CHAPTER 3: DECISION MAKING

Key words and terms:

- Decision making processes
- Decision making conditions
- Programmed decisions
- Non-programmed decisions
- Brainstorming
- Experiential decision making (experience)
- Hunches
- Intuition
- Experimentation
- Scientific decision making

The delivery of health services is continually changing. Therefore, supervisors must acquire effective decision-making skills to address these changes, as well as to solve the day- to -day problems that they encounter in their departments. In order for supervisors to make good decisions, they must receive guidelines from higher management and utilize effective decision making techniques.

All lower, middle, and upper level managers make decisions, and these decisions can be referred to as programmed or non-programmed decisions.

Programmed decisions involve problems with definite solutions. Hunches and experience for example, are most often associated with programmed decision making.

Non-programmed decisions refer to problems that have not been encountered and have no definite solutions.

Notably, decision making is in the center of all managerial activities such as planning, organizing, staffing, influencing, and controlling. Through the decision-making process, managers help their organization accomplish the expected outcome. It is important to note that the decisions that managers make are influenced by both the internal and external environment of an organization.

The five steps of the decision-making process are: (1) define the problem, (2) analyze the problem, (3) develop as many alternative solutions as possible, (4) evaluate the alternatives and select the best solution, and (5) implement the solution and follow up.

How can a supervisor know that a problem exists? A supervisor knows a problem exists when there is a deviation from what the supervisor wants to happen.

Complete and accurate information is important in making the best decision. Therefore, managers must learn as much as possible about the problem or issue at hand before generating alternative solutions. Managers should also evaluate how well does each alternative achieves the desired outcome before selecting the best one.

Decision making criteria: feasibility, risk, timing, acceptability, ethics, resources, and economy. Taking into account these many decision making criteria, the best decision is selected.

In addition, scientific decision-making techniques such as quantitative analysis, models, and computer applications are available to managers to solve problems.

CHAPTER 4: COORDINATING ORGANIZATIONAL ACTIVITIES

Key words and terms:

- Division of work
- Coordination
- Supervisory management
- Organization
- Cooperation
- Vertical coordination
- Horizontal coordination
- Diagonal coordination
- Liaison
- Coordinator

Division of work is dividing a job into manageable tasks and taking into account the skills and abilities of the people who will be performing the job.

Coordination requires:

- linking together activities
- communication
- an association between resources, information, and services
- group effort

A manager who performs the five managerial functions well will certainly achieve coordination. In other words coordination is derived from the execution of planning, organizing, staffing, influencing, and controlling.

One of the more challenging tasks for managers when they are coordinating activities is to ensure cooperation. Cooperation means people working together willingly for a common purpose. The cooperation of others is helpful when coordinating activities. Nonetheless, a manager cannot depend solely on cooperation to achieve the desired outcome.

It is important to note that all levels of management coordinate activities. However, the Chief Executive Officer (CEO) is responsible for all activities within a health care organization. Coordination occurs vertically, horizontally, and diagonally.

Vertical coordination relies on authority and it occurs between different levels of an organization. Meanwhile, one can say that vertical coordination can be better accomplished if management uses wisdom and insights when performing the functions of planning, organizing, staffing, influencing, and controlling.

Horizontal coordination involves personnel and departments on the same level, working together to achieve a particular goal. Problems may arise when horizontal coordination is carried out because one department does not ordinarily have the authority to direct another department. Horizontal coordination is usually mandated by policies and procedures. Issues regarding horizontal coordination should be referred to higher management.

Diagonal coordination is important because various departments may depend on a particular department to achieve a specific goal.

External coordination can be achieved through a liaison person. This person can facilitate communication with people that are outside of the organization.

CHAPTER 5 - COMMUNICATING

Key words and terms

- communication
- sender
- receiver
- formal channel
- informal channel
- grapevine
- upward communication
- downward communication
- horizontal communication/lateral communication
- diagonal communication
- communication media
- verbal or oral communication
- written communication
- media
- nonverbal communication
- body language
- poor communication
- barriers to communication
- language
- workplace diversity
- status and position
- resistance to change
- bias and prejudices
- filtering
- semantics
- credibility
- feedback
- repetition

Definition of communication: Communication is the process of passing information from one person to another in an understandable way.

Communication Process: Communication can be broken down into the following elements: sender (encoder), message, channel, receiver (decoder), and feedback

In the health field, the people we communicate with are managers, physicians, colleagues, subordinates, patients and families, agencies, and others. Regardless of the level of management, all managers must be able to communicate well because the success of performing the management functions partly depends on effective communication.

Poor communication in the workplace has a negative impact on interpersonal relationships and could prevent employees from performing well; whereas effective communication enhances employee performance and improves the manner in which they interact with each other.

Consequences of poor communication in the workplace:

- lost of time because tasks may have to be repeated
- frustration because employees are not sure what to do
- waste of resources if tasks are to be repeated
- low productivity
- employees may be trustless because messages are misunderstood
- creates risk of harm to employees, clients, and others based on the circumstance

How can communication improve in the workplace?

- sufficient preparation
- credibility
- feedback
- direct language
- effective listening and sensitivity
- appropriate actions
- repetition

Channels of communication: Formal and informal channel

The formal channel is the formal path through which information flows. The formal channel utilizes downward, upward, horizontal, and diagonal communication to send information through the organizational hierarchy.

Supervisors, for example, use downward channels to send messages to subordinates.

The upward channels are utilized by both subordinates and supervisors. Subordinates send messages to the supervisor, and supervisors send these messages to their superior.

Horizontal channels are used when sending messages across departments and among peer managers.

Diagonal channels are used to send messages between positions that are on different lateral planes and activities in the organization.

The informal channel is the grapevine. A major contribution of the grapevine is that management can use it as an outlet to disseminate information that could not be provided through the formal channel of communication (see example on page 82 in the text). The informal channel though, contains truthful information, gossips, and rumors. It is not the channel of choice to get accurate information.

Media used for communication: verbal or oral, written, visual, and nonverbal

CHAPTER 6 – LEGAL ASPECTS OF THE HEALTHCARE SETTING

Key words and terms:

- tort
- vicarious liability
- respondeat superior
- borrowed servant doctrine
- ostensible agency
- negligence
- malpractice
- Americans with Disabilities Act (ADA)
- sexual harassment
- EEOC
- Family and Medical Leave Act of 1993
- OSHA
- HIPPA

Legal issues in a health care setting:

- patient, employee, and visitors injury
- negligent conduct of independent contractors
- negligent conduct of employees
- unlawful discharge
- sexual harassment
- laws governing employee leave for family and medical reasons
- laws governing workplace safety
- laws governing the portability of insurances and medical information
- laws governing physical and emotional disabilities

The doctrine of respondeat superior:

Respondeat superior (let the master answer) is the doctrine that holds employees responsible for the negligent conduct of its employees during the course and scope of employment. Notably, employers are not responsible for the criminal conduct of their employees.

For an employer to be held liable for the negligent conduct of its employees, the following conditions must exist:

1. An employer-employee relationship
2. the negligent conduct must occur during the course and scope of employment

Who is an employee? A person who works under the direct supervision of an employer and is receiving compensation for the work provided.

Ostensible agency:

Ordinarily, an employer is not responsible for the negligent conduct of independent contractors. However, in certain circumstances the employer could be held liable based on the principle of ostensible agency. This doctrine or principle is a principal/agent relationship. This principle can be applied when patients do not know and are not expected to know that they are receiving the services of an independent contractor. If it appears to the patients that the independent contractor is an employee, the hospital, for example, can be held liable under the doctrine of ostensible agency (see example on page 98, second paragraph in your text).

Factors the courts have found to determine that ostensible agency or vicarious liability existed are listed on pages 98 -99 in your text.

Captain of the ship doctrine: This doctrine holds the surgeon responsible for the negligent conduct of the operating room personnel. The rationale is that the operating room personnel are temporarily the borrowed servants of the surgeon and are directly under his control and supervision. However, on a case-by-case basis many courts have rejected the application of the captain of the ship doctrine and rather hold the health institution liable for the negligent conduct of operating personnel under the doctrine of respondeat superior.

What is negligence: the doing of something a reasonable person would not do under a given circumstance, and not doing what a reasonable person would have done under a given circumstance. Notably, the reasonable person will normally act prudently and with care.

Elements of negligence:

To prove an action for negligence, a plaintiff must show:

1. duty owed
2. breach of duty
3. causation
4. injury

One of the tests commonly used to determine a negligent act is foreseeability.

Are supervisors liable for the negligent conduct of the people they supervise under the doctrine of respondeat superior?

Under the doctrine of respondeat superior, supervisors are not held liable for the negligent conduct of the people they supervise because the supervisor is not the employer. However, a supervisor can be held liable for negligent supervision.

CHAPTER 7 – MANAGERIAL PLANNING

Key words and terms:

- planning
- strategic planning
- mission
- vision
- environmental assessment
- internal assessment
- external assessment
- SWOT analysis
- short term planning
- planning horizon
- long term planning
- effective management
- management by objective
- goals
- objectives

Planning is a continuous process and provides a basis for all other management functions. Supervisors/managers must have plans before they can even think of utilizing the organization’s resources to achieve goals. Such plans reduce uncertainty and duplication, eliminate or minimize waste, establish coordination, objectives and standards.

Strategic planning focuses on the market environment in which an organization is operating. Although strategic planning is mainly the job of upper management, during the process supervisors are encouraged to make contributions. The process of strategic planning includes defining the mission, developing visions, setting goals and objectives, developing operations (such as assigning specific tasks and responsibilities), and monitoring the plan.

The mission of the organization should be clear and concise and must describe what the organization does and why it exists. The mission statement of an organization cannot be defined without conducting a SWOT analysis. By conducting a SWOT analysis, the organization will be able to determine its strengths and weaknesses, as well as identifying opportunities and threats in the external environment.

An environmental assessment may include the current, past, and potential future customers of the organization, competitors in the area, new innovations, government laws that have a bearing on the organization’s activities, and industry indicators.

The vision articulates the direction the organization is heading in the next five years. It is the responsibility of upper management to establish objectives to guide the future of the organization.

The Use of Goals and Objectives in Planning: Goals imply the end result an organization is trying to attain. An objective implies what actions to take to achieve the set goals. Goals and objectives then, are the steering force in the planning process or in other words they are the first step in planning. Without goals, the organization would be unable to establish policies, procedures, methods, programs, projects, and budgets. The use of objectives in planning helps supervisors to carry out the managerial functions.

The following is an example of a statement that defines a department goals and objectives:
The director of nutrition services at a hospital states that she wants to provide nutritious meals at good value for her customers.

Planning Periods: Short term, intermediate, and long term planning

Short term planning covers a time frame of one year and usually takes place at the supervisory level. However, the short term plans of the supervisor must fit with the long term plans of the organization.

Intermediate planning covers a period of five years and has fewer uncertainties than long term planning.

Long term planning usually goes beyond five years and it is generally done by top level administration such as the CEO of a hospital. The longer the planning time frame, the more uncertainties in the environment.

Management by objective (MBO) is a tool that managers or supervisors use to achieve the desired outcome or results. Both the supervisor and the subordinate must establish goals. The supervisor must ensure that the goals are tied with rewards. To accomplish these goals, the subordinate must develop objectives that are specific, measurable, result oriented, and attainable within a specified time frame. The supervisor should provide feedback periodically because communication is an important factor in determining the success of MBO. The supervisor may modify objectives and renegotiate resources to help the subordinate to achieve the desired results.
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CHAPTER 8: FORECASTING

Forecasting is a planning tool that is available to all levels of management. Supervisors make departmental forecasts in terms of technology, and labor requirements. These labor requirements include skill changes, impact of technology on staffing requirements, and compensation modification.

It is important to note that forecasting is not an exact science. However, the supervisor is attempting to predict the future based on information. Such information can be collected from attending lectures, national meetings, reading journal articles. From this information, supervisors can make assumptions, judgments, approximations, and give an opinion on what to anticipate in the future. Sometimes, the forecast may be accurate and other times it will not materialize because there is no exact formula or technique to predict the future.

CHAPTER 9: TACTICAL CONSIDERATIONS IN PLANNING

This chapter discusses the various techniques that are available when making changes to implement plans. For example when implementing plans, one strategy could be pulling resources together and taking action all at once. Another strategy is getting a foot in the door. Other strategies would be requiring others to join in and support the change planned and utilizing a team effort.

When management is planning the utilization of resources, they should consider the following: utilization of the workforce, utilization of equipment and other machinery, safety, use of space, materials and supplies.

When planning for equipment, the manager or supervisor ensures that employees use equipment with care, recognizes the downtime of current pieces of equipment, should evaluate equipment in cooperation with the medical staff and other users, must consider whether the equipment is cost effective, should identify the impact of the equipment on patient care.

When supervisor plan for safety in a hospital, they must consider the safety of patients, employees, as well as the public. Malpractice suits are common and safety should be a priority in planning.

The use of materials and supplies must be managed properly. Supervisors must be diligent in ensuring that these resources are not wasted or stolen. Space in a department must be planned; lack of adequate space or inefficient utilization of space can have a negative impact on the operation of the department to include low productivity.

Notably, a supervisor manages a variety of resources, but of all of these resources, human resources are the most important resource.

CHAPTER 10: PLANNING TOOLS
Key words and terms
- single use plans
- repeat –use plans
- policy
- procedure
- rules
- method
- project
- program
- practice
- budgets

CHAPTER 11- TIME MANAGEMENT TECHNIQUES

Key words and terms:

- desk calendar
- computer scheduling system
- planning sheet
- time-use chart
- regular supervisory duties
- special duties
- boss imposed time
- system imposed time
- self imposed time
- subordinate imposed time
- discretionary time
- theory Y
- theory X
- flextime
- telecommuting

Chapter 11 provides information on how supervisors spend their time, and identifies various tools to manage time. This chapter also focuses on the need to manage the time of subordinates, and other options available to schedule work.

Generally, effective supervisors use different tactics to enhance time management. Some of these strategies include prioritizing tasks, monitoring activities, and delegating some duties to staff members.

The three kinds of management time are boss-imposed time, system-imposed time, and self-imposed time.

Various tools are available to help supervisors manage their own time. They include desk calendars, computer scheduling system, list, and planning sheet.

It is beneficial to both the organization and employees if supervisors consider flextime, telecommuting, and modified work shifts in their recruitment plans.

Advantages of flexible work schedules:
1. Provides employees with the opportunity to adjust work to meet the other personal demands.
2. Improves employee satisfaction, productivity, and time utilization

Disadvantages of flexible work schedules:
1. Problems with proper supervision of employee
2. Difficulty in coordinating activities
3. Increased fatigue and errors

The advantages of flexible work schedule outweigh the disadvantages because supervisors can plan effectively to prevent or minimize the problems associated with flexible work schedules.