Clinical Management Theory Part I

Management is a critical element in any industry, and health care is certainly no exception. The question of how best to manage the clinical workers who provide health care has many different answers, and finding the correct one for an organization can make a significant difference in the quality of care offered. At Southcentral Foundation, the management style used in the Nuka System of Care works to reinforce the core values of the system while allowing flexibility for care teams and avoiding micromanagement.

tight loose tight infographic

SCF’s management theory can be broadly defined as “tight-loose-tight.” “Tight” management means that there is considerable structure that is set by management and leadership that employees must adhere to. “Loose” management means that there is no rigid structure in place and employees have more flexibility to do as they see fit. SCF’s approach to management employs both types.

There are two major things that are “tight” under SCF’s management style. The first is the overall philosophy and the broad picture of how we approach health care. All care teams must follow SCF’s philosophy and operational principles. They must practice relationship-based care and strive to understand the story of each customer-owner they serve. They must make use of communication techniques taught at SCF such as advocacy and inquiry to facilitate the formation of the strong relationships that are at the core of the Nuka System of Care.

The other element of clinical care that is “tightly” managed at SCF is outcomes. Each care team has certain health outcomes for the panel they care for that they are responsible for reaching. These health outcomes are tracked in SCF’s Data Mall and are compared to national benchmarks; care teams are able to view their panel’s status on these outcomes at any time. The team is accountable for reaching these outcomes, and if they fail to do so, management will step in and determine how best to support them so they can.

Management of all other aspects of clinical care at SCF is “loose.” This means that the specifics of how the team operates, and how they organize their work day-to-day, is mostly up to the team itself. So long as they are following the philosophy of the Nuka System of Care and achieving the outcomes they are accountable for, teams have considerable freedom in how they operate. They are free to experiment, innovate, and try new things. SCF’s management does track what teams are doing in these areas, but only so that practices that are working well can be spread further across the organization.

This “tight-loose-tight” philosophy of management has allowed SCF’s care teams a great degree of flexibility while maintaining the values of the Nuka System of Care and supporting good health outcomes for customer-owners. For more information about SCF’s approach to clinical management, feel free to contact the SCF Learning Institute.