Management Test 3

Communicating when Something Goes Wrong

...Communicating when Something Goes Wrong: 1. The best way to manage negative events in healthcare organizations is to prevent their occurrence. CQI efforts are beneficial in preventing or minimizing the occurrence of problems. 2. When prevention fails, managers must turn their attention to minimizing the damage that follow from unwanted events and addressing their consequences. In this, managers are best served by aggressive, positive, and proactive efforts to identify the harmed stakeholders and to make them whole again and to communicate openly in doing so. 3. Management Approaches when something goes wrong can include Concealment, obstruction, defensiveness, or rectification. a. Defensive approach can be taken when issues are layoffs, service reductions, downsizing, or closings or other operational problems. Defensive approach can include communicating what has gone wrong in a way that complies with the letter of the law b. Rectification is the best approach and involves fully accepting warranted responsibility for what has gone wrong and taking aggressive action to rectify the harms c. Concealment, the most inappropriate response, includes communicating as little as possible or misleading. d. Obstruction is less sever than concealment and involves denying wrongdoing, avoiding responsibility , and taking no action to address the consequences.

Communicating with External Stakeholder

...Communicating with External Stakeholder 1. Boundary Spanning is another name for the process through which organizations communicate with external stakeholders. Marketing and strategic planning are examples of boundary spanning.

Communicating with Public Sector

...Communicating with Public Sector: 1. Managers have 2 important categories of communication responsibilities regarding public decor environment of health care organizations. a. They are responsible for analyzing the environment which gives them information about the strategic consequences of event and forces their organization's public policy environment b. Managers are responsible for influencing the formulation and implementation of public policies.

Learned Need Theory

...Learned Need Theory Need theory, created by psychologist David McClelland, is a motivational model that attempts to explain how the needs for achievement, power, and affiliation affect the actions of people from a managerial context. Need for Achievement: a...........People who are achievement-motivated typically prefer to master a task or situation. They prefer working on tasks of moderate difficulty, prefer work in which the results are based on their effort rather than on anything else, and prefer to receive feedback on their work. Achievement based individuals tend to avoid both high risk and low risk situations. Low risk situations are seen as too easy to be valid and the high risk situations are seen as based more upon the luck of the situation rather than the achievements that individual made. This personality type is motivated by accomplishment in the workplace and an employment hierarchy with promotional position b. Achievers are comfortable in group situations and should take on Techologist, surgery, or technician jobs. Need For Power: This motivational need stems from a person's desire to influence, teach, or encourage others. People in this category enjoy work and place a high value on discipline. The downside to this motivational type is that group goals can become zero-sum in nature, that is, for one person to win, another must lose. However, this can be positively applied to help accomplish group goals and to help others in the group feel competent about their work. A person motivated by this need enjoys status recognition, winning arguments, competition, and influencing others. With this motivational type comes a need for personal prestige, and a constant need for a better personal status. b. Healthcare positions that satisfy the need for power include hospital administrator or dean Need for Affiliation: People who have a need for affiliation prefer to spend time creating and maintaining social relationships, enjoy being a part of groups, and have a desire to feel loved and accepted. People in this group tend to adhere to the norms of the culture in that workplace and typically do not change the norms of the workplace for fear of rejection. This person favors collaboration over competition and does not like situations with high risk or high uncertainty. People who have a need for affiliation work well in areas based on social interactions like customer service or client interaction positions.

Quasifirm

...Quasifirm: 1. Loosely coupled, enduring set of inter organizational relationships that are designed to achieve purposes of substantial importance to the viability of participating members 2. Quasifirm lies between market transactions and ownership arrangements. 3. Differ from a true firm in that they lack ownership linkages. 3. Example of quasi firm is collaboration of acute care hospitals , a large multispeciality group practice, skilled nursing facility, and an insurance carrier collaborating to design a managed care product.

Benefits of accountability & corporate design

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

Encouraging, Rewarding, and Celebrating success

1. 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

Transformational culture & leadership functions

1. The culture and leadership functions i. Culture can be measured directly by survey and indirectly by the measures of associate satisfaction. ii. 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.

3 Types of problems related to assessment of organizational effectiveness

3 Types of problems related to assessment of organizational effectiveness: 1. Definitional (what is measured) 2. Technical (how to measure) 3. Managerial (why it is being measured) Organizational performance is depicted using 4 inter-related concepts: 1. Productivity (ratio of outputs to inputs) 2. Efficiency (cost per unit of output) 3. Organizational Effectiveness (Degree to which organizational goal to be achieved could be subobjective) 4. Cost effectiveness. (measure that takes into account the degree of goal attainment and the costs to achieve them) Measuring outputs is the challenge in defining productivity and efficiency. Assessing effectiveness is complicated because of the problems linked to defining and measuring organizational goals.

Resolving Fundamental Disagreements

3. Resolving Fundamental Disagreements i. Transformational culture emphasizes negotiations. ii. Negotiating not only resolves concerns and disputes but also reassures associate that independent thought is a desirable behavior iii. 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.

4 Types of Task Interdependence

4 Types of Task Interdependence: 1. Pooled interdependence= each member makes contribution to group output without the need of interaction among members. Team performance is the sum of the individual efforts. Standardized rules and procedures are needed to enhance coordination of team outputs a. Example= dispersed nursing homes owned by a single corporation 2. Sequential interdependence= one group member must act before another can. Group members have different roles and perform different tasks in some prescribed order with the work flowing only in one direction. Coordination using schedules and plans is needed to keep the team on track. Example= Admissions office schedule patients for the OR, diagnostic tests, or dietician 3. Reciprocal interdependence= outputs of each member become inputs for the others, causing each member to pose a contingency for the other. Group members are often specialists with different expertise and have structured roles; therefore they perform different parts of the task. Leaders must provide for open communication between members and schedule meetings as needed. Example= Vertically integrated acute care & long-term care. Long-term care unit suffers if the patients are not discharged from acute care into long-term care 4. Team Interdependence= Members diagnose, problem solve, and collaborate as a group while doing work. Work flow is simultaneous and multi-directional. Coordination requires mutual interactions with group autonomy to decide the sequencing with group autonomy to decide among members. Leaders should plan frequent meetings, encouraging unscheduled ones

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

Boundary Spanning is implemented:

4. 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

Path for beginners

4. Path of beginners i. Transformational leadership is learned behavior. What this means for beginners in the healthcare field is summarized in 4 sentences: 1. Commitment to succeed outweighs the path to success a. Emotional stress and requirement for new learning are barriers b. 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. Regular review of competencies, identification of personal OFIs, and planned actions are critical to leadership development 6. Establishing plan for future goals 7. Formal education has role in leadership development, particularly for the leader who has build the foundations of commitment and practice C. Measures

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

Purpose of cultural leadership:

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

Training

6. Training i. 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

Planning Services Using Forecasts & Need for Demand:

7. Planning Services Using Forecasts & Need for Demand: i. Success of HCO depends on correct sizing of teams & facilities; Services must be large enough to meet needs and operate effectively a. Array of services must meet community needs without exceeding available funds b. Services must be based on market trends & population c. If local community does not generate enough demand to support the service, then services are referred to distant HCO d. Epidemiological planning model used to forecast the number of patients that need a specific service.

Accountability & corporate design can 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.

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.

Application of Adams Equity Theory

Application of Adams Equity Theory: People evaluate fairness by comparing themselves to others. In other words, people contrast their perceived inputs and outputs with their perceptions of others' inputs & outputs. Managers need to address perceptions of inequity so that the individuals are not motivated to reduce their contributions or inputs or leave the job. Inequity can be changed by explaining the differences between jobs or other conditions that make rewards necessary. Managers may need to consider pay raises. Motivation must be done an individual basis.

Application of Learned Need Theory

Application of Learned Need Theory: 1. Matching work environments with their needs is crucial for motivation and career success. Affiliation-oriented managers may not do well in entreprenurial jobs. 2. Psychological testing and structured interviewing in employment selection and promotion decision can aid in selecting individuals

Basic premise of QI

Basic premise of QI: The basic premise of QI is that every process has variation in how well it produces a service or product. In order to reduce the variation, the first step involves a careful and information-driven analysis of what can cause a failure of process, with what frequency such problems occur, and the extent to which problems vary over time. Understanding the process and developing and implementing corrective action by group process requires being able to communicate the information effectively. Simple & direct statistical tools such as histograms, bar charts, and scattergrams help ensure that anyone throughout the organization can understand and use them.

Benchmarking

Benchmarking: The process of establishing operating targets based on leading performance standards for the industry; Philosophy to guide the process of proactive, structured practices needed to achieve excellence. Benchmarking is similar to QI in that it starts with the premise that wide variation in practice indicates that something is amiss---not all rates can be correct, even if one doesn't know which rate is wrong.

Bureaucratic Model of evaluating non-professioanal work

Bureaucratic Model of evaluating non-professioanal work: **Definition: Compares observed performance values with established standards. Supervisor needs to have experience and judgement to detect nuances in the performer's activities that affect the performance values and their associated outcomes 1. Most problems linked to supervisor-wooer relations due to disagreements over performance. 2. In healthcare, interdisciplinary teams rather than individuals become the basic accountability unit within the organization, necessitating new means for evaluating work and improving process.

Classes of Measures

Classes of Measures: Structural measures of quality are valid to the extent that they motivate and encourage providers to chose efficacious, cost-effective actions. Process measures are valid if they lead to improved products or better outcomes. Measures based on process alone can only compare performance values with some specified standard; they cannot themselves assess the appropriateness of standards employed. 1. Structural Measures Assess those organizational features or participants characteristics that are presumed to have a positive impact on organizational performance ***Accreditation can be a structural performance indicator. 2. Process Measures Focuses on evidence relating to the quality of the performer's activities in carrying out the work. 3. Outcome Measures In healthcare delivery assess changes that occur in health outcomes of the person receiving the service that can be attributed to the quality of services performed.; Objects upon which the work is performed. Outcome measures have the advantage of focusing attention on changes produced and results achieved. Drawback is that they do no themselves provide evidence that can connect observed outcomes to the effects of performance. A comparison of actual verses expected decline/ comfort may be the most appropriate measures of outcome performance

Content Theory

Content Theory Content Theory is concerned with what energizes behavior and includes Heirarchy of need, ERG theory, Two factor Theory, Learned Need Theory, 1. Motivation can be considered goal-directed, internal dice, which is aimed at satisfying needs. A need can be physical or psychological deficiency that makes outcomes or goals attractive. The need stimulates the internal dives which directs them toward those goals. 2. Motivation can be increased to the degree that peoples' needs can be satisfied on the job. 3. Motivation is a function of working conditions, working hours, autonomy, and responsibility. 4. Content theories do not shed light on the process of motivation and should be considered as managerial approach.

Contingency view of coordination

Contingency view of coordination: 1. Requires that managers match the most appropriate coordinating mechanism to a given situation.

Coordination Mechanisms

Coordination Mechanisms: 1. Programming a. Seeks to clarify work responsibilities and activities in advance of the performance of work as well as to specify outputs of the work processes and skills required. Programming approaches essentially standardize work activities for all expected requirements b. Standardization of work process, Standardization of worker skills, and Standardization of work outputs are forms of programming 2. Feedback a. Involves exchanges of information among staff, usually while the work is being carried out. It permits staff to change or modify work in response to unexpected requirements and relies on effective communication b. Mutual adjustment & Direct Supervision are forms of feedback.

Coordination

Coordination: Definition= means of dealing with interdependence by effectively linking together the various parts of an organization or by linking together two or more organisions pursuing a common goal. 1. Staff coordination is relevant to their abiltiy to comply with requirements of accrediting bodies 2. Intraorganizational perspective= Coordination is a necessary response to the internal differentiation of organization. Differentiation is the state of segmentation of of the organizational system into subsystems, each of which tends to develop particular attributes in relation to the requirements posed by the relevant environment. 3. Organizational units are differentiated based on functions or disciplines relative to the organization's overall work activities. 4. Internal differentiation of organization leads to substantial coordination requirements (patient that needs two or more clinical specialities)

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

Criteria for all knowledge:

Criteria for all knowledge: i. Access= user gets the screens or documents needed with minimal delay ii. Protection= access is limited to appropriate users and protected against loss, service interruption, and distortion iii. Accuracy iv. Completeness = uses gets all needed information.

Critical Issues in Operational Leadership

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..

Employee involvement-participation programs

Employee involvement-participation programs are based on the belief that employees at all levels in the organization can and will contribute useful insights to the effective functioning of the organization given the opportunity. Common programs include gain-sharing systems, union-management committee, and total quality management systems. Employee participation in making job and organizational decisions is the critical element in all these programs Employee participation is to seek employee input into management policies, strategies, and tactics , and through employee attitude surveys. Employee empowerment via sharing information and knowledge enables them to understand and contribute to the organizational performance and gives them autonomy to make decisions that influence organizational outcomes. Gain-sharing programs are viewed as innovative approaches to bringing about productivity improvements in developed, labor-intensive industries like hospitals. These programs require top management to start disseminating relevant information and give employees time and tools to get involved. Economic and non-economic rewards are effective when they recognize only high-performing employees. Job Redesign is based on the premise that altering certain job aspects will satisfy the employees' psychological needs and motivate them to exert more effort

Define Empowerment of Associates

Empowerment of Associates is the associates ability to influence work conditions to improve mission achievement

Evaluation of Organizational Performance

Evaluation of Organizational Performance: The nature of organizations and the impact of time frames, the domains of activities being evaluated, the level of analysis, and the perspectives of stakeholders are complex so that one may find little consensus in selection criteria for evaluation of organizational performance. Stakeholders: Early performance measures focused primarily on profit for the owners or their agents. For publicly traded HCO, (nursing homes, home healthcare, assisted living), stockholder benefit remains a key measure of performance. Both external and internal stakeholder have different needs to be met. It is not possible for a given organization to be seen as equally effective by all of its stakeholder or constituent groups at any given time. Developing a community orientation would be the response for the disparate needs of multiple competing interests of various stakeholders.

Define Excellence in terms of management of a well-defined HCO

Excellence is a journey. We wont stay "pretty good" unless we look systematically how to get better Excellence is measured and documented, not just approximations. We could be benchmark and not just above average Excellence would be uniform; all our teams can better, we can rely on every team Excellence would be multidimensional: patient satisfaction and quality, associate satisfaction, cost, finances. Reaching Excellence is about teaching and dialoguing.It is about learning and empowerment It helps people to relate to each other.

Excellent HCO improve internal processes by:

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

Factors linked to Effective performance

Factors linked to Effective performance: 1. Quality of professional staff. (High levels of staffing is linked to greater patient satisfaction. Key factors are recruitment, retention, and having people work within their ability). Cross-train staff to gain greater flexibility. 2. High Standards (Setting high standards involves strict admissions requirements and strong control in enforcing standards; ie. greater control over admitting privileges and also by establishing best practices) 3. Participative organization culture emphasizes team approach (Structure allows for greater coordination and communication across disciplines that participate). Involve organizational members, esp professionals, in the development, implementation, and monitoring of productivity and efficiency initiatives. 4. Timely & accurate feedback raises the visibility of behavior in the organization's requirements 5. Active management of external forces 6. Develop scheduling systems that are consistent with professional values. Focus on areas of where quality can be improved 7. Develop productivity-based incentives based on work activities under the control of organizational members.

Five Functions that sustain operational infrastructure:

Five 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 a. Ensure that infrastructure is continuously improved

Forced Distribution

Forced Distribution: Rating systems where groups are proportionallhy distributed according to a normal bell-shaped curve. If every worker cannot attain the highest ranking simultaneously, then a "forced" ranking rating system in place. It can create problems with pay-for-performance and creates competition among employees Performance is normally distributed so force ranking should be fair. But organizations don't hire on the basis on normal distribution. Most health care workers choose their job by factors other than money. Employee involvement-participation programs are based on the belief that employees at all levels in the organization can and will contribute useful insights to the effective functioning of the organization given the opportunity. Common programs include gain-sharing systems, union-management committee, and total quality management systems. Employee participation in making critical element in all these programs

Fundamental Perspectives about Organizations & Performance assessment of organization.

Fundamental Perspectives about Organizations & Performance assessment of organization: 1. If the organization is primarily an instrument for production of goods and services for external consumption, emphasis is placed on measures of productivity and efficiency. 2. If organizations are envisioned as open systems that are highly interdependent with their environments, the key strategies involve acquisition of scare resources and the capacity to adapt to changing environment. 3. With the above different views of organizations, there are multiple views of effectiveness and conflicting features of performance 4. Effectiveness varies according to the stage of organizational development. Effectiveness in earlier stages depends primarily on creativity and mobilizing resources; later stages emphasize commitment and cohesion among members' still later, formal processes of control and efficiency come to the fore' and finally structural elaboration, de-centralization, and flexibility get emphasis

How can managers and organizations create an environment of excellence? Professional Model of evaluating professional performance

How can managers and organizations create an environment of excellence? (Professional Model of Performance Evaluation) 1. Organizations and managers emphasize high-performance expectations and provide the necessary support for obtaining excellence are likely to be more effective. 2. Achieving these standards is a function of both specification of rules and procedures (rules and procedures used to deal with routine problems) as well as informal communications and the use of ad hoc committees (used to deal with non-routine problems) 3. Involving professionals in the development of standards, norms, rules, policies, and practices is essential. Such involvement is association with greater professional satisfaction and play an important role in staff retention. Professionals want to participate in the decisions that will affect the nature of their work 4. In HCO, the rules and procedures must be based as much on professional needs, values, and aspiration as on the needs, values, and aspiration of the organization. 5. The professional need for autonomy must be kept paramount in all organization design procedures. 6. Studies suggest that evaluating and coordinating professional work is facilitated by high standards and clear expectations, specified rules and procedures combined with job autonomy, flexibility in coordinating work, and a high degree of professional involvement in decision making

How to involve physicians in the QI process?

How to involve physicians in the QI process? 1. Use physicians as consultants with acknowlegement that their participation will be episodic. 2. Nurture the involvement of physicians who are most likely to be interested 3. Empower physicians by involving them early in the process 4. Avoid statistics and review that threaten physician competency. Balance the need for autonomy with the needs of QI initiative. 5. Capitalize on the 4 stages of adoption specific units and groups have reached: a. Recognizing the problem in need of solution b. Identifying QI as a solution c. Implementing QI strategies related to the problem d. Institutionalize QI thinking and techniques into daily clinical practice.

Impact of evaluation on all types of performers

Impact of evaluation on all types of performers: 1. Primary purpose of evaluation is to exert influence on the performance of participants. 2. Reactivity to the performance criteria can result in appearance. 3. Diverting effects (Bias) occur due to difficulty or costly to devise evaluations systems and indicators that are accurate. Examination are created to test learning. 4. Physicians do respond to evaluation by peer review.

Improving Transformational Culture

Improving 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. iii. Purpose of improving cultural transformation is to increase return from culture over time iv. 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

Job Redesign & motivation

Job Redesign & motivation 1. Aims to enrich a job so that the employee is more motivated to do the work. 2. Job redesign is less powerful on motivation but still has significant impact on productivity. Participative decision making and job redesign are less certain to produce significant improvements. Employee training and goal setting are most likely to improve motivation or productivity, followed closely by changes such as financial incentives. 3. 3 core dimensions that make a job more meaningful are task identity, skill variety, and task significance. 4. Feedback about the job gives knowledge about the results of the core job. Autonomy contributes the feeling of personal responsibility for job outcomes 5. Studies support that redesigning nurse jobs in long-term care settings can motivate them to be more committed to the organization. Findings indicate that family member's satisfaction with the quality of services is positively influenced by organizational commitment, which in turn is positively correlated with autonomy, task identity, and skill variety.

Key concepts of TQM & CQI

Key concepts of TQM & CQI: 1. Productive work involves processes. Most work implies chain of processes whereby each worker gets inputs from suppliers, adds value, and then passes it on to the customers, who are defined to include everyone internal & external who get the product or service of the worker. 2. Customer is central to every process. Processes are improved to meet customer needs. 3. Two ways to improve quality: eliminate defects in the process and add features that meed customer needs. 4. Main source of quality defects is problems in process. 5. Quality defects are costly in terms of internal losses by lowered productivity and efficiency, increased requirements for inspection and monitoring, and dissatisfied customers. 6. Focus on most important processes to improve. Use statistical thinking and tools to identify desired performance levels, measure current performance and make action where necessary. 7. Involve every worker in QI. Use new structures such as teams and quality councils to advise and plan QI strategies.

Knowledge management can be implemented via:

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. 3. 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

Levels of Analysis & Organizational Performance

Levels of Analysis & Organizational Performance: 1. Open Systems theory states that all complex systems are nested units, systems within systems. 2. In horizontally integrated systems, there is overlap and no clear boundaries between departments and traditional performance measures are presumed association between utilization and revenue or the assumption that system's effectiveness can be maximized by maximizing the effectiveness of each component organization. 3. In vertically integrated system, the basic unit of data collection should not be a service or a patient but an episode of care that embraces services provided across multiple sites and involving numerous actors. 4. System performance at any given level may not be analyzable as a simple aggregation of system performance at lower levels. Performance is determined as much by the arrangements of its parts---their relations and interactions---as by the performance of the individual components.

Library of Work processes, protocols, and 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 iv. Protection 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

Management role in Developing the organizational culture

Management role in Developing the organizational culture: Management is a strategically focused and integrating activity. By integrating interpersonal, informational, and decisional management roles in the context of personal characteristics and style, the contect of the jobs and strategic priorities, the manager assures development of the organzational culture. By integratind executive leadership skills in management process app

Manager Guideliness for Teams

Manager Guideliness for Teams: 1. To increase performance of a team, managers should ensure the reward structure of the organization that rewards team accomplishments and individual performance. 2. Managers should identify the group norms that are dysfunctionsal and eliminate those norms. 3. Team members hold be aware of how teams communicate both inside and outside the team environment. 4. Managers should be aware of the status differences among team members, and how these differences affect individual participation, group decision making, and productivity . Managers should apply structured decision-making techniques such as nominal group technique, brainstorming, and Delphi Technique.

Manager's Role in Motivating People

Manager's Role in Motivating People is done to: 1. Reduce tardiness & absenteeism 2. Improve productivity & efficiency 3. To improve problem-solving ability 4. To work interdependently & cooperatively with team members 5. To re-motivate after workforce reduction 6. To re-energize those who don't feel challenged. 7. To motivate moral and ethical behavior.

Managerial Guidelines for Organizitonal Design

Managerial Guidelines for Organizitonal Design: 1. Important to understand the strengths and weaknesses of the organization so that the design strategy leverages the organization's competitive advantages 2. Assessment of the HR in the organization is essential task of organizational design. There must be systematic understanding of the HR capability esp for long and short-term succession planning as part of the preparation for re-design.

Managerial Guidelines for coordination & communication

Managerial Guidelines for coordination & communication: 1. Key to assigning the proper managerial priority to coordination and communication efforts is the degree of interdependence among people. Assessing the degree and nature of the interdependence is the first step toward effective communication and coordination. 2. The presence of professional in healthcare offers managers consultive relationships which can guide managers in choices about coordination & communication.

Managerial Role in creating high performance HCO

Managerial Role in creating high performance HCO: 1. The product of HCO is difficult to define & measure. Performance-related activities in healthcare are not controlled by managers but rather under the control of caregivers. 2. Transformational leaders think about performance in terms of controllable and non-controllable factors 3. Effective managers consider both controllable factors and healthcare industry trends and competitive and legal forces. 4. New areas for strategic growth include same-day surgery, satellite clinics, home health care, diagnostic imaging, health promotion, outpatient psychiatric care, and sports medicine 5. Emphasis on board members being stewards of the hospital's assets to becoming active builders of more diversified resource base. Entrepreneurial boards are more effective in obtaining needed resources. Board members need to adopt corporate forms of organization with emphasis on strategic planning, entrepreneur, and risk-taking activities. 6. Two key issues for resource acquisition (physician shortages may lead to restructuring nurse jobs to take on primary care duties & Resource acquisition via network strategy aka......mergers, consolidation, affiliation, or multihospital membership) 7. Future managers not only improve their own individual organization performance but also improve the performance of networks, coalitions, affiliations, and systems 8. Effective HCO needs to be proactive in managing the environment to compete more effectively. Organization needs to be adept in developing market niches and working with a segmented market. Must differentiate their product or service from competitors.

What factors need to be considered when choosing coordinating mechanisms?

Managers need to consider the following factors when choosing coordinating mechanisms: 1. Task uncertainty or the variability of work 2. Degree of interdependence among organizational units. 3. Size of the organization. a. Task uncertainty or variability of the work reduces the efficiency of the programming approach to coordinating. b. If work requirements are unpredictable, there will be greater need to establish feedback mechanisms to enable staff to modify or change methods as needed. c. The limitation to programming approaches reflects the difficulty of anticipating or specifying all of the work activities in advance in situation of reciprocal interdependence. d. Larger organizations tend be more differentiated; thus the interdependence among units is greater and may require feedback approaches to coordinating mechanisms.

Maslow's Hierarchy of Needs:

Maslow's Hierarchy of Needs: Five psychological need levels that must be satisfied in order to motivate an employee. In terms of rank from lower to higher, these include psychological needs, security needs, belongingness needs, esteem needs, and self-actualization needs Managers can promote satisfaction of belongingness needs by encouraging social interaction and by making employees feel part of the team or work group. Sensitivity to the employee's family problems can help meet these needs. Managers can help meet esteem needs by providing signs of accomplishments such as job titles, praise, and public recognition, giving more challenging opportunities. Allowing employees to participate in decision-making and learn new things promotes self-actualization. Heirarchy of needs does not give managers a practical approach. In practical terms, organizations need wages for food and shelter, reasonable protection of jobs, health, and safety, satisfactory physical and social environment, support growth needs with advancement opportunities and encourage self-development. Main implication of Maslow's theory is the organizations policies need to pay attention to all these needs to if they want employees to work full potential.

Motivational Problems

Motivational Problems 1. Motivating physicians is difficult. It focuses on individual discretion and autonomy in their day-to-day work. The more doctors work, the more rewards. Because of their professional socialization and strong achievement needs, physicians require feedback on a frequent basis. a. In order for feedback to have value, feedback needs to be timely, frequent, and given in precise intervals. Physicians need to understand that their behavior needs to change. 2. Support personnel view their jobs a s means of income and seek various forms of personal full-fillment off-the-job via families and leisure activities. Clerical workers lack higher-level needs like personal growth and autonomy. Manager may have to convince the employee that a broader scope and more autonomy is in his best interest. Manager might provide more structure and direction. 3. Regardless of the position, managers need to assess the employee's desire for fullfillment of higher needs and respond to those needs.

Myths about Motivation

Myths about Motivation: 1. Performance depends not just motivation but also on the ability and a host of factors. 2. Motivation is more specific to situations than it is about personality. Motivation and behavior are produced by complex interaction of individual and situational factors. 3. Managers must take into consideration job position, career stage, and personal factors when motivating worker and take each worker into consideration on an individual basis. 4. Managers can assess motivation can include informal interviews with employees using open-ended questions to ask about individual needs, motives, perceptions, and values. Managers play a critical role in taking the lead to alter conditions that can increase motivation.

Negotiating

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.

Operation Infrastructure Functions

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. 10. Operational infrastructure is managed by senior management, which establishes the direction, importance, and implementation of these activities.

Preference for Classes of performance measures

Preference for Classes of performance measures: 1. Executives and managers prefer structural measures since they have most control 2. Caregivers prefer process measures 3. Clients and representatives prefer outcome measures

Process Theory

Process Theory focuses on how behavior is energized. Process Theory suggest a cycle of managerial action as follows: 1. Goals should be set at the time of hiring and at periodic performance evaluations 2. Expectations about goal attainment and consequences should also be set at this time. 3. Perceptions of fairness should be checked periodically 4. Reinforcement should be given contingent on performance

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

QA verses QI

QA verses QI: QA solved problems and held individuals culpable for mistakes. QI prevents problems by continuously improving the source of the defects----process. QA was based on peer review and focused on upholding minimally acceptable standards of care. QI borrows principles applicable to any industry and encourages striving for excellence. QA form and function was required by external accreditors and third party payers for quality of care. QI permeates all processes and requires a strong internal culture to support it.

How to reduce intergroup conflict?

Reducing intergroup conflict: 1. Intergroup training, which uses team building techniques to improve the work interaction of different functions or divisions in an organization. 2. Structuring the relationship between teams around superordinate goals, or mutually important goals that neither team can achieve without cooperations from the other. 3. Examining the interfaces between teams to determine where change is necessary to decrease conflict. 4. Establishing self-contained teams, which involves the re-grouping of conflicting groups into new teams that perform work independently of each other. 5. Creativity & Authority to overcome obstacles.

Reinforcement Theory

Reinforcement Theory: Operant Conditioning in which a stimulus elicits a response that has a consequence. A consequence that changes the likelihood a response will occur again following that stimulus. Consequences include rewards & punishment. The primary lesson of reinforcement theory is that performance, if not motivation, is better if rewards are given contingently. Effectiveness of reinforcement schedules will vary; thus, it is best to take a pragmatic approach and see what works best in a given situation. 4 Type of Reinforcement Schedules: 1. Fixed interval= people paid on hourly basis 2. Fixed ration= Awards given on a fixed number of responses (fee for service) 3. Variable interval= Responses on a variable rewards (unannounced government inspection or pop quiz) 4. Variable Ratio= reward is based on behavior and the ratio of reward to responses varies (gambling)

Reward Mechanisms for Team-based Environment

Reward Mechanisms for Team-based Environment: 1. Skill based pay= reward employees for acquiring skills needed by team 2. Gain-sharing plans= team based performance awards 3. Team bonus plans= reward particular team based on the performance of the team

Satisfaction-progression principle

Satisfaction-progression principle: Individual satisfies one set of needs, the higher-level set of needs will dominate. Process will continue till self-actualization is reached.

Senior management maintains the 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.

Service Line Design

Service Line Design: 1. Healthcare organization can move to a program or service-line design, which places the traditional functional departments with specialized departments design with specialized units that focus on a program, service or a type of patient population. (Eg. Cancer center with social worker, oncologist, nurses, ext) 2. In the case of integrated delivery systems, a service-line structure may be used to coordinate patient care activities among multiple healthcare or organizations such as hospitals and physician organizations in a such a specialized areas as cancer care, women's health, and mental health 3. Although service-line design potentially reduces some of the coordination requirements associated with functional or discipline-based design, it also can crete new coordination problems among the programs or service line structures.

Sources of Team Cohesiveness

Sources of Team Cohesiveness: 1. Homogenous groups are more cohesive than heterogenous groups. 2. Lack of conflict, team training, positive predisposition to teamwork, and the presence of trust among members lead to cohesiveness. 3. Team cohesiveness is influenced by goal orientation or reward structure of the team. 4. Group members are judged and rewarded as individuals.

Success of transformational leadership depends on two conditions:

Success of transformational leadership depends on two conditions: 1. Consistent commitment----transformational management is perennial—diligent examination of senior management attitudes and behavior. 2. Simultaneous move to strengthen the operational foundation ad evidence based management

Surveillance Function

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.

T/F Joint Commissions and National Committee on Quality have adopted standards that address coordination among professional groups, patient care units, and service components within healthcare organizations

TRUE: Joint Commissions and National Committee on Quality have adopted standards that address coordination among professional groups, patient care units, and service components within healthcare organizations

Task Interdependence

Task Interdependence: Definition: Interconnections between tasks, or the degree to which team members must rely on one another to perform work effectively.

Team Goals

Team Goals: 1. Team goals and accompanying tasks can be categorized according to goal clarity, complexity, and diversity. 2. When team goals are repetitive, the communication and coordination is routinized. 3. When the team goals are ill-structured, communication is crucial and team members must be able to adapt to situations (ER team). 4. The more complex the task, the greater the need for interaction, so that it is important that managers plan for enhanced communication among the team members under conditions of complexity.

Teams & Status Differences

Teams & Status Differences: 1. If Status inequality exists, it is advisable to build a trust-sensitive environment in which members can disagree with the leader and others on the team without repercussions. 2. In multidisciplinary teams, lower status individuals should feel elevated by being part of such high-profile effective team

Locke's Goal Setting Theory

The Goal Setting Theory was developed by Edwin A. Locke in 1968, in order to explain human actions in specific work situations. The theory argues that goals and intentions are cognitive and willful, and that they serve as mediators of human actions and that our needs and our goals are mediated by our values, which determine what is beneficial for us. The two most important findings of this theory are that setting specific goals (e.g., I want to earn $500 more a month) generates higher levels of performance than setting general goals (e.g., I want to earn more money), and that goals that are hard to achieve are linearly and positively connected to performance. The harder the goal, the more a person will work to reach it. However, such influences on performance are mediated by two conditions—feedback, and that the person in question accepts the goal. Implications for Managers: 1. Set or encourage people to set goals that are difficult and specific. 2. Give timely and specific feedback to people on their progress towards goal 3. Build commitment to goals by helping people believe they can attain goals and select goals that are congruent with their values. 4. Consistent with the reinforcement theory, rewards should be given contingent on goal attainment 5. Make sure people have the ability to reach the goals that you set.

Three alternative models for embedding professionals effectively into the organization.

Three alternative models for embedding professionals effectively into the organization.: 1. Autonomous= professionals retain independent authority to control & evaluate themselves as a group 2. Heterenomous = Professionals are subject to more line-authority control 3. Conjoint= professionals and administration coexist in mutually interdependent setting in which each group is equal in power and in importance of their functions.

Three approaches to improve accuracy of information:

Three approaches to improve accuracy of information: a. Screens and information input designs ➢ Well designed screen reduce errors and encourage completeness ➢ Electronic entry add audit protections that increase accuracy and completeness ➢ Tags allow cross-referencing and retrieval b. Standardization of performance measures i. Validity= each measure reflects the process it purports to measure ii. Reliability= variation from prior values, goals, or benchmarks is meaningful iii. The cause of the variation is under the users' control. ➢ Measurement review committees assist in developing and testing measures ➢ 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. ➢ Goal of standardization of performance measures: i. Make transparent the measures used to evaluate performance, ii. identify OFI iii. Analyze alternative process ➢ Completeness as a criterion means the: i. Library is constantly expanding ii. Process get extended iii. Measures & adjustment get approved iv. Histories get longer. c. Audits ➢ High-performing HCO extended the internal audit to all dimensions of operational and strategic scorecards.

Three forms of Programming Coordination Mechanisms

Three forms of Programming Coordination Mechanisms: 1.Standardization of work processes: a. Alternative coordinating mechanism that programs or specifies the contents of work. Healthcare organizations standardize work processes when possible such as standard admission and discharge procedures or standard of performing lab test. 2. Standardization of work a. Specification of product or expected performance with the process of how to perform the work left for the worker 3. Standardization of worker skills a. Occurs when neither work processes nor output can be standardized. b. If standardization is to occur, it must be through worker training. Example is when surgeon and anaethesiologist meet to do surgery.....no communication needed due to standardization of training.

To be successful , accountability must pass 3 tests

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

Traits of a strong communication program:

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.

Two Factor Theory/ Herzberg

Two Factor Theory/ Herzberg 1. States that the key factor in satisfaction and motivation are achievement, recognition, the work itself, responsibility, and advancement which were labeled as motivators. 2. Also known as hygeine factors 3. States that 4 variables important to recruitment and retention are as follows: a. Freedom in decision making b. Opportunities for personal growth c. Caliber in management d. Advancement opportunities. **The appearance of the work environment was least important in retention of workers.

Two forms of Feedback Coordination Mechanisms

Two forms of Feedback Coordination Mechanisms: 1. Mutual Adjustment a. Coordination by informal communication among individuals who are not in hierarchical relationship to one and another. Example is two physicians sharing patient information. 2. Direct supervision a. Coordination of work that occurs when someone takes responsibility for the work of others, including issuing instructions and monitoring their actions. It entails some form of hierarchy within the organization. Example is when charge nurse gives instructions to the staff nurse

What is the difference between clinical guidelines or protocols verse critical pathways?

What is the difference between clinical guidelines or protocols verse critical pathways? Critical Pathways identify and manage steps in the production process. They are management plans that display goals for patients and provide ideal sequence and timing of staff actions. It specifies work activities in advance. While critical pathways standardize the treatment approach for a given clinical condition, clinical guidelines standardize the decision process for adopting a treatment approach.

Communicating with associates

c. Communicating with associates i. Reports on goal achievement, rounding, blogs/emails are examples of communication with associates 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. Communication does not have to be face to face. 3. Examples of Communication methods: a. Rounding=leaders meet worker in their units b. Informal meetings c. Focus groups with open-ended questions d. Random sampling surveys & comment cards 4. 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

High-performing HCO operate multi-site and multipurpose.

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.

Who defines corporate structure?

g. 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.

"Servant Leadership"

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.

Transformational culture & Measurement approach to leadership

iii. 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

Elements of a development program for managers

iv. 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.

Kilpatrick model and transformational culture

iv. 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

What is boundary spanning and what are its benefits

BOUNDARY SPANNING 1. Surveillance 2. Planning Services Using forecasts of need & demand 3. 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.

ERG Theory of Motivation

ERG Theory of Motivation: 1. Collapses Maslow's heirachy into 3 categories: Existence (psychological & security needs), Relatedness (esteem & belongingness needs), & Growth (self-esteem & self-actualization) 2. Unlike Maslow's theory, ERG states that more than one level of need can motivate behavior at the same time; Unlike Maslow, emgergence of the relatedness and growth needs does not required satisfaction of the existence needs. 3. Maslow's hierarchy functions on a satisfaction-progression principle, which states that each lower-level need must be satisfied before an individual can progress to a higer need level. ERG theory has frustration-regression element which states that if a person remains unsatisfied at higher levels then he becomes frustrated and regresses to lower levels and pursue those things again 3. ERG suggests that needs are not fixed. Main implication of ERG theory is that managers must understand that all employees have the potential for continued growth and development.

Four 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 integrated

How can managers implement the change to a team-based organizations?

How can managers implement the change to a team-based organizations? Senior management needs to: 1. believe that employees want to be responsible for their work 2. Be able to demonstrate the team philosophy 3. Articulate a coherent vision of the team environment 4. Have creativity and authority to overcome obstacles