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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, [email protected]
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
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.
32