Organization Structure Analysis Health Care

Lecture Note

Introduction

An organization's long-term success depends on the ability of that organization to sustain the delivery of quality products and services; yet many organizations fail in the area of a sustainable high-performance culture. For an organizational culture to maintain its strength and adapt to shifts in its environment, it requires contribution, candor, and constant learning. Key components that must be developed and maintained throughout are the concepts of teamwork, global thinking, and dynamic leadership, with specific focus on solutions. Performance can be influenced by any number of factors, including internal elements such as organizational culture, structures, processes, and leadership, as well as external elements. High performance depends upon the alignment of internal systems with the larger system within which the organization operates. Effective management and structure must be utilized to achieve organizational success. Additionally, certain dynamics can force an organization to redesign its structure.

 

Effective Management Structures

In an effective management structure, the factors of the business culture are recognized and leveraged for success. Such institutions are prepared to make changes that will enable them to meet challenges that may determine future viability. Through the decades-long development of effective management structures involving governance, senior management, and support staff, institutions, health care institutions in particular, are positioned for a new era of uncertainty which may require management and operational redesign. Health Care Reform will bring about a sea of change. Effective health care organizations will continue to leverage the mix of governance, senior management, and support staff as the basic management structure to be prepared to meet the programmatic changes that are being brought about by the recently enacted Health Care Reform Bill.

 

            New focus: The largest challenge that will set the stage for system redesign is being brought on by the fact that the health care industry is entering a world where the volume-based approach to paying for care is likely to disappear in favor of a system of mandated value and efficiency. Thus, the demand will be for plans wherein payments are tied to the quality and safety of care an institution delivers. This demand alone will call for major changes and challenges in how to manage finances and what health services to provide, and whether those provided services actually improve health quality, eliminate disparities, and can be provided at a reasonable yet profitable cost.

            Health care organizations will no longer merely take the sick and injured people who come through the door and make them well. In the future, the health of our communities will be measured in terms of low disease occurrences, high vaccination rates, low and controlled chronic disease rates, healthier lifestyles, and a better educated public. The new focus will be on preventive interventions of various types; that is, keeping people healthy will become a business imperative. This focus on wellness maintenance will foster major changes in the hospital's role in its community.

            New organizational structure: Physician integration into the new focus on community wellness will offer challenges with potentially promising pay-offs. A key to success will be to find a way to truly integrate physicians into the management and administrative segments of the organization, but that is not the complete answer. New models of physician leadership will be required. As an example, there is a much stronger role for the Chief Medical Officer (CMO) as a means of bringing together both clinical and operational skills. Consideration should be given to making the CMO a member of the operations management team so that person can be directly involved with management and medical operational issues and be given the privilege of reporting to the board. There is also a need to strengthen the role of the Board of Trustees. Those institutions with strong boards with a high degree of board engagement and commitment tend to be high-performing health care organizations. Management has an obligation to provide governance with tools to meet the challenges of the future, including educational resources, operational reconfigurations to improve efficiency, formal relationships with other health care providers, physician integration, and a broader leadership role in their respective communities. Additionally, management will need to change its care models to become more inviting to both older and younger employees.

 

AHA Role

The American Hospital Association (AHA) will play a significant role in assisting hospitals to be more effective in improving the delivery of health services. AHA's affiliate, Health Research and Education Trust (HRET), will provide information, tools, and services as a means of evaluating and improving the delivery of health care. HRET will work to answer the following questions:

 

            What are the most effective and efficient ways for hospitals and health systems to integrate care and improvement performance along the continuum of care?

            What organizational characteristics, structures, and processes lead to high-performing system of care?

            What are the most promising practices and system design elements for reducing health disparities, considering all factors such as organizational elements and social determinants?

            What is the role of a hospital in a new community environment that provides more efficient and effective health care? (HRET, 2010)

 

HRET Tools for Hospitals

Some of the HRET projects include:

 

            The comprehensive Unit-Based Safety Program is a national implementation program to provide initiative to reduce central line-associated blood stream infections in hospital intensive care units. This tool has been shown to save countless lives, prevent suffering, and reduce health care costs.

            Patient Safety Tools are used to assess patient safety needs. Hospitals are working to promote the successful implementation of over 30 developed safety tools.

            Guide to Reduce Readmissions synthesizes the underlying strategies from interventions that have been successful in reducing unplanned readmissions.

            HRET Disparities Tool Kit provides information and resources for systematically collecting race, ethnicity, and primary language data from patients (HRET, 2010).

 

Promoting Safety

Hospitals are urged to promote a culture of safety; however, despite hospitals' best efforts, major quality and safety problems remain. Persistence of serious quality and safety issues are not just an American problem: It is a global problem that no system has figured out how to solve entirely, and probably never will. Improvements can be made through a committed effort and the establishment of a culture of safety that will focus on preventable injuries, infections, and deaths; reduction of malpractice lawsuits; and a consequent overall reduction in costs.

 

While the total elimination the safety problems will never occur, high-reliability health organizations manage serious hazards extremely well by the interjection of operating and management principles and employment of HRET safety tools. All applied safety cultures must contain the promotion of trust and a procedure for reporting adverse occurrences and near misses as key to a focus on continued safety improvement. Governance should set the tone by making quality of and safety within the organization a priority, with discussions of and learning from adverse events and close calls.

 

Cultural Competency

A key component of the 2010 Health Reform Bill is increased access to health care for 32 million more underinsured and uninsured people. In the past, health care access for many of these people meant being seen and treated in the safety-net of public hospital emergency rooms.

This population has been verified by government sources as disproportionately comprised of racial and ethnic minorities and the recently unemployed. A retired hospital administrator has noted that "there are health care disparities in serving that population. Having been a part of this dilemma, I know that some hospitals have made great strides in cultural competency. More remains to be done, particularly in assuring that minorities are members of health care organizations, including both management and governance. In so doing, it provides a diversity of experience that leadership teams need, and it will allow our patients, our employees, and the communities we serve to increase the inclusiveness." (B. Dickens, personal communication, June, 2010)

 

Conclusion

Future health care industry challenges will involve greater emphasis on delivery systems that promote patient safety and payment reforms, that is, value and efficiency over volume, and that control health spending more effectively than merely cutting provider's payments. In the long run, cutting provider payments will undermine patient care. In the past, hospital management has fostered high occupancy rates under the mistaken belief that it will insure financial success. To the contrary, in the future the goal will not be to grow admissions, but to shrink admissions through programs that promote better health maintenance. In the new era of accountability, health care providers will be paid for patient outcomes. Finally, physician integration with hospital operations should improve operational effectiveness.

 

References

Health Research and Educational Trust (HRET). (2010). AHA Committee on Research (COR). Top research questions.Retrieved August 26, 2010, from http://www.hret.org/COR/index.shtml