P11.

1833 Health Care Management

NYU/Wagner P11.1833 Spring 2006 Mon 4:30 Prof. Anthony R. Kovner 3008 Puck/212-998-7444 (UC 57) [email protected]

HEALTH SERVICES MANAGEMENT This course is intended for graduate students and is about learning how to manage in health care organizations (HCOs). The prerequisites for this course are: P11.1020 - Managing Public Service Organizations P11.1830 - Community Health and Medical Care Students lacking the prerequisites must have work experience in HCOs. Learning Objectives At the end of this course, students will understand: How health services are governed and organized, particularly in non-profit organizations. How health care organizations assess and adapt to change. How performance control systems work in HCOs. Constraints/opportunities in shaping organizational performance and managerial careers. Use of evidence-based management in health care. Students will also learn to manage yourselves better with others on team projects, and improve your critical thinking and your skills in written and oral communication.

P11.1833 Health Care Management

Note 1:

If you have achieved these objectives already, please arrange to waive this course.

COURSE SESSIONS Session 1: Control (January 23) Course Expectations/Syllabus Control Systems: Goals and Objectives Kovner Elton and Billings, Transforming Health Management: An Evidence-Based Approach. K/N pp 3-35. Griffith and White, The Executive Office, G/W pp 113-144. Discussion Question: What is the relationship between measurable objectives and organizational accountability? Session 2: Control (January 30) Governance Information Sahney and Warden, The Quest for Quality and Productivity in Health Services. K/N 65-95. Griffith and White, The Governing Board, G/W, 65112. Case #1 A New Faculty Practice Administrator for the Department of Medicine, K/N 37-50. DQ: How should health care organizations measure organizational performance? Session 3: Control (February 6) Incentives Quality Management
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P11.1833 Health Care Management Griffith and White, Improving Quality and Economy in Patient Care, G/W, 237-278. Case #10, Organization Design for the Breast Service, K/N 248-252. Short Case #C: CQI at Suburban Hospital, K/N, 1245. Bradley, EH, Holmoe JO et al, The Roles of Senior Management in Quality Improvement Efforts Journal of Healthcare Management, 2003, Jan/Feb 48 (1), 15-28. DQ: How do health care organizations measure the quality of customer service? Session 4: Control (February 13) Guest Speaker (To be announced) Batalden P., and P. Stolz, Performance Improvement in Health Care OrganizationsThe Joint Commission Journal of Quality Improvement, Oct 1993, 19 (10), 424452. Leape, L. Error in Medicine, Journal of the American Medical Association, 1994, 272 (23), 1851-57. DUE DATE: Career Objectives Paper (Part One)

Session 5: Organizational Design (February 20) The Production of Medical Work. Herzlinger, R., Market-Driven, Focused Health Care, K/N, 139-154. Griffith and White, Emergence of the Health Care Organization, G/W 1-26.
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P11.1833 Health Care Management Case #13: A Personal Memorandum on the Hospital Experience, K/N, 333-342. DQ: What is the relationship between organizational design and organizational performance? Session 6: Organizational Design (February 27) Managing Hospital Work Griffith and White, Nursing Services, in G/W, 371406. Griffith and White Clinical Support Services, in G/W 327-370. Case #6: Restructuring Wise Medical Center, K/N 157-162. DQ: What do nurses expect from hospitals and why dont (or do they) get what they want? Session 7: Organizational Design (March 6) Managing Doctors Griffith and White, Organizing Physician Services, in G/W, 279-326. Commentary on Physician Integration, K/N, 187-220. Case #7 Reorganizing Primary Care at Blackwell Medical Center, K/N, 163-172. Short Cases #G-J, in K/N , 254-8 DQ: What do doctors expect from hospitals and why dont (or do they) get what they want?

Session 8: Organizational Design (March 20) Integrating health care delivery.

P11.1833 Health Care Management Griffith and White, Designing the Healthcare Organization, G/W 145-178. Gillies, Shortell, et al., Conceptualizating and Measuring Integration, Hospital and Health Services Administration, 1993, 38 (4), 467-489.. Case #3: Healthier Babies in Twin Falls, Idaho, K/N 96-105. DUE DATE: Control Paper GRADE BACK: Mid Term-grade on class participation DQ: What are the costs and benefits of integrating health delivery for a community hospital? Session 9: ORGANIZATIONAL DESIGN (March 27) HMOs and Managed Care Griffith and White, The Finance System, G/W 517572. Detmer, A New Health System and Its Quality Agenda, K/N, 307-330. Case #4: The Primary Care Instrument Panel at Central Community Health Plan, K/N, 106-114. Case #8 The Future of Disease Management at Superior Medical Group, K/N 173-186. DQ: What are the costs and benefits of health plans to provider systems? Session 10: Adaptation (April 3) Strategy Griffith and White, Planning Future Directions, G/W 443-484. Begun and Heatwole, Strategic Cycling: Shaking Complacency in Healthcare Strategic Planning, K/N, 263-280.
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P11.1833 Health Care Management Case #11: In a State of Change: Veterans Affairs and HMOs, K/N, 282-286. DQ: What are some of the obstacles facing managers seeking to implement strategic plans, and how may these be overcome?

Session 11: Adaptation (April 10) Marketing Griffith and White, Marketing the Health Care Organization, in G/W, 485-516. Berry, LL, and Bendapudi, Clueing in Customers, Harvard Business Review, Feb 2003, 100-106. Case #12: VNA of Greater Cleveland, K/N 287-298. DQ: What kinds of marketing work best for increasing market share of a group practice in geriatric care?

Session 12: Adaptation (April 17) Guest Lecturer (To be announced) Due Date: ADAPTATION PAPER Session 13: ADAPTATION (April 24) Creating and Sustaining High Performing Organizations, and Organizational Ethics. Griffith and White Measuring Performance, G/W 179-236. Kizer, KW, Health Care Not Hospitals: Transforming the VA, in Straight from the CEO, GW Dauphinais and C. Price, eds. NY: Simon and Schuster, 112-120.
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P11.1833 Health Care Management Case #9: Physician Leadership: MetroHealth System, K/N 225-247. Due date: CAREER OBJECTIVES PAPER, PART TWO DQ: How does a CEO change an organization from Good to Great? Session 14: Adaptation (May 1) Strategic Leadership Management Ethics Case #14: Whose Hospital, K/N 341-359. Managing Your Career Robbins, CJ, EH Bradley and M Spicer, Developing Leadership in Health Care: A Competency Assessment Tool, Journal of Healthcare Management, 46 (3), May/June 2001, 188-202. Warden GL, and JR Griffith, Ensuring Management Excellence in the Health Care System, Journal of Healthcare Management, 46 (4) July-August 2001, 228237. DQ: Where is the health care enterprise going and how will this affect your career? READINGS Required: Kovner, Anthony R. and Neuhauser, Duncan, Health Services Management: Readings, Cases and Commentary, Health th Administration Press, 2004, 8 ed. Griffith, John and Kenneth White, The Well Managed Healthcare Organization, 2002, 5th edition
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P11.1833 Health Care Management

Recommended: (Available on Reserve at Bobst Library) Longest, Beauford, Jr, Managing Health Programs and Projects, San Francisco: Jossey-Bass, 2004. Griffith, John, The Moral Challenges of Health Care Management, Chicago: Health Administration Press, 1993. Kovner, Anthony R., Health Care Management in Mind: Eight Careers, New York: Springer, 2000.

Health Care Management Journals The Journal of HealthCare Management, Health Administration Press, One North Franklin Street, Chicago IL, 60606-3451. Health Care Management Review, Aspen Systems Corp., 20010 Century Blvd., Germantown MD, 20767. Journal of Health Administration Education, AUPHA, 1911 N Ft. Myer Drive, Arlington VA, 22209. Frontiers of Health Services Management, Health Administration Press, One North Franklin Street, Chicago, IL, 60606-3451.

WRITTEN ASSIGNMENTS A. Career Objectives (Part One) Write a 3-5 page paper on your career objectives and how you plan to implement them. Please enclose a copy of your latest resume. Include family issues as relevant. It should be a personal guide for your professional development. Share this
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paper with your team mate for the next assignment and integrate his or her feedback into what you have to say. Discuss the following: 1. Current experience in terms of managerial roles, skills, and values. (Include an assessment of your strengths and weaknesses.) 2. A specific desired job within 3 - 5 years. (What skills and experience are required to obtain and excel in the desired job?) 3. Specific plan to address the weaknesses that you have identified and describe the steps that you plan to take to achieve your desired 3-5 year goal. B. Control Complete as a 2-person team. For the unit in which one of you work, or for some other health unit, write a memo addressed to the unit director, specifying: 1. How well is the unit performing, and how can you tell if the unit is performing well? 2. In what ways is the unit's director accountable for achieving the objectives? What is the governance of the unit? 3. What is the information used to measure current performance? 4. What incentives are used to affect attainment of objectives? 5. Evaluate the strengths and weaknesses of the control system.

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6. Make feasible recommendations to improve the control system. Discuss opportunities and constraints for implementation. The paper should be about 8 double-spaced pages in length. Forms used for control purposes can be added as an appendix, as appropriate.

C. Adaptation/Strategy Complete as a three person team. Your task is to develop a strategic plan for the unit of, or for a small health care organization. This can be a real organization or one you dream up. Whatever you choose, it must be reasonably realistic. Include a one-page appendix signed by all members of the team specifying who completed what tasks involved in writing this paper. Examine the following issues: What is the organizations mission? Who does it actually serve? What is current performance? Develop three measurable objectives for next year's performance for the unit and a rationale for these objectives. Develop a strategy to achieve each objective and a rationale for the strategy. Describe obstacles to implementing the strategies and what you recommend to overcome the obstacles. Prepare a 2 page annotated bibliography (8 to 10 references) that applies to your findings and recommendations. Focus on studies in which
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evidence is analyzed rather than on opinion pieces. You may consult the general management as well as the health care management literature. Specify what the reading is about and why it is or is not useful how to the manager. The Adaptation paper should be 8-10 pages (double-spaced), with appendices, as appropriate. Note 2: On #5 Bibliography/Recommended Readings Kovner, AR, JJ Elton, and J. Billings, Transforming Health Management: An Evidence-Based Approach, Frontiers of Health Service Management, 16:4, Summer 2000, pp 3-24. Walshe, K and TG Rundall. Evidence-based management: from theory to practice in health care. Milbank Quarterly, 2001: 79 (3); 429-42. For examples of articles in which evidence is analyzed rather than opinion pieces, review these two articles in the KN book of readings: (1) Curley et al, A Firm Trial of Interdisciplinary Rounds...pp 262-274, and (2) Bigelow and Arndt, Great Expectations: An Analysis of Four Strategies, pp 306-332. Journals you may wish to review include the following: Academy of Management Review Health Care Financial Management Medical Care Review Health Care Management Review Harvard Business Review Frontiers of Health Services Management Journal of Healthcare Management Joint Commission Journal on Quality and Safety Milbank Memorial Quarterly The New England Journal of Medicine
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P11.1833 Health Care Management

Health Affairs D. Learning Objectives Paper Write a short paper--no more than three pages--describing what you have learned this semester that is or will be useful to managing your career. I am particularly interested in what you have learned from participating in learning cells and in conducting searches for evidence for use in management applications. (Although this paper is ungraded, your performance on this paper will be considered in adjusting your final course grade.) E. Class Participation Class participation is evaluated based on three criteria: attendance, appropriate amount of participation and quality of participation. The professor calls on learners only if they raise their hands. Your grade can be adjusted two notches based on class participation, e.g. from C to B- or from A- to B. You are expected, under class participation to fill out the class bio and attach a recent photo (preferably not a copy of your ID). All photos will be returned to you (sign on the back). ASSIGNMENTS AND GRADING Grading: Career Objectives Control Adaptation/Strategy Learning Objectives Class participation % 1/3 1/3 Due

Week 5 Week 8 1/3 Week 12 Ungraded Week 13 (can adjust your grade up to two notches.)

Grading Criteria (Written Assignments)

P11.1833 Health Care Management

Each paper will be scored, considering the following template, from 1 to 3 on four criteria (3 = excellent, 2 = acceptable, 1 = not acceptable) I. Career Objectives 25% Sufficiently articulated account of the writers current skills and experience which is relevant to the job desired. 25% Specified job sought and logical account of what is required to obtain the job and perform the job well. 25% Workplan of what the writer plans to do in the short run (next three years) to attain the necessary skills and experience to get the desired job. 25% Account of constraints and opportunities faced by the writer in attaining the desired job and how constraints will be overcome and opportunities grasped. II. CONTROL 25% Valid and reliable account of existing unit performance and specification of what, if any, assumptions this account is based upon. 25% Valid and reliable account of the units current control system (objectives, information, incentives and governance) based on what evidence. 25% Recommendations to improve the control system so that unit performance is improved with rationale for the logic and feasibility of the recommendations. 25% Account of opportunities and constraints faced by the unit manager in implementing the consultants recommendations to include how the
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constraints will be overcome and opportunities grasped. III. ADAPTATION 25% Description of forces causing change in the units performance and/or processes. 25% Selection of measurable objectives for the next 12 months with rationale for the choice recommended. 25% Evidence underlying the selection of objectives with rationale for hoped-for success (why the strategy succeeds). 25% Opportunities and constraints faced by managers in implementing your recommendations and description of how the manager can overcome constraints and grasp opportunities.

SUPPLEMENTAL BIBLIOGRAPHY ON SELECTED TOPICS Career Objectives Kovner, Anthony R. Health Care Management in Mind: Eight Careers, New York: Springer, 2000. Prybil, Lawrence D, Challenges and Opportunities Facing Health Administration Practice and Education, Journal of Healthcare Management, 48:4 July/August 2003, 223-231. Control Gray, JA Muir, Evidence-Based Healthcare, 2nd ed. Edinburgh: Churchill Livingstone, 2004.

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Lewis, JE, "Improving Productivity: The Ongoing Experience of An Academic Department of Medicine, Academic Medicine, Vol 71, No 4, April 1996, pp. 317-328. Committee on Quality, Institute of Medicine, 2001. Crossing the Quality Chasm: A New Health System for the 21st Century, Washington DC: National Academy Press, 119-154. Studer, Q, Hardwiring Excellence, Gulf Breeze, FL: Studer Group 2003. Adaptation Herzlinger, Regina E., Market-Driven Health Care, Reading, Mass: Addison-Wesley, 1997. Luke, Roice D., J.W. Begun and Steven Walston, "Strategy Making in Health Care Organizations," in Shortell & Kaluzny, eds. Health Care Management, 4th ed., Albany NY: Delmar 2000, 394-431. Shortell, Stephen M. et al. Remaking Health Care in America, San Francisco: Jossey-Bass, 2000. Evidence-Based Management All 5 articles are in Health Care Management Review, Volume 28, Number 4, October-December 2003, pp 319-375. Agenda Setting for Health Care Management Research: Report of a Conference (Anthony R. Kovner) Management Matters: Strengthening the Research Base to Help Improve Performance of Safety Net Providers (John Billings) Generating Management Research on Improving Quality (Vinod Sahney)

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P11.1833 Health Care Management The Case for the Use of Evidence-Based Management Research for the Control of Hospital Costs (Steven Finkler and David Ward) Improving the Generation, Dissemination, and Use of Management Research (David Blumenthal and Samuel Thier) Also of interest is: Gray, Evidence-Based Healthcare (see above), and SS Mick and ME Wyttenbach eds. Advances in Health Care Organization Theory, San Francisco, CA, 2003. Note in particular the reading by Luke and Walston on strategy. Note: What may be of interest to some (perhaps more as consumers than as providers) are eight clinical dramas revealing the forces at play in making critical medical decisions. Groopman, J., Second Opinions, New York: Penguin, 2000.

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