Working together to develop health services managers

The developing emphasis in health and social care on working across traditional boundaries will demand different approaches to staff development. If we are to retain the strengths of expertise in the enormous number of areas represented in health and social care we will need to develop better ways of understanding each other in order to work together more effectively. This paper focuses on some of the issues raised in management development programmes which have multiple objectives demanding educational and developmental support. The emphasis is on identification of issues which arise in collaboration amongst those delivering a programme when they come from the different backgrounds of training and development, personal development and higher education. Some of the issues raised in partnership working between commissioning and providing organisations are also considered.

The critical success factor approach to strategic alignment: seeking a trail from a health organization's goals to its management information infrastructure

The critical success factor (CSF) approach is a technique that will aid health administrators, planners and managers to identify, specify and sort among the most relevant and critical factors determining an organization's survival and success. Following a top-down management perspective, this paper discusses the CSF methodology as a strategic information management process comprising several important phases: (i) understanding the external factors such as the organization's industry, market and environment; (ii) achieving strong support and championship from top management; (iii) encouraging the proactive involvement of management and staff in generic CSF identification; (iv) educating and directing the participation of staff members in CSF verification and further refinement of generic CSFs into specific CSFs; and (v) aggregating, prioritizing and translating activity-related CSFs into organizational information requirements for the design of the organization's management information infrastructure. The implementation of this CSF approach is illustrated in the context of a British Columbia community hospital, with insights provided into key issues for future health researchers and practitioners.

Diversity leadership and organizational transformation: performance indicators for health services organizations

Health services organizations can follow a five-part process to reposition themselves through diversity leadership. The first part of the process, discovery, refers to the emerging awareness of racial and ethnic diversity as a significant strategic issue; the second part, assessment, refers to systematic review of the organization's racial and ethnic diversity climate; the third part, exploration, denotes systematic training initiatives to improve the health services organization's ability to effectively manage diversity; the fourth part, transformation, refers to fundamental changes in organizational practices that result in a culture in which racial and ethnic diversity is valued; and the final part, revitalization, refers to renewal and expansion of racial and ethnic diversity initiatives to reward change agents and to include additional identity groups among the health services organization's diversity initiatives. This article presents a series of behaviorally based performance indicators for each of the five parts of the diversity leadership process. Healthcare executives are encouraged to assess their organization's strategic positioning against best demonstrated practices, as represented by the performance indicators. A method for analyzing organizational performance against the diversity leadership indicators is outlined as are suggestions for future research.

Introducing clinical governance in an acute trust

The introduction of clinical governance is a major imperative for the NHS. This paper describes the initial actions taken in a large acute trust to prepare for the clinical governance process. While this description is particular to one trust, it is hoped that it offers some generalizable lessons.

Succeeding beyond the Year 2000: how to rise to the challenges of the new millennium. Interview by Jill L. Sherer

Are you ready to take your organization into the 21st century? Do you fully grasp the implications of current and emerging trends in the field? Healthcare Executive talked with six healthcare experts and asked them what they saw as the greatest challenge for both executives and their organizations in the new millennium. Although the experts' opinions vary, their responses emphasize the importance of repairing old relationships and building new partnerships between those working in healthcare organizations, as well as bringing a consumer focus back to healthcare delivery.

Quality and accreditation in nephrology. The Italian perspective. Management and quality control

The economic approach of the industrial and commercial sector cannot be transferred to the medical one without proper measures. The final objective of the health service is not to gain profits but rather to achieve results in terms of health. Professional quality and, therefore, appropriateness becomes the foundation for proper management. In turn, appropriateness means to do the right things when they are useful regarding both the organisational, administrative, educational and training aspects and the medical ones. Management control is the right answer to this challenge to know and monitor consumption, strategies and results in relation to preestablished administration health policy objectives. Its purpose is to allow the organisation to carry out its objectives with the highest effectiveness and efficiency possible and it is joined with technical-professional elements which orient and support management in a logic of total quality. The adoption of the process of management control does not mean to turn doctors into managers. It must be hoped that doctors will understand the economic implications of the decisions made at clinical level as well as the technical-organisational ones. A medical action becomes effective if it is part of a system in which each person involved carries out his duties in an integrated logic where relationships are clearly defined. To decide what is appropriate, one refers to what is known and proven. It is clear that the problem of quality must be faced firmly and systematically. The activation of a quality program is not only based on the definition of "good practice", in terms of procedures, protocols, pathways and reference parameters for measuring quality but rather on the introduction of clinical methods that can guarantee a series of highly important opportunities.

A conceptual framework for the analysis of health care organizations' performance

Organizational performance remains an elusive concept despite its importance to health care organizations' (HCOs') management and analysis. This paper uses Parsons' social system action theory to develop a comprehensive theoretically grounded framework by which to overcome the current fragmented approach to HCO performance management. The Parsonian perspective focuses on four fundamental functions that an HCO needs to ensure its survival. Organizational performance is determined by the dynamic equilibrium resulting from the continual interaction of, and interchange among, these four functions. The alignment interchanges allow the creation of bridges between traditional models of organizational performance that are usually used as independent and competing models. The attraction of the Parsonian model lies in its capacity to: (1) embody the various dominant models of organizational performance; (2) present a strong integrative framework in which the complementarity of various HCO performance perspectives are well integrated while their specificity is still well preserved; and (3) enrich the performance concept by making visible several dimensions of HCO performance that are usually neglected. A secondary objective of this paper is to lay the foundation for an integrative process of arbitration among competing indicators and perspectives which is absolutely necessary to make operational the Parsonian model of HCO performance. In this matter, we make reference to the theory of communicative action elaborated by Habermas. It offers, we think, a challenging and refreshing perspective on how to manage HCO performance evaluation processes.

A review of organizational performance assessment in health care

As health care organizations look for ways to ensure cost-effective, high quality service delivery while still meeting patient needs, organizational performance assessment (OPA) is useful in focusing improvement efforts. In addition, organizational performance assessment is essential for ongoing management decision-making, operational effectiveness and strategy formulation. In this paper, the roles and impact of OPA models in use in health care are reviewed, and areas of potential abuse, such as myopia, tunnel vision and gaming, are identified. The review shows that most existing OPA models were developed primarily as sources of information for purchasers or consumers, or to enable providers to identify areas for improvement. However, there was little conclusive evidence evaluating their impact. This review of existing OPA models enabled the establishment of principles for the development, implementation and prevention of abuse of OPA specific to health care. The OPA models currently in use in health care may provide managers with false confidence in their ability to monitor organizational performance. To further enhance the field of OPA, areas for future research are identified.

Rolling out the red carpet

Legions of lawyers, consultants and accountants are pulling in the big bucks helping providers stay on the right side of government regulations. Compliance is the trendiest buzzword in healthcare today, and it's creating some lucrative business opportunities. Compliance officers, like Roy Snell (left) of University of Wisconsin Medical Foundation, ride herd to make sure healthcare companies stay within the lines.

Formulating a risk management strategy

In order to approach the process of healthcare risk management systematically, it is helpful to think in terms of the following four-step model for risk management:

Why a traditional health outcomes approach will fail in health care and a possible solution

This paper challenges the assumption that improved knowledge of health outcomes and their causation will lead to more rational decision-making, resulting in improved care at lower costs. The assumption implies that the health system completely controls all those functions, factors and initiatives that can affect the implementation of the standard. These include policies, procedures, applications of techniques, skill mix of staff, inter-team interaction, communication systems, education, and so on. Changes in policy do not automatically mean a change in practice. Implementation is often approached in a manner that is perceived by staff as punitive, focusing on changing the individual rather than the system in which they work. Not only is this approach opposite to basic total quality management principles, but it also fails to acknowledge that most of the improvements arising from the health outcomes approach are a result of staff being prepared to continuously work harder, often ignoring the 'system', to maintain their high standard. However, continuing deterioration in the system in which they work sets the scene for an accident or incident to occur. The answer lies in revisiting the traditional quality assurance cycle and acknowledging that health care has never been able to effectively 'close the feedback loop', that is, the health system is continuously increasing the sophistication of data collection techniques without giving equal consideration to what needs to be done to ensure effective implementation and evaluation. This paper outlines how Campbelltown Health Service directly addressed this issue through its process of achieving international certification to ISO 9002:1994.