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Chapter 6: Workforce Diversity

Objective 1:

What is diversity?
Dimensions of Diversity
• Human Diversity (minimum)
• Race, age, gender, family status, sexual orientation, disabilities

• Cultural Diversity (secondary)
• Language, social class, ethics, religion, etc…

• Systems Diversity
• Teamwork reengineering, strategic alliances, employee empowerment, quality focus, etc…

Barriers to achieving a diverse workplace include team members not understanding the differences between each other that can cause tension and conflict.

Prejudice in the Workplace

• What does prejudice mean?
• Invisible-hand effect

• What is a stereotype? • Healthcare related lawsuits filed by EEOC
• Lawsuit

Objective 2:

Business Case for Diversity
• Caregivers and leaders should represent the backgrounds of the communities they serve. • Unique for each HCO • An organization can achieve and sustain growth and profitability • Failure to take advantage of these opportunities will mean the difference b/n being a provider and employer of choice and losing ground to competitors.

Governance Impact
• Board members should reflect the diversity of the community.
• They will have an interest in making sure that the HCO is a fair and equitable employer and provider of care. • The will have a better understanding or knowledge of the needs of the community that can reduce health care disparities. • Can serve as a role model to minority employees. • They will do more than just show up to the board meetings.

• Having diverse board members can protect the HCOs by supporting diversity programs.

Legal Issues
• Does having a diversity program enhance the value of the healthcare organization?
• Educated, skilled, and experienced professionals that are in the minority bring (what to the HCO)?

• Laws prohibit the employment discrimination. • Civil Rights Act of 1964: bans discrimination in any activities (training, employment, construction…) that are funded by federal monies.
• Protects individuals whose native language is not English.

Objective 3:

Diversity in Healthcare Leadership
• Study 1: A Race/Ethnic Comparison of Career Attainments in Healthcare Management • 1992: Caucasian and African-American healthcare executives compared
• African-Americans were in lower positions • Made less money • Had lower job satisfaction levels

• 1996: < 2% of minorities held executive positions (CEO, COO, etc.) • 2002:
• More Caucasian administrators in hospital settings • Caucasian females/male earned more $$ than minority women/male administrators

Objective 3:

Diversity in Healthcare Leadership
• Study 2: Advancing Diversity Leadership in Healthcare

Objective 3:

Diversity in Healthcare Leadership
• Managing a diverse workforce
1) Employee perspective 2) Patient focus 3) Inclusion 4) Community perspective

Near the middle of Diversity on Care Delivery Impact 28%,of this century î ______ population more than half of 55%, ______ population î • “Unequal US citizens the Treatment” 122%, ______ population • Disparities members îcare will be in patient 190%, of “minority” ______ population î groups. •African-Americans, Asian, Hispanic, Native-Americans Our country is undeniably becoming home to an everincreasing number of individuals from distinct racial and ethnic backgrounds.

Objective 4: 9%, U.S. population growth

Objective 5:

Components of an Effective Diversity Program
• What are some actions that can be taken to establish a diversity program?
• • • • • • • Commitment from senior management and governing board Broaden the definition of diversity Recognize the business case for diversity at the leadership level Tie diversity goals to business objectives (the bottom line) Recruiting events that target different minority groups Mentoring minorities Develop programs that emphasize and celebrate diversity

Workforce Diversity

Cohen, J. J., Gabriel, B. A., & Terrell, C. (2002). The Case For Diversity In The Health Care Workforce. Health Affairs, 21(5), 90-102. Evans, R. M. (2008). Workforce Diversity. In B. Fried & M. D. Fottler (Authors), Human resources in healthcare: managing for success (pp. 145-162). Chicago: Health Administration Press.

This chapter focuses on the processes of recruitment, selection and retention. These three concepts are all related to each other and to other human resources management functions. If there is effective recruitment and selection then their will be a better chance of employee retention.

The main purpose of recruitment is to gather a pool of qualified personnel. Recruitment is the range of processes an organization uses to attract qualified individuals to apply at their organization. They want to attract qualified individuals on a timely basis and in sufficient numbers.

When an organization looks to recruitment strategies, they consider different questions that need to be asked. Whether they should promote from within for an available position or if they should go to external applicants. Whether the organization should look at alternatives to their full time employees such as, outsourcing, flexible staffing or contingent workers. And should the organization hire someone who has all the technical skills already or someone who fits the organization but may require some additional training.

The success of recruitment is reliant on many factors. Those factors would include, the attractiveness of the organization, where it is located, the work climate and culture of the organization, the managerial staff and their behaviors as well as workload. Another successful way of recruitment is looking at the perspective of applicants and potential employees. Being able to understand their needs and expectations is very important to the implementation of effective recruitment strategies.

The organization has a human resources plan which includes specifics on the organization’s strategies, recruitment and hiring approaches and a clear statement of how HR practices support the organization’s goals. Therefore, those involved in the recruitment and selection process must have in depth knowledge of the position that needs to be filled and well as how that position is related to other positions.

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The recruitment process begins with a job analysis. The job analysis consists of question of job tasks, knowledge, skills, abilities and specific qualifications required by applicants. The recruitment process also includes an examination of the external environment which looks at the supply of potential job applicants and competitiveness for the position.

Something else that the analysis should do is to evaluate the compensation and benefits that individuals are given at other organizations with similar jobs. The process should then continue with a review of past recruitment strategies for similar positions. The Human Resources Information System (HRIS) provides useful information during the process of recruitment.

The HRIS helps with determining potential internal candidates, potential external candidates, and provides information on the success of recruitment sources used in the past. Recruitment can be very costly but the HRIS is also helpful when determining the cost effectiveness and efficiency that comes along with recruitment.

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Advantages May improve employee moral and encourage valued employees to stay with the organization These applicants have a good understanding of the organization May reinforce employees sense of job security May be faster and may involve lower cost for certain jobs

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Disadvantages Possible morale problems among those not selected May require strong training and management development activities May manifest the Peter Principal May cause a ripple effect in vacancies which need to be filled

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Advantages Bring new ideas into the organization It may be less expensive than training internal applicants External applicants come without dysfunctional relationships with others and without being involved in organizational politics.

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Disadvantages May identify candidates who have technical skills but does not fit in the culture of the organization May cause morale problems with internal applicants who were not selected May require longer adjustment and socialization.

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Another excellent source for recruitment is employee referrals. This is a great source because the employee already knows the organization and what is expected. This is a powerful strategy because employee referrals tend to yield employees who stay longer and are more loyal to the organization. Another source would be former employees. These would be employees that left on good terms that they may want to return to the organization.

Employee selection is the process of collecting and evaluating applicant information that will help the employers to extend a job offer. Therefore, the selection process is a matter of predicting which of the candidates in the pool is likely to achieve success in the position. One goal of selection would be to find someone who will stay in the position and someone who will fit with the organization. With selection comes a careful analysis of the applicant’s knowledge, skills, abilities and attitudes.

The goal of selection is to identify from a group of people the applicant that to whom the job offer should be made. The organization then needs to use tools in order to assess the applicant’s knowledge, and abilities. There are many selection tools that can be used to evaluate the applicant. Such tools are job application forms, standardized tests, personal interviews, simulations and references.

The selection tools should be used based on a full range on knowledge of the job requirements such as education, credentials and experience. Without having a formal understanding of the job criteria, the organization runs the risk of hiring someone who is not going to perform successfully.

Selection tools need to be both reliable as well as valid. Reliability is defined as the repeatability or consistency of a selection tool. Construct validity refers to the degree in which the selection tool actually measures the construct it intends to measure and then determines the conclusions that can be drawn from the tools used.

There are a number of factors that effect the demand for healthcare workers. These would include population growth, the aging of the population, improved diagnostic techniques and consumer demand for a full array of diagnostic and therapeutic technologies. The turnover rate is a simple ratio that provides only a summary of the gross movement in and out of the organization during a specific time period.

The retention rate is the number of specific individuals or cohorts that enter and exit an organization. So the distinction is that retention views an individual or a group as an entity and therefore retention allows for a more thorough examination of how the loss of one individual or cohort influences retention strategies and productivity.

Annual average turnover rate for hospital workers is 20 percent. Nurse dissatisfaction is cited as the key reason for turnover. 5 reasons for poor nurse retention
◦ ◦ ◦ ◦ ◦ Absence of advancements opportunities Stress and burnout Unrealistic workloads Increased paperwork Lack of respect in the workplace

“Culture of Retention”- an environment where people want to stay because they enjoy their work and staff are cared for by managers and focusing on results and problem solving. Competitive compensation

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Structure jobs so they are more appealing and satisfying
Put in place a superb management team

Make opportunities for career growth possible
Magnet Recognition Program

Evaluating Nurse Turnover: Comparing Attitude Surveys and Exit Interviews

Evaluating Nurse Turnover:
• Importance of reliable data • Ways to obtain data on nursing terminations • Exit interviews • Attitude surveys • Identified reasons for nursing terminations • Personal • Professional • HCOs can control work related reasons • Why is it important to minimized turnover rates? • Quality of patient care • It’s expensive.

Exit Interviews
What is an exit interview and why are they used?
• Used to create better public relations • Check the soundness of initial selection procedures • Uncover poor personnel practices • Discover sources of job dissatisfaction

Exit Interviews
Cons: • • • • • • • • •

Difficulty in obtaining trained interviewers Inaccurate interviewee’s comments Possibility of distortion of facts Unwillingness to discuss reasons honestly Managers may be biased Jeopardize reference Low validity Deficient in identifying real issues Data to be simplistic and misleading

Attitude Surveys
• Predetermined questions with low to high scale responses • Used to learn how employees view their jobs, supervisors, wages and benefits, working conditions, and other work factors

• Surveys function as an employee voice
• Responsive to employee concerns

Attitude Surveys
PROS: • 69% of corporate respondents found attitude surveys to be successful (28% did not respond ) • Better financial performance • Higher financial ratings • Better employee relations • Attitude surveys give managers some time to intervene positively and address problems before a nurse terminates or leaves the HCO.

Case Study:Tertiary Care Medical Facility
• Do exit interviews of terminating nurses or attitude surveys of nursing staff provide the most useful and valid information concerning factors associated with nurse retention? • Do exit interview or attitude survey questions regarding specific recommendations the nurses would like to see implemented add additional information beyond that which can be generated by asking directly which factor impact the likelihood (or reality) of leaving?

Case Study:Tertiary Care Medical Facility

• Terminated nurses were much more likely than nursing staff to identify non-job related factors as determinants of termination.
• The most serious issues identified on the attitude survey were not mentioned by the departing staff.

• The nursing staff provided significantly more recommendations on the attitude survey than the departing nurses did on the exit interview.

Case Study:Tertiary Care Medical Facility

• Use both tools.
• Human resource professional that is trained should conduct the exit interview. • Report findings to employees. • Actions should be taken to address problems. • Follow-up surveys should be taken.

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The use of the web and social networks can cause some interesting advantages and disadvantages for both employers and applicants. More employers are looking at online journals and social networking sites such as Facebook to discover potentially damaging personal information about all applicants, but particularly college students and recent graduates. Recruiters and hiring managers use social networks to learn more about candidates and as an additional means to help find potential job applicants as job postings get passed throughout these networks. However, as employers start using social networks to make decisions about potential hires, a whole host of employment related legal issues can arise.

All methods used to make employment decisions are considered selection procedures and are subject to anti-discrimination regulations. To avoid discriminatory practices, try to standardize your process and treat everyone the same. lf you reject job seekers based on information found on their profile, make sure to record that information and perform analyses to determine if members of a protected class are disproportionally screened due to the use of social networking sites.

William James is the new director of human resources for an academic medical center. Employees have told him that employee morale is down especially among registered nurses. The turnover rates at this facility for registered nurses is 18.4 percent. James knows that all employees need to go through an exit interview and questioner before leaving the organization. He asked his assistant to pull all the exit interviews and compile the reasons as to why the registered nurses are leaving and specific suggestions on how the facility can increase its retention of nurses. James was disappointed with the utility of the data. Most respondents indicated they were leaving because of personal reasons, family responsibilities, or another job offer. Very few actually had recommendations for the facility. He found that employees were reluctant to discuss any sensitive issues or concerns for fear of alienating the interviewer or supervisor. James is now attempting to determine the best methods of identifying employee problems and assessing employee reaction to the organization, its various components, and various human resource policies and programs.

The problem is lack of integration of exit interview data and it is a common problem in many organizations. Typically, the data generated is of poor quality and follow up for problems identified is practically non-existent. Mr. James should consider modifications such as the following:
◦ (1) use focus groups of registered nurses to learn about the major causes of nurse frustration and stress; then use these data to develop a structured exit interviewer form. ◦ (2) Train the exit interviewer to probe and ask for more information concerning problems in the organization and their potential solution. ◦ (3) Assure departing employees that the information they provide will not be disclosed to supervisors or others in the organization.

The major alternative source of employee input concerning human resource policies and processes is a systematic, periodic employee attitude survey. Such surveys should be given periodically so comparisons can be made over time for particular departments or groups of employees’. Most important, the data generated should be used to make positive changes which will benefit both employer and employee. He should enhance both the existing process for exit interviews as well as the employee attitude survey process to generate more usable data. Then he should strive to enhance the job attributes that reduce retention while eliminating or minimizing those that cause turnover.

Mr. Jackson, CEO of Jackson Hotels, wants to expand his small corporation into 10 new locations. He would like know if it advantageous for a small corporation to recruit for high-level professionals through the internet.
 Advantages? Disadvantages?  Which one is better? Job boards, professional/career websites, or employer website.  Best way to pre-qualify a small number of TRULY qualified applicants?  What data should JH provide to applicants to receive the best qualified applicants?

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Mr. Jackson also needs to recruit low-level workers. Senior citizens can be a good source of lowlevel workers that can add value to JH. Background check concerns.
◦ Advantages? Disadvantages? Recruitment sources for seniors? ◦ Background investigation recommendations? ◦ Best selection criteria and processes to identify best candidates?