All posts by Mike Schadone

Criminal Justice, Politics, Society

Effects of Victimization

Selye (as cited in Roberts & Yeager, 2009) presents stress as natural component of life. Feelings of anxiety or memories of that anxiety are what drive us to fulfill our needs. This is where stress is important to the natural development. As we develop, we face many discomforting scenarios that we learn to avoid (e.g. hunger, cold, burns, pain; and later, losses of loved ones, debt, material losses, et al.). These stressors are learned and we live life trying to avoid them for the most part, and, according to Roberts and Yeager (2009), healthy stressors exist also, such as buying a home, the birth of a child, and others.

It is when stressful situations are too overwhelming to cope with that stress becomes a problem. Overwhelming stress can lead to crisis, acute stress disorder, or post-traumatic stress disorder (Roberts & Yeager, 2009). The key to dealing with stress is to have a positive outlet or sense of control over the stressors.

A study by Taylor (1995) shows that increases in crime, or at least the perception of crime, in a community leads to community decline; however, as this decline manifests, community participation grows to help to stop or slow the decline. This is possibly more akin to piling trash in the corner, then realizing one day that it is time to bring it all to the dump. The stress of living in a declining community is compounding until the community member finds a healthy outlet to alleviate the stress (help with clean-up efforts) or finds a negative outlet, contributing to the decline of the community. Positive outlets within a declining community allow the community members to take responsibility, once again, for the state of their environment, and thereby, relieving the stress of living amongst a declining community.

But, what happens when a person feels no control or ability to control their environment, such as a child? Kilpatrick, Saunders, and Smith (2003) explored the impact of violence and victimization on adolescents across the nation. Unlike adults who might have more opportunity to feel safe in the face of violence and have more options to redirect the stress, children are limited in their ability to react. They have yet to learn strategic coping mechanisms required to deal with stress productively. Kilpatrick, Saunders, and Smith show that “victimization in early childhood and adolescent years is the root of many problems [, such as PTSD, substance abuse, and delinquent behavior,] later in life” (p. 1). What is unclear, however, is the proximate cause of the cyclic phenomenon of violence.

As the studies suggest, violence (within the environment) begets violence (in the individual, especially children and adolescents). As children of violence mature through their environment and as they tend toward violence, they contribute to the environment of others by fulfilling what some might deem as their destiny. This, though, is shown to be untrue in many as not only can an individual contribute negatively to an environment, but many, even those touched by violence, find means of contributing positively, even if as an outlet for the stressors of such an environment. Being a product of one’s own environment does not dismiss the notions of self-reliance and personal responsibility. These ideals are the cornerstone of social change.

References

Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003, April). Youth victimization: prevalence and implications. Retrieved from http://www.ojp.usdoj.gov/nij/

Roberts, A. R. & Yeager, K. R. (2009). Pocket guide to crisis intervention. New York, NY: Oxford University Press.

Taylor, R. B. (1995). The impact of crime on communities. Annals of the American Academy of Political and Social Science, 539(1), 28-45. doi:10.1177/0002716295539001003

Academia, Emergency Management, Society

Defining Crisis

A crisis is any problem that has a significant impact. Most simply, a crisis is a decision-point of change, for better or worse. For example, a new father seeing his child for the first time might have a crisis of faith. A beautiful and healthy child may trigger thoughts of awe and trigger a divine revelation; whereas, a seriously ill child may bring feelings of doubt and religious contempt. In the field of crisis management, Coombs (2012) defines crisis as “the perception of an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes” (p. 2). In this definition, Coombs suggests that crises are both negative and unpredictable events that effect others. While I agree with the scope of the definition, as I stated above, crises do not necessarily have to be negative events, and frequently, they can be predicted. Predictable negative crises are usually caused by negligent management, such as economic crises (Berg & Pattillo, 1998; Compagnon, 2011; Feldstein, 2010; Roubini, 2010).

A crisis usually develops from a less significant issue and, if understood and contemplated, can be mitigated early (Coombs, 2012). A crisis stemming from an issue finds a causal relationship with risk. Risk can be categorized by human, systematic, and process or random (Youndt, Snell, Dean, & Lepak, 1996). Human and systematic risk can be mitigated easily; however, process risk is inherent and requires substantial process change to minimize.

The British Petroleum Deepwater Horizon event, which occurred on April 20, 2010, was said to have been fraught with risk of all three types. A New York Times article by Barstow, Rohde, and Saul (2010) describes the event and attempts to elucidate what went wrong. Initially, according to the article, there was a blowout of the Macondo Prospect well, a risk that is inherent to drilling, especially in deep water. Next, every single “formidable and redundant defenses against even the worst blowout” (para. 10) failed. This was certainly a failure of process errors (geological “bursts” causing the well blowout), systematic errors (“One emergency system alone was controlled by 30 buttons” [para. 18]), and human errors (“members of the crew hesitated and did not take the decisive steps needed. Communications fell apart, warning signs were missed and crew members in critical areas failed to coordinate a response” [para. 15]).

On a micro-organizational level (the rig), these failures are evident and allowed risk to develop into an issue, which developed into a crisis. On a macro-organizational level, however, the response seemed to be swift, but the focal response to the incident and the public relations response appeared very disjointed, which was compounded by both the media and the federal government, that is, until the U.S. Coast Guard took control. It was apparent very early that both British Petroleum and the federal government were concerned with reputation over response and recovery from the focal incident. This translated to poor support for both by the public. I believe the U.S. Coast Guard is the only managing entity involved in the response to have managed to maintain dignity throughout the effort.

Crisis management is promoted as a multifaceted approach to mitigate, alleviate, respond to, and recover from crises of different types and scope. Although there are many aspects to organizations that require attention during these efforts, it needs to be understood that some have higher priorities than others, and reputation is a culmination of all of these.

References

Barstow, D., Rohde, D., & Saul, S. (2010, December 25). Deepwater Horizon’s final hours. New York Times. Retrieved from http://www.nytimes.com/2010/12/26/us/26spill.html

Berg, A. & Pattillo, C. (1998). Are currency crises predictable: a test (Working paper #98/154). International Monetary Fund. Retrieved from http://books.google.com/

Compagnon, D. (2011). A predictable tragedy: Robert Mugabe and the collapse of Zimbabwe. Philadelphia, PA: University of Pennsylvania Press.

Coombs, W. T. (2012). Ongoing crisis communications: planning, managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Feldstein, M. (2010, June 14). A predictable crisis: Europe’s single currency was bound to break down. The Weekly Standard, 15(37), 1-3. Retrieved from http://www.weeklystandard.com/articles/predictable-crisis

Roubini, N. (2010, May 17). All crises are predictable: Contrary to beliefs, history shows there’s nothing new in debt or inflation. Gulf News. Retrieved from http://gulfnews.com/business/features/all-crises-are-predictable-1.627708

Youndt, M. A., Snell, S. A., Dean, J. W., & Lepak, D. P. (1996). Human resources management, manufacturing strategy, and firm performance. The Academy of Management Journal, 39(4), 836-866. doi:10.2307/256714

Criminal Justice, Society

Impact and Prevalence of Crime

In researching the crime rates of Connecticut and other states, I see that there has been a significant rise in crime during the ’70s, ’80s, and ’90s (The Disaster Center, 2011). Luckily, last year, we have been able to see crime rates reduced to those not seen since 1967.

The probability of being involved in a murder or assault, whether victim or perpetrator, is characterized by a propensity for violence; therefore, the advances in medicine, especially those of the emergency medical services, contribute by allowing these people to survive an initial act allowing them to reoffend (Wilson & Herrnstein, 1998). But what was contributing to the base increase in violent turpitude in the first place? Wilson and Herrnstein (1998) posit that changes in child-rearing focii (from moral development towards personality development) have changed dramatically from the late 19th century to the mid 20th century. No more are lessons in character, but more attention is now paid on enjoyment.

Luckily, my community is far removed from crime. Woodstock, Connecticut, has one of the lowest crime rates in the state; however, Connecticut, itself, does have problem areas, which are the typical urban centers. According to the Connecticut State Police Crime Analysis Unit (2010) Uniform Crime Reports database query tool, Woodstock, during 2009, has had only 25 index crimes (e.g. murder, rape, robbery, aggravated assault, burglary, larceny, motor vehicle theft) with only two violent crimes (aggravated assault and robbery). The remainder 23 crimes were burglary (11), larceny (10), and motor vehicle theft (2). A website by CLRChoice, Inc. (2010) that details crime risk shows the following indices compared to the national risk average (100): total crime risk (Woodstock: 2, Connecticut: 64), murder risk (Woodstock: 5, Connecticut: 49), rape risk (Woodstock: 8, Connecticut: 63), robbery risk (Woodstock: 4, Connecticut: 77), assault risk (Woodstock: 2, Connecticut: 49), burglary risk (Woodstock: 1, Connecticut: 51), larceny risk (Woodstock: 2, Connecticut: 74), and motor vehicle theft risk (Woodstock: 2, Connecticut: 71).

Considering the above statistics, I find the crime to have the most impact on my community is burglary. The psychological impacts of burglary are not unlike those related to other violent crimes, such as rape or assault, and can last up to 10 weeks after the initial incident (Blanco, 2010; Maguire, 1980). For the residents of Woodstock, the personal impact would be significant. Woodstock is still considered by many a sleepy community where door locks are optional. Whenever there is a burglary in the area, however, residents tend to be more vigilant. Incidently, my personal observation is that there are more firearms per capita in Woodstock than in most other areas of Connecticut. This could potentially create an issue, but so far it has not.

Woodstock does not have a police department and is patrolled solely by the Connecticut State Police. Whenever a crime of significance occurs in Woodstock, the police must take resources away from other areas of the state in order to respond and investigate the crime. This puts a burden on law enforcement in the community and surrounding communities.

Crimes of all types can have serious consequences not only for the involved parties but those fairly removed from the crimes (family, friends, etc.); however, burglary, unlike murder or assault that tend to be focused on a specific victim, impacts whole communities and can have far reaching effects that begin to harm the fabric of those communities.

References

Blanco, A. (2010, February 5). The psychological effects of home burglary. Security World News. Retrieved on October 18, 2011, from http://www.securityworldnews.com/2010/02/05/the-psychological-effects-of-home-burglary-3/

CLRChoice, Inc. (2010). Woodstock crime rates indexes. Retrieved on October 18, 2011, from http://www.clrsearch.com/Woodstock_Demographics/CT/Crime-Rate

Connecticut State Police, Crime Analysis Unit. (2010). Connecticut Uniform Crime Reports [Data]. Retrieved on October 18, 2011, from http://www.dpsdata.ct.gov

The Disaster Center. (2011). U.S. crime statistics: total and by state (1960-2007). Retrieved from http://www.disastercenter.com/crime/

Maguire, M. (1980). The impact of burglary upon victims. British Journal of Criminology, 20(3), 261-275. Retrieved from http://bjc.oxfordjournals.org/

Wilson, J. Q. & Herrnstein, R. J. (1998). Crime & human nature: The definitive study of the causes of crime (First Free Press paperback ed.). New York, NY: The Free Press.

Academia, Emergency Medical Services, Health Care, Public Health

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).

References

Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from http://mobile.commonwealthfund.org/

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from http://journal.nzma.org.nz/

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Academia, Culture, Emergency Management, Emergency Medical Services

Practical Use of Strategic Planning

 In this writing, I will describe the similarities and differences of planning versus strategic planning, and I will use these concepts to compare and contrast two very different strategic organizational plans within the health care industry. In my view, strategic planning should be bold, effective, prescient, and ethical, and the reader should keep these attributes in mind when considering the plans for themselves.

Planning is described as the directed implementation of the “blueprint for the future” (McConnell, 2012), or the means of expressing the organizational vision in order to achieve the organizational goals; whereas, strategic planning institutes planning with a consideration and focus towards the forces, whether or not controllable, that might both help and hinder the desired outcomes (Casciani, 2012). One example of an uncontrollable force, especially in health care, are the expectations of the patient or client. Crawford et al. (2002) provides a discussion on the increased propensity to involve patient views in the strategic planning of health care organizations, though at the time of the writing, there was no evidence as to the effect that the involvement of these views provided. Caution must be exercised when eliciting input from the client or patient. For instance, many patients complain about the amount of time that it takes at emergency departments for test results to be returned. As impressive as it would be to have test results returned within just a few minutes, this should not be attempted to the detriment of the accuracy of the tests. Perhaps, in this instance, considering the role of point-of-care testing might be more beneficial than attempting a costly overhaul of the laboratory processes. Approaching problems as they apply to an open system, looking from outside in, provides a better perspective than regarding the organization as an isolated microcosm.

To be effective, strategic planning must be all-encompassing and address the goals of each functional unit, or microsystem, to bring them into alignment with the plans of the macro organization (Kosnik & Espinosa, 2003). To wit, as an organization can only be measured by the outcomes of the integrated microsystems, an analysis of each or any functional unit can tell much about the goals and visions guiding the organization.

Children’s Hospital and Regional Medical Center

The Children’s Hospital and Regional Medical Center (Children’s; 2006), located in Seattle Washington, provides the first of two strategic plans I will review. On the opening pages, as with most strategic plans, the organization defines its mission and vision, and they are certainly bold statements including the elimination of pediatric disease and being the best children’s specialty care center. The only thing that I wish was stated on these first pages is some sort of organizational value statement. The value statement does much to intertwine an ethical approach to the mission and vision. However, I do not doubt the ethical approach Children’s relies on, which is evident by the whole of the plan.

Children’s (2006) is a true regional medical center that serves much of the northwest portion of the United States, including Alaska. An argument could be made that Children’s serves such a vital role to the region that it is too important to fail, yet the organization still seeks to ensure financial stability and “secure Children’s financial future” (p. 5). In health care, especially in today’s political climate, the future of funding sources are unclear, and the most ethical approach to the organizational delivery of health care is to provide it without burden to the community it serves. Children’s exemplifies this approach by maintaining charitable foundation to “expand philanthropy to the community” (p. 16), as well as ensuring sound and responsible investments and maximizing efficiency under cost controls while still ensuring quality and safety improvements.

Additionally, Children’s (2006) focuses its efforts at being the best, which means attracting the best clinicians, performing cutting-edge research, and providing the best care to achieve the best outcomes possible setting the standard for health care across the nation. Children’s holds a bold, effective, prescient, and ethical strategic plan that outlines some goals of many of the microsystems within the organization.

U.C. Davis Health System

The U.C. Davis Health System (2011) strategic plan, unlike the Children’s (2006) plan, immediately outlines the values, or “guiding principles” (p. 3), of the organization. Financially, however, U.C. Davis Health Systems seems less focused on self-reliance, financial security, and community involvement than Children’s and more focused on their stated goal of socially responsible environmental stewardship.

Although the U.C. Davis Health System (2011) strategic plan uses the word bold on the front cover, I find it to be less so and without many specifics and, instead, relying on generalized language that might promote the vision but does nothing to engage it.

It is apparent in the U.C. Davis Health System (2011) strategic plan that they wish to become a leader in many different areas while attracting the best workforce. This is a commendable, bold, and ethical position that helps to ensure quality and safety in the delivery of health care at U.C. Davis Health Systems.

Discussion

Many different variables drive the production of strategic plans, including politics, community, workforce, investments, geography, and the current status quo of health care delivery. Many of these differences can be seen immediately when comparing various strategic plans, yet by virtue of being a health care organization, many of the stated goals will be similar. Without being informed as to the climate of the organizational operation, it is difficult to appreciate the potential each plan has in regard to success or failure.

As a health care manager, the strategic plan is an obvious resource when deciding on possible employment. As a potential administrator, the strategic plan offers a view into how the administration seeks to direct the operation of the organization. Being responsible to help implement these plans, one must consider the alignment of his or her personal values with those of the organization. A manager might find it difficult to lead in an environment that demonstrates and promotes a different value system.

Strategic plans offer a significant advantage to organizations during their growth providing a clearly written prescription as to what is important to the organization so that it may guide decision-makers to develop and enhance programs to provide a cohesive effort towards future prosperity and relevance.

References

Casciani, S. J. (2012). Strategic planning. In S. B. Buchbinder & N. H. Shanks, Introduction to healthcare management (Laureate Education, Inc., Custom ed.; pp. 3-23). Sudbury, MA: Jones and Bartlett.

Children’s Hospital and Regional Medical Center. (2006). Our children deserve the best: Laying the foundation for the next 100 years (Strategic plan overview). Retrieved from http://www.seattlechildrens.org/pdf/strategic_plan.pdf

Crawford, M. J., Rutter, D., Manley, C., Weaver, T., Bhui, K., Fulop, N., & Tyrer, P. (2002). Systematic review of involving patients in the planning and development of health care. British Medical Journal, 325(7375), 1263-1267. doi:10.1136/bmj.325.7375.1263

Kosnik, L. K. & Espinosa, J. A. (2003). Microsystems in health care: Part 7. The microsystem as a platform for merging strategic planning and operations. Joint Commission Journal on Quality and Safety, 29(9), 452-459.

McConnell, C. R. (2012). Planning. In S. B. Buchbinder & N. H. Shanks, Introduction to healthcare management (Laureate Education, Inc., Custom ed.; pp. 131-139). Sudbury, MA: Jones and Bartlett.

University of California, Davis Health System. (2011). 2011-2016 strategic plan: Creating a healthier world through bold innovation. Retrieved from http://www.ucdmc.ucdavis.edu/ strategicplan/2011StrategicPlan.pdf

Academia, Culture, Emergency Management, Emergency Medical Services, Health Care, Politics, Public Health

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.

References

Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Academia, Emergency Medical Services, Health Care

Health Care Quality and Safety

Health care is a service devoted, by definition, to those who are vulnerable. People seek out health-related services during stressful times and may be easily swayed into trying less than effective methods, even ‘snake oil’ remedies, for treating their ails and pain. This being the case, the health care provider has a moral obligation to advocate for the patient. Advocacy entails considering only what is in the best interest of others, even to the detriment of one’s self. Patient advocacy helps to ensure both health care quality and safety. The Institute of Medicine defines health care as “[the] degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge” (as cited in Savage & Williams, 2012, p. 26). Savage and Williams (2012) discuss the importance of effective and efficient delivery of health care, which means avoiding overuse (providing services to those who will least benefit) and underuse (failing to provide services to those that would benefit) stating, “quality is important in health care because there are limited resources to improve the health of both individuals and the population as a whole” (p. 72).

According to Savage and Williams (2012), all stakeholders are affected by the level of quality in health care. From a patient’s perspective, health care delivery should be aimed at addressing the patient’s problem with the least invasive, yet most effective, therapy possible. Delivering health care is a high-risk endeavor that focuses the risk towards the patient, potentially causing harm and great suffering. The provider, driven by the desire to help without harming, would benefit greatly by the development of ‘best practices’, or evidence-based practice, in order to help the most people with the available resources. Additionally, providers wish to be paid a fair rate in exchange for the services performed, and this can only occur in an efficient system with little waste to impact revenue. On the other hand, third-party payors, the most prolific purchasers of health care, demand the most effective and efficient services in return for their payment in order to control the costs of their own services. Third-party payors, like Medicare, Blue Cross, and others, have such a large client base that they are able to effectively negotiate health care services for lower rates.

As a health care manager, it is increasingly important to ensure quality and safety in the delivery of health services. Medical malpractice litigation, according to Savage and Williams (2012), is costly to practitioners and organizations, even though it does little to deter poor quality. Rather than relying on the courts to make forceful recommendations, an effective manager can use tools already available to promote best practice within their organization. For instance, continuous quality improvement (CQI) programs promote systematic, data-driven process improvements focused by the customer’s perceptions. CQI can uncover interferring processes and can make modest to significant improvements that can indirectly improve other, linear processes, thereby, making greater improvements, overall.

References

Savage, G. T. & Williams, E. S. (2012). Performance improvement in health care: The quest to achieve quality. In S. B. Buckbinder, N. H. Shanks, & C. R. McConnell (Eds.), Introduction to healthcare management (Custom ed.; pp. 25-79). Sudbury, MA: Jones & Bartlett.

Academia, Culture, Emergency Management, Emergency Medical Services, Health Care

Leadership: Determining the Best Approach

 The true value of leadership is empowerment, or the ability to promote those traits through the chain of command for subordinates to use to effectively make decisions that are in the spirit of the vision of the leader (Buchbinder, Shanks, & McConnell, 2012; Kirkpatrick & Locke, 1991; Wieck, Prydun, & Walsh, 2002). When leaders make decisions, the focus is not on the myopic view of the here and now but reflects the nature of ethics and vision promoting the endeavor (Kirkpatrick & Locke, 1991).

Buchbinder, Shanks, and McConnell (2012), discuss various strategies and attitudes employed to both lead and manage the health care workforce. Though each of the styles presented are effectively used in certain scenarios, many managers and ineffective leaders misuse these styles due to misplaced attitudes, trust, and motives. These styles are authoritarian, bureaucratic, participative, theory Z, laissez-faire, and situational. The authoritarian and bureaucratic styles are closely related as dictatorial and at risk for involving micromanagement; however, authoritarians tend to be motivated by their responsibilities, whereas bureaucrats tend to disregard their responsibilities. The participative and theory Z styles are more democratic and egalitarian describing the usefulness of a majority opinion or consensus before moving forward. Though these styles could result in indecision, they are best implemented when a leader has ultimate decision-making capabilities and relies on his or her subordinates for input. Laissez-faire leadership is typically characterized as the hands off approach. Laissez-faire leadership, when used correctly, relies on the specialized training or focused scope of the work of the subordinates and lends guidance only when necessary. Laissez-faire leadership, however, can provide refuge for a lazy manager. Situational leadership is the use of all or some of the styles described above depending on the specific circumstances of a given situation. For instance, providing guidance to a new employee might benefit from an authoritarian approach; however, deciding on the best approach to implementing a new process might benefit from a participative style of leadership.

In the emergency medical services, a move has been made over the last decade to separate from the authoritarian leadership of the fire service. In my opinion (due to the gross lack of research within both the fire and emergency medical services), the attitudes of the fire service leadership do not correspond well with the manner in which paramedics wish to be led. As paramedics are formally educated and expected to perform as skilled clinicians in the field, they tend to operate independently and view their supervisors more as a resource tool than as tactical or clinical decision-makers. Combination departments, or those that operate both fire and emergency medical services, would do well with developing situational leadership skills to guide both operations (Mujtaba & Sungkhawan, 2009). Though paramedics may utilize an authoritarian style of leadership during an emergency call (and, do well to follow such styles in these environments), during normal day-to-day operations, paramedics respond much better towards a laissez-faire, or indirect, style of leadership that allows for independent critical thinking (Buchbinder, Shanks, & McConnell, 2012; Freshman & Rubino, 2002). For example, during a call, I expect that when I direct my crew to perform a certain task that it is completed immediately; however, between calls when I might say that in a particular scenario a certain intervention is necessary, I expect some discussion to aid in the learning of my crews and to help develop and hone their critical thinking skills.

True leadership has its own rewards, primarily, empowering those who follow to synthesize the traits of their leaders and evolve into leaders, themselves. This, in addition to watching your own visions take root and flourish.

References

Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9. Retrieved from http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12083173&site=ehost-live&scope=site

Kirkpatrick, S. A. & Locke, E. A. (1991). Leadership: Do traits matter? Academy of Management Executive, 5(2), 48-60. doi:10.5465/AME.1991.4274679

Mujtaba, B. G. & Sungkhawan, J. (2009). Situational leadership and diversity management coaching skills. Journal of Diversity Management, 4(1), 1-55. Retrieved from http://journals.cluteonline.com/

Wieck, K. L., Prydun, M., & Walsh, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34(3), 283-288. doi:10.1111/j.1547-5069.2002.00283.x

Academia, Emergency Medical Services, Health Care

Leading the Way in Health Care

As the mantra states: when you have it, well, you just have it. As true as that may be in regards to political and social attributes, the statement does not preclude the ability of anyone to learn to ‘have it’, but what is ‘it’? Every enterprise is started by a singular idea, and many ideas may come together to form the basis of any enterprise, but it takes a visionary mind to manifest these ideas. The people with these ideas are leaders who, by their very nature, are agents of change. These leaders tend to seek each other out when they have a common purpose and create solutions and fill voids that address problems in need of answers. However, once the paradigm of the enterprise is expressed, manpower is needed to ensure its operation and success. Much of this manpower is entrusted to managers who may appreciate the vision and goals of the enterprise but lack the vision themselves to affect significant change, and although this statement sounds pessimistic towards the manager’s abilities, hope is not lost. Managers can, and do, learn to be leaders. Further, one does not require a management position to be a leader; leadership is both intuitive and learned (Buckbinder, Shanks, & McConnell, 2012).

Aside from being visionaries, leaders need to be socially adept in order to promote their views and constructs; therefore, in order to gain the trust and respect of subordinates, managers should strive to hone attitude and behavior to be more fit to lead (Freshman & Rubino, 2002). Mayer and Salovey describe four specific abilities that can improve one’s emotional skill set, also known as emotional intelligence (EI): “(1) the accurate perception, appraisal, and expression of emotions; (2) generating feelings on demand when they can facilitate understanding of yourself or another person; (3) understanding emotions and the knowledge that can be derived from them; and (4) the regulation of emotion to promote emotional and intellectual growth” (as cited in Freshman & Rubino, 2002, p. 3).

The importance of EI is evident in the highly ethically charged environment of health care. Many recommendations have been made to cultivate EI within health care, both with clinicians and administrators, yet it is not evident that this has been taking place, according to Freshman and Rubino (2002). Perhaps, at least philosophically, one must know themselves before attempting to truly know others, but being comfortable with one’s self and possessing the ability to relate and empathize with others, especially in the health fields where patients are vulnerable and providers are, themselves, empaths, will offer a manager leadership capabilities that will create trust and mutual respect in the workforce. Applied to health care adminstration, EI can be divided into five components (e.g. self-awareness, self-regulation, self-motivation, social awareness, social skills) that can be programmatically improved using training and career development opportunities with the organization.

Self-awareness goes back to the previous philosophical statement about knowing one’s self. We must take inventory of ourselves constantly in order to ensure that we understand our own strengths, weaknesses, as well as our motivations. Self-regulation, an important ethical descriptor, allows us to improve our own personal ethics in order to make difficult decisions more easily and without troubling remorse. Tough choices are made daily in the health care setting, and a leader should be able to make these decisions ethically with compassion and understanding. Self-motivation involves challenging one’s self daily to preserve the desire and passion personally and professionally. Social awareness is borne of the former components that allow one to consider the effect decisions have on others. Finally, social skills are necessary for effective communication, especially when considering the need to promote ideas and negotiate with others. These skills, inherent in great leaders, are beneficial to the health care administrator and beneficial, over all, to the health care organization.

References

Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management. Sudbury, MA: Jones and Bartlett.

Buchbinder, S. B. & Thompson, J. M. (2010). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9.

Academia, Emergency Medical Services, Health Care

Profile of a Health Care Manager

According to Buchbinder and Thompson (2010), formal training in hospital administration did not exist until 1934 when Michael M. Davis, along with the University of Chicago, developed the first Health Administration program, combining both business and social education to meet the dynamic and unique needs of health care. In today’s economy of almost 10% unemployment nationwide, the health care field continues to grow, even in the face of uncertain regulation and remuneration (Fiscella, 2011; Sanburn, 2011; Scangos, 2009). However, as the economy continues to stagnate, health care providers still require to paid for their services. This is where the health care manager comes in.

A good health care manager is expected to make decisions that benefit both the organization and the client. Although health care is a business, one might say that it is expected to be the most ethical of all businesses as people’s lives are dependent upon its efficacy and continuity. As such, health care managers are expected, according to Buchbinder and Thompson (2010), to have a high ethical standard along with a requisite savvy business sense. Health care managers are also expected to have refined interpersonal skills, leadership, and integrity. Katz (as cited in Buchbinder & Thompson, 2010) defines the characteristics of an effective manager as possessing critical thinking and complex problem solving skills, expertise in their field, and the ability to effectively communicate with others.

Health care managers can work in a variety of settings and operate under many titles; however, these settings can be defined by two descriptors: direct care and nondirect care. Direct care settings, as described by Buchbinder and Thompson (2010), are those settings in which services are provided directly to the patient. Managers within direct care settings should be customer-focused with great interpersonal skills and dedication. These managers should also be excellent problem solvers, as direct consumers tend to require more expedient solutions than ubiquitous deadlines permit. A person may be better suited for this role if he or she enjoys dealing with the general public and solving complex problems with limited information. Nondirect care settings, on the other hand, can be described as health care support organizations as they might provide supplies, logistics, and expertise to those in direct care settings. Managers within nondirect care settings need to be more business savvy as they will typically interact with clients and associates on that level than, per se, a patient-provider level. Nondirect care managers must also be skilled in marketing and finance. Those with an affinity to these roles might possess more professional or technical skills, focusing more on business than personal relationships.

Both direct and nondirect care settings are important to the delivery of health care, today. Buchbinder and Thompson (2011) describe each as well-paying with opportunity, commensurate with education and experience, to advance within the field of health care management. Health care is both growing and changing, and it is a promising occupational arena.

References

Buchbinder, S. B. & Thompson, J. M. (2010). Career opportunities in health care management: Perspectives in the field. Sudbury, MA: Jones and Bartlett.

Fiscella, K. (2011). Health care reform and equity: promise, pitfalls, and prescriptions. Annals of Family Medicine, 9(1), 78–84. doi:10.1370/afm.1213

Sanburn, J. (2011, August 18). Health care industry growth beginning to slow. Time Moneyland. Retrieved from http://moneyland.time.com/2011/08/18/health-care-industry-growth-beginning-to-slow/

Scangos, G. A. (2009). Proceeding in a receding economy. Nature Biotechnology, 27(5), 424-425. doi:10.1038/nbt0509-424