Author(s): Genna R. Cohen, 2013

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COURSE MAP-WEEK 10

5 DOMAINS 10 METHODS

4 INFO.RESOURCES

EHRs (VistA)Elements & functions

of Info. SystemsHIT STANDARDS

time

i

iiSkill

Modules

Lectures 5 6

ON YOUR OWN

MANAGEMENT OF

HEALTHCARE

ORGANIZATIONS

HMP 668 –

SI 5

4 2 – B

IOI N

F 66 8

INTRODUCT IO

N TO H

EALTH

I NFORMAT I C

S

NOVEMBER 6, 2

0 13

Genna R. Cohen, HSOPgrcohen@umich.edu

BACKGROUND: WHO I AM PhD Candidate in Health Services Organization

and Policy School of Public Health Studying physician practices; HIT

Research Analyst at the Center for Studying Health System Change

Researched physician practices; HIT; health insurance Washington, DC

5

AGENDA: WHAT ARE WE GOING TO DO

1.Why Organizations?

2.Background about Healthcare Organizations

3.Management Issues in Healthcare Organizations

4.IT Issues and Healthcare Organizations

5.Methods of Studying Organizations

6

ARE ORGANIZATIONS IMPORTANT?

7

“Question Box” by Raymond Bryson

ARE HEALTH CARE ORGANIZATIONS UNIQUE?

Similarities to other human services organizations (ex: social work; advocacy; education)

1.Moral nature of work2.Atypical relationship with clients (like

students)

(Martin, Lassman, Washington, Catlin, & Team, 2012), (Hasenfeld, 1992), (Burns, Bradley, & Weiner, 2011).

8

ARE HEALTH CARE ORGANIZATIONS UNIQUE?

Differences from other human services organizations:

18% of 2010 GDP and growing – 2nd largest industry in the US!

Unique combination of attributes:1. Difficulty defining and measuring outcomes2. Variable and complex work3. Emergent and nondeferrable work4. Little tolerance for ambiguity or error5. Professional autonomy6. Organizations do not always employ their

members7. Interdependencies among staff

(Martin, Lassman, Washington, Catlin, & Team, 2012), (Hasenfeld, 1992), (Burns, Bradley, & Weiner, 2011).

9

US HEALTHCARE SYSTEM

10

Patient

Government

Provider

Insurer

Employer Patient

KEY CHARACTERISTICS OF HEALTH CARE PROVIDER ORGANIZATIONS

• Size• Affiliation with other organizations• Geographic location• Rural vs. Urban• Safety net status• Teaching status• Not-for-profit vs. For-profit (“investor-owned”) • Culture, leadership, payer mix

11

RELATIONSHIPS BETWEEN ORGANIZATIONS

3°

Medical Center

2° Community (District) Hospital

1° Health Center

Clinic

Slide courtesy of Rich Lichtenstein, 2010

12

BOUKUS, ELLYN, ALWYN CASSIL AND ANN S. O’MALLEY, A SNAPSHOT OF U.S. PHYSICIANS: KEY FINDINGS FROM THE 2008 HEALTH TRACKING PHYSICIAN SURVEY, DATA BULLETIN NO. 35, CENTER FOR STUDYING HEALTH SYSTEM CHANGE, WASHINGTON, D.C. (SEPTEMBER 2009). 13

Image Removed Due to Copyright

COMMUNITY HOSPITALS BY BED SIZE, 2008

51% of US hospitals are under 100 beds

Source: AHA Hospital Statistics, 200914

HOSPITAL-PHYSICIAN TRENDS 2000-2008

15

2000 2001 2002 2003 2004 2005 2006 2007 20080

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

Management Service Organi-zationCPHO

Employment

Independent Practice AssociationOpen Physician-Hospital Org

Source: American Hospital Association annual survey

AGENDA: WHAT ARE WE GOING TO DO

1.Why Organizations?

2.Background about Healthcare Organizations

3.Management Issues in Healthcare Organizations

4.IT Issues and Healthcare Organizations

5.Methods of Studying Organizations

16

1.Leadership and decision-making

17

MANAGEMENT ISSUES IN ORGANIZATIONS

• Autocratic• Bureaucratic• Charismatic• Democratic/ particip

ative• Laissez-faire

• People-oriented /relations-oriented

• Servant• Task-oriented• Transactional• Transformational

1.Leadership and decision-making2.Culture

Competing values around• Collaboration• Competition• Creation• Control

18

MANAGEMENT ISSUES IN ORGANIZATIONS

1.Leadership and decision-making2.Culture3.Integration/Relationship with Other Organizations

• Physician Organization: Multiple Practices• Physician-Hospital Organization: Hospitals + Physician Practices

• Integrated Delivery System: Health Plan + Providers

• ACOs

19

MANAGEMENT ISSUES IN ORGANIZATIONS

AGENDA: WHAT ARE WE GOING TO DO

1.Why Organizations?

2.Background about Healthcare Organizations

3.Management Issues in Healthcare Organizations

4.IT Issues and Healthcare Organizations

5.Methods of Studying Organizations

20

HEALTH CARE ORGANIZATIONS’ IT NEEDS

1.Operational (e.g., bill paying, medical history)

2.Planning (population management)3.Communication (handoffs)4.Documentation and reporting (joint

commission audits)5.Ability to use IT to transform and

innovate (ACOs/PCMH)

21

COMPETING IT PRIORITIES IN HCOS1.Clinical vs. administrative needs

Who is paying?Who is using?

2.Primary vs. secondary use

3.Current documentation care vs. future decision-making

4.HIPAA

22

Small

Suburban

Independent

Primary care

practice

Large

Urban

System

Hospital

23

TODAY, LET’S COMPARE…

•What are the IT priorities of these organizations?•What policy issues should they be concerned about•Who makes decisions? •How do you reach consensus?•What type of support do they have? •How does that affect the systems they buy?

Small Independent Suburban PCP

Vs

Large Urban Hospital System

24

COMPARE AND CONTRAST IT ISSUES…

AGENDA: WHAT ARE WE GOING TO DO

1.Why Organizations?

2.Background about Healthcare Organizations

3.Management Issues in Healthcare Organizations

4.IT Issues and Healthcare Organizations

5.Methods of Studying Organizations

25

HOW WE STUDY ORGANIZATIONS

26

Organization studies

Organizational Theory (Macro)

Organizational Behavior

(Micro)

WHAT DO WE WANT TO KNOW ABOUT ORGANIZATIONS?

O R G A N I Z A T I O N T H E O R Y

•Why don’t all organizations look the same?•Can organizations change, or must new ones replace ineffective ones?

O R G A N I Z A T I O N B E H A V I O R

•How do you motivate people in organizations?•What makes a good leader? What are the impacts of good leadership?

27

HOW DO WE ANSWER THESE QUESTIONS?

1.Surveys Who do you survey? More than one person per

organization? Same person multiple times?

28

HOW DO WE ANSWER THESE QUESTIONS?

1.Surveys

2.Interviews and site visits How do you select cases? What type of information are you

recording?

29

HOW DO WE ANSWER THESE QUESTIONS?

1.Surveys

2.Interviews and site visits

3.Linking together secondary datasets

Analyzing publicly available information – CEOs, boards of directors, stockholder reports

Market share and other performance metrics

What organizations are left out of this approach? 30

THANK YO

U!

QUEST IONS ?

Genna R. Cohen, HSOPgrcohen@umich.edu

IMAGE ATTRIBUTIONS• “Question Box” by Raymond Bryson is under a Creative Commons license CC BY 2.0. • “Pharmacy mortar and pestle 2” by J_Alves is in the Public Domain. • “Wood Table” by ozerkavak is in the Public Domain. • “Woman Doctor” by Gerald_G is in the Public Domain. • “PC back” by yyycatch is in the Public Domain. • “PC front” by yyycatch is in the Public Domain. • “Doctor” by moself is in the Public Domain. • “After the stroke” by moini is in the Public Domain. • “Thomasville Medical Center” by Novant Health is under a Creative Commons license CC BY-SA 3.0. • “Alaska Anchorage Community Hospital 1972 01” by Piergiuliano Chesi is under a Creative Commons

license CC BY 3.0. • “VSU Health Center” by Jadvii is under a Creative Commons license CC BY 3.0. • “Dzhida (Clinic) by Аркадий Зарубин is under a Creative Commons license CC BY-SA 3.0. • “Balance Scale” by Gerald_G is in the Public Domain. • “Pear” by matou is in the Public Domain. • “apple” by matou is in the Public Domain.

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