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Health Care Management
Unit I Assesment
1. Consider your own health care career aspirations. If you were managing a health care organization (HCO), identify three sectors of external factors that would influence how you manage your organization?
Your response should be at least 200 words in length.
2. Explain at least five key roles of health care managers. What do health care managers actually do on a daily, weekly, and monthly basis?
Your response should be at least 300 words in length.
Health Care Management 1
Upon completion of this unit, students should be able to:
2. Analyze the structure of governing boards and management for health care organizations.
2.1 Explain a key type of health care organization, its leadership, and how the external factors
impact it.
2.2 Assess important roles, functions, activities, and competencies of health care managers.
Course/Unit
Learning Outcomes
2.1
Chapter 1
Unit I Assessment
2.2
Unit Lesson
Chapter 2
Unit I Assessment
Chapter 1: Health, Healthcare, and Healthcare Organizations
Chapter 2: Management
Unit Lesson
Governance in Health Care
Some health care organizations are simply more successful than others, not just for a particular quarter or a
particular year, but over long periods of time. Other health care organizations seem to always be struggling,
barely making ends meet. Some of those fail financially and close their doors. Losing a hospital is a
devastating event for any community. So what makes the difference between a thriving and growing hospital
and an empty building? This is an interesting and important question for U.S. health care. What makes some
health care organizations better than others, giving then enduring success and stability?
UNIT I STUDY GUIDE
Health Care Organizations
and Management
Health Care Management 2
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Title
Professional hospital staff team includes doctors and the business administrators.
(Popov, n.d.)
Well, strong and responsible governance is a big part of that difference. This lesson-author has served as
chief executive officer (CEO) for four different health care organizations in four different states over the past
25 years. That means working with four different boards of governors (sometimes named board of directors)
over time. The differences in those boards have been striking. We have seen truly excellent and committed
leadership from some boards. Unfortunately, we sometimes see boards that barely meet the quorum
requirements to hold their meetings legally. Those boards do not seem to take a lot of interest in the facility.
The difference is evident. You can see it when you pull up to a hospital. You can feel it when you talk to the
patients, staff members, and doctors.
A key observation is this, effective governance is probably the single-most important factor for the success of
a health care organization. CEOs come and go, bigger opportunities arise, they give their 30-day notice and
they move on down the road. Then, the board undertakes a search for a new CEO. The stabilizing factor is
the board itself. It is a big responsibility to serve on any health care board of directors. The average tenure of
hospital CEO is about 5 years, so the board can anticipate a very big decision about every 5 years as to who
the new CEO will be (Hackett, 2020).
Board Election/Appointment
So how does anyone wind up taking on this important responsibility to serve on a health care board? Well,
that aspect has definitely changed over recent decades, so let us briefly trace the history. In years past, many
health care boards were elected by the people of a city or a county. An individual would run for a position on
the hospital board, just as they might run for school board position today, then the general populace would
vote board members in or out. However, the trend today is definitely toward more appointed boards, fewer
elected boards, and that relates to hospital ownership.
Health Care Management 3
UNIT x STUDY GUIDE
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The purpose of the Hill-Burton Act was to bring more health care facilities to every town or rural environment
across the country.
(Health Resources and Services Administration, 2021; Spiroview Inc., n.d.)
In 1946, Congress passed the Hill-Burton Act, which provided funding for the creation or expansion of
hospitals across the nation (Health Resources and Services Administration, 2021). World War II had recently
ended, and jobs were badly needed for returning troops. A total of 6,800 facilities were built or expanded as a
result of the Hill-Burton legislation. Any city or county could receive funding to open a hospital, and all across
the nation, communities jumped on the opportunity. It is probably fair to say, looking back, that some of these
hospitals were opened in communities that were too small to support a hospital for the long term, but open
they did. It was an economic boom for each community. Constructing the facility itself created economic
activity, and once built, many permanent jobs were created in the process. Americans loved having their own
hospitals in town instead of traveling long distance to a major city for health care. The board of directors of
those original hospitals were elected because the hospital was owned by a particular government entity
(Schumann, 2016).
Over time, a practice emerged in most states in which the elected officials of a city or county would appoint
the hospital board. Taking the example of a county hospital, the elected county commissioners would appoint
a board of directors for the hospital. The county retained ownership of the facility, but the commissioners
appointed a board to run it. For a municipal hospital, the city council would appoint the hospital board, and
this practice continued through the 1950s to 1980s.
Cities and counties began to realize that having a hospital in the community was a positive thing but that
actually owning the facility is troublesome, a lot of work, and very expensive. Today, only 21% of U.S.
hospitals are still owned by a city or county. Another 21% are for-profit organizations that purchased or
received the hospital from the city or county, but the majority of hospitals today are nonprofit non-
governmental organizations. We see 58% of hospitals in this model, and in such settings, the board of
directors is often self-appointing. When a vacancy exists, the board itself identifies a good candidate and
votes to appoint them to the board (American Hospital Association, n.d.).
Roles for Governance
So what does the board of governors actually do in an effective health care organization? Let us start with
what they do and not do. The board does not involve itself with the day-to-day operations of the facility. The
decisions of who to hire, fire, and receive a raise is the responsibility of management, not of governance.
When the board tries to involve itself in operational decisions, some truly awful things can happen. When the
board tries to manage, hospital management is undermined, and unethical things can happen. Take the
example of a board member whose wife is employed as a nurse working at the hospital. Anything the board
member does to impact that nurse’s position, pay, or career opportunities is a problem for management. This
would be considered an unethical use of the board position.
Health Care Management 4
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So what should the board do? The Health Catalyst organization provides us with a helpful framework for that.
View this interactive Health Catalyst Framework learning activity.
Conclusion
Being a health care board member is tough, but the role is so important. We need to remember that most
hospital board members serve without a salary. They are volunteers, doing something that they believe to be
very important. The great majority of them are in it for the right reason. New board members often have little
understanding of health care, so we must educate them and help them to understand their role. Over time,
they become more knowledgeable. They represent the community to us, the key stakeholders, and we need
to respect their contributions. Governance is crucial in health care.
References
American Hospital Association. (2021). Fast facts on U.S. hospitals, 2021. https://www.aha.org/statistics/fast-
facts-us-hospitals
Hackett, M. (2020, September 16). Hospital CEO turnover rate dipped in 2019 for the first time in five years.
Healthcare Finance News. https://www.healthcarefinancenews.com/news/hospital-ceo-turnover-rate-
dipped-2019-first-time-five-years
Health Resources and Services Administration. (2021, March). Hill-Burton free and reduced-cost health care.
https://www.hrsa.gov/get-health-care/affordable/hill-burton/index.html
Popov, A. (n.d.). Professional hospital staff (ID 51563193) [Photograph]. Dreamstime.
https://www.dreamstime.com/stock-photo-professional-hospital-staff-represented-both-medical-
profession-form-doctor-business-administrators-image51563193
Schumann, J. H. (2016, October 2). A bygone era: When bipartisanship led to health care transformation.
National Public Radio. https://www.npr.org/sections/health-shots/2016/10/02/495775518/a-bygone-
era-when-bipartisanship-led-to-health-care-transformation
Spiroview Inc. (n.d.). Modern hospital style building (ID 59693685) [Photograph]. Dreamstime.
https://www.dreamstime.com/stock-photo-modern-hospital-building-close-up-view-image59693685
In order to access the following resource, click the link below.
Health care quality and outcomes vary widely around the world. Why does the United States spend more than
any other nation, but we do not have better health?
Fred Friendly Seminars (Producer). (2008). Quality of healthcare (Segment 30 of 45) [Video]. In Reinventing
healthcare-a Fred Friendly seminar. Films on Demand.
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPl
aylists.aspx?wID=273866&xtid=40081&loid=82545
The transcript for this video can be found by clicking on “Transcript” in the gray bar to the right of the video in
the Films on Demand database.
https://online.columbiasouthern.edu/bbcswebdav/xid-140857840_1
https://libraryresources.columbiasouthern.edu/login?auth=CAS&url=https://fod.infobase.com/PortalPlaylists.aspx?wID=273866&xtid=40081&loid=82545
HCA 3301, Health Care Management 5
UNIT x STUDY GUIDE
Title
Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit
them. If you have questions, contact your instructor for further guidance and information.
Review and answer one For Discussion question from the end of Chapter 1 and one from the end of Chapter
2 in your textbook. Write a two-paragraph answer for each question and submit to your instructor.
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Course Learning Outcomes for Unit I
Learning Activity
Required Unit Resources
Unit Lesson
Governance in Health Care
Board Election/Appointment
Roles for Governance
Conclusion
References
Suggested Unit Resources
Learning Activities (Nongraded)
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Formatting
Title Page
Citation
Outline
