Human Resource Management Presented by Shana Ross MSHR

Human Resource Management Presented by Shana Ross, MSHR, MBA Vice President, Human Resources Bayhealth Medical Center

Human Resources Management as a Profession § Growth of human resources as a profession was stimulated greatly by the passage of the Pendelton Act of 1883 which established the Civil Service Commission. This Act established the use of competitive examinations for admission to the public service, provided job security for public employees and encouraged an unbiased approach to employee selection. § Human Resources Management emerged as a profession after World War II, in response to the complexities created by union contracts, wage and hour laws, and benefits management. § Health care organizations immune for many years until hospitals needed to establish an identified HR system and to hire specially trained leadership.

Human Resources Management as a Profession § No public certification for the profession; there is identified curriculum of formal education. § There a number of professional organizations to support the profession to include: the American Society for Healthcare Human Resources, a unit of the American Hospital Association. Other more generic organizations include the Society for Human Resources Management, the International Personnel Management Association, and the American Society for Training and Development.

Human Resources System § A typical medium-sized health care organization employs over three dozen licensed or certified professional, including building trades, engineers and clinical professions. Many positions are part-time § Physicians and other clinical specialists are frequently hired using contracts § Also use contracts to hire labor services, using long term management contracts for such services as housekeeping, food service and data processing. They use shorter contracts for specific temporary assistance with accounting firms, planning firms, and shift work for nurses, clerks or other hourly workers. § A medium-sized hospital requires over 1500 persons to perform 1000 full-time jobs in about 100 different skill areas. These employees are the organization's most important asset.

Human Resources System § Employees join an organization voluntarily seeking some combination of income, rewarding activity, society and recognition. § Employees are essential to the continued operation; their motivation and satisfaction directly affect both quality and efficiency. § Success in attracting and keeping employees tends to be self-sustaining; the organization with a satisfied, well-qualified member group attracts more capable and enthusiastic people.

Purpose of Human Resources System § The purpose is to plan, acquire, and maintain the skills, quality, and motivation of members consistent with the fulfillment of the health care organization's mission. § In well run organizations, the HR department advises on all human resources issues.

Functions of Human Resources Management § Workforce Planning - Tracks the service-level plan and translates it into specific requirements for each job category. These needs are compared to available resources within the organization and develop strategies to expand or reduce the number of positions, as necessary. For example, the number of RNs required and available by fiscal year. § Workforce Maintenance - Implements the strategies. Workers are recruited, selected, oriented, trained, and encouraged to stay, change, or leave as the plan directs. This includes the assessment of skill levels and recording of performance, conducting surveys of satisfaction and analysis of dissatisfaction, and grievance management. § Management Education - Conducting programs of supervisory training, human relations skills, and continuous improvement skills.

Functions of Human Resources Management § Compensation Management - Employee compensation includes direct wages and salaries, cash differentials and premiums, bonuses, retirement pensions, and a substation number of specific benefits supported by payroll dedication or supplement. Compensation constitutes more than half the expenditures of most health care organizations. Functions include conducting market surveys of base pay, benefits allowance and incentives. This is complicated by the need to match market levels for a wide range of jobs and to provide incentives to achieving the mission. Records hours worked and earnings. Maintenance of benefits eligibility, use and cost. § Collective Bargaining - This is important where the workforce is unionized. Response to organizing drives, contract negotiation, and administration. § Continuous Improvement and Budgeting - Analysis of employment markets, benefit trends, and work conditions. Development of improvement proposals for general working conditions. Development of department budget and budget for fringe benefit costs.

Measurement of Human Resources § It is possible to measure many characteristics of the workforce using sophisticated accounting, personnel record keeping, and satisfaction surveys. The level of achievement on the measures is an outcomes quality measure for the department and the state of the workforce is its principal product. § Specific measures include: § Demand - Requests for HR services such as training and counseling, recruitment assistance, monitoring total FTE budgeted. § Cost - Resources consumed in department operation to include department costs by functional account or physical resources used by department.

Measurement of Human Resources § Human Resources - Monitoring the workforce in the department as it relates to satisfaction, turnover, and absenteeism. § Output/Efficiency - Counts of the services actually performed by the department such as number of hires, training attendance, paychecks issued. Also includes unit costs per service offered. § Quality - Quality of the department services to employees and supervisors as determined by satisfaction surveys or process quality measures such as timeliness of services performed. § Constraint - Market-governed price for human resources services compared with alternative suppliers, historic trends, benchmark values.

Workforce Planning § The workforce plan is a subsection of the organization's longrange plan. § It develops forecasts of the number of persons required in each skill level by year for the length of time covered by the long-range plan. § It also projects the available human resources, including additions and attrition, to complete the plan. § The plan should include: the anticipated size of workforce needed by skill, category, and department; the schedule of adjustments through recruitment, retraining, attrition and termination; wage and benefit cost forecasts from national projections tailored to local conditions; planned changes in employment or compensation policy, such as development of incentive payments or the increased use of temporary or part-time employees; and preliminary estimates for the cost of operating the human resources department and fulfilling the plan.

Workforce Planning § The plan is often prepared by a task force including representatives from HR, planning, finance, nursing and one or two key clinical departments likely to undergo extensive change. § Plan is linked with the facilities plan because the number and location of employees determine the requirements for many plant services. § The annual budget guidelines direct the development of a more detailed plan for the coming year. These budget plans set precise expectations for the number of employees, the number of hours worked, the wage and salary costs, and the benefits costs. § Well-run organizations use the workforce plan to guide HR policies. These include the timing of recruitment campaigns, guidelines for the use of temporary labor to include overtime, part-time and contract labor, and incentive compensation and employee benefit design. § The penalty for inadequate workforce planning is loss of the time and flexibility needed to adjust to environmental changes.

Maintenance of the Workforce § Building and maintaining the best possible workforce requires continuing attention. § The best employees are more likely to remain with an organization that actively meets their personnel needs. § Investments in recruitment, retention, employee services, programs for training supervisors all become part of the intangible benefits required by employees. § Most health care organizations strive to promote diversity in their workforce because many people seek care from caregivers who resemble them

Recruitment and Selection § Position control - documentation of the number of FTE approved and hours to be worked per FTE; the number of vacancies linked to approved recruitment requests, and links all of this to the annual budget. § Job descriptions - Each position must be described in enough detail to outline the content of work to be done, specifies the level of training required, licensure, and describes the unique features, such as hazards, unusual hours, particular skills emphasized, and experience requirements to determine compensation. Descriptions are developed by the departments and approved by HR. § Classification and compensation - Wage, salary, incentive, and benefit levels must be assigned to each recruited position. Wage and salary administration includes: verification of compensable hours and compensation due; compensations scales; seniority, merit, and cost-ofliving adjustments; and incentive adjustments. Must be kept consistent to other internal positions, collective bargaining contracts and the external market.

Recruitment and Selection § Applicant pool priorities and advertising - policies covering affirmative action and priority consideration of current and former employees. Policies will also cover the design, placement and frequency of advertising. § Initial screening - Review and verification of data on the application. It includes a brief physical examination and may include drug testing. may or may not include the interview process. § Final selection - Applications who pass the initial screening are subjected to more intensive review, usually involving the immediate supervisor and other line personnel. Final selection must be consistent with state and federal equal opportunity (that there be no discrimination on the basis of sex, age, race, creed, national origin or handicaps) and affirmative action requirements (require special recruitment efforts and priority for equally qualified women or racial minorities).

Recruitment and Selection § Orientation - Should learn about the organization's mission, services, and policies to encourage their contribution. § Probationary review - Employees begin work with a probationary period which concludes with a review of performance and usually an offer to join the organization on a long term basis.

Staff Privileges § Purpose is to assure Professional clinical competency § The growth of liability for malpractice by heath practitioners has increased the need to develop comprehensive and systematic credentialing processes. § Two areas: § Credentialing – approval § Clinical Privileges – level of approval § The establishment of credentialing procedures should ultimately be the decision of the governing authority.

Staff Privileges § Process for credentialing includes, but is not limited to a review of: § § § § Primary source verification National Practitioner Database Criminal background check Medical records/hospital reports Attendance at required medical staff meetings Service on medical staff committees Timely and accurate completion of medical records Compliance with all applicable policies, rules, regulations, and procedures § Privileging involves three main steps: § Determination whether facility is equipped to support the requested procedure or treatment § Development of the criteria (education, training and experience) required for the procedure or treatment § Assessment of applicant’s qualifications against the criteria

Staff Privileges § Criteria is established by the Medical Staff By-Laws and could include: § § § State Licensing Board Certification Objective measurement of care provided Experience Prior training Continuing Medical Education § The governing authority of a healthcare facility can terminate the privileges of any member of the medical/professional staff at any time, if it follows its own adopted procedures. § While the credentialing processes for registered nurses, medical assistants and other ancillary clinical staff may not need to be as extensive as that for licensed independent practitioners, some credentialing processes should be in place for all staff who provide “hands on” patient care. § Verification of license or certification § Criminal background check § Competency assessment

Workforce Satisfaction and Retention § Health care organizations now routinely survey personnel at all levels to assess general satisfaction with he work environment. They conduct surveys, interviews, and focus groups and establish cross-functional teams to address workforce problems. § Well-run organizations make an effort to interview persons who are leaving to obtain candid comments which can identify negative factors in the work environment. § Policies for promotion, retirement, and voluntary or involuntary termination must be similar in fairness and consistency to those for recruitment. § Most organizations provide personal services to their employees, through HR, to help improve loyalty, morale and therefore efficiency and quality. Such services include: health education, health promotion, employee assistance to assist with stress or substance abuse; infant and child care; social events; recreational sports; or credit unions.

Occupational Safety and Health § A strong occupational safety and health program is imperative to communicate the organization's dedication to personal and public health and safety. § The federal Occupation Safety and Health Act establishes standards for safety in the workplace and supports inspections. Fines are levied for noncompliance. § Worker's compensation is governed by state laws. Premiums are based on settlements but also on process evidence of attention to safety.

Occupational Safety and Health § The HR department is assigned with the following functions: § Monitoring federal and state regulations and professional literature § on occupational safety for areas in which the organization may have hazards. § Identifying the department or group accountable for safety and compliance on each specific risk area. § Keeping records and performing risk analysis of general or widespread exposures. § Maintaining records demonstrating compliance and responding to visits and inquiries from official agencies. § Providing or assisting with training in the promotion of safe procedures. § Negotiating contracts for worker's compensation insurance, reviewing appropriate language where the insurance is negotiated as part of broader coverage, or managing settlements where the organization self-insures.

Educational Services § Human resources departments provide significant educational opportunities for employees and supervisors. Topics include: § Orientation - to include a review of the organization's mission, history, major assets, and marketing claims, as well as policies and benefits of employment. § Work policy changes - reviews covering the objectives and implications in major changes in compensation, benefits or work rules. § Major new programs - permanent or temporary actions that affect habits and lifestyles of current workers, such as new buildings, relocations and construction dislocation.

Educational Services § Retirement planning -offered to workers to understand their retirement benefits and also to adjust to retirement lifestyles. § Out placement - to assist persons being involuntarily terminated through reductions in workforce. § Benefits management - selection of options and procedures for using benefits, including efforts to minimize abuse. § Supervisory training - providing training about relevant policies and procedures; skills in human relations, supervision and motivation; and tools for budgeting and continuous improvement.

Workforce Reduction § Workforce planning is used to foresee reductions as far in advance as possible, allowing natural turnover and retraining to provide much of the reduction. § Temporary and part-time workers are reduced first. § Personnel in supernumerary jobs are offered priority for retraining programs and positions arising in needed areas. § Early retirement programs are used to encourage older, and often more highly compensated, employees to leave voluntarily. § Terminations are based on seniority or well-understood rules, judiciously applied

Collective Bargaining Agreements § Collective Bargaining is the process of negotiation between the representatives of organized workers and their employer to determine wages, working hours, rules, and working conditions. § In 1935, the passage of the National Labor Relations Act (NLRA) established the legal basis for labor management relations. The NLRA established employee rights to organize, join unions, and engage in collective bargaining. It also identified and recognized employer unfair labor practices, making it unlawful for an employer to interfere with an employee's rights to join a union and engage in union activities. More than any previous legislation, this Act promoted the widespread growth of labor unions in the US. § 1947 Labor-Management Relations Act (also known as the Taft- Hatley Act) established certain protections for management, most notably the identification of unfair labor practices on the labor side. Until 1974, healthcare organizations were largely excluded from labor-management relations.

Collective Bargaining Agreements § 1974 healthcare amendments to the Labor-Management Relations Act extended coverage to nonprofit hospitals and enacted special provisions for the healthcare industry as to bargaining notice requirements and the right to picket or strike. § Health care organizations are subject to both state and federal legislation governing the right of workers to organize a union for their collective representation on economic and other work-related matters. Federal legislation generally supports the existence of unions; state laws vary. Hospitals began to have unions in the 1970 s; by 1980 20 percent of all hospital employees were unionized. Northeastern states and California most likely to have unions, it varies greatly by state. Also more common in urban areas. By 1990, union members were only 15 percent of the US workforce. § In 1989 the Supreme Court upheld rules by the National Labor Relations Board (NLRB) to establish eight job classes for unionization in all hospitals: physicians, nurses, all other professional personnel other than doctors and nurses, technical personnel (including LPNs, internally trained aides, assistants and technicians), skilled maintenance employees, business office clerical employees, guards and all other employees. Any organizing vote must gain support of a majority of all members of a given class.

Collective Bargaining Agreements § Unionization and collective bargaining tends to be strong where employees perceive a substantial advantage to collective representation in situations where management is unfair, inequitable, careless or inconsiderate. Especially as it relates to the following key concerns within the workplace: output expectations, response to worker's questions, working conditions, and pay. It is possible to diminish both the perception and advantage to unionization by consistently good management. Management does this by ensuring that there is little room for complaint about key concerns in the workplace and/or with no obvious opportunity for improvement. In these cases the union has nothing to offer for its dues, and its strength is diminished. § Organizing drives are regulated by law and have become highly formal activities. The union, the employees, and management all have rights which must by scrupulously observed. Well-run organizations respond to organizing drives by hiring competent counsel specifically to fulfill their adversarial rights and obligations. § Collective bargaining is usually an adversarial procedure, although collaborations with unions can and should occur. Well-run organizations use experienced bargainers and have counsel available for the more complex formalities. § Management should take a position to avoid confrontation and seek collaboration. § Health care organizations with existing unions pursue a strategy of contract negotiations which attempts to minimize or eliminate dissent.

Collective Bargaining Agreements § Management will accept a strike on issues which depart significantly from the current exchange environment for workers or patients, but the strategy should be to avoid strikes whenever possible. § If management must pursue contracts which reduce income or employment for union members, two rules must apply: it must apply equally to nonunion workers and it must be well justified by external forces within the exchange environment. § Once a union contract is in place, the role of contract administration is to comply fully with the contract by to minimize literal interpretation. Considerable supervisory education is necessary to implement a new contract. § Supervisors should know the contract and abide by it but whenever possible their actions should be governed by fundamental concerns of human relations and personnel management.

Principles of Negotiation § Separate the person(s) from the problem; depersonalize the issues § Be respectful, non-judgmental and “easy” on the other person(s), § § § while “hard” on the problems Acknowledge problems directly where they exist Put yourself in the other person’s shoes Avoid extreme positions; focus on underlying principles, interests and needs Stress common interests rather than areas of difference Focus on mutual problem solving, not an adversarial approach Build on: issues agreed upon; time already spent in the settlement process; hard work put into negotiations to date.

Dimensions of Negotiation § Integrative (collaborative) increases the size of the pie § Negotiate collaboratively to reach a “mutual gain” agreement § Establish preconditions for mutual gain negotiation—such as shared understanding of the situation, the negotiation process, and the degree of trust. § Discuss the process—education about the process § Try to ensure that all parties are committed to the process and to a mutually beneficial solution (concern for both parties) § Discuss the implications of not maintaining a mutual gain, problem-solving approach § Consider means to invoke a mutual gain, problem-solving orientation § Maintain a focus on similar interests and needs § Distributive (competitive) Individual gain – Size of pie fixed § § § Gain and maintain control of the conflict situation Ambiguity; uncertainty; feigning ignorance Delay; asking for time to study, talking to someone else Small concessions and slow concession rate Extreme initial offers

Grievance Administration § To provide an authority independent of the normal accountability for employees who feel that their complaint or question has not been fully answered. § Ombudsman-type programs provide an unbiased counselor for concerns of any kind. § Personnel are equipped to handle a variety of problems: healthrelated issues they refer to employee assistance or occupational health services; complaints about supervisors or work conditions; sexual harassment, and discrimination. They are trained to settle them fairly and quickly and if possible to identify corrections which will prevent reoccurrence. § Under collective bargaining, the union contract included a formal grievance process which is often adversarial in nature, assuming a dispute to be resolved between labor and management.

Grievance Administration § Good grievance administration begins with sound employment policies, effective education for workers and supervisors, and systems which emphasize rewards over sanctions. § Effective supervisory training emphasizes the importance of responding promptly to workers' questions and problems. Good supervisors have substantially fewer grievances than poor ones. § When disagreements arise, they should stimulate the following informal reactions, which if done effectively should make the formal review process typically found in union contracts, leading to resolution by an outside arbitrator, unnecessary in the vast majority of cases: § Documentation of the issue, locations and positions of the two parties to provide guides to preventive or corrective action.

Grievance Administration § Credible, unbiased, informal review to identify constructive solutions. § Informal negotiations which encourage flexibility and innovation in seeking a mutually satisfactory solution. § Counseling for the supervisory involved aimed at improvement of future human relations. § Settlement without formal review, either by mutual agreement or by concession on the part of the organization. § Implementation of changes designed to prevent recurrences

Incentive Compensation § A management tool built on rewards and the search for continuous improvement which is based on two factors: the employee's unique contribution and shifts in the market that are major enough to require adjustments of the base salary. In designing such a system, the organization must consider: § The resources available will depend more on the organization's overall performance that on any individual's contribution. § The resources for rewards may be severely limited through factors outside the organization's control. § Equity and objectivity will be expected in the distribution of the rewards. § The incentive program must avoid becoming a routine or expected part of compensation.

Incentive Compensation § Well run organizations are beginning to experiment with incentive compensation. It is likely that successful designs will have the following characteristics: § The use of incentive compensation will begin at top executive levels and be extended to lower ranks with experience. § Annual longevity increases will disappear as incentive pay increases. § Incentives will be limited by difficulties in measurement and administration, but will eventually reach 25 percent of total compensation or higher. § Incentives will be related to overall performance but will be awarded to individuals based upon there perceived contribution. § Assessment of contribution will be retrospective but will be based upon achievement of improvements in expectations set in the preceding budget negotiation.

Benefits Administration § Non-age benefits are generally exempt from income tax, providing an automatic gain of at least 12 percent in the benefits that can be purchased for a given amount of after-tax money. As a result, health care and other employers in the US support extensive programs of benefits which add up to 40 percent beyond salaries and wages to the costs of employment. In general, there are five major classes of employee benefits and employer obligations beyond wage compensation: § Payroll taxes and deductions - The employer is legally obligated to contribute premium taxes to Social Security for pension and Medicare benefits, as well as to collect a portion of the employee's pay for Social Security and withholding on various income taxes. § Vacations, holidays, and sick leave - Employers pay full-time permanent employees for legal holidays, vacations, sick leave, and certain other time such as educational leave, jury duty, and military reserves duty. They grant unpaid leave for family needs in accordance with the Family and Medical Leave Act of 1993.

Benefits Administration § Voluntary insurance programs - Health insurance is an almost universal entitlement of full-time employment. Retirement programs must be funded according to rules similar to those for insurance. Life insurance, travel and accident insurance are also common. Direct employer contributions add about 10 percent to the cost of full-time employees. § Mandatory insurance - Employers are obligated to provide workers' compensation for injuries received at work, including both full health care and compensation for lost wages. They are also obligated to provide unemployment insurance, covering a portion of wages for several months following an involuntary termination. § Other perquisites - Generally given for higher professional and supervisory grades. Can include education programs, professional society dues and journal subscriptions.

Pensions and Retirement Administration § Pensions and retirement benefits pose different management problems from other benefits because they are used only after the employee retires. As a result, pension issues include the definition of suitable funding investments; to what extent they should be divided between fixed-dollar returns and those responsive to inflation, and the management of the funds including investment of them in the organization's own stocks and bonds. § The pension itself, but not other retirement benefits, is regulated under the federal Employee Retirement Insurance Security Act (ERISA). Regulations under ERISA specify the employer's obligation to offer pensions. These regulations leave several elements of a sound pension and retirement policy to the organization: § The amount of pension supplementing Social Security. § The amount, kind, and design of Medicare supplementation.

Pensions and Retirement Administration § Opportunities for additional contribution by employees. § Accounting for unvested liabilities (benefits not paid if the employee leaves the organization before the time required for vesting). § Funding of unvested pension liabilities. § Use of unvested funds in financing the organization. § Division of investments between equity and fixed-dollar obligations and selection of those investments. § Incentives to encourage or discourage retirement. § Most organizations accept an obligation to provide retirement counseling, including education to help the employee manage pensions and health insurance benefits.

Establishing an Environment of Continuous Improvement § The competitive health care environment will demand extraordinary efforts to improve human relations and organizations will be required to make major improvements in labor efficiency and cost § Loyalty, skill and motivation of the workforce are critical and any effort to improve efficiency and reduce costs must be coupled with the goal of making employees feel valuable to themselves and to the organization. § Badly-managed health care organizations make hasty, ill -considered decisions which devastate those persons who are terminated and demoralize those who remain.

Establishing an Environment of Continuous Improvement § Continuous improvement in human relations begins with § § § competency in each of functional area, placing special emphasis on workforce planning, Compensation management, and management education. This includes information's systems for retrieval and analysis of HR data and measures of performance for the HR department itself, emphasizing service and outcomes quality. Performance measures could include: employee satisfaction variance, review of incentive programs, revising health benefits selections, start cross-training and retraining programs. HR is designed to anticipate line needs and to be ready for them as they arise.

Budget Development § HR is responsible for developing the organizational budget covering all six dimensions of performance. § It is important to establish realistic costs that can be benchmarked against similar institutions and looking at outside contracts.

Information Systems § Position Control - List of approved full and part-time positions by § § § location, classification. This provides a basic check on the number and kinds of people employed. Personnel Record - Personal data, training, employment record, hearings record, benefits use. This provides tax and employment data aggregated for descriptions. Workforce Plan - Record of future positions and expected personnel. Shows changes needed in the workforce. Payroll - Current work hours or status, wage and salary level. Generates paychecks and provides labor cost accounting. Employee Satisfaction - Results of surveys by location, class. Training Schedules and Participation - Record of training programs and attendance. Benefits Selection and Utilization - Record of employee selection and use of services. Benefits management and cost control.

Performance Appraisal Process § All employees, especially managers and executives in high level positions, need structured, specific and constructive feedback on performance. Many organizations provide a process to conduct the appraisal and review process however it is frequently poorly executed. § Five key steps to ensure an effective performance review and appraisal process within the organization: § 1. Conduct a structured, systematic executive appraisal process. § This should include performance planning, on-going informal feedback about performance, periodic formal (written) reviews in conjunction with face-toface appraisal interviews, and established links between performance and rewards. § 2. Incorporate performance planning into the review and appraisal process. § Performance planning is the process which should lead to a document specifying both parties understandings about directions and priorities. § This should include a description of duties, goals for the year with the manager's role clearly defined as to how the goals will be accomplished, a discussion of management style to be used to accomplish goals, and agreement as to what constitutes successful performance.

Performance Appraisal Process § 3. Make performance review and appraisal an ongoing process. Guidelines for giving constructive feedback include: § make notes on critical instances and effective and ineffective performance on the basis of personal, "hands-on" observation; § use information systems to obtain regular financial and productivity indicators; § check the employee's performance with clients, customers, or other departments to assess external relation and teamwork abilities; § use subordinate appraisals to provide insight into management style strengths and weaknesses. § 4. Focus on process as well as outcomes during the review. § Process issues are more difficult to address but are hallmarks to good executive mentors. § Mentoring discussions about leadership style, organizational savvy, managing the ambiguity inherent in the job, and the many intangibles that go into executive work are all appropriate topics for an executive review.

Performance Appraisal Process § 5. Be as specific and thorough as possible in the appraisal. § Avoid using a standard form which tend to force appraisals into categories that are not necessarily appropriate for management performance. § Have subordinate executives provide written self-appraisals focusing on achievements, areas needing improvement and plans for development to supplement (not substitute for) the rater's impressions. § Use previously agreed-upon responsibilities, goals, and processes as the basis for the formal review. § Focus the review both on specific short-term goals and on long-term issues such as the processes used to achieve results. § Avoid nebulous language when giving performance feedback; avoid political and/or non-performance issues as much as possible. § Strengthen the link between performance and reward by citing specific reasons for any merit raises, bonuses, or perks. § Allow time for the employee to air concerns and to engage in personal development issues. The review is a forum for developing a blueprint for the coming year.

Bibliography § Fried, Bruce J. "Human Resources Management. " § Griffith, John R. The Well-Managed Health Care Organization. Ann Arbor, § Michigan: AUPHA Press, 1995. Chapter on "Human Recourses System, " pages 661 -702. § Longnecker, Clinton O. and Dennis A. Gioia. "The Executive Appraisal Paradox. " Academy of Management Executive, 6(2), 1992: 18 -28. § Brott, Elizabeth, “Credentialing, and Its Importance, ” Community Wealth Forum (July/August 2001): 24 -25.