Health care is in flux: in the United States, we spend too much money on health care which frequently does not impart adequate value to patients, employers, or the community.
The objective of this introductory course is to lay the groundwork for making decision makers capable of undertaking systemic redesign of health care delivery. Taught primarily in the first residential period, the class will have the opportunity of hearing from renowned health care reform authorities such as Elliott Fisher, Jim Weinstein, Gil Welch, and Jack Wennberg, as well as experts in competitive strategy from the Tuck School of Business. Through use of cases, students will be introduced to new ways to think about health care delivery, including understanding variation, shared decision making, clinical microsystems, and other ways to bend the value curve in health care and to produce ethically founded, competitive, new models for care delivery.
Reforming health care systems to deliver greater value will require a substantive understanding of the fundamental economic forces driving system-wide incentives and competition. This is as true of reform at both the public policy level and at the level of organizational policy and strategy.
While the economics of the health care industry appear different from other industries, the behaviors and outcomes are often the result of no more than the incentives faced by individuals and organizations, in combination with some form of competition. This course will equip participants with knowledge of health economics that enables them to understand the current state of affairs and to incorporate sound economic analysis in their role as managers. Topics to be covered include: economics of risk pooling and insurance markets, especially adverse selection and moral hazard; cost analysis; incentive effects of different payor and financing systems; supply of medical and physician services; supplier induced demand; and the economics of nonprofit organizations.
Faced with pressures on both the revenue and cost side, leaders in health care delivery are now required to do more with less. Managing the balance between clinical outcomes and financial soundness has become more demanding.
The goal of this foundational course is to develop a framework with tools and models to enable participants to make value-enhancing financial decisions in health care delivery. The course will develop the relevant ideas in three stages. The first stage (financial accounting) will build participants' skills in interpreting, analyzing, and forecasting financial statements (the income statement, the balance sheet, and the statement of cash flows). The second stage (corporate finance) will advance and synthesize the ideas from the first by building skills to make investment and financing decisions, as well as to value businesses. Topics include free cash flow and capital budgeting, different sources of financing to fund investments, cost of capital/ hurdle rates, and tools to value businesses using cases/examples of strategic partnerships and acquisitions in the health care delivery sector. The third stage (managerial accounting) will develop skills in the use of financial information to measure, evaluate, control, and plan future management decisions. Key topics include understanding the relation between volumes, costs and profits, financial planning, budgeting and control systems, standard costs and variances, cost allocation, and activity-based costing systems.
For reform to be successful, the U.S. health care system must reorient care delivery from a focus on the provider to a focus on the patient. The Clinical Microsystems Model effectively achieves this reorientation while leveraging front-line health care workers' ability to continuously improve their work.
This course will give participants the knowledge, skills, and attitudes necessary to design, lead, and improve microsystems of care in order to continuously improve the quality and value of the care delivered. In particular, the course will explore different methods of quality improvement in health care, such as traditional continuous quality improvement, implementation of JCAHO, NCQA and NQF metrics along with methods put forward by Juran, Deming, and Shewhart, and improvement techniques borrowed from other industries, such as six sigma and the Toyota production system. Participants will develop a good understanding of the different methodologies of continuous quality improvement, the ability to match the right methodology to the appropriate situation, and the ability to employ measurement methods that signal true improvement. In addition students will gain the insights and skills necessary to effectively use statistical process control charting techniques in order to measure the effectiveness of their improvement efforts.
Health communications exist on the patient, institutional, and population level. Aspects of health communications are increasingly seen as critical tools that can both facilitate patients' health care decisions and change the health behaviors of the population.
In the domain of patient decision-making we will discuss the role and appraisal of patient literacy and numeracy; risk communication (including such concepts as relative versus absolute risk, survival versus mortality, and balanced framing); shared decision-making; decision quality (including requisite knowledge and concordance of choice with personal values); effective care (recommended) versus preference-sensitive decisions (dependent on personal values) where there is no wrong answer. Additionally, the course will demonstrate how to design more effective health communications by using patient insights on decision-making and will assess the impact of these improvements at the institutional level. At the population level, we will explore legislative and other efforts nationally and internationally to move from a doctrine of informed consent to informed choice, and the impact of this change on both patients and health policy.
Health care leaders must make decisions based on imperfect, inconclusive, and conflicting data from market surveys, peer-reviewed literature and external consultants.
Data are derived from a number of sources, including variable study hypotheses, designs, and analyses. This course will provide leaders with the tools to evaluate these data. Participants will attain skills in developing and analyzing the findings from structured clinical studies and learn to use those findings to aid in decision-making. Finally, students will gain skills in identifying appropriate study designs and methods of analysis for addressing questions in their organizations and markets.
Health care services are characterized by enormous variability and multiple objectives. Given these challenges, this course aims to provide you with the language, concepts, insights, and tools to evaluate, design, and operate health care processes in order to increase value for patients and reduce costs.
Two themes will run throughout the course: 1) aligning the design and management of processes with the goals of the health care system and 2) managing variability. In health care, the first theme is crucial but complex, for the system's goals may be multidimensional. The second theme is also particularly challenging, for health care systems are faced with variability generated by fluctuations in customer demands, treatment times, patient expectations and preferences, and patient willingness or ability to participate in treatment. Specific concepts and tools in the course include process flow analysis, the theory of constraints, queueing/congestion analysis, quality improvement, and capacity management.
Managing modern health care organizations is a complex ordeal, more so in a time of health care reform. This course follows on the work done in previous courses, especially the Clinical Microsystems course, and it anticipates what will come in the Management of Organization Change and the Strategy for Health Care Organizations courses.
Participants take the vantage point of a high-level manager in a health care system and understand how divisions, departments, and microsystems currently interact, and how they might. This course will explore all aspects of a health care organization that are necessary for success, from human resources to credentialing, from finance to supply management, and from union management to physician management in a voluntary staff model. In anticipation of health care reform, students will learn how team leadership, performance measurement, and incentive structures will have an impact on care delivery. The course draws heavily on the general management literature and uses cases to apply those ideas to health care organizations.
Systematic health care problems undermine good-quality health care. Marketing plays an important and pervasive role in identifying problems and new opportunities to improve health care outcomes. This course will offer a philosophy and a set of tools.
Marketing philosophy is necessary to create, communicate, and deliver value to satisfy the needs of customers (patients, suppliers, and community) while meeting the goals of physicians, practitioners, and organizations. Marketing tools are needed to guide decisions on positioning (what do and don't we offer?), products and services (features, benefits, packaging, branding), price (list price, rebates, discounts), distribution (where and when it will be available), and communication (advertising, public relations, personal selling, social media, and direct marketing). Application of the marketing philosophy and tools will be based on in-depth knowledge of marketing research and health decision-making.
Increasingly, health care systems will orient health care delivery toward the goal of maximizing the service population's health status. Toward that end, primary and preventive care management will need to be more properly balanced with acute care management.
In this course, students will learn about the multiple determinants of health, how to measure health status, how health behaviors can be modified through social marketing, and how health disparities and socioeconomic status influence population health status. Students will come to understand the social mission of health care organizations and how they might work through social and behavioral determinants of health to improve overall health status, particularly as health care organizations adopt medical home models and begin to work with bundled and capitated payment systems.
This course will prepare the participant for the challenges in accomplishing significant change in health care organizations. Outside the world of health care, new patterns of competition, new technologies, and basic shifts in values have combined to require fundamental changes in the way that management is practiced.
Today, many organizations confront situations that require them to manage change on a continuous basis. This critical skill has become a core component of every manager's job and a substantial body of management knowledge has developed. In this course we will draw on the large body of relevant research and theory, and then complement and integrate this theory with experience from practice. We focus in particular on the process of change and on the sequencing of change activities. Recommended actions are matched with concrete, tested, and specific tools for their application. Proceeding from concepts to actions to tools provides a range and depth of practical understanding that is unusual in this important area of management activity. Our focus will be on the specifics of health care organizations, but much can be learned from studying other firms and industries that have seen substantial change.
The role of health information technology (HIT) in health care systems continues to grow in scope and complexity. While the industry is investing massive amounts of capital in these systems and while HIT presents the promise of improving the quality and safety of patient care, many of the theoretical benefits remain unproven and untested.
This course provides an overview of critical topic areas with greater depth provided in the arena of electronic medical record (EMR) evaluation, selection, and implementation. Additional topic areas will include: patient engagement through personal health records (PHR) and portals; patient-reported health status; the role of HIT in population health; HIPAA and security requirements; computerized order entry (CPOE); clinical documentation requirements and recommendations; the use of administrative and registry data for standard reports, scorecards, and dashboards; and the use of electronic patient information collected at the point of care and for ongoing comparative effectiveness evaluations.
This course will prepare participants to lead an innovation initiative in health care delivery or to support, enable, or catalyze the efforts of those who do.
Health care may be a mammoth industry, but clinical operations are local and narrowly focused. As such, fixing health care will require thousands of leaders on the front lines to transform the way care is delivered within their geography and practice area. We will examine what it takes for innovation leaders to succeed, building on more than a decade of research into the best practices for managing innovation within established organizations. We will study the process of forming new kinds of clinical teams and methods for proving that the new care model improves outcomes and reduces costs. We will discuss a wide range of initiatives, including those focused on prevention, standardization, coordination, and improved clinical decisions.
Strategy for health care organizations is both a capstone course and one that is taught throughout the program in each of the residential periods as well as online. Participants will develop a framework for formulating and evaluating strategic decisions, tools for identifying opportunities and evaluating alternative paths, and methods for encouraging innovation.
This course will focus on strategic innovation, strategy implementation, and combining strategic thinking with leadership skills to create successful change. All the previous course work will be brought to bear on strategic redesign of the health care delivery system. The course will re-examine best-in-class examples of system design to understand the strategic implications of systemic change. In addition, the course will use complex cases to examine the delivery system from the viewpoint of a CEO, a board member, or a senior public official, requiring learners to use all their skill sets to think through design options that create value and optimize measures including institutional accountability, patient outcomes, quality, cost, and employee satisfaction.
Transforming health care organizations presents special challenges and will require tremendous leadership by individuals within those organizations. This course provides participants with the knowledge to increase their personal leadership capability.
The focus of the course is concrete — building an understanding of one's strengths and opportunities for improvement as leaders, and using that knowledge to identify actions that advance leadership potential. The centerpiece of this course is a comprehensive, 360-degree assessment of each participant's leadership skills, based on confidential evaluations completed by bosses, co-workers, peers, and clients. During the course, participants will write their own Leadership Development Plan, a specific and measurable plan for strengthening their leadership skills.