chapter 13 organizational performance: managing for efficiency and effectiveness
TRANSCRIPT
Chapter 13
Organizational Performance:
Managing for Efficiency
and Effectiveness
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Purpose and Overview
• Purpose– To review assessing organizational
performance– To compare and contrast approaches to
quality assurance and quality improvement– To describe strategies to achieve an effective
health care organization
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Purpose and Overview
• Overview– The Challenge of Performance – Issues in Assessing Effective Performance – The Manager's Role in Creating High-
Performance Health Care Organizations
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The Challenge of Performance
• Health Care Organizations – Operate with constrained resources– Maximize productivity, quality, and market
share – Contain costs and minimize ineffective
services
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The Challenge of Performance
• Managers must: – Adapt organizations to ever-changing
environment– Innovate rather than passively react
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The Challenge of Performance
• Aspects of Organizational Performance Assessment– Efficacy– Appropriateness– Effectiveness
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The Challenge of Performance
• Aspects of Organizational Performance Assessment– Productivity– Efficiency – Organizational Effectiveness– Cost-Effectiveness
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The Challenge of Performance
• Factors Associated with Increased Productivity and Efficiency – High standard and goals– Information and feedback– Interdepartmental coordination and resource
sharing
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The Challenge of Performance
• Factors Associated with Increased Productivity and Efficiency – Compensation systems oriented toward
rewarding productivity or efficiency– Physician involvement in decision making and
governance
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The Challenge of Performance
• Factors Associated with Increased Productivity and Efficiency– Concentration of staff work and activity– Active governing boards that deal with
environmental pressures
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The Challenge of Performance
• Factors Associated with Increased Productivity and Efficiency– Type of ownership– Chain ownership and contract management– Degree of system integration
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Issues in Assessing Effective Performance
• Issues in Organizational Assessment– Fundamental perspectives – Domain of activity – Stakeholders
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Issues in Assessing Effective Performance
• Issues in Organizational Assessment– Different levels of analysis
• The organization itself• Larger social unit that contains the
organization• Subunits contained within organization
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Issues in Assessing Effective Performance
• Technical Issues in Assessment – Classes of measures
• Structural • Process • Outcome
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Issues in Assessing Effective Performance
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Issues in Assessing Effective Performance
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Issues in Assessing Effective Performance
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Issues in Assessing Effective Performance
• Technical Issues in Assessment – Preferences for classes of performance
measures • Managers: structural • Caregivers: process • Clients: outcomes or results
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Issues in Assessing Effective Performance
• Technical Issues in Assessment – Factors associated with effective performance
• Quality of professional staff• High standards• Experience with cases of same type• Organized professional staffs and conflict
management processes
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Issues in Assessing Effective Performance
• Technical Issues in Assessment – Factors associated with effective performance
• Participative cultures with team approaches• Timely and accurate performance feedback• Management of environmental forces
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Issues in Assessing Effective Performance
• Managerial Issues in Assessing Performance – Old model
• Quality relegated to quality assurance department
– New model• Quality improvement teams
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Issues in Assessing Effective Performance
• Managerial Issues – Model for evaluating professional performance
• Autonomous• Heteronomous• Conjoint• Modern health care is moving toward
conjoint model
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Issues in Assessing Effective Performance
• Managerial Issues – Model for evaluating nonprofessional work
• Bureaucratic model• Performance appraisal typically assigned to
a supervisor• Interdisciplinary teams increasingly utilized
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Issues in Assessing Effective Performance
• Managerial Issues – Impact of evaluation on all performers
• Expected to have effects on performance• Evaluations are ideally accurate
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Issues in Assessing Effective Performance
• Two Models for Changing Performance – Quality assurance
• Formal and systematic exercise to identify problems
– Quality Improvement (QI)• Management philosophy in which the
customer is central • Process-focused
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Issues in Assessing Effective Performance
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Issues in Assessing Effective Performance
• Precautions when Designing QI Strategy – Use physicians’ time wisely– Peak physicians’ interests– Empower physicians’ participation
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Issues in Assessing Effective Performance
• Precautions when Designing QI Strategy – Respect professional values– Capitalize on progress units and groups have
reached
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The Manager's Role in Creating High-Performance
• Focus on Controllable Variables and External Environment – Resource Acquisition– Managing Trade-Offs
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The Manager's Role in Creating High-Performance