The Role of Financial Management and Nurse Leadership in Health Care Organizations Angela Jukkala, PhD, RN, CNL University of Alabama at Birmingham
Historically • Primary role of nursing was patient care • Nursing and finance believed to be separate
Health Care Reimbursement Changes • P4P • Complexity of care
Finance and Management • Management functions • Planning • Control • Decision making
Planning • Consider possible options • Provides direction • Evaluate progress • Essential elements • Strategic planning • Budgeting
Control • Once a plan is developed, it must be implemented! • Refers to the managerial tasks related to ensuring the plan is carried out as close to the original plan as possible.
Decision-making • Over-riding role of management • Someone has to have decision-making authority • Change
Formal Lines of Authority • Organizational chart
Informal Lines of Authority • Not part of the organizations official structure • Can be as important as formal lines of authority • Based on: • History of the organization • Key players in the organization • Resources controlled by various players
Centralized Organizations • Planning, control, and decision making reside with a few individuals at the top level of the organization. • Often far from the point of care • Needs to be knowledgeable • Not necessarily “do-able” in today’s healthcare environment.
Decentralized Organizations • Planning, control, and decision-making occur much closer to the point of care. • Greater number of individuals • Enhances the development of unit managers • Information needed is more accessible • Ability to decentralize exceptions to rules • Timeliness
Disadvantages • Top has to relinquish power • Must have organizational information systems • Ensuring regulatory compliance • Active communication required • Commitment to education
Nurse Manager/Unit Manager • Varies • Decentralization • Must haves: • Budgeting • Applied economics • Health care finance • Inventory control • Skill in planning, control and decision making
Transition from Staff Nurse to Nurse Manager • Does a high level of clinical expertise guarantee success? • Need education • Formal • Informal
Interactions Between Fiscal and Nurse Managers • Lateral relationships • Strained • Relationships
Incentives and Motivation • People • Is the best interest of the organization always in the best interest of the individual? • Goal congruence • Incentives
Implications for Nurse Managers • Control of information about revenues, expenses and operations is key. • Aware of your role in engaging staff in financial management. • Need the requisite knowledge and skill to be successful.
Microsystem Framework Dartmouth
Microsystem • What is a microsystem? • A small group of people who work together on a regular basis • Care delivery: Provide care to discrete subpopulations • Education: Provide learning to a subset of students (Batalden, Nelson, Johnson, Godfrey) • Examining Microsystem performance
Microsystems • Clinical and business aims • Linked processes • Shared information environment • Produce performance outcomes • Evolve over time and are (usually) embedded in larger organizations
Microsystems UAB Cardiac Surgery Team LAB ER Birmingham
Characteristics of High Performance • Constancy of purpose • Investment in improvement • Alignment of role and training • Interdependence of the (care) team • Integration of information • Measurement systems • Supportiveness of the larger system • Connection to the community
Benefits of High Performing Units • Organizations with these characteristics perform better - Are better places to work • Provides direction for action • Establish constancy of purpose • Align objectives • Get everyone involved • Provide training • Promote interdependence • Community vis a vis autonomy
Microsystem Assessment • Form Interdisciplinary Team • Assessment • Purpose • Patients • Professionals • Patterns • Processes • Metrics that Matter • Diagnose • Treat • Evaluate
Interdisciplinary Team Who needs to be on this team?
What is the purpose of your microsystem? • Mission statement? • Does everyone agree? • Why do you need to agree?
Patients • What population does your microsystem serve? • Are they satisfied?
Professionals • Who are the professionals on your unit? • What skills do they have? • What skills do they feel they need? • Are they satisfied?
Patterns • What repetitive patterns occur on your unit that disrupt care and or quality? • Phone calls • Medication “runs”
Processes • Examine the processes that occur on your unit. • What is going well? • What not so well?
Metrics that Matter • Benchmarking • What are the challenges with rural benchmarking? • Do you feel national benchmarks are always relevant?
Treat Your Unit • Evidence based intervention