Management of Health Care Organizations: Assignment Week 1

Critical Reflection Paper: Chapters 1, 2, 3

Objective: To critically reflect your understanding of the readings and your ability to apply them to your Health care Setting. 

ASSIGNMENT GUIDELINES (10%):

Students will critically evaluate the readings from Chapter 1, 2 and 3 in your textbook. This assignment is planned to help you review, appraisal, and apply the readings to your Health Care organization managing for quality and performance as well as become familiarize in the strategic planning for operational and budgeting.

You need to read the article (in the additional weekly reading resources localize in the Syllabus and also in the Lectures link) assigned for week 1 and develop a 2 page paper reflecting your understanding and capability to apply the readings to your Health Care organization managing. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA format when referring to the selected articles and include a reference page.

  

EACH   PAPER SHOULD INCLUDE THE FOLLOWING:

1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words.

2. Your Critique (50%)

What is your reaction to the content of the articles and the chapters?

What did you learn about strategic planning, operational planning and budget planning?

What did you learn about Quality Improvement and how you can apply them?

Did these Chapter and articles change your thoughts about Managing for quality and Planning for improvement? If so, how? If not, what remained the same?

3. Conclusion (15%)

Briefly summarize your thoughts & conclusion to your critique of the articles and Chapter you read. How did these articles and Chapters impact your thoughts about managing and planning for quality?

Evaluation will be based on how clearly you respond to the above, in particular:

a) The clarity with which you critique the articles;

b) The depth, scope, and organization of your paper; and,

c) Your conclusions, including a description of the impact of these articles and Chapters on any Health Care Setting Organization and planning.

ASSIGNMENT DUE DATE:

The assignment is to be electronically posted no later than noon on Friday, January 17, 2020.

managementhealth care organization

Chapter 1: Introduction:
Managing for Quality and

Performance

Objectives

• Be familiar with the framework of this text
• Understand the importance of sound managerial

practices in contemporary organizations that
provide programs and services related to health

• Appreciate the advantages of applying systems
thinking to management

• Understand the importance of improving quality
and performance while demonstrating value

• Appreciate that quality management and quality
initiatives contribute to organizational success

Outline

• Overview of Management

• Introduce Systems Thinking

• Introduce Quality Improvement

What Is Management?

• “Those in charge of running a business”
(Princeton University, 2010)

• “The person or persons in charge of running a
business establishment, organization, or
institution” (American Heritage, 2006)

• Common thread of management: the need to
guide an organization toward its goals

• Accomplished by providing guidance and
sufficient resources for employees to be
productive

The Traditional Functions of
Management

• Planning for Improvement

• Organizing for Improvement

• Facilitating (Motivating/Leading)
Improvement

• Control and Improvement

Competencies of Management

• Common training

• Understanding of leadership, evaluation,
motivation, personalities, and communication
styles

• Adaptability

• Ability to adjust their expectations of
individual employees

• Mentor employees and help prepare them for
advancement

What Else Makes a Manager Effective?

• Ability to modify plans on short notice

• Trust of employees and giving them
opportunities to grow

• Accepting that occasionally employees will fail
and helping them learn from mistakes

• An open and prepared mind

• Commitment to and respect for employees,
employers, and self

Role of Employees

• All employees contribute to the planning,
organizing, motivating, controlling, and
improving of organizations

• In effective organizations, employees identify
with and contribute to management

• All persons, independent of their positions,
should understand and participate in the
management functions of the organization for
which they work

What Is Systems Thinking?

• “a general conceptual orientation [that is]
concerned with the interrelationships between
parts and their relationships to a functioning
whole, often understood within the context of an
even greater whole” (Trochim et al. 2006)

• “Forest” rather than “tree-by-tree” thinking

• Dynamic thinking rather than static thinking

• Pushes people to consider the consequences of
their actions over time

Systems Thinking in Health

• The consequences of health promotion and
disease prevention unfold over long periods of
time and involve complex interrelationships

• For this reason, systems thinking is a basic
competency in public health

• Systems thinking is promoted as a key
competency in health service delivery
organizations

What Is a System?

• Groups of interacting and interdependent
elements that form a unified whole (such as
an organization)

• Comprised of:
– Inputs (employees, managers, and financial

resources)

– Processes (policies, procedures, and production
activities)

– Outputs (products, programs, and services)

Causal Loops

• Diagram portraying the cause and effect
relationships within systems

• Circular to reflect feedback (information about
change that leads to further modifications)

• Can be either reinforcing (change in one
direction leads to more change in the same
direction) or balancing (change in one direction
creates resistance in the other direction)

• Helps visualize changes in the system over time

System Archetypes
• Patterns that occur repeatedly in different

settings
• Useful for training people to think dynamically

about complex interrelationships
• Examples:

– Fixes That Fail: a fix is applied to a systems
problem that has immediate positive results,
but unintended long term consequences
make the problem worse

– Drifting Goals: a gradual downward slide in
performance goes unnoticed, threatening the
long-term future of a system

Other Systems Thinking Tools

• Simulation modeling

• Learning laboratories

• Diagrams that portray organizational
performance over time

• Many quality improvement (QI) tools are
based in systems thinking

Systems Thinking in Management

• Systems thinking helps managers see
meaningful, underlying patterns, allowing
them to make better decisions by foreseeing
the system-level consequences of their actions

What is Quality Improvement (QI)?

• A set of methods and techniques that can be
used to improve programs, services, products,
or output of any organization and/or to
decrease organizational costs

• Used in manufacturing and industry for over
90 years

• Adopted by traditional health organizations in
the 1990s

• Only recently applied to public health

Two Common QI Approaches

1. Top-Down:

– Senior leaders support QI as a method for
improving performance, create a vision
that provides one or more goals, and
supply needed resources

2. Bottom-Up:

– Lower level workers are trained in basic QI
methods and techniques and then
conduct projects to apply their training

Transformational Change

• The ultimate application of QI within an
organization

• Involves a radical alteration with complete
rethinking about the way an organization is
structured or managed

QI Example: Process Engineering

• A methodology used to improve operational
efficiency that analyzes operational sequences

• Goal is to eliminate or modify activities that
do not add value

Applying QI
• Inefficiencies and areas of ineffectiveness exist

throughout the health care and public health
systems in the United States

• QI can address these problems; for example:

– A review of treatment protocols could identify
opportunities for procedural changes

– A review of service delivery might reveal gaps in
applications of existing service standards

– A review of outcomes could help to identify
unneeded treatments or services

Chapter 2: The Policy Context
for Management

Objectives

• Understand the interdependence of health
management and public policy

• Be able to describe the U.S. governmental
policy-making process

• Understand key distinctive features of health
policy in the United States

• Be able to identify key policy issues relevant to
health management

Outline

• The

Policy Making Process

• Distinctive Features of U.S.

Health Policy

• Key Health Policies Affecting Management

Laws and Regulations

• Laws and regulations affecting health
organizations are diverse and plentiful in the
United States

• Managers of health organizations are responsible
for assuring that their organizations and units
comply with laws and regulations

• Managers should understand the legislative
process so that they can participate in it and
anticipate changes in public policies

Laws and Regulations (continued)

• Laws are rules developed and approved by
legislative bodies and enforceable in the
courts

• Regulations are rules developed by
governmental agencies or by private
organizations that have been assigned
authority by the government, usually to enact
the provisions of laws

Health Policy

• Health policy refers to the principles and
activities guiding the allocation of resources
that affect the health of patients and
populations

• The concept of health policy is broader than
laws and regulations

• Health policy is heavily influenced by the laws
and regulations formulated and implemented
by governmental units

Policy Making Process

• Two principles undergird the policy making
process:

– Federalism

– Separation of powers

• Federalism refers to the sharing of power
between states and the national government

• Separation of powers divides government into
three branches: judicial, legislative, and
executive

Influencing the Policy Making Process

• Managers can develop or participate in coalitions of
like-minded individuals and advocate for their
viewpoints before, during, and after the legislative
process

• There are 5 stages at which the public policy can be
influenced (Longest, 2010):

1) Agenda setting stage
2) Legislation development stage
3) Rulemaking stage
4) Policy operation stage
5) Policy modification stage

Distinctive Features of U.S. Health
Policy

• In the U.S., the government is less involved in the
direct provision of health services than any other
industrialized country in the world (Greenwald,
2010; Jonas, 2007)

• No central agency governs the U.S. health system

• Government funds a wide array of health
research, training of health workers, and a variety
of direct delivery services, such as the Veterans
Health Administration

Key Health Policies Affecting
Management

• Health Information Technology Support and
Security

•

Access to Health Services

•

Quality Improvement

•

Emergency Preparedness

• Prevention and Health Promotion

Health Information Technology
Support and Security

• Health information technology has been targeted
by recent legislation designed to modify existing
policies and practices

• Information systems are often selected for their
financial advantage to the purchasing
organization rather than considering their utility
to customers, clients, or patients

• A National Coordinator for Health Information
Technology was mandated by the Health
Information Technology for Economic and Clinical
Health Act (HITECH Act)

National Coordinator for Health
Information Technology

• This legislation was included in the American
Recovery and Reinvestment Act (ARRA) of
2009

• Responsible for promoting a nationwide
health information technology infrastructure
that improves health quality and reduces costs

• ARRA also authorized nearly $20 billion over
five years to assist physicians in adopting
electronic health record (EHR) technology

Access to Health Services

• The federal Medicare health insurance
program and the joint federal-state Medicaid
health insurance program have served elderly
and disadvantaged populations for decades in
the United States

• A major expansion in the federal role in access
to health services occurred in 2010, with the
Patient Protection and Affordable Care Act

Patient Protection and Affordable Care
Act (PPACA)

• Prohibition on denial of health insurance coverage for
children due to pre-existing conditions and
requirements for full coverage of selected preventive
services in health insurance plans

• Individual mandate for health insurance—individuals
not covered by government insurance programs must
maintain health insurance or pay a penalty

• Funds a major expansion of Community Health Centers,
which largely serve inner city poor populations, and
increases payment levels to rural health care providers

Quality Improvement

• U.S. health policy is strongly behind efforts to
improve the quality of health services, with
increased expectations that health organizations
will report and enhance the quality and value of
their services

• A movement to accredit public health departments,
formally launched in 2011, is another example of
the growing inclusion of quality improvement in
U.S. health policy

Emergency Preparedness

• Government is heavily involved in health
policy for emergency preparedness

• U.S. Department of Homeland Security
develops and deploys national strategies for
prevention and response to emergencies

• States and many localities have similar
emergency preparedness units

Prevention and Health Promotion

• U.S. health policy has gradually increased
recognition of the importance of prevention
and health promotion

• PPACA created a $15 billion Prevention and
Public Health Fund

• PPACA requires health insurance plans to
cover selected preventive services

Health Disparities

• Health disparities are population-specific
differences in health

• Area of growing health policy concern

• Patient Protection and Affordable Care Act of
2010 expands services to low-income
populations, broadens initiatives to increase
racial and ethnic diversity in the health care
professions, and strengthens cultural
competency training for health care providers

Chapter 3: Strategic
Planning

Objectives

• Identify the purpose of strategic planning

• List the six steps of strategic planning

• Describe the importance of a mission, vision, and
values

• Describe how to use analysis of strengths,
weaknesses, opportunities, and threats (SWOT)

• Explain the strategic uses for

Healthy People 2020

• Describe Mobilizing for Action through Planning
and Partnerships (MAPP)

Outline

•

Strategic Planning

•

Operational Planning

• Strategic Planning for Community Health

Strategic Planning

• Defined as the process of developing
strategies which develops an overall sense of
direction for the future

• Strategy – address the question of how to
position an organization in its environment

• Strategic planning is not as widely used in not-
for-profit and public health organizations

Strategic Planning (continued)

• Strategic Planning is 1 of 3 different types of
planning used by management:

1) Strategic Planning – based on the mission,
vision, and values of an organization

2) Operational Planning – identifies and presents
program goals and objectives

3) Budget Planning – allocates the financial
resources of an organization based on
strategic and operational planning

Guiding Statements

• Mission

• Vision

• Values

Mission Statement

• Delineates an organization’s purpose and reason
for existence.

• Communicates the current intentions of the
organization

• Example: “Healthy People 2020 strives to identify
nationwide health improvement priorities and
engage multiple sectors to take actions to
strengthen policies and improve practices that
are driven by the best available evidence and
knowledge…”

Vision Statement

• Targeted description of the future outcomes
expected if the organization is successful

• Somewhat idealistic, because visions are
intended to motivate people and enroll the
hearts, as well as the minds, of organizational
stakeholders

• Example: “Healthy People 2020 envisions a
society in which all people live long, healthy
lives”

Values Statement

• Tends to be philosophical and often reflects
the beliefs or ethical systems of the founders

• Example: “Healthy People 2020 values the
promotion of quality of life, healthy
development, and healthy behaviors across all
life stages…”

Healthy People 2020

• Initiative utilized by the U.S. Department of
Health and Human Services (DHHS) which
includes a list of strategic priorities for
national health promotion and disease
prevention efforts

• HP 2020 is a tool used by all levels of
government and the public health systems
(state and local departments of health)

Six

Steps of Strategic Planning

• Internal organizational assessment

• External environmental assessment

• Analysis of internal strengths and weaknesses

• Analysis of external opportunities and threats

• Identification and evaluation of strategic
issues and choices

• Selection of strategic priorities

Steps of Strategic Planning

• Step # 1a and # 1b:

Internal Organizational Assessment; External
Environmental Assessment

Review of how the internal and external
environments affect an organization:

 Internal assessment includes laws and
regulations, competitors, and demographics

 External assessment includes staffing ratios,
patient satisfaction rates, and performance
measures

Steps of Strategic Planning

• Step # 2a and # 2b:

Analysis of Internal Strengths and Weaknesses and
External Opportunities and Threats (SWOT)

– Identify the factors that represent internal
strengths and weakness of an organization
(example: high quality services or low
productivity)

– Identify the factors that represent external
opportunities and threats to an organization
(example: increased funding or deteriorating
economy)

Steps of Strategic Planning

• Step # 3:

Identification and Evaluation of Major Strategic
Issues and Options

 Utilizes the SWOT analysis to identify strategies

 Key Issue Analysis – assessment of all events,
which if they occur or not, would have an
important impact on the organization

 Forecasting – predicting or estimating future
events in the environment based on past or
present trends

Steps of Strategic Planning

• Step # 4:

Selecting Strategic Priorities

– Reviews potential options identified in Step
# 3 and selects appropriate strategies to
pursue which addresses key issues

Operational Planning

• Requires setting goals and objectives at the
tactical level, usually the departmental and
subunit level, for carrying out the
organization’s strategies

• A business plan is a common type of
operational plan

– Describes services, products, or programs
and there markets

– Makes projections

Budget Planning

• Budget plans are common planning
mechanisms

– Capital budget for major purchases

– Operating budget for annual revenues and
expenses

– Cash budgets to predict inflow and outflow
of cash

Strategic Planning for Community
Health

• Due to the unique characteristics of public
health a specific strategic planning process
was developed by the National Association of
County and City Health Officials (NACCHO)
and Centers for Disease Control and
Prevention (CDC) called Mobilizing for Action
through Planning and Partnerships (MAPP)

MAPP

• The MAPP process is designed to create a
complete picture of the resources available to the
local public health system

Aids in:
1) Securing resources

2) Aligning needs and assets

3) Responding to external circumstances

4) Anticipate and manage change

5) Establish a long-term direction for improving the
health of the community

MAPP Process

• Step # 1:

Organizing for Success

– This step involves organizing the planning
process and developing partnerships within
the community

– Example: coordinate participation from key
stakeholders and build relationships with
appropriate external institutions

MAPP Process

• Step # 2:

Visioning

– The visioning step engages stakeholders in
a collaborative, creative process of
developing a shared community vision with
common values

– Example: draft vision and values statements

MAPP Process
• Step # 3:

Conducting Community Assessments

Four community assessments provide information
about internal and external environmental trends
relevant to the community:

1) Community Themes and Strengths Assessment

2) Local Public Health System Assessment

3) Community Health Status Assessment

4) Forces of Change Assessment

MAPP Process
• Step # 4:

Identifying Strategic Issues

– Development of prioritized lists of the most
important issues facing the community,
based on the results of the 4 community
assessments and the shared vision/values

MAPP Process

• Step # 5:

Formulating Goals and Strategies

– Develop strategy statements by using the
issues identified in the previous step and
formulating goals

– Example: “decrease childhood obesity by
implementing three new education
programs”

MAPP Process

• Step # 6:

Action Cycle

– Implementation of an action plan to
address priority goals and objectives with
the intent to evaluate progress and make
necessary adjustments

– Example: utilization of the Plan-Do-Check-
Act cycle