The following objectives should be met by the end of this first module:
- Understand the importance of organization design in healthcare organization and appreciate its historical roots in the thinking of early management theorists
- Distinguish between formal and informal aspects of organizational design
- Understand the advantages and disadvantages, and the implications for managers, of the division of work
- Understand the basic staffing process in healthcare organizations
- Understand the nature of informal relationships among people in organizations
- Review the personnel who make up the healthcare workforce by place of employment and occupation
- List trends in healthcare workforce employment by setting
- Review physician education and training as well as physician workforce issues
- Understand roles of allied health personnel and trends within this workforce
These notes are intended only to supplement your readings. The best way to ensure each module is absorbed is to complete all the readings prior to reviewing these lecture notes. I will try to highlight what I believe to be the most important topics from your module readings. If you have any questions or concerns or there is something you do not understand, please ask me. You can either post on the webboard the question you have (that way others can benefit from the response), or you can e-mail me if you want a more private response. Either way it is extremely important that you have a complete and thorough understanding of the material for the module. Good luck and have a great semester!
This is the second module in section two of this course focusing on the healthcare workforce. In the previous module we discussed strictly the healthcare administrator. This module we will focus on those who work for the healthcare administrator, the healthcare providers and other ancillary staff. The first reading will strictly focus on the individuals and the positions they fill in a healthcare organization. Organizational design is the first step to fully understanding how to manager human resources in the healthcare field. The second reading will focus more on the professions themselves reviewing education, credentials and job responsibilities as well as covering general trends for the healthcare workforce. A majority of the first readings should be an overview of your organizational management class, be sure you understand all main points. We are then going to take it one step farther by studying the professions themselves and applying our knowledge of organizational design.The design of an organization must start with the individual jobs within the organization (as seen on page 136). After this initial design then individuals can be grouped based on task, responsibility, or job to most effectively perform their job. This is part of the formal structure of the organization, outside of this structure is the informal structure. These are the relationships that are formed by people working together that is outside of the "sanctioned" formal structure.
Henri Fayol and Max Weber are some of the first theorists in organizational design. These classic concepts, although based on industry, still hold true for ideas in healthcare organizations. Their ideas focused on the formal structure of organizations that include the establishment of individual positions and the staffing of these positions. Informal structures that developed in organizations was first studied in the 1930's with the Hawthorne studies. Much of the informal aspects of organizational design is based on the work of sociologists and social psychologists. Both informal and formal groupings must be understood and "maintained" by the manager to promote an effective and efficient organization.
The health service industry is an extremely labor intensive organization, thus making healthcare professionals essential to the success of a HSO. The healthcare industry continues to be one of the largest employers in the country and is continuing to grow. Healthcare employment can be divided by either where an employee works or by their occupation. The majority of healthcare workers are employed in acute care facilities, but that is slowly changing as the hospital becomes less of "the center of healthcare". As is seen in Florida, long term care facilities and home health care are becoming more popular than ever as a health care delivery center. This means that employment in these settings is increasing as well.
It is important that we understand the role that the physician plays in healthcare. Essentially, all medical care is dictated by the practices of the physician. This is the primary reason for such strict control on their activities by managed care organizations to control costs and quality. Due to the large and important role the physician plays we need to understand the educational process as well as the supply and demand of the doctor in our medical system today. Both allopathic and osteopathic physicians must complete a medical school program before entering an internship and residency. Residency programs are considered graduate medical education (GME) and are being highly scrutinized currently due to costs and duties of residents. Women continue to be the minority in the profession, but are starting to increase as a percentage of the workforce. International medical school graduates (IMGs) complete medical school in a foreign country and then compete for U.S. residency positions. These too are being scrutinized due to costs as a whole to the system of GME.
Geographic distribution and professional specialization are maldistributed in our country today. These are areas in the country that are without medical care although we have approximately 500 people per physician in this country. This is due to the geographic maldistribution of physicians between rural and urban areas in the United States. This is very controversial area, some believe there is a true maldistribution between specialists and generalists physicians while others believe it is only a geographical issue.
Physician extenders and allied health care practitioners make up the additional health care provider workforce. Each has their individual educational and licensing criteria as well as a defined scope of practice. Each is also experiencing workforce trends specific to their field. In general healthcare is moving toward licensing and higher educational requirements for all disciplines. For example, radiation therapy which has primarily been a post-associates degree certificate program is moving toward a bachelor's requirement for certification. On the other hand, dental hygiene programs are moving from an AA degree based program to on the job training. Finally, other professionals such as lawyers, chaplains, health educators, and hospitality staff also are a part of the healthcare team. To administer and run a healthcare facility knowledge of all the fields is important if not essential.
That is it for notes for module #5! Let me know if you have any questions.