Hospital staffing policies and employment growth in health care

Health Care

The Staffing Policies Matrix

Hospitals are in the clubs quadrant of the staffing policies matrix. Hospitals are in this sector because careers are slow-moving. This means that the focus is not on constant promotion. Instead, individuals work based on their specialist area, whether it be nursing, rehabilitation, or various medical specialties. On a day-to-day basis the focus is on being reliable and consistent.

Sonnenfield and Pieperl (1988) note that organizations in the clubs sector have a fixed hierarchy with an emphasis on status. This is true of hospitals with overall status based on the hierarchy of professions. This hierarchy has support staff at the lower levels, nurses at the middle levels, medical professionals at the higher levels, and specialist medical staff such as surgeons at the highest level. Within the levels, seniority determines status. Seniority is also the basis on which promotion is generally given. This is a slow-moving process, where individuals will eventually gain a senior status and a subsequent promotion.

Another important point is that individuals work based on their specialty area, while all employees contribute to the overall service being supplied. The overall service is the provision of health care, with individual specialty areas needing to combine to provide the service. This makes hospitals group-based, which places them in the clubs sector of the staffing policies matrix.

Sonnenfield and Peiperl (1988) also noted that organizations in the clubs quadrant tend to have a public interest mission. This is true of hospitals, since they operate to provide a public service.

2. Employment Growth in Health Care

Given the figures for health care employment in 1998 and the projections for employment in 2008, the percentage growth can be calculated for each health care occupation. This shows the following growth levels, arranged from lowest growth to highest growth:

Occupation

Percentage Growth

Dentists

Optometrists

Clinical lab technologists and technicians

Licensed practical and licensed vocational nurses

Physicians

Registered nurses

Physical therapists

Speech-Language pathologists and audiologists

Dental hygienists

Respiratory therapists

Physician's assistants

The highest growth area is in support positions. For example, physician's assistants and dental hygienists have increased, while dentists, physicians, and registered nurses have decreased. This change reflects the strategic actions of health care organizations, specifically their focus on cost-cutting. The occupations that are growing are less specialist and allow health care organizations to reduce costs. For example, an organization pays less to a physician assistant than a registered nurse. Therefore, by replacing registered nurses with physician's assistant, the service is provided at a lower cost. The same applies to replacing dentists with dental hygienists.

It also seems that even physicians are being replaced by physician's assistants. This is part of the strategy to limit access to specialists, with patients now seeing lower level medical staff, with higher level staff only involved when the case warrants it.

The relatively low increase in physicians, dentists, and optometrists is also linked to the way that health care organizations are requiring copayments so that patients are more sensitive to the costs of health care. This strategy makes it more likely that patients will ignore minor complaints instead of choosing to get medical attention. This includes that they may forgo checkups. This partially explains why dentists, optometrists, and physicians are all expected to increase more slowly than other professions.

The emphasis on prevention is also reflected in the changes in growth rates. This is seen especially in the comparison between dentists and dental hygienists. A dental hygienist's job is specifically based on preventing dental problems. The growth in dental hygienists shows the increasing focus on prevention. This also explains the slow growth rate in dentists, since preventing dental problems effectively reduced the demand for dentists.

The market demand for medical care is expected to increase. Overall, this should improve employment in the health care sector. The demand for each occupation will be inline with growth in that occupation. This means that there will be limited demand for dentists, optometrists, and lab technicians. There will be a medium level of demand for vocational nurses, physicians, and registered nurses. Finally, there will be a high level of demand for physical therapists, speech-language pathologists and audiologist, dental hygienists, respiratory therapists, and physician's assistants.

4. Porter's Competitive Strategies

In Competitive strategy: Techniques for analyzing industries and competitors, Porter (1980) described three possible competitive strategies. These were differentiation, cost leadership, and focus. These three strategies can all apply to health care organizations.

Differentiation refers to a strategy based on differentiating products and services from those of competitors. Since health care organizations are competing against others, this strategy can apply. This may become especially significant as more health care organizations become part of HMOs.

Cost leadership refers to a strategy focused on reducing costs and applying tight controls to improve efficiency and profitability. This is the major strategy that the HMOs have used and will continue to be an important strategy for many health care organizations.

Focus refers to a strategy where an organization concentrates on a specific niche market or buyer group. This may be an effective strategy for some health care organizations. For example, a health care organization could target expectant and new mothers with a service designed specifically for them. A health care organization could also target elderly individuals with specific services. This may become an important strategy in the future, especially since a focus strategy is a competitive strategy that often involves increasing prices and profits, since the service has specific value for the targeted group. As health care organizations seek greater profits, this strategy may become more popular.