managing a homeless health care organization as a learning organization: a case study carl nelson,...
TRANSCRIPT
Managing a homeless health care organization as a learning
organization: A case study
Carl Nelson, PhDNortheastern University
Boston, MA
Objectives
• Illustrate the creation of inter and intra organizational learning environments to achieve improved outcomes in homeless heath care organizations.
• Demonstrate development of a stakeholder analysis as a guide to strategic choice.
• Develop respect for the measurement and analysis of complex socio-economic, clinical, and government policy related variables.
• Illustrate the difficulties and importance of maintaining an organization’s core values in times of rapid change.
• Discuss the internal and external leadership requirements of a new non-profit organization’s chief executive officer.
Top Ten Medical Problems of the Homeless:Relative Risk
Diagnosis Relative Risk Infestation ailments 52.5 Seizures 30.0 Dental problems 24.5 Nutritional deficiencies 22.0 Peripheral vascular diseases 16.3 Pregnancies 11.5 Lacerations, wounds 6.1 Superficial abrasions 5.5 Burns of all severity 5.4 Bruises, contusions 5.1
Revenues
Source Amount USPHS 900,000 Medicaid 2,700,000 Welfare 550,000 Free Care Pool 500,000 Medicare 145,000 Healthy Start 125,000 Misc. Programs 100,000 Total 5,020,000
Wages, Salaries, Benefits
MD's 1,113,750 NP's 911,250 PA's 182,250 Nurses 1,350,000 Social Service 594,000 Administrative 405,000 Total $4,556,250
Primary Stakeholders
Positive Impacts Negative Impacts
BHCHP Become “carve-out” caregiver of choice. Increase cost and revenue stream predictability. Improve staff productivity and accountability.
Cost containment pressures may impede quality, accessibility, and comprehensiveness of care. Potential increase in overhead expenses. “Painfulness of learning”
Homeless Population
Defined benefits. Improved continuity of care. Caregiver’s performance measured.
Potential barriers to entry. Potential reduction in benefits. New rules lead to confusion.
Homeless Shelters
Focus on social services.
Potential loss of covered medical services benefits.
Hospitals Cost reductions. Some revenue loss. Reduction in teaching material.
Medicaid Cost reductions. Regulatory burden
Secondary Stakeholders
Positive Impacts Negative Impacts
Taxpayers Reduced taxes. Other patients Less contact with
homeless patients in other non-managed care contracted facilities.
Homeless patients may become other patients and need new caregivers.
HMO’s May continue to focus on manageable, mostly well patients.
Regulations may require them to provide services.
Neighborhood Health Centers
May bid for homeless service provider contracts.
Regulations may require them to provide services.
Five learning disciplines
Personal Mastery-Staff members expand their personal capacity to create the results most desired by them and the organization.
Mental Models-Staff members reflect upon, clarify and improve their internal pictures of the environment, and see how this shapes actions and decisions.
Shared Vision-Staff commitment for achieving a shared image of the future.
Team Learning-Staff groups achieve abilities greater than the sum of individual member’s talents.
Systems Thinking-Staff is able to describe, understand, and change system.
Desired Components
1. Shelter-based outreach to and engagement of patients. Assistance with social services and medical services referral and advocacy.
2. Street outreach and engagement programs.3. The ability to provide integrated outpatient primary care, specialty services
and linkages to hospital emergency rooms.4. An electronic medical record capacity at key sites where homeless people
enter the system or receive their care.5. Integrated mental health and substance abuse assessment and treatment, and
linkage to emergency behavioral health services and residential follow-up care.
6. Linkages to shelter-based nursing clinics and “stay-in” units.7. Access to a medical respite/sub-acute in-patient facility for homeless adults.8. Linkages to transitional and permanent housing programs, and housing
search services.
Discussions
• Principles-What we are or wish to be
• Insights-What we know or understand
• Rules-What we must and may do
• Organizational Behavior-What we do
• Results-What we achieve
Post Script
• An irremediable clash of philosophies
• Attacks on Managed Care
• Saved by intra organizational learning
• Unanswered questions