The Role of Financial Management and Nurse Leadership in Health Care Organizations

1. The Role of Financial Management and Nurse Leadership in Health Care Organizations Angela Jukkala, PhD, RN, CNL University of Alabama at Birmingham

2. Historically • Primary role of nursing was patient care • Nursing and finance believed to be separate

3. Health Care Reimbursement Changes • P4P • Complexity of care

4. Finance and Management • Management functions • Planning • Control • Decision making

5. Planning • Consider possible options • Provides direction • Evaluate progress • Essential elements • Strategic planning • Budgeting

6. Control • 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.

7. Decision-making • Over-riding role of management • Someone has to have decision-making authority • Change

8. Formal Lines of Authority • Organizational chart

9. Informal Lines of Authority • 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

10. Centralized Organizations • 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.

11. Decentralized Organizations • 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

12. Disadvantages • Top has to relinquish power • Must have organizational information systems • Ensuring regulatory compliance • Active communication required • Commitment to education

13. Nurse Manager/Unit Manager • Varies • Decentralization • Must haves: • Budgeting • Applied economics • Health care finance • Inventory control • Skill in planning, control and decision making

14. Transition from Staff Nurse to Nurse Manager • Does a high level of clinical expertise guarantee success? • Need education • Formal • Informal

15. Interactions Between Fiscal and Nurse Managers • Lateral relationships • Strained • Relationships

16. Incentives and Motivation • People • Is the best interest of the organization always in the best interest of the individual? • Goal congruence • Incentives

17. Implications for Nurse Managers • 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.

18. Questions??

19. Microsystem Framework Dartmouth

20. Microsystem • 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

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

22. Microsystems UAB Cardiac Surgery Team LAB ER Birmingham

23. Characteristics of High Performance • 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

24. Benefits of High Performing Units • 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

25. Microsystem Assessment • Form Interdisciplinary Team • Assessment • Purpose • Patients • Professionals • Patterns • Processes • Metrics that Matter • Diagnose • Treat • Evaluate

26. Interdisciplinary Team Who needs to be on this team?

27. What is the purpose of your microsystem? • Mission statement? • Does everyone agree? • Why do you need to agree?

28. Patients • What population does your microsystem serve? • Are they satisfied?

29. Professionals • Who are the professionals on your unit? • What skills do they have? • What skills do they feel they need? • Are they satisfied?

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

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

32. Metrics that Matter • Benchmarking • What are the challenges with rural benchmarking? • Do you feel national benchmarks are always relevant?

33. Diagnose Your Unit

34. Treat Your Unit • Evidence based intervention

35. Questions