How important it is in healthcare management and administration.

Chapter 3 Organization Design and Coordination © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (1 of 2) • After completing this chapter, you will be able to: – Describe the variants of organization structure found in healthcare organizations – Describe the facilitating and hindering effects of organization structure on coordination © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (2 of 2) – Provide a framework for determining what organization design is most appropriate for a given healthcare organization – Describe the mechanisms and processes of coordination at the microlevel and their effects on quality of care © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Purpose • • • Functioning is affected by organizational structures and coordination Organization design: arrangement of responsibilities, authority, flow of information, result – organization structure Interrelated parts to organization design: – How to divide the work and responsibilities – How to coordinate work © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Why is Organization Design Important? • Strong empirical evidence shows coordination is related to patient outcomes – Organization design and effect on coordination important for health care leaders • • • At micro level, people grouped together into work units having common supervisor Organizations are complex Problems of any structure accompany its benefits © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Twin Structural Issues: Differentiation and Integration • • Every organization design has functional and dysfunctional characteristics Structural contingency theory: considers complex tradeoffs in organization design – Differentiation: each part of organization must be managed to meet unique requirements of specialty work – Integration: coordination of activities among units, including management of conflicts © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Coordination at the Macro-level (1 of 5) • Interdependence: – – – – – Interconnectedness of work Task uncertainty Size Sharing resources Types of interdependence © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Coordination at the Macro-level (2 of 5) • Structural approaches to coordination: – – – – – Hierarchy of authority Rules and procedures Planning and goal-setting Vertical information systems Lateral relations © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Coordination at the Macro-level (3 of 5) • Line and staff positions: – Line managers have authority for activities directly affecting goods/services • Integrated delivery systems: – Organized into one or more regions, each containing all area healthcare organizations • Service lines: – Programs organized around diseases or conditions, populations or technologies © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Coordination at the Macro-level (4 of 5) • Centralization and decentralization: – Vertical decentralization: degree to which decisions are made lower in organization – Centralization: degree to which decisions are made at higher levels of organization • Parallel organization: – Part of organization structure parallel to and distinct from main part of organization © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Coordination at the Macro-level (5 of 5) • Hybrid structures: – Organizations maintain traditional functional structures and structures for few program(s) • Organizations with multiple goals – Conflict among goals and organization design • Governance and the three-legged stool of administration, medical staff and board – Hospitals differ from other organizations because of unique position of medical staff © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Micro-level Coordination • Important considerations: – Can specific activities be assigned to different individuals/groups resulting in units’ efforts meshing together? – How familiar are the people involved with a particular action or decision? • Research shows coordination affects organizational performance © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Programming Approaches to Coordination • Standardization of work processes: – Use of rules, regulations, schedules, plans, procedures, policies, and protocols • Standardization of skills: – Specification of training or skills required to perform work • Standardization of output: – Specifies either form of or specifications for intermediate outcomes of work © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Feedback Approaches to Coordination • • • • Includes supervision, mutual adjustment, and group coordination More time consuming Require more effort than programming approaches Facilitation of coordination relies upon programming and feedback approaches – Types of coordinating approaches depend upon nature of work © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Relational Coordination • • • • Captures aspects of both programming and feedback approaches to coordination Takes account of work itself and process of people working together Comprised of relationships and communication Consists of shared goals, shared knowledge, and mutual respect © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. In Practice: The Veterans Healthcare System (1 of 3) • • Goal of Veterans Healthcare System redesign: to systematize quality management Redesign prompted by pressures from: – – – – Market-based restructuring of health care New scientific and biomedical knowledge, General dissatisfaction with health care Consumer expectations for quality, and many managerial and operational problems © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. In Practice: The Veterans Healthcare System (2 of 3) • Structural changes: – Basic operating unit within system from individual hospitals and medical centers to 22 regional networks – Shift from former disease-oriented, hospital-based, professional discipline-based paradigms to patient-centered, prevention-oriented, community-based, premised on universal primary care © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. In Practice: The Veterans Healthcare System (3 of 3) • Results – Transformation contributed to remarkable level of achievement – VA patients were receiving appropriate care at 90 percent or greater for 9 of 17 quality indicators – Quality indicators exceeded those for not only average community hospital but also average academic health center © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 4 Motivating People © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (1 of 2) • After completing this chapter, you will be able to: – Define motivation and distinguish it from other factors that influence individuals’ performance – Recognize popular but misleading myths about motivation – Understand that motivation depends heavily on the situations in which individuals work © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (2 of 2) – Understand managers’ roles in motivating people – Identify key characteristics of the content of peoples’ work that motivates them – Identify important processes involved in motivating people – Assess and deal with motivational problems © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Purpose • Develop understanding and ability needed to effectively motivate individuals: – Define motivation and distinguish it from other factors affecting performance – Describe common myths about motivation – Understand characteristics of individuals and settings in trying to motivate people – Examine role managers play to maintain or increase motivation © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Motivation and Management (1 of 2) • Motivation is central and a difficult topic for health care managers – Environment of health care changes rapidly • Requires improvements in productivity, quality of care, and cost – Managers need to motivate workers for a variety of reasons • e.g., improve problem-solving; promote creativity and innovation © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Motivation and Management (2 of 2) • Motivation – State of feeling/thinking where one is energized/aroused to perform task or engage in particular behavior • Myths about motivation – – – – Motivated workers are more productive Some people are motivated and others aren’t Motivation can be easily mass produced Money makes world go ‘round © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Manager’s Role • Managers need to periodically assess motivation and performance: – – – – Must take into account occupation, career stage, and personal factors Assessments should include informal interviews Employees must feel comfortable in expressing concerns Managers must problem solve and goal set © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The What and How of Motivation (1 of 4) • Needs as foundation for motivation: – Many people energized to work in order to meet particular needs – Needs: physical or psychological deficiencies that make specific outcomes or goals attractive – Can managers identify individuals’ needs and design work to maximize motivation? © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The What and How of Motivation (2 of 4) © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The What and How of Motivation (3 of 4) • Maslow’s hierarchy of needs: – People want to satisfy various needs, arranged in hierarchy of importance • Herzberg’s two-factor view of needs: – Motivators – Hygiene factors • Learned needs – Achievement, power, and affiliation © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The What and How of Motivation (4 of 4) © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. From Concept to Practice: Using Need-Based Views to Motivate • No simple set of needs and need satisfiers are universally applicable: – – – – People differ on basis of age, gender, race Context and culture of work differs Needs change over time Employees in different positions differ in their needs and potential motivators – Resource constraints may affect relative importance of various needs © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Process Perspectives • Equity: the importance of fairness – Relationships are fair when people perceive outcomes as proportionate to perceived contributions or inputs – People may use certain approaches to reduce inequity and restore balance in relationships – People compare themselves to others – Managers must address perceptions of inequities © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. The Power of Expectations • Four central components of expectancy theory – Job outcomes: rewards and negative experiences – Valences: feelings about job outcomes – Instrumentality: belief that attaining a job outcome depends on performance – Expectancy: perceived link between effort and performance © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Goal Setting and Feedback • • Goal: something that individual is consciously attempting to attain Conditions for goals to have positive influence on performance – Awareness of goals and knowing what must be done to attain them – Acceptance of goals as something they are willing to work for – Feedback in relation to goals © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. From Concept to Practice: Using Process Approaches to Motivate • • • Process approaches to motivation offer powerful set of guidelines for health care managers Process models believe content of work is often not enough to motivate people Reinforcement, expectations, fairness, and goals are necessary for high performance © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Motivating Health Care Professionals • Professionals are distinct from other occupational groups: – Have control of who may become members via rigorous selection and licensure – Work is based on codified, scientifically-based, knowledge and standards – Adhere to service-focused code of ethics – Have autonomy and control of activities © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Physicians • No “one best way” to motivate physicians – – – – Passive or “one-shot” approaches to behavior change do not work Financial incentives or payment systems alone do not work Useful approaches include use of reminders and feedback Critical to involve physician leaders in efforts to change physician practices © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Nurses • High levels of job dissatisfaction and turnover among nurses are major problem – Magnet programs aim to improve work environment, motivation, satisfaction and performance – Magnet hospitals must have: • • • Effective nurse leaders Participation of nurses in decision-making Collegial relationships between nurses and physicians © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. A Note on Support Staff • • • Clerical and service employees do not necessarily respond to same incentives as professionals One should not conclude that support personnel lack higher-level needs and necessarily need more structure and control Various methods of motivation should be viewed contingently © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Motivational Problems (1 of 3) • Nature and causes: – Inadequate definition of desired performance – Impediments to employee performance – Inadequate performance-reward linkages • Potential solutions: – – – – Goal-setting and performance based rewards Clear and shared expectancy of success Employee feedback and involvement Job redesign © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Motivational Problems (2 of 3) © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part. Motivational Problems (3 of 3) • Overall assessment: – Proper match of approach with primary causes of low motivation is important – How program was introduced and implemented is important – Compatibility of program with other aspects of organization’s culture is important © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
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