The effect of commitment to the organization on physicians' familiarity with guidelines for diabetes in managed care organizations

Despite continuous efforts, healthcare organizations still find it difficult to influence physicians to follow clinical guidelines. Previous studies have not taken into account the organizational context of the physicians' practice. We conducted a survey of a representative sample of 743 primary care physicians employed in Israel's 2 largest managed care health plans. The findings indicated that "commitment to the health plan" and "perceived monitoring by the health plan" had an independent positive effect on familiarity with guidelines for treating diabetes. We propose that managers of healthcare organizations consider enhancing physicians' commitment to the organization as a means for increasing their adherence with clinical guidelines, thereby improving the quality of care provided to diabetic patients.     

Incorporating ethics into your comprehensive organizational plan

Today's health care executives find their organizations facing internal and external environments that are behaving in chaotic and unpredictable ways. From inadequate staffing and an increase in clinical errors to outdated risk management procedures and increased competition for scare reimbursements, these health care managers find themselves making decisions without being fully informed of the ethical ramifications of these decisions. A 6-part Comprehensive Organizational Plan is presented that helps the health care decision maker better understand the key success factors for the organization. The Comprehensive Organizational Plan is an overall plan that is intended to protect and serve your organization. The 6 plans in the Comprehensive Organizational Plan cover the following areas: competition, facilities, finances, human resources, information management, and marketing. The comprehensive organizational plan includes an overlay of the ethical considerations for each part of the plan.     

Strategic planning and the health care supervisor

This article explores strategic planning from the perspective of the health care supervisor. It analyzes the strategic environment of organizations, the planning process, how to evaluate the strategic plan, and the implementation phase. A strategic planning model is offered as well as a view of the future of strategic planning. The article articulates that strategic planning should emphasize flexibility. The plan needs to be custom designed for the particular organization. Strategic planning is a primary vehicle for health care supervisors to use work teams to further develop organizational effectiveness. Finally, strategic planning is linked to both research and systems theory.     

Making customer-service a priority in health care organizations

Improving customer-service in health care organizations has been linked to better patient care, satisfied staff, a reduction in preventable medical errors, fewer malpractice lawsuits and improved revenue. However, it has been observed that there is sometimes a gap between the level of customer-service provided by health care organizations and their clients’ expectations. This paper integrates, synthesizes and extends theory and practice from existing literature to provide health care organizations with strategies for closing this gap. Methods are also outlined for creating, implementing and evaluating an organizational plan for improving customer-service.     

Towards an organization with a memory: exploring the organizational generation of adverse events in health care.

The role of organizational factors in the generation of adverse events, and the manner in which such factors can also inhibit an organization's abilities to learn, have become important agenda items within health care. The government report 'An organization with a memory' highlighted many of the problems facing health care and suggested changes that need to be made if the sector is to learn effective lessons and prevent adverse events from occurring. This paper seeks to examine some of these organizational factors in more detail and suggests issues that managers need to consider as part of their wider strategies for the prevention and management of risk. The paper sets out five core elements that are held to be importance in shaping the manner in which the potential for risk is incubated within organizations. Although the paper focuses its attention on health care, the points made have validity across the public sector and into private sector organizations.     

AIDS education for health care professionals in an organizational or systems context.

Traditionally, health education for practicing health professionals, as well as members of the public, focuses on the individual and relies on changing personal behavior. However, health care for persons with acquired immunodeficiency syndrome (AIDS), and members of their families, mainly is delivered within health and human services organizations. Providing AIDS education for health care professionals in an organizational or systems context shifts the focus from the individual to the group and from changing a person's behavior to offering health care professionals opportunities for interaction. In an organizational or systems approach, they can address patient care issues collectively, share interdisciplinary knowledge, identify problems of common concern, plan coordinated and integrated responses, and provide mutual support. A strategy for planning AIDS education is proposed for key administrators, supervisors, and care providers, who are the gatekeepers, opinion makers, and role models of organizations. Addressing organizational, community, and health care delivery system issues as part of an education program provides a forum for defining problems and a basis for uniting professionals and developing solutions.     

The EFQM excellence model: European and Dutch experiences with the EFQM approach in health care. European Foundation for Quality Management.

One way to meet the challenges in creating a high performance organization in health care is the approach of the European Foundation for Quality Management (EFQM). The Foundation is in the tradition of the American Malcolm Baldrige Award and was initiated by the European Commission and 14 European multi-national organizations in 1988. The essence of the approach is the EFQM Model, which can be used as a self-assessment instrument on all levels of a health care organization and as an auditing instrument for the Quality Award. In 1999 the EFQM Model was revised but its principles remained the same. In The Netherlands many health care organizations apply the EFQM Model. In addition to improvement projects, peer review of professional practices, accreditation and certification, the EFQM Approach is used mainly as a framework for quality management and as a conceptualization for organizational excellence. The Dutch National Institute for Quality, the Instituut Nederlandse Kwaliteit, delivers training and supports self-assessment and runs the Dutch quality award programme. Two specific guidelines for health care organizations, 'Positioning and Improving' and 'Self-Assessment', have been developed and are used frequently. To illustrate the EFQM approach in The Netherlands, the improvement project of the Jellinek Centre is described. The Jellinek Centre conducted internal and external assessments and received in 1996, as the first health care organization, the Dutch Quality Prize.     

Treating information and information technology as true resources

Hospitals and other health care organizations historically have been slow to adopt new managerial techniques. The same holds true for the acceptance of information and information technology as true strategic resources. With so much emphasis being placed on lowering operating costs and increasing the quality of care combined with the information revolution in today's society, the current complacent attitude often displayed toward health information management poses glaring organizational dilemmas for today's health care organizations. As many health care organizations begin to grapple with technical tasks such as developing the electronic patient medical record, they realize that there are many organizational implications to be dealt with as well. Issues such as who has the proper authority and responsibility not only to manage the mainframe and networks but also to correlate the information that all the hardware and technology provide with the strategic goals of the organization present significant hurdles. If these hurdles are not successfully cleared, any attempts at improving organizational strategy and performance via improved management of information resources are inhibited.     

A case study of organizational decline: lessons for health care organizations

This case study reports on an organizational decline situation involving a historically well-known and respected professional organization outside the health care field, with the intention of pointing to several implications for health care. We begin by discussing the results of a survey that involved both members of the organization and "outsiders." Our primary finding, both in the survey and in presenting the results to the membership, was that while those outside the organization perceived the organization as increasingly irrelevant and in decline, those inside it reacted with defensiveness to "meddling by outsiders." We then reviewed the literature on decline, with emphasis upon important findings by Guy, to further understand our results and to make recommendations. We then turn to the situation in health care organizations and point out why some organizations may be at risk and conclude with a series of recommendations with emphasis on health care.     

Procedures and perceptions of professionals and groups acting in the Brazilian health plan market

This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning.     

The process of managerial control in quality improvement initiatives

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.     

A systems-based methodology for structural analysis of health care operations

This paper introduces a systems-based methodology for conducting analysis of organizational structure for health care operations. Increasingly, health care organizations must operate in turbulent environments characterized by rapid change, high levels of uncertainty, and increasing levels of complexity. A fundamental issue for effective-performance in these environments is the development and maintenance of organizational structures that simultaneously provide both operational stability and agile response to environmental turbulence. Drawing from systems science, a systems-based methodology for structural analysis of healthcare operations is developed. This methodology identifies operational deficiencies stemming from inadequate organizational structure and suggests focal areas for structural modification. The results from an application of the methodology in a health care organization are examined. Implications and limitations for use of the methodology by health care professionals are provided.     

The component alignment model: a new approach to health care information technology strategic planning

The evolving health care environment demands that health care organizations fully utilize information technologies (ITs). The effective deployment of IT requires the development and implementation of a comprehensive IT strategic plan. A number of approaches to health care IT strategic planning exist, but they are outdated or incomplete. The component alignment model (CAM) introduced here recognizes the complexity of today's health care environment, emphasizing continuous assessment and realignment of seven basic components: external environment, emerging ITs, organizational infrastructure, mission, IT infrastructure, business strategy, and IT strategy. The article provides a framework by which health care organizations can develop an effective IT strategic planning process.     

Hybrids do it better: Lessons from websites of hybrid organizations in modern health movements

ABSTRACT

Hybrid organizations in modern health movements adopt multiple organizational logistics, allowing them to more effectively achieve social change. We conducted an analysis of 152 probreastfeeding organization websites categorized as institutionalized organizations, grassroots organizations, or hybrid organizations. Through a series of ANOVA analyses, we found that hybrid’s websites provide significantly more useful health care information, better maintained dialogue with members, more efficiently mobilized members, commoditized health care issues less, and created member identity while maintaining institutional ties. Ultimately, hybrids tended to incorporate the positive elements from both grassroots and institutional organizations, while rejecting many of the negative elements.     

Bringing human resources to the table: utilization of an HR balanced scorecard at Mayo Clinic

Rather than viewing HR as a critical driver of organizational strategy and outcomes, most health care organizations see HR as a drain on the organization's bottom line. Only by aligning HR with the organizational strategy will HR leaders truly get a seat at the leadership table. HR professionals can overcome impediments and gain a seat at the table by learning the language of business and the ways in which organizational leaders use data to drive their decisions. This article shows how Mayo Clinic uses the popular Balanced Scorecard approach to align its measures of HR performance to the organization's strategic plan.     

Three factors critical for end-of-life care

Appropriate care of persons with life-threatening illnesses requires a different, perhaps higher level of response from organized healthcare than has been typical in the past. This involves three critical components: Leaders must be committed, visible advocates of high-quality end-of-life care. This enables them to plan changes, deploy resources, and integrate this commitment throughout the organization's strategic plan. Ensuring appropriate care of the dying requires adequate human and financial resources. First, the organization must fully identify the educational and service needs of patients, families, and care givers experiencing life-threatening illnesses. The organization must work well with other community-based organizations to address identified needs. Senior managers can improve care by personally commissioning teams, acknowledging success, and rewarding performance. Finally, organizational goals, strategies, and performance objectives must be shaped by a commitment to ensure appropriate care of the dying. Our commitment to the dying must be based on our values. An organizational "statement of rights and responsibilities" is one way of providing a visible expression of the mission, core values, and mutual responsibilities among care givers and patients, residents, HMO members, and clients.     

Improving the system of public health financing]

The paper provides data on health status of children and adult population, and medico-demographic situation in the country. An account is also given of organizational and financial issues of medical care in foreign countries. The issues related to the organization of medical care, management of public health financing of the branch under new conditions are dealt with. On the basis of the experiment a new system of health services financing based on the principles of insurance medicine is proposed for introduction. The new system envisages such new organizational structures as health protection funds and insurance organizations. Functions of the existing managerial organizational public health structures at different levels are being changed, the status of medical institutions would also change and their responsibility for the quality of work would increase.     

Clinical effectiveness research in managed-care systems: lessons from the Pediatric Asthma Care PORT. Patient Outcomes Research Team

OBJECTIVE: To highlight the unique challenges of evaluative research on practice behavior change in the "real world" settings of contemporary managed-care organizations, using the experience of the Pediatric Asthma Care PORT (Patient Outcomes Research Team). STUDY SETTING: The Pediatric Asthma Care PORT is a five-year initiative funded by the Agency for Healthcare Research and Quality to study strategies for asthma care improvement in three managed-care plans in Chicago, Seattle, and Boston. At its core is a randomized trial of two care improvement strategies compared with usual care: (1) a targeted physician education program using practice based Peer Leaders (PL) as change agents, (2) adding to the PL intervention a "Planned Asthma Care Intervention" incorporating joint "asthma check-tips" by nurse-physician teams. During the trial, each of the participating organizations viewed asthma care improvement as an immediate priority and had their own corporate improvement programs underway. DATA COLLECTION: Investigators at each health plan described the organizational and implementation challenges in conducting the PAC PORT randomized trial. These experiences were reviewed for common themes and "lessons" that might be useful to investigators planning interventional research in similar care-delivery settings. CONCLUSIONS: Randomized trials in "real world" settings represent the most robust design available to test care improvement strategies. In complex, rapidly changing managed-care organizations, blinding is not feasible, corporate initiatives may complicate implementation, and the assumption that a "usual care" arm will be static is highly likely to be mistaken. Investigators must be prepared to use innovative strategies to maintain the integrity of the study design, including: continuous improvement within the intervention arms, comanagement by researchers and health plan managers of condition-related quality improvement initiatives, procedures for avoiding respondent burden in health plan enrollees, and anticipation and minimization of risks from experimental arm contamination and major organizational change. With attention to these delivery system issues, as well as the usual design features of randomized trials, we believe managed-care organizations can serve as important laboratories to test care improvement strategies.