Health Care Business Operations and Performance
Introduction
In this module, you will explore the relationship and potential synergy created by consistent vision, mission, goals, and strategic plan. Health care strategy can be formed in one of two ways: it is intended and deliberate, which is created by plans, or it emerges through a pattern of uncoordinated decisions and actions (it just happens). Plans help to create a deliberate strategy. This is a discovery process in which health care organizations define their markets and assess internal operations. Plans move the organization forward toward the realization of a vision. The strategic plan or plan of action is necessary to achieve certain goals and objectives. The plan helps to create alignment and consensus around the organization's intentions. Key managers help to organize efforts and garner momentum for these strategies.
The Strategic Plan
The strategic plan changes or creates additional service lines, clinical procedures, and geographic locations of new clinics, rooms, or other facilities. The plan helps decide where to allocate resources for the high-level initiatives such as new medical technologies. The plan also identifies potential partners for an integrated delivery network or expanded system. When assessing a health care organization, ask what evidence you see of them attempting to work towards a certain vision. What services are they providing? How do they implement the strategy? How are they different from other clinical organizations in the community? How do they remain competitive?
Operations Internal Assessment and Improvement
Introduction
In this module, you will learn to identify methods of assessing and improving the quality of a health care organization. Developing processes is critical in assessing and improving quality since a process is how work gets accomplished. Until processes are fully documented, the interactions and steps cannot be appreciated. The "as-is process" documents what is actually occurring, versus what is supposed to occur. The "to-be process" documents the vision and the proposed process once improvements have been made. By fixing the process, you improve performance. The business process is a set of activities and tasks that are performed in sequence to achieve a specific outcome. The strategy of process improvement increases the throughput (capacity or volume) of a process; eliminates choke points or bottlenecks; and reduces costs, steps, waste, and resources. Look for steps that add value and eliminate those that do not. Reduce the variation in performance over time, remembering that variability causes resource inefficiency.
Analyzing Performance
Methods for analyzing performance include trend analysis and benchmarking. Trend analysis helps health care organizations answer the question, "How are we performing over time?" Benchmarking asks how we compare to our competition. Benchmarking is the process of identifying best practices and comparing performance relative to others, with the intent of making improvements. There are four steps in the benchmarking process. The first step in the benchmarking process is selecting organizations (and industry) for comparison. It is often worthwhile to benchmark outside one's own industry to increase the organization's ability to be innovative and competitive within its own industry. The second step is to collect or observe data and processes. The third step is to identify sources of differential performance and the fourth and final step is to incorporate benchmarks into performance scorecards and make improvements to operational processes.
Some questions health care administrators should ask about each of the processes in their organization include the following: Why are we doing this process at all? What value does it add? What quality improvements are necessary to improve outcomes? Can multiple processes be combined into a single person's role? If we make this change, will it adversely impact our service quality to patients?
Financial Analysis and Management
Introduction
In this module, we will explore the components of a financial analysis and how that analysis relates to operations assessment and quality improvement. To understand health care finance, you must understand the underlying accounting data and their presentation on financial statements. Regulations and practices are continually evolving. To fully utilize operations management, it is necessary to be able to trace all costs and revenues for processes back to the general ledger. Financial analysis normalizes data, so one can compare different sizes and types of organizations that otherwise would not be comparable. Place financial figures in percentage format, which simplifies comparison and analyses. Allow managers to identify trends or changes over time. Focus analyses on key areas of financial health, such as profitability, liquidity, and efficiency.
Management Role
Health care managers must focus on obtaining the right degree of financial leverage, or debt outstanding, as this has a very high correlation with financial success. They must also identify distress, or adversity, that threatens survival of the organization. Managers should routinely examine multiple financial metrics in a scorecard to keep a comprehensive view of their organization's health. Health care organization strategies should consider the impact of decisions on key financial indicators. Once the financial analysis is completed, strategies are set, and operations are assessed, the organization can create a plan for quality improvement.
Resource and Asset Allocation and Management
Introduction
In this module, you will seek to understand capital planning and allocation, budget planning methods, and strategic financial planning. In order to make operational improvements, reduce costs, and improve productivity, investments often need to be made. For example, new facilities help to improve patient flows and provide additional space for new procedures and units. New information technologies might automate manual processes, thereby reducing labor costs. Upgraded medical equipment and devices might promote greater efficiency from nurses and technicians. All of these might help to continuously improve processes, but without monitoring, they also might needlessly increase total costs.
Understanding the ROI
A formalized ROI (return on investment) process requires that ROI is calculated before each investment in capital to ensure that the long-run benefits outweigh the costs. The formal ROI process helps to instill discipline in management, so purchases are not made without regard to benefit. While financial benefits might not be the primary goals of all projects, they must be known and calculated to ensure that the organization can sustain the investment and manage any consequences. Health care managers must understand the time value of money. Money received today is worth more than money received in the future. Money spent today costs more than the same amount spent in the future. Funds spent today reduce the compounding effect of interest. The total net impact of both the timing and amount of funds to be expended and received must be analyzed.
Risk Management
Introduction
In this module, you will diagnose operational and strategic issues through an understanding of project risk management. Projects are an organized effort involving a sequence of activities that are temporarily being performed to achieve a desired outcome. Effective project management involves a sequencing of events. Management functions are extremely important (planning, organizing, controlling, leading) and focused on achieving positive outcomes. Examples of health care projects include implementation of nursing labor staffing ratios; implementation of clinical systems or technologies, such as picture archiving or imaging, process re-engineering to shorten length of stay for a clinical procedure, or business process (such as admit-to-pay process); or the development of a new building or clinic.
Projects
Projects consume about a one-third of all work effort by health care managers. Managing projects take different types of skills and focus than traditional operations management. Teams come together for only a short period of time. The teams are usually cross-functional. The projects may have a multidisciplinary approach, requiring managers to broaden their understanding. This requires skilled facilitation to get the job done. Projects often tend to blur lines of organizational responsibility, creating tension and conflict. Sponsorship from physician and executive groups is important. Anything that jeopardizes or threatens project success is a project risk. Risks are factors that contribute to project failure. For example, long implementation cycles, large scope and scale, new or immature technologies, inexperienced participants, poor project managers, lack of sponsorship, and poor communication are all risks.
Project Management
Introduction
In this module, we will learn to link strategy and performance by using the tools of project management to track and advance projects. Some key terms used in project management are:
• Deliverable: Tangible outcomes
• Milestones: Deliverables due at specific intervals during the project timeline
• Timeline: Includes start and stop dates, as well as key activities / deliverables in the project schedule
• Budget: The total investment and resources required to complete the project
Some project management scheduling tools are:
• Gantt Chart: Scheduling chart that displays activities as blocks or bars over time.
• Critical Path Method: Identifies the longest path in a project to help focus efforts on the most critical path. Use nodes to model paths, interdependencies, constraints, and time estimates.
• Program Evaluation and Review Technique: Similar to the critical path method, but builds estimates based on a range of estimates: most likely, best case (optimal), and worst case (pessimistic).
Change
Projects are normally meant to create improvements, but they also require people and process to change. They often create uncertainty as well as both physical and emotional discomfort. Often, resistance to change is a factor in the project's measure of success. Change management is a key factor in overcoming and mitigating the negative impact of resistance. Management and leadership are essential to making change palatable and positive. Plans and vision help to provide others with understanding of the change and the path necessary. Aligning incentives for all participants is required. Resources (human, financial, technological) are necessary to ensure that projects are completed properly and achieve success.
Quality of Service Measurement
Introduction
In this module, you will evaluate the quality of our services and understand the relationship between quality of service measurement and the effectiveness of our health care operations. Modern health care facilities are busy, complex organizations. Patients, visitors, staff, medical providers, supplies, equipment, and other resources are constantly in motion, making coordination difficult.
Patient Flow
Attempting to control these flows of patients and processes is essential to maintaining efficiency and effectiveness. We can improve patient flow by better understanding of demand through forecasting and analysis. By aligning our capacity and resources with projections of patients, we can de-bottleneck the problematic flows. This will help us manage flows through better systems and tools.
Bottlenecks are a point in a process where demand is greater than capacity. They are a chokepoint or problem area where the available resources (e.g., physician labor, rooms, supplies, hallways) are not enough to keep up with demand. De-bottlenecking is a systematic process to identify and eliminate obstacles. Forecasts are part of a collaborative process that estimates the volume of patients that will be served over a specific time period. Forecasts need to be conducted to thoroughly understand the nature and volume of demand. Forecasts will measure the type and complexity of patients, time of day when volume peaks, day of week where volume peaks, locations (rooms, clinics, beds) that are unusually busy, requests for specific providers or treatments, and equipment (such as MRI or CT) where utilization drops or rises. Only when demand is known can managers align resources and capacity properly.
Forecasting Patient Flow
There are two types of forecasts. Quantitative relies on historical data (such as volumes of admits or treatments) and other causal inputs to predict the future. This analysis applies mathematical methods for extrapolating the past for some reasonable period in the future (moving average, linear trend, Box-Jenkins). The analysis can be univariate (based on only one variable) or multivariate (uses a variety of data elements to more accurately predict demand, such as number of square footage, case mix, etc.). This method works well with established health care service lines. Qualitative relies on collaboration and input from others to make subjective or judgmental decisions about the future, with little regard to the historical data. This type works well in cases such as opening a new emergency room, estimating demand for a new line of business (e.g., OB services or bariatric care), experimental treatments, or where reimbursement is not yet established with payers.
Logistical Analysis
Introduction
In this module, we analyze the tools and techniques of supply chain management and capacity utilization. Supply chain refers to all activities involved in sourcing, procuring, converting, storing, and distributing goods that a health care organization uses as part of its ongoing operations. It is an integrated (end-to-end) process that is sometimes defined as procure to pay. There are multiple definitions, but all generally focus on networks and facilities (warehouses, point-of-use locations). The supply chain has a relationship with components (distributors, manufacturers, and customers), value, and the financial impact of decisions (such as which products to buy, what vendors to buy from, quantities to order). Supply chain activities receive significant attention, since supply chain costs can be up to half of total health care organization costs.
Demand and the Supply Chain
Demand drives supply chain management strategy. Of the four cornerstones (inventory, facilities, distribution, and customer service), demand for products must drive the strategy. Demand is the quantity of products requested or consumed, either by users (clinical providers, technicians, or staff) or by patients. Forecasting demand to be used, also keeping in mind shelf-life of some items, helps supply chain managers make more intelligent decisions, such as where to place inventory and the most economical order size. Using ERP (enterprise resource planning) and clinical systems, supply chain management can use transactional data to align demand with logistics strategy.
To build the right supply chain management capabilities, we must focus on speed in moving products and information. We must work to become a consistent and reliable partner for health care providers so that they can trust that supplies will be available when needed. Build alignment of patient and user's preferences and purchasing patterns into daily supply chain management activities. Use advanced decision support tools to help build an agile and flexible materials management and sourcing team and become innovative in all processes.