Why ASCs Should Partner with HR / Staff Management Firms

MedHQ was recently consulted by a colleague about a growing healthcare management company. With over 100+ employees in ten facilities across the Midwest, the management company expects to double by the end of the year and is looking for systems to help manage the growing employee base.

To assist with the growth, the management company is looking for an applicant tracking system (ATS) to assist in tracking candidates throughout the application and interviewing process, as well as a human resources information system (HRIS) to manage offer letters, tax forms, compliance issues and more. In addition to that, the management company will likely transition to larger payroll company by the end of the year.

The question the healthcare management company posed was, “Should we build it, or should we buy it?”

Many companies opt to build the systems themselves because they are unsure if traditional PEOs, long-term staffing companies and HR Outsourcing (HRO) firms in general can resolve all their concerns while also maintaining a high standard of employee satisfaction. However, once a company reaches significant growth, outsourcing day-to-day human resources operations can free up valuable time and resources. Or, on the other hand, perhaps the company has a wonderful HR team internally that helped them get to where they are currently. For either scenario, we could make the case for HRO (“Buy”) instead of investing further in the internal HR function (Build).

If the growth has outpaced the internal operations, an HRO firm delivers an out-of-the-box solution that handles the areas mentioned with technology operated by HR and payroll professionals that have full proficiency in their roles. There are many good ATS and HRIS platforms; at least as important is how they are set up and how well the staff is trained and practiced in using the systems.

For development of an internal HR function, the question is whether it’s best to focus some or any of the executive management attention and capital investment in a support function. What creates value for a company? Likely that it includes developing relationships and delivering top clinical care to more and more patients – these and similar areas is likely what gets executive management’s focus and most capital investment.

At MedHQ we specialize in the healthcare industry, and because of this, can better understand our clients unique HR needs. Currently, we use PrismHR, which happens to be built specifically for the HR outsourcing industry. This system is automating our employee onboarding (paperless), benefits enrollment (paperless) and, of course, handles payroll. We have integrated PrismHR with our time and attendance system and we have an applicant tracking system as well. PrismHR just recently added a CRM capability to its core platform and we’re going through the implementation of that component now – this capability is going to greatly enhance our service to employees through more effective case and task management.

As an HR Services company, we will continue to invest in the best solutions that hit the HR market because these investments will drive value in our company. We find, however, that companies that opt to build internal solutions are susceptible to having those systems atrophy due to lack of ongoing investment.

What an HRO firm is and what it isn’t: HRO’s handle back office matters that are extensive – we break it down to a dozen or so areas and 100 or so separate activities – but almost entirely in a “support” mode. Management (the customer’s management team), on the other hand, is the “front office”. The HRO handles the essential or basic HR functions, while Management supervises and develops the organization. An HR Generalist fits well within the typical service model of a HRO, while an organizational development consultant is best fit within Management Consulting. A HRO’s leverage is its size and risk sharing model. The size creates efficiencies for the customer; the risk sharing removes barriers that get in the way of a customer’s growth.

Lastly, when it comes to culture, we would consider the development of a company’s culture to be the responsibility of the Management team. While we love to work on culture-supportive programs, we believe that for an organization to intentionally create a culture requires top leadership to spearhead the effort.

Interested in learning more about MedHQ’s unique HR services, click here.

Learn more about mitigating employment risk by downloadingHow to Mitigate Your ASC’s Top 5 Employment Risks. 

Steps to Take to Manage Involuntary Terminations

Every ambulatory surgery center needs a professional, dedicated staff to provide excellent patient care and operate efficiently. Successful ASC leaders are thorough in recruiting and hiring employees who are the best fit for their team, and modeling the culture they want to see in the organization.

But despite these efforts, there will still be times when an employee is not working out, and an involuntary termination is the best course of action. This is a delicate situation that can cause financial strain and employee stress for an ASC. Research suggests that a single termination, poorly handled, can cost $80,000 to $125,000 in legal fees and severance, compared to expenses of $5,000 to $10,000 when managed properly.

The following human resources best practices will mitigate risks associated with involuntary terminations.

Have direct conversations about performance and behavior.

When an employee is not meeting expectations or is behaving in an inappropriate way, management must step in and address the problem early on. A direct, private conversation with the employee should focus on specific examples of what is happening, and what needs to change going forward. Is there a reason for the employee’s behavior? Has something, such as a new work process or a problem at home, triggered this change? Leaders in the organization are responsible for starting this conversation, exploring possible solutions, and setting next steps.

Follow a progressive discipline process.

Progressive discipline is designed to bring unacceptable behavior or poor performance to an employee’s attention and outline the changes necessary to avoid involuntary termination. For example, if a manager notices an ASC employee who has a problem with arriving for work on time or missing shifts, this process might look like this:

  • First incident: Manager clarifies job expectations and responsibilities, and issues a verbal warning about the consequences of missing work
  • Second incident: Manager pulls the employee aside when the employee has arrived at work 40 minutes late, emphasizing that this is the behavior that must change, and documents the issue in writing, using a formal written reprimand
  • Third incident: Manager involves human resources and a determination is made as to whether an Employee Consultation or a final formal written reprimand is the next step. (In some situations, a suspension or demotion may be warranted)
  • If an Employee Consultation is scheduled, the employee and manager will have the opportunity to review the fact. After consideration of facts, a decision is made regarding involuntary termination.

Diffuse the impact on remaining employees.

When an involuntary termination is necessary, it’s important for leaders to take proactive and professional actions to make the transition as seamless as possible. The conversation that ends the staff member’s employment should be brief and respectful; it will not be a surprise, as it is a culmination of many previous steps and conversations. Immediately after a termination, management must inform the remaining staff of the change and prevent rumors from spreading. Leaders need to be prepared with a plan – answering questions, sharing what they need from employees in the short term, and showing that they are working to fill the vacancy as quickly as possible.

Learn how MedHQ uses its expertise to help ASCs mitigate HR risks.

Alleviating Hostile Work Environments & Harassment Claims

Ambulatory surgery centers rely on a highly skilled, experienced, and engaged workforce to run efficiently in a change-driven industry. These healthcare professionals have demanding and fast-paced jobs, and they need to work in a safe and supportive environment in order to provide the best patient care.

ASC leaders are responsible for creating a culture where all employees are treated with kindness and respect, regardless of gender or other characteristics. The following best practices aim to mitigate risks associated with sexual harassment, general harassment, and a hostile work environment.

Adopt a “top-down” approach.

ASC leaders must model the standards and behaviors they want to see in their organization. It is their duty to define and enforce clear harassment policies, both in formal guidelines and casual everyday conversations. An employee handbook should outline in writing the processes and procedures to be followed if a harassment claim is filed. And leaders should talk often about the behaviors they expect, and those they won’t tolerate.

Be proactive about addressing risks.

Negative interpersonal behaviors can sour a work environment quickly. Leaders must be proactive about preventing them, incorporating steps such as:

  • Online and in-person training about unacceptable behaviors
  • Frequent conversations about shared beliefs and values
  • Positive recognition of those demonstrating company values
  • Programs to strengthen culture
  • Leaders demonstrating desired behaviors
  • Zero tolerance policies for harassment

Address problems early on.

To foster a positive work environment, employees must feel supported in speaking up about any complaints they have. Whether they are bothered by an uncomfortable incident or an ongoing pattern of harassment, they need to have a safe space to air their concerns. This may involve a short, in-the-moment conversation when someone says something improper. Or it might require more official protocols. Especially with delicate situations, managers shouldn’t hesitate to involve human resources experts who can guide productive discussions, facilitate conflict resolution, and follow up with additional actions.

Learn how MedHQ utilizes its expertise to help ASCs mitigate HR risks.

New White Paper by MedHQ Delivers Proactive Strategies to Mitigate High-Risk HR Events for Surgical Facilities

When it comes to high-risk human resources events, ASCs need to ensure they understand how improperly handling adverse events in human resources (HR) can significantly derail workforce productivity, cost tens of thousands of dollars and cause upward pressure on insurance rates. To assist with that effort, a new guide from MedHQ titled, How to Mitigate Your ASC’s Top 5 HR Risks, provides ASC leaders practical and proven strategies to implement at their facilities.

Launched in 2003, MedHQ assists ASCs with improving revenue, enhancing company culture, and taking time-consuming tasks off the plates of administrators, allowing them to focus on the high-value priorities of running and managing surgery centers. Since 2011, MedHQ has tracked a “Top 10” of HR risk management issues, assigning a monetary risk factor to each event. Today, the company has hundreds of such events in a database, and helps clients gain the benefit of that history.

“In an environment of rapid change, ASC leaders are already stretched thin,” says Tom Jacobs, Co-Founder and Chief Executive Officer of MedHQ, the leading provider of human resources staffing and onsite management services focused specifically on the ASC market. “This topic matters for ASCs and out-patient healthcare businesses because HR risks divert the attention of senior management, distracting them from their goals to improve the quality of care, and improve business results.”

MedHQ’s Vice President of Human Resources, Rita Hernandez-Figi works with ASCs nationwide to provide the business insight they need, so organizations can keep their focus on their patients. “When it comes to preventive practices, it’s all about being proactive vs reactive. An experienced HR team knows how to craft a job description, recruit the right candidates, and implement an interview process that brings candidates with the best skills and fit to the top.”

Hernandez-Figi uses her deep expertise as she addresses the top five high-risk HR events including: FMLA/ADA interactions, workers’ compensation claims, involuntary termination, sexual harassment and hostile work environments.

For ASCs, the key to success with high-risk events is to leverage an expert HR skill set to mitigate risks by aligning HR best practices to business strategy and integrating competent HR execution into every day operations.

ASC leadership interested in more tips and recommendations for leveraging accurate, insightful leadership counsel can download the full white paper here.

How to Mitigate FMLA/ADA Interactions

For many busy healthcare executives, employment practices matters are often secondary to more immediate problems. But while employee/employer challenges might not seem pressing in the moment, if they aren’t addressed, they can become critical and costly in the future. Executives must anticipate and mitigate these risks before they damage an ASC’s reputation, finances, or work environment.

One of the top employment risk management issues is the intersection of the Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA), which oftentimes comes on the heels of a workplace injury and workers’ compensation insurance claim. The following action steps are designed to help ASCs make plans to protect their employees and their organization.

Understand the rules.

FMLA and ADA, along with worker compensation laws, exist to establish protocols for employees and organizations to follow in specific scenarios. The regulations are intended to safeguard all parties involved. Healthcare executives should have a comprehensive understanding of the laws and their parameters. Under which circumstances does FMLA or ADA – or both – apply?

Outline clear job descriptions.

Every position within an ASC must have a detailed job description that outlines its essential tasks and responsibilities. This is a vital element of managing the interaction between FMLA and ADA; it prevents misunderstanding and clarifies expectations.

Negotiate accommodations.

With a concrete description in place, it is easier to separate mandatory job functions from tasks that may allow for flexibility. This clarity facilitates an FMLA/ADA discussion and minimizes cause for dispute. For example, an office manager with a back injury may be able to negotiate reasonable accommodations for the job, such as delegating filing and moving boxes to another employee. But for a nursing position, accommodation may not be possible if this condition makes essential functions of the job – like lifting a patient – impossible.

Determine next steps.

Conversations about FMLA/ADA issues should happen early and often. It’s especially important for ASC executives to manage situations carefully when an employee is nearing the end of the 12-week, FMLA-allowed leave. This intersection point between FMLA and ADA is where ASCs often make mistakes, putting them at risk for claims. Every situation is different, so assumptions are dangerous.

Executives must work with employees to determine medical limitations, essential job functions, and options for returning to work. Sometimes it’s possible to temporarily restructure a position, or offer a short-term, modified description of job duties. In other scenarios, there isn’t as much room for adaptability. HR professionals are valuable resources in this phase, bringing their expertise to the process.

Learn how MedHQ helps ASCs mitigate HR risks.

ASCA Webinar: Tackle the Top HR Risk Events

Last month, two members of MedHQ’s leadership team hosted a presentation as part of the ASCA’s 2018 Webinar Series. In a webinar titled, “Tackle the Top Five Human Resources Risk Events,” Tom Jacobs, CEO, and Rita Hernandez-Figi, VP, Human Resources Services highlighted strategies for handling the most difficult human resources (HR) challenges facing ASCs:

1. FMLA and ADA interactions
2. Workers’ compensation claims
3. Sexual harassment
4. General harassment and hostile work environments
5. Involuntary terminations

These situations are significant because, if handled improperly, they can have long-lasting negative effects, including financial losses, a damaged organizational culture, and distracted or distressed employees and managers.

Guided by their years of HR experience, Jacobs and Hernandez-Figi outlined the best practices around:

• Preventive measures to avoid high-risk HR events
• Strategies for mitigating risk if one of these events does occur
• Timelines for reaching out to HR experts
• Ways to minimize the impact on the rest of the organization, particularly other employees

An important takeaway for all of these events is that early notification is paramount; employees should be encouraged to let their supervisors know about a small problem before it becomes a bigger one. This is key to resolving situations in the most amicable way possible.

What are best practices for mitigating the risk of FMLA/ADA events (including those that involve workplace injuries and workers’ compensation insurance claims)?

The Family and Medical Leave Act (FMLA) and the Americans with Disabilities Act (ADA) are closely linked, and managers must know how they interact and overlap – particularly when they involve an injury that occurs at work.

The FMLA is a federal law that offers certain employees up to 12 weeks of unpaid, job-protected leave per year, while the ADA exists to protect people with disabilities from discrimination. For employers and supervisors, it’s important to know whether an event involves an FMLA claim, an ADA claim or both. The questions they should ask to get to the heart of the issue are:

• How is the organization going to work with this employee?
• What is an accurate job description? What are the required day-to-day functions (i.e., “Essential Functions”) of this position? Can some of these be amended or covered by others?
• What reasonable accommodations can be made?
These complicated questions frequently come up as an employee is reaching the end of the 12-week FMLA period, and disability accommodation is up for discussion. This is often the time when managers make mistakes that can put ASCs at risk for claims of discrimination. These problems can be avoided with early and well-documented communication between the manager and the employee and other stakeholders.

What are best practices for mitigating the risk of claims of sexual harassment, general harassment or a hostile work environment?

When it comes to harassment – whether it’s sexual or general in nature – the main questions leaders should ask are:

• What is respectful behavior in the workplace?
• What is an inappropriate demand or request?
• Are people being treated differently because of their gender (or another characteristic)?
• Does this negatively affect the work environment?
• What are the values of this organization, and how are they modeled every day?

Inappropriate behavior must be addressed immediately. Sometimes a short private conversation with an employee is enough to stop the problem. Sometimes it is necessary to put more official protocols into effect to prevent a hostile work environment from developing. An ASC needs an employee handbook that details everything from the steps to report a claim of harassment, to consequences for different offenses.

What are best practices for mitigating the risk of problems following involuntary terminations?

When an employee’s behavior or performance is having a negative impact on the organization, managers must have a clear list of steps to follow. Often this is alerting them that they must improve in specific areas in a set amount of time, then following up at intervals. And if the employee doesn’t make changes, an involuntary termination may be required.

Following the termination of an employee, managers must quickly inform the remaining staff – not going into detail about the circumstances, but outlining clear next steps. Since employees will often need to take on additional temporary responsibilities after a termination, management should also have a staff recruitment and referral program ready to execute.

Learn more about MedHQ’s human resources expertise in ASCs.

To listen to “Tackle the Top Five Human Resources Risk Events, click here.

Is it Time to Outsource HR? : MedHQ Webinar Explores the Question

The August broadcast in the ongoing MedHQ webinar series shared key learnings about outsourcing HR gleaned over the company’s 14-year history. Titled “Is It Time to Outsource HR?”, the online seminar featured MedHQ Chief Executive Officer Tom Jacobs talking about the who, what and why of outsourcing the HR function, and sparked dialog on the benefits of outsourced resources and ease of transition for a typical surgery center.

Jacobs outlined the various types of Human Resources Outsourcing (HRO) vendors, all of which share a common goal of taking on the duties and takes of supporting the needs of the employees in an ambulatory surgery center (ASC.)  Despite the differences related to who takes responsibility for the role of “employer,” Administrative Services Only (ASO) offerings, Professional Employer Organizations (PEO), Long-Term Staffing solution and Management Services Organizations (MSO), all strive to save their clients’ money, reduce risk and enhance business performance, Jacobs explained. MedHQ offers both ASO and PEO options among its services to clients.

HR Outsourcing firms take on the responsibility for administering payroll, handling benefits, resolving employee conflicts and other activities critically important to the successful operation of an ASC.

“If those things aren’t done well, they can mushroom,” Jacobs said. “Outsourcing your HR can help you become more efficient; help you manage employee relations and compliance risks; and relieve managers from some of the administrative burden. We don’t directly improve patient satisfaction, or directly improve patient outcomes, or add a single dollar of revenue directly to your ASC. But we do free up time so your management team can do so.”

A former ASC administrator himself, Jacobs shared five essential functions delivered by HRO firms to deliver on their promises of reduced risk, reduced cost, and improved performance:

  1. Act as HR generalists / manage employee relations
  2. Manage Vendors
  3. Automate and improve process efficiencies using HCM software and automation
  4. Administer employee benefits
  5. Deliver best practices for safety and workers’ compensation insurance

As the HR Outsourcing market has matured over the past decade, many firms offer optional additional services as well, such as the Accounting Services offered by MedHQ.

Now a maturing industry, there are 800-900 HRO firms now operating in the U.S., and the PEO industry grew at a compounded annual growth rate of 8.7% from 2012 to 2017, with forecasts suggesting growth at a rate of nearly 3% through 2022. Jacobs suggested several possible reasons for this growth, from an increasingly complex regulatory environment causing small and medium-sized businesses to look for ways to handle compliance more efficiently, to new software platforms supporting the HRO model, to the proven track record of many firms in the HRO space.

And when it comes to ASCs, Jacobs sees a similar trend:

“There is growing recognition of the benefit of contracting with specialist management services firms to help ASCs thrive in a market that is more and more competitive each day.”

Jacobs highlighted specific examples of how HR outsourcing helps ASCs deal with the rising cost of health insurance, keep up with changing healthcare regulations and embrace software-enabled solutions to automate an HR information, manage the “high touch” aspects of employee relations to minimize risk – millennials in the workforce, employee turnover, etc., and helps manage risk.

“At MedHQ, we’ve been tracking what we call HR Risk Events for almost 8 years,” Jacobs explained. “Why? It’s the high-risk events that matter most. For example, on the low end, 55 unemployment claims we tracked had an estimated average risk of just under $6,000. But on the high end, just 11 sexual harassments cases were estimated at $95,000 each. Focus matters.”

Since no discussion of outsourcing would be complete without acknowledging the most frequent objections, Jacobs addressed the cost of HROs and the perceptions among some that fear loss of control over ASC operations.

“All of the services that are performed by an HRO are either already being performed by someone at your ASC – but an HRO/PEO will perform them more efficiently, thereby saving money for the ASC,” he argued. “Or, there are HR services that are being neglected or sub-optimized – so having an HRO or PEO perform them will improve productivity, resulting in even greater bottom line performance or better patient care, or both!”

If your organization is interested in saving money, reducing risk, and improving productivity, click here to chat with a member of the MedHQ team about your HR needs. And, to register for upcoming broadcasts in the ongoing MedHQ webinar series, click here.