Y472: Midterm

Management

"the act of getting things done through other people"

Stakeholders

-Consumers, patients & tax payers -Health care prof & institutions -Pharmacy, insurance, for profit companies -Payers & orgs that regulate & accredit

mission statement

-Drawn from vision, but more concise Identifies organizations: -Business -Reason -Purpose

Internal standards of practice

-Guide delivery of service to individuals -Standards of practice from ATRA (NTRS)

outcome

-Indicators pre-determined measurable aspect of care -Set thresholds (# or %) positive & negative variances arereported -Indicators in RT/TR prepared for each component of APIE

external agencies

-JCAHO joint commission on the accreditation of healthcare orgs. -CARF commision on the accrediattion of rehab facilities -CMS center for medicaid & medicare -social security administration -state departments -city departments

Expert Power

-Knowledge is power -possessing knowledge or expertise in a particular area EX: promoted to senior management

JCAHO

-Largest and most influential private organization involved in health care agencies -enhance the quality of care & services -More than 80% of the nation's acute care general hospitals voluntarily participate in JCAHO activities

vision statement

-Long range (lasts 5-20 years) (reviewed annually, but remains constant) -Desired state that they commit to -Statement of what they stand for, believe in, their why & what it intends to accomplish

vision statement guidelines

-Powerful -Concise -Present tense -Emotional -Detailed

3 Types of Care Providers

-Preventative Care -Primary Care -Speciality Care

goals

-Short term (achievable in 1.5 years) -Guide agency -Developed by first line manager

objectives

-Specific -Describe result -2-4 obj per goal -SMART

Preventative Care

-Vaccines -Screenings -Check ups

Broad → Specific Planning Statements

-Vision -Mission -Goals -Objectives

inpatient (type of care)

-acute (severe but short) -post acute (rehab) -extended care

CMS (centers for medicaid/medicare)

-agency under the federal Department of -Health & Human Services. -Contains regulations that are legislated by public law (reimbursement of Medicare/aid funds & direct funding implications)

legitimate power

-aka positional power -position a person holds in an organization's hierarchy EX: CEO.

US Healthcare

-always growing National health expenditures: 2.5 tril annually (2006) 4.5 tril annually (2023) 17.3% of GDP Employs more than: 14 mil (2006) 22 mil (2023)

3 Types of Care

-ambulatory -inpatient -home

stages of comprehensive program design

-analysis -conceptualization -investigation -determination

Reward Power

-arises from the ability of a person to influence the allocation of incentives in an organization EX: salary increments, positive appraisals and promotions

Confidentiality & Privacy

-disclose all relevant information to persons seeking services -do not disclose to anyone else

Characteristics of US Health Care System

-division of labor between public health system (keeps ppl healthy) & medical care system (takes care when they are not) -importance of institutions (hospitals) -med technology fuels expansion -tension between free market & gov control -dysfunctional finance & payment system

Referral Criteria

-how clients are referred to program -who is appropriate for protocol -whether a physician's order is required for individuals to participate in the program

investigation (stages of comprehensive program design)

-identify potential program components -Consider mission/vision, goals, resources -Convert client needs/strengths → primary components -translating goals --> programs

Referent Power

-interpersonal relationships w/ ppl in organization. -generates her power over others

First Line Manager, Resources to be Manged

-physical resources -technological resources -financial resources -human resources

Functions of First Line Manager

-planning -organizing -leading -controlling

Improvement in Healthcare System

-quality -access & coverage -public health care system -coordination, transparency & accountability -slowing the growth of health care costs -encourage healthy behavior

determination (stages of comprehensive program design)

-selection/review of program components & modalities/interventions in relation to goals -consider: strengths weaknesses resource use compatibility w/ other goals -select the most appropriate & desirable modalities

specific stages of comprehensive program design

-specific program design -implementation plan -evaluation plan

Concerns in Healthcare System

-spend too much -quality of care = uneven -ppl lack access (where you live)

First Line Manger (Levels of Management)

-supervise work of non managerial staff & volunteers -oversees day to day activities & RT department -coordinates services w/ other managers in same org. & other RT managers in community

process (quality improvement)

-the actual delivery of care as well as it's management -intervention implementation

sections in program protocol

-treatment modality -statement of program purpose -description of program -goals & objectives -group size -space requirements -equitment/materials needed -relationship to RT model -facilitation techniques -description of actvity -adaptive -contraindicated criteria -risk management -staff training/certification requirements -debrief questions -refrences

Characteristics of Management & Supervision

-visionary thinking -understand role of department -political astuteness & sensitivity -rise above bureaucratic boundaries

conceptualization (stages of comprehensive program design)

-write statement of purpose (vision/mission) -write goals & objectives

FOCUS-PDCA

A quality improvement model involving stages of focus, organize, clarify, understand, select, plan, do, check, and act.

regulatory agency that requires physician's orders for "skilled therapies providing active treatment"

CMS

internal customer

CTRS in facility

mission statement guidelines

Customer outcomes: -Who customers? (target client) -What services? (provide) -How delivered? (unique)

protocols

Describe the collective and proven strategies of specific interventions to bring about targeted behavioral change in clients

commonly used quality improvement framework

FOCUS-PDCA

Total Quality Management originated from what situation?

Oil shortages in the 1970's which eventually resulted in a push for greater quality in vehicle production.

Primary Care

Primary care physician

External

Set by groups outside of RT to monitor & improve services

Coercive Power

a person's ability to influence others via threats, punishments or sanctions.

fidelity

be loyal, faithful & meet commitments made to persons receiving services.

veracity

be truthful & honest

Speciality Care

cardiologist

outcome indicator

client health status

Compliance with Laws and Regulations

comply with local, state, federal laws, regulations & ATRA policies

Standards 10: Quality Improvement

continuously improving patient/client safety

1991 ATRA (internal standards of practice)

created standard designed to include clinical/community settings

1980 NTRS (National Therapeutic Recreation Society) (internal standards of practice)

created the 1st standard of practice (designed for non clinical/community settings)

ambulatory (types of care)

day treatment/clinics

classical management theory

developing a science for every job, carefully selecting workers with the correct abilities, and supporting those workers through training and incentives.

Standards 5: Discharge & transition Planning

develops a discharge plan to continue treatment and aftercare, as needed.

Autonomny

each individual makes their own choices. if cant make choice: respect the decisions of their qualified legal representative

city department

fire, personnel or safety

process criteria

focus on the provision of therapeutic recreation services

Standards 8: Written Plan of Operation

governed by a written plan of operation

Standards 3: Plan Implementation

implements an individualized treatment plan, using evidence-based practice, to restore, remediate or rehabilitate functional abilities in order to improve and maintain independence and quality of life as well as to reduce or eliminate activity limitations and restrictions

Competence

improve knowledge (CUES)

quality improvement

includes... -quality assurance -performance improvement -continuous quality improvement a process that monitors and evaluates service quality through the ongoing use of standards and mechanisms that evaluate services to ensure standards are met

Standards 1: Assessment

individualized assessment to collect systematic, comprehensive and accurate data necessary to determine a course of action and subsequent individualized treatment plan.

The Centers for Medicaid and Medicare Services specifies "quantifiable change" or change that is "functional in nature." What aspect of treatment planning would satisfy this requirement?

individualized client objectives

beauraucratic

leadership style that relies on policies and rules to identify goals and direct work processes & ensures that the same rules and policies are applied to every situation

Laissez-faire

leadership style where mature teams that are collaborating to achieve client goals

human relations theory

managers humanizing work and letting employees take an active role in decisions that affect them by reducing external controls.

Standards 2: Treatment Planning

plans and develops an individualized treatment plan that identifies goals and evidence-based treatment intervention strategies.

informed consent

provide services characterized by mutual respect & shared decision making.

Standards 7: Ethical Conduct

providing patient/client treatment and care that are humane and professional.

outcome criteria

reflect a desired goal for the clients condiiton

structure criteria

reflect measurement of the parameters of practice

Justice

responsible for ensuring that individuals are served fairly & there is equity in the distribution of services (aka don't be a bad person)

social security adminsiration

reviewing patients accounts, rate setting & reimbursement procedures

Standards 12: Program Evaluation & Research

staff engages in routine, systematic program evaluation and research determining the appropriateness and effectiveness of recreational therapy treatment and care

Standards 9: Staff Qualifications & Competency Assessment

staff meet the defined qualifications, demonstrate competency, maintain appropriate credentials and have opportunities for competency development.

behavioral school theory

success depends on motivated and skilled individuals who are committed to organizational objectives and that the function of a manger is to obtain employee cooperation so they can work towards organizational goals.

Standards 6: Prevention, Safety Planning & Risk Management

systematically plans to improve patient/client

Standards 4: Re Assessment & Evaluation

systematically re-assesses, evaluates and compares the patient's/client's progress & revised based upon changes

general sytems theory

the belief that an organization is a set of interrelated parts arranged in a unified whole to accomplish a common goal. If one part of an organization is removed then the whole organization is changed.

contingency theory

the belief that appropriate managerial behavior is dependent on a variety of elements

treatment modality

the identification of the type of program used to provide the therapeutic intervention

structure (quality improvement)

the material & human resources of an organization & the facility itself

outcome (quality improvement)

the resulting health status of patients

Beneficence

treat ppl in ethical manner by actively making efforts to provide for their well-being by maximizing possible benefits & minimizing possible harm.

Standards 11: Resource Management

treatment and care are provided in an effective and efficient manner that reflects the reasonable and appropriate use of resources.

Non-maleficence

use knowledge, skills, abilities, & judgment to help persons while respecting their decisions and protecting them from harm

state departments

workplace practices that protect the safety & health of both employee & client or to implement public law & policies