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Second Bruce J. Fried and
Edition Myron D. Fottler, Editors
Fundamentals of
Human Resources
in Healthcare
DETAILED CONTENTS
Preface...............................................................................................................xiii
Acknowledgments.................................................................................................xix
vii
Summary........................................................................................................ 230
For Discussion................................................................................................ 230
Experiential Exercises...................................................................................... 230
Glossary.................................................................................................................. 337
References.............................................................................................................. 355
Index........................................................................................................................ 397
About the Editors................................................................................................ 415
About the Contributors...................................................................................... 417
H
ealthcare is undergoing major changes as a result of a multitude of factors, includ-
ing rapidly changing technology, cost pressures and value-based payment models,
unprecedented consumer access to information, globalization and global changes,
changing demographics, and new levels and forms of competition among healthcare orga-
nizations. Change is a staple of the healthcare system: A Google search for “health care
change” generates about 602,000,000 results.
Human resources—that is, people—represent the bedrock of US healthcare organiza-
tions. As of this writing, the healthcare industry employs one in nine Americans, up from
one in 12 in 2000. In fact, since 2007, about 35 percent of job growth has come from the
healthcare sector (Terhune 2017). Even with these astronomical numbers, it is clear that
we will face severe staffing shortages with the confluence of the aging of the population and
of the healthcare workforce. Many communities are experiencing shortages among a wide
range of healthcare workers, and there are widespread disparities in the geographic distribu-
tion of the healthcare workforce. More than ever, data on the healthcare workforce clearly
indicate that healthcare workers are a scarce resource that we should nurture, develop, and
treat with the utmost care. Yet if we speak with a random group of workers in the healthcare
workforce, it is doubtful that we would find the sentiment reflected that they are in fact
treated with the respect and care required of a scarce resource. It’s not that we don’t know
how to manage healthcare workers; rather, it is a question of how well healthcare managers
understand the fundamental principles of effective human resources management.
Anybody who has worked in any type of organization—whether a hospital, a sports
team, or an educational institution—knows that planning is the easy part. A soccer team,
xiii
for example, prepares to meet its opposition by understanding its own strengths and weak-
nesses and those of the opposition. However, putting this plan into practice—implementa-
tion—is fraught with all kinds of obstacles. These obstacles are no less intense in healthcare
organizations. The difference is that when implementation fails in a sports team, a team
loses and fans are depressed for a day or two. In a healthcare organization, patients may
die, employees may be injured, and the organization’s survival can be put at risk.
This book is about putting plans into practice. Specifically, we address what is indis-
putably the most important part of implementation: the workforce. All too often, managers
become so enraptured and self-satisfied with their plans that they ignore the people who
are responsible for putting plans into practice. If we value employees who are patient ori-
ented and empathetic, are we considering these qualities when we hire people? If we want
to retain our employees (and not have them leave if they are offered an additional dollar
per hour by another organization), do we know the factors that are related to employee
turnover and retention? If we want our managers to help employees improve, do we train
our managers in how to conduct performance reviews and coach employees toward success?
The challenges encountered in motivating and managing the workforce are not
lost on entrepreneurs, consultants, and “pop business” writers (if you are in doubt, visit
an airport’s bookstore or Google “managing people”). What we frequently find are books
that are billed as the latest solution to workforce challenges; all too often, they are put
forward as commonsense cure-alls. Business books that present the topic as complex don’t
sell; simplicity sells.
The fact is, managing the workforce is complex—and uncertain. There is no magic
single solution. If there were, we would not have a flourishing market for management
cure-alls. This book is in many ways a back-to-basics approach. Managers frequently rely
on common sense in managing people, but common sense is not always correct, and situ-
ations do not present themselves neatly tailored to our theories and expectations.
This book sets forth fundamental concepts that will help healthcare managers do the
most important and most difficult part of their job: managing the people. Having a strong
knowledge base in what works is fundamental to good management, and that is what we
offer in this book. We acknowledge the complexity of managing people. We do not offer
panaceas and simple solutions: That would be a recipe for failure. What we do offer in this
book is information, best practices, ways to analyze workforce problems, evidence about what
works and under what circumstances, and tangible evidence-based strategies for successfully
working with employees so that our carefully laid-out plans are effectively implemented.
This book is intended for current and aspiring managers, and not solely for people
employed in human resources departments in organizations. Our philosophy is that every-
one is a human resource manager, whether one is a supervisor or an employee who must
manage relationships with coworkers and with one or more bosses. We are all human
resource managers.
C h a p t er O v e r v ie w s
Workforce management requires an understanding of multiple disciplines and functions,
such as employee motivation, compensation, and training strategies. A successful manager
will understand the multitude of disciplines required for managing the workforce. However,
the manager must also be able to synthesize these areas of knowledge and recognize that
organizations are systems, and as in all systems, changes in one part of an organization
affect other parts of the organization. For example, if we change the way we pay employees,
how will it affect employee motivation, productivity, and turnover? Although this book
is divided in a disciplinary manner for ease of presentation, it should be understood that
effective managers will master these areas and also develop the ability to view management
and organizations systemically.
Chapter 1, by Myron Fottler, introduces the concept of strategic human resources
management. For many years, human resources management has had an often well-deserved
reputation for playing a passive role in organizations. In contrast to such functions as mar-
keting and research and development, which were seen as contributing to organizational
growth and performance, the personnel department did not appear to support the organi-
zation but instead appeared at times to keep it from flourishing. Rather than finding ways
to promote progress in the organization, the personnel department was often perceived as
standing in the way of innovation and change.
In this first chapter, Fottler sets the stage for this entire volume. His approach
stresses the need to ensure that the way in which we manage people supports the organiza-
tion’s mission, strategies, and goals. He sets out a vision for human resources in which the
responsibility for managing people is not restricted to a particular department but is the
responsibility of everyone in the organization. The remainder of this book expands on this
simple framework: aligning our human resources management practices with the interests
of the organization.
Chapter 2, by Kenneth White, Dolores Clement, and Marisa Roczen, provides the
reader with an understanding of the variety of professionals working in healthcare organiza-
tions. Highlighting the major health professionals, the authors describe the unique char-
acteristics of these professions, paying particular attention to their functions in healthcare,
educational requirements, licensure, changing roles, and future prospects for professional
groups. They also address issues such as the impaired physician and other management
challenges.
Like much of healthcare management, effective human resources management
requires an understanding of an enormous body of laws and regulations. Written by Drake
Maynard, chapter 3 provides an overview of laws related to such topics as employee rights,
discipline and privacy, sexual harassment, and discrimination and equal employment
opportunity. A later chapter addresses the specific laws related to unionization and union–
management relations.
In chapter 4, Myron Fottler discusses job analysis and job design, which form an
essential foundation for virtually every other human resources management function. The
content and design of jobs have implications for recruitment, compensation, training,
employee supervision, and other key activities. Effective job analysis provides managers
with an understanding of the purpose and content of jobs, which in turn allows us to
create job descriptions and identify the qualifications for particular jobs. Such goals as
effective recruitment and fair compensation depend on having a clear understanding of
the requirements of a job. Fottler contends that the deliberate structuring of work can lead
to improved individual, group, and organizational performance.
Staffing and keeping competent employees pose an increasing challenge for healthcare
organizations. In chapter 5, Bruce Fried addresses the interrelated topics of recruitment,
selection, and retention. Reasons that employees choose to accept jobs, strategies for suc-
cessful selection of employees, and evidence about why healthcare employees stay with
or leave organizations are the focus of this chapter. We also look at staffing from a global
perspective and address such controversial topics as the global migration of healthcare
workers and the ethics of foreign recruitment of physicians and nurses.
With the rapid changes in healthcare, employees and organizations require continual
renewal. Effective training is a characteristic of all successful organizations, yet many if not
most healthcare organizations pay scant attention to the design and evaluation of training
initiatives. In chapter 6, Myron Fottler provides a framework for designing and evaluat-
ing training and development programs. He explains basic concepts in planning training
initiatives and discusses the uses for particular training formats.
Performance measurement and improvement have become central features of health-
care organizations. In many instances, healthcare organizations are financially rewarded
for excellent performance. However, excellent organizations depend on high-performing
employees. Performance management seeks to improve employee performance by accurately
evaluating employee performance, providing feedback to employees, coaching, designing
strategies for improvement, and evaluating the effectiveness of improvement efforts. In
chapter 7, Bruce Fried offers a variety of approaches for performance management. We
argue that effective performance management often requires a change in the organizational
mind-set because performance evaluation is often viewed as a punitive and judgmental
process, rather than a positive and collaborative experience.
In chapter 8, Brigid Grabert and Bruce Fried discuss the complex topic of compen-
sation in healthcare organizations. Compensation is anything but a routine function. This
chapter addresses the organizational challenge of balancing internal equity and external
competitiveness in compensation policy, the role of labor market conditions in determin-
ing compensation, and the controversial topic of pay-for-performance. As the relationship
between physicians and organizations changes, so does the manner in which physicians are
compensated, and these changes are evolving rapidly.
For the most up-to-date information about this book and its Instructor Resources,
go to ache.org/HAP and browse for the book’s title or author name.
This book’s Instructor Resources are available to instructors who adopt this book
for use in their course. For access information, please e-mail [email protected].
First and foremost, I wish to express heartfelt thanks to my wife, Nancy, for her unrelent
ing patience and support. As a clinical social worker, Nancy knows a great deal about
working with people and dealing effectively with the most difficult situations. She has
taught me more than I care to admit. Through our children—Noah, Shoshana, and
Aaron—I have learned how people cope with the large and small adversities of life while
continuing to grow and develop. They too have been my teachers.
My parents, Pearl and George, have always been and continue to be teachers and
inspiring models of character and empathy.
Bruce Fried
University of North Carolina at
Chapel Hill
I wish to express my extreme appreciation to both Alicia Pigon and Sandra Ruff, who
have worked with me on this and several other projects over the past five years, both
as master’s students and as program alumni. During the preparation of this book, they
assisted me in researching all my chapters while facilitating communications with
various colleagues and Health Administration Press editors. My gratitude also goes to my
wife, Carol (recently deceased), for her support for this and other projects over the years.
Finally, I wish to thank Emeritus Professor Eli Ginzberg (now deceased) at Columbia
University for sparking and supporting my interest in healthcare human resources
management during my years as a graduate student.
Myron D. Fottler
Professor Emeritus
University of Central Florida
xix
This book would not have been possible without our collaborative authors, who worked
hard and creatively to put their expertise into a readable, textbook format. They were
extremely patient with us as we asked for revisions and clarifications. Our authors came
through, and we are grateful for their generosity. Janet Davis, Tulie O’Connor, Jennette
McClain, Andrew Baumann, and Cepheus Edmondson at Health Administration
Press have been supportive and exercised remarkable patience throughout this process.
The authors also acknowledge the excellent, timely, and high-quality editorial services
provided by Lori Meek Schuldt, who did an outstanding job in bringing this book to
completion. She was ably assisted by freelance proofreader Adin Bookbinder.
Lay them for half an hour or more into a pan of strong brine, with
the stalk ends uppermost; this will destroy the small snails and other
insects which cluster in the leaves, and they will fall out and sink to
the bottom. A pound and a half of salt to the gallon of water will
answer for this purpose, and if strained daily it will last for some time.
TO BOIL VEGETABLES GREEN.
After they have been properly prepared and washed, throw them
into plenty of boiling water which has been salted and well skimmed;
and keep them uncovered and boiling fast until they are done, taking
every precaution against their being smoked. Should the water be
very hard, a small half-teaspoonful of carbonate of soda, may be
added with the salt, for every two quarts, and will greatly improve the
colour of the vegetables; but if used in undue proportion it will injure
them; green peas especially will be quickly reduced to a mash if
boiled with too large a quantity.
Water, 1 gallon; salt, 2 oz.; soda, 1/4 oz.; or carbonate of soda, 1
teaspoonful.
POTATOES.
104. We cannot refrain from a few words of remark here on the daily waste of
wholesome food in this country which constitutes one of the most serious
domestic abuses that exist amongst us; and one which it is most painful to
witness while we see at the same time the half-starvation of large masses of
our people. It is an evil which the steady and resolute opposition of the
educated classes would soon greatly check; and which ought not vainly to
appeal to their good sense and good feeling, augmenting, as it must, the
privations of the scantily-fed poor; for the “waste” of one part of the
community cannot fail to increase the “want” of the remainder.
TO BOIL POTATOES.
(As in Ireland.)
Potatoes, to boil well together, should be all of the same sort, and
as nearly equal in size as may be. Wash off the mould, and scrub
them very clean with a hard brush, but neither scoop nor apply a
knife to them in any way, even to clear the eyes.[105] Rinse them
well, and arrange them compactly in a saucepan, so that they may
not lie loose in the water, and that a small quantity may suffice to
cover them. Pour this in cold, and when it boils, throw in about a
large teaspoonful of salt to the quart, and simmer the potatoes until
they are nearly done, but for the last two or three minutes let them
boil rapidly. When they are tender quite through, which may be
known by probing them with a fork, pour all the water from them
immediately, lift the lid of the saucepan to allow the steam to escape,
and place them on a trivet, high over the fire, or by the side of it, until
the moisture has entirely evaporated; then peel, and send them to
table as quickly as possible, either in a hot napkin, or in a dish, of
which the cover is so placed that the steam can pass off. There
should be no delay in serving them after they are once taken from
the fire. Irish families always prefer them served in their skins. Some
kinds will be sufficiently boiled in twenty minutes, others in not less
than three quarters of an hour.
105. “Because,” in the words of our clever Irish correspondent, “the water through
these parts is then admitted into the very heart of the vegetable; and the
latent heat, after cooking, is not sufficient to throw it off; this renders the
potatoes very unwholesome.”
These are never good unless freshly dug. Take them of equal size,
and rub off the skins with a brush or a very coarse cloth, wash them
clean, and put them without salt into boiling, or at least, quite hot
water; boil them softly, and when they are tender enough to serve,
pour off the water entirely, strew some fine salt over them, give them
a shake, and let them stand by the fire in the saucepan for a minute;
then dish and serve them immediately. Some cooks throw in a small
slice of fresh butter, with the salt, and toss them gently in it after it is
dissolved. This is a good mode, but the more usual one is to send
melted butter to table with them, or to pour white sauce over them
when they are very young, and served early in the season.
Very small, 10 to 15 minutes: moderate sized, 15 to 20 minutes.
Obs.—We always, for our own eating, have new potatoes
steamed for ten minutes or longer after the water is poured from
them, and think they are much improved by the process. They
should be thoroughly boiled before this is done.
NEW POTATOES IN BUTTER.
Rub off the skins, wash the potatoes well and wipe them dry; put
them with three ounces of good butter, for a small dish, and with four
ounces or more for a large one, into a well-tinned stewpan or Keep
them well shaken or tossed, that they may be equally done, and
throw in some salt when they begin to stew. This is a good mode of
dressing them when they are very young and watery.
TO BOIL POTATOES.
108. Vegetables and fruit are now so generally forced and brought so early into
our markets, that there is little need of these expedients at present.
CRISPED POTATOES, OR POTATO-RIBBONS. (ENTREMETS.)
(A Plainer Receipt.)
After having washed them, wipe and pare some raw potatoes, cut
them in slices of equal thickness, or into thin shavings, and throw
them into plenty of boiling butter, or very pure clarified dripping. Fry
them of a fine light brown, and very crisp; lift them out with a
skimmer, drain them on a soft warm cloth, dish them very hot, and
sprinkle fine salt over them. This is an admirable way of dressing
potatoes, very common on the Continent, but less so in England
than it deserves to be. Pared in ribbons or shavings of equal width,
as in the receipt above, and served dry and well fried, lightly piled in
a dish, they make a handsome appearance, and are excellent
eating. If sliced they should be something less than a quarter of an
inch thick.
MASHED POTATOES.
Boil them perfectly tender quite through, pour off the water, and
steam them very dry by the directions already given in the receipt of
page 310, peel them quickly, take out every speck, and while they
are still hot, press the potatoes through an earthen cullender, or
bruise them to a smooth mash with a strong wooden fork or spoon,
but never pound them in a mortar, as that will reduce them to a close
heavy paste. Let them be entirely free from lumps, for nothing can be
more indicative of carelessness or want of skill on the part of the
cook, than mashed potatoes sent to table full of these. Melt in a
clean saucepan a slice of good butter with a few spoonsful of milk,
or, better still, of cream; put in the potatoes after having sprinkled
some fine salt upon them, and stir the whole over a gentle fire with a
wooden spoon, until the ingredients are well-mixed, and the whole is
very hot. It may then be served directly; or heaped high in a dish, left
rough on the surface, and browned before the fire; or it may be
pressed into a well buttered mould of handsome form, which has
been strewed with the finest bread-crumbs, and shaken free from the
loose ones, then turned out, and browned in a Dutch or common
oven. More or less liquid will be required to moisten sufficiently
potatoes of various kinds.
Potatoes mashed, 2 lbs.; salt, 1 teaspoonful; butter, 1 to 2 oz.; milk
or cream, 1/4 pint.
Obs.—Mashed potatoes are often moulded with a cup, and then
equally browned: any other shape will answer the purpose as well,
and many are of better appearance.
(Good.)
Boil some good potatoes as dry as possible, or let them be
prepared by Captain Kater’s receipt; mash a pound of them very
smoothly, and mix with them while they are still warm, two ounces of
fresh butter, a teaspoonful of salt, a little nutmeg, the beaten and
strained yolks of four eggs, and last of all the whites thoroughly
whisked. Mould the mixture with a teaspoon and drop it into a small
pan of boiling butter, or of very pure lard, and fry the boulettes for
five minutes over a moderate fire: they should be of a fine pale
brown, and very light. Drain them well and dish them on a hot
napkin.
Potatoes, 1 lb.; butter, 2 oz.; salt, 1 teaspoonful; eggs, 4: 5
minutes.
Obs.—These boulettes are exceeding light and delicate, and make
an excellent dish for the second course; but we think that a few
spoonsful of sweet fresh cream boiled with them until the mixture
becomes dry, would both enrich them and improve their flavour. They
should be dropped into the pan with the teaspoon, as they ought to
be small, and they will swell in the cooking.
POTATO RISSOLES.
(French.)
Mash and season the potatoes with salt, and white pepper or
cayenne, and mix with them plenty of minced parsley, and a small
quantity of green onions, or eschalots; add sufficient yolks of eggs to
bind the mixture together, roll it into small balls, and fry them in
plenty of lard or butter over a moderate fire, or they will be too much
browned before they are done through. Ham, or any other kind of
meat finely minced, may be substituted for the herbs, or added to
them.
POTATOES À LA MAÎTRE D’HÔTEL.
Boil in the usual manner some potatoes of a firm kind, peel, and
let them cool; then cut them equally into quarter-inch slices. Dissolve
in a very clean stewpan or saucepan from two to four ounces of
good butter, stir to it a small dessertspoonful of flour, and shake the
pan over the fire for two or three minutes; add by slow degrees a
small cupful of boiling water, some pepper, salt, and a tablespoonful
of minced parsley; put in the potatoes, and toss them gently over a
clear fire until they are quite hot, and the sauce adheres well to
them: at the instant of serving add a dessertspoonful of strained
lemon-juice. Pale veal gravy may be substituted for the water; and
the potatoes after being thickly sliced, may be quickly cut of the
same size with a small round cutter.
POTATOES À LA CRÈME.
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