Lecture10: Management and Supervision

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Outline

Management and Supervision Planning Preparing a Business Plan Organizing and Leading Controlling

Management Technology Technology Assessment Organizations for Technology Assessment Improving the Use of Medical Technology Methods of Technology Assessment

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Management and Supervision Two major factors that affect the

development of managerial skills Basic personality of the manger

“we manage because of what we are, but how we mange is because of who we are” (Benett, 1987).

Organizational structure or framework in which one must manage Top-down management structure Manager as facilitator

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Traditional top-down management Structure

Planning

Organizing

Leading

Controlling

Doing

Management

Employee

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Manager as Facilitator

Controlling

Doing

Planning

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Planning

Plan is specific design to achieve a desired future

Formal means of documenting where you have been Where you want to go Steps you intend to use

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Planning Process

MissionService and

Program Alternatives

Market Analysis

Analysis of Resource

Financial Analysis Plan

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Steps in Planning

Development of mission statement Identification of services or programs to

achieve the stated mission Analysis of markets, competitors and

roadblocks Analysis of the resources required, including

people, facilities and equipment Analysis of the financial resources required

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Mission statement

Critical starting point Focuses primarily on medically related end

products or services Technology management Contract management Repair and preventive maintenance Quality control Record maintenance Equipment evaluation and acqusition

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Identification of Clinical Management Services and Programs

MISSION

Review of Target Programs

Review of mixture of In-house and Outside Service

Review of Service Alternatives (Hands-on or

Contract Management)

Review of Institutional Relationships

To Market Analysis

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Market Analysis Diagram

From Services provided to

support mission statement

To Resource Programming

Shares Market

Program User Rates

Target Population Programs

Service Area demographics

Normative & Historical

Rates

Historical Trends & Projected Changes

Total Program Demand

Captured Program Demand

X X

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Resource Programming Diagram

From Market Analysis To Plan

Space Planning

Standards

Functional Productivities

Service Intensities

Historical Levels &

Technological Trends

Operational Policies & Industry

Standards

Institutional Policies & Industry

Standards

Equipment & Staff

Requirements

Space Requirements

Departmental Workloads

X X

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Financial Analysis Diagram

From Resource

ProgrammingTo Plan

Capital Budget

Unit CostsResource

Requirements X

Operation Budget

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Preparing a Business Plan

Business plan consists of the ff. major sections Executive summary Business history Product and services Market Competition Marketing Manufacturing and operations Management Financial projections

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Executive Summary A description of the business

A description of the departmental management team, emphasizing the relevant experience and special skills of each key executive

A summary of key financial projections for the next three or five years

A summary of funding requirements outlining when and what purpose

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Business History

A discussion of when the business was founded, its progress to date and a brief biographical sketch of the founders

The organizational structure

A discussion of the products and services that has been developed and marketed

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Product or Services

Define precisely what the department intends to provides in terms of products and services

Should be written in language easily understandable by a lay person

Includes appendices, lengthy or detailed diagrams, technical documents, or descriptions

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Market Because of comprehensive description of the

markets it’s important to management, to answer the ff. questions: Who are the users or customers? What is the historic or forecasted rate of growth for each

market segment or service provided? What are perceived future markets? How will each market segment be serviced? At what level of purchasing decisions made? How does each user/client purchase the product? What are the critical product/service characteristics?

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Competition

Identify competitors, indicating special strengths, weaknesses and market share of each

Principal competitive factors in the marketplace should be cited Product performance Reliability Durability Service price

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Marketing

Marketing goals Quantitative Realistic Consistent

Outline of methods used to monitor the market

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Operations

Summarize the nature, quality and extent of available facilities

Indicate strengths and weaknesses of facilities

Timing, cost, extent and importance of any planned expansion and related financing issues should be included

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Management

Emphasize the experience and competence of each key manger

Include when and how each position will be filled and the level of compensation

Include job description, compensation data, and detailed resumes on all managers who are already in place

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Financial Projections

All of company’s sales, market, and cost projections Past financial statements Profit and loss statements Current financial statements Profit and loss projections on monthly and

quarterly basis

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Organizing and Leading

Organizational Chart Before business plan be implemented, an

organizational scheme, framework or chart must be made

Job Description Develop job descriptions that clearly state the

educational and experience level required, the basic duties and the level of authority of the job

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Organizing and Leading

Performance Appraisal “Weakness in human resource management can be traced to

an attitude that the worker is a cost factor to be minimized rather than as an evolving human resource that has to be educated” (Benett, 1987)

Performance appraisal could be effective if: It is a positive experience An objective process A partnership in development A joint responsibility A progressive review of the future An experience that concentrates on performance

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Organizing and Leading

Evaluation of all technical employees centers on five major areas Job knowledge and skills

Departmental policies and procedures Medical terminology Codes and standards Equipment servicing

Quality of work Initiative/degree of supervision required Attendance Supervisory skills

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Organizing and Leading

Leadership Situational leadership theory (Center for Leadership

studies, 1976) is based upon: Amount of direction (task behavior) a leader

gives Extent of one-way communication with employees to explain what

must be done, when, where and how it should be accomplished

Amount of socio/emotional support (relationship behavior) a leader provides Extent psychological support and facilitating behaviors

“Maturity” level that the employees exhibit on a specific task, function or objective Capacity to set high but attainable goals

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Four Styles Situational Leadership Theory High task/low relationship behavior (S1)

Referred as “telling” One–way communication that defines the roles of followers

and tells them what, how, when and where to do various tasks

High task/high relationship behavior (S2) Referred to as “selling” Attempts two-way communication and socio/emotional

support to get the approval of the followers to decisions that has to made

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Four Styles Situational Leadership Theory High relationship/low task behavior (S3)

Called “participating” Leader and follower share in decision-making

through two-way communication and much facilitating behavior from the leader

Low relationship/low task behavior (S4) Labeled “delegating” Letting followers “run their own show’

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Quality Assurance and Risk Prevention Must document:

Corrective actions taken Assurance that the action was effective The need for continuation of monitoring

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ControllingEvaluation and Identification of

Problem

Corrective Action

Documentation of Corrective Action

Monitoring of Effectiveness of Corrective Action

Documentation of Monitoring

Evaluation of Results of Monitoring

Concluding Report to Appropriate Staff

Report of Equipment

Failure /Problem

Input

Steps involved in a closed –loop quality control assurance review

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Management Steps in Operating Quality Assurance and Risk Prevention Programs1. Assign responsibility

Assign overall responsibility for the program, specifying what indicators of performance will be used and who will collect data, evaluate service, take action and report findings

2. Define scope of service Specify services it will provide to the hospital

community

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Management Steps in Operating Quality Assurance and Risk Prevention Programs3. Identify important aspects of service

Prioritize the defined scope of services

4. Identify indicators Identify indicators that will be used to define the

measurable, objective characteristics of each important aspect of service

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Management Steps in Operating Quality Assurance and Risk Prevention Programs5. Establish thresholds

The level or point at which intensive evaluation of a service is triggered

Could be expressed as a percentage, ratio, or number

Define the level of service that is considered acceptable

Higher risk involved, the closer the threshold will be to 0 percent or 100 percent

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Management Steps in Operating Quality Assurance and Risk Prevention Programs5. Collect and organize data

Data sources should include existing documents whenever possible

If data are not available, the following factors should be considered in selecting an appropriate data collection method:

Source of information Data is retrospective or concurrent Number in the sample Frequency of data collection Whether appropriate data have been used

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Management Steps in Operating Quality Assurance and Risk Prevention Programs6. Evaluate service

When threshold is met, further evaluation is necessary

When threshold is not met, analyze data for the presence of certain trends to ascertain whether or not there are any deviations in the patterns of service

The goal is to improve service instead of asking what went wrong

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Management Steps in Operating Quality Assurance and Risk Prevention Programs7. Take actions to solve identified problems

Identified problems should have a necessary corrective actions

Action plan should specify the following: What actions are expected to occur Who is responsible for the implementation When change is expected

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Management Steps in Operating Quality Assurance and Risk Prevention Programs9. Assess actions and document improvement

If corrective action does not resolve the problem, action may not have address the actual problem and new action plan should be established

10. Communication and report information Unless information of Quality Assurance

activities are shared, much of their potential benefit can be lost

Excellence is seldom achieved alone

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Management Steps in Operating Quality Assurance and Risk Prevention Programs Steps 1-5 – initial procedure of identifying

what to include in the program and identifying indicators and thresholds

Steps 6-10 – actual implementation and evaluation of the program

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Quality Indicators

Compliance Measurement Degree of compliance with established schedules for

routine activities May be weighted by the sophistication or risk factor of the

equipment

Inspections performed Types of failures found during the inspections are the focus

of these indicator Specific measure is the numbers and types of failures

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Quality Indicators

Documentation All work done by clinical engineering department

must be documented

Equipment repair Indicator for equipment repair includes:

Turnaround time of repairs Number of repeat failures Total downtime due to a repair Type and frequency of certain repairs

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Productivity and Cost Control Controlling program cost is an important

function for clinical engineering manager

Two specific measures of cost control Employee productivity Expense versus revenue ratios

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Methods Design to monitor and improve Productivity % Productivity

(Repair hrs + Prev. Maint. hrs +Other productive Work hrs.) x 100(Available hrs.)

% OvertimeOvertime hrs.Available hrs.

% Labor Recovery – shows how well the staff is charging for its service

Charged hrs.Available hrs.

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Methods Design to monitor and improve Productivity Backlog Days – ave. amount of time needed to service

incomplete orders carried over

Carry over hrs.

Available hrs./day

Repair-Turnaround Days – ave. length of time a piece of equipment is out of the client’s department for repairs

Calculate by noting the time the receipt in the repair shop and time of equipment return to the client department

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Technology Assessment

Challenges faced by those responsible for technology management Ensure that hospitals effectively assess the

impact of technology on all human services Make effective adjustments in planning to ensure

that any new technologies will better serve the organization’s mission

Compare technology-based options Gain knowledge from post-deployment

experiences

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Technology Assessment

Technology assessment (National Institute of Health, 1985) Refers to assessing the results of clinical trials

and creating state-of-the-art reports on specific medical technologies

Consists of synthesizing complex scientific information in such a way that the reports are useful for decision making by practitioners or policymakers

Analysis of the effects of the introduction or widespread use of a technological innovation

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Technology Assessment Stages of assessment of technology

Establish the feasibility of a technique Determine if it is safe and can produce technically

acceptable results

Establish the efficacy The performance of the technology is under ideal

conditions using selected patients

Test of effectiveness Economical appraisal

Concerned with the value of technology

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Organization for Technology Assessment Food and Drug Administration (FDA)

Division of the Public Health Service, responsible for medical technology assessment

Regulates entry of drugs and medical devices, requiring manufacturers to demonstrate that their products are safe and efficacious

Charged with the protection of public health Requires that companies demonstrate safety and

efficacy

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Organizations for technology assessment National Institutes of Health (NIH)

Sponsors clinical trials and conducting consensus development conferences on specific medical practice issues

Consensus development program organized by the Office of Medical Application Research (OMAR)

Office of Technology Assessment Acts as technology research and advisory source Assist congress in developing policies concerning medical

technologies

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Organizations for technology assessment Health Care financing Administration (HCFA)

Responsible for administering Medicare and federal aspects of state Medicaid programs

Medical technology activities are mainly associated with coverage and reimbursement policies and, to a lesser content, research and demonstration

National Center for Health Services research and Health Care Technology Assessment Involved in technology assessment by sponsoring

extramural studies of technologies and by conducting intramural assessments

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Organizations for technology assessment Prospective Payment Assessment

Commission Advise and assist both Congress and the

Secretary of Health and Human Services in maintaining and updating Medicare’s Prospective Payment System (PPS)

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Improving the Use of Medical Technology Identify effective technologies

Determine the limits of appropriate use based on the sliding scale benefits and burdens

Determine affordable level of use

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Most important concern in assessment of medical technology Efficacy

Probability of benefit to individuals in a defined population from a medical technology applied for a given medical problem under ideal conditions of use

Safety / Acceptable level of risk (Banta et al., 1981) Probability of an adverse or untoward outcome occurring

and the severity of the resultant harm to health if individuals in a defined population, associated with use of medical technology applied for a given medical problem under specified conditions of use

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Factors important to a medical technology’s efficacy Benefit to be achieved (most complex factor)

Medical problem giving rise to the technology

Population affected

Conditions under which the technology is applied

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Benefit to be achieved Diagnostic Technology

Facilitates the clinician’s ability to distinguish diseased from nondiseased persons or to assess the severity of disease

Factors to determine the diagnostic benefit Technical capacity: Does the device or procedure perform

reliably and deliver accurate information? Diagnostic accuracy: Does the test contribute to making the

accurate diagnosis? Diagnostic impact: Does the test result influence the pattern

of subsequent diagnostic testing? Does it replace other diagnostic tests or procedures?

Therapeutic impact: Does the test result influence the selection and delivery of therapy? Is more appropriate therapy used after application of the diagnostic test than would be used if the test was not available?

Patient outcome: Does the performance of the test contribute to the improved health of the patient?

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Benefit to be achieved Therapeutic Technology

Benefits to be achieved include improvement in morbidity, mortality and life expectancy as consequences of a particular technology’s ability to correct physiology and control pathology.

Dimensions of the improvement of patient’s quality of life Whether patient will be able to return to a baseline of

functioning Degree of relief from expected symptoms Requirements of the treatment Psychological effects of the technology: the short-term as well

as the permanent long-term changes that may ensue Understanding the quality of life issue is the effect of the new

technology on self-image

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Medical Conditions Giving Rise to Use of Technology

“A technology’s efficacy can be evaluated only in relation to the disease or medical conditions for

which it is applied” – Banta et al, 1981

Range of medical conditions for which a particular technology is beneficial must be established empirically

Use of a technology in ways that maximize benefits to patients and minimize their risk of harm requires knowing as precisely as possible the ailment for which it is best applicable

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Population Affected Effect of a medical technology varies, depending on

the individual treated

It is important to determine whether its efficay is stable for all populations who suffer a condition or range of conditions

A technology may be highly efficacious for some populations and far less so for others even for the same ailment

Knowing how a technology’s efficacy varies across different patient populations is central to avoiding harmful use and maximizing benefits to patients

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Conditions Under which Technology is Applied The outcome of the application of a medical

technology partially determined by: Skills, knowledge, and abilities of physicians, nurses and

other health-care personnel Quality of the drugs, equipment, and institutional settings Support systems used by those personnel during the

application

Evaluation must continue beyond those optimal conditions to the less ideal conditions under which many, perhaps most, patients receives health-care

Complete evaluation of a technology must determine effectiveness as well as efficacy

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Methods of Technology Assessment Two ways to validate technology (McDermott,

1977)

Randomized Clinical Trials (RCTs) Provide only a portion of a currently studied group with

the technological intervention; the individuals in the total group are selected randomly

Method of Natural History Provide the technological intervention to a consecutive

series of persons with the disorder, and the nature and extent of change in the disorder from its previous characteristic behavior serves as the basis for evaluation

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Randomized Clinical Trials (RCTs) Important features of RTCs

Control group reduces the likelihood of bias systematically infecting

evaluation of a new technology Provides a set of responses with which the effects of the use

of a specific technology can be compared

Random assignment of patients between the control group and the experimental group Protects treatment comparisons from being rendered invalid

by biased assignment of individuals to the two groups Ensures that the two groups are identical with respect to all

relevant factors except treatment, even when some of those factors are unknown

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Mini-Case

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Mini-Case: select a host hospital and do the following Interview the hospital manager / director and

determine how the hospital plan, prepare a business plan, organize and lead the organization.

Make an analysis on the planning process of the hospital, preparation of business plan, organizing and leading: identify the strengths, problems or difficulties and make recommendations to solve these problems

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Mini-Case: select a host hospital and do the following Determine the method on how they monitor

their productivity and efficiency. Get at least 3 months data and analyze. Based on the analysis, make recommendations as well.

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Mini-Case: select a host hospital and do the following On technology assessment

Ask the steps on how they keep updated with technology. Analyze the process.

Identify the factors important to a medical technology’s efficacy

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References

Bronzino, J.D. (Ed.). (1992). Management of medical technology: a primer for clinical engineers. Boston: Butterworth-Heinemann

Webster, J.G. & Cook, A.M. (Ed.). (1979). Clinical engineering: principles and practices. Englewood Cliffs, N.J..: Prentice-Hall, Inc.

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