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This blog post continues our series of patient experience best practices from BLG, a HealthStream Company. 

Every week we will share information from BLG that demonstrates their expansive understanding of the challenges faced by healthcare organizations and the solutions BLG has identified for improving the patient experience and patient and business outcomes.

Over the years, BLG has been privileged to partner with many organizations as they embark on their own journey. The following are 3 reward and recognition best practices our partners crafted, unique to their very own healthcare environments.

Reward and Recognition Team

A BLG partner established a Reward and Recognition Team that meets regularly to plan and implement ongoing events and initiatives, with a goal of keeping the program’s momentum alive and well. The following are a few of their highly successful celebratory efforts in honor of employees.

 

  • Birthday with the Boss: each month, employees are invited to attend their choice of breakfast or lunch with the CEO in one of the hospital’s conference rooms to celebrate their birthday; nice meal is served and each employee is given a special gift.

  • Employee Service Awards banquet.

  • Chair massages on Thursdays.

  • Free Thanksgiving and Christmas holiday buffets.

  • Perfect attendance recognition (special reception, certificate presented and drawings for special prizes including a trip to a resort area).

  • Valentine’s Day Ice Cream Social/Late Night Sweetheart Breakfast for 3rd Shift employees (administrative team cooks and serves employees).

  • Holiday trips for employees/families that feature discounted tickets and rides on chartered buses at no charge.

  • Free tickets to sporting events including baseball, arena football, and hockey games.

  • Employee bowling league and basketball team (jerseys/fees paid by hospital).

  • Wall of Fame recognition.

  • Hospital Connection – daily briefings with staff for improvement of communication and recognition of employees’ special achievements

 

Prize Patrol

The Measurement Team at another healthcare facility in the Southeast formed a “Prize Patrol” who publicly acknowledges departments for excelling in patient satisfaction survey scores. 

The team, which monitors the scores on a weekly basis, recognizes 2 areas each month: 

 

  1. The department with the highest score.
  2. The most improved. 

 

Together with a representative from administration, the hard-hat-outfitted Prize Patrol members burst in on the two unsuspecting and honored departments with goodies, banners that are hung on the spot, and great fanfare.

Because the team keeps a close watch on patient satisfaction scores across the organization, the department/unit recognitions are immediate which makes them even more powerful. 

It has proved to be an exciting way to keep employees engaged about cultural improvements, and promote friendly competition among departments.

Caught You Caring

A client hospital in Pennsylvania mounted a “Caught You Caring” initiative to reinforce  extraordinary customer service behaviors through peer recognition. They found that asking employees to recognize and document acts of extraordinary customer service had a twofold effect: 

 

  • Increased attention to the contributions of co-workers.
  • Enhanced collaboration and teamwork.

 

Without prior announcement, Caught You Caring ballot boxes and nomination forms appear in every hospital department and unit. Employees who observe co-workers providing extraordinary “customer service efforts or random acts of kindness” simply document the behavior and place the form in the ballot box.

Again without prior announcement, the Caught You Caring boxes are removed and the forms

are collected. The following day, the campaign is celebrated in the employee dining room by a random drawing of several ballots, with small prizes subsequently awarded to those recognized. 

All submitted forms are posted in the dining area, and the president’s message in the monthly employee newsletter highlights several examples of extraordinary service.

In order to keep Caught You Caring fresh and fun, each campaign is somewhat different and is never announced. Caught You Caring boxes appear and disappear at the discretion of the President/CEO. Prizes, which change with each campaign, have included t-shirts, gift cards to local restaurants, and gas gift cards.

Finally, while the employee whose ballot form is randomly selected always receives an award, other prizes are bestowed which vary from campaign to campaign. 

For example, cookie trays may be delivered to the selected employee’s department. Or an award might be offered to the individual who took the time to document the outstanding service of his/her co-worker.

Reward and Recognition Training

BLG teaches key skills, approaches, techniques, and best practices to help leaders effectively reward and recognize high performers. 

Elements of this training include how to harvest reward and recognition opportunities, thank you notes as a key engagement tool, formal recognition programs that support a patient focused culture, and informal methods that create a custom, individualized approach to thanking team members in your employee family.

About BLG, a HealthStream Company 

BLG provides Patient-Centered Excellence Consulting, where the patient is at the center of everything we do. Our tools, tactics, and best practices are evidence-based and outcomes driven.  

We provide custom, individualized coaching that produces measurable, sustainable increases in patient satisfaction, employee engagement, quality outcomes, and profitability.

This article was written by Stephen McClure for HealthStream and used here with permission.

The following article is written by Lee P. Geiger and Jacklyn M. McGlothlin of Graydon Head and Ritchey LLP, and is used here with permission.


On December 12, the National Labor Relations Board (NLRB) approved a long-awaited Final Rule, which amends representation procedures in hopes to accelerate the union election process.  


The final rule will take effect April 14, 2015. 


In an NLRBnews release, Board Chairman Mark Gaston Pearce said that the final rule will simplify and streamline the representation process, resulting in improvements for all parties.  


However, the Board did not unanimously support the Final Rule.  Unsurprisingly, the Rule is meeting the same splintered reaction from practitioners, scholars, employee advocates, unions, employers, and the public.  


The final rule is lauded by labor unions because it heralds in a simpler and quicker election process.  


However, the rule has been called the "ambush" or "quickie" election rule by many employers because it substantially shortens the amount of time between filing the petition to request an election and the election itself.  


In fact, the final rule slashes the typical period of time in half.  


Usually, the time between a petition and an election has been 38 days. Under the final rule, elections would likely occur between 14 and 21 days.  


This significantly reduces the time both an employer and the union have to communicate with employees during a union campaign regarding the pros and cons of unionizing. 


Another goal of the board in finalizing the rule is to allow for more effective administration. 


By modernizing representation procedures to reflect current technology, the NLRB hopes it will create a more uniform approach across the different regions.  


To that end, the final rule affects the following key areas:


Filing


The Final Rule provides for electronic filing of petitions, notices, and other documents.


Standardized Process and Procedure


The final rule both standardizes and shortens service and notice procedures.  When filing a petition, the petitioner must also submit a showing of interest.  


Additionally, the petitioner must simultaneously serve all other parties identified in the petition. This gives the employer earlier notice than previously required. 


Once the NLRB serves the requisite notices and information regarding the process, the employer is required to post a notice to employees within 2 business days.  


Then, a pre-election hearing is generally set to start 8 days after the notice is served. Post-hearing elections are generally held 14 days after objections are filed.


Identifying Disputed Issues


The non-petitioning party (typically the employer) must submit a position statement identifying all disputed issues one day before the pre-election hearing.  


Parties are also provided an opportunity for oral argument before the closing of the hearing. When necessary, the regional director may also allow the parties to submit post-hearing briefs.


Voter Lists


As a part of an employer’s position statement, the employer must also provide an initial list of potential voters including job classification, shifts and work locations. This initial list does not include personal contact information.  


However, if an election is directed, an employer is now required to supplement its Excelsior list of eligible voters to include additional contact information including employees’ personal phone numbers and email addresses.


Pre-election Hearing Issues 


Only issues that are necessary to determine whether or not it is appropriate to hold an election will be discussed at the pre-election hearing. Challenges to voter eligibility and inclusion will now be deferred until after the election.


No Automatic Stay of Elections 


The final rule eliminates the 25-day waiting period between the direction of election and the election itself.


Appeal Process


To consolidate election-related appeals, all parties will seek review of regional representation-case rulings through a single post-election request.


This final rule is the NLRB’s second attempt at amending and modernizing its representation procedures.  The previous version was finalized in 2011, but was then struck down by a federal judge in 2012. 


The proposed rule was then reintroduced earlier this year.     


With the final rule, unionization is now faster and easier. This could mean increased union activity in 2015. Employers are encouraged to review labor relations strategies and communication plans so they are not caught off guard when the Final Rule takes effect.


LeadingAge would like to thank LeadingAge Legal Committee member, Daniel Burke, for his efforts in providing us with this summary. Graydon Head has a Health Care Industry Group whose dual focus is on health systems and senior care and living. Graydon Head attorneys also serve clients in a variety of industries with particular expertise in: healthcare, education, human resources, personal planning, banking and financial services, commercial real estate, media, communications and information, construction, and manufacturing.

A divided National Labor Relations Board (NLRB) held last month in Purple Communications, Inc., 361 NLRB No. 126 (Dec. 11, 2014) that employees have the right to use their employers' email systems as a vehicle for exercising their Section 7 rights under the National Labor Relations Act (NLRA), overturning a previous decision to the contrary. 


 


National Labor Relations Act: Section 7


 


Section 7 of the NLRA gives employees the right to organize, to bargain collectively, and "to engage in other concerted activities." 


More simply put: by operation of Section 7, employees enjoy the right to act for the benefit of, or on behalf of, themselves and their co-workers regarding wages, hours and other terms and conditions of employment. 


This includes activities such as complaining about pay and benefits or discipline to coworkers and taking more assertive action such as seeking union assistance, walking off the job, picketing, or filing a formal petition with the NLRB for a union election. 


Section 7 is broadly written and it is an unfair labor practice under the NLRA to "interfere with, restrain, or coerce employees in the exercise of their Section 7 rights."


The ruling in Purple Communications stems from a case the Communications Workers of America brought in 2012 after failing in its efforts to organize the employees of Purple Communications, Inc., a California company that provides interpreting services for the deaf and hard of hearing. 


Like many employers, Purple Communications had an "Internet, Intranet, Voicemail, and Electronic Communication Policy" that allowed employees to use company-owned electronic equipment and systems, including its email system, for "business purposes only," and prohibited employees from engaging in activities on behalf of organizations not affiliated with the company, as well as sending uninvited email of a personal nature. 


The union filed an unfair labor practice charge with the NLRB alleging that the policy violated the Section 7 rights of Purple Communications' employees.


The NLRB agreed with the CWA and ruled that, going forward, it will presume that employees who have been given access to their employer's email system for business reasons (non-business reasons, too) have the right under the National Labor Relations Act to use it to engage in Section 7 communications and activities, subject only to the following:


  • Employers may be able to justify a total ban on the non-work use of email, including Section 7 communications, if they can demonstrate that special circumstances make the ban necessary to maintain production or discipline. However, the NLRB cautioned that such a ban would be justified in only "rare" circumstances, albeit without offering any guidance as to what that might mean. 

     

  • Where a ban is not justified, employers may apply uniform and consistently enforced controls over their email system but only to the extent such controls are necessary to maintain production and discipline (e.g., no oversized attachments or audio/video segments, etc.).

The NLRA also prohibits employers from engaging in surveillance of employees' Section 7 activities. 


This means that employers are not allowed to spy on or otherwise monitor employees when they engage in Section 7 activities or even create the impression of doing so. 


In reaching its decision in Purple Communications, the NLRB recognized it was creating a degree of uncertainty for employers regarding how they might be able to lawfully monitor their email systems in the future now that employees may be using email to engage in Section 7 activities. 


The NLRB offered the following limited guidance:


  • Employers may monitor employee use of their email systems so long as the monitoring is not discriminatory or tailored to impede protected use, i.e., "so long as the employer does nothing out of the ordinary, such as increasing its monitoring during an organizational campaign or focusing its monitoring efforts on protected conduct or union activists." 

     

  • While an employer may not change its monitoring practices in response to protected activity, "an employer is not ordinarily prevented from notifying its employees … that it monitors (or reserves the right to monitor) computer and email use for legitimate management reasons and that employees may have no expectation of privacy in their use of the employer's email system."

Employers are advised to revisit their existing policies and practices on the use of email and monitoring to ensure compliance with Purple Communications, while also taking care to apply their email system policies (including monitoring) uniformly and consistently. 


First, and foremost, employers will want to consult with counsel to determine whether special circumstances exist that would warrant a total ban on email usage for non-work purposes. 


Failing that, any policy containing a "business purposes only" restriction on employee use of company email systems should be modified to allow for communications during non-working time regarding wages, hours, and other conditions of employment. 


Employers may also want to consider eliminating email access for employees whose jobs do not entail email communications or require such access. Finally, employers should double-check to make certain that company policies relating to email and social media usage make it abundantly clear that monitoring may take place and as a result employees have no expectation of privacy with respect to electronic communications. 


Keep in mind though that any such monitoring must be conducted even-handedly with a legitimate business purpose in mind and otherwise in accordance with the Purple Communications decision.


Court challenges to the NLRB's ruling are expected.


LeadingAge would like to thank LeadingAge Legal Committee member, Maureen Weaver of Wiggin and Dana LLP, for permission to use this summary.

The Home Care Rule, a regulation issued by the U.S. Department of Labor in 2013 extending minimum wage and overtime protections under the Fair Labor Standards Act (FLSA) to all companionship services workers employed by 3rd-party home care providers, will take effect and become enforceable on Nov. 13, 2015.

The reinstatement of the rule comes after a unanimous decision rendered August 21, 2015, by a 3-judge panel of the U.S. Court of Appeals for the DC Circuit that overturned a lower court decision vacating the rule.

In its opinion, the Circuit Court held that the Labor Department was entitled to deference in its interpretation of the statutory authority for the rule. 

The plaintiffs in the case reportedly will seek review by the U.S. Supreme Court and are seeking a stay of the rule pending that review.  It is expected that the Court of Appeals for the DC Circuit will rule on that petition shortly.  

History of the Case: District Court Decision

The U.S. District Court for the District of Columbia invalidated the Home Care Rule, a regulation published by the Labor Department in October 2013 that would have significantly narrowed the definition of companionship services and would have required 3rd-party employers to pay home care workers minimum wage and overtime.  

The Home Care Rule was slated to become effective on Jan. 1, 2015, and become enforceable 6 months later.

Home Care Association of America v. Weil

The first action taken by the court involved a memorandum opinion by Judge Richard J. Leon on December 22, 2014, in which the court ultimately invalidated the prohibition against third-party employers, such as agencies, from claiming the FLSA exemptions with respect to their home care workers. 

Since 1974, Section 213(a)(15) of the FLSA has exempted from its overtime and minimum wage requirements, any employee employed in domestic service employment to provide companionship services for individuals who (because of age or infirmity) are unable to care for themselves.

Because this exemption specifically refers to "any employee," DOL had previously interpreted the statutory exemption to apply to any employee engaged in the services covered by the rule, regardless of whether the employee was employed directly by the service recipient or a third party.

The 2013 rule, however, excluded third party employers from claiming the minimum wage and overtime exemptions for these workers.

Judge Leon noted that several bills had been introduced in Congress over the years to amend the FLSA to exclude third-party employers from claiming the exemptions, but in each case, the legislation never even made it to a vote.

As a result, the judge characterized the 2013 rule as a “thinly veiled effort to do through regulation what could not be done through legislation.”

He further opined that such conduct by the DOL “bespeaks an arrogance to not only disregard Congress’s intent [through the existing provisions of the FLSA], but seize unprecedented authority to impose overtime and minimum wage obligations in defiance of the plain language of Section 213 [of the FLSA].”

As a result, the judge concluded that the 2013 regulation exceeded the DOL’s rulemaking authority insofar as the third-party prohibition is concerned.

The decision, however, let stand other provisions of the regulation that significantly narrowed the definition of companionship services.

Those provisions were slated to go into effect on January 1, 2015, but on December 31, 2014, the same judge issued a temporary restraining order that prohibits the regulation from taking effect until at least January 15.

Judge Leon heard arguments regarding the narrowed definition of companionship on January 9, and on January 14, issued a memorandum opinion that invalidated the DOL’s revised definitions, which with the December 22 action, has the effect of vacating the entire regulation.

The January 14 decision involved the definition of “companionship services.”  Prior to the 2013 DOL revisions to the exemption rule, the term was defined to specifically include “care” for a person who, because of advanced age or physical or mental infirmity, cannot care for his or her own needs.  

Services included household work related to the care of the person such as meal preparation, bed making clothes washing, etc.  

The definition further included limited general household work not to exceed 20% of total weekly work hours, but did not include services that require and are performed by trained personnel such as a registered or practical nurse.  

The 2013 rule significantly narrowed the definition by redefining care to mean assistance with activities of daily living (ADLs) and assistance with “instrumental activities of daily living,” such as driving and meal preparation.  Most importantly, it limited the actual care component to 20% of the total hours worked per person and per workweek. 

In his decision, Judge Leon began his analysis by acknowledging that the statutory definition of “companionship services” is at least somewhat ambiguous and that Congress has explicitly delegated authority to the DOL to define the term.

That said, however, the judge explained that DOL’s authority is constrained by the terms of the FLSA.

He noted that the 20% limitation on care in the 2013 regulation (as opposed to the existing rule which placed a 20% limitation on work that benefits the service recipient’s entire household rather than solely the individual service recipient) for all intents and purposes eliminates care from the exemption and thus contravenes the specific requirements of the FLSA. 

Judge Leon addressed DOL’s insistence that the companionship exemption is intended to solely to provide an exemption for workers who are essentially babysitters for the elderly:

[DOL] repeatedly titles companions “elder sitters” and likens them to babysitters. (citation omitted).  The legislative history [of the FLSA] indicates that this analogy was indeed in the minds of legislators at the time of the exemption’s passage. (citation omitted).  

But what the [DOL] does not seem to realize, however, is that this analogy actually supports plaintiffs’ position.  

Babysitters -- good ones at least -- do not simply sit and stare at their charges ready to call for assistance if something should go wrong.  And their duties can extend far beyond playing games or making conversation.  Babysitters provider care -- assistance with activities of daily living and instrumental activities of daily living -- to the extent the children they are watching are unable to care for themselves.  

A babysitter, particularly one sitting for an infant or toddler, often is responsible for feeding, bathing and changing the clothes and diapers of the child.  

Babysitters regularly prepare food for their charges and drive them to places they cannot reach on their own. If [DOL] believes otherwise, its staff needs to spend some more time with children!

The judge further noted that despite several opportunities to change the scope of the definition since 1974 when the existing definition was enacted, Congress did not show “one iota of interest in cabining the definition of companionship services.”  

Thus, he explained, such failure to change the definition constitutes persuasive evidence that the interpretation in the existing regulation is the one intended by Congress.

As he did with the prohibition in the 2013 regulation against third party agencies claiming the companionship exemption, Judge Leon concluded that DOL is trying to do through regulation what must be done through legislation in Congress.  

Accordingly, the judge vacated the regulation in its entirety.

Training models for personal and home care workers will be the topic for discussion during an educational session that the LeadingAge Center for Applied Research will present at the PEAK Leadership Summit. The session takes place on Monday, March 17 from 12:30-2 p.m.

The PEAK Leadership Summit takes place March 17-19 in Washington, DC. Register today by visiting the PEAK website.

Presenters from Massachusetts and North Carolina

“Competency-Based Training Models for Personal and Home Care Workers” will focus on the federal Personal and Home Care Aide State Training (PHCAST) Demonstration Program. Six states participated in the PHCAST demonstration, which was authorized by the Affordable Care Act (ACA) and administered by the Health Resources and Service Administration (HRSA). The Center for Applied Research is helping to conduct an ACA-mandated evaluation of the program.

During the PEAK session, representatives from the Massachusetts and North Carolina PHCAST programs will describe how they used their HRSA grants to develop training models for the personal and home care aide workforce.

The Massachusetts PHCAST project implemented a number of innovative strategies to recruit participants for its training programs and ensure their success. These strategies included:

  • Working with 5 Head Start programs to identify prospective trainees and provide case management.
  • Partnering with community colleges to provide trainees with case management services.
  • Offering special services to trainees with limited English language skills. The program also offered a bilingual curriculum in 4 languages: Spanish, Brazilian, Portuguese and Haitian Creole. 

North Carolina’s training model provides workers with a career lattice that allows them to gain additional skills and competencies while remaining in the home care field. The state developed and pilot tested a 4-phase comprehensive training and competency development program for direct care workers. The training model:

  • Provides an introduction to direct care work.
  • Trains workers on direct care basics.
  • Provides intermediate training for Nurse Aide I. 
  • Offers advanced training that allows workers to earn designations as geriatrics nurse aides, home care aides or medication aides. The geriatric nurse specialty and medication aide specialty training existed prior to the PHCAST program. The specialties were pulled into the advanced training phase.

PEAK Session Goals

The PEAK session will explore how the Massachusetts and North Carolina programs were developed and how they have helped improve the personal and home care workforce. Presenters will share: 

  • The challenges involved in training culturally diverse workers.
  • Their experiences building partnerships and coalitions. 
  • The lessons they learned during the planning and implementation process.
  • The impact of their programs on trainees.

 

The move comes in response to OSHA's settlement of a legal challenge to the Letter.  The lawsuit asserted that the Letter was contrary to OSHA regulations that stated employee representatives “shall be” employees of the employer unless third parties could provide specific expertise such as language interpretation or technical expertise. The Letter expanded this to include union representatives as identified by employees.

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