Lecture10: Management and Supervision 550. Outline Management and Supervision Planning Preparing a...
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Transcript of Lecture10: Management and Supervision 550. Outline Management and Supervision Planning Preparing a...
Lecture10: Management and Supervision
550
Outline
Management and Supervision Planning Preparing a Business Plan Organizing and Leading Controlling
Management Technology Technology Assessment Organizations for Technology Assessment Improving the Use of Medical Technology Methods of Technology Assessment
551
Management and Supervision Two major factors that affect the
development of managerial skills Basic personality of the manger
“we manage because of what we are, but how we mange is because of who we are” (Benett, 1987).
Organizational structure or framework in which one must manage Top-down management structure Manager as facilitator
552
Traditional top-down management Structure
Planning
Organizing
Leading
Controlling
Doing
Management
Employee
553
Manager as Facilitator
Controlling
Doing
Planning
554
Planning
Plan is specific design to achieve a desired future
Formal means of documenting where you have been Where you want to go Steps you intend to use
555
Planning Process
MissionService and
Program Alternatives
Market Analysis
Analysis of Resource
Financial Analysis Plan
556
Steps in Planning
Development of mission statement Identification of services or programs to
achieve the stated mission Analysis of markets, competitors and
roadblocks Analysis of the resources required, including
people, facilities and equipment Analysis of the financial resources required
557
Mission statement
Critical starting point Focuses primarily on medically related end
products or services Technology management Contract management Repair and preventive maintenance Quality control Record maintenance Equipment evaluation and acqusition
558
Identification of Clinical Management Services and Programs
MISSION
Review of Target Programs
Review of mixture of In-house and Outside Service
Review of Service Alternatives (Hands-on or
Contract Management)
Review of Institutional Relationships
To Market Analysis
559
Market Analysis Diagram
From Services provided to
support mission statement
To Resource Programming
Shares Market
Program User Rates
Target Population Programs
Service Area demographics
Normative & Historical
Rates
Historical Trends & Projected Changes
Total Program Demand
Captured Program Demand
X X
560
Resource Programming Diagram
From Market Analysis To Plan
Space Planning
Standards
Functional Productivities
Service Intensities
Historical Levels &
Technological Trends
Operational Policies & Industry
Standards
Institutional Policies & Industry
Standards
Equipment & Staff
Requirements
Space Requirements
Departmental Workloads
X X
561
Financial Analysis Diagram
From Resource
ProgrammingTo Plan
Capital Budget
Unit CostsResource
Requirements X
Operation Budget
562
Preparing a Business Plan
Business plan consists of the ff. major sections Executive summary Business history Product and services Market Competition Marketing Manufacturing and operations Management Financial projections
563
Executive Summary A description of the business
A description of the departmental management team, emphasizing the relevant experience and special skills of each key executive
A summary of key financial projections for the next three or five years
A summary of funding requirements outlining when and what purpose
564
Business History
A discussion of when the business was founded, its progress to date and a brief biographical sketch of the founders
The organizational structure
A discussion of the products and services that has been developed and marketed
565
Product or Services
Define precisely what the department intends to provides in terms of products and services
Should be written in language easily understandable by a lay person
Includes appendices, lengthy or detailed diagrams, technical documents, or descriptions
566
Market Because of comprehensive description of the
markets it’s important to management, to answer the ff. questions: Who are the users or customers? What is the historic or forecasted rate of growth for each
market segment or service provided? What are perceived future markets? How will each market segment be serviced? At what level of purchasing decisions made? How does each user/client purchase the product? What are the critical product/service characteristics?
567
Competition
Identify competitors, indicating special strengths, weaknesses and market share of each
Principal competitive factors in the marketplace should be cited Product performance Reliability Durability Service price
568
Marketing
Marketing goals Quantitative Realistic Consistent
Outline of methods used to monitor the market
569
Operations
Summarize the nature, quality and extent of available facilities
Indicate strengths and weaknesses of facilities
Timing, cost, extent and importance of any planned expansion and related financing issues should be included
570
Management
Emphasize the experience and competence of each key manger
Include when and how each position will be filled and the level of compensation
Include job description, compensation data, and detailed resumes on all managers who are already in place
571
Financial Projections
All of company’s sales, market, and cost projections Past financial statements Profit and loss statements Current financial statements Profit and loss projections on monthly and
quarterly basis
572
Organizing and Leading
Organizational Chart Before business plan be implemented, an
organizational scheme, framework or chart must be made
Job Description Develop job descriptions that clearly state the
educational and experience level required, the basic duties and the level of authority of the job
573
Organizing and Leading
Performance Appraisal “Weakness in human resource management can be traced to
an attitude that the worker is a cost factor to be minimized rather than as an evolving human resource that has to be educated” (Benett, 1987)
Performance appraisal could be effective if: It is a positive experience An objective process A partnership in development A joint responsibility A progressive review of the future An experience that concentrates on performance
574
Organizing and Leading
Evaluation of all technical employees centers on five major areas Job knowledge and skills
Departmental policies and procedures Medical terminology Codes and standards Equipment servicing
Quality of work Initiative/degree of supervision required Attendance Supervisory skills
575
Organizing and Leading
Leadership Situational leadership theory (Center for Leadership
studies, 1976) is based upon: Amount of direction (task behavior) a leader
gives Extent of one-way communication with employees to explain what
must be done, when, where and how it should be accomplished
Amount of socio/emotional support (relationship behavior) a leader provides Extent psychological support and facilitating behaviors
“Maturity” level that the employees exhibit on a specific task, function or objective Capacity to set high but attainable goals
576
Four Styles Situational Leadership Theory High task/low relationship behavior (S1)
Referred as “telling” One–way communication that defines the roles of followers
and tells them what, how, when and where to do various tasks
High task/high relationship behavior (S2) Referred to as “selling” Attempts two-way communication and socio/emotional
support to get the approval of the followers to decisions that has to made
577
Four Styles Situational Leadership Theory High relationship/low task behavior (S3)
Called “participating” Leader and follower share in decision-making
through two-way communication and much facilitating behavior from the leader
Low relationship/low task behavior (S4) Labeled “delegating” Letting followers “run their own show’
578
Quality Assurance and Risk Prevention Must document:
Corrective actions taken Assurance that the action was effective The need for continuation of monitoring
579
ControllingEvaluation and Identification of
Problem
Corrective Action
Documentation of Corrective Action
Monitoring of Effectiveness of Corrective Action
Documentation of Monitoring
Evaluation of Results of Monitoring
Concluding Report to Appropriate Staff
Report of Equipment
Failure /Problem
Input
Steps involved in a closed –loop quality control assurance review
580
Management Steps in Operating Quality Assurance and Risk Prevention Programs1. Assign responsibility
Assign overall responsibility for the program, specifying what indicators of performance will be used and who will collect data, evaluate service, take action and report findings
2. Define scope of service Specify services it will provide to the hospital
community
581
Management Steps in Operating Quality Assurance and Risk Prevention Programs3. Identify important aspects of service
Prioritize the defined scope of services
4. Identify indicators Identify indicators that will be used to define the
measurable, objective characteristics of each important aspect of service
582
Management Steps in Operating Quality Assurance and Risk Prevention Programs5. Establish thresholds
The level or point at which intensive evaluation of a service is triggered
Could be expressed as a percentage, ratio, or number
Define the level of service that is considered acceptable
Higher risk involved, the closer the threshold will be to 0 percent or 100 percent
583
Management Steps in Operating Quality Assurance and Risk Prevention Programs5. Collect and organize data
Data sources should include existing documents whenever possible
If data are not available, the following factors should be considered in selecting an appropriate data collection method:
Source of information Data is retrospective or concurrent Number in the sample Frequency of data collection Whether appropriate data have been used
584
Management Steps in Operating Quality Assurance and Risk Prevention Programs6. Evaluate service
When threshold is met, further evaluation is necessary
When threshold is not met, analyze data for the presence of certain trends to ascertain whether or not there are any deviations in the patterns of service
The goal is to improve service instead of asking what went wrong
585
Management Steps in Operating Quality Assurance and Risk Prevention Programs7. Take actions to solve identified problems
Identified problems should have a necessary corrective actions
Action plan should specify the following: What actions are expected to occur Who is responsible for the implementation When change is expected
586
Management Steps in Operating Quality Assurance and Risk Prevention Programs9. Assess actions and document improvement
If corrective action does not resolve the problem, action may not have address the actual problem and new action plan should be established
10. Communication and report information Unless information of Quality Assurance
activities are shared, much of their potential benefit can be lost
Excellence is seldom achieved alone
587
Management Steps in Operating Quality Assurance and Risk Prevention Programs Steps 1-5 – initial procedure of identifying
what to include in the program and identifying indicators and thresholds
Steps 6-10 – actual implementation and evaluation of the program
588
Quality Indicators
Compliance Measurement Degree of compliance with established schedules for
routine activities May be weighted by the sophistication or risk factor of the
equipment
Inspections performed Types of failures found during the inspections are the focus
of these indicator Specific measure is the numbers and types of failures
589
Quality Indicators
Documentation All work done by clinical engineering department
must be documented
Equipment repair Indicator for equipment repair includes:
Turnaround time of repairs Number of repeat failures Total downtime due to a repair Type and frequency of certain repairs
590
Productivity and Cost Control Controlling program cost is an important
function for clinical engineering manager
Two specific measures of cost control Employee productivity Expense versus revenue ratios
591
Methods Design to monitor and improve Productivity % Productivity
(Repair hrs + Prev. Maint. hrs +Other productive Work hrs.) x 100(Available hrs.)
% OvertimeOvertime hrs.Available hrs.
% Labor Recovery – shows how well the staff is charging for its service
Charged hrs.Available hrs.
592
Methods Design to monitor and improve Productivity Backlog Days – ave. amount of time needed to service
incomplete orders carried over
Carry over hrs.
Available hrs./day
Repair-Turnaround Days – ave. length of time a piece of equipment is out of the client’s department for repairs
Calculate by noting the time the receipt in the repair shop and time of equipment return to the client department
593
Technology Assessment
Challenges faced by those responsible for technology management Ensure that hospitals effectively assess the
impact of technology on all human services Make effective adjustments in planning to ensure
that any new technologies will better serve the organization’s mission
Compare technology-based options Gain knowledge from post-deployment
experiences
594
Technology Assessment
Technology assessment (National Institute of Health, 1985) Refers to assessing the results of clinical trials
and creating state-of-the-art reports on specific medical technologies
Consists of synthesizing complex scientific information in such a way that the reports are useful for decision making by practitioners or policymakers
Analysis of the effects of the introduction or widespread use of a technological innovation
595
Technology Assessment Stages of assessment of technology
Establish the feasibility of a technique Determine if it is safe and can produce technically
acceptable results
Establish the efficacy The performance of the technology is under ideal
conditions using selected patients
Test of effectiveness Economical appraisal
Concerned with the value of technology
596
Organization for Technology Assessment Food and Drug Administration (FDA)
Division of the Public Health Service, responsible for medical technology assessment
Regulates entry of drugs and medical devices, requiring manufacturers to demonstrate that their products are safe and efficacious
Charged with the protection of public health Requires that companies demonstrate safety and
efficacy
597
Organizations for technology assessment National Institutes of Health (NIH)
Sponsors clinical trials and conducting consensus development conferences on specific medical practice issues
Consensus development program organized by the Office of Medical Application Research (OMAR)
Office of Technology Assessment Acts as technology research and advisory source Assist congress in developing policies concerning medical
technologies
598
Organizations for technology assessment Health Care financing Administration (HCFA)
Responsible for administering Medicare and federal aspects of state Medicaid programs
Medical technology activities are mainly associated with coverage and reimbursement policies and, to a lesser content, research and demonstration
National Center for Health Services research and Health Care Technology Assessment Involved in technology assessment by sponsoring
extramural studies of technologies and by conducting intramural assessments
599
Organizations for technology assessment Prospective Payment Assessment
Commission Advise and assist both Congress and the
Secretary of Health and Human Services in maintaining and updating Medicare’s Prospective Payment System (PPS)
600
Improving the Use of Medical Technology Identify effective technologies
Determine the limits of appropriate use based on the sliding scale benefits and burdens
Determine affordable level of use
601
Most important concern in assessment of medical technology Efficacy
Probability of benefit to individuals in a defined population from a medical technology applied for a given medical problem under ideal conditions of use
Safety / Acceptable level of risk (Banta et al., 1981) Probability of an adverse or untoward outcome occurring
and the severity of the resultant harm to health if individuals in a defined population, associated with use of medical technology applied for a given medical problem under specified conditions of use
602
Factors important to a medical technology’s efficacy Benefit to be achieved (most complex factor)
Medical problem giving rise to the technology
Population affected
Conditions under which the technology is applied
603
Benefit to be achieved Diagnostic Technology
Facilitates the clinician’s ability to distinguish diseased from nondiseased persons or to assess the severity of disease
Factors to determine the diagnostic benefit Technical capacity: Does the device or procedure perform
reliably and deliver accurate information? Diagnostic accuracy: Does the test contribute to making the
accurate diagnosis? Diagnostic impact: Does the test result influence the pattern
of subsequent diagnostic testing? Does it replace other diagnostic tests or procedures?
Therapeutic impact: Does the test result influence the selection and delivery of therapy? Is more appropriate therapy used after application of the diagnostic test than would be used if the test was not available?
Patient outcome: Does the performance of the test contribute to the improved health of the patient?
604
Benefit to be achieved Therapeutic Technology
Benefits to be achieved include improvement in morbidity, mortality and life expectancy as consequences of a particular technology’s ability to correct physiology and control pathology.
Dimensions of the improvement of patient’s quality of life Whether patient will be able to return to a baseline of
functioning Degree of relief from expected symptoms Requirements of the treatment Psychological effects of the technology: the short-term as well
as the permanent long-term changes that may ensue Understanding the quality of life issue is the effect of the new
technology on self-image
605
Medical Conditions Giving Rise to Use of Technology
“A technology’s efficacy can be evaluated only in relation to the disease or medical conditions for
which it is applied” – Banta et al, 1981
Range of medical conditions for which a particular technology is beneficial must be established empirically
Use of a technology in ways that maximize benefits to patients and minimize their risk of harm requires knowing as precisely as possible the ailment for which it is best applicable
606
Population Affected Effect of a medical technology varies, depending on
the individual treated
It is important to determine whether its efficay is stable for all populations who suffer a condition or range of conditions
A technology may be highly efficacious for some populations and far less so for others even for the same ailment
Knowing how a technology’s efficacy varies across different patient populations is central to avoiding harmful use and maximizing benefits to patients
607
Conditions Under which Technology is Applied The outcome of the application of a medical
technology partially determined by: Skills, knowledge, and abilities of physicians, nurses and
other health-care personnel Quality of the drugs, equipment, and institutional settings Support systems used by those personnel during the
application
Evaluation must continue beyond those optimal conditions to the less ideal conditions under which many, perhaps most, patients receives health-care
Complete evaluation of a technology must determine effectiveness as well as efficacy
608
Methods of Technology Assessment Two ways to validate technology (McDermott,
1977)
Randomized Clinical Trials (RCTs) Provide only a portion of a currently studied group with
the technological intervention; the individuals in the total group are selected randomly
Method of Natural History Provide the technological intervention to a consecutive
series of persons with the disorder, and the nature and extent of change in the disorder from its previous characteristic behavior serves as the basis for evaluation
609
Randomized Clinical Trials (RCTs) Important features of RTCs
Control group reduces the likelihood of bias systematically infecting
evaluation of a new technology Provides a set of responses with which the effects of the use
of a specific technology can be compared
Random assignment of patients between the control group and the experimental group Protects treatment comparisons from being rendered invalid
by biased assignment of individuals to the two groups Ensures that the two groups are identical with respect to all
relevant factors except treatment, even when some of those factors are unknown
610
Mini-Case
611
Mini-Case: select a host hospital and do the following Interview the hospital manager / director and
determine how the hospital plan, prepare a business plan, organize and lead the organization.
Make an analysis on the planning process of the hospital, preparation of business plan, organizing and leading: identify the strengths, problems or difficulties and make recommendations to solve these problems
612
Mini-Case: select a host hospital and do the following Determine the method on how they monitor
their productivity and efficiency. Get at least 3 months data and analyze. Based on the analysis, make recommendations as well.
613
Mini-Case: select a host hospital and do the following On technology assessment
Ask the steps on how they keep updated with technology. Analyze the process.
Identify the factors important to a medical technology’s efficacy
614
References
Bronzino, J.D. (Ed.). (1992). Management of medical technology: a primer for clinical engineers. Boston: Butterworth-Heinemann
Webster, J.G. & Cook, A.M. (Ed.). (1979). Clinical engineering: principles and practices. Englewood Cliffs, N.J..: Prentice-Hall, Inc.
615