Employee Discipline
Content
DISCIPLINARY AND GRIEVANCE PROCEDURES
The biggest issue in terms of policies is probably that related to disciplinary and grievance procedures. If you’re a small business, you may feel it unnecessary to have written procedures for these, but there are genuine benefits to having both clearly stated and given to all employees. These benefits are summarised here:
Employees prefer to know where the boundaries lie, particularly with conduct and behaviour It reduces grievances as everyone knows the “rules” from the outset It ensures consistency of decisions – and fairness is one of the key attributes of a good employer from an employee’s point of view The structure allows time for issues to be resolved without further action in most cases You have records of disciplinary and grievance discussions and actions agreed should the matter go to an Employment Tribunal Confronting employees may be unpleasant – no-one enjoys sacking someone – and having a procedure to follow makes it less personal
Employers are not required by law to have a disciplinary procedure but employers with 20 or more employees must, in a written statement, specify the person (by name or job title) to whom individuals may apply if they have a grievance or wish to appeal against any disciplinary action. This is where your reporting structure is important – the first person to go to is usually the employee’s line manager, followed by Head of Department (if applicable) to the Personnel Director or owner/general manager. Details should also be given of how they should make such an application. Does it need to be in writing, or verbal? You should also specify the procedure for dealing with the matter – the time scale (within 5 working days, for example), response mechanism (in writing or in a recorded meeting) etc. Workers may choose to be represented by a fellow worker or union official if they are subject to formal disciplinary action. This right to be accompanied is important – and easy to forget – as in what is usually a stressful situation, the employee has someone else to support him or her.
Employee Discipline
Employee Discipline is vital in any successful business or organisation. Yet, the very words Employee Discipline sound threatening, challenging and rather 'command and control'. The truth of the matter is that there have to be agreed ways of working that everyone subscribes to in a business, to generate the very best results. Within those boundaries, rather than have a stifling effect on creativity, fun and energy, quite the opposite occurs. Great Staff Discipline removes clutter and allows your people to focus on what they do best, without the distractions of petty squabbles or politics (well, maybe not all politics!). With agreed guidelines and standards, these tools provide the basis for developing that most effective discipline of all - Self Discipline. "I think of discipline as the continual everyday process of helping an employee learn selfdiscipline." Fred Rogers "We must all suffer one of two things: the pain of discipline, or the pain of regret or disappointment." Jim Rohn
Top Ten Things About Employee Discipline
In the very best organisations, or more precisely, the very best teams, Employee Discipline is not an issue. It just isn't there. In the culture, is embedded a way of working where discipline rarely shows up and even then, it is often dealt with quietly and efficiently by other members of the team. So, the very best with Employee Discipline... 1. Have Clear Expectations Everybody knows what is expected of them, one by one, to get their job done satisfactorily.
2. Listen and Hear By being able to listen to their people, the best at Employee Discipline are aware of issues easily. By 'hearing' what they say, this builds a two-way process which pre-empts issues and prompts pro-active solutions early. 3. Provide 'Ways of Working' Rules Through consultation and understanding the needs of their people, great exponents of Staff Discipline publish the core standards they expect of their people. 4. Are Approachable In conjunction with 2), they are easy to approach and therefore build strong relationships with their people, thus ensuring they are in the debates that happen. 5. Deal with Indiscipline For those who do transgress, there is a process which is firm and fair, delivered across the board, in a generative and supportive way, yet definite too. Staff are clear what will happen and it does. 6. Lead by Example The best with Employee Discipline 'Walk Their Talk'. They don't expect anyone to behave differently to the way they do - indeed they generate a relationship with their people such that they are given useful feedback, which they use. 7. Are Very Fair Whilst there are policies and practices in their business, the best with building a good Employee Discipline culture in their business appreciate that sometimes things need to be changed or challenged and so when that happens, they are fair about it and not closed. through this, even better outcomes are achieved. 8. Leverage Abilities Sometimes, an individual may give the impression of being wayward or even out of control. Great managers also realise that sometimes, people get into the wrong job and that has implications. So they seek to understand better and find the round hole that this round hole person wants and needs, rather than a square one. Then this leverages and 'turns around' the talented people who might otherwise be lost. 9. Have a Formal Process Organisations often have proscribed disciplinary procedures. These are to enable consistency and fairness, on both sides of the equation. In the best businesses, these are used properly with understanding, focus and commitment. Ironically, when this is the case, they have to be used less often. 10. In the Bones In the best businesses, Staff Discipline is not something 'done-to', it is inherent. That is it is the way of being, because individuals have taken it on board and made sure that they practice self-discipline.
Ten Ways to be Better at Employee Discipline
1. Get a System Ensure that all your people know what is expected of them personally and as part of a team. Add to this s formal structure for dealing with indiscipline and explain it upfront. Where you can, enable your people to be involved in creating these. 2. Build Relationships Take every opportunity to build informal relationships with your people, through conversation, discussion and any form of work or non-work related chat. 3. Be Honest Be honest with yourself and with your people, all the time. Create trust through keeping promises, being open and seeking to understand others better. 4. Focus on Outcomes If you keep in mind that it is your bottom line that is important here, it flushes out any sentimentality or weakness you might have in this area. 5. ...And Inputs Yet, recognise that you have the accountability to deliver this people stuff. It's what you put in that will dictate what you get out. Yes, again, it's up to you!
6. Build Consistency Through sticking with what you've agreed to be the 'rules' (albeit with a little tweaking), your people get to realise what is to be, is to be and will get better at accepting and then valuing the way it is in your business. 7. Be Respectful Even when you are working an agreed set of principles in your business, be caring and understanding - it costs you nothing and yet it builds your people's faith in you and the process without fail. 8. Encourage Involvement Getting your employees to take part in shaping the way you all agree to work together makes the acceptance of the agreement much easier and far more likely to succeed. 9. Appreciate Growth By seeing how far you have come and sharing with your people how much progress they, you and the business is getting from a set of principles you all stick to, more energy will come. 10. Support Others Be there for your people, especially in the early days as you fine tune and introduce a discipline process. They will welcome your support and encouragement
5 Simple Actions You Can Take Today!
Assess where you are with staff discipline. You need to know and be honest with yourself - so reflect on the issues you have faced in the last month and think carefully about the source of these. Then, be honest about what you need to do differently personally - what shifts do you have to make and what's stopping you? Ask your key people to be honest with you too - not just about what you need to do, but also what they see as changes that are needed as well. Work together. See the future - what do you want it to be like in three months, for things to evolve to be better - much better - be demanding of yourself. Ask for help in getting this right, but start now and take steps today to move yourself forward - then a step a day.
Read a great book – like
Health equity
From Wikipedia, the free encyclopedia Jump to: navigation, search See also: Social determinants of health and Inequality in disease
Health equity (related terms include healthcare inequality and healthcare disparities) refers to the study of differences in the quality of health and health care across different populations.[1]. This may include differences in the "presence of disease, health outcomes, or access to health care"[2] across racial, ethnic, sexual orientation and socioeconomic groups.[3] Differences among populations in the presence of disease and health outcomes is well documented in many areas. In the United States, disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos, with these groups having higher incidence of chronic diseases, higher mortality, and poorer overall
health outcomes.[4] For example, the cancer incidence rate among African Americans is 10% higher than among whites,[5] and adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes.[6] Similarly, disparities in the overall level of health in individuals also exist between differing socioeconomic groups, with lower-status socioeconomic groups generally having poorer health and higher rates of chronic illness including obesity, diabetes, and hypertension.[7] Health equity also includes differences in access to health care between populations. For example, those in lower-status socioeconomic groups receive less consistent primary care, which is positively correlated to overall level of health in the recipient.[8]. Similarly, in England, "people living in deprived areas were found to receive around 70% less provision relative to need compared with the most affluent areas for both knee and hip replacements."[9] A lack of health equity is also evident in the developing world, where the importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals.[10]
Ethnic and racial disparities
See Ethnicity and health and Race and health. The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these raciallycentered disparities continue to exist and are a significant social health issue.[11] The disparities in access to adequate healthcare include differences in the quality of care based on race and overall insurance coverage based on race. The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non-ethnic minorities.[12] There are also considerable racial disparities in access to insurance coverage, with 'ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and receive less regular medical care. The level of insurance coverage is directly correlated with the level of access to healthcare including preventative and ambulatory care.[11]. There is debate about what causes health disparities between ethnic and racial groups.[13] However, it is generally accepted that disparities can result from three main areas:
From the personal, socioeconomic, and environmental characteristics of different ethnic and racial groups (such as how certain racial groups, on average, live in poorer areas with high incidence of lead-based paint, which can harm children). A great deal of research on social
determinants of health and the socio-ecological model have also surfaced, which connect economic and social conditions in determining a community's or a population's health. From the barriers certain racial and ethnic groups encounter when trying to enter into the health care delivery system; and From the quality of health care different ethnic and racial groups receive.[14]
Each of these dimensions have been suggested as possible causes for disparities between racial and ethnic groups. However, most attention on the issue has been given to the health outcomes that result from differences in access to medical care among groups, and the quality of care different groups receive. Additionally, attention on health care disparities is largely focused on race and ethnicity; data on racial and ethnic disparities are relatively widely available. In contrast, data on socioeconomic health care disparities are collected less often, often using education as the indicator of socioeconomic status.[15] The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data.[16] The Institute of Medicine report, Race, Ethnicity, and Language Data[1] identifies current models for collecting and coding race, ethnicity, and language data; ascertains the challenges involved in obtaining these data in health care settings; and makes recommendations for improvement. A study of 20,000 cancer patients in the United States found that African Americans are less likely than European Americans to survive breast, prostate and ovarian cancer even when given equal care, but that other forms of cancer had equal survival chances, which suggests that biological factors may be at work.[17] Transplantation rates differ based on race, sex, and income. A study done with patients beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list.[18] For example, different groups express definite interest and complete the pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on patients currently on the transplantation waiting list.
LGBT minority group health disparities
Often under emphasized are the minority groups that are heavily affected by health disparities in America, UK and all the same worldwide. Health disparities are not just based on race, ethnic, and cultural differences. Such disparities are seen as affecting the sexuality minority groups and
observations and surveys show that one’s sexual minority status may limit access to health care, with especially bad impact on lesbians,[19] which are being discriminated both as females and as homosexual.[20] “Health inequalities exist for lesbian and bisexual women, largely related to experiences of discrimination, homophobia and heterosexism.” [21] This known interference with health care access is a prime example of heterosexual privilege and homosexual prejudice prevalence in Western societies. Just as this lack of health care affects minority races, ethnic groups, and less represented cultural beliefs; lesbian and bisexual women are deteriorating their health by either not seeing (being feared of) or not be attended to by health care professionals. It is important that health care professionals consider the nine cultural competency techniques suggested by the Agency for Healthcare Research and Quality and make an effort to break the barriers put into place through society’s homophobia and heterosexism.[22]
[edit] Healthcare equity and sex
The results in comparing inequities in access to adequate healthcare and gender are somewhat surprising, with women in the United States generally having higher levels of access to care. These disparities can be explained in part by looking at rates of overall insurance coverage (privatized and publicly assisted) between men and women, the effects of certain socioeconomic factors on levels of coverage between men and women, and overall gender-based differences in perceptions of health and health care. In the United States, women have better access to healthcare, in part, because they have higher rates of health insurance. In one study of a population group in Harlem, 86% of women reported having health insurance (privatized or publicly assisted), while only 74% of men reported having any health insurance. This trend in women reporting higher rates of insurance coverage is not unique to this population and is representative of the general population of the US[8]. Gender based perceptions of health and healthcare may help explain some of the lag of men behind women in levels of insurance coverage. Women report higher rates of illness than men, which barring the idea that women are sicker than men, indicates women are more likely to seek medical care out and are therefore more likely to possess medical insurance[8]. Gender related disparities in access to healthcare are also related to socioeconomic factors including geographic job-market differences and differing levels of government assistance available to men and women. There are fewer job opportunities with insurance coverage available to men and women living in poorer communities, and of these opportunities, women tend to occupy more of the jobs with these benefits. Government assistance available to these individuals without job-related coverage varies between men and women, with women, especially women with children, receiving a higher percentage of available public assistance than men.[8] Ultimately, for both men and women discrepancies in access to adequate healthcare is largely based on socioeconomic issues including income and full-time work status, with both groups of men and women with higher levels of income and full-time work receiving greater access to adequate healthcare[8].
[edit] Healthcare Inequality and Socioeconomic Status
While gender and race play significant factors in explaining healthcare inequality in the United States, socioeconomic status is the greatest determining factor in an individual's level of access to healthcare. Not surprisingly, individuals of lower socioeconomic status in the United States have lower levels of overall health, insurance coverage, and less access to adequate healthcare. Furthermore, individuals of lower socioeconomic status have less education and often perform jobs without significant health and benefits plans, whereas individuals of higher standing performs jobs that are more likely to have jobs that provide medical insurance[8].
[edit] Disparities in access to health care
Reasons for disparities in access to health care are many, but can include the following:
Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites.[23] Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.[24] Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.[25] Legal barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing Medicaid coverage to immigrants who have been in the country fewer than five years.[26] Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.[27] The health care financing system. The Institute of Medicine in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.[28] Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.[29] Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not English-proficient.[30] Health literacy. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.[31]
Lack of diversity in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population.[32] Age. Age can also be a factor in health disparities for a number of reasons. As many older Americans exist on fixed incomes which may make paying for health care expenses difficult. Additionally, they may face other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically. Also, they may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet.[33] This could put older individuals at a disadvantage in terms of accessing valuable information about their health and how to protect it.
[edit] Disparities in quality of health care
Health disparities in the quality of care different ethnic and racial groups receive can include:
Problems with patient-provider communication. This communication is critical for the delivery of appropriate and effective treatment and care and, regardless of a patient’s race, miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. Among non-English-speaking populations in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during health care visits report having one. Additional communication problems stem from a lack of cultural understanding on the part of white providers for their minority patients. For example, patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with.[34] Other type of communication problems are seen in LGBT health care with the spoken heterosexist (conscious or unconscious) attitude on LGBT patients, lack of understanding on issues like having no sex with men (lesbians, gynecologic examinations) and other issues.[35] Provider discrimination. This is where health care providers either unconsciously or consciously treat certain racial and ethnic patients differently than other patients. Some research suggests that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.[36] Lack of preventive care. According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care.[37] For example, minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people.
[edit] Ending health disparities
The Commonwealth Fund, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities:[38]
Consistent racial and ethnic data collection by health care providers. Effective evaluation of disparities-reduction programs. Minimum standards for culturally and linguistically competent health services. Greater minority representation within the health care workforce. Establishment or enhancement of government offices of minority health. Expanded access to services for all ethnic and racial groups. Involvement of all health system representatives in minority health improvement efforts.
Other methods for ending health disparities or reducing health disparities have been suggested based on research that observes cultural differences within health care systems. According to the Agency for Healthcare Research and Quality and the assisting authors Cindy Brach and Irene Fraserirector, in an effort to reduce disparities between racial and ethnic groups, the health care system should consider the following nine cultural competency techniques:
Interpreter services. If agencies take an active approach in hiring professional interpreters, for both foreign languages and for the speaking and hearing impaired, communication barriers will begin to decrease. Recruitment and Retention. Healthcare systems need to become more conscious of the staff within their facilities. It is essential to the reduction of disparities that most minority groups be represented within the various health care offices and clinics. Training. The Agency for Healthcare Research and Quality and its assisting authors emphasized the importance of health care professionals being trained to work with interpreters and minority groups. Coordinating with traditional healers. Health care workers should be supportive and able to adjust health care plans according to the patient’s cultural beliefs and traditional health practices. Use of Community Health Workers. These individuals could be responsible for bringing in the population of people who rarely seek out health care. Culturally competent health promotion. This information can be available through community health workshops, or simply by health care workers taking the necessary measures to promote early detection and treatment and outlining the good and risky health behaviors to all patients. Including family and/or community members. The Agency for Healthcare Research and Quality states that this particular cultural competency may be vital to obtaining consent and adherence to treatments. Immersion into another culture. Allowing yourself to step outside of your comfort zone will increase your tolerance for another culture as well as raise your awareness to new ideals and beliefs. Administrative and Organizational accommodations. These are some aspects of the health care offices that should be considered; they include the location of the healthcare offices, public transportation availability, clinic hours, the physical environment of the clinic, and the rapport built with the patients.[39]
[edit] Health inequalities
Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparative access to health care services. Such examples include higher rates of morbidity and mortality for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder. In Canada, the issue was brought to public attention by the LaLonde report. In UK, the Black Report report was produced in 1980 to highlight inequalities. On 11 February 2010 Sir Michael Marmot, an epidemiologist at University College London, published the Fair Society, Healthy Lives report on the relationship between health and poverty. Marmot described his findings as illustrating a "social gradient in health": the life expectancy of the poorest is seven years shorter than the most wealthy, and the poor are more likely to have a disability. In its report on the study, The Economist argued that the causes of this health inequality include lifestyles smoking remains more common, and obesity is increasing fastest, amongst the poor in Britain.[40]
Inequalities in Health Care
by Will Wilkinson on October 20, 2009 In a post on “Paying for Health” the philosopher Daniel Little writes: It seems a bitter but unavoidable truth that there are very substantial inequalities in the provision of health care in our society. One person’s likelihood of surviving a devastating cancer may be significantly less than another person’s chances, simply based on the second person’s ability to pay for premium health care services. Further, it seems unavoidable that these extreme inequalities are flatly unjust in any society that believes in the equal worth of all human beings. And where this seems to lead is to the conclusion that some system of universal health insurance is a fundamental requirement of justice. Clearly Little is merely gesturing at an argument, but I cannot follow the gesture. That some are able to afford, say, a treatment with very expensive new technology that significantly increases (how much is that?) their chances to survive a devastating cancer compared to the chances of those who cannot afford it does not seem to me unjust, flatly or otherwise. It seems a trivial consequence of the fact that new technology is often much more expensive than older technology. Moreover, it seems plain that any economically feasible scheme of universal health insurance must refuse to cover many expensive treatments (new or otherwise). So a system of universal health insurance will do nothing to eliminate “extreme inequalities” in many kinds of cases. In these cases, the only hope of eliminating the inequality is forbidding access to treatments that cannot be provided to all under the universal health insurance system. But a policy of coercively preventing exchanges that help someone (the doctor, at least!) but harm no one is flatly unjust. Which leads to the conclusion that the attempt to prevent some inequalities in the provision health care is ruled out by the requirements of justice.
If Little limited himself to the much weaker, and much more plausible, claim that justice demands a system of institutions that offers health care that is as good as it gets for the least well-off, then justice might plausibly demand in health services what we have (and Little seems to endorse) in food: a competitive market with means-tested vouchers. That just about everyone left of center, including philosophers, seem to glide from their moral premises, whatever those might be, to “some system of universal health insurance” will some day be appreciated as the peculiar ideological reflex that it is.
BARRIERS TO HEALTH CARE (4 OF 5) A Framework: 1. Geographic barriers
rural and inner-city health professional shortage areas
2. Cultural barriers
health beliefs and behaviors, practitioner beliefs and behaviors
3. Socioeconomic barriers
lack of health insurance, inability to pay out of pocket, poor education
4. Organizational barriers
lack of interpreters or wheelchair accessibility, long appointment wait times 5. Combinations of 1,2,3,4 many disparities likely due to mixture of these factors
The biggest issue in terms of policies is probably that related to disciplinary and grievance procedures. If you’re a small business, you may feel it unnecessary to have written procedures for these, but there are genuine benefits to having both clearly stated and given to all employees. These benefits are summarised here:
Employees prefer to know where the boundaries lie, particularly with conduct and behaviour It reduces grievances as everyone knows the “rules” from the outset It ensures consistency of decisions – and fairness is one of the key attributes of a good employer from an employee’s point of view The structure allows time for issues to be resolved without further action in most cases You have records of disciplinary and grievance discussions and actions agreed should the matter go to an Employment Tribunal Confronting employees may be unpleasant – no-one enjoys sacking someone – and having a procedure to follow makes it less personal
Employers are not required by law to have a disciplinary procedure but employers with 20 or more employees must, in a written statement, specify the person (by name or job title) to whom individuals may apply if they have a grievance or wish to appeal against any disciplinary action. This is where your reporting structure is important – the first person to go to is usually the employee’s line manager, followed by Head of Department (if applicable) to the Personnel Director or owner/general manager. Details should also be given of how they should make such an application. Does it need to be in writing, or verbal? You should also specify the procedure for dealing with the matter – the time scale (within 5 working days, for example), response mechanism (in writing or in a recorded meeting) etc. Workers may choose to be represented by a fellow worker or union official if they are subject to formal disciplinary action. This right to be accompanied is important – and easy to forget – as in what is usually a stressful situation, the employee has someone else to support him or her.
Employee Discipline
Employee Discipline is vital in any successful business or organisation. Yet, the very words Employee Discipline sound threatening, challenging and rather 'command and control'. The truth of the matter is that there have to be agreed ways of working that everyone subscribes to in a business, to generate the very best results. Within those boundaries, rather than have a stifling effect on creativity, fun and energy, quite the opposite occurs. Great Staff Discipline removes clutter and allows your people to focus on what they do best, without the distractions of petty squabbles or politics (well, maybe not all politics!). With agreed guidelines and standards, these tools provide the basis for developing that most effective discipline of all - Self Discipline. "I think of discipline as the continual everyday process of helping an employee learn selfdiscipline." Fred Rogers "We must all suffer one of two things: the pain of discipline, or the pain of regret or disappointment." Jim Rohn
Top Ten Things About Employee Discipline
In the very best organisations, or more precisely, the very best teams, Employee Discipline is not an issue. It just isn't there. In the culture, is embedded a way of working where discipline rarely shows up and even then, it is often dealt with quietly and efficiently by other members of the team. So, the very best with Employee Discipline... 1. Have Clear Expectations Everybody knows what is expected of them, one by one, to get their job done satisfactorily.
2. Listen and Hear By being able to listen to their people, the best at Employee Discipline are aware of issues easily. By 'hearing' what they say, this builds a two-way process which pre-empts issues and prompts pro-active solutions early. 3. Provide 'Ways of Working' Rules Through consultation and understanding the needs of their people, great exponents of Staff Discipline publish the core standards they expect of their people. 4. Are Approachable In conjunction with 2), they are easy to approach and therefore build strong relationships with their people, thus ensuring they are in the debates that happen. 5. Deal with Indiscipline For those who do transgress, there is a process which is firm and fair, delivered across the board, in a generative and supportive way, yet definite too. Staff are clear what will happen and it does. 6. Lead by Example The best with Employee Discipline 'Walk Their Talk'. They don't expect anyone to behave differently to the way they do - indeed they generate a relationship with their people such that they are given useful feedback, which they use. 7. Are Very Fair Whilst there are policies and practices in their business, the best with building a good Employee Discipline culture in their business appreciate that sometimes things need to be changed or challenged and so when that happens, they are fair about it and not closed. through this, even better outcomes are achieved. 8. Leverage Abilities Sometimes, an individual may give the impression of being wayward or even out of control. Great managers also realise that sometimes, people get into the wrong job and that has implications. So they seek to understand better and find the round hole that this round hole person wants and needs, rather than a square one. Then this leverages and 'turns around' the talented people who might otherwise be lost. 9. Have a Formal Process Organisations often have proscribed disciplinary procedures. These are to enable consistency and fairness, on both sides of the equation. In the best businesses, these are used properly with understanding, focus and commitment. Ironically, when this is the case, they have to be used less often. 10. In the Bones In the best businesses, Staff Discipline is not something 'done-to', it is inherent. That is it is the way of being, because individuals have taken it on board and made sure that they practice self-discipline.
Ten Ways to be Better at Employee Discipline
1. Get a System Ensure that all your people know what is expected of them personally and as part of a team. Add to this s formal structure for dealing with indiscipline and explain it upfront. Where you can, enable your people to be involved in creating these. 2. Build Relationships Take every opportunity to build informal relationships with your people, through conversation, discussion and any form of work or non-work related chat. 3. Be Honest Be honest with yourself and with your people, all the time. Create trust through keeping promises, being open and seeking to understand others better. 4. Focus on Outcomes If you keep in mind that it is your bottom line that is important here, it flushes out any sentimentality or weakness you might have in this area. 5. ...And Inputs Yet, recognise that you have the accountability to deliver this people stuff. It's what you put in that will dictate what you get out. Yes, again, it's up to you!
6. Build Consistency Through sticking with what you've agreed to be the 'rules' (albeit with a little tweaking), your people get to realise what is to be, is to be and will get better at accepting and then valuing the way it is in your business. 7. Be Respectful Even when you are working an agreed set of principles in your business, be caring and understanding - it costs you nothing and yet it builds your people's faith in you and the process without fail. 8. Encourage Involvement Getting your employees to take part in shaping the way you all agree to work together makes the acceptance of the agreement much easier and far more likely to succeed. 9. Appreciate Growth By seeing how far you have come and sharing with your people how much progress they, you and the business is getting from a set of principles you all stick to, more energy will come. 10. Support Others Be there for your people, especially in the early days as you fine tune and introduce a discipline process. They will welcome your support and encouragement
5 Simple Actions You Can Take Today!
Assess where you are with staff discipline. You need to know and be honest with yourself - so reflect on the issues you have faced in the last month and think carefully about the source of these. Then, be honest about what you need to do differently personally - what shifts do you have to make and what's stopping you? Ask your key people to be honest with you too - not just about what you need to do, but also what they see as changes that are needed as well. Work together. See the future - what do you want it to be like in three months, for things to evolve to be better - much better - be demanding of yourself. Ask for help in getting this right, but start now and take steps today to move yourself forward - then a step a day.
Read a great book – like
Health equity
From Wikipedia, the free encyclopedia Jump to: navigation, search See also: Social determinants of health and Inequality in disease
Health equity (related terms include healthcare inequality and healthcare disparities) refers to the study of differences in the quality of health and health care across different populations.[1]. This may include differences in the "presence of disease, health outcomes, or access to health care"[2] across racial, ethnic, sexual orientation and socioeconomic groups.[3] Differences among populations in the presence of disease and health outcomes is well documented in many areas. In the United States, disparities are well documented in minority populations such as African Americans, Native Americans, Asian Americans, and Latinos, with these groups having higher incidence of chronic diseases, higher mortality, and poorer overall
health outcomes.[4] For example, the cancer incidence rate among African Americans is 10% higher than among whites,[5] and adult African Americans and Latinos have approximately twice the risk as whites of developing diabetes.[6] Similarly, disparities in the overall level of health in individuals also exist between differing socioeconomic groups, with lower-status socioeconomic groups generally having poorer health and higher rates of chronic illness including obesity, diabetes, and hypertension.[7] Health equity also includes differences in access to health care between populations. For example, those in lower-status socioeconomic groups receive less consistent primary care, which is positively correlated to overall level of health in the recipient.[8]. Similarly, in England, "people living in deprived areas were found to receive around 70% less provision relative to need compared with the most affluent areas for both knee and hip replacements."[9] A lack of health equity is also evident in the developing world, where the importance of equitable access to healthcare has been cited as crucial to achieving many of the Millennium Development Goals.[10]
Ethnic and racial disparities
See Ethnicity and health and Race and health. The United States historically had large disparities in health and access to adequate healthcare between races, and current evidence supports the notion that these raciallycentered disparities continue to exist and are a significant social health issue.[11] The disparities in access to adequate healthcare include differences in the quality of care based on race and overall insurance coverage based on race. The Journal of the American Medical Association identifies race as a significant determinant in the level of quality of care, with ethnic minority groups receiving less intensive and lower quality care. Ethnic minorities receive less preventative care, are seen less by specialists, and have fewer expensive and technical procedures than non-ethnic minorities.[12] There are also considerable racial disparities in access to insurance coverage, with 'ethnic minorities generally having less insurance coverage than non-ethnic minorities. For example, Hispanic Americans tend to have less insurance coverage than white Americans and receive less regular medical care. The level of insurance coverage is directly correlated with the level of access to healthcare including preventative and ambulatory care.[11]. There is debate about what causes health disparities between ethnic and racial groups.[13] However, it is generally accepted that disparities can result from three main areas:
From the personal, socioeconomic, and environmental characteristics of different ethnic and racial groups (such as how certain racial groups, on average, live in poorer areas with high incidence of lead-based paint, which can harm children). A great deal of research on social
determinants of health and the socio-ecological model have also surfaced, which connect economic and social conditions in determining a community's or a population's health. From the barriers certain racial and ethnic groups encounter when trying to enter into the health care delivery system; and From the quality of health care different ethnic and racial groups receive.[14]
Each of these dimensions have been suggested as possible causes for disparities between racial and ethnic groups. However, most attention on the issue has been given to the health outcomes that result from differences in access to medical care among groups, and the quality of care different groups receive. Additionally, attention on health care disparities is largely focused on race and ethnicity; data on racial and ethnic disparities are relatively widely available. In contrast, data on socioeconomic health care disparities are collected less often, often using education as the indicator of socioeconomic status.[15] The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data.[16] The Institute of Medicine report, Race, Ethnicity, and Language Data[1] identifies current models for collecting and coding race, ethnicity, and language data; ascertains the challenges involved in obtaining these data in health care settings; and makes recommendations for improvement. A study of 20,000 cancer patients in the United States found that African Americans are less likely than European Americans to survive breast, prostate and ovarian cancer even when given equal care, but that other forms of cancer had equal survival chances, which suggests that biological factors may be at work.[17] Transplantation rates differ based on race, sex, and income. A study done with patients beginning long term dialysis showed that the sociodemographic barriers to renal transplantation present themselves even before patients are on the transplant list.[18] For example, different groups express definite interest and complete the pretransplant workup at different rates. Previous efforts to create fair transplantation policies had focused on patients currently on the transplantation waiting list.
LGBT minority group health disparities
Often under emphasized are the minority groups that are heavily affected by health disparities in America, UK and all the same worldwide. Health disparities are not just based on race, ethnic, and cultural differences. Such disparities are seen as affecting the sexuality minority groups and
observations and surveys show that one’s sexual minority status may limit access to health care, with especially bad impact on lesbians,[19] which are being discriminated both as females and as homosexual.[20] “Health inequalities exist for lesbian and bisexual women, largely related to experiences of discrimination, homophobia and heterosexism.” [21] This known interference with health care access is a prime example of heterosexual privilege and homosexual prejudice prevalence in Western societies. Just as this lack of health care affects minority races, ethnic groups, and less represented cultural beliefs; lesbian and bisexual women are deteriorating their health by either not seeing (being feared of) or not be attended to by health care professionals. It is important that health care professionals consider the nine cultural competency techniques suggested by the Agency for Healthcare Research and Quality and make an effort to break the barriers put into place through society’s homophobia and heterosexism.[22]
[edit] Healthcare equity and sex
The results in comparing inequities in access to adequate healthcare and gender are somewhat surprising, with women in the United States generally having higher levels of access to care. These disparities can be explained in part by looking at rates of overall insurance coverage (privatized and publicly assisted) between men and women, the effects of certain socioeconomic factors on levels of coverage between men and women, and overall gender-based differences in perceptions of health and health care. In the United States, women have better access to healthcare, in part, because they have higher rates of health insurance. In one study of a population group in Harlem, 86% of women reported having health insurance (privatized or publicly assisted), while only 74% of men reported having any health insurance. This trend in women reporting higher rates of insurance coverage is not unique to this population and is representative of the general population of the US[8]. Gender based perceptions of health and healthcare may help explain some of the lag of men behind women in levels of insurance coverage. Women report higher rates of illness than men, which barring the idea that women are sicker than men, indicates women are more likely to seek medical care out and are therefore more likely to possess medical insurance[8]. Gender related disparities in access to healthcare are also related to socioeconomic factors including geographic job-market differences and differing levels of government assistance available to men and women. There are fewer job opportunities with insurance coverage available to men and women living in poorer communities, and of these opportunities, women tend to occupy more of the jobs with these benefits. Government assistance available to these individuals without job-related coverage varies between men and women, with women, especially women with children, receiving a higher percentage of available public assistance than men.[8] Ultimately, for both men and women discrepancies in access to adequate healthcare is largely based on socioeconomic issues including income and full-time work status, with both groups of men and women with higher levels of income and full-time work receiving greater access to adequate healthcare[8].
[edit] Healthcare Inequality and Socioeconomic Status
While gender and race play significant factors in explaining healthcare inequality in the United States, socioeconomic status is the greatest determining factor in an individual's level of access to healthcare. Not surprisingly, individuals of lower socioeconomic status in the United States have lower levels of overall health, insurance coverage, and less access to adequate healthcare. Furthermore, individuals of lower socioeconomic status have less education and often perform jobs without significant health and benefits plans, whereas individuals of higher standing performs jobs that are more likely to have jobs that provide medical insurance[8].
[edit] Disparities in access to health care
Reasons for disparities in access to health care are many, but can include the following:
Lack of insurance coverage. Without health insurance, patients are more likely to postpone medical care, more likely to go without needed medical care, and more likely to go without prescription medicines. Minority groups in the United States lack insurance coverage at higher rates than whites.[23] Lack of a regular source of care. Without access to a regular source of care, patients have greater difficulty obtaining care, fewer doctor visits, and more difficulty obtaining prescription drugs. Compared to whites, minority groups in the United States are less likely to have a doctor they go to on a regular basis and are more likely to use emergency rooms and clinics as their regular source of care.[24] Lack of financial resources. Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations.[25] Legal barriers. Access to medical care by low-income immigrant minorities can be hindered by legal barriers to public insurance programs. For example, in the United States federal law bars states from providing Medicaid coverage to immigrants who have been in the country fewer than five years.[26] Structural barriers. These barriers include poor transportation, an inability to schedule appointments quickly or during convenient hours, and excessive time spent in the waiting room, all of which affect a person's ability and willingness to obtain needed care.[27] The health care financing system. The Institute of Medicine in the United States says fragmentation of the U.S. health care delivery and financing system is a barrier to accessing care. Racial and ethnic minorities are more likely to be enrolled in health insurance plans which place limits on covered services and offer a limited number of health care providers.[28] Scarcity of providers. In inner cities, rural areas, and communities with high concentrations of minority populations, access to medical care can be limited due to the scarcity of primary care practitioners, specialists, and diagnostic facilities.[29] Linguistic barriers. Language differences restrict access to medical care for minorities in the United States who are not English-proficient.[30] Health literacy. This is where patients have problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are not limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors.[31]
Lack of diversity in the health care workforce. A major reason for disparities in access to care are the cultural differences between predominantly white health care providers and minority patients. Only 4% of physicians in the United States are African American, and Hispanics represent just 5%, even though these percentages are much less than their groups' proportion of the United States population.[32] Age. Age can also be a factor in health disparities for a number of reasons. As many older Americans exist on fixed incomes which may make paying for health care expenses difficult. Additionally, they may face other barriers such as impaired mobility or lack of transportation which make accessing health care services challenging for them physically. Also, they may not have the opportunity to access health information via the internet as less than 15% of Americans over the age of 65 have access to the internet.[33] This could put older individuals at a disadvantage in terms of accessing valuable information about their health and how to protect it.
[edit] Disparities in quality of health care
Health disparities in the quality of care different ethnic and racial groups receive can include:
Problems with patient-provider communication. This communication is critical for the delivery of appropriate and effective treatment and care and, regardless of a patient’s race, miscommunication can lead to incorrect diagnosis, improper use of medications, and failure to receive follow-up care. Among non-English-speaking populations in the United States, the linguistic barrier is even greater. Less than half of non-English speakers who say they need an interpreter during health care visits report having one. Additional communication problems stem from a lack of cultural understanding on the part of white providers for their minority patients. For example, patient health decisions can be influenced by religious beliefs, mistrust of Western medicine, and familial and hierarchical roles, all of which a white provider may not be familiar with.[34] Other type of communication problems are seen in LGBT health care with the spoken heterosexist (conscious or unconscious) attitude on LGBT patients, lack of understanding on issues like having no sex with men (lesbians, gynecologic examinations) and other issues.[35] Provider discrimination. This is where health care providers either unconsciously or consciously treat certain racial and ethnic patients differently than other patients. Some research suggests that ethnic minorities are less likely than whites to receive a kidney transplant once on dialysis or to receive pain medication for bone fractures. Critics question this research and say further studies are needed to determine how doctors and patients make their treatment decisions. Others argue that certain diseases cluster by ethnicity and that clinical decision making does not always reflect these differences.[36] Lack of preventive care. According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care.[37] For example, minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people.
[edit] Ending health disparities
The Commonwealth Fund, in a report on how to eliminate health disparities, says that the following steps should be considered in developing policies to eliminate racial and ethnic disparities:[38]
Consistent racial and ethnic data collection by health care providers. Effective evaluation of disparities-reduction programs. Minimum standards for culturally and linguistically competent health services. Greater minority representation within the health care workforce. Establishment or enhancement of government offices of minority health. Expanded access to services for all ethnic and racial groups. Involvement of all health system representatives in minority health improvement efforts.
Other methods for ending health disparities or reducing health disparities have been suggested based on research that observes cultural differences within health care systems. According to the Agency for Healthcare Research and Quality and the assisting authors Cindy Brach and Irene Fraserirector, in an effort to reduce disparities between racial and ethnic groups, the health care system should consider the following nine cultural competency techniques:
Interpreter services. If agencies take an active approach in hiring professional interpreters, for both foreign languages and for the speaking and hearing impaired, communication barriers will begin to decrease. Recruitment and Retention. Healthcare systems need to become more conscious of the staff within their facilities. It is essential to the reduction of disparities that most minority groups be represented within the various health care offices and clinics. Training. The Agency for Healthcare Research and Quality and its assisting authors emphasized the importance of health care professionals being trained to work with interpreters and minority groups. Coordinating with traditional healers. Health care workers should be supportive and able to adjust health care plans according to the patient’s cultural beliefs and traditional health practices. Use of Community Health Workers. These individuals could be responsible for bringing in the population of people who rarely seek out health care. Culturally competent health promotion. This information can be available through community health workshops, or simply by health care workers taking the necessary measures to promote early detection and treatment and outlining the good and risky health behaviors to all patients. Including family and/or community members. The Agency for Healthcare Research and Quality states that this particular cultural competency may be vital to obtaining consent and adherence to treatments. Immersion into another culture. Allowing yourself to step outside of your comfort zone will increase your tolerance for another culture as well as raise your awareness to new ideals and beliefs. Administrative and Organizational accommodations. These are some aspects of the health care offices that should be considered; they include the location of the healthcare offices, public transportation availability, clinic hours, the physical environment of the clinic, and the rapport built with the patients.[39]
[edit] Health inequalities
Health inequality is the term used in a number of countries to refer to those instances whereby the health of two demographic groups (not necessarily ethnic or racial groups) differs despite comparative access to health care services. Such examples include higher rates of morbidity and mortality for those in lower occupational classes than those in higher occupational classes, and the increased likelihood of those from ethnic minorities being diagnosed with a mental health disorder. In Canada, the issue was brought to public attention by the LaLonde report. In UK, the Black Report report was produced in 1980 to highlight inequalities. On 11 February 2010 Sir Michael Marmot, an epidemiologist at University College London, published the Fair Society, Healthy Lives report on the relationship between health and poverty. Marmot described his findings as illustrating a "social gradient in health": the life expectancy of the poorest is seven years shorter than the most wealthy, and the poor are more likely to have a disability. In its report on the study, The Economist argued that the causes of this health inequality include lifestyles smoking remains more common, and obesity is increasing fastest, amongst the poor in Britain.[40]
Inequalities in Health Care
by Will Wilkinson on October 20, 2009 In a post on “Paying for Health” the philosopher Daniel Little writes: It seems a bitter but unavoidable truth that there are very substantial inequalities in the provision of health care in our society. One person’s likelihood of surviving a devastating cancer may be significantly less than another person’s chances, simply based on the second person’s ability to pay for premium health care services. Further, it seems unavoidable that these extreme inequalities are flatly unjust in any society that believes in the equal worth of all human beings. And where this seems to lead is to the conclusion that some system of universal health insurance is a fundamental requirement of justice. Clearly Little is merely gesturing at an argument, but I cannot follow the gesture. That some are able to afford, say, a treatment with very expensive new technology that significantly increases (how much is that?) their chances to survive a devastating cancer compared to the chances of those who cannot afford it does not seem to me unjust, flatly or otherwise. It seems a trivial consequence of the fact that new technology is often much more expensive than older technology. Moreover, it seems plain that any economically feasible scheme of universal health insurance must refuse to cover many expensive treatments (new or otherwise). So a system of universal health insurance will do nothing to eliminate “extreme inequalities” in many kinds of cases. In these cases, the only hope of eliminating the inequality is forbidding access to treatments that cannot be provided to all under the universal health insurance system. But a policy of coercively preventing exchanges that help someone (the doctor, at least!) but harm no one is flatly unjust. Which leads to the conclusion that the attempt to prevent some inequalities in the provision health care is ruled out by the requirements of justice.
If Little limited himself to the much weaker, and much more plausible, claim that justice demands a system of institutions that offers health care that is as good as it gets for the least well-off, then justice might plausibly demand in health services what we have (and Little seems to endorse) in food: a competitive market with means-tested vouchers. That just about everyone left of center, including philosophers, seem to glide from their moral premises, whatever those might be, to “some system of universal health insurance” will some day be appreciated as the peculiar ideological reflex that it is.
BARRIERS TO HEALTH CARE (4 OF 5) A Framework: 1. Geographic barriers
rural and inner-city health professional shortage areas
2. Cultural barriers
health beliefs and behaviors, practitioner beliefs and behaviors
3. Socioeconomic barriers
lack of health insurance, inability to pay out of pocket, poor education
4. Organizational barriers
lack of interpreters or wheelchair accessibility, long appointment wait times 5. Combinations of 1,2,3,4 many disparities likely due to mixture of these factors
