The Well-Managed Healthcare Organization

by Griffith, John R.; White, Kenneth R.

• ISBN13: 9781567931884
• ISBN10: 156793188X
• Format: Hardcover
• Copyright: 2002-11-01
• Publisher: HLTH-AD

Author Biography

John R. Griffith, M. B. A., Fache, is the Andrew Pattullo Collegiate Professor in the Department of Health Management and Policy, School of Public Health, The University of Michigan Kenneth R. White, Ph.D., Fache, is an associate professor and director of the graduate program in health administration at the Medical College of Virginia Campus of Virginia Commonwealth University

Table of Contents

List of Figures	xiii
Preface	xix
Emergence of the Healthcare Organization	1	(26)
Forces for Change in Healthcare	1	(2)
The Premise of ``The Well-Managed Healthcare Organization''	3	(2)
The Building Blocks: Healthcare Organizations at the Start of the Century	5	(13)
Hospitals	5	(6)
Physicians	11	(2)
Other Healthcare Providers	13	(2)
Health Insurance Organizations	15	(3)
Using This Book	18	(9)
Structure of the Book	18	(1)
How to Use the Book	19	(8)
PART I Governing: Making Healthcare Organizations Responsive to Their Environment
Relating Healthcare Organizations to Their Environment	27	(38)
Understanding the Forces Shaping Organizations	27	(6)
Open Systems	28	(1)
Community-Focused Strategic Management	29	(1)
Continuous Improvement	30	(3)
Applying the Theory to Healthcare Organizations	33	(10)
Open Systems	33	(6)
Community-Focused Strategic Management	39	(3)
Continuous Improvement	42	(1)
Important Customer Motivations	43	(10)
Samaritanism and Support of the Poor	44	(2)
Personal Health	46	(1)
Public Health	47	(1)
Economic Gain for the Community	48	(1)
The Healthcare Organization as a Control Organization	49	(4)
Important Member Motivations	53	(2)
The Future for the Well-Managed Healthcare Organization: A New Vision of Good Care	55	(3)
Safe	55	(1)
Effective	56	(1)
Patient Centered	56	(1)
Timely	57	(1)
Efficient and Equitable	57	(1)
Leading Strategies at the Turn of the Century	58	(7)
The Governing Board	65	(48)
Purpose	66	(1)
Functions	66	(24)
Appoint the Chief Executive	68	(3)
Establish the Mission and Vision	71	(6)
Approve the Corporate Strategy and the Annual Implementation	77	(3)
Approve the Annual Budget	80	(2)
Ensure Quality of Medical Care	82	(4)
Monitor Performance Against Plans and Budgets	86	(1)
Resource Distribution Functions	87	(2)
Resource Contribution Functions	89	(1)
Membership	90	(7)
Membership Criteria	90	(2)
Selection Processes	92	(2)
Compensation	94	(1)
Legal Issues of Board Membership	94	(1)
CEO Membership	95	(1)
Physician Membership	96	(1)
Education and Information Support	97	(1)
Structure for an Effective Corporate Board	97	(5)
Scheduling	98	(2)
Preparation	100	(1)
Focus	100	(1)
Accountable Delegation	100	(2)
Subsidiary and Joint Venture Boards	102	(3)
Subsidiary Boards	102	(2)
Joint Venture Boards	104	(1)
Measures of Board Effectiveness	105	(8)
Scope of Corporate Performance	105	(1)
Guidelines for Evaluating Performance	106	(2)
Annual Performance Review	108	(5)
The Executive Office	113	(32)
Purpose	113	(1)
Functions	114	(1)
Leadership	115	(10)
Support	117	(3)
Representation	120	(5)
Organization	125	(1)
Selecting Executive Personnel	125	(6)
Career Opportunities	125	(1)
Career Education	126	(2)
Career Experience	128	(1)
Assessment of Professional Skills	129	(1)
Recruitment of Effective Executives	130	(1)
Programs for Women and Minorities	131	(1)
Organization	131	(7)
Design of the Executive Office	132	(2)
Responsibilities of Executive Officers	134	(4)
Measures of Executive Performance	138	(1)
Measures for Individual and Group Performance	138	(1)
Encouraging Effective Executive Office Performance	138	(7)
Using Power	138	(1)
Timing the Response	139	(1)
Management Style	140	(5)
Designing the Healthcare Organization	145	(34)
The Informal Organization and Organization Culture	146	(1)
The Accountability Hierarchy, or Formal Organization	147	(12)
The Accountable Work Group	147	(5)
Grouping Work Groups	152	(1)
Structuring the Organization as a Whole	153	(1)
Organizing the Operating Core	154	(2)
The Service Line Organization	156	(3)
The Collateral Organization, or Decision-Making Structure	159	(8)
Criteria for Effective Decisions	160	(1)
Classifying Decisions	161	(1)
Achieving Effective Delegation	162	(5)
Using Middle Management Effectively	167	(1)
Multi-unit Organizations	167	(12)
Multi-unit Organizations Are Created	167	(2)
How Multi-unit Organizations Are Structured	169	(4)
The Record and Outlook for Multi-unit Organizations	173	(6)
Measuring Performance	179	(58)
Advantages of Quantitative Information	180	(1)
Criteria for Measurement Systems	180	(2)
Kinds of Quantitative Information	182	(12)
Programmatic Measures for Work Groups and Organizational Components	182	(9)
Strategic Measures	191	(3)
Approaches to Quantification	194	(12)
Scaling Performance	195	(3)
Acquiring Performance Management Data	198	(4)
Specification and Adjustment	202	(4)
Using Measures to Improve Performance	206	(13)
Setting and Achieving Expectations	206	(1)
Identifying Priorities by Constraint Analysis	207	(3)
Predictive Modeling	210	(6)
Experimentation	216	(2)
Improving Performance Measurements	218	(1)
Monitoring and Controlling	219	(18)
Cybernetic Systems	219	(2)
Spider Charts	221	(1)
Statistical Quality Control	222	(15)
PART II Caring: Building Quality of Clinical Service
Improving Quality and Economy in Patient Care	237	(42)
Definitions	238	(2)
Premises	238	(2)
The Clinical Quality Improvement Program	240	(8)
Decision Theory and Case Management	240	(4)
Building Continuous Improvement on Professional Foundations	244	(2)
The Organization's Contribution to Clinical Improvement	246	(2)
Using Clinical Expectations to Ensure Quality	248	(16)
Definition of Clinical Expectations	248	(1)
Types of Clinical Expectations	248	(9)
Using Protocols to Improve the Delivery of Care	257	(3)
Continuous Improvement of Clinical Management	260	(4)
Prevention and Health Promotion	264	(4)
Cost Effectiveness of Prevention and Health Promotion	265	(2)
Developing Prevention and Health Promotion Strategies	267	(1)
Measures and Information Systems for Clinical Performance	268	(11)
Demand and Output	268	(1)
Cost and Productivity	269	(2)
Quality and Satisfaction	271	(8)
Organized Physician Services	279	(48)
Purposes	282	(1)
Functions	283	(29)
Improvement of Clinical Quality and Cost Expectations	283	(2)
Review of Privileges and Credentials	285	(8)
Medical Staff Planning and Recruitment	293	(6)
Educational Activities	299	(2)
Representation, Communication, and Resolution of Conflicts	301	(6)
Collective Compensation Agreements	307	(5)
Designing the Physician Organization	312	(4)
Traditional Clinical Organization	312	(2)
The Emerging Physician Organization	314	(2)
Measures of Performance	316	(11)
Clinical Support Services	327	(44)
Definition and Purpose	327	(1)
Functions	328	(25)
Quality	328	(4)
Appropriateness	332	(2)
Facilities, Equipment, and Staff Planning	334	(1)
Amenities and Marketing	335	(2)
Patient Scheduling	337	(3)
Continuous Improvement	340	(1)
Budgeting	341	(9)
Human Resources Management	350	(3)
Management and Organization	353	(6)
Requirements of CSS Managers	353	(1)
Organizing CSSs	354	(1)
Integrating CSSs	354	(2)
Compensation of CSS Personnel	356	(3)
Measures and Information Systems	359	(12)
Demand and Market Measures	359	(1)
Costs and Resources	360	(2)
Human Resources Measures	362	(1)
Outcome and Productivity Measures	362	(1)
Quality Measures	362	(1)
Process Quality	363	(1)
Customer Satisfaction Measures	364	(1)
Constraints	365	(1)
Information Systems	366	(5)
Nursing	371	(36)
Definition	371	(1)
Purpose	372	(1)
Scope	373	(3)
Institutional Nursing	373	(1)
Community Nursing	373	(1)
Advanced Practice Nurse Roles	374	(2)
Functions	376	(19)
Nursing's Role in the Eight Functions of CSSs	376	(19)
Personnel and Organization	395	(3)
Educational Levels of Nursing Personnel	396	(1)
Nursing Organization	397	(1)
Measures and Information Systems	398	(9)
Measures	398	(3)
Information Systems	401	(6)
Prevention and Nonacute Services	407	(36)
Purposes	409	(2)
Coordinating Outreach Services	411	(12)
Prevention and Health Promotion Programs	413	(2)
Expanded Ambulatory Services	415	(1)
Home Care	415	(2)
End-of Life Care	417	(1)
Long-Term Institutional Care	418	(4)
Housing	422	(1)
Strategy for Integrated Healthcare Organizations	423	(5)
Measurement	428	(15)
Demand and Output	428	(2)
Costs and Productivity	430	(1)
Quality	431	(1)
Customer Satisfaction	431	(1)
Role of the Healthcare Organization	432	(11)
PART III Learning: Meeting Planning, Marketing, Finance, and Information Needs
Planning Future Directions	443	(42)
Purpose	443	(2)
Functions	445	(22)
Surveillance	445	(4)
Strategic Positioning	449	(13)
Developing and Evaluating Programmatic Proposals	462	(2)
Maintaining Relations with Government and Other Health Agencies	464	(3)
Organization	467	(3)
Personnel Requirements	467	(2)
Organization	469	(1)
Measures of Effectiveness	470	(3)
Demand, Output, and Productivity Measures	470	(1)
Resource Measures	470	(1)
Quality Measures	471	(1)
Customer Satisfaction Measures	472	(1)
Goals for Measures	472	(1)
Issues in Planning Success	473	(12)
Technical Foundations	473	(3)
Values of Community Healthcare Organizations	476	(9)
Marketing the Healthcare Organization	485	(32)
Purpose	486	(1)
Functions	486	(24)
Promoting the Organization	487	(3)
Identifying Markets	490	(5)
Marketing to Patients	495	(4)
Marketing to Members	499	(3)
Managing External Relationships	502	(5)
Measuring the Organization's Market Success	507	(3)
Measures of Performance	510	(1)
Global Measures of Marketing Programs	510	(1)
Organizing the Marketing Activity	510	(7)
The Finance System	517	(46)
Purpose	517	(1)
Controllership Functions	518	(24)
Transaction Accounting	518	(2)
Managerial Accounting	520	(9)
Financial Accounting	529	(1)
Budgeting	530	(9)
Protection of Assets	539	(3)
Financial Management Functions	542	(11)
Financial Planning	543	(3)
Pricing Clinical Services	546	(3)
Financial Management of Multicorporate Structures	549	(1)
Securing and Managing Long-Term Funds	550	(3)
Managing Short-Term Assets and Liabilities	553	(1)
Personnel and Organization	553	(4)
Chief Financial Officer	554	(1)
Organization of the Finance System	555	(2)
Measures of Performance	557	(6)
Cost Measures	557	(1)
Revenue Management Measures	558	(1)
Technical Quality of Financial Services	558	(1)
Customer Satisfaction	559	(4)
Information Services	563	(28)
Definitions and Purpose	565	(1)
Definitions	565	(1)
Purpose	566	(1)
Functions	566	(18)
Maintain the Information Services Plan	567	(6)
Ensure the Integrity, Quality, and Security of Data	573	(4)
Integrate Data Capture, Processing, and Communication	577	(3)
Archive and Retrieve Data	580	(2)
Train and Support Users	582	(2)
Organization	584	(5)
Chief Information Officer	584	(1)
Information Services Advisory Committee	585	(1)
Patient Registration and Records Management	585	(1)
Communications and Central Services	586	(1)
User Support and Systems Planning	586	(1)
Use of Outside Contractors	587	(2)
Measures of Performance	589	(2)
Human Resources System	591	(44)
Purpose	598	(1)
Functions	599	(26)
Workforce Planning	599	(4)
Maintenance of the Workforce	603	(7)
Management Education	610	(2)
Compensation	612	(8)
Collective Bargaining Agreements	620	(2)
Continuous Improvement and Budgeting	622	(3)
Personnel and Organization	625	(2)
Human Resources Management as a Profession	625	(1)
Organization of the Human Resources Department	625	(2)
Measures and Information Systems	627	(8)
Measurement of the Human Resources Department	627	(1)
Information Systems	628	(7)
Plant and Guest Services System	635	(36)
Purpose	635	(2)
Functions	637	(18)
Facilities Planning and Space Allocation	637	(5)
Facilities Operations	642	(2)
Clinical Engineering	644	(1)
Maintenance Services	644	(3)
Guest Services	647	(2)
Supplies Services	649	(2)
Continuous Improvement and Budgeting	651	(4)
Personnel and Organization	655	(7)
Personnel Requirements	655	(1)
Training and Incentives	656	(1)
Use of Contract Services	657	(4)
Organization	661	(1)
Measures of Performance	662	(9)
Measures of Output and Demand	662	(1)
Measures of Resource Consumption and Efficiency	663	(1)
Measures of Human Resources	664	(1)
Measures of Quality	665	(1)
Establishing Constraints and Expectations	666	(5)
Glossary	671	(14)
Index	685	(26)
About the Authors	711