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Management by Objective (MBO)
a complete system of management based upon a core set of goals to be accomplished by a program
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Four basic steps of program development:
- needs assessment
- program planning
- program implementation
- program evaluation
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Needs assessment:
- describe community
- describe target population's demographics, disorder, functional levels, presenting problems
- identify specific needs of target population
- determine discrepancy b/w real needs and felt needs
- establish unmet needs according to priority
- identify resources available for program implementation
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needs assessment methods:
- survey, interview, or self report of target population. A representative sample is required.
- key informant, which involves the surveying of specific individuals who are knowledgeable about the target population needs
- community forums to obtain information through public meetings or panels
- service utilization review of records and reports
- analysis of social indicators to identify social, cultural, environment, and/or economic factors that can predict problems
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Program planning:
- define focus for the program based on needs assessment
- adopt a FOR that are most likely to successfully address and meet the needs that are program's focus
- establish objectives and goals of the program specifically related to primary focus
- describe integration of program into existing system of care
- develop a system of referral for entry into, completion of, and discharge from the program
- describe the fiscal implications of program plan
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Program implementation:
- initiate program according to timetable and steps set forth in the program plan
- document programs activities, procedures, and use
- communicate and coordinate with other programs within the systems
- promote programs to ensure it reaches target population
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Purposes of fiscal management:
- to ensure cost-effective services and programs are planned and implemented
- to meet the demands of a managed health care system
- to remain competitive in a market-driven practice environment
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Purposes of personnel management:
- to serve as the link between the individuals working for an organization and the larger organizational structure
- to attain best practice from personnel
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The systematic review and analysis of care provided to determine:
if this care is at an acceptable level of quality
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purposes of program evaluation:
- to measure the effectiveness of a program; that is, were program goals accomplished
- to use information obtained in the evaluation to improve services and assure quality
- to meet external accreditation standards
- to identify program problems/limitations and to resolve them
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quality improvement (QI):
- system-oriented approach that views limitations and problems proactively as opportunities to increase quality
- emphasizes prevention
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total quality management (TQM)
creation of an organizational culture that enables all employees to contribute to an environment of continuous improvement to meet or exceed consumer needs
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performance assessment and improvement (PAI)
- systematic method to evaluate the appropriateness and quality of services
- uses interdisciplinary systems focus
- client-centered approach which focuses on rights, assessment, care, and education of the person
- organizational ethics, improved organizational performance, leadership, and management are emphasized
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Goal attainment scaling (GAS):
an evaluation tool that attains clients' goals for intervention and measures goal attainment and intervention outcomes after a specific time period
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utilization review:
- a plan to review the use of resources w/in a facility
- determination of medical necessity and cost efficiency
- often a component of a QI or PAI system
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statistical utilization review:
reimbursement claims data are analyzed to determine the most efficient and cost-effective care
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peer review:
a system in which the quality of work of a group of health professionals is reviewed by their peers
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professional review organization (PRO)
groups of peers who evaluate the appropriateness of services and quality of care under reimbursement and/or state licensure requirements
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Prospective review:
- evaluation of proposed intervention plan that specifies how and why care will be provided
- used by third party payers to approve proposed OT intervention program
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concurrent review:
- evaluation of ongoing intervention program during hospitalization, outpatient, or home care treatment
- method to ensure appropriate care is being delivered
- often a component of QI or PAI system
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retrospective review:
- audits of medical records after intervention were rendered
- method to ensure appropriate care was given
- a UR tool for third party payers that can be time consuming and costly
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risk management:
a process that identifies, evaluates and takes corrective action against risk and plans, organizes and controls the activities and resources of OT services to decrease actual or potential losses
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Develop marketing strategies to address the 5 Ps:
- product
- price
- place
- promotion
- position
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undifferentiated marketing:
use of the same marketing strategies and activities with the complete market (to general public)
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differentiated marketing:
the design and use of marketing strategies and activities for different market segments (to self-help groups)
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concentrated marketing:
the design and use of specific marketing strategies and activities to concentrate on one market segment (the elderly)
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true-experimental:
classic two-group design which includes random selection and assignment into an experimental group that receives treatment or a control group that receives no treatment. All other experiences are kept similar
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quasi-experimental:
an independent variable is manipulated to determine its effect on a dependent variable but there is a lesser degree of researcher control and/or no randomization
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non-experimental/correlational:
there is no manipulation of independent variable; randomization and researcher control are not possible
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retrospective:
investigation of data collected in the past
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prospective:
recording and investigation of present data
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descriptive:
investigation of several variables at once; determines existing relationships among variables
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predictive:
used to develop predictive models
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phenomenological:
study of one or more persons and how they make sense of their expeirence
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ethnographic:
patterns and characteristics of a cultural group, including values, roles, beliefs, and normative practices, are intensely studies
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heuristic:
complete involvement of the researcher in the experience of the subject to understand and interpret a phenomenon
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case study:
a single subject or a group of subjects is investigated in an in-depth manner
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credibility:
researcher's level of confidence that his/her findings truthfully reflect the reality of a study's participants and the study's context
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transferability:
how well other researchers can fit a study's findings into similar contexts; the "goodness of fit" between the contexts of two studies
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dependability:
the inclusion of the full range of data, including outlier or atypical findings
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confirmability:
the degree to which a study's conclusion are based on the data
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random sample
individuals are selected through the use of a table of random numbers
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systematic sample:
individuals are selected from a population list by taking individuals at specified intervals
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stratified sample:
individuals are selected from a population's identified subgroups based on some pre-determined characteristics
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purposive sample:
individuals are purposefully and deliberately selected for a study
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convenience sample:
individuals are selected who meet population criteria based upon availability to the researcher
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network/snowball sample:
study subjects provide names of other individuals who can meet study criteria
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semantic differential:
a point scale w/ opposing adjectives at two extremes, measuring affective meaning
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Likert scale:
respondents indicate their level of agreement, usually on a five point scale
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Guttmann scale rank ordering:
the respondent places a number alongside a list of items, indicating their order of importance
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multiple choice
a statement is provided, sometimes in a question format, and the respondent selects the item most reflective of their opinion. Used to elicit opinions or attitudes
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incomplete sentences:
phrase is provided to indicate a certain domain of concern and the respondent completes the sentence. Used to find out opinions, attitudes, knowledge, styles of behavior, personality traits.
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On a normal distribution, what percentage falls within +1 or -1 SD of the mean?
68%
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alpha level:
- pre-selected level of statistical significance
- most commonly .01 or .05: indicates that the expected difference is due to chance
- there are true differences on the measured dependent variable
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degrees of freedom:
based on number of subjects and number of groups; allows determination of level of significance based on consulting appropriate tables for each statistical test
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standard error:
expected chance variation among the means, the result of sampling error
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Type 1 error:
the null hypothesis is rejected by the researcher when it is true, e.g., the means of scores are concluded to be truly different when the differences are due to chance
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Type 2 error:
the null hypothesis is not rejected by the researcher when it is false, e.g., the means of scores are concluded to be due to chance when the means are truly different
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T test :
a parametric test of significance used to compare two group means and identify a difference at a selected probability level (0.05)
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Analysis of variance (ANOVA)
a parametric test used to compare two or more treatment groups or conditions while also controlling for the effects of intervening variables
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Chi square test:
a nonparametric test of significance used to compare data in the form of frequency counts occurring in two or more mutually exclusive categories
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Pearson product-moment coefficient (r)
used to correlate interval or ratio data
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Spearman's rank correlation coefficient (rs):
a nonparametric test used to correlate ordinal data
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intraclass correlational coefficient (ICC)
a reliability coefficient based on an analysis of variance
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strength of relationships:
positive correlations range from 0 to +1.0; indicates as variable X increases, so does variable Y
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high correlations:
0.70 to +1.00
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moderate correlations:
0.35-0.69
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low correlations:
0 to 0.34
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negative correlations:
- -1.0 to 0
- indicates as variable X increases, variable Y decreases
- an inverse relationship
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common variance:
a representation of the degree that variation in one variable is attributable to another variable
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