Aligning Human Resource Development with the Strategic Priorities of Healthcare Organizations

147 Pages·2015·0.96 MB·English

University of South Florida
Scholar Commons
Graduate Theses and Dissertations Graduate School
January 2013
Aligning Human Resource Development with the
Strategic Priorities of Healthcare Organizations:
The CFO Perspective
Carla Breedlove Smith
University of South Florida, [email protected]
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Smith, Carla Breedlove, "Aligning Human Resource Development with the Strategic Priorities of Healthcare Organizations: The CFO
Perspective" (2013).Graduate Theses and Dissertations.
http://scholarcommons.usf.edu/etd/4583
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Aligning Human Resource Development with the Strategic Priorities of Healthcare

Organizations: The CFO Perspective

by

Carla Breedlove Smith

A dissertation submitted in partial fulfillment
of the requirements for the degree of
Doctor of Philosophy
Department of Adult, Career, and Higher Education
College of Education
University of South Florida

Major Professor: Rosemary Closson, Ph.D.
William Young, Ed.D.
William Blank, Ph.D.
Kristine Hogarty, Ph.D.

Date of Approval
April 5, 2013

Keywords: performance measurements, CFO interviews, healthcare training, education
human resource development, performance improvement

Copyright © 2013, Carla Breedlove Smith
Acknowledgments
Many people supported this accomplishment whom I would like to acknowledge.
To my loving husband, James—you have been my champion from the beginning,
providing unwavering encouragement to pursue my dreams. I acknowledge my father,
who has always inspired me to achieve beyond the status quo. You have encouraged me
to believe that even when dreams are deferred, they can still come true. I wish to
acknowledge my major professor, Dr. Rosemary Closson, for her guidance and support
on this journey. And I thank Dr. William Young, Dr. William Blank, and Dr. Kristine
Hogarty for being on my dissertation committee and for their excellent feedback. And,
finally I would like to acknowledge my academic peers who, in spite of busy student
schedules, took the time to assist with this study.
Table of Contents
Chapter 1: Introduction ........................................................................................................1
Problem ....................................................................................................................6
Purpose and Significance of Study ..........................................................................7
Research Questions ..................................................................................................8
Conceptual Framework for Study ............................................................................8
Definition of Terms................................................................................................10
Author’s Perspective ..............................................................................................11
Delimitations of Study ...........................................................................................12
Limitations of Study ..............................................................................................13
Chapter 2: Literature Review .............................................................................................15
Defining HRD ........................................................................................................15
Performance Measurement System (PMS) ............................................................17
Training audit .............................................................................................19
Benchmark against the best .......................................................................20
Before-and-after metrics ............................................................................20
What Should Be Measured?...................................................................................21
Critique of the Four-Level Model ..........................................................................23
Human Capital Theory ...........................................................................................25
Strategic Planning ..................................................................................................26
Examples of Alignment in the Literature ...............................................................30
Case study 1: Patient safety and quality improvement ..............................31
Case study 2: Nursing leadership development .........................................34
Chapter 3: Method .............................................................................................................37
Qualitative Inquiry Rationale .................................................................................37
Research Procedures and Methods ........................................................................39
Research method ........................................................................................39
Participant selection ...................................................................................40
Recruitment method ...................................................................................41
Human subjects committee and informed consent ....................................42
Interview method. ......................................................................................43
Research Questions ................................................................................................49
Identifying Research Bias ......................................................................................51
Data Analysis Methods ..........................................................................................52
Listing and preliminary grouping ..............................................................53
Reducing (identifying) and labeling (coding) ............................................53
Clustering and thematizing ........................................................................53
Final identification and validation .............................................................54
Structural description .................................................................................54
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Ensuring Trustworthiness ......................................................................................55
Reliability ...............................................................................................................56
Chapter 4: Findings ............................................................................................................59
SDA Nonprofit Hospital Results ...........................................................................59
Organizational strategic priorities ..............................................................60
Direct training experience ..........................................................................62
Rate training as a priority ...........................................................................63
Areas of alignment .....................................................................................65
Areas of misalignment ...............................................................................67
Directives for achieving alignment ............................................................68
Major obstacles impeding alignment .........................................................71
Areas needing performance improvement .................................................72
Future strategy ...........................................................................................73
Downsizing trend .......................................................................................74
Budget allocation factors ...........................................................................75
No evidence of training value ....................................................................77
Measurement methods ...............................................................................78
Summary ....................................................................................................79
For-Profit Hospital Results ....................................................................................79
Organizational strategic priorities ..............................................................80
Direct training experience ..........................................................................82
Rate training as a priority ...........................................................................84
Areas of alignment .....................................................................................85
Areas of misalignment ...............................................................................87
Directives to achieve alignment .................................................................90
Major obstacles impeding alignment .........................................................92
Areas of performance improvement ..........................................................94
Future strategy ...........................................................................................95
Downsizing trend .......................................................................................96
Budget allocation factors ...........................................................................98
No evidence of training value ..................................................................101
Measurement methods .............................................................................104
Summary ..................................................................................................106
Composite Themes From CFO Interviews ..........................................................106
Chapter 5: Conclusions, Implications, Recommendations .............................................112
Conclusions ..........................................................................................................113
Implications..........................................................................................................119
Recommendations ................................................................................................121
Recommendations for Further Research ..............................................................122
Summary ..............................................................................................................122
References ........................................................................................................................124
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Appendices
A: CFO Job Description.......................................................................................132
B: Informed Consent to Participate in Research ..................................................135
C: Categories/Keywords ......................................................................................138

iii
List of Tables
Table 1. Research Questions and Interview Questions ......................................................50
Table 2. Themes by Keywords ........................................................................................107

iv
Abstract
The purpose of this qualitative study was to gain an understanding of how human
resource development (HRD) can align more closely with the healthcare system’s
strategic priorities from the perspective of chief financial officers (CFOs). Five common
themes emerged: (a) training is well aligned to the strategic priority to optimize clinical
delivery in hospitals; (b) training is viewed as a valuable resource for achieving the
strategic priorities within organizations, with CFOs rating it a score of 4 or 5 out of 5; (c)
communicating strategic priorities to HRD leaders and discussing HRD’s role in
alignment is seen as a CFO’s responsibility; (d) CFOs report consistent increases in
training budgets rather than decreases; and (e) HRD leaders are not reporting evidence of
trainings’ value in improving productivity and profitability. Many CFOs reported that
they had not thought of training as a resource for achieving strategic priorities but instead
viewed training budgets as a fixed cost and not subject to change based on performance
metrics. A semistructured interview format with open-ended questions was used in
conformity with commonly accepted phenomenological data collection procedures. CFOs
were intentionally selected as the focus of the study because they are the drivers of
education department budgets and therefore have the authority to determine the viability
of HRD within the organization. Eight hospital unit CFOs were interviewed. All
interviews were audiotaped and transcribed verbatim. Then the transcripts were sent to all
participants for review to ensure accuracy. Data analysis began with a careful and
methodical reading of each transcript. CFOs’ common experiences were coded by
keywords. The codes were then consolidated to enable identification across all
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participants. Each category was reviewed with its codes and a common thematic phrase
was generated, describing salient experiences and perceptions. Findings from this study
highlight the perceptions of CFOs concerning the alignment of HRD with strategic
priorities within their organizations that could potentially inform HRD’s critical place in
healthcare organizations. Recommendations are included for healthcare HRD leaders and
leaders of university programs who are interested in developing successful adult
education leaders in the field of healthcare.
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Chapter 1: Introduction
This is a qualitative study focusing on the perspectives of hospital chief financial
officers (CFOs) seeking to understand how human resource development (HRD) can
better align with the strategic priorities within their healthcare organizations. Alignment
of HRD with organizational strategic priorities has always been an issue in the HRD field
(Adelsberg & Trolley, 2008; Clarke, 2002; Holton, 2004). Nowhere is this more
important than in the healthcare field where rigorous quality measures require constant
performance improvement, while at the same time hospitals are expected to do more with
less, The Healthcare Association of New York State, reported the major drivers of
hospital costs include workforce shortages, pharmaceutical costs, advances in technology,
insurance premiums, disaster preparedness, emergency room overutilization, and
provision of care for the uninsured (Sisson, 2003). Additionally, reimbursements by
third-party payers for hospital services are being reduced with each passing year (Berger,
2006). In 2001, 58% of hospitals in New York had operating losses of $343 million in
revenue and an operating margin ratio of negative 1.0% across all hospitals statewide
(Sisson,2003). According to the American Hospital Association’s (AHA) annual report
(2009), nine in 10 hospitals have made cutbacks to address economic concerns by taking
the following actions:
1. Nearly half have reduced staff.
2. Eight in 10 have cut administrative expenses.
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