INTRODUCTION TO HEALTH CARE MANAGEMENT 101 @QASIMOOOV INTRODUCTION TO HEALTH CARE MANEGMENT 101 --------------------------------------------------Chapter 1: AN OVERVIEW OF HEALTHCARE MANAGEMENT ---------------------------Direct care Non-direct care Management Planning Organizing Staffing Controlling Directing Decision Making Hierarchy of management SelfManagement 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. Non-Business Use 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 settings. Conceptual Skills/ Competencies: 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 service 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 structure - 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/ Include: 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, and 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 talent. - 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/ - 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. Non-Business Use - 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 Chapter 2: LEADERSHIP ---------------------------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/ style Coercive Participative Pacesetting Coaching Definition Demanding and power based Soliciting input and allowing decision making Setting high performance standards Focus on personal development Followership/ - 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: - Professionalism Reciprocal trust and respect Confident, optimistic, passionate Being visible Non-Business Use Application Problematic employees Most followers Highly competent Top level - Open communicator - Risk taker - Admitting fault Governance/ Collectively assuming strategic oversight - Top accountable body Board of Directors or Board of Trustees Heighten scrutiny Transparency Each member has fiduciary responsibility Espouses meaning for healthcare delivery Healthcare Governance Trends/ - Smaller 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 Bioethics 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 Chapter 3: MANAGEMENT AND MOTIVATION ---------------------------Motivation/ 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. Existence: physiological and safety needs into one level Safety needs: shelter, jobs, pay, etc. Relatedness: belonging needs Belonging needs: social interactions, etc. Growth & Development : esteem and selfactualization Herzberg’s 2-Factor Theory Hygiene's: characterized as lower-level motivators and included Motivators McClelland’s Acquired Needs Theory Achievement Affiliation Power Esteem needs: status, recognition, etc. Self-actualization needs: achievement, personal 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 Promotions Status changes Supervision Praise/feedback Good boss Strong leader Inspirational people - Nurturing organizational culture Intrinsic Rewards: Intangibles/ - Healthy relationships – feeling a sense of connection Meaningful vs. meaningless work Competence 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 learn Non-Business Use Chapter 4: ORGANIZATIONAL BEHAVIOR AND MANAGEMENT THINKING ---------------------------Evolving Science of Organizational Behavior/ - Industrial Science Administrative Management Bureaucracy 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: - Psychology Social psychology Industrial psychology Sociology Communications Anthropology Organizational Behavior Occurs at Three Levels/ Individual perceptions attitudes assumptions Group (between individuals) leadership teamwork decision making Non-Business Use Collective (within organization) or corporate work structures organizational systems organizational culture organizational learning and adaptation Healthcare Challenges for Organizational Behavior/ Industry Rising costs & declining reimbursement financial pressure Increased competition Consumer demands New services Outpatient care Chronic illness Patient safety concerns Quality of care Labor shortages Organization 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. Cognition/ 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 Non-Business Use A Cognitive Model of Organizational Behavior: The role of thinking/ The cognitive model of behavior highlights how thinking influences behavior Situation/Task Thinking Interpersonal relations Assumptions Workplace cues Perceptions Problem-solving Beliefs Industry environment Biases Cognition principles Knowledge Behavior Reactions Decisions Work tasks Learning Adaptation Thinking Patterns Relevant to Organizational Behavior/ Individual Assumptions Perceptions Biases Expectancy Schemas Framing Mental models Between individuals Expectancy theory Self-fulfilling prophecy Attributions Framing 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 reward - 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 ambiguous 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 Chapter 5: STRATEGIC PLANNING ---------------------------Strategic Planning Process/ - SWOT Analysis Strategy Identification and Selection Strategy Tactical Plans Rollout and Implementation Monitoring and Control Feedback 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 MVV - Mission - Vision - Values Strategy Identification and Selection/ - Scenario Exploration Assumptions Financial Targets Resource Matching Outcomes 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 Chapter 7: QUALITY IMPROVEMENT BASICS ---------------------------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 Leadership Staff focus Strategic planning Focus on patient, other customers, and markets Process Improvement Outcomes Organizational performance outcomes or results Common Elements of quality improvement/ Measurement: - 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 process. - Statistical Process Control-method by which process variation is measured, tracked, and controlled in an effort to improve the quality of the process. Non-Business Use 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/PCDA: - 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 FOCUS/PDCA: • Plan – create an implementation plan for taking the process to the next level • Do – implement and test the new process Non-Business Use • 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 DMAIC: • 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 Flowchart Chart abstractions or chart audits Geographic mappingWorkflow diagram Process analysis Cause-and-effect (fishbone) diagram Pareto Chart Non-Business Use Chapter 8: INFORMATION TECHNOLOGY ---------------------------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 revenues. - 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 (HIMSS) - 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 Cost Lack of user friendliness – not intuitive like web based applications Industry very driven by units of service completed – early systems slowed them down 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 Interoperability Cybersecurity Capturing Socioeconomic data in EHRs Non-Business Use - ICD-10 Adoption The Future of Health care encompasses additional areas where healthcare mangers needs awareness and potential involvement/ - e-health mhealth Telemedicine Telhealth 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 Chapter 16: FRAUD AND ABUSE ---------------------------What is Fraud and abuse? - Fraud: an intentional act of deception. - Abuse: improper acts that are unintentional but inconsistent with standard practices. - 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. THE SOCIAL SECURITY ACT AND THE CRIMINAL-DISCLOSURE provision/ - Health care provider or a Beneficiary possess - Imposes a requirement to disclose overpayments to the government. THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT, EMTALA/ - Known as the Anti-Dumping Act. - Prevent patient dumping. Non-Business Use - 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 PHYSICIAN SELF-REFERRAL/ANTI-KICKBACK/SAFE HARBOR LAWS/ - 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 MANAGEMENT RESPONSIBILITY FOR COMPLIANCE AND INTERNAL CONTROLS/ • 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 : Non-Business Use Effectiveness and Efficiency of operations Reliability of Financial reporting Compliance with applicable law and regulations The COSO list 5 interrelated components of internal control: 12345- Control environment Risk assessment Control activities out. Information and communication Monitoring CORPORATE COMPLIANCE PROGRAMS/ - 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 Chapter 12: STRATEGIC MANAGEMENT OF HUMAN RESOURCES ---------------------------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 recruit. - 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 teams. - 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 available? - 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/ Strategic - 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 Administrative - 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 them • 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 Orientation 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 Compensation/ 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 Benefits/ 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 Vacation Holidays 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 improvement - Determine what additional training and development activities are needed to improve employee performance - Use the findings to clarify employee’s interests and desires Non-Business Use - Document performance in those cases where termination or re-assignment is necessary - Determine adjustments to compensation based on performance - Determine promotional or other advancement opportunities for the employee Non-Business Use 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 Committees 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. Non-Business Use 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 Non-Business Use 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 grid. 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. Non-Business Use Team Process: How To’s/ Team Leader Asks for ideas; Team members Take assignments with deadlines and follow through. 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 shared; Bargaining Voting Problem Solving Research Third party mediation Non-Business Use Chapter 14: ADDRESSING HEALTH DISPARITIES: CULTURAL PROFICIENCY ---------------------------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/ - Diabetes Infant Mortality Heart Disease Stroke Why Health Disparities? - biology and genetics, behaviors, 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 orientation, 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 Non-Business Use - Assessment 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 competence 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 community Benefits of Health Disparities/ Good business practice - Improved customer satisfaction Increased market share Decreased malpractice claims Return-on-investment Good workforce management - Decreased turnover - Enrich the future talent pool - Decreased lawsuits Non-Business Use Ethical and moral imperative ADDRESSING HEALTH DISPARITIES BY ENHANCING PUBLIC POLICY/ - Improve access to primary care - Enforce consumer and environment protection law Non-Business Use Chapter 15: ETHICS AND LAW ---------------------------Common law Interpretive justice Precedent Laws Preemption 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/ - Personal Organizational Theoretical Bioethics Some Basic Ethical Concepts/ - Respect for Persons Beneficence No maleficence Justice: Philosophical Issue of fairness Sources of American Law/ - Constitution Legislatures Executive Orders Administrative Regulations Courts Non-Business Use 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 EMTALA - 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/ - Self-determination Expect confidentiality of information Informed consent or competent surrogate Right to refuse care Emergency treatment, even without ability to pay Biomedical Concerns/ - Resource allocation Consent Beginning of life care End-of-life care Non-Business Use 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 administrators 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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