College of Health and Human Services s1
August 25, 2014
COLLEGE OF HEALTH AND HUMAN SERVICES
California State University, Long Beach
Health Care Administration Program
Hospital Management, HCA 536
Fall, 2014
Instructor: Richard L. Tradewell, MBA, Ph.D.E-mail:
Office Hours: Tu/W/Th 2pm – 6pm
Office Location: 04 (Patio behind HHS1)
Phone: (562) 985-5694 Office
(949) 400-0960 Cell (text for meeting) / Class Number: 7554
Class Meets: Tuesday, 7-9:45pm
Location: ET-105
HCA Program Administrative Coordinator: Deby McGill
Catalog Description
Analysis of hospitals by broad function and specific departments through cases, simulations and visits to develop familiarity with internal operations of acute care hospitals and skills in solving hospital operational problems. Prerequisite: HCA 502.
Course Description
Focus on controversial place of hospitals within the context of health care policy reform and the hospital’s changing role within integrated care systems. Several case studies will be used to provide students with a real world simulation of strategic, operational, legal and image problems confronting hospitals today.
Expected Learning Objectives & Outcomes; Activities, Assignments & Assessments. The Health Care Administration Department has adopted a competency-based curriculum, based on the American College of Health Care Executives (ACHE) Competencies Assessment Tool and the Healthcare Leadership Alliance (HLA) Competency Directory.
Focus is on acquiring competencies in the following Domains:
§ Domain 1: Communication and Relationship Management
§ Domain 2: Leadership
§ Domain 4: Knowledge of the Healthcare Environment
§ Domain 5: Business Knowledge and Skills
o Domain 5B: Business Knowledge and Skills: Human Resources
o Domain 5C: Business Knowledge and Skills: Organizational Dynamics and Governance
o Domain 5D: Business Knowledge and Skills: Strategic Planning and Marketing
o Domain 5E: Business Knowledge and Skills: Information Management
o Domain 5F: Business Knowledge and Skills: Risk Management
o Domain 5G: Business Knowledge and Skills: Quality Improvement
Alignment of the expected outcomes and the ACHE and HLA competencies provides clear expectations and standards for students and instructors alike. Students will demonstrate a level of proficiency in each of the expected outcomes through the course assignments as indicated in the following table.
Learning Objective / Domain / Competency – Knowledge of / Activity (A1), Assignment (A2) or Assessment (A3) /· How does employee relations, especially nursing, recruitment, training, and retention, relate to hospital competitive advantage? / 5. B / · Nursing shortage, staffing regulations, wage issues, training and development in support of hospital culture, role on treatment team; promotion opportunities. / Case studies; take home exams.
· Understand the changing role and legal responsibilities of the executive office, including the hospital board of directors and medical staff.
· Understand principles of effective communication.
· Understand effective hospital CEO leadership. / 5. C
1.
2. / · Board of Trustee selection, relationship of board to CEO and medical staff, Peter Drucker’s criteria for an effective board.
· Communication and Relationship Management
· CEO Leadership evaluation criteria / Graded case analysis.
Kovner Case P, “Whose Hospital?” used as study of CEO fired by board. Class discussion of board and CEO mistakes.
Interview of CEO or board member at local hospitals.
· Compare/contrast advantages and disadvantages of the three institutional and legal forms: for-profit, non-profit, and government operated hospitals. / 5.C. / · Understand regulatory requirements of the 501C(3) or public benefit corporation.
· Evaluate impact of government payments on charity obligations.
· Compare value of tax payments by for-profit hospitals with tax support of government hospitals. / Graded case analysis of King-Drew Medical Center as an example government failure.
Take home midterm exam covering Wall Street Journal and Health Affairs studies.
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· Identify methods of measuring performance outcomes. / 5.G. / · Develop competency in selecting performance measures and skill in monitoring variance from targets. / Take home midterm exam.Graded case analysis. Harvard Case Study, Cincinnati Children’s Hospital, presented as a model for development of techniques and culture for measuring outcomes.
· Discuss the function of the Organized Medical Staff. / 5.C. / Analyze effectiveness of several emerging models of physician leadership. / Graded case analysis of Kovner Case J, “Physician Leadership: MetroHealth System of Cleveland.”
· Negotiate the complexities of outsourcing hospital services. / 5.C. / Where outsourcing works in hospitals and where it does not. Selecting a model. / Final take home exam.
Answering questions from Tradewell’s “Privatizing Public Hospitals” Reason Foundation.
· Use IT to significantly increase the effectiveness and reduce the costs of hospital operation. / 5.E. / Analyze cost and benefits of hospital electronic medical records as a control mechanism. / Graded case analysis:
“Electronic Medical Records System Implementation at Stanford Hospital and Clinics.” Stanford Business School.
Methods of Presentation: the class is organized as a discussion seminar. Instructor posts a weekly PowerPoint and case study on BeachBoard to guide discussion. Students will read and answer questions on a different case each week to order to discuss and share solutions in class.
Use of Academic Technology in this Class
This course makes use of several forms of academic technology, including the web, e-reserves and BeachBoard. Students are required to use of this technology to fulfill the requirements for this course. To participate in the academic technology elements of this course, students must have access to, and be able to use:
· A computer, equipped with Adobe Acrobat Reader 5.0 or newer and word-processing software capable of reading Microsoft Word XP files.
· The internet. Specifically, the World Wide Web. Whatever internet service provider is used must be capable of accessing Web pages, BeachBoard and Acrobat files.
· An account on BeachBoard.
Student Responsibilities and University Policies
(1) CSULB policies on cheating and plagiarism shall apply, as delineated in California State University, Long Beach Policy Statement 85-19, December 13, 1985. One or more of the following academic actions are available to the faculty member who finds a student has been cheating or plagiarizing.
(a) Review—no action.
(b) An oral reprimand with emphasis on counseling toward prevention of further occurrences;
(c) A requirement that the work be repeated;
(d) Assignment of a score of zero (0) for the specific demonstration of competence, resulting in the proportional reduction of final course grade;
(e) Assignment of a failing final grade;
(f) Referral to the Office of Judicial Affairs for possible probation, suspension, or expulsion.
(2) Students who need accommodation for any type of disability must inform the instructor in advance.
(3) Withdawal is the responsibility of student. Withdrawal after the posted date is allowed only for serious and compelling reasons and requires the approval of the dean.
(4) Absences are excused consistent with University policies.
(5) Students are expected to have CSULB email accounts and to check their email and BeachBoard regularly for class announcements.
Methods of Evaluation
I Quizzes: 5 @ 20 points each 100
II Short case analysis papers (5 cases @ 20 points each to Dropbox) 100
III Long integrative case analyses:
Virginia Mason Medical Center 40
Hospital for Special Surgery 40
IV Final quiz 20
Total 300
Grading
90 % and higher: A
80 % and higher B
70 % and higher C
60 % and higher D
Below 60% F
Text required:
Griffin, Don. 2012. Hospitals: What They Are and How They Work. Fourth Edition. Boston: Jones and Barlett.
Provided by instructor:
Kovner, McAlearney, Neuhauser. 2009. Health Services Management: Cases, Readings, and Commentary. Ninth Edition. AUPHA.
Some interesting reading to get you started in hospitals:
Reinhardt, Uwe E. 2013. “Shocked, Shocked, Over Hospital Bills” New York Times
http://economix.blogs.nytimes.com/2013/03/01/shocked-shocked-over-hospital-bills/?_r=0&pagewanted=print
Bodenner, Chris. August 31, 2011. “How Hospitals Harm Us” http://dish.andrewsullivan.com/2011/08/31/how-hospitals-harm-us/ (Note: Bodenner is a clever graphic artist at “Medicalbillingandcodingonline.” See their course below).
The online course in medical billing and coding http://www.medicalbillingandcodingonline.com/
One of several consulting firms offering classes in 6sigma. http://www.6sigma.us/six-sigma-healthcare.php?gclid=CIuYp4LhgLkCFZF7QgodmgsAPQ
United HealthCare Hospital Comparison Program
https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=cf7f98675415e010VgnVCM100000c520720a____
Altman, Stuart H., et.al. 2006. “Could U.S. Hospitals Go the Way of Airlines? Health Affairs, Vol 25, No. 1. Jan/Feb. 2006.
“A Model Health Care Delivery System for Medicaid”
Richard E. Rieselbach, M.D., and Arthur L. Kellermann, M.D., M.P.H. New England Journal of Medicine. June 1, 2011.
“Managed Competition for Medicare? Sobering Lessons from the Netherlands” Kieke G.H. Okma, Ph.D., Theodore R. Marmor, Ph.D., and Jonathan Oberlander, Ph.D. New England Journal of Medicine. June 15, 2011.
Brink, Susan. March 6, 2006. “And Now, Four Star Hospitals” in Los Angeles Times.
Dentzer, Susan Still Crossing The Quality Chasm—Or Suspended Over It? Health Affairs. April 2011 30:554-555; doi:10.1377/hlthaff.2011.0287
Kovner, Anthony R. and Duncan Neuhauser. 2004. Health Services Management: Readings, Cases, and Commentary. Eighth Edition. AUPHA Press. (Provided as e-reserve by instructor)
Halpin, Helen A., Arnold Milstein, Stephen M. Shortell, Megan Vanneman and Jon Rosenberg. 2011. Mandatory Public Reporting Of Hospital-Acquired Infection Rates: A Report From California Health Affairs, 30, no.4 (2011):723-729
Mark McClellan, Aaron N. McKethan, Julie L. Lewis, Joachim Roski, and Elliott S. Fisher
A National Strategy To Put Accountable Care Into Practice
HEALTH AFFAIRS 29, NO. 5, May (2010): 982–990
Classen David C., et al. 2011. Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured aaHealth Aff April 2011 30:581-589; doi:10.1377/hlthaff.2011.0190
Goldsmith, Jeff. 2011. “Accountable Care Organizations: The Case For Flexible Partnerships Between Health Plans And Providers” HEALTH AFFAIRS 30, NO. 1 (2011): 32–40
Herzlinger, Regina E. “Hospital for Special Surgery,” Harvard Business School, Case Study 9-305-076, August 17, 2005 (Provided as e-reserve by instructor).
Herzlinger, Regina. E. 2007. Who Killed Health Care? America’s $2 Trillion Medical Problem and the Consumer-Driven Cure. New York: McGraw-Hill. (Entire book is useful; we will use Chapter 3, “The General Hospitals” on e-reserves with a pdf file posted on BeachBoard).
Lee, Fred. 2004. If Disney Ran Your Hospital. Bozeman, MT: Second River Healthcare Press. (Two chapters in e-reserves).
RTI International. August 27, 2010. “U.S. News and World Report 2010/11 Best Hospitals Ranking Methodology.”
Tradewell, Richard L. “Privatizing Public Hospitals: Strategic Options Policy in an Era of Industry-wide Consolidation.” Study No. 242, April 1998. Reason Foundation.
Weber, Tracy, Charles Ornstein and Mitchell Landsberg. “Deadly Errors and Politics Betray a Hospital’s Promise.” Los Angeles Times. December 5, 2004. All seven parts of the Los Angeles Times Pulitzer-prize series of articles documenting failure at King Drew Medical Center are on Beach Board.
Weimer, David L. and Aidan R. Vining. 2005. Chapter 8: “Limits to Public Intervention: Government Failures” in Policy Analysis: Concepts and Practice. Prentice Hall.
A wide variety of additional Health Affairs articles and other materials are identified in weekly reading assignments.
Useful websites:
Health Facilities Management http://www.hfmmagazine.com/hfmmagazine_app/index.jsp
Agency for Healthcare Research and Quality
http://www.ahrq.gov/
Healthcare Financial Management Association
http://www.hfma.org/
The Healthcare Information and Management Systems Society (HIMSS)
http://www.himss.org/ASP/index.asp
American College of Healthcare Executives
http://www.ache.org/
Centers for Medicare and Medicaid Servics
http://www.cms.hhs.gov/
Joint Commission on Accreditation of Healthcare Organizations
http://www.jointcommission.org/
Joint Commission’s Report: Improving America’s Hospitals
http://www.jointcommissionreport.org/
RAND
http://www.rand.org/
Robert wood Johnson Foundation
http://www.rwjf.org/
National Center for Policy Analysis
http://www.ncpa.org/pub/st/st296/st296.pdf (Why you do not know the price of your medical service).
http://sicko.ncpa.org/?c=reviews (Michael Moore alternatives)
Health Grades (examples of reports on hospitals):
http://www.healthgrades.com/consumer/index.cfm?fuseaction=modnw&modtype=content&modact=SHOP_HospQual_Example (fee)
http://www.healthgrades.com/consumer/index.cfm?fuseaction=mod&modtype=hospitals&modact=hospitals_search_results&prodtype=hosprat&state=CA&city=&maparea=&proc=&tabset=psa&hgid=&useragree=yes (CA hospital safety rankings: free to public).
Schedule of Classes
Week 1-2 Orientation; introductory remarks Lecture and discussion
FOCUS AREA: WHY ARE HOSPITALS THE TARGET OF PUBLIC CRITICISM?
Reading Assignments (All reading are on BeachBoard):
Herzlinger, 2007 “Chapter 3 The General Hospital: Death at the Hands of the Empire Builders” in Who Killed Health Care?
Wall Street Journal investigative article on Non-profit hospitals
Altman, Stuart H., et.al. 2006. “Could U.S. Hospitals Go the Way of Airlines? Health Affairs, Vol 25, No. 1. Jan/Feb. 2006.
Goldhill’s jaw-dropping and influential article (now a book) “How American Health Care Killed My Father” http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/307617/
Steven Brill shines a light on hospital charges in “Bitter Pill” (the only issue in Time magazine’s history entirely devoted to critically exposing one industry – hospitals) http://www.uta.edu/faculty/story/2311/Misc/2013,2,26,MedicalCostsDemandAndGreed.pdf
Chris Conover’s overview of Brill’s findings:
http://www.forbes.com/sites/chrisconover/2013/02/28/5-take-aways-from-steven-brills-time-tome-on-health-costs
Discussion questions:
1. What sources does Herzlinger use in her recent book to convince readers that U.S. hospitals are low quality and high cost?
2. How do nonprofit hospitals (supposedly tax exempt to serve the community interest) stifle innovation and efficiency through efforts to restrict competition?
3. Why is Herzlinger skeptical that vertical integration leads to better health care?
4. Why does Herzlinger believe no Sam Walton (WalMart) has arisen to save hospitals?
5. What does she think of specialty hospitals? Of global competition in hospital services?
6. What are the major problems in comparing hospitals to airlines?
7. What does Brill’s “Bitter Medicine” say about hospitals?
8. Why does Conover challenge Brill with creating myths?
9. What does Goldhill “Killed My Father” say about hospitals?
Week 3-4 How Are Hospitals Governed?
FOCUS AREA: THE UNIQUE CHALLENGES OF HOSPITAL ORGANIZATION
Griffin: Chapters 1-3.
A Drucker classic: Chapter 52. “Needed: An Effective Board”
Case 14 in Kovner: “Whose Hospital?”
Discussion:
1. Do hospitals have a unity of command problem? Can a hospital CEO fire a bad surgeon (dangerously incompetent or performing excessive surgery)?
2. What are the qualifications of members of a community hospital board? Are the board members in Case 14 typical?
3. Who/what is ultimately responsible under case law for patient mistakes in hospitals?