experienced manager of a health unit (huc5)

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Course Learning Outcomes for Unit V Upon completion of this unit, students should be able to:

5. Analyze basic management functions necessary to coordinate a health unit effectively. 5.1 Explore basic management functions, including planning, organizing, directing, coordinating,

and controlling. 5.2 Examine common competencies for health care managers. 5.3 Assess the hiring manager’s role in the hiring process. 5.4 Summarize key components of corrective action and performance improvement for employees. 5.5 Demonstrate understanding of the health care manager’s responsibility for budget development

and management.

Course/Unit Learning Outcomes

Learning Activity

5.1, 5.2, 5.3, 5.4, 5.5

Unit Lesson Chapter 4 Chapter 8 Chapter 13 Chapter 21 Article: “Common Competencies for All Healthcare Managers: The Healthcare

Leadership Alliance Model” Unit V PowerPoint Presentation

Required Unit Resources Chapter 4: Management and Its Basic Functions Chapter 8: Interviewing: Start Strong to Recruit Successfully Chapter 13: Criticism and Discipline: Guts, Tact, and Justice Chapter 21: Budget and Cost Control In order to access the following resource, click the link below. Stefl, M. E. (2008, November-December). Common competencies for all healthcare managers: The

Healthcare Leadership Alliance model. Journal of Healthcare Management, 53(6), 360–374. https://link.gale.com/apps/doc/A190196467/ITBC?u=oran95108&sid=bookmark-ITBC&xid=5f14aaf0

Unit Lesson Management positions within the health care industry require specific competencies and functions in which one should expect to participate when managing a health unit. Understanding these skills and duties is essential not only for preparation to work within the role of a manager or supervisor but also in order to successfully navigate an interview for a position within leadership. In this lesson, basic functions and competencies, the hiring process and recruitment, corrective action and discipline, as well as budget management will be explored.

UNIT V STUDY GUIDE Management Functions

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Basic Management Functions

Although each position may vary some, health care managers are routinely involved in operational administration, strategic planning, regulatory adherence, performance improvement, as well as oversight of the allocation of physical and capital resources, human resources, and financial management of their assigned units (Linnander et al., 2017). More specifically, depending upon the position, a health care manager or supervisor may be responsible for some or all the following duties: staffing, budgeting, payroll, quality assurance, physician relations, financial performance, resource allocation, technology procurement, and new service development (Thompson et al., 2017). Additionally, McConnell (2019) describes five key domains that describe the duties within the management role, including controlling, coordinating, directing, organizing, and planning. Planning Managers are responsible for planning all activities within their unit, which includes not only what should occur, but how and by whom. According to McConnell (2019), planning is a wide term applied to many of the tasks for which a manager is responsible. Planning includes goal setting for oneself as well as employees, strategic plans, the budget, and staffing. Moreover, managers may need to assist in planning for the patients served on their unit. Planning includes short-term and long-terms projects (“Strategic Planning,” 2009). Given the constant flux within the health care industry, plans must be flexible, and managers must be agile. At times, a manager may be required to conduct a SWOT analysis (strengths, weaknesses, opportunities, threats) as part of planning for their unit (“Strategic Planning,” 2009). Conducting a SWOT analysis includes reviewing each of these areas as it pertains to the unit or a particular decision. Assessing strengths and weaknesses is considered an internal assessment and typically includes evaluating objective data and may include gauging the perceptions of others such as staff, patients, another department, or physicians. The second phase is an external assessment, which is evaluating opportunities and threats. Calculating opportunities and threats might include analysis of trends; benchmarks; demographic information; fiscal trends; and even local, state, and national data. Once a SWOT analysis is complete, the health care manager can decide how to move the unit from its current position to the preferred or new position. Organizing Organizing ensures resources, both physical and human, are used efficiently and in a manner that optimizes outcomes (McConnell, 2019). Specifically, managers and supervisors often make decisions regarding the division of labor, which is at the epicenter of organizing one’s unit. McConnell emphasizes delegation as a key component to the successful organization of one’s unit. Delegation essentially entails distributing the workload across more than one individual (Laskowski-Jones, 2014). Delegation does not come easily to most managers and is a skill that often takes repeated practice to hone. When delegation is done properly, the work is done by the most appropriate people on the team and usually results in boosted morale, efficiency, and opportunities for professional growth amongst the team. However, when done incorrectly, the manager risks opposition, damage to team spirit, and even safety concerns for patients potentially. Those learning the art of delegation often describe feeling guilty for not doing the work themselves, or perhaps a sense that the work will not be done to their standards if completed by a member of the team. Laskowski-Jones stresses the importance of understanding organizational, regulatory, legal rules, regulations, and culture that dictate delegation. Further, delivering clear expectations when delegating is essential. Finally, to continue to master the craft of delegation, a manager must be open to ideas for improvement. Directing Directing can be seen as the common and repetitive tasks completed to manage and motivate employees in the work that must completed (McConnell, 2019). A health care manager or supervisor is consistently consumed by directing on a day-to-day basis. As such, McConnell emphasizes the ability to motivate one’s subordinates. Motivation is a complicated phenomenon that can sometimes be highly individualized (HRH Global Resource Center, n.d.). That is, what motivates one employee may not be the driving force in another. At a high level, motivation is directly related to employee satisfaction. Typically, the factors that satisfy most workers within health care include a clear tract for professional development, adequate staffing, strong

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compensation and benefit plans, and a good quality connection to one’s leadership team. Therefore, a negative perception of any one of these job attributes stands to negatively affect motivation of employees (HRH Global Resource Center, n.d.). Coordinating Coordinating includes balancing the team, tasks, and resources, as well as collaborating to ensure duties are completed effectively, and staff is organized in the best possible way. According to McConnell (2019), “In health care activities it is always essential that employees, facilities, supplies, and services all be combined in the right relationship to each other for the benefit of the patient” (p. 67). Orchestrating all these entities continually takes finesse, which is a leader’s prime purpose in health care. Collaborating occurs with a leader’s employees, between one or more departments or units and with patients and their families, physicians, and even community entities outside one’s organization (Morley & Cashell, 2017). Effective coordination and collaboration results in benefits to the quality of care patients receive, increased patient safety, better staff satisfaction, and overall improvement of organizational outcomes. Morley and Cashell also indicate that well-coordinated teams often result in improved processes, innovation, and less absenteeism. Controlling Controlling includes course-correction, performance improvement, and follow-up of all the above functions a manager is responsible for when running a health unit to constantly better the team and results. Essentially, managers must be able to constantly evaluate previous decisions and make minor adjustments as necessary (McConnell, 2019). This type of follow-up might include corrective action of employees, evaluating one’s own practice or decisions, reprioritizing tasks, or follow-up and adjustment of a new process or plan within the unit. Given the complexities and constant state of change experienced within the health care industry and health systems, controlling might be seen as the most vital, yet most challenging basic management function. Figueroa et al. (2019) characterize the challenges existing within the contemporary health care industry to three structural levels: macro, meso, and micro levels. The macro level includes societal and system-wide trends such as the overall expansion of the population combined with the increased age of patients, increased regulatory burdens, decreased reimbursement from payers, and an insufficient labor force that drive the need for constant course corrections for health care managers. Meso level struggles center on organizational challenges, including staffing shortages, operational inadequacies, and the lack of clear expectations for managers. Finally, micro or individual level challenges that require constant attention from managers include conflicting responsibilities for the manager and varying levels of accountability, transparency, and autonomy across mangers and roles. Thompson et al. (2017) also discuss the above five functions but add a sixth function: decision-making. Decision-making is inherent in all the above-stated functions and making effective decisions is a crucial skill for health care managers. Guo (2008) recommends the acronym DECIDE to aid a manager in making effective decisions, wherein each letter stands for a crucial step in the process of most if not all decisions to be made. “D” stands for defining the problem; “E” denotes establishing the criteria; “C” is to consider all alternatives; “I” includes identifying the best alternative; “D” is used to develop and implement an action plan; and finally, “E” requires one to evaluate and monitor the situation (Guo, 2008).

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Common Competencies for Health Care Managers

According to Thompson et al. (2017), common competencies for health care managers include skills in one of three domains, including conceptual, technical, and interpersonal. Conceptual skills can be thought of as critical thinking abilities. Technical skills include the many scientific or specialized tasks that must be performed within the health care industry specifically. Interpersonal skills include the ability to manage employees, collaborate with peers, and function in accordance with their supervisor’s objectives. Interpersonal skills include communication abilities, mentoring and coaching, partnership with others for projects, and receiving feedback from others. Stefl (2008) offers similar competencies considered crucial for health care managers divided into five categories, including communication and relationship management, professionalism, leadership, knowledge of the health care system, and business acumen. Communication skills must permeate both internal and external stakeholders and be effective in both individual and group settings. Relationship management includes the importance of being able to provide constructive feedback to ensure increased performance of staff when necessary. According to Stefl, the leadership domain really centers on the ability to motivate and inspire others toward a shared vision to achieve desired organizational outcomes. Stefl opined that professionalism entails ethical conduct, a service-oriented nature, and dedication to constant professional development. Of course, health care managers must possess sound knowledge of the industry and the system within which they work. Lastly, according to Stefl, health care leaders must possess strong abilities within the business domain, including financial strategy, human resource management, strategic planning, marketing, information management, performance improvement, and risk mitigation.

Recruitment and the Hiring Process

Another vital function under the purview of health care supervisors and managers is the recruiting, interviewing, and hiring process. This domain is of the utmost importance, given the striking staff shortages experienced within the health care industry. Thompson et al. (2017) describes the recruiting trend, which centers on talent management. The idea is that managers must not simply fill a position but rather seek the most capable and qualified person for the job. Arguably, the first step in the recruitment process is developing a sound job description (McConnell, 2019). The job description clearly and concisely outlines the specific knowledge, skills, and education required for a particular position. Applicants to a particular position may come from within the organization (internal) or outside the health system (external). Usually, candidate selection will focus on the immediate needs of the department or unit, but managers are also encouraged to consider the long-term needs of their area, which can lead to an opportunity for professional development amongst the team. Once one or more candidates for a position are identified, the manager or supervisor will participate in interviewing candidates. In most organizations, the human resources department will perform an initial screen of a candidate to evaluate the person against the basic requirements of the position. It is important to note that there are rules that regulate what can and cannot be asked during an interview. These rules exist to

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protect against discrimination, such as the basis of age, gender, religion, disability, nationality, and sexual orientation. McConnell (2019) offers broad advice for a successful candidate interview, including making the candidate comfortable during the interview, asking questions in a manner that requires the candidate to provide a substantial amount of information or specific past examples, and structuring interviews such that the applicant does most of the talking. During the interview, the manager should try to take minimal notes as to not detract one’s attention from the conversation at hand and should conclude the interview with some plan for next steps or follow-up with the candidate. After the desired candidate is identified, a job offer must be extended. Typically, this is done in collaboration between the manager and the human resources department. The extent to which the manager decides salary and benefits varies across organizations. Typically, a job offer is always contingent upon successful completion of pre-boarding activities, including references, a background check, and pre-employment drug screen.

Corrective Action and Performance Improvement for Employees

Another critical function for management is monitoring and sometimes correcting employee performance. Thompson et al. (2017) indicate that key activities for the manager in this regard include setting and communicating goals to the team, measuring performance, comparing individual and team performance against the goals, determining causes for variation, and developing corrective actions. Many managers use dashboards and scorecards to track and trend performance across key indicators developed for their unit or department. McConnell (2019) discusses the importance of managers providing feedback and constructive criticism to employees. Feedback should also include positive information on jobs well done. Constructive feedback is used when goals are not met or individual performance is below the standard. Constructive feedback must always be clear and provide a definite guide for improvement. Feedback must be provided as close to immediate as possible to have the maximum impact, delivered confidentially, and objectively delivered without emotion as much as possible. According to McConnell (2019), the most common reasons to necessitate constructive feedback to employees include, “lack of adequate job knowledge, poor understanding of management’s expectations, inability to perform as expected, and attitude problems” (p. 235). Essentially, the reasons for corrective actions are subdivided into either conduct or performance issues. McConnell indicates that discipline must be fair, and the punishment should always fit the crime. It is essential that the manager follow all policies, document all forms of discipline to keep in the employee file, and keep discipline confidential. Lastly, managers must take steps to avoid the common pitfall of acting on unfounded information. According to McConnell, “it is far better to run the risk of allowing someone who deserves punishment to slip through rather than to discipline an innocent person unjustly” (p. 241). Whenever possible, the first step in corrective action should be education, except in the cases of egregious issues. From there, corrective action is progressive if the employee fails to correct the issue or displays repeated behavior. According to McConnell, behavioral and performance issues are kept separate. A progressive path often includes education, oral warning, written warning, suspension, and termination. However, the exact path is always dictated by organizational policy, and managers should not hesitate to consult with the human resources department whenever there is question or the need to progress to the next level is unclear to the manager. For example, some infractions are severe enough to warrant skipping steps on the progressive path.

Budget Development, Management, and Cost Control

Gragg (2018) reported that budgeting concepts and trends are slower to change in the health care industry compared to other fields. Despite this, for the most part, gone are the days when managers and supervisors are not involved in the budget process (McConnell, 2019). The result of participative budgeting is a more practical and workable budget and better buy-in from management in adhering to the budget they helped create. Some key concepts for managers to understand in terms of their budget include knowing when the organization’s fiscal year is. This may be the calendar year that begins January 1, or it may be a different consecutive 12-month period used for accounting purposes (McConnell, 2019).

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Next, managers must understand various time periods used for different accounting activities such as payroll, supply expenses, and other key departmental financial indicators. Finally, a manager must know whether their budget is fixed or flexible. A flexible budget considers variable costs of certain things such as staffing during higher census periods versus a fixed budget, which assumes constant operations throughout the entire fiscal year and never changes. McConnell (2019) indicates most health care managers will have an operating budget and a capital budget. An operating budget contains revenue generated by their department and costs such as supplies, salaries, and other department-related expenses. A capital budget is the dollars allocated to capital purchases, such as new equipment for the unit. Managers within the health care industry must also learn the concept of the FTE or full-time equivalent. This is the term that denotes the quantity of workforce contribution equivalent to one full-time employee. Staffing the unit begins with understanding how many FTEs in each discipline are needed to cover all the required duties of the department or unit. Managers and supervisors usually have set guidelines for budget and staffing variances. That is, when costs exceed the target by a defined amount, the manager must provide an explanation, typically to the finance department. Budgets must be reviewed at least monthly, and managers should question any line items they do not understand. This allows for early trends to be corrected and serves as a means for the manager to consistently learn how the department’s expenditures add up. McConnell indicates that ultimately the health care leader is responsible for how the department’s resources are utilized, especially in comparison to the department’s outcomes. Cost Containment Because of the pressures to control costs within the health care industry presently, managers must become experts in cost containment, sometimes referred to as cost control. McConnell (2019) indicates cost control requires a manager to take active steps to keep department costs aligned with the budget. An example is bringing on more staff when the unit census is high but sending staff home or canceling their shift during periods of low census. Some costs are very difficult if not impossible for a unit manager to control. Examples include supply and medication costs, as well as food costs. Instead, focusing on cost control within the span of control for the manager is key. Important opportunities include prudent scheduling and frequent evaluation of staffing ratios, control of overtime incurred by employees, and controlling waste or misuse of supplies. Finally, it is noteworthy that evidence shows that hospitals that are financially stable provide better outcomes to patients (Akinleye et al., 2019). Specifically, a study of 108 acute care facilities found that there was a distinct association between fiscal outcomes and a better patient experience, lower hospital readmission rates, and fewer patient safety concerns. Financial performance was characterized as better cash flow, the ability to make more capital investments, and better performance on value-based performance initiatives.

Conclusion

As you can see, health care leaders are required to be skilled in many different areas, as their job consists of a variety of important tasks and responsibilities that can affect patient outcomes and the financial viability of their organization. Understanding overarching functions and competencies serves as a guide to the potential health care supervisor or manager, as well as a roadmap for ongoing professional development for those seeking leadership positions. Some key areas of leadership include building the team through recruitment and hiring, managing the team through feedback and performance improvement, realizing the importance of decision-making, and maintaining budget and cost control within the department. Clearly the forgoing information underpins the complexity of the health industry, the pace at which a manager must work, the agility required to manage competing priorities daily, and the overall importance of leadership to a department’s success.

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References

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Figueroa, C. A., Harrison, R., Chauhan, A., & Meyer, L. (2019). Priorities and challenges for health leadership

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