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AUPHA’s Management Forum chairs, Daniel Estrada and Suzanne Wood, have agreed to explore the RLO (“Reusable Learning Opportunity”) potential. In my blog, “Let’s Build a Library of RLOs,” I describe the concept—web-based teaching aids of all kinds—and proposed that every RLO should have

• an opportunity to simulate a professional action,
• a method for capturing individual student’s responses,
• a method for evaluating and scoring the responses,
• a method for conveying both the evaluation and the recommended response to the student.
• a method for recording scores for collective analysis, with relevant but anonymous student data.

And RLOs should meet 3 criteria:

1. Realism: The object should reflect real problems faced by HCO managers.
2. Excellent response or solution: The recommended responses should be those an excellent professional would pursue. (“Recommended” is more accurate than “correct.” Even the simplest problems often have several constructive responses, where the best depends heavily on context.)
3. Best Practice: Recommended responses should be consistent with excellence in HCO performance. They should support servant leadership, evidence-based medicine and evidence-based management. They should apply principles of empowerment, performance measurement, benchmarking, and continuous improvement.

I envision three basic kinds of RLOs: fully automated multiple choice questions, essay-response questions with rubrics to support instructor or TA scoring, and team assignments with rubric scoring that can be used by either instructors or students.

Here are some examples:

Automated multiple choice questions, with scoring and answer responses

The virtue is economy: students can make multiple trials, with guidance, with almost no faculty effort. Their liability is inflexibility.  They do not handle complex situations well. In this example, “Removing clinicians” is debatable as content for all workers. Debating it in class is possible, but it’s a step beyond the RLOs themselves.

Question

You are orienting a group of newly appointed first line leaders. You want them to know that your not-for profit governing board....(Select all appropriate answers.)

Is legally responsible for ensuring the quality of care and must monitor quality of care to maintain accreditation.

If necessary, will remove clinicians who cannot meet quality standards or who fail to uphold the HCO's values.

Holds the ultimate responsibility, but believes the quality of care is a matter best left to the clinical practitioners.

Must also monitor and maintain financial performance.

Expects improvement in quality measures that are not benchmark.

Automated Reply to Student

All these points should be mentioned except “Holds the ultimate responsibility, but believes the quality of care is a matter best left to the clinical practitioners.”

The message you want them to retain is that the board holds the ultimate responsibility for both quality and financial performance, and that it expects improvement. That's foundation for the specific negotiations that will occur each year. The board should not "believe the quality of care is a matter best left to the clinical practitioners." The issue of removing clinicians is also debatable. It's rare, and important only as a last resort, so why should first line leaders remember it? Because of the "values"--clinicians who do not respect patients or other associates must correct that behavior or leave. The fact that the board will remove them empowers the new leaders to report any concerns.

Scorable Discussion Questions

Question

Study Saint Luke’s strategic scorecard.* It shows total of 32 measures in five categories. Prepare a statement of not more than 400 words to become part of a handbook for new St. Luke's trustees. Your statement should summarize: (1) how each of the five categories contributes to the mission, (2) how the hospital uses the scorecard to promote improvement, (3) what the board expects to see when it reviews the report, and (4) why the balanced, multidimension approach is “best practice.”

* Saint Luke’s is a Baldrige Winner, and it discusses the scorecard on p. 8 of its Application,  http://patapsco.nist.gov/Award_Recipients/PDF_Files/Saint_Lukes_Application_Summary.pdf

An Excel score rubric (and also a copy of the figure.) is available on request, jrg@umich.edu. It identifies 27 reasonable responses, such as

• At our annual retreat, we set goals on all these measures.
• Four broad dimensions reflect customer and provider stakeholder needs, plus funds and operations.
• Omitting one of these four would be imprudent; the omitted dimension might cause difficulties achieving our mission, now or in the future.
• We can add dimensions for emphasis. (For example, we split customers and growth.)
• You can contact the CEO, board chair, or senior management with any questions.

The scoresheet can be summarized and returned to each student, showing class responses and instructor weighting.

Team Assignments

Assignments are projects for small student teams. Here are some topics generated by an executive program course for experienced managers. Each team considered what they would need to do to support an effective performance improvement team (PIT) on the topic.

Question

A clinic routinely has a full schedule and is experiencing a high no show rate that is impacting provider productivity and causing financial strain. A clinic routinely has a full schedule and is experiencing a high no show rate that is impacting provider productivity and causing financial strain.

Service line X at X hospital has experienced the concerning trends for post‐operative patients following hospital discharge: decreased patient satisfaction scores, poorer health outcomes and increased hospital readmissions for preventable complications.

The Addiction Treatment Services clinic in the Department of Psychiatry has a high rate of ‘no-shows’. The Chief Department Administrator would like to form a PIT to make recommendations on how to minimize ‘no-show’ rates in order to improve the efficiency and productivity of the Addiction Treatment Services clinic.

Reply to Student

The class scored each team’s presentation, using an anonymous survey with 7 Likert-scaled items:

Presentation:

Clarity: I fully understood the OFI, the potential contribution to scorecard, and implications of the proposed solution

Persuasiveness: The presentation was likely to be convincing in a real HCO.

Proposal

Definition: Expanded the OFI correctly, neither too broad nor too narrow.

Analysis: Sufficient to identify all probable root causes

Solution: Best practice clearly identified

Solution: Limitations preventing best practice identified and realistically evaluated.

Implementation: thought through, potential problems identified and addressed.