Organisations and management Flashcards
benefits of targets
need to be SMART
can measure progress - accountability, audits
can align personal objectives with targets
benchmarking
attach to financial incentives schemes
identify outliers
share best practice
drives efficiency and quality
focus the system on common goals
inform service improvements and resource allocation
disadvantages of targets
risk other areas being deprioritised
masks complexity
can mask clinical priorities - e.g. prioritising patients based on wait time not need
perverse incentives - gaming/cherry picking
under or overtreatment
compromise quality of care
demoralising if not met
need buy in from staff
some aspects of care are hard to measure
reporting requirements
example of a target
elective care: 2% of patients waiting for planned treatment should be seen within 18 weeks of being referred from GP services to hospital treatment by 2029.
Motivation theories
Herzberg hygiene-motivation theory
Maslow’s hierarchy of needs
McGregor’s x and y theory
Maslow’s hierarchy of needs
Maslow’s theory states that our actions are motivated by certain physiological and psychological needs that progress from basic to complex. People are motivated to fulfil basic needs before advancing to the next level.
Biological & physical needs
Safety needs
Belongingness and love needs
Esteem needs
Self-actualisation
strategy vs policy
strategy = a high level plan designed to achieve a goal
policy = a set of measures or principles which seek to achieve a goal - fixed rules which guide decision making
nuffield ladder (8)
eliminate choice
restrict choice
guide choice through disincentives
guide choice through incentives
change the default
enable choice
provide information
do nothing
Authority
is legitimized power – a voluntary submission to authority (Weber)
o conceptualized by Weber in the 1940s
o tradition
o rational-legal authority (position power)
o charisma (personal power)
o pure rational authority (expertness)
Power
- a much broader concept than authority
- is possession of controlling influence or ability to make things happen
- may refer to non-legitimized authority
- is the capacity to overcome resistance
- may be subtle or overt within a group or organisation
- French and Raven in 1986 also identified (in addition to the above) different power
types:
o Resource or reward power, e.g. granting or withholding high grades by professors
o Coercive power, the power to punish, e.g. firing a staff
o Negative power, capacity to stop things happening
position power
personal power
specialist power
health care funding models and considerations
beveridge (taxation)
social insurance/bismarck
private insurance
mixed
OOPP
considerations:
- incentives to control spending
- justice/equity
- admin and costs of running
- data
- choice
- access
- information asymmetry
-quality, responsiveness and efficiency
- input of government - political influence
General taxation example
UK
taxes raised from whole population to pay
seeks to pool risk
public providers - minimal private
UHC
providers funded by public system via ICBs
Private insurance model
US
focus on individualism rather than collective
indivudals (or their employers on their behalf) take out private insurance
some publicly funded insurance schemes e.g. for the unemployed and elderly
Private providers - reimbursed by insurance companies
some co-payments for patients
not UHC
regressive model
Bismarck model
France
employees and employers pay contributions to a fund to cover a defined package of services
government provides schemes for uninsured
some copayments
gov can raise additional funds e.g. through polluter pays policies
unlike private insurance model - the contribution is not related to the individual’s risk
motivation theories
Maslow’s hierarchy of needs
self actualisation
self esteem
love and relationships
safety
physical
How teams are formed and what makes and effective team
Tuckmans stages - forming, storming, norming, performing, adjourning
Belbin’s roles - SIC CTR PMS
lencioni five dysfunctions of a team:
focus on results, hold each other accountable, commitment, resolve conflict (avoid group think), build trust
Goleman’s 6 leadership styles
commanding (do what I say)
visionary (come with me)
pacesetting (do as I do, now)
coaching (try this)
democratic (how should we do this)
Affiliative (people come first)
CVPCDA
three rules of delegation
manager and employee must be confident that
employee understands that task
employee has the skills needed
the manager will provide feedback
outcomes of negotiation matrix
degree of assertiveness vs degree of cooperation
win lose
win win
lose lose
lose win
compromising
what are the three components of an organisation
structure
people working together
common goals
frameworks for where are we now?
SWOT / PESTLE
McKinsey 7s
5 whys/root cause
stakeholder analysis
formula for change - D * V * F > R
McKinsey 7 S
shared values
systems
structure
strategy
staff
style
skills
where do we want to go frameworks
vision review
SMART targets
how do we get there frameworks
Motivation of employees - Maslow’s needs
diffusion of innovation
ADKAR
Lewin - unfreeze, change, re-freeze
PDSA for smaller processes
stakeholder management
how will we know when we’ve got there frameworks
REAIM (for policy)
Maxwell’s EEE AAA
Logic model
KPIs
Policy formation frameworks
Lewes and Simmnet 5 approaches (medical, behavioural, educational, empowerment, societal)
Nuffield ladder
Policy triangle - for policy development
policy context
policy content
process
actors
Policy streams - for policy development
problem stream
solutions stream
politics stream
all three need to align for change to happen
Framework for persuasive comms
monroe’s motivated sequence:
grab attention
establish the need
satisfy the need
visulise the future
take actions
Belbins roles
Shaper
Implementer
Completer finisher
Coordinator
Teamworker
Resource investigator
Plant/problem solver
Monitor-evaluator
Specialist
symptoms of groupthink
illusions of unanimity, unquestioned beliefs, rationalization, stereotyping, “mindguards,” illusions of invulnerability, and direct pressure on opposing views.
Handy’s ideal traits of a team (MOLT)
organisation (clear purpose and objectives),
members (specific expertise, know their roles),
teamwork (mutual support),
leadership (coordinates and takes responsibility)
performance management cycle
planning, monitoring, reviewing, rewarding
7 pillars of clinical governance
Clinical effectiveness
Risk management
Audit
Patient centered and safety
Information management
Education and training
Staff
clinical audit stages
identify the topic / re-audit
identify the relevant standards
collect the data
anlayse the data
make recommendations
implement the change
e.g. HIV late diagnosis audit
adair action centred leadership model
three overlapping areas of leadership responsibility:
1. Task– Achieving the goal and getting the job done.
2. Team – Building and maintaining team cohesion.
3. Individual – Supporting and developing each team member.
A good leader balances all three areas to ensure effectiveness.
simple and practical
Flexible – Works across different industries and team structures.
Team-oriented – Encourages collaboration and individual growth.
Cons:
Lacks depth on emotional intelligence – Doesn’t fully address personal leadership traits.
Situational factors not emphasized – Doesn’t adapt as explicitly to different environments.
Assumes equal weight on all three areas
Policy cycle
A PIE
Agenda setting - whats the problem
Policy formation - options, stakeholders, evidence
implementation - interpretation, organisation, application
evaluation
types of change
magnitude (incremental or transformational) and origin (spontaneous, emergent, deliberate)
Programme budgeting
Programme budgeting considers how a budget is or should be spent
across programmes and takes into account the objectives/goals and outcomes achieved. It gives details of
all the activities that take place within a given budget
innovation - what is it, process, ways to encourage
ability to generate and execute creative ideas - viable solutions
input (ideas) -> process -> output (innovation)
requires: motivation, expertise, flexible thinking
ways to encourage: brainstorming, culture, team away days, funds and schemes to support scaling up (NHS accelerated access collaborative), management by objectives, reduce group think and fear of change
ways to increase spread of an idea: advantageous, interoperable, simple, can be trialed, visibly more effective
personal management skills
time management (prioritisation matrix of importance and urgency), self awareness (myers briggs, reflection), stress management, difficult people,
