HEALTH CARE MANAGEMENT

Transcription

1 1 HEALTH CARE MANAGEMENT For English speaking students Kateřina Ivanova

2 WHAT IS MANAGEMENT 1? Basic of Management (definitions of term; basic function of managements; managerial school; evolution of management theory) Planning (substance of managerial planning, primary assumptions of planning, use of SWOT theory, tapes of plans, specificity of planning in health care management) Decisions making (characteristics of decisional process specificity of decisions in health care management) Organizational Management (organizations vertical and horizontal approach, creation of organizational units, organizational structure, advantages and disadvantages, development trends in health care administration) 2

3 WHAT IS MANAGEMENT 2? Organizational culture (organizational culture is an important phenomenon in all organizations; its functions and influence on both behaviour of people; definition of specific artefacts, values and basic assumptions in health care organizations) Controlling (structure of control process, control techniques, overall and preventive control, specificity of controlling in health care management). 3

4 MANAGEMENT THEORY We can identify two types of writers at the start of the journey, writers based, for the most part, in Europe and the USA. First, those thoughtful managers who reflects on what was happening in their organisations (notable manager theorists including F.W. Taylor, L.F. Urwick and Henri Fayol) Second social scientists who undertook formal studies as part of their professional work (Elton Mayo, Abraham Maslow, Douglas Mc Gregory and Frederick Herzberg) 4

5 CULTURE AS THE BASIS OF HUMAN SOCIETY Culture may be understood as a relatively integrated whole comprising human behaviour and its products. In a given society, such behaviour is controlled in an interactive process by created cultural patterns. (compare Nový et al., 1996, p. 10) 5

6 CULTURE AS A MEANS OF VALUE FORMATION Culture determines the value system Culture also determines value-defining criteria and indicators Values are formed in the course of phylogeny, based on needs Both individuals and groups must constantly choose from various ways of need satisfaction legitimization of social values 6

7 SPHERES OF CULTURE Religious or ideological sphere National sphere Culture related with belonging to a gender, age group (generation) or class Institutional sphere (family, work organization, professional organization etc.) (Nový et al., 1996, pp ) 7

8 AUPHA Organizational Kultura organizace culture Modul 1 Tabulka 9 An Kultura organization s organizace culture vzniká is its jako ingrained soubor sdílených patterns of názorů, shared hodnot, beliefs, values, chování behaviors, a očekávání, and assumptions, s průvodními with symboly associated a rituály. symbols Tyto jsou and rituals, that postupem are acquired času jejími over time členyby its members. osvojeny. Connor, Daryl, Corporate: Health Care s Change Master, Health Care Executive, 5,March/April, 1990, p.28. As cited in Rakish, Longest, and Darr. 8

9 BASIC FEATURES OF ORGANIZATIONAL CULTURE INTERNAL It is always a team process with no individual form of existence It positively strengthens an affiliation to a group Newcomers become familiar with it through an adaptation process It provides its members with a good grasp of the organization s inner world 9

10 BASIC FEATURES OF ORGANIZATIONAL CULTURE - EXTERNAL It appears and disappears at a particular time and place It is a product of social learning based on the interaction of the external environment and internal coordination It enables the external environment to understand the organization s mission and goals with no need of explanation 10

11 BASIC FUNCTIONS OF ORGANIZATIONAL CULTURE Self-confirming function Continuity-assuring function Individual behaviour correction function Identificational function 11

12 STRUCTURE OF ORGANIZATIONAL CULTURE adapted from the structure of organizational culture by Schein (2004, pp. 26) artefacts values, norms level 3 level 2 level 1 basic assumption s values, norms artefacts 12

13 BASIC TYPES OF ORGANIZATIONAL CULTURE ACCORDING TO VALUES based on CVF (Competing Values Framework), adapted from Denison and Spreitzer (1991 in Parker, Bradley, 2000, p.128) etc. 13

14 SPECIFICITY OF ORGANIZATIONAL CULTURE IN HEALTH CARE Specificity of helping professions (roles of doctors, nurses and other health personnel) Specific values (health, life, solidarity) Goals that can never be fully achieved Ambiguous work results Conflicting objects of interest (patients, research or employment?) Receivers (roles of patients) 14

15 EFFECTIVE RADIUS OF ORGANIZATIONAL CULTURE IN HEALTH CARE adapted from Haddock et al. (1996, p. 23) and Ivanová (2003, s. 179) Motivate and lead people Encourage organizational change and renewal Organization al culture Guide the organization s future Organize and assure health services delivered Assure effective and efficient use of human and technical resources 15

16 WHO ARE THE MANAGERS - 1? Health care organizations need managers, just as do organizations engaged in manufacturing, finance, or retailing. Managers do many things, some conceptions of managerial work are detailed below, but their basic tasks is to create and maintain organizations that are capable of carrying out their missions. 16

17 WHO ARE THE MANAGERS - 2? Main dilemma: The mission of health care organizations (do delivered health service) x the nature of managerial work. Main question: Should health care managers be physicians (or some other type of clinically trained health care professional)? Should health care managers be professional managers who only happen to be (perhaps temporarily) employed in health care organizations? 17

18 THE DIFFERENT WAY IN THE DIFFERENT HEALTH CARE SYSTEMS - 1 In Unite States most health care managers are not clinical professionals. Many have health-related training acquired from a university program (often at the post-graduate level) in health administration, but even more not. Most of the few American physicians who are full-time managers have surrendered practice of medicine. Many of those have sought some specialized management training. 18

19 THE DIFFERENT WAY IN THE DIFFERENT HEALTH CARE SYSTEMS - 2 In Europe and Latin America, on the other hand, most senior managers in health care organizations are physicians, many of whom continue to practice medicine. What is the difference? One difference is certainly the larger management staff found in most American health care organizations (HCO), especially in hospitals and integrated health systems. American system is liberally and different that systems in Europe it is mean: American HCO be private organizations accountable to shareholders or to bond holders. 19

20 WHAT IS BETTER? QUESTIONS FOR YOU: Please, make a list of reasons (in groups) for recruiting managers: 1. Who are physicians 2. Who are not physicians And explain me: Why leadership of HCO is best exercised by physicians: Why leadership of HCO is best exercised by nonphysicians or other clinical professionals: We have 15 minutes in groups. 20

21 WHAT IS BETTER - 1? There are any reasons why the leadership of HCO is best exercised by physicians: Physicians, given their training and experiences, best understand the work of HCO; Physicians have more credibility that nonphysicians in managing the work of physicians and other clinical professionals; Physicians have more credibility that nonphysicians in representing HCO to outside parties. 21

22 WHAT IS BETTER - 2? There are any reasons why the leadership of HCO is best exercised by non-physicians (and other clinical professionals): There is nothing in medical training that prepares physicians to act as managers; Management of the HCO does not call for clinical decisions, but for management decisions best left to those trained and inexperienced in making them; Physicians talents are best used in the practice of medicine, not in non-medical activities for which they are not prepared; Although medical training emphasizes, individual decision making and independent action, organizational leadership calls for teamwork and group actions. 22

23 WHAT IS BETTER - 3? There is not correct solution to the dilemma: Where physicians are in senior management positions, functional management specialist (accountants, marketing specialist, industrial engineers, human resource managers) are required to perform specialized tasks. Where non-physicians managers are in senior managers positions, HCO often find it necessary to bring in physician-manager to coordinate the medical affairs function. 23

24 WHAT IS DIFFERENT IN MANAGERIAL WORK OF HCO - 1? On order to characterize managerial work in HCO, we must first make several distinctions: 1. Management is different from governance: Governance is the purview of governing boards, which may be called boards of directors, boards of trustees, or, for government owned organizations, the ministry of health. Governing boards establish the organizations missions and values and set broad policy guidelines. Managers are charged with accomplishing those missions and with seeing that the HCO acts consistently whit its values. 24

25 WHAT IS DIFFERENT IN MANAGERIAL WORK OF HCO - 2? 2. Line management is different from staff management The distinction was originally applied to military commands, in which line officers had command of troops in combat, and staff officers acted in specialized support capacities (supply, planning, communications). The distinctions is important in managing HCO, where line managers (chief executive officer, chief operating officer, director of radiology) are responsible for and supervise units that provide patient care, and where staff managers (chief financial officer, director of planning and marketing) perform specialized functions. The chief financial officer may supervise a large staff, but all of those in his domain are considered to be staff managers. 25

26 WHAT DO LINE MANAGERS DO -1? Line managers are to be leaders and motivators; A traditional list of suggest of line managers are: 1. Plan; 2. Organize and staff (that is, selection others to fill necessary positions); 3. Direct; 4. Control; 5. Evaluate. The staff managers (except to the extent that they supervise others) are charged with performing some specialized activity. 26

27 WHAT DO LINE MANAGERS DO -2? More modern conceptions of manager s role see all managers as being responsible form motivating and leading others to accomplish the organizations mission. They are the ones responsible for building teams and organization to accomplish the tasks implied by the mission. The higher the manager s position in the organization, the more he or she is responsible for developing and implementing a long-range view of the HCO and of positioning it strategically in the markets in which it operates. 27

28 WHAT IS LEADERSHIP - 1? Modern views of leadership are quite different from command. Leadership is (rather) relationship in which one party guides and facilitates a group in achieving a shared vision (or shared goals). A leader is a member of a team (albeit with responsibilities than go beyond those of other team members and, usually, with supervisory authority and responsibility over those other members). 28

29 WHAT IS LEADERSHIP - 2? A substantial part of leadership consist of building and communicating a shared vision for the HCO, usually articualted in the vision statement and in the moission statement. Senior management is also responsible for seeing that specific functions, both clinical and managerial, carried out. The senior manager need not be an expert in each of those functons. Senior manager must be able to assemble a team that is capable of carrying out these responsibilities, and ideally letting functional specialists perform their tasks as member of that team. 29

30 DISCUSSION QUESTIONS 1. What do managers actually do? What tasks occupy their time? Be careful to distinguish general line managers from staff performing functional specialties. 2. What happens in each step of group process described as forming, storming, norming, performing, adjourning? 3. What is leadership? Give some examples, form your experience, of good leaders and good leadership; and poor leaders and poor leadership. 30

31 SUGGESTED READINGS Shortell Stephen M. and Arnold D. Kaluzny, editors:, 3rd ed. Robert A. McLean: Health Care Policy and Economy and Management. Palacky University, Olomouc, ISBN