Health Program Management

From Development Through Evaluation

Beaufort B. Longest, Jr.

• Publisher: Jossey-Bass
• Year: 2014
• Print ISBN: 9781118834701
• eBook ISBN: 9781118834763
• Edition: 2
• Topic: Medicina
• Subtopic: Salud pública, administración y atención

Learn how to effectively plan, implement, and evaluate health programs

Health Program Management: From Development Through Evaluation, Second Edition is a practical and useful introduction to the management of health programs. While providing an overview of the current best practices in management, the textbook goes beyond simple management techniques, teaching students how to develop, lead, and evaluate their programs to ensure quality outcomes. The focus is on the three core management concepts of strategy, design, and leadership, but time is also devoted to describing facilitative management activities integral to successful programs. Students will learn techniques for communication, decision-making, quality assurance, marketing, and program evaluation within the structure of the book's program management model. Logically organized with a separate chapter for each activity, this resource provides a thorough, systematic overview of the effective development, implementation, and evaluation of health programs.

Health Program Management: From Development Through Evaluation, Second Edition provides a comprehensive approach to management throughout all stages of a health program.

• Learn to develop a strategy that steers the program toward specific goals
• Discover how to design, market, and lead an effective health program
• Become familiar with the manager's role in a quality health program
• Evaluate potential and existing programs for performance and capability

Students and aspiring managers and leaders preparing themselves for the challenges of managing health programs will find the information and techniques to develop the skills they need in Health Program Management: From Development Through Evaluation, Second Edition.

Chapter 1
The Work of Managers in Health Programs

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Learning Objectives

After reading this chapter, you should be able to:

1. 
   Define health, health programs, and management
2. 
   Understand the core and facilitative activities of managers' work
3. 
   Understand the roles managers play as they do management work
4. 
   Appreciate the underlying competencies demonstrated by managers in doing management work
5. 
   Understand the importance of applying well-developed personal ethical standards in doing management work

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Much of the pursuit of health occurs through a variety of health programs. For example, when a young adult with type 2 diabetes leads an active and productive life, her health improvements may well be attributed to a program that helps her understand the disease and take an active role in controlling it. When the federal Center for Medicare and Medicaid Innovation established the Innovation Advisors Program, supporting individuals who test and refine new models to drive health delivery system reform, improvements in the delivery system were made more likely (Centers for Medicare and Medicaid Services 2014). When a county health department mounts a project to enroll children in an innovative insurance plan, the impact on those children may be felt throughout a lifetime of better health.

One of the distinguishing characteristics of successful programs is how well their managers perform. This book is about the work program managers do. This chapter provides an overview of management work in health programs, as well as some key definitions and concepts, all of which serve as a framework for navigating the remainder of the book. Management work is described in terms of a set of core activities managers undertake in performing their work—developing/strategizing, designing, and leading—and a set of facilitative activities that also are important to management work—communicating, decision making, managing quality, marketing, and evaluating.

As a backdrop for considering management work, it is important to know that three distinct types of work occur in health programs (Charns and Gittell 2006). Direct work entails the actual provision of services or creation of products by participants in a program. This type of work is done by counselors, nurses, therapists, physicians, health educators, and others who form what Mintzberg (1992) classically termed the “operating core” of a program.

A second type of work done in health programs is support work. This work is a necessary adjuvant to the direct work. In health programs, participants performing support work are involved in such activities as fund-raising and development; recruiting patients for a clinical trial; providing legal counsel; or providing marketing, public relations accounting, or financial services for a program.

The third type of work done in health programs is management work. This work involves establishing—often with the direct involvement of others—the mission and objectives a program is intended to achieve, and creating the circumstances through which the direct work, aided by support work, can lead to the accomplishment of that mission and fulfillment of objectives.

An example will clarify the different types of work. A manager may establish one of the objectives of a program as enrolling one thousand children in an innovative insurance plan. The establishment of this objective is management work, as is the training of program participants to help parents or guardians enroll children. The act of enrolling children in the plan is some of the direct work of the program. The manager may also arrange for publicity surrounding the plan to increase awareness and encourage enrollment. The provision of publicity is support work, although arranging for the publicity is management work.

As we will see in this chapter, one useful way to assess and study management work is in terms of the activities managers engage in as they do this work. Often in the management literature the term functions is used instead of activities (Daft 2014; Marquis and Huston 2012). I will generally use the term activities, although the two words are interchangeable in this context. I will also discuss the roles that managers play in performing their work, as well as the competencies needed to do management work well.

Key Definitions

Before considering management work in more depth, it is useful to establish several key definitions to describe health and health determinants, health programs, and program management.

Health and Health Determinants

The World Health Organization (www.who.int/en/) has provided a long-standing definition of health as the “state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity” (World Health Organization 1948, 100). The state of health in human beings is a function of health determinants, which are a “range of personal, social, economic, and environmental factors that influence health” at both the individual level and the population level (U.S. Department of Health and Human Services 2014). The wide variety of determinants means that health programs have an enormous range of possible foci.

Health determinants for individuals or populations include the physical environments in which people live and work; their behaviors; and their biology (genetic makeup, family history, and physical and mental health problems acquired during life). Health determinants also include a host of social factors, which include economic circumstances; one's socioeconomic position in society; income distribution; discrimination based on race or ethnicity, gender, sexual orientation, or some other characteristic; as well as the availability of social networks and social support. Finally, the health services to which people have access also are health determinants (U.S. Department of Health and Human Services 2014). Health programs can be focused on any of these determinants, as well as on combinations of them.

Health Programs

A program is generally defined as an organizational unit intended to accomplish one or more objectives through a plan of action that describes what work is to be done, by whom, when, and how, as well as what resources will be used. Programs are embedded in organizations and exist to be of benefit to the larger host organization. Figure 1.1 depicts a program embedded in a host health services organization.

Figure 1.1 An Organization Design Depicting a Program Embedded in a Host Health Services Organization

Host organizations can be very large, involving thousands of participants. Expansive integrated health systems, large foundations, agencies of the federal government, or state health departments, for example, are large organizations that house numerous health programs. Interestingly, even though programs are typically much smaller than such organizations, they are in fact themselves organizations. Therefore, another way to define programs is as organizations, albeit usually small ones. They are organizations in that they meet the standard definition of an organization: groups of people and other resources formally associated with each other through intentionally designed patterns of relationships to pursue desired results. Wholey, Hatry, and Newcomer (2010, 5) defined a program as “a set of resources and activities directed toward one or more common goals, typically under the direction of a single manager or management team.” Because health programs are embedded within larger organizations, it is useful to think of these programs as organizations within organizations.

Programs that pertain to any of the determinants of health noted earlier are by definition health programs. Thus health programs address some aspect of the physical environments in which people live and work, their behaviors, their biology, the social factors that affect them, or the health services they receive.

The terms programs and projects are sometimes used interchangeably, although they do not refer to the same things. The differences between programs and projects are rather subjective and pertain mostly to scope and longevity. Some people view projects as subsets of programs. For example, the Project Management Institute (2013, 165) views a program as a “group of related projects.” The institute defines a project as “a temporary endeavor undertaken to create a unique product, service, or result” (168). In this view, projects are smaller and more focused than programs. In addition, projects are typically more time limited. That is, a project has a predetermined life cycle, and a program may have a more indeterminate life cycle. The duration of a project is scheduled at its beginning, although some run for a longer or shorter duration than originally planned because of changing circumstances.

Figure 1.2 graphically depicts a project's life cycle. Assume that the project is intended to involve conducting diabetes screenings at an annual health fair. The curve reflects the consumption of human, financial, and material resources during the life cycle of the project. A gradual buildup of activity during which arrangements are made for the conduct of the screenings precedes...

Table of contents

• Cover
• Series Page
• Title Page
• Copyright
• List of Figures, Tables, and Exhibits
• Preface
• Acknowledgments
• The Author
• Chapter 1: The Work of Managers in Health Programs
• Appendix A: Example of a Health Program: The Global Health Program of the Bill and Melinda Gates Foundation
• Appendix B: Example of a Health Project: The Mass General Care Management Project
• Chapter 2: Developing/Strategizing the Future
• Chapter 3: Designing for Effectiveness
• Chapter 4: Leading to Accomplish Desired Results
• Chapter 5: Making Good Management Decisions
• Chapter 6: Communicating for Understanding
• Chapter 7: Managing Quality—Totally
• Chapter 8: Commercial and Social Marketing
• Appendix C: A Step-by-Step Social Marketing Process
• Chapter 9: Evaluating
• Index
• End User License Agreement