Blog and Helpful Articles

What We’re Reading – NLRB on Social Media Policies

On May 30, 2012, The National Labor Relations Board (NLRB) released a report with new guidelines for social media policies in the workplace.  It is the NLRB’s position that numerous common clauses in social media policies violate the National Labor Relations Act (NLRA).

The report basically covers 3 areas:

Confidentiality Provisions – It is not OK for employers to prohibit employees from disclosing confidential information on social media websites. According to the NLRB, this could be seen as an attempt to prohibit employees from discussion and disclosure of information regarding their own conditions of employment or conditions of employment of employees other than themselves. This action according to the NLRB would be a clear violation of Section 7 of the NLRA which defines protected activity.

Topics and tone of online conversations – The NLRB’s position is that by warning employees to avoid “inflammatory” topics or to engage a “professional” tone when communicating through social media, an employer could be construed as trying to “prohibit robust but protected discussions” about topics such as working conditions or unionism.

Permitted Language – An employer may prohibit an employee from posting anything on the internet in the name of the employer or presenting a view or opinion on behalf of the employer. Employers may also enforce confidentiality policies that employees “maintain the confidentiality of employer trade secrets and private or confidential information.”

To read more…

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QI, PI, QA – Making Sense of Alphabet Soup (Part 2)

Welcome to Part II of our series entitled QI, PI, QA – Making Sense of Alphabet Soup.  In the last installment, we discussed the basics of the QI mindset and the elements of a solid QI program.  In this blog, we will review the guidelines of a typical QI study.

Once you’ve identified areas where your agency’s performance varies from the requirements, you need a plan.  The field of quality improvement is big on measurement, objectivity and study.   Don’t just assume something’s a problem.  Study it.  Let’s say you discover a problem with supervisory visits not being performed in a timely manner.  It’s a good idea to document what you are going to study so that everyone understands the parameters and you can assure consistency of measurement and reporting.  Here is an example:

On 1/1/12, Best Home Health created a quality study of supervisory visits.  The QI Manager will review charts of all patients on service during every quarter of 2012, and document the presence of HHA supervisory visits performed every 14 days, and LPN and PTA supervisory visits conducted every 30 days. The audit goal is 100% compliance with the supervisory visit schedule. This will be done by reviewing the notes filed in the patient charts and filling out the Supervisory Visit Audit Tool.  A report will be given to the QI Committee every quarter.

This little blurb tells you a few important things:  The period of time being studied (every quarter of 2012), the person responsible for the study (QI Manager), the nature of the study (supervisory visits), the parameters (HHA every 14 days, LPN & PTA every 30 days), the goal (100% compliance), the method of study (reviewing visit notes), the data collection process (using the Supervisory Visit Audit Tool), and the reporting schedule (to the QI Committee every quarter).

The next step is to gather your data.  Do a review of a sufficient time period; in this case, the audit is quarterly and involves reviewing the notes for the entire quarter.  Based on the outline of the quality study discussed above, your Supervisory Visit Audit Tool could look something like this: (click here for an example)

Note the section for scoring and recall that we explained that the field of QI requires objective measurement.  A score tells you quickly and without bias whether your agency is meeting the requirement or not.  There’s no leeway; either the supv visit was done or it wasn’t.  In this case, you would score the audit as follows:

[# Yes divided by the (# Yes + # No)] x 100%

Here is an example: (click here)

For Patient #23:  [# Yes (2) divided by the # Yes + # No (2+0)] x 100% = (2 )2) x 100% = 1 x 100% = 100%

For Patient #28:  [# Yes (1) divided by the # Yes + # No (1+2)] x 100% = (1 )3) x 100% = .33 x 100% = 33%

For Patient #19:  [# Yes (1) divided by the # Yes + # No (1+1)] x 100% = (1 )2) x 100% = .5 x 100% = 50%

Here is an example: (click here)

In the next part of our four-part series on Quality Improvement, we’ll discuss what to do with your audit results which, in our example, indicate a serious compliance problem.

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QI, PI, QA – Making Sense of Alphabet Soup (Part 1)

Few things strike as much fear in the hearts of home health agency managers like quality improvement.  For the record, QI, PI, QA all mean the same thing: by what means does your agency ensure you deliver quality care and service?  Most of our clients emphatically state that they give excellent care.  While we don’t doubt this, the challenge in health care is to prove it.  And as we all know, what isn’t measured isn’t managed and what isn’t managed usually falls by the wayside.  So where do you start?

This four-part blog series will explore the basics of QI and provide some suggestions on developing your QI process.

First of all, think about the areas in your agency where you experience the most challenge.  Is it performing supervisory visits on time?  Receiving all visit notes in a timely manner?  Making sure they reflect the POC? Medication reconciliation?  Managers can usually rattle off several areas of deficiency where their efforts fall short of the mark.  Tackle those first!

This is a good time to bring up the issue of auditing.  Objective audit means that you have pre-set criteria that are critical to optimal performance (or compliance with regulations) and you assess your agency’s reality against those criteria.   Auditing is a snapshot of today – the good, the bad and the ugly.  It’s not a process where you find something wrong or missing and you scramble to fix it so you can report your performance at 100%.  That defeats the purpose.  By means of the audit process, you are assessing the quality and accuracy of your agency’s policies and processes, and your staff’s compliance. Consider it supervision on steroids, if you will.

Give yourself a score.  For example, what percent of the time did your agency’s supervisory visits occur as per policy?  Obviously, the goal is 100%, but be honest.  What is it really?  Don’t worry about failing to miss the mark.  The QI arena isn’t focused on perfection, because it isn’t realistic. What surveyors want to see is that: you know the areas that are critical to compliance; you regularly review performance; you approach things methodically, consistently, and objectively; you don’t assume you know the cause – you study it with the input of other professionals; you brainstorm ideas and solutions; you select the best ones; you implement them in a systematic way; you address training needs; you monitor performance; and you adjust and re-evaluate periodically.

In Part II of this four-part series, we will review the guidelines of a typical QI study.

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What We’re Reading – Companies Increase Wellness Incentive Dollars

A large number of U.S. companies have begun to increase the dollar value of employee incentives to participate in wellness programs which will improve employee overall health and ultimately lower the cost of providing company group insurance. Statistics supporting this move were derived from an employer survey conducted by Fidelity Investments and the National Business Group on Health, and included a national sample of U.S. companies ranging in size from 1,000 to  100,000 employees. The survey completed during the period of Nov 1-Dec 30, 2011 included data on condition-management services, lifestyle management services and health risk management services.

Top findings of survey:

  • 3 out of 4 companies used incentives to get employees involved in health improvement programs
  • The average incentive offered was $430 in 2010 and $260 in 2009.
  • Different types of incentives were offered including cash, gift cards and contributions to HSAs.
  • The incentive-based programs had a better -than -expected success rate
  • Program costs to employers have increased since 2009 with the average for 2011 being $154.
  • Smoking cessation and EAPs are the most common programs being offered in the workplace but healthy cafeteria food options  have become prevalent with 51% of the companies surveyed that currently having those options in place and an additional 16% expected to introduce these options in 2012

More importantly, this excellent survey summarizes the right steps an organization can take to maximize returns on their investments in this area and ultimately realize a healthier workplace:

• Secure commitment from senior management. Employees are more likely to engage when there is encouragement from senior executives.
• Align programs with the health risks and challenges of the workforce. Determine what the pressing health issues are (such as high blood pressure) and offer solutions. Don’t offer diabetes management services if that illness is not a significant health risk for most workers.
• Set realistic goals and measure results. Define what the desired behavior is (e.g., weight loss) and track it.
• Offer incentives that appeal to the workforce. Collect feedback from employees on what is appealing and discontinue incentives that aren’t working.
• Manage vendors by establishing performance requirements. Employers should consolidate employee data collected from multiple vendors and measure the results. Vendors should be held accountable if the results fall short of objectives.”

Read more……

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Administering Drug Tests: Avoid Litigation

Health care employers are more frequently requiring a drug test as a condition of an employment offer to a potential candidate. However, failure to follow state and federal guidelines in this area can subject an employer to potential litigation.

Drug testing in the work place

There are currently no federal laws that specifically prohibit testing, but there is a fair amount of controversy challenging the legality of drug testing. If an organization is a federal contractor with contracts of $100,000 or more, or a recipient of any grants from the federal government, the organization must comply with the Drug-Free Workplace Act. It is imperative that employers establish a clear organizational drug policy which outlines: the policy’s purpose and scope; guidelines concerning pre-employment testing; voluntary testing; testing for reasonable cause; random or periodic testing; rules regarding the possession, distribution, sale or consumption of drugs; disciplinary procedures; and job rights.

The most common reasons for testing are discussed below:

  • Pre-employment drug testing may be done by employers to determine current illegal use of alcohol or drugs. It is imperative that this type of testing is consistently administered as a conditional offer of employment. Again, full disclosure must be in the application and the applicant must sign the disclosure granting permission for testing.
  • Testing due to reasonable suspicion or cause may be conducted if an employee shows signs of not being fit for work, or is showing a documented pattern of unsafe or negligent behavior.
  • Testing after an accident or unsafe practice to ascertain if alcohol or drug use was a factor.
  • Testing after an employee comes back to work following rehabilitation if the employee’s work was interrupted. This can only be done if the employee is involved in a treatment program of which the employer is aware.  Employees are not mandated to inform their employer if they are in a drug or alcohol treatment program.
  • Testing administered randomly for security or safety reasons.
  • Testing administered periodically, such as in the case of an annual medical examination that is required for employment. Example: an annual Department of Transportation physical required for certain drivers.

Following these basic guidelines will allow employers to protect their organizations from issues leading to litigation.

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What We’re Reading – Seven Steps to Being a Better Medical Office Manager

Wouldn’t we all love an article about ways to improve on our skill sets and make our company better?  Since a Medical Office Manager is the glue that holds a practice together and makes sure everything is running smoothly, you never want him or her to fall into a category this article calls “the lazy office manager.”  The author lays out seven steps your office manager can follow to avoid that distinction:

  1. Don’t manage solely from your desk.
  2. Answer phone calls, e-mails, and return left messages.
  3. Meet with representatives, listen, and thoroughly review their proposal for your clinic with your physician(s).
  4. Enforce no gossip policies.
  5. Don’t be afraid to get your hands dirty.
  6. Take some time to market your practice.
  7. Set a good example.

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Administering Background Checks: Avoid Litigation

It is not uncommon in the health care industry for employers to require a background check and a drug test as a condition of an employment offer to a potential candidate. However, failure to follow state and federal guidelines in this area can subject an employer to potential litigation.

Background checks may cover a range of areas and are designed to ensure that candidates who receive employment offers represent themselves accurately in the application and interview process. Although not all areas may be utilized in every hiring situation, background checks include: employment references; educational references; financial references; motor vehicle record checks; and criminal record checks. Many HR departments conduct these checks using individual resources; however there are companies that provide comprehensive background check services which cover any and all of the above.

Some issues to keep in mind and keep liability at bay are:

  • Employment references must be obtained with the candidate’s permission. Employers should ensure that their application forms include a statement granting this permission and that the statement is signed by the applicant. Most organizations will only supply information with a signed statement from the former employee while others will only verify dates of employment and salary. This is, in part, due to increased litigation by former employees who discovered that they were given poor recommendations.
  • Educational references can be requested from the candidate by requesting transcripts or verification of graduation from the educational institution listed on the application.
  • Financial references or credit history checks may be considered discriminatory toward women and minorities and generally should only be conducted if the position entails financial responsibility, such as the handling of significant amounts of currency or other valuables. Employers who need to do this type of screening must comply with the Fair Credit Reporting Act (FCRA) and more recently, the Fair and Accurate Credit Transactions Act (FACT). The FCRA requires employers to follow the following process when utilizing Consumer Reporting Agencies to perform investigations: provide a clear disclosure in writing to the candidate before the report is acquired; receive written authorization from the candidate to obtain the report;  if adverse action is going to be taken based on the report, the employer must provide to the candidate, within three days,  a copy of the report and a copy of the Federal Trade Commission notice “A Summary of  Your Rights Under the Fair Credit Reporting Act” and must advise candidate of his/her right to dispute the accuracy of information contained in the report.
  • Motor vehicle record checks are maintained by Departments of Motor Vehicles and can be accessed by the employer. It is suggested that motor vehicle record checks only be conducted on candidates seeking positions requiring the use of organizational or personal vehicles in the course of performing their duties.
  • Criminal Record Checks are considered consumer investigations and must comply with the FCRA requirements discussed above. Criminal record checks may be used to screen potential employment issues and to protect employers from litigation from negligent hiring that may arise if an employer knew, or should have known, about an applicant’s prior history that endangered customers, employees, vendors or others with whom the employee comes into contact.  If a criminal record check is going to be performed, the employment application must include a disclosure to that effect and must be signed by the applicant. Any negative information obtained should be carefully reviewed on a case-by-case basis, making sure to consider all the relevant information such as: how the crime relates to the position applied for; how recent was the conviction; how old was the applicant when the crime occurred; the level of risk to customers, coworkers, etc.  If the employer decides to make an adverse hiring decision based on negative information contained in the report, the applicant must be notified in writing and given a chance to respond. If the information is erroneous, the applicant is given an opportunity to provide information to clear the record.

Employers must ensure that they remain on top of federal and state guidelines, and the changes that may occur from time to time. Adhering to this will certainly avoid headaches and the dreaded threat of litigation.

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Is your office supply budget out of control?

Office supplies. Sounds pretty trivial, right?  But anyone who’s strolled the aisles (real & virtual) at Office Depot et al. can tell you how expensive these things can be. Exploding office supply expenses can start with some very bad habits like these:

1.  Lack of organization.  When things are strewn about in one or several places, employees can assume you’ve run out of something if it’s not readily found.  One colleague discovered the same thing in his office recently, where storage was spread out in various credenzas and one small closet.  Someone moved some of the labels to one of the credenzas.  Labels are commonly used items and that location makes them readily accessible by everyone.  The problem was that a stash of labels was also stored in the office supply closet.  Failure to combine all the labels in one place made it easy for someone to assume they’d run out of a particular size and re-stock; boxes of labels, by the way, can easily run $25+ each!  He solved this by consolidating all types of labels in one place and (here’s the other key) communicating their location to everyone.

2.  Too many favorites.  Some offices have very spoiled employees.  Sally likes gel-filled pens; Henry likes Bic medium point.  Aurora prefers blue ink and Vicky likes black.  Mechanical pencils are the preference of Patty and Sandy. Indulging everyone’s preferences makes for a large inventory of writing instruments – in this example – and the price tag can get out of control. Consider as well that pens are usually sold in boxes so how many of the 12 gel-filled pens will Sally use at one time before they dry up?  Select standard supplies and commit to purchasing only those, and especially when on sale or you have a coupon J  Employees are free to bring their favorite pens from home if they prefer something other than what you offer.

3.  Growing legs.  Ask a group of 100 people if they consider themselves to be honest, and every single one will answer affirmatively.  Ask if anyone’s a thief and you’ll get indignant looks as your reply.  Yet how many times have you ‘borrowed’ some pens, or notepads, or paper clips for a non-work project that’s coincidentally not performed at your place of business?  We’re not talking about the pen that absentmindedly goes in someone’s purse; the systematic, premeditated pilfering of supplies is the issue here and the cost adds up.  Consider keeping a small stash of expensive supplies in a central place and store the excess in a more secure location.  That will help you gauge the rate of use.  A related issue is the copier.  Some offices have a standard number of copies they’re allowed per month and pay extra when that target is exceeded.  Most employers don’t have a problem with someone copying receipts for a personal rebate or other personal information from time to time.  Reproducing volumes of materials for individual projects that have nothing to do with company business is unfair and adds up.  If your copier meter goes through the roof and you haven’t experienced a big influx of business to explain it, betcha dollars to donuts someone’s up to something.

4.  Stockpiling.  This is a variation of #1 and #2 above.  Some individuals believe in preparation and when they rely on a particular supply to get their work done – and its absence could set back their productivity – they might be tempted to stockpile.  The attitude is commendable: the employee wants to make sure he or she can do the job you expect.  But what starts with an extra packet of graph paper, morphs into other specialized supplies; next thing you know, organization falls by the wayside and you re-stock items that haven’t really been used, they’ve just been diverted.  Be prompt in your replenishment of supplies.  Every business experiences budget constraints and sometimes it seems that you run out of every expensive supply at the same time.  If you determine that you’re close to running out (more on that in a minute), by all means replace your stock so that productivity can continue.  This avoids the wasted time in speculation and waiting around that happens when something critical is gone.

Just about every single office supply company offers coupons or other purchasing incentives.  Don’t wait to run out completely so that you’re dashing to the store at the last minute.  Chances are you’ll pay top dollar and not receive any discounts.  Make a short list of the commonly used items in your office and watch the advertisements.  Sign up for email lists of specials.  A planned approach to supply ordering will maximize your savings and your sanity.

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Get Familiar with the EEOC Complaint process

In our previous blog, we discussed the Civil Rights Act of 1964, important federal anti-discrimination legislation as it relates to Title VII. As employers, we obviously strive to avoid litigation in any area of employee discrimination; however, we may be faced with defending ourselves at some time. This blog reviews the major points of the EEOC complaint process.

In any case of alleged discrimination, the individual – referred to as charging party or plaintiff – must file an administrative charge with the federal or state agency responsible for enforcing antidiscrimination laws or the U.S. Equal Employment Opportunity Commission (EEOC). The EEOC has field offices nationwide. As a general rule, claims must be filed within 180 days after the alleged discriminatory practice; in states that handle their own claims processing and investigation (referred to as deferral states), the plaintiff may have up to 300 days to file with the EEOC.

To handle the growing number of complaints, the EEOC, after performing an initial priority assessment and before undertaking a formal investigation, may ask the employer to initiate a mediation process with the charging party to attempt a resolution.

Here are the steps in the complaint process:

  • The EEOC sends a letter to the employer informing them of the charge and requesting information by a stated deadline. The employer can attempt to settle the case prior to responding as long as it’s within the deadline.
  • Based on the information received, the EEOC determines if the employer is subject to EEOC jurisdiction and if the charge is a violation within EEOC jurisdiction. Any charges found to be unrelated are immediately dismissed. Typically, the EEOC responds to the charging party within 120 days.
  • The EEOC makes a determination as to “probable cause” to confirm if discrimination has occurred. If there is no probable cause, notification is sent to both parties and the charging party is given notice of the right to file suit in court within 90 days. If there is probable cause, the EEOC attempts to work with the employer to provide the appropriate remedies on a voluntary basis to resolve the complaint. If the complaint cannot be settled in this manner, the EEOC may litigate the case on behalf of the charging party or issue a finding that there is cause and give the party the right to litigate the claim in court within 90 days.
  • If the EEOC does not make a determination, the charging party may request a right-to-sue letter after 180 days. Once the charging party receives that letter, he or she must file suit in court within 90 days.

Keep in mind that this information is only a brief outline of the basic process of the EEOC’s handling of discrimination complaints. HR professionals and employers should familiarize themselves with the details of the entire process in order to understand the employer’s rights and obligations, including all time frames.

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