Sally Thomas, SHRM-SCP, leaned back in her chair exhausted after 2 months of conducting research at...

          

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Sally Thomas, SHRM-SCP, leaned back in her chair exhausted after 2 months of conducting research at Emmitsburg Dialysis Services (EDS). Sally joined the organization as Vice President of Human Resources. The position had been vacant for 6 months and business results deteriorated during that time. The president of EDS was excited to hire Sally since she had a strong Human Resource Management (HRM) background, had worked on similar turnaround projects, and held a MS degree in HRM. EDS is currently facing a crisis. Its patient census (number of patients) has been declining dramatically and current patient levels are just at breakeven. That is, the current patient levels (about 20 patients per unit), with medical reimbursements from Medicare, Medicaid, and private insurance, are barely covering EDS's expenses. The downward trend is expected to continue. EDS, a not-for-profit organization, operates five units and serves Carroll and Baltimore counties in Maryland. There are no labor unions in EDS. Each unit has a capacity of 32 patients with 16 dialysis chairs and runs two shifts. Staffing includes a general manager, administrative assistant, medical director, dietician, clinical nurse manager, social worker, three full-time nurses, six technicians, two part-time nurses, and two part-time technicians. Other services like maintenance are contracted out. The main office oversees the five units and houses the management team including an operations vice-president, social work manager, human resources vice president, and an overall medical director/president. The HRM unit includes an administrative assistant and one full time manager; the general managers (GMS) at each unit all have dotted line reporting responsibilities to Sally. Sally can use the GMs to implement any changes needed. Sally divided her research into three parts, including (1) interviews with key staff from across the organization and patients, (2) satisfaction survey of patients and employees, and (3) walking around observations. Interviews Thirty-minute interviews were held with patients, staff, and supervisory level employees. Sally followed a structured interview process. TABLE 18.1 provides select responses from the interviews. TABLE 18-1 Select Interview Responses Patient Responses ■ "The staff seems friendly, but they are not always paying attention to us patients" ■ "It is awfully noisy here. Sometimes it is like a party atmosphere. I cannot listen to my music because it will bother someone else. However, sometimes the TVs are up so loud, I cannot think" "The administrator does not know our names; no one cares." Select Staff Responses - Below Supervisor Level ■ "There is so much back-biting going on here." "There is lots of freedom in this job; that can be a good thing if you want flexibility, but it is not good for the patients - it allows everyone to do what they want - anything goes." ■ "It seems like management has complete freedom to come in when they want and leave when they want. Those dealing with the patients do not have that freedom" "When people are terminated everyone is always suspicious as to why it happened, and the rumors persist for a long time." ■ "The place is a downer" Select Staff Responses - Supervisors and Above "There is a concern about the census level, but senior management does not seem to be doing anything about it." ■"We have other managers that are retired-in-place and that are not interested." "Our leader does not know what she is doing and does not seem to care; she is never here. The policy of combined sick time and vacation allows the supervisors to do what they want, and it leaves empty offices during core business hours." "There are times when there is not enough nursing staff to cover the patients" ■ "Everyone complains too much" Walking around Observations At the time of the interviews, Sally spent several hours at each unit. This afforded the opportunity to unobtrusively observe what was going on. Here are a few select notes she jotted down: The atmosphere seems friendly; I witnessed several interactions between patients and staff, and they were smiling. ■ I witnessed two instances in which a technician and nurse were openly screaming at each other. ■ There is no privacy for any of the patients. Curtains are used to separate the patients rather than walls. This raises HIPAA concerns. In one instance, a patient was in a conversation with the doctor and everyone could listen in. ■ Even though patients can be on dialysis for years (one patient had been with EDS for 35 years), dialysis patients are very sick. During one visit a patient coded, and the paramedics were called. Since all patients are captive to their chairs during the treatment, everyone observed the paramedics and nurses working on the patient and saw the patient die. ■ Overfamiliarity between staff, patients, and supervisory personnel seems to be standard. It is similar to a family dinner. I saw rambunctious and party like behavior at one moment, and later staff anvd patients bickering. ■ There seems to be some racial tensions in the unit between patients and between staff and patients; it was not openly negative, but it could be an underlying issue. Surveys The patients and employees were asked to complete a survey. The objective of the survey was to understand general levels of satisfaction or dissatisfaction with EDS. The results are in TABLES 18-2 and 18-3. TABLE 18-2 Select Employee Survey Results Variable Organizational direction and goals Rating of supervisors and managers ********** Attitude toward EDS: Job Percent Responding Favorably 67% 56% 55% Percentage different from industry (Dialysis)* +3% -8% -6% Attitude toward EDS: Job satisfaction 55% Respect and fairness Benefits (health insurance etc.) 48% Performance evaluation processes 53% 40% 36% 35% -6% 34% -9% Pay Job training -8% Working conditions -15% *Reveals whether EDS's results are above dialysis industry benchmark or below -9% -9% +4% TABLE 18-3 Select Patient Survey Results Variable % of EDS only responding favorably Nephrologists' communication and 65% caring Patients-quality of dialysis center 45% care and operations Patients-rating of the nephrologist Patients-rating of the dialysis center staff 55% 35% 57% % of Maryland dialysis patients responding favorably** https://data.medicare.gov/data/dialysis-facility-compare 68% 60% 58% Patients-rating of the dialysis facility **Data from Data.Medicare.gov, Dialysis Facility Compare datasets, Retrieved from 57% 62% Select employee survey comments: ■ When a job is done well, no one tells us; we are only told when things are wrong. The tone used by management at times is evil. ■ Supervisors don't care. ■ Our unit is run by favoritism. ■ My supervisor's tone is racist. ■ My supervisor will not pitch in and assist when needed, or she is never here. ■Management does not care about me at all; this survey will be just another piece of information they will do nothing with. Select patient survey comments: ■ The staff is very friendly and nice. It is how they work that is the problem. ■ The unit is not that comfortable; some days the temperature is freezing in the unit (even in the summer) and some days we boil. ■ The largest problem is attentiveness; I do not always believe they consider me as a person - just an object. ■ I hate when the staff is on their phone or listening to music - giving me the wrong medication could kill me. ■ At times, the unit does not appear clean. Sally looked up EDS on Glassdoor.com and found it to have a rating of 2.1 on a 5-point scale, indicating employees are dissatisfied. Competing dialysis units are rated on average 3.0 on the same scale, which is okay, but not great. Finally, Sally looked up EDS's rating on Medicare's Dialysis Facility Compare website - EDS is rated 1 star out of 5 or the lowest rating possible. As Sally reviewed the survey data combined with her observations, she sighed. Many problems needed to be addressed. Her initial questions were where to start and what to do first? Discussion Questions 1. 2. 3. 4. 5. 6. What are the primary presenting HRM problems? ************ What strengths and weaknesses about EDS can you conjecture from the research? Which HR problems, if addressed, will have the largest beneficial impact on EDS? Given the labor shortages that exist in the HSO marketplace, what actions can HR take to compete effectively for recruits? How can HR help the HSO improve Medicare reimbursements? Since health care is an important aim of union organizers, how can HR help prevent a union from gaining traction? Sally Thomas, SHRM-SCP, leaned back in her chair exhausted after 2 months of conducting research at Emmitsburg Dialysis Services (EDS). Sally joined the organization as Vice President of Human Resources. The position had been vacant for 6 months and business results deteriorated during that time. The president of EDS was excited to hire Sally since she had a strong Human Resource Management (HRM) background, had worked on similar turnaround projects, and held a MS degree in HRM. EDS is currently facing a crisis. Its patient census (number of patients) has been declining dramatically and current patient levels are just at breakeven. That is, the current patient levels (about 20 patients per unit), with medical reimbursements from Medicare, Medicaid, and private insurance, are barely covering EDS's expenses. The downward trend is expected to continue. EDS, a not-for-profit organization, operates five units and serves Carroll and Baltimore counties in Maryland. There are no labor unions in EDS. Each unit has a capacity of 32 patients with 16 dialysis chairs and runs two shifts. Staffing includes a general manager, administrative assistant, medical director, dietician, clinical nurse manager, social worker, three full-time nurses, six technicians, two part-time nurses, and two part-time technicians. Other services like maintenance are contracted out. The main office oversees the five units and houses the management team including an operations vice-president, social work manager, human resources vice president, and an overall medical director/president. The HRM unit includes an administrative assistant and one full time manager; the general managers (GMS) at each unit all have dotted line reporting responsibilities to Sally. Sally can use the GMs to implement any changes needed. Sally divided her research into three parts, including (1) interviews with key staff from across the organization and patients, (2) satisfaction survey of patients and employees, and (3) walking around observations. Interviews Thirty-minute interviews were held with patients, staff, and supervisory level employees. Sally followed a structured interview process. TABLE 18.1 provides select responses from the interviews. TABLE 18-1 Select Interview Responses Patient Responses ■ "The staff seems friendly, but they are not always paying attention to us patients" ■ "It is awfully noisy here. Sometimes it is like a party atmosphere. I cannot listen to my music because it will bother someone else. However, sometimes the TVs are up so loud, I cannot think" "The administrator does not know our names; no one cares." Select Staff Responses - Below Supervisor Level ■ "There is so much back-biting going on here." "There is lots of freedom in this job; that can be a good thing if you want flexibility, but it is not good for the patients - it allows everyone to do what they want - anything goes." ■ "It seems like management has complete freedom to come in when they want and leave when they want. Those dealing with the patients do not have that freedom" "When people are terminated everyone is always suspicious as to why it happened, and the rumors persist for a long time." ■ "The place is a downer" Select Staff Responses - Supervisors and Above "There is a concern about the census level, but senior management does not seem to be doing anything about it." ■"We have other managers that are retired-in-place and that are not interested." "Our leader does not know what she is doing and does not seem to care; she is never here. The policy of combined sick time and vacation allows the supervisors to do what they want, and it leaves empty offices during core business hours." "There are times when there is not enough nursing staff to cover the patients" ■ "Everyone complains too much" Walking around Observations At the time of the interviews, Sally spent several hours at each unit. This afforded the opportunity to unobtrusively observe what was going on. Here are a few select notes she jotted down: The atmosphere seems friendly; I witnessed several interactions between patients and staff, and they were smiling. ■ I witnessed two instances in which a technician and nurse were openly screaming at each other. ■ There is no privacy for any of the patients. Curtains are used to separate the patients rather than walls. This raises HIPAA concerns. In one instance, a patient was in a conversation with the doctor and everyone could listen in. ■ Even though patients can be on dialysis for years (one patient had been with EDS for 35 years), dialysis patients are very sick. During one visit a patient coded, and the paramedics were called. Since all patients are captive to their chairs during the treatment, everyone observed the paramedics and nurses working on the patient and saw the patient die. ■ Overfamiliarity between staff, patients, and supervisory personnel seems to be standard. It is similar to a family dinner. I saw rambunctious and party like behavior at one moment, and later staff anvd patients bickering. ■ There seems to be some racial tensions in the unit between patients and between staff and patients; it was not openly negative, but it could be an underlying issue. Surveys The patients and employees were asked to complete a survey. The objective of the survey was to understand general levels of satisfaction or dissatisfaction with EDS. The results are in TABLES 18-2 and 18-3. TABLE 18-2 Select Employee Survey Results Variable Organizational direction and goals Rating of supervisors and managers ********** Attitude toward EDS: Job Percent Responding Favorably 67% 56% 55% Percentage different from industry (Dialysis)* +3% -8% -6% Attitude toward EDS: Job satisfaction 55% Respect and fairness Benefits (health insurance etc.) 48% Performance evaluation processes 53% 40% 36% 35% -6% 34% -9% Pay Job training -8% Working conditions -15% *Reveals whether EDS's results are above dialysis industry benchmark or below -9% -9% +4% TABLE 18-3 Select Patient Survey Results Variable % of EDS only responding favorably Nephrologists' communication and 65% caring Patients-quality of dialysis center 45% care and operations Patients-rating of the nephrologist Patients-rating of the dialysis center staff 55% 35% 57% % of Maryland dialysis patients responding favorably** https://data.medicare.gov/data/dialysis-facility-compare 68% 60% 58% Patients-rating of the dialysis facility **Data from Data.Medicare.gov, Dialysis Facility Compare datasets, Retrieved from 57% 62% Select employee survey comments: ■ When a job is done well, no one tells us; we are only told when things are wrong. The tone used by management at times is evil. ■ Supervisors don't care. ■ Our unit is run by favoritism. ■ My supervisor's tone is racist. ■ My supervisor will not pitch in and assist when needed, or she is never here. ■Management does not care about me at all; this survey will be just another piece of information they will do nothing with. Select patient survey comments: ■ The staff is very friendly and nice. It is how they work that is the problem. ■ The unit is not that comfortable; some days the temperature is freezing in the unit (even in the summer) and some days we boil. ■ The largest problem is attentiveness; I do not always believe they consider me as a person - just an object. ■ I hate when the staff is on their phone or listening to music - giving me the wrong medication could kill me. ■ At times, the unit does not appear clean. Sally looked up EDS on Glassdoor.com and found it to have a rating of 2.1 on a 5-point scale, indicating employees are dissatisfied. Competing dialysis units are rated on average 3.0 on the same scale, which is okay, but not great. Finally, Sally looked up EDS's rating on Medicare's Dialysis Facility Compare website - EDS is rated 1 star out of 5 or the lowest rating possible. As Sally reviewed the survey data combined with her observations, she sighed. Many problems needed to be addressed. Her initial questions were where to start and what to do first? Discussion Questions 1. 2. 3. 4. 5. 6. What are the primary presenting HRM problems? ************ What strengths and weaknesses about EDS can you conjecture from the research? Which HR problems, if addressed, will have the largest beneficial impact on EDS? Given the labor shortages that exist in the HSO marketplace, what actions can HR take to compete effectively for recruits? How can HR help the HSO improve Medicare reimbursements? Since health care is an important aim of union organizers, how can HR help prevent a union from gaining traction?

Answer rating: 100% (QA)

1 What are primary presenting the HRM Problems These are some of the problems observed in the case study Staff across the organization are dissatisfied with multiple complaints and several reasonsfact... View the full answer