The Training of Lay (non-professional) Hospital Employees

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Hayhow, E d g a r C h a r l e s , 1 6 9 4 The t r a i n i n g o f l a y ( n o n - p r o f e s s i o n a l ) h o s p it a l em p lo y ees... New Y o r k , 1 9 4 2 . 3 p . 1 , , 1 2 2 , c l a , 1 0 , 123-21C t y p e w r i t t e n leaves. t a b l e s (1 f o l d . ) f o r m s (1 f o l d , ) ; 29cm. ' T h e s i s ( ? h . D . ) - New Y o r k u n i v e r s i t y , School of e d u c a tio n , 1942. ■B i b l i o g r a p h y : p . 1 8 0 -1 9 1 . A34400 Shelf List

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T H IS D IS S E R T A T IO N HAS BEEN M IC R O F IL M E D E X A C T L Y AS R E C E IV E D ,

ci c i, j ,

Bia aocejpted^ aocepted : Theni*

Date.

THE TRAINING OF LAY (NON-PROFESSIONAL) HOSPITAL EMPLOYEES

EDGAR 0. HAYHOW

Subm itted in p a r t i a l fu lf illm e n t o f the requirem ents f o r the degree of Doctor of P hilosophy in the School of Education of New York U n iv ersity

1942

>

JUN 5 x 1942

PLEASE NOTE:

Some pages may have in d is tin c t

p rin t.

F i l m e d as r e c e i v e d .

U niversity M icrofilm s,

A Xerox Ed u c at i o n Company

acknowledgment

This document owes so much to the cooperation and stim u lu s of c o lle a g u e s, f r ie n d s , and a u th o r itie s in the h o s p ita l, p erso n n el and r e la te d f i e l d s t h a t only a g en eral word of thanks can be expressed to th e many from whose correspondence, co n v ersatio n , ad d resses and w ritin g s c o n trib u tio n s have been made to these pages. S p ecial acknowledgment is due those named on a l a t e r page who have c o n s is te n tly follow ed the development of th is stu d y and whose ex p ert judgment on many of the problems encountered have c o n trib u te d to th e v a l i d i t y o f th e statem en ts made and the conclusions reached. S incere a p p re c ia tio n is a ls o extended to Mr. W. Crane Lyon and o th ers who have rendered u n tir in g serv ice in the arduous ta s k of assem bling and e v a lu a tin g p e rtin e n t data from b u sin e ss, i n d u s t r i a l , ed u c a tio n a l and h o s p ita l o rg a n iz a tio n s. F in a lly , the w r ite r i s genuinely conscious of deep indebtedness to h is sponsoring committee f o r th e i r c o n sta n t, f rie n d ly i n t e r e s t , guidance and co o p eratio n throughout the development o f th is work.

EDGAR C. HAYHOW P a te rso n , New J e rs e y A p ril 10, 1942

CONTENTS Page ACKNOWLEDGMENT.....................................................................................................

iii

INTRODUCTION: PURPOSE AND METHOD OP PROCEDURE.................................... PART I .

1

THE GROUNDWORK FOR EFFECTIVE EDUCATION AND TRAINING: BUILDING AND ADMINISTERING A SOUND HOSPITAL PERSONNEL POLICY

Chapter I

A Changed A ttitu d e and Approach ..................................... , . P ersonnel P o lic y F orm ulation, Transm ission and Execution . . II

PERSONNEL RECORDS AND THE CONTROL OF EMPLOYMENTSTANDARDS

. .

The P rocedure and Use o f P ersonnel R e c o r d s ................................. C e n tra liz e d P ersonnel Records an E ffe c tiv e C ontrol Technique VI

31 36 40 45 45 45 52

EMPLOYEE SELECTION AND PLACEMENT.................................................................. Recognizing In d iv id u a l D ifferen ces . . . . . . . Developing Sources o f Supply ............................................. H iring Techniques ....................................................................

V

30

THE ORGANIZATION OF A HOSPITAL PERSONNEL DEPARTMENT........................ Reasons fo r a P erso n n el Department ........................................................ Functions o f a P erso n n el Department . . . . . . . . . . . . Q u a lific a tio n s o f th e P erso n n el D ire c to r ...........................................

IV

15 17

NEW RESPONSIBILITIES AND DUTIES OF HOSPITAL TRUSTEES AND ADMINISTRATORS.............................................................................................. The Role o f th e H o sp ital T ru stee ....................... The H o sp ital A d m in istrator Today . . . . . . . . H o sp ital T ru stee and A dm inistrator R elatio n s ...................................

III

14

BUILDING AN EFFECTIVE HOSPITAL PERSONNEL POLICY.....................................

EMPLOYEE HEALTH AND SAFETY AN INTEGRAL PART OF TRAINING

. . .

The In cid en ce o f Employee H ealth and E ffic ie n c y . . . . . . A d m in istratio n o f H ealth and S afety W o rk ............................................ H ealth and S afe ty Education . . . . . . . . . .

55 55 57 58 71 74 78 81 81 88 89

Chapter VII

V III

Page SALARY ADMINISTRATION: JOB ANALYSIS AND EVALUATION........................

96

F acto rs in a Sound Wage Program. ............................................... Job A n aly sis and Joh E v a lu a tio n . . . . . . . . . . .................

97 104

TRANSFER AND PROMOTION; EMPLOYEE RA TING............................................

112

T ra n sfe r and Promotion P o lic ie s . . . . . . . .............................. The C o n stru ctio n o f R ating S cales to Measure In d iv id u a l P e rfo rm a n c e .............................................. 7 . . . .

112

PART I I . IX

115

ORGANIZATION OF AN EDUCATION AND TRAINING PROGRAM

THE FIELD OF EDUCATION AND TRAINING.................................................... I n d u s tr ia l Education and T rain in g Programs

133

.................

134

X TRAINING OPPORTUNITIES FOR HOSPITAL SERV ICE....................................

129

Government T rain in g P ro je c ts ............................................................... S p ecial E ducational Courses fo r H o sp ital E xecutives . . . . S p ecial Courses f o r NonAProfessional Employees . . . . . . . M easuring T rain in g R esu lts ........................................................... XI

TRAINING PROCEDURE: ORGANIZING A HOSPITAL TRAININGPROGRAM . . Who Are to Be Trained? ................................. The A d m in istratio n of T rain in g . . . . . ........................ . . . . . The O rg an izatio n o f th e T rain in g Program . . . . . . . . . . F acto rs to Be D ealt w ith in S e ttin g Up th e P ro g ra m .................

XII

X III

129 130 133 136 141 143 144 145 151

CONTENT OF THE EDUCATION AND TRAINING PROGRAM...............................

158

B asic Education and T rain in g Course fo r A ll Employees— "The H o sp ita l and Your Job" ....................................... S p e c ia liz e d D epartm ental T rain in g . . . ...................................... I n s tr u c tio n S h e e t s .................... Teaching Department Heads and Other I n s tr u c to r s . .................. Fundamentals of Good Teaching and E ffe c tiv e T rain in g . . . .

159 163 165 169 170

EVALUATION OF TRAINING RESULTS.................................................................

171

CONCLUSION.....................................................................................................

176

BIBLIOGRAPHY................................................................................................

180

APPENDIX.............................................................................................................

192

INTRODUCTION: PURPOSE AND METHOD OP PROCEDURE

Statem ent o f th e problem The major problem s e t f o r t h i s th e s is was (1) to determ ine th e need f o r sy stem atic s e le c tio n , ed u catio n and tr a in in g of n o n -p ro fe ssio n a l h o s p ita l employees, and (2) to o u tlin e a s p e c if ic program f o r guidance i n meeting th a t need. R e a liz in g th a t no p a te n t form ula has been a r riv e d a t which can be auto*, m a tic a lly ap p lie d to th e s o lu tio n of th e h o s p ita l personnel problem in i t s e n t i r e t y , th i s comprehensive stu d y aims s p e c if ic a lly to e s ta b lis h a p a tte r n which w ill serve a s an a u th o r ita tiv e guide f o r h o s p ita l a d m in is tra to rs in s e tt i n g up a sound and e f f e c tiv e personnel program. The purpose o f th e f i n a l t h e s i s , th e n , i s fo u r-fo ld * 1. To s e t f o r t h a sound p erso n n el philosophy and p r in c ip le s which should govern th e approach of the h o s p ita l tr u s te e s and admin­ i s t r a t o r s to t h e i r p erso n n el problem s. 2 . To show the im portance of c a re fu l p o lic y fo rm u latio n , tran sm issio n and ex e cu tio n , and to p o in t out the most p ro g re ssiv e and su ccessfu l personnel p o lic ie s and p ro ced u res, e . g . . those a f f e c tin g employ­ ment, wages, h e a lth , s a f e ty , ho u rs, working c o n d itio n s , education and tr a in in g , prom otion, employee b e n e f its and s e rv ic e f e a tu r e s , and jo i n t r e la tio n s o f th e a d m in istra tiv e s t a f f and employees. 3 . To in d ic a te h e lp fu l p sy ch o lo g ical t e s t s and to c o n s tru c t employee r a tin g s c a le s to a id in w ise s e le c tio n and placem ent, tr a n s f e r and promotion o f n o n -p ro fe ssio n a l employees. 4 . To d e t a i l th e techniques and co n ten t of a b a s ic education and t r a i n ­ in g program f o r n o n -p ro fe ssio n a l employees, which w ill t r a i n them f o r th e jo b s f o r which th ey have been s e le c te d , develop t h e i r p o t e n t i a l i t i e s and prepare them f o r prom otion, and make f o r high q u a lity s e rv ic e and m orale.

2

The Need f o r th e Study Organized employee tr a in in g in b u sin ess has proved i t s d o lla r and cen ts v a lu e .

Recognized as a v i t a l f a c to r in b u sin ess management d u rin g th e p re v i­

ous World War, the problem of developing the p o t e n t i a l i t i e s of employees has commanded in c re a s in g a t te n tio n ev er sin ce th a t tim e.

Many la rg e concerns

recognized and a c te d upon the f a c t th a t , no m a tte r how p l e n t i f u l the supply of workers o r how c a r e f u lly th e y a re s e le c te d , employees doing any kind of work cannot perform t h e i r d u tie s s a t i s f a c t o r i l y or econom ically w ithout adequate tr a in in g . B u t, f o r th e p re s e n t and no doubt f o r some time to come, we in the h o s p ita l world cannot th in k in term s of a p l e n t i f u l supply of w orkers.

We

must fa c e th e f a c t th a t a t b e s t th e wages paid n o n -p ro fe ssio n a l h o s p ita l employees a re low a s compared w ith s im ila r p o s itio n s in b u sin e ss and in d u s try . Tor v a rio u s reaso n s, h o s p ita ls d id not le a rn o r, a t l e a s t , could n o t apply the le sso n of World War I , and now, i f an y th in g , they a re more unprepared than fo rm erly f o r th e se rio u s problem of o b ta in in g and r e ta in in g the q u a li­ f ie d p erso n n el n ecessary f o r adequate o p e ra tio n . In th e armed fo rc e s and in in d u s try today tr a in in g has become a b ig b u sin e s s —the h e a rt o f th e war program.

In the h o s p ita ls a s im ila r need

e x i s t s , b o th from th e la r g e r view point of new a d m in is tra tiv e o p p o rtu n itie s and r e s p o n s i b il i t i e s s e t f o r t h in th e f i r s t p a r t of th is stu d y and to meet th e p r a c t ic a l s it u a t i o n which most be met d a ily .

There i s no denying the

f a c t th a t we in th e h o s p ita l f i e l d , lik e every o th e r group, have been c a ta p a u lte d in to a n a tio n a l and world c r i s i s which has fo rced a tte n t io n upon our g r e a tly aggravated perso n n el problems. As has been confirm ed through the q u estio n n aire method, the n a tio n 's s ix th la r g e s t in d u s try (w ith a c a p ita l investm ent of fo u r b i l l i o n d o lla r s ,

3

annual expenses of $900,000,000, and over a m illio n employees) has y e t to f a l l In l in e w ith th e fast-m oving tren d to recognize human v alu es In the work r e la tio n s through e s ta b lis h in g s c i e n t i f i c methods f o r the s e le c tio n , placem ent, fo llo w -u p , tr a in i n g , prom otion, reward and s e c u r ity of t h e i r n o n -p ro fe ssio n a l employees. G ranting phenomenal advances In medical s c ie n c e , h o s p ita l a d m in istra tio n , I n te r e s t in th e p a t i e n t , and s o c ia l conscience, th e re is one v i t a l phase of h o s p ita l a d m in is tra tio n which has been s a d ly n e g le c te d , as th is stu d y re ­ v e a ls ,

The f o rg o tte n man in most analyses o f h o s p ita ls —h is successes and

h is f a i l u r e s , h is p a s t, p re se n t and probable f u tu r e —has been the non-pro­ f e s s io n a l employee. Only i n b r i e f , s c a tte r e d a r t i c l e s do we f in d mention of th e need f o r th e development in h o s p ita ls of th e scie n ce and a r t of personnel a d m in istra tio n and th e f i r s t ste p s b ein g taken in th a t d ir e c tio n .

This stu d y i s an attem pt

to b rin g to g e th e r between two covers the b e s t th a t has been s a id , w r itte n and accom plished and to push forw ard the boundaries of e x is tin g knowledge and p r a c tic e in h o s p ita l perso nnel a d m in is tra tio n . H is to r ic a l Background Because o f th e ra m ific a tio n s o f a stu d y such as th is in a s e c to r of our s o c ie ty which has n o t y et developed s c i e n ti f i c procedures f o r th e s o lu tio n o f i t s human work r e la tio n s problem s, i t seems h e lp fu l to supplement the above b r i e f statem en ts o f th e problem and th e need f o r the stu d y w ith a s h o rt h i s t o r i c a l background development p o in tin g out the s o c ia l s i g n i f i ­ cance o f t h i s work. The modern h o s p ita l and what tak es p lace w ith in i t s w alls a re as f a r removed from the h a b ita t and p r a c tic e s o f h o s p ita ls e s ta b lis h e d on our shores in th e e a r ly E ig h teen th Century as i s th e manufacture and s a le of

4

any commodity today w ith th e making and exchange of a s im ila r a r t i c l e i n the e a r ly y ears of our R epublic.

Science has re v o lu tio n ized our liv e s from

every a n g le . Dr. MacEachern w rites:'*' The s to r y o f th e b i r t h and ev o lu tio n of the modern h o s p ita l i s an a c c u ra te index of th e trium ph of c i v il iz a tio n over b a r b a ris m ...o f a slow b u t c e r ta in upward stru g g le a g a in s t in d iv id u alism , and of a p ro g ress toward an id e a l as c h a ra c te riz e d by a wholehearded i n t e r ­ e s t in th e w elfare o f th e community as a w h o le .,. The stu d y o f th e p a s t w ill re v e a l e r ro r s which can be avoided; i t w ill d is c lo s e customs which p e r s i s t only because of t r a d iti o n ; i t w ill show p r a c tic e s which have been superseded by o th ers more e f ­ f e c tu a l, and perhaps i t w ill b rin g to lig h t some procedures, long abandoned, which may be rev iv ed to advantage. Thus w ill p rogress be made toward th a t i d e a l, th e p e rfe c t h o s p ita l. D uring th e tw e n tie th century h o s p ita ls have progressed by leaps and bounds,

A number o f causes a r e re sp o n s ib le .

th re e s ig n if ic a n t f a c t o r s :

A c lo s e r in sp e c tio n su g g ests

th e development of d iag n o stic and th e ra p e u tic

a id s ; g r e a te r confidence in h o s p ita ls on the p a rt of those needing t r e a t ­ ment because o f p u b lic ed u catio n and b e tte r e n d -re s u lts ; and, e s p e c ia lly in re c e n t y e a rs, more w idespread accommodations affo rd ed a l l c la s s e s and groups o f p e rso n s.

This has re s u lte d in fav o rab le le g is la tio n f o r s o c ie ty

and h o s p ita l a l i k e , p a r t ic u la r l y w ith referen ce to group h o s p ita l insurance p la n s .

A ll th ese measures have e ffe c te d a cohesiveness which has changed

a t t i t u d e s and brought h o s p ita ls in to c lo s e r r e la tio n w ith the p o te n tia l p a t i e n t —h is fa m ily , h is work and h is d a ily environment. P a r ti c u l a r l y w orthy of n o te , because of i t s clo se re la tio n s h ip to th e s p e c ific problem to which t h i s study is devoted, are the advances which have been made sin ce the tu rn o f th e cen tu ry in h o s p ita l a d m in istra tio n and in the ed u catio n and t r a in in g o f the p ro fe s sio n a l s t a f f , e s p e c ia lly n u rse s .

1.

M. T. MacEachern, H o sp ita l O rganization and Management, p . l .

5

This has helped to develop a s o c ia l co nscience, a tendency on the p a rt of h o s p ita l o rg an izatio n s and in d iv id u a l h o s p ita l workers to gauge t h e i r work in terms of s e rv ic e to th e p a tie n t* U sually, the g re a te r th e scope and e ffe c tiv e n e s s of th e i n s t i t u t i o n , the la r g e r and more complex th e o rg a n iz a tio n s tr u c tu r e .

P r in c ip le s and

o b je c tiv e s remain c o n sta n t; only management procedures v a ry .

As the ex­

p e n d itu re s of la rg e sums of th e p u b lic monies have demanded c lo s e r s c ru tin y of o p eratio n and departm ental f u n c tio n s , a more complete s e lf - a n a ly s is has r e s u lte d , making f o r b e t t e r working c o n d itio n s ,

A r e a l e f f o r t to d if f e r e n ­

t i a t e between the c h a rita b le concept of h o s p ita l philosophy on the one hand and what i s sound a d m in istra tiv e p r a c tic e on the o th e r has m anifested i t s e l f . Today the h o s p ita l stan d s as a liv in g symbol o f the community's w ill to h e a lth and s a fe ty .

H o sp ital o b je c tiv e s and means fo r m eeting those objec­

tiv e s are broadening.

The populous middle c l a s s , a la rg e p o rtio n of which

the Committee on the Costs o f Medical Care found a s h o rt decade ago to be "in d ig en t in r e la tio n to m edical and h o s p ita l c a re " —too poor to pay, too proud to a sk fo r c h a r ity —is f a s t becoming th e h o s p ita l m ainstay. Over the c e n tu rie s the e v o lu tio n o f the h o s p ita l has been spasmodic. I t has progressed and re g re sse d by tu rn s .

But never b efo re in i t s h is to r y

has i t dispensed the q u a lity and q u a n tity o f s c i e n t i f i c care f o r th e s ic k th a t i t does today; never b efo re has i t s in flu en c e been so ex ten siv e and so w idespread; never b efo re has i t played so im portant a p a r t in the l i f e of th e community. The h o s p ita l con tin u es to look toward ev er g r e a te r s e rv ic e .

I t has

the o p p o rtu n ity to serve i t s p u b lic w ith a maximum of e f f ic ie n c y , fo r th a t p u b lic today is more w illin g to co o p erate; i t is g ra d u a lly rid d in g i t s e l f of i t s old p re ju d ic e s .

U n til com paratively r e c e n tly the p a tie n t approached

6

th e h o s p ita l w ith re lu c ta n c e , apprehension—w ith the ex p ectatio n of death r a th e r than l i f e ; today he e n te rs w illin g ly , co n fid en t of reco v ery .

The

o b je c tiv e o f the h o s p ita l i s h e a lth —not s ic k n e s s . But we a l l know th a t th e p in n acle of h o s p ita l e v o lu tio n has not been re ac h ed .

In the p a s t h o s p ita ls have changed as c o n d itio n s have changed.

In th e fu tu re they w ill continue to change to meet the a d d itio n a l demands o f t h e i r communities. There comes a tim e, because of the c o n s ta n tly in c re a sin g s o c ia l la g , f o r demand and supply to meet as a t the c ro ss ro a d s . i s ex p erien cin g a v i t a l s o c ia l change.

The country as a whole

The d ep ressio n during a l l the decade

o f th e n i n e t e e n - t h ir t i e s and now the t e r r i f i c im pact o f the H r have changed v a lu e s add made new and unprecedented demands upon s o c ia l i n s t i t u t i o n s .

T et,

th o se o f us engaged in h o s p ita l work know th a t we most face a se rio u s and ■unfortunate la g because o f the conservatism a s s o c ia te d u s u a lly w ith the ex­ p e n d itu re s o f c h a r ita b le fu n d s.

D espite th is f a c t , o rg an iz a tio n and method

have been and w ill be a lte r e d as a d d itio n a l demands are made, although such change i s not uniform throughout h o s p ita l a d m in is tra tio n .

In th e h o s p ita l,

advances a f f e c tin g p a tie n ts and p ro fe s sio n a l s t a f f s have always become e f ­ f e c tiv e somewhat p r io r to s im ila r advances in th e in t e r e s t of paid a tta c h e s and th e p h y sica l and s o c ia l employment c o n d itio n s a tte n d in g them. In in d u stry , to o , p ro g ress in human r e la tio n s lagged, and as a m atter o f f a c t i s s t i l l la g g in g , behind te c h n ic a l p ro g re ss.

More than te n years

ago, P ro fe s so r Sumner H. S l i c h te r , well-known la b o r econom ist, summed up th e reaso n s th e r e fo r in an e x c e lle n t a n a ly s is b efo re a Bureau of Personnel A d m in istra tio n conference group,*

1.

He s a id :

S.H. S lic h te r , Why Has Human R elatio n s Lagged Behind T echnical P rogress in In d u stry ? B usiness Management As a Homan E n te rp rise (O ctober, 1930),

7

The to p ic which I am d isc u s s in g is sim ply one a sp e c t of a gen eral tendency f o r environm ental changes to o u tran the process of ad ap t­ in g o u rselv es to them. P ersonnel a d m in is tra tio n re p re s e n ts one e f f o r t by which we are a ttem p tin g to adapt o u rselv es more s a t i s ­ f a c t o r i l y to th e new environment th a t the advances of the n a tu ra l sc ie n ce s have c re a te d —to the environment c re a te d by la rg e sc a le in d u s try . Por th i s reason the personnel management movement un­ doubtedly re p re s e n ts one of the most im portant movements of the day. The la g in t h i s movement behind i n d u s tr i a l development re p re s e n ts a problem of f i r s t im portance. This la g was due, as Dr. S lic h te r p o in ts o u t, to men’ s a tt i t u d e toward n a tu r a l phenomena and toward human b eh av io r, to g e th e r w ith the abundance of cheap immigrant la b o r .

We 'have in te rp re te d human b ehavior in terras of s e l f —

m o tiv ated by s im ila r hopes, d e s ir e s , f e a r s ; in terms of human v o litio n r a th e r than in accordance w ith n a tu ra l law s.

I t is t h i s tendency to regard each

human b e in g a s a law unto h im self, in ste a d o f a p a r t o f a t o t a l , complex s o c ia l p a tte r n , th a t kept employers from seeking to understand the behavior o f t h e i r employees, which ions in terms of environm ental co n d itio n s r a th e r th an in terms of human v o l i tio n . The la g in the development of personnel a d m in is tra tio n as a science was even exceeded by th e estab lish m ent of personnel a d m in istra tio n as a p r a c tic e . This i s explained by the f a c t th a t i t is d i f f i c u l t to measure the e f f e c ts of p erso n n el a d m in is tra tio n .

An improvement in the methods of h ir in g men,

f o r example, a f f e c ts the q u a lity of the fo rce only slow ly.

So, lik e w ise ,

does a change in the methods of promotion or a more l i b e r a l p o lic y in a d ju s t­ in g g rie v a n c e s.

The e f fe c ts o f b e t t e r personnel methods may be of g re a t

im portance, b u t th ey are not p e rc e p tib le ; i t i s d i f f i c u l t to is o la te them. Because ex ecu tiv es d id not see c le a r and d e f in ite advantages in b e t t e r p e r­ sonnel m ethods, th ey d id not keep posted on the pro g ress of the scien ce of p erso n n el a d m in is tra tio n , and t h i s , in tu rn , prevented them from seein g how the e n te r p r is e could p r o f i t from changing i t s p erso n n el p o li c ie s .

8

Over th e p a s t two o r th re e decades, b u sin ess and in d u s tr ia l management a c t u a l l y have come to a p p re c ia te th a t sound a d m in istra tio n i s contingent upon stu d y and a p p lic a tio n of th e science and a r t of personnel ad m in istra­ tio n .

This new s o c ia l scien ce re p re se n ts an e f f o r t to adapt o u rselv es more

s a t i s f a c t o r i l y to th e environment c reated by advances in the n a tu ra l sciences —by la rg e s c a le in d u s try —and as such is one of the most im portant p re s e n tday movements. Of t h i s new and changing environm ent, the h o s p ita l is a v i t a l p a r t. Whether we a re co n sid e rin g a h o s p ita l, a f a c to ry , a s to r e , or a b u s in e s s , u n d e rly in g human work r e la tio n s a re the same, p re se n t s im ila r p sy ch o lo g ical, s o c io lo g ic a l and economic problem s, which can be solved through s im ila r p erso n n el te c h n iq u e s, ap p ly in g th e same p r in c ip le s .

The c e n tr a l f a c t to

be borne in mind in the esta b lish m en t of sound personnel r e la tio n s i s th a t each in d iv id u a l is a bundle of t i e s and r e la tio n s h ip s , a l l of which a f f e c t h is work r e l a t i o n s .

Yet nothing a f f e c ts the in d iv id u a l so much as h is work

r e l a t i o n s , u n le ss i t is perhaps h is re lig io u s c o n v ic tio n s, and in th e work r e la tio n s th e re i s o p p o rtu n ity f o r s a tis f y in g the ir r e p r e s s ib le human i n s t i n c t s in la rg e m easure, i f th e importance o f doing so i s recognized. The d ep ressio n has taught what i t has meant f o r h o s p ita ls to enjoy employing tra in a b le persons in th e lower b ra c k e ts on a more or le s s permanent b a s is .

The p re se n t s itu a tio n in in d u s try has a lte r e d t h i s .

h ig h e r than in any o th e r p erio d on reco rd , due to war needs.

Turnover i s P erhaps, in

th e long p u l l , the p a s t d ep ressio n w ill prove to have been a b le s s in g in d is g u is e . We are liv in g in new, re v o lu tio n a ry tim es.

F uture h is to r ia n s , liv in g

in an e ra o f w ider and more in te n s iv e p r a c tic e o f the science and a r t of p erso n n el ad m in istratio n ), w ill d o u b tless see our c u rre n t c h ao tic c i v i l i z a t i o n

9

in a l i g h t q u ite d if f e r e n t from th e c o n f lic tin g views gleaned from the d a ily doings o f p re se n t a c to r s . D e lim ita tio n For th e sake of com pleteness w ith in the a re a covered by th is stu d y , th e survey was lim ite d to the h o s p ita ls in the S ta te of Hew J e rs e y , and a s e le c te d number of o th e r re p re s e n ta tiv e h o s p ita ls throughout the U nited S ta te s .

Lead­

in g n a tio n a l a u th o r itie s in h o s p ita l a d m in istra tio n agreed th a t th e h o s p ita ls in Hew J e rs e y re p re s e n t a r e lia b le sample as to fu n c tio n , s iz e and management te c h n iq u e s. The stu d y has been lim ite d to la y personnel—excluding those f o r whom p ro fe s s io n a l tr a in in g i s re q u ire d : the re s id e n t p h y sic ia n , th e in te r n , the g rad u ate n u rse , the la b o ra to ry te c h n ic ia n , the en g in eer—as such tra in in g i s assumed and not w ith in th e scope o f th is t r e a t i s e . The personnel s e le c te d , th e re fo re , include s p e c if ic a lly : (1) N o n -tech n ical employees assig n ed to o f fic e departm ents, to in clu d e c le r k s , sten o g rap h ers, telephone o p erato rs and h o s te s s e s . (2) Employees assig n ed to k itc h e n departm ents, to in c lu d e , m ainly, cooks, k itc h e n h e lp e rs and w a itre ss e s. (3) Employees assig n ed to the housekeeping departm ent, to include p o rte rs and m aids. Method o f Procedure The co n clu sio n s s e t f o r th in th is study—sound guiding personnel p r in ­ c i p l e s , p o l i c i e s , and procedures; s p e c if ic a lly , e f f e c tiv e techniques f o r the s e le c tio n , placem ent fo llo w -u p , tr a in in g , r a tin g and t o t a l development of th e n o n -p ro fe ssio n a l h o s p ita l employee—were a rriv e d a t as a r e s u l t of the fo llo w in g p ro ced u res:

10

1. Survey of E x is tin g T ra in in g A c tiv itie s in H o s p ita ls . This was accom plished through a q u e stio n n a ire sen t to 98 h o s p ita ls in Hew J e rs e y and 97 o u tsid e o f New J e rs e y , in clu d in g one or more in each o f th e o th e r 47 s t a t e s . From the New J e rs e y group, 77 r e p lie s were re c e iv e d , covering 60 v o lu n ta ry h o s p ita ls , 3 s t a t e , 11 county, 2 m unicipal and 1 p r o p rie ta r y . Of the o u t-o f-S ta te group, 49 r e p lie d —39 v o lu n ta ry h o s p ita ls , 4 s ta te and 6 m unicipal. H o sp itals in New J e rs e y were c o n cen trated upon; th is s ta t e was se ­ le c te d as fu rn is h in g a re p re s e n ta tiv e c ro s s -s e c tio n of the h o s p ita l f i e l d , in clu d in g la rg e i n s t i t u t i o n s a d ja c e n t to New York C ity and P h ila d e lp h ia , suburban community h o s p ita ls , to g e th e r w ith those lo c a te d in r u r a l a r e a s . In o rd er to be assu red th a t th is r e f le c te d the tru e c o n d itio n s e x is tin g in the n a tio n as a whole, the c ro s s ­ check was made w ith out of s ta t e h o s p ita ls , re p re s e n tin g a wide range as to s iz e , fu n c tio n and c o n tr o l. The r e p lie s in d ic a te d t h a t s im ila r co n d itio n s e x is te d in the h o s p ita ls in o th e r s e c tio n s of th e country as in New J e rs e y , They a ls o rev ealed t h a t , even though some common p r a c tic e as w ell as advancement has been accom plished in some in s ta n c e s , th e re remains a d e f in ite need f o r s p e c ific t r a in in g programs f o r t h i s type of personnel in the h o s p ita l f i e l d as a whole. According to the r e p l ie s , most h o s p ita ls do n o t: (1) give any g en eral form al tr a in in g to employees concerning h o s p ita l p o l ic ie s ; (2) conduct p relim in ary c la s s e s or conferences f o r new employees b efo re assignm ent to duty; (3) a s sig n one person to i n s t a l l and a d m in iste r the form al tr a in in g given in any in s ta n c e ; (4) d i s tr i b u te to employees handbooks o r manuals which co n tain inform ation about the o rg a n iz a tio n , d e p a rt­ mental fu n c tio n s and the p a r tic u la r d u tie s of the job to be performed or (5) issu e s e r ie s o f s p e c if ic p rin te d in s tr u c tio n sh e e ts f o r a l l s itu a tio n s . A copy of th e q u e s tio n n a ire , w ith a summary of the in fo rm atio n r e ­ ceiv ed , i s in cluded in the Appendix. (See E x h ib it A* page 193,) 2 , An In te n siv e Study of the Most S u c c e s sfu lly Executed T rain in g A c t i v i t i e s ,

H o sp ital

These include th e Evanston H o sp ital A sso c ia tio n T rain in g Program (Evanston, I l l i n o i s ) , the h o s p ita l personnel management course given a t S t. Lukes' H o sp ita l, Denver, Colorado, and o th e rs . These e x p e ri­ ences are mentioned i n the te x t and th e r e s u lts ev alu ated and a p p lie d in th e procedures s e t f o r t h in succeeding c h a p te rs, 3. Study of T rain in g Programs F unctioning in Business and Other Service E n te rp ris e s , A stu d y was undertaken of tr a in in g methods and programs a v a ila b le in b u sin ess and o th er s e rv ic e e n te r p ris e s where co n sid e rab le re se a rc h

11

has been found necessary in s e tt i n g up su ccessfu l tr a in in g programs. Numerous c o n ta c ts were made w ith m anufacturing concerns, hotels., banks, insurance companies, u t i l i t y companies, and e d u catio n al in ­ s titu tio n s . I t was found th a t much in th ese tr a in in g programs could be r e a d ily adapted f o r e f f e c tiv e r e s u lt s in the h o s p ita l f i e l d . And, a g a in , a p p lic a tio n s have been made in th e personnel procedures s e t f o r th h e re in . 4 . Study of O utside O p p o rtu n ities A vailable f o r the T rain in g of H o sp ital Employees. A stu d y was conducted o f ed u catio n al i n s t i t u t i o n s , in clu d in g b u s in e s s , v o c a tio n a l and o th e r s c h o o ls, to a s c e r ta in the o p p o rtu n itie s a lre a d y e x is te n t which might be o f value to p o te n tia l and p re se n t h o s p ita l employees, and, a cc o rd in g ly , worthy of c o n sid e ra tio n in the develop­ ment of h o s p ita l tr a in in g programs. The fin d in g s a re s e t f o r t h in Chapter X, which in clu d es an a n a ly s is o f th e r e s u l t s of a t e s t of the value of form al tr a in in g in a re p re ­ s e n ta tiv e employee g ro u p -m e d ic a l s e c r e t a r ie s , 5. Survey of P a tie n ts* R ea ctio n s. An a n a ly s is was made o f 400 r e p lie s to follow -up l e t t e r s receiv ed ro u tin e ly from in q u irie s d ire c te d by th re e general h o s p ita ls in New J e rs e y to p r iv a te and sem i-p riv a te p a tie n ts g e n e ra lly , excepting (1) mothers whose new-born in fa n ts had d ie d , (2) those w ith sh o rt-te rm s ta y s ( le s s than fo u r d a y s ), and (3) fa m ilie s of deceased p a t ie n ts . A pproxim ately te n per cen t o f th e p a tie n ts addressed se n t in com­ m ents. They were la r g e ly fa v o ra b le ; b u t i t would seem to be a f a i r assum ption th a t th e re would be a h ig h c o r r e la tio n between persons w illin g and in te r e s te d to answer such an in q u iry and persons having fav o rab le comments. The r e s u lt s of the survey a re included in the d isc u ssio n o f h o s p ita l p u b lic r e la tio n s p o lic y (page 26)* 6. Review o f A vailab le l i t e r a t u r e and Other Media. A v a s t amount o f h e lp fu l l i t e r a t u r e and o th e r media—books, a r t i c l e s , r e p o r ts ; employee reco rd form s, t e s t s , handbooks, standard p ra c tic e manuals—were stu d ie d to determ ine the p re se n t s ta tu e of the non­ p ro fe s s io n a l h o s p ita l employee and the means f o r improving th a t s ta tu s through b e t t e r s e le c tio n and tr a in in g . There i s l i t t l e l i t e r a t u r e a v a ila b le which s p e c if ic a lly a p p lie s to h o s p ita ls w ith re fe ren ce to tr a in in g p ra c tic e s and programs. However, a g re a t d eal o f inform ation on general personnel tr a in in g was d iscovered and p eru sed , a s in d ic a te d by the b ib lio g ra p h y .

12

7 . "The Expert J u ry 11--C o n su lta tio n w ith H o sp ital A u th o ritie s and Pro­ f e s s io n a l E x p e rts. F in a lly , sin c e t h i s study u n q estio n ab ly v en tu res in to v ir g in t e r r i ­ to ry , i t was found necessary and most h e lp fu l in a r r iv in g a t conclu­ sio n s on many o f the problems encountered to r e ly upon the judgment and experience of ex p erts in the f i e l d —h o s p ita l o f f i c i a l s , teach ers of s o c ia l scien ce and la b o r problems, and personnel s p e c i a l i s t s . The w r i te r ’ s i n t e r e s t in th is problem became v ita liz e d as a member of the Committee on P ersonnel R elatio n s of the American H ospital A sso c ia tio n , under the chairm anship of Mr. James F. Hamilton, D irec­ t o r of the New Haven H o sp ita l, New Haven, C onnecticut, and P re s id e n t­ e le c t o f th e A sso ciatio n . He l a t e r succeeded Mr.Hamilton as Chairman of the s a id Committee, and in th a t c a p a c ity he has c a r rie d forward th is stu d y . The Committee members have m aintained an a c tiv e in ­ t e r e s t and made v i t a l c o n trib u tio n s throughout the p erio d of i t s development. The n e c e s s ity of e n l i s ti n g the in t e r e s t of p ro fe s s io n a l lead ers in th e th re e fu n c tio n a l areas under study was a ls o recognized, and the w r ite r had the b e n e f it of the continued co o p eratio n of Miss E liz a b e th Cole, D ire c to r, D ie ta ry Departm ent, M ountainside H o sp ita l, M o n tclair, New J e rs e y , to g e th e r w ith D r. Mary De Gfarmo Bryan, T eachers' C ollege, Columbia U n iv e rsity , New York C ity , as Advisor to the D ie ta ry S ectio n; Mrs. Doris L. Dungan, P r e s id e n t, N ational Executive Housekeepers A sso ciatio n and Executive Housekeeper, H artfo rd H o s p ita l, H artfo rd , C onnecticut; and Mr. M artin J . F en n elly , C hief A ccountant, S ain t Luke's H o sp ita l, New York C ity , and t h e i r re sp e c tiv e "expert ju r i e s ." Because i t was r e a liz e d th a t no h o s p ita l education and tr a in in g program could be su c c e ssfu l w ithout the understanding and whole­ h earted co o p eratio n of i t s tru s te e s and a d m in is tra to r, d u rin g the p ro g ress o f th e study the w r ite r a lso sought the ex p ert judgment and approval o f a group o f P re sid e n ts o f New J e rs e y h o s p ita ls and many o u tstan d in g h o s p ita l a d m in is tra to rs . For counsel and guidance on the s p e c ia liz e d problem of t e s ti n g and r a tin g employees, he tu rn ed to the most a u th o r ita tiv e source in t h i s f i e l d , the P sychological C orporation, of New York C ity — e s p e c ia lly Dr. George K. B ennett, A s s is ta n t S e c re ta ry , and Miss E d ith P o tts , R.N., D ire c to r of the HUrse T e stin g D iv isio n , of th is o rg a n iz a tio n . F in a lly , as a u th o r itie s on the personnel philosophy, p o lic ie s and pro ced u res, c e n te rin g in education and tr a in in g , which have been found e f fe c tiv e in m anufacturing and commercial concerns and s e rv ic e in d u s tr ie s , and the tr a n s la tio n th e re o f in to h o s p ita l personnel p r a c tic e , he consulted a number of personnel ex ecu tiv es and con­ f e rre d re g u la rly over a con sid erab le p erio d w ith a long-tim e a u th o r ity in th is f i e l d , Dr. Henry C. M etcalf, D ire c to r o f the Bureau of P er­ sonnel A d m in istratio n , and Miss Eve R o s se ll, A s s is ta n t D ire c to r.

13

I t is obvious th a t employee tr a in in g i s not a m a tte r which can he seg­ re g ated and co n sid ered in vacuo.

On the c o n tra ry , none can argue the f a c t

th a t any sound and w orthw hile treatm en t th e re o f must d e lin e a te th is im portant fu n c tio n in i t s p ro p er r e la tio n s h ip to o th er personnel a c t i v i t i e s and to the whole complex problem o f g iv in g the in d iv id u a l th a t o p p o rtu n ity f o r growth and ex p ressio n in and through th e work r e la tio n s which is a tenet of democ­ racy and th e o b jec t o f perso n n el a d m in istra tio n .

I f the tendency in h o s p ita ls

today i s to t r e a t th e "whole" p a t i e n t , i s i t not lo g ic a l to employ the "whole" person?

While experience f o r s p e c if ic manual and te c h n ic a l performance i s

n ecessary in every jo b , th e su c c e ss fu l employee must re a c t fav o rab ly to the "whole" s itu a tio n . This t r e a t i s e , th e r e fo r e , is divided in to two main p a r t s .

P a rt I covers

the broader asp e ct o f a personnel p o lic y and program, the n ecessary s e ttin g fo r and complements to an e f f e c tiv e education and tr a in in g program.

P a rt I I

d eals s p e c if ic a lly w ith th e o rg a n iz a tio n , procedures and co n ten t of an edu­ c a tio n and tr a in in g program f o r the development of co n ten ted , e f f ic ie n t h o s p ita l p erso n n el—as in d iv id u a ls and as a working u n i t .

PART I THE GROUNDWORK FOR EFFECTIVE EDUCATION AND TRAINING: BUILDING AND ADMINISTERING A SOUND HOSPITAL PERSONNEL POLICY

CHAPTER I

BUILDING AN EFFECTIVE HOSPITAL PERSONNEL POLICY

As th is survey of personnel work in h o s p ita ls progressed and as i t was stu d ie d in r e la tio n to th e personnel programs now in e f f e c t , i t became in ­ c re a s in g ly ev id en t th a t th e im portance and the magnitude of th e problem co n fro n tin g h o s p ita l a d m in istra tio n today w ith re s p e c t to p erso n n el p o lic y cannot be o v e r-e stim a ted , th a t a l t e r i n g the p erso n n el p a tte r n w ithout d is tu r b ­ in g th e o rg a n iz a tio n f a b ric re q u ire s much p a tie n c e , confidence and t a c t . In the old days, a h o s p ita l, lik e o th e r o rg a n iz a tio n s, was con sid ered th e lengthened shadow of one man—the su p e rin te n d e n t. in some d egree.

Perhaps i t s t i l l i s

C e rta in ly , while the h o s p ita l i s growing too la rg e and too

complex to have a u n ify in g " p e rs o n a lity ," the a t t i t u d e and perform ance of the workers continue to r e f l e c t th e le a d e rsh ip and a t t i t u d e of management. This focuses a tte n t i o n upon th e need f o r an u n d erstan d in g and o rd e rly p ro c e ssin g of employee r e l a t io n s . A lthough i t was found th a t sound personnel methods and procedures ad ap t­ a b le to h o s p ita l o rg a n iz a tio n and a d m in istra tio n have been worked out and e f f e c tiv e ly a p p lie d in p ro g re ssiv e b u sin ess and in d u s tr ia l concerns, th e re i s no p a te n t form ula which can be introduced and follow ed, in t o t o , w ith clock-w ork r e s u l t s .

H o sp itals a re autonomous o rg a n iz a tio n s .

T ru stees and

a d m in is tra to rs r e a d ily agreed w ith the accepted in d u s tr ia l p ro ced u re, th a t each i n s t i t u t i o n can b e s t ev alu ate i t s personnel r e la tio n s in th e l ig h t of i t s own human s to c k -ta k in g , and solve i t s human r e la tio n s problems through d e f i n it e p o lic ie s and procedures in keeping w ith in d iv id u a l co n d itio n s 14

15

and need s. The fundam ental problem Is to e n l i s t the w holehearted cooperation and co n tin u in g i n t e r e s t of the t r u s t e e s , the m edical s t a f f , the a d m in istra tio n and th e s e rv ic e s t a f f a l i k e .

According to the consensus of a state-^wide

group o f personnel d ir e c to r s , t h i s r e s u lt is b e s t accomplished through a c l e a r l y d efin ed a d m in is tra tiv e a t t i t u d e , given f u l l ex p ressio n in a w e llrounded perso n n el p o lic y , and dem onstrating the s in c e r ity of th a t p o lic y th rough a s c i e n t i f i c a l l y determ ined program of a c tio n .* A Changed A ttitu d e and Approach A h o s p ita l can be no more e f f e c tiv e than th e v is io n of i t s management, i t s a tte n d a n t exchequer and the s k i l l of i t s m edical s t a f f .

By the same

to k en , i t can be only a s e f f e c tiv e as the s e r v ic e , a b i l i t y and in te r e s t of i t s p e rso n n e l.

The f i r s t s te p in the development of a sound h o s p ita l p e r­

sonnel program, th e r e fo r e , i s a r e a liz a tio n of the need f o r a h ealth y a t t i t u d e , s tr a i g h t th in k in g a t th e to p .

That a t t i t u d e needs to be p re d i­

c a te d on an a p p re c ia tio n o f the s a n c tity o f human p e r s o n a lity and of manage­ m e n ts r e s p o n s ib ility in a democracy f o r s e le c tin g , tr a in in g and rew arding employees so as to provide f o r th e most f r u i t f u l development of t h e ir p o te n tia litie s .

To have meaning, th is a t t i t u d e may w ell fin d expression

in a statem en t o f th e o b jec tiv es of the h o s p ita l, which may be a rriv e d a t thro u g h an honest attem p t to answer the fo llo w in g q u e stio n s:#

* See: A sso ciated I n d u s trie s o f M assachusetts, Fundamentals of BnployerEmployee B e la tio n s , In d u stry . 1937. (This i s one o f the most concise and d ir e c t statem en ts of a w idely accepted b a s ic approach which has come to the w r i te r 18 a t t e n ti o n .) # This approach was o r ig in a lly suggested by Dr. Henry C. M etcalf, in the Report o f th e Committee on V ocational Guidance—o f which he was Chairman—to the N atio n a l A sso c ia tio n of C orporation Schools a t t h e i r F ourth Annual Conven­ t i o n , in Ju n e, 1916. I t has been developed in h is l a t e r w ritin g s , and ac­ cep ted by many o rg an iz atio n s in t h e i r development of personnel programs. The answers here given a re adapted from Employer-Employee R e la tio n s, Vo. I , No.7 , (O ctober 15, 1934), issu e d by the Bureau of P ersonnel A d m in istratio n .

16

1, What should th e tr u s te e s and a d m in istra tio n s tr i v e f o r through the work re la tio n s ? The a d m in is tra tio n should s tr iv e fo r a h e a lth y , com petent, co n ten ted , lo y a l body of w orkers, who w ill prove them selves an in v alu ab le a s s e t to th e h o s p ita l a d m in is tra to r, as w ell as to the medical and n u rsin g s t a f f , in perform ing most e f f e c tiv e ly the fu n ctio n s of the h o s p ita l. This can b e s t be accomplished by a t t r a c t in g and b u ild in g up th e most d e s ira b le a p p lic a n ts f o r the p o s itio n s ; by employing the b e s t methods of s e le c tin g , p la c in g and p ro te c tin g employees, and of in s tr u c tin g , tr a in in g and r e ta in in g them through f a i r treatm ent and prom otion, Quoting from James A. B o w i e “The id e a l is th a t the purpose of the whole should be r e f le c te d in th e purpose of each so th a t a l l be lin e d up to p u ll in the same s tr a ig h t li n e . The only way of in s u rin g th a t the b e s t i n t e r e s t of the whole business should take precedence over th e d iv is io n a l i n t e r e s t s o f i t s p a r ts is by re p la c in g a r b i tr a r y power w ith th e group power o f c o lle c tiv e in te llig e n c e ," 2 , What should the employee s tr iv e f o r in and through the work re la tio n s ? In a democracy ev ery employee has a r ig h t to expect and should be given th e o p p o rtu n ity to r e a liz e the f u l l e s t development of h is in d iv id u a l c a p a c itie s . This organic conception of the In d iv id u al in h is work r e ­ la tio n s re a liz e d in p ra c tic e w ill p ro te c t h is fundamental l i f e in t e r e s ts —p h y s ic a l, m ental and s p i r i t u a l in te g r ity ; j u s t i c e ; adequate compensa­ tio n ; ste a d y employment; freedom of o ccupational ch o ice; education and tr a in in g ; o p p o rtu n ity f o r promotion; re c re a tio n ; and freedom of a s s o c i­ a tio n . In r e tu rn f o r the o p p o rtu n ity to s a tis f y th ese j u s t human needs, the employee should p u t f o r th honest e f f o r t in the i n te r e s t of h is employer, c o n tr ib u tin g th e g r e a te s t p o s sib le amount and q u a lity o f s e rv ic e , toward high morale and s p i r i t of cooperation in the e n tir e s t a f f , 3,

What have th e p a tie n ts and the community a r ig h t to expect as a r e s u lt of the j o i n t e f f o r t s of the h o s p ita l a d m in istra to r and h is s ta f f ? The community has the r ig h t to expect and w ill in c re a s in g ly demand from employers and workers to g e th e r—whatever the type of o rg a n iz a tio n and working u n i t —th e f u l l e s t co nservation of our n a tu ra l and human resources and, above a l l , a chance to make p e rs o n a lity count. S p e c if ic a lly , th e community and p a tie n ts have a r ig h t to expect the b e s t q u a lity and q u a n tity of care and s e rv ic e which e f f ic i e n t management, a competent m edical s t a f f , and a c a r e f u lly se le c te d and tra in e d s e rv ic e s t a f f can j o i n t l y re n d e r. An a n a ly s is o f p a t i e n t s ’ re a c tio n s to t h e i r h o s p ita l experience in the

l i g h t o f t h e i r ex p ec tatio n s ^s included a t the c lo se of t h i s c h a p te r, and a

1 , Education f o r B usiness Management.

17

d isc u s s io n of tr u s te e and a d m in is tra to r a tti tu d e and fu n c tio n s w ill be found in Chapter I I . Every a d m in is tra to r a p p re c ia te s th a t c e r ta in fundamental p rin c ip le s gov­ e rn h is job fu n c tio n s .

His aim i s to c a rry out h is d u tie s as e f f e c tiv e ly as

p o s s ib le w ith in a given s e t of f in a n c ia l, s o c ia l and p ro fe s sio n a l c o n d itio n s. Follow ing an ev e n in g 's d is c u s s io n , a group of Few York and Few J e rs e y h o s p ita l a d m in is tra to rs agreed g e n e ra lly upon the problem of personnel p o lic y develop­ ment as s e t f o r th in t h i s c h a p te r and named the fo llo w in g a d m in istra tiv e id e a ls as w orth s tr i v i n g f o r in the estab lish m en t of a personnel and p u b lic r e la tio n s program: 1 . The prim ary o b je c tiv e i s to provide s e rv ic e s of such q u a lity and q u a n tity as w ill be most h e lp fu l to the community. 2. In p ro v id in g such s e rv ic e s , no p o lic y should be pursued th a t might be d e trim e n ta l to p a tie n ts , em ployees, su p p o rte rs, or tie community. 3. Wages, hours and working c o n d itio n s f o r a l l grades of workers should com­ pare fav o rab ly w ith the b e s t com petitive c o n d itio n s , in o rd er to keep an e f f i c i e n t work fo rc e , of high morale and avoid expensive tu rn o v er. 4. Adequate s e c u rity should be provided a g a in s t the hazards of unemployment, i l l n e s s , a cc id e n t and old ag e, 5. In so fa r as p o s s ib le , o p p o rtu n ity should be given f o r in d iv id u a l s a t i s f a c ­ tio n in a jo b , through S c ie n tif ic s e le c tio n and placem ent, tr a in in g , advancement and j u s t rew ard. P ersonnel P o lic y F orm ulation. Transm ission and Execution The second m ajor s te p i s to convey th is a t t i t u d e —th ese o b je c tiv e s — c o r r e c tly to departm ent heads and su p erv iso rs so th a t i t w ill be made known and f e l t through the e n tir e personnel s tr u c tu r e .

This c a l l s f o r the b u ild ­

ing o f an e f fe c tiv e h o s p ita l personnel p o lic y , i . e . . a plan d e fin in g the o b je c tiv e s of th e h o s p ita l and governing the methods of e f f e c tin g them. Such a p o lic y , c le a r ly expressed in w ritin g , should cover a l l employee r e la tio n s problems and f a c t o r s .

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In in d u stry and b u s in e s s , th e p ra c tic e of w ritte n company p o lic ie s , which has been in c re a sin g in re c e n t y e a rs, goes back a t l e a s t to 1919, when th e American l o l l i n g M ill Company form ulated, p rin te d and d is tr ib u te d to i t s employees a b o o k let e n t i t l e d "A1MC0 P o lic ie s ,"

R eplies to in q u irie s in d i­

c a te th a t today w r itte n p o lic ie s of some s o rt are f a i r l y gen eral among the la r g e r b u sin ess and in d u s tr ia l concerns. P o lic y Form ulation I t must be ad m itted t h a t , f o r the most p a r t, purpose and o b je c tiv e s , i f in cluded a t a l l , a re passed over r a th e r p e r fu n c to r ily in th ese documents. And, r a th e r than g u id in g p r in c ip le s f o r a c tio n , the " p o lic ie s " become a c tu a l working ru le s and p ro ced u res.

B ut, lo g ic a lly and c h ro n o lo g ic a lly , p o lic y

fo rm u latio n must be p r io r to program fo rm u latio n , the l a t t e r term being a p p lie d to th e p lan of a c tio n intended to be follow ed in c a rry in g out a given p o lic y . One Company's experience in " E sta b lish in g W ritten Employee P o lic ie s" i s sim ply to ld by i t s P ersonnel O ffic e r, Edward H. Hay.*

He w rite s :

E xecutives and su p e rv iso rs lik e d the idea of having d e f in ite p o lic ie s to cover employee problems and a ls o the p r in c ip le of c o n s is te n t a c tio n in a l l employee m a tte rs . G radually, however, i t was apparent they had a g re a t many q u estions to a sk about the v ario u s p o l ic ie s . Some o f th ese were qu estio n s o f in te r p r e ta tio n ; o th e rs were qu eries on m atters which had not as y et b e e n .re g u la te d by w ritte n p o lic y . Fur­ therm ore, sin ce most of th e su p e rv iso rs had not p a r tic ip a te d in the fo rm u latio n o f p o l i c i e s , th e re was a c e r ta in amount of d is s a t is f a c ­ tio n w ith some d e t a i l s . This s itu a tio n le d to th e su g g estio n th a t p o lic ie s be gone over in d e t a i l and re iss u e d to the su p e rv iso rs and e x ecu tiv es, and th a t , b efo re t h i s was done, a s e r ie s of d iscu ssio n s be held w ith a group o f key ju n io r e x e c u tiv e s. I t was argued th a t these were the men most concerned w ith the d a ily a p p lic a tio n and in te r p r e ta tio n of employee p o lic ie s and th a t th e re fo re t h e i r o p in io n s, being c lo s e r to the point of a p p lic a tio n , would be v a lu a b le to the O perating Committee in the f i n a l d eterm in atio n of th e p o lic y . This suggestion appealed to the Committee and ac co rd in g ly th e p re sid e n t arranged f o r such d iscu ssio n m eeting ask in g th a t su g g estio n s ma.de by th e ju n io r ex ecutives be brought back to th e O perating Committee, 1 . P ersonnel (September, 1941),

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These p o lic y d isc u ssio n s by ju n io r execu tiv es were a g re a t su ccess. Fourteen of th ese men met f o r fo u r o n e-an d -a-h alf-h o u r s e s s io n s . T h e ir enthusiasm and t h e i r g r a tif ic a tio n a t being c o n su lte d were e v id e n t. Every s in g le in d iv id u a l took p a r t in the d is c u s s io n . The T reasu rer of an o th er company w ith c a r e f u lly worked out p o lic ie s w rite s . . . our employees' b o o k lets have been prepared by the foremen and th e employees. This simple procedure makes the books much more a cc ep tab le and e f f e c t i v e . . . There are of course a l o t of d e ta i ls involved in th e p re p a ra tio n of the b o o k le t. A fte r a l l , i t is not the e a s ie s t m atte r to organize the l i t e r a r y e f f o r t of 150 foremen, b u t we d id i t . The f i r s t paragraph of "The Company's Statem ent of Hew P o lic y " of the Rocky Mountain Fuel Company^ re a d s: The p o lic y of the company w ill be based on the f a c t th a t the men employed are as much an e s s e n tia l f a c to r in the in d u stry as the c a p i ta l in v ested in i t , and have independent r ig h ts in th e d e te r­ m ination of working and liv in g c o n d itio n s. Ahd the fo llo w in g paragraph introduces the "Employee R e la tio n sh ip Policy"® of one of our g re a t p u b lic c o rp o ra tio n s—the Tennessee V alley A u th o rity —which i s , perhaps, one of the most e f f e c tiv e , in statem ent and o p e ra tio n , thus f a r produced: The Employee R elatio n sh ip P o lic y as adopted by the Board and pub­ lis h e d herew ith is the r e s u lt of long study and d isc u ssio n in which b o th employees and management p a r tic ip a te d . In a r e a l sense the P o lic y is a product of co operative and c o lle c tiv e e f f o r t and sugges­ tio n . The s e r ie s of conferences conducted p r io r to fo rm u latio n of th e f i n a l d r a f t e n lis te d the suggestions and c r itic is m s from a larg e number of employees, in d iv id u a lly and through t h e i r d u ly a u th o riz ed re p re s e n ta tiv e s . This is e s s e n tia lly a p o lic y of the Board of D ire c to rs . The Board, however, takes p leasu re in the f a c t th a t the P o lic y was drawn in i t s f in a l form a f t e r c o lle c tiv e conference and u n d erstan d in g . As th ese and o th e r w ritte n company p o lic ie s and s tu d ie s th e re o f p o in t o u t, p o lic y d eterm in atio n is not an ex clu siv e fu n c tio n of any p a r tic u la r

1. l e t t e r receiv ed in re p ly to in q u iry addressed to s e v e ra l s e le c te d companies. 2 . Mary Van K leeck, Miners and Management. 3 . See B iblio g rap h y .

20

in d iv id u a l o r group w ith in an o rg a n iz a tio n ; r a th e r everyone, in c lu d in g the ran k and f i l e w orkers, has a p a r t in p o lic y form ation and ex ecu tio n .

The

"broad g en eral p o lic ie s o f an o rg an iz a tio n are based upon f a c ts and judgments c o n trib u te d by those in the lower ranks as w ell as those in executive p o s i­ tio n s ,

P o lic ie s thus become a summation of judgments from the bottom up and

from th e to p down.

Every s p e c if ic a c t m odifies e x is tin g p o lic ie s or re v e a ls

the need f o r new ones.

A fte r due weight has been given to the f a c t th a t a

la rg e number of in d iv id u a ls are concerned in the development of a p o lic y , i t must be borne in mind th a t g e n e ra lly the f i n a l d e c is io n reg ard in g a p o lic y i s th e r e s p o n s ib ility of one in d iv id u a l (th e a d m in is tra to r in executing the p o lic ie s determ ined by the t r u s t e e s ) , though h is d e c isio n may b u t express the composite judgment of th e group. The f a c ts to be taken in to c o n sid e ra tio n in policy-m aking should include not only such as a re su b je c t to measurement, b u t a ls o opinions and a t t itu d e s of in d iv id u a ls and groups b o th w ith in and w ithout the o rg a n iz a tio n . B r ie f ly , th en , the b a s ic c o n d itio n s of p o lic y making are found to be: ( l) a common u n d erstan d in g o f p o lic y o b je c tiv e s and purpose; (2) system atic re se a rc h to in d ic a te th e need f o r new o r m odified p o li c ie s , to avoid p o lic ie s b eing s e t t l e d too e a r ly o r too l a t e , and to p rev en t su p erflu o u s p o lic ie s and v a c i l l a t i o n ; (3) re c ip ro c a l in te r a c tin g and in te g r a tin g o f p o lic ie s through a sense of sh arin g in p o lic y p ro g re ss—a long-tim e view . The purpose of p o lic ie s may be summed up as follow s*: 1. To provide a common, c e n tr a l goal f o r h o s p ita l o p eratio n as a whole and f o r i t s v ario u s departm ents.

* Adapted from B usiness P o lic y and Humanism, B usiness Management S erv ic e , V ol. I , No. 3 (Ju n e, 1931), p .3 , issu ed by the Bureau of Personnel Adraini s t r a t i on.

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2 . To d efin e g en e ral p r in c ip le s to govern executive management in achieving th e se o b je c tiv e s . 3 . To serv e as th e main b a s is of c o o rd in a tio n . 4 . To provide stan d a rd s to guide executive a c tio n . 5 . To determ ine a method of m easuring executive achievem ent. P o lic y Transm ission and Execution P o lic y form ation is only the p relim in ary s te p .

As mentioned p re v io u sly ,

the fountainhead of a l l p o lic ie s is the d ir e c to r a te ; the e ffe c tiv e n e s s of ex ecu tio n l i e s in th e personnel i t s e l f .

Plans a re in e f fe c tu a l w ithout mutu­

a l l y sym pathetic u n d erstan d in g and co -o p erativ e endeavor on the p a r t of tr u s te e s and p erso n n el a l i k e . O rganization s tr u c tu r e i s s im ila r to body s tr u c tu r e .

Interdependent

p a r ts fu n c tio n through more o r le s s autom atic r e f le x mechanisms. o th e r a c t i v i t i e s c a l l f o r s p e c ific c e re b ra l c o n tr o l. tio n .

C ertain

So w ith the o rg an iza­

The h o s p ita l a d m in is tra to r, as the d ire c tin g ex ecu tiv e, i s "the locus

of in te llig e n c e " o f h is o rg a n iz a tio n .

T herefore, he sees M s h o s p ita l—and

h is h o s p i t a l 's place in th e community and in the s ta te and nation-w ide h o s p ita l program—as an organic whole. I t is noted in the v a rio u s in v e s tig a tio n s conducted th a t th ere is a d e f i n it e tren d f o r p u ttin g in to p ra c tic e w ith in organized personnel d e p a rt­ ments of h o s p ita ls p lan s which have long been accepted as necessary and p r a c tic e d in b u s in e s s .

Education and tr a in in g procedures can be made e f f e c ­

tiv e through the th re e successive s te p s : and e x ec u tio n .

p o lic y tran sm issio n ; in te r p r e ta tio n

In f a c t , th e need i s being recognized f o r p u ttin g in to p rac­

ti c e in h o s p ita l o rg a n iz a tio n and management terms wMch have now been accep ted as n ecessary and p r a c tic a l in in d u stry —coop eratio n , c o o rd in a tio n , in te g r a tio n .

C oordination—th e tran sm issio n and in te r p r e ta tio n of p o lic ie s

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a t and between each a d m in istra tiv e le v e l—i s b ein g considered as th e c h allen g ­ in g problem i t i s .

N a tu ra lly , the la r g e r and more complex th e i n s t i t u t i o n ,

and th e f a r t h e r removed to p a d m in istra tio n is from the rank and f i l e employ­ e e s , the g re a te r the need f o r sound c o o rd in a tio n .

I t c a l l s f o r education

in i t s f u l l e s t meaning, given ex p ressio n in a w ell-rounded education and tr a in in g program—th e h e a rt o f any sound employer-employee r e la tio n s pro­ gram, be i t in a s t e e l m ill, a departm ent s to r e , or the f i e l d o f our immedi­ a te i n t e r e s t —a h o s p ita l.

The kind of education em inently needed today i s

through th e conference method, which w ill e f f e c t the necessary c o o rd in a tio n . I t i s not expected th a t th e personnel conference program in h o s p ita ls g e n e ra lly could or should conform to the e la b o ra te and ex ten siv e se t-u p s in some la rg e -s c a le c o rp o ra tio n s .

But i t seems p e r tin e n t to o u tlin e b r ie f l y

th e procedure which has been e f f e c tiv e ly follow ed.* Such a conference program begins a t the to p , w ith the major ex ecu tiv es fu n c tio n in g as an Executive Personnel Advisory Board (the membership of which in clu d es the c h ie f executive and heads of major d ep artm en ts).

This

board devotes much thought to the fo rm u latio n , i n te r p r e ta tio n , execution and measurement of th e o v e r -a ll p o lic ie s of a w ell-rounded personnel pro­ gram.

In a h o s p ita l, such a board should co n sid e r the im portant q u estio n —

how i s h o s p ita l perso n n el p o lic y b e s t co o rd in ated a t each o p eratin g le v e l and tra n sm itte d from one le v e l to another? In t h i s procedure management has a tw o-fold o b je c tiv e : ( l ) o rg an izatio n —which provides thef personnel s tr u c tu r e f o r an interchange of ideas f o r the development of perso n n el p o lic ie s and p r a c tic e s , and (2) ed u catio n —v i t a l i z ­ in g th e o p eratio n of t h i s machinery so th a t th e re ^s a r e a l m eeting of minds,

*SeeJ H.C. M etcalf, Developing Leaders Through the Conference Method. S o cie ty f o r the Advancement of Management J o u rn a l, Vol. I I I . U o .l, (Jan u ary , 1938) p . 40.

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in te g r a tin g o f o b je c tiv e s and harm onizing of d e s ire s in advance of a c tio n , which may be unpo p u lar. An e f f e c tiv e p erso n n el p o lic y provides f o r h o riz o n ta l as w ell as v e r t ic a l c o o rd in a tio n .

To complete th is o rg a n iz a tio n a l s e t- u p 9 a s im ila r board or

committee fu n c tio n s a t each o p e ra tin g le v e l, ta k in g p a r t in re g u la r, w e llorganized and d ire c te d co n ferences, F in a lly , o p p o rtu n itie s a re given to rank and f i l e workers to be educated reg ard in g and to p a r t ic ip a te in the form ation of p o l ic ie s , plans and proced­ u re s which d i r e c t l y a f f e c t them.

The type of ed u catio n and tr a in in g program

which complements t h i s c o o rd in a tin g p o lic y is o u tlin e d in Chapter IX, There is n o th in g s t a r t l i n g in these recommendations.

A ll th a t is

suggested i s th a t h o s p ita ls attem p t to keep pace w ith the tim es in planning to a t t r a c t and r e t a i n s a ti s f a c t o r y personnel through an honest in te g ra tio n of a l l p o in ts of view .

As ex p ressed by Tead and M etcalf'1, t h i s is p re d ic a te d

upon the sound dem ocratic p r in c ip le th a t "every s p e c ia l group a ffe c te d by a p o lic y should be a p arty to i t s form ulation and adoption and to the ac c e p t­ ance o f the g e n e ra l methods of i t s ex ecu tio n ."

I t means "working w ith" not

"working f o r . " In o th e r words, any su c c e ssfu l h o s p ita l personnel p o lic y must be in harmony w ith th e working c o n d itio n s o f those i t i s designed to govern. While th e c h ie f r e s p o n s ib ility f o r determ ining personnel p o lic y c le a r ly r e s t s w ith th e h o s p ita l a d m in is tra tio n , in c re a s in g ly , i f we are to take our cue from th e most s u c c e ss fu l b u sin ess experience and keep in s te p w ith F ed eral and S ta te s o c ia l la b o r l e g i s l a t i o n , i t must become a problem of j o i n t a n a ly s is and d ete rm in a tio n .

1 . Ordway Tead and H.C. M etcalf, Personnel A d m in istratio n : I t s p r in c ip le s and P r a c tic e , p . 353.

24

In h o s p ita l as in b u sin e ss management, the fo llo w in g i s tru e :* The modern manager is not one who marches w ell in advance, expecting h is s t a f f to fo llo w , He i s not a policy-m aker or c o o rd in a to r merely in the sense of ty in g to g e th e r judgm ents, or in te r p r e tin g f a c t s a r ­ riv e d a t by independent u n its of h is s t a f f . The kind of management th a t must be in c re a sin g ly developed in the larg e u n its o f today is management according to fu n c tio n w ith a u th o r ity a l l alo n g the l i n e , in c o n tr a s t to management by th e f i a t of a c e n tr a l power. The aim should be to c o lle c t a band of c o lleag u es, not to i n s t i t u t e a h ie r ­ arch y of o f f i c i a l s . By t h i s survey of p o lic y d eterm in atio n in b u sin ess and e x p ressio n of th e need f o r i t s development in h o s p ita ls i t is not intended to convey the im pression th a t no thought has y e t been given to the problem, nor th a t the u ltim a te aim of h o s p ita ls s h a ll be to fu n c tio n to the synchronized mechan­ ism o f an assem bly b lo ck .

In re c e n t y e a rs, le a d e rs in the h o s p ita l f i e l d

have s tr e s s e d in c re a s in g ly the need and made concrete su g g estio n s f o r the development o f sound h o s p ita l personnel p o l ic ie s , a t th e conference ta b le , in the h o s p ita l jo u rn a ls , and from the convention p latfo rm . T h eir a t t i t u d e is in d ic a te d by the fo llo w in g q u o ta tio n s; The c lo se p erso n al co n ta ct between c h ie f executive and employee in th e sm a ller h o s p ita l is d isap p e arin g as h o s p ita ls become la r g e r and must e n te r in to more d ir e c t com petition w ith in d u s try to secure employees. Thus wages have r is e n and lik ew ise th e number of employees housed is d e c re a sin g , and those liv in g o u tsid e a re g e ttin g b ro ad er s o c ia l and economic c o n ta c ts . This lead s to demands th a t the h o s p ita l o f f e r the same advantages as are o ffe re d in in d u s try and commerce, B asic human needs a re th rees (1) Heed f o r sustenance and reasonable p h y sic a l s e c u rity ; (2) the need to be a person; (3) th e need to be s o c ia ll y in te g ra te d and to have reasonable s o c ia l s e c u r ity . The economic needs are paramount, b u t alone they are not enough. Each d e s ire s re c o g n itio n as an in d iv id u al and as a member of a s ta b le s o c ia l group. With th e in c re a se in education has come a demand f o r a f u l l e r l i f e , and w hile the economic f a c to rs are e a s ily recognized th e p erso n al

1, James A. Bowie, Education f o r B usiness Management

25

and s o c ia l elem ents are e a s i ly l o s t s ig h t o f, but a re n ecessary i f the employee is to he c o n te n t, and w ithout contentment h is u se fu ln e ss i s much decreased. Too l i t t l e a tte n tio n has been paid to sound o rg a n iz a tio n , to c le a r d e f in itio n of lin e s o f a u th o r ity and of r e s p o n s ib ility and to proper conduct and in te g ra tio n of th e numerous a c t i v i t i e s re c u ire d f o r e f ­ fe c tiv e s e rv ic e . I t is w ell to have a c h a rt showing the fu n c tio n s of each departm ent, which a c t i v i t i e s each perform s and how they are in te r r e la te d .■*■ We are in the m idst o f re v o lu tio n a ry changes in employer-employee r e la tio n s h ip s . For many y e a rs h o s p ita ls have f e l t them selves pro­ te c te d a g a in st the lab o r s t r i f e s common in in d u stry ; but now h o s p ita l employees a re becoming la b o r conscious and h o s p ita ls are fin d in g i n t e l l i g e n t o rg a n iz a tio n and s c i e n t i f i c d ir e c tio n of personnel of in c re a sin g im portance. I t i s th e re fo re o f im portance th a t the fundamentals of personnel r e la tio n s be analyzed. P ersonnel problems a r is e because we a re human b e in g s. Hence the approach must be la r g e ly on th e b a s is of th e psychological f a c to rs invo lv ed . In our community l i f e s o c ia l p re s tig e v a r ie s d ir e c tly w ith the s o c ia l ranking of the p o s itio n r a th e r than w ith the s a la r y re c e iv e d . There­ fo re workers a re more s e n s itiv e to changes in s t r a t a than to a d ju s t­ ments in s a la r y . This i s a f a c to r even more p o ten t in the lower than in the higher jo b s t r a t a . The p h ilo so p h ies of p erso nnel r e la tio n s may be typed by in d u s tr ie s . Each in d u stry has a p h ilo sophy p e c u lia r to i t s e l f . And i t is on an u n derstanding o f i t s own philosophy th a t th e h o s p ita l lik e any in ­ d u stry must base i t s p erso n n el p o lic y . There i s an a r t and a scien ce of handling personnel r e la tio n s and techniques but each a d m in istra to r must take the tim e and e f f o r t necessary to develop a p o lic y s u ita b le to h is own c o n d itio n s. This w ill take tim e, e f f o r t and money b u t th e r e s u lts w ill be worth i t . . . A c a r e f u lly co n sid ered statem en t of lab o r p o lic ie s should be prepared and explained—p re fe ra b ly in group conferences w ith encouragement of d isc u s s io n . The a d m in istra to r must be a le a d e r r a th e r than a d i c t a t o r , be w illin g to have a u th o r ity q u estio n ed, develop the sense of team work and not change employee r e la tio n s h ip s w ithout c a r e fu l study of t h e i r a t t i t u d e and re a c tio n s .

1.

A.C. Bachmeyer, An Approach to the Personnel Problem, Jo u rn a l of the American D ie te tic A sso c iatio n (J u ly , 1939).

26

These r e s u lts cannot be expected by any s e t plan or to r e s u lt au to ­ m a tic a lly ; th ey re q u ire c a r e fu l and serio u s study and planning and a w illin g n e ss and p atie n ce in readjustm ent as changing co n d itio n s may in d ic a te ,* G radually the o f fic e o f p erso n n el d ir e c to r is becoming recognized as n e ce ssa ry in th e la r g e r i n s t i t u t i o n s , and a s t a r t in the d ire c tio n of develop­ ing sound personnel p o lic ie s and techniques i s being made.

Leaders are ho

lo n g e r s a t i s f i e d w ith mere words. The P ersonnel R elatio n s Committee of the American H ospital A ssociation is now u n d ertak in g the d r a f tin g of a body of h o s p ita l p o lic ie s which may be used as a model by a d m in is tra to rs in developing s im ila r documents f o r t h e ir in d iv id u a l i n s t i t u t i o n s .

A b a s is th e re fo r is in a p relim in ary statem ent of

p erso n n el p o lic ie s and procedures which has re c e n tly been compiled a t the New Haven (C onnecticut) H o s p ita l,

This re p o rt s ta t e s :

"In our e f f o r t to

develop a personnel program f o r New Haven H o sp ital we have drawn h eav ily upon th e se e s ta b lis h e d p ra c tic e s (in in d u stry and business) and have tr ie d to adapt them so as to f i t the p e c u lia r requirem ents of the h o s p ita l f i e l d , " The fu n c tio n s of i t s P ersonnel Departm ent, as s e t f o r th in th a t document, are o u tlin e d in Chapter I I I , p u b lic R elatio n s P o licy In th e in d u s t r i a l f i e l d the f a c t i s b eing in c re a sin g ly recognized th a t a sound e x te rn a l p u b lic r e la tio n e p o lic y mast be p re d ic a te d upon sound i n t e r n a l p erso n n el r e la tio n s .* However, the a n a ly s is made of p a t i e n t s ' re a c tio n s to t h e i r h o s p ita l

1 . J .A . Hamilton, Ah Approach to th e H ospital Personnel Problem, H o s p ita ls , (A p ril, 1939), * See: B usiness Management S e rv ic e . Vol, I , No. 9 (December, 1931) issu ed by th e Bureau o f P ersonnel A dm inistration .

27

experience (see page 11) in d ic a te d an a l l but complete unawareness of the a d m in is tra tiv e and perso n n el problem u n d erly in g and complementing a c tu a l m edical and n u rsin g c a re .

While the r e s u lts of th e 400 r e p lie s analyzed

do n o t lend them selves to s t a t i s t i c a l ta b u la tio n , some s p e c if ic conclusions can be drawn, sin c e th e comments conformed g e n e ra lly to uniform p a tte r n s : 1 . By and la r g e , i t would seem th a t s o c ie ty th in k s of h o s p ita l p e r s o n a litie s only in terms of doctors and n u rse s . There were more comments concerning nurses than a l l o th ers combined. With the ex cep tio n o f a few comments reg ard in g d o c to rs, a l l s p e c ific remarks were confined to n u rse s . I f a g en eral re p ly was given i t to o k some such form as ’’nurses and everybody,” "nurses and h e lp ," "nurses and p e rso n n e l," "doctors and n u rse s ." 2 . In reg ard to departm ental fu n c tio n in g , food was most g e n e ra lly m entioned. In p o in t of frequency, i t was mentioned as o fte n as a l l o th e r s e rv ic e s combined. There were f a r more fav o rab le than u nfavorable comments, in the main d e a lin g w ith food s e le c tio n and p re p a ra tio n r a th e r than s e rv ic e . 3 . The m a jo rity o f un fav orable comments f e l l in to th re e main groups: (a) p revalence of n o ise , p a r tic u la r ly from rad io s and v i s i t o r s ; (b) la c k of s u f f ic ie n t n u rsin g personnel to give adequate s e rv ic e — which in many in sta n ce s was not n u rsin g s e rv ic e ; (c) q u estions con­ cern in g h o s p ita l p o lic y w ith re sp e c t to v i s i t o r s and v i s i t i n g hours. The l a t t e r were about e q u a lly d ivided between asking f o r a stro n g e r and f o r a le s s r ig id p o lic y in re sp e c t to v i s i t o r s , 4 . The rem aining c r itic is m s were s c a tte re d over the i n s t i t u t i o n gen­ e r a l l y , w ith a few is o la te d re fe re n c e s to la c k of o f fic e e f fic ie n c y , poor p h y sic a l maintenance and housekeeping, la c k of p riv a c y , and so on. The obvious o v e r f a ll co nclusion is th a t h o s p ita l p a t ie n ts , a t le a s t those who a re in te r e s te d in o f fe r in g comments, th in k of h o s p ita l personnel i n term s of those w ith whom th ey mos t fre q u e n tly come in c o n ta c t.

A pparently,

in the eyes of the p a tie n t, a l l o th e r h o s p ita l s e rv ic e s —the o f f ic e , the v a rio u s la b o r a to r ie s , the housekeeping and m aintenance departm ents—are tr a n s la te d in terms o f e ith e r the nurses them selves or s e rv ic e rendered to th e p a tie n t through th e medium or su p erv isio n of the n u rse. This in d ic a te s th a t, in the development of wholesome h o s p ita l p u b lic

28

r e l a t io n s , the p u b lic as w ell as the employee needs to be educated to the meaning of sound p erso n n el management, expressed in an e f f e c tiv e tr a in in g program designed t o : (1) arouse th e employee’ s i n te r e s t by se e in g and making f e l t h is p a r t in th e t o t a l p i c t u r e , and (2) give th e p a tie n t some a p p re c ia ­ tio n o f th e ro le p layed by th e n o n -p ro fe ssio n a l employee. The importance of th i s a s p e c t of h o s p ita l p o lic y i s co nvincingly s e t f o r t h by W illiam V. M orgenstern:^ P u blic r e la tio n s has been d efin ed as "the management of a tti tu d e s e x te rn a l to an e n te r p r is e ." These " a ttitu d e s e x te rn a l to an e n te rp ris e " a re what people g e n e ra lly b e lie v e about an org an iza­ tio n , whether i t be U nited S ta te s S te e l or the lo c a l h o s p ita l. The e x te n t o f the i n t e r e s t in the question of p u b lic r e la tio n s i s new, though th e p r a c tic e is n o t. Hone can g ain say th e f in e s p i r i t and s e rv ic e which tr u s te e s and admin­ i s t r a t o r s a lik e have rendered over th e years in the i n t e r e s t of our s o c ia l in s titu tio n s . w ith in .

A ll recognize th e im p ellin g s o c ia l fo rc e s from w ithout and

A u th o r itie s , however, have perhaps been a t f a u l t in the p a st in

excusing some i n e f f i c i e n t management because of the c h a r ita b le concepts of h o s p ita l work.

S o iled lin e n , i n e f f i c i e n t employees and haphazard s e rv ic e

cannot be excused by the p re c e p ts of h o s p ita l management. In the a r t i c l e j u s t quoted, Mr. M orgenstern makes i t c le a r th a t sound p u b lic r e la tio n s , th e confidence of the p a tie n t and the approval of the community can be gained only by ad ap tin g a d m in is tra tio n p o lic ie s to the s o c ia l w ill o f the tim e.

We a re reminded th a t the c o s t may be heavy, b u t

th a t , f o r th e long ru n , no way has been devised to avoid paying i t .

We

must be reco n c iled to th e f a c t t h a t we have b efo re us a c h a lle n g in g problem in ad ju stm en t, which w ill n o t be e ffe c te d w ithout much tho u g h t, w ill and e ffo rt.

1 . B asic P rin c ip le of P u b lic R e la tio n s , H o s p ita ls , (June, 1939).

29

C o n c lu sio n .-- This c h a p te r p o in ts out the th re e fundam entals of sound employer-employee r e l a t io n s — (1) a c le a r ly d efin ed h o s p ita l a d m in istra tiv e a t t i t u d e , expressed in a statem ent of h o s p ita l o b je c tiv e s ; (2) a w e llrounded personnel p o lic y ; and (3) a s c i e n t i f i c a l l y determ ined program of a c tio n .

C losely a l l i e d to and dependent upon an organic in te r n a l personnel

program is a sound e x te rn a l p u b lic r e la tio n s p o lic y and program.

The f i r s t

two fundam entals—a t t i t u d e and p o lic y b u ild in g —a re d iscu ssed in t h is chap­ te r,

The p a r t ic u la r d u tie s and r e s p o n s ib ilitie s of the tr u s te e s and ad­

m in is tr a to r in personnel p o lic y development are elab o rated in the next c h a p te r, w hile Chapter I I I d e t a i l s the th ir d fundam ental— the dem onstration of th e new a d m in istra tiv e a t t i t u d e and personnel p o lic y through the techniques o f a w ell-developed program of a c tio n .

CHAPTER I I NEW RESPONSIBILITIES AND DUTIES OP HOSPITAL TRUSTEES AND ADMINISTRATORS

An in d ic a tio n o f th e r o le o f h o s p ita l tr u s te e and a d m in is tra to r in th e development o f sound personnel p o lic y , e ffe c tu a te d by education and tr a in in g , was g iv en in Chapter I .

So im portant is th i s r o le to d ay , in th e opinion of

many h o s p ita l le a d e rs them selves, th a t th i s ch ap ter is devoted to a f u l l e r p re s e n ta tio n th e re o f. As a r e s u l t of th e tre n d s and in flu en ces which a re fo rc in g a c o n sid e ra­ tio n o f th e human f a c to r as a prim ary problem, d u rin g re c e n t years th e re has been a marked a g ita tio n fo r and tre n d toward th e r e c o n s titu tio n and r e v i t a l ­ iz in g o f c o rp o ra tio n d ir e c to r a te s .

Government re g u la to ry measures have

a c c e le ra te d th e re c o g n itio n on th e p a r t of co rp o ratio n s o f t h e i r s o c ia l r e s p o n s i b il i t i e s — a r e a l i z a tio n th a t t h e i r o b lig a tio n s go beyond t h e i r sto c k h o ld e rs, and th e p r o f i t s due them, to in clu d e th e men whom they employ and th e p u b lic which they s e rv e .

For example, one o f th e la rg e Western

r a ilr o a d s reo rg an ized i t s board so th a t i t would be more re p re s e n ta tiv e of th e t e r r i t o r y i t covered.

Two New York co rp o ra tio n s have each added a prom­

in e n t educator to t h e i r b o ard s.

Other co rp o ratio n s have put t h e i r d ire c to rs

on an annual s a la r y . A re ce n t study of " P re v a ilin g P ra c tic e s Regarding C orporation D ir e c to rs ," ! based upon an a n a ly s is o f c o n fid e n tia l inform ation fu rn ish ed by 367 m anufactur­ ing and 148 non-m anufacturing companies, reached th e fo llo w in g conclusions:

1. N atio n al I n d u s tr ia l Conference Board, S tu d ies in A d m in istrativ e C o n tro l. No. 2 (September, 1939) 30

31

In th e l a s t a n a ly s is , good d ir e c tio n depends on c h a r a c te r , a b i l i t y and co n sc ie n tio u s e f f o r t o f th e in d iv id u a l d ir e c to r , r a th e r than upon th e mere c r e a tio n o f a group of 'p ro fe ss io n a l* d i r e c t o r s . . . Many companies a p p a re n tly f e e l th a t th e prime need of co rp o rate boards today is f o r a b le r men, r a th e r than f o r b a s ic s tr u c tu r a l changes. Evidence o f th e in c re a sin g s o c ia l consciousness o f management was in d ic a te d by th e co n sid e rab le number of ex ecu tiv es who b e liev ed th a t d ir e c to r s (as a u n it) were not only in f id u c ia ry r e ­ la tio n s h ip to s h a re h o ld e rs, b u t a lso were re sp o n sib le to th e p u b lic and to the employee. The Role of the H o sp ita l T ru stee This awakening o f s o c ia l consciousness h a s, by no means, been lim ite d to c o rp o ra te d ir e c to r a te s .

I t has s tru c k w ith equal fo rc e th o se persons

charged w ith th e r e s p o n s ib ility o f m ain tain in g v i t a l community s e rv ic e .

A

fa r-re a c h in g attem pt is being made to remedy th e e v ils wrought by o v ers p e c ia liz a tio n and c an a lize d th in k in g , through an in c re a sin g number of in ­ s t i t u t e s and co n feren ces, aim ing a t e v a lu a tio n , ed u catio n , co o p eratio n and c o o rd in a tio n , in and among a l l s e c to rs o f s o c ie ty —b u sin ess and i n d u s tr ia l , ed u catio n , sc ie n c e , th e Church, h o s p ita ls and o th e r s o c ia l w e lfa re o rg a n i­ z a tio n s .

C e rta in ly what a p p lie s in p r in c ip le and p r a c tic e to th e sto ck

c o n tro lle d c o rp o ra tio n a p p lie s even more to th e v o lu n ta ry c o rp o ra tio n , because o f i t s p u b lic and m oral t r u s t ; and th e tre n d h a s, in f a c t , advanced m arkedly in h o s p ita l a d m in is tra tio n , c h ie f ly through th e e f f o r ts of the t r u s t e e S ectio n of th e American H o sp ita l A sso c ia tio n . In an attem pt to g et f ir s t- h a n d inform ation on th e a t t i t u d e of h o s p ita l tr u s te e s toward th e perso n n el problem, the w r ite r c a lle d a conference of a group o f re p re s e n ta tiv e New J e rs e y h o s p ita l p r e s id e n ts .

There was g en eral

agreement on th e p a rt o f th e tr u s te e s p re se n t reg ard in g the v i t a l importance o f th e h o s p ita l personnel problem , and evidence of a r e a l d e s ir e to h elp d is ­ cover and e f f e c t ways and means o f developing a sound h o s p ita l education and tr a in in g program.

32 I t was g e n e ra lly f e l t , however, th a t i t is d i f f i c u l t to compare th e h o s p ita l tr u s t e e and th e c o rp o ra tio n d ir e c to r b ecau se, w ithout th e p r o f it m otive to h old them in l i n e , h o s p ita ls and h o s p ita l a d m in istra tio n have "grown up l i k e Topsy"—from a sm a ll, p e rso n a lly managed and c o n tro lle d p h ila n th ro p y to a la r g e i n s t i t u t i o p —w ith o u t th e in je c tio n o f sound b u s i­ n ess perso n n el p r in c ip le s .

The h o s p ita l tr u s te e is appointed w ith l i t t l e

in v e s tig a tio n as to h is f it n e s s f o r th e p o s itio n , and he resig n s a t w i l l . The concluding exp ressio ns of th e group were to th i s e f f e c t: We came to g e th e r to co n sid e r th e need f o r tr a in in g h o s p ita l la y p e rso n n e l. I th in k we must come to th e conclusion th a t our prob­ lem goes deeper and h ig h e r—th a t we need f i r s t to consider educa­ tio n and tr a in in g fo r th e t r u s te e s . We d e f i n it e l y need to s e t s ta n d a rd s , by which we can measure v a lu e s—th e valu e of a tr u s te e , of a su p e rin te n d e n t, of a pur­ chasing a g e n t, o f a c o m p tro lle r, o f th e bookkeeping s t a f f , o f th e housekeeping s t a f f , o f the d ie ta r y s t a f f , o f the sup erin ten d en t of n u rses and tr a in in g school s t a f f . We need to a s c e r ta in how th is can be accom plished and how employees can be tra in e d to make them f i t in to a smoothly fu n c tio n in g o rg a n iz a tio n . The fo llo w in g were in d ic a te d as d e s ir a b le reasons fo r th e s e le c tio n of an in d iv id u a l to membership on a board o f tr u s te e s : 1. 2. 3. 4. 5. 6. 7. 8.

Sound o rg a n iz a tio n and executive judgment. Knowledge o f te c h n ic a l d e t a i l s of h o s p ita l. R epresents im portant community i n t e r e s t s —banks, fin a n c e , b u sin e ss. F in a n c ia l co u n sel. Legal co u n sel. Knowledge of personnel a d m in is tra tio n . R epresents sources o f s p e c ia l g i f t s , endowments, e tc . R epresents a l l i e d commercial o r p ro fe s s io n a l in te re s ts .—equipment, a p p a ra tu s, en terta in m e n t. 9. R e tire d and in te r e s te d in h o s p ita l s e rv ic e .

Regarding th e m ajor o b je c tiv e o f a h o s p ita l board of tr u s te e s , th e re was no q u e stio n in anyone's mind—i t is to d ir e c t th e a c t i v i t i e s of th e h o s p ita l in such a way as to a s su re t h e i r maximum c o n trib u tio n to the h e a lth of th e community. Toward th e accomplishment of th is o b je c tiv e the T ru stee S ectio n of

33

th e American H o sp ital A sso c ia tio n , in 1924, s ta te d th e fu n c tio n s and r e ­ s p o n s i b i l i t ie s o f h o s p ita l tru s te e s as fo llo w s:* 1. To determ ine th e p o lic y of th e i n s t i t u t i o n w ith r e l a tio n to th e community needs. 2. To see th a t proper p ro fe s sio n a l standards a re m aintained in th e c are o f th e s ic k . 3. To d ir e c t th e a d m in is tra tiv e personnel o f th e h o s p ita l in o rd er to c a rry out th e above p o lic y . 4 . To provide adequate fin a n cin g by sec u rin g a s u f f ic ie n t income and by en fo rcin g b u s in e s s -lik e c o n tro l o f e x p en d itu res. 5. To c o o rd in a te th e p ro fe s sio n a l in te r e s ts o f th e h o s p ita l w ith a d m in is tra tiv e , f in a n c ia l and community needs. D uring th e p a s t two decades many in flu en c es from w ithout have a ffe c te d h o s p ita l a d m in is tra tio n .

Of prime im portance is th e new le g i s l a t i o n con­

cern in g th e c a re o f : (l) cases coming under th e purview o f th e compensation and autom obile l i e n a c ts and (2) s u b sc rib e rs to a s s o c ia te d h o s p ita l in s u r­ ance p la n ts . Because o f th e new F ed eral and s t a t e law s, and th e fu rth e ra n c e of community h e a lth by many p ro g ressiv e a g e n c ie s, in clu d in g in d u s tr ia l h e a lth a c t i v i t i e s , and now th e a c c e le ra tin g needs of w ar, h o s p ita l tr u s te e s a r e fa c in g th e in flu e n c e of new, com pelling s o c ia l fo rc e s which, taken to g e th e r, a re p la c in g upon than new d u tie s and w ider o p p o rtu n itie s fo r s o c ia l s e rv ic e . In o rd er to a p p re c ia te th e new demands upon h o s p ita l t r u s t e e s , i t should be borne in mind th a t th e keynote of th e modern h o s p ita l and o f modern m edicine i s , as in o th e r major l i f e i n s t i t u t i o n s , co o p e ra tio n .

Anything th a t th r e a t­

ens l i f e or h e a lth i s th e concern of th e modem h o s p ita l, and th a t which concerns th e h o s p ita l concerns th e tr u s te e .

The p o in t h ere is th a t th e

modem h o s p ita l means more than the p ro v isio n of a bed f o r a p a tie n t w ith a c u te a p p e n d ic itis , and tru s te e s h ip means more than a p assin g c u r io s ity about t r i f l i n g management d e t a i l s .

* As quoted by John A. McNamara, What the H o sp ital T ru ste e Should know. P .27.

34

No one group occupies q u ite th e s tr a t e g ic p o s itio n and c a r r ie s such c r u c ia l r e s p o n s i b i l i t i e s , d u tie s and power as th e top a d m in is tra to rs — th e board of t r u s t e e s .

They a r e th e source of f in a l a u th o r ity in the

i n s t i t u t i o n a l perso n n el h ie ra rc h y , where l e g i s l a t i v e fu n c tio n s , adm inis­ t r a t i v e perform ance, and j u d i c i a l d e c isio n s a r e made.

Q uestions of

p h y sic a l expansion, fin a n c e , p urchasing, budget making, s e le c tio n of p ro fe s s io n a l s t a f f , managing executives and key departm ent w orkers— in f a c t a l l q u estio n s of major im portance—f i n a l l y r e s t w ith D ire c to rs , C onsidering th a t more than h a lf th e h o s p ita l budget is assig n ed to th e p a y ro ll i t is no wonder th a t personnel problems have fo rced them selves to th e f o re . Much thought ha6 been given to th is problem, as evidenced by th e fo llo w ing q u o ta tio n s from h o s p ita l a u th o r itie s s e le c te d from th e many a r t i c l e s which appear each month in h o s p ita l jo u rn a ls : I f we need s tr a ig h t th in k e rs anywhere, i t is upon th e boards o f such s o c ia l w e lfa re o rg an iz a tio n s as h o s p ita ls , where th e tr u s te e must co n sid e r m a tte rs n o t only in th e l i g h t of b u s i­ ness but in term s o f human v a l u e s ... Having s e le c te d our model t r u s t e e , l e t us not fo rg e t th a t each new member needs to be educated in th e h is to r y , th e id e a ls , th e tr a d itio n s and th e aims o f th e o rg a n iz a tio n .*

The tim e has a r riv e d when th e tr u s te e must be cognizant of the f a c t th a t th e h o s p ita l plays a most im portant p a rt in th e remak­ ing o f our s o c ia l o rd e r. The more abundant l i f e does n o t mean th a t in creased w ealth o r earn in g power w il l produce th e compo­ nent elem ent. I t r a th e r means th a t th o se who a re so g lib ly re fe r r e d to as th e u n d e r-p riv ile g e d w i l l , in some way and by some means, be accorded th o se p riv ile g e s w hich, in the new scheme o f th in g s , w i l l be t h e i r d u e ...

1. C.W. Munger, What a re th e Q u a lific a tio n s f o r T ru steesh ip ? The Modern H o s p ita l (May, 1 9 3 3 ).

35

Hers th e n , is th e f i r s t duty of th e tr u s te e . Not to s tr i v e s o le ly f o r th e i n s t i t u t i o n o f which he is a tr u s te e , hut to stu d y th e h o s p ita l problem from i t s s o c ia l s id e and to become a c tiv e in h is thoughts and endeavors in o rd e r to cooperate in every way p o s sib le to th e end th a t h o s p ita ls , in d iv id u a lly and c o lle c tiv e ly , may serv e t h e i r purpose w ell in th is new scheme of th in g s .^ D r. Joseph C. Doane has d ra fte d a "Decalog fo r th e Board o f Trus­ t e e s , "2 which is w e ll w orth heeding.

He concludes:

G en erally , th e commonest m istake in a d m in istra tiv e work is to con­ found p r in c ip le s and p e r s o n a liti e s . I t is not urged th a t th e Tamtw s id e o f h o s p ita l a d m in is tra tio n be overlooked and th a t each u n it be co n sid ered as a mere cold and u n fe e lin g automaton. On th e other hand, human lik e s and d i s l i k e s , i f p erm itted f r e e re ig n , a re common d e s tro y e rs o f e f fic ie n c y . One p ro g re ssiv e s te p is an annual conference of H o sp ital T ru ste e s, sponsored by th e U n iv e rs ity of Chicago and th e K ellogg Foundation.

The

le c tu r e s and ro u n d ta b le d is c u s s io n s —conducted by o u tstan d in g le a d e rs in th e h o s p ita l and m edical f i e l d —and th e f ie l d t r i p s to h o s p ita ls a re in ­ tended to g iv e th e h o s p ita l tr u s t e e a b e tt e r understanding o f th e gen eral p r in c ip le s involved in th e s o lu tio n of tr u s te e problems.

The program of

th e Second C onference, h eld June 12x14, 1941, a t Judson C ourt, U n iv e rsity of Chicago, i s included in th e Appendix as an example o f the edu catio n al a c t i v i t y which is being c a r rie d on in th e executive a re a of h o s p ita l ad­ m in is tr a tio n .

(See E x h ib it B.)

D r. C. Rufus Borem, an a u th o r ity on h o s p ita l and m edical economics, i n h is paper read b efo re th e conference, s ta te d : H o s p ita lis a tio n is a b ig b u s in e s s , but not of th e ordinary k in d . I t i s e s s e n tia lly a p u b lic s e rv ic e , financed by th e gen eral pop­ u la tio n e ith e r through t h e i r v o lu n tary a c t i v i t i e s or through

1 H.L. E ise n , S e c re ta ry , Mount S in a i H o sp ita l, Milwaukee, W isconsin. A T r u s te e 's Role in His H o s p ita l's P lace in th e Community. H o sp ital Management. (June, 1936). 2 Ten Commandments f o r T ru s te e s,

The Modern H o s p ita l. (November, 1940)

36 t a x a t io n . The h o s p ita l is a t once a h o t e l , a home, an e d u c a tio n a l i n s t i t u t i o n , and a p la c e o f b u s in e s s , i t p ro v id e s m e d ic a l c a re , n u rs in g , and board and room s e r v ic e t o customers who a re s ic k in body and m ind, and each o f whom fa c es an e m o tio n a l c r is e s ; th e p o s s i b i l i t y o f d e a th and th e p r o b a b i li t y o f a la r g e economic ex­ p e n d itu re w h ich must be met by him o r somebody e ls e .

' The people own th e h o s p ita ls , th e people u s e th e h o s p ita ls , and th e people must support th e h o s p ita ls . A growing tre n d in America is th e re c o g n itio n o f th e h o s p ita l as a p u b lic s e rv ic e i n s t i t u t i o n . Yet one must n o t make o f h o s p ita liz a tio n a mere ro u tin e o r machine b u i l t pro cess from which th e p a tie n ts a r e d e liv e re d as a fin is h e d p ro d u ct. The p a tie n t is a lso a human b ein g , and th e beginning and th e end o f h o s p ita l s e rv ic e must be th e saving and enrichment of h is l i f e . H o sp ita ls everywhere must combine w ith in t h e i r w alls and in t h e i r r e la tio n s h ip s to th e community an example o f in d iv id ­ u a l r e s p o n s ib ility , based upon th e re c o g n itio n o f t h e i r s o c ia l o b lig a tio n s to th e people who comprise th e p o p u la tio n ;! The H o sp ital A d m in istrato r Today What has been s a id concerning th e in c re a sin g r e s p o n s ib ility and com­ p l e x i t y o f th e t r u s t e e 's p o s itio n holds eq u a lly w ith re sp e c t to th e admin­ is tra to r.

I t is perhaps even more tru e ; f o r he is th e person charged

w holly w ith th e ex ecu tiv e r e s p o n s ib ility , and is employed s o le ly to d ir e c t th e i n s t i t u t i o n in keeping w ith accepted p o lic ie s and sta n d a rd s. B roadly speaking, th e su c c e ssfu l o p era tio n o f a h o s p ita l depends upon th e previous tr a in in g and experience of th e a d m in is tr a to r, th e d efin ed ob­ j e c t i v e s o f th e h o s p ita l, th e sources from which o p e ra tin g funds a re d e riv e d , th e s iz e and c h a ra c te r o f th e community.

I t involves a h ig h ly organized in ­

s t i t u t i o n o f many complex and s c i e n t i f i c techniques in which th e s e rv ic e ren d ered is in th e in t e r e s t o f a s ic k p a tie n t and d is tr e s s e d r e l a t iv e s .

The

in te r n a l p la n t o p e ra tio n c a l l s f o r a high degree o f many tra d e s k i l l s , a c ­ co u n ting s k i l l s , d ie ta r y and housekeeping f u n c tio n s , n e c e s s ita tin g a f u l l

C.H. Eorem, D ire c to r, H o sp ital S erv ice P lan Commission, American H o sp ital A sso c ia tio n , "Some Economic Issu e s in H o sp ita l S erv ic e and Management." P resen ted a t Second Annual I n s t i t u t e of H o sp ita l T ru s te e s, U n iv e rsity o f Chicago (June 13, 1941).

37

comprehension of modern p ersonnel p r in c ip le s and tech n iq u es. S iz e and in te r n a l o rg a n iz a tio n have a d e f i n it e e f f e c t upon th e d u tie s o f th e a d m in is tra to r.

O ften s e v e ra l fu n c tio n s a re combined, according to

th e v ary in g experience and p a st tr a in in g o f th e a d m in is tra to r and th e p ar­ t i c u l a r demands o f th e i n s t i t u t i o n .

The p h y sician d ir e c to r in s p e c ia liz e d

in s titu tio n s may se rv e in v arious combined a d m in is tra tiv e and c l i n i c a l c a p a c itie s ; th e n u rse d ir e c to r may head up e d u catio n al and tr a in in g programs as w e ll; th e la y d ir e c to r may in clu d e acco u n tin g , p u rch asin g , personnel o r p u b lic r e la tio n s d u tie s . Follow ing is a s u c c in t a n a ly s is of th e a d m in is tr a to r 's job:* R esponsible f o r th e a d m in is tra tio n and d isch a rg e o f p a tie n ts , f o r seein g th a t adequate care is given to a l l p a tie n t s . R esponsible f o r seein g th a t th e h o s p ita l meets and m ain tain s th e minimum s ta n d ­ a rd s e s ta b lis h e d by th e v ario u s a c c re d itin g a g e n c ie s. R esponsible f o r seein g th a t th e p o lic ie s o f th e governing board a re follow ed by th e h o s p ita l s t a f f . R esponsible in c o lla b o ra tio n w ith th e m edical s t a f f , f o r engaging th e r e s id e n t m edical s t a f f , and fo r seein g th a t only a u th o riz e d p h y sician s a re allow ed th e p r iv ile g e s of th e h ospi­ ta l. R esponsible fo r th e c o o rd in atio n of a l l departm ents w ith in the h o s p ita l, f o r th e p ro v iding of n ecessary f a c i l i t i e s fo r a l l d e p a rt­ m ents, f o r th e employment and d isch a rg e of a l l p erso n n el, and f o r p ro v id in g n ecessary f a c i l i t i e s f o r th e c are o f th e h e a lth o f a l l p e rso n n el. R esponsible f o r th e p re p a ra tio n o f p e rio d ic re p o rts to th e govern­ ing b o ard , o f a budget, o f stan d in g o rd e rs . R esponsible f o r s e tt in g th e r a te s and fe e s to be charged and fo r a u th o riz in g ex p en d itu res. R esponsible f o r th e education of a l l stu d e n ts connected w ith th e fcW p ital. R esponsible f o r m ain tain in g cooperation w ith o th e r h o s p ita ls , h e a lth and s o c ia l a g e n c ie s, w ith organized m edicine, w ith community o rg an i­ z a tio n s , and w ith th e p r e s s . R esponsible fo r engaging in th e a c tiv ­ i t i e s o f l o c a l , s t a t e and n a tio n a l h o s p ita l o rg a n iz a tio n s.

1 . American H o sp ita l A sso c ia tio n , Job S p e c ific a tio n s f o r a H o sp ital Organi­ z a tio n . p. 31.

38

I t is beyond th e scope of t h i s re se a rc h to p resen t a d is s e r ta tio n on th e q u a l i t i e s e s s e n tia l to s u c c e ssfu l management—on th e a t t r i b u t e s and q u a lif ic a tio n s an a d m in is tra to r should possess to meet th ese job s p e c if i­ c a tio n s .

Much has been w r itte n on th is s u b je c t, and many l i s t s of le a d e r­

s h ip q u a litie s have been com piled.^

This l i s t o f q u a lific a tio n s was drawn

up on th e b a s is o f wide rea d in g and c o n s u lta tio n w ith a number of ex ecu tiv es, personnel d ir e c to r s and a "ju ry " of h o s p ita l a d m in is tra to rs .

They agreed

th a t a com bination l ik e th e follow ing should r e s u lt in a competent adm inis­ tra to r: 1 . C h aracter—t r u t h f u l , h o n e st, s tra ig h tfo rw a rd , j u s t , sym pathetic and genuine. 2 . C re a tiv e , sober im agination—the a b i l i t y to p ro je c t o n e se lf in to th e f u tu r e w hile comprehending th e f a c ts of today; seein g th e th in g s which belong in h is p resen t p ic tu re , but which a re not y e t th e r e . 3. Sound judgment—an u n d erstanding of w hether and when ideas are w orkable, based upon a sound a p p re c ia tio n of human n a tu re and re c o g n itio n o f th e P r in c ip le of the " i n e v i t a b i l it y of g rad u al­ n e s s," 4 . O rganizing a b i l i t y —w ith reg ard not only fo r e ffic ie n c y but l i k e ­ w ise f o r th e development o f in d iv id u a l workers into an e f f e c tiv e working u n i t . 5. Courage—to co u n ter th e i n e r t i a of h a b it and b lin d p re ju d ic e and stan d by h is co n v ictio n s in g e ttin g h is ideas and judgment e f f e c tiv e ly tra n s la te d through b e t te r p o lic ie s , new procedures and methods. 6. Dynamic energy—a balanced p e rs o n a lity ; body and mind stro n g enough to c a rry out h is p la n s.

1 . S ee, f o r example: E lto n Mayo, The Human Problems of an I n d u s tr ia l C iv iliz a tio n . Henry C. M e tc a lf. (Ed.) The P sy ch o lo g ical Foundations o f Management. e s p e c ia lly W.V. Bingham, L ead ersh ip , Ch. 15 Henry C. M etcalf and L. Urwick, (E d .), Dynamic A d m in istratio n : The C o lle c te d Papers o f Mary P ark er P o l l e t t . e s p e c ia lly Ch. X II, Leader and E x p e rt, and Ch. X III, Some D iscrepancies in L eadership Theory and P r a c tic e C harles R e i t e l l , ra in in g Workers and S u p e rv iso rs, pp. 136-142 Ordway Tead, The A rt o f L eadership ___________ , Human N ature and Management. Ch. H I

j

39

7 . E eceptivenese—.p ro g ressiv ely open-minded and a l e r t to th e tre n d s , fo rce s and f a c to rs a f f e c tin g h is work. 8.

(Technical knowledge—f a m ilia r ity w ith a l l phases o f h is jo t), and a c le a r p erc e p tio n of i t s r e la tio n s h ip s .

9.

C ooperativeness, ta c t and diplomacy—th e " s u b tle e ffic ie n c y o f ta c t" in winning genuine support in th e working out of h is p la n s.

Some day i t may be p o s sib le to measure s t a t i s t i c a l l y th e r e l a t iv e v alue o f each o f th e above l i s t e d a tt r i b u t e s in d ir e c t r e la tio n to suc­ c e s s fu l a d m in istra tio n ; b u t, in any ev en t, h o s p ita l managanent w ill always remain a p erso n alized s e rv ic e to both p a tie n ts and p erso n n el.

An ap p re c ia ­

tio n of " in ta n g ib le s ," as D r. E.M. B luestone chooses to c a l l them, must always be a c o ro lla ry to th e a p p lic a tio n o f th e s c i e n t i f i c method. Before any s a tis f a c to r y program f o r th e education and tr a in in g of th e w orker can be launched th e a d m in istra to r must be convinced th a t ed u catio n , t r a in in g , a t t i t u d e s , le a d e rsh ip and experience a r e of paramount concern. Good le a d e rsh ip of tomorrow—good management—w i l l not be a c c id e n ta l.

A

wave of s c ie n ti f i c experim entation is fin d in g i t s way in h o s p ita l adm inis­ t r a t i o n , and newer techniques w il l follow th e le a d e rsh ip of today in recog­ n iz in g th e v alue o f th e tra in e d s t a t i s t i c i a n , a c tu a ry , c o m p tro lle r, psy­ c h o lo g ist and personnel d ir e c to r .

P re v io u sly , ex ten siv e re se a rc h in

h o s p ita ls was lim ite d to th e m edical f i e l d . In o th er words, the su c c e ssfu l h o s p ita l a d m in istra to r of th e fu tu re w i l l need to d is p la y th e q u a lity o f le a d e rsh ip which is a p tly expressed in th e follow ing q u o ta tio n , where the re fe re n c e is to th e p re s id e n t o f a b u s in e s s jl I t is recognized by many th a t the most s u c c e ss fu l p re sid e n t of a b u sin ess is not u s u a lly th e one who can fo rc e h is ideas on h is e x ec u tiv e s, but th e one who can make them do th e b e s t k in d of team work.

1 . Henry C. M etcalf and L. Urwick, Dynamic A d m in istra tio n , pp. 282-3

40

Whatever th e method, i t is th e p r e s id e n t’ s r e s p o n s ib ility to see th a t a l l p o s s ib le c o n trib u tio n s a re u t i l i z e d and made in to an o rg an ized , s ig n if ic a n t whole su b ordinated to a common purpose. There i s p re-em in en tly th e le a d e rsh ip q u a lity —the a b i l i t y to o rg an ize a l l th e fo rc e s th e re a re in an e n te r p r is e . Men w ith t h i s a b i l i t y c re a te a group power r a th e r than express a personal power. They p e n e tra te to the s u b tle s t connections of th e fo rces a t t h e i r command, and make a l l th ese fo rces a v a ila b le , and most e f f e c tiv e ly a v a ila b le , fo r th e accomplishment of t h e ir purpose. H o sp ital T ru stee and A d m in istrato r B elatio n s Given th is working base—o f th e r e s p o n s ib ilitie s and d u tie s coming w ith in th e compass o f each o f th e se two o f f ic e s —i t must be c o n sta n tly borne in mind th a t i t is in th e r e la tio n s h ip e x is tin g between th e board and th e su p e rin te n d en t i t s e le c ts th a t th e success of th e h o s p ita l in f u l f i l l i n g i t s o b je c tiv e s l i e s .

O bviously, th e Board cannot be dominated

by i t s a d m in is tra to r; a mere to o l o r rubber stamp a d m in istra tio n is equally in e f f e c tiv e . A review o f s ta t e and n a tio n a l programs shows much a tte n tio n to ques­ tio n s o f p o lic y form ulation and tr u s te e and a d m in is tra to r r e la tio n s , as in d ic a te d by th e follow ing q u o ta tio n s.

The f i r s t is from a h o s p ita l tru s te e ,

th e second from an a d m in is tra to r. The tr u s te e w r ite s ; The fundam ental p rin c ip le s governing the a d m in is tra tio n of a h o s p ita l a re id e n tic a l w ith th o se of any w ell-o rg an ized b u sin e ss. The su p e rin te n d e n t’ s r e la tio n to h is board should be th e same as th a t e x is tin g between th e g e n e ra l manager of an in d u s tr ia l or commercial c o rp o ra tio n to h is board, o r an o p e ra tin g v ic e p re sid e n t o f a r a ilr o a d to h i s . He should be the executive o f­ f i c e r and should a c t on a l l m a tters of a d m in istra tio n f o r the board between m eetings. Yet th e re o fte n a r is e s th e question w hether a su p erin ten d en t should a tte n d board m eetings. ’Dr. Lewinski-Corwin gives th e r e s u lts of an in v e s tig a tio n of th is s itu a tio n in 88 h o s p ita ls , in h is book, "The H o sp ital S itu a tio n in G reater New York." In 55 th e su p erin ten d en t re g u la rly atten d ed board m eetin g s. In 3 i t was o p tio n a l, and in 30 he was sen t fo r i f th e Board thought th ey needed him. I t would seem th a t i f a man was not competent to jo in w ith th e tru s te e s in t h e ir d e lib e r a tio n s , he was not competent to a d m in iste r th e a f f a i r s o f th e i n s t i t u t i o n .

41

While we a r e not d isc u s s in g th e im portant r e la tio n s h ip to th e p h y s ic ia n , th e su p erin ten d en t stands a t the apex o f a tr ia n g le o f s t a f f , b o ard , and p a tie n ts . No one b e n e fits more than th e p h y sic ia n by a proper r e la tio n s h ip between th e su p erin ten d en t and h is b o ard , and p a tie n ts . No one b e n e fits more than the p h y sic ia n by a proper r e la tio n s h ip between th e su p erin ten d en t and h is b o ard , which more than anything e ls e makes f o r good s e rv ic e to h is p a t i e n t s . Many su p erin ten d en ts have brought about r e g u la r j o i n t m eetings between th e executive committee o f th e board and th e a d m in is tra tiv e committee of th e s t a f f . This has been found o f g re a t valu e in g iv in g th e tr u s te e f i r s t ­ hand knowledge o f p ro fe s s io n a l m a tte rs . He begins to ask ques­ t io n s , to v is u a liz e some o f h is own r e s p o n s ib ilit ie s , to g rasp th e meaning o f th e m aintenance of p ro fe s sio n a l s ta n d a rd s , th e c o -o rd in a tio n o f th e p ro fe s s io n a l and a d m in istra tiv e departm ents. There is something wrong w ith th ese m eetings i f th e i n t e r e s t o f th e board is n ot a r o u s e d ... 'No su p erin te n d en t can face h is d i f f i c u l t day w ith c h eerfu ln ess and courage u n le ss he has th e g o o d -w ill, sympathy, and under­ s ta n d in g o f h is board. He cannot hope to b u ild up proper team work between h is d epartm ents, proper m orale among h is p erso n n el, u n le ss th e e n t i r e o rg a n iz a tio n f e e ls th a t h is board is back of him. The d e lic a te problems o f a h o s p ita l cannot be r ig h t l y ad­ ju s te d in an atm osphere o f d e s tr u c tiv e c r itic is m . The t r u s t e e is a man of many i n t e r e s t s , of which h is h o s p ita l is b u t one. I t is both lo g ic a l and im perative th a t he accord to h is h o s p ita l su p erin ten d en t th e same co -o p eratio n and c o n s id e ra tio n which he g iv es to an ex ecutive in h is b u sin e ss. On th e o th e r hand, i f th e s u p e rin te n d e n t's a t t i t u d e toward h is board is one of fra n k ­ ness and s e lf - r e s p e c t , i f he dem onstrates th a t he is s in c e re ly doing h is b e s t, i f he stim u la te s t h e ir in t e r e s t in th e work, he w i l l win t h e i r c o -o p e ra tio n and su p p o rt. T h eir confidence w ill be in p ro p o rtio n to h is a b i l i t y and s u c c e s s .! The a d m in is tra to r) expresses h is view point as fo llo w s: My r ig h t to expect anything from my board of tr u s te e s d e riv e s from th e f a c t th a t I was engaged by i t in the f i r s t p la c e . I am not su re th a t th e m edical men o f th e h o s p ita l were co n su lted ; b u t, i f th ey wer®, th e y a p p a re n tly gave t h e i r ap p ro v al. Those who were to be my c h ie f concern—th e p a tie n ts —w ere not co nsulted in my s e le c ­ t i o n . While I must adm it th a t th is gives me food fo r th o u g h t, I must say a t once th a t I f e e l as deep a sense o f r e s p o n s ib ility to

1 . C.W. N eergaard, T ru s te e , Carson C. Peck Memorial H o s p ita l, Brooklyn, and H o sp ita l C o n su lta n t, The R elatio n s of th e Board o f T ru ste es to th e S u p e rin ten d e n t. B u lle tin o f .American C ollege o f Surgeons (A p ril, 1938) r e p r i n t .

42

than as i f they were my m a ste rs. The f i r s t th in g th a t I expect from our hoard o f t r u s t e e s , th e r e f o r e , is an a p p re c ia tio n o f my i n t e r e s t in th e com fort o f th e p a tie n ts who have been e n tru ste d to i t s c a re . The hoard o f tr u s te e s and I have pledged our f a i t h to each o th e r. I t i s hy th e grace o f th a t supreme e x e c u tiv e , l e g i s l a t i v e and ju d i­ c i a l body th a t I ho ld th e mandate o f my o f f ic e . Since th e tr u s te e s a r e thus om nipotent, I expect th a t s u f f ic ie n t power w i l l he co n ferred upon me to p a r a l l e l th e a u th o r ity th a t goes w ith my p o s i t i o n . .. I expect my hoard to e x e rc ise th e g r e a te s t c a re in s e le c tin g i t s ex­ e cu tiv e o f fic e r s and a ls o in s e le c tin g new t r u s t e e s , w ith a l l o f whom I am expected to work in such a hum anitarian e n t e r p r i s e .. . I must have th e h o a rd 's te c h n ic a l a s s is ta n c e from tim e to tim e and expect i t to be g ran ted to me f r e e l y . . . There must he no tr a c e of fa v o ritis m in any phase of h o s p ita l a c t i v i t y in which th e s ic k a re concerned. Complete and a b s o lu te freedom from biaB must p re v a il in every a c t i v i t y o f th e h o s p ita l w hether p a t ie n t, r e l a t i v e o r employee i s in v o lv ed . I expect my hoard to see to th is hy s e tt i n g th e ex am p le... I expect my hoard to a p p re c ia te i t s r e s p o n s i b i l i t i e s . . . t o th e e x ten t th a t i t w i l l remove from my mind, as much as p o s s ib le , th e burden o f worry over th e f in a n c ia l d e f ic ie n c ie s o f h o s p ita l l i f e . This k in d of r e s t r a i n t lias a deadening e f f e c t and I expect ray hoard to r e a l i z e i t ... I want my tru s te e s to know what not to do. Many o f my colleag u es dread th e in te rfe re n c e o f tr u s te e s in th e r o u tin e a d m in is tra tio n of th e h o s p ita l. This in te rf e r e n c e is g e n e ra lly conceded to he th e g r e a te s t s in g le th r e a t to th e a u th o r ity of th e a d m in is tra to r. A d isc u ssio n a t th is p o in t w ith a newly e le c te d tr u s te e is th e f i r s t s te p in h is education f o r h o s p ita l s e rv ic e , u n le ss he a r r iv e s w ith a f u l l u n d erstan d in g o f th e s i t u a t i o n . . . The upper m ills to n e , c o n s is tin g o f th e governing hoard, and th e lower m ills to n e , c o n s is tin g of th e working s t a f f , must g rin d out th e f in e s t product th a t can c o n trib u te to th e h e a lth o f th e commun­ i t y . The a d m in is tra to r must never allow h im se lf, or he p e rm itte d , to he caught between th e se two f o rc e s . I t i s fo r him to see th a t th e in te r a c tio n between th e se two p a r ts is as p e r fe c t as human be­ ings can make I t - h u t he must have safeguards to p ro te c t him from in ju ry in han d lin g such d e lic a te y e t cumbersome m achinery. C o lla b o ra tin g w ith such a hoard as I have d e s c rib e d , any adm inis­ t r a t o r may c a rry on w ith a f e e lin g of s a f e ty . He need not he uneasy about th e c o n d itio n s o f h is employment, in clu d in g th e ten u re o f h is o f f ic e , Which is th e g r e a te s t s in g le worry to any q u a lif ie d man whose l o t may he c a s t w ith a hoard th a t has not been educated to i t s essen­ t i a l t a s k . . . 3-

1 . E. M. B luestone. M.D., What I Expect from my Board, The Modern H o sp ital (August, 1939)

43

The need f o r t r a n s la tin g in to b a s ic p o lic ie s th e fin d in g s p resen ted in th i s and th e preced in g c h ap ter was expressed in an e d i t o r ia l in Modern h o s p ita l* some y ears ago: Would i t not be p o s sib le f o r a code of re la tio n s h ip s to be so th o u g h tfu lly conceived and so c o n c ise ly s e t down, th a t i t might se rv e as a document to guide boards and a d m in istra to rs and thus avoid harm ful m isunderstandings? I t could cover auch m a tte rs as a d e f in itio n o f th e policy-m aking a c t i v i t y f o r th e board as d is ­ tin g u ish e d from th e a d m in is tra tiv e fu n c tio n of th e su p e rin ten d en t, th e r e la tio n s h ip of board committees to th e executive and to the board as a whole, th e d e p re c a tio n of s u rp r is e v i s i t s in sp e c tin g com m ittees, and th e procedure reg ard in g the o r ig in a tio n and ro u t­ ing of o rd e rs , % en l e f t u n c e rta in th e se m atters serv e to a g ita te th e calm w aters o f everyday h o s p ita l liv in g . B u ttre s s in g th i s sound p le a , th e supplem entary views of both a h o s p ita l p re sid e n t and a h o s p ita l su p erin ten d en t a r e ag ain quoted: What th e tr u s te e s expect o f th e a d m in istra to r cannot a c tu a lly be known by th e a d m in is tra to r u n le ss th e tr u s te e s d e fin e th e p o li ­ c ie s to be observed by th e a d m in is tr a to r .. . The tru s te e s a re th e governing body of v o lu n tary h o s p ita ls , th e re fo re i t i s t h e i r duty to form ulate p o lic ie s fo r t h e i r h o s p ita ls . I t is only by an understan d in g and p re se n ta tio n of th e se p o lic ie s to th e people of t h e i r communities th a t tr u s te e s can expect th e a d m in istra to r to fu n c tio n in keeping w ith th e b e s t i n t e r e s t s o f a l l concerned. C ooperation be­ tween tr u s te e s and a d m in istra to rs is always n ecessary and e s s e n tia l f o r th e b e s t p a tie n t c a re . And th is can only be a tta in e d by mutual u n d erstan d in g o f each o th e r 's d u tie s and r e s p o n s ib ilit i e s .2

. . . t h e r e l a t i o n o f th e board o f tru s te e s o r th e g o v ern in g body to th e s u p e rin te n d e n t and p e rso n n el o f th e h o s p ita l should be th e same as th a t o f th e board o f d ir e c to r s o f any business c o r­ p o ra tio n to t h e i r a d m in is tr a tiv e o f f i c e r and h is s u b o rd in a te s . To accom plish such a r e la t io n s h ip in h o s p ita ls throughout th e c o u n try th e re must be a s ta n d a r d iz a tio n o f o r g a n iz a tio n and a d m in is tr a tio n on much th e same b a s is as banks o r tru B t companies.

1 . Wanted—A Code f o r T ru s te e s, (March, 1938), p. 41. 2 . Samuel S te w art, P re sid e n t Board o f T ru ste e s, C entral Maine General H o s p ita l, Lew iston, What T ru stees Expect from th e A d m in istrato r.

44

A f u r th e r need f o r such s ta n d a rd iz a tio n is th a t tr u s te e s , su p erin ten d en ts and o th e rs may speak a s im ila r language.1 C onclusion. —I t has been th e purpose and in te n t of th is ch ap ter to p o in t out th e in c re a sin g tren d toward th e r e c o n s titu tio n and r e v i ta li z a ti o n o f boards o f d i r e c t o r s , p a r tic u la r ly th e e f fe c t o f th e apparent s o c ia l awak­ ening upon th e d u tie s , r e s p o n s ib ilitie s and o p p o rtu n itie s o f p resen t-d ay h o s p ita l tr u s te e s and a d m in is tra to rs .

Most im p o rtan t, perh ap s, i s th e

c a p a c ity to be c o n sta n tly conscious of th e organic u n ity of the in d iv id u a l, p a tie n t and employee. r e la tio n s h ip s .

Sound human r e la tio n s is a problem of in te g ra te d

A l i s t of e s s e n tia l q u a lif ic a tio n s of a su c c e ssfu l admin­

i s t r a t o r is given on page 37. There is only one road d ire c te d towards p ro g re ss; i f success is to be a tta in e d , tr u s te e s and a d m in istra to r must tr a v e l th a t road to g e th e r. S q u a lly im p o rtan t, however, is th e r e a li z a tio n th a t each must b ear h is s h a re o f the lo a d .

In o th e r words, i t is a m a tte r o f a board and an

a d m in is tra to r who know w hither they a re going, th a t they must go to g e th e r, and why and how th ey a re going.

1 . Sidney G. Davidson, S u p erin ten d en t, B utterw orth H o s p ita l, Grand E apids, M ichigan, The E e la tio n of th e Board of T ru stees o f th e Governing Board to th e S uperintendent and P ersonnel o f th e H o sp ita l. American H o sp ital A sso ciatio n T ra n s a c tio n s . 1928

CHAPTER III

TEE ORGANIZATION OP A HOSPITAL PERSONNEL DEPARTMENT

Throughout t h i s th e s is runs the thought th a t the tr a in in g fu n c tio n can he i n t e l l i g e n t l y co n sid e red only in i t s r e la tio n to o th er personnel a c t i v i ­ t i e s , and to the whole complex problem of m eeting, so f a r as p o s s ib le , the w orker’ s claim in a democracy to o p p o rtu n ity f o r growth and development in and through the work r e l a t io n s .

Chapters I and I I have d e a lt, broadly,

w ith o b je c tiv e s and p erso n n el policy-m aking.

This ch ap ter commences the

p re s e n ta tio n o f th e reasons f o r and the a c tu a l fu n c tio n in g of a rounded perso n n el program, follow ed in succeeding c h ap ters by a more d e ta ile d d is ­ cussio n of th e v ario u s p erso n n el fu n c tio n s which were found to govern and to be interw oven w ith e f f e c tiv e education and tr a in in g of employees. This view point i s c o rro b o rated by a statem ent from the P reface of a new volume on tr a in in g : T raining methods to be s u c c e ssfu l must be woven in to a dynamic program which has i t s tap ro o ts in a v i t a l m orale. Anything sh o rt of th is is only motion w ithout p ro g re ss, form w ithout l i f e or sub­ stance.^Reasons fo r a P ersonnel Department A dm itting the t r a d i t i o n a l d i f f i c u l t i e s and co m p licatio n s, p rev io u sly d isc u sse d , which have hampered th e in tro d u c tio n of sound management pro­ cedures in h o s p ita ls , the w rite r found alm ost u n iv e rs a l agreement in the minds of tr u s te e s and a d m in is tra to rs of la rg e h o s p ita ls t h a t , w ith the

1.

Churls? R s i t e l l , T rain in g Workers and S u p erv iso rs, p , v i . 45

46

ex cep tio n of m otive, t h e o r e tic a lly .th e r e i s no v i t a l d i s tin c tio n between the running of a h o s p ita l and the running of any o th e r s e rv ic e o rg a n iz a tio n , th a t id e a l l y , in the i n t e r e s t o f economy and e ffic ie n c y and of the human beings employed, the same p r in c ip le s should govern the management of a h o s p ita l as have been found e f f e c tiv e in b u s in e s s . This being the c a se , th e reasons f o r the c e n tr a liz in g of personnel work i n a h o s p ita l run alo n g the same lin e s as those given fo r the establishm ent of a perso n n el departm ent in in d u s try or b u s in e s s .

These reasons have been

d iv id e d b ro ad ly , in to th re e c a te g o rie s —economic, p sy ch o lo g ical and adm inis­ tr a ti v e .^ Economic J u s t i f i c a t i o n From th e view point of economy, experience has shown th a t the co sts of s e le c tin g , m ain tain in g and tr a in in g the members o f the working s t a f f of any o rg a n iz a tio n , as w ell as th e c o s ts of secu rin g the b e s t a p p lic a tio n of t h e i r work e f f o r t s , can be s u b s ta n tia lly reduced by s c i e n t i f i c pro ced u res.

Where

p erso n n el work has been sound and e f fe c tiv e f o r a number of y e a rs, the e v i­ dence i s co n clu siv e th a t in creased o p era tin g charges due to h ig h la b o r tu rn ­ o v er, unnecessary a c c id e n ts , absences, w aste, damaged m a te r ia ls , i n e f f ic ie n t workmanship r e s u ltin g from inadequate tra in in g or poor working c o n d itio n s, and la c k of c o lla b o ra tio n have been g re a tly reduced. In the h o s p ita l, however, i t must be adm itted th a t l i t t l e co n sid e ra tio n has been given to th e p o s s i b i l i t y of reducing la b o r co sts through s c ie n t i f i c perso n n el p ro ced u res.

H o sp itals are only now attem p tin g to f i x p a tie n ts*

charges by in c lu d in g d ir e c t la b o r co st on the b a s is of s p e c ific se rv ic e s ren d ered .

1.

We a re b eg inning to sense the f a c t th a t, inasmuch as the lab o r

Ordwsy Tead and H»C. M etcalf, P ersonnel A d m in istratio n : I t s P rin c ip le s and P r a c tic e , pp. 36-40.

47

co st in every type o f organized e f f o r t is a v i t a l p a r t o f th e t o t a l c o s t, perso n n el a d m in is tra tio n has been econom ically j u s t i f i e d because of i t s a b i l i t y to reduce la b o r c o s ts , while i t has continued to urge the economic n e c e s s ity f o r paying the h ig h est p o s sib le wages. P sychological J u s t i f i c a t i o n P r a c tic a lly every problem connected w ith th e w orker’ s a t t i t u d e i s in p a r t p sy c h o lo g ic a l.

The in c re a sin g re c o g n itio n of the im portance of a t t i ­

tude is evidenced by th e a tte n tio n th a t is being given to what the worker th in k s .

E xtensive and in te n siv e s tu d ie s of the su b je c t have been made,

and i t has become q u ite u su a l f o r in d iv id u al managements to sound out th e ir own employees so as to g e t a t grievances and m isconceptions, and be in a p o s itio n to make i n t e l l i g e n t adjustm ents in the work r e l a tio n s .

The p e r­

sonnel e x e c u tiv e ’s job i s la r g e ly one of g e ttin g the r ig h t a t t i t u d e ssiong ex ecu tiv es and among the w orkers,

"The o rg an iz a tio n from h is stan d p o in t

i s a working to g e th e r of minds and f e e lin g s .

And a s a tis f a c to r y working

b a s is s u re ly re q u ire s th e u t i l i z a t i o n of the f u l l e s t p o s sib le p sy ch o lo g ical knowledge. We fin d t h i s a n a ly s is a b ly corroborated in a re c e n t volume, "Management and M orale,"^ based upon the r e s u lts of s ix te e n years o f re s e a rc h a t the Hawthorne P la n t of th e Western E le c tr ic Company.

P ro fe sso r F .J . H o eth lisb erg er

here co n c lu siv e ly dem onstrates th a t o rg an izatio n s have a s o c ia l as w ell as a lo g ic a l s tr u c tu r e , th a t "th e s o c ia l s tr u c tu r e of any p a r tic u la r company determ ines the kind of c o lla b o ra tio n , the kind of p eo p le, who w ill s ta y in

1* Loc. c i t . 2 . Fa .T. H o e th lis b e r g e r ,

Management and Morale,

48

the company and the kind o f people who w ill reach th e to p . 11 P ro fe sso r R o e th lis b e rg e r's conclusion is th a t the n ecessary c o lla b o ra tio n cannot be l e f t to chance; i t re q u ire s conscious planning and e f f o r t , based upon a knowledge of human m o tives, c h a r a c t e r is t i c s , d e s ir e s , a s p ir a tio n s . The more s c i e n t i f i c knowledge we have about human b e in g s, in t h e i r work r e ­ la tio n s h ip s e s p e c ia lly , th e more obvious becomes the n e c e s s ity of having one executive in the o rg a n iz a tio n an ex p ert in and re sp o n sib le f o r human r e l a ­ tio n s problems. A d m in istrativ e J u s t i f i c a t i o n A d m in istra tiv e ly speaking—the personnel movement, as i t is conceived today, is r e l a t iv e ly new.

I t i s the cum ulative r e s u l t of a number of

s c a tte re d a tte m p ts, la r g e ly p r io r to the f i r s t world w ar, i n t e l l i g e n t l y to r e l a t e a l l those e f f o r t s which sought to u t i l i z e , a d ju s t and develop the human resources in an o rg a n iz a tio n under one a d m in is tra to r.

The v o c a tio n a l

guidance movement, the employment management movement, the s a f e t y - f i r s t , i n d u s tr ia l h e a lth , v o c a tio n a l tr a in in g , and s c i e n t i f i c management movements (to mention b ut a few) a l l p o in ted to the a d m in is tra tiv e e f fic ie n c y and economy of a c e n tra l personnel departm ent.

Today, the impetus of c o lle c tiv e

b a rg ain in g is adding to th e need f o r c e n tr a liz in g p ersonnel a d m in is tra tio n . Whatever the purpose of the o rg a n iz a tio n —whether i t i s economic, c iv ic , p h ila n th ro p ic , c o r re c tiv e , o r f o r any o th e r end—i t is today a u n iv e rs a l f a c t th a t employee r e la tio n s h ip s re q u ire competent a d m in is tra tio n .

I t i s hard to

say which of the th re e grounds—economic, p sy ch o lo g ica l, a d m in is tra tiv e — p re se n ts the s tro n g e s t case f o r c e n tr a liz e d personnel a d m in is tra tio n ; but c e r ta in ly the th re e to g e th e r combine to form an in c o n te sta b le argum ent.

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F unctions o f a P erso n n el Department Although th e c h a ra c te r of the d u tie s of a personnel departm ent v a rie s sonewhat from o rg a n iz a tio n to o rg an iz a tio n and may a l t e r in d e t a i l w ith the y e a rs , i t s e s s e n tia l ro le w ill rem ain.

And th a t e s s e n tia l ro le in the hos­

p i t a l , as viewed "by th e au th o r on th e h a s is o f these s tu d ie s , conference and c o n s u lta tio n , is to give to the employees the same i n t e r e s t , re sp e c t and u n d erstan d in g t h a t h o s p ita ls have p rid ed them selves f o r years in rendering to th e p a t i e n t .

The end r e s u l t w ill be an o rg a n iz a tio n which, as a whole

and in a l l departm ents and groups, renders g ra c io u s, e f f i c ie n t se rv ic e by an i n t e l l i g e n t , lo y a l, co o p erativ e body of w orkers. The o b je c tiv e of every a d m in is tra to r i s to conduct h is i n s t i t u t i o n as e f f i c i e n t l y as p o s sib le w ith in a s e t of given circum stances.

The personnel

departm ent s tr i v e s to enhance t h i s aim through the proper maintenance of the employee.

There i s no reason why r e s u lts in the h o s p ita l f ie ld should

be d if f e r e n t from th o se achieved in in d u stry and b u sin e ss, except f o r the f a c t th a t i t is perhaps more d i f f i c u l t to measure a c c u ra te ly a d m in istra tiv e e f f ic ie n c y in an o rg a n iz a tio n w ithout a prod u ctio n or p r o f i t m otive. The major fu n c tio n s of the personnel departm ent~ and the d u tie s of th e p erso n n el manager—are now reaso n ab ly w ell e s ta b lis h e d .

B u t,as p re v io u sly

s ta t e d , no two h o s p ita ls w ill f in d i t f e a s ib le to accept com pletely any one stan d a rd ize d p la n ,

q u estions o f re o rg a n iz a tio n o f d u tie s to conform to a

s e t-u p o f t h i s n a tu re and o f the r a p id ity w ith which these d u tie s a re developed in te n s iv e ly in any p a r t ic u la r h o s p ita l are m atters of p r a c tic a l in te r n a l expediency.

In working out a c e n tr a liz e d personnel fu n c tio n ,

th e r e fo r e , personnel e x p e rts and h o s p ita l a d m in istra to rs agreed th a t these f a c ts should be c o n s ta n tly borne in mind: 1 , A th e o r e tic a l p la n i s unim portant as compared w ith a c o rre c t delega­ tio n o f d u tie s in a c tu a l p r a c tic e by a l l e x e c u tiv e s.

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2.

The personnel departm ent should not assume new r e s p o n s ib ilit ie s and tak e on new d u tie s f a s t e r than i t i s a b le com petently to a d m in ister them.

3.

No procedures should be adopted as a permanent p r a c tic e u n t i l experience has proved t h e i r e ffe c tiv e n e s s and p r a c t i c a b i l i t y . Large in d u s t r i a l and commercial concerns o fte n have s e v e ra l e x e c u tiv e s,

each re sp o n sib le f o r a c e r ta in personnel fu n c tio n , e . g . . Employment Manager, T rain in g D ire c to r, S afety E ngineer, e tc .

But i t can be assumed f o r the

p r e s e n t, where th e s iz e w arrants a personnel departm ent in h o s p ita ls , th a t th e r e s p o n s ib ility f o r the v ario u s fu n ctio n s in d ic a te d alm ost w ithout excep­ tio n w ill be assig n ed to only one personnel e x e c u tiv e . Nor i s i t to be expected, or even suggested, th a t every h o s p ita l should d e sig n a te a f u ll- tim e o f f ic e r to handle personnel problems e x c lu s iv e ly . However, because of the number of a c t i v i t i e s which g r a v ita te to i t , the p erso n n el fu n c tio n in s e v e ra l la rg e h o s p ita ls has been c e n tr a liz e d and is a t t a i n i n g the d ig n ity o f a major s t a f f r e s p o n s ib ility . The fu n c tio n s o f a w ell-rounded personnel departm ent, s e t f o r th by Tead and Metcalf^- and in harmony w ith o th er a u th o r itie s on personnel ad m in istra ­ tio n , ^ which are now e ffe c tiv e in p ro g ressiv e in d u s tr ia l and b u sin ess concerns, coming to th e fo re in h o te ls and o th e r se rv ic e o rg a n iz a tio n s, and a lto g e th e r ac ce p ta b le as a g o al f o r sound h o s p ita l p erso n n el management a r e : Employment, which covers a l l the work e n ta ile d in se c u rin g , p ro p e rly in tro d u c in g , s t a b i l i s i n g , and r e ta in in g a w illin g and e f f e c tiv e worfein g fo rc e . H ealth work, which covers c o rre c tiv e and p rev en tiv e e f f o r ts to main­ t a i n th e s t a f f in sound p h y sic a l and m ental h e a lth , in clu d in g p h y sica l exam inations and g en eral o v ersig h t of working c o n d itio n s as th ey a f f e c t h e a lth . 1 . Tead and M etcalf, ogi. e f t . , Chapter IV 2 . See e s p e c ia lly , W.D, S co tt and o th e rs , Personnel Management. Ch. I l l

51

S afety work. which in clu d es th e m inim izing of ac c id e n ts through b o th proper mechanical safeg u ards and continuous ed u catio n al and p rev en tiv e e ffo rts . Education and tr a in i n g , which covers a l l th e v ario u s e d u catio n al a c t i v i t i e s of the o rg a n iz a tio n , having to do b o th w ith d e f in ite job in s tr u c tio n and w ith b roader c u ltu r a l ed u catio n . R esearch, which comprises a l l e f f o r ts to stu d y liv in g c o s ts , wage le v e ls , a l l o th er d a ta which g iv e a f a c tu a l b a s is f o r d e c isio n s about terms of employment, and new p erso n n el developments in o th e r o rg an iza­ tio n s as they may be a p p lic a b le to th e p a r tic u la r o rg a n iz a tio n . P e rio d ic a n a ly sis and a u d it of p erso n n el p o lic ie s are in clu d ed , as w ell as a su p erv iso ry r e l a t io n to the work of job a n a ly s is and the establishm ent of p ro d u ctio n s ta n d a rd s . S erv ic e, which in clu d es a l l the m iscellaneous a c t i v i t i e s which are d ir e c tly r e la te d to the com fort and w elfare of th e in d iv id u a l, such as in su ran ce, p en sio n s, r e s ta u r a n ts , savings p la n s, housing, and re c re a tio n . A djustm ent. which covers th e h an d lin g of in d iv id u a l grievances and com plaints, absen ces, d i s c ip lin a r y m easures, and d isc h a rg e . Supervision of j o i n t n e g o tia tio n s , which im plies r e s p o n s ib ility fo r d e alin g as management r e p re s e n ta tiv e s w ith any organized employee groups to discu ss terras of employment or o th e r group problem s, in ­ clu d in g the terms o f a la b o r c o n tr a c t and th e in te r p r e ta tio n o f th a t c o n tra c t. The re p o rt on the development o f personnel p o lic ie s and procedures a t the New Haven H o sp ita l, r e fe r r e d to in Chapter I , s ta t e s : The technique of personnel a d m in is tra tio n has been c o n s ta n tly improved by a p p lic a tio n f o r many yearB in i n d u s tr ia l and commercial e n te r p r is e s . In our e f fo r t to develop a p erso n n el program f o r New Haven H o sp ita l we have drawn h eav ily upon th e se e s ta b lis h e d p r a c tic e s and have t r i e d to adapt them so as to f i t th e p e c u lia r requirem ents of the h o s p ita l f i e l d . The functions of i t s P ersonnel Department are s e t f o r th as fo llo w s: The Personnel Department, as e s ta b lis h e d f o r New Haven H o s p ita l, s h a ll fu n c tio n as a s t a f f d epartm ent, in i t s r e la tio n s h ip to o th e r d e p a rt­ m ents. In a l l phases of p e rs o n n e l, the departm ent s h a ll develop d e f in ite p o lic ie s and p rocedures f o r the conduct of th ese a c t i v i t i e s . The fu nctions w ith which th e P ersonnel Department w ill be concerned w ill co n sist of th e fo llo w in g : 1 . Employment of h o s p ita l p e rso n n el (which s h a ll in clu d e the develop­ ment and maintenance o f an adequate source of supply, the o r ig in a l h irin g , tr a n s f e r r in g , prom oting and term in a tio n of s e r v ic e ) .

52

2 . Working c o n d itio n s o f h o s p ita l personnel (which s h a ll include ho u rs, com pensation, v a c a tio n s , s ic k le a v e s , leaves of absence, h o lid a y s, s p e c ia l absences from work). 3 . T rain in g and ed u catio n of h o s p ita l p erso n n el, 4 . The esta b lish m e n t and maintenance of an adequate system f o r pro­ te c tin g th e p h y sic a l w ell-b ein g o f h o s p ita l personnel and the development and maintenance of an em ployees1 w elfare program, 5 . To conduct re se a rc h , compile s t a t i s t i c s and submit re p o rts on v a rio u s phases of p erso n n el a d m in is tra tio n and to m aintain ac c u ra te reco rd s of p ro sp e c tiv e , p re se n t and former employees, 6. To a c t as a l ia is o n agency between the management and any of the employees in m atters o f employer-employee r e la tio n s h ip s . Q u a lific a tio n s of th e P erso n n el D ire c to r F in a lly , l e t i t be s a id th a t the most im portant duty of the personnel departm ent, w ith o u t doubt, i s th a t of in fu s in g management th in k in g as a whole w ith th e most wholesome personnel p o in t of view .

The personnel

d ir e c to r should tak e th e i n i t i a t i v e in proposing and sponsoring p rogressive personnel p o lic ie s and procedures when th e s itu a tio n is r ig h t f o r t h e ir in tro d u c tio n .

When major p o lic ie s are under c o n s id e ra tio n , he should see

to i t th a t a l l perso n n el im p lic a tio n s a re understood and recognized and th a t no p o lic y is adopted which w ill in ju re the cooperative a tti t u d e of the employee group.

The perso n n el d ir e c to r should be a person, who, by v irtu e

of h is p erso n al q u a lif ic a tio n s , tr a in in g and ex p erien ce, w il l m erit the re sp e c t of management and h is judgment given f u l l w eight. The Committee on P erso n n el R ela tio n s of the American H o sp ital Associa­ tio n agreed upon th e fo llo w in g s p e c if ic a tio n s fo r the p o s itio n of Personnel D ir e c to r ;-*D u tie s : Under a d m in is tra tiv e d ir e c tio n , to c a rry out a coordinated p erso n n el program f o r th e h o s p ita l; and to perform r e la te d work as r e q u ire d .

1. American H o s p ita l A sso c ia tio n , Job S p e c ific a tio n s f o r a H o sp ital O rg a n iz a tio n , p . 78,

53

Examples: In te rv ie w in g a p p lic a n ts f o r employment; m ain tain in g employment records on p re sen t and past p erso n n el; conducting t r a i n ­ in g co u rse s; a c tin g as lia is o n o f f ic e r in the conducting of employeremployee r e la tio n s h ip s ; conducting job a n a ly s is and making job s p e c if ic a tio n s ; fo rm u lating ladders of promotion; holding e x it in terv ie w s w ith a l l persons leav in g the s e rv ic e s of the h o s p ita l; and d ir e c tin g employee w elfare programs* Minimum Q u a lif ic a tio n s : G raduation from a recognized c o lle g e o r u n iv e r s ity . P re fe ra b ly w ith a major in p C B t-g ra d u a te work in the f i e l d of A pplied Psychology. Two y e a rs ' experience in personnel work. S u f fic ie n t experience in an a c c re d ite d h o s p ita l to provide a thorough and complete knowledge of h o s p ita l personnel needs. S upervisory a b ility * Good judgment. But narrow , s p e c ia liz e d tr a in in g is not s u f f ic ie n t f o r success in p e r­ sonnel a d m in is tra tio n .

The p ersonnel d ire c to r should have a broad grasp of

economic and g e n eral c u ltu r a l l i t e r a t u r e and make a conscious e f f o r t to keep a b re a s t of th e tim es in personnel thought and procedures. sound th in k e r and a v i r i l e p e r s o n a lity .

I t c a ll s f o r a

In the d e lic a te s itu a tio n of

e s ta b lis h in g h im self w ith the lin e s t a f f , he must prove th a t h is advice i s sound, o r he w ill lo se a l l in flu en ce and p re s tig e f o r h is departm ent. These a re sound r e q u is ite s f o r a l l su ccessfu l e x ecu tiv es; the personnel d i r e c t o r i s no ex c ep tio n .

A program of conscious self-developm ent should

be one of the v i t a l elem ents in h is working program. C onclusion. — The modern tren d s and fo rces now rem oulding a l l our major i n s t i t u t i o n s in a l l p r o b a b ility w ill not pass the h o s p ita l by.

The time is

h e re , a s th is Chapter s tr e s s e s , f o r the u p -to -d a te h o s p ita l to fu n ctio n th rough a w ell-rounded personnel departm ent.

In th i s fu n c tio n in g only can

i t hope to f u l f i l l i t s p re se n t r e s p o n s ib ilitie s to meet s u c c e s s fu lly the new c h a lle n g e s—economic, psy chological and a d m in istra tiv e in c h a r a c t e r crowding upon i t . The fu n c tio n s o f an organic personnel departm ent, as o u tlin e d in th is c h a p te r, cover employment, h e a lth and s a fe ty , education and tr a in in g , < \c - \

c-r

54

research., s e rv ic e , adjustm ent and su p e rv isio n of j o i n t n e g o tia tio n s .

The

procedures f o r ca rry in g out the f i r s t of these fu n c tio n s are s e t f o r t h in the fo llo w in g c h a p te r.

CHAPTER IV EMPLOYEE SELECTION AND PLACEMENT

In accordance w ith the statem en t of fu n c tio n s of a c e n tr a liz e d personnel departm ent, as s e t f o r t h in th e preceding c h a p te r, the f i r s t s te p in develop­ ing a lo y a l, co n ten ted working s t a f f , who can he r e lie d on f o r c o n s is te n t q u a lity perform ance i s employment» This fu n c tio n should provide in th e f i r s t in s ta n c e , through s c i e n t i f i c s e le c tio n and placem ent, f o r the r ig h t man on th e r ig h t jo b . A stu d y of te x tu a l m a te ria l and of s u c c e s s fu lly o p era tin g personnel p ro ­ grams l e f t no doubt as to th e two b a s ic r e q u is ite s of proper s e le c tio n and placem ent.

They a re comprehensive knowledge of th e .job and an eq u a lly good

u n d erstan d in g of th e in d iv id u a l.

The personnel

o f f ic e r must know b o th ,

The form er can be g u aran teed only on th e b a s is of a thorough-going job a n a l­ y s is , job s p e c if ic a tio n s and job r a tin g . Chapter V II,

These procedures are explained in

The l a t t e r c a lls f o r a knowledge of sources of la b o r supply

and th e a b i l i t y to s iz e up th e in d iv id u a l c o r r e c tly , which are tr e a te d in th i s C hapter . Recognizing In d iv id u a l D ifferen ces The f a c t o f in d iv id u a l d iffe re n c e should be recognized as the g lo ry of life ,

p sy c h o lo g ists t e l l us th a t to g et along to g e th e r we cannot apply a

" g lib ru le of thumb," but must d ili g e n tl y ac q u ire in s ig h t in to a c tu a l d iv e r »

s i t i e s of our n eig h b o rs. and why d iffe re n c e s co u n t.

We must a p p re c ia te how we d i f f e r , why we d i f f e r , This holds p a r t ic u la r l y f o r those who are se­

l e c t i n g job incum bents, 55

56

How and why do we d if f e r ?

p ro fe s s o r H.L. H ollingsw orth* t e l l s u s :

1. A ll men a re born u n lik e , and th is is n o t t h e i r f a u l t . Wise a c tio n must take b o th f a c ts in to a c c o u n t ...I t may sta n d a rd iz e i t s opera­ t io n s , i t s methods, and i t s rew ards. But u n le ss i t in tro d u ces f l e x i b i l i t y in to i t s sta n d a rd s, sons men w ill waste t h e i r ta le n ts while o th e rs w ill s u f f e r under the e f f o r t to do what is beyond them. The only o th e r r e s o r t i s fo r management to s e le c t b e fo re ­ hand men who are found to be approxim ately a lik e in the t r a i t s th a t a re c r u c ia l f o r a given e n t e r p r i s e .. . 2 . Men d i f f e r co n tin u o u sly alo n g any sc a le o f measurement, and by types or s p e c ie s , and the range of d iffe re n c e v a rie s w ith the t r a i t measured. 3 . The more f u n c tio n a l, the more complex, the more re c e n tly developed and the more symbolic the performance or t r a i t , the more w ill men d i f f e r in i t . 4 . Men d i f f e r more in t h e i r a b i l i t y to s a t i s f y t h e i r needs than they do in th e natu re and s tr e n g th of those needs, hence our wishes are more lik e those of o th ers than our a b i l i t i e s a r e , 5. Both h e re d ity and environment are re sp o n sib le f o r the le v e l of human c a p a c ity , b ut the form er is more re sp o n sib le f o r the human d iv e rs itie s . We can g e t along to g e th e r, P ro fe sso r H ollingsw orth m ain tain s, to the degree th a t we d isc o v e r, reco g n ize, and openly communicate these f a c ts of human d iv e r s ity , and adapt our i n s t i t u t i o n s and ex p ectatio n s to them. I t was a r e a liz a tio n of the importance of d isco v e rin g and recognizing in d iv id u a l d iffe re n c e s which le d s c i e n t i s t s , educators and p ro g re ssiv e b u s i­ ness le a d e rs , and in re c e n t years personnel workers in p a r t ic u la r , to s e e k , improved methods of s e le c tio n and placem ent.

T h eir purpose was to b u ild up

e f f e c tiv e in d iv id u a litie s through tr a in in g , adjustm ent and proper working r e la tio n s h ip s . P ro fe sso r H ollingsw orth

o

c ite s the r e s u lts of 40 d if f e r e n t experim ents

of the e f f e c ts of tr a in in g on in d iv id u a l d iff e r e n c e s , performed by d if f e r e n t

1 . H. L. H ollingsw orth, The E th ic a l S ig n ifican ce of the R ecognition of In d iv id u a l D iffe re n c e s. The Development of E th ics in Modem Business Management, (December, 1929). 2 . Loc. c i t .

57

in v e s tig a to r s over a p erio d o f tw enty y e a rs, on w idely ranging types and ag es, and on a wide v a r i e t y of a c t i v i t i e s .

In a l l th ese cases the q u estio n

asked was, "How does tr a in in g a f f e c t in d iv id u a l d iffe re n c e s ? "

He w rite s :

The 40 experim ents t e l l a c o n s is te n t s to r y . When the i n i t i a l d i v e r s i t i e s are s l i g h t , t r a in in g does nothing to them or s l i g h t l y decreases them. When the i n i t i a l d i v e r s i t i e s a re g r e a t, tr a in in g makes them a l l the g r e a te r . That is to sa y , j u s t to th e e x ten t th a t men a re d i f f e r e n t , t r a in in g makes them more d if f e r e n t than e v e r. Only when the d iffe re n c e s to begin w ith are t r i v i a l does tr a in in g make men more a l i k e . The e f f e c t of tr a in in g , broadly speaking, is to make men more d if f e r e n t in the th in g s in which they a lre ad y d i f f e r , and to make them sometimes more a lik e in the th in g s in which th ey a re n e a rly eq u al. I t i s obvious th a t the problem o f adjustm ent to in d iv id u a l d iffe re n c e s cannot be solved by any system of p ro v id in g uniform tr a in in g f o r a l l . The only o th er ed u c atio n al t r i c k would be to enforce d if f e r e n t amounts of tr a in in g . What would then r e s u l t ? , , . Rules of r ig h t a c tio n , e t h i c a l p r in c ip le s , have o fte n been formu­ la te d w ith a consciousness of nothing b u t the d is tr e s s e s and tro u b le s th ey tend to a l l e v i a t e . What is req u ired in modern e t h i c s , in b u s i­ ness and p ro fe s s io n , in management, work and c a su a l a s s o c ia tio n , is more than t h i s , (Jettin g alo n g to g e th e r re q u ire s a profound and somewhat d e ta ile d consciousness of the way th e d is tr e s s e s and tro u b le s a ris e . In the long run i t i s only t h i s knowledge th a t w ill put our a c tio n s on a le v e l o f j u s t i c e and achieve a s o lu tio n th a t i s s u b s ta n tia l and permanent, I have t r i e d to show th a t the c h ie f source of such tro u b le is to be found in the in d iv id u a l d i v e r s i t i e s of human b e in g s. The c h ie f e th ic a l im p lic a tio n of in d iv id u a l d iffe re n c e s i s th a t these d iffe re n c e s should be f u l l y d isco v ered , w idely communicated, and openly reco g n ized . In these statem en ts l i e the reasons f o r the development of sound employ­ ment and tr a in in g p ro ced u res. Developing Sources of Supply Turning f i r s t to th e problem of knowing and developing sources of la b o r supply—a p a r t ic u la r l y acu te problem f o r h o s p ita ls today, when they must compete w ith in d u s t r i a l jo b s paying f a r h ig h er wages f o r comparable d u tie s and r e s p o n s i b il i t i e s . Nominally one of th e most dependable sources o f supply—f o r p o s itio n s above the low est grades— should be workers a lre a d y in th e h o s p ita l who may

58

be advantageously tr a n s f e r r e d or promoted,

A su ccessfu l system of promotion

from w ith in - c a lls f o r c a r e f u lly planned and executed tech n iq u es,

This is

such an im portant a sp e c t of a tr a in in g program th a t i t i s d iscussed in some d e t a i l in Chapter V III. O bviously, even w ith a s a ti s f a c to r y promotion p o lic y , i t is necessary to develop sources o f supply from w ithout fo r even the sm a lle st h o s p ita l, For b o th th e p ro fe s s io n a l and n o n -p ro fessio n al groups these sources a r e : f rie n d s and r e la tiv e s of p re sen t employees; form er employees who have re ­ signed or been la id o f f ; job a p p lic a n ts who c a l l or w rite in ; newspaper a d v e r tis in g when n ecessary ; p r iv a te and p u b lic employment ag en cies, although in th e case of the form er care should be taken to use only agencies of un­ impeachable i n t e g r i t y and c a re fu l s e le c tio n procedure. The w r ite r has long f e l t t h a t , by and la r g e , h o s p ita ls would b e n e fit by c u ltiv a tin g the p r a c tic e which is used e x te n siv e ly by many la rg e co rp o ratio n s of r e c r u itin g employees from high sc h o o ls, v o catio n al schools and c o lle g e s . In th e course of t h i s stu d y , v o c a tio n a l schools were v is ite d and. t h e i r cur­ r i c u l a stu d ie d in r e la tio n to h o s p ita l demands.

The fin d in g s are reviewed

in Chapter X, H irin g Techniques With sources of supply e s ta b lis h e d , the problem becomes tw o-fold: (1) a d ju s tin g the c u r ric u la o f s p e c ia liz e d schools which a re w illin g to cooperate so as to prepare stu d e n ts fo r s p e c if ic h o sp ita l p o s itio n s , and (g) s e le c tin g from th e v ario u s sources the in d iv id u a ls who seem to come n e a re st to meet­ in g th e d u tie s and p erso n a l q u a litie s c a lle d f o r in the job s p e c ific a tio n s . Many h o s p ita ls , a d ja c e n t to ed u c a tio n a l i n s t i t u t i o n s , may w ell develop f u l l

59

oi* p a rt-tim e programs o f mutual b e n e f it.* I t goes w ithout saying t h a t, where p r a c t i c a l , c e n tr a liz e d h irin g by a perso n n el o r employment departm ent is the most e f f e c tiv e and o rd e rly arrangem ent f o r s e le c tin g and in d u ctin g new workers in to an o rg a n iz a tio n . In th e com paratively rece n t p ast a number of h o s p ita ls have recognized the f a c t th a t the adoption o f such a c e n tr a liz e d employment p o lic y makes fo r homogeneity of working s t a f f and reduced la b o r tu rn -o v e r.

The re p o rt of

evolving personnel p o lic ie s and procedures of th e New Haven H o sp ital s ta te s : 1 . The P ersonnel Department s h a ll develop and m ain tain an adequate supply o f s u ita b le a p p lic a n ts f o r th e v a rio u s p o s itio n s w ith in th e h o s p ita l o rg a n iz a tio n , w ith th e fo llo w in g ex cep tio n s: a . P ro fe s sio n a l and te c h n ic a l p o s itio n s s h a l l be the re s p o n s ib il­ i t y o f th e departm ent head concerned. b . Department heads s h a ll be th e concern of th e D ire c to r of th e H o sp ita l. In both o f th e above exceptions th e P erso n n el Department s h a ll be g la d to o f f e r any of i t s a v a ila b le reso u rces upon re q u e s t. 2 . In in sta n ce s where th e l i s t o f a p p lic a n ts is not s u f f ic ie n t to meet th e need s, p ro fe s sio n a l employment ag encies s h a ll be u t i l i z e d . 3 . In in sta n ce s where a l l a v a ila b le reso u rces have f a ile d to produce q u a lifie d a p p lic a n ts , reco u rse to a d v e r tis in g may be allow ed. The " h i t o r miss" method of s e le c tio n , which i s too g e n e ra l in th e h o s p ita l, has been found exceedingly c o s tly both to th e a d m in istra tio n and to th e employee— to management because of heavy tu rn o v e r, w aste and in e f­ fic ie n c y ; to th e worker because he is in the wrong jo b .

To a id th e

* An o p p o rtu n ity was arranged a t th e P aterso n General H o s p ita l, P aterso n , New J e rs e y , fo r c o lleg e and secondary school stu d e n ts to v o lu n teer t h e i r s e rv ic e s during the-summer months fo r the p r iv ile g e of g ain in g experience in s e le c te d jobs in th e housekeeping, k itc h e n and o f f ic e departm ents. From ten to f i f t e e n acadanic i n s tit u tio n s were rep re se n te d each term. H o sp ital a u th o r itie s communicated w ith school o f f i c i a l s p a r tic u la r ly in th o se in sta n ce s where "o u tsid e" p r a c tic e was re q u ire d by th e academic re g u la tio n . The experiment proved so s u c c e ss fu l as to become a re g u la r p r a c tic e .

60

employment manager in f i t t i n g th e in d iv id u a l to th e jo b th e re a r e a v a ila b le two techniques—-interview ing and, in c re a sin g in u s e , p sy ch o lo g ical te s tin g . The In te rv ie w The in te rv ie w is th e o ld e s t method of s e le c tio n .

While i t remains and

w i l l always be e s s e n t i a l , i t is th e one in which we a re s t i l l probably the le a s t s c ie n tif ic .

Yet th e f a c to r s surrounding s u c c e ss fu l in terv iew in g have

been reasonably w e ll e s ta b lis h e d .

There is g en eral agreement in th e te x tu a l

m a te ria l on th i s su b je c t t h a t they concern (1) th e p erso n a l q u a lif ic a tio n s of th e in te rv ie w e r, (2) th e p h y s ic a l surroundings of th e in te rv ie w , and, as a lre a d y s tr e s s e d , (3) an in tim a te knowledge of jo b req u irem en ts.

One source

p o in ts out th re e d i s t i n c t fu n c tio n s o f th e employment in te rv ie w : "securing in fo rm atio n , g iv in g in fo rm atio n , and e s ta b lis h in g a f rie n d ly r e la tio n s h ip ." * I t should be recognized th a t even in th e average h o s p ita l which cannot pro v id e one in d iv id u a l s o le ly to in te rv ie w a p p lic a n ts f o r p o s itio n s , i t is im portant fo r departm ent heads to f a m ilia r iz e them selves w ith th e techniques o f su cc essfu l in te rv ie w in g and th e q u a lif ic a tio n s of in te rv ie w e rs . The g e n era l p r a c tic e in la r g e r concerns is to d iv id e the work of i n t e r ­ viewing in to a p re lim in a ry and a re g u la r in te rv ie w .

Tead and M etc alf1 s tr e s s

th e f a c t th a t "whoever has th e f i r s t co n tact w ith a p p lic a n ts should be chosen w ith g re a t c a r e . . . L et th e f i r s t c o n ta c t w ith a company r e p re s e n ta tiv e proper­ l y r e f l e c t th e p o lic y o f humane personnel d ealin g s which you a re try in g to exem plify w ith in th e company w a lls I"

They co n tin u e:

* This q u o tatio n is tak en from th e 1931 E d itio n o f How to In te rv ie w by W. V. Bingham and B. V. Moore. See the b ib lio g rap h y f o r re fe re n c e to the c u rre n t e d itio n . 1*

Qrdwajf Tead and H. 0. M e tc a lf, P ersonnel A d m in istratio n : I t s P r in c ip le s and P r a c tic e , p . 66.

61

Both, p re lim in a ry and. f i n a l in te rv ie w e rs should be persons of m a tu rity and human sympathy. The work of s e le c tio n c a lls fo r p a tie n c e , in s ig h t, fin e n e ss o f f e e lin g reg ard in g th e s e n s ib il­ i t i e s , and r e tic e n c e s o f a p p lic a n ts . I t w ill be th e excep tio n al you n g ster who can e x h ib it th e se q u a l i t i e s . The good in terv iew er in v ite s t r u s t and confidence; he is confided in because he em­ bodies good w i l l and c o n s id e ra te n e s s. A lso he is a b e tt e r i n t e r ­ view er u s u a lly i f he knows th e w o rk er's problems from th e o th er s id e of th e d e s k ...a n d i f he has had experience in going out and lo o k in g f o r a jo b h i m s e l f ... In te rv ie w e rs , l i k e a l l o f u s , approach t h e i r c o n ta c ts w ith a p p li­ c a n ts w ith in e v ita b le p reconceptions as to c e r ta in evident c h a ra c te r­ i s t i c s in people which th ey b e lie v e have d ia g n o stic v a lu e . The g e n e ra l appearance and manner o f th e a p p lic a n t have, of co u rse, to be r e l i e d h e a v ily upon in re ach in g a d e c is io n . Yet th e experienced and candid in te rv ie w e r w i l l r e a l i z e how d ecep tiv e appearances alone can be and w i l l be always a l e r t to secure and r e l y on more o b je c tiv e d ata to h e lp in form ing h is c h o ic e s. More than t h a t , he must conscien­ tio u s ly t r y to f re e h is mind of u n te ste d and preconceived notions which he may be c h e rish in g about what appearances r e v e a l . . . The b a s ic demand upon th e good in terv iew er is fo r a warm h e a r t, a s e n s itiv e awareness of th e u n d ercu rren ts of p e rs o n a lity ex p ressio n , a spontaneous in t e r e s t in human beings—a l l coupled w ith a c o o l, shrewd judgment of ch a rac ter* He meets people under circum stances which a re to than try in g and d i f f i c u l t ; he must somehow reduce th e in e v ita b le sense o f s t r a i n . This tak es tim e and sympathy. 3ut i f a su c c e ssfu l placem ent is e ffe c te d and i f th e in terv iew er m aintains a co n tact w ith th e new worker on th e jo b , th e company has made a f rie n d and one more p e rso n al bond has been e s ta b lis h e d which i t th en remains f o r th e de­ partm ent head to develop. One c r itic is m which can s t i l l be made o f many m anufacturing p la n ts , departm ent s to r e s and o th e r o rg a n iz a tio n s should be avoided by h o s p ita ls in th e estab lish m en t o f c e n tr a liz e d in terv iew in g and h ir in g . E e it e l l * w r ite s ;

Charles

"Hot th e e x c e p tio n a l, but th e ty p ic a l, employment

o f f ic e gives a poor r e p re s e n ta tio n o f th e q u a lity of th e f ir m .11 In o rd er to g et from p erso n al experience a check on the statem ents of th e se a u th o r itie s in p e rso n n el, th e w r ite r went through the ro u tin e employ­ ment procedures—m ainly th e in te rv ie w — in a few commercial and in d u s tr ia l co n cern s.

1*

The p o in ts s tr e s s e d reg a rd in g th e in terv iew er and in terv iew in g

C harles R e i t e l l , T ra in in g Workers and S u p erv iso rs, pp. 36

62

tech n iq u e were found to be em inently sound. The im portance o f th e p h y sic a l surroundings f o r th e in te rv ie w was a ls o n o te d .

They should be c h e e rfu l and u n re s tra in e d ; and, so f a r as p o s s ib le ,

p ro v isio n s should be made f o r in terv iew in g a p p lic a n ts w ithout too long a w a it, and p r iv a te ly .

I t is im portant th a t th e r ig h t r e la tio n s h ip be e sta b ­

lis h e d a t th e s t a r t by making th e a p p lic a n t f e e l th a t th e choice is a mutual one, in which he is s e le c tin g a jo b as w e ll as being s e le c te d f o r i t .

The

aim o f th e in te rv iew is to draw out enough g en eral inform ation concerning th e a p p lic a n t's p erso n al h is to r y to s a ti s f y th e in te rv ie w e r th a t he w arran ts f u r t h e r c o n s id e ra tio n and is ready f o r the next s te p in th e employment pro­ cedure—f i l l i n g out th e a p p lic a tio n form.

The im portance and th e make-up of

t h i s form a re d iscu ssed in th e next c h a p te r. Then follow s th e main in terv iew , in which should be brought out n o t only s p e c if ic background in fo rm atio n, as in d ic a te d in th e a p p lic a tio n form, but a ls o a knowledge o f th e f e e lin g s , d e s ir e s , p re ju d ic e s and a s p ir a tio n s of th e a p p lic a n t.

R e i t e l l l g ives a su g g estiv e c h a r t, o u tlin in g the f ie ld s to be

explored in th e in terv iew —suggested to p ic s fo r q u e stio n in g , and th e purpose and valu e o f th e d e s ire d in fo rm atio n .

A guide o f th is n a tu re w ill be h e lp fu l

f o r th e in te rv ie w e r in g e ttin g f u l l inform ation reg ard in g ed u c a tio n a l and employment h is to r y ; v o c a tio n a l aim s; i n te r e s ts and hobbies; fam ily background; h e a lth , and p r a c tic a l c o n sid e ra tio n s. The aim o f th e in te rv ie w , th en , is to b u ild up a p erso n al r e la tio n s h ip w hich, allow ing fo r th e a p p lic a n t's n a tu r a l re se rv e s and sense of s e l f r e s p e c t, w i l l g ra d u a lly d is c lo s e whether th e t o t a l p e rs o n a lity o f th e one in terv iew ed seems to promise to develop harm oniously in r e l a tio n to the h o s p ita l o b je c tiv e s and p o lic ie s .

Quoting ag ain from Tead and M etcalf

1 . I b i d . . 38-39 2 . Tead and M etc alf, p £ . c i t . . p . 72

63

The im portant p o in t to s tr e s s here is th a t th e in terv iew i t s e l f should be s e t up on th e most s e n s ib le b a s is thus f a r known be­ fo re th e attem p t i s made to in tro d u ce th e refinem ents of s p e c ia l p sy ch o lo g ical t e s t s . In o th e r words, have an experienced a b le in te rv ie w e r, g iv e him a p r iv a te room fo r h is in te rv ie w s, allow him p len ty o f tim e w ith each a p p lic a n t (in c lu d in g a second i n t e r ­ view b e fo re f i n a l h irin g whenever p o s s ib le ) , l e t him co n sid er th e a p p lic a n t*8 t o t a l perso n al h is to r y —and only when th e se elements of sound procedure have been w ell worked out is i t w orthw hile to co n sid e r what t e s t s might be added. Before f i n a l l y h ir in g an employee, h is re fe re n c e s should be checked, as a means of le g a l p ro te c tio n to the employer.

While i t has been found

in p r a c tic e th a t in v a ria b ly an em ployer's r e p lie s a r e s la n te d in fav o r of th e employee, re fe re n c e s do a id in determ ining th e c h a ra c te r and working c a p a c ity o f th e a p p lic a n t, p a r tic u la r ly on th e c l e r i c a l and a d m in istra tiv e le v e ls . The Use of P sy ch o lo g ical T ests The survey re v ea led th a t much study and experim entation has been c a r­ r ie d on over th e p ast h a lf cen tu ry in an attem pt to develop s c ie n ti f i c s u b s titu te s f o r th e " h i t and miss" method o f s e le c tio n and prom otion.

Psy­

ch o lo g ic a l t e s t i n g has met w ith w ider acceptance and p r a c tic e w ith each p assin g y e a r. In f a c t , th e in t e r e s t in t e s t s has in th e re c e n t p a s t in creased so r a d i c a l l y th a t p sy ch o lo g ists f e e l c a lle d upon from time to tim e to issu e n o tes o f w arning.

Many who a re not tra in e d in s c i e n t i f i c methods, who do

not know th e fundam entals of human n a tu re , have rushed in to th e t e s tin g f i e l d and a re prone to o f f e r f u t i l e , quick c u r e - a lls fo r human m alad ju st­ m ents.

The sound p sy c h o lo g ists—a l l too few a t p re s e n t—make no e x tra v a ­

gant claim s.

They a r e cau tio u s in sending f o r th fin d in g s not f u ll y

v a lid a te d ; they do not promise "uncanny accuracy."

But they a re conscious

o f th e f a c t th a t they a re fo rg in g new and b e t te r to o ls needed to improve and "supplement o ld e r tech n iq u es."

64

As Mr. Palm erston w e ll s t a t e s j l ...w e do i n s i s t th a t we have in our hands a new and b e t te r s e t of to o ls needed to supplement old te c h n iq u e s. As we continue to im­ prove our m ethods, to reexamine our c r i t e r i a , to search fo r b e tte r d i f f e r e n t i a t i n g symptoms, we s h a ll u se th e b e s t psychological in ­ strum ents a v a ila b le , as a means o f f i t t i n g men and women and jo b s , an approach to th e problem of la b o r turnover and a ccid en t prone­ n e s s , a tech n iq u e f o r r e lie v in g a t l e a s t p a rt o f th e m aladjustment o f th e i n d u s tr ia l m i s f i t , a d ev ice to be employed in low ering u n it c o s ts o f p ro d u ctio n , and a method of a tta c k on s tu d e n ts ' problems in our sch o o ls and c o lle g e s , w ith p o s s i b i l i t i e s of enormous saving to s o c ie ty in th e form of in creased e ffic ie n c y and a g re a te r volume o f goods and s e rv ic e s , w ith a g r e a te r degree of human s a ti s f a c tio n . In th e concept o f th is th e s is i t was planned to determ ine the value of s p e c ia l t e s t s as an element o f a h o s p ita l s e le c tio n and tra in in g program and to attem p t to c o n s tru c t t e s t s which promised to be u s e f u l.

To th is end, in ­

q u ir ie s were addressed to s ix te e n personnel d ire c to rs and in d u s tr ia l psychol­ o g is ts known to have in tro d u ced and s u c c e s s fu lly adm inistered t e s t s f o r o f f ic e and o th e r employees in in d u s tr ia l and commercial firm s, as a source f o r guidance in d ecid in g upon th e t e s t s which might f i r s t be in tro d u ced , w ith rea so n a b le assu ran ce o f s u c c e ss fu l r e s u l t s , as an a id in th e s e le c tio n , tr a n s f e r and prom otion o f h o s p ita l employees.

Eleven r e p lie s were re c e iv e d ,

a l l o f which gave th e su b je c t c a re fu l p erso n al c o n s id e ra tio n . The r e s u l t s showed th a t th e most g e n e ra lly used types of t e s t s ares g e n eral in te llig e n c e a p titu d e , e .g . . c l e r i c a l , mechanical s p e c ia l a b i l i t i e s , e .g . . manual d e x te r ity tra d e knowledge and s k i l l s p e c ia l in te r e s t s p e rs o n a lity A ll th e companies who r e p lie d in d e ta i l to th e in q u iry s ta te d th a t they g iv e p r a c t i c a l l y a l l th e se types of t e s t s ; some of them l i s t e d ten or more t e s t s in u s e .

Other sm aller companies who use psychological t e s t s c o n s is te n tly

have th re e o r fo u r stan d ard t e s t s —an in te llig e n c e t e s t (most fre q u e n tly th e

1 . L.R . P alm erton, P sy ch o lo g ical T e s ts , Personnel Jo u rn a l Qlarch, 1941).

65

O tis S elf-A d m in iste rin g T e sts o f M ental A b i l i t y ) , a p e rs o n a lity t e s t (Wonderlic P erso n n el o r Huram-JITadEworth.) and s p e c ia l a b i l i t i e s t e s t s (such as th e Thurstons or M innesota C le r ic a l and th e MacQyarrie M echanical) and tra d e t e s t s .

Since

th e copies o f t e s t s subm itted a re copyrighted or c o n f id e n tia l, they a re not a v a ila b le fo r reproduction in th is stu d y .* The r e p lie s had th re e p o in ts in common, a l l o f which b ear heeding by h o s p ita l ex ecu tiv es who may be in te r e s te d in i n i t i a t i n g t e s t s in t h e i r employ­ ment p ro ced u res: 1. A firm b e l i e f in the e ffic a c y of t e s t s once the r ig h t t e s t s have been found or c o n stru cted and c o r r e c tly a p p lie d , 2 . The need fo r "cu sto m -built" t e s t s and fo r c a r e fu l v a lid a tio n of r e s u lts . 3 . The need f o r tra in e d p sy ch o lo g ists to a d m in ister the t e s t s i f th ey a r e to bear e f f e c tiv e r e s u l t s . These ex cerp ts from th e l e t t e r s i l l u s t r a t e th e above p o in ts and give o th e r h e lp fu l comment: The Company fo r some years has been u sin g t e s t s fo r measure­ ment o f a p titu d e s . These te s ts a r e an e s ta b lis h e d p a rt of our s e le c tio n procedures in most branches of th e Company and a id m a te ri­ a l l y in d isco v erin g more capable in d iv id u a ls f o r th e O rg an isatio n . The v alu e we have d eriv ed from t e s t s is due to : f i r s t , th e te s ts have been custom b u i l t to s u it th e needs of each branch of th e b u sin e ss; second, th e development o f t e s t s has been under th e super­ v is io n o f te ch n ical^ - tra in e d psychom etricians; and t h i r d , th e t e s t s have been used in th e s e le c tio n process w ith f u l l knowledge of t h e i r l i m ita tio n s . Our t e s t s a re made up c h ie f ly of items s im ila r to those in w ell known t e s t s o f in te llig e n c e , i n t e r e s t , p e r s o n a lity , e tc .

The — Company has been u sin g t e s t s fo r over te n y e a rs . This is perhaps th e b e s t s in g le index o f our b e l i e f in the e ffe c tiv e n e s s of th e se in stru m en ts.

* For th e most complete and a u th o r ita tiv e study of psychological t e s t s and t h e i r u s e , see: W. V. Bingham, A ptitudes and A ptitude T e stin g .

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F o rtu n a te ly , we have a s t a t i s t i c a l l y r e l i a b l e c r i te r i o n o f success on th e jo b in th e fo ra o f p rod u ctio n re c o rd s . We a re a b le th e re fo re to compare t e s t sco res w ith prod u ctio n reco rd s to determ ine w hether any o f th e t e s t s may be used to p r e d ic t subsequent success o r f a i lu r e on th e p a r tic u la r j o b . . . Not being a. p s y c h o lo g is t, I th in k I am e n ti t l e d to say th a t anyone who purchases a few well-recommended t e s t s and expects to improve h ir in g and promotion procedures i s alm ost c e r ta in to g e t in to tro u b le . There is no perso n n el technique more p ro d u ctiv e than psychology. For example, we have in c reased th e output o f our machine bookkeepers approxim ately f iv e p er cent by our a b i l i t y to h ir e b e tte r bookkeepers by means o f t e s t s . There a re immense p o s s i b i l i t i e s in th e improve­ ment by e x e cu tiv e and su p erv iso ry perform ance through b e tte r s e le c tio n and promotion w ith th e h elp o f t e s t i n g . At th e same time t h i s is th e most d i f f i c u l t personnel technique to u s e . I t is n o t a t a l l a m a tte r o f m erely g iv in g a few t e s t s .

Scores on th e M innesota C le r ic a l T est have been found to d if f e r e n t i a t e su c c e ss fu l c le rk s from workers in o th e r o ccu p atio n s, and c l e r i c a l groups such as a c c o u n ta n ts , bookkeepers, sten o g rap h ers, and g e n e ra l c l e r i c a l w orkers tend to make h ig h er scores th an ro u tin e c l e r i c a l w orkers. F u rth e r, w ith th e c o o p eratio n o f Dr. George K. B en n ett, o f th e Psycho­ lo g ic a l C o rp o ratio n , a r a tin g sc a le was devised (see Appendix, E x h ib it

F ).

The p lan in mind was t h a t , on the b a s is o f th e resu ltB o f r a tin g a re p re s e n ta ­ t i v e c la s s o f employees (w a itre sse s wene s e le c te d ) , a h e lp fu l t e s t might be c o n s tru c te d .

The a c tu a l r a tin g r e s u l ts a re of more d ir e c t in t e r e s t in the

treatm en t o f th a t s u b je c t, and a r e th e re fo re included in Chapter V III. With re s p e c t to th e te s t i n g o f a p p lic a n ts fo r h o s p ita l jo b s , i t appears from th e two in v e s tig a tio n s made th a t th is is not a procedure which can be put in to immediate u se w ith s a tis f a c to r y r e s u l t s .

I t is obvious th a t sev­

e r a l p re c a u tio n s, a lre a d y su g gested, must be tak en , fo r t e s t s a re h ig h ly re fin e d a d m in is tra tiv e to o ls and can be s u c c e s s fu lly employed only under c e r ta in c o n d itio n s . P erso n al c o n s u lta tio n w ith s e v e ra l a u th o r itie s proved g e n e ra l agreement on th e p o in t th a t only by experim ent can a s a fe choice of t e s t s be made fo r

67

most n o n -p ro fe ssio n a l h o s p ita l jo b s .

The experience in th is f ie ld is as y et

to o lim ite d to w arrant w ise a p p lic a tio n of t e s t s in any gen eral sen se.

A

survey o f th e f i e l d showed A few h o s p ita ls , p a r tic u la r ly those a f f i l i a t e d w ith u n iv e r s ity departm ents, experim enting in th is f i e l d .

But a r a th e r wide

group o f h o s p ita ls a ffo rd in g reaso n ab ly s a fe comparable co n d itio n s w ill need to experim ent in th e f i e l d b e fo re u s e f u l, sa fe r e s u lts a re a v a ila b le .

One

such experim ent, on which r e s u lts a re not y e t a v a ila b le , is being c a rrie d on in C leveland, by th e P erso n nel R esearch I n s t i t u t e , re c e n tly organized by W estern Reserve U n iv e rsity .

Any given h o s p ita l cannot fu rn is h , in i t s

s e p a ra te jo b c l a s s i f i c a t i o n s , a wide enough experience to f u rn is h s c i e n t i f i c v a lid ity . C o n stru ctin g t e s t s is only th e f i r s t s te p .

Any te s ts which are in tr o ­

duced must be ad m in istered by tra in e d s p e c ia lis t s fo r e f fe c tiv e r e s u l t s . There i s , f u r th e r , th e complex problem o f sco rin g th e t e s t s and determ ining th e r ig h t c o rre la tio n s o f th e r e s u lts w ith job su ccess.

This has been proved

to be a h ig h ly s p e c ia liz e d , te c h n ic a l jo b . Employment f itn e s s involves much more than t e s t s . should come f i r s t .

And f i r s t things

A sound s e le c tiv e procedure must include many human

f a c to r s which a re not rev ea led by t e s t s , such as lo y a lty to s e l f and o rg an i­ z a tio n , p la in h o n esty , tru th f u ln e s s , moral i n t e g r ity , power o f a p p lic a tio n , p e r s is te n c e , a l l of which a re of prime importance in the most humane of a l l i n s t i t u t i o n s —th e h o s p ita l.

In t h e i r p re se n t stag e of development, even

where th e f u l l e s t p re p a ra tio n fo r t h e i r in tro d u c tio n has been made, the v alu e o f t e s t s a t b e s t is only suppementary, never a b s o lu te . As s ta te d above, th ese c o n tr o llin g co n d itio n s mean th a t th e su ccessfu l in tro d u c tio n o f u s e fu l t e s t s takes tim e and means money.

The P sychological

C o rp o ratio n , of Hew York C ity , an a u th o r ity on and c le a rin g house fo r a wide

68

v a r ie ty o f t e s t s , does not perm it t h e ir u se w ithout an u n d erstan d in g th a t th e y w i l l he introduced and t h e i r use c o n tro lle d by a tra in e d p sy c h o lo g ist, A y ear o r more o f experim ent is u s u a lly re q u ire d f o r v a lid a te d r e s u l t s . These s p e c i a l is t s b e lie v e d , in f a c t , as a r e s u l t o f th e e x p lo ra tio n made, th a t th e problem o f c o n stru c tin g proper t e s t s f o r h o s p ita l employees i s in i t s e l f a worthy su b je c t fo r a PH.D. t h e s i s .

D r. B e n n e tt's conclusion

was:* I t is probably d e s ir a b le to have a b r ie f t e s t and in terv iew given to each can d id ate fo r h o s p ita l s e rv ic e p o s itio n s . I do not b e lie v e th a t a s u f f ic ie n t number of conv en ien tly lo c a te d p sy ch o lo g ists a re a v a ila b le to render o u tsid e c o n s u lta tio n f e a s ib le . The e x is tin g t e s t s a re not p a r tic u la r ly s u ite d to th is type of employee and i t should be f e a s ib le to develop an in terv iew re p o rt form th a t would h e lp to summarize th e im portant p e rs o n a lity a sp e c ts as w ell as a b r i e f o r a l t e s t o f in te llig e n c e th a t would s u f f ic e fo r your pur­ pose. Plaoement and Follow-up The survey rev ealed th a t good employment procedure includes s e v e ra l f u r th e r s te p s .

A fte r i t has been p r e tty w ell e s ta b lis h e d th a t th e a p p li­

cant is to be h ire d , he is u s u a lly given a p h y sic a l exam ination.

This may

b rin g out p h y sical d e fe c ts , which might be p a r t ic u la r ly d e trim e n ta l to suc­ c e s s f u l f u lf illm e n t o f th e jo b d u tie s , not d e te c ta b le in th e in te rv ie w . The v alu e of th e p h y sica l exam ination in i t s r e la tio n to th e development of th e employee on th e jo b is d iscu ssed in C hapter V II. With the in tro d u c tio n of c e n tra liz e d employment, one q u estio n which u s u a lly comes up fo r d isc u ssio n concerns f in a l a u th o r ity in h ir in g w o rk ers-w hether i t should r e s t w ith top management, in th e personnel departm ent or in th e o p eratin g departm ent head.

P ersonnel a u th o r itie s were found gen erally

to ag ree th a t f i n a l a u th o r ity should be in th e hands o f the departm ent head*

* L e tte r d ated : A p ril 7, 1942

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who is re sp o n s ib le f o r th e conduct o f h is departm ent and w ill g e t the b e st r e s u l t s from w orkers w ith whom he f e e ls co n g en ial. I t i s one o f th e fu n c tio n s o f th e personnel departm ent o r a s s is ta n t a d m in is tra tiv e e x ecu tiv e to study th e needs o f th o se who r e q u is itio n w orkers, and to s e le c t from a la r g e number of a p p lic a n ts one or more which seem b est f i t t e d f o r th e jo b in q u e stio n .

I f a departm ent head or s u p e rv iso r seems

c o n s is te n tly to u se poor judgment in acce p tin g or r e je c tin g th e candidates s e le c te d , a l i t t l e e d u ca tio n al work may be n e c e ssa ry .

The p erso n al d e p a rt­

m en t's r o le is one o f p e rsu a sio n , s e rv ic e and salesm anship. A fte r th e d e c is io n re g ard in g th e a p p lic a n t's employment has been made, he i s u s u a lly g iven a f i n a l in te rv ie w and an in tro d u c tio n to h is job and the o rg a n iz a tio n .

The f i r s t days on a new job o fte n loom la rg e in th e fu tu re

adjustm ent o f a new employee.

" S e le c tin g th e worker fo r a c e r ta in kind of

work and b rin g in g him in to a p ro d u ctiv e r e la tio n s h ip w ith i t a re two e n tir e ly d i f f e r e n t th in g s . h is w o rk .11^

In o rder to b rid g e th e gap we must in tro d u ce th e worker to

I f he is to become a c o n te n te d , lo y a l, v i t a l p a r t of th e hos­

p i t a l o rg a n iz a tio n , th is du ty cannot be l e f t to chance. plan n in g and s u p e rv is io n .

I t re q u ire s c a re fu l

S ta r tin g w ith th e in tro d u c to ry in terv iew th e em­

ployee should be gradual!^ acq u ain ted w ith h is p a r tic u la r p o s itio n and d e p a rt­ m ent, as w ell as th e p u rp o ses, p o lic ie s and re g u la tio n s o f th e whole o rg an i­ z a tio n . The f i r s t s te p in th e in tro d u c to ry process is o fte n taken care of in p a r t through an in fo rm a tio n a l b o o k le t, or employee manual.

Some one in

a u th o r ity should go over i t s co n ten ts w ith new w o rk ers, e ith e r in d iv id u a lly o r in groups.

The purpose and content of employee handbooks a r e d iscu ssed

in P a r t I I of t h i s stu d y .

1 . W alter D ill S c o tt,

and o th e r s , P ersonnel Management, p. 250

70

F in a lly , good personnel p r a c tic e c a lls f o r th e new employee being p e rs o n a lly conducted to h is work p la c e and introduced to the departm ent h ead, who in tu rn in tro d u ces him to h is immediate s u p e rio r or working a s s o c ia te s .

At th e P a terso n General H o sp ital and many o th ers th e p ra c ­

t i c e i s to have th e S u p erintendent each month meet p e rso n a lly a l l new em ployees. Beyond th i s p o in t th e procedure u s u a lly becomes a m a tte r o f tr a in in g . C onclusion. —In th e b u ild in g of an e f f i c i e n t , co n ten ted , s ta b le working s t a f f , th e m a tte r o f s c i e n t i f i c s e le c tio n and placement of workers is of f i r s t im portance.

This ch ap ter s e ts f o r th th e e s s e n tia ls —knowledge of

th e b e s t sources o f la b o r su pply, o f th e job and of th e in d iv id u a l. F u r th e r , i t d isc u sse s in some d e t a i l th e a c tu a l employment procedures which were found to be producing th e b e s t r e s u l t s —th e in terv iew , p sy ch o lo g ical t e s t s , p h y s ic a l exam ination and in tro d u c tio n to th e jo b . A v i t a l p a rt o f sound employment p ro c e d u re ~ a c le a r and e f f e c tiv e p erso n n el reco rd system —i s tre a te d in the next c h ap ter.

CHAPTER V

PERSONNEL RECORDS AND THE CONTROL OP EMPLOYMENT STANDARDS

In the p reced in g c h a p te r, th e statem ent was made, on th e b a s is of the fin d in g s in th is stu d y , th a t th e two b a s ic r e q u is ite s f o r s c i e n t i f i c s e le c ­ tio n o f employees was (1) a thorough knowledge o f the job and (2) an eq u ally thorough knowledge and •understanding of th e in d iv id u a l.

This c a l l s fo r

recorded f a c ts —f i r s t , f a c ts about th e job and i t s r e l a t io n to o th e r jo b s, and second, f a c ts re g ard in g the in d iv id u al w orker.

Any o rg a n iz a tio n as

reco rd -co n scio u s as a h o s p ita l should be the f i r s t to recognize the f a c t th a t personnel reco rd s c o n ta in in g the n ecessary f a c ts f o r c a rry in g on the employment, h e a lth , s a fe ty , e d u catio n and tr a in in g , re s e a rc h and s e rv ic e fu n c tio n s o f the personnel d epartm ent, are e s s e n tia l to o b ta in in g , main­ ta in in g and c o n tr o llin g an e f f i c i e n t working s t a f f . This ch a p te r t r e a t s o f th e need and the re q u ire d forms f o r a c c u ra te ly rec o rd in g f a c ts p e r ta in in g to th e w orker. . C hapter VII i s devoted to a d i s ­ cu ssio n of procedures f o r re co rd in g th e n e cessary f a c ts reg a rd in g th e jo b . B u ild in g An E ffe c tiv e P ersonnel Record System The c au tio n re p e a te d ly found, however, was th a t i t should be borne in mind th a t reco rd s a r e to o ls , not th e end, of personnel management.

Cumber­

some, poorly-planned record system s may e a s ily d e fe a t the purpose f o r which they were designed—th e c o n tro l of employment stan d a rd s and personnel r e l a ­ tio n s , and, more and more, to f u r n is h inform ation req u ired by government ag e n c ie s. 71

72

The reco rd s should provide only fo r e s s e n tia l inform ation; and whatever i s recorded must be a c c u ra te .

Ho uniform se t o f forms can be compiled to

meet w ith complete s a ti s f a c t io n the requirem ents of i n s t itu tio n s of v ary in g s iz e , o rg a n iz a tio n , s tr u c tu r e and fu n c tio n s.

Y et, h o s p ita l o rg a n iz a tio n s

and a d m in is tra tio n s would seem to be s u f f ic ie n tly s im ila r to make a degree o f s ta n d a rd iz a tio n in b a s ic forms em inently p r a c tic a b le . p i t a l s are becoming more co o rdinated each day.

In d iv id u a l hos­

N ational and re g io n a l groups

a re re q u e stin g in fo rm atio n and forms f o r purposes of comparison.

Many

p ro fe s s io n a l groups a re now recommending comprehensive s e ts of stan d a rd iz e d reco rd s in o rd er to f a c i l i t a t e ta b u la tio n of comparable d a ta .

The American

College of Surgeons, and the N ational League of Nursing Education (to m ention only two) a re fo llo w in g t h i s p r a c tic e . As p re v io u sly s t a t e d , th e so le aim and governing f a c t in p re p a rin g forms should be to pro v id e th e in fo rm ation which is needed and a c tu a lly u sed .

It

i s c le a r t h a t , in c o n sid e rin g th e personnel records which a re e s s e n tia l fo r th e n o n -p ro fe ssio n a l employees fo r a given h o s p ita l, the fo llo w in g f a c to rs should be borne in mind:

th e s iz e and fu n ctio n of the i n s t i t u t i o n ; i t s

p re se n t o rg a n iz a tio n and a d m in is tra tio n , and e s p e c ia lly the p re se n t s ta tu s and a c t i v i t i e s of th e perso n nel departm ent. N a tu ra lly th e la rg e h o s p ita l, i . e . . one w ith a la rg e number of employ­ ees to be p ro p e rly s e le c te d and developed, w ill need more ex te n siv e reco rd s than the sm all h o s p ita l.

But th e re was general agreement on th e p a r t o f th e

ju r y o f h o s p ita l a d m in is tra to rs and a u th o r itie s in the departm ents b ein g stu d ie d th a t no h o s p ita l today i s sm all enough to do w ithout personnel reco rd s a lto g e th e r o r to allow merely haphazard n o tatio n s reg ard in g employ­ e e s , which cannot be understood or f a i r l y in te rp re te d when a q u estio n re g ard in g t r a n s f e r o r prom otion, f a i r compensation, or d ischarge may

73

come up f o r co n sid e ra tio n . For t h i s reason, the Committee on P erso n n el R elatio n s of the American H o sp ital A sso ciatio n i s conducting a comprehensive stu d y o f personnel re c o rd s , the fin d in g s of which w ill be in co rp o rated in a s p e c ia l r e p o r t.

This survey

re v e a ls th a t h o s p ita ls , by and la r g e , have not developed comprehensive fo rra g iv in g a complete and accu rate conception o f th e background and experience of th e a p p lic a n t.

Yet the high r a t e of la b o r tu rn o v e r, th e problem of tap p in g

ad eq u ately sources of la b o r supply, and th e need f o r long-term planning a re bding recognized. The importance of adequate and d e ta ile d employment reco rd s regarding every a sp e c t of the employee’s s e rv ic e , from th e time he f i l l s out a n ^ p p lic a tio n form through th e term in atio n of h is employment, has been in c re a s in g ly recognized in th e m anufacturing and s e rv ic e in d u s tr ie s , a s rev ealed by a stu d y of the forms and records now in use w ith a view to t h e i r a d a p ta b ility to h o s p ita ls .

A recen t survey by th e N atio n al A sso ciatio n of M anufacturers*

of th e v ario u s employment forms used by a number of le a d in g i n d u s tr ia l companies, supplemented by the o b serv atio n s of s e v e ra l o u tstan d in g employee r e la tio n s e x p e rts, revealed s e v e ra l s ig n if ic a n t f a c to rs and tre n d s which w ill be included in t h i s b r ie f review of th e n a tu re and purpose of s e v e ra l o f th e forms l i s t e d below. From th e r e s u lts o f these surveys and s p e c ia l c o n s id e ra tio n of the forms now in use in c e r ta in la rg e h o s p ita ls , th e fo llo w in g l i s t i s drawn as sug­ g e s tiv e o f the most e s s e n tia l records f o r a h o s p ita l of 200 or more beds.

1 . N atio n al A sso ciatio n of M anufacturers, Enployment Records, la b o r Inform ation B u lle tin . No. 33 (September, 1940). This i s by f a r the most u p -to -d a te and comprehensive co m p ilatio n o f employment records which the w rite r has seen.

74

They mast o f course be ad ap ted , p o s s ib ly some o f them combined and others added, to meet th e s p e c ia l requirem ents in c e r ta in in s t i t u t i o n s : 1. 3. 3. 4, 5* 6* 7. 8. 9. 10, 11, 13, 13, 14, 15, 16, 17,

A p p lica tio n form p erso n n el r e q u is itio n form P erso n a l and employment re feren ce forms P h y sic a l exam ination and m edical record Employment s l i p Workmen*s Compensation n o tic e A ccident re p o rt A ccident reco rd M erit r a tin g forms Employee tr a n s f e r form P a y ro ll t i c k e t form Change o f r a te form Absence reco rd form A ttendance record form E x it in te rv ie w form T erm ination of s e rv ic e form Employee s e rv ic e record

The Procedure and Use of Personnel Records The u se o f p erso n n el reco rd s begins when th e a p p lic a n t f i r s t p re se n ts h im self a t the h o s p ita l f o r c o n s id e ra tio n f o r a p o s itio n .

He i s u s u a lly

req u e ste d to f i l l o ut th e a p p lic a tio n form, a f t e r a b r i e f in tro d u c to ry in te rv ie w to determ ine w hether he i s g e n e ra lly q u a lifie d f o r a p o s itio n in th e h o s p ita l.

The form is th en used as a b a s is f o r and am p lified in

th e main in te rv ie w . The im portance of a c a r e f u lly planned a p p lic a tio n form in the s e le c tio n p ro c e ss cannot be overem phasized,

During the p a s t few y e a rs—due in p a r t to

th e e x ig e n c ie s o f ihewar p ro d u ctio n program—th is form has undergone wide r e v is io n i n an attem p t to g ain a more complete and a ccu rate conception of the background and experience of the a p p lic a n t.

This d e s ire fo r f u l l e r in ­

fo rm atio n about the in d iv id u a l is in accord w ith long-term planning, which reco g n izes the " l if e - c a r e e r " m otive of the employee in h is work r e la tio n ­ s h ip s .

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The c o n ten t o f the a p p lic a tio n form can be an index of a more s e le c tiv e p erso n n el approach.

I t can h elp immeasurably in e lim in a tin g " a t th e f ro n t

door th o se a p p lic a n ts who, f o r one reason o r a n o th e r, a re judged u n s u ite d , u n q u a lifie d o r undesired"^ by the o rg a n iz a tio n . Through n e c e s s ity and ex p erien ce, the a p p lic a tio n form has been developed to g e t a t th e f a c ts reg ard in g the in d iv id u a l in a system atic and a c c u ra te manner and to a id in the f in a l s e le c tio n or r e je c tio n of the c a n d id a te . S tu d ies o f a p p lic a tio n forms re v e a l no stan d ard p r a c tic e in the d a ta req u ested , s e t-u p and s iz e o f th e rec o rd ; each is designed to meet the s p e c if ic needs of the company o r o rg a n iz a tio n .

Yet the main p o in ts reg ard in g which in f o r ­

m ation i s req u ested are much th e same.

They a r e :

Name and A ddress. This heading includes permanent and tem porary a d d re sse s, telephone number, and s o c ia l s e c u r ity number. 2 . P erso n al H isto ry and Family Record. Inform ation about th e fo llo w in g item s i s requested by most o rg an iza­ tio n s : d ate and p lac e of b i r t h ; c itiz e n s h ip and lin e of d e sc e n t; b irth p la c e o f p a re n ts ; number of dependents, and r e lig io u s a f f i l i ­ a tio n , The q u estio n o f m a rita l s ta tu s i s o fte n a d e lic a te one. A number o f companies sim ply a s k w hether m arried o r s in g le and r e ly upon the in terv iew to o b tain a d d itio n a l inform ation i f n ecessary . Yet in c re a s in g ly th is is b eing made more s p e c if ic —w ith th e words •’d iv o rced ” , "se p a ra te d " , and "widowed" in clu d ed . Many o rg a n iz a tio n s are in te r e s te d in th e liv in g s ta tu s of the in d iv id u a l, e .g . . home owner, l iv e w ith p a re n ts , board o r r e n t. The p o s itio n d e s ire d and time o f a v a i l a b i l i t y a r e fre q u e n tly ask ed . 3 . P h y sic a l C h a r a c te r is tic s . I t seems to be g e n e ra lly f e l t th a t a few s p e c ific q u estio n s r e la tin g to h e ig h t, w eight, g en eral p h y sica l c o n d itio n , and d e fe c ts a re s u f­ f i c i e n t on th e a p p lic a tio n form, the answers to ’ which w ill be supple­ mented by a d e ta ile d p h y sic a l exam ination. This s e c tio n v a r ie s , however, w ith th e n atu re of the work f o r which a p p lic a tio n i s made.

1. E v e re tt A lle n , A Study of Employment A p p licatio n Forms. (May, 1939).

NEW YORK U N I V E R S I T Y S C H O O L OF E D U C A T IO N • LIBRARY •

P ersonnel

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4 . E ducationt The name and p lac e of the g rad e, h ig h o r te c h n ic a l sch o o l, to g e th e r w ith th e number o f years a tte n d e d , o r y ear of g ra d u atio n , as w ell as s im ila r q u estio n s about c o lle g e and p o stg rad u ate stu d y , are custom­ a r i l y ask ed . Many forms provide f o r d a ta reg ard in g s p e c ia l courses of stu d y , e x tr a - c u r r ic u la r and a v o c a tio n a l a c t i v i t i e s , the answers to the l a t t e r throw ing added l ig h t upon the c h a ra c te r and in te r e s ts of th e a p p lic a n ts . Some a d m in is tra to rs f e e l i t i s not n ecessary to go in to much d e t a il f o r workers in th e lower ra n k s. But o fte n persons w ith advanced ed u ca tio n , f o r one reason and a n o th e r, fin d themselves employed w ith in th i s group, and any sound prom otional p o lic y re q u ire s a knowledge o f the a p titu d e s and tr a in in g of every employee. 5. Employment Becord. Inform ation as to the a p p lic a n t 's work experience f o r the p a st te n years (o r f o r th e l a s t th r e e , or f i v e , jo b s) i s u s u a lly requested— w ith space f o r name and ad d ress of form er em ployers, le n g th of employment, name of immediate s u p e rv is o r, n atu re of work, reason f o r le a v in g , and o c c a s io n a lly s a la r y l a s t rec e iv e d . 6 . M iscellaneous P ro v isio n f o r a tta c h in g a photograph is o fte n made. And questions which a re in c re a s in g ly found on the a p p lic a tio n form concern U.S. c itiz e n s h ip and membership in or sentim ent toward fo re ig n id e o lo g ie s. F in a lly , space i s g e n e ra lly allow ed f o r a d d itio n a l remarks by the a p p lic a n t and h is le g a l s ig n a tu re , as w e ll as f o r n o ta tio n s by the in te rv ie w e r. A specimen a p p lic a tio n form i s included in the Appendix. (See E x h ib it C ). The stu d y o f reco rd s in d ic a te s th a t in c o n s tru c tin g an a p p lic a tio n form th ese p o in ts should be borne in mind:

the q u estio n s asked should be s p e c if ­

i c a l l y r e la te d to in fo rm atio n needed f o r placem ent; the im portance of the im pression c re a te d in the mind of th e a p p lic a n t by the appearance of the form—an a sp e c t o f p u b lic r e la tio n s p o lic y —i s im portant; allow ance should be made f o r s u f f i c i e n t space f o r answers to q u e stio n s, which im plies a l e t t e r - s i z e form ; i t i s a d v isa b le to use sim ple, b r ie f q u e stio n s, to avoid ask in g q u estio n s of a d eeply p erso n a l or o ffe n siv e n a tu re , to form questions which re q u ire some thought r a th e r than those which may be answered by "yes11

77

o r "n o ."

As a lre a d y s ta te d , i t i s obvious th a t much v alu ab le inform ation nay

be o b tain ed i f the f i l l i n g out of the record i s c o n tro lle d —w e ll organized and c a r e f u lly checked by the in te rv ie w e r. Beyond th is d isc u ssio n o f the a p p lic a tio n form and i t s im portance as an a id in th e s e le c tio n p ro c ess, i t i s not w ith in the scope of t h i s th e s is to c o n sid e r in d e t a i l o r to reproduce the v ario u s reco rd s l i s t e d above and o th e rs which a re or may be in clu d ed in a h o s p ita l personnel reco rd system . Follow ing i s a b r i e f review in d ic a tin g g e n e ra lly how they were found to t i e in w ith the employment procedure. In la rg e i n s t i t u t i o n s , employment departm ents o fte n re q u ire w r itte n r e q u is itio n s from foremen o r department heads f o r a d d itio n a l employees, w ith s p e c if ic inform ation a s to the number and n atu re o f the new workers re q u ire d , wage r a t e s , e tc .

In o rd er to do a c a r e fu l s e le c tio n jo b , these

r e q u is itio n s should be se n t to th e employment o f fic e a t l e a s t tw en ty -fo u r, and p re fe ra b ly f o r ty - e ig h t, hours in advance o f the time when the workers w ill be needed. I f an a p p lic a n t im presses the in te rv ie w e r fa v o ra b ly , he i s asked to r e tu rn a t a fu tu re hour o r day; during th e in te rim h is re fe re n c e s are checked.

So th a t th e r e p lie s receiv ed may be o f d e f in ite v a lu e , referen ce

forms u s u a lly have s p e c ific q u estio n s reg ard in g h is c h a ra c te r, the nature and q u a lity o f h is work and reason fo r le a v in g .

I f no adverse inform ation

comes from th e re fe re n c e s , and i f th e re i s a r e q u is itio n f o r h e lp f o r which th e a p p lic a n t seems w ell q u a lif ie d , he is sen t to th e proper departm ent head f o r an in te rv ie w .

I f he i s approved f o r employment, he i s then sent

to th e m edical departm ent f o r a p h y sica l exam ination, th e r e s u lts of which a re recorded on a s p e c ia l form; and h is medical reco rd i s s ta r t e d .

78

When th e employee has been c e r t i f i e d by the medical departm ent, the employment departm ent may f i l l out an employment s l i p , which includes the em ployee's name, a d d re ss, m a rita l s ta t u s , telephone number and s o c ia l s e c u r ity number; s t a r t i n g d a te , time and r a t e ; h is s ig n a tu re , and such o th e r in fo rm atio n as seems d e s ir a b le .

This form may w ell be made out in

t r i p l i c a t e , one copy going to the accounting departm ent and one to the head of the departm ent employing th e new worker. The forms f o r re co rd in g the amount and method of wage payment and o th er terms of employment and b e n e f its v ary w ith the b u sin ess o f fic e accounting procedures.

The use of o th e r re c o rd s , such as a c c id e n t re p o rts and m e rit-

r a tin g form s, w ill be in d ic a te d in th e treatm en t of th ese s u b je c ts in l a t e r c h a p te rs . C e n tra liz e d P erso n n el Records an E ffe c tiv e C ontrol Technique Record keeping i s not new in h o s p ita ls .

D eta ile d records of the

p a t i e n t s ' h is to r y a re the v ery h e a rt of h o s p ita l fu n c tio n in g . im portant to have d e ta ile d in fo rm ation reg ard in g the employee.

I t is eq u a lly R e sp o n sib ility

f o r record-m aking and keeping l i e s mainly w ith th e h o s p ita l, through th e p e r­ sonnel departm ent.

During th e course of h is employment, the employee h im se lf,

as a g e n eral r u le , f i l l s out only the a p p lic a tio n form and perhaps one or more a p p lic a tio n s f o r some form of b e n e f it. In h o s p ita ls , as in b u sin ess o rg a n iz a tio n s, w ell-developed personnel procedures f o s t e r c e n tr a liz a tio n of personnel re c o rd s .

Although in the

m a jo rity o f h o s p ita ls reco rd keeping may have to be combined w ith other d u tie s , i t i s c l e a r th a t r e s p o n s ib ility th e r e fo r should be d e f in ite ly p laced and ample time allow ed f o r doing a p a in sta k in g jo b .

Department heads should

be im pressed w ith th e f a c t th a t d a ta necessary f o r c e r ta in departm ental fu n c tio n s mast be thorough and always up to d a te .

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Even where th e re is no personnel departm ent, experience shows th a t a m aster reco rd f i l e f o r a l l employees* re co rd s, form er and p re s e n t, should he k ep t in some s p e c ific executive o f f ic e , f o r check and re fe re n c e . i s s e p a ra te and d i s t i n c t from departm ent re c o rd s . s t i t u t e a c le a rin g house f o r personnel in fo rm atio n .

This

C e n tra liz e d records con­ The s u p e rv is o r, the

departm ent head, th e medical departm ent and many o th e rs may have im portant in fo rm atio n re g ard in g an employee.

B ut, u n le ss a l l th ese d a ta are c e n tr a lly

a v a ila b le , i t i s im possible to give the employee the a ll-ro u n d co n sid e ra tio n to which he i s e n t i t l e d on any p o in t a t is s u e . P ro fe s s io n a l groups are r a is in g standards c o n s ta n tly in keeping w ith the grow th and development of h o s p ita ls .

Various p ro fe s sio n a l groups,

governm ental agencies and in d iv id u a l employees fre q u e n tly req u est s p e c if ic in fo rm atio n concerning p rese n t and former w orkers.

The records should be

comprehensive enough to fu rn is h a l l inform ation which is and may be c a lle d fo r. The h o s p ita l a d m in istra tio n should know the s ta tu s o f each employee— h is p a s t rec o rd , p re se n t s itu a tio n , and the p ro sp e c ts of fu tu r e development and grow th.

The cum ulative reco rd , which fu rn is h e s a continuous s to ry of

th e em ployee's l i f e and work, is an e f fe c tiv e in d ic a to r o f in d iv id u a l and c o lle c tiv e personnel progress in the h o s p ita l. I t goes w ithout saying th a t a record system is of no valu e u n le ss i t i s u se d .

The v is i b l e index system, now much in vogue, adapts i t s s l f admir­

a b ly to th is purpose.

But a word of cau tio n may be a d v isa b le —the amount

sp en t f o r records should be d ic ta te d by t h e i r need and u s e .

In adopting a

re co rd system , management should f i r s t assu re i t s e l f th a t i t i s w ell adapted to th e h o s p ita l needs, th a t a d d itio n s to the reco rd s can be re a d ily made, and t h a t th e upkeep w ill not be out of p ro p o rtio n to i t s u s e .

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In th e d isc u s s io n in t h i s and th e preceding ch ap ter of employment procedures and perso n n el re c o rd s , no mention hs,s been made of the p a rt which unions a re in c re a s in g ly p la y in g in the d eterm in a tio n of employment s ta n d a rd s.

This f a c t i s , however, b eing in c re a s in g ly recognized by the

h o s p ita ls , and th e consensus o f opinion was found to be th a t employment stan d ard s must be determ ined upon an i n t e l l i g e n t and m utually, as w ell as s o c ia lly , s a ti s f a c t o r y b a s is . Conclusion. — R esearch, s ta n d a rd s , c o n tr o l, cooperation a re the marks o f s c i e n t i f i c procedure in human r e l a tio n s , as in the stu d y of n a tu ra l phenomena.

Records a re e s s e n tia l to the o rd e rly use of s c i e n t i f i c d a ta .

Sound personnel fu n c tio n in g i s dependent upon forms f o r an accu rate record­ in g o f f a c ts about th e in d iv id u a l worker, h is r e la tio n s to h is jo b , to h is fellow -w orker, to h is em ployer, to the community. A ccurate reco rd s of each employee and stan d ard s o f performance s c i e n t i f i c a l l y developed a re an e f f e c tiv e in d ic a to r of in d iv id u a l and c o lle c tiv e perso n n el p ro g ress in th e h o s p ita l. Chapter V i s c h ie f ly devoted to the procedures f o r reco rd in g the f a c ts about and r e g u la tin g employee r e l a tio n s —the c o n s tru c tio n and use of person­ n el reco rd s and th e im portance of c e n tr a liz e d personnel records as a technique of c o n tro l f o r h elp in g s e t up, advance and m aintain h o s p ita l sta n d a rd s. D ecisio n s, to be f a i r and sound, must be based on f a c t s —f a c ts reg ard ­ ing th e w orker, as shown by the p erso n n el re c o rd s , and f a c ts reg ard in g the work which are o b ta in a b le on ly through job a n a ly s is , th e s u b je c t Chapter VII*

of

CHAPTER VI

EMPLOYEE HEALTH AND SAFETY M INTEGRAL PART OF TRAIUIUG

At i t s in c e p tio n , th e h o s p ita l was, as th e name im p lie s, a hospice —a house fo r th e s ic k and dying.

Today i t stands as a symbol o f the

community's w i l l to h e a lth and s a f e ty . o b je c t i v i t y .

There is a d e f in ite sense of

Y et, p arad o x ical as i t may seem, i t was found th a t compara­

t i v e l y few h o s p ita ls have a c te d on th e p r in c ip le th a t care of the h e a lth of t h e i r own employees is not only s o c ia lly but a ls o econom ically sound. On th e o th e r hand, th e study o f education and tr a in in g programs in in d u stry re v e a le d w idespread re c o g n itio n of th is f a c t .

A ccordingly, h e a lth and s a fe ­

ty were among th e elem ents most s tro n g ly emphasized in th e course of employee t r a in in g and development. In i n d u s tr ia l and b u sin ess o rg a n iz a tio n s, re se a rc h has proved co n clu siv e­ l y th e h ig h s t a t i s t i c a l c o r r e la tio n between absenteeism , s ic k n e ss , i n d u s tr ia l a c c id e n ts , o ccu p atio n al d is e a s e s , h o u rs, s a n ita r y and h e a lth co n d itio n s and reduced p ro d u ctio n and p r o f i t s .

While no s im ila r a n a ly s is could be made

s p e c i f i c a l l y re g ard in g h o s p ita l employees, f o r lack of adequate re c o rd s , th e w r ite r found g en e ral agreement on the p a rt of h is "ex p ert j u r i e s ," both hos­ p i t a l a d m in istra to rs and le a d e rs in th e fu n c tio n a l areas being s tu d ie d , th a t th e r e s u l t s found in m anufacturing, commercial and s e rv ic e in d u s trie s un­ doubtedly hold tru e also in h o s p ita ls . The In cid en ce o f Employee H ealth and E ffic ie n c y The fo llo w in g p o in ts , made and c a r e fu lly s u b s ta n tia te d by D r. M ichael M. D avis, in a p ap er, e n t i t l e d "H ealth and D isease: 81

T h eir R elatio n s to

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E ffic ie n c y and Democracy in I n d u s tr y ,111 a re worthy of i n te r e s t: 1. D isease th re a te n s e f fic ie n c y and causes g re a t economic lo s s . P ro d u ctiv e power and in d u s t r ia l e ffic ie n c y depend upon the p h y sica l and m ental h e a lth of th e w orker. 2. In d u stry has a d ir e c t economic i n te r e s t in the h e a lth o f the worker hut can only express th is in te r e s t d i r e c t ly in those very lim ite d f ie ld s o f h e a lth s e rv ic e which r e l a t e to th e employees' tim e and to working co n d itio n s w ith in th e p la n t. Here management can do much, hut must recognize th a t many o f the co n d itio n s which cause d ise a se and d e te r io r a te h e a lth a r i s e in th e employees’ l i f e o u tsid e of working ho u rs. With th ese co n d itio n s in d u stry is concerned, h u t in d u stry must express th is concern through p a r tic ip a tio n in community e f­ f o r ts to promote h e a lth and to prevent and care fo r d is e a s e . Of 1,000,000 r e je c tio n s under th e S e le c tiv e S ervice A ct, 900,000 were due to p h y sic a l o r m ental and nervous d is e a s e . puts i t :

As D r. Hugh Cahot

"The most s tr i k i n g le sso n to he learn ed from th e f a c t th a t

something lik e h a lf o f those who should he th e f i t t e s t people in the country have heen r e je c te d fo r m ilita r y s e rv ic e is th a t we have heen caught sq u arely in th e tr a p o f our own complacency."

More em phasis, he

d e c la re s ought to he placed on " p o s itiv e h e a l t h . . . Today is not only a world war hut a s o c ia l re v o lu tio n .

I f th is re v o lu tio n is to avoid chaos

and bloodshed and is to r e s u l t in improved s o c ia l co n d itio n s under demo­ c r a t i c i n s t i t u t i o n s , a profound re v o lu tio n in our th in k in g in regard to m edical care is in e v ita b le .

*

1 . P resen ted in a Bureau o f P ersonnel A dm inistration conference s e rie s on th e C onservation o f I n d u s tr ia l C ap italism . February 2 , 1939 * Dr. Hugh Cahot, Lesson o f th e E e je c te e s , Survey G raphic. March, 1942. This s p e c ia l number o f th e Survey G raphic. "Witness fo r Freedom," is a v e r ita b le h e a lth in v e n to ry . I t is p re d ic a te d upon th e d o c trin e : "(Jetting f i t and keeping f i t i s more than a m edical problem, an eco­ nomic problem, a n u i t r i t i o n problem, o r a p r iv a te p erso n al problem. The t o t a l p e rs o n a lity o f each and every one of us is involved in th e human s tru g g le o f th e h i s t o r i c p re se n t; our conception of ourselves and our n eig h b o rs, our a t t i t u d e toward s o c ie ty ; our a p p lic a tio n of sc ie n c e , r e lig io n , philosophy; our w i l l , our purpose, our l i v e s , our fo rtu n e s , and our sacred honor."

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The "basic m easuring rods o f th e h e a lth o f a group a re th e r a te s of s ic k n e s s , a c c id e n t and d e a th .

The c r i t e r i a used to measure th e s o c ia l

and economic s ig n ific a n c e o f h e a lth problems among workers a r e th e fa c to rs o f tim e l o s t from work through ill n e s s or a c c id e n t, th e co st of id le n e ss , l o s t wages, and co st of m edical c a re .

Casual f a c to r s , p a r tic u la r ly those

a s s o c ia te d w ith a c c id e n ts , need be determ ined.

B roadly, they c la s s if y

them selves in to two main c a te g o rie s : ( l) environm ental f a c to r s —-working and l iv in g c o n d itio n s , and (2) p erso n al f a c to r s , both p h y sica l and m ental. The r e a l l y s ig n if ic a n t a sp e c ts to be determ ined a re ag e, p la c e , means, work, ty p e o f d i s a b i l i t y and p red isp o sin g cau ses. The p rev en tio n o f a c c id e n ts in in d u stry has receiv ed much considera­ tio n .

S a fe ty en g in eerin g and s o c ia l le g is la tio n have done much fo r th e

p ro te c tio n and m aintenance o f w orkers1 s a f e ty .

The r e s u lt has been th a t

only a sm all p ercen tag e o f a c c id e n ts in in d u stry a r e now due to mechanical fa ilu r e s .

But even here much remains to be done w ith re sp e c t to th e mental

a s p e c ts o f a c c id e n ts , p a r t ic u la r ly f a tig u e . A study by D r. L e v e re tt D. B risto l-^ , H ealth D ire c to r o f the American Telephone and T elegraph Company, showed th a t S5 per cent of workers a r e , as he terms i t , " a c c id e n t-p ro n e ." p ro p o rtio n o f a l l a c c id e n ts .

This group is re sp o n sib le f o r a la rg e

Poor atten d an ce re c o rd s , in a tte n tiv e n e s s or

w orry, u n w illin g re a c tio n s to su p e rv isio n a re c h a r a c te r is tic s of th ese workers whose d i f f i c u l t i e s a r i s e from p sy ch o lo g ical causes—f e a r , conscious o r unconscious resen tm en ts, dom estic problem s.

A co n sid erab le p ro p o rtio n of

th e t o t a l p o p u latio n s u ff e rs in m ild ways from th i s psychoneurosis, which in many cases accounts f o r th e v o c a tio n a l m is f it w ith high accid en t r a t e s .

It

1 . L.D. B r i s t o l , H ealth M aintenance in In d u s try , American Jo u rn al of P u b lic H e alth . V ol. 107, Ho. 9 , (August 29, 1936).

84

has been estim ated th a t as much as 90 per cent of a l l in d u s tr ia l ac c id e n ts a r e due to th e m ental f a c to r . Another in te r e s tin g f a c t is t h a t , g e n e ra lly speaking, th e same persons who a re most l i k e l y to have ac c id e n ts a re a lso those who have more 6ickness. I t has been found th a t th e workers w ith the h ig h e st a ccid en t r a te s a re the most freq u e n t v i s i t o r s to th e m edical departm ent. As D r. Davis has s ta te d in th e paper p rev io u sly quoted: A ll th e se s t a t i s t i c s might be summed up -under th e g en eral statem ent th a t a human being is a l l o f one p ie c e . You c a n 't s e p a ra te h is body from h is mind o r h is mind from h is body. You c a n 't se p a ra te h is work in th e p la n t from the r e s t o f h is l i f e . His working co n d itio n s in flu en c e h is e n tir e p h y sic a l and m ental l i f e , and a f f e c t h is g en eral m ental a t t i t u d e s . Conversely, h is g en eral m ental a tti tu d e s and h is nervous and p h y sic a l c o n d itio n a re in flu en ced by h is home, h is r e c re ­ a tio n and ev ery th in g th a t he does, as a husband, a w ife , or a c itiz e n , and a l l th e se a ls o a f f e c t h is conduct and h is working e ffic ie n c y w ith ­ in th e p la n t. Among th e estim a tes which have been made as to th e co sts of s ic k n e ss , th e d i r e c t c o s t to in d u stry and the f u r th e r c o s ts to th e employees and to th e community as a w hole, th e study of th e Cheney B ro th e rs, s i l k manufac­ t u r e r s , lo c a te d in South M anchester, C onnecticut, is n o ta b le .

The co sts

of sic k n e ss fo r th is p la n t o f 4500 employees were estim ated as fo llo w s: D ire c t c o s ts to in d u s try : 1. Cost o f id le n e s s , due to re p la c in g old employees w ith new ones, because o f tra n s f e r s and la y - o ff due to sick n ess $

67,000 150,000

2.

Cost o f id le n e ss due to absence from sickness

3.

Cost o f red u c tio n in production in c id e n ta l to lo sse s of v i t a l i t y o f th o se rem aining a t work, caused by illn e s s T o tal

50.000 $267,000

Costs to employees and community: 1. D ire c t lo s s o f wages because o f d i s a b i l i t y

$162,000

2. I n d ir e c t lo ss through red u c tio n o f earning c a p a c ity a f t e r il l n e s s

40.000

3 . M edical, d ie ta r y , s u rg ic a l and n u rsin g expense

45.000

4 . P u b lic expenses and c h a r ita b le r e l i e f T otal

56.000 $303,000

85 Here i s a d i r e c t lo s s to th e company, estim ated to exceed a q u a rte r of a m illio n d o lla r s a y e a r, o r about $60 p er employee; and a s t i l l la r g e r lo ss to employees and to th e community on account o f s ic k n e ss . In h o s p ita ls , w o rk ers' tim e l o s t by a c c id e n t o r i l l n e s s does not a f f e c t d i r e c t l y th e immediate p r o f i t p o te n tia l.

However, th e r e s u lts in lowered

e f f ic ie n c y , e r r o r in perform ance, reduced p ro d u c tiv ity a r e j u s t as s i g n i f i ­ c a n t. The r e s u lts o f a fo u r y e ar stu d y by th e Committee on H e a lth fu l Working Conditions o f th e N a tio n al A sso c ia tio n o f M anufacturers* has c o n c lu siv e ly proved th a t measures to p r o te c t th e h e a lth o f the n a tio n 's in d u s tr ia l workers pay dividends to employer and employee a l i k e .

The re p o rt emphasised th a t the

im portance o f e f f e c tiv e in d u s t r ia l h e a lth s e rv ic e s d u rin g th e defense produc­ tio n p erio d was u n d e rlin e d by th e e x te n t to which a c c id e n ts and i l l n e s s had been reduced by such s e rv ic e s in f a c t o r i e s .

S p e c ific red u c tio n s c ite d were:

a c c id e n t frequency, reduced 44.9 p er c e n t; o ccu p atio n al d is e a s e s , 52.8 p e r c e n t; la b o r tu rn o v e r, 2 7 .3 p e r c e n t; absenteeism , 2 9 .7 p er c e n t, and compensation in su ran ce premium, 28.8 p er c e n t. A few years ago th e U nited S ta te s P u b lic H ealth S erv ice p u b lish ed "An E stim ate o f th e M onetary Value to In d u stry o f P la n t M edical and S a fe ty S e rv ic e ."

The estim a te s were based on "estab lish m en ts in which th e in ­

d u s tr i a l a c c id e n t r a t e i s c o n sid e rab ly below th e average and in which th e re a re no occu p atio n al h e a lth h a z a rd s."

The a p p lic a tio n o f m edical and s a fe ty

measures w ith in th e p la n t, th e re p o rt s t a t e s , would b rin g a saving to th e employer o f $12,600 p er year p er 1000 employees and, in a d d itio n , about o n e -h a lf as much would be d i r e c t ly saved to th e employees by th e same m easures,

1 . N atio n al A sso ciatio n of M an ufacturers. P r a c tic e s . 1941.

Survey o f I n d u s tr ia l H ealth

86

Experience w ith i n d u s tr ia l h e a lth work in d ic a te s th a t " in a business w ith a reaso n ab ly re p re s e n ta tiv e personnel w ith re sp e c t to age and sex , w ith no o u tsta n d in g o ccu p atio n al h az a rd s, t o t a l absence ra te s should be c o n tro lle d a t about 4 per cent of working tim e.

S ickness d i s a b i l i t y

should not exceed 2 p er cent o f working tirae."^ In co n sid erin g th e need f o r developing h e a lth and s a fe ty standards in h o s p ita l management, i t should be borne in mind th a t th e American College o f Surgeons has worked out a minimum stan d ard fo r m edical s e rv ic e in indue*. t r y , and th a t i t has made a f i e l d survey of in d u s tr ia l m edical work in many p e sta b lish m e n ts. A pamphlet p ublished by the C ollege in 1938 s ta te s Up to October 1 , 1937, a t o t a l o f 1,657 in d u s tr ia l esta b lish m en ts, re p re s e n tin g approxim ately 5,500,000 employees, has been surveyed, of which number 843 o r 50 per cent have been f u ll y or p ro v isio n ­ a l l y approved. A C e r tif ic a te o f Approval is granted to an in ­ d u s t r i a l esta b lish m en t in which th e m edical o rg an iz a tio n and s e rv ic e a re f u l l y approved and a re of such a n a tu re as to give reaso n ab le assu ran ce of continued compliance w ith th e Minimum S tandard. Our problem is to t r a n s la te th ese d a ta in to terms o f h o s p ita l admin­ is tra tio n .

T h eir a p p l i c a b i l i t y is s u b s ta n tia te d in a re p o rt prepared by the

N atio n a l S a fe ty Council® based on th e a ccid en t prev en tio n experience o f a number o f h o s p ita ls .

The re p o rt s ta t e s :

In v e s tig a tio n s have shown th a t th e re a re s p e c ific accid en t hazards in h o s p ita ls a g a in s t which s p e c ia l means of p ro te c tio n a re necessary , a ls o th a t many o f th e in ju r ie s received in h o s p ita ls a re due to causes common to o th e r f ie ld s o f a c t i v i t y . With re sp e c t to causes o f a c c id e n ts , the re p o rt continues:

1 . R.S. Quimby and W.H, Lange, P erso n al H ealth S e rv ic e . A d m in istra tio n , pp. 1252-1269.

Handbook of B usiness

2 . M.N. Newquist, M edical S erv ice In In d u stry and Workmens Compensation Laws. 3 . N atio n al S a fe ty C ouncil, S a fe ty in H o sp ita ls. Pamphlets C. E. 3 (O u tlin e ), p. 1.

I n d u s tr ia l S afety S e rie s

87

P r a c tic a lly a l l in ju r ie s to p a tie n ts , employees and v i s i t o r s in h o s p ita ls are due to one o r more of the fo llo w in g causes: a . Lack of f a i lu r e to use s u ita b le safeguards a g a in s t f i r e and c o n fla g ra tio n . b . Lack o f or f a i lu r e to use proper safeguards in handling, s to r in g and u sin g chem icals. c . Unsafe o r im properly used e l e c t r i c a l equipment. d . Im properly used or guarded mechanical equipm ent. e . Unsafe c o n d itio n s of f lo o r s , s t a i r s and lan d in g s. f . Hot substances o r a r t i c l e s . g . Contact w ith sharp o b je c ts . h . Fumes from r e f r ig e r a tin g p la n ts . i . Lack of good housekeeping. P rev en tiv e measures w ith re sp e c t to each of these causes are given in the o u tlin e . Hazards in h o s p ita ls are n a tu r a lly not as p re v a le n t as in in d u stry which d eals so la r g e ly in machine p ro d u ctio n .

However, they do have v u l­

n e ra b le sp o ts and th ese jobs should have p a r tic u la r a tte n tio n .

A ccident

re p o rts show a f t e r s lip p e ry flo o r s the g r e a te s t number of a c c id e n ts in th e lau n d ry , en g in eerin g and k itc h e n departm ents.

E special p recau tio n s

a lso should be taken f o r w indow -cleaners, ambulance d r iv e r s , and o th ers p a r t ic u la r l y hazardous d u tie s . While no la rg e sc a le a n a ly s is of il l n e s s and accid en t among h o s p ita l workers in r e la tio n to employee morale and e f fic ie n c y has been made, th e need f o r e f fe c tiv e h e a lth and s a fe ty work i s being in c re a s in g ly recognized. In an a r t i c l e on "Employee H ealth S e rv ic e ," Robert E. Neff wrote The h o s p ita l i s a beacon l i g h t in the promotion of p u b lic h e a lth b u t too o fte n i s la x in the care of the h e a lth of i t s own em­ ployees . In d u stry has convinced i t s e l f of the economic soundness of h e a lth se rv ic e f o r i t s employees and the same reasons alone are s u f f ic ie n t to prompt the h o s p ita l to e s ta b lis h a s im ila r s e rv ic e . We estim ate th a t the p ro d u c tiv ity of our employees i s cu t by about 2 p e r cent by acu te i l l n e s s and a c c id e n ts . The a d d itio n a l delays due to d is ­ turbance of ro u tin e , tr a in in g of new employees and g e n e ra lly lowered e f fic ie n c y reduce p ro d u c tiv ity of the h o s p ita l even more.

1. Robert E. N eff, H o s p ita ls . (January, 1940)

88

Our s a la r y budgets mast make allow ance f o r the payment of s u b s ti­ tu te s b u t i f t h i s sum were devoted to a h e a lth and a c c id e n t p re ­ v e n tio n program our lo s s e s in th is d ir e c tio n would be ap p reciab ly reduced. The h e a lth program should en v isio n every kind of s e rv ic e necessary f o r th e p rev en tio n and cure o f d is e a s e , f o r promotion of f u l l mental and p h y sic a l e f fic ie n c y , and a program o f a c c id e n t p rev en tio n . Everyone reco g n izes th e v alue o f h e a lth education programs and the h o s p ita l p erso n n el should be regarded as a group fo r s p e c ia l a t te n ­ tio n in t h i s program. Committees o f th e American H o sp ital A sso ciatio n a re g iv in g much a tt e n t i o n now to h e a lth and s a f e ty .

Close co o p eratio n w ith the n a tio n a l

S a fe ty Council i s b rin g in g the im portance of education in h e a lth and s a f e ­ ty to the a t te n tio n o f h o s p ita l management.

A re c e n t survey shows th a t

more and more h o s p ita ls a re g iv in g se rio u s thought to h e a lth s e rv ic e s fo r employees, and th e ex te n siv e n ess o f the program v a rie s w ith the s iz e of the i n s t i t u t i o n .

However, t h i s p r a c tic e i s f a r from u n iv e r s a l.

A d m in istratio n o f H ealth and S afety Work The most advanced h o s p ita l managements, e s p e c ia lly in the la rg e u n iv e r s ity s e t- u p s , a re c o n sid e rin g and ad opting the follow ing h e a lth p ro v is io n s , which a re g e n e ra lly accepted in p ro g re ssiv e b u sin ess con­ cerns : 1 . P h y sic a l exam ination. I t i s a f a i r l y gen eral p r a c tic e to r e ­ q u ire a p h y sic a l exam ination b efo re an a p p lic a n t i s f i n a l l y h ire d , as th e b a s is o f a l l subsequent c o n ta c ts between worker and d o c to r and in d iv id u a l suggestions on h e a lth m easures. The o b je c tiv e s o f th e p h y s ic a l exam ination a re ( l) to d e te r ­ mine p h y sica l f i t n e s s ; (2) to a ssu re proper placem ent; (3) to d e te c t and c o rre c t minor d e fe c ts in accepted a p p lic a n ts ; (4) to id e n tif y d e fe c ts which may c o n trib u te to serio u s a c c id e n ts ; (5) to p r o te c t o th e r employees and p a tie n ts from new sources of con­ tag io n o r o th e r a f f l i c t i o n s . The success o f the p h y sic a l exam ination depends upon s e v e ra l f a c to r s , among which a re ( l) the co o p eratio n of the worker, who should be made to r e a liz e th e b e n e f its to him of a check-up of

89

h is c o n d itio n ; (2) th e p e r s o n a lity of the examining p h y sic ia n ; (3) th e emphasis upon c o r re c t placement and c o rre c tio n of de­ f e c ts r a th e r th an on r e je c tio n ; and (4) the c a re fu l follow -up o f workers to whom c o rre c tiv e suggestions have been made. 2 . P e rio d ic Reexam ination. In c re a s in g ly , an annual reexam ination i s being re q u ire d o f a l l employees as a prev en tiv e and educa­ tio n a l m easure. Only through such a p e rio d ic check-up is i t p o s s ib le f o r th e h e a lth program to develop i n t e l l i g e n t l y and c o n s tr u c tiv e ly . For such co n tacts enable the m edical d iv is io n s t a f f to ad ap t t h e i r p rev en tiv e program to the s p e c ia l needs of each in d iv id u a l and thus give i t the utm ost value and e f f e c t . 3 . F i r s t a id tre a tm e n t. 4 . Treatm ent o f minor a ilm e n ts . 5. S upervision of maintenance of a h e a lth fu l working environm ent— re d u c tio n of occupational d isease hazards; fa tig u e d im in u tio n . 6 . Home v i s i t a t i o n . A d m in istrato rs w ell know of th e e x c e lle n t r e s u lts which a re being achieved through th e ex ten siv e h e a lth measures ap p lied in th e i n t e r e s t of stu d e n t nurse program s.

Through th e means of thorough p h y sic a l exam ination

upon adm ission, in c lu d in g ro u tin e la b o ra to ry and x -ray check-up, and f o l ­ lowed up p e r io d ic a lly , time l o s t through nurse i l l n e s s and stu d e n t nurse s e p a ra tio n because o f i l l n e s s have been reduced alm ost to a minimum.

This

stu d y p o in ts to the wisdom o f s im ila r procedure and r e s u lts f o r la y workers and management. H ealth and S afety Education I t goes w ithout saying th a t th e r e s u lts of any h e a lth and s a fe ty pro ­ gram a r e measured la r g e ly by the degree of education and the time and e f f o r t p u t in to i t . To p la n an ed u c atio n al program fo r s a fe ty and h e a lth m aintenance c a lls f o r an u n d erstan d in g of s p e c if ic f a c ts and co n d itio n s needing improvement in any p a r t ic u la r s it u a t i o n . th e re c o rd s .

These f a c ts should be revealed by an a n a ly s is of

90 As an example, the fo llo w in g ta b le shows th e number and percentage of a c c id e n ts acco rd in g to departm ents a t the P aterso n General H o sp ita l, P a te rso n , Hew J e rs e y , d u rin g th e y ear 1941; TABLE I AH ANALYSIS BY DEPARTMENTS OF EMPLOYEE ACCIDENTS OCCURRING IN 1941 AT THE PATERSON GENERAL HOSPITAL, PATERSON, N .J.

Department

A ccidents P ercentage Number

Housekeeping . . . . . . . . . . . . . . (E lev ato r o p erato r 4$, Laundry 26$, Maids 31$, P o r te r s , 35$, S erving Room 4 $ ).

43

47.2

Nursing ................................................................ (Nurses 58$, n o n -p ro fessio n als 42$)

31

34.1

L a b o ra to r y .......................................................

4

04.4

D ie ta ry

......................... .....................................

5

05.5

In te rn s

. . . . • •

1

01.1

A d m in istratio n (C lerk) ..................................

1

01.1

P hysio th erap y

1

.......................... . . .

. . . . . . .

......................

01.1 ;

Storeroom E ngineering

. .......................................................

1

....................................................... T o tal

91

01.1 j

04.4 100.0 . ............ _ .......

Of f i r s t im portance, th e n , i s a w ell-planned and adm inistered record system .

One of the major fu n c tio n s o f the m edical d iv is io n i s the c a re ­

f u l reco rd in g of a l l cases tr e a te d .

The frequency of cases f o r the v ario u s

departm ents should be stu d ie d from time to tim e by the re sp o n sib le o f f i c e r . An a n a ly s is of a c c id e n ts in the th re e main groups—m echanical, p h y sio lo g i­ c a l, and m ental—fre q u e n tly su g g ests the remedy.

A c a re fu l review of

follow -up records i n comparison w ith the i n i t i a l h irin g p h y s ic a l exam ination

91

w ill fre q u e n tly re v e a l d e fe c ts th a t have no s p e c ia l in flu e n c e upon the w o rk e r's e ffic ie n c y and o th ers th a t are a danger s ig n a l f o r c e r ta in occu­ p a tio n s .

A ty p ic a l a cc id e n t re p o rt form, which i s in use a t th e P aterson

General H o s p ita l, P a te rso n , Hew J e rs e y , i s included in the Appendix. (See E x h ib it D) Regarding th e im portance of a ccid en t records and a n a ly s is , W illiam B. S e lz e r, S uperin ten d en t of Bronx H o sp ital of Hew York, w r ite s :1 Every a c c id e n t, no m atte r how t r i v i a l , should be reco rd ed , re g a rd ­ le s s of whether o r not an in ju ry to a person o r damage to p ro p e rty has r e s u lte d . These records Bhould be se n t to one p erso n , p r e f e r ­ a b ly the a s s i s ta n t a d m in istra to r o r personnel manager, and should co n ta in th e name of th e in ju re d p erso n , d ate of in ju r y , treatm ent g iv en , tim e l o s t , cause o f in ju ry and s te p s taken to prev en t a re c u rre n c e . P ro g ress in e lim in a tin g or p rev en tin g a c c id e n ts may be made through an a n a ly s is of a s e r ie s o f a c c id e n ts . I t i s d i f f i c u l t to make a uniform s e t of ru le s th a t would be a p p lic a b le to a l l h o s p ita ls . In one h o s p ita l a c e r ta in type of a ccid en t may be more p re v a le n t than in an o th er because of the p a r tic u la r f a c i l i t i e s o r equipment o r the p h y s ic a l lo c a tio n of c e r ta in departm ents in th a t h o s p ita l. Analyses of a c c id e n ts should be made not only by the a d m in is tra tio n b u t a lso by a s a f e ty committee c o n s is tin g o f employees from each departm ent. This committee should meet fre q u e n tly and th e R ep resen tativ e of each departm ent should re p o rt the f a c ts brought out and the conclusions reached, p a r t ic u la r l y aS they a f f e c t h is departm ent. Persons in ju re d in a ccid en ts should be asked to appear b efo re th is com m ittee, not to be reprimanded but to be given an o p p o rtu n ity to ex p lain th e n a tu re of th e a ccid en t and the cause of i t s occurrence. The appearance o f the in ju re d person gives the committee an oppor­ tu n ity to o b ta in the f a c ts of the a ccid en t a t f i r s t hand and a t the same time gives th e employee the f e e lin g t h a t he i s accountable to somebody f o r h is c a re le s s n e s s . I f a p a r t ic u la r departm ent—the d ie ta r y departm ent, f o r example— should re p o rt a s e r ie s of ac c id e n ts of a minor n a tu re , such as cu ts o r in fe c tio n s from s t e e l wool, the s a f e ty committee would study the causes and make recommendations fo r e lim in a tin g these minor a c c id e n ts . I t i s only by th i s type of stu d y and a n a ly s is th a t the source of ac­ c id e n ts can be e s ta b lis h e d and e f f o r ts co n cen trated on e lim in a tin g th e cau ses. Both in d iv id u a l and group m eetings are employed to make th is work e ffe c tiv e .

The p h y sic a l exam ination and the re-exam ination c o n s titu te ,

o f c o u rse, the f i r s t v i t a l p o in ts of c o n tact out of which much subsequent 1. E ducating Enployees f o r S a fe ty . The Modern H o s p ita l, (O ctober, 1938).

92

p re v en tiv e work can develop.

Encouraging in d iv id u a ls to b rin g minor

ailm en ts f o r c o n s id e ra tio n and encouraging the m edical departm ent to fa m ilia r iz e i t s e l f w ith th e p e c u lia r a c c id e n t, occupational d is e a s e , and p h y sic a l and m ental s t r a i n hazards of the e n te rp ris e may be the means of beginning p re v e n tiv e work. An im portant f a c to r in th e success of a h e a lth and s a f e ty program i s found to be the a t t i t u d e o f the su p e rv is o rs .

The program mast be "sold"

so th a t a l l w ill cooperate in c a rry in g out h e a lth and s a f e ty ru le s and a c tiv itie s .

The a d m in is tr a tio n ’ s s a fe ty p o lic y becomes e f f e c tiv e only as

i t s ed u ca tio n a l in flu e n c e g alv an izes the e n tir e o rg an iz a tio n in to co n sta n t a tte n tio n to sa fe p r a c tic e s . One method of a s s u rin g employee in te r e s t in a h e a lth program i s the form ation o f an employee’s h e a lth committee.

Such a conm ittee may be

e i t h e r appointed o r e le c te d , w ith p e rio d ic r o ta tio n of members.

The mem­

b e rs should n a tu r a lly be re p re s e n ta tiv e of those d ir e c tly a f fe c te d by i t s a c tio n s .

In h o s p ita ls , such a committee lo g ic a lly includes th e su p e rin ­

ten d en t o r one o f th e a s s i s t a n t s u p e rin te n d e n ts, the p erso n n el manager ( in th e la rg e i n s t i t u t i o n ) , a departm ent head, the en g in eer o r b u ild in g su p e rin te n d e n t, a worker re p re s e n ta tiv e , and perhaps th e Chairman of the P ersonnel Committee of th e Board.

They Bhould be encouraged to consider

and re p o rt on s p e c ia l h e a lth problems p e c u lia r to the h o s p ita l. In la rg e h o s p ita ls th e s a f e ty work comes under th e su p e rv isio n of an a s s i s ta n t su p erin ten d en t o r the en g in eer.

There may be ( l) a gen eral s a fe ty

committee, (2) a s u p e rv is o rs ' committee, and (3) a j o i n t management and em­ ployee committee.

The fu n c tio n of the f i r s t i s gen eral su p erv iso ry charge

of s a fe ty m a tte rs , sin c e i t u s u a lly includes as a s s i s ta n t a d m in is tra to r, one or two departm ent heads, and th e head mechanical maintenance man.

This

93

committee i s re sp o n sib le f o r th e establishm ent of the e n tir e s a fe ty p o lic y . The su p e rv iso rs committee is designed to help i n every p o s sib le way to keep th e su p e rv iso ry group c o n tin u a lly hammering away a t the s a fe ty id ea in job in s tr u c tio n and d a ily ro u tin e .

The fu n c tio n o f the j o in t management-employ­

ee committee i s to review c a r e f u lly a l l a c c id e n ts , to study p rev en tiv e m ethods, to s tim u la te and m aintain enthusiasm in s a fe ty c o n te s ts , to receiv e a l l s a f e ty su g g estio n s from th e w orkers. This j o i n t committee may be appointed by th e management o r , b e t t e r s t i l l , be e le c te d d ep artm en tally by th e workers them selves, and the membership ro ­ ta te d every s ix months in o rd er th a t as many employees as p o s sib le w ill have th e b e n e f it of t h i s in te n s iv e s a f e ty in s tr u c tio n and stu d y . may even have t h e i r own committees f o r th is same purpose.

Large departm ents Workers serv in g on

such bodies come to le a r n , as th ey w ill in no o th e r way, th a t accid en t p re ­ v e n tio n im plies co o p eratio n o f th e workers no le s s than of th e management and s u p e rv is o rs . A study o f th e l i t e r a t u r e on th e su b je c t included th e fo llo w in g among th e te s te d methods o f s a f e ty ed u catio n and propaganda a r e : s a f e ty c o n te sts among v ario u s d epartm ents, b u l l e t i n b o ard s, su g g estio n system s, s a fe ty r a l l i e s , a r t i c l e s in employee m agazines, s lip s in the pay envelope, s p e c ia l conferences of workers on s a f e ty codes.

B ut, a f t e r a l l i s s a id and done, i t

i s c le a r th a t a major r e lia n c e must be placed upon having each worker, as he le a rn s the d e t a i l s of h is jo b , le a r n the sa fe way to do i t .

I f proper in ­

s is te n c e i s placed on safe p r a c tic e a t th is s ta g e , so th a t i t becomes a p a r t o f th e w orker’ s a t t i t u d e , ranch l a t e r work can be minimized.

As Tead and

M etcalf1 express i t :

1, Ordway Tead and H.C. M etcalf, Personnel A d m in istratio n : I t s P rin c ip le s and P r a c tic e , p . 115.

94

The h e a t g u aran tee o f s a f e ty in an o rg a n iz a tio n i s a body of c a r e fu l and a l e r t w orkers. C arefulness and a le r tn e s s a re in ta n g ib le a s s e ts which are o f g re a t value not alo n e i n r e ­ ducing a c c id e n ts b u t in e f f e c tin g economies in o th e r ways. Like o th e r a s s e ts th ey may be secured and h eld only a t a p r ic e . The p r ic e i s absence of d riv e and f a tig u e , a p o lic y throughout th e works which s e ts l i f e above d o l l a r s , an edu­ c a tio n a l campaign which t r a n s la te s th i s p o lic y in to a demand f o r a q u a lity product made under wholesome co n d itio n s and by workers who have learn ed how to work s a f e ly a t t h e i r ta sk s and who f e e l them selves f a i r l y tr e a te d . A s a fe ty program which i s to be su c c e ssfu l cannot, in s h o r t, be sep arate d from th e p erso n n el program as a whole. Only when i t i s dominated by a humane p o in t of view and d ire c te d by one who understands and v alu es men as human b e in g s, w ill a program fu n c tio n in the s u s ta in e d , e d u c a tio n a l, and p e r ­ so n al way th a t i t should i f i t i s to produce the b e s t re s u lts .

C onclusion. — This c h ap ter i s based upon th e prem ise th a t a whole, wholesome p e r s o n a lity is e s s e n t ia l to job perform ance o f high q u a lity . This should be recognized e s p e c ia lly by the h o s p ita l, which now re p re ­ se n ts th e community's w ill to h e a lth . The importance of a sound h e a lth program and the clo se r e la tio n s between h e a lth and s a f e ty a re s tr e s s e d .

The a c c id e n t problem i s ever

w ith us and accid en t-p ro n en ess is a m a tte r c a llin g f o r c o n sta n t v i g i ­ la n c e .

As revealed by th e s tu d ie s c ite d , the c o s t to w orkers, to

i n s t i t u t i o n s , to s o c ie ty a t la rg e i s stag g e rin g when expressed in money v a lu e , to say n o thing about s u ffe rin g and s h a tte r e d l i v e s .

H o sp ital

a u th o r itie s a re w ell aware of the high co st o f workmen's compensation in su ran ce to a l l i n s t i t u t i o n s .

R ates a re based on ex p erien ce.

A

s e rio u s lo s s in any one y ear s e rio u s ly a f f e c ts th e premium f o r subse­ quent y e a rs .

The o ld adage—"A s t i c h in time saves n in e "—has very

p r a c t i c a l a p p lic a tio n s .

95

The im portance of and th e techniques f o r h e a lth and s a f e ty educa­ tio n as th ey r e la te to the broader education and tra in in g program envisaged f o r th e h o s p ita l employee a re here d e ta ile d .

CHAPTER VII

SALARY ADMINISTRATION - JOB ANALYSIS AND EVALUATION

Job a n a ly s is , th e major s u b je c t o f th is c h a p te r, was found to b ear a dual re la tio n s h ip to employee growth and tr a in in g , e s p e c ia lly in p ro g res­ siv e in d u s tr ia l p r a c t i c e .

Ab p re v io u sly s tr e s s e d , i t p ro v id e s, in the f i r s t

in s ta n c e , th e f a c ts n ecessary f o r a thorough knowledge o f th e job f o r which a worker is to be h ir e d .

Secondly, i t provides

the b a s is f o r a sound wage

program, f o r f a i r l y gauging th e jo b ’s w orth. In a war economy, even more than in normal tim es, two fo rc e s p a r tic u la r emphasis on th e th in k in g of wage e a rn e rs :

a c t w ith

(1) the d e s ire f o r

s ta t u s —job s e c u r ity , and (2) in c re a sin g income, in clu d in g re c o g n itio n and o p p o rtu n ity f o r advancement.

I t i s a sim ple, psychological f a c t th a t the

re c o g n itio n o f th e se b a s ic human d riv e s i s e s s e n tia l to se c u rin g employee e f fic ie n c y —employee i n t e r e s t in g iv in g the g r e a te s t amount and b e s t q u a lity of s e rv ic e .

Yet h o s p ita l a d m in istra to rs know a l l too w ell th a t in a war

economy the d e s ire f o r in c re a se d income tak es precedence in most cases over fa c to rs o f permanent s e c u r ity , and th a t is one o f the most se rio u s personnel problems w ith which they have to contend today. Com paratively l i t t l e o f th e s o c ia l- la b o r le g i s l a t i o n which has c r y s t a l ­ liz e d the changing tre n d s w ith re sp e c t to in d u stry has d i r e c t ly a ffe c te d h o s p ita ls throughout the co u n try .

H o sp ital a u th o r itie s have c o n s is te n tly ,

perhaps r ig h t f u l l y so , req u ested exemption because of t h e i r c h a rita b le s t a t u s . Yet th e re is a school o f thought among a d m in istra to rs th a t h o s p ita ls w ill

96

97

soon be fo rc ed to compete s u c c e s s fu lly w ith o u tsid e in flu e n c e s or be w illin g to sa d d le them selves w ith the type of workers who are unable to render a r e a d ily s a la b le s e rv ic e elsew here.

T herefore, i t seems im portant f o r the

com pleteness o f t h i s t h e s i s , th a t a b r ie f review of the development of s o c ia l th in k in g and l e g is la tio n over the y e a rs, as rev ealed by a wide amount of rea d in g on the s u b je c t,* be recorded here f o r fu tu re guidance in h o s p ita l p erso n n el p r in c ip le s and p rac tice* F ac to rs in a Sound Wage Program Wages and hours c o n s titu te two of the major terms of work r e la tio n s . As to hours—we have as y e t no s t r i c t l y s c i e n t i f i c d a ta to prove what le n g th of working day i s most productive in a sense which tak es account of b o th o utput and human energy and the number of employables to be provided fo r.

Since human f a c to rs and com petitive c o n d itio n s p la y a la rg e p a r t,

o th e r c o n sid e ra tio n s than science help to determ ine the le n g th of th e work­ ing day and week.

With the growth of h o s p ita ls , the im portant th in g to b e a r

in mind i s th a t some d e f in ite p o lic y on hours and working p erio d s should be ad o p ted . Good management does h ot w ait u n t i l tim es o f s tr e s s to determ ine work­ in g p e rio d s which attem p t to conform to in d iv id u a l and group d e s ir e s . H o sp ita ls must recognize th e double r e s p o n s ib ility of employer and c u sto d ia n . In th e l a t t e r r o le , i t must co n sid er the h e a lth , home, s o c ia l l i f e , educa­ t i o n a l o p p o rtu n ity , re c re a tio n , l o y a ltie s and s a ti s f a c to r y s e rv ic e of employees as th ey a f f e c t and a re a ffe c te d by p o lic ie s reg ard in g working p e r io d s .

In th e form er, i t must adopt sound p o lic ie s reg ard in g re g u la r

* E s p e c ia lly Methods of B u ild ing I n d u s tr ia l Self-Government and E ffe c tin g Sound Income D is tr ib u tio n , a comprehensive stu d y by the Bureau of P ersonnel A d m in istratio n , 1936 (unpublished)•

9§

hours o f work, and o v ertim e, n ig h t s h i f t s , Sunday a r ^ h o lid ay s e rv ic e , and v a c a tio n s . Hours o f work in th e h o s p ita l have been d e f in ite ly a f fe c te d from w ith o u t, and a s in c e re attem p t to meet the number of working hours common in th e community fo r s im ila r jobs made.

Older p ro fe s s io n a l personnel

b o a st of th e 20-hour day o f former y e a rs .

Tw enty-five years ago n u rsin g

s e rv ic e in th e home was on a 24-hour b a s is . from tw elve to te n h o u rs.

This was reduced in h o s p ita ls

The eig h t-h o u r day fo r s p e c ia l nurses is a com­

p a r a tiv e ly re c e n t in n o v a tio n , Regarding p re se n t h o s p ita l p o lic y and p ra c tic e s on hours and working p e rio d s , th e Augustine^"

study shows th a t "th e averages fo r hours of work

seem reaso n ab le in le n g th o f sp read , working hours per day, p er week and in tim e o ff per week.

Workers in the South g e n e ra lly have longer h o u rs,

w hile th o se i n th e W e s t... have th e s h o r te s t," v a r ia tio n in le n g th o f working p e rio d s.

There i s , however, wide

The p resen t tre n d , in flu en ced

by in c re a sin g s t a t e l e g i s l a t i o n , i s toward an eig h t-h o u r day and f o r t y e ig h t hour week.

Men more o fte n than women re c e iv e a f u l l day o f f .

The

average tim e allow ance fo r meals is t h i r t y m inutes; th e range extending from f i f t e e n m inutes to one hour.

Enployees working overtim e, which is

re q u ire d in q u ite a number of i n s t i t u t i o n s , do n o t, in th e m a jo rity of c a s e s, re c e iv e pay fo r th i s a d d itio r a l s e rv ic e .

More o fte n a correspond­

ing amount o f tim e o ff duty is given to m aintain the scheduled work week. With re sp e c t to wages fundam ental questions co n fro n tin g h o s p ita l management a r e : 1, What is a f a i r day*s serv ic e ?

1 Grace M. A ugustine, Labor P o lic ie s in H o sp ita ls, D ie te tic A sso ciatio n (May 1938).

Jo u rn al o f American

99

2 . What is a f a i r day*s pay fo r a s c i e n t i f i c a l l y determ ined se rv ice? As in d ic a te d by s c i e n t i f i c jo b e v a lu a tio n procedures now c u rre n t in in d u s try , th e number o f q u estio n s re le v a n t to the fix in g of a f a i r wage is much la r g e r th an is u s u a lly supposed.

The whole range of f in a n c ia l,

te c h n ic a l, economic, p e rso n n el, s o c ia l, and e th ic a l questions p e rta in in g to an o rg a n iz a tio n is involved,

A sound wage p lan takes in to considera­

tio n a number o f elem ents, in clu d in g th e fo llo w in g :^ 1 , The minimum wage w i l l b ear a c lo se r e la tio n to th e co st of liv in g . I t w ill be enough to m ain tain th e pro d u ctiv e power o f th e w orker, enough to p reserv e h e a lth , v ig o r and s tre n g th . The tren d in h o s p ita ls has been to reduce as f a r as p o s sib le wages on a cash b a s is , ta k in g in to eo x E id eratio n p e r q u is ite s o ffered in l i e u of cash . Workers re c e iv in g f u l l m aintenance as p a rt o f th e wage increm ent a re of course not so se v e re ly a ffe c te d by changes in th e co st of liv in g as a re th o se who receiv e th e i r f u l l wages in cash. 2, Beyond t h i s p ro v is io n , th e wage and s a la ry program w ill be r e ­ la te d to amount and q u a lity o f output and s e rv ic e , 3 , I t w ill note time f a c to r s —le n g th o f working day, r e g u la r ity , e tc , 4 , I t w ill r e l a t e i t s e l f to th e hazards o f th e jo b , d isag reeab le char­ a c te r o f th e work, e t c , 5 , I t w ill reco g n ize p revious education n ecessary , and the amount of jo b in s tr u c tio n r e q u ire d . The wage should be commensurate w ith s k i l l and e f f o r t . 6 , I t w i l l be r e la te d to th e number of major processes th e worker can perform , th e r e s p o n s i b il itie s he b e a rs , h is cooperation and g en eral conduct, 7, I t w i l l perm it a g ra d u a lly r is i n g stan d ard of l i f e f o r th e group, 8 , I t should have some d e f in ite r e la tio n to th e e th ic a l standards of wage j u s t i c e , 9 , Wages must be governed i n p a r t by lo c a l and com petitive c o n d itio n s, w ith due reg ard fo r th e m aintenance o f a reasonable standard o f liv i n g .

1. Bureau of P erso n n el A d m in istra tio n , Methods of B uilding I n d u s tr ia l S e lf Government and E ffe c tin g Sound Income D is tr ib u tio n . 1936 (unp u b lish ed ), pp, 110~111,

100

A Living .Wage The b a s ic claim to m a te ria l goods is human need s.

While th e p r in c ip le

o f human needs cannot he accepted as a r u le fo r complete wage j u s t i c e , s o c ie ty i s in c re a sin g ly demanding th a t th e minimum stan d ard of wage j u s t i c e be safeguarded in every l i n e o f endeavor.

The f a c t o f needs is f i r s t ; then

comes th e method o f most advantageously s a tis f y in g them. The r ig h t to a decent liv e lih o o d means c o n c re te ly th e r ig h t to a l i v ­ ing wage.

I t is th e prim ary r ig h t o f every c itiz e n to receiv e a wage

commensurate w ith th e n e c e s s itie s o f l i f e , which w i l l not degrade him; fo r a low m a te ria l stan d a rd in v a ria b ly involves a low m ental and moral stan d ard ; and th e community as a whole s u ff e rs i f th e c itiz e n s a re not p ro p e rly com­ p en sated ,

The elem ents of a decent minimum stan d ard of l i v i r g have been

w ell sunmarized by D r. Ryan,* as follow s: . . . food, c lo th in g and housing s u f f ic ie n t in q u a n tity and q u a lity to m ain tain th e worker in normal h e a lth , in elem entary com fort, and in an environment s u ita b le to the p ro te c tio n of m o ra lity and r e lig io n , s u f f ic ie n t p ro v is io n f o r th e f u tu r e to b rin g elem entary contentm ent, and s e c u r ity a g a in s t s ic k n e ss , accid en t and in v a lid ity ; and s u f f ic ie n t o p p o rtu n ity o f r e c r e a tio n , s o c ia l in te rc o u rs e , educa­ tio n , and church-membership to conserve h e a lth and s tre n g th and to render p o s sib le in some degree th e e x e rc ise of th e higher f a c u l t ie s . I t has been c o n s is te n tly held by stu d e n ts o f in d u s tr ia l human r e la tio n s , by th e c o u rts , and by a r b i t r a t o r s in d ecid in g wage issu e s between employers and employees th a t th e payment of a liv in g wage is a f i r s t o b lig a tio n upon th e employer.

I t would seem th a t th is p r in c ip le o f wage j u s t i c e should be

accepted as covering h o s p ita l employees as w e ll as those engaged in th e pro­ d u c tiv e p ro c e sse s.

1,

John A. Ryan, D is tr ib u tiv e J u s t i c e .

101

The old th eo ry o f " th e law o f wages"—*that la b o r was a commodity, w ith th e p ric e th e re fo r fix e d by th e in te rp la y o f the fo rc e s o f supply and demand—receiv ed a setb ack when Congress ordained i n th e Clhyton Act in 1916 th a t la b o r is not a commodity.

F u rth e r, th e Labor P ro v isio n s

o f th e Peace T reaty o f V e r s a ille s , in 1919, provided:

" In f a c t and in

r ig h t th e la b o r o f a human beixg s h a ll not be tr e a te d as merchandise or as an a r t i c l e of commerce," Minimum wage l e g i s l a t i o n is based upon th is p r in c ip le of th e r ig h t o f each worker to a liv in g wage. n e a rly f i f t y y e a rs . grew

I t has been in fo rc e in A u s tra lia fo r

In Great B r ita in th e Trade Board A ct, passed in 1909,

out of a campaign a g a in s t sw eatin g .

I t provided fo r r e p re s e n ta tiv e

boards to f ix minimum r a te s o f pay i n s p e c ifie d in d u s tr ie s where wages were unduly low, th ese r a te s to apply to both men and women.

The Coal

Mines Minimum Wage Act of 1912 a p p lie d th e r a te s to m in ers, and many o th e r in d u s tr ie s have sin c e been added, in clu d in g a g r ic u ltu r e . In 1910, l e g i s l a t i o n app lying to women and minors was enacted i n the Union o f South A fric a ,

This was follow ed, two years l a t e r , by a law in

M assach u setts, th e f i r s t o f seventeen minimum wage laws to be passed in th e U nited S ta te s between then and 1923,

While th e s e t t i r g o f minimum

wages was declared u n c o n s titu tio n a l by th e Supreme Court some years ago, th a t d e c isio n was re v e rse d , and th e estab lish m en t o f minimum wages and maximum hours under th e Wage-Hour Act has been upheld by the h ig h c o u rt. During th e p a st two decades v ario u s s tu d ie s have been made, by both p u b lic and p r iv a te ag e n c ie s, in an e f f o r t to determ ine c o n c re te ly what c o n s titu te s a minimum or liv in g wage.

The follow ing ta b le l i s t s fiv e

well-known budgetary s tu d ie s of re c e n t years and g ives fo r each one the estim ated cost fo r a fam ily o f f iv e persons a t th e time the study was made

102

and th e c o st (to th e n e a re st d o lla r) in F ebruary, 1942,

The adjustm ent

was made on th e b a s is o f th e index of changes in th e c o st o f liv in g fo r th e p a r t ic u la r communities concerned, as rep o rted by the Bureau of Labor S t a t i s t i c s o f th e U nited S ta te s Department o f Labor* Examination o f th ese f iv e budgets shows a s tr ik in g s im ila r it y in c o s t, in s p ite o f t h e i r wide g eographical d is tr ib u tio n and the f a c t th a t th ey were made a b s o lu te ly independently of each other* TABLE XI COST OF REPRESENTATIVE MINIMUM BUDGETS IN FIFE CITIES ’MEN ORIGINALLY MADE AND IN FEBRUARY, 1942

Agency and C ity

Date of Study

Bureau o f M unicipal R esearch, P h ila ­ d e lp h ia ; Workingman*s Family

March 1923

Council o f S o c ia l A gencies, Chicago: Dependent Family

June 1932

1629^

1810.

V is itin g H ousekeeper's A sso ciatio n , D e tr o it; Dependent Fam ily

May 1931

1743.

1996.

C a lifo rn ia C iv il S erv ic e Comnission: L a b o re r's Family

Nov, 1921

2050.

2300..

N atio n a l I n d u s t r ia l Conference Board; I n d u s t r ia l Worker in New York C ity

1926

1880.

2068.

(1) O rig in a l budget is $1268*64 w ithout r e n t. month or $360 a y ear is allowed fo r r e n t.

Cost o f Budget When Made F ebruary, 1942 $1834.

$2052

In t h i s com putation $30 per

As s ta te d p re v io u sly , th is d isc u ssio n of the p r in c ip le of th e liv in g wage is included fo r i t s g e n eral i n te r e s t r a th e r than i t s s p e c ific bearing on th e immediate problem of d ev elo p ir^ h o s p ita l em ployees.

By the same token,

budgetary s tu d ie s do not have a too c lo se a p p lic a tio n to most h o s p ita ls a t th e p re se n t tim e.

P o ssib ly la rg e urban i n s t i t u t i o n ; , teach in g c e n te rs and

103

th o se under c i v i l s e rv ic e o r governm ental re g u la tio n prove the ex cep tio n . H i s to r i c a l l y , th e custom in h o s p ita ls has been to o f f e r complete or par­ t i a l m aintenance.

The stan d ard of liv in g fo r th e w orker, th e r e fo r e , was

th a t e s ta b lis h e d and m aintained by th e h o s p ita l.

Changes in p ric e le v e ls

had and have l i t t l e e f fe c t upon th e worker who receiv es room and board as a p a rt o f h is com pensation.

This in fo rm atio n , however, is p e r tin e n t to

wage d e te rm in a tio n , now th a t th e tre n d in h o s p ita ls is away from th e d o m ic ilia ry system in fa v o r o f charging the worker fo r housing, meals and s e r v ic e s . For those " liv in g in " , c e r ta in p e r q u is ite s , such as food, lau n d ry , v a c a tio n a n n u itie s , p en sio n s, o ffe re d . item s,

v a c a tio n s , h e a lth se rv ic e s a re o fte n

Real wage com parisons, to be s ig n if ic a n t , must in clu d e th ese A stu d y o f perso n n el reco rd s in a group of h o s p ita ls rev ealed

t h i s i n te r e s tin g and s ig n if ic a n t inform ation: 1 , Because o f th e " liv in g in" fe a tu re r e la tiv e ly few workers were m arried . 2 , With th e excep tio n o f th e p ro fe s s io n a l or a r t is a n groups, wage le v e ls and th e n a tu re o f th e work were such as to exclude workers w ith la rg e f a m ilie s , 3 , M arried women employed (in c lu d in g a l l b rack ets) were supplementing husband income, 4 , I n th e lower b ra c k e ts , many cases showed both husband and w ife were employed in th e same i n s t i t u t i o n , 5 , I n th e lower b ra c k e ts , few m arried w orkers, w ith la rg e f a m ilie s , e x is te d on t h e i r wages, w ithout some o u tsid e a s s is ta n c e , 6 , Most w orkers i n the o f f ic e and s e rv ic e departm ents were young people o r above m iddle age; th o se not s u ite d to in d u stry and com petitive employment, 7 , Few w orkers, o th e r th an th e p ro fe s sio n a l executive and ju n io r executive groups enjoyed s a la r ie s approaching th e le v e l o f Table I , 8 , None o f th e u n s k ille d la b o r group irr e s p e c tiv e of t h e ir m a r ita l s ta tu s came n ea r approaching th is f ig u r e .

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I t was found a ls o th a t few workers in h o s p ita ls reaching superannua­ tio n had su rv iv in g r e l a t iv e s who could assume f in a n c ia l r e s p o n s ib ility fo r them*

C onsequently, because o f th e low income w ithout pension or old

age s e c u r ity , th ey must look to p u b lic sources f o r c u s to d ia l s u rv iv a l. P re se n t in d ic a tio n s seem to fav o r p u b lic l e g i s l a t i o n to in clu d e h o s p ita l workers in o ld age b e n e f its . Job A nalysis And Job E v alu atio n The preceding pages p re sen t th e case f o r a decent liv in g wage fo r a l l w orkers.

But any system based upon f r e e com petition demands th a t r e ­

wards s h a ll bear some d e f i n it e r e l a t io n to worth— to p r o d u c tiv ity .

Over

and above p roviding a bare minimum based upon needs, th e problem which h o s p ita l management fa ce s is th e d eterm in atio n of f a i r compensation fo r s e rv ic e s ren d ered .

Judging by s u c c e ss fu l experience in busin ess organiza­

t io n s , th is can be b e s t accom plished through a wage program based upon the p r in c ip le s enumerated above, c a rrie d out through s c i e n t i f i c jo b a n a ly s is and m e rit r a t i r g , to g e th e r w ith a study of com parative community wage r a t e s , D e f in itio n and Uses of Job A nalysis According to accepted u s a g e ,a comprehensive .job a n a ly s is , co n cisely s ta t e d , is an organized statem ent o r reco rd o f th e d u tie s which an employee is expected to perform in h is p a r tic u la r jo b , h is p re p a ra tio n fo r th e work, type o f equipment and m a te ria ls handled, p erso n a l q u a lif ic a tio n s and th e working co n d itio n s surrounding th e d isch a rg e o f h is r e s p o n s i b i l i t i e s .

The

jo b s p e c if ic a tio n s , prepared from the d a ta g ath ered and an aly zed , s e t prac­ t i c a l stan d ard s fo r each occupation in such a manner as to be g e n e ra lly a p p lic a b le to vario u s in d iv id u a ls occupied in th e same manner.

The scope

o f th e t r e a t i s e does n ot perm it a d isc u s s io n of th e v arian ces of opinion

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as to d e f in itio n s and th e d iv id in g lin e s between job a n a ly s is , jo b s p e c i­ f i c a t i o n and th e th ird p ro ced u ral s te p , jo b e v a lu a tio n .

Upon th e value of

th e procedure and i t s s p e c ific u s e s , however, g e n e ra l agreement was found. Job A nalysis F u rth e r, i t was agreed th a t a comprehensive jo b a n a ly s is has g r e a t edu­ c a tio n a l v a lu e s .

While i t i s h ig h ly im portant th a t every jo b in th e o rg an isa­

t i o n should be thoroughly an aly sed , and th a t th e o b je c tiv e s and procedure of th e jo b a n a ly s is should be understood by th e workers on th e jo b s and by those d i r e c t l y re sp o n s ib le fo r th e work, i t s in d ir e c t r e s u l t s , along ed u catio n al l i n e s , a re eq u ally im portant. This statem ent holds a ls o w ith re s p e c t to h o s p ita l le a d e r s .

Although

a survey showed th a t few h o s p ita l a d m in is tra to rs have y et a c tu a lly attem pted to analyze and ev alu a te job fu n c tio n s , th e Committee on P ersonnel E e la tio n s o f th e American H o sp ital A sso ciatio n has given th e problem much thought and 1 s tu d y , r e s u ltin g in a manual, which s ta t e s th e need f o r jo b s p e c if ic a tio n s , t h e i r u s e s , and methods o f a p p lic a tio n , to g e th e r w ith d e ta ile d jo b s p e c ific a ­ tio n s fo r th e r o s te r o f personnel in both la r g e and sm all h o s p ita ls .

The

s p e c ific a tio n s given in th is manual f o r th e a d m in is tr a to r 's jo b were quoted i n Chapter I I , page 37, and fo r the p erso n n el d i r e c t o r 's p o s itio n in Chapter I I I , page 51, F u rth e r, in the course of t h is stu d y , a c a re fu l a n a ly s is was made o f th e jo b s in th e th re e departm ents under stu d y —b u sin ess o f f i c e , housekeeping and d ie ta r y .

In undertaking th is a n a ly s is o f th e co n ten t of h o s p ita l jo b s ,

i t was agreed th a t i t might f u l f i l l s e v e ra l d i s t i n c t purposes, in c lu d in g the two m ajor uses s ta te d a t th e beginning of th i s c h a p te r.

These a r e , b r ie f ly :

2

1 , American H o sp ital A sso cia tio n , Job S p e c ific a tio n s f o r a H o sp ita l O rganizatio n , 2 . Adapted from Ordway Tead and H, C, M e tc a lf, P ersonnel A d m in istra tio n : I t s P r in c ip le s and P r a c tic e , p , 236.

106

1. To improve th e in te r n a l r e la tio n s h ip s of th e o rg an izatio n th ro u g h co o rd in atio n . 2 . To supply f a c ts which w ill improve th e process of s e le c tin g w orkers. 3. To c o rre c t s p e c ia l h e a lth or s a fe ty h azard s. 4. To improve th e p ro cess d e ta ils of a p o s itio n . 5. To supply a standard p ra c tic e and co n ten t f o r t r a in i n g . 6. To supply d ata from which a standard o f s e rv ic e can be set* 7 . To g iv e a b a s is fo r th e c l a s s i f ic a tio n and grading o f p o s itio n s . 8 . To g iv e a b a s is fo r th e s c ie n ti f ic d eterm in atio n o f r a te s of pay. The u su al methods o f assem bling jo b d a ta ares 1. To have jo b d e s c rip tio n s prepared by su p e rv is o rs . 2 . To send q u e stio n n a ire s to employees o r req u est employees to l i s t a l l th e d u tie s assig n ed to them. 3. To b rin g employees from t h e i r workplaces f o r in te rv ie w in th e s t a f f o f f ic e s . 4 . To have a jo b a n a ly st in te rv ie w employees a t t h e i r re g u la r w orkplaces. Very o f te n , as was th e case in t h i s stu d y , a com bination of two or more o f th e s e methods i s employed.

However, whichever method or combination o f

methods i s u sed , i t was a p p re c ia te d th a t th e r e should be some one in d iv id u a l s k ille d in th e knowledge and procedures of jo b a n a ly s is in to whose hands should be placed a d e f i n it e r e s p o n s ib ility f o r co u n sel, guidance and c o n tro l o f th e e n tir e job a n a ly s is program.

He should be made th e chairman o f a committee

composed o f th o se lo g ic a lly concerned w ith th e work.

I f no q u a lif ie d person

i s in th e employ of th e h o s p ita l o rg a n iz a tio n , i t was agreed t h a t counsel should be s o l i c i t e d from members o f th e Board, from p erso n n el d ir e c to r s in b u sin ess suggested by them, or from recognized i n d u s t r i a l and b u sin ess le a d e rs in th e community. G enerally speaking, in making such a stu d y , each jo b should be id e n tif ie d .

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A fte r th e in terv iew s and co n ferences, a d e s c rip tio n th e re o f should be recorded in sim p le, b r i e f se n te n c e s.

I t is w e ll to have two or more r e p re s e n ta tiv e

w orkers in terv iew ed to g e t th e complete p ic tu re of i t .

f u r th e r , i t was found

t h a t , in order to prevent in te r-d e p a rtm e n ta l m isunderstanding, su p e rv iso rs of o v erlap p in g departm ents should be co n su lte d . s e rv in g food to p a tie n ts is an example.

P r iv a te f lo o r k itc h e n maids

I f th is assignm ent is under th e

d ie ta r y d epartm ent, approval of th e n u rsin g departm ent is e s s e n ti a l, and v ice v e rs a . The use to which th e job a n a ly s is is to be put u s u a lly c o n tro ls th e procedure o f i t s co m p ilatio n .

Analyses a re seldom exhaustive enough to meet

a l l e ig h t o f th e p o s sib le purposes mentioned above.

I t is p o s s ib le , th e r e ­

f o r e , only to sug g est in a g e n eral way a broad c h e c k - lis t of su b je c ts and to p ic s to be in q u ired in to .

No complete s ta n d a rd iz a tio n of in q u iry or

q u e s tio n n a ire is p o s sib le or d e s ir a b le .

Nor was th e q u e stio n n a ire type of

in q u iry found to be e f f e c tiv e , e s p e c ia lly in th e case o f th e lower income g ro u p s. A su g g estiv e c h e c k - lis t of major to p ic s to be covered in th e form ulation o f a jo b a n a ly s is fo llo w s:* 1 . The jo b i t s e l f a. b. c. d. e. f.

G eneral d e s c rip tio n Equipment M a te ria ls M otions anci time Records P«y

2. Q u a lific a tio n s necessary in th e worker 3 . Standard p r a c tic e in s tr u c tio n s 4 . E ffe c ts o f th e jo b on th e worker 5. R e la tio n o f th e job to th e o rg a n iz a tio n

* See: R.G. V a le n tin e , R.B. Gregg and 0. Tead, O u tlin e of Job A n a ly sis.

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Job S p e c ific a tio n s The next s te p in th e jo b a n a ly s is procedure is th e p re p a ra tio n of the jo b s p e c if ic a tio n .

The m ajor items which experience has shown to be v alu ab le

on th e job s p e c if ic a tio n card a re l i s t e d below; 1 . Q u a lific a tio n s n ecessary in th e worker a. b. c. d.

P h y sic a l M ental Education P revious experience

2 . N ature o f th e work—d u tie s 3 . C onditions o f work 4 . Length of tim e to le a rn 5 . E a p id ity o f advancement and chance fo r promotion 6. Terms o f employment 7 . Methods o f m easuring in d iv id u a l progress on th e jo b The consensus o f o p inion among th e "expert ju r ie s " was th a t the draw­ in g up o f th e jo b s p e c if ic a tio n s , or th e ir com pilation from th e job an aly ses should be done by th e a d m in is tra to r, the department head or personnel d ir e c to r . For th e sm aller h o s p ita l th ey need not be e la b o ra te ; the im portant p o in t is t h a t th e f in is h e d copy is c o r re c tly prepared from th e jo b a n a ly s is in ques­ tio n .

S p e c ific a tio n s should be rechecked p e r io d ic a lly f o r a d d itio n s and

d e le tio n s . C la s sify in g and E v alu a tin g P o sitio n s The th ir d s te p is th e c la s s if y in g and grading o f p o s itio n s .

In com­

p arin g and r a tin g jo b s , s e v e ra l f a c to rs must be co n sid e red , such as previous t r a in in g n e c e ssa ry , te c h n ic a l knowledge, h azard s, volume of work, hours, s p e c ia l a p titu d e s , accu racy , judgment, m eeting the p u b lic c re a tiv e n e s s .

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The pro cess o f c la s s if y in g and grading p o s itio n s was found to include th e s e d i s t i n c t s te p s : (1) g iv in g id e n tic a l and c o n s is te n t t i t l e s to p o s itio n s re q u irin g th e same d u tie s and q u a lif ic a tio n s ; (2) c la s s if y in g a l l p o s itio n s under c o n s id e ra tio n in to a number of g roups, o r f a m ilie s ; and (3) a s sig n in g every jo b w ith in a c la s s to i t s proper p la c e in a l i s t i n g o f jobs graded in importance and v alu e. The id ea u n d erly in g job e v a lu a tio n is not something complex and academ ic; r a th e r i t is sim ple and human.

The process is m erely an exten­

sio n o f th e l i n e o f thought which is follow ed in comparing one l i n e of work w ith a n o th e r.

Employees c o n s ta n tly compare t h e i r jobs w ith o th ers

in terms of what they c o n sid e r th e r e la tiv e value of se rv ic e s ren d ered . Department heads compare s a la r y schedules assigned to them w ith those of o th e r d ep artm en ts.

S im ila rly , executives having j u r i s d ic tio n over the

/

a p p lic a tio n of wage r a te s a re fre q u e n tly faced w ith the n e c e s s ity of a r r iv in g a t a d e c is io n between the r e la tiv e w orth o f th e s e rv ic e s rendered in v ario u s c a p a c itie s by employees coming under t h e i r su p e rv isio n . W hile, n a tu r a lly , th e emphasis placed upon the same p o in t by employee and employer may d i f f e r , th e re is g e n e ra lly a common agreement reg ard in g th e f a c to rs b ea rin g upon th e s itu a tio n .

Most disagreem ents concern hours

and wages, p a r t ic u la r l y in r e la tio n to r e s p o n s ib ility .

In th e process of

e v a lu a tio n , th e re fo re , th e f i r s t s te p —and a very p r a c tic a l one—is to l i s t th e v ario u s f a c to rs which e x e rt an in flu en ce over th e r e la tio n s h ip which should e x is t between o ccu p atio n s. In proceeding to c l a s s i f y p o s itio n s th e follow ing were found to be th e u s u a l methods o f procedure: ( l) by making comparisons of e x is tin g d e s c rip tio n s as su p p lied by job a n a ly s e s , which is probably the more n a tu r a l method;

110

(2) "by a r a tin g method which assig n s p o in t values to d if f e r e n t a t t r i b u t e s and adds up to a t o t a l r a tin g fig u r e which then a u to m a tic a lly p laces th e joh in a c la s s ; or (3) by a p ro g ress method, in which both c l a s s i f ic a t io n and grad­ ing a re accom plished a t once by ranking jobs from th e bottom to th e to p , w ith re sp e c t to d i f f i c u l t y , im portance, and r e l a ­ t i v e v alu e. The problem in g rading is to a s sig n each job a p a r tic u la r p la c e in a la r g e r c la s s o r "fa m ily ."

H o sp ital o rg an izatio n i s now g e n e ra lly d ivided

in to th re e main c l a s s i f ic a t io n s :

( l) p ro fe s sio n a l groups (p h y sic ia n s,

e x e c u tiv e s , in c lu d in g departm ent heads, nurse su p erv isio n and f a c u l t ie s ) ; (2) te c h n ic a l s t a f f s and o f f ic e groups (in c lu d in g s e c r e ta r ie s , c le r k s , s o c ia l w orkers, a r t i s a n s , e t c . ) ;

(3) serv an t groups (in c lu d in g m ainly

p o rte rs and potw ashers, m aids, ward h e lp e rs , o r d e r lie s , e t c . ) .

Each

c la s s w i l l have w ith in i t s own a p ro g ressio n o f jobs from th a t o f th e l e a s t im portance and v alu e up to th e g r e a te s t. f o r example, k itc h e n men and sa la d g i r l s

In in d iv id u a l departm ents,

would be ra te d between p o rte rs and

potw ashers, on th e one hand and b utchers and a s s i s ta n t cooks

on the o th e r.

The ta s k o f g rad in g is to a ssig n the proper value p lace w ith in th e c la s s to each p o s itio n .

I t i s on a b a s is o f thiB ev alu atio n of a jo b

by c la s s e s , and

w ith in a c la s s , th a t pay r a te s a re subsequently fix e d . As an i l l u s t r a t i o n o f th e r e s u lts a rriv e d a t in the h o s p ita l jo b study, th e re is included in th e Appendix (see E x h ib it E) a ch a rt summarizing th e jo b s p e c ific a tio n s and c l a s s if ic a tio n s fo r the D ie ta ry D epartm ent. C onclusion. — The s u b je c t of th is ch ap ter—pay—i s always a c r i t i c a l and d e l i c a t e one.

Because o f our h ig h ly organized money economy, l i f e revolves

a l l too com pletely f o r th e ra h k -a n d - f ile worker around h is pay envelope. T his s itu a t i o n becomes doubly se rio u s when we a re forced to fa c e th e cru sh itg

I ll s t r a i n o f a war p ro d u ctio n program, as a t p re s e n t.

The workers must he

s a t i s f i e d th a t they a re g e ttin g a f a i r d e a l i f e ffic ie n c y and harmony a r e to he m ain tain ed .

The f a c to r s and procedures c o n tro llin g a w ise wage pro­

gram a re s e t f o r t h A wage and s a la ry program hased upon th ese job a n a ly s is -e v a lu a tio n procedures has th e follow ing c h a r a c te r is tic s and v alu es: 1. I t may he e f f i c i e n t l y ad m in istered in accordance w ith h o s p ita l p o lic ie s and th e stan d ard s s e t , so th a t s a la ry co sts may he c o n tr o lle d . 2 . Employees may he rewarded in accordance w ith d iffe re n c e s in in d iv id u a l perform ance. 3 . R e su lts o f th e program may he reviewed p e r io d ic a lly . 4 . Trends in wage and s a la ry p o lic ie s in o th er h o s p ita ls and in o th e r o rg a n iz a tio n s in th e community may he made a v a ila b le fo r study and comparison. In s h o r t, th i s ch ap ter has attem pted to answer the f i r s t two o f th re e q u estio n s re le v a n t to s a la r y - f ix in g : WHAT IS THE JOB? and WHAT IS IT WORTH? The t h ir d q u e stio n , HOW WELL DOES THE EMPLOYEE DO IT? is a problem o f e v a l­ u a tio n o f in d iv id u a l employee perform ance.

T h is, th e process of m e r it-

r a t i n g , w i l l he d iscu ssed in th e next c h ap ter.

CHAPTER V III TRANSFER AW PROMOTION: EMPLOYEE RATING

The p reced in g ch a p te rs have s e t f o r th th e personnel philosophy and procedures which have been found e s s e n tia l to —in f a c t a p a r t o f— sound tr a in in g f o r h o s p ita l employees.

They culm inate in an understand­

ing o f th e employee on the job and re c o g n itio n th e re o f through a f a i r system of t r a n s f e r and prom otion.

I d e a lly th is would mean th a t every

employee s e le c te d would fin d h is way to the p o s itio n in the o rg an izatio n f o r which he i s b e s t q u a lifie d by temperament, education and tra in in g , and of which he i s most d e se rv in g , through p erso n al a p p lic a tio n , e n th u si­ asm, and c o o p e ra tiv e n e ss—expressed in q u a lity and q u a n tity of work perform ance, p o p u la r ity w ith h is fello w -w o rk ers, the re sp e c t of h is su b o rd in ates and th e approval of h is s u p e rio r o f f ic e r s .

As a r e s u lt of

such re c o g n itio n , each employee could be counted on to give h is b e s t toward th e most e f f e c tiv e group perform ance of th e employees in each de­ partm en t, and, in tu r n , of the whole working s t a f f . s

T ran sfer and Promotion P o lic ie s Experience has shown th a t b o th i n t e r - and in tra -d e p a rtm e n ta l tr a n s f e r and promotion i s a most e f f e c tiv e tech n iq u e.

The promise of breaking a

d u ll ro u tin e , o f change and new o p p o rtu n ity , and an appeal to the in d iv id ­ u a l 's p rid e o f work and self-developm ent a re powerful s tim u li.

C areful

s e le c tio n follow ed by p e r s i s te n t i n t e r e s t , a p p lic a tio n and d ilig e n t e f f o r t coupled w ith a p ro p e r tr a in in g sequence has in the p a s t been the means of prom oting more than one k itc h e n h e lp e r to cook, a maid to executive

113

housekeeper, a c le r k to co m p tro ller and h ig h e r. The words " tra n s fe r" and "promotion" are o fte n confused.

To c la r if y

t h e i r use in th i s stu d y they a re d efin ed "b rie fly , in accordance w ith th e ir more u su al usage in perso n n el t e x t s . T ran sfer is a change o f w orkers to o th er jobs re q u irin g approxim ately equal a b i l i t i e s , f o r th e purposes o f secu rin g a b e t t e r adjustm ent of the worker to work, of p ro v id in g a v a rie d o u tle t f o r h is e n e rg ie s, o r re g u la r­ iz in g h is employment so as to supply steady work. Promotion i s an advancing of workers to new p o s itio n s re q u irin g g re a te r a b i l i t y , in v o lv in g g r e a te r r e s p o n s i b il i t i e s , and u s u a lly command­ ing h ig h er pay. The f a c t must be fac ed th a t th e high departm ental s p e c ia liz a tio n c h a ra c te riz in g h o s p ita l o rg a n iz a tio n c re a te s a r e a l problem in the a t t a i n ­ ment o f a u n ifie d working whole.

A lso, th e re i s not th e same lin e of

lo g ic a l advancement which holds more g e n e ra lly in b u sin e ss.

Because of

th is h o s p ita l work has been r e f e r r e d to as a s e r ie s of "dead end" jo b s. Those a t th e top c a l l f o r h ig h ly departm ental te c h n ic a l perform ance, w ith s p e c ific p ro fe s s io n a l or sem i-p ro fe ssio n a l s k i l l s ; those a t th e bottom are m enial ta sk s from which th e re i s not much prom otional o p p o rtu n ity . T herefore, some method of s tim u la tin g and h olding the w orker’s i n t e r ­ e s t among the g en eral run of h o s p ita l employees i s needed.

H o sp itals

should encourage a more g e n era l u s e of tr a n s f e r p o lic y , judging from the su cc essfu l r e s u lts which a number of commercial companies r e p o rt.

Thus

th e monotony of many jo b s would be re lie v e d ; f o r sy stem atic r o ta tio n has been found to stim u la te employees’ z e s t f o r work, o ffe rin g , as i t does, th e o p p o rtu n ity fo r growth and expansion.

I t reduces tu rn -o v e r.

E rrors

in s e le c tio n , p e rs o n a lity m aladjustm ents and f r i c t i o n between workers and departm ent heads can be c o rre c te d .

114 In some In sta n ce s tr a n s f e r i s w arranted on h e a lth grounds.

I f i t is

found th a t work b rin g s on c e r ta in s tr a in s o r p red isp o ses to c e r ta in diseases* th e worker should be tra n s f e rr e d b e fo re the exposure has become hazardous. In a few in d u s tr ia l companies a tim e lim it i s s e t on jobs where th e re is a lik e lih o o d of occupational d is e a s e .

At the c lo se of t h i s p e rio d th e employee

i s re-exam ined to determ ine w hether tr a n s f e r i s a d v isa b le . The ju s tic e and value of a sound promotion p o lic y a re more w idely recog­ n ized than the advantages in h e re n t in tr a n s f e r s .

The adage th a t the o rg an i­

z a tio n i s b u t th e lengthened shadow of i t s a d m in is tra to r can be tr a n s la te d in to th e statem ent t h a t th e temper of an o rg a n iz a tio n as a whole r e f le c ts in i t s prom otional p o lic y .

The b e n e f its from w ith in are r e f le c te d a ls o in the

e f fic ie n c y w ith which the p erso n n el departm ent o p e ra te s , and in the a t t i t u d e of the employees—f o r th ese reasons 1 . I t is a co n crete ex p ressio n of management's re c o g n itio n of employees' d e s ire f o r growth and la r g e r o p p o rtu n ity . 2 . I t w ill encourage am bitious and capable employees to p ress forward and take advantage of any tr a in in g fo r understudy p o s itio n s which may be a v a ila b le . 3 . I t w ill reduce la b o r tu rn o v e r by en ab lin g workers to s te p up r a th e r than out when th ey f e e l they have reached a sto p p in g place in a p a r tic u la r p o s itio n . 4 . I t w ill sp u r the e n tir e o rg a n iz a tio n to i t s b e s t e f f o r t , making f o r "co rp o rate u n ity " as w ell as c a p ita liz a tio n f o r the h o s p ita l's b e n e f it on th e experience and te c h n ic a l knowledge of the in d iv id u a ls who are advanced* The p r e re q u is ite s o f a sound p o lic y o f promotion and tr a n s f e r a re the p o lic ie s and techniques which have been s e t f o r t h in preced in g ch ap ters: (1) c a r e fu l s e le c tio n , placem ent and follow-up* w ith d e ta ile d inform ation recorded reg ard in g th e em ployee's education and previous work experience and h is experience in the h o s p ita l; (2) an eq u ally good knowledge of the jo b s,

1 . Tead and M etcalf, i b i d . * p p .2 0 8 -9 .

115 t h e i r r e l a t iv e w orth and o p p o rtu n ity , e s ta b lis h e d through uob a n a ly s is , s p e c if ic a tio n s , c l a s s i f ic a t io n and e v a lu a tio n ; (3) th e development therefrom of a prom otional c h a rt showing th e lin e s of prom otion;^ (4) th e use of t e s t s , perform ance re c o rd s, and r a tin g s c a le s ; (5) u n d e rs tu d ie s , and tr a in in g f o r h ig h e r p o s itio n s . The wisdom o f in c lu d in g a sound tr a n s f e r and promotion p o lic y as an i n t e g r a l p a r t o f h o s p ita l personnel and tr a in in g p o lic ie s has been recog­ n ized in th e p o lic ie s developed a t the Hew Haven H o s p ita l, p re v io u sly r e ­ f e r r e d to .

They reed as fo llo w s:

Promotion 1 . The employees o f the h o s p ita l s h a ll be regarded as th e m ajor source o f a p p lic a n ts f o r a l l prom otional p o s itio n s . In cases where th e re a re no s u ita b le employee a p p lic a n ts f o r a promo­ tio n a l p o s itio n , th is p o s itio n s h a ll be tre a te d in the same manner as any p o s itio n of o r ig in a l employment. Prom otional p o s itio n s p ro v id in g t h e i r q u a lif ic a tio n s a re equal or n e a rly equal to those of th e o th e r a p p l i c a n t s , ,. T ran sfers 1 . In c e r ta in in sta n c e s employees may be tra n s f e rr e d from one p o s itio n to a n o th e r, such tr a n s f e r s not being in the n a tu re of a prom otion. This in clu d es change o f occupation or environ­ ment, 2 . At the time of the e x it in te rv ie w , c o n s id e ra tio n s h a ll be given to tr a n s f e r r in g the employee, when such a c tio n i s f e a s i b l e , r a th e r than term in atin g h is employment. The procedure to be follow ed i s a ls o e x p l i c i t l y s ta te d . The C o n stru ctio n o f R ating Scales to Measure E ffic ie n c y of In d iv id u a l Performance Any f a i r and sound promotion p lan today must re c o n c ile th e two top f a c to r s to be co n sid ered —m erit and s e n io r ity ,

A study of company plans

1. A d e ta ile d d e s c rip tio n of the c o n s tru c tio n and development o f the prom otional c h a rt appears in W alter D i ll S c o tt, end O th ers, Personnel Management, pp.134-42.

116

and agreem ents w ith unions showed th a t where th e l a t t e r are s tro n g , th e s tr e s s i s upon s e n io r ity —"p referen ce in c e r ta in c o n d itio n s of employment, on the h a s is of an em ployee's le n g th of s e rv ic e ."

Where management alone has the

say a s to who s h a ll be promoted th e b a s is , on th e re c o rd , i s m e rit.

I t was

found th a t th e m a tte r of determ ining m e rit, r a t in g in d iv id u a ls , has been u n t i l r e c e n tly p r e t ty g e n e ra lly a subconscious m ental p ro c e ss .

How, however,

many companies are a cc ep tin g m erit r a tin g as a p o lic y of personnel manage­ ment, alth o u g h none has been found who w ill adm it th a t a p e r fe c t r a tin g sc a le has y e t been d ev ised . The fo llo w in g comment^ from a long-tim e stu d en t of the problem, Dean Knowles, g iv es v a lu ab le counsel reg ard in g th e f i e l d f o r m erit r a tin g , aB w ell as i t s lim ita tio n s ; i t i s in accord w ith the th in k in g and experience of o th e r e x p e rts , b o th those who were p e rs o n a lly co n su lted and those whose w ritin g s were s tu d ie d ; M erit r a tin g i s a to o l f o r measuring the e ffe c tiv e n e s s of employees on t h e i r jo b s —a to o l f o r a p p ra isin g the r e la tiv e q u a lit ie s of t h e i r d if f e r e n t p e r s o n a litie s w ith re sp e c t to the jobs they f i l l . I t attem p ts to minimize the amount of s u b je c tiv e judgment u s u a lly found where in d iv id u a ls a p p ra ise one a n o th e r, and to s u b s titu te , i f p o s s ib le , o b je c tiv e measures to a p p ra ise the in d iv id u a l d i f f e r ­ ences which a t p re se n t e re alm ost u n iv e r s a lly handled s u b je c tiv e ly . I t is p rim a rily u s e fu l in e v a lu a tin g worker performance on the jo b , and i t i s in t h i s f i e l d th a t i t s c h ie f advantage is to be found. (M erit r a tin g may be used f o r o th er purposes and in conjunction w ith v ario u s t e s t s —v o ca tio n , in te llig e n c e , e t c . —b u t th ese uses a re as y et com paratively le s s im portant, and sin ce they re q u ire d if f e r e n t procedures they are b e t te r l e f t to se p a ra te tre a tm e n t.) M erit r a tin g has become a r e q u is ite of good employer-employee r e la tio n s in n e a rly a l l types and s iz e s of in d u s tr ia l o rg an iza­ tio n s , because i t provides an e f fe c tiv e medium f o r av o id in g a r b i t r a r y su p erv iso ry a t t i t u d e s toward l a b o r . . . I t is h ig h ly im portant f o r those who a re j u s t g e ttin g acquainted w ith m erit r a tin g to recognize th a t i t has d e f in ite lim ita tio n s . R egardless of th e q u a lity of the p la n b eing used, the r e s u l ts achieved can never be b e t t e r than the judgm ent, honesty and f a i r ­ ness o f th e men o p e ra tin g i t . Furtherm ore, no r a tin g system can ev er rep lac e le a d e rs h ip —th e re i s no adequate s u b s titu te f o r an a b i l i t y to in s p ire men to do t h e i r b e s t. M erit r a tin g i s merely a to o l which when p ro p erly w ielded provides composite opinions 1 . Asa S. Knowles, M erit S atin g and Labor Management P ersonnel (R ep rin t, p . 3 ) .

117

of employees "baaed on uniform , s c i e n t i f i c procedures r a th e r than th e snap judgments of in d iv id u a ls . I t i s a means, not an end in i t s e l f . F in a lly , i t i s not a mechanism f o r s e tti n g wage r a te s b u t r a th e r a to o l f o r te s tin g t h e i r adequacy. I t s g r e a te s t valu e in t h i s co nnection (wage d eterm in atio n ) i s when i t i s used in conjunc­ tio n w ith job e v a lu a tio n . The l a t t e r determ ines the base r a te p aid to th o se who meet the requirem ents of a jo b , and m erit r a tin g the wage d i f f e r e n t i a l to which each is e n ti t l e d on the b a s is o f in d iv id u a l d i f f e r e n c e s ..» Any company p lan n in g to use m erit r a tin g should form ulate i t s own program . I t i s v ery seldom th a t an e x is tin g plan e x a c tly f i t s the needs o f an o th e r o rg a n iz a tio n . Moreover, th e background and knowl­ edge gained by d ev isin g a system more th an compensates f o r th e time and c o s t—th e su p erv iso rs and employees have more confidence in a p la n which th ey have fo rm ulated. Not only w ill they have a b e t t e r u n d erstan d in g o f i t , b u t th e y w ill a ls o have an in t e r e s t in making i t work s u c c e s s fu lly . AO Dean Knowles im plies in th e l a s t paragraph, again in l i n e w ith the b e s t experience found in th is survey, the development and o p e ra tio n of a r a tin g sc a le in any o rg an iz atio n should not be th e so le r e s p o n s ib ility of any one e x e c u tiv e .

I t i s fo r th e most p a rt the fu n c tio n o f a comm ittee,

th e chairm an of which is u s u a lly th e personnel d ir e c to r .

Such a committee

has th e fo llo w in g d u tie s and fu n c tio n s :1 1 . D eciding th e purpose of r a tin g and who w ill be ra te d 2 . Developing and weighting th e r a tin g sc a le 3 . D eterm ining th e r a tin g procedure a. b. c. d.

Who w ill r a te How o fte n Who w i l l check How scored and copies to whom

4 . E s ta b lis h in g and c a rry in g on a tr a in in g program f o r th e r a te r s 5. Developing and carry in g out ed u catio n al program reg ard in g r a tin g among employees. E s ta b lis h in g V a lid ity and R e l ia b i lity o f E atings No doubt experienced personnel d ir e c to r s in h o s p ita ls w ill be in te re s te d to stu d y th e l i t e r a t u r e on r a tin g in o rd er to adapt i t to h o s p ita l perform ance.

1 . I b id , p .9

118 Many s p e c i a l i s t s , who have developed h ig h ly r e fin e d methods, urge t h a t r a tin g s should not he accep ted as a cc u rate before th ey a re proved v a lid and r e l i a b l e . Several methods of determ ining the v a l i d i t y o f ra tin g s have been found h e lp fu l and r e l i a b l e . 1

Obviously th e b e s t method o f dem onstrating v a l i d i t y

of th e r a tin g s c a le s is a s t a t i s t i c a l com parison, where p o s s ib le , w ith some d ir e c t measure of perform ance, such as p ro d u ctio n re c o rd s.

Measures of th is

type a r e , however, d i f f i c u l t to o b tain in the g r e a t m a jo rity o f h o s p ita l pos i t i o n s . Many in v e s tig a to r s f e e l th a t s im ila r s t a t i s t i c a l comparison w ith the r e s u l t s of p sy ch o lo g ical t e s t s aiming to measure the same a b i l i t y i s a prom is­ ing approach.

I t i s com plicated, however, by th re e la c k s :

1 . No t e s t s have been developed which measure the d i s t i n c t t r a i t s which r a tin g s are designed to measure. 2. Many t e s t s have been v a lid a te d by comparing them w ith r a tin g s . Obviously then a recom parison may r e s u l t in a se rio u s e r r o r . 3 . No t e s t y e t developed has been proved to be a com pletely v a lid stan d ard of comparison fo r o th er m easuring d e v ic e s. A method which seems prom ising is comparison w ith work-sam ples—i . e . , "a s h o rt p e rio d of performance under c o n tro lle d c o n d itio n s, th e r e s u l t of 2 which can be m easured." This method has been used q u ite s a t i s f a c t o r i l y in v a lid a tin g t e s t s , and f u r th e r re se a rc h may prove i t s e ffe c tiv e n e s s when ap p lie d to r a tin g s . Another method which some in v e s tig a to rs hold to be h e lp fu l i s an a n a ly s is of th e d is tr ib u tio n of r e s u l t s .

This i s th e method follow ed in the e x p e ri­

ment re p o rte d below in th e r a tin g of h o s p ita l w a itr e s s e s .

As in a l l human

r e la tio n s problem s, th e follow -up procedure i s probably the most h e lp f u l.

1. See e s p e c ia lly : Bandolph S. D riv er, The V a lid ity and H e lia b ility of E a tin g s. P ersonnel (February, 1941), p . 185. 3 . I b i d . . p . 187.

119

This method re q u ire s th a t r a tin g s be obtained f o r each in d iv id u a l, and then l a t e r th a t these ra tin g s be compared w ith the pro g ress of the in d iv id u a l in th e o rg a n iz a tio n . Other p o s sib le methods are comparison of r a t e r s 1 opinions w ith those of some s p e c if ic perso n who is considered w ell-inform ed; comparison o f r a tin g s w ith recommendations fo r s a la r y changes; a n a ly s is of th e d iffe re n c e s o c c u rrin g in r a tin g s as a r e s u l t o f tr a in in g the r a t e f s ; a n a ly s is of th e co n siste n c y of r a tin g s when an in d iv id u a l i s ra te d in d if f e r e n t departm ents; comparison of th e r a tin g s o f a group of in d iv id u a ls considered o u tstan d in g in th e company w ith th e r a tin g s o f a group of in f e r io r in d iv id u a ls .

The re a d in e ss w ith

which a r a t e r i s w illin g to change h is opinion may a ls o be in d ic a tiv e of v a lid ity * Often many o f th e se methods may be used a t one tim e, the re s u lt's of which may be more in d ic a tiv e than the r e s u lt of any one method.

In combin­

in g methods i t should be noted th a t probably one i s v a lid a tin g the r a tin g method as a whole ( s c a le , r a t e r , ra te e ) as i t e x is ts in one p a r t ic u la r s i t u a t i o n , r a th e r th a n a c tu a lly v a lid a tin g one p a r tic u la r r a tin g s c a le . E s ta b lis h in g th e r e l i a b i l i t y of ra tin g s i s not as d i f f i c u l t or i l l u s i v e a problem as th a t of computing v a l i d i t y . ing r e l i a b i l i t y a re !

The most u su a l methods f o r o b ta in ­

comparison of r e - r a tin g s (which should be spaced a t

th re e month intervals)"*-, and agreement e x is tin g between r a tin g s o f a number o f independent r a t e r s . Types of B ating Scales S ev eral types o f s c a le s have been developed.

The i n d u s tr ia l personnel

e x ec u tiv es co n su lted s a id q u ite fra n k ly th a t the p e rfe c t r a tin g s c a le has

1* Ib id * , p.191

120 not y e t been c o n s tru c te d .

The most su ccessfu l form, in o rg a n iz a tio n s which

have sp en t much tim e and e f f o r t on the problem, appears to be a composite sc a le com prising r a tin g s on from f iv e to ten item s .u sin g a c tio n phrases to denote th e q u a l i t i e s and g rad a tio n s w ith a lin e a r sc a le f o r s c o rin g purposes. But i t i s a p p re c ia te d t h a t many in the h o s p ita l f i e l d (o r any o th e r f o r th a t m atter) w ill not f e e l ready to adopt a system o f e v a lu a tin g in d iv id u a l employee perform ance on a permanent r a tin g form.

At a l l e v e n ts , i t must

be

remembered th a t th e c a u tio n advised in the use of t e s t s holds eq u ally

in

the development and a d m in istra tio n of a r a tin g system . I t i s c le a r th a t th e h o s p ita l f ie l d needs to

be explored by persons

experienced in assem bling the necessary m a te ria l and competent to make de­ d u ctio n s in th e l i g h t o f f a c ts before sweeping a lle g a tio n s can be made. As the soundest approach in th is d ire c tio n , i t was a g re e d , in consul­ ta tio n w ith e x p e rts in psy ch o logical te s tin g and m erit r a tin g th a t a simple r a tin g sc a le be d ev ised and t r ie d on a ty p ic a l employee group.

R ather than

attem p t to weight th e d u tie s of the v arious c la s se s of employees they sug­ g este d th e type o f form used by one well-known p ro g ressiv e in d u s tr ia l company, in which th e s p e c if ic r e s p o n s ib ilitie s are not co n sid ered b u t in which the r a tin g i s based on th re e c h a r a c te r is tic s : p erso n al c h a ra c te ris t i c s .

q u a lity , q u a n tity , and

Since the r e la tiv e importance o f th e se c h a ra c te r­

i s t i c s may v ary from jo b to jo b , th e o v e ra ll r a tin g was added to perm it the s u p e rv iso r to combine these t r a i t s in whatever manner h is judgment d ic ta te s . A copy of the s c a le developed, to g eth er w ith r a tin g in s tr u c t io n s , is in ­ cluded in the Appendix, as E x h ib it F. W aitresses were s e le c te d fo r the experim ent, as s ta te d in Chapter IV, in d ic a tin g the r e la tio n s h ip of the r a tin g and te s tin g p ro c e d u re s.

D ie titia n s

in some f i f t y h o s p ita ls cooperated, in r a tin g the w a itre sse s coming under

121 t h e i r s u p e rv is io n .

A sum m arization of the ra tin g s obtained follow s: TABLE I I I

SUMMARY OP RATINGS OP 136 HOSPITAL WAITRESSES

C h a r a c te r is tic s Q p a lity Q u an tity

Very Below | Poor Average 1Average ! i 8 1 j 47 1

11

38

J

6

43

24 i

3

.

!

i

P e rso n a l C h a r a c te r is tic s

j

D e p e n d a b ility and P u n c tu a lity G eneral Morale and I n te re s t

54

Very j Good | E x cep tio n al

Above Average

12

|

34

43

37

10

i

j —

ti

12

!'}

51

32

38

3

A b ility to Cooperate

3

1

14

j

49

31

32

7

O v e r-a ll R ating

—

!

51

35

i 39 1

3

i

8

i

C onclusion. —-The above r e s u l t s exem plify many of the p o in ts made in t h i s c h a p te r , e s p e c ia lly w ith re s p e c t to the d iffe re n c e s in r a t e r s .

D r.

George K. B ennett* comments: There i s a d i s t i n c t tendency f o r "average11 and "above average" r a t ­ in g s to predom inate. I t does show th a t d iffe re n c e s in a b i l i t y a re re co g n ize d , alth o u g h , a s we would su sp ect, some su p erv iso rs tend to r a t e employees high whereas o th e rs are more reserved in th e ir com­ m endations. N a tu r a lly , th e r e s u l t s of an i n i t i a l r a tin g such as th is are in no way c o n c lu s iv e .

E s ta b lis h in g the v a l id ity and r e l i a b i l i t y of such r e s u l t s

r e q u ire s a r e r a tin g a f t e r a p erio d of time has elap sed , as w ell as a check on th e r a t e r s , and o th e r methods suggested in th is ch ap ter. The m ajor f a c t rev e ale d by t h i s experiment was th a t here i s a v ir g in

* A s s is ta n t S e c re ta ry o f th e P sy ch o lo g ical C orporation; in a l e t t e r d a te d March 2 6 , 1942.

123

f i e l d fo r the development of s c i e n t i f i c p erso n n el methods, th a t a g re a t d eal of spade work needs to be done b efo re the most u s e fu l psychological te s ts and e f fe c tiv e r a tin g s c a le s can be decided upon. I t would seem, however, th a t t h i s or a s im ila r r a tin g sc a le may w ell be used in any h o s p ita l f o r th e i n i t i a l reco rd in g of employee q u a lific a tio n s and p o t e n t i a l i t i e s as a b a s is f o r a sound tr a n s f e r and promotion p o lic y and the ascertain m en t of s p e c if ic t r a in in g need, • •

mm

mm

With th is C hapter, P a r t I of t h i s t h e s i s —which t r e a ts th e broader asp ects of and r e l a t e s e s s e n t i a l elem ents in an e f fe c tiv e education and tr a in in g program—comes to a c lo s e .

The read er* s a tte n tio n is now d ire c te d

to P a r t I I , which d e a ls s p e c i f i c a ll y w ith th e o rg an iz a tio n and content of the education and t r a in i n g program p ro p er.

I t o u tlin e s p ro g ressiv e indus­

t r i a l and b u sin ess p r a c tic e which holds v alu ab le suggestions f o r a id in g in the development of a h o s p ita l tr a in in g program; surveys the outside sources which provide tra in e d employees f o r h o s p ita ls ; and d e ta i ls the o rg a n iz atio n procedure and c o n ten t of a h o s p ita l tra in in g program, which, in th e lig h t o f th e co n clu sio n s reached in P a rt I and the judgment of the "expert j u r i e s ," prom ises e f f e c tiv e r e s u l t s .

PART II ORGANIZATION AND CONTENT OP AN EDUCATION AND TRAINING PROGRAM

In introducing P art I I , i t may be w ell to r e s ta te again the major purpose of the th e s is , p a rtic u la rly th a t se ctio n dealing with th e a c tu a l program or course content i t s e l f and the method necessary to accomplish e ffe c tiv e r e s u lts . P art I se ts out "to determine the need f o r system atic se le c tio n , education and tra in in g of non~professional h o s p ita l employees". P art I I , by c o n tra st, concerns i t s e l f w ith the problem "to out­ lin e a sp e c ific program f o r guidance in meeting th a t need" and "to d e ta il the technics and content of a b asic education and tra in in g program which w ill tr a in employees f o r the jobs fo r which they have been se le c te d , develop t h e i r p o te n tia litie s and prepare them f o r promotion and make fo r a high q u a lity service and m orale".

P art I I

i s , th e re fo re , the "essence" of the th e s is growing rig h t out of P art I.

The f i r s t i s a s e ttin g ; th e second, a suggestive program evolved

from experience, the findings of th e in v e stig a tio n through the various media of research and the judgment of "e x p e rts". I t was recognized as th e study progressed th a t t h i s in v e stig a tio n in the f ie ld of n o sp ita l adm in istratio n was venturing in to v irg in t e r ­ r ito r y and th a t published d a ta on personnel r e la tio n s in h o sp ita ls, p a rtic u la rly e ffe c tin g tr a in in g procedures, was w oefully lack in g .

Much

of the lite r a tu r e av ailable merely served to emphasize th e need fo r recognized and system atized tra in in g p lans. Knowledge of hospital ad m in istratio n acknowledges, to o , th a t much of th e tra in in g e s s e n tia l fo r p ro fic ie n t performance w ithin the areas of the th e s is is te c h n ic a l.

T herefore, i t was apparent at the outset

to develop groups of s p e c i a l is ts in th ese areas to serv e as "expert j u r ie s " in o rd er to give o f t h e i r advice and counsel and p a r tic u la r ly to a s s i s t in developing, b efo re f i n a l acceptance, a course content f o r t h e i r re s p e c tiv e fu n c tio n s which would be worthy of experim enta­ t i o n toward su c c e ssfu l end r e s u l t s . In th e D ie ta ry a re a , Miss E liz a b e th C ole, D ir e c to r, D ie ta ry De­ partm ent, M ountainside H o s p ita l, M o n tclair, New J e rs e y , to g e th e r w ith Dr. Mary DiGarmo Bryan, Teachers C ollege, Columbia U n iv e rs ity , as ad­ v is o r , assumed r e s p o n s ib ility . Miss Miss Miss Miss Miss

Mary Curfman E liz a b e th Ruppert E liz a b e th Pugh A lta Atkinson W inifred Cushing

They were a s s is te d by: S t. Luke’s H o s p ita l Hackensack H o s p ita l V eterans H o sp ita l New York H o s p ita l P aterso n General Hos­ p ita l

New York C ity Hackensack, N .J. New York C ity New York C ity P ate rso n , N J .

Mrs. D oris Dungan, P re s id e n t, N ational E xecutive Housekeepers A ssocia­ t i o n , assumed th e chairm anship fo r th e Housekeeping a re a .

She was as­

s is t e d by: Miss Mahoney P re sb y te ria n H o sp ital Miss Burt M ountainside H o s p ita l Miss C rete Dahl, Housekeep­ in g C onsultant

New York C ity M o n tclair, N .J. New York C ity

Mr. W illiam Dawson, C onsulting Accountant f o r th e U nited Hospitad Fund, was Chairman o f th e o ffic e group.

He was a s s is te d by:

Mr. C harles R o sev ille (th e n C om ptroller) of S t . Luke’ s H o sp ita l, New York C ity and l a t e r by Mr. Mairtin J . F ennelly, C hief A ccountant, S t . L uke's H o sp ita l, New York C ity .

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The w rite r was able to secure the cooperation o f th ese groups as Chairman of the Personnel Committee of th e American H ospital As­ so c ia tio n as i t was agreed th a t (1)

A ll the m a te ria l when assembled in fin a l form would carry th e stamp of approval of each group of s p e c ia lis ts ;

(2)

The m aterial would be accepted by members of th e Personnel Committee and th e Council of A dm inistrative P ra c tic e o f the American H ospital A ssociation, a l l adm inistrators in hospi­ ta ls ;

(3)

The m a te ria l would be used as an o f f ic ia l document o f the American H ospital A ssociation and i t s su b sid ia ry groups.

The Personnel Committee of th e American H ospital A ssociation con­ s i s t s of: Mr. James A. Hamilton, D irector New Haven H ospital Mr. Fred Walker,D irecto r Memorial H ospital Mr. Frank W alter, Super­ intendent S t. Luke’s H ospital Dr. A. C. Bachmeyer, Medical D ire c to r U niversity C lin ics H ospital

New Haven, Conn, C h a rlo tte, N.C. Denver, Colo. Chicago, 111.

Mr. Crane Lyon, Executive S ecretary, H ospital C ouncil, I n c ., New­ ark , Chairman of th e Subcommittee on T raining, acted as Chairman and C oordinator.

At the o u ts e t, the opinion was expressed and concurred

in th a t business standards and methods were mecessary to make f o r a smoothly functioning h o sp ita l organization.

This statem ent was con­

firm ed by a group of in d u s tria l leaders and h o te l o f f i c i a l s a t a meet­ ing held January 1940 and a t which the cooperation o f organized busin­ ess e n te rp ris e was s o lic ite d and agreed upon. To make c e rta in th a t th is statement of tr a n s f e r a b ility of business methods to h o sp ita l organization

c arried s u ffic ie n t v a lid ity , a meeting

c.

hayhow

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was c a lle d l a t e r of se v era l o f th e P residents of New Jersey hos­ p ita ls ,

These men were in te re s te d in and responsible fo r h o sp ita l

organ ization in t h e i r re sp e c tiv e communities and were outstanding business lea d ers in th e same l o c a l i t i e s .

Those present at th e meet­

ing were: Mr. C urtis R. B urnett P resident Vice President Mr. C. Rowe, P resident P resident Dr. E. Knight, P resident Past Medical D irector Mr. William A. Sumner President Mr. I . Lichtman, President D r. Henry C. M etcalf D irecto r Miss Eve R osselle, Associate

Presbyterian Hospital Associated H ospital Service Plan S t . Barnabas Hospital Murphy Varnish Co. Somerset H ospital M etropolitan Life Insurance Co. Paterson General Hos­ p ita l Beth I s r a e l H ospital Bureau of Personnel A dm inistration Bureau of Personnel A dm inistration

Newark, N .J . Newark, N .J . Newark, N .J. Newark, N .J . S o m e rv ille , N .J. New York C ity P a te rso n , N .J. Newark, N .J .

New York C ity New York C ity

The two l a t t e r mentioned acted in the capacity o f advisors.

The min­

u te s of the meeting proved without question th a t the tru s te e s presen t re a d ily agreed with th e accepted in d u s tria l practice as applicable to h o sp ita ls and th e need fo r i t s a p p licatio n to h o sp ita ls.

The same

opinion was held by a group o f outstanding h o sp ital adm inistrators a t a meeting of th e H ospital S ociety (an asso ciatio n of m etropolitan New York h o sp ita l a d m in istrato rs) held a t the New York A th le tic Club October 9, 1941, to discu ss th is problem and to seek approval of a p r a c tic a l approach to th e problem of organizing the procedures to be adopted in form ulating a tra in in g program, methods of adm inistering i t and the content of course d a ta .

I t was here agreed th at i t was im port­

ant to include in the curriculum as a whole a plan of the h o sp ita l o r-

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g anization, the personnel s tru c tu re , the " in ta n g ib le s” of h o sp ital e n te rp ris e , the ra is o n d 'e tr e of th e h o s p ita ls , functions and em­ ployee s e le c tio n . Training programs in each h o s p ita l were discussed and i t was agreed e s s e n tia l to explore the program, technics and m aterial c arried out in th ese i n s titu tio n s and to study in d u s tria l p ractice known to be e f f e c tiv e . Obviously, th e next approach to the study was to in v estig ate tra in in g programs and methods as follow s: (a)

An in te n siv e study of th ese suggested and S uccessfully Executed H ospital Training A c tiv itie s in order to gain the b e n e fits of accepted p ra c tic e . V isita tio n s were made and conferences held with the ad m inistrators and personnel d ire c to rs of P resb y terian H o sp ital, S t. Luke's H o sp ita l, M ontefiore H ospital and New York H ospital, a ll in New York and Hew Haven H ospital, New Haven, Connecti­ c u t. S e ries of hand books, manuals, job in stru c tio n sh eets were made av aila b le and stu d ied . While much data were c o lle c te d and used, p rin c ip a lly the ones most f r e ­ quently mentioned in the th e s is are the Evanston Hospi­ t a l A ssociation Training Program (Evanston, I l li n o i s ) and the h o sp ita l personnel management course given at S t. Luke's H ospital, Denver, Colorado. These are in­ cluded as a c r i t e r i a and from them the re s u lts of each tra in in g program have been evaluated.

(b)

A study of outside o p p o rtu n ities available fo r the Train­ ing of H ospital Personnel to a sc e rta in the opportunities a lread y e x ista n t in educational in s titu tio n s , including b u sin ess, vocational and o th er schools which might be of value to p o te n tia l and presen t h o sp ita l employees. Par­ t i c u l a r emphasis was given to th e course m aterial given a t th e Essex County V ocational School, Newark, New Jersey, Paine H a ll, New York (both schools sp e c ia liz in g in the tr a in in g of medical stenographers, o ffic e p rac tic e and medical la y a s s is ta n ts ) and the Schooljfor Record L ibrar­ ians a t Orange Memorial H o sp ita l, Orange, New Jersey.

J D G .li.

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(c)

6

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A study of T raihing Programs Functioning in Business and other Service E n te rp ris e s . Considerable research was found necessary in s e ttin g up successful tra in in g programs. Numerous contacts were made with manufactur­ ing concerns, h o te ls , insurance companies, u t i l i t y com­ panies and educational i n s t i t u t i o n s . Of p a rtic u la r value were th e c o n fid e n tia l f i l e s of the Bureau of Personnel A dm inistration made possible through the cooperation o f Dr. Henry C. M etcalf. Conferences were held w ith leading executives of these many organiza­ tio n s and th e w rite r was perm itted to study, evaluate and use, c o n fid e n tia lly , th e m ateria l o f the M etropoli­ tan L ife Insurance Company, th e New Jersey B ell Telephone, the S t a tl e r Hotel Corporation and the Consolidated Edison Company, gourse m a te ria l used a t the Westinghouse Com­ pany, General E le c tric Company, Eastman Kodak Company, Standard O il and th e Sewall Company were studied in de­ t a i l and of inestim able value were the conferences op­ p o rtu n ity perm itted with the kind auspices of Mr. Ralph H itz, P resident of th e New Yorker H otel, Mr. Herbert Rhodes, A ssistant Personnel D ire c to r, M etropolitan L ife Insurance Company and Mr. Donald Smith of the New Jersey B ell Telephone Company, to mention only a few au th o ri­ tie s .

A ttention is c a lle d to th e extensive bibliography fo r Chapters 9, 11 and 12, which enumerates th e m ate ria l from which the th e s is data were developed. A fter a l l th e d a ta from th ese vaious sources of business en­ te r p r is e had been accumulated, i t was a l l r e c la s s if ie d to determine the arrangement and organization o f each tra in in g program and th e various methods employed f o r i t s su ccessfu l adoption.

From t h is

the methods fo r tra in in g suggested i s l i s t e d on Table VII on Page 146.

The organization o f the Standard O il Company of New Jersey

i s shown ra th e r in d e ta il as the program was ty p ic a l of the pro­ grams in general.

From a l l t h i s evolved th e course co n ten t of th e su g g estiv e program of th e t h e s i s .

The form at of th e c o n ten t program was

suggested p r in c ip a lly by th e le c tu r e s as o u tlin e d by th e Evandon H o sp ital program as fo llo w s: I.

Forjiial T raining - The Evanston H o sp ita l A sso ciatio n School (b a s ic course) I I . Formal T rain in g - P ersonnel L ectu res f o r Department Heads I I I . A c tiv itie s to Acquaint Employees w ith th e Need f o r Economy IV. H ealth Program - Annual P h y sic a l Examinations V. Personnel P u b lic a tio n s - "Among O urselves" V I. S a fe ty A c tiv itie s V II. Employees Open House V IIL M iscellaneous P ersonnel A c tiv itie s This program was by f a r the n e a re s t approach found by th e in ­ v e s tig a tio n to be e x is ta n t as re p re s e n tin g a h ig h ly organized pub­ lis h e d document in th e h o s p ita l f i e l d and i t s s p e c ia l v alu e was th e f a c t i t l i s t e d c ritic is m s and emphasized how i t WASNfT done. When th e suggested o u tlin e o f th e manual was prepared, i t was s e n t, s e c tio n by s e c tio n , to th e members o f th e afore-m entio n e d "ex p ert j u r i e s " .

Each group d iv id ed i t s e l f in to sub-groups

to develop d e ta ile d " In s tru c tio n S heets" c o n stru c te d from in d iv id ­ u a l job an aly ses used in t h e i r se p a ra te i n s t i t u t i o n s .

(These

sample in s tr u c tio n sh e e ts a re in clu d ed as a se p arate s e c tio n o f P a rt I I . ) Conferences were held p e r io d ic a lly w ith each group a t which tim e d a ta were p rese n te d , in d iv id u a l comments and c r itic is m s o f -

fe re d and changes made.

Members of th e ju ry concurred in what

should be in clu d ed in th e f i n a l document and approved th e sug­ g e s tiv e program. 7/hen th e s e d ata were assem bled f i n a ll y , i t was subm itted to Dr. Hen ry C. M e tc alf, D ire c to r o f th e Bureau o f P ersonnel Admin­ i s t r a t i o n and u n q u estio n ab ly th e dean of Personnel A dm inistration in th e co u n try .

D r. M etcalf gave h is stamp o f approval.

The manual was th en se n t to th e in d iv id u a l members of th e P ersonnel Committee and th e C ouncil of A dm inistrative P ra c tic e o f th e American H o sp ita l A sso ciatio n mentioned p re v io u sly . As r e l a t e s s p e c if ic a lly to P a rt I I , th e follow ing b r ie f s t a t e ­ ments of a few of th e ty p es o f approval receiv ed from t h i s source:

COMMENTS Mr. S a ra ts o , P erso n n el O ffic e r, S t. Luke1s H o sp ita l, New York C ity , 11/ 11/ 41: " I have j u s t f in is h e d read in g manual on "T raining of H o sp ita l Lay P erso n n el". I t i s a good g en eral o u tlin e which can be a p p lie d to any type o f h o s p ita l. The g e n e ra l procedures f o r tr a in in g appear to be sound and i f a p p lied w ith a l i t t l e in te llig e n c e sh o u ld be worthy th e tim e devoted to them. The b ib lio g rap h y should be v ery u s e fu l. "The only su g g e stio n I would make regarding th e content i s to omit some of th e p o in ts in reg ard to ty p e s of p o lish e s to be used on the f lo o r s and th e q u a lity o f p la te s to be used in th e d ie ta r y d e p a rt­ ment. These item s appear on pages 48-50 under "Care o f C leaning of F lo o rs" and page 52 under "Q u ality and Types o f D ish e s" . Informa­ t i o n o f t h i s kin d i s n o t of concern to p o rte rs and w a itr e s s e s . " I th in k th e "D epartm ental M eetings", page 19 and " I n s tr u c tio n S heets could be a p p lie d t o good advantage to c e r ta in groups of our employees

x EDGAR C. HAYMOW

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Dr. John G o rre ll, D ire c to r, B a ttle Creek S an itariu m , Grand R apids, M ichigan, 8 /3 0 /4 1 :

"Unquestionably th e copy o f th e Manual i s the f in e s t th in g I have ever seen or expected to see in the h o sp ita l fie ld fo r at le a s t a decade. You and your committee have earned a g reat c r e d it." Dr. R. C. Buerki, D irec to r, The U niversity of Wisconsin Gen­ e ra l H ospital, Madison, Wisconsin, 8/28/41: " I have no co n stru ctiv e c ritic is m s . I t i s w ell done. While to some i t may seem wordy, I b e liev e th a t considerable de­ t a i l is e s s e n tia l i f we are to improve the q u a lity of t r a i n ­ in g ." Mr. O liver G. P r a tt, Superintendent, Salem H ospital, Salem, Massa­ c h u se tts, 9/12/41: " C e rta in ly a grand and comprehensive jo b ."

Mr. Graham L. Davis, D ire c to r, W. K. Kellogg Foundation, B attle Creek, Michigan, 9/5/41: "In general., I may say th a t I lik e i t , but two or th re e sug­ gestions I would lik e t o make " (NOTE:) Suggestions describe courses contemplated a t the Michigan S ta te College under th e auspices of th e Michigan Community Health P r o je c t.) Dr. B asil C. MacLean, P resident of th e American H ospital A ssociation, 4/1 8/41: " I have passed i t around among A ssistan ts here and th e only c ritic is m is th a t th e f i r s t te n pages should be condensed." In g en eral, the committee meeting a t which the m aterial was sub­ m itted and be which th e

w rite r attended agreed th a t in general the

tra in in g program suggested did give evidence of e ffe c tiv e r e s u lts and could be vised, p r a c tic a lly , as a b a sic guide f o r a p p lic a tio n to sp e c ific needs in in d iv id u al h o s p ita ls .

- 10 T raining is a new approach to h o s p ita l a d m in is tra tio n .

No

doubt, much t r i a l and e r r o r w i l l be necessay before th e American H o sp ital A ssociation can p rep are a tr a in in g program which can be used—in to to —by a l l th e seven thousand h o s p ita ls in th e co u n try . S u ffic e to say , th e e d u c a tio n a l program proposed fo llo w s th e b e s t o f accepted p ra c tic e s in b u sin e ss and h o s p ita ls to d ate as r e ­ v ealed through th e means o f prolonged in v e s tig a tio n and re s e a rc h . I t s p r a c t i c a b i l it y can o nly be e s ta b lis h e d through prolonged ex­ p erim en tatio n over th e y e a rs , y e t evidence seems to in d b ate what has been t r i e d s u c c e s s fu lly in a l l th e in sta n c e s reco rd ed gives r i s e to s im ila r assum ption f o r th e b e n e f it of h o s p ita ls .

£D0

6/ 2/ 4^

r/,\h i . !;0

:i

CHAPTER IX THE FIELD OF EDUCATION AND TRAINING

Throughout t h i s whole work, the c e n tra l theme i s th e development o f th e w orker’ s p e r s o n a lity , which can be re a liz e d only th rough s c ie n ­ t i f i c p erso n n el p ro ced u res, s p e c if ic a lly education and t r a in in g . As has been p o in ted o u t, i t was th e frank judgment o f th e v arious "ex p ert j u r i e s ," from th e tru s te e s down, th a t the e d u c a tio n a l p ro cessin g i s needed a t a l l a d m in istra tiv e le v e ls , i f hoped f o r r e s u lt s a re to be e f fe c te d .

The broader ed u cational o b jectiv es which i t was agreed should

be borne in mind in the development o f the program may be b r i e f l y summar­ ized a s fo llo w s: 1 . The c o r r e la tio n o f new fa c ts w ith past le a rn in g and ex p erien ce. 2 . The a p p lic a tio n of the newly-absorbed f a c ts to th e jo b , 3 . The development o f c r i t i c a l judgment. 4 . An in c re a s e in th e w orker's s to r e of knowledge. 5 . S tim u la tio n of a d e s ire fo r f u rth e r study, 6. Improvement of m orale—in creased lo y a lty , r e s p e c t, confidence. 7 . The s tim u la tio n of i n t e r e s t , enthusiasm , and " f r ie n d ly r iv a lr y ." S ince employee education and tra in in g programs have reached t h e i r b ro a d est f i e l d o f u se fu ln e ss in in d u s tr ia l and b u sin ess concerns, th is f i r s t c h ap te r o f P a r t I I surveys in d u s tr ia l programs b r i e f l y and in ­ clu d es an o u tlin e o f one such rounded program, which may suggest an e v en tu al g o al f o r education and tra in in g in larg e h o s p ita ls . 123

124

I n d u s tr ia l E ducation and T raining Programs An a n a ly s is o f th e e d u c a tio n a l and tra in in g programs^ in f iv e re p re ­ s e n ta tiv e i n d u s t r i a l concerns—'which were known to be working p ro g re s siv e ly along th e lin e s o f (l) employee development, (2) supervisory education and t r a in i n g and (3) management conferences—showed consistency on only one e s s e n t i a l p o in t: T h is was in regard to th e source and i n i t i a l d ire c tio n of the program s. I n one way o r a n o th e r, th e p re sid e n t o f th e v arious companies seemed to have assumed very la rg e r e s p o n s ib ility fo r f u r th e r in g th e program. In some cases those who were a c tu a lly c a rry in g out the program re p o rte d d ir e c tly to the p re sid e n t of th e company. The b e s t work was being done in those in s titu tio n s where educa­ t i o n a l a c t i v i t i e s encompassed and very la rg e ly coordinated the p o l i c i e s of management—job a n a ly s is , r a t e s , s a la r ie s , employ­ m ent, e tc . I n o th e r words, th e educational program seemed to be b e s t s e t up where i t s fu n c tio n in in d u s tr ia l economics was f u lly r e a l i z e d and where su p erin ten d en ts and foremen through th e educa­ t i o n a l program a c tu a lly c o n trib u te d and in a sense form ulated th e company’ s p o lic ie s . E d u cation in the la r g e r sen se—as i t is c a rrie d out in p ro g re ssiv e i n d u s t r i a l concerns and a d a p ta b le to the h o s p ita l—by means o f the con­ fe re n c e method, i s discu ssed in Chapter I , in connection w ith th e develop­ ment and a d m in is tra tio n of an e f f e c tiv e personnel p o licy and program.

(See

pages 2 3 -2 4 ). To complete th e p ic tu re of education and tr a in in g in th e company r e f e r r e d to in th e e a r l i e r c h a p te r, a statem ent by i t s E ducational D ire c ­ t o r i s h ere qu o ted :^

1. Bureau o f P ersonnel A d m in istratio n f i l e s (unpublished). 2 . B ureau o f P erso n n el A d m in istra tio n , Methods o f B uilding I n d u s tr ia l Self-G overnm ent and E ffe c tin g Sound Income D is trib u tio n (unpub­ lis h e d ) , p. 95.

125

Our e d u c a tio n a l program has as i t s c h ie f o b je c tiv e the improvement of in d u s t r i a l r e l a t io n s . The improvement of in d u s tr ia l r e la tio n s as an e d u c a tio n a l fu n c tio n involves ex ecu tiv e tra in in g , su p erv iso ry t r a in in g , tr a in in g fo r improving worker e f fic ie n c y , and te c h n ic a l tr a in in g fo r tradesm en and f o r those who are being prepared fo r p o s itio n s o f f u tu r e le a d e rs h ip . The program i s d e f i n it e l y b u i l t in such a way as to f u r th e r the development of stan d ard s in personnel r e l a tio n s . These include such stan d ard s as those which a re e s s e n tia l to meet requirem ents f o r e ffic ie n c y in p ro c e ssin g , in in s p e c tio n , and in departm ental management. In a d d itio n , the program i s r e la te d to the develop­ ment of stan d a rd s f o r employment. In e f f o r t s to achieve th ese o b je c tiv e s and r e a liz e the standards in d ic a te d , the e d u c atio n a l program i s grouped under the follow ing head in g s: 1. M aster Methods Groups— These methods groups c o n s is t of foremen, conference le a d e rs , group conference le a d e r s , O pportunity School f a c u lty , and in ­ s tr u c to r s o f a p p re n tic e s . At th ese meetings s p e c ia l a tte n tio n i s given to such problems as the p re p a ra tio n of te x t m a te r ia l, th e conducting of c la s s e s and co n feren c es, and the standards which the i n s t i t u t i o n wishes to have m aintained in a l l ph&ses of ed u c a tio n a l work. Those who te a c h in the O pportunity School are expected to submit in advance to the D ire c to r of Education a l l o u tlin e s of co u rses, co p ies of q u iz ze s, and so f o r th . The conference le a d e rs and the group lead ers* in s tr u c to r s re c e iv e t h e i r te x t m ateria l in an e d ite d form ; th e r e fo r e , th ey spend p r a c tic a l ly a l l of t h e ir tim e on th e q u estio n o f methods. 2 . Foreman T rain in g Foremen conferences a re held weekly f o r approxim ately nine months in th e y ear on Company tim e. Groups of approxim ately twenty men a re assig n ed to s p e c ific co n feren ces. A c a re fu l check of a tte n d ­ ance and p u n c tu a lity i s k e p t. Men who miss the meeting to which th ey a re r e g u la r ly assig n ed during the week, are expected to make up atten d an ce a t a subsequent m eeting. Absence on the p a r t of any man i s re p o rte d to h is d iv is io n su p erin ten d en t once a month. The s e r ie s o f tr a in in g u n its f o r the y ear reviewed covered the follo w in g major to p ic s : a. b. c. d. e. f.

Managing Men Human R e latio n s in D epartm ental Management D eveloping Standards of Foremanship D epartm ental Management and P rocesses Fundamentals o f an Economic S o cial Order I n d u s tr ia l C ooperation

126

3 . Group Leaders Men d esig n a te d as Group Leaders o fte n a re known or as "working foremen" in o th e r i n s titu tio n s * c o n tro l over a sm all group of w orkers. In most not have f u l l tim e f o r su p erv iso ry a c t i v i t i e s . from f iv e to tw e n ty -fiv e group le a d e r s .

as "straw ‘b osses" They have d ir e c t c a s e s, they do Each foreman has

Meetings a re h eld weekly o r semi-monthly and u s u a lly l a s t f o r about one and a h a lf h o u rs. The foreman i s in d ir e c t charge. The program follow s th re e main d iv is io n s : (1) Shop Problem s, (2) S a fe ty , and (3) Job T ra in in g . In most cases the le a d e r (foreman) subm its a r e p o rt on each m eeting alth o u g h t h i s i s not a compulsory p r a c tic e . Topics follow r a th e r c lo s e ly those used in foreman c o n fe re n c es. 4. Student Group—Cadets (T echnical G raduates) and Others The tr a in in g course o u tlin e d below i s e s s e n t ia ll y a th re e or fo u r year co u rse: a. b. c. d. e. f. g. h.

Company p ro c essin g Company products The Company and i t s b u sin ess I n d u s tr ia l Economics P e r s o n a lity and A pplied Psychology P ersonnel A d m in istratio n P u b lic Speaking Seminar

Although i t i s arranged in s e p a ra te i n t e r - r e l a t e d s e c tio n s , the sequence i s such as to perm it the assignm ent of an employee so th a t he might e n te r upon h is tr a in in g a t th e beginning of any s e c tio n . Under the above p la n only one u n it o f a course w ill be o ffered a t a tim e. The le c tu r e p e rio d is held weekly a t some s e t tim e. Men in the company who have knowledge of the s p e c ia l f i e l d s , teaching a b i l i t y , and an i n t e r e s t in tr a in in g are assig n ed to conduct le c ­ tu re s and q u iz z e s. Each le c tu r e i s follow ed by a d isc u ssio n hour, d u rin g which re p o rts a re made on r e la te d to p ic s . 5. Cooperative E ngineering Students A number of employees a re m aintained as a squad studying en g in eer­ in g on a c o o p era tiv e b a s is a t the U n iv e rsity of C in c in n a ti. These men are chosen a f t e r c a r e f u l exam ination o f high school records and a b a t t e r y o f in te llig e n c e and a p titu d e t e s t s . In a d d itio n , each boy is expected to prove h is w orth a t some hard job in the p la n t b e fo re he is f i n a l l y approved. 6 . A pprentices f o r machine shops and foundry are s e le c te d in much the same manner, w ith th e added requirem ent of s p e c ific approval by s u p e rin ten d e n ts in the d iv is io n in which th e ap p ren tice is to do th e major p o r tio n of h is work.

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O pportunity School C lasses are o ffe re d to employees in any su b je c t in which th e re is a pronounced i n t e r e s t , so long as the su b jec t c o n trib u te s to the d e f in ite advancement of employees or to t h e i r c u ltu r a l i n t e r e s t s . Emphasis i s placed upon m athem atics, drawing, and te c h n ic a l co u rses. C ourses, t e s t s , e t c . , are approved by the D ire c to r o f E ducation, S p e c ific tr a in in g is given to a l l members o f the O pportunity School f a c u lty , and achievem ent i s measured by q u izzes, standard t e s t s , and f i n a l exam inations, 8, L ib rary The l i b r a r y , which i s in i t s in fa n c y , i s g iv in g more a t te n tio n to the c a r e fu l s e le c tio n of c ir c u la tio n , to c it a tio n s f o r s p e c ific in d iv id u a ls and to fo llo w in g up than i t i s to secu rin g a la rg e l i s t of books o r an e x te n siv e c ir c u la tio n , 9 . Correspondence Study The company does not d i r e c t ly tend to c o n tro l the correspondence study of any employee. The p o lic y which i s follow ed is th a t of guiding th e employee in h is s e le c tio n of a co u rse, once he decides d e f i n it e l y th a t he wishes to pursue th a t method ofjstudy. A rrange­ ments are made by which courses may be purchased through the C redit Union a t cash p r ic e s , the lo an being re p a id by deductions from wages. R eports are received from correspondence schools of th e progress of in d iv id u a ls . These re p o rts are forwarded to th e correspondence s tu d e n ts . Upon the com pletion of a course by a s tu d e n t, the D ire c to r of Education informs the Employment Department and the su p erin ten d en t of t h i s f a c t , 10, S p ecial L ectu res and E xecutive Development Top management recognizes the need f o r ta k in g the long-tim e view of foreman tr a in in g , and th a t stan d ard s of achievem ent in any in ­ s t i t u t i o n cannot be b u i l t w ithout the proper human m a te ria l. I t is h e a r t i ly in sympathy w ith t h i s comprehensive ed u catio n al program, and the f u r th e r r e q u is ite th a t the r e s u l ts of foreman tr a in in g be ev a lu a te d . The Company i s d e f i n it e l y committed to a re se a rc h pro­ gram which has a s i t s major purpose an e v a lu a tio n of progress in achievement of stan d ard s of forem anship and p erso n n e l, A p e rio d ic check i s n ecessary to determ ine the degree to which o b je c tiv e s are b eing achieved. The education and tr a in in g of ex ecu tiv es i s b eing attem pted a t th e p rese n t time by means of (1) S p ecial le c tu r e s (2) Conferences of s e le c te d top groups w ith an ex p ert in the f i e l d of personnel and in d u s tr ia l r e la tio n s (3) A c a re fu l s e le c tio n o f magazines and books c ir c u la te d by the l i b r a r y (4) M aster sessio n s

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H o sp itals must lo o k to a s s i s ta n t d ir e c to r s , personnel d ir e c to r s , and departm ent heads f o r le a d e rsh ip and to a c t as l ia i s o n o f f ic e r s between the a d m in is tra to r and th e worker#

This means, of c o u rse, tr a n s la ti n g foremen,

conference and group le a d e r s , f a c u lty and in s tr u c to r s

in the foregoing pro­

grams in to the corresponding h o s p ita l s t a f f members. C onclusion. — Follow ing th is b r ie f p re s e n ta tio n of th e p o te n tia l f i e l d f o r ed u catio n and t r a in in g i n h o s p ita ls , through i l l u s t r a t i o n s from in ­ d u s try , a survey of o u tsid e tr a in in g o p p o rtu n itie s f o r h o s p ita l personnel i s given in Chapter X,

However, th e purpose of tr a in in g —to make the worker

e f f e c tiv e on h is jo b —fin d s r e a d ie s t ex p ressio n in the a c tu a l job in s tr u c ­ tio n .

There are th re e approaches to tr a in in g f o r the p o s itio n , which i s ,

a f t e r a l l , th e f i e l d of our immediate i n t e r e s t :

(1)tr a in in g courses in

th e p u b lic and in s p e c ia l sch o o ls; (2) tr a in in g th a t can be accomplished by th e j o i n t e f f o r ts of the h o s p ita l and the community, and (3) h o s p ita l tr a in in g programs.

These procedures a re d e ta ile d in succeeding chapters#

CHAPTER X

TRAINING OPPORTUNITIES FOR HOSPITAL SERVICE

The survey of e x is tin g v o c a tio n a l o p p o rtu n itie s rev ealed a

1101111)61

of

sc h o o ls , ed u catio n al courses and experiences o u tsid e th e h o s p ita l i t s e l f which may serve as h e lp fu l sources f o r the tr a in in g o f p re se n t and p o te n tia l h o s p ita l p erso n n el. Government T raining P ro je c ts I t seems lo g ic a l f i r s t to c a l l a t t e n t i o n to the re c e n t in t e r e s t in the h o s p ita l tr a in in g problem on the p a r t o f the Government,

R ea lizin g the need

f o r a tr a in in g program f o r i n s t i t u t i o n a l su b sid ia ry workers in h o s p ita ls and i n s t i t u t i o n s , in F ebruary, 1941, a p ro sp ectu s was sen t to S ta te Works P ro je c ts A d m in istrato rs providing a n ation-w ide p ro je c t to t r a i n 50,000 persons w ith in a y e ar who could a s s i s t under p ro fe s s io n a l su p erv isio n in m eeting acute h e a lth s itu a tio n s in n a tio n a l em ergencies.

This group included ward h e lp e rs,

o r d e r lie s and n o n -p ro fessio n al a s s i s t a n t s .

These s e rv ic e s a re now fu rn ish ed

to many h o s p ita ls under e x is tin g i n s t i t u t i o n a l s e rv ic e p r o je c ts . More re c e n tly , through th e O ffice of C iv ilia n Defense and in cooperation w ith the American jjed Cross, a p r o je c t was undertaken to t r a i n in h o s p ita ls 100,000 v o lu n teers to serve as nurse aid es in a s s i s ti n g graduate nurses in h o s p ita ls and c l i n i c s .

The course provides 80 hours of in te n s iv e in s tr u c tio n

d u rin g a p e rio d of about seven weeks. F u rth e r s p e c ific d a ta concerning th ese p ro je c ts are o m itted , as these p a r t ic u la r fu n ctio n s are not w ith in the purview of the th re e a re a s which 129

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th i s document co v e rs.

The courses ore mentioned h e re , f i r s t , to c a l l a tte n ­

tio n to th e im portance which th ese n a tio n a l agencies place on tr a in in g , and, seco n d ly , to p o in t out t h a t , d e s p ite th e unusual p re ssu re s (decreased s t a f f s , h ig h la b o r tu rn o v e r and in creased number of p a tie n ts ) which a re co n fro n tin g th e h o s p ita ls in t h i s war e f f o r t , when a u t h o r it i e s are brought face to face w ith th e problems, e x is tin g o rg an izatio n s and f a c i l i t i e s can be and are adapted in an a l l - o u t e f f o r t to reach a s o lu tio n . S p e cial E ducational Courses fo r H o sp ita l Executives I t is r e a d ily understandable th a t the n e a re r the to p , th e more ex p ert and th e more thorough need be the e d u catio n al tr a in in g program. f i e l d i s in c re a s in g ly recognizing th is f a c t .

The h o s p ita l

H o sp ital a d m in istra to rs are not

coming in to the f i e l d through the a p p re n tic e method in an ything lik e the form er p ro p o rtio n s.

F u ll-tim e grad u ate courses under recognized u n iv e r s ity

and h o s p ita l au sp ices a re now a v a ila b le f o r q u a lifie d stu d e n ts looking to h o s p ita l a d m in istra tio n as a c a r e e r . The y ear 1941 has been p a r tic u la r ly o u tsta n d in g in the development of t r a in in g courses f o r executives and personnel upon whom w ill depend, in la rg e m easure, th e r e s p o n s ib ility o f p ro g re ssiv e h o s p ita l management. Short courses s p e c if ic a lly planned f o r h o s p ita l personnel have been o rgan­ ized in connection w ith c e r ta in u n i v e r s i t i e s .

S everal i l l u s t r a t i o n s of

such tr a in in g o p p o rtu n itie s are here c ite d , C o rn ell U n iv e rsity Department of Hotel A dm inistration o f fe r s each sum­ mer, f o r those a c tiv e ly engaged in h o te l or h o s p ita l work, a s e r ie s of s h o rt co u rses given in u n its of one, two, or th re e weeks.

These in clu d e H ospital

O p eratio n , P ersonnel Methods, I n s t i t u t i o n Menu P lanning, Q jiantity Food P re p a ra tio n , Accounting and Housekeeping, le c tu re rs .

H o sp ita l a u th o r itie s serv e as

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H o sp ital accounting has j u s t i f i a b l y come in f o r i t s sh are of a t te n tio n . Here a re two s ig n if ic a n t developments: At In d ian a U n iv e rsity in June, 1941, in co o p eratio n w ith and sponsored by the American H o sp ital A P sociation, was held the f i r s t of what promises to be an annual I n s t i t u t e f o r h o s p ita l ac c o u n ta n ts.

P ro fe sso r S ta n le y A. P r e s s le r ,

of th e In d ian a U n iv e rsity School of B usiness, who was in charge of the s e s ­ s io n s , l a i d p a r t ic u la r s tr e s s upon the im portance of uniform r e p o rtin g , sin c e more a c c u ra te s t a t i s t i c s on h o s p ita l s e rv ic e in th is country a re b ad ly needed. A ll th e r e g is tr a n ts agreed th a t th e I n s t i t u t e should be re p e a te d ; 94 per cen t favored o rg an izin g a N ational A sso ciatio n of H o sp ital A ccountants. A ccountants, a u d ito rs and c o m p tro lle rs, from la rg e and sm all h o s p ita ls , atte n d e d the s e s s io n , which c o n s is te d of le c tu r e s and round ta b le d is c u s s io n s . Follow ing t h e i r su g g e stio n s, P ro fe sso r P r e s s le r w rite s th a t f o r next y e a r, "we might provide a speaker of n a tio n a l prominence to open each morning s e s ­ s io n .

The group could th en be broken up in to v ario u s types of sm aller groups

fo r sm a lle r s e s s io n s ." The U nited H o sp ital Fund of New York and th e G reater New York H o sp ital A sso ciatio n sponsor an advanced "Course in H o sp ital Accounting and S t a t i s t i c s , " given by a u th o r itie s in th e f i e l d , members of th e Advisory Committee on H o sp ital A ccounting.

In the f a l l of 1941, m eetings were held two evenings

a week over a p erio d of th re e months.

The course was designed to provide a

gen eral review o f th e h o s p ita l accounting and s t a t i s t i c a l problem s.

Account­

a n ts a tte n d in g the se ssio n s were req u ired to complete s o lu tio n of an account­ ing problem, in v o lv in g (1) i n s t a l l a t i o n of an accounting system; (2) o rg an i­ z a tio n of an accounting departm ent; (3) p re p a ra tio n of a c o s t re p o rt based on h o s p ita l re c o rd s .

The le c tu r e to p ic s included th e p r in c ip le s of acco u n tin g ,

b u d g etin g , c o n tro l and c o st accounting, c r e d it and c o lle c tio n s , p u rch asin g ,

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■business o f f ic e o rg a n iz a tio n , o ffic e forms and accounting equipm ent, le g a l asp e c ts of acco u n tin g , s t a t i s t i c s and graphic p re s e n ta tio n . Of r e a l i n t e r e s t in connection w ith the development of sound h o s p ita l perso n n el p o lic ie s and procedures i s the course in P ersonnel Management given by th e U n iv e rsity o f Colorado, under th e au sp ices of th e Denver H o sp ital C ouncil, p rim a rily f o r Denver h o s p ita l ex ecu tiv es and s u p e rv is o rs . This w ell-p lan n ed c o u rse , as given in 1940-41, p o in ted to the development of personnel a d m in is tra tio n as b o th a scien ce and an a r t — As a Science—method, s c i e n t i f i c management; aim , e f f ic ie n c y . As an A rt—method, p e rs o n a liz a tio n ; aim, contentm ent (h a p p in e ss). I t covered sources o f c o n f lic t in employer-employee r e l a tio n s ; the s ta tu s of la b o r from a h i s t o r i c a l p e rsp e c tiv e ; s c ie n t i f i c management, and types of c o n tro l and o rg a n iz a tio n as r e la te d to personnel problems; the psychology of la b o r r e la tio n s —the development of in d iv id u a lity in the work r e la tio n s ; problems of employee s e le c tio n and te s tin g tech n iq u es; personnel m ainte­ nance—wage and hour a d m in is tra tio n , tr a n s f e r , prom otion, d is m is s a ls , tu rn ­ over, employment s t a b i l i z a t i o n , superanuated employees; q u a li tie s and r e s p o n s i b il i t i e s o f personnel le a d e rsh ip ; jo in t r e la tio n s and c o lle c tiv e b a rg a in in g , independent unions and personnel management. To cement a firm foundation and to perm it an exchange o f newer s o c ia l p a tte r n s , n a tio n a l and re g io n a l o rg an izatio n s o f f e r b a s ic and r e fr e s h e r co u rses f o r ex e cu tiv es and department heads in th e f i e l d . more o r more* o f th e s e le c te d departm ental s e rv ic e s .

This i s tr u e ,

Every s p e c ia l d e p a rt­

ment worthy of th a t d e s ig n a tio n , can be proud of th e f a c t th a t the p re ­ r e q u is ite s of i t s head have been ra is e d to include some academic recog­ n itio n . The H otel and R estau ran t Courses given under the d ir e c tio n of the I n te rn a tio n a l Geneva A sso c ia tio n , which are a p p lic a b le to th e h o s p ita l,

133

in clu d e management, accounting and p u b lic r e la tio n s .

Most of th e p o s itio n s

in the d ie ta r y and housekeeping departm ents are inuch the same a s those in h o te ls .

T herefore hotej. tr a in in g courses or h o te l experience f u rn is h a

good t r a in in g and proving ground f o r s e rv ic e in th ese departm ents of the h o s p ita l. V ocational c o lle g e s , such as Simmons, R ussell Sage and Skidmore, have s p e c ia liz e d co u rses which give adm irable equipment f o r h o s p ita l s e rv ­ ic e —household economics and d i e t e t i c s , gen eral sc ie n c e , s o c ia l se rv ic e and s e c r e t a r i a l , A new course f o r developing American born chefs i s being in s t i t u t e d a t th e Food Trades V ocational High School in Hew York C ity .

D elegates to

the second annual C ulinary Congress were asked to s e le c t two men w illin g to devote t h e i r l i f e to teach in g the new c la s s e s in c u lin a ry a r t .

An

exam ination was arranged and judged by the American C ulinary F ederation and th e New York H otel Trades C ouncil. In the b u sin e ss o f f ic e , many of the d u tie s —bookkeeping, c le r ic a l work, sw itchboard o p e ra tio n , the o p eratio n of v arious machines", e t c . — vary l i t t l e from th e perform ance of such work in any number of busin ess and s e rv ic e in d u s tr ie s , and tr a in in g received f o r them can be turned to good use in th e h o s p ita l. S p ecial Courses f o r N on-P rofessional Bnployees When i t comes to m edical s e c r e ta r ie s and sten o g rap h ers, however, i t has been o b je c tiv e ly determ ined th a t s p e c ific tr a in in g fo r th is work is of r e a l v a lu e .

Two New York schools s p e c ia liz e in the tra in in g of medical

a s s i s t a n t s —iPaine H a ll and th e Mandl School.

The experim ent was made a t

the fo rm er, which g ives in te n siv e courses of tr a in in g f o r m edical a s s is ta n ts

134

and m edical s e c r e t a r i e s .

The r e s u lt s are b r i e f l y analyzed and summarized

a t the c lo se of th i s c h a p te r. Several v o c a tio n a l schools in New J e rs e y —n o tab ly the Essex County V ocational Schools—give co u rses in clu d in g a number of su b je c ts which are h e lp fu l b a s ic tr a in in g f o r h o s p ita l p erso n n el.

Each of the courses o ffe re d ,

in c lu d in g p ro fe s s io n a l a s s i s t a n t co u rse s—d e n ta l and m edical—and busin ess co u rses—s e c r e t a r i a l , ste n o g ra p h ic , gen eral c le r k , c a lc u la tin g machines, d u p lic a tin g and machine bookkeeping—is designed to prepare young men and women f o r a s p e c ific f i e l d o f employment which has been c a r e f u lly surveyed to determ ine the need f o r workers and the tr a in in g needed to q u a lify fo r work. The b u sin e ss co u rses have been c a r e f u lly organized so as not to d u p lic a te o r compete w ith th e courses o ffe re d in high sch o o ls.

They have

been planned to serv e fo u r d if f e r e n t groups: (1) those who have completed high school or the eq u iv alen t and seek to e n te r some f i e l d f o r which t r a i n ­ ing was n ot o ffe re d in the school they a tte n d e d ; (2) those who have taken some b u sin ess t r a in in g in the high sch o o l, b u t a f t e r f in is h in g high school f in d a need f o r more s p e c ia liz a tio n or more advanced work than they had in high sch o o l; (3) th o se who have completed the co lleg e p re p a ra to ry or some g en eral course in hig h school or th e eq u iv alen t and then fin d th a t they need s p e c ific in te n s iv e v o c a tio n a l tr a in in g th a t w ill prepare them f o r work as quick ly a s p o s s ib le ; (4) those who have completed two o r more years of high sch o o l. For example, the n atu re and requirem ents of the course given by the Essex County V ocational Schools f o r g en eral c le r k s —the c l a s s i f ic a t io n

135

which includes th e g r e a te s t number of o f fic e w orkers—is as fo llo w s :1 The general c l e r k course g iv es a v a r ie ty of o ffic e tr a in in g while th e more s p e c ia liz e d courses emphasize tr a in in g in c e r ta in s p e c if ic phases of o f fic e work. The general c le r k course g iv es tr a in in g on many o f the machines included in th e s p e c ia l co u rses b u t the stan d ard s o f achievement d if f e r .,, A p p lican ts must be a t l e a s t s ix te e n years of age and must have completed the te n th grade w ith a good re c o rd . I t i s p re fe ra b le th a t th ey complete the tw e lfth grade or the equiv­ a l e n t . They must dem onstrate t h e i r a b i l i t y to do the work req u ired by s a t i s f a c t o r i l y com pleting a p titu d e t e s t s . I t w ill take the stu d en t who has completed only two years of high school about two years to complete a l l the work req u ired f o r a diplom a. The high school graduate should be able to complete i t in one y e a r. Program O utline P eriods P er Week 10

Typing C a lc u la tin g and B illin g Machines B usiness A rith m etic Bookkeeping or A ccounting B usiness Routine D u p licatin g Machines B usiness E n g lish Gym O ccupational Hygiene P e rs o n a lity and Human R elatio n s L ib rary and Study

5 4 3 2 5 3 2 1 3 2 40

I t w ill be r e c a lle d th a t our in te n s iv e study of tra in in g a c t i v i t i e s in h o s p ita ls was lim ite d to th e S ta te of Hew J e rs e y .

This holds a ls o

fo r th is p a r t of th e s tu d y - tra in in g sources o u tsid e th e h o s p ita l proper f o r th e n o n -p ro fe ssio n a l employee.

However, th e s itu a tio n throughout

the country g e n e ra lly was s u f f i c i e n t ly checked to confirm our assumption

1. Essex County V ocational Schools, T raining f o r a p o s itio n , B u lle tin #8,

136

th a t e d u ca tio n al o p p o rtu n itie s in o th er S ta te s were comparable to those in New J e rs e y , M easuring T rain in g R esu lts As p rev io u sly s tr e s s e d , th ere is in the a c tu a l a re a o f t h i s in v e s ti­ g a tio n very l i t t l e experience which lends i t s e l f to o b je c tiv e measurement. In s te a d , th is study is rev o lv ing i t s e l f in to a proving ground f o r such ex p erien ce.

However, one r e l i a b l e , w e ll-e s ta b lis h e d i n s t i t u t e f o r

tr a in in g n o n -p ro fe ssio n al h o s p ita l employees cooperated in ag reein g to give t e s t s which should in d ic a te the valu e of s p e c ia liz e d tr a in in g f o r th e work in q u estio n . The procedure was as fo llo w s:

An incoming c la s s of p o te n tia l

m edical s e c r e ta r ie s a t paine H all were given two t e s ts - —one in the s p e llin g and one in the d e f in itio n of one hundred medical term s.

The

terms were s e le c te d by a committee of p h y sician s and m edical lib r a r ia n s as re p re s e n ta tiv e s o f those commonly used in m edical d ic ta tio n .

At the

com pletion of the te n months' work—in clu d in g in te n s iv e tr a in in g in m edical d ic ta tio n and tr a n s c r ip tio n , case h is to r y w ritin g , m edical book­ k eep in g , and E n g lish —s im ila r t e s t s were given to those stu d en ts who had s a t i s f a c t o r i l y completed the co u rse. The r e s u lts re sp e c tin g the f o r ty - f iv e stu d e n ts who took b o th the i n i t i a l and th e f i n a l t e s t s are here b r ie f l y summarized and an aly zed . Table IV gives the grade receiv ed by each stu d e n t in b o th the s p e llin g ftnd d e f in itio n s t e s t taken b efo re and a f t e r com pleting the co u rse, as w ell as th e percentage of change,

137 TABLE

IV

COMPARISON OP RECORDS OF 45 STUDENTS IN WORD-TEST (SPELLING AMD DEFINITIONS) GIVEN BEFORE AND AFTER TAKING THE PAINE-HALL. MEDICAL SECRETARIAL COURSE Gr a d e

S tu d e n ts, Numbered A lp h a b e tic a lly

s

i

; 1st Test

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

8t I | s1 5 1, t

Ii \ i

I i

! ?j•

f j !i K I V £ I j 4 | I5 '1 | jI j I i 1 \ I

i

1 ( |s I{ § s

.66 .53 .6 4 .56 .44 .57 • 63 .33 .6 8

.9 5 .6 3

.6 8 .70 .67 .41 .45 .57 .67 .57 .60 .79 .72 .59 .44 .71 .67 .70 .70 .6 4 .60 .56 .50 .33 .46 .61 .54 .61 .53 .50 .52 .50 .50 .50 .43 .35

De f i n i t i o n s [ > tt $ of |{ I| "i of change i r 1 st Test :< 2nd T est I change

p e 1 1 i n g 2nd Test

•)

i j

j j j j | | ]

: I

.96 .91 .96 .83 .82 .77 .86 .65 .78 .97 .93 .88 .96 .91 .88 .80 .82 .90 .89 .76 .92 .84 .79 .88 .64 .88 .85 .86 .94 .74 .73 .82 .79 .84 .91 .87 .88 .89 .89 .89 .70 .86 .85 .85 .82

.30 .38 .32 .27 .38 .20 .23 .32 .10 .02 .30 .20 .26 .24 .47 .35 .25

.8*

.32 .16 .13

12

.20 .44 - .0 7 .21 .15 .16 .30 .14 .17 .32 .46 .38 .30 .33 .27 .36 .39 .37 .20 .36 .35 .42 .47

[

: \

? t

j \

| I

f

I 1 I \ < I

? { j j ‘j | 1 I j | j j

f

1

f

.41 .20 .41 .31 .24 .20 .41 .13 .26 ,84 .28 .28 .52 .26 .08 .27 .33 .24 .35 .30 .35 .44 .19 .27 •43 .31 .23 .34 .28 .22 .30 .33 .13 .23 .27 .27 .24 .28 .24 .30 .44 .16 .21 .31 .15

.46 .40 .52 .43 .42 .44 .43

\

.1 9

!

.31 .87 .53 .36 .66 .37 .45 .44 .45 .36 .46 .32 .52 .49 .35 .36 .59 .44 .52 .60 .50 .36 .36 .45 .23 .09 .45 .48 .43 .33 .28 .44 .49 .33 .50 .32 .34

! j

|

! !

?

1

\

; I | 1 1 ] 5 1

.05 .20 .11 .12 .18 .24 .02 .06 .05 .03 .25 .08 .14 .11 .37 .17 .12 .12 .11 .02 .17 .05 .16 .09 .16 .13 .29 .26 .22 .14 .06 .12 .12 • 14 .18 .21 .19 .05 .04 .14 .05 .17 .29 .01 .19

138

Table V shows the d i s t r i b u tio n of the stu d e n ts according to the grade receiv ed in the s p e llin g t e s t and according to th e percentage of change in th ese g rad e s. TABLE V SHOWING THE DISTRIBUTION OP 45 STUDENTS ACCORDING TO GRADE RECEIVED IN INITIAL AND PINAL SPELLING TEST AND THE PERCENTAGE OP CHANGE

Per cent

Number of

2nd Test

Change

Students

0 2 8 24 11

Decrease In crease 1-9 10-19 20-29 30-39 40 and over

Grade

Nhinber of S tudents

(«

1 s t T est

Below 60 60-69 70-79 80-89 90-100

24 14 6 0 1

1 1 8 12 18 5

.........................................-

Table VI g iv es a s im ila r d is tr ib u t io n of the r e s u lts of the d e f in itio n s t e s t , TABLE VI SHOWING THE DISTRIBUTION OP 45 STUDENTS ACCORDING TO GRADE RECEIVED IN INITIAL AND PINAL DEFINITIONS TEST AND THE PERCENTAGE OP CHANGE

Grade

Number of S tudents

P er cent

Number of

(*>

1 st Test

2nd Test

Change

Students

Below 30 30-39 40-49 50-59 60-69 70-79 80 and over

26 11 6 1 0 0

4 13 18 7 2 0

Decrease Increase 1-9 10-19 20-29 30 and over

1

1

. ............ ...

1 14 21 8 1

J

139

One o f th e prim ary q u a lif ic a tio n s of a good s e c r e ta r y I s a knowledge o f th e use and the s p e llin g o f words.

A dm ittedly, th e m edical vocabulary

i s q u ite d if f e r e n t from th a t even of a g e n e ra lly w ell educated person.

It

i s obvious, th e n , t h a t th e h o s p ita l o ffic e and te c h n ic a l employees, who w ill be c o n s ta n tly u s in g and w ritin g these unusual te c h n ic a l words w ill need to study them in o rd er to s p e ll them c o r r e c tly and to u se them in te llig e n tly . The s p e llin g r e s u l t s shown in Table V, th e r e fo r e , should be h earten ­ in g to th e h o s p ita l a d m in is tra to r and departm ent head.

More than h a lf of

th ese stu d e n ts b e tte r e d them selves 30 p er c en t o r more.

A ll b u t two of

th e 45 showed more than 10 p e r c e n t improvement.

In the i n i t i a l t e s t only

one stu d e n t re ce iv ed a grade over 80; in th e f i n a l t e s t 35 were in the 80-100 grouping. I t w ill be noted in comparing th e s p e llin g and the d e f in itio n r e s u lts th a t in th e i n i t i a l t e s t s the s tu d e n ts ' knowledge o f d e f in itio n s was much below t h e i r a b i l i t y to s p e l l , and th a t th e improvement in th e form er was a ls o le s s marked.

However, th e d e f in itio n r e s u lt s a ls o seem encouraging.

In th e f i r s t t e s t , as i s u n d erstan d ab le, the stu d e n ts ra te d v ery l o w more th an h a lf were below 30 p e r c e n t.

In the f i n a l t e s t the m a jo rity

ro se to an over 40 p e r cen t r a tin g . Conclusion. — This c h a p te r has s e t f o r th two of the th re e designated approaches to tr a in in g —tr a in in g provided in th e p u b lic and s p e c ia l sc h o o ls, and th a t accom plished by the j o in t e f f o r t s of th e h o s p ita l and th e community. The survey of o p p o rtu n itie s fo r tr a in in g re v e a le d : 1. An in c re a sin g aw areness on th e p a r t o f fe d e ra l and s ta t e agencies o f problems fa c in g th e h o s p ita l, e s p e c ia lly th a t of n o n -p ro fessio n al p erso n n el, and th e attem p t to meet th e se needs through j o i n t com­ m unity t r a in in g program s.

140 2 , A c o n sta n t In c rea se in th e number of c o lle g e s , u n iv e r s i tie s and p ro fe s s io n a l o rg an izatio n s providing stan d a rd and s p e c ia l courses f o r h o s p ita l a d m in istra to rs and departm ent heads. This i s im­ p o rta n t in view of the f a c t th a t (a) i t in d ic a te s th e v alu e of continued ed u catio n f o r p ro fe s s io n a l w orkers, and (h) th e suc­ c e ss o f a tr a in in g program f o r n o n -p ro fe ssio n a l employees w il l depend upon th e degree to which i t i s supported and given v i t a l i t y by th e a d m in is tra tio n . 2 . P u b lic and s p e c ia l schools a re a ls o h e lp in g to meet th e h o s p i t a l 's need f o r tra in e d w orkers. In a d d itio n , experience in B im ilar p o s itio n s in h o te ls , r e s ta u r a n ts and o f f ic e s provides v alu ab le tr a in in g f o r h o s p ita l work. 4 . Most im p o rtan t, perhaps, th e valu e o f s p e c ia liz e d tr a in in g f o r h o s p ita l p o s itio n s was o b je c tiv e ly measured and e s ta b lis h e d by an a n a ly s is o f th e r e s u l ts of s p e llin g and d e f in itio n t e s t s given a c la s s o f m edical s e c r e t a r ia l stu d e n ts a t the beginning and end o f t h e i r c o u rse .

CHAPTER

TRAINING PROCEDURE:

H

ORGANIZING A HOSPITAL TRAINING PROGRAM

R ecognition o f th e f a c t th a t th e ta s k of tr a in in g h o s p ita l employees has been incom plete and s u p e r f ic ia l is th e ra iso n d » e tre of t h i s t h e s i s . The consensus o f o p in io n , as e s ta b lis h e d by th e q u e stio n n a ire and ex p ert ju ry te c h n iq u e s, is th a t g r e a te r p re c is io n in tr a in in g methods is needed f o r a co n ten ted and s ta b le working fo rc e and e f f i c i e n t , f r ie n d ly s e rv ic e . The b roader a sp e c ts o f education and tr a in in g —p r in c ip le s , o b je c tiv e s , b e n e f i t s , r e la te d f a c to r s —have been explored, as have a ls o th e tr a in in g o p p o rtu n itie s in in d u stry and in the community.

We now tu rn to a c tu a l

tech n iq u es w ith th e h o s p ita l i t s e l f . Based upon the conclusions reached, and s e t f o r th in P a r t I of th is document, i t i s th e purpose o f th is ch ap ter to o u tlin e th e s p e c if ic ques­ tio n s to be answered and procedures to be follow ed in s e ttin g up a h o s p ita l p erso n n el tr a in in g program.

I t is im portant a t th e o u tse t once more to

sound a n o te o f c a u tio n reg ard in g the p o s s ib ilit y of tak in g an o v e r - a ll plan o r program and ad o p tin g i t b o d ily to f i l l th e needs of any p a r tic u la r s i t u ­ a tio n .

N e v e rth e le ss, th e follow ing procedure is p resented w ith th e thought,

concurred in by th e "Expert J u r ie s ," th a t i t w ill serv e as a h e lp fu l guide and working b a s is f o r any la rg e o r medium-sized h o s p ita l whose a d m in istra ­ ti o n e a rn e s tly d e s ir e s to s e t up an e f f e c tiv e personnel tr a in in g program. While we a re h ere concerned w ith the concrete tr a in in g of employees who a r e a lre a d y h ire d and on th e jo b , a d m in istra to rs and departm ent heads 141

142 need c o n s ta n tly to b e ar in mind th a t a n ecessary p r e r e q u is ite and c o ro lla ry to su c c e ssfu l tr a in i n g , u sed in i t s narrow er se n se , i s s c i e n t i f i c s e le c tio n , placem ent and fo llo w -u p , based upon (1) a thorough knowledge of the jo b — d u tie s and q u a lif ic a tio n s , and (2) an u n d erstan d in g o f the in d iv id u a l— gained through the in te rv ie w , psy ch o lo g ical t e s t s and performance r a tin g . These employment p o lic ie s and procedures a re d e ta ile d in Chapters 4 - 8 . With t h i s f a c t in mind, the launching o f an employee tr a in in g program c a l l s f i r s t f o r c o n s id e ra tio n of and answers to the fo llo w in g g eneral q u e stio n s: 1. Who a re to be tra in e d ? 2 . Who i s to be re sp o n sib le f o r t h e i r tra in in g ? 3. How a re th ey to be tra in e d ? 4 . What a re th e y to be tra in e d in? Who Are to Be T rained? For th e purposes o f t h i s stu d y , the problem , as s ta te d , has been lim ite d to th e tr a in i n g o f la y (n o n -p ro fe ssio n a l) personnel in the th re e a d m in istra tiv e d ep artm en ts:

B usiness O ffic e , Housekeeping, and D ietary*

The survey and c o n s u lta tio n w ith h o s p ita l a d m in is tra to rs and department heads showed g e n e ra l agreement on the fo llo w in g procedures as u s e fu l fo r tr a in in g employees in th ese c l a s s i f ic a t io n s : B usiness O ffice Accounting P u rch asin g Agent S e c re ta rie s Bookkeeper C ashier Stenographer A dm itting Clerks

ClerkB - B i l l s p ay ab le. P a y ro ll Inform ation - HosteSs Telephone Messenger

143

Housekeeping Department Head Seamstress ♦ P ain ter ♦U pholsterer F loor P o lish e r Linen Room Supervisor ♦ P a in te r 's Helper ♦Wall Washer Window Washer In sp ec tre ss Linen Room Workers Maids Bath Chamber Cleaning P o rte rs

Laundry Manager Wash Man E x tra c to r—A s s is ta n t Wash Man I ro n e r Hand P la t Work O perators P ress Checkers P o rte rs S o rte rs ♦ E levator Man

D ie ta ry Department Baker Cook Head Night P a stry Meat C utter A ssista n t Cook Baker Meat C u tter Cook, D iet Kitchen Head Salad K itchen A ssista n ts Deliveryman Kitchenmen Maids - Beverage D iet Kitchen P o rte rs Potwashers Silverman

Pood S ervice A s s is ta n ts Bus Boys C ashiers Checkers Countermen Dishwashers P a n try maids men W aiters W aitresses Storeroom men c le rk s

In g en eral i t may be sa id th a t any employee in the work group who is s u f f i c i e n t l y in te re s te d in the o r g a n is a tio n 's w elfare to improve h is knowledge and s k i l l should be adm itted to th e t r a in in g c la s s e s .

In some

s it u a t i o n s , however, i t may be im perative to r e s t r i c t th e s iz e of th e

♦ Many in s t i t u t i o n s consider these p o s itio n s as p a r t of th e Mechanical and Maintenance Department,

144

group because o f p r a c t i c a l c o n s id e ra tio n s —e ith e r by choosing th o se who appear to have the b e s t chances of b e n e fitin g by the course and o f advanc­ in g w ith the o rg a n iz a tio n , o r, perhaps, by s e le c tin g those in g r e a te s t need o f a d d itio n a l tra in in g s

I f a s e le c tio n must be made, the use of a r e l ia b le

employee r a tin g s c a le (d isc u sse d in Chapter V III) is d e s ir a b le . The A d m in istratio n o f T rain in g I t i s a p p re c ia te d t h a t e f f e c tiv e employee tra in in g re q u ire s s p e c ia liz e d d ir e c tio n .

Many la rg e i n d u s tr ia l and business concerns have an ed u c a tio n a l

d i r e c t o r , working a s a s t a f f a id re p o rtin g to th e personnel e x e c u tiv e , who is charged w ith t h i s r e s p o n s ib ility .

In la rg e h o s p ita ls , w ith a c e n tr a liz e d

p erso n n el d epartm ent, th e p erso n n el d ir e c to r would lo g ic a lly d i r e c t th e t r a in in g work.

In o th e r h o s p ita ls , th is r e s p o n s ib ility w ill probably r e s t

w ith the a d m in is tr a to r, o r an a s s is ta n t a d m in is tra to r.

In any e v e n t, th e

in d iv id u a l in charge m ist be w ell q u a lifie d end experienced and possessed of th e n e ce ssary a u th o r ity to produce e f fe c tiv e r e s u l t s .

He should under­

stan d the p r in c ip le s of te ac h in g —a type of knowledge q u ite d i f f e r e n t from th a t o f m edical care or b u sin ess management. The keystone to s u c c e ss fu l tra in in g i s the wholehearted su p p o rt o f the ad m in istratio n , e x p re ssin g an a p p re c ia tio n o f the importance o f tr a in in g , i t s d ir e c t and in d ir e c t v a lu e s , and an understanding o f the methods and procedures to be u se d .

A h e lp fu l procedure is to have the a d m in is tr a to r

and th e in te r e s te d departm ent heads, organized as an Advisory C ouncil or Committee, meet a t re g u la r in te r v a ls w ith the in d iv id u a l in charge of t r a in in g to form ulate p erso n n el tr a in in g p o lic ie s , and to r e l a t e these p o l i c i e s , a s the work p ro g re s se s , to the broader h o s p ita l p o l i c i e s — s e rv ic e , f in a n c i a l , p u b lic r e la t io n s .

145 Whether o r n o t such an a d v iso ry co u n cil i s s e t up, experience has shown th a t the in d iv id u a l charged w ith r e s p o n s ib ility f o r o rg an izin g and ad m in iste r­ in g the tra in in g program w i l l fin d th e fo llo w in g approaches h e lp fu l: 1. Extensive c o n s u lta tio n w ith re sp o n sib le ex ecu tiv es and su p e rv is o rs , in th e v a rio u s d ep artm en ts. When s u p e rv iso rs have a p a r t in i n i t i ­ a tin g a t r a in i n g p la n , th ey w ill n a tu r a lly f e e l a g re a te r degree of r e s p o n s i b il i t y f o r i t s su ccess. 2 . Acquaintance w ith job a n a ly s is and c l a s s i f i c a t i o n , and w ith standards o f perform ance and s e rv ic e r a t in g s , as a p p lie d to nonp ro fe s s io n a l em ployees. 3 . Survey o f any e a r l i e r tr a in in g programs which may have been under­ taken. 4 . A nalysis o f su g g estio n s and c r itic is m s made by tr u s te e s and p ro fe s ­ sio n a l s t a f f re g a rd in g th e e f f ic ie n c y of se rv ic e and performance of jo b s . 5. Survey o f o p in io n o f th o se to be tr a in e d . This may be done d i r e c t ly through th e q u e stio n n a ire o r p erso n al in te rv ie w method. 6. Survey o f p a tie n ts * r e a c tio n s . The O rganization o f th e T rain in g Program The tr a in in g o f h o s p ita l employees d iv id e s i t s e l f in to two general c la s s ific a tio n s : 1 . Group t r a in i n g —c o u rse s, le c tu r e s and co n feren c es. 2. In d iv id u a l t r a in in g —on the jo b , d em o n stratio n . The two n e c e s s a r ily o v erlap to some e x te n t in p r a c tic e .

E ith e r group

o r in d iv id u a l methods may be used f o r "breaking in" new employees o r f o r fu rth e rin g the development of experienced w orkers. A b r ie f summary o f th e v a rio u s tr a in in g d e v ic e s , c u rre n tly in use in hos­ p i t a l s , or in i n d u s t r i a l and commercial o rg a n iz a tio n s which may be adapted f o r tra in in g the n o n -p ro fe ss io n a l h o s p ita l employees w ith in the scope of t h i s r e ­ p o r t, as e s ta b lis h e d by th e survey and the agreement o f the "expert j u r i e s ," is given on the fo llo w in g page, in Table V II.

In such a c l a s s i f ic a t io n i t i s

of course a l l b u t im p o ssib le to avoid some o v erlap p in g .

Ahd in many In stan ces

two o r more of th e ty p es l i s t e d a re used to achieve th e d e s ire d r e s u l t .

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Housekeeping Dept, (in c lu d in g laundry and lin e n room em­ p lo y ees, m aids, por­ t e r s , etc* )

1

D ietary Dept, (in ­ clu d in g c o o k s ,k it­ chen em ployees,w ait­ e r s , w a itre s s e s ,p o r­ t e r s , maids, e tc .)

i j

: ? !

'( .

S . . . .

a* Are employees liv i .ng in su pplied a l l m eals? A ll laundry serv ices? Yes No

I

ii

TOTAL Yes

No

i

I

J ______i

b . Are employees not liv in g in supplied meals during period in h o s p ita l? Laundry se rv ic e s fo r uniform s? Yes No e . Do you r a t e th e se p e r q u is ite s in fig u rin g wages?

Yes

d. I f so, are employees informed o f f i c i a l l y of th e amount se t?

I

Yes

No Yes

No

e. Do you favor elim in atin g the resid en ce fe a tu re f o r n o n -p ro fessio n al employees and as n e a rly a s p o ssib le paying co m p etitiv e wages a l l in cash? Yes No

No

208 H.

VACATION

ALLOWANCES

(P le a se check th e p ro p e r space fo r each c la s s if ic a tio n

G eneral C la s s if ic a tio n E xecutive (in c lu d in g Ad­ m in is tr a to r , Dept.Heads S u p e rv iso rs, e tc * ) C le r ic a l and O ffice ( in ­ clu d in g bookkeepers,clerke ste n o g ra p h ers, t y p i s t s and te le p h o n e o p e ra to rs)

'lone

1 wk

4 wks ‘

1

I

!

over 4 wks

a d d itio n to v ac a tio n

.......

1

1 i

p ':flulfrfeyg“ln

:

j 2 wks j 3 wks

i S

1 i s j f I

U n sk ille d and SemiS k ille d (in c lu d in g p o r te r s , m aids, k itc h e n and laundry w orkers, e t c .)

i j

i

----------- —U

P le a s e answer th e fo llo w in g questions as ap p ly in g only to th e l a s t too c la s s if ic a t io n s l i s t e d above ( c l e r i c a l and o ffic e * U nskilled and s e m i-sk ille d ) a*

Do you re q u ire a c e r ta in p erio d o f s e rv ic e before v acatio n w ith pay i s allow ed? Yes No How long

b.

Do you pro r a t e v a ca tio n a f t e r six months of s e rv ic e ?

c.

Do p aid s u b s titu te s cover during v acatio n p erio d s?

d.

I f h o lid a y s occur during v a c a tio n period do you allo w extra days?

Yes

No

e.

Do you allow accumulated days o f f to b e added to v a c a tio n period?

Yes

No

f.

Do you in c re a s e v a ca tio n p erio d s w ith le n g th o f serv ice? I f so, on what b a sis?

S«

I s tim e allow ed fo r conventions in a d d itio n to v acatio n time?

h.

With c la s s e s of employees allowed v acatio n s where s im ila r c la s s e s (laundry w orkers) in in d u stry a r e n o t, do you express t h i s p e r q u is ite in te r n s of a d d itio n a l com­ p e n sa tio n to t h e employee? Yes No

Yes Yes

No No

Yes

No Yes

No

209

III.

SICK

LEAVE

AND

HEALTH

SERVICE

(P lea se check th e p ro p er space fo r each c la s s if ic a tio n * and in d ic a te in proper space le n g th of sic k le a v e allow ance)

G eneral C la s s if ic a tio n

. ?ick ] fone

Hospi­ ta l leav e allow ance Care Time allow ed F ree

Medi-* cal | Care I With F ree ISL.

r

With Pay i f i l l afj AccommoHome j d a tio n s

E xecutive (in c lu d in g A dm inistrator* d e p t, heads* supervisors* e tc .) C le r ic a l and O ffice (in c lu d in g bookkeepers^ clerks* ste n o g ra p h e rs, | ty p i s t s and telep h o n e o p e ra to rs ) I

i

U n sk illed and SemiI s k ille d (in c lu d in g | p o rte rs* maids* k itch e;| and laundry workers* ) P le a se answer t h e follow ing q u estio n s as applying only to th e l a s t two c l a s s if ic a tio n s l i s t e d above ( c l e r i c a l and o ffice* u n s k ille d and s e m i-sk ille d ) a.

Does S uperintendent have power to vary from p o lic y in d ic a te d ?

b.

What i s your p o licy i f employee i s a v title d to h o s p ita l c a r e and belongs to a hos­ p i t a l s e r v ic e plan?

c.

Do you conduct a h e a lth serv ice f o r ^employees?

d.

Are p h y s ic a l exam inations re q u ire d b efo re employment—f o r a l l c la s s e s o f employees? Yes No I f n o t, f o r which c la s s e s ?

e.

Are r o u tin e p h y sic a l exam inations re q u ire d ?

f.

Do you have a h e a lth o f f i c e r t o care f o r ro u tin e exam inations and am bulatoiy i l l ­ n e sse s—f o r a l l c la s s e s of employees? Yes No For c e r ta in c la s se s ? Yes No I f la tte r * p le a s e s ta te which c la s s e s

g.

Do you allo w the employees to choose t h e i r own doctor?

h.

Do you express h e a lth se rv ic e in term s o f value to employees?

i.

Do you express s ic k le a v e allow ance in terms of v a lu e to employees?

Yes

Yes

Yes

No

No

No

Yes

No Yes

No Yes

No

210

EXHIBIT I (Re*

Conclusion, P.178)

SHOWING PRESENT AGE AND LENGTH OF SERVICE BY SEX OF 1554 EMPLOYEES OF FOUR NEW JERSEY STATE HOSPITALS N u m b e r Age Groups

Under 20 y r s . 20-24 25-29 30-34 35-39 40-44 45-49 50-59 60 and over T otal

P’o ta l A ll Occupa­ tio n s M 9 29 45 75 108 110 89

E m p l o y e e s Food and Food Care of Service P a tie n ts M M F

P la n t Mainte­ nance M F 1 3 10 18 33 45 41 79 54

o 3 5 4 3 3

4 7 0

7 18 23 40 55 46 31 101 47

O ffice Work M

124

10 76 112 100 111 106 89 126 34

0 1 3 5 6 8 3 3 7

790

764

36

96

10

0 5

°

201

of

2

15 13 23 ( 20 12

7 50 87 67 84 85 71

1 7 9 12 14

1 8 7

11

6 8

6

4

25

14 18 16

13 5

368

576

102

58

I 284 i

34

13 63 31 28 16 87 90 25 15

9 89 59 44 35 153 124 46 17

1

1 7

9

6

8 6

5 1 18 13 5 2

1 20 16 11 11 67 84 49 25

0

21

5 14 3 1

96 I 368

576

58

284

34

100

6 6

4

Length o f Serv ic e in Years Less th an 1 1 under 2 2 " 3 " 4 3 4 " 5 5, to 9 14 10 15 19 20 and over T otal

15 109 58 48 34 183 82 51

114 75 59 43 193 170 77 23

790

764

210

2

'I

1 1 5 12 4

7

36

f

5 ! 17 19 | 23 ! 3 i

NEW YORK U N IV E R SIT Y SC H O O L OF EDUCATION • I IB R A R Y •

24 24 4 5 102

2

4 3 2