Health Care Organizations from the Inside-Out EPI 247: Week 2 Anatomy of Systems

1. Health Care Organizations from the Inside-OutEPI 247: Week 2 Anatomy of Systems Laura Schmidt, PhD, MSW,MPH Associate Professor

2. KEY PARTS OF AN ORGANIZATION 1. Structure 2. Culture 3. Governance/Power Structure 4. Organizational Environment

3. Discussion Questions: Organizational Anatomy • Does the organizational culture keep people on task? Clearly define the mission? • Is the structure optimal for the mission and technical aspects of the work? • Are the powerful people in the organization critical to its survival and performance? • Are people attentive to the most important stakeholders in the environment?

4. STRUCTURE: Discussion Questions • What is the size, hierarchy, degree of complexity and interdependency in the organization? • What is the optimal structure for the goals and tasks it wishes to pursue?

5. CULTURE: Discussion Questions • What is the professed goal of the organization? • Does the organization spend most of its energy pursuing that goal? • If not, what was the main goal people pursue?

6. GOVERNANCE/POWER: Discussion Questions • To whom does power flow in the organization? • To what extent should decision-making be routinized? • To what extent do informal rules (off-the-books practices) govern decision-making?

7. ENVIRONMENT: Discussion Questions • What players in the environment are critical to the organization’s survival? • How does the organization stay legitimate? • How much influence does the organization have over key parts of its environment?

8. WEEK 3 INTRODUCTION The Central Problem for Managing Healthcare Systems: Autonomy and Control

9. The Bureaucracy Modernity’s answer to the problems of controlling subordinates. Max Weber 1864-1920

10. POWER, AUTHORITY AND CONTROL POWER= The ability to impose one’s will on someone else. AUTHORITY=The routinization of power based on an assumption of legitimacy. CONTROL= Fixed, built-in systems that maintain constrain subordinates automatically and invisibly.

11. Features of the Classical Bureaucracy • Equal treatment for all employees • Reliance on expertise, skills, experience • Position belongs to the organization • Specific standards of work and output • Extensive record-keeping • Rules and regulations serve the organization’s interests • People are bound to the organization by formal contract

13. The Central Problem for Managing Healthcare Organizations • AUTONOMY versus CONTROL • How does the system control professionals who require autonomy and decision-making power?

14. Solutions to the Problem • Classic dual hierarchy hospital • Newer managed care systems: • Integrated Delivery Systems • Network Model Health Plans

15. The Classic Form: Dual Hierarchy

16. Newer Forms: Integrated Delivery Systems

17. Newer Forms: Network Models

18. Week 3 Exercise • How bureaucratic is the organization? • How much professional autonomy is required? • How does management balance autonomy and control? Is it working?