Superior Productivity in Health Care Organizations:
How to Get It, How to Keep It
By Paul Fogel, MBA
Health Professions Press, Baltimore, MD
2004, 187 pp., $26.95
REVIEWED BY LAWRENCE A. PLUTKO
Today's health care environment places many demands upon health care administrators
and managers to achieve optimal operational results through a deployment of
resources that uses the best available practices, information, and designs available.
In this book, Paul Fogel lays out a logical program to help organizations move
from poor performance to optimal performance by controlling their largest expense–labor.
In a preface, the author notes that health care industry journals address productivity
management in piecemeal fashion and largely remain at the theoretical level.
Perceiving a practical industry need, then, Fogel sets out to provide the reader
with "a conceptual framework that fits productivity into the overall management
structure of the hospital" (p. xi) and explains "the underlying management
philosophy necessary for developing superior productivity" (p. xii). It
is important to note that, to the writing of this book, the author brings a
unique and practical perspective based on working with more than 50 hospitals
on these issues.
The book contains six chapters, an appendix of case studies of actual situations,
a welcome glossary of terms, and an index. In his first chapter, "The State
of the Union," Fogel addresses current popular strategies for reducing
costs, including layoffs, changing the skill mix, benchmarking, "float
pools," and hospital mergers. He also indicates how these strategies have
often come up short and can have unfavorable consequences for the quality of
patient care. Chapter 2, "How to Develop Realistic Productivity Standards,"
very nicely demonstrates how an organization can develop practical standards
by "mining" its history, down to the level of each department. "Drilling
down" in a department results in the department manager's confronting
hard data, negotiating effective standards, and then being held accountable
for those results.
Chapter 3, "Implementation," is the critical "how-to" section
of the book, once one has arrived at realistic staffing standards. However,
if these standards are to work as intended, the organization must artfully resolve
core productivity concepts and management challenges before designing the necessary
reporting and monitoring tools. Once again, Fogel says that it is necessary
to "drill down" to the department level to discover how delegation
of authority and responsibility accrue to each department manager. This collapsing
of authority also requires the development of new organizational rules to govern
productivity management.
In Chapter 4, "Monitoring and Reporting," Fogel moves on to a practical
and useful discussion of customizing monitoring systems, protocols, and user-friendly
reports. He challenges the reader to admit that "the arcane language of
management engineering is largely impenetrable to department managers, the very
people charged with using the system" (p. 105).
In the fifth chapter, "Incentives and Consequences," the author turns
to motivational issues. An organization must provide a rationale for asking
its people to change, he writes. In this chapter, Fogel addresses a valid concern
related to incentive plans: Do they not ask managers to cut service and compromise
quality to save money? Here, the author maintains that it is critical that an
organization have an effective productivity policy so that the organization
can be managed according to its declared values and guiding principles, rather
than according to utility.
Chapter 6, "The Politics of Productivity," concerns gaining cooperation
from key stakeholders: medical staff, labor unions, executives, department managers,
and the board. All must be engaged and involved in moving the organization culture
along to realizing superior productivity, Fogel writes.
This reviewer was impressed by the way Fogel directly takes on vital questions
involving organizational politics, employee relations, quality of care, and
other values-laden issues. His approach is balanced and speaks to the heart
of good stewardship: the responsibility to wisely care for and share the human,
environmental, and financial resources we hold in trust for others. The reviewer
sees this book as also contributing to another aspect of the health care ministry:
the principle of subsidiarity. By encouraging department managers to assume
responsibility for their areas, all organizational leaders can improve their
understanding of the notion of personal and professional accountability in the
workplace.
Lawrence A. Plutko
System Director
Office of Privacy and Corporate Compliance
Yale New Haven Health System
New Haven, CT
Copyright © 2005 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.