Human Resources
Policies and Procedures
Sound human resource policies are essential to the delivery of quality patient care, helping to ensure that the outpatient healthcare setting employs competent staff who provide services within their licensure or certification. These policies also should reflect applicable federal, state and local legal requirements.
Job Description
Prior to hiring a new employee, review the job description for the position to ensure that it is accurate and complete, encompasses the essential duties and physical demands of the position, as well as required education/training, experience, knowledge and skills. Stated requirements should be job-related and reflect actual job responsibilities. If a job description does not exist, one should be drafted.
Application
Applications should not include questions on topics which may elicit information that may be protected and/or lead to allegations of discrimination, such as:
- Maiden or previous name/title.
- Citizenship or birthplace.
- Children or other family commitments.
- Race, religion or ethnicity.
- Date of birth or high school graduation date.
- Physical description or photo.
- Whether English is the primary language.
- Club or union memberships.
Background Check
Background checks should be comprehensively and consistentlyimplemented and documented, verifying education, licensure, credentials and references. Criminal background checks should query both conviction history and sex offender status and should be performed on both a state and national level in accordance with governing laws and regulations.
Exercise caution when screening prospective employees based upon criminal record or credit history. Equal Employment Opportunity Commission (EEOC)
guidance discourages blanket restrictions of applicants with criminal conviction records because they also may have a disparate impact on certain protected classes. Instead, the
EEOC recommends that employers assess each applicant individually to ensure that exclusions are jobrelated and consistent with business necessity.
Factors such as the age of the offense, the nature of the offense in relation to the job duties of the position, and the degree to which the employee will be supervised by others may be considered in order to determine whether to disqualify an applicant based upon a criminal conviction record.
EEOC guidance also discourages the use of credit information in hiring decisions. Criminal background and credit checks are complex issues which should be discussed with an employment attorney prior to implementation.
Drug Testing
If drug testing is part of the hiring process, establish a policy addressing the following issues:
- Testing timetable.
- Positions to which testing applies.
- Specific “target” substances.
- Testing procedures.
- Consequences of a positive result.
Drug testing should be performed only after a contingent offer of employment has been tendered. As laws vary from state to state, consult with an employment attorney to ensure compliance.
Orientation
Orientation should include basic information about the practice, organizational mission and vision, clinical practice standards, work schedules, emergency protocols and behavioral expectations. It also should address such relevant issues as workplace rules, vacation time and insurance options, as well as staff responsibilities regarding patient safety and incident reporting. Orientation sessions should be tailored to the role and duties of newly hired staff, and should include:
- Review of the job description.
- Description of the performance evaluation process.
- Signed confirmation that the employee understands and accepts his/her responsibilities.
Verification of Skills and Competencies
Delegation of clinical tasks to unlicensed assistive personnel, i.e., medical assistants, technicians, patient care representatives, and others, must be consistent with state regulations, licensing boards and/or certification programs. In situations where state regulations have not been promulgated, delegation of clinical tasks must be consistent with the education, training and demonstrated clinical proficiency of the unlicensed assistive personnel.
Decisions about delegation of clinical tasks should consider whether it is safe and permissible to transfer tasks from a highly trained to a less-trained provider. Healthcare leaders should have a clear understanding of the tasks and activities that may be safely delegated, and those tasks which should not be assigned to others. As a general rule, tasks delegated to unlicensed providers should not require independent assessment or a high degree of problem-solving ability.
The following questions can help enhance the process of determining whether an activity is safe for delegation to unlicensed medical assistive personnel:
- Is there evidence-based literature demonstrating safe delegation of the clinical task?
- Does the staff have the education, training and competence to safely carry out the task?
- Is the task performed on a routine basis within the healthcare setting?
- Can the task be performed safely and guided by standing orders or directions?
- Is the task relatively simple, or does it involve making complex observations, interpretations and/or critical decisions?
- Is the task invasive, creating potentially life-threatening consequences for the patient if performed incorrectly?
- Will a licensed provider be available for consultation while the task is carried out, if applicable?
Skill competency of all healthcare staff (nurses, technicians, physical therapists, aides, and others) should be demonstrated upon hire, annually and when new tasks are added to a provider’s role. Competencies should be documented in hiring records, personnel files and job performance reviews, including primary credentials, continuing education courses and the dates and results of competency testing.
Competency evaluations should focus on the following performance indicators, at a minimum:
- Basic skills and level of competence.
- Proficiency in completing the delegated task.
- Compliance with practice protocols.
- Urgency of response to unexpected situations.
- Openness of communication with the delegating provider.
- Accuracy of documentation.
- Timeliness of progress reports.
- Transparency in error reporting.
- Overall reliability and professionalism.
Continuing Education and Performance Review
Continuing education (CE) and other ongoing training opportunities should be aligned with licensure/certification requirements. CE should include relevant topics relating to patient safety i.e., professional boundary violations, sexual abuse prevention, adverse event and medical device reporting, and medical error mitigation. CE credits, annual performance appraisals and training programs should be documented and stored in personnel files.
Employee Termination
Terminating employees is a challenging component of human capital management. Disciplinary actions or termination may be necessary when employees are not complying with policies relating to conduct, clinical practice guidelines, and/or deficient performance. In order to preclude legal ramifications emanating from terminations, including violations of local, state or federal laws and regulations, healthcare organizational leaders must follow appropriate steps and comprehensively document all performance issues, disciplinary actions, and other steps taken prior to terminating an employee. Managers and clinical leaders tasked with employment matters should work closely with their human resources manager, compliance officer and/or legal counsel when addressing disciplinary or employee termination cases.
The organization should have a written policy outlining the necessary steps and required documentation for employee termination. The policy should be reviewed by legal counsel on an annual basis to ensure that it is in compliance with state and federal employment laws.
The American Society for Health Care Human Resources Administration (ASHHRA) provides additional information.
Continue reading Chapter 7: Human Capital Risks
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