Lecture Two: Health Care Administration Foundations and Components
|1. Describe and discussion the foundations and components of health care administration.||READINGS:
Mann & Gotz: Overview, I; Christensen & Overdorf;
1. Define: health care administration, creativity, critical thinking, reasoning and fallacious reasoning.
2. What is systems theory and how can it be applied to the field of health care administration?
3. How do the four themes from Mann & Gotz' Overview (i.e., individualism, pragmatism, free enterprise system and professional management) relate to the health care industry?
4. How does the evolution of management thought in the U.S. support, or differ from, the development of the health care industry in the United States?
5. Do health services managers carry out "classical" management functions?
6. What features of the health care industry do its various components have in common and what features differ? Is there an overall theme to the components of the health care industry?
7. How does UMUC's MS in HCA degree program integrate significant health care industry topics?
No new assignment.
Continue reading and thinking about your individual paper (20-pg) topic.
Terms and Concepts to Know:
A working definition of creativity: A company is creative when its employees do something new and potentially useful without being directly shown or taught."
The results of creativity in companies are improvements (changes to what is already done) and innovations (entirely new activities for the company).
The six elements of corporate creativity, which play a role in every creative act, are the key to increasing corporate creativity. They are:
2. Self-initiated activity
3. Unofficial activity
4. Serendipity [this if defined as a chance occurrence, linked with the wisdom to recognize the possibilities of that chance occurrence-Edwards, 2002]
5. Diverse stimuli
6. Within-company communication. (Robinson and Stern, 1998)
One of your references for this week, Christensen and Overdorf (2000) speak of the challenge of disruptive change. You will be studying about disruptive change throughout your MSHCA program. The concept means the changes that create an entirely new market that at first is judged by customers' response as negative. What examples of disruptive change in the health care industry come to mind? What about shorter lengths of hospital stays? How about surgery when it was first performed in free standing surgery centers, outside of hospitals?
A sustaining innovation, on the other hand, is a product or service that customers already value. In the health care industry, think of medications that are already on the market but are reformulated to absorb more quickly or to be given in fewer doses, while achieving the same clinical goal.
Disruptive changes will always be a part of a manager's world. While Christensen and Overdorf posit that managers see these disruptive changes coming, the authors feel that managers don't always think about their organizations' capabilities in responding to disruptive change as much as they think about individual people's capabilities to deal with disruptive change.
To help managers understand how to assess the abilities and disabilities of their organizations to deal with disruptive change, Christensen and Overdorf offer a framework (another term for model, view or paradigm) for looking at how organizations respond to change.
Christensen and Overdorf describe several ways that organizations can cope with change; these ways call for managers to create a new organizational space where organizational change capabilities can be created. The authors suggest three possible scenarios for organizations that want to change: creating new organizational structures; spinning out an independent organization; and acquiring a different organization. You may have witnessed or read about a change in the health care industry that demonstrates each of these three capabilities for organizations to deal with disruptive change.
A series of rational cognitive processes which allows the thinker to look at an issue or situation at both macro and micro levels, without the influence of subjective judgment, in order to determine the relative merit of that issue or situation. (Edwards, 2002)
REASONING: A definition: 1. Use of reason, especially to form conclusions, judgments, or inferences. 2. Arguments or evidence used in reasoning. (Webster's Dictionary, 1988)
FALLACIOUS REASONING: A definition: 1. Containing fundamental errors in reasoning. 2. Misleading; deceptive. (Webster's Dictionary, 2002) Fallacious reasoning can be examined in the context of health claims made for dietary supplements. According to Kreth (2000), these claims can contain two types of common fallacies of thinking: post hoc reasoning and inappropriate appeals to authority. Kreth writes the following:
Post hoc fallacies most often take the form of testimonials from allegedly satisfied consumers who simply assume a causal relationship between a supplement and its perceived effects, as if subjective opinions are valid and reliable evidence of a supplement's epidemiological effects. In fact, any perceived effect of taking a particular supplement might simply be a placebo effect, i.e., a psychological effect rooted in the user's belief in the product's efficacy, rather than any actual effect induced by the product itself. Another widely used form of fallacious reasoning among supplement ads is inappropriate appeals to authority. For example, the television ad of a ginkgo biloba supplement offers an endorsement by an actor (who plays a doctor on a popular television show) to establish the effectiveness of the product, even though an actor does not possess the necessary expertise to legitimately make such an endorsement" (paragraph 5).
In both of these examples, having to do with health claims for dietary supplements, appeals to the potential customer's thinking are based on spurious logic, or fallacious reasoning. Be on the alert for such types of claims in articles and reports, as well as in popular advertising. As the semester progresses, you may be asked to critique the writing of others to detect possible examples of fallacious reasoning.
HEALTH CARE ADMINISTRATION
Health care administration is that set of management practices and procedures where health care services are conceptualized, planned for, delivered, evaluated and reinvented in order to assist individuals, families and communities to prevent disease and promote healthful living. In addition to licensed health care providers, this broad area of business management also includes practices and procedures for administrators whose role and functions are reflected in an "in behalf of" method, for instance, by persons who work in managed health and other insurance businesses or by persons who work in pharmaceutical or health products supply companies (Edwards, 2002).
One of the first things to consider as you begin your exploration of the field of health care administration is to know that there are several ways to view the system that comprises health care administration. Throughout your MSHCA degree program, you will read about various "models" or frameworks that have been designed to make it simpler to see the component parts of a system. One such set of models appears in the lecture, below, that focuses on different phases in the evolution of management thought. Examples of models are the human relations and scientific management schools of thought. Before discussing models or frameworks, it is best to begin with the large picture of scientific thought, which starts with a system.
A system, according to Daft (2001), who writes texts on general management, is a "set of interacting elements that acquires inputs from the environment, transforms them, and discharges outputs to the external environment" (p. 14).
In the field of health care administration, there are also models or frameworks through which one views the components of that field of study and practice. For instance, one can look at the health care system, as does Daft (2001). Daft describes two types of systems: the open and the closed. The open system must interact with its environment: it consumes resources and it exports resources. It is constantly changing and responding to its environment. The human relations school of management would be considered an example of an open system. A hospital could demonstrate an open system model.
Systems theory implies a set of steps whereby a process or procedure can be separated into its constituent parts. The first step, input, includes all of the items of human and non human elements that are needed to begin a process. In a public health school immunization program, inputs would include the children whose parents or guardians believe the children need the immunizations, the nurses or other health care providers who administer the injections, and the vaccines, needles and syringes needed for the injections.
The throughput, or second stage of the system, is that place where an action or activity produces a transformation or change, to the constituent parts that enter the system of inputs. For example, in the school immunization program, the administering of the injection to a student is a change or transformation, since the child's body now contains the vaccine, which presumably will assist the child in warding off disease.
The third step in the systems model is the output. This is the place where outcomes or outputs emerge. An output is some object or action that can be counted, for example, the number of children who were vaccinated in a school public health immunization program during a set time period. An outcome is something that is produced as a result of the transformation or change step. For example, to determine the outcome of a school public health immunization program, one would try to determine the number of cases of a communicable disease before the immunization program, then compare that number with the number of cases of that same communicable disease for some future time period, after the immunization program, in order to attempt to create a link between the prevention (the immunization) and the outcome (the, hopefully, decreased number of cases of that communicable disease).
The final step in the systems process is the feedback loop. This step is identified by the returning, or looping back into the system, of the information gathered during the above steps. The information fed back into the system is analyzed and evaluated, so that changes to the system can be made, based upon the information obtained. The feedback loop should be in place before the system's process begin, so that changes to the system that are perceived to be needed can be made as soon as the need is determined. Thus, the feedback loop is critical to improving the system at every stage of the system's life cycle. (Edwards, 2002)
What types of feedback do you believe could be used to complete the systems model of health care administration for the school public health immunization program discussed above? What types of feedback could be gleaned from parents/guardians of children to be immunized? From the students themselves? From school personnel? From private physicians in the community served by that school? By other public health programs, e.g., the communicable disease surveillance unit of the local public health department or the public health nurses who offer clinics and home visiting services to that community?
Compare the open system, exemplified above by the school health immunization program, with a closed system. Are there examples of closed systems in the health care industry? What might they be? Daft describes, on the other hand, a closed system, which does not depend on its environment. It is "autonomous, enclosed, and sealed off from the outside world" (p.14). Daft links early scientific management, see its description below, as being a closed system.
As you read and as you carry out research, learning more about frameworks and models used to study health care administration, you will add to your list of possible models or frameworks. As you have seen above, the frameworks or models that can be used to examine health care administration include systems theory.
Another way to study health care administration is to "experiment" with the fit between what you learn and what you have already observed in the health care industry, both as a consumer and as a provider, support person, etc. For instance, health care administration can also be looked at from the viewpoint of a problem solving perspective. Health care administration can also be examined from a explore health care administration is from a process or quality improvement viewpoint. More will be discussed on the topics of frameworks or models, as your HCA degree program unfolds.
Whatever models for studying health care administration are selected, the application of them to health care administration is required in order to enhance a person's ability to make sense of the component parts of a system, to explain their interdependencies and to make suggestions for improvement to the system and its parts. A student of health care administration will use models and frameworks to look at management, to look at the health care industry and to make cogent and reasoned linkages between them.
A final thought on framework or systems of thought. In your MSHCA degree program, you begin the program with this introductory course, HCAD 600. You are then expected to take ADMN 625, the organizational communication course, ADMN 635, the leadership course, ADMN 638 the quantitative methods course (be sure to take this quantitative methods course before you take ADMN 630 since it will be a big help to you)) and finally, take your fourth core course, ADMN 630 or 631, financial management for managers. There is a rationale to the university's design of which courses you take and in what order.
Part of that rationale is given here: You begin your graduate course work with HCAD 600, the overview of management, of health care administration, of ethics, of writing and usage of a style manual, of critical thinking, of creativity and of graduate level expectations.
You proceed to core courses, which form the basis or foundation for the required and one elective health care administration courses you will take.. In ADMN 625, the importance of communication, of really listening to others in the workplace, of working in teams, of understanding both conformity and conflict, their advantages and disadvantages, are emphasized. In ADMN 635, the multiple types of leadership and how they are demonstrated are thoroughly explored. In ADMN 638, you will review and further strengthen your reasoning and quantitative evaluation skills. And, in ADMN 630 (or 631, for those with a financial management background), you will develop an appreciation for financial management for managers.
In each of these courses, there is an immediate application of subject matter to the health care administration field. You can view these core courses as the framework for later courses in this program. Keep your core course texts and notes, since they should assist your work in your health care courses. As you view the foundation of management and of these special management areas, i.e., communication, leadership, quantitative methods and financial management, you will begin to form the model or prism through which your graduate level studies flow. Consider at each stage of your MSHCA program how each course links with each other, to form a synchronous whole, from which the depth of your graduate level achievements will flow.
Finally, for this week, here is some very foundational information, in brief, based on one of your course texts (the edited Mann and Gotz book), which highlights some of the principal components of management thought. As you read the information below, on the evolution of management thought, be thinking of health care settings that you know, identifying how the management that you have observed in those settings relates to the various phases of management thought and practice discussed here. Sometimes, organizations, including health care organizations, have gotten "stuck" in a particular management phase from history, and need to move out of it, but have not yet done so.
By the end of this degree program, you should be able to identify what phase of management thinking seems most represented by a health care organization, and be able to make suggestions for improvement in the management thinking of that organization.
EVOLUTION OF MANAGEMENT THOUGHT:
Why study management thought throughout history? Dr. Alan Sutherland, UMUC faculty person, discusses this question. Based on Michael Frank's chapter in the Mann and Gotz text, (p. 33), people need to know where they have been in order to determine where they are to go, especially if they want to avoid the "quick fix" to management problems that may cause more damage in the long run. Management theory has been a combination of academic discipline and applied discipline; in other words, theory that is field tested in real organizations, often with conflicting results.
Briefly -- very briefly -- the stages of management theory have been:
1. The "Pre-Industrial Age" (roughly up to the early or mid-19th century). Since most commerce was still one of individual or small group effort, management was focused mostly in public organizations (especially the military) and in nonprofit organizations (primarily the church) -- only those institutions were large enough to be concerned about the movement of large groups of people and large amounts of material toward a specific goal or goals.
2. The "Early Industrial Age" (roughly the mid- to late 19th century). Here is seen the beginning of collective effort to produce profits, primarily the result of the use of new forms of energy, particularly steam energy. Production becomes more a collective effort, especially as factories replace cottage industry and craft guilds. Management begins to be seen as a theory, though not yet as a discipline.
3. The "Mid-Industrial Age" (roughly the mid-19th century to the early 20th century). Management theory expands, and management, previously a subset of economics, psychology and sociology, evolves as a separate discipline. Management theory is dominated by "Classical Management," with its focus on hierarchical structure, and "Scientific Management," with its focus on measurement.
4. The "Late Industrial Age" (basically, post World War I to the present). Management theory "comes into its own" as a discipline. Many theories are developed during this time period, e.g., human relations, Total Quality Management, systems theory, critical path, etc. Earlier theories during this period focused on employees as motivated individuals, not just as cogs in a wheel. Later theories were directed more toward the relationships among components in organizations. However, the focus of these theories remained primarily within the organization.
5. The "Information Age" (roughly the 1990s to the present). This is the set of theories emerging from the post-Industrial Age. These theories are focused on the relationship between organizations (singularly and in multiple numbers) and their environment in the broadest sense of that term. The focus is more on the role that information (and the management of information) plays in organizations, "corporate citizenship," and the increasing globalization of commerce and inter organizational activity. These schools of thought can best be symbolized by "chaos theory," which (as a gross oversimplification) holds that the flapping of the wings of a single butterfly relates to the movement of air currents that cause changes in weather."
THE HEALTH CARE INDUSTRY AND ITS ORIGINS:
What is important for those who study health care administration is to view the evolution of management thought as it has affected health care administration as a discipline and a field of study. The early history of health care shows that religious orders, nuns in particular, provided health care to travelers. Members of these orders in abbeys and other walled fortresses took care of those injured in battle, and botanists and herbalists provided medicinal therapeutics to those ill and infirm. Over time, the role of physicians and the education of physicians assumed roles in health care earlier that had been provided by lay midwives, barbers/surgeons and the aforementioned herbalists.
One example, from Paul Starr (1982), of the ascendancy of physicians' roles in health care decision making was that hospitals were constructed for the care of ill persons. Formerly, even persons who were seriously ill were cared for at home: for those of limited finances, family members, friends and houses of worship provided care takers. For those with the means to do so, paid workers were hired, such as untrained nursing personnel. Over time, with the advent of professional nursing education, private duty nurses often cared for persons in their homes, working with physicians who made regular home visits to these patients. But as time went on, physicians recognized that they could see more patients in shorter periods of time, if the patients were all located in one place: thus, the advent of the hospital. This is an example of a business that moved from being a "cottage" type of industry to one that moved into an industrialized mode of production.
This change in location of patients made a large leap into health care administration: groups of patients needing 24 hour care, needing laundry and meal service, housekeeping, medicine, creating a market for health care management services. Early hospitals were headed by physician "superintendents" and run by nurses. Boards of directors, trustees or visitors made policy and others carried out their guidance.
Florence Nightingale, a British noblewoman, who worked in the Crimean War, was heralded as a leading force in the reform of hospital standards of cleanliness, care and overall compassionate nursing. Her efforts were rewarded by the British Army in that she was commissioned to reform all of its hospitals. The work of Nightingale can be seen in the U.S. in such areas as open, airy hospital design and the elevation of the standards for nursing education programs. (Raffel & Raffel, 1994)
More recent analyses of Nightingale's work have added new information to our understanding of this complex historical character. Authors have said that Nightingale's primary interest was not the reform of civilian nursing but rather a: "... thorough overhaul of the health of the army in peacetime." Nightingale's contributions have also been characterized as "enormous" to the fields of public health, statistics and nursing. (Nelson, 2003)
As time went by, a separate role from physicians and nurses, who were the early health care givers and administrative decision makers in the health care field, was developed. This role evolved into the lay, meaning non religious or non clinical, hospital administrator. Over more time, lay health care administrators' roles grew into administering hospitals, nursing homes and other types of health care settings. The need for such health care administrators engendered educational programs to best prepare persons for these roles. You are in one such program.
In addition to physicians, nurses and lay health care administrators, there were other societal representatives who had a role to play in the delivery and administration of selected health care services. Persons interested in social justice were alert to the needs of the vulnerable in society, whether children, the elderly or the ill. Private citizens donated land and money to care for the less fortunate. Governments assumed some role for the care of the disadvantaged: those with certain communicable diseases, those with developmental disabilities, those with other unmet mental health needs. Hospitals and other care giving facilities were erected to provide health and related services to a variety of people, through the coming together of a number of people and organizations.
As you think about the origins of the health care industry and as you look at the evolution of management thought, consider Mann's discussion in the Mann and Gotz Overview (2002). If the four themes from that Overview do represent management thought in the U.S., compare them with the health care industry.
Individualism as a societal theme looks out first for number one and is juxtaposed with more communitarian societies that seem to work for the common good. Has the health care industry demonstrated a communitarian value system, or is it composed of individualists?
Pragmatism, valued by many, for its emphasis on clarity, cognitive functions and getting things done, seems to fit with many businesses in the U.S. Is the health care industry among them?
In terms of the free enterprise system, has the history of the health care industry allowed individual entrepreneurs to easily gain a foothold in the health care marketplace? What have been the dominant forces that have combined to make our U.S. health care system what it is today?
And, finally, when one considers professional managers, the history of management in the health care industry demonstrates a focus on the early use of highly skilled workers, physicians, nurses, etc., who then became managers, without professional management education. Can people who are very knowledgeable in their disciplines also become competent leaders and managers?
It seems that the themes of management thought in the U.S. give an idea that the U.S. health care industry has some unique characteristics that make it complex to analyze and a challenge to manage. What seems to be, is that as a result of the work of a variety of individuals and organizations, the health care industry has arrived at the unique place where it is today. As a "business" of today, it is not immune from some of the same issues that impact other industries. The topic of health care workers and their productivity and motivation, for example, will be explored more fully in our week four discussion.
In this lecture, we will continue to explore below some basic concepts related to our industry and how various "branches" of our industry contribute to the whole of the health care system.
Classical Management Functions in the Health Care Industry-Timmreck:
Before we look at some of the components of the health care industry, let's review what one of our readings this week had to say about the classical management functions in our industry. In his article, Timmreck (2000) gives the results of an interview format study of 122 midmanagers working in the broad spectrum of health services. When you have completed taking your ADMN 638 course, I believe you may evaluate this article differently than you may at this point in your MSHCA program. By this, I mean that this article is not the most rigorously defined, written nor analyzed article that you may ever read. But its content has value, in terms of discussing management functions.
The Timmreck (2000) study identified that for its respondents, organizing, then problem solving, then coordinating, then planning and then directing were the classical management functions identified as being used.
The findings of this study may differ from what you do in your job, or from what you see of midmanagers in your work setting. The author also pointed out some differences in the study population, in terms of gender.
When you take ADMN 625, UMUC's organizational communication course, you will be exposed to further data on gender differences in management, specifically in the area of communication. Deborah Tannen is an author who has done extensive research in the area of gender and styles of communication.
One of the things that came to my mind when I read Timmreck was that the complex, sometimes chaotic nature of the health care industry may be the reason why HC industry midmanagers spend more time in problem solving than the literature reports is done by midmanagers in other industries.
Can you think of other reasons for more problem solving being done by HC industry midmanagers? What did you think of Timmreck's assertions re the wisdom (or not) of the promotion of technically competent persons in the HC industry to management positions?
Also, how do you evaluate the author's views that many HC midmanagers really don't know about the importance of motivation in getting the job done?
The usefulness of Timmreck's article may be that it is useful for health services mid-level administrators to ponder and consider.
One final question about the Timmreck article: do you agree with the view of some of his survey respondents that doing menial computer work is an advantage to you, or do you believe that midmanagers see such computer work as lowly and demeaning?
In a reader on management practices, edited by Gibson (2000) and not a required text for this course, Charles Handy writes about rethinking principles. Timmreck used the term "midmanagers" to describe the group on which his study results were based. In the Gibson text, Handy (2000) writes with depth about all workers and managers, in relation to several basic issues about life, business and careers. Handy writes, for instance, that chaos has discernible patterns and that organizations have stable cores, with a flexible surround of employees, where employees carry out their creative functions.
Handy (p. 22) also writes that the classic management functions are "not terribly useful" today. He states that one can't predict more than two to three years ahead and that the future is a "series of discontinuities" that must be taken in stride. How do you think such a belief affects business' desire to do long term planning? How might it affect health care industry planning processes?
Handy speaks of the need for career resilience by workers, of working for oneself, and of people needing islands of security, as well as the importance of meeting this need in personal relationships. He writes that people can't just be problem solvers, but that in order for continued growth to occur, one needs to be "ahead of the problem."
In another of Handy's assertions, he discusses that global competitiveness should not be applied to health care activities. He states that hospitals and other health care components have to "compete with the world in terms of cost efficiency." Do you agree with his views on this?
Handy closes by suggesting that the responsibility of organizations, if they want to retain good people, is to provide a purpose. What purpose do you believe that your part of the health care industry demonstrate?
In that same Gibson text (2000), Stephen Covey, who writes about principle centered leadership, discusses the foundations of health care administration. Covey reviews the paradigm of principle centered leadership and, interestingly, uses occasional health care industry examples (e.g., blood letting, aspirin use and small pox vaccines) to present his concepts. One of Covey's emphases is on high quality and low cost business, which he says needs to be based on high trust or the ability to make meaningful partnerships within and without the organization. (p. 35)
Covey writes that trust comes emerges from the basic, universal principles of: fairness, justice, honesty and integrity. He further states that high trust cultures bring together pragmatism and idealism. Do you see pragmatism and idealism being operationalized in your work setting? Are you working in what Covey describes as a "high trust" culture?
Covey suggests (p. 37) that we need to change the way we think about people, realizing that people are an organization's most valuable assets, capable of immense achievement. He feels that we need to help people find meaning and fulfillment in their lives, to feel that they are making a "personal contribution" to something. In your current work setting, if you asked your coworkers if they felt they were by their work personally contributing to something meaningful, would they respond yes?
In discussing why organizations might not be performing up to the level they desire, Covey says there is a human barrier in organizations that is based on lack of courage and on fear: a myth of we can't. Do you agree with Covey that most organizations are overlaying new technologies, team activities and empowerment plans on top of an old benevolent authoritarian paradigm? Covey says this won't work.
Covey explores the need for patience with workers because of how long it takes for minds and hearts to change. He offers other suggestions, beyond patience, needed to build high trust, high performance, low cost organizations. He suggests building principles into all organizational structures and systems and using 360 degree performance reviews (which performance appraisal method is not seen by all as a useful tool).
Covey closes by writing that high trust organizations may be "immune" to the rigors of tough times; that tomorrow's leaders need to value principles more than they value the organization; and that it takes a long time to put in place in organizations the right set of conditions, combined with nurturance of workers, with humility and courage being demonstrated by organizational leaders. He adds that organizations, and their leaders, need to say what they are about, based on their identified principles and that when mission statements are written for organizations, input from workers at all levels is needed.
Consider, as you think about Covey's concepts, composing, for your own use, a personal mission statement. Hold on to it after you create it, returning to it later in this course or in your MSHCA program, looking for the inevitable changes in your personal goals that may come.
Let us turn our attention now from general issues that affect the world of work, to some specifics about our study of the world of health care administration.
Selected Health Care Administration Topic Areas:
When you consider the functions that most managers carry out, you see that the role of the manager is complex. One can add to that functional complexity the variety of work settings where a health care administrator may be employed. These two sets of concepts, managerial role functions and organizational work settings, can create much challenge for the health care administrator. As you read the information below, on components of the health care industry and about UMUC courses that you will be taking, consider how you might apply this information about the health care industry in your career.
Long Term Care (LTC). In this area of the health care industry, health care administrators deal with important quality of life issues, not just for elderly persons, but for other disabled persons, regardless of age, whose health care needs are not best met in acute care hospitals. Over time, the acuity level of patients in LTC settings has risen, and many patients who would have in the past remained in acute care hospitals for longer periods of time are now admitted to subacute and extended care units in LTC facilities. LTC facilities have also, over time, taken on certain ancillary service delivery for related non acute health care needs. Examples of these services are adult day care centers for persons with medical conditions who require day treatment programs as well as the delivery of health care services to persons who live in other settings, e.g., group homes, independent living arrangements, etc. More in depth study of the LTC industry will be found in HCAD 670.
Public, or Community, Health. The history of public health is rich with examples of groups of interested people (e.g., members of religious orders, the military, private citizens, local, state and federal government workers) coming together in pursuit of a common health care goal. An example of such efforts can be seen in the history of the polio, yellow fever and small pox programs. An example from today would include the work of local, state and federal government agencies in response to anthrax tainted mailings. The work of community health also involves voluntary health associations and organizations and many branches of government, along with numerous citizen groups, working together to improve the health of an entire geographical area, either focused on a particular disease (e.g., lung cancer) or focused on improving the overall health of the community. More examination of the public health movement in the U.S., and globally, is carried out in HCAD 630.
Health Care Finance. In all areas of the health care industry, there is controversy about, and there are discussions about, scarce resources and optimal utilization of available funds and other resources. The study of health care financial management and health care economics is contained in HCAD 640. (In order to be prepared for that course, be sure you have taken the course prerequisite, ADMN 630, or 631, prior to registering for HCAD 640.) In the past, health care economists looked most closely at the funding of hospital based care, the role of the pharmaceutical industry in the cost of health care and the ever increasing costs of the long term care industry.
Over time, various funding and payment schema have been developed to deal with the issues of health care funding; notable among the concepts developed have been managed care organizations. The premises of managed care, that patients could receive care of appropriate quality and quantity, in a timely manner, do not seem to have yet been fully realized. The U.S. and other countries continue to wrestle with the best way to deal with health care costs. A fuller examination of the topics of health care budgeting, cost, revenue and funding schema is also touched upon in HCAD 620, 630 and 670.
Health Care Law. If funding for health care services and products were not complex enough, the addition of numerous legal aspects of health care administration makes for interesting work for health care administrators. Legal topics of special concern in our industry include: the rights of patients; the liabilities of health care providers; and the regulation of the industry itself. A full treatment of these, and other, health care topics is presented in HCAD 650. In addition to legal aspects of health care administration, the issues of ethics and of corporate social responsibility (CSR) must be examined by students of health care administration.
In this course, HCAD 600, you will explore ethics and CSR, applying that information to the health care industry. Many days, it is the small ethical challenges, rather than major legal issues, that demand a health care administrator's time. To the extent that this is true in your work setting, learn all that you can about ethics, so that your decisions will be as ethical as possible.
Hospital and Other Health Care Delivery Settings. In HCAD 660, the major managerial and leadership roles of health care administrators are explored. Building on the work of ADMN 625 (organizational communication) and ADMN 635 (leadership), the quirks of management that pertain to the health care industry are analyzed. One example of an idiosyncrasy of the health care industry is that a delayed or erroneous decision can affect the life of a patient (customer). At the end of your MSHCA program, you will have an opportunity to examine in detail the kinds of strategic decisions that health care industry leaders must make in a variety of health care settings. This work is carried out in HCAD 690.
Technology and Health Care Administration. The role of technology in all aspects of the health care industry is of extreme importance, to patients, to families, to providers, to payers and to government regulators. Whether working on an improved personnel database for a hospital or creating a state of the art pharmacy monitoring and distribution system for a long term care facility, there is a growing need for health care administrators to know about and be able to speak knowledgeably of the best uses of technology in the health care industry. HCAD 610 offers an opportunity to examine and recommend improvements to technology uses in health care settings.
Special HCA Topics. The health care industry is a microcosm of society. As societal issues bloom, then recede, the health care industry often is required to move in those particular directions. Examples of this need to follow societal issues include a focus on communicable diseases at particular points in time, or on birth defects, or on cancers. In HCAD 680, health care topics of timely interest are addressed. At the present time, the importance of the behavioral-mental health continuum in health care; health care marketing; and public health's role in bioterrorism are emphasized in HCAD 680.
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