Draft Syllabus for Undergraduate Course Fall 2014

Managing innovation in Health Care

Professors Kovner and Sendach

This is a 14 week course for undergraduates aimed at students intending to work as clinicians or as managers in the health care industry. There are no pre- requisites.

Learning Objectives:

 Understand how health care organizations operate, the contexts they face.

 Understand the opportunities and constraints facing those who wish to innovate in health care organizations.

 Understand how healthcare organizations are governed and managed.

 Examine successful innovations implemented in healthcare organizations.

 Understand how to motivate workforce in healthcare organizations

 Improve writing, presenting, and listening skills

Course Texts and Required and Recommended Readings:

Required:

 Kovner and Knickman, Health Care Delivery in the United States, 10th edition

 McAlearney and Kovner Health Services Management: Cases, Readings and Commentary

 Christensen, The Innovator’s Prescription

Recommended:

1  Kenney C, 2010, Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience. New York: Taylor and Francis

 Berry and Saltman, 2008. Management Lessons from Mayo Clinic. New York: McGraw Hill

 Studer, Q, 2003. Hardwiring Excellence, Gulf Breeze FL, Firestarter Press.

All assigned readings that are not included in the required textbooks will be posted on NYU Classes.

Course Sessions

1 Course Expectations, Impact of ACA and Evidence-Based Management

Disruption in Health Care: Impact of ACA

Move toward more scientific management

What does “innovation” mean”?

What “better outcomes are we talking about?”

Readings: The Current USA health system (K & K)

What is Evidence-Based Management? (Rousseau)

Effects of Change Interventions (Barends et al)

2 How Organizations Measure Performance.

Cost, quality and patient behavior metrics

How do HCOs measure managerial performance?

2 How does North Shore measure performance?

Readings: Cost, Quality and Health Behavior (K&K)

Financial Reporting to the Board (Kovner)

How Intermountain Trimmed health Care Costs and Improved Quality James and Savitz)

3 Constraints to Producing Better Outcomes

What are key external factors influencing HCO performance?

How do managers adapt to external pressures?

What incentives affect managerial performance?

Readings:

Griffith on Frontiers of Hospital Management (M&K)

Millenson, 2013. The Long Wait for Medical Excellence (Health Affairs 1757- 1760)

4 Governance and Management of HCOs.

Hospitals

Physician organizations

Suppliers

Readings:

Kovner, Governance and Managers of HCOs, in (K & K)

3 Case: Sparks Medical Center and the Board (M & K)

5 Disrupting the Hospital Model

How hospitals are currently organized

Problems and issues

Readings:

Christensen, Hospitals Chapter (C)

Case: Hand-offs in the ED (M & K)

NSHS organizational chart

6 Disrupting the Business Model of Physician Practice

How Physician Practice is Currently Organized

Problems and Issues

Readings:

Christensen chapter (C)

Case: Implementing an Accountable Care Organization (M & K)

7 Disrupting Solutions for the Care of Chronic Disease

How is chronic care currently organizaed.

Problems and Issues

4 Examining community benefit

The challenge of obesity solutions

Readings:

Christensen chapter (C)

Case: Examining the North Shore Community Benefit Plan

Case: How is obesity managed at NSHS

8 A Physician and a Nurse (Guest speakers) discuss their work

Education of doctors and nurses

Impact of education on Managing innovation in HCOs

e.g. Physician management of ambulatory care

e.g. Nurse management of inpatient care units

Readings:

Workforce chapter (K & K)

9 Class presentations

(see Class Assignments)

10 Class Presentations

(see Class Assignments)

11 Innovative Solutions

5 Virginia Mason: Ambulatory Care Breakthrough

Intermountain: Lowering Pre-elective surgery rates before 39 weeks

North Shore : Forming an Insurance Company

Readings:

Kenney, Ambulatory Care Chapter pp 69-92

Intermountain

North Shore

12 Two Managers (not in inpatient hospital care) discuss their work

What do managers do?

Work relationships between managers and clinicians

Readings:

Interview with Patrick Charnin (M & K)

Tucker and Edmonson, Why Hospitals Don’t Learn from Failures (M & K)

Case Study: Kovner: Where the Rubber Hits the Road (M& K)

13 Managing Your Career

200 different health occupations

How choose between them?

How get to Square One and Beyond

Clinicians as Managers and Clinician Managers

Readings:

Readings: 101 Careers in Health Care Management (Friedman and Kovner).

14 Motivating the Work Force

Managing Up and Down

Getting the Elusive Buy-In

Culture Change in HCOs

Readings:

Case Study: Taking Care of your nurses. (M & K)

Case Study: Buy-in for the Patient Care Medical Home model? (M & K)

Case Study: Staff support and buy-in for a new lift system? (M & K)

Assignments

Assignment 1 HCO Performance paper (due week 4)

Select an HCO which you would like to work in or about which you would like to learn more about. See what you can learn from their web site about organizational performance. Interview a manager, a clinician or a human resources manager. How does their HCO perform on metrics of cost, quality and service? How does the interviewee(s) say that people achieve these metrics? How does the organization set these metrics? How does top management review unit performance?

3-5 double-spaced pages in 12 point font. Please cite sources as appropriate. An appendix may be included but is not required.

7 Note: If you need assistance in contacting a specific organization, contact one of us, and we shall try and assist you making contact.

Presentation (due week 7 or week 8)

The class will be divided into teams. Six teams will present during weeks 7 and 8. Presentations will be limited to 10 minutes each. Hand out to the class a one page summary of what you are going to say. The topic is either about HCO performance or managing innovation in an HCO. Discuss the current situation, problems or opportunities to improve performance or manage innovation, and explain the rationale behind your conclusions. The presentations will be graded by the class, and these ratings considered by the professor before grading each team’s presentation. All members of the presenting team get the same grade. The professor will return a written evaluation and grade to each team presenting. The audience evaluations will also be graded and comprise part of the class participation grade.

#2 Managing Innovation Paper (due week 12)

Select a health care organization (this can be the same organization that you selected in assignment #1). Interview a manager, clinician of human resources manager. Interview at least one different (a second) manager for assignment #2. What encourages the interviewee(s) to innovate to improve unit performance? Is there any innovation the interviewee(s) would like to see made now? What has he or she done to try and get the innovation accomplished? If nothing, how could he or she push to get the innovation implemented now? What are some innovations that could be considered (e.g. to contain costs, improve quality, or improve access?)

3-5 double-spaced pages in 12 point font. Please cite sources as appropriate. An appendix may be included but is not required.

8 Class Participation

Class participation is an important part of the course. You will be asked to submit a resume at the beginning of the course and to share with the professor during the last class what you have learned in taking this course. Students will also be evaluated on attendance, engagement in the classroom, and on constructive contributions to class discussion. Students will receive a mid-year grade on class participation when they receive the presentation evaluation during weeks 8 and 9.

Grading

25% Assignment 1 Due Week 4

25% Presentations Week 7 and Week 8

25% Assignment 2 Week 12

25% Class Presentation Throughout (Includes resume)