Public Health Econ

Herzberg's 2 Factor Theory

Maintenance (Hygiene) Needs and Motivation Needs

Management Theories of Motivation

Taylor's scientific management, McGregor's Theory X and Y, Ouchi's theory Z, integrative model of motivation

Interpersonal roles

negotiator - to represent organization externally leader - to direct organization members to reach goals liaison - to develop external relationships figurehead - symbolic external representative

Medical Care market - comparison to competitive model

non marketable commodities, increasing returns, entry, pricing

Future of Health Information

portability, apps, virtual health care, things to wear to regulate/monitor, improvements for complex info

Pricing Practices

price discrimination based on income, competition on price is essentially non existent, prices may respond to resource availability but not as fluid as open markets

expectancy

prior beliefs and experiences that shape ones thoughts and perceptions

Healthcare Challenges for Organizational Behavior - Organization

professional workforce, exacting work, high reliability, technical expertise, professional autonomy

Leadership Protocols

professionalism, reciprocal trust and respect, confident, optimistic, passionate, being visible, open communicator, risk taker, admitting fault

mental models

believes about how things work

Motivations that influence modes of social cognition

belonging, understanding, controlling, enhancing self, trusting in group

rollout and implementation

board endorsement, operating plan, marketing plan, facilities plan, capital plan

Financial Governance

board of directors, CEO, CFO, controller, treasurer, internal auditory, managers in health care

Major Competitive preconditions

existence of competitive equilibrium, marketability of all goods and services relevant to cost and utilities, non-increasing returns to production

Between individuals thinking patterns relevant to organizational behavior

expectancy theory, self-fulfilling prophecy, attributions, mental models, sensemaking

self-fulfilling prophecy

expectations about another's behavior that can elicit the expected behavior

attribution theory

explaining another's behavior by presuming it is caused either by a person's disposition or by the situation

Structures

facilities, personnel, technology

underuse

failure to provide a service whose benefit is greater than its risk example: beta blockers, diabetic eye and foot exams

socio emotional skills

interpersonal relations, teamwork, empathy, self awareness, self discipline

Work Situation / Work Task

interpersonal relations, workplace design, business challenges, healthcare industry changes

Prices

involve the money actually spent, involving perceived value of the services and the other opportunities foregone by consumers to acquire the services

Cost allocation

involves the determination of the total cost of producing a healthcare service through assigning costs from non revenue producing departments into revenue producing departments

Financial Management

providing oversight of the org. day to day financial operations, planning the organization's long range financial direction, increasing the org's revenue and decrease costs

Charges

published prices, there is a wide disparity between published prices and contract prices, since most 3rd party payers negotiate lower rates w providers

Resulting behaviors

reactions, conflicts, decisions, choices, work tasks, learning, adaption, effectiveness

Product Uncertainty

recovery from disease is an unpredictable as its existence, lack of learning from own or experience of others, wide variability in the utility of the product as perceived by consumers, information asymmetry between consumer and physician provider, asymmetry is known to both parties, and affects the relationship

Nature of demand

irregular and unpredictable demand for services, the services provide satisfaction 'utility' only in the event of illness, the demand is associated with assault on personal integrity - risk of death/loss, illness is costly risk in itself

expectancy theory

managers affect employee motivation when they influence employees expectations about ability to accomplish a task and expectations of reward

histogram

measure rate and frequency, reveal patterns

cognitive biases

mental processing that simplified handling information and that can compromise decision quality

schemas

mental representations about concepts, including persons, roles, and events

schemas

mental representations of what is known about something

Elements of Organization Culture

mission, vision, values

Extrinsic Rewards

money, benefits, flexible schedules, promotions, praise, good boss, strong leader, status changes

informational roles

monitor - to gather information and evidence disseminator - to share and exchange information spokesperson - to provide information externally

Not for profit tax status

serve public interests and are tax exempt, provide community benefit and optimal patient care 1) Business oriented 2) government owned

U in FOCUS

understand - collect and analyze data to gain comprehensive info about the current process and possible improvement plans

quality problems

underuse, misuse, overuse

Braden Scale

used to predict risk of developing pressure sores, scale of 1-4 for level of risk and 6 dimensions of patient status dimensions: sensory perception, moisture, activity, mobility, nutrition, friction and shear

Stages of Integration 0-1

very basic automation of individual areas

Perception

what is noticed, to what attention is paid

Second optimality theorem

without increasing returns in production, every optimal state is a competitive equilibrium corresponding to some distribution of purchasing power

Cognitive Model of Behavior

work situation/work task --> thinking processes --> resulting behaviors

Theories X and Y

two different view about the nature of employee behavior that can influence how a manager views employees, and how employees react to that view

Payment methods used by medicare and medicaid

Reimbursements to hospital, reimbursements to physicians, reimbursements to other providers

empathy

sensitivity to the emotional state of others

For Profit, Investor Owned tax status

serve private interests and pay taxes, maximize profits for the owner

HIT impact on manager

- Complex and quickly evolving work environment - Effective managers must use technology themselves - Dependency will create new norms around computer competencies, processes to use during "downtimes," - Costs have risen; quality has not. - adoption of clinical systems is increasing - model, EMRAM, that helps gauge adoption

Problems with Ideal Insurance

- moral hazard -effects ability to properly price coverage - alternative methods - influence service provision - third party control over payments - check on the moral hazard that obtains when physicians control payment levels - admin costs - dif in types of insurance - predictability and insurance - wide variation in costs - pooling of unequal risks - issue of risk adjusted premiums

Uncertinity of effects of treatment

- uncertain about effectiveness of medical treatment, different uncertainty from physicians

Ideal Insurance

1) coverage for the risk of becoming ill 2) coverage for the risk of total vs. incomplete, and delayed, recovery 3) assumption here of risk aversion so that ppl will pay a premium equivalent to the mean random costs of medical care 4) offsetting admin costs and risk aversion of the insurance company, a deductible with some level of co-insurance to meet this risk aversion

Intrinsic Factor Theories of Motivation

Adam's equity theory, Vroom's expectancy theory, locke's goal setting theory

C in Focus

Clarify - study the process to identify all areas of the problem

D in PDCA

Do - implement the plan as a small demonstration project

Emotional Intelligence

EI Dimension - self awareness, self regulation, motivation, empathy, social skills Leadership Application - knowing values are congruent - ethical considerations - optimism facing challenges - setting a patient centered vision - having rapport with staff and Board

Domains of Health Care

External and Internal

F in Focus

Find - determine a process problem that needs to be improved

Healthcare Challenges for Organizational Behavior

Industry and Organization

Medical Care Market

Nature of demand, expected behavior of the physician, product uncertainty, supply conditions, pricing practices

O in Focus

Organize - create a team that is knowledgeable about the process problem and willing to work together

Maslow's Hierarchy of Needs

Physiological, Safety/security, social, ego, self-actualization

P in PDCA

Plan - determine the goals to be achieved and develop a strategy to reach those goals

Types of Health Care Organizations

Public (NIH, VA, PH debt) Private (GW Hospital) Industrial/Commercial/Retail (Urgent care/minute clinic)

Reimbursements to other providers

SNFs, HHAs, outpatient hopsital

FOCUS-PDCA

a framework created by hospital corporation of American for thinking about and applying different tools for CQI - used widely in one form or another in health care and industry

Fishbone diagram (cause and effect)

a mechanism to examine cause and effect, identifies major problems and associated cause visual display - causes are clustered by category, general cause are 'bones' of diagram

Stages of Integration 7

ability to share or exchange data with external entities

Stages of Integration 2

ability to start bringing disparate data together

Redistribution of Purchasing Power

accomplished through money derived either from taxes or subsidies

A in PDCA

act - revise the plan to meet more of the goals and test it with demonstration projects or implement the successful plan throughout the organization

Individual thinking patterns relevant to organizational behavior

assumptions, perceptions, biases, expectancy, schemas, mental modes, theory X and Y

Thinking processes

assumptions, perceptions, heuristics, attributions, knowledge, beliefs, biases, mindsets, schema, emotions

Organizational Behavior - Individual

assumptions, perceptions, personality

Electronic Health Record (EHR)

broader term than EMR, refers to total health of patient - immunizations, allergies, medications, data in EHR accessible to many

C in PDCA

check - evaluate this demonstration by comparing the resulting outcomes with the original goals

S in FOCUS Select

chose a process improvement plan

Leadership Styles

coercive, partipate, pacesetting, coaching

empathetic perspective taking

cognitively understanding and emotionally sharing the feelings of another

External Domains of Health Care

community needs, licensure, accreditation, regulations, stakeholder demands, competitors, medicare and medicaid, managed care organizations

Electronic Medical Record (EMR)

computer application that includes: - clinical data repository - clinical decision support - controlled medical vocab - physician order entry - pharmacy and clinical documentation used cross impatient/outpaitient, used by all to document, monitor, and manage health care delivery

Health Information Systems (HIS)

computer system (software, hardware, operating systems, end user devices), networks

Competencies of Management

conceptual skills, technical skills, interpersonal skills

Problems with Marketability

consumer pays to cover costs to others or others pay consumer to have the immunization

Reimbursements to hospitals

contractual allowances, diagnosis related groups, case mix or patient mix

Thinking skills

critical thinking, reasoning, problem solving, decision making, mental flexibility

values

defining the organization culture

Retrospective Payments

determined after service, charges, charges minus a discount, cost plus

Prospective Payment

determined before service delivery, per diem, per diagnosis, capitation

Ethical Responsibility

doing right vs. wrong, bioethics, managerial ethics, code of ethics

Contemporary Models

emotional intelligence, inspirational leadership, diversity leadership, servant leadership, spirituality leadership

Mission

enduring statement of purpose

Decisional roles

entrepreneur - to innovate and improve disturbance handler - to resolve problems and disagreements resource allocator - to distribute resources

Leadership Competencies

establishing mission, setting vision/direction, motivating stakeholders, being an effective spokesperson, determining strategies for future, transforming the organization, networking

Objectives of Financial Management

generate a net income, set prices for services, facilitate relationships and manage contracts with 3rd party payers, record and analyze cost info, prepare, audit, disseminate the org's financial reports, invest in long term capital assets, ensure the payroll is covered, protect tax status, control financial risk to org

overuse

health services provided when its risk outweighs its benefit

Market Assessment (Porter's Five Forces Model)

healthcare workforce, consumers and payers, innovations in technology, regulatory environment, competitive rivalry

Intrinsic Rewards

healthy relationships - sense of connection, meaningful vs. meaningless work, competence, choice and participation in decision making, progress

Work Process Flowchart

helps clarify complex processes, identify steps that do not add value, impose delays, create unnecessary duplication of work, or increase costs without benefits, compare actual work flow with planned work flow, serve as a basis for designing new processes

Stages of Integration 3-6

implementation of advanced clinical systems

strategy tactical plans

implementation steps, timeframes, results

critical cycle

importance of follow up: make new decisions or reenforce original decisions in light of the findings of the various performance studies, use the findings to adjust work processes in light of current info

attributions

impulsing the likley cause of another's behavior

Organizational Behavior - 3 Levels

individual, group, collective

cognitive empathy

knowing and understand another's perspective

Capital Budget

land acquisition, facility construction, renovation, routine capital equipment, tech upgrades

Health Leadership Barries and Challenges

laws and regulation, physicians, new technology, culture of safety

Organizational Behavior - Group

leadership, teamwork, decision making, power, conflict

Determining of setting charges/prices

legal and regulatory issues, establishing pricing goals and objectives, estimate the economic market conditions - supply and demand, estimate costs and break even point, consider policies and 3rd party payers, consider competition, effects of over and under pricing

vision

long term goal for future state

statistical quality

ongoing monitoring of variation

Major Types of budgets

operating/cash budget, revenue budget, expense budget, capital budget

Organizational Behavior - Collective

organization of work, structure of authority, power relationships, design organization systems, HR management, organizational culture, organizational learning and adaption

Quality in practical terms

patient satisfaction, relationships, decision making efficiency, patient outcomes, amenities and convenience

Managing budgets

plan for turning the objectives of the organization into a program for earning revenues and controlling expenditures

Strategy Identification and selection

planning assumptions, scenario exploration, financial targets, resource matching

Six Management Functions

planning, organizing, staffing, controlling, directing, decision making

reimbursements to physicians

resource based relative value system, capitated managed care plans

Outcomes

results from the production of care

misuse

right service is provided poorly, and an avoidable complication reduces benefit to patient

Healthcare Challenges for Organizational Behavior - Industry

rising costs and declining reimbursements --> financial pressure, increased competition, consumer demands, new services and tech, outpatient care, chronic illness, patient safety, quality of care, labor shortages

Gantt Chart

scheduling and progress measurements, emphasizes work time relationships, allows examination of interrelationships, and conflicts in work activities

thinking patterns between individuals that can alter common understanding

self fulfilling prophecy, expectancy theory, attributions, attribution theory, mental models, schemas

emotional empathy

sharing another's feelings

scattergram

show the relationship between 2 variables

Strategic Planning Process

situational assessment, strategy identification and selection, strategy tactical plans, rollout ad implementation, monitoring and control, feedback

Managerial Competencies

staffing personnel, assuring patient centered resources, controlling resources, supervising the services provided, overseeing adherence to regulation, counseling/developing employees, managing operations

Internal Domains of Health Care

staffing, budgeting, quality services, patient satisfaction, physician relations, financial performance, technology acquisition, new service development

Systems in Health Care

standard office applications, budget systems, cost accounting systems, enterprise resource planning, time and attendance, staffing and scheduling, productivity system, marketing system, fundraising system, billing and accounts receivable systems

Internal Assessment

strengths, weaknesses, organizational volume forecast, financial condition, strategic performance

Health Care quality

structures, processes, outcomes

Theories of Motivation

study motivation from perspectives of: needs at different levels, extrinsic factors, intrinsic factors, integration of needs, extrinsic and intrinsic factors

Supply Conditions

supply is normally controlled by the returns from being in one industry v. another, entry into medical profession is restricted by licensing and educational institutions, BUT, returns to physicians outstrip costs to become trained and yet unlike other markets there is not an increase in supply to reduce the price of medical services, social non-market forces influence the quantity and quality of supply

Socio Emotional Intelligence

the ability to sense, understand, and effectively respond to other's emotions - empathy, emotional empathy, cognitive empathy, empathic perspective taking

Expected behavior of the physician

the product and the production of the product are identical, consumer cannot test product, reliance on physician provider is integral to the transaction, advice and treatment should be divorced from self interest, treatment should be dictated by the needs of the case, not limited by financial considerations, physicians are relied upon experts in knowledge and information about illness and injuries

processes

the provision of care services, use of structural resources

First Optimality Theorem

there is no other allocation of resources to services that will make all participants in the market better off

Payments from Uninsured

those without insurance are billed for full charges, results in rise of personal bankruptcies, due to inability to pay such large sums of money Uncompensated Care - bad debt: no payment received for billed services, written off by the organization - charity care: organization provides care, knowing the patient will be unable to pay

Pareto Chart

to determine priorities by comparing factors, allows sorting of elements from most to least critical

Run chart

to identify trends, useful in determining resource needs

Governance

top accountable body, board of directors + trustees, heighten scrutiny, transparency, fiduciary responsibility