dashboards in the healthcare sector howard gitlow, ph.d. steve ullmann, ph.d. amy zuo, m.b.a....

Dashboards in the Healthcare Sector

Howard Gitlow, Ph.D.

Steve Ullmann, Ph.D.

Amy Zuo, M.B.A.

University of Miami

School of Business Administration

305 284 4296

[email protected]

www.howardgitlow.com

mailto:[email protected]

Traditional Management in Healthcare

• Management by Objective• Performance Appraisal

Traditional Management in Healthcare: Management by Objective

• Management by Objectives (MBO) is a process of negotiating periodic performance objectives between superiors and subordinates in an effort to cascade top management’s wishes throughout an organization. Frequently, objectives (MBOs) are set using numeric targets with deadlines for key process metrics, or just deadlines for projects.


• Management Information Systems (MIS) are needed to operationally define and measure key metrics in respect to their MBOs. MIS usually track key metrics over time, for example, monthly or yearly, or comparatively, for example, “this month this year with this month last year,” or “this quarter this year with this quarter last year.” (Drucker, Peter F., "The Practice of Management", 1954. ISBN 0060110953)

http://en.wikipedia.org/wiki/Special:BookSources/0060110953


• An MBO type dashboard is a tool used by policy makers and managers to clarify and assign accountability and responsibility for the key objectives needed to steer an organization toward its mission statement.

• Dashboards are used to deploy the mission statement throughout the levels of a healthcare system, from top to bottom, through the development of a cascading and interlocking set of key objectives as measured through numeric targets or deadlines.


• There are many variants of MBO type dashboards which are used in a wide variety of applications ranging from manufacturing, to service, to healthcare, to government, to education. However, all of these applications contain several similarities. First, all of the applications display a drill-down system of key objectives. Second, all of the applications use data on key metrics to determine the status of each key objective. However, these systems do not usually consider the managerial implications of an automated MBO style of management.


Copyright by Howard S. Gitlow, Ph.D. Coral Gables, Florida, 2008

Examples hyperlink

Traditional Management in Healthcare: Performance Appraisal

• Performance Appraisal Systems (P.A.S.s) are the vehicles used to assign accountability and responsibility to the individual responsible for a process that generates a key metric subjected to an MBO. The MBO-PAS package is the extrinsic motivational hammer used to enforce MBOs, or in other words, top management’s will.



• Employees can be monitored in respect to many types of MBOs, for example, Quality MBOs, Quantity MBOs, Cost MBOs, or Time based MBOs.



• Examples of Quality MBOs are: Percentage of defective product produced in the Miami plant in the Second Quarter of 2007 <10%, or the Number of warranty claims in the Miami plant as of December 31, 2007 < 2%.

• Examples of Quantity MBOs are: Number of Sales Calls Made in the Miami Office by Salesperson X at the end of the first quarter of 2007 > 650 sales calls, or Number of Records Processed in the Miami Office at the end of the first quarter of 2007 > 25,000 records.



• Examples of Cost MBOs are: Raw Materials Expense in the Miami plant in the Second Quarter of 2007 < $150,000, or Revenue from Product X in Florida in the Third Quarter of 2007 > $1,000,000.

• Examples of Time Based MBOs are: The computer system in the Red River plant must be fully operational before December 31, 2007, or The Ad campaign for Product Y must be submitted to the client no later than 5:00 pm on June 15, 2007.


Dashboard Management in Healthcare

(1)Macro Model (Dashboards)

(2) Micro Model (DMAIC, DMAVD, Lean)

(3) Management Model (Deming’s SoPK)


Macro Model (Dashboards)

Mission Statement: --------------------------------------------------------------------------

President Direct Reports

Key Objectives Key Indicators Area Objectives Area Indicators Potential Tasks and Projects

Key objectives must be achieved to attain the mission statement.

One or more key indicators show progress toward each business objective.

Area objectives are established to move each business indicator in the proper direction.

One or more area indicators show progress toward each area objective.

Projects are used to improve or innovate processes to move area indicators in the proper direction.


Cascading System of Mission statements

Business School of the University of Miami

Example of a Dashboard


Example of a Dashboard

Cascading System of Key Objectives and Key Indicators

Business School of the University of Miami


Partial Dashboard of Health Sector Management & Policy

University of Miami

Health Sector Management & PolicyDirector - Steve Ullmann, Ph.D

Key Objectives Key Indicators

Below are parial CAHME objectives Criteria for accreditation (Apr 2007)Effective for site visits fall 2008 and beyond

II.A. Students, Graduates and Others

II.A.2. Enroll quality students into the program Number of students in the program by category by year (e.g., physicians, administrators, nurse managers, etc.) (hyperlink)


Partial Dashboard of Health Sector Management & Policy

University of Miami

CAHME Competency Model NCHL Competency Model Key Indicator (Measurement)III.B.12. Statistical analysis and application

TRANSFORMATION - Analytical Thinking: The ability to understand a situation, issue, or problem by breaking it into smaller pieces or tracing its implications in a step-by-step way. It includes organizing the parts of a situation, issue, or problem systematically; making systematic comparisons of different features or aspects; setting priorities on a rational basis; and identifying time sequences, causal relationships, or if-then relationships.

List of student’s projects from Dr. Gitlow’s MAS 641 class who have demonstrated competencies in statistical analysis and application (Analytical thinking, Performance measurement, Process management and organizational design, self-confidence) via their course projects by class

EXECUTION - Performance Measurement: The ability to understand and use statistical and financial methods and metrics to set goals and measure clinical as well as organizational performance; commitment to and employment of evidence-based techniques.

Percentage of students in Dr. Gitlow’s MAS 641 class who have demonstrated competencies in statistical analysis and application (Analytical thinking, Performance measurement, Process management and organizational design, self-confidence) via their course projects by class

EXECUTION - Process Management and Organizational Design: The ability to analyze and design or improve an organizational process, including incorporating the principles of quality management as well as customer satisfaction.

PEOPLE - Self-Confidence: A belief and conviction in one’s own ability, success, and decisions or opinions when executing plans and addressing challenges.

DIARY


Example of Key Indicator – Diary(This part is from “Thank God It’s Monday!”)

Episode # Date Description of Unassertive Episode

1 1/15/05 Can’t say no

2 1/15/05 Let my son get away with murder




6 1/15/05 Can’t ask for simple directions



… ………………………………………………

124 1/28/05 Can’t say no

125 1/28/05 Let my son get away with murder

126 1/28/05 Can’t say no

Part of Marsha’s Diary of Unassertive behavior for Two Weeks


Daily Count of Number of Unassertive Episodes

Date # of Unassertive Eepisodes

1/15/2005 111/16/2005 91/17/2005 91/18/2005 81/19/2005 71/20/2005 91/21/2005 91/22/2005 111/23/2005 71/24/2005 131/25/2005 91/26/2005 61/27/2005 71/28/2005 111/15/2005 111/16/2005 91/17/2005 9

Total 126

It shows the number of unassertive episodes per day taken from Table 22 before a change to Marsha’s behavioral response to unassertive episodes



Marsha’s c-Chart of Unassertive Behavior per Day



Marsha’s Pareto Diagram of Unassertive Behavior



Marsha’s Before and After c-Chart



Marsha’s After Pareto Diagram



Benefits of Dashboard Management

Healthcare Administration program managers use a dashboard at monthly operations review meetings for several purposes.

– First, they use dashboards to clarify mission statements and key objectives, and accountability for them, among all personnel and areas.

– Second, they use dashboards to promote statistical thinking about reacting to fluctuations in key indicators. For example, is the number of applicants to the healthcare administration program for last year due to a special or common cause of variation in the admissions process.


Benefits of Dashboard Management

– Third, managers use dashboards to clarify and reduce the perception that most of the daily crises (called “helter skelter” items) requiring immediate and special attention are really special cases of known key objectives. A manager’s ability to recognize “helter skelter” items as special cases of key objectives reduces the amount of tension involved in dealing with a multitude of crises “du jour.”

– Fourth, managers use dashboards to develop and test hypotheses concerning potential changes to processes.

– Fifth, mangers can use dashboards to ensure the routine and regular updating of key indicators.


Micro Model (Projects)

• Visual Management (for example, the ‘5Ss”)• SDSA/PDSA• Six Sigma

– Improvement model (DMAIC)– Invention and Innovation model (DMADV)

• Lean Thinking (the Toyota Production System)


Management Model (Deming’s System of Profound Knowledge)

• Purpose: Pursue the organizational mission through the promotion of “joy at work.”

• Assumptions (needed for a data based system of management):– Optimize the whole system, not just your component of the system– Improve the process to get results, do not just demand results– Cooperate, do not compete, if the aim of the system is not to win– Balance extrinsic and intrinsic motivators, do not rely only on

extrinsic motivators

• The above assumptions form an integrated system and cannot be separate


dashboards in the healthcare sector howard gitlow, ph.d. steve ullmann, ph.d. amy zuo, m.b.a....

Documents

healthcare management

traditional management

practice of management

objectives mbos

healthcare system

system of key objectives

key process metrics

objective copyright