Managing Health Services Organizations and Systems

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ISBN: 9781878812575 | 1878812572
Cover: Hardcover
Copyright: 7/1/2000

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Univ. of Pittsburgh, PA. Textbook for students to help set the benchmark of excellence in the management of health services. Covers a model of managing in HSOs/HSs, a description of the healthcare system, organizational designs of HSOs and HSs, and the role technology plays in health services. Author also wrote Health Professionals in Management, c1996, a Brandon/Hill title (#260).

About the Authors

xxvi

Preface

xxviii

Acknowledgments

xxx

Part I Managing in the Health Services Environment

Management and Managers

(40)

Key Definitions

(4)

Health

(1)

Health Care and Health Services

(1)

Health Services Organizations

(1)

Health Systems

(2)

Managers

(1)

Management

(1)

Management and Organizational Culture, Philosophy, and Performance

(2)

Management and Organizational Cultural and Philosophy

(1)

Management and Organizational Performance

(1)

Management Functions, Skills, Roles, and Competencies

(13)

Management Functions

(1)

The Planning Function

(2)

The Organizing Function

(1)

The Staffing Function

(1)

The Directing Function

(1)

The Controlling Function

(1)

The Pervasiveness of Decision Making

(1)

Management Skills

(1)

Management Roles

(1)

Interpersonal, Informational, and Decisional Roles

(2)

Designer, Strategist, and Leader Roles

(2)

Management Competencies

(1)

Conceptual Competence

(1)

Technical Managerial/Clinical Competence

(1)

Interpersonal/Collaborative Competence

(1)

Political Competence

(1)

Commercial Competence

(1)

Governance Competence

(1)

Summary

(1)

A Management Model for HSOs/HSs

(5)

Inputs (Resources)

(2)

Outputs (Objectives)

(1)

Conversion (Integration)

(1)

Managers Managing

(1)

External Environment (An Open Systems Perspective)

(1)

The Challenges of Management

(1)

Structure of the Book

(1)

Summary

(1)

Discussion Questions

(1)

The CEO's Day

(3)

Role and Functions of Executive Management

(1)

The Role of the Health Care Executive in a Consolidation, Merger, Acquisition, or Affiliation

(2)

A Management Function Questionnaire

(1)

Notes

(3)

Selected Bibliography

(4)

The Health Care System

(68)

Health and System Goals

(2)

Lack of Synchrony

(1)

A Brief History of Health Services in the United States

(5)

Technology

(1)

Mortality and Morbidity

(1)

Social Welfare

(1)

Federal Initiatives

(3)

Other Western Systems

(1)

Present Structure of the Health Services System

(3)

Classification and Types of HSOs

(2)

Profit or Not for Profit

(1)

Ownership

(1)

Length of Patient Stay

(1)

Role in Health Services System

(1)

Unique Institutional Providers

(1)

Mental Health Organizations

(1)

Teaching Hospitals

(1)

Health Services Workers

(5)

Physicians

(3)

Nonphysician Clinicians

(1)

Licensed Independent Practitioners

(1)

Regulation and Education of Managers

(1)

Regulation

(1)

Education

(1)

Regulation and Education of Caregivers

(6)

Licensure, Certification, and Registration

(1)

Education and Regulation of Sample Health Occupations

(1)

Physicians

(1)

Nonphysician Caregivers

(4)

State and Federal Regulations of HSOs

(5)

Inspections

(1)

Licensure and Regulation

(1)

Conditions of Participation

(1)

Planning and Rate Regulation

(1)

Utilization Review, PSROs, and PROs

(1)

Government Payment Schemes

(1)

Diagnosis-Related Groups

(1)

Resource Utilization Groups

(1)

Ambulatory Patient Groups and Ambulatory Payment Categories

(1)

Resource-Based Relative Value Scale

(1)

Summary

(1)

Other Regulators

(1)

Health Services Delivery Accreditation

(4)

Joint Commission

(2)

American Osteopathic Association

(1)

International Organization for Standardization (ISO)

(1)

Community Health Accreditation Program

(1)

National Committee for Quality Assurance

(1)

Utilization Review Accreditation Commission

(1)

Associations for Individuals and Organizations

(2)

Professional Associations for Individuals

(1)

Managers

(1)

Physicians

(1)

Nonphysician Affiliations

(1)

Professional Associations for HSOs/HSs

(1)

American Hospital Association

(1)

Federation of American Health Systems

(1)

American Osteopathic Healthcare Association

(1)

Other Hospital Associations

(1)

American Health Care Association

(1)

American Association of Homes and Services for the Aging

(1)

American Association of Health Plans

(1)

Educational Accreditors

(3)

Managers

(1)

Physicians

(1)

Nurses

(1)

Medical Specialty Boards for Allopaths

(2)

Financing Health Services

(10)

Expenditure Trends

(1)

Sources and Uses of Funds in Health Care

(6)

Private Payment Under the Insurance Principle

(1)

Government Programs

(3)

Trends and Developments in the System

(1)

Summary

(1)

Discussion Questions

(1)

Gourmand and Food---A Fable

(1)

Where's My Organ?

(1)

Appendix

(4)

Medicare at a Glance

(1)

What Is Medicare and How Is It Financed?

(1)

Who Is Covered Under Medicare?

(1)

What Benefits Does Medicare Cover?

(1)

Gaps in Medicare: Implications for Beneficiaries

(1)

Growth of Medicare Managed Care

(1)

Medicare Expenditures

(1)

Outlook for Medicare's Future

(1)

Medicaid at a Glance

(1)

Who Is Covered by Medicaid?

100

(1)

What Services Are Covered Under Medicaid?

100

(1)

How is Care Delivered Under Medicaid?

100

(1)

Enrollee and Expenditure Growth

101

(1)

Notes

101

(7)

Selected Bibliography

108

(3)

Concepts of Organization Design

111

(42)

Design Concepts in Building Formal Organization Structures

113

(18)

Classical Concepts

114

(1)

Weber's Contribution to Design

114

(1)

Fayol's Contributions to Design

114

(1)

Relevance of Classical Concepts

115

(1)

Division of Work

115

(1)

Classical View

115

(1)

Contemporary View

116

(1)

Authority and Responsibility Relationships

117

(1)

Classical View

117

(1)

Contemporary View

118

(1)

Departmentation

119

(1)

Classical View

119

(1)

Contemporary View

120

(1)

Span of Control

121

(1)

Classical View

121

(1)

Contemporary View

122

(2)

Coordination

124

(1)

Classical View

124

(1)

Contemporary View

125

(5)

Summary of the Classical Organization Design Concepts

130

(1)

Design Concepts in Informal Organization Structures

131

(5)

Nature of Informal Organizations

131

(2)

Why People Form Informal Groups

133

(1)

Leadership in Informal Groups

133

(1)

Stages of Group Development

134

(1)

Structure of Informal Groups

134

(1)

Positive Aspects of the Informal Relationships in HSOs/HSs

135

(1)

Living with Informal Relationships in Organizations

136

(1)

An Integrated Perspective on Organization Design

136

(4)

Five Basic Organization Designs

137

(1)

Simple Structure

137

(1)

Machine Bureaucracy

137

(1)

Professional Bureaucracy

138

(1)

Divisionalized Form

138

(1)

Adhocracies

138

(2)

Choosing an Organization Design

140

(1)

Summary

140

(3)

Discussion Questions

143

(1)

A New Approach on the Nursing Units

144

(1)

Trouble in the Copy Center

144

(1)

Alternative Facilities: New Mini-Hospital Raises Hackles

145

(1)

``I Cannot Do It All!''

146

(1)

The Secretaries

147

(1)

Somebody Has to Be Let Go

148

(1)

Notes

148

(2)

Selected Bibliography

150

(3)

How Health Services Organizations Are Organized

153

(70)

Background

153

(1)

Governing Body

154

(1)

Chief Executive Officer

154

(1)

Clinical Staff

154

(1)

The Triad

155

(1)

Legal Status

155

(1)

Organization Structure

156

(1)

Governing Bodies

156

(3)

Role and Functions

157

(1)

Composition

158

(1)

Committees

158

(1)

Relationship to the CEO

159

(1)

Management

159

(2)

Function

160

(1)

Qualifications

161

(1)

Relationships

161

(1)

CEO and Senior Management

161

(1)

Organizing the Professional Staff

161

(9)

History

162

(1)

Professional Staff Organization

162

(1)

Self-Governance

162

(1)

Open or Closed

163

(1)

Committees

163

(1)

Clinical Departmentation

164

(1)

Managing the PSO

164

(1)

Credentialing

164

(1)

Process

165

(1)

PSO Membership---Initial Appointment

165

(1)

PSO Membership---Reappointment

166

(1)

Clinical Privileges

166

(1)

PSO Discipline

167

(1)

Special Issues in Managing the PSO

167

(1)

Economic Credentialing

167

(1)

Turf Conflicts

168

(1)

Integration

168

(1)

Licensing and Credentialing

169

(1)

Impaired Clinicians

169

(1)

Organization of Selected HSOs

170

(36)

Acute Care Hospitals

170

(1)

Definitions and Numbers

171

(1)

Classification

171

(1)

New Types

172

(1)

Functions

172

(2)

Organization Structure

174

(4)

Licensure and Accreditation

178

(1)

Future

178

(1)

Nursing Facilities

178

(1)

Definition and Numbers

179

(1)

Functions

180

(1)

Organization Structure

180

(3)

Licensure and Accreditation

183

(1)

Future

183

(1)

Ambulatory Health Services

183

(2)

Organization Structure

185

(1)

Licensure and Accreditation

186

(1)

Future

186

(1)

Hospice

186

(1)

Function and Numbers

187

(1)

Models

188

(1)

Organization Structure

188

(1)

Licensure and Accreditation

189

(1)

Future

189

(1)

Managed Care

189

(1)

Characteristics

190

(1)

Types

191

(2)

Payment

193

(2)

Organization Structures

195

(2)

Licensure and Accreditation

197

(1)

Future

198

(1)

Birth Centers

199

(1)

Definition and Numbers

199

(1)

Organization Structure

200

(1)

Licensure and Accreditation

200

(1)

Future

200

(1)

Home Health Agencies

201

(1)

Definition and Numbers

201

(1)

Functions

202

(1)

Organization Structure

203

(2)

Licensure and Accreditation

205

(1)

Future

206

(1)

Summary

206

(1)

Discussion Questions

206

(1)

The Clinical Staff

207

(1)

The Emergency Department

207

(1)

Authority Relationships

208

(1)

The Orthopedic Surgery Group Practice

209

(1)

The Right Thing to Do

209

(1)

Notes

210

(9)

Selected Bibliography

219

(4)

How Health Systems Are Organized

223

(48)

Interorganizational Relationships

224

(1)

Strategic Alliances

225

(12)

Reasons to Ally

226

(1)

Approaches to Understanding SAs

227

(1)

SAs Categorized by Participants

227

(1)

Physician-Physician SAs

227

(1)

Physician-HSO/HS SAs

227

(1)

HSO-HSO SAs

228

(3)

SAs Categorized by Purpose

231

(1)

SAs Categorized by Form

232

(1)

Co-opting

233

(1)

Loose Coupling or Coalescing

233

(2)

Mergers and Consolidations

235

(1)

Summary

236

(1)

The Future of SAs: A New Health Services Ecosystem

237

(1)

Managing SAs

237

(5)

Conceptual Competence in Managing SAs

239

(1)

Technical Managerial/Clinical Competence in Managing SAs

239

(1)

Interpersonal/Collaborative Competence in Managing SAs

240

(1)

Political/Commercial Competencies in Managing SAs

241

(1)

Governance Competence in Managing SAs

242

(1)

Governance in HSs

242

(5)

Centralized Versus Decentralized Governance Structures

242

(3)

Composition of the GB

245

(1)

Governance Responsibilities

246

(1)

Selected Technical Issues in Managing IORs

247

(6)

Negotiations in Managing IORs

247

(2)

Unique Aspects of Managing Involuntary IORs

249

(2)

Corporate Restructuring and Corporate Diversification

251

(2)

Summary

253

(1)

Discussion Questions

254

(1)

Texas Health-Baylor: Networks Agree to Mega-Merger

254

(1)

Hard Times

255

(1)

Community Health Plan

256

(1)

Does It Make Sense?

257

(1)

American Hospital Association's Policy on Community Accountability with Changes in the Ownership or Control of Hospitals or Health Systems

258

(2)

Board Effectiveness

260

(1)

How to Turn an Intimidating Government Bureaucracy into a Partner and Ally

261

(1)

Notes

262

(5)

Selected Bibliography

267

(4)

Health Care Technology

271

(46)

History and Background

273

(1)

Types of Technologies

274

(3)

Definitive (Curative, Preventive) Technologies

274

(1)

Halfway (Add-On) Technologies

274

(1)

Deferral Technologies

274

(1)

Competing Technologies

275

(1)

Cost-Saving Technologies

275

(2)

Effects of Technology on Health Status

277

(1)

Forces Affecting Development and Diffusion of Technology

277

(4)

Medical Education and Practice

277

(2)

Reimbursement

279

(1)

Third-Party Payment

279

(1)

Diagnosis-Related Groups

279

(1)

Health Care Financing Administration

280

(1)

The Public

280

(1)

Competitive Environment

280

(1)

Responses to Diffusion and Use of Technology

281

(3)

Public Sector Activities

282

(1)

Food and Drug Administration

282

(1)

PSROs and PROs

282

(1)

Certificate of Need

283

(1)

Private Sector Activities

283

(1)

Joint Commission

283

(1)

ISO 9000

284

(1)

Tort Law

284

(1)

Technology Assessment

284

(2)

Public Sector Activities

284

(2)

Private Sector Activities

286

(1)

Summary

286

(1)

HSO/HS Technology Decision Making

286

(3)

Review and Planning

287

(1)

Financing Technology

287

(1)

Evaluating and Acquiring Technology---TEAM

288

(1)

Newer Alternatives to TEAM

288

(1)

Chief Technology Officer

288

(1)

Technical Support Committee

288

(1)

Multidisciplinary Technology Assessment Committee

289

(1)

Summary

289

(1)

Managing Biomedical Equipment in HSOs/HSs

289

(5)

Systems Engineering

291

(1)

Organization

291

(1)

External Standards

291

(1)

Service

291

(3)

Electronic Health Information Systems

294

(5)

Regional Level---CHINs

295

(1)

Goals and Activities of CHINs

295

(1)

Problems of Implementing CHINs

296

(1)

Future of CHINs

296

(1)

Enterprise Level---EMRs

297

(1)

Advantages of EMRs

297

(1)

Problems of Establishing EMRs

297

(1)

Summary

298

(1)

Telemedicine

299

(2)

Future Developments

301

(1)

Biomedical Equipment

301

(1)

Clinical Support and Information Systems

301

(1)

Medical Technology

302

(1)

Summary

302

(1)

Discussion Questions

302

(1)

The Feasibility of Beam

303

(1)

``Who Does What?''

304

(1)

``Let's `Do' a Joint Venture''

305

(1)

``Why Can't You Keep My Lab Running?!''

305

(1)

``Isn't There a Better Way?''

306

(1)

Notes

307

(6)

Selected Bibliography

313

(4)

Part II Managerial Tools and Techniques

Managerial Problem Solving and Decision Making

317

(30)

Problem Analysis and Decision Making

317

(2)

Types of Decisions

318

(1)

Ends-Means

318

(1)

Administrative-Operational

318

(1)

Nonprogrammable-Programmable

319

(1)

Overlap of Decision Types

319

(1)

Managerial Problem Solving

319

(1)

Problem-Solving Process and Model

320

(13)

Conditions that Initiate Problem Solving

321

(1)

Problem-Solving Activities

322

(1)

Problem Analysis [1]

322

(2)

Problem Recognition and Definition

324

(1)

Problem Statement

324

(1)

Facts and Reasoning

325

(1)

Developing Assumptions [2]

326

(1)

Identifying Tentative Alternative Solutions [3]

327

(1)

Developing and Applying Decision Criteria [4]

328

(1)

Selecting, Implementing, and Evaluating the Alternative Solution [5, 6, and 7]

329

(1)

Implications for the Health Services Manager

330

(1)

Problem-Solver Attributes

330

(1)

Experience, Knowledge, and Judgment

330

(1)

Perspective, Personality, and Biases

330

(1)

Values and Philosophy

331

(1)

The Situation

331

(1)

Urgency of Results and Time Pressures

331

(1)

Magnitude and Importance

331

(1)

Structure, Uncertainty, and Risk

332

(1)

Cost-Benefit

332

(1)

The Environment

332

(1)

External

332

(1)

Internal

333

(1)

Implications for the Health Services Manager

333

(1)

Unilateral and Group Problem Solving

333

(2)

Group Problem-Solving and Quality Improvement Techniques

334

(1)

Quality Circles

334

(1)

Other Group Formats

335

(1)

Problem-Solving and Decision-Making Styles

335

(4)

Involving Others---A Conceptual Model

335

(1)

Situational Variables (Problem Attributes)

335

(1)

Situations and Styles

336

(1)

Using the Model

336

(1)

Situations 1, 2, and 3

336

(1)

Situations 11, 12, 13, and 14

336

(2)

Implications for the Health Services Manager

338

(1)

Summary

339

(1)

Discussion Questions

339

(1)

The Nursing Assistant

339

(1)

The New Charge Nurse

340

(1)

Preferred Provider Organization

340

(1)

There Are Hours and There Are Hours

341

(1)

Notes

342

(2)

Selected Bibliography

344

(3)

Strategic Planning and Marketing

347

(58)

Planning Defined

348

(1)

Planning and the Management Model

348

(1)

Planning Characteristics

349

(2)

Type of Planning

349

(1)

Time Frame of Planning and Who Plans

350

(1)

Approach to Planning

350

(1)

Planning Outcomes

351

(5)

Mission

351

(1)

Objectives

351

(2)

Organizational Strategies and Operational Programs

353

(2)

Policies and Procedures

355

(1)

General and Operational Policies

355

(1)

Characteristics of Good Policies

355

(1)

HSO/HS Planning Environment

356

(1)

Health Services Marketing---An Environmental Link

357

(6)

Marketing Concept

358

(1)

Marketing Audit

359

(1)

Target Market

359

(1)

Product Line/Service Mix

359

(2)

Elements of Marketing---The Four Ps and SCAP

361

(1)

Service

362

(1)

Consideration

362

(1)

Access

362

(1)

Promotion

362

(1)

HSO/HS Strategic Planning

363

(1)

Formulating Objectives [I] in Strategic Planning

363

(4)

Organizational Culture

363

(3)

Stakeholders

366

(1)

Values and Ethics

366

(1)

Comments

367

(1)

Strategic Assessment [II] in Strategic Planning

367

(6)

External Environmental Analysis [IIa]

367

(1)

Sector Analysis

367

(1)

Industry Structure and Competitive Position: Porter's Five-Forces Model

368

(3)

Marketing Audit [IIb]

371

(1)

Internal Capability Analysis [IIc]

371

(1)

Yields [IId]

372

(1)

Strategy Choice [III] in Strategic Planning

373

(10)

Formulate and Consider Strategies [IIIa]

373

(1)

Porter's Competitive Strategies

373

(1)

Classification of Generic Strategies

374

(4)

Context of Strategy Choice [IIIb]

378

(1)

Type of Organization

378

(1)

Strategic Decision Style

379

(1)

Managerial Philosophy

380

(1)

Organizational Culture and Choice-Maker Values

380

(1)

Portfolio Analysis

380

(1)

Organization Life Cycle

381

(1)

Competitive Position

381

(2)

Strategy Choice [IIIc]

383

(1)

Stakeholders and Strategic Planning

383

(1)

Strategic Issues Management

384

(5)

Issue Life Cycle

386

(1)

Anticipatory

386

(1)

Emergence

386

(1)

Enactment

387

(1)

Implementation

387

(1)

Factors that Can Affect Public Policy Issues

387

(2)

Implications

389

(1)

Summary

389

(1)

Discussion Questions

390

(1)

Hospital Marketing Effectiveness Rating Instrument

391

(2)

HSO Strategic Assessment

393

(1)

Closing Pediatrics

393

(1)

National Health Insurance

394

(1)

Violation

395

(1)

Trends for the Future---Industry Structure and Competitive Position

395

(1)

Notes

396

(5)

Selected Bibliography

401

(4)

Quality and Competitive Position

405

(64)

Quality---Two Dimensions

406

(1)

CQI Philosophy

407

(2)

CQI Model

409

(2)

Are We Doing the Right Things?

409

(1)

Are We Doing Things Right?

409

(2)

How Can We Be Certain We Do Things Right the First Time, Every Time?

411

(1)

QI, Productivity Improvement, and Competitive Position

411

(1)

Approaches to QI

412

(7)

W. Edwards Deming

413

(2)

Joseph M. Juran

415

(2)

Philip B. Crosby

417

(2)

Statistical Control

419

(1)

Process Improvement Models

419

(8)

Understanding and Measuring a Process

424

(1)

Benchmarking

424

(2)

ISO 9000

426

(1)

Improvement and Problem Solving

427

(3)

Productivity Improvement

430

(4)

Productivity and Productivity Improvement

430

(1)

CQI and Productivity Improvement

430

(1)

Analysis and Improvement of Work Systems and Job Design

431

(1)

Capacity Planning and Facilities Layout

432

(1)

Production Control, Scheduling, and Materials Distribution

433

(1)

Reengineering

434

(5)

Outward-In, Right to Left

434

(1)

Reengineering Defined

435

(1)

Attributes

435

(1)

What Reengineering Is Not (Reengineering and CQI)

435

(1)

Elements

436

(1)

Handling Resistance to Change

437

(1)

Applications

437

(1)

Facilitators and Barriers

438

(1)

Strategic Quality Planning: Hoshin Planning

439

(4)

Choose the Focus

440

(1)

Align the Organization

440

(2)

Implement the Plan and Review and Improve

442

(1)

Physician Involvement in QI

443

(3)

Practice Parameters

443

(1)

Involving Physicians

443

(2)

Results

445

(1)

QI---The Next Iteration

446

(1)

Summary

447

(1)

Discussion Questions

448

(1)

Fed Up in Dallas

448

(1)

The Carbondale Clinic

449

(1)

Total Quality Management (TQM) Inventory

450

(3)

Noninvasive Cardiovascular Laboratory

453

(1)

Trying Hard Memorial Hospital and Do It Right Medical Center

454

(2)

Notes

456

(7)

Selected Bibliography

463

(6)

Control and Resource Allocation

469

(62)

Control and Planning

470

(1)

Monitoring (Control) and Intervention Plans

470

(2)

Output Control

470

(1)

Process Control

471

(1)

Input Control

471

(1)

Control Model

472

(1)

In Control Loop

472

(1)

Acceptance Control Loop

472

(1)

Required Change Control Loop

473

(1)

Positive Control Loop

473

(1)

Levels of Control

473

(1)

Control and CQI

474

(1)

Control and Problem Solving

474

(1)

Control Considerations

474

(1)

Managerial Considerations

474

(1)

Design Considerations

475

(1)

Information Systems and Control

475

(4)

Information Systems: LANs, WANs, and CHINs

476

(1)

Clinical-Patient Care is and Electronic Medical Records

476

(2)

Is Issues

478

(1)

Is Uses

478

(1)

RM and Quality Improvement

479

(16)

Risk Management

480

(1)

Link to Senior-Level Management

481

(1)

Risk Manager

482

(1)

Principles of Managing Risk

482

(1)

Financing Risk

483

(1)

Process of RM

484

(1)

Improving Quality and Performance

485

(2)

Structure, Process, and Outcome in Quality Assessment

487

(1)

Developments for Beyond 2000: Practice Parameters

488

(2)

Importance of QI

490

(1)

QI and Quality Assurance Compared

490

(4)

Summary

494

(1)

Control Methods

495

(8)

Budgeting

495

(1)

Cost Allocation

496

(1)

Activity-Based Costing

496

(3)

Financial Statements

499

(1)

Ratio Analysis

499

(1)

Operational-Activity Analysis

500

(2)

Financial Analysis

502

(1)

Use of Analytical Techniques in Resource Allocation

503

(14)

Volume Analysis with Revenue

503

(9)

Volume Analysis without Revenue

512

(1)

Capital Budgeting

513

(1)

Cost-Benefit Analysis

514

(2)

Simulation

516

(1)

Summary

517

(1)

Discussion Questions

518

(1)

Admitting Department

518

(1)

Centralized Photocopying

519

(1)

Barriers to an Effective QI Effort

520

(1)

Don's Risk Management

521

(1)

The Array Machine

521

(1)

Financial Ratios

522

(2)

Notes

524

(3)

Selected Bibliography

527

(4)

Human Resources and Labor Relations

531

(58)

Role of Human Resources Management

532

(1)

Staffing Activities

533

(1)

Acquiring Human Resources

533

(14)

Human Resources Planning

533

(1)

Profiling

534

(1)

Estimating

535

(1)

Inventorying

535

(1)

Forecasting

535

(1)

Planning

535

(1)

Summary

535

(1)

Human Resources Sources

536

(1)

Job Analysis and Job Descriptions

536

(1)

Job Analysis

536

(1)

Job Descriptions

536

(1)

Recruitment

537

(1)

Selection

537

(1)

Application Forms and Preemployment Interviews

537

(3)

Testing

540

(2)

Selection---A Shared Responsibility

542

(1)

Orientation

543

(1)

Equal Employment Opportunity

543

(2)

What Is Equal Opportunity and Discrimination?

545

(1)

Adverse Impact

545

(1)

Bona Fide Occupational Qualifications

546

(1)

Affirmative Action

546

(1)

Sexual Harrassment

547

(1)

Retaining Employees

547

(11)

Performance Appraisal

549

(1)

Uses of Performance Appraisal

549

(1)

Appraisal Methods

550

(1)

Benefits of Systematic Appraisal

550

(1)

Appraisal Problems

550

(3)

Continuous Quality Improvement

553

(1)

Training and Development

553

(1)

Discipline (Corrective Counseling)

554

(1)

Compensation Administration

554

(1)

Establishing and Administering a Compensation System

555

(1)

Executive and Incentive Compensation

556

(1)

Benefits Administration

556

(1)

Pension Programs

557

(1)

Employee Assistance Programs

557

(1)

Workplace Health and Safety

558

(1)

Separation from Employment (Exit)

558

(1)

Preretirement Planning

559

(1)

Outplacement

559

(1)

Exit Interviews

559

(1)

Human Resources Department and Clinical Staff

559

(1)

Human Resources in HSs

559

(1)

Labor Relations

560

(1)

Labor Movement

560

(1)

Federal Labor Legislation

561

(5)

Norris-LaGuardia Act (Anti-Injunction Act, 1932)

561

(1)

Wagner Act (National Labor Relations Act, 1935)

561

(1)

Employer Unfair Labor Practices

561

(1)

National Labor Relations Board

561

(1)

Taft-Hartley Act (Labor-Management Relations Act, 1947)

562

(1)

Employee Protection

563

(1)

Union Unfair Labor Practices

563

(1)

Bargaining Procedures

563

(1)

Nonprofit Hospital Amendments to the Taft-Hartley Act (1974)

563

(1)

Pre-1974 Environment

563

(1)

1974---A Changed Environment

564

(1)

Unique Provisions

565

(1)

Labor Organizations in Health Services

566

(1)

Why Employees Unionize

566

(4)

Symptoms of an Organization Change

567

(1)

Bargaining Units

568

(1)

Solicitation and Distribution

568

(1)

Employer Conduct During an Election Campaign

569

(1)

Managerial Responsibilities in Labor Relations

570

(2)

Setting the Tone and Environment

571

(1)

Proactive Steps

571

(1)

Collective Bargaining

572

(1)

Negotiation

572

(1)

Impasses

573

(1)

The Human Resources Perspective

573

(2)

Summary

575

(1)

Discussion Questions

575

(1)

Personnel Policies at Robbins Memorial Hospital

576

(1)

Complaint of LPN Pay Inequality

577

(1)

Substance Abuse and EAP

578

(1)

Missing Narcotics

578

(1)

Physician Harrassment

579

(1)

Union Membership Solicitation and Distribution of Union Material at Dunlap Memorial Hospital

579

(1)

Promotion at Visiting Nurse Service

580

(1)

Notes

580

(6)

Selected Bibliography

586

(3)

Organizational Change

589

(34)

Pressures for Change in HSOs/HSs

590

(1)

Organizational Change Defined

591

(1)

Process of Managing Organizational Change

592

(14)

Identifying the Need for and Nature of Necessary Organizational Changes

594

(3)

Planning for Implementing Organizational Change

597

(1)

Developing a Set of Viable Alternative Changes for Consideration

598

(1)

Choosing from Among the Change Alternatives

598

(1)

Devising a General Approach to Implementing Organizational Change

599

(2)

Selecting Techniques to Support Implementation

601

(3)

Implementing Organizational Change

604

(2)

Evaluating Organizational Change

606

(1)

Human Resources Changes

606

(2)

Constancy of the Change Agent's Responsibility in Management Work in HSOs/HSs

608

(3)

Special Case of Being a Change Agent in Retrenchment

609

(1)

Special Case of Being a Change Agent in Health Systems (HSs)

610

(1)

Summary

611

(1)

Discussion Questions

612

(1)

Labor, Delivery, Recovery, Postpartum (LDRP) Staffing Situation

613

(1)

A Response to Change

613

(1)

How Ready Are You for Managing in a Turbulent World?

614

(1)

A Human Resources Change at Sun Coast Health System

615

(1)

``You Didn't Tell Me!''

616

(1)

Notes

617

(1)

Selected Bibliography

618

(5)

Part III Managing Relationships

Ethics

623

(68)

Sources of Law

623

(2)

Relationship of Law to Ethics

625

(1)

Moral Philosophies

626

(3)

Teleology

626

(1)

Deontology

627

(1)

Natural Law

628

(1)

Casuistry

628

(1)

Virtue Ethics

629

(1)

Philosophical Bases for Ethics

629

(3)

Respect for Persons

630

(1)

Beneficence

631

(1)

Nonmaleficence

631

(1)

Justice

631

(1)

Summary

632

(1)

Codes of Ethics

632

(1)

Health Services Codes of Ethics

633

(2)

Institutional Trade Associations

633

(1)

Health Professions

633

(1)

Managers

633

(1)

Physicians

634

(1)

Nurses

634

(1)

Patient Bills of Rights

635

(1)

Ethical Issues Affecting Governance and Management

635

(5)

Fiduciary Duty

635

(1)

Conflict of Interest

636

(2)

Confidential Information

638

(1)

Ethics and Marketing

638

(1)

Need Versus Demand

639

(1)

Responsible Marketing

639

(1)

Future of Competition

640

(1)

Conflicts of Interest in Managed Care

640

(2)

Marketing and Operations

640

(1)

Physician Incentives and Other Constraints

641

(1)

Minimizing Conflicts of Interest in Managed Care

642

(1)

Biomedical Ethical Issues

642

(25)

Resource Allocation

642

(1)

Consent

643

(1)

Ethical Issues in Research

644

(2)

End-of-Life Decisions

646

(1)

Life-Sustaining Treatment

647

(1)

Child Abuse

647

(1)

Advance Directives

648

(5)

Euthanasia

653

(2)

Physician-Assisted Suicide

655

(2)

Futile Treatment

657

(1)

Implications

658

(1)

Alternatives to Futile Care Policies

659

(1)

Acquired Immunodeficiency Syndrome

660

(1)

Incidence and Prevalence

660

(1)

Research and Treatment

661

(1)

Implications for HSOs/HSs

662

(4)

Conclusion

666

(1)

Organizational Responses to Ethical Problems

667

(1)

Means to Resolve Ethics Issues

667

(6)

Institutional Ethics Committees

667

(1)

Organizing IECs

668

(1)

Purpose and Role of IECs

668

(1)

Membership of IECs

669

(1)

Relationships of IECs

670

(1)

Summary

670

(1)

Infant Care Review Committees

670

(1)

Institutional Review Boards

671

(1)

Membership and Purpose of IRBs

671

(1)

IRB Requirements

672

(1)

Exempt Research and Expedited Review

672

(1)

Summary

672

(1)

Specialized Assistance

672

(1)

Ethics Consultation Services

672

(1)

Ethicists

673

(1)

Ethics Officer

673

(1)

Summary

673

(1)

Discussion Questions

673

(1)

``What's a Manager to Do?''

674

(1)

Bits and Pieces

675

(1)

Demarketing to Avoid Bankruptcy

675

(1)

Choices

676

(1)

Benefiting Older Adults by Infecting Them with Influenza

677

(1)

Knowing Whether or When to Stop

678

(1)

Something Must Be Done, but What?

678

(1)

Notes

679

(7)

Selected Bibliography

686

(5)

Legal Considerations

691

(44)

Processes that Produce the Law

691

(4)

Official or Public Processes

691

(1)

Legislative Process

691

(1)

Regulatory Process

692

(1)

Judicial Process

693

(1)

Executive Orders

694

(1)

Unofficial or Private Processes

694

(1)

Influence of HSOs/HSs

694

(1)

Trade Associations and Interested Parties

694

(1)

Political Action Committees

695

(1)

Contracts

695

(1)

Elements of a Contract

695

(1)

Breach of Contract

696

(1)

Torts

696

(7)

Breach of Contract and Tort Distinguished

696

(1)

Intentional Torts

697

(3)

Negligence

700

(1)

Standard of Care

701

(1)

Proof of Negligence and Recovery of Damages

701

(1)

Torts and HSOs/HSs

702

(1)

Agency and Corporate Liability

702

(1)

Enterprise Liability

703

(1)

Malpractice ``Crises''

704

(3)

Effects of Malpractice Suits

705

(1)

Reforms of the Malpractice System

706

(1)

Nonjudicial Means of Resolving Disputes

707

(1)

Developing Legal Areas

708

(11)

HIV and AIDS Legal Issues and Litigation

708

(2)

Antitrust

710

(1)

Professions

710

(1)

Facilities Planning

710

(1)

Mergers

710

(1)

Peer Review

711

(1)

Summary

712

(1)

Emergency Medical Treatment and Active Labor Act

713

(1)

Employee Retirement Income Security Act

713

(1)

Medicare and Medicaid Fraud and Abuse

714

(1)

Fraudulent Billing

714

(1)

Physician Self-Referral

714

(1)

Healthcare Integrity and Protection Data Bank

715

(1)

Qui Tam Actions

716

(1)

Tax-Exempt Status of HSOs/HSs

716

(2)

Telemedicine

718

(1)

Confidentiality

718

(1)

Data Compression

718

(1)

Artificial Intelligence

718

(1)

Licensure

719

(1)

Consent

719

(1)

Summary

719

(1)

Legal Process of a Civil Lawsuit

719

(2)

Special Considerations for the Manager

721

(2)

Record Keeping

721

(1)

Effective Use of House and Retainer Counsel

722

(1)

Testifying

722

(1)

Summary

723

(1)

Discussion Questions

723

(1)

Reporting Suspected Child Abuse or Neglect

724

(1)

Effective Consent

725

(1)

The Missing Needle Protector

725

(1)

Is This the Most Efficient Way?

726

(1)

Stakeholders

727

(1)

Notes

728

(5)

Selected Bibliography

733

(2)

Leadership

735

(36)

Leadership Defined and Modeled

736

(1)

Power and Influence

737

(3)

Sources of Power

737

(2)

Effective Use of Power

739

(1)

Approaches to Understanding Leadership

740

(1)

Leader Traits and Skills

740

(2)

Leader Behavior and Leadership Style

742

(7)

Early Leader Behavior Studies

743

(1)

Likert's System 4 Management Model

744

(2)

Blake and McCanse's Leadership Grid

746

(1)

Tannenbaum and Schmidt's Continuum of Leader Behavior

746

(3)

Situational or Contingency Theories of Leadership

749

(8)

Fielder's Contingency Theory

749

(2)

Hershey and Blanchard's Situational Leadership Model

751

(2)

Vroom and Yetton's Model

753

(2)

House and Mitchell's Path--Goal Model

755

(2)

Toward an Integrative Framework for Leadership

757

(2)

Summary

759

(1)

Discussion Questions

759

(1)

Charlotte Cook's Problem

760

(1)

The Presidential Search

760

(1)

Is Leadership the Issue?

761

(1)

Leadership Questionnaire

761

(2)

Lessons Where You Find Them

763

(1)

Supervisory Behavior Questionnaire

763

(2)

Notes

765

(2)

Selected Bibliography

767

(4)

Motivation

771

(32)

Motivation Defined and Modeled

772

(2)

Motivation Theories

774

(1)

Content Theories

774

(7)

Maslow's Hierarchy of Needs

774

(2)

Alderfer's ERG Theory

776

(2)

Herzberg's Two-Factor Theory

778

(1)

McClelland's Learned Needs Theory

779

(1)

Managerial Implications of the Content Theories of Motivation

780

(1)

Process Theories

781

(8)

Vroom's Expectancy Theory

781

(3)

Managerial Implications of Expectancy Theory

784

(1)

Adams's Equity Theory

785

(1)

Managerial Implications of Equity Theory

786

(1)

Locke's Goal-Setting Theory

786

(1)

Managerial Implications of Goal-Setting Theory

786

(2)

Skinner's Reinforcement Theory

788

(1)

Managerial Implications of Reinforcement Theory

788

(1)

Toward an Integrative Framework for Motivation

789

(2)

Summary

791

(1)

Discussion Questions

792

(1)

A Potential Conflict

792

(1)

The Young Associate's Dilemma

793

(1)

Clockwork

793

(1)

Bill's Promotion

794

(1)

What Needs Are Most Important to You?

794

(3)

The Holdback Pool

797

(1)

Notes

797

(3)

Selected Bibliography

800

(3)

Communication

803

(26)

Communication Defined and Modeled

804

(2)

A Model of the Communication Process

805

(1)

Elements of Effective Communication

806

(2)

Barriers to Effective Communication

808

(3)

Environmental Barriers

808

(1)

Personal Barriers

809

(1)

Managing Barriers to Effective Communication

810

(1)

Flows of Intraorganizational Communication

811

(4)

Downward Flow

811

(1)

Upward Flow

811

(1)

Horizontal and Diagonal Flows

812

(1)

Communication Networks

812

(2)

Informal Communication

814

(1)

Summary of Intraorganizational Communication Flows

815

(1)

Communicating with External Stakeholders

815

(7)

Communicating with the Public Sector

817

(2)

Communicating with the Community

819

(1)

Listening to External Stakeholders

820

(1)

Communicating When Things Go Badly

821

(1)

Summary

822

(1)

Discussion Questions

823

(1)

ABC Nursing Facility

823

(1)

The Business Office

824

(1)

Good Work Is Expected

824

(1)

Group Health Cooperative of Puget Sound's Hard Rock Sell

825

(1)

How Much Should We Say?

826

(1)

Notes

826

(1)

Selected Bibliography

827

(2)

Author Index

829

(18)

Subject Index

847

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Managing Health Services Organizations and Systems

Summary

Table of Contents

Supplemental Materials