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It was organized in 1944 and has 501(c)(3) status under the Internal Revenue Code. Its purposes are

(1) To promot public welfare through the development of hospital and outpatient service;

(2) To encourage and engage in professional education and scientific research in the administration of hospital and outpatient service and aid in the health education of the public with respect to hospital and outpatient service; and

(3) To improve the quality and increase the distribution of hospital and outpatient service. The trust is closely associated with, but separate from, the American Hospital Association with which you are all familiar. The trust has seven trustees, three of whom are officers of the American Hospital Association and four of whom are men of affairs not directly associaated with hospitals. I have here a list of the trustees which I shall leave with you.

Since its formation, the trust has undertaken some 75 projects largely financed by gifts from foundations or other donors and by contract with Government agencies. At present, we have 17 projects underway, including the 2 contracts with the Labor Department.

One worthy of special mention is hospital administrative services, which analyzes the financial and statistical data from its 1,300 subscribing hospitals and provides them comparative reports, and another is the hospital continuing education project, which is conducting a series of experimental educational activities aimed at improving hospital administration. I have here material about each of these, which I will leave with you.

Now for the business of this hearing and our two contracts with the Bureau of Apprenticeship and Training of the Labor Department.

The first contract is for $148,473 and calls for us to produce on-thejob training manuals for seven occupations: nursing aid, orderly, ward clerk, housekeeping aid, dietary aid, psychiatric aid, and surgical technician. This contract expires on May 31, 1966. We have subcontracted a great deal of this work to the IIospital Research & Educational Trust of New Jersey, which shares some of our name, but is not otherwise affiliated with us. It is an arm of the New Jersey Hospital Assoication. The objectives of the contract include

(1) Provision of on-the-job training programs, both for those to be upgraded and for those newly hired.

(2) Development of training materials for hospital occupations for which a need exists. In the initial stage of the project, need was determined in part on the basis of the applications for onthe-job training programs already received by the Bureau of Apprenticeship and Training from individual hospitals.

(3) Utilization, wherever possible, of high-quality training materials which have already been developed

(a) Through the Bureau of Apprenticeship and Training contracts with individual hospitals;

(6) By Government agencies, such as the Veterans' Administration, the armed services, and the Department of Health, Education, and Welfare; and

(c) By voluntary hospitals.

(4) Preparation of on-the-job training materials which :

(a) Utilize sound training techniques; (b) Can be utilized by hospital personnel who are familiar with the job content with only a minimal review of the materials required prior to conducting the training sessions;

(c) Require only minor modifications to fit individual hospital requirements;

(d) Can be made available to every hospital in the United States on a nonprofit publication cost basis; and

(e) Finally, can be made available to Labor Department personnel in order that the Bureau of Apprenticeship and

Training can better assist individual hospitals. We hope this contract will serve as a basis for developing additional programs for other hospital occupations. A need may exist to have on-the-job training programs for 50 or more job classifications in the hospital. The methods developed in this contract can be used in the development of future programs in order to maximize on-thejob training of hospital personnel.

We have produced final versions of a training manual for the nursing aid and a manual for the instructor of the nursing aid. I will leave copies with you. These are copies for testing and evaluation, and already we are making provision for corrections.

For the other six occupations, manuals are in various degrees of completion. I have here copies of all lessons and chapters that are completed. These manuals, complete or incomplete, are now being used by the hospitals with which we have subcontracts under our second contract.

Senator Javirs. Mr. Churchill, the manual which you are producing will be marked for the information of the subcommittee. We will not necessarily include them for the record: we will look them over. We will mark them for the information of the committee. Mr. CHURCHILL. Yes, sir.

Our second contract was signed on May 3, 1965. It requires us to provide on-the-job training to 4,000 people at a total cost of $1.6 million, or $100 per trainee. Through subcontracts with individual hospitals

, we provide them training materials and money with which to pay the wages of the trainer from the Manpower Development and Training Act funds.

The hospitals pay the trainees and provide the classrooms, consumable supplies and clinical setting. Some trainees are new hires, others are upgraded. The hospitals conducting training under this contract are using the manuals produced under the first contract.

When the contract was first discussed with officials of the Department of Labor, the need for on-the-job training of health service workers was described as follows:

During the past 50 years, dozens of new occupations have been created to care for patients in hospitals. With rapid advances in medical technology and greater degrees of specialization necessary in the medical profession, it has been estimated that the ratio of health workers to physicians has increased from 5 to 1 in 1940 to 13 to 1 in 1964. This growth is expected to continue for at least another decade. Over 200,000 job opportunities are created every year due to the nature of the health worker labor force. Most hospital employees are women and, thus, may terminate employment because of marriage, family obligations or pregnancy. In addition, many others leaving hospital employment originally come to the

hospital lacking experience and job training. Once training and experience are gained, they leave to take employment in other industries. In this way, hospitals furnish a large number of experienced workers to other parts of the economy.

Much of the training given to new employees has not been in sound programs that could be utilized by other institutions. Instead, each hospital has attempted to provide new employees with a training program that would get the employees on the job as quickly as possible. Therefore, there is a definite need for on-thejob training programs to be developed so that all hospitals can benefit from sound techniques, developed through experience, in order to train the thousands of new employees needed annually.

For example, bed increases in short-term general hospitals have averaged 2.7 percent per year in the last five years; and it is estimated that the bed count will increase from the current complement of 698,000 to 840,000 by 1974. At the current rate of 1.83 employees per bed, the addition of 260,000 persons is required by 1974 merely to maintain the current staffing rate, and this figure does not allow for increased services or for attrition from the hospital labor force.

Concurrent with the expansion of hospitals, there will be an increase in the number of untrained people whose skills must be developed if they are to render productive service to the hospital. The application of forward planning and professional attention to this unskilled group is an attempt to make maximum use of available manpower.

While no one can accurately predict the pattern of medical care that the future holds, historically, advances in medical care have not reduced the number of employees per bed. Instead, there has been a steady increase in this ratio. Automation has not affected hospitals to any appreciable extent. Furthermore, future planning should include the distinct possibility that new jobs with better training will be necessary in hospitals. Some of these occupations may be necessary, not to replace, but to supplement the existing short supply of professional personnel. (Hospitals, Journal of the American Hospital Association, October 16, 1964.)

Senator Javits. Do you believe this is the optimum way to get those workers, through on-the-job training under the manpower development and training program?

Mr. CHURCHILL. We believe that on-the-job training is the optimum way to train these workers.

Senator Javits. Do you follow through, in respect of compensation, conditions of work and job procurement, in the programs you undertake?

Mr. CHURCHILL. The local offices, the field offices of the Labor Department are responsible for assisting us in procuring the new workers and for these matters which you just mentioned.

Senator Javits. And you feel there are enough openings so that if the personnel are adequately trained, the jobs will be available!

Mr. CHURCHILL. Yes, sir.

Senator JAVITs. In other words, there is a real vital need in this whole field.

Mr. CHURCHILL. Yes.

Senator Javits. Is that general throughout the country or are there some areas that are peculiarly susceptible to this situation?

Mr. CHURCHILL. I would think it is general.
Senator JAVITs. General, all right.

Mr. CHURCHILL. We sought the training materials contract. The Department of Labor sought our help for the training contract. We were asked to serve as an extension of the Department, which we were, of course, glad to do.

Soon after the training contract was signed, we notified some 5,600 hospitals of the availability of training moneys through us. It should be remembered that the Labor Department had a number of contracts

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with individual hospitals for on-the-job training before we came into the picture.

We obtained indications of interest from more than 1,500 hospitals. Meanwhile, we were hiring a staff and setting up subcontracting procedures. The present procedures of the Department of Labor, insofar as they pertain to our contract, require approval of each subcontract by a field officer of the Bureau of Apprenticeship and Training; and it is here that we have encountered problems that need to be resolved.

A few days ago, we had submitted over the course of several months, subcontracts on which we and the hospitals had agreed for some 5,455 trainees, but only 1,941 have yet been approved by the Labor Department. We have suggested changes in the procedures, which, we feel, will be in the best interest of trainees, hospitals, and the Government. We believe that if they are accepted, the backlog of unapproved subcontracts can be substantially reduced and not allowed to reoccur.

Senator Javits. Do you have a record of the changes you suggested?
Mr. CHURCHILL. Yes, sir, of those now under consideration.
Senator JAVITs. Would you submit them for the record?
Mr. CHURCHILL. I have them here.

Senator JAVITs. Without objection they will be made part of your
testimony.
(The material subsequently supplied follows:)

CHANGES PROPOSED BY HOSPITAL RESEARCH AND EDUCATIONAL TRUST Steps to be followed : 1. Prime contractor representative shall develop OJT-3A and OJT-2A subcontracts in accordance with the following basic procedures : A. Term of the subcontract shall not exceed period of prime contract

DC-J-23. B. Procedures for completing OJT-3A will continue as previously outlined. 2. Prime contractor representative shall discuss the project with the local union representative, if the hospital is organized, to check terms and conditions of the bargaining agreement that affect the training program and/or the trainee and to obtain the concurrence of the local union.

3. Prime contractor representative shall obtain the signature of the appropriate representative at the health facility as well as the signature of the union representative (if applicable). 4. After proper signatures have been obtained and the wages to be paid the trainee have been verified as in accordance with the bargaining agreement or at least the $1.25 per hour minimum, (if the individual hospital is not unionized), the prime contractor shall utilize the following procedures to gain approval. A. Prime contractor will approve the subcontracts if it meets currently

established policies. B. The representative of the prime contractor shall send three reproduced

copies of the OJT-3A and OJT-2A (subcontract) directly to the national office of BAT immediately for purpose of notification retaining copies

for files paying the minimum or above. C. Additional training can be phased into the subcontract by notifying the

national representative of BAT of the starting date and the job description for the job in which training is to be offered. This also can be done by phone to be followed immediately with the proper forms and

written job description and individual trainee information. 5. If the individual hospital is unionized and for any reason the local union representative will not countersign the subcontract the following procedure is to be followed. A. The prime contractor shall complete three copies of the OJT-3A and

OJT-24 in every respect except for the union representative's signature,

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B. All copies to be sent directly to the national representative of BAT with

complete information on the local union, international union and the

name of the union representative contacted on the local level. C. On receipt the national representative assigned to the contract shall con

tact the appropriate international union to obtain the suppor necessary

for subcontract approval. D. When agreement is reached with the international union, the national

representative of BAT shall approve the subcontract and so notify the

prime contract representative.
6. Upon approval of the subcontract HRET will proceed as follows.

A. Notify the individual hospital that approval has been granted.
B. Notify the local office of Employment Security.
C. The prime contractor representative shall see that the individual trainee

is enrolled with the appropriate local office of the employment service,
as appropriate. The enrollment, at which time the MT-101 is to be
completed shall take place before trainee starts on-the-job wherever

possible. However, this procedure should not delay the start of training. 7. After placement, routine follow-up procedure shall be carried out by the prime contractor representative as necessary.

8. T'he national representative of BAT assigned to the prime contract shall notify each regional director of BAT of any activity in his area under this prime contract, giving complete information as to numbers of trainees by state for regional statistical purposes.

9. The nationa representative of BAT shall make such spot checks of individual hospital as deemed necessary to determine if approaches being delegated HRET are within guidelines established.

If wages are less than $1.25 per hour the Manpower Order No. 33-65 outlines specific procedures to be followed.

Senator Javits. How many of your contracts call for expenditure of less than $75,000?

Mr. CHURCHILL. Most of them.
Senator JAVITs. They are all small contracts?
Mr. CHURCHILL. Yes.

Senator Javits. Are you aware of the amendment to the law which I had the honor to sponsor, which permits delegation by the Secretary of Labor of authority to approve locally contracts up to $75,000? Mr. CHURCHILL. It is local approval we are having trouble with. Mr. Chairman, may I add a word of explanation?

It appears to us that the principal cause for delay in the field in the approval of subcontracts has been the number of clearances required at the State level before the Bureau of Apprenticeship and Training representative, and the field oflices are apparently understaffed, can endorse the subcontract.

We have suggested that we be given authority to execute subcontracts without field approval within such guidelines as may be established in Washington, subject, of course, to thorough audit and checking of our compliance.

Our contract would permit us to conduct on-the-job training of the 4.000 employees at a cost to the Government of $400° per trainee, which was somewhat below the average of the contracts then in force between hospitals and the Department when we came into the picture. We are going to be able to do it for substantially less-in fact, probably for less than half that amount-and will, therefore, be able to train many more people than originally envisioned.

We noted in Secretary Wirtz statement to this committee on February 16 that the cost to the Government for on-the-job training had averaged $495 per trainee in 1965.

Our experience with the Hospital Research & Educational Trust of New Jersey, and with the hospitals where its manuals were initially

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