Howard Gitlow PhD Steve Ullmann PhD Amy Zuo MBA University of Miami School of Business Administration 305 284 4296 hgitlowmiamiedu wwwhowardgitlowcom Traditional Management in Healthcare ID: 429226
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Slide1
Dashboards in the Healthcare Sector
Howard Gitlow, Ph.D.
Steve Ullmann, Ph.D.
Amy Zuo, M.B.A.
University of Miami
School of Business Administration
305 284 4296
hgitlow@miami.edu
www.howardgitlow.comSlide2
Traditional Management in Healthcare
Management by Objective
Performance AppraisalSlide3
Traditional Management in Healthcare: Management by Objective
Management by Objectives (MBO) is a process of negotiating periodic performance objectives between superiors and subordinates in an effort to cascade top management’s wishes throughout an organization. Frequently, objectives (MBOs) are set using numeric targets with deadlines for key process metrics, or just deadlines for projects. Slide4
Traditional Management in Healthcare: Management by Objective
Management Information Systems (MIS) are needed to operationally define and measure key metrics in respect to their MBOs. MIS usually track key metrics over time, for example, monthly or yearly, or comparatively, for example, “this month this year with this month last year,” or “this quarter this year with this quarter last year.” (
Drucker
, Peter F., "The Practice of Management", 1954.
ISBN 0060110953
)Slide5
Traditional Management in Healthcare: Management by Objective
An MBO type dashboard is a tool used by policy makers and managers to clarify and assign accountability and responsibility for the key objectives needed to steer an organization toward its mission statement.
Dashboards are used to deploy the mission statement throughout the levels of a healthcare system, from top to bottom, through the development of a cascading and interlocking set of key objectives as measured through numeric targets or deadlines. Slide6
Traditional Management in Healthcare: Management by Objective
There are many variants of MBO type dashboards which are used in a wide variety of applications ranging from manufacturing, to service, to healthcare, to government, to education. However, all of these applications contain several similarities. First, all of the applications display a drill-down system of key objectives. Second, all of the applications use data on key metrics to determine the status of each key objective. However, these systems do not usually consider the managerial implications of an automated MBO style of management.Slide7
Traditional Management in Healthcare: Management by Objective
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008
Examples hyperlinkSlide8
Traditional Management in Healthcare: Performance Appraisal
Performance Appraisal Systems (P.A.S.s) are the vehicles used to assign accountability and responsibility to the individual responsible for a process that generates a key metric subjected to an MBO. The MBO-PAS package is the extrinsic motivational hammer used to enforce MBOs, or in other words, top management’s will.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide9
Traditional Management in Healthcare: Performance Appraisal
Employees can be monitored in respect to many types of MBOs, for example, Quality MBOs, Quantity MBOs, Cost MBOs, or Time based MBOs.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide10
Traditional Management in Healthcare: Performance Appraisal
Examples of Quality MBOs are: Percentage of defective product produced in the Miami plant in the Second Quarter of 2007 <10%, or the Number of warranty claims in the Miami plant as of December 31, 2007 < 2%.
Examples of Quantity MBOs are: Number of Sales Calls Made in the Miami Office by Salesperson X at the end of the first quarter of 2007 > 650 sales calls, or Number of Records Processed in the Miami Office at the end of the first quarter of 2007 > 25,000 records.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide11
Traditional Management in Healthcare: Performance Appraisal
Examples of Cost MBOs are: Raw Materials Expense in the Miami plant in the Second Quarter of 2007 < $150,000, or Revenue from Product X in Florida in the Third Quarter of 2007 > $1,000,000.
Examples of Time Based MBOs are: The computer system in the Red River plant must be fully operational before December 31, 2007, or The Ad campaign for Product Y must be submitted to the client no later than 5:00 pm on June 15, 2007.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide12
Dashboard Management in Healthcare
Macro Model (Dashboards)
(2) Micro Model (DMAIC, DMAVD, Lean)
(3) Management Model (Deming’s SoPK)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide13
Macro Model (Dashboards)
Mission Statement: -----------
---------------------------------------------
------------------
President
Direct Reports
Key Objectives
Key Indicators
Area Objectives
Area Indicators
Potential Tasks and Projects
Key objectives must be achieved to attain the mission statement.
One or more key indicators show progress toward each business objective.
Area objectives are established to move each business indicator in the proper direction.
One or more area indicators show progress toward each area objective.
Projects are used to improve or innovate processes to move area indicators in the proper direction.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide14
Cascading System of Mission statements
Business School of the University of Miami
Example of a Dashboard
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide15
Example of a Dashboard
Cascading System of Key Objectives and Key Indicators
Business School of the University of Miami
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide16
Partial Dashboard of
Health Sector Management & Policy
University of Miami
Health Sector Management & Policy
Director
-
Steve
Ullmann
,
Ph.D
Key Objectives
Key Indicators
Below
are
parial
CAHME
objectives Criteria for accreditation (Apr 2007)
Effective for site visits fall 2008 and beyond
II.A.
Students, Graduates and Others
II.A.2.
Enroll quality students into the program
Number of students in the program by category by year (e.g., physicians, administrators, nurse managers, etc
.)
(hyperlink)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide17
Partial Dashboard of
Health Sector Management & Policy
University of Miami
CAHME Competency
Model
NCHL Competency Model
Key Indicator (Measurement)
III.B.12. Statistical analysis and application
TRANSFORMATION -
Analytical Thinking
: The ability to understand a situation, issue, or problem by breaking it into smaller pieces or tracing its implications in a step-by-step way. It includes organizing the parts of a situation, issue, or problem systematically; making systematic comparisons of different features or aspects; setting priorities on a rational basis; and identifying time sequences, causal relationships, or if-then relationships.
List
of
student’s projects from Dr.
Gitlow’s
MAS 641 class who have demonstrated competencies in statistical analysis and application (Analytical thinking, Performance measurement, Process management and organizational design, self-confidence) via their course projects by class
EXECUTION -
Performance Measurement
: The ability to understand and use statistical and financial methods and metrics to set goals and measure clinical as well as organizational performance; commitment to and employment of evidence-based techniques.
Percentage of students in Dr.
Gitlow’s
MAS 641 class who have demonstrated competencies in statistical analysis and application (Analytical thinking, Performance measurement, Process management and organizational design, self-confidence) via their course projects by class
EXECUTION -
Process Management and Organizational Design
:
The ability to analyze and design or improve an organizational process, including incorporating the principles of quality management as well as customer satisfaction.
PEOPLE -
Self-Confidence
:
A belief and conviction in one’s own ability, success, and decisions or opinions when executing plans and addressing challenges.
DIARY
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide18
Example of Key Indicator – Diary
(This part is from “Thank God It’s Monday!”)
Episode #
Date
Description of Unassertive Episode
1
1/15/05
Can’t say no
2
1/15/05
Let my son get away with murder
3
1/15/05
Can’t say no
4
1/15/05
Can’t say no
5
1/15/05
Can’t say no
6
1/15/05
Can’t ask for simple directions
7
1/15/05
Can’t say no
8
1/15/05
Can’t say no
…
………………………………………………
124
1/28/05
Can’t say no
125
1/28/05
Let my son get away with murder
126
1/28/05
Can’t say no
Part of Marsha’s Diary of Unassertive behavior for Two Weeks
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide19
Daily Count of Number of Unassertive Episodes
Date
# of Unassertive Eepisodes
1/15/2005
11
1/16/2005
9
1/17/2005
9
1/18/2005
8
1/19/2005
7
1/20/2005
9
1/21/2005
9
1/22/2005
11
1/23/2005
7
1/24/2005
13
1/25/2005
9
1/26/2005
6
1/27/2005
7
1/28/2005
11
1/15/2005
11
1/16/2005
9
1/17/2005
9
Total
126
It shows the number of unassertive episodes per day taken from Table 22 before a change to Marsha’s behavioral response to unassertive episodes
Example of Key Indicator – Diary
(This part is from “Thank God It’s Monday!”)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide20
Marsha’s c-Chart of Unassertive Behavior per Day
Example of Key Indicator – Diary
(This part is from “Thank God It’s Monday!”)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide21
Marsha’s Pareto Diagram of Unassertive Behavior
Example of Key Indicator – Diary
(This part is from “Thank God It’s Monday!”)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide22
Marsha’s Before and After
c
-Chart
Example of Key Indicator – Diary
(This part is from “Thank God It’s Monday!”)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide23
Marsha’s After Pareto Diagram
Example of Key Indicator – Diary
(This part is from “Thank God It’s Monday!”)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide24
Benefits of Dashboard Management
Healthcare Administration program managers use a dashboard at monthly operations review meetings for several purposes.
First, they use dashboards to clarify mission statements and key objectives, and accountability for them, among all personnel and areas.
Second, they use dashboards to promote statistical thinking about reacting to fluctuations in key indicators. For example, is the number of applicants to the healthcare administration program for last year due to a special or common cause of variation in the admissions process.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide25
Benefits of Dashboard Management
Third, managers use dashboards to clarify and reduce the perception that most of the daily crises (called “helter
skelter
” items) requiring immediate and special attention are really special cases of known key objectives. A manager’s ability to recognize “helter
skelter
” items as special cases of key objectives reduces the amount of tension involved in dealing with a multitude of crises “du jour.”
Fourth, managers use dashboards to develop and test hypotheses concerning potential changes to processes.
Fifth, mangers can use dashboards to ensure the routine and regular updating of key indicators.
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide26
Micro Model (Projects)
Visual Management (for example, the ‘5Ss”)
SDSA/PDSA
Six Sigma
Improvement model (DMAIC)
Invention and Innovation model (DMADV)
Lean Thinking (the Toyota Production System)
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008Slide27
Management Model (Deming’s System of Profound Knowledge)
Purpose: Pursue the organizational mission through the promotion of “joy at work.”
Assumptions (
needed for a data based system of management
):
Optimize the whole system, not just your component of the system
Improve the process to get results, do not just demand results
Cooperate, do not compete, if the aim of the system is not to win
Balance extrinsic and intrinsic motivators, do not rely only on extrinsic motivators
The above assumptions form an integrated system and cannot be separate
Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008