INTRODUCTION TO PERSONNEL MANAGEMENT

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INTRODUCTION TO PERSONNEL MANAGEMENT

• Robert W. Smithee, JD
• Director
• Virtual Medical Group Programs
• Center for Healthcare
• Innovation, Education and Research
• Texas Tech University

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Management Philosophy Pick One

• There is no shortage of gurus advocating
  searching for excellence, downsizing,
  rightsizing, building it to last, reengineering,
  managing by objectives or walking around,
  developing seven effective habits, total-quality
  management or searching for quality, looking for
  megatrends, swimming with sharks and waiting for
  future shock, and doing it all in one minute.
• According to Peter Drucker guru charlatan.

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EFFECTIVE SUPERVISION IS A NECESSITY, NOT A LUXURY

• Employment practices are heavily regulated, with
  potential liability for employers and
  supervisors.
• Effective supervision is good risk management and
  must be a priority.
• Effective supervision is necessary for a
  productive, efficient workforce.

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The Effective Supervisor

• Must be knowledgeable of the various functions
  included in supervision.
• Must have a working knowledge of the legal
  framework governing the employer/employee
  relationship.
• Must know how to apply knowledge of supervisory
  functions within legal guidelines to day-to-day
  performance.

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LEGAL STATUS OF THE SUPERVISOR

• Supervisor as Employee.
• Protected by same laws as other employees
• Must comply with rules and regulations as other
  employees.
• Everyone has a boss.

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LEGAL STATUS OF THE SUPERVISOR

• Supervisor as Management Employee
• Actions can legally bind employer and create
  liability.
• May be exposed to personal liability.
• Employer will expect that manager will uphold
  policies and procedures higher level of
  expectation.

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CRITICAL THINGS THE MANAGER MUST KNOW

• WHERE YOUR AUTHORITY COMES FROM DIRECT, IMPLIED,
  APPARENT, EMERGENCY.
• SCOPE OF AUTHORITY
• WHAT IS BEYOND YOUR AUTHORITY
• WHAT LIABILITY CAN RESULT FROM YOUR ACTIONS.

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SPECIFIC PERSONNEL MANAGEMENT PROBLEM AREAS

• THE DOCTOR ISSUE
• HIPAA ENFORCEMENT AREAS
• HEAVY STATE AND FEDERAL REGULATION OF EMPLOYMENT
  PRACTICES

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I. THE DOCTOR ISSUE

• Supervision of staff must take into account the
  unique actions and reactions of physicians.
• Top management must avoid extending special
  standards or deference when physician discipline
  is involved.
• Physicians dont receive any formal coursework or
  training in personnel management or supervision.
• Physicians practice the Captain of the Ship
  model of supervision

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II. HUMAN RESOURCE POLICIES AREINCLUDED IN HHS
OIG GUIDANCE FOR FRAUD AND ABUSE COMPLIANCE

• 1. Practice policies and procedures
• 2. Training and education
• 3. Communication
• 4. Services provided by the practice
• 5. Patient relations

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III. EMPLOYMENT PRACTICES ARE HEAVILY
REGULATEDMAJOR EMPLOYMENT LAWS

• DISCRIMINATION IN EMPLOYMENT
• WAGE AND HOUR LAWS

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DISCRIMINATION IN EMPLOYMENT

• U.S. Constitution
• Title VII of the Civil Rights Act of 1964
• Civil Rights Act of 1991
• Section 1981 of the Civil Rights Act of 1866
• Section 1983 of the Civil Rights Act of 1871
• Equal Pay Act of 1963
• Age Discrimination in Employment Act of 1967
• Veterans Reemployment Act

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Discrimination in Employment(cont)

• Age Discrimination Act of 1975
• Immigration Reform and Control Act of 1986
• Americans with Disabilities Act of 1990
• Pregnancy Discrimination Act of 1978
• Fair Labor Standards Act of 1938
• Family and Medical Leave Act of 1993
• Workers Compensation (State Law)
• OSHA
• State Laws regarding Discrimination and Wages

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A. WHERE TO START
THE EMPLOYEE HANDBOOK

• Describes practice philosophy and describes
  services provided.
• Explains work rules, pay and benefits.
• Provides protection to the employer.

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ABOUT EMPLOYEE HANDBOOKS

• Every organization should have an employee
  handbook.
• Handbook should be brief, but give outline of
  major policies and procedures.
• Handbook is not a substitute for policies
  organization should have more detailed policies
  for reference and full explanation.
• BE CAREFUL about using canned or generic
  policies they generally do not include state
  law, and they may impose procedures which the
  organization may not or cannot implement.

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B. TIME AND ATTENDANCE

• Describe work schedules and hours.
• Describe how vacation and sick time is accrued
  and taken.
• Record keeping time sheets, payroll records,
  deductions.

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C. THE EMPLOYMENT PROCESS

• Job descriptions
• Recruitment and interviewing process.
• Salary determination
• Training requirements, probationary period.

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D. PAY AND BENEFITS

• SALARY SCHEDULE, RAISES, PROMOTIONS.
• ELIGIBILITY FOR HEALTH, PENSION PLANS.
• HOW OVERTIME IS ACCRUED AND PAID.

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E. DISCIPLINE AND TERMINATION

• Starts with employee handbook and specific
  policies explaining job requirements and personal
  and behavioral expectations.
• Explain what types of disciplinary actions may
  be taken and for what offenses.
• Should advise who will enforce different levels
  of discipline, i.e., who has authority to hire
  and fire.

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Notes about Discipline and Termination

• Many managers dont know what the organization
  policies are for discipline and termination.
• Many managers, including physicians, are afraid
  of the employees in their office. Dont confuse
  loyalty with performance.
• Biggest problem in managing or imposing
  discipline no or inadequate documentation.
• Many managers dont receive training on how to
  counsel employees or how to impose effective
  discipline or motivation measures.
• Managers are afraid of violating discrimination
  rules, so dont take any disciplinary measures.

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DISCRIMINATION IN EMPLOYMENT
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Title VII Civil Rights Act of 1964

• Prohibits discrimination in employment based on
• Race
• Color
• Religion
• Sex
• National Origin

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Title VII Theories of Discrimination

• Disparate Treatment treated differently from
  other employees because of because of category.
• Disparate Impact even though employers actions
  appear to be non-discriminatory, they in fact
  operate to the disadvantage of a protected class.

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Title VII Problem Areas

• English Fluency Requirements
• Selection guidelines not a BFOQ
• Language and Communication Skills
• Sexual Preference
• Foreign Training and Experience
• Hiring Family Members
• Dress and Appearance Policies
• Arrest and Conviction Records
• Pregnancy and Maternity

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Title VII Sexual Harassment

• Conduct includes
• Unwelcome sexual advances
• Requests for sexual favors
• Verbal or physical conduct of a sexual nature

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Title VII Sexual Harassment

• Constitutes a violation of the law when
• Submission to such conduct is made a term or
  condition of employment
• Submission to or rejection of conduct is used as
  the basis for employment decisions, e.g., pay
  increases, promotion, disciplinary action, etc.
• Such conduct interferes with performance or
  creates an offensive environment.

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Title VII Sexual Harassment

• Employer is liable for the conduct of others
• Supervisors. Employer is liable for the acts of
  its officers, agents, and supervisors with
  respect to sexual harassment regardless of
  whether the employer knew or should have known
  about the unlawful conduct.

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Title VII Sexual Harassment cont

• Responsibilities of employers (cont)
• Actions of non-supervisory employers. The
  employer is responsible for the act of sexual
  harassment between fellow employees when the
  employer, agent, or supervisor knew or should
  have known about the unlawful conduct, unless the
  employer can show that it took immediate and
  appropriate corrective action. (Whatever that
  is.)

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Title VII Sexual Harassment cont

• Responsibilities of employers (cont)
• Actions of Non-Employees. The employer is liable
  for the actions of non-employees with respect to
  sexual harassment in the workplace where the
  employer knew or should have known of the conduct
  and failed to take immediate and corrective
  action.

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Title VII Age Discrimination

• It is unlawful for an employer to discipline or
  discharge an employee who is over 40 because of
  the employees age.
• Applies to employers with 20 or more employees.
• Restricts mandatory retirement at age 65.

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Americans with Disabilities Act of 1990

• Applies to employers with 15 or more employees
• Prohibits activity that discriminates against a
  qualified individual with a disability.
• Administered by the Equal Employment Opportunity
  Commission

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ADA of 1990 (cont)

• A disability means a physical or mental
  impairment that substantially limits one or more
  of the major life activities of such individual
• A physical or mental impairment means any
  physiological disorder or condition. Cosmetic
  disfigurement, or anatomical loss affecting most
  body systems, and mental or psychological
  disorders such a mental illness, learning
  disabilities, mental retardation, etc. Includes
  HIV infection and AIDS

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ADA of 1990 (cont)

• Employer must make reasonable accommodation but
  need not incur undue hardship. May include
• Making facility accessible and usable
• Job restructuring
• Modified work schedules
• Acquisition or modification of equipment
• Adjustment or modification of exams, training
  material, and policies
• Provision of qualified readers or interpreters.

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Enforcement of Title VII

• Complaint filed with the Equal Employment
  Opportunity Commission.
• EEOC investigation. May be done by state agency
  to investigate and settle claim.
• If unable to settle, EEOC can issue right to
  sue letter, even if no reasonable cause found
  for discrimination.
• Remedies can include, reinstatement, back pay,
  compensatory and punitive damages, court imposed
  affirmative action, injunctions.

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FAIR LABOR STANDARDS ACTWAGE AND HOUR LAWS

• Establish minimum wage requirements
• Establish overtime eligibility and rules
• Prohibits wage discrimination based on sex
• Establishes records-keeping requirements

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Wage and Hour Laws (cont)

• Must comply with both federal and state wage and
  hour laws.
• Applies even if your organization has no
  collective bargaining agreement.
• Applies to nearly all physician practices and
  medical facilities

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Wage and Hour Laws (cont)OVERTIME

• An employee is eligible for overtime pay for all
  hours worked in excess of 40 hours per work week.
• Overtime is paid at one and one/half times the
  regular hourly rate.
• 8 and 80 option for certain health facilities.
• Work not requested but suffered and permitted
  counts as worktime.
• Must define workweek, workday, and regular
  rate for your organization.

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Wage and Hour Laws (cont)OVERTIME -
ELIGIBILITY

• Exempt Employees Are not eligible for overtime
  pay, but must meet specific job criteria for one
  of the following categories
• Executive
• Administrative
• Professional

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Wage and Hour Laws (cont)OVERTIME -
ELIGIBILITY

• Non-exempt are required to be paid overtime pay
  for hours worked in excess of 40 per week.
  Example of jobs
• LVN
• Clerk
• Lab Tech
• Nurse Aide
• Food Service Aide
• Custodial Service
• New law Any employee paid 455 a week or
  23,660 a year is eligible for overtime
  regardless of job or title.

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Wage and Hour LawsRegistered Nurses

• Registered Nurses are exempt from the overtime
  rules, but may be paid overtime at the discretion
  of the employer.
• RNs who are full time or whose primary duties
  are administrative are normally exempt and are
  not paid overtime
• RNs who are part time or temporary charge nurses
  or shift leaders, and who are otherwise eligible
  for overtime pay, do not lose overtime
  eligibility and must be paid overtime for hours
  worked over 40 per week.

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Wage and Hour Laws (cont)

• COMPENSATORY TIME. Nonexempt private sector
  employee may not be given comp time in subsequent
  workweeks in lieu of overtime, must be paid for
  overtime hours. May reschedule hours in the same
  workweek to avoid overtime.
• If paid biweekly, employer must pay overtime for
  hours worked in first week, and may reduce worked
  hours in second week at time and one-half to
  offset overtime expenses.
• Public sector employees have separate rules and
  may receive comp time.
• Job titles are not adequate to determine
  eligibility for overtime, must meet criteria for
  the specific exemption.
• FLSA does not require overtime to be paid at a
  double-time rate.

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Wage and Hour Laws (cont)

• FLSA does not require overtime premium for
  weekend, Saturday, Sunday or holiday work.
• Bona fide meal periods are not hours worked.
• Short rest breaks are considered worked hours and
  must be paid
• Consider organization policy and specific
  circumstances for standby, on-call, travel time,
  preparing and concluding work, training time, and
  waiting time.

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Wage and Hour Laws (cont)Recordkeeping

• Failure to maintain accurate records is a
  violation of law. FLSA does not require records
  be kept in any particular manner as long as they
  are accurate and complete. Review organization
  policy or the law to determine what information
  must be kept.
• Maintenance of records known to be incorrect can
  be prosecuted under the False Information Act and
  penalties are more extensive than the FLSA.

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Reference Material

• Personnel Management in the Medical Practice
  American Medical Association
• Legal Aspects of Health Care Administration
  George D. Pozgar
• Law for Physicians American Medical Association
• Department of Labor Publications

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MORAL OF THE STORYITS IMPORTANT TO COMPLYWITH
REGULATIONS, BUT THE GOAL IS TO HAVE AN
EFFECTIVELY MANAGED, PRODUCTIVE STAFF