Changes that can be observed in the sphere of health care are usually rapid, especially for all the employees who are engaged in this area. The most significant changes occurred in the areas of regulation of the health care industry (this includes the changes in management and in lawmaking) (AHA, 2006), principles of education and recruitment, and the change in technology (the use of digital technologies in the examination of a patient, and in treatment and surgery) (AHA, 2006). The most notable changes in the health care industry are social and ethical factors. Some examples of these factors include illegal organ transplantation, the right to die, abortions, and the use of organs of aborted children (Watson, 2006) (Mustafa, 2004). With the production of managed care, declining compensations, and national Medicare legislation and compliance, consistent information is significant now more than ever (Greiner, 2006). In an era of technological development, electronic commerce has emerged as the most imperative archetype, not only in healthcare but also across a wide range of industries (American Hospital Association, 2006).
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Changes in Health Care Law
HIPAA (Health Insurance Portability and Accountability Act) regulations concern security and confidentiality provisions to protect the integrity and privacy of patient information (HHS, 2007). The law project which was adopted in 2004 essentially changed the regulation policies in the health care industry. The changes refer to the personal information of a patient, data security, and privacy. The HIPAA regulates the accessibility and diversity of the group and personal health insurance plans. It amends both the Employee Retirement Income Security Act and the Public Health Service Act. Title II of HIPAA classifies numerous offenses concerning health care and establishes civil and criminal penalties for them. It also produces several plans to control fraud and mistreatment within the health care system. HIPAA security and privacy regulations touch upon the use and revelation of Protected Health Information (PHI). PHI is any information about health conditions, provision of health care, or expense for health care that can be connected to a person. This is understood rather broadly and includes any part of a patient’s medical record or expense history (AHA, 2006).
Covered entities must reveal PHI to the person within 30 days upon request. They also must release PHI when required to do so by law, such as reporting suspected child abuse to state child welfare agencies. Privacy rules also require informing any individual, if his/her personal data has been used, and anybody can require PHI in order to check, whether any information fixed is correct (HHS, 2007).
Major organizational changes in health care involve a shift from dependence on hospital-based care to more care being provided on the basis of outpatient treatment and in nursing homes; the shift to managed care; the increase of private clinics, working on a competitive basis, and on-profit activity; and business restructuring which includes horizontal (the owners who manage several hospitals) and vertical (across the care continuum) incorporation. (AHA, 2006) Admittance to public hospitals decreased 7.5 percent from 1995 to 2005, while outpatient visits to public hospitals increased 89.4 percent all through the same period (American Hospital Association, 2006). Moreover, a growing number of care is being offered in non-hospital settings, such as patients’ homes, physicians’ offices, and self-supporting outpatient clinics or surgery centers(AHA, 2006). Fennel and Alexander (2003) mention that this raise in the diversification of organization types and products allows the hospital to diminish its vulnerability to hesitation within the inpatient acute care sector, by broadening its base of activity.
Patient Care and Service Delivery Changes
In the recent decade, health care industries are conducting researches to re-engineer internal organizations in order to increase efficiency, save money, and improve patient satisfaction (Greiner, 2006). Changes involve not only the work organization but also the culture of the workplace. In health care, re-engineering seems to engage breaking down departmental obstacles and specialized alliances; re-examining and reconfiguring the strategies of job requirements; and linking the “great divide” of inpatient and outpatient services (Greiner, 2005). Hospitals are usually structured along departmental ranks organized by skill and qualified scopes of practice.
Greiner (2005) explains the three most important work-restructuring models: patient-centered care (PCC), patient-focused care (PFC), and operations improvement (OI). The PCC model (the least known of the three) provides comprehensive analysis data that are used to define what organizational changes need to be made to humanize the hospital image (2005). Thorough patient reports are commonly used to perform structural reorganizations, overwork the production and activity processes, and afford ongoing information for quality advancement processes. Money savings are not the main goal of implementing this model (2005).
Both, PFC and OI strategies claim the restructuring and the development of the efficiency of the operations are involved in the more prevalent models, which include the reformation of Remote Nursing, licensed practical nurse (LPN), and nurses aides jobs. These two models are frequently described as interchangeable. The OI model focuses on cost reduction and impacts mostly nurses, while PFC highlights both cost and quality and influences a wide range of professions through multi-skilling, redeployment of subsidiary services, and teamwork. Operation Improvement strategy focuses on reducing the number of Remote Nurses and using more nurses aides, while subsidiary services stay centralized as a whole (Greiner, 2005).
The management process consists of four independent functions. These functions are planning, organizing, motivating, and controlling (Ackroyd & Fleetwood, 2000). The planning function defines the main goals of the organization, and what all the workers should do in order to achieve these goals. The planning function asks the three main questions: What level have we achieved? What level do we want to achieve, and in what way are we going to make it? By planning, the leaders strive to set up the main directions of the efforts and decision-making, which will help to form the united goal for all organization-members (Ackroyd & Fleetwood, 2000). It is difficult to say that planning in the health care industry differs from planning in other spheres. The manager of any clinic also needs to enhance the activity of the personnel, elaborate strategies for further development of the clinic (especially if the clinic he/she manages is private).
To organize means to create some structure. There are lots of elements that need to be structured; in order for the organization could fulfill its plans, thus achieving the setup goal. One of the key aspects of the organization is the definition, who is responsible for making any concrete assignment. The manager selects necessary staff for the completion of the assignments, thus passing rights and obligations to these people (Ackroyd & Fleetwood, 2000). Organizing in health care does not differ much from the general principles and definitions of planning. The manager is obliged to create the structure of subordinate personnel, to make the hierarchy of employees the most efficient, in order, everybody could cope with the work in a proper way, and proportionally to status. (Ackroyd & Fleetwood, 2000)
Leaders should always consider that even perfectly composed plans and faultlessly organized structure is worthless if someone is not able to make the assigned work. The purpose of motivation is to make the workers fulfill the tasks according to the elaborated plan. Motivation is a result of a complex combination of factors and needs, which change constantly. In order to make the employees work efficiently, the manager needs to define those factors within the group (Ackroyd & Fleetwood, 2000). Motivating clinical workers is of a raised importance. The faults by doctors are rather crucial, and if a mistake has been done by a professional, the manager needs to line up all the necessary motivations, in order for the doctor could rest, and never repeat the mistake (Ackroyd & Fleetwood, 2000)
Unforeseen circumstances may cause changes and deviations in the previously concluded plan (Ackroyd & Fleetwood, 2000). If management appears disabled to find and check these deviations, the organization most probably will experience losses. The survival of the organization is swindled in this case. Control is the process of providing the completion of the goals by the organization (2000). There are three aspects of managing control. First, the set up of the standards means the exact definition of the goals which should be gained during the set amount of time and is based on the elaborated plans (2000). The second aspect is the measuring of the gained results and comparing them with expected achievements. If these two phases are completed properly then the third aspect enters into force which is the correction of the deviations from the primary plan. One of the possible actions is the reconsideration of the goals, which would make them more realistic (Ackroyd & Fleetwood 2000).
Control of clinical employees is rather important, as in any organization, where structured work is an integral part of the activity. Workers need to be controlled in the order they could feel the authority of management, and never sit back in coping with direct responsibilities. Money stream control is inevitable. Costs should be strictly distributed in the health care industry, as the development of the whole sphere depends on it.
Concepts of Total Quality Management
Farazmand (2002) describes several key concepts which have contributed efficiently to the development of the implementation process of Total quality management. TQM relates to every organization, where management and employees exist, especially if the enterprise strives to expand. Clinics and hospitals are not an exception. Here are the main concepts of TQM enlisted.
- Create the stability of purpose for steady improvement of products and services;
- Approve a commitment to gain continual perfection;
- Use defect prevention, and eliminate the defect detection;
- In dealing with suppliers one should end the practice of awarding business on price, move towards the quality of product, reliability of delivery, and willingness to co-operate and improve;
- Develop partnership relations with all the employees and suppliers;
- Improvement should consider not only the products but also supporting services and activities;
- Training must be in a moderate way, and acting in organizational one;
- Change supervision using the methods of coaching;
- Encourage two-way communication, and eliminate any display of fear in management-employees interaction;
- Remove barriers between departments;
- Do not set unrealistic goals;
- Remove barriers that prevent employees from having pride in the work that they perform;
- Encourage education, training, and self-improvement for everyone; and,
- Publish top management’s permanent commitment to continuous improvement of quality and productivity. (Farazmand, 2002)
Functional Differences between Technician and Manager
Any enterprise has its own system of knowledge. This system identifies the division into managers and technicians. This knowledge can be classified into WHAT-knowledge, HOW-knowledge, (WHO, WHERE, WHEN)-knowledge, and WHY-knowledge (Tarasov, 2006). These types correspond to the roles of the staff. Thus manager needs to possess (WHO, WHERE, WHEN)-knowledge, and technician HOW-knowledge (Tarasov, 2006). It is necessary to mention, that the theory of knowledge includes also such factors as a customer (WHAT-knowledge) and director (WHY-knowledge) (Tarasov, 2006). As has been mentioned above, the management theory is applicable to all spheres of activity. Differences between clinical technicians and managers are the same in structure. The manager of a hospital needs to possess (WHO, WHERE, WHEN)-knowledge and issues, and technician HOW-knowledge to fulfill the necessary work.
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The Role of Management in Facilitating Change
Change is no longer an alternative in the health care industry. Rapid advances in information technology, globalization, and industry consolidation have driven change to an anxious tempo. Some researchers compare the impact of these current changes in the workplace to the changes caused by the industrial revolution (Sallis, 2002). To make changes, managers need to get the working environment prepared for the necessary changes which can be done with the help of specially created focus groups, discussions and individual interviews (2002). Building an environment of trust and co-operational relations will also encourage teamwork. The personnel needs to be morally and physically prepared for all the changes. The majority of the responsibility is on the manager as a motivator and coordinator of the teamwork (Sallis, 2002).
Decision-making is the cognitive process leading to the selection of a course of action among variations (Guffey, 1998). The process itself is divided into several steps. For better decision making scholars advise to follow the next steps: (1) Identify the issue (2) collect information and data (3) Evaluate the evidence, the source of its information, its relevance, and importance (4) work out alternatives (5) choose the best decision (1998). Decision-making in health care follows the same steps and principles. But the only amendment should be done; these steps are taken with the consideration of the specificity of the sphere. Thus if some source is relevant for some sphere, it does not mean, it is relevant for health care. The same is with decision-making. If, for example, in the insurance sphere some managers prefer to employ students, and invest in their training, the health care field needs only experienced professionals.
General Concepts of Personnel Management
One of the most important general concepts is the correct use of available resources. When searching for the necessary candidate, special tactics of selection should be elaborated (Malinovsky, 2002). Meanwhile, the company needs to diversify the selections of the candidate, along with the three coordinates which are quality, time, and cost (Malinovsky, 2002). The same is with the HC sphere. When seeking an experienced surgeon (for example), it is inevitable to elaborate a strict strategy for searching and attracting necessary specialists.
Factors that Motivate Employees
Motivation is not a set of standard rules. The main task of a human resources manager is to refine these methods for each worker. The motivations can be material and moral, and the exaggeration of each may have crucial consequences Ackroyd & Fleetwood, 2000). The best way of material motivation is the implementation of a bonuses system. Moral motivation would be rather useful in the conditions of a crisis (2000). As it has been pointed in chapter “Motivation”, motivating HC staff is of vital importance. If regarding the case with a mistaken specialist, he needs to be morally motivated, as that mistake could ruin his/her imagination about self-professional skills, and cause deep depression.
Planning and its Relevance to Management
The planning process in the management sphere is very important. Planning is usually regarded as a guarantee of order and success. Everybody manages his/her own time, but the management plans not only his own timetable but also the timetables of his/her staff. Managers also set goals and arrange the completion of these goals by the criteria “importance-urgency”, in order to achieve goals more efficiently. The time that the manager operates is regarded as a resource and this resource is extracted for the achievement of a concrete goal. (Pheng & Teo, 2003) It is hard to say that planning in the health care industry is different from planning in other spheres. The manager of any hospital also needs to improve the activity of the personnel, elaborate strategies for further development of the clinic (especially private).
Control Mechanisms in Management
The most effective control scheme in management is the system of redistribution of authorities and responsibilities (Tarasov, 2006). The mechanism of monitoring is necessary to implement, as it plays a sufficient role in managerial control. Monitoring of the achieved results helps to compare it with the set goals, and consequently change the strategy. Backup in the manager-employee relations is the essence of the current control in any organization. To maintain successful work, the manager needs to develop the backup and determine whether employees cope with the work properly (Tarasov, 2006). Control of HC workers is important enough, as in any organization where structured work is an integral part of the activity. Employees need to be controlled in the order they could feel the power of management, and never relax while coping with their direct responsibilities. Money stream control is inevitable. Costs should be strictly distributed in the health care industry, as the development of the whole sphere depends on it.
Organization of the Resources
To organize the necessary resources it is essential to collect information about all the resources available. These are the journals related to health care management, the specialized forums, web sites, where the issues of personnel management in health care industries are described.
http://www.cio-chime.org/ – College of Health Care Information Management Executives
http://www.eurasiahealth.org/ -Euroasia Health Knowledge network
http://aidsinfo.nih.gov – A Service of The U.S. Department of Health and Human Services
http://www.mchpolicy.org/ – National Academy for State Health Policy
http://www.cdc.gov – Centers for Disease Control and Prevention
Journal of Law and Health – Issues on rapidly changing law-making in health care industries are described.
Environmental Health Perspectives – HC issues, related to the environmental protection and atmosphere pollution
Journal of Environmental Health – Journal, which is like the previous one. Describes the issues of protection of the environment, and how pollution impacts people’s health
Various management styles can be used depending on the culture of the business, the origin of the task, the nature of the personnel, and the personality and skills of the leaders (Bjerke, 1999). The authoritarian style manager takes all the decisions and extracts all the necessary information. The main benefit of this style is that the direction of the business stays stable and this can project an image of a positive, well-managed business. On the other hand, subordinates may become highly dependent upon the leaders and supervision may be needed 1999).
The paternalistic style is also in some measure dictatorial, though the decisions are taken mostly to account employees’ interests, but not a business. Thus it is in some measure democratic and loyal to personnel.
The democratic style involves that employees take part in the discussion and decision-taking, and all the solutions are accepted by the majority. This style can be characterized by two-way communication. It means, that manager-employee communication is encouraged, which helps to consider employees’ opinions in taking the decisions. (Bjerke, 1999)
All these styles may occur in any enterprise, and it depends on the traditions of the collective, and on the personal features of a manager. Clinic or hospital is not an exception, and doctors’ personnel may also experience one of the enumerated styles.
Scientific Management Theory
At the beginning of the 20th century, The United States highly appreciated scientific and technical issues, including careful measurement and arrangement of activities and results. Management had a tendency to be the same. Frederick Taylor developed the “scientific management theory” which promoted this careful specification and measurement of all organizational aims. The theory includes the standardization of the tasks, and the simplest forms of awarding and punishing the workers (Taylor, 1911).
Bureaucratic Management Theory
It is a reason for working the scientific theory by Max Weber, who overstated it with his bureaucratic theory. Weber argued on implementing the hierarchical division of the organizations, thus establishing strong lines of authority and control. He suggested organizations develop comprehensive and detailed standard operating procedures for all routine tasks. (Taylor, 1911)
Human Relations Theory
In this theory, more attention is paid to persons and their unique capabilities in the enterprise. The essence lays in the thesis that the organization would succeed if its workers succeeded as well. The implementation of this theory encouraged the creation of Human Resources departments (Bjerke, 1999).
In the conclusion it needs to be said, that management principles are the only for all the spheres of human activity. These can be applied to any management-employee relations, and are of vital importance. The enumerated and explained principles are claimed to simplify the ruling process in any enterprise and make the work more efficient, to organize the workers and eliminate anarchy in management.
- Ackroyd, S. & Fleetwood, S. (2000). Realist Perspectives on Management and Organisations. London: Routledge.
- American Hospital Association. 2006. Hospital Stats: Emerging Trends in Hospitals. The American Hospital Association.
- Bjerke, B. (1999). Business Leadership and Culture National Management Styles in the Global Economy. Cheltenham, England: Edward Elgar.
- Farazmand, A. 2002 ‘Total Quality Management’ The Third International Conference on Quality Management
- Fennel, M. L. Alexander J. A. 2003. “Perspectives on Organizational Change in the U.S. Medical Care Sector.” Annual Review of Sociology. 19:89-112.
- Greiner, A. 2006. “Impacts of Hospital Restructuring on Nursing.” Technical Paper. Washington, DC: Economic Policy Institute.
- Greiner, A. 2005. Cost and Quality Matters: Workplace Innovations in the Health Care Industry. Economic Policy Institute.
- Guffey, G.R. 1998 ‘Business Communication: Process and Product’ South-Western College Publishing
- HHS – Office for civil rights – HIPAA. 2007 “Health Human Services”.
- Malinovsky, P. (2002), ‘Methods of evaluation of the personnel’ Materials from the seminar “systems of personnel attestation”
- Mustafa, F. 2004 ‘Right to Die: Venkatesh case shows time has come to legalize mercy killing’ The Statesman (India), p, 32
- Tarasov V. (2006) New strategies in reorganization of enterprises. Management in enterprises, (13), pp. 40-84
- Pheng, L. S., & Teo, J. A. (2003). Implementing Total Quality Management in Construction through ISO 9001: 2000. Architectural Science Review, 46(2), 159
- Sallis, E. (2002). Total Quality Management in Education. London: Kogan Page
- Taylor, F. W. 1911 ‘The Principles of Scientific Management’ New York: Harper Bros. p. 5
- Watson, C. 2006 ‘The organized crime of organ trafficking’ The Faculty of Law, University of the Free State, Department of Criminal and Medical Law, p. 56