Evaluating Management Effectiveness Across Levels, Explained

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Evaluating Management Effectiveness Across Levels

Healthcare Organization and Management · Chapter 5: Core Management Functions in Healthcare OrganizationsSection 5.6 · lesson 30 of 1059 min · free with a free account

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In this lesson

Evaluate managers fairly with controllable, balanced, and leading measures.

  • Distinguish effectiveness, efficiency, and activity when choosing management measures
  • Match evaluation measures to what first-line, middle, and senior managers control
  • Build a small balanced measure set that pairs lagging and leading indicators
  • Explain attribution, adjustment across units, and the limits of multi-source feedback

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Transcript

Everything said in the video, section by section (1,177 words). Read along, or search it.

Opening Case

An ED Number Hurt by Closed Beds

Jamal Carter manages Larkfield's emergency department, and his yearly evaluation leans on one number: how long patients stay in the ED. This year it got worse. Twelve inpatient beds upstairs closed for renovation, so admitted patients waited in the ED for a bed. Jamal flagged the risk twice, in writing, months ago. His director's answer: the target was the target. So what should a manager be judged on? And how do you read a number like this for what it can't show?

Key Terms

Effectiveness, Efficiency and Activity

Start with three words that get blurred. Effectiveness is how far intended results were achieved. Efficiency is results compared with the resources used. Activity is simply what was done. Peter Drucker drew this line in 1967: efficiency is doing things right, effectiveness is getting the right things done. Evaluations drift toward activity, because it's easiest to count: committees joined, programs started, emails answered. None of these are results. So for every proposed measure, ask which of the three it captures, and keep at least one true effectiveness measure.

Management Levels

Judge Each Level on What It Controls

Each management level controls different things, and holding a level to something it doesn't control is the commonest unfair evaluation. First-line managers control how work is carried out. Judge them on process reliability, staff retention and absence, and the quality of their unit's work. Middle managers control a department and its connections. Judge them on departmental results, and on whether the handoffs at their boundaries work. Senior managers control strategic position and organizational health. Judge them on position, financial sustainability, and the workforce, culture, and successors they leave behind.

Common Mistake

Real Numbers Pinned on the Wrong Person

Each level also has a measure that's commonly misapplied. A real, useful number, pinned on someone who doesn't move it. A first-line manager judged on departmental margin, when staffing budgets and skill mix are decided at a higher level. A middle manager judged on raw patient outcomes, when case mix and referrals come from outside. And a senior leader judged on this week's throughput, which middle managers already own.

Quick Check

Supply Prices Set by Purchasing

Quick check. The manager of 4 North is rated on the prices the unit pays for supplies. Those prices come from contracts the purchasing department negotiates. Is that a fair measure for her? Pause, and decide. Unfair. She doesn't negotiate the contracts, so the number moves for reasons outside her control. How much she uses is hers. The price isn't. It's tempting to call it fair because it's her unit's spending. But a fair measure has to be within the person's control.

Balanced Measures

A Small Set That Resists Gaming

A single measure of management gets gamed, because a single measure always is. What resists distortion is a small set of dimensions that trade off against each other: financial, operational, workforce, quality and safety, and stakeholders, like patients and referrers. Then a manager who improves the money while the workforce deteriorates shows up in the same document. And the number matters: a balanced set of five gets read. A balanced set of forty doesn't.

Leading and Lagging

Indicators Inside the Decision Window

Next, timing. A lagging indicator reports a result after it happens. A leading indicator changes earlier and predicts the result. For a goal of shorter clinic waits, vacancies filled and appointment slots released on time are leading. The wait finally achieved is lagging. Dashboards overweight lagging indicators, because regulators require them and nobody can argue with them. But by the time a lagging measure moves, the window in which a manager could have changed it has closed. So every objective needs at least one leading indicator that moves inside the decision window. A review of lagging numbers alone is an audit, not management.

Quick Check

A Leading Indicator for Falls

Quick check. 4 South sets a goal: fewer patient falls this year. Which of these is a leading indicator for it: falls per thousand patient days, hourly rounding completed, or the yearly cost of fall injuries? Pause, and decide. Hourly rounding completed. It's a condition of the result, it moves week by week, and the manager can act on it before falls happen. The fall rate is tempting, since it's the goal itself. But it only moves after patients have already fallen.

Attribution Problem

Separating Contribution From Inheritance

The hardest technical problem is attribution: separating a manager's contribution from what she inherited and what she didn't cause. Take over a well-run department and you'll post good numbers for a year, whatever you do. Take over a failing one, and the reverse. Reading the level rewards inheritance. Reading the change rewards arriving when things are bad, and gives little credit for keeping something good. So use both, state the starting position, and ask what this manager did, and whether a defensible causal path links it to what moved. That's a judgment, not a score.

Comparing Units

Adjust Before Ranking Managers

Comparing managers across units needs adjustment, because case mix, referral patterns, buildings, local labor markets, and equipment all differ. An unadjusted league table ranks circumstances, not management. Two safeguards help. Compare a unit with its own history first, because a unit is the best control for itself. And when you must compare across units, state the adjustment made and what's left unadjusted, so the remaining gap is read as a question, not a finding.

Multi-Source Feedback

What 360 Reviews Capture and Miss

Multi-source feedback, sometimes called three-sixty, collects views from a manager's boss, peers, direct reports, and internal customers. It captures what operational numbers can't: behavior under pressure, whether concerns get received, whether other departments find the person workable. Its limits: it measures perception, swayed by recent events and unpopular but necessary decisions. Small groups make anonymity thin, and thin anonymity softens ratings. And it's unreliable when the same tool serves both development and pay, because those purposes pull answers in opposite directions.

Management Reviews

Reviews That Change Something

A management review is useful when it changes something. The manager brings the problems, at least half the time goes to what happens next, and her operating conditions can change. A review where no bad news is ever reported has just taught people what it wants to hear. Three misuses recur: ranking without adjustment, target ratcheting, which resets next year's target to this year's result, and managing the measure. A manager may fairly ask for four things: measures agreed in advance, inside her control, a recorded starting position, and at least one leading indicator. Asking for them is a professional act, not a defensive one.

Case Resolution

Measures Jamal Can Control

Back to Jamal and his one number. He doesn't ask to be excused. He asks to be measured on the right things. Time from arrival to a decision to admit or discharge, which his team controls. Leading indicators he can act on, like time from admission decision to bed request. And a written note of the bed capacity the target assumed, so the closure shows against the target instead of hiding inside the result. His set is harder to compare across hospitals. He argues that's the right price: a measure that's comparable and wrong produces bad decisions.

Key Takeaways

Fair, Balanced and Timely Evaluation

To recap. Separate effectiveness from efficiency and activity, and keep one true effectiveness measure. Hold each level only to what it controls. Use a small, balanced set, and pair lagging results with leading indicators. State the starting position, and adjust before comparing units. And treat attribution as a judgment, with a causal path, not a score.

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.

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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.
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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 Evaluating Management Effectiveness Across Levels

What is the difference between effectiveness and efficiency in management?
Effectiveness is how far intended results were achieved, while efficiency compares results with the resources used. Activity, simply what was done, is a third thing often mistaken for both. Peter Drucker popularized the distinction: efficiency is doing things right, while effectiveness is doing the right things. A fair evaluation keeps at least one true effectiveness measure.
What is the difference between leading and lagging indicators?
A lagging indicator reports a result after it happens, while a leading indicator changes earlier and predicts that result. For a goal of fewer patient falls, the fall rate is lagging and completed hourly rounding is leading. Lagging measures move only after the chance to act has passed, so each objective needs at least one leading indicator a manager can act on.
How should managers at different levels be evaluated?
Each level should be judged on what it controls. First-line managers control how work is carried out, so process reliability, staff retention, and unit quality fit. Middle managers answer for departmental results and the handoffs at their boundaries. Senior managers answer for strategic position, financial sustainability, and the workforce and culture they leave. Measures outside a level's control are unfair.
What are the limitations of 360-degree feedback for managers?
Multi-source feedback captures behavior that numbers miss, such as conduct under pressure, but it measures perception. Ratings are swayed by recent events and by unpopular but necessary decisions. In small groups anonymity is thin, which softens ratings. It also becomes unreliable when the same tool serves both development and pay decisions, because those purposes pull answers in opposite directions.

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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