MANAGEMENT AND ORGANIZATIONAL DESIGN

STRATEGIC MANAGEMENT IN HEALTHCARE

11 February 2008

WHAT IS HEALTH ?

• A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING, NOT MERELY THE ABSENCE OF DISEASE - WORLD HEALTH ORGANIZATION

WHAT IS HEALTHCARE ?

• HEALTH CARE IS THE TOTAL SOCIETAL EFFORT, UNDERTAKEN IN THE PRIVATE AND PUBLIC SECTORS, FOCUSED ON PERSUING HEALTH

• MAY ACT ON INDIVIDUALS OR THE ENVIRONMENT

• EXPANDED GREATLY OVER THE LAST 40 YEARS

PUBLIC HEALTH VS PERSONAL HEALTH

• PUBLIC HEALTH - TO IMPROVE THE HEALTH OF A POPULATION

• PERSONAL HEALTH - TO IMPROVE THE HEALTH OF THE INDIVIDUAL

PREVENTION

• PRIMARY - PREVENTION OF DISEASE

• SECONDARY - PREVENTION OF CONSEQUENCES OF DISEASE

• TERTIARY - PREVENTION OF DEATH OR DISABILITY

EFFICIENT VS EFFECTIVE

• EFFICIENT - DOING THINGS RIGHT

• EFFECTIVE - DOING THE RIGHT THINGS

MANAGEMENT

• IT IS A PROCESS

• WORKS TOWARD OBJECTIVES

• USES RESOURCES

• OCCURS IN A FORMAL ORGANIZATIONAL SETTING

MANAGEMENT FUNCTIONS

• DECISION MAKING– PLANNING - DECIDING IN ADVANCE– DIRECTING - INITIATING WORK– CONTROLLING - REGULATING

ACTIVITIES– ORGANIZING - INTENTIONAL PATTERNS– STAFFING

KISS PRINCIPAL

• KEEP IT SIMPLE STUPID

• FIGURE 1.7 ON PAGE 25

HEALTH CARE ORGANIZATIONS

• CONSTANT TENSION BETWEEN MANAGERS AND PROFESSIONAL OR TECHNICAL STAFF

• MANAGER’S JOB SHOULD BE TO SUPPORT PATIENT CARE

SYSTEMS FAILURES

• MOST PROBLEMS ARE SYSTEMS PROBLEMS

• MOST PROBLEMS ARE BLAMED ON PEOPLE

• CHANGE THE SYSTEM NOT THE PEOPLE

WEBER’S BUREAUCRACY

• CLEAR DIVISION OF LABOR• POSITIONS ARE ARRANGED IN A

HEIRARCHY - CHAIN OF COMMAND• FORMAL RULES AND REGULATIONS

GUIDE EMPLOYEES• IMPERSONAL RELATIONSHIPS• EMPLOYMENT BASED ON TECHNICAL

COMPETENCE

JOBS OF A BUREAUCRAT

• COVER YOUR ASS

• CHECK YOUR STATUS

FAYOL’S PRINCIPALS

• 14 PRINCIPALS OF MANAGEMENT– page 114

• GOOD BASIC CONCEPTS

CLASSIC CONCEPTS OF ORGANIZATION DESIGN

• DIVISION OF WORK

• AUTHORITY AND RESPONSIBILITY

• DEPARTMENTATION

• SPAN OF CONTROL

• COORDINATION

DIVISION OF WORK

ROLE OF THE INDIVIDUAL

• BALANCE OF GENERALIZATION AND SPECIALIZATION

• PEOPLE ARE NOT COMMODITIES

EFFICIENCY

• EVERYTHING TAKES TIME

• LOOK AT YOUR LAZIEST EMPLOYEE

GENERALIZATION

• EVERYONE DOES EVERYTHING

• WORK IS INTERESTING & VARIED

• PRIDE AND ACCOUNTABILITY

• THE ORGANIZATION IS FLEXIBLE

• JACK OF ALL TRADES, MASTER OF NONE

SPECIALIZATION

• EVERYONE DOES ONE TASK

• HENRY FORD’S ASSEMBLY LINE

• TENDS TO BE BORING

• LITTLE INDIVIDUAL RESPONSIBILITY

• INFLEXIBLE - SLOW TO RESPOND

• REQUIRES MORE MANAGEMENT

AUTHORITY AND RESPONSIBILITY

AUTHORITY

• POWER DERIVED FROM ONE’S POSITION

• LINE AUTHORITY - CHAIN OF COMMAND

• STAFF AUTHORITY - ADVISORY

RESPONSIBILITY

• OBLIGATIONS DERIVED FROM ONE’S POSITION

• TO PERFORM FUNCTIONS• TO ACHIEVE OBJECTIVES

• THESE TWO OBLIGATIONS MAY CONFLICT

DEPARTMENTALIZATION

PURPOSE OF DEPARTMENTS

• DIVIDE WORK INTO MANAGEABLE UNITS

• COORDINATE WORK AMONG UNITS

BASIS OF DIVISION

• KNOWLEDGE & SKILLS

• PROCESSES OR FUNCTIONS

• TIME OR PLACE

• OUTPUTS

• CLIENTS

SPAN OF CONTROL

CONTROL

• FLAT VS TALL

• EXECUTIVE VS OPERATIVE

• HOW MANY ARE SUPERVISED

• HOW TIGHT IS THE CONTROL

POWER

• LEGITIMATE AUTHORITY

• REWARD

• COERCIVE

• EXPERT

• REFERENT/CHARISMATIC

LEADERSHIP

• BE WILLING TO DO ANYTHING YOU ASK OF YOUR PEOPLE, EVEN IF YOU ARE NOT ABLE TO DO EVERYTHING.

REWARD/PUNISHMENT

• PRAISE SELECTIVELY

• DISCIPLINE COLLECTIVELY

COORDINATION

STRUCTURAL

• ORGANIZATIONAL STRUCTURE

• SUPERVISION

• STANDARDIZATION

LESS FORMAL

Customs, Informal Groups

Feedback and Adjustment

Committees, Planning

Program Development

MANAGEMENT STYLES

• CLASSIC VS CONTEMPORARY

• HEIRARCHICAL VS COOPERATIVE

• LINEAR VS MULTITASKING

• FORMAL VS INFORMAL

• MALE VS FEMALE