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.     

Challenges and opportunities for Medicare's original prospective payment system

The Medicare program initiated prospective payment for inpatient hospital services in 1983. Although the payment system has achieved many of its goals, changes in the health care market and the public nature of the program will continue to present both challenges and opportunities for improvement. Looking forward, policymakers must consider how to balance paying accurately for services with using Medicare to achieve broader policy objectives. Paying for new technologies, responding to market segmentation and specialization, and encouraging quality improvement must also be addressed. To successfully navigate these issues, policymakers and program administrators need accurate and timely information.     

State health agencies and the legislative policy process.

A new era of health care reform places increasing pressure on public health leaders and agencies to participate in the public policy arena. Public health professionals have long been comfortable in providing the scientific knowledge base required in policy development. What has been more recent in its evolution, however, is recognition that they must also play an active role in leading and shaping the debate over policy. A profile of effective State legislative policy "entrepreneurs" and their strategies has been developed to assist health agencies in developing such a leadership position. Based on the experiences of State legislative liaison officers, specific strategies for dealing with State legislatures have been identified and are organized into five key areas--agency organization, staff skills, communications, negotiation, and active ongoing involvement. A public health agency must be organized effectively to participate in the legislative policy process. Typically, effective agencies centralize responsibility for policy activities and promote broad and coordinated participation throughout the organization. Playing a key role in the agency''s political interventions, the legislative liaison office should be staffed with persons possessing excellent interpersonal skills and a high degree of technical competence. Of central importance to effective legislative policy entrepreneurship is the ability to communicate the agency''s position clearly. This includes setting forward a focused policy agenda, documenting policy issues in a meaningful manner, and reaching legislators with the proper information. Once a matter is on the legislative agenda, the agency must be prepared to negotiate and build broad support for the measure. Finally, public health agencies must be active policy players.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Arguing for Rural Health in Medicare: A Progressive Rhetoric for Rural America

Rural health policy is the laws, regulations, rules, and interpretations that benefit or affect health and health care for rural populations. This paper examines how rural health policy is viewed in the broader field of public policy, discusses the role of advocacy in developing rural health policy, and suggests ways to make that advocacy more effective. This paper critically reviews policy statements and policy positions taken by key opinion leaders and the leading stakeholders in rural health policy to determine how advocacy for rural communities is expressed. It is not clear how the rural health advocacy coalition is viewed by the professional policy world or the public: as an issues network pressing for fair and equal treatment or as an interest group seeking special advantages. This paper also explores the types of claims that rural advocates make in the specific context of Medicare policy to determine to what extent those claims reflect a central theme of fairness and inclusiveness in national policies versus claims that benefit special interests. The paper suggests that the rhetoric of rural advocates can be better structured to advocate for policies on the basis of a progressive sense of fairness.     

The new health care paradigm: roles and competencies of leaders in the service line management approach

PURPOSE: The purpose of this paper is to discuss the need for the service line management approach in health care. Service line management is increasingly utilized by US health care organizations as an innovative method for providing the needed stimulus to increase viability and profitability for the ailing health care sector. DESIGN/METHODOLOGY/APPROACH: Using current literature, this study describes a paradigm shift from traditional health care management approaches to focus on the importance of a service line management approach with its specific emphasis on competencies of leaders. RESEARCH LIMITATIONS/IMPLICATIONS: Four essential competencies--conceptual, participation, interpersonal, and leadership--must be gained by leaders to bring about organizational growth. PRACTICAL IMPLICATIONS: Health care managers must understand and practice these four key competencies to become effective health care leaders. ORIGINALITY/VALUE: This paper provides useful information on the need for the service line management approach in health care.     

Bridging the gap. Catholic health care organizations need concrete ways to connect social principles to practice

Establishing and maintaining institutional identity is a challenge for leaders in Catholic health care. A process known as "progressive articulation" can be used to help leaders assess how well their organizations reflect Catholic social tradition and help them apply this tradition toward specific organizational practices. The particular approach described here is called the "Identity Inquiry and Improvement Process" (31P), and it takes Catholic social principles and translates them into criteria and benchmarks for assessing an organization's interactions with internal and external stakeholders. In other words, 31P seeks to make mission measurable and concrete.     

Issues management: the other side of strategic planning

Most health services organizations follow a strategic planning model that emphasizes organizational changes to adapt to the environment. This limited view overlooks the possibility of changing the environment to better suit the organization's goals. Health services leaders in particular are concerned because they have not been effectively engaged in dealing with external policy matters. A strategic issues management system provides an integrated approach to this responsibility and can be established by expanding current strategic management activities. Additional resources will be required for new analyses and interpretations and for more intense interaction with stakeholders, but these costs will be significantly less than the benefits realized from operation of an effective strategic issues management system.     

Applying quality improvement to Canadian health care: can organizational skills address strategic challenges?

Most health care organizations in Canada employ quality improvement methods and tools to secure internal efficiencies rather than to achieve broader strategic aims or improve key clinical processes. If quality improvement efforts are to have much impact on the quality of Canadian health care, health care leaders must increase their advocacy of quality improvement methods and demonstrate that these can be used to achieve health care reform.     

American health care and the law--we need to talk!

The first section of this paper highlights five critical legal developments over the past half-century that, while not reflecting considered policy judgments about how the health care industry should operate, put American health care on some surprising paths. The second part then observes five fundamental policy contradictions discernible in health care law today, each of which reflects severe ambivalence in public attitudes toward health care. Although such confusion in the law is interesting in itself, the main purpose of the paper is to propose, in section three, the creation of a permanent high-level forum, perhaps in the Institute of Medicine, where leaders from the health and legal worlds could meet regularly with a view to helping the legal system resolve some of the policy confusion that exists.     

Life and liberty: the power of positive purpose

The authors believe that health care and the courts, through their commitments to positive purpose, are the fundamental keepers of life and liberty in American society. In fact, they postulate that the power of positive purpose works in every sector-public, private, and not-for-profit. More specifically, by the use of data, operational examples, and cases, this article shows how high performing hospitals, courts, and other organizations make optimism tangible by developing concepts, theories, and policies based on positive values. Effective court and hospital leaders take the abstractions and hopes of wishes and dreams and make them concrete and operational in a caring, sensitive, and humane way. Increasingly with the new generation of employees, loyalty and motivation are based more on affirmative values anchored in empowerment, participation, involvement, and spirituality than on cash. Leaders in health care and the courts must possess and be able to communicate a clear set of positive values to these individuals. Consequently, the authors show that we in health care and the court arena can influence the events in our personal lives and in our organizations' lives by making the values, visions, and cultural anchors in our organizational settings the foundations of performance. Strong leadership that ties the organizational goals to uplifting values based on a committed sense of optimism is the key to confronting creatively the philosophical, strategic, organizational, and operational changes necessary to improving the institutional effectiveness of health care and the law as we move into the new millenium. As reflective-practitioner leaders, it is our responsibility to be the catalysts and role models for our professional colleagues by retaining, communicating, and demonstrating a profound sense of optimism and a high level of performance in judicial and health care organizations.     

Polling analysis: public support for health reform was broader than reported and depended on how proposals were framed

The excessive focus of news organizations on "horse race" public opinion polls during the debate about health reform in 2010 left the impression that the public was fickle, as well as sharply divided on whether the government's role in health care should expand. We examined polling data and found that public support for health reform depended very much on how individual policies were described. For example, support for the public insurance option, which was not included in the final version of the Affordable Care Act, ranged from 46.5?percent to 64.6?percent depending on how pollsters worded their questions. Our findings indicate that public support for health reform was broader and more consistent than portrayed at the time. Going forward, policy makers should strive to communicate how health care policy choices are consistent with existing public preferences or should make changes to policy that reflect those preferences.     

Evaluating the impact on public policy of foundation-sponsored programs in the health professions

The leaders of national philanthropic foundations have long been active in informing public policy makers about their organizations' accomplishments and lessons learned in health care and other issues. The public policy context also is seen increasingly as an important factor influencing changes in the health care market. This article outlines how public policy was monitored and evaluated in a recent initiative in health care by a prominent national foundation. The markers of policy change in the evaluation of this initiative represented a mixture of the initiative's efforts to inform policy makers, the success the participant projects had in making policy makers aware of the initiative's goals, and actual changes in policy outcomes.     

Becoming an information master: using "medical poetry" to remove the inequities in health care delivery

In response to the spiraling costs, the US populace, for now, has chosen to ration health care by choosing who can receive it rather than what services are provided. Changing this approach will require an organized national policy and will be difficult. Clinicians must accept that providing minimally beneficial but not absolutely necessary care to their patients increases cost without significantly improving quality, and results in more people who lack adequate health care. The public must accept that exclusively focusing health care decisions on individuals places patients in conflict with their community, their family, and, eventually, themselves. Effectively using valid Patient-Oriented Evidence that Matters (POEMs) will give family physicians the tools necessary to improve the value of health care services. Family physicians are in the unique position to guide the necessary changes in health care delivery to resolve these conflicts and to be leaders in this process.     

Implementing and assessing organizational practices in local health departments.

One of the most difficult forms of public health practice to characterize involves governmental public health agencies, especially at the local level. A lack of consensus within the public health community as to the purpose and content of organizational public health practice inhibits efforts to increase the capability of public health to address effectively its core functions of assessment, policy development, and assurance. Meaningful capacity building efforts must establish both benchmarks and expectations for the organizational practice of public health. Those markers must be established so that the impact of practice on outcomes and health status can be examined. A model identifying 10 organizational practices was established through the work of the Centers for Disease Control and Prevention (CDC) in collaboration with national practice organizations. Early applications of the model to public health capacity building activities have been effective. Among the applications have been approaches to surveillance of health department practice, certification of local health departments using practice guidelines, and development of leadership within the public health enterprise. Although results are promising, use of the model requires additional external examination and validation, as well as acceptance and consensus within the public health community. The development of organizational practice guidelines for public health agencies may be useful in further efforts to characterize and measure public health practice and its impact on the public''s health.     

Hiring for "organizational fit". A St. Louis system has developed tools for assessing candidates' compatibility with the organization

To a great extent, the continued success of Catholic health care organizations is dependent on the selection of co-workers and leaders who are committed to carrying on the organization's mission. The Sisters of Mercy Health System, St. Louis, uses three tools to help leaders be more consistent and objective in assessing employment candidates for organizational fit. The first tool involves behavioral-based interviewing, which looks at a candidate's potential for future behaviors based on his or her past behaviors. The second tool assesses a candidate's values in such a way that accounts for and reduces the interviewer's own subjectivity. And the third tool-values-based interviewing-helps reveal a candidate's natural aptitude for, interest in, and personal agreement with the organization's charism, religious heritage, and values.     

Physician outcome measurement: review and proposed model.

As health care moves from a free-for-service environment to a capitated arena, outcome measurements must change. ABC Children's Medical Center is challenged with developing comprehensive outcome measures for an employed physician group. An extensive literature review validates that physician outcomes must move beyond revenue production and measure all aspects of care delivery. The proposed measurement model for this physician group is a trilogy model. It includes measures of cost, quality, and service. While these measures can be examined separately, it is imperative to understand their integration in determining an organization's competitive advantage. The recommended measurements for the physician group must be consistent with the overall organizational goals. The long-term impact will be better utilization of resources. This will result in the most cost effective, quality care for the health care consumer.     

The pharmacy leadership competency gap: diagnosis and prescription

The purpose of this paper is to inform the health administration community and its educators about the importance of pharmacy leadership, the competencies associated with the role, and a suggested path to achieve a greater number of pharmacy leaders. The role of the pharmacy leader is often unrecognized or undervalued, yet it has significant implications for many facets of the healthcare delivery organization, including the cost of care, patient safety and quality, the influence and potential involvement of the pharmacist in the hospital or health system. Hospitals and health systems should recognize the power of an effective pharmacy leader, and strive to fill those positions. Unfortunately, should care leaders demand high performing pharmacy leaders, they will find that such individuals are in short supply, and will become more rare with time because of an aging pharmacy workforce. The health administration education community must respond to the demand by marrying pharmacy management education with the Master's in Health Administration degree (MHA). This article proposes the creation of a PharmD/MHA dual degree program, giving clinically trained pharmacists the skills they need to be effective managers and leaders in hospitals and health systems.     

Public health reform.

Changes in funding and social and public policy will compel public health departments to reexamine their structure and values. Along with a reduction in providing health care services, public health will see a renewed emphasis on primary prevention. At the heart of primary prevention are marketing, communication, and community organizing. Unfortunately, these disciplines are all too often considered beyond the scope of public health and are contracted out or ignored. The commentary calls for a revitalized role for public health based on organizational adjustments consistent with anticipated changes in social policy and health care delivery.     

From the inside out: the engagement of physicians as leaders in health care settings

Health care delivery must be transformed to manage spiraling costs and preserve quality care. Transforming complex health systems will require the engagement of physicians as leaders in their health care settings, in both formal and informal roles. In this article we explore the experience of physician leader engagement and identify factors operating at the individual, team, and organizational levels related to increased or decreased physician leader engagement. Using an inductive approach, our analysis of the transcribed interviews yielded a rich understanding of what motivates physicians to be engaged as leaders, how they experience engagement, the role of the physician leader, how physicians understand other physicians' engagement, what encourages and discourages their engagement efforts, and the role that education and training has in physician engagement. We conclude by offering strategies that physicians, health care organizations, and educational institutions can implement to increase the engagement of physician leaders.