2.09 (R) [INFO] Topic 4. Healthcare Administration Frameworks
Topic 4. What administrative/management frameworks are used in healthcare administration? Evidence-based healthcare administration strives to use the best healthcare administration practices – based on the evidence – to achieve specified healthcare organizational outcomes. Such practices often relate to strategy frameworks (a.k.a., models, theories) and tactics frameworks (a.k.a., models, theories). Every organization has strategic and tactical goals and objectives. Achievement of these goals and objectives leads to achievement of the specified organizational outcomes. The combined strategy and tactics frameworks used to achieve the goals and objectives - and thus specified outcomes - are often called administrative/management frameworks. This section addresses: Overview of the Origins of Administrative/Management Frameworks Administrative/Management Frameworks Used in Healthcare Administration Note [FUN]: Links within this section lead to external [FUN] readings not needed for the certificate work. You do not have to visit these external links. Do so only if you have the interest and the time. Note [CERT]: Pay attention to the text in bold. It just may be included on the [CERT] Lesson Two Quiz. Overview of the Origins of Administrative/Management Frameworks Most human groups have strategic goals and objectives both formal and informal. So at some level strategy frameworks and tactical frameworks have existed as long as there have been humans living in groups. However, specified frameworks to achieve organizational goals and objectives to achieve specified outcomes are fairly recent in human history. Such administrative/management frameworks have their foundation in the Industrial Revolution which is generally considered to be the time period between 1760 and 1830. The Industrial Revolution brought about the urbanization – the movement of people away from rural areas to cities – of many countries including the United States. People moved to cities because there was work in the cities – the Industrial Revolution brought new manufacturing processes and new jobs. The first factory in the United States is generally considered to be the textile factory established by Samuel Slater in 1793 in Pawtucket, Rhode Island. In the United States, the population became urban-majority (more people living in cities than in rural areas) sometime between 1910 and 1920. The number of family farms in the United States peaked at 6.4 million in 1910. With factories and urbanization came an interest in administrative/management frameworks. Adam Smith is credited with laying the foundation of modern administrative/management frameworks in his observation that division of labor (each person is responsible for a specific task) increases productivity. He published this observation in An Inquiry into the Nature and Causes of the Wealth of Nations in 1776. This publication, which is often referred to as the Wealth of Nations , is considered the foundational publication for modern economics. The Wharton School, established in 1881 at the University of Pennsylvania, is recognized as being the world's first college/university-based business school. The first comprehensive management framework/theory is generally credited to Frederick Winslow Taylor with his publication in 1911 of The Principles of Scientific Management. A brief overview of the evolution in administrative/management frameworks can be found in the article entitled Management's Three Eras: A Brief History. Administrative/Management Frameworks Used in Healthcare Administration A reasonable question to ask is whether the administrative/management frameworks developed for non-healthcare organizations apply to healthcare organizations. Do the Principles of Scientific Management, for example, improve productivity in healthcare organizations? The Institute for Healthcare Optimization believes that they do. The Institute's “main goal is to facilitate wider adoption of scientific management practices in healthcare”. The authors of Medical Taylorism are not as convinced. There is disagreement as to whether the frameworks apply because there is disagreement as to whether the workflow processes of healthcare organizations are sufficiently similar to those found in manufacturing for manufacturing administrative/management frameworks to be successfully applied in healthcare administration. The health care delivery workflow process is the way in which the people in the healthcare organization (large or small) process customers (patients): 1) when they arrive, 2) are provided health care, and 3) when they leave. For healthcare organizations, this is the "manufacturing process"; the process by which the organization's "products" are "manufactured". Some may consider it odd to think of the health care delivery workflow process in terms of the manufacturing workflow process, but some healthcare organizations have successfully used manufacturing administrative/management frameworks (e.g., scientific management) to improve health care delivery. Two other commonly used manufacturing-related frameworks are Six Sigma developed at Motorola and Lean which was originally developed as the Toyota Production System. More information about the Lean System can be found at the Lean Enterprise Institute (LEI) website. Some people advocate a combination of the two frameworks such as those at the Lean Six Sigma Institute (LSSI). Note [FUN]: The video for Topic 4 - An Introduction to Lean Thinking - is a YouTube video produced by the Washington State Department of Revenue Lean Transformation Office and Taxpayer Services Communication. It provides an overview of the Lean strategy and compares it to traditional management. There are many articles and reports on the Six Sigma and Lean applications to healthcare organizations. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: Lean Management – The Journey from Toyota to Healthcare How a Manufacturing Process Transformed Healthcare Delivery The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research Lean and Six Sigma in Acute Care: A Systematic Review of Reviews (PubMed Abstract Only) Another popular framework with relevance to healthcare administration is the Art of War written by Sun Tzu 2500 years ago. Technically, the Art of War is a book on military strategy, but it has become popular as an administrative/management framework. A free copy of the book as translated by Lionel Giles can be found at the Internet Classics Archive, The Art of War. The book and framework are popular because of the similarity between military operations and organizational functioning regarding the importance of strategic and tactical goals and objectives. Achievement of these goals and objectives leads to achievement of the specified outcomes - whether they be military outcomes or organizational outcomes. A strategy is the overall plan for achieving the outcomes. A tactic is the specific action taken to achieve the outcomes. Below are some of the Sun Tzu quotes related to strategy and tactics. "All men can see the tactics whereby I conquer, but what none can see is the strategy out of which victory is evolved." "He who can modify his tactics in relation to his opponent and thereby succeed in winning, may be called a heaven-born captain." "The general who thoroughly understands the advantages that accompany variation of tactics knows how to handle his troops." There is also a popular quote mis-attributed to Sun Tzu which sums up the relationship between strategy and tactics: “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.” There are many articles and reports on Sun Tzu's Art of War applications to healthcare organizations. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: The Art of War Adapted to U.S. Medicine 2011 Sun Tzu and The Art of War: Implications for the Healthcare Professional (PubMed Abstract Only) A common healthcare administration strategy decision is what to do about healthcare organization silos? Organizational silos exist when members of departments have a primary loyalty and identification with their department and departmental co-workers rather than with the organization as a whole. Members of a silo do not like to share resources (e.g., information, supplies, ideas) with those outside the department. Such independent departments are often termed “silos” and, in healthcare organizations (of all sizes and purposes), silos are the norm. There are two basic strategies for dealing with silos: 1) reduce or eliminate silos; or 2) connect and manage silos. In the first situation (reduce or eliminate), silos are considered bad and an organizational flaw. It is thought that silos must be eliminated if the healthcare organization is to function well. This approach agrees with the Business Dictionary which states that a Silo Mentality “will reduce efficiency in the overall operation, reduce morale, and may contribute to the demise of a productive company culture.” The overall goal in this situation is to blur departmental boundaries and encourage people to identify with the healthcare organization as a whole rather than with their department or healthcare profession. The focus on interprofessional education and practice in healthcare organizations is an attempt to reduce or eliminate healthcare silos. The National Center for Interprofessional Practice and Education is a resource for more information on such interprofessional healthcare efforts. In the second situation (connect and manage), silos are considered good or at least a functional outcome of an organization comprised of highly specialized and trained professionals. It is thought that silos must be networked and managed – but not eliminated – if the organization is to function well. The overall goal in this situation is to connect and network silos to build bigger and bigger silos. Departments, for example, are networked to build a division. Divisions are networked to build an organization. Each silo is encouraged to be a high functioning unit (team) networked to other units (teams); the organization is a team-of-teams. This approach is based in the application of a military strategy as published by General Stanley McChrystal in his book Team-of-Teams: New Rules of Engagement for a Complex World. It is the framework used by McChrystal Group when consulting with many organizations including healthcare organizations. There are many articles and reports on strategic and tactical approaches to silos in healthcare organizations. You may find the ones listed below interesting and relevant to this question. Each is optional; you do not have to read it. They are: Better Patient Flow Means Breaking Down the Silos Breaking Down Silos to Improve Patient Flow, Hospital Efficiency Breaking Down Silos: Enhancing Care Coordination Quashing the Silos and Getting to Integrated Health Care Breaking Down Silos Is a Myth, Do This Instead The Need for a Team of Teams It Takes a Team of Teams to Transform Healthcare Fixing Healthcare Safety: Team of Teams
