Modern strategic planning for “Human Capital & Talent Management” (HCTM) begins with a Board and CEO-level self-assessment framework that has five parts. Each part contains questions for a quick assessment by the leadership team of the Health System’s human capital policies and practices in the respective area. Not every health system will have these capabilities, and most of the conclusions that users arrive at can be expected to be somewhat subjective. The checklist is intended to be a relatively simple diagnostic tool rather than a methodologically rigorous evaluation. It is meant simply to capture senior leaders’ informed views of their health systems’ human capital policies and practices. Users may wish to develop a kind of “status check” of their health systems’ human capital situation, in which case they may wish to respond to the questions with answers ranging from “not at all” to “generally not” to “partially” to “generally yes” to “definitely (or completely) yes.” However, regardless of whether health system leaders choose to record their views in these terms, the overall picture that emerges through use of the checklist should help them begin a more systematic, in-depth, and continuous effort to evaluate and improve their health systems’ human capital systems. The five parts of the human capital self-assessment framework are:
- Goal 1. Strategic Planning: Establish the Health System’s mission, vision for the future, core values, goals and objectives, and strategies.
- Goal 2. Organizational Alignment: Integrate human capital strategies with the Health System’s core business practices.
- Goal 3. Leadership: Foster a committed leadership team and provide reasonable continuity through succession planning.
- Goal 4. Talent: Recruit, hire, develop, and retain employees with the skills for mission accomplishment.
- Goal 5. Performance Culture: Empower and motivate employees while ensuring accountability and fairness in the workplace.
The Patient Protection and Affordable Care Act requires hospitals to conduct a community needs assessment every three years and make it widely available to the public. Hospitals must attach their implementation strategy for meeting community needs to its Form 990, beginning with any tax year starting after March 23, 2012. (That would be starting next year for hospitals with a fiscal year starting in April, July, or October; and in 2013 for hospitals operating on a calendar year.) The IRS just issued a notice of proposed rules, Notice 2011-52. See www.irs.gov/irb/2011-16_IRB/ar08.html. Given the various attacks on hospitals’ tax-exemption, some experts are advising hospitals to do more to publicize all the community benefits they provide in exchange for their tax exemption. Some even suggest tying a portion of executives pay to community benefit or tying tax-exemption to the amount of community benefit provided. Some boards already tie a portion of executives’ incentive awards to community benefit in one way or another. Some set a hurdle that must be passed before any incentive awards can be paid. Others tie a portion of incentive opportunity to specific goals related to community benefits. Now that hospitals must develop, publish, and implement a strategy for meeting community needs, doesn’t it make sense to tie a portion of incentive opportunity at every hospital to its success at achieving whatever goals it sets for meeting community needs? This would demonstrate hospitals’ outward focus on serving their communities well. Otherwise incentive awards demonstrate an inward focus on operations—clinical quality and patient safety, patient service, and operating efficiency or cost-effectiveness (keeping costs below reimbursement). Of course providing safe, high-quality, patient-focused care is meeting community needs and is therefore a community benefit, but this in itself may not be enough to justify continuing public support for hospitals’ tax exemption. The new regulation suggests that more is required or at least expected. Some might argue that tying a portion of pay to meeting community needs could distort the intent of this new requirement, by turning it into something that is intentionally structured to justify pay, or structured to make it easy to earn a reward. But incorporating measures of community benefit into an incentive plan could encourage hospitals to do an even better job than they do now in meeting community needs.
Employees have grown weary of the economic recession and the resulting minimal pay increases, benefit reductions and even staff reductions. Labor unions are taking advantage of the declining employee moral and stepping up their battle to regain decades of lost membership, launching a well thought out war plan on three main fronts.
- Long-term organizing strategies aimed at hospitals. Unions, particularly Service Employees International Union (SEIU) and the new National Nurses United (consisting of the California Nurses Association and others) simply develop a core group of followers and exploit the growing distrust in the workplace by regularly highlighting issues, real or perceived. When a serious enough action is made by management, like a minimal wage increase announcement or a significant benefit change, the union then bringing all forces of the union to bear on the hospital, including free meals and conferences, dozens of paid union organizers, and well orchestrated demonstrations and political actions.
- Pushing the National Labor Relations Board (NLRB) to make procedural changes that result in quicker and more favorable elections for the unions. This includes shortening the time frame from petition to election to possibly less than ten days, and more importantly, allowing the unions to gerrymander a voting unit to include only those jobs which have a high percentage of employees favorable to the union. The union’s goal for these procedural changes is simply to get in the door with a small group and then work to expand the bargaining unit later through contract negotiations or additional organizing efforts. The NLRB is not making any effort to appear even-handed in their decisions, and has even stated that its objective is to increase the number of represented employees in America by making the process easier for unions. Many healthcare organizations have faced an NLRB that clearly was not open to previously effective legal arguments on the composition of the voting unit or the timing of the election. In addition, the Department of Labor (DOL) is also preparing to make what appears to be a minor definitional change on what is currently permitted in employer communications and the use of legal and consultative support during a union organizing attempt. The DOL now wants to require public financial disclosures on the funds used to support any ‘anti-union’ activity, possibly including the time spent by managers talking with employees, as well as any amounts used to gather legal and other professional support.
- Taking a much more aggressive, less flexible, and arguably, unreasonable position in bargaining and striking. Unions, especially the Nursing Associations, believe hospitals are simply in too weak of a position to take a strike and they also know that employees are more willing to strike than they have been for decades. This year alone in Boston, a number of hospitals have been faced at the same time with a clear and convincing threat of strike, along with negotiation demands by the union which were orchestrated and in coordination with other hospitals throughout the northeast. This effort, led by the new National Nurses United and driven by the California Nurses Association, creates a new battlefield in existing contract negotiations. Hospitals facing these situations need to go beyond just creating a negotiation plan for the bargaining table, to also crafting a communication plan for the employees and education for the managers to ensure enough employees (although represented by a union) remain connected to the hospital and the leadership team, thus diminishing the unions threat of strike.
Union activity has tripled since last summer and three years from now, 2011 may likely be seen as the calm before the storm. The unions have declared war on hospitals and their multi-front battle plan is already proving to be effective.