Chapter 13 Organizational Performance: Managing for Efficiency and Effectiveness

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 2 Purpose and Overview Purpose –To review assessing organizational performance –To compare and contrast approaches to quality assurance and quality improvement –To describe strategies to achieve an effective health care organization

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 3 Purpose and Overview Overview –The Challenge of Performance –Issues in Assessing Effective Performance –The Manager's Role in Creating High- Performance Health Care Organizations

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 4 The Challenge of Performance Health Care Organizations –Operate with constrained resources –Maximize productivity, quality, and market share –Contain costs and minimize ineffective services

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 5 The Challenge of Performance Managers must: –Adapt organizations to ever-changing environment –Innovate rather than passively react

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 6 The Challenge of Performance Aspects of Organizational Performance Assessment –Efficacy –Appropriateness –Effectiveness

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 7 The Challenge of Performance Aspects of Organizational Performance Assessment –Productivity –Efficiency –Organizational Effectiveness –Cost-Effectiveness

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 8 The Challenge of Performance Factors Associated with Increased Productivity and Efficiency –High standard and goals –Information and feedback –Interdepartmental coordination and resource sharing

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 9 The Challenge of Performance Factors Associated with Increased Productivity and Efficiency –Compensation systems oriented toward rewarding productivity or efficiency –Physician involvement in decision making and governance

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 10 The Challenge of Performance Factors Associated with Increased Productivity and Efficiency –Concentration of staff work and activity –Active governing boards that deal with environmental pressures

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 11 The Challenge of Performance Factors Associated with Increased Productivity and Efficiency –Type of ownership –Chain ownership and contract management –Degree of system integration

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 12 Issues in Assessing Effective Performance Issues in Organizational Assessment –Fundamental perspectives –Domain of activity –Stakeholders

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 13 Issues in Assessing Effective Performance Issues in Organizational Assessment –Different levels of analysis The organization itself Larger social unit that contains the organization Subunits contained within organization

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 14 Issues in Assessing Effective Performance Technical Issues in Assessment –Classes of measures Structural Process Outcome

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 15 Issues in Assessing Effective Performance

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 16 Issues in Assessing Effective Performance

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 17 Issues in Assessing Effective Performance

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 18 Issues in Assessing Effective Performance Technical Issues in Assessment –Preferences for classes of performance measures Managers: structural Caregivers: process Clients: outcomes or results

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 19 Issues in Assessing Effective Performance Technical Issues in Assessment –Factors associated with effective performance Quality of professional staff High standards Experience with cases of same type Organized professional staffs and conflict management processes

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 20 Issues in Assessing Effective Performance Technical Issues in Assessment –Factors associated with effective performance Participative cultures with team approaches Timely and accurate performance feedback Management of environmental forces

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 21 Issues in Assessing Effective Performance Managerial Issues in Assessing Performance –Old model Quality relegated to quality assurance department –New model Quality improvement teams

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 22 Issues in Assessing Effective Performance Managerial Issues –Model for evaluating professional performance Autonomous Heteronomous Conjoint Modern health care is moving toward conjoint model

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 23 Issues in Assessing Effective Performance Managerial Issues –Model for evaluating nonprofessional work Bureaucratic model Performance appraisal typically assigned to a supervisor Interdisciplinary teams increasingly utilized

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 24 Issues in Assessing Effective Performance Managerial Issues –Impact of evaluation on all performers Expected to have effects on performance Evaluations are ideally accurate

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 25 Issues in Assessing Effective Performance Two Models for Changing Performance –Quality assurance Formal and systematic exercise to identify problems –Quality Improvement (QI) Management philosophy in which the customer is central Process-focused

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 26 Issues in Assessing Effective Performance

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 27 Issues in Assessing Effective Performance Precautions when Designing QI Strategy –Use physicians’ time wisely –Peak physicians’ interests –Empower physicians’ participation

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 28 Issues in Assessing Effective Performance Precautions when Designing QI Strategy –Respect professional values –Capitalize on progress units and groups have reached

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 29 The Manager's Role in Creating High-Performance Focus on Controllable Variables and External Environment –Resource Acquisition –Managing Trade-Offs

Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED. 30 The Manager's Role in Creating High-Performance