This is a sample of the instructor resources for The Well-Managed Healthcare
Organization, Seventh Edition by Kenneth R. White, PhD, FACHE, and John R. Griffith,
FACHE. This sample contains teaching tips, two discussion questions with teaching, and
a sample of PowerPoints for Chapter 1.
The complete instructor resources consist of a guide to using the instructor materials;
chapter-by-chapter teaching tips, discussion questions, notes for the discussion questions,
and gradable questions and answer rubrics; 157 PowerPoint slides containing all the
figures from the book; and 90 PowerPoint slides to accompany the discussion questions.
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Teaching This Chapter
The Well-Managed Healthcare Organization 7th edition
Chapter 1
1. Explain the learning model. (A slide is in the Instructors’ website.)
a. Learning Chapter __ is a brief, generally single page set of learning tips.
b. The Exhibits are useful summaries.
c. The transition from cognitive learning (WMHO content) to things managers do,
(“Look, listen, talk, act,”) is built into the Milestone Questions, the QFD, and (if
you use our Graded Questions) into the examinations and grades.
2. Ask for questions about cognitive content. For Chapter 1, we often find a level of
disbelief or denial, around two points:
a. Is this really how HCOs operate? It doesn’t sound like what’s on TV, or what I
heard from my (mom, dad, uncle, etc.) who’s a (doctor, nurse, etc.)
Reiterate that the text is best practice, not common practice. The issue is
frequently disempowerment. If possible, show how empowerment would make
the family member a lot less frustrated. Note that empowerment goes hand in
hand with process. Many associates are disempowered by dysfunctional
processes.
b. You really want me to learn how to act? I can’t just memorize the text to get an A?
Professionals practice. They don’t recite. WMHO is for people who want to be
professionals.
Students often have difficulty expressing these concerns, especially b. It can pay to bring
them into the dialogue and deal with them forthrightly.
3. Move to either the Milestone Questions or the QFD to start student discussion.
a. Encourage the students to deconstruct the situations presented in the QFD. Locate
the issues in terms of Exhibits. The following exhibits will get repeated reference
later in the text:
1.1 Components of HCOs
1.3 HCO Stakeholders Model
1.6 Building Excellence in Healthcare Organizations
1.7 Mission/Vision/Values of Excellent HCOs
1.10 Operational Performance Measures for Individual Teams and Activities
1.11 Strategic Measures of HCO Performance
1.12 Process Analysis: Changing OFIs to Improved Performance
1.13 Competitive Tests for Investment Opportunities
b. Try to stimulate student-student, rather than student-instructor interaction.
©2010 KR White and JR Griffith
Chapter 1Page 1
Teaching This Chapter
The Well-Managed Healthcare Organization 7th edition
c. Provide a summary to the QFD, drawn from White and Griffith’s commentary or
from your experience. Emphasize the managerial actions that promote solution,
and the measures you would expect to improve.
4. Go back to the Milestone questions as a summary of chapter content, and draw attention
to those not already addressed.
5. Encourage use of the Self Assessment questions as a way to judge comfort and mastery.
Note that the situations are realistic and challenging. Beginners should strive for midrange comfort. Confidence on every issue might be over-confidence.
6. Assign a “gradable question” if you wish. (The authors don’t try to test every chapter,
although it would probably help the students.)
©2010 KR White and JR Griffith
Chapter 1Page 2
Chapter 1 Answers to in-book discussion questions
The Well-Managed Healthcare Organization 7th edition
CHAPTER 1 FOUNDATIONS
1. The chapter outlines a “transformational” style of management, emphasizing values,
empowerment, communication, trust/accountability, and rewards. Why do high-performing
HCOs strive for transformational styles? Some people say “transformational” is completely
unrealistic. You must enforce order, they say, to have accountability. How is accountability
achieved in high-performing, transformational HCOs? Do you think you would be comfortable
working in a high-performing, transformational organization?
A set of questions designed to force reflection on the leadership requirements of
transformational management. It’s a good exercise to get at student denial.
Why do high-performing HCOs strive for transformational styles? Because it pays off in mission
achievement. Because it works. The answer is so simple, it raises questions on why HCOs don’t
support transformational styles. This is dangerous territory. The best way out is (1) because
they haven’t learned the lesson, (2) because it requires subjugating egos to output, which is
hard for a lot of people, and (3) because it takes training.
How is accountability achieved in high-performing, transformational HCOs? By training. When
workers don’t understand their relationship to mission, empowering them doesn’t work. All the
clinical work teams and many other HCO teams start with both a commitment to the mission
and insight into their contribution. These teams move to improvement. They also provide role
models for others.
Do you think you would be comfortable working in a high-performing, transformational
organization? Designed to make the students face the ego-subjugating requirements. Expand on
this by looking at Sharp Healthcare’s expectations.
2. The history and current activities of HCOs are strongly oriented to healing the sick. The first
word of the chapter, “patients,” is consistent with that tradition. Some say that the real role of
HCOs is community health, including but going well beyond healing the sick. (Contrast the
missions of SSM, Bronson, and St. Luke’s with those of Baptist, RW Johnson, and North
Mississippi in Exhibit 1.7.) Should the text have started, “Building healthy communities is the
focus of HCOs, including patient care but going well beyond.”?
The point of the question is to show the alternatives. Let the students learn the difference by
discussing or arguing about it.
WMHO 7 does not start at community health because half the Exh. 1.7 places don’t, and the
payment system doesn’t, and we suspect the majority of U.S. HCOs are patient care focused. They
are not very good at that. We feel the “excellence in patient care” is a pre-requisite for “community
health.” It is, and will remain, the distinctive competency of HCOs.
The details of the issue are in Chapter 9. This question is to get it on the table.
© 2009 KR White and JR Griffith
Used with permission
1
EXHIBIT 1.1 Components of Healthcare Organizations
Caregiving Teams* provide care
to patients with similar needs.
Major groups are:
•Primary care (Family
Medicine General
Internal Medicine
Pediatrics Obstetrics
Psychiatry Advanced
Care Practitioners)
•Acute care (By specialty)
•Rehabilitation
•Home Care
•Hospice
•Continuing care
Clinical Support Teams* provide
specific clinical services to Care-giving
Teams.
Caregiving
Teams
Clinical Support Teams
Important examples are:
Clinical Laboratory
Pharmacy
Imaging
Cardio-pulmonary Laboratory
Surgery/Anesthesia/Recovery
Intensive Care
Physical Therapy
Social Service
Logistic Support Teams
Strategic Support Teams
Strategic Support Teams provide marketing,
governance, internal consulting, finance,
stakeholder relations management, and
strategic positioning. They protect the
organization’s culture and its tangible
resources.
Logistic Support Teams provide
trained personnel, information,
facilities, accounting, cash
management, and supplies.
* HCOs have varying sets of clinical or clinical support activities. The logistic support and
many strategic support activities are required for any clinical activities.
© 2010 K.R. White & J.R. Griffith
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EXHIBIT 1.2 General Model of Stakeholder–Organization
Interaction
Owners
Individuals or groups who have contributed
capital for the organization.
Capital
Customers/Buyers:
Individuals or groups who
have needs that they want
to fulfill.
Returns
Services
Services
Organization
Compensation
Suppliers/Workers:
Individuals or groups who
have resources that they
want to contribute.
Compensation
Laws, regulations, and
societal constraints
© 2010 K.R. White & J.R. Griffith
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EXHIBIT 1.3 Model of Stakeholder/Healthcare Organization Interaction
Owners
Not for profit corporations, for profit
corporations, and government entities
Customers/Buyers
Health Insurers and
Payment Agencies:
Differentiated by carrier
and kind of coverage
Buyers:
Differentiated by individual,
employer, and government
Caregivers:
Differentiated by
professional credentials
Caregiving
Teams
Clinical Support Teams
Logistic Support Teams
Other Employees:
Differentiated by job
description
Strategic Support Teams
Contract Providers:
Differentiated by purpose
of contract
Local, State, and Federal licenses, permits, and
certifications
Private certifications and accreditations
Health-care specific laws and regulations
General corporate laws and regulations
Suppliers
Volunteers
Suppliers/Workers
Patients and Families:
Differentiated by Age,
Gender, and Clinical Need
Trade Associations, Professional Organizations, Unions,
Customer Associations, Lobbies,
and other collectives influencing healthcare
transactions
© 2010 K.R. White & J.R. Griffith
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EXHIBIT 1.4 Ownership & Size of U.S. Community & Federal Hospitals
Number of
Hospitals
Ownership
State & Local
Government
Religious Not
for Profit
Other Not for
Profit
For Profit
Federal
All
Percent of
Percent of
All
Total Expenditures
Total
Hospitals
($ in Millions)
Expenditure
Average
Expenditures
per Hospital
($ in
Millions)
1,110
22%
$ 77,914
14% $
2,425
47%
$ 315,265
57% $
533
868
226
5,162
10%
$ 70,728
17%
$ 51,833
100%
$ 552,570
4%
$ 36,830
70
$
16
130
$
62
13% $
133
9% $
60
7% $
100% $
163
107
Source: American Hospital Association Annual Survey Database, Fiscal Year 2005
© 2010 K.R. White & J.R. Griffith
Median
Expenditures
per Hospital
($ in
Millions)
$
$
$
$
99
36
141
35
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EXHIBIT 1.5 System Affiliations of U.S. Hospitals
System Affiliation *
Number of hospitals
Number
of
Systems
Ownership
Total Expenditures ($ in Millions)
In
Systems
Not in
Systems
Percent
in
Systems
System
Members
Not in
Systems
Percent
in
Average Size Median Size
Systems of System
of System
State & Local Government
31
289
821
26%
$ 30,032
$ 47,882
39%
$ 869
$452
Religious Not-for-Profit
51
472
61
89%
$ 63,458
$ 7,270
90%
$ 1,551
$923
211
1,190
1,235
49%
179,009
$136,256
57%
$ 785
$518
54
765
103
88%
$ 47,953
$ 3,880
93%
$ 926
$152
5
226
4
98%
$ 36,422
$
408
99%
$ 7,284
$143
352
2,942
2,224
57%
$356,874
$195,696
65%
$ 1,014
$483
Other Not-for-Profit
For-Profit
Federal
Total
* Many systems include hospitals of differing ownership. The systems are assigned to their largest ownership share.
Source: American Hospital Association Annual Survey Database, Fiscal Year 2005
© 2010 K.R. White & J.R. Griffith
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