HCM 413 Long Term Care Admin.

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HCM 413 Long Term Care Admin.

• Part One (Management, Governance, and Leadership)
  Overview

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Management is decision making

• It is also Planning, Organizing, Staffing,
  Directing, Coordinating, Reporting, and
  Budgeting.
• Also, an administrator might
• Forecast, Plan, Budget, Organize, Staff, Direct,
  Evaluate, Control Quality, Innovate, and ensure
  connection to its Market.
• The nursing-facility administrator is responsible
  for all of these activities.

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Consider these functions individually

• Forecasting, or projecting trends into the
  future.
• Planning, or deciding what is to be done.
• Budgeting, or deciding acceptable costs.
• Organizing, or deciding the scheme of the
  organization and the staffing it will require.

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• Directing, or providing daily supervision,
  employing good communication and people skills.
• Evaluating, or comparing actual to expected
  results.
• Controlling quality.
• Innovating.
• And Marketing, or identifying and attracting the
  persons to be served.

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Forecasting

• Forecasting The successful manager will be the
  one who can anticipate and prepare for rapid
  change.
• Forecasting involves trend identification and
  analysis. Clues to the future are present in
  trends that the alert administrator can observe.

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Planning

• Plans are a means of coping with the uncertainty
  of the future.
• A plan is a prediction of what the facilitys
  decision makers believe they must do to cope with
  the future.
• Strategic planning vs. operational planning.

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Steps in planning

• Phase One Decide what ought to be done.
• Phase Two Set short- and long-range objectives.
• Phase Three Decide on the means to achieve the
  objective.
• And than plan on changing your plans

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Organizing

• Organizing is a method of ensuring that the work
  necessary to achieve a goal is broken down into
  segments, each of which can be handled by one
  person.
• Job descriptions are a useful way to define these
  segments.
• Note that organizing also occurs within the
  context of a system.

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Conversely

• Another approach to leadership shows the
  administrator leading by walking around, or LBWA.
  
• Another description of the managers function in
  that of getting things done through people.

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• Still another group of theorists shows the
  manager performing 5 functions, to include
• Planning for future operations
• Designing and administering decision-making
  structures (organizing)
• Developing human resources and capabilities
  (staffing and directing)
• And representing and holding an org. responsible
  to its various constituencies.

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In addition to the managerial functions

• There are three distinct levels of management
• Upper level management
• Middle level management
• Lower level management
• Note that each level will require distinct
  skills, and duties will vary, as will roles.

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Line vs. staff

• A person who is empowered by the administrator to
  make decisions for the organization is said to
  have line authority.
• Includes the director of nurses.
• A staff position, on the other hand, is an
  advisory role.
• Accountants and a paid consultant would be staff
  positions.

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• Consider the following. Every 10 years, one
  fourth of all current knowledge and accepted
  practices in the health care and other industries
  will be obsolete. The life span of new
  technologies is down to 18 months.
• Between 1985 and 1995, mankinds cumulative
  knowledge doubled, and will double again every 5
  years.

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The Organization as a System

• The facility is surrounded by and part of a
  larger environment it exists in an open
  system. An open system consists of
• Inputs,
• process,
• outputs,
• control,
• plans of action,
• feedback,
• and the environment.

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• Inputs are of three kinds money, people, and
  materials (also knowledge, I think).
• The process is the work that the organization
  accomplishes. Orgs. transform the inputs
  available to them into outputs, using a
  process.
• Output is the result of the work, to include
  caring for patients/residents.

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• While producing an output, it is important to
  keep the organization on course, using control,
  or any corrective action taken after evaluation
  of outputs.
• Policies and plans of action are the guidelines
  the administrator uses to compare the actual
  output against the expected output.

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• Next, feedback, though a form of control,
  includes the responses to the output of the
  nursing facility. Specifically, feedback from
  residents and their families represent a key
  source of evaluative help. There is also
  regulatory feedback and external feedback (word
  of mouth evaluations, newspaper articles, the
  number of potential residents applying).

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Continuing

• The environment.
• Defining the relevant environment of ones
  organization is extremely important.
• The environment consists of opportunities and
  constraints, and this needs to be evaluated.
• Constraints might include regulations,
  competition, inflation, etc.
• Opportunities might include niches in care needs,
  the increase of elderly, etc.

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When considering constraints and opportunities

• Consider a S.W.O.T. analysis
• Strengths
• Weaknesses
• Opportunities
• Threats

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Staffing

• Staffing is hiring the right persons for the jobs
  in the organization.
• Note that staffing patterns of nursing homes are
  more prescribed than for most other health care
  institutions.
• The success of the nursing home depends directly
  on adequate staffing.

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Directing

• Directing is the process of communicating to
  employees what is to be done by each of them and
  helping them to accomplish it.
• Policies, procedures, and plans of action are
  used to direct decision making, and direct
  behavior. Policies are generalized statements of
  intention while procedures are more step by step
  actions to carry out policies or plans of action.

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• Put another way, policies serve as general
  statements or understandings that guide or
  channel subordinates thinking as they make
  decisions.

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What about Leading?

• Organizations will only survive if they have
  effective leadership.
• There have been countless theories re what makes
  for an effective leader.
• There are various styles of leadership, to
  include democratic, authoritarian, laissez-faire,
  and as referenced previously, LBWA.
• What are each of these?

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How does one choose a leadership style?

• It appears that the best nursing home
  administrators might be those with the following
  mindsets
• They have passion for what they do.
• They push their limits, and continuously try new
  moves.
• They accept the fact that they will make mistakes.

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• They respect the chaotic environment they work
  within, and never turn their back on it.
• They keep their eyes on the horizon.
• They are able to forecast and plan.
• They have someone to share their hopes, dreams,
  and frustrations with.

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Tannenbaum, Wechsler, and Massarik on leadership

• They view leadership as a continuum, from
  Manager-Centered Leadership on one end of the
  continuum to Employee-Centered Leadership on the
  other end of the continuum.
• Next slide please

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Thus,

• In a Manager-Centered Leadership view, the
  manager simply makes the decision, than announces
  it (autocratic style).
• Midway between the extremes, the manager might
  present a tentative decision, subject to change,
  and the employees are involved in the process
  (consultative or participative approach).
• At the far other extreme, the manager allows the
  subordinates to make the decisions ( a
  laissez-faire leadership style).

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So how do you decide how to lead?

• Consider three things
• Forces in the administrator.
• Values, confidence in the dept. heads, his or her
  feelings of security, etc.
• Forces in the employees.
• Maturity, ability to make decisions, need for
  independence, interest in leading, etc.
• Forces in the organization.
• Expectations by Board, ability of subordinates to
  function as a group, time constraints, etc.

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What skills will be needed?

• At the upper level of management, the
  administrator will be primarily responsible for
  creating and changing the organizations
  structure. Skill in envisioning may be needed.

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• The middle level manager, or the heads of
  dietary, housekeeping, or other departments, are
  responsible for the development of more specific
  policies that interpret administration policy
  implications for their departments. This person
  must understand how the subsystems of the
  organization fit together. Organizational and
  political skills become very important.

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• The lower level manager (the charge nurse) has
  the responsibility of applying the policies
  provided by the director of nursing to the hour
  by hour care given. Lower level managers guide
  employees according to established policies of
  the facility. This person must understand the
  rules, and must have good people skills, as well
  as technical skills.

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Katz and Kahn and the effective leader

• He or she is a person who
• Mediates and tempers the org. requirements to the
  needs of persons in a manner that is
  organizationally enhancing. He supports his
  employees.
• He or she promotes group loyalty.
• He or she demonstrates care for individuals.
• He or she relies on referent power (respect)
  rather than the power of legitimacy and sanctions.

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• In reality, in the day to day administration of
  the typical long-term care facility the
  administrator will face a variety of situations
  that call for different kinds of leadership.
• Would that we could all have charisma, and lead
  because we had that magical aura that invites
  people to follow us.

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Back to Directing

• What about Power and Authority?
• Power is the ability to control the behavior of
  others.
• A person has power when he or she is able to make
  other people do what we want.
• Note that power is a reciprocal relationship, in
  that the employees and patients/residents must
  accept that power as permissible if it is to be
  meaningful.

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The different kinds of power

• Legitimate Power Also known as position power.
• Reward Power Based on the Administrators
  ability to bestow rewards.
• Punishment Power Based on the ability to
  punish.
• Referent Power Based on liking or identifying
  with another person.
• Expert Power Based on levels of skill or
  ability.

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More on Directing

• Directing is the process of communicating the
  organizational objectives to the staff,
  residents/patients, and their significant others.
  
• Communication is the exchange of information and
  the transmission of meaning.

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• Steps in the communication process are
• A. someone initiates it.
• B. it is transmitted from its source to its
  destination.
• C. it has an impact on the recipient.
• How do we confirm receipt and impact?
• Feedback and active listening.

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• Communication Information Power
• Also, organizations usually have at least two
  systems of communication the formal and the
  informal system.
• In terms of direction of flow, communication can
  flow, and should flow, upward, downward,
  horizontally, and diagonally.

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What might be a barrier to effective
communication?

• Having an agenda.
• Selective hearing.
• Differences in levels of knowledge.
• The Filter Effect.
• Subgroup allegiance.
• Status distance.
• Language barriers.
• Self protection.
• Information overload.

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A priority of management is to develop loyalty to
facility goals.

• The reality is that employees will behave less as
  members of the nursing facility and more in terms
  of some compromise of their many commitments.
• To enable staff to accomplish the necessary work,
  organizations develop and specify roles (job
  descriptions) that are carefully prescribed forms
  of behavior associated with the tasks the
  organization wants performed.

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Thus,

• To build loyalty, organizations try to identify
  roles and the persons filling them with the norms
  or values of the organization, the general
  expectations for all employees.
• Professional standards for nurses and nurses
  aides are examples of such norms, which are
  behavior patterns that all members of the group
  are expected to adhere to.

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• Norms are justified by values, which are more
  generalized statements about the behavior
  expected from staff members.
• Note that system norms and values are attempts to
  connect employees with the system so that they
  remain within system values while carrying out
  their role assignments.
• Nursing facilities norms and goals revolve
  around providing the highest quality of life
  possible for residents.

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• Organizational values are also reflected in the
  mission statement, which defines the purposes and
  values held by the facility.
• Also, the administrator, through his or her
  actions, demonstrates what is important, or what
  the values are.

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Additional concepts reviewed in Part I

• Corporate Culture, or the overall style or
  atmosphere of a facility. It governs how people
  relate to each other.
• Delegation, or permitting decisions to be made at
  the lowest possible level.
• Unity of command, which emphasizes the importance
  of each person being accountable to only one
  supervisor.

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• Span of Control, or how many subordinates are
  supervised by any one supervisor.
• Short chain of command, or the fact that there
  should be as few levels of management as possible
  between the chief administrator and the rank and
  file.

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• Balance, or the fact that there is a constant
  need for review to maintain balance among the
  following
• Size of the various departments
• Standardization of procedures and flexibility
• Centralization and decentralization
• Span of control and short chain of command

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Regarding the history of the management concept

• Organizations have been managed for thousands of
  years.
• By the 1800s the early scientific management
  movement was underway, exemplified by Frederick
  Speedy Taylor.
• At the end of the 19th century writers emerged
  who thought management could be an exact science.

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• Some focused on the physical activities involved
  in production (Drucker George).
• Others focused on management universals, to
  include planning, organizing, commanding, and
  controlling or coordinating (Henri Fayol).
• During the 1920s and 30s, a group of theorists
  led by Elton Mayo described management as
  consisting primarily of human relations skills.

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Re quality control

• Several of the current methods used for
  controlling quality are discussed, to include
• The Deming method.
• Benchmarking.
• Reengineering.
• Continuous Quality Improvement (CQI).

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W. Edwards Deming

• He identified 14 dos and 7 deadly
  organizational diseases, or donts.
• The 14 dos include such things as creating and
  publishing the aims of the organization
  understanding the purpose of inspections the
  need to create trust, etc.
• The 7 deadly diseases include such things as
  having a lack of constancy of purpose having an
  emphasis on short term profits and having
  excessive medical costs.

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Benchmarking

• Benchmarking is a management tool by which an
  organization seeks to improve its business
  practices by comparing them with the best
  practices of other organizations.
• To do so, one needs to decide what needs to be
  benchmarked, etc.

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Total Quality Management/Continuous Quality
Improvement

• TQM is difficult to define because it is a
  philosophy of total organizational involvement in
  improving all aspects of quality of service, and
  there is no single set of steps that illustrates
  how that is done.
• However, six factors seem to be keys to a
  successful TQM program.

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The six contributors to TQM

• 1. Visionary leadership.
• 2. Commitment to customers.
• 3. Trained teams.
• 4. Physician involvement.
• 5. Processes, or having an improvement process
  that solves problems and improves processes.
• 6. Avoiding a separate TQM program., rather the
  TQM program should be the only quality program.

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• J.M. Juran, on the other hand, saw the management
  of quality as a three-fold process involving
• 1. Quality planning (who are the customers, what
  are their needs, etc.).
• 2. Quality control (evaluate the actual outputs,
  etc.).
• 3. Quality improvement, through establishing the
  needed infrastructure and establishing project
  teams to improve quality.

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How can quality be measured?

• Structure
• Having an adequate physical plant, the proper
  equipment, enough staff, etc.
• Process
• Are all the organizational arrangements in place.
  Process measures the way in which resident care
  is given.
• Outcome
• The result of the effort made, the measurable
  impacts on the residents. Are residents living a
  high quality of life, etc.

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Re innovating

• The effective manager is always an innovator.
  Innovating is the process of bringing new ideas
  into the way an organization accomplishes its
  purposes.
• Note that it is desirable to include staff in
  change and innovation, because they have constant
  contact with the changing needs of residents.

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Marketing the Long-Term Care Facility

• Marketing is necessary due to a number of factors
  currently facing the administrator
• Narrower profit margins
• The reduction of the Federal influence in shaping
  the product and payment mix.
• If you dont mess with your success, your
  competitor will. If you take your success for
  granted, you will be lulled into complacency.

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• Hospitals have turned to marketing because the
  occupancy rates across the U.S. have fallen in
  each of the past several years.
• To increase occupancy rates, hospitals are
  competing with one another, introducing
  out-patient surgery and other service centers,
  nursing facilities, and home health agencies for
  patients in order to distinguish themselves.

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What is marketing?

• The process of planning and executing the
  conception, pricing, promotion, and distribution
  of ideas, goods, and services to create exchanges
  that satisfy both individual and organizational
  objectives.
• Otherwise referred to as the 4 Ps.
• Marketing involves an audit, market segmentation,
  choosing a market mix, implementing the plan,
  evaluating the results, and taking corrective
  action.

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Need for a marketing strategy

• The organization must continually adapt to
  changes within and outside the organization. An
  adaptive organization systematically monitors its
  external (and internal) environment and revises
  its mission, strategies, and objectives to take
  advantage of emerging opportunities.
• Remember S.W.O.T.?

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• A marketing strategy includes selecting a target
  market or markets, choosing a competitive
  position, and developing an effective marketing
  mix to reach and serve the identified customers.
• Note that a market is all the people who have
  an actual or potential interest in using your
  facilitys services.

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However

• Within your market, you may concentrate on only
  one market or market segment (called market
  concentration). Also, you may decide to offer
  only one service for all markets (called product
  concentration). Or, you might market specialize,
  by offering only one service and by serving only
  one market segment.

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More on developing a marketing strategy.

• Step One The Audit, or the process of
  identifying, collecting, and analyzing
  information about the external environment.
  Marketers typically characterize a market as
  potential, available, qualified, served, and
  penetrated.

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More on the market..

• Within the whole market, is the available market,
  which does not include those who cannot pay, but
  rather represents those who have the funds and
  the access to a market offering. The qualified
  available market includes those who have
  interest, financial means, and access. The served
  market is that segment of the qualified available
  market that the facility wants, and the
  penetrated market are those who are admitted to
  or served by the facility.

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Back to the audit

• In forecasting future demand Kotler and Clarke
  suggest the facility examine three things
• 1. uncontrollable environment factors such as the
  economy, technological changes, etc.
• 2. New competition from other providers.
• 3. Inter-organizational factors such as the
  condition of ones facility, possible new
  services, and promotional efforts.

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Step 2 3 in developing a market strategy

• Step Two Market Segmentation, or using the audit
  information to divide the people who are
  potentially to be served into identifiable
  subgroups (long vs. short term residents, etc.).
• Step Three The Marketing Mix, or deciding what
  types of residents to approach and in what
  proportions.

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• Note the difference between the product mix (the
  set of all product lines and items the facility
  intends to offer) and the product line (a set of
  services within a product mix) and a product item
  (or a distinct unit within a product line.
• Product Mix Assisted Living services vs. Nursing
  Home care.
• Product Line Condo vs. apartment living.

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Step Four

• Implementing and evaluating the plan.
• Within this step is marketing implementation, or
  creating awareness among potential consumers that
  the services exist, assisting them in deciding,
  and assuring that they are satisfied with the
  quality of services.

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Steps Five and Six Evaluation and Control

• Once the marketing effort is operational it is
  necessary to devise ways to measure the results
  and take corrective action to assure that the
  desired results are achieved.

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• Lastly, note that the nursing home facility is
  primarily in the business of marketing services.
  Services have certain characteristics
• They are intangible- cannot be touched, sat in,
  or driven like a car.
• They are inconsistent from day to day.
• They are inseparable, the consumer does not
  separate the service from the setting in which it
  is provided or the person who provides it.
• And there may be idle production capacity. An
  empty bed is an idle bed.

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Lastly, advertising

• The purpose of advertising is to motivate the
  target audience to move through the following
  buyer-readiness states toward actual use of the
  facility services
• Cognitive (awareness that the facility is
  available)
• Affective (favorable image of the facility)
• Behavioral (conviction or decision to use the
  facility)

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Re promotion

• In 1977, the U.S. Supreme Court ruled illegal any
  self-imposed restrictions by health and other
  professionals against advertising services or
  prices that result in keeping the public ignorant
  or inhibiting the free-flow of commercial
  information.
• As a result, the marketing of health services has
  become an increasingly accepted practice.
• In 1978 hospitals employed only 3 marketing
  executives by 1988, more than 2,000 marketing
  execs. were employed in U.S. hospitals.

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Another way to look at Marketing

• Simple Definition Marketing is managing
  profitable customer relationships.
• Goals
• Attract new customers by promising superior
  value.
• Keep and grow current customers by delivering
  satisfaction.

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Marketing Old vs. New

• Old view of marketing
• Making a sale -- Telling and Selling

New view of marketing Satisfying customer needs
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Marketing Defined

• A social and managerial process by which
  individuals and groups obtain what they need and
  want through creating and exchanging products and
  value with others.

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A Simple Model of the Marketing Process
Create value for customers and build customer
relationships
Capture value from customers in return
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What are Consumers Needs, Wants, and Demands?
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This Is a Need

• Needs - state of felt deprivation including
  physical, social, and individual needs.

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Types of Needs

• Physical
• Food, clothing, shelter, safety
• Social
• Belonging, affection
• Individual
• Learning, knowledge, self-expression

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This Is a Want

• Wants - form that a human need takes, as shaped
  by culture and individual personality.

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This Is Demand
Demand
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Need / Want Fulfillment

• Needs and Wants Fulfilled through a Marketing
  Offer
• Some combination of products, services,
  information, or experiences offered to a market
  to satisfy a need or want.

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Product as an Idea
Products do not have to be physical objects.
Here the product is an ideaprotecting animals.
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What is a Market?

• The set of actual and potential buyers of a
  product.
• These people share a need or want that can be
  satisfied through exchange relationships.

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Marketing Management

• The art and science of choosing target markets
  and building profitable relationships with them.
• Questions to ask
• What customers will we serve?
• What is our target market?
• How can we best serve these customers?
• What is our value proposition?

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Segmentation and Target Marketing
1
2
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Value Proposition

• The set of benefits or values a company promises
  to deliver to consumers to satisfy their needs.

It cleans and freshens like sunshine!
www.gainlaundry.com
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The Marketing Mix
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Customer Relationship Management

• The process of building and maintaining
  profitable customer relationships by delivering
  superior customer value and satisfaction.

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Customer Loyalty Retention

• Customer Lifetime Value
• The entire stream of purchases that the customer
  would make over a lifetime of patronage.

• Share of Customer
• The share a company gets of the customers
  purchasing in their product categories.

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Customer Equity

• Customer equity is the total combined customer
  lifetime values of all the companys customers.

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Tabloid Tidbits

• Dumb mom jailed for washing baby in machine.
• A numbskull mom has been arrested for child
  abuse after she was caught giving her baby a bath
  in her washing machine, says the Aug. 22 issue
  of the Sun.
• I dont know what all the fuss is about says
  Vera Dundee, who has admitted shes been bathing
  her nine month old son in the washer for two
  months, I always use the gentle cycle, Dion
  loves it, she says.
• However, authorities say a number of injuries on
  Dion were caused by his being tossed about in
  the machine.

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Twisted Sayings

• Clones are people, two
• Microbiology Lab Staph Only!
• Santas elves are just a bunch of subordinate
  Clauses
• Coles Law Thinly sliced cabbage

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Twisted Sayings

• Atheism is a non-prophet organization
• Air Pollution is a mist-demeanor
• 186,000 miles/sec Not just a good idea, its the
  law