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HCM 101 Health Care Management

--------------------------------------------------Chapter 1: AN OVERVIEW OF HEALTHCARE MANAGEMENT
---------------------------Direct care
Non-direct care
Hierarchy of
provide care directly to a patient, resident or client who seeks services
from the organization
not directly involved in providing care to persons needing health
services; support the care of individuals through products and service
made available to direct care settings
The process comprised of social and technical functions and activities,
occurring within organizations for accomplishing predetermined
objectives through human and other resources.
requires the manager to set a direction and determine what needs to
be accomplished
The overall design of the organization or the specific division, unit, or
service for which the manager is responsible
Acquiring and retaining human resources. In addition, Developing and
maintaining the workforce through various strategies and tactics.
monitoring staff activities and performance, and taking the
appropriate actions for corrective action to increase performance
Initiating action in the organization through effective leadership and
motivation of, and communication with, subordinates.
critical to all of the aforementioned management functions and means
making effective decisions based on consideration of benefits and the
drawbacks of alternatives
authority, or power, is delegated downward in the organization, and
that lower-level managers have less authority than higher-level
managers whose scope of responsibility is much greater
- the individual manager must be able to effectively manage
himself or herself, as well as time, information, space, and
materials; being responsive and following through with peers,
supervisors, and clients.
- Maintaining a positive attitude and high motivation; developing
and applying appropriate skills and competencies.
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Direct Care Employment Growth/
- Expected to grow 16 percent from 2008 to 2018.
- Greatest growth in managerial positions will occur in outpatient centers, clinics
and physician practices.
- Largest growth numbers will be in hospitals due to size of sector.
Non-Direct Care Employment Growth/
- Consulting firms, pharmaceutical companies, associations, and medical
equipment companies provide significant assistance to direct care organizations.
- Expected that growth will also occur in managerial positions in non-direct care
Conceptual Skills/
Technical Skills/
Those skills that involve the
ability to critically analyze and
solve complex problems
Those skills that reflect expertise
or ability to perform a specific
work task
EX: manager determines a
strategy to reduce patient
complaints regarding food
EX: manager develops and
implements a new incentive
compensation program for staff
Interpersonal Skills/
Enable a manager to
communicate with and work well
with other individuals, regardless
of whether they are peers,
supervisors, or subordinates
EX: manager counsels an
employee whose performance is
below expectation
Vertical Structure/
Size and complexity of the specific health services organization will dictate the particular
Larger organizations—such as large community hospitals, hospital systems, and academic
medical centers—will likely have deep vertical structures reflecting varying levels of
administrative control for the organization.
Matrix Structure/
team-based models
functional staff, such as nursing and
rehabilitation personnel, are assigned to a
specific program such as geriatrics and
report for programmatic purposes to the
program director of geriatrics
service line management models
manager heads a specific clinical service
line (e.g., cardiology) with accountability for
staffing, resource acquisition, budget, and
financial control
Non-Business Use
The matrix model recognizes:
that a strict functional structure may limit the organization’s flexibility to carry out the work,
That the expertise of other disciplines is needed on a continuous basis.
Unit/Team Management/
- The expertise of the manager at this level involves managing others in terms of
effectively completing the work through task interdependence.
- Includes assigning work tasks, review and modification of assignments,
monitoring and review of individual performance, and carrying out the
management functions described previously.
Organizational Management/
- Managers must work together as part of the larger organization to ensure
organizational-wide performance and organizational viability.
- Success of the organization depends upon the success of its individual parts, and
effective collaboration is needed to ensure that this occurs.
Talent Management/
- Recruitment, retention, training and development of highly skilled employees
human resources is critical to health care organizations.
- Health care organizations compete with each other for the brightest and the best
- Managers look for and keep the talent!
Ensuring High Performance/
- High performance organizations are results oriented
- One framework has pillars of excellence for the specific goals of the organization:
people , service, quality, finance, and growth
- Another framework speaks of “champions” and the “championship process”
measures of performance.
- Governance and strategic management; clinical quality, customer satisfaction;
clinical organization (caregivers); financial planning; planning and marketing;
information services; human resources; and plant and supplies
- Stakeholders, including insurers, state and federal governments, and consumer
advocacy groups, are expecting, and in many cases demanding, acceptable levels
of performance in healthcare organizations.
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- Want to make sure that services are provided in a safe, convenient, low cost, and
high-quality environment
Succession Planning/
- The concept of taking actions to ensure that staff can move up in management
roles within the organization, in order to replace those managers who retire or
move to other opportunities in other organizations.
- Now more than ever before, succession planning is needed at all levels, not just
senior management.
Health Care Policy/
- Managers must be knowledgeable about health policy matters under
consideration at the state and federal levels that affect organizations and health
care delivery.
- Often organizations have designated staff to monitor this—but manager must
stay current with or lose opportunities. Professional organizations such as ACHE
and MGMA help with this.
Non-Business Use
---------------------------Management competences :
Staffing personnel
Controlling resources
Supervising the service provided
Overseeing adherence to regulations
Counseling employees
Leadership competences :
Setting direction or mission
Motivating stakeholders
Being an effective spokesperson
Determining strategies for the future
Transforming the organization
Contemporary Models/
Self-Actualized Leadership Theories
Emotional IntelligenceAuthentic Leadership
Inspirational Leadership
Diversity Leadership
Servant Leadership
Spirituality Leadership
Leadership Styles/
Demanding and power based
Soliciting input and allowing decision making
Setting high performance standards
Focus on personal development
For every leader, need a follower
Not everyone can or should be a leader
True leaders inspire commitment
Leaders can’t be self-absorbed
Recognize importance of getting respect
Leadership Protocols/
Appropriate ways a leader acts:
Reciprocal trust and respect
Confident, optimistic, passionate
Being visible
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Problematic employees
Most followers
Highly competent
Top level
- Open communicator
- Risk taker
- Admitting fault
Collectively assuming strategic oversight
Top accountable body
Board of Directors or Board of Trustees
Heighten scrutiny
Each member has fiduciary responsibility
Espouses meaning for healthcare delivery
Healthcare Governance Trends/
Balance of members within and outside
Conflicts of interest disclosed
Strategic information presented
Evaluations used to identify issues
Generative source of leadership
Barriers and Challenges/
Healthcare is a dynamic industry:
• Laws and regulations
• Physicians
• New technology
• Culture of safety
Ethical Responsibility/
Exhibiting appropriate behavior:
Doing right vs. doing wrong
Managerial ethics
Code of ethics
Non-Business Use
Patient Protection and Affordable Care Act/
Does not provide full health care reform
Will alter the way health insurance is administered
Call for a new breed of healthcare leaders
Challenging times
Key elements of success will be perspective, adaptability and passion
Leaders Looking to the Future/
Leadership can be taught
Continual leadership development
Professional association memberships
Look for partners
Keeping current
Reassess how he/she fits into organization
- Consider succession planning
Non-Business Use
Motive: “something (a need or desire) that causes a person to act.”
Motivate “to provide with a motive.”
Motivation: “the act or process of motivating.”
Motivated versus Engaged/
The concepts go hand-in-hand
Engaged healthcare employees display the following characteristics:
Are more productive
Are more focused on patient care and treatment
Are safer
Are loyal to their employers
Model positive behaviors of engagement
Witness greater profitability for a provider the Motivated versus Engaged
an a disengaged employer
Why Motivation Matters/
Motivated employees…
Are fully engaged in their work
Contribute at a much higher level
Are invested, happier, and loyal
Motivated employees motivate others
Influence better organizational outcomes resulting in a better competitive
advantage for the organization
Theories of Motivation/
Psychologists study motivation from the perspectives of:
Needs at different levels
Extrinsic factors
Intrinsic factors
Integration of needs, extrinsic and intrinsic factors
Non-Business Use
Maslow’s Hierarchy
of Needs
Derfer’s 3 Factor
ERG Theory
Physiological needs:
food, water, sexual
drive, etc.
physiological and
safety needs into
one level
Safety needs:
shelter, jobs, pay,
belonging needs
Belonging needs:
social interactions,
Growth &
Development :
esteem and selfactualization
Herzberg’s 2-Factor
characterized as
motivators and
Acquired Needs
Esteem needs:
status, recognition,
needs: achievement,
development and
growth, etc.
Management Theories of Motivation/
- Theory X: managers view employees as unmotivated and disliking work.
• Under the Theory X approach, the manager's role is to focus on the hygienes and to
control and direct employees; it assumes that e
- Theory Y: managers focus on Herzberg's motivators and work to assist
employees in achieving these higher levels.
- Theory Z: managers provide rewards, such as long-term employment,
promotion from within, participatory management, and other techniques to
engage and motivate employees
Extrinsic Rewards: Tangibles/
- Money
- Benefits
- Flexible schedules
Non-Business Use
Job Responsibilities
Status changes
Good boss
Strong leader
Inspirational people
- Nurturing organizational culture
Intrinsic Rewards: Intangibles/
Healthy relationships – feeling a sense of connection
Meaningful vs. meaningless work
Choice and participation in decision-making
Progress – accountability, meeting milestones
Myths about Motivation and Satisfaction/
“Although I’m not motivated by extrinsic rewards, others are”
All motivation is intrinsic
Some people just are not motivated
People are motivated by money
Motivation is manipulation
One-size-fits-all reward programs
Motivational people are born, not made
There’s only one kind of employee satisfaction
Motivational Strategies/
Expect the best
Reward the desired behavior
Create a FUN (Focused, Unpredictable, Novel) Approach
Reward employees to enhance performance and motivate
Tailor rewards
Focus on revitalizing employees
Find create ways to obtain information and reward excellence
Get subordinates to take responsibility for their own motivation
Play to employee’s strengths, promote high performance, focus on how they
Non-Business Use
---------------------------Evolving Science of Organizational Behavior/
Industrial Science
Administrative Management
Human Relations
Organizational behavior is an interdisciplinary field that draws on the ideas and research of
many disciplines concerned with human behavior and interaction.
Organizational Behavior/
The study of how (and why) people behave in the workplace
Draws on many other disciplines:
Social psychology
Industrial psychology
Organizational Behavior Occurs at Three Levels/
Group (between
decision making
Non-Business Use
Collective (within
organization) or corporate
work structures
organizational systems
organizational culture
organizational learning and
Healthcare Challenges for Organizational Behavior/
Rising costs & declining reimbursement
financial pressure
Increased competition
Consumer demands
New services
Outpatient care
Chronic illness
Patient safety concerns
Quality of care
Labor shortages
Professional workforce
Exacting work
High reliability
Technical expertise
Professional autonomy
The Effect of Thinking on Behavior/
- In the cognitive framework, behavior is closely tied to thinking and reasoning.
- We cannot understand behavior without understanding the thoughts,
assumptions, and perceived attributes of a situation that precede behavior and
its consequences.
Mental processes of thinking include…
- What information is noticed
- How information is processed
- How meaning is created
Mental processes for handling information
- control the perceptions, thinking and reasoning that behavior is based upon
- inherently limited
- have predictable patterns
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A Cognitive Model of Organizational Behavior: The role of thinking/
The cognitive model of behavior highlights how thinking influences behavior
Interpersonal relations
Workplace cues
Industry environment
Cognition principles
 Behavior
Work tasks
Thinking Patterns Relevant to Organizational Behavior/
Mental models
Between individuals
Expectancy theory
Self-fulfilling prophecy
Mental models
Sense making
Common Individual Thinking Patterns that can Alter Understanding/
- Assumptions: fundamental premises believed true
- Perceptions: what is noticed; to what attention is paid
- Cognitive biases: mental processing that simplifies handling information and that
can compromise decision quality
Common Thinking Patterns between Individuals that can Alter Understanding/
- Self-fulfilling prophecy: expectations about another’s behavior that can elicit the
expected behavior
- Expectancy theory: managers affect employee motivation when they influence
employee expectations about ability to accomplish a task and expectations of
- Attributions: imputing the likely cause of another’s behavior
- Attribution theory: explaining another’s behavior by presuming it is caused
either by a person’s disposition or by the situation
- Mental models: beliefs about how things work
- Sense making: process in which organization members interpret the meaning of
Non-Business Use
Five Disciplines of Organizational Learning (Senge)/
1- Systems thinking to recognize patterns of connection
2- Striving for individual proficiency and personal mastery
3- Surfacing and challenging mental models
4- A common identity and shared vision of the future
5- Team learning that reduces assumptions and creates shared meaning
NB: the last 3 disciplines counteract thinking limitations
Communication in Organizations/
Communication: sender and receiver exchange understanding
Communication barriers: arise from:
sender’s thinking and behavior,
receiver’s thinking and behavior, and
From the organizational setting.
Two Phases of Problem Solving in Organizations/
Problem identification
Recognize problem
Identify cause
Set goals
Generate options
Problem solution
Assess options
Choose among options
Implement options
Evaluate solution
Action Inquiry to Check Assumptions/
Framing: state purpose and intentions
Advocating: state opinion or feeling
Illustrating: give supporting example
Inquiring: ask for listener’s views
Non-Business Use
---------------------------Strategic Planning Process/
SWOT Analysis
Strategy Identification and Selection
Strategy Tactical Plans
Rollout and Implementation
Monitoring and Control
Situational Assessment/
Market Assessment
Healthcare Workforce
Consumers and Payers
Innovations in Technology
Regulatory Environment
Competitive Rivalry
Market Volume Forecast
Organizational Assessment
Organizational Volume Forecast
Financial Condition
Strategic Performance
Core Capabilities
- Mission
- Vision
- Values
Strategy Identification and Selection/
Scenario Exploration
Financial Targets
Resource Matching
Non-Business Use
Strategy Tactical Plans/
- Implementation Steps
- Timeframes
- Results
Rollout and Implementation/
Board Approval/ Endorsement
Operating Plan
Marketing Plan
Facilities Plan
Capital Plan
Non-Business Use
---------------------------Definition of Quality/
Institute of Medicine “degree to which health services for individuals or populations
increase the likelihood of desired health outcomes and are consistent with the current
professional knowledge”
Donabedian conception of quality as:
- Structure: material and human resources of an organization and the facility
itself- Quality of personnel while the quality of facilities lies in accreditation
- Process: Actual delivery of care, quality processes both in management and
production of health care
- Outcomes: quality resulting from the application of structural and process
variables like health status of the patient.
Donabedian’s four parts:
1- Technical management of health and illness: focuses on the clinical
performance of healthcare providers
2- Interpersonal relationships between providers and their clients: health
service quality is driven both by clinical and nonclinical processes
3- Amenities of care: speak to the patient's interest in pursuing individual wellbeing (or variety)
4- Ethical principles guiding care: speak to the provider's interest in furthering
societal and organizational well-being (or effectiveness).
Two Quality Questions:
a. Are the right things done? (effectiveness)
b. Are things done right? (efficiency)
Effectiveness is “providing services based on scientific knowledge to all who
could benefit and refraining from providing services to those not likely to benefit
(avoiding underuse and overuse)”
- efficiency is “avoiding waste, in particular waste of equipment, supplies, ideas,
and energy”
Why is Quality Important?/
One of the key issues in healthcare quality is the appropriate use of scarce resources to
improve the health of both individuals and the entire population.
Non-Business Use
- Underuse: failure to provide a service whose benefit is greater than its risk
When doctors or hospitals neglect to give patients medically necessary care or to
follow proven health care practices
- Overuse: use of service when risk outweighs its benefits
Occurs when a drug or treatment is given without medical justification
- Misuse: risk service is provided badly reducing benefit to patient
Misuse is another way of describing medical errors. It occurs when a patient does not
fully benefit from a treatment because of a preventable problem – or when a patient
is harmed by a treatment.
Baldrige Award Criteria/
“Integrated management framework”: a tool for understanding and managing
organizational performance
Three Structural variables
Two Process variables
Staff focus
Strategic planning
Focus on patient, other
customers, and markets
Process Improvement
Organizational performance
outcomes or results
Common Elements of quality improvement/
- Definition
- Reliability
- Validity
Process Variation:
Range of values that quality metric can take because of different causes within the process.
- Special Cause Variation-due to unusual, infrequent, or unique events
- Common Cause Variation-due to the usual or natural causes of variation within a
- Statistical Process Control-method by which process variation is measured,
tracked, and controlled in an effort to improve the quality of the process.
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Approaches in quality improvement/
1. Continuous Process Improvement (CQI)
A structured organizational process in which employee teams identify and address
problems in their work processes and do continuous flow of process improvements that
meet or exceed customer—or patient expectations
TQM/CQI’s five dimensions:
1. Process focus
2. Customer focus-“delight the customer.”
3. Data-based decision making
4. Employee empowerment
5. Organization-wide impact
- the Shewhart/Deming cycle of PDCA is generally used in manufacturing and
other industries.
- 1980s, the Hospital Corporation of America (HCA) modified the PDCA cycle to
create the FOCUS—PDCA framework-most commonly used framework in
healthcare industry.
- FOCUS clarifies the steps that need to be done prior to the implementation of
any process change.
- The changes in the process will then be guided by the PDCA cycle.
• Find: identify process problem
• Organize: put together a team to work on process
• Clarify: use techniques to clarify the problem
- Geographic mapping
- Flowcharting
• Understand: measure and collect data to
• Select: identify process improvements for implementation
• Plan – create an implementation plan for taking the process to the next level
• Do – implement and test the new process
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• Check – evaluate the measures used and assess outcomes
• Act – assure continuation of newly implemented process, if successful ,or redo the
process, if not successful
2. Six Sigma
Data-driven quality methodology that seeks to eliminate variation from a process
• Define: delimit scope of work and time frames for completion
• Measure: create and apply measures and metrics
• Analyze: assess and flowchart the process
• Improve: specify the steps to be taken to meet goals
• Control: assure permanence of the improvements
Quality Improvement Tools/
Data collection
Check sheet
Process mapping
Chart abstractions or chart
Geographic mappingWorkflow diagram
Process analysis
(fishbone) diagram
Pareto Chart
Non-Business Use
---------------------------Health Information System/
Include all computer systems (Including hardware, software, operating systems and end
user devices connection people to the system), networks (the electronic connectivity
between systems, people, and organizations), and the data those system capture and
create through the use of software”
Telecommunication, various types of networks & Data storage capabilities:
Are the foundation for all information system applications, can be defined as the electrical
transmission of data among systems, weather through Analog, Digital OR wireless media
Networks can be categorized as: Intranets and extranets
Networks also characterized as: Local Area Networks (LANs), Wireless LANs(WLANs), Wide
area networks(WANs), wireless WANs (WWANs), and storage area networks(SANs)
System Application in healthcare/
- Key purpose of traditional systems is to manage organization’s expenses and
- Mostly costly healthcare resources are staff and equipment.
- Widely implemented systems include:
- Standard office applications
- Budget systems
- Fundraising
- Enterprise Resource Planning
- Cost accounting
- Billing and receivables
What is EMR?
An EMR is an application environment, which includes:
Clinical data repository
Clinical decision support
Controlled medical vocabulary
Physician order entry
Computerized provider order entry
Pharmacy , and Clinical documentation
Non-Business Use
Adoption of Clinical Systems by Hospitals/
- Developed by industry association of healthcare information technology (HIT)
professionals: The Healthcare Information and Management Systems Society
- EMRAM (Electronic Medical Record Analytical Model) designed by HIMSS
Analytics to track EMR Progress at hospitals and health systems in U.S.
- Hospitals are scored in a national database
- Stages 0 – 7, indicating progressively higher and more clinically sophisticated
uses of HIT
EMRAM Model/
Stages 0-1: Very basic automation of individual areas
Stages 2: Ability to start bringing disparate data together for clinical decision-making
Stages 3-6: Implementation of advanced clinical systems primarily used by direct care
personnel such as nurses and physicians
Stage 7: Ability of the organization to share or exchange data with external entities
Non-Business Use
From EMR to EHR/
- “EHR focus on the total health of the patient-going beyond standard clinical data
collected in the providers office and inclusive of a broader view on a patient’s
care and are built to share information with other healthcare providers”
- That’s mean EHR is a broader term than EMR
Top 5 Major Barriers to EHR adoption/
1. Cost of purchasing a system;
2. Loss of productivity;
3. Annual Maintenance cost;
4. Adequacy of training; and
5. Finding EHR to meet practice needs
Challenges to Adoption/
Patient privacy
Lack of standard vocabulary
Lack of user friendliness – not intuitive like web based applications
Industry very driven by units of service completed – early systems slowed them
Future of Health care Information Technology (HIT)/
- Portability – EMR in your pocket.
- Virtual healthcare – be ‘seen’ without need for physical exam.
- Future uses of technology in healthcare include:
– Patients wearing computers to regulate and/or monitor (smart vests).
– Embedded microchips.
- Systems improvements in ability to manage complex information
Some of the areas which are likely confound this process include-
Optimizing existing vs. replacing EHRs
Data Integrity
Promoting safety
Capturing Socioeconomic data in EHRs
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- ICD-10 Adoption
The Future of Health care encompasses additional areas where healthcare
mangers needs awareness and potential involvement/
Health informatics
Analytics/big data
Research and policy
HIT Impact on the Manager/
- Complex and quickly evolving work environment.
- Effective managers must use technology themselves and understand well
enough to manage effectiveness of their employees use.
- Dependency will create new norms around computer competencies, processes
during ‘downtimes
Non-Business Use
---------------------------What is Fraud and abuse?
- Fraud: an intentional act of deception.
- Abuse: improper acts that are unintentional but inconsistent with standard
- Examples of Fraud and Abuse: Providers billings for services that were not
provided or did not meet medical necessity criteria (False claims), submitting
duplicate bills, up coding services to receive higher reimbursement
Operation Restore Trust ORT/
Started to counter charges about healthcare fraud and abuse
Involved the five states with the heaviest volume of Medicare beneficiaries
Now includes all 50 states in the US.
Provides advisories to prevent violations.
DHHS has organized state and federal agencies to monitor activities under ORT.
Recovery Audit Contractors RAC/
- Was introduced in response to the continuing fraud and abuse problem faced by
Medicare and Medicaid.
- Examiners work on a contingency basis, meaning they only get paid when they
find a mistake.
- The biggest effort since ORT
- Use computer systems to find data that will lead to discrepancies
Health Care Fraud Prevention and Enforcement Action Team HEAT/
- To stop fraud and abuse of Medicare and Medicaid claims.
- The President is also using it as an enforcement tool against the agencies to stop
fraud and abuse.
- Health care provider or a Beneficiary possess
- Imposes a requirement to disclose overpayments to the government.
- Known as the Anti-Dumping Act.
- Prevent patient dumping.
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- Prevent emergency rooms from refusing treatment or transferring a patient to
another facility because of patient’s inability to pay for treatment.
- Act mandates that an appropriate medical screening exam be given to any
patient who come to Emergency room.
- Restricts the emergency room staff from discussing financial or insurance
information until after MSE has been performed and the emergent condition has
been stabilized.
Hospital Compliance with EMTALA To avoid EMTALA violations, providers should:
- Require all clinical, administrative, and contact staff to review
- understand the EMTALA requirements
- Ensure all patients are offered a medical screening exam and treatment
- Ensure that the ER staff understands all statutory rules
- Enforce the requirement that prevents staff from asking for financial and
accounting information
Antitrust laws/
To protect the citizenry from the negative effects of monopolies.
The Sherman Antitrust Act
The Clayton Act
The Federal Trade Commission Act
- To prevent conflicts of interest in Medicare patient referrals.
- The Physician Self-Referral Laws are also known as Stark I and Stark II.
 The Stark II “prohibits physicians from referring patients to providers with
which the physician has a financial relationship”
 This law is an extension of the Stark I Law, which was only applied to
Laboratory referring.
- The Anti-Kickback Act known as Medicare and Medicaid Anti- Kickback Act to
prevent the offer or payment of bribes as an inducement to refer Medicare
patients for services
• Committee of sponsoring Organization says internal Control is a process effected by
entity's board of directors , management, and other internal personnel designed to
provide reasonable assurance regarding the achievement of objectives :
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 Effectiveness and Efficiency of operations
 Reliability of Financial reporting
 Compliance with applicable law and regulations
The COSO list 5 interrelated components of internal control:
Control environment
Risk assessment
Control activities out.
Information and communication
Limits the risk of compliance errors
Limits the liability of management and directors.
Limits liability under the Federal Sentencing Guidelines
Gives employees the guidelines necessary to follow the laws
Allows management to know that the laws are being followed.
Non-Business Use
---------------------------Human Resources Management/
Addresses the need to ensure that qualified and motivated personnel are available to staff
the business units operated by the health service organization
HR Example/
- A large physician practice is in need of hiring someone to head up their
information management area. The practice has grown from seven to 23
physicians in the past five years, and the practice administrator has realized that
the clinical and financial records needs of the practice have outpaced current
administration expertise. The administrator wants to define the job and then
- A large system-affiliated hospital desires to train patient care technicians to
assist in direct clinical care of patients. The hospital has experienced a shortage
of RNs in the past three years and has found that a multidisciplinary team
approach using patient care technicians will help the organization meet patient
and manpower needs.
- The vice president of Patient Care desires to know the best way to train these
- An ambulatory care clinic plans to add new diagnostic imaging equipment in
order to compete for more patients in its service area. The purchase of this
equipment raises several questions for the organization, including: What are the
specific human resources needed to staff the new technology, and are they
- How will the addition of new technology and services affect the operating
budget and the achievement of the business strategy of the clinic?
HR includes activities that are/
- Compete for labor and want to have an adequate supply and the proper mix of
high quality staff
- HSO staff should be viewed as a “strategic asset” to gain competitive advantage
- Organizational performance depends on individual performance
Non-Business Use
- There are a number of administrative functions and action steps carried out in
support of the human resources of the HSO to ensure high levels of performance
Environmental Forces Affecting HR/
Declining reimbursement
Low supply of workers
Increasing population needs for health and medical care
Increasing competition among HSOs
External pressure on HSOs for accountability and performance
Impact of Environmental Forces/
- Fewer resources to recruit, compensate and develop workforce
- Shortage of skilled workers, changes in recruiting and staffing specialized
services, lower satisfaction of workers
- Increased volumes of patients and workload for HSOs
- Competition for healthcare workers and pressure for higher wages/benefits
- HR must ensure high performance in HSO
Employees as Drivers of Performance/
• Core services provided by HSOs—patient care services—are highly dependent on the
capabilities and expertise of the employees of the organization
• HSOs are service organizations, unlike traditional businesses or manufacturing firms
- They are highly specialized organizations that provide a range of care using
individual employee expertise
- Health care workers from different departments and units must work together to
provide the overall service for each patient
Selected Key Federal Legislation Affecting HR/
1938: Fair Labor Standards Act
1964:Civil Rights Act
1967:Age Discrimination in Employment Act
1973: Rehabilitation Act of 1973
1974: Employee Retirement Income Security Act
1986: Immigration Reform and Control Act
1993: Family Medical and Leave Act
2003: Health Insurance Portability and Accountability Act
2010: Patient Protection and Affordable Care Act
Non-Business Use
HR Domains/
• Workforce Planning/Recruitment: Determine the future staff needed and acquire
• Employee Retention: Care, support and development of the staff
HR Functions:
Workforce Planning/Recruitment/
Job Analysis
Workforce/manpower Planning
Establishing Job Descriptions
Recruitment ,Interviewing, Selection, Negotiation and Hiring
Employee Retention/
Employee Relations and Engagement
Training and Development
Compensation and Benefits
Employee Assistance Program
Assessing Performance
Labor Relations
Leadership Development
Employee Suggestion Program
Responsibilities of HR Staff in Recruitment/
HR Staff:
Prepares Position Description
Job Pricing
Prepares advertisements/recruitment materials
Keeps track of applicants/maintains HR info system
Checks applicant references
Keeps personnel files
Narrows candidate pool
Non-Business Use
Responsibilities of Line Managers in Recruitment/
Line Staff:
Clarifies job function/provides input into Position Description
Interviews candidates
Ranks candidates
Selects candidate
Negotiates with and hires candidate
Base pay:
- Tied to knowledge, skills, experience and basic expectations for a specific job
Incentive compensation:
- Designed to improve organizational performance by motivating employees to
higher levels of achievement and performance
Defined as compensation provided in a form other than salary or direct wages, paid for
totally or in part by employer
Major Types of Benefits/
Sick leave
Health Insurance
Life Insurance
Retirement plan
Flexible spending accounts
Uses of Performance Appraisals/
- Compare absolute and relative performance of staff
- Determine a plan for improving performance for those employees in need of
- Determine what additional training and development activities are needed to
improve employee performance
- Use the findings to clarify employee’s interests and desires
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- Document performance in those cases where termination or re-assignment is
- Determine adjustments to compensation based on performance
- Determine promotional or other advancement opportunities for the employee
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Chapter 13: TEAMWORK
---------------------------What is a Team?
A team is a group of people, with complementary skills who are committed to a common
approach for which they hold themselves mutually accountable, working together to
achieve a common goal.
Short vs Long Term/
Different tasks/timeframes, different team structures:
Cross functional teams (CFTs)
Virtual teams
Task forces
The Challenge/
- Formal teamwork educational training for physicians and nurses is rare.
- Developing teams and facilitating team activities are recognized competencies
for healthcare managers.
- However, there is little formal preparation in teamwork in undergraduate and
graduate healthcare management education programs
Clinical vs Managerial/
- Conflicts between physicians and nurses are often due to physicians refusal to
embrace teamwork.
- Physicians and nurses work from a clinical framework, advocating at the
individual level for patients and families.
- Healthcare managers are trained to look at population level and organizationwide issues
Benefits of Effective Teams/
Teams that are empowered to be innovative and rewarded for performance:
Improve coordination and quality of care.
Use of health care services more efficiently.
Increase job satisfaction among team members.
Increase patient satisfaction.
Increase productivity.
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Higher Level Managers/
For this audience, the answer lies in the bottom line:
Improved communication.
Increased productivity.
Decreased absenteeism.
Increased job satisfaction.
Decreased nursing turnover.
The Costs of Teamwork/
Meeting time, place to meet and food and coffee;
Opportunity costs, i.e, how that time might have been better spent;
Perceived loss of autonomy;
Risk-taking associated with letting go of one’s turf,
Resistance to organizational change
Tuckman’s Stages/
- Forming: getting oriented to the team goals and each other, finding out what the
tasks are, and who they will be working with.
- Storming: intragroup conflict, attempts at dominance, passive-aggressive
behavior, along with information withholding, and other forms of resistance to
team tasks and goals.
- Norming: team members start working together and agreeing on things, and
formally or informally expectations and roles become codified
- Performing: peace breaks out and team members actually begin the work at
hand, have open dialogue with one another, and share information to
accomplish the team’s goals.
- Adjourning: team members have worked together over a long period of time,
have developed respect for one another, and like each other as individuals and
the team as a whole and become sad that they are disbanding.
Tame vs Wicked Problems/
- Tame problems can be defined and while not easy, can be solved.
- Wicked problems are difficult to define and not easily resolved, and sometimes
can never be truly solved due to multiple layers of issues, such as we see in
health care
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Good Managers/
- Good managers don’t mind if a new staff member makes a list of questions and
asks for clarification and direction.
- Coaching, mentoring, and guiding are all part of the manager’s role.
- Good managers want thoughtful observations from a new perspective: yours
Myers-Briggs Type Indicator/
- Myers-Briggs Type Indicator (MBTI): is a paper and pencil personality inventory
used for understanding differences in team members’ personalities, based on
Jung’s theory of psychological types.
- Assesses four domains and four subsets within those domains on a four-by-four
Emotional Contagion (EC)/
- People emotionally in tune with others can read emotions within nanoseconds.
- Women and physicians scored higher on EC scale, i.e. the ability to read other
people’s emotions.
- Teammates catch each other’s moods.
Leadership and EC/
- Enthusiasm, confidence and optimism are critical to leading others.
- Emotionally aware team members can change an organization’s emotional
environment and improve the quality of employees’ and patients’ lives by
helping others to become “infected” with positive emotions
Crew Resource Management/
- Crew Resource Management (CRM), in the high-stakes airline industry, has been
developed to address attitudes, change behavior, and improve performance.
- Sexton, Thomas and Helmreich have applied crew resource management
research to the hospitals, where stakes are also high, and lives depend on the
smooth functioning of the healthcare team.
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Team Process: How To’s/
Team Leader
Asks for ideas;
Team members
Take assignments with
deadlines and follow
Acknowledges input, writes
it down;
Doesn’t interrupt and
doesn’t let others interrupt;
Asks critics for suggestions;
Remains calm.
Follow up and follow
through critical
Conflict Management for Teams/
Critical Elements
Summary of meeting is
Problem Solving
Third party mediation
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---------------------------Underserved populations/
An underserved population is a group with economic barriers or cultural and/or linguistic
barriers to primary medical care services
Health disparity/
Significant gaps or differences in the overall rate of disease incidence, prevalence,
morbidity, mortality, or survival rates in the population as compared to the health status of
the general population.
Examples of Health Disparities/
Infant Mortality
Heart Disease
Why Health Disparities?
biology and genetics,
living or working conditions,
income and socioeconomic status,
Patient’s beliefs
Patient’s adherence to preventive and therapeutic measures
education, age, race, ethnicity, culture, sexual
Access to insurance.
Strategy for handling health disparity/
- Cultural competence is one strategy to begin to address health disparities and
to drive toward equity in health and health care
Cultural Proficiency Initiatives/
- Workforce diversity
- Supportive leadership and culture
- Appropriate human resource policies
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Education and training
Multilingual services and support materials
Evaluation and research
Community outreach and engagement
Public policies
Best Practices/
Healthcare managers must recognize the issues of health disparities and build a framework
to link interventions to eliminating disparities.
Cultural proficiency requires that organizations and interdisciplinary staff value diversity
and manage the dynamics of difference. Healthcare organizations should pursue initiatives
to acquire the awareness, knowledge, and skills in continual pursuit of greater cultural
Essential components of a culturally proficient healthcare organization include:
1- A diverse healthcare workforce,
2- Management practices including supportive leadership and culture and
appropriate human resource policies,
3- Assessment,
4- Education and training for all staff,
5- Effective multilingual services and support materials,
6- System capacities such as evaluation and research data collection for tracking
health outcomes, and
7- The ability to adapt to the context of and respond to and engage the
Benefits of Health Disparities/
Good business practice
Improved customer satisfaction
Increased market share
Decreased malpractice claims
Good workforce management
- Decreased turnover
- Enrich the future talent pool
- Decreased lawsuits
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Ethical and moral imperative
- Improve access to primary care
- Enforce consumer and environment protection law
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Chapter 15: ETHICS AND LAW
---------------------------Common law
Interpretive justice
Interpretive justice
or judicial authority
A form of law that depends on judicial decisions as opposed to
legislative acts. It is often referred to as judge-made law.
An academic approach to defining the justice system so that legal
standards can be better understood
The term “precedent” refers to legal cases (at common law) that
were decided by judges
govern the relationship between private individual and
organizations and between both of these parties and government
federal laws take precedence over state laws
to set precedents in order to have sound understanding of what
the laws says-how can a constitution possibly cover every single
issue that arises in society
Sources of Ethics/
Some Basic Ethical Concepts/
Respect for Persons
No maleficence
 Philosophical
 Issue of fairness
Sources of American Law/
Executive Orders
Administrative Regulations
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Types of Tort/
- Negligence: generally unintentional
 Can be a commission or omission
- Intentional torts: deliberate acts
 Assault and battery
 False imprisonment, etc.
- Infliction of mental distress
Provider Responsibilities/
- Healthcare organizations are affected by Federal and state laws, including
- Individual providers are affected by licensure and malpractice laws
- Professional standards and codes of ethics also apply
Patient Responsibilities/
- ask questions of their providers
- provide accurate information to the provider
- follow the care plan agreed upon with their provider
Provider Rights/
- be treated with fairness and dignity by their employers
- be protected from sexual or other types of harassment
- generally be able to excuse themselves from patient care with which they
disagree (although this is under litigation at present)
Patient Rights/
Expect confidentiality of information
Informed consent or competent surrogate
Right to refuse care
Emergency treatment, even without ability to pay
Biomedical Concerns/
Resource allocation
Beginning of life care
End-of-life care
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Beginning of Life Care Issues/
Provision and funding of contraception
Provision and funding of abortion
Court cases and state laws
Balancing parental, societal, and practitioner rights and responsibilities
End of Life Care Issues/
Advance Directives
Surrogate decision-makers
Care in the absence of clear directives
Decisions about life-sustaining treatment
Balancing familial, societal, and practitioner rights and responsibilities
Protections for Patients/
Institutional Ethics Committees in most hospitals oversee a range of issues
Patient Advocate/Ombudsman Offices
Provider Codes of Ethics for each clinical profession
American College of Healthcare Executives Code of Ethics for healthcare
Issues that Health Reform/
- Opportunity for expansion.
- Changes for patients and providers.
- Health reform may not be the saving grace for health care, but it will definitely
change the way we look at law and ethics.
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