HRM Week 3 2011

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College of Public HealthCollege of Public Health

HSRA 841/CPH 562HSRA 841/CPH 562

Public Human Resources ManagementPublic Human Resources Management

Spring 2011



Healthcare Professionals

January 25, 2011

Nizar Nizar WehbiWehbi,, MD, MPH, MBAMD, MPH, MBA

ObjectivesObjectives

Understand the relationship between healthcare

professionals and the human resources

management process

Understand various healthcare professions, their

required educational levels, licensures, and

duties

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OverviewOverview

Various Types of Healthcare Professionals

Education options and Requirements

Accreditation Licensin Credentialin, , ,

Certification, and Registration

Communication Skills: Listening

Creating Value in HealthcareCreating Value in Healthcare

Safe: avoiding injuries to patients from

the care that is intended to help them*

Patient-centered: providing care that is respectful of

and responsive to individual patient preferences,

needs, and values, and ensuring that patient values Effective: providing services based on scientific Efficient: avoiding waste, including waste of

Equitable: providing care that does not vary in quality

because of personal characteristics such as gender,

ethnicity, geographic location, and socioeconomic

Status*

gu e a c n ca ec s onsknowledge to all who could benefit, and

refraining from providing services to those not

likely to benefit* Timely: reducing waits and sometimes harmful

delays for both those who receive and those who

give care*

equipment, supplies, ideas, and energy*

* IOM, Crossing the Quality Chasm, NAE, 2000

DiscussionDiscussion

Which of the previous elements set

by IOM is most important in your

opinion?

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Health Professionals in HCOHealth Professionals in HCO

Healthcare industry = 6.5% of the US

total Labor Force

Acute Care Community Hospital

200 different types of positions

Teaching Hospital

300 types


Hospitals35%

Home HealthServices

Dentists Office6%

Others12%

Nursing andResidential

Care Facilities23%

PhysicianOffices17%

7%

SOURCE: BLS Quarterly Census of Employment and Wages, 2008.

Total FullTotal Full--time Equivalent Employeestime Equivalent Employees

Working i n Hospitals , 1988Working i n Hospitals , 1988 – – 20082008

Source: Avalere Health analysis of American Hospital Association Annual Survey data, 2008, for community hospitals.

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Physicians

Dentists

Nurses

Pharmacists

Allied Health Professionals

Nonphysician Practitioners

Healthcare Administrators


Hernandez, Strategic HRM in HSO

Occupation Employment Projections to 2016, Monthly Labor Review, Nov 2007

PhysiciansPhysicians

Education (MD)

College degree

Medical school (126 accredited schools)

4 years

Residency (3-7 years)

Education (DO): (Focus on Musculoskeletal system)

College degree

School of Osteopathy (20 accredited schools)

4 years

Residency (3-7 years)

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Accreditat ion Accreditat ion

Liaison Committee on Medical Education

Medical Schools

Accreditation Council for Graduate Medical Education

(ACGME)

Residency programs

American Medical Association (AMA)

Continuing education

PhysiciansPhysicians

Licenses

By state

US Medical Licensing Examination

Independent practitioner

Credentialing/Privileges

Review of didactic and clinical experience

By medical center

Board Certification

Specialties

Total Number of Active PhysiciansTotal Number of Active Physicians

per 1,000 Persons, 1980per 1,000 Persons, 1980 – – 20072007

Source: National Center for Health Statistics. Health, UnitedStates, 1982, 1996-97, 1999, 2000, 2001, 2002, 2003, 2004,

2005, 2006, 2007, 2008 , and2009. Hyattsville, MD.(1) 1980 does notinclude doctors of osteopathy.(2) 2004 andlater years include bothfederal and non-federal physicians. Prior to 2003, data includednon-federal physicians only.

(1) (2)

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Baseline Physician FTE Supply and Demand Projections,

2006 - 2025

AAMC, 2008, The Comp lexit ies of Ph ysici an Sup ply an d Demand : Projec tion s Thro ugh 2025

PCP vs. SpecialistsPCP vs. Specialists

Primary care physicians (PCP)

Internal Medicine

General Medicine

Family Medicine

Some states include OBS/GYN

Pediatrics

“Gatekeeping”

PCP vs. SpecialistsPCP vs. Specialists

Historical target: 2/3 PCP and 1/3 Specialists

In 1996: 34% PCP

In 2003: 40.8% PCP

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Class DiscussionClass Discussion

Why are PCP’s essential in providing

healthcare services?

y s t e num er o spec a sts muc

higher?

How to fill the gap?

NursesNurses

Registered Nurse (RN) Education

Bachelor of Science in Nursing (BSN)

4 years, college or university based

Considered as Gold Standard

Diploma

3 years, hospital based

Associate (ADN)

2 years, community based

NursesNurses

Licensed Practical Nurse (LPN)

Certified Nursing Assistant (CAN)

Advanced Practice Nurses (APN)

Nurse ractitioners NP

Certified Registered Nurse Anesthetists (CRNA)

Certified Nurse Midwives (CNM)

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NursesNurses

Licensing (RN)

By states Passing National examination

Competency

Continuing education

Demonstration of annual competency

RN Employment by Type of Provider,RN Employment by Type of Provider,

19801980 – – 20082008

All Other

Source: Bureau of Health Professions, Health Resources and Services Administration. (1980-2008). Findings from the

National Survey of Registered Nurses . Link: http://bhpr.hrsa.gov/healthworkforce/rnsurvey/.

National Supply and Demand ProjectionsNational Supply and Demand Projections

for FTE RNs, 2000for FTE RNs, 2000 – – 20202020

Shortage of over

Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health Resources andServices Administration. (2004). What Is Behind HRSA’s Projected Supply, Demand, and Shortage of

Registered Nurses? Link: ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdf.

, ,2020

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DentistsDentists

Education

Doctor of Dental Surgery (DDS)

Doctor of Dental Medicine (DMD)

By state

Dentistry services are 7% of all Healthcare

Expenditures

PharmacistsPharmacists

To be licensed

Bachelors in Pharmacy

State Exam

6 year program (85 accredited schools)

Increased demand

Increased salaries

All ied Health Professionals All ied Health Professionals

More than 200 allied health occupations

60% of Healthcare Workforce

Educational Programs The Commission on Accreditation of Allied Health Education

Programs (CAAHEP)

Degrees

Certificate, Associate, Bachelor, Masters, Doctoral

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All ied Health Professionals All ied Health Professionals

Long list of Professions

Behavioral Health

Clinical Lab

Dental Services

Dietetic Services

Occupational therapy

Physical therapy

Respiratory Therapy

Speech Pathology

Radiological Services

AHP Accredited Programs AHP Accredited Programs

Source: CAAHEP Annual Report 2010

OCCUPATION 1970 1980 1990 2000

Alli ed healt h perso nnel 750,000 1,276,000 1,831,000 2,672,000

Dental hygienists 40,000 54,000 81,000 112,000

Dental assistants 112,000 156,000 201,000 224,000

Dental laboratory technicians 31,000 43,000 50,000 54,000

Dietitians 17,000 32,000 57,000 90,000

Dietetic technicians 20,000 38,000 36,000 41,000

Emergency Medical Technician 35,000 70,000 98,000 125,000

Estimated Numbers of Active Allied Health PersonnelEstimated Numbers of Active Allied Health Personnel

19701970--20002000

-, , , ,

Health information administrators 10,000 13,000 18,000 24,000

Health information technologists 42,000 60,000 69,000 77,000

Clinical laboratory workers 135,000 249,000 297,000 337,000

Occupational therapists 6,000 25,000 42,000 72,000

Orthotics and Prosthetics 1,000 2,000 3,000 4,000

Physical therapists 30,000 50,000 92,000 130,000

Radiologic service workers 87,000 116,000 157,000 220,000

Respiratory therapy workers 30,000 56,000 75,000 125,000

Speech pathologist/ audiologists 19,000 50,000 65,000 121,000

Other allied health 2/ 135,000 262,000 490,000 916,000

SOURCE: Health Resources and Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis

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NonphysicianNonphysician PractitionersPractitioners

Physician Assistants

Diagnostic, preventive and therapeutic services

Prescribe medication (in 47 states)

Under supervision of MD

Healthcare AdministratorsHealthcare Administrators

Organize and manage delivery of healthcare services

Educational Programs

MBA, MHA, MPA, MPH

MD/MBA, MD/MHA

American College of Healthcare Executives (ACHE)

American College of Physician Executives (ACPE)

Chief Medical Officer Role (CMO)

Human Resources ManagementHuman Resources Management

Keeping track of licenses expiration and renewal dates

Verifications

Previous experience

Continuing Education

Evaluate Performance / Competence

Practitioner Impairment

Evaluate Proficiency

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Trends in Healthcare ProfessionsTrends in Healthcare Professions

Aging Workforce

Decreasing enrollment Decrease in Supply

Reasons for shortages

Education sector

Employment characteristics

Professional organizations

Credentialing mechanisms

Payer policies

Reasons for Shortages in Healthcare ProfessionsReasons for Shortages in Healthcare Professions

Education sector

Does not respond to shortages

Employment characteristics

Lack of advancement opportunities

Establishing credentialing standards

Credentialing mechanisms

Could be length, tedious

Payer policies

Reimbursement levels

Number of Physicians by Age, 1980, 1990,Number of Physicians by Age, 1980, 1990,

2000, and 20082000, and 2008

200

250

300

350

400

450

500

55-64

65 & Over

g e 4 5 a n d o v e r

u s

a n d s )

Age Group550

600

Source: American Medical Association. (2010 Edition).Physician Characteristics and Distribution in the US.

350

300

250

200

150

100

50

0

50

100

1980 1990 2008

Under 35

35-44

45-54

A

A g e u n d e r 4 4

N u m b e r o f P h y s i c i a n s ( T h

4002000

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Distribution of RN Workforce by AgeDistribution of RN Workforce by Age

Group , 1980Group , 1980 – – 2020 (Projected)2020 (Projected)

h o u s a n d s )

4 0 a n d o v e r

AgeGroup

50s

60s

1,000

1,500

2,000

2,500

0

N u m b e r o f R N s ( T

A g e u n d e r 4 0

A g e

20s

30s

40s

1,000

500

500

1980 1990 2000 2010 (proj.) 2020 (proj.)2004

Source: Bureau of Health Professions, Health Resources and Services Administration. (1980-2004). Findings from

the National Survey of Registered Nurses. Link: https://bhpr.hrsa.gov/healthworkforce/nursing.htm. 2010 and 2020

projections derived from The LewinGroup analysis of the National Sample Survey of Registered Nurses , 2000.

Annual Percentage Change in En try Level Annual Percentage Change in En try Level

Baccalaureate Nursing Enrollment, 1990Baccalaureate Nursing Enrollment, 1990 – – 20082008

Source: American Association of Colleges of Nursing. (1994-2008). Percent Change in Enrollments in Entry-Level Baccalaureate

Nursing Programs: 1994-2008. Link: http://www.aacn.nche.edu/Media/pdf/EnrollChanges.pdf, and Berlin, L.E. et al. Enrollment and

Graduations in Baccalaureate and Graduate Programs in Nursing . Washington, DC: AACN.

Class DiscussionClass Discussion

Is state licensing good or bad? Why?

What else could be done to ensure physician

competency? Nurse competency?

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Creating Value in HealthcareCreating Value in Healthcare

* IOM, Crossing the Quality Chasm, NAE, 2000


In what way does healthcare

professionals contribute to the six

What are ways to enhance these

values?

Case StudyCase Study

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Questions?Questions?

Readings

Maslow’s Hierarchy of Needs

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Esteem Needs

Maslow ’s Hierarchy of Needs

Self-actualization

Belongingness

Safety Needs

Physiological Needs

Physiological NeedsPhysiological Needs

Biological needs

Oxygen

Food

Water

Shelter

Sleep

The strongest needs

If a person were deprived of all needs, the

physiological ones would come first in the person's

search for satisfaction

Safety NeedsSafety Needs

Safety Needs

Security

Stability

Law and Order

Protection from physical and emotional harm

A lot of people never get pass these needs

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Belongingness & Love NeedsBelongingness & Love Needs

Belongingness & Love Needs

Affection

Belonging Acceptance

Friendship

Community

Being accepted by other

Loved by others

Esteem NeedsEsteem Needs

Internal Esteem Needs

need for self-respect

Confidence

Autonomy

Achievement

External Esteem Needs

Need for respect of others

Status

Fame

Glory

Recognition

Attention

Self Self--Actualization Actualization

When all other needs are satisfied

Maslow describes self-actualization as a person's

need to be and do that which the person was “born

to do.”

The Growth need

Now that people have everything met they can

maximize their potential

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Is Maslow’s Hierarchy of Needs relevant to Human

resources?

What about International Healthcare professionals?



Listening Skills

January 25, 2011

Nizar Nizar WehbiWehbi,, MD, MPH, MBAMD, MPH, MBA

How doHow do people Communicate?people Communicate?

Robbins, Essential of Organizational Behavior, 2010 Pearson Education, Inc. publishin g as Prentice Hall

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Listening ConceptsListening Concepts

Many communication problems arise from poor

listening skills

Hearing is not listening

Listening is a skill that can be learned

Most important interpersonal skill

Active vs . Passive Listening Active vs . Passive Listening

Passive listening = Tape recorder

Active listening

Intensity (concentration)

Empathy (from the other person’s point of view)

Acceptance (objectively)

Willingness to take responsibility for completeness

Students who use active listening during class will

be as tired as their instructor

Listen with eyes, ears and minds

Effective ListeningEffective Listening

Be motivated

Exert the effort to hear and understand

Make eye contact

No eyes contact is interpreted as disinterest

Show interest Through nonverbal signals

Head nods, facial expressions

Avoid distracting actions

Don’t look at your watch, shuffle papers

Empathy

Put yourself in the speaker’s shoes

Adopted from Robbins, Training in Interpersonal Skills, 2003

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Effective Listening (2)Effective Listening (2)

Take in the whole picture

Interpret feelings and emotions as well as factual content

Ask questions Analyze what you hear and ask questions for clarifications

Paraphrase

Restate what the speaker has said using your own words

Ex: “What I hear you saying is…” or “Do you mean…?”

Do not interrupt

Do not try to second guess

Integrate what’s being said

Put the pieces of what is said to gether to see the whole

picture


Effective Listening (3)Effective Listening (3)

Don’t overtalk

Listening is the price you pay in order to talk

Confront your biases

Notice the speaker’s credibility, appearance, mannerisms

but don’t let them distract you

Make smooth transition between speaker and

listener

Shifting back and forth from listener to speaker

Be natural

Develop a style that is natural and authentic

Do not become a compulsive listener.


ExerciseExercise – – Role PlayRole Play

HRM Week 3 2011

Documents

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