ACHE/SOHL STUDY GROUP

1. ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

2. SOHL/ACHEFACHE Advancement ExamStudy Group Management MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

3. Perspective/Approach • 200 Questions • Management Knowledge • 15% • 30 questions • Theory vs. Practical • Read the question • Select the BEST option that ANSWERS the question MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

4. Management • As a discipline, management comprises of the interlocking functions of formulating corporate-policy and planning,organizing, staffing, directing, and controlling the firm's resources to achieve the policy's objectives. MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

5. Management ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE • Planning • Most Important • Organizing • Workflow Design • Relationships • Directing • Operational Processes • Day to Day Supervision • Controlling • Monitoring performance metrics

6. Planning • Strategic Management (Direction) • Systematic analysis of the factors associated with customers and competitors (the external environment) and the organization itself (the internal environment) to provide the basis for rethinking the current management practices. Its objective is to achieve better alignment of corporate policies and strategic priorities. • Strategic Plan • Broadly-defined plan aimed at creating a desired future. • Determines where an organization is going over the long term, how it's going to get there and how it'll know if it got there or not. • Policies • The guidelines and rules within which the organization operates • Operating Plan (Execution) • Short-term, highly detailed plan formulated generally by junior or departmental managers to achieve tactical objectives. Also called operational plan. Incorporates the Financial and Personnel plans. • Tactical plans address the short term (less than one year) actions to achieve an objective. • Business plan address development of new program or service. Includes Financial, marketing and operating plan sub components. MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

7. Implementation Planning • SYSTEMS FRAMEWORK MODEL • Strategy • Structure • Process • People • Systems ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

8. Strategy • Alignment with Organizational Direction • Vision, Goals and Objectives • Milestones and Timeline • Change Management • Key Stakeholders • Political Feasibility • Evaluation Metrics • Structure • Reporting Relationships • Coordination with other Units • Span of Control • Organizational Feasiblity MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

9. Process • Workflow Sequence and Steps • Process Mapping • Lean/Six Sigma Processes • Hands-offs to other units • Failure Analysis and Contingency Plan • People • Staffing Plan • Readiness for Change • Desired Culture • Behavioral Expectations • Recruiting, Hiring, Training • & Rewarding Success • Teamwork • Competency Assessment • Systems • Information Technology • Reporting Mechanisms • Data Reports • Redundancy • Contingency Plan MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

10. What are examples from your own management experience? MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

11. Organizational Theory • Table of Organization • Complex Systems and Processes • Units, Departments, Service Lines, Divisions • Span of Control • Policies and Procedures • Organizational Alignment • Managing Upward and Direct Reports MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

12. Links to Policies and Procedures Administration Policies and Procedures Ambulatory Nursing Policies and Procedures Blood Administration Guidelines National Policy Library Safety Guidelines Pharmacy Policies and Procedures Point of Care Manual MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

13. Health System Hospital Department Unit Staff Health Service Organization Division Medical Group Hospital Site Dept/Unit Staff Organizational Structures • Organizational Structure • - From Broad to Specific • - Scope of Decision Making • - Responsibility • - Accountability • Considerations • Span of Control • Chain of Command • Interrelationships MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

14. Vertical Hierarchical Traditional Top-Down BOD CEO CFO CHRO COO CNO Unit Unit Dept Dept Dept Dept Management Structure • Considerations • Span of Control • Chain of Command • Interrelationships MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

15. BOD CEO CFO CHRO COO CNO Unit Unit Dept Dept Dept Dept Management Structure • Considerations • Span of Control • Chain of Command • Interrelationships • Horizontal • Program/Service Line Program Service MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

16. Management Structure • Matrix - Multifunctional team structure that facilitates horizontal flow of authority, in addition to its normal (vertical) flow, by abandoning 'one person, one boss' rule of conventional organizations. In addition to a multiple command and control structure, a matrix organization necessitates new support mechanisms, organizational culture, and behavior patterns. - Blends Organization and Management Structures - Cross Functional • Considerations • Span of Control • Chain of Command • Interrelationships ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

17. PPH Matrix Structure MANAGEMENT PRINCIPLES AND PRACTICE ACHE/SOHLSTUDY GROUP

18. Staffing • Administrative discipline of hiring and developing employees so that they become more valuable to the organization. It includes (1) conducting job analyses, (2) planning personnel needs, and recruitment, (3) selecting the right people for the job, (4) orienting and training, (5) determining and managing wages and salaries, (6) providing benefits and incentives, (7) appraising performance, (8) resolving disputes, (9) communicating with all employees at all levels • Position control defines the number, skill level and hours of staff required to service a defined volume of activity. • Productivity management provides for monitoring and controlling adjustments to staffing based on fluctuations in volume of activity. • Performance appraisal entails the setting of expectations in objective measureable terms and providing regular feedback. • Professional Development involves coaching and training to improve performance of individual staff ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

19. Directing • Management function that includes building an effective work climate and creating opportunity for motivation, supervising, scheduling, and disciplining • Incentive Plans • “what’s in it for me” • Communication • All forms • Distribution vs. holding of information • Accessibility & Approachability • Rounding • Staff Meetings • 1:1 sessions • Professional development ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

20. Roadmap to Success ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

21. Controlling • Management function of (1) establishing benchmarks or standards, (2) comparing actual performance against them, and (3) taking corrective action, if required • Balanced Scorecard of metrics and benchmarks/targets sets objective performance expectations • Business Reviews is the mechanism to assure accountability ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

22. ControllingEmploy Balanced Scorecard • Proposed by Robert Kaplan and David Norton in 1996, utilizes leading and lagging indicators to monitor achievement of strategic direction • Defines Organizational Long and Short Term focus • Strategic Domains • Quality, Finance, Customer Service, Workforce, Workplace • Departmental scorecards derived from annual organizational initiatives ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

23. PPH Balanced Scorecard ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

24. Non-Tactical/RelationshipLeading vs. Managing ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

25. Leadership Theory and Situational Applications • In its essence, leadership in an organizational role involves (1) establishing a clear vision, (2) sharing (communicating) that vision with others so that they will follow willingly, (3) providing the information, knowledge, and methods to realize that vision, and (4) coordinating and balancing the conflicting interests of all members or stakeholders. • Leadership Styles: • Authoritative - Leadership style in which the leader dictates policies and procedures, decides what goals are to be achieved, and directs and controls all activities without any meaningful participation by the subordinates • Transformational - Style of leadership in which the leader identifies the needed change, creates a vision to guide the change through inspiration, and executes the change with the commitment of the members of the group • Participative - Style of leadership in which the leader involves subordinates in goal setting, problem solving, team building etc., but retains the final decision making authority • Delegative – Leadership style in which a leader transfers decision making power to one or more employees, but remains responsible for their decisions • Bureaucratic - Style of leadership that emphasizes procedures and historical methods regardless of their usefulness in changing environments. Bureaucratic leaders attempt to solve problems by adding layers of control, and their power comes from controlling the flow of information • When to apply • “weigh the votes” vs “count the votes”, accountability, “trust but verify”

26. Leadership Roles ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE • Public Leader • Storyteller, Advocate, Accountable • Diversity Leader • Inclusive, Approachable • Focused Leader • Results Oriented, Analytical and Knowledgeable • Change Leader • Consensus Builder, Creative, Follow-Up • Cyber Leader • Technology Savvy

27. Clarity Strategic/Systems Thinking Service Orientation Decisiveness Results Orientation Confidence / Initiative Committment Capacity Communication Influence Team Focus Change Leadership Cultural Competence Develops Others Personal Development Leadership Actions Create Clarity Organizational Direction Individual Contribution Build Commitment Alignment/Influence Build Capacity Motivation Skills Reward and Recognition ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

28. Followers • Inherently want to do well • Make up their own minds • Tolerate opinions of others, but act on their own • Align independent action with organizational direction ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

29. Management Theory • Management Roles • Henry Mintzberg published results of his studies about the work of managers in The Nature of Managerial Work (New York: Harper & Row, 1973). Defined ten managerial roles in three categories. • Interpersonal Roles involve people and other ceremonial duties • Leader – Responsible for staffing, training, and associated duties • Figurehead – The symbolic head of the organization • Liaison – Maintains the communication between all contacts and informers that compose the organizational network • Informational Rolesrelates to collecting, receiving, and disseminating information • Monitor – Personally seek and receive information, to be able to understand the organization • Disseminator – Transmits all import information received from outsiders to the members of the organization • Spokesperson – On the contrary to the above role, here the manager transmits the organization’s plans, policies and actions to outsiders • Decisional Roles revolve around making choices • Entrepreneur – Seeks opportunities. Basically they search for change, respond to it, and exploit it • Negotiator – Represents the organization at major negotiations • Resource Allocator – Makes or approves all significant decisions related to the allocation of resources • Disturbance Handler – Responsible for corrective action when the organization faces disturbances ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

30. Leading vs. Managing • Conclusions: • Management theory, based on the premises that there is no single best way to manage because every situation and every manager is different. Therefore, an appropriate management style depends on the demands of a particular situation. • Management activity occurs at all levels • Management activity varies by level • Managers utilize all the roles to varying degrees and based on the situation ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

31. Use of Power in Management • Coercive: Authority or power that is dependent on fear, suppression of free will, and/or use of punishment or threat, for its existence. • Referent: Influence over others, acquired from being well liked or respected by them. • Legitimate: Fair or just power derived from a job, position, or status • Reward: Extent to which an entity can control the dispensing of rewards or benefits • Executive: Authority to enforce orders and to ensure they are carried out as intended • Personal: Influence over others, the source of which resides in the person instead of being vested by the position he or she holds • Position: Authority and influence bestowed by a position or office on whoever is filling or occupying it ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

32. Organizational Culture • Definition • as groups evolve over time, they face two basic challenges: integrating individuals into an effective whole, and adapting effectively to the external environment in order to survive. As groups find solutions to these problems over time, they engage in a kind of collective learning that creates the set of shared assumptions and beliefs we call "culture" ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

33. Culture ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE • Behaviors, patterns, practices, customs • Influence on structure • Workarounds • Level of formality • Change management impact • Cultural diversity • Ethnicity, gender, age • Cultural competency

34. Culture and the Organization • Understand the culture across all dimensions • Decide what dimensions need to change • Modify organizational practices to drive change • “Walk the Talk” at ALL levels of the Organization • Hold leadership accountable ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

35. Organizational Climate • Flexibility • Bureaucracy minimized, Innovation • Responsibility • Autonomy, Risk-Taking • Standards • Improvement, Excellence • Rewards • Performance-Based, Recognition/Praise • Clarity • Mission/Direction, Roles and Functions • Team Commitment • Cooperation, Dedication, Group Pride ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

36. Competition Egalitarian Admission of Error Individualism Youth Emotional Deadlines Contractual Openness to Change Cooperation Hierarchical Save Face Collectivism Age Controlled Time not an Issue Consensus Reluctance to Change Cultural Differences ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

37. Low/High High/High Low/Low High/Low Cultural ConundrumWhat do you do? Train Support VALUES Liberate ??? PERFORMANCE ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

38. Decision Making “The fine art of executive decision consists in not deciding questions that are not now pertinent, in not deciding prematurely, in not making decisions that cannot be made effective and in not making decisions that others should make.” • Inform/Advise • Consult • Substantial Input • Consensus ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE ART OF EXECUTIVE DECISION

39. Decision Making • Three categories of decisions • Decisions under certainty: where a manager has far too much information to choose the best alternative • Decisions under conflict: where a manager has to anticipate moves and counter-moves of one or more competitors • Decisions under uncertainty: where a manager has to dig-up a lot of data to make sense of what is going on and what it is leading to • Information is raw data that: • has been verified to be accurate and timely • is specific and organized for a purpose • is presented within a context that gives it meaning and relevance • leads to increase in understanding and decrease in uncertainty • Process • Define the objective • Collect relevant information • Generate feasible options • Make the decision • Implement and evaluate ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

40. Decision makingLinking Leadership Styles and Decision Making • Leadership Styles: • Authoritative - Leadership style in which the leader dictates policies and procedures, decides what goals are to be achieved, and directs and controls all activities without any meaningful participation by the subordinates • Transformational - Style of leadership in which the leader identifies the needed change, creates a vision to guide the change through inspiration, and executes the change with the commitment of the members of the group • Participative - Style of leadership in which the leader involves subordinates in goal setting, problem solving, team building etc., but retains the final decision making authority • Delegative – Leadership style in which a leader transfers decision making power to one or more employees, but remains responsible for their decisions • Bureaucratic - Style of leadership that emphasizes procedures and historical methods regardless of their usefulness in changing environments. Bureaucratic leaders attempt to solve problems by adding layers of control, and their power comes from controlling the flow of information • Decisions at the right level • dependency vs. self reliance • Decisions following the Chain of Command • redirect appropriately • Differentiate between: • Doing things right • Doing the right thing ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

41. Team Building ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE • Developmental Stages • Norming, Forming, Storming, Performing • Foundational Phase • Training, Tools, Charter, Work styles, Communication Plan, Metrics • Transitional Phase • Performance Improvement Training, Tests of Change, Measure Results, Track Performance • Self-Sustaining Phase • Continue Performance Improvement on Larger Scale and Track Results

42. Team Work Styles • Self-Assessment with Forced Ranking • Identifies Preferred or Dominant Style ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

43. Teambuilding Techniques • Teambuilding is focused to bring out the best in a team to ensure self development, positive communication, leadership skills and the ability to work closely together to problem solve for organizational effectiveness • Types of Teambuilding exercises • Communication Exercise • Communications exercises are problem solving activities that are geared towards improving communication skills. The issues teams encounter in these exercises are solved by communicating effectively with each other. • Goal: Create an activity which highlights the importance of good communication in team performance and/or potential problems with communication. • Problem Solving/Decision Making Exercise • Problem Solving/Decision making exercises focus specifically on groups working together to solve difficult problems or make complex decisions. • Goal: Give team a problem in which the solution is not easily apparent or requires the team to come up with a creative solution • Planning/Adaptability Exercise • These exercises focus on aspects of planning and being adaptable to change. These are important things for teams to be able to do when they are assigned complex tasks or decisions • Goal: Show the importance of planning before implementing a solution • Trust Exercise • A trust exercise involves engaging team members in a way that will induce trust between them • Goal: Create trust between team members ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

44. Fairness Perfect Attendance Goes to you Honesty Integrity Truth

45. Conflict Management • Goals • Scope • Direction • Timing • Methods • How To • Processes • Values • Individual • Organizational • Cultural Origin and Traditions • Assumptions, Deams, Hopes, Beliefs • Conflict Comes from Clash of Expectations ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

46. Formal Conflict Resolution ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE PEER TO PEER CHAIN OF COMMAND GRIEVANCE PROCESSES PERSONNEL POLICIES COLLECTIVE BARGAINING AGREEMENTS MEDIATION ARBITRATION

47. Dispute Resolution Techniques • Judicial • Law suits decided in a court • Arbitration • Emulates the judicial approach but with a single arbiter, selected by the parties, who decides the case and whose decision is binding if the parties have so agreed. • Mediation • An independent mediator selected by the parties has no legal power to force acceptance of his or her decision but relies on persuasion to reach an agreement. Also called conciliation process. • Avoiding Disputes • Foster relationships • Regular interaction, formal and informal • Understand the other parties circumstances • Be definitive about what you can and cannot do ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

48. Negotiation • Process to avoid formal Dispute Resolution • Two types • Cooperative (win-win) • Competitive (win-lose) • Used routinely in management • Informally in day-to-day interactions • Formally in contract discussions • Effective negotiations include • Preparation • Understanding the expectations, yours and the other party • Understand any personal motivations and psychological factors • Awareness of the options and your latitude • Willingness to compromise (not relax M/V/V) • Avoid personal statements, focus on the business • Focus on the business points, leave legal terms to counsel ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

49. Contingency Planning • Proactive approach to deals with uncertainty by identifying specific responses to possible future conditions • Business Continuity Planning (IT) • Emergency Preparedness Planning • Internal • Fire • Utilities Failure • water, electricity, natural gas • Failure Mode and Effects Analysis (FMEA) • Proactive analysis of potential failure modes within a system for classification by the severity and likelihood of the failures • Tracer methodology • Follow an patient through your hospital, beginning to end • External • Hazards Vulnerability Assessment • Natural Event (earthquake, wild fire, tornado, flood) • Unexpected event • Terrorist Action (bio-hazard, radiation exposure, bomb threat) ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE

50. Contingency Planning • Plan of Correction • Assessment • Gap Analysis • Mitigation Action Plan • Implementation/Training • Testing • Refinement ACHE/SOHLSTUDY GROUP MANAGEMENT PRINCIPLES AND PRACTICE