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K. Monique Bloomfield Unit 10 Assignment 1- Final Proposal- Healthcare Succession Planning HS 8118 Dr. Chavez June 17, 2011

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Table of Contents Introduction----------------------------------------------------------------------------------Problem Statement------------------------------------------------------------------------Proposal Overview------------------------------------------------------------------------- Recommendations----------------------------------------------------------------Theoretical Support---------------------------------------------------------------4 4 4 6 7 9 10 11 12 13 14 14 17 18 22

Analysis and Evaluation------------------------------------------------------------------- Sociological Analysis--------------------------------------------------------------Socio-Political Analysis-----------------------------------------------------------Implementation Process----------------------------------------------------------Proposed Succession Planning Scheme-------------------------------------Comparative Decision-Making--------------------------------------------------Cost-Benefit Analysis--------------------------------------------------------------Ethical Dilemmas---------------------------------------------------------------------

Conclusion-------------------------------------------------------------------------------------References--------------------------------------------------------------------------------------

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Abstract This course project will introduce a new health policy proposal that the senior policy analyst at the American Society for Healthcare Human Resources Administration (ASHHRA) of the American Hospital Association will be advocating implementation for. This policy will be regulatory in design in that it will be used to influence the actions, behaviors, and decisions of those in leadership roles at mid-size to large healthcare facilities. (Longest, 2010) Additionally, this policy is intended to maintain conditions that permit markets to work well and fairly; it is a regulatory policy that will present rules which will implement market-preserving controls within our seriously depleted U.S. healthcare human resources industry. Succession planning is a strategic management tool that is severely underutilized in the healthcare industry. It must become more commonly used in this industry in order to assist with the issues of low retention, high attrition, and lack of interest in the health care professions, especially the allied health professions. This project component represents the draft of this essential policy proposal.

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Unit 8 Assignment 1- Project Draft- Healthcare Succession Planning Succession planning is one of the most utilized proactive business strategies in all U.S. industries, except healthcare. According to a study conducted by the American College of Healthcare Executives (2004) only 21% of 722 hospitals routinely engaged in leadership-succession planning compared with two out of three for-profit companies in other industries. Due to the catastrophic shortages that are occurring in healthcare professions, especially nursing, succession planning has become more recognized as a needed device for recruiting, retention, mentoring, administration activities, and continuous forecasted succession planning frameworks. Comprehensive and effective succession planning requires human resources to be deeply involved with the strategic initiatives of the healthcare organization. Succession planning is a strategy or plan which ensures that internal, qualified candidates are continuously identified and available to take up leadership positions when vacancies occur. (Bonczek & Woodward, 2006; Schmalzried & Fallon, 2007) Problem statement Succession planning is a strategic management tool that is severely underutilized in the healthcare industry. It must become more commonly used in this industry, for technical as well as managerial positions, in order to assist with the issues of low retention, high attrition, and the lack of interest in the health care professions, especially the allied health professions. This policy will focus on creating an agenda for both technical and managerial succession planning in healthcare. I. Proposal overview

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Succession planning is an essential process that allows knowledge, intellect, and skills to remain in an organization; the human capital is retained in organizations that freely and purposely utilize this tool; it keeps the organization viable in the market. More importantly, this practice sustains the quality of care healthcare consumers are receiving. Most succession plans deal with executive leadership. This is a proposal that extends to lower-level leadership throughout U.S. healthcare organizations as a way of implementing a necessary retention and acquisition of healthcare workers strategy on a national level. This proposal is also about developing talent and building sufficient bench strength; technical succession planning. Without technical, as opposed to just managerial, succession organizations place themselves in a greater capacity for losing the essential knowledge base that is needed in order to develop strategically, technically, continually, and in unison with the changes that occur in the organizational and industrial environment of the times. Essentially, the proverbial knowledge pool has to be maintained and filled. Succession planning can mean, any effort designed to ensure the continued effective performance of an organization, division, department, or work group by making provision for the development, replacement and strategic application of key people over time. (Rothwell, 2000b,p.47 ) Most succession planning within organizations is focused on preparing for the departure of upper-level management, those who are in top positions that give them the authority to make decisions, mobilize resources, and direct others to take action. However, this policy proposal recommends that healthcare organizations focus on more than just the succession of management. This proposal recommends the succession planning of technical positions as well, in order to preserve

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and enhance specialized knowledge, learned from experience, across the horizontal chart of the organization chart. According to Rothwell and Poduch (2004) technical succession planning means, any effort designed to ensure the continued effective performance of an organization, division, department, or work group by making provision for distilling, preserving, maintaining, and communicating the fruits of the organizations institutional memory and unique experiences over time. (p. 407) Consequently, technical succession planning is a form of knowledge management (Smeltzer & Bonello, 2004) the theory of which will bring more light and emphasis to the proposal, in conjunction with the Human Capital and Organizational Development theories, later on. Recommendations This health policy proposal is a declaration for a national mandate that will cause the implementation of structured succession plans in all healthcare organizations which employees 50 or more personnel. The plans must include an emergency plan, standard plan, and anticipatory plan. The emergency plan will be referred to should unforeseen circumstances such as death of a leader occur within the organization. The standard plan will be utilized when leadership takes a different position that is either internal or external to the organization. The anticipatory plan is used when an organization is privy to the retirement date of a healthcare leader. This plan will also be initiated when the evaluation of the internal and external organizational environment deems it necessary to prepare for changes.

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Additionally, it is recommended that the succession planning process begin with the development of preliminary replacement charts (Flynn, Mathis, Jackson, & Langan, 2007). These charts will: 1) ensure that the right individuals with sufficient capabilities and experience to perform the targeted jobs are available at the right time; 2) show the backup players for each position; 3) identify positions without a current qualified backup and; 4) identify who could take over key jobs if someone leaves, retires, dies unexpectedly, or otherwise creates a vacancy. Finally, it is suggested that the organization makes successorship, the process of selecting those interested in and qualified for the possibility of being trained as a successor, open and known throughout the organization. Having the process of training for potentially obtaining advanced positions, shows that the organization encourages self-development of its employees and is will to encourage and provide employees with the resources and encouragement that is often times needed in order for them to pursue self-development as stated in The Receivables Report in 2005 and as is recommended by many other research sources that are too numerous to name in this proposal. However, in referring to any paper written about human capital development succession planning and encouragement of employees are on top of every organizations list that has a vested interest in the subject matter. Theoretical support The expected objectives for this new policy are: to make healthcare organizations more accountable for the level of staffing that they require in order to keep the quality of healthcare provisions optimal.

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to enforce proactivity and forward-thinking to provide the necessary funding for job retention, recruitment, mentoring, administrative duties, and continuous forecasted succession planning frameworks.

to revitalize the healthcare industry and make it more appealing to current-day generations. Another essential and to many organizations, the primary reason for having a

succession plan is for the development of knowledge management. There have been fundamental changes in the structure of organizations which have led to massive increases in productivity. Along with the need to continue production has been the desire of organizations to improve upon and maintain the companys knowledge base. The tenets of Knowledge Management are to (KPMG, 1999): 1. support innovation, the generation of new ideas and the exploitation of the organizations thinking power 2. capture insight and experience to make them available and usable when, where, and by whom required 3. make it easy to find and reuse source of know-ho and expertise, whether they are recorded in a physical form or held in someones mind 4. 5. 6. foster collaboration, knowledge sharing, continual learning and improvement improve the quality of decision making and other intelligent tasks Understand the value and contribution of intellectual assets and increasing their worth, effectiveness and exploitation

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Knowledge management can contribute to organizational goals for reducing process/service development time, employee satisfaction, profitability, cost reduction, waste reduction, consistency, and organizational branding (Smeltzer & Bonello, 2004). According to Davenport, DeLong, and Beers (1998), knowledge management and related strategy concepts are promoted as important and necessary components for organizations to survive and maintain their competitive keenness. It has become necessary for managers and executives to address Knowledge Management (Goodman & Chinowsky, 1997) seeing that is it now seen as a prerequisite for higher productivity and flexibility in both the private and the public sectors (Martensson, 2000) II. Analysis and Evaluation

There are many perspectives from which an analysis of succession planning can be derived and defined. The definition mentioned previously in this policy reflects a perspective that is focused on filling lateral or technical positions, which is the premise of this policy proposal. However, what if succession planning was looked at from a depleted leadership pipeline perspective as is exemplified by Charan, Drotter, and Noel (2011) who explicitly state that, the demand for leadership has risen while the supply of leaders has not kept pace. (p. 2) They emphasize how the requirements for leadership have changed dramatically and most organizational development strategies are not equipped for the dynamics of change and the chaos that may accompany it. Examples of chaotic changes include: mergers, acquisitions, downsizing, delayering, globalization, and the Internet, which all are causing a substantial change in organizations by invalidating the importance of some job positions that may be considered crucial in an organization. Essentially, from the pipeline perspective it is important for organizational

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strategic business plans such as succession planning to include provisions for future possibilities. This alternative definition for succession planning considers future possibilities (Charan, Drotter & Noel, 2011): Succession planning is perpetuating the enterprise by filling the pipeline with high-performing people to ensure that every leadership level has an abundance of these performers to draw from, both now and in the future. (p. 207) This policy will focus on creating an agenda for both technical and managerial succession planning in healthcare. In keeping in line with the dynamics of the healthcare industry this policy will also focus on making it a point that organizations create their plans by first thoroughly evaluating their unique environments. Sociological analysis Organizations need realistic and accurate information on the capabilities and talents of their current staff in order to know the striking force of their human capital. If the talent, skills, and knowledge pool is weak then an organizations ability to withstand a drastic change such as retirements, job cuts, job layoffs, military conflicts, and loss of personnel due to competition, will falter. (Pynes, 2004) According to Pynes (2004), To be competitive, organizations must be able to anticipate, influence, and manage the forces that impact their ability to remain effective. In the service sector, this means they must be able to manage their human resource capabilities. (p. 390) Forty-two percent of the 15.7 million individuals working for state and local government in 1999 were between the ages of 45 and 64 years old.( Carroll & Moss, 2002)Two-fifths of state and local government employees will be eligible to retire in the next 15 years. (Ehrenhalt,

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2000) Having a succession plan strategy in place could prepare an organization for the ramifications of change happening without being prepared for it. The nursing profession is well documented as being a critical profession with regard to shortages. This shortage began in 1998 which progressed to 126,000 unfilled position in 2001 and in 2006 the profession entered its ninth year as being severely understaffed, making it the longest shortage in the past fifty plus years. (Buerhaus, Staiger & Auerbach, 2000; 2001; 2005) Within the business community, succession planning historically began with family-owned businesses but is has now integrated in other strategic frameworks with similar practices such as healthcare, corporations, financial institutions, etc. (Garman & Glawe, 2004. Scholars and consultants both stress the importance of the succession planning process to ensure continuity and prosperity of family businesses. (Sharma, Chrisman, & Chua, 2003) Researcher believe, however, that many family firms leave succession planning to chance (Rue & Ibrahim, 1996). Unfortunately, this assumption is accurate and has left the family business sector and has galloped into the industry that is in dire need of retention and recruitment planning, the healthcare sector. Socio-political analysis The political circumstances surrounding each problem/ potential solution form the crucial third variable in creating a window of opportunity through which problems/potential solutions have move toward development of legislation (Longest, 2010) Political circumstances can by far be the most critical factor in stimulating policy change or implementation. Factors that contribute to political circumstances are (2010):

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public attitudes, concerns, and opinions; the preferences and relative ability to influence political decisions of various groups interested in the problem of the way it is addressed; and the positions of involved key policymakers in the executive and legislative branches of government. Each of these factors can influence whether a problem is addressed through policy and the shape and scope of any policy developed to address the problem. (p. 67 ) Implementation process strategies. Like with any policy: federal, organizational, international or likewise, continuous monitoring and updating must occur depending on the external and internal environmental changes that occur. The formulation of the policy is just the first step of many. After formulation is the implementation stages which is a huge determinant for whether or not the policy fits into the environment of the organization or nation that it was intended to serve. Therefore, it is imperative that top leaders of healthcare organizations get to present their opinions about what would be needed in order for this initiative to be successful. Essentially, the first strategy would be a reemphasis on the problems in the current healthcare industry. The second strategy would be to present to top healthcare leaders the importance of this new policy and how it would address the problems the industry is facing. Next a presentation of data that argues for the implementation of this policy and that is supported by policy development theory will be analyzed and synthesized. Finally, an implementation strategy will be suggested to healthcare leaders on a local and national level. The further the research progresses for this new policy implementation the more strategic the organization will become thus leading to the development of a calculated policy development

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Proposed Succession Planning Scheme

Select Employee Evaluation Methods: Determine continued Interest in Program

Determine or Forecast Future Service Needs

Select training and Development Activities: Based on Financial Resources Assessment

Develop Action Plan for Implementing Human Resources Strategies

Conduct a Complete Gap Analysis

Executive Leadership or Management Involvement

Identify Critical Positions and High Potential Employees

Identify the Competencies That Will Move the Firm Forward

Continuous Quality Improvement: Monitor and Evaluate Each Component of the Plan Strategically

Figure 1. Succession Planning Scheme adapted from Succession Planning: An Idea Whose Time Has Come, by P. Ibarra, 2005, Public Management, 87(1), p. 20. Copyright 2005 by ICMA.

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Comparative decision-making According to several resources, strategies and tactics that promote effective succession planning for healthcare management positions are: 1) early and frequent identification of successor candidates; 2) demand for forecasting and gap analysis for future role and key position needs; 3) intentional formal and informal mentoring and coaching; 4) exposure to career broadening future role development co mpetency opportunities; 5) resource dedication for leadership development, including formal education for new competency development; and 6) serious evaluation when desirable successor candidates who are high performers leave the organization. (Roddy, 2004; Charan, 2005; Blouin, et al., 2006; Flynn, et al., 2007; Kappia, Dainty, & Price, 2007) In understanding the different strategies that are or should be utilized in a succession planning program it is essential for organizations to understand that this kind of business strategy cannot be limited to only top-level management. These tactics must also be implemented throughout all positions that require the need to fill key positions. Cost-benefit analysis The costs and benefits of the proposal will be specific, they affect a single group, which alone bears the projects favorable or harmful outcome. (Gupta, 2011, p.86) According to Gupta (2011) the easiest projects for lawmakers to accept are those that benefit specific groups of people while distributing costs over a large, diffuse population. This is referenced as pork-barrel legislation, where appropriations of public funds by Congress (or other legislative assemblies) for projects that do not serve the interests of

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any large portion of the country's citizenry but are nevertheless vigorously promoted by a small group of legislators because they will pump outside taxpayers' money and resources into the local districts these legislators represent. (Johnson, 2005, p.1) Examples of this kind of legislation include: appropriations bills for dams, bridge and highway construction and job-training centers. This proposal can be judged synonymously with a job-training center; more specifically as an, at-the-job-training center. With succession planning being a business strategy it provides benefits that are essential for any organization upon implementation. These benefits do not come without costs to the organization. The following is a listing of potential benefits and costs of succession planning in healthcare organizations. (Bolton & Roy, 2004, p. 589-590; Blouin, McDonagh, Neistadt,& Helfand, 2006) benefits. Provides good return on investment by decreasing recruitment and orientation costs and minimizing time-to-fill for vacancies It enhances the ability to achieve orderly transitions (Redman, 2003) and maintain productivity levels Provides for the systematic development of new and emerging leadership competencies called for by technological and cultural changes As an open process, it promotes the continual development of the leadership potential in rank and file, and encourages staff ownership of their own professional growth

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Recruitment and retention are enhanced because it identifies opportunities for growth and establishes a policy of promoting from within

It creates a culture that supports career advancement and instills worker loyalty It demonstrates a commitment to career development and professional advancement and is a powerful employee retention strategy

It ensures continuity of services, helps the bottom line, and gives a competitive edge in the market place

It provides intentional formal and informal mentoring and coaching Ensures resource dedication for leadership development, including formal education costs.

Time and resource commitment for the ongoing growth and development of staff Funding continuing education (internal and external) Funding matriculation in degree granting programs Funding leadership advancement programs Recognizing and rewarding competency achievement Essentially the argument for mandate of the implementation of a sound business

strategy such as succession planning is simple. Based on the return in investment of having readily available successors in a tight labor market, eliminating recruitment and orientation expenses, maintaining productivity at times of turnover, and responding quickly to market demands adds up to significant dollars being saved. According to NAS Recruitment Communications (2010) healthcare management is the FTE (full-time

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employee) occupation with the longest average time-to-fill of 78.9 days in 2009. The average recruitment expense per hire includes the total fixed and variable recruiting costs divided by the number of positions filled. Recruiting costs include advertising, employment and advertising agency fees, travel, office rental, equipment, staff salaries and benefits, relocation costs, and other costs associated with a new hire (NAS, 2010). The average recruitment expense per FTE hire in 2009 was $2,302 (2010). Ethical dilemmas Healthcare organization leaders must make themselves willing and able to step aside and allow new leaders to emerge. If an organization is one for accepting the challenge of implementing a succession plan into its organization then there has to be open communication about the process. An organization cannot say that they believe in and is in support of a succession plan if they feel it necessary to keep the ideas, structure, organization and the potential successors out of the communication loop. (Levett & Guenov, 2000) Additionally, the assessment of potential successors must be fair; the standards for judging potential must be consistent across the board of potentials. According to Charan, Drotter, and Noel (2011) standards for judging potential can rest on the employees: Exhibits operating, technical, and professional skills that are extremely required Exhibits managerial skills that are expected at the next highest organizational level

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Demonstrates leadership skills that are expected at the next highest organizational level

Regularly works a building new skills and abilities Demonstrates fire in the belly Is oriented towards total business results, not just focused on the success of own area (p. 212)

These standards must be addressed for all potentials for succession within the organization. This standard process could be by way of utilizing a tool called combined potential-performance matrix. According to Charan et al. (2011), this tool is useful for gaining snapshots of a leadership layer. Companies can determine, for instance, that their functional managers do not have many highly promotable people at this level and they had better remedy the situation. (p. 216) Whatever process is decided upon, leaders must make sure that all candidates are tested, evaluated, and compared in the exact same manner. As with any other function in healthcare, it is a professional and ethical duty to behave in a manner that is respectable and admirable. Tomorrows leaders are looking at the examples made by todays. III. Conclusion

This project will represent the creation of a new health policy that will focus on mandating the implementation of succession planning within healthcare organizations which employ 50 or more personnel. All required organizations must have emergency, standard, and anticipatory planning strategies in the overall policy. This policy will be advocated for through the eyes of a senior policy analyst at the American Society for Healthcare Human Resources Administration of the American Hospital Association.

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In our increasingly competitive business climate, where consumers are being more informed, becoming more involved with the decision making process of their care, and therefore, are expecting the knowledge of their healthcare providers and care management teams (providers, nurses, radiologists, phlebotomists, laboratory technologists, physical therapists, etc.) to be top-notch and on top of their game. Todays healthcare consumers are demanding high quality in all respects from their chosen healthcare entity. In knowing this, it would be in the best interest of healthcare organization management to have an implemented plan for the retention of the knowledge that is incorporated and has added to the reputation of its health care dynamic. According to a federally funded coalition entitled Building Engineering and Science Talent (BEST), we are entering a quiet crisis based on the fact that American colleges and universities are not graduating enough scientific and technical talent to step into research labs, software centers, science policies offices, and high tech start upsthere is going to be a shrinking workforce, and an unprecedented labor shortage. (Roddy, 2004, p. 487) The limitation of this proposal is essentially the scope at which succession planning is viewed. There are organizations that feel succession planning is just the process of selecting the next chief. They are eluded to the fact that succession planning, if done thorough and as a component of the organizations strategic pl an, extends in to areas as leadership development programs, mentoring networks, performance assessment, governance theory, aligning organizational goals with human capital, and overall building the internal leadership pipeline. (Blouin, et al., 2006; Charan et al, 2011). When the pipeline is nonexistent it cause the organization to shift

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their sole focus to external sources of candidates and bypassing the internal prospective, which is a process that has been shown to lower success rates.(Charan, 2005; Byham & Nelson, 1999). Additionally, this limitation extends into what an organization is financially capable or able to do. In thinking about succession implementations that could be made at the a large, multi-faceted, metropolitan hospital in comparison to a 150-bed suburban community hospital the scale is slammed in the direction of the large metropolitan hospital. There are going to be differences amongst hospitals as to what is needed, required, and works with the cultural environment of that organization. This allocation of funds would have to take into account these essential limitations of this proposal. The strength of this proposal comes from the literature that is in support of succession planning. This business plan has traveled across several different paths; that of family-owned businesses right into large healthcare systems. This is a business strategy that is highly recognized and recommended in the field, especially with the bleak outlook that has been forecasted in the healthcare industry regarding the loss of the essential knowledge pool of the organization. A subsequent strength is the blatantly overt support that the cost-benefit analysis put forth; the benefits significantly outweigh the costs of what it would take for an organization to step up and put more manpower into developing a succession plan that would be incorporated into the strategic plan of the organization. Pork-barrel legislation shows that legislators are already more apt at passing this kind of law because it allows for funding to go into the areas that they represent. In classifying it as an at -the-jobtraining center this should be considered more favorable because the needed

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resources at already within the healthcare facility. There would be no need to pay rent for a building space, the hospital would be it. There would be no need to pay additional salary dollars, the succession plan would be implemented right into the strategic goals of the facility; therefore, the additional activities and duties could be considered lateral duties. The primary need for funds would be contingent upon the succession plan design that is utilized. If training is to occur externally instead of internally costs will rise. If external trainers were utilized instead of the internal knowledge pool costs would rise. If the organization decides that training should take place before or after work hours instead of incorporating the training on the job then costs will rise. Essentially, organizations have to thoroughly review, analyze, and map-out their financial responsibilities and be creative and open-minded to the idea of planning for the foreseeable and unforeseeable future. The support shows that legislation is for the development of human capital (with ulterior motives of course, but nonetheless supportive) with regards to accepting proposals for job training centers. This proposal is exactly for a program like that. The only difference is it will be within an organization, that would have to decide on their own if they are willing to take the time to develop an on-the-job-training plan.

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References

American College of Healthcare Executives. (2004). Succession planning routinely done by 21% of freestanding U.S. hospitals: ACHE study finds well-structured plans more likely to be perceived as effective. Retrieved from http://www.ache.org/pubs/releases/112204_succession_release.cfm on April 23, 2011 Blouin, A.S., McDonagh, K.J., Neistadt, A.M., & Helfand, B. (2006). Leading tomorrows health care organizations: Strategies and tactics for effective succession planning. Journal of Nursing Administration, 36(6), p. 325-330.

Bolton, J. & Roy, W. (2004). Succession planning: Securing the future. Journal of Nursing Administration, 34(12), p. 589-593. Bonczek, M.E. and Woodward, E.K. (2006). Wholl replace you when youre gone? Nursing Management, 37(8), p. 31-34.

Buerhaus, P.I., Staiger, D.O., & Auerbach, D.I. (2000). Why are shortages of hospital RNs concentrated in specialty care units? Nursing Economics, 18(3), 111-116.

Buerhaus, P.I., Staiger, D.O., & Auerbach, D.I.(2001). The hospital workforce shortage: Immediate and future. Trendwatch 3, 2(1).

Buerhaus, P.I., Staiger, D.O., & Auerbach, D.I. (2005). Is the shortage of hospital Registered Nurses getting better or worse?: Findings from two recent national surveys of RNs. Nursing Economics, 23(2), 61-71.

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Byham, W.D., Nelson, G.D. (1999). Succession planning Rx: Developing the next generation of leaders. Health Forum Journal, 42 (6), 24-26.

Carroll, J.B. & Moss, D.A. (2002). State employee worker shortage, the impending crisis. Lexington, KY: The Council of State Governments

Charan, R. (2005) Ending the CEO succession crisis. Harvard Business Review, 83(2), 72-81.

Charan, R., Drotter, S. Noel, J. (2011). The leadership pipeline: How to build the leadership powered company. (2nd ed.). San Fransico: John Wiley & Sons

Developing Leaders Among Your Employees. (2005). Receivables Report for America's Health Care Financial Managers, 20(3), 3-4. Retrieved from EBSCOhost.

Ehrenhalt, S.M. (2000). The employee exodus. Governing, 12(6), 36-38.

Flynn, W.J., Mathis, R.L., Jackson, J.H., and Langan, P.J. (2007). Healthcare human resource management (2nd ed.). Mason, OH: Thomson Learning

Garman, A.N. & Glawe, J. (2004). Succession planning. Consulting Psychology Journal: Practice and Research, 56(2), 119-128.

Goodman, R.E. & Chinowsky, P.S. (1997). Preparing construction professionals for executive decision making. Journal of Management in Engineering, 13(6), p. 5561.

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Gupta, D.K. (2011). Analyzing public policy: Concepts, tools, and techniques (2 nd ed.). Washington, DC: CQ Press.

Ibarra, P. (2005). Succession planning: An idea whose time has come. Public Management, 87(1), 18-24.

Johnson, P.M. (2005). A glossary of political economy terms: Pork-barrel Legislation. Retrieved from http://www.auburn.edu/~johnspm/gloss/pork-barrel_legislation on June 5, 2011.

Kappia, J.G., Dainty, A.R., & Price, A.D.F (2007). Prioritising career development in relation to recruitment and retention: a trade and craft perspective. Construction Management and Economics, 25, 239-253.

KPMG. (1999). The power of knowledge: A business guide to knowledge management. KPMG Management Consulting. Retrieved from http://www.kpmg.com on June 6, 2011

Levett, G.P. & Guenov, M.D. (2000). A methodology for knowledge management implementation. Journal of Knowledge Management, 4(3), 258.

Longest, B. B., Jr. (2010). Health policymaking in the United States (5th ed.). Chicago: Health Administration Press. Martensson, M. (2000). A critical review of knowledge management as a management tool. Journal of Knowledge Management, 4(3), 204

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NAS Recruitment Communications. (2010). Healthcare recruitment metrics. Retrieved from http://www.nasrecruitment.com/docs/recruitment_hotsheets/HealthcareRecruitment-Metrics.pdf on June 7, 2011. Pynes, J.E. (2004). The implementation of workforce and succession planning in the public sector. Public Personnel Management, 33(4), 389-404. Redman, R.W. (2003). Practice environments: Leadership succession planning: Would nursing benefit? Research and Theory for Nursing Practice, 17(4), 277-279. Roddy, N. (2004). Leadership capacity building model: Developing tomorrows leadership in science and technology. Public Personnel Management, 33(4), 487-496. Rue, L.W. & Ibrahim, N.A. (1996). The status of planning in smaller family-owned business. Family Business Review, 9(1), 29-43. Rothwell, W. (2000b). Effective succession planning: Ensuring leadership continuity and building talent from within. 2nd ed. New York: Amacom. Rothwell, W.J. & Poduch, S. (2004). Introducing technical (not managerial) succession planning. Public Personnel Management, 33(4), 405-419. Schmalzried, H. & Fallon, F. Jr. (2007). Succession planning for local health department top executives: Reducing risk to communities. Journal of Community Health, 32(3), p. 169-180. Sharma, P., Chrisman, J.J., a& Chua, J.H. (2003). Succession planning as planned behavior: Some empirical results. Family Business Review, 16(1), p. 1-15.

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Smeltzer, J. & Bonello, D. (2004). Building the foundation for knowledge management. Chief Learning Officer,