Exam 2

The committee chairperson's responsibilities include arranging for logistical support, chairing meetings, and monitoring follow-up assignments. The chair must also

-Coordinate the schedules of committee members -Correlate committee activities with the work of other related committees -Obtain meeting space -Prepare the agenda -Send meeting notices and the agenda -Distributing support materials before the meetings

Job Descriptions can be used for:

-Job analysis, rating, and classification -Recruitment -Selection -Orientation and training -Evaluation

Line and Staff Interaction

1. Personal assistant to a line authority holder (the assistant to) 2. specialized assistance (legal counsel) 3. Full department of specialized staff (architectural planning)

Common Titles

•Chief of staff •Chief of service •Department chairperson •Medical director •President of the medical staff

The Dual Pyramid

•Common in healthcare organizations •Organization of medical staff as one track •Organization of administrative units as a second track •Each track with its distinctive authority-responsibility designations

The Credentialed Practitioner as Consultant

•Consultative arrangements: -One time only -Initial survey with implementation of findings -Ongoing maintenance of project or program •The independent contractor -Importance of clear definition of relationship (e.g., IRS definitions)

Job Rating

•Job rating elements include: -Complexity of duties -Error impact -Contact with patients and families -Degree of supervision received -Degree of required training Mental and physical demands

Job rating is based on

-complexity of duties -error impact -contact with patients, families, and other individuals inside and outside of the organization -degree of supervisors received -the nature of duties from unskilled to highly technical

Staff Assistant

provides advice, counsel, or technical support that the line officer may accept or reject

Line and Staff

•A LINE function provides service and directly advances the objectives of the organization. •A STAFF activity supports the line activity.

Underlying Premises

•A common goal •Detailed plans •Need for clear authority-responsibility relationships •Reconciliation of power and authority elements •Need for reduction of inevitable conflict •Reconciliation of individual needs with organizational needs •Preserving unity of command •Necessity of delegating authority

the management inventory

•An overview of anticipated changes in the workforce •Manager gives particular attention to: -Known, planned retirements -Planned temporary leaves (e.g. military duty, family leave) -Promotional opportunities -Cross-training capacity and needs -Phase out or consolidation of positions due to planned systems changes

Flexibility in organizational structure

•Matrix pattern •Temporary departmentation •Temporary agency services •Outsourcing •Contracted services •Telecommuting

Effect of Split Reporting

•Worker must balance two reporting relationships •Potential burnout when there is conflict between the two authority holders •Doubles the communication demands

The Span of Management

Span of management refers to the number of immediate subordinates who report to any one manager. The number of subordinates a manger may supervise effectively is limited. At higher levels of management, a span of 4 or 5 subordinates may be ideal, while at lower levels a span of 8 to 12 may be acceptable. Factors that impact the appropriate span of management include: -type of work - routine and repetitive work allows for a larger span degree of training of the worker - the more highly trained the subordinates are, the greater the span can be -organizational stability - greater stability allows a greater span geographical location - work units that are scattered may require more supervision -flow of work - if much coordination of the work flow is needed, a smaller span is required -supervisor's qualifications - higher trained and experienced supervisors may allow for a greater span -availability of staff specialists - staff development departments and other support may facilitate a greater span -value system of the organization - highly coercive organizations may have a larger span while normative organizations may have smaller spans.

Temporary Departments

Temporary departments are formed to create an organizational division with a predetermined lifeline to meet a temporary need. The lifeline may be imposed by some self limiting factor, such as funding from a research grant. The unit formed remains relatively unchanged during this time. Temporary departments usually last longer than a few months and may last for several years. This provides organizational structure without interrupting with the organization's normal business. Separate workers are often hired from the funds available in the grants, and equipment is also purchased form these funds. The temporary employees should be made aware that they will not necessarily move into the main organization at the end of the grant or project.

Process of Organizaing

1.Goal recognition and statement 2.Review of organizational environment 3.Determination of structure needed to reach the goal 4.Determination of authority relationships and development of organizational chart, job descriptions, and support documents

Overcoming Problems of Splintered Authority

1.Managers pool their authority to make decisions and solve problems. 2.Refer the problem to a higher level for reconciliation. 3.Reorganize to eliminate splintered-authority situations.

Limitations

Decision making by committees can be a slow process. Committee work can also be time consuming. Committee members may come to meetings unprepared, resulting in inefficient meetings. Members who do not show up may limit the ability of the committee to vote, especially if a quorum is required. Time pressures may limit deliberation time. Some members may attempt to dominate the committee, while others may provide little or no input.

Committee members should be of approximately equal rank and status in the organization in order to permit the free exchange of ideas. Individual members should be able to

-Express themselves in a group -Keep to the point -Discuss issues in a practical way Be flexible -Work as part of a group rather than as an individual -Present and support the views of the group they represent, and not just express their own opinions.

Periodic review of the purpose and function of each committee is warranted. For most committees this should occur once per year. Committees can take a life of their own while not really serving any important function. Questions to be asked include:

-Has the mission or charge of the committee changed? -What would happen to the organization if the committee was eliminated? -What changes should be made to the committee? -Should the frequency of meetings be changed? -Could this committee be combined with another committee? -Should the structure of the committee be changed in any way? -Should the reporting requirements of the committee be changed?

The job description itself should be concise and present the information in an orderly manner. There is no standard format, but typically includes:

-Job title -Immediate supervisor -Job summary - a short statement of the major activities of the job that specifically states the purpose and scope of the job. -Job Duties - this is the major part of the job description and states what the employee does and how the duties are accomplished. This also includes the degree of supervision received or given. -Job Specifications - the minimum hiring requirements for a particular job and what is needed to perform the job effectively. This includes mental and manual skills, personal traits and qualities. The physical demands of the job are also included.

The use of independent contractors may generate cost savings because of the cost saving from the elimination of expenses associated with training, physical space requirements, unemployment compensation and other costs related to direct employment. In order to qualify as an independent contractor based on the Internal Revenue Service (IRS) guidelines, an individual must demonstrate a level of independence based on certain factors:

-The worker invests in facilities and equipment that are used in performing the services -The worker expects to make a profit or experience a loss from their activities -The worker provides services to two or more unrelated clients or customers within the same period of time -The worker makes services available to any or all potential clients or customers on a regular and consistent basis.

The consultant provides written reports that are formal and detailed. These reports are formal business records and must be retained by the consultant and organization. These reports are subject to inspection and review by licensing and accrediting agencies. The report should focus on compliance with required licensure, accreditation and professional practice standards. Positive findings are typically listed first followed by the negative findings in an "Areas Needing Improvement" section. Recommendations should be made for each area needing improvement. Findings can be prioritized in order of importance:

1. Priority Class One: Address an practice that has potential for direct harm to the patient 2. Priority Class Two: Address any practice for which the facility received a citation during the last external survey or audit, especially those areas for which a plan of correction was filed with state or federal agencies, or any practice having repeat citations even if they are in full compliance now. 3. Priority Class Three: address any practice that is out of compliance with state licensure requirements, federal conditions of Medicare, HIPAA regulations, accrediting standards, or generally accepted principles of practice.

Minutes serve as the permanent record of committee proceedings. These typically include a record of attendance, business items, conclusions, and recommendations from each meeting. These records are usually kept in a permanent file or for a predetermined length of time. They may also be sent to certain individuals who do not attend the meetings but have a vested interest in the committee proceedings. There are five basic dispositions of agenda items:

1.Item is discussed; a formal motion is made and voted on 2.Item is discussed and there is a general consensus. No formal motion is made 3.Item is discussed and tabled informally or set aside for discussion at another time because members need more information 4.Item is discussed and a formal motion is made to table it permanently. 5.Item is not discussed and carried as old business to the next meeting

Organizing is the development of the role structures of superior and subordinate. It involves the process of grouping necessary responsibilities and activities into workable units, establishing lines of authority and communication, and developing patterns of coordination. The general steps involved in organizing include:

1.defining the goals of the organization in terms of scope, function, and priorities 2.reviewing the organizational environment 3.developing the organizational structure needed to reach the goal 4.determining authority relationships and developing the organizational chart, job descriptions, and other related documents

Committees do allow participation by more employees, or at least allow them to be represented. Individuals affected by a decision are more likely to accept it and abide by it if they feel they have participated, or at least had input, in making the decision. Managers have an opportunity to present their positions, and participants can develop a better understanding of other departments' roles and how they may be affected by a certain decision. Communication is facilitated across units and departments.

A single manager may not have the authority to solve a particular problem or implement a plan. Committees can also serve to consolidate organizational authority and coordinate efforts across department boundaries. Special purpose committees may be created to deal with a problem or project that involves several units. In highly decentralized organizations, committees can be used to foster coordination among units. Under these conditions, the focus is on the need for consistency of action and coordination of plans among several units that may be separated geographically. An executive committee may be formed in some organizations that has the power to finalize all decisions. This counterbalances concentrated power and diffuses authority.

There is no single number or narrow range of numbers indicating the ideal size of a committee. The size of the group should be small enough to promote open communication and deliberation. However, a committee should be large enough to represent all parties that may be impacted by the decisions made by the committee. Often, the committee composition is stipulated by the organizations' bylaws. Size also depends on the mission of the committee. Some effective committees might be as small as two or three working members, while some committees might include 25 to 30 members. Size, however, has a definite affect on committee operations, in that the larger the committee the more complex committee operation becomes. Once a committee exceeds a size of about six to eight members, communication and coordination problems visibly multiply.

Committee members should have sufficient authority to commit the group they represent to the course of action adopted by the committee. The committee member should report to the group or person they represent on the work of the committee, especially on key issues. The committee member should ask for feedback from the group so that they can best represent the interests of the group at the committee meetings.

Consultants and Contractors

Credentialed practitioners can serve as external consultants or independent contractors. Consultants offer advice and counsel as well as carry out professional activities within the scope of their competence and licensure. There are three general categories of consultant arrangement: -One time only arrangements - the consultant carries out an in-depth assessment of current practices or procedures or assists in the development of a major project. -Initial survey with implementation. The professional practitioner remains under contract to implement the initial findings. -Ongoing maintenance of a project or program - the professional practitioner agrees to provide continuous service over a specific period of time (e.g. one year).

Departmentation

Departments are usually developed as a result of the specialization and division of labor within an organization. This facilitates the coordination process because it produces a logical grouping of related activities. Departments may be developed based on: -Function: grouping related activities or jobs together. This is the most common form. -Product: all activities required for the development, production and marketing of a product are grouped together -Territory: geographical boundaries are used to develop departments. Customer - client needs are the basis for departments. -Time: the time of day activities are performed determines how departments are formed. -Process: technological considerations and specialized equipment usage determine departments -Number: simply dividing workers into groups based on the number of workers in each group.

Job Descriptions

In order to provide control of work assignments, the duties and responsibilities of each job should be in written form. This helps prevent an employee from being assigned random tasks, and more tasks than they can manage. Job descriptions also ensure that the employee's concepts of the job are the same as the manager's and the needs of the department. Job descriptions are written objective statements defining duties and functions and include: -responsibilites -experience -organizational relationships -working conditions

Mental and physical demands may also be assessed. Job classification, wage and salary, and fringe benefit package may be based on the job rating process. This also helps determine exemption or inclusion under provisions of the fair Labor Standards Act, and collective bargaining agreements, and eligibility for overtime pay.

Information from the job description may also be used in the recruitment process. Job postings based on the description will help some potential employees decide whether they are interested in and qualified for the job. The initial screening of potential employees by the human resources department requires sufficient information so that qualified applicants can be identified. The information must be conveyed in a way that can be understood by persons who are not involved in the unit or department.

The job description also provides a focus during the selection interview process. The manager and potential employee can deal with the expectations described in the job description. Job qualifications and mental, physical, and technical demands become the objective measures of candidate suitability. The job description should provide all parties with necessary information about the job so that there is no misunderstanding later. Orientation and training programs can be more meaningful for employees when they are tailored to specific job duties and qualifications. Training outcomes can be stated in terms of the trainee's ability to perform the duties.

Job descriptions also provide a focus for performance evaluations. The worker can be evaluated based on the duties and responsibilities made clear in the job description. Error correction, retraining, and disciplinary action should be carried out based on the job for which the individual was hired. If the employee files a grievance, emphasis should be given to the worker's accomplishments of the job duties. Those job duties should have been made known to the worker, and an up to date job description provides these. The job description also provides information to determine eligibility for claims under Workers' Compensation and similar programs.

Some activities may not merit a separate department by themselves, and there may be no obvious place for them in the organization. In this case, the major department that most often uses or needs the service absorbs it. This is the "most use" criterion for placing activities in a department. Other departments or units that need the service obtain it from the department that absorbed the service.

Sometimes, dual organizational units are created for the purposes of control or competition. This permits the comparison of costs, productivity, and other factors between units or departments that are serving the same function.

There are two major kinds of charts: master and supplementary. The master chart displays the entire organization including all departments and major positions of authority. It usually shows the major functions of the organization. Supplementary charts provide more detail, and there is one for each section, department, or unit. The supplementary chart for each department shows the direct chain of command from highest authority to the department head. It includes each job title, number of positions, and full time or part time status.

The conventional organizational chart is a line or scalar chart showing each layer of the organization in sequence. Sometimes the flow of authority may be shown from left to right, similar to the normal reading pattern. The chart includes all of the units based on the major functions they perform, and the jobs associated with them. Ordinarily, line authority and line relationships are indicated by solid lines and staff positions are indicated by broken or dotted lines. Sometimes staff positions are indicated with a small "s" and slash mark before the job title. Special relationships such as affiliated organization are sometimes are sometimes shown on the chart by placing them in a box formed with broken lines that is unconnected to other units.

Employee teams are generally seen as less formal and less structured than committees. Teams are often used in quality improvement programs.

The initial question to be addressed before a committee is established and its form is chosen should be one of necessity: Is this committee absolutely necessary? Only once this question is answered honestly in the affirmative should committee formation proceed.

The Organizational Chart

The organizational chart depicts organizational relationships including: The major functions by department The relationships of functions or departments Channels of supervision Lines of authority and communication Positions within departments or units The organizational chart maps the major lines of decision making and authority. It can be used to identify any inconsistencies and complexities in the organizational structure. It may be used to orient new employees as to how each job fits in relation to supervisors and other jobs. Managers can review the span of management, mixed lines of authority, and splintered authority. They can also compare current practice with the original plan of job assignments to determine if discrepancies exist. Organizational charts must be updated at least once a year so that they do not become obsolete. Also, charts may be misinterpreted in that where someone is placed on the chart may be interpreted as that individual having authority over everyone placed below them. The emphasis should be on the direct authority relationships and chain of command.

Line and Staff

The principal distinction to remember between line and staff is that a line function's activities advance the accomplishment of the organization's work and a staff function's activities provide supportto the line functions. Stated another way, line refers only to those who have direct responsibility for accomplishing the objectives of the organization, and staff refers to those that help the line units achieve the objectives. In health care, direct patient care units are considered to perform the line functions, and all other units are staff services.

Certain factors can improve the effectiveness of committees. The top management should create a climate in which the work of committee members is valued. The employee evaluation system for merit raises and promotions should include an assessment of committee work and assignments. Job descriptions should also include committee work as an important part of the job, and work hours should be allocated for committee work. Training for effective committee involvement should also be part of the training program for employees.

The purpose and function of a committee must be clearly presented, as well as the scope of its authority and activities. It is also important that the committee is clear on whom it is that they report to. Staff assistance should be given to the committee, especially the committee chairperson. Other logistical support such as assistants to prepare material for review by the committee prior to meetings and clerical support for recording and transcribing minutes.

Occasionally committees are created to undertake the traditional functions of a manager. Often these types of committees appoint a chief executive officer and assign management functions to that officer. The committee members may meet infrequently and remain less visible. This obscures the authority of the committee and may reduce it to a committee that is more symbolic than authoritarian.

The task force is created to carry out a specific project or assignment and present it findings to a person or committee that has line authority. The assigned task is usually very focused and requires technical expertise related to the task. The task force analyzes the question, completes research related to the question, and makes recommendations. The task force ceases to function as soon as its assigned task is completed. Members of a task force are selected based on their expertise and specialized training, and not necessarily to represent their department or unit. The findings of a task force are often forwarded to a committee.

Purposes

The use of committees allows the knowledge, experience, and judgment of several individuals to be applied to a problem in a coordinated manner. No single manager has all of the knowledge necessary to see all of the ramifications of a problem. The use of a committee may lead to a better decision than could be reached by one individual working alone. A group of people has acted in a way that focused multiple minds on the issue or problem to produce a result. This diffusion of responsibility can also be seen as a disadvantage. One negative view might hold that group responsibility is no more than "spreading the blame", such that no single individual can be held accountable. Committees may also sometimes used to avoid or postpone action. In this case a manger may create a committee to study a question or problem, or refer it to a pre-established committee in order to delay making a decision. This can be a positive use of a committee if it allows time for an emotionally charged issue to calm.

A committee involves group deliberation on a recurring basis based on a specific grant of authority.

There is an organized basis for its activity and interaction, and the committee is accountable for its function. Committees may be temporary or permanent. The temporary (ad hoc) committee is created to deal with one issue, and its work is limited to that one issue. Standing committees focus on recurring issues. The members on the committee may change, but the basic purpose of the committee and its characteristics such as the number of members and distribution of representatives remain. A committee may have line or staff authority. If the committee has authority over subordinates who answer to the committee, then the committee has line authority over those employees. If the committee has an advisory relationship to the line mangers, it is a staff unit. Sometimes committees that are advisory in structure also have line authority because their advice is almost always followed.

If the professional practitioner is hired to provide regular ongoing service for a period of time the relationship between the practitioner and the contracting organization may fall into the category of independent contractor. There are federal and state laws regarding independent contractor status, including those from the IRS. The HIPAA regulations also contain provisions concerning privacy and confidentiality requirements for business partners and independent contractors.

When performing as a consultant or independent contractor, the professional practitioner works under a written contract and provides formal reports to the administrators of the facility. The contract typically includes a clear statement of the parties to the contract, services to be provided, fees and payment schedule, ownership of materials, privacy and confidentiality of patient and business information, and provisions for termination of the contract. An attorney is usually utilized to develop the contract.

Telecommuting

is an arrangement in which an employee works a regularly scheduled amount of time each week at home or some other external location with the support of the appropriate equipment and services. The employee is not supervised by an immediately present supervisor. Telecommuters are regular employees on the payroll of the organization. The organization sets the criteria for working in telecommuting stations, and typically requires employees to first prove themselves as reliable self-starters. The criteria set in the organization's policy on telecommuting typical include: -Where the telecommuter can work -Work status, either part time or full time. -When the telecommuter can work -The technology required, and who determines what is required.

Line Authority

is based on a direct chain of command. A manager with line authority has direct authority and responsibility of a unit, and has the right to command others to act.

Outsourcing

is the process of having services that could be provided internally performed by agencies or individuals external to the organization. It makes sense to outsource if a service can be obtained externally for less than the costs of providing it internally. Often the decision is driven by volume considerations. If there is not enough of a demand for a particular service to justify hiring and staffing to perform it, then outsourcing may be a better solution. Another consideration may be the absence of specific capabilities within the organization. Outsourcing includes the use of contract management services and independent contractors. Under contract management a particular service is managed or provided in full by an external organization that specializes in that service. In other words, it may involve management of a service alone or complete provision of the service.

Functional Authority

is the right of individuals to exercise a limited form of authority over the specialized functions for which they are responsible, regardless of who exercises line authority over the employees performing the activities. A staff officer or manager may be in charge of a support department, such as the personnel department. Within that unit, the manager may be in charge of several workers and would have line authority within that department.

Split-Reporting

relationships exist when a single subordinate is answerable to two or more superiors for certain job responsibilities. In classical organization theory, split-reporting relationships are seen as violating the unity of command principle and are thus to be discouraged. However, the reality of the modern health care organizational environment has essentially dictated the use of split-reporting relationships in many instances. Split-reporting relationships can be effective and efficient, but may also create problems. Problems may result due to: - two superiors who have not coordinated their demands and expectations. -superiors who try to use the subordinate at the expense of the other superior. poor -communications with and between two superiors.

Temporary help from agencies

specializing is supplying trained personnel for short term needs also provides flexibility in staffing. Short term is usually considered less than six months. The workers remain employees of the agency, and not the organization. The organization is spared the effort and expense of recruiting, hiring, and training these short term employees. The employees usually come trained in the basics of the job they are assuming and only require orientation. The temporary alternative is often more economical than paying regular employees overtime. However, in health care there are some professions that are more expensive as temporaries than regular staff. These include nurses and physical therapists. These professional temps are often used though, because of the shortage of adequate staff. Federal law requires that anyone working for an organization for a period exceeding six months must be considered an employee for the purposes of earning credit toward retirement. Also, any temporary position that last longer than six months is probably not as economical as hiring permanent staff.

Departments may be established according to:

•Function (common in healthcare) •Product (common in manufacturing) •Territory (common in outreach services) •Customer (common with large, specific-need groups) •Time (frequent with around-the-clock services) •Process (work procedures) •Number (of workers doing the same work)

Sequence of development

•In preparation for development of new job descriptions or the revision of existing ones, the manager: - Carries out a job analysis - Prepares the new or revised job description - Applies the job classification criteria

Job Description Content

•Job title •Immediate supervisor •Job summary •Job duties •Job specifications

Use of Job Description

•Legal, regulatory, contractual, and accrediting mandates •Basis for job rating, classification, and wage and salary administration •Basis for categorization under Fair Labor Standards Law and Collective Bargaining •Basis for orientation and training •Basis for performance evaluation, error correction, retraining requirements, and grievance determinations •Basis for determining eligibility for claims under workers' compensation, OSHA, and similar programs

the organizational

•Major functions, usually by department •Relationships of functions or departments •Channels of supervision •Lines of authority and communication •Positions (by job title) within departments or units

Organizing

•The process of grouping the necessary responsibilities and activities into workable units, determining the lines of authority and communication, and developing patterns of coordination.

Functional Authority

•The right of staff individuals to exercise a limited form of authority over the specialized function for which they are responsible, regardless of who exercises line authority over the employees performing the activity.

Span of Control Determined by:

•Type of work •Degree of worker training •Organizational stability •Geographic location •Flow of work •Supervisor's qualification •Availability of staff specialists •Organization's value system