Lecture Notes Flashcards
Internal domain
The areas of focus that managers need to address on a daily basis, such as ensuring the appropriate number and types of staff, financial performance, and quality care.
External domains
The influences, resources, and activities that exist outside the boundary of the organization, but affect the organization
6 functions of management
Planning Organizing Staffing Controlling Directing Decision making
Planning
Set direction and determine what needs to be accomplished. Set priorities
Organizing
Overall design of the organization: designating reporting relationships, determining positions, teamwork assignments and distribution of authority and responsibility
Staffing
Acquiring and retaining human resources. Developing and maintaining the workforce
Controlling
Monitoring staff activities and performance and taking corrective actions
Directing
Initiating acting action in the organization through effective leadership and motivation of subordinates
Decision making
Making effective decisions based on considerations of benefits and drawbacks of alternatives
3 compitencies
Conceptual skills
Technical skills
Interpersonal skills
Conceptual skills
Those skills that involve the ability to critically analyze and solve comes problems
Technical skills
Those skills that reflect expertise or ability to perform a specific work task
Interpersonal skills
Enable manager to communicate with and work well with other individuals, regardless of whether they are peers, supervisors, or subordinates
Stakeholders
Includes insurers, state and federal governments, and consumer advocacy groups. Anyone who has in interest in the performance of the organization
Leadership domains
Functional and technical
Self development and understanding
Interpersonal
Organizational
Emotional intelligence
There are certain skills (intra/interpersonal) that a person needs to be well adjusted in today’s world. Needs for self awareness, self-regulation, motivation, empathy, and social skills. Suggests a more caring, confident, and enthusiastic boss can establish good relations with workers
Authentic leadership
People will want to naturally associate with someone who is following their internal compass.
Inspirational leadership
Focus on leaders who inspire by giving people what they need. Supports the concept of ‘tough empathy’. Managers care passionately about their employees and work but are prudent in what they provide in the way of support
Servant leadership
Acknowledges that a healthcare leader is largely motivated by a desire to serve others, everyone contributes to a greater whole.
Spirituality leadership
Emphasizes ethics, values, relationship skills, and promotion of balance between work and self. Leader created a positive working environment that supports individuals finding meaning in what they do.
Coercive leadership style
Only to be used with a very problematic subordinate or an an emergency situation
Participative leadership style
Leader asks managers for their input and gives them a voice in making decisions; lets them know they are respected and valued
Pacesetting leadership style
The leader sets high performance standards for his or her followers. Good for situations where employees are self motivated and highly competent
Coaching leadership style
Focused on the personal development of his or her followers rather than tasks. Recommended for top, competent, trusted followers in the organization
Barriers to leadership
Laws and regulations
Physicians
New technology
Culture of safety
Maslow’s hierarchy of needs
Physiological Safely Belonging Esteem Self-actualization
characteristics of engaged healthcare employees
More productivity More focus on patient care and treatment Safer Loyal to their employers Model positive behaviors of engagement Greater profitability for a provider
Alderfer’s 3 factor ERG theory
Existence
Relatedness
Growth & development
Herzberg’s 2-factor theory
Hygienes (lower level motivators)
Motivators (higher level factory such as achievement)
McClelland’s acquired needs theory
Achievement
Affiliation
Power
Skinners reinforcement theory
Extrinsic
Positive reinforcement, avoidance learning, punishment and extinction
Adams equity theory
Intrinsic
Individuals are motivated when they perceived that they are treated equitably in comparison to others in the organization
Vroom’s expectancy theory
Intrinsic
Expectations of the individual and how they are motivated by performance and the expected outcomes of their own behavior
Locke’s goal setting theory
Intrinsic
By establishing goals, individuals are motivated to take action to achieve those goals
Taylor’s Scientific Management
focuses on efficiency; rewards employees for productivity and hard work. Assumes that employees are continually able to work harder and will do so to earn higher pay
McGregor’s Theory X
managers view employees as unmotivated and disliking work; manager’s role is to direct and control employees
McGregor’s Theory Y
managers focus on higher level motivators and work to assist employees in achieving higher levels such as achievement, recognition for achievement, the work itself, responsibility, , and growth and advancement
Ouchi’s Theory Z
states that employees who are involved in and committed to an organization will be motivated to increase productivity. The rewards are long term employment, promotion from within, participatory management, and other techniques to engage and motivate
Integrative Model of Motivation
most managers draw upon on a combination of needs, extrinsic factors, and intrinsic factors to help motivate employees; also to help employees meet their own personal needs and goals an ultimately to achieve effectiveness and balance within an organization.
Assumptions
fundamental premises believed true
Perceptions
what is noticed; to what attention is paid
Cognitive Biases
mental processing that simplifies handling information and that can compromise decision quality
Hueristics
simplify the decision making process and lead to biases
Self-fulfilling prophecy
expectations about another’s behavior that can elicit the expected behavior
Expectancy Theory
managers affect employee motivation when they influence employee expectations about ability to accomplish a task and expectations of reward
Attributions
imputing the likely cause of another’s behavior
Attribution Theory
explaining another’s behavior by presuming it is caused either by a person’s disposition or by the situation
Mental Models
beliefs about how things work
Sense Making
process in which organization members interpret the meaning of ambiguous situations. How employees arrive at a shared interpretation of a complex or ambiguous situation
Strategic Planning
The process of identifying a desired future state of an organization and a means to achieve it
Four P’s of strategic planning
Promotion
Product
Price
Place
SWOt meaning
Strengths
Weaknesses
Opportunities
Threats
Mission
is the organization’s is its permanent statement of purpose
Vision
statement strives to identify a specific future state of the organization
Values
define the practice culture. What characteristics it wants employees to convey to the customers
Marketing
The activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large.
Social Marketing
The application of commercial marketing principles and techniques to influence behavioral change, of a specific target audience, in order to promote public health for the benefit of society as a whole.
Cause related marketing
Links a for-profit company and its offerings to a social issue, with the goal of building brand equity and increasing profits
Segmentation
Refers to the process of dividing the total market into groups or segments that have relatively similar needs for products and services
Targeting
concentration or multi-segment
Positioning
the various techniques used by healthcare organizations and providers to position to brand image and offerings in the mind of the target market
Quality
degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge
Components of Donabedian definitions of quality
Technical management of health and illness
Interpersonal relationships; clients and providers
Amenities of care; the patient’s interest in individual well being
Ethical principles guiding care
Two quality questions
Are the right things done (effectiveness)
Are things done right (efficiency)
underuse
failure to provide a service whose benefit is greater than its risk
overuse
use of service when risk/cost outweighs its benefits
misuse
risk service is provided badly reducing benefit to patient
Baldridge award criteria
Strategic framework Structure Process Outcomes Supported by measurement, analysis, and knowledge management
CQI five dimensions
Process focus Customer focus Data-based decision making Employee empowerment Organization-wide scope
FOCUS meaning
Find - identify process problem
Organize - put together a team to work on process
Clarify - use techniques to clarify the problem
Understand - measure and collect data to
Select - identify process improvements for implementation
PDCA meaning
Plan – create an implementation plan for taking the process to the next level
Do – implement and test the new process
Check – evaluate the measures used and assess outcomes
Act – assure continuation of newly implemented process, if successful ,or redo the process, if not successful
Six Sigma DMAIC meaning
Define –delimit scope of work and time frames for completion
Measure – create and apply measures and metrics
Analyze – assess and flowchart the process
Improve – specify the steps to be taken to meet goals
Control – assure permanence of the improvements
What is EMRAM
model to gauge hospital EMR adoption
What should you know before you enter the patient room
Patient Name Patient Diagnosis Patient Prescription Physician Name Insurance Source
Domains of Practice Analysis
Patient Assessment Formulation of the treatment plan Implementation of plan Follow-up to plan Practice Management Promotion of competency and enhancement of professional practice
Benefits of effective teams
Improve coordination and quality of care
Use of health care services more efficiently
Increase job satisfaction among team members
Increase patient satisfaction
Increase productivity
Costs of Teamwork
Meeting time, place to meet and food and coffee
Opportunity costs
Perceived loss of autonomy
Risk-taking associated with letting go of one’s turf
Resistance to organizational change
Tuckman’s Stages
Forming
Storming
Performing
Adjourning
Three components in clinical decision making
Scientific Evidence
Practitioner Experience
Patient Values
Cost-consequence
descriptive profile of the costs and outcomes (impact on health and economics) of one or more interventions
Cost-minimization
identifies the least costly alternative for services that result in equivalent outcomes
cost-effectiveness
describes and compares the relative costs and outcomes of two or more interventions that result in the same type of outcome
cost-utility
describes and compares the relative costs and outcomes of two or more interventions in which the outcomes of interest include health status and the value of the status to the individual
cost-benefit
describes and compares the relative costs and outcomes of two or more interventions in which both the costs and outcome can be measured in monetary values
Moral model
contends that disability was a direct result of past and/or current sin and shame
Medical model
measures disability in terms of mortality and morbidity. Trying to fix and individual.
Pathology
the underlying pathological state that interferes with normal bodily functions or structure
Impairments
any loss or abnormalcy of psychological, physiological, or anatomical structure or function.
Functional limitations
the functional consequences of the pathology
Disability
any restriction or lack (resulting from impairment) to perform an activity in the manner or within the range considered normal for a human being
Handicap
A disadvantage that limits or prevents fulfillment of a normal role
4 constructs of disablement according to ICF
Body functions and structures
Activities and participation
Environmental factors
Personal factors
Factors in health disparities
Access to health insurance Genetics and biology Socioeconomic factors Living and working conditions Patient's beliefs Patient't adherence to preventative and therapeutic measures
Race
Physical appearance
Shared genealogy due to geographical isolation
Ethnicity
Relates to cultural factors including nationality, culture, language and beliefs
Cultural Proficiency
The ability and willingness to respond respectfully and effectively to people of all cultures, classes, races, ages, ethnic backgrounds, and religions in a manner that values all
Benefits of cultural proficiency
Good business practice
Good workforce management
Ethical and moral imperative
Amputee coalition mission
to reach out to and empower people affected by limb loss to achieve their full potential through education, support and advocacy, and to promote limb loss prevention.
Amputee coalition AIMS
Awareness
Impact
Member Services
Sustainability
AC - Awareness
The vast majority of those affected by limb loss will know of the Amputee Coalition and understand the value of being a part of the Amputee Coalition community.
AC - Impact
Amputee Coalition-led collaborations, programs, relationship-building and strategic alliances will create changes in healthcare delivery that ensure all amputee patients and their families in the U.S. have access to and receive quality care, support and information for both pre- and post-limb loss.
AC - Member Services
The Amputee Coalition will provide meaningful services and programs.
AC - Sustainability
Amputee Coalition-led collaborations and strategic alliances will increase funding for the full spectrum of our services
Sources of ethics
Personal
Organizational
Theoretical
Bioethical
Respect for persons
The right for individuals to make informed decisions when they are competent, or to have respectful guardianship when they cannot self determine their care.
Beneficence
requires doing the best one can for the recipient of one’s services; stems from Hippocratic tradition/oath.
Nonmaleficence
the parallel concept; “do no harm”, or at least “don’t make it worse”.
Justice
tied to ethical philosophy and implies fairness
Criminal Law
a wrong against society as a whole, even if a particular individual is harmed
Civil Law
wrongs against a particular person or organization, either by contract violations or by wrongful acts (torts)
Types of torts
Negligence
Intentional
Infliction of mental distress
4 element of negligence
- a duty toward the harmed party
- breach of duty
- injury or damages
- causation (breach of duty has to be directly connected to the harm that occurred
Patient Responsibilities
- ask questions of providers
- provide accurate info
- follow the care plan the agreed to
Patient rights
- self-determination
- expect confidentiality
- informed consent or competent surrogate
- right to refuse care
- emergency treatment
What is included in an EMR
Clinical data
Clinical decision support
Physician order entry
Clinical documentation
EMRAM
Electronic Medical Record Analytical Model
gauges hospital EMR adoption
O and P uses of EMR
Patient intake forms
Patient records
Ordering
Materials management
Challenges to EMR adoption
-high cost of system
slow development of data standards
-user unfriendliness of systems
-patient privacy (lack of trust by patient that info is secure)
Reasons medical records may be disclosed
Treatment
Payment
Healthcare operations
Parts of Medicare
A - hospital insurance
B - medical insurance
C - medicare HMO
D - Rx drug benefit
Medicare Assignment
Supplier agrees to accept the Medicare fee for that procedure as payment in full except for the applicable 20% co-payment and any unmet deductible.
Participating supplier
Must accept assignment for all covered medicare services
Non-participating
can decide whether to accept assignment on a claim by claim basis
Retrospective reimbursement
determined AFTER service delivery
- charges
- charges minus a discount
- cost plus
Prospective reimbursement
determined BEFORE service delivery
- per diem
- per diagnosis
- capitation (per member per month)
Reasons to do cost accounting
- estimate and manage costs
- set charges and analyze profits
- make decisions regarding adding, enhancing, or eliminating services
- provide methods for classifying, allocating, and determining product costs
Direct costs
components
outside/inside fab
materials
Indirect costs
% of fixed salary
rent
depreciation
utilities
HR domains
Workforce planning/recruitment
Employee retention
HR functions within workforce planning/recruitment
- Job analysis
- Workforce Planning
- Establishing job descriptions
- Recruitment
- Interviewing, selection, negotiation and hiring
- Orientation
HR functions within employee retention
- employee relations and engagement
- training and development
- compensation and benefits
- employee assistance program
- assessing performance
- leadership development
- employee suggestion program
Two types of compensation
base pay - tied to knowledge skill and experience
incentive compensation - designed to improve organizational performance
Major types of benefits
- sick leave
- vacation
- holidays
- health insurance
- life insurance
- retirement plan
- flexible spending accounts
Job satisfaction
The pleasurable of positive emotional state resulting from the appraisal of one’s job or job experiences
Job burnout
A prolonged response to chronic emotional and interpersonal stressors on the job
Qualities to assess when judge environmental burnout
- job autonomy, variety, and significance
- fairness of pay and benefits
- opportunities for promotion and advancement
- relationships with supervisors
- relationships with coworkers
