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Health-care organizations utilize an increasing number of types of

health-care personnel, each with their own set of credentialing, licensure, and certification requirements. Nurses are the largest category, but advanced practice levels are developing for many categories of providers. Shortages are growing. Human resource management is critical and involves administrative and strategic elements. Environmental forces are impacting human resource management. Choose two environmental forces, and describe and provide suggestions on how they might best be addressed through human resource management initiatives/actions (Chapter 12, Table 12-1, p. 324).

ENVIRONMENTAL FORCES AFFECTING HUMAN RESOURCES MANAGEMENT There are several key environmental forces that affect the availability and performance of human resources within health services organizations (HSOs) (see Table 12-1). The environment for HSOs is the external space beyond the organization that includes other organizations and influences that affect the organization. First, declining reimbursements from government payers and other third parties have reduced the revenues coming to HSOs. In efforts to contain their expenses, the Medicare and Medicaid programs, private insurance, and managed care organizations have reduced their payments on behalf of covered beneficiaries. Declining reimbursements for health services organizations have left HSOs with fewer resources to recruit, compensate, and develop their workforces. Because other organizations in local and regional markets are also competing for the same labor, this has made recruitment and retention of staff more difficult for many HSOs. Second, the low supply of health care workers—particularly highly specialized clinical personnel—has made recruitment of needed health care personnel very challenging (Fottler, Ford, & Heaton, 2002). Many areas of the country have experienced shortages of nursing, diagnostic, and treatment personnel, a phenomenon that has left many HSOs understaffed, requiring remaining staff to work longer hours per week (Shanahan, 1993). This has also contributed to lower levels of staff satisfaction and higher rates of turnover in certain staff positions, which has in turn increased human resources costs to the HSOs (Izzo & Withers, 2002; Shanahan, 1993). In addition, recruiting staff members who are highly specialized and who are in short supply tends to raise human resources costs as HSOs have to pay these staff members' higher wages and provide other incentives to appeal to these potential workers (Shanahan, 1993). Third, competition among health services organizations has increased dramatically in the past 20 years due to an increase in supply of traditional HSOs, such as hospitals and nursing homes, as well as the influence of newly emerging HSOs, such as retirement communities, assisted living facilities, and ambulatory care programs. HSOs have engaged in service competition and, to a lesser degree, price competition in trying to outperform their rivals. Competition in services and competition for labor has contributed to increased demands on human resources management. Fourth, the population's needs for health and medical care have increased in the past two decades and will continue to grow during the next 25 years as the population ages and Baby Boomers approach retirement and qualify for Medicare. Older adults require more health services, and therefore, HSOs will require more health care workers to care for the increasing volumes of patients served at their facilities. This is further complicated by the fact that much of the current health care workforce is nearing retirement age themselves (Burt, 2005). Thus, in the future, health services organizations will be faced with declining workforces due to retirements, on the one hand, and expanded demands from the population on the other hand. Projections of the future number of health care workers show significant opportunities for employment (see Table 12-2). However, this puts HSOs in a difficult situation: additional workers are needed to care for the increased patient workload, while the supply of workers in many categories continues to be low. This creates additional challenges for recruiting as well as retaining HSO staff. Finally, increasing regulation and scrutiny of health services organizations by external organizations have increased pressures for high-quality and high-performing organizations. While licensing and accrediting organizations monitor HSO conformance to standards, they also make these performance indicators available to the public, legislators, and other stakeholders. In addition, reimbursement organizations and government payers, like Medicare and Medicaid, are increasing requirements on HSOs for accountability and performance by mandating reports on quality, morbidity, and mortality, as well as efficiency and costs. For HSOs, this means that human resources management must help the HSO become a high-performing, high-quality organization that can demonstrate quality processes and outcomes to these external stakeholders. Human resources can help accomplish this by hiring staff that are high quality, retaining those that are high quality, and reinforcing the culture of a high-performing organization.!/4/28%400:62.2

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