AMERICAN WORKPLACE Volume 2 Issue 1 January 1994 U.S. DEPARTMENT OF LABOR MARTIN MANLEY CONFIRMED AS ASSISTANT SECRETARY FOR THE AMERICAN WORKPLACE On November 10, the U.S. Senate voted to confirm Martin Manley as Assistant Secretary of the Labor Department s newly created Office of the American Workplace (OAW). Secretary of Labor Robert B. Reich created the new agency to promote employee training, participation, and other practices that improve business results and help create better jobs. The OAW will help companies, labor organizations, and workers to implement practices that enhance employee skills, reward initiative, and take full advantage of the experience and knowledge of front-line workers. According to Manley, three of the OAW's most important initiatives will be to: 1. Build a clearinghouse to help companies and employees learn from the experience of America's most successful companies; 2. Develop partnerships with business and labor organizations to identify and promote high-performance work practices, employee ownership, and new roles for labor unions; and 3. Promote the use of new measurements of workplace practices to allow investors, managers, and board members to better determine the economic impact of high-performance work practices. Prior to his nomination by President Clinton to direct the OAW, Manley had an unusual career as a union leader and a business consultant. "A group of us helped the management and the Steelworkers Union to jointly save a 5,000-employee steel company up in Canada," he reports. The company, Algoma Steel, is now the largest North American company that is majority-owned by its employees and is widely admired in Canada for the role union members play on the shop floor and on the board of directors. Manley expects the OAW to work closely with business leaders, a skill he developed while serving with McKinsey & Co., an international business consulting firm. Manley advised top managers of European and North American companies in industries ranging from software and food distribution to insurance and auto assembly. He recalls that "our job was to help CEOs and other senior managers develop solid, real-world solutions to some very tough business problems. In that same spirit, the OAW will assist companies and business organizations to improve their workplaces." The OAW will also work closely with unions to ensure democracy and financial integrity and to help unions build effective workplace partnerships with management. Manley spent 10 years as a union leader and front-line worker, working as a journeyman machinist and serving in elected and staff positions with the Service Employees, the Machinists, and the AFL-CIO. Recalls Manley: "I came to have a great deal of respect for the difference that an effective union can make to front-line workers. I am committed, as is the Clinton Administration, to building a strong, progressive, and productive role for unions in the American workplace. ____________________________________ PATIENT-CENTERED HEALTH CARE By Patricia Vastano and Frank Wilson Confronted by the economic challenges of the '90s, hospitals are searching for creative ways to provide higher-quality health care at a reasonable cost. Some pioneering facilities have involved workers at every level to help redesign the delivery of care. Principles of high-performance work--including employee participation and empowerment, training, and the use of multi-skilled, cross-functional teams--are becoming more common. "Patient centered" care is an emerging theme among some of the more innovative hospitals. Applied to a traditional business, patient-centered care might be called "putting the customer first." And it represents a sea change from traditional approaches to care delivery. At the heart of patient-centered care is the redesign of the work so that resources, personnel, and processes are organized around patient needs rather than centralized, functional departments. Although no two institutions look alike, there are some common attributes associated with these efforts. DECENTRALIZATION OF SERVICES For many hospitals, it is surprising to discover how little staff time is devoted to delivering medical, technical, and clinical care. However, some facilities--Lee Memorial Hospital in Fort Meyers, FL, and Sentara Health System in Norfolk, VA, for example--have chosen to increase available staff time for direct patient care by decentralizing many of their basic operations and bringing them directly to the unit. Satellite pharmacies and labs are located within care units to perform routine functions reducing paperwork and turnaround time. Nursing stations are small, decentralized pods located closer to patients. Patient rooms have cabinets stocked with most necessary medical supplies, avoiding frequent trips to centralized supply areas. EMPLOYEE PARTICIPATION AND JOB FLEXIBILITY Successful restructuring efforts, according to those with experience, stress the importance of involving staff in program design and implementation. "Front-line workers know the patient and product best," notes Wendy Baker, director of the Center for Patient Care and Innovation at Vanderbilt University Hospital in Nashville, TN. In a labor-intensive industry like healthcare, it is essential to recognize and utilize the skills and insights of the front-line work force. Empowering employees to make decisions while broadening their role in patient care is an important part of this process. These industry approaches are consistent with federal and state health care reform efforts to improve the quality of care while reducing costs. Some facilities have initiated self-directed care teams, consisting of nurses and other health care professionals cross-trained in routine competencies of several disciplines. At Lakeland Regional Hospital, Lakeland, FL, for example, team members may acquire competencies in several areas, such as respiratory care, rehabilitative services, laboratory procedures, and radiology. The John C. Lincoln Hospital in Phoenix, AZ, uses a different team-based approach. Registered nurses direct teams of multi-skilled, non-licensed personnel and consulting specialists from other disciplines. Lincoln's organizational change process is deeply rooted in staff involvement and participation. Worker teams designed logistics and planned changes in policies, procedures, and work flow. Boston's Beth Israel Hospital is noted for giving its staff the authority to make changes to improve the quality of care. It was among the first hospitals in the nation to implement a gainsharing program. Beth Israel is currently working on a project to integrate clinical practice, including: fostering collaborative relationships among all disciplines, easing the transition from new graduate to nurse, and redistributing non-nursing tasks to specially designated workers. There are many approaches to employee involvement and improved quality of care. Hospitals with organized employees are well-positioned to achieve systematic staff input that results in widespread 'buy in" and program success. At both Mercy Hospital in Minneapolis, MN, and Kaiser's Bellflower Hospital in Los Angeles, CA, management and members of the Service Employees International Union (SEIU) are working as partners to address all aspects of quality, cost, and service delivery. Margaret Peisert of SEIU says, "The value of involving unions and workers early in the planning and implementation process is the demonstration of a focus on quality care and the assurance that restructuring is not only about containing staff costs." INFORMATION SYSTEMS Successful patient-centered care is highly dependent on the way information is disseminated throughout a hospital. Integrating information technology for use by all departments and teams can provide ready access to the most current information on each patient. Bedside computer terminals, while not yet the norm, are on the increase. RESULTS Investments in patient-centered care approaches--whether for staff training, space redesign, or new equipment--can be easily justified, according to those implementing these strategies. They cite both higher quality and anticipated longer-term cost savings as payoffs. St. Vincent Hospital in Indianapolis, IN, reports reduced patient stays by an average of 17 percent for admissions projected at more than 2 days. Vanderbilt University Hospital, looking forward to implementing a hospital-wide, patient-centered model, projects a 7.5 percent decrease in cost-per-patient day. Other favorable outcomes include: increased time devoted to direct care, improved patient satisfaction, enhanced communication among physicians and care teams, elimination of unnecessary procedures, greater job satisfaction, decreased staff turnover, and lower absenteeism. The Office of the American Workplace is studying workplace innovation in the health care industry as part of a broader effort to promote high performance work in the service sector OAW invites readers to contact us with examples of best practices and innovative approaches. For further information or to bring examples to OAW's attention, please contact Pat Vastano or Marjie Haas at (202) 219-8647 ____________________________________________ [Article entitled "Snap Shot: Employee Education/Training omitted: depends on a color chart for its meaning.] ____________________________________________ DIVERSITY AWARD OPEN TO NOMINATIONS The Glass Ceiling Commission, chaired by Labor Secretary Robert B. Reich, is accepting nominees for a new annual presidential award to recognize U.S. business for excellence in promoting a more diverse, skilled work force at the management and decision-making levels. "This prestigious award will be given to the business that demonstrates substantial effort and progress in promoting the oppor- tunities and developmental experiences of minorities and women," says Joyce Miller, the commission's executive director. We want to highlight successful businesses with the hope that other businesses will take notice and apply similar programs and policies within their own organizations." Evaluations will be made of policies, programs, and achievements of each applicant in the following areas: leadership; recruitment, selection, and retention practices; developmental practices; and successful initiatives. Evaluations will include an on-site tour of the top finalists and interviews with selected officials and other employees. The National Award for Diversity and Excellence in American Executive Management was established by the Glass Ceiling Act of 1991. The application deadline is February 28, 1994, with the award to be presented at a ceremony in Washington, DC, in mid-September. On February 11, 1994, the Glass Ceiling Commission will hold its second hearing in Los Angeles, CA. Top-level executives from business, labor, and community organizations are invited to give testimony. For detailed award criteria or additional information about the Glass Ceiling Commission's activities, call or write to: Glass Ceiling Commission, U.S.. Department of Labor, 200 Constitution Avenue N.W., Washington, DC 20210. Phone. (202)219-7342, or fax (202) 219-7368. _______________________________________ INTERNATIONAL EXAMINATION OF TECHNOLOGY, PRODUCTIVITY The link between technology, improved productivity, equity, and environmental impact is the of focus of the sixth International Productivity Symposium (IPS Vl), to be held June 5-8, 1994, in Vancouver, B.C., Canada. The symposium, co-sponsored by the Canadian Labour Market and Productivity Centre and the International Productivity Service, will feature sessions on workplace innovations in the service sector, work organization and its impact on quality and employment stability in manufacturing, and effectiveness in the public sector. Past symposia have drawn participants from North America, Europe, and Asia. For a detailed program or to register for IPS Vl, contact: IPS Vl, c/o The Canadian Labour Market and Productivity Centre, 6-66 Slater Street, Ottawa, Ontario, Canada, KlP 5H1, by fax, (613)2342482, b y phone (613) 2340505 ____________________________________________ HIGH-PERFORMANCE CONFERENCE VIDEO RELEASED Video highlights from the conference on the Future of the American Workplace are now available from Garrigan Media. The conference, jointly sponsored by the Departments of Labor and Commerce, was convened in July to look at high-performance workplaces and their importance to the Nation's economy. The 2-hour video highlights capture the views and experiences of some of the more than 350 workplace leaders in attendance, including representatives from business, labor, and front-line employees. For ordering information, contact: Garrigan Media, Inc., 93 Pike St., Suite 315, Seattle, WA 98101, or phone (206) 223-5548 or fax (206) 223-0818. [SysOp note: The transcript of this conference is available for download on the TQM BBS (301-585-1164). Filename: WRKPLACE.ZIP.]