1. McConnell, Charles R. Editor

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A sizeable multihospital system composed of several organizations fell on hard times. No surprise in that; much of organized health care has seen hard times in recent years. Given the impact of Medicare cuts mandated by the Balanced Budget Act of 1997 on top of an already severely negative bottom line, management embarked on a serious "reengineering" effort. A couple of facilities were closed, some unprofitable services were cut back or eliminated, and affected areas of the work force were targeted for reductions (to most employees, "reengineering" and its various synonyms have but a single meaning: jobs will be lost).


Layoffs were spread out over a period of months, with a few people vanishing every second Friday (a reduction pattern that was undoubtedly easiest on finance and human resources staff but which had the effect of prolonging the suspense for those who were vulnerable). Among those whose positions were eliminated were 2 employees of nearly 20 years of service who worked in adjoining departments and had known each other for most of their employment. On one Friday, 1 of the 2 was terminated; the other followed 2 weeks later.


An individual's termination is, of course, a personal matter, and each terminated employee was dealt with individually. It was only on a chance meeting shortly following both terminations that the 2 former employees had occasion to converse about their terminations. Everything was handled the same for both-severance pay, limited continuation of insurance, retirement vesting, and such-with one exception. One individual, age in the early 50s, had received a reasonably generous outplacement package to assist in finding new employment; the other party, age nearing the mid-60s, received no such benefit.


The point? Some assumptions about age were at work in the situation just described. Extending every benefit of the doubt concerning motives, it is perhaps reasonable to believe that no one made a conscious decision to deny to one party a benefit that was extended to another. The implicit assumptions were that the party whose age was in the early 50s would necessarily have to seek new employment but that the mid-60s individual would not be doing so. Aside from working in different occupations, the only substantial difference between these 2 employees was 12 or 13 years in age. However, it was that difference in age that apparently prompted the differential treatment.


It seems fixed in any number of minds that someone in the mid-60s would no longer want to work or need to work; when the position of one of that age disappears, the logical move for that person is retirement. Not only is this outlook a holdover from years past; when it is reflected in practice as in the foregoing situation, it constitutes age discrimination. In addition, despite significant legislation making it illegal, age discrimination continues to be a problem of increasing proportions.


Interestingly enough, age discrimination was not addressed in Title VII of the Civil Rights Act of 1964. Rather, the subject was given over for study to the US Department of Labor. In 1967, the Congress reacted to the US Department of Labor recommendations with the Age Discrimination in Employment Act, protecting workers aged 40-65. In 1978, protection was extended through age 70; in 1987, the upper age limit was eliminated altogether and the defining criterion for one performing any particular job became the ability to do the job as expected.


In spite of the Age Discrimination in Employment Act having been twice strengthened and in spite of the passage of other legislation such as the Older Workers Benefit Protection Act, complaints of age discrimination filed with the Equal Employment Opportunity Commission continue to mount. During 2002, the Equal Employment Opportunity Commission received nearly 20,000 complaints of age discrimination, an increase of roughly 40% over 1999.


As much of health care continues to shake out and adjust to today's financial realties, an increasing number of workers in their middle years or older are finding themselves out on the job market for the first time in 20 or 25 or more years. In addition, many of them are encountering age discrimination, genuine although usually subtle; after all, there can always be numerous reasons cited for not hiring a particular individual.


Discrimination of various kinds is gradually disappearing from employment. Focus on the word gradually. Laws can call for change, but real, long-term change, change in human behavior, takes time. First, people begin to do what they are called on to do because some law says so; it is only through experience that attitudes change and people behave in the desired fashion because they believe doing so is right and proper. Today's work force has a long way to go to be completely free from age discrimination and other forms of employment discrimination. However, change is occurring; consider that pre-1967 a person could be refused a job "because you are too old" and one could be forced into retirement at an age established by the employer.


All change that depends on altering human behavior takes time-often, lots of it. It may seem to take impossibly long to get where we want to go, but how will we ever get there if we fail to take the first steps?


This issue of The Health Care Manager (HCM 23:1) offers the following articles for the reader's consideration:


"The Ethic of 'the Organizational Good': Is Doing the Right Thing Enough?" defines "the organizational good" as the unchanging soul of an organization and suggests that an organization can thrive if all of its members from the board of directors on down reinforce ethical principles by modeling them in all of their dealings.


"Self-promotion: A Strategy for Career Advancement" suggests that self-promotion, a mode of behavior many managers consider inappropriate, can under the right circumstances help advance one's career while assisting in getting one's ideas and contributions heard and recognized.


"The History of US National Health Plans: Will These Same Issues Resurface in 2004?" reviews health care plans and proposals from a historic perspective and uses what has occurred in the recent past to suggest what might be expected to be proposed in the near future.


"The Measurement of Performance in a Physical Therapy Clinical Program: A ROI Approach" presents a performance measurement model for a physical therapy program that uses revenue, patient outcomes, staff productivity, costs, and patient satisfaction to determine the return on investment for the program.


Case in Health Care Management, "The 'Demanding' Manager," asks the reader to consider the problems arising when a new manager assuming command of a department comes across to the staff as unreasonably demanding by comparison with the former, long-time manager.


"Utilization of Performance Appraisal Systems in Health Care Organizations and Improvement Strategies for Supervisors" presents the results of a case study of one health care organization's performance appraisal process and describes how what was learned can be used to improve appraisal systems.


"HIPAA Compliance: Deadlines and Beyond" advances the necessity for continual follow-up on the Privacy Rule and the Transactions and Code Sets Rule of the Health Insurance Portability and Accountability Act and suggests how follow-up might best be pursued.


"Health Care in the Sultanate of Oman From a Graduate Internship Experience Perspective" presents an overview of health care in the Sultanate of Oman, relates the experiences of a graduate student with the Oman system, and offers some observations and recommendations for future consideration.


"Conflict Management Styles of Asian and Asian American Nurses: Implications for the Nurse Manager" examines the differences in conflict management behavior between Asian and Asian American nurses, recognizing that health care team members from diverse cultural backgrounds bring to the work setting different behaviors that directly influence the outcome of conflicts.


"Nursing Generations: An Expanded Look at the Emergence of Conflict and Its Resolution" suggests that 3 distinctly different generations are active in today's nursing work force and that forces at work between and among the different generational groupings are exacerbating the current nursing shortage and creating additional problems for those who must manage this mix of workers with their differing attitudes and needs.


"Improving Productivity Through More Effective Time Management" suggests that the effective management of time has become increasingly important in today's restructured health care organizations and offers a common-sense review of time management principles for department managers.


"Can the Value of Training Be Measured?" addresses the age-old question of its title by describing how one hospital approached the problem and offers relatively simple approach that trainers and managers can use to assess the value of training programs.


"The Comprehensive Organizational Plan: How a COP Can Protect and Serve Your Health Care Organization" suggests how health care facilities can improve operating efficiency, reduce duplication of services, and compete more effectively through the use of the 5-stage comprehensive organizational plan.


"The Causes and Consequences of Conflict and Violence in Nursing Homes: Working Toward a Collaborative Work Culture" addresses the special dynamics that accelerate dysfunctional conflict in nursing homes and offers strategies, tactics, and other recommendations to help leaders build more collaborative work cultures.


Charles R. McConnel