Organisation and management of healthcare and healthcare programmes Flashcards
What are Belbin’s eight (9) roles for an effective team?
ICE FIRST + S
Implementer - makes things happen, deliver on time.
Co ordinator/chair- step back to see bigger picture
Evaluator - observes and monitors, even handed. Might struggled to be inspired
Finisher- perfectionists, may frustrate team mates
Innovator- unusual solutions
Resource investigator - networker, loose momentum towards the end of a project
Shaper - eager, provoke action, may be insensitive
Team worker- Good listener and diplomat, smooth over conflicts
Specialist- high level of skill
Tuckman and Jenson stages of team development
Forming - tasks and rules established, resources acquired. Reliance on team lead
Storming - internal conflict
Norming - co operation develops, views exchanged, norms developed
Performing - teamwork achieved, flexible roles developed,
Adjourning - team disbanded
Handy’s traits of an ideal team
1978
Organisation -
clear objectives and tasks
Members-
Know their role
Teamwork -
Supportive of each other, complementary skills, commitment
Leadership -
coordinates and takes responsibility
Groupthink
Concept where teams avoid conflict by forgoing critical discussions in order to agree.
Symptoms of groupthink:
Overestimation of groups power & morality
- illusions of invulnerability
- Unquestioned belief
Closed minded ness
- collective rationalisation
- stereotyping
Pressure towards uniformity
- self censorship
- Illusions of unanimity
- pressure for conformity but others
- mind guards
Advantages and disadvantages to inter professional training
+ Improved communication between different professions
+ Reduced formation of silos
+ Promotes debate by increasing awareness of other positions
+ Improves teamwork through appreciation of other staffs work
+ Improves patient care through patient centred rather than professional structured care
+ Enhances capacity by expanding roles as required for the team.
- undermine peer support by reducing traditional professional networks
- Costly to configure training
Ways to improve self awareness
Appraisal, Myers briggs type indicator, reflective practice, action learning activities.
Conflict
Difficult situations
Personality clashes
Inappropriate behaviour
External factors
Jessop’s meeitng activities
Before
- Know your aims
- Know your attendees aims
- Know the benefits rather than details of ideas/proposals
- Build relationships
- Consider timing, venue and agenda for the meeting
During
- Listen first
- Appropriate language
- Realise when objectives have been achieved
- Use summery statements
After
- Follow through on tasks
- Send out minutes and action points
Management by wondering around
Set aside time to walk through departments and have discussions with employees
Listen to concerns, explain any new ideas/changes, and offer assistance as required
Management by objective
Delegate through setting goals not tasks
+ Managers avoid becoming too engrossed in day to day events
+ all employees participate in the planning process
+ Performance can be measured against objectives
Dimensions of communication in management: Formality
Formal :
Official communication
Informal: Information based among discussions with colleagues
Dimensions of communication in management: Direction
Diagonal: No obvious line of authority
Vertical: From decision makers down to front line workers e.g policy, strategy
Dimensions of communication in management: Method
Verbal : spoken or written
- Oral
- Written
Non verbal
Fundamental principles of negotiation
Fisher and Ury
Separate the people from the problem: Problems arise from motion, communication and people. Frame the problem first ensuring both groups are involved.
Focus on interests not positions: interest are what people want, positions are how they hope to achieve it.
Invent options for mutual gain
Insist on objective criteria: use 3rd party precedents or guidance to understand what is fair in that situation.
Manifestations of authority
Weber 1958
Traditional authority- derived from preserved customs
Charismatic authority - from personality and leadership
rational - legal - from powers of bureaucracy
Inter organisational relationships
Barringer and Harrison 2000
Joint ventures - 2+ orgs join resources into a new venture.
+ Economies of scale
+ quicker launch
Networks- Collections of orgs that have joint projects on an informal basis
+Can use Hub and spoke model
Consortia- Orgs with a common need come to gather to make a new entity that satisfies this need. E.g HR consortium across LAs
Alliances - Arrangements between orgs that establish a relationship. Often informal and short term
Interlocking directorates - Exec of one org sits on board of another.
+spread innovation and co operation
Motivation theories: Maslow
Hierarchy of human need
Humans motivated by higher levels of need only after lower levels have been satisfied. Workers need some/all of the levels.
Physiology- Basic needs, pay
Safety- pensions, substantive contract
Love/belonging- Supportive manager, professional associations
Self esteem- Job title, appraisals
Self actualisation- Promotion, opportunity
+ Identifies individuals who fail to process to higher levels
+highlights how basic problems can inhibit motivation e.g office heat
+ Intuitive
- Individualistic
- No consideration of altruism
- Some argue that needs can be simultaneous
Motivation theories: Hertzberg
Motivator-hygiene theory
Some work place factors lead to satisfaction, while others lead to dissatisfaction. Factors are categorised into motivators, and hygiene factors. where hygiene factors aren’t positive but their absence is negative.
Motivators:
Varied work, responsibility, recognition, promotion, growth, achievement,
Hygiene:
pay, working conditions, Job security, policy, team dynamics, supervision, personal life
+ direct focus on employees motivation
+ solvable problems
+ not entirely focussed on pay
- doesn’t focus on external factors
- not necessarily linked to efficiency
- doesn’t really consider different cultural backgrounds to motivators
McGregor’s X & Y theory
Builds on Maslow. Simplified, extreme, managerial attitudes towards workers and their motivations.
Theory X - carrot and stick. Direction comes from central controlling authority. Top down.
Assumes- Employees lazy, dislike work. Avoid responsibility, punishment is strategy, safety is driver.
Theory Y - organisational and individual goals are integrated. Bottom up.
Assumes- Employees see work as important, seek and accept responsibility, strategy is seeking commitment to objectives/maximise employees capabilities, self esteem/self actualisation is driver.
Each has pros and cons depending on the team.
Name 4 theories of change management
Lewin’s force field analysis,
Gleichers formula for change,
Roger’s innovation adoption curve, ADKAR
Discuss Lewin’s force field analysis
The status quo will change when the driving forces are greater than resisting forces. E.g strengthen driving forces, or weaken resisting forces.
Driving forces include: government interventions, research, new innovation, environmental pressure, user demand, dissatisfaction.
Resisting forces: fear of change, lack of motivation, last of information, cost, lack of time, internal politics, poor leadership, lack of clear benefit, disruption.
Helps to identify obstacles, and understanding of the topic.
Can miss aspects unless all areas/groups are researched, analysis showing restrictions may have negative effects on teams/management systems.
Discuss stakeholder analysis
Identify stakeholders
Assess their degree of interest/position
Estimate their reaction to change based on ideology, strategic and financial interests
Assess power- capacity to influence policy.
Obstacles to engaging stakeholders-
Hidden agendas, Limited access, Competing priorities, Ignorance
Discuss Gleicher’s formula for change
Three factors required for change to occur:
- Dissatisfaction with the status quo
- Vision for future possibility
- First steps in the direction of the vision
And the product of these must be greater than Resistance.
Change = DxVxF > R
If any of DVF are very low (0) it is hard to make the product greater than R. Must all be present.
Discuss Rogers innovative adoption curve
Classifies adopters on innovation into groups.
Innovators: people pulling change
Early adopters: opinion leaders but cautious
Early majority: careful but accepting of change above average
Late adopters: skeptics, but will follow new ideas with the majority
Laggards: critical towards new ideas and only accepting once mainstream
Suggest to target innovators/early adapters first. Not to try to convince masses
Can be adapted to many settings,
Individual blame bias - doesn’t take into account the system around individual decisions. Socio economic distribution of innovators and where innovation spread.
Name 3 management/ project management tools
SWOT analysis, McKinseys 7s, Stakeholder analysis, PESTELI
Discuss SWOT analysis
List and consider:
Strengths,
Weaknesses
Opportunities
Threats
+Widely used across the UK,
+ internal and external factors, +simple and low cost.
-Too many and too general factors listed.
- Sometimes meaningless ideas considered
- As such not always implemented
- Focus on process rather than outcomes.
Discuss McKinsey’s 7s
Identifies strengths and weaknesses of an organisation as 7S
Shared values
Strategy
Structure
Systems
Style
Staff
Skills
Beneficial for identifying internal factors. No consideration of external factors and should feed into SWOT
Discuss PESTELI analysis
Tool used to identify external opportunities and threats
Demographics
Epi
Politics
Economics
Sociology
Technology
Ecological
Legislation
Industry analysis
Only external factors and need to be considered along side internal factors
Theories and models of leadership
Participative theory - MBWA, Likert.
Contingency- style depends on context. Blake managerial grid.
Instrumental theory- depends on leaders behaviour patterns
Charismatic theory- leader is charismatic
VMC model- leaders have Vision, Management skills, and commitment.
ADKAR
Staff need to go through these steps for successful change:
Awareness- staff know why change is required
Desire- support change. know benefits, issues addressed
Knowledge - How to change. Training
Ability: to change. Training, protocols
Reinforcement: to sustain change. encouraging, feedback, incentives.
Performance mamagement
Ensures the aims of the organisation are being achieved.
Policy
Vision of goals and objectives
e.g EU health policy
protecting people from threats of disease
promote health lifestyles
Strategy
How policy will be implemented
e.g EU health strategy
health promotion for older people, actions on tobacco, new guidelines for cancer screening …
Principles of policy making
Clear shared goals- MDT approach, clear what aiming to achieve
Involve stakeholders
Minimise burdens- appraise benefits and costs and seek to minimise burdens
Plan for contingencies- consider other factors, other policy/events
Learn from experience- e.g other countries, research, use pilots, evaluate and continuous process.
Steps to delivering policy
Agenda setting
Policy formulation- review possible proposals, HIA, Assess barriers, Discuss with stakeholders
Implementation- Strategic action
Evaluate
RE- AIM
Framework for evaluating policy
Reach- uptake/participation measures
Efficacy- Positive and negative outcomes
Adoption- what proportion of sites adopted the policy?
Implementation- was it delivered as intended?
Maintenance- enforcement over time
Challenges to policy evaluation
Definition- policies change over time so agreeing the exact aim to evaluate against is hard
Resources
Timeline
Sequencing- ideally plan evaluation before implementation. designate control group
Problems of policy implementation
Direct resistance
Incomplete accomplishment
Policy adaptations
Define strategic decisions
Decisions that:
- Define the institutions relationship with the environment
- Important to the whole organisation
- Depend on inputs from several areas
- Affect the administration and operation of the entire institution
Approaches to strategic planning : Four step model
Analysis of current situation - HNA, benchmarking, McKinsey’s 7S, DEPESTELI, SWOT, Stakeholder analysis
Set further direction- Review of vision/aims, SMART targets
Appraise how to get from step 1 to 2. Results of HNA, economic evaluation, Review evidence, review management methods.
Evaluate- KPIs, PDSA, Evaluation/monitoring.
Policy analysis: Stages heuristic
Lasswell 1956
Agenda setting, formulation, implementation, evaluation.
- Too linear
Policy analysis: Policy triangle
Walt and Gilson 1994
Considers impact of actors, context and process & how these interact in the policy
Drivers of change in health services
Technology advances
New information flows, National policy, public perception
Single registration
Patients can only be registered with one GP
+ Single gate keeper- avoids over investigations
+ Continuity
+ Single person receives correspondence
- Less consumer choice
- Conflict of interest: GP caring for one patine but needs to consider impacts on all patients.
Healthcare systems: Australia
Universal free healthcare for all
£ Public insurance- reimburses 80% of costs
Self employed GPs
Public hospitals
Healthcare systems: Canada
Public funding with private providers. Regulated by royal colleges and provincial governments
£ National health insurance
GP Fee for service
Not for profit private hospitals
Healthcare systems: France
Private and public hospitals
£ National insurance, tax and social insurance. Citizens also use private insurance
No gatekeeping GP
IP public and private hospitals
OP private specialists
Healthcare systems: Germany
90% covered by statutory health insurance
£ tax and social insurance
Free access to office based doctors (general and speciality)
Outpatient doctors as gatekeepers
Healthcare systems: USA
Private organisations. Gov funded through insurance for >65s + CKD, low income, veterans and children.
£ private insurance, many people not insured
No gatekeeping GPs
private, public and not for profit hospitals
Healthcare systems: NZ
Mostly general taxation
Primary- co payments
Secondary- Taxation, mostly public
Healthcare systems: HK
General taxation, mixture of public and private.
Primary care 75% private practitioners
Secondary care- 85% public hospitals
Clinical guidelines
Define clinical care that is suitable for most patients
Exercise that assesses cost effectiveness of care
Quality standards
Clarify what represents high quality care, and how to achieve it.
Measure and improve quality of care, multiple stakeholders, consensus on approach to delivering quality care.
Steps in the development of guidelines
- Define the issue
- Establish working group
- Identify existing guidance
- Appraise existing guidance
- Adapt guidance
- Pilot and review
- Disseminate and implement
- Monitor impact
Principles underlying development of NICE guidance
Aim- improve patient care
Consultation- Take account of key view points e.g healthcare professionals, patients and groups, managers, Public, Government & NGOs, industry
Appraise evidence
Use a standard process to develop the guidance
Transparency
Status- advisory not compulsory
AGREE criteria
Appraising clinical guidelines
Scope and purpose
Stakeholder involvement
Rigour in development
Clarity and presentation
Applicability
Editorial independence
Clinical governance
Defined as:
‘a framework through which NHS organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’
A first class service: Quality in the new NHS 1998
Good systems improve clinical care. E.g good incident reporting system
Regulatory bodies
E.g GMC, NMC, GDC, Royal colleges,
Role:
- Maintain register
- States how competencies are maintained & maintain evidence of competence
- Holds hearings/ reviews misconduct
- Overseen by Council for Healthcare Excellence
Fifth report of the Shipman enquiry
Recommendations to modernise regulation
- Align organisation wide professional regulation
- Strengthen revalidation
- Support safe expansion of professional roles in contact with patients
Approaches to budget setting in healthcare : Historical/ incremental
Based on previous year, adjusted for inflation
+ Easy to apply
+ Good when services haven’t changed
- Dosen’t facilitate innovation
Approaches to budget setting in healthcare : Zero based
Fresh financial plan, req re evaluating all services/contracts
+ Useful for new services
- Time consuming
Approaches to budget setting in healthcare : Activity based
Budget for a defined activity, including info on budget with changing activity levels
+ Pay providers based on activity levels
- Req detailed data and understanding of costs
Programme budgeting marginal analysis
Programme budgeting - analysing how money is spent across specialities
Marginal analysis- assessment of impact (costs and benefits) of incremental changes in inputs
- Choose programmes
- Identify activity and expenditure
- Consider improvements
- Weight up costs and benefits
- Consult widely
- Decide on changes
- Effect changes
- Evaluate
Payment methods in healthcare: Block budget
periodic lump sum for all services provided e.g a salary
+ More investment in preventative care
+ Limits healthcare activity
+ Risk sharing between organisations
- Less responsive
- Can cause perverse incentives
Payment methods in healthcare: Capitation
Risk adjusted periodic payment per patient
+ More investment in preventative care
+ Limits healthcare activity
- Less responsive
Payment methods in healthcare: Resource group
Payment for grouped services e.g diagnostic serves group
+ More responsive to needs
- Less investment in non reimbursed preventative care
- Increases activity
Payment methods in healthcare: Fee for service
Payment for each item.
+ More responsive
- Less investment in non reimbursed preventative care
- Increases activity
Principles of commissioning
Population needs: HNA
Local service gaps: Evaluations
Equity: Health equity audit, equity impact assessments
Evidenced based: lit review
Partnerships: Change management analysis
Value for money: economic evaluation
Benefits of risk pooling and specialised commissioning
Improving access to rarer services for patients
Restrict specialist centres to maintain high level of expertise
Smooth risk volatility for commissioners
Cash flow for rare and expensive services
Focus point for discussion about pacifist services
Functional organisational structure
Grouping professionals based on the functions they perform e.g HR
+ high competence
+ cross cover during absence
+ shared professional identity
+ clear lines of accountability
- inhibits horizontal communication/working
- potential for conflict
- reduced problem solving capacity
- problems are often more complex, not bound by one function
Project organisational structures
Teams are designed around achieving shared aims/ a project
+ clear accountability
+ MDT
+ good training
+ common project manager can more easily resolve conflict between specialities
- may be more competition for resources
- less in depth specialist expertise
- projects are time limited and staff could be lost at the end of the project
Matrix organisational structure
Combination of project and functional structures. Dual line of authority
+ use of specialists
+ flexible resources
+ collaborative working
+ useful in larger/complex organisations where communication is key
+ can be used between organisations
- role/authority ambiguity
- potential for conflict
- not always good for accountability
- making the team work well take time and commitment to communication, accountability, role allocation etc
Power vs Authority
Power- persons capacity to influence others. Through 5 domains (french and raven) Legitimate (same as authority), reward, expert, respect, coercion
Authority- legitimacy of power. appointed or elected right to power.
