Week 1Be sure to read the lecture notes thoroughly, as they .docx
- 1. Week 1 Be sure to read the lecture notes thoroughly, as they supplement the information offered in your textbook. You will be responsible to know the information provided here and in your assigned reading. Health Care is Evolving The way we once delivered health care services, is much different than the way we do today. Where we once focused on individual patients and treating illness, today we focus on groups of patients and promoting wellness. Because of the environment in which we operate today, we strive to provide high quality services to patients in the most appropriate way that we can. Many procedures and treatments that once required an overnight stay are now done on an outpatient basis. Patient care is provided using health care teams and an integrated approach. Patients themselves are becoming more and more active in their own health care. A variety of forces are impacting our health care delivery system and have caused this paradigm shift. Some of these include: Forces · Pay for performance based systems · Technological advances · Aging population and associated increase in chronic illness · Diversifying population · Supply and demand of heath professionals · Social morbidity · Advances in information technology and information sharing · Globalization In today's health care system we have a variety of organizations that provide care to patients. This includes providers, supplier organizations, and payers. No matter what type of health care
- 2. organization we are talking about, the same basic processes must be accomplished by each of them. Basic Organizational Processes A health care organization must provide a product or service. Acquiring and maintaining physical and human infrastructure such as office space, laboratory equipment, and employees is necessary to operate and produce the product or service. To do this most effectively, the organization must consider its relationship to the environment in which it operates. Every organization also needs management and governance. Management plans, organizes, directs, and controls, while governance oversees management and the organization as a whole. Governance helps to provide the strategic direction for the organization and holds it accountable for patient outcomes, treatment effectiveness, patient satisfaction, cost containment, and ethical and appropriate use of resources. An organization must also be able to adapt to changing conditions both internal and external to it. This function is critical to organization success in today's rapidly changing health care environment. Processes · Production · Boundary spanning · Maintenance · Adaptation · Management · Governance Areas of Managerial Activity The position of a health services manager encompasses many different activities. These activities can be looked at using either a micro approach or a macro approach. The micro approach looks at the individuals within an organization and issues such as motivation, leadership, groups and teams, communication and conflict management. The macro approach focuses on organizational and interorganizational issues such as change and innovation, performance and strategy, and alliances.
- 3. Most management courses group management tasks and responsibilities into four or five "functions." We use four: planning, organization, directing, and controlling. The level of a manager in an organization determines what percentage of his or her time is spent in each of these areas. For example, a front line supervisor will spend the majority of his or her time directing and controlling. On the other hand, a CEO of an organization will spend most of his or her time planning. Perspectives on Health Services Organizations The following different perspectives apply not only to health service organizations, but also to other types or organizations outside of the health care environment. In fact, if you took any management class you would study these same perspectives. These theories attempt to explain how organizations, managers, and employees operate. Over time our ideas have evolved, but a study of both historical and current perspectives is necessary to gain an understanding about the structure and functioning of health service organizations today. Perspectives Bureaucratic Theory Hierarchal structure, defined procedures, lack of individual freedom. The Scientific Management School Program the job, match the person to the job, departmentalization, appropriate span of control and delegation of authority, unity of command. The Human Relations School Focus on the individual, employee empowerment, participatory decision making. Contingency Theory Most appropriate structure of an organization depends on the environment in which it operates. Resource Dependency Theory Secure necessary resources in order to compete and survive. Strategic management Perspective Position the organization in a way that allows it to achieve its
- 4. objectives and be competitive in the market. Population Ecology Theory Minimizes the role of managers, environment selects out certain organizations for survival. Institutional Theory Must adhere to external norms, rules, and regulations to receive legitimacy and support. Social Network Perspective Social networks to transfer best quality improvement practices. Complex Adaptive Systems Interdependency of people and activities, outcomes not always predictable, experimentation, rapid information sharing to facilitate improved performance. Week 2 Be sure to read the lecture notes thoroughly, as they supplement the information offered in your textbook. You will be responsible to know the information provided here and in your assigned reading. Role of the Health Services Manager Due to the complex nature of today's health care organizations, health services managers are often times forced to wear many hats. Individuals in these positions must play a combination of executive leadership, organizational management, and strategic management roles. Below are several theories and perspectives regarding the role of health services managers. Henry Mintzberg Mintzberg defined ten roles of managers and organized them into three domains: Interpersonal Roles Figurehead
- 5. Leader Liaison Informational Roles Monitor Disseminator Spokesperson Decisional Roles Entrepreneur Disturbance handler Resource allocator Negotiator David Garvin Garvin defined the role of management in terms of management processes and organizational processes in his "process-based view." Management Processes Direction Setting Processes Develop an agenda and engage others to pursue it, motivate, rewards, punish. Negotiating and Selling Processes Solicit and present ideas, develop and maintain communication networks. Monitoring and Controlling Processes Detect variations in systems and initiate corrective action to
- 6. restore equilibrium. Organizational Processes Work Processes Work design, work redesign to improve quality and/or efficiency. Behavioral Processes Decision making, communication, organizational learning Managing Strategically Executive leaders in health care organizations today must manage strategically in order to ensure the survival and success of their organization. Managing strategically involves setting the future course for the organization. First, it requires one to determine the current state of the organization as it exists today and how it came to be. This also involves evaluating the organization's competition. An internal and an external analysis should be performed. Next, the ideal future state of the organization must be envisioned. This is where goals and objectives are created. A path or map, including action steps, establishes the details for how to achieve the goals and objectives. Lastly, the action steps are implemented. Resources are allocated, and responsibilities for specific tasks are assigned. This entire process must be monitored and adjustments made for any variances encountered along the way. The outcome of this process is called a strategic plan and is used by the organization to guide the creation of functional and divisional plans. All planning and activities pursued by the organization should be in congruence with the strategic plan. Skills and Competencies Think about this: Who was the worst manager that you worked for in the past? Who was the best? What skills or competencies made them bad or good managers? People in management and leadership roles within a health care organization must possess certain skills and competencies in order to be effective in their positions.
- 7. In order to succeed in management roles, a person must have technical, human, and conceptual skills. Skills · Technical - ability to perform the job. · Human - work with and through others to accomplish goals and objectives, motivate others. · Conceptual - understand how all parts of the organization come together, visualize the big picture. The National Center for Health care Leadership (NCHL) has developed competencies that leaders must possess in order to be successful in health care professions. Twenty-six competencies are grouped into three domains. NCHL's Health Care Leadership Competency Model, version 2.0 Domains · Transformation - involves creating and striving towards a vision, strategic thinking, and innovative thinking. · Execution - initiative, performance measurement, and change leadership. · People - interpersonal understanding, relationship building, human resource management, and talent development. Challenges and Demands In 2000 and 2001 the Institute of Medicine (IOM) (http://www.iom.edu) published two reports that address the challenges and demands faced by health service organizations. They are available in summary form through this week's readings. 1. To Err is Human: Building a Safer Health System - reported that health care is not as safe as it should be, recommended that health care organizations work to create safe systems of care 2. Crossing the Quality Chasm: A New Health System for the 21st Century - proposed six aims to improve the functioning of our health care system, "health care should be (1) safe, (2) effective, (3) patient-centered, (4) timely, (5) efficient, and (6) equitable." Managers and leaders working in health care are tasked with working towards overcoming the issues and meeting the goals
- 8. set forth by the IOM. Week 3 Be sure to read the lecture notes thoroughly, as they supplement the information offered in your textbook. You will be responsible to know the information provided here and in your assigned reading. Motivation A primary task of health services managers is to motivate people and teams to perform effectively in the organization. Effective performance can be translated into performing at high levels or meeting organizational goals and objectives. Health services managers also motivate people to do things like improve productivity, promote teamwork, and reduce problems such as tardiness or absenteeism. Regardless of the objective, motivation involves instilling a desire in a person to want to accomplish a goal or objective. It is critical that health services managers understand their employees in terms of what does and what does not motivate them. Not all employees will be motivated by the same thing. For example, one employee might be motivated to work hard towards promotion or advancement; another employee might be perfectly content remaining in his or her current position. For the second employee, promotion or advancement might actually be a negative motivator. It is also crucial that managers and leaders in health care organizations recognize that professional workers might respond to difference incentives and motivators than clerical or service employees. Health services managers must first determine what motivates various individuals and/or groups and then work to increase motivation for all employees by altering conditions in the workplace. Theories and Perspectives
- 9. The following are some of the key theories and perspectives regarding motivation. Maslow's Hierarchy of Needs Five need levels that must be satisfied sequentially: physiological, security, belongingness, esteem, and self- actualization. Alderfer's ERG Theory An alternative hierarchy with made up of three levels: existence, relatedness, and growth. Herzberg's Two Factor Theory Motivators (achievement, recognition, responsibility) and hygiene factors (supervision, pay, working environment). McClelland's Learned Need Theory Three needs acquired through life experiences: achievement, power, and affiliation. Adam's Equity Theory Employees compare themselves to others and seek fairness and equity from their managers. Vroom's Expectancy Theory Employees will put effort into situations that will lead to desired rewards. Reinforcement Theory Operant conditioning based on three components: stimulus, response, and consequences. Locke's Goal Setting Theory Goals provide guidelines for how much effort to put into work; the more difficult and specific the goal, the greater motivation to attain it. Leadership Merriam Webster's Online Dictionary defines leadership as "the office or position of a leader" or the "capacity to lead." To lead is "to direct on a course or in a direction." In order to lead, one must have followers. Leadership is a process where by an individual intentionally influences others to accomplish a goal. All organizations need leaders in order to get things done. Leaders are found at all levels in an organization, not only at
- 10. the top. Anyone can be a leader! Think about this: Who is someone that you think is or was an effective leader? What makes or made this person an effective leader? What characteristics do or did they possess? Theories and Perspectives The following are some theories and perspectives surrounding what make a person a leader and also how to lead most effectively. · Trait perspective - certain traits or characteristics are present in leaders and not in followers: intelligence, articulateness, confidence, initiative and persistence, and sociability. · Skills perspective - leadership is dependent upon possessing or developing three core skills: technical, conceptual, and human. · Behavioral/Style perspectives - models/styles for how to lead. · Autocratic, democratic, and laissez-faire · Job-centered or employee-centered · Production orientation or people orientation · Theory X or Theory Y · Contingency perspectives - models for how to lead based on characteristics of the manager, followers, and situation. · Leadership match model - leadership does not involve fitting one's style to the situation, but rather on choosing a situation that is conducive to one's style · Path-goal model - manager provides direction and support to guide followers on the best path towards reaching their goals · LEAD model - presents four different leadership styles; style should be based upon follower task-relevant maturity · Attribution theory - manager selects leadership style based upon the way follower behavior is perceived and interpreted · Transactional versus transformational leadership · Transactional - seeks to preserve and work within the status quo · Transformational - seeks to upset and replace the status quo Challenges Faced by Health Care Organizations There are several distinctive challenges faced by health care organizations. Below are two of the challenges:
- 11. · Professionalism - professionals, such as physicians, perform most of the "real work" done in the organization and control the organization's core output. · Gender - managerial positions in health care organizations, at all levels, are increasingly being held by women Week 4 Be sure to read the lecture notes thoroughly, as they supplement the information offered in your textbook. You will be responsible to know the information provided here and in your assigned reading. Levels of Conflict Conflict can occur on one of two levels: individual level or group level. Individual conflict involves only one person; group conflict occurs between two or more people. Below are several types of both individual and group level conflict. Individual Level - Intrapersonal · Approach-approach - when a person has to choose between two equally attractive alternatives, thus rejecting a good option. · Avoidance-avoidance - when a person has to choose between two equally unattractive options. · Approach-avoidance - when a person has multiple options that have both favorable and unfavorable aspects. Group Level - Interpersonal · Intragroup - conflict between members of the same group. · Intergroup - conflict between members of different groups. Managing Conflict - The Dual Concern Model The Dual Concern Model reflects a concern for both an individual's own outcome as well as that of his or her opponent. This model predicts and explains how parties choose a particular conflict style. Dual Concern Model · Avoid · Compete · Accommodate · Collaborate
- 12. Negotiation We use negotiation tactics in both our personal and professional lives, sometimes without even realizing it. Negotiation is a process through which multiple parties work together to satisfy the interests of all involved. It requires each of the parties to decide what it will give and take in an exchange between them. An important part of negotiation is knowing your BATNA, or your Best Alternative to a Negotiated Agreement. If an agreement cannot be reached, your BATNA is the course of action that you will take. Your BATNA is your alternative if an impasse is reached, and it can be a very powerful negotiating tool. Other Alternative Dispute Resolution Techniques Negotiation is one of three forms of alternative dispute resolution, along with mediation and arbitration. Mediation involves using a third party to the dispute to assist in reaching an agreement. However, the agreement reached using the mediator is not legally binding on the parties. Whereas arbitration is conducted similarly, the decision reached by an arbitrator is legally binding on both parties. Rasmussen Personal Support Center, call toll-free, 24/7: 1-866- 693-2211 Week 5 Types of Groups and Teams Groups and teams are a part of organizational life. If organized and managed effectively, groups and teams can be useful for improving quality and accomplishing other organizational objectives. For example, patient care in many instances is performed by a team of health care professionals. Teams of specialists work together to provide quality care for the patient. Also, much of the quality improvement work that is done in health care organizations today is dependent on cross functional
- 13. teams. There are many different types of groups and teams in health care organizations. It is important to understand the structure of teams, so that they can best be leveraged for organizational success. Groups can be classified into two different types: informal and formal. Teams are a kind of formal group and can be further broken down into different types based on function or purpose. Informal and formal groups and teams are explained further in the sections below. Informal Groups Groups that are not intentionally formed by the organization are called informal groups. Informal groups usually form naturally by individuals who desire to fulfill a personal or social interest or need. One example is a car pool. Another example would be a walking or book club that meets during lunch or before or after work hours. Formal Groups Groups that develop because of the direct actions or structuring of an organization are called formal groups. Formal groups are intentionally established and recognized by the organization. A team is an example of a formal group. Teams As mentioned above, a team is a type of formal group. Below are examples of different types of teams that may be formed by an organization. Work Teams Work units that produce a good or service; usually ongoing. Parallel Teams Group of people from different departments or jobs that perform a function that the regular organization is not equipped to perform; i.e. task forces, employee involvement groups, quality improvement teams, etc. Project Teams Group formed for the sole purpose of completing a project; team is dissolved once project is finished. Management Teams
- 14. Team that coordinates and provides direction to subordinates under their scope of authority. Stages of Team Development Teams go through stages of development. The sequence of team development described below is widely known and has been found to occur in many groups. This sequence was developed in the mid-1960's by Bruce W. Tuckman. Stages Forming Team members are getting to know one another and trying to understand their roles; people are polite and tentative; make sure the purpose and task(s) of the team are clearly defined. Storming General disagreement about the purpose and process of the team; politeness wears off and conflicts arise; conflicts should be addressed and team achievement stressed. Norming Teams grow more cohesive and aligned to accomplish their goals; agreement on process, rules, roles, and expectations emerges; keep the focus on the purpose and task. Performing Team is functioning effectively; tasks are accomplished; for the most part, the team is self-managing itself. Team Characteristics Every team has certain characteristics that influence and determine its effectiveness. It is important that the characteristics of a team are understood and managed well to help to ensure high performance. Teams must be both set up and run correctly. Characteristics Composition and Size Number of members on a team and diversity of those members; age, occupation, gender, tenure, abilities, race, ethnicity, personality, and experience. Status Differences
- 15. Measure of worth conferred on an individual or group. Psychological Safety Team member's perceptions regarding interpersonal risk taking in the work environment; on a "safe" team, a person can make a mistake and not be penalized or looked down upon. Teams Norms Standards that are shared by members of the team; behavior norms and performance norms. Team Cohesiveness Degree to which members of the team are attracted to one another, motivated to stick together and committed pursue the group's purpose. Rasmussen Personal Support Center, call toll-free, 24/7: 1-866- 693-2211