pad health management - Askew School of Public Administration ...

PAD 5935-05: HEALTH CARE MANAGEMENT
FALL 2011
TUESDAYS, 5:30-8:15 PM
HCB 207
Instructor: Keon-Hyung Lee, PhD, MPH
Office: Bellamy 659
Office Hours: Mondays 4:00-5:25 PM
Tuesdays 4:00-5:25 PM
Or by appointment
Office Phone: 850-645-8210
Office Fax: 850-644-7617
E-Mail: klee2@fsu.edu
COURSE DESCRIPTION
This course is designed to understand management in healthcare organizations including
hospitals, nursing homes and other larger health care agencies. This course includes a
description of healthcare system; an understanding of healthcare organizational
operation; concepts and methods of health management; and the application of these
concepts and methods using case studies.
LEARNING OBJECTIVES
Understand healthcare system and how it is organized.
Understand the context of healthcare organizations: the component parts and how
they fit together.
Understand basic management principles and skills and apply them to case
problems.
Develop tools, capacity, and interest in continued learning about healthcare
management.
The way in which healthcare organizations are organized and governed.
Be able to use evidence-based management in health care.
TEXTBOOKS AND READINGS
White, Kenneth and John Griffith, The Well Managed Healthcare Organization, 7 th
Edition, Health Administration Press, Chicago, 2010. (required) (W&G)
Kovner, Anthony, Ann S. McAlearney and Duncan Neuhauser, Health Services
Management: Readings, Cases, and Commentary, 9 th Edition, Health Administration
Press, Chicago, 2009. (required) (KM&N)
Leiyu Shi and Douglas Singh. Delivering Health Care in America – A Systems Approach (4th
Edition). Sudbury, Massachusetts: Jones & Bartlett Publishers. 2008. (recommended)
Journal articles and other readings (posted in Blackboard (BB))
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COURSE REQUIREMENTS AND GRADING
Students are expected to read and reflect upon assigned readings and prepared to discuss
them. Grades will be based on the following requirements:
Three Case Analyses (3×10%=30%): (4-page double-spaced)
Weekly Critique of Readings and Participation (15%): (1-page single-spaced)
Presentation and Final Paper (30%) (15-page double-spaced excluding references)
Final Exam (25%)
Letter grades will be assigned according to the following point totals: A=93 or higher; A-
=90-92.99; B+=87-89.99; B=83-86.99; B-=80-82.99; C+=77-79.99; C=73-76.99; C-=70-
72.99; D+=67-69.99; D=63-66.99; D-=60-62.99; F= less than 60.
ACADEMIC HONOR CODE
The Academic Honor System of The Florida State University is based on the premise that
each student has the responsibility (1) to uphold the highest standards of academic
integrity in the student's own work, (2) to refuse to tolerate violations of academic
integrity in the university community, and (3) to foster a high sense of integrity and social
responsibility on the part of the university community. Please see the following web site
for a complete explanation of the Academic Honor Code.
http://www.fsu.edu/Books/Student-Handbook/codes/honor.html
STUDENTS WITH DISABILITIES
Students with disabilities needing academic accommodation should: (1) register with and
provide documentation to the Student Disability Resource Center; and (2) bring a letter to
the instructor indicating the need for accommodation and what type. This should be done
during the first week of class. For more information about services available to FSU
students with disabilities, contact the Student Disability Resource Center at 644-9566,
sdrc@fsu.edu, or visit the web site at http://www.disabilitycenter.fsu.edu/
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COURSE SCHEDULE
Session 1 (August 30, 2011)
Course Introduction: Expectations/Syllabus
Health Care Access, Cost, Quality
MODULE #1: HEALTHCARE AS A SYSTEM
Session 2 (September 6, 2011)
Healthcare Institutions and Trends (BB)
W&G Chapter 1: Foundations of High-Performing Healthcare Organizations,
pp.1-38.
Public Health Policy: Competition and Managed Care (BB)
Gift TL, Arnould R, DeBrock L. (2002) “Is healthy competition healthy New
evidence of the impact of hospital competition.” Inquiry, 39(1):45-55.
Lee KH. (2007) “The effects of case mix on hospital costs and revenues for
Medicare patients in California.” Journal of Medical Systems, 31(1):254-262.
Rivers PA, Fottler MD. (2004) “Do HMO penetration and hospital competition
impact quality of hospital care” Health Services Management Research,
17(4):237-248.
Session 3 (September 13, 2011)
Public Health Policy: Medicare, Medicaid & S-CHIP (BB)
Allison RA.(2003/2004) “The impact of local welfare offices on children’s
enrollment in Medicaid and SCHIP.” Inquiry, 40(4):390-400.
Fronstin P, Weinstein M. (2001) “Medicare in the 21 st century.” Benefits
Quarterly, 17(4):14-23.
Large JT, Sear AM. (2005) “The effects of Medicare health management
organizations on hospital operating profit in Florida.” Health Services
Management Research, 18(1):63-74.
Long SK, Coughlin TA. (2001/2002) Access and use by children on Medicaid:
Does state matter” Inquiry, 38(4):409-422.
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Kaiser Commission. (2007) “Medicaid at glance.”
MODULE #2: UNDERSTANDING THE CONTEXT OF HEALTHCARE:
ECONOMICS, TECHNOLOGY & MANAGEMENT
Session 4 (September 20, 2011)
Health Economics, Competition, Cooperation, Cost Effectiveness (BB)
Medical Technologies and Possible Futures (BB)
Culler SD, Hawley JN, Naylor V, Rask KJ. (2007) “Is the availability of hospital
IT applications associated with a hospital's risk adjusted incidence rate for patient
safety indicators: Results from 66 Georgia hospitals.” Journal of Medical
Systems, 31:319-327.
Goldman D, Smith JP. (2005) “Socioeconomic differences in the adoption of new
medical technologies.” The American Economic Review, 95(2):234-237.
Coye MJ, Kell J. (2006) “How hospitals confront new technology.” Health
Affairs, 25(l):163-173.
Session 5 (September 27, 2011)
Healthcare Management: The Role of the Manager
KM&N Overview, pp.xxvii-xxxix.
KM&N Part I, pp.3-33.
KM&N Case B: The Associate Director and the Controllers, pp.50-58.
Robbins CJ, Bradley EH, Spicer M, Mecklenburg GA. (2001) “Developing
leadership in healthcare administration: A competency assessment tool.” Journal
of Healthcare Management, 46(3):188-202.
Warden GL, Griffith JR. (2001) “Ensuring management excellence in the
healthcare system.” Journal of Healthcare Management, 46(4):228-237.
Session 6 (October 4, 2011)
Healthcare Management: Control and Governance I.
KM&N Part II, pp.79-105.
W&G Chapter 2: Cultural Leadership, pp.39-68.
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KM&N Case D: An Information Technology Implementation Challenge,
pp.108-115.
Session 7 (October 11, 2011)
Healthcare Management: Control and Governance II.
W&G Chapter 3: Operational Leadership, pp.69-102.
W&G Chapter 4: Strategic Leadership: Governance, pp.103-140.
KM&N Case F: Evidence-Based Quality Management in a Home Health
Organization, pp.124-137.
Session 8 (October 18, 2011)
Healthcare Management: Incentives and Quality Management
W&G Chapter 5: Foundations of Clinical Performance, pp. 141-181.
KM&N Case I: Selling an Evidence-Based Design for Waterford Hospital,
pp.194-202.
Sower V, Duffy J, Kilbourne W, Kohers G, Jones P. (2001) “The dimensions of
service quality for hospitals: Development and use of the KQCAH scale.” Health
Care Management Review, 26(2):47-59.
McGlynn EA, Asch SM, Adam J, Keesey J, Hicks J, DeCristofaro A, Kerr EA.
(2003) “The quality of health care delivered to adults in the United States.” New
England Journal of Medicine, 348(26):2635-45.
MODULE #3: ORGANIZATIONAL DESIGN
Session 9 (October 25, 2011)
The Production of Medical Work
KM&N Part III: Organizational Design, pp.149-172.
KM&N Case G: Improving Organizational Development in Health Services,
pp.175-183.
Griffith JR, White KR, Bernd DL. (2005) “The Revolution in Hospital
Management.” Journal of Healthcare Management, 50(3):170-190.
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Hadley J, Zuckerman S. (2005) “Physician-owned specialty hospitals: A market
signal for Medicare payment revisions.” Health Affairs, 24:491-493.
Session 10 (November 1, 2011)
Managing Doctors
KM&N Part IV: Professional Integration, pp.213-259.
W&G Chapter 6: The Physician Organization, pp.182-218.
KM&N Case J: Physician Leadership: MetroHealth System of Cleveland,
pp.265-287.
Budetti PP, Shortell SM, Waters TM, Alexander JA, Burns LR, Gillies RR.
Zuckerman H. (2002) “Physician and health system integration.” Health Affairs,
21(l):203-210.
Zuger A. (2004) “Dissatisfaction with medical practice.” New England Journal of
Medicine, 350(1):69-75.
Session 11 (November 8, 2011)
Managing Hospital Work
W&G Chapter 7: Nursing, pp.219-249.
KM&N Case K: Managing Relationships: Taking Care of Your Nurses, pp.287-
292.
Robin P. Newhouse RP, Dearholt S, Poe S, Pugh LC, White KM. (2007)
“Organizational change strategies for evidence-based Practice.” Journal of
Nursing Administration, 37(12):552-557.
Himmelstein DU, Woolhandler S. (2005) “Hope and hype: Predicting the impact
of electronic medical records.” Health Affairs, 24(5):1121-1123.
MODULE #4: ADAPTATION AND ACCOUNTABILITY
Session 12 (November 15, 2011)
W&G Chapter 9: Beyond Acute Care to Community Health, pp.281-316.
K/N Part VI: Accountability, pp.355-376.
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KM&N Case M: The Piney Woods Hospital Emergency Department. pp.329-
340.
Epstein AJ. (2001) “The role of public clinics in preventable hospitalizations
among vulnerable populations.” Health Services Research, 36(2):405-420.
Peppard PE, Kindig DA, Dranger E, Jovaag A, Remington PL. (2008) “Ranking
community health status to stimulate discussion of local public health issues: The
Wisconsin county health rankings.” American Journal of Public Health,
98(2):209-212.
Schlotthauer AE, Badler A, Cook SC, Perez DJ, Chin MH. (2008) “Evaluating
interventions to reduce health care disparities: An RWJF program.” Health
Affairs. 27(2):568-573.
Session 13 (November 22, 2011)
Public Health Program Budgeting
W&G Chapter 13: Financial Management, pp.417-458.
Runy LA. (2005) “8 financial measures every hospital executive should know.”
Hospitals & Health Networks, 79(6):30.
Love D, Revere L, Black K. (2008) “A current look at the key performance
measures considered critical by health care leaders.” Journal of Health Care
Finance, 34(3):19-33.
Parkinson J, Tsasis P, Porporato M. (2007) “A critical review of financial
measures as reported in the Ontario hospital balanced scorecard.” Journal of
Health Care Finance, 34(2):48-56.
Voss GBW, Limpensb PGP, Brans-Brabantc L, van Ooijd O. (1997) “Costvariance
analysis by DRGs; a technique for clinical budget analysis.” Health
Policy, 39:153-166.
Session 14 (November 29, 2011)
Student Presentation
Session 15 (December 6, 2011)
Student Presentation
Final Exam: 5:30-7:30 PM on December 13, 2011: A study guide will be distributed.
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UNDERSTANDING AND PREPARING CASE ANALYSES
Solving a case is much like solving any problem. First, the issues are defined,
information is gathered, and alternatives are generated, evaluated, selected and
implemented. The following set of steps might be helpful in your analysis:
1. Summarize the facts, organize the information, and classify the information into
groups of available data and gaps in data. Illustrative categories might include but
not be limited to: expectations about the organization by stakeholders, financial
performance indicators, internal organizational strengths or weaknesses, and
environmental issues, demands and challenges. Getting the facts may mean
performing analyses, such as financial analyses, with the data presented in the
case.
2. Infer other information from the facts. For example: Who are the major players
and what are their perspectives and interrelationships What are the critical issues
as defined by the key players How does the influence of the player affect or alter
the importance of the issue
3. Identify themes, issues, and problems raised by the case. Generally, the cases
have many issues that can be addressed. Some are more important than others.
Cull out and prioritize the important issues. Questions to contemplate might
include: Why do these problems exist Who needs to be involved in the solution
From where will support or resistance come in resolving the issue To what
extent are the necessary solutions long or short term To what extent are these
system problems or people problems
4. Generate alternatives to solve the problem or address the issues.
5. Evaluate the alternatives. Examine the rationale and data to support each
alternative. Criteria helpful in evaluating alternatives include judging the
alternative’s relative merits and suitability in solving a problem. Questions to
guide decision-making might include: Which alternative provides the greatest
benefits What are the relative costs of each alternative Is there consistency of
choices with organizational mission, culture, philosophy, objectives Is there
consistency of skill mix and organizational competency to carry out
recommended action How acceptable are the possibilities to the internal and
external stakeholders What are the expectations of support or resistance
6. Make a recommendation. Do not sit on the fence. Do not bunt. Do not abstain. Do
not pass. Commit.
You need to submit four cases during the course. The cases will be turned in on the day
of the class. Late submission will not be accepted. Cases are to be no more than 4 pages
long, double-spaced in 12-point font.
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In preparing the cases, the student will address the questions posed in the case description
In support of the case analysis, cases may require that applicable theory and learning
from the readings and class sessions be integrated into the write-up. Writing should be
clear, concise, demonstrating strong written English in terms of grammar, syntax and
format of the case. The key to successful communication is to be able to articulate ideas
clearly and concisely.
Cases will be evaluated based upon the student’s:
demonstrated understanding of the case and the issues involved, including an
objective assessment of the situation from all points of view
application of readings and theory
the logical implications indicated
the student’s ability to defend recommendations
quality of written communication including grammar, diction, syntax and
spelling. Be sure to proofread. Spell check does not identify incorrectly used
words of typos that are still words.
FINAL PAPER & CLASS PRESENTATION
Each student needs to submit a 15-page final paper. The student should choose a topic
that is related to public health management. During the last two class sessions, a student
needs to make a 10-minute presentation on his/her final paper.
General Format of the Paper
1. Introduction
2. Background and Literature Review
3. Research Questions
4. Analysis
5. Conclusion
6. Recommendations
7. Implication
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