Chapter14 Management Healthcare - University of South Florida

Management in Healthcare

Companion to Jonas & Kovner's Health Care Delivery in the United States, Chapter 14,

"Governance, Management, and Accountability"

PHC 4630

Understanding U.S. Healthcare

Management Definition

? Organized way of getting work done with the right info, resources, and people at the right time

? Work done through others - done properly, on time, within budget

? Process, composed of interrelated social and technical functions and activities, occurring within a formal organizational setting for the purpose of accomplishing predetermined objectives through utilization of human and other resources.

Source: Koontz, Harold, "The Management Theory Jungle," Academy of Management, 4, December 1961, pp. 174-188

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Three Primary Objectives of Healthcare Administrators

? Business and financial aspects

? Efficiency and effectiveness ? Roles include: human resources, financial

management, data collection and analysis, strategic planning, and marketing

? Social services ? care for dependent people

? Moral and social order ? advocate and arbitrate

Haddock, C. C., McLean, R. A., & Chapman, R. C. (2002). Careers in healthcare management: how to find your path and follow

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it. Health Administration Press.

Presentation Objectives

? Define management ? Review functions of effective management ? Differentiate efficiency and effectiveness ? Review disaster preparedness and

response concepts

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Healthcare Administration History

? Early hospital administration only (late 1800s and early 1900s)

? Broadening of opportunities

? American College of Healthcare Executives (1933)

? Medical Group Management Association (1926)

? Healthcare Financial Management Association (1968)

Haddock, C. C., McLean, R. A., & Chapman, R. C. (2002). Careers in healthcare management: how to find your path and follow

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it. Health Administration Press.

Public Health Administration

? Government and social agencies ? Prevention vs. intervention ? Core Functions

? Assessment ? Policy ? Assurance

? Disaster Preparedness and Response

? Population-base emergency management

Novick, L. F., & Mays, G. P. (Eds.). (2005). Public health administration: principles for population-based management. Jones & 6 Bartlett Learning.

Cycle of Management Functions

Planning

Controlling

Organizing

Directing

Staffing

Source: Swain, GR, et al. Three Hundred Sixty Degree Feedback: Program Implementation in a Local Health Department. J. Public 7 Health Management and Practice. 2004;10(3):266-271.

Effectiveness and Efficiency

? Effectiveness

? Measures the degree to which goals are achieved

? Goal attainment

? Efficiency

? Greatest benefit at given cost ? "Biggest bang for the buck"

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Efficiency

? Produce largest results for a given amount of resources

? Recognizes that resources are constrained ? Use time and energy, without wasting any ? Ratio of useful work performed relative to total

resources used ? Greatest benefit at given cost (costs are more

easily measured than benefits)

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Accountability

? Answerable to important stakeholders for decisions that affect organizational performance

? Goals

? Improving the health of a population ? High-quality care at a reasonable cost (value)

? Challenges

? Health must be operationalized ? Short-term results

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Effectiveness

? Measures of effectiveness depend on perspective

? Employees: work satisfaction and compensation. ? Customers: satisfaction with quality and cost of

goods/services ? Local community: contribution to community health ? Government: compliance with laws and regulations

? Goals should appropriate and meaningful for the organization

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Effectiveness vs. Efficiency

? Organizations and managers can be:

? Effective and efficient ? Effective but inefficient ? Efficient, but ineffective ? Ineffective and inefficient

? ICU Nurse-to-Patient Ratio example

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Effective Management

? Effective management ensures quality and desired outcome

? Effective management ensures disciplined and organized effort against specific challenges and problems of each organization

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Emergency Management Cycle

Prevention/ Mitigation

Recovery

Preparedness

Response

Khan, A. S., & Curran, J. P. (2011). Public health preparedness and response in the USA since 9/11: a national health

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security imperative. Lancet, 378(9794), 953.

Disaster Preparedness

? Readiness and impact assessment ? Expansion of surveillance and epidemiology

capacity ? Infection control measures including isolation

and quarantine ? Mass provision of clinical interventions (vaccine

or medications) ? Coordination and capacity assessment of health

care delivery system

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Planning Benefits

1. Focus 2. Flexibility 3. Action orientation 4. Coordination 5. Time management 6. Control

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Disaster Prevention / Mitigation

? Measures taken to reduce the harmful effects of a disaster by attempting to limit impacts on human health and economic infrastructure

? Levels of strategies:

Primary Secondary Tertiary

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Public Health Response

? Conduct initial assessments of health needs Viability of the health care infrastructure Environmental infrastructure (food, water, sanitation,

and vector control)

The needs of the elderly and other special populations Level of access to health care providers (acute,

continuity of care, primary care, and emergency care)

? Applied epidemiology ? Plan for the delivery of services ? Encompasses relief efforts

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Disaster Escalation

? In the event of insufficient local resources Escalate a request to the state or federal level Request for outside aid called "escalate upward" Federal resources may require 72 hours to arrive

? Federal resources are made available to the states National Guard CDC (i.e., Epidemic Intelligence Service) U.S. Public Health Service (i.e., the Agency for Toxic

Substances and Disease Registry)

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Conclusion

? Management is an iterative process with many functions

? Health services management is a relatively new profession covering a broad spectrum of healthcare settings

? Effectiveness and efficiency are distinct management concepts

? Public health plays an important role in disaster preparedness and response

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Disaster Recovery

? Begins with stabilization of an incident and ends when the community has re-established normal social, economic and political routines

? Public health concerns: Water quality Food Shelter Sanitation Vector control

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