Towards an evidence based health care management

Inspired by the development of Evidence Based Medicine, this article introduces a new approach for health care management called Evidence Based Management. This approach promises to improve the practice of health care management, at the same time as it may stimulate research on the organization and management of health care. Evidence Based Management means that health care managers should learn to search for and critically appraise evidence from management research as a basis for their practice. This will require some new managerial skills that should be included in the education and training of health care managers. It will also require a new orientation for research on health care management. There will be a demand for more applied research, and also for research with a more positivist orientation. Copyright © 1998 John Wiley & Sons, Ltd.     

A new approach to assessing skill needs of senior managers

Management of health care organizations must improve to meet the well-documented challenges of quality improvement and cost control. Other industries have developed the tools--entry education, mentoring, planned mid-career formal education and experience, and special programs for senior management. The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. We propose using formal lists of technical, interpersonal, and strategic competencies and specific real events chosen by the respondent to identify and prioritize competencies. Results of a trial with 30 large health care system CEOs and 15 early careerists demonstrate that the method reveals useful depth and detail about managers' educational needs. The results suggest that current thinking about managerial education and learning patterns may be seriously inadequate in several respects. The continued improvement of U.S. health care is a pressing national concern. Quality of care is highly variable and substantially deficient in many institutions (Chassin and Galvin 1998; Committee on Quality of Health Care in America 2001). "Quality improvement should be the essential business strategy for healthcare in the 21st century (Kizer 2001)." Productivity improvements will be essential to balance cost pressures from an aging population and growing technology (Heffler, et al. 2002). Skillful management is necessary to improve quality and productivity. Teams of dozens of caregivers are often required to improve a patient's health. The organizations that provide care have grown larger in response to the greater cost, complexity of operation and finance, and evidence of the success of scale in other industries. While many small professional practices, hospitals, and nursing homes remain, consolidation has created a few dozen provider and intermediary organizations exceeding a billion dollars a year in expenditures. These large health care organizations are, or should be, modern corporate organizations at least as effective as their counterparts in manufacturing, retailing, or finance. To achieve that goal, they will require managers with comparable ability, motivation, and preparation. The National Summit on The Future Of Health Management and Policy Education emphasized the development of "evidence-based management education" by identifying, prioritizing, and measuring mastery of specific skills, knowledge, and abilities (Griffith 2001). Faculty of Association of University Programs in Health Administration (AUPHA) are working with practitioners to identify and prioritize specific learning competencies at the graduate degree level. Their effort focuses on skills teachable in the classroom, and it is expected to lead to measured performance of graduate school cohorts (Griffith 2001). The purpose of this paper is to pilot test an alternative method to identify competencies and performance of health care executives. Although it deliberately draws competency elements from academic sources, it supplements the teachable skills approach with a questionnaire that asks practitioner respondents to identify the skills and knowledge necessary to manage a specific management event and to evaluate the performance of an anonymous colleague against these skills and knowledge.     

Continuing education on teaching skills for health professionals. Evaluation of training the trainers

Effective Patient Teaching (EPT), a health professions continuing education course, improves educators' teaching skills when presented by its developers. This study aimed to determine whether others could teach EPT with similar effectiveness. Four nurse managers who provide staff training and supervision for multiple hospital diabetes care units presented EPT to health care professionals at seven such sites; another seven served as controls. The evaluation included observations of trainers conducting EPT programs in the field, teaching skills ratings of health professionals in both groups, and knowledge test administered to patients. Six months after training, teaching skills scores of health professional EPT participants were better (p < .05) than controls. The EPT program improves participants' teaching skills and maintains these effects in field settings, when presented by faculty not involved in its development.     

Assessment of time management attitudes among health managers

These days, working people are finding it difficult to manage their time, get more done at work, and find some balance in their work and personal lives. Successful time management is often suggested to be a product of organizing skills, however, what works for one person may not work for others. Context current competence assessment formats for physicians, health professionals, and managers during their training years reliably test core knowledge and basic skills. However, they may underemphasize some important domains of professional medical practice. Thus, in addition to assessments of basic skills, new formats that assess clinical reasoning, expert judgment, management of ambiguity, professionalism, time management, learning strategies, and teamwork to promise a multidimensional assessment while maintaining adequate reliability and validity in classic health education and health care institutional settings are needed to be worked on. It should be kept in mind that institutional support, reflection, and mentoring must accompany the development of assessment programs. This study was designed to describe the main factors that consume time, effective hours of work, time management opportunities, and attitudes and behaviors of health professionals and managers on time management concept through assessment by the assessment tool Time Management Inquiry Form (TMIQ-F). The study was conducted at the State Hospital, Social Security Hospital, and University Hospital at Kirikkale, Turkey between October 1999 and January 2000, including 143 subjects defined as medical managers and medical specialists. According to the results, a manager should give priority to the concept of planning, which may be counted among the efficient time management techniques, and educate him/herself on time management.     

Evidence-based management: from theory to practice in health care

The rise of evidence-based clinical practice in health care has caused some people to start questioning how health care managers and policymakers make decisions, and what role evidence plays in the process. Though managers and policymakers have been quick to encourage clinicians to adopt an evidence-based approach, they have been slower to apply the same ideas to their own practice. Yet, there is evidence that the same problems (of the underuse of effective interventions and the overuse of ineffective ones) are as widespread in health care management as they are in clinical practice. Because there are important differences between the culture, research base, and decision-making processes of clinicians and managers, the ideas of evidence-based practice, while relevant, need to be translated for management rather than simply transferred. The experience of the Center for Health Management Research (CHMR) is used to explore how to bring managers and researchers together and promote the use of evidence in managerial decision-making. However, health care funders, health care organizations, research funders, and academic centers need wider and more concerted action to promote the development of evidence-based managerial practice.     

The medical records professionals' view of the electronic medical record

The migration of Kaiser-Permanente (KP), a large managed care organization, to the management of health care information in a paperless environment is presented from the viewpoint of Health Information Management (HIM) professionals. The author conducted an informal survey of these professionals and presents a synopsis of their recommendations in the context of KP's efforts to develop an enterprise Electronic Medical Record. Their consensus is that physicians are primarily information managers and that successful health care organizations will be those who most effectively manage their information.     

Management competencies for medical practice executives: skills, knowledge and abilities required for the future

The purpose of this study was to obtain a consensus of opinion from a large and diverse population of experienced ambulatory health care administrators regarding the essential ambulatory health care management competencies, and their related skills, knowledge and abilities (SKA) requirements, that will be required for successful management performance in ambulatory health care delivery settings in the next five years. A literature review suggests limited research in this essential and rapidly developing area for the health care community. The research design and methods employed the Delphi technique. Three hundred and twenty (320) Fellows of the American College of Medical Practice Executives (ACMPE) were asked to respond to two rounds of a Delphi mail survey. The results indicate that the essential ambulatory management competencies could be discretely grouped into six Management Domains, each with related SKAs. The respondents rated leadership and strategic management as the most important Management Domains. The highest rated SKA emphasized interpersonal skills with the next highest SKA relating to ethical and moral dimensions. Patient care management, as well as two SKAs relating to computer skills, were rated lowest.     

A study and comparative analysis of effective and ineffective leadership skills of physician and non-physician health care administrators.

This paper explores and compares, at both micro and macro levels, the leadership skills of effective and ineffective managers in a health care setting. In addition, it compares the leadership skills of physician and non-physician health care administrators at both levels. The results indicate that effective managers have significantly different leadership skill profiles than ineffective managers. Furthermore, effective managers have a more complete set of skills and are not as likely to rely on one type of skills as the ineffective managers. In addition, no substantial evidence was found to support prior assertions that physician administrators would be deficient in leadership skills.     

DECIDE: a decision-making model for more effective decision making by health care managers

The purpose of this article is to describe a step-by-step process for decision making, and a model is developed to aid health care managers in making more quality decisions, which ultimately determines the success of organizations. The DECIDE model is the acronym of 6 particular activities needed in the decision-making process: (1) D = define the problem, (2) E = establish the criteria, (3) C = consider all the alternatives, (4) I = identify the best alternative, (5) D = develop and implement a plan of action, and (6) E = evaluate and monitor the solution and feedback when necessary. The DECIDE model is intended as a resource for health care managers when applying the crucial components of decision making, and it enables managers to improve their decision-making skills, which leads to more effective decisions.     

Academy of Nutrition and Dietetics: Revised 2014 Standards of Professional Performance for Registered Dietitian Nutritionists in Management of Food and Nutrition Systems

Management in food and nutrition systems is presented with an ever-challenging tension between effective utilization of manpower resources, mechanical equipment, financial management, material production, and time constraints to produce optimal products. Management drives opportunities for personal development for multiple levels of its employee workforce. Given an increasing need to deliver high-quality food and services to satisfied customers, the Management in Food and Nutrition Systems Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed the Revised 2014 Standards of Professional Performance, which replace the 2009 Standards, as a tool for registered dietitian nutritionists working in food and nutrition systems management within health care and non−health care organizations. These Standards of Professional Performance consist of six domains of professionalism: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate how strong communication skills, attention to customer satisfaction, use of various resources, and application of personnel management principles can be applied to practice. The indicators describe three skill levels (ie, competent, proficient, and expert) for registered dietitian nutritionists managing food and nutrition systems.     

Identifying management competencies for health care executives: review of a series of Delphi studies

This analysis reviews a selected body of research that identifies the essential areas of management expertise required of future health care executives. To ensure consistency, six studies are analyzed, utilizing the Delphi technique, to query a broad spectrum of experts in different fields and sites of health care management. The analysis identifies a number of management competencies, i.e., managerial capabilities, which current and aspiring health care executives, in various settings and with differing educational backgrounds, should possess to enhance the probability of their success in current and future positions of responsibility. In addition, this review identifies the skills (technical expertise), knowledge (facts and principles) and abilities (physical, mental or legal power) required to support achievement of these competencies. Leadership and resource management, including cost and finance dimensions, are the highest-rated requisite management competencies. The dominant skills, knowledge and abilities (SKAs) are related to interpersonal skills. The lowest-rated SKAs are related to job-specific, technical skills. Recommendations include the review of this research by formal and continuing education programs to determine the content of their courses and areas for future research. Similarly, current health care executives should assess this research to assist in identifying competency gaps. Lastly, this analysis recommends that the Delphi technique, as a valid and replicable methodology, be applied toward the study of non-executive health care managers, e.g., students, clinicians, mid-level managers and integrated systems administrators, to determine their requisite management competencies and SKAs.     

Health information management in the computer era

Medical record professionals are confronted with change at practically every front. Technologic advancements are changing the technical aspects of our job responsibilities. These advancements also have implications for the interpersonal aspects of our jobs. The effect of new technology on working relationships is exacerbated by the introduction of TQM, which also encourages a change in organizational relationships through a move away from traditional heirarchical management by fostering teamwork and staff empowerment. The changes that are transforming health care organizations can be viewed in two lights: (1) as unwanted hindrances to accomplishment or (2) as opportunities to enhance accomplishment. Medical record professionals are presented with unprecedented opportunities to enhance our accomplishments and maximize our position in health care facilities. We cannot long for the way things were or be satisfied with the status quo. Such action (or lack thereof) will only ensure that our role on the health care team will be taken over by someone else. To capitalize on the opportunities presented, medical record professionals must hone the knowledge and skills we already possess, gain other knowledge and skills necessary to function in the computerized environment, and, most of all, be proactive rather than reactive. Such action will ensure that we truly become health information managers.     

Hospital middle managers' perceptions of their work and competence

Middle managers in acute care hospitals in New England rated the importance of most work roles and skills higher than their competence to perform them. Being male, having a bachelor's or graduate degree, and reporting to a vice president were related to higher competence ratings for some roles and skills while having held a clinical position in the same organization was related to lower ratings. Middle managers rated skills and roles focused on their individual work units as more important than those associated with their organizations or external environments. This framework for categorizing work may be useful in identifying education, institutional support, or work redesign that would assist middle managers in being more effective.     

Perceptions of management development in selected hospitals

Today health care executives are managing organizations that are complex and require a higher degree of financial management, medical knowledge, and general business skills. The skills and academic background required to manage health care facilities have been debated by practitioners and academicians over the years. This study will examine executives' perceptions of management development activities in their organizations. To assess these perceptions, an eight-item questionnaire was mailed to 587 executives. Forty-two percent were returned. The data showed that a majority of the respondents indicated that the management development programs in their organizations were well received and that the morale of managers had improved. The pressures and challenges facing health care organizations will require managers and executives to make use of a wide range of skills if they are to be successful.     

Roles, skills, and competencies of middle managers in occupational therapy

This article describes the most essential roles, skills, and competencies needed by middle managers in occupational therapy organizations. Middle-level managers are responsible for a specific segment of the organization. They are uniquely positioned to foster changes in the department. Because of the challenges in the health care environment, it is important to discuss the roles that middle managers need to bring out the viability and growth of their departments and organization. These roles include planner, strategic planner, coordinator, leader, problem solver, and negotiator. To conduct these roles, skills and competencies that are closely linked to the effective performance of those roles are also described. Skills include human relations, marketing, and conceptual skills. Competencies include being able to manage attention, meaning, trust, and self, as well as being competent when conducting utilization reviews, program evaluations, documentation of services for quality and reimbursement purposes, and fiscal management. With these outlined roles, skills, and competencies, middle managers should be able to promote the mission of their organizations, support their employees, and navigate successfully in the competitive and ever-changing health care environment.     

What chance a caring management culture?

Management of the NHS is necessary and vital to effective delivery of health services. It is not a process that can be avoided, whoever does it. New Labour needs effective managers in the NHS if they are to bring about the changes they want to see. Manager bashing, which New Labour is showing signs of continuing, is counter productive and encourages a climate of threat for managers which subsequently translates into bad management practice with its inevitable consequences for service quality and productivity. The NHS badly needs a positive long-term strategy of serious investment in individual and organizational development. It is a question of balanced investment between the long-term management capability of the NHS and immediate patient care. The major issues of rationing, priorities and the balance between health and health services will always be part of the difficult national and local management task. Some move by politicians in the direction of open recognition of these difficulties and the burden they place on the skill, will and courage of managers could go a long way to building a caring management culture.     

Time management and leadership styles: an empirical study of long-term health care administrators

Is there a relationship between the type of leadership style employed by long-term health care administrators and the effective use and management of time? This paper describes a 1989 study of 188 administrators of skilled nursing facilities and intermediate care facilities in Connecticut. Two self-rating instruments were employed: the Executive Time Management Inventory (Hartley, Kramer, et al.) and the LEAD-Self instrument (Hersey and Blanchard). Four hypotheses were tested at the .05 level of significance to examine relationships among time management, leadership style, size of facility, administrator experience, and cost factors. Statistical procedures included Pearson Product-Moment correlations, analysis of variance, t-tests, and partial correlations. Results of the study included (1) time management effectiveness increased as administrators gained more experience; (2) no significant relationship existed between type of leadership style and time management effectiveness; (3) women administrators perceived themselves as significantly more effective time managers than men did; (4) most health care administrators employed the same primary leadership style: "selling," which is defined as high relationship/high task; and (5) institutional size was not related to the time management effectiveness of the administrator. The findings have implications for pre-service and in-service training and for future studies in health administration education.     

Assessment of the managerial functions in primary health care settings

During October 1988 to June 1990, the authors developed a conceptual framework with which to measure the quality of prenatal care in primary health care (PHC) settings. That framework was applied during June-December 1990 to the public maternal and child health facilities in the Irbid Governorate of North Jordan which provide prenatal care. Management is an essential component of quality prenatal care. The authors describe the indicators of the managerial functions practiced in the PHCs and report upon the extent to which they are performed. Management was analyzed at the levels of both structure and process. The 31 managers of the PHCs providing prenatal care in the Irbid Governorate were interviewed about their various management functions. General information was also collected on the personnel and facilities available at the centers. The managers were of mean age 37 years with an average 2 years of experience managing their facilities. The managers in all but two facilities were male physicians. Study findings suggest that the management functions of prenatal care services in PHC settings are inadequately performed. The indicators suggest that the controlling function was better performed than the planning, organizing, and directing functions.