The Well-Managed Healthcare Organization 9th Edition by Griffith.

Section I Introduction and Overview Chapter 1. Foundations of Well-Managed Healthcare Organizations ..3 Chapter 2. Creating and Sustaining a Transformational Culture........35 Chapter 3. Building Continuous Improvement.................................63 Chapter 4. Establishing Strategic Governance ...................................99 Section II Clinical Excellence Chapter 5. Foundations of Clinical Excellence ................................139 Chapter 6. The Clinical Staff Organization .....................................173 Chapter 7. Nursing.........................................................................209 Chapter 8. Clinical Support Services...............................................241 Chapter 9. Population Health.........................................................273 Section III Logistic and Strategic Support Chapter 10. Knowledge Management...............................................307 Chapter 11. Human Resources.........................................................337 Chapter 12. Environment of Care ....................................................369 Chapter 13. Financial Management ..................................................401 Chapter 14. Internal Consulting.......................................................439 Chapter 15. Marketing and Strategy .................................................471 Glossary .................................................................................................507 Index.....................................................................................................515 About the Authors ..................................................................................557 v DETAILED CONTENTS Preface....................................................................................................xvii Section I Introduction and Overview Chapter 1. Foundations of Well-Managed Healthcare Organizations ..3 Purpose: Mission of Healthcare Organizations ..................4 Defining Excellence............................................................5 Excellence in Patient Care..............................................5 Excellence in Population Health.....................................6 Sources for The Well-Managed Healthcare Organization.6 Team Structure of Twenty-First-Century Care...................7 Clinical Teams—Interprofessional Care and Clinical Support.....................................................................7 Clinical Support Teams ..................................................9 Logistic and Strategic Teams..........................................9 Current Trends............................................................10 Stakeholders....................................................................10 Patients and Families....................................................11 Associates.....................................................................12 Other Customer Partners.............................................12 Other Provider Partners...............................................15 Stakeholder Influence: Networking, Coalition Building, and Legal Controls..................................................15 The Healthcare Marketplace............................................16 The Origin and Development of HCOs.......................16 The Current American Marketplace..............................17 The Hospital Sector.....................................................18 Physician and Other Health Services.............................20 Post-Acute and Specialty Care......................................20 Other Sectors of the Healthcare Economy ...................21 Achieving Excellence in HCOs........................................21 vii Detailed Contents viii Transformational Culture .............................................22 Continuous Improvement............................................23 Commitment to Evidence ............................................23 Leaders ........................................................................24 The Role of Strategic Teams ........................................25 Managing and Leading Excellent Healthcare Organizations.............................................................25 Reducing Variation in Healthcare Organization Performance ............................................................26 Meeting the Needs of Clinical Care Teams...................27 Supporting Continuous Improvement..........................28 Practice Applications .......................................................29 Notes..............................................................................30 Chapter 2. Creating and Sustaining a Transformational Culture........35 Purpose...........................................................................36 Functions........................................................................37 Empower HCO Associates...........................................37 Promote Service Excellence..........................................39 Communicate...............................................................43 Define and Model Values..............................................46 Reward-Associated Contribution..................................48 Protect HCO Assets.....................................................50 Improve Continuously .................................................53 People.............................................................................53 Measures.........................................................................55 Managerial Leadership.....................................................56 Explaining the Culture.................................................57 Practice Applications .......................................................59 Notes..............................................................................60 Chapter 3. Building Continuous Improvement.................................63 Purpose...........................................................................64 Functions........................................................................64 Monitor Stakeholder Needs and Identify Responsive Goals.......................................................................66 Provide Evidence-Based Information............................68 Long- and Short-Term Forecasts..................................74 Coordinated Goals, Logistics, and Support: The Annual Planning Calendar...................................................78 Design Corporate Structure .........................................79 Detailed Contents ix Support HCO-wide Process Analysis............................83 Improve Continuously..................................................88 People.............................................................................89 Measures.........................................................................90 Managerial Leadership.....................................................92 Making the Case for Continuous Improvement............92 Enhancing Transformational Culture and Continuous Improvement...........................................................93 Practice Applications .......................................................95 Additional Resources.......................................................96 Notes..............................................................................97 Chapter 4. Establishing Strategic Governance ...................................99 Purpose.........................................................................100 Functions......................................................................101 Maintain Leadership Capability...................................103 Establish the Mission, Vision, and Values ...................105 Ensure Quality of Clinical Care..................................105 Approve the Corporate Strategy and Annual Implementation.....................................................107 Monitor Performance Against Plans and Budgets.......111 Improve Continuously................................................113 People...........................................................................114 Board Membership.....................................................114 Membership Qualifications.........................................117 Board Selection..........................................................119 Board Organization....................................................121 Education and Information Support for Board Members...............................................................127 Measures.......................................................................128 Managerial Leadership...................................................128 Operating Discipline...................................................128 Legal and Ethical Issues of Board Membership...........130 Practice Applications......................................................132 Additional Resources.....................................................132 Notes............................................................................133 Section II Clinical Excellence Chapter 5. Foundations of Clinical Excellence ................................139 Purpose.........................................................................140 Detailed Contents x Functions......................................................................141 Ensure Accurate Diagnosis.........................................141 Provide Excellent Care...............................................145 Individualize Patient Care Planning and Treatment....153 Improve Community Health......................................155 Improve Clinical Performance....................................156 People...........................................................................157 Building an Engaged Workforce.................................157 Organizing Clinical Units...........................................158 Interprofessional Conflicts..........................................159 Measures.......................................................................160 Scorecards for Clinical Services...................................160 Value-Based Purchasing..............................................163 Managerial Leadership...................................................164 Sustaining the Platform of IPOCs, Guidelines, and Protocols...............................................................164 Sustaining a Culture of Teamwork and Respect..........165 Maintaining Continuous Clinical Improvement..........166 Practice Applications......................................................167 Additional Resources.....................................................168 Notes............................................................................168 Chapter 6. The Clinical Staff Organization......................................173 Purpose.........................................................................174 Functions......................................................................175 Achieve Excellent Care...............................................175 Review Credentials and Recommend Privileges...........179 Determine, and Recruit for, Clinical Staff Need..........186 Provide Clinical Education.........................................191 Negotiate Compensation Arrangements.....................193 Improve Continuously................................................195 People...........................................................................197 Clinical Staff Organization..........................................198 Clinical Staff Leadership.............................................199 Measures.......................................................................199 Managerial Leadership...................................................200 Building Supportive Relationships..............................200 Representing Clinical Staff on the Governing Board...202 Ensuring Adequate Clinical Staff Supply.....................203 Practice Applications......................................................203 Additional Resources.....................................................204 Notes............................................................................204 Detailed Contents xi Chapter 7. Nursing.........................................................................209 Purpose.........................................................................210 Functions......................................................................211 Deliver Excellent Care................................................211 Coordinate Interprofessional Care..............................217 Educate Patients, Families, and Communities.............219 Maintain the Nursing Organization............................220 Improve Continuously................................................223 People...........................................................................225 Team Members..........................................................225 Organization..............................................................230 Measures.......................................................................231 Managerial Leadership...................................................233 Sustaining the Nurse Supply.......................................233 Providing Adequate Training .....................................234 Supporting Empowerment.........................................234 Delivering Continuous Improvement.........................235 Practice Applications .....................................................235 Additional Resources.....................................................236 Notes............................................................................236 Chapter 8. Clinical Support Services...............................................241 Purpose.........................................................................242 Functions......................................................................243 Provide Excellent Care...............................................243 Maintain Patient Relationships....................................245 Maintain Consultative Relationships...........................247 Plan and Manage Operations......................................249 Improve Continuously................................................253 People...........................................................................260 Team Members..........................................................260 CSS Leadership..........................................................261 The HCO Manager....................................................261 Organization..............................................................262 HCO–CSS Relationships............................................263 Measures.......................................................................263 Managerial Leadership...................................................265 Should the HCO Offer the Service?...........................266 How Big Should the CSS Be?.....................................266 What Are the Continuous Improvement Goals the CSS Should Meet?.................................................267 Detailed Contents xii What Is the Best Contractual Form for the HCO–CSS Relationship?..........................................................267 Does the CSS Have the Coordination It Needs?.........268 Are CSS Activities Correctly Assigned to Professional and Nonprofessional Associates?.............................268 What Are the Longer-Term Trends and Implications for the CSS?...........................................................269 Practice Applications .....................................................270 Additional Resources.....................................................271 Notes............................................................................271 Chapter 9. Population Health.........................................................273 Purpose.........................................................................274 Functions......................................................................276 Quantify Population Health Needs.............................277 Establish a Population Health Strategy.......................284 Operationalize a Population Health Strategy ..............290 Improve Continuously ...............................................292 People...........................................................................292 Measures.......................................................................294 Operational................................................................294 Strategic.....................................................................294 Managerial Leadership...................................................295 Promote and Teach Population Health.......................296 Extend Management Concepts to Population Health Care Teams............................................................297 Expand and Integrate Primary Care............................298 Maintain the Infrastructure for Population Health .....299 Manage the Impact of Population Health on Acute Care Services.........................................................300 Practice Applications .....................................................300 Additional Resources.....................................................301 Notes............................................................................302 Section III Logistic and Strategic Support Chapter 10. Knowledge Management...............................................307 Purpose.........................................................................308 Functions......................................................................309 Provide Prompt and Useful Access to Management Information...........................................................310 The EHR and “Meaningful Use”...............................314 Detailed Contents xiii Ensure the Reliability and Validity of Data..................316 Maintain Communications and Software Support.......320 Ensure the Appropriate Use and Security of Data.......321 Improve Continuously................................................324 People...........................................................................326 Chief Information Officer...........................................326 KM Planning Committee............................................327 Organization..............................................................327 Measures.......................................................................327 Managerial Leadership...................................................328 Achieving an Effective Knowledge Management Planning Committee..............................................328 Expanding the Use of the EHR and Clinical Data......331 Practice Applications......................................................332 Additional Resources.....................................................333 Notes............................................................................333 Chapter 11. Human Resources.........................................................337 Purpose.........................................................................338 Functions......................................................................339 Plan Workforce Needs................................................341 Develop Workforce Contribution................................341 Provide Workforce Services.........................................348 Manage Compensation and Benefits...........................350 Conduct Collective Bargaining...................................358 Improve Continuously................................................359 People...........................................................................359 Human Resources Professionals .................................359 Organization of the Human Resources Department...360 Measures.......................................................................361 Managerial Leadership...................................................363 Associates’ Perceptions...............................................363 Adequate Human Resources Funding.........................364 Consistent Leadership ................................................364 Practice Applications......................................................365 Additional Resources.....................................................366 Notes............................................................................366 Chapter 12. Environment of Care.....................................................369 Purpose.........................................................................370 Functions......................................................................370 Design and Plan Facilities and Allocate Space .............370 Detailed Contents xiv Maintain Facilities and Provide Guest Services............376 Comply with Regulatory and Safety Requirements.....381 Manage Supply Chain and End-User Satisfaction .......384 Plan for Emergency and Disaster Response.................386 Improve Continuously................................................388 People...........................................................................389 Leadership and Professional Personnel........................389 Outside Contractors...................................................390 Training .....................................................................391 Incentives and Rewards..............................................391 Organization..............................................................391 Measures.......................................................................392 Resource Consumption and Effectiveness...................393 Quality.......................................................................393 Managerial Leadership...................................................394 Facilities Planning and Space Allocation......................395 Selection and Management of Outsourcing Contracts...............................................................396 Integration of Environmental Services with Other Activities................................................................397 Practice Applications......................................................397 Additional Resources.....................................................398 Notes............................................................................399 Chapter 13. Financial Management...................................................401 Purpose.........................................................................402 Functions......................................................................402 Record and Report Transactions That Change the Value of the Firm...................................................402 Assist Operations in Setting and Achieving Performance Improvements...................................407 Manage Future Financial Status..................................411 Manage Cash, Financing, and Debt............................418 Protect Corporate Assets Against Loss, Distortion, or Conversion............................................................423 Improve Continuously................................................427 People...........................................................................427 Chief Financial Officer ...............................................427 Other Professional Personnel......................................428 Organization of the Finance System ...........................428 Measures.......................................................................430 Detailed Contents xv Quantitative Performance Measures ...........................430 Subjective Quality Assessment....................................430 Managerial Leadership...................................................432 Supporting an Atmosphere of Honesty and Transparency..........................................................432 Maintaining a Collegial, Supportive Culture...............433 Continuously Improving Finance................................433 Practice Applications......................................................436 Additional Resources.....................................................436 Notes............................................................................437 Chapter 14. Internal Consulting.......................................................439 Purpose.........................................................................440 Functions......................................................................440 Support the Organization as a Whole.........................443 Support Process Improvement Teams.........................452 Support Routine Capital Investment Requests............455 Implement and Integrate Recommendations..............461 Improve Continuously................................................461 People...........................................................................462 Internal Consulting Team Members...........................462 Organization..............................................................462 Measures.......................................................................463 Managerial Leadership...................................................465 Sustaining Continuous Improvement and the Effectiveness of PITs..............................................465 Ensuring Quality of Work...........................................467 Sizing Internal Consulting..........................................468 Practice Applications......................................................469 Additional Resources.....................................................470 Notes............................................................................470 Chapter 15. Marketing and Strategy..................................................471 Purpose.........................................................................472 Functions......................................................................473 Marketing Functions......................................................473 Identify and Segment Markets....................................475 Listen to Stakeholder Needs.......................................477 Develop Brand and Media Relations...........................480 Convince Potential Customers....................................482 Attract and Motivate Associates..................................484 Detailed Contents xvi Manage Collaborative and Competitive Stakeholder Relationships.........................................................485 Improve Marketing Continuously...............................488 Strategic Functions........................................................488 Maintain the Mission, Vision, and Values ...................489 Define the Strategic Position......................................489 Implement the Strategic Position................................495 Improve Continuously................................................495 People...........................................................................495 Associates...................................................................495 Organization..............................................................496 Measures.......................................................................497 Strategic Measures......................................................497 Operational Measures.................................................498 Establishing Strategic, Marketing, and Internal Consulting Expenditure Goals...............................499 Managerial Leadership...................................................500 Commitment to Respect.............................................501 Commitment to Strategic Listening............................501 Commitment to Fact..................................................502 Commitment to Excellence........................................503 Practice Applications......................................................503 Additional Resources.....................................................504 Notes............................................................................504 Glossary .................................................................................................507 Index .....................................................................................................515 About the Authors ..................................................................................557