Rationale:
The following assignment was selected from the Human Resources class. It shows some of the skills and
competencies I have learned in demonstrating principles of ethical reasoning and professional practice implicit in
public health decisions to improve the public’s health. For this assignment, we were to work as a group to develop
a new employee orientation on an organization. We were to cover some overall aspects of the organization and
some of the main policies including benefits, size, history, security, discipline, and the ethical decisions that may
be faced at the organization. We chose to right about the facility that I work in and provided many details about its
functions, the different roles employees have, benefits, etc. I wrote about the ethical framework of the
organization. I wrote about a few of the ethical decisions that staff may face every day: medications, treatment,
and transfers. Many people with mental illness are prescribed medications; we believe in choice, but sometimes
and person is violent and too ill and refuses to take them. We may have to go through a process that forces
medications which may be difficult for people to understand. Some staff may find it difficult to treat some of the
patients that we treat; they are forensic patients, meaning they have committed some type of crime, some of them
are very bad, and some staff may feel these people do not deserve to be treated. Doing therapy with that person
every day may be very difficult for the staff member, but it is a struggle that they have to accept because we
believe in helping all individuals. There is the opposite dilemma for some staff. We can be slow to transfer
someone out of the facility into a less-restrictive setting because we have to take not only the patient’s progress
into account but what their crime was and whether we believe no one else will get hurt. We have to weigh the risk
to society with the patient’s rights. This fits with this competency because I was able to show the ability to
demonstrate ethical reasoning in making health decisions in an organization and how those decisions could
contribute to improving health.
Fulton State Hospital
A forensic psychiatric hospital
Objectives
❖ Learn about Fulton State Hospital (FSH)
❖ Identify a few of the legal and ethical frameworks
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Review a vacant Case Manager job description
Identify training and development needs
Review some of the New Hire Orientation training
Understand Performance Management in the
organization
❖ Identify current trends in healthcare and HR at FSH
Overview
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FSH is a long-term forensic psychiatric hospital
Public, government funded, not-for-profit hospital
Census is about 340 with a capacity of 376
85% male patient population
55% white; 42% African American; 2% Hispanic; 1%
Asian
❖ Average Length of Stay is 4.5 years
❖ 1200 employees including approximately 900 in directcare roles
Overview
❖ Maximum, intermediate, and minimum security
settings
❖ Seriously mentally ill with diagnoses of schizophrenia,
bipolar disorder, borderline personality disorder,
intellectual disabilities, autism, impulse disorder, etc
❖ Nationally known evidence-based programming
➢ Social Learning Program
➢ New Outlook Program
➢ Competency Restoration Program
Legal Concerns at FSH
❖ FSH is an equal opportunity employer
➢ Diversity leads to a stronger, more innovative
organization
➢ Employment is based on personal capabilities and
qualifications without discrimination
❖ Several Laws that guide our processes
➢ Civil Rights act of 1964
➢ Equal Pay Act of 1963
➢ Age Discrimination in Employment Act of 1967
➢ Americans with Disabilities Act of 1990
HR Legal Frameworks
Equal Employment Opportunity Commission (EEOC)
❖ Enforcement of the aforementioned laws is the
responsibility of the EEOC.
❖ EEOC holds the greatest influence in enforcing the
laws of any federal agency.
❖ Prosecutes accused employers.
❖ For additional EEOC information and guidance, visit
http://www.eeoc.gov/laws/index.cfm
Ethical Framework
❖ Ethical decision making process
➢ respecting the right to make treatment choices
Daily ethical decisions may include:
❖ Medications
➢ forced
➢ side-effects
➢ quality of life
Ethical Decisions (continued)
❖ Treating a forensic patient
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the patient
the victims
the families
society
❖ Transferring a client
➢ when they do not want to go
➢ when you are worried about the next provider’s care
Positions/Roles at Fulton State Hospital
❖ Psychiatrists
❖ Accountants
❖ Medical physicians
❖ Chief Operating Officer
❖ Psychologists
❖ Administrative Assistants
❖ Nurses
❖ Ward Clerks
❖ Case Managers
❖ Security Officers
❖ Social Workers
❖ Research Analysts
❖ Rehab services
❖ Infection Control Nurse
❖ Environmental Services
❖ Occupational Therapists
❖ Dietary staff
❖ Director of Treatment Services
HR Responsibilities
❖ Interview/Hire
❖ Train employees
❖ Educate employees on HR
processes
❖ Provide recognition to employees
❖ Help the HR dept monitor TJC HR
standards
❖ Review competency forms/audit
HR files
HR Responsibilities
Specific to New Hire
Potential opening for case manager at Fulton
❖ Advertise position/provide job description
❖ Interview/Hire
❖ Train employees
❖ Educate employees on HR processes
(Orientation)
❖ Maintain performance records
Case Manager Responsibilities
❖ Direct supervision of patients to ensure safety and well being of clients
and staff
❖ Participation in individualized care plans for individual clients
❖ Works collaboratively with other treatment staff to ensure clients are
meeting daily and weekly goals
❖ Promoting healthy behaviors of clients
❖ Utilizes evidence based interventions and strategies to promote
health, growth and development
❖ Communicates effectively with fellow staff members and treatment
team
❖ Participate in daily and weekly rounds
❖ Conduct therapeutic milieu activities and groups independently
Case Manager Requirements
Case managers are required to have:
❖ a bachelor’s degree in psychology or related field
❖ at least one year of psychiatric care managing in residential facility
❖ the ability to prioritize information and tasks
Case managers must:
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be a legal resident of the United States
have valid drivers license
be CPR and first aid certified
be proficient in Microsoft Office
Preferred requirements:
❖ Bi-lingual in Spanish
Training Needs and Development
PLAN STRATEGY
DATA COLLECTION
DATA ANALYSIS
IMPLEMENTATION
EVALUATION,
REVIEW,
Training Needs and Development
❖ Cultural Competency
➢ Understanding religious and cultural beliefs of
patients
➢ Strengthening the ability to work with employees
of all backgrounds
❖ Employee Development
➢ Leadership Training
➢ CEUs
New Hire Orientation
❖Mission, Vision and Values
❖History of Fulton State Hospital
❖Benefits
❖Computer Access, Security and Internet Use
❖HIPAA, Incident Reporting and Grievances
❖EEO and Diversity
❖Disciplinary Process
❖Staff recognition
Mission, Vision and Values
❖ Mental illness affects many people and their families
❖ Every individual is worth helping
❖ Everyone should be given hope that they can excel in
life
❖ We partner with the individual, the families, and the
community
❖ Recovery is the ultimate goal
Our prime purpose in this life is to help others. And if you can't help them, at least don't hurt them.
~Dalai Lama
History of Fulton
❖ Opened in 1851
❖ At one time housed over 5000 patients, census is
currently 340
❖ Treating seriously mentally ill people
❖ Nationally known evidence-based programming for our
patients
❖ SMART program—crisis management program
developed by our staff
Benefits
❖ Work hours vary by department/hospital
needs.
❖ Probationary period lasts 6 months, but can be
extended
❖ 12 holidays per year (comp-time is earned if
working)
❖ Employees earn 10 hours of vacation and sick
time every month
Benefits Continued
❖ 3 types of health insurance options
➢ HMO with smaller monthly premium but higher
deductible ($600)
➢ HMO with higher monthly premium but higher
deductible ($300)
➢ High-Deductible Health Plan (very small monthly
premium, but large deductible ($1500)
❖ Flexible Spending Account
❖ Dental and Eye insurance at an additional cost
❖ Life insurance
Computer Access, Security and
Internet Use
❖ Computer Access
➢ Everyone needs at least email access, this is an important
tool in the communication process at the facility
❖ Security
➢ This is a highly secured environment
➢ Contraband and weapons take many different forms
❖ Internet use
➢ Employees have access to the internet (email doesn’t work
without it)
➢ Internet use must be business related
HIPAA, Incident Reporting and
Grievances
❖ Health Insurance Portability and Accountability Act
➢ Privacy is very important to our patients and their families
❖ Incident Reporting
➢ Incident reporting allows the facility to collect data on
safety and security in the hospital.
❖ Grievances
➢ Grievances are about employees (if you think a supervisor
is treating you unfairly, another employee is rude or
harassing you, or complaints about work conditions)
Disciplinary Process
❖ Written Reprimand is the first step in the
disciplinary process
❖ Unacceptable Conduct Notice is the second
step
❖ Suspension is the third step
❖ Dismissal is the final step
❖ Union and arbitration rights
Security
❖ This is a highly secure environment
❖ Contraband comes in many different forms.
Here are a few examples:
➢ Compact mirrors
➢ Some combs
➢ Certain pens and notebooks
➢ And most importantly, cell phones!
❖ Weapons take many different forms, vigilance
Staff Recognition
❖ Employee of the month (small monetary reward and
parking space)
❖ Employee of the year (monetary reward)
❖ Department and discipline recognition (shirts, cups,
pens, celebrations)
❖ Years of Service Awards
❖ “Seen Doing Good” Awards
❖ Recognition Hotline
Performance Management
A systematic process by which an
agency involves its employees,
as individuals and members of a
group, in improving
organizational effectiveness in
the accomplishment of agency
mission and goals.
Job Performance Data
Data collected from employee performance is typically
used for:
❖ administrative decisions (e.g. promotions, raises)
❖ developmental purposes
❖ to help an employee recognize strength and weaknesses
Never mistake activity with
accomplishment. ~ John Wooden
Employee Performance Plan
A performance plan is created with 1 to 3 elements
defined by federal regulations.
Critical Element
❖ required in a performance plan
❖ a duty of great importance that directly affects performance
rating and summary level
❖ a responsibility which the employee is expected to have
control over
Employee Performance Plan
Non-Critical Element
❖ optional
❖ a dimension of
performance that is
important but not of such
importance that one
would fail if the standard
is not met
❖ it is used to give a
summary level
Additional Performance Element
❖ optional
❖ a dimension of performance
that’s important but doesn’t
affect the summary level
Fulton State Hospital
Case Manager Appraisals
Multisource appraisal
approach:
❖ supervisor
❖ peers
❖ subordinates
❖ patients
❖ patients’ families
Appraised on:
❖ job responsibilities
❖ leadership
❖ teamwork
❖ duties as assigned
❖ behavioral observations
Trends Affecting Healthcare HR
(as a
whole)
PassageP
❖ Passage of the Patient Protection and
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Affordable Care Act (“Obamacare”)
Competition for positions and/or employees
Economic uncertainty
Becoming more goal and results oriented;
playing role in organizational strategic planning
Utilization of software as a service
Changes in recruitment processes
Trends Affecting HR at Fulton
❖ Implementation of PPACA and expanded
Medicaid coverage
❖ Increased training and planning
❖ Staff recruitment and retention
❖ Technology advances
❖ Economic uncertainty
References
Appone. (2013). Audit Inpatient Mental Health Worker/Case Manager. Retrieved from
https://www.appone.com/maininforeq.asp?Ad=171995&R_ID=758092&Refer=http://www.indeed.com/q-InpatientMental-Health-Counselor-jobs.html&B_ID=44
Brown, J. (n.d.). Employee orientation: keeping new employees on board! Retrieved from http://ipmahr.org/sites/default/files/pdf/hrcenter/Employee%20Orientation/cpr_eo_Overview.pdf.
Fried, B. J. & Fottler, M. D. (2011). Fundamentals of Human Resources in Healthcare. Chicago, IL: Health
Administration Press
Industry Resource Articles (n.d.). HR Trends in Health Care Companies. Retrieved from
http://www.unicornhro.com/articles/hr-trends-in-health-care-companies
Missouri Department of Mental Health (DMH) (2014). Fulton State Hospital. Retrieved from http://dmh.mo.gov/fulton/
Office of Personnel Management. (n.d.). Performance Management Overview and History. Retrieved from
http://www.opm.gov/policy-data-oversight/performance-management/faqs/?cid=d45e4c00-8815-4d80-8a16-
References
Office of Minority Health. (2013). What is cultural competency? Retrieved from
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11
Parker, F. (2007) Ethics Column: "The Power of One" OJIN: Online Journal of Issues in Nursing. Vol. 13, No. 1.
Retrieved from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/Power.
html
World Health Organization. (n.d.). Mental Health Policy and Service Guidance Package: Human Resources and
Training in Mental Health. Retrieved from http://www.who.int/mental_health/policy/Training_in_Mental_Health.pdf