HHC HRM Analysis 1

Donna Crane-Edwards

An Analytical Approach to New York City’s Health & Hospital Corporation’s Human Resource

Management Systems and Practices

Professor Tom Javarinis, PhD

March 26, 2009

HHC HRM Analysis 2

Thesis Statement

The current condition of the Human Resource Management (HRM) System and Practices of

New York City’s Health & Hospital Corporation (HHC), a subsidiary government agency does

not coincide with its future strategic plan for the firm. HHC has hired the Crane-Edwards

Consulting Firm to exam and recommend changes to the overall HRM system and practices of

the organization. The consulting firm will rely on the history, past and present systems; top

management expectations, the perception of its employees, and the strategies of the organization

to help the overall organization to make decisions on the restructure, revamp or transform the

current HRM system to help them reach their overall goals. The strategic plan used by HHC and

how it affects the current HRM systems and the need for changes to the system to meet the

growing demands of the organization’s population.

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Introduction

The New York City’s Health & Hospital Corporation (HHC), now one of the largest healthcare

facilities in the United States was founded in 1969 incorporating over 11 area hospitals and

health care facilities. “The Corporation operates the largest municipal health care system in the

Unites States with 38,988 employees as of June 30, 2008 and with annual operating revenues of

more than $5.6 billion for the fiscal year ended June 30, 2008” (Health and Hospital

Corporation,2009, pp. 41). According to New York City Center for Economic Opportunity

(CEO), “The population in the New York state is 8.2 million which 8 million are at or under the

poverty level which is 97 percent of the population” (pp. 22). This population makes up a large

percentage of the population seen and treated at the HHC facility. HHC reports “In accordance

with the Corporation’s mission, a significant number of its patients are persons that have

household incomes below the poverty level are medically indigent or both” (Health and Hospital

Corporation, 2009, pp. 42).

Over two centuries and a half ago, HHC is now continuing that goal of serving its growing

community of both under or uninsured clients. Though the demographics has changed from

predominately white middle class people to mostly Hispanic middle to poverty stricken families

with minimal or no insurance, the strategies of the organization still remains the same. The only

exception is that HHC now has backing from both the federal and local governments which gives

it a fiscal budget well over 5.6 billion dollars currently has a 180 million dollar growth project in

place but does not have money set aside for the new HRM technology system that will be

installed in the Spring of 2010.

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Analytical Findings

HHC has over 38, 988 employees, the majority of them hold non medical, non

managerial positions that are hired from the civil service pool, other government work first

agencies, and/or from the area population which is mostly composed of Hispanic citizens. Other

employees are hired through volunteer services that get the majority of their workers through

human services and/or coop programs from area high schools. 90% of these employees are in a

union.

A closer look at the strategic plan statement of the organization to see if its current vision

fits with the current and future plans of the organization. According to an article written by

Summers & Summers (1997), “The challenge to strategic skills analysis is to get a clear picture

of what the organization will be doing by the end of the planning period” (pp. 15). They further

state the need for a job analysis. In this case, starting at the top management level and building

on the skills of the HRM systems could be a good place to start.

After analyzing the organizations history and work ethics, New York City’s Health &

Hospital Corporation (HHC) has been identified as a defender firm according to the definition

specified by Dreher & Dougherty (2002), pp. 104. The work processes identified by the

organization focuses on development on training the medical staff within the organization and

the community to address quality and patient care concerns. Further analysis shows the lack of

training in the general and/or clerical personnel which attributes to the need for greater

performance in the human resource department in selection, training, benefits and strategic

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planning. The strategic plan used by HHC’s and how it affects the current HRM systems and the

need for changes to the system to meet the growing demands of the organization’s population.

The current state of New York City’s Health & Hospital Corporation (HHC) shows

through assessment that the current strategies of the organization do not coincide with the KSAs

of the current staff; the performance appraisals currently used does not effect employee

performance, and the organization currently has a freeze on the hiring of new employees needed

to meet the demands of the current and future growth of the organization.

In addition, over 90% of the staff is in a unionized position from mail room clerk to

medical director and that there are five different union organizations. The ten percent that do not

fall in the unionized category are top and middle management who are responsible for

implementation of duties, goals and future planning of the direction of the organization.

Moreover, the managers are also expected to train the current staff in the LEAN method

which will be coming in 2010 as well as change the current performance appraisals, prepare for

the new technology while maintaining a departmental budget that does not include an updated or

new HRM system needed to help with the implementation of the new strategic plans of the firm.

Job Pricing and Compensation Packages

Another area that needs to be addressed is the compensation systems which currently use

pay scales for all employees regardless of skills, experience and/or education that tend to

overlap. For example, on the employment website, looking at a clerical position with minimal

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experience start at $31,000 while a position for Assistant Director which requires a bachelor’s

degree starts at $32,000 both positions requires at least two years experience. This may cause a

problem because it shows that the organization does not show the importance of attracting the

best candidate by offering a salary that is competitive in the market. The textbook puts it best “…

employees must perceive a strong relationship between attaining performance standards and

receiving pay incentives” (pp. 18).

Moreover, Performance Management is one of the most important aspects to an

organization. Business functionality relies on the performance of the staff which leads to higher

productivity and greater profitability. According to Joseph Martocchio (2001), “The standards by

which employee performance is judged should be linked to a company’s competitive strategy or

strategies” (pp. 93). Not only is the performance essential to the organization, but it can be

rewarding for the employee through various compensation methods offered by the employer.

Currently HHC does not offer pay incentives to their employees only seniority pay is

given to the long time employees and their performance is not congruent with the need for better

performance.

Furthermore, as stated earlier the company is using strategies that are similar to the

defender firm, they lack some key components in the defender firm attributes which include their

hiring processes and organizational strategies which are more in line with the prospector firm.

The two prospector firm strategies that they adopted according to Dreher & Dougherty (2002)

are “Entry at multiple career stages and exit resulting from either poor individual performance or

the pull of external opportunities” (pp. 105).

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Description of Analysis of current and targeted work processes

According to the HHC, “As of June 2008, the clinical staff employed by the corporation

in FTEs numbered an estimated 484 physicians, 1,969 residents, 91 physician assistants 7,330

nurse practitioners and 7,801 technicians and specialists” (pp. 58).

Moreover, the corporation also employed 14, 977 FTEs for administrative, clerical, and

other support functions. From their entire work population 90.9% are in unions (see HHC, 2009,

pp. 59). The unions protect the rights of the individual employees in the corporation which can

be somewhat complicated as each class of employees utilizes their own union. The following

unions are under individual contract with the corporation: District Council 37, Doctor’s Council,

Teamsters Local 237; 199 Service Employees International Union, New York State Nurses

‘Association, and the Committee of Interns and Residents, (see HHC, 2009, pp. 59). In the last

decade, the job classification was changed for non managerial supervisor positions where they

too needed to have a college degree when hired from outside the agency although most of the

positions hire employees who are already in the HHC system.

While these positions ask for some experience in the health care and a degree, most are at

the management level. The lower level positions require two years experience in healthcare and

one of their main concerns is that applicants be bilingual. Internally, many employees who are

promoted are either bilingual or required to take an in-house Spanish speaking course set up by

the Human Resource department training division.

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Relevant Technology to achieve organization goals

New York City Health & Hospital Corporation is an organization that utilizes internalized

systems to satisfy employee development and production. The department of Information

Technology utilizes the Hospital Information Systems (HIS) in each facility that is responsible

for training all employees in the Health & Hospital Corporation for use in current and future

technology. The assessment(s) target area is the application, evaluation, need, training and

performance measures used by the department to support staff enrichment in an on-going process

and to help new hires to acclimate to their new work environment.

The middle management is usually trained prior to the installation of new technology in the HHC

facilities throughout the tri-state area to ensure that upon staff training, the new application of

technology is learned.

In the HHC organization, all staff has access to training through the Hospital Information

System’s program which is located on the employees’ personal access web site and approved

through the supervisor/manager of the department. The evaluation process is mandatory

throughout the organization and is performed by lower management. The form used is similar to

the graphic rating scale as discussed by Dreher & Dougherty (2002), pp. 149. The employees’

are given evaluations every six months that offer performance measures which give the

supervisor a view of the need or motivation for advancement, learning, and or retraining.

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One of the strategic plans for HHC is to strengthen its competitive position. According to

the President Mr. Aviles, in order to do this, he believes that introducing the corporation to “…

use cutting edge information technology (IT to drive clinical effectiveness and operational

efficiency; engage senior leadership at the corporation to drive patient safety and promote

transparency; implement collaborative process redesign initiatives that improve efficiency and

care delivery…” (pp. 48) along with other goals and plans targeted at better patient care.

In addition, the President plans on modeling training program for all staff and

management utilizing the LEAN a methodology borrowed by the Toyota Corporation. The

program is said to start in 2010 and is currently being set up by an outside consulting firm to

assess the training needs for current and future employees.

According to Dreher & Dougherty (2002), an organization’s business strategies should be

aligned with their HRM systems to help them gain competitive advantage (see pp. 168). The

problem here is that HHC has not address this issue yet but should be aware of the significance

of investing in a HRM system that will help bring in and maintain the staff needed to meet the

goals of the organization. In this instance the HRM practice would be invaluable to the HHC

organization.

Therefore, it is suggested that the organization either train their H.I.S. staff to handle the

training needs of the organization by hiring an outside consulting firm to retrain the H.I.S. staff;

revise and implement the current HRM system so that current and future candidates will be

correctly selected and placed in the areas needed to maintain growth and productivity; to provide

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staff development for current employees to learn and grow within the company, and to make sure

that all training is conducive to the position by providing an on going assessment that will

measure the KSAs used and learned during former training and the need for additional training to

maintain productivity.

Labor Market and appropriate labor law context

According to Dreher & Dougherty (2001), “Knowledge of equal employment opportunity

(EEO) and labor relations laws, government guidelines, and country-specific practices affects the

strategic decision-making process and the implementation of strategies” (pp. 216).

New York City’s Health & Hospital Corporation has the difficult task of trying to

modernize an impending growing population with the mission of incorporating the rules and

regulations, laws and mandates of a municipal principality; keeping in agreement with the labor

laws set forth by the government, the state and the city of New York. In addition, introduce

change to a working environment that is over ninety percent protected by unionized employee

rules and regulations which limit their ability to make oftentimes mistaken radical changes in

their work environment due to the fact that it will not only effect their budget, but it could cost

them tremendous fines by the auditing agencies as well as the being threatened with lost of jobs

and/or even shutting down.

In addition, “All aspects of a firm’s human resources activities, such as hiring.

Promotions, discipline, termination, transfers, training, and compensation, are to some extent

influenced and constrained by the equal employment and labor relations environment” (pp. 216).

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Identification of companies that are preparing to address the changes

After accessing the Wake Med Health Services site, which the following information is

available about training:

Employee Training

WakeMed staff have access to a wealth of continuing education and professional training

resources.

WakeMed offers traditional continuing education, on-site specific training, tuition

reimbursement, on-line programs and tracking of individual employee’s educational plans and

courses, brokered training resources and direct teaching by faculty and staff who are on-site

every day.

In addition to this, the Wake Med Foundation offers an Employee Skills Development

Scholarship that enables employees to enhance their job skills through avenues not typically

supported by budgeted continuing education or tuition reimbursement programs.

Learning Link is an on-line catalog of courses available. Employees may review courses through

the Wake Med intranet or by contacting the Staff and Workforce Development Office. Learning

Link tracks the employee’s mandatory program participation, as well as voluntary education. 

Classes may fall under these categories:

Management Development

Clinical Analysis

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Employee Development

Quality Improvement Strategies and Measures

Self-Directed Learning Opportunities

Computer Courses

While the size of Wake Med is tiny by comparison to the HHC organization, they do

meet their mission, strategies and goals with the use of HRM systems. When searching the HHC

site, no information is found other than a press release regarding any training, development or

staffing systems.

While HHC employees lack the technology skills needed to prepare them for future

changes, the entire staff relies on the Hospital Information System department to handle any and

all technology difficulties that it may require in the future to minimize spending. While this may

sound cost effective, it does not address the needs of the individual employees who want to

advance from their current positions within the organization or have the ability to seek

employment at a more advanced organization due to the lack of KSAs required during hiring; or

help productivity within their current positions.

On the other hand, it is fair to say that Wake Med is considered a private facility

receiving little funding from the local, state or government while HHC relies mainly on those

funds as well as private donations to continue its capacity to grow and treat patients who can

hardly pay for services.

In addition, Wake Med does not offer these services nor do they have the manpower or

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the population size that HHC has to contend with nor the same demographic population. The

need for care of patients by the residence surrounding Wake Med is different because their

population is mostly middle class citizens in the Cary area with a median salary of $74,000 per

annum while HHC has a 90% poverty line population with a median salary of $20, 025 per

annum and a population well into the millions as compared to Cary and its surrounding areas not

reaching ½ of one million currently (see Town of Cary demographics, pp. 1).

Therefore, it is suggested that the organization either train their H.I.S. staff to handle the

training needs of the organization by hiring an outside consulting firm to retrain the H.I.S. staff;

revise and implement the current HRM system so that current and future candidates will be

correctly selected and placed in the areas needed to maintain growth and productivity; to provide

staff development for current employees to learn and grow within the company, and to make

sure that all training is conducive to the position by providing an on going assessment that will

measure the KSAs used and learned during former training and the need for additional training

to maintain productivity.

one of the most important aspects in an organization that has never modernized or

updated their system where employees who have been unmotivated for over ten years, the need

to change the reward system where seniority is not the only means to getting raises but using

modernized performance appraisal methods as catalyst to offer employees incentives to motivate

their efforts to be more competitive and productive in a changing and growing work

environment.

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Prescribe a set of HRM recommendations tailored for the selected firm (19 dimensions of an

HRM system presented in Chapter 3)

New York City’s Health & Hospital Corporation (HHC) assessment shows a need for a

HRM system that will coincide with their current strategic plan to stay competitive, become

technologically modernized; enhance quality and quantity of care, prepare staff for the training

and use of the LEAN method, to increase employee performance within a strict budget set by

government guidelines and regulations. The HRM system must provide value, cost effectiveness,

return on investment; and provide the ability to fit future hires with the KSAs (knowledge, skills

and attitude) necessary to perform the duties necessary for the firm’s upgrades. The fact that

there is a freeze on hiring for the entire organization means that the current employees must be

motivated to learn the needed skills required to perform the new tasks. In order to achieve this,

the general manager must analyze the current performance appraisals as to the behavior of the

employees separating the high performance appraisals from the lower performance appraisals.

In addition, take the lower performance appraisals and depending on the number of

employees that do not meet the required level of performance needed to train for the new system,

address a solution that would help motivate them to not only train but perform the new duties

successfully. The student would suggest a change in the compensation system from seniority

raises only to include incentive pay for high performance appraisals to motivate the newer

employees to work more efficiently.

Furthermore, the general manager should look for a method of HR systems that meet the

LEAN method which initiates team work over individual work and set up a performance

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appraisal that will link team work, incentive pay for performance and the strategic goal of the

organization to show that the division of the three will cause problems for the organization.

According to Joseph Martocchio (2001)”Job descriptions serve as a cornerstone in the

development of internally consistent compensation systems as well as performance standards in

performance evaluation systems” (pp. 147). Providing HHC with a closer look at the current

conditions of their job descriptions as they relate to current pay and the current market will give

them a broader view of the need for a new HR system and/or changes within the current system.

In addition, a job analysis followed by an evaluation will provide a starting point for the

type of training that will be needed to ensure that all employees meet the KSAs needed to

perform the job after the new technology is installed.

Furthermore, because HHC is a government agency, it is important that the legalities of a

job analysis meet the labor laws required by the state and local government. HHC has to follow

government regulated policy and procedures to ensure that all labor laws are met when doing a

job analysis.

Other HRM issues

Another important factor that HHC will look at as to the need for or updating their

current HR system is the knowledge of its importance as to price and value. According to Dreher

& Dougherty (2001), “For an investment in an HR system to add value to the firm it must

generate a reasonable rate of return” (pp. 203).

Selling the need for a renewed HR system will be difficult because unlike the idea of the

agency to switch to the LEAN method which was decided at the government level, determining

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the need for an improved and or new HR system will be very difficult because they HHC agency

takes most of their cues from the federal level when it comes to changes in part because most of

their budget is government regulated as well as provided by the government while other funding

comes from private donations.

While it is not quite apparent how HR Systems can bring value at the state and federal

level, thirty year employee of the federal government, Colleen Woodard (2005) believes that

slowly but surely some government agencies are coming around because they have been given

the green light to make changes to the HRM systems emulating the private business sector on the

belief that merit systems, HRM systems and strategic goals are connected and together not only

add value to an organization but help attract well qualified candidates to do the job (see pp. 4).

Furthermore, Colleen Woodard believes that it is just a matter of time before the value of

HRM systems and practices are realized by the entire government and they will be quickly

embraced and utilized to help lead the cornerstone of a more harmonized and uniformed

organizational system.

Finally, while HHC may not have the authority to change their current HRM system

other than to make it computerized to meet the demands of the market, when the government

does fully recognize the value of an HRM system, the one that would most likely match the

overall needs of the organization as it effects their cost effectiveness would be one that is merit

based because it has the most value as to the direction the organization is trying to go and would

better motivate the current employees by offering them an incentive to perform more effectively

and at the same time helping the organization to take a congruent approach to employee

performance.

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References

Dreher, G. & Dougherty, T. (2002). Human resource strategy: A behavioral perspective for the general

manager Boston, MA: McGraw-Hill/Irwin.

Martocchio, J.J. (2001). Strategic Compensation: A Human Resource Management Approach (5th

edition). Prentice Hall.

New York City Health & Hospitals Corporation (2009). Site visited February 20, 2009 from

http://www.nyc.gov/html/hhc/html/about/about.shtml.

Summers, T.P. & Summers, S. B. (1997). Strategic skills analysis for selection and development. HR.

Human Resource Planning, 20(3), 14-19.  Retrieved March 3, 2009, from ABI/INFORM

Global database. (Document ID: 23326349).

The CEO Poverty Measure (2009) A Working Paper by The New York City Center for Economic

Opportunity (August 2008). Site visited on March 14, 2009 from

http://www.nyc.gov/html/ceo/downloads/pdf/final_poverty_report.pdf.

Town of Cary (2009).

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Wake Med Health Service (2009). Site retrieved March 7, 2009 from www.wakemed.org

Woodard, C.A.  (2005). Merit by Any Other Name-Reframing the Civil Service First Principle. Public

Administration Review, 65(1), 109-116.  Retrieved March 21, 2009, from ABI/INFORM

Global database. (Document ID: 788053501).