Textbook Human Resources in Healthcare Managing For Success Bruce J Fried Ebook All Chapter PDF

Human Resources in Healthcare
Managing for Success Bruce J. Fried

Visit to download the full and correct content document:
https://textbookfull.com/product/human-resources-in-healthcare-managing-for-succes
s-bruce-j-fried/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...
Managing Human Resources Parbudyal Singh
https://textbookfull.com/product/managing-human-resources-
parbudyal-singh/
Managing Human Resources Scott A. Snell
https://textbookfull.com/product/managing-human-resources-scott-
a-snell/
Everything Fried A Fried Cookbook with Delicious Fried

Recipes for Amazing Fried Foods 2nd Edition Booksumo
Press
https://textbookfull.com/product/everything-fried-a-fried-
cookbook-with-delicious-fried-recipes-for-amazing-fried-
foods-2nd-edition-booksumo-press/
Advances in Human Factors and Ergonomics in Healthcare

and Medical Devices Nancy J. Lightner
https://textbookfull.com/product/advances-in-human-factors-and-
ergonomics-in-healthcare-and-medical-devices-nancy-j-lightner/
Information security in healthcare managing risk
Terrell W. Herzig
https://textbookfull.com/product/information-security-in-
healthcare-managing-risk-terrell-w-herzig/
Mastering Informatics A Healthcare Handbook for Success

1st Edition Patricia Sengstack
https://textbookfull.com/product/mastering-informatics-a-
healthcare-handbook-for-success-1st-edition-patricia-sengstack/
CPHIMS Review Guide: Preparing for Success in

Healthcare Information and Management Systems 3rd
Edition Healthcare Information And Management Systems
Society (Himss)
https://textbookfull.com/product/cphims-review-guide-preparing-
for-success-in-healthcare-information-and-management-systems-3rd-
edition-healthcare-information-and-management-systems-society-
himss/
The Healthcare Professional Workforce Understanding

Human Capital in a Changing Industry 1st Edition
Timothy J. Hoff
https://textbookfull.com/product/the-healthcare-professional-
workforce-understanding-human-capital-in-a-changing-industry-1st-
edition-timothy-j-hoff/
Diaspora Networks in International Business:

Perspectives for Understanding and Managing Diaspora
Business and Resources Maria Elo
https://textbookfull.com/product/diaspora-networks-in-
international-business-perspectives-for-understanding-and-
managing-diaspora-business-and-resources-maria-elo/
HUMAN
RESOURCES IN
HEALTHCARE
Managing for Success
FOURTH EDITION
Bruce J. Fried and

Myron D. Fottler, Editors
Copying and distribution of this PDF is prohibited without written permission.

For permission, please contact Copyright Clearance Center at www.copyright.com
AUPHA/HAP Editorial Board for Graduate Studies
Thomas J. Stranova Jr., ScD, Chairman
H
R
Tulane University
LTC Lee W. Bewley, PhD, FACHE

Army Baylor University
H
José A. Capriles, MD
University of Puerto Rico
Dolores G. Clement, DrPH, FACHE

Virginia Commonwealth University
Michael Counte, PhD

St. Louis University M
Jonathan P. DeShazo, PhD
Virginia Commonwealth University
Mark L. Diana, PhD

Tulane University
Blair D. Gifford, PhD

University of Colorado
James W. Henderson, PhD

Baylor University
Suzanne Hobbs, DrPH

University of North Carolina at Chapel Hill
Pamela R. McCoy
Loyola University Chicago
Nir Menachemi, PhD

University of Alabama at Birmingham
Mary S. O’Shaughnessey, DHA

University of Detroit Mercy

HUMAN
RESOURCES IN
HEALTHCARE
Managing for Success
FOURTH EDITION
Bruce J. Fried and

Myron D. Fottler, Editors
Health Administration Press, Chicago, Illinois
Association of University Programs in Health Administration, Arlington, Virginia

Your board, staff, or clients may also benefit from this book’s insight. For more information
on quantity discounts, contact the Health Administration Press Marketing Manager at
(312) 424-9470.
This publication is intended to provide accurate and authoritative information in regard to

the subject matter covered. It is sold, or otherwise provided, with the understanding that the
publisher is not engaged in rendering professional services. If professional advice or other expert
assistance is required, the services of a competent professional should be sought.
The statements and opinions contained in this book are strictly those of the authors and do not
represent the official positions of the American College of Healthcare Executives, the Foundation
of the American College of Healthcare Executives, or the Association of University Programs in
Health Administration.
Copyright © 2015 by the Foundation of the American College of Healthcare Executives.

Printed in the United States of America. All rights reserved. This book or parts thereof may
not be reproduced in any form without written permission of the publisher.
19 18 17 16 15 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Human resources in healthcare : managing for success / Bruce J. Fried and Myron D. Fottler,
editors.—Fourth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-56793-708-4 (alk. paper)
I. Fried, Bruce, 1952– , editor. II. Fottler, Myron D., editor. III. Association of University
Programs in Health Administration, publisher.
[DNLM: 1. Personnel Management—methods. WX 159]
RA971.35
362.1068'3—dc23
2015004329
The paper used in this publication meets the minimum requirements of American National
Standard for Information Sciences—Permanence of Paper for Printed Library Materials, ANSI
Z39.48-1984. ∞ ™
Acquisitions editor: Tulie O’Connor; Project manager: Andrew Baumann; Manuscript editor:
Karin Horler; Cover designer: Carla Nessa; Layout: Cepheus Edmondson
Found an error or a typo? We want to know! Please e-mail it to hapbooks@ache.org, and put
“Book Error” in the subject line.
For photocopying and copyright information, please contact Copyright Clearance Center at
www.copyright.com or at (978) 750-8400.
Health Administration Press Association of University Programs

A division of the Foundation of the American in Health Administration
College of Healthcare Executives 2000 North 14th Street
One North Franklin Street, Suite 1700 Suite 780
Chicago, IL 60606-3529 Arlington, VA 22201
(312) 424-2800 (703) 894-0940

BRIEF CONTENTS
Preface.......................................................................................................xv
Acknowledgments....................................................................................xxiii
Chapter 1. Strategic Human Resources Management...........................1

Myron D. Fottler
Chapter 2. Employment Law, Employee Relations, and Healthcare...35

Drake Maynard
Chapter 3. Healthcare Professionals...................................................79

Kenneth R. White and Dolores G. Clement
Chapter 4. Credentialing of Healthcare Providers............................107

John C. Hyde II
Chapter 5. Workforce Diversity........................................................123

Rupert M. Evans Sr.
Chapter 6. Job Analysis and Job Design..........................................143

Myron D. Fottler
Chapter 7. Recruitment, Selection, and Retention...........................181

Bruce J. Fried and Michael Gates
Chapter 8. Performance Management..............................................235

Bruce J. Fried
Chapter 9. Compensation Practices, Planning, and Challenges.........275

Bruce J. Fried and Howard L. Smith
Chapter 10. Employee Benefits..........................................................321

Dolores G. Clement, Maria A. Curran, and Sharon L. Jahn
Chapter 11. Organizational Development and Learning....................351

Donna L. Kaye and Myron D. Fottler
v
vi B rief Co n te n ts
Chapter 12. Managing with Organized Labor...................................389

Donna Malvey and Amanda Raffenaud
Chapter 13. Workforce Planning in a Rapidly Changing

Healthcare System..........................................................427
Erin P. Fraher and Marisa Morrison
Chapter 14. The Nurse Workforce in Healthcare Organizations.........455

Cheryl B. Jones, George H. Pink, and Lindsay T. Munn
Chapter 15. Human Resources Management Practices for

Quality and Patient Safety..............................................503
Jordan Albritton and Bruce J. Fried
Appendix A: Human Resources Metrics..................................................529

Myron D. Fottler and Bruce J. Fried
Appendix B: Cases..................................................................................537
Bruce J. Fried
Case 1: Implementing Comparable-Worth Legislation....539
Case 2: Physician Engagement.......................................542
Case 3: Nurse Staffing Ratios and the State Nursing
Association................................................................545
Case 4: Is the Nurse Shortage Over for Good? ..............546
Case 5: A Living Wage...................................................549
Case 6: Same-Sex Marriage and Human Resources
Policy........................................................................551
Index......................................................................................................555
About the Editors.....................................................................................557
About the Contributors............................................................................559

DETAILED CONTENTS
Preface.......................................................................................................xv
Acknowledgments....................................................................................xxiii
Chapter 1. Strategic Human Resources Management...........................1

Myron D. Fottler
Learning Objectives...........................................................1
Introduction......................................................................1
Environmental Trends........................................................6
The SHRM Model.............................................................9
Organizational Mission and Corporate Strategy................14
Human Resources and The Joint Commission.................23
A Strategic Perspective on Human Resources...................25
Who Performs HR Tasks?................................................26
Summary.........................................................................27
Discussion Questions.......................................................28
Experiential Exercises.......................................................29
References........................................................................30
Chapter 2. Employment Law, Employee Relations, and Healthcare...35

Drake Maynard
Learning Objectives.........................................................35
Introduction....................................................................36
History of Employment Law in the United States ...........38
Employment Law in the Twenty-First Century................48
How Employment Law and Employee Relations
Can Promote Strategic Human Resources
Management...............................................................56
Other Employment Law and Employee Relations
Issues..........................................................................68
Summary.........................................................................70
Discussion Questions.......................................................72
vii
viii Det a iled C o n te n ts
Experiential Exercises.......................................................72
Notes...............................................................................75
References........................................................................76
Web Resources.................................................................77
Chapter 3. Healthcare Professionals...................................................79

Kenneth R. White and Dolores G. Clement
Learning Objectives.........................................................79
Introduction....................................................................79
Professionalization...........................................................80
Healthcare Professionals...................................................82
Considerations for Human Resources Management..........95
Changing Nature of the Health Professions.....................98
Summary.......................................................................103
Discussion Questions.....................................................103
Experiential Exercise......................................................104
References......................................................................104
Chapter 4. Credentialing of Healthcare Providers............................107

John C. Hyde II
Learning Objectives.......................................................107
Introduction..................................................................107
Historical Background....................................................109
Elements of the Credentialing/Privileging Process.........112
Concerns and Issues of Credentialing and Privileging.....115
Typical Credentialing/Privileging Encounter.................118
Future Trends in Credentialing and Privileging..............119
Summary.......................................................................119
References......................................................................121
Chapter 5. Workforce Diversity........................................................123

Rupert M. Evans Sr.
Introduction..................................................................123
Definition of Diversity and Inclusion..............................124
Prejudice in the Workplace.............................................126
The Business Case for Diversity......................................127
Diversity in Healthcare Leadership:
Two Major Studies....................................................131

D etailed C ontents ix
Diversity Management...................................................134
The Impact of Diversity on Care Delivery......................134
Components of an Effective Diversity Program..............136
Summary.......................................................................138
References......................................................................140
Chapter 6. Job Analysis and Job Design..........................................143

Myron D. Fottler
Introduction..................................................................143
Definitions.....................................................................144
The Job Analysis Process................................................145
Job Design.....................................................................160
Specialization in Healthcare...........................................160
Summary.......................................................................171
Experiential Exercises.....................................................173
References......................................................................173
Supplement....................................................................179
Chapter 7. Recruitment, Selection, and Retention...........................181

Bruce J. Fried and Michael Gates
Introduction..................................................................181
Recruitment...................................................................183
Selection........................................................................201
Turnover and Retention.................................................217
Summary.......................................................................223
References......................................................................228
Chapter 8. Performance Management..............................................235

Bruce J. Fried
Introduction..................................................................235
The Role of Performance Management..........................241
Establishing Job Standards and Appraisal Criteria...........243
Collecting Job Performance Data...................................244

x Det a iled C o n te n ts
The Cynicism About Performance Management.............254

Conducting Effective Performance
Management Interviews............................................257
The Special Case of Bullies and Toxic Managers.............260
Summary.......................................................................265
References......................................................................272
Chapter 9. Compensation Practices, Planning, and Challenges.........275

Bruce J. Fried and Howard L. Smith
Introduction..................................................................275
The Strategic Role of Compensation Policy....................277
Compensation Decisions and Dilemmas.........................280
Determining the Monetary Value of Jobs.......................287
Special Considerations for Compensating Physicians.......303
Summary.......................................................................314
References......................................................................316
Chapter 10. Employee Benefits..........................................................321

Dolores G. Clement, Maria A. Curran, and Sharon L. Jahn
Introduction..................................................................321
Brief Historical Background...........................................323
Major Federal Legislation...............................................324
Overview of Employment Benefits.................................327
Designing a Benefits Plan...............................................343
Managerial Implications.................................................346
Summary.......................................................................346
References......................................................................349
Chapter 11. Organizational Development and Learning....................351

Donna L. Kaye and Myron D. Fottler
Introduction..................................................................352
Organizational Development: Objectives
and Services...............................................................353

D etailed C ontents xi
Competencies Needed....................................................354
Employee Engagement..................................................354
Performance Improvement Consultation........................357
Change Management.....................................................360
Succession Planning.......................................................360
Learning Goals...............................................................365
Designing Training for Sustainability..............................367
Instructional Methods....................................................373
Employee Onboarding...................................................375
Trends in Organizational Development
and Learning.............................................................377
Summary.......................................................................380
References......................................................................383
Web Resources...............................................................387
Chapter 12. Managing with Organized Labor...................................389

Donna Malvey and Amanda Raffenaud
Introduction..................................................................389
Overview of Unionization..............................................391
The Labor Relations Process..........................................392
A Review of Legislative and Judicial Rulings..................402
Developments in Organizing Healthcare Workers...........408
Interview with a Nurse Activist......................................413
Management Guidelines.................................................416
Summary.......................................................................418
References......................................................................421
Web Resources...............................................................426
Chapter 13. Workforce Planning in a Rapidly Changing

Healthcare System..........................................................427
Erin P. Fraher and Marisa Morrison
The Link Between Macro-Level Policy and Micro-
Level Healthcare Workforce Outcomes......................427
The Importance of Healthcare Workforce Planning
in a Rapidly Changing System...................................429

xii Det a iled C o n te n ts
The Strengths and Weakness of Workforce Models ........430

Estimating the Supply of Healthcare Workers.................432
Estimating the Demand for Healthcare Services.............436
Matching Supply to Demand.........................................442
Real-World Applications ................................................444
Summary.......................................................................446
Notes ............................................................................449
References......................................................................450
Chapter 14. The Nurse Workforce in Healthcare Organizations.........455

Cheryl B. Jones, George H. Pink, and Lindsay T. Munn
Introduction..................................................................455
Types of Nursing Personnel...........................................456
Definitions and Measurement.........................................457
Determining Nurse Staffing Requirements.....................464
Key Issues in Managing Nurse Staffing and
Workload...................................................................466
Looking to the Future...................................................481
Summary.......................................................................487
Notes ............................................................................490
References......................................................................490
Supplement....................................................................498
Chapter 15. Human Resources Management Practices for

Quality and Patient Safety..............................................503
Jordan Albritton and Bruce J. Fried
Introduction..................................................................503
Quality and Process Improvement..................................508
Common Quality Improvement Strategies.....................509
Common Themes and Tools..........................................512
The Importance of Human Resources............................513
Human Resource Practices and Team Effectiveness........514
Summary.......................................................................523

D etailed C ontents xiii
References......................................................................526
Appendix A: Human Resources Metrics..................................................529

Myron D. Fottler and Bruce J. Fried
References......................................................................534
Appendix B: Cases..................................................................................537
Bruce J. Fried
Case 1: Implementing Comparable-Worth Legislation....539
Case 2: Physician Engagement.......................................542
Case 3: Nurse Staffing Ratios and the State Nursing
Association................................................................545
Case 4: Is the Nurse Shortage Over for Good? ..............546
Case 5: A Living Wage...................................................549
Case 6: Same-Sex Marriage and Human Resources
Policy........................................................................551
Index......................................................................................................555
About the Editors.....................................................................................557
About the Contributors............................................................................559

PREFACE
This book is the fourth edition of Human Resources in Healthcare: Manag-

ing for Success. The first edition was published in 2001, an infamous year
that brought issues of globalization to the forefront in the United States.
Economic vulnerability had been present for some time, notably in the loss
of dominance of the United States as a manufacturing economy dating to
the 1970s. For Americans born after World War II, we experienced—many
for the first time—a vulnerability that extended beyond economics, politics,
and changes in social structure. We learned in a brutal manner that our sense
of personal safety was illusional and that globalization was more than an
abstract concept. The lessons of the Vietnam War, notably that US military
dominance had disintegrated, were reinforced by two arguably inconclusive
wars. US vulnerability extended from personal safety concerns to cyber-
security threats and the global emergence and reemergence of diseases. From
within, we saw the disintegration of confidence in our economic structures,
culminating in the 2008 economic collapse spurred by a deregulated banking
sector.
Technologically, the changes have been monumental, leading to
extraordinary progress in communication, medicine, and countless other
areas of life but also posing very significant threats. Socially, the demographics
of the US population came to encompass increasing diversity in both num-
bers and types, viewed by many as a validation of the American dream and
by others as a threat to the American identity. Election of the first African-
American president was seen by many as a victory for hope, upward mobility,
and profound cultural change, but by many others as a threat to the social
order. With few exceptions, the political environment in Washington, DC,
was characterized by unprecedented polarization and outright hatred.
Healthcare, of course, has not stood still since 2001. It has undergone
tremendous changes, many of which were affected by larger economic, politi-
cal, technological, and social factors. Economic constraints and the uncon-
strained increase in the cost of healthcare fed into demands for “bending the
cost curve,” leading to changes in incentive structures in the US healthcare
system and its payment mechanisms. Politically, even in the midst of congres-
sional gridlock, passage of the Affordable Care Act in 2010 represented the
most important federal legislation since the enactment of Medicare in 1965.
xv
xvi Prefa c e
As of this writing, the law continues to be under attack, and the eventual state
of the law is uncertain.
Whatever the eventual outcome, more people are likely to have access
to healthcare services, placing additional pressures on the healthcare system
for effectiveness and efficiency. Socially, the aging of the baby boomers
has, as predicted, placed increasing pressures on the healthcare system. The
increasing diversity of the population has reinforced the need for cultural
competence and systems of care that are responsive to social and cultural dif-
ferences. In the workforce, generational diversity has created the need to con-
sider reward and motivational structures that are generationally appropriate.
Healthcare systems continue to be under pressure to meet three aims:
quality, cost containment, and access to care. Attention to quality has become
increasingly acute as incentive structures focus on rewarding quality and in
effect have begun to place sanctions on organizations, in some cases arguably,
for substandard care. Quality improvement processes are a mainstay of orga-
nizations, requiring the active engagement and participation of employees.
Enter healthcare human resources management (HRM). Despite the
changes of the past 15 years, people continue to play a critical and central
role in providing health services. While automation and other technological
advances have allowed other industries to downsize, technological changes
in the healthcare industry generate the need for trained and well-managed
health professionals. While other industries have outsourced an incalculable
number of jobs, healthcare services cannot be significantly outsourced, with
the exception of medical tourism, which operates on the margins of US
healthcare.
Moreover, the healthcare workforce is under increasing pressure.
Incentive structures have led to increased severity among hospitalized
patients, and cost containment pressures have led in some instances to
decreases in staffing with the remaining workers facing an increased work-
load. Managers are being asked to manage and retain a workforce that is in
many cases highly stressed and mobile. Millennials, in contrast to earlier gen-
erations, tend to have a high need for personal development but only limited
attachment to the organization. Further, jobs are changing as the healthcare
system creates demands for new competencies. Effective job design, training,
and performance management mechanisms need to be well developed and
executed effectively.
We could go on documenting changes in the healthcare system, but
instead we will describe the current edition of Human Resources in Health-
care and how each chapter in this edition addresses key realities and changes
in healthcare. Undoubtedly, we will have overlooked some changes, and
future changes are difficult to predict with confidence. Therefore, we offer
this volume under the assumption that readers consider the content of this

Prefac e xvii
book in the spirit of continuous lifetime learning. Change is a given, but

recognizing change and adapting effectively do not necessarily follow. In the
words of Albert Einstein: “As far as the laws of mathematics refer to reality,
they are not certain; and as far as they are certain, they do not refer to real-
ity.” We could say the same about healthcare and healthcare management.
Effective HRM is a product of at least three elements: cognitive
knowledge, affective competencies, and experience. This book addresses
domains of cognitive knowledge, including the idea of organizational strat-
egy and HRM; the larger environment within which HRM occurs, including
the legal environment and health workforce labor markets; and the multiple
processes and systems involved in managing the healthcare workforce. For
this knowledge (and, for that matter, any management knowledge) to be
applied effectively, managers need to possess a variety of affective character-
istics including competencies in such areas as emotional intelligence, inter-
viewing, conflict management, and problem solving. Mastery of HRM, like
virtually every other aspect of life, requires experience, practice, and learning
from successes and failures through self-insight, reflection, and mentoring.
The topics in this book are a starting point for developing mastery in working
effectively with people in healthcare organizations.
In Chapter 1, Myron D. Fottler establishes the framework for this
book: strategic HRM. An overall theme is that HRM is a responsibility of all
people in the organization and certainly is not limited to the formal human
resources (HR) department. The basic premise of strategic HRM is that HR
practices and processes need to support the mission and strategies of the
organization. This situation is far from a given. We have found repeatedly
in the classroom that when we query a group of experienced managers, we
are far more likely to find examples of poor HR practices than effective ones.
Similarly, HR departments, which should be a key part of the senior manage-
ment team, are very often viewed as operating in opposition to the interests
of employees and the organization as a whole.
All organizations operate within a legal environment, and in Chapter
2, Drake Maynard provides foundational knowledge in the multitude of laws,
regulations, and court decisions affecting HRM. Like other aspects of the
law, the legal framework for HRM is in a constant state of flux with changing
legislation at multiple levels, new interpretations resulting from court deci-
sions, and changing regulations. Among the many areas of law covered are
the Americans with Disabilities Act as amended, Title VII of the Civil Rights
Act, the Fair Labor Standards Act, and the Family and Medical Leave Act.
The chapter discusses the legal issues surrounding sexual harassment, the
forms of sexual harassment, and how managers can avoid as well as respond
to charges of sexual harassment. Written by a legal expert in employment
law and containing many references to landmark legal cases, the chapter is

xviii Prefa c e
nevertheless remarkably accessible to the nonlawyer. While most managers

need not have a thorough knowledge of all aspects of employment law, they
need to know the boundaries of the law and realize when their practices may
be testing the boundaries of legality. This chapter effectively provides this
foundation.
Healthcare organizations likely employ a broader range of profession-
als than do any other type of organization. The role of health professionals
continues to evolve as a result of changes in technology, health services, and
competency requirements. In Chapter 3, Kenneth R. White and Dolores G.
Clement provide essential information on the distinction between profes-
sions and occupations, the process of becoming a professional, licensure and
regulation, scope of practice, and the changing role of professionals. They
also provide background information on factors associated with supply and
demand for health professionals, including changes in technology, changes
in payment mechanisms, and the increasing diversity of the settings in which
healthcare services are provided.
John C. Hyde II authors a new chapter in this book on the creden-
tialing of healthcare providers. Physicians have a complex relationship with
many healthcare organizations yet play a central role in determining the qual-
ity of health services. In Chapter 4, Hyde discusses the legal framework and
key court cases related to credentialing and privileging. He details the Joint
Commission requirements to ensure high-quality and safe patient care and
describes the processes that organizations should follow in ensuring a compe-
tent workforce. Hyde acknowledges the uncertainties and risks in credential-
ing and the difficulties faced, for example, when a surgeon requests privileges
for a new procedure despite having limited experience with the procedure.
The issue of diversity is perhaps the most misunderstood aspect of
management, yet its importance is integral to employee satisfaction and
effectiveness as well as the quality of patient care. In Chapter 5, Rupert M.
Evans Sr. stresses the importance of understanding the impact of diversity
among patients and healthcare workers. He provides an expansive definition
of diversity, characterizing diversity as falling into the three categories of
human diversity, cultural diversity, and systems diversity. Using this frame-
work, he makes the important distinction between diversity and the idea of
inclusion. Taking a positive approach, he cites the business case for diversity
and the potential for effectively managing diversity to positively affect patient
outcomes and reduce disparities.
An employee’s actual job is a central part of HRM. As described by
Myron D. Fottler in Chapter 6, jobs continue to change in their competency
requirements, how they are designed, and how they interact with other jobs
in an organization. Jobs also are the foundation for other HR practices. For
example, without a clear understanding of job requirements, establishing

Prefac e xix
selection criteria for new employees is not possible. Nor is it possible to effec-
tively coach individuals on their performance.
In Chapter 7, Bruce J. Fried and Michael Gates address the interre-
lated topics of recruitment, selection, and retention. In a rapidly changing
healthcare system, finding and selecting the right people for the job is critical.
However, selecting the best people for the job does not mean that prospec-
tive employees will choose to work for the organization, and it certainly does
not ensure that they will stay with the organization. Fried and Gates describe
alternative modes of employee recruitment as well as effective techniques for
distinguishing between job applicants with similar skill sets and backgrounds.
They address the controversial area of organizational fit and analyze its role
in the selection process. Employee retention is of paramount importance in
healthcare, and the authors provide evidence to support the importance of
retention and evidence-based practices that organizations can use to maxi-
mize the likelihood of retaining the right people.
Part of keeping people in the organization is working with them to
continually improve their performance. In Chapter 8, Bruce Fried addresses
the topics of measuring employee performance and using this information
to help employees develop their skills. This process, known as performance
management, also includes ensuring a work environment where people are
respected and valued. In this edition of the book, we have added a section
on an unfortunate but highly prevalent aspect of organizational life: the bully.
We describe the phenomenon of bullying, how to prevent it from occurring,
and how to respond once it comes to light.
Reward systems are central to employee motivation, satisfaction,
and performance. Noting that people work for both intrinsic and extrinsic
rewards, Chapter 9 focuses on extrinsic rewards, namely compensation. In
this chapter, Bruce J. Fried and Howard L. Smith address the role of compen-
sation within the overall reward structure of the organization. They address
the key topic of how jobs are valued in monetary terms and how objective
job evaluation processes often need to be tempered by labor market consid-
erations. In light of the current emphasis on individual and organization-
wide pay for performance, they describe the strengths and drawbacks of dif-
ferent forms of incentive compensation, as well as considerations and trends
in physician compensation.
Financial compensation is but one part of the total compensation
that an employee receives. Employee benefits play a critical role in employ-
ees’ decision to join an organization, their satisfaction, and their likelihood
of staying with the organization. Dolores G. Clement, Maria A. Curran,
and Sharon L. Jahn devote a chapter to the highly significant role played
by employee benefits, in terms of both the cost to the organization and
the motivational potential of these benefits. They provide a road map of

xx Prefa c e
employee benefits ranging from mandatory benefits, such as Social Security

contributions and workers’ compensation, to an array of voluntary benefits
including health insurance, life insurance, and leave. Of particular importance
is the attention to benefits plan design and how different employees value
various benefits. Among the benefits design issues addressed are the inclusion
of domestic partners in benefits, budget concerns, and related information
about self-insurance and stop-loss insurance.
Performance improvement is a critical function in all organizations
and is particularly important in healthcare, where technologies and methods
of providing care are in a state of continuous change. In Chapter 11, Donna
L. Kaye and Myron D. Fottler address performance improvement from
both organizational and individual perspectives. They note that performance
improvement initiatives are typically based on enhancing individual skills and
expanding an employee’s skill set. Training activities typically focus on the
individual employee’s current job and on remediating particular skill-set defi-
cits. While these activities are important, when conducted alone they ignore
the impact of organizational factors on individual performance. By contrast,
organizational development is centered on enhancing both current and
future jobs, improving the work group or organization over the long term,
and attending to future work demands. Organizational development inter-
ventions are broad and include such activities as organizational diagnosis,
succession planning, and communication. Kaye and Fottler describe a broad
array of key organizational development processes and provide guidance on
implementation.
Among the many sectors of the economy, healthcare organizations
and public-sector organizations hold the greatest potential for increased
unionization. Laws and rules governing unionization in healthcare are some-
what different from those in other sectors. In Chapter 12, Donna Malvey and
Amanda Raffenaud summarize the legislative framework and judicial rulings
governing healthcare unionization, describe the evolving role of unions in
healthcare, and provide a description of the unionization and labor relations
process in healthcare organizations. They describe all phases of the labor rela-
tions process, from the union recognition phase through contract administra-
tion. The specific requirements and obligations of management and unions
in healthcare organizations, based largely on the 1974 amendments to the
National Labor Relations Act, are described. The chapter also addresses the
controversial area of physician unionization and the potential impact of the
Affordable Care Act on unions. Given the likelihood of increased unioniza-
tion in healthcare, the authors provide guidance on working effectively in a
unionized environment.
Among the most difficult tasks in the healthcare system is projecting
health workforce needs and matching these needs with supply. While most of

Prefac e xxi
the chapters in this book approach workforce issues from an organizational

perspective, Erin P. Fraher and Marisa Morrison address workforce planning
from a broader macro policy perspective. They discuss and assess methods used
to ensure that the United States, or, for that matter, any country or jurisdic-
tion, has the needed workforce in place, now and into the future. They examine
workforce planning not in a vacuum, but cognizant of changes throughout the
healthcare system that may affect workforce needs as well as new skill require-
ments. They address multiple related topics, including the distinction between
“demand” and “need,” the nature of oversupply and shortages, and alternative
methods of assessing projected supply of and demand for health workers, as
well as the lasting problem of uncertainty in making accurate projections.
The nursing profession is critical to the functioning of the healthcare
system. In the hospital sector, nurses are the only professional group present
24 hours a day and every day of the year. Nurses are highly skilled, indispens-
able, and central to patient care and quality. In Chapter 14, Cheryl B. Jones,
George H. Pink, and Lindsay T. Munn begin with a description of the types
of nursing personnel, their education, competency requirements, and scope
of practice. Understanding nursing roles is essential to understanding the
critical factors involved in nurse staffing and deployment. They then discuss
the substance of nurses’ work, staffing and alternative methods of measur-
ing nursing workload, and issues such as the role of nurses in unionized and
nonunionized settings, nurse–physician relationships, and stress and burnout.
They also address the key influence nurses have in value-based purchasing,
being heavily involved, for example, in care coordination and in ensuring a
patient- and caregiver-centered experience.
The quality improvement movement has finally achieved its migration
from manufacturing and service industries to healthcare. Given incentive
schemes that link reimbursement to quality indicators, and the availability of
information on quality to payers and consumers, quality and patient safety
are clearly hallmarks of healthcare organizations. Quality improvement is
based on a synthesis of process analysis, measurement, and human creativity.
In Chapter 15, Jordan Albritton and Bruce J. Fried provide a review of the
quality improvement approach and summarize its forms (e.g., Lean). They
take the view that a great deal of attention has been given to the mechanics
of quality improvement, namely, the use of such quality improvement tools
as run charts and Pareto diagrams. However, the human element, which is
necessary to interpret data and devise creative and effective solutions to qual-
ity problems, has received less attention. In this chapter, Albritton and Fried
identify the HR requirements, such as the development of effective quality
improvement teams, that are essential to effectively apply quality improve-
ment tools, interpret data, and develop effective and sustainable quality
improvement changes.

xxii Prefa c e
The two appendixes are new to this book. Appendix A discusses HR

metrics. Evaluation has become increasingly important in all aspects of orga-
nizational life, including HR functions. Appendix A provides background
information on the need for and use of HR metrics, and offers examples of
HR metrics. Appendix B includes six problem-based learning (PBL) cases.
PBL is a student-centered learning methodology requiring the student, along
with team members, to research a complex problem and design an evidence-
based and feasible solution to the issue. As described in Appendix B, student
teams read the case problem and identify what they need to learn in order to
respond to the problem. These learning objectives form the basis for inde-
pendent research and eventual collaboration of team members in writing the
case response. The PBL method has a motivational element in that students
themselves define their learning needs. Substantively, this approach provides
the opportunity for students to delve into specific HR issues in greater depth
and to use the most current research and writing on the topics presented in
the cases.
This textbook and the accompanying instructor resources are designed
to facilitate discussion and learning. The instructor resources include Power-
Point slides for each chapter and key teaching points. For access information,
e-mail hapbooks@ache.org.

ACKNOWLEDGMENTS
We are first and foremost very grateful to our colleagues who participated
in writing this book. They are all very busy and successful people who gen-
erously gave of their time and expertise to write creative and interesting
chapters, and were enormously responsive to our comments and suggestions.
Thank you so much to all contributing authors.
Next, our colleagues at Health Administration Press provided extraor-
dinary guidance from the overall book concept to the finest editing details. In
fact, as one chapter author indicated in an e-mail to a Health Administration
Press editor, “I wish you could edit all my manuscripts!” So we offer special
thanks to Andrew Baumann, Janet Davis, Cepheus Edmondson, Karin Hor-
ler, and Tulie O’Connor.
Bruce J. Fried and Myron D. Fottler
Thanks to my wife, Nancy, for her limitless emotional and intellectual sup-
port, and for, to the extent humanly possible, keeping me grounded in real-
ity. For continuously keeping me motivated, challenged, and inspired, credit
most certainly goes to Aaron, Shoshana, Noah, Kit, and Scout. I am also
thankful for the opportunity over the past 23 years to have taught and learned
from the enormously talented students at the University of North Carolina
at Chapel Hill.
Bruce J. Fried
Thanks to Alicia Beardsley-Pigon, my student assistant and health services

administration graduate student at the University of Central Florida. Her
assistance and patience with typing versions of my chapters, facilitating com-
munications with editorial colleagues and other authors, and finding appro-
priate and relevant materials to update the chapters were invaluable and very
much appreciated. My gratitude also goes to my wife, Carol, for her support
on this and other projects over the years. Finally, I thank Reid Oetjen, chair
of the Department of Health Management and Informatics at the University
of Central Florida, for his support of this project.
Myron D. Fottler
xxiii
CHAPTER
STRATEGIC HUMAN RESOURCES

MANAGEMENT
1
Myron D. Fottler
Learning Objectives
After completing this chapter, the reader should be able to
• define strategic human resources management,

• outline key human resources functions,
• discuss the significance of human resources management to present and
future healthcare executives, and
• describe the organizational and human resources systems that affect
organizational outcomes.
Introduction
Like most other service industries, the healthcare industry is labor intensive.
One reason for healthcare’s reliance on an extensive workforce is that produc-
ing a service and then storing it for later consumption is not possible.
In healthcare, the production of the service that is purchased and
the consumption of that service occur simultaneously. Thus, the interaction
between healthcare consumers and healthcare providers is an integral part of
the delivery of health services. Given the dependence on healthcare profes-
sionals to deliver services, the possibility of heterogeneity of service quality
must be recognized within an employee (as skills and competencies change
over time) and among employees (as different individuals or representatives
of various professions provide a service).
Human resources are all of the people who currently contribute to the
work of the organization as well as those who might contribute in the future
and those who have contributed in the recent past. The term human resources
also refers to the management of these people’s contributions and in this
sense is often abbreviated HR.
The intensive use of labor for service delivery and the possibility of
variability in professional practice require that leaders in the industry direct
1
2 Hu m a n Re so u rc e s i n H e a l th c a re
their attention toward managing the performance of the people involved in

the delivery of services. The effective management of people requires that
healthcare executives understand the factors that influence the performance
of individuals employed in their organizations. These factors include not only
the traditional human resources management (HRM) activities (i.e., recruit-
ment and selection, training and development, appraisal, compensation, and
employee relations) but also the environmental and other organizational
aspects that impinge on human resources’ activities.
Strategic human resources management (SHRM) is the process of
formulating HR strategies and implementation tactics that are aligned and
reinforce the organization’s business strategy. It requires development of a
comprehensive set of managerial activities and tasks related to developing
and maintaining a qualified workforce. This workforce, in turn, contributes
to organizational effectiveness, as defined by the organization’s strategic
goals. SHRM occurs in a complex and dynamic milieu of forces within the
organizational context. A significant trend within the last decade is for HR
managers to adopt a strategic perspective in their job and to recognize critical
linkages between organizational strategy and HR strategies.
This book explains and illustrates the methods and practices for increas-
ing the probability that competent personnel will be available to provide the ser-
vices delivered by the organization and the probability that these employees will
appropriately perform the necessary tasks. Implementing these methods and
practices means that requirements for positions must be determined, qualified
persons must be recruited and selected, employees must be trained and devel-
oped to meet future organizational needs, job performance must be evaluated,
and adequate rewards must be provided to attract and retain top performers.
All of these functions must be managed within the legal constraints
imposed by society (i.e., legislation, regulation, and court decisions). This
chapter emphasizes that HR functions are performed within the context of
the overall activities of the organization. These functions are influenced or
constrained by the environment, the organizational mission and strategies
that are being pursued, and the systems indigenous to the organization.
Why study SHRM? How does this topic relate to the career interests
or aspirations of present or future healthcare executives? Staffing the organiza-
tion, designing jobs, building teams, developing employee skills, identifying
approaches to improve performance and customer service, and rewarding
employee success are as relevant to line managers as they are to HR manag-
ers. A successful healthcare executive needs to understand human behavior,
work with employees effectively, and be knowledgeable about the numerous
systems and practices available to put together a skilled and motivated work-
force. The executive also has to be aware of economic, technological, social,
and legal issues that facilitate or constrain efforts to attain strategic objectives.

C h a p ter 1: Strategic H um an Resourc es Managem ent 3
Healthcare executives do not want to hire the wrong person, experi-

ence high turnover, manage unmotivated employees, be taken to court for
discrimination actions, be cited for unsafe practices, have poorly trained staff
undermine patient satisfaction, or engage in unfair labor practices. Despite
their best efforts, executives often fail at HRM because they hire the wrong
people or they do not motivate or develop their staff. The material in this
book can help executives avoid mistakes and achieve great results with their
workforce.
Healthcare organizations can gain a competitive advantage over com-
petitors by effectively managing their human resources. This competitive
advantage may include cost leadership (i.e., being a low-cost provider) and
product differentiation (i.e., having high levels of service quality). A 1994
study examined the HR practices and productivity levels of 968 organizations
across 35 industries (Huselid 1994). The effectiveness of each organization’s
HR practices was rated based on the presence of such benefits as incentive
plans, employee grievance systems, formal performance appraisal systems,
and employee participation in decision making. The study found that organi-
zations with high HRM effectiveness ratings clearly outperformed those with
low HRM rankings. A similar study of 293 publicly held companies reported
that productivity was highly correlated with effective HR practices (Huselid,
Jackson, and Schuler 1997).
Several more recent studies have also shown that effective management
of human resources can increase profitability, annual sales per employee, pro-
ductivity, market value, and growth and earnings per share (Kaufman 2010;
Messersmith and Guthrie 2010). In these studies, surveys were used to study
the sophistication of the organization’s HR practices, and responses created a
score from 0 to 100, where high scores represented state-of-the-art practices.
Performance was measured using accounting financial data. Results indicated
that organizations with better HR practices experienced greater increases in
financial performance relative to others. In addition, a survey of 200 chief
financial officers (CFOs) revealed that 92 percent believed that effective man-
agement of employees improves customer satisfaction (Mayer, Ehrhart, and
Schneider 2009). Customers also report more satisfaction when the climate
of the organization is more positive, employees generally get along well, and
turnover is low (Nishii, Lepak, and Schneider 2008).
Exhibit 1.1 summarizes HR practices that appear to enhance the effec-
tiveness and outcomes of organizations. These practices are often present in
organizations that are effective in managing their human resources, and they
recur repeatedly in studies of high-performing organizations. In addition,
these practices are interrelated and mutually reinforcing; achieving a posi-
tive result by implementing just one practice on its own is difficult. Recent
research in healthcare suggests that innovative and sophisticated HR practices

4 Hu m a n Re so u rc e s i n H e a l th c a re
are becoming more prevalent and enhance an organization’s overall perfor-

mance (Platonova and Hernandez 2013).
While these HR practices generally have a positive impact on organi-
zational performance, their relative effectiveness may vary depending on their
alignment (or lack thereof) among themselves and with the organization’s
EXHIBIT 1.1
Category Practices
Effective HR
Practices for HR planning/job analysis • Encourage employee involvement so that
Healthcare HR practices and managerial initiatives have
strong buy-in.
Organizations
• Encourage teamwork to make employees
more willing to collaborate.
• Use self-managed teams and decentraliza-
tion as basic elements of organizational
design to minimize management layers.
• Develop strategies to enhance employee
work/life balance.
Staffing • Be proactive in identifying and attracting
talent.
• In selecting new employees, use additional
criteria beyond basic skills (i.e., attitudes,
customer focus, and cultural fit).
• Provide opportunities for employee growth
so that employees are stretched to enhance
their skills.
Training/organizational • Invest in training and organizational pro-
development grams to enhance employee skills related to
organizational goals.
• Provide employees with future career oppor-
tunities by giving promotional priority to
internal candidates.
• Include customer service in new employee
onboarding and skill development.
Performance management • Recognize employees by providing monetary
and compensation and nonmonetary rewards.
• Offer high compensation contingent on orga-
nizational performance to reduce employee
turnover and increase attraction to high-
quality employees.
• Reduce status distinction and barriers such
as dress, language, office arrangement,
parking, and wage differentials.
• Base individual and team compensation on
goal-oriented results.
(continued)

Another random document with
no related content on Scribd:
There are six of these strange compositions, upon the stories of
David and Goliath, of David and Saul, of Jacob and Leah, and
others. Some years later they undoubtedly suggested to Sebastian
Bach the delicate little capriccio which he wrote upon the departure
of his brother for the wars. Apart from this they are of slight
importance except as indications of the experimental frame of mind
of their composer. Indeed, beyond imitation and to a small extent
description, neither harpsichord nor pianoforte music has been able
to make much progress in the direction of program music.
Kuhnau’s musical narratives were published in August, 1700. Earlier

than this he had published his famous Sonata aus dem B. The work
so named was appended to Kuhnau’s second series of suites or
Partien. It has little to recommend it to posterity save its name, which
here appears in the history of clavier music for the first time. Nor
does this name designate a form of music akin to the sonatas of the
age of Mozart and Beethoven, a form most particularly associated
with the pianoforte. Kuhnau merely appropriated it from music for
string instruments. There it stood in the main for a work which was
made up of several movements like the suite, but which differed from
the suite in depending less upon rhythm and in having a style more
dignified than that which had grown out of experiments with dance
tunes. In addition, the various movements which constituted a
sonata were not necessarily in the same key. Here alone it
possessed a possible advantage over the suite. Yet though in other
respects it cannot compare favorably to our ears with the suite,
Kuhnau cherished the dignity of style and name with which tradition
had endowed it. These he attempted to bestow upon music for the
clavier.[6]
The various movements lack definite form and balance. The first is in
rather heavy chord style, the chords being supported by a dignified
counterpoint in eighth notes. This leads without pause into a fugue
on a figure of lively sixteenth notes. The key is B-flat major. There
follows a short adagio in E-flat major, modulating to end in C minor,
in which key the last movement, a short allegro in triple time, is taken
up. The whole is rounded off by a return to the opening movement,
signified by the sign Da Capo.
Evidently pleased with this innovation, Kuhnau published in 1696 a

set of seven more sonatas called Frische Clavier Früchte. These
show no advance over the Sonata aus dem B in mastery of musical
structure. Still they are evidence of the efforts of one man among
many to give clavier music a life of its own and to bring it in
seriousness and dignity into line with the best instrumental music of
the day, namely, with the works of such men as Corelli, Purcell, and
Vivaldi. That he was unable to do this the verdict of future years
seems to show. The attempt was none the less genuine and
influential.
In the matter of structure, then, the seventeenth century worked out

and tested but a few principles which were to serve as foundation for
the masterpieces of keyboard music in the years to come. But these,
though few, were of vast importance. Chief among them was the
new principle of harmony. This we now, in the year 1700, find at the
basis of fugue, of prelude and toccata, and of dance form, not
always perfectly grasped but always in evidence. Musical form now
and henceforth is founded upon the relation and contrast of keys.
Consistently to hold to one thematic subject throughout a piece in

polyphonic style, skillfully to contrast or weave with that secondary
subjects, mark another stage of development passed. The fugue is
the result, now articulate, though awaiting its final glory from the
hand of J. S. Bach. To write little dance pieces in neat and precise
form is an art likewise well mastered; and to combine several of
these, written in the same key, in an order which, by affording
contrast of rhythms, can stir the listener’s interest and hold his
attention, is the established rule for the first of the so-called cyclic
forms, prototype of the symphony and sonata of later days. Such
were the great accomplishments of the musicians of the seventeenth
century in the matter of form.
V
In the matter of style, likewise, much was accomplished. We have
had occasion frequently to point out that in the main the harpsichord
remained throughout the first half of the seventeenth century under
the influence of the organ. For this instrument a conjunct or legato
style has proved to be most fitting. Sudden wide stretches,
capricious leaps, and detached runs seldom find a place in the
texture of great organ music. The organist strives for a smoothness
of style compatible with the dignity of the instrument, and this
smoothness may be taken as corollary to the fundamental
relationship between organ music and the vocal polyphony of the
sixteenth century.
On the other hand, by comparison with the vocal style, the organ
style is free. Where the composer of masses was restricted by the
limited ability of the human voice to sing wide intervals accurately,
the organist was limited only by the span of the hand. Where
Palestrina could count only upon the ear of his singers to assure
accurate intonation, the organist wrote for a keyboard which,
supposing the organ to be in tune, was a mechanism that of itself
could not go wrong. Given, as it were, a physical guarantee of
accuracy as a basis for experiment, the organist was free to devise
effects of sheer speed or velocity of which voices would be utterly
incapable. He had a huge gamut of sounds equally at his command,
a power that could be mechanically bridled or let loose. His
instrument could not be fatigued while boys could be hired to pump
the bellows. So long as his finger held down a key, or his foot a
pedal, so long would the answering note resound, diminishing,
increasing, increasing, diminishing, according to his desire, never
exhausted.
Therefore we find in organ music, rapid scales, arpeggios rising from

depths, falling from heights, new figures especially suited to the
organ, such as the ‘rocking’ figure upon which Bach built his well-
known organ fugue in D minor; deep pedal notes, which endure
immutably while above them the artist builds a castle of sounds;
interlinked chords marching up and down the keyboard, strong with
dissonance. There are trills and ornamental turns, rapid thirds and
sixths. And in all these things organ music displays what is its own,
not what it has inherited from choral music.
Yet, notwithstanding the magnificent chord passages so in keeping

with the spirit of the instrument, in which only the beauty of harmonic
sequence is considered, the treatment of musical material by the
organists is prevailingly polyphonic. The sound of a given piece is
the sound of many quasi-independent parts moving along together,
in which definite phrases or motives constantly reappear. The
harmony on which the whole rests is not supplied by an
accompaniment, but by the movement of the several voice-parts
themselves in their appointed courses. And it may be said as a
generality that these parts progress by steps not wider than that
distance the hand can stretch upon the keyboard.
During the first half of the seventeenth century the harpsichord was
but the echo of the organ. Even the collections of early English
virginal music, which in some ways seem to offer a brilliant
exception, are the work of men who as instrumentalists were
primarily organists. In so far as they achieved an instrumental style
at all it was usually a style fitting to a small organ. The few cases
where John Bull’s cleverness displayed itself in almost a true
virtuoso style are exceptions which prove the rule. Not until the time
of Chambonnières and Froberger do we enter upon a second stage.
About the middle of the seventeenth century Chambonnières was

famous over Europe as a performer upon the harpsichord. As first
clavicinist at the court of France, his manner of playing may be taken
to represent the standard of excellence at that time. Constantine
Huygens, a Dutch amateur exceedingly well-known in his day,
mentions him many times in his letters with unqualified admiration,
always as a player of the harpsichord, or as a composer for that
instrument. Whatever skill he may have had as an organist did not
contribute to his fame; and his two sets of pieces for harpsichord,
published after his death in 1670, show the beginnings of a distinct
differentiation between harpsichord and organ style.
Title page of Kuhnan's "Neue Clavier-Übung".
The harpsichord possesses in common with the organ its keyboard
or keyboards, which render the playing of solid chords possible. The
lighter action of the harpsichord gives it the advantage over the
organ in the playing of rapid passages, particularly of those light
ornamental figures used as graces or embellishments, such as trills,
mordents, and turns. A further comparison with the organ, however,
reveals in the harpsichord only negative qualities. It has no volume
of sound, no power to sustain tones, no deep pedal notes.
Consequently the smooth polyphonic style which sounds rich and
flowing on the organ, sounds dry and thin upon the weaker
instrument. The composer who would utilize to advantage what little
sonority there is in the harpsichord must be free to scatter notes here
and there which have no name or place in the logic of polyphony, but
which make his music sound well. Voice parts must be interrupted,
notes taken from nowhere and added to chords. The polyphonic web
becomes disrupted, but the harpsichord profits by the change. It is
Chambonnières who probably first wrote in such a style for the
harpsichord.
He learned little of it from what had been written for the organ, but
much from music for the lute, which, quite as late as the middle of
the century, was interchangeable with the harpsichord in
accompaniments, and was held to be equal if not superior as a solo
instrument. It was vastly more difficult to play, and largely for this
reason fell into disuse. The harpsichord is by nature far nearer akin
to it than to the organ. The free style which lutenists were driven to
invent by the almost insuperable difficulties of their instrument, is
nearly as suitable to the harpsichord as it is to the lute. Without
doubt the little pieces of Denis Gaultier were played upon the
harpsichord by many an amateur who had not been able to master
the lute. The skilled lutenist would find little to give him pause in the
harpsichord music of Chambonnières. The quality of tone of both
instruments is very similar. For neither is the strict polyphony of
organ music appropriate; for the lute it is impossible. Therefore it fell
to the lutenists first to invent the peculiar instrumental style in which
lie the germs of the pianoforte style; and to point to their cousins,
players of the harpsichord, the way towards independence from
organ music.
Froberger came under the influence of Denis Gaultier and

Chambonnières during the years he spent in Paris, and he adopted
their style and made it his own. He wrote, it is true, several sets of
ricercars, capriccios, canzonas, etc., for organ or harpsichord, and in
these the strict polyphonic style prevails, according to the
conventionally more serious nature of the compositions. But his fame
rests upon the twenty-eight suites and fragments of suites which he
wrote expressly for the harpsichord. These are closely akin to lute
music, and from the point of view of style are quite as effective as
the music of Chambonnières. In harmony they are surprisingly rich.
Be it noted, too, in passing, that they are not lacking in emotional
warmth. Here is perhaps the first harpsichord music which demands
beyond the player’s nimble fingers his quick sympathy and
imagination—qualities which charmed in Froberger’s own playing.
Kuhnau as a stylist is far less interesting than Froberger, upon

whose style, however, his clavier suites are founded. His importance
rests in the attempts he made to adapt the sonata to the clavier, in
his experiments with descriptive music, and in the influence he had
upon his contemporaries and predecessors, notably Bach and
Handel. Froberger is the real founder of pianoforte music in
Germany, and beyond him there is but slight advance either in style
or matter until the time of Sebastian Bach.
What we may now call the harpsichord style, as exemplified in the

suites of Chambonnières and Froberger, is relatively free. Both
composers had a fondness for writing in four parts, but these parts
are not related to each other, nor woven together unbrokenly as in
the polyphonic style of the organ. They cannot often be clearly
followed throughout a given piece. The upper voice carries the music
along, the others accompany. The arrangement is not wholly an
inheritance from the lute, but is in keeping with the general tendency
in all music, even at times in organ music, toward the monodic style,
of which the growing opera daily set the model.
But the harpsichord style of this time is by no means a simple

system of melody and accompaniment. Though the three voice parts
which support the fourth dwell together often in chords, they are not
without considerable independent movement. They constitute the
harmonic background, as it were, which, though serving as
background, does not lack animation and character in itself. In other
words, we have a contrapuntal, not a polyphonic, style.
A marked feature of the music is the profuse number of graces and

embellishments. These rapid little figures may be akin to the vocal
embellishments which even at the beginning of the seventeenth
century were discussed in theoretical books; but they seem to flower
from the very nature of the harpsichord, the light tone and action of
which made them at once desirable and possible. They are but
vaguely indicated in the manuscripts, and there can be no certainty
as to what was the composer’s intention or his manner of
performance. Doubtless they were left to the discretion of the player.
At any rate for a century more the player took upon himself the
liberty of ornamenting any composer’s music to suit his own whim.
These agrémens[7] were held to be and doubtless were of great
importance. Kuhnau, in the preface to his Frische Clavier Früchte,
speaks of them as the sugar to sweeten the fruit, even though he left
them much to the taste of players; and Emanuel Bach in the second
half of the eighteenth century devoted a large part of his famous
book on playing the clavier to an analysis and minute explanation of
the host of them that had by then become stereotyped. They have
not, however, come down into pianoforte music. It is questionable if
they can be reproduced on the pianoforte, the heavy tone of which
obscures the delicacy which was their charm. They must ever
present difficulty to the pianist who attempts to make harpsichord
music sound again on the instrument which has inherited it.
The freedom from polyphonic restraint, inherited from the lute, and
the profusion of graces which have sprouted from the nature of the
harpsichord, mark the diversion between music for the harpsichord
and music for the organ. In other respects they are still much the
same; that is to say, the texture of harpsichord music is still close—
restricted by the span of the hand. This is not necessarily a sign of
dependence on the organ, but points rather to the young condition of
the art. It is not to be expected that the full possibilities of an
instrument will be revealed to the first composers who write for it
expressly. They lie hidden along the way which time has to travel.
But Chambonnières, in France, and Froberger, in Germany, opened
up the special road for harpsichord music, took the first step which
others had but to follow.
Neither in France nor in Germany did the next generation penetrate

beyond. Le Gallois, a contemporary of Chambonnières, has
remarked that of the great player’s pupils only one, Hardelle, was
able to approach his master’s skill. Among those who carried on his
style, however, must be mentioned d’Anglebert,[8] Le Begue,[9] and
Louis and François Couperin, relatives of the great Couperin to
come.
In Germany Georg and Gottlieb Muffat stand nearly alone with

Kuhnau in the progress of harpsichord music between Froberger and
Sebastian Bach. Georg Muffat spent six years in Paris and came
under French influence as Froberger had come, but his chief
keyboard works (Apparatus Musico Organisticus (1690)) are twelve
toccatas more suited to organ than to harpsichord. In 1727 his son
Gottlieb had printed in Vienna Componimenti musicali per il
cembalo, which show distinctly the French influence. Kuhnau looms
up large chiefly on account of his sonatas, which are in form and
extent the biggest works yet attempted for clavier. By these he
pointed toward a great expansion of the art; but as a matter of fact
little came of it. In France, Italy, and Germany the small forms were
destined to remain the most popular in harpsichord music; and the
sonatas and concertos of Bach are immediately influenced by study
of the Italian masters, Corelli and Vivaldi.
In Italy, the birthplace of organ music and so of a part of harpsichord
music, interest in keyboard music of any kind declined after the
death of Frescobaldi in 1644, and was replaced by interest in opera
and in music for the violin. Only one name stands out in the second
half of the century, Bernardo Pasquini, of whose work, unhappily,
little remains. He was famous over the world as an organist, and the
epitaph on his tombstone gives him the proud title of organist to the
Senate and People of Rome. Also he was a skillful performer on the
harpsichord; but he is more nearly allied to the old polyphonic school
than to the new. A number of works for one and for two harpsichords
are preserved in manuscript in the British Museum, and these are
named sonatas. Some are actually suites, but those for two
harpsichords have little trace of dance music or form and may be
considered as much sonatas as those works which Kuhnau
published under the same title. All of Kuhnau’s sonatas appeared
before 1700 and the date on the manuscript in the British Museum is
1704. Pasquini was then an old man, and it is very probable that
these sonatas were written some years earlier; in which case he and
not Kuhnau may claim the distinction of first having written music for
the harpsichord on the larger plan of the violin concerto and the
sonatas of Corelli.[10]
Two books of toccatas by Alessandro Scarlatti give that facile

composer the right to be numbered among the great pioneers in the
history of harpsichord music. These toccatas are in distinct
movements, usually in the same key, but sharply contrasted in
content. The seventh is a theme and variations, in which Scarlatti
shows an appreciation of tonal effects and an inventiveness which
are astonishingly in advance of the time. He foreshadows
unmistakably the brilliant style of his son Domenico; indeed, he
accounts in part for what has seemed the marvellous instinct of
Domenico. If, as is most natural, Domenico approached the
mysteries of the harpsichord through his father, he began his career
with advantages denied to all others contemporary with him, save
those who, like Grieco, received that father’s training. Alessandro
Scarlatti was one of the most greatly endowed of all musicians. The
trend of the Italian opera during the eighteenth century toward utter
senselessness has been often laid partly to his influence; but in the
history of harpsichord music that influence makes a brilliant showing
in the work of his son, who contributed perhaps more than any other
one man to the technique of writing not only for harpsichord but for
pianoforte.
Little of the harpsichord and clavichord music of the seventeenth

century is heard today. It has in the main only an historical interest.
The student who looks into it will be amazed at some of its beauties;
but as a whole it lacks the variety and emotional strength which
claim a general attention. Nevertheless it is owing to the labor and
talent of the composers of these years that the splendid
masterpieces of a succeeding era were possible. They helped
establish the harmonic foundation of music; they molded the fugue,
the prelude, the toccata, and the suite; they developed a general
keyboard style. After the middle of the century such men as
Froberger and Kuhnau in Germany, Chambonnières, d’Anglebert,
and Louis and François Couperin in France, and Alessandro
Scarlatti in Italy, finally gave to harpsichord music a special style of
its own, and to the instrument an independent and brilliant place
among the solo instruments of that day. Out of all the confusion and
uncertainty attendant upon the breaking up of the old art of vocal
polyphony, the enthusiasm of the new opera, the creation of a new
harmonic system, the rise of an instrumental music independent of
words, these men slowly and steadily secured for the harpsichord a
kingdom peculiarly its own.
FOOTNOTES:
[1] It should be noted in passing that during the early stages of the growth of
polyphonic music, roughly from the eleventh to the fifteenth century, composers
had brought over into their vocal music a great deal of instrumental technique or
style, which had been developed on the crude organs, and on the accompanying
instruments of the troubadours. In the period which we are about to treat the
reverse is very plainly the case.
[2] At the head of Sebastian Bach’s Musikalisches Opfer stands the Latin
superscription: Regis Iussu Cantio et Reliqua Canonica Arte Resoluta. The initial
letters form the word ricercar.
[3] Cf. Vol. VI, Chap. XV.
[4] Suites were known in England as ‘lessons,’ in France as ordres, in Germany as

Partien, and in Italy as sonate da camera.
[5] There was a form of suite akin to the variation form. In this the same melody or
theme served for the various dance movements, being treated in the style of the
allemande, courante, or other dances chosen. Cf. Peurl’s Pavan, Intrada, Dantz,
and Gaillarde (1611); and Schein’s Pavan, Gailliarde, Courante, Allemande, and
Tripla (1617). This variation suite is rare in harpsichord music. Froberger’s suite on
the old air, Die Mayerin, is a conspicuous exception.
[6] 'Denn warum sollte man auf dem Clavier nicht eben wie auf anderen
Instrumenten dergleichen Sachen tractieren können?’ he writes in his preface to
the ‘Seven New Partien,’ 1692.
[7] So they were called in France, which until the time of Beethoven set the model
for harpsichord style. In Germany they were called Manieren.
[8] D’Anglebert published in 1689 a set of pieces, for the harpsichord, containing
twenty variations on a melody known as Folies d’Espagne, later immortalized by
Corelli.
[9] Le Begue (1630-1702) published Pièces de clavecin in 1677.
[10] See J. S. Shedlock: ‘The Pianoforte Sonata,’ London, 1895.

CHAPTER II
THE GOLDEN AGE OF HARPSICHORD
MUSIC
The period and the masters of the ‘Golden Age’—Domenico
Scarlatti; his virtuosity; Scarlatti’s ‘sonatas’; Scarlatti’s technical
effects; his style and form; æsthetic value of his music; his
contemporaries—François Couperin, le Grand; Couperin’s
clavecin compositions; the ‘musical portraits’; ‘program music’—
The quality and style of his music; his contemporaries, Daquin
and Rameau—John Sebastian Bach; Bach as virtuoso; as
teacher; his technical reform; his style—Bach’s fugues and their
structure—The suites of Bach: the French suites, the English
suites, the Partitas—The preludes, toccatas and fantasies;
concertos; the ‘Goldberg Variations’—Bach’s importance; his
contemporary Handel.
In round figures the years between 1700 and 1750 are the Golden
Age of harpsichord music. In that half century not only did the
technique, both of writing for and performing on the harpsichord,
expand to its uttermost possibilities, but there was written for it music
of such beauty and such emotional warmth as to challenge the best
efforts of the modern pianist and to call forth the finest and deepest
qualities of the modern pianoforte.
It was an age primarily of opera, of the Italian opera with its

senseless, threadbare plots, its artificial singers idolized in every
court, its incredible, extravagant splendor. The number of operas
written is astonishing, the wild enthusiasm of their reception hardly
paralleled elsewhere in the history of music. Yet of these many works
but an air or two has lived in the public ear down to the present day;
whereas the harpsichord music still is heard, though the instrument
for which it was written has long since vanished from our general
musical life.
Practically the whole seventeenth century has been required to lay

down a firm foundation for the development of instrumental music in
all its branches. This being well done, the music of the next epoch is
not unaccountably surprising. As soon as principles of form had
become established, composers trod, so to speak, upon solid
ground; and, sure of their foothold, were free to make rapid progress
in all directions. In harpsichord music few new forms appeared. The
toccata, prelude, fugue, and suite offered room enough for all the
expansion which even great genius might need. Within these limits
the growth was twofold: in the way of virtuosity and refinement of
style, and in the way of emotional expression. That music which
expands at once in both directions, or in which, rather, the two
growths are one and the same, is truly great music. Such we shall
now find written for the harpsichord.
Each of the three men whose work is the chief subject of this chapter
is conspicuous in the history of music by a particular feature.
Domenico Scarlatti is first and foremost a great virtuoso, Couperin
an artist unequalled in a very special refinement of style, Sebastian
Bach the instrument of profound emotion. In these features they
stand sharply differentiated one from the other. These are the
essential marks of their genius. None, of course, can be
comprehended in such a simple characterization. Many of Scarlatti’s
short pieces have the warmth of genuine emotion, and Couperin’s
little works are almost invariably the repository of tender and naïve
sentiment. Bach is perhaps the supreme master in music and should
not be characterized at all except to remind that his vast skill is but
the tool of his deeply-feeling poetic soul.
I
It will be noticed that each of these great men speaks of a different
race. We may consider Scarlatti first as spokesman in harpsichord
music of the Italians, who at that time had made their mark so deep
upon music that even now it has not been effaced, nor is likely to be.
His father, Alessandro, was the most famous and the most gifted
musician in Europe. From Naples he set the standard for the opera
of the world, and in Naples his son Domenico was born on October
26, 1685, a few months only after the birth of Sebastian Bach in
Eisenach. Domenico lived with his father and under his father’s
guidance until 1705, when he set forth to try his fame. He lived a few
years in Venice and there met Handel in 1708, with whom he came
back to Rome. Here in Rome, at the residence of Corelli’s patron,
Cardinal Ottoboni, took place the famous contest on organ and
harpsichord between him and Handel. For Handel he ever professed
a warm friendship and the most profound admiration.
He remained for some years in Rome, at first in the service of Marie

Casimire, queen of Poland, later as maestro di capella at St. Peter’s.
In 1719 came a journey to London in order to superintend
performances of his operas. From 1721 to 1725 he seems to have
been installed at the court of Lisbon; and then, after four years in
Naples, he accepted a position at the Spanish court in Madrid. Just
how long he stayed there is not known. In 1754 he was back again in
Naples, and in Naples he died in 1757, seven years after the death
of Bach.
Scarlatti wrote many operas in the style of his father, and these were
frequently performed, with success, in Italy, England, Spain, and
elsewhere. During his years at St. Peter’s he also wrote sacred
music; but his fame now rests wholly upon his compositions for the
harpsichord and upon the memory of the extraordinary skill with
which he played them.
We have dwelt thus briefly upon a few events of his life to show how
widely he had travelled and in how many places his skill as a player
must have been admired. That in the matter of virtuosity he was
unexcelled can hardly be doubted. It is true that in the famous
contest with Handel he came off the loser on the organ, and even his
harpsichord playing was doubted to excel that of his Saxon friend.
But these contests were a test of wits more than of fingers, a trial of
extempore skill in improvising fugues and double fugues, not of
virtuosity in playing.
Two famous German musicians, J. J. Quantz and J. A. Hasse, both

heard him and both marvelled at his skill. Monsieur L’Augier, a gifted
amateur whom Dr. Burney visited in Vienna, told a story of Scarlatti
and Thomas Roseingrave,[11] in which he related that when
Roseingrave first heard Scarlatti play, he was so astonished that he
would have cut off his own fingers then and there, had there been an
instrument at hand wherewith to perform the operation; and, as it
was, he went months without touching the harpsichord again.
Whom he had to thank for instruction is not known. There is nothing

in his music to suggest that he was ever a pupil of Bernardo
Pasquini, who, however, was long held to have been his master. J.
S. Shedlock, in his ‘History of the Pianoforte Sonata,’ suggests that
he learned from Gaëtano Greco or Grieco, a man a few years his
senior and a student under his father; but it would seem far more
likely that Domenico profited immediately from his father, who, we
may see from a letter to Ferdinand de’ Medici, dated May 30, 1705,
had watched over his son’s development with great care. It must not
be forgotten that Alessandro Scarlatti’s harpsichord toccatas,
described in the previous chapter, are, in spite of a general
heaviness, often enlivened by astonishing devices of virtuosity.
Scarlatti wrote between three and four hundred pieces for the
harpsichord. The Abbé Santini[12] possessed three hundred and
forty-nine. Scarlatti himself published in his lifetime only one set of
thirty pieces. These he called exercises (esercizii) for the
harpsichord. The title is significant. Before 1733 two volumes, Pièces
pour le clavecin, were published in Paris; and some time between
1730 and 1737 forty-two ‘Suites of Lessons’ were published in
London under the supervision of Roseingrave. More were printed in
London in 1752. Then came Czerny’s edition, which includes two
hundred pieces; and throughout the nineteenth century various
selections and arrangements have appeared from time to time, von
Bülow having arranged several pieces in the order of suites, Tausig
having elaborated several in accordance with the modern pianoforte.
A complete and authoritative edition has at last been prepared by
Sig. Alessandro Longo and has been printed in Italy by Ricordi and
Company.
By far the greater part of these many pieces are independent of each
other. Except in a few cases where Scarlatti, probably in his youth,
followed the model of his father’s toccatas, he keeps quite clear of
the suite cycle. The pieces have been called sonatas, but they are
not for the most part in the form called the sonata form. This form
(which is the form in which one piece or movement may be cast and
is not to be confused with the sequence or arrangement of
movements in the classical sonata) is, as we shall later have ample
opportunity to observe, a tri-partite or ternary form; whereas the so-
called sonatas of Scarlatti are in the two-part or binary form, which
is, as we have seen, the form of the separate dance movements in
the suite. Each ‘sonata’ is, like the dance movements, divided into
two sections, usually of about equal length, both of which are to be
repeated in their turn. In general, too, the harmonic plan is the same
or nearly the same as that which underlies the suite movement, the
first section modulating from tonic to dominant, the second back from
dominant to tonic. But within these limits Scarlatti allows himself
great freedom of modulation. It is, in fact, this harmonic expansion
within the binary form which makes one pause to give Scarlatti an
important place in the development of the sonata form proper.
The harmonic variety of the Scarlatti sonatas is closely related to the

virtuosity of their composer. He spins a piece out of, usually, but not
always, two or three striking figures, by repeating them over and
over again in different places of the scale or in different keys. His
very evident fondness for technical formulæ is thus gratified and the
piece is saved from monotony by its shifting harmonies.
A favorite and simple shift is from major to minor. This he employs
very frequently. For example, in a sonata in G major, No. 2 of the
Breitkopf and Härtel collection of twenty sonatas[13] measures 13,
14, 15, and 16, in D major, are repeated immediately in A major. In
20, 21, 22, and 23, the same style of figure and rhythm appears in D
major and is at once answered in D minor. Toward the end of the
second part of the piece the process is duplicated in the tonic key. In
the following sonata at the top of page seven occurs another similar
instance. It is one of the most frequent of his mannerisms.
The repetition of favorite figures is by no means always

accompanied by a change of key. The two-measure phrase
beginning in the fifteenth measure of the third sonata is repeated
three times note for note; a few measures later another figure is
treated in the same fashion; and in yet a third place, all in the first
section of this sonata, the trick is turned again. Indeed, there are
very few of Scarlatti’s sonatas in which he does not play with his
figures in this manner.
We have said that often he varies his key when thus repeating
himself, and that such variety saves from monotony. But it must be
added that even where there is no change of key he escapes being
tedious to the listener. The reason must be sought in the sprightly
nature of the figures he chooses, and in the extremely rapid speed at
which they are intended to fly before our ears. He is oftenest a
dazzling virtuoso whose music appeals to our bump of wonder, and,
when well played, leaves us breathless and excited.
The pieces are for the most part extremely difficult; and this, together
with his ever-present reiteration of special harpsichord figures, may
well incline us to look upon them as fledgling études. The thirty
which Scarlatti himself chose to publish he called esercizii, or
exercises. We may not take the title too literally, bearing in mind that
Bach’s ‘Well-Tempered Clavichord’ was intended for practice, as
were many of Kuhnau’s suites. But that Scarlatti’s sonatas are
almost invariably built up upon a few striking, difficult and oft-
repeated figures, makes their possible use as technical practice

Textbook Human Resources in Healthcare Managing For Success Bruce J Fried Ebook All Chapter PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Textbook Human Resources in Healthcare Managing For Success Bruce J Fried Ebook All Chapter PDF

Uploaded by

Copyright:

Available Formats

Human Resources in Healthcare

Managing for Success Bruce J. Fried

Managing Human Resources Parbudyal Singh

Managing Human Resources Scott A. Snell

Everything Fried A Fried Cookbook with Delicious Fried

Advances in Human Factors and Ergonomics in Healthcare

Mastering Informatics A Healthcare Handbook for Success

CPHIMS Review Guide: Preparing for Success in

The Healthcare Professional Workforce Understanding

Diaspora Networks in International Business:

Bruce J. Fried and

Copying and distribution of this PDF is prohibited without written permission.

LTC Lee W. Bewley, PhD, FACHE

Dolores G. Clement, DrPH, FACHE

Michael Counte, PhD

Mark L. Diana, PhD

Blair D. Gifford, PhD

James W. Henderson, PhD

Suzanne Hobbs, DrPH

Nir Menachemi, PhD

Mary S. O’Shaughnessey, DHA

Copying and distribution of this PDF is prohibited without written permission.

Bruce J. Fried and

Health Administration Press, Chicago, Illinois

Association of University Programs in Health Administration, Arlington, Virginia

Copying and distribution of this PDF is prohibited without written permission.

This publication is intended to provide accurate and authoritative information in regard to

Copyright © 2015 by the Foundation of the American College of Healthcare Executives.

Library of Congress Cataloging-in-Publication Data

Health Administration Press Association of University Programs

Copying and distribution of this PDF is prohibited without written permission.

Chapter 1. Strategic Human Resources Management...........................1

Chapter 2. Employment Law, Employee Relations, and Healthcare...35

Chapter 3. Healthcare Professionals...................................................79

Chapter 4. Credentialing of Healthcare Providers............................107

Chapter 5. Workforce Diversity........................................................123

Chapter 6. Job Analysis and Job Design..........................................143

Chapter 7. Recruitment, Selection, and Retention...........................181

Chapter 8. Performance Management..............................................235

Chapter 9. Compensation Practices, Planning, and Challenges.........275

Chapter 10. Employee Benefits..........................................................321

Chapter 11. Organizational Development and Learning....................351

Chapter 12. Managing with Organized Labor...................................389

Chapter 13. Workforce Planning in a Rapidly Changing

Chapter 14. The Nurse Workforce in Healthcare Organizations.........455

Chapter 15. Human Resources Management Practices for

Appendix A: Human Resources Metrics..................................................529

Copying and distribution of this PDF is prohibited without written permission.

Chapter 1. Strategic Human Resources Management...........................1

Chapter 2. Employment Law, Employee Relations, and Healthcare...35

Chapter 3. Healthcare Professionals...................................................79

Chapter 4. Credentialing of Healthcare Providers............................107

Chapter 5. Workforce Diversity........................................................123

Copying and distribution of this PDF is prohibited without written permission.

Chapter 6. Job Analysis and Job Design..........................................143

Chapter 7. Recruitment, Selection, and Retention...........................181

Chapter 8. Performance Management..............................................235

Copying and distribution of this PDF is prohibited without written permission.

The Cynicism About Performance Management.............254

Chapter 9. Compensation Practices, Planning, and Challenges.........275

Chapter 10. Employee Benefits..........................................................321

Chapter 11. Organizational Development and Learning....................351

Copying and distribution of this PDF is prohibited without written permission.