Role of a Health Care Manager

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We dedicate this book to our loving spouses,

Dale Buchbinder, Rick Shanks, and Casey Kite—

Who coached, collaborated, and coerced us to

“FINISH THE FOURTH EDITION!”

1114237 - Jones & Bartlett Learning ©

Contents

Foreword

Preface

Acknowledgments

About the Editors

Contributors

Chapter 1 An Overview of Health Care Management Jon M. Thompson, Sharon B. Buchbinder, Nancy H. Shanks, and Bobbie Kite

Introduction

The Need for Managers and Their Perspectives

Management: Definition, Functions, and Competencies

Management Positions: The Control in the Organizational

Hierarchy

Focus of Management: Self, Unit/Team, and Organization

Role of the Manager in Establishing and Maintaining

Organizational Culture

Role of the Manager in Talent Management

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Role of the Manager in Strategic Planning and Strategy

Development

Role of the Manager in Ensuring High Performance

Role of the Manager in Ensuring a Positive Patient Experience

Role of the Manager in Leadership Development and Succession

Planning

Role of the Manager in Innovation and Change Management

Role of the Manager in Health Care Policy

Opportunities for Research on Health Care Management

Conclusion

Chapter 2 Leadership Louis Rubino

Leadership vs. Management

History of Leadership in the U.S.

Contemporary Models

Leadership Styles

Leadership Competencies

Leadership Protocols

Governance

Barriers and Challenges

Ethical Responsibility

Important New Initiatives

Leaders Looking to the Future

Opportunities for Research on Health Care Leadership

Conclusion

Chapter 3 Management and Motivation Nancy H. Shanks

Introduction

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Motivation—the Concept

History of Motivation

A Bit More About Incentives and Rewards

Why Motivation Matters

Motivated vs. Engaged—Are the Terms the Same?

Measuring Engagement

Misconceptions About Motivation and Employee Satisfaction

Motivational and Engagement Strategies

Motivating Across Generations

Managing Across Generations

Opportunities for Research on Management and Motivation

Conclusion

Chapter 4 Organizational Behavior and Management Thinking

Sheila K. McGinnis

Introduction

The Field of Organizational Behavior

Organizational Behavior’s Contribution to Management

Key Topics in Organizational Behavior

Organizational Behavior Issues in Health Organizations

Thinking: The “Inner Game” of Organizational Behavior

The Four Key Features of Thinking

Mental Representation: The Infrastructure of Thinking

Processing Information: Fundamental Thinking Habits

Decision Making, Problem Solving, and Biased Thinking Habits

Social Cognition and Socio-Emotional Intelligence

Social Categorization and Biases

Implications of Social Cognition and Socio-Emotional Intelligence

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Opportunities for Research on Organizational Behavior and

Management Thinking

Conclusion

Chapter 5 Strategic Planning Susan Casciani

Introduction

Purpose and Importance of Strategic Planning

The Planning Process

SWOT Analysis

Strategy Identification and Selection

Rollout and Implementation

Outcomes Monitoring and Control

Strategy Execution

Strategic Planning and Execution: The Role of the Health Care

Manager

Opportunities for Research on Strategic Planning

Conclusion

Chapter 6 Health Care Marketing Nancy K. Sayre

Introduction

What Is Marketing?

A Brief History of Marketing in Health Care

Key Components of the Marketing Concept

The Strategic Process

Understanding Marketing Management

Health Care Buyer Behavior

Marketing Mix

Marketing Plan

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Ethics and Social Responsibility

Outcomes of Marketing

Opportunities for Research on Health Care Marketing

Conclusion

Chapter 7 Quality and Performance Improvement Basics

Robert V. Casanova

Introduction

Defining Quality in Health Care

Why Is Clinical Quality Management Important?

Quality of Health Care and Patient-Centered Care

Leaders of the Quality Improvement Movement

The Complex Nature of Health Care

Common Elements of Quality and Improvement

Approaches to Quality Improvement

Quality Improvement Tools

Opportunities for Research on Quality and Performance

Improvement Basics

Conclusion

Chapter 8 Health Information Systems and Technologies

Bobbie Kite

Introduction

Health Information Systems Used by Managers

Evolution of the Electronic Medical Record (EMR)

The Challenges to Clinical System Adoption

Health Care Information Technology Moving Forward

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The Impact of Information Technology on the Health Care

Manager

Opportunities for Research on Health Information Technology

Conclusion

Chapter 9 Financing Health Care and Health Insurance

Nancy H. Shanks

Introduction

Introduction to Health Insurance

Brief History of Health Insurance

Characteristics of Health Insurance

Private Health Insurance Coverage

The Evolution of Social Insurance

Major “Players” in the Social Insurance Arena

Statistics on Health Insurance Coverage and Costs

Those Not Covered—the Uninsured

Opportunities for Research on Financing Health Care and Health

Insurance

Conclusion

Chapter 10 Managing Costs and Revenues Matthew Dyer

Introduction

What Is Financial Management and Why Is it Important?

Tax Status of Health Care Organizations

Financial Governance and Responsibility Structure

Managing Reimbursements from Third-Party Payers

Coding in Health Care

Controlling Costs and Cost Accounting

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Setting Charges

Managing Working Capital

Managing Accounts Receivable

Supply Chain Management and Inventory

Managing Budgets

Opportunities for Research on Managing Costs and Revenues

Conclusion

Chapter 11 Managing Health Care Professionals Sharon B. Buchbinder and Dale Buchbinder

Introduction

Physicians

Registered Nurses

Licensed Practical Nurses/Licensed Vocational Nurses

Nursing Assistants and Orderlies

Home Health Aides and Personal Care Aides

Midlevel Practitioners

Health Care Organizations and Sexual Harassment

Opportunities for Research on Managing Health Care

Professionals

Conclusion

Chapter 12 Strategic Management of Human Resources

Mark A. Arvisais

Introduction

Environmental Forces Affecting Human Resources Management

Understanding Employees as Drivers of Organizational

Performance

Key Functions of Human Resources Management

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Workforce Planning/Recruitment

Employee Retention

Opportunities for Research on Strategic Management of Human

Resources

Conclusion

Chapter 13 Teamwork Sharon B. Buchbinder and Susan Casciani

Introduction

What Is a Team?

The Challenge of Teamwork in Health Care Organizations

The Benefits of Effective Health Care Teams

The Costs of Teamwork

Real-World Problems and Teamwork

Who’s on the Team?

Emotions and Teamwork

Team Communication

Methods of Managing Teams of Health Care Professionals

Emerging Issues

Virtual Teams

Electronic Tools and Remote and Virtual Teams

Face to Face Versus Virtual Teams

Organizational Learning

Opportunities for Research on Teamwork

Conclusion

Chapter 14 Addressing Health Disparities: Cultural Proficiency

Nancy K. Sayre

Introduction

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Changing U.S. Demographics and Patient Populations

Addressing Health Disparities by Fostering Cultural Competence

in Health Care Organizations

Best Practices

Individuals and Communities Play a Role in Addressing Health

Disparities

Addressing Health Disparities by Enhancing Public Policy

Opportunities for Research on Addressing Health Disparities:

Cultural Proficiency

Conclusion

Chapter 15 Law and Ethics Ellen D. Breckenridge

Introduction

Legal Concepts

Health Care Law

Tort Law

Malpractice

Contract Law

Ethical Concepts

Patient and Provider Rights and Responsibilities

Legal/Ethical Concerns in Managed Care

Biomedical Concerns

Beginning- and End-of-Life Care

Opportunities for Research on Law and Ethics

Conclusion

Chapter 16 Health Care Regulation and Compliance Ellen D. Breckenridge

Introduction

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What Is Fraud and Abuse?

False Claims Act

Anti-Kickback Statute

Physician Self-Referral Laws—the Stark Law

The Social Security Act Exclusion Statute

Civil Monetary Penalties Law (CMPL)

The Emergency Medical Treatment and Active Labor Act

Antitrust Issues

Management Responsibility for Compliance and Internal Controls

Corporate Compliance Programs

Opportunities for Research on Health Care Regulation and

Compliance

Conclusion

Chapter 17 Special Topics and Emerging Issues in Health Care Management

Sharon B. Buchbinder and Bobbie Kite

Introduction

Vaccine Preventable Diseases, Re-Emerging Outbreaks, and

Deaths

Violence in Health Care Settings

Mental Illness, Substance Use Disorders, and Federal Legislation

Emergency and Disaster Management

Opportunities for Research on Special Topics and Emerging

Issues in Health Care Management

Chapter 18 Health Care Management Case Studies and Guidelines

Sharon B. Buchbinder, Donna M. Cox, and Susan Casciani

Introduction

Case Study Guidelines

Team Structure and Process for Completion

CASE STUDIES Emergency Department Complications – Case for Chapters 13, 7,

and 17

Plight After Oversight at Community Medical Services – Case for

Chapters 7, 9, and 10

Chaos Reigns – A Troubled Dialysis Organization – Case for

Chapters 12 and 5

Dr. Osso’s New Practice – Case for Chapter 16

To Implant or Not to Implant? That Is the Question – Case Study

for Chapter 15

Implementing a Practice Change – Case for Chapters 2, 3, and 13

She Said, He Said, She Said: Three Stories, Multiple Sides – Case

for Chapters 11, 12, and 15

Bon Voyage, Claire Voyant! – Case for Chapters 11 and 15

Death by Measles – Case for Chapters 17, 11, and 15

Exercises for Reviving the Art of Letter Writing – Exercises for

Chapters 1, 7, 12, 15, and 17

Five Exercises to Address Gun Violence as a Public Health

Epidemic – Exercises for Chapters 2, 9, 12, 15, and 17

Five Exercises to Address the Opioid Epidemic as a Public Health

Problem – Exercises for Chapters 2, 9, 12, 15, and 17

Five Exercises to Address Politics and Policy – Exercises for

Chapters 5, 9, 12, 15, and 17

How to Write an Email with Five Exercises – Exercises for Chapter

Informational Interviewing Exercise – Exercise for Chapters 1

and 12

Patient Advocate Interview Exercise

The Do-Good Clinic – Case for Chapters 16 and 17

Door to Balloon (Percutaneous Coronary Intervention [PCI]) –

Case for Chapter 7

Team or Hot Mess? – Case for Chapter 13

The Case of the Warm Brownies – Case for Chapter 5

Executive Ethics: Inflating the Numbers – Case for Chapter 2

We Care Medical Center: Allocating Costs – Case for Chapter 10

Davis Perkins University Hospital: Hiring Dilemma in the

Emergency Room – Case for Chapters 12 and 13

Data and Care Coordination – Case for Chapter 8

Leadership and Teamwork – Case for Chapters 2 and 13

Giving Feedback—Empathy or Attributions? – Case for Chapter 4

Socio-Emotional Intelligence Exercise: Understanding and

Anticipating Major Change – Case for Chapter 4

The Patient’s Experience: What Were They Thinking? – Case for

Chapter 4

Keeping the Community Health Center’s Doors Open – Case for

Chapters 10 and 5

Accessing Specialty Care for Community Health Center Patients

– Case for Chapters 5, 9, and 10

Communication of Patient Information During Transitions in Care

– Case for Chapters 7 and 15

Multidrug Resistant Organism (MDRO) in a Transitional Care Unit

– Case for Chapters 7 and 15

Black Mothers and Babies – Case for Chapter 14

Children of the Opioid Crisis – Case for Chapters 14 and 17

Marketing and the Opioid Crisis in America – Case for Chapters 6

and 17

Patients “Like” Social Media – Case for Chapters 5 and 6

Where Do You Live? Health Disparities Across the United States –

Case for Chapter 14

Generational Tension in the Office – Case for Chapters 3, 4, and

Should Our State Expand Medicaid – Case for Chapter 9

To Partner or Not to Partner with a Retail Company – Case for

Chapter 5

Improving the Patient Experience at Major Medical Center – Case

for Chapters 1 and 12

Poor Communication or Micromanagement? – Case for Chapter

Whispers in the Development Office – Case for Chapter 13

Glossary

Index

Foreword

Effective learning occurs when students are engaged and inspired. Effective teaching creates the environment for engagement and inspiring thought. Introduction to Health Care Management, fourth edition, is a comprehensive text that covers essential content material and provides an extensive variety of cases to stimulate thought. The revisions in this edition are timely and extend the learning that is possible about the health care industry. Students and instructors will benefit from the expertise shared in this text.

Health care is complex, and management of its delivery entails a breadth and depth of knowledge, skill, and ability. The responsibility of implementing service, coordinating those providing it, and ensuring the quality of care is the mantle of the health care manager. It is imperative that both the clinical and business aspects of service and patient care are understood and closely monitored. Leaders rely on the knowledge and skill of competent managers to make informed decisions. Management requires a deep understanding of multiple functions and processes while also leading people from a variety of disciplines in a multitude of roles.

Mentorship of managers is part of the developmental process of leaders. A good foundation for health care management is the start of lifelong learning and career development.

The knowledge of management science with an interdisciplinary foundation is needed to succeed in the ever-changing health care industry. The demand for health care coverage is constantly in the news. Working with teams of professionals to provide quality care that is cost-effective is an ongoing challenge for health care managers. This text lays the groundwork of a health care management curriculum; other courses may add depth and can benefit from the breadth of the cases in this text.

Population health, community well-being, and medical care delivery are growing fields where excellent management makes a difference. Management responsibility of care extends outside the walls of an organization. One is now managing the health of the population they serve. The continuum of care includes collaboration across various service modalities. This text is not just hospital-based and includes settings that span the continuum of care. The span of specialty care from obstetrics to gerontology takes coordination to ensure that it is safe, timely, efficient, effective, equitable, and patient-centered, the aims of the Institute of Medicine. The aging of a population that wants to remain independent is changing all aspects of health care, especially long-term care. From pre-conception and birth to end of life and death, health care management is all-encompassing.

To be successful as a manager one needs to focus on creating the right culture. In an environment of new, disruptive technologies, communication is critically important for people to keep learning and experimenting with new knowledge, products, and processes. Keeping up with a culture of change and innovation while building on a traditional foundation takes skill and diligence. In addition, disparities that exist must be acknowledged and addressed. The new edition of this text incorporates information management that will help to invest in culture. Good, constant, and credible communication takes skilled managers to accomplish. A positive and productive culture is dependent on open and transparent communication.

A manager needs to be prepared for any eventuality. Planning for disasters and emergencies is much more than fire or air raid drills or having an evacuation plan. Extreme weather, mass shootings, chemical and biological exposures, infectious disease outbreaks, and ED diversion, for example, are all too common occurrences. Communities and health care institutions are more vulnerable when panic or chaos is the initial reaction. Plans that are known, practiced, and updated are the hallmark of a well-positioned organization if or when the no longer unexpected happens. The new edition of this text helps instructors further develop student competence in strategy and planning.

The text is already a classic and serves as a reference for many who learned from early editions. It is a resource for faculty as well as a foundational text for practitioners transitioning to supervisory roles. Each

new edition builds on the prior and is improved with new contributions.

Exceptional management is all about being able to tell stories. A story engages, and to be memorable is inspirational. The authors of this text are master story crafters. Drs. Buchbinder, Shanks, and Kite and their contributors have woven together a comprehensive yet concise guidebook for an entry level manager. Whether new to health care, or an experienced clinician transitioning to management, the content is clear, and the stories resonate. This text is so readable because it tells stories and urges the reader to solve cases with the intent to teach the learner to create their own stories by managing complex situations.

When the last page is read, and the cover is closed—or the eBook is shut down—the theories and cases within will serve as the underpinning for the stories to be told by the next generation of health care managers.

Dolores G. Clement, DrPH, FACHE

Sentara Professor

College of Health Professions

Virginia Commonwealth University

Richmond, VA