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Communication, organization andmanagement
Lecture 1
Solutions-->
1. First logic: Adam Smith said: government should not intervene; laissez faire. People
only pursue their own wellbeing. In a market, patient/client is king. Alain Einthoven--
> going Dutch.
2. Second logic: bureaucracy is a model, after industrial revolution. Organizations
became larger and more complex. Hierarchy slows down a process. Operating
principles are rationalization, formality and focus on standardization and
specializations and hierarchy (to get permission from higher rank)
a. Bureaucracy works when you have 1 job. It is regulated by rules and
procedures, top-down management
3. Third logic: professionalism. We need to give the power back to professionals and we
need to get back the trust in them
Misfit culture to manage, bureaucratic system is good for universal access, but no individual
control. Supply driven vs demand driven. We want the system to take care of us.
Dutch government regulates the competition within the healthcare system. Also, what gets
reimbursed or not by insurance.
Health care markets linear logic:
- Consumer choice: insurance gets triggered to provide the best package. Good quality
care for good care. They bargain with the hospitals. Less than 10% switch each year,
these people are higher educated and get lower costs
- Competitions between the insurances
- Are they negotiating a good price? A lot of hospital merges to compete with the
growth of the insurances. Privatization within hospitals and entire parts of hospitals
(Spaarne and AVL)
Is a hospital an organization?
- Common purpose: people are working on it collectively.
- An organization group of people working on a particular goal
Health care is not a business, insufficient coopetition to offer quality care at best price. No
direct …
Doctors are not educated on how to manage/start change. Choosing Wisely wants to have
doctors to also be educated on managing etc.
Bottom-up approach is very interesting in that people from within who knows what needs to
change, however doctors to not have the right skill set. Fulfilling role are patient’s advocate.
,Organization structure--> structure is sum of design choice, stable set of relationships.
Reduce the distribution of responsibilities.
- Centralization: is top manager deciding. Easier to implement, consistency with
strategy, faster decision-making. Easier to achieve coordination.
- Decentralization: front line has decision making power. Good in unstable
environment. Sense of control food for staff motivation. Opportunities for staff
development.
Organizational design: a specific organizational structure that results from managers’
decisions and actions.
1. Division of labor
2. Authority
3. Departmentalization
4. Span of control
Control vs. autonomy. -->
- Professional autonomy: information asymmetry. They need autonomy for their work.
But on the other hand, the insurance decides what will be covered. Tense struggle
between autonomy and having control
Differentiation vs. integration-->
- Integration: you want to align people. Differentiation is specializing in specific task.
You have now overspecialization; someone can only treat 1 thing and needs to go to
someone else for another symptom. Creating health care silos. Trying to more to
more integrative system. Patients are experiencing more co-morbidity/multi-
morbidity. Needs collaboration and toward holistic view of patients and care
delivery. Holistic view mean that you don’t want to be seen as just a patient, but also
just as a person.
Functional structure: every employee position in a group with their own specialization.
Become very efficient, standardized work. Hierarchal structure, only work vertically. Bad
thing: to coordinate across departments, it is not possible. Another negative is you only think
of yourself. Creates fragmentation! Might harm quality of care. Us/them culture.
Is this fostering the common purpose of the organization? People working together on a
common cause. Think of St. Athenius hospital.
Program/service line structure: Moeder/kind centrum in Spaarne. Less efficient and
duplication of work.
,Matrix structure: combining functional and program structure. Temporary project, on
getting to goal. Efficient use of resources. However, now 2 managers to report to. Managers
need prevent a fight of who gets reported to.
- Wide span of control: flat organization. More flexible--> faster reaction to changes
and work more in projects. You can work freely.
- Narrow span of control: a lot of control. Slows down decision-making. Lard overhead
(costly).
Design trade-offs
Lecture 2
Evolution of management:
Scientific management (Frederick W. Taylor) is a body of literature that emerged during the
1890-1930 that reports the ideas and theories of engineers concerned with such problems
as job definitions, incentive systems and selection and training.
Administrative management (Henry Fayol) emphasized the importance of carefully
practicing efficient planning, organizing, commanding (leading nowadays), coordinating and
controlling. Management is a separate body of knowledge that can be applied in any type of
organization, a theory of management can be taught and learned and there is a need for
teaching management in colleges.
, Organizational behavior is drawing on psychology, sociology, political science and cultural
anthropology, OB is the study of the impact that individuals, groups and organizational
structure have on behavior within organizations. OB is a way of thinking, multidisciplinary,
distinctly humanistic orientation within organizational behavior, OB is performance-
oriented, scientific method is used to study OB and the field is application oriented.
Leaders must have: social responsibility, cultural diversity, ethics, global competitiveness,
social networking, reengineering and must contend with changes both domestic and global
markets and competition.
Hawthorne studies: maximizing the employer’s output, but it did not consider the
employee’s needs. Mary Parker Follett was the first to promote participatory decision
making and decentralization. She emphasized the individual and group needs, however
without scientific evidence to support her views. Research was done by comparing two
groups, one group with constant good lights and the other without lights and the lights
turned on and off. The group with changing lights were more efficient. This is: The
Hawthorne effect is that the employees felt important and therefore increased their
productivity because someone was observing them and studying them at work.
Systems theory is a theory that an organization is a managed system that changes inputs
into outputs. An input being goods and services organizations take in and use to create
products or services. An output is the product and services that organizations create.
Effectiveness should be reflected on by looking at both the input and the output and must
reflect on the interrelationships between the organization and the outside environment.
Criteria of effectiveness:
- Quality: total quality control (TQC) is the application of quality principles to all
company programs. US leaders; to survive, organizations must provide high quality
and reliable. Japan leaders; quality has nothing to do with how shiny or good looking
something is or with how much it costs. Quality is defined as meeting customers’
needs and expectations products and services, as well as treat customers in a close
to-perfect manner. Today: an effective company is the one that provides customers
with consistently high-quality products or services.
- Productivity: reflects the relationship between inputs and outputs. Measures of
productivity are profits, sales, market share etc.
- Efficiency: defined as the ratio of outputs to inputs. Measures of efficiency are rate of
return on capital or assets, occupancy rates, cost per patient
- Satisfaction: refers to the extent to which the organization meets the needs of
employees. Measures are attitudes, absenteeism, tardiness, grievances
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