P11.1833 Health Care Management


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P11.1833 Health Care Management

  1. 1. P11.1833 Health Care Management NYU/Wagner (NY/P) P11.1833 ________________________________________________________________________ Fall 2007 Prof. Anthony R. Kovner 3008 Puck (P) 212-998-7444 anthony.kovner@nyu.edu HEALTH SERVICES MANAGEMENT LEARNING OBJECTIVES At the end of this course, learners will understand: • How hospitals and nursing units are governed and organized. • How hospitals(HCOs) assess and adapt to change. • How performance control systems work in HCOs. • Constraints/opportunities facing nurse leaders in shaping organizational performance and managerial careers. • Use of evidence-based management in HCOs. Learners will be able to manage themselves better with others on team projects, improve critical thinking and gain written and oral communication skills. COURSE SESSIONS Session 1: Control A (September 4) Course Expectations/Syllabus Control Systems: Goals and Objectives • Kovner Elton and Billings, “Transforming Health Management: an Evidence-Based Approach.” K/N pp 3-35. • Griffith and White, “Managing the Health Care Organization,” G/W pp 109-154. • Griffith and White, “Nursing Organization,” G/W pp 253-292. Discussion Question (DQ): What is the relationship between measurable objectives and organizational accountability? Session 2: Control B (September 11) Governance Information • Griffith and White, “The Governing Board,” 65-108. • Griffith and White, “Information Services,” 381-414. • Case #1 “A New Faculty Practice Administrator for the Department of Medicine, K/N 37-50. • DQ: How should health care organizations measure organizational performance? Session 3: Control C (September 18) Incentives Process Improvement • Griffith and White, “Financial Management,” 415-464. 1
  2. 2. P11.1833 Health Care Management • Griffith and White, “Clinical Support Service, 293-340. • Case2 (handout) “Competing Priorities in the Ortho Unit” • Short Case #C: “CQI at Suburban Hospital,” K/N, 124-5. DQ: How do health care organizations measure the quality of customer service? Session 4: Control D (September 25) Guest Speaker: Gina Bufe, Ph.D, RN, Director of Nursing Education, Quality and Research. • Griffith and White, “Clinical Performance,” 155-202. • Bradley, EH, Holmoe JO et al, “The Roles of Senior Management in Quality Improvement Efforts…” Journal of Healthcare Management, 2003, Jan/Feb 48 (1), 15-28. Due Date: Career Objectives Paper (Part One) Session 5: Organizational Design A (October 2) How Medical Work Is Organized • Griffith and White, “Relating Healthcare Organizations to their Environment” 27-64. • Herzlinger R., “Market-Driven, Focused health Care,” K/N 139-154 • Case #13, “A Personal Memorandum on the Hospital Experience,” K/N, 333-342. • Dear CEO: The Perceptions of a Recently Discharged Hospital Patient,” Quality Management in Health Care, Vol 14, No 4, 219-233. DQ: What is the relationship between organizational design and organizational performance? Note: October 9 No Class. Reception at NY Hospital Session 6: Organizational Design B (October 16) Managing Hospital Workforce • Studer, “Building a Culture Around Service,” in Hardwiring Excellence, Fire Starter, 2003, 75-108. • Griffith and White “Human Resources pp 465-512. • Case1 NYP : “A WorkForce of Choice” (handout). DQ: What do nurses expect from hospitals and why don’t (or do they) get what they want? Session 7: Organizational Design C (October 23) Managing With Physicians • Griffith and White, “The Physician Organization,” 203-252. • Case #7 “Reorganizing Primary Care at Blackwell Medical Center,” K/N, 163-172. • Short Cases #G-J, in K/N , 254-8 2
  3. 3. P11.1833 Health Care Management DQ: What do doctors expect from hospitals and why don’t (or do they) get what they want? Session 8: Organizational Design D (October 30) Community Health • Griffith and White, “Community Health,” 341-380. • Anderson and Knickman, “Chronic Care,” in Jonas and Kovner’s, Health Care Delivery in the United States, 248-273. • Case #3: Healthier Babies in Twin Falls, Idaho, K/N 96-105. DQ: What are the costs and benefits of “integrating” health delivery for a community hospital? DUE DATE: Control Paper GRADE BACK: Mid Term-grade on class participation Session 9: ORGANIZATIONAL DESIGN E (November 6) HMOs and Managed Care • Draper, Hurley and Short “Medicaid Managed Care: The Last bastion of the HMO” Health Affairs, Vol 23, No 2, 155-167. • Robinson, “The End of Managed Care, JAMA, May 23-30, 2001, Vol 285, No. 20, 2622-8. • Case #4: “The Primary Care Instrument Panel at Central Community Health Plan,” K/N, 106-114. • Case #8 The Future of Disease Management at Superior Medical Group, K/N 173-186. DQ: What are the costs and benefits of health plans to provider systems? Session 10: Adaptation A (November 13) Strategy • Griffith and White, “Planning and Internal Consulting,” 551-584. • Begun and Heatwole, “Strategic Cycling: Shaking Complacency in Healthcare Strategic Planning,” K/N, 263-280. • Case4 “Getting from Good to Great” (handout) DQ: What are some of the obstacles facing managers seeking to implement strategic plans, and how may these be overcome? Session 11: Adaptation B (November 20) Marketing • Griffith and White, “Marketing and Strategy” 585-632. • Berry, LL, and Bendapudi, “Clueing in Customers,” Harvard Business Review, Feb 2003, 100-106. • Case #12 “The Visiting Nurse Association of Cleveland,” K/N, 287-296 3
  4. 4. P11.1833 Health Care Management DQ: What kinds of marketing work best for increasing market share of a group practice in geriatric care? Session 12: Adaptation C (November 27) Guest Lecturer: Wilhelmina Manzano, MA, RN, CNAA, BC, Senior Vice President and Chief Nursing Officer NY/P Due Date: ADAPTATION PAPER Session 13: ADAPTATION D (December 4) Creating and Sustaining High Performing Organizations, and Organizational Ethics. • Case #9: Physician Leadership: MetroHealth System,” K/N 225-247. • Case 3: “Take Care of Your Nurses” (handout) DQ: How does a CEO change an organization from Good to Great? Due date: CAREER OBJECTIVES PAPER, PART TWO Session 14: Adaptation E (December 11) Strategic Leadership Management Ethics • Managing Your Career • Robbins, CJ, EH Bradley and M Spicer, Developing Leadership in Health Care: A Competency Assessment Tool,” Journal of Healthcare Management, 46 (3), May/June 2001, 188-202. • Warden GL, and JR Griffith, “Ensuring Management Excellence in the Health Care System,” Journal of Healthcare Management,” 46 (4) July-August 2001, 228-237. • Case5 “How Put Two Pounds of Rice in a One Pound Bag?” (handout) DQ: Where is the health care enterprise going and how will this affect your career? 4
  5. 5. P11.1833 Health Care Management READINGS Required: Griffith, John and Kenneth White, The Well Managed Healthcare Organization, 2007, 6th edition Kovner, Anthony R. and Neuhauser, Duncan, Health Services Management: Readings, Cases and Commentary, Health Administration Press, 2004, 8th ed. Kovner, AR, Set of Five case Studies (hand out), 2007 Other handouts. Recommended: See supplemental bibliography at the end of the syllabus. Nursing Management Journals American Journal of Nursing Nurse Leader Journal of Nursing Administration Health Affairs Health Forum Journal Health Care Management Review Health Care Strategic Management Image: Journal of Nursing Scholarship Journal of Advanced Nursing (U.K.) Journal for Healthcare Quality Journal of Nursing Administration Journal of Nursing Care Quality Journal of Nursing Education Journal of Nursing Management (U.K.) Journal of Professional Nursing Nursing 2003 Nursing Administration Quarterly Nursing Economics Nursing Leadership Forum Nursing Management Nursing Outlook Nursing Spectrum Policy, Politics, & Nursing Practice RN Seminars for Nurse Managers 5
  6. 6. P11.1833 Health Care Management ASSIGNMENTS A. Career Objectives (Part One) Write a 3-5 page paper on your career objectives and how you plan to implement them. Please enclose a copy of your latest resume. Include family issues as relevant. It should be a personal guide for your professional development. Share this paper with your team mate for the next assignment and integrate his or her feedback into what you have to say. Discuss the following: 1. Current experience in terms of managerial roles, skills, and values. (Include an assessment of your strengths and weaknesses.) 2. A specific desired job within 3 - 5 years. (What skills and experience are required to obtain and excel in the desired job?) 3. Specific plan to address the weaknesses that you have identified and describe the steps that you plan to take to achieve your desired 3-5 year goal. B. Control Complete as a 2-person team. For the unit in which one of you work, or for some other health unit, write a memo addressed to the unit director, specifying: 1. How well is the unit performing, and how can you tell if the unit is performing well? 2. In what ways is the unit's director accountable for achieving the objectives? What is the governance of the unit? 3. What is the information used to measure current performance? 4. What incentives are used to affect attainment of objectives? 5. Evaluate the strengths and weaknesses of the control system. 6. Make feasible recommendations to improve the control system. Discuss opportunities and constraints for implementation. The paper should be about 8 double-spaced pages in length. Forms used for control purposes can be added as an appendix, as appropriate. C. Adaptation/Strategy Complete as a three person team. Your task is to develop a strategic plan for the unit of, or for a small health care organization. This can be a real organization or one you dream up. Whatever you choose, it must be reasonably realistic. Include a one-page appendix signed by all members of the team specifying who completed what tasks involved in writing this paper. Examine the following issues: 1. What is the organization’s mission? Who does it actually serve? What is current performance? 2. Develop three measurable objectives for next year's performance for the unit and a rationale for these objectives. 3. Develop a strategy to achieve each objective and a rationale for the strategy. 6
  7. 7. P11.1833 Health Care Management 4. Describe obstacles to implementing the strategies and what you recommend to overcome the obstacles. 5. Prepare a 2 page annotated bibliography (8 to 10 references) that applies to your findings and recommendations. Focus on studies in which evidence is analyzed rather than on opinion pieces. You may consult the general management as well as the health care management literature. Specify what the reading is about and why it is or is not useful how to the manager. For #5 Bibliography/Recommended Readings Kovner, AR, JJ Elton, and J. Billings, Transforming Health Management: An Evidence-Based Approach, Frontiers of Health Service Management, 16:4, Summer 2000, pp 3-24. Walshe, K and TG Rundall. Evidence-based management: from theory to practice in health care. Milbank Quarterly, 2001: 79 (3); 429-42. For examples of articles in which evidence is analyzed rather than opinion pieces, review these two articles in the KN book of readings: (1) Curley et al, A Firm Trial of Interdisciplinary Rounds...pp 262-274, and (2) Bigelow and Arndt, Great Expectations: An Analysis of Four Strategies, pp 306-332. The Adaptation paper should be 8-10 pages (double-spaced), with appendices, as appropriate. D. Learning Objectives Paper Write a short paper--no more than three pages--describing what you have learned this semester that is or will be useful to managing your career. I am particularly interested in what you have learned from participating in “learning cells” and in conducting searches for evidence for use in management applications. (Although this paper is ungraded, your performance on this paper will be considered in adjusting your final course grade.) E. Class Participation Class participation is evaluated based on three criteria: attendance, appropriate amount of participation and quality of participation. The professor calls on learners only if they raise their hands. Your grade can be adjusted two notches based on class participation, e.g. from C to B- or from A- to B. You are expected, under class participation to fill out the class bio and attach a recent photo (preferably not a copy of your ID). All photos will be returned to you (sign on the back). 7
  8. 8. P11.1833 Health Care Management GUIDELINES FOR TEAMWORK The papers are a collaborative effort, requiring a division of labor and shared responsibility. Just as in the world of work, the product will be judged by the adequacy of the case it makes and the thoughtfulness that goes into its presentation. Some general guidelines to teamwork: MEET: The value of teamwork comes from working together and developing the paper in collaboration. Even if you are busy, find time to meet. PLAN: Develop a plan for the paper and the work to be done in preparing it. Establish a work plan that includes the steps involved in researching, developing, and writing the paper. Timeframes are important. AGREE ON RESPONSIBILITIES: An honest assessment of team strengths and determination of a fair division of labor is part of the planning process. Specific responsibilities should be identified at the first team meeting. MAINTAIN COMMUNICATION: Team members should stay in touch with each other. Regular sharing of information (by email, telephone, meetings) can help advance the project and identify difficulties. CLARIFY UNDERSTANDINGS: At the end of each meeting or discussion, be sure members of the team have a common understanding of what was decided and what is next. DETERMINE HOW ANY PROBLEMS WILL BE RESOLVED: Agree in advance on how the team will resolve difference of opinion, delay in meeting deadlines, and unexpected complications. EVALUATE: At the conclusion of the project, the team should evaluate how successfully it worked together and suggest ways that it would modify its approach on another project. 8
  9. 9. P11.1833 Health Care Management WRITTEN ASSIGNMENTS AND COURSE GRADING Grading: % Due Career Objectives 1/3 Week 5 Control 1/3 Week 8 Adaptation/Strategy 1/3 Week 12 Learning Objectives Ungraded Week 13 Class participation (can adjust your grade up to two notches) Grading Criteria (Written Assignments) Each paper will be scored, considering the following template, from 1 to 3 on four criteria (3 = excellent, 2 = acceptable, 1 = not acceptable) A. Career Objectives • 25%: Sufficiently articulated account of the writer’s current skills and experience which is relevant to the job desired. • 25%: Specified job sought and logical account of what is required to obtain the job and perform the job well. • 25%: Work plan of what the writer plans to do in the short run (next three years) to attain the necessary skills and experience to get the desired job. • 25%: Account of constraints and opportunities faced by the writer in attaining the desired job and how constraints will be overcome and opportunities grasped. B. CONTROL • 25%: Valid and reliable account of existing unit performance and specification of what, if any, assumptions this account is based upon. • 25%: Valid and reliable account of the unit’s current control system (objectives, information, incentives and governance) based on what evidence. • 25%: Recommendations to improve the control system so that unit performance is improved with rationale for the logic and feasibility of the recommendations. • 25%: Account of opportunities and constraints faced by the unit manager in implementing the consultant’s recommendations to include how the constraints will be overcome and opportunities grasped. C. ADAPTATION • 25%: Description of forces causing change in the unit’s performance and/or processes. • 25%: Selection of measurable objectives for the next 12 months with rationale for the choice recommended. • 25%: Evidence underlying the selection of objectives with rationale for hoped-for success (why the strategy succeeds). • 25%: Opportunities and constraints faced by managers in implementing your recommendations and description of how the manager can overcome constraints and grasp opportunities. 9
  10. 10. P11.1833 Health Care Management Grading Criteria (Course Grades) A Excellent: Exceptional work for a graduate student. Work at this level is unusually thorough, well reasoned, creative, methodologically sophisticated, and well written. Work is of exceptional, professional quality. A- Very Good: Very strong work for a graduate student. Work at this level shows signs of creativity, is thorough and well-reasoned, indicates strong understanding of appropriate methodological or analytical approaches, and meets professional standards. B+ Good: Sound work for a graduate student; well-reasoned and thorough, methodologically sound. This is the graduate student grade that indicates the student has fully accomplished the basic objectives of the course. B Adequate: Competent work for a graduate student even though some weaknesses are evident. Demonstrates competency in the key course objectives but shows some indication that understanding of some important issues is less than complete. Methodological or analytical approaches used are adequate but student has not been thorough or has shown other weaknesses or limitations. B- Borderline: Weak work for a graduate student; meets the minimal expectations for a graduate student in the course. Understanding of salient issues is somewhat incomplete. Methodological or analytical work performed in the course is minimally adequate. Overall performance, if consistent in graduate courses, would not suffice to sustain graduate status in “good standing.” C/-/+ Deficient: Inadequate work for a graduate student; does not meet the minimal expectations for a graduate student in the course. Work is inadequately developed or flawed by numerous errors and misunderstanding of important issues. Methodological or analytical work performed is weak and fails to demonstrate knowledge or technical competence expected of graduate students. F Fail: Work fails to meet even minimal expectations for course credit for a graduate student. Performance has been consistently weak in methodology and understanding, with serious limits in many areas. Weaknesses or limits are pervasive. 10
  11. 11. P11.1833 Health Care Management SUPPLEMENTAL BIBLIOGRAPHY ON SELECTED TOPICS Career Objectives Kovner, Anthony R. Health Care Management in Mind: Eight Careers, New York: Springer, 2000. Prybil, Lawrence D, Challenges and Opportunities Facing Health Administration Practice and Education, Journal of Healthcare Management, 48:4 July/August 2003, 223- 231. Drucker, P. F. “Managing Oneself.” Harvard Business Review, 77 (2): 64-74, 1999. Control Gray, JA Muir, Evidence-Based Healthcare, 2nd ed. Edinburgh: Churchill Livingstone, 2004. Committee on Quality, Institute of Medicine, 2001. Crossing the Quality Chasm: A New Health System for the 21st Century, Washington DC: National Academy Press, 119- 154. Studer, Q, Hardwiring Excellence, Gulf Breeze, FL: Studer Group 2003. Griffith, J and K White Six Strategies for Highly Successful Organization, Health Administration Press, 2003. Longest, Beauford, Jr, Managing Health Programs and Projects, San Francisco: Jossey- Bass, 2004. Adaptation Herzlinger, Regina E. Consumer-Driven Health Care: Implications for Providers, Payers, and Policy-Makers. San Francisco: Jossey-Bass, 2004. Lake, Eileen T, “The Nursing Practice Environment: Measurement and Evidence,” in Medical Care Research and Review, special supplemental issue on The Art and Science of Nursing Quality Measurement, ed. J. Spetz, Sage, Volume 64, No 2, April 2007, 104S-122S. Luke, Roice D., J.W. Begun and Steven Walston, "Strategy Making in Health Care Organizations," in Shortell & Kaluzny, eds. Health Care Management, 4th ed., Albany NY: Delmar 2000, 394-431. Griffith, John. The Moral Challenges of Health Care Management, Chicago: Health Administration Press, 1993. Evidence-Based Management Kovner, A. R. Ph. D., and T. G. Rundall, Ph. D. 2006. “Evidence-based Management Reconsidered”. Frontiers of Health Services Management 22 (3): 3-21. Pfeffer, J., and R. Sutton. 2006. Hard Facts, Dangerous Half-Truths and Total Nonsense: Profiting from Evidence-based Management. Boston: Harvard Business School Press. 276 pages. Walshe, K. and T. G Rundall. 2001. “Evidence-based management: from theory to practice in health care.” The Millbank Quarterly 79 (3): 429-57. Mick, S. S. and ME Wyttenbach, eds. Advances in Health Care Organization Theory, San Francisco, CA, 2003. (Note in particular the reading by Luke and Walston on strategy.) 11
  12. 12. P11.1833 Health Care Management Health Care Management Review, “Agenda Setting for Health Care Management Research: Report of a Conference,” Volume 28, Number 4, October-December 2003, pp 319-375. 12