi Contents

Healthcare Reform and HR Practices 360

Organizational Incentives 360
Successes and Failures of Variable Pay Plans 361
Case 361
End notes 362

C ha pter 1 4 Safety, Health, and Security in Healthcare

Organizations 364
Healthcare HR Insights 365
Nature of Safety, Health, and Security 365
Safety, Health, and Security Responsibilities 366
The Joint Commission and Safety, Health, and Security 367
Environment of Care 367
Infection Prevention and Control 367
Emergency Management 368
Legal Requirements for Safety and Health 368
Workers’ Compensation 369
Americans with Disabilities Act and Safety Issues 370
Child Labor Laws 371
Occupational Safety and Health Act 371
OSHA Enforcement Standards 372
Ergonomics and OSHA 374
Work Assignments and OSHA 374
OSHA Record-Keeping Requirements 375
OSHA Inspections 376
Critique of OSHA 378
Safety Management 379
The Organization and Safety 379
Safety and Engineering 379
Individual Considerations and Safety 380
Safety Policies, Discipline, and Record Keeping 381
Safety Training and Communication 381
Employee Safety Motivation and Incentives 382
Effective Safety Committees 382
Inspection, Investigation, and Evaluation 382
Measuring Safety Efforts 383
Healthcare Reform and HR Practices 384
Health 384
Healthcare Workplace Health Issues 385
Health Promotion 388
Security 389
Workplace Violence 390
Security Management 392
Employee Screening and Selection 393
Security Personnel 393
Case 394
End notes 394

Glossary 397
Index 405
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 Preface

Why a Book on Healthcare Human

Resource Management
As the authors of this textbook, we have long recognized the unique aspects of
healthcare human resource management (HRM) and the need for a textbook
specifically focused on this area. Collectively, we have experience in healthcare
HRM as practitioners, consultants, and professors. In this book, we provide
both the HRM student and the practitioner a comprehensive, focused source
of information on this important body of knowledge and specialized field of
practice.

Primary Audiences for This Book

There are several audiences that will find this book to be a useful resource,
including college and university students and faculty members, various HR
practitioners in healthcare organizations, and healthcare professionals and man-
agers in numerous fields where HRM issues affect organizational and individual
performance.

College/University Students
and Faculty Members
The importance of human relations skills and HRM knowledge for application
in the healthcare industry has grown due to the significant recruitment and re-
tention issues that exist for healthcare workers. Graduates of healthcare-related
administration/management degree programs must have a solid knowledge

xvii

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 xviii Preface

base of HRM topics to be successful in their careers. The types of courses that
are well suited for this text include:
• Undergraduate courses in human resource management offered to health-
care administration majors.
• Undergraduate human resource management courses that emphasize the
healthcare industry.
• Graduate-level human resource management courses offered in healthcare
administration programs.
• College curriculums for management tracks for degrees in:

°° Nursing Allied Health °

°° Respiratory Care Public Health °
°° Radiological Technology Health Promotion °
• Distance learning programs containing the courses and related to the degrees
described above.

Healthcare HR Professionals and

Healthcare Management Practitioners
HR management issues will continue to be a major focus for all individuals with
management responsibilities in healthcare organizations. Both the academic
and practical experiences of the authors have contributed to the book’s balance
between the theoretical and the practical aspects of healthcare HR. This balance
makes the textbook not only useful for the academic setting, but equally useful
as a reference for healthcare leaders and professionals with HR responsibilities.
Even highly experienced healthcare HR professionals will find the presentations
of both theory and actual healthcare organizational HR practices insightful and
informative.

Organization of This Book

The textbook includes 14 chapters; each chapter discusses a particular HRM
topic. Each chapter can be used in instruction as a stand-alone presentation, or
in conjunction with the other chapters. Regardless of the approach, this book
provides a comprehensive source of information on both theory and practice in
healthcare HRM.
Chapter 1 discusses the nature and challenges of healthcare HR manage-
ment through an overview of the current and future states of the healthcare
industry. The chapter also describes the various types of organizations that make
up the healthcare industry.
Chapter 2 presents a unique review of the competencies that are important
for healthcare HR professionals. The chapter discusses healthcare organizational

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 Preface xix

structures and the placement of HR departments within the organizational

structure, and HR budgets and staffing. The Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) is also described along with the key qual-
ity standards that impact healthcare HRM.
Chapter 3 describes the importance of strategic HRM. The chapter
discusses the process and relevance of effective HR planning against the
backdrop of the most challenging HRM issues that confront healthcare
organizations.
Chapter 4 discusses the legal issues affecting the healthcare workplace,
with particular focus on equal employment opportunity regulations and issues.
­Chapter 5 reviews the importance of job design and analysis as it affects all
aspects of HRM in healthcare organizations.
Chapter 6 presents a comprehensive discussion on the critical topics for
healthcare organizations of recruitment and selection. The chapter includes a
discussion on strategic recruiting and an overview of various recruitment meth-
ods that are successful in the healthcare industry.
Chapter 7 explores employee retention, presenting many of the acknowl-
edged “best practices” that are achieving retention results in healthcare or-
ganizations. Given both the current state and the anticipated shortage of
healthcare workers, employee retention is one of the most important re-
sponsibilities that healthcare HR professionals and healthcare managers
have.
Chapter 8 provides a comprehensive discussion on training and development
in healthcare organizations. The JCAHO standards dealing with orientation and
training also are highlighted in the chapter, as they relate to the verification and
development of healthcare worker competencies.
Chapter 9 focuses on the topic of performance management. This chapter
includes a review of both the theoretical and practical aspects of establishing
performance criteria and developing and conducting performance appraisals
for healthcare workers.
Chapters 10 and 11 deal with the interrelated healthcare HR management
topics of employee and labor relations. Chapter 10 focuses on a variety of con-
cerns that affect how healthcare organizations manage their workers. Chapter 11
deals specifically with the complexities of managing healthcare workers who are
covered under collective bargaining agreements.
Chapters 12 and 13 present healthcare compensation, benefits, and vari-
able pay practices. Chapter 12 details the various compensation programs and
­processes, including executive pay plans, utilized in healthcare organizations.
Chapter 13 discusses the benefits and variable pay programs that make up the
total compensation provided to healthcare workers.
Chapter 14 describes the safety, health, and security issues in healthcare
organizations and how they affect HRM. The safety, health, and security con-
cerns present in healthcare environments are emphasized as part of health-
care HRM.

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 xx Preface

Textbook Features and Highlights

To enhance the readability and healthcare focus, there are a number of features
in the book, including:

Examples Specific to the Healthcare Focus

The healthcare environment is the focus of each HRM topic covered. “Best prac-
tice” examples appear throughout the text, enriching the discussion of current
theory.

Healthcare HR Insights
Each chapter begins with a “Healthcare HR Insight,” which is an example of
programs, solutions, and/or initiatives undertaken by various healthcare organi-
zations relevant to the topic covered in the chapter. Special attention has been
given by the authors to ensure that healthcare institutions of different types are
represented in the Healthcare HR Insights.

Healthcare Reform and HR Practices

Each chapter includes a feature discussing how the Affordable Care Act and
other healthcare reform initiatives have and will impact healthcare organiza-
tions and HR practices. The Affordable Care Act is the most sweeping legislation
of its nature in decades and has far-reaching implications for HR management.
Each feature presents a commentary on an aspect of healthcare reform and how
it impacts the topic presented in the chapter.

Study Aids
Figures, including illustrations, process maps, charts, and tables, are used
throughout the chapters to assist readers in examining the topics discussed.

Glossary: Key Vocabulary and Concepts

Key vocabulary and concepts are contained in the glossary. For ease of refer-
ence, these terms also appear in bold print in the text to alert readers that a
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