Management Certainly Matters, and There Are Multiple Ways to Conceptualize the Process Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health".

The authors of "Management matters: a leverage point for health systems strengthening in global health," raise a crucial issue. Because more effective management can contribute to better performing health systems, attempts to strengthen health systems require attention to management. As a guide toward management capacity building, the authors outline a comprehensive set of core management competencies needed for managing global health efforts. Although, I agree with the authors' central premise about the important role of management in improving global health and concur that focusing on competencies can guide management capacity building, I think it is important to recognize that a set of relevant competencies is not the only way to conceptualize and organize efforts to teach, learn, practice, or conduct research on management. I argue the added utility of also viewing management as a set of functions or activities as an alternative paradigm and suggest that the greatest utility could lie in some hybrid that combines various ways of conceptualizing management for study, practice, and research.

Medical practice management in a nutshell.

Obviously, an endeavor as complicated as managing a medical practice cannot be reduced to a "nutshell." However, the array of activities involved can be modeled in a comprehensive manner. This article does just that, providing practice managers with a blueprint for their management work. Management is defined in terms of a set of activities through which the goals or purposes of a practice are established and pursued. The work of managers, which is contrasted to direct and support work, is described in terms of helping establish the goals and creating the conditions under which these goals can be accomplished. A comprehensive model of the eight separate, but related, activities comprising management work in a medical practice is presented. A set of core activities is described as developing/strategizing, designing, and leading. A set of facilitative activities is described as communicating, decision-making, managing quality, marketing, and evaluating.

Management challenges at the intersection of public policy environments and strategic decision making in public hospitals.

Hospitals in the United States are heavily impacted by public policies that affect them. For example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). The public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments. Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. The multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals. This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.

Schools of public health and the health of the public: enhancing the capabilities of faculty to be influential in policymaking.

Faculty members of schools of public health contribute to better health largely through their teaching, research, and community service roles. We suggest attention to another role: exerting their influence to ensure effective public health policy. Using recent actions taken at the University of Pittsburgh's Graduate School of Public Health as a template, we describe some of the key steps that public health schools can take to help their faculties be more influential in public health policy. These steps include (1) building infrastructures to support and facilitate this role, (2) teaching faculty members how to be more influential in the policy arena, and (3) aligning incentives and rewards for faculty who contribute to improved public health by influencing the formation and implementation of public health policy.

Administrative deficiency citations and quality of care in nursing homes.

In this investigation, we examine deficiency citations for administration in nursing homes. Administration is defined as the top managers in each facility, consisting of the nursing home administrator and director of nursing. We examine the association between deficiency citations for administration (indicating poor administration practices) and quality of care. Regulators, as well as consumers, are interested in this association. Data used came from the 1996-2004 Online Survey, Certification And Recording (OSCAR) data, representing approximately 17,000 facilities per year. We find that 5% of facilities received a deficiency citation for administration, and lower facility quality is associated with these administration deficiency citations.

Logic models as aids in managing health programs.

Logic models, which are graphic depictions of how programs are intended to operate, can be very useful devices for improving the management of health programs in two important ways. They can assist program managers to perform the core management activities of strategizing, designing, and leading other program participants in an integrated manner. Logic models also can assist managers in establishing and maintaining good program stakeholder relationships.

Can nonprofit hospitals do both well and good?

This study demonstrates a significantly positive association between corporate citizenship and financial performance in a sample of nonprofit hospitals in Massachusetts. Without demonstrating causation in either direction, the analysis shows that the nonprofit hospitals in this study can simultaneously do well for themselves financially, and good in terms of the benefits provided to communities. That is, they perform better financially as they spend relatively more on their community benefits initiatives. This may reflect the same relationship found in numerous studies of corporate citizenship and financial performance in business firms. Namely, that business advantages accrue to firms through their practice of good corporate citizenship. Implications of the findings for public policymakers and for decision makers in nonprofit hospitals are considered.

Communication between public health agencies and their external stakeholders.

Effective communication between public health agencies and their external stakeholders is vital to the agencies, as well as to those they serve. Agency leaders must obtain information from stakeholders and provide information to them. A process is described whereby agencies can systematically obtain necessary information from external stakeholders, and three of the most important forms of communications are described through which an agency provides information to stakeholders: promotion of the agency, advocacy, and social marketing. Barriers to effective communication of the interpersonal, personality, organizational, operational, skill/knowledge, attitude, and nature-of-information types are described, and guidelines are provided for minimizing the impact of these barriers.

What is the appropriate health policy content in a program curriculum?

Faculties of graduate health administration programs have considerable flexibility in applying curriculum guidelines established by the Accrediting Commission on Education for Health Services Administration (ACEHSA) to help achieve their self-determined missions. When a program's mission includes preparing graduates for eventual careers at the strategic levels of healthcare organizations, specific health policy content is appropriate. In determining this curriculum content, faculties can be guided by the need to prepare graduates to accomplish three policy-related activities that are vital to successful strategic management: 1. comprehend and understand relevant governmental health policy aspects of a healthcare organization's external environment, including assessing the impact of these aspects of the environment on the organization; 2. lead strategic responses to the challenges and opportunities emanating from the governmentalhealth policy aspects of an organization's external environment; and 3. participate in shaping, to the organization's benefit, the governmental health policy aspects of its external environment. Curriculum design options for providing this content are discussed.

Strategic management and public policy.

Making strategic decisions that ensure a productive fit between the internal situation and external environment of a healthcare entity--sometimes, even decisions that ensure its survival--is a great challenge. The author suggests that hospitals must adopt specific strategies to anticipate and respond appropriately to changes in policy.

Medicare: how you see it depends on where you stand.

Stepping outside of one's own frame of reference in regard to Medicare can yield greater understanding of the program's importance, complexities, and strengths. Hospitals in states like Pennsylvania, which has a large proportion of senior citizens, are particularly strapped by declines in payment. A national study finds Medicare beneficiaries tend to be more pleased with their level of service than are those who have private Insurance. Medicare trustees predict the program will remain solvent through 2030, although cash deficits will reemerge in 2016, creating challenges for policy-makers.

Nonprofit health systems: a promising new class of corporate citizen.

Leading nonprofit health systems are demonstrating that communities can benefit from the emergence of this new class of corporate citizens. Just as the business sector has produced many good corporate citizens to the great advantage of American society, health systems with sufficient financial and organizational gravitas increasingly are assuming these roles, and in so doing, are making positive differences in their communities. More system leaders, however, must find compelling reasons to assume these demanding roles. They also must learn how to play citizenship roles more fully and effectively if the potential social good available through health systems' corporate citizenship is to be realized.

The competent board: stitching together needed skills and knowledge.

The skills and knowledge that boards need overall are different from what individual trustees bring to the table. But the right mix of members creates a board with the necessary skills to govern effectively.