Clinical operations in health care management involve the efficient and effective execution of daily activities within a health care facility, emphasizing patient care, resource allocation, and regulatory compliance to ensure quality and safety. The health care landscape requires forward-thinking leaders and professionals to pave the way and build resilient organizations and communities. These leaders must adopt best practices in clinical operations and health care management to tackle emerging health care issues and drive impactful change initiatives.
Transition to Value-based Care and the Transformation of Clinical Operations
As health care organizations prepare for an evolving market environment that is shifting from a fee-for-service to a value-based care delivery model, they embrace new delivery models and revise and establish new operational strategies and tactics to enhance patient care and outcomes. Health care clinical and business leaders must recognize that value-based care (VBC) demands an operational shift from volume-focused to value-focused services centered on cost efficiency, patient outcomes, and quality. This transition necessitates developing competencies that support the complex and financially uncertain nature of VBC models, such as accountable care organizations (ACOs) and bundled payments. However, early adopters gain a “first-mover” advantage, positioning themselves for greater market share and an enhanced reputation, as payers, employers, and government entities increasingly demand value-driven health care.
One crucial lesson in this undertaking is emphasizing the importance of strategic planning, data sharing, and stakeholder alignment. VBC models require a robust collaborative effort between clinical and business leaders to establish payment models that reward high-quality, cost-efficient care. Establishing financial data transparency and sharing among providers, health plans, and other stakeholders is essential. This transparency enables health care organizations to reduce operational inefficiencies and optimize costs, ultimately enhancing patient outcomes and resource allocation. Leaders should foster a culture of data-driven decision-making within health care organizations. Data interoperability across systems enables real-time feedback, which is crucial for promptly adjusting care strategies and avoiding unnecessary interventions. Value-based care has emerged as the better approach in today’s health care environment.
Leadership Competencies for Supporting Clinical Operations Excellence
Today’s health care market landscape and structure differ significantly from past standards. Changing policies, new payment models, technological developments, and growing consumer pressures have forced health care to evolve and organizations to transform their vision. For health care organizations to continuously improve, they must be innovative with forward-thinking leaders who can negotiate boundaries and possible conflicts that can become barriers to innovation.
Forward-thinking health care organizations focus on pinpointing the most effective management and operational practices to leverage against the competition. To survive and prosper, these organizations need strong, qualified, competent aspiring managers and forward-thinking leaders with outstanding leadership core competencies to build resilient organizations and communities. Health care leaders in this evolving landscape must have the vision to anticipate future health care needs and the ability to respond to rapidly changing measures such as regulatory shifts, technological advancements, and patient needs. These qualities are essential if the ambitious vision of a transformed health care system is to be realized. Strong leadership can help an organization adapt to change and position it as a innovator in a competitive landscape.
A great health care leader demonstrates strong ethics and safety, empowers others to self-organize, fosters a sense of connection and belongingness, shows openness to new ideas, and nurtures growth. These themes outline a safe environment where leaders trust employees. Leaders should create a feeling of succeeding or failing together to build a strong foundation of connection and be open to new ideas and opinions. Forward-thinking and strong leadership are indispensable when transforming health care systems. Effective leaders are also willing to challenge the status quo, inspiring others to embrace change and work toward a shared vision. Transforming health care requires radical shifts in approach, just as accessing untapped resources and reaching new milestones often demand interdisciplinary collaboration and a willingness to adopt emerging technologies. Clinical leaders are the cornerstone of health care organizations and are essential to bridge the gap between upper management and frontline clinicians. They will be crucial in the transition from fee-for-service to value-based care, enabling clinicians to focus more on patient care and patient engagement to improve care while also reducing costs.
Given the ever-changing nature of modern health care, health care organizations require agile leaders who can guide them through market dynamics, rapid technological advancements, and evolving patient expectations. Strong, authentic leadership is essential for navigating these disruptions and ensuring sustainable, lasting change. Leaders must set clear strategies, cultivate a culture of curiosity and problem-solving, and prioritize the needs of both patients and caregivers. This approach fosters a commitment to a transformative vision that can endure well beyond the leader’s tenure.
Sustaining a High-Performance Workforce to Support a Culture of Safety, Quality, Clinical Accountability, Innovation, and Excellence
Excellence in clinical operations and delivering high-quality medical care requires health care organizations to build, sustain, and empower highly qualified clinical and business teams to support a safety, accountability, and performance excellence culture. Organizations must leverage best practices in human resources management to support their workforce and organizational needs.
Today’s health care landscape is a complex web of intrinsic and external forces that mandate changes in health care organization approaches to delivering care with optimal outcomes. Examples of modern health care challenges include staffing shortages, staff burnout, motivation, increased regulations, mergers, and technology advancements and transformation, to name a few. These challenges must all be addressed while maintaining a level of clinical excellence. HR management (HRM) involves supporting, recruiting, and developing an organization’s most valuable asset, its employees. As the health care industry faces increasing demands, HR management is evolving to meet increased needs with digital technology. A wide range of HRM technologies can, in principle, support and human resources practices and thus help address and transform how we work and manage organizations.
Change is the name of the game in the health care space. Change management in health care involves processes intended to guide organizational and personal changes, leading to improved clinical outcomes. By leveraging digital technologies and platforms to enhance workforce effectiveness, efficiency, and strategic alignment, health care organizations can create value for their employees, stakeholders, and society while simultaneously advancing sustainable development goals and principles.
A supportive workforce framework prioritizes employee well-being, recognizing that a healthy workforce is essential for delivering quality care. Health care organizations that promote mental health, work-life balance, and stress management contribute to a more resilient and effective workforce. Implementing systems for gathering feedback from both patients and employees enhances accountability. Lastly, HRM practices that encourage feedback can improve care delivery and safety initiatives.
Digital Health Transformation — The Way Forward for Excellence in Clinical Operations
In today’s complex and challenging health care delivery system environment, digital health integration and optimization enable clinical operations leaders to implement evidence-based population health management programs effectively. Clinical leaders can analyze vast amounts of clinical and demographic data to identify health trends within specific populations. This can include the prevalence of chronic diseases, behavioral health trends, and social determinants of health that impact patient outcomes. Analytics tools can aid in segmenting patients into different risk categories based on their health status, previous health care utilization, and outcomes. This can allow for targeted interventions, helping prioritize resources for high-risk populations and tailoring health initiatives that align with their needs.
Data analytics can help improve care coordination by tracking patients’ health care paths across different providers and settings. By identifying gaps in care and potential barriers patients face, clinical operations leaders can implement strategies that promote better communication and collaboration among health care teams. Additionally, establishing metrics for success and utilizing data analytics to evaluate the effectiveness of population health initiatives is essential. Leaders can continuously analyze clinical outcomes, patient satisfaction, and cost-effectiveness data to refine and improve their programs based on real-world evidence. Data analytics can also help identify unnecessary tests, hospitalizations, and procedures, allowing for improved care pathways that are evidence-based and cost-effective. Analytics can be used to understand patient behaviors and preferences, supporting the development of personalized outreach and engagement strategies. Evidence suggests that engaged patients are more likely to adhere to treatment plans and preventive care guidelines. Data analytics equips clinical operations leaders with the insights and tools to design, implement, and improve evidence-based population health management programs, ultimately leading to better patient outcomes and more efficient health care systems.
Digital (information and technology) transformation — manifested in big data analytics, health informatics, telehealth, AI, etc., and continually digitally connected health systems — must-have survival strategies to improve clinical and business outcomes in the health care landscape. Clinicians and health care leaders work together to identify actionable insights and communicate data to patients and other stakeholders in ways that support shared decision-making. Clinical operations leaders must find ways to leverage and share information to improve care quality with reduced health care costs. Big Data analytics can be used to develop personalized treatments that optimize operational efficiency, reduce patient wait times, and enhance the effectiveness of medical staff. Health care leaders can look to electronic health records (EHR) to create opportunities to utilize population-based evidence in ways paper records never could. However, EHRs currently only provide patient-specific views without population information. This information can be critical for diagnosis and treatment, such as in cases of infectious disease, where there is a lack of evidence-based information, so population-based information has greater weight.
Financial Management Strategies for Sustainable Clinical Operations Outcomes
The United States health care system faces the ongoing challenge of improving care quality while lowering costs. Organizations can face this challenge by understanding the actual costs of services and other expense drivers. Health care payment and financing also play a critical role in achieving health equity, and addressing these issues can address the root cause of health disparities. Before making any changes, organizations should identify their business needs and ensure they align with their overall vision. Health care organizations are increasingly challenged by fiscal constraints from rising operational costs and declining reimbursement rates. The transition to value-based care, implementing risk-shared payment models, and escalating health care core costs leave these organizations with no choice but to leverage financial management best practices as a top priority for survival. Organizations that successfully implement financial strategies to reduce costs and improve efficiency can help ensure financial sustainability.
Financial challenges force creativity and can also drive innovation to address inefficiencies. Reducing hospital readmission rates is another tangible way to improve financial performance and patient outcomes. High readmission rates incur direct costs and impact reimbursement levels from programs such as Medicare and Medicaid. Developing targeted programs to address preventable readmissions, such as enhanced discharge planning or chronic disease management, can yield significant cost savings and improve patient care. Aligning financial incentives with improved patient outcomes can lead to long-term financial stability.
Leveraging Operational Innovations to Improve Patient Care Delivery and Business Outcomes
The health care industry faces significant challenges that impede its ability to meet the Triple Aim of improving patient experience, enhancing population health, and reducing costs, as well as the Quadruple Aim, which supports providers. To navigate these complexities, health care organizations can implement innovative change management strategies. For health care organizations to succeed in meeting the Quadruple Aim, they must focus on leveraging data, fostering interdisciplinary collaboration, and cultivating a culture of change readiness. These strategies enhance clinical outcomes and improve overall business performance, paving the way for a more efficient and patient-centered health care system.
Many industry-based and empirical research studies show a significant relationship between excellence in health care operational performance and the quality of care. Today’s forward-thinking hospitals and health systems are implementing innovative operations models of medical care and delivery structures to support desired patient care delivery and business outcomes. These organizations use a benchmark, evidence-based learning knowledge, and best practices from other service industries to improve patient satisfaction and address health care consumers’ needs.
Health care’s inherent complexities necessitate sophisticated change management strategies to drive clinical and operational excellence. Change management is a process intended to guide organizational or personal change. Organizations must constantly adapt to stay competitive, whether adopting new technologies, restructuring teams, or shifting strategies. Change is rarely easy, and one of the most significant challenges leaders face is managing employee resistance. Effective change management is a vital skill needed for today’s health care leaders.
Unfortunately, stakeholder resistance is a common occurrence. Leaders need to understand the impetus behind changing resistance to guide followers to understand why they are resistant and how they can overcome their challenges. Stakeholders may better adapt to change through strong leadership, transparency, education, compassion, and interpersonal communication frameworks.
Any successful strategic initiative hinges on the readiness of the organization’s culture to embrace change. Health care organizations need to foster a culture open to innovation and continuous improvement. Leadership should actively engage staff in the change process by clearly communicating the vision and benefits of proposed changes. Providing training and resources to help employees adapt to new technologies or procedures can also be instrumental. Additionally, establishing feedback mechanisms can empower staff to share insights and feel valued. A culture that embraces change will lead to higher employee morale and engagement, ultimately translating to better patient care and financial performance, as staff are more likely to support initiatives that align with the organizational mission.
Clinical Operations Health Care Management Career Opportunities
Many health care professionals enrolled in the MSHS COHM program work in a variety of settings in the health care industry, such as all kinds of clinics, hospitals, integrated health systems, academic medical centers, pharmaceutical and medical equipment manufacturing companies, medical insurance payers, nursing and long-term facilities, public health departments, and consulting companies in the United States and abroad. The positions’ titles that graduates of MSHS COHM can seek are:
- Executive Officers: Chief Executive Officer, Chief Operating Officer, and other Senior Officers
- Hospital and Clinical Administrator/Director
- Physician Group Administrator
- Vice President (Clinical and Business areas)
- Operations Director/Manager
- Health Care Consultant
- Medical Insurance Payers Administrator
- Health Care Line Manager (Finance, Operations, Human Resources, Information Technology, Marketing, Supply Chain, etc.)
MSHS COHM program graduates often apply and get accepted at renowned and prestigious national fellowship training programs that train them to become upcoming executives in the clinical operations space.
For those interested in shaping the future of health care, the clinical operations health care management program offers a dynamic and impactful career path.
Clinical Operations Health Care Management at George Washington University
The George Washington University School of Medicine and Health Sciences (GW-SMHS) offers the Clinical Operations Health Care Management program designed to prepare professionals to take the next step in their health care leadership careers through learning the clinical operational skills needed in today’s complex health care service delivery.
This flexible online program, with low faculty/student ratios, teaches you what it takes to lead a health care delivery system that is clinically effective, cost-efficient, and improves overall patient care and safety. With a focus on population health care, you will learn ways to improve communication skills for optimal interprofessional practice, lead efforts in quality improvement, and understand the technological tools needed to conduct effective data analyses for strategic development.
Graduates will benefit from:
- Expert faculty with real-world experience in clinical operations and health care management and outstanding academic preparation,
- Cutting-edge curriculum based on the industry’s latest trends and opportunities that explore clinical operations excellence innovations and best practices, and
- Flexible experiential learning options that accommodate working professionals and career changers.
Whether you are a current health care professional looking to upskill or a health care leader eager to apply your expertise to clinical operations health care management, our fully online programs offer a pathway to success.
Online MSHS Clinical Operations Health Care Management (COHM) Program
The COHM is an innovative and cutting-edge graduate program. The COHM program is designed to meet the curriculum standards set by the leading academic and professional organizations in the health care management field, such as:
- National Center on Health Care Leadership (NCHL) Competency Model
- American College Health Care Executives (ACHE), the Competency Assessment 2.0 Tool
- Medical Group Management Association (MGMA) Body of Knowledge Competency Model
The MSHS COHM program offers courses that integrate required critical experiential learning and professional preparation to sit for certification and fellowship credentials, such as:
- American College of Health Care Executives - ACHE
- The Health Care Financial Management Association - HFMA
- Health Care Information and Management Systems Society - HIMSS
- Medical Group Management Association - MGMA
- National Association for Health Care Quality - NAHQ
Take the First Step
If you’re ready to be part of this exciting field, consider exploring your educational options at GW SMHS. By equipping yourself with the right skills and knowledge, you can help drive the future of health care.
Explore our programs to learn more:
- Graduate Certificate in Clinical Operations and Health Care Management
- MSHS in Clinical Operations and Health Care Management
Need more assistance determining which program is right for you? Get in touch with an admissions representative.
