ACHE/SOHL STUDY GROUP
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Transcript ACHE/SOHL STUDY GROUP
ACHE/SOHL
STUDY GROUP
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
SOHL/ACHE
FACHE Advancement Exam
Study Group
Management
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Perspective/Approach
• 200 Questions
• Management Knowledge
– 15%
– 30 questions
• Theory vs. Practical
• Read the question
• Select the BEST option that ANSWERS
the question
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Management
• As a discipline, management comprises of
the interlocking functions of formulating
corporate-policy and planning, organizing,
staffing, directing, and controlling the
firm's resources to achieve the policy's
objectives.
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Management
• Planning
– Most Important
• Organizing
– Workflow Design
– Relationships
• Directing
– Operational Processes
– Day to Day Supervision
• Controlling
– Monitoring performance
metrics
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
•
•
•
•
Planning
Strategic Management (Direction)
– Systematic analysis of the factors associated with customers and
competitors (the external environment) and the organization itself (the
internal environment) to provide the basis for rethinking the current
management practices. Its objective is to achieve better alignment of
corporate policies and strategic priorities.
Strategic Plan
– Broadly-defined plan aimed at creating a desired future.
– Determines where an organization is going over the long term, how it's
going to get there and how it'll know if it got there or not.
Policies
– The guidelines and rules within which the organization operates
Operating Plan (Execution)
– Short-term, highly detailed plan formulated generally by junior or
departmental managers to achieve tactical objectives. Also called
operational plan. Incorporates the Financial and Personnel plans.
– Tactical plans address the short term (less than one year) actions to
achieve an objective.
– Business plan address development of new program or service. Includes
Financial, marketing and operating plan sub components.
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MANAGEMENT PRINCIPLES AND
PRACTICE
Implementation Planning
• SYSTEMS FRAMEWORK
MODEL
– Strategy
– Structure
– Process
– People
– Systems
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Strategy
•Alignment with
Organizational Direction
•Vision, Goals and
Objectives
•Milestones and Timeline
•Change Management
•Key Stakeholders
•Political Feasibility
• Evaluation Metrics
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Structure
•Reporting Relationships
•Coordination with other
Units
•Span of Control
•Organizational Feasiblity
MANAGEMENT PRINCIPLES AND
PRACTICE
Process
People
•Workflow Sequence and
Steps
•Process Mapping
•Lean/Six Sigma Processes
•Hands-offs to other units
•Failure Analysis and
Contingency Plan
•Staffing Plan
•Readiness for
Change
•Desired Culture
•Behavioral
Expectations
•Recruiting, Hiring,
Training
& Rewarding
Success
•Teamwork
•Competency
Assessment
Systems
•Information Technology
•Reporting Mechanisms
•Data Reports
•Redundancy
•Contingency Plan
ACHE/SOHL
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MANAGEMENT PRINCIPLES AND
PRACTICE
What are examples from your
own management experience?
ACHE/SOHL
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MANAGEMENT PRINCIPLES AND
PRACTICE
Organizational Theory
• Table of Organization
• Complex Systems and Processes
• Units, Departments, Service Lines,
Divisions
• Span of Control
• Policies and Procedures
• Organizational Alignment
• Managing Upward and Direct Reports
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MANAGEMENT PRINCIPLES AND
PRACTICE
Links to Policies and
Procedures
Administration Policies and Procedures
Ambulatory Nursing Policies and
Procedures
Blood Administration Guidelines
National Policy Library
Safety Guidelines
Pharmacy Policies and Procedures
Point of Care Manual
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MANAGEMENT PRINCIPLES AND
PRACTICE
Organizational Structures
Organizational Structure
- From Broad to Specific
- Scope of Decision Making
- Responsibility
- Accountability
Health System
Hospital
Department
Unit
Staff
Health Service Organization
Division
Medical Group
Hospital
Site
Considerations
• Span of Control
• Chain of Command
• Interrelationships
Dept/Unit
Staff
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MANAGEMENT PRINCIPLES AND
PRACTICE
Management Structure
• Vertical
– Hierarchical
– Traditional Top-Down
Considerations
• Span of Control
• Chain of Command
• Interrelationships
BOD
CEO
CNO
Unit
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Unit
CHRO
Dept
CFO
Dept
COO
Dept
Dept
MANAGEMENT PRINCIPLES AND
PRACTICE
Management Structure
• Horizontal
– Program/Service
Line
Considerations
• Span of Control
• Chain of Command
• Interrelationships
BOD
CEO
CNO
Unit
Unit
CHRO
Dept
CFO
Dept
COO
Dept
Program
Service
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MANAGEMENT PRINCIPLES AND
PRACTICE
Dept
• Matrix
Management Structure
- Multifunctional team structure that facilitates
horizontal flow of authority, in addition to its
normal (vertical) flow, by abandoning 'one
person, one boss' rule of conventional
organizations. In addition to a multiple
command and control structure, a matrix
organization necessitates new support
mechanisms, organizational culture, and
Considerations
behavior patterns.
• Span of Control
• Chain of Command
- Blends Organization and Management
• Interrelationships
Structures
MANAGEMENT PRINCIPLES AND
- Cross Functional
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PRACTICE
PPH Matrix Structure
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MANAGEMENT PRINCIPLES AND
PRACTICE
Staffing
• Administrative discipline of hiring and developing
employees so that they become more valuable to the
organization. It includes (1) conducting job analyses, (2)
planning personnel needs, and recruitment, (3) selecting
the right people for the job, (4) orienting and training, (5)
determining and managing wages and salaries, (6)
providing benefits and incentives, (7) appraising
performance, (8) resolving disputes, (9) communicating
with all employees at all levels
• Position control defines the number, skill level and hours
of staff required to service a defined volume of activity.
• Productivity management provides for monitoring and
controlling adjustments to staffing based on fluctuations
in volume of activity.
• Performance appraisal entails the setting of
expectations in objective measureable terms and
MANAGEMENT
ACHE/SOHL
providing regular
feedback. PRINCIPLES AND
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PRACTICE
• Professional
Development involves coaching and
Directing
• Management function that includes building an effective
work climate and creating opportunity for motivation,
supervising, scheduling, and disciplining
• Incentive Plans
– “what’s in it for me”
• Communication
– All forms
– Distribution vs. holding of information
• Accessibility & Approachability
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–
–
Rounding
Staff Meetings
1:1 sessions
Professional development
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MANAGEMENT PRINCIPLES AND
PRACTICE
Roadmap to Success
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MANAGEMENT PRINCIPLES AND
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Controlling
• Management function of (1) establishing
benchmarks or standards, (2) comparing
actual performance against them, and (3)
taking corrective action, if required
• Balanced Scorecard of metrics and
benchmarks/targets sets objective
performance expectations
• Business Reviews is the mechanism to
assure accountability
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MANAGEMENT PRINCIPLES AND
PRACTICE
Controlling
Employ Balanced Scorecard
• Proposed by Robert Kaplan and David
Norton in 1996, utilizes leading and
lagging indicators to monitor achievement
of strategic direction
• Defines Organizational Long and Short
Term focus
• Strategic Domains
– Quality, Finance, Customer Service,
Workforce,
Workplace
MANAGEMENT
PRINCIPLES AND
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STUDY
GROUP
PRACTICE
• Departmental
scorecards derived from
PPH Balanced Scorecard
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MANAGEMENT PRINCIPLES AND
PRACTICE
Non-Tactical/Relationship
Leading vs. Managing
Percent of
time Leading
Percent of
time
Managing
CEO
80% - 90%
10% - 20%
Senior Mgmt.
60% - 70%
30% - 40%
Middle Mgmt.
40% - 50%
50% - 60%
Line Mgmt.
10% - 20%
80% - 90%
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MANAGEMENT PRINCIPLES AND
PRACTICE
Leadership Theory and Situational
Applications
•
•
In its essence, leadership in an organizational role involves (1) establishing a
clear vision, (2) sharing (communicating) that vision with others so that they will
follow willingly, (3) providing the information, knowledge, and methods to realize
that vision, and (4) coordinating and balancing the conflicting interests of all
members or stakeholders.
Leadership Styles:
– Authoritative - Leadership style in which the leader dictates policies and
procedures, decides what goals are to be achieved, and directs and controls all
activities without any meaningful participation by the subordinates
– Transformational - Style of leadership in which the leader identifies the needed
change, creates a vision to guide the change through inspiration, and executes
the change with the commitment of the members of the group
– Participative - Style of leadership in which the leader involves subordinates in
goal setting, problem solving, team building etc., but retains the final decision
making authority
– Delegative – Leadership style in which a leader transfers decision making
power to one or more employees, but remains responsible for their decisions
– Bureaucratic - Style of leadership that emphasizes procedures and historical
methods regardless of their usefulness in changing environments. Bureaucratic
leaders attempt to solve problems by adding layers of control, and their power
comes from controlling the flow of information
•
When to apply
– “weigh the votes” vs “count the votes”, accountability, “trust but verify”
Leadership Roles
– Public Leader
• Storyteller, Advocate, Accountable
– Diversity Leader
• Inclusive, Approachable
– Focused Leader
• Results Oriented, Analytical and Knowledgeable
– Change Leader
• Consensus Builder, Creative, Follow-Up
– Cyber Leader
• Technology Savvy
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STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Leadership Actions
Clarity
Create Clarity
Strategic/Systems Thinking
Organizational Direction
Individual Contribution
Service Orientation
Build Commitment
Confidence / Initiative
Alignment/Influence
Build Capacity
Motivation
Skills
Reward and Recognition
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STUDY GROUP
Decisiveness
Results Orientation
Committment
Capacity
Communication
Cultural Competence
Influence
Develops Others
Team Focus
Personal Development
Change Leadership
MANAGEMENT PRINCIPLES AND
PRACTICE
Followers
• Inherently want to do well
• Make up their own minds
• Tolerate opinions of others, but act
on their own
• Align independent action with
organizational direction
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Management Theory
•
Management Roles
– Henry Mintzberg published results of his studies about the work of managers in The
Nature of Managerial Work (New York: Harper & Row, 1973). Defined ten managerial
roles in three categories.
• Interpersonal Roles involve people and other ceremonial duties
– Leader – Responsible for staffing, training, and associated duties
– Figurehead – The symbolic head of the organization
– Liaison – Maintains the communication between all contacts and informers that
compose the organizational network
• Informational Roles relates to collecting, receiving, and disseminating information
– Monitor – Personally seek and receive information, to be able to understand the
organization
– Disseminator – Transmits all import information received from outsiders to the
members of the organization
– Spokesperson – On the contrary to the above role, here the manager transmits
the organization’s plans, policies and actions to outsiders
• Decisional Roles revolve around making choices
– Entrepreneur – Seeks opportunities. Basically they search for change, respond
to it, and exploit it
– Negotiator – Represents the organization at major negotiations
– Resource Allocator – Makes or approves all significant decisions related to the
allocation of resources
– Disturbance Handler – Responsible for corrective action when the organization
faces disturbances
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MANAGEMENT PRINCIPLES AND
PRACTICE
Leading vs. Managing
• Conclusions:
– Management theory, based on the
premises that there is no single best way to
manage because every situation and every
manager is different. Therefore, an
appropriate management style depends on
the demands of a particular situation.
– Management activity occurs at all levels
– Management activity varies by level
– Managers
utilize
all
the
roles
to
varying
MANAGEMENT PRINCIPLES AND
ACHE/SOHL
degrees
and
based
on
the
situation
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PRACTICE
Use of Power in Management
• Coercive: Authority or power that is dependent on fear,
suppression of free will, and/or use of punishment or
threat, for its existence.
• Referent: Influence over others, acquired from being
well liked or respected by them.
• Legitimate: Fair or just power derived from a job,
position, or status
• Reward: Extent to which an entity can control the
dispensing of rewards or benefits
• Executive: Authority to enforce orders and to ensure
they are carried out as intended
• Personal: Influence over others, the source of which
resides in the person instead of being vested by the
position heMANAGEMENT
or she holds
PRINCIPLES AND
ACHE/SOHL
• Position:
STUDY
GROUP Authority and influence bestowed by a position
PRACTICE
Organizational Culture
• Definition
– as groups evolve over time, they face two basic challenges: integrating
individuals into an effective whole, and adapting effectively to the
external environment in order to survive. As groups find solutions to
these problems over time, they engage in a kind of collective learning
that creates the set of shared assumptions and beliefs we call "culture"
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MANAGEMENT PRINCIPLES AND
PRACTICE
Culture
• Behaviors, patterns,
practices, customs
• Influence on structure
– Workarounds
– Level of formality
• Change management impact
• Cultural diversity
– Ethnicity, gender, age
– Cultural competency
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MANAGEMENT PRINCIPLES AND
PRACTICE
Culture and the Organization
• Understand the culture across
all dimensions
• Decide what dimensions need
to change
• Modify organizational
practices to drive change
• “Walk the Talk” at ALL levels
of the Organization
• Hold leadership accountable
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STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Organizational Climate
• Flexibility
– Bureaucracy minimized,
Innovation
• Responsibility
– Autonomy, Risk-Taking
• Standards
– Improvement, Excellence
• Rewards
– Performance-Based,
Recognition/Praise
• Clarity
– Mission/Direction, Roles and
Functions
• Team Commitment
– Cooperation,MANAGEMENT
Dedication, Group PRINCIPLES AND
ACHE/SOHL
Pride
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PRACTICE
Cultural Differences
•
•
•
•
•
•
•
•
•
Competition
Egalitarian
Admission of Error
Individualism
Youth
Emotional
Deadlines
Contractual
Openness to Change
ACHE/SOHL
STUDY GROUP
•
•
•
•
•
•
•
•
•
Cooperation
Hierarchical
Save Face
Collectivism
Age
Controlled
Time not an Issue
Consensus
Reluctance to
Change
MANAGEMENT PRINCIPLES AND
PRACTICE
VALUES
Cultural Conundrum
What do you do?
Low/High
Train
High/High
Support
Low/Low
Liberate
High/Low
???
PERFORMANCE
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Decision Making
ART OF EXECUTIVE DECISION
“The fine art of executive decision
consists in
not deciding questions that are not now pertinent, in
not deciding prematurely, in not making decisions that
cannot be made effective and in not making decisions
that others should make.”
Inform/Advise
Consult
Substantial Input
Consensus
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Decision Making
• Three categories of decisions
– Decisions under certainty: where a manager has far too much information to
choose the best alternative
– Decisions under conflict: where a manager has to anticipate moves and
counter-moves of one or more competitors
– Decisions under uncertainty: where a manager has to dig-up a lot of data to
make sense of what is going on and what it is leading to
• Information is raw data that:
–
–
–
–
has been verified to be accurate and timely
is specific and organized for a purpose
is presented within a context that gives it meaning and relevance
leads to increase in understanding and decrease in uncertainty
• Process
–
–
–
–
–
Define the objective
Collect relevant information
Generate feasible options
Make the decision
Implement and evaluate
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Decision making
•
Linking Leadership Styles and Decision
Making
Leadership Styles:
–
–
–
–
–
•
Decisions at the right level
–
•
dependency vs. self reliance
Decisions following the Chain of Command
–
•
Authoritative - Leadership style in which the leader dictates policies and procedures,
decides what goals are to be achieved, and directs and controls all activities without any
meaningful participation by the subordinates
Transformational - Style of leadership in which the leader identifies the needed change,
creates a vision to guide the change through inspiration, and executes the change with the
commitment of the members of the group
Participative - Style of leadership in which the leader involves subordinates in goal setting,
problem solving, team building etc., but retains the final decision making authority
Delegative – Leadership style in which a leader transfers decision making power to one or
more employees, but remains responsible for their decisions
Bureaucratic - Style of leadership that emphasizes procedures and historical methods
regardless of their usefulness in changing environments. Bureaucratic leaders attempt to
solve problems by adding layers of control, and their power comes from controlling the flow
of information
redirect appropriately
Differentiate between:
–
–
Doing things right
Doing the right thing
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Team Building
• Developmental Stages
– Norming, Forming, Storming, Performing
• Foundational Phase
– Training, Tools, Charter, Work styles, Communication
Plan, Metrics
• Transitional Phase
– Performance Improvement Training, Tests of
Change, Measure Results, Track Performance
• Self-Sustaining Phase
– Continue Performance Improvement on Larger Scale
and Track Results
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Team Work Styles
• Self-Assessment with Forced Ranking
• Identifies Preferred or Dominant Style
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Teambuilding Techniques
•
•
Teambuilding is focused to bring out the best in a team to ensure self
development, positive communication, leadership skills and the ability to work
closely together to problem solve for organizational effectiveness
Types of Teambuilding exercises
–
Communication Exercise
•
•
–
Problem Solving/Decision Making Exercise
•
•
–
Problem Solving/Decision making exercises focus specifically on groups working together to solve
difficult problems or make complex decisions.
Goal: Give team a problem in which the solution is not easily apparent or requires the team to come
up with a creative solution
Planning/Adaptability Exercise
•
•
–
Communications exercises are problem solving activities that are geared towards improving
communication skills. The issues teams encounter in these exercises are solved by communicating
effectively with each other.
Goal: Create an activity which highlights the importance of good communication in team performance
and/or potential problems with communication.
These exercises focus on aspects of planning and being adaptable to change. These are important
things for teams to be able to do when they are assigned complex tasks or decisions
Goal: Show the importance of planning before implementing a solution
Trust Exercise
•
•
A trust exercise involves engaging team members in a way that will induce trust between them
Goal: Create trust between team members
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Fairness
Honesty
Integrity
Truth
Conflict Management
• Goals
– Scope
– Direction
– Timing
• Methods
– How To
– Processes
• Values
– Individual
– Organizational
• Cultural Origin and Traditions
• Assumptions, Deams, Hopes, Beliefs
• Conflict Comes from Clash of Expectations
MANAGEMENT PRINCIPLES AND
ACHE/SOHL
STUDY GROUP
PRACTICE
Formal Conflict Resolution
•
•
•
•
•
•
•
PEER TO PEER
CHAIN OF COMMAND
GRIEVANCE PROCESSES
PERSONNEL POLICIES
COLLECTIVE BARGAINING AGREEMENTS
MEDIATION
ARBITRATION
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Dispute Resolution Techniques
• Judicial
– Law suits decided in a court
• Arbitration
– Emulates the judicial approach but with a single arbiter,
selected by the parties, who decides the case and whose
decision is binding if the parties have so agreed.
• Mediation
– An independent mediator selected by the parties has no
legal power to force acceptance of his or her decision but
relies on persuasion to reach an agreement. Also called
conciliation process.
• Avoiding Disputes
– Foster relationships
– Regular interaction, formal and informal
– Understand the other parties circumstances
– Be definitive
about what you PRINCIPLES
can and cannot do
MANAGEMENT
AND
ACHE/SOHL
STUDY GROUP
PRACTICE
Negotiation
• Process to avoid formal Dispute Resolution
• Two types
– Cooperative (win-win)
– Competitive (win-lose)
• Used routinely in management
– Informally in day-to-day interactions
– Formally in contract discussions
• Effective negotiations include
–
–
–
–
–
–
–
Preparation
Understanding the expectations, yours and the other party
Understand any personal motivations and psychological factors
Awareness of the options and your latitude
Willingness to compromise (not relax M/V/V)
Avoid personal statements, focus on the business
Focus on the business points, leave legal terms to counsel
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Contingency Planning
• Proactive approach to deals with uncertainty by identifying specific
responses to possible future conditions
• Business Continuity Planning (IT)
• Emergency Preparedness Planning
– Internal
• Fire
• Utilities Failure
– water, electricity, natural gas
• Failure Mode and Effects Analysis (FMEA)
– Proactive analysis of potential failure modes within a system for classification by
the severity and likelihood of the failures
• Tracer methodology
– Follow an patient through your hospital, beginning to end
– External
• Hazards Vulnerability Assessment
– Natural Event (earthquake, wild fire, tornado, flood)
• Unexpected event
– Terrorist Action (bio-hazard, radiation exposure, bomb threat)
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Contingency Planning
• Plan of Correction
– Assessment
– Gap Analysis
– Mitigation Action Plan
– Implementation/Traini
ng
– Testing
– Refinement
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
EOC Section Chief Roles
• Operations Chief
– Evaluate bed and ED capacity for influx
– Assess personnel availability for labor pool
• Logistics Chief
– Assess materials and supplies on hand
– Determine food, drug, potable water, utility
reserves
• Planning Chief
– Anticipate needs for 24-48 hours and
beyond
• Finance Chief
MANAGEMENT
PRINCIPLES
AND
ACHE/SOHL
–
Record
expenses
and
submit
financial
STUDY GROUP
PRACTICE
records
Emergency Preparedness
•
•
•
•
Emergency Management Plan
Hospital Incident Command System
Code Orange and On Site EOC
Designate Incident Commander
– Executive in Charge on site
• Public Information Officer
– Communicate with key audiences
• Safety Officer
– Assist Incident Commander
• Linkage with Local Government Emergency
Operations Center (EOC)
ACHE/SOHL
STUDY GROUP
MANAGEMENT PRINCIPLES AND
PRACTICE
Questions