California State University, Long Beach
Health Care Administration Program
HCA 505: Organization and Systems of Health Care
Fall, 2006
Instructor:
Telephone:
E-mail:
Office Hours:
Richard L. Tradewell, MBA, Ph.D.
949 400-0960
rtradewe@csulb.edu
Phone to arrange appointment.
Schedule: W 4-6:45PM
Location: ET-105
Call Number 6744
Program Office: 562 985-5694
Course Description
Analysis of operational activities and managerial functions essential to the health care
delivery system, with emphasis on management and leadership influence on developing
effective systems of care within various institutional arrangements. This is intended as a
foundation course in the principles of organization theory and organizational behavior as
applied to healthcare organizations. During this course we will read and discuss the most
important classical works in organization theory, written by the most influential authors
in the field. Although emphasis is on masterworks that have stood the test of time, the
course also devotes considerable attention to organizational cultural reform movements
and postmodern and information age theory, including the concept of the learning
organization.
These theories will be applied in a series of case studies of healthcare organizations,
dividing our attention between cases in which principles were applied effectively and
those in which principles were ignored or never applied.
Finally, because your careers as healthcare managers may find you working in as many
as three distinct legal/institutional settings: 1) nonprofit, 2) for-profit (either a public or
privately held investor-owned firm) and 3) government-operated, the political, economic
and legal framework of each of these institutional settings will be analyzed for their
specific strengths and weaknesses in terms of organization theory. The organizational
implications of other current challenges to the healthcare manager, specifically
containing cost, improving productivity, increasing quality, and meeting customer needs
are considered in the context of the advantages and constraints in each of the three
institutional settings.
Expected outcome
As a result of this class, students will be able to:
1. Understand the evolution of management theory over several centuries from 1491
B.C. to present.
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2. Be familiar with the most important classical contributions to the field of
management theory.
3. Understand how the reactionary neoclassical theorists challenged the conventional
classical wisdom in terms in human behavior and incentive.
4. Appreciate how human resource theory further awakened thought to an
understanding of the human side of enterprise.
5. Apply the recent work in organizational culture reform movements and the
enabling role of information technology to solving many the challenges to today’s
healthcare organization.
6. Understand how the role of the management leader has evolved as management
theory has evolved.
7. Understand the relative advantages and disadvantages, similarities and
differences, of the for-profit, nonprofit, and governmental forms of organization
to the healthcare industry today, and the controversies over trends for the future.
8. Apply theory to the solution of management problems in the student’s own
organization.
Required Textbook
Classics of Organization Theory (Fifth Edition). 2001. Wadsworth Group/Thomson
Learning. Belmont, CA. ISBN: 0-15-506869-5
Required Cases and Articles (provided by instructor):
Collins, James C. and Jerry I. Porras. 1994. Built to Last: Successful Habits of Visionary
Companies. New York: HarperBusiness. (Classic). Chapter 6 in e-reserves: “Cult-like
Cultures.”
Kovner, Anthony R. and Duncan Neuhauser (2004). Health Services Management:
Readings, Cases and Commentary. Chicago: Health Administration Press. Eighth edition.
Case 13 (“A Personal Memorandum”) and Case 14 (“Whose Hospital”?) will appear on
BeachBoard and in Ereserves.
Griffith, John R. “The Revolution in Hospital Management.” Journal of Healthcare
Management, Vol 50, No. 3, May/June, 2005. Case reviews of the five health systems
that have won the Malcolm Baldrige National Quality Award in Health Care.
BeachBoard or download from ACHE: http://www.ache.org/PUBS/jhm503.cfm
Embertson, Mari K. “The Importance of Middle Managers in Healthcare Organizations.”
Journal of Healthcare Management, Volume 51, Number 4 July/August 2006.
http://www.ache.org/pubs/jhm/jhm_index.cfm. BeachBoard or download from ACHE.
Herzlinger, Regina E. “Hospital for Special Surgery,” Harvard Business School, 9-305076, August 17, 2005. (Distributed in class).
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King Drew Medical Center Pulitzer prize-nominated seven part series in the Los Angeles
Times, the Final Report from Navigant Consulting, and the Department of Health
Services’ Quality Improvement Plan, will be posted on BeachBoard.
Bibliography:
Beauford B. Longest, Jr., Jonathon S. Rakich, Kurt Darr, Managing Health Services
Organizations and Systems, 4th Edition, Health Professions Press,2000
Bennis, W.G., Spreitzer, T., Cummings. 2001. The Future of Leadership, San Francisco,
CA., Jossey-Bass.
Borkowski, Nancy. 2005. Organizational Behavior in Health Care, Sudbury, MA.,Jones
and Barlett,
Bridges, William. 1993. Managing Transitions, William Bridges and Associates.
(Classic)
Dye, Carson F. (2000). Leadership in Healthcare: Values at the Top. Chicago: Health
Administration Press.
Drucker, Peter F. (1973). Management: Tasks, Responsibilities, Practices. New York:
Harper & Row. Mandatory reading: Chapter 37: The Effective Decision and Chapter 52:
Needed, An Effective Board will appear on BeachBoard and in Ereserves. (Classic).
Griffith, John R. and Kenneth R. White. 2002. The Well-Managed Healthcare
Organization. AUPHA Press.
Fayol, Henry. 1949. General and Industrial Management, trans Constance Storrs,
London, Pitman Publishing. (Classic)
Ginter Peter, Linda Swayne, Jack Duncan. 2002. Strategic Management of Health Care
Organizations, 4th Edition,Maldem, MA.
Gift, Robert and Catherine Kinney. 1996. Today’s Management Methods, American
Hospital Publishing (Classic)
Griffith, John R. The Well Managed Health Care Organization, 4th Edition, Chicago, Il.,
Hospital Administration Press, 1999
Herzberg, Fredrick Brenard Mausner, and Barbara Bloch Snyderman. 1967. The
Motivation to Work, 2nd Edition, New York: John Wiley and Sons (Classic)
Kissler, Gary D. 1996. Leading the Health Care Revolution, Chicago: Health
Administration Press. (Classic)
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Kouzes, James and Barry Posner. 1995. The Leadership Challenge, Jossey-Bass
Publishers (Classic)
Lee, Fred 2004. If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently.
Second River Healthcare Press, PO Box 11202, Bozeman, MT 59719. ISBN 0974386014
Mayo, Elton. The Human Problems of Industrial Management, New York, Macmillan,
1933 (Classic)
Maslow, “A Theory of Human Motivation,” Psychological Review(Volume 50, July
1943), pp, 370-396. (Classic)
McGregor, Douglas. 1960. The Human Side of Enterprise, New York McGraw Hill, ,
(Classic)
Ott, J. Steven, Sandra J. Parkes, and Richard B. Simpson. 2003. Classic Readings in
Organizational Behavior. Belmont, CA: Thomson Publishing.
Peters, Thomas J. and Robert H. Waterman, Jr. (1982). In Search of Excellence: Lessons
from America’s Best-Run Companies. New York: Harper & Row. Dated material,
perhaps, but Chapter 6, “Close to the Customer” and Chapter 8, “Productivity Through
People” are still classics (on ereserves and BeachBoard). (Classic).
Senge, Peter. 1990. The Fifth Disclipine: The Art and Practice of theLearning
Organization, New York, Doubleday (Classic)
Taylor, Fredrick Shop Management. 1911. New York: Harper and Brothers, (Classic)
Weil, Peter. (2004). Evaluating the Performance of the Hospital CEO. 3rd Edition.
Chicago: American College of Healthcare Executives.
Wheatley, Margaret. Leadership and the New Science,1994, Berrett-Koehler Publishers
(Classic)
Wren, Daniel A. 2004. The History of Management Thought, 5th Edition. Wiley.
Ross, Wenzel, & Mitlyng (2002). Leadership for the Future: Core Competencies in
Healthcare. Chicago: Health Administration Press.
General Resources
California Health Line, a service of California Health Care Foundation, daily Internet
news on healthcare in California, www.chcf.org
Journal of Science and Health Policy, www.scipolicy.net
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National Information Center for Health Services Administration, www.nichsa.org
(web links to American College of Healthcare Executives, American Hospital
Association, American Health Information Management Association)
American College of Healthcare Executives, ache.org
American Hospital Association, aha.org
Additional Journals
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Administrative Science Quarterly
Journal of Applied Behavioral Science
Journal of Organizational Behavior
Organizational Behavior and Human Decision Processes
Organizational Dynamics
Academy of Management Review
Management
Scheduled Topics
The readings are organized around the following nine core topics:
1. Classical Organization Theory:
Aug 30
Introductory essay: pp 27-33
Readings: Adam Smith (1776), Henri Fayol (1916), Frederick Taylor (1916), Max
Weber (1946), Luther Gulick (1937).
Sep 6
Case: Herzlinger, Regina E. “Hospital for Special Surgery,” Harvard Business
School, 9-305-076, August 17, 2005. (Distributed in class).
How does HSS promote specialization to improve efficiency? Are scientific
management practices used to improve productivity and workflow? Do hospital
organizations violate Gulick’s unity of command or span of control principles?
2. Neoclassical Organization Theory:
Sep 13
Introductory essay: pp 88-91
Readings: Chester Barnard (1938), Herbert Simon (1946), Phillip Selznick (1948),
Richard Cyert & James March (1959).
Presentation: Classical/Neoclassical (Group 1)
Case 14: “Whose Hospital?” in Kovner and Duncan (2004).
Sep 20
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In what ways does this hospital function as a rational organization? How do the nonrational aspects of organization behavior undermine the administrator? What is the
board’s role in governance? How does it fail?
3. Organizational Behavior Perspective:
Sep 27
Introductory essay: 145-151
Readings: Mary Parker Follett (1926), Fritz Roethlisberger (1941), Abraham Maslow
(1943), Douglas McGregor (1957), Irving Janis (1971), Bart Victor & Carroll
Stephens (1994).
Presentation: Behavior (Group 2)
Oct 4
Readings: Los Angeles Times King-Drew series on BeachBoard or online at
www.latimes.com. Visit also the Health Services Department King-Drew website:
http://www.ladhs.org/mlk for consultant report and improvement plans.
What role did employee motivation (or lack thereof) play in the King-Drew scandals?
Why do you think employees seemed to care so little for patient welfare?
Readings: Joe Sobran, “The Unasked Question,” July 22, 2004 and “Remember
Sarajevo,” July 27, 2006 at .” www.sobran.com.
What is “groupthink?” What are the eight symptoms? What is the evidence of
groupthink in government policy making?
4. Modern Structural Theory:
Oct 11
Introductory essay: 193-196
Readings: Tom Burns & G.M. Stalker (1961), Peter Blau & Richard Scott (1926),
Arthur Walker and Jay Lorsch (1968), Henry Mintzberg (1979), Elliott Jaques (1990).
Presentation: Structure (Group 3)
Oct 18
Embertson, Mari K. “The Importance of Middle Managers in Healthcare
Organizations.” Journal of Healthcare Management, Volume 51, Number 4
July/August 2006. http://www.ache.org/pubs/jhm/jhm_index.cfm. BeachBoard or
download from ACHE.
How can the loss of middle management through downsizing affect an organization
such as HSS?
Objective Midterm Examination: theories 1-3
October 25
Theories of Power and Politics:
Nov 8
Readings: Jeffrey Pfeffer (1981), John French & Bertram Raven (1959), James March
(1966), Rosabeth Kantor (1979), Henry Mintzberg (1983).
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Presentation: Power and Politics (Group 4)
Nov 15
Readings: Los Angeles Times King-Drew series on BeachBoard or online at
www.latimes.com. Visit also the Health Services Department King-Drew website:
http://www.ladhs.org/mlk for consultant report and improvement plans.
Where is power located in the King Drew quality failure scandals? How powerful are
the unions, the community groups, the political representatives from Los Angeles and
neighboring cities, the medical school? Can management act to put power in the
hands of experts or will politics prevail?
5. Organizational Culture: NO CLASS; DO READINGS
(Nov 22)
Introductory essay: 352-359
Readings: Edgar Schein (1993), Scott Cook & Dvora Yanow (1993), Harrison Trice
& Janice Beyer (1993), Joanne Martin (2002).
Presentation: Culture (Group 5 )
Nov 29
Describe the culture at the Hospital for Special Surgery. How did they achieve this
cultural tradition; how are new employees introduced to the culture?
Reading: Collins, James C. and Jerry I. Porras. 1994. Built to Last: Successful Habits
of Visionary Companies. New York: HarperBusiness. Chapter 6 in e-reserves: “Cultlike Cultures.”
6. Organizational Reform Movements:
Nov 29
Introductory essay: 415-423
William Ouchi (1981), Thomas Peters & Robert Waterman (1982), Peter Senge
(1990).
Griffith, John R. “The Revolution in Hospital Management.” Journal of Healthcare
Management, Vol 50, No. 3, May/June, 2005. Case reviews of the five health systems
that have won the Malcolm Baldrige National Quality Award in Health Care.
BeachBoard or download from ACHE: http://www.ache.org/PUBS/jhm503.cfm
What do Deming and Baldrige have in common? What are their differences? Who is
more influential in healthcare organizations today?
Presentation: Org Reform (Group 6)
7. Systems, Organizations and Environments Theory:
Dec 6
Introductory essay: 476-479
Readings: Daniel Katz & Robert Kahn (1966), James D. Thompson (1967)Michael
Jensen & William Meckling (1976), Jay Barney & William Ouchi (1986), Paul Rubin
(1990).
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Presentation: Systems (Group 7) Note: Group 7 also has privilege of drawing upon
any of the prior theorists, or outside readings, to integrate its conclusions.
In class objective examination: theories 4-7 (25 points)
AND
Take home Comprehensive Final Examination (25 points)
Dec 13
Method of Evaluation
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Midterm examination
Application of Theory Essay
Final examination (25 pts objective and 25 pts take home)
Reading discussion PowerPoint presentation
Class attendance/participation
Total
=
=
=
=
=
=
50 points
40 points
50 points
40 points
20 points
200 points
Grading
A
B
90%+
80-89%
C
D
70- 79%
60-69%
F
below 60%
Essay Requirement (Applying Research to Home Organization)
You will write a short critical essay (five pages) with an additional page of complete
references. In the essay you will pick one of the eight theory topic areas (e.g. human
resources, power, culture, structure, etc.) and a representative writer/theorist of that topic
area (e.g. Maslow, Pfeffer, Senge, Mintzberg, etc.) and apply the principles you have
learned from that theorist to an event, a situation, or a condition in your own
organization.
Three steps are involved:
1. Objectively and briefly describe the situation at work (who, what, where,
when) as if you were a news reporter (one page).
2. Identify the theory or theories that help you to explain, understand, or cope
with the situation (one page).
3. Critically analyze how the theory works (or does not work) in actual
practice. This ideally should involve discussion and interview with
managers of the organization in question to obtain their insights (two to
three pages).
Grading is based on clarity of writing, use of proper grammar, organization of the
material, your critical insights and interviews and your ability to add additional
references to clarify and support your conclusions.
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Class Presentation Requirement
The class will be divided into seven work groups corresponding to each of the seven
theoretical perspectives studied in class: classical, neoclassical, behavioral, etc. Each
group of three-four students will select at least three (3) of its favorite theorists/writers
from within its assigned perspective from the class readings and produce a PowerPoint
presentation for the class reviewing these writers’ contributions to management and
organizational theory and its application and relevancy to healthcare organizations today.
The presentations should be organized to give each group member an opportunity to
speak and to allow time for class discussion. As a guideline, assume that each of the three
members of a group gives a five minute PowerPoint presentation followed by five minute
discussion. This helps to maintain class interest and equates to a total of 15 minutes of
presentation and 15 minutes of discussion, or 30 minutes per group.
Grading is based on clarity of presentation, the degree of class involvement you’re your
presentation encourages, and your overall conclusions. Supplementing the assigned
readings with outside research, photos, and antidotes about the authors may add interest
to the presentation, but is not required. Passing out a question sheet to the class in
advance of the presentation promotes discussion.
Use of Academic Technology in this Class
This course makes use of several forms of academic technology, including the web, ereserves and BeachBoard. Students are required to use of this technology to fulfill the
requirements for this course. To participate in the academic technology elements of this
course, students must have access to, and be able to use:
 A computer, equipped with Adobe Acrobat Reader 5.0 or newer and wordprocessing software capable of reading Microsoft Word XP files.
 The internet. Specifically, the World Wide Web. Whatever internet service
provider is used must be capable of accessing Web pages, BeachBoard and
Acrobat files.
 An account on BeachBoard.
The Library E-Reserve System
Other readings and materials will be available on the CSULB Library’s E-Reserve
system. To access the system type the following address in your web browser:
eReserves.library.csulb.edu. Type “Tradewell” in the space for “ERes QuickSearch”
and click on the “search” button. You will then see the course password page. Enter the
password for the course, which is “think,” and then click on the “accept” button. You
should now be in the main course folder. You will see a folder titled “Readings,” click
on it and you will see each reading. Click on the reading and you can read the article on
screen or download and print it.
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Expectations of Student Skill Performance
To complete the requirements for the course, students are expected to:
Write clearly and concisely, using correct grammar, punctuation and spelling.
Communicate articulately in oral presentations.
Be proficient in using PowerPoint for presentations.
Search the web and research publication, then apply the information found.
Analyze information, both numeric and text.
Apply internationally-accepted metrics to compare health and healthcare.
Synthesize information about factors that impact health and health care.
Compare and contrast countries, situations, historic and current times.
Participate in class discussions.
Submit all assignments on time.
Submit assignments on line and provide professor with a paper copy during class.
Student Responsibilities and University Policies
(1) CSULB policies on cheating and plagiarism shall apply, as delineated in California
State University, Long Beach Policy Statement 85-19, December 13, 1985. One or more
of the following academic actions are available to the faculty member who finds a student
has been cheating or plagiarizing.
(a) Review -- no action.
(b) An oral reprimand with emphasis on counseling toward prevention of further
occurrences;
(c) A requirement that the work be repeated;
(d) Assignment of a score of zero (0) for the specific demonstration of competence,
resulting in the proportional reduction of final course grade;
(e) Assignment of a failing final grade;
(f) Referral to the Office of Judicial Affairs for possible probation, suspension, or
expulsion.
(2) Students who need accommodation for any type of disability must inform the
instructor in advance.
(3) Withdawal is the responsibility of student. Withdrawal after the posted date is
allowed only for serious and compelling reasons and requires the approval of the dean.
(4) Absences are excused consistent with University policies.
(5) Students are expected to have CSULB email accounts and to check their email and
BeachBoard regularly for class announcements.
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STUDENT INFORMATION SHEET
Fall, 2006
(TURN IN TO INSTRUCTOR)
Name___________________________________________________________
Name you prefer to use____________________________________________
Address_________________________________________________________
________________________________________________________________
Phone(s):________________________________________________________
Best time/place to reach you:_______________________________________
Fax(es):_________________________________________________________
E-mail address:__________________________________________________
Please describe briefly:
a.
Your educational background and work experience:
b.
Future educational and career plans:
c.
Your reasons for taking this course, what you hope to learn from it:
d.
Other HCA classes you are taking or have completed: