Management of Food and Nutrition Programs and Services - Domain III Flashcards
planning phase of management
basic function of management
- objectives
- policies
- procedures
- time span
- emergency preparedness
organizing and staffing
identify tasks and activities, divide tasks into positions, establish relationships among all other functions of management
- organizational chart
- chain of command
- span of control
- staffing patterns
- work schedules
- FTE
FTE/day
labor hours worked/day / 8 hr normal work load
FTE/week
labor hours worked/week / 40 hr normal work load
FTE/year
labor hours worked that year / 2080
absolute FTE
min number of employees needed to staff the facility; counts productive hours (hours actually worked)
adjusted FTE
also takes into account the benefit days and days off
relief workers
approx 1.55 employees are necessary for everyday
0.55 (129/236)
inputs (resources)
labor, money, materials, facilities, energy
outputs (units of service)
meal, patient days, consults
meals per labor hour
meal produced / # hours worked
work simplification - motion economy
reduce motions and time required
use shortest and straightest routes to move materials.
work simplification - occurrence sampling
observe random samples (intermittent observations) to determine percentages of time working or idle
work simplification - pathway chart or flow diagram
scale drawing showing path of a worker during a process
work simplification - operation charts
movement of hands; reduces transportation and re-plan work areas. use both hands simulataneously and effectively
work simplification - process charts
steps involved in process using symbols
work simplification - cross charts
efficiency of equipment placement, studies work motions, shows number of movements between pieces of equipment
directing
coordination links activities of various departments within the organization
delegation is the distribution of work to qualified people
communication
transmitting and receiving information to bring about a desired action
downward communication
from Dept head through the ranks of workers
upward communication
from works up to the Dept head
horizontal communication
between depts or between production and service
diagonal communication
minimizes time and effort expended in org
informal channel (grapevine)
meets social needs of group
maslow’s hierarchy of needs
determinants of behavior, motivated by the desire to satisfy specific needs
basic needs
when the basic needs are met, then the high needs become motivators
maslow’s hierarchy of needs - physiological (survival needs)
food, clothing, shelter
- pay, benefits, working conditions, schedule
maslow’s hierarchy of needs - security and safety
insurance, retirement plans, job security
maslow’s hierarchy of needs - social
belonging, acceptance, affiliation
maslow’s hierarchy of needs - self-esteem
job title, praise, rewards, promotions, recognition
maslow’s hierarchy of needs - self-realization
realizing your potential growth using creative talents; advanced training, job enrichment
Herzberg’s two-factor theory
- motivation and maintenance approach
maintenance hygiene factors
motivators call forth energy and enthusiasm
Herzberg’s two-factor theory - maintenance hygiene factors
if present and perceived as good…satisfiers
if lacking or perceived as negative, dissatisfiers will interfere with work
do not produce motivation, but can prevent motivation from occurring
fair wage, conditions (working), retirement benefit, insurance, supervision, interpersonal relationships on the job, schedule
Herzberg’s two-factor theory - motivators
job enrichment
achievement, personal accomplishment, recognition, responsibility, participation in decision-making, opportunity to growth and advance
McClelland’s theory
suggests that all people have three needs
- achievement - motive is a desire to do something better or more efficiently
- power - enjoy competition and seek confrontation
- affiliation - desire to be liked by others
MacGregor theory X & Y
attitude of the manger toward employees has an impact on job performance
theory X - people inherently dislike work and will avoid it if possible, authoriarian, work-centered; workers prefer to be controlled and directed by pressure; negative, autocratic
theory Y - work as a natural as play or rest; management should arrange conditions so workers can achieve goals by directing own efforts, positive, participative
Hawthorne studies, Elton Mayo
- if you involve people in the process, they become more productive
- productivity due to: employees were given special attention, were involved in an interesting experience, and were well-treated by supervisors
- placebo effect (special attention improves behavior)
expectancy theory - beer, vroom
- rewards serve as motivators only under certain circumstances
- employees must believe that effective performance leads to certain rewards
- employees must feel that rewards offered are attractive
path goal theory
focuses on leader’s effect on employee’s motivation to perform. motivation to behave in a particular manner is the result of an expectation that a behavior will result in a particular goal and how strongly a person desires the goal.
leadership theories - autocratic
demands obedience, most control, full responsibility, crisis control
leadership theories - consultative
asks for input, but makes major decisions alone
leadership theories - bureaucratic
by the book, follows procedures to the letter
leadership theories - participative
emerging trend in management. encourage workers to participate in decision-making. uses quality circles: small group of employees who meet regularly to identify and solve problems
leadership theories - democratic
guides and encourages the group to make decisions
leadership theories - free rein (laissez-faire)
least control, allows group to make decisions
Likert - management of conflict
exploitive, autocratic
job-centered, makes all decisions
Likert - management of conflict
benevolent, autocratic
job-centered, minor decisions made by workers
Likert - management of conflict
consultative
employee-centered, gain some confidence
Likert - management of conflict
participative
employee-centered, trust and responsibility
leadership grid - blake and mouton
plot’s leader’s concern for people (employees) vs. their concern for production
- country club management
- team management
- middle of the road management
- impoverished management
- autocratic
leadership continuum - tanenbaum and schmidt
- developed continuum or range of possible leadership behaviors. each type of beahvior is related to the degree of authority used by the manager and the amount of freedom available to subordinates in reaching decisions
- tells decision, sells decision, discusses decision, asks for input on decision, collaborates on decision, delegates responsibility for decision
contingency approach - fiedler
in both highly favorable and highly unfavorable situations, a task-oriented leader is more effective.
in moderately favorable situations, a relationship-oriented leader tends to be more effective because cooperation is more successful than task-oriented leadership
leadership effectiveness model: hersey, blanchard, johnson
readiness of followers and recommended leadership styles to use for each. readiness - desire for achievement, willing and able to accept responsibility, skills relevant to task
- low readiness: tell
- low to mod readiness - sell
- mod to high readiness - participate
- high readiness - delegate
* how you lead depends on who you are leading and their ability to follow
transactional vs. transformational leadership
how leaders and followers influence each other
- transactional leader - clarifies roles and responsibilities; uses rewars and punishments to achieve goals (autocratic)
transformational - agents of changes (participative)
- inspire followers to becmoe motivated to work towards organizational goals rather than personal gain; builds on extends transactional leadership; cultivation of employee acceptance of the group mission
management - traditional or classical
formal structure that organizes and administers the work activities
coordination is main responsibility of management
focus on tasks, structure, authority
management - traditional or classical - scalar principle
authority and responsibility flow in a direct line vertically from the highest to lowerest echelons: clear and unbroken lines
management - traditional or classical - unity of command
each is accountable to only one superior
management - human relations (behavioral) theory
uses behavioral sciences, workers exist in social groups
employee partcipation in decision-making is essential
theory Z (ouchi)
the value of the company is the people
everyone who will be affected by a decision is involved in making the decision (consensus decision-making)
systems approach
system is an organized whole composed of interdependent parts called subsytems (classified according to their purpose: procurement, production, distribution and service, safety and sanitation)s
subsystem
complete system within itself that is part of a larger system (foodservice) is a subsystem of the hospital, production is a subsystem of the foodservice department)
systems - interdependency of parts
each part affects performance of other parts leading to integration and synergy. view as a whole, not as isolated parts
systems - integration
parts are blended together into a unified whole (which leads to…)
systems - synergy
units working together may have greater impact than each operating separately
systems - dynamic equilibrium
steady state, continuous response and adaptation to environment
systems - equifinality
same or similar output can be achieved by using different inputs or by varying the transformation process (various alternatives may be used to achieve similar results)
systems - permeability of boundaries
allows system to be affected by changing environment
systems - interface
where two systems or subsytems come in contact with each other
scientific management - Taylor
work centered - workers must work at fastest pace possible and at max efficiency, systematic approach ot improving worker effieincy
management by objectives (MBO) - Drucker
type of democratic management that provides control from within
establish performance goals and objectives with employees
participative leadership
controlling/evaluating
measure present performance against standard performance
- determine whether goals have been reached
- shows strengths and weaknesses, solves problems
- establish qualitative and quantitative standards (what is expected to happen)
- measure performance
- compare to standard
- take corrective actions
informational roles
monitor, disseminator, spokesman
informational - monitor
constantly searching for information to become more effective
informational - disseminator
transmits info to subordinates
informational - spokesman
transmits info to people inside and outside
interpersonal roles
leader, liaison, figurehead
interpersonal - leader
responsible for work of the staff, hiring, training
interpersonal - liaison
dealing with those inside and outside the org
decisional roles
negotiator, entrepreneur, resource allocator, disturbance handler
decisional steps in problem solving
recognize and analyze problem, determine workable solutions, gather data, choose solutions, take action, follow up the action
nominal group technique
- Delbecq
- generate innovate, creative ideas
- has authoritative leader, controlled interactions
- silent generation of ideas by participants
- round robin reporting
- group ranks items in priority order; vote for final decision
Delphi technique
- consensus of experts
- designed to probe expert minds in a series of written interviews from which some consensus is sought
- participants do not meet
cause and effect fish diagram
what influences the outcome?
what are the causes of the effects (results) you are seeking?
technique to increase worker involvement in decision-making
- causes: interesting topic, knowledgeable speaker, interested attendees
- effects - sound info, pleasant experience
pareto analysis, bar chart
illustrates the relative importance of problems
- work on the tallest bar or problem that occurs more frequently
- most effects have relatively few causes
80-20 rule: 80% of a given outcome results from 20% of an input
(80% of sales come from 20% of customers)
queue
- queuing theory
- develops the relationships involved in waiting in line
- used in analyzing flow of customers in a cafeteria - balance cost of waiting lines with the cost of preventing waiting lines through increased service
traits of leadership - reward power
ability to reward another for carrying out an order, give incentives
traits of leadership - coercive power
negative side of reward power, ineffective in motivating behavior change, may create resistance
traits of leadership - position (legitimate) power
subordinate acknowledges that the influencer has the right to exert influence due to position (job title)
traits of leadership - expert power
belief that influencer has some relevant expertise that the subordinate does not; provides credibility
traits of leadership - referent power
- based on the desire to identify with or imitate the influencer, how well you are liked
expert and legitimate powers
are important for compliance
expert and referent powers
are related to subordinates’ performance and satisfaction
unemployment comp
insurance against loss of income
must be employed for specific time, able and willing to work
each state has own laws that define benefits in accordance with minimum federal standards
workman’s compensation
- administered by state
- insurance covering employers’ liability for the costs of any accident incurred by an employee in connection with their job
- must furnish a safe place to work, competent, supervision, instructions
national labor relations act
wagner act
- guaranteed right to organize and join labor unions
- gave union the right to be the bargaining agent
- created the national labor relations board - NLRB
taft hartley labor act
labor Management Relations act
- balanced powers of labor and management
- outlawed the closed shop; limited union shop to one year
- specified unfair labor practices of the union
landrum-griffin, labor management reporting and disclosure act
- bill of rights for union members; regulates internal union affairs
civil rights act
- prevents discrimination on basis of race, color, national origin; prohibits sexual harassment
- overseen by the EEOC
equal employment opportunity act
prevents discrimination in employment based on race, color, religion, sex, national origin, political affiliation, overseen by EEOC
fair labor standards act
- may be called minimum wage or wage hour law; set min wage
- for overtime work (over 40 hrs in 1 week) must pay time and one-half
- amendment - equal pay act - prohibits discrimination on basis of sex
- donated (tolerated) time - compensable - must be paid
- child labor laws regulate owrk hours and duties of children
- in food service, students can handle and clean cutters and slicers only if enrolled in food-related programs
- occupations exempt from min wage and overtime requirements: executive, administrative, professional, outside salespersons
age discrimination in employment act
prevents discrimination due to age
FMLA
family and medical leave act
- applies to public agencies and private agencies employing >50 workers
- up to 12 workweeks of UNPAID job protected leave during any 1 months for: birth or placement of a child for adoption, to care for an immediate family member, or medical leave for a serious health condition
- when you return you are guaranteed an equal job, but NOT the same job
Americans with disabilities act
- covers employers with 15 or more employees
- must provide “reasonable accommodations” - remove barriers, have wide aisle (36”) and doors (32”); install ramps, lower shelves and phones, rearrange tables and chairs, flashing alarm lights
HIPAA
health insurance portability and accountability act
- allows employees to transfer coverage of existing illness to a new employer’s insurance plan
social security act
insurance program to protect employees against wage loss from retirement, unemployment or diasability
NPI
national provider identifier
10-digit identification number for providers and practitioners of health care services. used in standard transactions, such as in coordination of benefits between health plans, in healthcare claims, medical records
NCQA
national committee for quality assurance
credentialing is the process used to assess and verify the qualifications of a healthcare provider. many insurance companies require RDNs to become credentialed in order to provide services for their members and in order to pay claims
CAQH ProView
is an online credentialing portal that a provider can elect to share with multiple health plans or payer orgs. it eliminates the need for multiple insurance credentialing submissions
licensure
a state agency issues a license to individuals who meet specified qualifications to practice a particular profession. licensing statutes for dietetics and nutrition always include a title protection provision, which is designed to prevent unlicensed individuals from holding themselves out to the public as Dietitians.
check off
deduction of union dues from pay
union shop
must join union after being hired
open shop
can join union or not
closed shop
must be member of union first before hiring
union and closed shops are
illegal in public employment
agency shop
all workers must pay agency fee, but not required to join union
collective bargaining
- bargaining between union steward and management
- if that fails: mediation - neutral person helps settle differences; decision not binding
- if that fails: arbitration - hearing to dissolve a dispute during an impasse; decision is usually binding. FINAL step in bargaining
unions can negotiate
working conditions, vacations, and holidays, but not personnel requirements or strategic initiatives
job analysis
studies all aspects job, done by worker and their supervisor
- conducted first to collect information for job description
job description
reflects required skills and responsibilities
- matches applicants to job, orientation and training, employee appraisal
job specification
duties involved, conditions, qualifications (education, experience); written for each job
- used in selection and placement of employees (hiring)
- does not have detailed info as to what to do or time involved
fair employment practice law
adopted by states - makes it illegal to ask about a candidate’s race, religion, sex, national origin, age, marital status, or if they have children (after hire, can ask). check with personal dept regarding restrictions
benefits - statutory
payment required by law to ensure income in event of unemployment, injury or death
benefits - compensatory
benefits or pay for time not worked
benefits - supplementary
life and health insurance
disciplinary action
steps taken to correct undesirable behavior
1. oral warning
2. written warning
3. suspension
4. dismissal
obstacles to effective appraisals - halo effect
judge on most noticeable positive trait
obstacles to effective appraisals - leniency of error
rate everyone higher than they deserve
obstacles to effective appraisals - error of central tendency
rate everyone as average
labor turnover rate
high labor turnover rates result in higher labor costs (replacement, hiring, training).
goal: low turnover rate
Cultural Awareness:
Involves recognizing &
acknowledging one’s own cultural biases, values,
beliefs, & their impact on healthcare practices
Cultural Skill:
Involves the ability to conduct a
cultural assessment & effectively communicate with
individuals from different cultural backgrounds using
culturally appropriate communication techniques
Cultural Knowledge:
Understanding of different
cultural practices, beliefs, & values of diverse
populations; Involves seeking information about
specific cultural groups, including their health beliefs,
communication styles, & healthcare practices
Cultural Encounters:
Engaging in direct cultural
interactions with diverse individuals & communities
Cultural Desire:
Motivation & commitment to
providing culturally competent care; Involves
developing a genuine interest and respect for
diverse cultures
cultural humility
involves the ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identify that are most important to the client/employee
cultural competence
is the ability of systems to provide care to pts with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet pt’s social, cultural, and linguistic needs
cultural sensitivity
is being aware of similarities and differences among various cultures as you engage in active communication with other communities
operating budget
forecast of revenues, expenses, and profit for a specific period of time
first step - forecast sales or revenue (income) portion then budget expenditures (labor, food, operating expenses) related to the projected level of revenue
cash budget
projects revenue and expenses, showing inflow and output of cash
purpose is to determine if funds will be available when needed
capital budget
plant facilities, equipment, cost of improvements and repairs (service, maintenance contracts), expansions, replacements, long term
- includes expenditures whose returns are expected to last beyond one year
pro forma statement
(hypothetical), projects expected income, expenditures and profit
traditional (incremental, baseline)
uses existing budget as base and projects changes for the ensuing year in relation to the current budget
- usually begins with this year’s expenses plus an inflation factor
zero-based budget (ZBB)
not this year’s expenses plus an inflation factor, instead begins at 0. must justify each expense
fixed budget
prepared at one level of sales or revenue (no expected major change in patient or customer count during the year)
flexible budget
adjusted to various levels of operation with varying levels of sales or revenue throughout the year (changes in patient or customer count)
performance budget
details what it costs to perform an activity (how much to supervise the trayline)
straight line depreciation
value of the equipment (cost) - salvage value / # of years of useful life
differential costs
amount of increase or decrease in cost when you compare alternative choices; difference in costs between two delivery systems
edible portion vs. as purchased prices
raw purchase cost (AP) / cooked edible weight = EP cost/lb.
food costs
most readily controlled item
labor costs
less controllable than food costs
operating costs
12-18% of budget
utilities (electricity), laundry
income statement
profit and loss statement, shows operating results over a period of time (dynamic)
presents the income (revenue), expenses and profit over the course of the budget period
analyzes operational effectiveness
balance sheet
shows financial condition as of a particular date (static)
- lists assets (goods and products owned) - cash, inventory, accounts receivable (amounts owed to you)
- lists liabilities - amounts owed to others
- assets = liabilities + capital (equity)
- quick way to view financial condition
liquidity ratios
assess ability to meet short term debt (pay bills when due)
- current assets and current liabilities
net worth ratios
assess ability to meet long term debt, solvency
- total assets and total liabilities; debt to asset ratio
turnover ratios
- asset management - shows current effectiveness of inventory control
- inventory turnover rate = cost of sales (food costs or COGS) / average inventory cost
- high ratio indicate a limited inventory is being kept
- low ratios indicate large amounts of money are tied up in stock
- 2-4 times per month is desirable
daily food cost report / food cost percentage
daily food cost / daily income = food cost percentage
food cost per meal
food cost per month / # meals per month
food cost = beginning inventory minus ending inventory, plus food purchases
profit margin
financial efficiency;
net profit (profit after ALL expenses have been paid) / sales dollars (revenue)
cost of sales
cost of the raw food and bev sold COGS
gross profit
profit shown after deducting raw food and beverage (cost of sales) from sales (revenue)
net profit
profit shown after ALL expenses have been deducted from sales
payback period
- determines the length of time it will take for the cash inflows from a project to equal the initial cash outlay
- add up the costs of the service
- add up costs saved by using the new service
- divide costs of service by dollars saved
marketing process first step
identify a need that is not being filled (market niche)
market segmentation
divide market into groups of people with similar product needs
demographic variables
age, gender, race, education, income
geographic variables
urban, suburban, climate, resources, cultural values
psychographic
social class, lifestyle, motive
innovators
high income, high self-esteem
makers
lower income, focus on self-sufficiency, family-oriented
achievers
successful individuals, higher incomes
experiencers
young, impulsive, variety seekers
behavioristic
occasions, loyalty, purchase volume
positioning statement
how you would like the marketplace to view your product
marketing mix - product
a good, a service, an idea
- signature brands refer to unique items your business has developed
marketing mix - place
where it is offered
marketing mix - price
amount that is offered
marketing mix - promotion
to increase or renew awareness, short term
publicity, news releases
direct mail packages
paid aids
public visability
breakeven point
BE = Fixed costs / selling price - variable costs
breakeven point in sales volume
BE = Fixed costs / 1 - (variable costs / sales)
factor pricing method, traditional method, markup method
- 100/food cost percentage = markup factor
- markup factor x raw food cost = selling price
- hidden costs of 10% may be added to food cost to cover unproductive costs (losses in preparation, etc.)
prime cost method
- determine prime cost: raw food cost + direct labor cost
- determine price factor (markup)
- add desired food cost percentage to percentage of direct labor cost
- divide total into 100
- selling price = prime cost x price factor (markup factor)
loss leaders
items priced lower to draw people in in the hope that they will purchase other items at normal markups
cost of profit pricing
add up all costs (including profit cost) as percentages
- subtract the total from 100% to find the targeted food cost percentage
- to determine the selling price of the item:
-> total food cost / desired food cost percentage
DNV GL healthcare accreditation program
validates Medicare compliance
TJC
the joint commission accredits and certifies healthcare orgs
CMS
centers for medicare and medicaid services
AWV
a wellness visit is provided by ACA affordable care act to medicare beneficiaries.
PPS
prospective payment system
medicare part A
hospital inpatient stays under prospective payment system using predetermined rates for hospital discharges
medicare part B
optional insurance for supplementary benefits
IBT
intensive behavioral therapy: benefit for obese under Medicare part B. coverage is granted only in primary care setting. bmi must be >30, continued treatment contigent on wt loss assessed at the 7th month of treatment
medicaid
federal law administered by states, payment for medical care for all eligible needy: all ages, blind, disabled, dependent children
ACA
patient protection and affordable care act: opportunities to provide MNT under benefit category “preventive and wellness services”
CHIP
children’s health insurance program under the SSA is a partnership between federal and state govs expanding health coverage to uninsured children whose families earn too much income to qualify for medicaid but too little to afford private coverage
PCMH
patient centered medical home
focuses on the relationship between the patient and their personal physician. THe RDN should be considered part of the medical home treatment plan
ACO
accountable care org
is a healthcare org that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the US are formed from a group of coordinated health-care practitioners
APM
an alternative payment model is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population
ICD-10-CM
international classification of diseases 10th revision, clinical modification describes an individual’s disease or medical condition
- codes for malnutrition E43-E46
CPT
codes current procedural terminology: five digits that describe the services rendered. MNT codes 97802, 97803, 97804 are used to report RDN provided services
CMS 1500 form
submit noninstitutional claims to medicare/medicaid for healthcare services
cost benefit
determines whether the goal of the intervention is worthwhile in terms of cost
the value of the benefits derived from the intervention must outweigh the costs of providing the intervention
cost effectiveness
assumes that the goal of the project is worthwhile
the question to resolve is which method of intervention is the most effective in terms of value in achieving the goal. it compares costs of alternative strategies using the results of outcomes research
TQM
total quality management
- focuses on improving organizational processes to increase overall performance & customer satisfaction
- encourages involvement from everyone in the org, including employees in responding to customer needs and finding solutions
- Plan do study act (PDSA) / plan do check act (PDCA)
CQI
continuous quality improvement
- component of TQM that specifically focuses on data collection and process improvement
- assumes performance and processes can always get better
rate-based indicator
comparative rate indicator
- what will happen with the BEST care, thresholds between 1% and 99%
example: 95% high risk patients are assessed within 24 hrs
sentinel event indicator
is a serious event that requires further investigation each time it occurs; undesirable but avoidable events
- threshold of either 0% of 100% (never or always)
example: 100% oncology patients are fed within 5 days
effectiveness
refers to the degree to which an exchange helps to achieve your objectives (doing the right thing)
efficiency
refers to the minimization of resources you must spend to achieve that desired level of exchange (doing things right)
six sigma
data driven approach for improving quality by removing defects and their causes
DIMAC approach - define, improve, measure, analyze, control
little variation in a process
kaizen philosophy
good change suggests making continuous and small incremental improvements in process on a daily basis, rather than large revolutionary changes.
focuses on teamwork, discipline, improved morale, quality circles and suggestions for improvements
lean method
use less human effort, less space, less capital and less time to make products exactly as the customer wants with few defects
SOP
standards of practice - describes in general terms a competent level of nutrition care practice as shown by the NCP (problem-solving method used to think critically and make decisions to provide safe, effective, high-quality nutrition care). for those working in direct pt care.
SOPP
standards of professional performance - describes a competent level of behavior in the professional role
- provision of service, application of research, communication and application of knowledge, utilization and management of resources, quality in practice, competency and accoutability
code of ethics - non-maleficence
competence and professional development in practice: intent to not inflict harm
code of ethics - autonomy
integrity in personal and organizational behaviors and practice
code of ethics - beneficence
professionalism: take positive steps to benefit others; participate in and contribute to decisions that affect the well-being of patients/clients
code of ethics - justice
supports fair, equitable and appropriate treatment for individuals and fair allocation of resources
FOCUS - PDCA
In the FOCUS-PDCA model for performance improvement, F represents finding an area to improve.
F = Find an improvement area
O = Organize a team
C = Clarify current practices
U = Understand source of variation/problem
S = Select a strategy
PDCA = Plan Do Check Act
