chapter 13 organizational performance: managing for efficiency and effectiveness

Chapter 13

Organizational Performance:

Managing for Efficiency

and Effectiveness

2Copyright © 2006 by Thomson Delmar Learning. ALL RIGHTS RESERVED.

Purpose and Overview

• Purpose– To review assessing organizational

performance– To compare and contrast approaches to

quality assurance and quality improvement– To describe strategies to achieve an effective

health care organization


Purpose and Overview

• Overview– The Challenge of Performance – Issues in Assessing Effective Performance – The Manager's Role in Creating High-

Performance Health Care Organizations


The Challenge of Performance

• Health Care Organizations – Operate with constrained resources– Maximize productivity, quality, and market

share – Contain costs and minimize ineffective

services



• Managers must: – Adapt organizations to ever-changing

environment– Innovate rather than passively react



• Aspects of Organizational Performance Assessment– Efficacy– Appropriateness– Effectiveness



• Aspects of Organizational Performance Assessment– Productivity– Efficiency – Organizational Effectiveness– Cost-Effectiveness



• Factors Associated with Increased Productivity and Efficiency – High standard and goals– Information and feedback– Interdepartmental coordination and resource

sharing



• Factors Associated with Increased Productivity and Efficiency – Compensation systems oriented toward

rewarding productivity or efficiency– Physician involvement in decision making and

governance



• Factors Associated with Increased Productivity and Efficiency– Concentration of staff work and activity– Active governing boards that deal with

environmental pressures



• Factors Associated with Increased Productivity and Efficiency– Type of ownership– Chain ownership and contract management– Degree of system integration


Issues in Assessing Effective Performance

• Issues in Organizational Assessment– Fundamental perspectives – Domain of activity – Stakeholders



• Issues in Organizational Assessment– Different levels of analysis

• The organization itself• Larger social unit that contains the

organization• Subunits contained within organization



• Technical Issues in Assessment – Classes of measures

• Structural • Process • Outcome



• Technical Issues in Assessment – Preferences for classes of performance

measures • Managers: structural • Caregivers: process • Clients: outcomes or results



• Technical Issues in Assessment – Factors associated with effective performance

• Quality of professional staff• High standards• Experience with cases of same type• Organized professional staffs and conflict

management processes



• Technical Issues in Assessment – Factors associated with effective performance

• Participative cultures with team approaches• Timely and accurate performance feedback• Management of environmental forces



• Managerial Issues in Assessing Performance – Old model

• Quality relegated to quality assurance department

– New model• Quality improvement teams



• Managerial Issues – Model for evaluating professional performance

• Autonomous• Heteronomous• Conjoint• Modern health care is moving toward

conjoint model



• Managerial Issues – Model for evaluating nonprofessional work

• Bureaucratic model• Performance appraisal typically assigned to

a supervisor• Interdisciplinary teams increasingly utilized



• Managerial Issues – Impact of evaluation on all performers

• Expected to have effects on performance• Evaluations are ideally accurate



• Two Models for Changing Performance – Quality assurance

• Formal and systematic exercise to identify problems

– Quality Improvement (QI)• Management philosophy in which the

customer is central • Process-focused



• Precautions when Designing QI Strategy – Use physicians’ time wisely– Peak physicians’ interests– Empower physicians’ participation



• Precautions when Designing QI Strategy – Respect professional values– Capitalize on progress units and groups have

reached


The Manager's Role in Creating High-Performance

• Focus on Controllable Variables and External Environment – Resource Acquisition– Managing Trade-Offs


The Manager's Role in Creating High-Performance

chapter 13 organizational performance: managing for efficiency and effectiveness

Documents

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effective performance

governance slide

increased productivity

resource sharing slide

rewarding productivity

efficiency high standard

overview purpose