Budgeting and Managing Healthcare Resources

1) I expected to learn about budgeting monies in a healthcare setting and managing my resources effectively.  

2) I actually learned how to understand a budget and manage it effectively by controlling my expenses in the company. I learned it is important to look at monthly goals and how much was actually spent in the month. Then compare that figure to the year-to-date amount. This can help you see where sudden expenses are occurring or what average monthly amounts should be at. By comparing the actual year-to-date amount to the previous years, you can determine trends in your company finances and see where money is going. To me, it is important to continue educating staff members about conserving supplies and not being wasteful with resources. According to an online article, 20-25% of expenses go toward cost of supplies (http://www.ehow.com/how_7456719_calculate-cost-supplies-hospital-unit.html). By being efficient with supplies (i.e. changing from brand-name to generic products or not over-stocking patient rooms) expenses can be reduced dramatically.  

I also learned that “managing my resources” can be applied to actually working on the floor as a nurse and delegating tasks to my patient technicians. In my case, I always under-delegate. This results in an increased work-load for myself, which also increases my stress or feelings of resentment towards my technicians. From the PowerPoint presentation, I learned that the four causes for under-delegating are:

·        - Fear it may be interpreted as a lack of ability

·        - Desire to do whole job yourself

·        - Fear of resentment by subordinates

·         -Lack of experience in job or with delegation

All four of these reasons explain why I under-delegate. Now that I have learned why, I feel more empowered to start practicing delegating so I can become better at it. Also, I learned that it is important to not delegate boring tasks to others. (I have found that’s what I have always done because I didn’t want to seem like I was burdening my techs). Obviously this is not the right way to go about it. By delegating harder tasks, they have the opportunity to “shine”. Also, by delegating ineffectively, poor outcomes can be expected. I definitely want the best outcomes for my patients (and for myself), so I need to practice delegating better until it becomes my strength.

3) I enjoyed the discussion about how to cut our annual budget by 10%. I found I was right in line with what my peers thought. They also considered cutting employee hours and ensuring over-staffing was not occurring.

4) Once again, I plan to start delegating from here on out in my nursing profession. This will bring about better patient outcomes, decrease my stress, and make my relationships with my techs more positive.

5) I really enjoyed learning about budgeting and delegating. By managing my resources more effectively, I can stick to my budget and be successful. This is helpful in my own personal life with our family finances. I feel like I have learned more tips on adhering to our budget better. I enjoyed the portions on delegation as well. I feel more empowered to implement that into my daily nursing practice.  

Power Reflective Journal

Before beginning this unit, I expected to learn about leaders who were powerful and why. After completing the required readings and watching the lectures, I realized I was sort of correct, but mostly wrong. I ended up being very enlightened about the differences in leadership style/skill between men and women and why they tend to miscommunicate.

Communication differences among men and women are mainly due to the fact that “each gender is a culture unto itself, raised with basic rules of conduct “instinctively” known to all adult members of that gender” (Heim, 1995).  Little boys were taught to compete on teams at a young age. They won 50% of the time, and lost 50% of the time. They learned to shake off their losses and move forward. Sometimes they played with the big, tough, and rough guy, even if they didn’t really like them. They were given a goal with directions and were supposed to follow them exactly. On the other hand, women were raised playing with dolls. They did not lose much…since you can’t really lose with dolls. This can explain why women take losses in the workplace more harshly and internalize it more. Girls are usually taught to avoid conflict and tend to play with other girls they like. This can be more difficult in the workplace setting for women, since conflict can often arise with other employees. Women also tend to be more invested in forming relationships in order to expect greater outcomes. Whereas men enjoy the hierarchy of power (Heim, 1995). Dr. Pat Heim summarized her lecture by stating that one may need to change the way they behave between cultures in order to get the desired outcome.  

According to the “Business Women” online article (2008), men’s styles are characterized as being: task-oriented, autocratic, command-and-control, and punishment-oriented. Whereas, women’s styles are characterized as being: team players, democratic, transformational, and reward-oriented (“Business Women”, 2008). Women tend to use their positions of authority to create a supportive, nurturing environment(“Business Women”, 2008). While men use their positions of authority to create a hierarchal environment in which they issue orders and expect obedience (“Business Women”, 2008).

From the team discussion, I was a little uncomfortable learning about my peer’s own stereotypes of women in the workplace. I hoped through my discussion with them, they could be more open to the idea of women performing well in leadership positions.

I plan to change the way I communicate in my profession as a nurse, in order to achieve my desired outcomes. When delegating to my male techs, I may need to state directly what I want them to do, without the chit-chat beforehand. With my female techs, I may need to invest in my relationship with them more first, and then can expect better outcomes and for them to follow through with what I have asked them. Bridging these communication gaps can be essential for me in a leadership position. I think it will be helpful for me when communicating with male physicians as well.

I enjoyed learning about the differences in style and skill between men and women in leadership positions. I did not realize the major influence social norms play on our miscommunication and differences. I think a collaborative approach is most effective in a hospital environment, and I am greatful for my own traits and abilities which will help me facilitate and create this type of environment naturally.

References

“Business women differ from business men in style, not skill.” (2008). Retrieved online from http://www.coaching-for-new-women-managers.com/business-women.html

Heim, P. (1995). The power dead-even rule. Retrieved online from http://www.enterprisemedia.com/content/misc/powerdeadlg.pdf

Firing/Discipline Interview

For our Firing/Discipline assignment, I interviewed Richard Williams, former Associate Academic Vice President over faculty at Brigham Young University, and now President of the Wheatley Institute there. He has experience with disciplining employees that are either faculty or administrative staff. From the interview, I learned how much the Honor Code influences the decisions made regarding discipline or termination, since they are guiding principles of the school and in line with doctrine of the Church of Jesus Christ of Latter-day Saints.

 The process for disciplining an employee is outlined in the BYU policy guidelines. It shows the course of action one must follow when disciplining an employee.  Initially, he addresses the problem with the employee and makes a memo about it.  The memo is typed and printed out, then placed in the employee’s permanent file. The hope is the employee will correct the undesired behavior. If they don’t, then a warning letter will be written to the employee. Richard will also meet with the employee face-to-face and have them sign it if they do not correct behavior. Memos are encouraged throughout the entire process so if it comes to termination, then there will be a documented paper trail.

Richard states he does not necessarily have a witness present when confronting the employee about their inappropriate behavior. If it more serious of an infraction, then he will advise the Human Resource department and go from there.

To Richard, it does not matter whether he disciplines or terminates an employee on a Friday. If he knows the employee is likely to be “hot and confrontational” about it, then he purposely chooses a Friday so the employee will keep that type of behavior at home and not in the work-place. Richard states he has never considered the possibility of an employee losing their job and ending their life (when terminated on a Friday). He is interested if there is research to back this notion up.

For Richard, he does not like to discipline an employee, so not much makes it easier to do.  Richard states what makes it difficult for him is he does not like confrontation. “I don’t function that way and it is not in my nature” to discipline others. Although, he does it because it is a part of his job description and it has to be done, even though “it’s not fun”.  What makes it most difficult for Richard is when the employee isn’t responding much or trying to correct their behavior. Also, if they are dishonest it is hard because it ends up degenerating into two different stories of “he-said, she-said.”

Richard says that he does set a plan of action with the employee to correct the infraction. This way they are aware they are “warned” and it gives them some time to change.

In regards to a probation time prior to termination of employment, Richard states that BYU doesn’t really have a set type of probation. If an employee violates the Honor Code or they are not Temple worthy, they can be put on “probation” for a time in hopes of fixing the problem. If there is a faculty member coming up for “continuing status” or “tenure”, but BYU is pretty sure they will not be receiving tenure, they can receive a time off before they are terminated.

Seniority and experience actually greatly influences decisions regarding termination of an employee. Richard states he helped write the policy to implement a system where employees could be terminated even with tenure. Most often, a senior employee struggling with infractions will be allowed to continue out their employment if they are nearing retirement. Sometimes they can be used elsewhere at BYU and possibly be more successful there. On other occasions, if the infractions are serious enough, the employee can be given a lump-sum of money that would make them “whole”, or as if they had worked the 2 years. 

Lastly, the types of things that warrant discipline at BYU are most often in relation to morals and the Honor Code. For example, an employee with a Word of Wisdom problem would warrant discipline and Richard will give them time and work with them to change that behavior. If there is something as serious as adultery, Richard is more likely to move to termination. He states there are many factors to be weighed when making these decisions: What is the likelihood of the employee changing their undesired behavior? What is the effect or damage done to students from their inappropriate behavior? And, lastly, one must consider the reputation of BYU and how it will be affected if the employee is allowed to continue on or not.

Overall, I really enjoyed this interview and didn’t realize that in the case of BYU, the Honor Code was often the guiding law. (I assumed it applied mostly to the students attending BYU). It was interesting to know that he did not have a witness present for disciplinary action, unless the offense was more serious in nature. I also found it interesting that Richard does not like confrontation, even though his position is high-ranking at BYU. I guess I assumed that leaders felt comfortable with confrontation because they knew it was an expected part of their job description. I also liked learning that Richard would perform yearly stewardship reviews with his employees and would bring up weaknesses to work on during this time. 

Reflective Journal- Ethics Unit

1) I expected to learn about ethics and values this unit. I wasn’t quite sure how it applied to nursing leadership though.

2) After learning about ethics, I feel I have a better view of what ethical dilemmas are, the nursing leader’s role, and how to generate issues to an Ethics Committee. First, an Ethics Committee is a group of professionals with diverse backgrounds that specialize in ethics training. The committee usually consists of about 7-8 members and can include physicians, nurses, lawyers, quality improvement directors, and stay-at-home moms. This diverse group can offer insight to both sides of an issue and back it up with research. Even when their advice is given, it is still up to the physician and hospital to choose what they want to decide regarding the issue.

I also learned research is an effective source for determining the direction to proceed with an issue. Both issues may seem right. Or both issues may seem wrong. My opinion can easily be wrong, and I need to realize that. This is why it is helpful to have outside recommendations from an ethics committee. They are trained professionals with expertise in ethical dilemmas.

3) I enjoyed the team activities. Our group came to the consensus that more information should be provided, regarding the patient in the coma needing dialysis. This taught me the importance of looking at all the facts and background situation. This aides in making a better decision for the patient.

4) I will apply this unit to my nursing practice by remembering that both sides of an argument can be right (i.e case of good intent versus good intent), or wrong. It is important to listen to everything, research the issue, and address the background, while seeking out other’s advice when I am unsure of what to do.

                                                                                                                                

5) I was very surprised to learn in the PowerPoint lecture that spouses of patients have been faced with allowing their pregnant wife to live in her vegetative state, just so the fetus can come to term, or to the point of viability. I never really considered this before. One would think the answer would be to definitely let the fetus survive. Although, after reading about actual real-life examples of this, it became apparent to me that costs should be considered, the predicted survival of the infant, and the fact that keeping the pregnant woman alive, in her vegetative state, might be against her wishes, regardless of being pregnant or not.  

From this unit on ethics, I feel enlightened. If dilemmas present themselves, I now am aware of Ethics Committees and can choose to access them. I feel using their expertise can be so beneficial to all parties involved—the patient, staff, and family.

Performance Appraisals Interview

The Interview

For this assignment, I interviewed Aaron, the manager of Ridleys grocery store in Utah. Aaron stated he conducts employee evaluations biannually. When evaluating the employee, he uses 5 different areas (i.e. attitude, performance, timeliness, etc) as benchmark criteria. The employee rates themselves on a scale from 0 to 10 on how well they feel they have been doing. A score of zero points means the employee performed very poorly. A score of ten points means they excelled in the specific area. (Aaron did state he disliked the 10 point system, since it wasn’t truly reflective of actual performance and too wide a margin. He would prefer a smaller set of numbers in the future to decrease the complexity.) After the employee evaluates themselves, they will have an initial interview, lasting about 45 minutes, with their direct supervisor. This supervisor will rate them as well. Lastly, Aaron will have a face-to-face interview with the employee. These typically last 10-15 minutes. Aaron always has a witness present, usually another manager, to protect himself, the company and the employee. At the end, he takes the total of each of the scores. This number, out of the total, is supposed to be reflective of how well the employee is doing.

As a manager, Aaron feels performance evaluations are very important. He states that how a manager handles the performance appraisals reflects what kind of manager they are. To him, a good manager finds ways to inspire and motivate their employees to be better. His idea is if you build up an employee and show them they are valued, even with their weaknesses, they are more likely to stay loyal to and working with the company. Some managers focus only on what is wrong with an employee, and this creates a negative work environment. A manager like this cannot expect much change from an employee if they are constantly criticizing. Aaron also stated that it is okay to have weaknesses. The performance evaluation can help point out areas that need to be worked on. Usually it is quite evident from the benchmark scoring system they have. Together, he will work with his employee to create goals to improve upon their weaknesses. If the employee’s goal does not seem in line with objectives and company goals, Aaron will help assist the employee with more specific goals.

What I found interesting is Aaron looks at each employee and “grades” them against themselves. He doesn’t compare them to others. He knows each employee has their own circumstances, strengths and weaknesses. He feels it important to gauge them against themselves and their own personal practice of work. This way, it is fairer to the employee. Of course, if an employee is blatantly disobeying rules and consistently failing to meet expectations, then disciplinary action will follow. (He mentioned this part is important to document all warnings and have the employee sign each one. This helps protect the company from law-suits in the future. It also gives the employee rights as well.)

What I Learned

Aaron, seems to be a very understanding manager to me. I felt he was very aware of his managerial position and what his job description entailed.  He was up-to-date and familiar with current practice regarding the law and what it mandates. He had another witness present to protect himself and the employee’s rights. He viewed performance appraisals as a time to look at weaknesses and turn them into strengths. Even if an employee continued to perform poorly in an area such as sales, but were trying their best, Aaron would look and see if there was another position in the company where this employee would be more effective. I really admire his leadership style.  

Performance Appraisals & Problem Employees

            What I learned

            Before beginning this unit, I wasn’t really even sure what a performance appraisal meant. I figured it would deal somewhat with problem employees and disciplining them. I also thought it might mean praising an employee for doing good things. I was sort of correct, but mainly wrong.

            From our PowerPoint presentations and assigned online readings, I learned that performance appraisals are basically a report card or check-up on how employees are performing on the job. Some companies choose to have bi-annual or annual evaluations. Others choose to have monthly evaluations. It mainly is dependent on what the manager wants to do, company policy, or how many employees there are to evaluate. Most managers state they hate doing these face-to-face interviews and evaluations with the employees. They often feel it is a complete waste of time. From our assigned readings, I learned ways to make the performance appraisals more meaningful to the employer and employee.

            First, it is important to know the purpose behind performance appraisals. They can tell an employee how well they are doing at their job, their strengths, and what they can do to improve. From the company’s perspective, they can decide whether to keep the employee, challenge the employee with leadership opportunities, or terminate them. In addition, performance appraisals allow for consistency in the company. Job descriptions can be clearly outlined with company expectations and standards to adhere to. These policies are consistent for all employees, and can include benchmarks with specific criteria. Some benchmarks are 3-scale, such as “Poor”, “Average”, and “Exceptional.” Others can be 5-scale, including “Not Met,” “Low-Met”, “Met”, “High-Met” and “Outstanding.” Numbers 1 through 5 can be used with 1 being the lowest score and 5 as the highest. For example, “Poor” would mean the employee does not meet expectations, does not complete their job description and basically needs a new job. (They can be successful elsewhere). A rating of “Average” means the employee completes the job description as outlined. The employee is a good employee and is dependable. An “Exceptional” rating would mean the employee exceeds expectations and goes above and beyond what is required of them. Often these employees should be told how great they are and given opportunities for growth in the company. This way, the employer can expect to retain them. It is important to remember that the common employee will likely score a “3” or “Average” in their employee appraisals. This still means they are a great employee and valued.

           

            When performing the evaluations, it is important to have the employee grade themselves, as well as the employer give a rating. Peer evaluations from staff members with leadership positions are helpful to give a better picture of how the employee functions on the job as well. The face-to-face interviews needn’t be long. About 5 minutes seems an effective amount of time. This way the employee leaves the interview knowing what is expected of them, what they can improve upon, what their strengths are, and feeling valued so they will desire to continue working for the company. They will also know the company goals and how they can best accomplish them.

            In addition to learning about performance appraisals, I learned about the dispciplinary process to follow when confronted with problem employees. Terminating an employee is in the top three things bosses hate to do. By establishing a process that all employees are aware about, the job of disciplining or terminating an employee can be made easier.  

            First, one must understand that disciplining someone means correcting their undesired or inappropriate behaviors.  When disciplining an employee it is important to do your research beforehand. Ensure the employee is really doing what they have been accused of. Gather facts in writing. Speak with other staff members with leadership positions. Next, take the employee aside privately and have a witness present. An HR member is preferable. The steps for disciplining include a verbal warning first (written down and signed by employee), a written warning next, and then a final warning. If the employee still does not change their inappropriate or undesired behavior, then the employer can move to terminating the employee. It is important to be kind and respectful with each of these warnings. Documenting everything is a must. This protects your company in the future against any legal appeals. Lastly, never discipline or terminate an employee on a Friday. There have been cases of employee’s taking their life on the weekend after learning they were fired. Being kind in the process and treating the person how you would want to be treated is best.

My Thoughts on Team Activities

            This week we participated in three different discussions, including creating benchmarks for performance appraisals, choosing the greatest leader of all time, and how we felt we should discipline an employee. I learned from my peers that real-life happens, and it is important to understand this with problem employees. Yet, at the same time, once you have spoken with this employee, it is important that change takes place afterwards. If not, the discipline process should be implemented with the next steps of a written warning, a final warning, and then termination.

            I thought it interesting that one of my peers chose Jesus of Nazareth as the greatest leader of all time. I had written the same thing. He was very influential with his perfect attributes, his service to others, his belief in others to learn and grow, and the fact that about two billion persons still believe in him, with that number growing. Our group came to the consensus that he was the greatest of all, and he alone.

            I enjoyed learning the criteria my team members came up with for the benchmarks prior to discussion. I think I have super high expectations for others. One of my peers seemed more realistic in their expectations. It made me reflect why I was this way. I guess it is because I work very hard and expect the best of myself. Because of my own high standards, I know others can achieve these same standards through hard work and dedication. Sometimes they just need to be taught how. I feel I could help exemplify that if I were in a leadership position.

How I will utilize the information I have learned?

            I plan to use the information I have learned when I am in a leadership position. I will include the disciplinary process for problem employees and do biannual performance appraisals. My interviews will be short, about 5 minutes maximum. Although, I plan, as a leader, to make daily rounds on the floors, to ensure I have personal relationships with each of my staff members. This way they will feel needed, important, and that what they do matters for the corporation.

My Personal Feelings

            I loved learning about the discipline process. I do not like confrontation. Although, what bothers me more is when my fellow staff members are not performing their job well, and making others pick up their slack. From the lecture presentation, I have now learned the proper steps to discipline an employee. This way they know what is expected of them. Having a plan or outline in place, makes it easier for me to be able to confront the individual to help correct their undesired or inappropriate behavior. It no longer seems like confrontation to me, or a scary thing to do.