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CaliforniaStateUniversity, Long Beach

Health Care Administration Program

HCA 505: Organization and Systems of Health Care

Fall, 2006

Instructor:Richard L. Tradewell, MBA, Ph.D.Schedule: W 4-6:45PM

Telephone:949 400-0960Location: ET-105

E-mail:all Number 6744

Office Hours:Phone to arrange appointment.Program Office: 562 985-5694

Course Description

Analysis of operational activities and managerial functions essential to the health care delivery system, with emphasis on management and leadership influence on developing effective systems of care within various institutional arrangements. This is intended as a foundation course in the principles of organization theory and organizational behavior as applied to healthcare organizations. During this course we will read and discuss the most important classical works in organization theory, written by the most influential authors in the field. Although emphasis is on masterworks that have stood the test of time, the course also devotes considerable attention to organizational cultural reform movements and postmodern and information age theory, including the concept of the learning organization.

These theories will be applied in a series of case studies of healthcare organizations, dividing our attention between cases in which principles were applied effectively and those in which principles were ignored or never applied.

Finally, because your careers as healthcare managers may find you working in as many as three distinct legal/institutional settings: 1) nonprofit, 2) for-profit (either a public or privately held investor-owned firm) and 3) government-operated, the political, economic and legal framework of each of these institutional settings will be analyzed for their specific strengths and weaknesses in terms of organization theory. The organizational implications of other current challenges to the healthcare manager, specifically containing cost, improving productivity, increasing quality, and meeting customer needs are considered in the context of the advantages and constraints in each of thethree institutional settings.

Expected outcome

As a result of this class, students will be able to:

  1. Understand the evolution of management theory over several centuries from 1491 B.C. to present.
  2. Be familiar with the most important classical contributions to the field of management theory.
  3. Understand how the reactionary neoclassical theorists challenged the conventional classical wisdom in terms in human behavior and incentive.
  4. Appreciate how human resource theory further awakened thought to an understanding of the human side of enterprise.
  5. Apply the recent work in organizational culture reform movements and the enabling role of information technology to solving many the challenges to today’s healthcare organization.
  6. Understand how the role of the management leader has evolved as management theory has evolved.
  7. Understand the relative advantages and disadvantages, similarities and differences, of the for-profit, nonprofit, and governmental forms of organization to the healthcare industry today, and the controversies over trends for the future.
  8. Apply theory to the solution of management problems in the student’s own organization.

Required Textbook

Classics of Organization Theory (Fifth Edition). 2001. Wadsworth Group/Thomson Learning. Belmont, CA. ISBN: 0-15-506869-5

Required Casesand Articles (provided by instructor):

Collins, James C. and Jerry I. Porras. 1994. Built to Last: Successful Habits of Visionary Companies. New York: HarperBusiness. (Classic). Chapter 6 in e-reserves: “Cult-like Cultures.”

Kovner, Anthony R. and Duncan Neuhauser (2004). Health Services Management: Readings, Cases and Commentary. Chicago: Health Administration Press. Eighth edition. Case 13 (“A Personal Memorandum”) and Case 14 (“Whose Hospital”?) will appear on BeachBoard and in Ereserves.

Griffith, John R. “The Revolution in Hospital Management.” Journal of Healthcare Management, Vol 50, No. 3, May/June, 2005. Case reviews of the five health systems that have won the Malcolm Baldrige National Quality Award in Health Care. BeachBoard or download from ACHE:

Embertson, Mari K. “The Importance of Middle Managers in Healthcare Organizations.” Journal of Healthcare Management, Volume 51, Number 4 July/August 2006. BeachBoard or download from ACHE.

Herzlinger, Regina E. “Hospital for Special Surgery,” HarvardBusinessSchool, 9-305-076, August 17, 2005. (Distributed in class).

King Drew Medical Center Pulitzer prize-nominated seven part series in the Los Angeles Times, the Final Report from Navigant Consulting, and the Department of Health Services’ Quality Improvement Plan, will be posted on BeachBoard.

Bibliography:

Beauford B. Longest, Jr., Jonathon S. Rakich, Kurt Darr, Managing Health Services Organizations and Systems,4th Edition, Health Professions Press,2000

Bennis, W.G., Spreitzer, T., Cummings. 2001.The Future of Leadership, San Francisco, CA., Jossey-Bass.

Borkowski, Nancy. 2005. Organizational Behavior in Health Care, Sudbury, MA.,Jones and Barlett,

Bridges, William. 1993. Managing Transitions, William Bridges andAssociates. (Classic)

Dye, Carson F. (2000). Leadership in Healthcare: Values at the Top. Chicago: Health Administration Press.

Drucker, Peter F. (1973). Management: Tasks, Responsibilities, Practices. New York: Harper & Row. Mandatory reading: Chapter 37: The Effective Decision and Chapter 52: Needed, An Effective Board will appear on BeachBoard and in Ereserves. (Classic).

Griffith, John R. and Kenneth R. White. 2002. The Well-Managed Healthcare Organization. AUPHA Press.

Fayol, Henry. 1949. General and Industrial Management, transConstance Storrs, London, Pitman Publishing. (Classic)

Ginter Peter, Linda Swayne, Jack Duncan. 2002.Strategic Management of Health Care Organizations, 4th Edition,Maldem, MA.

Gift, Robert and Catherine Kinney. 1996. Today’s Management Methods, American Hospital Publishing (Classic)

Griffith, John R. The Well Managed Health Care Organization, 4th Edition, Chicago, Il., Hospital Administration Press, 1999

Herzberg, Fredrick Brenard Mausner, and Barbara Bloch Snyderman. 1967. The Motivation to Work, 2nd Edition,New York: John Wiley and Sons (Classic)

Kissler, Gary D. 1996. Leading the Health Care Revolution, Chicago: Health Administration Press. (Classic)

Kouzes, James and Barry Posner. 1995. The Leadership Challenge, Jossey-Bass Publishers (Classic)

Lee,Fred 2004. If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently. SecondRiver Healthcare Press, PO Box 11202, Bozeman, MT59719. ISBN 0974386014

Mayo, Elton. The Human Problems of Industrial Management,New York, Macmillan, 1933 (Classic)

Maslow, “A Theory of Human Motivation,”Psychological Review(Volume 50, July 1943), pp, 370-396. (Classic)

McGregor, Douglas. 1960. The Human Side of Enterprise, New York McGrawHill, , (Classic)

Ott, J. Steven, Sandra J. Parkes, and Richard B. Simpson. 2003. Classic Readings in Organizational Behavior. Belmont, CA: Thomson Publishing.

Peters, Thomas J. and Robert H. Waterman, Jr. (1982). In Search of Excellence: Lessons from America’s Best-Run Companies. New York: Harper & Row. Dated material, perhaps, but Chapter 6, “Close to the Customer” and Chapter 8, “Productivity Through People” are still classics (on ereserves and BeachBoard). (Classic).

Senge, Peter. 1990. The Fifth Disclipine: The Art and Practice of theLearning Organization, New York, Doubleday (Classic)

Taylor, Fredrick Shop Management. 1911. New York: Harper and Brothers, (Classic)

Weil, Peter. (2004). Evaluating the Performance of the Hospital CEO. 3rd Edition. Chicago: AmericanCollege of Healthcare Executives.

Wheatley, Margaret. Leadership and the New Science,1994, Berrett-Koehler Publishers (Classic)

Wren, Daniel A. 2004. TheHistory of Management Thought, 5th Edition. Wiley.
Ross, Wenzel, & Mitlyng (2002). Leadership for the Future: Core Competencies in Healthcare. Chicago: Health Administration Press.

General Resources

California Health Line, a service of California Health Care Foundation, daily Internet news on healthcare in California,

Journal of Science and Health Policy,

National Information Center for Health Services Administration, (web links to American College of Healthcare Executives, American Hospital Association, American Health Information Management Association)

American College of Healthcare Executives, ache.org

American Hospital Association, aha.org

Additional Journals

  • Administrative Science Quarterly
  • Journal of Applied Behavioral Science
  • Journal of Organizational Behavior
  • Organizational Behavior and Human Decision Processes
  • Organizational Dynamics
  • Academy of Management Review
  • Management

ScheduledTopics

The readings are organized around the following nine core topics:

  1. Classical Organization Theory: Aug30

Introductory essay: pp 27-33

Readings: Adam Smith (1776), Henri Fayol (1916), Frederick Taylor (1916), Max Weber (1946), Luther Gulick (1937).

Sep 6

Case: Herzlinger, Regina E. “Hospital for Special Surgery,” HarvardBusinessSchool, 9-305-076, August 17, 2005. (Distributed in class).

How does HSS promote specialization to improve efficiency? Are scientific management practices used to improve productivity and workflow? Do hospital organizations violate Gulick’s unity of command or span of control principles?

  1. Neoclassical Organization Theory:Sep13

Introductory essay: pp 88-91

Readings: Chester Barnard (1938), Herbert Simon (1946), Phillip Selznick (1948), Richard Cyert & James March (1959).

Presentation:Classical/Neoclassical (Group 1)Sep 20

Case 14: “Whose Hospital?” in Kovner and Duncan (2004).

In what ways does this hospital function as a rational organization? How do the non-rational aspects of organization behavior undermine the administrator? What is the board’s role in governance? How does it fail?

  1. Organizational Behavior Perspective:Sep 27

Introductory essay: 145-151

Readings: Mary Parker Follett (1926), Fritz Roethlisberger (1941), Abraham Maslow (1943), Douglas McGregor (1957), Irving Janis (1971), Bart Victor & Carroll Stephens (1994).

Presentation: Behavior (Group 2)Oct 4

Readings: Los Angeles Times King-Drew series on BeachBoard or online at Visit also the Health Services Department King-Drew website: for consultant report and improvement plans.

What role did employee motivation (or lack thereof) play in the King-Drew scandals? Why do you think employees seemed to care so little for patient welfare?

Readings: Joe Sobran, “The Unasked Question,” July 22, 2004 and “Remember Sarajevo,” July 27, 2006 at .”

What is “groupthink?” What are the eight symptoms? What is the evidence of groupthink in government policy making?

  1. Modern Structural Theory:Oct 11

Introductory essay: 193-196

Readings: Tom Burns & G.M. Stalker (1961), Peter Blau & Richard Scott (1926), Arthur Walker and Jay Lorsch (1968), Henry Mintzberg (1979), Elliott Jaques (1990).

Presentation: Structure(Group 3)Oct 18

Embertson, Mari K. “The Importance of Middle Managers in Healthcare Organizations.” Journal of Healthcare Management, Volume 51, Number 4 July/August 2006. BeachBoard or download from ACHE.

How can the loss of middle management through downsizing affect an organization such as HSS?

Objective Midterm Examination: theories 1-3October 25

Theories of Power and Politics:Nov 8

Readings: Jeffrey Pfeffer (1981), John French & Bertram Raven (1959), James March (1966), Rosabeth Kantor (1979), Henry Mintzberg (1983).

Presentation: Power and Politics (Group 4)Nov 15

Readings: Los Angeles Times King-Drew series on BeachBoard or online at Visit also the Health Services Department King-Drew website: for consultant report and improvement plans.

Where is power located in the King Drew quality failure scandals? How powerful are the unions, the community groups, the political representatives from Los Angeles and neighboring cities, the medical school? Can management act to put power in the hands of experts or will politics prevail?

  1. Organizational Culture:NO CLASS; DO READINGS(Nov 22)

Introductory essay: 352-359

Readings: Edgar Schein (1993),Scott Cook & Dvora Yanow (1993), Harrison Trice & Janice Beyer (1993), Joanne Martin (2002).

Presentation: Culture (Group 5)Nov 29

Describe the culture at the Hospital for Special Surgery. How did they achieve this cultural tradition; how are new employees introduced to the culture?

Reading: Collins, James C. and Jerry I. Porras. 1994. Built to Last: Successful Habits of Visionary Companies. New York: HarperBusiness. Chapter 6 in e-reserves: “Cult-like Cultures.”

  1. Organizational Reform Movements:Nov 29

Introductory essay: 415-423

William Ouchi (1981), Thomas Peters & Robert Waterman (1982), Peter Senge (1990).

Griffith, John R. “The Revolution in Hospital Management.” Journal of Healthcare Management, Vol 50, No. 3, May/June, 2005. Case reviews of the five health systems that have won the Malcolm Baldrige National Quality Award in Health Care. BeachBoard or download from ACHE:

What do Deming and Baldrige have in common? What are their differences? Who is more influential in healthcare organizations today?

Presentation: Org Reform (Group 6)

  1. Systems, Organizations and Environments Theory:Dec 6

Introductory essay: 476-479

Readings: Daniel Katz & Robert Kahn (1966), James D. Thompson (1967)Michael Jensen & William Meckling (1976), Jay Barney & William Ouchi (1986), Paul Rubin (1990).

Presentation: Systems(Group 7) Note: Group 7 also hasprivilege of drawing upon any of the prior theorists, or outside readings, to integrate its conclusions.

In class objective examination: theories 4-7 (25 points)

AND

Take home Comprehensive Final Examination (25 points)Dec 13

Method of Evaluation

  • Midterm examination = 50 points
  • Application of Theory Essay= 40 points
  • Final examination (25 pts objective and 25 pts take home) = 50 points
  • Reading discussion PowerPoint presentation = 40 points
  • Class attendance/participation = 20 points

Total = 200 points

Grading

A 90%+C70- 79%Fbelow 60%

B80-89%D60-69%

Essay Requirement (Applying Research to Home Organization)

You will write a short critical essay(five pages) with an additional page of complete references. In the essay you will pick one of the eight theory topic areas (e.g. human resources, power, culture, structure, etc.) and a representative writer/theorist of that topic area (e.g. Maslow, Pfeffer, Senge, Mintzberg, etc.) and apply the principles you have learned from that theorist to an event, a situation, or a condition in your own organization.

Three steps are involved:

  1. Objectively and briefly describe the situation at work (who, what, where, when) as if you were a news reporter (one page).
  2. Identify the theory or theories that help you to explain, understand, or cope with the situation (one page).
  3. Critically analyze how the theory works (or does not work) in actual practice. This ideally should involve discussion and interview with managers of the organization in question to obtain their insights (two to three pages).

Grading is based on clarity of writing, use of proper grammar, organization of the material, your critical insights and interviews and your ability to add additional references to clarify and support your conclusions.

Class Presentation Requirement

The class will be divided into seven work groups corresponding to each of the seven theoretical perspectives studied in class: classical, neoclassical, behavioral, etc. Each group of three-four students will select at least three (3) of its favorite theorists/writers from within its assigned perspective from the class readings and produce a PowerPoint presentation for the class reviewing these writers’ contributions to management and organizational theory and its application and relevancy to healthcare organizations today. The presentations should be organized to give each group member an opportunity to speak and to allow time for class discussion. As a guideline, assume that each of the three members of a group gives a five minute PowerPoint presentation followed by five minute discussion. This helps to maintain class interest and equates to a total of 15 minutes of presentation and 15 minutes of discussion, or 30 minutes per group.

Grading is based on clarity of presentation, the degree of class involvement you’re your presentation encourages, and your overall conclusions. Supplementing the assigned readings with outside research, photos, and antidotes about the authors may add interest to the presentation, but is not required. Passing out a question sheet to the class in advance of the presentation promotes discussion.

Use of Academic Technology in this Class

This course makes use of several forms of academic technology, including the web, e-reserves and BeachBoard. Students are required to use of this technology to fulfill the requirements for this course. To participate in the academic technology elements of this course, students must have access to, and be able to use:

  • A computer, equipped with Adobe Acrobat Reader 5.0 or newer and word-processing software capable of reading Microsoft Word XP files.
  • The internet. Specifically, the World Wide Web. Whatever internet service provider is used must be capable of accessing Web pages, BeachBoard and Acrobat files.
  • An account on BeachBoard.

The Library E-Reserve System

Other readings and materials will be available on the CSULB Library’s E-Reserve system. To access the system type the following address in your web browser: eReserves.library.csulb.edu. Type “Tradewell” in the space for “ERes QuickSearch” and click on the “search” button. You will then see the course password page. Enter the password for the course, which is “think,” and then click on the “accept” button. You should now be in the main course folder. You will see a folder titled “Readings,” click on it and you will see each reading. Click on the reading and you can read the article on screen or download and print it.

Expectations of Student Skill Performance

To complete the requirements for the course, students are expected to:

Write clearly and concisely, using correct grammar, punctuation and spelling.

Communicate articulately in oral presentations.

Be proficient in using PowerPoint for presentations.

Search the web and research publication, then apply the information found.

Analyze information, both numeric and text.

Apply internationally-accepted metrics to compare health and healthcare.

Synthesize information about factors that impact health and health care.

Compare and contrast countries, situations, historic and current times.

Participate in class discussions.

Submit all assignments on time.

Submit assignments on line and provide professor with a paper copy during class.

Student Responsibilities and University Policies

(1) CSULB policies on cheating and plagiarism shall apply, as delineated in CaliforniaStateUniversity, Long Beach Policy Statement 85-19, December 13, 1985. One or more of the following academic actions are available to the faculty member who finds a student has been cheating or plagiarizing.

(a) Review -- no action.

(b) An oral reprimand with emphasis on counseling toward prevention of further occurrences;

(c) A requirement that the work be repeated;

(d) Assignment of a score of zero (0) for the specific demonstration of competence, resulting in the proportional reduction of final course grade;

(e) Assignment of a failing final grade;

(f) Referral to the Office of Judicial Affairs for possible probation, suspension, or expulsion.

(2) Students who need accommodation for any type of disability must inform the instructor in advance.

(3) Withdawal is the responsibility of student. Withdrawal after the posted date is allowed only for serious and compelling reasons and requires the approval of the dean.