Organisation and management of healthcare and healthcare programmes

Question 1

What are Belbin’s eight (9) roles for an effective team?

Answer 1

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

Question 2

Tuckman and Jenson stages of team development

Answer 2

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

Question 3

Handy’s traits of an ideal team

Answer 3

1978

Organisation -
clear objectives and tasks

Members-
Know their role

Teamwork -
Supportive of each other, complementary skills, commitment

Leadership -
coordinates and takes responsibility

Question 4

Groupthink

Answer 4

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

Question 5

Advantages and disadvantages to inter professional training

Answer 5

+ 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

Question 6

Ways to improve self awareness

Answer 6

Appraisal, Myers briggs type indicator, reflective practice, action learning activities.

Question 7

Conflict

Answer 7

Difficult situations
Personality clashes
Inappropriate behaviour
External factors

Question 8

Jessop’s meeitng activities

Answer 8

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

Question 9

Management by wondering around

Answer 9

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

Question 10

Management by objective

Answer 10

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

Question 11

Dimensions of communication in management: Formality

Answer 11

Formal :
Official communication

Informal: Information based among discussions with colleagues

Question 12

Dimensions of communication in management: Direction

Answer 12

Diagonal: No obvious line of authority

Vertical: From decision makers down to front line workers e.g policy, strategy

Question 13

Dimensions of communication in management: Method

Answer 13

Verbal : spoken or written
- Oral
- Written

Non verbal

Question 14

Fundamental principles of negotiation

Answer 14

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.

Question 15

Manifestations of authority

Answer 15

Weber 1958

Traditional authority- derived from preserved customs

Charismatic authority - from personality and leadership

rational - legal - from powers of bureaucracy

Question 16

Inter organisational relationships

Answer 16

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

Question 17

Motivation theories: Maslow

Answer 17

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

Question 18

Motivation theories: Hertzberg

Answer 18

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

Question 19

McGregor’s X & Y theory

Answer 19

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.

Question 20

Name 4 theories of change management

Answer 20

Lewin’s force field analysis,
Gleichers formula for change,
Roger’s innovation adoption curve, ADKAR

Question 21

Discuss Lewin’s force field analysis

Answer 21

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.

Question 22

Discuss stakeholder analysis

Answer 22

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

Question 23

Discuss Gleicher’s formula for change

Answer 23

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.

Question 24

Discuss Rogers innovative adoption curve

Answer 24

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.

Question 25

Name 3 management/ project management tools

Answer 25

SWOT analysis, McKinseys 7s, Stakeholder analysis, PESTELI

Question 26

Discuss SWOT analysis

Answer 26

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.

Question 27

Discuss McKinsey’s 7s

Answer 27

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

Question 28

Discuss PESTELI analysis

Answer 28

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

Question 29

Theories and models of leadership

Answer 29

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.

Question 30

ADKAR

Answer 30

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.

Question 31

Performance mamagement

Answer 31

Ensures the aims of the organisation are being achieved.

Question 32

Policy

Answer 32

Vision of goals and objectives e.g EU health policy protecting people from threats of disease promote health lifestyles

Question 33

Strategy

Answer 33

How policy will be implemented e.g EU health strategy health promotion for older people, actions on tobacco, new guidelines for cancer screening ...

Question 34

Principles of policy making

Answer 34

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.

Question 35

Steps to delivering policy

Answer 35

Agenda setting Policy formulation- review possible proposals, HIA, Assess barriers, Discuss with stakeholders Implementation- Strategic action Evaluate

Question 36

RE- AIM

Answer 36

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

Question 37

Challenges to policy evaluation

Answer 37

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

Question 38

Problems of policy implementation

Answer 38

Direct resistance Incomplete accomplishment Policy adaptations

Question 39

Define strategic decisions

Answer 39

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

Question 40

Approaches to strategic planning : Four step model

Answer 40

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.

Question 41

Policy analysis: Stages heuristic

Answer 41

Lasswell 1956 Agenda setting, formulation, implementation, evaluation. - Too linear

Question 42

Policy analysis: Policy triangle

Answer 42

Walt and Gilson 1994 Considers impact of actors, context and process & how these interact in the policy

Question 43

Drivers of change in health services

Answer 43

Technology advances New information flows, National policy, public perception

Question 44

Single registration

Answer 44

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.

Question 45

Healthcare systems: Australia

Answer 45

Universal free healthcare for all £ Public insurance- reimburses 80% of costs Self employed GPs Public hospitals

Question 46

Healthcare systems: Canada

Answer 46

Public funding with private providers. Regulated by royal colleges and provincial governments £ National health insurance GP Fee for service Not for profit private hospitals

Question 47

Healthcare systems: France

Answer 47

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

Question 48

Healthcare systems: Germany

Answer 48

90% covered by statutory health insurance £ tax and social insurance Free access to office based doctors (general and speciality) Outpatient doctors as gatekeepers

Question 49

Healthcare systems: USA

Answer 49

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

Question 50

Healthcare systems: NZ

Answer 50

Mostly general taxation Primary- co payments Secondary- Taxation, mostly public

Question 51

Healthcare systems: HK

Answer 51

General taxation, mixture of public and private. Primary care 75% private practitioners Secondary care- 85% public hospitals

Question 52

Clinical guidelines

Answer 52

Define clinical care that is suitable for most patients Exercise that assesses cost effectiveness of care

Question 53

Quality standards

Answer 53

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.

Question 54

Steps in the development of guidelines

Answer 54

- Define the issue - Establish working group - Identify existing guidance - Appraise existing guidance - Adapt guidance - Pilot and review - Disseminate and implement - Monitor impact

Question 55

Principles underlying development of NICE guidance

Answer 55

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

Question 56

AGREE criteria

Answer 56

Appraising clinical guidelines Scope and purpose Stakeholder involvement Rigour in development Clarity and presentation Applicability Editorial independence

Question 57

Clinical governance

Answer 57

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

Question 58

Regulatory bodies

Answer 58

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

Question 59

Fifth report of the Shipman enquiry

Answer 59

Recommendations to modernise regulation - Align organisation wide professional regulation - Strengthen revalidation - Support safe expansion of professional roles in contact with patients

Question 60

Approaches to budget setting in healthcare : Historical/ incremental

Answer 60

Based on previous year, adjusted for inflation + Easy to apply + Good when services haven't changed - Dosen't facilitate innovation

Question 61

Approaches to budget setting in healthcare : Zero based

Answer 61

Fresh financial plan, req re evaluating all services/contracts + Useful for new services - Time consuming

Question 62

Approaches to budget setting in healthcare : Activity based

Answer 62

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

Question 63

Programme budgeting marginal analysis

Answer 63

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

Question 64

Payment methods in healthcare: Block budget

Answer 64

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

Question 65

Payment methods in healthcare: Capitation

Answer 65

Risk adjusted periodic payment per patient + More investment in preventative care + Limits healthcare activity - Less responsive

Question 66

Payment methods in healthcare: Resource group

Answer 66

Payment for grouped services e.g diagnostic serves group + More responsive to needs - Less investment in non reimbursed preventative care - Increases activity

Question 67

Payment methods in healthcare: Fee for service

Answer 67

Payment for each item. + More responsive - Less investment in non reimbursed preventative care - Increases activity

Question 68

Principles of commissioning

Answer 68

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

Question 69

Benefits of risk pooling and specialised commissioning

Answer 69

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

Question 70

Functional organisational structure

Answer 70

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

Question 71

Project organisational structures

Answer 71

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

Question 72

Matrix organisational structure

Answer 72

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

Question 73

Power vs Authority

Answer 73

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.