Week 8 Human Resource Management And Financial Management

What is the goal of human resources management?

•To develop good procedures in order to assessand develop skilled, valued staff:

-recruit, screen and interview applicants

-Retain staff/training

-Performance evaluation

-Produce high morale through team building•Orientation

•Salariesand oncost

•Rosteringand allocation of holidays/leave etc•Reduceproblems/resolve minor issues

•Termination

•Conduct work safely ......Provide good working conditions e.g. -environment -facilities and equipment

•Manage change appropriately

•Develop good relationships with unions

•Develop good and effective communicationstrategies

•Use money correctly

The goals of human resources management should result in....

•high quality performance

•high levels of satisfaction

•high internal motivation

•low absenteeism

•Department of Health (Federal)

•Individual states

-NSW Ministry Health: •Local boards and clinical councils•Agency of Clinical Innovation•Clinical Excellence Commission•Health Education and Training Institutes

•COAG – Council of Australian Governments•Funding: National Partnership Agreementon Hospital and Health Workforce Reform•2011 – National Health Reform Agreement(NHRA)Independent Hospital pricing Authority(IHPA

The National Health Workforce Taskforce: •Established in 2006 through Council ofAustralian Governments (COAG) agreement to address the need for significant nationalhealth workforce reform needed to better respond to changing needs of thecommunity wrthealth while maintaining a high quality and safe workforce.

•Taskforce designed to develop strategiesto meet the National Health Workforce Strategic Framework Outcomes:

•1. Education and Training

•2. Innovation and Reform

•3. Planning, Research and Data

•4. Secretariat support for the managingcommittee

National Health Workforce Taskforce

•Increase workforce supply

•increase capacity & productivity forclinical education

•increase immigration of o/seas trainedH.P.

•Increase use use of VET qualified healthworkers.

•Innovative new models of care e.g.

-patient centred roles

-expanded roles & scope of practice.

•Identify reasons for workforce shortage? e.g.

- population growth, ageing population,more treatment at home; changing nature of the burden of disease; greater focuson health prevention.

•Ensuring and sustaining supply

•Workforce distribution that optimiseshealth care and meets health needs for all Australians•Health environments being places in whichpeople want to work

•Ensuring the health workforce is alwaysskilled an competent

•Optimal uses of skills and workforceadaptability

Managing occupational safety

•Legislation

•Work Health and Safety Act 2011

•Obligation of employers & employeesto all contribute to health and safety in the workplace.•Accident prevention, risk assessment& risk control safety walks, hazardinspection, job safety analysis, safe work practices

•Accident investigation

•WorkCover NSW-Return to work

Anti-Discrimination Legislation

•Commonwealth government ratified theInternational labour Organisation Convention # 111 Discrimination (employmentand occupation) in 1973

•This convention recognises thatemployment is the major way in which equality can be achieved in society

Affirmativeaction aims to develop objectives and strategies that will remedy thediscrimination disclosed by the statistical analysis of the workforce and thereview of personnel policies and programs

Industrial Environment

•Fair Work Australia replaced AustralianIndustrial Relations Commission and Renamed the Fair Work Commission

•Nationalworkplace relations tribunal•Minimumwages, employment conditions and range of workplace functions and regulation

•National and State Awards (egNSW Health) which are collectively argued and set to cover all workers in anindustry in a particular jurisdiction.

•Enterprise agreements which includesindustrial unions – who collectively bargain conditions and pay with a singleemployer (egUON staff)

•Independent contractor ( self employedprivate practice dietitian)

•Australian Fair Pay + Conditions Standard(employed private practice dietitian)

Unions

•Key players in the IR framework

•Rights at work and representation ofemployees•Negotiate industrial cases on behalf ofUnion members Right of entry into workplaces

•Union benefits- indemnity insurance,legal services, credit union, scholarships, holiday cottages, industrialtraining

HealthPractitioner ( Qld Health) Certified Agreement ---> enterprise agreement

•Both States have integrated varioustertiary qualified health practitioners'/ professionals into a single Award.

•More transparent approach to careerplanning•Development and support strategicworkforce.•Framework for potential future extendedscope of practice.

•Explicit supervision and recognition ofextended skill development .....Extended scope of practice

•Recognition of direct clinical patientservices, & increasing levels of responsibility and complexity.

•Recognition of need for clinicalsupervision for beginning practitioners.

•Recognition of advanced clinical,research and education roles & skills.

•Improve recruitment (better pay rates,incentives & allowances (at least in Qld)) & retention rates (clinical& educational career paths)

The future

•It is important to recognise that the raft of national and state based legislation and regulation that provides the framework within which we work in the health service can, in themselves be barriers to the innovative and flexible workforce that is needed for the future

•Industrial and regulatory reform need to be addressed to realise fundamental changes in job design, scope of practice, professional demarcation and creation of new roles.

Built environmental and organisational design

•Effect of the environment on the flow ofwork and the efficiency of tasks and workers

-Impact on health of workers and consumers

-Inter professional teams and bestpractice

•Professional silos and professionalcultures are barriers to good inter-professional practice

•Organisational culture

-Personnel, employee focused.Individualised

-Values and beliefs of the organisation

-Managed/influenced in a strategicplanning process

-Influenced by leaders/management

•Learning organisations as an example offunctional culture

-Self actualisation

-Support for ongoing learning

-Good management and leadership

•Communication strategies are integral tomaintaining functional cultures

Managing for performance

•staff to develop necessary skills,knowledge and abilities to meet organisational goals.

•dedicated time for the manager and staffmember to build on their working relationship. Confidential two-way feedback.

•planning & managing work & development activities.

•assist the individual, work unit, &HNE to achieve goals.

•Jointly develop PDR agreement

•Identify /review work expectations &performance measures.

•Identify/ review core skills, jobspecific skills•Identify strengths & gaps in currentdevelopment

•Prepare plan, milestones, KPI, behaviours

•Job rotation, higher duties, shadowing,coaching, external program, corrective counselling•Not a formal disciplinary process

•Performance Management is about

1.Setting standards (Performance targets)

2.Achieving standards on time and within budget

3.Active monitoring and evaluation

4.Sensitive use of resources

5.Setting higher standards (stretch targets) •…….for all aspects of an organization’swork

Managing clinical safety

•Appropriate and up-to-date qualifications

•Continuing professional development

•Clinical supervision (formative,normative and restorative)

•Morbidity and mortality review to improvepractice

• Root cause analysis- open disclosure tofind out what went wrong & improve systems

Disciplinary processes

•Procedural fairness

•Fact finding interview

•Consideration of the fact finding

••••Grievance resolution•••

•Complaintsprocess

•Formalisedand transparent

•Proceduralfairness

•Zerotolerance- right to work in a violence free workplace

HNE recruitment & selection policy

•Vision:attract & retain a skilled workforce to provide quality health services.

•Method:Select best possible person for the job (merit selection). Ensure appropriate competence &skills,experience, personal qualities & registration (credentials). Selection process must be timely & ableto withstand external scrutiny.

•Values:competence; courtesy and respect for individuals; cultural sensitivity; ethicalbehaviour;fairness and impartiality; transparency & openness; honesty,accountability, responsibility, efficiency & effectiveness.

Selection Processes

•Set key selection criteria for the position (KSC)

•There are usually no more than 5-7 KSC

•Assess written applications against the KSC

•At interview expand on these as well as looking for additional issues which you cannot list in the KSC

•Must not ask about irrelevant issues (eg marital status) Table 8.1 p 196/7 excellent

Recruitment process

•Selection of people for positions needsto be planned. There are rules andguidelines for the recruitment of people in the public sector.•Ensure -goodselection criteria which match the position correctly -correctprocedures for conducting interviews -fairness

•Document process appropriately

Recruitment Processes

•Selection panel

-Convenor, job specialist, independent

•Application addressing the essential& desirable selection criteria- based on the job description with evidence.

•Resume: qualifications & education,employment history; professional activities, skills, attributes

•Referees (3)

•Interview

Recruitment documentation

•Interview questions

•Committee notes taken at interview

•Documentation collected from applicants

•Working with Children background checkconsent form- child related employment

•National police criminal history checkconsent form- aged care related•Prohibited employment declaration

•100 points ID

•Qualifications sight originals /Visas/work permits

•Current & relevant referees

Staff Establishment

•An establishment is the number ofpositions and their classifications that a department has allocated within itsbudget.

•Positions are expressed as FTEs (fulltime equivalents)

•1 FTE =38 hrs work normally note your text has 40

•Establishments can be written as FTE indecimal points or as shifts

•Example 10.4 FTE

Strategic planning

•Essential to have clearly statedorganisation vision, goals and objectives

-These can be translated into the work ofthe organisation

-Influence the culture of the organisation

-Assist HRM in establishing recruitment,selection, training and review processes

-Functional in motivating and retainingemployees

•Performance indicators identify thoseoutcomes which can be used to determine whether the task has been successfullycompleted or not.

•At an individual position level theyspecify what the position must be able to complete or fulfill.

•Usually include measurable outcomeswithin set timeframes

•At a department level they are used to determine if the department is on target.

Performance Appraisal

•There should be regular assessment ofperformance against set criteria to provide feedback.

•The criteria should be based on theposition description

•Performance appraisal is not to “get”staff but is designed to be able to assist staff to maintain performance orimprove performance. It also gives duewarning when performance is below expectations.

•Corrective measures and careerdevelopment should be identified.

•Performance appraisal should be positive.

Potential Problems in Performance Appraisal

•Lack of predetermined tools for theappraisals

•Lack of consistency

•“halo” effect and overlooking issues

•“central tendency” ieranking whole person rather than actions separately

•bias

Role Clarification

•Part of good HRM and supervision

•Always need to clarify roles and limitsto authority, no matter how well you have done the orientation and training.

•Best done participatively

•Should be done regularly betweensupervisor and staff.

Extended scope of practice

•Entry level qualifications and APD andthen AdvAPD

•30 hours CPD

•Extended scope of practice recognisesthat post undergraduate education, discreet knowledge and skill base additionsare possible

•Normally carried out by other HP

•Examples include taking BGL, Adjustinginsulin dosages, inserting nasogastric feeding tubes

•May need change to legislation to allowprescribing of drugs

•Need to be appropriate training,recognition and credentialing to ensure it is possible

•The support and delivery of health services impacts on the health, wellbeing, social inclusion, productivity and quality of life of individuals and communities.

•In OECD countries total spending on health is outstripping economic growth

•2007-8 Australia’s health budget exceeded $1 billion ($103.6 billion) and accounted for 9.1% of GDP

•70% of this paid by government

•Currently >25% of government spending is accounted for by health, age related pensions and aged care

Implications to funding the health service

•Population size, age and health

•Increased longevity

•Spending on >65s 4 times per personthan <65

•positive outcomes of previous health policy

•Advances in treatment and technology

•Increased cost of pharmaceuticals

•Market forces driving increased use andhigher expectations of health system.

•Ageing workforce and decreasingparticipation in the workforce due to age related circumstances

•Underserved rural and remote indigenouscommunity

•Inequities in health outcomes for peopleliving in rural and remote locations

•Inequities in health outcomes forindigenous people

•Three tiered system of government

•Mix of public, private, not for profitand Indigenous community controlled service delivery

•Impact on access and delivery of healthcare

Challenges in NSW

•Growth and ageing of the population

•Increasing prevalence of chronic disease

•Health workforce shortages

•Increasing consumer expectations

•Keeping up with advances in medical,communications and information technology.

•Health is the largest single expensefor NSW. It represents 27% of allgovernment expenditure. In the early1970s, it represented 14% of government outlays.

The goal for managing financial resources

“to make the most productive use of thefinite resources available for health care”

•In a climate of changing focus of healthcare, with increasing pressures on the system and a need for innovativesolutions to the care of patients.•In a systems approach financialmanagement is a subsystem

•A long term view of financial managementis needed instead of a short term solution which will become the problem lateron

•A decision in one part of the system canunintentionally impact on care in another part of the system

•Healthcare financing decisions canunintentionally impede reform and innovation

Policy levers to shape health

•Education

•Organisational structure and design

•Occupational regulation

•Health care financing

Budget

•The budget is a prospective document - it

-forecasts costs

-forecasts expenditure

-It is a PLAN

Expenses

•Labour•Materials•Includingutilities•Overheads•includesplant and equipment and most people include management as an overhead•Other•theones listed like telephones computers etc are often included in overheads – but asvariable overhead, not fixed overheads

Incremental/ fixed budget - just read

The budget is based on the previous budget cycle; the next budget is increased by (CPI)% for the next budget cycle.

Episode funding = Activity Based Funding•New phase in funding for NSW Health began in 2009. To be phased in over the subsequent 3 years. Replaces historical budget. •Means of funding Acute Admitted patient activity and Emergency Department. •Aim is to drive improvements in hospital efficiency.

Activity Based Funding

•Acute inpatient care costs about $16billion per year and represents about 60% of the costs of Australian publichospitals.

•Only acute inpatient care has a nationallyadopted classification that can currently be used to define the ‘activity’.

•Australian-Refined Diagnosis RelatedGroup (AR-DRG) classification.

•670 patient classes with each patientbeing classified based on their diagnoses, surgical procedures and otherroutinely collected data. •In ABF, a different price is paid foreach class and that price depends on what each class typically costs. •In 2013/14 sub and non acute services andnon admitted services and mental health added to the funding model

Benefits of Activity Based Funding?

•Better identification and understandingof the variations between cost and budget.

•Facilitate an equitable, transparent andappropriate allocation of funding within Local Health Districts.

•Improve capacity to benchmark servicesand undertake objective comparisons.

•Facilitate informed decisions to improveefficiency and meet changes in consumers health needs.

Diet intervention is cost effective

•Even intensive nutrition interventions are cheap compared with the costs to the health service of not implementing them •In the management of diabetes type 2, the estimates are that cost reduction on a population basis of a 3 kg weight loss each is $26.2m alone (AUSDIAB study 2002)

•In activity based funding models, interventions are only cost recovered if there is a recognized classification to register the activity. •Lobbying to recognize ongoing key practices •Success with malnutrition and obesity underway

•Be aware of the necessary wording and classification systems to ensure your activity is appropriately identified and funded

Making money from services?

What can you sell?

•expertise

-nutrition information

-nutrition assessment

-Right to private practice.

•time/contact

-nutrition programs

-educational materials

Food service is:

•Is Big business

•Is profitable

•Can assist to offset costs in other parts of an organisation

•Is largely outsourced in NSW Health

•The menu ultimately controls the dollar spent in foodservice

•There is a growing imperative for health professionals to master the fundamentals of costing, cost controls, and financial planning.

Challenges

•Existing organisational structureincorporates foodservice in Health support with other hotel services not underclinical care

•Food costs are fairly “elastic”. You can change them fairly easily (ormanagers think you can) but you must be clear about maintaining quality.

•In acute care, many people look to thefoodservice as an area of saving $$ - hence the need for nutrition advocacy andfor a good quality monitoring system in place.

•price must be high enough to allow forwaste

•profit might vary between products

•tend to higher profit on low cost itemscompared to high cost items eg coffee at 2.50 per cup where you mightbe able to make 1.50 profit to offset reduced profit on items such as smokedsalmon bagel which might return you a profit of only $1

Reducing/controlling costs

•Cost of inputs•reduce cost per unit of input by

-working smarter

-using new technology

-reduce wasted time

-do not conduct interventions which arenot effective

-organise time so that travel/waiting timeis minimised

•Increase output•see clients in groups/ telephone/internet where appropriate•use tools to identify clients learningstyles/needs faster•use standard dietary information•do not reinvent the wheel•do not collect data which does not add tothe output•plan the evaluation first

•It is vital that we do the ‘right’ thingsthe ‘right’ way in order to be cost effective

Summary

•The budget is part of the input sub-system

•Good financial management is vital

•need to appreciate the terminology

•Cost control is an important issue for foodservice management

•A systems approach allows you to take a more holistic approach to financial management where more than simply for example food cost is considered

•Clinical costing and productivity is hard as there are many qualitative aspects to a good service

•Clinical costing will become more of an issue in the future