Planned change Flashcards
What are 21st center health organizations focused on?
Restructuring
Quality Improvement
Employee Retention
What is planned change vs accidental or change by drift?
Planned change is well thought out
How do managers think of change?
Managers embrace the status quo
How do leaders feel about change?
Leaders embrace the change
3 good reasons for change
Change to solve some problem
Make procedures more efficient
Reduce workload
What is a change agent?
What qualities will they have?
Person skilled in the theory of implantation and planned change - and they typically have skills in how to make changes
Visionary, risk taker, flexible, communication skills, creative, sensitive, current
Kurt Lewin’s Chang theory
Unfreeze
Change
Refreeze
Lewin’s driving forces
Force that pushes the system towards change
ex: wanting to advance career
Lewin’s restraining forces
Pull the system away from change; ex: the cost
Lewin’s four rules for change
- change should be for good reasons
- it should be gradual
- plan it out
- involve everyone involved
Rational empirical strategies
Used best with least resistance bc people can see that it is reasonable/rational
we will change once given factual info
Normative-Re-educative strategy
Assumes we are social beings so they utilize peer pressure and norms
Power-Coercive strategy
Assumes we are set in out ways and that we will only change due to being forced or receiving a reward
Should we start a change if early change agent isn’t available?
No we shouldn’t. We need people to commit and see it through who have influence
How should those making changes expect resistance?
It disrupts homeostasis and so they need to expect it
What does individual resistance depend on
Flexibility
Evaluation of immediate situation
Anticipated consequences of change
Perception of what they lose vs gain
What is the greatest resistance to change by employees tho?
A lack of trust between the employee and the manager of the organization
T/F
It is easier to change a groups mindset than it is one person
false. one persons mindset is easier to change
Which is easier to change : knowledge levels or attitudes
Knowledge levels
What happens if there’s one or two employees that aren’t accepting change?
Their opinion is discarded and we move forward assuming we have the majority of the group on board
How do organizations progress?
They go through developmental changes. Young to old
Describe young organizations
High energy and movement
Constant change and adaptation
Aged organizations have established ______.
Turf boundaries
- predictable rules and orders
What is fiscal planning?
What do we have to consider while doing this?
A learned skill that manages the business side of healthcare
Consider goals and values since those drive your planning
Incremental budgeting
Simple form of budgeting where you budget for needs
- not the best for healthcare
Zero-based budget
Annual budget based that means each year you go back to the zero mark
- must justify why it needs to be there
Flexible budget
Can fluctuate during the budget cycle and its flexible
Performance budget
Budgeting based on performance /outcome
how many patients can we dismiss example
- also not well suited for hospital
Cost -effectiveness
Producing good results for the amount of money spent
consider length of service, the need for it, and alternatives
What is the organizations majority of expenses?
personnel budget - paying employees
Hours per patient day
how many hours of care a patient needs
Components of personnel budget
Hours per patient day
Staffing
Full-time equivalent - a position not person
Productive time - working
Nonproductive time - pto, vacations etc
calculating nursing care hours
nursing hours worked in 24 hrs/patient census
involve rn, cna, unit clerk etc all included in nursing care hours
Second biggest expense of a budget?
Supplies to take care of patients
Operating budget definiton
Reflects expenses that flex up or down in predetermined manner to reflect variation in volume of service load
- what they are operating on day to day
- something you use daily like an IV pump
Capital budget
Plan for the purchase of something big
- MRI machine; equipment w life expectancy of 5 years
- building
- often have to raise money for from donors/grants
- building
In early 1900’s where was healthcare
Went on in the home
What was the birth of the blues?
When blue cross and blue shield insurance
Fee for service
Means payment and it caused healthcare costs to spiral
When did medicare arrive?
What parts?
1965 - Elderly, disabled, and renal dialysis patients
Part A - social security and federal tax; hospital coverage
Part B - subsidized 75% by feds and 25% subscribers ; voluntary
Who supplies medicare part a?
What falls under medicare part a?
Payroll deductions and contributions
Inpatient hospital care, limited skill nursing families, home health, hospice
Will have to pay co-pay
Medicare Part B
Financed from federal funds
Covers primary care, outpatient diagnostics, med supplies
Optional and has premiums 1:36:00
Who receives Medicaid?
Who administers medicaid?
For financial indigent ; you have to qualify
For women and children especially
Administered by the states - each state can set its eligibility and coverage
Managed Care
System that attempts to integrate efficiency of care, access, and cost of care.
It wants us to have primary care provider who assists us in navigating the system.
DRG - Diagnosis Related Groups
Predetermined payment schedule that reflects the historical costs of specific Patient conditions so each medicare patient receives a specific amount of money per admission (regardless of the actual cost)
Critical pathways
Courses of progress that are predetermined for patients diagnosis
Strategy for assessing, implementing, and evaluating the cost-effectiveness of patient care
Utilization review
Process used by insurance companies to assess the need for medical care and to assure that payment will be provided for the care
T/F
We always receive reimbursement
false. no guarantee
We need to document accurately
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