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6.power_points_week_1_chapter_1-1.pptxChapter 1
THE CHANGING SCENE: ORGANIZATIONAL ADAPTATION AND SURVIVAL
Objectives
Describe the present healthcare environment
Examine megatrends in the environment.
Address organizational survival
Identify survival strategies
Examine phases of the organizational life cycle
Trends
Changes in client characteristics
Regulation of health care
Reimbursement patterns and mandates
Restructuring of healthcare organizations
Impact of technology
Ongoing social and ethical factors
Health Care Regulation
State licensure laws for facilities
State licensure laws for professions
State-mandated health care planning
State laws governing reimbursement and insurance
Health Care Regulation
Federal laws governing reimbursement
Federal laws regarding privacy and security of information
Patient Protection and Affordable Care Act
American Recovery and Reinvestment Act
Reimbursement and Payment
Charitable roots and the not-for-profit model
Fee-for-service
Health insurance: non-profit and commercial
Managed care
Current legislation: health care reform
The Managed Care Era
Providing access to quality care at affordable cost.
Primary care physician as “gatekeeper”.
Premium costs by limits on services.
Arrangements between managed care group and hospitals.
Issues about denial of service or payment
Capitation
Reimbursement system under which provider is paid specific amount of money to look after all the health care needs of a given population.
Literally, it is reimbursement based on so much per head.
Reasons for Restructuring
Desire to achieve greater negotiating clout
Desire to penetrate new markets
Need for improved efficiencies
Desire to express an overall value of promoting comprehensive, readily accessible care
Mergers and Affiliations
MERGER: two or more corporate entities blend to create one new organization.
AFFILIATION: formal agreement between facilities to coordinate and share activities while remaining separate corporate entities.
The Virtual Enterprise
…is the result of available technology
Consists of a relatively temporary partnership of independent companies or individuals
Is readily adaptable to user needs and demands
Has heavy utilization of outsourcing and contractual arrangements
Impact of Technology
“eVisits” and “digital doctor”
Translational medicine
Data Warehousing
Data Mining
“real-time” interventions
Common language and standards: standard vocabulary and classification systems
National information infrastructure: to capture, access, use, exchange, and store data.
Two Key Threats to Survival:
lack of strong, formal leadership *
Competition *
Lesser Threats:
too rapid change either internal or external
shifting client demand
high turnover rate
failure to accept survival as a legitimate purpose
Threats to Survival
Threats to Survival
Bureaucratic Imperialism
Cooptation: formal and informal
Hibernation and Adaptation
Organizational Survival Strategies
Bureaucratic Imperialism
An organization stakes out its “territory”
The organization seeks to expand its client base
Characterized by intense competition and conflict
Co-optation
FORMAL: symbols of authority and administrative burdens are shared but no substantial power is transferred.
INFORMAL: no change in administrative structure; no new positions created. Emphasis is on true power
Hibernation and Adaptation
HIBERNATION: passive form of adaptation to changing demands. The organization enters into a phase of retrenchment.
ADAPTATION: an active form of response to changing demands. The organization actively anticipates change, goals are adjusted and organizational restructuring occurs.
Modification of Original Goals
Goal Succession
Goal Expansion
Goal Multiplication
Organizational Life Cycle
Not a real cycle – Organizations can jump from one category to any other out of sequence.
Gestation
Youth
Middle Age
Old Age
Gestational Phase
predates formal organization, with strong impetus to become formal
strong and committed leadership and willing membership
strong identification with new organization
highly innovative period
self-selection process, free of formal resignation or separation from the organization.
Youth Phase
continued enthusiasm and idealism
creativity channeled toward organizing
strong camaraderie
intensification to become formal
new generation of workers who need orienting to the value system
Youth Phase
shift from charismatic to formal authority and leadership
need for formal and informal channels of communication
inevitable modification of original plans
concern for organizational survival
Middle Age Phase
highly bureaucratic
very stable
decision by precedent
increased number of traditions
periods of rejuvenation
Old Age Phase
intense concern for organizational survival
loss of clients resulting in further loss of resources
attention to alternate job placement for workers
formal closure proceedings
managers in a caretaker role
the paradox: expanded roles for some managers
