Health Care Human Resource Management

11 Jun Health Care Human Resource Management

ealthcare Human Resources HSA320 Wk 7 DQ

Walker, J. R. (2018). The restaurant: From concept to operation (8th ed.). Hoboken, NJ: John

Wiley & Sons.

DQ1:

Training Programs”  Please respond to the following:

· Evaluate two differences between various training and professional development programs in terms of the effects that each difference has on health care human resources management issues.

· Analyze at least two reasons for implementing an organizational and personnel assessment program. Provide specific examples to support your rationale.

DQ2:

Employee Motivation”  Please respond to the following:

· Compare and contrast two of the five types of employee training presented in the textbook. Then, suggest one situation that would merit each type of training for various health care employees.

· Select two motivational theories as they apply to health care. Then, assess the impact of the chosen theories on related health care human resources issues.

Chapter 7

Training, Developing, and Motivating Healthcare Employees

Introduction

The goal of healthcare organizations is to provide quality care to their patients. Nurses, physicians, and other healthcare providers have direct contact with patients. There are also different types of healthcare employees that provide indirect care to patients. Laboratory technologists and technicians have a major role in diagnosing disease, assessing the impact of interventions, and applying highly technical procedures, but they may never see the patients directly.

Regardless of their roles, employees that underperform could risk the lives of their patients. Research on high-performing organizations, including healthcare organizations, reveals that employees are motivated to perform well by the quality of the work environment. A quality work environment includes initiatives such as employee empowerment, training and career development programs, pay for performance, management transparency and support, and work–life balance (Lowe, 2002). This chapter will describe different motivational theories and different organizational strategies to motivate employees to perform.

 How to Motivate Employees

What Is Motivation?

Motivation is composed of two major factors: the ability of the employee to perform well and a work environment that encourages the employee’s performance. If an organization has a quality selection process in place that will lead to hiring of employees with the appropriate knowledge, skills, and abilities (KSAs), the second component of motivation is the processes that the organization has established to motivate an employee’s performance. According to Hitt, Miller, and Colella (2006), employee performance is a combination of ability and motivation. Two employees may have the same ability, but their performance may differ because they are motivated by different forces. In order for an employee to be motivated, the employee must view the process or environment as a reward that he or she values. Motivational theorists have analyzed several theories over the past 100 years to explain employee performance differences.

Motivational Theories

Employee rewards can be extrinsic or intrinsic. Extrinsic or external rewards are outcomes that have been developed by the organization that encourage high performance. An employee is motivated by the possibility of achieving a bonus or a promotion. Intrinsic or internal rewards are the positive feelings of employees that are the result of an action such as performing a job well (Knicki & Kreitner, 2009). An employee experiences a positive emotional experience because of his or her positive job performance. Regardless of whether an employee is motivated by either intrinsic or extrinsic rewards, the employee should receive recognition. To ensure that the rewards are valued by employees, the human resources (HR) department should survey employees to assess preference.

There are several motivational theories that have been discussed over the past decades. Four theories will be explored: expectancy theory, equity theory, goal-setting theory, and a four-prong model of intrinsic motivation. They focus on how employees’ feelings or emotions influence their performance. Expectancy theory states that motivation is a function of an employee’s expectation that his or her efforts will lead to a certain level of performance. If an employee works overtime to care for a patient or a laboratory technician works overtime to analyze emergency test results, the employee would expect praise from his or her supervisor and possible overtime pay. As part of expectancy theory, the concept of valence of value is addressed. Any outcome must be considered valuable or have valence to an employee or the outcome will not be a motivator.

Equity theory focuses on employer fairness. Employees expect to be paid fairly in comparison with other employees in the same position and to receive the same rewards if both employees work similarly. If protected class employees are not treated fairly, legality issues of discrimination can result. Equity theory is important in healthcare because of the continued nursing shortage, which creates unequal staffing levels and job dissatisfaction. This is particularly true in hospital settings because there is a higher patient to nurse ratio, which results in emotional exhaustion (Aiken, Clarke, Sloane, Sochalski & Silber, 2002).

Goal-setting theory states that establishing performance goals for employees encourages employee performance. Setting challenging and specific goals that are realistic to obtain are a motivator for high performance. Employee participation in goal setting may also have a positive impact on job performance (Hitt, Miller & Colella, 2006; Buchbinder & Shanks, 2007).

Thomas (2000) developed a four-prong model of intrinsic motivation: sense of choice, competence, meaningfulness, and progress. A sense of choice is the opportunity an employee feels when selecting tasks in his or her job. This sense of choice is tied into employee empowerment. The employer provides autonomy to the employee when making decisions. A sense of competence is the feeling that occurs when an employee performs a challenging job well. The challenge level of the job relates to the competence level. This sense is related to job enrichment and job rotation. A sense of meaningfulness is the feeling an employee experiences when performing a task that contributes to organizational goals. For example, many healthcare employees experience a sense of meaningfulness because their tasks are directly related to patient welfare. Finally, a sense of progress, which is tied to a sense of meaningfulness, is the feeling that an employee’s tasks are progressing forward and that the employee is not wasting time in performing tasks. In health care, an employee that is managing the chronic disease of a patient feels a sense of progress if the patient physically or mentally feels better.

In general, if employees feel they are being treated unfairly, their performance will suffer. It is important that an organization demonstrate both procedural and distributive justice. Procedural justice occurs when the process or procedures of allocating outcomes is perceived as fair or equitable. Distributive justice is the employees’ perception of how rewards are allocated. Interactional justice focuses on how employees are actually treated by an organization when outcomes are distributed (Knicki & Kreitner, 2009). This is particularly important if an organization has to downsize and reduce the number of employees: If an employer sends an e-mail informing employees without notice or tells one employee personally and tells other employees via e-mail, the employer is not practicing interactional justice.

Motivational Strategies for Employee Performance

Thomas (2000) also developed four building blocks for his four types of intrinsic rewards. For his sense of choice, employers should (1) delegate authority to encourage employee decision making, (2) establish an organizational culture of worker trust, and (3) provide employees with adequate information to make decisions, and finally (4) employees should feel secure if they make honest mistakes as long as they do not compromise the safety of patients or other employees. This is important in healthcare organizations because much of the workload is often fulfilled by teams. Therefore, developing a culture of trust for each of the employees and teams can result in high team performance.

For a sense of competence, an employer should provide employee training to ensure an adequate level of knowledge for employees to perform their jobs. Supervisors should also provide positive feedback when an employee performs at a high level, recognizing his or her skills. Employees should also be challenged by establishing attainable goals to encourage a high level of performance. Health care is constantly changing with increased use of technology and changing regulations, therefore continuous training provided by the organization is needed. For example, the healthcare industry requires extensive safety measures for many employees’ activities. There are traditional approaches to employee motivation for safety such as speakers, posters and signs, punitive action, and/or awards and incentives. They all have value, but, based on the theories described in the previous paragraphs, employees must value the motivation for promoting safety success. Regardless of the chosen approach, employees should be engaged in the safety improvement process. Asking for employee participation in developing and maintaining a safe work environment increases and encourages employees to achieve these goals because they participated in the process and attached a valence or value to the process (Krause, 2000).

To achieve a sense of meaningfulness, an employer establishes a motivating strategic vision that encourages employees to perform. Employees are given tasks that contribute to the organizational goal. A sense of progress should be supported by a collaborative organizational culture that celebrates milestones and employee accomplishments. A system measures employee performance. In 2009, the National Quality Forum contracted with the U.S. Department of Health and Human Services to establish performance measures for improving healthcare quality. These measures focus on patient conditions that account for more than 90% of Medicare costs (HHS Performance Measurement, 2011). Based on these measures, strategies will be developed to improve performance.

 Training and Professional Development Programs

Training and professional development programs for employees are implemented to increase the knowledge of an employee. Training programs are typically developed to increase employee performance (Byars & Rue, 2006). Employees are trained to develop specific KSAs that are used in their jobs. Like training programs, professional development programs are targeted to employees, but the programs have broader knowledge goals, which can be applied to an employee’s career goals. In addition to these types of training programs, other training programs are often implemented that are more behavior based. Such training programs include diversity in the workplace, business ethics, workplace safety, correction of performance issues, teamwork training, and cross-cultural training.

Organizational and Personnel Needs Assessment

Prior to implementation of any training initiatives, a needs assessment or evaluation is completed to determine types of training needed (Mathis & Jackson, 2006). The first component of the needs assessment is organizational analysis. The organization’s corporate strategy must be assessed to determine the training needed. For example, if an organization is expanding its operations overseas or is increasing the number of foreign employees in its domestic operations, then cross-cultural and diversity training should be provided. If an organization must downsize, the remaining employees may need to be cross-trained in different jobs.

Another aspect of the organizational needs assessment is to determine what training infrastructure is in place. Some organizations have the ability to provide simulations and e-training rather than traditional class lectures. Some organizations offer in-house training, and others contract or outsource the training. These parameters must be assessed prior to development of a training structure.

Employee Analysis

The second component of the needs assessment for training is the assessment of individual employees, or employee analysis. The following questions should be answered: (1) Does an employee lack the skills or knowledge to perform his or her job well? (2) Does the employee need training in other areas such as diversity, safety, or cross-culture? Then, based on the answers to the first two questions, a list of employees is prepared.

Task Analysis

The third component of the needs assessment is task analysis (i.e., analysis of specific activities that are part of a job). Several tasks are part of a job position. Managers need to identify the skills and knowledge needed to perform a task well. The task analysis is used as the benchmark to compare with the employee assessment to determine what training is needed for the employee to complete the tasks well.

 Training Versus Professional Development Programs

Training was identified earlier as a program that is specifically given to employees to improve their job performance by improving their KSAs. Professional development programs are more general and target employees’ career goals, not just specifically the jobs they are currently performing (Noe, Hollenbeck, Gerhart & Wright, 2011). The knowledge gained in a professional development program may be used when an employee is promoted or if he or she is moved to another position. If your employer asks you to attend a professional development program, it may mean the employer believes that you have the qualifications and potential to be promoted, and the offer should be accepted.

 Planning the Training and Professional Development Programs

The healthcare industry has varied environments that require different training programs; therefore goals are established for these training programs. For example, a hospital training program may have varied levels of training because of the different employees hired such as physicians, nurses, and technicians, whereas a physician’s office training for employees would be less complex because the office is a smaller operation.

Participants must be identified for training programs. All new employees would require training; however, existing employees might also need training. A readiness for training determines whether an existing employee is interested in participating in the training and has the ability to learn (Dessler, 2012).

The healthcare organization must decide whether the training will be provided by the organization itself or outsourced to another company. Does the organization have the capabilities within to provide training?

Finally, the type of training methods must be identified. These decisions should be made based on employee input and surveys of other organizational programs. Evaluation of past training programs can be used to evaluate current programs.

Succession Planning

Organizations need to implement succession planning before they offer professional development programs. Succession planning consists of establishing a long-term plan for the replacement of important employees (Thompson, Strickland & Gamble, 2010). As stated earlier, professional development programs are offered to employees that have potential for promotion; therefore it is important to assess the strategic plan of the company to determine long-term labor needs and to assess potential labor shortages due to employee turnover, both voluntary and involuntary. Establishing a time frame for professional development programs will enable the organization to have employees at the ready to fill future vacated or new positions.

 Training Methods

Once an employee is hired, his or her first training session is an orientation, which consists of an introduction to the organization and its policies and procedures (Mathis & Jackson, 2006). The length of the orientation program is dependent on the complexity of the organization. An orientation can be 1 day or 1 week. Orientation consists of an overview of the organization and the department of the new employee; HR issues such as employee benefits, policies, and procedures; and an introduction to the employee’s job. Most employees are provided specific computer training. During an orientation, an employee will often receive an employee handbook, which the employee may sign for to indicate the receipt of the material. Orientation is an important introduction to the new employee’s career at the organization. Anonymous evaluations of the orientation should be obtained to determine its effectiveness. Surveying existing employees about the orientation may also provide important feedback.

On-the-Job Training

On-the-job training is informal training that involves the new employee and colleagues who provide advice about the workplace and job. A new employee will observe an established employee while he or she performs the daily tasks. Internships and apprenticeships are types of on-the-job training. Internships are often established through relationships with academic institutions. Upper-level students in colleges or universities are assigned as interns in an organization. Depending on the length of the internship, students may receive credit for the internship or may receive a small stipend. Internships provide an opportunity for students to learn what it is like to work in a specific industry. In many academic programs, internships are required. Internships may lead to full-time employment.

Many medical students serve as interns at different healthcare facilities to assist with their career preference by providing on-the-job exposure (Byars & Rue, 2006). Many healthcare graduate and undergraduate students are required to perform internships as part of their degree requirement. As for medical internships, healthcare internships provide a glimpse into healthcare organizations. Some organizations hire individuals who have participated in internships because the organization already is familiar with the performance of the individual through his or her participation in the in-house internship program. An internship represents a wonderful opportunity for an individual to experience, on a short-term basis, different job aspects. It may help an individual to decide if the job or the career path is actually the correct one for him or her.

Apprenticeships are skilled trade programs such as carpentry and plumbing. The U.S. Department of Labor’s Office of Apprenticeships, Registered Apprenticeship Model, has 40 programs that address labor shortages and increased demand for skilled workers. The model is a “learn while you earn” method that combines on-the-job training, instruction, and wages earned while on the job. Upon completion of the apprenticeship, the apprentice will earn a certificate that can be applied nationally. For example, a certified nursing assistant level 1 certificate requires 150 hours of training; level 2 requires 1000 hours, resulting in wage increase and an advanced certificate of training. Level 3 apprenticeships focus on hospice care, geriatrics, and dementia (U.S. Department of Labor, 2010).

Classroom Instruction and Computer-Based Training

Classroom instruction is a common method of providing information to employees. Traditionally, employees would attend classroom instruction in the organization’s building. However, with the advent of computer technology, classroom instruction can be delivered electronically. Distance learning programs allow employees to train at different locations via video conferencing. Employees can take webinars (web-based classes) via an organization’s distance learning programs. Many of these electronic offerings can be taken at the convenience of the employees outside usual work hours (Dessler, 2012). Participants may learn in interactive courses online, take exams, and participate in chat rooms. Computer-based training is less expensive and can be more easily customized to employees.

Audiovisual Training

Audiovisual training is another electronic offering that uses classroom material, but it is provided on CDs, DVDs, or as podcasts, which are downloaded lectures for iPods. There are many quality videos on YouTube that can be used for instruction. An advantage to offering portable electronic information is the ability of the participant to review the material for further clarification.

Simulations

A simulation is a training method that imitates real-life situations and enables employees to make decisions that would mirror real-life situations but without the risk. Simulations are very important in the healthcare industry because many decisions may be life threatening. Simulations allow employees to practice their decision making. In 2004, the Society for Simulation in Healthcare was established to support the increased use of simulation. Simulations that are offered online enable employees to create avatars, which are simulated people that the employees manipulate to reflect their knowledge while performing a task (About SSH, 2011).

Virtual Realty

Virtual reality (VR) is a computerized three-dimensional learning experience. It has become a key feature in training for minimally invasive surgical procedures in understaffed departments and for the completion of those procedures in actual operating rooms (Virtual Technologies Find Real Life Applications in Healthcare, 2011). The three-dimensional nature of VR allows the employee to view an object or environment from all sides and from its interior. A participant uses specialized equipment or can view an interactive environment three-dimensionally on a computer screen. A surgical unit of a hospital can use VR to practice surgery or to view the human body to assist with diagnosing a disease. A Healthcare IT report found that between 2006 and 2010, the U.S. market for health-related VR applications experienced a compound annual growth rate of more than 10%, reaching about $670 million in sales in 2010 (Market for Healthcare Virtual Reality Systems to Grow, 2011).

Types of Healthcare Training

Employees may participate in experiential programs, which mimic real-life situations in the training programs. Case studies are an example of experiential learning (Noe et al., 2011). Case studies are written narratives that provide facts about a real-life or fictitious situation in the healthcare industry. Questions are asked of the trainee about the narrative that focus on the trainee’s behavior in the described situation. The goal of case studies is to develop critical thinking in students. Case studies enable the trainee to practice his or her response to a projected real-life situation in health care.

Diversity and Cultural Awareness Training

Because of continued labor shortages, healthcare organizations hire international employees. In addition to this trend, the labor laws that focus on antidiscrimination hiring have increased the hiring of more diverse employees at all management levels. Organizations such as the American Organization of Nurse Executives, American College of Healthcare Executives, and the Council on Graduate Medical Education have performed research on diversity issues in the healthcare industry that recognized the importance of diversity training. Organizations realize that different perspectives and backgrounds increase an organization’s value to its customers (Salisbury & Byrd, 2006). This is certainly true in health care. Healthcare consumers are from diverse backgrounds and are more comfortable selecting a provider that has a similar background. Diversity training focuses on increasing awareness of individual differences. The goal is to make healthcare services culturally competent, which means behaviors, attitudes, and policies in an organization create an effective cross-cultural work environment (What Is Cultural Competency, 2011). The Office of Minority Health, U.S. Department of Health and Human Services, was created in 1985 to improve the health of minority populations through the development of health policies. Its position is that different cultures and languages will affect a healthcare consumer’s and a healthcare provider’s perception of the wellness system and that training must be performed to ensure differences are respected.

A diversity training program consists of three major components: legal, cultural, and sensitivity awareness (Mathis & Jackson, 2006). Legal awareness training is the most important component and provides training on legal discrimination. Cultural awareness training educates employees on the differences among nationalities and ethnicities. Sensitivity awareness training builds on cultural awareness training by focusing on the impact of actions by employees. Diversity training should be customized to the cultural and diversity needs of the organization and customer base. It must be supported by leadership, included in the organization’s strategic plan, and implemented continually (Fried & Fottler, 2008).

Safety Training

The Occupational Safety and Health Act was passed in 1970 to ensure worker safety and to legislate that an organization has a general duty to provide a work environment free from hazards. Job hazard analysis technique,building on the job analysis, examines each job task, rating each task for any potential safety issue. Either the hazardous activity is changed or the employee is retrained if the employee was not performing the task safely. The technic of operations review analyzes job tasks that led to an accident. The circumstances of the workplace accident are reviewed and analyzed to determine which activity caused the accident. The employee will be retrained if necessary or the action will be eliminated (Dessler, 2012). Employees should be trained and evaluated regularly regarding safety procedures. In addition to training programs, incentive programs should reward employee safety practices to encourage safe behavior. In addition to employee safety training, safety information should be given to each employee to review any procedures.

It is difficult to ensure that safety practices are continued in an international setting. Many countries have different safety regulations. Organizations must develop a standardized policy for workplace safety, regardless of geographic location. Adoption of a standardized model ensures a safe work environment.

Business Ethics Training

Legal standards are the minimal standard of action established for individuals in a society. Ethical standards are considered to be one level above legal standards because individuals make a choice based on what is the “right thing to do” not what is required by law. There are many interpretations of the concept of ethics. Ethics has been interpreted as the moral foundation for standards of conduct (Taylor, 1975). The concept of ethical standards applies to actions that are hoped for and expected by individuals. Actions may be considered legal but not ethical. There are many definitions of ethics, but ethics is concerned with what are right and wrong choices as perceived by society and its individuals.

The concept of ethics is tightly woven throughout the healthcare industry. It has been dated back to Hippocrates, the father of medicine, who lived during the 4th century B.C., and evolved into the Hippocratic Oath, which is the foundation for the ethical guidelines for patient treatment by physicians. In 1847, the American Medical Association published a Code of Medical Ethics that provided guidelines for the physician–patient relationship, emphasizing the duty to treat a patient (Medical Ethics, 2011). To this day, physicians’ actions have followed codes of ethics that demand the “duty to treat” (Wynia, 2007).

There is an impact on ethics in providing health care. Ethical dilemmas are often a conflict between personal and professional ethics. A healthcare ethical dilemma is a problem, situation, or opportunity that requires an individual, such as a healthcare provider, or an organization, such as a managed care practice, to choose an action that could be unethical (Niles, 2011).

Organizational ethics training can be delivered through classroom training, online training, or simulation training. An employee handbook may have a section on ethics training. Training should include informed consent, confidentiality, special populations, research ethics, ethics in public health, end-of-life decisions, genetic testing and profiling, and biomedical ethics and is reinforced throughout the employee’s career with an organization.

Training to Correct Performance Problems

Every employee receives an appraisal of his or her job performance. Typically, an employee receives an annual review; however, new employees may have a probation period, which means they will be reviewed within 3 to 6 months of their initial hire. If an employee receives a favorable review, no training is needed to improve his or her performance. If the employee receives an unfavorable performance appraisal, training is needed to correct the problem. The problem may be the result of poor performance of a task or an attitude problem. Specific issues are identified to provide appropriate training to improve the employee’s performance. Providing a plan of action to correct the employee’s behavior gives the employee an opportunity to improve his or her performance.

Efficiency and Professional Development Training: Job Redesign

Job redesign is a professional development opportunity for an employee. It consists of job enlargement, job rotation, and job enrichment. Both job enlargement and job enrichment are common in health care. Job rotation is rarer in the healthcare industry because many jobs require a certification or license, so it would be more difficult to cross-train an employee unless he or she is willing to obtain the license or certification. An employee may need additional training for the enlargement or increase of his or her responsibilities. In job enlargement, the employee expands his or her existing job tasks, depending on the needs of the organization and the strengths of the employee. In job enrichment,the employee receives an increase in responsibilities at a higher level. In any professional development training, it is a hint to the employee that the organization believes in his or her abilities and is providing the employee with the opportunity to expand his or her job capabilities.

Teamwork Training

The healthcare industry commonly performs teamwork. The care of a patient is provided by a team, not just the provider. According to Chinn (2010), quality teamwork performance contains the following characteristics: shared leadership, communication, and monitoring of all team performance. Shared leadership consists of all team members participating in the implementation of the decisions, rather than one team member making all of the decisions. This procedure is tied closely to the importance of team communications. Finally, team performance is monitored and evaluated to ensure that the best outcome was achieved. If the best outcome was not achieved, then a reevaluation of the team activity is performed.

 Evaluation of Training Programs

Regardless of the goal of the training program, an evaluation component is required to assess if the program achieved its stated goal. Did the training positively alter the skills, knowledge, or abilities of an employee as it relates to his or her job? The purpose of a transfer of training is to evaluate any on-the-job use of the training material (Noe et al., 2011). In addition, any training programs can be evaluated by an online test or a simulation to assess the trainee’s knowledge. A pretest of the trainee’s KSAs and a posttest of the trainee’s KSAs after the training can identify the impact of the training program.

Conclusion

Hughes (2003) and Trautman (2005) have developed tips for motivating employees that can be applied to healthcare organizations:

1. Orientation: Provide an in-depth orientation program for new employees.

2. Incentives: Providing incentives for quality performance will encourage the performance of other employees. This addresses any issues related to expectancy theory.

3. Careful criticism: Criticism is based solely on performance using standards for all employees. This addresses any issues of equity theory including procedural, distributive, and interactional justice.

4. Routine performance of employee appraisals: Employees need routine feedback to maintain, improve, or increase performance.

5. Coaching and mentoring: Instituting relationships with experienced employees provides a way to communicate organizational knowledge.

6. Training and employee career development: Providing opportunities to contribute to an employee’s job performance and career encourages quality performance.

7. Empowerment of employees: Trusting employees to make decisions instills freedom for employees to continue to grow and enhance their performance.

8. Management by objectives: Asking for input from employees about their performance creates an atmosphere of empowerment and freedom to perform at a high level.

9. Dedication of senior management: Senior management must be dedicated to the organization, believe in the mission and vision of the organization, and act as role models for employees.

10. Management transparency: Senior management provides information on a continual basis to employees about the organizational operations. Employees have the opportunity to pursue any issues with senior management openly.

Motivation of healthcare employees can be achieved in different ways. Provision of both extrinsic and intrinsic rewards is appropriate. Employee training and development programs are motivational. There are several different motivational theories described in this chapter that can improve employee performance. In health care, high productivity is vital. If employees are not satisfied, their job performance will suffer. Nurses suffer from burnout because of high patient-to-nurse ratios. A high patient-to-nurse ratio also causes a lower quality of care because nurses do not have time to provide quality care, and if they are dissatisfied in general, the quality of work suffers. Employee burnout causes high employee turnover, which results in high organizational operating costs.

References

About SSH (2011). Available at: http://www.ssih.org/SSIH/ssih/Home/AboutSSH/Default.aspx. Accessed February 13, 2011.

Aiken, L, Clarke, S., Sloane, D., Sochalski, J. & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout and job dissatisfaction. Journal of the American Medical Association, 288(16):1993.

Buchbinder, S. & Shanks, N. (2007). Introduction to Healthcare Management. Sudbury, MA: Jones and Bartlett Publishers, pp. 23–34.

Byars, L. & Rue, L. (2006). Human Resource Management (8th ed.). New York, NY: McGraw-Hill/Irwin, pp. 371–383.

Chinn, D. (2010). Factors that promote effective teamwork in healthcare. Available at: http://www.ehow.com/list_6778245_factors-effective-teamwork-health-care.html. Accessed February 20, 2011.

Dessler, G. (2012). Fundamentals of Human Resource Management. Upper Saddle River, NJ: Prentice Hall, pp. 404–419.

Fried, B. & Fottler, M, (2008). Human Resources in Health Care (3rd ed.). Chicago, IL: Health Administration Press.

HHS Performance Measurement (2011). Available at: http://www.qualityforum.org/projects/ongoing/hhs/. Accessed March 6, 2011.

Hitt, M., Miller, C. & Colella, A. (2006). Organizational Behavior: A Strategic Approach. Hoboken, NJ: John Wiley & Sons, pp. 194–232.

Hughes, L. (2003). Motivating your employees. WIB, March/April:17.

Knicki, A. & Kreitner, R. (2009). Organizational Behavior: Key Concepts, Skills & Practices. New York, NY: McGraw-Hill/Irwin, pp. 174–187.

Krause, T. (2000). Motivating employees for safety success. American Society of Safety Engineers, March:22–25.

Lowe, G. (2002). High-quality healthcare workplaces: A vision and action plan. Hospital Quarterly, Summer:49–56.

Market for Healthcare Virtual Reality Systems to Grow (2011). Available at http://www.ihealthbeat.org/articles/2011/2/8/market-for-health-care-virtual-reality-systems-to-grow-report-says.aspx. Accessed January 9, 2012.

Mathis, R. & Jackson, J. (2006). Human Resource Management (11th ed.). Mason, OH: Thomson/South-Western, pp. 524–565.

Medical Ethics (2011). Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics.html. Accessed December 15, 2011.

Niles, N. (2011). Basics of the U.S. Health Care System. Sudbury, MA: Jones & Bartlett Learning: 250–255.

Noe, R., Hollenbeck, J., Gerhart B. & Wright, P. (2011). Fundamentals of Human Resource Management (3rd ed.). New York, NY: McGraw-Hill/Irwin, pp. 29–30.

Salisbury, J. & Byrd, S. (2006). Why diversity matters in health care. CSA Bulletin, Spring:90–93.

Taylor, P. (1975). Principles of Ethics: An Introduction. Encino, CA: Dickson Publishing Co.

Thomas, K. (2000). Intrinsic motivation and how it works. Training, October:130–135. Available at: http://www.evaluationengineering.com/index.php/solutions/management-and-career/my-top-10-practices-for-leading-and-motivating-a-workforce.html. Accessed March 6, 2011.

Thompson, A., Strickland, A. & Gamble, J. (2010). Crafting & Executing Strategy: The Quest for Competitive Advantage. Boston, MA: McGraw-Hill/Irwin, pp. 1–15.

Trautman, J. (2005). My top 10 practices for leading and motivating a workforce. Available at: http://www.highbeam.com/doc/1G1-135082130.html. Accessed December 13, 2011

U.S. Department of Labor (2010). Using registered apprenticeships to build and fill healthcare career paths. Available at: http://www.doleta.gov/oa/pdf/Apprenticeship_Build_HealthCare_Paths.pdf. Accessed February 13, 2011.

Virtual Technologies Find Real Life Applications in Healthcare (2011). Available at: http://www.kaloramainformation.com/about/release.asp?id=1873. Accessed February 20, 2011.

What Is Cultural Competency? (2011). Available at: http://minorityhealth.hhs.gov/templates/browse.aspx.?lvl=2&lv1ID=11. Accessed February 20, 2011.

Wynia, M. (2007). Ethics and public health emergencies. Encouraging responsibility. The Amercian Journal of Bioethics, 7, 1–4.

http://www.youtube.com/watch?v=HaLBXHgeIGo