EOH3402 Community Health

Programme Management
Lecture 4
Role of a manager in the health care (HC)
organization and management
Introduction
Healthcare (HC) management is a growing profession
and increasing opportunities in both direct care and
non-direct care settings.
Direct care settings – those organisations that provide
care directly to a patient, resident or client who seek
services from the organisation
Non-direct care settings – support the care of
individuals through products and services made
available to direct care settings.
HC management is one of the fastest growing
occupations, due to the expansion and diversification
of the HC industry.
These managers are expected to be needed in inpatient
and outpatient care facilities, with the greatest growth
in managerial positions occurring in outpatient
centres, clinics and physician practices.
Hospitals may also experience a large number of
managerial jobs because of the hospital sector’s large
size.
HC management is the profession that provides
leadership and direction to organisations that deliver
personal health services, and to divisions, departments,
units or services within those organisations.
HC management provides significant rewards and
personal satisfaction for those who want to make a
difference in the lives of others.
The Needs for Managers and Their
Perspectives
Managers are required to provide leadership, as well as
supervision and coordination of employees.
The scope and complexity of tasks carried out in
provision of services are so great that individual staff
operating on their own couldn’t get the job done. In
order to produce services in HC organisations, many
highly specialised disciplines must be coordinated and
work together seamlessly.
Managers must make certain that organisational tasks
are carried out in the best way possible to achieve
organisational goals and that appropriate resources
such as financing and human resources are adequate to
support the organisation.
HC managers are appointed to positions of authority,
by making important decisions.
Decisions made are related to
Recruitment and development of staff
Acquisition of technology
Service additions and reductions
Allocation and spending of financial resources

Ultimately, decisions made by an individual manager

affect the organisation’s overall performance.
In order to carry out various tasks and make decisions,
managers must consider two domains
External domain – refers to the influences, resources and
activities that exists outside the boundary of the organisation
but that significantly affect the organisation, for example
 Community needs
 Licensure
 Accreditation
 Regulations
 Stakeholder demands
 Competitors
 Medicare and medicaid
 Managed care organisations / insurers
Internal domain – areas of focus that managers need to
address on a daily basis, for example
Staffing
Budgeting
Quality services
Patient satisfaction
Physician relations
Financial performance
Technology acquisition
New service development
Management: Definition, Functions and
Competencies
Management is defined as “the process, comprised of
social and technical functions and activities, occurring
within organisations for the purpose of accomplishing
predetermined objectives through human and other
resources (Longest, Rakish and Darr, 2000).
A manager is anyone in the organisation who supports
and is responsible for the work performance of one or
more persons (Lombardi and Schermerhorn, 2007).
Managerial positions, by organisational
settings
Physician practice (clinics)
Practice manager
Director of medical records
Supervisor, billing office

Nursing home
Administrator
Director, food services
Admissions controller
Supervisor, environmental services
Hospital
Chief executive officer
Vice president, marketing
Clinical nurse manager
Director, revenue management
Supervisor, maintenance
Managers implement six management functions as
they carry out the process of management
Planning
Organising
Staffing
Controlling
Directing
Decision making
In order to effectively carry out these functions,
managers need to possess several key competencies
Conceptual skills – the ability to critically analyse and
solve complex problems
Technical skills – reflect expertise or ability to perform a
specific work task
Interpersonal skills – enabling a manager to
communicate with and work well with other individuals,
regardless of whether that are peers, supervisors or
subordinates.
Management Positions: The Control in the
Organisational Hierarchy
Management positions are found throughout the HC
organisations.
Management positions exist at all levels, and the
hierarchy of management means that authority is
delegated downwards and that lower level managers
have less authority than higher-level managers, whose
scope responsibility is much greater.
The upper level is referred to as senior management
 For example – vice president of Patient Care Services are in
charge of a few different functions, including nursing,
diagnostics, imaging and laboratory services
 Compared to
 Director of medical records – is responsible only for patients
medical records
Some managerial positions are line managerial positions
because the manager supervises other employees
Some are staff managerial positions as they carry out
work and advice their bosses, but they do not routinely
supervise others
The most common organisational structure for HC
organisations is a pyramid-shaped hierarchy, which
defines the functions carried out and the key
management positions assigned to those functions
The size and complexity of the specific health
organisation will dictate the particular structure.
Larger organisations (large community hospitals,
academic medical centres) will likely have deep
vertical structures reflecting varying levels of
administrative control for the organisation
This is due to
The large scope of services provided
Corresponding vast array of administrative and support
services that are needed to enable the delivery of clinical
services
Other characteristics of this structure include a strict
chain of command and line of reporting

Other administrative structures adopted by the HC

organisation
Matrix or team-based models
Service line management models
Focus of Management: Self, Unit/Team and
Organisation
Effective HC management involves exercising
professional judgment and skills and carrying out the
aforementioned managerial functions are three levels
Self
Unit/team
Organisation wide
First and foremost – the individual manager must be
able to effectively manage himself or herself
The second management focus – this involves
managing others in terms of effectively completing the
work
The third management focus – reflects the fact that
managers must work together as part of a larger
organisation to ensure organisational-wide
performance and organisational viability
The role of the Manager in Talent
Management
Management must have the requisite number and types of
highly motivated employees in order to effectively master
the focal areas of management and carry out the required
management functions
In many HC organisations, human resource management
has been replaced with “talent management” – where the
focus has shifted to securing and retaining the talent needed
to do the job in the best way, rather than simply fill a role
As a result, managers are now focusing on effectively
managing talent and workforce issues because of the link to
organisational performance.
Beyond recruitment, managers are concerned with
developing and retaining those staff who are excellent
performers
Strategies used by managers to develop and maintain
excellent performers
Offering training programmes
Providing leadership development programmes
Identifying employees needs
Measuring employees satisfaction through engagement surveys
Providing continuous education
Enabling job enrichment
Role of the Manager in Ensuring High
Performance
The role of the manager is to ensure that the unit,
service, division or organisation achieves high
performance
Goals and objectives are desired end points for activity
and reflect strategic and operational directions for the
organisation
They are
Specific
Measurable
Meaningful
Time oriented
Pillars of Excellence (Studer, 2003)
The organisation as needing to be results oriented
The pillars are
 People (employees, patients and physicians)
 Service
 Quality
 Finance
 Growth

Griffith (2000) – high performance organisation is like

championship organisations – where they are expected to
perform well on different yet meaningful measures of
performance
Stakeholders (insurers, state/federal govt, consumer
advocacy groups) are expecting / demanding,
acceptable level of performance in HC organisations –
they want to ensure that services are provided in
A safe
Convenient
Low cost and
High quality environment.
To meet the required reporting requirements of the
aforementioned organisations, HC organisations use
varying method to measure and report the performance
measurement process
This include
Developing and using dashboards
Balanced scorecards
that allow for a quick interpretation on the
performanceacross a number of key measures
Example of balanced scorecard
Role of the Manager in Succession Planning
Succession planning – the concept of taking actions to
ensure that staff can move up in management roles
within the organisation, in order to replace those
managers who retire or more to other opportunities in
other organisations
It is mostly been emphasised at the senior level of
organisations, in part due to the large number of
retirements that are anticipated
Practices to address leadership succession needs
Mentoring programmes for junior management that
senior management participate
Formal leadership development programmes
Role of the Manager in HC Policy
Managers should be knowledgeable about health policy
matters under consideration in the state and federal levels
that affect health services organisations and HC delivery –
this is particularly true for senior-level management
This is necessary in order to influence policy in positive
ways that will help the organisation and limit any adverse
effects
For example
Staying current with HC policy discussions
Participating in deliberations of health policy
Providing input where possible
will allow HC managers’ voices to be heard
HC managers must strive to keep their knowledge
current in order to understand and influence health
policy
This can be accomplished by
Targeted personal learning
Networking with colleagues within and outside of their
organisations
Participation in professional associations
Knowledge gained can be helpful in shaping health
policy in accordance with the desires of HC managers