Managers/Leaders and Healthcare Organizations

describe the mechanistic model.

-clear job description, rigid vertical chain of command, centralized control, and standardization

-reliance on written communication, rules, and specialized tasks and departments (a traditional bureaucracy)

when is the mechanistic model effective?

when the environment is stable and predictable

describe the organic model.

-flexible structures for quick adaptation to the environment

-vague job descriptions with less specialization

-fluctuating divisions of labor and authority

-high use of information technology

-tasks assigned to teams with autonomy in their work

-committees, taskforces, and teams with liaisons who function across all units

how can healthcare organizations lean to the mechanistic model?

-more efficient with a lower cost/unit

-fewer mistakes because more protocols and highly specialized workers

-many people must work together

-innovation slows down, change is difficult, adaptation to external forces is weak

how can healthcare organizations lean to the organic model?

-allows quicker response

-reliance on interdepartmental coordination

-empowerment of employees to make immediate decisions for reimbursement changes, pt requests, new technology

-less predictability, lower efficiency, increased costs

is there potential to combine these two models?

-depends on the situation

-need to use mechanistic models because of volume of predictable tasks that are simple and routine, or complicated and dangerous (standardized to reduce risks and costs)

-some clinical departments may be more organic models for unpredictable tasks and processes allowing flexible problem solving with worker input

what two skill sets must leaders and managers have?

both mechanistic and organic skill sets

why is a mechanistic skill set needed?

to control costs, provide direction, and progress in established work

why is an organic skill set needed?

to collaborate with others, plan new work, and develop new ideas for services

what is the general agreement about the definitions of leaders and managers?

-leaders guide, set the overall course, and determine the major goals of organizations

-managers implement the plans to accomplish those goals through oversight of combined efforts of others on a day to day basis

what must leaders and managers both do?

-commit to reliance on facts and evidence in business decisions

-find and analyze information to successfully run contemporary healthcare

what are the types of followers?

-isolates

-bystanders

-participants

-activists

-diehards

what is an isolate?

-a completely unengaged follower

-don't care anything about the leader or what they are doing

what is a bystanders?

they are there, but not really making any decisions

what is a participant?

-get involved in something to either be anti or for the leader

-care enough to invest something to have an impact (money, time, etc.)

what is an activist?

-have very strong feelings about the leader (either for or against)

-eager and are engaged

what is a diehard?

will literally die for their cause

what is leadership?

-an influencing process to accomplish an organization's outcomes that reflects the characteristics and behaviors of leaders as they are perceived by their followers

-leadership appears vital, yet outcomes of leaders' efforts are nebulous

what do leaders do?

leader is not really a job title with a clear job description

what are the different perspectives of leaders?

person, results, position, and process perspectives

what are the differences between the perspectives?

-person: is it who leaders are that makes them leaders

-results: is it what leaders achieve that makes them leaders

-position: is it where leaders operate that makes them leaders

-process: is it how leaders get things done that makes them leaders

how can leadership be contradictory?

-on one side: have to be in control and project confidence, be wise, lead, and build systems and teams

-on the other side: have to realize limitations, be modest to avoid self-enhancement, get out of the way, take little direct credit for successful systems and teams

what are lateral leaders?

-lead from alongside rather than from above

-team members may have several lateral leaders

describe how lateral leadership works.

-the more creative, flexible, and self-motivated people need to be, the more centralized (lateral) leadership needs to be facilitated using information technology

-"no leadership is the best leadership" is derived from these concepts

what is needed with lateral leadership?

an executive unit for global responsibility

which population is underrepresented among healthcare executives?

females (although 78% of workers are women)

what are the potential barriers to female leaders?

-poor mentoring for women and other minorities

-lack of opportunities to serve on boards and committees

-gender-based compromises and sacrifices within two-career families

-stereotypes about gender differences in social roles, personality traits, and leadership capabilities

what is influence?

-a mechanism for using power to change behaviors or attitudes

-people feel that decisions made are their choices

-process of acceptance and mutual agreement results in commitment and good work

what is direct power?

-people without influence rely on direct commands

-this leads to employee discontent

-discontent means more supervision for compliance

-leads to more commands

-leads to more discontent

describe management and its importance.

one of the most transforming innovations of civilization - managers play a major role in everyday lives and organizations of any configuration

what is definition of management?

the process of affecting groups of people and manipulating resources that are beyond the scope of individual effort

when do things need to managed?

-when needs exceeds the resources available

-management is a generic, innate ability rather than a set of specialized skills

-span of control is a critical factor in management

what are the types of managers?

-affiliative power managers

-personal power managers

-institutional managers

describe affiliative power managers.

-want to be liked more than they want to get the job done

-makes decisions on what makes people happy

describe personal power managers.

-make employees feel strong

-competitive, but not team players

-decisions are based on 'me' first

describe institutional managers.

-are of service to the organization

-eagerly award performance

-put organization before themselves in decision making

what are the seven principles of management?

-management's task is to make people capable of joint performance so that their strengths are effective and their weaknesses are irrelevant

-management is deeply embedded in all cultures

-management's job is to think through and exemplify an organization's objectives, values, and goals so that people are committed to them

-training and development must be built into every aspect of an organization

-every organization is built on communication and individual responsibility

-a diversity of measures is needed to determine the performance of an organization and its continuous improvement

-the results of organizations are not within its walls. Results only exist on the outside in the satisfied customer, the healed patient, and the student who learned something and who puts that learning into practice over the long term.

what determines the manager's span of control (SOC)?

-type of work

-degree of training of the worker

-organizational stability

-geographical location

-flow of work

-supervisor's qualifications

-availability of staff specialization

-value system of the organization

what is the definition of organizational culture?

"The pattern of shared basic assumptions learned by a group. . .

as it solved its problems of external adaptation and internal integration. . .

which has worked well enough to be considered valid, and,. . .

therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems"

describe the aspects of organizational culture.

-drives all aspects of an organization's decision-making about operations, relationships, priorities, etc.

-provides comfort, meaning, and predictability so reluctance to change it

-deep, pervasive, yet abstract and vague

-defined by observed interactions of people, group norms

what is the goal of healthcare?

-improve access to care

-improve quality of care

-reduce costs and cost acceleration

what does the value of healthcare equal?

quality of care/costs of care

what do healthcare organizations deliver to influence value?

-higher level of quality at the same cost

-the same level of quality at a lower cost

-higher quality at a lower cost

what are some factors that impact healthcare value (quality/costs)?

-new technology increases demand for healthcare.

-insurance premiums are raised to pay for new technologies used.

-new technology does not decrease workforce needs.

-healthcare systems compete for patients.

-consumers cannot easily assess quality, but they expect it.

-consumers are not repeat users of most healthcare.

-emphasize the practice of defensive medicine.

-poor communication occurs among providers and with patients.

-wide geographical variations exist in costs and availability.

-the moral hazard is that consumers become isolated from the actual costs.

-acute care remains the model, but chronic conditions are the problem.

-physician practice rather than populations is the focus of healthcare.

what are some increased demands on healthcare organizations?

-accountability

-unexpected epidemiology

-patient safety

-increased complexity of care

-decreased federal and state budgets

-sharing and privacy of patient information

how are healthcare organizations (public and private) different from other businesses?

-their mission of service to alleviate pain and suffering and restore patients to health

-the complex, highly regulated environment—internal and external—under which they operate

-professional cultures (physicians, nurses, healthcare managers)

-rapidly changing healthcare market

what are shareholders (stockholders)?

-person or organization that owns shares of a for-profit corporation by owning stock in a company.

-share the profits and may be able to vote for board members and be involved in other decisions.

what are stakeholders?

-much broader groups including anyone who has a legitimate interest (stake) in any organization.

-may influence an organization or be affected by it.

what is the relationship between shareholders and stakeholders?

all shareholders are stakeholders but not all stakeholders are shareholders