Operational and Budget Planning
Learning Objectives
After reading this chapter, you should be able to:
• Describe broad operational issues such as systems and systems thinking, information systems,
consensus building, and the role of policies.
• Evaluate the differences between operational planning and budget planning.
• Discuss how to involve everyone in the operational planning process.
• Assess the issues involved in getting operational planning done before the start of the new
fiscal year.
Chapter 8
Evgeny Tomeev/iStock/Thinkstock
spa81202_08_c08.indd 223 1/15/14 3:50 PM
CHAPTER 8Section 8.1 Broad Operational Issues
No strategy is useful unless it can be implemented, and no strategy can be implemented
with any degree of success without operational and budget planning (refer to Figure 1.1).
This chapter explains how to do such planning, why it is important, and other essential
process issues.
8.1 Broad Operational Issues
Operational planning involves preparing detailed organizational plans for the coming
fiscal year. It includes programs, projects, and activities that the organization is already
doing as well as new ones required by any change in strategy. Detailed plans by organi-
zational unit are part of operational plans. Finally, it includes coordinating all these activi-
ties to make sure they support stated strategies. Some aspects of operational planning
are more encompassing than just planning programs, projects, and tasks for people to
do. These include systems and systems thinking, management information systems, the
need for consensus in decision making, and organization-wide policies. Not only are these
issues more encompassing, but they also are determinants of effective strategy execution
and should be taken into account.
Systems and Systems Thinking
For the most part, our world is made up of systems—from the galactic solar system to the
human body, which has many subsystems of its own, such as the immune, reproductive,
digestive, and cardiovascular systems. Organizations are complex social systems, consist-
ing of individuals and units that work
together (or not) to produce services
for their customers. Complex sys-
tems are self-regulating systems; that
is, they are self-correcting through
feedback. HSOs must be responsive
to feedback, such as the organiza-
tion’s patient volume figures, quality
performance results, and other met-
rics important to success. Engaging
in systems thinking means viewing
your HSO as a system with interact-
ing, interdependent components and
realizing that what is done must ben-
efit the integrated whole and not just
a particular part at the expense of
other parts.
The systems approach to understand-
ing organizations also examines the
nature of the boundaries between the
organization and the outside world. The more permeable an organization’s boundaries,
the more the organization is able to place its finger on the pulse of the competition, th ...
Chapter 12 IT Alignment and Strategic Planning Learning ObjectivesEstelaJeffery653
Chapter 12 IT Alignment and Strategic Planning Learning Objectives To be able to understand the importance of an IT strategic plan. To review the components of the IT strategic plan. To be able to understand the processes for developing an IT strategy. To be able to discuss the challenges of developing an IT strategy. To describe the Gartner Hype Cycle recognizing the wide range of emerging technologies at various stages of maturity. Information technology (IT) investments serve to advance organizational performance. These investments should enable the organization to reduce costs, improve service, enhance the quality of care, and, in general, achieve its strategic objectives. The goal of IT alignment and strategic planning is to ensure a strong and clear relationship between IT investment decisions and the health care organization's overall strategies, goals, and objectives. For example, an organization's decision to invest in a new claims adjudication system should be the clear result of a goal of improving the effectiveness of its claims processing process. An organization's decision to implement a care coordination application should be a consequence of its population health management strategy. Developing a sound alignment can be very important for one simple reason—if you define the IT agenda incorrectly or even partially correctly, you run the risk that significant organizational resources will be misdirected; the resources will not be put to furthering strategically important areas. This risk has nothing to do with how well you execute the IT direction you choose. Being on time, on budget, and on specification is of little value to the organization if it is doing the wrong thing! IT Planning Objectives The IT strategic planning process has several objectives: To ensure that information technology plans and activities align with the plans and activities of the organization; in other words, the IT needs of each aspect of organizational strategy are clear, and the portfolio of IT plans and activities can be mapped to organizational strategies and operational needs To ensure that the alignment is comprehensive; in other words, each aspect of strategy has been addressed from an IT perspective that recognizes not all aspects of strategy have an IT component, and not all components will be funded To identify non-IT organizational initiatives needed to ensure maximum leverage of the IT initiative (for example, process reengineering) To ensure that the organization has not missed a strategic IT opportunity, such as those that might result from new technologies To develop a tactical plan that details approved project descriptions, timetables, budgets, staffing plans, and plan risk factors To create a communication tool that can inform the organization of the IT initiatives that will and will not be undertaken To establish a political process that helps ensure the plan results have sufficient organizational support At the end of the alignment an ...
A Nurse’s Role in the Systems Development Life CycleWhile the proc.docxJospehStull43
A Nurse’s Role in the Systems Development Life Cycle
While the process of developing and implementing a health information technology system may seem overwhelming at first, the systems development life cycle (SDLC) provides organizations with a framework to deliver efficient and effective information systems. Though the SDLC is a common overarching structure for implementing information systems, it is not a one-size-fits-all process. In fact, there are a multitude of approaches that can be used to guide the systems development life cycle. The SDLC approach that is most appropriate for a particular organization will be highly contextual and subject to organization-specific differences.
This week prompts you to analyze the process of selecting an appropriate health information technology and then evaluate techniques that positively impact the steps of the systems development life cycle in an EHR implementation. You also determine what barriers might occur at each stage and how these could be overcome.
Learning Objectives
Students will:
Analyze how a nurse can contribute to each stage of the systems development life cycle
Photo Credit: Jose Luis Pelaez Inc]/[Brand X Pictures]/Getty ImagesCredit
Learning Resources
Note:
To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 10, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making”
This chapter explains the systems development life cycle and explores various methods of applying it. The chapter also examines the importance of interoperability in implementing HITECH.
Chapter 11, “Administrative Information Systems”
This chapter provides an overview of agency-based health information systems. The text also details how administrators can use core business systems in their practice.
Boswell, R. A. (2011). A physician group’s movement toward electronic health records: A case study using the transtheoretical model for organizational change.
Consulting Psychology Journal: Practice and Research, 63
(2), 138–148.
Retrieved from the Walden Library databases.
The authors of this article present a case study on an EHR implementation in a multispecialty physician group. The case study attempts to determine actions that promote successful EHR implementation and the pros and cons of implementation.
Hsiao, J., Chang, H., & Chen, R. (2011).A study of factors affecting acceptance of hospital information systems: A nursing perspective.
Journal of Nursing Research, 19
(2), 150–160.
Retrieved from the Walden Library databases.
The focus of this article is to determine what factors are most important in predicting the acceptance of new health information technology. The results of the study indicated .
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
Chapter 12 IT Alignment and Strategic Planning Learning ObjectivesEstelaJeffery653
Chapter 12 IT Alignment and Strategic Planning Learning Objectives To be able to understand the importance of an IT strategic plan. To review the components of the IT strategic plan. To be able to understand the processes for developing an IT strategy. To be able to discuss the challenges of developing an IT strategy. To describe the Gartner Hype Cycle recognizing the wide range of emerging technologies at various stages of maturity. Information technology (IT) investments serve to advance organizational performance. These investments should enable the organization to reduce costs, improve service, enhance the quality of care, and, in general, achieve its strategic objectives. The goal of IT alignment and strategic planning is to ensure a strong and clear relationship between IT investment decisions and the health care organization's overall strategies, goals, and objectives. For example, an organization's decision to invest in a new claims adjudication system should be the clear result of a goal of improving the effectiveness of its claims processing process. An organization's decision to implement a care coordination application should be a consequence of its population health management strategy. Developing a sound alignment can be very important for one simple reason—if you define the IT agenda incorrectly or even partially correctly, you run the risk that significant organizational resources will be misdirected; the resources will not be put to furthering strategically important areas. This risk has nothing to do with how well you execute the IT direction you choose. Being on time, on budget, and on specification is of little value to the organization if it is doing the wrong thing! IT Planning Objectives The IT strategic planning process has several objectives: To ensure that information technology plans and activities align with the plans and activities of the organization; in other words, the IT needs of each aspect of organizational strategy are clear, and the portfolio of IT plans and activities can be mapped to organizational strategies and operational needs To ensure that the alignment is comprehensive; in other words, each aspect of strategy has been addressed from an IT perspective that recognizes not all aspects of strategy have an IT component, and not all components will be funded To identify non-IT organizational initiatives needed to ensure maximum leverage of the IT initiative (for example, process reengineering) To ensure that the organization has not missed a strategic IT opportunity, such as those that might result from new technologies To develop a tactical plan that details approved project descriptions, timetables, budgets, staffing plans, and plan risk factors To create a communication tool that can inform the organization of the IT initiatives that will and will not be undertaken To establish a political process that helps ensure the plan results have sufficient organizational support At the end of the alignment an ...
A Nurse’s Role in the Systems Development Life CycleWhile the proc.docxJospehStull43
A Nurse’s Role in the Systems Development Life Cycle
While the process of developing and implementing a health information technology system may seem overwhelming at first, the systems development life cycle (SDLC) provides organizations with a framework to deliver efficient and effective information systems. Though the SDLC is a common overarching structure for implementing information systems, it is not a one-size-fits-all process. In fact, there are a multitude of approaches that can be used to guide the systems development life cycle. The SDLC approach that is most appropriate for a particular organization will be highly contextual and subject to organization-specific differences.
This week prompts you to analyze the process of selecting an appropriate health information technology and then evaluate techniques that positively impact the steps of the systems development life cycle in an EHR implementation. You also determine what barriers might occur at each stage and how these could be overcome.
Learning Objectives
Students will:
Analyze how a nurse can contribute to each stage of the systems development life cycle
Photo Credit: Jose Luis Pelaez Inc]/[Brand X Pictures]/Getty ImagesCredit
Learning Resources
Note:
To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
McGonigle, D., & Mastrian, K. G. (2015).
Nursing informatics and the foundation of knowledge
(3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 10, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making”
This chapter explains the systems development life cycle and explores various methods of applying it. The chapter also examines the importance of interoperability in implementing HITECH.
Chapter 11, “Administrative Information Systems”
This chapter provides an overview of agency-based health information systems. The text also details how administrators can use core business systems in their practice.
Boswell, R. A. (2011). A physician group’s movement toward electronic health records: A case study using the transtheoretical model for organizational change.
Consulting Psychology Journal: Practice and Research, 63
(2), 138–148.
Retrieved from the Walden Library databases.
The authors of this article present a case study on an EHR implementation in a multispecialty physician group. The case study attempts to determine actions that promote successful EHR implementation and the pros and cons of implementation.
Hsiao, J., Chang, H., & Chen, R. (2011).A study of factors affecting acceptance of hospital information systems: A nursing perspective.
Journal of Nursing Research, 19
(2), 150–160.
Retrieved from the Walden Library databases.
The focus of this article is to determine what factors are most important in predicting the acceptance of new health information technology. The results of the study indicated .
Chapter 4 Information Systems to Support Population Health Managem.docxketurahhazelhurst
Chapter 4 Information Systems to Support Population Health Management Learning Objectives To be able to understand the data and information needs of health systems in managing population health effectively under value-based payment models. To be able to discuss key health IT tools and strategies for population health management including EHRs, registries, risk stratification, patient engagement, and outreach, care coordination and management, analytics, health information exchange, and telemedicine and telehealth. To be able to discuss the application and use of data analytics to monitor, predict, and improve performance. The enactment of the Affordable Care Act (ACA) brought about sweeping legislation intended to reduce the numbers of uninsured and make health care accessible to all Americans. It also ushered in an era in which changing reimbursement and care delivery models are driving providers from the current fragmented system focused on volume-based services to an outcomes orientation. As a result, the health care system now taking shape is one in which value-based payment models financially reward patient-centered, coordinated, accountable care. Against this backdrop, providers' increasing use of evidence-based medicine and growing capabilities in managing volumes of clinical evidence through sophisticated health IT systems will mean that treatments can be tailored for the individual and interventions can be made earlier to keep patients well. Furthermore, patient engagement is fast becoming a critical component in the care process, particularly in the area of population health management (PHM). Health care providers' interest in improving population health appears to be increasing because of the sudden ubiquity of the phrase, because many are participating in accountable care organizations (ACOs), and because even hospitals not participating in an ACO increasingly have incentives to reduce their number of potentially unavoidable admissions, readmissions, and emergency department visits (Casalino, Erb, Joshi, & Shortell, 2015). In this chapter we'll not only seek a common understanding of PHM but also explore how the advent of shared accountability financial arrangements between providers and purchasers of care has created significant focus on PHM. We'll also review the core processes associated with accountable care and examine the strategic IT investments and data management capabilities required to support population health management and enable a successful transition from volume-based to value-based care. PHM: Key to Success Although the ACO model is still new and evolving, approximately 750 ACOs are in operation today, covering some 23.5 million lives under Medicare, Medicaid, and private insurers. Although not all ACOs have demonstrated success in delivering better health outcomes at a lower cost, many have achieved promising results (Houston & McGinnis, 2016). As such, significant ACO growth is expected. In fact, it is predicte ...
Running head: ANALYSIS PAPER 1
ANALYSIS PAPER 2
Analysis Paper
Krista Kim
Rasmussen College
Author Note
This paper is being submitted on January 21st, 2018, for Kim Sanders’s H490/HSA4922 Section 01 Healthcare Management Capstone - Online Plus - 2018 Winter Quarter
Analysis Paper
Based on the results of the SWOT analysis, what should Barbara recommend as an overall strategy?
From the SWOT analysis, the overall strategy that Barbara should recommend is a system that is capable of meeting the needs of the healthcare facility effectively and efficiently. The strategy focuses on having systems that are fast to allow for easy processing of information and offer quality support to the patients. It should also have a high level of functionality to allow for the normalizing, analyzing, access and the storage of the entire patient's data and saving it for easy retrieving in the future. The system should also be user-friendly so that the professionals and the staff using it can be in a position to easily maneuver in the process of care delivery. The other component of the system that the company should consider is that it should have a wide range of features to enhance maximum utilization and the ease of data access by the patients and physicians. Finally, the medical professionals should also be trained on how to use the system upon implementation.
How will the selection of the chosen EHR system contribute to the strategy? Further explain why it was the best choice.
One of the ways in which the selection of eClinical works EHR will contribute to strategy is that it is the ability to maintain highly organized data; it’s fast and also has amazing features. The EHR system adapted for use in the organization should be in a position to increase effectiveness, efficiency, achieve quality in the delivery of care and also enhance the patient’s outcomes (Sinha et al., 2013). Due to its organization, the system will make it easy for the health care professionals to retrieve the patients’ information while at the same time ensuring security to prevent access of the patient information by unauthorized persons. The e-Clinical works will also contribute to the strategy because it offers low and affordable prices and has low maintenance costs and this aids in the reduction of the costs that the healthcare facilities incur in the maintenance. The other way in which the system will contribute to the strategy is that it has a wide scope of features which make it easy for the patients and the physicians to login into their portals and interact with each other.
On what basis should she develop actions items? What should the action items be, as they directly relate to the strategy?
The action items should be developed based on their importance in m ...
THE TECHNOLOGY OF USING A DATA WAREHOUSE TO SUPPORT DECISION-MAKING IN HEALTH...ijdms
This paper describes the technology of data warehouse in healthcare decision-making and tools for support
of these technologies, which is used to cancer diseases. The healthcare executive managers and doctors
needs information about and insight into the existing health data, so as to make decision more efficiently
without interrupting the daily work of an On-Line Transaction Processing (OLTP) system. This is a
complex problem during the healthcare decision-making process. To solve this problem, the building a
healthcare data warehouse seems to be efficient. First in this paper we explain the concepts of the data
warehouse, On-Line Analysis Processing (OLAP). Changing the data in the data warehouse into a
multidimensional data cube is then shown. Finally, an application example is given to illustrate the use of
the healthcare data warehouse specific to cancer diseases developed in this study. The executive managers
and doctors can view data from more than one perspective with reduced query time, thus making decisions
faster and more comprehensive
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 ...
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 ...
Understanding hmis implementation in a developing country ministry of health ...Ime Asangansi, MD, PhD
Abstract
Globally, health management information systems (HMIS) have been hailed as important
tools for health reform (1). However, their implementation has become a major challenge for
researchers and practitioners because of the significant proportion of failure of
implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS
implementation, in part, to the complexity of meeting with and satisfying multiple (poorly
understood) logics in the implementation process.
This paper focuses on exploring the multiple logics, including how they may conflict and
affect the HMIS implementation process. Particularly, I draw on an institutional logics
perspective to analyze empirical findings from an action research project, which involved
HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The
analysis highlights the important HMIS institutional logics, where they conflict and how they
are resolved.
I argue for an expanded understanding of HMIS implementation that recognizes various
institutional logics that participants bring to the implementation process, and how these are
inscribed in the decision making process in ways that may be conflicting, and increasing the
risk of failure. Furthermore, I propose that the resolution of conflicting logics can be
conceptualized as involving deinstitutionalization, changeover resolution or dialectical
resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved
by implementation strategies that are made based on an understanding of these conflicting
logics.
System Dynamics Modeling for IntellectualDisability Services.docxmabelf3
System Dynamics Modeling for Intellectual
Disability Services: A Case Studyjppi_342 112..119
Meri Duryan*,†, Dragan Nikolik‡, Godefridus van Merode§, and Leopold Curfs*,§
*Gouverneur Kremers Centrum; †University of Maastricht; ‡Maastricht School of Management; and §Maastricht University Medical
Center, Maastricht, the Netherlands
Abstract Organizations providing services to persons with intellectual disabilities (ID) are complex because of many interacting
stakeholders with often different and competing interests. The combination of increased consumer demand and diminished resources
makes organizational planning a challenge for the managers of such organizations. Such challenges are confounded by significant
demands for the optimization of resources and the goal to reduce expenses and to more effectively and efficiently use existing
resources while at the same time providing high quality services. The authors explore the possibilities of using “system dynamics
modelling” in organizational decision-making processes related to resource allocations. System dynamics suggests the application of
generic systems archetypes as a first step in interpreting complex situations in an organization. The authors illustrate the application
of this method via a case study in one provider organization in the Netherlands. The authors contend that such a modeling approach
can be used by the management of similar organizations serving people with ID as a tool to support decision making that can result
in optimal resource allocation.
Keywords: allocation of resources, intellectual disabilities, system dynamics modeling, systems thinking, waiting lists
INTRODUCTION
Healthcare organizations are complex entities as they have
multiple stakeholders with often conflicting objectives and goals
(Drucker, 1993). Provider organizations specializing in intellec-
tual disabilities (ID) are also complex because of the nature of the
care and supports they provide and how they are organized. Some
of the complexities relate to the difficulties that adults with ID
might have in expressing themselves. Moreover, the specifics of
the care often require a deeper involvement of carers with respect
to their relationships with families and other sectors of society.
Because of their complexity, ID provider organizations, com-
pared with healthcare providers, often require a higher level of
resource planning, collaboration, and cooperation among social,
health, and education services, mental health services, and other
sectors (WHO, 2010).
To manage the complexities and challenges ID provider orga-
nizations face, managers need to analyze and understand complex
interdependencies among the systems with which they are dealing.
In order to achieve that, ID provider managers need to examine
and shift their mental models regarding their role in managing
the organization and in establishing relationships with all the
stakeholders involved. However, as Forrester (1980) has noted,
traditiona.
Treasury Board of Canada Secretariat. (2012). Policy on evalua.docxturveycharlyn
Treasury Board of Canada Secretariat. (2012). Policy on evaluation. Retrieved from
http://www.tbs-sct.gc.ca/pol/doc-eng.aspx?id=15024
U.S. Government Accountability Office. (2011). GPRA Modernization Act implementation
provides important opportunities to address government challenges (GAO-11–617T).
Retrieved from http://www.gao.gov/assets/130/126150.pdf
Von Bertalanffy, L. (1968). General system theory: Foundations, development, applications (Rev.
ed.). New York: G. Braziller.
Wandersman, A., & Fetterman, D. (2007). Empowerment evaluation: Yesterday, today, and
tomorrow. American Journal of Evaluation, 28(2), 179–198.
Weibe, R. H. (1962). Businessmen and reform: A study of the progressive movement. Cambridge,
MA: Harvard University Press.
Wholey, J. S. (2001). Managing for results: Roles for evaluators in a new management era.
American Journal of Evaluation, 22(3), 343–347.
Wildavsky, A. B. (1979). Speaking truth to power: The art and craft of policy analysis. Boston,
MA: Little Brown.
Williams, D. W. (2003). Measuring government in the early twentieth century. Public
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WorkSafeBC. (2011). Reports: See 2010 annual report and 2011–2013 service plan. Retrieved
from http://www.worksafebc.com/publications/reports/default.asp
CHAPTER 9
DESIGN AND IMPLEMENTATION OF
PERFORMANCE MEASUREMENT SYSTEMS
Introduction
Key Steps in Designing and Implementing a Performance Measurement System
Identify the Organizational Champions of This Change
Understand What Performance Measurement Systems Can and Cannot Do
Establish Multichannel Ways of Communicating That Facilitate Top-Down, Bottom-Up,
and Horizontal Sharing of Information, Problem Identification, and Problem Solving
Clarify the Expectations for the Intended Uses of the Performance Information That Is
Created
Identify the Resources Available for Designing, Implementing, and Maintaining the
Performance Measurement System
Take the Time to Understand the Organizational History Around Similar Initiatives
Develop Logic Models for the Programs for Which Performance Measures Are Being
Developed, and Identify the Key Constructs to Be Measured
Identify Any Constructs That Apply Beyond Single Programs
Involve Prospective Users in Reviewing Logic Models and Constructs in the Proposed
Performance Measurement System
Measure the Constructs That Have Been Identified as Parts of the Performance
Measurement System
Record, Analyze, Interpret, and Report the Performance Data
Regularly Review Feedback From the Users and, If Needed, Make Changes to the
Performance Measurement System
Performance Measurement for Public Accountability
Summary
Discussion Questions
Appendix A: Organizational Logic Models
References
INTRODUCTION
In this chapter, we begin by introducing two complementary perspectives on public sector
organizations: (1) a technical/rational view ...
SYSTEMS THEORYAs noted in the Learning Resources, systems theory p.docxjonghollingberry
SYSTEMS THEORY
As noted in the Learning Resources, systems theory provides a meaningful and beneficial means of examining challenges in health care organizations. To do this effectively, however, it is essential to assess
all
system components, as some may be relatively healthy while others are problematic.
For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (
Note:
You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)
To prepare:
·
Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
·
Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.
·
Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
·
Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
·
Research professional standards that are pertinent to your identified problem.
·
Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)
To complete:
Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:
·
Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.
·
Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).
·
Based on this information, explain how you would address the problem as follows:
o
Formulate a desired outcome.
o
Identify goals and objectives that would facilitate that outcome.
o
Translate those goals and objectives into policies and procedures for the department or unit.
o
Describe relevant professional standards.
·
Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.
*This paper must include a title page, introduction, summary, and references.
* Follow APA 6
th
ed for the ci.
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.
The Discipline of Business Intelligence(Course 3)
Introduction
This section provides an overview of the discipline of business intelligence, as applied to the
business of healthcare service delivery for the improvement of decisions. It includes the types
of analytics and examples, timeframe based viewpoints that engaging analytics provides and
presents these viewpoints in relation to decision-making power generated. This section will also
discuss the concept of decision management, decision types and analytic tools.
Analysis, Analytics and Business Intelligence
A good deal of discussion and some confusion exists as the science of working with data
evolves, especially in healthcare. When there is talk of engaging business intelligence(BI), often
a question arises,”What does this encompass?” Various definitions are put forth and another
question arises, “How is business intelligence different from business analytics? How does this
differ from Clinical informatics being engaged in many healthcare organizations?” And now the
water is very muddy. This will require filtering, clarity and foundation.
Analytics
The science of analytics-processes for separation and/or manipulation of data(simultaneously
applying statics, mathematics, operations research and computer programming) to develop
greater understanding is a more recent idea, however, its roots are, by extension of the above, a
branch of logic dealing with analysis. Analytics also favors the visual display of information to
communicate insights.
Analysis
At its core, all of this work is analysis, that is, separation of a whole or complex idea or topic into
its component parts to gain a greater understanding. These techniques have been applied in the
study of mathematics and logic since before Aristotle.
Business Intelligence(BI)
BI does the same work of simplifying data to amplify meaning in relation to internal, structured
data and business ...
DSS In the Public SectorDesign andImplementation ofDec.docxjacksnathalie
DSS In the Public Sector
Design and
Implementation of
Decision Support
Systems in the
Public Sector
By: John C. Henderson
Sloan School of Management,
Massachusetts Institute of
Technology
Cambridge, Massachusetts
By: David A. Schiiiing
Facuity of Management Sciences
Ohio State University
Abstract
This article examines the implications of utilizing deci-
sion support systems (DSS) in the public sector based
on a DSS developed and implemented for a community
mental health system. The DSS includes a multiple
objective (goal programming) allocation model and
encompasses a multiple party decision process. The
experiences and insights acquired during the develop-
ment and implementation of this DSS are relevant to
public sector decision support in general. The impor-
tance of a DSS as a process-support aid rather than a
product-oriented aid (i.e., simply providing answers)
and the interaction of system architecture and the
chosen design strategy are key insights. In particular,
the distinction between model-oriented and data-
oriented DSS does not appear to be appropriate. The
public sector decision maker's concern with issues of
equity requires the ability to operate in a higher dimen-
sional framework than the typical spreadsheet model
and there is a critical need for communication support.
Keywords: Goal programming, decision support
systems, public sector.
ACM Categories: H.4.2
Introduction
Developing and implementing decision aids in
the public sector is a challenging task. As Lamm
[14] points out, the political process tends to pro-
mote those that survive or win, not those seeking
truth. Often, the essential benefit of a decision
aid — a valid model — is the very element that
most threatens the survival of the public deci-
sion maker. It is not surprising that Brill [3] notes,
"Designing a solution to a public sector problem
is largely an art."
Hammond [8] suggests that it may not be suffi-
cient to provide decision aids unless explicit
attention is given to how these aids support
effective learning. Without effective learning
support dysfunctional consequences are likely
to result from policy-making processes.
Although Hammond argues a quasi-experimen-
tal approach is a necessary condition for learn-
ing, he notes that the strong quasi-rational
model of inquiry represented by the application
of management science techniques has had
positive impact on public sector decision mak-
ing. For example, management science models
can help to externalize multiple objectives and,
when combined with the results of quasi-experi-
ments, provide an enhanced learning
environment.
The need to facilitate access to decision aids as
well as to support individual and organizational
learning is explicitly addressed in the decision
support systems literature [1]. The basic design
strategy for DSS begins with an analysis of the
decision process and adaptively developing a
tool for the user to learn about and cope with
semi-structured decisions.
Experie ...
1. Primary sources2. Secondary sources3. La Malinche4. Bacon’s.docxvannagoforth
1. Primary sources
2. Secondary sources
3. La Malinche
4. Bacon’s rebellion
5. Robert Carter III
6. Mesoamerica
7. Middle Passage
8. Indentured servitude
9. The Jefferson-Hemings Controversy
10. Triangular trade
11. Saint Dominique Revolt
12. Syncretism
13. Olaudah Equiano
14. Christopher Columbus
15. Columbian Moment
16. Hernan Cortes
17. Florentine Codex
18. Master Narrative of American History
19. Reconquista
20. The Paradox of Slavery
21. Indian Removal Act 1830
22. Trail of Tears
23. Treaty of Guadalupe Hidalgo
24. Niños Heroes (Heroic Children)
25. Antonio López de Santa Anna y Pérez de Lebrón
26. The Royal Africa Company
27. John Locke
28. St. Patrick’s Battalion
29. Chilam Balam
30. Popol Vuh
31. El requerimiento (The Requirement)
32. Manifest Destiny
33. Moses and Stephen F. Austin
34. Colonialism
35. Colonial Legacy
.
1. Prepare an outline, an introduction, and a summary.docxvannagoforth
1. Prepare
an outline
,
an introduction
, and
a summary
on the article selected. It s
hould be
a report of at least 4 page
double spaced.
2. Prepare a 4
PowerPoint slides
from the report.
NOTE
: See the attachment below to review the article.
.
More Related Content
Similar to Operational and Budget PlanningLearning ObjectivesAfte.docx
Running head: ANALYSIS PAPER 1
ANALYSIS PAPER 2
Analysis Paper
Krista Kim
Rasmussen College
Author Note
This paper is being submitted on January 21st, 2018, for Kim Sanders’s H490/HSA4922 Section 01 Healthcare Management Capstone - Online Plus - 2018 Winter Quarter
Analysis Paper
Based on the results of the SWOT analysis, what should Barbara recommend as an overall strategy?
From the SWOT analysis, the overall strategy that Barbara should recommend is a system that is capable of meeting the needs of the healthcare facility effectively and efficiently. The strategy focuses on having systems that are fast to allow for easy processing of information and offer quality support to the patients. It should also have a high level of functionality to allow for the normalizing, analyzing, access and the storage of the entire patient's data and saving it for easy retrieving in the future. The system should also be user-friendly so that the professionals and the staff using it can be in a position to easily maneuver in the process of care delivery. The other component of the system that the company should consider is that it should have a wide range of features to enhance maximum utilization and the ease of data access by the patients and physicians. Finally, the medical professionals should also be trained on how to use the system upon implementation.
How will the selection of the chosen EHR system contribute to the strategy? Further explain why it was the best choice.
One of the ways in which the selection of eClinical works EHR will contribute to strategy is that it is the ability to maintain highly organized data; it’s fast and also has amazing features. The EHR system adapted for use in the organization should be in a position to increase effectiveness, efficiency, achieve quality in the delivery of care and also enhance the patient’s outcomes (Sinha et al., 2013). Due to its organization, the system will make it easy for the health care professionals to retrieve the patients’ information while at the same time ensuring security to prevent access of the patient information by unauthorized persons. The e-Clinical works will also contribute to the strategy because it offers low and affordable prices and has low maintenance costs and this aids in the reduction of the costs that the healthcare facilities incur in the maintenance. The other way in which the system will contribute to the strategy is that it has a wide scope of features which make it easy for the patients and the physicians to login into their portals and interact with each other.
On what basis should she develop actions items? What should the action items be, as they directly relate to the strategy?
The action items should be developed based on their importance in m ...
THE TECHNOLOGY OF USING A DATA WAREHOUSE TO SUPPORT DECISION-MAKING IN HEALTH...ijdms
This paper describes the technology of data warehouse in healthcare decision-making and tools for support
of these technologies, which is used to cancer diseases. The healthcare executive managers and doctors
needs information about and insight into the existing health data, so as to make decision more efficiently
without interrupting the daily work of an On-Line Transaction Processing (OLTP) system. This is a
complex problem during the healthcare decision-making process. To solve this problem, the building a
healthcare data warehouse seems to be efficient. First in this paper we explain the concepts of the data
warehouse, On-Line Analysis Processing (OLAP). Changing the data in the data warehouse into a
multidimensional data cube is then shown. Finally, an application example is given to illustrate the use of
the healthcare data warehouse specific to cancer diseases developed in this study. The executive managers
and doctors can view data from more than one perspective with reduced query time, thus making decisions
faster and more comprehensive
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 ...
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 ...
Understanding hmis implementation in a developing country ministry of health ...Ime Asangansi, MD, PhD
Abstract
Globally, health management information systems (HMIS) have been hailed as important
tools for health reform (1). However, their implementation has become a major challenge for
researchers and practitioners because of the significant proportion of failure of
implementation efforts (2; 3). Researchers have attributed this significant failure of HMIS
implementation, in part, to the complexity of meeting with and satisfying multiple (poorly
understood) logics in the implementation process.
This paper focuses on exploring the multiple logics, including how they may conflict and
affect the HMIS implementation process. Particularly, I draw on an institutional logics
perspective to analyze empirical findings from an action research project, which involved
HMIS implementation in a state government Ministry of Health in (Northern) Nigeria. The
analysis highlights the important HMIS institutional logics, where they conflict and how they
are resolved.
I argue for an expanded understanding of HMIS implementation that recognizes various
institutional logics that participants bring to the implementation process, and how these are
inscribed in the decision making process in ways that may be conflicting, and increasing the
risk of failure. Furthermore, I propose that the resolution of conflicting logics can be
conceptualized as involving deinstitutionalization, changeover resolution or dialectical
resolution mechanisms. I conclude by suggesting that HMIS implementation can be improved
by implementation strategies that are made based on an understanding of these conflicting
logics.
System Dynamics Modeling for IntellectualDisability Services.docxmabelf3
System Dynamics Modeling for Intellectual
Disability Services: A Case Studyjppi_342 112..119
Meri Duryan*,†, Dragan Nikolik‡, Godefridus van Merode§, and Leopold Curfs*,§
*Gouverneur Kremers Centrum; †University of Maastricht; ‡Maastricht School of Management; and §Maastricht University Medical
Center, Maastricht, the Netherlands
Abstract Organizations providing services to persons with intellectual disabilities (ID) are complex because of many interacting
stakeholders with often different and competing interests. The combination of increased consumer demand and diminished resources
makes organizational planning a challenge for the managers of such organizations. Such challenges are confounded by significant
demands for the optimization of resources and the goal to reduce expenses and to more effectively and efficiently use existing
resources while at the same time providing high quality services. The authors explore the possibilities of using “system dynamics
modelling” in organizational decision-making processes related to resource allocations. System dynamics suggests the application of
generic systems archetypes as a first step in interpreting complex situations in an organization. The authors illustrate the application
of this method via a case study in one provider organization in the Netherlands. The authors contend that such a modeling approach
can be used by the management of similar organizations serving people with ID as a tool to support decision making that can result
in optimal resource allocation.
Keywords: allocation of resources, intellectual disabilities, system dynamics modeling, systems thinking, waiting lists
INTRODUCTION
Healthcare organizations are complex entities as they have
multiple stakeholders with often conflicting objectives and goals
(Drucker, 1993). Provider organizations specializing in intellec-
tual disabilities (ID) are also complex because of the nature of the
care and supports they provide and how they are organized. Some
of the complexities relate to the difficulties that adults with ID
might have in expressing themselves. Moreover, the specifics of
the care often require a deeper involvement of carers with respect
to their relationships with families and other sectors of society.
Because of their complexity, ID provider organizations, com-
pared with healthcare providers, often require a higher level of
resource planning, collaboration, and cooperation among social,
health, and education services, mental health services, and other
sectors (WHO, 2010).
To manage the complexities and challenges ID provider orga-
nizations face, managers need to analyze and understand complex
interdependencies among the systems with which they are dealing.
In order to achieve that, ID provider managers need to examine
and shift their mental models regarding their role in managing
the organization and in establishing relationships with all the
stakeholders involved. However, as Forrester (1980) has noted,
traditiona.
Treasury Board of Canada Secretariat. (2012). Policy on evalua.docxturveycharlyn
Treasury Board of Canada Secretariat. (2012). Policy on evaluation. Retrieved from
http://www.tbs-sct.gc.ca/pol/doc-eng.aspx?id=15024
U.S. Government Accountability Office. (2011). GPRA Modernization Act implementation
provides important opportunities to address government challenges (GAO-11–617T).
Retrieved from http://www.gao.gov/assets/130/126150.pdf
Von Bertalanffy, L. (1968). General system theory: Foundations, development, applications (Rev.
ed.). New York: G. Braziller.
Wandersman, A., & Fetterman, D. (2007). Empowerment evaluation: Yesterday, today, and
tomorrow. American Journal of Evaluation, 28(2), 179–198.
Weibe, R. H. (1962). Businessmen and reform: A study of the progressive movement. Cambridge,
MA: Harvard University Press.
Wholey, J. S. (2001). Managing for results: Roles for evaluators in a new management era.
American Journal of Evaluation, 22(3), 343–347.
Wildavsky, A. B. (1979). Speaking truth to power: The art and craft of policy analysis. Boston,
MA: Little Brown.
Williams, D. W. (2003). Measuring government in the early twentieth century. Public
Administration Review, 63(6), 643–659.
Wilson, W. (1887). The study of administration. Political Science Quarterly, 2(2), 197–222.
WorkSafeBC. (2011). Reports: See 2010 annual report and 2011–2013 service plan. Retrieved
from http://www.worksafebc.com/publications/reports/default.asp
CHAPTER 9
DESIGN AND IMPLEMENTATION OF
PERFORMANCE MEASUREMENT SYSTEMS
Introduction
Key Steps in Designing and Implementing a Performance Measurement System
Identify the Organizational Champions of This Change
Understand What Performance Measurement Systems Can and Cannot Do
Establish Multichannel Ways of Communicating That Facilitate Top-Down, Bottom-Up,
and Horizontal Sharing of Information, Problem Identification, and Problem Solving
Clarify the Expectations for the Intended Uses of the Performance Information That Is
Created
Identify the Resources Available for Designing, Implementing, and Maintaining the
Performance Measurement System
Take the Time to Understand the Organizational History Around Similar Initiatives
Develop Logic Models for the Programs for Which Performance Measures Are Being
Developed, and Identify the Key Constructs to Be Measured
Identify Any Constructs That Apply Beyond Single Programs
Involve Prospective Users in Reviewing Logic Models and Constructs in the Proposed
Performance Measurement System
Measure the Constructs That Have Been Identified as Parts of the Performance
Measurement System
Record, Analyze, Interpret, and Report the Performance Data
Regularly Review Feedback From the Users and, If Needed, Make Changes to the
Performance Measurement System
Performance Measurement for Public Accountability
Summary
Discussion Questions
Appendix A: Organizational Logic Models
References
INTRODUCTION
In this chapter, we begin by introducing two complementary perspectives on public sector
organizations: (1) a technical/rational view ...
SYSTEMS THEORYAs noted in the Learning Resources, systems theory p.docxjonghollingberry
SYSTEMS THEORY
As noted in the Learning Resources, systems theory provides a meaningful and beneficial means of examining challenges in health care organizations. To do this effectively, however, it is essential to assess
all
system components, as some may be relatively healthy while others are problematic.
For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (
Note:
You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)
To prepare:
·
Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
·
Reflect on your organization or one with which you are familiar. Within a particular department or unit in this organization, identify a problem the staff is encountering.
·
Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
·
Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
·
Research professional standards that are pertinent to your identified problem.
·
Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)
To complete:
Write a 3- to 5-page paper (page count does not include title and reference page) that addresses the following:
·
Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.
·
Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).
·
Based on this information, explain how you would address the problem as follows:
o
Formulate a desired outcome.
o
Identify goals and objectives that would facilitate that outcome.
o
Translate those goals and objectives into policies and procedures for the department or unit.
o
Describe relevant professional standards.
·
Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.
*This paper must include a title page, introduction, summary, and references.
* Follow APA 6
th
ed for the ci.
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.
The Discipline of Business Intelligence(Course 3)
Introduction
This section provides an overview of the discipline of business intelligence, as applied to the
business of healthcare service delivery for the improvement of decisions. It includes the types
of analytics and examples, timeframe based viewpoints that engaging analytics provides and
presents these viewpoints in relation to decision-making power generated. This section will also
discuss the concept of decision management, decision types and analytic tools.
Analysis, Analytics and Business Intelligence
A good deal of discussion and some confusion exists as the science of working with data
evolves, especially in healthcare. When there is talk of engaging business intelligence(BI), often
a question arises,”What does this encompass?” Various definitions are put forth and another
question arises, “How is business intelligence different from business analytics? How does this
differ from Clinical informatics being engaged in many healthcare organizations?” And now the
water is very muddy. This will require filtering, clarity and foundation.
Analytics
The science of analytics-processes for separation and/or manipulation of data(simultaneously
applying statics, mathematics, operations research and computer programming) to develop
greater understanding is a more recent idea, however, its roots are, by extension of the above, a
branch of logic dealing with analysis. Analytics also favors the visual display of information to
communicate insights.
Analysis
At its core, all of this work is analysis, that is, separation of a whole or complex idea or topic into
its component parts to gain a greater understanding. These techniques have been applied in the
study of mathematics and logic since before Aristotle.
Business Intelligence(BI)
BI does the same work of simplifying data to amplify meaning in relation to internal, structured
data and business ...
DSS In the Public SectorDesign andImplementation ofDec.docxjacksnathalie
DSS In the Public Sector
Design and
Implementation of
Decision Support
Systems in the
Public Sector
By: John C. Henderson
Sloan School of Management,
Massachusetts Institute of
Technology
Cambridge, Massachusetts
By: David A. Schiiiing
Facuity of Management Sciences
Ohio State University
Abstract
This article examines the implications of utilizing deci-
sion support systems (DSS) in the public sector based
on a DSS developed and implemented for a community
mental health system. The DSS includes a multiple
objective (goal programming) allocation model and
encompasses a multiple party decision process. The
experiences and insights acquired during the develop-
ment and implementation of this DSS are relevant to
public sector decision support in general. The impor-
tance of a DSS as a process-support aid rather than a
product-oriented aid (i.e., simply providing answers)
and the interaction of system architecture and the
chosen design strategy are key insights. In particular,
the distinction between model-oriented and data-
oriented DSS does not appear to be appropriate. The
public sector decision maker's concern with issues of
equity requires the ability to operate in a higher dimen-
sional framework than the typical spreadsheet model
and there is a critical need for communication support.
Keywords: Goal programming, decision support
systems, public sector.
ACM Categories: H.4.2
Introduction
Developing and implementing decision aids in
the public sector is a challenging task. As Lamm
[14] points out, the political process tends to pro-
mote those that survive or win, not those seeking
truth. Often, the essential benefit of a decision
aid — a valid model — is the very element that
most threatens the survival of the public deci-
sion maker. It is not surprising that Brill [3] notes,
"Designing a solution to a public sector problem
is largely an art."
Hammond [8] suggests that it may not be suffi-
cient to provide decision aids unless explicit
attention is given to how these aids support
effective learning. Without effective learning
support dysfunctional consequences are likely
to result from policy-making processes.
Although Hammond argues a quasi-experimen-
tal approach is a necessary condition for learn-
ing, he notes that the strong quasi-rational
model of inquiry represented by the application
of management science techniques has had
positive impact on public sector decision mak-
ing. For example, management science models
can help to externalize multiple objectives and,
when combined with the results of quasi-experi-
ments, provide an enhanced learning
environment.
The need to facilitate access to decision aids as
well as to support individual and organizational
learning is explicitly addressed in the decision
support systems literature [1]. The basic design
strategy for DSS begins with an analysis of the
decision process and adaptively developing a
tool for the user to learn about and cope with
semi-structured decisions.
Experie ...
Similar to Operational and Budget PlanningLearning ObjectivesAfte.docx (20)
1. Primary sources2. Secondary sources3. La Malinche4. Bacon’s.docxvannagoforth
1. Primary sources
2. Secondary sources
3. La Malinche
4. Bacon’s rebellion
5. Robert Carter III
6. Mesoamerica
7. Middle Passage
8. Indentured servitude
9. The Jefferson-Hemings Controversy
10. Triangular trade
11. Saint Dominique Revolt
12. Syncretism
13. Olaudah Equiano
14. Christopher Columbus
15. Columbian Moment
16. Hernan Cortes
17. Florentine Codex
18. Master Narrative of American History
19. Reconquista
20. The Paradox of Slavery
21. Indian Removal Act 1830
22. Trail of Tears
23. Treaty of Guadalupe Hidalgo
24. Niños Heroes (Heroic Children)
25. Antonio López de Santa Anna y Pérez de Lebrón
26. The Royal Africa Company
27. John Locke
28. St. Patrick’s Battalion
29. Chilam Balam
30. Popol Vuh
31. El requerimiento (The Requirement)
32. Manifest Destiny
33. Moses and Stephen F. Austin
34. Colonialism
35. Colonial Legacy
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1. Prepare an outline, an introduction, and a summary.docxvannagoforth
1. Prepare
an outline
,
an introduction
, and
a summary
on the article selected. It s
hould be
a report of at least 4 page
double spaced.
2. Prepare a 4
PowerPoint slides
from the report.
NOTE
: See the attachment below to review the article.
.
1. Normative moral philosophy typically focuses on the determining t.docxvannagoforth
1. Normative moral philosophy typically focuses on the determining the right action for a person to perform in a given situation. First, how specifically is Aristotle’s virtue ethics focused slightly differently? Next, Aristotle thought that virtues are traits of character that manifest themselves through habitual activity and that are good for anyone to have. What are some of the virtuous traits to have according to Aristotle and how does acting in accordance with them over time bring about “correct” moral action? What does it mean to act in a morally correct way according to Aristotle?
Directions:
Please provide detailed and elaborate responses to the following questions. Your responses should include examples from the reading assignments. Each response should be at least one half of one page in length and utilize APA format.
1. According to virtue ethicists, how are virtues acquired?
2. What is situationist psychology?
3. List and briefly describe one of the criticisms of virtue ethics.
4. What is "The Golden Mean?"
5. Why is virtue ethics particularly well-suited to the medical profession?
PART I:
Directions:
The following problems ask you to evaluate hypothetical situations and/or concepts related to the reading in this module. While there are no "correct answers" for these problems, you must demonstrate a strong understanding of the concepts and lessons from this module's reading assignment. Please provide detailed and elaborate responses to the following problems. Your responses should include examples from the reading assignments and should utilize APA guidelines. Responses that fall short of the assigned minimum page length will not earn any points.
1.
Think of a profession you are considering as a career: engineering, or perhaps law or accounting or teaching. Could you develop a distinctive set of virtues for that profession? That is, are there some virtues that would be particularly important for members of that profession? Your response should be at least one page in length.
2. An important distinction for virtue theorists is between people who are happy and people who are flourishing. Do you know anyone (a public figure or an acquaintance) whom you would count as happy but not flourishing?
Your response should be at least one half of one page in length.
3. I have lived a dissolute life for many years: a life devoted to excessive eating, heavy drinking, laziness, deceitfulness, and pettiness. At age 45, I awaken one morning in the gutter, painfully sober after a three-day binge, and I resolve to change my ways and pursue virtue. In your opinion, how long would it make me to become a virtuous person? Could I become virtuous in an hour? A week? A month? Ever?
Your response should be at least one page in length.
4. Suppose Dan is dying from an unknown disease. He is wealthy and will give half of his money to anyone who can save his life. Joe, not know.
1. Paper should be 5-pages min. + 1 page works cited2. Should have.docxvannagoforth
1. Paper should be 5-pages min. + 1 page works cited
2. Should have at least 10 annotated sources (copy article onto word, highlight main point, write a few sentences about how it'll help you in writing the paper at the bottom of page)
3
. Should have an INTRO, NARRATION, ARGUMENTS, REFUTATION, CONCUSION
4. Use in-text citations and have organized mla format works cited page
SAMPLE OUTLINE
Research Paper Outline
Title: Rebellious Libya
Thesis: The United States should not get involved with Libya’s conflicts.
I.
Introduction:
A.
Start with the question, what is war? Explain briefly.
B.
Talk about the wars of the United States.
C.
What were the outcomes of some of those wars?
II.
Narration:
A.
Give some background on Libya.
B.
Explain how Col. Muammar Gaddafi became the leader of Libya
C.
Talk about why the citizens of Libya want to overthrow Gaddafi.
D.
Explain why the people feel that the United States should get involved in Libya’s conflicts.
III.
Partition:
A.
Thesis: I believe that the United States should not get involve with Libya’s conflicts.
B.
Essay Map.
1.
Cost of war.
2.
Using money in other Departments other defense.
3.
Killing innocent civilians and soldiers.
4.
Helping unknown rebels
5.
Involvement of foreign wars
IV.
Arguments:
A.
The cost of war is rising by the minute. The Obama Administration proposed a budget of $553 billion dollars for the department.
B.
Instead of spending all that money on war, we should be investing that money on health care and education.
C.
This conflict has caused the lives of many innocent civilians. NATO openly admitted to have killed innocent civilians, due to misguidance.
D.
The rebels fighting against Gaddafi are in need of military supplies. I don’t think that it is a good idea to help unknown rebels. We helped the Afghanistan rebels when they were fighting Russia. After they were victorious, they later became the “Taliban” and used those weapons to attack the US.
E.
Getting involved in foreign wars is not a good idea. The US has been involved in many foreign wars lately. These wars have been in foreign countries where Islam is the prominent religion. Libya is one of these countries. The involvement of the US in these places, builds a bad reputation worldwide and among the Muslim community.
V.
Refutation:
A.
Gaddafi’s actions against the civilians of Libya are totally wrong. Killing your own people is bad and therefore, we should help the rebels overthrow him.
B.
Gaddafi has been in power for many years. In fact, he holds the record for most years in power in a single country. This type of power can potentially lead to corruption and mistreatment of civilians.
C.
The people of Libya deserve to have democracy. They should have the right to elect their own leader.
D.
If Al Qaeda is threatening NATO and Libyan mercenaries then we should help them fight terrorism.
VI.
Conclusion:
A.
Summarize my arguments.
B.
State why we should not get involve with Libya’s conf.
1. Name and describe the three steps of the looking-glass self.2.docxvannagoforth
1. Name and describe the three steps of the 'looking-glass self'.
2. List and describe the three stages in George Mead's model of human development.
3. Piaget developed a four-stage process to explain how children develop reasoning skills. List each and give an example of one of the stages.
4. Briefly summarize the three elements of Freud's theory of personality and explain why sociologist have negative reactions to his analysis.
5. How does the mass media reinforce society's expectations of gender?
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1. Provide an example of a business or specific person(s) that effec.docxvannagoforth
1. Provide an example of a business or specific person(s) that effectively use social media. What tools does the business or person use? How do they apply the tools effectively? Describe areas of improvement.
This assignment has to be 4 pages long, then it needs a cover page and reference page however that can not be a part of the four pages. So it would be 6 pages if you count the cover page and reference page!
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1. Mexico and Guatemala. Research the political and economic situati.docxvannagoforth
1. Mexico and Guatemala. Research the political and economic situation of these countries and write about their peculiar circumstances.
2. Honduras, El Salvador and Panama. Research the political and economic situation of these countries and write about their peculiar circumstances.
3. Costa Rica and Nicaragua. Research the ecological and political situation of these countries and write about their peculiar circumstances.
4. Colombia and Ecuador. Research about the truths and myths about this two countries and write about your impressions on these stereotypes.
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1. Many scholars have set some standards to judge a system for taxat.docxvannagoforth
1. Many scholars have set some standards to judge a system for taxation for its validity. How can you decide if a tax is good or bad?
You can consider these five following principles for your Discussion. What do these issues mean? How do you think they matter?
Adequacy Equity Exportability Neutrality Simplicity
What other tax revenue systems could you consider? How do you think they would be better or worse?
2. What role do taxes play in political issues?
3. What is your opinion of a flat tax as some politicians have proposed?
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1. List and (in 1-2 sentences) describe the 4 interlocking factors t.docxvannagoforth
1. List and (in 1-2 sentences) describe the 4 interlocking factors that led to the ourbreak of world war 1
2. Explain the difference between and authoritarian regime and a totalitarian regime.
3. List and (in 1-2 sentences) describe the 5 factors that led to the ourbreak of world war 2.
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1. Please explain how the Constitution provides for a system of sepa.docxvannagoforth
1. Please explain how the Constitution provides for a system of separation of powers and checks and balances. Provide a fully developed essay of at least 500 words, and cite sources used.
2. Describe how a bill becomes a law at the national level, in a fully developed essay of at least 500 words. Support your work with cited sources, references to Lecture Notes, or URLs where you obtained your information.
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1. Please watch the following The Diving Bell & The Butterfly, Amel.docxvannagoforth
1. Please watch the following: The Diving Bell & The Butterfly, Amelie, The Lookout, A Single Man, Her, Little Children, and An Education and
Please respond to the films. In particular, respond to how the film develops the identity of a single character for an audience, and which you responded to (either the characters themselves or the way the film constructed the character) the most, or the least please , 10 sentence min and no plagiariasm also it has to be
followowed exactly whats written here.
PS: please dont waste my time if you will do a messy assigment, just dont send me a msg.
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1. Most sociologists interpret social life from one of the three maj.docxvannagoforth
1. Most sociologists interpret social life from one of the three major theoretical frameworks/perspectives (conflict theory, functionalism, symbolic interactionism). Describe the major points of each one. List at least one sociologist who has been identified with each of these three theories.
2. What is the difference between basic sociology and applied sociology?
3. List and describe the eight steps of the scientific research model.
4. Discuss the importance of ethics in social research. Define what is meant by ethics.
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1. Members of one species cannot successfully interbreed and produc.docxvannagoforth
1. Members of one species cannot successfully interbreed and produce fertile offspring with members of other species. This idea is known as
a. reproductive success.
b. punctuated evolution.
c. adaptive radiation.
d. the biological species concept.
e. geographic isolation.
2. The origin of new species, the extinction of species, and the evolution of major new features of living things are all changes that result from
a. macroevolution.
b. fitness.
c. speciation.
d. the biological species concept.
e. convergent evolution.
3. Which is a barrier that can contribute to reproductive isolation?
a. timing
b. behavior
c. habitat
d. incompatible reproductive structures
e. all of the above
4. Which of the following statements is false?
a. Horses and donkeys are separate species.
b. Two mules can mate and produce fertile offspring.
c. A horse and a donkey can mate and produce offspring.
d. Two donkeys can mate and produce fertile offspring.
e. Two horses can mate and produce fertile offspring.
5. The evolution of the penguin’s wing from a wing suited for flying to a “flipper-wing” used for swimming is an example of
a. refinement of existing adaptations.
b. reproductive isolation.
c. adaptation of existing structures to new functions.
d. inheritance of acquired characteristics.
e. the biological species concept.
6. Which of the following have been preserved as fossils?
a. dinosaur footprints
b. insects preserved in amber
c. petrified plant remains
d. animal bones
e. all of the above
7. The mass extinctions that included the dinosaurs took place during which period?
a. Cambrian (543–510 million years ago)
b. Devonian (409–363 million years ago)
c. Carboniferous (363–290 million years ago)
d. Jurassic (206–144 million years ago)
e. Cretaceous (144–65 million years ago)
8. The development of the complex, camera-like eye of a mammal is an example of
a. refinement of existing adaptations.
b. reproductive isolation.
c. adaptation of existing structures to new functions.
d. inheritance of acquired characteristics.
e. the biological species concept.
9. Which of the following statements is true?
a. Carbon-14 dating is useful for studying the age of early dinosaur fossils.
b. Carbon-14 has a half-life of 5,730 years.
c. Uranium-238 has a very short half-life.
d. Uranium-238 is present in all organisms.
e. Carbon-12 is not found in living plants.
10. Which of the following provides the best explanation for why Australia has so many organisms unique to that continent?
a. punctuated equilibrium
b. the biological species concept
c. convergent evolution
d. continental drift
e. cladistics
11. Scientists think that a meteor that fell in ____________________ may have led to the extinction of the dinosaurs.
a. Australia
b. the Yucatán peninsula
c. The Galápagos Islands
d. Pangaea
e. India
12. The great diversit.
1. Of the three chemical bonds discussed in class, which of them is .docxvannagoforth
1. Of the three chemical bonds discussed in class, which of them is simultaneously the weakest and most important for life on this planet as we know it?
2.Carbohydrates are very important sources of energy for life. Plants and arthropods also use carbohydrates as components of structures that are very important for their existence. Provide the names of the two most important carbohydrate based structures (one for plants and one for arthropods) and the carbohydrate components that are used to form them.
3._____________ _____________ are joined by ______________ bonds to form proteins.
4.Proteins can be used for several functions. Provide examples of structural and metabolic functions of proteins.
5.Describe the phosholipid bilayer of the plasma membrane. Why is this bilayer important for the formation of cells and the sequestration of chemical reactions within the cell?
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1. Look at your diagrams for hydrogen, lithium, and sodium. What do .docxvannagoforth
1. Look at your diagrams for hydrogen, lithium, and sodium. What do they all have in common? What group are these elements in on the periodic table?
2. Look at your diagrams for fluorine and chlorine. What do they have in common?
Picture is in the link. Put answers on the word document and re-submit
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1. Name the following molecules2. Sketch the following molecules.docxvannagoforth
1. Name the following molecules:
2. Sketch the following molecules:
3-cyclohexenone
4-ethyl 2,2,5-trimethyl 3-hexanone
ethyl butyrate
pentanoic acid
2-chloro 4-methyl 2,5-heptadienal
3,4-dichloro 4-ethyl octanal
p-chloro phenol
3-bromo 2-chloro 4-methyl hexane
3-cyclopropyl 1,2-cyclopentanediol
methyl phenyl ether
3,5-dimethyl 2-heptene-4,5-diol
3. Give two different uses for ethanol.
4. Name two categories of organic compounds (alkanes, aldehydes…) that have very strong characteristic odours.
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1. List the horizontal and vertical levels of systems that exist in .docxvannagoforth
1. List the horizontal and vertical levels of systems that exist in organizations.
2.
Describe at least five steps involved in systems integration
3.
What is the role of ERP systems in system integration?
4. Why do you think functional silos are not appropriate for today's organization? Discuss your answer from organizational and technical perspectives.
5. Pick an organization that you know of or where you are/were working and provide examples of logical and physical integration issues that were faced by the organization when they broke the functional silos and moved to integrated systems.
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1. Kemal Ataturk carried out policies that distanced the new Turkish.docxvannagoforth
1. Kemal Ataturk carried out policies that distanced the new Turkish republic of the 1920s from the Ottoman past. Why? What specific policies did Ataturk pursue? 2. Why many Arabs felt betrayed by the British (and the French) after the First World War? 3. Discuss at least three features of patrimonial leadership. List three or more Middle Eastern states where such type of political leadership persists 4. Describe the key processes (both internal and external) that initiated political and economic disintegration of the Ottoman Empire in the nineteenth century. 5. European military superiority in the late eighteenth century prompted Ottoman rulers to respond with what specific political measures? 6. The Zionist political movement originated in Europe rather than in the Middle East. Explain why and how. 7. After the Second World War, several Arab countries went through the process of transition from constitutional monarchies to republics. Identify three such countries and describe the course of events that brought about this transition. 8. How is religious Zionism different from secular Zionism? What is the relevance of this difference for the creation of the state of Israel? Has the relative influence of the two remained stable since the creation of the Israeli state? 9. What was the principle source of political legitimacy of the Ottoman Empire? 10. While most Ottoman European provinces, riding the tide of the nineteenth century nationalism, sought and won independence from Istanbul, Ottoman Arab provinces maintained their political loyalty to the Ottomans. What explains this difference between Arab and European provinces? 11. Social and political forces in favor of a constitutional reform in Iran (1905-1911) were markedly different from the groups that promoted constitutional limitations on executive powers of the sultan in the Ottoman Empire prior to the First World War? Explain this difference. 12. What are some of the key features of Arab socialisms? Which Arab leaders adopted socialist ideology? Which Arab leaders were opposed to it? 13. After the First World War, the new Middle Eastern protectorates (e.g., Syria, Lebanon, Iraq) were expected to develop into modern secular states. What specific policies did France and Britain try to implement? How successful have theses policies been? 14. The 1967 war was a watershed event for all major actors in the Middle East. Explain the consequences of the war for domestic politics in Israel and Egypt respectively.
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1. If we consider a gallon of gas as having 100 units of energy, and.docxvannagoforth
1. If we consider a gallon of gas as having 100 units of energy, and 25 of those units are used to move the car, what law of thermodynamics accounts for the other 75 units of energy? (Points : 2)
the first law
the second law
2. Which of these is not a component of a molecule of adenosine triphosphate (ATP)? (Points : 3)
adenosine
phosphate
deoxyribose sugar
ribose sugar
3. Glycolysis is a sequence of ______ chemical reactions. (Points : 3)
nine
six
five
ten
4. Exergonic reactions produce products with a ___ energy level than that of the initial reactants. (Points : 3)
lower
higher
the same
5. When chemical X is reduced, which of these expressions would be an accurate representation of its reduced state? (Points : 3)
XO
XH
X
HX
6. Most enzymes are which kind of organic compound? (Points : 3)
carbohydrates
lipids
proteins
none of the above
7. The area on an enzyme where the substrate attaches is called the: (Points : 3)
active site
allosteric site
anabolic site
inactive site
8. Which of the following creatures would not be an autotroph? (Points : 3)
cactus
cyanobacteria
fish
palm tree
9. The process by which most of the world's autotrophs make their food is known as: (Points : 3)
glycolysis
photosynthesis
chemosynthesis
herbivory
10. Plants are the only organisms that use ATP for the transfer and storage of energy. (Points : 2)
True
False
11. The colors of light in the visible range (from longest wavelength to shortest) are: (Points : 3)
ROYGBIV
VIBGYOR
GRBIYV
ROYROGERS
12. Chlorophyll is a green pigment because it absorbs only the green part of the visible light spectrum. (Points : 2)
True
False
13. The photosynthetic pigment that is essential for the process to occur is: (Points : 3)
chlorophyll a
chlorophyll b
beta carotene
xanthocyanin
14. A photosystem is: (Points : 3)
a collection of hydrogen-pumping proteins
a series of electron-accepting proteins arranged in the thylakoid membrane
a collection of photosynthetic pigments arranged in a thylakoid membrane
found only in prokaryotic organisms
15. Which of these molecules is NOT a product of the Electron Transport System? (Points : 3)
ATP
Water
Pyruvate
NAD+
16. The dark reactions require all of these chemicals to proceed except: (Points : 3)
ATP
NADPH
carbon dioxide
oxygen
17. The structural unit of photosynthesis, where the photosystems are located, are called: (Points : 3)
chlorophylls
eukaryotes
stroma
thylakoids
18. Which of the following does NOT occur during the light independent process? (Points : 3)
CO2 is used to form carbohydrates
NADPH converts to NADP
ADP converts to ATP
ATP converts to ADP
19. The production of ATP that occurs in the presence of oxygen is called: (Points : 3)
aerobic respiration
anaerobic respiration
chemiosmosis
photosynthesis
20. The first stable chemical formed by the Calvin Cycle is: (Points :.
1. In 200-250 words, analyze the basic issues of human biology as th.docxvannagoforth
1. In 200-250 words, analyze the basic issues of human biology as they relate to chronic conditions and describe the interaction between disability, disease, and behavior. Examine and discuss the impact of biological health or illness on social, psychological, and physical problems from the micro, mezzo, and macro perspectives. Choose a chronic condition from those provided in your text and consider how you might feel, think, and behave differently if the condition were affecting you versus if the condition were affecting a stranger. How might you think differently about this chronic condition if it were affecting someone close to you, your neighbor, or someone in your community? Please include at least two supporting scholarly resources.
2.Our stage of life, intellectual/cognitive abilities, and sociocultural position in life, affect our perspectives and resultant behaviors about a number of conditions including cancer. Consider the information provided in the
“Introduction to the Miller Family”
document. Both Ella and Elías have been diagnosed with cancer. Ella has been fighting cancer with complementary and alternative methods with some success for many years. Elías, her grandson, is 10 years old and has recently been diagnosed with leukemia but has not yet begun treatment. Putting yourself in either Ella or Elías’s place, what might your perspective on your cancer be? Integrate how the stage of life, cognitive abilities, and sociocultural position of your chosen person impacts her/his perspective on his/her individual disease.
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How to Create Map Views in the Odoo 17 ERPCeline George
The map views are useful for providing a geographical representation of data. They allow users to visualize and analyze the data in a more intuitive manner.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Operational and Budget PlanningLearning ObjectivesAfte.docx
1. Operational and Budget Planning
Learning Objectives
After reading this chapter, you should be able to:
• Describe broad operational issues such as systems and
systems thinking, information systems,
consensus building, and the role of policies.
• Evaluate the differences between operational planning and
budget planning.
• Discuss how to involve everyone in the operational planning
process.
• Assess the issues involved in getting operational planning
done before the start of the new
fiscal year.
Chapter 8
Evgeny Tomeev/iStock/Thinkstock
spa81202_08_c08.indd 223 1/15/14 3:50 PM
CHAPTER 8Section 8.1 Broad Operational Issues
No strategy is useful unless it can be implemented, and no
strategy can be implemented
with any degree of success without operational and budget
2. planning (refer to Figure 1.1).
This chapter explains how to do such planning, why it is
important, and other essential
process issues.
8.1 Broad Operational Issues
Operational planning involves preparing detailed organizational
plans for the coming
fiscal year. It includes programs, projects, and activities that the
organization is already
doing as well as new ones required by any change in strategy.
Detailed plans by organi-
zational unit are part of operational plans. Finally, it includes
coordinating all these activi-
ties to make sure they support stated strategies. Some aspects of
operational planning
are more encompassing than just planning programs, projects,
and tasks for people to
do. These include systems and systems thinking, management
information systems, the
need for consensus in decision making, and organization-wide
policies. Not only are these
issues more encompassing, but they also are determinants of
effective strategy execution
and should be taken into account.
Systems and Systems Thinking
For the most part, our world is made up of systems—from the
galactic solar system to the
human body, which has many subsystems of its own, such as the
immune, reproductive,
digestive, and cardiovascular systems. Organizations are
complex social systems, consist-
ing of individuals and units that work
together (or not) to produce services
3. for their customers. Complex sys-
tems are self-regulating systems; that
is, they are self-correcting through
feedback. HSOs must be responsive
to feedback, such as the organiza-
tion’s patient volume figures, quality
performance results, and other met-
rics important to success. Engaging
in systems thinking means viewing
your HSO as a system with interact-
ing, interdependent components and
realizing that what is done must ben-
efit the integrated whole and not just
a particular part at the expense of
other parts.
The systems approach to understand-
ing organizations also examines the
nature of the boundaries between the
organization and the outside world. The more permeable an
organization’s boundaries,
the more the organization is able to place its finger on the pulse
of the competition, the
Blend Images/SuperStock
Organizations—including HSOs—are complex social
systems, consisting of individuals and units that work
together.
spa81202_08_c08.indd 224 1/15/14 3:50 PM
CHAPTER 8Section 8.1 Broad Operational Issues
4. marketplace, and industry trends. Boundaries may be created,
for instance, by employer
apathy toward staff member development. An HSO that does not
send employees to con-
ferences and training establishes a less permeable boundary
between the organization
and the industry. Open systems with permeable boundaries are
preferred to closed sys-
tems for their greater functionality and innovativeness. Viewing
an organization as an
open system requires strategic thinkers to consider the complex
interactions the system
has with its environment, as well as the ways in which the
different units within the orga-
nization (known as subsystems) import and export ideas,
services, and other resources.
Additionally, systems are characterized by subsystem
interdependence. For example, to
add a new clinical service, the service director must interact
with the finance department
to learn about the costs and collaborate with physicians and
other members of the clinical
team to create a development strategy. In some HSOs,
functional units act as if they are
isolated from the others. For example, a hospital materials
department may order sup-
plies without knowledge of inventory levels on the units or
expected patient volumes. In
both strategic and operational planning, managers must be
cognizant that affecting one
part of the system affects other parts. Furthermore, operational
decisions must benefit the
whole organization and not just a particular functional area to
the detriment of others. The
performance of any system, including an HSO, is thus never
5. equal to the sum of the per-
formance of its parts considered separately, but rather the
product of their interactions
(Ackoff, 1986).
In operational planning, tactics should be coordinated between
functional units of the
organization, especially those between which there is an output–
input relationship. The
higher one’s position in the organiza-
tional hierarchy, the more emphasis
must be placed on having a system-
wide perspective and maintaining
awareness of the purposes and goals
of the entire organization. Even at a
basic operational level, tremendous
coordination is needed. As Russell
Ackoff (1986), one of the most influ-
ential management thinkers of our
time, says, understanding how one
unit’s activities affect and are affected
by other organizational activities
is a benefit that “cannot be realized
unless the planning is comprehen-
sive, coordinated, and participative”
(pp. 202–203).
There is a class of systems thinking
that has been applied to clinical
healthcare systems that stemmed
from James Quinn’s analysis of best-in-service companies such
as Nordstrom and
McDonald’s. He found that these companies organized around
and continually improved
7. ney dialysis unit. Some HSOs are using the clinical microsystem
model or other system
dynamics models to improve performance.
Management Information Systems
Every day, at every level in the organization, decisions are
being made. Earlier chapters
focused on strategic decisions, while this chapter and the next
focus on operational deci-
sions. Simple decisions require a person’s knowledge and
experience; however, in some
organizations, an established policy may govern decisions in
routine situations. Startup
HSOs operate with the entrepreneur making all the decisions
seemingly “off the cuff,” as
speed is of the essence and the entrepreneur knows what he or
she is doing.
The more complex decisions become, the less one person or
even a group is able to act
independently. Should local radio advertisements for our walk-
in clinic be continued for
another month? That would depend on how effective the
advertisements had been in
increasing revenue, and without those data the right decision
could not be made. Should
the hospital hire another nurse case manager? Without knowing
the patient volumes,
costs, utilization data for targeted patient populations, and so
on, that question also could
not be answered. And these are operational decisions. We
already know that strategic
decisions need a lot of data to be analyzed and processed before
they are made; opera-
tional decision making is no different.
8. Cleveland Clinic Health System (CCHS), considered by some to
be one of the best HSOs
in the United States, has an extensive information system that
supports strategic and
operational decision making. Balazs Nemeth, head of Clinical
Resource Management and
Decision Support for East Region of CCHS, notes that being
one of the best is not enough:
“We want to be the best system” (PQ Systems, n.d., para. 3).
With the exception of startups, no organization can afford to be
without a management
information system (MIS). Typically, MIS refers to a broad
range of data-driven decision
support systems that provide information about an
organization’s administrative func-
tions associated with the provision and use of patient care
services (Sandefer & Seidl,
2013). These systems are crucial to the operation of the
organization and include, but are
not limited to, general accounting and finance systems,
operations and plant management
systems, patient health record systems, and customer
relationship management systems.
By definition, these systems must supply the basic information
needed by managers for
making decisions. The extent to which a system succeeds in
doing this determines the
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CHAPTER 8Section 8.1 Broad Operational Issues
9. quality of decisions made (Mason
& Hofflander, 1972). Even before
the advent of computers, there were
information systems, usually in the
form of reams of paper and informa-
tion stored in people’s minds.
An MIS is more than a stream of
unprocessed data that people can
access. Unprocessed data is a data-
base, not an MIS. An accounting sys-
tem is an example of a database. The
data needed for day-to-day opera-
tions in an HSO are stored in various
databases, which should be acces-
sible for later analysis during strate-
gic and operations decision making.
Ideally, these databases are linked
in a central data repository, or “data
warehouse,” which is the source of
information for various analyses: identification of areas of
excess variances from best
practices, cost accounting and case-based budgeting, studies of
factors contributing to
clinical outcomes, prediction of healthcare resource utilization,
evaluation of the revenue
stream and factors controlling it, and so on.
There are several types of data-driven decision support systems
that support effective
strategic and operations decision making, including predictive,
action, and executive
information systems.
Predictive Information Systems
Predictive information systems permit decision makers to draw
11. CHAPTER 8Section 8.1 Broad Operational Issues
Executive Information Systems
An MIS specifically designed to support the decision making of
senior managers is often
called an executive information system (EIS). This system
provides direct access to timely,
accurate, and actionable information. Typically, the EIS is in a
useful and navigable for-
mat so managers can easily explore trends, identify broad
strategic issues, and drill down
into the data for answers to strategic questions. An EIS cannot
simply be purchased and
installed. Its implementation requires the integration of many
databases and capabilities.
Kelly (2002) suggests that EIS capabilities include the
following:
• Design that is specific to manager’s information needs
• Ability to access data about specific issues and problems
• Extensive online analytic tools including trend analysis,
exception reporting,
and data-mining capabilities
• Ability to aggregate data into meaningful reports
• Capability of accessing a broad range of internal and external
data
• Interface that is easily navigated
• Capability of being used by executives without assistance
• Ability to present data in a graphic form
Enterprise Resource Planning
Over the past few years, more HSOs have put in place
12. administrative and clinical elec-
tronic information systems to better support operations planning
and strategic manage-
ment. The creation of enterprise resource planning (ERP)
capabilities is a process that
attempts to electronically integrate and manage all of the
individual computer systems
in an organization’s departments. ERP is often the term given to
a variety of applications
that support administrative functions, such as materials
management, the general ledger,
accounts payable, and payroll. Ideally, for strategic and
operational planning purposes in
HSOs, ERP capabilities can integrate data from back office,
patient care, and support ser-
vice systems (see Figure 8.1). In organizations with such
integrated information systems,
strategy formulation is facilitated using data from the system
and is easily updated as
conditions change.
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CHAPTER 8Section 8.1 Broad Operational Issues
Figure 8.1: Overview of ERP in HSOs
The enterprise resource planning capabilities in a healthcare
services organization use a single software
program to integrate and manage all of the organization’s
departments and functions as well as serve
each department’s specific needs.
Building Consensus
13. Operational planning is, in essence, a string of decisions that
have to be made quickly at
whatever level that planning is done. Unless there is
consensus—complete agreement—
on a decision by a group of people, majority rule takes over.
There is nothing intrinsically
wrong with that, except that it introduces the possibility that a
minority is not committed
to the decision. So how can consensus be built when there are
differences of opinion?
Back O�ce Systems
HR management
Payroll management
Accounts/Financial management
Inventory management
Supplier management
Patient Care Systems
Diagnostics
Pharmacy
Physiological monitoring
Electronic health records
Automated care plans
Personal health records
Order entry
Support Service Systems
Patient billing
14. Scheduling/appointments
Dietary
Linen/laundry
Biomedical waste
Transportation
Charge capture
spa81202_08_c08.indd 229 1/15/14 3:50 PM
CHAPTER 8Section 8.1 Broad Operational Issues
If time allows, it is best to get more
data on the alternatives to aid in the
decision-making process; however,
that is not always possible. It may
be that the lack of consensus is due
to different positions and political
ploys, not just different opinions. It
is frequently easier to get managers
and people to agree first that con-
sensus is desirable (as well as pos-
sible) than it is to obtain it (Ackoff,
1986). The additional time and effort
it takes to achieve consensus is more
than compensated for by the surge
in motivation after agreement has
been reached.
Role of Policies
A policy is an organizational directive designed to guide the
thinking, decisions, and
15. actions of managers and their subordinates (Pearce & Robinson,
2005). A policy plays
several roles and serves several purposes. First, it saves higher
management from wasting
time making decisions that could be handled just as well lower
down the hierarchy. Sec-
ond, it empowers people lower in the organization to make
those decisions, often where
they should be made. Third, policies address issues that crop up
frequently, so the amount
of time saved is considerable. Finally, the decisions themselves
could save the organiza-
tion money, for example, by limiting the insurance plans
accepted by the HSO.
In addition, policies
• establish indirect control over independent action
immediately;
• promote uniform handling of similar activities;
• ensure quicker decisions through using standardized answers;
• institutionalize basic aspects of organizational behavior;
• clarify what is expected and facilitate smooth execution of
strategy;
• provide predetermined answers to routine problems (Pearce &
Robinson, 2005).
Examples of policies include the customer recovery policy at
University of Wisconsin
Hospitals and Clinics that allows registration staff to offer
complaining patients some
compensation to relieve their concerns, such as free parking or a
vendor retail coupon
(Berkowitz, 2010, p. 248). ZoomCare (2013) has a strict policy
of not accepting patients
covered by Medicare, Medicare Advantage, Medicaid, and
16. Tricare insurance because of
the low reimbursement rates. Interfaith Community Health
Center (2013) in Bellingham,
Washington has a policy of not prescribing narcotics or
controlled substances. Patients
requiring such treatment are referred to a specialist for pain
management.
West Rock/The Image Bank/Getty Images
When consensus is not achieved, a decision is often
based on majority rule.
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CHAPTER 8Section 8.2 Operational Planning and Budget
Planning
Discussion Questions
1. All organizations are systems, yet they themselves contain
many systems. Is this possible?
Explain.
2. How might one manage the microsystems to improve the
functioning of the larger system?
3. How can “systems thinking” improve operational decision
making?
4. If some management information systems are simply
databanks, are they really systems?
Explain.
5. Can an information system provide an HSO with a
competitive advantage? If so, how?
17. 6. The point was made that consensus in decision making means
total buy-in to the decision
and smoother implementation. How might you tell the
difference between real consensus
and several people just “going along” with the majority?
7. If consensus is desirable to achieve, whatever happened to
dissent? Isn’t dissent also con-
sidered a spur to better decision making? Discuss.
8. A downtown physician clinic has a policy of not validating a
patient’s parking receipt unless
the patient was there for an office visit. One day, a patient of
the clinic came in to see a
nurse who happened to be off that day. When he asked to have
his parking permit vali-
dated, the front desk registrar refused. What should the registrar
do—stick to the policy and
risk angering or perhaps losing a patient or make an exception?
Policies should be developed in written form, widely distributed
throughout the HSO,
and discussed at all meetings once finalized. In written form,
employees can constantly
refer to them as an authoritative source until they become
second nature.
8.2 Operational Planning and Budget Planning
In most organizations, operational
and budget planning are combined
into the same process. However,
because the two are significantly
different, they will be discussed
separately.
19. meet those objectives. Their
challenge is to decide what must be done to meet the objectives
by the end of the fiscal
year. This may mean continuing to do what they have already
been doing, changing what
they have been doing, or even changing an objective if it
appears to be impossible. They
must develop a series of tasks and specify who will be
accountable to do what, when, and
for how much, with a clear output and summary of their efforts.
The operating units then submit their draft plans to their
managers, who coordinate with
other plans in the functional area and modify, if necessary, the
objectives and budgets.
These then go to top management, who reviews them with
knowledge of other plans
from the other functional areas. Because no first draft is ever
perfect and usually goes
over budget, the plans are sent back down for revision. The
iterative nature of the opera-
tional planning process means that, in practice, draft versions of
plans could go up and
down the hierarchical chain more than twice (see Figure 8.2).
The revision process takes
place in a succession of meetings, at the end of which planning
documents are revised.
After one or two more iterations, top management approves and
finalizes the operational
objectives, budgets, and tasks before the fiscal year begins.
Only if they have changed
significantly might the board get involved again.
Figure 8.2: Operational planning process
During the operational planning process, draft versions of plans
20. could go up and down the hierarchical
chain more than twice before final approval. This figure
incorporates budget planning, which will be
discussed later in the section.
CEO and
Board
Functional
VP Level and
Physician
Leaders
Managers,
Employees,
and
Physicians
Approve chosen
strategies and
organization-wide
objectives, programs,
and contingencies
Review functional
plans and
adjustments made
to match available
resources
21. Set unit objectives,
activities, budgets,
and accountabilities
Negotiate
adjustment to
plans to match
allocated budget
Final
approval
Set functional
objectives
Consolidate
functional plans
and budgets
Final
approval
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CHAPTER 8Section 8.2 Operational Planning and Budget
Planning
Project Management Tools
For smaller companies, project management software exists to
help in operational plan-
ning at the department or unit level. This software is especially
22. useful for initiatives with
lots of smaller tasks that must be done both sequentially and in
parallel. PERT (Project
Evaluation and Review Technique) has been around for a long
time and is an operational
tool used in project management to analyze and represent the
tasks involved in complet-
ing a given project.
The most valuable use of PERT is helping project managers
determine when a project
will be finished and the likelihood that it will be completed on
time. Each task is mapped
on a network diagram clarifying which tasks must be completed
before others can be
started and which tasks can be done simultaneously. For
instance, suppose one of the
operational plans of a community health center is to implement
a colon cancer screening
initiative. There are three major tasks that need to be
completed: changes to the comput-
erized patient record system to allow for data mining to identify
patients needing to be
screened, staff training in the use of the data mining
capabilities, and creation of a patient
notification system. First, the record system software changes
must be planned with pro-
grammers and updates completed. Staff training can start before
the computer updates
are completely finalized. Last, the system can begin generating
patient notifications. Each
of the three major tasks might include 10 or 20 substeps. By
using a PERT chart, the health
center can interconnect the substeps in a sequential timeline that
allows them to see the
minimum and maximum time frames for the major tasks and all
23. the different substeps
that are required.
Online project management solutions are widely available. Most
Web-based project man-
agement tools offer the same basic options, including task
allocation and tracking, resource
allocation and management, risk management, scheduling
timelines and deadlines, doc-
ument archives, and communication. Online project
management solutions offer users
transparent, easy access to files and communications, which in
turn enables improved
teamwork, enhanced time management, and improved task
efficiency.
Reward Systems
Once the detailed departmental plans are finally approved, it is
important to put in place
a reward system that will motivate the achievement of
operational, and hence strate-
gic, objectives. This system of rewards incentivizes people to
excel and achieve beyond
expectations. Rewards are primarily (but not exclusively)
financial and vary by hierarchi-
cal position.
Incentives make up approximately 10% of CEO pay at HSOs,
according to a 2012 survey
of 262 leaders from a variety of organizations, including
hospitals and health systems
(HealthLeaders Media Intelligence Unit, 2012). Hospital CEOs
listed operating margin
(67%), patient satisfaction (60%), clinical quality (54%), and
financial efficiency (44%) as
the four top factors for their current incentive payments.
24. The rewards given to middle managers are typically tied to
functional or operational objec-
tives such as productivity, cost savings, quality improvements,
and myriad others. The
rewards include performance bonuses, promotions, raises, profit
sharing, and possibly
stock options. Employees’ and supervisors’ rewards are
generally tied to contributing to
the achievement of functional or operational objectives as team
players and may include
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CHAPTER 8Section 8.2 Operational Planning and Budget
Planning
some combination of profit sharing, bonuses for
exceptional and timely work, and raises.
Monetary reward possibilities, however, are much
more limited in nonprofit organizations because the
use of financial rewards such as ownership incen-
tives, stock-based pay, and profit sharing is impos-
sible or inappropriate, due to the non-distribution
constraints (Brickley & Van Horn, 2002). Other
rewards, while nonfinancial, are nonetheless
important. Intangible rewards range from fre-
quent words of praise (or constructive criticism),
to special recognition at organizational gather-
ings or in its newsletter, increased autonomy, and
more opportunities for continuing education.
Both financial and nonfinancial rewards require
26. of total expected physician compensation to achievement of
strategic priorities.
Geisinger employs more than 800 primary care and specialty
physicians. Each month, these physi-
cians receive a paycheck representing 80% of their base salary,
which is calculated according to
workload and other factors such as skills, training, intensity of
services, and other activities such
as research, teaching, and administrative duties. It is expected
that employed physicians meet
defined work unit requirements. However, Geisinger is not just
focused on productivity. Thus,
approximately 20% of the salary of employed physicians is tied
to achievement of strategic quality,
efficiency, and patient volume goals. Physicians receive these
incentive payments twice a year—in
March and September. The March payment reflects the
physician’s July–December performance,
and the September payment reflects the physician’s January–
June performance.
(continued)
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CHAPTER 8Section 8.2 Operational Planning and Budget
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The following is a useful checklist for designing a financial
incentive-compensation
(reward) system:
• The performance payoff should be significant—perhaps 10%–
27. 12% of base pay,
while 20% will command the attention of the potential
recipient.
• Incentives should extend to all workers, not just the top
executives.
• The reward system should be administered with scrupulous
care and fairness.
• All individuals should know what the reward system is at the
beginning of the
year or else they won’t be appropriately motivated.
• Incentives and the performance targets on which they are
based should not be
impossible to achieve.
• Payoffs should occur as soon as possible after results have
been acknowledged.
• Confine payoffs only to results achieved. Payoffs should not
be made for behav-
iors such as putting in long hours for a long period, or even
going the extra mile
but coming up short. Once an exception is made for one person,
they will be
made for more, and the reward system will quickly get out of
hand (Thompson,
Strickland, & Gamble, 2008).
Financial rewards should never be made when the
organization’s revenue is below a level
to make them possible or for average or below-average
performance.
Case Study: Geisinger Physician Compensation Tied to
Strategic Priorities
28. (continued)
Goals that support the strategic aims of Geisinger Health are
defined at the service-line level, and
physicians are financially rewarded for achieving the goals in
their service area. For instance, a
goal for emergency department (ED) physicians is to reduce the
percentage of patients who leave
without being seen to less than 1.5% of all ED patients.
Specialty physician incentive payments are determined by work
in the following areas: quality,
innovation, legacy (educational and research missions), growth
(increase in populations served
by Geisinger), and financial (units of work for patients in fee-
for-service contracts). The areas are
weighted, with approximately 40% of a specialty physician’s
incentive payment based on four to
five service-line-specific measures of quality that have been
jointly agreed to by physician leader-
ship and Geisinger senior management. Only 25% of specialty
physician incentive payments are
based on meeting financial goals.
Primary care physician incentive payments are based on work in
similar areas. System-wide strate-
gic goals such as improving care for patients with chronic
diseases (e.g., diabetes) and improving
patients’ satisfaction are examples of quality expectations tied
to incentive payments for pri-
mary care physicians. The physician’s citizenship—
collaboration and teamwork with colleagues—
accounts for 6% of incentive compensation (Lee, Bothe, &
Steele, 2012).
spa81202_08_c08.indd 235 1/15/14 3:50 PM
29. CHAPTER 8Section 8.2 Operational Planning and Budget
Planning
Discussion Questions
1. Some HSOs are content to keep doing what they have always
done. In fact, the strategy and
organization-wide objectives eventually comprise their
operational plans added together.
How would you persuade such organizations to do planning the
other way around?
2. How does an organization specifically benefit from doing
operational planning? (Contrast
with an organization that might do no operational planning.)
3. Some HSOs operate “on the edge” and are forever “putting
out fires.” Operational planning
isn’t even in their lexicon. If you had an opportunity to talk to
the CEO of such an organiza-
tion, what would you say? How might the conversation go?
4. If you were the CEO of a hospital, what type of rewards
would you offer managers for stay-
ing within budget and meeting operational goals? Are financial
rewards the best way to
motivate people to excel and achieve beyond expectations?
Explain the advantages and
drawbacks of different types of incentive rewards.
Budget Planning
Budget planning is the process of matching available
31. Making precise financial resource predictions is often
a difficult task, given the perpetual uncertainty of
regulations and reimbursement in the healthcare
industry.
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CHAPTER 8Section 8.2 Operational Planning and Budget
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The perpetual uncertainty of regulations and reimbursement in
the healthcare indus-
try makes precise financial resource predictions a difficult task.
HSOs often base future
resource predictions on historical financial relationships—
volume versus revenue, and
volume versus expenses. For instance, Fairview Park Hospital in
Dublin, Georgia “deter-
mines their budget based on prior year usage, gauging future
treatment and service usage
on percentages from the previous year to project future
volumes” (Fruitticher, Stroud,
Laster, & Yakhou, 2005, p. 174).
As Figure 8.2 shows, departments may get their plans back from
an upper-management
review with a mandate to reduce spending in some way to match
the budget. Either
departmental members become creative and find a way to
deliver the mandated reduc-
tions or they respond that the only way to get the two numbers
to match is to modify the
objectives. Of course, the latter reply must include their
reasoning for the position, and
32. their supervisor then becomes their advocate.
The revised plans are resubmitted so that the CEO and top
management have the ben-
efit of looking at all the departmental plans and budgets. At this
point, they can be per-
suaded that implementing the strategy will indeed take more
money than they thought
and see whether they can raise the additional capital. If they
can, then higher budgets
are approved that match the estimated spending from all
departments, and the budget-
planning process ends. If they can’t, then some or all
departments are told that they must
meet their objectives with the available budget. For example, if
adding two people was in
the business office plan to help reach its customer service
objectives, then it might have to
get the same objective accomplished with existing staff. The
process ends when depart-
mental budgets finally match available financial
resources together with their commitment to
achieve their functional objectives.
Normally, operational and budget planning
should be enough to enable each organizational
unit and, by extension, everyone in the organiza-
tion, to know what they have to do and accom-
plish during the coming fiscal year. However,
some organizations also engage in profit plan-
ning, which is the process of arriving at an esti-
mate, month by month, of the profit the whole
organization intends to achieve. For each month,
the total company budget is subtracted from esti-
mated revenues; the sum of the monthly profits
33. equals the overall profit objective for the coming
year. Profit planning is not widely used and is con-
sidered unnecessary by some strategic planners.
The budget planning process can also be thought
of as a process for reducing costs. Not only does it
ensure that spending will be covered by projected
financial resources, but it also is a forcible func-
tion for reducing costs. It is human nature to take
the easy route or continue doing what you have
Corbis/SuperStock
Costly “sacred cows”—such as shoe
covers—are not unique to healthcare,
but they may be especially prevalent in
hospitals.
spa81202_08_c08.indd 237 1/15/14 3:50 PM
CHAPTER 8Section 8.2 Operational Planning and Budget
Planning
always done. That will happen unless someone requires it to be
done for less. The very
requirement forces the consideration of alternatives.
For-profit business entrepreneurs are often faced with this
problem when writing their
business plan and trying to seek startup capital: Their first pass
at a cash-flow projection
often shows that the business might not make enough money, or
even make any money
at all, which is certainly not what the entrepreneurs or potential
34. investors want to hear.
All the assumptions must be reexamined and, with more
research and thought, revised
figures should be produced of both the revenue model and the
expenses. If the revised
business plan looks better but still doesn’t come close to
achieving the 20%–40% ROI
required by typical investors, at this point the entrepreneur
should consider any and all
alternatives for achieving the targeted revenues for less cost.
More attractive margins, at
least on paper, won’t be possible until he or she is forced to
consider lower-cost alterna-
tives. Having had to put so much thought into the revised
estimates also makes defending
them easier.
The budget planning process is an ideal time to force people to
examine ways of reducing
costs, which might not happen any other way. David
Kaczmarek, director at the Chicago-
based consulting firm Huron Healthcare, notes that costly and
wasteful “sacred cows are
not unique to healthcare. But they do seem to have a special
affinity to hospitals” (2011,
para. 8). Kaczmarek suggests that operating room practices such
as using shoe covers and
requiring hospital-laundered scrubs are needless “resource-
consuming anachronisms”
(2011, para. 36).
Discussion Questions
1. What risk is the organization running when it approves
expenses that exceed anticipated
financial resources?
35. 2. Departments in publicly funded (city, state, and federal)
HSOs are well known for trying to
spend their entire budget allocations so that they will be funded
again the following year at
least at the same level. If they do not, they might be viewed as
not “needing” their budget
allocation and so be allocated a lesser amount. What is wrong
with this process?
3. What do you think might happen when, midway through the
year, expected financial
resources fail to appear (for example, Medicare rates are
lowered or funding from a govern-
ment agency is slashed)? What options might an organization in
this position have?
4. Whose responsibility is it in the organization to reduce costs?
5. What would prompt an individual or departmental unit to
investigate how something done
in its area could be done at lower cost?
6. In your opinion, what “sacred cows” in healthcare delivery
could be eliminated or done at a
lower cost?
spa81202_08_c08.indd 238 1/15/14 3:50 PM
CHAPTER 8Section 8.3 Involve Everyone
8.3 Involve Everyone
Just as it is a mistake to do strategic planning with the
participation of only the top manage-
36. ment group, so also is it a mistake to do operational planning
with just middle managers.
To be sure, middle managers bear the brunt of the responsibility
for operational planning
because they will be called upon later in the year to implement
the plans. But make no
mistake, everyone in the organization is and ought to be
involved, not only in operational
planning but also in carrying out the plans.
By virtue of their size, small HSOs have no option but to
involve everyone. Yet exceptions
abound. The manager for a small medical equipment provider
complained of being left
out of the planning process entirely. The company was being
squeezed by its large cus-
tomers, who were forcing the price down to maintain their own
profitability. The custom-
ers said that if this firm could not supply medical equipment at
the desired price, there
would be lots of other suppliers that would. The president and
co-owner of the company
was the one who negotiated with these large clients for future
business. Time and again,
he approved a price point that was below cost, because he was
convinced that he wouldn’t
get the business otherwise, and he never checked first with the
manager, who could have
advised him of current costs and margins. The result was that it
put enormous additional
pressure on reducing costs while margins all but eroded. This
scenario was repeated many
times, and this was a management team of only three people.
In large HSOs, it is all too common not to involve the rank and
file in operational planning.
37. In many organizations, information is divulged or passed down
only on a “need to know”
basis. People at the bottom just do what they are told. This is
not what happens at health-
care organizations recognized by the American Nurses
Credentialing Center (ANCC) as
magnet facilities. The Magnet Recognition Program (MRP)
recognizes healthcare orga-
nizations for quality patient care, nursing excellence, and
innovations in professional
nursing practice (ANCC, 2013). One criterion that applicants
must meet is involvement
of nurses in budget development. A
2008 MRP recipient, Wheaton Fran-
ciscan Healthcare–St. Joseph in Mil-
waukee, Wisconsin, has a shared
governance operations council where
direct care nurses are provided an
opportunity to tell management what
resources they need to be effective
in their job. These resources may
include requests for new equip-
ment, additional education time, and
staffing changes. This input is used
by unit directors and patient care
supervisors to prioritize operating
and capital budget planning needs.
At St. Joseph’s Hospital, informa-
tion related to departmental budgets
and overall organizational finances is
shared with nurses through staff and
leadership meetings (Erny, 2009).
Cultura Limited/SuperStock
One reason to involve everyone in an HSO is that it
38. makes it easier to get people to stop doing things that
either block new initiatives or hinder the organization’s
productivity.
spa81202_08_c08.indd 239 1/15/14 3:50 PM
CHAPTER 8Section 8.4 Get It Done on Time
As the discussion of organizational change in Chapter 2 made
clear, smooth and enthusi-
astic implementation of any task is not possible unless those
who are to do the work are
involved in the planning. This is much easier said than done. It
depends to a large extent
on the kind of culture that exists in the organization. Cultures
that are command-and-
control or bureaucratic are by their very nature not inclined to
involve everyone as they
should. Open, adaptive, innovative, nimble organizational
cultures as discussed in Chap-
ter 2 would not be able to progress without involving everyone
and seeking their input,
especially in planning and suggesting new ideas. This culture of
openness requires the
implementation of participative leader–member behavior, which
encourages supportive-
relationship behavior and the open sharing of ideas during
decision making and strategic
and operational planning. As noted in Section 8.1, building
consensus is important during
operational planning and is also important for organizational
change.
Another reason to involve everyone in the organization is to
39. make it easier to get people
to stop doing things that either get in the way of new initiatives
or are no longer useful
in helping the organization be more efficient and productive.
Change involves dropping
old habits if new ones are to take their place. Change will stall
or not take hold to the
extent that people cannot or will not forget what they used to
do. It is therefore wise to
involve everyone and make sure they understand what they have
to do and why; how
their jobs, roles, and expectations are changing; and how and
why they will benefit from
the changes. They should also have a mechanism for repeating
the new imperatives often
until force of habit takes over and the changes and
improvements become second nature.
Discussion Questions
1. The ease with which everyone in the organization can be
involved in operational planning
depends on the organization’s culture. Might involving
everyone actually change the cul-
ture? Comment.
2. This section advocated involving everyone. Surely not
everyone? Would this include the
people loading supplies on the receiving dock? The maintenance
staff? The mailroom clerk?
The secretaries? Comment.
3. If you don’t agree that everyone should be involved, where
might your cutoff be? Give rea-
sons for your answer.
40. 4. If you advocate a cutoff, explain why that might be superior
to involving everyone.
8.4 Get It Done on Time
The operational planning process should be timed so that by the
time the new fiscal year
starts, all the strategic decisions, operational plans, and budgets
are completed. Final
approval of the plans and budgets should be completed within a
couple of weeks of the
start of the fiscal year. Bear in mind that both strategic and
operational planning takes place
in addition to people’s regular daily activities. But how long
should the strategic and opera-
tional planning processes take? There is no simple answer.
Consider four scenarios—among
many—beginning with the best or ideal situation:
spa81202_08_c08.indd 240 1/15/14 3:50 PM
CHAPTER 8Section 8.4 Get It Done on Time
Case Study: Strategic Planning Process at Henry Ford Health
System
Henry Ford Health System, headquartered in Detroit,
Michigan, is a nonprofit integrated healthcare deliv-
ery and insurance system that offers services across
the care continuum through nine business units with
a diverse network of facilities throughout southeast
Michigan. The health system’s strategic planning pro-
cess, which is repeated annually, spans an entire year.
During the first 6 months scheduled, facilitated meet-
ings are held with the board of trustees, the system
41. performance council, senior leaders in the business
units, and key community stakeholders. These discus-
sions result in identification of short-term (1-year)
and long-term (3-year) strategic initiatives and orga-
nization-wide measures of success.
Each strategic initiative owner creates detailed action plans that
include estimated revenue,
expense, and capital projections. This information is used by the
finance department to refine
the system’s 3-year operating and capital budgets. The system
strategic plan for the next 3 years
is approved by the board of trustees each October. The system
and business unit level strate-
gic plans and budgets are then communicated to all leadership,
employees, partners, and suppli-
ers through meetings, newsletters, and emails/podcasts. System
and business unit action plans
and performance targets are communicated to departments and
integrated with departmental
and individual performance management plans. As action plans
are implemented by the assigned
strategic initiative owners, progress is reviewed at biweekly
organizational performance review
sessions. Progress toward achieving system-wide strategic
initiatives is evaluated at least twice a
year. What is learned during these reviews becomes part of the
strategic discussions at the start of
the next cycle (Henry Ford Health System, 2011).
Pixtal/SuperStock
If one runs out of time with the operational
planning process, one can shorten the
approval cycle. Instead of going all the way up
the hierarchy, plans should go up to the next
42. higher level where they can be refined.
• The HSO is used to formulating strategies, and much of the
required research is
done throughout the year. It is performing well and is used to
transforming stra-
tegic decisions into operational plans and can get those plans
approved in one
cycle. The two processes together, especially for small to mid-
size companies,
take no more than 2 months.
• Like the scenario just described, but for a well-performing
larger HSO with more
divisions and vertical layers, coordinating operational and
budget planning
takes longer but still gets done within 2 to 3 months.
• This HSO is not performing very well and has financial
problems, but because
it has some experience with strategic and operational planning,
operational and
budget planning takes no longer than 3 months.
• This HSO is constantly putting out fires, lurching from crisis
to crisis; strategic
and operational planning take back seats, if done at all. If
anything is done, it will
probably be done badly, with changes continuing to be made
after “approvals”
have been given. The time frame needed for planning is
impossible to estimate.
The ideal situation is illustrated in Case Study: Strategic
Planning Process at Henry Ford
Health System.
43. spa81202_08_c08.indd 241 1/15/14 3:51 PM
CHAPTER 8Section 8.4 Get It Done on Time
There are organizations, of course, that are run autocratically,
with the CEO telling every-
body what to do and being the only one to approve anything. In
this situation, the com-
bined processes should not take long at all, perhaps 2 to 4
weeks. This was not included as
a scenario in the preceding list because, although it might take
the least amount of time,
it doesn’t qualify as a “best” or “ideal” scenario. However, it
often works in that kind of
organization.
Sometimes, the process takes longer than anticipated, and the
deadline of the new fis-
cal year is missed. What usually happens is that the full
operational planning process is
aborted, and whatever stage it has reached is hurriedly
approved. After all, the start of
the new fiscal year cannot be changed. One way around this
dilemma is to shorten the
approval cycle. Instead of going all the way up the hierarchy for
every approval cycle, as
shown in Figure 8.2, plans should go only to a higher level,
where they are refined much
further. This will shorten the operational planning cycle.
For an organization that has not previously done operational
planning, 2 months is a rea-
sonable allowance for the first time. In each successive year,
44. familiarity with the process
and everyone’s ability to produce better plans should enable the
HSO to be more accurate
in scheduling the process without any drop in quality. It is best
to start strategy formula-
tion as late in the fiscal year as possible while leaving enough
time for decent operational
and budget planning. The time frame of 3 months, mentioned
earlier, is a whole quarter
and, really, too long to devote to planning, mainly because
conditions will have changed
during such a long planning process. For a large organization
that has many layers and
planning units, operational planning does take more time than
anyone would like.
Should a company ever abandon the operational planning
process if time is running out?
The short answer is no. As long as management approves what
should be allocated and
achieved during the first month of the fiscal year, there will be
that additional month to
finish the process properly. In the next chapter, we consider
some tools that large organi-
zations can use to speed up both strategic and operational
planning and keep the “intru-
sion” of planning in people’s busy lives to a minimum.
Discussion Questions
1. Suggest one way in which operational and budget planning
could suffer if the process were
rushed.
2. Imagine that the operational planning process was well into
its third month and already
45. extant conditions had changed (for instance, Medicare
reimbursement rates are unexpect-
edly slashed). What should the HSO do? For example, should
plans at the lowest levels be
changed first or only those plans most affected by the changed
conditions?
3. Should just the plans in question 2 be changed or should the
budgets be changed as well?
4. With more experience in operational and budget planning, it
should be possible to get it
done in less time each year. Exactly how important is getting it
done quicker?
spa81202_08_c08.indd 242 1/15/14 3:51 PM
CHAPTER 8Summary & Resources
Summary & Resources
Chapter Summary
• Operational planning focuses on planning the projects,
programs, tasks, and
activities the organization needs to implement its strategies and
includes both
what it already does as well as additional programs it must do
the next year.
• Budget planning focuses on getting all operating units to
spend what they need
to spend to do what they must do without exceeding the total
financial resources
46. that the HSO has or may have at its disposal for the coming
year. As plans take
shape for each operational or functional unit, they inevitably
undergo changes
until their estimated costs match the estimated financial
resources allocated to
that operational unit.
• Operational planning is carried out more effectively when
everyone involved in
the process understands that everything is part of a larger
system, that anything
they do affects other parts of the system, and vice versa. That
understanding,
called systems thinking, is critical in operational planning.
• Having access to the right information for management
decision making and
action is vital—HSOs could not operate without such
information. Many such
systems are nothing more than databanks, forcing the user to
make sense of
and interpret the data. Transforming them into systems such as
ERP (enterprise
resource planning) makes such data far more useful, but they
require consider-
able investment, not only in capital, but also in transforming the
way people
work and learn.
• Operational decisions should be based on consensus at each
decision-making
level, which means complete agreement. Getting a majority
vote, for example,
means there is a minority that disagrees with the decision,
which in turn means
47. that implementation will be that much more difficult.
• The policies in an organization are in effect the rules that
guide behavior in often-
encountered situations. That way, in such situations people will
make the correct
decision all the time. Having the policies in writing allows
people to refer to them
at any time and gives them the force of law (which, in the HSO,
they are). Policies
can cover, for example, how consumers and the environment
and vendors are
treated, as well as mundane subjects like what can and cannot
be included in an
expense report. Operational planning must take into account the
organization’s
current policies.
• Operational planning is the process by which objectives are
translated into proj-
ects, programs, tasks, and activities that get progressively more
detailed the fur-
ther down in the organization the process goes. Budget planning
is done at the
same time. Operational units must develop their plans while
staying within the
budget allocated to each one, requiring first drafts to undergo
several revisions
in order to balance these two requirements as they go up and
down the organiza-
tional hierarchy. One of the unheralded benefits of budget
planning is the creativ-
ity unleashed in order to reduce costs.
spa81202_08_c08.indd 243 1/15/14 3:51 PM
48. CHAPTER 8Summary & Resources
• Everyone in the organization should be involved in
operational and budget plan-
ning, not just managers and supervisors. When this happens,
new ideas have
a chance to surface, consensus is more likely, and
implementation goes more
smoothly.
• Operational and budget planning have to be done fairly
quickly just before the
start of the new fiscal year. Doing this is difficult without
compromising the
process and because involvement is an additional burden on top
of day-to-day
responsibilities. The risk with taking up to 3 months to do
operational and bud-
get planning is that conditions will change during the process,
requiring plans
to be further changed as a result. Experience helps, as does
revising plans first
before submitting them up the ladder for approval.
Web Resources
http://www.clinicalmicrosystem.org
The Dartmouth Institute Microsystem Academy is a globally
recognized leader in research,
education, and development of healthcare systems of care based
in clinical microsystem
applied research.
http://www.naccho.org/topics/infrastructure/accreditation/strate
gic-plan-how-to.cfm
49. This is a National Association of County and City Health
Officials booklet titled Strategic
Planning: A How-To Guide for Local Health Departments.
http://www.nursecredentialing.org/Magnet/
The Magnet Recognition Program- sponsored by the American
Nurses Credentialing
Center provides a model for involving staff in accomplishing
organizational goals to
achieve desired outcomes.
Key Terms
action information system A system that
automatically makes (the right) decisions
that are acted upon immediately.
budget planning The process of matching
available organizational financial resources
(cash on hand, a line of credit or loan, and
any investment) with what the organiza-
tion needs to spend to implement its cho-
sen strategies. It includes revising requests
for money from organizational units until
their requests and available resources
match. What each organizational unit is
finally approved to spend constitutes its
budget.
clinical microsystem The combination
of a small group of people who work
together in a defined setting on a regular
basis—or as needed—to provide care and
the individuals who receive that care.
enterprise resource planning (ERP)
A process that attempts to electronically
50. integrate and manage all of the individual
computer systems in an organization’s
departments.
executive information system (EIS)
A system that supports the decision mak-
ing of senior managers.
spa81202_08_c08.indd 244 1/15/14 3:51 PM
http://www.clinicalmicrosystem.org
http://www.naccho.org/topics/infrastructure/accreditation/strate
gic-plan-how-to.cfm
http://www.nursecredentialing.org/Magnet/
CHAPTER 8Summary & Resources
management information system (MIS)
A system that must supply the basic
information managers need for making
decisions.
operational planning A process that
involves preparing detailed organizational
plans for the coming fiscal year. It includes
programs, projects, and activities that the
organization is already doing, as well as
new ones required by any change in strat-
egy. It includes detailed plans by organiza-
tional unit. Finally, it includes coordinating
all these activities to make sure they sup-
port stated strategies.
PERT (project evaluation and review
technique) An operational tool useful in
51. planning, scheduling, costing, coordinat-
ing, and controlling complex projects.
policy An organizational directive
designed to guide the thinking, deci-
sions, and actions of managers and their
subordinates.
predictive information systems Permits
decision makers to draw inferences and
make predictions from the data.
reward system A system that incentivizes
people to excel and achieve beyond stated
objectives.
systems thinking The realization that
affecting one part of the system affects
other parts and that what is done must
benefit the whole and not just a particular
part at the expense of other parts.
spa81202_08_c08.indd 245 1/15/14 3:51 PM
spa81202_08_c08.indd 246 1/15/14 3:51 PM
Leadership, Governance,
Values, and Culture
Learning Objectives
52. After reading this chapter, you should be able to:
• Describe what strategic leadership entails.
• Compare the differences and similarities between leaders and
managers.
• Discuss why strategic success depends on finding,
developing, and evaluating capable leaders.
• Compare and contrast governance in for-profit and nonprofit
HSOs.
• Examine the relationship between an HSO’s organization and
the strategy it is pursuing.
• Analyze the importance of organizational values and culture
and the extent to which they can
enable or hinder strategy implementation.
• Explain how and why organizational change is inevitable and
desirable if an HSO wants to
improve its competitiveness and performance.
Chapter 2
Noel Hendrickson/Photodisc/Thinkstock
spa81202_02_c02.indd 39 1/15/14 3:47 PM
CHAPTER 2Section 2.1 Strategic Leadership and Developing a
Vision
This chapter focuses on the roles of power, leadership,
organizational culture, values, and
53. attitudes toward innovation as they relate to strategic planning
and management (refer
back to Figure 1.1 in order to see the components of the
strategic management model for
Chapter 2). The importance of leadership, the roles of top
management and the board of
directors, values and culture, and organizational change all
affect the quality of strategic
planning and are in turn affected by it.
2.1 Strategic Leadership and Developing a Vision
In articles in the business press and the literature, the words
manager, leader, executive, and
administrator are often used interchangeably. Consider,
however, the implied judgments
in the descriptions of a person as “a
real leader” versus “just a manager,”
and it becomes evident that the terms
are different.
One might assume the only person
who creates a vision is the individ-
ual at the apex of an organization,
such as the HSO administrator or the
president of a health system. This is
certainly not the case. Leaders can be
found at any level in an organization.
A leader is anyone who can visualize
a better state of affairs and persuade
others that such a vision makes sense.
A leader is anyone who is dissatisfied
with the status quo, has suggestions
for improvement, and is able to con-
vince others of the merits and bene-
fits of such changes. By contrast, managers are responsible for
implementing changes and
54. achieving performance objectives. Managers do not need to be
leaders, although what
they do is nonetheless critical to an organization’s success.
What makes leadership “strategic”? Strategic leadership
involves creating a vision and
strategy that helps the organization succeed at its mission in
both the short and the long
term. Whereas leadership may be required for bringing about
changes or improvements
to parts of the organization, strategic leadership determines the
long-run survival and
success of the entire organization.
Power in an Organization
All types of executives have the authority to force others to do
what they want done.
Executives with leadership capabilities more often use
communication and a range of pro-
social influence tactics (e.g., reward, rationality, and
friendliness) to gain others’ coopera-
tion (Lamude, Scudder, Simmons, & Torres, 2004). Leaders
have the power to influence
Blend Images/SuperStock
True leaders use influence rather than authority to get
people to do what they want them to do.
spa81202_02_c02.indd 40 1/15/14 3:47 PM
CHAPTER 2Section 2.1 Strategic Leadership and Developing a
Vision
55. or affect the people around or under
them. This is true regardless of
whether they hold leadership posi-
tions. There are five types of power
in an organization.
Legitimate power is the authority
derived by virtue of occupying a
position in the organization. The
higher the position a person occu-
pies, the greater the authority or
legitimate power that person holds.
Expert power is derived from a per-
son’s unique competencies, skills,
and experience. For example, a group
surviving a crash on a mountainside
is likely to willingly follow the mem-
ber with survival knowledge and
skills. Referent power is derived from
subordinates’ or followers’ respect,
admiration, and loyalty to the leader;
it is often referred to as leadership charisma. Leaders who have
the ability to give or with-
hold meaningful incentives hold reward power. Incentives can
be tangible rewards such
as pay raises, bonuses, or preferred job assignments or
intangible rewards such as verbal
praise or respect. A leader or manager in a position to punish a
subordinate is said to have
coercive power, which could take the form of firing someone,
denying a raise or bonus, or
reassigning the person to an undesirable location (Jones &
George, 2007).
56. Transactional leadership has been the dominant style in many
healthcare organizations
(Schwartz & Tumblin, 2002). Transactional leadership relies on
interactions between the
leader and follower, with followers rewarded for meeting
specific goals set by leaders.
For instance, hospital governing boards often set performance
expectations (financial and
quality criteria) by which the CEO is evaluated and rewarded.
The CEO, in turn, sets
performance expectations for top management, top management
sets performance expec-
tations for middle managers, and so on. Leaders in the
hierarchical healthcare environ-
ment are followed primarily because the followers benefit. For
example, the relationship
between hospital leadership and the hospital’s organized
medical staff is transactional in
that leadership relies on the independent physicians caring for
hospitalized patients to
assist the organization in meeting financial and quality
performance goals. The physicians
benefit from providing this assistance—they have a hospital in
which to care for their
patients that is financially strong and has a good reputation.
Mission and Vision Statements
Healthcare organizations—indeed, any kind of organization—
need mission and vision
statements. Like many terms in the business lexicon, these are
misunderstood and often
misused.
Thomas Northcut/Digital Vision/Thinkstock
57. A physician who has received many years of medical
training and achieved a position of authority in a
healthcare organization can be said to have both
legitimate and expert power. Whether she has referent
power will depend to a large extent on her own charisma.
spa81202_02_c02.indd 41 1/15/14 3:47 PM
CHAPTER 2Section 2.1 Strategic Leadership and Developing a
Vision
Mission Statements
A mission statement is a concise statement of an HSO’s reason
for being—its purpose,
what it actually does, and for whom. It describes what services
are provided for which tar-
get market, as well as how the organization considers itself
different or unique. A mission
statement should not contain descriptions of values, strategies,
or objectives (although
many organizations make this error). It could also contain a
description of what the
HSO’s consumer will experience when using its services
(known as the customer value
proposition).
A mission statement answers the questions “What do you do?”
and “What is your raison
d’être (reason for being)?” For many HSOs, the answers have
not changed for many years.
With today’s fast-moving transitions in the healthcare industry,
many organizations are
revisiting their mission statements to determine if they are still
valid. The ideal time to do
58. this is at the end of the annual strategic planning process.
When crafting a mission statement, care should be taken in how
broadly or narrowly the
HSO is characterized. For example, an organization could
conceive of itself as a primary
care clinic or as a public health clinic, the latter precluding any
work or involvement in
the private sector. It could be a home health agency or a hospice
agency, the former being
broader and the latter more restrictive in the kind of services
provided and the target
consumers.
Suppose that in the course of conducting its strategic analysis,
an organization partnered
with a national health system. If its existing mission statement
characterized it as being
local in scope, then clearly the mission statement would need to
be modified and aligned
with the new reality. This is why both the mission and vision
statements are reconsidered
at the end of the strategic planning process.
Consider the following example of a poorly written mission
statement:
Care. Trust. Heal.
You might never identify this as the mission statement of a
hospital. While the statement
is short, as recommended by some management consultants, it is
probably more of a
marketing slogan than a mission. Missing is what the
organization actually does and for
whom, and so on. Contrast this with the well-written mission
59. statement of Mayo Clinic in
Rochester, Minnesota:
To inspire hope and contribute to health and well-being by
providing the
best care to every patient through integrated clinical practice,
education
and research. (2013, para. 1)
It is obvious from this mission statement that patients are the
primary reason Mayo Clinic
exists. How it strives to provide patient care is clearly
articulated. The customer value
proposition at Mayo Clinic is hope and best patient care.
Mission statements are a communication device—they inform
internal stakeholders
(physicians, managers, staff members) as well as external
stakeholders (consumers, com-
munity of interest, investors) about the HSO’s unifying themes
and goals that guide deci-
sion making, resource allocation, and planning. Although some
management consultants
spa81202_02_c02.indd 42 1/15/14 3:47 PM
CHAPTER 2Section 2.1 Strategic Leadership and Developing a
Vision
Examples of Vision Statements
Read the following vision statements, and, using the criteria
discussed, evaluate each.
60. Accurate HomeCare (2013, para. 2): “Build the largest and most
trusted home care company in the
Midwest.”
The Dental Service at the Salt Lake City Veterans
Administration Medical Center “will accomplish
the following”:
1. Provide an integral part of the patient’s total health care
2. Provide appropriate and quality care
3. Provide a caring atmosphere
4. Provide timely and efficient care
5. Function as a team to maximize use of resources
6. Advocate for eligibility reform/equitable access to dental
care
7. Provide holistic care
8. Provide quality education for dentists, auxiliaries, trainees,
and the community
9. Make health promotion for patients a priority. (2013, para. 2)
discourage organizations from including value statements in
their missions, HSOs affili-
ated with religious groups are an exception. Hospitals in the
Adventist Health System, for
example, always espouse a mission that includes references to
Christ’s healing ministry
and Christian values.
Vision Statements
Does a strategic leader simply conjure up in isolation a vision
for the organization? Do
effective leaders rely on others in the organization to support
the development of a realis-
tic vision? Let us examine the nature of organization vision
statements and the approaches
used to create them. A vision statement is a concise expression
61. of where the organization
would like to see itself in the next 5 or 10 years. What makes an
effective vision statement
rather than one that just sounds good? At some point, the
organization will want to know
if the vision has been achieved.
The vision of Centura Health, based in Denver, Colorado, is
“Fulfill a covenant of caring
for our communities with excellence and integrity to become
their partner for life” (2013,
para. 5). While this vision sounds very good, how will Centura
Health determine if this
vision has been achieved?
Vision statements should include some type of quantitative
measure. For example, the
vision for University of California, Irvine, Medical Center and
School of Medicine is “to be
among the best (top 20) academic health centers in the nation in
research, medical educa-
tion, and excellence in patient care” (2012, para. 3). This is a
measurable vision. Ideally, the
vision statement should be concise, inspiring, memorable, and
achievable—a tall order,
but not impossible. (For a few samples of real-world vision
statements, see Examples of
Vision Statements.)
spa81202_02_c02.indd 43 1/15/14 3:47 PM
CHAPTER 2Section 2.1 Strategic Leadership and Developing a
Vision
62. It is imperative that a healthcare organization’s strategy and
vision be completely aligned.
This is why an organization should review and, if necessary,
revise its vision statement
after deciding on the strategy and strategic direction, in case the
latter has changed.
Visionary leaders should collaborate with other top managers
and their board of directors
to craft a good vision statement that embodies their vision and
makes sense to all of the
organization’s stakeholders. Getting everyone’s agreement takes
time; however, such col-
laboration is necessary if the vision is to be truly shared and
owned by everyone. A great
vision becomes realized only when every person in the
organization makes a contribution
toward its achievement and does not merely rely on those at the
top. Table 2.1 summarizes
the differences between mission and vision statements.
Table 2.1: Characteristics of mission and vision statements
The mission statement focuses on current
activities—“who we are” and “what we do”
The vision statement concerns the future
path—“where we are going”
Current service offerings Markets to be pursued
Consumer needs being served Future service–customer focus
Operational and business capabilities Kind of organization that
management is trying
to create
63. Discussion Questions
1. Are most CEOs and presidents of healthcare organizations
today “strategic” leaders? Why or
why not?
2. Consider the following leaders. For each one, state the source
or sources of their power—
legitimate, expert, referent, reward, coercive—and explain the
reasons for your choice:
• Martin Luther King, Jr.
• Your mother
• U.S. surgeon general
• Michael Ellis DeBakey, world-renowned heart surgeon
• The professor of your strategic management course
3. If you wrote the mission statement for your local hospital,
what would it say? How does it
compare to the hospital’s official mission statement?
4. Why do healthcare organizations find it difficult to develop a
good vision statement?
5. If an organization has a good vision statement, why is a
mission statement necessary?
6. Vision statements typically look 5 or 10 years into the future.
Name an organization (or
an industry) where a vision statement might be developed for 20
or more years, and one
where less than a year might make sense.
7. Many organizations have vision statements that “sound nice”
purely for public relations
(PR) purposes. How can you tell the difference between the
64. “PR” vision statement and the
genuine thing?
8. Should every employee in the organization be able to recite
the mission statement? The
vision statement? Both? Why or why not?
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CHAPTER 2Section 2.2 Leaders and Transformational Change
2.2 Leaders and Transformational Change
Warren Bennis, a pioneer in the contemporary study of
leadership, once said, “Managers
do things right; leaders do the right thing” (Bennis & Nanus,
2012, p. i). Bennis’s words
echo a common saying in business that “leaders create change
while managers implement
change.” The way that healthcare leaders create change is by
creating a vision for the orga-
nization and then “selling” the benefits of that vision to the rest
of the organization. To
the extent that they succeed, they create followers and motivate
or influence them to put
forward their best efforts for making the vision a reality. The
leader’s vision then becomes
their vision. One test of leadership is whether the leader
actually has any followers. Who,
indeed, has the leader succeeded in influencing?
“Fundamentally, management is about
coping with complexity (control),
whereas leadership is about transfor-
mational change” (Schwartz & Tum-
65. blin, 2002, p. 1421). Robert Allio also
has written on the differences between
leaders and managers. The key differ-
ences he describes are summarized in
Table 2.2. He further provides five pre-
scriptions for improving the quality of
leadership. Allio contends that good
leaders must have good character and
integrity, a personal style that balances
managing with leading, a commitment
to collaboration, and adaptability.
Lastly, leaders are self-made, and good
leadership requires constant practice
(Allio, 2009).
Table 2.2: Leaders vs. managers
Leaders Managers
Take the long view Take the short view
Formulate visions Make plans and budgets
Take risks Avoid risks
Explore new territory Maintain existing patterns
Initiate change Transact
Transform Control
Empower Enforce uniformity
Encourage diversity Invoke rationality
Invoke passion Act amorally
66. Source: Allio, R. J. (2009). Leadership—the five big ideas.
Strategy & Leadership, 37(2), 4–12. Used with permission.
Creatas/Thinkstock
Effective leaders know how to make others feel
comfortable, using nonverbal behaviors that create a
sense of personal connection.
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CHAPTER 2Section 2.2 Leaders and Transformational Change
Is it difficult to be a leader? The list of attributes in Table 2.2
might appear daunting to a
junior person in a healthcare organization. To someone who
seeks out challenges, learns
from experience, works well with others, takes the initiative,
and in other ways “prac-
tices” leadership, it is a natural progression to leadership
positions with ever-increasing
responsibility and visibility.
Communication and Effective Leadership
Although personality, business acumen, legitimate power and
authority, and expertise
are factors in leadership ability, communication competence is
central to the practice of
influence and leadership in organizations. Without the ability to
relate to others at work
through interactions, influence and leadership are virtually
impossible. A foundation of
67. strong relational and communication skills is critical to the
ability to inspire motivation
within others and to encourage the pursuit of organizational
vision.
Impression Management
Leadership effectiveness and communication satisfaction within
organizations rely heav-
ily on perceptions of individuals in formal or informal
leadership positions. Thus, strong
leaders are able to manage others’ perceptions and have a
heightened degree of self-
awareness. They must be aware of what is appropriate and
expected in a given situa-
tion, possess the skills to deliver it, and demonstrate the
motivation for accomplishing
excellence.
Effective Message Content
Good leaders pay a great deal of attention to the content of their
messages. They approach
their leadership communication as a goal-directed activity,
rather than mindlessly. They
craft their messages strategically so as to provide others with a
clear, concrete sense of
their vision. The content of their formal and informal messages
should be motivational
and inspirational and succeed in convincing others that
behaving consistently with the
leader’s (or organization’s) vision is truly in their own best
interests. Needless to say, lead-
ers must also have unquestionable ethics and engage in this type
of influence carefully
and thoughtfully.
Strong Message Delivery
68. Effective message delivery, often referred to as charisma, is
central to leadership effec-
tiveness. Numerous research studies point to the importance of
message exchanges that
foster a sense of connectedness among communicators.
Although connection can be dif-
ficult to define, studies have isolated factors such as smiling,
using others’ first names in
conversation, appropriate touch and diminished physical
distance, making eye contact,
removal of physical barriers (for example, sitting on the same
side of a table or desk with
the other communicator and avoiding the use of lecterns during
public presentations or
meetings), engaging in some degree of self-disclosure, and
using animated facial expres-
sions as important to reducing the psychological distance
between people.
spa81202_02_c02.indd 46 1/15/14 3:47 PM
CHAPTER 2Section 2.2 Leaders and Transformational Change
Leader Communicator Styles
An animated leader relies primarily on nonverbal
behaviors such as gestures, eye contact, and facial
expressions to motivate others. An individual who
fits this profile but is not able to draw on behaviors
associated with the other styles will lack influence
in contexts other than face-to-face communication.
An attentive leader relies primarily on listening
skills in relationships with others to exert influence.
69. Through both verbal (asking questions, paraphras-
ing, and validating others’ positions) and nonverbal
(eye contact, head nodding, and leaning forward)
means, attentive communicators illustrate that they
value individuals and their ideas. Attentive leaders
must be careful to listen to others and actually incorporate their
perspectives into organizational
strategies and plans to maximize their credibility and impact.
A contentious leader is argumentative and challenging in
communication with others. These lead-
ers may enjoy playing the devil’s advocate and will often
challenge others to prove or support their
positions. Although the contentious communicator can be
challenging to work with, this style can
enable transformation by encouraging others to think outside
the box. This leader’s communica-
tion style and interactions with others focuses on asking
questions, raising the bar, and being intel-
lectually stimulating.
A dominant leader is similar to a contentious leader, but instead
of questioning and challenging
others, dominant leaders take charge of conversations and speak
in a strong manner. They tend
to communicate more frequently than others in meetings and
conversations. This style suits the
authoritative leader but can be precarious for leaders operating
in more democratic environments.
A dramatic leader communicates both verbally and nonverbally
in flowery and exaggerated ways.
These leaders use narratives and expressive language to convey
their positions. They may even rely
on poetry, literature, or dramatic quotations from others to drive
71. Leader Communicator Styles (continued)
An open communicator leader expresses emotion and self-
discloses personal experiences (both
positive and negative) as a way of inspiring and influencing
others.
An impression-leaving leader finds ways to deliver memorable
messages that others think about
after the conversation is over.
A relaxed leader is calm and understated in his or her approach.
These leaders rarely reveal anxiety
or nervousness and react unflappably under pressure. They
exude confidence and composure.
Effective leaders understand that impression management,
strong message content, and
effective delivery are central to their ability to influence others.
Further, they recognize
that there is not one perfect communicator style for a leader.
Strong leaders are adept at
analyzing people and situations and selecting a message,
delivery approach, and personal
style that best fits the circumstances.
Beckhard and Pritchard (1992) note that high-performing
organizations have a strong
sense of purpose with a team-driven model of management that
involves shared,
knowledge-based decision making. Continuous learning and
improvement are encour-
aged, and employees are considered valued partners in these
efforts. Paul O’Neill, former
chairman and chief executive officer of Alcoa, suggests people
working in a healthcare
72. organization should be able to answer “yes” to these three
questions every day:
• Am I treated with dignity and respect by everyone, every day,
in
each encounter, without regard to race, ethnicity, nationality,
gen-
der, religious belief, sexual orientation, title, pay grade, or
number
of degrees?
• Do I have what I need—education, training, tools, financial
support,
encouragement—so I can make a contribution to this
organization
that gives meaning to my life?
• Am I recognized and thanked for what I do? (Lucian Leape
Institute,
2013, p. ES2)
Discussion Questions
1. What are some strategies leaders can use for managing how
other people perceive them?
What are some specific ways in which you already practice
these perception-management
strategies in your personal and professional life?
2. Consider each of Norton’s communicator styles as they relate
to leaders and leadership.
Identify at least two situations in which each style would be
appropriate, and two situations
in which each style would probably be ineffective. Explain.
3. What is the difference between a goal-directed message and a
73. mindless message? Explain
your perspective. Why is goal-directed communication more
desirable for leaders than
mindless communication?
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CHAPTER 2Section 2.2 Leaders and Transformational Change
Leadership Traits
It is well known that experience is the best teacher of
leadership. An Accenture study of
leaders in all fields found they agreed that real work and life
experiences had taught them
more about leadership than any classes they had taken (Thomas
& Cheese, 2005). When
interviewed about the making of healthcare leaders, one hospital
vice president recounted
that he had not learned leadership skills in his graduate
program: “We received technical
education on finance, operations, accounting, policy and policy
development. Even with
my degrees, I still needed a lot of mentoring in terms of
executive expectations” (Witt/
Kieffer, 2007, p. 3).
While experience is certainly valuable to leadership
development, some key personal-
ity traits can typically be found in people with leadership
positions at various levels.
The first of these is vision—the ability to see the big picture,
imagine likely futures,
and infuse that vision with passion. Integrity is a requisite trait
74. because it is impossible
to influence others without gaining their trust. Communication
skills, compassion, and
charisma are needed to articulate the vision and persuade others
to embrace it. Leaders
demonstrate strong moral and ethical principles. Attention is
given to all stakeholders,
not some at the expense of others. A commitment to
collaboration encourages everyone
to work together to achieve a vision. A less obvious trait of
leaders is humility. Effective
leaders typically give others credit for an organization’s success
but will accept responsi-
bility for poor results. These traits can be summed up in the
phrase emotional intelligence,
which Goleman (2004) asserts is the indispensable ingredient of
effective leadership.
Five domains constitute Goleman’s definition of emotional
intelligence: self-awareness,
self-regulation, motivation, empathy, and social skills.
Robert K. Greenleaf introduced the servant leadership
philosophy in 1970 and defined
servant leaders as those who achieve results for their
organizations by attending to the
needs of those they serve (Greenleaf, 1970). Max de Pree, the
longtime chairman and
CEO of the Herman Miller office furniture company,
personified the concept of servant
leadership in business. He characterized the art of leadership as
“liberating people to do
what is required of them in the most effective and humane way
possible” (O’Toole, 1989,
pp. xviii–xvix). This puts the leader as the “servant” of his
followers by removing
obstacles that prevent them from doing their jobs, thus enabling
75. them to realize their
full potential.
The importance of humility also figures prominently in the
concept of Level 5 leadership,
developed by Jim Collins. Collins’s research examined how
companies were able to tran-
sition from being merely “good” to “great.” He concluded that a
leader builds “endur-
ing greatness through a paradoxical blend of personal humility
and professional will”
(Collins, 2001, p. 20). Table 2.3 further elaborates on humility
and will as these traits per-
tain to leadership. So where might you find a Level 5 leader?
According to Collins, “Look
for situations where extraordinary results exist but where no
individual steps forth to
claim excess credit. You will likely find a potential Level 5
leader at work” (2001, p. 37).
Level 5 leadership is transformational. Leaders in high-
performing HSOs inspire and
motivate followers to achieve greatness. Studies have shown
that healthcare leaders who
promote innovation and change are critical to the success of
implementing “best practice”
patient care (Aarons, 2006).
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CHAPTER 2Section 2.3 Developing and Evaluating Leaders
Table 2.3: Summary of the two sides of Level 5 leadership
Professional will Personal humility
76. Creates superb results, a clear catalyst in the
transition from good to great
Demonstrates a compelling modesty, shunning
public adulation; never boastful
Demonstrates an unwavering resolve to do
whatever must be done to produce the best
long-term results, no matter how difficult
Acts with quiet, calm determination; relies
principally on inspired standards, not inspiring
charisma, to motivate
Sets the standard for building an enduring great
company; will settle for nothing less
Channels ambition into the company, not the
self; sets up successors for even greater success
in the next generation
Looks in the mirror, not out the window, to
apportion responsibility for poor results, never
blaming other people, external factors, or luck
Looks out the window, not in the mirror,
to apportion credit for the success of the
company—to other people, external factors, and
good luck
Source: Based on Collins, J. (2001). Good to great: Why some
companies make the leap . . . and others don’t. New York, NY:
HarperCollins Publishers.
Many primary care providers, particularly those practicing in
77. rural settings, are poorly
trained in leadership skills (Markuns, Culpepper, & Halpin,
2009). With primary care pro-
viders being asked to transform to patient-centered, medical
home models of healthcare
delivery, leadership skills that are facilitative in nature, as
opposed to the more common
authoritative approaches, will be needed.
Discussion Questions
1. What leadership traits, if any, have you learned in your work
experiences? What traits may
be more difficult to learn on the job?
2. When managers are promoted to more senior positions with
substantial leadership respon-
sibilities, what problems might they encounter in their first year
in the new position?
3. What is more important to a leader’s success: high
intelligence and solid technical skills, or
high emotional intelligence? Or are these traits equally
important?
4. Do you have what it takes to be a Level 5 leader? Why or
why not?
5. Recount an experience you have had that shows you have
leadership potential.
2.3 Developing and Evaluating Leaders
Leadership development in HSOs involves identifying future
leaders, giving them
opportunities to function in leadership roles, and providing
feedback and mentoring.
Many healthcare organizations fail to develop and groom talent.
79. In addition to having a higher risk
of failure, recruiting external candi-
dates for leadership positions is more
costly. Direct costs include search fees, interview costs, signing
bonuses, relocation, and
severance packages, among others. There are also indirect costs
and post-hiring costs. One
study suggests that replacing a chief nursing executive could
cost a hospital upwards of
$1.5 million (Sredl & Peng, 2010). By contrast, developing
people in the organization to
assume leadership positions is much less costly. Internal
development costs are associated
with training, education, mentoring, and job rotation.
Finally, an organization that practices internal promotion is
more likely to retain high-
potential talent. Executive retention is positively correlated
with formalized succession
programs. In companies having an executive turnover rate of 1–
5% annually, 84% had
formal development programs. At companies reporting turnover
rates of 6–10%, 24%
had succession programs. Of businesses experiencing turnover
rates of 11–20%, only 11%
had succession programs.
Developing the next generation of leaders is a difficult
challenge for an HSO. Organi-
zations committed to promoting from within can take certain
measures to increase the
prospects of success (Allio, 2009). First, they must have a good
talent pool, which means
hiring people with leadership potential in the first place. The
organization must have a
80. leadership development program that intentionally puts these
people in challenging situ-
ations and as members of cross-functional teams. A good
development program obtains
feedback about them and their performance from those who see
them in action (Fulmer,
Stumpf, & Bleak, 2009).
A 2007 survey of 104 health systems found that 52% had
executive leadership develop-
ment programs, and programs were under development at
another 12% (McAlearney,
2008). Healthcare leaders suggest that some organizations
getting into leadership develop-
ment are “just going through the motions” and not implementing
a substantive program
(McAlearney, 2006). However, several healthcare organizations,
including the follow-
ing, were recently recognized as having outstanding leadership
development programs
and practices:
2.3 Developing and Evaluating Leaders
Leadership development in HSOs involves identifying future
leaders, giving them
opportunities to function in leadership roles, and providing
feedback and mentoring.
Many healthcare organizations fail to develop and groom talent.
In a survey of 200
healthcare provider CEOs, almost half indicated that no
potential successor to their orga-
nization’s top management spot had been identified, and only
17% felt that someone in
the organization was prepared to step into the top spot
(Witt/Kieffer, 2012). As the health-
care environment becomes more complex, the development of