Aligning Management Functions with Organizational Goals

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Aligning Management Functions with Organizational Goals

Healthcare Organization and Management · Chapter 5: Core Management Functions in Healthcare OrganizationsSection 5.8 · lesson 32 of 1059 min · free with a free account

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In this lesson

Test whether structure, measures, rewards, and resources serve stated goals.

  • Apply the four-way alignment test of structure, measure, reward, and resources
  • Identify proxy measures and pair them with balancing measures
  • Explain reward misalignment and how budgets reveal real priorities
  • Sequence realignment from confirming the priority to moving the reward

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Transcript

Everything said in the video, section by section (1,219 words). Read along, or search it.

Opening Case

Utilization Versus Access

Larkfield's strategic plan names three priorities, and the first is better access to care for the local community. Dana Whitfield runs the outpatient clinics. Her quarterly review is almost entirely about one number: utilization, how full her clinic slots are. She could hit it easily. Fill the slots with straightforward cases, and push complex referrals onto a waiting list her measures never see. Her numbers would shine, and access would get worse for the people the plan was written for. So which goal is Larkfield really pursuing?

Definition

What Alignment Means

Helen Wu, the chief executive, tells Dana that every management function can be done well and still fail, if the functions point in different directions. Alignment is consistency between what an organization says it wants, how it's structured, what it measures, and what it rewards, with resources to match. When a plan names a priority, the structure makes it nobody's job, the measure tracks a stand-in, and the reward pays for something else, nobody has made a mistake. The organization still fails.

Four-Way Test

Structure, Measure, Reward and Resources

That gives a four-way test for any stated goal. Structure: is there a position with authority over enough of the process to be held responsible? Measure: does it capture the goal, or a stand-in that can move the opposite way? Reward: do recognition, promotion, and senior attention, not only money, follow the goal or the stand-in? And resources: does the funding match the priority claimed? A goal that fails any one isn't being pursued, whatever the plan says. The test turns a vague unease into a specific finding. Its standard symptom is goal displacement, where the measure replaces the goal. It's visible from outside: staff describe what they're asked to achieve, and it isn't what the plan says.

Structure

When Structure Lags Strategy

Start with structure. Alfred Chandler argued in 1962 that structure follows strategy. It does, but slowly, and the lag is where most execution failures live. A hospital that commits to integrated care pathways, while staying grouped by profession, has a strategy its structure can't deliver. Goodwill fills the gap, until the people leave. The test: if this strategy failed, which single position would be accountable? If the honest answer is the chief executive, the structure hasn't caught up. But naming an accountable position without matching authority is worse. It manufactures someone to blame for an outcome they couldn't control.

Quick Check

A Coordinator Without Authority

Quick check. Larkfield's plan says it will cut readmissions. It funds a transitions coordinator, puts readmissions on every report, and the chief executive reviews them monthly. But the coordinator can't book follow-up visits or arrange home care. Only each department can do that. Which link fails the test? Pause, and decide. Structure. The goal has an owner on paper, but she can't act on the process that produces readmissions. Accountability without authority. Resources is tempting, because more money often helps. But this priority is funded and measured. What it lacks is the power to move the work.

Measurement

Proxies and Balancing Measures

Next, measurement. Tom Brennan, the chief financial officer, knows the usual trap is a proxy: something easier to count that drifts from the goal exactly when effort is applied to it. Utilization stands in for access. Length of stay stands in for efficient care. Complaint volume stands in for service quality, and it falls when complaining gets harder. Two disciplines help. Write down what each measure is a proxy for, right beside it. And pair every improvement measure with a balancing measure, the term the Institute for Healthcare Improvement uses, that would move the wrong way if the goal were being subverted. For utilization, the share of complex referrals accepted. For length of stay, readmissions. It doesn't need to be perfect. It needs to make the subversion visible in the same report.

Reward

Rewarding A While Hoping for B

Reward misalignment is the oldest failure in management. Steven Kerr named it in 1975: the folly of rewarding A while hoping for B. Reward means everything handed out for performance: recognition, interesting work, promotion, control over one's time, senior attention. Money is the smallest part. An organization that praises teamwork but promotes only individual stars rewards individual stars. One that praises candor, while managers who report problems get extra scrutiny, rewards silence. Nobody writes that down, and everyone learns it quickly.

Resources

Budgets Reveal the Real Priorities

Resources are the most honest statement of priority, because budgets, positions, and protected time are the only statements of intent that cost something. A priority with no funded post, no budget line, and no protected time is a preference, and staff read it as one. So here's a diagnostic move. Compare the stated priorities with where money moved in the last budget round. The difference is the real priority order.

Cross-Department Alignment

Shared Goals With Shared Consequences

One manager can align a department. Alignment between departments is harder, and it's where most patient-facing goals fail. What works is a shared goal, with a shared measure that neither department can move alone, and a consequence for both. If either side can move the measure alone, one will, and call it done. And a consequence for only one side isn't sharing. It's transferring the blame. To diagnose misalignment, don't read the plan. Ask staff four things: what are you measured on? What gets people promoted? What would you stop doing? Which decisions go upward?

Realignment Order

Fixing Misalignment Step by Step

Fixing it takes the right order, and the common error is starting with the announcement. A change to structure alone gets pulled back soon by incentives that survived it. First, confirm the goal truly is the priority, and drop something to make room. A priority added to a full list isn't a priority. Second, name the accountable position and give it the authority, and the resources, the goal requires. Third, change the measure so the goal is visible, pair it with a balancing measure, and let a baseline form. Fourth, move the reward: recognition and promotion first, since they beat pay.

Quick Check

Balancing a Faster ED Discharge

Quick check. Larkfield's emergency department is measured on time from arrival to discharge, and the number is improving fast. Which balancing measure would reveal it if patients were being rushed out too soon? Pause, and decide. Returns within seventy-two hours. If speed is bought by sending people home too early, more of them come back, and it shows in the same report. Patients seen per hour is tempting, but it rises with rushing too. A balancing measure has to move the wrong way when the goal is subverted.

Case Resolution

A Finding Instead of a Complaint

Back to Dana. Instead of quietly gaming utilization, she runs the four-way test, and brings Helen a finding instead of a complaint. Structure: no one owns access end to end, since referral triage and booking sit in different departments. Measure: utilization is a proxy that diverges. Reward: her review and her recognition follow utilization. Resources: access is in the plan, with no funded post. She proposes a balancing measure beside utilization, the share of complex referrals seen within thirty days, and labels utilization as a proxy. And she asks who owns access. She tells Helen her own numbers will look worse before they look better. That's the point.

Key Takeaways

Say It, Structure It, Measure It, Fund It

To recap. Align what you say with structure, measures, rewards, and resources. Fail one link of the four-way test, and the goal isn't really being pursued. Label proxies as proxies, and pair them with balancing measures. Follow the money to find the real priorities. And realign in order: confirm the priority, empower an owner, fix the measure, then move the reward.

About Healthcare Organization and Management at UPI Study

Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.

Every lesson transcript is free on pages like this one, and the videos are free with a free UPI Study account. Enrolling adds a practice quiz after each lesson, the graded work and final exam that earn the credit, lifetime access, and an official transcript on completion. UPI Study has helped over 130,000 students with college credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

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Why take it here

Why students take Healthcare Organization and Management with UPI Study

How hospitals and clinics are runHealthcare Organization and Management covers how care organizations are led and run: health law and ethics, leadership and teams, strategic planning, health informatics, budgets, quality improvement, staffing and marketing. It is a core course in healthcare administration and health management degrees.
Credit at a fraction of the priceThe same 3 credits can cost $750 or more at a US college. Here it is one payment, self-paced, with lifetime access.
Finish your degree soonerTransfer credits reduce the courses you still owe, so you can graduate earlier or lighten a heavy semester.
Strengthen an applicationA completed college-level course on an official transcript shows admissions and scholarship committees you can do the work.
Study on your own scheduleNo start dates, no deadlines. Watch the lessons, practice, and take the final when you are ready.
130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

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FAQ

Questions students ask us

About Aligning Management Functions with Organizational Goals

What is a balancing measure in healthcare quality improvement?
A balancing measure, a term the Institute for Healthcare Improvement uses, tracks whether improving one measure is causing harm elsewhere. It should move the wrong way if the goal is being subverted. For example, an emergency department improving arrival-to-discharge time can watch returns within 72 hours. If patients are rushed home, more come back, and it shows in the same report.
What is goal displacement in an organization?
Goal displacement happens when hitting a measure replaces the goal it was meant to represent. A clinic judged only on slot utilization could fill slots with simple cases and push complex referrals onto a waiting list no one tracks, so its numbers improve while access worsens. Labeling each measure as a proxy and pairing it with a balancing measure makes this visible.
What did Steven Kerr mean by rewarding A while hoping for B?
Steven Kerr's 1975 article described organizations that hope for one behavior while rewarding another. Reward includes recognition, interesting work, promotion, control over time, and senior attention, not only money. An organization that praises teamwork but promotes only individual stars is rewarding individual stars, and staff learn the real rule quickly even though nobody writes it down.
How can a strategy fail because of organizational structure?
Strategy fails when no position has authority over enough of the process to be held responsible. Alfred Chandler argued in 1962 that structure follows strategy, but the lag can be long. A useful test asks which single position would be accountable if the strategy failed. Naming an owner without matching authority, such as a coordinator who cannot book follow-up care, sets that person up to fail.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Healthcare Organization and Management.

105 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

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