ADAPTING TO THE INEVITABLE
When we encounter pressures to adopt practices that are not of our own choosing or when we are expected to change the way we work to conform with outside requirements that seem to make less than complete sense, we can either resist or give in and make the best of what we might well see as a bad situation.
It is no secret that health care organizations continue to face many changes, some dramatic, some traumatic, and a dismaying proportion of them decidedly less than welcome. Among other circumstances, health care organizations are experiencing the following:
* government regulation of the creation or expansion of various services;
* various mandated cost containment efforts;
* increasingly complex and restrictive limits on reimbursement for services;
* continued pressure by organized labor to unionize health care workers;
* increasing numbers of medical malpractice lawsuits, accompanied by rising malpractice insurance rates;
* increasing numbers of employee complaints filed with organizations such as the Equal Employment Opportunity Commission and other advocacy agencies or lodged as lawsuits, including steadily growing numbers of complaints of sexual harassment and age discrimination;
* continuing shortages of employees in certain critical occupations; and
* increasing demands by health care workers for a greater role in determining the conditions of their employment.
Regarding the latter point, conditions of employment, managers and their organizations continue to experience pressure to consider nontraditional work schedules. Although not an area of major impact when compared with reimbursement and regulatory problems, nontraditional work schedules nevertheless present the manager with new choices and new problems. Variations now commonly encountered include the following:
* compressed work weeks, in which employees work, for example, four 10-hour days or three 12-hour days to make up a workweek;
* flextime arrangements, in which certain employees are free to set their own work hours within specified limits; and
* job sharing, in which 2 or more employees provide the services ordinarily provided by a single employee.
The basic 40-hour (or in some instances 37.5-hour or 35-hour) workweek remains the dominant scheduling practice in health care and elsewhere, but the use of nontraditional scheduling approaches has become relatively common. Service organizations such as those in health care have become the most common users of nontraditional scheduling.
Why consider nontraditional scheduling approaches? Sometimes, the change is made to entice needed skills into the workplace during a period of staff shortage. For example, nontraditional schedules have become common in the employment of registered nurses, who remain in short supply in many areas of the country. For example, in many emergency departments and critical-care areas, nurses are working compressed workweeks. Unusual part-time and sharing arrangements designed to accommodate the needs and desires of individuals are also becoming more common.
Whether skill shortages exist, the needs and desires of individuals present another set of pressures, moving some employers toward nontraditional work arrangements. An increasing number of single parents, working mothers, and second wage earners are actively seeking employment arrangements that offer schedule options other than the traditional 40-hour workweek.
The simple concept of job sharing often proves troublesome for some managers. At first, the concept may seem a ready, even desirable, way to fill a particular position that you seem unable to fill for any appreciable time; simply let 2 people who have expressed their wish to do so split the hours and duties so that the job is fully covered and both people get their own special arrangement. Often, however, this simple concept proves anything but simple in its application.
The manager who hastily supports job sharing may soon discover that the whole is not equal to the sum of its parts. Job continuity suffers, communication with others suffers because contacts must now deal with 2 persons instead of 1, and-most important to the manager-the potential for employee problems doubles and the manager's performance evaluation duty doubles. Even total costs can rise; in some organizations, half-time employees receive some of the same benefits as those of full-time employees.
As with other nontraditional approaches, job sharing is sometimes, but not always, the answer to a particular problem. However, whether management likes it or not, job sharing has become a fact of working life in many departments. Also, these departments' managers must adapt to its presence.
Whether with job sharing or another alternative to the standard workweek, a cost containment mandate stemming from reduced reimbursement, or the need to adhere to the conditions of a collective bargaining agreement, the manager finds it necessary to adapt. Waves of the future pick us up and carry us along whether or not we want to go. An unwelcome factor can quickly become a new fact of life. We can only look closely at what is new, determine what we as managers can or cannot control, and focus on the best aspects of what we are given to work with-and do our best to make it work.
This issue of The Health Care Manager (28:1, January-March 2009) offers the following for the reader's consideration:
* "One Method for Financing America's Uninsured" presents one possible scenario for providing birth through old-age health care coverage for the approximately 45 million Americans lacking coverage.
* "Provider Satisfaction With Virtual Specialist Consultations in a Family Medicine Department" describes how virtual consultations have successfully replaced face-to-face specialist visits in a large multispecialty clinic.
* "Core Competencies of the Entrepreneurial Leader in Health Care Organizations" identifies 3 overlapping areas of core competencies-system, organizational, and interpersonal competencies-essential for leaders seeking long-run survival and growth of today's health care organization.
* "Determining Return on Investment for Training Using Simple Regression: A Hypothetical Study for the Healthcare Industry" presents a possible means of evaluating training programs to determine whether specific training programs are financially beneficial.
* "Point-of-Care Technologies: A Case for Resource Integration" presents the results of a case study that addresses the role of point-of-care technologies as enablers of the efficient delivery of quality care.
* "The Balanced Scorecard as a Strategic Management Tool: Its Application in the Regional Public Health System of Campania" describes the use of the "balanced scorecard" approach in addressing the health care system of the of Campania, Italy.
* The Case in Health Care Management, "The First-Class Grouch" asks the reader to consider how to approach the problem presented by a formerly satisfactory public-contact employee who has turned temperamental and abrupt in dealings with physicians, employee, and the public.
* "Building a Baccalaureate Community Nursing Curriculum Using a Participatory Evaluation Approach" describes how the University of North Florida School of Nursing developed a community-based and community-focused curriculum that engaged student, faculty, and community stakeholders.
* "The Experience of Teaching in a Diabetes Program" addresses the problems inherent in preparing and managing diabetic educators in the face of the increasing prevalence of diabetes in the United States.
* "Health Information Privacy: Why Trust Matters" calls for increased awareness of the importance gaining consumers' trust concerning the ways in which their personal health information is accessed and used.
* "The Importance of Encounter Form Design" addresses the negative impact of outdated encounter forms and stresses the need for up-to-date completeness and accuracy for this key component in accurate billing and collection.
* "Resource-Based Relative Value Scale Analysis Between Teaching and Nonteaching Hospitalist Services" presents the results of a study undertaken to explore the use of the resource-based relative-value scale in addressing comparisons of physician productivity.
* "The Manager's Career Development: Attending to Today's Responsibilities While Preparing for Tomorrow" offers suggestions for the working manager to consider in preparing for advancement while remaining fully attentive to current job responsibilities.