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
