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Health Services Administration - Gale Encyclopedia of Nursing and Allied Health

Health Services Administration

Definition

Health services administration is a phrase that describes the career opportunities for individuals with a college education—often a master's degree—who choose to work in a health-related arena as a manager or administrator.

Description

The roles of individuals in health services administration are most commonly site specific but in general include skills in leadership, financial management, health informatics, marketing, and human resources. Because the health field is so diverse, an individual can choose to specialize in one division of a hospital, for example surgery, or in a specialty area in outpatient services such as managing an independent primary care center. An individual who is hired as a surgical health services administrator would function under the direction of either a hospital administrator or a surgeon. Coordination of services for surgical patients, acquisition of supplies, scheduling of surgical procedures, financial billing, and evaluation of quality outcomes would likely be job expectations. For the individual who is hired as a manager of a primary care center, responsibilities might include coordination of the hiring and firing of clerical staff, instituting community outreach, marketing the services of the center within the community, financial planning, and overseeing the billing sequence. In both these examples, the roles are site specific in that the needs of the different types of health services determine what responsibilities logically belong to the administrator.

Leadership skills needed for success in health service administration are centered around effective communication and understanding the principles of many theories used to characterize organization management. Situational leadership is a theory that states an individual in a leadership position varies the response to employees and the publics served by gathering data, fully analyzing the incident or occurrence, and then adapting the leadership style to the event. As an example, in a fire, a leader is not democratic but must use the situation (the fire) and then becomes autocratic and directive to avoid injury or harm to staff, patients, and the facility. As an another example, if the organization wanted to expand services in an unknown area of the city, the administrator might choose to use a laissez faire leadership style to elicit information from employees who live in the area of interest. Laissez faire leadership means that the administrator identifies the task (the seeking of information about the new area in the city) and does not direct the group but waits and watches as the group interacts to achieve the goal of identifying information. The administrator then simply records the information gleaned from the group meeting. Management by objectives is another commonly used management theory. This theory states that the best way for any individual to manage the performance of others is to make sure the overall goal is clear to everyone and that knowledge of the objectives helps all employees meet expected outcomes. The health services administrator is responsible for choosing the objectives (along with a Board of Trustees) and then defining and explaining these objectives to all employees.

Financial management includes the ability to develop and assess a budget, to determine where monies are best spent, to set up systems to monitor and evaluate the outcomes, to complete a cost benefit analysis of the service provided, and the ability to write up the needed reports. A meaningful budget that avoids overpayment of anything is a must in today's marketplace. Thus, health services administration is focused on insuring that costs (output) are offset by income through budgetary and fiduciary oversight. Health informatics is a phrase used to describe the management of all types of data that compose computerized health records. It includes setting up, modifying, manipulating, and evaluating systems and the output from the systems using appropriate statistics to determine the cost of the service provided. The health services administrator combines knowledge of financial management and informatics to direct and oversee the organization as a whole.

Marketing is a word that is used to identify the skill needed to interact with employees and the public in an articulate way to achieve a favorable perception about the organization. This includes good verbal communication skills and a positive outlook about the organization when interacting with the media, multiple levels of professionals employed by the organization, and patients and their families. The health services administrator uses both knowledge and information as marketing tools to drive the agenda for the organization forward. Marketing includes developing networks with other organizations to maximize something of value for the establishment. As an example, the administrator might want to develop a local network to enhance buying power for the equipment and disposable supplies used for care. In addition, the administrator would be responsible for assessing the market relevance before any planned organizational change was implemented.

Human resources deals with the personnel component of any organization. For a health services administrator, the responsibilities would include developing policy for hiring, discipline, and termination of personnel through direct management or as a supervisor of the individual assigned to these services. Adherence to state employment law is an integral part of this responsibility. In a unionized setting it includes overseeing that all unionized personnel adhere to the union contract. In a non-unionized setting it might include approving the utilization of employee benefits as well as assessing what these benefits are and determining when the employee meets the requirements to earn the benefits. Human resources administrators insure that employee records are kept to meet state and federal regulatory requirements to document who is in the facility on any given day and the type of services provided by all employees on a daily basis.

Strategic planning is a process of working within an organization to develop a master plan that provides for survival and continuity of the organization, with planned growth in selected areas while insuring quality indicators of the services provided are met. This strategic plan provides clear and simple goals and direction to avoid confusion within the organization. Leadership and the strategic directions provided to employees determine whether or not the organization is successful. Overseeing the development of the plan and evaluation of the outcomes are the responsibility of the health services administrator. Avoiding common mistakes such as creating large, unwieldy teams of people to oversee a service or instituting systems that interfere with economic effectiveness are part of the expectations in health services administration. For all organizations positive outcomes are the goal. The strategy for effective leadership in any health care organization is focused on positive outcomes. An old adage that has meaning for anyone choosing a career in health services administration runs something like 'a happy customer, makes a happy administrator which leads to happy employees.' Basically when services are provided as promised or as promoted, then all levels of personnel have achieved the desired positive outcome. This also leads to financial success. The focus within the organization remains at all times on cost reduction and quality improvement. The effective strategic plan leads to that outcome.

Work settings

The work sites for individuals who choose health services administration include public health, public administration, business administration, allied health administration, or hospital administration. Job titles commonly used in the field are supervisor, director, executive director, administrator, executive, superintendent, overseer, governor, steward, and foreman. In the vernacular, the title of the health services administrator usually represents the chief, boss, or head for a division within an organization or for the entire organization. Individuals who select careers in health services administration can choose to work in government, the penal system, public health service, managed care organizations, or in any aspect of health care. In addition, a background in health services administration provides opportunities for selected professionals to work in other service firms such as accounting, law, or management consulting.

At the government level, health services administration is often focused on policy issues. Several ongoing topics that fall in this category include any aspect of health care reform and expansion of the coverage provided by tax levy monies. From a health services administration perspective, fear of expanded government regulation to the point of oppression can have a negative effect on any organization. An example that describes oppressive regulation would be a federal law mandating that the specifics of all health education be documented in the medical record. In this example the health care provider, the nurse or the doctor, would then spend more time documenting what was taught than the time actually spent teaching patients. The role of the health services administrator is to monitor potential legislation that would have a negative effect on the organization and to then organize appropriate staff to participate in a lobby effort to prevent this type of legislation from becoming law.

Managed care describes a delivery system for health care based on paid insurance coverage that often includes a written plan outlining the specific aspects of care usually provided to patients with a specific medical diagnosis. Managed care refers to the process of regulating care to avoid unnecessary treatments of all kinds and thus limiting costs. If employed by a managed care company, the health services administrator functions as a proponent of the company's care options and the rules covering services with an overall goal of helping to prevent any further regulation of the insurance provider or the managed care corporation. In the same way, if employed by a hospital or an organization providing health service, the heath services administrator is responsible for interpreting the rules and regulations mandated by the managed care organization and helping insure that the hospital or other provider receive maximum reimbursement for allowed services.

The roots of all public health services rest with public education about disease potential and avoidance, and health screening. Health service administrators employed in the public health arena are responsible for the management of many health issues. The role might include employment in centers with specific health functions such as: asthma education, services for the homeless, well child care, direct observational treatment for tuberculosis, prevention/treatment of sexually transmitted disease, HIV outreach and prevention services, or preventive care for all types of substance abuse, including smoking cessation and alcohol and drug rehabilitation.

Future outlook

The future is extremely positive for individuals who seek careers in health services administration. With the continued movement away from in-patient hospital services, small, independent, stand-alone health service agencies are opening all over the nation. Each of these independent facilities needs an administrator who understands the overall goals of the agency and is willing to join with the professional staff to make the organization a successful venture.

In conclusion, a career in health services administration is a management level position that is focused on achieving positive outcomes, using good internal controls, insuring sound financial management, keeping a pointed focus on the services provided and having overall management skills that insure organization survival and success. The National Association of Health Services Executives (NAHSE) offers additional information about this health care career.

Resources

PERIODICALS

Bohmer, R., and A.C. Edmondson. 'Organizational Learning in Health Care.' Health Forum Journal 44, no. 2 (March-April 2001): 32-35.

Chowdhary, N.R. 'Marketing Healthcare: Lessons for Smaller Hospitals.' Health Services Management Research 13, no. 1 (2000): 1-5.

Fahey, D.F., and R.C. Myrtle. 'Career Patterns of Healthcare Executives.' Health Services Management Research 14 (2001): 1-8.

Oliveira, J. 'The Balanced Scorecard: An Integrative Approach to Performance Evaluation.' Health Finance Management 55, no. 5 (May 2001): 42-46.

Roth, R.L., and M.H. Nahra. 'Knowledge is Payment: Understanding State Prompt-payment Laws.' Healthcare Financial Management 55, no. 5 (May 2001): 37-8, 40.

Tyler, J.L., and E.L. Biggs. 'Practical Governance: CEO Performance Appraisal.' Trustee, vol. 54, no. 5 (May 2001): 18-21.

ORGANIZATIONS

National Association of Health Services Executives. 〈http://www.nahse.org〉.