Human Resources Capstone Project - Research Paper Example

? Human Resources Capstone Project Human Resources Capstone Project Executive Summary This paper gives a of the organization on which the needs assessment/gap analysis will be conducted. This is followed by the actual needs assessment/gap analysis, a proposal of an intervention based on the needs assessment/gap analysis and an explanation justifying the relevance of the selected intervention. Finally, the paper outlines a plan for implementing this intervention, a marketing communication plan on how the stakeholders will be informed and kept up-to-date at various stages of intervention implementation and a plan for measuring the effectiveness of the selected intervention. Description of the organization Harlem Hospital Centre is public, municipally owned hospital located in the Harlem community of Manhattan, New York City. The 257-bed facility is an acute care hospital founded on 18th April, 1887 with 54 beds and it served as a unit for receiving patients awaiting to be moved to Ward’s Island (Center Harlem Hospital General Surgery Residency, 2007). The hospital is, thus, about to mark its 125 years of service. Bailey (1991) explains that the hospital was designated as Area Wide Burn Center and a Level 1 Trauma. It has a full spectrum specialty services including an adult intensive care unit, a pediatric intensive care unit, a neonatal intensive care unit, burn unit, a cardiac care unit and a special asthma treatment unit for providing specialized care (Ferdinand, 2009). It also operates a physician assistant program and a nursing school. The hospital is the largest healthcare facility in Harlem that responds to people who are seriously ill and it operates under the patent system New York City Health and Hospitals Corporation (HHC). According to Generations+/Northern Manhattan Health Network (2008), the hospital operates in an area composed of about 893,498 residents, the majority of whom are aged under 45. Ethnic composition of the area is 55% African-American, 33% Hispanic, 6.9% white and 2.3% Asian. The Center records an average of 450,000 outpatient visits, over 13,000 admissions, and over 76,000 visits to the emergency department annually. In 2011, there were 374,017 outpatient visits, 11,796 admissions, 1,705 in patient surgeries, 3,906 outpatient surgeries, 76,969 emergency room visits and 1,211 births (American Hospital Association, 2012). Most of its patients come from the economically disadvantaged community of Harlem. The demographics of 2003 indicate that 44% were African-American, 6% were white, 46% were Hispanic and other races comprised the remaining 2% (Harlem Medical Center, 2012). In central Harlem, over one-third of the total population lives under the federal poverty line and the facility provides a health option for the uninsured. Disease and injury prevalence is also higher in the community. For example, 4% of New York residents suffer from asthma but the percentage is close to 20% in Harlem. The center can be said to be urban since it is located within the environs of New York City. Needs Assessment/Gap Analysis The hospital offers over 90 specialty services. These include Alcoholism/Substance Abuse, Cancer Control Center, Ambulatory Surgery, , Directly Observed Therapy, Adult Medicine, Gastroenterology, Geriatric Medicine, Asthma Care, Cardiology, Mammography, Chest Clinic, Community Outreach, Dental Services, Dermatology, Diabetes Care Ear-Nose-Throat, EKG, Emergency Medicine, Endocrinology, Health Education, Hemodialysis, HIV/AIDS, Hypertension, Infectious Diseases, Internal Medicine, Laboratory Services, Medina Clinic, Family Planning, Gynecology, and Men’s and women’s Health Services. Others are Pediatrics, Vascular Surgery Pharmacy, Orthopedics, Plastic Surgery, Podiatry, Mental Health, Nephrology, Neurology, Sickle Cell Anemia Services, Nutritional Counseling, Oncology, Ophthalmology, Oral Surgery, Pathology, PCAP, Prenatal Care, Proctology, Psychiatry, Tuberculosis, Urology, Psychiatric Emergency Services, Rehabilitation Medicine, Renal Services, Rheumatology, Stroke Center, Social Work, Surgery, Urgent Care Center, Pulmonary Medicine, Radiology, and WIC (Harlem Medical Center, 2012) The hospital accomplishes this through its key workforce composed of many dentists, physicians and allied health personnel, most of whom are full time and a few are part timers. 200 among these are doctors. The hospital has 8 physicians including the US top news doctors. These doctors span 7 hospital’s specialty areas and their selection was conducted through a peer nomination process. As of 2011, the hospital had 401 registered nurses (RNs), and 95 licensed practical nurses working as full time employees. In addition, it had 10 RNs, and 1 licensed practical nurse working as a part timer (American Hospital Association, 2012). Because of its affiliation with Columbia University, Harlem hospital has always benefitted from adequate staffing levels, specifically the number of physicians. Under the 48-year contract which started in 1962, Columbia University employed and managed the staff working in the hospital. In 2010, HHC wanted to reduce its expenses by restructuring the affiliations of the health centers/hospitals it oversees. This culminated in some layoffs including Harlem Health Center. The restructuring and layoffs have led to a lot of dissatisfaction among the hospital’s doctors because of the many benefits they have lost as a result of the divorce between the hospital and the University of Columbia. It has also reduced the ability of the hospital to attract and retain doctors. For example, 10% of the doctor positions at the hospital were vacant but never filled for over a year. Before the restructuring, the hospital had a total of 220 doctors. However, by the end of 2010, it had only 200 (Raja, 2010). This is unusual in a world were physicians are always looking for a chance to move and grow. The layoff that was experienced by the hospital has led to a slight reduction in some services offered by the hospital, especially neurosurgery and rehabilitation. This is a direct threat to the stroke and trauma centers, achievements that Harlem Hospital Center had already received for responding adequately to the conditions which are most prevalent in the community. Immediately after the restructuring, doctors in the departments promised to leave en-mass and indeed, some of them did leave. In addition, there have been unfilled positions in the hospital’s Division of Cardiology resulting in a backlog of echocardiograms that are unread and thus unattended. This has put a lot of patients at risk because they are never called for further treatments as a response to the results obtained. Although the restructuring affected various areas of the hospital, the main problem faced by the hospital right now is the shortage of doctors. Some of the doctors left because they wanted to continue being associated with Columbia University. They did not want to lose the financial benefits and their titles as Columbia University professors. There is an added responsibility or overload among the current group of doctors due to inadequate staffing. Apart from loss of jobs, there is a general state of job insecurity among the doctors and other key medical personnel resulting in the low ability to attract and retain employees. This is the area that requires a quick strategic response in terms of recruitment, motivation and retention. Patient satisfaction level has already dropped, and its percentage is slightly above average. According to health.usnews.com (2012), inquiry into patient satisfaction revealed that 52% would definitely recommend their family and friends to the hospital while 16% would not. About 52% is low as expected of a hospital that had already been recognized for its specialty care and service to a poor neighborhood most of whom depend on the hospital. Proposed intervention based on the needs/gap analysis It took many years of hard work for the hospital to grow to become among the biggest public hospitals in New York. The affiliation between Harlem hospital center and the University of Columbia through the HHC has led to great improvements in the health status of the local population and the provision of honorable service to the community. This goal can only be maintained through the proper recognition of the roles played by various healthcare experts from public health, medicine and nursing. The best intervention for this human resource gap is for HCC to enter into a contract with another private company that will be responsible for hiring and managing the hospital’s doctors, for example Physician Affiliate Group of New York. Under this strategy, doctors of Harlem will contract with Physician Affiliate Group of New York, but they will continue to serve as faculty members of Columbia University. However, they will no longer be serving as doctors at the hospital as employees of Columbia University. In order to cover up for the loss of some direct financial benefit resulting from the disaffiliation, the doctors will be compensated through pensions. Under the contract, the tuition fees for their children who study or will study at Columbia University will also be fully covered. For those whose children will study in another university, they will be given generous allowances. At the same time, Columbia University will maintain its function in training medical residents in the Harlem Hospital Center. The hospital will have to achieve this through fresh negotiations with HHC since it is a public hospital operating under this larger parent system alongside other hospitals like Woodhull, Elmhurst, Bellevue and Queens Hospital Centers. Although such contracts could be somehow costly, these costs are lower than those incurred when hiring and firing of staff and left to affiliated academic institutions. To reduce costs, HHC will conduct collective bargains for all its affiliate hospitals for the sake of salvaging the credibility of Harlem Hospital Center as one of the best hospitals that provides healthcare to racial minorities and the economically disadvantaged. Justification of proposed intervention The proposed intervention is most suitable when analyzed from the perspectives of managed care, reimbursement, social, cultural and economic aspects. The main justification for this intervention is that contracts with academic institutions are very costly and might not be sustainable (Hartocollis, 2010). HCC has to pay huge lumps of money to these institutions for them to conduct the hiring and management of doctors for the various hospitals affiliated to HCC. This calls for a cheaper and sustainable hiring and management contract in order to reduce costs and avert the closure or sell of the hospital to a private owner. At the same time, it is clear that if the HHC is truly serious in developing care organizations that are viable and accountable, then it cannot in any way ignore experts from as many fields as law, business, nursing, public health and nursing. This means that affiliations with institutions within New York are important because such institutions provide a breadth and depth of expertise across various disciplines. In addition, such a trend of uncertainty among doctors could lead to the loss of some of the hospital’s long-serving physicians and other medical staff as a result of decreased motivation and loss of benefits that come along with such affiliations. This means that the hospital is at risk of totally relying on new inexperienced physicians in the near future. This also indicates that an inadequate response to its staffing crisis could lead to a health crisis in its present community. The future of medical operations in the hospital cannot be entrusted to a small group of inexperienced physicians. Instead, it is more rational for the institution to turn to an institution that already has the resources required and multiple levels of expertise. This option provides the best way forward. To add to this, the remaining physicians may not be able to cope within the increased workload within a short time, and the main people who will suffer are the many uninsured Harlem residents who depend on the hospital as the cheapest and best health solution. However, new contracts will provide some form of reimbursement for staff leading some levels of satisfaction among the doctors. This strategy will enable the hospital to attract and retain more doctors and at the same time, it will prevent the transfer of its rehabilitation and neurosurgery departments to other hospitals. This, in turn, will reduce doctor layoffs and call for filling of physician vacancies. A plan to implement the intervention The main stakeholders that will be involved in the implementation of this intervention will include the management of Harlem Hospital Center, Physician Affiliate Group of New York, the HHC and Columbia University. The role of the Physician Affiliate Group of New York is to contract and manage doctors who will provide the required services for Harlem Hospital Center on behalf of HHC. The role of HHC will be to negotiate for this contract for the doctors on behalf of the Harlem Hospital Centre. It will, therefore, pay Physician Affiliate Group of New York who, in turn, will take over the employment, management and payment of doctors in Harlem Hospital Center on behalf of HHC. Columbia University will maintain the role of providing incentives in form of free tuition for children belonging to doctors working at the Harlem Hospital Center who go to study at the university or subsidies for those who enroll in other universities. This will ensure that doctors do not lose the educational benefits that featured under the hospital’s affiliation with Columbia University. In return, the University will be allowed to retain its role as an academic affiliate to the hospital. This means that Harlem hospital’s department of medicine will continue serving as one of the 3 main teaching units that are utilized by the Columbia University College of Physicians and Surgeons. This will give the hospital doctors a chance to be identified with and work as faculty members at the university and thus, they will not lose their academic titles. A marketing communication plan on how the stakeholders will be informed and kept up-to-date at various stages of the implementation process Prior to the intervention, all the stakeholders will be contacted physically by HHC officials to inform them of the new intervention, their importance in its success and what is expected of them. On agreement, all stakeholders will be sent circulars officially informing them of the structure of the plan for the new intervention and their respective roles. During the intervention, the HHC will monitor and inform all stakeholders of the various logistics and structural changes taking place among other stakeholders. There will also be one or two meetings during this transition in management and functions to ensure that all stakeholders are all responding adequately and correctly. After the intervention, HHC will be coordinating communications between all stakeholders to ensure that they move at the same pace, act on similar information and are all in agreement with the implementation process, for example, grievances or information from the doctors to Physician Affiliate Group of New York, changes or information to Physician Affiliate Group of New York to the doctors, and also between doctors and Columbia university. A plan for measurement effectiveness of the intervention Since the main target group is doctors, the effectiveness of this intervention will be measured using satisfaction by doctors and feedback given by other stakeholders. HHC will hold regular meetings with the doctors to inquire the level to which they are comfortable with their new contract with Physician Affiliate Group of New York, basing on what was agreed before the contract. If any grievances occur, Physician Affiliate Group of New York will be contacted and notified of their failures with reference to what was agreed on. If these grievances are directed towards Columbia University, HHC will also be required to analyze how they respond to the demands of the doctors like education of their children in relation to the agreement made. The satisfaction of doctors and other stakeholders will be the most powerful indicator that the intervention is successful. References American Hospital Association. (2012). Harlem Hospital Center. Retrieved from http://health.usnews.com/best-hospitals/harlem-hospital-center-6212830/details#fn2 Bailey, P. (1991). The Harlem Hospital story: 100 years of struggle against illness, racism and genocide. Richmond, VA: Sun-Publishers. Ferdinand, K. (2009). Cardiovascular disease in racial and ethnic minorities. London: Humana Press. Generations+/Northern Manhattan Health Network. (2008). MANAGEMENT. Retrieved from http://www.himss.org/content/files/davies/2006/HHCGenerations_Davies2006enhanced.pdf Harlem Hospital General Surgery Residency. (2007). History of Harlem Hospital Center. Retrieved from http://www.cumc.columbia.edu/harlemhospital/surgery-residency/generalsurgerydept/History%20of%20Harlem%20Hospital%20Center Harlem Medical Center. (2012). Harlem Medical Center. Retrieved from http://www.nyc.gov/html/hhc/harlem/html/home/home.shtml Hartocollis, A. (2010). Public hospitals look to overhaul affiliations with medical schools. Retrieved from http://www.nytimes.com/2010/09/03/nyregion/03hhc.html Harlem Hospital Center. (2012). health.usnews.com. Retrieved from http://health.usnews.com/best-hospitals/harlem-hospital-center-6212830 Raja, Z. (2010). Harlem Hospital is going through a bad divorce. Retrieved from http://northattan.com/2010/12/07/harlem-hospital-isnt-closing-its-just-going-through-a-bad-divorce/ Read More