Review of methods to identify the critical job-tasks undertaken by the emergency services.

BACKGROUND: The roles of the emergency services are challenging and often physically demanding. Readiness to meet these challenges and demands is a fundamental requirement for staff to deliver their roles safely and effectively. Furthermore, employers are required by law to demonstrate every reasonable effort to protect their staff from undue risk of work-related injury. Implementing Physical Employment Standards (PES) enables employers to assign staff to roles for which they are physically-suited whilst contributing to such duty-of-care. However, for PES to be successful and legally-defendable, standards must reflect the demands of those job-tasks which are truly critical to the readiness of these services. OBJECTIVE: To determine whether a standardised approach to identifying critical job-tasks exists in the development of PES for the emergency services. METHODS: Studies which conducted analysis of job-tasks to develop PES within the emergency services were reviewed. RESULTS: Forty-two reported studies (i.e. records) met the inclusion criteria. Methods to determine job-tasks varied but were typically criteria-based incorporating one, or all, of 9 reported techniques. Methods were subjective and based upon reference to past or present job-task performance. CONCLUSION: Correctly determining critical job-tasks is essential for effective, legally-defendable PES. A standardised method to define job-tasks remains to be established.

Where Hospital Boards Often Fail: Auditing Leadership Performance.

Hospital boards address quality of care and patient safety as well as financial performance through long-accepted practices. By contrast, a hospital's administrative operations and institutional culture are not usually subject to such detailed scrutiny. Yet, despite a healthy bottom line and patient commendations, hospital personnel can be underperforming, burdened with poor morale, and suffering from less-than-optimal leadership, unwarranted inefficiency, and ethically questionable management practices. The resulting employee dissatisfaction or disengagement can affect productivity, quality, turnover, innovation, patient and donor attraction and retention, public image, etc., and can be missed by an unsuspecting board. While boards do not scrutinize most administrative operations, they do examine financial performance, through review of the independent auditor's Management Letter. Designed to help the chief financial officer (CFO) improve the efficiency and integrity of the hospital's financial systems and to recommend improvements to the board for implementation (rather than to assess the CFO's performance), the Management Letter has no equal with respect to a comparable evaluation of the hospital's administrative performance and workplace culture. When, as is often the case, there is only superficial review of the chief executive officer, the board has no source of analysis or recommendations to improve the hospital's institutional environment. In this Invited Commentary, the authors suggest a methodology to provide such a review, leading to a Leadership Letter, and discuss its utility for both nonprofit and for-profit organizations.

The Fundamentals of Resident Dismissal.

Residents have the rights and responsibilities of both students and employees. Dismissal of a resident from a training program is traumatic and has lasting repercussions for the program director, the faculty, the dismissed resident, and the residency. A review of English language literature was performed using PUBMED and OVID databases, using the search terms, resident dismissal, resident termination, student dismissal, student and resident evaluation, legal aspects of education, and remediation. The references of each publication were also reviewed to identify additional appropriate citations. If the Just Cause threshold has been met, educators have the absolute discretion to evaluate academic and clinical performance. Legal opinion has stated that it is not necessary to wait until a patient is harmed to dismiss a resident. Evaluations should be standard and robust. Negative evaluations are not defamatory as the resident gave consent to be evaluated. Provided departmental and institutional polices have been followed, a resident can be dismissed without a formal hearing. Residencies are entitled to modify academic requirements and dismissal is not considered a breach of contract. Although there is anxiety regarding resident dismissal, the courts have uniformly supported faculty having this role. When indicated, failure to dismiss a resident also places the program director and the faculty at risk for educational malpractice.

Fair Evaluations, No Witch Hunts.

Physicians have greater protection against "sham" peer review thanks to a decision by the Texas Supreme Court. The decision will help physicians who believe business competitors or a hospital's administrators are using every means available to destroy their reputation.