BHSC2970A: Leadership & Mgt in Hlth Care Exam 2

Ignaz Semmelweis

- Aseptic technique

- Midwives wash hands and have better outcome

Florence Nightingale

- Helped develop standardized nursing education

- Evidence-based medicine

Donabedian elements of quality

Structure, process, outcomes

Special cause vs common cause variation

Special-cause: unexpected

Common cause: 90% of process variation, inherent in the system

Root cause analysis

Used to analyze serious adverse events (patient injury that does not lead to death). The error is due to the system NOT the individual.

- Considers active and latent errors

FOCUS

Find problem, Organize team, Clarify, Understand data, Select process improvements

PDCA

Plan, do, check, act

Six Sigma

- Aims to eliminate variation (errors/defects)

- Downside: requires personnel

- DMAIC: Define scope of work, Measure, Analyze, Improve, Control

Lean

- Getting rid of waste

Pareto chart

- Contributions to a common effect

- 80% of consequences come from 20% of causes

The Quality Gap

Difference between health care processes or outcomes observed in practice and those thought to be achievable with the most current and effective professional knowledge.

Patient Protection and ACA

Looks at unnecessary hospital readmissions within 30 days

Pay for Performance

Linked to fee-for-service, pay based on quality so outcomes are better

National Committee for Quality Assurance (NCQA)*

NCQA is private, nonprofit organization to which health plans report on quality of care delivered to members enrolled in health insurance plans

True or myth? Motivated workers are more productive

Myth

Herzberg's two-factor view of needs

Looks at environment:

motivators (+): not needed for satisfaction, but nice

hygiene factors (-): company policy, salary

McClelland Learned Needs

Achievement, power, affiliation

Great Man Theory of leadership

Leaders are born

Adaptive leadership

Focuses on the organization

4 Competencies of Emotional intelligence

Self-awareness (very important), self-management, social awareness, relationship management (social skills)

Responsibilities of HR

Sustain organization, maintain staff, implement methodologies and strategic plans for training/evaluation

Benefits

-Compensation that are not salary, 25% of base pay

- Includes healthcare, moving expenses, PTO, retirement plans, flexible spending accounts, etc.

Taxing bonuses

Bonuses are taxed higher than salary (30-45%)

Mission vs vision statement

- Mission statement: current focus/aim

- Vision statement: future

GAP analysis

Internal evaluation of current performance compared to desired performance

SWOT

- Strengths, weaknesses, opportunities, threats

- Looking at a company against competitors

-External and internal evaluation

Five Forces Framework

- Rivalry (competition)

- Threat of substitution

- Buyer power (customers)

- Supplier power

- Threat of new entrants

PESTEL

-Political factors, Economic factors, Sociocultural factors, Technological factors, Environmental factors, Legal factors

-Framework to analyze external events and trends

6 primary elements of a quality program

Safety, effectiveness, patient-centered care, timeliness, efficiency, and equity

Expectancy theory

Job outcomes, valences, instrumentality, expectancy

Job analysis

Necessary to define a job for recruitment purposes

Performance appraisal goals

- identify areas of performance needing improvement

- adjust compensation based on performance

- help to decide on promotions of staff

Why does an HSO need to pay close attention to how its pay scales compare to other HSO's?

Lower pay will reduce expenses but may also reduce the quality of the workforce AND high pay may lead to higher productivity

Human resource decisions need to be strategic because...

of increasing competition among HSO's

Contingent ethics is association with mission, vision, or values?

Values

What is a statute?

Statute = a law

3 domains of health policy

bioethics, public health, healthcare

Does federal or state law usually overrule?

State law (think Roe v. Wade)

3 branches of U.S. government

Legislative: congress, senate

Executive: president

Judiciary: judges

Clinton's Health Reform Plan

Problems: limited freedom of choice, $$, bureaucracy

Are medicare and medicaid federal or state programs?

- Medicare: federal

- Medicaid: state

When was private health insurance introduced?

During the great depression (1930s)

Health Information for Economic and Clinical health Act (HITECH)

Use technological to improve quality and outcomes

Emergency Medical Treatment and Labor Act (EMTALA)

Cannot turn away patients based on their ability to pay, citizenship status, etc. If you can't treat a patient you must transfer them

Federal anti-kickback statute/Stark Law

Cannot refer for your own benefit

Phantom billing

Billing on a patient that doesn't exist

Up-billing

Say it took more time than it did

Unbundling

Taking apart combined charges for a service

Who oversees medicare and medicaid?

Department of Health and Human Services (DHHS)