Unit 3 Healthcare Management

What are healthcare budgets?

tools to help an organization achieve its mission and align with the law; define goals and ensure that resources are directed to achieve those goals

The big picture strategy is set by who?

board of directors

What is the revenue cycle?

money in and money out

What makes the revenue cycle complicated? What are the most common sources of revenue?

numerous revenue sources, variations in numbers of patients; medicare and insurance (operating) and grants (non-operating)

Major budget categories

capital expenses, supplies, special expenses, personnel budget

What is a budget?

a plan expressed in terms of projected activity and proposed expenditures

What is the budget as a plan?

statement of anticipated results; a basis for future or continuing plans; a statement of intended accomplishments (more than a forecast or guess)

What is the budget as a control tool?

provides accountability; basis for monitoring the use of resources; a basis for comparison of planned vs. actual performance

Fiscal year

defined, sequential period; most common cycle (often same as calendar year)

Long range budget

associated with special projects and/or capital improvements; may cover three to five years

periodic moving budget

as each period is completed, an equal time period is added; allows manager to use most up-to-date projections

milestone budgeting

associated with major initiatives; budget periods are not uniform; they are tied to the project timeframe for the major activities of the project

operating budget includes:

statistical, expense, revenue, capital, cash budgets

zero based / planning-programming budgeting system

planning oriented; past dollar allocations not the basis for new projections; cost justification based on various aspects of project; longer time periods; time consuming; may open old conflicts; best for one-time, major project

incremental budgeting

immediate past year(s) budget is increased by some percentage; generally used with annual budget period; an efficient, practical approach when no major changes are anticipated; object oriented; significant changes may be overlooked; ongoing programs, methods, practices are not challenged

What is the initial preparation for the budget process?

overal limits are set by top level management; assumptions are updated and reviewed by department manager; priorities and initiatives for upcoming year are noted; detailed projections of income and cost are developed

the budget reference portfolio

part of over-all management reference portfolio; has specific info on budget; can review wheel book for information about systems and equipment

Budget process of review and approval

justification review with senior officials; compromise, bargaining; cost entertainment review; external review by public review boards

What entails budget justification?

support documentation for specific requests

Budget implementation

approved allocation is activated, periodic reconciliation of planned vs. actual expenses; budget variances accounted for; potential for budget cuts or budget freeze with a contingency plan made; periodic internal and external audit

The budget cut

reduce or eliminate specific expenditures; tie to budget justification information; identify categories of desired vs. essential expenditures; identify categories that cannot be cut

Primary purpose of variance analysis

to obtain information with which to improve financial planning and to correct practices that affect expenditures

What is budget variance analysis

verify the accuracy of posting; review specific object codes; review codes where actual costs are under budget

The audit trail

track each expenditure from its approved budget entry through its actual expenditure; allows catching of errors

Managers want to shape employees’ ________

knowledge, skills, attitudes

inadequate orientation and training lead to what?

increase in short-term turnover

What are the important management functions for employee training?

planning, organizing, directing, controlling

employee development

required as part of licensure and accreditation; can be included as a labor contract stipulation; part of continuity of operations and succession planning; important aspect in promoting employee satisfaction

General orientation includes

brief history of organization and mission; identification of departments and services; employee policies; chart of development; department policies and procedures; productivity

standards of conduct and behavior

conflicts of interest; use of organizational assets and information; referral practices; employee privacy; patient confidentiality; employee relationships

examples of conflict of interest

financial interests, research funding, ownership interests, gifts and perks, and employment relationships

Are business emails private?

no

components of an effective training program

identify training needs; establish training objectives; select appropriate methods and techniques; implement the program; evaluate the training outcomes

identification of training needs

comparison of job requirements with current or new employee skill set, analysis of performance ratings, analysis of personnel records, analysis of short and long term plans, analysis of current trends, laws, and standards

components of training objectives

statement of focus, level of mastery or acceptable performance, conditions associated with the work tasks, time frame or performance standard for each stage of the training program

training methods and techniques

job rotation, formal lecture presentation, seminars and conferences, role playing, committee assignments, case studies, mentoring and peer pals, coaching

implement the program

monitor the physical and psychological environment, provide the best possible educational impact while maintaining work output, control the pace and timing of the training to help maintain engagement

evaluation of outcomes

direct before and after comparison, fact tests, performance tests based on work content, evaluation in stages

how to address diversity?

attentive to diversity in the workforce and in patients, cultural diversity and proficiency, generational diversity, need for visible support and involvement of top management, need for repeated and reinforced diversity training

resources for training

professional association materials, distance learning, shared learning activities among departments

clinical affiliation

fulfills mission of healthcare organizations for research and education

organizational leadership determines what?

overarching policies for receiving students

management does what?

prepare department and staff for receiving them

What are the benefits of receiving sutdents?

fulfill organization mission, allow sites to see potentially good future employees, students can help identify good potential employers

clinical affiliation contract

elements include importance of definition of trainee, liability insurance is covered by academic institution, intellectual property and copyrights

it is hard for individuals to see how they fit into a large organization because

they are decentralized and specialized

adapting to organizational life is

the need to get work done efficiently and effectively; leads to a need to motivate workers and help them fit the organization; leads to a decrease in the need for control and disciplinary action

fostering integration into the organization

work rules, sanctions, selection, training, identification with organization, the work group

the art of motivating

built on recognition of human needs, desire within an individual to pursue some goal

bases of motivation

questioning and observation of existing work situation, review of cultural expectations concerning work, studying the work of management theorists

motivational strategies

performance appraisal, job rotation, enrichment, and enlargement, delegation, awards and honors, career ladders and parallel path progression system

appreciative inquiry

approach to organizational change, development and assessment, identify what is working well by actively recalling successes, affirm the best of the individual and group experiences, build on the positive outcomes to envision continued improvement

model for analyzing organizational conflict

basic conflict (overt hidden agenda and source of conflict), the participants (immediate, secondary, audience), provision of arena, development of rules, strategies for dealing with the conflict

sources of conflict

nature of the organization, organizational climate, organizational structure, individual vs. organizational needs, solutions to previous conflicts

progressive discipline

counseling, oral warning, written warning, before suspension, suspension and discharge → escalating consequences that allow employees opportunities to correct their behavior

collective bargaining agreement

address most or all of elements in model agreement; contractual conditions will limit decision-making flexibility, essentially providing premade decisions

communication

verbal, nonverbal (body language) → these are inseparable and both critical; the exchange of ideas, thoughts, or emotions between or among two or more people; the transfer of meaning and the development of mutual understanding, process of exchanging information in such a way that mutual understanding is achieved between two or more people

communication is a skill that is

commonly overlooked, underrated, difficult; requires skill at individual and group levels; awareness that there is an increasing level of complexity as the number of people involved is increased; conscious effort to make effective

manager’s day to day communications

receiving → delivering → coaching, counseling and disciplining → interviewing and selecting → networking → connecting → responding

face to face communication

involved parties have direct verbal and nonverbal communication and have the opportunity for immediate feedback and response; strongest means of communication

informal and formal

hallway conversations - meetings

communication via voicemail or video message

initial transmission is rapid, can convey information w/o direct connection, recipients have verbal communication but not nonverbal (unless video), can provide a record, opportunity for feedback and response is delayed; timing of response is dependent on the recipient

communication via email and texts

only the words are available to convey the meaning; feedback and responses can range from immediate to never; most highly dependent on accuracy in the choice of words and phrases; can provide written record; editing and rewriting are still necessary

communication via letters and memos

only words are available to convey meaning, feedback and response are generally the slowest, highly dependent on accuracy in choice of words and phrases; provide written record

memos and letter considerations

one way, focus on clarity, write for specific audience, avoid unneeded words, simple and direct language, edit and rewrite

email considerations

avoid misuse, no unimportant or personal information, eliminate junk emails, deal with message only once, avoid accumulating, edit and rewrite, not private

necessary components of communication

initiation, transmission, reception, feedback

effective communication

in which the receiver receives and understands the message as the sender intended it

methods of improving communication

observing (perceiving events, objects, and people), attending (active listening), responding (verbal/nonverbal, quality of response shapes remainder of communication), checking (checking through repeating with exactitude, paraphrasing, and/or asking for feedback)

flow of formal communication channels

upward (lower to higher levels), downward (higher to lower levels), diagonal (b/w positions that are on different hierarchical levels and perform different activities in terms of the organizational structure), and lateral (across department or among peer managers, coworkers in charge of different activities)

is informal communication directional?

no

grapevine

informal channel of communication in an organization

communication barriers

nonverbal, verbal, choice in language

human communication barriers

unconscious motives and biases, psychological factors, culture

organizational barriers to communication

organization size, logistical factors, overstimulation, organizational structure, phases in life cycle

SBAR method

provides framework for communication for important info to be conveyed clearly and concisely, helps reduce misunderstandings and errors - improve patient safety, facilitate quick and effective information exchange in critical situations, encourages all team members to have a voice

SBAR steps

situation - concise statement of problem

background - pertinent and brief information related to the situation

assessment - analysis and considerations of options (what you found/think)

recommendations - action requested/recommended (what you want)