0
Q
Resource Distribution
A
Views Org as source of largesse and the Governing Board as a body to distribute resources… Political
1
Q
Board
A
to create and maintain a foundation for relationships among the stakeholders that it’s and implements their wishes as effectively as possible.
Legally responsible for ensuring the quality of medical care.
5 obligations-
- Approve medical staff by laws
- Appoint medical executives at all levels
- Approve plan for medical staff recruitment and development, a part of the long range plans
- Approve appointments and reappointments of individual physicians, after a review according to the by laws
- Approve contracts with physicians and physician org’s
2
Q
Resource Contribution
A
Board Members are contributors of resources to Org. Emphasizes funds or services board members may donate or,the influence they can bring to bear on critical external relations.
3
Q
Long-Range Financial Plan
A
An ongoing projection of financial position showing earnings, debt, and capitalization for at least the next seven years. The plan integrates the strategic business plans and tests their reality.
Generates a cash need for each year.
Identifies immediate financial needs.
4
Q
Referents for goal setting.
A
- TRENDS: Last years value, or a time series of several years, provides an initial baseline and allows judgement on the direction of the measure.
- COMPETITOR AND INDUSTRY COMPARISONS: what other organizations are achieving provides crude guidelines, even if the available information is not strictly from competitors.
- BENCHMARKS:
- VALUES
5
Q
4 monitoring functions of Board-
A
1- routine surveillance of performance data
2- acceptance of reports from Auditors, Accreditors, and other external agencies… The management letter is an audit of the internal auditor and the board’s ultimate protection against misrepresentation, fraud, or misappropriation of funds.
3- approval of major contracts and transactions
6
Q
Nat’l Committee for Quality Assurance
A
Accredits health insurance plans AND physician org’s
7
Q
Board- 6 Functions
A
- Maintain management capability
- Establish the MVV
- Approve corporate strategy and annual implementation
- Ensure quality and appropriate medical care
- Monitor organizational performance
- Continuously improve board performance
8
Q
5 functions of an HCO
A
- Ensuring accurate dx
- Ensuring excellent care- safe, effective, patient-centered, timely, efficient, and equitable
- Individualizing patient care planning and treatment
- Improving community health
- Improving clinical performance
9
Q
Clinical protocols- Advantages
.
A
- Make cooperation possible and are nec to allow any level of sophisticated teamwork
- Provide basis for assessing and monitoring clinical performance
- Convenient statement in contracts w patients and insurers.
10
Q
Functional protocol
A
Procedures and sets of activities to carry out elements of care.
Usually written, but carried out from memory.
Most failures (falls, infections, wrong site surgeries) trace to incomplete, inaccurate, or overlooked fxnl protocols.
Stable over time.
11
Q
Functional protocols contain
A
Authorization- who may perform the procedure
Indication- clinical conditions that support
Contraindications- conditions where protocol must be modified, replaced or avoided
Req’d supplies, equip, and conditions
Actions- clear, step-by-step
Recording- instructions for recording procedure and patient responses/reaction
Follow-up-
12
Q
Patient Management Protocols
A
Aka- pathways, guidelines
Define N steps/processes in care of a clinically related group of patients.
Organized around episodes of pt care, classified by sx, disease or condition (e.g. Chest pain)
Specify the fxnl components of care, outcomes and quality goals.
13
Q
AHRQ
A
Agency for a healthcare Research and Quality
- nat’l Quality Measures Clearinghouse
14
Q
Managerial issues revolving around clinical performance:
A
- Sustaining a Culture of Teamwork and Respect
- Credentialing and Ensuring Continued Competence
- Minimizing and Responding to Unexpected Clinical Events
- Resolving Interprofessional Rivalries
15
Q
Physician Supply Plan
A
Allows HCO to I’d community needs and move to meet them in a timely manner. It also allows the HCO to protect the income of effective practitioners.
The medical staff plan protects physicians against new competitors, because the HCO will,decline privileges to applicants exceeding the planned numbers. If physicians were to do this themselves, it would be collusion in restraint of trade, a violation of antitrust law. Because of this, although the medical staff comment should be solicited on the plan, approval must rest with the governing board.
16
Q
Physician Organization- 6 functions
A
- Achieve excellent care
- Credential and delineate privileges
- Plan and implement physician recruitment
- Provide clinical education for physicians and other professionals
- Communicate and resolve unmet needs
- Negotiate and maintain compensation arrangements
17
Q
Elements of Privelege
A
- Bylaws
- Privileges
- Independent physician-patient relationship
- Continuous quality improvement and peer review
18
Q
Healthcare Quality Improvement Act, 1986
A
The Health Care Quality Improvement Act of 1986 is, ostensibly, meant to protect the public from incompetent physicians by allowing those physicians on peer review committees to communicate in an open and honest environment and thus weed out incompetent physicians, without the specter of a retaliatory lawsuit by the reviewed physician.
However, the consequences of the Act have instead helped promote an environment that protects those physicians on a peer review committee when they distort the review process for their own gain, by maliciously disciplining those physicians that may be in political or economic competition.
19
Q
Future Need for Physicians- Modeling
A
Model 1- applied to each specialty of the physician org. the services provided per physician year can be estimated from history. Physicians involved are surveyed about their work intentions, such as retirements, leaves, and plans to change their HCO affiliation. The survey can improve the forecast of services provided as well as provide a forecast of physicians available.
Works well w major clinical events (Ns) it is impractical for Primary Care.
Model 2- still requires survey of physician intentions. It’s weakness is the standard, which may or may not be reliable for the future in a specific community.
20
Q
Accreditation Council for Graduate Medical Education (ACGME)
A
ContentbformeducationnofmResidents/Fellows/House Officers
21
Q
ACGME- 6 General Competencies of Physicians
A
- Patient Care
- Medical Knowledge
- Practice-based learning and improvement
- Interpersonal and communication skills
- Professionalism
- Systems-based Practice
22
Q
NIC-as part of nursing PoC
A
Nursing Interventions Classification- plan for nursing interventions
23
Q
NOC- as part of Nursing PoC
A
Nursing Outcomes Classification, clinical outcomes
24
NANDA
North American Nursing Dx Association
25
Long-Term Contract w Separately Owned Corp
An independent corp owns facilities, employs associates, and sells services to the HCO. THE CONTRACT SHOULD SPECIFY AS CLEARLY AS POSSIBLE the obligations and intentions to both parties.
It is difficult to incorporate standards for effectiveness or to prevent the contractor from competing as an independent org.
26
Joint venture corp
The HCO gains partial strategic control and can include explicit reserved powers and super majority rules that gain control of size, location, clinical privileges, and management appointments. The corp,can purchase services from the HCO. The principle advantages relate to capital.
27
HITSP
Health Information Technology Panel
A public-private to enable and support widespread interoperability among healthcare software applications
28
National e-Health Collaboration
A public-private partnership driving the grassroots development of a secure interoperable, nationwide HIS
29
Specification
A statistical analysis that identifies values for a measure by defined subsets of the population, to measure the extent to which the values change across the sets.
Specification and adjustment allow apples-to-apples comparison; important in many clinical measures.
E.g. Low birthweight babies by socioeconomic class.
30
Adjustment
A statistical technique using specification to remove variation caused by differences in the relative size of subset populations.
Specification and adjustment allow apples-to-apples comparison; important in many clinical measures.
Recalculate the whole population rate from the specific rates, standardizing the characteristics of a single population. E.g. Age-adjusted rate for each state if its population had the same age distribution as the nations.
Common in clinical measures of cost and quality.
31
Deming's special causes
Factors that are unique and may not recur- not worth investigating.
32
Deming's common cause
A significant variation that should be investigated.
33
Standard Deviation
Used to compare two individual values
34
Standard Error
Used to compare two samples with several individual values in each.
35
5 Functions of Knowledge Management
1. Ensuring the reliability and validity of data
2. Maintaining communications for daily operations
3. Supporting information retrieval for continuous improvement
4. Ensuring the appropriate use and security of data
5. Improving knowledge management services continuously
36
HR Functions
1. Workforce planning
2. Workforce development
3. Workforce maintenance
4. Empowerment, transformation, and service excellence
5. Compensation and benefits management
6. Collective bargaining
7. Continuous improvement
37
Core files of HRM knowledge management
1. Position control enter
2. Personnel record
3. Workforce plan
4. Succession plan
5. Payroll
6. Employee satisfaction
7. Training schedules and participation
8. Benefit selection and utilization
38
Position control
Protects only against paying the wrong person, hiring in violation of establish policies, and issuing fraudulent checks. It is not protect against overspending the labor budget.
39
Fair compensation should meet three general criteria
1. Compensation should equal long-run economic opportunities for similar positions elsewhere
2. Compensation should reflect actual contribution to the healthcare organizations strategic goals
3. Compensation should encourage professional growth and fulfillment consistent with organizational needs
40
Functions of environment of care services
1. facilities design, planning and space allocation
2. facilities maintenance
3. guest services
4. materials management services 5. enhanced environmental management
6. performance improvement and budgeting
41
Annual hospital construction expenditure should be...
10% of total operating costs
42
Transfer price
Computed cost revenue for a good or service transferred between two units of the same organization, such as housekeeping services providing two nursing units
Transfer pricing history important advantages: return number one the cost of the unit cost of producing the service can be benchmarked, improving the producing units goalsetting return number two unit cost to be compared to competing alternatives, such as purchasing instead of making the service for centralizing producers for efficiency return number three the consuming in a conventual the volume of service used to establish a OFI to optimize the quantity of service. Parentheses note that at the optimum service is going to best fulfills the users mission, but this is really the least expensive. And parentheses
43
Revenue transactions
Those that provide elements of care to patients or other services such as meals to families.
Revenue transactions record virtually all of the HCO's routine cash acquisition, except gifts loans and sales of assets.
44
Expense transactions
Those that acquire resources such as personnel, supplies and equipment.
Expense transactions describe all commitments to pay cash. Cost ledgers are organized by type of resource (e.g., labor, supplies)
45
Physical transactions
Patient days of care hours work and drugs used. Generally captured by the information system.
46
Three main functions of the finance system
1. controllership
2. financial management
3. Auditing
47
Controllership
1. transaction accounting
1. financial accounting
3. managerial accounting
4. goal setting and budgeting
48
Financial management
1. financial planning
2. price clinical services
3. financial structures
4. securing a managing liquid assets
5. managing multi corporate accounting
49
General ledger
Technically, the record of all the firms transaction; the term often refers to the fixed and collective assets, such as depreciation, that must be allocated to operational units.
General ledger entries assign capital cost of depreciation of long-term assets, I just inventory values, and allocate expenses of central services. The 10th reflect resources that are shared by the organization as a whole rather than by individual accountability centers and attend to deal with resources that last considerably longer than one budget for financial cycle.
50
Financial accounting
Fulfills a direct obligation to the owners, creditors, and the public. It assembles and transactions to stay as accurately as possible the position of the institution as a hole in terms of the value of its assets, the equity residual to its owners, and a change in value occurring each accounting.
51
Four reports that are standard for HCO's and most other nongovernmental enterprises are:
1 balance sheet
2 income or profit and loss statement
3 statement of sources and uses of funds
4 statement of changes in fund balances
52
IRS form 990
As a 2009 at the profit ratios have substantial obligation to report to financial activities through IRS form 990
Form become public information. It is intended to monitor the public's return for the privilege of tax exemption.
```
It requires reporting of:
1 income
2 profit
3 executive compensation
4 community benefit for parent corporations major subsidiaries and joint ventures
```
Community benefit is identified as charitable care, that's, Medicaid losses, community health activities, will education, and research.
Values reported on 990 are subject to a "reasonableness" test. IRS can eliminate HCO's tax exemption in whole or in part on the basis of values reported.
53
Not operating revenue
Income generated from non-patient care activities, including investments in securities and earnings from unrelated businesses. Also includes gifts.
54
Managerial accounting
Hey structures transaction data to support monitoring, planning, setting expectations, improving performance. Opposite to financial accounting is oriented to produce information for internal organization uses, line management decisions about revision, continuation, discontinuation of services and monitoring operational measures of costs, efficiency, and demand.
55
Activity-based costing
Provides the basis for make-or-buy decisions
1 show the resource elements of cost so that the producing unit or a performance improvement team can compare to benchmark and evaluate changes in the activity.
To provide a transfer price for internal transactions. The transfer price can be compared prices offer but still vendors. It also encourages the using unit to identify and control consumption.
3 encourage the producing unit to think of the purchasing units as customers whose needs must be met.
56
Managerial accounting reports
Identify the quantities and cost of resources consumed, the pricing mechanism (market priced, transfer price, or allocated), and the assigned transfer and allocated costs. Unit management can classify these cost is fixed variable or semi variable.
57
Operating Budget
The aggregate of accountability-center expenditure budgets and the corporate revenue budget.
Includes:
1. Accountability-unit budgets by kind of resource and reporting period- costs are negotiated w the other 5 dimensions of operational scorecards. The 6 dimensions comprise the unit goals for coming year.
2. Aggregate expenditures budgets ("roll ups") that summarize larger sections if the organization that parallel accountability hierarchy.
3. Revenue budgets that show expected income and profits for DRGs at Org levels that parallel payment aggregates- leading institutions report revenues only at aggregates that can be held accountable, now usually the service line.
58
Financial budget
Expectation of future financial performance: composed of:
1. income & expense budget- expected net income and expenses incurred by the org as a whole by period.
2. budgeted financial statements, cash flow budget- used by Finance in cash/debt management
3. capital and new programs budget.
59
Pro forma
A forecast of financial statements, establishing the future financial position of the organization for a given set of operating conditions or decisions.
60
Working Capital
The amount of cash rqr'd to support operations for the period of delay in collecting revenue.
Funds that are used to cover expenditures made in advance of payment for services.
61
Multiple Corporate Structures- Benefits
1. Capital Opportunities- large systems offer scale and diversification attractive to bond buyers
2. Reward- separate for-profit corporations allow various groups to invest in activities of interest to them and receive financial reward for the success of those activities. Joint subsidiaries can reward physicians for loyalty and quality.
3. Risk- the parent only risks those assets actually invested in the subsidiary.
4. Taxation- separate corporations can frequently be designed with a view toward minimizing the overall tax obligation.
62
Finance Committee of the Board
- assist in selection of CFO
- annually review the LRFP and recommend final version to the full board
- recommend the budget guidelines to the full board
- recommend pricing policies to the full board
- review the proposed annual budget, and recommended it to the full board
- set the final priorities, and recommend the capital and new programs budget to the board
- receive the monthly/quarterly report that compares operations to expectations.
- support the audit committee, super using both the internal and external audits
- review major capital expenditure and financing proposals
63
Internal consulting- purpose
To provide information, forecasts, tools, and analyses in support of evidence-based management
Establishes the facts; it's clients decide the HCOs future.
64
Internal Consulting- 5 Vehicles for helping clients:
1. Immediate Reply- short answer, brief discussion or short follow up messages
2. JIT support-training or a specific service, including calling on other logistic and support services. Be.g. HCOs electrical power mgr can consult on new equipment needs.
3. Designated team member-
4. Internal consulting project team- for a complex question, a team of internal experts can be assembled. Members can come from any part of the HCO. The team differs from the initial PIT- it is charges with fact finding; the PIT is charged with a recommendation
5. External consultants- the internal consulting mgr can help select, instruct and coordinate outside consultants
65
Internal Consulting- functions
1. Supporting the org as a whole
2. Supporting improvement projects
3. Supporting capital investment review
4. Implementing and integrating
66
Sensitivity Analysis
Analysis of the impact of alternative forecasts, usually developing most favorable, expected and least favorable scenarios to show the robustness of a proposal and to indicate the degree of risk involved.
67
Specification
Identifies external groups whose performance differs. In marketing, this is called "segmentation".
It examines whether specific groups differ in performance characteristics.
68
Statistical Process Control
Method of identifying significant changes in measures subject to random variation.
69
Forecasts
Identify trends in data and forecast them to future situations.
70
Ethics Committee- 3 functions
1. Used to assist caregivers, patients and families w difficult ethical decisions.
2. Formulating institutional policies to guide the professional staff in making ethical decisions
3. Educating hospital personnel about HC ethics in general.
71
ORB- Institutional Review Board
Addresses questions related to research.
Per HHS, no requirement for IRB oversight of quality improvement activities.
72
OHRP
Office for Human Research Activities
73
Process modeling
1. Activity-based cost analysis
2. Econometric models
3. Simulation models
4. Markhov Approaches
5. Optimization Models
These models:
1. Expand understanding of the process under study
2. ID useful solutions
3. Allow sensitivity analysis
4. Establish realistic performance goals for the ultimate solution
Although cheaper than real-world trials, costly to develop, require many hours to develop, must be modified to incorporate local data
74
Econometric models
Indicate price trends
75
Simulation Models
Allow exploration of hourly operation, testing performance against uncontrollable variation
76
Markov approaches
Allow study of complex chains of demands-for example, from emergency Department to the Cath Lab to the operating room
77
Optimization models
Allow examination of trade-offs between resources and outputs and help identify critical constraints
78
Checklist for project planning
1. The expected contribution to mission achievement-this is usually measured by changes in operational goals and, for large projects, changes in the strategic scorecard. The contribution, or return, must exceed the investment required
2. Physical constraints- Changes in facilities involve architectural issues like floor loads, radiation safety, and life safety code requirements. Equipment must fit spaces and utility constraints must meet safety requirements
3. Asset controlling cost minimization-purchases must be carefully specified and, if possible, competitively bid. Delivered goods must match the specifications.
4. Implementation-even relatively small project involves several steps of equipment changes, innovation, process redesign, and retraining. Installation must be scheduled and coordinated with ongoing activities. Large projects require months or years of management.
5. The actual contribution to mission achievement-expected contribution must be built into the appropriate units operational goals, and support was provided to achieve the improve targets.
79
Programmatic Opportunities
- focus on a single or small group of accountability units
- small in size and scope; numerous
- reviewed by management
- encouraged because they reflect an alert, flexible work attitude; create OFIs
80
Strategic Opportunities
- affect several activities
| -
81
Internal Consulting- managerial issues
1. What is adequate quality?
2. How big should the unit be?
3. How does the HCO protect the empowerment of PITs and Operating teams?
82
Marketing
- deliberate effort to establish fruitful relationships w exchange partners and stakeholders
- identify, evaluate and respond to changes in stakeholder needs
The analysis, planning, implementation, control of carefully formulated programs designed to bring about voluntary exchanges of values with target markets for the purpose of achieving organizational objectives.
83
Strategy
Selection of the profile of stakeholder needs to be met.
84
Four P's - marketing
1. Product
2. Place
3. Price
4. Promotion
85
Formal Surveys
- most reliable quantitative information about relationships and attitudes
- widely used in mktg, journalism and politics
- allows inference from a relatively small number of contacts
86
Monitors
- HCOs use a variety of reports generated by the associates, patients, and family directly involved to identify situations where results fall short of expectations or exceed expectations
- limitations- under reporting
87
Personal contact
- encourages senior mgmt to be highly visible via rounds and on-call responses
- encourage PITs to observe and walk-thru the processes they are studying
- hire agents to observe and report on competitors processes
- assemble focus groups
Yield only QUALITATIVE and HIGHLY SUBJECTIVE information.
Accomplish 3 important goals:
1. Show managements commitment to continuous improvement and put a human face on policies and work requirements
2. Improve mangers empathy w the work environment
3. Provide detailed info that is often valuable in solving specific situations
88
Branding
A community-wide communication effort to convey the mission and the competitive advantages of the org
89
Transaction Costs
The costs of maintaining a relationship, including the costs of communication, negotiation, etc.
90
Strategic Positions
The Set of decisions about mission, ownership, scope of activity, location, and partners that defines the organization and related to stakeholder needs
91
Porters framework for evaluating strategy
1 buyers and customers-what are buyers patients in the communities needs
2 new technology and substitutes-what are the implications of new diagnostic technology opportunities exist the cost of technology
3. Resources available/needed- funds/land
4. Competitor activity
5. Potential competitors and regulatory impact- new models for healthcare? Competition?
92
Scenarios
Alternative approaches to improving the profile of opportunities reflected in the environmental assessment
93
Business Plan
A model of a specific strategy or function that guides design, operations and goal setting
94
Strategic scorecard- key indicators
1. Market Share- many HCOs have high shares of local markets and cannot appropriately increase them. Declining market share is a critical sign; if not reversed, it suggests that the HCO should be closed, merged or substantially restructured.
2. Costs- the LT expectation must be for sufficient cash flow (profits plus depreciation) to manage debt and meet replacement needs. An HCO that cannot meet that expectation needs substantial restructuring.
3. Associate satisfaction
4. Overall HCO goal achievement - failure rate> 5%= important signal; >10%= disabling. The solution may lie in better performance improvement, an improved and more responsive culture, enhanced training and/or more realistic goal setting. It may also involve strategic repositioning.
5. Surprises
ACHE
flashcards
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