Human resources for health interventions in high- and middle-income countries: findings of an evidence review.

Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.

A Systematic Review of the Benefits of Hiring People with Disabilities.

Purpose We reviewed literature on the benefits of hiring people with disabilities. Increasing attention is being paid to the role of people with disabilities in the workplace. Although most research focuses on employers' concerns, many companies are now beginning to share their successes. However, there is no synthesis of the peer-reviewed literature on the benefits of hiring people with disabilities. Methods Our team conducted a systematic review, completing comprehensive searches of seven databases from 1997 to May 2017. We selected articles for inclusion that were peer-reviewed publications, had a sample involving people with disabilities, conducted an empirical study with at least one outcome focusing on the benefits of hiring people with disabilities, and focused on competitive employment. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality. Results Of the 6176 studies identified in our search, 39 articles met our inclusion criteria. Findings show that benefits of hiring people with disabilities included improvements in profitability (e.g., profits and cost-effectiveness, turnover and retention, reliability and punctuality, employee loyalty, company image), competitive advantage (e.g., diverse customers, customer loyalty and satisfaction, innovation, productivity, work ethic, safety), inclusive work culture, and ability awareness. Secondary benefits for people with disabilities included improved quality of life and income, enhanced self-confidence, expanded social network, and a sense of community. Conclusions There are several benefits to hiring people with disabilities. Further research is needed to explore how benefits may vary by type of disability, industry, and job type.

Good practice for one-to-one care.

Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, reflects on the patient and carer experience of one-to-one care.

Dust Off the Historical Approach to Total Compensation.

Employers have been afforded new opportunities with the enactment of the Affordable Care Act (ACA). ACA creates a unique opportunity for employers to take a fresh, strategically based total compensation approach to planning. The concept of a total compensation framework is not new; however, a new way to achieve this approach is now possible. Employers need to create their own level playing field, and a total compensation approach is the optimal solution. This article discusses how employers that consider a framework driven toward total compensation accomplish many key objectives.

HRM and its effect on employee, organizational and financial outcomes in health care organizations.

BACKGROUND: One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions: financial, organizational and employee (HR) outcomes. Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction. METHODS: This study uses a unique dataset, based on the 'ActiZ Benchmark in Healthcare', a benchmark study conducted in Dutch home care, nursing care and care homes. Data from autumn 2010 to autumn 2011 were analyzed. In total, 162 organizations participated during this period (approximately 35% of all Dutch care organizations). Employee data were collected using a questionnaire (61,061 individuals, response rate 42%). Clients were surveyed using the Client Quality Index for long-term care, via stratified sampling. Financial outcomes were collected using annual reports. SEM analyses were conducted to test the hypotheses. RESULTS: It was found that HR practices are - directly or indirectly - linked to all three outcomes. The use of HR practices is related to improved financial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR outcomes (measure: sickness absence). The impact of HR practices on HR outcomes and organizational outcomes proved substantially larger than their impact on financial outcomes. Furthermore, with respect to HR and organizational outcomes, the hypotheses concerning the full mediating effect of job satisfaction are confirmed. This is in line with the view that employee attitudes are an important element in the 'black box' between HRM and performance. CONCLUSION: The results underscore the importance of HRM in the health care sector, especially for HR and organizational outcomes. Further analyses of HRM in the health care sector will prove to be a productive endeavor for both scholars and HR managers.

Time-driven activity-based costing: a driver for provider engagement in costing activities and redesign initiatives.

OBJECT: To date, health care providers have devoted significant efforts to improve performance regarding patient safety and quality of care. To address the lagging involvement of health care providers in the cost component of the value equation, UCLA Health piloted the implementation of time-driven activity-based costing (TDABC). Here, the authors describe the implementation experiment, share lessons learned across the care continuum, and report how TDABC has actively engaged health care providers in costing activities and care redesign. METHODS: After the selection of pilots in neurosurgery and urology and the creation of the TDABC team, multidisciplinary process mapping sessions, capacity-cost calculations, and model integration were coordinated and offered to engage care providers at each phase. RESULTS: Reviewing the maps for the entire episode of care, varying types of personnel involved in the delivery of care were noted: 63 for the neurosurgery pilot and 61 for the urology pilot. The average cost capacities for care coordinators, nurses, residents, and faculty were $0.70 (range $0.63-$0.75), $1.55 (range $1.28-$2.04), $0.58 (range $0.56-$0.62), and $3.54 (range $2.29-$4.52), across both pilots. After calculating the costs for material, equipment, and space, the TDABC model enabled the linking of a specific step of the care cycle (who performed the step and its duration) and its associated costs. Both pilots identified important opportunities to redesign care delivery in a costconscious fashion. CONCLUSIONS: The experimentation and implementation phases of the TDABC model have succeeded in engaging health care providers in process assessment and costing activities. The TDABC model proved to be a catalyzing agent for cost-conscious care redesign.

A conceptual framework for cost management training in the Limpopo Province of South Africa.

AIMS: This paper describes the perceptions of nurse managers about their dual role in nursing units as cost centres. BACKGROUND: The tertiary hospital in the Limpopo province is the first institution to appoint nurse managers with a dual role in cost centres. The development of a conceptual framework for a context-specific programme for Cost Centre Managers is the first of its nature in South Africa. METHOD: A qualitative, exploratory, descriptive design was followed. The target population included nurse managers (n = 35) formally appointed as cost centre managers with a dual role of delivering quality care and cost management. A focus group and individual interviews were conducted until data saturation occurred. RESULTS: Personal and professional distress, an empowering potential of being a cost centre manager, and the need for decentralized cost centre management were indicated as barriers for nurse managers that led to a framework for a context-specific training programme. CONCLUSION: There is a need for a context-specific training programme for cost centre managers in a hospital with cost centres. IMPLICATIONS FOR NURSING MANAGEMENT: The training of cost centre managers for their dual role in cost centres could enhance cost effectiveness, quality care and staff satisfaction.

Knowing (and understanding) the key numbers for your practice.

Most dentists see accounting and bookkeeping as a necessary evil instead of a helpful tool. Yet the most financially successful and happy dentists understand the need for good financial management. Here's an overview that will help you better-understand the key numbers in your practice.

Motivating salespeople: what really works.

No sales force consists entirely of stars; sales staffs are usually made up mainly of solid perfomers, with smaller groups of laggards and rainmakers. Though most compensation plans approach these three groups as if they were the same, research shows that each is motivated by something different. By accounting for those differences in their incentive programs, companies can coax better performance from all their salespeople. As the largest cadre, core performers typically represent the greatest opportunity, but they're often ignored by incentive plans. Contests with prizes that vary in nature and value (and don't all go to stars) will inspire them to ramp up their efforts, and tiered targets will guide them up the performance curve. Laggards need quarterly bonuses to stay on track; when they have only annual bonuses, their revenues will drop 10%, studies show. This group is also motivated by social pressure-especially from new talent on the sales bench. Stars tend to get the most attention in comp plans, but companies often go astray by capping their commissions to control costs. If firms instead remove commission ceilings and pay extra for overachievement, they'll see the sales needle really jump. The key is to treat sales compensation not as an expense to rein in but as a portfolio of investments to manage. Companies that do this will be rewarded with much higher returns.

The impact of workplace incivility on the work environment, manager skill, and productivity.

OBJECTIVE: The objective of the study was to investigate the impact of workplace incivility (WPI) on staff nurses related to cost and productivity. BACKGROUND: Healthful practice environments are one of the goals of the American Organization of Nurse Executives 2010 to 2012 Strategic Plan. Healthy work environments are linked to patient safety and quality. METHODS: A postal survey was sent to 2,160 staff nurses (n = 659 completed) and included the Nursing Incivility Scale and Work Limitation Questionnaire. RESULTS: Although almost 85% (n = 553) reported experiencing WPI in the past 12 months, nurses working in healthy work environments(defined as MagnetA, Pathway to Excellence, and/or Beacon Unit recognition) reported lower WPI scores compared with nurses working in the standard work environment (P G .001). Workplace incivility scores varied between types of unit. Nurses' perception of their manager's ability to handle WPI was negatively associated with WPI scores (P G .001). Lost productivity as a result of WPI was calculated at $11,581 per nurse per year. CONCLUSIONS: Not only does WPI exist at high rates, but also it is costly. Nursing leaders play a vital role ensuring a healthy work environment.

Can digital communication technology reduce health system personnel time? An evaluation of personnel requirements and costs in a randomized controlled trial.

Use of digital communication technologies (DCT) shows promise for enhancing outcomes and efficiencies in asthma care management. However, little is known about the impact of DCT interventions on healthcare personnel requirements and costs, thus making it difficult for providers and health systems to understand the value of these interventions. This study evaluated the differences in healthcare personnel requirements and costs between usual asthma care (UC) and a DCT intervention (Breathewell) aimed at maintaining guidelines-based asthma care while reducing health care staffing requirements. We used data from a pragmatic, randomized controlled trial conducted in a large integrated health system involving 14,978 patients diagnosed with asthma. To evaluate differences in staffing requirements and cost between Breathewell and UC needed to deliver guideline-based care we used electronic health record (EHR) events, provider time tracking surveys, and invoicing. Differences in cost were reported at the patient and health system level. The Breathewell intervention significantly reduced personnel requirements with a larger percentage of participants requiring no personnel time (45% vs. 5%, p < .001) and smaller percentage of participants requiring follow-up outreach (44% vs. 68%, p < .001). Extrapolated to the total health system, cost for the Breathewell intervention was $16,278 less than usual care. The intervention became cost savings at a sample size of at least 957 patients diagnosed with asthma. At the population level, using DCT to compliment current asthma care practice presents an opportunity to reduce healthcare personnel requirements while maintaining population-based asthma control measures.

Employee customer orientation in context: how the environment moderates the influence of customer orientation on performance outcomes.

This empirical study evaluated the moderating effects of unit customer orientation (CO) climate and climate strength on the relationship between service workers' level of CO and their performance of customer-oriented behaviors (COBs). In addition, the study examined whether aggregate COB performance influences unit profitability. Building on multisource, multilevel data, the study's results suggest that the influence of employee CO on employee COB performance is positive when the unit's CO climate is relatively high and that the constructs are unrelated when unit CO climate is relatively low. In addition, the data reveal that unit COB performance influences unit profitability by enhancing revenues without a concomitant increase in costs. The study's results underscore the theoretical importance of considering cross-level influencers of employee-level relationships and suggest that managers should focus on creating a climate that is supportive of COBs if their units are to profit from the recruitment, hiring, and retention of customer-oriented employees.

Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

Bullying, incivility, and disruptive behaviors in the healthcare setting: identification, impact, and intervention.

Bullying, incivility, and their associated disruptive behaviors are insidious and destructive forces with negative consequences that require identification and intervention at the individual and organizational level. Costs incurred secondary to these insensitive behaviors are substantial and involve matters of patient safety, absenteeism, turnover, turnover intentions, organizational commitment, and employee healthcare. Factors that increase the risk of hostile behaviors include changing hierarchies, conflicting loyalties, stress, and the state of the science. Each organization has the responsibility to develop processes for managing threatening and intimidating actions. New criteria are proposed to guide the implementation of successful programs.