Angela Jukkala, PhD, RN, CNL University of Alabama at Birmingham

 Primary role of nursing was patient care  Nursing and finance believed to be separate

 P4P  Complexity of care

 Management functions ◦ Planning ◦ Control ◦ Decision making

 Consider possible options  Provides direction  Evaluate progress  Essential elements ◦ Strategic planning ◦ Budgeting

 Once a plan is developed, it must be implemented!  Refers to the managerial tasks related to ensuring the plan is carried out as close to the original plan as possible.

 Over-riding role of management  Someone has to have decision-making authority  Change

 Organizational chart

 Not part of the organizations official structure  Can be as important as formal lines of authority  Based on: ◦ History of the organization ◦ Key players in the organization ◦ Resources controlled by various players

 Planning, control, and decision making reside with a few individuals at the top level of the organization. ◦ Often far from the point of care ◦ Needs to be knowledgeable ◦ Not necessarily “do-able” in today’s healthcare environment.

 Planning, control, and decision-making occur much closer to the point of care.  Greater number of individuals  Enhances the development of unit managers  Information needed is more accessible  Ability to decentralize exceptions to rules  Timeliness

 Top has to relinquish power  Must have organizational information systems  Ensuring regulatory compliance  Active communication required  Commitment to education

 Varies  Decentralization  Must haves: ◦ Budgeting ◦ Applied economics ◦ Health care finance ◦ Inventory control ◦ Skill in planning, control and decision making

 Does a high level of clinical expertise guarantee success?  Need education ◦ Formal ◦ Informal

 Lateral relationships  Strained  Relationships

 People  Is the best interest of the organization always in the best interest of the individual?  Goal congruence  Incentives

 Control of information about revenues, expenses and operations is key.  Aware of your role in engaging staff in financial management.  Need the requisite knowledge and skill to be successful.

Dartmouth

 What is a microsystem?  A small group of people who work together on a regular basis ◦ Care delivery: Provide care to discrete subpopulations ◦ Education: Provide learning to a subset of students (Batalden, Nelson, Johnson, Godfrey)  Examining Microsystem performance

 Clinical and business aims  Linked processes  Shared information environment  Produce performance outcomes  Evolve over time and are (usually) embedded in larger organizations

Birmingham UAB ER Cardiac Surgery Team LAB

 Constancy of purpose  Investment in improvement  Alignment of role and training  Interdependence of the (care) team  Integration of information  Measurement systems  Supportiveness of the larger system  Connection to the community

 Organizations with these characteristics perform better - Are better places to work  Provides direction for action ◦ Establish constancy of purpose ◦ Align objectives ◦ Get everyone involved ◦ Provide training ◦ Promote interdependence  Community vis a vis autonomy

 Form Interdisciplinary Team  Assessment ◦ Purpose ◦ Patients ◦ Professionals ◦ Patterns ◦ Processes ◦ Metrics that Matter  Diagnose  Treat  Evaluate

Who needs to be on this team?

 Mission statement?  Does everyone agree?  Why do you need to agree?

 What population does your microsystem serve?  Are they satisfied?

 Who are the professionals on your unit?  What skills do they have?  What skills do they feel they need?  Are they satisfied?

 What repetitive patterns occur on your unit that disrupt care and or quality?  Phone calls  Medication “runs”

 Examine the processes that occur on your unit.  What is going well?  What not so well?

 Benchmarking  What are the challenges with rural benchmarking?  Do you feel national benchmarks are always relevant?

 Evidence based intervention