Managing Health Services Organizations and Systems

by Longest, Beaufort B.

• ISBN13: 9781878812575
• ISBN10: 1878812572
• Edition: 4th
• Format: Hardcover
• Copyright: 2000-07-01
• Publisher: Health Professions Pr

Summary

Univ. of Pittsburgh, PA. Textbook for students to help set the benchmark of excellence in the management of health services. Covers a model of managing in HSOs/HSs, a description of the healthcare system, organizational designs of HSOs and HSs, and the role technology plays in health services. Author also wrote Health Professionals in Management, c1996, a Brandon/Hill title (#260).

Table of Contents

About the Authors	xxvi
Preface	xxviii
Acknowledgments	xxx
Part I Managing in the Health Services Environment
Management and Managers	3	(40)
Key Definitions	4	(4)
Health	4	(1)
Health Care and Health Services	4	(1)
Health Services Organizations	5	(1)
Health Systems	5	(2)
Managers	7	(1)
Management	7	(1)
Management and Organizational Culture, Philosophy, and Performance	8	(2)
Management and Organizational Cultural and Philosophy	8	(1)
Management and Organizational Performance	9	(1)
Management Functions, Skills, Roles, and Competencies	10	(13)
Management Functions	10	(1)
The Planning Function	10	(2)
The Organizing Function	12	(1)
The Staffing Function	13	(1)
The Directing Function	13	(1)
The Controlling Function	13	(1)
The Pervasiveness of Decision Making	14	(1)
Management Skills	14	(1)
Management Roles	15	(1)
Interpersonal, Informational, and Decisional Roles	16	(2)
Designer, Strategist, and Leader Roles	18	(2)
Management Competencies	20	(1)
Conceptual Competence	20	(1)
Technical Managerial/Clinical Competence	20	(1)
Interpersonal/Collaborative Competence	21	(1)
Political Competence	21	(1)
Commercial Competence	21	(1)
Governance Competence	22	(1)
Summary	23	(1)
A Management Model for HSOs/HSs	23	(5)
Inputs (Resources)	24	(2)
Outputs (Objectives)	26	(1)
Conversion (Integration)	26	(1)
Managers Managing	26	(1)
External Environment (An Open Systems Perspective)	27	(1)
The Challenges of Management	28	(1)
Structure of the Book	28	(1)
Summary	29	(1)
Discussion Questions	30	(1)
The CEO's Day	30	(3)
Role and Functions of Executive Management	33	(1)
The Role of the Health Care Executive in a Consolidation, Merger, Acquisition, or Affiliation	34	(2)
A Management Function Questionnaire	36	(1)
Notes	36	(3)
Selected Bibliography	39	(4)
The Health Care System	43	(68)
Health and System Goals	44	(2)
Lack of Synchrony	46	(1)
A Brief History of Health Services in the United States	47	(5)
Technology	47	(1)
Mortality and Morbidity	47	(1)
Social Welfare	48	(1)
Federal Initiatives	49	(3)
Other Western Systems	52	(1)
Present Structure of the Health Services System	52	(3)
Classification and Types of HSOs	55	(2)
Profit or Not for Profit	55	(1)
Ownership	55	(1)
Length of Patient Stay	56	(1)
Role in Health Services System	56	(1)
Unique Institutional Providers	56	(1)
Mental Health Organizations	57	(1)
Teaching Hospitals	57	(1)
Health Services Workers	57	(5)
Physicians	58	(3)
Nonphysician Clinicians	61	(1)
Licensed Independent Practitioners	61	(1)
Regulation and Education of Managers	62	(1)
Regulation	62	(1)
Education	62	(1)
Regulation and Education of Caregivers	63	(6)
Licensure, Certification, and Registration	63	(1)
Education and Regulation of Sample Health Occupations	64	(1)
Physicians	64	(1)
Nonphysician Caregivers	65	(4)
State and Federal Regulations of HSOs	69	(5)
Inspections	69	(1)
Licensure and Regulation	69	(1)
Conditions of Participation	69	(1)
Planning and Rate Regulation	69	(1)
Utilization Review, PSROs, and PROs	70	(1)
Government Payment Schemes	71	(1)
Diagnosis-Related Groups	71	(1)
Resource Utilization Groups	72	(1)
Ambulatory Patient Groups and Ambulatory Payment Categories	72	(1)
Resource-Based Relative Value Scale	72	(1)
Summary	73	(1)
Other Regulators	73	(1)
Health Services Delivery Accreditation	74	(4)
Joint Commission	74	(2)
American Osteopathic Association	76	(1)
International Organization for Standardization (ISO)	76	(1)
Community Health Accreditation Program	77	(1)
National Committee for Quality Assurance	77	(1)
Utilization Review Accreditation Commission	77	(1)
Associations for Individuals and Organizations	78	(2)
Professional Associations for Individuals	78	(1)
Managers	78	(1)
Physicians	78	(1)
Nonphysician Affiliations	79	(1)
Professional Associations for HSOs/HSs	79	(1)
American Hospital Association	79	(1)
Federation of American Health Systems	79	(1)
American Osteopathic Healthcare Association	79	(1)
Other Hospital Associations	79	(1)
American Health Care Association	80	(1)
American Association of Homes and Services for the Aging	80	(1)
American Association of Health Plans	80	(1)
Educational Accreditors	80	(3)
Managers	80	(1)
Physicians	81	(1)
Nurses	81	(1)
Medical Specialty Boards for Allopaths	81	(2)
Financing Health Services	83	(10)
Expenditure Trends	83	(1)
Sources and Uses of Funds in Health Care	83	(6)
Private Payment Under the Insurance Principle	89	(1)
Government Programs	90	(3)
Trends and Developments in the System	93	(1)
Summary	94	(1)
Discussion Questions	94	(1)
Gourmand and Food---A Fable	95	(1)
Where's My Organ?	96	(1)
Appendix	97	(4)
Medicare at a Glance	97	(1)
What Is Medicare and How Is It Financed?	97	(1)
Who Is Covered Under Medicare?	97	(1)
What Benefits Does Medicare Cover?	98	(1)
Gaps in Medicare: Implications for Beneficiaries	98	(1)
Growth of Medicare Managed Care	99	(1)
Medicare Expenditures	99	(1)
Outlook for Medicare's Future	99	(1)
Medicaid at a Glance	99	(1)
Who Is Covered by Medicaid?	100	(1)
What Services Are Covered Under Medicaid?	100	(1)
How is Care Delivered Under Medicaid?	100	(1)
Enrollee and Expenditure Growth	101	(1)
Notes	101	(7)
Selected Bibliography	108	(3)
Concepts of Organization Design	111	(42)
Design Concepts in Building Formal Organization Structures	113	(18)
Classical Concepts	114	(1)
Weber's Contribution to Design	114	(1)
Fayol's Contributions to Design	114	(1)
Relevance of Classical Concepts	115	(1)
Division of Work	115	(1)
Classical View	115	(1)
Contemporary View	116	(1)
Authority and Responsibility Relationships	117	(1)
Classical View	117	(1)
Contemporary View	118	(1)
Departmentation	119	(1)
Classical View	119	(1)
Contemporary View	120	(1)
Span of Control	121	(1)
Classical View	121	(1)
Contemporary View	122	(2)
Coordination	124	(1)
Classical View	124	(1)
Contemporary View	125	(5)
Summary of the Classical Organization Design Concepts	130	(1)
Design Concepts in Informal Organization Structures	131	(5)
Nature of Informal Organizations	131	(2)
Why People Form Informal Groups	133	(1)
Leadership in Informal Groups	133	(1)
Stages of Group Development	134	(1)
Structure of Informal Groups	134	(1)
Positive Aspects of the Informal Relationships in HSOs/HSs	135	(1)
Living with Informal Relationships in Organizations	136	(1)
An Integrated Perspective on Organization Design	136	(4)
Five Basic Organization Designs	137	(1)
Simple Structure	137	(1)
Machine Bureaucracy	137	(1)
Professional Bureaucracy	138	(1)
Divisionalized Form	138	(1)
Adhocracies	138	(2)
Choosing an Organization Design	140	(1)
Summary	140	(3)
Discussion Questions	143	(1)
A New Approach on the Nursing Units	144	(1)
Trouble in the Copy Center	144	(1)
Alternative Facilities: New Mini-Hospital Raises Hackles	145	(1)
``I Cannot Do It All!''	146	(1)
The Secretaries	147	(1)
Somebody Has to Be Let Go	148	(1)
Notes	148	(2)
Selected Bibliography	150	(3)
How Health Services Organizations Are Organized	153	(70)
Background	153	(1)
Governing Body	154	(1)
Chief Executive Officer	154	(1)
Clinical Staff	154	(1)
The Triad	155	(1)
Legal Status	155	(1)
Organization Structure	156	(1)
Governing Bodies	156	(3)
Role and Functions	157	(1)
Composition	158	(1)
Committees	158	(1)
Relationship to the CEO	159	(1)
Management	159	(2)
Function	160	(1)
Qualifications	161	(1)
Relationships	161	(1)
CEO and Senior Management	161	(1)
Organizing the Professional Staff	161	(9)
History	162	(1)
Professional Staff Organization	162	(1)
Self-Governance	162	(1)
Open or Closed	163	(1)
Committees	163	(1)
Clinical Departmentation	164	(1)
Managing the PSO	164	(1)
Credentialing	164	(1)
Process	165	(1)
PSO Membership---Initial Appointment	165	(1)
PSO Membership---Reappointment	166	(1)
Clinical Privileges	166	(1)
PSO Discipline	167	(1)
Special Issues in Managing the PSO	167	(1)
Economic Credentialing	167	(1)
Turf Conflicts	168	(1)
Integration	168	(1)
Licensing and Credentialing	169	(1)
Impaired Clinicians	169	(1)
Organization of Selected HSOs	170	(36)
Acute Care Hospitals	170	(1)
Definitions and Numbers	171	(1)
Classification	171	(1)
New Types	172	(1)
Functions	172	(2)
Organization Structure	174	(4)
Licensure and Accreditation	178	(1)
Future	178	(1)
Nursing Facilities	178	(1)
Definition and Numbers	179	(1)
Functions	180	(1)
Organization Structure	180	(3)
Licensure and Accreditation	183	(1)
Future	183	(1)
Ambulatory Health Services	183	(2)
Organization Structure	185	(1)
Licensure and Accreditation	186	(1)
Future	186	(1)
Hospice	186	(1)
Function and Numbers	187	(1)
Models	188	(1)
Organization Structure	188	(1)
Licensure and Accreditation	189	(1)
Future	189	(1)
Managed Care	189	(1)
Characteristics	190	(1)
Types	191	(2)
Payment	193	(2)
Organization Structures	195	(2)
Licensure and Accreditation	197	(1)
Future	198	(1)
Birth Centers	199	(1)
Definition and Numbers	199	(1)
Organization Structure	200	(1)
Licensure and Accreditation	200	(1)
Future	200	(1)
Home Health Agencies	201	(1)
Definition and Numbers	201	(1)
Functions	202	(1)
Organization Structure	203	(2)
Licensure and Accreditation	205	(1)
Future	206	(1)
Summary	206	(1)
Discussion Questions	206	(1)
The Clinical Staff	207	(1)
The Emergency Department	207	(1)
Authority Relationships	208	(1)
The Orthopedic Surgery Group Practice	209	(1)
The Right Thing to Do	209	(1)
Notes	210	(9)
Selected Bibliography	219	(4)
How Health Systems Are Organized	223	(48)
Interorganizational Relationships	224	(1)
Strategic Alliances	225	(12)
Reasons to Ally	226	(1)
Approaches to Understanding SAs	227	(1)
SAs Categorized by Participants	227	(1)
Physician-Physician SAs	227	(1)
Physician-HSO/HS SAs	227	(1)
HSO-HSO SAs	228	(3)
SAs Categorized by Purpose	231	(1)
SAs Categorized by Form	232	(1)
Co-opting	233	(1)
Loose Coupling or Coalescing	233	(2)
Mergers and Consolidations	235	(1)
Summary	236	(1)
The Future of SAs: A New Health Services Ecosystem	237	(1)
Managing SAs	237	(5)
Conceptual Competence in Managing SAs	239	(1)
Technical Managerial/Clinical Competence in Managing SAs	239	(1)
Interpersonal/Collaborative Competence in Managing SAs	240	(1)
Political/Commercial Competencies in Managing SAs	241	(1)
Governance Competence in Managing SAs	242	(1)
Governance in HSs	242	(5)
Centralized Versus Decentralized Governance Structures	242	(3)
Composition of the GB	245	(1)
Governance Responsibilities	246	(1)
Selected Technical Issues in Managing IORs	247	(6)
Negotiations in Managing IORs	247	(2)
Unique Aspects of Managing Involuntary IORs	249	(2)
Corporate Restructuring and Corporate Diversification	251	(2)
Summary	253	(1)
Discussion Questions	254	(1)
Texas Health-Baylor: Networks Agree to Mega-Merger	254	(1)
Hard Times	255	(1)
Community Health Plan	256	(1)
Does It Make Sense?	257	(1)
American Hospital Association's Policy on Community Accountability with Changes in the Ownership or Control of Hospitals or Health Systems	258	(2)
Board Effectiveness	260	(1)
How to Turn an Intimidating Government Bureaucracy into a Partner and Ally	261	(1)
Notes	262	(5)
Selected Bibliography	267	(4)
Health Care Technology	271	(46)
History and Background	273	(1)
Types of Technologies	274	(3)
Definitive (Curative, Preventive) Technologies	274	(1)
Halfway (Add-On) Technologies	274	(1)
Deferral Technologies	274	(1)
Competing Technologies	275	(1)
Cost-Saving Technologies	275	(2)
Effects of Technology on Health Status	277	(1)
Forces Affecting Development and Diffusion of Technology	277	(4)
Medical Education and Practice	277	(2)
Reimbursement	279	(1)
Third-Party Payment	279	(1)
Diagnosis-Related Groups	279	(1)
Health Care Financing Administration	280	(1)
The Public	280	(1)
Competitive Environment	280	(1)
Responses to Diffusion and Use of Technology	281	(3)
Public Sector Activities	282	(1)
Food and Drug Administration	282	(1)
PSROs and PROs	282	(1)
Certificate of Need	283	(1)
Private Sector Activities	283	(1)
Joint Commission	283	(1)
ISO 9000	284	(1)
Tort Law	284	(1)
Technology Assessment	284	(2)
Public Sector Activities	284	(2)
Private Sector Activities	286	(1)
Summary	286	(1)
HSO/HS Technology Decision Making	286	(3)
Review and Planning	287	(1)
Financing Technology	287	(1)
Evaluating and Acquiring Technology---TEAM	288	(1)
Newer Alternatives to TEAM	288	(1)
Chief Technology Officer	288	(1)
Technical Support Committee	288	(1)
Multidisciplinary Technology Assessment Committee	289	(1)
Summary	289	(1)
Managing Biomedical Equipment in HSOs/HSs	289	(5)
Systems Engineering	291	(1)
Organization	291	(1)
External Standards	291	(1)
Service	291	(3)
Electronic Health Information Systems	294	(5)
Regional Level---CHINs	295	(1)
Goals and Activities of CHINs	295	(1)
Problems of Implementing CHINs	296	(1)
Future of CHINs	296	(1)
Enterprise Level---EMRs	297	(1)
Advantages of EMRs	297	(1)
Problems of Establishing EMRs	297	(1)
Summary	298	(1)
Telemedicine	299	(2)
Future Developments	301	(1)
Biomedical Equipment	301	(1)
Clinical Support and Information Systems	301	(1)
Medical Technology	302	(1)
Summary	302	(1)
Discussion Questions	302	(1)
The Feasibility of Beam	303	(1)
``Who Does What?''	304	(1)
``Let's `Do' a Joint Venture''	305	(1)
``Why Can't You Keep My Lab Running?!''	305	(1)
``Isn't There a Better Way?''	306	(1)
Notes	307	(6)
Selected Bibliography	313	(4)
Part II Managerial Tools and Techniques
Managerial Problem Solving and Decision Making	317	(30)
Problem Analysis and Decision Making	317	(2)
Types of Decisions	318	(1)
Ends-Means	318	(1)
Administrative-Operational	318	(1)
Nonprogrammable-Programmable	319	(1)
Overlap of Decision Types	319	(1)
Managerial Problem Solving	319	(1)
Problem-Solving Process and Model	320	(13)
Conditions that Initiate Problem Solving	321	(1)
Problem-Solving Activities	322	(1)
Problem Analysis [1]	322	(2)
Problem Recognition and Definition	324	(1)
Problem Statement	324	(1)
Facts and Reasoning	325	(1)
Developing Assumptions [2]	326	(1)
Identifying Tentative Alternative Solutions [3]	327	(1)
Developing and Applying Decision Criteria [4]	328	(1)
Selecting, Implementing, and Evaluating the Alternative Solution [5, 6, and 7]	329	(1)
Implications for the Health Services Manager	330	(1)
Problem-Solver Attributes	330	(1)
Experience, Knowledge, and Judgment	330	(1)
Perspective, Personality, and Biases	330	(1)
Values and Philosophy	331	(1)
The Situation	331	(1)
Urgency of Results and Time Pressures	331	(1)
Magnitude and Importance	331	(1)
Structure, Uncertainty, and Risk	332	(1)
Cost-Benefit	332	(1)
The Environment	332	(1)
External	332	(1)
Internal	333	(1)
Implications for the Health Services Manager	333	(1)
Unilateral and Group Problem Solving	333	(2)
Group Problem-Solving and Quality Improvement Techniques	334	(1)
Quality Circles	334	(1)
Other Group Formats	335	(1)
Problem-Solving and Decision-Making Styles	335	(4)
Involving Others---A Conceptual Model	335	(1)
Situational Variables (Problem Attributes)	335	(1)
Situations and Styles	336	(1)
Using the Model	336	(1)
Situations 1, 2, and 3	336	(1)
Situations 11, 12, 13, and 14	336	(2)
Implications for the Health Services Manager	338	(1)
Summary	339	(1)
Discussion Questions	339	(1)
The Nursing Assistant	339	(1)
The New Charge Nurse	340	(1)
Preferred Provider Organization	340	(1)
There Are Hours and There Are Hours	341	(1)
Notes	342	(2)
Selected Bibliography	344	(3)
Strategic Planning and Marketing	347	(58)
Planning Defined	348	(1)
Planning and the Management Model	348	(1)
Planning Characteristics	349	(2)
Type of Planning	349	(1)
Time Frame of Planning and Who Plans	350	(1)
Approach to Planning	350	(1)
Planning Outcomes	351	(5)
Mission	351	(1)
Objectives	351	(2)
Organizational Strategies and Operational Programs	353	(2)
Policies and Procedures	355	(1)
General and Operational Policies	355	(1)
Characteristics of Good Policies	355	(1)
HSO/HS Planning Environment	356	(1)
Health Services Marketing---An Environmental Link	357	(6)
Marketing Concept	358	(1)
Marketing Audit	359	(1)
Target Market	359	(1)
Product Line/Service Mix	359	(2)
Elements of Marketing---The Four Ps and SCAP	361	(1)
Service	362	(1)
Consideration	362	(1)
Access	362	(1)
Promotion	362	(1)
HSO/HS Strategic Planning	363	(1)
Formulating Objectives [I] in Strategic Planning	363	(4)
Organizational Culture	363	(3)
Stakeholders	366	(1)
Values and Ethics	366	(1)
Comments	367	(1)
Strategic Assessment [II] in Strategic Planning	367	(6)
External Environmental Analysis [IIa]	367	(1)
Sector Analysis	367	(1)
Industry Structure and Competitive Position: Porter's Five-Forces Model	368	(3)
Marketing Audit [IIb]	371	(1)
Internal Capability Analysis [IIc]	371	(1)
Yields [IId]	372	(1)
Strategy Choice [III] in Strategic Planning	373	(10)
Formulate and Consider Strategies [IIIa]	373	(1)
Porter's Competitive Strategies	373	(1)
Classification of Generic Strategies	374	(4)
Context of Strategy Choice [IIIb]	378	(1)
Type of Organization	378	(1)
Strategic Decision Style	379	(1)
Managerial Philosophy	380	(1)
Organizational Culture and Choice-Maker Values	380	(1)
Portfolio Analysis	380	(1)
Organization Life Cycle	381	(1)
Competitive Position	381	(2)
Strategy Choice [IIIc]	383	(1)
Stakeholders and Strategic Planning	383	(1)
Strategic Issues Management	384	(5)
Issue Life Cycle	386	(1)
Anticipatory	386	(1)
Emergence	386	(1)
Enactment	387	(1)
Implementation	387	(1)
Factors that Can Affect Public Policy Issues	387	(2)
Implications	389	(1)
Summary	389	(1)
Discussion Questions	390	(1)
Hospital Marketing Effectiveness Rating Instrument	391	(2)
HSO Strategic Assessment	393	(1)
Closing Pediatrics	393	(1)
National Health Insurance	394	(1)
Violation	395	(1)
Trends for the Future---Industry Structure and Competitive Position	395	(1)
Notes	396	(5)
Selected Bibliography	401	(4)
Quality and Competitive Position	405	(64)
Quality---Two Dimensions	406	(1)
CQI Philosophy	407	(2)
CQI Model	409	(2)
Are We Doing the Right Things?	409	(1)
Are We Doing Things Right?	409	(2)
How Can We Be Certain We Do Things Right the First Time, Every Time?	411	(1)
QI, Productivity Improvement, and Competitive Position	411	(1)
Approaches to QI	412	(7)
W. Edwards Deming	413	(2)
Joseph M. Juran	415	(2)
Philip B. Crosby	417	(2)
Statistical Control	419	(1)
Process Improvement Models	419	(8)
Understanding and Measuring a Process	424	(1)
Benchmarking	424	(2)
ISO 9000	426	(1)
Improvement and Problem Solving	427	(3)
Productivity Improvement	430	(4)
Productivity and Productivity Improvement	430	(1)
CQI and Productivity Improvement	430	(1)
Analysis and Improvement of Work Systems and Job Design	431	(1)
Capacity Planning and Facilities Layout	432	(1)
Production Control, Scheduling, and Materials Distribution	433	(1)
Reengineering	434	(5)
Outward-In, Right to Left	434	(1)
Reengineering Defined	435	(1)
Attributes	435	(1)
What Reengineering Is Not (Reengineering and CQI)	435	(1)
Elements	436	(1)
Handling Resistance to Change	437	(1)
Applications	437	(1)
Facilitators and Barriers	438	(1)
Strategic Quality Planning: Hoshin Planning	439	(4)
Choose the Focus	440	(1)
Align the Organization	440	(2)
Implement the Plan and Review and Improve	442	(1)
Physician Involvement in QI	443	(3)
Practice Parameters	443	(1)
Involving Physicians	443	(2)
Results	445	(1)
QI---The Next Iteration	446	(1)
Summary	447	(1)
Discussion Questions	448	(1)
Fed Up in Dallas	448	(1)
The Carbondale Clinic	449	(1)
Total Quality Management (TQM) Inventory	450	(3)
Noninvasive Cardiovascular Laboratory	453	(1)
Trying Hard Memorial Hospital and Do It Right Medical Center	454	(2)
Notes	456	(7)
Selected Bibliography	463	(6)
Control and Resource Allocation	469	(62)
Control and Planning	470	(1)
Monitoring (Control) and Intervention Plans	470	(2)
Output Control	470	(1)
Process Control	471	(1)
Input Control	471	(1)
Control Model	472	(1)
In Control Loop	472	(1)
Acceptance Control Loop	472	(1)
Required Change Control Loop	473	(1)
Positive Control Loop	473	(1)
Levels of Control	473	(1)
Control and CQI	474	(1)
Control and Problem Solving	474	(1)
Control Considerations	474	(1)
Managerial Considerations	474	(1)
Design Considerations	475	(1)
Information Systems and Control	475	(4)
Information Systems: LANs, WANs, and CHINs	476	(1)
Clinical-Patient Care is and Electronic Medical Records	476	(2)
Is Issues	478	(1)
Is Uses	478	(1)
RM and Quality Improvement	479	(16)
Risk Management	480	(1)
Link to Senior-Level Management	481	(1)
Risk Manager	482	(1)
Principles of Managing Risk	482	(1)
Financing Risk	483	(1)
Process of RM	484	(1)
Improving Quality and Performance	485	(2)
Structure, Process, and Outcome in Quality Assessment	487	(1)
Developments for Beyond 2000: Practice Parameters	488	(2)
Importance of QI	490	(1)
QI and Quality Assurance Compared	490	(4)
Summary	494	(1)
Control Methods	495	(8)
Budgeting	495	(1)
Cost Allocation	496	(1)
Activity-Based Costing	496	(3)
Financial Statements	499	(1)
Ratio Analysis	499	(1)
Operational-Activity Analysis	500	(2)
Financial Analysis	502	(1)
Use of Analytical Techniques in Resource Allocation	503	(14)
Volume Analysis with Revenue	503	(9)
Volume Analysis without Revenue	512	(1)
Capital Budgeting	513	(1)
Cost-Benefit Analysis	514	(2)
Simulation	516	(1)
Summary	517	(1)
Discussion Questions	518	(1)
Admitting Department	518	(1)
Centralized Photocopying	519	(1)
Barriers to an Effective QI Effort	520	(1)
Don's Risk Management	521	(1)
The Array Machine	521	(1)
Financial Ratios	522	(2)
Notes	524	(3)
Selected Bibliography	527	(4)
Human Resources and Labor Relations	531	(58)
Role of Human Resources Management	532	(1)
Staffing Activities	533	(1)
Acquiring Human Resources	533	(14)
Human Resources Planning	533	(1)
Profiling	534	(1)
Estimating	535	(1)
Inventorying	535	(1)
Forecasting	535	(1)
Planning	535	(1)
Summary	535	(1)
Human Resources Sources	536	(1)
Job Analysis and Job Descriptions	536	(1)
Job Analysis	536	(1)
Job Descriptions	536	(1)
Recruitment	537	(1)
Selection	537	(1)
Application Forms and Preemployment Interviews	537	(3)
Testing	540	(2)
Selection---A Shared Responsibility	542	(1)
Orientation	543	(1)
Equal Employment Opportunity	543	(2)
What Is Equal Opportunity and Discrimination?	545	(1)
Adverse Impact	545	(1)
Bona Fide Occupational Qualifications	546	(1)
Affirmative Action	546	(1)
Sexual Harrassment	547	(1)
Retaining Employees	547	(11)
Performance Appraisal	549	(1)
Uses of Performance Appraisal	549	(1)
Appraisal Methods	550	(1)
Benefits of Systematic Appraisal	550	(1)
Appraisal Problems	550	(3)
Continuous Quality Improvement	553	(1)
Training and Development	553	(1)
Discipline (Corrective Counseling)	554	(1)
Compensation Administration	554	(1)
Establishing and Administering a Compensation System	555	(1)
Executive and Incentive Compensation	556	(1)
Benefits Administration	556	(1)
Pension Programs	557	(1)
Employee Assistance Programs	557	(1)
Workplace Health and Safety	558	(1)
Separation from Employment (Exit)	558	(1)
Preretirement Planning	559	(1)
Outplacement	559	(1)
Exit Interviews	559	(1)
Human Resources Department and Clinical Staff	559	(1)
Human Resources in HSs	559	(1)
Labor Relations	560	(1)
Labor Movement	560	(1)
Federal Labor Legislation	561	(5)
Norris-LaGuardia Act (Anti-Injunction Act, 1932)	561	(1)
Wagner Act (National Labor Relations Act, 1935)	561	(1)
Employer Unfair Labor Practices	561	(1)
National Labor Relations Board	561	(1)
Taft-Hartley Act (Labor-Management Relations Act, 1947)	562	(1)
Employee Protection	563	(1)
Union Unfair Labor Practices	563	(1)
Bargaining Procedures	563	(1)
Nonprofit Hospital Amendments to the Taft-Hartley Act (1974)	563	(1)
Pre-1974 Environment	563	(1)
1974---A Changed Environment	564	(1)
Unique Provisions	565	(1)
Labor Organizations in Health Services	566	(1)
Why Employees Unionize	566	(4)
Symptoms of an Organization Change	567	(1)
Bargaining Units	568	(1)
Solicitation and Distribution	568	(1)
Employer Conduct During an Election Campaign	569	(1)
Managerial Responsibilities in Labor Relations	570	(2)
Setting the Tone and Environment	571	(1)
Proactive Steps	571	(1)
Collective Bargaining	572	(1)
Negotiation	572	(1)
Impasses	573	(1)
The Human Resources Perspective	573	(2)
Summary	575	(1)
Discussion Questions	575	(1)
Personnel Policies at Robbins Memorial Hospital	576	(1)
Complaint of LPN Pay Inequality	577	(1)
Substance Abuse and EAP	578	(1)
Missing Narcotics	578	(1)
Physician Harrassment	579	(1)
Union Membership Solicitation and Distribution of Union Material at Dunlap Memorial Hospital	579	(1)
Promotion at Visiting Nurse Service	580	(1)
Notes	580	(6)
Selected Bibliography	586	(3)
Organizational Change	589	(34)
Pressures for Change in HSOs/HSs	590	(1)
Organizational Change Defined	591	(1)
Process of Managing Organizational Change	592	(14)
Identifying the Need for and Nature of Necessary Organizational Changes	594	(3)
Planning for Implementing Organizational Change	597	(1)
Developing a Set of Viable Alternative Changes for Consideration	598	(1)
Choosing from Among the Change Alternatives	598	(1)
Devising a General Approach to Implementing Organizational Change	599	(2)
Selecting Techniques to Support Implementation	601	(3)
Implementing Organizational Change	604	(2)
Evaluating Organizational Change	606	(1)
Human Resources Changes	606	(2)
Constancy of the Change Agent's Responsibility in Management Work in HSOs/HSs	608	(3)
Special Case of Being a Change Agent in Retrenchment	609	(1)
Special Case of Being a Change Agent in Health Systems (HSs)	610	(1)
Summary	611	(1)
Discussion Questions	612	(1)
Labor, Delivery, Recovery, Postpartum (LDRP) Staffing Situation	613	(1)
A Response to Change	613	(1)
How Ready Are You for Managing in a Turbulent World?	614	(1)
A Human Resources Change at Sun Coast Health System	615	(1)
``You Didn't Tell Me!''	616	(1)
Notes	617	(1)
Selected Bibliography	618	(5)
Part III Managing Relationships
Ethics	623	(68)
Sources of Law	623	(2)
Relationship of Law to Ethics	625	(1)
Moral Philosophies	626	(3)
Teleology	626	(1)
Deontology	627	(1)
Natural Law	628	(1)
Casuistry	628	(1)
Virtue Ethics	629	(1)
Philosophical Bases for Ethics	629	(3)
Respect for Persons	630	(1)
Beneficence	631	(1)
Nonmaleficence	631	(1)
Justice	631	(1)
Summary	632	(1)
Codes of Ethics	632	(1)
Health Services Codes of Ethics	633	(2)
Institutional Trade Associations	633	(1)
Health Professions	633	(1)
Managers	633	(1)
Physicians	634	(1)
Nurses	634	(1)
Patient Bills of Rights	635	(1)
Ethical Issues Affecting Governance and Management	635	(5)
Fiduciary Duty	635	(1)
Conflict of Interest	636	(2)
Confidential Information	638	(1)
Ethics and Marketing	638	(1)
Need Versus Demand	639	(1)
Responsible Marketing	639	(1)
Future of Competition	640	(1)
Conflicts of Interest in Managed Care	640	(2)
Marketing and Operations	640	(1)
Physician Incentives and Other Constraints	641	(1)
Minimizing Conflicts of Interest in Managed Care	642	(1)
Biomedical Ethical Issues	642	(25)
Resource Allocation	642	(1)
Consent	643	(1)
Ethical Issues in Research	644	(2)
End-of-Life Decisions	646	(1)
Life-Sustaining Treatment	647	(1)
Child Abuse	647	(1)
Advance Directives	648	(5)
Euthanasia	653	(2)
Physician-Assisted Suicide	655	(2)
Futile Treatment	657	(1)
Implications	658	(1)
Alternatives to Futile Care Policies	659	(1)
Acquired Immunodeficiency Syndrome	660	(1)
Incidence and Prevalence	660	(1)
Research and Treatment	661	(1)
Implications for HSOs/HSs	662	(4)
Conclusion	666	(1)
Organizational Responses to Ethical Problems	667	(1)
Means to Resolve Ethics Issues	667	(6)
Institutional Ethics Committees	667	(1)
Organizing IECs	668	(1)
Purpose and Role of IECs	668	(1)
Membership of IECs	669	(1)
Relationships of IECs	670	(1)
Summary	670	(1)
Infant Care Review Committees	670	(1)
Institutional Review Boards	671	(1)
Membership and Purpose of IRBs	671	(1)
IRB Requirements	672	(1)
Exempt Research and Expedited Review	672	(1)
Summary	672	(1)
Specialized Assistance	672	(1)
Ethics Consultation Services	672	(1)
Ethicists	673	(1)
Ethics Officer	673	(1)
Summary	673	(1)
Discussion Questions	673	(1)
``What's a Manager to Do?''	674	(1)
Bits and Pieces	675	(1)
Demarketing to Avoid Bankruptcy	675	(1)
Choices	676	(1)
Benefiting Older Adults by Infecting Them with Influenza	677	(1)
Knowing Whether or When to Stop	678	(1)
Something Must Be Done, but What?	678	(1)
Notes	679	(7)
Selected Bibliography	686	(5)
Legal Considerations	691	(44)
Processes that Produce the Law	691	(4)
Official or Public Processes	691	(1)
Legislative Process	691	(1)
Regulatory Process	692	(1)
Judicial Process	693	(1)
Executive Orders	694	(1)
Unofficial or Private Processes	694	(1)
Influence of HSOs/HSs	694	(1)
Trade Associations and Interested Parties	694	(1)
Political Action Committees	695	(1)
Contracts	695	(1)
Elements of a Contract	695	(1)
Breach of Contract	696	(1)
Torts	696	(7)
Breach of Contract and Tort Distinguished	696	(1)
Intentional Torts	697	(3)
Negligence	700	(1)
Standard of Care	701	(1)
Proof of Negligence and Recovery of Damages	701	(1)
Torts and HSOs/HSs	702	(1)
Agency and Corporate Liability	702	(1)
Enterprise Liability	703	(1)
Malpractice ``Crises''	704	(3)
Effects of Malpractice Suits	705	(1)
Reforms of the Malpractice System	706	(1)
Nonjudicial Means of Resolving Disputes	707	(1)
Developing Legal Areas	708	(11)
HIV and AIDS Legal Issues and Litigation	708	(2)
Antitrust	710	(1)
Professions	710	(1)
Facilities Planning	710	(1)
Mergers	710	(1)
Peer Review	711	(1)
Summary	712	(1)
Emergency Medical Treatment and Active Labor Act	713	(1)
Employee Retirement Income Security Act	713	(1)
Medicare and Medicaid Fraud and Abuse	714	(1)
Fraudulent Billing	714	(1)
Physician Self-Referral	714	(1)
Healthcare Integrity and Protection Data Bank	715	(1)
Qui Tam Actions	716	(1)
Tax-Exempt Status of HSOs/HSs	716	(2)
Telemedicine	718	(1)
Confidentiality	718	(1)
Data Compression	718	(1)
Artificial Intelligence	718	(1)
Licensure	719	(1)
Consent	719	(1)
Summary	719	(1)
Legal Process of a Civil Lawsuit	719	(2)
Special Considerations for the Manager	721	(2)
Record Keeping	721	(1)
Effective Use of House and Retainer Counsel	722	(1)
Testifying	722	(1)
Summary	723	(1)
Discussion Questions	723	(1)
Reporting Suspected Child Abuse or Neglect	724	(1)
Effective Consent	725	(1)
The Missing Needle Protector	725	(1)
Is This the Most Efficient Way?	726	(1)
Stakeholders	727	(1)
Notes	728	(5)
Selected Bibliography	733	(2)
Leadership	735	(36)
Leadership Defined and Modeled	736	(1)
Power and Influence	737	(3)
Sources of Power	737	(2)
Effective Use of Power	739	(1)
Approaches to Understanding Leadership	740	(1)
Leader Traits and Skills	740	(2)
Leader Behavior and Leadership Style	742	(7)
Early Leader Behavior Studies	743	(1)
Likert's System 4 Management Model	744	(2)
Blake and McCanse's Leadership Grid	746	(1)
Tannenbaum and Schmidt's Continuum of Leader Behavior	746	(3)
Situational or Contingency Theories of Leadership	749	(8)
Fielder's Contingency Theory	749	(2)
Hershey and Blanchard's Situational Leadership Model	751	(2)
Vroom and Yetton's Model	753	(2)
House and Mitchell's Path--Goal Model	755	(2)
Toward an Integrative Framework for Leadership	757	(2)
Summary	759	(1)
Discussion Questions	759	(1)
Charlotte Cook's Problem	760	(1)
The Presidential Search	760	(1)
Is Leadership the Issue?	761	(1)
Leadership Questionnaire	761	(2)
Lessons Where You Find Them	763	(1)
Supervisory Behavior Questionnaire	763	(2)
Notes	765	(2)
Selected Bibliography	767	(4)
Motivation	771	(32)
Motivation Defined and Modeled	772	(2)
Motivation Theories	774	(1)
Content Theories	774	(7)
Maslow's Hierarchy of Needs	774	(2)
Alderfer's ERG Theory	776	(2)
Herzberg's Two-Factor Theory	778	(1)
McClelland's Learned Needs Theory	779	(1)
Managerial Implications of the Content Theories of Motivation	780	(1)
Process Theories	781	(8)
Vroom's Expectancy Theory	781	(3)
Managerial Implications of Expectancy Theory	784	(1)
Adams's Equity Theory	785	(1)
Managerial Implications of Equity Theory	786	(1)
Locke's Goal-Setting Theory	786	(1)
Managerial Implications of Goal-Setting Theory	786	(2)
Skinner's Reinforcement Theory	788	(1)
Managerial Implications of Reinforcement Theory	788	(1)
Toward an Integrative Framework for Motivation	789	(2)
Summary	791	(1)
Discussion Questions	792	(1)
A Potential Conflict	792	(1)
The Young Associate's Dilemma	793	(1)
Clockwork	793	(1)
Bill's Promotion	794	(1)
What Needs Are Most Important to You?	794	(3)
The Holdback Pool	797	(1)
Notes	797	(3)
Selected Bibliography	800	(3)
Communication	803	(26)
Communication Defined and Modeled	804	(2)
A Model of the Communication Process	805	(1)
Elements of Effective Communication	806	(2)
Barriers to Effective Communication	808	(3)
Environmental Barriers	808	(1)
Personal Barriers	809	(1)
Managing Barriers to Effective Communication	810	(1)
Flows of Intraorganizational Communication	811	(4)
Downward Flow	811	(1)
Upward Flow	811	(1)
Horizontal and Diagonal Flows	812	(1)
Communication Networks	812	(2)
Informal Communication	814	(1)
Summary of Intraorganizational Communication Flows	815	(1)
Communicating with External Stakeholders	815	(7)
Communicating with the Public Sector	817	(2)
Communicating with the Community	819	(1)
Listening to External Stakeholders	820	(1)
Communicating When Things Go Badly	821	(1)
Summary	822	(1)
Discussion Questions	823	(1)
ABC Nursing Facility	823	(1)
The Business Office	824	(1)
Good Work Is Expected	824	(1)
Group Health Cooperative of Puget Sound's Hard Rock Sell	825	(1)
How Much Should We Say?	826	(1)
Notes	826	(1)
Selected Bibliography	827	(2)
Author Index	829	(18)
Subject Index	847