MANAGEMENT TEST 1

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2 Benefits of Boundary spanning

2 Benefits of Boundary spanning: i. Monitor all external stakeholder groups to identify changes in their needs and desires ii. Forecast patient needs to plan staffing and facilities.

Define Alternative Dispute Resolution

• Alternative Dispute Resolution: The methods that can be used to settle disputes other than by recourse to the legal system are known as alternative dispute resolution (ADR). ADR has been widely used for decades to resolve commercial disputes, and it is becoming more common in the health services field. ADR is private, inexpensive and efficient—attributes that are especially important to health services organizations. (ref manual, 113) Negotiation should always be a first step used by any manager in solving disputes.

"Organization within Organization"

"Organization" within an Organization • The informal organization usually exists within a formal organization • Characterized by dynamic behavior and activity patterns that occur within the formal organization structure of people working together • Combined, the formal and informal organizations make up the actual organization • Either should not be ignored!!!! A healthcare delivery organization is a bureaucratic organization. that recognizes and capitalizes on those individuals' interdependence & uses specialization to enhance individual contributions, so that the whole is substantially more valuable then anything they could have achieved on their own. The purpose of the bureaucratic organization is to facilitate responsiveness to the environment. Longstanding groups develop informal organizations. The formal organization or hierarchical organization is where people are granted authority over certain activities, held accountable for certain results, and given incentives for achieving them. Rules of collaboration must be established for a collateral organization of group activities, committees, task forces, and work groups. The formal organization strengthens the informal organization and does what the informal one cannot. Informal organizations are powerful, if not always reliable, communication links. They can exert power here formal orgs cannot.

Purpose of Cultural Leadership?

2. Purpose of Cultural Leadership: a. Effectively implement transformational management of teams from the bedside to boardroom b. Sustain environment where all associates are empowered and motivated to meet customer needs

Qualifications of Leaders?

2. Qualifications of Leaders i. Leaders should be promoted on the basis of contribution. ii. Leadership qualities were formerly described in terms of degrees and years of experience. iii. Competency (requisite of adequate ability or quality that results in effective action and/or superior job performance) has expanded the opportunities to describe leadership requirements, evaluate candidates, and develop learning opportunities. v. When selecting a leader, interviews are conducted, references checked and written documentation reviewed to assess each candidate's record and compare it with the required competencies. The task of judging is assigned to small search committee. vi. As leaders advance, clinical and professional understanding grows along with business acumen but need for mastery of specific area diminishes. vii. Studies support that the top qualities for hiring an early careerist healthcare manager are the following rank-ordered skills: interpersonal communication, working in teams, planning and managing projects, and solving business problems, and professional ethics

3 key interrelated actions that make up design:

3 key interrelated actions that make up design: i. specifying the tasks and the accountability for each small work group ii. establishing the reporting and supervisory responsibilities of middle management, which constitutes the accountability hierarchy iii. building collateral relationships between hierarchies, thereby allowing them to coordinate and integrate their expectations toward a common goal • Responsibility falls more heavily on the executive office than on any other unit • Governing board is rarely involved but sometimes approves the final plan

Leadership Development Programs

3. Leadership development programs i. Definition= internal program to assist managers in improving leadership skills ii. All levels of leadership must maintain continuous improvement, promote & implement the work of PITs, and address the identified needs of associates and customers. iii. Leadership must also models the behaviors expected of associates and customers; responds to associate needs; maintain alignment and integration between teams; and effectively use the elements of cultural, operational, and strategic foundation.

What makes Culture Effective?

3. What makes Culture effective? a. Two forces that make transformational, empowerment, service-excellence culture effective: i. Energy and commitment released from empowerment ii. Establishment of clear goals, not just overall, but in detail so that every associate knows the HCO's mission and his contribution to it

3 Performance measures for responsive communication

3Performance measures for responsive communication: 1. responsive communication 2. Number of issues raised 3. Retention, vacancy measures, absenteeism

4 Critical Issues in Leadership?

4 Critical issues in Leadership: a. Listen to associates and provide associates with what they need to fulfill the mission b. Implement responsive leadership to build and sustain culture (use training, selection, and modeling to create this environment) c. Measuring and improving HCO culture (associate and customer satisfaction measures used to improve relationships and communication. d. Establishing program to respond to resistance and protect against damage.

4 characteristics of evidence-based medicine and evidence-based management:

4 characteristics of evidence-based medicine and evidence-based management: a. It strengthens the physician's role as selector of protocol and monitor of protocol , with the obligation to depart from the usual path when it is failing the patient b. It empowers nurses and other caregivers both to provides physician-ordered services and to identify and meet patient needs c. It stresses measured, audited, benchmarked performance in all components of care, enabling the results to be shared with the governing board and the stakeholders. d. It approaches benchmark performance through continuous improvement.

5 Critical Issues in Operational Leadership

5 Critical Issues in Operational Leadership: i. Maintaining contact with all stake holder groups a. Conduct surveys, listen, and hold formal meeting to ensure balanced, timely flow of information from external to internal stakeholders ii. Sizing the organization and its components a. Use epidemiological planning model to size clinical and other units to meet clinical needs iii. Measuring & reporting performance a. Maintain a system of timely performance measures & benchmarks iv. Supporting a learning organization a. Maintain consultation and training services to meet all performance improvement needs. v. Resolving issues in timely manner and adhering to an annual calendar a. Use board's authority to limit negotiations and prevent unnecessary delay..

5 FUNCTIONS THAT SUSTAIN OPERATIONAL INFRASTRUCTURE

5 FUNCTIONS THAT SUSTAIN OPERATIONAL INFRASTRUCTURE 1. Boundary Spanning 2. Knowledge management 3. Accountability & Corporate Design 4. Continuous Improvement 5. Sustaining and improving the operational infrastructure.

Five Functions that sustain operational infrastructure:

5 Functions that sustain operational infrastructure: i. Boundary spanning a. Monitor all external stakeholder groups to identify changes in their needs and desires b. Forecast the need for services, the number of services to be supplied, and the size of these services. ii. Knowledge management a. Ensure that each individual and team has prompt, complete, and reliable information for achieving their goals. iii. Accountability & corporate design a. Establish explicit expectations of every team, and assemble an integrated array that optimally meets the community needs iv. Continuous improvement a. Pursue opportunities for OFI, set goals, and implement improvement in timely and coordinated fashion. v. Sustaining & improving Operational infrastructure

5 Steps in a Major Reorganization:

5 Steps in a Major Reorganization: i. Plan the process - small team convened to examine issues, identify goals and participants ii. Build awareness - deliberate effort to make most trustees, managers and medical leaders aware of the need iii. Formulate the overall strategy - incorporate constraints and guidelines suggested by the organization's history and mission and incorporate them into a revised mission/plan iv. Check resources and requirements - staff and task forces outline the long range plans implied by the strategy v. Implement the design - write the new processes, train the people, obtain any relevant equipment and supplies and install measures of success

5 Traits of a strong communication program

5 Traits of a strong communication program: 1. Managers model desirable behavior to reinforce formal training 2. Senior management is involved along with associates in the work and two-way communication 3. Systematic review of customer complaints 4. Servant leadership 5. Frequent direct contact between leader & associates and associates & customers.

5 major sources of data given by the epidemiological planning model:

5 major sources of data given by the epidemiological planning model: a. Population that will use the service b. Disease risk/ Population at risk that will need the service ➢ Indicators used to identify the risk of occurrence of medical needs: i. Incidence= number of new cases in the population in given period ii. Prevalence= number of cases at the point in time iii. Demand= number of cases actually sought. ➢ Risk of disease is dependent on age, genetics, income, and lifestyle c. Market share / Population at risk that will seek care at a specific HCO. ➢ Protocols and historic usage data used to estimate market share ➢ Market share is forecast on the basis of the HCO's ability to retain or increase its attractiveness to patients. ➢ Market share is established by the planning committee d. Staff requirements(number of people needed to meet demand) ➢ Staffing requirement is estimated on the basis of capacity of each skill level required. ➢ Capacity is measured by history, survey, and benchmark. e. Facility requirements (Facility size needed to meet demand) ➢ Estimated on the basis of the number of patient expected and length of time they will require service plus ➢ Allowances must be made to meet peak, rather than average, demand ➢ History, benchmarks, and simulation models are used to forecast how many rooms and specialized facilities will be required.

5 management functions and their link to decision making

5 management functions and their link to decision making • Five Management Functions: i. Planning ii. Organizing iii. Controlling iv. Directing v. Staffing • Link to Decision Making: Decision making is an inherent activity of managers, and they make decisions within and among the five management functions. Decision making is part of the process of problem solving, which also includes problem analysis. Performance of the management functions and the decision making of problem solving should be evaluated using explicit and measurable criteria. In addition to engaging in the five management functions, managers must use specific skills, play various roles and show that they possess a number of competencies. (ref manual, 107)

6 Elements of Management Style

6 Elements of Management Style (Griffith Ch 4 - The Executive Office): i. Predictability - in work product ii. Candor - in telling the truth in situations iii. Responsiveness - to questions/concerns from both above and below iv. Persuasiveness - across the organization v. Conflict resolution - in a way that is predictable, reasonable and as constructive as possible vi. Participation - adding opinion Mnemoic= P3C2R1

6 Elements of a leadership development program?

6 Elements of a development program: 1. Cultural foundations are clear to all associates and reinforced by leaders at all levels. 2. Promotion to any leadership position is based on demonstrated superiority in relevant subordinate positions and mastery of the new position's required competencies. 3. Promoted leaders get training in the cultural and operational requirements of the new position (includes classroom education, coaching, and modeling by superiors) 4. Every leader has personal development program to improve performance and prepare them to next promotion. 5. Organization's succession plan identifies at least one successor for every position and coordinates with the successor's development plan 6. For individuals with highest ranks of leadership, the development plan includes expansion in two directions---a graduate degree in healthcare management and experience in leading a relatively autonomous unit.

6 Steps for starting cultural transformation?

6 Steps for starting cultural transformation: 1. It restates and re-commits its mission, vision, and values. It uses visioning process to build board consensus on purposes. 2. The governing board adopts the concepts of the reinvigorated vision and accepts the challenge to move to excellence, recognizing the changes will be profound, but setting milestones and anticipated completion dates 3. Senior leaders agree unanimously to the effort. They begin the spread of the new culture by changing their behavior to reflect responsive leadership. 4. Success of pilots and demonstrations is celebrated and used to show the nature of the new culture and the HCO's commitment to it. 5. Coaching, modeling, and training are used to deliberately to help other managers make the transition to responsive leadership 6. Operational foundation and strategic protections are developed to support continuous improvement and evidence-based management. iv. Success of transformational leadership depends on two conditions:

6. 6 Functions of Cultural Leadership:

6. 6 Functions of Cultural Leadership: 1. Promoting Shared Values 2. Empowering Associates 3. Communication with Associates 4. Supporting Service Excellence 5. Encouraging, rewarding, and celebrating success 6. Improving transformational culture

5 indicators that a culture is effective

A culture is effective : 1. If the associate retention and satisfaction are high 2. Recruitment shortages, accidents, and absenteeism are low 3. Operating goals are met and moving toward benchmark 4. Patients are satisfied 5. Market share is growing.

How can Accountability & corporate design be implemented:

Accountability & corporate design can be implemented: i. Expectations and accountability are established and integrated in the annual goal-setting process ii. Corporate structures such as subsidiaries, joint ventures, and strategic partnerships support a broad scope of healthcare activities, including primary, acute, and post-acute care

Define Accountability Hierarchy.

Accountability Hierarchy: i. A reporting and communication system that links each operating unit to the governing board, usually by grouping similar centers together under middle management. ii. Establishes managerial rank with work teams reporting directly to "manager" who report to "division director" iii. Excellent HCO that operate under evidence-based management have moved beyond hierarchy concepts iv. Hierarchy is retained because it is essential in negotiating goals and monitoring performance.

Adam Smith & management

Adam Smith the father of economic theory, asserted in The Wealth of Nations that greater productivity and efficiency could be achieved in manufacturing processes if each task were separately identified and performed by a specialist. Like manufacturing, medicine has evolved similarly.modern medical practitioners have distinct areas of interest, requiring people in need of services or treatment to travel from one specialist to another. In this way, healthcare became organized around the convenience and productivity of the physician—the highest cost resource—and not the patient....

Define Agency or accountability failures

Agency or Accountability Failures: board members are failing to act as agents of the community as whole. Example= using membership as tool for social or business gain or viewing membership as honorific rather than community obligation. Defenses against such failures lie in board leadership and selection. Boundary spanning and visioning exercises can be helpful. They can elect new members from the community who can comitt to the HCO's mission and are skilled in transformational and evidence-based management

All of the following are the advantages of informal relationships in organizations except: a) Provide social values and stability b) Provide additional channel of communication c) May simplify managers' job d) Their inflexible characteristic prevents deviations from organizational policies Answer: D. (Pg 135, Chapter 3 - Concepts of Organizational Design) in fact the flexibility & spontaneous nature permit deviations that contribute to organizational objectives.

All of the following, according to Mint berg, are important implications to grouping (or departmentalization) for workers and their organizations except: a) Sets up a system of common supervision b) Facilitates sharing resources c) Leads to common measures of performance d) Leads to communication breakdown

All of the following, according to Mintzberg, are important implications to grouping (or departmentalization) for workers and their organizations except: a) Sets up a system of common supervision b) Facilitates sharing resources c) Leads to common measures of performance d) Leads to communication breakdown Answer: D. Leads to communication breakdown. Grouping actually encourages communication due to shared input resources and output objectives along with close physical proximity. Online Packet, Chapter 3, Concepts of Organizational Design, Page 120.

Annual Planning Calendar

Annual Planning Calendar i. Board refines the long-range plans into short-terms goals for all dimensions of the strategic performance measures. Board's task is to balance customer and associate needs, establishing organization-wide goals that sustain excellence. iii. Senior management begins the translation to operational goals for every unit. iv. Board's finance committee establishes the amount of funds for capital investment and expansion. v. All groups set operational goals using the strategic goals as a guide along with OFI. vi. Negotiations conclude, and explicit operational goals for every gour in the accountability hierarchy vii. New process improvements allow board to raise the strategic goals in the next annual planning round viii. Anticipated improvements are implemented by 90-day interim period.

Appeals process is governed by the following 5 principles

Appeals process is governed by the following principles: 1. Evidence drives decisions 2. Negotiations improved by patience, listening, and imagination 3. Equity, not equality, drives the organization's ultimate position 4. Stakeholders and associates are free to terminate their relationship with the organization; conversely, the group as a whole can terminate its relationship with any stakeholder (usual goal is to retain and strengthen relationship) 5. Governing board forces decision.

How to assess leaders as individuals?

Assessing leaders as individuals i. Each leader has an annual 360-degree or multi-rater review to supplement the measures of unit performance. ii. Self-assessments from the National Center for Healthcare Leadership and Healthcare Leadership Alliance allow individuals to compare their skills with those demonstrated by successful managers. iii. Organizations put a premium on diversity, seeking to advance underrepresented groups to higher management levels with the goal of incorporating the demographics characteristics of the community into the organizational hierarchy.

Define Boundary Spanning

BOUNDARY SPANNING 1. Surveillance 2. Planning Services Using forecasts of need & demand Can to be used to forecast patient needs to plan staffing and facilities. Involves monitoring all external stakeholders to identify changes in needs

Benefits of Knowledge Management

Benefits of Knowledge Management: i. Provide prompt, complete, and reliable information for any associate or team purpose

Benefits of accountability & corporate Design?

Benefits of accountability & corporate design: i. Establishes explicit expectations of every team ii. Provides an integrated array that optimally meets community needs.

Benefits of continuous improvement

Benefits of continuous improvement i. Improve measured performances ii. Reaches decision in a timely and coordinated fashion.

Benefits of encouraging, rewarding, and celebrating success

Benefits of encouraging, rewarding, and celebrating success" 1. Build associate loyalty 2. Reinforces appropriate behavior

Benefits of sustaining & improving operational infrastructure

Benefits of sustaining & improving operational infrastructure: i. Improve the operational & strategic foundations

Main reason for selecting a board member?

Board members are selected for their community commitment and demonstrated skill.

Qualitative indicators for boundary spanning

Boundary Spanning a. Qualitative Indicator ➢ Systematic listening and comments of customer stakeholder leadership ➢ Competitor activities (eg. Published/suspected competitor activities) ➢ Changes in healthcare financing (source= reports/awards) ➢ Changes in healthcare technology ➢ Changes in local employment, attitudes, or civic commitments (source = government legislation or regulation)

How to implement boundary spanning?

Boundary Spanning is implemented: i. Governing board members, senior executives, and other managers solicit stakeholder perspectives and describe HCO opportunities ii. Ongoing market analysis identifies trends in patient and associate needs iii. Epidemiological planning model sizes all clinical unites

Communications Network

Communications Network i. Short-term responses to patient and other needs must be communicated quickly and accurately. ii. Accuracy and completeness are improved by multiple users; erroneous material is questioned and corrected or abandoned iii. Policies placed that forbid spamming, deliberate distortion, and other improper messaging

Define Completeness as a criterion.

Completeness as a criterion means the: i. Library is constantly expanding ii. Process get extended iii. Measures & adjustment get approved iv. Histories get longer.

Contingency planning and its application in health services organizations

Contingency planning and its application in health services organizations • Contingency planning: a plan devised for a specific situation when things could go wrong. Contingency plans are often devised by governments or businesses who want to be prepared for anything that could happen. They are sometimes known as "Back-up plans", "Worst-case scenario plans" or "Plan B". Contingency plans include specific strategies and actions to deal with specific variances to assumptions resulting in a particular problem, emergency or state of affairs. They also include a monitoring process and "triggers" for initiating planned actions. They are required to help governments, businesses or individuals to recover from serious incidents in the minimum time with minimum cost and disruption. (Wikipedia, 2008) • Application in Health Services Organizations (ref manual, 112): i. Disaster planning ii. Interruption planning (of vital utilities - water, electricity)

Qualitative Indicator for continuous improvement

Continuous improvement a. Qualitative Indicator ➢ Difficulty in negotiating goals ➢ Complaints about PITs or timetable

How is continuous improvement implemented?

Continuous improvement can be implemented: i. PITs develop improved processes, guided by a PIC, which coordinates and integrates improvements ii. PITs and goal-setting process follow a quarterly and annual calendar

Corporate Design

Corporate Design a. Consists of charters, bylaws, and long-term contracts that establish the HCO's legal entities and link together its major units b. Care is so fragmented, and individual units are so small that healthcare is frequently called "cottage industry"--- ➢ Fragmentation is believed to be opportunity to improve quality, service, and efficiency. ➢ Healthcare reform will increase pressure for integration and strengthen incentives for improving cost and quality. c. Physician ownership creates a conflict of interest and the potential excess use of services. d. Nonprofit ownership gives local community greater control over the size and scope of the healthcare enterprise. e. Most nonprofit hospital are in single community systems that retain privilege contracts with independent physicians. f. High-performing HCO operate multi-site and multipurpose. ➢ They are acquiring or joint-venturing with medical practices and non-acute services ➢ Extended their influence via collaborative efforts, forming consortiums, joint ventures, and partnerships with private, charitable, and government organizations that share a common mission. ➢ Emerging corporate design includes parent corporation, wholly owned subsidiaries, partially owned joint ventures, and long-term strategic partnership contracts without ownership.

Difference between Critical pathway and clinical protocol

Critical pathway standardizes the treatment approach for a given condition. Clinical protocol standardizes the decision process for adopting a treatment approach.

How does Cultural Leadership celebrate, reward, and encourage success?

Cultural Leadership & Encouraging, Rewarding, and Celebrating success i. Patient satisfaction, bonus, and "caught in the act" programs are examples of encouraging, rewarding , and celebrating success. 1. Simple recognition and encouragement is the most common form of celebration 2. "Caught in the act" is public reporting to identify positive behavior; Any associate or visitor can submit the decription of the act he or she thinks is exceptional and the submission is posted to the associate's record. ii. Benefits of encouraging, rewarding, and celebrating success" 1. Build associate loyalty 2. Reinforces appropriate behavior iii. Performance reviews, celebrations and incentive compensation can be used to implement rewards and encouragement

How does Cultural Leadership Support service excellence? (6 key elements)

Cultural Leadership & Supporting service excellence: i. Service excellence model is the goal of transformational culture. ii. All associates and managers are partners in satisfying the patient as the ultimate customer iii. Leaders trust the associates. iv. To establish a transformational culture, leaders do: 1. Promote shared values 2. Empower associates 3. Communication 4. Implement the operational foundation. v. Negotiating 1. Associates must be encouraged to raise concerns. 2. Recurring issues are settled by formal processes rather than individual judgments 3. Leaders must be trained to respond to concerns. A good answer begins with reassurance that concern is legitimate and assumes the associate's good intention without placing blame; They explain how the current situation was reached and how the process can be improved. This approach reduces disagreement. vi. Continuous improvement e. Encouraging, rewarding, and celebrating success Performance reviews and incentive compensation can be used to implement rewards and encouragement

Differentiate the formal and informal organization and how each can aid in achieving objectives

Differentiate the formal and informal organization and how each can aid in achieving objectives • Informal Organization: any group that develops in which people learn to respect the power, if not the rights of others, to share information and gratification, to make partnerships and friendships, and finally to divide and specialize work. (Griffith, Ch 5 - Designing the Organization) • Formal Organization: also called heirarchial, in which people are granted authority over certain activities, held accountable for certain results and given incentives for exceeding them. (Griffith, Ch 5 - Designing the Organization) • Aid in Achieving Objectives: the best formal organizations not only recognize their informal structures, but also exploit their strengths and overcome their weaknesses. The formal organization strengthens the informal one and does what the informal can not. Informal organizations are powerful, if not always reliable, communications links. (Griffith, CH 5 - Designing the Organization)

Differentiation is the extent to which units produce the same complementary or disparate scope of services. Structures that combine similar organizations have a low differentiation and are said to be: a) Vertically integrated b) Horizontally integrated c) Diversified d) Technically integrated

Distinguish strategic and operational planning and know their elements and processes

Distinguish strategic and operational planning and know their elements and processes • Strategic Planning: a process reviewing the mission, environmental surveillance and previous planning decisions used to establish major goals and non-reoccurring resource allocation decisions. (Griffith) Strategic planning addresses the longer-term direction and goals selected by the organization through its governance and management in order to accomplish its goals. Strategic planning may also be called strategic management, which suggests the broader, more dynamic concept of fully integrated management and planning. An extension of strategic planning that seeks to affect the external environment is strategic issues management (SIM). SIM is a systematic process that proactively influences the external environment so that it is more favorable to the organization rather than reacting to events after they occur. (ref manual, 110) • Operational Planning: Operational planning focuses on the direction and activities of individual units and departments of the organization. The operational plan must be coordinated with and is subordinate to the strategic plan. (ref manual, 111)

How to ensure leadership continuity?

Ensuring leadership continuity i. Leadership succession plan is a systematic process for evaluating the leadership requirement of each opposition, identifying potential candidates for those positions, and prompting the candidates to develop skills needed for being successful in higher-level roles. ii. Primary purpose of leadership succession plan is to fill leadership vacancies with available internal talents. iii. Successions plan is reviewed and approved by the governing board. iv. 3 key features of succession plan: 1. Attracts the "best and brightest" 2. Rewards learning and achievement 3. Builds a culture of "a great place to give care" that supports the retention of not only more people but also more capable people than alternative approaches.

How to implement the epidemiological planning model?

Epidemiologic Planning Model is implemented via i. Computerized analysis that combines population forecasts and usage data from national sources and applies them to local areas ii. Resulting projections are translated to actual personnel and facility forecasts by internal or external consultants iii. Size of support services is driven by the aggregate forecasts of clnical services. iv. Governing board has the final decision of clinical services. Senior management is responsible for negotiating a recommendation that is acceptable to associates involved in service and board

Examples of Boundary Spanning

Examples of Boundary Spanning: i. Board members selected to prior community service ii. Senior managers participate in community services such as education and housing; monitor state and national developments that could affect HCO iii. Quantified plans for services, facilities, and personnel reflect trends in community need

Examples of knowledge Management?

Examples of Knowledge management include: i. Automated patient record and access to clinical information ii. E-mail & intranet iii. Readily accessible data warehouse with operational measures, goals, benchmarks, and current achievements

Examples of accountability & corporate design?

Examples of accountability & corporate design include: i. 90-day plans used to reach agreed-on goals ii. HCO includes primary and continuing care services, forms joint ventures with medical staff, and merges with another HCO iii. HCO organizes care-giving teams into service lines and makes effective clinical support services available

Examples of continuous improvement:

Examples of continuous improvement: i. Annual goal-setting and budgeting activities proceed according to a prearranged timetable initiated and finished by governing board action. ii. PITs are scheduled to coordinate with budget deadlines.

How do excellent HCO improve internal processes?

Excellent HCO improve internal processes by: a. Pursuing listening opportunities b. Repeated demonstration of commitment to values c. Training associates d. Assembling and reviewing notes from contacts.

Five Functions of Leadership?

Five functions of leadership: a. Promote shared values by establishing, disseminating and modeling attractive mission, vision, and values b. Empower associates so they they can change their work environment to achieve mission c. Listen responsively to associates so that their needs are met and the responses model the organization's values. d. Support service excellence that helps delighted associates delight patients e. Celebrate and reward success.

For most members of well-managed organizations, the front office is: a) A source of authority b) A resource and a guide c) A major stakeholder d) A decision maker only

For most members of well-managed organizations, the front office is: a) A source of authority b) A resource and a guide c) A major stakeholder d) A decision maker only Answer: B. Griffith and White, page 114.

4 prerequisites for effective boundary spanning

Four prerequisites for effective boundary spanning: a. Network of listening activities must be established so that HCO has entrance into and recognition with specific stakeholder groups b. Trust must be established and common values recognized, so that the stakeholders are candid and comfortable discussing complex topics c. Associates must be trained to hear accurately what the stakeholders are saying and to represent the HCO's perspective. d. Knowledge gained from dozens of individual contacts must be systematically assembled, analyzed, and integrate

From the "Management & Managers" chapter in "Managing in the Health Services Environment", one conceptualization of the roles of managers views them as playing a "trinity" of roles; those three roles are described as: a) Designer, leader, and strategist b) Developer, despot, and diviner c) Creator, coordinator, and theorist d) Educator, expert, and evaluator

Goal of Standardization of performance measures?

Goal of standardization of performance measures: i. Make transparent the measures used to evaluate performance, ii. identify OFI iii. Analyze alternative process

Hershey and Blanchard describe a model of situational leadership that includes four styles of leadership behaviors which must be balanced according to the situation. These leader behaviors include all of the following styles except: a) Telling b) Delegating c) Consulting d) Selling

How Does Cultural Leadership Empower Associates?

How Does Cultural Leadership Empower Associates? b. Empowering associates i. 360-degree manager assessments and associate role in performance improvement teams (PIT) serve as examples of empowering associates. ii. Benefits of empowering associates are: 1. Strengthens associate self-image, encourages continuous improvement, and promotes responsiveness to customers iii. "Servant Leadership"= term that describes that leader's role in reinforcing empowerment by being sensitive to associate's needs iv. Empowerment and servant leadership create a culture where questions can be asked, answers sought, and changes implemented. They remove blame. They reassure associates that the HCO's commitment to mission and values is real.

How does Cultural Leadership Communicate with associates?

How does Cultural Leadership Communicate with associates? Communicating with associates: i.Communication methods include reports on goal achievement, rounding, informal meetings, focus groups with open ended questions, surveys & comment cards. Communication does not have to be face to face. ii. Cultural leadership requires leaders to participate in communication by reinforcing the values. Reinforcement is supplied by listening and modeling 1. Transformational management depends on making sure that all associates concerns are heard and are given constructive response (responsive leadership). It is a major factor in associate satisfaction and essential to performance improvement 2. Transformational leadership relies on repetition and consistency and leaders are expected to model the HCO's values and demonstrate how they are applied. a. Coaching, modeling, and training are used to help managers to transition to responsive leadership. b. Operational foundation and strategic protections support continuous improvement and evidence-based management

How does Cultural Leadership promote shared values?

How does Cultural Leadership promote shared values? a. Promoting Shared values i. Repetitive modeling, rewards, and visioning exercises can be used to implement shared values ii. Training is critical to establishing mission and value based culture 1. New applicants are asked to read & accept mission 2. CEO or senior manager explain the mission and values to new associates 3. Leader reinforce the message by breaking down the vision and describing how the overall vision affects the individual and the work unit

How does an HCO starts its cultural transformation?

How does an HCO start its cultural transformation? a. Goal (what customer wants and needs) is the organizing force. b. Cultural transformation begins with visioning exercise (deliberate effort to get stakeholders to focus on the mission, vision and value and to understand them)

HR measures of leadership

Human Resources Measures of Leadership 1. Leader retention is expected 2. Leaders departure is reviewed and analyzed 3. Leader satisfaction is assessed by survey

If management functions are seen as being interrelated like the pieces of a puzzle, which piece below does not fit: a) Direct work; does the front line work the staff can not perform b) Planning; deciding in advance what is to be done c) Staffing; acquiring, maintaining, and retaining human resources d) Organizing; developing intentional patterns of relationships among people and other resources Answer: A. Management is general not doing front line work and instead concerns themselves with planning, organizing, decision making, controlling, directing, and staffing.

Impact of Bundled Payments?

Impact of bundled payment is to align physician and hospital incentives to control cost, providing strong motivation for collaboration in managing complications and selecting the most cost-effective treatment

How can the transformational culture be improved?

Improving the transformational culture: i. Improvements in transformational culture can be implemented with review of learning, perceptions, attitudes, and achievements ii. Examples of improvements= better programs to help new leaders & improved incentive programs.

In Mintzberg's view, almost all organizations can be included in one of five basic designs. Which form is characterized by an operating core that is composed primarily of professionals that form the heart of the organization? a) Divisionalized form b) Professional bureaucracy c) Adhocracy d) Machine bureaucracy

In Mintzberg's view view, almost all organizations can be included in one of five basic designs. Which form is characterized by an operating core that is composed primarily of professionals that form the heart of the organization? a) Divisionalized form b) Professional bureaucracy c) Adhocracy d) Machine bureaucracy Answer: B. From pages 137-138 of the Online Packet.

In Mintzberg's view, how many basic organization designs are there, and what are they? a) 1 b) 3 c) 5 d) 7

In Mintzberg's view, how many basic organization designs are there, and what are they? a) 1 b) 3 c) 5 d) 7 Answer: C. There are 5 basic organization designs, they are: Simple Structure, machine bureaucracy, professional bureaucracy, divisionalized form, and adhocracies.

Key organization design concepts that guide the formal structure of most HSOs/HSs were developed by a group of general administrative theorists. Which of the following theorist utilizes 14 Principles of Management: a) Adam Smith b) Max Weber c) Henri Fayol d) Nicolo Machiavelli Answer: C. (Chapter 3 - Concepts of Organization Design) Fayol's work was one of the first comprehensive statements of a general theory of management. He proposed that there were six primary functions of management and 14 principles of management 6 Functions of management To forecast To plan To organize To command or direct To coordinate To lead

Kilpatrick model implication on cultural & leadership?

Kilpatrick model implies: 1. Any culture getting mission results is good culture 2. If mission results are unsatisfactory, the culture should be considered as one possible cause. 3. Assumes that training must be justified by mission achievement

How to implement knowledge management?

Knowledge management can be implemented via: i. Strong clinical & business information systems, widespread access and a culture of communication ii. Training for repetitive tasks iii. Just-in-time training for arising tasks.

Leadership influence

Leaders are able to exercise leadership behavior that influences followers'behavior to achieve objectives because they have authority or power. Various sources of power have been identified: legitimate (formal), reward, coercive, expert and referent. Effective leaders understand the risks and benefits of using each kind of power and try to use it appropriately. Researchers have identified leader traits (e.g., assertive, cooperative, decisive,dependable) and skills (e.g., intelligent, conceptually skilled, creative, persuasive) as a way to explain leader success. Others have focused on leader styles; forexample, Likert's continuum of leadership effectiveness spans autocratic,benevolent, consultative and participative/democratic. An

Library of Work process, protocols, & measures

Library of Work processes, protocols, and measures: i. Access, protection, and accuracy criteria must be applied to library because it is the resource for training and communication network. ii. Strategic information relating to work in process must be protected to allow orderly decision making. iii. Open access enhances empowerment, speeds communications, and reduces errors

Likert's continumum

Likert's 4 Leadership Styles 1)Exploitive authoritative One-ways communication, centralized decision-making and use of threats and fear to encourage conformance. 2) Benevolent authoritative One-way communication, centralized decision-making with some delegations, use of reward to encourage staff. 3) Consultative Two-way communication (limited upward communication), decentralized decision-making (limited), and reward-based. 4) Participative Two -ways communication- engaging people lower down the organization in decision-making. Based on group participation. and decentralized decision-making

Machiavelli & management

Machiavelli & management Leadership - Because centuries of tradition, going back to Machiavelli and before, have worked on a very different model: "Truth is what the authority says it is." "Might makes right." "Fear keeps people in line." "Rank has its privileges." The transformational model says "Truth is empirically verifiable fact." "Truth makes right." "Training and rewards keep people in line." "Leaders are servants; rank has obligations." A Good leaders (1.) Should be feared rather than loved "if you cannot be both" in order to avoid a revolt; 2. Should have the support of the people because it's difficult to take action without their support; 3. Should hold good virtues; 4. Should never turn to outside auxiliary or mercenary units, but always rely on his (or her) own arms; and 5. Should be intelligent.

How to maintain ethical foundation?

Maintaining the Ethical Foundation 1. Mission, vision, and values are moral statements 2. Patient care is moral virtue 3. Day-to-day pursuit of servant leadership, continuous improvement, and stakeholder satisfaction are ethical frontiers. 4. Ethical foundation of transformational management is rooted in utilitarian, post-enlightenment moral philosophy 5. Rights to life, liberty , and pursuit of happiness lead to autonomy, malfeasance, beneficence, and justice that underpin the care giving profession. 6. Ethical foundations are supported by laws & regulations that reflect stakeholder consensus 7. Laws and regulation speak to obligations, conflict of interest, and transparency of information (federal acts covering compensation and ect) 8. Professional HCO leaders are to adhere to codes of conducts 9. Evidence-based medicine and evidence based management are adaptations of scientific method that arose in 17th century. (fact drives all analytic and improvement activity) 10. Leader are required to model ethical behavior.; If leaders do not follow consistently, doubt develops and culture deteriorates. 11. Ethics committee is complemented with institutional review board, which monitors ethical issues in research and approves research protocols for involving patients and associates. 12. Ethical decision-making tools identify and involve all stakeholders of an ethical conflict in determining the root causes and implementing approaches that reduce occurrence and associated costs. 13. Servant leadership offers ready assistance when ethical questions arise. 14. Enforcement of ethical rules is carried as part of protection audit activities

Management 10 Roles: CEO, COO, CFO, CMO, CNO, CIO, VP/Planning & Marketing, General Counsel(3), VP HR(5), and VP Plant services(4)

Management's Roles (Griffith Ch 4 - The Executive Office): i. CEO - executive office leadership, for representing the organization to the outside world, for relations with the governing board. ii. COO - operations, selection and support of other line officers, coordination of staff support iii. CFO - finance, accounting, protection of assets iv. CMO - medical staff relations, medical education, medical staff recruitment, physician-hospital organization v. CNO - nursing staff planning and recruitment, inpatient care, outpatient facilities management vi. CIO - information services, information planning, medical records vii. VP, Planning & Marketing - planning support, marketing to intermediaries and buyers viii. General Counsel - bylaws, major contracts, risk management ix. VP HR - workforce planning, recruitment, benefits management, training programs, compensation programs x. VP Plant Services - facilities planning, space allocation, plant operations, plant services

Managers Managing and Leaders Leading

Managers Managing and Leaders Leading • Managers are more caretaking and maintaining status quo (transactional) • Manager skills are used in different proportions, depending on the task and hierarchical level. (senior managers use more conceptual skills; middle-and entry level managers tend to have a more even mix of technical, interpersonal & conceptual skills) • Mintzberg's research; different roles of managers include interpersonal (figure-head, influencer), informational (monitor and spokesperson), and decisional (entrepreneur and negotiator) • Competencies of mangers include conceptual, technical managerial/clinical. Interpersonal/collaborative, political, commercial, and governance • Leading is more visionary and dynamic (transformational). Followers are influenced by a leader's authority or power • Various sources of power for leaders are: legitimate (formal), reward, coercive, expert and referent • Some researchers have identified leader traits (e.g., assertive, cooperative, decisive dependable) and skills (e.g., intelligent, conceptually skilled, creative, persuasive) as a way to explain leadership success; some have focused on leadership styles

Managers as Negotiators

Managers as Negotiators • The art of negotiation involves all transactions in which parties decide what they will give and what they want to get • Often characterized by win-win (cooperative), or win-lose (competitive) • Deming argued that the result of win-lose negotiations is really lose-lose; both parties lose. • Can be formal (contracts), where parties seek mutual benefit fro the legal relationship that results; or informal (memos depicting 2 managers' agreement) • Two sources of conflict in negotiations: the tangibles (how the resources are to be divided) and the intangibles (psychological dynamics - egos, appearances, cooperating fairly, competing effectively)

How is culture measured?

i. Culture can be measured directly by survey and indirectly by the measures of associate satisfaction

Match the correct definition for each of the five management functions. 1. Planning - c 2. Organizing - b 3. Staffing - e 4. Directing -d 5. controlling - a a) Collecting information about and monitoring activities and performance, comparing actual with expected results, and intervening as necessary b) Developing intentional relationships among staff and other resources c) Deciding prospectively what to do or determining a course of action for the organization d) Initiating action by leading, motivating, and communicating with staff e) Acquiring, retaining, and maintaining human resources

Match the correct definition for each of the five management functions. 1. Planning - c 2. Organizing - b 3. Staffing - e 4. Directing -d 5. controlling - a a) Collecting information about and monitoring activities and performance, comparing actual with expected results, and intervening as necessary= Controlling b) Developing intentional relationships among staff and other resources = Collaboration c) Deciding prospectively what to do or determining a course of action for the organization= Planning d) Initiating action by leading, motivating, and communicating with staff= Directing e) Acquiring, retaining, and maintaining human resources= Staffing Answer: No Answer Posted

How can a leader's ability to carry out cultural leadership be measured?

Measurement approach can be refined by measuring the leaders' capability to carry out cultural functions via the Kilpatrick Model: 1. Reactions---leaders should be satisfied with the development activities a. Reactions and learning can be assessed for most of the training and other programs that support each function b. New Associates can be asked to recite the mission, vision, and values c. Clients can be surveyed to assess the skills of their mentors/counselors d. Leaders completing training program can be tested on content. 2. Learning—leaders should be able to recite what they learned 3. Transfer—leaders should be able to apply what is learned a. Can be assessed by surveys of associates and by observation. b. Annual satisfaction surveys c. 360-degree/multi-rater review is critical part of transfer assessment and measured performance should be supported by counseling. d. Retention, absenteeism, and work-related injury are influenced by leadership skill. 4. Results—learning should improve mission achievement measured in the unit operational scorecard. a. Mission related results are assessed by unit operational measures. b. Review of transfer assessment and OFI are helpful.

Measures of Leadership Quality

Measures for Quality of leadership: 1. Quality of training programs is assessed by survey, examination, observation, and later job performance 2. 360-degree reviews directly measure leader capability.

Measures for the Cost & Resources of Leadership

Measures for the Cost & Resources of Leadership: 1. Direct costs of programs are measured and reported by HR 2. Total coast of leadership development is difficult to estimate because many developmental activities are integrated into other work.

Measures of Customer Satisfaction for Leadership

Measures of Customer Satisfaction for Leadership: vi. Customer Satisfaction 1. All measures of unit performance reflect on leadership 2. Associate satisfaction, retention, absenteeism, and work-related lost time measure the leaders' effectiveness.

How to measure the demand for leadership?

Measures of demand for :Leadership 1. Counts of new hires and promotion; goal is 100% new leader participation

Mintzberg's 5 Coordinating Mechnisms

Mintzberg's 5 Coordinating Mechnisms: 1) Mutual adjustment= coordination via informal communication among those in non-heirarchial relationship (eg. 2 nurses sharing info. ) 2) Direct Supervision =coordination where one person takes responsibility for work of others. 3) Standardization of Work Processes= coordinating mechanism that specifies the content of work 4) Standardization of work outputs= specifies the product or expected performance 5) Standardization of worker skills= occurs when neither work process or worker output can be standardized due to complexity of the work.

Mintzberg's Five Types of Organizational Structure

Mintzberg's Five Types of Organizational Structure 1)Entrepreneurial organization:----- loose organizational structure driven by entrepreneurial-minded /creative leaders. Eg=Startup companies managed by founders. Forward-thinking ideals, energy and enthusiasm are strengths. Limited structure, poor task discipline, inefficiency and controlling management are drawbacks if work processes aren't defined. 2)Machine ----highly bureaucratic organization as being like a "machine." (Government agencies & large, set-in-their-ways corporations e.g). Sructure, consistency and longevity are strengths, limited openness to new perspectives & inefficiencies are deficiencies. 3)Professional----similar level of bureaucracy as machine type but has professional, competent knowledge workers. Technically skilled workers have specialized skills and autonomy in their work, creating more decentralized decision making than is prevalent in the machine type. 4)Divisional-- -- Eg, large corporations with multiple business units & product lines. Centralized control with Businesses and products organized into divisions to promote specific management of each division. 5)Innovative-----allows for cutting-edge leadership is the innovative type. Eg. new industries or companies aiming to be innovative leaders. Decentralized decision making is a key trait as leaders allowed to make judgments with efficiency in mind. Potential leadership conflict and uncertainty over authority are drawbacks.

Nationally defined measures are a priority for two reasons:

Nationally defined measures are a priority for two reasons: i. Definitions are rigorously developed and tested and national standardization is essential for benchmarking ii. When unique measures are created or national measures are adjusted for local conditions, the committee provides expert guidance.

Nonjudicial Means of Resolving Disputes.

Nonjudicial Means of Resolving Disputes • Alternative dispute resolution (ADR) - private, inexpensive, and efficient (rather than legal means) • May include and each has qualities that make it best for resolving a certain type of dispute: a) Binding and nonbonding: binding arbitration is contractually required by some health plans to resolve disputes involving alleged medical malpractice and other disputes with enrollees b) Mediation - especially useful when both parties want to maintain relationship c) Mini-trials d) Neutral fact finding e) Variations of the above • Private organizations provide panels of arbitrators, mediators, and other experts in ADR • Negotiation is not a part of the ADR lexicon, but should be used by managers in the first effort to resolve any dispute

Operational Infrastructure

Operation Infrastructure: i. Implements evidence-based management ii. Supports a measured, protocol-driven clinical system iii. Stress on continuous improvement iv. Implements through organizational units: how they will be sized, located, measured, and coordinated and how they will interact and be improved. v. Is essential with purpose of cultural leadership: to sustain an environment of where every associates is empowered and motivated to meet his or her customer needs. Operational infrastructure is managed by senior management, which establishes the direction, importance, and implementation of these activities.

Operational foundation for continuous improvement has 3 major parts:

Operational foundation for continuous improvement has 3 major parts: i. Annual planning calendar ii. Internal consulting resource iii. Process for conflict resolution

4 Qualitative Indicators for Organization Design

Organization Design a. Qualitative Indicator ➢ Requests for service expansion ➢ Effectiveness of PITs (logs of unexpected events= source) ➢ Customer and associate complaints or service concerns ➢ Effective adoption of new technology.

Measures of Output and productivity of leadership?

Output & productivity Of leadership: 1. Counts of program attendance and completion are routine 2. Direct cost per leader served is productivity measure that can be benchmarked

Path of beginners & Transformational Leadership

Path of beginners & Transformational Leadership i. Transformational leadership is learned behavior. What this means for beginners in the healthcare field is summarized in 6 sentences: 1. Commitment to succeed outweighs the path to success a. Emotional stress and requirement for new learning are barriers Even for clinical chiefs, the competency required is in leadership rather than clinical areas. 2. Practice is the foundation for mastering competencies 3. Guided practice—with training, coaching, and feedback---help more leaders succeed and do so faster. 4. Regular review of competencies, identification of personal OFIs and planned actions are critical to leadership development 5.. . Establishing plan for future goals. 6. Formal education has role in leadership development, particularly for the leader who has build the foundations of commitment and practice

5 Performance measures for corporate Design

Performance Measures for Corporate Design: 1. Market share (Surveys of market share) 2. Efficiency of care 3. Per capita cost of care (cost per case and length of stay) 4. Variation in internal performance improvement 5. Unmet or Delayed Demand

5 Performance measures for boundary spanning?

Performance measures for boundary spanning: 1. Trends & variations in satisfaction surveys (patient satisfaction surveys) 2. Counts on unexpected events 3. Financial performance (finance reports) 4. Community health measures (community health surveys) 5. Quality of care measures

Peter Druker & management (4)

Peter Drucker 1) Employees are assets not liabilities. He taught that knowledgeable workers are the essential ingredients of the modern economy, and that a hybrid management model is the sole method of demonstrating an employee's value to the organization. People are an organization's most valuable resource, and that a manager's job is both to prepare people to perform and give them freedom to do so 2) discounted the command and control model and asserted that companies work best when they are decentralized. 3) Introduced "outsourcing" and MBO and concept of knowledge worker. 4) Stated that basic task of a management as twofold: marketing and innovation. Nevertheless, innovation is also linked to marketing (product innovation is a central strategic marketing issue).

Process comprising interrelated social and technical functions and activities.

Process comprising interrelated social and technical functions and activities. • Occurs in formal organizational setting • Undertaken for purpose of accomplishing predetermined objectives • Senior Managers and various managers at various levels are involved at setting those objectives • Managers shape the organizational values and culture; senior managers usually have the clearest and most direct effect • Decisions made at the senior management level have the most dramatic effect on the organization

Process for Conflict Resolution

Process for Conflict Resolution. i. Conflicts, defensiveness, and denial are best handled in private sessions where emotions as well as facts can be explored. ii. Annual planning calendar is essential part of conflict resolution because it establishes deadline for resolution. iii. Governing board is responsible for holding on to the deadline for annual planning calendar

How to protect against destructive behavior?

Protecting Against Destructive Behavior i. Core issues to protect the HCO against minority stakeholder group with divergent goals or against individuals with intentions to impair the organization. ii. Security system iii. Strategic protections---multistep corrective action process for associates iv. Individual with conflicting values or actions is warned, retrained, warned again, and then terminate

In knowledge management, how is protection of information achieved? (4)

Protection Of knowledge is achieved via: a. Identification & password b. Organizing users in groups and knowledge in sets c. Allowing Group access to specific sets of information d. Safeguarding records and communication network

Purpose of Operational Leadership

Purpose of Operational Leadership: i. To sustain an infrastructure to ensure the HCO's array of services is effectively designed, aligned, integrated, and continuously improved.

Purpose of cultural leadership?

Purpose of cultural leadership: i. To sustain an environment of where every associates is empowered and motivated to meet his or her customer needs.

Qualitative Indicators of OFI for Maintaining the Cultural & Operational Infrastructure

Qualitative Indicators of OFI for Maintaining the Cultural & Operational Infrastructure: 1. Boundary Spanning 2. Organizational Design 3. Responsive Communication 4. Continuous Improvement

Resources for internal consulting?

Resource of internal consulting: i. Large PITs have two kinds of technical assistance: a. Meeting management b. Systems analysis ii. PIT chair is trained to lead meeting and is assisted by meeting manager to assist with details iii. Fact-finding and analyses must be assigned to personnel who have time, skills, and resource to do them. iv. Tasks such as epidemiological planning model and designing a staff system require experience and skills v. To support continuous improvement, large HCOs rely on in-house consultants, while small HCOs hire external consultants

4 Qualitative indicators of responsive communication.

Responsive Communication a. 4 Qualitative Indicators ➢ Associate complaints or concerns ➢ Unionization efforts ➢ Success of new hires and promotions ➢ Terminal interview comments

Who Define corporate structure? How do they define corporate design?

Senior management and governance define the corporate structure. ➢ Corporate design is the board decision ➢ Corporate design is based on boundary spanning results and implemented as part of the strategic positioning activities.

How does senior management maintain hierarchy?

Senior management maintains the hierarchy. a. Hierarchies organize patient care around service lines, clinical support around groups of related services and logistic support around functions. b. Managers at every level of the hierarchy are expected to do the following: ➢ Listen continuously to the units, individuals, and patients in their assignment ➢ Achieve agreed-on goals for service, and resolve all issues that threaten goal achievement, either by direct action or by seeking assistance outside their area ➢ Intiate requests for assistance from other areas, and respond to requests from other areas ➢ Convey the organization's global needs, and negotiate realistic improvement goals in their assigned area ➢ Participate in PITs and other continuous improvement activities.

Sources of Leaders? How are leaders chosen in transformational management?

Source of Leaders: i. First level leaders are promoted from team members because they have mastered both relevant knowledge and interpersonal skills. ii. Managers and division directors are promoted from first levels leaders, but at higher ranks they may be recruited from other organizations. iii. Consultants may move to executive posts iv. In logistics & strategic support areas, experience in other industries relevant. v. Senior managers reach their position by following one of the following 3 routes: 1. Obtaining a graduate degree in healthcare mgmt and moving up the organizational hierarchy from initial administrative, support position 2. Developing an interest in management and learning its skills from being a patient care or clinical support professional; this interest then grows as the person is given broad exposure and opportunities for executive education 3. Transitioning from strategic or logistic position into a management role through building a record of excellent performance in large HCOs or consulting companies and then pursing graduate education in healthcare management. vi. Leadership development programs recognize the difference in leaders' background and decisive ways to build comprehensive skill.

Strategic & Operational Planning

Strategic planning addresses the longer-term direction and goals selected by the organization through its governance and management in order to accomplish its goals. Strategic planning may also be called strategic management, which suggests the broader, more dynamic concept of fully integrated management and planning. An extension of strategic planning that seeks to affect the external environment is strategic issues management (SIM). SIM is a systematic process that proactively influences the external environment so that it is more favorable to the organization rather than reacting to events after they occur. Operational planning focuses on the direction and activities of individual units and departments of the organization. The operational plan must be coordinated with and is subordinate to the strategic plan.

Supportive environment can be beneficial to early careerists in 2 ways?

Supportive environment can be beneficial to early careerists in two ways: 1. Supported manger are more likely to remain with HCO because they like the environment 2. Supported managers gain skill and effectiveness that help them successfully address complex issues.

Surveillance

Surveillance i. Surveillance identifies OFI that arise from changes ii. Planning analyses translate the OFI to quantitative forecasts and explicit business plans that the governing board can weigh and adopt. iii. Effective boundary spanning means that a specific plan is created for every existing and proposed unit of the HCO and for all critical resources, including funds, caregivers, facilities, and information. iv. Technology, population changes, attitudes, caregiver shortages, financing mechanisms, and regulation drive change in healthcare. v. Unmet stakeholder needs can impair excellence. vi. Beyond the redesign of internal processes, the HCO should participate in community-related discussion about issues such as income, education, health safety, and the needs of the disadvantaged. vii. Community HCO is expected to keep pace with changes in environment changes rather than replaced by new model: a. Long-term survival of community HCO is promoted by: ➢ Non-profit corporate structure ➢ Tax exemptions that give non-profits a competitive advantage. viii. Identifying and rank-ordering the OFIs that arise from external change requires an ongoing system of listening and negotiating with customers. a. Marketing surveys & customer listening activities cover broad spectrum of current & potential customers and target specific groups. b. Data about stakeholder likes/dislikes and alternatives for attracting stakeholders allow PITs and planning teams to create proposal that met stakeholder needs. ix. Senior management monitors state and national developments that could affect HCO.

How to implement sustaining and improving operational infrastructure?

Sustaining & improving operational infrastructure can be implemented via: i. Sessions of the governing board and senior management meetings are devoted to review of infrastructure effectiveness measures, identification of OFIs, and development of improvements

The Chief Executive Officer (CEO) leads the executive office with the senior management team. Which one of the following best describes the role of the CEO? a) Assigns accountability for operations b) Makes organizational decisions as the chief decision maker c) Serves as an organizational stakeholder d) Deals directly with actions Answer: A. Assigns accountability for operations and allows decisions of great importance to be made at every level of the organization. The CEO is an agent of the stakeholder consensus established by the governing board. The CEO deals with design methods by which questions are decided rather than dealing directly with actions. 'Well Managed Healthcare Organization', Griffith and White, Chapter 4

Situational Leadership Theory

The Hersey-Blanchard Situational Leadership Theory has two pillars: leadership style and the maturity level of those being led. Situational leadership theory is that there is no single "best" style of leadership. Effective leadership is task-relevant, and the most successful leaders are those that adapt their leadership style to the maturity of the individual or group they are attempting to lead or influence. S1: Telling - is characterized by one-way communication in which the leader tell their people what to do and how to do it. S2: Selling - Leaders provide information and direction, but there's more two-way communication with followers. Leaders "sell" their message to get people on board. S3: Participating - Leaders focus more on the relationship and less on direction. The leader works with the team, and shares decision-making responsibilities. S4: Delegating -Leaders pass most of the responsibility onto the follower or group. The leaders still monitor progress, but they're less involved in decisions.

Max Weber Theory on Management

The Max Weber theory of management, sometimes called bureaucratic management theory, is built on principles outlined by Frederick Taylor in his scientific management theory. Like Taylor, Weber advocated a system based on standardized procedures and a clear chain of command. Weber stressed efficiency, as did Taylor, but also warned of the danger of emphasizing technology at the expense of emotion. 5 Key elements of the Max Weber management theory include: Clearly defined job roles, an essential part of Max Weber management theories A hierarchy of authority Standardized procedures Meticulous record-keeping Hiring employees only if they meet the specific qualifications for a job Central to Max Weber scientific management is the mandate to only hire employees who possess the specific skill set the job requires. Weber worried about the impact of nepotism, fearing companies would hire people not qualified for a job, and this would hinder the efficiency of the entire company. By accurately assessing an applicant's abilities, you ensure you hire only those who are a good fit for the job and the company.

The dual capability to accurately assess the impact of public policies on the performance of the manager's domains of responsibility and to influence public policy making at state and federal levels is known as __________. a) Interpersonal/Collaborative Competence b) Commercial Competence c) Governance Competence d) Political Competence

The following executive's role has an inside, implementation focus that complements the CEO. They are accountable to deliver on the short-term expectations for cost, demand, quality, patient satisfaction and quality of work life: a) CNO b) COO c) CFO d) VP of Human Resources

To be successful, what are the 3 tests for accountability?

To be successful , accountability must pass 3 tests: ➢ Control i. Operational scorecard performance should equal or exceed negotiated goals ➢ Comparability i. Organization's scorecard values should be less than the values in alternative sources for the product/service and should be close to benchmark ➢ Profitability i. At the level of aggregation at which revenue is received, expenditures should equal the amount paid minus allowance for funding the long run strategic goals of the organization. ii. With bundled insurance payments, only service lines and hospital receive revenue and can assess profitability

How does Transformational culture contribute to mission achievement? (3 Ways)

Transformational culture contributes to mission achievement in several ways: 1. It trains, empowers, and rewards associates, making them partners, not agents, in turning the service excellence model into reality. 2. It encourages a blame-free environment that facilitates PITs 3. It creates the "best place to give care" mind-set, which encourages associates to remain with HCO, thus increasing the return on the ongoing training investment.

How do Leader establish transformational culture?

To establish a transformational culture, leaders do: 1. Promote shared values 2. Empower associates 3. Communication 4. Implement the operational foundation.

2 forms of training

Training takes two forms: a. Scheduled training ➢ Prepares associates for recurring needs ➢ Used for orientation, preparation for promotion, standardization of work methods, and implementation of ongoing values ➢ Offered in variety of modes, including online courses and onsite exercises b. Just-in-time training ➢ Offered when skill involved is used less frequently ➢ Often involves self-training ➢ Example= looking up clinical evidence and verifying procedures on internet, coaching a new manager, helping PIT chairman manage a meeting

Two surveys used to evaluate leadership:

Two surveys used to evaluate leadership: 1. Associate satisfaction surveys 2. 360-degree or multi-rater review= formal evaluation of performance by subordinates, superiors, and peers of the individual or unit.

What is Cultural leadership?

What is Cultural leadership? a. Culture establishes how an organization feels to customer and associate stakeholder b. High-performing HCO have built a new culture i. It "empowers" all associates and it is built around transformational (ie. Negotiation and persuasion) rather than transactional (ie authority and command) relationships ii. Every empowered associate is confident that she can change the work environment when needed to achieve the mission. She expects answers, not orders from managers iii. Leadership must be responsive to associates; solutions must be negotiated not imposed

Which of the following is not a function of the Executive Office? a) Organize work groups b) Support all levels c) Represent the Governing Board to the staff d) Serve as hands-on manager

Which of the following is not a function of the Executive Office? a) Organize work groups b) Support all levels c) Represent the Governing Board to the staff d) Serve as hands-on manager Answer: D. Taken from the Power Point Presentation by K. Darr

Which of the following is not an Executive Office Function? a) Lead b) Support c) Control d) Represent e) Organize

Which of the following is not an Executive Office Function? a) Lead b) Support c) Control d) Represent e) Organize Answer: C. Found on Pg.115 of Griffith/White

Which of the following is not an executive function? a) Lead b) Support c) Train d) Organize

Which of the following is not an executive function? a) Lead b) Support c) Train d) Organize Answer: C. Page 115 Griffith & White

Which of the following statements related to mediation is not true? a) Useful when both parties wish to have a continued relationship b) Legally binding c) Uses a neutral third party d) The first step in a process to find a solution Answer: B. The agreement that results from mediation is not legally binding. An agreement which results from arbitration is legally binding.

7 healthcare management compentencies (D'Aunno)

iv. 7 healthcare management competencies (Gilmartin & D'Aunno) 1. Interpersonal relationship 2. Communication 3. Finance & business acumen 4. Clinical knowledge 5. Collaboration & Team building 6. Change management 7. Quality improvement

v. Three approaches to improve accuracy of information:

v. Three approaches to improve accuracy of information: 1. Screens and information input designs 2. Standardization of performance measures 3. Audits

How do managers use their skills as negotiators?

• How Managers Use their Skills: Most negotiating in organizations is informal, e.g., two managers agree to change how their departments coordinate activities. The result of these negotiations may be reflected in a memorandum, thus adding a level of formality. Typically, there are two sources of conflict in negotiating. The first is how the resources are to be divided—the money, goods, or services that are to be exchanged for what consideration. The second is resolving the psychological dynamics and satisfying the personal motivations of the negotiators in the organizations involved. The latter source of conflict is known as the intangibles of negotiation and can include variables such as the ego involvement of appearing to win or lose, competing effectively or cooperating fairly. The intangibles of negotiating are often the most difficult to understand and resolve. (ref manual, 113)

Roles of Mediation & Arbitration

• Mediation: a form of alternative dispute resolution (ADR) or "appropriate dispute resolution", aims to assist two (or more) disputants in reaching an agreement. Whether an agreement results or not, and the content of that agreement (if any) the parties themselves determine — rather than accepting something imposed by a third party. (Wikipedia, 2008) • Arbitration: is a legal technique for the resolution of disputes outside the courts, wherein the parties to a dispute refer it to one or more persons (the "arbitrators", "arbiters" or "arbitral tribunal"), by whose decision (the "award") they agree to be bound. (Wikipedia, 2008) Arbitration may be binding and non-binding. Binding arbitration is contractually required by some health plans to resolve disputes involving alleged medical malpractice and other disputes with enrollees.

Uses of Negotiation

• Negotiation: the art of bargaining (ref manual, 113) • Uses: applies to all internal or external transactions in which the parties decide what they will give and what they want to get. The most common type of formal negotiating occurs when contracts are negotiated (and usually signed) between or among parties who seek mutual benefit from the legal relationship that results. These contracts may be for the purchase of goods or services that an organization uses as input to achieve its objectives or they may bind organizations horizontally or vertically in health systems from which they hope to benefit. (ref manual, 113)

Operational managers concerned with

• Operational managers concerned with a) Individual positions b) Aggregations of individual positions into workgroups c) Clusters of workgroups

Senior Manager Concerns

• Senior managers, and possibly the governing body are concerns with broad aspects a) Authority and responsibility relationships b) Departmentation c) Coordination and relationships of components; either within or among the elements in a system of organizations

Weber, Fayol, and Barnard

• Weber, Fayol, and Barnard have a theoretical basis for organizational design in the last 19th and early 20th centuries (Fig. 13 shows level of design) from ACHE Manual • Their concepts included division of work, authority and responsibility relationships, departmentation, span of control, and coordination

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