Health Program Management E-Book

Beaufort B. Longest

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Jossey-Bass Public Health/Health Services Text
• Sprache: Englisch

Seitenzahl: 619

Veröffentlichungsjahr: 2014

Beschreibung

Learn how to effectively plan, implement, and evaluate health programs

Health Program Management: From Development Through Evaluation, Second Edition is a practical and useful introduction to the management of health programs. While providing an overview of the current best practices in management, the textbook goes beyond simple management techniques, teaching students how to develop, lead, and evaluate their programs to ensure quality outcomes. The focus is on the three core management concepts of strategy, design, and leadership, but time is also devoted to describing facilitative management activities integral to successful programs. Students will learn techniques for communication, decision-making, quality assurance, marketing, and program evaluation within the structure of the book's program management model. Logically organized with a separate chapter for each activity, this resource provides a thorough, systematic overview of the effective development, implementation, and evaluation of health programs.

Health Program Management: From Development Through Evaluation, Second Edition provides a comprehensive approach to management throughout all stages of a health program.

• Learn to develop a strategy that steers the program toward specific goals
• Discover how to design, market, and lead an effective health program
• Become familiar with the manager's role in a quality health program
• Evaluate potential and existing programs for performance and capability

Students and aspiring managers and leaders preparing themselves for the challenges of managing health programs will find the information and techniques to develop the skills they need in Health Program Management: From Development Through Evaluation, Second Edition.

Leseprobe

CONTENTS

Cover

Series Page

Title Page

Copyright

List of Figures, Tables, and Exhibits

Preface

Acknowledgments

The Author

Chapter 1: The Work of Managers in Health Programs

Key Definitions

The Work of Program Managers in Terms of Core and Facilitative Activities

Core Activities in Program Management Work

Facilitative Activities in Program Management Work

Roles Played by Program Managers: The Mintzberg Model

Competencies That Underpin Program Management Work

Managing Health Programs Ethically

Managers and the Success of Programs

Summary

References

Appendix A: Example of a Health Program: The Global Health Program of the Bill and Melinda Gates Foundation

The Host Organization

The Global Health Program

Appendix B: Example of a Health Project: The Mass General Care Management Project

Chapter 2: Developing/Strategizing the Future

Developing the Underlying Theory of a Program

Using Program Theory and Logic Models in Establishing and Maintaining Effective Stakeholder Relationships

Developing/Strategizing Activity

Situational Analysis: Determining a Program's Current Situation

Reconsidering and Revising a Program's Current Situation

Assessing and Controlling Performance to Achieve Desired Results

The Link between Developing/Strategizing and the Performance of Programs

Writing a Business Plan

Planning for Interventions Undertaken by Programs

Summary

References

Chapter 3: Designing for Effectiveness

Creating Organization Designs

Key Concepts in Formal Organization Design

Application of the Key Organization Design Concepts

Informal Aspects of Organization Designs

Designing Program Logic Models

The Staffing Process in Health Programs

Summary

References

Chapter 4: Leading to Accomplish Desired Results

Leading Defined

Influence and Leading; Interpersonal Power and Influence

Motivation as a Basis for Leading Effectively

The Ongoing Search to Understand Effective Leading

Toward an Integrative Approach to Effective Leading in Health Programs

Summary

References

Chapter 5: Making Good Management Decisions

Decision Making Defined

Involving Other Program Participants in Decision Making

Key Characteristics of Management Decisions and Decision Making in Programs

The Decision-Making Process

Summary

Key Terms and Concepts

References

Chapter 6: Communicating for Understanding

Communicating: Key to Effective Stakeholder Relations

A Model of the Communication Process

Barriers to Communicating Effectively

Communicating within Programs

Communicating with External Stakeholders

Communicating When Something Goes Wrong

Summary

References

Chapter 7: Managing Quality—Totally

Quality Defined

Measuring Quality

Managing Quality

A Total Quality Approach to Managing Quality

Patient/Customer Focus

Continuous Improvement

Teamwork

Summary

References

Chapter 8: Commercial and Social Marketing

Commercial Marketing

Social Marketing

Commercial Marketing in Health Programs

The Five Ps of Commercial Marketing

Social Marketing in Health Programs

Conducting Social Marketing Initiatives in Health Programs

Ensuring the Success of Social Marketing Initiatives

Ethics Considerations in Commercial and Social Marketing Strategies

Summary

References

Appendix C: A Step-by-Step Social Marketing Process

Describing the Problem

Choosing a Target Audience

Conducting Formative Research

Creating the Social Marketing Strategy

Next Steps

Chapter 9: Evaluating

Program Evaluation Defined

What Do Program Managers Evaluate?

Program Theory and Logic Models

Types of Program Evaluations

The CDC Framework for Conducting Program Evaluations

Standards in the CDC Evaluation Framework

Steps in the CDC Evaluation Framework

Summary

References

Index

End User License Agreement

List of Tables

Table 8.1

Table 9.1

List of Illustrations

Figure 1.1

Figure 1.2

Figure 1.3

Figure 1.4

Figure 1.5

Figure 1.6

Figure 2.1

Figure 2.2

Figure 2.3

Figure 3.1

Figure 3.2

Figure 3.3

Figure 3.4

Figure 3.5

Figure 3.6

Figure 3.7

Figure 3.8

Figure 3.9

Figure 4.1

Figure 4.2

Figure 4.3

Figure 4.4

Figure 4.5

Figure 5.1

Figure 5.2

Figure 5.3

Figure 5.4

Figure 5.5

Figure 5.6

Figure 5.7

Figure 5.8

Figure 5.9

Figure 5.10

Figure 5.11

Figure 6.1

Figure 6.2

Figure 6.3

Figure 6.4

Figure 6.5

Figure 6.6

Figure 6.7

Figure 6.8

Figure 7.1

Figure 7.2

Figure 7.3

Figure 7.4

Figure 7.5

Figure 7.6

Figure 7.7

Figure 7.8

Figure 8.1

Figure 8.2

Figure 8.3

Figure 9.1

Figure 9.2

Figure 9.3

Figure 9.4

Figure 9.5

Figure 9.6

Guide

Cover

Table of Contents

Begin Reading

Chapter 1

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For Carolyn

Praiseworthy

Health Program Management

From Development Through Evaluation

Second Edition

Beaufort B. Longest, Jr.

Cover design by Wiley

Cover image: © esenkartal | Getty

Copyright © 2015 by Beaufort B. Longest, Jr. All rights reserved.

Published by Jossey-Bass

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Library of Congress Cataloging-in-Publication Data

Longest, Beaufort B., Jr., author.

[Managing health programs and projects]

Health program management: from development through evaluation/Beaufort B. Longest, Jr. – Second edition.

p.; cm.

Preceded by Managing health programs and projects/Beaufort B. Longest Jr. 1st ed. c2004.

Includes bibliographical references and index.

ISBN 978-1-118-83470-1 (pbk.) – ISBN 978-1-118-83463-3 (pdf) – ISBN 978-1-118-83476-3 (epub)

I. Title.

[DNLM: 1. Health Planning–methods. 2. Health Services Administration. 3. Organizational Innovation. 4. Program Evaluation. 5. Total Quality Management. W 84.1]

RA427

610.68′5–dc23

2014015932

List of Figures, Tables, and Exhibits

Figures

Figure 1.1

An Organization Design Depicting a Program Embedded in a Host Health Services Organization

Figure 1.2

A Project's Life Cycle

Figure 1.3

Model of the Core Activities in Program Management Work

Figure 1.4

Model of the Core and Facilitative Activities in Program Management Work

Figure 1.5

The Manager's Roles

Figure 1.6

Relative Mixes of Competencies Needed for Effective Management Work in a Large Program

Figure 2.1

Logic Model of a Program

Figure 2.2

Control of Performance in an HIV Screening Program's Laboratory

Figure 2.3

Model of Interventional Planning

Figure 3.1

Hierarchy of Organization Design

Figure 3.2

Contrasting Spans of Control

Figure 3.3

Simplified Organization Design of a Functionally Organized Health Services Organization

Figure 3.4

Simplified Organization Design of a Functionally Organized Program

Figure 3.5

Programmized Organization Design

Figure 3.6

Matrix Organization Design

Figure 3.7

A Contact Chart

Figure 3.8

Informal Group Structure

Figure 3.9

The Staffing Process

Figure 4.1

The Motivation Process for an Individual

Figure 4.2

Comparison of the Content and Process Perspectives on Motivation

Figure 4.3

Maslow's Hierarchy of Needs

Figure 4.4

Basic Model of Expectancy Theory

Figure 4.5

Comparing Three Approaches to Understanding Effective Leading

Figure 5.1

Vroom's Decision Model

Figure 5.2

The Decision-Making Process

Figure 5.3

Fishbone Diagram of Possible Causes of Nosocomial Pneumonia

Figure 5.4

Pareto Chart of Causes of Nosocomial Pneumonia

Figure 5.5

Decision Grid for the Possible Addition of a Satellite Clinic in a Program

Figure 5.6

Payoff Table for Ordering Syringes

Figure 5.7

Decision Tree for Automation or Overtime Pay

Figure 5.8

PERT Network for the Development of an Open-Heart Surgery Program

Figure 5.9

Beta Curve for Optimistic, Most Likely, and Pessimistic Time Estimates for Activities in Developing the Open-Heart Surgery Program

Figure 5.10

Conceptual Model of a Decision Support System

Figure 5.11

Lewin's Three Steps in Implementing Changes Resulting from a Decision

Figure 6.1

Prototype of an External Stakeholder Map for Health Programs

Figure 6.2

Typical Relationships between a Program and Its Stakeholders

Figure 6.3

A Model of the Communication Process

Figure 6.4

Communication Flows in a Program

Figure 6.5

Common Types of Communication Networks in Programs

Figure 6.6

“A” Frame for Advocacy

Figure 6.7

Types of Errors in Clinical Settings

Figure 6.8

Continuum of Management Responses When Something Goes Wrong

Figure 7.1

What Patients/Customers Should Expect of Health Services

Figure 7.2

Components of a TQ Approach to Managing Quality

Figure 7.3

FOCUS-PDCA Model

Figure 7.4

Pre-Intervention Flowchart of the Patient Care Process.

Figure 7.5

Generalized Cause-and-Effect (Fishbone) Diagram

Figure 7.6

Run Chart of an Intervention to Shorten Wait Times

Figure 7.7

Key Determinants of Team Effectiveness

Figure 7.8

Model of the Problem-Solving Process for Improvement Teams

Figure 8.1

Elements of a Commercial Marketing Strategy

Figure 8.2

Phases of the Social Marketing Assessment and Response Tool

Figure 8.3

Main Components of a Social Marketing Plan

Figure 9.1

Evaluating Walk a Mile for Health without a Program Theory

Figure 9.2

Evaluating Walk a Mile for Health with a Program Theory

Figure 9.3

CDC Framework for Program Evaluation

Figure 9.4

Checklist for Gathering Credible Evidence

Figure 9.5

Justifying Conclusions and Making Recommendations in a Program Evaluation

Figure 9.6

Outline of a Program Evaluation Report

Tables

Table 8.1

Examples of Patient/Customer Market Segments

Table 9.1

Options for Evaluating Commercial or Social Marketing Activities in Programs

Exhibits

Exhibit 2.1

A Program's Operating Budget for Year X

Preface

This book is about managing health programs. Effective management of programs is important because these are mechanisms through which a great many health services are organized and provided in both the public health and health care sectors. I provide information drawn from management research to assist you in developing a comprehensive approach to the practice of management in health programs. A focused reader will take away a solid overview of the current best practices in management that apply to managing health programs.

Health programs target any of the determinants of health. They can focus on some aspect of the physical environments in which people live and work, on human behavior, on biology, on the social factors that affect people, or on the health services offered to them. There is therefore a broad array of health programs. For example, at the prevention end of the health services spectrum, people receive information about safe sex practices or how to eat healthier in the context of health education programs. At the advanced acute care end of the spectrum of services, people receive kidney transplants within the context of transplant programs.

A persistent, decades-long trend has created ever larger and more elaborate structures that organize, deliver, and finance health services throughout the industrialized world. Current manifestations of this phenomenon can be seen in major public health agencies, such as the California Department of Public Health (www.cdph.ca.gov), or large health services organizations, such as the Massachusetts General Hospital (www.massgeneral.org). Within these large and complex structures, however, health services are provided directly through relatively small units called programs.

A substantial literature exists pertaining to the management of large and complex public- and private-sector health agencies, organizations, and systems. I have contributed to this literature myself. Nevertheless, there is a relative paucity of literature about managing at the level of health programs, where so much of the direct delivery of health services occurs. With this book, I seek to partially address this imbalance.

The intended audience for this book includes students in public health, in health services management, and in a wide variety of health professions who want to prepare themselves for the challenges of managing health programs. Even those who aspire to leadership positions in large agencies, organizations, and systems may begin their management career at the level of programs. The book will also be useful for those who already occupy a program management position, because it comprehensively and systematically presents current information about management.

Programs are defined in this book as organizational units intended to accomplish one or more objectives through a plan of action that describes what work is to be done, by whom, when, and how, as well as what resources will be used. Programs are embedded in organizations and should be of benefit to the larger host organization. Program management is defined as the activities through which the mission and objectives of a program are established and pursued by means of various processes using human and other resources.

As a way of organizing the discussion of program management, and to give a sense of the structure of the book itself, I present in Chapter 1 a model of the activities managers engage in as they manage programs. These activities are divided into two sets: core activities and facilitative activities. All health program managers engage in three core activities as they perform management work: developing/strategizing, designing, and leading. In addition, managers also engage in other activities that facilitate and support the accomplishment of a program's mission and objectives. Program managers engage extensively in such facilitative activities as decision making and communicating as they carry out their management work. Increasingly, they also engage in managing quality, marketing, and evaluating. Individual chapters of the book are devoted to each of these activities, presenting in-depth information about each of them. A brief précis of each chapter follows.

Chapter 1, “The Work of Managers in Health Programs,” contains key definitions and a background discussion of programs and program management. The work of managers is considered in terms of the core activities in which all managers engage as they do management work: developing/strategizing, designing, and leading. Consideration of this work is extended to include managers' facilitative activities: decision making, communicating, managing quality, marketing, and evaluating. The entire set of core and facilitative activities in management work is modeled graphically in Figure 1.4. This figure is the chapter's centerpiece, depicting the core and facilitative activities of management work as an integrated and interactive set of activities. There is also a discussion of the roles played by managers and the competencies necessary to manage health programs well.

Chapter 2, “Developing/Strategizing the Future,” emphasizes the initial development and strategizing that bring programs into existence. Developing a program initially simply means conceptualizing the program as a vehicle for delivering services or products that may succeed in the marketplace. In ongoing programs, development pertains to improving established services or products, or to expanding a program's portfolio of services or products. Development triggers strategizing, which is the work that managers do as they establish or revise the specific mission and objectives of a program and plan the means of achieving them.

Chapter 3, “Designing for Effectiveness,” is built around discussion of the work managers do when establishing and changing the intentional patterns of relationships among human and other resources within a program, and when establishing and changing the program's relationship to its external environment, including to the larger organizational home in which it is embedded. Attention is also given to designing logic models for programs.

Chapter 4, “Leading to Accomplish Desired Results,” describes leading as the work managers do when influencing other participants to contribute to the performance of a program. Emphasis is given to the fact that leading requires managers to help participants be motivated to contribute to programs in positive ways. Attention is given to specific leader behaviors that can improve management in programs.

Chapter 5, “Making Good Management Decisions,” emphasizes that decision making permeates all management work. The discussion of decision making represents a turn from core management activities to facilitative activities. Decisions are divided into two subsets: problem-solving decisions and opportunistic decisions. Problem-solving decisions are made to solve existing or anticipated problems. Opportunistic decisions are typically sporadic and arise with opportunities to reshape or advance accomplishment of a program's mission and objectives. Although decision making is defined simply as making a choice from among alternatives, the decision-making process is discussed in terms of seven steps: (1) becoming aware that a decision must be made, whether it stems from a problem or an opportunity; (2) defining in as much detail as possible the problem or opportunity; (3) developing relevant alternatives; (4) assessing the alternatives; (5) choosing from among the alternatives; (6) implementing the decision; and (7) evaluating the decision, and making necessary follow-up decisions.

Chapter 6, “Communicating for Understanding,” stresses that communicating activities are also ubiquitous in facilitating a manager's performance of all other management activities. Communicating is discussed as being both vital to the successful performance of management work and a challenge for managers. It is described as an activity that involves senders (individuals, groups, or organizations) conveying ideas, intentions, and information to receivers (also individuals, groups, or organizations). Communication is effective when receivers understand ideas, intentions, or information as senders intend, but several environmental and interpersonal barriers must be overcome to communicate effectively. The communicating activity is discussed as a key to managing relationships with a program's internal and external stakeholders.

Chapter 7, “Managing Quality—Totally,” discusses why managers of health programs typically make effectively managing the quality of the services provided a high priority. Quality is important not only to those who use the services of a program, having an important impact on their service-seeking decisions, but also to people who work in programs. This chapter stresses that above all else, managing quality in a health program requires a systematic approach. Three components of what is called a total quality approach to managing quality in health programs are presented: patient/customer focus, continuous improvement, and teamwork.

Chapter 8, “Commercial and Social Marketing,” discusses two important ways managers of health programs can use marketing to facilitate program performance. The financial or commercial success of many programs is affected by the use of commercial marketing. In addition, especially in programs focused on health promotion and education, social marketing is used in the provision of services. The classic four Ps of successful commercial marketing strategies are discussed: product or service, price, place, and promotion, with attention given to an increasingly important fifth P, people. Social marketing is discussed in terms of using some elements of commercial marketing to influence the voluntary behavior of individuals and groups for their own benefit, and in some instances for the larger society's benefit.

Chapter 9, “Evaluating,” discusses health program managers' evaluating activities in terms of collecting and analyzing data and information about a program or some aspect of a program as a basis for making decisions about the program. Managers' reasons for engaging in evaluating activities are discussed, including the following: (1) improving the overall performance of programs, (2) demonstrating accountability to stakeholders and justifying the use of resources, (3) demonstrating the effectiveness of programs in terms of accomplishing missions and objectives, and (4) demonstrating the effectiveness of specific interventions undertaken by programs.

Although it is convenient for purposes of discussion and description to separate into individual chapters the core and facilitative activities that constitute management work, the danger in doing so is that it may incorrectly depict management as a series of separate activities, perhaps performed in a particular sequence. In practice, health program managers engage in these activities in a way that results in an interdependent mosaic. When managers integrate and perform this set of activities well, they are more likely to be satisfied with the performance of their programs and the results achieved. To the extent that reading this book contributes to this occurrence, I will have achieved my purpose in writing it.

An instructor's supplement is available at www.wiley.com/go/longest2e. Additional materials, such as videos, podcasts, and readings, can be found at www.josseybasspublichealth.com. Comments about this book are invited and can be sent to [email protected].

October 2014

Beaufort B. Longest, Jr.

Pittsburgh, Pennsylvania

Acknowledgments

I wish to acknowledge the contributions made by several people to this book, and to thank them for their involvement. At the University of Pittsburgh, which has been my professional home for thirty-four years, Mark Nordenberg, Arthur Levine, Don Burke, and Mark Roberts provided a supportive environment for scholarship. At Jossey-Bass, Andy Pasternack first saw the potential in this book. Following Andy's untimely death, Seth Schwartz picked up the pieces and made the book happen. I also want to thank Justin Frahm, who managed production flawlessly, and the very thorough Francie Jones, for contributing her professional expertise to this project. Reviewers Joseph DeRanieri and Barbara Hernandez provided insightful suggestions, which are greatly appreciated. At home, Carolyn and Butterbean continue to make joy a welcome part of life, for which I am very grateful.

The Author

Beaufort B. Longest, Jr., is a professor of health policy and management in the Graduate School of Public Health at the University of Pittsburgh. He is the founding director of Pitt's Health Policy Institute, which he led from 1980 to 2011.

Professor Longest is a fellow of the American College of Healthcare Executives and a member of the Academy of Management, AcademyHealth, and the American Public Health Association. With a doctorate from Georgia State University, he served on the faculty of Northwestern University's Kellogg School of Management before joining the Pitt faculty in 1980. He is an elected member of Beta Gamma Sigma, the international honor society in business, and of the Delta Omega Honor Society in Public Health.

His research on modeling managerial competence, issues of governance in health services organizations, and health policymaking has appeared in numerous peer-reviewed journals, and he is author or coauthor of eleven books and thirty-two chapters in other books. His book Health Policymaking in the United States, soon to be published in its sixth edition, is among the most widely used textbooks in health policy and management graduate programs. His book Managing Health Services Organizations and Systems, coauthored with Kurt Darr, is now in its sixth edition.

He has consulted for health services organizations and systems, universities, associations, and government agencies on health policy and management issues, and he has served on several editorial and organization boards.

Chapter 1The Work of Managers in Health Programs

Learning Objectives

After reading this chapter, you should be able to:

Define health, health programs, and management

Understand the core and facilitative activities of managers' work

Understand the roles managers play as they do management work

Appreciate the underlying competencies demonstrated by managers in doing management work