NYU/Wagner
Course: Health Care Management: Part 1 P11.4833
Faculty: Kovner
Class Meeting Time: Wednesday 04:55 PM-06:35 PM Location: Silver Center for Arts and Science Rm. 701
HEALTH SERVICES MANAGEMENT – Part I
This course is intended for graduate students and is about learning how to manage in health care organizations (HCOs). The prerequisites for this course are:
– P11.1020 - Managing Public Service Organizations – P11.1830 - Community Health and Medical Care
Students lacking the prerequisites must have work experience in HCOs. RELATED HEALTH MANAGEMENT COMPETENCIES ADDRESSED IN THIS COURSE:
• The ability to examine and synthesize data, use information systems and apply evidence-based management principles to organizational analysis, problem-solving and strategic decision-making
• The ability to measure, monitor and improve safety, quality, access and system/care delivery processes in health care organizations LEARNING OBJECTIVES:
• At the end of Part I, students will have acquired a knowledge base and skill set that enables evaluation of statistical, financial, economic and cost-effectiveness information and the ability to:
• Apply the principles of evidence-based management to decision-making in a health care organization.
• Evaluate the governance, organizational and accountability structures of various forms of health care systems, particularly in non-profit organizations.
• Critically evaluate clinical, financial and strategic performance in acute and chronic care delivery systems.
• Implement performance control and accountability systems in health care organizations.
COURSE TEXTS AND RECOMMENDED READINGS: Required:
• Kovner AR, McAlearney A, Neuhauser D eds. Health Services
Management: Readings, Cases and Commentary. 9th ed. Chicago, IL:
Health Administration Press, 2009.
• Bohmer RMJ. Designing Care: Aligning the Nature and Management of Health Care. Boston, MA: Harvard Business Press, 2009.
• P11.4833 CoursePack.
Recommended: (Available on Reserve at Bobst Library)
• Berry LL and Seltman KD. Management Lessons From the Mayo Clinic. New York, NY: McGraw-Hill, 2008.
• Kovner AR, Fine DJ, D’Aquila R. Evidence-Based Management in Healthcare. Chicago, IL: Health Administration Press, 2009. Health Care Management Journals:
• The Journal of HealthCare Management. Health Administration Press, One North Franklin Street, Chicago IL, 60606-3451.
• Health Care Management Review. Aspen Systems Corp., 20010 Century Blvd., Germantown MD, 20767.
• Journal of Health Administration Education. AUPHA, 1911 N Ft. Myer Drive, Arlington VA, 22209.
• Frontiers of Health Services Management. Health Administration Press, One North Franklin Street, Chicago, IL, 60606-3451.
COURSE SESSIONS: Session 1: Control
• Course Expectations/Syllabus • Evidence-Based Management • Readings:
o Kovner AR, Rundell T. Evidence-Based Management
Reconsidered. In: Kovner AR, McAlearney A, Neuhauser D eds. Health Services Management: Readings, Cases and
Commentary. 9th ed. Chicago, IL: Health Administration Press, 2009 (KMN9):7-33.
o Griffith JR. Finding the frontier of hospital management.
Journal of Health Care Management. 2009;54(1):57-73. On Blackboard.
o Kovner AR, Kaplan DM. Case A: A new faculty practice
administrator for the Department of Medicine. In: KMN9:37-50.
• Discussion Question (DQ): What is the usefulness of evidence-based management to health care managers?
Session 2: Control • Governance
• Using information to improve performance • Incentives
• Readings:
o Spath P. Taming the measurement monster. In: KMN9:89-105. o McDonagh KJ. Hospital governing boards: a study of their
effectiveness in relation to organizational performance. J
Healthcare Mgmt. 2006; 51(6):377-391. On Blackboard.
o Rosenthal, MB, Dudley, RA, Pay for Performance: will the latest
payment trend improve care? JAMA. 2007; 297 (7): 740-4. On Blackboard.
o Inamdar I, Kaplan R. Applying the balanced scorecard in healthcare
provider organizations. J Healthcare Management. 2002; 47(3): 179-195. On Blackboard.
o Kovner AR. Short Case 10: Financial reporting to the Board. In:
KMN9:143-147.
o McAlearney AS. Case D: An information technology implementation
challenge. In: KMN9: 108-115.
• DQ: How should health care leadership measure organizational performance?
Session 3: Organizational Design • Managing Acute Care • Readings:
o Bohmer RMJ. Designing Care: Aligning the Nature and
Management of Health Care. Boston, MA: Harvard Business Press, 2009.
o Cohn K, Friedman LH, Allyn TR. Tectonic plates are shifting:
cultural change vs. mural dyslexia. In: KMN9:219-239.
o Lin DQ. Convenience care clinics: opposition, opportunity, and
the path to health system integration. In: KMN9:159-173.
o Shaffer D. Case 3: Healthier babies in Twin Falls, Idaho. In:
Kovner AR, Neuhauser D, ed. Health Services Management: Readings, Cases and Commentary. 8th ed. Chicago IL: Health Administration Press; 2004:96-106. In Course Pack.
o Anonymous. Case O: Letter to the CEO. In: KMN9:380-387.
• DQ: What is the relationship between organizational design and HCO performance?
Session 4: Control
- DUE THIS CLASS – ASSIGNMENT 1: Consultant Report • Performance Management & Improvement
• Guest Speaker
o To be announced
• Reading:
o Bradley EH, Holmboe ES, Mattera JA, et al. The roles of senior
management in quality and performance improvement efforts: what are the key components? J Healthcare Mgmt.
2003;48(1):15-29. On Blackboard.
• DQ: How should health care leadership manage organizational performance?
Session 5: Organizational Design • Managing Chronic Care • Readings:
o Rundell TG, Shortell SM, Wang MC, et al. As good as it gets?
Chronic care management in nine leading US physician organisations. BMJ. 2002;325:958-961. On Blackboard.
o Bodenheimer T, Lorig K, Holman H, et al. Patient
self-management of Chronic disease in primary care. JAMA. 2002;288(19):2469-2475. On Blackboard.
o Robinson J. The end of managed care. JAMA. 2001; 285(20):
2622-28. On Blackboard.
o Nunberg H. Case H: The future of disease management at
Superior Medical Group. In: KMN9:183-193.
o Struk C. Case F: Evidence-based quality care in a home care
organization. In: KMN9:124-137.
• DQ: Managing organizations, or managing care? Session 6: Organizational Design
• Managing with Clinicians • Readings:
o Tucker AL, Edmondson AC. Why hospitals don’t learn from
failures: organizational and psychological dynamics that inhibit system change. California Management Review.
2003;45(2):55-72. On Blackboard.
o TCAB. A New Era in Nursing. Transforming Care at the Bedside.
The Robert Wood Johnson Foundation and the Institute for Healthcare Improvement. On Blackboard.
o Kovner AR. Case K: Managing relationships: taking care of your
nurses,” In: KMN9:287-292.
o Kovner AR. Case J: Physician leadership: MetroHealth System
of Cleveland” In: KMN9:265-287.
o Weiss J. Short Case 13: A hospitalist program for Plateau
University Hospital. In: KMN9:204-207.
o Kalkut G. Short Case 20: Building the Office of the Medical
Director. In: KMN9:294-295.
• DQ: What do clinicians expect from hospitals, and why don’t get what they expect?
Sessions 7: Organizational design
– DUE THIS CLASS – ASSIGNMENT 2: Control Paper • Models of Accountable Programs
• Readings:
o Griffith JR, White KR. The revolution in hospital management.
o McCarthy D, Mueller K. Organizing for higher performance:
case studies of organized delivery systems, series overview, findings and methods. Commonwealth Fund. July 2008. On Blackboard.
o Oliver A. Public-sector health-care reforms that work? A case
study of the US Veterans Health Administration. Lancet. 2008; 371: 1211-13. On Blackboard.
o Longman P. The best care anywhere. The Washington Monthly.
2005; 37: 38-48. On Blackboard.
o Gawande A. Annals of Medicine: the checklist: if something so
simple can transform care, what else can it do? The New Yorker. December 10, 2007. On Blackboard.
• DQ: What opportunities exist for health systems to become more accountable for quality, access, health outcomes and cost?
ASSIGNMENTS – Part I Written Assignment 1 – Consultant Report
Be a consultant to a manager in an organization. Do this for a real organization or for an organization taken from a Case Study in Kovner, McAlearney, Neuhauser. Discuss the current accountability system, its strengths and weaknesses. Make recommendations to the manager to improve the organizational unit; include a discussion of constraints and opportunities for implementation.
The report should be approximately 3-5 pages, double-spaced, in length. Tables or charts describing current performance and recommended
measurement tools should be included as an appendix. Cite references as appropriate.
Written Assignment 2 – Control Paper
Complete as a 2-person team. For the unit in which one of you work, or for some other health unit, write a memo addressed to the unit director, specifying:
1. How well is the unit performing, and how can you tell if the unit is performing well?
2. In what ways is the unit's director accountable for achieving the objectives? What is the information used top measure current performance? What incentives are used to affect attainment of objectives?
3. Evaluate the strengths and weaknesses of the control system.
4. Make feasible recommendations to improve the control system. Discuss opportunities and constraints for implementation.
The paper should be about 8 double-spaced pages in length. Forms used for control purposes can be added as an appendix, as appropriate.
GRADES:
Grading Weight: % Due
Consultant Report 1/3 Week 4
Control Paper 1/3 Week 7
HEALTH SERVICES MANAGEMENT – Part II
This course is intended for graduate students and is about learning how to manage in health care organizations (HCOs). The prerequisite for this course is:
– P11.4833 - Health Services Management-Part I
RELATED HEALTH MANAGEMENT COMPETENCIES ADDRESSED IN THIS COURSE:
• The ability to understand and apply legal and ethical principles when leading health care organizations
• The ability to apply statistical, financial, economic and
cost-effectiveness tools and techniques to organizational analysis and strategic decision-making
• The ability to manage teams, projects and people, and lead and transform health care organizations
• The ability to communicate and interact productively (via listening, speaking and writing) on matters of healthcare with a diverse and changing industry, work force and citizenry
• The ability to engage in continuous learning; to reflect on and assess one’s strengths and developmental needs; to seek feedback from others; and establish and sustain a professional development network
LEARNING OBJECTIVES:
At the end of Part II, students will have demonstrated the ability to: • Design a strategic and marketing plan for health services
organizations, particularly in non-profit organizations.
• Recognize how health care organizations assess and adapt to change, and evaluate health services strategic and marketing plans.
• Apply ethical principles to clinical and administrative decision-making in health care organizations
• Better manage their career, understand the constraints/opportunities facing them.
• Work better with others on team projects, and using their critical thinking and written and oral communication skills.
COURSE TEXTS AND RECOMMENDED READINGS: Required:
• Kovner AR, McAlearney A, Neuhauser D eds. Health Services
Management: Readings, Cases and Commentary. 9th ed. Chicago, IL: Health Administration Press, 2009.
• Collins JC. Good to great and the social sectors: why business thinking is not the answer: a monograph to accompany Good to great: why some companies make the leap—and others don’t. Boulder, CO: J Collins, 2005.
• P11.1833 CoursePack.
Recommended: (Available on Reserve at Bobst Library)
• Berry LL and Seltman KD. Management Lessons From the Mayo Clinic. New York, NY: McGraw-Hill, 2008.
• Griffith JR, White KR. The well managed healthcare organization. 6th ed. Chicago, IL: Health Administration Press, 2009.
Health Care Management Journals:
• The Journal of HealthCare Management. Health Administration Press, One North Franklin Street, Chicago IL, 60606-3451.
• Health Care Management Review. Aspen Systems Corp., 20010 Century Blvd., Germantown MD, 20767.
• Journal of Health Administration Education. AUPHA, 1911 N Ft. Myer Drive, Arlington VA, 22209.
• Frontiers of Health Services Management. Health Administration Press, One North Franklin Street, Chicago, IL, 60606-3451.
COURSE SESSIONS: Session 8: Adaptation
• Strategy
• Meeting Community/Population Need • Readings:
o Begun J, Heatwole KB. Strategic cycling: shaking complacency
in healthcare strategic planning. In: KMN9:301-316.
o Foreman S. Montefiore Medical Center in the Bronx, New York:
improving health in an urban community. Academic Medicine. 2004;79(12):11541161. On Blackboard.
o Allinder E, Dopoulos J, Pfotenhauer B, et al. Case Study N: An
investment decision at Central Medical Health System. In: KMN9:342-348.
• DQ: What are main obstacles facing managers seeking to implement strategic plans, and how may these be overcome?
Session 9: Adaptation • External Marketing • Readings:
o Berry LL, Bendapudi N. Clueing in customers. Harvard Business
Review. 2003;81(2):100-106. On Blackboard.
o Griffith JR, White KR. The Well-Managed Healthcare
Organization. 6th ed. Chicago: Health Administration
Press;2006. Chapter 15: “Marketing and Strategy,” pp585-631. In Course Pack.
o Spector H. Cleveland Clinic's new look: more than just a pretty
face. Medical News: Northeast Ohio Medical Industry, Hospital and Health Care News. Sept 07, 2008. On Blackboard.
o Burt N, McAlearney AS. Case I: Selling an evidence-based
design for Waterford Hospital,” In: KMN9:194-202.
o Neuhauser D. Case L: The Visiting Nurse Association of
Cleveland. In: KMN9:318-328.
• DQ: What kinds of marketing work best for increasing market share?
• Readings:
o Collins JC. Good to great and the social sectors: why business
thinking is not the answer: a monograph to accompany Good to great: why some companies make the leap—and others don’t. Boulder, CO: J Collins, 2005.
o Studer Q. Build a culture around service. In: Studer Q.
Hardwiring Excellence. Gulf Stream FL, Fire Starter:2003:75-106. In Course Pack.
o Berwick DM. My right knee. Ann Intern Med.
2005;142(2):121-125. On Blackboard.
• DQ: How does a CEO change an organization from good to great? Session 11: Adaptation
- DUE THIS CLASS – ASSIGNMENT 3: Career Objectives Paper • Guest Lecturer
o To be announced
• Organizational adaptation, strategic planning and organizational marketing – a leader’s view
• Reading:
o Griffith JR, White KR. The Well-Managed Healthcare
Organization. 6th ed. Chicago: Health Administration Press; 2006. Chapter 14: “Planning and Internal Consulting” pp551-584. In Course Pack.
• DQ: What is the role of a health care leader in keeping large and diverse groups of staff and stakeholders, often with conflicting agendas, aligned toward the mission?
Session 12: THE PROFESSIONAL MANAGER • Organizational Ethics
• Readings:
o Nelson WA. An organizational ethics decision-making process.
Healthcare Executive. 2005;20(4):9-14. On Blackboard.
o Nelson WA, Campfield J. The ethics of hospital marketing.
Healthcare Executive. 2008; 23(6): 44-45. On Blackboard.
o Lutz S. Transparency – “Deal or No Deal?” In: KMN9:363-376. o McAlearney AS, Song P. Case Q: What happens when patients
cannot pay? In: KMN9:405-408.
• DQ: What role does institutional culture and ethics play in shaping strategic planning and decision-making?
Session 13: THE PROFESSIONAL MANAGER
- DUE THIS CLASS – ASSIGNMENT 3: Adaptation Paper • Management Ethics
• Readings:
o Weber LJ. Business ethics in healthcare: beyond compliance.
Indianapolis IN: Indiana University Press; 2001: 3-22. On Blackboard.
o Kovner AR. Case P: Whose hospital? In: KMN9:387-405. o Spencer Foreman, MD In First Person: An Oral History.
Interviewed by Larry Walker. On November 14, 2007. Edited by Kim M. Garber. Sponsored by AHA Center for Hospital and Healthcare Administration History and Health Research and Education Trust. Chicago, IL. 2008. On Blackboard.
• DQ: How does a CEO manage ethically? Session 14: THE PROFESSIONAL MANAGER
• Managing Your Career • Readings:
o Melman D. Short Case 1: Nowhere job. In: KMN9:68-69.
o Agoritsas S. Short Case 2: Manager morale at Uptown Hospital.
In: KMN9:69-71.
o Kaplan DA, Kovner AR. Short Case 3: A sure thing. In:
KMN9:72-75.
o McAlearney AS. Short Case 4: The first day. In: KMN9: 75-76. o Victory J. Short Case 5: Mid-career change. In: KMN9:76-78
• DQ: Where is the health care enterprise going and how will this affect your career?
WRITTENASSIGNMENTS: A. Career Objectives
Write a 3-5 page paper on your career objectives and how you plan to implement them. Please enclose a copy of your latest resume. Include
family issues as relevant. It should be a personal guide for your professional development. Share this paper with another member of the class and
integrate his or her feedback into what you have to say. Discuss the following:
1. Current experience in terms of managerial roles, skills, and values. (Include an assessment of your strengths and weaknesses.)
2. A specific desired job within 3 - 5 years. (What skills and experience are required to obtain and excel in the desired job?)
3. Specific plan to address the weaknesses that you have identified and describe the steps that you plan to take to achieve your desired 3-5 year goal.
B. Adaptation/Strategy
Complete as a three person team. Your task is to develop a strategic plan for the unit of, or for a small health care organization. This can be a real organization or one you dream up. Whatever you choose, it must be
reasonably realistic. Include a one-page appendix signed by all members of the team specifying who completed what tasks involved in writing this paper.
Examine the following issues:
• What is the organization’s mission? Who does it actually serve? What is current performance?
• Develop three measurable objectives for next year's performance for the unit and a rationale for these objectives.
• Develop a strategy to achieve each objective and a rationale for the strategy.
• Describe obstacles to implementing the strategies and what you recommend to overcome the obstacles.
• Prepare a 2 page annotated bibliography (8 to 10 references) that applies to your findings and recommendations. Focus on studies in which evidence is analyzed rather than on opinion pieces. You may consult the general management as well as the health care
management literature. Specify what the reading is about and why it is or is not useful how to the manager.*
The Adaptation paper should be 8-10 pages (double-spaced), with appendices, as appropriate.
Journals you may wish to review:
• Academy of Management Review • Health Care Financial Management • Medical Care Review
• Health Care Management Review • Harvard Business Review
• Frontiers of Health Services Management • Journal of Healthcare Management
• Joint Commission Journal on Quality and Safety • Milbank Memorial Quarterly
• The New England Journal of Medicine • Health Affairs
GRADES:
Grading Weight: % Due
Career Objectives 1/3 Week 11
Adaptation 1/3 Week 13
