Reflect upon and integrate course concepts

Modular Learning Objectives By the end of this module, the student shall be able to satisfy the following outcomes expectations: - Module o Reflect upon and integrate course concepts (Module 6) o Prepare and submit a self-reflective essay (SFE) - TD o Participate in a threaded discussion in which you will reflect on course concepts (TD) As your study in this course draws to a close, it is important to integrate the course content to ensure a comprehensive understanding of the concepts presented in each module. It is also important to "step back" and reflect on new levels of understanding, skills, and knowledge that were developed as a result of your efforts put forth throughout this course. It is particularly important to reflect on the course objectives (what you were intended to learn in this course). The course objectives were: 1. Distinguish and compare the roles of leaders and managers and aspects of effective management. (Module 1) 2. Discuss the attributes of Quality management (Module 2) 3. Explain and outline organizational design, structure, and methods of work organization within health care organizations. (Module 3) 4. Describe professional integration as it pertains to healthcare organizations. (Module 4) 5. Explain adaptability and accountability in the context of health care delivery systems. (Module 5) 6. Reflect upon and integrate course concepts (Module 6) To close out this course please proceed to the module 6 threaded discussion forum and then the Self-Reflective Essay. Course Summation Many times, when working through a step-by-step or module-by-module course, we may lose the "big picture". So the intent of this module is to close the circle, and provide you the student with a clear aggregate summation. We have presented to you the essential foundations, and provided the building blocks. As always, it is up to YOU, to add common sense and personal experience, to the specific situation and environment. Highlights Module 1 - Leadership & the Role of Managers 1. In order to establish and operate an effective program or organization, all managers perform 5 major functions: Planning; Organizing and staffing; Leading; and Controlling. 2. Bateman and Zeithaml define an effective manager as: an active leader who creates a positive work environment in which the organization and its employees have the opportunity and the incentive to achieve high performance. Effective Management - There are four key components to effective management: 1. Managers as Leaders 2. Positive Work Environment 3. Opportunity for High Performance 4. Incentive to Achieve High Performance Module 2 - Quality Management Introduction 1. Outside of the healthcare industry, quality is defined as exceeding customer expectations. In applying TQM in healthcare, experts have viewed customer satisfaction as one of three dimensions of quality: a. Patient Quality :whether the service gives patients what they want; b. Professional Quality: professionals' views of whether the service meets patients? needs as assessed by professionals (outcome is one measure), and, whether personnel correctly select and carry out procedures which are believed to be necessary to meet patient?s needs, (process); and c. Management Quality: the most efficient and productive use of resources to meet client needs, without waste and within limits and directives set by higher authorities. (Ovretveit,1992) 2. TQM and CQI (continuous quality improvement) have emerged in Europe over the last ten years as a distinct approach to improving quality which may be more cost-effective than other approaches. It is useful to distinguish between two aspects of TQM: a. TQM as an organization-wide approach and philosophy, with a strategy for organization and personnel development, a quality management and information structure. An example of this aspect of TQM is the "Baldridge" quality award framework and its many variations (EFQM, SUK, QUL, NKP, FQA). b. quality team methods and frameworks for process improvement. 3. In European healthcare many different activities are carried out under the name of total quality management. Two definitions distinguish TQM from other approaches. TQM is has been defined as, "A comprehensive strategy of organizational and attitude change, for enabling personnel to learn and use quality methods, in order to reduce costs and meet the requirements of patients and other "customers" (Ovretveit (1996)). 4. A definition given by US theorists emphasizes that TQM is a management method: "TQM/CQI is simultaneously two things: a management philosophy and a management method". They propose four "distinguishing characteristics or functions", which are "often defined as the essence of good management: a. empowering clinicians and managers to analyze and improve process; b. adopting a norm that customer preferences are the primary determinants of quality and the term "customer " includes both the patients and providers in the process; c. developing a multidisciplinary approach which goes beyond conventional departmental and professional lines; and, d. providing motivation for a rational, data-based cooperative approach to process analysis and change" (McLaughlin and Kalunzny (1992). 5. Main components of TQM - Another way to define TQM is in terms of different "components", and this type of definition can help to assess the degree to which an organization has adopted TQM: a. Customer focus - internal and external. b. Process analysis. c. Quality project teams. d. Simple methods used in a systematic way to analyze quality problems, plan change, and evaluate the results. e. Data - to identify and analyze problems and to evaluate the results of change. f. Change implementation (the most difficult of these components to carry out in healthcare, because of complexity and because of the power and autonomy of many professions). 6. Some theorists take the view that TQM should also involve a system perspective, working to control unwanted variation in process performance using statistical process control methods (SPC), as well as Quality Function Deployment to match customer needs to organizational capability (Ishikawa (1992) Module 3 - Organizational Design and Culture Introduction 1. "To understand how the professional bureaucracy functions in its operating core, it is helpful to think of it as a repertoire of standard programs - in effect, the set of skills the professionals stand ready to use - which are applied to predetermined situations, called contingencies, which are also standardized." (Mintzberg). 2. Once an organization has decided on its mission, goals and objectives, the leadership must identify and designate the tasks, personnel, and equipment and technology needed to achieve its goals and objectives efficiently. For the purposes of coordination and in the interest of economy the resources just listed must be grouped together. It is the grouping of these resources (personnel and equipment) that is called organizational design. (Kovner & Neuhauser, 2001) 3. According to Mintzberg there are five basic types of organizational design: a. Simple organization such as that seen in a doctor's office with a manager or two, support staff, but generally no technological structure or middle management. The key means of coordination in this type of organization is direct supervision. b. Machine bureaucracy such as that seen in an outpatient clinic for lower income people. The key means of coordination is work standardization. c. Professional bureaucracy such as that seen in a community hospital. The key means of coordinating work is the standardization of professional skills. d. Divisionalized firm such as that seen in a multi-hospital corporation. The key means of coordination is the standardization of outputs such as profits or market share. e. "Adhocracy" such as that seen in a rehabilitation unit. The key to coordination of the work is how well the clinicians adjust to working with one another. 4. Mintzberg also identifies three ways in which work may be organized: a. Process or occupation - All professionals report directly to their director or chief. For example, nurses report to the Director of Nursing and doctors report to the Chief of Staff. b. Purpose or division - Reporting cuts across professional and occupational disciplines. For example, doctors, nurses and allied health professional within a particular unit report directly to the unit head. c. Matrix - Both process and purpose apply in a matrix. Which reporting is used depends on the activities. Since the matrix adds another level of management, organization or program managers must decide whether the benefits derived by the matrix outweigh the costs. 5. Which of the three organizations is used will depend on, among others, the changing demands of the delivery system. Module 4 - Professional Integration Introduction 1. Experts agree that as managed care extends its reach across the United States , physicians are increasingly concerned about potential reductions in income and loss of clinical autonomy. "Managed care's emphasis on cost reduction -- together with its logical consequences -- is forcing physicians to seek new organizational structures that will allow them to compete in this changing health care environment." (J. Mark Clapp) 2. Physicians in increasing numbers are realizing that participation in some form of integration is necessary to not only decrease operating costs of individual practices but to effectively compete. There are a myriad integration options available to physicians. The difficulty is choosing among alternatives, in light of differing opinions among physicians. Choices among the various options depend on expectations, future goals, level of autonomy desired, and the degree of risk they are willing to assume to consummate the deal. 3. J. Mark Clapp suggests some questions that physicians should first ask themselves: a. What do I expect from this affiliation? In simple terms, how will my life be affected by this decision, and how will I measure my satisfaction with it? b. What aspects of my practice do I want to separate from the other entities represented in this decision? Many physicians have some aspect of their practice over which they jealously maintain control. These special areas must be identified up front so that as the deal unfolds the impact on these areas will be clear. c. Is this decision to integrate physician- or purchaser-based? Is the physician driving the decision because of specific goals he or she wishes to achieve, or will the overall direction be determined by the purchaser? If by the purchaser, is the physician ready, willing, and able to take direction from another management authority? d. Is integration a short- or long-term strategy? Once consummated, the decision becomes difficult to revoke. All too often, the decision to proceed with an affiliation agreement is reached without any thought of fall-back options. 4. Integration options include: a. Open Physician Hospital Organization (PHO). b. Closed Physician Hospital Organization. c. Comprehensive Management Service Organization. d. Equity Management Services Organization. e. Foundation Model. f. Staff Model Module 5 - Adaptation & Accountability Adaptation 1. Generally speaking, the external environment of an organization affects/influences the organization at varying levels: a. The organization's "macro-environment" (Government, Social forces, Economy, Demographics, etc...). b. The organization's "task environment" (Customers, Patients, Suppliers, etc...). c. The industry which contains the organization/firm and its competitors. 2. Health care organizations and programs function in highly complex volatile environments. Their responses to a variety of pressures will vary. Whether it is the pursuit of a merger, investment in technology, or termination of programs due to funding shortfalls, the manager must be prepared to effectively direct the organization to ensure its adaptation. 3. Five aspects of healthcare sector that impact adaptation. (Adapted from Kovner and Neuhauser, 2001): a. Competition. b. Technology. c. Community Service. d. Funding. e. Workforce Accountability 1. Traditionally, accountability in health programs and health services organizations was directed to clinicians - those who knew what services should be provided and the best ways in which to provide those services. 2. Over the past decade or so, we have witnessed a major shift in accountability from clinicians to third party payers and consumers of health services. In other words, we now must account for actions to those who use and pay for health services. 3. Kovner and Neauhauser identify two factors that are vital when applying the concept of accountability: a. Specification of organizational performance that is mutually agreed upon in advance by all interested parties, and b. Capability of managers to control the resources and behavior necessary to achieve the specified performance. 4. The health services field is particularly challenging for managers because of difficulties in specifying organizational performance and the dynamics of the health care delivery system that impact the health status of the community. Managers are responsible for obtaining a level of resources and productivity necessary for achieving organizational goals. 5. The various stakeholders and conflicts among their interests make the job of the manager difficult. The stakeholders include boards of trustees, physicians, other professionals, and of course, patients and payers.