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. Class Number: 7554 E-mail: [email protected] Class Meets: Tuesday, 7-9:45pm Office Hours: Tu/W/Th 2pm – 6pm Location: ET-105 Office Location: 04 (Patio behind HHS1) HCA Program Administrative Coordinator: Phone: (562) 985-5694 Office Deby McGill [email protected] (949) 400-0960 Cell (text for meeting)

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

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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 Activity (A1), of Assignment (A2) or Assessment (A3)  How does employee 5. B  Nursing shortage, Case studies; take home relations, especially staffing regulations, exams. nursing, recruitment, wage issues, training and training, and retention, development in support relate to hospital of hospital culture, role competitive advantage? on treatment team; promotion opportunities.  Understand the changing 5. C  Board of Trustee Graded case analysis. role and legal selection, relationship of responsibilities of the board to CEO and Kovner Case P, executive office, including medical staff, Peter “Whose Hospital?” the hospital board of Drucker’s criteria for an used as study of CEO directors and medical staff. effective board. fired by board. Class  Understand principles of 1.  Communication and discussion of board and effective communication. Relationship CEO mistakes.  Understand effective 2. Management hospital CEO leadership.  CEO Leadership evaluation criteria Interview of CEO or board member at local hospitals.  Compare/contrast 5.C.  Understand regulatory Graded case analysis of advantages and requirements of the King-Drew Medical disadvantages of the three 501C(3) or public benefit Center as an example institutional and legal corporation. government failure. forms: for-profit, non-  Evaluate impact of profit, and government government payments on Take home midterm operated hospitals. charity obligations. exam covering Wall  Compare value of tax Street Journal and payments by for-profit Health Affairs studies. hospitals with tax support of government hospitals.

 Identify methods of 5.G.  Develop competency in Take home midterm measuring performance selecting performance exam. outcomes. measures and skill in monitoring variance from Graded case analysis. Harvard Case Study,

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targets. Cincinnati Children’s Hospital, presented as a model for development of techniques and culture for measuring outcomes.  Discuss the function of the 5.C. Analyze effectiveness of Graded case analysis of Organized Medical Staff. several emerging models of Kovner Case J, physician leadership. “Physician Leadership: MetroHealth System of Cleveland.”  Negotiate the complexities 5.C. Where outsourcing works in Final take home exam. of outsourcing hospital hospitals and where it does services. not. Selecting a model. Answering questions from Tradewell’s “Privatizing Public Hospitals” Reason Foundation.  Use IT to significantly 5.E. Analyze cost and benefits of Graded case analysis: increase the effectiveness hospital electronic medical “Electronic Medical and reduce the costs of records as a control Records System hospital operation. mechanism. 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.

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(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:

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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

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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/

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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&stat e=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:

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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? 4. Should hospitals be reorganized to allow CEO full unity of control powers? 5. Should doctors be hospital employees? http://video.foxnews.com/v/2608920118001/obamacares-impact-more-doctors-becoming- hospital-employees/ http://www.forbes.com/sites/scottgottlieb/2013/03/15/hospitals-are-going-on-a-doctor- buying-binge-and-it-is-likely-to-end-badly/ http://online.wsj.com/article/SB10001424127887323628804578346614033833092.html? mod=WSJ_Opinion_LEADTop (Your doctor has clocked out).

Week 5-6 FOCUS: HOSPITALS FROM A CONSUMERS POINT OF VIEW

Case 13 in Kovner: “A Personal Memorandum on Hospital Experience.” Lee: Chapter 1 and Chapter 5 in If Disney Ran Your Hospital. Discussion: 1. How do hospitals treat patients? Do hospitals seeks competitive advantage in the area of customer service/

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2. Where does the hospital communication and service in Case 13 break down? How much of the problem is designed into the way hospitals are built? 3. What departments of the hospital are most critical to customer service? 4. What are “silos” in an organization? How does Lee suggest dismantling them? 5. Why is hospital pricing so difficult to understand? 6. Do hospitals compete on price?

Week 7-8 Finance FOCUS AREA: ARE CONSUMERS GETTING POOR VALUE FOR MONEY FROM HOSPITALS? WHY ARE HOSPITALS IN U.S. SO MUCH MORE PRICEY THAN EUROPE AND JAPAN? Reinhardt: “Pricing of Hospital Services: Chaos Behind a Veil of Secrecy” (Health Affairs)

“Bitter Pill: Why Medical Bills Are Killing Us” By Steven Brill Monday, Mar. 04, 2013. The entire issue of Time magazine carried this single story. http://www.time.com/time/magazine/article/0,9171,2136864,00.html#ixzz2cqgdb4U7

Forbes columnist, Chris Conover, thanks Brill for his gift to consumers but then painstakingly explorers the myths in a two part article. http://www.forbes.com/sites/chrisconover/2013/03/04/5-myths-in-steven-brills-opus-on-health- costs-part-1/2/ http://www.forbes.com/sites/chrisconover/2013/03/07/5-myths-in-steven-brills-bitter-pill-part- 2/print/ http://www.nationalreview.com/agenda/341951/guest-post-oren-cass-what-steven-brill-gets- wrong-us-health-care-costs-reihan-salam

Two Health Affairs articles compare and contrast current understanding of cost shifting. Discussion: 1. Is cost shifting, or private insurers carrying the higher burden for a government that purposely underpays for care, a reason why prices in the U.S. are so high? Do hospitals set prices far above the cost of providing care so they can overbill the privates and self- insured? 2. How big a factor in overcharging is the high percentage of uninsured patients that are admitted through the emergency room?

Week 9-10 Can managers be trained to make good decisions?

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FOCUS AREA: THE ROLE OF THE HOSPITAL MANAGER

Kovner: pp 3-34. “Evidence-Based Management Reconsidered.”

Drucker: Chapter 37, “The Effective Decision” in Management: Tasks Responsibilities and Practices (in e-reserves and on BeachBoard). Case A: “A New Faculty Practice for the Department of Medicine Case B: “The Associate Director and the Controllers” Case C: “Now What?”

Week 11 Measuring and Controlling Performance (No class meeting Week 12, Veteran’s Day, Nov 11)

FOCUS AREA: CONTROL Patrice L. Spath: “Taming the Measurement Monster” in Kovner, Part II, Control, pp. 89-105. Griffin, answer questions 5-9 on page 334. Week 11-12 Lecture: Measuring Performance Case D: Ann Scheck McAlearney:“An Information Technology Implementation Challenge.”

Case E: Anthony R. Kovner: “Improving Financial Performance in the Orthopedic Unit.” Case F: Cynthia Struk: Evidence-Based Quality Management in a Home Health Organization.” “Electronic Medical Records System Implementation at Stanford Hospital and Clinics.” Stanford Business School

Case from LA Times seven article investigative journalism series: Article 1: “Deadly Errors” through Article 7: “Wrong Drug” Discussion: 1. What were the warning signs that King-Drew was not performing? 2. How does the selection of performance measurements affect direction and outcome? 3. How do you know when you are measuring the wrong things?

Healthcare Financial Management Association: “Key Strategies for Sustained Performance Improvement.” (on BeachBoard or http://www.hfma.org/library/revenue/performancemanagement/Key_Strategies_Performance_Im prove.htm . Lecture: Quality and Safety: Evaluating Care Reading Assignment: Griffin, Chapter 19-24 100K Lives Campaign Griffin, Case 1, “Towel? What Towel?” Griffin Case 6: “The Case of Jill” Discussion: 1. What is ORYX?

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2. What is the100k lives campaign? Week 13-14 Lecture/ Organizational Design for Effectiveness

Week 13-14: How Do We Design for Effectivness?

FOCUS AREA: ORGANIZATIONAL DESIGN

Commentary: Understanding Organizations, pp. 151-158. Dean Q. Lin: “Convenient Care Clinics: Opposition, Opportunity and the Path to Health System Integration.” Answer the two questions on page 168.

Short Case 12: Restructuring Wise Medical Center

Case 7: Reorganizing Primary Care at Blackwell Medical Center

Case 8: Future of Disease Management at Superior Medical Group Herzlinger “Focused Factory” article in K&N, page 139-156 Text Reading Assignment: Griffin, Chapters 6-10. Discussion: 1. What is Herzlinger’s concept of focus? 2. What is her problem with the general or community hospital? 3. How important is design in creating a sustainable competitive advantage?

Lecture: Hospital Culture

Reading Assignment: Collins and Porras. 1997. Built to Last: Successful Habits of Visionary Companies, Chapter 6, “Cult-Like Cultures”. Discussion: 1. Compare the culture of Hospital for Special Surgery (HSS) with that of Nordstrom. 2. How does HSS culture differ from that of typical hospitals? 3. How does Nordstrom and HSS perpetuate their culture?

Week 15-16: Can We Stay Out in Front? FOCUS AREA: SUSTAINABLE COMPETITIVE ADVANTAGE Lecture: Hospital strategic market management Michael E. Porter, January 2009, “The Five Competitive Forces that Shape Strategy”. How does the “Threat of New Entrants,” the “Threat of Substitute products and Services,” the “Bargaining Power of Buyers,” the “Bargaining Power of Suppliers” and the state of “Rivalry

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Among Existing Competitors” all affect hospital strategy? Compare and contrast these five competitive forces at HSS and King Drew. Lecture: Performance improvement

Reading Assignment:

Griffin: Chapters 23 and 24. Answer 5 of the 10 questions on page 282. Brink, Susan. March 6, 2006. “And Now, Four Star Hospitals” in Los Angeles Times. Discussion: 1. How do community hospitals discourage competition? 2. How did the veteran in Herzlinger’s chapter learn about hospital services in Thailand. 3. What was superior about the Thai experience?

Final Quiz

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STUDENT INFORMATION SHEET HCA 536; Fall 2014 (TURN IN TO INSTRUCTOR OR POST BIO ONLINE)

Name______

Name you prefer to use______

Address______

Phone(s):______

Best time/place to reach you:______

Fax:______

E-mail address:______

Please describe briefly: a. Your educational background and work experience:

b. Future educational and career plans:

c. Your reasons for taking this course, what you hope to learn from it:

d. Other HCA classes you are taking or have completed:

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