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A new social contract. Catholic healthcare leaders rethink their relationship with employees.

The sea changes that have occurred recently in economics, technology, and social order have profoundly disturbed the relationships between organizations and their workers. The promise of lifelong employment--once the foundation of the "social contract" between employer and employee--has evaporated. The dissolution of this social contract has led managers of Catholic healthcare organizations to ask, if we can no longer guarantee lifelong employment, then what is our relationship with employees? Participants in two think tanks sponsored by the Catholic Health Association's Center for Leadership Excellence addressed this question. Participants in the first think tank (i.e., one senior executive and several human resources professionals from Catholic healthcare systems) agreed that a new social contract with employees was needed, one of mutual responsibility to replace the paternalistic relationships of the past. To begin constructing such a contract, the group articulated a set of values held by Catholic healthcare regarding employees. Based on the values they identified, participants in the first think tank drafted the "Social Contract for Turbulent Times." Participants in the follow-up think tank expanded this draft contract in the "Elements of a New Relationship Agreement with Employees."

Catholicism↗
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Hospital layoffs. One facility's experience with a work force reduction.

In 1994 the conversion of Tennessee's Medicaid program to managed care sharply reduced the census of all Memphis hospitals, including St. Joseph Hospital and Health Care Centers. St. Joseph's Operations Leadership group (OLG) decided that expenditures must be cut by $8 million-$6 million of it coming from wages and salaries--so the hospital could enter fiscal year 1995 with a balanced budget. With the help of a consulting firm, the OLG determined that the wage and salary cuts could be realized by laying off a certain number of employees. All workers were told, in a series of round-the-clock meetings, that 162 jobs (22 managers and 140 hourly workers) would be eliminated in nine days. The hospital's labor relations attorney approved the criteria according to which workers would be dismissed. On the designated days (one for managers, another for rank-and-file workers), the layoffs were completed in an organized manner. The OLG had arranged with a private firm to set up a career placement center for the dismissed employees. Of the 162, 105 took advantage of the center's services. Thirty-five of those (21 percent) had new jobs within 45 days of the layoffs. The OLG was straightforward with the local media about the layoffs. Hospital leaders calmed remaining St. Joseph workers' anxieties with a series of follow-up meetings. These sessions also provided the OLG with useful feedback on the way it had conducted the layoffs.

Budgets↗
PubMed1995

Legal issues in medical practice acquisitions.

As the changing healthcare delivery environment places increased emphasis on primary care, many healthcare organizations are striving to broaden their base of primary care physicians. One method that organizations are using to accomplish this goal is acquisition of medical practices. Practice acquisitions require careful planning to address the complex legal issues involved, including possible violations of antikickback, self-referral, and antitrust laws. This article offers an overview of the acquisition process and a checklist of relevant legal issues.

Antitrust Laws↗
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A model to begin reengineering the laboratory. How do you change an outmoded laboratory structure?

If a traditionally structured laboratory cannot incorporate new technologies efficiently and can no longer meet its changing service demands, it may require reengineering. A model is presented that can be followed by the laboratory director and a small group of planning colleagues to begin the process. The model was effectively used at British Columbia's Children's and Women's Hospitals (BCCH/WH) to review their laboratory structure and redraft it for the future. The model considers the external and internal pressures facing the laboratory. Technological trends, which have significant impact on laboratory service, are also incorporated into the model. The current list of services, staff expertise, and laboratory specialties is used as the base in the model to formulate the opportunities for improvements and identify the future direction of the laboratory. These opportunities are the context for the vision of the future laboratory. With this vision in mind and a creative planning approach, a new optimum laboratory structure can be outlined. This model begins the reengineering process and can be applied to any laboratory where there is the need for dramatic improvements to accommodate the changes in today's rapidly evolving health-care environment.

British Columbia↗
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Strategies for a successful organizational transition. Identifying staff roles and fulfilling their needs during changing times.

For a successful reorganization of the laboratory, there is a role for each staff member to play during the transition. The role of those in laboratory administration is that of leading change agent. Corporate support staff, such as those in a human resources department, can advise the laboratory director in their areas of expertise. The role of the medical and technical supervisory staff is that of chief implementers of the plan. General laboratory staff has a confusing dual role--not only must they continue to provide laboratory services during the transition, but they also may have to change what they are doing and how they are doing it. Success also depends on meeting the individual personal needs of staff. Laboratory directors and administrators want to make a meaningful contribution to health care. Corporate support staff need to feel that they are a part of the change process. Supervisors' needs vary--coping with the loss of identity, position, or territory will be difficult for some; others will want to be involved in all stages of planning and implementation. The major need of the general laboratory staff is stability. Strategies are listed for each staff grouping to help the laboratory director coordinate staff roles and satisfy staff needs during the transition period.

Attitude of Health Personnel↗
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Hospital laboratory consolidation. Reduce costs, improve service, enhance the workplace.

Laboratory management faces a challenge to improve service and become more cost effective. For some, the need is for dramatic change. Implementing change in a proactive manner allows laboratory management to improve while protecting the important aspects of a laboratory's contribution to a hospital's programs and services. In this article, we describe how reorganization and consolidation of hospital clinical laboratories had the effect of reducing costs, improving service, and enhancing the workplace.

Boston↗