Angela Jukkala, PhD, RN, CNL

University of Alabama at Birmingham

Primary role of nursing was patient care

Nursing and finance believed to be separate

P4P
Complexity of care

Management functions
Planning
Control
Decision making

Consider possible options

Provides direction
Evaluate progress
Essential elements

Strategic planning
Budgeting

Once a plan is developed, it must be

implemented!
Refers to the managerial tasks related to
ensuring the plan is carried out as close to
the original plan as possible.

Over-riding role of management

Someone has to have decision-making
authority
Change

Organizational chart

Not part of the organizations official

structure
Can be as important as formal lines of
authority
Based on:

History of the organization

Key players in the organization
Resources controlled by various players

Planning, control, and decision making

reside with a few individuals at the top level
of the organization.
Often far from the point of care
Needs to be knowledgeable
Not necessarily do-able in todays healthcare
environment.

Planning, control, and decision-making

occur much closer to the point of care.
Greater number of individuals
Enhances the development of unit
managers
Information needed is more accessible
Ability to decentralize exceptions to rules
Timeliness

Top has to relinquish power

Must have organizational information
systems
Ensuring regulatory compliance
Active communication required
Commitment to education

Varies
Decentralization
Must haves:

Budgeting
Applied economics
Health care finance
Inventory control
Skill in planning, control and decision making

Does a high level of clinical expertise

guarantee success?
Need education

Formal
Informal

Lateral relationships
Strained
Relationships

People
Is the best interest of the organization
always in the best interest of the individual?
Goal congruence
Incentives

Control of information about revenues,

expenses and operations is key.
Aware of your role in engaging staff in
financial management.
Need the requisite knowledge and skill to be
successful.

Dartmouth

What is a microsystem?
A small group of people who
work together on a regular
basis

Care delivery: Provide care to

discrete subpopulations
Education: Provide learning to
a subset of students
(Batalden, Nelson, Johnson, Godfrey)

Examining Microsystem performance

Clinical and business aims

Linked processes
Shared information environment
Produce performance outcomes
Evolve over time and are (usually)
embedded in larger organizations

UAB

Cardiac Surgery
Team

LAB

ER

Birmingham

Constancy of purpose
Investment in improvement
Alignment of role and training
Interdependence of the (care) team
Integration of information
Measurement systems
Supportiveness of the larger system
Connection to the community

Organizations with these characteristics

perform better - Are better places to work
Provides direction for action

Establish constancy of purpose

Align objectives
Get everyone involved
Provide training
Promote interdependence

Community vis a vis autonomy

Form Interdisciplinary Team

Assessment

Purpose
Patients
Professionals
Patterns
Processes
Metrics that Matter

Diagnose
Treat
Evaluate

Who needs to be on this team?

Mission statement?
Does everyone agree?
Why do you need to agree?

What population does your microsystem

serve?
Are they satisfied?

Who are the professionals on your unit?

What skills do they have?
What skills do they feel they need?
Are they satisfied?

What repetitive patterns occur on your unit

that disrupt care and or quality?
Phone calls
Medication runs

Examine the processes that occur on your

unit.
What is going well?
What not so well?

Benchmarking
What are the challenges with rural
benchmarking?
Do you feel national benchmarks are always
relevant?

Evidence based intervention