City Hospital is one of five major hospitals in the core of a large Midwestern City. The hospital has just recently added a small addition for the treatment of “well known” patients, such as Athletes, Music Stars, and top business executives relative to the area. Local and visiting celebrities always choose City Hospital when they are in the city and in need of medical assistance. The Hospital has a 1,200 patient bed capacity and currently employs 4,500 workers, 40 of which are patient escorts. Patient escorts serve a vitally important, and under recognized role in the hospital. They are responsible for moving patients from room to room or escorting patients that have been discharged out to the front door or to his or her car in the parking lot. The role of the patient escort requires very little physical talent and mental ability.
The major requirement of this job is to be personable and friendly. The patients that are discharged are taken down to the front door or their car by the patient escort, which means that the very last face and impression the patient has of the hospital and their experience is the one the patient escort leaves them with. The addition of the small celebrity wing is extremely important that all patients leave feeling healthy and with a positive experience. Should for any reason the reputation of the hospital is damaged, the influx of celebrity and high profile traffic will begin to decrease, which will most likely result in horrible losses both financially and characteristically for the hospital. Recently, it has been stated that multiple patients have reported being treated poorly by the patient escorts over the last two years. Thus leaving a negative connotation of the hospital in the minds of the patients.
The problem at hand in City Hospital is in regards to the way that the patient escorts are treating the patients both during their stay and upon their departure. There are roughly 40 patient escorts employed by City Hospital, approximately three-fourths of them are men, and one-fourth are women. The majority of them are high school graduates in their early twenties. Many of them are working morning shifts and attending school at night, using the financial compensation from the hospital to fund their schooling. The turnover rate of this position is relatively high at 25 percent, but adversely 25 percent of the employees each year also move up in the hospital to better compensated jobs. This means that there is a 50 percent new hire rate per year. The patient escort is to provide a smile to each patient as they are moved throughout the hospital or to the front door upon their discharge.
This high replacement rate explains why patients have reported being treated rudely, being ordered around, or even being scolded by their patient escort during the discharge process. Some patients have even complained that they had been treated carelessly while they were being wheeled out their cars. In one extreme case, a patient reported that their escort haphazardly tipped him over out of the wheel chair. This type of action has left a negative connotation on City Hospital and many hospital administrators are fed up with this and looking for the cause of this problem, and seeking desperately for a change to be made.
Causes of the Problem
The mistreatment of patients has an extremely negative effect on the reputation of City Hospital. Due to the importance of this matter, the cause of this problem needed to be identified. Previously mention above, was the fact of the very high replacement rate being at roughly 50 percent. This is a combination of a 25 percent turnover rate and a 25 percent promotion rate. The fact of the matter is those 25 percent who are likely to be out of a job within a year, and the 25 percent that know they are likely to be promoted within a year, know exactly who they are and what position they are in. The 25 percent that are most likely to be job-hunting in the near future are more likely to be quick tempered with patients and more inclined to ignore the simplest job duties and requirements. Meanwhile, a quarter of the staff knows that they are doing the best job possible and are likely to be taken into consideration to move up in the hospital and to a more pleasantly compensated position within the next year or so.
In addition to the high replacement rate of the position, we believe that a major outlet of concern needs to be directed at the size of the identification tags that patient escorts must wear. The nametags are in all likelihood standard ID badges that have a small picture and name on them for security purposes. However, due to the small scale of the information provided on the nametag it’s very difficult for patients to be able to see and remember the names and faces of the patient escorts that are treating them so unjustly. Another area of concern in relation to the problem at hand is the permitting of trading patients between escorts. This makes it very difficult to address which patient was paired with which escort at any time of the day. Patients are also generally groggy from any type of medication, in pain because of any injuries, or feeling woozy because of any illness. The patient escorts raise a valid point when they mention the increased irritability of the patients who are leaving the hospital on a daily basis. The pairing of the patient’s irritability and the lack of care provided by these escorts is a recipe for disaster for the reputation of the hospital. Lastly, a major cause of this problem is likely to be carried over from the selection process.
It was stated in the case that the Chief Supervisor of Patient Escorts brought to light the lack of substance in the application for the position. The application does not really give any insight into the personality of the employee, rather it asks for some references and work experience. Essentially the job is a personality-based position so shouldn’t the application and selection process reflect on that? The administrators suggested a few solutions for the problem plaguing City Hospital. They advocated:
* Employees are asked about their hobbies, outside activities, and their personal likes and dislikes
* Employees are asked to submit three letters of recommendation from people who know the applicant well that focus on the prospective employee’s personality, particularly the applicant’s ability to remain friendly and polite at all times
* Four or five stress-producing questions should be asked during the interview
* Develop some sort of attitude test and have it revalidated with the government requirements
We definitely agree with the hospital administrators on many of their suggestions on how to correct this problem and prevent it from reoccurring in the future. However, it seems to us that their plans are only paper deep and can be bypassed by the forging of letters by their friends while putting on a fake smile and attitude during the interview with the ‘updated’ questions. Which is why we propose the following standards be made in regards to the selection process:
* The same application and interview questions be added to the selection process as mentioned by the administrators but also making sure they follow the EEOC standards
* A situational test be implemented during the interview in addition to the situational questions to further see how they respond
* Make sure the recommendation letters are from a valid source they have worked with in the past, rather than someone who knows them well
* Escorts should not only be paid hospital staff, but they should be independent from any other medical care or service
* Use of incentives to raise their work ethic and the value in them promoting the specific brand of the hospital This allows the interview to have more substance in relation to the application and interview procedure. It saves the administrators valuable time, in which they would be reading, falsified and misguided recommendation letters from the applicant’s friends and family. Also, it will provide an actual live situation in which the interviewee is tested to see how they react in a high stress situation, which will be evaluated by the interviewer or any overseers observing the interview.
Once the selection process has been completed and the employees have been hired, we have a few more suggestions on how to regulate the patient escorts to make sure there is a more than satisfactory job is completed on a daily basis. First, we suggest that all patient escorts wear larger ID badges. This ID badge should have the employees name in large bold writing and an unmistakable picture of them just above the name. This makes it much easier for patients to know who is handling them and taking care of their escort needs. Additionally, all escorts should be assigned to rooms or patients to the discretion of the nurses in advanced. We think the current process where a nurse just calls for an escort needs to be eliminated.
This allows the hospital to know who is taking care of which patient at which times and will negate any opportunity for an employee to mistreat a patient and hide behind a lie as to whether they handled that specific patient or not. The current tradition of being able to trade patients needs to be eliminated. If there is any reason that a patient needs to be traded it needs to be done through the nurse who assigns patient escorts to the patients and it needs to be documented. Any under the table trading should be discouraged and reprimanded by upper administration immediately. Lastly, we believe that an incentive based work program be put together for the patient escorts. Enticements should be provided based on good reports, excellent reviews from patients, and completing all job requirements above satisfactory standards. Incentive based programs provide willingness for employees to strive to exceed and perform their job to the highest of standards.
While it would obviously benefit the company to implement all of the changes recommended above. It is imperative that we chose the alternative solution that we believe would have the greatest overall outcome on the job at City Hospital. We wholeheartedly believe that due to the age and current motives of the majority of the employees in this position the best solution to the issue of mistreatment of patients is to institute an incentive based program, for the personnel in the patient escort line of work. Since most of the employees are in their mid twenties and some of them are using their financial compensation to fund their way through college, we deem that further financial incentives will increase performance and the treatment of employees.
We feel that if there were possibilities for earning more money, which is something that many college students or young adults are always in need of, it would encourage the patient escorts to strive to earn great reports from the patients that they have handled. Also, it would give them a reason to not want to trade away their patients because the more they serve and the better they do the more incentives they will earn.
The upper tier of administrators should begin immediately by calling a meeting to all employees that are affected by this change. At the meeting the problems should be addressed. Administrators should not point out at any individual in front of the group, but if they have individuals to speak to they should do so in private when the meeting is over. After addressing the dilemma at hand, the new incentives plan should be presented to the employees that it applies to. Based on the assumptions employees make $140 per day that they work, making approximately $700 per week (5 days). A reward of $70 per week can be acquired by meeting and receiving the following reviews and reports.
* Above satisfactory job duties performed as observed by upper administrators, nurses, and all positions overseeing the patient escorts
* 10+ excellent reviews from patients
* 0 negative reports from patients
* Must go above and beyond the calls of duty to help other and further benefit the overall welfare of the hospital each and everyday
It should be noted to all employees while this may seem like a stretch to accomplish, it is the equivalent of half a days pay, in order to perform their job to the utmost satisfaction. Bonuses can be earned weekly and the hospital administrators will be looking to implement more financial incentives in the months to come. Finally, the hospital will also institute a bi-annual performance appraisal, which will be followed by a financial bonus to those who have earned it over the course of many weeks of hard work. The amount of this bonus will be substantially larger than the weekly bonus, as it is much harder to attain. The bi-annual performance appraisals will be upper administrations way of seeing progress in the new incentives program.
City Hospital was showing rapid growth in the large Midwestern City. It was one of five major hospitals, it had just added a special addition for “well-known” patients, which made it the number one choice of all celebrities in the area when medical assistance was needed and all signs were pointing up until they saw the possible demise of the hospital flash before them. In regards to hiring, the job that required the minimal skill and knowledge had the least amount of consideration from administration. It also had the highest replacement rate in the hospital and was the very job that could change the image of the hospital in the eyes of everyone. Patient escorts were mistreating patients, being extremely rude to them, scolding them in public, and even carelessly tipping them out of wheelchairs.
This was leaving a horrible image on the face of the hospital and something needed to be changed. The hospital administration came up with a few good ideas, but it wasn’t until they brought us in until they received a few more great ideas. In an ideal situation, all of changes would be implemented, but the hospital asked for just one. So we went with the financial incentives package. Due to the age and education statistics, it was determined that the majority of these patient escorts placed a strong value on incentives.
Whether it was for living expenses or to fund their way through college, incentives are the most important motivating factor to showing up everyday. This is why we introduced the ability to receive weekly bonuses based on positive reviews as well as other deciding factors that could be earned the employees. We believe this is the solution with the best chance of solving the issue and bi-annual performance appraisals will soon show the effectiveness of the plan.
[ 1 ]. *Assumptions: 10 hour shifts, $14/hour, work 4-5 days/week, 50 hour work week