Healthcare Management Unit 4 Review

the function of management documents

reflect trends, response to change, reflect the corporate culture, transparency, celebration of success, commitment to accountability, communication, historical record of the organization’s development, some plans are mandated by laws or regulations

why do management documents matter in healthcare?

they directly affect patient care and professional practice (determine what services are offered and who gets access, influence staffing levels, training, and workflows, required for licensure, accreditation, and funding, used to demonstrate quality, safety, and accountability to the public)

skills needed from the manager

planning, decision making, organizing, staffing, directing or actuating, controlling

types of management documents

• strategic plan (SWOT analysis)

• annual report (executive summary)

• project proposal (request for project proposal (RFP))

• business plan

• due diligence report

• plan of correction

strategic plan

• a proactive response to change

• combines idealism (mission and values) with realism (goals and objectives)

• a long-range plan of desired outcomes to be accomplished over several years

• usually prepared early in the life cycle of the organization (moving out of youth and into middle-age)

• updated in intervals and/or when a major change occurs (ex: merger, change of ownership)

strategic vs operational thinking

• strategic planning is long term (3+ years), sets direction and priorities, focuses on mission, vision, and future needs, led by executive leadership and boards

• operational planning is short term (annual or daily), focuses on how work gets done, implements the strategic plan, led by managers and department staff

contents of strategic plans

vision and mission statement, core values and principles, a strategic overview of the current state, major strategic goals, an action plan or detailed objectives, the resources needed and their probable source, an evaluation process

step 1 of strategic planning process

define mission and vision, top management directives provided, team framework and timeline developed

step 2 of strategic planning process

in-depth assessment of current circumstances, attention to changes in conditions and clientele network, review of factors and constraints, analysis of strength, weaknesses, opportunities, and threats (SWOT)

SWOT analysis

strengths, weaknesses and challenges, opportunities, and threats. commonly associated with strategic planning

step 3 of strategic planning process

in light of the SWOT analysis: development or reaffirming of existing mission and core values

step 4 of the strategic planning phase

determine goals and objectives or reaffirm existing goals and objectives, identify in detail the resources needed to attain each goal and objective

step 5 of the strategic planning phase

• implementation of the plan

• year-to-year delineation of the objectives

• emphasis on evaluation process each year

• communication of the plan

the annual report

• a detailed summary of the organization’s efforts throughout the designated fiscal year

• reflects the annual plan, which was derived from the long-range master plan, part of the strategic plan

• managers prepare portions of the report dealing with their specific department

• an opportunity to present successes and challenges of each department

• leadership compiles the department reports for an overall summary

• includes information about goal achievement: full, partial, and non-achievement

• part of the evaluation process

usual content of annual report

• performance improvement and quality efforts

• budget issues

• staff development and training

• interdepartmental coordination

• patient and client education

• special projects

• licensure and accrediting agencies may request access as part of the review process

the executive summary

• concise overview of a larger document

• condensed version of the annual report

• major topics are highlighted

• short, to-the-point summary

annual report example

how planning documents connect

1. strategic plan - sets the long-term goals

2. annual plan – define yearly objectives

3. implementation – puts plans into action

4. annual report – measures and communicates results

5. evaluation & correction – adjusts plans as needed

planning

a continuous cycle, not a one-time task

project proposal

• project proposals may be developed from opportunities noted in the

strategic plan

• precedes the project charter

• includes both internal and external project proposals

• may include a Request for Proposal (RFP)

  • announces a project, describes it, and solicits bids from qualified parties to complete it

• as a manager, you may be involved with

  • responding to RFPs from external funding agencies, and / or

  • requesting another organization to respond to your organization’s RFP

project proposal content

• statement of objectives

• methods to achieve objectives

• detailed timeline for project implementation

• budget calculations

• fundraising or other institutional support

• evaluation process, including both internal and external review

the development officer

• designated official within the organization who coordinates project proposals

• different than a Project Manager (PM) or a Project Management Office (PMO)

• monitors funding availability

• initiate contacts with potential donors

• provides assistance with critical issues such as: need for institutional review board or ethics committee review, organization’s eligibility to request certain funds, boilerplate information about the organization (e.g., its history)

business plan

• a tool used in response to a professional opportunity

• details: purpose of a proposed business, describing its products or services, potential clientele, and forecasts for revenue and expenses

• used in the effort to secure funding for a venture

points of consideration for entreprenuers

• may need to obtain clearance from top management if employed by an organization

• attention to conflict of interest rules

• confer with legal and accounting professionals about: self-employment taxes and income, zoning codes and business permits, incorporation

due diligence review (DDR)

• an intense review of legal and financial matters intended to prevent undue

  harm to either party considering involvement in an arrangement with

  significant legal and financial implications

• usually carried out when a merger or acquisition is being considered

• focus is on both assets and liabilities

• highly confidential

focus and content of DDR

• licensure and accrediting reviews (plan of correction)

• financial status and obligations

• grants and special endowments

• pending and recent lawsuits; risk management

• patents, royalties, intellectual property

• equipment inventory

• human resource considerations

the plan of correction (POC)

• formal document developed and submitted to accrediting or reviewing agencies

• a response to specific citations given in the agency’s formal report

• mandatory response

• part of public record

• when the manager is preparing it, it is generally recommended that they:

  • give particular attention to repeat citations/deficiencies

  • address only the specific citations

  • do not use defensive language

  • provide specific supporting evidence for corrective plan for each citation

plan of correction example and why it’s critical

• scenario: infection control citation

  • accrediting agency identifies deficiency

  • organization must submit a formal response

• plan of correction includes:

  • what went wrong

  • how it will be fixed

  • how improvement will be monitored

management commitment to excellence

• an underlying philosophy

• participative management style

• active promotion of the concept

• truly delegate authority and responsibility

• employee empowerment

• intra- and interdepartmental teamwork

management style: authoritarian / autocratic vs participative

autocratic focuses strongly on command by the leader, there’s a clear separation between leader and team members, work tends to be highly structured and very rigid

performance / quality improvement focus

1. continuous quality improvement: focus on standard operations

2. routine, periodic studies stemming from external mandates (ex: joint commission)

3. “debug” new processes (ex: joint commission tracer methodology implementation

4. critical areas of interest (ex: patient safety, revenue cycle, disaster preparation)

when improvement fails

• during the early stages of implementation, the manager must:

  • remain attentive to feedback

  • make necessary adjustments

  • provide clients with assistance in adjusting to the change

• when the data and feedback indicate that the hoped-for improvement has not occurred, the manager must be willing to make the necessary change, including withdrawal of the new process

controlling function of management

the management function in which performance is measured and corrective action is taken to ensure the accomplishment of organizational goals

the basic control process

1. establish standards

2. measure performance

3. correct deviations

the dmaic process

• D: define the project goal and customers/clients

• M: measure the process to determine current performance

• A: analyze and determine root cause(s) of the defect

• I: improve the process by eliminating the defect

• C: control future process performance

who participates in the control process?

• governing board: leadership role; adoption of philosophy of excellence

• line managers: continuous process improvement of routine activities and periodic quality improvement initiatives

• quality improvement teams and committees: interdepartmental cooperation (ex: patient safety studies)

• employees: peer group activities through quality circles and teams

• clients: response to invitation to give feedback (ex: patient satisfaction surveys)

characteristics of adequate controls

• timely

• economical

• comprehensive

• specific and appropriate

• objective

• responsible

• understandable

six sigma (strategy for quality improvement)

• based on statistical analysis of variations in performance measures

• widely used in the 1990s

• managers can get certified in six sigma training

waterfall or cascading impact review (strategy for quality improvement)

• emphasizes early detection and correction so that one error is not repeated and compounded throughout the system

• ex: an incorrect diagnosis which then cascades down to all other aspects of patient care

rapid improvement cycle (strategy for quality improvement)

• emphasizes a short improvement window (a few months)

• may be mandated by federal and state agencies in response to deficiencies

dashboard reporting (strategy for quality improvement)

• timely, concise capture of data

• real time updates

• like the dashboard of a car, we don’t need data on the most minute details of function, but we need an immediate review of the key elements of function

benchmarking

• select a standard of practice against which performance will be measured

• standards may be internal (ex: a department’s best performance)

• standards may be obtained from external sources (ex: a professional association, federal agencies, accrediting organizations)

commonly used tools of control

• gantt chart

• flowchart

• TQM display charts (run chart, histogram, scattergram)

TQM display charts

• run chart: helps identify trends over time

• histogram: patterns; rates and frequency

• scattergram / scatterplot: visualize relationship between variables

• cause-effect / ishikawa diagram / fishbone: problem identification (a form of root cause analysis)

• pareto chart: determining priorities

run chart

helps identify trends over time

histogram

histogram: patterns; rates and frequency

scatterplot

visualize relationship between variables

pareto chart

helps determine priorities

control process vs directing-coordinating-control

basic control process:

1. re-evaluation of standards

2. ensure accurate performance measures

3. positive steps to implement corrective action

• charting the course (where do we want to go, how will we get there, how close are we?)

directing-coordinating-control process

1. progress is evaluated based on the standards set in the basic control process

2. new decisions are made as work progresses

• actively “coaching” through it (are we doing the work appropriately?)

the importance of follow up

• make new decisions, or re-enforce original decisions based on the findings of the various performance studies

• use the findings to adjust work processes based on current information

human resources as a vital staff function

• engages in acquiring, maintaining, and retaining employees so that the objectives of the organization may be fulfilled

• offers a variety of support services including personnel policy and guidance

• proactive assistance

primary functions of HR

1. employment (recruitment)

2. compensation (wage and salary administration)

3. benefits administration

4. employee relations

factors increasing the value of HR services

• increase in employee related tasks

• proliferation of laws pertaining to employment

• effects of flattening the organization chart

flattening

compressing the organizational hierarchy by removing layers of management and moving the essential elements of the eliminated position to an adjoining management level (up or down)

employment as an HR function

advertising for applicants, screening, referring applicants, checking references, extending offers of employment, bringing employees into the organization (onboarding)

compensation as an HR function

process of creating and maintaining a wage structure and ensuring that this structure is administered fairly and consistently

benefits administration as an HR function

consists of maintaining the organization’s benefits structure and assisting employees in understanding and accessing their benefits (benefits are part of an employee’s total compensation)

employee relations as an HR function

dealing with employees and their problems, needs, and concerns (may include complaints and appeals, processing disciplinary actions, arranging employee recognition and recreation activities)

additional HR functions

• labor relations (typically associated with unionization and unions)

• employee health

• training

• payroll

• security and parking

• safety

• childcare

employee evaluation / performance appraisal process

• HR provides overall assistance through guidance about employee evaluation and performance appraisals so there is uniformity across the organization

• as the manager, you perform the evaluation / performance appraisal

• different reviews for different time frames (annual review, final review, etc)

• HR can review patterns in the manager’s rating practices

• HR can help, as the manager, avoid evaluation of inflation and deflation

review disciplinary actions and separation from the organization

• in most situations the manager decides on disciplinary action

• HR works with the manager to follow proper process and documentation

• in most organizations its a requirement for the manager to take proposed disciplinary actions through HR before implementation of any separation

• the manager works with HR and other departments to account for and turn in keys, passwords, IDs, invalidate passwords, freeze computer and file access, complete final evaluation of worker’s performance (the line managers responsibility)

documentation

the key to showing due process and following procedures (if it wasn’t documented, it wasn’t done)

exit interview

conducted by HR and is different than an evaluation/performance apparaisal

how managers help HR

• reactions and comments on personnel policies

• employee perceptions of pay and benefits

• comments ons services (positive or negative)

• employee feedback on benefits

• suggested changes in recruiting or retention practices

HR is a balance

• protective of employees

• concerned for the rights of employees (micro)

• equally concerned for the organization as a whole (macro)

• aware of the necessity for proper documentation of procedural steps

• protective of the organization against legal risks

national labor relations act (NRLA) of 1935 (Wagner act)

• protected the rights of private sector employees to organize into trade unions, engage in collective bargaining, and take collective action such as strikes

• in 1975, the health care amendment provided hospitals with certain legal protections (required 10 days’ notice before picketing, strike, or other concerted refusal to work)

• if there is a union in place, a lot of the manager’s behavior will be governed by a collective bargaining agreement

• the manager’s primary source of guidance needs to be the HR department

fair labor standards act (FLSA)

• federal wage and hour law

• wage and hour law spells out:

  • who is to be paid for what and how

  • who can be exempt (exempt from overtime provision)

  • who must be considered nonexempt

• managers often need to answer employees’ wage and hour questions

• the manager’s primary source of guidance needs to be the HR department

equal pay act (EPA) of 1963

• amended the fair labor standards act

• required FLSA covered employers to provide equal pay for men and women who are performing the same work

• was extended beyond employees covered by FLSA

civil rights act of 1964

• ended segregation in public places and prohibited discrimination on the basis of race, color, religion, sex or national origin in any term, condition, or privilege of employment

• enforced through the Equal Employment Opportunity Commission (EEOC), title vii covers:

  • all private employers of 15 or more persons, all educational institutions, both public and private, state and local government, public and private employment agencies, labor unions with 15 or more members, joint labor-management committees for apprenticeship and training

• civil rights act of 1991 increased the financial damages against organization found guilty of discriminatory practices

• EEOC investigates job discrimination complaints (active employees and job applications)

• the civil rights act has made the greatest impact on the workload of the HR department

• the manager’s primary source of guidance needs to be the HR department and legal counsel

laws and regulations impacting employment

• title vii of the civil rights act of 1964 includes protections against sexual harassment

• in recent years, sexual harassment has been one of the 2 leading causes of legal complaints against employers (the other is age discrimination)

• includes protections against sexual harassment, which may take the form of:

  • quid pro quo harassment (job benefits that are tied to sexual favors)

  • hostile work environment harassment

• sexual harassment is not limited to the physical workplace and can occur through work-related events, business travel, emails, texts, or online communications related to work

americans with disabilities act (ADA) of 1990

• affirmed the right of persons with disabilities to equal access to employment; services; and facilities available to the public including transportation and telecommunication

• requires that employers provide reasonable accommodation for disabled individuals who are capable of performing the essential functions of the position for which they apply

• court decisions have led to increasing the number of conditions that may be considered disabilities

family and medical leave act (FMLA) of 1993

• made it possible for an eligible employee to take up to 12 weeks of unpaid leave in a 12 month period for certain specified reasons without loss of employment

• qualifying reasons include:

  • birth of the employee’s child or the care of that child up to 12 months of age

  • placement of a child with the employee for adoption or foster care

  • employee to care for a spouse, child, or parent having a serious health condition

  • employees own serious health condition

• law has expanded to include military caregiver considerations

• an employee returning to work within their 12 week limit must be returned to his or her original position or to a fully equivalent position in terms of pay and benefits and overall working conditions