Unit 1: Introduction to Healthcare Management.
Healthcare organisations are complex and have been likened to ‘double-headed monsters’ (Drucker in Cinagolu, 2016), referring to the often-conflicting priorities of clinicians and managers. Management in healthcare requires complex juggling to meet national targets whilst remaining focused on local priorities and placing the patient at the heart of decisions. Managers should consider the different levels of the healthcare system and how they can develop skills to effectively navigate complex organisational processes (Cinagolu, 2016). This unit will analyse the terms leadership and management, discuss multi-level factors which impacted on the organisational failure at Mid Staffordshire and introduce the notion of sense-making and how to manage effectively in the challenging climate of healthcare.
Welcome to the first lecturecast for your Healthcare Management: Principles and Practices module. In this lecturecast we will:
- Define management and analyse the differences between management and leadership
- Begin to understand the nature of healthcare systems and organisations and what informs organisational culture
- Contextualise healthcare management, including the social, demographic, economic and political aspects and,
- Identify contemporary concerns in healthcare management.
Defining Management
“Management matters. Without it, nothing happens” (The Kings Fund p.1). Management has been defined as “getting things done” through a process of planning, organising, guiding and monitoring (Gopee and Galloway 2017). This involves a variety of skills including decision-making and problem solving, action planning, prioritisation, allocating resources, communicating with staff and patients and using data (Gopee and Galloway 2017). Effective management contributes to positive organisational cultures, patient safety and quality of care. Unfortunately, too often, healthcare management is discussed in negative terms, associated with bureaucracy and “pen-pushing”. To embed effective management throughout healthcare organisations requires managers to be
supported and developed and their role celebrated (The Kings Fund 2011). Management, along with leadership and administration, is essential to keep healthcare services and organisations running smoothly – the three roles are interdependent (The Kings Fund 2011). For instance, a GP would not be able to concentrate on seeing patients without administration staff to book appointments, fill forms and send letters, and a practice manager to control the budget, built environment and staffing structure. An ambulance service would not run effectively without an efficiently managed call centre and maintenance of vehicles (The Kings Fund 2011). Yet, healthcare organisations have been described as “double-headed monsters” due to the often-conflicting priorities of clinicians and managers (Drucker 1980 in Cinaroglu 2016)– managers who are tasked with meeting targets which clinicians see as unnecessary or detrimental to their care delivery. The primary loyalty of care professionals to their own professions (rather than the organisation) has been identified as one of the issues for healthcare managers and organisations (Shortell and Kalzuny 2000) and may cause leadership conflict.
Managers vs. Leaders
On the other hand, Jennings et al (2007) found that out of 894 management and leadership competencies for nurses, only 32 applied distinctly to either management or leadership, the remainder overlapped the two.
Specific management competencies included: - Human resource management and
- Information management
Specific leadership competencies included: - Setting the vision and
- Developing people
Jennings et al (2007) argue that the lack of distinction could suggest that there is little difference between the two roles, or that the gap between leadership and management is closing. For instance, using information in an engaging way to advocate for improvement in the quality of care could be seen as a leadership skill.
Aspects of The Healthcare Organisation The “variable and complex” nature has been identified as one of the factors unique to healthcare organisations, along with the emergency nature and minimal opportunity for error (Shortell and Kalzuny 2000) The Australian Commission on Safety and Quality in Healthcare identified seven key aspects of a healthcare organisation as strategy, people, governance, partnerships, technology and built environment, measurement and care delivery – they then identified how structures, systems and processes can be manipulated to deliver person-centred care (Australian Commission on Safety and Quality in Healthcare 2018). In your recommended reading, Gopee and Galloway (2017) discuss the different management structures and how they impact on the levels of autonomy staff experience and
therefore staff morale and productivity. Healthcare organisations are very complex and managers who can see the bigger picture and understand the relationships between organisational structures, processes and outcomes for patients and staff, are likely to have a significant advantage (Cinagolu 2016). This image shows the relationship between structures such as the technology or staffing structures, care/treatment and management processes and patient and staff outcomes – described by Donabedian (1988) and adapted by Glickman (2007). Organisational culture can be a structure or an outcome of systems and processes. Local cultures are affected by and can also affect the wider organisation (NHS Improvement 2016), for example, actions taken (or not taken) by individuals in one hospital can affect the health system as a whole.
Reflect
Now reflect on an international example of care failure or an example from your own practice setting, you may wish to record your thoughts in your journal tool in your module.
Throughout the module, you are signposted to reflect on aspects of your learning and management practice. This is a personal space and provides you with somewhere to record your reflections. There are points throughout the module where your tutor may access your journal to provide you with some feedback, you can also request for your tutor to provide feedback if you wish. Please contact your tutor directly for this.
You can also post reflections into the journal from the various lecturecast activities throughout the module, which will help support your reflective development.?
Outside of the guidance provided throughout the module, you may also wish to consider: - The key things you have learned
- How can they relate to the workplace?
- How they can aid your personal and professional development?
Remember to be specific and give examples. This will help you to initiate some ideas for your assignments, which you can use throughout your studies.
Consider the use of a reflective model such as Gibbs or Kolb - to aid your journal entries.
I need it as Gibbs
I am a staff nurse working in Dermatology clinic. I am working with medical and non-medical professionals.
In the reflections, the participants are expected to reflect any critical incidence or management of an individual or a team or a group. The reflection should contain the elements of the Gibbs reflective cycle.
You need to explain the management process in the reflection the mention the circumstances of the situation in the health care organisation or place of work like hospital.
In this reflection, the participants need to mention incidence which they you encouraged during their work, but the reflection should have your own management experience.
Participants should mention any concerns (related to managing person or team) or any incident that has taken place while they were managing the person or team.
Make sure to mention any ethical or sustainability issues that were arising during such situation.
I will upload the article which need it to reflect in Gibbs a reflective model. To add some point is mention in this module (Module one, Management: Principle and Practices) which is related to the article.