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August 18, 2016

COLLEGE OF HEALTH AND HUMAN SERVICES

California State University, Long Beach

Health Care Administration Program

Hospital Management, HCA 536

Fall, 2016


Instructor: Richard L. Tradewell, MBA, Ph.D.

E-mail: richard.tradewell@csulb.edu

Office Hours: To be announced

Phone: (562) 985-5694 Office

(949) 400-0960 Cell (text for meeting)



Instructor Office: SSPA-006


Class Number: 6158

Class Meets: Tuesday, 7-9:45pm

Location: HHS1-200

HCA Program Administrative Coordinator: Deby McGill deby.mcgill@csulb.edu

HCA Office Location: HHS2-118

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 505.

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

    • Domain 5B: Business Knowledge and Skills: Human Resources

    • Domain 5C: Business Knowledge and Skills: Organizational Dynamics and Governance

    • Domain 5D: Business Knowledge and Skills: Strategic Planning and Marketing

    • Domain 5E: Business Knowledge and Skills: Information Management

    • Domain 5F: Business Knowledge and Skills: Risk Management

    • Domain 5G: Business Knowledge and Skills: Quality Improvement

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 of

Activity (A1), Assignment (A2) or Assessment (A3)

  • How does employee relations, especially nursing, recruitment, training, and retention, relate to hospital competitive advantage?

5. B

  • Nurse staffing regulations, wage issues, training and development in support of hospital culture, role on treatment team; promotion opportunities.

Case studies, especially Virginia Mason Medical Center and Hospital for Special Surgery.

  • Understand the changing role and legal responsibilities of the executive office, including the hospital board of directors and medical staff.

  • Understand principles of effective communication.

  • Understand effective hospital CEO leadership.




5. C
1.
2.

  • Board of Trustee selection, relationship of board to CEO and medical staff, Peter Drucker’s criteria for an effective board.

  • Communication and Relationship Management

  • CEO Leadership evaluation criteria

Graded case analysis.
Kovner Case entitled “Whose Hospital?” used as study of CEO fired by board at urging of medical staff. Class discussion of board and CEO mistakes.

Interview of CEO or board member at local hospitals.



  • Compare/contrast advantages and disadvantages of the three institutional and legal forms: for-profit, non-profit, and government operated hospitals.

5.C.

  • Understand regulatory requirements and tax advantages of the 501C(3) or public benefit corporation hospital.

  • Evaluate impact of government payments on charity obligations.

  • Analyze new ACA public benefit regulations on nonprofit hospitals.

Attendance quizzes covering Wall Street Journal and Health Affairs studies of hospitals that are deficient in meeting public benefit requirements.




  • Identify methods of measuring performance outcomes.



  • 5.G.

  • Develop competency in selecting performance measures and skill in monitoring variance from targets.

  • VMMC and HSS case analysis and Attendance Quizzes.

  • Discuss the function of the Organized Medical Staff.



  • 5.C.

  • Analyze effectiveness of several emerging models of physician leadership.

  • Readings from Herzlinger; impact of Accountable Care Organization regs.

  • 5.D.

  • How does the price transparency industry impact the hospital model?

  • Essays on Disruptive Technology

  • Use IT to significantly increase the effectiveness and reduce the costs of hospital operation.

  • 5.E.

  • Analyze innovation in use of cloud and big data innovation to produce competitive advantage.

  • Attendance quizzes and Disruptive Technology essays.



  • Discussion Seminar

  • the class is organized as a discussion seminar. Instructor posts a weekly PowerPoint and case study on BeachBoard to guide discussion. In addition, there is an Attendance Quiz at most meetings to focus discussion and to give instructor feedback on your progress. Students will read and answer questions on a different case or outside reading 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.

  • (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


  • Five Online Quizzes plus Final Recap Quiz: 6 @ 10 points each (Lowest score dropped) 50



  • Your Disruptive Innovation Essay (Share creative ideas) 20

  • Essay Presentation (Encourage class discussion with question) 10



  • Long integrative case analyses:

  • Virginia Mason Medical Center 40

  • Hospital for Special Surgery 40

  • Kaiser Sepsis Case 40

  • In-class Attendance Quizzes: 12 @ 10 points each, with the lowest scores dropped. 100

  • Total 300

  • Note on grading and participation in off-campus hospital site visits

  • This class includes off-campus visits to LA and Orange County hospitals to discussion problems and issues with hospital management and to benefit from a hospital tour. Often these visits must be scheduled during normal business hours. If you have a work conflict, let instructor know and you will be excused without penalty.



  • Grading

  • 90 % and higher: A (270+)

  • 80 % and higher B (240+)

  • 70 % and higher C (210+)

  • 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.

  • Christensen, Clayton M. 2009. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York, McGraw Hill. Chapter 3: “Disrupting the Hospital Business Model.” PP 73-110.



  • Feldstein, Paul J. 2015. Health Policy Issues: An Economic Perspective. Chapter 16: “The Future Role of Hospitals.” PP 251-269. Chicago: Health Administration Press.





  • Some interesting reading to get you started in hospitals:
  • Brill, Steven. “Bitter Pill: Why Medical Bills Are Killing Us.” Time. April 4, 2013. (This is the first time in history that Time magazine devoted an entire issue to one story – an indication of the importance of hospital bills in people’s lives).

  • Conover, Chris. “5 Take-Aways from Steven Brill's Time Tome on Health Costs.” Forbes. Feb 28, 2013. “5 Myths in Steven Brill's Opus on Health Costs--Part 1.” Forbes. Mar 4, 2013. (Here, Conover, a health economist, tells Brill he is wrong, especially in misunderstanding superior outcomes in U.S., and in misrepresenting profits in nonprofit hospitals which Conover shows are about average for American industries). Part 2 is here: http://www.forbes.com/sites/chrisconover/2013/03/07/5-myths-in-steven-brills-bitter-pill-part-2/

  • 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
  • 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/
  • 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&state=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? WHY DOES CLAYTON ARGUE THE INDUSTRY IS RIPE FOR DISRUPTION?



  • Reading Assignments (All reading are on BeachBoard):



  • Christensen, Clayton M. 2009. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York, McGraw Hill. Chapter 3: “Disrupting the Hospital Business Model.” PP 73-110.



  • Feldstein, Paul J. 2015. Health Policy Issues: An Economic Perspective. Chapter 16: “The Future Role of Hospitals.” PP 251-269. Chicago: Health Administration Press.



  • Herzlinger, Regina. 2007 “Chapter 3 The General Hospital: Death at the Hands of the Empire Builders” in Who Killed Health Care? New York, McGraw-Hill.



  • 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

  • Example of Attendance Quiz discussion questions:



  1. What sources does Herzlinger use in her recent book to convince readers that U.S. hospitals are low quality and high cost?

  2. What are Christensen’s arguments for disruption of the hospital industry?

  3. What is Feldstein’s vision for future of hospitals? What are the two threats to the existing industry model? Why does Feldstein think the future involves managing a population rather than an edifice?

  4. How do nonprofit hospitals (supposedly tax exempt to serve the community interest) stifle innovation and efficiency through efforts to restrict competition?

  5. Why is Herzlinger skeptical that vertical integration leads to better health care?

  6. Why does Herzlinger believe no Sam Walton (WalMart) has arisen to save hospitals?

  7. What does she think of specialty hospitals? Of global competition in hospital services?

  8. What are the major problems in comparing hospitals to airlines?

  9. What does Brill’s “Bitter Medicine” say about hospitals?

  10. Why does Conover challenge Brill with creating myths?

  11. 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?

  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 FOCUS: HOSPITAL FINANCE

  • ARE CONSUMERS GETTING POOR VALUE FOR MONEY FROM HOSPITALS? WHY ARE HOSPITALS IN U.S. SO MUCH MORE PRICEY THAN EUROPE AND JAPAN? IS THE PROBLEM PRODUCTIVITY?



  • Gottlieb, Scott. “Hospitals Are Going on a Doctor-Buying Binge, And It Is Likely To End Badly.” http://www.forbes.com/sites/scottgottlieb/2013/03/15/hospitals-are-going-on-a-doctor-buying-binge-and-it-is-likely-to-end-badly/



  • 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?

  • Are “nonprofit” hospitals using tax advantages to rip us off?



  1. Wall Street Journal investigative article on Non-profit hospitals.



  1. Altman, Stuart H., et.al. 2006. “Could U.S. Hospitals Go the Way of Airlines? Health Affairs, Vol 25, No. 1. Jan/Feb. 2006.



  • 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 9-10 : FOCUS AREA: CENTERS OF EXCELLENCE AND THE VMMC CASE

  • See Beachboard Content and Attendance Quizzes.

  • Week 11-12: FOCUS AREA: CENTERS OF EXCELLENCE AND THE HSS CASE

  • See Beachboard Content and Attendance Quizzes.

  • Week 13-14: FOCUS AREA: HOSPITAL SAFETY AND THE KAISER SEPSIS CASE

  • See Beachboard Content and Attendance Quizzes.

  • Week 15- 16: FOCUS AREA: SUSTAINABLE COMPETITIVE ADVANTAGE

  • Lecture and readings: Hospital strategic market management



  • STUDENT INFORMATION SHEET

  • HCA 536; Fall 2016

  • (TURN IN TO INSTRUCTOR OR POST BIO ONLINE)


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  • Phone(s):________________________________________________________

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  • 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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