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Ways to improve poor performance!
- Employer training
- More experience
- More supervision
- More independent studyingand practice
- College course
- More time to perform certain task
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Things to consider before I challenge an evaluation that I believe is unfair or untrue!
- Is the challenge worth the risk?
- How often have others fared when they challenged an evaluation?
- Am I going to be here long enough for a bad evaluation to affect me?
- Make a list of pros and cons
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Steps I should take when challenging it in a formal manner!
- Folow chain of command
- Through evaluator
- Through evaluator's manager
- Through human resources
- You must have evidence; proof; not opinion: Previous evals, letters from patients
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Formal response!
- Presentation is important
- Remain calm and unemotional
- Practice your statement
- Present evidence in logical order
- Avoid accusations
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Informal response!
- Less risky, non threatening
- No appointment
- Meet with evaluator at lunch/break
- Lodge a mild protest
- Mention area of contention
- Could you review this case again and let me know if there is any change
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The two basic responses to stress!
- Fight: Catatoxic reaction
- Flight: Syntoxic reaction
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"Fight" response to stress!
- Catatoxic reaction
- More sever, defensive
- Used primarily with physical stress
- Increases HR, BP, RR, adrenalin
- Decreases gut
- Blood is diverted to skeletal muscles
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"Flight" response to stress!
- Produces less tension, pressure
- Fewer/ different hormones
- Suntoxic reaction
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Stress
- Overengagement
- Emotions are overreactive
- Produces urgency & hyperactivity
- Loss of energy
- Leads to anxiety disorders
- Primarily damage is physical
- May kill you prematurely
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Burnout
- Disengagement
- Emotions are blunted
- Produces helplessness & hopelessness
- Loss of motivation
- Leads to detachment & depression
- Primary damage is emotional
- May make life seems not worth living
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The four "R" of stress management!
- Recognize good / bad stress conditions
- Reverse
- Resolve to do something about the situation, decide to make a change
- Resilience, take care of your physical and emotional health
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Causes of work related burnout!
- Feeling of no control over your work
- Lack of recognition, reward for good work
- Unclear, overly demanding job expectations
- Monotonous, unchallenging work
- Chaotic, high pressure enviroment
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Factors that contribute to the increase in healthcare cost!
- Aging population
- Ability to substain life
- High patient expectations
- Expensive medical equipment
- Expensive drugs
- Health insurance
- Medicare and medicaid
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Diagnosis Related Groups (DRGs)
- Applies to hospitals cost only
- Determines payment for every type of disease and condition
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Economic models!
- The free market
- Command system or central planning
- Macroeconomic model
- Indicative planning
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Health care economics!
- Very little, if any, open competition
- Competition is convert
- Goverment restricts number of healthcare facilities
- Restriction of number of health care providers
- Any restriction in supply increases prices
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Salary levels vary within a job class due to...
- Level of education
- Experience
- Special skills
- Abilities
- Seniority
- Responsibility
- Time of day worked
- Quality of work
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Benefits plans!
- Vacation
- Holidays
- Sick leave
- Retirement
- Dental insurance
- Health insurance
- Child care
- Leave of absence
- Disability insurance
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Interqual Data
- Screening criteria to determine...
- Appropriateness of admission
- Each patient admission from the ED is medically necessary
- Observation status may be alternative
- Relates to intensity of service and servity of illness
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Pros of managed care!
- Better allocation of resources
- More standardized care
- Reduced over ordering
- Reduction in waste
- More consistency
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Cons of managed care!
- Rations healthcare
- Additional layers of costly bureaucracy
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Why do people resist change!
- Fear: of failure, unknown
- Inertia: Current practice should remain in force & unchanged
- Incovenience: must learn something new
- Economics: people fear job loss
- Suprise: more resistance when change is sudden
- Revenge: when employee dislikes the manager, he sabotages change effort to even score
- Misunderstanding: intent, motive of change not understood due to lack of communcation
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How change is accomplished!
- Training: educating people on how to use new method helps the change to the new method
- Directive: usually in writing & posted, assumed they will be obeyed, change might not be made at all
- Participatives decision making: employees decide the way the change will be implemented and change will cause less disruption
- Manipulation: change & method already by manager; staff is tricked into believing tha they participated in change
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How would I implement change?
- Participative decision making
- and then determin the resistance to change that was presence. Then i would provide support and assistance to help cope with the change.
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