DETAILED CONTENTS

List of Exhibits.........................................................................................xvii

Preface...................................................................................................xxiii

Chapter 1.. Foundations.of.High-Performing.Healthcare.Organizations. 1

. In.a.Few.Words......................................................................1.

. Critical.Issues.........................................................................1.

. Questions.for.Discussion.........................................................2.

. Activities.................................................................................3.

. Contribution..........................................................................4.

. Stakeholders...........................................................................5

. .....Customer.Partners.............................................................6

. .....Provider.Partners...............................................................9.

. .....Sources.of.Stakeholder.Influence......................................11.

. Ownership............................................................................13

. .....Not-for-Profit,.For-Profit,.and.Government.Owners........13

. .....Healthcare.Systems..........................................................13

. Designing.Excellence.in.an.HCO..........................................14

. .....Cultural.Foundation.of.Excellence:.Transformational..

. .........Management...............................................................16

. .....Operational.Foundation.of.Excellence:.Evidence-Based..

. .........Management...............................................................23

. .....Strategic.Foundation.of.Excellence:.Positioning.and..

. ........Protection....................................................................30

. Suggested.Readings..............................................................36

Chapter 2 . Cultural.Leadership. 39

. In.a.Few.Words....................................................................39

. Critical.Issues.......................................................................39

. Questions.for.Discussion.......................................................40

. Purpose................................................................................41

. Functions.............................................................................41

. .....Promoting.Shared.Values.................................................43

. .....Empowering.Associates....................................................44

. .....Communicating.with.Associates.......................................45vii

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SupportingServiceExcellence.........................................47 Encouraging,Rewarding,andCelebratingSuccess..........51 ImprovingtheTransformationalCulture........................52 People.................................................................................52 SourcesofLeaders..........................................................52 QualificationsforLeaders...............................................53 LeadershipDevelopmentPrograms.................................55 PathsforBeginners.........................................................56 Measures.............................................................................57 TheCultureandLeadershipFunctions...........................57 AssessingLeadersasIndividuals......................................60 EnsuringLeadershipContinuity......................................61 ManagerialIssues.................................................................62 StartingthePathtoTransformationalCulture.................63 MaintainingtheEthicalFoundation................................64 ResolvingFundamentalDisagreements...........................66 ProtectingAgainstDestructiveBehavior.........................67 SuggestedReadings.............................................................67

Chapter 3 OperationalLeadership 69

InaFewWords....................................................................69 CriticalIssues......................................................................69 QuestionsforDiscussion......................................................70 Purpose...............................................................................71 Functions............................................................................72 BoundarySpanning........................................................72 KnowledgeManagement................................................79 AccountabilityandCorporateDesign..............................82 ContinuousImprovement...............................................88 SustainingandImprovingtheOperationalStructure.......90 People.................................................................................93 Measures.............................................................................93 ManagerialIssues.................................................................94 StartingthePathtoEvidence-BasedManagement..........94 UnderstandingtheRiskFactorsoftheModel.................97 SuggestedReadings...........................................................100

Chapter 4 StrategicLeadership:Governance 103

InaFewWords..................................................................103 CriticalIssues....................................................................103 QuestionsforDiscussion....................................................104 Purpose.............................................................................105 Functions..........................................................................106

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MaintainingManagementCapability.............................108 EstablishingtheMission,Vision,andValues.................110 ApprovingtheCorporateStrategyandAnnual Implementation.......................................................110 EnsuringQualityofClinicalCare..................................115 MonitoringPerformanceAgainstPlansandBudgets.....116 ImprovingBoardPerformance......................................119 People...............................................................................122 BoardMembership.......................................................122 MembershipQualifications..........................................122 BoardSelection............................................................124 BoardOrganization.....................................................127 EducationandInformationSupportforBoardMembers...131 Measures...........................................................................132 ManagerialIssues...............................................................133 OperatingDiscipline.....................................................133 LegalandEthicalIssuesofBoardMembership..............135 SuggestedReadings...........................................................137

Chapter 5 FoundationsofClinicalPerformance 141

InaFewWords..................................................................141 CriticalIssues....................................................................141 QuestionsforDiscussion....................................................142 Purpose.............................................................................143 Functions..........................................................................144 EnsuringAccurateDiagnosis.........................................144 EnsuringExcellentCare................................................146 ImplementingProtocols...............................................148 IndividualizingPatientCarePlanningandTreatment....162 ImprovingCommunityHealth.....................................163 ImprovingClinicalPerformance...................................165 People...............................................................................167 Organization................................................................167 Measures...........................................................................168 DemandandOutput....................................................169 QualityAssessment.......................................................169 PatientandAssociateSatisfaction..................................172 ManagerialIssues...............................................................175 SustainingaCultureofTeamworkandRespect.............175 CredentialingandEnsuringContinuedCompetence.....175 MinimizingandRespondingtoUnexpectedClinical Events......................................................................176 ResolvingInterprofessionalRivalries.............................176 SuggestedReadings...........................................................177

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Chapter 6 ThePhysicianOrganization 182

InaFewWords..................................................................182 CriticalIssues....................................................................182 QuestionsforDiscussion....................................................183 Purpose.............................................................................184 Functions..........................................................................184 AchievingExcellentCare..............................................185 CredentialingandDelineatingPrivileges.......................187 PlanningandImplementingPhysicianRecruitment.......194 ProvidingClinicalEducation........................................200 CommunicatingandResolvingUnmetNeeds...............203 NegotiatingandMaintainingCompensation Arrangements...............................................................206 People...............................................................................210 PhysicianLeadership.....................................................210 OrganizationofPhysicians............................................211 Measures...........................................................................211 ManagerialIssues...............................................................211 ManagingConflictingValues........................................212 MaintainingAdequatePhysicianSupply........................214 NegotiatingCompensationArrangements.....................214 SuggestedReadings...........................................................215

Chapter 7 Nursing 219

InaFewWords..................................................................219 CriticalIssues....................................................................219 QuestionsforDiscussion....................................................220 Purpose.............................................................................221 Functions..........................................................................222 DeliveringExcellentCare.............................................222 CoordinatingandMonitoringInterdisciplinaryCare.....228 EducatingPatients,Families,andCommunities............230 MaintainingtheNursingOrganization..........................231 ImprovingNursingPerformance...................................234 People...............................................................................236 TeamMembers.............................................................236 Organization................................................................241 Measures...........................................................................241 ManagerialIssues...............................................................242 RecruitmentandRetention...........................................244 ImproveNursing’sEffectiveness...................................244 SuggestedReadings...........................................................246

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Chapter 8 ClinicalSupportServices 250

InaFewWords..................................................................250 CriticalIssues....................................................................250 QuestionsforDiscussion....................................................251 Purpose.............................................................................252 Functions..........................................................................253 ProvidingExcellentCare..............................................254 MaintainingPatientRelationships.................................255 MaintainingConsultativeRelationships.........................257 PlanningandManagingOperations.............................259 PromotingContinuousImprovement...........................262 People...............................................................................269 TeamMembers.............................................................269 CSSManagement.........................................................270 TheHCOManager......................................................270 Organization................................................................271 HCO–CSSRelationships..............................................271 Measures...........................................................................272 ManagerialIssues...............................................................274 ShouldtheHCOOffertheService?..............................275 HowBigShouldtheCSSBe?.......................................275 WhatAretheStandardsofPerformance?.......................276 WhatFormofAffiliationBestMeetstheHCO’s Needs?......................................................................276 DoestheCSSHavetheCoordinationItNeeds?............277 AreCSSActivitiesCorrectlyAssignedtoProfessionaland NonprofessionalAssociates?......................................277 WhatAretheContinuousImprovementGoals?............278 WhatAretheLong-TermTrends?.................................278 SuggestedReadings...........................................................279

Chapter 9 BeyondAcuteCaretoCommunityHealth 281

InaFewWords..................................................................281 CriticalIssues....................................................................281 QuestionsforDiscussion....................................................282 Purpose.............................................................................286 Functions..........................................................................286 UnderstandingandPromotingCommunityHealth.......286 EstablishingaCommunityHealthStrategy...................294 OperationalizingaCommunityHealthStrategy............302 ImprovingPerformance................................................304 People...............................................................................304 Measures...........................................................................305

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Operational.................................................................305 Strategic.......................................................................307 ManagerialIssues...............................................................307 PromotingandTeachingCommunityHealth................309 ExtendingManagementConceptstoCommunity HealthcareTeams.....................................................310 ExpandingandIntegratingPrimaryCare......................310 MaintainingtheInfrastructureforCommunityHealth..311 SuggestedReadings...........................................................312

Chapter 10 KnowledgeManagement 317

InaFewWords..................................................................317 CriticalIssues....................................................................317 QuestionsforDiscussion....................................................318 Purpose.............................................................................319 Functions..........................................................................320 EnsuringtheReliabilityandValidityofData.................320 MaintainingCommunicationsforDailyOperations......327 SupportingInformationRetrievalforContinuous Improvement............................................................329 EnsuringtheAppropriateUseandSecurityofData.......332 ImprovingKnowledgeManagementServices Continuously............................................................333 People...............................................................................336 ChiefInformationOfficer.............................................336 KMPlanningCommittee..............................................336 Organization................................................................337 Measures...........................................................................337 ManagerialIssues...............................................................339 ExploitingtheKMPlanningCommittee.......................339 PromotingtheUseofKnowledge................................340 UsingOutsideContractorsandVendors.......................341 SuggestedReadings...........................................................343

Chapter 11 HumanResourcesManagement.........................................346

InaFewWords..................................................................346 CriticalIssues....................................................................346 QuestionsforDiscussion....................................................347 Purpose.............................................................................349 Functions..........................................................................349 WorkforcePlanning......................................................349 WorkforceDevelopment...............................................353 WorkforceMaintenance................................................356

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Empowerment,Transformation,andServiceExcellence363 CompensationandBenefitsManagement......................365 CollectiveBargaining....................................................371 ContinuousImprovement.............................................372 People...............................................................................372 HumanResourcesProfessionals....................................372 OrganizationoftheHumanResourcesDepartment......372 Measures...........................................................................374 ManagerialIssues...............................................................375 AdequateFunding........................................................375 ConsistentSeniorLeadership........................................377 PerceivedFairness.........................................................377 StrategicAchievement...................................................378 SuggestedReadings...........................................................378

Chapter 12 Environment-of-CareManagement 383

InaFewWords..................................................................383 CriticalIssues....................................................................383 QuestionsforDiscussion....................................................384 Purpose.............................................................................385 Functions..........................................................................385 FacilitiesDesign,Planning,andSpaceAllocation..........386 FacilitiesMaintenance...................................................393 GuestServices..............................................................396 MaterialsManagementServices.....................................399 EnhancedEnvironmentalManagement.........................400 PerformanceImprovementandBudgeting....................405 People...............................................................................406 ManagersandProfessionalPersonnel...........................406 OutsideContractors.....................................................407 TrainingNeeds.............................................................407 IncentivesandRewards.................................................408 Organization................................................................408 Measures...........................................................................408 OutputandDemand....................................................409 ResourceConsumptionandEffectiveness.....................410 Quality.........................................................................411 ManagerialIssues...............................................................412 FacilitiesPlanningandSpaceAllocation........................413 SelectionandManagementofOutsourcingContracts...413 IntegrationofFacilitiesOperationswithOther Activities..................................................................414 SuggestedReadings...........................................................414

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Chapter 13 FinancialManagement.......................................................417

InaFewWords..................................................................417 CriticalIssues....................................................................417 QuestionsforDiscussion....................................................418 Purpose.............................................................................419 ControllershipFunctions...................................................419 TransactionAccounting................................................419 FinancialAccounting....................................................422 ManagerialAccounting.................................................425 GoalSettingandBudgeting.........................................427 FinancialManagementFunctions......................................434 FinancialPlanning........................................................434 PricingClinicalServices................................................437 SecuringandManagingLiquidAssets...........................440 ManagingMulticorporateAccounting..........................444 AuditingFunctions............................................................445 InternalAudits.............................................................445 ExternalAudits.............................................................448 ContinuousImprovementoftheAccountingandFinance Functions.................................................................449 People...............................................................................449 ChiefFinancialOfficer..................................................449 OtherProfessionalPersonnel........................................450 OrganizationoftheFinanceSystem..............................450 Measures...........................................................................452 QuantitativePerformanceMeasures..............................452 SubjectiveQualityAssessment.......................................452 ManagerialIssues...............................................................454 SupportingIntegrityinAllFinancialAreas....................454 MaintainingaCollegial,Blame-FreeCulture.................454 ManagingAreasatRiskforConflict..............................454 SuggestedReadings...........................................................457

Chapter 14 InternalConsulting 459

InaFewWords..................................................................459 CriticalIssues....................................................................459 QuestionsforDiscussion....................................................460 Purpose.............................................................................461 Functions..........................................................................461 SupportingtheOrganizationasaWhole.......................464 SupportingImprovementProjects................................472 SupportingtheCapitalInvestmentReview....................475 ImplementingandIntegrating.....................................481 RespondingtoAnyOtherFactualConcern...................481

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ImprovingInternalConsulting.....................................482 People...............................................................................482 TeamMembers.............................................................482 Organization................................................................482 Measures...........................................................................484 ManagerialIssues...............................................................484 EnsuringQualityofWork.............................................486 SizingInternalConsulting...........................................486 ProtectingAssociates’Empowerment............................487 SuggestedReadings...........................................................488Chapter 15 MarketingandStrategy 491

InaFewWords..................................................................491 CriticalIssues....................................................................491 QuestionsforDiscussion....................................................492 Purpose.............................................................................493 MarketingFunctions..........................................................494 IdentifyingandSegmentingMarkets.............................496 ListeningtoStakeholderNeeds.....................................497 DevelopingBrandandMediaRelations........................501 ConvincingPotentialCustomers...................................502 AttractingandMotivatingAssociates............................505 ManagingOtherStakeholderRelationships...................505 ImprovingtheMarketingActivity.................................508 StrategicFunctions............................................................509 MaintainingtheMission,Vision,andValues.................509 DefiningtheStrategicPosition......................................509 ImplementingtheStrategicPosition.............................515 People...............................................................................515 Associates.....................................................................515 Organization................................................................516 Measures...........................................................................516 StrategicActivity...........................................................517 OperationalMeasures...................................................518 ManagerialIssues...............................................................519 SkillsforSuccessfulStrategy..........................................520 StrategicLeadershipRequirements...............................520 MultihospitalSystemContribution..............................521 SuggestedReadings..........................................................522

Glossary................................................................................................527

Index.....................................................................................................537

About the Authors..................................................................................553