Notes on CHAPTER 1 and CHAPTER 2: Health, Healthcare, and Management in Healthcare Organizations
CHAPTER 1: HEALTH, HEALTHCARE, AND HEALTHCARE ORGANIZATIONS
Learning Objectives (Chapter 1)
Explain what health and population health are.
Describe major forces that determine the health of a population.
Identify types of health services in the continuum of care.
Identify types of healthcare organizations.
Explain external environment and how it affects healthcare organizations.
Describe trends that will affect healthcare organizations in the future.
Appreciate the variety of healthcare management jobs and careers.
Using Determinants of Health (determinants and HCOS use)
HCOS use five determinants of health to improve health of individuals and to improve health of local populations.
To improve health, HCOS improve and help people improve:
healthcare
individual behavior
physical environment
social environment
HCOs cannot improve people’s genetics but can use genetics to better predict, prevent, diagnose, and treat health problems.
Health Disparities
Differences in health associated with economic, social, and/or environmental disadvantage.
Health disparities adversely affect groups facing greater obstacles to health based on characteristics.
Examples of characteristics associated with health disparities include race/ethnicity, geographical location, gender, etc. (student note: see full list in transcript).
What Is Health?
Health: a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity.
Population Health
The health outcomes of a group of individuals, including the distribution of outcomes within the group.
HCOs' Focus
Historically focused on improving health of individual patients.
Now many HCOs also focus on improving health of local populations.
Five Determinants of Health (broad forces)
Genetics
Healthcare and Health Services
Individual Behavior
Physical Environment
Social Environment
(These five broad forces interact to determine overall health outcomes.)
Healthcare Services and Continuum of Care (CoC)
Health services span a wide range of care types:
Acute care
Assisted living
Chronic care
Dental care
Health promotion
Hospital care
Mental health care
Personal lifestyle care
Preventive care
Rehabilitative care
Skilled nursing care
Subacute care
Adult day care
Behavioral health care
Community health services
Diagnostic care
Home care
Inpatient services
Office-based care
Physician care
Primary care
Respite care
Specialty care
Urgent care
Ambulatory care
Chiropractic care
Complementary care
Emergency care
Hospice/palliative care
Long-term care
Outpatient services
Post-acute care
Public health services
Self-care
Sports medicine
Virtual care
Continuum of care is a tool to plan which services to provide in which sequence to meet healthcare needs of a person or population.
The continuum helps improve coordination of services among HCOs and staff.
The complete continuum provides all services needed during a person’s life.
Smaller CoCs are used for specific healthcare needs (e.g., obstetrics, cancer, adolescent behavioral health).
Example: University of Pittsburgh Medical Center Rehabilitation Institute uses a rehabilitation CoC that includes inpatient, outpatient, community, and home-based services.
External Environment and Stakeholders
External environment: factors outside the HCO that influence it (people, organizations, trends, events, developments).
Stakeholders: people and organizations with a stake in what the organization does (for a designated organization).
An HCO exists in, is influenced by, and must adapt to its external environment; environment is mostly beyond the HCO’s control.
Examples of stakeholders include: employees, creditors, patients, physicians, media/press, government, neighbors, vendors/suppliers, accreditation commissions, special-interest groups, other HCOS.
External environment affects HCOS; HCOS depend on external environment, must interact effectively with it, and can influence it.
HCOs and External Environment: Managers work in many types of HCOS
Accountable care organizations
Ambulatory clinics
Consulting firms
Diagnostic centers
Health insurers
Health care associations
Medical supply companies
Mental health organizations
Outpatient surgery centers
Personal care homes
Pharmaceutical businesses
Physician practices
Health-related charities, advocacy groups
Public health departments
Home care businesses
Rehabilitation centers
Hospitals
Research institutions
Integrated health systems
Respite care facilities
Other specialized areas and roles for managers
Business development
Clinical integration
Digital health
Diversity and inclusion
Facilities management
Finance
Government relations
Human resources
Information systems
Logistics for supplies and equipment
Marketing and public affairs
Medical affairs
Patient access
Patient experience
Population health
Professional services
Strategic planning
Transformation
Continuum of Care: How HCOs use CoC in practice
CoC is a tool to plan services in sequence to meet needs and coordinate care across the system.
The complete continuum provides end-to-end services across a person’s life.
Smaller CoCs can be designed for specific needs (e.g., obstetrics, cancer, adolescent behavioral health).
Healthcare Trends and Future Developments (factors shaping HCOs)
COVID-19 and new diseases
Demographics
Diversity, equity, and inclusion
Financing, cost, value-based payment
Consolidation
Digitization, big data, and AI
Connectedness (e.g., retail health, patient experience)
Population health
Workforce challenges
Sustainability and going green
Clinical care, staff, and performance
External Environment Sectors (influence on HCOS)
Industry competitors and partners
Customers and potential customers
Suppliers of equipment, supplies, services
Human resources and labor
Governments, laws, court decisions
Financial institutions and services
Technology and innovation
Economic forces and developments
Social forces and developments
Notes on CoC usage and Trends (summary)
CoC helps align services over a person’s life; supports coordination and efficiency.
Contemporary trends push HCOS toward data-driven care, equity, sustainability, and workforce resilience.
Chapter 2 Preview (transition to Management):
The material from CHAPTER 1 lays the groundwork for understanding management within HCOS, including the external environment, determinants of health, and the continuum of care that managers must navigate.
CHAPTER 2: MANAGEMENT
Chapter Overview and Learning Objectives
Define and explain management.
Describe how management has evolved as a field of knowledge, theory, and practice.
Explain major theories of management.
Identify important roles, functions, activities, and competencies of healthcare managers.
Explain how management theory is used to manage healthcare organizations.
What Is Management? (Key ideas)
Management is the process of getting things done through and with people by directing and motivating the efforts of individuals toward common objectives.
Management always involves people—usually many of them.
Health is determined by five broad forces (genetics, healthcare, individual behavior, physical environment, social environment); managers can influence all determinants except genetics directly.
Healthcare services range along the continuum from prenatal care to end-of-life palliative care, forming a continuum of care (CoC).
HCOs exist in and are influenced by external environment; managers must adapt and respond to environment.
Managers work in many types of jobs and HCOS.
Toolbox concepts: five determinants of health, continuum of care, stakeholder analysis.
History and Evolution of Management Theory (why study and what it adds)
Studying management theory provides tools to analyze past problems, identify patterns, and guide future problem-solving; helps motivate employees and achieve organizational goals with work satisfaction.
Taylor and Scientific Management
Scientific Management emphasizes standardization, specialization, and scientific analysis to design jobs for efficiency and productivity.
Work is based on objective analysis, not personal preference.
Tools and methods maximize productivity while minimizing injury; ergonomic/human engineering concepts are used.
Detailed instructions, methods, rules, techniques, training, and time allowances are developed for each job.
Goal: work smarter, not harder.
Fayol (Administrative Theory)
Integrated set of ideas to organize work, positions, departments, supervisor-subordinate relationships, hierarchy, and span of control to design an organization.
Key principles include planning, organizing, commanding, coordinating, and controlling; division of work, specialization, coordination, authority within an organizational structure.
Weber (Bureaucratic Theory)
Employees operate within a hierarchal system governed by rules, standards, and discipline.
Authority is formal; the organization is managed according to written documents.
Hiring based on qualifications and ability, pay based on position/responsibility, promotions based on seniority and achievement.
Mayo and Human Relations
Management includes social and psychological factors.
Emphasizes employees’ feelings, motivation, organizational culture, group behavior, and job design.
Managers need both technical and diagnostic skills plus interpersonal skills to counsel, motivate, lead, and communicate with employees.
Supports a top-down approach but values human relations and motivation.
Gulick and Urwick: Management Functions
Five fundamental management functions: Planning, Organizing, Staffing, Directing, Controlling.
Supporting concepts: Division of Work, Specialization, Coordination, Authority.
Organization chart example illustrating how tasks and authority flow from the board to the CEO to departments and individuals.
Drucker and Management by Objectives (MBO)
Managers should focus work on performance objectives.
Emphasizes aligning employee activities with organizational results.
Example structure shown with roles like Secretary, Medical Director, Director of Finance, Director of Patient Care, Director Administration, and functional areas (Accounting, Nursing, Marketing, etc.).
Unity of Command and Span of Control; Centralization
Unity of Command: each employee should report to one boss.
Span of Control: number of subordinates a manager can effectively supervise.
Centralization vs. Decentralization: degree to which decision-making is concentrated at the top.
Bertalanffy, Boulding, and Open Systems Theory
Open Systems Theory: organizations are influenced by and interact with their external environment; they import resources and export outputs to sustain themselves.
Emphasizes the need for organizations to be responsive and adaptable to environmental changes.
Lewin and Organization Development (OD) Theory
OD aims to increase the health of social and technical systems (work processes, communication, shared goals).
Uses interventions to improve organizational effectiveness and health.
Common OD methods include team-building, interdepartmental activities, employee participation, group dynamics, autonomy and fairness, constructive conflict resolution, organizational and process redesign, culture change, respect and trust, and employee empowerment.
Meyer and Rowan; DiMaggio and Powell; Institutional Theory
Society creates customs, beliefs, standards, ethics, norms, and values that become institutionalized.
Organizations that comply with societal expectations are viewed as more legitimate, potentially increasing stakeholder support and resources.
Managers sometimes fulfill institutionalized expectations even if not the most efficient choice.
Institutions shape organizational behaviors and structures; legitimacy can influence funding, sales, accreditation, and resources.
Mintzberg’s Management Roles (three groups of ten roles total)
Interpersonal Roles: Figurehead, Leader, Liaison
Informational Roles: Monitor, Disseminator, Spokesperson
Decisional Roles: Entrepreneur, Disturbance Handler, Resource Allocator, Negotiator
These roles reflect how managers spend time and the variety of tasks they perform.
Woodward and Contingency Theory
Contingency Theory: the best organizational structure depends on various factors (environment, purpose, plans, size, technology).
There is no one-size-fits-all approach; management style and structure depend on context.
Katz and Management Skills
Technical Work: proficiency in a specialized domain and tools.
Human/Interpersonal Work: ability to work with people, motivation, communication, leadership.
Conceptual Work: ability to see the organization as a whole, strategize, and understand abstract relationships.
Institutional Skills and Management Roles: integration of technical, human, and conceptual capabilities with organizational and leadership responsibilities.
Applications: examples range from creating job descriptions to budgeting and population health goal setting; involves envisioning future goals and planning how relocation or other changes affect access to care.
Key Takeaways about Management Theory
Although managers perform similar roles, they do not perform them the same way; individuals bring different personalities, attitudes, worldviews, biases, styles, and situational needs.
Management is a blend of art and science; scientific research and theory guide practice, but context matters.
“There is no single best way to organize (or lead, etc.); instead, it all depends.”
Toolbox and Reference Concepts (from the chapter)
Five determinants of health model
Continuum of care (CoC)
Stakeholder analysis
Administrative Theory, Open Systems Theory, Organizational Development, Contingency Theory
Scientific Management
Organizational charts and lines of authority
Management by Objectives (MBO)
Mintzberg’s management roles
Katz’s management skills
Practical Implications for Healthcare Managers
Managers must navigate a broad external environment consisting of regulatory, economic, technological, social, and competitive forces.
They must design and adapt CoCs to meet diverse patient needs and to coordinate care across settings.
They should apply appropriate management theories and tools according to context, while developing skills across technical, human, and conceptual domains.
Real-World Relevance
Trends like digitization, AI, population health, and value-based payment require new management approaches and open systems thinking.
Understanding institutional expectations helps balance legitimacy with efficiency and innovation.
Summary of Core Connections
Health determinants inform where managers intervene (notably excluding genetics directly).
The CoC guides service delivery across the life course and informs organizational design and collaboration.
A diverse toolkit of theories (from Taylor to contingency) supports managers in different HCOS contexts.
Leadership requires balancing technical proficiency with people management and strategic thinking to achieve organizational health and population health goals.
Quick Reference List (recap)
Five determinants of health: genetics, health services, individual behavior, physical environment, social environment.
Continuum of care: a lifelong service range; enables coordinated care.
Key management theories: Scientific Management; Administrative Theory; Bureaucratic Theory; Human Relations; Open Systems Theory; OD; Institutional Theory; Contingency Theory; Mintzberg roles; Katz skills.
Core management functions: Planning, Organizing, Staffing, Directing, Controlling (plus Division of Work, Specialization, Coordination, Authority).
Objective-focused management: Management by Objectives (MBO).
Open, adaptive systems: organizations interact with and adapt to their external environment.