When an employee brings forward a compliance concern, they’re engaging in what the law defines as protected activity. This might involve reporting a potential violation of hospice regulations, concerns about Medicare fraud, or even raising issues about unsafe working conditions. These are rights guaranteed under various laws, like the False Claims Act, OSHA protections, and Title VII of the Civil Rights Act, which protect employees who speak up.
In responding to employee concerns, there is a fine line between addressing workplace concerns and crossing into retaliation territory. Retaliation isn’t always a blatant act of revenge. Sometimes, it’s more subtle, even subconscious. Sometimes management at the hospice agency may feel frustrated or betrayed by an employee’s complaint and – without realizing it – allow those feelings to influence their decisions. Maybe the employee was already struggling with performance, or maybe there were pre-existing tensions on the team. But when an adverse action—like firing, demotion, or cutting hours—happens shortly after a complaint, it’s easy for that decision to be seen as retaliatory, even if it wasn’t intended that way.
What is Retaliation?
To clarify what retaliation means, it’s any adverse action taken against an employee because they engaged in protected activity. Timing is a major red flag here. If an employee files a compliance report and is terminated shortly after, it raises questions. Even if you feel justified in your decision, the timing alone can look suspect to a court, regulatory agency, or even the employee’s peers.
What are the Consequences of Retaliation
And the consequences for retaliation? They’re not just legal—they’re also reputational. If a claim is brought against an agency, the agency could face:
Reinstatement of the employee to their position, even if you’ve moved on.
Back pay, damages, and legal fees, which can quickly add up.
Regulatory scrutiny, which might open the door to deeper investigations into the agency’s practices.
And, perhaps most damaging, the perception that we don’t care about compliance or employee rights. That’s not a message we can afford to send.
From the employee’s perspective, they have a number of options if they feel they’ve been retaliated against. They might file a complaint with OSHA, EEOC, or state regulators. They could seek legal action for wrongful termination or take their concerns to external auditors or even the media. Once that door is opened, the hospice agency loses control of the narrative.
How Can You Avoid Retaliatory Behavior?
So, what can you do to avoid even the appearance of retaliation? Here’s are some suggestions:
Document everything: If there are performance concerns or other issues unrelated to the complaint, make sure there’s a clear, consistent record. This documentation can be your best defense.
Separate decision-making: If you’re in the middle of handling a compliance complaint, let someone outside the situation—like your compliance officer or HR—review any proposed actions against the employee.
Follow established protocols: Deviating from your normal policies, especially when dealing with someone who has raised a complaint, can make it look like you are targeting them.
Train your leaders: Everyone in management needs to understand what retaliation looks like and how to avoid it.
Leadership sometimes expresses concerns about employees “stirring up trouble” or raising issues for self-protection. But the law doesn’t distinguish between “valid” and “troublesome” complaints. Protected activity is protected activity, full stop.
Take a step back. If you’re ever considering taking action against an employee who has engaged in protected activity, discuss it first with your HR or compliance team. Together, you can ensure the decision is based on legitimate, well-documented reasons and not influenced—even unconsciously—by the complaint itself.
At the end of the day, your goal is to serve patients and families with integrity and compassion. That means creating a culture where employees feel safe to speak up about compliance issues without fear of retaliation. Protecting that culture isn’t just about avoiding lawsuits—it’s about doing what’s right for your team, your agency, and the people you care for.
As a manager in hospice care, your role goes beyond overseeing patient care and managing staff. It includes ensuring that your team feels valued and fairly compensated. Pay transparency is becoming a hot topic, and understanding its implications can help you effectively navigate this evolving landscape.
What Is Pay Transparency?
Pay transparency refers to the practice of openly sharing information about compensation within an organization. This can include posting salary ranges in job listings, discussing pay openly among employees, or providing detailed breakdowns of how pay is determined. The goal is to ensure that employees understand how their pay is calculated and that there are no disparities based on gender, race, or other factors.
What is the status of pay transparency regulations in the U.S.?
The U.S. is starting to experience a trend in adoption of pay transparency regulations. Several states have introduced laws that require employers to provide salary ranges in job postings or upon request. For example:
Colorado: The state’s Equal Pay for Equal Work Act requires employers to include salary ranges in job postings and provide pay information to employees upon request.
New York City: The city requires employers with four or more employees to include salary ranges in job advertisements.
California: As of January 2023, California employers with 15 or more employees must include pay scales in job postings.
It is likely that more states will follow and that the laws with transparency requirements will continue to be more comprehensive.
Why Is Pay Transparency Important?
Fosters Trust and Engagement: When employees understand how their pay is determined and believe it is fair, they are more likely to feel valued and engaged in their work. In a field as emotionally demanding as hospice care, high employee engagement is crucial for maintaining a positive work environment and delivering high-quality care.
Reduces Pay Disparities: Pay transparency helps to identify and address pay disparities that may exist within your organization. In healthcare, where women and minorities are often overrepresented in lower-paying roles, transparency can be a tool for promoting equity and ensuring that all employees are paid fairly for their work.
Compliance with Regulations: Some states in the U.S. are implementing laws that require employers to provide pay ranges in job postings or share salary information upon request. Staying ahead of these regulations by adopting pay transparency practices can help your hospice avoid legal challenges and demonstrate a commitment to fairness.
How to Implement Pay Transparency
Review Current Pay Practices: Start by conducting a thorough review of your current pay practices. Ensure that salaries are consistent with market rates and that there are no unexplained disparities among employees with similar roles and experience levels.
Communicate Clearly: If you decide to move towards more transparency, communicate clearly with your team about what information will be shared and why. For example, explain how pay ranges are determined and what factors influence individual salaries.
Train Managers: Provide training for all managers to ensure they understand the principles of pay transparency and are equipped to have open and honest conversations about pay with their team members.
Update Job Postings: If your state requires it or if you choose to do so, include salary ranges in job postings. This not only meets regulatory requirements but also attracts candidates who appreciate transparency and fairness.
Regularly Review and Adjust: Pay transparency is not a one-time effort. Regularly review your compensation practices and make adjustments as needed to ensure ongoing fairness and compliance with any new laws or guidelines.
Challenges of Pay Transparency
Managing Expectations: One of the challenges of pay transparency is managing employee expectations. If employees see that their pay is lower than a colleague’s, they may feel undervalued, even if there are legitimate reasons for the difference. It’s important to be prepared to explain these differences clearly and fairly.
Confidentiality Concerns: In some cases, employees may prefer to keep their salaries private. It’s important to balance transparency with respect for individual preferences and privacy.
Complexity in Pay Structures: Healthcare organizations often have complex pay structures with various factors influencing salaries, such as certifications, years of experience, and additional responsibilities. Transparency requires clear communication about these complexities, which can be challenging.
The Future of Pay Transparency in the U.S.
It is likely that the U.S. will continue to see increased pressure for transparency in the coming years. The healthcare industry, including hospice care, may need to adapt to more stringent regulations and expectations around pay disclosure.
As a manager, staying informed about these trends and proactively implementing transparent pay practices can position your hospice to lead in this area. Not only will this help in complying with potential future regulations, but it will also foster a more equitable and supportive work environment for your team.
Conclusion
Pay transparency is an important and evolving issue. Adopting transparent pay practices now can help foster trust, promote fairness, and ensure compliance with current and future regulations. By being proactive in this area, you can create a more equitable and positive work environment for your team, ultimately leading to better care for your patients.
Where Can You Find Out More
Gallagher: How managers can respond to pay transparency
SHRM: How Companies can Respond to New Pay Transparency Laws
Creating and using benchmarks to compare your company’s hiring demographics against those used by government agencies like the EEOC (Equal Employment Opportunity Commission) is crucial. Benchmarking helps ensure that your company’s hiring practices are fair and compliant with federal regulations. Here’s are some considerations to keep in mind when you consider the right benchmarks
Why Benchmarking Matters
Government agencies monitor and require companies to report on the demographic composition of their workforce, especially larger companies. For instance, the EEOC uses benchmarks to compare a company’s demographics against broader population data from sources like the U.S. Census and the American Community Survey. Knowing how your company’s demographics stack up against these benchmarks is essential for several reasons:
Diversity Goals: Meeting your company’s diversity and inclusion goals.
Fair Hiring Practices: Ensuring fair and unbiased hiring practices.
Best Practices for Benchmarking
Collect Internal Data: Gather detailed demographic data of your current workforce and applicants.
Ensure you track data on race, gender, age, and other relevant demographics.
Choose the Right External Data: Depending on your hiring scope, use national, regional, or local data. For example, if you recruit nationwide, use national benchmarks. For local hires, consider regional data.
Occupation and Industry-Specific Data: Align your benchmarks with the specific occupations and industries relevant to your company. Different industries and roles may have distinct demographic compositions.
Adjust for Educational Requirements: Consider the educational requirements for the roles you are hiring. This will help you compare your applicant pool against the qualified population.
Use Census Data: The U.S. Census Bureau provides comprehensive data that can be segmented by occupation, geography, and other factors. This data is a good starting point for creating your benchmarks.
Ensuring Fair Selection
To avoid over- or under-selecting any protected group, follow these steps:
Regularly Update Benchmarks: Demographic data changes over time. Ensure your benchmarks are based on the most recent data.
Monitor Hiring Practices: Continuously monitor your hiring practices and outcomes against your benchmarks.
Training and Awareness: Educate hiring managers on the importance of diversity and compliance with hiring practices.
External Data Sources
Looking at external data sources is important because it provides a broader context for your internal data. It helps you understand the labor market and demographic trends in your industry and location. External benchmarks serve as a snapshot of the current workforce composition, which can change over time.
Creating effective benchmarks involves a blend of using accurate external data and understanding your company’s unique needs. By comparing your company’s demographics against reliable benchmarks, you can ensure fair and compliant hiring practices. Regularly updating these benchmarks and educating your hiring team on best practices will help maintain a diverse and inclusive workforce.
Where Can You Find Additional Information?
Of Significance: Don’t Miss the Mark! Podcast on what to keep in mind when creating benchmarks
Harvard Business Review: Smart benchmarking starts with knowing whom to compare yourself to
Artificial Intelligence (AI) is transforming the workplace. It offers immense potential for employers to enhance efficiency, decision-making, and overall performance. However, as AI is increasingly integrated into hiring decisions and other HR functions, employers must take note of the ethical and regulatory considerations that surround its use.
In this blog we review some of the potential benefits of the use of AI for employers as well as regulations considerations in using AI for hiring decisions.
Potential Benefits of AI for Employers
Enhanced Efficiency: AI can automate routine tasks, freeing up time for the HR team to focus on strategic activities. Ai can support activities such as sorting through resumes and scheduling interviews, both activities that typically consume significant resources.
Improve Decision-Making: AI systems can quickly and accurately analyze large volumes of data, providing insights that help employers make informed decisions. This includes identifying trends in employee performance, predicting future hiring needs, and optimizing workforce planning.
Bias Reduction: When properly designed and implemented, AI can help reduce unconscious bias in hiring decisions. AI can objectively evaluate candidates based on data rather than subjective impressions, leading to more fair and more inclusive hiring practices.
Cost Savings: Automating aspects of the hiring process can significantly reduce costs. AI can handle initial screenings, reducing the need for extensive human involvement until the later stages of the hiring process. The efficiency can translate into considerable savings.
Better Candidate Matching: AI-powered tools can analyze job descriptions and candidate profiles to identify the best matches, improving the quality of hires. By considering a broader range of factors, including skills, experience, and cultural fit, AI can help employers find candidates who are more likely to succeed in their roles.
Rules and Regulations Surrounding the Use of AI
While AI offers many benefits, its use in hiring is subject to various restrictions and regulations designed to ensure fairness and protect candidate rights. Employers must be aware of these to avoid legal pitfalls and ethical dilemmas.
Data Privacy Laws: Regulations like the General Data Protection Regulation (GDPR) in Europe and the California Consumer Privacy Act (CCPA) in the U.S. impose strict requirements on how personal data is collected, stored, and used. Employers must ensure that AI systems comply with these laws, particularly when handling sensitive candidate information.
Anti-Discrimination Laws: In the U.S., the Equal Employment Opportunity Commission (EEOC) enforces laws that prohibit discrimination based on race, color, religion, sex, national origin, disability, and genetic information. AI systems must be designed to comply with these laws, avoiding biases that could lead to discriminatory practices.
Transparency and Accountability: Employers must be transparent about their use of AI in hiring decisions. Candidates should be information when AI is used to evaluate their applications and employers should be prepared to explain how AI decisions are made. This transparency is crucial for building trust and ensuring fairness.
Algorithmic Fairness: AI systems must be regularly audited to ensure that they are fair and unbiased. Employers should work with AI vendors who prioritize ethical AI development and are willing to provide insights into their algorithms’ workings.
Bias Mitigation: Employers must actively work to mitigate any biases in their AI systems. This involves continuous monitoring, testing, and updating of AI algorithms to ensure they do not perpetuate or exacerbate existing biases.
Beware of Evolving Regulations
To harness the benefits of AI while navigating its regulatory landscape, employers need to keep up to date with the latest regulatory landscape and best practices related to AI in hiring. The AI regulations are evolving – and vary by jurisdictions. Employers must constantly monitor to ensure that they remain aware of the most recent regulations. Additionally, employers must regularly audit AI systems to ensure that they are fair, unbiased, and compliant with relevant laws. Finally, success will require collaboration of all stakeholders – HR, legal, and IT teams – to ensure that the AI systems that are implemented reflect a holistic approach.
Where Can You Find Out More?
Using AI to remove bias from hiring decision-making:
How can your hospice organization find out what your employees are thinking? How do you know if your employees are satisfied? Dissatisfied? How do you know if employee satisfaction varies across different agencies in your organization? Do you have a systemic problem in one of your agencies? Is one of your regions better or worse than the others?
Using employee surveys to measure employee sentiment
Hospice organizations typically conduct employee surveys to try to dig into this information. Employee surveys are prepared by the corporate office and survey the entire organization – that is – all hospice agencies across the entire organization. The surveys are typically conducted no more frequently than once per year and involve significant planning and cost. A survey response rate of 70% is considered a good response rate.
Organization may also conduct more targeted “pulse surveys” – to gather the employee sentiment on a targeted issue. Pulse surveys are run more frequently, and a 50% response rate is considered a good response rate.
Using public data sources to measure employee sentiment
However, there is another valuable source of employee sentiment that is often overlooked by hospice organizations: both current and former employees post valuable company reviews on public employment websites. These reviews provide valuable and actionable insight that can be used to monitor employee sentiment, detect trends over time, identify differences between agencies or regions in the organization and a wealth of other useful information.
How can information from public websites be used?
How can a review from a public website be used to provide insight to a hospice agency? Let’s examine some reviews to see what insight can be gained.
Data points that we can gather from this review are the following:
Rating: 5 star
Employment status: current
Date of review: March 10, 2023
Type of employment: per diem
Job role: Home recovery RN
Location: Marshfield, WI
General comments: supportive management
Here is another review:
Data points that we can gather from this review are the following:
Rating: 5 star
Employment status: former
Date of review: April 10, 2017
Type of employment: contractor
Job role: data entry
Location: Brentwood, TN
General comments: excellent company to work for
Here is a third review:
Data points that we can gather from this review are the following:
Rating: 3 star
Employment status: former
Date of review: August 1, 2021
Type of employment: full time
Job role: Patient care coordinator
Location: Vestavia Hls, AL
General comments: management does not respond to input
How can the data be stored so maximum value can be extracted?
A hospice agency should store the data in a database format – either in a database or in a spreadsheet – so that maximum value can be extracted. By storing the data in this manner, metrics of interest and can be created. Performance over time can be monitored. We provide an example below. Suppose the three reviews above are for three different locations for the same hospice organization – one for an agency located in Marshfield, WI, one for an agency located in Brentwood, TN, and one for an agency located in Vestavia Hls, AL. The data can be stored in a spreadsheet as follows:
Additional columns in the spreadsheet can be added to provide additional information. For example, categories of interest may be:
classify the employee type by categories such as clinical, corporate, office team, etc.
classify the city / state by regions in the organization.
As the number of rows in the spreadsheet grows patterns can be identified and valuable metrics can be created and monitored – in time and over time.
Maslow’s hierarchy of needs is a theory that can be used to provide leaders and organizations with guidance on how to motivate employees. But what is this hierarchy and what is Maslow’s theory?
What is Maslow’s Hierarchy of Needs?
Maslow developed his theory on the Hierarchy of Needs in the 1940s. The hierarchy suggests that people are first motivated to fulfill basic needs before they move on to more advanced needs.
The theory states that there are five fundamental human needs that can be represented as a pyramid. Each of the five needs builds on the prior need. Individuals want to meet needs at a lower level before progressing to needs at a higher level.
The highest-level need in Maslow’s hierarchy is self-actualization, where an individual achieves self-fulfillment.
How does Maslow’s Hierarchy of Needs relate to leadership?
A good manager understands this hierarchy of needs and leads his team so that he is meeting each employee at the employee’s current level of need while simultaneously encouraging the employee to continue to move up the pyramid so that the employee eventually achieves self-actualization. In the workplace, self-actualization translates to an employee’s desire to maximize his potential at work.
What are the levels of the hierarchy?
In Maslow’s hierarchy, Level 5 is the lowest level and Level 1 is the highest level. An individual or employee will start at a lower level and move up levels as he tries to achieve the highest level in the hierarchy.
Level 5: Psychological needs – survival
This is a most basic need for survival. Employees at this level want to feel secure that they have a steady income.
Level 4: Safety and security
Managers and leaders need to make employees feel secure. Some managers do not realize this and think that employees will work harder if they are “kept on their toes.” But this strategy usually fails. Rather than working harder, employees become obsessed with job security.
How can a leader make employees feel secure?
Communication: Share the big picture with employees.
Clear rules: Employees should know where they stand at all times
Be supportive: Support employees if they are struggling or if they fail
Be consistent: Be the same every day
Be fair
Level 3: Belonging (social needs)
Employees enjoy a team environment and a social workplace.
How can a leader create a social environment and a feeling of belonging?
Conduct team meetings
Create an area where people can gather, e.g., for coffee
Encourage a feeling that people are a part of the team
Organize social events outside of work
Level 2: Esteem/status
Employees want to be noticed, on occasion, and to stand out for their accomplishments and for what they do better than others. People like to feel important, occasionally.
How can a leader meet this need of employees to feel important?
Give employees regular recognition
Spend time with employees
Level 1: Self actualization
Self-actualization is maximizing an self-fulfillment where an individual discovers his potential and uses his skills to the utmost. This is the highest level of Maslow’s hierarchy, where employees are maximizing their potential at work.
How can a leader help employees maximize their potential?
Give employees ownership of tasks or projects
Empower employees
Help employees find ways to advance in their careers
What defines a great organization?
Maslow believes that in a great organization, employees will be at the level of self-actualization. That is, all employees must achieve Level 1. For employees to achieve Level 1, leadership must support employees through all the lower levels of the hierarchy. The pyramid will crumble if employees are lacking the supporting levels.
Further, leadership must make it possible for employees to achieve self-actualization. Employees need to be trained, to acquire new skills, and to have an environment where they gain a sense of satisfaction. A good leader will learn his employees’ potential and create an environment where people are trusted, can flourish, and are given important tasks to complete. A good leader will create an environment where employees can achieve self-actualization.
