Hello, I have an exam and I need help. This is 100 mins class, with 4 essay type questions. Once i open it, I will attached the questions and you need to send me back in 100 min. NO Plagiarism because it will use Turnintin and plagiarism report must be attached. I attached the lectures for your help. No specific word limits to each questions but my guess it should be at least 300 words each buy main thing it should be properly answered.

 This exam requires you to answer 4 essay questions based upon class Panopto presentations. Each question is worth 25 points. You have 100 min to complete the exam. Once you start you cannot stop and go back to it at a later date. Do not open multiple course moodle sites. You may be unable to submit your exam responses.Good luck! 

I will send you pics of the questions and you need to send answers within 100 mins.

Labor Relations and
Healthcare Organizations

Week 6 session 3

1

Unions
Union
— A formal association of workers that promotes its members’ interest through collective bargaining
— The official employee representative
Unions in the United States
Represent about 11% of the U.S. civilian workforce
Union membership declining
Unions heavily concentrated in metropolitan areas
Union activity in healthcare industry likely to increase
2

Why Employees Unionize
Employees feel mistreated
Employees concerned about staff-to-patient ratios
Employees believe a union can negotiate financial & job security, and better working conditions
JOB DISSATISFACTION
Poor working conditions
Lack of recognition
Job stress
Lack of career opportunities
Competing personal family commitments
3

Manager’s role is to create positive work environment in order to avoid unionization
4
Unionization in Healthcare
A vote AGAINST management
A vote FOR the union
Unionization is frequently…
vs.

Labor-Relations Philosophy
Both parties try to control process & relationship
Information used selectively to gain advantages
Decisions made by compromise
Not favorable for long-term relationships
Shared responsibility to address mutual concerns from both sides
Openly share information
Decisions made by consensus
Favorable for long-term relationships

5
Union-management relationship
Adversarial
Collaborative

National Labor Code
6

National Labor Relations Act (NLRA)
Also known as: Wagner Act
Enforced by: National Labor Relations Board (NLRB.gov)
Federal Mediation and Conciliation Services
— Agency that mediates labor negotiations and conflicts
(http://www.fmcs.gov/)
7

Taft-Hartley Act
(rights of management)
Passed in1947
Designed to equalize the efforts of the NLRA
Defines and prohibits unfair labor practices by unions
Landrum-Griffin Act
(rights of union members & their unions)
Passed in 1959
Designed to protect workers from the unions that represent them
Curtails corrupt union practices
8
Taft-Hartley Act & Landrum-Griffin Act

Who’s covered by the NLRA?
9

NLRA rights
Employee Rights
to form, join, decertify, or assist a labor organization
to bargain collectively through representatives of their own choosing
to refrain from such activities.
Employees may also join together to improve terms and conditions of employment without a union (concerted activities)
Examples of concerted activities
Two or more employees addressing their employer about improving their pay.
Two or more employees discussing work-related issues beyond pay, such as safety concerns, with each other.
An employee speaking to an employer on behalf of one or more co-workers about improving workplace conditions.
10

Unfair Labor Practices
By Employers:
Threatening employees with loss of jobs or benefits if they join or vote for a union or engage in protected concerted activity.
Threatening to close the plant if employees select a union to represent them.
Questioning employees about their union sympathies or
Promising benefits to employees to discourage their union support.
Transferring, laying off, terminating, assigning employees more difficult work tasks, or otherwise punishing employees because they engaged in union or protected concerted activity.
By Unions:
Threats to employees that they will lose their jobs unless they support the union.
Seeking the suspension, discharge or other punishment of an employee for not being a union member
Refusing to process a grievance because an employee has criticized union officials
Engaging in picket line misconduct, such as threatening, assaulting, or barring non-strikers from the employer’s premises.
11

Example of unfair labor practices by an employer
12

Example of unfair labor practices by an employer
13

Special provisions specific to healthcare industry
Purpose: To protect communities in case of strike
10-day strike notice
– required of unions who intend to strike
Negotiation Notification
– requires parties to notify FMCS 90 days prior to contract
expiration, of intent to begin negotiation
Impasse
– when the parties cannot resolve a dispute
– requires notification to FMCS & mediator is assigned
Board of inquiry
– investigates, reports, & recommends solutions to resolve
contract disputes
14
NLRA & the Healthcare Industry

Most employees in the private sector are covered by the NLRA. However, the Act specifically
excludes individuals who are:
 employed by Federal, state, or local government
 employed as agricultural laborers
 employed in the domestic service of any person or family in a home
 employed by a parent or spouse
 employed as an independent contractor
 employed as a supervisor (supervisors who have been discriminated against for refusing
to violate the NLRA may be covered)
 employed by an employer subject to the Railway Labor Act, such as railro ads and airlines
Mek Arden, LLC d/b/a Arden Post Acute Rehab, Board Case No. 20 -CA-156352 (reported at 365 NLRB
No. 109) (D.C. Cir. decided December 7, 201 8)
In an unpublished judgment, the Court enforced the Board’s order issued against this operator of a long –
term-care and rehabilitation facility in Sacramento, California. The Board’s order remedies several
violations of Section 8(a)(1) committed during t he weeks leading up to an election in which a unit of
certified nursing assistants, cooks, housekeepers, and maintenance workers voted 41 to 45 not to be
represented by Service Employees International Union, Local 2015.
The Board found that the Employer unlawfully directed employees to wear attire associated with its
anti-union campaign, created the impression that employees’ union and protected activities were under
surveillance, prohibited the posting of union literature and removed such postings, and directed
employees not to wear union scrubs or to visit areas of the facility to which they were not assigned. The
Board also found that the Employer unlawfully s olicited employee grievances and impliedly promised to
remedy them. Finally, the Board set aside the election and remanded the case to the Regional Director
to conduct a new election.
Linwood Care Center (04-CA-146362, et al.; 367 NLRB No. 14 ) Linwood, NJ, October 10, 2018.
The Board adopted the Administrative Law Judge ’s conclusions that the Respondent violated: (1) Section
8(a)(1) by coercively interrogating employees about their union sympathies, and creating the impression
that their union activities were under surveillance; and (2) Section 8(a)(5) and (1) by unilate rally
changing the parties’ agreement concerning the Union’s access to its facility, and unreasonably delaying
in furnishing information the Union requested about personnel files of disciplined employees. The
Board also affirmed the judge’s dismissal of a llegations that the Respondent violated Section 8(a)(1) by
creating the impression of surveillance concerning employee support for the Union.
Moreover, ruling on complaint allegations that the judge did not address, the Board unanimously found,
based on uncontested facts, that the Respondent violated Section 8(a)(1) by: soliciting employees’
grievances and impliedly promising to remedy them; promising better working conditions and terms of
employment if employees voted to get rid of the Union; promising inc reased staffing and retroactive pay
increases in order to discourage employees’ support for the Union; telling an employee that a pay
increase could not be made because of the Union; and promising to discharge a disliked supervisor, train
a supervisor, increase wages, and change management in order to discourage employees from
supporting the Union.

Healthcare Compensation Practices

Week 5: Part 1

1

Direct & Indirect Compensation

Base Pay
Wages
Salaries
Variable Pay
Bonuses
Incentives
Stock options

Benefits
Health/medical insurance
Life/disability insurance
Paid time off
Retirement pensions
Education assistance
2
Direct Compensation
Indirect Compensation

Majors Goals of any Compensation System
4 goals:
Attract
Motivate
Retain
Labor cost containment
3

Compensation Issues
Compensation philosophy
Entitlement v. performance based
Market approach
At-market
Above market
Below market
4

Employees paid for their knowledge or skill rather than the completion of tasks, duties, & responsibilities
Considerations
Significant time investment
Strong management commitment
Training required to gain & maintain competencies
Limitations on number of people allowed to gain competencies
5
Do we want to use Competency-Based Pay?

Pay Secrecy vs. Openness
The degree or openness or secrecy that organizations allow regarding their pay systems
Internal v. External Equity
The perception of pay fairness
Team v. Individual rewards
Should all team members be compensated equally?
6
Other Compensation issues

The Management of Benefits in Healthcare

Week 5 session 4

1

Health Care – Fee for service plans
Traditional fee-for-service medical plans are available through many employers but at a declining rate.
These plans offer the greatest freedom of choice in selecting health care providers.
Deductible.
Co-insurance.
Out-of-pocket maximum.
Employers may elect to self-fund the insurance vs. purchasing from a benefits provider.
2

Health Care – Managed Care options
Health Maintenance Organizations (HMOs)
An HMO provides comprehensive health care coverage to plan participants through a network of physicians and hospitals.
Traditionally, HMOs require a referral from the individual’s primary physician to receive care from a specialist.
Copays
Preferred Provider Organizations
Point-of-service plans
hybrid between an HMO & a fee-for-service
Network
Deductibles
Copays
The costs of services from an out-of-network provider are higher than from an in-network provider
Consumer-Driven Health Plans
High deductible plans
HSA’s & HRA’s
3

Consolidated Omnibus Budget Reconciliation Act (COBRA)
A law enacted in 1986 helps workers and their families keep their group health coverage due to certain qualifying events
Former employees and/or their spouses and qualified dependents eligible for continuing coverage for 18 to 36 months
Employer may charge no more than 102% of the premium costs to insure similarly covered employee
Covers group health plans maintained by employers with 20 or more employees in the prior year
Qualifying events include:
voluntary or involuntary termination of the covered employee’s employment for reasons other than “gross misconduct”;
reduced hours of work for the covered employee;
covered employee becoming entitled to Medicare;
divorce or legal separation of a covered employee;
death of a covered employee;
loss of status as a “dependent child” under plan rules

4
Healthcare Legislation

5
Health Insurance Portability & Accountability Act (HIPAA)
Allows employees to switch their health insurance plan from one employer to another, regardless of pre-existing health conditions
The ACA prohibits plans from imposing preexisting condition exclusions for plan years beginning on or after January 1, 2014.
For prior years, HIPAA limited these exclusions and required plans to offset preexisting condition exclusion periods if the individual had prior health coverage.
Defines protected health information and it’s distribution rights
Healthcare Legislation cont.

Health Care Reform Act
The Patient Protection and Affordable Care Act
Penalty to employers for not offering health insurance
Covers children up to age 26
W-2 reporting
Required breaks for nursing moms
Tax on expensive health plans
Can’t exclude based on preexisting conditions
Eliminating Lifetime Limits on Insurance Coverage on essential benefits
6

7
Cost Control Strategies for Healthcare Benefits

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Second level
Third level
Fourth level
Fifth level

Common Benefits Offered
Dental
Vision
Life
Disability
Plans Offered to:
Employees
Dependents
8
Other Healthcare Benefits

Employee Retirement Income Security Act
Regulates operation of pension plans
Fiduciary responsibilities
Retirement Benefits & Age Discrimination
Age Discrimination in Employment Act (ADEA) prohibits forcing employees to retire as a specific age
Early or phased Retirement
Older Workers Benefit Protection Act (OWBPA) requires early retirement be offered on voluntary basis only
9
Legal Issues with Retirement Benefits

Two main types:
Defined-benefit plans
Defined-contribution plans

10
Types of Retirement Plans

Defined-Benefit Plan (aka: Non-Contributory)
Employer provides all the funds
Amount is based on set criteria
Years of service
% of salary
Pension Benefit Guaranty Corp (PBGC)
Insures pension plans in the private sector

11
Pension Plans

401(k), 403(b), and 457 Plans
Plans that allow the employee to reduce their current pay by a certain percentage, which is then used to fund a retirement plan
403(b) and 457 Plans only available to non-profits
401(k) plans available to both profit and non-profit
TIAA-CREF
Key issues:
Vesting
Portability
12
Defined Contribution Plans

Holiday Pay
Vacation Pay
Paid Time-Off (PTO)
Leaves of Absence
Personal
Medical (FMLA)
Military leave
Election leave
Jury leave
Funeral/bereavement leave
13
Time-Off Benefits

14
Miscellaneous Benefits
Employee
Discounts
Educational
Benefits
Social & Recreational
Benefits
Family-Oriented
Benefits
Domestic Partners & Spousal Equivalents
Day care
Other Benefits

Flexible Benefits Plan
“flex” or “cafeteria plan”
Allows employees to select benefits they prefer from groups of benefits established by the employer
Flexible Spending Accounts
Allows employees to contribute pretax dollars to buy additional benefits
Additional health care (including deductibles)
Life insurance
Disability insurance
Dependent care benefits
15
Flexible Benefits

Healthcare Compensation Practices

Week 5: Part 2

1

Enforced by: U.S. Department of Labor
Provisions of the Law:
Establishes a minimum wage
Child labor – minimum age requirements
Defines exempt and non-exempt status
Sets overtime provisions
Sets rules for compensatory time off
2
Legal Issues: Fair Labor Standards Act (FLSA)

Independent contractor v. employee
Why does it matter?
IRS test
Key factors
Behavioral control
Financial control
Type of the relationship
3

4
Partial IRS Test for Employees & Independent Contractors

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Second level
Third level
Fourth level
Fifth level

Job Evaluation
A systematic basis for determining the relative worth of jobs within an organization
Priced according to:
Relative importance of the job
Knowledge, skills, & abilities (KSAs) needed to perform the job
Difficulty of the job
Many methods:
Point system is very common
Compensable factors
Factor comparison, ranking, job classification
Wage surveys are used
Benchmark Jobs are identified
Ranges are created

5
Job Evaluation

6
Pay Ranges
Start with market line,
used as the midpoint

Determine minimum and
maximum pay levels
Types of Jobs Range Above Minimum % Around Midpoint
Executives 50%-70% + or –20-25%
Mid-Management/Professional 40%-50% + or –16-20%
Technicians/Skilled Craft & Clerical 30%-40% + or –13-16%
General Clerical/Others 25%-35% + or –11-15%

Pay Compression
Occurs when the pay differences among individuals with different levels of experience and performance becomes small
7
Pay Rate Issues
Red-Circled Employees
Green-Circled Employees
An incumbent who is paid
above the range of the job
An incumbent who is paid
below the range of the job
Rates out of Range

Seniority
Step systems — pay increases based solely on how long they have been with the organization
Performance Appraisals
– How much of the pay increase is variable?
Cost-of-Living Adjustments (COLA)
How much does inflation play a role? (CPI)
Lump-Sum Increases (LSI)
A one-time payment for all or part of the yearly pay increase
Does not increase base pay
8
Issues Involving Pay Increases

9
Performance-Based Pay Adjustment Matrix

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Second level
Third level
Fourth level
Fifth level

Compa-ratio
A person’s pay level divided by the midpoint of the pay range
Examples:
10
Pay Adjustment Factor: Compa-Ratio

104

100
(midpoint)

$24.00
pay)
(current

$25.00

A

Employee
=
´
=
92

100
(midpoint)

$24.00
pay)
(current

$22.00

B

Employee
=
´
=

The Management of Benefits in Healthcare

Week 5 session 3

1

Benefits
Benefit
An indirect form of compensation provided to workers for being part of the organization

2

Typical Benefit Dollar Spending
3

Benefits Needs Analysis
How much total compensation, including benefits, should be provided?
What part should benefits comprise of total compensation?
What expense levels are acceptable for each?
Why is each type of benefit offered?
Which employee should be given/offered which benefits?
What does the organization get in return?
How does the benefits package aid in recruiting and retention?
How flexible should the benefits package be?
4

Types of Benefits
5

Types of Benefits
Government-Mandated Benefits
Mandated benefits that employers
in the United States must provide
to employees by law

Voluntary Benefits
Benefits that employers voluntarily offer to compete and retain employees
6
Social Security
Unemployment Insurance
Workers Compensation

The Social Security Act of 1935
Established a system providing:
Retirement benefits
Survivor benefits
Disability benefits
Medicare benefits
Employers and employees share the cost through taxes on employees’ wages or salaries
Administrator Social Security Administration
Web site: www.ssa.gov
7
Social Security

Nice resources on SSA.GOV
Estimating your retirement benefits
https://www.ssa.gov/OACT/quickcalc/
Estimating your life expectancy
https://www.ssa.gov/OACT/population/longevity.html
When you should start collecting social security
http://www.ssa.gov/pubs/10147.html
8

History of Social Security
“We can never insure one hundred percent of the population against one hundred percent of the hazards and vicissitudes of life, but we have tried to frame a law which will give some measure of protection to the average citizen and to his family against the loss of a job and against poverty-ridden old age.”–
President Roosevelt upon signing Social Security Act
The earliest reported applicant for a lump-sum benefit was a retired Cleveland motorman named Ernest Ackerman, who retired one day after the Social Security program began. During his one day of participation in the program, a nickel was withheld from Mr. Ackerman’s pay for Social Security, and, upon retiring, he received a lump-sum payment of 17 cents.
On January 31, 1940, the first monthly retirement check was issued to Ida May Fuller of Ludlow, Vermont, in the amount of $22.54. Miss Fuller, a Legal Secretary, retired in November 1939. She started collecting benefits in January 1940 at age 65 and lived to be 100 years old, dying in 1975. During her lifetime she collected a total of $22,888.92 in Social Security benefits.
9

Unemployment Compensation
A tax paid by the employer to state and federal unemployment compensation funds
Percentage paid by employers determined by experience rates (# claims filed by people who leave)
Eligible?
How long?
How much?
State run: PA Dept of Labor
10

Worker’s Compensation
Provides benefits to persons injured on the job
Who pays?
How much do you get?
Injured on the job?
Fraud?
Ready to return?
State Run program: PA Dept of Labor & Industry http://www.dli.state.pa.us/landi/site/default.asp

11

Holiday Party & WC?
In this case, plaintiff’s husband, an employee of defendant, Memorial Sloane Kettering Cancer Center (“MSK”), became intoxicated at a holiday party organized by workers in MSK’s facilities department. The party was not sanctioned by MSK, did not occur on MSK property, nor was it paid for by MSK. All employees there were off duty.
Several coworker friends of the decedent contacted plaintiff, a registered nurse at MSK, advised plaintiff as to her husband’s condition, and then helped decedent into the plaintiff’s car. Plaintiff drove home with her husband, but left him in the car, parked in their driveway, in order that he might sleep off his condition. Approximately one hour later, plaintiff checked on her husband, finding him on the floor of the back seat, unresponsive. The autopsy report listed the cause of the death as alcohol intoxication and positional asphyxia.
Plaintiff sued MSK, contending, inter alia, that the co-employee’s actions were causally connected to her husband’s death. MSK denied the allegations and later sought to amend its answer to assert the workers’ compensation affirmative defense. The trial court denied both of MSK’s motions.
12

Outcome?
On appeal, the appellate court indicated the employees, in assisting decedent and placing him in his wife’s care, did not assume a duty, and nothing they did placed him in a worse or different position of danger. The court added that placing decedent into the car was not the proximate cause of his death; it merely furnished the occasion for the unfortunate occurrence. Summary judgment should have been entered in favor of MSK and MSK’s workers’ compensation affirmative defense was, therefore, moot.
See Gillern v. Mahoney, 154 A.D.3d 438, 60 N.Y.S.3d 819
13

Other worker comp cases
A group of employees were taking a celebratory canoe trip after a big new product launch. Some of the employees in a canoe were attempting to pull a co-worker from the mainland into the water. One of the men grabbed a little too hard, and the co-worker flew to the ground, sustaining a serious neck injury. He was awarded workers’ compensation because the team-building event was mandatory.
Can you break a hip on a vending machine? – Apparently, yes. This is what happened to one employee who was trying to help a co-worker get a bag of chips out of a 90-year-old broken vending machine. In an attempt to loosen the machine’s death grip on his friend’s chips, the man bumped the machine so hard he actually broke his hip. His workers’ comp claim was paid.
A woman set down her soda in the break room and mistakenly drank from another – except this one contained the highly poisonous liquid, lye. She suffered third-degree burns to her esophagus and was paid workers’ comp for her injuries.
14

Labor Relations and
Healthcare Organizations

Week 6 session 4

1

Step I: Organizing campaign
Group of employees approach union or union approaches employees
Informational meetings held by union for employees
Union assesses likelihood of a successful campaign
Step II: Authorization cards
NLRB requires 30% of employee group to sign authorization cards to hold a union election
If 30% or greater, then
2
The Union Campaign Process
Representation Election

3
Appropriate Bargaining Units in Healthcare

Example of a bargaining unit
4

Should physicians be a bargaining unit?
5

6

Step IV: Certification
Union becomes exclusive bargaining representative
Management or union can challenge results if they believe election was handled improperly or unfair labor practices occurred
7
The Union Campaign Process (cont’d)
Simple majority reached
Simple majority not reached
No election for at least 12 months

Step III: Representation Election
Election is supervised by NLRB, union, & management
Determined by simple majority = 50% + 1 employee

Step IV: Certification (cont’d)
Employees may decertify the union
The employee group removes the union as their representative
Signatures from 30% of employee union members to hold de-certification election
Determined by simple majority = 50% + 1 employee
Step V: Collective Bargaining
Initial contract sets foundation for the union-management relationship
8
The Union Campaign Process (cont’d)

Management rights clauses
– Right to manage, direct, and control its business
Union security clauses
– Right to bargain on behalf of represented employees
– Dues check-off process – union dues deducted from
paychecks
Wages and benefits
– Base and premium pay, shift differential, incentives
– Health, dental, life, disability benefits, etc.
Working conditions and scheduling
– Work schedules, workplace safety concerns, etc.
9
Collective Bargaining – FOUR key Contractual Components

Grievance procedures
A formal process used to resolve issues between managers and workers
Arbitration
Union and company present their cases to a mutually selected arbitrator, who makes binding decision
Mediation
Third party facilitates discussions and proposes solutions to the two parties; suggestions not binding
10
Contract Administration: Grievance Procedures

11
Finalizing The Agreement
Constituents reject
Constituents accept
Formal agreement signed
Re-negotiate/strike/ratify

Negotiations complete
Draft of contract agreement prepared for review
Constituents review & hold ratification vote

Healthcare unions
In 2007 the Service Employees International Union (SEIU) created a national healthcare union
Largest healthcare union
Represents: hospitals, nursing homes, long-term care facilities, outpatient workers & physicians
In 2010, the CA Nurses Assoc, United American Nurses, MA Nurses Assoc merged to create National Nurses United
Largest nursing union in U.S.
Over 150,000 members
12

Healthcare unions cont.
Three physician unions:
SEIU
Doctors Council
National Doctors Alliance
20,000 physician members
Independent contractors ineligible
13

Board issues decision on appropriate units in non -acute health
care facilities
August 30, 2011
The 3-to-1 decision in Specialty Healthcare and Rehabilita tion Center of Mobile [4] finds
that Certified Nursing Assistants at a nursing home may comprise an appropriate unit
without including all other nonprofessional employees. It overrules the Board’s 1991
decision in Park Manor, which had adopted a special te st for bargaining unit
determinations in nursing homes, rehabilitation centers, and other non -acute health care
facilities.
Employees at such facilities will now be subject to the same “community -of-interest”
standard that the Board has traditionally appli ed at other workplaces. The Board majority
found that the 53 CNAs who sought an election in Specialty Healthcare constituted an
appropriate unit, and remanded the case to the region to schedule an election.
Third Coast Emergency Physicians, P.A. and Seton Third Coast
Emergency Physicians Association, Petitioner. Case 16–RC–10160
February 29, 2000

Having carefully reviewed the record testimony, we affirm the Acting Regional
Director’s findings that the emergency physicians are not statutory supervis ors

and that
the emergency physicians on the senior advisory council are neither statutory
supervisors nor managerial employees for the reasons stated by the Acting Regional
Director, with the exceptions set forth below. Further, we agree with the Acting
Regional Director that Dr. Calomeni is not a statutory supervisor and find that he is not a
managerial employee. In finding that the physicians at issue do not make ef fective
recommendations with regard to hiring, disci pline, or evaluations, and that t hey do not
formulate and implement management policy, the Acting Regional Di -rector reasoned,
inter alia, that the ultimate decision -making authority in these areas is retained by the
two medical directors rather than the physicians.
BENEDICTINE HOSPITAL v. NEW YORK STATE NURSES ASSOCIATION

The Union, pursuant to a Certification of Representative issued in Case 3 -RC-
11841 on November 13, 2008, is the exclusive representative of employees in
the following appropriate bargainin g unit, herein called the Unit:

All full-time, regular part-time and per diem levels I, II, III and IV registered
nurses, clinical nurse specialists, SWAT nurses, discharge nurses, care
coordination nurses, staff educators, admission assessment registered nurses,
and registered nurses on permit employed by the Employer, excluding office
clerical employees, service and maintenance employees, technical employees,
guards, all non-supervisory professional employees not working as registered
nurses, and all managerial and supervisory employees, including the chief
nursing officer, the program director of the rehabilitation unit, the director of
surgical services, the administrative director of patient care services, the
manager of infusion therapy, the director of care coordinators, denial
management coordinators, infection control coordinators, quality assurance
improvement (QAI) coordinators, risk management coordinator, the vice-
president of patient care services, nurs e managers, administrative directors,
clinical coordinators, nursing supervisors and evening/night charge nurses.

Safety, Health, and Security in Healthcare Organizations

Week 6 Session 1

1

Safety, Health, & Security
Safety
The protection of the physical well-being of people
Health
A general state of physical, mental, and emotional well-being
Security
The protection of employees, patients/residents, clients and visitors, & organizational facilities
Responsibilities
Supervisors, managers, HR or safety specialists
2

Joint Commission and Safety, Health & Security
Several topic areas that contain standards for safety, health & security
Primary Topic Areas
Environment of Care (EC)
Healthcare organizations must provide a safe, functional, and effective environment of care for patients, visitors, medical and nursing staffs, vendors, volunteers, students, etc.
Surveillance, Prevention, & Control of Infection (IC)
Focuses on identifying the organization’s infection risks, and taking the necessary risk-taking steps
3

Components of the Environment of Care Plan
4

Joint Commission and Emergency Preparedness
Preparation for Disaster
(recommended by American Hospital Association)
General “all hazards” plan,
adaptable for any crisis situation
Plans include components for
mass casualty terrorism
Integrated with local response agencies in the local community
Plans to support families of staff members
Ensure unexpected illness patterns are reported to public health department and/or Centers for Disease Control
5

Elements of a Hospital Emergency Response Plan – OSHA
pre-emergency drills implementing the hospital’s emergency response plan;
practice sessions using the Incident Command System with other local emergency response orgs;
lines of authority & communication between the incident site and hospital personnel regarding hazards and potential contamination;
designation of a decontamination team, including emergency department physicians, nurses, aides and support personnel;
description of the hospital’s system for immediately accessing information on toxic materials;
designation of alternative facilities that could provide treatment in case of contamination of the hospital’s Emergency Department;
plan for managing emergency treatment of non-contaminated patients;
decontamination procedures & designation of decontamination areas
hospital staff use of PPE based on routes of exposure, degree of contact, & each individual’s specific tasks;
prevention of cross-contamination of airborne substances via the ventilation system;
air monitoring to ensure that the facility is safe for occupancy following treatment of contaminated patients;
post-emergency critique of the hospital’s emergency response.
6

7
Healthcare Workplace Health Issues
Emotional/Mental Health Concerns
Workplace Air Quality
Latex Allergy
Inadvertent Needle Sticks
Slips and Falls

Legal Requirements for Safety & Health
Workers’ Compensation
FMLA
Americans with Disabilities Act (ADA)
Recovering alcoholics & drug abusers
Employers returning employees to “light duty” work may re-define what the essential functions of the job are
Civil Rights Act & PDA
Healthcare organizations cannot bar workers from occupations that may threaten reproductive health
8

Substance Abuse
The use of illicit substances or the misuse of controlled substances, alcohol, or other drugs
Firm-choice option: preferred mgt response
Stress
Causes?
Consequences
Stress mgt
9
Healthcare Workplace Issues

10
Health Promotion
A supportive approach to facilitate, encourage, and help employees to enhance healthy actions and lifestyles

11
Health Promotion Levels

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Second level
Third level
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Safety, Health, and Security in Healthcare Organizations

Week 6 Session 2

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“To assure safe and healthful working conditions and to preserve human resources”
OSHA – enforcement agency
Web: www.osha.gov
Basic Provisions:
General duty
Notification and posters
Right to refuse
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Occupational Safety and Health Act (OSHA)

Under OSHA, Employers must:
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Under OSHA, employee rights:
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Overall rate = 3.0%
Construction = 3.2%
Manufacturing = 3.3%
Healthcare overall= 3.9%
More specifically
Hospitals = 5.5%
Nursing homes = 6.2%
http://www.bls.gov
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Injury & Illness Incident Rates

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OSHA Enforcement Standards
Personal Protective
Equipment (PPE)
Equipment, clothing & training required
for hazards or hazardous materials
Hazard
Communication
*Material Safety Data Sheets (MSDS)
*Lock-out / tag-out regulations
Blood-Borne
Pathogens
Regulation designed to protect employees
who are regularly exposed to blood
Record Keeping
Requires annual records for recording injuries, accidents, and fatalities

OSHA form 300
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OSHA helps employers as well
Needle sticks
FDA, NIOSH & OSHA JOINT SAFETY COMMUNICATION:
Blunt-Tip Surgical Suture Needles Reduce Needlestick Injuries and the Risk of Subsequent Bloodborne Pathogen Transmission to Surgical Personnel
http://
www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035

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On-the-spot Inspections
Warrant required?
Citations and Violations
Willful
Serious
Other Than Serious
Repeated
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OSHA Inspections

OSHA issues notices to West Haven, Connecticut VA Medical Center for exposing workers to new and recurring hazards
Employer name: U.S. Department of Veterans Affairs, VA Connecticut Health Care System, 950 Campbell Ave., West Haven, CT 06516
Dec. 1, 2015, OSHA issued notices to the medical center identifying 12 repeat, seven serious and three other-than-serious safety and health violations.
Investigation findings: OSHA conducted an inspection to workplaces that report high numbers of lost time work cases.
The cited repeat violations include blocked or obstructed emergency exit routes; locked and unmarked emergency exits; lack of guardrails around open pits; absent or inadequate procedures, equipment, training and inspections to prevent the unintended activation of machinery during servicing or maintenance; inadequately protected bench grinders; and several electrical hazards.
The serious violations involve floors not maintained in dry and clean condition; unlabeled containers of potentially hazardous chemicals; damaged electrical cords; and failing to de-energize electrical circuits before working on them.
The repeat violations stem from similar violations cited between 2011 and 2015 at the West Haven medical center and at DVA facilities in Palo Alto, California, Bedford, Massachusetts, and Albany, New York.
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Approaches to Effective Safety Management

Workplace violence aggressors?
Criminals
Current & Former employees
Domestic Causes
Patients & their families
 A safer room for a possibly violent patient:
Has furniture arranged to prevent entrapment of staff, furniture should be minimal, lightweight, without sharp corners, and/or affixed to the floor.
Is free from clutter, nothing available on countertops to throw at workers or use as weapons.
Is provided with a secondary door for escape in case main door is blocked by patient.
Is one entered with a buddy, do not be alone with patient
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Security – Workplace Violence

Workplace violence cont.
Management of Workplace Violence
Conduct a risk assessment for prevention efforts
Establish a violence response team
Post-violence response for affected employees
Training on Workplace Violence
how to recognize the signs of a potentially violent employee & how to respond to violence
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Security Audit
A comprehensive review of
organizational security
Survey the area around the facility
parking lot, lighting, traffic flow, location of emergency response services, etc.
Assess Access Control
accessibility of the facilities (locks,
electronic access or keycard systems)
Assess Computer Security
prevention of unauthorized access to computer systems (i.e. HRIS)
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Security Management

Employee Screening and Selection
Firms may be held liable for crimes committed by employees in the case of inadequate screening
Security Personnel
Importance of having sufficient security personnel
Many employers contract this service with firms specializing in security
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Other Security Factors

• Follow all relevant OSHA safety and health standards.
• Find and correct safety and health hazards.
• Inform employees about chemical hazards through training, labels, alarms, color -coded
systems, chemical information sheets and other methods.
• Notify OSHA within 8 hours of a workplace fatality or when three or more workers are
hospitalized.
• Provide required personal protective equipment at no cost to workers.*
• Keep accurate records of work -related injuries and illnesses.
• Post OSHA citations, injury and illness summary data, and the OSHA “Job Safety and
Health – It’s The Law” poster in the workplace where workers will see them.
• Not discriminate or retaliate against any worker for using their rights under the law.
 Working conditions that do not pose a risk of serious harm.
 Receive information and training about chemical and other hazards, methods to
prevent harm, and OSHA standards that apply to their workplace.
 Review records of work-related injuries and illnesses.
 Get copies of test results done to find and measure hazards in the workplace.
 File a complaint asking OSHA to inspect their workplace if they believe there is a
serious hazard or that their employer is not following OSHA rules.
 Use their rights under the l aw without retaliation or discrimination.

Q1) Medical Testing Services (MTS) is a large medical testing center. MTS provides a wide array of medical tests: x-rays, MRIs, CAT scans, blood testing and even urinalysis. As you would imagine most employees of MTS are various medical testing specialists (e.g., x-ray technicians, phlebotomists, MRI technologists). We discussed that the all compensation systems have 4 primary goals: attract, retain, motivate and control labor costs. MTS is considering three compensation initiatives: (1) all raises will be performance-based, no across-the-board increases; (2) the pay system will be open rather than closed; and (3) the compensation system will emphasize external over internal equity. Select

TWO of these three initiatives and discuss whether or not you would recommend these initiatives in the context of the four primary goals of compensation for health care organizations. (25 pts)

Q2) Based upon the scenario in question 1, answer all three parts below. (A) Of the three major government mandated benefit programs: social security, worker’s compensation and unemployment compensation, which one do you believe would be most important for MTS in terms of managing their human resources? In other words, if you were in HR which of these 3 programs would concern you the most? Why? (B) Which non-government mandated benefit would be most critical for MTS in terms of managing their human resources? Why? (C) Regardless of your answers above, which cost-control strategy to would you recommend to MTS regarding health care? Why? (25 pts)

Q3)

What THREE safety issues do you believe are very critical for MTS? Why? For each issue identify which of the three approaches to effective safety management (organizational, engineering or individual) would you recommend to address that issue. Explain. (25 pts)

Q4)

I indicated that in collective bargaining there are four primary contractual components. Which TWO of these components do you think would be most critical for MTS? Why? If a dispute arises regarding the components of a collective bargaining agreement, do you recommend arbitration or mediation? Justify your choice. (25 pts)