assignment week 1 Health care organization


Chapter 1: Introduction: Managing for Quality and



• Be familiar with the framework of this text • Understand the importance of sound managerial

practices in contemporary organizations that provide programs and services related to health

• Appreciate the advantages of applying systems thinking to management

• Understand the importance of improving quality and performance while demonstrating value

• Appreciate that quality management and quality initiatives contribute to organizational success


• Overview of Management

• Introduce Systems Thinking

• Introduce Quality Improvement

What Is Management?

• “Those in charge of running a business” (Princeton University, 2010)

• “The person or persons in charge of running a business establishment, organization, or institution” (American Heritage, 2006)

• Common thread of management: the need to guide an organization toward its goals

• Accomplished by providing guidance and sufficient resources for employees to be productive

The Traditional Functions of Management

• Planning for Improvement

• Organizing for Improvement

• Facilitating (Motivating/Leading) Improvement

• Control and Improvement

Competencies of Management

• Common training

• Understanding of leadership, evaluation, motivation, personalities, and communication styles

• Adaptability

• Ability to adjust their expectations of individual employees

• Mentor employees and help prepare them for advancement

What Else Makes a Manager Effective?

• Ability to modify plans on short notice

• Trust of employees and giving them opportunities to grow

• Accepting that occasionally employees will fail and helping them learn from mistakes

• An open and prepared mind

• Commitment to and respect for employees, employers, and self

Role of Employees

• All employees contribute to the planning, organizing, motivating, controlling, and improving of organizations

• In effective organizations, employees identify with and contribute to management

• All persons, independent of their positions, should understand and participate in the management functions of the organization for which they work

What Is Systems Thinking?

• “a general conceptual orientation [that is] concerned with the interrelationships between parts and their relationships to a functioning whole, often understood within the context of an even greater whole” (Trochim et al. 2006)

• “Forest” rather than “tree-by-tree” thinking

• Dynamic thinking rather than static thinking

• Pushes people to consider the consequences of their actions over time

Systems Thinking in Health

• The consequences of health promotion and disease prevention unfold over long periods of time and involve complex interrelationships

• For this reason, systems thinking is a basic competency in public health

• Systems thinking is promoted as a key competency in health service delivery organizations

What Is a System?

• Groups of interacting and interdependent elements that form a unified whole (such as an organization)

• Comprised of: – Inputs (employees, managers, and financial


– Processes (policies, procedures, and production activities)

– Outputs (products, programs, and services)

Causal Loops

• Diagram portraying the cause and effect relationships within systems

• Circular to reflect feedback (information about change that leads to further modifications)

• Can be either reinforcing (change in one direction leads to more change in the same direction) or balancing (change in one direction creates resistance in the other direction)

• Helps visualize changes in the system over time

System Archetypes • Patterns that occur repeatedly in different

settings • Useful for training people to think dynamically

about complex interrelationships • Examples:

– Fixes That Fail: a fix is applied to a systems problem that has immediate positive results, but unintended long term consequences make the problem worse

– Drifting Goals: a gradual downward slide in performance goes unnoticed, threatening the long-term future of a system

Other Systems Thinking Tools

• Simulation modeling

• Learning laboratories

• Diagrams that portray organizational performance over time

• Many quality improvement (QI) tools are based in systems thinking

Systems Thinking in Management

• Systems thinking helps managers see meaningful, underlying patterns, allowing them to make better decisions by foreseeing the system-level consequences of their actions

What is Quality Improvement (QI)?

• A set of methods and techniques that can be used to improve programs, services, products, or output of any organization and/or to decrease organizational costs

• Used in manufacturing and industry for over 90 years

• Adopted by traditional health organizations in the 1990s

• Only recently applied to public health

Two Common QI Approaches

1. Top-Down:

– Senior leaders support QI as a method for improving performance, create a vision that provides one or more goals, and supply needed resources

2. Bottom-Up:

– Lower level workers are trained in basic QI methods and techniques and then conduct projects to apply their training

Transformational Change

• The ultimate application of QI within an organization

• Involves a radical alteration with complete rethinking about the way an organization is structured or managed

QI Example: Process Engineering

• A methodology used to improve operational efficiency that analyzes operational sequences

• Goal is to eliminate or modify activities that do not add value

Applying QI • Inefficiencies and areas of ineffectiveness exist

throughout the health care and public health systems in the United States

• QI can address these problems; for example:

– A review of treatment protocols could identify opportunities for procedural changes

– A review of service delivery might reveal gaps in applications of existing service standards

– A review of outcomes could help to identify unneeded treatments or services