Effective Human Resource Management

Effective Human Resource Management

Please reply to each part with 150 words apiece.

Part 1

Effective human resource management has been shown to impact the effectiveness and outcomes of organizations by improving profitability and productivity (Fried & Fottler, 2018). Organizations that utilize human resource best practices have proven to have better financial performance when compared to those who do not utilize these practices. Additionally, patient and family satisfaction tends to be impacted by human resources practices. Effective management of employees leads to more engaged and satisfied staff because they are more positive, moral within the organization is high, and turnover is low. This level of employee engagement has been shown to be directly correlated to patient and customer satisfaction (Fried & Fottler, 2018). These positive impacts on finances and customer service places organizations who use effective human resource management practices a competitive advantage because the environment is attractive, and the organization is able to retain high quality staff to deliver high quality and exemplary care (Fried & Fottler, 2018).

Two current human resource management practices that are utilized in healthcare organizations today to improve the organizational and employees’ performance are staffing and performance appraisal. Staffing as a human resource management method that refers to an organization’s ability to identify, recruit, and retain quality staff with the knowledge, skills, and attitudes necessary to perform a job and who are compatible with and engaged in the organization’s mission and values (Nasurdin, Ahmad, & Tan, 2016). Over the last decade, staffing strategies have shifted from managers making the hiring decisions to peers making the final decision. These decisions were formerly based mostly on the technical skills and abilities of candidates but have more recently shifted to the candidates’ likelihood to fit within the organization’s culture (Fried & Fottler, 2018). Additionally, when downsizing of staff occurs, organizations are more apt now to offer eligible staff incentives for early retirement, rather than older practices of laying off staff based on position or rank (Fried & Fottler, 2018).

Performance appraisal as another human resource management practice that refers to the recognition of employee contributions to the team and organization by providing monetary or nonmonetary rewards. One strategy to provide this recognition is through the establishment of individual and team goals which are compensated based on the results achieved (Fried & Fottler, 2018). Appraisals are also used to validate performance-based pay decisions, encourage and motivate individuals as well as the team working together, identify career development goals and opportunities, and determine training and development needs (Pegulescu, 2018). Former practices for performance appraisal included uniformed appraisals with supervisors as the only provider of input. More current practices include more customized appraisals targeted at the individual’s professional development after receiving input from multiple avenues, including self and peer reviews (Fried & Fottler, 2018). There is risk involved with appraisals; they can demotivate staff, especially if the supervisor’s appraisal of the employee and the employee’s appraisal of him or herself do not match. A competency-based appraisal can be utilized to make the appraisal process more positive and focused on the progress an individual makes in the job and their contribution to the organization achieving its goals and carrying out the mission and values (Pegulescu, 2018).

Part 2

Effective human resource management has been shown to impact the effectiveness and outcomes of organizations by improving profitability and productivity (Fried & Fottler, 2018). Organizations that utilize human resource best practices have proven to have better financial performance when compared to those who do not utilize these practices. Additionally, patient and family satisfaction tends to be impacted by human resources practices. Effective management of employees leads to more engaged and satisfied staff because they are more positive, moral within the organization is high, and turnover is low. This level of employee engagement has been shown to be directly correlated to patient and customer satisfaction (Fried & Fottler, 2018). These positive impacts on finances and customer service places organizations who use effective human resource management practices a competitive advantage because the environment is attractive, and the organization is able to retain high quality staff to deliver high quality and exemplary care (Fried & Fottler, 2018).

Two current human resource management practices that are utilized in healthcare organizations today to improve the organizational and employees’ performance are staffing and performance appraisal. Staffing as a human resource management method that refers to an organization’s ability to identify, recruit, and retain quality staff with the knowledge, skills, and attitudes necessary to perform a job and who are compatible with and engaged in the organization’s mission and values (Nasurdin, Ahmad, & Tan, 2016). Over the last decade, staffing strategies have shifted from managers making the hiring decisions to peers making the final decision. These decisions were formerly based mostly on the technical skills and abilities of candidates but have more recently shifted to the candidates’ likelihood to fit within the organization’s culture (Fried & Fottler, 2018). Additionally, when downsizing of staff occurs, organizations are more apt now to offer eligible staff incentives for early retirement, rather than older practices of laying off staff based on position or rank (Fried & Fottler, 2018).

Performance appraisal as another human resource management practice that refers to the recognition of employee contributions to the team and organization by providing monetary or nonmonetary rewards. One strategy to provide this recognition is through the establishment of individual and team goals which are compensated based on the results achieved (Fried & Fottler, 2018). Appraisals are also used to validate performance-based pay decisions, encourage and motivate individuals as well as the team working together, identify career development goals and opportunities, and determine training and development needs (Pegulescu, 2018). Former practices for performance appraisal included uniformed appraisals with supervisors as the only provider of input. More current practices include more customized appraisals targeted at the individual’s professional development after receiving input from multiple avenues, including self and peer reviews (Fried & Fottler, 2018). There is risk involved with appraisals; they can demotivate staff, especially if the supervisor’s appraisal of the employee and the employee’s appraisal of him or herself do not match. A competency-based appraisal can be utilized to make the appraisal process more positive and focused on the progress an individual makes in the job and their contribution to the organization achieving its goals and carrying out the mission and values (Pegulescu, 2018).

Part 3

Workforce diversity are similarities and differences on employees with regards to age, ethnic and cultural background, race, religion, gender, sexual orientation, physical abilities and disabilities. According to Fried & Fottler (2018), having a diverse workforce will help in understanding and helping the needs of the population’s concerns in health and will bring novel ideas in finding solutions to challenging situations. As diversity is evolving, it comprises not only the attributes of the employee like the age, gender, race but also the work style variations, experiences, perspectives, opinions, thoughts, and an inclusive environment (Fried & Fottler, 2018).

The Human Resource Management (HRM) must be able to abide the laws and regulations in place for hiring employees. The Equal Employment Opportunity (EEO) law prohibits any type of discrimination at the workplace. The Civil Rights Act of 1964, or Title VII has prohibited in the discrimination of employment, voting, public education, and public accommodations and facilities (DOL, 2019). It prohibits any basis of discrimination against race, color, religion, sex, and national origin. This act also prohibits any discrimination on HR to hire, promote, compensate, train, and offer benefits (Fried & Fottler, 2018).

There are legal and ethical ramifications in maintaining a diverse workforce in the U.S. The Human Resources Management legal environment constantly undergoes federal scrutiny and reform. Organizations are penalized for breaking the EEO law. Equitable relief are made like back and front pay, lost benefits, attorney’s fees as well as enforcing provision for compensatory and punitive damages are given to the employee (Fried & Fottler, 2018). It will be ethical to hire a diverse workforce and not discriminate anyone who is a potential candidate. Ethics plays a huge component in the sustainability of the culture in the organization. It guides the moral principles and beliefs of the hospital and clear ethical standards are integrated into operational policies and procedures.

Diversity ramifications are enacted and practiced in the hospital organizations. Workplace discrimination and unfair employment practices will result in counter productivity and loss of profit. The Equal Employment Opportunity Commission Enforcement (EEOC) is handling several laws that impacts recruitment and process of selection. Hospital organizations can be audited or investigated if these laws and processes are not followed. The diversity inclusion has provided the hospital environment to have an organizational culture based on the perspectives and encouragement of a diverse staff. It allows good hospital business and succumb to organizational challenges. The FRAME acronym enables everyone to value each one’s differences and encourage to overcome bias and appreciate other people’s perspectives (Fried & Fottler, 2018).

Healthcare organizations have processes and procedures in encouraging a diverse workforce. The initiative of minority programs by healthcare organizations are creating significant progress to the change in the environmental culture. My hospital organization has a regional and facility wide campaign on Equity, Inclusion, and Diversity (EID). It provides the employees of Kaiser Permanente (KP) an array of training, strategies in each person’s differences regardless of education, personal lifestyle, cultural heritage, functional abilities that makes everyone different. We recently had a symposium last month for EID in my medical center. It makes me proud knowing that I work in an organization that values equality, inclusion and diversity. We are also huge in our LGBTQ program. KP is ranked in the top 50 companies that employs LGBT (DiversityInc, 2019). Thirty-eight of KP hospitals are recognized by the Human Rights Campaign Foundation as leader in LGBTQ healthcare equality (Kanter, 2018). KP has one of the nation’s largest integrated health system and has encouraged an equal care for Americans who are LGBTQ. The organizations’ dedication to meet the complex needs and health of the LGBTQ community provides a reflection and recognition of the welcome environment of diversity (Kanter, 2018).

Health care organizations should relate workforce diversity to health equity. True equity means a fair opportunity for everyone to have a better life, equal access to quality healthcare. Health equity is the root of the diversity approach in my hospital organization. This includes improving cross-cultural competency, health disparity reduction, advanced workforce diversity agenda and achieving growth in the market across a diverse population (Tyson, 2015). Everyone has the right in pursuing life, happiness and liberty.

A continued growth in diverse population is seen and hospital administrators, healthcare providers, policy makers, and caregivers must pay attention to demographic shifts and the implications made in the healthcare aspect. Employing a diverse culture will enable to attract more patient demographics and better understand the different cultural and diverse background of patients. Health equity means no health compromise due to an individual or populations demographic, social-economic status and determinants of health. A diverse and an inclusive workforce provides a competitive advantage in the marketplace. This makes the organization competitive, effective, and provide an enhanced quality (Fried & Fottler, 2018).

It enables to partner with surrounding communities being served in an organization and better understand and serve the populations needs and address their health concerns (Fried & Fottler, 2018).

Part 4

We are to answer every one of these questions with ideas, comments and our thoughts and we are to use

examples to reinforce our ideas with diversity with cognitive mediator variables and the approaches and

the HR productivity.

What comprises workforce diversity? A major challenge is workforce diversity. What is more important

than seeking diversity is managing diversity by managers; because, it maximizes the following: a. social

identity, b. organizational justice, c. productivity, and it includes d. organization attraction of human

resource has all been identified thru the data analyses that was conducted by using the SEM

(Structural Equation Model), sample comprises 500 employees. The facts are followed: A. Organizational

Justice Structural Equation Modeling, B. Human Capital, C. Industrial Management, and D. Industrial Productivity.

(Authors: Fathi, Saied, Ardakani, Mohammad Shaker, Shaemi, Ali & Abzari, Mehdi, Spring, 2016).

When collaborative and designing a project in retaining students and recruiting these students there are

disadvantages of the backgrounds and minorities that are underrepresented . There were high school students

who were introduced to the nursing program thru admissions with retention strategies implemented graduated

with licensure examination. The minorities who are enrolled within the nursing education programs are insufficient

and can’t meet the needs of the workforce diversity. The facts are followed: A. School holding power, B.

academic achievement, C. Student recruitment, D. Educatoirs, E. Occupational Roles, F. Endowments, G.

Government aid, H. High School Stuudents, I. Vocational Guidance, J. Labor supply, J. scholarships, K.

Mentoring, L. Cultural pluralism, M. Nursing education, and last N. Role Models (Authors: Holmes, Shearon,

Murray, teri A., Ciarlo, Erica M., & Pole, David C., May/Jun2016).

What is the responsibility of the Human Resources Department to address this, for example is the selection

and retention of employees?

Are there legal and ethical ramifications of maintaining a diverse workforce?

What are some of the diversity ramifications, and how do health care organizations characterize components

such as various minority programs?

For a healthcare organization, why would workforce diversity relate to health equity?

Is there a relationship between workforce diversity and improvements in patient care?

Part 5

Human Resources Management focuses in aligning the organizational goals and incorporating them to each employee. Flexibility is needed among organizations as the demands for healthcare is continuously changing and a rapid adaptability is needed to attain high quality performance in the organization (Toussaint, 2015). Performance management serves as the development and function in assisting employees in their performance improvement (Fried & Fottler, 2018). This is also utilized as a tool by administrators who want to decide on personnel decisions like promoting, disciplining or terminating an employee (Fried & Fottler, 2018). The administrative and developmental functions are the two purposes of performance management

The Joint Commission is an accredited organization that is requiring healthcare organizations in assessing, tracking, and improving the competency of employees (Joint Commission, 2018). Patient safety and quality care are the forefront of Joint Commission’s initiative and standard. Accreditation has several benefits: (1) organizing and strengthening efforts of patient safety, (2) providing an advantage in the market in an environmental health and improving the ability in securing new business, (3) attracting qualified personnel in serving in an institution that is accredited and providing the staff in an opportunity in developing skills and knowledge and (4) providing a framework for the organizations management and structure wherein a survey is prepared and a quality of high level and compliance in the most recent standards (Joint Commission, 2018). This accredited organization is proving guidance in a healthcare organization ‘s efforts in improving quality.

Team-based are one of the methods utilized in performance management. Evaluating and rewarding the performance as a team shows that the organization is valuing teamwork in the organization. In this method, rewards are given. There are positive and negative advantages for this type of method. Positive (1) Team cohesion is increased (Fried & Fottler, 2018). This allows everyone to work as a team, collaborate, discuss and brainstorm on ideas and ways to improve in achieving goals for high-quality performance within the department and organization. In the hospital I work in, we have monthly staff meetings in the PACU department where data on performance is shown to us. We analyze and identify the areas we need improvements on, and we designate our representatives in our Unit Based Team (UBT) to help create a plan for improvement. (2) Communication is enhanced among management and employees (Fried & Fottler, 2018). The collaboration among staff and nurse leaders allows an open communication for suggestions and ways to improve the performance of the team. We have Labor Management Partnership (LMP) in my hospital organization and it really helps with the cohesiveness among team members in the healthcare organization. The engagement between staff and management allows a process for shared governance. An improved efficiency and accountability are seen in shared governance through improved communication and a unified vision (Barclay et al., 2017). Negative: (1) can lead to exacerbation of anxiety and frustration if there is a free rider in the team (Fried & Fottler, 2018). This is a real issue especially if high performers are producing more compared to employees who are not. There should be a category for incentive compensation if rewards are given for goals achieved in the performance. (2) alienation and conflict are resulted due to poor feedback given (Fried & Fottler, 2018). There must be training provided to everyone and team leaders in the process of feedback so that there is no feeling of conflict or alienation within the team.

Part 6

Performance Management is a process of continuous communication between managers and employees to set goals and monitor employees progress towards the goal (Fried & Fottler , 2018). Performance improvement is a whole work strategy that provides ongoing feedback and coaching to ensure goals are met effectively and efficiently (Fried & Fottler , 2018). Performance management aims to ensure that healthcare organizations processes are in place to align mission and goal to t he productivity of employees, teams, and primarily, the organization ( Hosain , 2016 ).

The importance of performance management is to coordinate and to build an empowered and skilled workforce. It is the most significant contributor to organizational effectiveness. According to Fried & Fottler (2018), The Joint Commission requires accredited healthcare organizations to assess, monitor, and improve the competence of all employees. It is believed that recognizing the value of high performer individuals and teams will have a better organizational outcome.

The most po werful method for performance method is the 360-Degree Feedback Evaluation. According to Hosain (201 6 ), 360- Degree feedback evaluation pr esents a structured appraisal method that generates feedback from multiple levels within the organization . It comprises of detailed information about the strength and weaknesses of an employee to enable relevant information to aid in professional development plans and promotion ( Hosain , 201 6 ). Unlike other traditional methods, all employees that work with the employee may provide ratings. It can include people in senior management, supervisors, employee’s peers, team members, and patients ( Hosain , 201 6 ). It is providing feedback information about how their peers, patients, and any co-workers can gain as much as honest opinions. It can be an eye-opening what others see. According to Basu (2015), 360-Degree feedback is the most useful method in the field of the performance appraisal process. It involves l awfulness , dependability , and holistic approach in the general process ( Basu , 2015). The input or feedback of multi-level employees has a broad objective and perspective measures of individual performance. Feedback can be positive to the organization mission and vision and recognize the v alue of input from different sources of the organization .

There are some disadvantages to the 360-degree rating. According to Hosain (201 6 ), the drawback from employees when they receive feedback from peers and other multi-levels within the organization, they tend to be r esponsive to the feedback provided. Other organizations stated that when administrative results like increase pay, promotions, bonuses, providers feedback tend to be dishonest, or they will only give them unbiased feedback thinking that they affect the results ( Hosain , 201 6 ). People might say all beautiful thing resulting in all positive feedback. Negative 360-feedback coming from peers who may possibly be a competitor may distort results. Lastly, the confidentiality breach, participants can openly share and discuss openly the appraisal of the individual, which can violate the privacy and impact careers ( Basu , 2015).

Part 7

Succession Planning is a strategy planned within an organization on the next qualified candidate of a major or minor job position in the case of having to replace someone. It’s a strategy for identifying and developing future leaders at your company at all levels (What Is Succession Planning? Your Steps to Success, 2018). Succession planning comes into place when the unexpected is happening, rather someone resigns, fired, death, or that person is moving up in the company and positions needs to be replaced. Continuously training someone for vital positions in the company keep from having delays within the company. Have one or more qualified candidate trained brings more security to the organization without gaps.

Succession Process

There are many steps that can be taken to develop a succession plan. One step is to identify the important business are and position that are needed to stay filled. Identifying the difficulty and task amongst the position and qualification and experiences that are needed. Choosing and training a candidate that are trainable and knowledgeable of the position at hand. Many people may not have the skills or strength to carry and take on such positions. It is vital a company get to know their workers to find out their strengths and weakness. What level of experience do they carry? Have they been trained at an acceptable level, or if they have a degree that qualify for such position? Getting to know your employees are potential candidates can be vital to the company. Coming up with a plan for training, learning, development, experience sharing can be a contribute to its goal. Many companies have not introduced the concept of succession planning in their organizations, others plan informally and verbally for succession for key roles (What Every Manager Needs to Know About Succession Planning , 2019).

Part 8

Healthcare organizations need to always keep in mind those employees within the organization that may be able to take on roles as they are vacated. This acknowledgement that positions are vacated within time due to retirement or relocations of employees needs to be followed up with a plan to fill in these gaps as they arise. One way that healthcare organizations can be proactive with turnover is implementing succession planning. According to Fried and Fottler (2018), succession planning is the process of identifying and developing employees to help fill the gaps as they arise. With the aging nurse force healthcare organizations need to build up their young employees to step into these roles. One way that Kaiser Permanente influences and encourages their nurses to develop professionally is to provide educational opportunities to obtained advanced degrees. The healthcare organization can identify employees to develop through committees they serve on such as magnet committees. The employee’s involvement in these committees can provide an example of the work and leadership they can give to the organization.

Succession planning is different than replacement planning in that the emphasis is on forecasting the healthcare organization’s needs (Gridley, Ulreich, & Bluth, 2016). By utilizing succession planning, employees can be identified within the organization which is beneficial because the internal employee understands the organization’s goals and it cost less to train them for their new role. The healthcare organization must continually reassess the direction and goals of the healthcare organization and position people to fill in the gaps. These potential people need to align with the organization’s mission and vision. Reviewing the mission, goals, and objectives of an organization is one of the first steps of the succession planning process. According to Fried and Fottler (2018), there are six steps in the succession planning process which include reviewing the mission, goals and objectives of the organization, identifying critical positions and their competencies, identifying potential successors and their competencies, provide professional development activities, review plan as vacancies arise, and update employee base as organizational goals change.

It is important that people don’t feel that they are being pushed out of a position because this can impact the organization negatively. These employees who have done an excellent job in their position but are retiring, promoting or moving are essential in helping the new employee serving in this role to make a smooth transition. This team dynamic of passing the baton should be promoted in a positive manner.

Part 9

The legal framework that guides the labor relations process in the United States (US) is the National Labor Relations Act (NLRA) of 1935 (Fried & Fottler, 2018). This law protects workers and affords them the right to form and join unions. The labor relations process consists of key participants which include management officials, union officials, the US government and third-party neutrals that serve as arbitrators. In addition, there are three phases of the labor relations process which include the following: (a) the recognition phase (b) the negotiation phase (c) the administration phase.

Recognition Phase

During the recognition phase of the labor relations process the union organizes employees to represent the employee. This is done either through voluntary recognition of the union or through an election process (Fried & Fottler, 2018). People have always joined together to solve problems and make changes to improve their lives and the communities they live in. Through unions workers join to improve workplace conditions. The freedom of workers to join in unions is a fundamental right in the United States. According to (Bivens, et al. (2017), there are over 16 million working men and women in the US who are exercising this right. Through collective bargaining unions work with employers to negotiate on behalf of the workers.

Negotiation Phase

After being elected to represent employees the union enters the negotiation phase. The negotiation phase is when the union negotiates a contract for the employees through collective bargaining (Fried & Fottler, 2018). The law requires the employer to bargain in good faith, but the employer does not have to agree with the union. Collective bargaining is very time

consuming and consist of four points of interest which include people, interests, option, and criteria (Fried & Fottler, 2018).

Administration Phase

After an agreement between the union and the employer is reached and is recorded in good faith then the next phase of the labor relations process is the administration phase or grievance procedure. The heart of the administering the collective bargaining agreement is the grievance procedure (Fried & Fottler, 2018). This grievance procedure serves as a tool that allows interpretation and implementation of the contract. There are four steps in the grievance process. However, if the grievance is resolved in step one then the grievance does not progress through steps two to four. The following are the steps taken in the grievance procedure: (a) presentation of the grievance by the employee (b) written grievance (c) in house review by top management (d) arbitration.

Importance of Human Resource Managers Knowledge of Labor Relations

It is a challenge for managers in healthcare to manage within the guidelines of collective bargaining contract. It is important for a manager to have knowledge of the verbiage in the contract so that it can guide the managers decision making when it comes to interacting, responding and disciplining employees. If the manager does not follow the contract when intervening in employee matters, then the employee can call on their union representative to intercede. Managers must maintain a positive labor relations program especially since union membership and election has increased in the healthcare settings (Fried & Fottler, 2018).

Part 10

The continuous change and shape of the healthcare’s landscape draws for more reform, safety and concerns for healthcare workers at the workplace. It is important for the organization and its leadership team to be mindful and stay abreast in understanding the needs and finding ways for solving issues and concerns to avoid tensions at the workplace (Fried & Fottler, 2018). This helps in creating and promoting positive outcomes for programs of labor relations at work. The National Labor Relations Act (NLRA) which was passed by the US Congress in the year 1935 protected the right of the employees to have a union and encourages a collective bargaining and protects the welfare of the employees, business and the US economy (NLRB,2019). A labor relations process happens when a manger and a union representative of the entire employee workforce meet up and discuss the rules and regulations set at work and is jointly agreed, determined and administered upon after the collaborative meeting (Fried & Fottler, 2018). The labor relation process has three phases:

(1)Recognition phase

This phase occurs when the union is seeking employees to be represented by them. An election happens to find out which union will represent for the employee. After the determination of the union organization, this allows the union to represent in behalf of the employee in instances for negotiating or collective bargaining agreements. The key issues for the desirability to have a union are employee wages, benefits and workplace perceptions (Fried & Fottler, 2018).

(2)Negotiation phase

The National Labor Relations Act (NLRA) mandates an employer in recognizing and bargaining with the certified union that was chosen and elected by the employees to represent them. Collective bargaining occurs in this phase and is encouraged by Federal labor laws for the employer and employee in reaching agreement issues on wages, hours, contributions, and employment conditions (Fried & Fottler, 2018). There are four basic points in the negotiation phase which comprises the people, interests, options, and criteria. The laborious process of collective bargaining is time-consuming which would require a full attention to understand and listen to the reasons and motivation behind the bargaining (Fried & Fottler, 2018). The three types of bargaining behavior and strategies are concessionary, integrative and distributive bargaining.

(3)Administration phase

This phase occurs when an agreement has been reached by both parties between the employer and the union wherein it is written, and the terms and conditions of the agreement must be signed, applied and enforced. The agreement includes wages, salaries, disciplinary, grievances, and arbitration procedures (Fried & Fottler, 2018). Arbitration occurs when both the union and manager get the opportunity in presenting the case. Management must have the awareness in critical situations that is affecting the ability and willingness in withstanding a strike (Fried & Fottler, 2018). The most severe dispute in labor-management in the healthcare setting is a strike. An assessment in critical issues and the possibility of a strike is driven from wages lost, and revenues. There must be compromise in both parties to have an agreement in order to prevent or stop the strike.

The Human Resources Management’s understanding on labor relations is essentially important to promote a healthy working environment, meet the needs of the employee (wages, revenues, benefits, retirement), and achieve and function as a healthcare organization in providing care to patients and promote great outcomes. HRM affects skill, motivation, attitude, innovative behavior of the employee and well-being once a perspective of mutual gain and positive relationship is attained between the employer and employees are achieved (Messersmith & Ogbonnaya, 2018). The workforce of the employee is needed to continue hospital operations and financial gains. There must be a Labor Management Program (LMP) in order to achieve partnership and understanding in both sides. Communication is the key to achieve understanding. There must be policies, regulations, defined responsibility, training, processes in place and a full understanding of the labor relations process in order to enhance and impede the overall process of labor relations in a healthcare organization (Fried & Fottler, 2018).