This document summarizes a study assessing the effectiveness of budgeting systems in the NHS. Key findings include:
1) The NHS Foundation Trust studied lacked a clear strategic plan, making resource allocation and cost improvement targets difficult.
2) Senior doctors were only minimally involved in strategic contracting processes, despite their expertise being valuable.
3) Managers were responsible for budgets they had little control over, weakening accountability.
4) While information provided to managers was of good quality, further devolution of budget holding was still debated.
The document is a dissertation proposal by Ikwu Oku that aims to study how linking strategy and operations can improve healthcare delivery in Nigeria. The proposal discusses challenges in healthcare systems today and the need to consider strategy, environment, and implementation capacities to improve organizational performance. While businesses have applied operations management concepts, similar effects have not been seen in healthcare due to lack of understanding between healthcare professionals and operations experts. The dissertation will study how operational strategies interact within the healthcare framework and conduct empirical research to determine if superior performance and quality healthcare can be achieved without increased costs when linking operations and strategies in hospitals, especially at the primary level.
The document discusses two recent NHS reviews - the Five Year Forward View and the Dalton review - that recommend exploring new models of healthcare delivery and organizational structures. This includes more integrated models of care, innovative organizational forms like hospital chains, and encouraging successful organizations to act as "system architects" to spread best practices. It also recognizes the need for quicker regulatory processes for organizational changes. The briefing examines lessons from recent NHS mergers and acquisitions to understand key factors for success when moving to new models. A survey found leadership, culture and stakeholder support were most important. While some new forms show promise, there is limited UK evidence and implementation may be gradual until more is known. Near term, acquisitions and management contracts are most feasible
Article 1ECG management consultants. (2007). The Strategic Imper.docxfredharris32
Article 1
ECG management consultants. (2007). The Strategic Imperative of Adapting the Hospital’s Management Structure. Insight, 1-6. http://www.healthleadersmedia.com/content/86219.pdf
a)
The author points out that many hospitals are struggling with how to execute strategic plans effectively in their organizational structure. These institutions lack efficient decision-making processes, accountability for the performance of key strategies and the recognition of the importance of hospital strategies to propel them to new business. The key challenge in provider-based organizations is their inability to focus their strategies on the provision of high-quality patient care services. Hospitals should stop focusing on performance-driven traditional strategies and instead align their strategies to focus on a service line.
To ensure that such procedures are executed efficiently, it is important that their organizational structures are informed by the care service strategy. The organizational structure should ensure that the strategy is encompassed in their strategic plan, organizational control structure, management responsibilities and physician leadership. In today’s world, patients are seeking more care on their heart conditions, cancer or other illnesses or injuries rather than on traditional hospital departments such as nursing, physical therapy or radiology. By focusing on patient care functions along these service lines, hospitals can optimize performance. The organizational structure should also be streamlined to support key strategies. Laying a strong foundation for the organization structure is important to ensure that key strategies are executed effectively. The control structure should also be flexible enough to adapt to shifts in strategy. Introducing changes such as a focus on traditional performance-driven strategies to a service line is sometimes stalled due to a rigid management structure. It is important to have a flexible control structure to facilitate decision-making processes that are most times challenged by poor leadership structures.
b)
Given the opportunity, I would correct an inefficient hospital strategy by reorganizing the organizational structure to focus entirely on key strategies of a service line. Clinical services, planning, marketing and public affairs are some of the new elements that I would to traditional organizational structures in hospitals. This way, any shifts in strategies can easily be adapted due to a flexible control structure. At the same time, as a leader, I would focus on building value around my employees by assigning them responsibilities based on the right service lines. This will ensure that they remain accountable for their performance and use of resources along with their service lines. A good management structure is also necessary to maintain a good relationship between the business strategy and the performance of my employees.
Article 2
Perera, F. D. P. R., & Peiró, M. (2012). St ...
Lessons from pfm in the health sector finalHFG Project
Over the past five years, the Health Finance and Governance (HFG) project has supported over 35 countries and programs in their efforts to strengthen public financial management (PFM) systems. Activities have been tailored to address key priorities within a health system context, and have ranged from improving financial data systems to conducting costing exercises, financial analyses, and capacity-building workshops. Across these activities, several lessons have emerged.
Insights in this brief stem from analysis of over 200 HFG financing activities; interviews with stakeholders from Ukraine and Vietnam; and experience from cross-cutting program activities. These lessons are shared as a resource for fellow implementing partners, country practitioners, and donor agencies. As the project ends, this brief considers the global context and established frameworks for PFM alongside the contributions of the HFG experience, and suggests a way forward.
Health system strengthening evidence review – A summary of the 2021 updateReBUILD for Resilience
A presentation given by Professor Sophie Witter to the UK government's Foreign, Commonwealth & Development Office. This summarises a 2021 review of a health systems strengthening evidence review originally undertaken for the office in 2019.
This is a legacy publication from the NHS Institute for Innovation and Improvement. It outlines a framework of five models for thinking about making change happen, based on the work of McKinsey and Co
NHSFP6004 Activities and Materials Needed for Telehealth Training Paper.pdfbkbk37
The document outlines a training plan assignment for a healthcare organization. Students are asked to develop a training plan for a role group in the organization that will be responsible for implementing new practice guidelines. This includes preparing a 2-hour workshop agenda and summarizing strategies for working with the group, expected outcomes of the training, and why the group was chosen. The document provides an overview of the assignment and its competencies, including developing strategies to engage stakeholders and advocate for their role in implementing policy changes.
NHSFP6004 Activities and Materials Needed for Telehealth Training Paper.pdfbkbk37
This document provides an overview of a training plan for implementing new organizational policies at a healthcare organization. It discusses developing an agenda for a two-hour workshop to train a specific role group. The training aims to prepare the group to successfully apply new policies and guidelines. It also justifies selecting this group to pilot the changes and discusses strategies for engaging the group to ensure they are prepared and buy into the changes.
The document is a dissertation proposal by Ikwu Oku that aims to study how linking strategy and operations can improve healthcare delivery in Nigeria. The proposal discusses challenges in healthcare systems today and the need to consider strategy, environment, and implementation capacities to improve organizational performance. While businesses have applied operations management concepts, similar effects have not been seen in healthcare due to lack of understanding between healthcare professionals and operations experts. The dissertation will study how operational strategies interact within the healthcare framework and conduct empirical research to determine if superior performance and quality healthcare can be achieved without increased costs when linking operations and strategies in hospitals, especially at the primary level.
The document discusses two recent NHS reviews - the Five Year Forward View and the Dalton review - that recommend exploring new models of healthcare delivery and organizational structures. This includes more integrated models of care, innovative organizational forms like hospital chains, and encouraging successful organizations to act as "system architects" to spread best practices. It also recognizes the need for quicker regulatory processes for organizational changes. The briefing examines lessons from recent NHS mergers and acquisitions to understand key factors for success when moving to new models. A survey found leadership, culture and stakeholder support were most important. While some new forms show promise, there is limited UK evidence and implementation may be gradual until more is known. Near term, acquisitions and management contracts are most feasible
Article 1ECG management consultants. (2007). The Strategic Imper.docxfredharris32
Article 1
ECG management consultants. (2007). The Strategic Imperative of Adapting the Hospital’s Management Structure. Insight, 1-6. http://www.healthleadersmedia.com/content/86219.pdf
a)
The author points out that many hospitals are struggling with how to execute strategic plans effectively in their organizational structure. These institutions lack efficient decision-making processes, accountability for the performance of key strategies and the recognition of the importance of hospital strategies to propel them to new business. The key challenge in provider-based organizations is their inability to focus their strategies on the provision of high-quality patient care services. Hospitals should stop focusing on performance-driven traditional strategies and instead align their strategies to focus on a service line.
To ensure that such procedures are executed efficiently, it is important that their organizational structures are informed by the care service strategy. The organizational structure should ensure that the strategy is encompassed in their strategic plan, organizational control structure, management responsibilities and physician leadership. In today’s world, patients are seeking more care on their heart conditions, cancer or other illnesses or injuries rather than on traditional hospital departments such as nursing, physical therapy or radiology. By focusing on patient care functions along these service lines, hospitals can optimize performance. The organizational structure should also be streamlined to support key strategies. Laying a strong foundation for the organization structure is important to ensure that key strategies are executed effectively. The control structure should also be flexible enough to adapt to shifts in strategy. Introducing changes such as a focus on traditional performance-driven strategies to a service line is sometimes stalled due to a rigid management structure. It is important to have a flexible control structure to facilitate decision-making processes that are most times challenged by poor leadership structures.
b)
Given the opportunity, I would correct an inefficient hospital strategy by reorganizing the organizational structure to focus entirely on key strategies of a service line. Clinical services, planning, marketing and public affairs are some of the new elements that I would to traditional organizational structures in hospitals. This way, any shifts in strategies can easily be adapted due to a flexible control structure. At the same time, as a leader, I would focus on building value around my employees by assigning them responsibilities based on the right service lines. This will ensure that they remain accountable for their performance and use of resources along with their service lines. A good management structure is also necessary to maintain a good relationship between the business strategy and the performance of my employees.
Article 2
Perera, F. D. P. R., & Peiró, M. (2012). St ...
Lessons from pfm in the health sector finalHFG Project
Over the past five years, the Health Finance and Governance (HFG) project has supported over 35 countries and programs in their efforts to strengthen public financial management (PFM) systems. Activities have been tailored to address key priorities within a health system context, and have ranged from improving financial data systems to conducting costing exercises, financial analyses, and capacity-building workshops. Across these activities, several lessons have emerged.
Insights in this brief stem from analysis of over 200 HFG financing activities; interviews with stakeholders from Ukraine and Vietnam; and experience from cross-cutting program activities. These lessons are shared as a resource for fellow implementing partners, country practitioners, and donor agencies. As the project ends, this brief considers the global context and established frameworks for PFM alongside the contributions of the HFG experience, and suggests a way forward.
Health system strengthening evidence review – A summary of the 2021 updateReBUILD for Resilience
A presentation given by Professor Sophie Witter to the UK government's Foreign, Commonwealth & Development Office. This summarises a 2021 review of a health systems strengthening evidence review originally undertaken for the office in 2019.
This is a legacy publication from the NHS Institute for Innovation and Improvement. It outlines a framework of five models for thinking about making change happen, based on the work of McKinsey and Co
NHSFP6004 Activities and Materials Needed for Telehealth Training Paper.pdfbkbk37
The document outlines a training plan assignment for a healthcare organization. Students are asked to develop a training plan for a role group in the organization that will be responsible for implementing new practice guidelines. This includes preparing a 2-hour workshop agenda and summarizing strategies for working with the group, expected outcomes of the training, and why the group was chosen. The document provides an overview of the assignment and its competencies, including developing strategies to engage stakeholders and advocate for their role in implementing policy changes.
NHSFP6004 Activities and Materials Needed for Telehealth Training Paper.pdfbkbk37
This document provides an overview of a training plan for implementing new organizational policies at a healthcare organization. It discusses developing an agenda for a two-hour workshop to train a specific role group. The training aims to prepare the group to successfully apply new policies and guidelines. It also justifies selecting this group to pilot the changes and discusses strategies for engaging the group to ensure they are prepared and buy into the changes.
The document provides instructions for an assignment to write a directional strategies report for a healthcare organization. It discusses analyzing the alignment between an organization's mission, vision, and values (directional strategies) with its strategic goals. The report should identify any gaps and make recommendations. Previous assessments examined the organization's environment and strategic objectives. The directional strategies guide the organization to achieve its strategic goals. The report must demonstrate competencies in analyzing organizational structures and recommending improvements to better achieve strategic plans.
This document provides an overview of a study on implementing total quality management (TQM) in the healthcare sector in India. It includes an abstract that describes the rising costs and pressures in healthcare that have led organizations to adopt quality management approaches like TQM. The introduction discusses issues in healthcare quality and the need for reforms. The document then proposes a model for TQM implementation that identifies key factors like leadership, momentum, teamwork, training, focus on core processes, and measures.
Community Benefit vs. Organizational BenefitPerhaps you have b.docxmonicafrancis71118
Community Benefit vs. Organizational Benefit
Perhaps you have been to a health fair sponsored by a local hospital in your community. Who benefits from such an effort? When you or your neighbors are screened for signs of illness (hypertension, for instance) or learn about available services, clearly the promotion benefits you, but what about the hospital? Having its name associated with "community service" benefits the institution. Any patients and/or clients the institution attracts may also result in some financial benefit, even if the organization is ostensibly "non-profit."
In this Discussion, you will identify examples of promotion for social change in your community and analyze whether the promotion benefits the community, the organization, or both.
To prepare for this Discussion:
· Review this week's Learning Resources.
· Identify two local health care providers and identify an example of each organization's effort in promoting a service or services as a form of positive social change. One of the organizations should be for-profit, the other, not-for-profit.
Post a brief description of how each organization's promotion fosters social change. Then, evaluate how each organization's marketing promotion benefits the community and how it benefits the organization. Finally, for each example of marketing promotion you have identified, analyze whether the interest of the community and the interest of the organization are in conflict. Briefly comment on how the promotions of the for-profit and non-profit organizations differ and how they are similar.
Support your work with specific citations from this week's Learning Resources and/or additional sources as appropriate.
Fortenberry, J. L., Jr., Elrod, J. K., & McGoldrick, P. J. (2010). Is billboard advertising beneficial for healthcare organizations? An investigation of efficacy and acceptability to patients. Journal of Healthcare Management, 55(2), 81–9 5.
STRATEGY CHALLENGE
Alan M. Zuckerman
What Would You Do?
does the strategic plan require updating because
of healthcare reform?
Metro Health System (MHS) is a successfiil integrated
delivery system (IDS) and the second largest health-
care organization operating in its metropolitan area.
With the passage of healthcare reform into law, how-
ever, MHS s leaders see a need to review and possibly
revise the organization's strategic plan. Although
MHS's relatively recent full plan update still should
be valid, over the past nine months, board members
and executives have raised important questions about
the strategy. The question is, does MHS need to fine-
tune its plan or is a more significant change in strate-
gic direction required?
The Situation
MHS is a $1.3 billion (annual operating revenue),
multifaceted IDS in a medium to large city. Its
performance has been consistently strong for the
past seven years as measured by margin, share,
and other indicators. The organization comprises
two large hospitals, about 300 emplo.
The document summarizes the findings of a study on practice-based commissioning (PBC) in the UK. Some of the key findings include:
1) Clinical engagement in PBC worked best when GPs felt the process was legitimate and their tasks were not too onerous.
2) Successful PBC structures involved elected boards making decisions and keeping other GPs informed.
3) PBC outcomes varied but were most successful when integrated into the wider commissioning agenda of local health authorities.
4) Clear agreements on budgets and savings helped avoid disputes between practices and health authorities.
This document provides a roadmap for clinical integration as healthcare transitions from fee-for-service to value-based payment. It outlines three phases of integration - asset aggregation, functional integration, and system optimization. True clinical integration requires optimization across clinical, financial, and operational areas through shared governance, financial alignment, and clinical/business integration. Following this roadmap by focusing on vision, governance, alignment, and culture can help cardiovascular groups successfully balance the current and future healthcare worlds.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Austerity And Financial Governance A UK Case Study Of The National Health Se...Addison Coleman
This document summarizes a study on financial governance in the UK National Health Service (NHS) during a time of austerity. The study used questionnaires and interviews with NHS finance directors and staff to assess financial governance systems and practices. Key findings included that some financial management systems were not prioritized as highly as good practice recommends, existing systems were not always seen as adequate, and the complexity of NHS funding sometimes resulted in opaque financial risks. Weak financial governance could lead to further scandals negatively impacting patient care. The study provides valuable insight into strengthening financial governance in the NHS during austerity.
The document discusses using a health production function to analyze two existing programs and make recommendations about allocating resources. The programs aim to reduce diabetes among low-income obese individuals in Detroit. Program 1 focuses on bariatric surgery centers while Program 2 emphasizes healthy lifestyle education and coaching. The analysis recommends reallocating funding from Program 1 to Program 2 due to the latter's lower costs and ability to impact more patients through preventative efforts aligned with current health trends prioritizing prevention over treatment. Stakeholder views also influenced preferring Program 2's community-based approach.
The document discusses using a health production function to allocate resources between two programs in Detroit, Michigan. Program 1 is "Bariatricity Detroit", which establishes bariatric surgery centers. Program 2 is "Healthy Lifestyles Detroit", which provides education and coaching on healthy behaviors. The health production function shows that allocating funding to the smaller Program 2 would yield larger decreases in diabetes rates among low-income individuals due to diminishing returns. Marginal analysis also supports funding Program 2, as its marginal cost per individual is lower than Program 1's. The executive summary should recommend funding the lower-cost Program 2 to maximize health outcomes efficiently.
This document summarizes an initiative by Duke Medicine's Private Diagnostic Clinic to improve patient access and appointment availability across several departments. It discusses:
1. FTI Consulting partnering with Duke to develop new governance structures and use analytics to increase appointments.
2. Two key elements of the project - a new appointment management framework and an "Access Algorithm" tool to measure and score access.
3. Recommendations to consolidate resources into a new "Access Practices Team" to oversee scheduling and hold departments accountable to access standards.
4. The "Access Algorithm" used 12 metrics like lag times, no-show rates, and utilization to score and compare access across specialties and identify areas for
ECO/561 Week 5 Assignment Rubric
Individual Assignment: Effectiveness of the Counter-Cyclical PoliciesPurpose of Assignment
This assignment addresses how both monetary and fiscal policies have been used during the so-called Great Recession, which began in December 2007 and ended in June 2009, to the present to moderate the business cycle. Resources Required
Tutorial help on Excel® and Word functions can be found on the Microsoft® Office website. There are also additional tutorials via the web offering support for Office products.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
Selected an industry that suffered heavy losses during the Great Recession and produced an Excel® Workbook including the following data from December 2007 to the present:
· One dataset related to the U.S. housing industry such as housing starts, the FHFA housing price index, or another dataset of your choice related to the housing market.
· One dataset related to personal or household income or to personal or household saving.
· One dataset related to the labor market such as the unemployment rate, initial claims for unemployment insurance, or another dataset of your choice related to the U.S. labor force.
· One dataset related to production and business activity within the market or industry you choose to analyze.
15 points
Using data results analyzed the economic and sociological forces that drove the market equilibrium to unsustainable heights, commonly referred to as "bubbles," and the shocks that brought the markets back down.
10 points
Discussed specific changes in supply and demand within the markets and/or industries you chose to analyze.
10 points
Determined whether specialization of industry had any influence on the impact of the recession. 10 points
Examined prior government policies and legislation that might have exacerbated the impact of the shocks. Also, discuss government actions/regulations that might be undertaken, and/or have been undertaken, to moderate the effects of extreme economic fluctuations. 15 points
Evaluated the actions of the federal government (fiscal policy) and the Federal Reserve (monetary policy) to restore the economy and foster economic growth. Based your evaluation on information available at Internet sources such as, but not limited to, the Fed's The Economy Crisis and Response website as well as other appropriate sources found on the Internet and in the University Library. You did address the effectiveness of those counter-cyclical policies. 20 points
The analysis is a minimum of 1,050 words in length. 5 points
Total Available
Total Earned
85
#/85
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page, and reference page—is consistent with APA formatting guidelines and meets course-level requirements. 10 points
Intellectual property is recognized with in-text citations and a reference page. 10 points
Paragraph and s ...
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
Newark Analysis of a Pertinent Healthcare Issue HW.docxwrite5
1) The document discusses competing needs within healthcare organizations as payment models shift from fee-for-service to value-based. This puts pressure on care quality and resource allocation.
2) Strategies used to address this include establishing separate performance measures for quality and preventative care. This improves primary care coordination but requires additional training and resources.
3) Adopting a strategy that integrates varied healthcare professionals and specialties can improve outcomes but coordinating different performance metrics takes effective administration and financial investment.
The document discusses opportunities around accountable care organizations (ACOs) and bundled payments under healthcare reform legislation. It outlines proposed ACO pilots that would test payment models to reduce costs and improve outcomes. It also discusses proposals for bundled payment pilots for post-acute care services beginning in 2011. Key questions are raised around which providers can participate in ACOs, what organizational structures and partnerships may look like, and how providers can position themselves for these new models.
This document provides a guide for strategic cost transformation in hospitals and health systems. It discusses three pathways for strategic cost transformation: 1) reducing costs of current operations through cost management, 2) reducing costs by restructuring businesses and services through business restructuring, and 3) reducing costs through clinical transformation. The guide focuses on specific elements of pathways 1 and 2, including understanding an organization's readiness for cost management, evaluating businesses and services, and conducting service distribution planning. It emphasizes that strategic cost transformation is required for hospitals to continue meeting community needs in a value-based healthcare system with constrained payments.
Chapter 101. Describe the concepts and models of plann.docxcravennichole326
Chapter 10
1. Describe the concepts and models of planning and decision making in the context of the healthcare supply chain.
2. Discuss the importance of situational factors (trends, environmental issues, technology, regulatory compliance, etc…) in the planning process and how leadership principles, metrics and improvement tenets can be used to positively impact the organizational culture of healthcare supply chain operations.
3. Relate, discuss and provide areas of integration between planning and decision making amid continuous operations of the healthcare supply chain to include the use of metrics and improvement strategies.
4. Distinguish the differences between planning and contingency planning.
5. Merge principles of leadership, planning and decision making to develop a personal plan for operating in a fast paced healthcare supply chain environment.
6. Evaluate the benefits for organizational operations with a solid planning process and standing operating procedures as part of the healthcare supply chain culture to include outside sales representatives.
Chapter 10: Building a Culture of Healthcare Supply Chain Excellence: Leading, Planning, Managing, Deciding, and Learning
Learning Objectives
Describe the concepts and models of planning and decision making in the context of the healthcare supply chain.
Discuss the importance of situational factors (trends, environmental issues, technology, regulatory compliance, etc…) in the planning process and how leadership principles, metrics and improvement tenets can be used to positively impact the organizational culture of healthcare supply chain operations.
Relate, discuss and provide areas of integration between planning and decision making amid continuous operations of the healthcare supply chain to include the use of metrics and improvement strategies.
Distinguish the differences between planning and contingency planning.
Merge principles of leadership, planning and decision making to develop a personal plan for operating in a fast paced healthcare supply chain environment.
Evaluate the benefits for organizational operations with a solid planning process and standing operating procedures as part of the healthcare supply chain culture to include outside sales representatives.
Introduction
Planning and decision making are essential to efficient, effective and efficacious healthcare supply chain operations and strategies.
Leaders and managers must structure and facilitate plans that integrate well with the healthcare organization’s strategic plan and must make consistent decisions in alignment with those plans.
Creating standing operating procedures for routine and consistent operations of the supply chain allows leaders and managers to spread the operational culture at all levels of the supply chain enterprise.
This chapter provides an overview of planning, improvement strategies, metrics, regulatory compliance and decision making.
These constructs should be reviewed and ...
In Week 4, you identified some immediate areas of concern that you w.docxwiddowsonerica
In Week 4, you identified some immediate areas of concern that you were able to effectively address. You must present the final phase of your improvement plan to your staff and upper-level management. You will create a presentation of 15-20 slides addressing the following areas:
In preparation for the accreditation visit for AKT, choose 1 health care accrediting and credentialing organization.
Select a quality improvement focus (QIF) area to improve patient outcomes in beyond the 3 issues that you identified and addressed in Week 4.
Discuss the selected accreditation agency related to the QIF and why the organization is seeking this particular agency for credentialing.
As part of the quality improvement initiative, select 3-4 related accrediting standards that the organization will use as the basis for the quality improvement plan.
Provide a clear mission statement and set of 3-4 specific, measurable, attainable, realistic, and timely (SMART) goals for the QIF initiative.
Using the online database provided the by the organization you selected conduct an analysis.
Provide general statistical data related to the QIF.
Discuss specific health care examples of local, state, and national policies that have been developed to improve this QIF based on evidence-based practice research.
What internal policies do you plan to implement based on evidence-based practice approaches to ensure your organization meets these standards?
Develop a plan that includes strategies for your facility to improve patient outcomes regarding the QIF.
Describe how the QIF initiative can be incorporated to the organization’s overall strategic plan.
Describe how you plan to evaluate the effectiveness of the initiative.
Each slide will have 4-6 bullets and 100-150 words of speaker’s notes and pictures.
HERE IS WEEK 4'S ASSIGNMENT THAT WAS REFERENCED ABOUT
TO:
The Staff and the Management
FROM:
Joycelyn Henry
DATE:
Thursday, August 06, 2015
SUBJECT:
Evidence-Based Practice and Policies
Introduction
Having reviewed the evidence-based practice from health statistics data, it has emerged that we have deviated from standard practice. There have been long waits in the emergency rooms, capacity management strategies are not effectively implemented by the AKT and we have high number of re-admissions than never before.
As we are aware of the Future of Nursing report (IOM, 2011a), our focus should be on the convergence of our knowledge to provide quality services and realize the necessity of new competencies. If we ignore these, we are likely to support the attitude of resistance to change as shown in research by y still faced significant barriers in employing it in practice (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). As highlighted by Pfeffer and Suton (2006), our financial performance and control of expenditure depend on implementation of this practice. Furthermore, we stand to lose patients through obsolete practices and endanger the lives of many.
Wh.
Effective management of health care operations includes multiple points of interest in evaluation for performance. A key danger lies in the potential to evaluate departments and processes separately, without analyzing the interdependence of people, procedures, and goals. The use of a balanced scorecard in health care is supported in the literature because of its ability to link processes by clinical and non-clinical factors, to include financial goals. The literature has described several areas of review under a balanced scorecard, including finance, operations, employee retention, patient satisfaction, and public reporting. As the balanced scorecard is critical to strategic management, this author supports the use of such in health care organizations. This is due in part to gestalt theory, namely, that the combination of parts equals more than its sum total. The balanced scorecard enables health care managers to view processes both within each compartment and as a contributor to the overall organization mission and vision. Thus, financial stability becomes viable, and stakeholders may be informed of organization progress in the areas of particular importance to their specific groups.
Mahankali Week 15 - DiscussionCOLLAPSETop of FormWeek 15 –.docxcroysierkathey
Mahankali
Week 15 - Discussion
COLLAPSE
Top of Form
Week 15 – Discussion
ERM at Learner Centered Teaching & Strategic Risk Management:
Learner Centered Teaching (LCT) is based on learning research that summons more active, inductive instruction. It is extremely interesting to see students strongly arguing for the most important step in an ERM process even when there may not actually be a hierarchy, Increased student engagement strengthened team-based skills, personalized student guidance, focused classroom discussion, and faculty freedom are several benefits of the growing LCT adoption.
Managing Financial Risk assessment is a major point that TL approach gives an example of the trade-offs, costs, and benefits of hedging with futures contracts often starting with a simple natural hedge. Here, the student records the respective payoffs to long and short positions when prices change. Students memorize the transactions and expect to replicate the steps with different numbers, and maybe even a different futures contract for a challenging TL course.
ERM is a business management support process for several years and proponents of ERM have been advocating incorporating the ERM process into strategic and business planning to increase its utility. The specific purpose is to reduce the impact of adverse events and be ready to exploit emerging opportunities and adapting the ERM process within the existing strategic and business planning methodology. Organizations that view the ERM process as supporting business strategies should consider positioning it where the primary goals are both to grow the business and to protect value: corporate planning and the business units can be utilized to incorporate ERM into the strategic and annual business planning process with three internal scan elements -
· Surveying the C-Suite on risk managements
· Effectiveness of risk controls & security audit
· Creating ERM Risk register
The surveys will enable a comparison between the current state of risk management activities and the corresponding risk control efforts and ERM risk register is a tool for organizing the identified risks and their internal owners.
References:
· Fraser, J., Simkins, B., & Narvaez, K. (2014). Implementing enterprise risk management: Case studies and best practices. John Wiley & Sons.
Bottom of Form
For the final paper in this course, you will find a case study on a healthcare organization that conducted a quality improvement (QI) project where they implemented a quality improvement process such as those found in Chapter 4 of the textbook including, but not limited to: Shewhart Cycle or PDCA/PDSA Cycle, API Improvement Model, Six Sigma, Baldridge Award, etc. Once you identify the case study, you will include the following sections in your paper listed below.
You are required to submit your selected case study for approval. Please check the course schedule for the due date.
· Introduction/Background
· Background information about the healthca ...
The document discusses best practices for internal auditing in government organizations. It defines best practices as the most efficient and effective methods for accomplishing tasks based on proven successful procedures. An effective internal audit function is a key component of good governance and can improve accountability, decision-making, and performance. Best practices for internal auditing in government include risk-based audit planning, timely reporting, grading audit findings by level of criticality, and rigorous follow-up processes to ensure issues are addressed. Maintaining independence, developing codes of conduct, and establishing audit committees are also important aspects of internal auditing best practices.
How To Write Law Essays Exams By S.I. Strong (EnglClaire Webber
The document provides instructions for creating an account and submitting assignment requests on the HelpWriting.net website. It outlines a 5-step process: 1) Create an account with a password and email, 2) Complete an order form with instructions and deadline, 3) Review bids from writers and choose one, 4) Receive the paper and authorize payment if satisfied, 5) Request revisions until fully satisfied and receive a refund if plagiarized.
Give You Wedding A Hint Of Luxury. When You Plan, UsClaire Webber
The document discusses the importance of intelligence fusion centers in sharing information between federal, state, and local law enforcement agencies. It notes that if the FBI had informed local law enforcement about the previous arrest of the Orlando nightclub shooter for domestic violence with his ex-girlfriend, and his link to terror groups, it could have helped prevent the deadly shooting. Fusion centers are presented as important for facilitating communication across different levels of law enforcement.
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The document provides instructions for an assignment to write a directional strategies report for a healthcare organization. It discusses analyzing the alignment between an organization's mission, vision, and values (directional strategies) with its strategic goals. The report should identify any gaps and make recommendations. Previous assessments examined the organization's environment and strategic objectives. The directional strategies guide the organization to achieve its strategic goals. The report must demonstrate competencies in analyzing organizational structures and recommending improvements to better achieve strategic plans.
This document provides an overview of a study on implementing total quality management (TQM) in the healthcare sector in India. It includes an abstract that describes the rising costs and pressures in healthcare that have led organizations to adopt quality management approaches like TQM. The introduction discusses issues in healthcare quality and the need for reforms. The document then proposes a model for TQM implementation that identifies key factors like leadership, momentum, teamwork, training, focus on core processes, and measures.
Community Benefit vs. Organizational BenefitPerhaps you have b.docxmonicafrancis71118
Community Benefit vs. Organizational Benefit
Perhaps you have been to a health fair sponsored by a local hospital in your community. Who benefits from such an effort? When you or your neighbors are screened for signs of illness (hypertension, for instance) or learn about available services, clearly the promotion benefits you, but what about the hospital? Having its name associated with "community service" benefits the institution. Any patients and/or clients the institution attracts may also result in some financial benefit, even if the organization is ostensibly "non-profit."
In this Discussion, you will identify examples of promotion for social change in your community and analyze whether the promotion benefits the community, the organization, or both.
To prepare for this Discussion:
· Review this week's Learning Resources.
· Identify two local health care providers and identify an example of each organization's effort in promoting a service or services as a form of positive social change. One of the organizations should be for-profit, the other, not-for-profit.
Post a brief description of how each organization's promotion fosters social change. Then, evaluate how each organization's marketing promotion benefits the community and how it benefits the organization. Finally, for each example of marketing promotion you have identified, analyze whether the interest of the community and the interest of the organization are in conflict. Briefly comment on how the promotions of the for-profit and non-profit organizations differ and how they are similar.
Support your work with specific citations from this week's Learning Resources and/or additional sources as appropriate.
Fortenberry, J. L., Jr., Elrod, J. K., & McGoldrick, P. J. (2010). Is billboard advertising beneficial for healthcare organizations? An investigation of efficacy and acceptability to patients. Journal of Healthcare Management, 55(2), 81–9 5.
STRATEGY CHALLENGE
Alan M. Zuckerman
What Would You Do?
does the strategic plan require updating because
of healthcare reform?
Metro Health System (MHS) is a successfiil integrated
delivery system (IDS) and the second largest health-
care organization operating in its metropolitan area.
With the passage of healthcare reform into law, how-
ever, MHS s leaders see a need to review and possibly
revise the organization's strategic plan. Although
MHS's relatively recent full plan update still should
be valid, over the past nine months, board members
and executives have raised important questions about
the strategy. The question is, does MHS need to fine-
tune its plan or is a more significant change in strate-
gic direction required?
The Situation
MHS is a $1.3 billion (annual operating revenue),
multifaceted IDS in a medium to large city. Its
performance has been consistently strong for the
past seven years as measured by margin, share,
and other indicators. The organization comprises
two large hospitals, about 300 emplo.
The document summarizes the findings of a study on practice-based commissioning (PBC) in the UK. Some of the key findings include:
1) Clinical engagement in PBC worked best when GPs felt the process was legitimate and their tasks were not too onerous.
2) Successful PBC structures involved elected boards making decisions and keeping other GPs informed.
3) PBC outcomes varied but were most successful when integrated into the wider commissioning agenda of local health authorities.
4) Clear agreements on budgets and savings helped avoid disputes between practices and health authorities.
This document provides a roadmap for clinical integration as healthcare transitions from fee-for-service to value-based payment. It outlines three phases of integration - asset aggregation, functional integration, and system optimization. True clinical integration requires optimization across clinical, financial, and operational areas through shared governance, financial alignment, and clinical/business integration. Following this roadmap by focusing on vision, governance, alignment, and culture can help cardiovascular groups successfully balance the current and future healthcare worlds.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Austerity And Financial Governance A UK Case Study Of The National Health Se...Addison Coleman
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The document discusses using a health production function to analyze two existing programs and make recommendations about allocating resources. The programs aim to reduce diabetes among low-income obese individuals in Detroit. Program 1 focuses on bariatric surgery centers while Program 2 emphasizes healthy lifestyle education and coaching. The analysis recommends reallocating funding from Program 1 to Program 2 due to the latter's lower costs and ability to impact more patients through preventative efforts aligned with current health trends prioritizing prevention over treatment. Stakeholder views also influenced preferring Program 2's community-based approach.
The document discusses using a health production function to allocate resources between two programs in Detroit, Michigan. Program 1 is "Bariatricity Detroit", which establishes bariatric surgery centers. Program 2 is "Healthy Lifestyles Detroit", which provides education and coaching on healthy behaviors. The health production function shows that allocating funding to the smaller Program 2 would yield larger decreases in diabetes rates among low-income individuals due to diminishing returns. Marginal analysis also supports funding Program 2, as its marginal cost per individual is lower than Program 1's. The executive summary should recommend funding the lower-cost Program 2 to maximize health outcomes efficiently.
This document summarizes an initiative by Duke Medicine's Private Diagnostic Clinic to improve patient access and appointment availability across several departments. It discusses:
1. FTI Consulting partnering with Duke to develop new governance structures and use analytics to increase appointments.
2. Two key elements of the project - a new appointment management framework and an "Access Algorithm" tool to measure and score access.
3. Recommendations to consolidate resources into a new "Access Practices Team" to oversee scheduling and hold departments accountable to access standards.
4. The "Access Algorithm" used 12 metrics like lag times, no-show rates, and utilization to score and compare access across specialties and identify areas for
ECO/561 Week 5 Assignment Rubric
Individual Assignment: Effectiveness of the Counter-Cyclical PoliciesPurpose of Assignment
This assignment addresses how both monetary and fiscal policies have been used during the so-called Great Recession, which began in December 2007 and ended in June 2009, to the present to moderate the business cycle. Resources Required
Tutorial help on Excel® and Word functions can be found on the Microsoft® Office website. There are also additional tutorials via the web offering support for Office products.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
Selected an industry that suffered heavy losses during the Great Recession and produced an Excel® Workbook including the following data from December 2007 to the present:
· One dataset related to the U.S. housing industry such as housing starts, the FHFA housing price index, or another dataset of your choice related to the housing market.
· One dataset related to personal or household income or to personal or household saving.
· One dataset related to the labor market such as the unemployment rate, initial claims for unemployment insurance, or another dataset of your choice related to the U.S. labor force.
· One dataset related to production and business activity within the market or industry you choose to analyze.
15 points
Using data results analyzed the economic and sociological forces that drove the market equilibrium to unsustainable heights, commonly referred to as "bubbles," and the shocks that brought the markets back down.
10 points
Discussed specific changes in supply and demand within the markets and/or industries you chose to analyze.
10 points
Determined whether specialization of industry had any influence on the impact of the recession. 10 points
Examined prior government policies and legislation that might have exacerbated the impact of the shocks. Also, discuss government actions/regulations that might be undertaken, and/or have been undertaken, to moderate the effects of extreme economic fluctuations. 15 points
Evaluated the actions of the federal government (fiscal policy) and the Federal Reserve (monetary policy) to restore the economy and foster economic growth. Based your evaluation on information available at Internet sources such as, but not limited to, the Fed's The Economy Crisis and Response website as well as other appropriate sources found on the Internet and in the University Library. You did address the effectiveness of those counter-cyclical policies. 20 points
The analysis is a minimum of 1,050 words in length. 5 points
Total Available
Total Earned
85
#/85
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page, and reference page—is consistent with APA formatting guidelines and meets course-level requirements. 10 points
Intellectual property is recognized with in-text citations and a reference page. 10 points
Paragraph and s ...
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
Newark Analysis of a Pertinent Healthcare Issue HW.docxwrite5
1) The document discusses competing needs within healthcare organizations as payment models shift from fee-for-service to value-based. This puts pressure on care quality and resource allocation.
2) Strategies used to address this include establishing separate performance measures for quality and preventative care. This improves primary care coordination but requires additional training and resources.
3) Adopting a strategy that integrates varied healthcare professionals and specialties can improve outcomes but coordinating different performance metrics takes effective administration and financial investment.
The document discusses opportunities around accountable care organizations (ACOs) and bundled payments under healthcare reform legislation. It outlines proposed ACO pilots that would test payment models to reduce costs and improve outcomes. It also discusses proposals for bundled payment pilots for post-acute care services beginning in 2011. Key questions are raised around which providers can participate in ACOs, what organizational structures and partnerships may look like, and how providers can position themselves for these new models.
This document provides a guide for strategic cost transformation in hospitals and health systems. It discusses three pathways for strategic cost transformation: 1) reducing costs of current operations through cost management, 2) reducing costs by restructuring businesses and services through business restructuring, and 3) reducing costs through clinical transformation. The guide focuses on specific elements of pathways 1 and 2, including understanding an organization's readiness for cost management, evaluating businesses and services, and conducting service distribution planning. It emphasizes that strategic cost transformation is required for hospitals to continue meeting community needs in a value-based healthcare system with constrained payments.
Chapter 101. Describe the concepts and models of plann.docxcravennichole326
Chapter 10
1. Describe the concepts and models of planning and decision making in the context of the healthcare supply chain.
2. Discuss the importance of situational factors (trends, environmental issues, technology, regulatory compliance, etc…) in the planning process and how leadership principles, metrics and improvement tenets can be used to positively impact the organizational culture of healthcare supply chain operations.
3. Relate, discuss and provide areas of integration between planning and decision making amid continuous operations of the healthcare supply chain to include the use of metrics and improvement strategies.
4. Distinguish the differences between planning and contingency planning.
5. Merge principles of leadership, planning and decision making to develop a personal plan for operating in a fast paced healthcare supply chain environment.
6. Evaluate the benefits for organizational operations with a solid planning process and standing operating procedures as part of the healthcare supply chain culture to include outside sales representatives.
Chapter 10: Building a Culture of Healthcare Supply Chain Excellence: Leading, Planning, Managing, Deciding, and Learning
Learning Objectives
Describe the concepts and models of planning and decision making in the context of the healthcare supply chain.
Discuss the importance of situational factors (trends, environmental issues, technology, regulatory compliance, etc…) in the planning process and how leadership principles, metrics and improvement tenets can be used to positively impact the organizational culture of healthcare supply chain operations.
Relate, discuss and provide areas of integration between planning and decision making amid continuous operations of the healthcare supply chain to include the use of metrics and improvement strategies.
Distinguish the differences between planning and contingency planning.
Merge principles of leadership, planning and decision making to develop a personal plan for operating in a fast paced healthcare supply chain environment.
Evaluate the benefits for organizational operations with a solid planning process and standing operating procedures as part of the healthcare supply chain culture to include outside sales representatives.
Introduction
Planning and decision making are essential to efficient, effective and efficacious healthcare supply chain operations and strategies.
Leaders and managers must structure and facilitate plans that integrate well with the healthcare organization’s strategic plan and must make consistent decisions in alignment with those plans.
Creating standing operating procedures for routine and consistent operations of the supply chain allows leaders and managers to spread the operational culture at all levels of the supply chain enterprise.
This chapter provides an overview of planning, improvement strategies, metrics, regulatory compliance and decision making.
These constructs should be reviewed and ...
In Week 4, you identified some immediate areas of concern that you w.docxwiddowsonerica
In Week 4, you identified some immediate areas of concern that you were able to effectively address. You must present the final phase of your improvement plan to your staff and upper-level management. You will create a presentation of 15-20 slides addressing the following areas:
In preparation for the accreditation visit for AKT, choose 1 health care accrediting and credentialing organization.
Select a quality improvement focus (QIF) area to improve patient outcomes in beyond the 3 issues that you identified and addressed in Week 4.
Discuss the selected accreditation agency related to the QIF and why the organization is seeking this particular agency for credentialing.
As part of the quality improvement initiative, select 3-4 related accrediting standards that the organization will use as the basis for the quality improvement plan.
Provide a clear mission statement and set of 3-4 specific, measurable, attainable, realistic, and timely (SMART) goals for the QIF initiative.
Using the online database provided the by the organization you selected conduct an analysis.
Provide general statistical data related to the QIF.
Discuss specific health care examples of local, state, and national policies that have been developed to improve this QIF based on evidence-based practice research.
What internal policies do you plan to implement based on evidence-based practice approaches to ensure your organization meets these standards?
Develop a plan that includes strategies for your facility to improve patient outcomes regarding the QIF.
Describe how the QIF initiative can be incorporated to the organization’s overall strategic plan.
Describe how you plan to evaluate the effectiveness of the initiative.
Each slide will have 4-6 bullets and 100-150 words of speaker’s notes and pictures.
HERE IS WEEK 4'S ASSIGNMENT THAT WAS REFERENCED ABOUT
TO:
The Staff and the Management
FROM:
Joycelyn Henry
DATE:
Thursday, August 06, 2015
SUBJECT:
Evidence-Based Practice and Policies
Introduction
Having reviewed the evidence-based practice from health statistics data, it has emerged that we have deviated from standard practice. There have been long waits in the emergency rooms, capacity management strategies are not effectively implemented by the AKT and we have high number of re-admissions than never before.
As we are aware of the Future of Nursing report (IOM, 2011a), our focus should be on the convergence of our knowledge to provide quality services and realize the necessity of new competencies. If we ignore these, we are likely to support the attitude of resistance to change as shown in research by y still faced significant barriers in employing it in practice (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). As highlighted by Pfeffer and Suton (2006), our financial performance and control of expenditure depend on implementation of this practice. Furthermore, we stand to lose patients through obsolete practices and endanger the lives of many.
Wh.
Effective management of health care operations includes multiple points of interest in evaluation for performance. A key danger lies in the potential to evaluate departments and processes separately, without analyzing the interdependence of people, procedures, and goals. The use of a balanced scorecard in health care is supported in the literature because of its ability to link processes by clinical and non-clinical factors, to include financial goals. The literature has described several areas of review under a balanced scorecard, including finance, operations, employee retention, patient satisfaction, and public reporting. As the balanced scorecard is critical to strategic management, this author supports the use of such in health care organizations. This is due in part to gestalt theory, namely, that the combination of parts equals more than its sum total. The balanced scorecard enables health care managers to view processes both within each compartment and as a contributor to the overall organization mission and vision. Thus, financial stability becomes viable, and stakeholders may be informed of organization progress in the areas of particular importance to their specific groups.
Mahankali Week 15 - DiscussionCOLLAPSETop of FormWeek 15 –.docxcroysierkathey
Mahankali
Week 15 - Discussion
COLLAPSE
Top of Form
Week 15 – Discussion
ERM at Learner Centered Teaching & Strategic Risk Management:
Learner Centered Teaching (LCT) is based on learning research that summons more active, inductive instruction. It is extremely interesting to see students strongly arguing for the most important step in an ERM process even when there may not actually be a hierarchy, Increased student engagement strengthened team-based skills, personalized student guidance, focused classroom discussion, and faculty freedom are several benefits of the growing LCT adoption.
Managing Financial Risk assessment is a major point that TL approach gives an example of the trade-offs, costs, and benefits of hedging with futures contracts often starting with a simple natural hedge. Here, the student records the respective payoffs to long and short positions when prices change. Students memorize the transactions and expect to replicate the steps with different numbers, and maybe even a different futures contract for a challenging TL course.
ERM is a business management support process for several years and proponents of ERM have been advocating incorporating the ERM process into strategic and business planning to increase its utility. The specific purpose is to reduce the impact of adverse events and be ready to exploit emerging opportunities and adapting the ERM process within the existing strategic and business planning methodology. Organizations that view the ERM process as supporting business strategies should consider positioning it where the primary goals are both to grow the business and to protect value: corporate planning and the business units can be utilized to incorporate ERM into the strategic and annual business planning process with three internal scan elements -
· Surveying the C-Suite on risk managements
· Effectiveness of risk controls & security audit
· Creating ERM Risk register
The surveys will enable a comparison between the current state of risk management activities and the corresponding risk control efforts and ERM risk register is a tool for organizing the identified risks and their internal owners.
References:
· Fraser, J., Simkins, B., & Narvaez, K. (2014). Implementing enterprise risk management: Case studies and best practices. John Wiley & Sons.
Bottom of Form
For the final paper in this course, you will find a case study on a healthcare organization that conducted a quality improvement (QI) project where they implemented a quality improvement process such as those found in Chapter 4 of the textbook including, but not limited to: Shewhart Cycle or PDCA/PDSA Cycle, API Improvement Model, Six Sigma, Baldridge Award, etc. Once you identify the case study, you will include the following sections in your paper listed below.
You are required to submit your selected case study for approval. Please check the course schedule for the due date.
· Introduction/Background
· Background information about the healthca ...
The document discusses best practices for internal auditing in government organizations. It defines best practices as the most efficient and effective methods for accomplishing tasks based on proven successful procedures. An effective internal audit function is a key component of good governance and can improve accountability, decision-making, and performance. Best practices for internal auditing in government include risk-based audit planning, timely reporting, grading audit findings by level of criticality, and rigorous follow-up processes to ensure issues are addressed. Maintaining independence, developing codes of conduct, and establishing audit committees are also important aspects of internal auditing best practices.
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A Method For Assessing The Effectiveness Of NHS Budgeting And Its Application To A NHS Foundation Trust
1. A method for assessing the effectiveness
of NHS budgeting and its application
to a NHS Foundation Trust
Research executive summary series
Volume 7 | Issue 10
Dr Donald Harradine, Professor Malcolm Prowle, Mr Glynn Lowth
Health and Social Care Finance Research Unit (HSCFRU)
Nottingham Business School
2. Key findings:
• Senior doctors should be accountable in managerial and financial roles to enable
robust strategic and operational planning and control to be optimised.
• Clear lines of accountability and authority for the budgeting and the service
line reporting (SLR) systems – as well as understanding of the relevant roles
– are essential requirements for organisational control both operationally and
strategically.
• SLR should be the basis for strategic decisions and as a guide to strategy
development.
• NHS trusts and foundation trusts require a coherent strategy – implemented
throughout the organisation – for survival in a time of funding austerity.
• The checklist for effectiveness of budgeting systems, developed from the findings
of this report, to be used to examine the adequacy of financial control mechanisms
within provider healthcare organisations.
3. 1 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
Introduction and objectives of the study
This report examines the complex nature of budgetary and
associated financial systems, particularly SLR in NHS provider
units.The relationship between these two systems and the
issues that arise from their joint use are explored in the context
of the research questions posed. NHS Trusts (NHSTs) are
multifunction organisations made more complex by political
issues in and outside of the organisation, which are influential to
the findings of this study.
The objectives of the study were as follows:
• Determine the appropriateness of the current budgetary
arrangements in the Trust and identify generic issues for
other organisations.
• Identify the appropriateness of delegation of budget
authority.
• Examine the lines of responsibility and accountability for
resources.
• Explore the role of strategy in the budget process and the
allocation of resources.
• Explore the role of SLR in conjunction with budgeting.
• Examine budget and managerial structures.
• Identify the role of the budgeting system in promoting
improved operational performance in the organisation.
• Identify key behavioural issues.
NHS Foundation Trusts (NHSFTs) differ from NHSTs in having
additional financial freedoms and their accountability is outside
of the NHS management structure and is dealt with by monitor
– a regulatory body directly accountable to parliament.This
project involved an in-depth study of one NHSFT. However,
both NHSTs and NHSFTs operate systems of budgeting which
have broadly similar characteristics. Addressing the above
objectives in one NHSFT will enable a judgement to be made
about the criteria for judging overall effectiveness and utility of
budgeting systems for both types of organisation in relation to
the three criteria identified below.Thus for the remainder of this
report, any comments made about NHSFTs can be regarded as
applicable to NHSTs unless otherwise stated.
Management control systems, particularly budgeting provide
more than a mere method of financial control and should have
the following objectives illustrated below and subsequently
discussed in respect of a framework for the analysis of this
study:
Strategy implementation – The magnitude of the financial
challenges faced by the NHS coupled with the changes in
commissioning arrangements suggests there is an imperative
for a much stronger emphasis on the development and
implementation of financially robust strategies.This puts a focus
on strategic performance improvement.We would suggest
comparisons with practices in the private sector where the
pressures of globalisation have led to a focus on what is termed
strategic cost management (Hoque, 2006).This implies a focus
on strategic routes to cost improvement.
Such changes will demand innovations in practice and
responsibilities, will be complex and often difficult to implement
because of resistance from many quarters.These improvements
will usually require significant organisational changes and
the support and engagement of a senior doctor will be vital.
Senior doctors will have key roles in facilitating the success or
otherwise of such strategic initiatives and therefore it is key they
are fully engaged in the process.
The budgeting system should be one of the key mechanisms by
means of which the longer term strategy of the organisation is
implemented. Changes to the budgets of the organisation should
reflect the longer term resource trends identified within the
strategy.
Control and empowerment – The budgeting system should be
an instrument of effective managerial control but at the same
time, should facilitate an appropriate degree of empowerment
among NHS staff and managers. Such empowerment will
facilitate decisions being taken nearer the point of action – e.g.
the patient – and in the right circumstances, should result in
better and quicker decisions. However, there are sometimes
problems in doing this.
Firstly, the financial systems of the organisation may find it
difficult to provide the information necessary for a much larger
pool of budget holders. Secondly, it is not clear as to what the
factors are that might facilitate the engagement of health
professionals – especially senior doctors – in budgeting systems
or the factors which deter them.
Furthermore, even where there is a degree of interest and
willingness, it is not clear what is the capacity and capability
of health professionals to have such involvement. Also, to what
extent they have the necessary knowledge and capabilities to
discharge that role effectively.
Performance improvement – The budgeting system should
be a key driver of continuous performance improvement in the
organisation. In order for performance to improve, budgets must
be set within the organisation in a manner which is rational and
transparent, and adequate feedback on financial performance
is provided. In our view, while there will always be a place for
operational cost improvement – doing the same things but at
lower costs – it is possible that such a focus will now provide
diminishing returns. As noted above, the magnitude of the
financial challenges faced by the NHS suggests there is an
imperative for a focus on strategic cost improvement – doing
4. 2 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
things differently to improve outcomes at lower cost.The SLR
initiative should also have a key role here (Harradine and Prowle,
forthcoming).
We suggest it is against these three criteria that the
effectiveness of a modern budgeting system should be judged. In
recent years, NHSTs have gone through many changes and faced
many challenges. An effective budgeting system will help Trusts
deal with these challenges but it is not clear how effective Trust
budgeting systems are in practice.
Contextual background of the study
Financial control in the UK National Health Service (NHS) is
currently at the forefront of political debate with regard to the
financial regime proposed by the current coalition government.
They state that providing much of the budget for the NHS
to General Practitioners (GPs) means they can purchase and
therefore provide the funding for those organisations providing
the healthcare within a market environment.This fundamental
change in the funding mechanism in a market environment,
along with a cost reduction target for the NHS over the next
four years of approximately £20b will require tight financial
control in NHS Trusts to secure their long-term survival. It is
against this background of necessity for financial control in
these organisations that this study is contextualised.
Budgeting systems are a key component of financial
management in NHSFTs and NHSTs. Furthermore, in recent
years the budgeting systems in most NHSFTs and many NHSTs,
have been complimented by the introduction of SLR (Monitor,
2006, Harradine and Prowle, forthcoming).This promotes the
examination of the financial contribution – the comparison of
income with the associated costs – provided by different aspects
of the services. SLR offers an alternative view of performance
to that of the budgeting system, which is primarily cost
control driven within healthcare organisations, by examining
the relationship for a service of cost and income. However, we
believe the findings of this study are applicable to all types of
NHS provider units.
Research description
The study has involved an in-depth study of one NHSFT which
aimed to provide an understanding of the budgeting issues
associated with such an organisation.This is so generalisations
may be made to assist the development of a methodology for
the evaluation of budgeting systems in other organisations.
The NHSFT examined was established as an NHS Trust in 2001
and subsequently became a foundation trust during early 2007.
It has a turnover of £180m and employs some 3,000 staff. Its
financial performance was considered to be good at the time of
selection for this study and in most other respects the NHSFT
appeared to have performed well.
The organisation is divided into four divisions – three clinical
divisions and one support division.The three clinical divisions
– clinical support services; emergency care and medicine; and
planned care and surgery – are all accountable to the trust
director of operations. Each of the divisions identified has its
own director of operations, specific to that division.The service
director and service managers are accountable to each division
and the director of operations. In the majority of cases the
service directors of the predominantly clinically based divisions
were senior doctors.
Strategy
Performance
improvement
Control and
empowerment
Budgeting system
5. 3 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
The study involved the following approach:
• A review of published literature on budgeting systems
both in the NHS and in general.
• Review of appropriate documentation on the budgeting
system of the pilot Trust.
• Interviews – this involved interviews with Trust middle and
senior managers and senior doctors in a sample of clinical
directorates.This has involved taking two vertical slices
through the directorates and interviewing staff at each
level in the organisation. Eighteen staff were interviewed,
namely non-executive director with responsibility for
financial control; chief executive; director of finance;
six managers at different levels of the organisation; six
members of the finance function; and three senior doctors
with budgetary responsibilities.
• Budget holders were asked to complete a questionnaire.
Furthermore, between them the authors have more than fifty
years practical experience of financial management in the NHS
as well as related experience in other organisations in the UK
and overseas.
Findings
This section summarises the key findings from the study
concentrating on the issues of budgeting within the
organisation. In addition, there are a separate set of findings
concerning the important issue of the involvement of doctors in
budget management.
The role of budgeting in the implementation of
strategy
There were a number of findings here:
Lack of strategy – The NHSFT, although required to have
clear strategic objectives – particularly those concerning
financial performance – was found to be limited with regard to
strategic planning at the appropriate levels of the organisation.
Consequently, the implementation of any strategy incorporating
the associated financial strategy was problematic. Many high
level managers of the organisation were aware there was a lack
of strategy and stated it was ‘in the process of development’.
This lack of a coherent strategy caused issues with regard to the
allocation of resources within the organisation.This is because
it was based on previous expenditure patterns which were
unlikely to reflect the strategic direction of the organisation.
It was noted the lack of direction caused problems for budget
holders who said they perceived this as an issue with regard to
the planning for their services. In particular, when dealing with
the cost improvement programmes (CIP), which imposed targets
on the NHSFTs designed to elicit funding to be used for future
developments.
The timing of the study – The last two months of 2010 – was
a time of considerable uncertainty for managers in the NHS
as the NHS’s future had not yet been officially announced
by the coalition government. It was known there would be a
fundamental change in NHS structure and that funding would
not be based on the degree of growth experienced in the
previous ten years. However, details of the reform were not
known.This degree of uncertainty may have been a contributory
factor to the lack of clear strategy for the organisation. However,
there was evidence this was an area of management that had
been neglected for some time.
Cost improvement – This is a major strategic priority
throughout the NHS. Many commentators have identified the
savings expected from the NHS, for the period of the current
parliament, are greater than historically achieved in any other
healthcare system.The CIP for the NHSFT were – depending
upon the service area – approximately 7% for the current year
and it was stated by managers that similar amounts were
expected for forthcoming years.
There were examples where managers had been approaching
this significant issue on an annual basis and not as a long
term programme of savings which would achieve the target
over a number of years.There were examples where vacancies
were being held to meet the saving target for the current year.
However, the chief executive did indicate that in future years,
there would be a more strategic approach to CIP based around
long-term projects. All savings from the CIP were removed
from budgets and contributed to achieving the NHSFT’s overall
targets. Other than achieving a break-even position on their
budgets, there were no budgetary incentives for managers to
perform to achieve these targets or indeed exceed them.
Service line reporting (SLR) – This has been an aspect of the
accounting information used within the organisation for the
past three years as a condition of becoming an NHSFT.The
system provides information on the performance of service lines,
which at the research site, were mainly clinical specialties as is
the case for most organisations currently using the system. SLR
provides financial information concerning the costs incurred by
the specialty and the associated income.Therefore, the service
line is able to demonstrate the degree to which a contribution
is being made to the organisation in respect of its activities.
For the first time in this particular organisation, it enabled an
understanding of which specialties were making a positive or
negative contribution.
The SLR information was provided to the service directors
who were predominantly senior doctors and their associated
management teams as well as the senior tiers of management
within the organisation.There were several instances where
managers and senior doctors who were responsible for the
service line had little understanding of the content of the
6. 4 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
reports.Training had been provided at the inception of the
system however, this would appear to not be adequate in
certain cases.
However, strategically the main issue was that the reports were
used as an adjunct to the budgeting system and the strategic
value of the SLR was not universally recognised by their users.
There was confusion as to their importance with regards to
financial control and their status compared to that of the
budgeting system.The SLR identifies the services that provide
the greatest and least contribution from their activities and
therefore provide information that can assist in developing and
reducing services.
In the context of the current plans of the coalition government
– concerning the growth of market mechanisms in the NHS
where competition can and is likely to be based on price/
cost – information on the contribution being made by services
would strategically be of benefit to the organisation. One of
the interesting observations from the study was the potential
for conflict of the two systems.This is explored later in sections
‘Confusion as to the role of SLR’ and ‘Control issues of SLR.’
Clinical involvement – The involvement of senior doctors
in budgeting and management is a long standing issue of
debate in the NHS (Nugus et al., 2010, Lapsley, 2001). In the
NHSFT, senior doctors holding managerial positions within the
organisation, were only involved on an extremely limited basis
in those strategic issues of the organisation concerning the
contracting process.This is particularly an issue when dealing
with the funding providers where the senior doctor’s expertise
could and should be invaluable.
This particular point becomes increasingly important with the
advent of much of the NHS budget (£80b annually) being at
the disposal of the GPs to purchase healthcare services for their
patients.
Control mechanisms and the empowerment of staff
Key findings were as follows:
Information flows – The operational information provided to
managers in the NHSFT was stated by the recipients to be of
good quality.The use of a dashboard approach was considered
by the research team to be impressive, when compared to other
organisations regardless of sector.The control information under
this system was provided to managers, usually a week after the
end of the month for which it was represented.The information
was provided in a variety of graphical formats and was stated
by managers to be useful in the management of their services.
The interviews and questionnaire data indicate a high degree
of satisfaction with the performance of finance professionals
within the organisation and the information provided.
Lack of responsibility – Considerable examples were identified
of managers being responsible for budgets for which they had
little control. In some cases it was identified that the control
processes in regards to authorising the filling of posts or
purchasing equipment meant that managers had little authority
over the majority of their responsible budgets.This was
identified as an issue almost 30 years ago by one of the authors
of this report and it is a concern that it is still the case today
(Lapsley and Prowle, 1977).
Level of budget holding – Devolving budget holding in the
organisation is a way of empowering staff at lower levels to
make decisions in such a way that improves both the speed and
quality of decision making. However, such devolvement must
be done on the basis that effective financial control will not be
compromised.
In the NHSFT being studied, budgets were still being held
at a fairly high level and there is ongoing debate about the
appropriateness of further devolution.This debate is to some
degree compromised by the difficult financial environment
facing the Trust in future years and the fear of losing financial
control through greater devolvement.
Conflicting duties – It has long been recognised that managers
within organisations have many competing priorities and duties
and that the financial position of the organisation, or sub-unit,
is therefore one amongst many others.This was a particularly
acute observation at the NHSFT under review.The majority
of senior managers interviewed who were representative of
their colleagues, were from clinical backgrounds with clinical
responsibilities within the organisation as well as their financial
duties.
Many managers identified that there was potential for conflict
when dealing with declining resources. Managers in every
instance stated their clinical priorities were clearly more
important than their financial responsibilities, although an
appreciation was identified that finance was an important
aspect of their role. One senior manager exemplified this point
when she stated that the consequences were greater for a
manager if there was a major clinical problem resulting in deaths
compared to the repercussions of a major financial problem.
This issue was compounded by a lack of understanding of the
financial issues and the financial regime of the organisation.This
was identified at all levels within the organisation.
Confusion as to the role of SLR – There was confusion with
many budget holders as to the role of the SLR system. Managers
stated they were not sure as to the monitoring system on which
their financial performance was ultimately to be judged: the
budgeting system or the SLR system? It was stated by most
senior managers that it was the budgetary position which had
predominance however there was not a clear understanding of
this evidence at the operational levels of the organisation. In
3 Verganti, R. (2009) Design-driven innovation: changing the rules of competition by radically innovating what things mean, Harvard Business School Press; and
Christensen, CM., Raynor, ME. (2003) The innovator’s solution: creating and sustaining successful growth, Harvard Business School Press.
7. 5 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
some cases this caused confusion at the operational level as to
which of the performance targets was to be achieved.
Control issues of SLR – The objective of this study was not
to explore issues of SLR in depth however some observations
regarding control are worthy of note. SLR offers an alternate
approach to control within the organisation – potentially
maximising contribution as opposed to the fixed budget
approach used in most NHS organisations.The fixed budget
approach offered the organisation a system which was simple
and had been used within the organisation. It enabled a budget
to be set that allowed the organisation to delegate responsibility
to managers for areas and attempt to hold them to account.The
budgeting system generally appeared to be understood by most
managers within the organisation.
The SLR approach however, offered a different view of the
financial performance of the organisation. In many cases this
cut across the delegated authority of the budget holders and
caused some confusion as to accountability as discussed above.
The SLR also opened the debate concerning income: where
the responsibility for increasing income was to reside and also
where the benefit of income earned was to be assigned.This
question offered an interesting decision for NHSFTs in terms
of accountability for income and potentially the organisational
structure that is required to deal with SLRs. This is likely to be
different from the general functional approach found in most
provider healthcare organisations.
The NHSFT in the study had devoted considerable resources
to the development of the system for SLR in terms of cross-
charging systems and methods of apportionment for some
support services and overheads. Studies examining clinical/
management budgeting and specialty costing found such
approaches to be generally counter-productive in a health
environment, particularly when dealing with senior doctors.
This is because any failings in the information provided caused
a lack of confidence in the system resulting in the approaches
being abandoned at some stage.This is an issue that needs to be
addressed by all NHSFT using SLR. However it must be noted,
this was not an issue at the research site. It is suggested by the
authors that this is only likely to occur when managers/senior
doctors are held to account for SLRs and sanctions or reward for
good performance are an issue.
Performance improvement
The budgeting system and particularly the budget setting
process provides an opportunity to improve operational
performance in the NHSFT.The following findings emerged in
this study.
• Resource allocation and motivation – The method of
allocating resources between departments and activities
caused motivational issues with regard to the fairness
of the process.The budgets for service areas were based
on the previous year’s expenditure thereby perpetuating
previous practices and doing little to address underlying
funding or performance issues.This was recognised as
a problem by senior finance staff but they stated the
approach had been taken to reflect the ‘reality’ of the
spending patterns and the approach would be reviewed in
future years.
• Comparative performance – The authors found little
evidence from this study that budget managers had any
real perception of how well their services were performing
– particularly in financial terms – in comparison with
other NHS provider units or other types of relevant
organisations.We saw no evidence of attempts to improve
the unit costs of operational activities by comparing
performance with other providers.There is considerable
information available on comparative performance within
the healthcare sector, however there was little evidence
at the research site this was being used to gain a better
understanding of the organisation’s performance.
• Workload budgeting – It is common in many
organisations for the budgets of a department to
be flexible and for them to be varied each month
according to changes in workload.While there are many
departments in an NHSFT (e.g. pharmacy, pathology)
where the level of workload is outside the control of the
department itself and is subject to other forces, we saw
no examples of such budgets being flexed accordingly.
The lack of such an approach can reduce the degree of
confidence in the budgeting system.
• Financial reserves – The NHSFT had considerable
financial reserves which were held centrally. Operational
budget holders interviewed said they knew of the
existence of the organisation’s reserves but not the size
or their specified use.The majority of budget holders
expressed the view that these reserves would be used to
assist the organisation to reach its financial targets should
they – the budget holders – overspend on their individual
budgets and in total.This may or may not be true but
clearly, the belief that it is true inhibits the attitude of
budget holders to financial control. It also weakens the
control aspect of the organisation’s budgetary system and
reduces the impetus to improve performance.
4 Halberstam, D. (1987) The Reckoning, Bloomsbury Publishing Ltd, pp236.
8. 6 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
The role of senior doctors in the budgetary process
The role of the senior doctors in the management and financial
control of the organisation poses some interesting issues at the
heart of the NHS and in the findings. Furthermore, this concerns
the important staff group that are to be explored separately in
this section.The position of those doctors in occupying service
director’s posts appeared to be particularly problematic and are
discussed below.
Accountability of service directors – There was little clear
understanding of the role of service director, particularly when
the role was occupied by a senior doctor.These posts on all
structure representations within the organisation appear to be
the accountable post for particular services. However in practice,
this did not appear to be the case.The issue is exemplified
by the monthly monitoring meetings, usually chaired by the
director of finance, to review the performance of particular
services.
The managers from the service under review who attended
these sessions would be the service managers.They would
usually be accompanied by the accountant allocated to the
particular service from the finance function, but never the
service director –a position usually held by a senior doctor.
These robust meetings explored the reasons for variances in
terms of financial and non-financial performance.
This approach poses the problem for the organisation as to
accountability and from discussions at all levels, it appeared
there was no clear view as to who was accountable for the
performance of a particular service.This is a significant issue for
budgeting, considering it was a widely expressed view by most
managers that medical staff had a considerable influence over
how resources were used within the organisation.Yet when in
the post of service director, they were not accountable for the
service.This is regarded as a key issue examined in the study.
Lack of engagement – The engagement and degree of
commitment of senior doctors to the management process –
although based on a limited sample of senior doctors in the role
of service director – differed significantly.This was due to several
factors including:
• Limited time allowance for managerial duties.
• Financial rewards for managerial roles were negligible
considering the earning capacity of senior doctors in their
clinical role.
• The temporary nature of managerial roles – they usually
last for four years before the senior doctor reverts back to
full-time clinical duties.
• Cultural attitudes to management roles and managers by
senior doctors.
The benefits of having doctors in management roles was
exemplified by one service director who, owing to his
understanding of the working practices of his colleagues, said
that he was able to make savings within his clinical specialty
of approximately £200,000.This was during his first year in
the role with an expectation that the recurrent savings would
exceed £300,000 per annum.These savings were from senior
colleagues pay and required adjustments to their workload
planning and additional payment rates.The service director
stated there were possibly similar practices in other specialties,
which might deliver further savings. However, this action not
surprisingly, resulted in the service director becoming unpopular
with colleagues within his specialty. He doubted that others in
a similar role would want to take similar actions to those he
had taken considering the implications to relationships with
colleagues.
It would appear there are barriers to senior doctors being
involved in the management process, which have been present
since the inception of the NHS. However the benefits available
from their involvement would appear to be considerable.The
inclusion of this staff group would appear to be fundamental
to the financial management of such organisations. However
there is a history in the UK of this inclusion being fraught with
difficulties, particularly in times of financial restriction when
there is the possibility that senior doctors may be required to be
involved in cutting or restricting access to services.
Conclusions and recommendations
The main conclusions, findings and recommendations
identified are developed from the findings from the case study
organisation. However, there are generic issues that are likely to
relate to similar organisations in the sector and beyond.
There was a lack of a coherent strategy identified in the
implementation of the budgeting system, as typified by the
approach to CIP.This was said in part to be due to uncertainties
in the organisation’s environment at the time of the research
project. However, the NHSFTs in the era of competition,
resulting from the coalition governments proposals’, will need a
coherent strategy to enable survival in their new environment.
Such strategies should be the basis for resource allocation
and budgeting within the organisation and the predominant
determining factor for decision making.
The advent of GP budget holders will require a significant
understanding of the organisation’s environment to enable
strategy development, which can then be put into action
throughout the organisation via the budgeting system. It is
suggested that to maximise the benefits of budgeting and SLR
for the organisation, there should be a clear strategy driving
these systems. For the organisation to implement its strategy, it
is heavily reliant on these activities.This symbiotic relationship
9. 7 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
between strategy and financial systems is at the heart of
survival for an organisation in a competitive environment.
Service line reporting should be the basis for strategic decisions
and as a guide to strategy development.There is a need for
managers at all levels of an NHSFT to understand the roles of
budgets and SLR.They also need to understand their relationship
and relative importance in both control and decision making.
Therefore there is a clear need for the training of users of such
information and an understanding of the motivational aspects
of such systems by all levels of management.
Clear lines of accountability within the organisation, the
budgeting system and the relationship with SLR required
attention. It is the view of the research team that this was
an issue for the NHSFT examined in this study owing to the
structure and, particularly, the role of service directors. However
other studies reviewed by the team indicate accountability
within healthcare organisations is a generic issue. It is suggested
that the issues of accountability are tied to determining the
roles of senior doctors in the management process and are
identified as a major issue in the ‘Findings’ section of this report.
Managers were deemed by the organisation to be responsible for
budgets, however in many instances they had little authority to
use their budgets, indicating a lack of trust and real delegation.
This issue should be addressed and will require training and
potentially a culture change.The lack of delegation is evidenced
by the processes in place to authorise expenditure and also with
the treatment of the organisation’s reserves.These are issues
that are potentially a problem for organisations which require
tight control of finances and therefore attempt to centralise
control. In complex organisations such as an NHSFT the research
team consider this likely to result in dysfunctional behaviour.
The role of doctors in the management of hospitals has been
an issue since 1948 – the birth of the NHS – and a definitive
solution has never been established. Different approaches
have been attempted but for reasons of role conflict and
inadequacies of information systems these have all failed to
progress or gain universal adoption.This particular project offers
some interesting insights into this issue, particularly the degree
of financial control that may be obtained by the engagement of
medical staff in the management of the organisation.There is
currently little incentive for a senior doctor to be involved in the
general and financial management of the organisation.Those
doctors interviewed currently in service director posts stated
they did so for a variety of reasons such as: to avoid being bored
with a clinical role – no one else was interested – to make a
difference in healthcare.
This study offers evidence that such involvement is a vital
component in strategic and financial control in terms of
operational and strategic issues in the forthcoming competitive
healthcare environment. In order to facilitate such involvement
incentives need to be available to doctors to take on these
roles and reduce the hygiene factors preventing involvement.
Such an initiative is required to start at a national level and
then followed locally to review the terms and conditions
of employment for senior doctors.This is in order to make
managerial roles attractive and to reduce the burden of role
conflict in terms of managerial verses clinical priorities.The
above approach to this issue will be strengthened synergistically
by appropriate training programmes. Such a change will also
require a considerable cultural shift, which is unlikely to occur
quickly therefore this should be seen as a long-term solution.
The above recommendations provide a typology to examine
the budgeting arrangements of NHSTs and NHSFTs, to assist
them in meeting the demands of their changing funding regime
and accountability framework.The authors have developed
a checklist for effectiveness of budgeting systems, based on
this study. It is hoped this will assist further similar reviews in
healthcare organisations.
This is the study of one NHSFT and it is suggested the study is
performed in other NHSFT to gain a higher degree of validity for
the findings. It should be noted, by others attempting to explore
such issues, to be aware of the significant efforts required for
ethical approval from the NHS for such studies. It is believed
this will and is causing researchers to avoid investigation of NHS
organisations, which is to the detriment of the NHS and also to
academic enquiry.
The authors wish to thank CIMA’s General Charitable Trust for
assisting in funding this project and the managers and staff of
the NHSFT at the heart of this study for their assistance and
patience. It is the authors’ ambition that this study offers them
some guidance in their future success and also other NHSTs in
England facing similar problems.
10. 8 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
Contact details
donald.harradine@ntu.ac.uk
malcolm.prowle@ntu.ac.uk
glynn.lowth@ntu.ac.uk
Nottingham Trent University
Nottingham
NG1 4BU
England
References
Harradine, D. & Prowle, M. Forthcoming. Service Line Reporting in a NHS Foundation Trust: an initial assessment of its relevance and
applicability. Public Money and Management.
Hoque, Z. 2006. Strategic Management Accounting, London, Prentice Hall.
Lapsley, I. 2001. The accounting-clinical interface: implementing budgets for hospital doctors. Abacus, 37, 79-109.
Lapsley, I. & Prowle, M. 1977. The effectiveness of functional budgetary control in the NHS: an empirical investigation. University of
WarwickYellow Paper Series.Warwick: University of Warwick.
Monitor. 2006. Guide to developing reliable financial data for service-line reporting [Online]. London.
Available: www.monitor-nhsft.gov.uk/home [Accessed 2011].
Nugus, P., Greenfield, D.,Travaglia, J.,Westbrook, J. & Braithwaite, J. 2010. How and where clinicians exercise power: interprofessional
relations in health care. Social Science & Medicine, 898-909.
11. 9 | A method for assessing the effectiveness of NHS budgeting and its application to a NHS Foundation Trust
Appendix 1
Checklist for effectiveness of budgeting systems
Strategy implementation
• Does the organisation have a well defined strategy with strategic objectives which are SMART – Specific, Measurable,
Achievable, Realistic,Time?
• Is the content of the strategy – and particularly the change requirements – known throughout the organisation and
particularly among senior doctors?
• Does the organisation have a multi-year financial plan which underpins and supports the strategy?
• Can proposed trends in the strategy be observed as shifts in resources in the multi-year financial plan?
• What evidence is there that annual budgets reflect the changes which appear in the multi-year financial plan?
• Does the organisation have a clear strategic approach to cost improvement and is this promulgated throughout the
organisation and particularly among senior doctors?
• How well is SLR information promulgated throughout the organisation and particularly among senior doctors?
• Do strategic decision changes in the organisation pay any cognisance of SLR information?
Control and empowerment
• To what extent are there situations where managers have responsibility for budgets but their degree of control over such
expenditure is compromised for whatever reasons?
• Have any actions been considered or implemented to resolve the above deficiencies?
• Has the organisation – systematically and thoroughly – assessed the level of budget holding in the organisation?
• Has it concluded the current arrangements are adequate?
• Has it identified any areas where further delegation of budget holding might be deemed appropriate?
• In those areas, have the staff involved got the capacity and capability to effectively manage devolved budgets?
• Are the current budget reporting arrangements seen as representing best practice?
• What is the focus of financial control in the organisation – budgeting systems or SLR?
• Has any consideration been given to the reconciliation of the two systems?
• Has the future role of SLR and SLM in the organisation been clarified?
Performance improvement
• Is the current approach to budgetary resource allocation in the organisation seen as being broadly fair? Have other
approaches been considered?
• To what extent do budget managers compare their financial performance with that of comparable organisations when setting
budgets? What actions do they take?
• Is any form of workload based budget setting operating in the organisation? Is there scope for doing this?
• Is the level of centrally held financial reserves in the organisation too high? Can it be reduced by enlarged distribution of
resources to budget managers?
• Are the right incentives/sanctions in place to encourage improved financial performance? If not, what can be done to
improve this?
• Is the current approach to identifying cost improvement programmes seen as fair and sustainable?
• Are planned cost improvement programmes being successfully implemented and incorporated into budgets? If not, what can
be done to improve?
• Does the organisation employ any form of priority based budget setting to identify activities of lower priority?