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Performance improvement: how to get employee buy-in.

The radiology department at Northern Michigan Hospital in Petoskey, Mich. operated with little change under the same leadership for nearly 20 years. Its equipment was archaic and its operations production focused. Staff morale and both physician and patient satisfaction were low. Given a directive to measurably improve the service and quality offered by the department, the new director let her staff know she needed their support. She then set out to weave in performance expectations for both the organization and the department. Her goal was to create a relationship to both individual and organizational performance improvement, and in turn, to add value to the success of each individual, the department and the organization. Defining work processes was important for the definition of a common vision and core behaviour. The result was the F.A.S.T. concept (friendly, accurate, safe and timely) that put each general work process in a flowchart showing its steps. The next phase involved identifying the measurement for each critical point in the process and determining how to measure it. At each step, questions were defined, answered and translated into individual job descriptions and performance plans. Now, employees know how they and their departments are doing through quarterly reviews. Results are presented monthly at staff meetings, where report cards are posted to provide timely feedback. In some cases, individual report cards within a modality are shared. Successes are celebrated, both in staff meetings and on annual Quality Day, where departments present story boards showing how they have improved service or quality.

Attitude of Health Personnel↗

The Finnish informatics nurse, her job and education against a background of international development.

This paper presents a small survey made to Finnish "adp-nurses" working at adp-departments or as contact persons and informants at the wards. Their positions, job descriptions and informal education is discussed in relation to recent international development in the field. Finally the necessity of starting formal education for the European informatics nurse is stressed.

Computer Literacy↗

Recruitment and retention. A personal issue.

Recruitment and retention has always been seen to be the sole remit of managers--that was never the case but now it has to be seen as the remit of everybody working in the operating department. The role of perioperative nurse is interesting and challenging--a truly exciting role which, used as a marketing tool, can sell itself.

Career Choice↗

Allied health educators: a functions analysis and needs assessment survey.

Three hundred and Thirty-eight allied health educators, geographically and institutionally distributed throughout Kentucky, participated in a field survey conducted to gather background and employment information and to determine topics and teaching skills identified by practitioners both as functions performed in their work and as areas where the need for further teaching expertise is greatest. No stereotype "allied health educator" existed. Job descriptions, teaching qualifications and experience, and needs for further preparation differ according to the settings in which allied health professionals teach. A large audience exists for teacher-training efforts directed toward improvement of applied skills and day-to-day teaching activities. Those desiring further preparation and improvement of their teaching skills prefer to do so within their own communities rather than by traveling to major educational centers for traditional coursework. There is, however, a desire for CEU or academic credit.

Allied Health Personnel↗

Hiring a CEO made (almost) easy.

Selecting a CEO and establishing his compensation and the terms of his employment are among the board's most important functions. This article suggests a series of steps intended to help the board approach the task in an organized and rational manner, from the development of a mission statement and job description through the recruitment of candidates to the development of a compensation package and personnel policies.

Contract Services↗

A management contract for your CEO?

A task force of the Massachusetts Hospital Association has recommended that hospitals consider strengthening the management role of their chief executive officers by providing them with job security in the form of a management contract; by establishing a well-defined job description that clearly identifies the CEO's role in the management of the hospital; and by developing an annual set of goals and objectives that the CEO is expected to accomplish.

Governing Board↗

Appraisal scales that measure performance outcomes and job results.

The major deficiency with most common graphic performance-appraisal scales is their emphasis on retrospective evaluation and documentation, rather than on communication and education. So charges author Roger Plachy, management consultant, who advocates instead the use of the Performance Outcome Appraisal Scale (POAS) or the Jobs Results Appraisal Scale (JRAS). The focus of the POAS is away from the employee and toward behavior outcomes so as to minimize personal defensive reactions and to emphasize a performance standard or level of management expectation for the job responsibility or dimension. A conceptual difference separates POAS from other rating scales--that is, it is based on the belief that although the product of the procedure is a job plan and performance appraisal, the nature of the process is communication. The emphasis is not on judging behavior, but on teaching employees to think in terms of which job performance outcomes are really important to the organization. The JRAS is identical to the POAS in structure, but it starts with the desired job results as defined in the job description, rather than with performance outcomes.

Employee Performance Appraisal↗

Mission statement translated into managerial, staff goals.

Although mission statements have the power to unify, this power will be limited unless the values the statements affirm are translated into language that relates to employees' work. St. Joseph Hospital and Health Care Center, Tacoma, WA, has developed a mission awareness project to assist staff in developing goals that reflect the organization's values. The program includes managerial-level discussions of mission goal setting followed by sessions during which the employees of each department create work objectives based on mission values. Evaluation of the program is conducted quarterly. Plans include incorporating the mission effectiveness program into job descriptions, employees evaluations, and the budget process.

Catholicism↗

A successful implementation of a hospital pharmacy computer module.

The Mississauga Hospital Pharmacy Department recently implemented the unit dose dispensing portion of a hospital-wide computer system. Initially, a pharmacist was assigned to the position of Computer Preceptor to build the data base and help coordinate the implementation process. A joint management/staff Computer Advisory Committee was also formed. This group revised job descriptions, workload priorities and the physical layout of the department and directed the implementation plan. Staff training was conducted at first on a "volunteer" basis, followed by a formal program, using a training manual developed by a staff pharmacist. Staff concerns were constantly monitored and various "morale boosters" were utilized. The computerized dispensing was run parallel with the manual system on two nursing units for one week prior to undertaking a step-by-step conversion of the hospital. Following the "break-in" period, procedures will be formalized and quality assurance programs established.

Hospital Bed Capacity, 500 and over↗

Hospital administrators in a market environment: the case of Utah.

This study describes selected characteristics of hospital administrators in Utah, who are implementing a market strategy of cost containment. A mail survey was used to query hospital administrators concerning their personal backgrounds, professional practice patterns, and perceived role performance. The questionnaire elicited a 75.6 percent return from a limited universe sample. Analytical results disclose that Utah hospital administrators are relatively young, professionally dynamic, well educated, and subject to frequent career-motivated moves. Using Mintzberg's ten administrative roles, respondents identified two as key: "Leader" ranks as the role performed best, the role second most critical to survival, second best prepared for, second most time-consuming, and second most satisfying. "Entrepreneur" ranks as the role most critical to survival, most satisfying, most deserving of improvement, second least prepared for, and second best performed. Suggestions for innovative ways in which administrators can develop their skills to be better prepared to meet future challenges are listed.

Health Facility Administrators↗

Nurse specialist: an evolving need.

For too long, to advance their careers and earn higher salaries, nurses have had to veer away from clinical experience, which they knew best, into managerial and other fields. To curb this trend and respond to the need for high-quality care, St. Edward Mercy Medical Center, Fort Smith, AR, instituted the nurse specialist program, in which nurses can develop competency in multiple clinical areas with accompanying financial incentives. In developing the program, which provides a cadre of nurses to augment the regular staff wherever needed, job descriptions and the requirements for selection, recruitment, and training were developed, as was some method to evaluate the program. Requirements for participation included at least one year of hands-on experience at the medical center, good clinical skills, and adherence to the Mercy philosophy of care. Those selected were trained in five specialized clinical areas: intensive care, labor and delivery, emergency services, post-anesthesia recovery, and nursery. The program at first met resistance from other nurses and abuse from nursing supervisors. But this has been replaced by acceptance and appreciation. The nurse specialists are seen as an elite group, meeting patient and staff needs as extra pairs of caring and competent hands, with the potential to calm a stressful clinical environment.

Arizona↗

Writing procedures and protocols: using the Marker Model.

This is the fourth in a series of articles about writing standards for the operating room. A standards overview was published in the August issue. Structure standards were addressed in September. The first two types of process standards-job descriptions and performance standards-were described in November. The fifth and final article will focus on guidelines and standards of care.

Clinical Protocols↗