An analysis and recommendation for an improved HRM system change as it relates to growth and expansion of one of the largest healthcare systes in the United States.

1. HHC HRM Analysis 1
Donna Crane-Edwards
An Analytical Approach to New York City’s Health & Hospital Corporation’s Human Resource
Management Systems and Practices
Professor Tom Javarinis, PhD
March 26, 2009

2. HHC HRM Analysis 2
Thesis Statement
The current condition of the Human Resource Management (HRM) System and Practices of New
York City’s Health & Hospital Corporation (HHC), a subsidiary government agency does not
coincide with its future strategic plan for the firm. HHC has hired the Crane-Edwards Consulting
Firm to exam and recommend changes to the overall HRM system and practices of the
organization. The consulting firm will rely on the history, past and present systems; top
management expectations, the perception of its employees, and the strategies of the organization to
help the overall organization to make decisions on the restructure, revamp or transform the current
HRM system to help them reach their overall goals. The strategic plan used by HHC and how it
affects the current HRM systems and the need for changes to the system to meet the growing
demands of the organization’s population.

3. HHC HRM Analysis 3
Introduction
The New York City’s Health & Hospital Corporation (HHC), now one of the largest healthcare
facilities in the United States was founded in 1969 incorporating over 11 area hospitals and health
care facilities. “The Corporation operates the largest municipal health care system in the Unites
States with 38,988 employees as of June 30, 2008 and with annual operating revenues of more than
$5.6 billion for the fiscal year ended June 30, 2008” (Health and Hospital Corporation,2009, pp.
41). According to New York City Center for Economic Opportunity (CEO), “The population in the
New York state is 8.2 million which 8 million are at or under the poverty level which is 97 percent
of the population” (pp. 22). This population makes up a large percentage of the population seen
and treated at the HHC facility. HHC reports “In accordance with the Corporation’s mission, a
significant number of its patients are persons that have household incomes below the poverty level
are medically indigent or both” (Health and Hospital Corporation, 2009, pp. 42).
Over two centuries and a half ago, HHC is now continuing that goal of serving its growing
community of both under or uninsured clients. Though the demographics has changed from
predominately white middle class people to mostly Hispanic middle to poverty stricken families
with minimal or no insurance, the strategies of the organization still remains the same. The only
exception is that HHC now has backing from both the federal and local governments which gives it
a fiscal budget well over 5.6 billion dollars currently has a 180 million dollar growth project in
place but does not have money set aside for the new HRM technology system that will be installed
in the Spring of 2010.
Analytical Findings

4. HHC HRM Analysis 4
HHC has over 38, 988 employees, the majority of them hold non medical, non managerial
positions that are hired from the civil service pool, other government work first agencies, and/or
from the area population which is mostly composed of Hispanic citizens. Other employees are
hired through volunteer services that get the majority of their workers through human services and/
or coop programs from area high schools. 90% of these employees are in a union.
A closer look at the strategic plan statement of the organization to see if its current vision
fits with the current and future plans of the organization. According to an article written by
Summers & Summers (1997), “The challenge to strategic skills analysis is to get a clear picture of
what the organization will be doing by the end of the planning period” (pp. 15). They further state
the need for a job analysis. In this case, starting at the top management level and building on the
skills of the HRM systems could be a good place to start.
After analyzing the organizations history and work ethics, New York City’s Health &
Hospital Corporation (HHC) has been identified as a defender firm according to the definition
specified by Dreher & Dougherty (2002), pp. 104. The work processes identified by the
organization focuses on development on training the medical staff within the organization and the
community to address quality and patient care concerns. Further analysis shows the lack of training
in the general and/or clerical personnel which attributes to the need for greater performance in the
human resource department in selection, training, benefits and strategic planning. The strategic
plan used by HHC’s and how it affects the current HRM systems and the need for changes to the
system to meet the growing demands of the organization’s population.

5. HHC HRM Analysis 5
The current state of New York City’s Health & Hospital Corporation (HHC) shows
through assessment that the current strategies of the organization do not coincide with the KSAs of
the current staff; the performance appraisals currently used does not effect employee performance,
and the organization currently has a freeze on the hiring of new employees needed to meet the
demands of the current and future growth of the organization.
In addition, over 90% of the staff is in a unionized position from mail room clerk to
medical director and that there are five different union organizations. The ten percent that do not
fall in the unionized category are top and middle management who are responsible for
implementation of duties, goals and future planning of the direction of the organization.
Moreover, the managers are also expected to train the current staff in the LEAN method
which will be coming in 2010 as well as change the current performance appraisals, prepare for the
new technology while maintaining a departmental budget that does not include an updated or new
HRM system needed to help with the implementation of the new strategic plans of the firm.
Job Pricing and Compensation Packages
Another area that needs to be addressed is the compensation systems which currently use
pay scales for all employees regardless of skills, experience and/or education that tend to overlap.
For example, on the employment website, looking at a clerical position with minimal experience
start at $31,000 while a position for Assistant Director which requires a bachelor’s degree starts at
$32,000 both positions requires at least two years experience. This may cause a problem because it

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shows that the organization does not show the importance of attracting the best candidate by
offering a salary that is competitive in the market. The textbook puts it best “…employees must
perceive a strong relationship between attaining performance standards and receiving pay
incentives” (pp. 18).
Moreover, Performance Management is one of the most important aspects to an
organization. Business functionality relies on the performance of the staff which leads to higher
productivity and greater profitability. According to Joseph Martocchio (2001), “The standards by
which employee performance is judged should be linked to a company’s competitive strategy or
strategies” (pp. 93). Not only is the performance essential to the organization, but it can be
rewarding for the employee through various compensation methods offered by the employer.
Currently HHC does not offer pay incentives to their employees only seniority pay is given
to the long time employees and their performance is not congruent with the need for better
performance.
Furthermore, as stated earlier the company is using strategies that are similar to the
defender firm, they lack some key components in the defender firm attributes which include their
hiring processes and organizational strategies which are more in line with the prospector firm. The
two prospector firm strategies that they adopted according to Dreher & Dougherty (2002) are
“Entry at multiple career stages and exit resulting from either poor individual performance or the
pull of external opportunities” (pp. 105).

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Description of Analysis of current and targeted work processes
According to the HHC, “As of June 2008, the clinical staff employed by the corporation in
FTEs numbered an estimated 484 physicians, 1,969 residents, 91 physician assistants 7,330 nurse
practitioners and 7,801 technicians and specialists” (pp. 58).
Moreover, the corporation also employed 14, 977 FTEs for administrative, clerical, and
other support functions. From their entire work population 90.9% are in unions (see HHC, 2009,
pp. 59). The unions protect the rights of the individual employees in the corporation which can be
somewhat complicated as each class of employees utilizes their own union. The following unions
are under individual contract with the corporation: District Council 37, Doctor’s Council,
Teamsters Local 237; 199 Service Employees International Union, New York State Nurses
‘Association, and the Committee of Interns and Residents, (see HHC, 2009, pp. 59). In the last
decade, the job classification was changed for non managerial supervisor positions where they too
needed to have a college degree when hired from outside the agency although most of the positions
hire employees who are already in the HHC system.
While these positions ask for some experience in the health care and a degree, most are at
the management level. The lower level positions require two years experience in healthcare and
one of their main concerns is that applicants be bilingual. Internally, many employees who are
promoted are either bilingual or required to take an in-house Spanish speaking course set up by the
Human Resource department training division.

8. HHC HRM Analysis 8
Relevant Technology to achieve organization goals
New York City Health & Hospital Corporation is an organization that utilizes internalized systems
to satisfy employee development and production. The department of Information Technology
utilizes the Hospital Information Systems (HIS) in each facility that is responsible for training all
employees in the Health & Hospital Corporation for use in current and future technology. The
assessment(s) target area is the application, evaluation, need, training and performance measures
used by the department to support staff enrichment in an on-going process and to help new hires to
acclimate to their new work environment.
The middle management is usually trained prior to the installation of new technology in the HHC
facilities throughout the tri-state area to ensure that upon staff training, the new application of
technology is learned.
In the HHC organization, all staff has access to training through the Hospital Information System’s
program which is located on the employees’ personal access web site and approved through the
supervisor/manager of the department. The evaluation process is mandatory throughout the
organization and is performed by lower management. The form used is similar to the graphic rating
scale as discussed by Dreher & Dougherty (2002), pp. 149. The employees’ are given evaluations
every six months that offer performance measures which give the supervisor a view of the need or
motivation for advancement, learning, and or retraining.
One of the strategic plans for HHC is to strengthen its competitive position. According to
the President Mr. Aviles, in order to do this, he believes that introducing the corporation to “…use
cutting edge information technology (IT to drive clinical effectiveness and operational efficiency;

9. HHC HRM Analysis 9
engage senior leadership at the corporation to drive patient safety and promote transparency;
implement collaborative process redesign initiatives that improve efficiency and care delivery…”
(pp. 48) along with other goals and plans targeted at better patient care.
In addition, the President plans on modeling training program for all staff and management
utilizing the LEAN a methodology borrowed by the Toyota Corporation. The program is said to
start in 2010 and is currently being set up by an outside consulting firm to assess the training needs
for current and future employees.
According to Dreher & Dougherty (2002), an organization’s business strategies should be
aligned with their HRM systems to help them gain competitive advantage (see pp. 168). The
problem here is that HHC has not address this issue yet but should be aware of the significance of
investing in a HRM system that will help bring in and maintain the staff needed to meet the goals
of the organization. In this instance the HRM practice would be invaluable to the HHC
organization.
Therefore, it is suggested that the organization either train their H.I.S. staff to handle the
training needs of the organization by hiring an outside consulting firm to retrain the H.I.S. staff;
revise and implement the current HRM system so that current and future candidates will be
correctly selected and placed in the areas needed to maintain growth and productivity; to provide
staff development for current employees to learn and grow within the company, and to make sure
that all training is conducive to the position by providing an on going assessment that will measure

10. HHC HRM Analysis 10
the KSAs used and learned during former training and the need for additional training to maintain
productivity.
Labor Market and appropriate labor law context
According to Dreher & Dougherty (2001), “Knowledge of equal employment opportunity
(EEO) and labor relations laws, government guidelines, and country-specific practices affects the
strategic decision-making process and the implementation of strategies” (pp. 216).
New York City’s Health & Hospital Corporation has the difficult task of trying to
modernize an impending growing population with the mission of incorporating the rules and
regulations, laws and mandates of a municipal principality; keeping in agreement with the labor
laws set forth by the government, the state and the city of New York. In addition, introduce change
to a working environment that is over ninety percent protected by unionized employee rules and
regulations which limit their ability to make oftentimes mistaken radical changes in their work
environment due to the fact that it will not only effect their budget, but it could cost them
tremendous fines by the auditing agencies as well as the being threatened with lost of jobs and/or
even shutting down.
In addition, “All aspects of a firm’s human resources activities, such as hiring. Promotions,
discipline, termination, transfers, training, and compensation, are to some extent influenced and
constrained by the equal employment and labor relations environment” (pp. 216).
Identification of companies that are preparing to address the changes

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After accessing the Wake Med Health Services site, which the following information is
available about training:
Employee Training
WakeMed staff have access to a wealth of continuing education and professional training resources.
WakeMed offers traditional continuing education, on-site specific training, tuition reimbursement,
on-line programs and tracking of individual employee’s educational plans and courses, brokered
training resources and direct teaching by faculty and staff who are on-site every day.
In addition to this, the Wake Med Foundation offers an Employee Skills Development Scholarship
that enables employees to enhance their job skills through avenues not typically supported by
budgeted continuing education or tuition reimbursement programs.
Learning Link is an on-line catalog of courses available. Employees may review courses through
the Wake Med intranet or by contacting the Staff and Workforce Development Office. Learning
Link tracks the employee’s mandatory program participation, as well as voluntary education.
Classes may fall under these categories:
Management Development
•
Clinical Analysis
•
Employee Development
•
Quality Improvement Strategies and Measures
•
Self-Directed Learning Opportunities
•
Computer Courses
•

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While the size of Wake Med is tiny by comparison to the HHC organization, they do meet
their mission, strategies and goals with the use of HRM systems. When searching the HHC site, no
information is found other than a press release regarding any training, development or staffing
systems.
While HHC employees lack the technology skills needed to prepare them for future
changes, the entire staff relies on the Hospital Information System department to handle any and all
technology difficulties that it may require in the future to minimize spending. While this may sound
cost effective, it does not address the needs of the individual employees who want to advance from
their current positions within the organization or have the ability to seek employment at a more
advanced organization due to the lack of KSAs required during hiring; or help productivity within
their current positions.
On the other hand, it is fair to say that Wake Med is considered a private facility receiving
little funding from the local, state or government while HHC relies mainly on those funds as well as
private donations to continue its capacity to grow and treat patients who can hardly pay for
services.
In addition, Wake Med does not offer these services nor do they have the manpower or the
population size that HHC has to contend with nor the same demographic population. The need for
care of patients by the residence surrounding Wake Med is different because their population is
mostly middle class citizens in the Cary area with a median salary of $74,000 per annum while
HHC has a 90% poverty line population with a median salary of $20, 025 per annum and a
population well into the millions as compared to Cary and its surrounding areas not reaching ½ of

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one million currently (see Town of Cary demographics, pp. 1).
Therefore, it is suggested that the organization either train their H.I.S. staff to handle the
training needs of the organization by hiring an outside consulting firm to retrain the H.I.S. staff;
revise and implement the current HRM system so that current and future candidates will be
correctly selected and placed in the areas needed to maintain growth and productivity; to provide
staff development for current employees to learn and grow within the company, and to make sure
that all training is conducive to the position by providing an on going assessment that will measure
the KSAs used and learned during former training and the need for additional training to maintain
productivity.
one of the most important aspects in an organization that has never modernized or updated
their system where employees who have been unmotivated for over ten years, the need to change
the reward system where seniority is not the only means to getting raises but using modernized
performance appraisal methods as catalyst to offer employees incentives to motivate their efforts to
be more competitive and productive in a changing and growing work environment.
Prescribe a set of HRM recommendations tailored for the selected firm (19 dimensions of an HRM
system presented in Chapter 3)
New York City’s Health & Hospital Corporation (HHC) assessment shows a need for a
HRM system that will coincide with their current strategic plan to stay competitive, become
technologically modernized; enhance quality and quantity of care, prepare staff for the training and
use of the LEAN method, to increase employee performance within a strict budget set by
government guidelines and regulations. The HRM system must provide value, cost effectiveness,

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return on investment; and provide the ability to fit future hires with the KSAs (knowledge, skills
and attitude) necessary to perform the duties necessary for the firm’s upgrades. The fact that there
is a freeze on hiring for the entire organization means that the current employees must be
motivated to learn the needed skills required to perform the new tasks. In order to achieve this, the
general manager must analyze the current performance appraisals as to the behavior of the
employees separating the high performance appraisals from the lower performance appraisals.
In addition, take the lower performance appraisals and depending on the number of
employees that do not meet the required level of performance needed to train for the new system,
address a solution that would help motivate them to not only train but perform the new duties
successfully. The student would suggest a change in the compensation system from seniority raises
only to include incentive pay for high performance appraisals to motivate the newer employees to
work more efficiently.
Furthermore, the general manager should look for a method of HR systems that meet the
LEAN method which initiates team work over individual work and set up a performance appraisal
that will link team work, incentive pay for performance and the strategic goal of the organization
to show that the division of the three will cause problems for the organization.
According to Joseph Martocchio (2001)”Job descriptions serve as a cornerstone in the
development of internally consistent compensation systems as well as performance standards in
performance evaluation systems” (pp. 147). Providing HHC with a closer look at the current
conditions of their job descriptions as they relate to current pay and the current market will give
them a broader view of the need for a new HR system and/or changes within the current system.

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In addition, a job analysis followed by an evaluation will provide a starting point for the
type of training that will be needed to ensure that all employees meet the KSAs needed to perform
the job after the new technology is installed.
Furthermore, because HHC is a government agency, it is important that the legalities of a
job analysis meet the labor laws required by the state and local government. HHC has to follow
government regulated policy and procedures to ensure that all labor laws are met when doing a job
analysis.
Other HRM issues
Another important factor that HHC will look at as to the need for or updating their current
HR system is the knowledge of its importance as to price and value. According to Dreher &
Dougherty (2001), “For an investment in an HR system to add value to the firm it must generate a
reasonable rate of return” (pp. 203).
Selling the need for a renewed HR system will be difficult because unlike the idea of the
agency to switch to the LEAN method which was decided at the government level, determining the
need for an improved and or new HR system will be very difficult because they HHC agency takes
most of their cues from the federal level when it comes to changes in part because most of their
budget is government regulated as well as provided by the government while other funding comes
from private donations.
While it is not quite apparent how HR Systems can bring value at the state and federal
level, thirty year employee of the federal government, Colleen Woodard (2005) believes that
slowly but surely some government agencies are coming around because they have been given the
green light to make changes to the HRM systems emulating the private business sector on the

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belief that merit systems, HRM systems and strategic goals are connected and together not only
add value to an organization but help attract well qualified candidates to do the job (see pp. 4).
Furthermore, Colleen Woodard believes that it is just a matter of time before the value of
HRM systems and practices are realized by the entire government and they will be quickly
embraced and utilized to help lead the cornerstone of a more harmonized and uniformed
organizational system.
Finally, while HHC may not have the authority to change their current HRM system other
than to make it computerized to meet the demands of the market, when the government does fully
recognize the value of an HRM system, the one that would most likely match the overall needs of
the organization as it effects their cost effectiveness would be one that is merit based because it has
the most value as to the direction the organization is trying to go and would better motivate the
current employees by offering them an incentive to perform more effectively and at the same time
helping the organization to take a congruent approach to employee performance.

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References
Dreher, G. & Dougherty, T. (2002). Human resource strategy: A behavioral perspective for the general
manager Boston, MA: McGraw-Hill/Irwin.

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Martocchio, J.J. (2001). Strategic Compensation: A Human Resource Management Approach (5th edition).
Prentice Hall.
New York City Health & Hospitals Corporation (2009). Site visited February 20, 2009 from
http://www.nyc.gov/html/hhc/html/about/about.shtml.
Summers, T.P. & Summers, S. B. (1997). Strategic skills analysis for selection and development. HR.
Human Resource Planning, 20(3), 14-19. Retrieved March 3, 2009, from ABI/INFORM
Global database. (Document ID: 23326349).
The CEO Poverty Measure (2009) A Working Paper by The New York City Center for Economic
Opportunity (August 2008). Site visited on March 14, 2009 from
http://www.nyc.gov/html/ceo/downloads/pdf/final_poverty_report.pdf.
Town of Cary (2009).
Wake Med Health Service (2009). Site retrieved March 7, 2009 from www.wakemed.org
Woodard, C.A. (2005). Merit by Any Other Name-Reframing the Civil Service First Principle. Public
Administration Review, 65(1), 109-116. Retrieved March 21, 2009, from ABI/INFORM
Global database. (Document ID: 788053501).