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(BQ) Part 2 book Introduction to health care management has contents: Managing health care professionals, the strategic management of human resources, health care management case studies and guidelines, special topics and emerging issues in health care management,.... and other contents.
CHAPTER 11 Managing Health Care Professionals Sharon B Buchbinder and Dale Buchbinder LEARNING OBJECTIVES By the end of this chapter, the student will be able to: Distinguish among the education, training, and credentialing of physicians, nurses, nurse aides, midlevel practitioners, and allied health professionals; Deconstruct factors affecting the supply of and demand for health care professionals; Analyze reasons for health care professional turnover and costs of turnover; Propose strategies for increasing retention and preventing turnover of health care professionals; Create a plan to prevent conflict of interest in a health care setting; Examine issues associated with the management of the work life of physicians, nurses, nurses’ aides, midlevel practitioners, and allied health professionals; and Investigate sources of data for health workforce issues INTRODUCTION Health care organizations employ a wide array of clinical, administrative, and support professionals to deliver services to their patients The Bureau of Labor Statistics (BLS) indicated that there were close to 16 million jobs in hospitals, offices of health practitioners, nursing and residential care facilities, home health care services, and outpatient settings (Torpey, 2014) The largest employment setting in health care is hospitals and the largest category of health care workers is registered nurses, with 2.7 million jobs, 61% of which are in hospitals (BLS, 2014h) According to the BLS, there were 691,400 physicians and surgeons who held jobs in 2012 (BLS, 2014e) Increasingly, physicians are choosing to practice in large groups or to be employed by hospitals, rather than in solo or small practices In 2013, Jackson Healthcare re-conducted a survey of physicians and found 26% were employed by hospitals, an increase of 6% over the previous year Ownership stakes in practices, solo practices, and independent contractor statuses all declined in the same period (Vaidya, 2013) Employment offers physicians a safe haven in a volatile health care environment Under the umbrella of a hospital or other large health care organization, they have better work hours, benefits, and time off, which they could not always afford in small or solo practice It is expected the proportion of employed physicians will continue to grow in the coming decade In 2012, physician assistants held 86,700 jobs, over 55% of which were in ambulatory health care services, including physician practices, about 20% were in hospitals, and the rest in nursing care facilities and government settings (BLS, 2014f) Allied health professionals constitute a broad array of 28 health science professions, including, but not limited to, anesthesiologist assistants, medical assistants, respiratory therapists, and surgical technologists (Commission on Accreditation of Allied Health Education Programs, 2015) These statistics mean that, as a health care manager, in many instances you will be working with a mix of people with either more or less education than you have It also means you will not have the clinical competencies that these health care providers have—an intimidating scenario, to say the least Instead of clinical expertise, however, you will bring a background that enables you to enhance the environment in which these highly specialized personnel deliver health care services You will be the person responsible for making sure nurses, doctors, and other health care professionals have the resources to provide safe and effective patient care Your role will be to provide and monitor the infrastructure and processes to make the health care organization responsive to the needs of the patients and the employees The more you understand clinical health care professionals, the better prepared you will be to do your job as a health care manager The purpose of this chapter is to provide you with an overview of who your future colleagues are, how they were trained, and ways to manage the quality of their work environment PHYSICIANS Physicians begin their preparation for medical school as undergraduates in premedical programs Premedical students can obtain a degree in any subject; however, the Association of American Medical Colleges (AAMC) (2015) indicates that the expectation is that they will graduate with a strong foundation in mathematics, biology, chemistry, and physics Entry into medical school is competitive; applicants must have high grade point averages and high scores on the Medical College Admission Test (MCAT) There are some shorter, combined Bachelor of Science/Medical Doctor (BS/MD) programs; however, the majority of medical school graduates will have 8 years of post–high school education before they go through the National Residency Matching Program (NRMP), a matching process whereby medical students interview and rank their choices for graduate medical education (GME), also known as residencies, and the residency training programs do the same (NRMP, 2015) Once matched with a residency training program, physicians are prepared in specialty areas of medicine Depending on the specialty, the length of the residency training program can be as short as 3 years (for family practice) or as long as 10 years (for cardio-thoracic surgery or neurosurgery) According to the Accreditation Council for Graduate Medical Education (ACGME), “When physicians graduate from a residency program, they are eligible to take their board certification examinations and begin practicing independently Residency training programs are sponsored by teaching hospitals, academic medical centers, health care systems and other institutions” (ACGME, 2015, para 4–5) Due to recent GME legislation working on the physician shortage, there will be a gradual increase of residency training positions over the coming years with a priority on primary care physician residency spots (AMA Wire, 2015a) Some authors have begun to question the need for lengthy training programs, given the presence of shorter pre-medical programs, competency based education, the looming shortage of physicians, and levels of debt incurred by medical students (Duvivier, Stull, & Brockman, 2012; Emanuel & Fuchs, 2012) Regardless of the specialty, length of physician training programs, or number of trainees, depending on the type of health care organization where you are employed, you may be working with residents-in-training and medical students, as well as physicians who have been in independent practice for decades In addition to having a long time before they can practice independently, residents work extensive hours as part of their training programs At one time, it was not uncommon for residents to be on call continuously for 48 hours, because ceilings on hours of work for residents varied by residency training program However, that all changed due to the death of Libby Zion, an 18-year-old college student, who was seen at the Cornell Medical Center in 1984 and allegedly died due to resident overwork (AMA, Medical Student Section, n.d.) Although the hospital and resident were exonerated in court, the battle over resident work hours had begun New York was the first state to institute limits on resident work hours in 1987 Over the past two decades, various specialty societies, medical associations, and legislators fought over the definition of “reasonable” work hours for physicians in training The battle has continued, and new rules have been updated from those published in 2003 Per these new rules, hospitals and residency training program directors will be required to limit resident work hours to no more than “80 hours per week, averaged over a four-week period, inclusive of in-house call activities and all moonlighting” (i.e., side jobs in addition to the 80 hours per week) (ACGME, 2014, p 4) First-year residents (PGY-1) are not permitted to moonlight (ACGME, 2011) “Sponsoring institutions and programs must ensure and monitor effective, structured hand-over processes to facilitate both continuity of care and patient safety” (ACGME, 2014, p 13) This mandate means when the resident goes home, the next person taking care of the patient must be briefed to ensure that the patient care team has all relevant information Despite the restrictions on work hours, residents are not permitted to walk out the door without communicating this important patient care information At times, this means a delicate balancing act to ensure compliance with all standards, which also emphasize the need for interpersonal and communication skills, professionalism, systems-based practice as components in a culture of safety and patient-centric care When the work-hour rules first went into effect, physicians who trained under the “work until you drop” mentality protested that professionalism would decline and residents would miss out on learning opportunities associated with continuity of the care from patient admission to discharge Surgeons, in particular, protested, fearing walk-outs in the middle of long cases, a reflection of a time-clock-punching and a shift-work mentality Ethnographic research conducted among medical and surgical residents in two hospitals did not find evidence for those fears Over the course of three months, Szymczak, Brooks, Volpp, and Bosk (2010) followed residents, observed behaviors, and conducted in-depth face to face interviews These researchers found that rather than leave at a critical juncture, the residents were, on occasion, more inclined to stay—off the clock Interviews elucidated thoughtful, analytical rationales for the non-compliant behaviors, as well as a respect for the work-hour rules Residents were mindful of the implications of their behaviors and the implications of non-compliance and were conflicted about under-reporting their hours, i.e., lying about their time on duty These work-hour rules and patient handoff protocols underscore the fact that residents are in the hospital for education, not to provide service to the hospital, a major departure from the way graduate medical education was conducted a few decades ago More time is needed to see if the pendulum will swing back to longer duty-hours in light of actual behaviors The implications of limits on resident work hours are multifold While residency training program directors are responsible for monitoring resident work hours, they must be in compliance with the health care institution’s policies as well You may be responsible for ensuring compliance by collecting work-hour data for your managers Health care managers are obligated to ensure adequate coverage of the hospital with physicians Resident work-hour restrictions may mean that you need to employ more physicians or midlevel practitioners—physician assistants and nurse practitioners And your organization may need to hire ancillary staff and allied health professionals, such as intravenous therapists and surgical assistants, to do tasks previously covered by resident physicians Most physicians are eligible to obtain a license to practice medicine after one year of postgraduate training Licensure, granted by the state, is required for physicians, nurses, and others to practice and demonstrates competency to perform a scope of practice (National Council of State Boards of Nursing [NCSBN], 2015a) Limited licensure is granted for PGY1s in hospital practice under supervision State Boards of Physician Quality Assurance (BPQA) establish the requirements for medical licenses These requirements are lengthy and strenuous For example, the state of Maryland requires the following (Annotated Code of Maryland, 2015): Good moral character; Minimum age of 18 years; A fee; Documentation of education and training; and Passing scores on one of the following examinations: • All parts of the National Board of Medical Examiners’ examinations, and/or a score of 75 or better on a FLEX exam, or a passing score on the National Board of Osteopathic Examiners, or a combination of scores and exams; or • State Board examination; • All steps of the U.S Medical Licensing Examination (USMLE) Candidates must demonstrate oral and written English-language competency and supply the following: A chronological list of activities beginning with the date of completion of medical school, accounting for all periods of time; Any disciplinary actions taken by licensing boards, denying application or renewal; Any investigations, charges, arrests, pleas of guilty or nolo contendere, convictions, or receipts of probation before judgment; Information pertaining to any physical, mental, or emotional condition that impairs the physician’s ability to practice medicine; Copies of any malpractice suits or settlements, or records of any arrests, disciplinary actions, judgments, final orders, or cases of driving while intoxicated or under the influence of a chemical substance or medication; and Results of all medical licensure, certification, and recertification examinations and the dates when taken In addition to the above requirements, many states also mandate Continuing Medical Education (CME) in such topics as domestic violence, child abuse, drug abuse, and quality assurance, to name but a few A new commission is working to help streamline the process for those physicians seeking licensure in multiple states The eligible physician designates her “principle state of licensure and selects other states in which she desires licensing” (AMA Wire, 2015b, para 3) At the time of this writing, seven states were participating in this compact It is anticipated that with the rise of telemedicine, more states will join the Federation of State Medical Boards, Inc (FSMB)–initiated agreement Physicians must also undergo criminal background checks (CBCs) in all but a few states As of 2014: “45 state medical boards conduct criminal background checks as a condition of initial licensure; 39 state medical boards require fingerprints as a condition of initial licensure; 43 state medical boards have access to the Federal Bureau of Investigation database; and The Minnesota Board of Medical Practice will conduct criminal background checks and require fingerprinting (including access to the FBI National Crime Information Center [NCIC]) by January 1, 2018” (FSMB, 2014, p 1) The reasons for increasing numbers of medical boards requiring CBCs are numerous and include, but are not limited to, increasing societal concerns about alcohol and drug abusers, sexual predators, and child and elder abusers If a CBC contains information about convictions, the state licensure board will examine the application on a case-by-case basis The reviewers will be looking for level and frequency of the criminal behavior, basing their decision on that, along with other materials submitted by the applicant, such as proof of alcohol and drug rehabilitation In addition to obtaining a license, physicians may voluntarily submit documentation of their education, training, and practice to an American Board of Medical Specialists (ABMS) member board for review (ABMS, 2015) Upon approval of the medical specialty board (i.e., successful completion of an approved residency training program), the physician is then allowed to sit for examination Successful completion of the examination(s) allows the physician to be granted certification, and she is designated as board certified in that specialty (e.g., a board-certified pediatrician or a board-certified general internist) Certificates are timelimited; physicians must demonstrate continued competency and retake the exam every 6 to 10 years, depending on the specialty The purpose of American Board of Medical Specialties Maintenance of Certification (ABMS MOC) is to ensure that physicians remain up-to-date in their specialties (ABMS, 2015) Board certification is a form of credentialing a physician’s competency in a specific area For staff privileges and hiring purposes, most hospitals, HMOs, and other health care organizations require a physician to be board certified or board eligible (i.e., preparing to sit for the exams) because board certification is used as a proxy for determining the quality of health professionals’ services This assumption of quality is based on research that more education and training leads to a higher quality of service (Donabedian, 2005; Tamblyn et al., 1998) Lipner, Hess, and Phillips (2013) conducted a meta-analysis of the perceptions of the value of ABMS MOC on stakeholders The authors found patients and health care organizations valued MOC and participation across the boards was high, perhaps due in large part to hospitals requiring it for privileging However, not all physicians were not convinced re-certification was useful The same literature review found the association between physician board certification and quality of care to be positive, but “modest in effect sizes and are not unequivocal” (Lipner et al., 2013, p S20) Since the ABMS MOC is still a relatively new requirement, it remains to be seen if the impact on quality of care will grow over time Most states require that physicians complete a certain number of continuing medical education (CME) credits to maintain state licensure and to demonstrate continued competency Additionally, hospitals may require CME credits for their physicians to remain credentialed to see patients (National Institutes of Health [NIH], 2015) Seven organizations, the ABMS, the American Hospital Association (AHA), the AMA, the Association of American Medical Colleges (AAMC), the Association for Hospital Medical Education (AHME), the Council of Medical Specialty Societies (CMSS), and the FSMB, are members of the Accreditation Council for Continuing Medical Education (ACCME) (ACCME, 2015b) The ACCME establishes criteria for determining which educational providers are quality CME providers and gives its seal of approval only to those organizations meeting their standards The ACCME also works to ensure “uniformity in accreditation” of educational offerings to maintain the quality of continuing physician education and now requires educational providers to reapply for maintenance of recognition (ACCME, 2015a) Physician credentialing is the process of verifying information a physician supplies on an application for staff privileges at a hospital, HMO, or other health care organization Most health care organizations have established protocols, and as a health care manager, you will be required to follow that protocol Physicians are tracked by the AMA from the day they graduate from medical school until the day they die Information about every physician in the U.S is in the AMA Physician Masterfile, which has been in existence for more than 100 years Originally created on paper index cards to establish biographic records on physicians, “the Masterfile…serves as a primary resource for professional medical organizations, universities and medical schools, research institutions, governmental agencies, and other health-related groups” (AMA, 2015b, para 5) Physician credentialing is a time-consuming, labor-intensive, costly process that must be repeated every two years When physicians apply for privileges at a hospital, they must specify what they want by specialty and, within the surgical specialties, by procedure For example, a general surgeon who wants to do laparoscopic cholecystectomies (i.e., removal of the gall bladder through a very small incision, using an instrument like a tiny telescope) would apply for both general surgery privileges and for that specific procedure Using extensive documentation, the surgeon must demonstrate competency for those privileges Normally, physician credentialing criteria are established by the department where the physician would be affiliated Core privileges cover a multitude of activities that a physician is allowed to do in a health care services organization Using family practice (FP) as an example, the Department of Family Practice in a hospital would establish the criteria for privileges Core privileges for a FP might include: admission, evaluation, diagnosis, treatment and management of infants and children, adolescents, and adults for most illnesses, disorders, and injuries (American Academy of Family Practice [AAFP], 2015b) Specific privileges would be those activities outside the core privileges and would require documentation of required additional training and expertise in a procedure In this example, if the FP also wanted to be allowed to deliver babies at a hospital, that FP would be required to provide documentation of that training and might be subject to observation or proctorship to ensure he or she had the requisite competencies (AAFP, 2015a) If there are two departments with physicians who do the same thing (e.g., Obstetrics and Gynecology and Family Practice), each department is responsible for its own criteria The Medical Staff Office would enforce, but not establish, the criteria A hospital must conduct diligent research on physicians before granting privileges, or it can be held liable in a court of law for allowing an incompetent physician on its staff, should there be a bad outcome The same is true for HMOs, ambulatory care centers, and other health care delivery organizations In Taylor v Intuitive, lawyers for the estate of Fred Taylor alleged Intuitive, the company that created the daVinci robotic surgery system, failed to provide adequate training for the surgeon, which led to major complications and the death of the patient Intuitive argued it had no responsibility for assessing the surgeon’s competency in using the technology The jury agreed with the defense, underscoring the importance the hospital’s legal liabilities associated with negligent credentialing and privileging (Pradarelli, Campbell, & Dimick, 2015) It is preferable to obtain primary, meaning firsthand, verification and documentation by contacting each place of education, training, and employment individually by phone and obtain original documents, such as transcripts with raised seals Verification can include, but is not limited to, the following elements (Government Accountability Office [GAO], 2010): Name, address(es), and telephone numbers; Birthdate and place of birth; Medical school; Residency training program and other graduate education, including fellowships; State licensure details, including date of issue and expiration; Specialty and subspecialty, including board certification and eligibility; Continuing medical education; Educational and employment references; Drug Enforcement Agency (DEA) registration status; and Licensure, Medicare/Medicaid, and other state or federal sanctions The importance of primary verification of these elements has been statistical process control, 154 strategic framework for, 151–153 teams, 156, 364, 385 tools, 160–164 quality of care, physician rank EHRs, 178b quantified-self movement, 485 qui tam provision, 443 R RAC See Recovery Audit Contractors racial groups uninsured population and, 234, 235f in U.S population, 398–400 rate setting, 264 ratio method of determining needs, 330 rationing, 435 RBRVS See Resource-Based Relative Value System REC program See Regional Extension Center program reckless behavior, 463 recognition phase of decision making, 92 Recovery Audit Contractors (RAC), 442–444 recruiters, 334 recruitment advertising methods for, 333–334 case study, 595 challenges, 595 responsibilities for, 333, 333t referrals, patient Anti-Kickback statutes, 448–451 safe harbor regulations, 450 Stark Laws I and II, 448 Regional Extension Center (REC) program, 181 registered nurses (RNs), 294–302 board certification, 300 continuing education for, 300–301 criminal background checks, 295 educational requirements for, 295 foreign educated, 301–302 job dissatisfaction, 297 job satisfaction, organizational climate and, 299 licensure, 295 new, concerns of, 296 number of, 294–302 specialties for, 290 turnover, 296–297 unionization, 351 regulatory environment, 112–113 Rehabilitation Act, 329t reimbursement based on performance, 253 concerns about, 323, 325 modified on basis of performance, 253 of physicians, 258 prospective, 253–256 of providers, 252–259 retrospective, 253 by uninsured individuals, 253 reinforcement theory, 53–54 relator (whistle blower), 336 reliability, 153–154 research on emerging issues, 238, 389, 488 in fraud and abuse, 454–455 in health care ethics and law, 437 in health care management, 18–19 in health care marketing, 140–141 on health care professionals, 193–194, 310 in health care quality, 164–165 on health disparities and cultural proficiency, 414–415 in human resources management, 354–356 issues, 43 in management and motivation, 71 on managing costs and revenues, 274–275 in organizational behavior and management thinking, 99–100 in strategic planning, 122–123 in team, 389 residency training programs, for physicians, 281 resilient leadership, 31 resource allocation, in strategic planning, 108 Resource-Based Relative Value System (RBRVS), 217, 258 Resource Utilization Groups (RUGs), 217, 254 resources allocation, 435 allocation of, strategic planning and, 108 misuse of, 148 overuse of, 148 underuse of, 148 respect for persons, 431 respectful guardianship, 431 respiratory therapists (RTs), 309 respondeat superior, 427 retention, employee benefits and, 343–344 compensation for, 339–341 Employee Assistance Programs and, 345 employee suggestion programs and, 353–354 labor relations management and, 350–352 nurses, 297 retirement benefits, 343 retrospective reimbursements, 253 revenue budget, 249, 273 revenue cycle, health care coding, 260 rewards, 50 for desired behavior, 62 extrinsic, 56 incentives and, 55–56 intrinsic, 56 tailored, 62 Right to Try Laws, 436–437 case study, 603–604 risk assessment, for internal control, 452 risk sharing, 206 RNs See registered nurses “Road to Zero: the CDC’s Response to the 2014 Ebola Epidemic, The,” 463 Roe v Wade, 436 role schemas, 84 rollout, of strategic plans, 118–119 rounding, 35 RUGs See Resource Utilization Groups rules and regulations, 425, 434 S safe harbor laws, 448–451 safety needs, Maslow’s hierarchy of needs, 52 Sarbanes-Oxley, 35–36 Sarrell Dental, 484 satisfaction progression, 52 schemas, 83–85 event, 84 interpretative, 84–85 organizational, 84 person, 84 role, 84 Schiavo, Terri, 422 Scientific Management Theory, 54–55 second victim programs, 345 select, in FOCUS-PDCA framework, 157 selective perception, 89 self-actualization needs, Maslow’s hierarchy of needs, 52 self-awareness, 29 self-development domain, 33 self-funded health insurance plan, 216 self management, 9–10 self-regulation, 29 self-understanding domain, 33 senior management, 13 sentinel events, 297, 299 servant leadership, 30 service connected conditions, veterans and, 230, 230t service line management, 7, 9 services, upcoding, 442 Sherman Antitrust Act, 447, 448t Shewhart cycle, 151, 156 Shewhart, Walter A., 150 shortages, of health care personnel, 281, 290, 324 similar-to-me bias, 96 simplifications, cognitive, 84, 92 situational approach to leadership, 26 Six Sigma, 157–158 skill sets, 6 skilled nursing facilities (SNFs), 217 Skinner’s Reinforcement Theory, 53–54 SMI See Supplemental Medical Insurance SNFs See Skilled nursing facilities social awareness, 384 social categorization, 97–98 social cognition, 82, 95–99 attribution, 95–96 biases, types of, 96–97 empathy and socio-emotional intelligence, 98–99 social categorization and biases, 97–98 social determinants, 400 social facility, 384 social insurance Affordable Care Act of 2010, 218–220 Balanced Budget Act (BBA) of 1997, 217–218 Children’s Health Insurance Program, 228 CHIP reauthorization act of 2015, 220 Department of Defense, 228–229 Employee Retirement Income Security Act of 1974, 216–217 evolution, 216–220 major legislation, 216 Medicaid, 223–227, 226f Medicare, 220–223, 222f, 223f Medicare Prescription Drug, Improvement, and Modernization Act of 2003, 218 Omnibus Budget Reconciliation Act of 1989, 217 operational issues, 231–232 Patient Protection and Affordable Care Act of 2010, 218–220 Social Security Act of 1935, 216 Tax Equity and Fiscal Responsibility Act in 1982, 217 TRICARE, 228–229 Veterans Affairs, 230–231, 230f social intelligence (SI), 384 social loafer syndrome, 387 social marketing, 138 social media, 137–138 case study, 576–577 Social Security Act (SSA) Amendments of 1965, 216 Criminal-Disclosure Provision of, 445 Medicare, 216, 220–223 Medicaid, 216, 223–227 social skills, 29 socialized medicine, 207 socio-emotional intelligence, 95–99 socio-emotional skills, 78 soft skills, 78 SPC See statistical process control “special cause” variation, 150, 154 specific identification, for valuing inventory, 269 Spina Bifida Healthcare Program, for Vietnam veterans, 231 spiritual focus, 30 spirituality leadership, 30–31 SSA See Social Security Act, Amendments of 1965 staff manager positions, 6–7 staff model health maintenance organizations, 213 staff training, cultural competency and, 405 staffing management functions, 5 staffing needs, 330–331 stalking, 473–474 case study, 527–528 standard of care, 427 standards of behavior, 10 Stark Laws I and II, 448, 449t State Boards of Physician Quality Assurance (BPQA), 283 Statements of Antitrust Enforcement Policy In Health Care, 447 Statistical Method from the Viewpoint of Quality Control, 151 statistical process control (SPC), 151, 154, 155 statistics budget, 273 statutes, 425, 426b stereotypes, social categorizations, 97–98 stock-outs, 268 storming, of teams, 374 strategic leader, 24 strategic management, of human resources See human resources management strategic marketing components, 130, 130f defined, 131–132 management of, 132–135 process, 129–132, 131f strategic planning, 107–123, 536–537 case studies, 536–537, 574–575, 576–577 Continuous Quality Improvement, 152 definition of, 107 diversity initiatives, 408 execution, 120–122 financial forecasts, 114–115 in health care, history of, 107 health care manager role in, 122 implementation of plan, 118–119 importance of, 108 market assessment, 110, 110f mission, vision, and values (MVV) statements, 113–114 monitoring and control, 119–120 organizational assessment, 114 participants, 121–122 process, 108–109 research in, 122–123 rollout, 118–119 supporting plans for, 119, 119f SWOT Analysis, 108–116, 110f, 116t workforce cultural competence strategy, 408 strategy execution, 120–122 identification and selection, 116–118, 118t outcomes, 117–118 performance, 115 purpose of, 108 resource allocation and, 108 rollout of plan, 118–119 tactical plans, 118, 118t strict liability, 450 stroke incidence, 399 structural elements in quality, 146 structural variables, 152 structured interviews, 335 style approach to leadership, 26 succession planning, 42, 353 manager role in, 13–16 suicide incidence, 399 Sunshine Act, 293 Supplemental Medical Insurance (SMI), 221 supply chain management, 268 surrogate decision makers, 436 SWOT Analysis components, 108–116, 110f, 116t in marketing management, 132 purpose, 113 systems perspective, of health care quality, 152f systems thinking, 88, 108 T talent management, manager role in, 11 tame problems, 379 target market segment selection, 132–133 task forces, 267 Tax Equity and Fiscal Responsibility Act (TEFRA), 217, 257 Tax Relief and Healthcare Act of 2006, 442–444 tax status, of health care organization, 249–250, 251t teams benefits of, 370–373 communication in, 384–387 composition of, 364 conflict resolution in, 381 convening, 370 definition of, 364–367 diversity of, 385 effectiveness of, 369 interdisciplinary, 364, 368 leadership of, 378 management of, 9–10, 364, 380–381 members personalities of, 381–382 selection of, 376 with minimal interpersonal conflict, 385 of physicians and nurses, 298–299 stages of, 374 trust building for, 388–389 teamSTEPPS, 386–387 teamwork, 363–389 case studies, 523–525, 531–532, 538–539 challenges for health care organizations, 368–369 costs of, 374–375 in FOCUS-PDCA framework, 157 Guidelines for Teamwork, 387, 388f problems, 379–380 real-world focus of, 379–380 requirements for, 364 technical domain, 33 technical management, of health care providers, 147 technical skills, 6 TEFRA See Tax Equity and Fiscal Responsibility Act telecommunications, 171 Telehealth, 190 Telehealth Enhancement Act of 2013, 190 telemedicine, 189–190 termination, employee, 350 Terri Schiavo case, 422, 422b The Joint Commission (TJC), 472 communication standards, 298–301 diversity standards, 406 leadership standards, 38 quality standards, 146 retention of nursing staff and, 296–297 Theory X, 55 Theory Y, 55 Theory Z, 55 thinking attention, 90 in communication, 81 features, 82–83 habits, fundamental, 87–91 influence on organizational behavior, 81–83 infrastructure of, 83–87 inner game, 81–82 mental models and, 83 non-rational, 83 perception, 90–91 in problem solving, 91–95 schemas and, 84–85 skills, 78 third-party mediation, for teams, 389 third-party payers policies, in setting charges and prices, 264–265 reimbursement by, 252–259 360-degree performance feedback, 14 360-degree performance appraisal systems, 347 Time Warner Cable Business Class, 484 TIP See Trafficking in Persons TJC See The Joint Commission To Err is Human (Institute of Medicine report), 145 top-down flowchart, 160, 162 tort law, 427–428 vs contract law, 430t torts assault and battery, 427, 535 defamation, 428 definition of, 425 false imprisonment, 427–428, 535 intentional, 427–428 invasion of privacy, 428 malpractice, 428–429 negligence, 427 Total Quality Management (TQM), 27, 150 See also Continuous Quality Improvement Toyota Production System (TPS), 158–160 TQM See Total Quality Management traditionalists, 64, 66–67t trafficking, 520 Trafficking in Persons (TIP), Protocol, 467–468 Trafficking Victims Protection Act (TVPA), 469 training, employee, 338–339 transitional care, case studies, 570–571, 572–573 transformational leader, 27 treasurer, 252 TRICARE plan, 228–229 TRICARE Prime, 229 TRICARE Standard, 229 Triple Aim, 70b trust building, for teams, 388–389 truth-telling, 431 turnover costs of, 296–297, 303, 373 health care workers, 324 nurses, 296 physicians, 291–293 staff, 324 TVPA See Trafficking Victims Protection Act U uncompensated care, 237–238, 259 underserved health problems of, 397–398 populations, 397–398 understand, in FOCUS-PDCA framework, 157 underuse of resources, 148 underutilization of staff, in Lean in health care industry, 159 UNEP See United Nations Environmental Programme uninsured individuals, provider reimbursements, 253 uninsured population ACA, 236–239 addressing problem of, 238 by age group, 235, 235f characteristics of, 236 by racial group, 234, 235f unions, 350–352 unit management, 9–10 United Nations Environmental Programme (UNEP), 466 United Physician Group (UPG), 509–510 United States, diseases by cases and deaths in, 462t unity of purpose, in Lean in health care principles, 159–160 upcoding, 442 case study, 529 U.S Constitution, 424 U.S health care system, 478 U.S health systems, 19 U.S Immigration and Customs Enforcement (ICE), 470 U.S population, racial groups in, 398–400 U.S State Department Trafficking, 470 V VA See Veterans Affairs vacation benefits, values statement, 113–114 vaccinations and health care managers, 464–465 vaccine preventable diseases, 460–465 Vaccine Preventable Outbreaks, 461 vaccines, 460 validity, quality improvement, 154 value-based purchasing, 38, 58–59, 223 value creation, 159 Value Stream Mapping, 162 values, 10 values statement, 113–114 valuing inventory, methods for, 269 Veteran Integrated Service Networks (VISN), 230 Veterans Affairs (VA), 228, 230–231, 230f Civilian Health and Medical Program (CHAMPVA), 228, 230 Veterans Health Administration (VHA) CHAMPVA program, 228, 230 enrollment categories, 230, 230t financing for, 231 Veteran Integrated Service Networks, 230 Vietnam Veterans and, 231 Vietnam Veterans, health care programs for, 231 VHA See Veterans Health Administration violence, in health care settings, 472–475 case studies, 517–518, 526, 257–528, 533–534, 535 vision, 24 of organization, 10 vision statement, 113–114 VISN See Veteran Integrated Service Networks visualization, in Lean in health care industry principles, 160 voting, in teams, 389 Vroom’s Expectancy Theory, 54 vulnerable populations, 397 W Walgreens, 483 Walmart, 484 weighted average, for valuing inventory, 269, 271t wellness tourism, case study, 586–587 whistle blower (relator), 443 case study, 601–602 Whistleblower Protection Act, 329t, 336 wicked problems vs tame, 379–380 Wickline v California, 435 work-hour rules, residents, 282 Worker Adjustment and Retraining Notification Act, 329t workers’ compensation coverage, 344 workers, types of, 472–473 workflow diagrams, 161f, 162 workforce issues, 328–337 diversity strategies, 408 planning/recruitment, 327–337, 329t, 332f, 333t retention, 337–354 retirement, 324 supply, 324 working capital management, problems/concerns for, 266–267 sources of, 266 worklife analysis, 303–304 workplace violence, 472 world-class facilities, 479 World Medical Association, 431 worldview, mental models, 85 ...hospitals, offices of health practitioners, nursing and residential care facilities, home health care services, and outpatient settings (Torpey, 20 14) The largest employment setting in health care is hospitals and the largest... leave (Kennedy, 20 05) Then who will provide the care? The job of the health care manager is to improve retention to slow down or stop turnover by addressing the quality of work life The place to start is with a comparable... It is expected the proportion of employed physicians will continue to grow in the coming decade In 20 12, physician assistants held 86,700 jobs, over 55% of which were in ambulatory health care services, including physician practices, about 20 % were in hospitals, and the rest in nursing care