Finance, Culture, &
Labor
Seminar 7
Seminar Seven
The Legal and Financial Environment
Introduction
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Law—“rules of the game”
Finance—“keeping score”
Fundamental elements of HR environment
By what authority do you act?
Purpose: when to contact an attorney
Legal Environment
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• Employment-at-will
– Termination without cause
– Employer and employee
– Varies by state
– Anti-discrimination statutes
– Unless there is an implied contract
Legal Environment
• Exceptions to employment-at-will
1. Implied contract
2. Public policy exception
3. Fair dealing and good faith
• Implied contract
– Personnel manual/employee handbook
– With disclaimer—not a contract
– Medical staff bylaws—not a contract
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Legal Environment
• Public policy exception
– Activity protected by specific state law
• Reporting abuse in a nursing home
• Not trying to improve patient care or quality
– Minority endorses a broader scope
– “Whistleblower statute”
Legal Environment
• Fair dealing and good faith
– Implied duty
– Crenshaw v. Bozeman Deaconess Hospital
– Failing to investigate charges before termination
– Not extended to physicians
Legal Environment
• Fair Labor Standards Act (1938)
– Great Depression
– Minimum wages
– Time-and-a-half guaranteed overtime
– Prohibition of employing minors
– Nonprofit and for-profit hospital employees
– Salaried employees exempt
Legal Environment
• National Labor Relations Act of 1935
– Defines unfair labor practices
– National Labor Relations Board (NLRB)
– Hearings for complaints of unfair labor practices
– Taft-Hartley amendments of 1947
– Labor-Management Reporting and Disclosure Act
Legal Environment
• NLRA provisions unique to health care
– Sufficient advanced notice of strike
– Recognizes eight possible bargaining units
– Limit solicitation and distribution of union materials
The Way Things are Done
Around Here
Management of Culture
Culture
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Quality of employees is important
Culture determines treatment of employees
New interest in value of culture
Influences individual and organizational
performance
• Goal—improve performance
Leadership
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Develop consistent standards
Implement positive change
Requires new skill sets
“Creating a Learning Culture for Quality and
Leadership”
Culture
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Mystical, magical, invisible power
Very real phenomenon
Must be understood, considered, and managed
Culture can control an organization
Innumerable definitions
Culture
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• Schein’s Three-Level Model
1. Artifacts
2. Beliefs and Values
3. Basic Underlying Assumptions
Cultural Artifacts
• Most visible and objective aspect
• In an organization’s physical, social, and emotional
environment
• Examples: dress, facility layout and decor, furnishings,
written documents, spoken words
• Highly visible manifestation of culture
• Easy to examine and describe
Cultural Artifacts
• Categories
– Symbols
– Language
– Ceremonies and rituals
– Stories, myths, and legends
– Heroes and heroines
Beliefs and Values
• Offer insights into how individuals explicitly
interpret, account for, and uphold their actions
as organizational members
• Values: conscious outcomes
– Mission, vision
• Beliefs: conscious understanding of what is
believed to be real and true in an organization
Basic Underlying Assumptions
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Unstated and unrecognized
Strongly regulate behavior
“Out-of-conscious” beliefs and values
“Way we do things around here”
Example: honor and respect elderly
Most difficult dimension to grasp
Cultural Strength
• Strong cultures
– Dominant and unified
– Clear sense of direction
– Helps achieve valued outcomes
– Greater commitment, cooperation, loyalty
– Necessary for the establishment of high quality levels
– Improve decision making
Cultural Strength
• Weak cultures
– Lack consensus and commitment
– Cultures in disarray
– Splinter groups
– Animosity, conflict, divisiveness
– Self-interested decision making
– Less gratifying work experience
CHAPTER 15
Labor Relations
Employee Relations Philosophy
and Strategy
• Part of overall policy development
• Geographic, demographic, and historical factors
• Developed on basis of objectives
– Communication with employees
– Management rights
– Union preferences
• Formal vs. informal nonunion policy
Nonunion Status
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Unions preventable by management actions
Positive employee-relations climate
Workers seek union assistance
Workers vote against management, not for a
union
• Union avoidance is winning
Labor Law History and Trends
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National Labor Relations Act (Wagner Act)
Taft-Hartley Act
Landrum-Griffin Act
1974 Amendment
– Labor laws included health care organizations
• Difficult for managers to stay nonunion
Labor-Management Problems
• Fundamental differences between goals and
objectives
• Management rights
• Efficiency vs. human value
• Organized labor shifts locus of control
• Cost constraints on management
Why Do Employees Join Unions?
• Three main issues
1. Wages
2. Dissatisfaction with work benefits
3. Perceptions about the organization
• Increased unions in health care
Why Do Employees Join Unions?
• Hospital administrator errors
• Acceptance of the notion that low wages and
poor fringe benefits cause dissatisfaction
• Assumption that interviewing of supervisors is a
true barometer of employee feelings
• Ignorance of what is troubling the employees
– Not listening to the employees’ understanding
– Not allowing communication to flow
What the Union Organizer Looks For
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Usually invited by workers
Employee loyalty by work shift
Female-male employee ratio
Work environment and job safety
Wage rates
Incentive pay
What the Union Organizer Looks For
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Overtime practices
Seniority
Job security
Promotion policy
Fringe benefits
Discipline and grievance procedures
Multiunit systems
Proactive Management Program
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Many types of management responses
Practical
Suited to the situation
Improving in an honest and fair manner
Unique strategy around employee-related
issues
Story Time-Discipline
• What do you is the best way to
discipline employees?
Story Time-Morale
• What do you think the manager
should use as the best startegy
to combat bad morale in the
workplace?
Story time-Fallible
• If we like people better when
they make mistakes why do so
many people feel that they have
to be perfect?
The Propinquity Effect
• The more we meet and interact with
people, the more likely we are to become
friends with them.
• As we meet people we become familiar
and find things we like about them.
• It is not so much 'birds of a feather flock
together' as 'birds who just happen to be
near each other grow similar feathers'.
Realistic Conflict Theory
• When there is limited resources,
then this leads to conflict, prejudice
and discrimination between groups
who seek that common resource.
Once hostility has been aroused, it is
very difficult to return to normal
relations and an ongoing feud can
arise.
Relative Deprivation Theory
• We tend to decide how well-off or deprived
we are not from any absolute standard or
how hungry are, but by comparing
ourselves with other people.
• In particular, we decide on what we
deserve and what we should expect from
looking at other people. We then compare
ourselves with this standard. Even rich
people can feel poor as the even richer
parade in front of them.
Scapegoat Theory
• When problems occur, people do not like to blame
themselves. They will thus actively seek
scapegoats onto whom we can displace our
aggression. These may be out-group individuals or
even entire groups. Like bullies, we will often pick
on powerless people who cannot easily resist.
• Scapegoating increases when people are frustrated
and seeking an outlet for their anger.
• Once cast as a scapegoat it can be difficult to
shake off the classification.
Goal Setting Theory
• Locke's research showed that there was a
relationship between how difficult and specific a
goal was and people's performance of a task. He
found that specific and difficult goals led to better
task performance than vague or easy goals.
• Telling someone to "Try hard" or "Do your best" is
less effective than "Try to get more than 80%
correct" or "Concentrate on beating your best
time."
Five Principles of Goal
Setting
• To motivate, goals must take into
consideration the degree to which each of
the following exists:
• Clarity.
• Challenge.
• Commitment.
• Feedback.
• Task complexity.
Pickle Jar Theory
• "Pickle Jar Theory" uses the analogy
of an empty pickle jar to think about
how we use the fixed amount of time
available to us each day. If we think
of it as we plan our schedule, we can
get important work done while still
leaving time for the small things that
make life fun.
Golf Balls
• Firstly, forget about time management
altogether, and just imagine that you have
a huge empty pickle jar (think of the
largest pickles you have ever seen). Now,
imagine filling the jar with golf balls. And,
when you get it to the point you think it
can hold no more, try adding another golf
ball or two.
Marbles
• Even though it seems full, you're not done
yet. You're going to now squeeze in a
handful of marbles. Give your pickle jar a
shake and as the golf balls and marbles
start to settle and create more room, add
in a bit of sand. Now, fill your pickle jar to
the tip-top by adding back in some of the
pickle juice.
Story Time-Pickle Jar
• If you had all the time in the
world how would you fill your
pickle jar.
Treasure Mapping
• When you want to achieve something
really badly, have you ever tried closing
your eyes and imagining yourself "there"?
You touch it, feel it and see it clearly. You
scan every detail in your mind's eye.
• This is a powerful and important technique
for motivating yourself and building the
self-confidence needed to achieve your
goals. Yet when you open your eyes, the
vivid image start fades: it takes real
concentration to visualize again each time
you want some inspiration.
Visualize It!
• What if you could keep hold of that vivid
image and refer to it when ever you need a
little motivation or reminder of what you
are working towards?
• Treasure mapping is a simple tool to help
you do just that. Visualization itself is a
very powerful technique. And treasure
mapping can be the icing on the
visualization cake!
Appreciative Intelligence
• To see things in the seed, that is genius", said Laotzu, Chinese philosopher. This is what we now refer
to as Appreciative Intelligence, a term coined by
Tojo Thatchenkery to describe the capacity by
certain individuals to see the positive inherent
potential of situations or people - it is the ability to
see a breakthrough product, top talent, or valuable
solution of the future that is not readily visible in
the present situation. In short, it is the ability to
see the mighty oak in the acorn.
Tactical Approaches
• Short-term actions to achieve a
plan
• Involves peers
• Scratch my back; I’ll scratch yours
• Reciprocity
• Involves subordinates
• Brainstorming
• Timing is critical
Tactical Options
• Strike While the Iron is Hot
• Prompt action when the situation and
time for action are favorable
• Wait and See
• The situation may resolve itself over
time
• Concentrated Mass Offensive
• Quickly pulling together resources and
taking radical action all at once to get
immediate results
Utilization of Resources
• Management is responsible for
managing three categories of
resources (3Ms):
• Materials (supplies)
• Machinery (equipment)
• Manpower (labor)
Machinery/Equipment
• Manager’s responsibility:
• To maintain the equipment for
which he/she is responsible
• To determine when equipment
should be updated
• To determine when equipment
should be replaced
Replacing Equipment
• Evaluate options by consulting
others, reading professional
journals/literature, viewing
demos
• Assess how equipment will
affect patient care, utilization,
cost of doing business,
community service, customer
satisfaction
Capital Requests
• A standardized approach to
requesting new equipment or
projects that help the
organization achieve its
strategic plan
• Requests are evaluated by the
capital expenditures committee
and prioritized according to the
need and the benefits the
Safe Environment
• Managers are responsible for
ensuring a safe environment for
patients, employees, and
visitors
• JCAHO and Institute of
Medicine Initiatives
• National Patient Safety Goals
• Expanding the use of electronic
health records
Story time-Safety
• If you discovered that the
supervisors in the place you
work knew the work place was
unsafe what would you do?
Departmental Measures
for Safety
• Educating staff on safety
practices
• Orienting to fire and ergonomic
safety
• Replacing defective equipment
• Performing routine maintenance
• Educating staff on MSDS
precautions
• Guarding against workplace
Space Planning
• Effective space planning can
contribute to safe environments
• Managers must plan for best
utilization of space
• Space is costly
• Space is limited
• There are other demands on the
same space
• Assess whether work can occur
Control of Supplies and
Materials
• Manager should plan for the
appropriate use, security, and
conservation of materials used
in the department
• Control those items that may be
targets for theft (pocket loss)
• Monitor equipment whereabouts
and supplies
• RFID
• Bar codes
Workforce Planning
• Recruiting employees
• Enhancing employee satisfaction
• Tapping sources of qualified
employees
• Providing adequate training
• Appraising employee performance
• Retaining employees
• Compensating employees equitably
and competitively
• Promoting employees
Plans
• Plans are necessary to implement
the organization’s goals
• Types of plans:
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Policies
Procedures
Methods
Rules
Programs
Projects
Budgets
Plans
• Support each other
• Must be consistent and
integrated
• Ensure consistency in
application of plans
• Two groups
• Repeat use
• Single use
Story Time-Plans
• You start working at a new job and
notice that they do not have plans
for what to do in various situations
that can happen.
• How would convince the employees
that they need plans and procedures
for the office?
Repeat-Use Plans
• Applicable whenever a problem
situation presents itself often
• Include:
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Policies
Procedures
Rules
Methods
Repeat-Use Plans:
Policies
• Policies: Provide managers
with general guidelines; reflect
constraints, help coordinate
activities, and are established
by the executives of the
organization
• When a policy does not exist
and guidance is needed, an
“appealed policy” may need to
be created.
Repeat-Use Plans:
Policies
• Should be clearly written
• Provide for flexibility
• “whenever possible”
• “under usual circumstances”
• Serve as guides to thinking
• Management may be reluctant
to change them
• Should be periodically reviewed
Repeat-Use Plans:
Procedures
• Derived from policies
• Much more specific than
policies
• Serve as guides to action
• Step by step (chronological order
for acts to be performed)
• Often created by
managers/supervisors
• Written at different learning
Repeat-Use Plans:
Procedures
• Creating Procedures
• Analyze the work to be done
• Involve the employee doing the job
in the procedure preparation
• Help ensure consistent
performance
Repeat-Use Plans:
Methods
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A standing plan for action
More detailed than a procedure
Methods = practices
Are concerned only with a
single operation or with one
particular step
• Manager’s role is to determine
the best method
Using Work
Simplification to Find
Best Methods
• Methods improvement
• An organized approach to determine how
to accomplish a task with less effort, time,
or cost.
• Foundation in work by the Gilbreths (see
Chapter 2)
• Process charts
• Should encourage employee involvement
Repeat-Use Plans:
Rules
• Most explicit standing plan
• Is a statement that either
forbids or requires a certain
action or inaction without
variation
• Leaves no discretion in action
to take
• Related to procedures in that
they are guides to action
Repeat-Use Plans:
Organizational Manual
• A comprehensive collection of
decisions, other repeat-use
plans, organization charts, and
job descriptions
• A tool for orienting new staff
• Explains complex relationships
• Defines the organization’s
objectives and goals
• Needs to kept current
Single-Use Plans
• Used for non-recurring
situations
• Include:
• Programs
• Projects
• Budgets
Single Use Plans:
Programs and Projects
• Program:
• A complex set of activities to
achieve an objective
• Has its own set of policies,
procedures, and budget
• Project:
• Smaller in scope than a program
• Requires coordination of other
projects
Single-Use Plans:
Programs and Projects
• Coordinating a complex project
• Gantt Chart
• Developed by Henry Gantt
• Bar chart that shows planned and
actual activities
• Control device
• PERT tool (Program Evaluation
Review Technique)
• Used by the military in the 1950s
• Critical path method (CPM) is a similar
tool used by civilians
Story Time-Explain
• If you were in charge of
explaining the plans and
procedures of the office to the
employees how would avoid
boring they silly?
PERT
• Graphic display
• Shows links between dependent
tasks
Single-Use Plans:
Budgets
• Plans that express the
anticipated activities and
results in numerical terms
• Instruments for controlling
• Supervisors should be involved
in preparing the budget
• Thoroughly cover all critical needs
• Creates buy-in in controlling the
use of financial resources
Good Night!
• Thank you for attending the
seminar tonight!