Superior Productivity in Health Care Organizations How to Get It, How to Keep It By Paul Fogel, M.B.A.

About the Author
Preface
Introduction

1. The State of the Union
   
   Been There, Done That 
   Do Layoffs Really Work?
   Skill Mix Strategy
   Benchmarking
   Problem of Overtime and Registry
   Sample Overtime and Registry Analysis
   Strategies for Reducing Overtime and Registry
   Float Pools 
   Hospital Mergers             
   Market-Based Solution        
   Summary  
             
2. How to Develop Realistic Productivity  Standards 
   
   Learn From History          
   Assign Performance Measures       
   Performance Measures for the Entire Organization   
   Do the Math     
   How to Prepare the Analysis       
   Illustration: 3-Year Productivity Analysis     
   Don’t Forget Registry         
   Float Pool           
   Communicating the Findings       
   How Many Years Are Best for the Analysis?  
   What to Expect          
   After the Analysis         
   Translating the Analysis into Standards   
   There Are No Shortcuts        
   Do You Need Outside Help?   
   Executive Commitment    
   How Long Will This Take?      
   Managing for Change      
   Comparing Apples and Oranges   
   Illustration: Accounting for Changing Service or Patient Mix
   Internal Benchmarking       
   Summary    
      
3. Implementation    
   
   Fixed and Variable: Fact or Fiction?    
   Mechanics of Fixed/Variable Splitting     
   Fixed and Variable within the Department  
   Illustration           
   Don’t Shield Managers from Managing   
   The New Deal         
   Let Managers Manage         
   Don’t Take Testimony  
   Budget Discipline—Missing in Action
   Accountability: The Brave New World   
   Individual Accountability    
   Executive Accountability
   Terms of the Deal   
   Implications for Managers
   What Is in it for Us? 
   Rules for Changing Standards  
   The New Deal: Harsh or Kind?    
   Implementation Strategy     
   Relate Productivity to Strategic Goals  
   Allow for a Transition Period       
   How Long Should the Transition Take?     
   Factor in the Composition of Labor      
   Summary
               
4. Monitoring and Reporting   
   
   Seduced by Technology        
   Technology and Good Management      
   Complex Systems Do Not Work  
   The Law of Unintended Consequences
   Timing of Reviews   
   Reporting Frequency     
   The New Productivity Report
   How to Create Your Own Report
   Format of the Productivity Report    
   How to Analyze the Report   
   Make the Master Schedule Work  
   Adjusting Staffing Schedules 
   Guidelines for Fixed Departments  
   Summary
     
5. Incentives and Consequences    
   
   Laying the Foundation 
   Incentives     
   End Symbolic Efforts        
   Why Should We Change?    
   Quality Standards          
   How to Draft an Effective Incentive Plan
   Executive Incentives 
   Manager Incentives      
   Consequences           
   How to Draft an Effective Productivity Policy 
   Six Principles of an Effective Productivity Policy
   Establishing the Proper Limits   
   Keep It Public      
   Productivity Committee Procedure     
   Parting Company        
   Summary 
             
6. The Politics of Productivity   
   
   Medical Staff         
   Labor Unions         
   Executives        
   Department Managers
   The Board     
   Productivity for the Long Term 
   Summary      

Appendix Case Studies  

• Emergency Room         
• Dietary
• Mother/Baby Unit       

Glossary of Terms
Index