Article Content


A manager necessarily spends a significant part of the average workday dealing with employees. The first-line manager's task is to get things done through the efforts of people, specifically the employees in the group. Therefore, the manager spends a great deal of time and effort not only working through the employees to get the work accomplished but also working with employees to help maintain them as effective producers of output, as effective caregivers, or as other supporters of patient care.


The human resources department, especially the employee relations function, is ordinarily involved in many of the manager's concerns with problem employees and employee problems. From numerous situations ranging from problems requiring mild disciplinary action to serious difficulties involving grave potential consequences, 2 apparent patterns of worker behavior have emerged in recent years.


The first has been gradually emerging in most areas of life for quite some time, and it seems to be growing more pronounced in the workplace. It is the increasing inability of some people to take responsibility for their own actions. This growing tendency has been aided and abetted by the government. In passing an accumulation of laws regulating essentially every dimension of employment, the government has caused many to believe that if one does not agree with any particular action or decision, then one is being treated unfairly. This attitude has also been fostered through modern popular psychology suggesting that anything "wrong" with someone's behavior stems from environment, background, or past experience (giving us, eg, 1 of the most overworked words in modern English: dysfunctional).


Surely, the causes of the trend toward the inability to accept responsibility for one's own behavior are far more complex than suggested above, but regardless of cause, however, the tendency is present and it must be addressed in relations with employee. It makes the manager's task more difficult because one who does not-and in many instances actually cannot-accept responsibility also does not readily accept correction as valid. Surely, anyone who has supervised employees for a few years has encountered the occasional employee who can "do no wrong"; whatever happens is always the fault of other persons or is caused by circumstances beyond the individual's control.


The other troublesome growing tendency is evidenced in the behavior of an increasing number of workers who seem to believe that the work organization exists primarily for their benefit. Once again, the government's efforts to regulate most aspects of employment have played into the creation of this condition, and labor unions and some social action organizations have behaved as though employment should be the work organization's first concern, but again, the problem's causes are broader and more complex than a pair of simply stated possibilities.


Even in the face of relatively high unemployment, among some who are employed, we find a surprising number of employees who want to work just the hours they prefer to work, arrive and leave when they feel like it, do their jobs the way they would like to do them regardless of what the organization's clients need, and leave the job for prolonged periods when they feel they need to and be guaranteed return to a secure position. In short, they consider the organization's primary responsibility as ensuring their livelihood.


It would be great if every work organization could do for employees what some of today's workers-fortunately not an overwhelming number but surely a significant number-want from their employment. The essential difficulty with this desire, however, is that it places the concerns of the employee above the concerns of the customer or, more specific to health care, the needs of the patient or client. If our customers are not always our first concern, they will eventually become someone else's customers-and we will have no employees to be concerned about.


Neither of the foregoing trends shows signs of dissipating at present, so their effects will be with us in employee relations for the foreseeable future. We can be assured, however, that conditions will eventually change and we will be faced with new trends in employee relations not yet imagined.


This issue of The Health Care Manager (32:4, October-December 2013) offers the following articles for the reader's consideration.


* "Dress Codes and Appearance Policies: Challenges Under Federal Legislation, Part I: Title VII of the Civil Rights Act and Religion" suggests that a policy governing dress and appearance based on business needs, consistently and fairly applied and has no disproportionate effect on any protected class, will generally be upheld if challenged in court.


* "The Organizational Attraction of Nursing Graduates: Using Research to Guide Employer Branding" reports on a survey of graduating nurses in Quebec to determine the extent to which quality of care, type of work, compensation, and employer branding are instrumental in attracting university-trained nurses.


* "Massachusetts Health Care Reform: Is It Working?" reports on research undertaken to assess Massachusetts health care reform in terms of access, cost, and sustainability, concluding that reform has not necessarily saved money but has expanded coverage to more individuals.


* "Emergency Department Utilization at a Large Regional Hospital: A Strategy for Survival" reports on research that examined the operational, patient, and financial patterns of the multiple emergency departments of a large hospital system in the southeastern United States.


* "Generational Differences of the Frontline Nursing Workforce in Relation to Job Satisfaction: What Does the Literature Reveal?" presents a review of existing literature examining the differences in variables such as job stress, work-life balance, and compensation that are linked to job satisfaction of nurses belonging to different generations.


* "The Evolution of Retail Clinics in the United States, 2006-2012" presents an evaluation of the evolution of retail clinics between 2006 and 2012 and examines the yearly openings and closings of clinics by location, owner, operator, and other major characteristics.


* Case in Health Care Management: "It's His Job, Not Mine" asks the reader to consider an apparently unsuccessful instance of delegation and suggests what the manager in the case might have done differently to improve the chances of successful delegation.


* "Performance Management Excellence Among the Malcolm Baldridge National Quality Award Health Care Winners" identifies the best practices in performance management demonstrated by 15 recipients of the Malcolm Baldridge National Quality Award in Health Care.


* "Developing a Hospital-Specific Electronic Inpatient Fall Surveillance Program: Phase I" reports on a study undertaken to analyze nurses' perceptions of patient fall risk factors to provide information that may subsequently be used in developing an electronic patient decision support system for preventing patient falls.


* "The Use of Innovative Advance Directives Programs in Nursing Homes" explores the relationship between nursing home profit status and innovativeness in the use of advance directive programs in an effort to determine what other types of innovations are associated with the use of these and the differences in use according to nursing home characteristics.


* "Determinants and Benefits of Physical Activity Maintenance in Hospital Employees" reports on a study investigating whether the positive behavioral and anthropometric outcomes of a pedometer-based physical activity 8-week challenge were maintained 6 months after the conclusion of the program.


* "ICD-10 Training: What Coders Are Saying" reports on a pre-presentation and postpresentation survey completed by the attendees at a workshop concerning the application of the new ICD-10-CM/PCS coding system to be effective October 1, 2014.