Nursing Leadership and Management

1
Nursing Leadership and Management
2
Perspectives on the Health Care Industry
3
Historical Overview

• Social welfare
• Religious/moral
• Political/war
• Economic

4
Rich Culture and History

• Mesopotamia.
• Hammurabi Code, 1728-1686 B.C.
• Greek.
• Hippocratic 460 B.C. (oath).
• Aesculapius, Temples.
• India.
• Asoka 273-232 B.C.
• China.
• The Yellow (medicine) and Red (herbal) Emperors
  1766-1000 B.C.

5
Roman 300 A.D.

• Trauma.
• War, surgery.
• Resins or pitch to bind wounds
• Herbal Pharmacy.

6
Islam 700A.D.

• Pharmacy.
• Epidemiology.
• Research.

7
Europe

• Middle ages - dark ages 400 -1400 A.D.
• Religious/charity.
• Leprosy, plague.
• Loss of anatomy.
• Care/cure.

8
Renaissance 1400-1600 A.D.

• Return to Greek methods
• Catholic Church
• 1506 Royal College of Surgeons
• 1528 Royal College Of Physicians
• Gender wars/healers, shamans, physicians and
  witches

9
Hospitals Are Temples of Healing, Hospitals Are
Places Places to Die
10
1600-2001

• Acute care
• Obstetrics, Pediatrics, Oncology
• Psychiatric
• Rehabilitative
• Veterans services

11
United States Follows European Model with
advances following war

• Civil war/ Lessons from Crimea
• WWI, WWII, Korea, Vietnam

12
1940-2001 Rapid Advances in Target Areas

• Nutrition
• Vitamins
• Insulin
• Antibiotics
• Technology
• Imaging
• Replacement
• Genetic Therapies

13
Common language

• Systems orientation
• Cause and effect
• Ethics, morality
• Business

14
Organization

• Anatomy, physiology
• Sanitation
• Obstetrics
• Trauma
• Charity

15
Systems Theory

• Integrated parts
• Closed or open
• Needs Energy to operate
• Creates Energy

16
Health Care Organization Is an Open System

• Integrating the Idea of Energy

17
Organizational Systems Theory

• Productivity Is the Result of the Interplay
  Between, Structure, People, Technology and the
  Environment.

18
Organizational System

• A Set of Interrelated Parts Arranged Into a Goal
  Directed Unified Whole.

19
Simple Open Systems Model
Through put
Output
Input
Feedback
Environment
Katz and Kahn, 1978
20
Environment

• Organizations Exist and Are Dependant Upon the
  External Environment for Survival

21
The External Environment

• Accepts Output and Provides Input

22
Input

• Any Thing Imported From the External Environment

23
Examples of Inputs

• Labor, people
• Materials
• Equipment
• Information
• Energy

24
Throughput

• Process by Which Raw Materials (Inputs) Are
  Utilized to Create a Product (Output)

25
Output

• Result of Through Put Process, Outcome or Product

26
Feedback

• Raw Material Returned to the Organization From
  the Environment or From With in the Organization

27
Evaluation

• Method Utilized to Adjust Organization to Better
  Meet Selected Goals

28
Effectiveness

• A Defined, Desired Outcome of Organizational
  Activity

29
Summary Systems Theory
External environment
Output Products Decisions Energy
Input Knowledge Skills Abilities Raw
material Energy
Throughput Process Analysis
Feedback Evaluation
Internal environment
30
Hospital Process
Inputs
Processing
Outputs
Employees, Staff
Examination
Healthy patients
Hospital
Surgery
Medical Supplies
Monitoring
Equipment
Medication
Laboratories
Therapy
31
Using System AnalysisHierarchy and order
32
Health Care Organizations

• Businesses
• Acute long term care - hospitals
• Residential - long term care facilities
• Ambulatory centers
• Home health agencies
• Temporary services agencies
• Managed care organizations

33
Private

• Ownership held by a select group of individuals.

34
Public

• Shares in company are available for sale to any
  individual.
• Limited liability equal to the level of
  investment.

35
Ownership Chitty Pg. 308

• Government owned, supported by taxes or line
  items on fiscal budget.
• Veterans administration.
• Indian health services.

36
Chitty pg. 310

• Non government - not for profit
• Hillcrest, St.Francis's, St. John.
• Non governmental - for profit
• Investor owned - TRMC, doctors, Southcrest

37
The Business of Health care

• Provides a necessary service
• Provides Jobs
• Taxes
• Responds to the laws of supply and demand

38
Supply and Demand

• Supply-production
• Demand-utilization
• Balance
• Supply is consumed by demand
• Curve
• Supply-how much a product should cost
• Demand - how much product should be produced

39
Law of Supply and Demand

• Buyers will purchase more of a product as the
  price drops.
• Predecessors will produce more of a product as
  its price rises.
• There is a theoretical point at which supply
  price and purchase all intersect.
• Equilibriummarket price.

40
Surpluses and Shortages

• Supply and demand out of balance
• Birth of market research
• Identify variables that can be manipulated to
  return the balance
• Profits are made and loss during these cycles

41
Patterns of Utilization

• Increase use of technology
• Diversity of population
• Aging
• Increased gap between middle class and very
  wealthy

42
Health Care Reform 1992 Campaign Issue

• Balance of Supply and demand
• Unequal access, quality and quantity
• Increasing cost
• Increasing utilization
• Increasing of GNP
• 1999 13.5 of GNP 2X other nations spend on
  health care

43
Increasing the Cost of Health Care

• Research and development
• Acute Services
• Rehabilitative Care
• Prevention

44
Spiraling Cost

• Resulted in
• Cost containment
• Integrated health care systems
• Moral dilemma

45
Hospital Cost, Breakdown

• Hotel services
• Bed leasing
• Food
• Labor
• Utilization of services
• Tests
• Therapies

46
Medical Cost

• Pharmacy
• Price control
• Physicians
• Discourage fee for service
• Price control
• Retrospective vs. Prospective payment

47
Financing Health Care

• Government, Individual and Corporate Money

48
Reimbursement

• Self pay
• Insurance
• Grants - Hill Burton Act
• Medicaid - State
• Medicare - Federal

49
Risk Sharing

• Insurers and Providers of Care

50
Distributing Risk

• Decrease the probability of incurring loss
• Includes a Moral Hazard
• What befalls one doesn't affect another
• Events are independent
• Not necessarily true for health care

51
Protecting the Enterprise Against Risk

• Risk
• Variations in possible outcomes based on chance
  exposure to loss
• Insurance
• Written contract that transfers risks/financial
  responsibility for losses up to specified limits
  to an insurer for a money payment called premium

52
How Insurance Works
53
Health Insurance

• 90 percent of insured people acquire private
  health insurance through company benefit plans
• Employers providing group health insurance
  typically cover employees and eligible dependents

54
Common Types of Health Insurance
55
Health Insurance

• Health Maintenance Organizations (HMOs)
• Prepaid medical plans in which consumers pay a
  set fee in order to receive a full range of
  medical care from a group of medical
  practitioners
• Preferred-Provider Organizations (PPOs)
• Health-care providers offering reduced-rate
  contracts to groups that agree to obtain medical
  care through the providers organization

56
Spiraling Utilization

• Decrease Utilization
• Access
• Increase Prevention
• Decrease coverage as a deterrent to utilization

57
Controlling Utilization

• Aligning Quantity, Quality
• And Cost

58
Diagnostic Related Group

• Data base of 300 categories
• assignment of cost
• negotiation of reimbursement
• Criteria
• Utilization of raw materials
• Implies usual quality

59
Managed Care, Chitty Pg. 322

• Capitation fixed payments for a category of
  patients.
• type of patient.
• number of patients.
• Focus on outcomes.
• Patient will be discharged from acute Gallbladder
  and Lap Choly with out Infection to home prepared
  for self care.
• All services to complete outcome.

60
Competing Outcomes

• Limited resources
• Sequential products
• Unequal power bases

61
Medical Staff

• Too many doctors in urban areas
• Not enough Primary care
• Socialization, length of education, Reimbursement

62
What does this mean for the Hospital?

• Primary careadmissions
• Specialists technology

63
Cost containment

• Effects on rural health
• Effects on health care providers
• Effects on health care recipients

64
Evolutions in nursing

• Increased Utilization
• Changes in settings
• Changes in care delivery
• Substitution for other providers
• Decrease in of population
• Increase of management /business concepts

65
Challenges of Nurse Managers

• Integrity
• Managing with decreasing resources
• Bridging the gap between team members