Healthcare Management Introduction

• Introductory healthcare management texts must define the profession, major functions, roles, responsibilities, and competencies for healthcare managers.

Healthcare Management

• A growing profession with increasing opportunities in direct and non–direct care settings.
• Direct care settings: organizations providing care directly to patients.
• Non–direct care settings: organizations supporting patient care through products and services.
• Projected to grow 16% from 2008 to 2018 (BLS).
• Fastest growth in outpatient centers, clinics, and physician practices.
• Healthcare management provides leadership and direction to organizations delivering personal health services.
• Understanding the roles, responsibilities, and functions carried out by healthcare managers is important for those considering the field.

Need for Managers

• Healthcare organizations are complex and dynamic, thus, requiring leadership, supervision, and employee coordination.
• Healthcare organizations are too complex for a single person to carry out tasks.
• Organizations are created to achieve goals beyond individual capacity.
• Successful management requires coordination between specialized disciplines.
• Managers make sure organizational tasks are carried out seamlessly.
• Managers consider external and internal domains in decision-making.
• External domain: influences and resources outside the organization significantly affecting it, including community needs, population characteristics, and reimbursement from insurers and government plans (CHIP, Medicare, and Medicaid).
• Internal domain: focus areas within the organization that managers address daily, including staffing, financial performance, and quality of care.
• Balancing internal and external perspectives is important.

Management Functions and Competencies

• Accomplishing predetermined objectives through humans and other resources constitutes management.
• Managers work with others to achieve organizational objectives using technical and interpersonal skills.
• A manager supports and is responsible for work performance.
• Managerial positions: supervisor, coordinator, and director.
• Planning: setting direction and determining priorities/performance targets.
• Organizing: designing the organization, designating relationships, and distributing authority
• Staffing: acquiring and retaining human resources.
• Controlling: monitoring performance and taking corrective action.
• Directing: initiating action through leadership and motivation.
• Decision making: making effective decisions based on benefits and drawbacks.
• Conceptual skills: critically analyze and solve complex problems.
• Technical skills: reflect expertise in a specific work task.
• Interpersonal skills: enable communication and collaboration.

Management Positions and Organizational Hierarchy

• Management positions exist at the lower, middle, and upper levels.
• Upper level is referred to as senior management.
• Authority is delegated downward in the organization.
• Lower-level managers have less authority than higher-level managers.
• Vice president of Patient Care Services manages functional areas.
• Director of Medical Records manages patient medical records.
• A supervisor manages a small housekeeping staff such as within the Environmental Services Department.
• Line managerial positions: supervising other employees.
• Staff managerial positions: advising bosses but not routinely supervising others.
• Organizational structure: pyramid-shaped hierarchy defining functions and key management positions.
• Functional organizational structure is the most common.
• Vertical structures reflect administrative control.
• Strict chain of command ensures linear communication.
• Structures offer specific divisions of labor and clear lines of accountability.
• Administrative structures: matrix or team-based models.

Management Focus

• Management involves self, unit/team, and organization-wide levels.
• Individual managers must manage time, information, space, materials, peers, supervisors, clients, attitude, motivation, and substantive issues.
• Supervisory role includes assigning tasks, reviewing performance, and ensuring service delivery.
• Organizational level: collaborating for organization-wide performance.

Talent Management

• Management must have highly motivated employees.
• Healthcare organizations view employees as strategic assets.
• Human resources is replaced by talent management through effective management to link to organizational performance.

Ensuring High Performance

• Managers ensure high performance at the unit, service, division, or organizational level.
• Goals and objectives are desired end points for activity.
• Goals and objectives are specific, measurable, meaningful, and time oriented.
• Studer (2003): organizations should be results-oriented with pillars of excellence.
• Pillars: people, service, quality, finance, and growth.
• Griffith (2000): high performing organizations are championship organizations with meaningful measures.
• Measures include governance, clinical quality, financial planning, and human resources.
• Manager jobs ensure targets are met.
• Control process: set objectives, measure performance, compare, identify deviations, and take action.
• The Joint Commission and NCQA have standards for healthcare facilities and health plans.
• CMS compares hospital performance with incentives for clinical measures.
• Health insurers implement pay-for-performance programs. Common methods include dashboards/scorecards.

Succession Planning

• Managers face the challenge of succession planning.
• Succession planning: taking actions to ensure staff can move up.
• Recent emphasis is at the senior level due to retirements.
• Senior managers are interested in finding talent.
• Mentoring programs prepare future leaders, which view mentoring efforts as helpful to the organization.
• Multiple mentors capture expertise.
• Formal leadership development programs identify management potential to assess skill sets.
• Formal programs focus on high potential people.
• Executive-level programs address leadership development at all levels.

Health Policy

• Managers consider external and internal domains.
• Knowledgeable about health policy affecting organizations and delivery and is necessary to influence it positively.
• Staying current with policy discussions allows management voices to be heard and advocate for associations' interests.

Summary

• Managers should understand the external perspective.
• Managers should understand the internal perspective, as well as the dual perspectives.
• Also instrumental are talent recruitment and retention, succession planning, and shaping health policy.