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The why of policies and procedures; an organization's purpose or mission gives rise to policies, and from policies flow procedures.

The terms policy and procedure are often used interchangeably, but they are far from identical. "Honesty is the best procedure" doesn't quite work as a saying.

These management buzzwords are not the only ones frequently misused and abused. Goals and objectives, for example, are another source of confusion. Goals are long-run aims that answer the question, "Where do we plan to be 10 years from now?" Objectives are shorter steps, formulated incrementally to help individuals or organizations meet their goals.

These distinctions are more than theoretical. Understanding them is the first step toward developing a cohesive management style. Goals and objectives form the rationale for an institution's policies and procedures. Even more fundamental, however, is the basic purpose of the institution itself--a purpose that underlies its long-term goals. In most health care organizations, this

basic purpose is summed up in the mission statement.

Most of the health care professionals I've met in management courses have never seen or even heard of their organization's mission statement. I usually suggest that they find it and read it, because this statement tells them what business they are actually in and what it is that motivates their institution's policymakers.

My suggestion may seem puzzling: If you're in health care delivery, then your business is taking care of patients, isn't it? The answer, as with most management questions, depends on several factors.

The primary goal of any organization is its survival, and there is always a hierarchy of objectives, official or unofficial, to insure that survival. The mission, which defines the organization's main order of business, also motivates policy formation.

If your hospital is a for-profit institution owned by investors, then its highest priority is to make a return on their investment. Many hospitals state their mission as being "to provide the highest quality care at the lowest possible cost to the patient." That statement could just as easily read "at no cost to the patient" or even "regardless of cost to the patient."

This idea of mission determines policy, and policy in turn shapes procedure. If policies are the "what" of hospital philosophy, procedures are the "how." Procedures are an act; by following them, you proceed toward a goal in fulfillment of a policy.

Policies are usually set at the top level of management, typically by the board of directors. The organization's chief executive officer, often serving as administrator or president, is charged with putting these policies into effect. Procedures are thus developed to implement policy in all departments of the organization.

The organizational structure of most hospitals is heavily bureaucratic, communication is average to poor, and policy is rarely conveyed clearly to all levels. Implementation is further complicated by the presence of various health care professions, all competing for a share of the hospital's resources.

These professions may have different and conflicting goals. The laboratory technologist works to produce accurate, timely results to assist the clinician in diagnosis and treatment. The clinician wants to get the patient well enough to leave the hospital as soon as possible--an especially pressing goal under prospective payment. The nurse wants to provide a caring and supportive environment for treatment and recovery. While we speak affectionately of these players as members of the health care team, they may resemble a different kind of team from the one we vaguely envision. Their roles tend to be distinct, like those of baseball fielders at their fixed positions on the diamond.

As a result, hospital policy is usually communicated ineffectively and seldom understood thoroughly. Most well-intentioned staff members find it easier just to learn procedures and follow them as closely as possible. As a manager, however, you need a clear view of the big picture to guide a host of everyday decisions.

In a graduate management course I once took, we were asked to write a set of all-encompassing management principles. Our task was to create policies that would cover any possible situation that might arise in an organization. Were such guidelines universally followed, no manager would ever get into trouble--provided that these written principles were read, understood, adhered to, and periodically evaluated by everyone in the organization.

In one form or another, the following principles form the basis for goal setting and policy formation in any well-run institution:

* Identify and establish long- and short-range organizational goals that are feasible and acceptable to those affected.

* Set down policies, procedures, rules, and regulations to cover all aspects of employees' roles, including the selection and effective use of talent.

* Delineate an organizational structure that establishes duties, responsibilities, and authority. Clearly define each individual's position and expected contribution.

* Implement a program of incentives for employees to improve their own performance and that of the organization. This motivational plan should meet the needs of both the staff and the institution.

* Establish an effective two-way system of communication to keep employees fully informed of all changes that will affect them.

* Develop a plan of action to implement agreed-upon objectives.

Documentation is the key to averting problems in carrying out policies. Diversion from established policies and procedures can quickly become standard laboratory practice--and practice, in the eyes of your personnel and of the law, essentially turns into policy.

Some managers avoid putting policies and procedures in writing for fear of losing flexibility. But policies, like budgets, are intended to serve as administrative guidelines rather than ironclad statutes. They are subject to review and change. The manager who knows how to write, evaluate, and revise them will have more control, not less.
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Author:Day, Carmel Marti
Publication:Medical Laboratory Observer
Date:Jun 1, 1985
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